published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

F1651, les pili Pap et l’antigène CS31A associé aux antigènes de surface K88 sont tout trois des membres de la famille de type P des facteurs d’adhérence jouant un rôle prépondérant lors de l’établissement d’une maladie causée par des souches Escherichia coli pathogènes, en particulier des souches d’E. coli pathogènes extra-intestinales (ExPEC, Extra-intestinal pathogenic E. coli). Leur expression est sous le contrôle d’un mécanisme de régulation transcriptionnel dépendant de l’état de méthylation de l’ADN, résultant dans l’existence de deux populations définies, l’une exprimant l’adhésine (population ON) et l’autre ne l’exprimant pas (population OFF). Malgré de fortes identités de séquences, ces trois systèmes diffèrent l’un de l’autre, principalement par le pourcentage de cellules ON rencontrées. Ainsi, quand CS31A est systématiquement orienté vers un état considéré comme OFF, F1651 présente une phase ON particulièrement élevée et Pap montre deux états OFF et ON bien distincts, selon le phénotype de départ. La protéine régulatrice sensible à la leucine (Lrp, Leucine-responsive regulatory protein) joue un rôle essentiel dans la réversibilité de ce phénomène épigénétique et il est supposé que les différences de séquences au niveau de la région régulatrice modifient la localisation à ces sites de fixation de Lrp; ce qui résulte, en final, aux différences de phase existant entre CS31A, F1651 et Pap.À l’aide de divers techniques parmi lesquelles l’utilisation de gènes rapporteurs, mutagénèses dirigées et d’analyse des interactions ADN-protéines in vitro, nous montrons dans ce présent projet que la phase OFF prédominante chez CS31A est principalement due à une faible interaction de Lrp avec la région distale de l’opéron clp, et que la présence d’un homologue du régulateur local PapI joue un rôle également clef dans la production de CS31A. Dans le cas de F1651, nous montrons dans cette étude que le taux élevé de cellules en phase ON est dû à une altération dans le maintien de Lrp sur les sites répresseurs 1-3. Ceci est dû à la présence de deux nucléotides spécifiques, situé de part et d’autre du site répresseur 1, qui défavorisent la fixation de Lrp sur ce site précis. Tout comme dans le cas de CS31A, la formation d’un complexe, activateur ou répresseur de la phase ON, dépend également de l’action de du régulatuer local FooI, qui favorise alors le déplacement de Lrp des sites répresseurs 1-3 vers les sites activateurs 4-6. / F1651, the pyelonephritis-associated pili (Pap) and the K88-related surface antigen CS31A are three members of the type P family of adhesive factors that play a key role in the establishment of disease caused by Extra-intestinal Escherichia coli (ExPEC) strains. They are all under the control of methylation-dependent transcriptional regulation that defines the number of fimbriated (ON) and afimbriated (OFF) cells within a clonal population. Despite a high similarity in DNA sequence, these three adhesive systems nonetheless differ in the ratio of ON cells. While CS31A is always turned toward the OFF state, F1651 presents a particularly high level of ON cells and Pap shows two distinct OFF and ON states, depending on the starting phenotype. The leucine-responsive regulatory protein (Lrp) plays an essential role in the reversibility of this epigenetic switch and it is believed that the difference in nucleotides within the regulatory region of each operons could modify the binding of Lrp and, in turn, CS31A, Pap and F1651 phase variation. Using a variety of techniques including gene expression, site-directed mutagenesis, and in vitro protein–DNA interaction analysis, we demonstrate that the preferential OFF state observed in CS31A-positive cells is mainly due to a weak interaction of Lrp with the clp distal region and that the presence of a PapI homologue within the cell plays a key role in CS31A production. For F1651, we show in this study that the high level of ON cells found during F1651 phase variation is due to an altered stability of the DNA complex formed by Lrp at its repressor binding sites 1-3. Again, after each cell cycle, complex formation is modulated by the local regulator FooI (homologue to PapI) which promotes the transit of Lrp toward its activator binding sites 4-6. Furthermore, we identify two nucleotides (T490, G508) surrounding the Lrp-binding site 1 that are critical to maintaining a high OFF to ON switch rate during F1651 phase variation, as well switching Pap fimbriae toward the OFF state.

3’-end modification by polyadenylation is a ubiquitous feature of almost all eukaryotic mRNA species and is catalyzed by a consortium of enzymes, the polyadenylation factors. Poly(A) polymerase (PAP), the enzyme catalyzing the addition of adenosine residues during the polyadenylation stage, exists in four isoforms within Arabidopsis. In silico and yeast two-hybrid studies showed that PAP1 has unique expression and interaction pattern in Arabidopsis, suggesting non-canonical functions of PAP1. Its exclusive interaction with PAP4 has not been reported in other living systems until now and hints at a difference in polyadenylation in plants with respect to mammals and yeast. Cleavage Stimulation Factor (CstF), a heterotrimeric complex of the polyadenylation factors CstF50, CstF64 and CstF77, plays a role largely in cleavage of pre-mRNA. This study highlights some aspects of the Arabidopsis homologs of CstF64 and CstF77, central to various cellular processes other than nuclear polyadenylation. In silico studies showed an elevated expression of CstF64 in the pollen while that of CstF77 remained fairly low. Yeast two-hybrid assays indicated a novel kind of interaction of CstF64 with Fip1(V). It is also speculated from sub-cellular localization techniques by agroinfiltration in tobacco leaves that CstF64 localizes in the cytoplasm and CstF77 in the nucleus, as found for the orthologs of CstF77 in other systems.

Abstrakt Fysisk aktivitet på recept (FaR), är en metod som används för att förebygga och behandla folksjukdomar. Syftet med FaR är att få individer att bli mer fysiskt aktiva [FA] och därigenom påverka sjukdomsbesvären i en positiv riktning. Till denna förändring krävs motivation och någonting som skapar en vilja att utföra FA. Syftet med denna studie har därför varit att undersöka om ett FaR- recept kan motivera till ökad FA hos FaR-klienter. Den metod som användes var semistrukturerade intervjuer med öppna frågor. Sex respondenter deltog i studien. Kravet var att personerna skulle ha FaR-recept. Resultatet pekar på att det upplevda stödet från såväl sjukvården, FaR- ledaren samt den sociala delen i form av familj, vänner och bekanta spelar stor roll för skapandet och upprätthållandet av motivation till FA hos FaR- klienten. Slutsatsen är att genom förmedlad kunskap och stöd från sjukvården och FaR- ledaren skapas en meningsfullhet, förståelse och hanterbarhet hos klienten. Detta kan leda till att öka motivationen till FA hos FaR-klienten. / Abstract Physical activity on prescription, (PaP), is a method used to prevent and treat common diseases. The aim of PaP is to get individuals to become more physically active [PA] and through that influence the disorders in a positive direction through a more active lifestyle. This change requires motivation and something that creates a desire to perform the PA. The purpose of this study was therefore to investigate whether a prescriptions may warrant increased PA in the clients. The methodology used in this study was semi-structured interviews with open questions. Six respondents participated. The requirement was that the people would have a PaP- prescription. The results indicate that the perceived support from both the healthcare, PaP- leader and social support plays a major role in the creation and maintenance of motivation to the PA in the PaP- client. The conclusion is that the mediated knowledge and support from health care and PaP leader created a meaningfulness, understanding and manageability of the client. This can lead to increased motivation to PA in PaP client.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-10-11T20:26:15Z No. of bitstreams: 1 GuianezzaMescherichiaDeGoisSaraivaMeira_TESE.pdf: 2819422 bytes, checksum: 9cf8c37817977b92201e3ffabf0604c7 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-10-13T20:00:14Z (GMT) No. of bitstreams: 1 GuianezzaMescherichiaDeGoisSaraivaMeira_TESE.pdf: 2819422 bytes, checksum: 9cf8c37817977b92201e3ffabf0604c7 (MD5) / Made available in DSpace on 2016-10-13T20:00:14Z (GMT). No. of bitstreams: 1 GuianezzaMescherichiaDeGoisSaraivaMeira_TESE.pdf: 2819422 bytes, checksum: 9cf8c37817977b92201e3ffabf0604c7 (MD5) Previous issue date: 2016-04-19 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / Os pap?is assumidos pelas mulheres na modernidade recente (MOITA LOPES, 2013) despertaram o interesse de in?meros pesquisadores nacionais e internacionais. O termo emancipa??o tem sido gerador de discord?ncias e pol?micas, tendo-se em conta o fato de que a mulher, mesmo havendo ingressado no mercado de trabalho, continua a exercer os pap?is socialmente impostos ? o de m?e, esposa e dona de casa. Em paralelo, as revistas femininas, em especial a revista Claudia, assumiram o prop?sito de orientar as mulheres no desempenho de suas muitas fun??es: como educar os filhos, como cuidar do lar, como agradar o c?njuge, e at? como ter sucesso na carreira profissional. Circunscrita nesse contexto, esta tese visa revelar as perman?ncias e as rupturas que se manifestam nos discursos femininos registrados na fanpage Claudia online, testemunhando como os pap?is sociais e as rela??es de poder influenciam na (trans)forma??o das identidades femininas. Em fun??o desse alcance, buscou-se uma sustenta??o te?rica nos postulados da An?lise Cr?tica do Discurso (ACD); mais especificamente, na Abordagem Sociol?gica e Comunicacional do Discurso (ASCD) ?, que, por sua vez, est? sendo desenvolvida na Universidade Federal do Rio Grande do Norte, em concomit?ncia com a Universidade Federal de Sergipe, sob a coordena??o da professora Dr.? Cleide Em?lia Faye Pedrosa (PEDROSA, 2012). Tamb?m se fez ancoragem, neste percurso investigativo, em saberes da Lingu?stica Sist?mico-Funcional (LSF); especialmente, no que concerne ao Sistema de Avaliatividade; na Sociologia para Mudan?a Social e nos Estudos Culturais. A ancoragem metodol?gica firma-se no paradigma qualitativo-interpretativista (MOITA LOPES, 2006), circunscrito ?s Ci?ncias Humanas e Sociais, com foco na Lingu?stica Aplicada (LA). O corpus comp?e-se de vinte e quatro postagens, divididas em seis tem?ticas recorrentes na fanpage Claudia online. Os resultados indicam que a fanpage Claudia online discute, de fato, os pap?is que as mulheres exercem em nosso meio social. Observa-se, ainda, que alguns desses pap?is foram solidificados devido aos par?metros conservadores da sociedade, perpetuando-se por muitas gera??es e sendo naturalizados ao sexo feminino. A constata??o ?, pois, a de que h? perman?ncia dos pap?is impostos, e de que, na modernidade recente, as mulheres passaram a exercer outros tantos pap?is, merecendo destacar o fato de que, hoje, a mulher trabalha fora, investe na forma??o acad?mica, frequenta academia diariamente, dirige autom?vel, participa das reuni?es escolares dos filhos, vai ao sal?o de beleza, administra o pr?prio sal?rio, delega fun??es ? secret?ria dom?stica; enfim, executa muitas tarefas concomitantemente, configurando-se, assim, o ac?mulo de fun??es exercidas pelas mulheres, o que justifica a atribui??o do r?tulo de ?mulher maravilha?, e leva ? ruptura nos padr?es e na execu??o dos pap?is femininos. / The roles played by women in late modernity (MOITA LOPES, 2013) encouraged the interest of a great number of national and international researchers. The term emancipating in anyway has been of disagreement and controversy, taking into account the fact that the woman, even though has conquered the labor market, continues to play the roles imposed by society ? of mother, wife and of housewife. At the same time, women's magazines, mainly Claudia magazine, have assumed the purpose to guide women in the performance of their multiple functions: how to educate their children, how to take care of their home, how to please their spouse, and even how to succeed in their professional careers. Circumscribed in this context, this thesis aims at investigating the permanence and the ruptures that are expressed in women's speeches posted in the fan page of Claudia magazine online, testifying how social roles and power relations influence the (trans)formation of female identities. Due to this scope, this research is based on the theoretical framework postulated by the Critical Discourse Analysis (CDA); specifically, in the Sociological and Communication of Discourse Approaches (ASCD) ? that is being developed at the Universidade Federal do Rio Grande do Norte, in partnership with the Universidade Federal de Sergipe, coordinated by the PhD Profesor Cleide Emilia Faye Pedrosa (Pedrosa, 2012). This study is also based, during the investigation, on knowledge of Systemic Functional Linguistics (SFL); especially regarding to the Appraisal System; in Sociology for Social Change and Cultural Studies. Methodologically, the research is anchored in the qualitative-interpretative paradigm (MOITA LOPES, 2006), circumscribed to Human and Social Sciences, focusing on Applied Linguistics (LA). The data of this research is made up of twenty-four postings, divided into six recurring themes, in the fan page of Claudia Magazine online. The results show that the fan page Claudia online, in fact, discusses the roles that women play in our social context. It is also observed that some of these roles were solidified due to conservative parameters of society, perpetuating itself for many generations and being naturalized to female gender. The finding is, therefore, that there is a permanence of the imposed roles, and that, in late modernity, women have come to play so many other roles, deserving to highlight the fact that nowadays the woman works outside, invests in academic education, visits regularly the gym, drives a car, attends the school meetings of their children, frequents beauty salon, manages their own incomes, delegates household jobs to the housemaid; finally, she carries out many tasks simultaneously, establishing thus the accumulation of positions held by women, which justifies the label attributes of "wonder woman", and leads to disruption in patterns and in the implementation of women's roles.

No description available.

Orientador: Marilisa Berti de Azevedo Barros / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T02:24:18Z (GMT). No. of bitstreams: 1 Amorim_VivianMaeSchmidtLima_D.pdf: 1143037 bytes, checksum: 7b0304c669d1160e712a666b80ef0553 (MD5) Previous issue date: 2010 / Resumo: Justificativa: O câncer de mama, do colo de útero e de próstata são neoplasias importantes na incidência e na mortalidade no Brasil e são agravos que dispõem de métodos de rastreamento para detecção precoce oferecidos pelo Sistema Único de Saúde (SUS). Existe a necessidade de se identificar os grupos de mulheres e de homens que não realizam os exames de detecção precoce para esses agravos, como forma de implementar as estratégias para captação desses indivíduos visando minimizar as desigualdades sociais ainda existentes em relação ao acesso aos serviços de saúde. Objetivos: Analisar as práticas de detecção precoce para o câncer de mama, do colo uterino e de próstata, segundo características sociodemográficas, filiação a planos privados de saúde, morbidade e comportamentos relacionados à saúde. Material e Métodos: Estudo do tipo transversal, de base populacional, que teve como população de estudo todos os indivíduos do sexo feminino com idade de 20 a 69 anos residentes no município de Campinas, participantes do ISACAMP 2008/2009 e homens com idade superior a 50 anos residentes nos municípios de Campinas, Botucatu, Taboão da Serra, Embu e o distrito do Butantã em São Paulo, participantes do ISA-SP 2002/2003. Para a obtenção da amostra, os setores censitários dos municípios, foram agrupados em três estratos, segundo o percentual de chefes de família com nível universitário. Foram sorteados 10 setores censitários de cada estrato, e de cada setor censitário foram sorteados os domicílios e selecionados os indivíduos que seriam entrevistados, segundo os domínios de sexo e idade. As informações foram obtidas por meio de questionário estruturado em blocos temáticos, com a maioria das questões fechadas, aplicado diretamente à pessoa sorteada. O presente estudo incluiu 992 homens com 50 anos ou mais, 696 mulheres de 40 a 69 anos e 508 mulheres de 20 a 59 anos. Foram incluídos na análise dois grupos de variáveis: as independentes compostas por variáveis sociodemográficas, filiação a plano privado de saúde, comportamentos relacionados à saúde e estado da saúde e as dependentes, referentes à realização das práticas preventivas para a detecção do câncer de mama, do colo de útero e da próstata. Para as análises estatísticas foi utilizado os programas STATA 9 e STATA 11.0, que possibilitou levar em consideração as variáveis do plano de amostragem e o efeito de delineamento. As análises bivariadas incluíram estimativas de prevalência e intervalos confiança de 95% (IC) e modelos de regressão logística múltipla de Poisson. Resultados: O presente estudo verificou que 44,4% (IC 95%: 37,3-51,7) da população estudada dos homens de 50 anos ou mais, nunca haviam realizado exame preventivo para o câncer de próstata. Dos homens que referiram ter realizado exames de detecção do câncer de próstata (55,6%) o toque retal foi referido por 61,8%, o PSA por 73,2%, a ultra-sonografia por 28,2% e a biópsia por 7,3%. Dentre os homens que referiram ter realizado algum exame, 49,7% o haviam feito no ano que antecedeu a entrevista, 23% entre um a dois anos, 10% entre dois a três anos e 17% quatro anos ou mais antes da entrevista; Dos exames realizados, 41% foram financiados SUS. Os resultados da análise de regressão múltipla de Poisson apontam que a não realização dos exames preventivos para o câncer de próstata foi significativamente mais freqüente nos homens com menos de 70 anos, menor escolaridade, de menor renda familiar per capita, que não apresentam Diabetes Mellitus, que referiram algum tipo de deficiência visual e que não fizeram consulta odontológica no ano que antecedeu a entrevista. Em relação à realização da mamografia o presente estudo mostrou que das mulheres de 40 a 69 anos residentes no município de Campinas 47,7 % (IC95% 39,1-56,5) relataram filiação a planos privados de saúde e que 64,2% das mulheres realizaram a mamografia nos dois anos que antecederam a entrevista. O principal motivo apresentado para a realização da a mamografia foi realizá-la como procedimento de rotina sem a presença de queixas ou sintomas. Para as mulheres que nunca realizaram a mamografia o motivo mais alegado foi achar que a realização do exame não é um procedimento necessário s ser feito. Não ter o conhecimento do resultado do exame mostrou-se mais prevalente nas mulheres SUS dependente em relação as que têm plano privado de saúde. Das mamografias realizadas, 49,3 % foram financiadas pelo SUS e 50,7% pelos planos privados de saúde. A análise de regressão múltipla hierarquizada de Poisson revelou que persistiram significantes as variáveis: renda e plano privado de saúde, na 1ª etapa atividade física no lazer, diabetes mellitus e a consulta odontológica na 2ª etapa. Quanto a realização da citologia oncótica 46,4% (IC95% 34,1-59,2) das mulheres de 20 a 59 anos são filiadas a planos privados de saúde e que 86,2% (IC 95% 82,6-89,1) das mulheres entre 20 a 59 anos residentes no município de Campinas fizeram o exame nos últimos 3 anos, não sendo observada diferença na realização do Papanicolaou entre as mulheres que tem e as que não tem plano privado de saúde. Apenas 6,8% das mulheres entrevistadas referiram nunca ter realizado o Papanicolaou. O principal motivo alegado para a realização do exame foi fazê-lo como exame de rotina (92,8%). Já o principal motivo referido pelas mulheres que nunca fizeram o exame foi de acharem não ser um exame necessário. Quanto ao resultado do exame somente 4,5% não sabiam do resultado do último exame. Das citologias oncóticas realizadas, 55,7 % foram financiadas pelo SUS e 44,3% por planos privados de saúde. Não foi observada a associação entre as variáveis sócio-demográficas, de filiação a planos privados de saúde, de comportamento de saúde, morbidade e a realização da citologia oncótica nos três anos que antecederam a entrevista. Conclusão: Esse estudo mostrou importantes desigualdades socioeconômicas na realização do PSA, a presença da eqüidade na realização da citologia oncótica entre as mulheres de 20 a 59 anos residentes filiadas a planos privados de saúde e as SUS dependentes. Também apontou a existência de desigualdades, na realização da mamografia, entre das mulheres de 40 a 69 mostrando que as filiadas a planos privados de saúde realizam mais o exame do que as SUS dependentes. Quanto ao acesso na realização do Papanicolaou observou-se a existência da equidade apontando para a possibilidade de que o mesmo possa ocorrer em relação as outras praticas de saúde. Estratégias que garantam a equidade no acesso necessitam serem desenvolvidas com o objetivo de minimizar as desigualdades na realização da mamografia e do PSA e da integralidade das ações pertinentes às políticas nacionais da saúde do homem e da mulher / Abstract: Justification: Breast, uterine and prostate cancer are important malignancies in terms of incidence and mortality in Brazil. The Brazilian public healthcare system offers early detection methods for these conditions. There is need to identify groups of women and men who have not undergone early detection exams in order to implement strategies for reaching these individuals with the aim of minimizing existing social inequalities related to healthcare services. Objectives: The aim of the present study was to analyze early detection practices for breast, uterine and prostate cancer based on socio-demographic characteristics, affiliations with private health plans, morbidity and health-related behavior. Materials and Methods: A population-based cross-sectional study was carried out involving a study population of all females between 20 and 69 years of age in the city of Campinas (SP, Brazil) who participated in the ISACAMP 2008/2009 health survey and men aged 50 years or older residing in the cities of Campinas, Botucatu, Taboão da Serra and Embu and the district of Butantã in Sao Paulo (SP, Brazil) who participated in the ISA-SP 2002/2003 health survey. For the determination of the sample, the census sectors of the municipalities were grouped into three strata based on the percentage of heads of family with a university education. Ten census sectors of each stratum were selected by lots; residences were selected by lots from each census sector; and the individuals to be interviewed (based on gender and age) were then selected. The information was collected using a questionnaire structured in thematic blocks, with the majority of items closed questions, administered directly to the individual selected. The study involved 992 men aged 50 years or older, 696 women between 40 and 69 years of age and 508 women between 20 and 59 years of age. Two groups of variables were used in the analysis: independent variables, made up of socio-demographic variables, affiliations with private health plans, health-related behavior and health status; and dependent variables referring to preventive practices for the detection of breast, uterine and prostate cancer. The STATA 9 and STATA 11.0 programs were used for the statistical analysis, which allowed taking the sampling plan and design effect into consideration. The bivariate analyses included prevalence estimates and 95% confidence intervals (CI) as well as Poisson multiple logistic regression models. Results: A total of 44.4% (95% CI: 37.3-51.7) of population of males aged 50 years or older had never undergone a preventive prostate cancer exam. Among the men who reported having a prostate exam (55.6%), 61.8% reported undergoing the digital rectal exam, 73.2% reported undergoing the PSA exam, 28.2% reported undergoing ultrasonography and 7.3% reported undergoing biopsies. Among the men who reported undergoing an exam, 49.7% had done so in the year prior to the interview, 23% had done so one to two years earlier, 10% had done so two to three years earlier and 17% had done so four or more years prior to the interview. A total of 41% of the exams were financed by the Brazilian public healthcare system. The results of the Poisson multiple regression analysis revealed that the failure to undergo preventive prostate cancer exams was significantly more frequent among men under 70 years of age, those with less schooling, those with a lower household income, those without diabetes mellitus, those who reported some type of visual impairment and those Who had not visited the dentist in the previous year. With regard to mammography, among the female residents of the city of Campinas aged 40 to 69 years, 47.7% (95% CI: 39.1-56.5) reported affiliations with private health plans and 64.2% reported undergoing a mammogram in the two years prior to the interview. The main reason given for undergoing the exam was as a routine procedure, with no complaints or symptoms. Among the women who had never undergone a mammogram, the most reported reason was the belief that the exam is not a necessary procedure. A lack of knowledge regarding the results of the exam was more prevalent among those dependent on the public healthcare system in comparison to those with a private health plan. Among the mammograms performed, 49.3% were financed by the public healthcare system and 50.7% were financed by private plans. The following variables remained significant in the Poisson hierarchal multiple regression analysis: income and private health plan in the 1st step; and physical leisure activity, diabetes mellitus and dental appointment in the 2nd step. Regarding cancer cytology, 46.4% (95% CI: 34.1-59.2) of the women affiliated to private health plans between 20 and 59 years of age and 86.2% (95% CI: 82.6-89.1) of those between 20 and 59 years of age residing in the city of Campinas had taken the exam in the previous three years, with no significant difference in having undergone a Papanicolaou test between women with and without a private health plan. Only 6.8% of the women interviewed reported never having taken this exam. The main reason given for taking the test was as a routine exam (92.8%). The main reason given by the women who had never taken the test was the belief that it was unnecessary. Only 4.5% did not know the result of their last Papanicolaou test. A total of 55.7% of the cancer cytology exams were financed by the public healthcare system and 44.3% were financed by private plans. No associations were found between the socio-demographic variables, affiliation with private health plans, health-related behavior, morbidity and having undergone a cancer cytology exam in the three years prior to the interview. Conclusion: The present study demonstrated important socioeconomic inequalities with regard to having undergone a PSA exam as well as equity regarding having undergone cancer cytology exams among women between 20 and 59 years of age either affiliated to private health plans or dependent on the public healthcare system. Inequalities were detected in having undergone mammography among women aged 40 to 69 years, demonstrating that those affiliated to private health plans underwent the exam more than those dependent on the public healthcare system. Equity was found with regard to the Papanicolaou test, indicating the possibility that the same could also occur with other health practices. Strategies that ensure equity in relation to access to health services need to be drafted in order to minimize inequalities regarding mammography and the PSA test as well as the promotion of integral actions that are relevant to national health policies for men and women / Doutorado / Epidemiologia / Doutor em Saude Coletiva

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Objetivos: avaliar o desempenho da citologia oncÃtica convencional e da captura de hÃbridos II na detecÃÃo de lesÃes cervicais neoplÃsicas e prÃ-neoplÃsicas. Sujeitos e MÃtodos: foram recrutadas aleatoriamente 1685 mulheres, da demanda espontÃnea de postos de saÃde da rede pÃblica, em cinco municÃpios do estado do CearÃ. As pacientes, apÃs assinarem termo de consentimento, responderam a um questionÃrio prÃ-elaborado e, a seguir, foram submetidas à coleta de material para CO, CH II e à realizaÃÃo de colposcopia, que, sendo positiva, levou à imediata biÃpsia dirigida das Ãreas anormais. Os dados foram digitados no programa Microsoft Excel 2000 e analisados no SPSS-for Windows, versÃo 10.0. O desempenho da CO e CH II foram calculados atravÃs da sensibilidade, especificidade, dos valores preditivos positivo e negativo e dos respectivos intervalos de confianÃa de 95%. Considerou-se, para anÃlise, como padrÃo ouro negativo, o resultado da colposcopia negativo ou resultado negativo no exame histopatolÃgico e, como padrÃo ouro positivo, o resultado positivo do histopatolÃgico. Avaliaram-se dois pontos de corte distintos: qualquer achado prÃ-neoplÃsico e neoplÃsico do colo uterino e achados de lesÃes intra-epiteliais de alto grau ou cÃncer. Resultados: 56 mulheres (3,4%) apresentaram atipias celulares na CO, sendo a CH II positiva em 315 (19%). Embora 337(20,32%) mulheres tenham sido positivas em um dos testes, somente 19(1,1%) foram positivas nos dois. Entre as 150 que tiveram colposcopia positiva somente em 53 foram encontradas lesÃes no exame histopatolÃgico, sendo a prevalÃncia estimada de 3,2% para qualquer lesÃo e de 0,4% para lesÃes de alto grau/cÃncer. Considerando o ponto de corte o achado de qualquer lesÃo prÃ-neoplÃsica ou neoplÃsicas, a sensibilidade encontrada para a CO e a CH II foi de 30,2% e de 71,7%, respectivamente. A especificidade dos testes mencionados foi de 97,5% e de 82,7%. O VPP e VPN da CO foram de 28,6% e de 97,7%, respectivamente. Jà o VPP e VPN da CH foram 12,1% e 98,9%. Considerando o ponto de corte lesÃes de alto grau ou cÃncer, temos: sensibilidade e especificidade da CO de 28,6% e de 99,9%, enquanto os VPP e VPN foram de 54,8% e de 99,7%, respectivamente. A CH II alcanÃou 100% de sensibilidade e 81,3% de especificidade. Os VPP e VPN ficaram em 2,2% e 100%. ConclusÃo: o teste de detecÃÃo do DNA-HPV pela CH II foi mais sensÃvel, porÃm menos especÃfico que a CO. Quando associado à CO, melhora significativamente a detecÃÃo das lesÃes cervicais, principalmente as de alto grau e cÃncer. Para este grupo de lesÃes, a CH II isolada apresentou melhor especificidade sem perda da sensibilidade, mostrando-se um bom teste para o rastreamento primÃrio. / Objective: to compare the usual Pap smear (Papanicolaou) and the Hybrid Capture II tests in detecting cervical intraepithelial neoplasia in women of Ceara State. Subjects and Methods: 1685 women were enrolled from routine practice in five municipalities of the main Cearà State Health Regions. The whole study was explained to the volunteers, who accepted to participate by signing an informed consent form. The study procedures included filling a questionaire and a cervical sample collection, done by a physician, for cytology and HPV-DNA Hybrid Capture, followed by a complete colposcopic evaluation with directed biopsy if necessary. Data were analyzed in Statistical Package for Social Sciences - SPSS - for Windows 10.0. The accuracy of both tests â Pap smear and Hybrid Capture II - was evaluated by using the sensitivity, specificity, positive predictive value, negative predictive value and the respective 95% confidence intervals. The negative colposcopic examination or negative histological result were considered gold standard for negative results. Positive histological results were considered gold standard for positive results. Results: 56 women (3,4%) had abnormal pap smear. Hybrid Capture tests were positive in 315 women (19%). Despite 337 (20,32%) tests had positive results for one of the two tests, only 19 (1,1%) were positive in both tests. Lesions were detected in 53 women among those 150 considered positive in colposcopic examination. The prevalence for any lesion was estimated in 3,2% and for high grade lesions and cancer in 0,4%. Using the cut-off point as the finding of any cervical lesion, the sensitivity of pap smear and HC II was 30,2% and 71,7%, respectively. The specificity for pap smear and HC II was 97,5% and 82,7%, respectively. The positive and negative predictive value for pap smear was 28,6% and 97,7%, respectively. The positive and negative predictive value for HC II was 12,1% and 98,9%, respectively. By using the cut-off value as high grade cervical lesions and cancer, the sensitivity and specificity for pap smear were 28,6% and 99,9%, respectively, and the positive predictive value and negative predictive value for the same test were 54,8% and 99,7%. The sensitivity and specificity for HC II were 100% and 81,3%, respectively, as well as 2,2% and 100% for positive and negative predictive value. Conclusions: hybrid Capture II test was more sensitive than pap smear, however Hybrid Capture II test was less specific than pap smear. When both tests were used together for detecting cervical lesions the results improved significantly, mainly high grade lesion and cancer. For this group of lesions, HC II alone, presented better specificity, without loss of the sensitivity, apparently itâs a good test for primary sceening.

Bakgrund: Otillräcklig fysisk aktivitet orsakar förtida dödsfall, sjukdomsbörda och sänkt livskvalitet. Uppskattningsvis uppfyller inte hälften av Sveriges befolkning riktlinjerna för fysisk aktivitet och detta kommer få konsekvenser för folkhälsan. Fysisk aktivitet på recept (FaR) är ett evidensbaserat och effektivt verktyg. Det är samtidigt en kostnadseffektiv behandlingsmetod som enkelt kan anpassas efter de individuella behov som föreligger. Dock tenderar användningen av FaR att vara låg bland vårdpersonal. Syfte: Syftet med denna studie är att kartlägga sjuksköterskors förskrivning samt uppföljning av fysisk aktivitet på recept på vårdcentraler. Metod: Studien genomfördes som en icke-experimentell, deskriptiv tvärsnittsstudie med kvantitativ ansats. En webbenkät skickades ut till 69 sjuksköterskor som arbetar på vårdcentraler, varav 34 inkluderades i studien. För att jämföra skillnader mellan grupper användes Mann Whitney U-test. Statistiken analyserades i programmet SPSS statistics. Resultat: Användningen av FaR var generellt låg bland sjuksköterskorna, 32,4 % uppgav att de aldrig hade förskrivit FaR och endast 5,9 % svarade att de förskrev FaR några gånger i veckan. De sjuksköterskor som saknade en utbildning i FaR utgjorde majoriteten, 90,9 %, av alla svarsdeltagare som angett att de aldrig förskrivit ett recept på fysisk aktivitet. En signifikant skillnad (p < 0,001) mellan de som hade FaR-utbildning och de som saknade utbildning, kunde ses i förskrivning men inte när det kom till uppföljning av FaR. Slutsats: Studien belyser hur FaR tenderar att användas av sjuksköterskor på vårdcentraler och till vilken utsträckning det utförs en särskild uppföljning av receptet. Resultatet indikerar att förskrivningen av FaR tenderar att vara låg och att utbildning i FaR tycks spela en signifikant roll för sjuksköterskors förskrivning. Mer forskning på en större population behövs för att kunna dra några mer generella slutsatser angående detta. / Background: Inadequate physical activity is causing early death, disease burden and lowering quality of life. Half of Sweden's population is estimated not to meet the recommendations for physical activity and this will have an impact on public health. Physical activity on prescription (PAP) is an efficient tool with scientific evidence. The method is cost effective and can easily be customized and prescribed according to the individual needs that exists. Though the use of PAP among health professionals tend to be low. Aim: The aim of this study is to map nurse's prescription and follow up of physical activity on prescriptions at health centers. Method: The study was conducted as a non-experimental, quantitative descriptive cross-sectional study. A websurvey was sent to 69 nurses working at health centers, 36 of whom were included in the study. Mann Whitney U-test was conducted to compare differences between groups. The statistics were analyzed using the SPSS statistics program. Results: The use of PAP was generally low among nurses, 32.4% reported that they had never prescribed PAP and only 5.9% responded that they prescribed PAP a few times a week. Nurses who lacked education in PAP represented the majority, 90.9%, of all respondents who stated that they never prescribed a prescription for physical activity. A significant difference (p < 0.001) between those who had an education in PaP and those who lacked education could be seen in prescription but not when it came to follow-up of PAP. Conclusion: The study shows how PAP tend to be used among nurses at health centers and to what extent a follow-up of the prescription is done. The results indicate that the prescription of PAP tend to be low and that education in PAP seems to play a significant role in nurse’s prescription. More research on a greater population is needed to draw any general conclusions about this.

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