Estimação de parâmetros genéticos para resistência à infecção por IMNV em camarões Litopenaeus vannamei por meio de análise de sobrevivência

The main specie of marine shrimp raised at Brazil and in the world is Litopenaeus vannamei, which had arrived in Brazil in the `80s. However, the entry of infectious myonecrosis virus (IMNV), causing the infectious myonecrosis disease in marine shrimps, brought economic losses to the national shrimp farming, with up to 70% of mortality in the shrimp production. In this way, the objective was to evaluate the survival of shrimps Litopenaeus vannamei infected with IMNV using the non parametric estimator of Kaplan-Meier and a model of frailty for grouped data. It were conducted three tests of viral challenges lasting 20 days each, at different periods of the year, keeping the parameters of pH, temperature, oxygen and ammonia monitored daily. It was evaluated 60 full-sib families of L. vannamei infected by IMNV in each viral challenge. The confirmation of the infection by IMNV was performed using the technique of PCR in real time through Sybr Green dye. Using the Kaplan-Meier estimator it was possible to detect significant differences (p <0.0001) between the survival curves of families and tanks and also in the joint analysis between viral challenges. It were estimated in each challenge, genetic parameters such as genetic value of family, it`s respective rate risk (frailty), and heritability in the logarithmic scale through the frailty model for grouped data. The heritability estimates were respectively 0.59; 0.36; and 0.59 in the viral challenges 1; 2; and 3, and it was also possible to identify families that have lower and higher rates of risk for the disease. These results can be used for selecting families more resistant to the IMNV infection and to include characteristic of disease resistance in L. vannamei into the genetic improvement programs

Avaliação genética da eficiência reprodutiva em vacas pardo-suíças por meio da análise de sobrevivência

Among the traits of economic importance to dairy cattle livestock those related to sexual precocity and longevity of the herd are essential to the success of the activity, because the stayability time of a cow in a herd is determined by their productive and reproductive lives. In Brazil, there are few studies about the reproductive efficiency of Swiss-Brown cows and no study was found using the methodology of survival analysis applied to this breed. Thus, in the first chapter of this study, the age at first calving from Swiss-Brown heifers was analyzed as the time until the event by the nonparametric method of Kaplan-Meier and the gamma shared frailty model, under the survival analysis methodology. Survival and hazard rate curves associated with this event were estimated and identified the influence of covariates on such time. The mean and median times at the first calving were 987.77 and 1,003 days, respectively, and significant covariates by the Log-Rank test, through Kaplan-Meier analysis, were birth season, calving year, sire (cow s father) and calving season. In the analysis by frailty model, the breeding values and the frailties of the sires (fathers) for the calving were predicted modeling the risk function of each cow as a function of the birth season as fixed covariate and sire as random covariate. The frailty followed the gamma distribution. Sires with high and positive breeding values possess high frailties, what means shorter survival time of their daughters to the event, i.e., reduction in the age at first calving of them. The second chapter aimed to evaluate the longevity of dairy cows using the nonparametric Kaplan-Meier and the Cox and Weibull proportional hazards models. It were simulated 10,000 records of the longevity trait from Brown-Swiss cows involving their respective times until the occurrence of five consecutive calvings (event), considered here as typical of a long-lived cow. The covariates considered in the database were age at first calving, herd and sire (cow s father). All covariates had influence on the longevity of cows by Log-Rank and Wilcoxon tests. The mean and median times to the occurrence of the event were 2,436.285 and 2,437 days, respectively. Sires that have higher breeding values also have a greater risk of that their daughters reach the five consecutive calvings until 84 months

Prevalência e fatores associados ao risco e a desnutrição em idosos institucionalizados

One of the most important problems in the elderly is a nutritional deficiency. Several physiological changes and the use of multiple drugs interfere with appetite, food intake and absorption of nutrients, which can lead to the risk and malnutrition in the elderly, especially among institutionalized. The present study aimed to evaluate the prevalence of malnutrition and risk for malnutrition and its associated factors in institutionalized elderly. The same can be characterized by the type individual, observational and cross-sectional. Obtaining the sample was through the records of individuals of long-stay institutions for the elderly in the city of Natal, RN. The elderly were evaluated through the Mini Nutritional Assessment (MNA) and triceps skinfold (TSF) and each senior or caregiver answered a questionnaire about information like type and dietary restrictions, accessibility to food, use of alcohol and tobacco, practice physical activity and appetite. Variables such as age, gender, education, marital status, time that the elderly living in the institution, the reason for the institutionalization and comorbidities were taken from the records of each senior. The frequency of food consumption of various food groups was assessed from the questionnaire frequency of feeding study Health, Wellbeing and Aging (HWA). Data were presented as means and standard deviations, absolute and relative frequencies. To analyze the frequency of consumption, there was a factor analysis with extraction of factors from the principal components analysis with varimax rotation. A bivariate analysis was performed using the chi-square and the magnitude of the effect observed by prevalence ratio (95% CI). The Poisson regression assessed the net effect of independent variables on the two outcomes, considering a significance level of 5%. We studied twelve Homes for the Aged totaling 381 seniors eligible for the study. The prevalence of risk of malnutrition was 46.1% (45.9 to 46.2) and malnutrition was 31.4% (31.2 to 31.5). The risk of malnutrition was significantly associated with the presence of urinary incontinence (RP = 1.444, 1.113 to 1.874) was associated with malnutrition and lack of appetite (RP = 1.757, 1.246 to 2.476), the fact that the individuals do not have access to food outside the institution (RP = 0.565, 0.337 to 0.946), low water consumption (RP = 1.646, 1.101 to 2.459) and dementia (PR = 1.537, 1.072 to 2.204). The high prevalence of malnutrition and risk of malnutrition in the study suggests that we should pay attention to information related to eating habits and the presence of comorbidities, as these can influence the nutritional status of this population

Fatores de risco pré-operatórios para o desenvolvimento de Insuficiência Renal Aguda em cirurgia cardíaca

OBJETIVO:Avaliar os fatores de risco clínicos pré-cirurgicos para o desenvolvimento de Insuficiência Renal Aguda (IRA) em pacientes submetidos à cirurgia cardíaca. MÉTODO: Foram estudados, de modo prospectivo, 150 pacientes submetidos à cirurgia cardíaca, durante 21 meses consecutivos, havendo um leve predomínio de homens (57%), idade média de 56 ± 15 anos, sendo que 66% apresentavam insuficiência coronariana como principal diagnóstico e 34% valvulopatias. A mediana da creatinina sérica no período pré-operatório foi de 1,1 mg/dl. IRA foi definida como elevação de 30% da creatinina sérica basal. O protocolo de variáveis clínicas teve seu preenchimento iniciado 48 horas antes do procedimento cirúrgico e encerrado 48 horas após o mesmo, incluindo variáveis cardiológicas e não-cardiológicas, além de resultados laboratoriais. RESULTADOS: A IRA esteve presente em 34% dos casos. Após análise multivariada, presença de doença vascular periférica foi fator pré-operatório identificado. CONCLUSÃO: Os resultados obtidos nesse estudo permitiram sinalizar alguns fatores contributivos para o desenvolvimento de IRA em cirurgia cardíaca, o que pode possibilitar condutas clínicas simples para evitar a disfunção renal nestas situações e, conseqüentemente, redução da taxa de mortalidade. No presente trabalho, o tamanho da amostra talvez tenha impedido a identificação de outros fatores de risco significativos.

O turismo de base local como um possível indutor de desenvolvimento rural: uma análise da realidade e das potencialidades no distrito de dondo-moçambique

The current debate on rural development focuses on the territorial approach, recognizing the multifunctional character of rural areas. Emphasize the use of endogenous forces, the need of implement policies which valorize local specificities, the participation of social actors in revitalization of rural areas. In this context tourism enters as a means to induce a new dynamic to rural areas, since the activity is regarded as a channel for the upgrading of the natural and cultural resources and the rural way of life. This study focuses on local-based tourism as a promoter of rural development, giving an analysis of the social reality and potential for this tourism in the district of Dondo. In it, is proposed to analyze the potential for development of local-based tourism in the district of Dondo, assessing the extent to which local reality enables the inclusion of the community in the management of local tourism resources. For this, was showed the inclusion of local-based tourism in the current context of rural development, was identified and organized systematically the factors that influence the implementation of local-based tourism in the study area and was verified as far as possible the study area corresponds to the constraints identified, showing how local-based tourism can best been encouraged. Was adopted a qualitative methodological approach to both the procedures and data processing, but also by critical approach, using bibliographical research, semi-structured interviews that fell on the group of public administrators who work in tourism and community leaders. The critical analysis was based on the principles of sustainability o Sachs particular ecological, social, cultural, economic, space, beyond the analysis of political and institutional aspects. The survey results show that the district of Dondo has a potential for implementing a model of tourism development on a local basis, since it is rich in natural and cultural research, benefits from good network accessibility in the context of the market in the region, the population live according to their habits and customs and value their identity. There is also a good cooperation between community members, although not in tourism, a fact which is observed through the lever of community participation in associations, cooperatives, working in areas such as agriculture, fishing, environment, civic education etc. It also has public funding sources to augment or stimulate local investment. Despite obstacles such as inexistence of policies and local plans for tourism development, lack of awareness of tourism, lack of basic infrastructure, as well as equipment and facilities to support tourism, the results shows that these problems can be solved through a public commitment from both government, and community through a joint planning and participation

Avaliação econômica dos incentivos fiscais e financeiros: uma análise das empresas industriais têxteis localizadas no Rio Grande do Norte, no período de 1999 a 2003

This study has as main objective to verify the effect of the tax and financial incentives granted by the brazilian states, specially in the reduction of ICMS on the investment decision of the entities, which in the last years led to the companies to decide new projects in based on the region that presented the better infrastructure beyond lesser tributary expense. For in such was made an economic valuation of the companies with focus in the beneficiary s optics using an adaptation of the Discounted Cash Flow method to measure the impact of the tax incentives in the value of the companies, this study selected the textile industry segment located in the State of Rio Grande do Norte, Brazil. The results indicated that such incentives created addition in the value of the companies, however the inexistence of incentives would not be enough to a negative decision of investment in the Rio Grande do Norte. The smallest difference between the value with and without incentive observed was 8.9%, and the biggest 31.7%, and the average of value aggregation with the tax incentives represented 18.9%

Lupus eritematoso sistêmico: novo fator de risco para aterosclerose?

OBJETIVO: Avaliar a prevalência de eventos cardiovasculares (ECV) secundários à aterosclerose em pacientes com lupus eritematoso sistêmico (LES) e correlacioná-los aos tradicionais fatores de risco, tempo de doença e drogas utilizadas na terapia. MÉTODOS: Estudo retrospectivo através da coleta e análise dos dados contidos nos prontuários de pacientes com diagnóstico confirmado há no mínimo dois anos e seguidos desde 1992. Foram considerados ECV: angina do peito (AP), IAM e acidente vascular cerebral (AVC) de causa não relacionada à atividade do LES. Foram computados os fatores de risco para aterosclerose e dados sobre tratamento. RESULTADOS: Foram analisados 71 prontuários. A média de idade dos pacientes foi de 34,2±12,7 anos; 68 mulheres e três homens; 58 caucasóides (81,6%). Dez (14,08%) apresentaram ECV. Os pacientes nos quais os eventos cardiovasculares foram observados apresentavam idade mais elevada (42,7 vs 32,8 anos p=0,0021) e maior tempo de doença (10,8 vs 7,2 anos p=0,011). Os tradicionais fatores de risco, as doses diárias e cumulativas de esteróides, imunossupressores e antimaláricos não apresentaram diferença estatística significante entre pacientes que apresentaram ou não ECV. CONCLUSÃO: A prevalência de secundários à aterosclerose no LES foi semelhante ao da literatura, 14,08%. Os tradicionais fatores de risco não mostraram associação com a ocorrência ou não de ECV no LES. Os pacientes nos quais os eventos cardiovasculares foram observados apresentavam idade mais elevada e maior tempo de doença. É precoce estabelecer-se que o LES possa ser um fator independente no desenvolvimento da aterosclerose.

Injúria renal aguda em unidade de terapia intensiva: estudo prospectivo sobre a incidência, fatores de risco e mortalidade

OBJETIVO: Comparar características clínicas e evolução de pacientes com e sem injúria renal aguda adquirida em unidade de terapia intensiva geral de um hospital universitário terciário e identificar fatores de risco associados ao desenvolvimento de injúria renal aguda e à mortalidade. MÉTODOS: Estudo prospectivo observacional com 564 pacientes acompanhados diariamente durante a internação em unidade de terapia intensiva geral do Hospital das Clínicas da Faculdade de Medicina de Botucatu por 2 anos consecutivos (de maio de 2008 a maio de 2010), divididos em 2 grupos: com injúria renal aguda adquirida (G1) e sem injúria renal aguda adquirida (G2). RESULTADOS: A incidência de injúria renal aguda foi 25,5%. Os grupos diferiram quanto à etiologia da admissão em unidade de terapia intensiva (sepse: G1:41,6% x G2:24,1%, p<0,0001 e pós operatório neurológico 13,8% x 38,1%, p<0,0001), idade (56,8±15,9 x 49,8± 17,8 anos, p< 0,0001), APACHE II (21,9±6,9 x 14,1±4,6, p<0,0001), ventilação mecânica (89,2 x 69,1%, p<0,0001) e uso de drogas vasoativas (78,3 x 56,1%, p<0,0001). Com relação aos fatores de risco e às comorbidades, os grupos foram diferentes quanto à presença de diabetes mellitus, insuficiência cardíaca congestiva, insuficiência renal crônica e uso de anti-inflamatórios não hormonais (28,2 x 19,7%, p=0,03; 23,6 x 11,6%, p=0,0002, 21,5 x 11,5%, p< 0,0001 e 23,5 x 7,1%, p<0,0001, respectivamente). O tempo de internação e a mortalidade foram superiores nos pacientes que adquiriram injúria renal aguda (6,6 ± 2,7 x 12,9± 5,6 dias p<0,0001 e 62,5 x 16,4%, p<0,0001). À análise multivariada foram identificados como fatores de risco para injúria renal aguda, idade>55 anos, APACHE II>16, creatinina (cr) basal>1,2 e uso de anti-inflamatórios não hormonais (OR=1,36 IC:1,22-1,85, OR=1,2 IC:1,11-1,33, OR=5,2 IC:2,3-11,6 e OR=2,15 IC:1,1-4,2, respectivamente) e a injúria renal aguda esteve independentemente associada ao maior tempo de internação e à mortalidade (OR=1,18 IC:1,05-1,26 e OR=1,24 IC:1,09-1,99 respectivamente). À análise da curva de sobrevida, após 30 dias de internação, a mortalidade foi de 83,3% no G1 e 45,2% no G2 (p<0,0001). CONCLUSÃO: A incidência de injúria renal aguda é elevada em unidade de terapia intensiva, os fatores de riscos independentes para adquirir injúria renal aguda são idade >55 anos, APACHE II>16, Cr basal >1,2 e uso de anti-inflamatórios não hormonais e a injúria renal aguda é fator de risco independente para o maior tempo de permanência em unidade de terapia intensiva e mortalidade.

Análise da evolução costeira do litoral setentrional do estado do rio grande do norte, região sob influência da indústria petrolífera

The northern coast of Rio Grande do Norte State is characterized by strong changes in coastal morphology, caused by various geological and climatic factors. In this region are installed the main socio-economic activities of the State, highlighting the oil industry, which exerts much of its activities in the coastal area studied. Erosion is a constant problem in this region because it affects the entire local populace to the destruction of houses and trade, rendering tourism, affecting the livelihood activities and industrial activities. The greatest risk is related to environmental damage that can be caused by the oil spill in this region. To understand what determines the changes in coastal morphology this Doctoral Thesis is proposed to identify the factors at local, regional and even global corroborate coastal dynamics to this coast in question. For this study, used several different products and tools for interpreting the conditions of the erosive effect that dominates the whole northern coast of the State, in an attempt to quantify and describe the causes and effects that affect the entire coastal zone monitored. The development of activities is built into the projects Rede 05 PETROMAR (CTPETRO-FINEP/PETROBRAS/CNPq), PETRORISCO, HIDROSEMA, PETROMAR e Rede 05/04 POTMAR (FNDCT/CTPETROFINEP/ CNPq), in the activities of multidisciplinary and inter-features in issues involving environmental monitoring and oil activity

Fatores de risco para mortalidade na lesão renal aguda

OBJETIVO: Este trabalho tem como objetivo avaliar a evolução de pacientes com lesão renal aguda (LRA) por Necrose Tubular Aguda internados no Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP. MÉTODOS: Trata-se de estudo de coorte retrospectivo, no qual foram avaliados 477 pacientes maiores de 18 anos, no período de janeiro de 2001 a dezembro de 2008. LRA foi definida de acordo com os valores de creatinina sérica, conforme proposto pelo Acute Kidney Injury Network (AKIN). RESULTADOS: A média de idade da população estudada foi de 65,5 ± 16,2 anos, com predomínio de homens (62%) e com idade > 60 anos (65,2%). Diabetes mellitus ocorreu em 61,9%, hipertensão arterial em 44,4% e doença renal crônica em 21,9%. A mortalidade foi de 66%. Após análise multivariada, foram variáveis associadas ao óbito a necessidade de diálise, internação em UTI, idade > 60 anos e menor tempo de acompanhamento nefrológico. A recuperação renal entre os sobreviventes foi de 96,9%. CONCLUSÃO: Este trabalho mostra que a evolução dos pacientes com LRA provenientes de enfermarias clínica e cirúrgica é semelhante à literatura. Porém, a alta mortalidade do grupo mostra a necessidade da identificação de fatores de risco para o desenvolvimento de LRA nesses pacientes e capacitação da equipe assistente para o diagnóstico precoce dessa síndrome.

Análise multitemporal dos elementos geoambientais da região da Ponta do Tubarão, área de influência dos campos petrolíferos de Macau e Serra, município de Macau/RN

The study area is inserted in Ponta do Tubarão region, Macau City, setentrional littoral of Rio Grande do Norte State, composed of Tertiary and Quatemary sedimentary rocks and sediments. This region is characterized for the intense action of the coastal processes, causing the morphologic instability in part of the area, beyond the interference of human activities, as the Petroliferous Industrial Polo, salt companies and shrimp farms. This justifies the integration of multidisciplinary and multitemporal detailed scientific studies dealing with the evaluation of the changing behavior of this coastal environment by geoenvironments elements characterization, identifying protected and recuperation areas, mainly those under socioeconomic intervention. The main objective was the coastal monitoring using geoprocessing techniques to prepare thematic maps useful for oil spilling environment risk areas survey. The methodology was based on multitemporal interpretation of remote sensing images and field checking, integrated in a Geographical Information System (GIS). The Geologic, Geomorphologic, Vegetation, Soil and Land Use maps were prepared, and later on they allowed the generation of the Natural Vulnerability and Environmental Vulnerability maps. These maps had been classified in accordance with vulnerability degrees: very low, low, medi um, high and very high. Beyond these maps the GIS allowed the analysis of the shoreline evolution for 10 distinct dates, using Landsat 5 TM and 7 ETM+ and SPOT-HRVIR images. This analysis made possible the attendance of the coastal morphodynamic evolution, where the results had been represented by areasof erosion and accretion (or deposition) of sediments, pointing critical areas under erosive process to the petroliferous industry (Macau and Serra fields). The GIS also provided to prepare the Environmental Sensitivity Maps of Oil Spill (SAO Maps) in operational scale (1: 10.000), according to the norms ofthe Ministério do Meio Ambiente (MMA 2002). The SAO Map in operational scale was based on IKONOS images mosaic where the ESI (Environmental Sensitivity Index) was represented according with two tides phases of theregion. Therewere recognizedfiveESI (3, 4,7,9, 1O) for the low tide; to the high tide the ESI number increased to seven (3, 4, 5, 7, 8, 9, 10). All these information are necessary to the decisions making about oi! spill and its derivatives containment. These techniques application makes possible the optimization and implantation ofnew socioeconomics activities of low environmental impact, indicates areas for better productivity and security exploration, and benefits local communities with fauna and flora preservation. The development of these activities is inserted in the scope of Monitoramento Ambiental de Áreas de Risco a Derrames de Petróleo e Seus Derivados Cooperation Project (Rede 05/01 - PETRORISCO, FINEP/CTPETRO/PETROBRAS) of multidisciplinary and interinstitucional characteristics dealing with subjects involving the environmental monitoring and the petroliferous activity

Avaliação da atenção ao recém-nascido de risco, na perspectiva de uma política pública de saúde

Objetivou-se avaliar a atenção à saúde de recém-nascidos de risco, acompanhados no primeiro ano de vida pelo Programa Crescer Feliz, desenvolvido em município do interior paulista. Trata-se de estudo epidemiológico populacional, do tipo avaliação de programa de saúde, que se baseou, para análise dos dados, nas diretrizes nacionais da Agenda de Compromissos da Criança. Os resultados evidenciaram a vulnerabilidade institucional do programa, decorrente de problemas relacionados à estrutura e processo, com implicações nos resultados. Considerando a adequação dos critérios adotados pelo programa, para definição dos recém-nascidos de risco e das intervenções e estratégias propostas, que se mostram em consonância com a Agenda de Compromissos, aponta-se a necessidade dos gestores priorizá-lo, inserindo-o, efetivamente, na política pública de saúde a ser desenvolvida no âmbito do município, para reversão da vulnerabilidade institucional identificada.

Análise hidrodinâmica e morfodinâmica do complexo estuarino do Rio Piranhas-Açu/RN, Nordeste do Brasil

The aim of this study was the seasonal characterization of the morphology, sedimentology and hydrodynamic of the Açu, Cavalos and Conchas estuaries. These estuaries are inserted in a semi-arid climate area and form the mouth of the hydrographic basin of the Piranhas-Açu river, that represent the discharge of the largest watershed in the state. They are embedded in an environment consisting of a fluvial-marine floodplain, mangrove ecosystem, sandbanks, fields of dunes, spits and sandy beaches. Adjacent to the natural units are the main local socioeconomic activities (oil industry, salt industry, shrimp farming, fishing and tourism) are dependent on this river and its conservation. The environmental monitoring is necessary because it is an area under constant action of coastal processes and at high risk of oil spill. The acquisition and interpretation of hydrodynamic, sonographic and sediment data was conducted in two campaigns, dry season (2010) and rainy season (2011), using respectively the current profiler ADCP Doppler effect, the side-scan sonar and Van Veen sampler. In these estuaries: Açu, Cavalos and Conchas were identified the following types of bedforms: flatbed and Dunes 2-D and 3-D (small to medium size), generated at lower flow regime (Froude number <1). Structures such as ripples were observed in the Açu estuary mouth. The higher values of flow discharge and velocity were recorded in the Açu estuary (434,992 m³.s-¹ and 0,554 m.s-¹). In rainy season, despite the record of highest values of discharge and flow velocities at the mouth, the energy rates upstream did not differ much from the data of the dry season. However, in all estuaries were recorded an increase in speed and flow, with reservation to the flow in the Açu estuary and flow at the mouth of the Conchas estuary. Sediment grain sizes tend to increase towards the mouth of the estuary and these ranged from very fine sand to very coarse sand, medium sand fraction being the most recurrent. Based on the data acquired and analyzed, the estuaries Açu, Cavalos and Conchas are classified as mixed , dominated by waves and tides. According to their morphology, they are classified as estuaries constructed by bar and according to the classification by salinity, estuaries Conchas and Cavalos were ranked as hypersaline estuaries, and Açu as hypersaline and vertically well mixed type C

Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária

OBJETIVO: identificar fatores de risco para a macrossomia fetal na população de gestantes portadoras de diabete ou hiperglicemia diária. MÉTODOS: estudo retrospectivo, tipo caso-controle, incluindo 803 pares de mães e recém-nascidos desta população específica, distribuídos em dois grupos: macrossômicos (casos, n=242) e não macrossômicos (controles, n=561). Foram comparadas variáveis relativas à idade, paridade, peso e índice de massa corporal (IMC), ganho de peso (GP), antecedentes de diabete, hipertensão arterial e tabagismo, tipo e classificação do diabete e indicadores do controle glicêmico no terceiro trimestre. As médias foram avaliadas pelo teste F e as variáveis categorizadas foram submetidas à análise univariada, utilizando-se o teste do chi². Os resultados significativos foram incluídos no modelo de regressão múltipla, para identificação do risco independente de macrossomia, considerando-se OR, IC 95% e valor de p. Para todas as análises foi estabelecido o limite de significância estatística de 5% (p<0,05). RESULTADOS: observou-se associação significativa entre macrossomia e GP maior que 16 kg, IMC >25 kg/m², antecedentes pessoais, obstétricos e, especificamente, o de macrossomia, classificação nos grupos de Rudge (IB e IIA + IIB), média glicêmica (MG) >120 mg/dL e média de glicemia pós-prandial >130 mg/dL no terceiro trimestre. Na análise de regressão múltipla, o GP >16 kg (OR=1,79; IC 95%: 1,23-1,60), o IMC >25 kg/m² (OR=1,83; IC 95%: 1,27-2,64), o antecedente pessoal de diabete (OR=1,56; IC 95%: 1,05-2,31) e de macrossomia (OR=2,37; IC 95%: 1,60-3,50) e a MG >120 mg/dL no terceiro trimestre (OR=1,78; IC 95%: 1,13-2,80) confirmaram risco independente para macrossomia nestas gestações de risco. CONCLUSÃO: o GP superior a 16 kg, o IMC maior ou igual a 25 kg/m², a MG superior a 120 mg/dL no terceiro trimestre e a presença de antecedentes pessoais de diabete ou de macrossomia foram identificados como fatores de risco para macrossomia fetal em gestantes portadoras de diabete ou de hiperglicemia diária.

Prevalência e fatores de risco para transtornos mentais comuns entre estudantes de medicina

OBJETIVO: Estimar a prevalência de transtornos mentais comuns entre estudantes de medicina e respectivos fatores de risco. MÉTODOS: Estudo transversal realizado com 551 universitários de um curso de medicina de Botucatu, SP. Utilizou-se questionário auto-aplicável investigando aspectos sócio demográficos, relacionados ao curso e o Self Reporting Questionnaire. Para análise dos dados empregaram-se os testes de qui-quadrado e regressão logística. RESULTADOS: Participaram 82,6% dos alunos matriculados no curso, predominando mulheres (61%), jovens (60% 20-23 anos), procedentes de outros municípios (99%). A prevalência de transtornos mentais comuns foi de 44,7% associando-se independentemente a: dificuldade para fazer amigos (RC=2,0), avaliação ruim sobre desempenho escolar (RC=1,7), pensar em abandonar o curso (RC=5,0), não receber o apoio emocional de que necessita (RC=4,6). Embora na primeira análise a prevalência tenha se mostrado associada ao ano do curso, esta associação não se manteve na análise multivariada. CONCLUSÕES: A prevalência de transtornos mentais comuns mostrou-se elevada entre os estudantes de medicina, associando-se a variáveis relacionadas à rede de apoio. As experiências emocionalmente tensas como o contato com pacientes graves, formação de grupos, entre outras, vividas nos últimos anos do curso, são provavelmente potentes estressores, especialmente para sujeitos com uma rede de apoio considerada deficiente. Sugere-se que instituições formadoras estejam atentas a esse fato, estabelecendo intervenções voltadas ao acolhimento e ao cuidado com o sofrimento dos estudantes.