Riscos ocupacionais e acidentes de trabalho em um serviço de atendimento móvel de urgência do Rio Grande do Norte

Exploratory, descriptive and quantitative study with prospective data, performed in the Mobile Emergency Care Service in the metropolitan region of Natal/RN, in order to identify the knowledge of the multidisciplinary team about the rules of standard precautions and worker safety, to identify occupational hazards peculiar to the activities of this service; characterize work-related accidents (WRA) and know the procedures adopted after each WRA. The population consisted of 162 professionals and data were collected between the months of November and December 2010. As for personal and professional characteristics, of the 162 professional, 12,96% were physicians; 6,79%, nurses; 33,95%, nursing technicians, 46,29%, conductors; 74,70% were male; 43,21% were between 31 and 40 years old; 69,33% lived in Natal/RN, 50,00% had completed high school; 58,64% were married; 69,75% had children, 46,91% were between 1 and 4 years of training; 61,73% had improvement courses; 59,25% had 3 to 4 years of service; 54,32%, with 1-4 years experience in emergency; 44,44% received 1-2 minimum wages; 78,40% received insalubrity premium; 67,28% worked in Basic Support Unit (BSU); 83,95% had journey on SAMU Metropolitano of 31-40 hours per week; 52,47% had other employments. As for knowledge of rules of standard precautions, safety and occupational hazards, 99,38% knew what it was WRA; 62,96% gave incomplete answers; 74,07% knew the rules of prevent WRA; 46,67% acquired this knowledge in lectures; 53,09% knew Personal Protective Equipment (PPE); 71,60% gave incorrect answers about the importance of standard precautions; 45,06% never received an educational intervention on this issue; 89,51% said that educational interventions in the prevention of WRA are very important; 90,12% pointed out this as a very important issue in the workplace; 27,00% suggested guidance on the topic in the workplace; regarding the physical hazards, 34,57% considered noise as the most important; about chemical hazards, 78,40% chose the gases and smoke; for biological hazards, 48,77% reported contact with the blood; for mechanical hazards, 80,86% said that were transport accidents; about ergonomic risks, 40,12% say it is the tension/stress in the care of critically ill, psychiatric and aggressive patients; and there was an average of 4,5 to the feeling of safety in the workplace. Regarding the data on the WRAs occurred, 31,48% experienced at least one accident event; 72,55% did not notify it; 60,98% answered that there was no routine for notification; 56,86% were performing patient transportation; 49,02% were hurt in the Basic Support Unit/Rescue Unit (BSU/RH); 60,78% occurred during the day; 96,08% of professionals were in normal work schedule (24 hours on duty); 31,37% had contusion; 58.82% had damage to members/pelvic girdle; 43,14% had traffic accidents. About the evolution of the WRA, 62,75% did not have to take time away from work; 76,47% had no sequelae; 88,24% did not require rehabilitation; no professional had a change of occupation. And by means of univariate logistic regression, showed that the nurses and male sex were risk factors for the occurrence of WRA. We conclude that there were gaps in the knowledge of staff regarding WRA, emphasizing the need for continuing education in biosafety in the service.

Acurácia dos indicadores clínicos do diagnóstico de enfermagem volume de líquidos excessivo em pacientes submetidos à hemodiálise

Trasnversal study, with the objective of evaluating the accuracy of clinical indicators of nursing diagnosis excessive fluid volume in patients undergoing hemodialysis. The study occurred in two stages, the first consisted of the evaluation of the diagnostic indicators in study; and the second, the diagnostic inference conducted by nurse diagnosticians. The first stage occurred from december 2012 to april 2013, in a University Hospital and a Hemodialysis Clinic in Northeastern of Brazil, with a sample of 100 chronic renal failure patients on hemodialysis. The data were selected through an interview form and a physical examination, organized into spreadsheets and analyzed as to the presence or absence of the indicators of diagnosis excessive fluid volume. In the second step, the spreadsheets were sent to three nurses diagnosticians, who judged the presence or absence of diagnosis in the clientele searched. This step was conducted from july to september 2013. For analysis of the data, we used descriptive and inferential statistics. In the descriptive analysis, we used measures of central tendency and dispersion. In inferential analysis, we used the tests Chi- square, Fisher and prevalence ratios. The accuracy of the clinical indicators pertaining to the diagnosis were measured as to the specificity, sensitivity, predictive values, likelihood ratios and Diagnostic Odds Ratio. Also developed a logistic regression. The results were organized in tables and discussed with literature. This study was approved by the Ethics Committee in Research of the Federal University of Rio Grande do Norte, with Presentation Certificate for Ethics Appreciation nº 08696212.7.0000.5537. The results revealed that the diagnosis studied was present in 82% of patients. The characteristics with prevalence above 50 % that stood out were: azotemia, decreased hematocrit, electrolyte imbalance, intake exceeds output, anxiety, edema, decreased hemoglobin, oliguria and blood pressure changes. Eight defining characteristics were presented statistically significant association with the nursing diagnosis investigated: pulmonary congestion, intake exceeds output, electrolytes imbalance, jugular vein distension, edema, weight gain over short period of time, agitation and adventitious breath sounds. Among these, the 10 characteristics which showed higher prevalence ratios were: edema and weight gain over short period of time. The features with the highest sensitivity were edema, electrolytes imbalance and intake exceeds output and the standing out with greater specificity were: anasarca, weight gain over short period of time, change in respiratory pattern, adventitious breath sounds, pulmonary congestion, agitation and jugular vein distension. The indicators jugular vein distension, electrolytes imbalance, intake exceeds output, increased central venous pressure and edema, together, were identified in the logistic regression model as the most significant predictors. It is concluded that the identification of accurate clinical indicators allow a good prediction of the nursing diagnosis of excessive fluid volume in patients undergoing hemodialysis in order to assist the nurse in the inference process, which will contribute to the success of patient care. In addition, nurses will consider for diagnostic inference not only his clinical experience, but also scientific evidence of the occurrence of excessive fluid volume, contributing to the control of volemia in these patients

Fatores que afetam a satisfação e a fidelidade do consumidor: um estudo com usuários de calçado esportivo (tênis), na Região Sul da cidade de Natal

This paper aims to investigate the factors that influence the satisfaction and fidelity of tennis´s users with the region southern city of Natal, capital of Rio Grande do Norte as the area of analyzing , using the national satisfaction index models as a tool to study. In this study was used the questionnaire as a tool for collecting data based on the new Norwegian customer satisfaction barometer model proposed by Johnson et. al. (2001). The data collection took place during the months of May and June 2008, when 450 tennis´s users were interviewed. The main results obtained by multiple regression analysis and logistic regression showed that the users' satisfaction with the tennis´s brand is influenced by the quality, comfort, material used in the manufacture and price, while fidelity is potentized by the image of the brand and the satisfaction degree with the user's tennis and with the brand of tennis. In relation to user satisfaction with the tennis, that satisfaction is influenced by the quality, comfort, weight and the material used, while fidelity is potentized by the satisfaction with the tennis´s brand, with the possibility of paying the same amount again and the emotional commitment. As the processing of claims there was no direct influence on satisfaction and consumers fidelity due to the low number complaints

Metodologia estatística na solução do problema do caixeiro viajante e na avaliação de algoritmos : um estudo aplicado à transgenética computacional

The problems of combinatory optimization have involved a large number of researchers in search of approximative solutions for them, since it is generally accepted that they are unsolvable in polynomial time. Initially, these solutions were focused on heuristics. Currently, metaheuristics are used more for this task, especially those based on evolutionary algorithms. The two main contributions of this work are: the creation of what is called an -Operon- heuristic, for the construction of the information chains necessary for the implementation of transgenetic (evolutionary) algorithms, mainly using statistical methodology - the Cluster Analysis and the Principal Component Analysis; and the utilization of statistical analyses that are adequate for the evaluation of the performance of the algorithms that are developed to solve these problems. The aim of the Operon is to construct good quality dynamic information chains to promote an -intelligent- search in the space of solutions. The Traveling Salesman Problem (TSP) is intended for applications based on a transgenetic algorithmic known as ProtoG. A strategy is also proposed for the renovation of part of the chromosome population indicated by adopting a minimum limit in the coefficient of variation of the adequation function of the individuals, with calculations based on the population. Statistical methodology is used for the evaluation of the performance of four algorithms, as follows: the proposed ProtoG, two memetic algorithms and a Simulated Annealing algorithm. Three performance analyses of these algorithms are proposed. The first is accomplished through the Logistic Regression, based on the probability of finding an optimal solution for a TSP instance by the algorithm being tested. The second is accomplished through Survival Analysis, based on a probability of the time observed for its execution until an optimal solution is achieved. The third is accomplished by means of a non-parametric Analysis of Variance, considering the Percent Error of the Solution (PES) obtained by the percentage in which the solution found exceeds the best solution available in the literature. Six experiments have been conducted applied to sixty-one instances of Euclidean TSP with sizes of up to 1,655 cities. The first two experiments deal with the adjustments of four parameters used in the ProtoG algorithm in an attempt to improve its performance. The last four have been undertaken to evaluate the performance of the ProtoG in comparison to the three algorithms adopted. For these sixty-one instances, it has been concluded on the grounds of statistical tests that there is evidence that the ProtoG performs better than these three algorithms in fifty instances. In addition, for the thirty-six instances considered in the last three trials in which the performance of the algorithms was evaluated through PES, it was observed that the PES average obtained with the ProtoG was less than 1% in almost half of these instances, having reached the greatest average for one instance of 1,173 cities, with an PES average equal to 3.52%. Therefore, the ProtoG can be considered a competitive algorithm for solving the TSP, since it is not rare in the literature find PESs averages greater than 10% to be reported for instances of this size.

Síndrome da fragilidade e fatores associados em idosos comunitários do município de Santa Cruz RN

The frailty in the elderly is characterized by decreased physiological reserves, and is associated with increased risk of disability and high vulnerability to morbidity and mortality. This study is part of a multicentric project on Frailty in Elderly Brazilians (REDE FIBRA). Aims: to investigate characteristics, prevalence and associated factors related to frailty. Metodology: We interviewed 391 elderly patients aged 65 years, selected randomly. Data collection was performed using a multidimensional questionnaire containing information about socio-demographic and clinical variables. To characterize the frail elderly, was considered the phenotype proposed by Fried. Data were analyzed using descriptive statistics, bivariate analysis (χ ²) and binary logistic regression. Results: The prevalence of frailty was 17.1%. In the final model of multivariate analysis, was obtained as factors associated with frailty: advanced chronological age (p <0.001), have comorbidity (p <0.035), show dependence on performing basic activities of daily living (p <0.010) and instrumental (p <0.003) and have poor perception of health status (p <0030). Conclusions: The factors associated with frailty suggest a predictive model helping to understand the syndrome, guiding actions that minimize adverse effects on the aging process

Saúde física e emocional de cuidadores da cidade de Santa Cruz-RN: perfil epidemiológico e fatores associados

Taking care for an impaired elderly is a hard and costly task that could affect directly the caregiver health. The purpose of this study was to evaluate the physical and mental health of elderly caregivers from the city of Santa Cruz-RN and analyze the potential correlated factors through an observational analytic design of a crosssectional. A multidimensional questionnaire was used to evaluation of the social demographics characteristics and those related to the care activity, as well as the caregivers´ physical and mental health. It was realized a descriptive analyze using frequency distribution and measures of the central tendency and dispersion to description of the caregivers. To verify the magnitude of the association between the variables was used the bivariate analysis through the Pearson and Spearman correlations and qui-square test. To evaluation of the association of the correlated factors to the adverse outcome with the caregivers´ physical and mental health was made a multivariate analysis by logistic binary regression and multiple linear regression models. The final sample was constituted by 304 persons, mostly women with a mean age of 50.3 ±16.8 years. The principal factors related to the physical health were age, stress and life satisfaction. Be a male caregiver, caring for a little while the elderly with cognitive deficit and not been spouse were related to worse mental health. Have worse physical health, high stress, depressive symptomatology, burden and low levels of satisfaction were also related to the mental health. After adjust through multiple linear regression was observed R2 values of R2=0,21 for Stress, R2 =0,17 for Depressive Symptomatology, R2 =0,21 for Burden and R2 =0,16 for Satisfaction. The attainment of the factors associated with caregiver´s health can help in the elaboration of specifics politics witch the goal is the integral attention to the elderly and his caregiver. The inability of continuous taking care could result in adverse outcomes such as institutionalization, impairment and death

Apoio social e síndrome da fragilidade em idosos residentes na comunidade

Introduction: The frailty in the elderly is the result of a complex interplay between many social and clinical factors involved in its genesis. Although there is an understanding of its association with increased risk of adverse clinical outcomes, still it is unclear whether this syndrome can be aggravated due to lack of social support. So, the objective of this study was to analyze the association between social support and frailty syndrome in elderly community residents. Materials and methods: Observational analytical cross-sectional study, with a sample of 300 elderly living in the city of Natal-RN. Were collected informations about socialdemographic, economics and physical health data. The Social support was assessed by the status of cohabitation; marital status; contact frequency and diversity rate; received and given attendance frequency rate; and Map Minimum Relations of the Elderly. The frailty was assessed using the following criteria: unintentional weight loss, weakness, low physical activity, exhaustion and Slowness. To observe any possible associations, we performed the Pearson chi-square test, the Student t test and multivariate analysis using binary logistic regression, adopting a significance level of 5%. Results: It was observed that there were no associations of frailty with the social support variables, except for housekeeping mode (p = 0.046) of the MMRI. For the sociodemographic, economic, physical health and social support data, only age (p <0.001), sedentary lifestyle (p = 0.002) and poor perceived health (p = 0.001) were the ones that remained in the logistic regression model, with strong association for the presence of frailty. Conclusion: Among the variables related to social support, only to help with housekeeping was significantly associated with frailty. However, more studies need to be developed to characterize the social vulnerability, as well as health services need to recognize the importance of social support as an integral part of care for the elderly

Avaliação de lesões brancas de cáries: um estudo de prognóstico

Objective: The aim of the present study is to assess the current situation of white enamel lesions on vestibular surfaces of permanent upper incisors, diagnosed 6 years ago, without clinical intervention. Methods: A prospective study reassessed 53 students of both sexes, aged between 13 and 18 years old, all attending the public school system in Natal, Brazil. Data collection was performed by duly calibrated examiners, and a clinical chart consisting of demographic data on dental caries, oral hygiene, and gingival condition was prepared. A tactile-visual examination was conducted using a clinical mirror and periodontal probe. Data compilation and analysis were carried out using a SPSS software. In this analysis the chi-squared test was used for qualitative independent variables. To identify the net effect of treatment, multiple logistic analysis with forward stepwise model selection was performed. Results: The final sample was composed of 106 lesions in the 53 individuals, with mean age of 15.02 years, visible plaque index (VPI) of 23.34%, and gingival blood indices (GBI) of 25.92%. A statistically significant relationship (p = 0.003) was found between initial DMFS and prognosis of white enamel lesion. Conclusions: We observed that past caries experience and dental plaque were the main predictive factors for negative lesion outcomes, demonstrating the need for oral hygiene control through continuing preventive measures

Qualidade subjetiva do sono e queixa de insônia em pacientes com Acidente Vascular Cerebral

Brain injury can be associated with changes in the sleep-wake cycle. However, studies about sleep disturbances and their relationship with quality of sleep are scarce. Besides, it remains to be known how stroke affects the mechanisms of sleep. The aim of this study was to investigate quality of sleep, complaints of sleep disturbances and associated factors in stroke patients from the Physical Therapy services in Natal -RN. This was a cross-sectional descriptive study involving 70 individuals (aged 45-65 years), 40 patients (57 ± 7 years), 11 ± 9 months after injury, and 30 healthy individua ls (52 ± 6 years), evaluated with the Pittsburgh Sleep Quality Index (PSQI) and Sleep Habits Questionnaire. The data were analyzed by Chi-square test, t Student test and logistic regression. Poor quality sleep was found in 57,5% of the patients (6,3 ± 3,5) and was significantly higher than in the control population (3,9 ± 2,2) (t Student test, p=0,002). The patients showed significantly higher value of PSQI than controls: sleep latency (p=0,019), length of sleep (p=0,039) and dysfunction during the day (p=0,001). Regarding complaints of sleep disturbances (dyssomnias and parasomnias) analyzed by Chi-square test, the complaint of insomnia was the most prevalent (patients: 37,5%; healthy subjects: 6,7%; p=0,007). Regression analysis showed that sl eep latency (p=0,036) and complaint of insomnia (p=0,036) were associated with quality sleep. In addition, female gender (p=0,036) and complaint of broken sleep (p=0,003) were considered risk factors for the presence of insomnia. Our results show that stroke affects the homeostatic process of sleep. Shorter sleep latency and the absence of insomnia are considered protective factors for good sleep quality and this should be taken into consideration in the diagnostic and therapeutic strategies

Prevalência de incontinência urinária e fatores associados em idosos institucionalizados

Urinary incontinence (UI) is a geriatric syndrome that is especially prevalent in institutionalized individuals, and that causes economic and social impacts derived from treatment costs and overload of caregiver. UI also entails physical consequences to the health of the elderly, such as urinary tract infections or pressure ulcers, among other health problems. However, the existing national research on this condition is still scarce and comprises serious methodological biases. Therefore, the objective of this study is to determine the prevalence of urinary incontinence and associated factors in institutionalized elderly. A cross-sectional study is presented herein, conducted between October and December, 2013 and carried out in 10 nursing homes in the city of Natal (Northeast Brazil). UI was verified through the program Minimum Data Set version 3.0, which was also used to assess fecal incontinence, urinary devices and UI control programs. Data collection included sociodemographic information, UI characterization, as well as variables related to the institution itself and to health conditions (comorbidities, medication, pelvic floor surgery, Barthel Index for functional capacity and Pfeiffer test for cognitive status). Bivariate analysis was performed using the Chi-Square Test (or Fisher‟s Exact Test) and the Linear Chi-Square Test, calculating the prevalence ratio with 95% confidence interval. Variables with p value under 0.20 were included in the multivariate analysis, which was performed using the Stepwise Forward logistic regression. The inclusion of variables in the final model depended on the likelihood ratio test, absence of multicollinearity and on the Hosmer-Lemeshow test. A statistical significance level of 0.05 was considered. Six (1.8%) hospitalized elderly, one individual in palliative care (0.3%) and one (0.3%) individual under the age of 60 were excluded from the study. The final sample consisted of 321 elderly, mostly females, with a mean age of 81.5 years. The prevalence of UI was 59.43% and the final model revealed statistically a significant association between UI and white race, physical inactivity, stroke, mobility constraints and cognitive decline. The most frequent UI type was functional UI due to physical or cognitive disability, and incontinence control measures were applied only to a minority of residents (approximately 8%). It is concluded that UI is a health issue that affects more than half of the institutionalized elderly, and is associated with white race, physical inactivity, stroke and other geriatric syndromes such as immobility and cognitive disability. Most of these associated factors are modifiable and therefore the findings of this study highlight the importance of UI prevention and treatment in nursing homes, which include general measures, such as physical and psychosocial activities, and specific measures, such as prompted voiding

Fatores de riscos cardiovasculares em adolescentes da cidade do Natal-RN

Estudos têm demonstrado elevada prevalência de fatores de risco cardiovascular em adolescentes a redor do mundo, entretanto, é possível que esses fatores de risco se comportem de modo diferente em diferentes localidades. Objetivos: Examinar a prevalência do sobrepeso/obesidade e sua associação com outros fatores de risco cardiovasculares, em adolescentes, da cidade do Natal-Brasil. Métodos: Estudo observacional de delineamento transversal, realizado em 626 adolescentes (10 a 19 anos) de ambos os sexos. Foram estudadas as variáveis: peso, idade, gênero, cor, escolaridade, renda familiar, hábitos de vida, história familiar, peso, estatura, índice de massa corporal, relação cintura/quadril, pressão arterial, perfil lipídico, Glicose e Insulina de jejum e pós Dextrosol. Resultados: Foram avaliados 273 (43,6%) adolescentes do sexo masculino e 353 (56,4%) feminino. 26,4% dos adolescentes apresentaram sobrepeso/obesidade. A presença de obesidade familiar foi relatada por mais de 30 % da nossa amostra. Na análise de regressão logística múltipla; Idade, renda familiar, percentil de pressão sistólica, história familiar de hipertensão e obesidade, triglicerídeos, HDL colesterol, e HOMA RI mostraram-se associados com sobrepeso/obesidade. A relação cintura quadril apresentou-se mais elevada nas mulheres, e encontramos 10,9 % dos adolescentes com percentil de pressão sistólica (PAS) 95, e 7,4 % com percentil de pressão diastólica (PAD) 95. As dosagens de triglicerídeos, colesterol HDL e HOMA-RI alterados foram mais prevalentes nos que apresentavam IMC aumentado. As alterações do xi colesterol total, triglicerídios, glicemia pós dextrosol e HOMA teste, tiveram maior prevalência no gênero feminino. Na regressão logística binária, foram observadas associações do sobrepeso / obesidade com idade; OR 0,85, IC de 95% (0,78-0,92); p<0,001, pressão arterial sistólica; OR 2,65, IC de 95% (1,18- 5,94); p< 0,020, renda familiar; OR 2,34, IC de 95% (1,53-3,58); p< 0,001, história familiar de hipertensão arterial; OR 1,76, IC de 95% (1,15-2,71); p< 0,009, história familiar de obesidade; OR 1,50, IC de 95% (1,09-2,27); p< 0,04, aumento dos trigliceridios; OR 2,74, IC de 95% (1,69-4,43); p< 0,001, redução do colesterol; HDL OR 0,58, IC de 95% (0,38-0,87); p< 0,009 e o aumento do HOMA OR 3,16, IC de 95% (1,64 - 6,02); p<0,001. Conclusão: A prevalência de fatores de risco cardiovascular em Natal – Brasil se constitui em grave problema de saúde pública, atingindo níveis que se igualam ou até superam os de outras cidades tanto no Brasil, como em outros países

Influência das medidas antropométricas sobre a pressão arterial sistêmica de hipertensos cadastrados nas unidades de saúde da família no município de João Pessoa - PB

Este trabalho objetiva avaliar a influência das medidas antropométricas sobre a pressão arterial sistêmica de uma coorte de hipertensos atendidos nas Unidades de Saúde da Família (USF) no município de João Pessoa-PB durante o período de 2008 a 2011. Para verificar as diferenças de níveis pressóricos entre as medidas realizadas nas consultas referentes ao cadastro, e a ultima pressão obtida no período de acompanhamento foram utilizadas informações sobre a identificação, dados clínicos do paciente, fatores de risco e doenças concomitantes. Testes estatísticos de comparabilidade entre grupos foram empregados. Para investigar os padrões de associação dos fatores de risco das variáveis antropométricas e sociodemográficas com a hipertensão dos pacientes, foi empregado o Modelo de Regressão Logística. Foram encontradas associações significativas (p<0,005) da hipertensão com a obesidade e o sedentarismo. Com os resultados desta pesquisa pretende-se: fornecer indicadores sobre a efetividade da Estratégia Saúde da Família; avaliar a qualidade das informações antropométricas; contribuir para a definição de estratégias que garantam o melhoramento dos acompanhamentos dos hipertensos e fornecer elementos científicos de apoio para outras USF e instituições governamentais.

HIV/AIDS: um perfil epidemiológico do vírus e uma análise das práticas seguras, conhecimento e percepção de mulheres

In recent decades, the debate surrounding the consequences of the HIV has passed by great changes. Earlier, prevention campaigns focused risk groups then risk behaviors and ultimately vulnerability. Furthermore, over the years, the dimensions of HIV that emerged in the social environment are these: internalization, heterosexualization, impoverishment and feminization. Based on these contexts, the composition of this study comprises two papers: the former has the overall objective to analyze the epidemiology and incidence of HIV in Brazilian regions in the period from 1980 to 2012; the latter, it aims to find out whether there is the relationship among safe practices, knowledge and perception of women residents in Manaus and Boa Vista cities on the infection by HIV. In paper 1, it was used information from the Health Ministry, as a data source. Besides, it was developed an exploratory and spatial analysis of incidence rates and relative proportion of notified cases. In paper 2, was used as a source of data, the research "Evaluating the process of spatial and epidemic diffusion of HIV in the federal units of Brazil-Northern Region" in 2008. Furthermore, Statistical Techniques of Cluster Analysis, Analysis of Variance, Chi-Square and Logistic Regression were applied. In this paper, it was found that, in Brazilian Regions, the prevalence of reported cases occurred among heterosexuals in men 20-40 year age group and residing in metropolitan areas. It was observed a significant spatial correlation of the incidence rate of reported cases of HIV. It was also noted by the results that have good knowledge and awareness about HIV does not imply, essentially, in a safe sexual intercourse. These results have shown the need public policies geared to the guiding of society, based in educational strategies aiming both information about the virus and its prevention, as well as public awareness for safe sex practices or in stable or not intercourses

Parâmetros bioquímicos e níveis de IgE total e específicas para aeroalérgenos em mulheres obesas com síndrome dos ovários policísticos

Introduction: Polycystic ovary syndrome (PCOS) whose classic features (menstrual irregularity of oligo/ amenorrhea type, chronic anovulation, infertility and hyperandrogenism clinical and/ or biochemical), is associated with aspects of metabolic syndrome (MS), as obesity and insulin resistance. The level of obesity determines different levels of inflammation, increasing cytokines participants of metabolic and endocrine functions, beyond modulate the immune response. Metabolic changes, added to the imbalance of sex hormones underlying irregular menstruation observed in (PCOS) can trigger allergic processes and elevation of total and specific IgE antibodies indicate that a sensitization process was started. Objective: To evaluate the influence of PCOS on biochemical parameters and levels of total and specific IgE to aeroallergens in obese women. Methods: After approval by the Committee of Ethics in Research, were recruited 80 volunteers with BMI ≥ 30 kg/m2 and age between 18 and 45 years. Among these, 40 with PCOS according to the Rotterdam criteria and 40 women without PCOS (control group). All participants were analysed with regard to anthropometric, clinical, gynecological parameters, interviewed using a questionnaire, and underwent blood sampling for realization of laboratory tests of clinical biochemistry: Total cholesterol, LDL-cholesterol, HDL- cholesterol, Triglycerides, Fasting glucose, Urea, Creatinine, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) and immunological: total and specific IgE to Dermatophagoides pteronyssinus, Blomia tropicalis, Dermatophagoides farinae and Dermatophagoides microceras.Statistical analysis was performed using SPSS 15.0 software through the chi-square tests, Fisher, Student t test and binary logistic regression, with significance level (p <0.05). Results: It was observed in the group of obese women with PCOS that 29 (72.5%) had menstrual cycle variable and 27 (67.5%) had difficulty getting pregnant. According to waist-hip ratio, higher average was also observed in obese PCOS (0.87). Blood level of HDL (36.9 mg/dL) and ALT (29.3 U/L) were above normal levels in obese women with PCOS, with statistically significant relationship. In the analysis of total and specific IgE to D. pteronyssinus high results were also prevalent in obese PCOS, with blood level (365,22 IU/mL) and (6.83 kU/L), respectively, also statistically significant. Conclusions: Observed predominance of cases with high levels of total IgE in the group of obese women with PCOS, 28 (70%) of the participants, whose mean blood concentration of the group was 365.22 IU/mL. In the analysis of Specific IgE between the groups, the allergen Dermatophagoides pteronyssinus showed greater dispersion and average the results of sensitization in the group of obese PCOS, whose mean blood concentration was 6.83 kU/l. Keywords: Obesity, Allergens and Polycystic Ovary Syndrome

Modelos de dispersão para extremos de precipitação. Estudo de caso: o nordeste do Brasil

In this thesis used four different methods in order to diagnose the precipitation extremes on Northeastern Brazil (NEB): Generalized Linear Model s via logistic regression and Poisson, extreme value theory analysis via generalized extre me value (GEV) and generalized Pareto (GPD) distributions and Vectorial Generalized Linea r Models via GEV (MVLG GEV). The logistic regression and Poisson models were used to identify the interactions between the precipitation extremes and other variables based on the odds ratios and relative risks. It was found that the outgoing longwave radiation was the indicator variable for the occurrence of extreme precipitation on eastern, northern and semi arid NEB, and the relative humidity was verified on southern NEB. The GEV and GPD distribut ions (based on the 95th percentile) showed that the location and scale parameters were presented the maximum on the eastern and northern coast NEB, the GEV verified a maximum core on western of Pernambuco influenced by weather systems and topography. The GEV and GPD shape parameter, for most regions the data fitted by Weibull negative an d Beta distributions (ξ < 0) , respectively. The levels and return periods of GEV (GPD) on north ern Maranhão (centerrn of Bahia) may occur at least an extreme precipitation event excee ding over of 160.9 mm /day (192.3 mm / day) on next 30 years. The MVLG GEV model found tha t the zonal and meridional wind components, evaporation and Atlantic and Pacific se a surface temperature boost the precipitation extremes. The GEV parameters show the following results: a) location ( ), the highest value was 88.26 ± 6.42 mm on northern Maran hão; b) scale ( σ ), most regions showed positive values, except on southern of Maranhão; an d c) shape ( ξ ), most of the selected regions were adjusted by the Weibull negative distr ibution ( ξ < 0 ). The southern Maranhão and southern Bahia have greater accuracy. The level period, it was estimated that the centern of Bahia may occur at least an extreme precipitatio n event equal to or exceeding over 571.2 mm/day on next 30 years.