Introdução- Em abril de 2009, novo subtipo viral foi identificado, Influenza A(H1N1)pdm09. Em 11 de junho de 2009, a Organização Mundial da Saude anunciou o início de uma pandemia de influenza. Objetivo- Investigar os fatores de risco para óbito por Influenza A(H1N1)pdm09 em pacientes e em gestantes hospitalizados com Doença Respiratória Aguda Grave-DRAG. Nas gestantes, foram analisados também os desfechos gestacionais e neonatais. Metodologia- Foram realizados dois estudos caso-controles, em pacientes e em gestantes hospitalizados com Influenza A(H1N1)pdm09 confirmada laboratorialmente e DRAG. Os casos evoluíram para óbito e os controles para cura. Os casos e controles foram selecionados no Sistema de Informação de Agravos de Notificação-SINANInfluenza- web, sendo sorteados dois controles no estudo dos pacientes, e quatro no das gestantes, pareados por semana epidemiológica da data de internação do caso. O primeiro estudo foi realizado nas regiões Metropolitanas de São Paulo e de Campinas, de 28 de junho a 29 de agosto de 2009. Nas gestantes, o estudo incluiu o Estado de São Paulo, de 09 de junho a 01 de dezembro de 2009. Foram realizadas avaliações dos prontuários hospitalares e entrevistas domiciliares, a partir de formulários padronizados. Foram empregados testes de Mann-Whitney-U ou quiquadrado para comparação das variáveis, e cálculos dos odds ratio brutos-ORb e seus intervalos de confiança-IC95 por cento , para avaliação dos fatores de risco. No primeiro estudo foi definido modelo de regressão logística múltipla para análise dos fatores associados ao óbito. Resultados- No primeiro estudo, foram investigados 193 casos e 386 controles, 73,6 por cento dos casos e 38,1 por cento dos controles tinham alguma condição de risco para complicações relacionadas à influenza. No modelo final, as seguintes variáveis foram fatores de risco para óbito: idade entre 18 a 59 anos, Odds Ratio Ajustado-ORa de 2,31, 95 por cento IC 1,31-4,10, (referência pacientes < 18 anos), presença de pelo menos uma condição de risco (ORa=1,99, 95 por cento IC 1,11-3,57), mais de uma condição de risco (ORa=6,05 95 por cento IC 2,76-13,28), obesidade (ORa=2,73, 95 por cento IC 1,28- 5,83), imunossupressão (ORa=3,43 95 por cento IC 1,28-9,19) e ter tido atendimento prévio à internação (ORa=3,35, 95 por cento IC 1,75-6,40). O tratamento antiviral, quando administrado nas primeiras 48 horas do início dos sintomas foi fator de proteção para óbito, (ORa=0,17, 95 por cento IC 0,08-0,37). Houve benefício também da administração do antiviral entre 48 a 72 horas, (ORa=0,30, 95 por cento IC 0,11-0,81). Em gestantes, foram investigados 48 casos e 185 controles. Foram fatores de risco para óbito: ter tido atendimento prévio à internação, (ORb de 8,03, 95 por cento IC 2,38-27,09) e terceiro trimestre de gestação, (ORb=4,45, 95 por cento IC 1,15-29,25). Tratamento antiviral foi fator de proteção, quando administrado até 48 horas do início dos sintomas (ORb=0,14, 95 por cento IC 0,05-0,37), e de 48 a 72 horas, (ORb=0,13, 95 por cento IC 0,02-0,68). Em relação aos desfechos gestacionais, houve maior proporção de perdas fetais e partos prematuros entre os casos, p=0,001. As gestantes que evoluíram para óbitos tiveram recém nascidos vivos com mais baixo peso e índices inferiores no Apgar do primeiro minuto, p=0,016, quando comparado aos controles que tiveram parto durante a internação, p<0,001. Conclusão: A identificação dos pacientes de maior risco e o tratamento precoce são fatores importantes para a redução da morbimortalidade por influenza. / Introduction - In April 2009, a new viral subtype was identified, influenza A (H1N1)pdm09. On June 11, the World Health Organization announced the beginning of the influenza pandemic. Objective - To investigate the risk factors for death from influenza A(H1N1)pdm09 in hospitalized patients and pregnant women with Severe Acute Respiratory Infections-SARI. In the pregnant women, the gestational and neonatal outcomes were analyzed. Methodology - Two case control studies were performed in hospitalized patients and pregnant women with laboratory confirmed influenza A (H1N1)pdm09 and SARI. The cases died and the controls recovered. The cases and controls were selected from the Information System for Notifiable Diseases-SINAN-Influenza-web. Two controls were randomly selected in the study of patients and four in the pregnant women, matched by epidemiological week of the date of admission of the case. The first study was conducted in the metropolitan regions of São Paulo and Campinas, from June 28th to August 29th, 2009. The study on pregnant women included the State of São Paulo, from June 09th to December 1th, 2009. Evaluations of the medical records and home interviews were conducted using standardized forms. The Mann-Whitney U test or the chi-square tests were performed to compare the variables, in addition to calculations of crude odds ratio- ORc and their 95 per cent confidence intervals for the assessment of the risk factors. In the first study a multiple logistic regression model was used to analyze factors associated with death. Results - In the first study, 193 cases and 386 controls were investigated, 73.6 per cent of cases and 38.1 per cent of controls presented some risk condition for developing influenza-related complications. In the final model, the following variables were risk factors for death: aged between 18 and 59 , Adjusted Odds Ratio-ORa of 2.31, CI95 per cent 1.31-4.10, (reference patients <18 years), the presence of at least one risk condition (ORa=1.99, CI95 per cent 1.11-3.57), more than one risk condition (ORa=6.05 CI95 per cent 2.76-13.28), obesity (ORa=2.73, CI95 per cent 1.28-5.83), immunosuppression (ORa=3.43 CI95 per cent 1.28-9.19) and being attended prior to hospitalization (ORa=3.35, CI95 per cent 1.75-6.40). Antiviral treatment, when administered during the first 48 hours of onset of symptoms, was a protective factor for death, (ORa=0.17, CI95 per cent 0.08-0.37). There were also benefits from antiviral administration between 48 and 72 hours, (ORa=0.30, CI95 per cent 0.11-0.81). In the pregnant women, 48 cases and 185 controls were investigated. The risk factors for death were: being attended prior to hospitalization, (ORc 8.03, CI95 per cent 2.38-27.09) and third trimester of pregnancy, (ORc=4.45, CI95 per cent 1.15-29.25). Antiviral treatment was a protective factor when administered within 48 hours of onset of symptoms (ORc=0.14, CI95 per cent 0.05-0.37) and between 48 and 72 hours, (ORc= 0.13, CI95 per cent 0.02-0.68). In relation to pregnancy outcomes, there was a higher proportion of fetal losses and premature births among cases, p=0.001. The pregnant women who died had live newborns with lower weight and lower Apgar scores in the first minute, p=0.016 compared to controls who gave birth during hospitalization, p<0.001. Conclusion: The identification of high-risk patients and early treatment are important factors in the reduction of morbidity and mortality from influenza.

Objetivo: Avaliar os aspectos clínicos e nutricionais de mulheres na pósmenopausa com doença arterial coronária (DAC). Metodologia: Estudo transversal retrospectivo. Obtiveram-se dados do prontuário médico de 217 mulheres, na ocasião da primeira consulta no Ambulatório de Nutrição do InCor-HCFMUSP, referentes à idade, índice de massa corpórea, presença de diabetes melito (DM), hipertensão arterial sistêmica (HAS), uso de drogas hipolipemiantes, perfil lipêmico (colesterol e frações) e consumo alimentar habitual. Para os dados dietéticos utilizou-se impresso próprio. Resultados: A idade média observada foi 60,98 &#177; 9,23 anos com prevalência de obesidade de 56%. A presença de DM, HAS e uso de drogas hipolipemiantes foi observada em 46%, 80% e 73%, respectivamente. Quanto ao perfil lipêmico, 44% apresentavam altos níveis plasmáticos de colesterol. Em relação ao consumo alimentar, 59% consumiam gorduras acima do limite superior aceitável e 95% apresentavam consumo deficiente de fibras alimentares. Conclusões: As inadequações observadas podem refletir no surgimento de fatores de risco para DAC e, apesar de já ter desenvolvido a doença, esta população ainda cultiva os fatores que o levaram a ela. Faz-se necessária a ação multidisciplinar em Programas de Saúde da Mulher, abrangendo aspectos preventivos relacionados a DAC para, assim, melhorar a qualidade de vida nesta população. / Objective: To assess clinical and nutritional aspects of postmenopausal women with coronary arterial disease (CAD). Methodology: Retrospective cross-sectional study. It was taken data of the clinicai handbook of 217 women, in first interview at Heart Institute (InCor) - HCFMUSP. The variables studied were: age, body mass index, diagnoses to diabetes mellitus (DM), hypertension (Hy), using of lipid-Iowering drugs, blood lipids (cholesterol and fractions) and food intake. It was used a specific tool for dietary data. Results: The mean age was 60,98&#177;9,23 years old with high prevalence of obesity (56%). DM, Hy and using of lipid-lowering drugs were observed in 46%, 80% and 73%, respectively. About blood lipids, 44% presented high serum cholesterol levels. About food intake, 59% had intake fats up to acceptable superior limit and 95% presented low dietary fiber intake. Conclusions: This inadequates data can reflect in the sprouting of factors of risk for DAC and despite already has developed the illness this population still cultivates the factors that had taken it. It is necessary the action of a multidiscipline team in Health Programs for Women, to involve preventive aspects related to the DAC and to improve the quality of life of this population.

Muitas crianças e adolescentes são vítimas de maus-tratos infantis, no Brasil e no Peru, e estas práticas constituem-se em uma violação aos seus direitos. Em ambas as sociedades, tais direitos são preconizados e garantidos por dispositivos legais, tendo em vista sua proteção integral, sendo que um destes dispositivos prevê a suspensão temporária do direito de guarda pelos pais/responsáveis. A presente investigação propõe-se a conhecer melhor as famílias brasileiras e peruanas nessa situação, em termos de exposição a fatores de risco maleáveis, específicos para os maus-tratos, situados no micro e no exosistema. O referencial é o da Teoria Bioecológica e o Modelo Transacional. Trabalhou-se com amostras de conveniência no Brasil, na cidade de Ribeirão Preto - SP (n=30) e no Peru, na cidade de Arequipa (n=30), formadas por adultos mãe/pai ou cuidador, responsável legal. Os instrumentos utilizados para a coleta de dados foram: um Roteiro de Entrevista de Caracterização Sociodemográfica da Família; o Inventário de Potencial de Maus-Tratos Infantis (CAP); a Escala de Avaliação da Coesão e Adaptabilidade Familiar Versão IV (FACES IV); o Inventário de Estilos Parentais - Práticas Educativas Maternas/Paternas (IEP) ou, a depender da idade da criança, o Roteiro de Entrevista de Habilidades Sociais Educativas Parentais (RE-HSE-P); e o Questionário de Apoio Social (QAS). Cada instrumento foi corrigido segundo seus próprios critérios técnicos, sendo que os dados obtidos puderam ser categorizados e comparados estatisticamente. Os resultados indicaram que as famílias investigadas, em ambas as sociedades, seriam vulneráveis em termos socioeconômicos. No Brasil, embora padecendo menos do ponto de vista econômico, devido ao fato de serem, em sua maioria, beneficiárias de ajuda governamental, as famílias teriam baixo status social, tendo em conta o baixo nível de escolaridade dos pais/cuidadores e a situação de desemprego. No Peru, as famílias também teriam baixo status social, embora tendo em média uma escolaridade mais alta que as brasileiras. Essas, contudo, viveriam em condições mais precárias, com baixa renda, advinda de trabalho informal, e em moradias mais precárias, em regiões da cidade caracterizadas por escasso acesso aos serviços básicos. Nos dois países, as famílias perceberiam seus bairros como violentos ou perigosos: no Brasil, devido à venda de drogas; no Peru, devido à venda de álcool, aos roubos e ao pouco policiamento. Elas também se assemelhariam no tocante a aspectos de configuração: a maioria seria desconstituída e, por vezes, reconstituída, denotando-se histórico de violência entre os parceiros íntimos, para a maioria. Com relação às características pessoais dos pais/cuidadores, destaca-se que no Brasil estes seriam, em sua maioria, usuários de substâncias psicoativas e teriam familiares com envolvimento criminal. Em relação aos instrumentos padronizados, sublinha-se que, de modo geral, nas duas amostras, os dados indicaram a existência de problemáticas consideradas fatores de risco específicos para os maus-tratos. Focalizando as diferenças estatisticamente significativas (p<0,05) entre as amostras, destaca-se que no CAP os participantes brasileiros pontuaram mais alto na subescala rigidez, indicando uma problemática maior nesse plano. No FACES, as amostras apresentaram diferenças nas escalas Coesão, Flexibilidade, Comunicação e Satisfação Familiar, denotando maior disfuncionalidade na amostra brasileira. O IEP diferenciou as amostras somente na dimensão de Punição inconsistente, denotando que a amostra peruana empregaria com maior frequência esta prática negativa. Em síntese, os dados sugerem que as famílias no sistema de proteção infantil efetivamente vivem problemas associados à ocorrência dos maus-tratos. Novas pesquisas na área devem se dedicar a conhecer e a analisar se os serviços que lidam com essas famílias e com seus filhos têm contemplado suas necessidades. / Many children and adolescents are victims of child abuse in Brazil and Peru; these practices constitute a violation of their rights. In both societies such rights are recommended and guaranteed by the law, in view of its full protection, with one of these law disposition standing a temporary suspension of guard by parents / guardians. This research proposes to better understand Brazilian and Peruvian families in this context in terms of exposure to manageable risk factors specific to ill-treatment, located in the micro and exosistema. The theoretical framework is the bio-ecological theory and the transactional model. We worked with convenience samples in Brazil, in the city of Ribeirão Preto - SP (n = 30), and Peru, in the city of Arequipa (n = 30) were composed, formed by adults - mother / parent or caregiver, guardian. The instruments used for data collection were: A Sociodemographic Family characterization Interview; the Child Abuse Potential (CAP); the Family Adaptability and Cohesion Evaluation Scale- IV (FACES IV); Inventory of Parenting Styles - Educational Practices Maternal / paternal (IEP) or, depending on the age of the child, the Interview Script Education Social Skills Parental (RE-HSE-P); and the Social Support Questionnaire (SAQ). Each instrument has been analysed according to their own technical criteria, and data could be categorized and compared statistically. The results indicated that the families investigated in both countrys would be vulnerable in socioeconomic terms. In Brazil, although suffering less from the economic point of view, due to the fact that they are mostly beneficiaries of government aid programms, families have low social status, due to the low level of parents / caregivers`s education and the unemployment situation. In Peru, families also have low social status, while having on average higher education scores than the Brazilian. These, however, would live in precarious conditions, with low income, related to informal work ones and in precarious houses, in city regions characterized by poor access to basic services. In both countries, families perceive their neighborhoods as violent or dangerous: in Brazil, due to the sale of drugs; in Peru, due to the sale of alcohol, theft and little policing. They also would resemble regarding the configuration aspects: most would broked and sometimes reconstituted, showing up history of intimate partners violence, for most. With regard to parents/caregivers`s personal characteristics, in Brazil they would be, mostly psychoactive substances users and have family members with criminal envolvement. Regarding standardized instruments, it is emphasized that, in general, in both samples, the data indicate the presence of problematics considered specific risk factors for maltreatment. Focusing on statistically significant differences (p <0.05) between samples is emphasized that, in the CAP, , Brazilian participants scored higher in subscale Rigidity, indicating a larger problem here. In FACES, the samples showed differences in cohesion scales, flexibility, communication and family satisfaction, showing increased dysfunctionality in the Brazilian sample. The IEP differentiated samples only in the size of inconsistent punishment, indicating that the Peruvian sample used more often this negative practice. In summary, the data suggest that families in the child protection system effectively face problems associated with the occurrence of maltreatment in significant levels. New research in the area should be devoted to know and consider whether the services dealing with these families and their children contemplate their needs.

Estudo descritivo-transversal de abordagem quantitativa, com o objetivo de identificar os indicadores clínicos e bioquímicos de risco cardiovascular entre pessoas com diagnóstico de Transtornos Alimentares (TAs). A população foi composta por 22 usuários em seguimento ambulatorial, em dois hospitais universitários situados no interior paulista e na capital, no período de março de 2013 a fevereiro de 2014. Para a coleta de dados, realizou-se uma entrevista para identificação das variáveis sociodemográficas: idade, sexo, cor da pele, estado familiar conjugal, escolaridade e renda familiar. Os dados clínicos foram coletados por meio de avaliação antropométrica: estatura, peso, circunferência abdominal (CA), cálculo do índice de massa corporal (IMC); aferição das dobras cutâneas: tríceps, bíceps, subescapular e suprai líaca; medida indireta da pressão arterial (PA) e do Índice Tornozelo Braquial (ITB) e cálculo do percentual de gordura corporal. Foram realizados exames laboratoriais para a dosagem de proteína C reativa, colesterol total e frações, triglicérides, homocisteína, vitamina B12 e ácido fólico. Os dados foram agrupados em categorias, e as variáveis quantitativas foram expressas como média e desvio-padrão. Os testes estatísticos foram realizados por meio do aplicativo Statistical Package for the Social Science (SPSS), versão 16.0 e pelo R i386 versão 3.0.0, adotando-se o nível de significância de ?=0,05. Para a análise da associação entre a classificação do IMC (eutrófico e baixo peso) com as variáveis clínicas, antropométricas e bioquímicas, uti lizou-se o Teste Exato de Fisher. Os participantes possuíam idade média de 28,41 ± 7,51 anos, 95,5% eram do sexo feminino, 86,4%, brancos, 72,7% viviam sem cônjuge, 45,5% eram estudantes e 31,9%, trabalhadores com vínculo empregatício, 31,8% declararam ensino superior em curso ou incompleto, com média de 12,45 ± 2,94 anos de estudo, 59,1% informaram renda fami liar entre três e quatro salários-mínimos; 59,1% apresentaram o diagnóstico médico de anorexia nervosa (AN), com média de tempo de tratamento de 3,23 ± 2,34 anos; 59,1% eram eutróficos, com média de IMC de 19,19 ± 2,90 Kg/m2 ; 86,4% apresentaram valores de CA normais; 95% com ITB normal, 70% com delta ITB (diferença entre os ITBs) normal; 95,4% com cifras de PA inferiores a 120x80 mmHg, 18,2% com pulso radial inferior a 60 batimentos por minuto; 9,1% com pressão de pulso >50 mmHg. A soma das quatro dobras cutâneas foi de 62,05 ± 19,92 mm, e o percentual de gordura foi de 28,95 ± 5,65; 47,6% classificaram-se como acima da média para o risco de morbidade, devido à alta porcentagem de gordura corporal, de acordo com as dobras cutâneas. Quanto aos exames bioquímicos, 42,1% apresentaram aumento nos níveis do colesterol total; 33,3%, aumento do LDL-C, 10,5%, aumento nos níveis de triglicérides, 18,2%, aumento da homocisteína, 31,8%, aumento do ácido fólico, 4,5%, da PCR e 9,0% estavam com níveis de vitamina B12 maiores ou menores do que os valores de referência. Houve associação estatisticamente significante para a associação entre o IMC e o diagnóstico de AN e bulimia nervosa, p=0,002. Concluímos que as pessoas com TA apresentaram indicadores clínicos e bioquímicos de risco cardiovascular, devendo ser adotadas medidas e ações preventivas que priorizem a promoção da saúde neste grupo de indivíduos / This is a cross-sectional descriptive study with quantitative approach that aim to find out the clinical and biochemical indicators of cardiovascular risk among people diagnosed with eating disorders (ED). The population was composed of 22 users an outpatient follow-up from two university hospitals located on the countryside and capital of São Paulo during the period from March 2013 to February 2014. The data collection occurred through interview to identify socio-demographic variables such as age, sex, skin color, marital status, education, and family income. The clinical data collected from anthropometric assessment were height, weight, waist circumference (WC), and body mass index (BMI); skinfold-thickness measurement: triceps, biceps, subscapular and suprai liac; indirect measurement of blood pressure (BP) and ankle-brachial index (ABI); body fat percentage. Laboratory examinations were carried out to identify the presence of C-reactive protein (CRP), cholesterol (total or individual components), triglycerides, homocysteine, vitamin B12, and folic acid. The data were grouped into categories and the quantitative variables were expressed as median and standard deviation. It was used SPSS (Statistical Package for the Social Science), version 16.0 and R i386 version 3.0.0 and the significance level adopted was ?=0.05. It was used the Fisher Exact Test for association analysis between BMI classification (eutrophic and low weight) with clinical, anthropometric and biochemical variables. The average age of participants was 28.41 ± 7.51 years, female (95.5%), white (86.4%), not living with a partner (72.7%), students (45.5%), employment relationship (31.9%), bachelor degree in progress or incomplete (31.8%) with average study of 12.45 ± 2.94 years, and family income between three and four minimum wages (59.1%); the medical diagnosis presented that 59.1% of persons had anorexia nervosa (AN) with an average treatment time of 3.23 ± 2.34 years; eutrophics (59.1%) with BMI average of 19.19 ± 2.90 Kg/m2 ; normal WC values (86.4%); normal ABI (95%), normal delta-ABI (70%) is the difference between the ABI; BP levels below 120x80 mmHg (95.4%), radial pulse less than 60 beats per minute (18.2%); pressure pulse > 50 mmHg (9.1%).The sum of four skinfold thicknesses was 62.05 ± 19.92 mm and body fat percentage was 28.95 ± 5.65; 47.6% was classified average above of morbidity risk due to high level of body fat based on skinfold thicknesses. The biochemical tests showed increase of levels as follows: total cholesterol (42.1%); LDL-C (33.3%), triglycerides (10.5%), homocysteine (18.2%), folic acid (31.8%), CRP (4.5%), and 9.0% presented vitamin B12 levels higher or lower than the reference values. There was a statistically significant association between BMI and the diagnosis of AN and bulimia nervosa, p=0.002. We conclude that persons with ED present clinical and biochemical indicators of cardiovascular risk. Therefore, preventive actions that prioritize the health promotion should be considered in this group

Introdução: O problema da violência tem chamado a atenção em diversos níveis da sociedade, especialmente no ambiente escolar. A escola é um lugar que permite a observação de questões relacionadas à socialização, promoção da cidadania e expressão de atitudes e opiniões, no qual o desenvolvimento pessoal e social dos alunos deve ser estimulado. Objetivo: Analisar a violência sofrida e/ou praticada por adolescentes no contexto escolar e os fatores individuais e ambientais associados. Métodos: Trata-se de um estudo transversal, no qual os dados foram coletados utilizando-se dois questionários autoaplicáveis: o primeiro continha questões sociodemográficas e comportamentais e o segundo, questões relacionadas à violência sofrida e/ou praticada dentro do contexto escolar. A mostra foi composta por 643 adolescentes, com idades entre 12 e 18 anos, matriculados nos Ensinos Fundamental e Médio de escolas Estaduais da Cidade do Recife, Estado de Pernambuco, Brasil. Os dados coletados foram organizados em planilhas eletrônicas, analisados quanto às distribuições absolutas e percentuais, e analisados estatisticamente com o auxílio do programa SPSS. A existência de associação entre duas variáveis categóricas foi avaliada utilizando-se o teste estatístico Qui-quadrado ou o teste Exato de Fisher, adotando-se a margem de erro de 5%, e o grau de associação entre as variáveis foi avaliado pela razão de prevalências e o respectivo intervalo de confiança (IC 95,0%). Resultados: Na população do estudo, a prevalência da violência na condição de vítima, de agressor, e de expectador foi de 62,2%, 51,9% e 82,3% da população do estudo, respectivamente. Os indivíduos do sexo masculino foram tanto os agressores (62,2%) quanto as vítimas (68,7%) mais frequentes da violência no ambiente escolar. O tipo de agressão relatado com maior frequência, na condição de vítima e de agressor, foi a violência verbal (54,2% e 55,6%, respectivamente), seguida pela violência física (24,0% e 33,5%, respectivamente). Os principais protagonistas da violência foram os colegas de sala (96,0%), sendo que 44,6% dos agressores referiram não querer mudar os seus comportamentos, e 26,3% dos adolescentes que presenciaram a agressão apoiaram o agressor e riram da situação. A sala de aula foi o local de maior ocorrência de atos violentos, tanto praticados (49,7%) quanto sofridos (45,9%). Houve associação significativa da: (a) violência física sofrida e praticada com a faixa etária de 12-14 anos; (b) violência verbal sofrida e praticada com a faixa etária de 15-18 anos, sendo a última mais elevada em adolescentes do sexo feminino; (c) faixa etária de 15-18 anos com o consumo de álcool e de drogas ilícitas, a ideação suicida e a atividade sexual; (d) violência sofrida com a ideação suicida. Conclusões: Os resultados obtidos apontam para o fato de que o envolvimento dos adolescentes em situações de violência contribui para a adoção de outros comportamentos negativos, com reflexos em sua saúde presente e futura. O conhecimento da violência escolar associada à exposição dos adolescentes a comportamentos de risco servirão de subsídio para ações que visem o desenvolvimento de habilidades sociais saudáveis e da autoestima desta população / Introduction: Violence has called attention as a problem at different social levels, especially in the school environment. The school is a place that permits observing issues related to socialization, promotion of citizenship, expression of attitudes and opinions, in which the students\' personal and social development should be stimulated. Objective: To analyze the violence adolescents suffer and/or practice in the school context and the individual and environmental factors associated. Methods: A cross-sectional study was undertaken, in which the data were collected using two self-applied questionnaires: the first contained sociodemographic and behavioral questions, and the second contained questions related to the violence suffered and/or practiced in the school context. The sample consisted of 643 adolescents, between 12 and 18 years of age, enrolled in primary and secondary education at state-owned schools in the city of Recife, State of Pernambuco, Brazil. The collected data were organized in electronic worksheets, their absolute and percentage distribution were analyzed and statistical analysis was applied using the software SPSS. The Chi-square test or Fisher\'s Exact test was used to assess the existence of association between two categorical variables, with a 5% error margin. The prevalence ratio and respective confidence interval (95% CI) were used to assess the degree of association between the variables. Results: In the study population, the prevalence of violence in the condition of victim, aggressor and spectator corresponded to 62.2%, 51.9% and 82.3%, respectively. Male individuals acted as the most frequent aggressors (62.2%) as well as victims (68.7%) in the school context. The most frequent type of aggression mentioned, in the condition of victim and aggressor, was verbal violence (54.2% and 55.6%, respectively), followed by physical violence (24.0% and 33.5%, respectively). The main protagonists of the violence were classmates (96.0%), with 44.6% of the aggressors mentioning that they do not want to change their behaviors and 26.3% of the adolescents who were present at the aggression supporting the aggressor and laughing at the situation. The classroom was the most frequent location of violent acts, both practiced (49.7%) and suffered (45.9%). A significant association was found between: (a) physical violence (both suffered and practiced) and age range between 12 and 14 years old; (b) verbal violence (both suffered and practiced) and age range between 15 and 18 years old - the latter was higher in female adolescents; (c) age range between 15 and 18 years old and alcohol and illegal drug consumption, suicidal thinking and sexual activity; (d) violence suffered and suicidal thinking. Conclusions: The results point to the fact that the adolescents\' involvement in situations of violence contributes to the adoption of other negative behaviors, with reflexes in their present and future health. Knowledge about school violence associated with the adolescents\' exposure to risk behaviors will support actions aimed at the development of healthy social skills and self-esteem in this population

The aim of this work is to study the phenomenon of suicide of seniors in the context of PBSP needs. The suicidality of seniors is a serious problem and it can be assumed that its importance will increase as a result of aging of population. I tried to find out which PBSP needs are in the largest deficit in sucidal threatened seniors and how to describe the phenomenon of suicidality of elderly people. This dissertation project was realized in the form of a qualitative research study, namely the method of interpretative phenomenological analysis, the principle of which is the study of living human experience and its individualized meaning, supplemented by other relevant research methods. The primary source of data was semi-structured interviews with seniors who had suicidal thoughts, tendencies, or attempts. This research confirmed that every need of a suicidal senior can be detected by the PBSP system and then use it to better understand how to work with this individual. The need, which respondents had in the biggest deficit, was the need of place (doubt about one's own place in the world, loneliness, and the loss of meaning). It also turned out that suicidal ideas of seniors, no matter how many actually acts suicidal, unexpectedly high. The risk and safety factors, that this research has shown,...

There is limited research into the impact of non-specific factors on the outcome of Cognitive Behaviour Therapy (CBT). This current study aimed to investigate the relationship between client and therapist attachment styles and client interpersonal problems to the therapeutic relationship and symptom reduction over eight sessions of CBT. Seventeen therapist-client dyads were asked to complete measures of interpersonal problems, attachment style and report on the therapeutic relationship. Results showed that in this small sample there was a relationship between core alliance, as rated by clients, to reduction in symptoms of depression over the course of eight sessions of CBT (TB=0.423, p<0.05) but not anxiety. Client level of confidence in relationships was negatively correlated with the reduction in anxiety symptoms over time (TB =-.320; p<0.05). The level of difference in scores on a measure of ‘confidence in relationships’ between therapists and clients was found to be positively correlated to the level of reduction in anxiety scores over eight sessions (TB = .0428; p<0.05) and negatively correlated to the therapist rated core alliance (TB=-.428, p<0.05). These results indicate that the role of attachment styles in CBT warrants further investigation and both clinical and theoretical implications of these findings are discussed. Key words: Cognitive Behaviour Therapy, therapeutic relationship, treatment outcomes, attachment, interpersonal problems Service Improvement Project Title: What is helpful about attending an Alzheimer’s café: does it do what it says on the tin? Abstract: Alzheimer’s Cafes were developed in 1997 in the Netherlands and have since been set up all over the world. They are a post-diagnostic support group for people with dementia and their families with an aim to reduce stigma around having dementia. As yet there have been very few evaluations of these cafes. This project aimed to find out what family carers of people with dementia found helpful about attending one of two Alzheimer’s cafes. Seven carers took part in a focus group and two were interviewed individually about what they found helpful about attending an Alzheimer’s Café and what they thought could be improved on in the future. Results showed that people found the opportunities to socialise with others ‘in the same boat’ the most helpful aspect as well as meeting professionals outside of the clinic. The results of this study will enable the development of a questionnaire that can be used to continue to evaluate the café and the feedback provided used to guide future service development. Key words: Alzheimer’s Café, social support, dementia, service evaluation Critical Literature Review Title: Risk and protective factors for psychological adjustment of children born with a cleft lip and/or palate and their families: A review of the literature Abstract: Research suggests that around 30-40% of children born with a cleft lip and /or palate will develop psychological difficulties. Services supporting these individuals need to be able to identify those that might be vulnerable as early as possible so that preventative support can be offered. This review summarises findings from research studies looking at within-group differences in samples of children with a cleft and their families. Risk factors found included being male, experiencing bullying or having additional difficulties. Protective factors included satisfaction with appearance and social support. The methodological strengths and weaknesses of these studies are discussed along with implications of the findings for theory and clinical practice.

Depression is a common mental health concern on college campuses, especially among Asian Americans. This review aims to bring together the current findings on the unique contributors to depression in this minority population. Thirteen peer-reviewed articles were included in the systematic review. Identified risk factors for depression unique to Asian Americans included: perceived racial discrimination and intergenerational differences. Identified protective factors included: strong ethnic identity and cultural individualism. Other factors related to depression that were common to a general college sample were also identified. The review provides a reference for researchers and higher education professionals seeking information on depression among Asian American college students. Recommendations for addressing depression in minority students as a whole are discussed.

Offspring of parents with bipolar disorder (BD) are at high risk for psychiatric disorders, but mechanisms conferring risk are not well understood. Identifying and understanding factors that increase offspring vulnerability may inform intervention efforts. Three studies examined the following risk factors: (1) obstetric complications (OCs); (2) family functioning; and (3) clinical characteristics of parental BD. Investigations included cross-sectional data from two Massachusetts General Hospital studies of 109 BD parents and 206 offspring. Study 1 examined associations between: (1) maternal lifetime comorbid anxiety and OCs in pregnancy/delivery; (2) OCs and development of offspring psychopathology. Associations emerged between maternal anxiety and OCs. OCs, particularly during delivery, also correlated with offspring anxiety disorders. Path analyses revealed that delivery complications mediated the relationship between maternal and offspring anxiety. Study 2 examined associations between family functioning (cohesion, expressiveness, conflict) and offspring psychopathology, and explored moderation by offspring age and sex. Higher conflict and lower cohesion correlated with offspring internalizing and externalizing symptoms. Lower cohesion correlated with offspring mood disorders. Moderation analyses indicated that the link between cohesion and internalizing symptoms was stronger for younger compared to older children. Also, conflict and mood disorder were associated in younger boys, but not in older boys or in girls. Study 3 classified parents according to BD course presentation using latent class analysis, and examined associations between parental class membership and offspring psychopathology. The best-fitting model yielded three parent groups that were based on 8 illness characteristics. Some notable patterns differentiated classes: Class 1 and 2 parents had earlier illness onset, whereas Class 3 parents had later onset; Class 2 consisted of parents with Bipolar-II Disorder, whereas Class 1 parents had Bipolar-I Disorder. Class differences emerged for offspring anxiety disorders, but only among females. Class 3 parents had girls with fewer anxiety disorders compared to the other classes, with girls of Class 2 parents at greatest risk. Altogether, these studies identify several specific environmental mechanisms that increase psychopathology risk in offspring of BD parents. Such findings have important implications for targeted prevention and intervention.

Made available in DSpace on 2017-07-24T19:22:14Z (GMT). No. of bitstreams: 1 Ricelia Cecilia Possagno.pdf: 1935834 bytes, checksum: b8da96685dd93850721d2ac62bf78db5 (MD5) Previous issue date: 2010-02-25 / Fundação Araucária de Apoio ao Desenvolvimento Científico e Tecnológico do Paraná / Cardiovascular diseases are the leading cause of death almost in the whole world. Among these, the coronary atherosclerotic disease (CAD) is by far the most frequent cause of death. By through different studies, many researchers are trying show an association between periodontal disease and atherosclerosis. Therefore, it is necessary clarify what are the factors involved in this process. This study aimed to evaluate the oral health and periodontal status of patients undergoing catheterization examination. Subjects were divided into two groups: patients with atherosclerotic disease, comprising 67 individuals and patients without atherosclerotic disease consisted of 28 individuals. The results of catheterization examinations, biochemical and periodontal were related, trying find potential risk markers between periodontal disease and atherosclerosis. Can be verified statistically significant difference in the number of sites with presence of dental plaque (p <0.0001) and inflamed sites (p = 0.0003) between the group of patients with and without atherosclerotic disease, as well as the number of sites with bleeding (p <0.0001) and exudate (p <0.0001). Spearman correlation to the levels of urea in saliva versus serum levels in patients with coronary atherosclerosis was statistically significant (p = 0.0077). The data suggest a possible correlation between inflammatory periodontal disease and coronary atherosclerosis. / As doenças cardiovasculares são a principal causa de morte em quase todo o mundo. Entre essas, doença aterosclerótica coronariana (DAC) é de longe a causa mais freqüente de morte. Por meio de diferentes estudos, muitos pesquisadores estão tentando mostrar uma associação entre a doença periodontal e aterosclerose. Portanto, é necessário esclarecer quais são os fatores envolvidos neste processo. Este estudo teve como objetivo avaliar a saúde bucal e condição periodontal de pacientes submetidos a exame de cateterismo. Os pacientes foram divididos em dois grupos: pacientes com doença aterosclerótica, que inclui 67 indivíduos e pacientes sem doença aterosclerótica consistiu de 28 indivíduos. Os resultados dos exames de cateterismo, bioquímicos e periodontais foram relacionados, tentando encontrar marcadores de risco em potencial entre a doença periodontal e aterosclerose coronariana. Pode ser verificada diferença estatisticamente significante no número de sítios com presença de placa bacteriana (p <0.0001) e sítios inflamados (p = 0.0003) nas cavidades orais entre o grupo de pacientes com e sem doença aterosclerótica, bem como no número de sítios com sangramento ( p <0.0001) e exsudato (p <0.0001). Correlação de Spermann com os níveis de uréia na saliva versus níveis séricos em pacientes com doença aterosclerótica coronariana foi estatisticamente significativa (p = 0.0077). Os dados sugerem uma possível correlação entre a doença periodontal inflamatória e aterosclerose coronária.