Made available in DSpace on 2016-06-02T19:44:00Z (GMT). No. of bitstreams: 1 TeseRFB.pdf: 913534 bytes, checksum: 101c6a0e4213462df968b7bbd6f273d3 (MD5) Previous issue date: 2006-12-08 / Universidade Federal de Sao Carlos / The topic of this study is primary and secondary child sexual abuse (CSA) prevention in the educational area. The study goals involved planning, implementation and assessment of an intervention program in which teachers acted as CSA prevention agents. The first study step was the program planning based on others experiences described in the literature. Secondly, the program was implemented with 101 pre-school teachers in São Carlos, Brazil, 2.918 children (teachers students aged 4-6 years), and 2.732 children s family members. The program was implemented twice, with 52 and 49 teachers in the first and second time, respectively. Each group was divided into three sub-groups in order to receive the intervention. The program involved a theoretical section with teachers and a workshop conducted by teachers with children and family members. The third part involved the program assessment. Indicators of Sexual Abuse (IAS) data was obtained from 101 teachers at three different moments: before to the intervention, in the middle and at the end of the intervention. Teachers Drill on Child Abuse Identification data was obtained before and after the intervention. IAS and Family Members Drill on Child Abuse Identification data was obtained from 101 family members before and after the workshops conducted by teachers. The Drill on Self-Protective Skills Acquisition for Children data was obtained from 96 children before and after workshops conducted by teachers. IAS teachers results showed that they increased their knowledge about CSA specific symptoms. However, no changes in teachers knowledge about CSA nonspecific symptoms were observed. There was an increase in the percentage of appropriate answers from teachers in Teachers Drill on Child Abuse Identification. Family members IAS results showed no changes in their knowledge about CSA specific or non-specific symptoms. After the workshops, there was an increase in the percentage of appropriate answers by family members in Family Members Drill on Child Abuse Identification and children s performance in the Drill on Self-Protective Skills Acquisition for Children. In order to assess the impact of the program in the community, the number of CSA cases notified were identified from 2002 to 2005, in São Carlos. The data obtained showed an increase of CSA cases notified after the program, as well as an increase of reported cases involving young children s victimization. Simultaneously with the program, the teachers received consultation on how to identify CSA suspected cases in their schools. When sexual abuse suspicion was confirmed, the case was reported by teachers. In general, the program s assessment had an important impact in the schools and community as well. The need to plan and assess CSA preventive actions in others sectors of society is discussed. / O tema desse estudo foi a prevenção do abuso sexual infantil na área educacional sob o ponto de vista primário e/ou secundário. Os objetivos do estudo foram elaborar, implementar e avaliar um programa de intervenção para professores no sentido de capacita-los a atuar como agentes de prevenção do abuso sexual infantil. A primeira etapa do estudo envolveu a elaboração do programa a partir de experiências de outros programas desenvolvidos, avaliados e descritos na literatura. Na segunda etapa, o programa elaborado foi realizado contando com a participação de 101 professores de Escolas Municipais Infantis do município de São Carlos, 2.918 crianças de 4 a 6 anos, alunos desses professores e 2.732 familiares das crianças. O programa foi realizado duas vezes em dois momentos distintos, sendo que os professores foram divididos em duas turmas de 52 e 49 profissionais respectivamente. As duas turmas foram subdivididas em três sub-grupos em cada momento da realização do programa. O programa envolveu uma parte teórica com os professores e uma parte prática (oficinas) feita pelos professores com as crianças e os familiares. A terceira etapa foi referente a avaliação do programa realizado. Todos os professores participantes do programa preencheram uma escala - Indicadores de Abuso Sexual IAS, em três momentos distintos, antes, no meio e após o término do programa. Além disso, foi aplicado um Exercício sobre Abuso Sexual antes e depois da intervenção. Os familiares também preencheram o IAS e responderam ao Exercício sobre Abuso Sexual antes e depois das oficinas realizadas pelos professores. As crianças responderam ao Exercício sobre Aquisição de Habilidades de Auto-proteção antes e depois das oficinas realizadas pelos professores. Os resultados obtidos na aplicação do IAS para os professores demonstraram que os mesmos melhoraram seu conhecimento sobre sintomas específicos do abuso sexual, mas mantiveram seu desempenho estável quanto aos sintomas inespecíficos. No Exercício os professores apresentaram um aumento na porcentagem de respostas adequadas após a intervenção. Para os familiares, os resultados obtidos na aplicação do IAS demonstram um desempenho estável tanto em relação a sintomas específicos quanto inespecíficos. Em relação ao Exercício os familiares apresentaram um aumento no percentual de respostas adequadas após as atividades práticas realizadas pelos professores. As crianças apresentaram aumento no percentual de respostas adequadas após as atividades práticas realizadas pelos professores. Como medida de avaliação adicional foi realizado um levantamento dos casos notificados de abuso sexual entre os anos de 2002 e 2005 no município de São Carlos para verificar o impacto do programa na comunidade. Os dados obtidos indicam um aumento no número de denúncias após a realização do programa e o surgimento de denúncias envolvendo crianças mais novas. Simultaneamente ao desenvolvimento do programa, foi realizada uma assessoria aos professores que identificassem suspeita de abuso sexual entre as crianças de sua escola. Dentre os casos em que foi prestada assessoria, todos aqueles em que ficou confirmada a suspeita foram encaminhados para denúncia. De maneira geral, a avaliação do programa verificou um importante impacto da realização do mesmo nas escolas e na comunidade, além de apontar a necessidade de se planejar e avaliar ações preventivas do abuso sexual em outros setores da sociedade.

Made available in DSpace on 2016-06-02T19:46:19Z (GMT). No. of bitstreams: 1 4349.pdf: 1260983 bytes, checksum: 19d54377d5a3b829ce976ba857dd264b (MD5) Previous issue date: 2012-02-27 / Universidade Federal de Sao Carlos / Preterm Infants born and/or low birth weight often spend a long period of stay in neonatal intensive care unit (NICU) because they have greater instability organic frameworks. The deployment of these units was a key milestone in the care of newborn due to reduced neonatal morbidity and mortality, especially among extremely premature and very low birth weight premature. However, admission to NICU, besides being a stressor for the infant, because too painful treatments to which is submitted, constitutes a psychosocial risk factor in development Considering the possible relation between changes in the integration of sensory information, motor development and its effects on the pre-school, proposes that the present study from the perspective of secondary prevention in Special Education. The purpose of this study is to evaluate the sensory processing and motor development of infants preterm between 4 to 6 months, compared with full-term infants. It is therefore a descriptive, cross-sectional and prospective, composed of a study group made up of premature infants (n=15) and a control group composed of full-term infants. The sample (n=30) was assessed using the Test of Sensory Functions in Infant (TSFI), and scale Alberta Infants Motor Scale (AIMS). In the preterm group, when compared motor performance with sensory processing, the result was not significant. As for the Test of Sensory Functions in Infants, had significant difference between groups in total score (p=0.0113) and the sub item 1 (reactivity to tactile deep pressure) (p&#706;0.0001). Factors such as length of stay, maternal complications, complications in the NICU and brackets may be associates with this change. Among the most frequent maternal complication was hypertension, the brackets more used were oxygen and antibiotics, the most prevalent complications were hyaline membrane disease, and respiratory distress. A maternal and neonatal morbidity, in addition to prolonged hospitalization, may be associated with delayed motor development and the change in sensory processing, so it is essential to the assessment and referral to early intervention programs, justifying the need prevention strategies, as sensory an motor deficits may last throughout the years is most evident in the school year. Therefore, from the assessments, you can obtain information so that preventive measures can be implemented or, if necessary, therapies aimed at promoting development. / Lactentes nascidos pré-termo e/ou com baixo peso geralmente enfrentam um período longo de internação em unidade de tratamento intensivo neonatal (UTIN), por apresentarem quadros de maior instabilidade orgânica. A implantação destas unidades foi um marco fundamental na atenção ao recém-nascido devido à redução da morbimortalidade neonatal, especialmente entre os prematuros extremos e de muito baixo peso ao nascer. Porém, a internação em UTIN, além de ser um fator estressante para o lactente, devido aos tratamentos dolorosos a que este é submetido, constitui-se em fator psicossocial de risco ao desenvolvimento. Considerando-se possíveis relações entre alterações na integração de informações sensoriais de crianças nascidas prematuras, desenvolvimento motor e seus efeitos na etapa pré escolar, propõe-se o presente estudo numa perspectiva de prevenção secundária em Educação Especial. O objetivo é avaliar o processamento sensorial e o desenvolvimento motor de recém-nascidos pré-termo na faixa etária de 4 a 6 meses e relacionar os dados de seus desempenhos com seus pares nascidos a termo. Trata-se, portanto, de um estudo descritivo e transversal composto por um grupo de lactentes prematuros (n=15) e um grupo composto por lactentes nascidos a termo (n=15). A amostra (n=30) foi avaliada por meio do Test of Sensory Functions in Infants (TSFI) e da escala Alberta Infants Motor Scale (AIMS). Os resultados apontam diferença significativa entre os grupos no escore total (p=0.0113) e no sub item 1 (reatividade ao tato de pressão profunda) (p< 0.0001) no Test of Sensory Functions in Infants. Fatores como dias de internação, complicações maternas, intercorrências e suportes na UTIN podem estar associados a essa alteração. Dentre às complicações maternas, a mais frequente foi a hipertensão, os suportes mais utilizados foram oxigênio e antibióticos, as intercorrências mais prevalentes foram membrana hialina e desconforto respiratório. Uma série de morbidades maternas e neonatais, além dos longos períodos de internação, podem estar associados ao atraso no desenvolvimento motor e à alteração no processamento sensorial, de modo que torna-se essencial as avaliações e o encaminhamento a programas de intervenção precoce, justificando a necessidade de estratégias de prevenção, uma vez que déficits motores e sensoriais podem perdurar ao longo dos anos sendo mais evidente nos anos escolares. A partir das avaliações, medidas preventivas ou, se necessário, terapêuticas orientadas, poderão ser implementadas para a promoção do desenvolvimento.

The Czech Republic is numer one in the mortality and morbidity due to cardio-vascular diseases. It is evidence that the incidence of cardio-vascular dieseases can be influenced positively by primary prevention as to the lifestyle of the population and that the secondary prevention can improve the lifequality of patiens, diminish thein mortality and morbidity and reduce the numer of recurrences and complications. The degree work on the subjekt {\clqq}Change in the lifestyle of men after an acute myocardial infarct`` is in its general part concentrated on risk factors connected with cardio-vascular diseases, on a self-contained system of rehabilitation, on prevention (primary, secondary, tertiary) and on the welfare system in the Czech Republic. The risk factors connected with cardio-vascular diseases can be dividend into influenceable ones (nutrition, smoking, lack of physical exercise, alkohol consumption, hypertension, dyslipoproteineme, diabetes mellitus, obesity), into uncontrollable ones, (age, sex, genetic factors) and into behavioural ones, among which count psychosocial and economic factors. The mail aim of the work was to establish the extent as to the occurrence of risk factors in relation to men, who underwent an acute myocardial infarct and to determine the posibility of involving them in an active change in the lifestyle. The research proceeded in the form of questionnaires distributed at cardiological out-patients` departments in the region of Příbram.The data collection was under way from November 2009 to February 2010. The research was quantitative, the questionnaire was anonymous, in printed form, contained 29 questions and the respondents answered in writing. One thousand questionnaire were distributed, where of 231 fully completed questionnaires came back. The return rate of questionnaires were destined only for men, who underwent an acute myocardial infarct (two fundamentals identifications marks). I arrived to two hypotheses. The first was that the education of population played an important role in occurrence of cardio-vascular diseases and in awareness of influence of the lifestyle on reducing the risks connected with the development of these diseases. The second hypothesis was that the secondary prevention of risk factors connected with cardio-vascular diseases was not effetively and regorously applied to men, who underwent myocardial infarct. Both hypothese of mine proved to be right. The doctors and the learned public are doubtless well informed of the prevention and therapy as to the cardio-vascular diseases. The question is how effectively the professional information and recommendations find their way into the subconsciousness of our population. The research results show that an imaginary gap arises between recommended advices relating to the change in the lifestyle and in the positive influencing of influenceable and behaviour risk factors, the doctors give in thein routine practice. It is neccessary to create programmes of intervention in the lifestyle within the scope of a self-contained rehabilitation system. This system is applied on the occasion of spa care in the Czech Republic. The effect of the spa care is shortterm, lasts half a year to one year and there is no direkt further contact of the patient with dietary centres and with specialized physiotherapists. The recommendations concerning the change in the lifestyle should be popularized in the society as a whole in order to find their way into the wide subconsciousness of our population.

INTRODUÇÃO: Estudantes universitários apresentam frequências maiores de Dirigir sob efeito do álcool (DEA) e de uso pesado de álcool, assim como de uso nos últimos trinta dias, do que não-estudantes da mesma idade. O objetivo principal deste estudo foi avaliar a efetividade da Intervenção Preventiva (IP) relacionada a esses comportamentos entre estudantes da Faculdade de Medicina da Universidade de São Paulo (FMUSP), da cidade de São Paulo. Este estudo teve como objetivo secundário a tradução e a validação do Questionário baseado na Teoria de Proteção e Motivação (QPMT) para identificar aspectos cognitivos relacionados à avaliação de ameaças e de adaptação quanto ao DEA. MÉTODOS: O QPMT foi traduzido pela equipe técnica de acordo com metodologia da Organização Mundial da Saúde. A etapa de validação (EV), com desenho de estudo transversal, ocorreu entre estudantes do 1º ano da FMUSP/2007. Na Etapa de Intervenção (EI), o desenho do estudo foi o de seguimento. Estudantes do 2º ano da FMUSP/2007 responderam o QPMT e o AUDIT, para avaliação do padrão de consumo de álcool, no tempo zero (T0), no tempo um (T1) logo após as IP, e após um ano, no tempo dois (T2). Em T0, os estudantes foram divididos por sorteio em dois grupos, o grupo de intervenção (GI), que recebeu cinco IP de 15 minutos cada, e grupo controle (GC), que não recebeu IP. RESULTADOS: Todos os estudantes presentes à aula aceitaram participar da EV e responderam os questionários (n = 63). A consistência interna do QPMT foi satisfatória. Na EI, entre 106 estudantes presentes à aula, 91 concordaram em participar e responder os questionários, índice de resposta de 85,9%. Com relação ao DEA 40,5% dos estudantes do GI (n = 17/42) e 38,8% do GC (n = 19/49) referiram o comportamento, em T0 (p = 1,00). A regressão linear múltipla (RLM) demonstrou que, para o GI, aumentos na pontuação do AUDIT e menor percepção de ameaças e de respostas adaptativas para o DEA tiveram efeito preditivo na frequência da intenção de DEA (IDEA). Para o GC, apenas aumentos nas pontuações do AUDIT foram preditivos de maior IDEA. Quando comparados T0 e T2, apenas o GI apresentou redução significativa da média do AUDIT (p = 0,012). Em T2, o DEA foi referido por 45,4% dos estudantes do GI e 63,6% do GC (p = 0,027, comparando o GC entre T0 e T2) e o GI apresentou redução na IDEA. Na RLM em T2, aumentos na pontuação do AUDIT foram preditivos para a IDEA apenas para o GC. O Risco Relativo (RR) para o DEA foi 4,3% maior no GI do que no GC em T0, enquanto na avaliação em T2, o GC teve um RR 28,6% maior. CONCLUSÃO: Reduções no padrão de consumo de álcool e na proporção de IDEA são sugestivos de efetividade da IP em estudantes da FMUSP / INTRODUCTION: College students have higher rates of Driving Under the Influence of alcohol (DUI) and of heavy or last 30-days alcohol consumption than same age non-students. The main objective of this study was to evaluate the effectiveness of a Preventive Intervention (PI) related to these behaviors among university students of the Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo City. A secondary objective was to translate and validate a questionnaire with the Protection Motivation Theory (PMT) in order to recognize cognitive aspects related to threat and coping appraisals process of the DUI behavior METHODS: The PMT was translated by the research team according to the World Health Organization methodology. The Validation Phase (VP), with a cross-sectional design, assessed FMUSP 2007 first-year students. At the Intervention Phase (IP) a follow-up study was conducted. FMUSP 2007 second-year students answered the PMT and the AUDIT, to assess the pattern of alcohol consumption, at baseline, just after PI, and one year later. At baseline, students were randomly selected to an intervention group (IG) or a control group (CG). The IG was submitted to five PI of 15 minutes each. The CG didnt receive any intervention. RESULTS: All of the first-year students attending to a lecture accepted to participate and answered the questionnaires (n = 63). Internal consistency of the PMT was satisfactory. At the IP, from 106 students attending to a lecture, 91 accepted to participate and answered the questionnaires, a response rate of 85.9%. Rates of DUI at baseline were 40.5% for the IG (n = 17/42) and of 38.8% for the CG (n = 19/49, p = 1.00). The multiple linear regression (MLR) showed that for the IG, increasing of AUDIT scores and lower perceptions of threat and coping appraisals for DUI prevention were strong predictors of intention to DUI (IDUI). For the CG increasing of AUDIT scores were predictive of IDUI. Comparison between baseline and one-year follow-up showed that just the IG had significant reductions of the mean AUDIT score (p = 0.012). At follow-up, DUI was reported by 45.4% and by 63.6% of IG and CG students, respectively (p = 0.027 comparing CG results from baseline and follow-up), and the IG showed reductions in IDUI. MLR at follow-up showed that increasing AUDIT scores predicted IDUI just among the CG. Relative Risk (RR) for DUI among IG was 4.3% higher than for the CG at baseline, meanwhile, at follow-up, CG reached a 28.6% higher RR for DUI. CONCLUSION: Reductions in the pattern of alcohol use and in the proportion of IDUI were suggestive of effectiveness of PI among FMUSP students

O câncer configura-se como um problema de saúde pública e seu controle depende essencialmente de ações nas áreas da promoção da saúde, proteção específica e do diagnóstico precoce da doença. A efetividade das intervenções designadas para seu controle pode contar com o auxílio do processo de persuasão empregado. O presente estudo buscou avaliar o grau de risco para apresentação de câncer contemplando os fatores de risco pertinentes, bem como, avaliar a presença e as características da persuasão na comunicação para prevenção e detecção precoce de câncer. Trata-se de um estudo observacional, com caráter transversal, onde foram empregados dois instrumentos para o alcance dos objetivos; a população abordada foi de um bairro da cidade de Ribeirão Preto/SP. Constatou-se que os altos riscos foram para os cânceres de cólon/reto, cérvico e de endométrio; e moderados riscos para estes acrescidos de pulmão e mama. Quanto à persuasão, observou-se que houve o desencadeamento das informações acerca do câncer, no entanto estas não conseguiram manter-se efetivas por longos períodos; também não se identificou o reforço dessas informações. Portanto, diante do risco de câncer e dos comportamentos preventivos levantados, considera-se que a persuasão é uma estratégia útil para diminuição desses riscos e, de incentivo e manutenção de comportamentos preventivos; porém, ela deve conter todas as etapas do processo a fim de que não se perca a oportunidade de gerar comportamentos preventivos ou de detecção precoce. / The cancer is configured as a problem of public health and its control depends essentially on action in the areas of the promotion of the health, specific protection and of the precocious diagnosis of the illness. The effectiveness of interventions assigned for its control can count with auxiliare of the process of persuasion employed. This study aims to evaluate the risk level of developing cancer, considering the pertinent risk factors, and the presence of persuasion and characteristics in the communication regarding cancer prevention and early detection. It is an observational study, conducted on 110 inhabitants of a neighborhood in the city of Ribeirao Preto, Sao Paulo, Brazil. It was confirmed there are high risks for colon/rectum, cervical, and endometrial cancer; and moderate risks for these and also lung and breast cancer. In terms of persuasion, it was observed that cancer information was spread but was not sustained for long periods. Moreover, there was no reinforcement. In view of cancer risk and the identified preventive behaviors, persuasion is considered a useful strategy to reduce these risks as well as to encourage and sustain preventive behaviors, however it must contain all the stages of these process for doesn\'t lose the chance to develope preventive behaviors or precocious detection.

As doenças cardiovasculares se apresentam como uma das principais causas de morte e incapacidade na atualidade. Tais alterações compreendem a doença arterial coronariana ou isquêmica e apresentam etiologia multi-fatorial. No presente estudo objetivou-se avaliar os efeitos de uma intervenção cognitivo-comportamental sobre a qualidade de vida, sintomas depressivos, ansiosos e sob fatores de risco em pacientes isquêmicos que haviam apresentado um episódio agudo da doença nos últimos três meses. Participaram do estudo 71 pacientes, os quais foram divididos em dois grupos; controle (n=35) e experimental (n=36) e avaliados em três momentos: logo após o primeiro contato com pesquisadora; após 14 semanas (reavaliação) e depois de seis meses (seguimento). Nas avaliações os pacientes responderam a uma entrevista estruturada, ao Inventário de qualidade de vida da Organização Mundial de Saúde (WHOQUOL), ao Inventário de depressão de Beck (BDI) e ao Inventário de ansiedade de Beck (BAI). O grupo experimental foi submetido a um programa de intervenção cognitivo-comportamental, entre as duas primeiras avaliações. Este programa foi estruturado em oito sessões grupais semanais, com duração de duas horas cada. Durante as sessões foram trabalhadas técnicas de manejo de ansiedade, relaxamento e visualização, técnicas de resolução de problemas e discutidas informações sobre a doença cardíaca e seus fatores de risco (psicoeducação). Dentre os participantes, a maioria era do sexo masculino, tinham mais de 55 anos, era casada, haviam estudado por um período máximo de dez anos e se encontravam aposentados. Com relação aos dados sociodemográficos, não foram encontradas diferenças estatísticas entre os dois grupos. Verificou-se uma diminuição significativa do peso corporal e do índice de massa corpórea dentre os sujeitos do grupo experimental no decorrer das avaliações, bem como um aumento no número de atividades de lazer. Os resultados sugerem ainda uma diminuição dos sintomas depressivos dos pacientes do grupo experimental em relação aos do grupo controle, na reavaliação e no seguimento, e uma melhora na qualidade de vida do grupo experimental no decorrer das progressivas avaliações, o que não foi observado com relação ao grupo controle. Considera-se que o programa de intervenção cognitivo-comportamental apresentou resultados positivos na reabilitação de pacientes isquêmicos e na prevenção secundária da doença arterial coronariana, promovendo alterações físicas e emocionais importantes. / Cardiovascular diseases are presented as a major cause of death and disability in actuality. These changes include coronary artery disease or ischemic etiology and present multi-factorial. This study aimed to evaluate the effects of a cognitive-behavioral intervention on quality of life, depression, anxiety and under risk factors in ischemic patients who had shown an episode of acute illness in the last three months. Study participants were 71 patients, who were divided into two groups; control (n = 35) and experimental (n = 36) and evaluated in three times: soon after the first contact with researcher; after 14 weeks (revaluation) and after six months (follow up). In assessments the patients responded to a structured interview, the inventory quality of life of the World Health Organization (WHOQUOL), the Beck Depression Inventory (BDI) and the anxiety of Beck Inventory (BAI). The experimental group was subjected to a program of cognitive-behavioral intervention, between the top two ratings. This program has been structured into eight weekly group sessions, with duration of two hours each. During the sessions were worked techniques of management of anxiety, relaxation and visualization, techniques for solving problems and discussed information about heart disease and its risk factors. Among the participants, the majority were male, had more than 55 years, was married, had studied for a maximum period of ten years and were retired. With respect to sociodemographic data, no statistical differences were found between the two groups. There was a significant decrease in body weight and body mass index among the subjects of the experimental group in the course of the evaluations, as well as an increase in the number of leisure activities. The results also suggest a decrease in depressive symptoms of patients in the experimental group in relation to the control group, and following the revaluation, and an improvement in the quality of life of the experimental group in the course of progressive evaluations, which was not observed with respect the control group. It is considered that the programme of cognitive-behavioral intervention showed positive results in the rehabilitation of patients ischemic and secondary prevention of coronary artery disease, promoting physical and emotional changes important.

A dieta Mediterrânea (DM) tem sido amplamente estudada do ponto de vista epidemiológico porém, o efeito pleno específico da DM, bem como os mecanismos pelos quais esse padrão dietético contribui para redução do risco cardiovascular em prevenção secundária, são desconhecidos. Isso ocorre, em parte, devido à dificuldade de aderência observada em ensaios clínicos de intervenção dietética, especialmente estudos comparativos com dietas hipolipemiantes, por exemplo, a dieta TLC, Therapeutic Lifestyle Changes Diet (TLCD) do National Cholesterol Education Program-ATPIII. Assim, realizamos um estudo clínico, controlado, não randomizado, comparando o perfil de risco cardiovascular de dieta Mediterrânea (DM) versus dieta TLC (DTLC) em 40 pacientes com doença arterial coronariana, homogeneamente selecionados (45-65 anos de idade, homens, que tiveram ao menos um evento coronariano nos 2 últimos anos) e intensamente medicados. Uma questão paralela foi entender os efeitos de ambas as dietas nos processos de inflamação, disfunção endotelial e do estresse oxidativo, fatores-chave na aterogênese e particularmente importantes na prevenção secundária. Os hábitos culturais e dietéticos foram relevantes para alocação dos pacientes nos grupos de dieta Mediterrânea (n = 21; dieta rica em grãos integrais, vegetais, frutas, oleaginosas 10 g/dia, azeite de oliva extra-virgem 30 g/dia e vinho tinto 250 ml/dia) ou dieta TLC (n = 19; suplementada com fitosteróis 2g/dia através de creme vegetal 20 g/dia). Escores de aderência validados na literatura e específicos às dietas mostraram resultado > 90% no índice de aderência aos dois padrões dietéticos. Alguns efeitos foram comuns à dieta Mediterrânea e à dieta TLC. Com ambas, houve redução significativa de peso, índice de massa corporal (kg/m²), variáveis de composição corporal e pressão arterial. Além disso, ambas as dietas promoveram redução dos níveis plasmáticos de ADMA e da relação L-arginina/ADMA. A reatividade da artéria braquial dependente do endotélio permaneceu inalterada em ambos os grupos; no entanto, pacientes sob DM e sob DTLC melhoraram a velocidade de fluxo no momento basal (pré-hiperemia vascular). Outros efeitos foram específicos a cada padrão dietético. Com a DM, foram observados diminuição na contagem total de leucócitos versus DTLC (p =0.025) e aumento nos níveis de HDL-colesterol em 3 mg/dL (p = 0.053) versus DTLC, que mantiveram níveis de HDL-C inalterados. O diâmetro basal da artéria braquial aumentou com a DM, mas não com a DTLC. Com a DTLC, houve redução estatisticamente significante versus DM nas variáveis lipídicas colesterol total, LDL-colesterol (p < 0.05) e LDL oxidada (p = 0.009), embora a razão LDL oxidada/LDL total não tenha se alterado. Níveis séricos/plasmáticos de apolipoproteína A-1, lipoproteína(a), glicose, mieloperoxidase, sICAM, sVCAM, e as razões glutationa reduzida/oxidada em plasma e eritrócitos não se alteraram em ambos os grupos. Em conjunto, estes dados indicam um perfil de efeitos da DM e DTLC compatíveis com redução do risco cardiovascular, mesmo em pacientes intensamente medicados, em prevenção secundária. Embora estes efeitos tenham sido equivalentes entre DM e DTLC, eles parecem ser mediados tanto por alguns mecanismos comuns, como alguns mecanismos específicos de cada dieta / The Mediterranean Diet (MD) has been widely studied with respect to epidemiology, but mechanisms whereby the Mediterranean Diet (MD) is cardioprotective are unclear. This is partly because of the difficulties of adherence in clinical trials of dietary intervention, particularly trials comparing it to traditional lipid-restraining diets, e.g., Therapeutic Lifestyle Changes Diet (TLCD) from National Cholesterol Education Program ATPIII. We performed a controlled, non-randomized clinical trial comparing the cardiovascular risk profile of the Mediterranean Diet (MD) versus the TLC Diet (TLCD) in 40 selected, highly-homogeneous, and intensively medicated patients with coronary heart disease (45-65 years, males, at least one coronary event over prior 2 years). In addition, we sought to investigate both diets effects on inflammation, endothelial dysfunction and oxidative stress, all key factors in atherogenesis and particularly important in secondary prevention. Dietary/cultural habits were the basis to allocate patients for 3 months to either MD (n = 21; rich in whole grains, vegetables, fruits, nuts 10g/day, extra-virgin olive oil 30g/day, red wine 250ml/day) or TLCD (n = 19; plus phytosterols 2g/day). Specific scores showed that both diets had >90% adherence. Some effects were common to both diets. Patients in both groups showed a significant reduction in weight, body mass index, body composition and blood pressure. Also, both groups presented a reduction in plasma levels of ADMA and L-arginine/ADMA ratio. Endothelial-dependent brachial artery reactivity remained unaltered in both groups. However, patients under MD and TLCD improved flow velocity at baseline (prior to hyperemia). Nevertheless, other effects were specific to each diet. With MD, there was significant decrease in leukocyte count vs. TLCD (p = 0.03) and average increase in HDL-cholesterol by 3 mg/dL (p = 0.053) versus TLCD. The brachial arterials basal diameter increased with MD but not with TLCD. However, with TLCD there was a statistically significant reduction of lipid variables: total cholesterol, LDL-cholesterol (p < 0.05) and oxidized LDL (p = 0.009) vs. MD even though the ratio of oxidized / total LDL remained unaltered. Plasma and serum levels of apolipoprotein A-1, lipoprotein(a), glucose, myeloperoxidase, sICAM, sVCAM, and glutathione reduced/oxidized ratio in plasma and erithrocytes also remained unaltered in both groups. Together, these results demonstrate a pattern of effects of MD and TLCD compatible with cardiovascular risk reduction, in secondary prevention, even in intensely medicated patients. Although these effects were equivalent between MD and TLCD, they seem to be mediated by some common mechanisms, as well as by each diets specific mechanisms

Aims: The DETECT study was performed to obtain representative data about the frequency, distribution, and treatment of patients with coronary artery disease (CAD) in the primary care setting in Germany. Methods and results: The DETECT study was a cross–sectional clinical– epidemiological survey of a nationally representative sample of 3795 primary care offices and 55 518 patients. Overall, 12.4% of patients were diagnosed with CAD. Stable angina pectoris and myocardial infarction were the most frequent (4.2%) subgroups, followed by status post (s/p) percutaneous coronary interventions (PCI, 3.0%) and s/p coronary bypass surgery (2.2%). Patients with CAD were prescribed AT1 receptor antagonists (in 19.4% of cases), beta blockers (57.2%), ACE inhibitors (49.9%), antiplatelet agents (52.7%), statins (43.0%), and long–term nitrates (24.5%). When comparing all CAD patients with social health care insurance to those who had private insurance, private patients had significantly higher rates of revascularisation procedures and use of preventive medications. Conclusion: Great potential remains for improving secondary prevention in primary care in Germany to reduce the risk of further coronary or vascular events, especially in patients with social health care insurance.

Introducción: La prevención significa reducir factores de riesgo, detener el avance de la enfermedad y atenuar sus consecuencias (OMS). En el 2006, no se encontró asociación entre los determinantes sociales en los estudiantes de medicina de una universidad peruana, y la promoción y prevención de la salud. Como objetivo se planteó determinar si existe asociación entre tener familiares profesionales de la salud y haberse realizado una radiografía de tórax, en el último año, en estudiantes de medicina de una universidad peruana. Material y métodos: Transversal analítico; que utilizó una ficha de recolección de datos, probada en piloto para calcular tamaño muestral. La población comprendió estudiantes de medicina de una universidad peruana. Se realizó un muestreo aleatorio simple y se empleó Stata12 para análisis. Resultados: El 26,38% de encuestados se realizó una radiografía de tórax, principalmente por chequeo general (57,89%); aquellos que no fue predominantemente por falta de interés (60,38%). No se encontró asociación significativa entre las variables estudiadas (RP: 1,3 IC 95%: 0,6-2,9). Conclusión: No existe asociación significativa entre tener familiares profesionales de la salud y realizarse una radiografía preventiva. Más del 70% de casos con ausencia de placa son por falta de interés. / Introduction: Prevention is defined as the reduction of risk factors, detention in the progression of the disease and minimizing its consequences (WHO). In 2006, no association was found between social determinants among medical students in a Peruvian university, and health promotion and prevention. The main of the study is to determine if there is an association in having healthcare professional relatives and getting chest x-ray in the last year, in medical students from a Peruvian university. Materials and method: analytical transversal, in which a data collection form was used, tested in a pilot in order to calculate the sample size. The study population was medical students from a Peruvian University. We performed a simple random sampling and used Stata12 for the analysis. Results: 26,38% students got a chest x-ray, mainly because of general medical examination (57,89%), the ones who did not were mostly because of lack of interest (60,38%). We didn`t found a significant association between the studied variables (PR:1,3 IC95%:0,6-2,9). 31,58% of the interviewed with healthcare professional relatives and the 24,53% without healthcare professional relatives got the test. Conclusions: There is no significant association between having healthcare professional relatives and getting a preventive chest x-ray. More than 70% of the cases that did not get a chest x-ray are due to the lack of interest. / Tesis

The role of patent foramen ovale (PFO) in stroke was debated for decades. Randomized clinical trials (RCTs) have shown fewer recurrent events after PFO closure in patients with cryptogenic stroke (CS). However, in clinical practice, treating stroke patients with coexisting PFO raises some questions. This brief review summarizes current knowledge and challenges in handling stroke patients with PFO and identifies issues for future research. The rationale for PFO closure was initially based on the concept of paradoxical embolism from deep vein thrombosis (DVT). However, RCTs did not consider such details, limiting their impact from a pathophysiological perspective. Only a few studies explored the coexistence of PFO and DVT in CS with varying results. Consequently, the PFO itself might play a role as a prothrombotic structure. Transesophageal echocardiography thus appears most appropriate for PFO detection, while a large shunt size or an associated atrial septum aneurysm qualify for a high-risk PFO. For drug-based treatment alone, studies did not find a definite superiority of oral anticoagulation over antiplatelet therapy. Remarkably, drug-based treatment in addition to PFO closure was not standardized in RCTs. The available literature rarely considers patients with transient ischemic attack (TIA), over 60 years of age, and competing etiologies like atrial fibrillation. In summary, RCTs suggest efficacy for closure of high-risk PFO only in a small subgroup of stroke patients. However, research is also needed to reevaluate the pathophysiological concept of PFO-related stroke and establish strategies for older and TIA patients and those with competing risk factors or low-risk PFO.