Introdução: A queima da cana de açúcar para a colheita ocorre para facilitar o trabalho de corte, reduzir o volume de resíduos, controlar pragas, evaporar e concentrar o açúcar na haste e eliminar animais perigosos do canavial. A queima da cana de açúcar e seus efeitos à saúde humana são o objeto de diversas pesquisas na área da saúde pública brasileira e mundial. Objetivos: Estudar, por diferentes métodos, a relação entre as queimadas de cana de açúcar e a incidência de doenças respiratórias na mesorregião de Presidente Prudente. Verificar a evolução das queimadas e da produção de cana de açúcar na região, no período de 2008 a 2011. Metodologia: Revisão bibliográfica. Composição de banco de dados geográficos com as variáveis em estudo. Análise dos dados. Elaboração de mapas temáticos e gráficos das variáveis. Cálculo do índice de Moran local das variáveis de estudo. Análise de estatística espacial com os dados de focos de queimadas, hectares de cana de açúcar colhidos com queima prévia e internações. Elaboração de mapas temáticos para comparação e análise. Descrição dos resultados. Resultados: A revisão bibliográfica, entre outras coisas, mostrou diferentes impactos à saúde devido a queima de cana de açúcar. A produção de cana de açúcar aumentou na região de estudo nos últimos anos, consequentemente aumentando a quantidade de queimadas em oposição ao previsto na legislação. Os aglomerados espaciais onde há a colheita com queima prévia coincidiram com os de maior incidência para doenças respiratórias. Identificou se uma área, na porção norte do território estudado de maior vulnerabilidade à poluição atmosférica e, consequentemente, com maior incidência de internações. Conclusões: No período de 2008 a 2011 ocorreu aumento no número de hectares colhidos com queima prévia, associado ao aumento da produção de cana de açúcar. Este efeito não se repetiu nas internações por doenças respiratórias para as faixas etárias selecionadas. Novas pesquisas são necessárias para uma melhor correlação entre o aumento da utilização da queima como método de colheita e as internações respiratórias na região. / Introduction: The burning of sugarcane for harvest occurs to facilitate the cutting work, reduce the volume of waste, control pests, evaporate and concentrate the sugar in the stem and remove dangerous animals from a sugarcane field. The burning of sugar cane and its effects on human health are the subject of several studies in the area of the brazilian and global public health. Objectives: To study, by different methods, the relationship between the burning of sugarcane and the incidence of respiratory illnesses in the middle region of Presidente Prudente. Checking the progress of fires and sugar cane production in the region, from 2008 to 2011. Methods: Literature review. Geographic database composition with the study variables. Data analysis. Preparation of thematic maps and charts of the variables. Calculation of the local Moran index of the study variables. Spatial statistics analysis with data from outbreaks of fires, hectares of sugar cane harvested with previous burning and hospitalizations. Preparation of thematic maps for comparison and analysis. Description of the results. Results: The literature review, among other things, showed different health impacts due to burning of sugar cane. The production of sugar cane increased in the study region in 9 recent years, thus increasing the amount of fires in opposition to the law. The clusters where there is the harvest with previous burning coincided with the highest incidence of respiratory diseases. Identified if an area in the northern portion of the territory studied most vulnerable to air pollution and consequently a higher incidence of hospitalizations. Conclusions: In the period 2008-2011 there was an increase in the number of acres harvested with previous burning, associated with increased production of sugar cane. This effect was not repeated in admissions for respiratory diseases for selected age groups. Further research is needed to better correlation between the increased use of burning as harvesting method and respiratory hospitalizations in the region.

Introdução São Paulo é uma das maiores cidades da América Latina, com quase 11 milhões de habitantes e cerca de 6 milhões de veículos. Embora o tráfego seja a mais importante fonte de poluição atmosférica, poucos estudos investigaram a relação da poluição veicular com a saúde da população. A maioria dos estudos analisou os efeitos da poluição do ar à saúde utilizando valores médios de poluição ambiental para toda a área da cidade, os quais não evidenciam os gradientes de exposição na área intra-urbana. Objetivos- Avaliar a exposição da população à poluição relacionada ao tráfego e sua associação com as internações por doenças respiratórias de crianças e adolescentes de 0 a 18 anos. Métodos As concentrações de CO, NOx e PM10, foram calculadas a partir do modelo de dispersão CALINE-4 para os períodos de verão (Janeiro) e Inverno (Julho). Os casos de internação hospitalar por doenças respiratórias (AIH + CIH) foram georreferenciados por local de residência. O setor censitário do IBG foi considerado como unidade de análise. Um modelo de regressão logística foi usado, para estimar a associação entre exposição à poluição relacionada ao tráfego e hospitalização por doenças respiratórias, e controlado pelo IDH como indicador sócio econômico. Resultados Do ponto de vista espacial, os poluentes veiculares estudados tiveram maior concentração na área central do centro expandido de São Paulo. Do ponto de vista temporal, as maiores concentrações foram observadas no inverno. A poluição veicular estava diretamente associada às internações de crianças e adolescentes (0-18) anos por doenças respiratórias. Crianças e adolescentes que moravam em setores censitários classificados no 4º quartil de CO no período de inverno tiveram chance 80 por cento maior de serem internadas por doenças respiratórias. Conclusões Os poluentes veiculares analisados aumentam a chance de crianças e adolescentes (0-18 anos) serem internadas por doenças respiratórias. As condições socioeconômicas, avaliadas pelo IDH, também aumentam as chances de internação. O método usado neste estudo é importante para avaliações em micro-escala da relação entre os poluentes veiculares e a saúde da população. Outras cidades brasileiras ou cidades de países em desenvolvimento podem se beneficiar desta abordagem, dado que modelos são mais baratos e rápidos que campanhas de amostragem de poluentes atmosféricos ou aquisição/manutenção de estações de monitoramento da qualidade do ar / Introduction- Sao Paulo is one of the largest cities in Latin America, with almost 11 million inhabitants and around 6 million vehicles. Although traffic is the main source of air pollution, few studies investigated the relationship between vehicle pollution and health outcomes. Most studies analyzed health effects using average concentrations of environmental pollution for the whole city, which cannot give evidence for intra-urban gradients of exposure. Objectives- To evaluate the populations exposure to traffic-related air pollution and its association with hospital admission for respiratory diseases among children and adolescents aged 0-18 years. Methods - Concentrations of CO, NOx and PM10 were modeled using CALINE-4 dispersion model, in two periods: summer (January) and winter (June). Hospitalizations due to respiratory diseases (by private and public assistance) were geocoded by the residence address. IBGEs census sectors were considered as unit of analysis. A logistic regression model was used to estimate the association between exposure to traffic-related air pollution and hospitalization for respiratory disease which, allowing for HDI as a socioeconomical indicator. Results- Spatially, pollutants presented higher concentration at the central area of the Expanded Center of Sao Paulo city. Temporally, higher concentrations were observed at winter periods. Traffic-related pollutants was directly associated with hospitalization for respiratory disease among children and adolescents aged 0-18 years. Children and adolescents who lived in census sectors ranked in the 4º quartile of CO in the winter period had 80 per cent greater chance of being hospitalized for respiratory diseases. Conclusions- Traffic-related pollutants increase the chance of children being hospitalized for respiratory diseases. Socioeconomic conditions (evaluated by the HDI) also raised the chance of hospitalization. The method used in this study is important for micro-scale evaluations of the relationship between vehicular pollutants and population health. Other Brazilian cities or cities from developing countries may benefit from this approach, since models are less expensive and faster than air quality monitoring campaigns or acquisition/maintenance of air quality monitoring stations

A asma é uma doença inflamatória crônica, predominantemente das vias aéreas, mas também envolve o sistema vascular e parênquima pulmonar, na qual as células inflamatórias, a musculatura lisa e o epitélio brônquico têm um papel fundamental na fase inicial, progressão e perpetuação da doença. O treinamento físico aeróbio tem sido indicado como uma relevante forma de auxílio no tratamento de pacientes asmáticos por melhorar a qualidade de vida e reduzir sintomas e o uso de medicamentos. No entanto, não existe um consenso a respeito sobre a intensidade de treinamento ideal para esses pacientes assim como também existem pouquíssimos estudos a respeito dos possíveis mecanismos da atividade física aeróbia para esses pacientes. Por esses motivos, os objetivos do presente estudo foram avaliar os efeitos de duas intensidades de atividade física aeróbia (leve e moderada) sobre um modelo de inflamação pulmonar alérgica crônica em camundongos. Os animais foram sensibilizados com ovalbumina por 51 dias. A atividade física aeróbia teve início no dia 21 e perdurou por 30 dias. Os resultados demonstraram que ambas as intensidades de atividade aeróbia inibiram o desenvolvimento da inflamação predominantemente eosinofílica no lavado broncoalveolar, nos compartimentos peribrônquico, perivascular e no parênquima pulmonar, a expressão de interleucina 4 e 5 pelas células inflamatórias nestes três compartimentos pulmonares. Ambas intensidades de atividade física aeróbia também inibiram significativamente a deposição de fibras colágenas e elásticas (nas vias aéreas e vasos pulmonares) e também o espessamento da musculatura lisa brônquica e vascular assim como da camada epitelial brônquica. Por outro lado, ambas intensidades de atividade física aeróbia não inibiram a síntese de anticorpos anafiláticos IgE e IgG1 e a hiperresponsividade brônquica. Portanto, concluímos que a atividade física aeróbia de intensidade leve e moderada são capazes de inibir o desenvolvimento da inflamação e do remodelamento pulmonar, mas não a hiperresponsividade num modelo experimental de inflamação pulmonar alérgica crônica em camundongos. / Asthma is a chronic inflammatory disease, predominantly involving the airways, but also involving the pulmonary vessels and parenchyma, in which the inflammatory cells, bronchial smooth muscle and epithelium have a central role in the initial phase, progression and perpetuation of the disease. The low and moderate intensity of aerobic physical training have been indicated as a relevant mean to help in the treatment of asthmatic patients, improving life quality, decreasing symptoms and the use of medicines. However, there is not a consensus about the best intensity of training to these patients and also there are few studies about the possible mechanisms of aerobic physical training for asthmatic patients. Therefore, the aims of this study was to evaluate the effects of two intensities of aerobic physical training (low and moderate) on an experimental model of chronic allergic lung inflamattion in mice. The animals were sensitizes with ovalbuim during 51 days. The aerobic physical training started to 21st day and endures for 30 days. The results showed that as low as moderate intensities of aerobic physical training inhibited the eosinophilic inflammation in the bronchoalveolar lavage, peribronchial, perivascular and in the pulmonary parenchyma, as well as the expression of interleukin 4 and 5 by inflammatory cells in these three pulmonary compartments. Both intensities of aerobic physical training also inhibited the collagen and elastic fibers deposition (in the airways and in the pulmonary vessels) and also the thickness of smooth muscle in the airways and vessels, as well as of the airway epithelial layer. On other hand, both intensities of aerobic physical training did not inhibit the synthesis of anaphylactic antibodies IgE and IgG1 and the hyperresponsiveness. Therefore, we conclude that aerobic physical training, to both intensities, were capable of inhibit the development of pulmonary inflammation and remodeling, but not of hyperresponsiveness in an experimental model of allergic lung inflammation in mice.

Ma, Hok Lun. / Thesis submitted in: December 2008. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 233-273). / Abstracts in English and Chinese. / Abstract --- p.i / Abstract (Chinese version) --- p.v / Tables of contents --- p.vi / Acknowledgement --- p.xvi / List of figures --- p.xvii / List of tables --- p.xxi / List of abbreviations and symbols --- p.xxviii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Respiratory illnesses in children --- p.1 / Chapter 1.1.1 --- Worldwide burden of childhood pneumonia --- p.1 / Chapter 1.1.2 --- Further mortality related to childhood pneumonia --- p.4 / Chapter 1.2 --- Etiology agent of childhood respiratory illnesses --- p.5 / Chapter 1.2.1 --- Difficulties in determining etiological agent --- p.5 / Chapter 1.2.2 --- Overall situation of etiological agents in childhood pneumonia --- p.6 / Chapter 1.2.3 --- Relationship between age and pathogens --- p.9 / Chapter 1.2.4 --- "Relationship between serotypes, carriage and invasiveness" --- p.11 / Chapter 1.2.4.1 --- Carriage and Invasiveness --- p.12 / Chapter 1.2.4.2.1 --- Carriage of S. pneumoniae and H. influenzae in children in Hong Kong --- p.12 / Chapter 1.2.4.2.2 --- "Serotypes, carriage and invasiveness in S. pneumoniae" --- p.14 / Chapter 1.2.4.2.3 --- "Serotypes, carriage and invasiveness in H. influenzae" --- p.17 / Chapter 1.3 --- Epidemiology of antibiotic-resistant pathogens --- p.18 / Chapter 1.3.1 --- Molecular typing methods --- p.18 / Chapter 1.3.2 --- Spread of antibiotic-resistant pathogens --- p.20 / Chapter 1.3.2.1 --- Spread of antibiotic-resistant S. pneumoniae --- p.26 / Chapter 1.3.2.1.1 --- Spread of penicillin-resistant S. pneumoniae --- p.26 / Chapter 1.3.2.1.1.1 --- Spread of Spanish-23F-1 --- p.27 / Chapter 1.3.2.1.1.2 --- Spread of Spanish-6B-2 --- p.28 / Chapter 1.3.2.1.1.3 --- Spread of antibiotic-resistant S. pneumoniae clones in Hong Kong --- p.28 / Chapter 1.3.2.1.2 --- Spread of cephalosporin-resistant S. pneumoniae --- p.29 / Chapter 1.3.2.1.3 --- Spread of macrolide-resistant S. pneumoniae --- p.30 / Chapter 1.3.2.1.4 --- Spread of fluoroquinolone-resistant S. pneumoniae --- p.31 / Chapter 1.3.2.2 --- Spread of antibiotic-resistant H. influenzae --- p.32 / Chapter 1.3.2.2.1 --- Spread of β-lactam-resistant H. influenzae --- p.32 / Chapter 1.3.2.2.2 --- Spread of macrolide-resistant H. influenzae --- p.33 / Chapter 1.3.2.2.3 --- Spread of fluoroquinolone-resistant H. influenzae --- p.34 / Chapter 1.4 --- Mechanism of antibiotic-resistance in respiratory pathogens --- p.36 / Chapter 1.4.1 --- Mechanism of antibiotic-resistance in S. pneumoniae --- p.37 / Chapter 1.4.1.1 --- Mechanism of penicillin- and cephalosporin-resistance in S. pneumoniae --- p.37 / Chapter 1.4.1.1.1 --- Penicillin-binding protein (PBP)-mediated mechanism --- p.37 / Chapter 1.4.1.1.2 --- PBP-independent mechanisms --- p.49 / Chapter 1.4.1.1.2.1 --- "Murine peptide branching genes, murMN operon" --- p.49 / Chapter 1.4.1.1.2.2 --- "Two-component system, CiaRH" --- p.50 / Chapter 1.4.1.1.2.3 --- "Putative glycosyltransferase, CpoA" --- p.52 / Chapter 1.4.1.1.3 --- RNA and protein expression studies on S. pneumoniae for β-lactam-resistance --- p.52 / Chapter 1.4.1.1.3.1 --- RNA expression in penicillin-sensitive S. pneumoniae --- p.53 / Chapter 1.4.1.1.3.2 --- Protein expression in penicillin-resistant S. pneumoniae --- p.53 / Chapter 1.4.1.2 --- Mechanism of macrolide- and lincosamide- resistance in S. pneumoniae --- p.54 / Chapter 1.4.1.3 --- Mechanism of tetracycline-resistance in S. pneumoniae --- p.55 / Chapter 1.4.1.4 --- Mechanism of fluoroquinolone-resistance in S. pneumoniae --- p.55 / Chapter 1.4.2 --- Mechanism of antibiotic-resistant in H. influenzae --- p.56 / Chapter 1.4.2.1 --- Mechanism of β-lactam-resistance in H. influenzae --- p.56 / Chapter 1.4.2.1.1 --- β-lactamase-producing H. influenzae --- p.56 / Chapter 1.4.2.1.2 --- β-lactamase-negative ampicillin-resistant (BLNAR) H. influenzae --- p.58 / Chapter 1.4.2.1.2.1 --- Relationship between amino acid substitutions in PBP3 and β-lactam- resistance --- p.58 / Chapter 1.4.2.1.2.2 --- Relationship between amino acid substitutions in AcrR and β-lactam-resistance --- p.60 / Chapter 1.4.2.2 --- Mechanism of macrolide-resistance in H. influenzae --- p.61 / Chapter 1.4.2.3 --- Mechanism of fluoroquinolone-resistance in H. influenzae --- p.64 / Chapter 1.5 --- Impact of vaccination --- p.65 / Chapter 1.5.1 --- H. influenzae type b vaccination --- p.65 / Chapter 1.5.1.1 --- Efficacy of Hib conjugate vaccine --- p.66 / Chapter 1.5.1.2 --- Herd immunity related to Hib conjugate vaccine --- p.66 / Chapter 1.5.2 --- Pneumococcal vaccination --- p.66 / Chapter 1.5.2.1 --- Vaccine efficacy and herd immunity of pneumococcal vaccines --- p.67 / Chapter 1.5.2.2 --- Development of conjugate vaccines with higher valency --- p.67 / Chapter 1.5.2.3 --- Serotype replacement --- p.67 / Chapter 1.5.2.4 --- Development of pneumococcal vaccines with new targets --- p.69 / Chapter 1.6 --- Objectives of this study --- p.70 / Chapter Chapter 2 --- Materials and methods --- p.72 / Chapter 2.1 --- Collection and Identification of microorganisms --- p.72 / Chapter 2.1.1 --- Collection of S. pneumoniae and H. influenzae --- p.72 / Chapter 2.1.2 --- Identification of S. pneumoniae and H. influenzae --- p.73 / Chapter 2.2 --- Serotyping of S. pneumoniae and H. influenzae --- p.74 / Chapter 2.2.1 --- Serotyping by polymerase chain reaction (PCR) --- p.74 / Chapter 2.2.1.1 --- Preparation of crude DNA extract --- p.74 / Chapter 2.2.1.2 --- Screening for common serotypes by multiplex PCR --- p.74 / Chapter 2.2.1.3 --- Composition of PCR Mix --- p.77 / Chapter 2.2.1.4 --- Serotyping PCR conditions --- p.81 / Chapter 2.2.1.5 --- Gel Electrophoresis --- p.81 / Chapter 2.2.2 --- Serotyping by serum agglutination --- p.82 / Chapter 2.3 --- Antimicrobial susceptibility testing --- p.83 / Chapter 2.4 --- Clonal analysis of penicillin- and cephalosporin-resistant S. pneumoniae --- p.87 / Chapter 2.4.1 --- Pulsed-field Gel Electrophoresis (PFGE) --- p.87 / Chapter 2.4.1.1 --- Preparation of agarose plugs for PFGE --- p.87 / Chapter 2.4.1.2 --- Lysis of bacteria in agarose plugs --- p.89 / Chapter 2.4.1.3 --- Digestion of chromosomal DNA by restriction enzyme --- p.89 / Chapter 2.4.2 --- Multi-locus sequence typing (MLST) --- p.90 / Chapter 2.4.2.1 --- PCR amplification of house-keeping genes in MLST --- p.90 / Chapter 2.4.2.1.1 --- Preparation of DNA from agarose plugs --- p.92 / Chapter 2.4.2.1.2 --- Composition of PCR Mix --- p.92 / Chapter 2.4.2.1.3 --- MLST PCR conditions --- p.92 / Chapter 2.4.2.1.4 --- Gel Electrophoresis of MLST PCR products --- p.92 / Chapter 2.4.2.1.5 --- MLST PCR products purification --- p.93 / Chapter 2.4.2.2 --- Sequencing of housekeeping genes in MLST --- p.93 / Chapter 2.4.2.3 --- Sequencing analysis and sequence type (ST) determination in MLST --- p.94 / Chapter 2.4.3 --- Extended panel of antibiotic susceptibility testing on S. pneumoniae with known STs --- p.94 / Chapter 2.5 --- Analysis on potential penicillin- and cephalosporin-resistance mechanisms in S. pneumoniae --- p.96 / Chapter 2.5.1 --- Sequencing of potnetial penicillin- and cephalosporin- resistance determinants in S. pneumoniae --- p.96 / Chapter 2.5.1.1 --- Primer design of penicillin-binding protein (PBP) genes --- p.96 / Chapter 2.5.1.2 --- Primer design of non-PBP resistance determinants --- p.100 / Chapter 2.5.1.3 --- PCR amplification and sequencing of resistant determinants --- p.100 / Chapter 2.5.1.4 --- Sequence analysis --- p.100 / Chapter 2.5.2 --- Study on efflux mechanism of S. pneumoniae --- p.103 / Chapter 2.5.2.1 --- Modification of macrodilution for efflux assay --- p.103 / Chapter 2.5.2.2 --- Cefotaxime MIC determination with efflux inhibitors --- p.104 / Chapter 2.5.2.3 --- Determination of appropriate CCCP concentration --- p.105 / Chapter 2.5.2.4 --- Growth curve with efflux inhibitor --- p.105 / Chapter 2.5.3 --- Heteroresistance assay of S. pneumoniae --- p.106 / Chapter 2.5.4 --- "RNA expression study on penicillin- and cefotaxime-resistance determinants (pbp2x, pbpla and pbp2a) of S. pneumoniae" --- p.107 / Chapter 2.5.4.1 --- Growth of S. pneumoniae for RNA extraction --- p.107 / Chapter 2.5.4.2 --- RNA extraction and DNase digestion --- p.107 / Chapter 2.5.4.3 --- cDNA synthesis and real-time PCR --- p.108 / Chapter 2.6 --- Analysis on cephalosporin- and macrolide-resistance mechanisms in H. influenzae --- p.111 / Chapter 2.6.1 --- β-lactamase production of H. influenzae --- p.111 / Chapter 2.6.1.1 --- Nitrocefin Hydrolysis --- p.111 / Chapter 2.6.1.2 --- Screening for the presence of p-lactamase gene (blaTEM-1 and blaROB-1) by multiplex PCR --- p.111 / Chapter 2.6.2 --- PCR detection and sequencing of β-lactam- and macrolide- resistance determinants in H. influenzae --- p.113 / Chapter Chapter 3 --- Results of S. pneumoniae and H. influenzae children study --- p.116 / Chapter 3.1 --- Patient demographics of children study --- p.116 / Chapter 3.2 --- Serotype distributions --- p.117 / Chapter 3.2.1 --- Serotypes / serogroup distribution in S. pneumoniae --- p.117 / Chapter 3.2.2 --- Serotype distribution in H. influenzae children study --- p.120 / Chapter 3.3 --- Antibiotic susceptibilities and resistance antibiograms --- p.122 / Chapter 3.3.1 --- Antibiotic susceptibilities of S. pneumoniae --- p.122 / Chapter 3.3.2 --- Relationship between antibiotic resistance profiles and serotypes in S.pneumoniae --- p.126 / Chapter 3.3.3 --- Antibiotic susceptibilities of H. influenzae --- p.135 / Chapter 3.3.4 --- Antibiotic resistance profiles of H. influenzae --- p.138 / Chapter 3.4 --- Clonal analysis of penicillin- and cephalosporin-resistant S.pneumoniae --- p.139 / Chapter 3.4.1 --- Pulsed-field gel electrophoresis (PFGE) of S. pneumoniae --- p.139 / Chapter 3.4.2 --- Multi-locus sequence typing of S. pneumoniae --- p.141 / Chapter 3.5 --- Analysis of the penicillin- and cephalosporin-resistance determinants in S. pneumoniae --- p.143 / Chapter 3.5.1 --- "Sequence analysis of major pbp genes (pbp2x, pbpla and pbp2a)" --- p.143 / Chapter 3.5.2 --- "Sequence analysis of other potential penicillin- and cephalosporin- resistance determinants (pbp 1 b, pbp2b, pbp3, cpoA, ciaRH and murMN)" --- p.152 / Chapter 3.5.3 --- Sequence analysis of putative promoter sequences of pbp genes --- p.167 / Chapter 3.5.4 --- Efflux Inhibition Assay --- p.171 / Chapter 3.5.5 --- Heteroresistance Assay --- p.177 / Chapter 3.5.6 --- "RNA expression study on penicillin- and cephalosporin resistance determinants (pbp2x, pbpla and pbp2a)" --- p.179 / Chapter 3.6 --- Analysis of β-lactam-resistance determinants in H. influenzae --- p.185 / Chapter 3.6.1 --- β-lactamase production and blaTEM-1 promoter study --- p.185 / Chapter 3.6.2 --- "Sequence analysis of β-lactam-resistance determinants (ftsl, acrR genes, AcrAB-TolC efflux pump)" --- p.188 / Chapter 3.6.2.1 --- Sequence analysis offtsl --- p.188 / Chapter 3.6.2.2 --- Analysis of acrR and AcrAB-TolC efflux pump --- p.189 / Chapter 3.7 --- "Analysis of macrolide-resistance determinants in H, influenzae (AcrAB-TolC efflux pump, 23SrRNA, Ribosomal proteins L4 and L22)" --- p.199 / Chapter Chapter 4 --- Discussion on S. pneumoniae and H. influenzae children study --- p.204 / Chapter 4.1 --- Carriage rate of S. pneumoniae children collection --- p.204 / Chapter 4.2 --- Serotype distribution --- p.205 / Chapter 4.2.1 --- Serotype distribution and potential vaccine coverage in S. pneumoniae --- p.205 / Chapter 4.2.2 --- Serotype distribution in H. influenzae --- p.209 / Chapter 4.3 --- Antimicrobial resistance --- p.210 / Chapter 4.3.1 --- Antimicrobial resistance in S. pneumoniae --- p.210 / Chapter 4.3.2 --- Antimicrobial resistance in H. influenzae --- p.214 / Chapter 4.4 --- "Clonal analysis of high-level β-lactam-resistant S, pneumoniae" --- p.217 / Chapter 4.5 --- "β-lactam-resistance mechanisms in S, pneunomiae" --- p.220 / Chapter 4.6 --- Antimicrobial resistance mechanisms in H. influenzae --- p.224 / Chapter 4.6.1 --- β-lactam-resistance mechanism in β-lactamase-producing H. influenzae --- p.224 / Chapter 4.6.1.1 --- Variations in blaTEM-1 promoters in β-lactamase-producing H.influenzae --- p.224 / Chapter 4.6.1.2 --- β-lactam-resistance in β-lactamase-nonproducing H. influenzae --- p.225 / Chapter 4.6.2 --- Macrolide-resistance mechanisms in H. influenzae --- p.228 / Chapter Chapter 5 --- Conclusion and future studies --- p.230 / Chapter 5.1 --- "S, pneumoniae children study" --- p.230 / Chapter 5.2 --- H. influenzae children study --- p.231 / Chapter 5.3 --- Future studies --- p.232 / Bibliography --- p.233 / Appendix I 一 Sequence alignments and Tables --- p.274 / Appendix II 一 Materials and Methods --- p.313

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2017-02-23T18:08:51Z No. of bitstreams: 1 Ilana Andrade Santos do Egyto.pdf: 1683328 bytes, checksum: 29e96e570cfb8bdc614748fda148ce3c (MD5) / Made available in DSpace on 2017-02-23T18:08:51Z (GMT). No. of bitstreams: 1 Ilana Andrade Santos do Egyto.pdf: 1683328 bytes, checksum: 29e96e570cfb8bdc614748fda148ce3c (MD5) Previous issue date: 2017-02-06 / INTRODUCTION: Most of Brazilian States has no network of air quality monitoring, but all are exposed to air pollution from industries, automobiles, fires and those produced naturally by the environment. In the State of Paraíba no monitoring of air quality and therefore, there is no measurement of atmospheric pollutants and climatic variables. OBJECTIVE: Assess the relationship between air pollution and hospital admissions of children under five by respiratory diseases in Paraíba: contribution in decision-making of public policies aimed at controlling air pollution. METHODOLOGY: Analytical and descriptive study of the spatial distribution of vulnerable areas in relation to socioeconomic data, data on health information (hospitalization), population and pollutant sources (fleet and burned). The tabs and data analyses were conducted for the State of Paraíba stratified by region. We opted for the use of thematic cartography for the generation of maps of vulnerability to consider its potential as a tool for easy and intuitive visualization, to communicate the results of the environmental risk assessments. Descriptive analysis, Chi-square test, Kruskal-Wallis, and multiple comparisons of Dunn. The significance level was 5%. RESULTS: There is no relationship between the increase of air pollution and hospital admissions of children from zero to five years for respiratory problems. With respect to the spatial distribution of the hotspots and hospitalization, we have that in 2010 was the worst year among the analyzed in this study. The regions with the largest numbers of cases are the hinterland and coast. CONCLUSION: There is a need for a balance between economic development and sustainability. A plan of strategies should be designed and implemented, not depending on only one institution and the set of actions of various organs for the results to be favourable both to the quality of life of the population as to the economy of the State. / INTRODUÇÃO: A maior parte dos Estados Brasileiros não possui rede de monitoramento da qualidade do ar, porém todos estão expostos a poluição atmosférica provenientes de indústrias, automóveis, queimadas e as produzidas naturalmente pelo meio ambiente. No Estado da Paraíba não há monitoramento da qualidade do ar e portanto, não há mensuração dos poluentes atmosférico e de variáveis climáticas. OBJETIVO: Avaliar a relação entre poluição atmosférica e internações de crianças menores de cinco anos por doenças respiratórias na Paraíba: contribuição na tomada de decisões de políticas públicas voltadas ao controle da poluição do ar. METODOLOGIA: Estudo analítico e descritivo da distribuição espacial das áreas vulneráveis em relação a dados socioeconômicos, dados sobre informações de saúde (internações), população e fontes poluidoras (frota e queimadas). As tabulações e análises dos dados foram realizadas para o estado da Paraíba estratificada por região. Optou-se pela utilização da cartografia temática para a geração de mapas de vulnerabilidade ao considerar seu potencial como ferramenta intuitiva e de fácil visualização, para comunicar os resultados das avaliações de risco ambiental. Foi realizada a análise descritiva, testes de Qui-quadrado, Kruskal-Wallis, e de comparações múltiplas de Dunn. O nível de significância foi de 5%. RESULTADOS: Existe relação entre o aumento da poluição atmosférica e as admissões hospitalares de crianças de zero a cinco anos por problemas respiratórios. Com relação à distribuição espacial dos focos de calor e internação, temos que em 2010 foi o pior ano dentre os analisados neste estudo. As regiões com maiores números de casos são o sertão e litoral. CONCLUSÃO: É necessário um equilíbrio entre desenvolvimento econômico e sustentabilidade. Um plano de estratégias deve ser pensado e posto em prática, não dependendo apenas de uma instituição e sim do conjunto de ações de diversos órgãos para que os resultados sejam favoráveis tanto para a qualidade de vida da população como para a economia do Estado.

published_or_final_version / Public Health / Master / Master of Public Health

The overall aim of the research described in this thesis was to evaluate the effect of vitamin A supplementation on respiratory health, assessed by lung function in children aged 6--9 years. It comprises three studies. / The first study determined the magnitude of vitamin A deficiency in the target population in Wukro wereda, Northern Ethiopia. Of the 1339 eligible children identified by house to house surveys, 824 had complete data for vitamin A indicators and anthropometry. Xerophthalmia was detected in 5.8% of the children, 8.4% had serum retinol levels <0.35 mumol/L and 51.1% between 0.35--0.70 mumol/L. Liver vitamin A reserve was also found to be low in 41.0% of the children using the Modified Relative Dose Response (MRDR) and in about 85% of the children, the daily vitamin A intake was below the FAO/WHO basal requirement (<250 RE/day). / The second study found that in comparison with children with adequate vitamin A reserve (MRDR < 0.06), those with low reserve (MRDR &ge; 0.06) had forced expiratory volume in one second (FEV1) 48.8 ml (p = 0.006) lower when unadjusted, 23.1 ml (p = 0.04) when partially adjusted for age, gender and height and 14.1 ml (p = 0.20) when fully adjusted for demographic, general health, lung function and household related characteristics. / The third study describes the results of a randomized controlled trial (RCT) to evaluate the impact of vitamin A supplementation on respiratory health as assessed by change in FEV1 at 4 months. The average change was 53.3 ml (n = 496) and 53.8 ml (n = 501) in the vitamin A and placebo groups respectively. After adjusting for baseline covariates, the difference between them was -3.6 ml (95%CI: -21.6, 14.4). In sub-analysis of the data, gender and vitamin A status subcategories were found to be effect modifiers. / In conclusion, high dose vitamin A supplementation did not show an effect on change in FEV1 at 4 months in children aged 6--9 years with high prevalence of vitamin A deficiency. Sub-analysis findings suggest that the benefits to vitamin A intervention in the study setting can probably be achieved if the other nutritional deficiencies such as zinc are addressed. Moreover, the results also suggest that the effects of vitamin A supplementation on respiratory health status are complex and these need to be taken into account in future studies to assess the clinical and public health implications of vitamin A supplementation in this age group.

A poluição do ar é um problema de saúde pública nas grandes cidades, no Brasil e no mundo. As principais fontes de contaminação são as emissões dos veículos automotores, indústrias, usinas de energia, e as atividades humanas em geral, como a agricultura. Os objetivos deste estudo foram investigar as associações de curto prazo entre os níveis de material particulado (PM10) e internações de crianças e idosos, devido a problemas respiratórios ou cardiovasculares em uma região ao leste do Rio de Janeiro cidade, conhecida como Grande Tijuca. Uma associação entre PM10 e os resultados obtidos sobre a população sensível foi encontrada na área de estudo. / Air pollution is a public health problem in major cities, in Brazil and the world. The main sources of contamination are emissions from motor vehicles, industries, power plants, and human activities in general, as agriculture. The aims of this study were investigating short-term associations between levels of particulate matter (PM10) and hospital admissions of children and elderly due to respiratory or cardiovascular disorders in a region to the East of the Rio de Janeiro city, known as Grande Tijuca. An association between PM10 and the targeted outcomes among the sensitive population was found in the study área.

Made available in DSpace on 2015-05-14T12:47:14Z (GMT). No. of bitstreams: 1 ArquivoTotal.pdf: 5481354 bytes, checksum: 0c13ae5c154f04c9968451cecffae9ab (MD5) Previous issue date: 2013-03-08 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Until late 1980s, urban air pollution was attributed to industrial emissions. However, the fast urban growth in the developing nations caused the vehicles to become an issue of large magnitude. Nowadays, there is a situation in which the most responsible for the a relevant part of the air quality degradation in the bigger urban centers are the motor vehicles that are currently circulating on the roads, due to their great amount and poor state of repair. In some cities, the air pollutant concentration indexes have reached levels that threaten people's health, forcing the authorities to make decisions to control such problem. This current work aimed to verify the relationship among meteorological factors, vehicular air pollutants and the number of respiratory system disease cases notified by the department of health of Salvador-BA', by using the Poisson Regression Model. This investigation was conducted by using an ecological drawing made from secondary information about hospitalizations, collected from DATASUS and from data related to the monitoring of major air pollutants and to the meteorological parameters, from November 2010 to September 2012, acquired from the Environment and Water Resources Institute - INEMA. In this work, the most susceptible groups of people, that is, children (≤9 years old) and the elderly ( ≥65 years-old), were monitored. Acording to the achieved results, it was observed that the independent variables "SO2", "NO2", "CO" and "Temperature" were statistically relevant to justify the variability of the responds variable "Hospitalizations by respiratory system diseases" in children, to the exploratory level of 5%. Regarding to elderly, only the variables "NO2" and "O3" were statistically relevant to the significance level of 5%. Through the residual graphics and the diagnostic measures related to the Poisson model adjusted to the data about hospitalizations caused by respiratory system diseases in children and the elderly, it was possible to verify the proper suitability of the model used for the decision-making. / A poluição atmosférica urbana, até meados de 1980, era atribuída basicamente às emissões industriais, no entanto, o rápido crescimento urbano nos países em desenvolvimento fez com que os veículos se tornassem um problema de grande magnitude. Hoje se verifica uma situação em que os maiores responsáveis por grande parte da degradação da qualidade do ar nos grandes centros urbanos são os veículos automotores em circulação nas rodovias, devido à grande quantidade e péssimo estado de conservação. Em algumas cidades, os índices de concentrações de poluentes do ar passaram a atingir níveis que colocam em risco a saúde das pessoas obrigando as autoridades a tomar decisões para controlar este problema. o presente trabalho teve como objetivo verificar a relação entre fatores meteorológicos e poluentes atmosféricos veiculares com o número de casos de doenças respiratórias notificadas pela Secretaria de Saúde de Salvador-BA, mediante a utilização do Modelo de Regressão de Poisson. Essa investigação foi realizada utilizando-se um desenho ecológico a partir de informações secundárias de internações hospitalares coletados junto ao DATASUS e de dados acerca do monitoramento dos principais poluentes atmosféricos e dos parâmetros meteorológicos, no período de novembro de 2010 a setembro de 2012, adquiridos junto ao Instituto do Meio Ambiente e Recursos Hídricos - INEMA. Foram observadas neste estudo as populações mais suscetíveis que são crianças (< 9 anos) e idosos > 65 anos). De acordo com os resultados obtidos, observou-se que as variáveis "SO2", "NO2", "CO2", e "Temperatura" são estatisticamente significantes para justificar a variabilidade da variável resposta "internações por doenças respiratórias" em crianças, ao nível exploratório de 5%. Com relação aos idosos, apenas as variáveis "NO2" e "O3" foram estatisticamente significantes ao nível de 5% de significância. Através dos gráficos de resíduos e de medidas de diagnóstico referentes ao modelo de Poisson ajustados aos dados sobre internações por doenças do aparelho respiratório em crianças e idosos. Foi possível verificar a boa adequação do modelo utilizado para a tomada de decisão.

Made available in DSpace on 2014-12-17T15:54:52Z (GMT). No. of bitstreams: 1 ElisangelaML.pdf: 3702195 bytes, checksum: 706cae0d6a157da81de334adcc48655b (MD5) Previous issue date: 2009-02-26 / This work aims to characterize the workers in mineral activities exposed to lung injuries in Parelhas Municipality, Rio Grande do Norte State, seeking to relate respiratory diseases to the mining activity. The studied area (Parelhas City), with about 19,700 inhabitants, is located in the Serido region, approximately 232 km far from Natal City. The number of people involved in informal mining activity (garimpo) in the Serid? region reaches about 5,000. These workers generally do not use any kind of individual protection equipments and develop, at early ages of greater productivity, severe forms of diseases, which end up disabling them to professional activities, family and social life. Deceases by respiratory problems (e.g. silicosis) have been reported in very young adults. A descriptive observational study was conducted based on information from the records found in Dr. Jos? Augusto Dantas Hospital, between the years 1996- 2006. The occupational and socio-economic features of the population, which was selected by using the hospital records, were achieved through individually answered forms. The purpose was to link the occupational activities with the respiratory diseases. The next stage of the research was an observational case-control study, in the 1:1 proportion. The achieved data allowed confirming the central hypothesis of the research, which states that the pneumoconiosis cases are due to the mineral-based activities in the studied area. The final step of the investigation tried to assess the knowledge of relatives of students in public and private elementary and high schools from Parelhas City, regarding silicosis. About 15.4% of urban schools were analyzed through application of a structured questionnaire. The results show distinct socio-economic levels and a difference in the perception of the relatives of students in public and private schools, concerning silicosis. It was possible to identify the characteristics of the population economically involved with mineral-based activities and to define the group that deserves preferential attention in preventive actions. The work indicates some environmental problems caused by inadequate mining operations in the region / O presente trabalho tem por objetivo a caracteriza??o de trabalhadores em atividades de base mineral expostos aos danos pulmonares, no Munic?pio de Parelhas/RN, buscando relacionar as patologias respirat?rias que mais se manifestam nesta popula??o a atividades de base mineral. A ?rea estudada (cidade de Parelhas) localiza-se no Serid? oriental norte-riograndense a aproximadamente 232 km de Natal com cerca de 19.700 habitantes. A quantidade de pessoas envolvidas na atividade informal de minera??o (garimpo) na regi?o do Serid? norte-riograndense chega a cerca de 5.000. Esses trabalhadores em geral n?o utilizam equipamentos de prote??o individual (EPIs) de qualquer esp?cie e desenvolvem, na faixa et?ria de maior produtividade, formas graves da doen?a, que acabam incapacitando-os para atividades profissionais, vida familiar e social, existindo relatos de mortes por problemas respirat?rios (silicose, por exemplo) em adultos muito jovens. Foi realizado estudo observacional do tipo descritivo transversal, a partir de informa??es sintomatol?gicas presentes nos prontu?rios do Hospital Dr. Jos? Augusto Dantas da cidade de Parelhas, entre os anos de 1996-2006. A caracteriza??o ocupacional e socioecon?mica da popula??o selecionada atrav?s dos prontu?rios foi feita atrav?s de aplica??o de formul?rios, respondidos individualmente e ap?s leitura do termo de consentimento livre e esclarecido (TCLE). Esta caracteriza??o objetivou vincular a atividade ocupacional com as patologias respirat?rias sofridas A etapa seguinte da pesquisa correspondeu a estudo observacional anal?tico do tipo casocontrole, na propor??o 1:1. Os dados obtidos possibilitaram a confirma??o da hip?tese central da pesquisa, de que os casos de pneumoconioses devem-se ? presen?a de atividades de base mineral na ?rea de estudo. Na fase final do trabalho, buscou-se avaliar o conhecimento da popula??o de familiares de estudantes do ensino fundamental e m?dio de escolas p?blicas e privadas do Munic?pio de Parelhas/RN referente ? silicose. Foram analisadas 15,4% das escolas urbanas, atrav?s da aplica??o de question?rio estruturado. Os resultados mostram distintos n?veis socioecon?micos e uma diferen?a na percep??o nos familiares de estudantes das escolas p?blica e privada, em rela??o ? silicose, permitindo identificar as caracter?sticas das popula??es economicamente envolvidas com atividades de base mineral e definir o grupo que mereceria aten??o preferencial em a??es preventivas. O trabalho possibilitou tamb?m apontar alguns problemas ambientais deixados pela inadequada explora??o mineral existente na