As metástases cerebrais são os tumores cerebrais mais freqüentes do sistema nervoso central. Entre as modalidades terapêuticas, a radiocirurgia (SRS) vem ganhando destaque nas duas últimas décadas como forma efetiva de tratamento associada com baixa morbidade e mortalidade. Porém, mesmo após ampla revisão da literatura, várias perguntas permanecem sem resposta sobre a radiocirurgia no tratamento das metástases cerebrais, perguntas estas principalmente relacionadas sobre as complicações tardias, dependência ao corticóide e relação das complicações com áreas cerebrais funcionais eloqüentes. O objetivo deste trabalho foi analisar a radiocirurgia como modalidade terapêutica das metástases cerebrais (MC) de uma grande série de casos, que estuda criteriosamente clínica e radiologicamente as lesões e identificando fatores preditivos para complicações, falha terapêutica e necrose pós-tratamento, a qual enfatiza principalmente localização da MC e suas relações com áreas eloqüentes cerebrais. Foi realizado estudo retrospectivo em 213 pacientes com 261 metástases cerebrais tratadas com radiocirurgia. Várias características demográficas deste grupo de pacientes foram analisadas, onde destacamos a boa distribuição de lesões de várias histologias tratadas e na grande maioria de pacientes em bom estado geral. Além disso, dividimos estes tumores de acordo com uma classificação estabelecida para relação com áreas eloqüentes em 3 grupos (graus I, II e III). No nosso estudo encontramos dependência ao corticóide em 24,3% dos casos, que se distribui em 15%, 25% e 29% nas lesões grau I, II e III respectivamente. O autor demonstra que o dobro das lesões localizadas nas áreas eloqüentes apresenta dependência ao corticóide, comparando-se com tumores em áreas não eloqüentes. Destacamos que a dependência ao esteróide ocorre em 54,5% dos tumores do tronco cerebral, 38,8% dos relacionados com centro motor/sensitivo, 35,5% daqueles relacionados com centros da fala e 20% dos casos relacionados com áreas visuais. Também nestes grupos específicos ocorreu queda destas taxas de dependência com o passar dos meses. Na nossa casuística, a SRS foi efetiva em 184 lesões tratadas (70,5%), diante de acompanhamento prolongado. As complicações em geral foram mais freqüentes em áreas eloqüentes, ocorrendo, especificamente, em 64,7% , 64,9% e 55,3% respectivamente, para lesões do tronco cerebral, centros da fala e áreas motoras/sensitivas. Dentre as muitas variáveis utilizadas encontramos diferenças significativas para complicações para casos com doença primária progressiva, lesões grau III (áreas eloqüentes), lesões do tronco cerebral e relacionadas com áreas motoras/sensitivas. Se estudarmos apenas os casos com falha terapêutica, notamos diferenças para predizer falha terapêutica em casos com doença sistêmica avançada, a não realização de radioterapia prévia e lesões relacionadas com áreas motoras/sensitivas e centros da fala. Foram considerados fatores preditivos de necrose pós-tratamento metástases de melanoma e carcinoma de células renais, presença de metástases outras além do encéfalo, realização prévia de radioterapia, doses acima de 20 Gy e tumores relacionados com áreas motoras/sensitivas. Em todas as análises, notamos diferenças significativas quanto maior o tamanho da lesão tratada. Não houve diferenças significativas quanto à efetividade ou complicações comparando as várias histologias, ocorrendo diferenças para o surgimento de necrose póstratamento em casos das lesões consideradas \"radioresistentes\" (melanoma e carcinoma de células renais). Considerando os resultados obtidos, concluise que a realização de radioterapia prévia a radiocirurgia esteve associada com maior efetividade e maior possibilidade de ocorrer necrose póstratamento. Doença primária em estágio avançado foi considerada como fator preditivo de complicação e de falha terapêutica. Lesões maiores apresentaram significativas diferenças para complicações, falhas terapêuticas e necrose pós-tratamento, do que lesões menores. Podemos concluir, ainda, que a localização da metástase cerebral deve ser considerada uma variável importante em predizer complicação do tratamento, visto que encontramos significativas diferenças para o surgimento de complicações em lesões localizadas em áreas eloqüentes (grau III) e ainda especificamente em lesões do tronco cerebral e em áreas motoras/sensitivas, comparando-se com demais regiões cerebrais. Tais áreas também apresentaram maior taxa de dependência ao corticóide / Brain metastases are the most common Central Nervous System tumors. Among the therapy options stereotactic radiosurgery has became in the last two decades an usefulness treatment technique attending with lower complication and mortality rate. However, even an extended literature review, many questions remain unclear about this therapy modality, mainly related with long-term complications, steroids dependency, and relations with brain eloquent areas. The goal of this project is analyze stereotactic radiosurgery as treatment modality for brain metastases in a large series, considering clinics and radiologic lesions aspects and identifying predictors factors for complications, treatment failure and treatment necrosis regarding the relation with brain eloquent areas. We retrospectively review 213 patients with 261 brain metastases treated with stereotactic radiosurgery. Several demographics aspects were analysed. We noticed a good distribution of histological groups and the performing patient status. We also lump these lesions in groups based on their location in relation with eloquent brain areas (grade I, II and III). This study found a general steroids dependency rate of 24,3% for all cases, occurring in 15%, 25% and 29% in lesions grade I, II and III respectively. That\'s twice the frequency for lesions located in eloquent brain areas compared with non eloquent located lesions. Specifically, the steroids dependency occurred in 54,5% of brain stem tumors, 38,8% tumors related with motor/sensory centers, 35,5% speech center tumors related and 20% of cases related with visual areas. Even in these subgroups the dependency rate decreases with time. The long-term tumor local control was achieved in 184 treated lesion (70,5%). Complications were more often found in eloquent areas, specifically in 64,7%, 64,9% and 55,3% respectively for brain stem, speech centers and motor/sensory related lesions. Among all variables we found significant differences for complications in cases of progressive primary disease, lesions grade III (located in eloquent areas), brain stem lesions, and related with motor/sensory areas. Regarding only treatment failure prediction, we noticed significances in cases of progressive primary disease, none previously radiated cases, and lesions related with motor/sensitive and speech areas. We considered predictors of treatment necrosis melanoma and renal cell carcinoma metastases, extra-cranial metastases, previously radiated patients, doses > 20Gy. In all analysis we found significant differences as bigger as the treated lesion. We did not find significant differences regarding efficacy and complication comparing all histological types. We identify statistically significant considering \"radioresistent\" tumors for treatment necrosis. Based on the results, we conclude that radiotherapy previously stereotactic radiosurgery were related higher effectiveness and treatment necrosis. Progressive primary disease predicts complications and treatment failure. Bigger lesions were statistically significant related with complications, treatment failure and necrosis compared with smaller ones. We can also conclude that brain location of metastases is an important variable to predict complications, with results that showed statistically significant differences found in grade III lesions, specifically brain stem tumors, lesions related in motor/sensitive areas, compared with non eloquent located lesions. These areas are also related with higher steroids dependency rates

Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-04-25T15:17:25Z No. of bitstreams: 1 andreajanuariodasilva.pdf: 7879109 bytes, checksum: 9f5caac2b5a01b90f4a3414be2faaddf (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-04-25T15:29:48Z (GMT) No. of bitstreams: 1 andreajanuariodasilva.pdf: 7879109 bytes, checksum: 9f5caac2b5a01b90f4a3414be2faaddf (MD5) / Made available in DSpace on 2017-04-25T15:29:48Z (GMT). No. of bitstreams: 1 andreajanuariodasilva.pdf: 7879109 bytes, checksum: 9f5caac2b5a01b90f4a3414be2faaddf (MD5) Previous issue date: 2011-03-25 / O estudo pretendeu identificar os fatores de associação para morbimortalidade de neonatos egressos de Unidade de Terapia Intensiva Neonatal no município de Juiz de Fora e a frequência de morbidade e mortalidade comparadas com a da Vermont Oxford Network. Método: Estudo analítico-descritivo; coorte dos egressos das UTIN de Juiz de Fora. População do estudo: todos os pares de mães e recém-nascidos residentes em Juiz de Fora e que tiveram internação em UTIN em 2009 pelo Sistema Único de Saúde. Duzentos e cinquenta e oito recém-nascidos e mães participaram deste trabalho. A inclusão de participantes iniciou em 01 de janeiro de 2009 e terminou no dia 31 de dezembro de 2009. Os dados foram coletados utilizando os formulários da Vermont Oxford Network (VON) e, para avaliação do desempenho motor, foi feito o Teste da Performance Motora Infantil (TIMP). Para comparação de proporções e médias, foram utilizados o qui-quadrado (c2) e o teste t. Para verificar a associação dos fatores obstétricos, perinatais e neonatais com a morbidade TIMP alterado e óbito foram feitas análises bivariadas e análises de regressão logística para identificação de fatores independentes associados ao desfecho. A análise foi feita utilizando o SPSS versão14 e o Minitab para Windows versão 12. Foram analisados os grupos de RN da população geral, menores de 1501g e maiores de 1500g. Resultados: 64,0% dos participantes tinham baixo peso ao nascimento, 67,1% eram prematuros e 59,7% do sexo masculino. Na comparação entre Juiz de Fora e VON, existiram diferenças significativas quanto às intercorrências, às intervenções e às morbidades nos sobreviventes (p ≤ 0,05). A sobrevivência dos usuários de UTIN em Juiz de Fora foi 84,9% e a frequência de morbidades 22,4%. Na análise dos fatores de risco para mortalidade dos usuários de UTIN as variáveis que apresentaram associação significativa na regressão logística foram: assistência ventilatória com máscara facial ou tubo orotraqueal nos dez primeiros minutos de vida e alteração do sistema nervoso central. Mais de um terço dos participantes apresentaram alteração no desenvolvimento motor no TIMP considerando desvio padrão de -1 ou menos. Na análise dos fatores de risco para alteração no desenvolvimento motor, as variáveis que apresentaram associação significativa na regressão logística foram: idade gestacional, sexo e convulsão. Conclusão: A comparação entre os dados coletados dos usuários de UTIN, atendidos pelo SUS, no município de Juiz de Fora com os dados derivados do banco da VON mostra que a frequência das complicações associadas às intercorrências e intervenções no pré-natal, perinatal e na UTIN foi, na maioria dos casos, maior em Juiz de Fora. Espera-se que uma estratégia terapêutica menos agressiva, baseada principalmente na prevenção e na gestão global da assistência, possa estar associada a melhorias nos desfechos clínicos em recém-nascidos usuários de UTIN. / This study aims to identify the correlated aspects that contribute for the morbimortality of newborn that has left Neonatal Intensive Care (NICU) in Juiz de Fora. Another goal is to compare the morbidity and mortality rates with the rates indicated by Vermont Oxford Network. Method: Descriptive-analytical study, cohort of the NICU discharges in Juiz de Fora. Study population: all the mothers and their newborns that lives in Juiz de Fora and who were hospitalized in 2009 by Health Care (SUS). Two hundred fifty-eight newborns and their mothers took part of this work. The participants inclusion started on 01/01/2009 and finished on 12/31/2009. The data were collected by using Vermont Oxford Network (VON) forms. The children motor skill performance test (TIMP) was applied to evaluate the motor skills. Chi-square and the t-Test were used to compare proportions and averages. In order to verify the link among obstetrics, perinatal and neonatal data and the TIMP morbidity and death, bivariate and logistic regression analysis were done to identify the independent factors connect with the outcomes. The analysis were executed by SPSS version 14 and Minitab for windows version 12. It was analyzed newborns groups in general under 1501 grams and over 1500 grams. Results: 64,0% of the participants had low weight when they were born; 59,7% were male and 67,1% premature newborn. By comparing Juiz de Fora and VON, it was possible to realize that there were huge differences concerned to the intercurrences, interventions and the morbidity found in the survivals (p ≤ 0,05).The survival of NICU patients in Juiz de Fora was 84,9% and 22,4%the numbers of morbidity. By analyzing of the mortality risk factor for NICU patients, it was concluded that the variables that have shown a substantial connection with the logistic regression were: ventilatory assistance with facial mask within ten life minutes and the variation of the central nervous system. More than one third of the participants had some modification of the motor development at TIMP, considering the pattern deviation of -1 and -2. The analysis of risk factors that contributes for the alteration of the motor development concluded that the variables that have shown a substantial connection with the logistic regression were: gestational age, gender and seizures. Conclusion: The comparison of the data collected from NICU patients treated by Health Care (SUS) in Juiz de Fora with the data from VON bank shows that the frequency of the complications connected to the intercurrences and prenatal interventions, perinatal and at NICU were, in most cases, bigger in Juiz de Fora. It is expected that a suitable therapeutic strategy, based mainly on prevention and global assistance management, could bring some improvement of the clinical discharges of newborns treated at NICU.

Orientadores: Jose Guilherme Cecatti, Maria Laura Costa do Nascimento / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T00:58:50Z (GMT). No. of bitstreams: 1 Ferreira_EltonCarlos_M.pdf: 3220735 bytes, checksum: adb82ed562a5753986a41b8a54b80cb0 (MD5) Previous issue date: 2014 / Resumo: Objetivo: avaliar a distribuição dos partos segundo o Sistema de Classificação em Dez Grupos de Robson (RTGCS) explorando os dados da Rede Brasileira de Vigilância da Morbidade Materna Grave (RBVMMG) e do Hospital da Mulher (CAISM) da Universidade Estadual de Campinas (UNICAMP), Brasil; e comparação de ambos com os dados do estudo Global Survey da Organização Mundial de Saúde (WHO). Método: Foram realizadas duas abordagens. A primeira foi uma análise secundária de um estudo de corte transversal multicêntrico que ocorreu em 27 maternidades brasileiras de referência, localizadas nas cinco regiões do país e participantes da RBVMMG. Foi realizada a codificação dos dados para alocação de todas as mulheres segundo o RTGCS e as mulheres foram classificadas de acordo com o espectro clínico de gravidade e a condição subjacente de morbidade materna grave. Para a segunda abordagem, foi realizado um estudo de corte transversal, com avaliação das mulheres admitidas para parto no CAISM no período de janeiro 2009 a julho de 2013. As mulheres foram agrupadas segundo a RTGCS e, adicionalmente, a distribuição das mulheres entre os diferentes grupos foi comparada entre os casos que tiveram morbidade materna grave, operacionalmente definida pela necessidade de internação em unidade de terapia intensiva (UTI), com os demais casos sem complicações graves. Para as duas abordagens (RBVMMG e CAISM), realizou-se também uma comparação com resultados publicados de outro grande estudo, realizado em diferentes contextos e países, fundamentalmente com os dados para o Brasil, disponíveis no estudo Global Survey da WHO. Resultados: Para a RBVMMG, das 7247 mulheres que compuseram o estudo, 73.2% foram submetidas à cesariana (CS). O grupo 10, grupo com provável indicação de cesárea por complicação materna e/ou fetal, foi o mais prevalente com 33.9% e também aquele com maior contribuição para a taxa geral de cesárea, 28%. Os grupos que tiveram maior gravidade (¨near miss¨ e óbito materno) foram, em ordem decrescente, os grupos 7 e 9, o grupo 8 e o grupo 10. O grupo 3 teve um caso de resultado materno grave (¨near miss¨ + óbito materno) para cada 29 casos de condição potencialmente ameaçadora da vida. Nas mulheres desse grupo submetidas a CS, essa relação atingiu valores de 1:10. Em todos os grupos avaliados, a hipertensão foi o fator de gravidade mais frequente. Na segunda abordagem, foram admitidas 12.771 parturientes durante o período do estudo. A taxa de cesariana encontrada foi de 46.6%. O grupo 1 foi o mais prevalente com 28.1%, sendo o grupo 5 aquele que mais contribui para a taxa geral de cesárea (12.7%). Apresentaram, proporcionalmente, mais internação em UTI os grupos 10 (46.8%), 5 (13.3%) e 2 com 9.8%. Conclusões: O estudo evidenciou uma alta taxa de cesárea nas duas populações avaliadas e o uso do RTGCS mostrou-se útil, evidenciando grupos clinicamente relevantes com alta taxa de parto por cesárea. Estudos futuros serão necessários para melhor avaliar a associação entre cesárea e morbidade materna grave, assim como definir possíveis intervenções e a taxa de cesárea esperada para esse grupo específico de mulheres / Abstract: Objective: To evaluate the distribution of delivering women according to the Robson¿s Ten Group Classification System (RTGCS) exploring the data from the Brazilian Network for the Surveillance of Severe Maternal Morbidity (RBVMMG) and from a tertiary hospital (CAISM), University of Campinas, Brazil; comparing both data with that from the WHO Global survey. Method: Two approaches were proposed. The first, a secondary analysis of a database obtained from a multicenter cross-sectional study taking place in 27 referral obstetric units located in the five geographical regions of Brazil, members of the Brazilian Network for the Surveillance of Severe Maternal Morbidity (RBVMMG), was carried out. For this analysis, data was organized following information necessary to classify all women into one of the RTGCS and cases from each of the 10 groups were classified according to case severity and underlying cause of severe morbidity. Subsequently, certain Robson groups were subdivided for further analysis. For the second approach, a cross-sectional study of data from women delivering at CAISM from January 2009 to July 2013 was carried out. Women were grouped according to RTGCS and, additionally, the distribution of women among the different groups was compared between cases who had severe maternal morbidity (SMM), operationally defined by intensive care unit (ICU) admission, with the other cases without severe complications. For both approaches (RBVMMG and CAISM), patients distributed among groups were compared to another Brazilian study population, available on the WHO Global Survey study. Results: For RBVMMG, among the 7247 women considered, 73.2% underwent cesarean section (CS). Group 10 had the highest prevalence rate (33.9%), also contributing most significantly (28%) to the overall CS rate. Groups associated with a severe maternal outcome (maternal ¨near miss¨ or maternal death), in decreasing order were: groups 7 and 9, 8 and 10. Group 3 had one case of severe maternal outcome (maternal ¨near miss¨ + maternal death) for every 29 cases of potentially life-threatening conditions. When evaluating only women undergoing CS in this group, ratios of 1:10 were achieved, indicating a worse outcome. Among all groups evaluated, hypertension was the most common condition of severity. For CAISM, of the 12771 women, 46.6% underwent CS. Group 1 had the highest prevalence rate (28%) and Group 5 contributed most significantly to overall CS rates. ICU admission was proportionally higher in groups 10 (46.8%), 5 (13.3%) and 2 with 9.8%.Conclusions: The study demonstrated a high cesarean section rate in the two populations studied and the use of RTGCS proved to be extremely useful, showing clinically relevant groups with high rates of cesarean section. Future studies are needed to better evaluate the association between cesarean section and severe maternal morbidity, as well as to define possible interventions and the expected cesarean section rate for this particular group of women / Mestrado / Saúde Materna e Perinatal / Mestre em Ciências da Saúde

Orientador: Marilisa Berti de Azevedo Barros / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T22:40:27Z (GMT). No. of bitstreams: 1 Senicato_Caroline_M.pdf: 3202832 bytes, checksum: f60916a87fc11b0b7b32b1b72c9162b3 (MD5) Previous issue date: 2012 / Resumo: A ocupação da mulher no mercado de trabalho e seu papel central no núcleo familiar, na organização e cuidado da moradia e da família, incluindo a amamentação, a criação dos filhos e o cuidado de familiares idosos e doentes, diferenciam-se dependendo do segmento socioeconômico a que pertencem e isso influencia distintamente no perfil de saúde e morbidade. O objetivo deste estudo foi avaliar desigualdades sociais no estado de saúde e uso de serviços de saúde segundo o nível de escolaridade de mulheres adultas. Trata-se de um estudo transversal de base populacional com amostra por conglomerados. Analisaramse 508 mulheres de 20 a 59 anos de idade residentes na área urbana do município de Campinas, participantes do Inquérito de Saúde do Município de Campinas - ISACAMP 2008. Foram estimadas prevalências e razões de prevalências ajustadas, utilizando modelos de regressão simples e múltipla de Poisson e considerando as ponderações relativas ao desenho amostral. Mulheres de menor nível educacional apresentaram pior condição de vida e maior prevalência de hipertensão, problemas circulatórios, dor de cabeça/enxaqueca, tontura/vertigem, obesidade, transtorno mental comum (SRQ-20), saúde autorreferida como ruim ou muito ruim, uso de prótese dentária e deficiência visual, e menor prevalência de uso de óculos ou lentes. Mas, não houve diferença entre os dois segmentos sociais de mulheres na prevalência de uso de serviços de saúde nas duas últimas semanas, no uso de medicamentos nos últimos três dias, no autoexame mensal das mamas, no exame clínico das mamas no último ano, no exame de Papanicolaou nos últimos três anos, nas hospitalizações e cirurgias no último ano, e na vacinação contra rubéola em algum momento da vida. Diferenças significativas foram observadas apenas quanto ao acesso aos serviços odontológicos no último ano e à mamografia nos últimos dois anos. O estudo detectou a presença de desigualdades sociais em diversos indicadores do estado de saúde e a presença de equidade no acesso a vários componentes dos serviços de saúde, apontando a potencialidade do SUS na redução das iniquidades na saúde da mulher no município / Abstract: The occupation of women in the labor market and its central role within the family, the organization and care of the house and the family, including breastfeeding, raising children and care of elderly and sick, differs according to socioeconomic segment belonging and that distinctly influences of health and morbidity profile. The present study assessed the inequalities in health status and use of health services according to educational status between adult women. It is population-based cross-sectional study was carried out with conglomerate sampling. Were analyzed 508 women between 20 and 59 years of age from the urban area of Campinas, participants in the Health Survey the city of Campinas - ISACAMP 2008. Prevalence values were estimated and prevalence ratios were adjusted using Poisson regression and considering weights related to the sampling design. Women with a lower level of schooling had a poorer quality of life and greater prevalence values for hypertension, circulatory problems, headache/migraine, dizziness/vertigo, obesity, common mental disorders (SRQ-20), worse self-reported health, use of dental prosthesis and visual impairment, but a lower prevalence of glasses. No differences between groups were found regarding in the use of health services in the previous two weeks, use of medication in the previous three days, monthly breast self-examination, clinical breast examination in the previous year, Pap smears in the previous three years, hospitalizations and surgeries in the previous year, and rubella vaccination in life. Significant differences were only to dental visits in the previous year and mammograms in the previous two years. This study demonstrate social inequalities in different health status indicators and equity in access to some health service components, pointing to the potential of SUS in reducing inequities in women's health in the municipality / Mestrado / Epidemiologia / Mestre em Saude Coletiva

Orientador: Roberto Wagner Lourenço / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T00:32:29Z (GMT). No. of bitstreams: 1 Leao_GustavoSoares_M.pdf: 1033387 bytes, checksum: 8546a1fb629f55995f774f235a7da1f4 (MD5) Previous issue date: 2012 / Resumo: Foi realizado um estudo ecológico entre os anos de 2003 a 2010 com dados mensais sobre o número de mortalidade e morbidade por doenças respiratórias, áreas destinadas a monocultura de cana de açúcar e a distribuição espacial dos focos de queimadas no município de Botucatu, SP. Os dados foram extraídos, respectivamente, das bases de dados DATASUS e do Instituto de Pesquisas Espaciais (INPE). A associação dos dados foi analisada considerando a determinação de cenários elaborados através da utilização de ferramentas de Sistema de Informação Geográfica - SIG e seus indicadores da transformação e ocupação do território do município estudado. Esse estudo teve como objetivo demonstrar a relação da mortalidade e morbidade por fatores respiratórios no município de Botucatu, a dispersão espacial dos registros dos focos de queimada e área plantada para monocultura de cana de açúcar, assim como analisar a correlação entre as variáveis de interesse. As análises sugerem uma relação entre as emissões de poluentes derivados da queima de cana de açúcar com os níveis de mortalidade e morbidade. Esse estudo possibilitou observar, na mesma perspectiva, dados sobre a exposição humana aos compostos produzidos em queimadas e os problemas de saúde respiratória que impactaram a população / Abstract: An ecological study conducted between the years 2003 to 2010 with monthly data on the number of mortality and morbidity from respiratory diseases, areas for monoculture of sugar cane and spatial distribution of outbreaks of fires in Botucatu, São Paulo. Data were extracted, respectively, of databases DATASUS AND THE Institute for Space Research (INPE). The association of the data was analyzed for determination of scenarios developed through the use of tools of Geographic Information System - GIS and these indicators of transformation and occupation of the territory of the municipality. This study aimed to demonstrate the relationship of mortality and morbidity due to respiratory factors in Botucatu, the spatial dispersion of records of outbreaks of fire and the area planted to sugar cane monoculture, as well as to analyze the correlation between variables of interest. The analyzes suggest a relationship between emissions of pollutants derived from burning of sugar cane with the levels of mortality and morbidity. This study allowed to observe in the same perspective, data on human exposure to the chemicals produced in fires and respiratory health problems that impacted the population / Mestrado / Epidemiologia / Mestre em Saude Coletiva

It has been generally recognised that sick children have an increased risk on malnutrition. An activated immune system requires more nutrients while illness is often associated with a lower absorption and decreased consumption because of lack of appetite. When these increased needs are not balanced with an adequate availability of nutrients, the sick child is at higher risk of developing malnutrition.Médecins Sans Frontières investigated the question whether this process is mitigated by simple short term nutritional supplementation given to sick children alongside medical treatment. Three Randomised Controlled Trials (RCT’s) were conducted. The first, in Democratic Republic of Congo, was a pilot; 180 children with malaria were randomised in 2 arms: 1 group receiving 2 weeks of ready to use therapeutic food (RUTF) and a control group. The children were followed for a period of 4 weeks. Children in the RUTF group showed a higher weight gain in the first 14 days compared to the control group, at day 28 the weight gain in both groups was similar.Thereafter, 2 RCT’s were implemented in Uganda and Nigeria using a similar methodology. Children with malaria, lower respiratory tract infection or diarrhoea (sample size of 2202) were randomised in three groups: supplemented with 2 weeks of RUTF, supplemented with 2 weeks of micronutrient powder (MNP), and not receiving supplementation after each disease episode. The incidence of malnutrition was compared after an observation period of 6 months. The trial in Uganda showed a reduction in malnutrition in the RUITF group with 31%, while in Nigeria, there was no significant reduction in the RUTF group. The MNP group did not show reduction in malnutrition in any site. In the group of moderate malnourished children the RUTF and MNP supplementations were not effective in preventing deterioration to severe malnutrition. However, when the studies were combined the RUTF group showed a lower mortality compared to the MNP group.Multi-variate analysis did not show a reduction of incidence of malnutrition in the supplementation groups. A strong association with morbidity was found. A higher frequency of diarrhoea was associated with an increased incidence of malnutrition. The association with malaria episodes was mixed; it was associated with a higher incidence of malnutrition in Kaabong, but in Goronyo a higher frequency of malaria decreased the incidence of malnutrition. In addition, a more frequent monitoring of the children and treatment of their illnesses was associated with a decreased incidence of malnutrition.The difference in effectiveness of supplementation between the sites can be explained by differences in food security and level of morbidity. It is argued that the fragile food security in Kaabong limits the supply of nutrients, and therefore supplementation with RUTF was effective. In Goronyo the high frequency of morbidity limits convalescence and therefore supplementation was not effective.It is likely that malnutrition is more effectively prevented when several interventions are combined like water and sanitation to prevent diarrhoea, malaria chemoprophylaxis and preventative and curative health and nutrition interventions.This dissertation will present the background, the methods of the trials and the results, followed by a discussion on the implications for programming and research. / Doctorat en Santé Publique / info:eu-repo/semantics/nonPublished

Magister Public Health - MPH / Despite all measures taken by the South African government since 1994, there is a contiuous increase of maternal mortality in the country and the Northwest Province is amongst the highest. Studies to date combining the review of maternal deaths and severe acute maternal morbidity (SAMM) have been conducted primarily in urban areas. The aim of this study was to determine the causes of death and avoidable factors for maternal mortality and severe acute maternal morbidity in a rural regional hospital from 01/01/2005 to 30/04/2006. / South Africa

Magister Curationis - MCur / The study proposed to conduct a descriptive study related to the correlation of infant feeding (EFF or EBF) and occurrence of morbidity diarrhoea and/or respiratory infections, in infants by 14 weeks of age. The study adopted a quantitative epistemological approach in seeking to describe the correlation of infant feeding and the occurrence of diarrhoea or respiratory infections by 14 weeks of age. The researcher embarked on a descriptive survey design and employed the questionnaire method during the data collection process. The Amathole District of the Eastern Cape Province was selected due to the accessibility of the targeted population. The unique demographic profile and rural-urban setting allows for a potentially rich data source whilst simultaneously reducing the potential incidence of bias in the data collection. The study sample was drawn from routine immunization and growth monitoring clinics in the Amathole district. / South Africa

Women treated for a gynecological cancer report longstanding post-treatment difficulties for which they rarely seek or receive help. Few intervention studies have successfully improved global sexual health within this population. Research in this domain is challenging due to inconsistent measurements of sexuality, low response rates and high attrition rates. The overarching study objectives were: (a) To contribute to the advancement of research on supportive care needs (including sexual health needs), desire for help, and predictors of needs; and, (b) To inform the development of services for gynecological cancer survivors. In Study 1, a qualitative interview study explored the experiences of 15 gynecological cancer survivors. Interviews were conducted and analysed based on the Interpretive Description approach . In Study 2 (for which results were analyzed in two parts), a descriptive, cross-sectional needs assessment was conducted to measure supportive care needs, desire for help, sexual health and vaginal changes, and service format preferences in 113 patients. In Part 1 of Study 2, descriptive and regression analyses explored patient needs, desire for help and potential predictors of these variables. In Part 2, a descriptive analysis explored sexual health needs and vaginal changes, desire for help with sexual health needs, and their associations with sociodemographic and medical variables. Qualitative results from Study 1 suggested that psychological, emotional and relational aspects of sexuality were as important to the participants as physiological sexual response. In the needs assessment, the strongest predictors of greater unmet needs and increased readiness for help were younger age and shorter time since treatment. Moderate to high sexual and social needs were equally prevalent in women recently treated and those treated several years prior to the study, suggesting that sexual and social needs may remain unaddressed over time. Further, many women who reported a need did not desire help, demonstrating the subjectivity of needs and distress, as well as the potential presence of barriers to seeking help. Both studies revealed a common finding, where sexual health needs were a product of the discordance between participants’ current sexual experiences and their perceptions of ideal sexual health. Overall, the two studies indicate that a significant subgroup of patients experience unmet needs in cancer survivorship, most of which are non-physical; also, while some needs were higher following treatment, unmet social and sexual health needs show little relationship with time since treatment. Ambivalence about receiving help with unmet needs is related to beliefs about the role of the health care team in meeting non-physical needs, as well as other perceived barriers. Patient’s perceived sexual health needs and barriers to receiving help should be evaluated within a comprehensive framework of needs and discussed one-on-one. Future research should explore the added predictive value of other groups of medical and psychological variables.

Orientador: Djalma de Carvalho Moreira Filho / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T09:34:37Z (GMT). No. of bitstreams: 1 Santos_MarcelideOliveira_D.pdf: 636134 bytes, checksum: 78b53a7902f3e2cfd099088e331c0646 (MD5) Previous issue date: 2009 / Resumo: A informação sobre incidência de câncer, obtida através dos registros de câncer de base populacional - RCBP é um componente essencial de qualquer estratégia de controle de câncer. Nos últimos vinte anos o papel dos registros de câncer tem se ampliado, incorporando o planejamento e avaliação das atividades de controle de câncer. Neste cenário, torna-se de fundamental importância a qualidade das informações fornecidas pelos registros. Uma breve revisão das metodologias para realizar o controle de qualidade dos dados nos registros de câncer, das mais tradicionalmente utilizadas às alternativas propostas torna claro que tais processos não são de fácil aplicação. O RCBP de Porto Alegre foi escolhido para verificar a aplicabilidade desta metodologia à realidade dos registros de câncer brasileiros. O Método de Fluxos apresenta-se neste contexto como adaptável a registros de câncer de diferentes padrões, de rápida execução e sem custos financeiros adicionais. O método proposto permite que o registro de câncer estabeleça uma rotina de vigilância de cobertura, segundo variáveis, tais como, localização primária, idade, sexo e área geográfica. / Abstract: Population-based cancer registries are essential to public health and research. The cancer registries provide information on the surveillance of cancer incidence and survival. At the last 20 years, because of the emerging importance of cancer as a health problem, the cancer registries play a important role to evaluate and to frame public health policy to cancer control. A high-quality cancer registration is fundamental to monitoring cancer burden and identifies patterns and trends in various population groups, in different geographic areas, and over time. Cancer registries try to achieve maximum completeness in case-findings procedures in order to ensure that comparative studies are not distorted by variations on efficacy of registry procedures. A brief review about available methods used to estimate completeness of cancer registrations shows that these methodologies are not easy to use, especially in developing countries. The PBCR Porto Alegre was chosen to verify if the method could be applied to Brazilian cancer registries reality. In this context the Flow Method claims to be adaptable to cancer registries with different patterns of registration and can be executed rapidly and inexpensively. The proposed method allows to a cancer registry to provide a routine surveillance of completeness by variables such as tumor site, age, sex and geographic area. / Doutorado / Saude Coletiva / Doutor em Saude Coletiva