Introdução: As disfunções respiratórias agudas por exposição à poluição atmosférica afetam a principalmente crianças e idosos. Estes grupos são mais vulneráveis, apresentando quadros de morbidade e mortalidade em função dos efeitos dos poluentes sobre a função respiratória. A qualidade do ar que respiramos tem sido de grande interesse científico, para que se possa minimizar os impactos da poluição sobre a saúde da população. Atualmente, sabe-se que os poluentes atmosféricos estão associados a uma grande variedade de sintomas, disfunções e doenças agudas e crônicas. Objetivo: O objetivo deste estudo foi verificar a associação entre poluição atmosférica e alterações da função pulmonar em crianças do ensino fundamental nas cidades Cubatão e Atibaia. Método: O método aplicado foi subdividido em fases. Inicialmente foi realizada mensuração de PTS, MP10 e O3 na cidade de Atibaia, para caracterização da concentração destes poluentes na região central do município e comparação com as concentrações da estação da CETESB Cubatão/Centro. Na seqüência foram aplicados questionários de sintomas respiratórios em ambos os municípios, em estudantes do ensino fundamental. Por ultimo foram realizados os testes espirométricos para verificar a função respiratória dos participantes. Resultados: Os resultados das medidas de concentração de poluentes em Atibaia indicam uma boa qualidade do ar. A média mensurada respectivamente foram de 36,25 µg/m para PTS, 30,04 µg/m para MP10 e de O 474 µg/m demonstrando que a qualidade do ar é Boa. As concentrações médias encontradas em Atibaia foram comparadas com àquelas observadas em Cubatão no mesmo período. As concentrações em Cubatão mostraram-se mais elevadas. Os resultados do questionário sócio clínico e de sintomas respiratórios mostraram após análise estatística, que ser portador de doença respiratória associada com causa pré-existente foi mais comum em Atibaia. Os sintomas respiratórios das vias aéreas se manifestaram de forma semelhante nas duas cidades. Na espirometria foi evidenciado o distúrbio ventilatório restritivo com significância em Cubatão (p<0,05). Este resultado teve significância ainda maior quanto ao decréscimo da função respiratória ao se constatar que a presença da alteração do teste de espirometria em crianças não portadoras de doenças respiratórias foi maior em Cubatão, na análise estatística obteve-se OR = 8,25 e p=0,007. Conclusão: Conclui-se que a exposição a poluentes atmosféricos, principalmente O3 e PM10 causa disfunção respiratória e pode ser responsável pela morbidade de crianças com idade de 6 a 12 anos na cidade de Cubatão, e que morar nesta cidade aumenta o risco de desenvolver doenças respiratórias / Introduction : Acute respiratory disorders from exposure to air pollution mainly affects children and elderlies. These groups are most vulnerable, showing pictures of morbidity and mortality due to the effects of pollutants on respiratory function. The quality of air we breathe is of great scientific interest, so you can minimize the impacts of pollution on health. Currently, it is known that air pollutants are associated with a variety of symptoms, disorders and acute and chronic diseases. Objective: The objective of this study was to assess the association between air pollution and lung function changes in elementary school children in the cities and Atibaia Cubatão. Method: The method used was divided into phases. Measurements of PTS, PM10 and O3 in the city of Atibaia were performed, to characterize the concentration of pollutants in the central city and compared to the concentrations of CETESB Cubatão station / center. Questionnaires were administered in the sequence of respiratory symptoms in both towns, with all participants, elementary school students. Finally spirometric tests were performed to verify the participants\' respiratory function. Results: The results of the measures of concentration of pollutants in Atibaia indicate good air quality, respectively the average measured was 36.25 mg/m3 for TSP, PM10 30.04 µg/m3 to 474 µg/m3 O3 showed that the air quality is good. The average concentrations found in Atibaia were compared with those observed in Cubatão the same period. Concentrations in Cubatão were more elevated. The results of clinical and social questionnaire of respiratory symptoms after statistical analysis showed that being a carrier of respiratory disease associated with pre-existing cause was more common in Atibaia. Symptoms of respiratory airways expressed similarly in both cities. Spirometry was evidenced in restrictive ventilatory disorder with significance in Cubatão (p <0.05), this result has even greater significance as the decrease in lung function in children not suffering from diseases breathing was higher in Cubatão in the statistical analysis we obtained OR = 8.25 and p = 0.007. Conclusion: Exposure to air pollutants, especially PM10 and O3 cause impairment of respiratory function and may be responsible for morbidity of children aged 6 to 12 years in the city of Cubatao, living in this city increases the risk of developing respiratory diseases

INTRODUÇÃO: O baixo peso ao nascer representa fator de risco importante para a morbidade e mortalidade neonatal e infantil, sendo acompanhado por prematuridade, retardo de crescimento intra-uterino, ou ambos os fatores. OBJETIVO: Estudar as características maternas, perinatais, ambientais, econômicas, evolução ponderoestatural e alimentação das crianças nascidas com baixo peso e sua interação no aumento da morbidade durante o primeiro ano de vida. MÉTODOS: Estudo de coorte retrospectivo realizado na cidade de Sobral, Ceará, no período de três anos (2005 a 2007) onde foram incluídas 261 crianças nascidas com baixo peso (BP) e acompanhadas pelo Programa de Saúde da Família. Foi utilizado a Base de Dados do Sistema de Informações de Nascidos Vivos e revisão de prontuários hospitalares e ambulatoriais destas crianças para coleta de dados, quantificação e causa das consultas e internações. Para análise das variáveis foram realizadas distribuições de freqüência, Odds Ratio (OR), respectivos intervalos de confiança (95%) e significância estatística das associações. A análise final de associação utilizou modelo de regressão multivariado para avaliar os fatores de risco relacionados com o aumento da morbidade. RESULTADOS: Entre as 261 crianças estudadas, a média da idade materna foi de 24 anos, sendo que 29,12% das mães eram adolescentes. Cerca de 41,76 % das mães eram solteiras e 31,42% casadas ou com união estável, e 24,14% eram sem escolaridade. Quanto às características perinatais, 52,11% das crianças nasceram de parto vaginal, 52,49% pré-termos; 55,56% eram do sexo feminino, 98,08% das crianças obtiveram Apgar de 5 minutos maior que 6. O peso médio de nascimento foi de 2140 g, sendo que 72,03% das crianças nasceram com peso entre 2000 e 2500 g. Houve incremento do escore-z de peso até os quatro meses de idade cronológica para crianças nascidas a termo e idade gestacional corrigida para os pré-termo em cerca de 87% das crianças e 45% do escore-z do comprimento. O índice de aleitamento materno exclusivo foi de 26,05% e 8,43% até os 4 e 6 meses de idade respectivamente. Observou-se que 13,97% das crianças residiam em casa de taipa, 36,49% dos domicílios utilizavam fogão a lenha e 36,11% viviam com renda familiar inferior a um salário mínimo. Quanto a morbidade, as 261 crianças nascidas com baixo peso realizaram 1103 consultas por motivo de doença no Programa de Saúde de Família, tendo como causa principal infecções respiratórias agudas. Ocorreram 469 consultas ocorreram em emergência pediátrica e 156 internações hospitalares, principalmente no período neonatal. Foram identificados como fatores de risco para maior morbidade: a) Interrupção do aleitamento materno exclusivo antes dos quatro meses o qual esteve associado a presença de consulta em emergência (OR 3,07; p<0,001); b) Idade gestacional e peso de nascimento baixos, com maior probabilidade de internação no período neonatal (OR 6,26; p<0,001); c) Prematuridade e a ausência de recuperação de peso até os 4 meses estiveram associados a internação por pneumonia, diarréia aguda e outros motivos (OR 5,15 e 0,65; p = 0,036 e 0,013, respectivamente). As demais variáveis não tiveram relação com a morbidade estudada. CONCLUSÃO: A prematuridade, a interrupção do aleitamento materno exclusivo antes dos quatro meses e a ausência do incremento de peso estiveram associadas a maior morbidade nas crianças de baixo peso ao nascer. Nesta população atendida pelo PSF, as características maternas, ambientais e econômicas não estiveram associadas à maior morbidade / BACKGROUND: Low birth weight represents an important risk factor for neonatal and infant morbidity and mortality, accompanied by prematurity, intrauterine growth restriction, or both. OBJECTIVE: To study maternal, perinatal, environmental, economic characteristics, growth and feeding of children with low birth weight and their interaction in the increased morbidity during the first year of life. METHODS: A retrospective cohort study conducted in the city of Sobral, Ceará, in the period of three years (2005-2007) which included 261 children with low birth weight (LBW) and followed by the Family Health Program. We used the database of the Sistema de Informação de Nascidos Vivos (SINASC) and review data collection of hospital and ambulatory records of these children, quantification and causes of emergency room visits and hospitalizations. For analysis of the variables, were used frequency distributions, odds ratio (OR), confidence intervals (95%) and statistical significance of associations. The final analysis of association used logistic regression analysis to assess the risk factors associated with increased morbidity. RESULTS: Among 261 children studied, the average maternal age was 24 years, and 29.12% of mothers were teenagers. Approximately 41.76% were single mothers and 31.42% were married or with a stable union, and 24.14% were uneducated. Regarding perinatal characteristics, 52.11% were born vaginally, 52.49% were preterm, 55.56% were female and 98.08% of the children had Apgar 5 minutes greater than 6. The average birth weight was 2140 g, and 72.03% of children born weighing between 2000 and 2500 g. There was catch up in weight to four months of chronological age for children born at term and corrected gestational age for preterm at around 87% and 45% in height. The rate of exclusive breastfeeding was 26.05% and 8.43% to 4 and 6 months of age respectively. It was observed that 13.97% of children lived in wattle and daub house, 36.49% of households used wood stoves, and 36.11% lived with less than one minimum wage. As for morbidity, the 261 children born with low birth weight were 1103 visits due to illness in the Family Health Program, with the main cause was acute respiratory infections. There were 469 emergency visits and 156 pediatric emergency hospital admissions, especially in the neonatal period. Were identified as risk factors for increased morbidity: a) interruption of exclusive breastfeeding before 4 months which was associated with the presence of emergency consultation (OR 3.07, p <0.001), b) low gestational age and birth weight, with a greater likelihood of hospitalization in the neonatal period (OR 6.26, p <0.001), c) Prematurity and the no catch up in weight at to 4 months of age were associated with hospitalization for pneumonia, diarrhea and other reasons (OR 5, 15 and 0.65, p = 0.036 and 0.013, respectively). The other variables were not associated with morbidity study. CONCLUSION: Prematurity, interruption of exclusive breastfeeding before four months and no catch up growth were associated with greater morbidity in children with low birthweight. In the population served by the PSF, maternal characteristics, environmental and economic were not associated with increased morbidity

O trabalho estudou queixas, cuidados, importância e satisfação com a saúde bucal em uma população de idosos cadastrados no Núcleo de Saúde da Família III na cidade de Ribeirão Preto. Os idosos foram selecionados para participarem na pesquisa levando-se em conta a capacidade cognitiva (Mini Mental Examination), as atividades normais da vida cotidiana, bem como o consentimento em participar por livre vontade. Os participantes responderam um questionário, em suas residências, sobre saúde bucal elaborado especificamente para o presente estudo, em data previamente agendada pelo pesquisador. O questionário continha questões relacionadas à situação sócio-demográfica, cuidados com saúde bucal, situação protética, auto-avaliação sobre saúde bucal, bem como queixas referentes a este fato. Procurou-se desta forma, identificar o perfil da população estudada segundo levantamento das queixas mais prevalentes, situação em relação aos cuidados com dentes e/ou próteses, bem como a satisfação e o valor dado à saúde bucal. Os dados receberam tratamento estatístico para observação de associações de variáveis através de Teste exato de Fisher e Qui-quadrado, aceitando-se a associação quando o valor de p era menor ou igual a 0,05. A população adscrita, no referido núcleo no período de realização do presente estudo, era de 503 idosos dos quais foram entrevistados 261, e deste número, 90 idosos (34,5%) eram do sexo masculino e 171 (65,5%) do sexo feminino. A população possuía baixa escolaridade (60,2% com até 4 anos de estudo) e maior número de representantes com idade entre 60 a 69 anos (46,7%). A maioria dos idosos morava com familiares e os homens eram os responsáveis financeiros. Parte significativa dos entrevistados relatou ser desdentada total (48,7%) e este fato esteve associado à idade, escolaridade e convívio na mesma residência. Os indivíduos desdentados totais referiram sua saúde bucal como importante (45,2%) e boa (77,7%) sendo que, entre indivíduos satisfeitos com sua saúde bucal 53,6% eram desdentados totais, e tais variáveis estiveram associadas. Em relação aos cuidados, idosos mais jovens relataram maior número de escovações diárias dos dentes e/ou próteses. Quanto às queixas observou-se maior ocorrência de lesões/feridas na cavidade bucal, queixas referentes à articulação temporomandibular (ATM), mau hálito, boca seca e dificuldade para mastigar. Dentre estas queixas o mau hálito (p=0,015) e a dificuldade para mastigar (p=0,000) mostraram-se estatisticamente associadas à quantidade de dentes. A queixa referente à dificuldade para mastigar estava associada à mobilidade de próteses inferiores (p=0,001). Desta forma concluiu-se que os cuidados com a saúde bucal diminuíram com o avançar da idade, os idosos relataram sentir-se satisfeitos com suas condições de saúde bucal, classificando a mesma como importante, e ser desdentado total não significou necessariamente atribuir valores negativos a esta condição. A falta de dentes não foi referida como uma queixa porém apareceu associada à insatisfação com a saúde bucal. E finalmente concluiu-se que a dificuldade para mastigar esteve associada à idade e à mobilidade das próteses inferiores, sendo que na faixa etária mais avançada esta queixa foi mais freqüente. / The present survey was carried out to study complaints, care, value and satisfaction toward oral health in an aged population filled in the Family Heath Centre III at Ribeirão Preto. The elder were selected to participate in the study according to their cognitive status (Mini Mental Examination Test), normal life activities and their own acceptance to participate. The elder answered at their home, in a previous scheduled procedure, a questionnaire about oral health which was developed specific to the study purpose. The specific domiciliary questionnaire had questions about social demographical profile, oral health care, prosthetic condition, subjective self-reported oral health status and oral health complaints. It was identificated the population profile toward the most prevalent oral health complaints, teeth and prosthetic hygiene and care, satisfaction and self-reported oral health value. The data received statistical treatment to observe the association between variables according to the Fischer Exact and Chi square Tests, and the association was accepted when the p value was equal or lower than 0.05. The population, filled at the Family Health Centre III in the period of the study development, was 503 aged people with more than 60 years old, and 261 were interviewed, where 90 (34.5%) were male and 171 (65.5%) were female. In general the aged reported low education level (60.2%) and they were represented most frequently by the age between 60 to 69 years old (46.7%). The higher of the aged reported living with family and the men were responsible for the financial support of the family. Significant sample of the aged reported being edentate (48.7%) and this fact was correlated to the aged, educational level and living with the family. The edentate people reported that their oral health were important (45.2%) and good (77.7%), and the satisfied people (53.6%) were edentate and these variable were correlated. According to own oral health care, the younger subject reported a higher number of diary tooth brushing. It was reported a higher number of oral wounds, temporomandibular joint, fetid breath, dry mouth and masticator complaints. Among these complaints the fetid breath (p=0,015) and the masticator difficulty (p=0,000) were statistically correlated to inferior denture mobility (p=0,001). It was concluded that oral health care decrease as time goes by, the aged reported being satisfied with their oral health condition, and their oral health was self-classified as an important issue. The subject reported that being edentate do not mean that it is a negative profile. The tooth missing was not reported as complaint but it was statistically correlated with dissatisfaction toward own oral health. Finally it was concluded that masticator difficulty was statistically correlated to inferior dentures mobility being this complain higher reported in the older aged subject sample.

A morbidade materna grave é um continuum que se inicia com a ocorrência de uma complicação materna, durante a gestação, parto ou puerpério, e que pode terminar em morte. Situações de altos níveis de estresse têm sido relatadas como disparadoras de alterações emocionais e mentais, portanto, através desta pesquisa questiona-se se a morbidade materna grave, durante a gestação e/ou puerpério, está relacionada com o desenvolvimento de alterações mentais. O objetivo deste estudo foi analisar a depressão, ansiedade e os transtornos de estresse em mulheres que vivenciaram um episódio de morbidade materna grave. Realizou-se um estudo epidemiológico, descritivo, transversal de base hospitalar, com dados primários coletados por meio de entrevistas. As variáveis foram analisadas através de frequências e percentuais. Para as associações, utilizou-se o exato do qui-quadrado com um nível de significância de ?<=0,05. Para as variáveis em que foi rejeitada a hipótese de normalidade, foi utilizado o teste não paramétrico de Mann-Whitney. A amostra constituiu-se de 78 mulheres, sendo as morbidades mais frequentes as síndromes hipertensivas, apresentadas em 65 (83,3%) participantes, os transtornos hemorrágicos em sete (9,0%) e os indicadores de gravidade em seis (7,8%). Quanto à depressão, foram encontradas 12 participantes (15,4%) com diagnóstico positivo e 66 (84,6%) sem depressão. Em relação à Ansiedade-Estado, encontrou-se baixa ansiedade em sete (9,0%) participantes, ansiedade controlada em 64 (82,1%), alta ansiedade em sete (9,0%), Quanto à Ansiedade-traço, 25 (32,1%) participantes foram pouco ansiosas, 43 (55,1%), ansiosas e dez (12,8%), muito ansiosas. Em relação aos transtornos de estresse, observou-se a presença de estresse em 17 (21,8%) pacientes e 78,2% não apresentaram. Encontrou-se diferença significativa entre a depressão e o lugar de procedência (p= 0,04<= 0,05). Houve associação estatisticamente significativa entre Ansiedade-Traço e ocorrência de depressão (p=0,001<= 0,05), e Ansiedade-Traço e transtorno de estresse (p=0,001<= 0,05). Conclui-se que a ocorrência de alterações mentais é determinada pelas características psicológicas e avaliação individual do evento, e não propriamente por vivenciar um episódio de morbidade materna grave. / The severe maternal morbidity is a continuum that begins with the occurrence of a maternal complication during pregnancy, childbirth or the postpartum period, and that can end in death. Situations of high stress levels have been reported as triggers of emotional and mental changes. Therefore, this research questions whether severe maternal morbidity during pregnancy and/or postpartum is related to the development of mental changes. The objective of this study was to assess depression, anxiety and stress disorders in women who experienced an episode of severe maternal morbidity. It was an epidemiological, descriptive, cross-sectional hospital-based study with primary data collected through interviews. The variables were analyzed using frequencies and percentages. For associations it was used the exact chi-square test with a significance level of ? <= 0,05. For variables in which the hypothesis of normality was rejected it was used the nonparametric Mann-Whitney test. The sample consisted of 78 women and the most frequently morbidities were hypertensive syndromes presented in 65 (83,3%) participants, bleeding disorders in seven (9,0%) and severity indicators in six (7,8%). As for depression were found 12 participants (15,4%) with positive diagnosis and 66 (84,6%) without depression. In relation to anxiety-state a low anxiety was found in seven (9,0%) participants, controlled anxiety in 64 (82,1%), high anxiety in seven (9,0%). As for anxiety-trait 25 (32,1%) participants were less anxious, 43 (55,1%) anxious and ten (12,8%) very anxious. In relation to stress disorders it was observed the presence of stress in 17 (21,8%) patients and 78,2% did not present stress. A significant difference was found between depression and place of provenance(p=0,04). There was a significant association between trait anxiety and the occurrence of depression (p=0,001), and between trait anxiety and stress disorder (p=0.001). It is concluded that the occurrence of mental disorders is determined by psychological characteristics and individual evaluation of the event and not exactly by experiencing an episode of severe maternal morbidity. Key-

Samsjuklighet i form av psykisk ohälsa och ett missbruk har blivit allt mer uppmärksammat och vanligt förekommande, något som ställer högre krav än någonsin på en fungerande samverkan mellan psykatrisk- och beroendevård inom öppenvården. Syftet med denna studie är, utöver att belysa den uppfattade omfattningen av samsjuklighet, att genom kvalitativa intervjuer med yrkesverksamma från två aktörer inom de båda vårdområdena identifiera befintlig samverkan och förbättringsområden. Utöver detta är syftet även att se hur personal inom de båda verksamheterna förhåller sig till vad det innebär hos klienter och patienter att vara diagnostiserad med två stigmatiserade diagnoser. Den teoretiska referensramen denna studie använder sig av är teorin om samverkan och Goffmans teori om stigma, samt tidigare forskning som berör samverkan och samsjuklighet. Empirin består av fyra semi-strukturerade intervjuer med yrkesverksamma inom de båda vårdområdena. Resultaten visar på att samtliga respondenter uppfattar samsjukligheten som utbredd och omfattande, samt att samverkan är uppskattat och eftersträvansvärt – men kräver både motivation och vilja av personalen för att fungera effektivt. Vidare visar resultaten att det främst inom beroendevården arbetas aktivt och uttalat för att avstigmatisera den enskilde och befria denna från skam och skuld, även om psykiatrin också anser sig vara relativt avstigmatiserad. / Co-morbidity in the form of mental health problems and an addiction has become increasingly noticeable and commonplace, which places higher demands than ever on a functioning collaboration or integration between psychiatric- and addiction care amongst open care. The purpose of this study, in addition to highlighting the perceived scope of co-morbidity, is to identify existing collaboration and improvement areas through qualitative interviews with professionals from two different organizations within the two care areas. In addition, the purpose is also to see how staff within the two activities relate to what it means for clients and patients to be diagnosed with two stigmatized diagnoses. The theoretical frame of reference this study uses is the theory of collaboration and Goffman's theory of stigma, as well as previous research that concerns collaboration and co-morbidity. The data consists of four semi-structured interviews with professionals in the two care areas in a selected municipality. The result shows that all respondents perceive co-morbidity as widespread and extensive, and that the collaboration is appreciated and desirable - but requires both the motivation and the will of the staff to function effectively. Furthermore, the results show that it is primarily in addiction care to work actively and explicitly to de-stigmatize the individual and liberate it from shame and guilt, even if the actor within psychiatric care also considers itself to be relatively de-stigmatized.

Frontal lobe atrophy (FLA) is associated with late-life depression and cognitive impairment, although the pathogenesis of FLA in stroke is unclear. In an aim to ascertain whether FLA is affected by WMLs, we analyzed the MRIs of 471 Chinese ischemic stroke patients. Lobar atrophy was defined by a widely-used visual rating scale. WML severity was rated using the Fazekas scale. There was no correlation between PVH and DWMH and temporal and parietal atrophy. The results of this study suggest that FLA in ischemic stroke may be associated with SVD. / Poststroke depression (PSD) is the most common form of poststroke psychiatric morbidity. Small subcortical infarcts (SSIs) can result from small vessel disease (SVD) and large artery disease (LAD). No study has yet explored PSD in different etiological types of SSIs. To address this gap, 127 patients with SSIs resulting from LAD or SVD were examined. PSD was evaluated with the Geriatric Depression Scale (GDS) three months after stroke. The LAD group had a significantly higher frequency of PSD, and LAD was found to be a significant independent risk factor for PSD. This study suggests that cerebral blood perfusion may play an important role in PSD. / Post-stroke emotional lability (PSEL) is a distressing and embarrassing complaint among stroke survivors. Lesions located in various cortical and subcortical areas are thought to be involved in the pathophysiology of PSEL.The clinical significance of microbleeds (MBs) in the development of psychiatric conditions following stroke is unknown. We carried out a study to examine the association between PSEL and MBs in 519 Chinese patients with acute ischemic stroke admitted consecutively. PSEL was evaluated three months after the index stroke, and the number and location of MBs were evaluated with MRI. According to Kim's criteria, 74 (14.3%) of the patients had PSEL. Our results suggest that MBs in the thalamus may play a role in the development of PSEL. The importance of MBs in PSEL and other psychiatric conditions in stroke survivors warrants further investigation. / The first study reported in this thesis involved 328 Chinese ischemic stroke patients who were administered a series of neuropsychological tests covering seven domains three months after stroke. Two hundred and fifty-six of these patients were followed-up for one year. Volumetry of the infarcts, WMLs, and hippocampus atrophy on magnetic resonance imaging (MRI) was conducted. The prevalence of cognitive impairment was 54.9% at baseline and 52.4% at the one-year follow-up, although most of the patients (85.5%) remained cognitively stable. The evolution of cognitive impairment no dementia (CIND) at the one-year follow-up was bidirectional, with 11.2% progressing to dementia and 21.0% reverting to cognitive intact. WMLs volume rather than hippocampal volume was a significant predictor of cognitive impairment, cognitive decline, and delayed dementia. WMLs also had an independent effect on executive function, attention, visual memory, visuoconstruction, and visuomotor speed. / This thesis investigates the clinical and imaging characterization of cognitive impairment and psychiatric morbidity in Chinese stroke patients. The conclusions of the studies reported herein can be summarized as follows. (1) The prevalence of cognitive impairment is high among Chinese poststroke patients, but most remain cognitively stable at one year after stroke; WMLs rather than hippocampal atrophy predict cognitive impairment, longitudinal cognitive decline, and delayed dementia; (2) DLPFC atrophy is correlated with poor verbal fluency in elderly women with stroke, but not in their male counterparts; (3) LAD may be associated with PSD in patients with small subcortical infarcts; (4) MBs in the thalamus are associated with PSEL; (5) frontal lobe infarction and diabetes may be risk factors of insomnia symptoms in stroke patients; and (6) FLA in ischemic stroke may be associated with SVD. (Abstract shortened by UMI.) / Chen, Yangkun. / Adviser: Wai Kwong Tang. / Source: Dissertation Abstracts International, Volume: 72-04, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 217-238). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Objetivo: Identificar a frequência das fístulas após a palatoplastia primária dos pacientes com fissura transforame unilateral do Estudo Clínico Randomizado (ECR) - Projeto Flórida (PF), de acordo com dados registrados pelos profissionais de Cirurgia plástica (CP) e Fonoaudiologia (FGA); descrever a terminologia utilizada pelos profissionais ao reportar a localização das fístulas e descrever o tamanho, a sintomatologia e o gerenciamento destas complicações; e verificar a concordância entre as áreas da CP e FGA quanto às informações sobre presença e localização das fístulas em relação ao forame incisivo (pré ou pós-forame incisivo). Métodos: Foram analisados 466 prontuários de pacientes com fissura transforame unilateral não sindrômica e operada. Os dados quanto a presença de fístula, a localização, o tamanho e a sintomatologia, foram compilados e analisados, de modo descritivo, em duas janelas de tempo. O primeiro tempo abrangeu todos os registros datados até três anos após a realização da palatoplastia primária e o segundo tempo abrangeu os registros durante e após a expansão rápida da maxila (ERM). Comparou-se os achados com uma classificação Padrão Ouro das fístulas no ECR-PF, verificando o nível de concordância entre as informações registradas pela CP e FGA (Estatística Kappa). Resultados: A área da CP reportou um total de 117 (25,1%) fístulas, enquanto a FGA reportou 171 (36,7%), comparados às 164 (35,2%) fístulas identificadas na classificação Padrão Ouro. Combinando as duas áreas, obteve-se um total de 184 (39,5%) casos de fístulas, sendo que 104 (56,5%) foram registradas por ambas as áreas, 67 (36,4%) foram identificadas apenas nas documentações da FGA e 13 (7,1%) somente nos registros da CP. Quanto ao tamanho, dos 104 casos com esta informação, a maioria foi classificada como fístula de tamanho pequeno (N=50; 48%). A sintomatologia mais reportada nos 184 casos foi o refluxo nasal de alimentos em 125 (68%), seguido do escape de ar nasal em 62 (33,6%) e hipernasalidade em 56 (30,4%). Durante a análise do segundo tempo deste estudo (ERM), observou-se um total de 50 (14%) casos de fístulas em 359 pacientes que realizaram esse tratamento ortopédico, sendo que 39 (78%) destas fístulas foram localizadas em região pré-forame incisivo. Quanto ao tamanho, a maioria foi classificada como fístula de tamanho pequeno (N=25; 50%) e a sintomatologia mais encontrada foi o escape de ar nasal em 29 (58%). Tanto no primeiro, quanto no segundo tempo de análise, observou-se o uso de terminologia variada entre as duas áreas, aspecto este que dificultou a classificação da localização das fístulas em relação forame incisivo. Obteve-se uma concordância moderada entre a classificação Padrão Ouro e os dados reportados no prontuário pelo CP (Kappa = 0,32) e uma concordância substancial entre a classificação Padrão Ouro e os dados reportados no prontuário pela FGA (Kappa = 0,63). Conclusão: Com base no levantamento dos registros cirúrgicos e fonoaudiológicos, os dados encontrados indicaram uma concordância moderada e substancial entre as áreas em relação ao Padrão Ouro. Dessa forma, fica claro a necessidade de se estabelecer e validar um protocolo para a utilização em rotina clínica e multiprofissional. / Purpose: To identify the frequency of fistulas after primary palatoplasty of patients with unilateral cleft lip and palate at a Randomized Clinical Trial (RCT) - Florida Project (FP), according to the data registered in patients records by the areas of Plastic surgery (PS) and Speech-language pathology (SLP); to describe the terminology used by this professionals to record the location of the fistulas, as well as to describe the size, symptoms and management of these complications; and to verify the agreement between the areas of PS and SLP regarding the presence and location of fistula in relation with the incisive foramen (pre- or post-foramen). Methods: A total of 466 medical records of patients with unilateral, nonsyndromic and operated cleft lip and palate were analyzed. The data about presence of fistula, location, size and symptoms, were compiled and analyzed descriptively considering two time-windows regarding the primary palatoplasty. The first window included all data registered up to three years after the primary palatoplasty, and the second window included data registered during and after rapid maxillary expansion (RME). The findings were compared to a Gold Standard classification of fistula from the RCT, with the verification of the level of agreement (Kappa Statistics) between the information recorded by the two areas. Results: A total of 117 (25,1%) fistulas were reported by the PS while 171 (36,7%) were reported by the SLP area compared to 164 (35,2%) fistulas identified with the RCT-Gold Standard classification. A total of 184 (39,5%) cases of fistula was indicated, and 104 (56,5%) were recorded in both areas, 67 (36,4%) were recorded only in the SP and 13 (7,1%) were identified only in CP records. Considering the 104 cases with information regarding fistula size, most were classified as small (N=50, 48%). The most common symptom reported for the 184 cases with fistula was nasal regurgitation in 125 cases (68%), followed by nasal air escape in 62 (33,6%) and hypernasality in 56 (30,4%). A total of 50 (14%) fistulas were identified for the 359 patients who received rapid maxillary expansion (RME), and 39 (78,0%) fistulas were located prior to the incisive foramen. The most of fistulas were classified as small (N=25, 50%) and the most common symptom reported was nasal air escape in 29 cases (58%). On the first and second time-window, a large variation was found regarding terminology used by both areas to refer to fistula, making it very difficult to classify the location regarding to the incisive foramen. The agreement between the Gold Standard classification of fistula and the findings reported by the PS was moderate (Kappa = 0,32) while it was substantial for the SLP (Kappa = 0,63). Conclusion: Based on the survey of surgical and speech records, the data found indicated a moderate and substantial agreement between the findings regarding fistula occurrence reported by the areas of PS and SLP when compared to the Gold Standard classification for the RCT-FP. Thereby, it is clear the need to establish and validate a protocol for use in clinical and multidisciplinary routine.

A morbidade materna grave é um continuum que se inicia com a ocorrência de uma complicação materna, durante a gestação, parto ou puerpério, e que pode terminar em morte. Situações de altos níveis de estresse têm sido relatadas como disparadoras de alterações emocionais e mentais, portanto, através desta pesquisa questiona-se se a morbidade materna grave, durante a gestação e/ou puerpério, está relacionada com o desenvolvimento de alterações mentais. O objetivo deste estudo foi analisar a depressão, ansiedade e os transtornos de estresse em mulheres que vivenciaram um episódio de morbidade materna grave. Realizou-se um estudo epidemiológico, descritivo, transversal de base hospitalar, com dados primários coletados por meio de entrevistas. As variáveis foram analisadas através de frequências e percentuais. Para as associações, utilizou-se o exato do qui-quadrado com um nível de significância de ?<=0,05. Para as variáveis em que foi rejeitada a hipótese de normalidade, foi utilizado o teste não paramétrico de Mann-Whitney. A amostra constituiu-se de 78 mulheres, sendo as morbidades mais frequentes as síndromes hipertensivas, apresentadas em 65 (83,3%) participantes, os transtornos hemorrágicos em sete (9,0%) e os indicadores de gravidade em seis (7,8%). Quanto à depressão, foram encontradas 12 participantes (15,4%) com diagnóstico positivo e 66 (84,6%) sem depressão. Em relação à Ansiedade-Estado, encontrou-se baixa ansiedade em sete (9,0%) participantes, ansiedade controlada em 64 (82,1%), alta ansiedade em sete (9,0%), Quanto à Ansiedade-traço, 25 (32,1%) participantes foram pouco ansiosas, 43 (55,1%), ansiosas e dez (12,8%), muito ansiosas. Em relação aos transtornos de estresse, observou-se a presença de estresse em 17 (21,8%) pacientes e 78,2% não apresentaram. Encontrou-se diferença significativa entre a depressão e o lugar de procedência (p= 0,04<= 0,05). Houve associação estatisticamente significativa entre Ansiedade-Traço e ocorrência de depressão (p=0,001<= 0,05), e Ansiedade-Traço e transtorno de estresse (p=0,001<= 0,05). Conclui-se que a ocorrência de alterações mentais é determinada pelas características psicológicas e avaliação individual do evento, e não propriamente por vivenciar um episódio de morbidade materna grave. / The severe maternal morbidity is a continuum that begins with the occurrence of a maternal complication during pregnancy, childbirth or the postpartum period, and that can end in death. Situations of high stress levels have been reported as triggers of emotional and mental changes. Therefore, this research questions whether severe maternal morbidity during pregnancy and/or postpartum is related to the development of mental changes. The objective of this study was to assess depression, anxiety and stress disorders in women who experienced an episode of severe maternal morbidity. It was an epidemiological, descriptive, cross-sectional hospital-based study with primary data collected through interviews. The variables were analyzed using frequencies and percentages. For associations it was used the exact chi-square test with a significance level of ? <= 0,05. For variables in which the hypothesis of normality was rejected it was used the nonparametric Mann-Whitney test. The sample consisted of 78 women and the most frequently morbidities were hypertensive syndromes presented in 65 (83,3%) participants, bleeding disorders in seven (9,0%) and severity indicators in six (7,8%). As for depression were found 12 participants (15,4%) with positive diagnosis and 66 (84,6%) without depression. In relation to anxiety-state a low anxiety was found in seven (9,0%) participants, controlled anxiety in 64 (82,1%), high anxiety in seven (9,0%). As for anxiety-trait 25 (32,1%) participants were less anxious, 43 (55,1%) anxious and ten (12,8%) very anxious. In relation to stress disorders it was observed the presence of stress in 17 (21,8%) patients and 78,2% did not present stress. A significant difference was found between depression and place of provenance(p=0,04). There was a significant association between trait anxiety and the occurrence of depression (p=0,001), and between trait anxiety and stress disorder (p=0.001). It is concluded that the occurrence of mental disorders is determined by psychological characteristics and individual evaluation of the event and not exactly by experiencing an episode of severe maternal morbidity. Key-

Poisoning is frequently associated with psychological and physiological co-morbidities that can be assessed in order to improve patients' management and reduce cost. The primary objective of this study is to conduct a review of emergency department (ED) poisonings to characterize its demographics and assess associated co-morbidities. The second objective is to explore correlation between personal history of diseases and poisonings. Predictors for poisonings and its outcomes were investigated and risk factors for suicidal poisoning and how it relates to mental illnesses were explored. Six hundred and forty nine cases admitted to ED between 2004 and 2007 were studied. Results indicate that difference in ethnic background was substantial as poisoning cases were predominantly African Americans (79.9%) between 36-45 years old with a male to female ratio of 1.3. Intentional illicit drug overdose was the greatest risk factor for ED poisonings, and among the 649 cases, heroin overdose was the most common cause of poisoning at 35.4% (n=230), cocaine overdose at 31.7% (n=206), heroin and cocaine overdose at 4.3% (n=28), multiple drug poisoning at 5.5% (n=36), and antidepressant/antipsychotic poisoning at 6% (n=39). A significant correlation between heroin poisonings and asthma (F=20.29, DF=1, p= .0001) was found, as well as between cocaine poisoning and hypertension (F=33.34, DF=1, p=.0001), and cocaine poisoning and cardiovascular diseases (F=35.34, DF=1, p=.0001). Another significant finding is the change in the pattern of the route of illicit drug use from injection to inhalation; it is thought this may reduce the rate of HIV and Hepatitis transmission via hypodermic needles among illicit drug users. As well, inhalation and insufflation may be risk factors that aggravate preexisting asthma. Mental illnesses, chiefly depression, remain one of the greatest risk factors for suicidal poisoning beside age, Hispanic race, gender, ingestion route and unemployment. This study provides supporting evidence that poisoning, particularly deliberate poisoning with illicit drugs remains a serious issue that significantly aggravates co-morbidities and raises treatment cost by increasing both the rate of hospitalization and hospital length of stay (LOS). Pragmatic guidelines and innovations in reducing heroin and cocaine abuse in these patients may lessen the severity of diseases and reduce its burden on the healthcare system and on society.

Developing countries like Nigeria continue to have HIV epidemic challenge due to the scarcity of evidence-based information and lack of resources to boost HIV education. The study population, Owerri, is one of the states in Nigeria with a high incidence rate of HIV. The purpose of this phenomenological study was to explore the experiences of people living with HIV/AIDS regarding the effects of nonadherence to HIV/AIDS drugs. The integrated theory of health behavior model provided the framework for the study. I collected, transcribed, and analyzed interview data to identify clusters and themes. Results showed that various factors influenced and (e.g., free drugs, fear, culture, medication side effects, discrimination, relationship/support system, poverty, belief, easy access) contributed to adherence behavior among respondents. People living with HIV/AIDS may be encouraged to adhere to drug treatments because of these research findings. This study contributed to a positive social change in that respondents were excited and open about sharing their fears, challenges, struggles and hope with the anticipation to influence others to be open about their HIV disease.