Orientador: Luzia Aparecida Trinca / Resumo: A depressão é apontada como a doença crônica não transmissível que terá maior abrangência até 2030, atingindo direta ou indiretamente vários setores nos quais a população está inserida. No Brasil, a situação da depressão é alarmante, respondendo pela maior taxa do continente latino-americano. A Pesquisa Nacional de Saúde (PNS) é um inquérito de base domiciliar de abrangência nacional. Trata-se de uma iniciativa do Ministério da Saúde em parceria com o Instituto Brasileiro de Geografia e Estatística (IBGE) e tem como objetivo caracterizar a situação de saúde e os estilos de vida da população brasileira, e assim conhecer como acontece a atenção à saúde em diversos grupos da população. Neste trabalho a depressão será o objeto de estudo por ser caracterizada como uma doença complexa de difícil mensuração e observação devido a suas causas multifatoriais. O levantamento de dados da PNS utilizou um planejamento amostral complexo, o que demanda uma atenção especial em relação à análise das informações coletadas. Considerando a magnitude da pesquisa e levando em consideração as diversidades regionais, foram ajustados modelos com base na teoria de classes latentes. Essa abordagem identifica grupos baseados nos padrões de respostas observadas nas variáveis categóricas utilizando um modelo probabilístico. Assim é possível classificar cada indivíduo como pertencente a um grupo, estimar a prevalência e identificar características decisivas para o surgimento dos grupos. A partir de itens qu... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Depression is indicated as the non-transmissible chronic disease that will be more widespread until 2030, reaching directly or indirectly several sectors in which the population is inserted. In Brazil, the situation of depression is alarming, accounting for the highest rate in the Latin American continent. The National Health Survey (PNS) is a nationwide household survey. It is an initiative of the Ministry of Health in partnership with the Brazilian Institute of Geography and Statistics (IBGE) and aims to characterize the health situation and the lifestyles of the Brazilian population, and thus to know how health care happens in different groups of the population. In this study, depression will be the object of study because it is characterized as a complex disease of difficult measurement and observation due to its multifactorial causes. The PNS data collection used a complex sampling plan, which demands special attention in relation to the analysis of the information collected. Considering the magnitude of the research and taking into account the regional diversities, models were adjusted based on latent class theory. This approach identifies groups based on the patterns of responses observed in the categorical variables using a probabilistic model. Thus it is possible to classify each individual as belonging to a group, to estimate the prevalence and identify decisive characteristics for the emergence of groups. Based on items dealing with mental health, it was possible t... (Complete abstract click electronic access below) / Doutor

Latent variable models play an important role in psychological and educational measurement, which attempt to uncover the underlying structure of responses to test items. This thesis focuses on the development of statistical learning methods based on latent variable models, with applications to psychological and educational assessments. In that connection, the following problems are considered. The first problem arises from a key assumption in latent variable modeling, namely the local independence assumption, which states that given an individual's latent variable (vector), his/her responses to items are independent. This assumption is likely violated in practice, as many other factors, such as the item wording and question order, may exert additional influence on the item responses. Any exploratory analysis that relies on this assumption may result in choosing too many nuisance latent factors that can neither be stably estimated nor reasonably interpreted. To address this issue, a family of models is proposed that relax the local independence assumption by combining the latent factor modeling and graphical modeling. Under this framework, the latent variables capture the across-the-board dependence among the item responses, while a second graphical structure characterizes the local dependence. In addition, the number of latent factors and the sparse graphical structure are both unknown and learned from data, based on a statistically solid and computationally efficient method. The second problem is to learn the relationship between items and latent variables, a structure that is central to multidimensional measurement. In psychological and educational assessments, this relationship is typically specified by experts when items are written and is incorporated into the model without further verification after data collection. Such a non-empirical approach may lead to model misspecification and substantial lack of model fit, resulting in erroneous interpretation of assessment results. Motivated by this, I consider to learn the item - latent variable relationship based on data. It is formulated as a latent variable selection problem, for which theoretical analysis and a computationally efficient algorithm are provided.

This dissertation encompasses three studies on issues of model-data fit methods for latent variable models implemented in modern educational measurement. The first study proposes a new statistic to test the mean-difference of the ability distributions estimated based on the responses of a group of examinees, which can be used to detect aberrant responses of a group of test-takers. The second study is a review of the current model-data fit indexes used for cognitive diagnostic models. Third study introduces a modified version of an existing item fit statistic so that the modified statistic has a known chi-square distribution. Lastly, a discussion of the three studies is given, including the studies’ limitations and thoughts on the direction of future research.

Os modelos de riscos proporcionais são muito utilizados na análise do tempo de sobrevivência, porém, assumem implicitamente que, observado um conjunto de variáveis explicativas, a população em estudo seja homogênea e que os indivíduos permaneçam sob risco durante todo o período de observação ou até que apresentem o evento de interesse. Tais suposições não são adequadas quando os indivíduos da população em estudo possuem diferentes pré-disposições ao surgimento de uma doença ou quando estão sujeitos à cura após o período de tratamento. Esta dissertação discute o modelo de sobrevivência com fração de cura quando o evento de interesse é caracterizado por fatores latentes competitivos, enquanto a heterogeneidade não observada entre os riscos dos pacientes é modelada através de um fator aleatório denominado termo de fragilidade. / Proportional hazards models are widely used in the analysis of survival time, however, it is implictly assumed that given a set of explanatory variables, the population under study is homogeneous and individuals remain at risk throughout the observation period time or until they have the event of interest. However, such assumptions are not reasonable when individuals from the population under study have dierent pre-dispositions to the emergence of a disease or are subject to the cure after treatment. This work discusses the cure fraction model when the event of interest is characterized by latent competitive factors, with patient risk modeled by a random factor called frailty.

Introdução: A terapêutica da psoríase foi modificada pela introdução dos imunobiológicos, que permitem melhor controle da doença e melhor qualidade de vida aos pacientes, mas promovem aumento do risco de tuberculose latente, exigindo diagnóstico antecedendo seu início. Objetivo: Avaliar o desempenho do teste T-SPOT.TB no diagnóstico de infecção tuberculosa latente em pacientes com psoríase. Métodos: Em estudo experimental, prospectivo, analítico, com comparação de grupos,de prevenção primária, para validade de teste diagnóstico, 33 pacientes com psoríase (grupo psoríase) e 30 pacientes com outras doenças dermatológicas (grupo base), atendidos nos Ambulatório de Dermatologia Geral ou de Psoríase do Centro de Estudos Dermatológicos do Recife, da Santa Casa de Misericórdia, entre fevereiro e novembro de 2009, foram submetidos aos testes do PPD e T-SPOT.TB. Para ambos os grupos, admitiu-se inclusão com idade mínima de 18 anos e critérios de exclusão doenças ou condições fisiológicas que comprometessem a competência imunológica, exceto psoríase, para o grupo psoríase. Adotou-se a técnica de Mantoux para o teste do PPD e uma variante simplificada da técnica Enzyme-Linked Immunospot para a determinação de células T efetoras, secretoras de IFN-g em resposta à estimulação pelos antígenos específicos do M. tuberculosis para o teste T-SPOT.TB. As variáveis dependentes foram os resultados do teste T-SPOT.TB contra antígenos ESAT-6, CFP-10, e os resultados do teste do PPD, considerando enduração de 0-4 mm: não reator; 5-9 mm: reator fraco; ≥ 10 mm: reator forte. As variáveis independentes foram: idade, sexo, cor da pele, tempo de evolução da psoríase, ocupação, história de contato intradomiciliar e renda, alcoolismo e gravidade da doença. Foram submetidos a teste Qui quadrado ou exato de Fisher, em nível de significância de 0, 05, assim como ao teste de Mantel-Haenszel, três modelos comparando o teste T-SPOT.TB com teste do PPD, contato intradomiciliar e associação teste do PPD e contato intradomiciliar. A pesquisa foi aprovada pelos Comitês de Ética da Universidade Federal de Pernambuco e Universidade de São Paulo. Resultados: O grupo psoríase diferiu do grupo base quanto a razão de sexo com predomino do masculino (razão=0,7:1; p=0,047); maior idade média 42,1±1,9 anos (contra 34,1±1,4 anos no grupo base, p=0,023); fototipos I e II (p=0,020); menor nível de instrução e renda média mensal e contato intradomiciliar com tuberculose menos freqüente (p=0,001). Os grupos também diferiram quanto à positividade do teste do PPD (maior no grupo base; p=0,001). O teste T-SPOT.TB apresentou sensibilidade e especificidade de 9,1% e 95,5%, no modelo 1, 27,3% e 60%, no modelo 2, e valores de 60% e 53,3%, respectivamente no modelo 3. Foi no modelo 1 do grupo psoríase que o teste TSPOT. TB mostrou a maior concordância e o maior valor de Odds Ratio ponderado pelo teste de Mantel-Haenszel, tendo esses dois parâmetros significância estatística, quando comparados aos outros dois modelos. Conclusões: O teste T-SPOT.TB apresentou maior capacidade de diagnosticar casos negativos para tuberculose latente, constituindo-se numa opção para triagem de pacientes na instituição de terapêutica com imunobiológicos. / Introduction: The therapy for psoriasis was modified by the introduction of immunebiological products that allow better disease control and better quality of life for patients, but promotes increased risk forf latent tuberculosis, requiring diagnosis shortly before its establishment. Purpose: To assess the performance of T-SPOT.TB test for the diagnosis of latent tuberculosis infection in patients with psoriasis. Methods: Within a experimental, prospective, analytic, clinical assay type study, with comparison of groups, to validate a diagnostic test, 33 patients with psoriasis (psoriasis group) and 30 patients with other dermatological diseases (basis group), attempted at General Dermatology and Psoriasis Out-patients Departments of Recife\'s Dermatological Studies Center of Santa Casa de Misericórdia, from February to November 2009, were submitted to PPD and TSPOT. TB tests. For both groups, we admitted 18 years as minimal age for inclusion. The exclusion criteria included disease ou physiological conditions that compromised immunological competence, except psoriasis to psoriasis group. We used Mantoux technique for PPD test and a simplified variant of Enzyme-Linked Immunospot technique to determine effector T cells, secretors of IFN-g in response to M. tuberculosis specific antigens, to T-SPOT.TB test. Dependent variables were the results of T-SPOT.TB test against ESAT-6 and CPF-10 antigens, and the results to PPD test, considering enduration of 0-4 mm as non reactor; 5-10 mm weak reactor and ≥ 10 mm, strong reactor. Independent variables were age, sex, skin color, psoriasis evolution time, occupation, history of intradomiciliar contact and income, alcoolism and disease grade. Three models, comparing T-SPOT.TB test to PPD test, intradomiciliar contact and both, were submitted to Qui Squared test or Exact Fisher Test, at significance level of 0.05, as well as to Mantel- Haenszel test. The research has been approved by Ethics Committee of Universidade Federal de Pernambuco e Universidade de São Paulo. Results: Psoriasis group differed from base group on sex ratio with predominance of male gender (rate=0.7:1; p=0,047), major mean age (42,1 ± 1.9 years against 34,1 ± 1.4 years in basic group, p = 0,023) phototypes I and II (p = 0,020); lower scholarship, income and less frequent intradomiciliar contact with tuberculosis (p = 0,001). The groups also differed on the positivity of PPD test (greater in base group; p = 0,001). T-SPOT.TB test had sensibility and specificity of 9,1% and 95.5%, in model 1; 27,3% and 60%, in model 2, and values of 60% and 53,3% respectively in model 3. Model 1 showed greater concordance and highest value of Odds Ratio test weighted by Mantel-Haenszel test, having these two parameters statistical significance when compared to the other two models. Conclusions: T-SPOT.TB test had great ability to diagnose negative cases for latent tuberculosis, and constitutes an option for screening patients to immunobiological therapy administration.

Physical activity (PA) has been labelled the miracle drug (Pimlott, 2010) and participating in regular PA has ample physical and mental wellbeing benefits. However, physical inactivity remains a critical public health concern, particularly across adolescence. In England the proportion of adolescents aged 13-15 years meeting the recommended guidelines for PA decreased significantly from those at a younger age (Health and Social Care Information Centre, 2009; 2012; 2015). The adolescent years (13 18 years) have been identified as the age of greatest decline in PA, although it is possible that large declines can also be seen at younger ages (Sallis, 2000). Among girls the decline in PA is greater at younger ages (9 12 years old) and among boys it is greater at older ages (13 16 years old) (Dumith, Gigante, Domingues, & Kohl, 2011). Thus, examining behaviour of early adolescents (aged 11-13 years) is a primary focus of this thesis. Researchers have called for a more comprehensive grasp of PA correlates and determinants and their impact on behaviour (Biddle & Mutrie, 2001, 2008). This broader picture needs to incorporate longitudinal study designs to accurately portray developmental changes (Evenson & Mota, 2011). This thesis aims to work towards a better understanding of associations among variables across aspects of the ecological model in relation to PA behaviour during early adolescence. Early adolescents within their first year of secondary school (year 7, aged 11 12 years) were recruited through schools across the East Midlands, United Kingdom (UK). These participants completed various measures across an 18 month period to compile all data required for the thesis. The thesis begins with a focus on active transport as a means of commuting to school which can significantly contribute to overall PA levels (Aibar, Bois, Generelo, Bengoechea, & Paillard, 2015; Slingerland, Borghouts, & Hesselink, 2012). The distance from home to school is an important influence on the decision to use active transport; however, ecological perspectives would suggest this variable may interact with individual, interpersonal and environmental factors. Therefore, the first study of this thesis investigates whether the relationship between distance to school and active transport is moderated by (i) gender, (ii) biological maturation, (iii) perceived family support for PA and (iv) multiple deprivation. Cross-sectional results from the baseline data collected demonstrated that the relationship between distance to school and the likelihood to actively travel to school is moderated by biological maturation, multiple deprivation and family support of PA in adolescents. Further analysis revealed that late-maturing children, those from less socio-economically deprived backgrounds and children with low family support of PA are less likely to actively commute to school as distance to school increases. Due to the interaction between these variables described above, the second study focused on the variables collectively using a person-oriented approach, which aimed to classify distinct profiles of early adolescents based on correlates of PA. The outcome variables were also broadened to include active transport and overall PA across two time points. Findings from this second study illustrate that the highly supported, shortest commuters produced the highest levels of self-reported PA and that affluent, short commuters were the most likely to use active transport to travel to school. The affluent, short commuters lived a relatively short distance to school in areas of the lowest deprivation and had relative moderate family support of PA. The highly supported, shortest commuters were characterised by the highest family support of PA and lived the shortest distance to school in areas of low deprivation. Study 1 evidenced an association between biological maturation and PA behaviour; however, study 2 displayed that biological maturation did not meaningfully contribute to the class characteristics, and were not a predictor of PA. Previous evidence as to whether early, average or late maturing adolescents are more likely to disengage from PA is mixed and tends to focus on one gender only (Sherar, Cumming, Eisenmann, Baxter-Jones, & Malina 2010; Bacil, Mazzardo, Rech, Legnani, & Campos, 2015). Thus for the third study a more focused inspection of biological maturity was undertaken. Biological maturity status was investigated as a predictor of PA behaviour at two subsequent time points (6 9 months after baseline and 12 18 months after baseline) and whether there was variation across genders. Findings displayed that biological maturity status does not predict subsequent PA, with no distinction across genders. To conclude, the final study examined additional forms of PA behaviour. For children to develop and maintain healthy PA behaviours, their PA during the school day, particularly during physical education (P.E) classes is important (Owen, Smith, Lubans, Ng, & Lonsdale, 2014). Self-reported PA was divided into school-time PA (during P.E. lessons, break and lunchtimes) and leisure-time PA (after school, during evenings and weekends). The final study fully utilised the longitudinal data collected and utilised longitudinal growth modelling to describe the changes in PA behaviour across 12-18 months during early adolescence. Results displayed that school-time PA and leisure-time PA are distinct. Males; those from less deprived backgrounds and individuals with higher family support of PA all separately reported more school-time PA than their counterparts (females, those from higher deprived backgrounds and individuals with lower family support of PA) at baseline. Males and those with higher family support of PA also reported more leisure-time PA than their respective counterparts at baseline. On average, both genders decreased in school-time PA across 18 months yet for leisure-time PA, on average, there was no change over time and no significant difference in the rate of change between genders. There were no observed significant differences in the rate of change between multiple deprivation status and biological maturation across the 18 months for both behaviours. For family support, on average school-time PA decreased over time and results showed significant difference in the rate of change between individuals with lower or higher levels of family support of PA across the 18 months. On average, there was no change over time for leisure-time PA yet there was a significant difference in the rate of change between individuals and their family support of PA across 18 months. Further analysis demonstrated if an individual s family support increases, so does their leisure-time PA and vice versa. These overall key findings demonstrate the complexity of PA behaviour throughout early adolescence. This thesis works towards predicting individuals, correlates and determinants that may be susceptible to physical inactivity and/or a decrease in activity over time. Results can be used to target and direct PA intervention work.

Lam, Kwok Hap. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 68-72). / Abstract also in Chinese. / Chapter 1 --- Introduction --- p.1 / Chapter 2 --- Two-level NSEM with outcomes from Exponential Family --- p.6 / Chapter 2.1 --- Basic Model Description --- p.7 / Chapter 2.2 --- Generalization from Normal Distribution to Exponential Family Distributions --- p.9 / Chapter 2.3 --- Bayesian Analysis of the Model --- p.10 / Chapter 2.3.1 --- Posterior Analysis and Gibbs Sampler --- p.10 / Chapter 2.3.2 --- Prior Distributions --- p.11 / Chapter 2.3.3 --- Bayesian Estimation --- p.13 / Chapter 2.3.4 --- Bayesian Model Selection --- p.14 / Chapter 2.4 --- A Simulation Study --- p.15 / Chapter 3 --- Two-level NSEM with mixed continuous and ordered categorical data --- p.28 / Chapter 3.1 --- Model Description --- p.29 / Chapter 3.2 --- Bayesian Analysis of the Model --- p.30 / Chapter 3.2.1 --- Posterior Analysis and Gibbs Sampler --- p.30 / Chapter 3.2.2 --- Bayesian Estimation --- p.31 / Chapter 3.3 --- A Simulation Study --- p.31 / Chapter 4 --- "Two-level NSEM with mixed continuous, count and binomial data" --- p.36 / Chapter 4.1 --- Model Description --- p.37 / Chapter 4.2 --- Bayesian Estimation --- p.38 / Chapter 4.3 --- A Simulation Study --- p.39 / Chapter 5 --- Two-level NSEM with mixed continuous and unordered categorical data --- p.43 / Chapter 5.1 --- Basic Model Description --- p.44 / Chapter 5.2 --- Bayesian Analysis of the Model --- p.47 / Chapter 5.2.1 --- Posterior Analysis and Gibbs Sampler --- p.47 / Chapter 5.2.2 --- Prior Distributions --- p.48 / Chapter 5.3 --- A Simulation Study --- p.49 / Chapter 6 --- Conclusion and Discussion --- p.53 / Chapter A --- Technical Details for Chapter 2 --- p.56 / Chapter A.1 --- Full conditional distributions --- p.56 / Chapter A.2 --- Implementation of the Metropolis-Hastings (MH) Algorithm --- p.59 / Chapter A.3 --- Gelman-Rubin statistic --- p.61 / Chapter B --- Technical Details for Chapter 3 --- p.63 / Chapter B.1 --- Full conditional distributions --- p.63 / Chapter B.2 --- Implementation of the Metropolis-Hastings (MH) Algorithm --- p.64 / Chapter C --- Technical Details for Chapter 5 --- p.66 / Chapter C.l --- Full conditional distributions --- p.66 / Bibliography --- p.68

A TB é a principal doença oportunista a acometer as pessoas vivendo com HIV/aids (PVHA), sendo a coinfecção TB/HIV um importante desafio para os sistemas de saúde. O estudo objetivou descrever a vigilância da tuberculose latente nas PVHA acompanhadas pelos Serviços de Atenção Especializada ao HIV/aids (SAE) da rede municipal de saúde de Ribeirão Preto- SP, nos anos de 2012 e 2013. Trata-se de um estudo epidemiológico, descritivo, do tipo levantamento. Participaram 33 indivíduos que desenvolveram diagnóstico de tuberculose latente em 2012 e 2013, notificadas no Sistema de Informação \"Quimioprofilaxia TB\", e que viviam com HIV/aids, acompanhadas nos cinco SAE de rede pública municipal de Ribeirão Preto- SP. Para proceder à coleta de dados, inicialmente foi realizado um levantamento das PVHA diagnosticadas com tuberculose latente, a partir do número de indivíduos cadastrados no sistema de informação \"Quimioprofilaxia TB\". Posteriormente, foi utilizado um questionário estruturado contendo 30 questões do qual trabalhou-se com as seguintes seções: I - Dados sociodemográficos; II - Dados sobre o perfil clínico das PVHA - no momento do diagnóstico da TB latente; III- Dados sobre o controle da TB nas PVHA; IV- Dados sobre a situação, estratégias de acompanhamento e o desfecho da TB latente nas PVHA. O estudo foi desenvolvido a partir de fontes secundárias de informação: Sistema de Informação (SI) \"Quimioprofilaxia TB\"; Prontuário Clínico; Sistema Informatizado Hygia-Web e Sistema de Informação de Agravos de Notificação (SINAN). De forma complementar, com apoio de um roteiro específico foi realizada entrevista com o ator chave - coordenador do Programa Municipal de Controle da Tuberculose e do Programa de DST/aids/hepatites virais - com o intuito de caracterizar o cenário com enfoque na descrição das ações de prevenção e controle da TB nas pessoas com HIV/aids. A análise dos dados foi realizada por meio de técnica estatística descritiva. Dos 355 casos identificados no SI Quimioprofilaxia TB, 135 foram notificados em 2012 e 220 em 2013, sendo que 44 ocorrências envolviam as PVHA em seguimento na rede pública municipal de saúde, dos quais 21 (47,7%) pertenciam ao SAE \"C\". Foram excluídos 11 casos devido à não localização de prontuários clínicos e equívocos na classificação de indivíduos que não possuíam o diagnóstico de HIV/aids. Das 33 PVHA consideradas na amostra final do estudo, houve predomínio do sexo masculino (54,5%), faixa etária de 31 a 60 anos (72,7%), economicamente ativos e casados/ união estável (36,4%). Em relação ao perfil clínico, 75,8% tinham a aids como situação diagnóstica, faziam uso da TARV, porém apenas 30,3% tinham registros de retirada mensal de tais medicamentos. A contagem de células de proteção (TCD4+) e carga viral indicava estabilização do HIV/aids na maioria dos sujeitos. Quanto ao controle e desfecho da QT, a maioria (93,9%) dos pacientes realizou o tratamento na modalidade autoadministrada, sendo que 22 (66,7%) finalizaram o tratamento, mas observou-se uma taxa de abandono de 18,1%. Sendo a TB a principal doença oportunista a acometer e ser responsável pelo maior número de mortes associadas às PVHA, torna-se essencial a implementação de estratégias que favoreçam a vigilância da TB latente nas PVHA contribuindo como medida fundamental para o controle da doença ativa. A vigilância dos dados contribui para o planejamento e melhoria das ações e intervenções prestadas. Assim, desafios são lançados no que se refere à integração de ambos programas frente à importância da vigilância e manejo dos agravos no contexto das políticas públicas / TB is the main opportunistic infection to affect people living with HIV/AIDS (PLWHA), and TB/HIV coinfection is a major challenge for health systems. The study aimed to describe the monitoring of latent TB in PLWHA followed by HIV/AIDS Specialized Health Services Specialized (SHS) of Ribeirão Preto-SP, in the years 2012 and 2013. It was an epidemiological descriptive study. Were included 33 individuals who developed diagnosis of latent tuberculosis in 2012 and 2013, reported in the System Information \"TB chemoprophylaxis,\" and living with HIV/AIDS, followed by the five SHS municipal public health network of Ribeirão Preto-SP. For data collection, it was initially conducted a survey of PLWHA diagnosed with latent tuberculosis, from the number of individuals registered in the information system (IS) \"TB chemoprophylaxis.\" After, it was used a structured questionnaire containing 30 questions which were considered the following sections: I - Socio-demographic data; II - Data on the clinical profile of PLWHA - at diagnosis of latent TB; III - Data on the control of TB in PLWHA; IV Data on the situation, monitoring strategies and the outcome of latent TB in PLWHA. The study was developed from secondary sources of information: Information System \"TB chemoprophylaxis\"; Health Record; Computerized Hygia-Web system and Notifiable Diseases Information System (SINAN). As a complement, with the support of a particular script we interviewed the key actor - Municipal Program Coordinator for Tuberculosis Control and STD/AIDS - in order to characterize the scenario focusing on the description of the actions about prevention and control of TB in PLWHA. Data analysis was performed using descriptive statistics technique. Of the 355 cases identified in the IS chemoprophylaxis TB, 135 were reported in 2012 and 220 in 2013, with 44 occurrences involving PLWHA in the follow-up in the municipal public health system, of which 21 (47.7%) belonged to the SHS \"C\". Eleven cases were excluded due to non-location clinical records and errors in the classification of individuals who did not have the diagnosis of HIV/AIDS. Of the 33 PLWHA considered in the final study sample, there was a predominance of males (54.5%), aged 31-60 years (72.7%), economically active and married/common-law marriage (36.4%). Regarding the clinical profile, 75.8% had AIDS as a diagnostic situation, made use of ART, but only 30.3% had monthly removal of records of such drugs. The protective cell count (CD4 +) and viral load indicated stabilization of HIV/AIDS in most subjects. As for the control and outcome of QT, the majority (93.9%) of patients held in the self-administered treatment modality, with 22 (66.7%) completed the treatment but there was a dropout rate of 18.1 %. TB being the main opportunistic disease to affect and be responsible for more deaths associated with PLWHA, it is essential to implement strategies that enhance the surveillance of latent TB in PLWHA contributing as a key measure to control active disease. Surveillance data contribute to the planning and improvement of actions and interventions provided. So challenges are launched with regard to the integration of both programs forward the importance of surveillance and management of diseases in the context of public policy

Previous research on marital help-seeking has often focused on formal approaches such as marital therapy or relationship education and there is a greater need to understand married individual's informal help-seeking behaviors. This study explores both formal and informal help-seeking behavior using a national sample of 745 participants who have thought about divorce within the past 6-months. Findings indicate these participants more often engaged in informal help-seeking approaches to repair their marriage. Of those sampled, only 25% engaged in marital therapy together and only 9% engaged in a marriage strengthening class while over 30% read a relationship themed self-help book or visited a website as a form of repair-behavior. A series of logistic regressions indicate there are no statistically significant differences in help-seeking behavior by gender while those that were highly religious and had more serious thoughts of divorce were more likely to engage in all forms of help-seeking. A latent class analysis was conducted to determine if there are common patterns in help-seeking behavior. Results indicate there are 4 distinct types of help-seekers: Highly Engaged (5%), Private Information Gatherers (7%), Private Seekers (43%), and Minimally Engaged (45%). Follow up analyses indicate having higher levels of religiosity or having more serious thoughts of divorce were both associated with a greater likelihood of being in one of the three more engaged classes compared to the minimally engaged class. Results demonstrate the need to place more emphasis on informal help-seeking approaches, private repair-behaviors, and to consider common patterns in help-seeking behavior.

Tese de mestrado integrado. Engenharia Informática e Computação. Faculdade de Engenharia. Universidade do Porto. 2010