M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2009 / Background: Herpes Simplex Virus type 2 (HSV-2) is a common cause of genital ulcers worldwide and has emerged as a co-factor in human immunodeficiency virus (HIV) acquisition and transmission. A study was conducted to determine the prevalence of HSV-2, its correlates, the accuracy of reported history of genital ulcer disease (GUD) to predict HSV-2 infection and the extent of symptom recognition in a clinic population in Johannesburg. Methods: 210 women aged 18 years or older were interviewed and socio-demographic, sexual behaviour and clinical information collected. Serological testing for HSV-2 and HIV infections was performed, but only where sera were available for the latter. Factors associations with HSV-2 infection were assessed using logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI). The sensitivity, specificity, predictive values and likelihood ratios of a history of GUD were calculated. Results: The estimated sero prevalence of HSV-2 was 73% (95% CI 67% - 79%). Few participants, 13/206 (6%) participants had knowledge of genital herpes. Only 9/203 (4%) participants recognised lesions of genital herpes following education and counselling about HSV-2 infection. HSV-2 infection was associated with older age(>25 years of age) OR 2.6 (95% CI 1.4-5.0), spending more than 2 nights away from home, OR 6.0 (95% CI 1.0-62.7), having more than 2 sexual lifetime partners, OR 2.2 (95% CI 1.1-3.9), a history of an STI in the past 3 months ,OR 3.6 (95% CI 1.2-9.5) and HIV infection, OR3.3( 95%CI 1.4-7.9). A history of genital ulceration performed poorly as a predictor of HSV-2 seropositivity; the sensitivity was 7% and specificity was 96%. Conclusion: HSV-2 prevalence was high and few participants were aware of their infection. HVS-2 infection was associated with risky sexual behaviour .A history of genital ulcer disease was not sufficient as a diagnostic tool for HSV-2 infection. Public health interventions should focus on behavioural modification and increasing awareness of genital herpes. HSV-2 management should be incorporated into HIV care and STI protocols.

M.A., Faculty of Humanities, University of the Witwatwersrand, 2011 / Posttraumatic growth has been an ongoing area of interest in the field of positive psychology. In recent years posttraumatic growth has been linked with the presence of posttraumatic stress symptomatology. The existence of posttraumatic growth has been validated in a number of cultures. There are certain domains that have been implicated in the construction of the phenomenon which taps into different aspects of people’s lives like relating to others, personal strength, new possibilities and appreciation of life. Particular interest has risen with regard to whether this phenomenon develops as a function of ethnic and cultural influences. This study aimed to investigate whether there are differences in posttraumatic growth and posttraumatic stress symptoms as a function of ethnocultural identity. This was investigated by the use of self-report measures of MEIM (Phinney, 1992), Traumatic Stress Schedule (Norris, 1990), Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996) and the Impact of Events Scale Revised (Weiss & Marmar, 1997). The sample consisted of 80 students from the Faculty of Humanities and the Faculty of Commerce, Law and Management, at the University of Witwatersrand. Results of the multivariate analysis showed that ethnocultural identity interacts with ethnicity to moderate posttraumatic stress symptoms. Specifically, findings suggested that Black South African and Indian students who identified with their ethnocultural heritage, reported fewer PTSD symptoms. Whereas the converse was true for White South Africans and Black Africans from other countries. The more they adopted ethnoculturally informed beliefs, the more likely they were to report symptoms of PTSD. There were no significant findings regarding ethnocultural identity in relation to posttraumatic growth. Implications for further research and clinical intervention are discussed.

Em uma amostra de 12 por cento da população urbana de Botucatu, São Paulo, constituída de 7.075 pessoas, foram identificados 525 indivíduos com sintomas sugestivos de doença respiratória crônica inespecífica (DRCI). Utilizando o questionário de sintomas respiratórios \"ATS-DLD-78\", aplicado por entrevistadores leigos, a autora determinou a prevalência de alguns sintomas e de associações sugestivas de asma brônquica, bronquite crônica e doença pulmonar obstrutiva crônica (DPOC). Os sintomas mais frequentes no sexo masculino, foram: tosse, expectoração e chiado, cuja prevalência foi de 6,2 por cento , 5,4 por cento e 5,3 por cento , respectivamente. No sexo feminino os sintomas mais frequentes foram: tosse, chiado, dispnéia e rinite alérgica cujas taxas de prevalência foram: 4,7 por cento , 4,7 por cento , 4,2 por cento e 4,0 por cento , respectivamente. Houve maior prevalência de sintomas respiratórios nos maiores de 50 anos de idade e nos menores de 15 anos. A prevalência média de sintomas sugestivos de asma brônquica foi de 5, 0 por cento , e de 1,9 por cento para bronquite crônica e de 0,1 por cento para DPOC. A influência do hábito de fumar, presente entre os sintomáticos respiratórios em 33,7 por cento dos homens e 23,4 por cento das mulheres, foi estudada em relação aos sintomas de tosse e expectoração pela manhã e aos sintomas sugestivos de bronquite crônica. Em vista dos resultados, a autora analisa e comenta a metodologia utilizada e a aplicabilidade do questionário \"ATS-DLD-78\" em nosso meio. Frente a escassez de dados relativos às DRCI, no Brasil, conclui sobre a necessidade de novos inquéritos epidemiológicos em regiões diferentes, realizados com metodologia adequada que possibilite a comparação dos resultados, complementados, quando possível, por estudos clínicos, tendo em vista o planejamento de medidas e programas de intervenção. / In a sample of 12 per cent of the urban population of Botucatu, São Paulo (7075 persons) submitted to a general health and life conditions survey, 525 people with symptoms of inespecific chronic respiratory diseases (ICRD) were detected. The \"ATS-DLD-78\" questionnaire for respiratory symptoms was applyed to these 525 people by non-medical interviewers, and from the collected data the prevalence of some symptoms and association of symptoms suggesting asthma, chronic bronchitis and chronic obstructive pulmonar disease (COPD) was determined. The most frequent symptoms in males were cough (6,2 per cent ), expectoration (5.4 per cent ) and wheezing (5.3 per cent ) and in females, cough (4.7 per cent ), wheezing (4.7 per cent ), dyspnea (4.2 per cent ) and allergic rhinitis (4.01). The prevalence os respiratory symptoms was greater before 15 after 50 years of age. The mean prevalence of symptoms suggesting asthma was 5.0 per cent , suggesting chronic bronchitis, 1.9 per cent and COPD 0,1 per cent . Tobacco smoking was presente in 33.7 per cent of symptomatic men and 23.4 per cent of the symptomatic women. There was a relation between smoking and the presence of morning cough and phlegm and symptoms of chronic bronchitis. The used metodology and the applicability of the \"ATS-DLD-78\" questionnaire to our population is analysed and commented. Taking into account the scarcity of data about ICRD in Brazil, the author concludes emphazising the need of another epidemiological surveys in different parts of the country, using tested and standardized methods that make possible a comparison of data, with the aim of planning intervention measures and programmes.

Made available in DSpace on 2016-08-10T10:53:30Z (GMT). No. of bitstreams: 1 FABIOLA CURADO.pdf: 968004 bytes, checksum: 6b4b82075a1b0e1f620232a1879668f9 (MD5) Previous issue date: 2010-11-05 / Silicosis, respiratory disease associated with occupational exposure to crystalline silica represents a serious public health problem, since, in spite of being potentially avoidable, presents high rates of incidense and prevalence, especially in less developed countries. Objectives: measure values of Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1) and Peak Expiratory Flow (PEF), verify the occurrence of respiratory symptoms characteristic of silicosis; test whether there is relevant differences between spirometric values and occurrence of respiratory symptoms length of employment, workers' age and smoking factor; test whether there is correlation between spirometric rates and length of employment, age and smoking habit. Methodology: The study was applied by descriptive analytical transversal methods. The studied sample was composed of workers from six companies in the field of stone processing industry (quarries / marble), one in Goiânia-GO district and the other five in the city of Pirenopolis-GO, totaling 56 workers. The method of data collection consisted in two questionnaires and a portable spirometry equipment. Results: Regarding the use of Collective Protection Equipment (CPE), 100% of the employees answered that there was collective protection, 73% related to ventilation with open shelter shed and 27% with semi-open shelter. Regarding to the exhaust ventilation, 100% of the employees related that there was not this kind of ventilation. Regarding the use of Personal Protective Equipment (PPE), specifically in the case of respiratory protection, the mask filter was used by 20 employees and mask without filter (made of fabric) by 36 employees. It can be stated that 100% of the workers wore masks for personal protection, covering any kind of mask, including inappropriate types. The result of the averages of the three spirometric rates presented a highly significant difference when compared to t normal average of reference (P < 0.0001). In the universe of 56 men surveyed, 40 men were symptomatic (71%). There was no statistically significant differences between spirometric values and exposure time (at about 5 years); symptomatic and asymptomatic; and between smokers and nonsmokers. There was statistically significant differences between spirometric values and age (at about 45 years old). At the correlation test showed that there was no statistically differences between spirometric rates and exposure time, number of cigarettes smoked and length of smoking habit. There was negative correlation between spirometric values and age. Conclusion: it was verified that the employees present a high percentage of symptomatic factor; for spirometric values changed significantly for the three indices studied compared with the reference literature. / Silicose, doença respiratória associada à exposição ocupacional ao cristalino, sílica, representa um sério problema de saúde pública, uma vez que, apesar de ser potencialmente evitável, apresenta altos índices de incidência e prevalência, especialmente nos países menos desenvolvidos. Objetivos: mensurar valores de Capacidade Vital Forçada (CVF), Volume Expiratório Forçado no 1º segundo (VEF) e Pico Fluxo Expiratório (PEF); verificar a presença de sintomas respiratórios, característicos de Silicose; testar se há diferença significativa entre os valores espirométricos e presença de sintomas respiratórios, tempo de serviço, idade dos trabalhadores e fator tabagismo; testar se há correlação entre os índices espirométricos e tempo de serviço, idade e hábito tabagista. Metodologia: o estudo foi do tipo descritivo - analítico, transversal. A população estudada foi composta por trabalhadores de seis empresas do ramo de beneficiamento de pedras (pedreiras/marmorarias), uma no município de Goiânia-GO e as outras cinco no município de Pirenópolis-GO, totalizando 56 trabalhadores. Os instrumentos de coleta de dados foram dois questionários e um equipamento de espitometria portátil. Resultados: em relação ao uso de Equipamento de Proteção Coletiva (EPC), 100% dos funcionários respondeu que existia proteção coletiva; 73% referente à ventilação do galpão aberto e 27% com galpão semi-aberto. Em relação à ventilação exaustora, 100% dos funcionários afirmou que não existia esse tipo de ventilação. Referente ao uso de Equipamento de Proteção individual (EPI), tratando-se especificamente de proteção respiratória, a máscara com filtro era utilizado por 20 funcionários e a máscara sem filtro (tecido) por 36 funcionários. Pode-se afirmar que 100% dos trabalhadores usavam máscaras de proteção individual, abrangendo qualquer tipo de máscara, inclusive não apropriadas. O resultado das médias dos três índices espirométricos apresentou uma diferença altamente significativa quando comparado às médias normais de referência (p < 0,0001). Dos 56 homens pesquisados, 40 homens apresentam-se sintomáticos (71%). Não houve diferença estatística significativa entre valores espirométricos e tempo de exposição (mais ou menos de 5 anos), sintomáticos e assintomáticos e tabagistas e não tabagistas. Houve diferença estatística significativa entre valores espirométricos e idade (mais ou menos de 45 anos). No teste de correlação verificou-se que não houve diferença estatística significativa entre os índices espirométricos e tempo de exposição, número de cigarros fumados e tempo de hábito tabágico. Houve correlação negativa entre os valores espirometricos e idade. Conclusão: verificou-se que os funcionários apresentam um alto percentual de fator sintomático; para os valores espirométricos houve alteração significativa para os três índices pesquisados comparados com a literatura de referência.

The aim of the current investigation is to explore potential subtypes of depressive symptomatology from a phenomenological vantage point, focusing on dimensions of positive human functioning and character strengths. The study examines distinct presentational depressive symptom clusters in light of recent research on developmental depression—defined as depressive symptomatology that may characterize periods of major life transition, existential upheaval, and personal growth. To inductively derive clusters, unique homogeneous classes are explored across depressive and positive psychological variables within a large heterogeneous sample of 3,806 emerging adults (aged 18-25, mean = 20.0, SD = 1.9). The present investigation utilizes two latent class analysis (LCA) models, both interpreted in light of the developmental depression hypothesis. Phase I examines a LCA model containing three depressive symptomatology clusters, including mood/anhedonia, somatic, and cognitive areas of depressive functioning. Average scores on spiritual, existential, positive psychological, and relational covariate variables are examined across classes. Phase II produces a LCA model that combines salient depressive symptomatology and positive psychological variables from Phase I into a unified model. Results suggest that distinct subtypes of depression may exist throughout emerging adulthood. An interpretation of these results that supports the developmental depression hypothesis is proposed.

Cows’ milk generally contains two types of β-casein, A1 and A2 types. A2 beta-casein is recognized as the original beta-casein variant because it was present before a proline to histidine point mutation occurrence in the polypeptide chain at 67th position. A1 and A2 are processed differently by digestive enzymes, and once milk or milk products are consumed, a seven-amino acid bioactive opioid peptide, beta-casomorphin-7, is released as a result of incomplete digestion of A1-beta-casein. This is a single-dose, randomized and double-blinded study. Participants received four different treatments (Regular milk, A2 milk, Jersey cow milk, and lactose free milk) in a randomized order. The lactose free milk acted as a negative control. This study aimed to evaluate tolerance to milks containing different levels of A2 β-casein (Jersey and A2 milks) as compared to commercial A1 (regularmilk containing both A1 and A2 β-casein) and lactose-free milk controls in lactose digesters and maldigesters. Seven subjects completed this double-blinded, randomized, crossover trial. Lactose malabsorption (LM) was determined by breath hydrogen test and milk intolerance were assessed by validated questionnaires. Treatments were fed as a single dose with a 6-day washout period to minimize any residual effects. Each subject was fed milk containing 0.5 g lactose per kg body weight. The pilot data from the seven subjects does strongly suggest greater hydrogen production from commercial A1 milk as compared to lactose-free, A2 and Jersey milks. Regular milk containing high A1 β-casein produced significantly higher hydrogen compared to lactose-free milk from 2 hours until 5hours. This suggests biologically relevant differences in lactose digestion among these milks. In addition, Jersey milk produced significantly higher hydrogen compared to lactose-free milk similar to regular milk between 2 and 6 hours while A2 milk was acting similar to lactose-free milk and did not result in increased hydrogen throughout the same time intervals. Taken together, these results suggest that the amount of A2 β-casein in Jersey milk was not adequate to attenuate the increased hydrogen concentration while pure A2 milk was effective. In this pilot clinical trial, abdominal pain, bloating, flatulence, diarrhea, fecal urgency and total GI symptoms were reported as measures of digestive discomfort. Although the mean values of total GI symptom scores were numerically lower on the lactose free, pure A2 and Jersey group compared to regular milk group, none were statistically different. With seven subjects reported in this pilot data, and a calculated sample size requirement of 26, we can interpret trends that ultimately could result in significant differences as additional subjects complete this protocol.

Orientadores: Sophie Françoise Mauricette Derchain, Luis Otávio Zanatta Sarian / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-11-07T13:25:01Z (GMT). No. of bitstreams: 1 Moraes_DenisedaRochaPittaLimade_D.pdf: 1846599 bytes, checksum: 5c83c44db1103b63041e2ceb928d48d4 (MD5) Previous issue date: 2012 / Resumo: Objetivo: Avaliar a acurácia da mesotelina, CA125, HE4 e índice ROMA na diferenciação de mulheres brasileiras com tumores malignos de ovário daquelas com tumores benignos e ou mulheres saudáveis, e avaliar se os sintomas específicos relatados pelas mulheres podem ser usados em associação à expressão desses marcadores séricos, na diferenciação pré-operatória de neoplasia maligna de ovário. Sujeitos e Métodos: Neste estudo de corte transversal foram incluídas 199 mulheres com massa anexial (67 com tumores malignos e 132 com tumores benignos) e 150 mulheres saudáveis. Todas as mulheres com massa anexial, atendidas no hospital do Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da UNICAMP, foram convidadas a participar do estudo. Um grupo-controle, de mulheres saudáveis atendidas nos ambulatórios de menopausa e planejamento familiar no mesmo hospital, foi selecionado. Após uma explicação sobre os métodos e objetivo da pesquisa, todas as mulheres responderam o questionário com relação aos sintomas específicos. Foram coletados dados sobre a idade e índice de massa corpórea e sangue periférico para quantificação da mesotelina, o CA125 e a HE4. Foi usado o algoritmo de particionamento recursivo baseado no modelo de regressão linear para verificar a contribuição da idade e de cada marcador sérico no diagnóstico de tumores malignos. Foram comparadas as áreas sob as curvas (AUCs) obtidas através das curvas ROC (Receiver Operator Characteristics) de cada marcador sérico e índice ROMA, para diferenciar mulheres com tumores malignos. Foi calculada a proporção de mulheres com cada um dos 22 sintomas específicos nos grupos com tumores malignos de ovário, tumores benignos e mulheres saudáveis. O sintoma foi considerado positivo quando ocorria mais que 12 vezes ao mês e por até um ano. A proporção de sintomas foi comparada utilizando teste de qui-quadrado ou teste exato de Fischer, quando apropriado. Os 16 sintomas específicos aplicáveis a toda a coorte e para o qual a periodicidade foi verificada foram submetidos à análise pelo Método de Ward para agrupamento hierárquico. Os agrupamentos de sintomas e sintomas isolados identificados foram: abdômen (abdômen inchado e/ou aumento do volume abdominal); dor (dor pélvica, costas e/ou abdominal); pernas inchadas; digestão (estômago cheio e/ou náusea /vômito); alimentação (dificuldade para comer e/ou empachada); sente alguma massa abdominal; diversos (fadiga e/ou dificuldade para respirar); bexiga (urgência em urinar e/ou urinar frequentemente). Foi avaliada a proporção de mulheres com cada agrupamento de sintomas ou sintomas isolados em mulheres com tumores malignos, tumores benignos e saudáveis, através do teste qui-quadrado para tendências. Utilizou-se um algoritmo de particionamento recursivo para verificar a contribuição da idade da mulher, de cada agrupamento de sintomas ou sintomas isolados, estado menopausal, perda de peso e marcadores séricos no diagnóstico de tumores malignos. Resultados: O CA125 foi o marcador sérico com maior capacidade para discriminar mulheres com tumores malignos (p<0,001). Entre as mulheres com tumores benignos e CA125 positivo, a HE4 foi positiva em apenas um caso e a mesotelina foi positiva em outro. Em mulheres com CA125 negativo, a idade, a mesotelina e a HE4 não contribuíram para a diferenciação entre mulheres com tumores malignos, tumores benignos e saudáveis. Em contrapartida, em mulheres com CA125 positivo, a HE4 contribuiu significantemente para detecção de mulheres com tumores malignos (p<0,01). A AUC da mesotelina foi menor que das AUC dos outros marcadores. O ROMA e o CA125 apresentarm melhores AUCs do que o HE4. A proporção de mulheres com cada um dos agrupamentos de sintomas ou sintomas isolados foi significativamente maior em mulheres com tumores malignos, quando comparadas àquelas com tumores benignos e, destas, comparadas com as mulheres saudáveis (p tendência em todas as comparações <0,01). Após a análise multivarida, as associações mais significativas para detecção de tumores malignos de ovário foram as do agrupamento abdômen (p<0,001), expressão do CA125 (p<0,001), agrupamento dor (p=0,01) e perda de peso (p=0,03). Conclusões: Em mulheres com CA125 negativo, a mesotelina e HE4 não contribuíram para detecção do carcinoma de ovário. Entretanto, em mulheres com CA125 positivo, a HE4 contribuiu para diferenciar aquelas com tumores malignos. Em mulheres com tumores malignos de ovário, os sintomas específicos, abdômen e dor foram significantemente mais frequentes. Podem ser utilizados em associação ao CA125 na diferenciação de tumores malignos em mulheres com massa anexial / Abstract: Objective: To evaluate the accuracy of mesothelin, CA125, HE4 and ROMA index in the differentiation of Brazilian women with ovarian malignant tumors from those with benign tumors or healthy women; and to evaluate whether the prevalence of specific self-reported symptoms can be used in association to the expression of serum markers for the preoperative differentiation of ovarian malignant tumors. Study Design: For this cross sectional study, 199 women with adnexal mass (67 with malignant tumors and 132 with benign tumors) and 150 healthy women were included. All women with adnexal masses, attending the hospital of the Department of Obstetrics and Gynecology of the Unicamp School of Medicine were invited to participate in the study. A control group of healthy women attending menopause and family planning clinics at the same hospital were selected. After an explanation about the study research methods and purpose all women answered a survey regarding specific symptoms. There were also collected data on age and body mass index. Peripheral blood was collected for serum measurements of mesotelina, CA125 and HE4. A recursive partitioning algorithm, based on a linear regression model was used to confirm the contribution of age and each of the serum markers to the diagnosis of malignant tumors. Comparison of Area Under the Curve (AUC) obtained through Receiver Operator Characteristics (ROC) curves for each of the serum markers and ROMA index were used to differentiating women with malignant tumors. We next calculated the proportion of women with each of the 22 specific symptoms in the groups of women with ovarian malignant tumors, benign tumors and healthy women. We considered a symptom positive if it occurred more than 12 times per month and for less than one year. The proportions were pairwise compared using chi-square or the Fisher exact test where appropriate. The 16 specific symptoms which applied to the entire cohort and for which the periodicity had been ascertained were further subjected to the Ward's Hierarchical Clustering Method. Clusters of symptoms and isolated symptoms were: abdomen (abdominal bloating and/or increased abdomen size); pain (pelvic, back and/or abdominal pain); leg swelling; digestion (indigestion and/or nauseas /vomiting); eating (unable to eat normally and/or feeling full quickly); able to feel abdominal mass; miscellaneous (fatigue and/or difficulty breathing); bladder (urinary urgency and/or frequent urination). We evaluated the trend in proportion of women with each cluster of symptoms in the groups of women with malignant tumors, benign tumors and healthy women using the chi-squared test for trend in proportions. Another recursive partitioning algorithm was used to confirm the contribution of patient age, clusters of symptoms, menopausal status, weight loss and the serum markers to the diagnosis of malignant tumors Results: CA125 was the serum marker that had the greatest capacity to discriminate women with malignant tumors (p<0.001). Among the women with benign tumors and positive CA125, HE4 was positive in only one case and mesothelin in another case. In women with negative CA125 neither age nor mesothelin nor HE4 contributed any further to the differentiation between women with malignant, tumors benign tumors and healthy women. In contrast, for women with positive CA125, HE4 contributed significantly to the detection of women with malignant tumors (p<0.01). The AUC for mesothelin was smaller than that for all the other curves, and ROMA and CA125 had better AUC than HE4. The proportion of women with each of the clusters of symptoms and isolated symptoms decreased significantly from the group of women with malignant tumors to that with benign tumors and from this group to the healthy women (p for trends in all comparisons= <0.01). After a multivariate analysis the association that contributed the most to the detection of malignant ovarian tumors was that of the abdomen cluster (p<0.001), CA125 expression (p<0.001), pain cluster (p=0.01) and weight loss (p=0.03). Conclusion: In women with negative CA125 neither mesothelin nor HE4 contributed to detect ovarian carcinoma. HE4 was helpful to differentiate malignant tumors when CA125 is positive. Specific symptoms, abdomen and pain were significantly higher in women with malignant ovarian tumors and may be used along with the CA125 to select women with ovarian malignancy among those with adnexal masses / Doutorado / Oncologia Ginecológica e Mamária / Doutora em Ciências da Saúde

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / Introduction: Obstructive Sleep Apnea Syndrome (OSAS) in children, as defined by the American Thoracic Society, is a disorder of breathing during sleep characterized by prolonged partial airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns. Objective: This study aimed to investigate retrospectively the prevalence of OSAS among children aged 6 to 12 years old, evaluated through polysomnography and sleep questionnaires between 2011 and 2012, analyzing severity, symptoms and associated risk factors. Methods: We evaluated 63 children referred to the Sleep Laboratory of the Dell Childrenâs Hospital in Austin, Texas (USA) with suspition of Sleep Disordered Breathing. The patients were submitted to a pre-sleep questionnaire and to polysomnography. Results: The mean age was 8,8 Â1,9 years old, and 55,6% of the children were male. Children without OSAS accounted for 30,2% of the sample. The OSAS observed in the remainder was mild in 49,2%, moderate in 11,1% and severe in 9,5%. Gender and age were not associated with OSAS. Hispanic and African-American children were at higher risk for OSAS. Twenty two hispanic children presented OSAS ( 88%) and ten African-american children presented OSAS (83,3%). In children with OSAS, the most common symptoms were: snoring (86%), periodic limb movements (64,3%), arousals during sleep (60,5%) and restless sleep (58,1%). Excessive daytime sleepiness was reported in only 33,3% of the patients. Bruxism was more prevalent among the patients without OSAS (52,6%) than in the patients with OSAS (31%). Overweight children were at higher risk for OSAS. Conclusions: Overweight children are at a higher risk for developing OSAS. Hispanic and African American children presented a higher risk for developing OSAS. Age and gender were not associated to the diagnose of OSAS. Bruxism was more prevalent among the children who did not present OSAS. / IntroduÃÃo: Em crianÃas, a SÃndrome da Apneia Obstrutiva do Sono (SAOS) à um distÃrbio respiratÃrio caracterizado por obstruÃÃo parcial prolongada e/ou episÃdios intermitentes de obstruÃÃo completa da via aÃrea superior, que interrompe a ventilaÃÃo normal e o padrÃo normal de sono. Objetivo: Este trabalho buscou investigar a prevalÃncia de SAOS entre crianÃas de seis a doze anos de idade, avaliadas por meio de polissonografia e questionÃrio sobre o sono, no perÃodo de 2011 a 2012, avaliando gravidade, sintomatologia e fatores de risco associados. MÃtodos: Foram estudadas 63 crianÃas encaminhadas ao LaboratÃrio do Sono do Dell Childrenâs Hospital em Austin, Texas (EUA) com suspeita de Transtornos RespiratÃrios do Sono. Os pais preencheram um questionÃrio sobre o sono, jà rotineiramente utilizado como padrÃo para todos os pacientes encaminhados para polissonografia no Dell Childrenâs Hospital (ApÃndice A). Em seguida, as crianÃas foram submetidas ao exame polissonogrÃfico. Resultados: A idade mÃdia foi de 8,8Â1,9 anos, sendo 55,6% das crianÃas do sexo masculino. NÃo apneicos corresponderam a 30,2% dos investigados. SÃndrome da Apneia Obstrutiva do Sono em grau leve ocorreu em 49,2%, moderado em 11,1% e grave em 9,5%. NÃo foi encontrada diferenÃa entre a incidÃncia de SAOS entre meninos e meninas. Observou-se uma associaÃÃo estatisticamente significante entre raÃa e presenÃa/ausÃncia de SAOS, sendo que as crianÃas negras e hispÃnicas apresentaram maior risco de SAOS do que as crianÃas brancas. Entre os hispÃnicos, 88% dos pacientes apresentaram SAOS (n=22); nos negros 83,3% (n=10) e nos brancos 46,7% (n=7). Dentre as crianÃas diagnosticadas com SAOS, os sintomas mais frequentes foram: ronco (86%) movimentos periÃdicos de membros (64,3%), despertares durante o sono (60,5%) e sono agitado (58,1%). SonolÃncia excessiva foi relatada apenas em 33,3% dos casos. O bruxismo foi relatado com maior frequÃncia no grupo sem SAOS (52,6%) do que no grupo de pacientes com diagnÃstico de SAOS (31%). CrianÃas com sobrepeso apresentaram maior risco de desenvolver SAOS (100%) (Testes Qui quadrado e exato de Fisher). ConclusÃes: Sobrepeso à um fator de risco para SAOS. CrianÃas da raÃa hispÃnica e negra apresentaram maior risco a SAOS. Sexo e idade nÃo se associaram a SAOS. O bruxismo foi mais frequentemente relatado por pacientes que nÃo demonstraram SAOS.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-11T20:58:32Z No. of bitstreams: 1 AndreAlmeida.pdf: 1209602 bytes, checksum: 5e9d024317045cd5c5e47ebea29cf505 (MD5) / Made available in DSpace on 2017-05-11T20:58:32Z (GMT). No. of bitstreams: 1 AndreAlmeida.pdf: 1209602 bytes, checksum: 5e9d024317045cd5c5e47ebea29cf505 (MD5) Previous issue date: 2016-06-10 / Respiratory symptoms are an important cause of mothers seeking health services; We can characterize them according to the presence of one or more symptoms, such as coughing, wheezing, difficulty breathing, runny nose; the study aimed to examine the respiratory symptoms and related factors in children and 36 months. Crosssectional study a nested cohort "etiological factorsof preterm birth and perinatal factors consequences in child health: birth cohorts in two Brazilian cities" – BRISA (Brasilian Birth Cohort Studies) the sample used were the information of the second moment of the cohort, conducted with mothers and children, these 1 to 3 years, with total 3306. The results showed the mother's other children (50.03%), lives with up to 4 people at home (68.43%), have an income less than minimum salary (26.76%), do not have adequate schooling to the age (35.30%), children were breastfed exclusively until the sixth month of life (59.09%), were born of natural childbirth (51.16%), respiratory symptoms (46.52%), father/mother or brothers with a history of asthma (15.48%) parent or sibling with a history for rhinitis (30.01%). The relationship between the independente and dependent variables was estimated in univariate analysis Chi-square test with a significance level of 5%. There was statistical significance between the variable respiratory symptoms and the presence of other children (57.41%) p=0.0001, economic class C(53.39%) p=0.007, children born of natural childbirth p=0.005, asthma and family history (61.72%) p=0.0001, family history for rhinitis (57.42%) p=0.003, smokers in the home (58.29%) p=0.041 and adequate schooling mother (50.67%) p=< 0.0001. The study showed that the assessment of respiratory symptoms and related factors when are important instrument in the quest for better service the child and his family, the nurse should identify early those factors and be able to give attention and quality. / Os sintomas respiratórios constituem uma importante causa das mães procurarem os serviços de saúde, podem ser caracterizados de acordo com a presença de um ou mais sintomas, como: tosse, chiado no peito, dificuldade de respirar, coriza; o estudo teve como objetivo analisar os sintomas respiratórios e os fatores relacionados em crianças menores e 36 meses. Estudo transversal descritivo aninhado a uma coorte “Fatores etiológicos do nascimento pré-termo e consequências dos fatores perinatais na saúde da criança: coortes de nascimento em duas cidades brasileiras” - BRISA (Brasilian Birth Cohort Studies) os dados da amostra utilizada foram das informações do segundo momento da coorte, realizado com as mães e crianças, estas com idade entre 1 a 3 anos, total de 3306. Os resultados mostraram a mãe que tem outros filhos (50,03%), mora com até 4 pessoas no domicílio (68,43%), tem uma renda menor que um salário mínimo (26,76%), não apresentam escolaridade adequada para a idade (35,30%), as crianças foram amamentadas exclusivamente até o sexto mês de vida (59,09%), nasceram de parto normal (51,16%), apresentaram sintomas respiratórios (46,52%), pai/mãe ou irmãos com histórico de asma (15,48%) pai/mãe ou irmãos com histórico para rinite (30,01%). A relação entre as variáveis independentes e dependentes foi estimada na análise univariada pelo teste qui-quadrado com nível de significância de 5%. Houve significância estatistica entre a variavel sintomas respiratórios e presença de outros filhos (57,41%) p=<0,0001, classe econômica C (53,39%) p=0,007, crianças nascidas de parto normal p=0,005, histórico familiar para asma e (61,72%) p=<0,0001, histórico familiar para rinite (57,42%) p=0,003, fumantes no domicilio (58,29%) p=0,041 e a escolaridade adequada da mãe (50,67%) p=<0,0001. O estudo mostrou que a análise dos sintomas respiratórios e fatores quando relacionados são instrumento importante na busca por uma melhor atendimento a criança e sua família, o enfermeiro deve identificar precocemente esses fatores e estar capacitado para dar atenção direcionada e com qualidade

O presente estudo aborda a função dos sintomas das doenças inflamatórias intestinais (DII) para o sujeito do ponto de vista do referencial psicanalítico. Partimos da solicitação de intervenção junto a portadores de DII, feita pela equipe médica, que havia observado uma dependência psíquica extremada entre paciente e cuidador (em sua maior parte, mães), que parecia colaborar na manutenção das manifestações clínicas da doença, dificultando a condução do tratamento médico. Consideramos o referencial teórico psicanalítico apropriado para darmos encaminhamento à nossa questão, tendo em vista que a matriz freudiana e as contribuições de Lacan nos levam além da constatação de um ganho secundário relacionado ao adoecimento, ao pensarmos o sintoma como modo de gozo, implicando o efeito da palavra no real do corpo. Analisamos três casos de pacientes com doenças inflamatórias intestinais (DII), sendo um caso com retocolite ulcerativa e os demais com doença de Crohn, com objetivo de discutir as formas pelas quais o sintoma orgânico pode fazer o enlaçamento do sujeito com seu corpo e com o Outro. No primeiro caso, pudemos ver que os sintomas da retocolite faziam suplência, servindo como o significante que faltou para interpretar o desejo materno, único recurso da paciente para enlaçar-se ao Outro. No segundo caso, a função dos sintomas da doença de Crohn foi revelar a relação sintomática do casal parental e encobrir o que estava em jogo para à sujeito na assunção da sexualidade. No terceiro caso, os sintomas físicos encobrem a ausência de um saber acerca do sexo e da feminilidade. A concepção de corpo libidinal permite considerarmos as manifestações somáticas como algo próprio do sujeito. O sintoma, como modo de gozo, é a própria junção do significante com o corpo do ser vivo que fala, podendo ser chamado de acontecimento de corpo. Entendemos que o sintoma decorre da forma como o sujeito interpretou seu lugar no desejo do Outro, e, reciprocamente, como o discurso do Outro afetou seu corpo, produzindo gozo. Concluímos que, o sintoma somático está intimamente ligado à posição que o sujeito assume em relação ao desejo do Outro, o que determinará as vicissitudes de seu adoecimento. O caráter crônico de certas doenças é um fator a dar fixidez a esse modo de existir e de se relacionar com o Outro. Pela perspectiva psicanalítica, as DII, bem como qualquer outra doença crônica, são tidas como acontecimentos de corpo, independentemente de presumíveis fatores emocionais aventados em sua patogenia. Entender o adoecimento crônico dessa forma permite abordá-lo pela palavra, mobilizando o gozo específico de cada um para produzir mudanças subjetivas. Tais deslocamentos possibilitam ao sujeito inscrever seu mal-estar fora da esfera do adoecimento físico. / The current study was aimed at assessing the function of the manifestations of inflammatory bowel diseases (IBD) to the subject, from a psychoanalytical perspective. The medical staff of our institution has observed a deep psychological dependency between the patient and the one who takes care of him, the mother in most of the times, which required the intervention of the Psychology Division. According to those observations, the dependency seemed to contribute to the maintenance of the symptoms and to hamper medical therapy. To our knowledge, the psychoanalytical theory was appropriate to this investigation, since the contributions of Freud and Lacan strengthen the notion of secondary gain derived from an illness, consider symptom as a way of jouissance and implicate the effect of the speech in the body. Three patients with IBD were analyzed in the current investigation (one patient had ulcerative proctocolitis and two had Crohn disease).Our aim was to assess the function of the disease in the life of each patient. In the first case, we could observe the suppletive function of symptoms of IBD, which played the role of the missing signifier for the interpretation of the mother desire, representing the last resource of the patient in order to articulate with the Other. In the second case, the function of Crohn disease symptoms was to disclose the symptomatic relationship of the parental couple and to cover interplaying factors of the sexuality of the subject. In the third case, physical symptoms had hidden the unawareness about sex and femininity. According to the concept of libidinal body, somatic manifestations of a disease are something related to one\'s own subject. The symptom, understood as a way of jouissance, is the association of the signifier with the body of the human being that talks, and may be denominated events in the body. We are aware that the symptom is a consequence of the way the subject has interpreted his own place in the desire of the Other and, reciprocally, as the speech of the Other has affected his body to produce jouissance. In summary, somatic symptoms are c1osely related to the position of the subject regarding the desire of the Other and this is an important determinant of the characteristics of the sickness process. In this regard, the chronic course of some diseases is a factor that may contribute to the strong attachment of one\'s subjective position to the Other. By the psychoanalytical point of view, the IBD and any other chronic disease are events in the body, regardless of presumed emotional factors involved in their pathogenesis. Such understanding of the chronic sickness process gives grounds for a therapeutic approach by the speech, mobilizing the specific jouissance to produce changes in the subjective position of the analysand. Those changes will displace the ill-being to outside the field of physical sickness.