Made available in DSpace on 2015-04-14T13:54:16Z (GMT). No. of bitstreams: 1 464804.pdf: 1590458 bytes, checksum: e5fa70202dba1d1fd2d06ce2fd978999 (MD5) Previous issue date: 2014-07-25 / Introduction: Heart failure (HF) is the final pathway of most diseases affecting the heart. It is estimated that this syndrome, with high mortality rate, affects 80% of the elderly people in the world within five years of disease evolution. Objective:The objective was to evaluate the role of natriuretic peptide NT - proBNP in the diagnosis of HF in the elderly. Method: Cross-sectional study of diagnosis to determine the accuracy (sensitivity, specificity and predictive value) in serum BNP level, checking if there is a correlation between the serum BNP level and severity of heart failure. While testing patients, in the NT-proBNP study, the NT-proBNP serum level was determinedby the blood. Chest X-rays, transthoracic echocardiography and clinical examination were used to define groups with and without HF. A total of 74 elderly were researched in this group, 46 had HF and 28 had noHF. Results: Female gender was more prevalent 92,9% (p = 0.001), the age range was 60-69 years old (with/HF=37%) (without/HF=57.1%) (p=0.025). They had no active physical activities (95.7% w/HF) (p < 0.001 ), both groups had hypertension (p<0.001); dyslipidemic ( 10.9 % with HF ) and ( 39.3 % without HF ) ( p = 0.004 ), diabetic ( 47.8 % w/HF) and (21.4 % without/HF) (p=0.023); acute myocardial infarction, coronary artery disease (87% w/HF) (p < 0.001). Ejection fraction > 50% (average 363.2) and < 50 % (average 678.2). Ranked using the New York Heart Association I (20 to 344.2 average), IV (12 to 664.9 average) (p=0.412), with sensitivity 58.7 % and specificity 82.1 %, linear regression (r=-0.291, p=0.05) between BNP andEF. Conclusion: The NT-proBNP serum level was useful in aiding the diagnosis of HF in the elderly, with prediction capacity approximately 74%, according to the area under the ROC curve. A low correlation between the NT-proBNP serum level and the ejection fraction in patients with HF was observed. Further clinical studies are necessary so as to define the role of NT-proBNP in the clinical practice with elderly patients / Introdu??o: A insufici?ncia card?aca (IC) ? a via final da maioria das doen?as que acometem o cora??o. Estima-se que 80% de idosos do mundo sejam afetados por essa s?ndrome, com taxa de mortalidade elevada entre um e cinco anos do diagn?stico da doen?a. Objetivo: Avaliar o papel do Pept?deo Natriur?tico NT proBNP no diagn?stico da IC em idosos. M?todo: Estudo transversal de diagn?stico, para determinar a acur?cia (sensibilidade, especificidade e valor preditivo) do n?vel s?rico NT proBNP, verificando se existe correla??o entre o n?vel s?rico do NT proBNP e a gravidade da IC, neste estudo. Na realiza??o dos exames dos pacientes do estudo, o n?vel s?rico do pept?deo foi dosado atrav?s do sangue. Radiografia do t?rax, ecocardiograma transtor?cico e exame cl?nico foram utilizados para definir grupos com e sem a IC. O total de 74 idosos, 46 com IC e 28 sem IC, foi estudado neste grupo. Resultados: O sexo feminino foi mais prevalente 92,9% (p=0,001), a faixa et?ria 60 a 69 anos, (c/ IC= 37%) (s/IC=57,1%) (p=0,025). N?o praticavam atividade f?sica (95,7% c/IC) (p <0,001), hipertens?o ambos os grupos (p <0,001); dislip?micos (10,9% com IC) e (39,3% sem IC) (p=0,004), diab?ticos (47,8% c/IC) e (21,4% s/IC) (p=0,023); IAM/DAC (87% c/IC) (p<0,001). Fra??o de Eje??o>50% (m?dia de 363,2) e <50% (m?dia de 678,2). Classificados usando a NYHA I(20-344,2 m?dia), IV(12-664,9 m?dia) (p=0,412) com sensibilidade 58,7% e especificidade de 82,1%, regress?o linear (r= -0,291 e p=0,05) entre BNP e FE. Conclus?o: O n?vel s?rico de NT-proBNP se mostrou ?til no aux?lio ao diagn?stico de IC em idosos, com capacidade de predi??o de aproximadamente 74%, segundo a ?rea sob a curva ROC. Foi observada uma correla??o fraca entre o n?vel s?rico de NT-proBNP e a fra??o de eje??o nos pacientes com IC. Estudos cl?nicos adicionais s?o necess?rios para definir o papel do NT-proBNP na pr?tica cl?nica em pacientes idosos

Made available in DSpace on 2015-04-14T13:34:38Z (GMT). No. of bitstreams: 1 411954.pdf: 1943189 bytes, checksum: b8512a0b7a8966dc29fb921e76e53ab4 (MD5) Previous issue date: 2009-03-04 / Introdu??o: Os enxertos ?sseos continuam sendo utilizados com freq??ncia na resolu??o de situa??es cl?nicas com perda de subst?ncia ?ssea. A viabilidade das c?lulas ?sseas transferidas com o enxerto ? um dos fatores determinantes para as propriedades mec?nicas e fisiol?gicas do enxerto. Uma d?vida inerente ao procedimento cir?rgico quando se utiliza enxertos ?sseos vascularizados ?: ser? que o enxerto ?sseo manter? sua viabilidade atrav?s do ped?culo vascular com o decorrer do tempo? Atrav?s de um modelo experimental, almejamos criar infer?ncias sobre a viabilidade do enxerto ?sseo vascularizado da crista il?aca em ratos e verificar suas caracter?sticas histol?gicas. M?todos: Foram utilizados 23 ratos machos isog?nicos da linhagem Kyoto, os quais foram divididos em dois grupos, o primeiro composto por animais submetidos ? t?cnica do enxerto ?sseo vascularizado da crista il?aca baseado no ramo il?aco da art?ria iliolombar, e o segundo (grupo controle) submetidos ao mesmo procedimento que o primeiro com a adi??o da ligadura do ped?culo vascular. A viabilidade dos enxertos ?sseos foi verificada durante tr?s semanas, atrav?s da visualiza??o direta do enxerto, histologia e imuno-histoqu?mica. Resultados: Todos os enxertos vascularizados avaliados na primeira semana apresentaram viabilidade segundo a observa??o direta, histologia e imuno-histoqu?mica. Entretanto na segunda e terceira semana os enxertos mostraram-se invi?veis em 75% dos casos quando submetidos ? avalia??o segundo a observa??o direta e em 50% dos casos quando realizada a an?lise histol?gica e imuno-histoqu?mica. Conclus?o: Alguns enxertos vascularizados em sua concep??o tornaram-se invi?veis e passaram a se comportar como enxertos n?o-vascularizados sob a an?lise da observa??o direta e histol?gica. Apesar da possibilidade de falha, o uso de enxertos ?sseos vascularizados deve ser incentivado, pois a histologia descritiva demonstrou maior densidade celular na por??o ?ssea medular, oste?citos com maior funcionalidade na deposi??o de matriz ?ssea, com rede vascular intra-?ssea preservada.

Submitted by Jorge Silva (jorgelmsilva@ufrrj.br) on 2017-04-07T17:22:42Z No. of bitstreams: 1 2012 - Carolina Elisabetta Martins Maccariello.pdf: 1658920 bytes, checksum: 73dc71d6017888854e4d3036c14a6ad8 (MD5) / Made available in DSpace on 2017-04-07T17:22:42Z (GMT). No. of bitstreams: 1 2012 - Carolina Elisabetta Martins Maccariello.pdf: 1658920 bytes, checksum: 73dc71d6017888854e4d3036c14a6ad8 (MD5) Previous issue date: 2012-05-31 / CNPq / The study of autonomic and behavioral responses in dogs subjected to a stress model is crucial at the present time, since animals and humans are constantly subjected to stress in their daily lives. Several stimuli can generate stress in dogs, as areas with crowed of people or animals and sounds of fireworks and thunder. The continuous and repeated exposure to these situations can affect the welfare and health of dogs. The Acupuncture is one of the therapies of Traditional Chinese Medicine (TCM) that targets the prevention and treatment of behavioral and physiological disorders induced by stress, however there are few studies about its efficacy and its mechanisms of action. The present study aimed to evaluate the sympathetic-vagal balance through the analysis of Heart Rate Variability (HRV) and 14 behavioral parameters in response to an acute sound stress in healthy dogs treated with acupuncture. Therefore, we used 24 beagle dogs divided into three groups of 8 animals each: one control group received no treatment (CTL), the second control group received acupuncture treatment at points not corresponding to those used in TCM (NP) and the third group received acupuncture at acupoints VG20, Yintang, PC6, C7 and E36 (ACUP). The treatments lasted 20 minutes and then the animals were subjected to an acute stress model consisting of a sound stimulus (thunders) with intensity of 103-104 dB and duration of 2.5 minutes. The results of HRV analysis showed that during the stress stimulus, acupuncture significantly reduced the LF/HF ratio and the heart rate (HR) compared to NP and CTL. The NP group also had significantly lower LF/HF ratio compared to the CTL during the stress, showing intermediate values between the CTL and ACUP groups. In the behavioral analysis, when compared to CTL group, ACUP showed significantly lower behavioral scores of panting, restlessness, hiding, bolt, startle and escape of the room; and when compared to the NP, ACUP reduced the behavioral scores of hiding, bolt, startle and escape of the room. In addition to reducing significantly the parameters of panting and bolt when compared to the CTL group, the NP group produced intermediate scores between CTL and ACUP groups. The analysis of these data shows that acupuncture treatment promoted reduction of sympatho-vagal balance probably through a sympathetic inhibition associated to parasympathetic stimulation, as well as producing a reduction of behavioral responses of fight and flight characteristics of stress. / O estudo das respostas auton?micas e comportamentais em c?es submetidos a um modelo de estresse se mostra de grande import?ncia na atualidade, uma vez que animais e humanos s?o constantemente submetidos a situa??es de estresse no seu cotidiano. V?rios est?mulos podem ser considerados geradores de estresse como ?reas em que h? aglomera??o de pessoas ou de animais e sons de fogos de artif?cio e de trov?es. A exposi??o continuada e repetida a tais est?mulos pode afetar o bem-estar e a sa?de dos c?es. A acupuntura ? uma das terapias da Medicina Tradicional Chinesa (MTC) que visa o tratamento e a preven??o de dist?rbios fisiol?gicos e comportamentais induzidos pelo estresse, por?m h? poucos estudos na literatura sobre a sua efic?cia e aos seus mecanismos de a??o. O presente estudo teve como objetivo avaliar o balan?o simpato-vagal, atrav?s da an?lise da Variabilidade da Frequ?ncia Card?aca (VFC) e 14 par?metros comportamentais em resposta ao estresse sonoro agudo em c?es saud?veis tratados com acupuntura. Desta forma, foram utilizados 24 c?es da ra?a Beagle divididos em tr?s grupos de 8 animais cada: o primeiro grupo controle n?o recebeu tratamento (CTL), o segundo grupo controle recebeu tratamento por acupuntura em pontos n?o correspondentes aos utilizados na MTC (NP) e o terceiro recebeu acupuntura nos pontos VG20, Yintang, Pc6, C7 e E36 (ACUP). Os tratamentos tiveram dura??o de 20 minutos e em seguida os animais foram submetidos a um modelo de estresse agudo que consistiu de est?mulo sonoro (som de trov?o) com intensidade de 103-104 dB e dura??o de 2,5 minutos. Os resultados da an?lise da VFC demonstraram que durante o est?mulo sonoro a acupuntura significativamente reduziu a raz?o LF/HF e FC m?dia em rela??o aos grupos NP e CTL. O grupo NP tamb?m apresentou valores significativamente menores da raz?o LF/HF em rela??o ao CTL no momento do estresse, apresentando valores intermedi?rios entre os grupos CTL e ACUP. Na an?lise comportamental, a ACUP quando comparado ao grupo CTL apresentou escores comportamentais significativamente menores de arfar, se esconder, inquieta??o, disparada, fugir da sala e sobressalto; e quando comparado ao grupo NP, a ACUP reduziu os escores comportamentais de se esconder, disparada, sobressalto e fugir da sala. Al?m de reduzir significativamente os par?metros de arfar e disparada em rela??o ao CTL, o grupo NP produziu escores intermedi?rios entre CTL e ACUP. A an?lise destes dados demonstra que o tratamento com acupuntura promoveu redu??o do balan?o simpato-vagal provavelmente atrav?s de uma inibi??o simp?tica associada ? estimula??o parassimp?tica, al?m de produzir redu??o das respostas comportamentais de luta e fuga caracter?sticas de estresse.

Submitted by Jorge Silva (jorgelmsilva@ufrrj.br) on 2017-04-11T21:02:55Z No. of bitstreams: 1 2015 - Daniel de Castro Trindade.pdf: 4241082 bytes, checksum: 050e5970f8afecacd5ab5af40fcf6348 (MD5) / Made available in DSpace on 2017-04-11T21:02:55Z (GMT). No. of bitstreams: 1 2015 - Daniel de Castro Trindade.pdf: 4241082 bytes, checksum: 050e5970f8afecacd5ab5af40fcf6348 (MD5) Previous issue date: 2015-07-29 / The heart rate variability (HRV) consist in a method able of assess the modulation of the autonomic nervous system (ANS) on the heart, allowing to determine possible simpatovagal changes. The analysis of time and frequency domain are types of signal processing used to investigate this variability, both dependent of the measures of RR intervals. The aim of this study was to evaluate the simpatovagal balance through HRV analysis by Holter method in dogs with valvar disease submitted to convencional drug therapy for heart failure or associate with Pimobendan. We used 37 adult dogs (13 males and 24 females), 03-14 years old and different breeds constituting 03 groups: CONT (healthy dogs without any treatment); CTP (dogs with heart failure receiving conventional therapy for CHF) and CTP + Pimo (dogs with heart failure receiving conventional therapy for CHF, associated with Pimobendan). The Holter examination was performed in different veterinary clinics in the Rio de Janeiro state, lasting 30 minutes and after a minimum period of 30 days from starting treatment. The parameters studied were: minimum heart rate; mean; maximum and QRS number. In the time domain were studied values: NN mean, SDNN, SDANN, SDNN index, rMSSD and pNN50. In the frequency domain the values studied were: Fc; HF; LF; VLF; LF / HF. Statistical values were showed as mean ? sem. The mean values of minimum heart rate, mean, maximum and QRS complex number of the different groups showed no statistical significance (P> 0.05). The mean values of the study of HRV in the time domain, the CTP and CTP + Pimo groups showed significant reduction (P <0.05) of the following parameters (SDNN; SDANN; SDNNIDX; RMSSD and pNN50) vs CONT group. In the heart rate variability in the frequency domain, CTP and CTP + Pimo groups showed significantly lower values of total power spectrum vs CONT (P <0.05); LF smaller values of CTP vs CONT group (P <0.05); larger values of LF of CTP + Pimo vs CTP group (P <0.05); smaller values of VLF of CTP + Pimo vs CONT group (P <0.01); lower values of LF / HF of CTP vs CONT group (P <0.05) and higher values to CTP + Pimo vs CTP group (P <0.01). Our study showed significant changes in HRV reduction in the time and frequency domains in CTP and CTP + Pimo groups when compared to CONT group. However, dogs treated with Pimobendan showed no significant evidence of improvement in their HRV parameters when compared to other dogs with heart failure that did not receive this drug, at least during the period proposed in this study. The changes in HRV parameters in dogs with heart failure were able to maintain even working with patients showing large breed diversity, of weights, sex and age; showing significant lower values in time and frequency domain when compared to normal dogs. The Pimobendan therapy, still no described in literature as able to influence HRV parameters in dogs with heart failure, in our study showed that animals treated with this drug showed larger sympathetic modulation, verified by LF/HF relation. / A variabilidade da frequ?ncia card?aca (VFC) constitui um m?todo capaz de aferir a modula??o do Sistema Nervoso Aut?nomo (SNA) sobre o cora??o, permitindo determinar poss?veis altera??es simpatovagais. A an?lise do dom?nio de tempo e frequ?ncia s?o tipos de processamento de sinal utilizados para investigar essa variabilidade, ambos dependentes da efic?cia das medidas dos intervalos RR. O objetivo deste estudo foi avaliar o balan?o simpatovagal atrav?s da an?lise da VFC pelo m?todo de Holter em c?es portadores de doen?a valvar submetidos ? terapia farmacol?gica convencional para insufici?ncia card?aca ou associada ? droga Pimoendan. Utilizamos 37 c?es adultos (13 machos e 24 f?meas), de 03 a 14 anos de idade e de diferentes ra?as, formando 03 grupos experimentais: CONT (c?es sadios n?o submetidos a qualquer tratamento); CTP (c?es cardiopatas submetidos ? terapia convencional para ICC) e CTP + Pimo (cardiopatas submetidos ? terapia convencional para ICC, associada ao Pimobendan). O exame Holter foi realizado em diferentes cl?nicas veterin?rias do estado do RJ, com dura??o de 30 minutos e ap?s um per?odo m?nimo de 30 dias do in?cio das terapias. Os par?metros estudados foram: frequ?ncia card?aca m?nima; m?dia; m?xima e N? QRS. No dom?nio do tempo foram estudados os valores de: NN m?dio, SDNN, SDANN, SDNN ?ndex, rMSSD e pNN50. No dom?nio da frequ?ncia foram estudados os valores: HF; LF; VLF; LF/HF. Os valores estat?sticos foram representados como m?dia ? s.e.m. Os valores m?dios das frequ?ncias card?acas m?nima, m?dia, m?ximas e n?mero de complexos QRS apresentados pelos c?es dos diferentes grupos n?o mostraram signific?ncia estat?stica (P > 0,05). Nos valores m?dios do estudo da VFC no dom?nio do tempo, os animais dos grupos CTP e CTP + Pimo apresentaram redu??o significativa (P < 0,05) dos seguintes par?metros (SDNN; SDANN; SDNNIDX; RMSSD e pNN50) vs grupo CONT. No dom?nio da frequ?ncia, os grupos CTP e CTP + Pimo mostraram valores significativamente inferiores da pot?ncia total de espectro vs CONT (P < 0,05); menores valores de LF do grupo CTP vs grupo CONT (P < 0,05); maiores valores de LF do grupo CTP + Pimo vs CTP (P < 0,05), menores valores de VLF do grupo CTP + Pimo vs CONT (P < 0,01); menores valores da raz?o LF/HF do grupo CTP vs CONT (P < 0,05) e maiores valores para CTP + Pimo vs CTP (P< 0,01). Nosso estudo mostrou mudan?as significativas da redu??o da VFC nos dom?nios do tempo e da frequ?ncia nos grupos CTP e CTP + Pimo quando comparados ao grupo CONT. Por?m, c?es tratados com Pimobendan n?o mostraram evid?ncia significativa em melhora de seus par?metros da VFC quando comparado aos outros c?es cardiopatas que n?o receberam esta droga, pelo menos durante o per?odo proposto nesse estudo. As altera??es em par?metros da VFC em c?es cardiopatas foram capazes de se manter mesmo trabalhando com pacientes apresentando grande diversidade racial, de pesos, sexo e idade; mostrando valores significativamente inferiores nos dom?nios do tempo e frequ?ncia quando comparados aos c?es normais. A terapia com Pimobendan, ainda n?o descrita na literatura como capaz de influenciar par?metros da VFC em c?es cardiopatas, em nosso estudo mostrou que animais tratados com essa droga apresentaram maior modula??o simp?tica, comprovada atrav?s da rela??o LF/HF.

Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2018-12-11T13:17:23Z No. of bitstreams: 1 FERNANDA DALLAZEN.pdf: 1913250 bytes, checksum: 643c26e233052ab4843690b459dd637d (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-12-13T12:27:07Z (GMT) No. of bitstreams: 1 FERNANDA DALLAZEN.pdf: 1913250 bytes, checksum: 643c26e233052ab4843690b459dd637d (MD5) / Made available in DSpace on 2018-12-13T12:40:00Z (GMT). No. of bitstreams: 1 FERNANDA DALLAZEN.pdf: 1913250 bytes, checksum: 643c26e233052ab4843690b459dd637d (MD5) Previous issue date: 2018-10-05 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Objective: To construct a risk score model for prolonged mechanical ventilation (PMV) in patients undergoing coronary after bypass grafting (CABG). Methods: An observational, retrospective and historical cohort study, with 4.165 patients submitted to coronary artery bypass grafting, between January 1996 and December 2016. The duration of ?12 hours on mechanical ventilation defined as prolonged. The multiple logistic regression was used to evaluate the predictor variables. The modeling database, divided in 2/3 of the sample (2.746 patients) generated the preliminary model and its performance was tested in the validation database, divided in 1/3 of the sample (1.419 patients). The final risk score was validated in the total database and the accuracy of the model was tested by performance statistics. Results: The incidence of PMV was 18.8% (783). The variables associated with prolonged PMV were: age ?65 years (OR=1.91; [CI95%=1.62-2.24]; p<0.001); urgent/emergency surgery (OR=2.79; [CI95%=2.09-3.73]; p<0,001); obesity (OR=1.49; [CI95%= 1.21-1.84]; p<0.001); chronic renal failure (OR=1.98; [CI95%=1.61-2.44]; p<0.001); chronic obstructive pulmonary disease (OR=1.43; [CI95%=1.16-1.76];p<0,001) and extracorporeal circulation time ?120 minutes (OR=1.75; [IC95%=1.42-2.16]; p<0.001). The area under de the ROC curve was 0.66 (IC95%=0.64-0.68), the chi-square was 3.38 and the correlation coefficient of r=0.99 (p<0.000). Conclusion: The preoperative predictor variables (age ?65 years, urgent/emergency surgery, obesity, chronic renal failure and chronic obstructive pulmonary disease) and perioperative (extracorporeal circulation time ?120 minutes) were associated with PMV and allowed the constructed of risk score classified in low, medium, high and very high. / Objetivo: Construir um modelo de escore de risco para ventila??o mec?nica prolongada (VMP) em pacientes p?s-cirurgia de revasculariza??o mioc?rdica (CRM). M?todos: Estudo observacional, retrospectivo e de coorte hist?rica, com 4.165 pacientes submetidos ? CRM, entre janeiro de 1996 a dezembro de 2016. A perman?ncia >12 horas em ventila??o mec?nica foi definida como prolongada. A regress?o log?stica m?ltipla foi utilizada para avaliar as vari?veis preditoras. O banco de dados modelagem, dividido em 2/3 da amostra (2.746 pacientes) gerou o modelo preliminar e seu desempenho foi testado no banco valida??o, dividido em 1/3 da amostra (1.419 pacientes). O escore final foi validado no banco total e a acur?cia do modelo foi testada pelas estat?sticas de desempenho. Resultados: A incid?ncia de VMP foi de 18,8% (783). As vari?veis associadas ? VMP foram: idade ?65 anos (OR=1,91; [IC95%=1,62-2,24]; p<0,001); cirurgia de urg?ncia/emerg?ncia (OR=2,79; [IC95%=2,09-3,73]; p<0,001); obesidade (OR=1,49; [IC95%= 1,21-1,84]; p<0,001); insufici?ncia renal cr?nica (OR=1,98; [IC95%=1,61-2,44]; p<0,001); doen?a pulmonar obstrutiva cr?nica (OR=1,43; [IC95%=1,16-1,76]; p<0,001) e tempo de circula??o extracorp?rea ?120 minutos (OR=1,75; [IC95%=1,42-2,16]; p<0,001). A ?rea sob a curva ROC foi 0,66 (IC95%=0,64-0,68), o qui-quadrado de 3,38 (p=0,642) e o coeficiente de correla??o de r=0,99 (p<0,000). Conclus?o: As vari?veis preditoras pr?-operat?rias (idade ?65 anos, cirurgia de urg?ncia/emerg?ncia, obesidade, insufici?ncia renal cr?nica e doen?a pulmonar obstrutiva cr?nica) e perioperat?ria (tempo de circula??o extracorp?rea ?120 minutos) estiveram associadas com a VMP e permitiram a constru??o do escore de risco classificado em baixo, m?dio, alto e muito alto.

Submitted by Jadi Castro (jadiana.castro@ucb.br) on 2017-02-22T17:23:11Z No. of bitstreams: 1 RamiresAlsamirTibanaDisserta????o2013.pdf: 2478809 bytes, checksum: 1138c2ed8b196eb6709bc5bc2898da5b (MD5) / Made available in DSpace on 2017-02-22T17:23:11Z (GMT). No. of bitstreams: 1 RamiresAlsamirTibanaDisserta????o2013.pdf: 2478809 bytes, checksum: 1138c2ed8b196eb6709bc5bc2898da5b (MD5) Previous issue date: 2013-02-19 / The aim of the present study was to evaluate the acute and chronic effects of resistance training (RT) on cardiovascular risk factors in women with overweight/obesity and/or metabolic syndrome. This study was divided in four steps: (1) systematic review to elucidate the effectiveness of RT to prevent and treatment of cardiovascular risk factors in patients with metabolic syndrome (MetS); (2) to evaluate the clinical and ambulatory behavior of blood pressure (BP) after a acute RT session completed between 08:00-09:00 p.m. and of a control session in women with overweight/obesity; (3) to evaluate the clinical and ambulatory behavior of BP, and heart rate variability (HRV) after an acute RT session completed between 08:00-09:00 p.m. and a control session in women with Met and (4) to evaluate the effects of a eightweek RT without dietetic control on the risk factors of MetS in women with overweight/obesity. Methods: Sedentary women (18-49 years) with and without risk factors for MetS participated in this study. Volunteers were submitted to a acute RT session with six exercises (machine leg press, leg extension, leg curl, machine chest, frontal lat pull-down and machine shoulder press) with 3 sets of 10 repetitions and an intensity of 60% of one repetition maximum (1RM). After the acute RT and control session (35 minutes in the seated position) systolic (SBP) (PAS), diastolic (DBP) and mean blood pressure (MBP) were clinically monitored during 60 minutes and after this, the ambulatory monitor of BP (MAPA) was inserted to the non dominant arm to the analysis of SBP, DBP and MBP during 24h. The HRV was monitored after the RT session during 60 minutes post-exercise. The chronic study was performed during eight weeks (3x) of RT for the whole body with a intensity of 8-12 repetitions maximum and 1 minute rest interval between exercises and sets. Before and after the eight weeks anthropometric, biochemical, BP and muscle strength evaluations were completed. Results: Collectively, these data demonstrated that an acute RT session is capable of decreasing clinical and ambulatory BP both in women with overweight/obesity and MetS, with similar autonomic response post exercise in with and without MetS. Moreover, the eight-week RT without dietetic control and aerobic exercise presented a low effectiveness in modifying blood glucose, BP, waist circumference, triglycerides and HDL. However, short-term RT was effective in increasing absolute and relative muscle strength and muscle volume of the quadriceps. Conclusions: An acute RT session is capable if decreasing clinical and ambulatory BP in women with overweight /obesity and MetS. However, chronic RT without dietetic control did not decrease cardiovascular risk factor in women with MetS. / O objetivo do presente estudo foi avaliar os efeitos agudos e cr??nicos do treinamento de for??a (TF) sobre os fatores de risco cardiovascular em mulheres com sobrepeso/obesidade e/ou s??ndrome metab??lica. Este estudo foi dividido em quatro etapas: (1) revis??o sistem??tica para elucidar a efetividade do TF para a preven????o e tratamento dos fatores de risco cardiovascular em pacientes com s??ndrome metab??lica (SM); (2) avaliar o comportamento cl??nico e ambulatorial da press??o arterial (PA) ap??s uma sess??o de TF aguda realizado entre 20:00-21:00 e de uma sess??o controle em mulheres portadoras de sobrepeso/obesidade; (3) avaliar o comportamento cl??nico da PA e da variabilidade da frequ??ncia card??aca (VFC) e ambulatorial da PA ap??s uma sess??o de TF aguda realizado entre 20:00-21:00 e de uma sess??o controle em mulheres portadoras de SM e (4) avaliar os efeitos do TF realizado durante oito semanas sem controle diet??tico sobre os fatores de risco da SM em mulheres com sobrepeso/obesidade. M??todos: Participaram do presente estudo mulheres sedent??rias (18-49 anos) com e sem fatores de risco para SM. As volunt??rias submetidas ao TF agudo realizaram seis exerc??cios (leg press na m??quina, cadeira extensora, cadeira flexora, supino vertical na m??quina, puxada frontal e desenvolvimento na m??quina) com 3 s??ries de 10 repeti????es e intensidade de 60% de uma repeti????o m??xima (1RM). Ap??s as sess??es aguda do TF e controle (35 minutos na posi????o sentada) foram monitoradas clinicamente a press??o arterial sist??lica (PAS), diast??lica (PAD) e m??dia (PAM), durante 60 minutos e ap??s foi inserido no bra??o n??o dominante o monitor ambulatorial da press??o arterial (MAPA) para an??lise da PAS, PAD e PAM durante 24h. A VFC foi monitorada ap??s a sess??o de TF durante 60 minutos p??s-exerc??cio. O estudo cr??nico foi realizado durante oito semanas (3x) de TF para o corpo todo com intensidade de 8-12 repeti????es m??ximas e 1 minuto de intervalo de recupera????o entre os exerc??cios e s??ries. Antes e ap??s as oito semanas foram realizadas avalia????es antropom??tricas, bioqu??micas, press??ricas e de for??a muscular. Resultados: Coletivamente, estes dados demonstram que uma sess??o aguda do TF ?? capaz de diminuir a PA cl??nica e ambulatorial tanto em mulheres com sobrepeso/obesidade como em mulheres com SM, com similar resposta auton??mica p??s exerc??cio em mulheres com e sem SM. Al??m disso, o TF realizado durante oito semanas sem o controle diet??tico e sem a realiza????o de exerc??cios aer??bios foi pouco efetivo em alterar a glicose sangu??nea, PA, circunfer??ncia da cintura, os triglicer??deos e o HDL. No entanto, o TF realizado em curto prazo foi efetivo em aumentar a for??a muscular absoluta e relativa e o volume muscular do quadr??ceps. Conclus??es: Uma sess??o aguda do TF ?? capaz de diminuir a PA cl??nica e ambulatorial em mulheres com sobrepeso/obesidade e SM. No entanto, o TF cr??nico sem controle diet??tico n??o reduz os fatores de risco cardiovascular em mulheres com SM.

Relocating health behaviors within a political-economic framework, this article utilizes health behavior and health insurance governance perspectives to showcase the complexities of cultural and economic factors (e.g., job lock, wage differentials, social location, and health insurance status) that influence choices in efforts to mitigate the financial burden of health risk. By exploring the financial links to health behaviors that emerged through ethnographic participant observation and semistructured interviews with community and union members of the United Steelworkers and Retail, Wholesale, and Department Store Union in a metropolitan Central Appalachian community in 2007–8, this article argues for expanding the health behaviors concept to include a broader array of actions individuals and families take to better their health and well-being in the context of neoliberal shifting of risk management to individuals through increased consumer market-based cost-sharing health insurance disincentives. In so doing, this article argues for the importance of social and political-economic context in health behaviors and in evaluating health policy, including the Affordable Care Act.

The human papilloma virus (HPV) is the most frequent cause of sexually transmitted diseases (STDs) and cancers for U.S. adults. The Affordable Care Act (ACA), enacted in 2010, eliminated copay expenses for childhood immunizations and expanded access to health care. The purpose of this secondary data analysis study was to determine if there was an association between ACA and the usage of HPV vaccine among adolescent females in Georgia. Data concerning HPV vaccinations from 2011 to 2015 were obtained from the National Immunization Survey-Teen dataset. Andersen's BM of health care use was applied to ascertain the factors that enhanced the usage of HPV vaccine. Multiple logistic regression analysis was used to determine if there was any association between ACA and HPV vaccination. The study results showed a significant association between ACA and provider visit (p<.05). Also, provider visit was significantly associated with HPV vaccination rate (p<.05). Adolescent females with health insurance had a higher rate of provider visit after the passage of ACA. From 2011 to 2015, 87.2% of insured adolescent females visited their provider. The rate of HPV vaccination increased among the insured adolescent females who visited the provider from 35.3% in 2011 to 53.9% in 2015. Provider visit was identified as the most influencing factor that enhanced usage of HPV vaccine. The knowledge gained from the results contributed to social change by providing insight on how, through increased provider visits, ACA has improved the HPV vaccination rate among teenage females in Georgia. The conclusion will assist in developing effective strategies and policies that will achieve the Healthy People 2020 goal of 80% of herd immunity against HPV.

Health care costs for small businesses have been rising annually for the past few decades. Congress voted to pass the Affordable Care Act (ACA) to lower the cost of health care in 2010. The purpose of this phenomenological study was to explore small business owners' experiences in implementing ACA requirements and how the ACA affects small businesses as their owners work to make these organizations profitable. Complex adaptive systems theory formed the conceptual framework for this study Data were gathered during face-to-face and telephone interviews with a sample of 20 small business owners in the Philadelphia region. The research questions focused on participants' experiences with the ACA and changes made to their business model to maintain profits throughout the implementation process. A modified version of the Van Kamm data process assisted in finding themes within the data collected and analyzed using descriptive coding. Following data analysis, member checking was used to establish the trustworthiness of the outcomes. The themes that emerged indicated that small business owners adjusted their strategies because of ACA implementation but were concerned about the healthcare needs of their employees. This study may promote positive social change by informing small business leaders about ways to create efficient and inventive prototypical solutions specific to the needs of the business community, as well as ways to improve profitability. Both employees and employers may benefit.

<p>This Master Thesis was conducted at Octapharma AB in Stockholm.</p><p>Anticomplementary activity (ACA) is a measure of the product’s abilities to activate the complement system. IgG aggregates are mainly responsible for this activation. Two different performances of a method for determination of ACA in Octagam^® are available. The two performances are based on the reference method for test of ACA in immunoglobulins in the European Pharmacopoeia Commission Guideline 6.0 (chapter 2.6.17). The method is carried out either in test tubes or on microtiter plates. The test tube method can be performed either in a manual manner or modified, being more automated. The latter performance has been applied in this study. The plate method is more automated than both of the tube methods. The plate method and the manual tube method have earlier seemed to result in different outcomes, which was the basis for this thesis.</p><p>The plate method and the modified test tube method have been compared and robustness parameters have been studied in order to see which factors influence on the end result. The adequacy of using Human Biological Reference Preparation (human BRP) as a control for the ACA method in general has also been investigated. Samples of the product are outside the scope of this thesis and have not been investigated.</p><p>According to this study, the plate method and the modified tube method are not comparable with regard to complement titration results and to ACA of the BRP control. A higher precision is gained with the plate method. This in combination with the higher degree of automation makes the plate method advantageous in several aspects. When it comes to the robustness of the ACA method in general, the sheep red blood cells (SRBC) used are critical. Haemolysin dilution and complement activity seem to be critical as well.</p><p>Human BRP is, according to this study more adequate as a reference for the plate method than for the tube method. An In house control is believed to be more representative to the ACA method in general as it is of the same nature as the samples analysed, in contrast to the human BRP.</p>