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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
151

Valor dos instrumentos de avaliação de risco de quedas em idosos com fibrilação atrial / Utility of evaluation tools for assessment of the risk of falls in eldelry patients with atrial fibrillation

Santos, Angela Cristina Silva dos 03 December 2007 (has links)
INTRODUÇÃO: A queda é um fenômeno complexo, altamente prevalente e de alto custo, podendo causar sérias conseqüências inclusive a morte. O idoso com fibrilação atrial se beneficia do uso de anticoagulante. No entanto, a ocorrência de quedas pode restringe o seu uso. Este trabalho objetivou analisar a associação entre a ocorrência de queda e as variáveis obtidas na avaliação clínica e multifatorial em idosos com fibrilação atrial; verificar a freqüência, características e conseqüências das quedas. MÉTODOS: Neste estudo transversal, foram avaliados 107 idosos com 60 anos ou mais com fibrilação atrial crônica do ambulatório de cardiogeriatria do InCor-HCFMUSP. Os participantes foram divididos em dois grupos: (1) sem história de queda no último ano e (2) com história de um ou mais episódios de queda no último ano. Foram submetidos à avaliação que incluiu: dados sóciodemográficos; história da quedas; suas características e conseqüências; questionários de qualidade de vida (BOMFAQ); de nível funcional (HAQ); de risco nutricional (Guigoz); da função psico-cognitiva (Prime MD, Mini-Mental); avaliação do equilíbrio e da mobilidade (escala de Berg, POMA, Timed up & go); avaliação neurológica e de força muscular; avaliação da acuidade visual (tabela de Snellen e teste de Donders) e avaliação auditiva. Todos os dados foram submetidos à análise estatística com teste qui-quadrado ou teste de verossimilhança ou teste exato de Fisher. As médias das variáveis quantitativas foram comparadas com teste t-Student ou teste da soma de postos de Wilcoxon. Os valores de p<0,05 foram considerados estatisticamente significantes. As variáveis significantes na análise univariada foram utilizadas no ajuste do modelo de regressão logística, determinando sensibilidade, especificidade e probabilidade estimada de queda. Resultados: 1) 51,4% (55 idosos) caíram ao menos uma vez no último ano, sendo que as quedas resultaram em lesões corporais em 90% dos casos, 2) não houve diferenças entre os grupos com respeito à idade, sexo, índice de massa corporal, hábitos, riscos nutricionais e atividade física, 2) houve relação significante entre a ocorrência de queda com: a presença de sintomas, como cansaço; o uso de amiodarona; diagnóstico de insuficiência cardíaca CF III e de diabete melito; força muscular; o BOMFAQ (dificuldade de manter o equilíbrio); deficiência auditiva e visual e a escala equilíbrio da POMA A regressão logística das variáveis significantes positivas mostrou as seguintes variáveis independentes: uso de amiodarona, diagnóstico de diabete melito e a queixa de dificuldade de manter equilíbrio no BOMFAQ. O conjunto apresentou sensibilidade de 92,9% e especificidade 44,9%, a razão de chance foi de 5,95 e razão de verossimilhança positivo foi de 5.0. Conclusão:Em um grupo de idosos com FAC capaz de freqüentar ambulatório e relativamente independente, muitos fatores de risco de quedas foram identificados, sendo preditores independentes deste risco, a simples referência de dificuldade em manter o equilíbrio, o diagnóstico de diabete melito e o uso de amiodarona; A ocorrência de quedas com recorrências e conseqüências foi elevada. Nesses pacientes, o questionamento sobre a ocorrência de quedas no último ano e a avaliação do risco de quedas é fundamental diante da decisão em indicar a anticoagulação. / Introduction: Falling is a complex phenomenon, highly prevalent and costly. It may cause serious consequences, including death. Anticoagulation is beneficial for elderly patients with atrial fibrillation. However, falls may limit its use, especially when recurrent. The goals of this study were to evaluate the association between the occurrence of falls and variables derived from clinical and multidisciplinary evaluation of elderly patients with atrial fibrillation, to analyze the prevalence, characteristics and consequences of falls. Methods: This cross-sectional study involved 107 elderly patients older than 60 years of age with chronic atrial fibrillation who were followed in the Geriatric Cardiology Outpatient Clinic of InCor-HCFMUSP. Subjects were divided in two groups: (1) those with no history of falls in the past year, and (2) patients with at least one fall within the previous year. All patients underwent clinical and multifactorial evaluation, which included socio-demographic data, history of falls, their characteristics and consequences, questionnaires on quality of life (BOMFAQ), functional activity (HAQ), nutritional risk (Guigoz), psycho-cognitive function (PRIME MD, Mini-Mental), and the following evaluations: balance and mobility (Berg scale, POMA, Timed up & go), neurologic, muscular strength, and hearing status, and visual acuity (Snellen table and Donders test). Statistical tests employed included chi-square, analysis of likelihood methods, and Fisher exact test, as appropriate. Quantitative variables were compared by t-test or Wilcoxon. A p-value <0.05 was considered statistically significant. Variables statistically significant by univariate analysis were employed in a model of logistic regression to determine sensitivity, specificity, and estimated probability of falls. Results: 1) 51.4% of the patients (55) fell at least once in the preceding year, with 90% of the falls resulting in corporal lesions. 2) There were no difference between the two groups in regard to age, gender, body mass index, habits, nutritional risks, and level of physical activity. 3) There was a significant relationship between the occurrence of fall and the following univariate variables: symptom of fatigue, use of amiodarone, class III heart failure , diabetes, muscular strength, difficulty to maintain balance detected by the BOMFAQ questionnaire, hearing and visual impairment, and POMA balance scale. 4) The risk factors most frequent were hypertension, visual and hearing impairments, and muscular weakness. Logistic regression yielded the following independent variables: use of amiodarone, diabetes, and difficulty to maintain balance by BOMFAQ. These variables together had 92,9% sensitivity and 44,9% specificificity for predicting the occurrence of falls, with a hazard ratio of 5.95 and likelihood methods of 5.0. Conclusion: in a group of relatively independent, elderly patients with chronic atrial fibrillation which were able to visit an out-patient clinic, many risk factors for falls were identified. The multivariate analysis identified as independent risk factors, the use of amiodarone, the diagnosis of diabetes and difficulty in maintaining balance detected by the BOMFAQ questionnaire. The frequency of falls with recurrences and consequences was high. In these patients, it is very important to ask about the occurrence of falls in the last year and to evaluate the risk of falls, considering the decision to prescribe anti-coagulation.
152

Efeitos da história de exposição a estímulos apetitivos não contingentes e do custo da resposta sobre a aquisição de comportamento operante

Silva, Carlos Henrique Santos da 26 February 2016 (has links)
Made available in DSpace on 2016-04-29T13:17:57Z (GMT). No. of bitstreams: 1 Carlos Henrique Santos da Silva.pdf: 832548 bytes, checksum: 03094bcd7f2ef9a4031d5d74a5282e2b (MD5) Previous issue date: 2016-02-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Based on Seligman & Maier´s (1967) experiment related to learned helplessness indicating that exposition to response independent shocks may produce learning disabilities of an operant response, several authors have concerned to produce same effects in appetitive context and they have presented results indicating interference on operant acquisition (Engberg et al., 1972; Welker, 1976; Oakes et al., 1982 & Job, 1988) or results which do not support interference on operant acquisition (Schwartz et al., 1974; Wheatley et al., 1977 & Beatty & Maki, 1979). The suggestion of the present experiment is that response cost required from operant may be a relevant variable to produce interference on responding after a non contingent appetitive stimuli exposition. Eighteen male Wistar rats were allocated in six different conditions: Contingent CRF (CCRF), Contingent FR (CFR), Non Contingent CRF (NCCRF), Non Contingent FR (NCFR), Control CRF (CTCRF) and Control FR (CTFR). In first phase, subjects in Contingent conditions could produce reinforcers (water) through nose poke response while subjects in Non Contingent conditions were yoked with Contingent subjects and appetitive stimuli were delivered independently of responding and subjects in Control conditions were not exposed. In second phase, all rats in CRF conditions could produce reinforcers through barpressing response reinforced on a continuous reinforcement and rats in FR conditions through the same response reinforced on FR 3. Data suggest subjects exposed to non contingent appetitive stimuli that required more time to task completion in Phase 2 (100 reinforcer acquisitions) indicated more marked interference when FR 3 was utilized instead CRF. Furthermore, interference was identified on Phase 2 in subjects who showed accidentally reinforced variability in Phase 1 unlike subjects who presented stereotypy on responding. Results are discussed based on temporal contiguity among non contingent events, interference / response competition, and aversive / appetitive context differences / A partir do estudo de Seligman e Maier (1967) em relação ao desamparo aprendido , que indicou que a exposição a choques independentes do responder podem produzir dificuldades de aprendizagem de uma resposta operante, autores têm se preocupado em produzir os mesmos efeitos no contexto apetitivo e têm mostrado resultados que apontam interferência no responder na aquisição de resposta operante (Engberg et al., 1972; Welker, 1976; Oakes et al., 1982 & Job, 1988) ou resultados que contradizem o efeito (Schwartz et al., 1974; Wheatley et al., 1977 & Beatty & Maki, 1979). A sugestão do presente experimento é que o custo da resposta exigido da resposta operante pode ser uma variável relevante para a produção de interferência no responder após exposição a estímulos apetitivos não contingentes. Dezoito ratos Wistar machos foram alocados em seis diferentes condições: Contingente CRF (CCRF), Contingente FR (CFR), Não Contingente CRF (NCCRF), Não Contingente FR (NCFR), Controle CRF (CTCRF) e Controle FR (CTFR). Na primeira fase, os sujeitos de condições contingentes poderiam produzir água por meio da resposta de focinhar, os sujeitos de condições não contingentes estavam acoplados aos contingentes e recebiam os estímulos independentes do responder e os sujeitos das condições controle não foram expostos. Na segunda fase, todos os sujeitos das condições CRF poderiam produzir o reforçador por meio da resposta de pressão à barra reforçada em CRF e os sujeitos de condições FR por meio da mesma resposta reforçada em FR 3. Os dados sugerem que os sujeitos expostos a estímulos apetitivos não contingentes que precisaram de mais tempo para completar a tarefa na Fase 2 (aquisição de 100 reforçadores) apresentaram interferência mais acentuada quando a resposta foi reforçada em FR 3 do que quando a resposta foi reforçada em CRF. Além disso, interferência foi identificada na Fase 2 nos sujeitos que mais apresentaram variabilidade de respostas acidentalmente reforçadas na Fase 1, mas não nos sujeitos que mostraram padrões estereotipados no responder. Os resultados são discutidos com base na contiguidade temporal entre eventos não contingentes, interferência / competição de respostas e diferenças entre contexto aversivo e apetitivo
153

Tai Chi Chuan na atenção primária à saúde: avaliação de equilíbrio funcional e do medo de queda em idosos de uma unidade de saúde

Fagundes, Ricardo Augusto Lopes January 2011 (has links)
A queda em idosos é um problema significativo em saúde pública, já que este tipo de acidente pode resultar em fraturas, diminuição da mobilidade e aumento da mortalidade. Neste contexto, o Tai Chi Chuan (TCC) pode ser visto como uma prática corporal promissora na Atenção Primária à Saúde (APS). Nesta dissertação, foram produzidos dois artigos. No primeiro, avaliamos a relação entre a prática de TCC, como atividade de grupo em uma Unidade de Saúde, no equilíbrio estático e dinâmico de idosos. Para isto, 80 idosos da comunidade (≥ 60 anos) foram convidados a realizar entrevista e avaliação de equilíbrio e a participar de um grupo de TCC (amostra por conveniência). Os participantes foram avaliados antes e seis meses após o treinamento da “Sequência Simplificada de TCC de 24 Movimentos” (baseada no estilo Yang), 1x/semana. As 19 pessoas que frequentaram ≥8 aulas foram consideradas praticantes. Foram realizadas 26 aulas durante o estudo, com uma média de 18 participantes. Ocorreu uma melhora de aproximadamente dois pontos na Escala de Equilíbrio Funcional de Berg (p<0,001) no grupo de praticantes sendo que 100% destes, ou melhoraram ou mantiveram os escores anteriores. Tratase de uma das primeiras avaliações da prática de TCC realizada no âmbito da APS, no Brasil. No segundo artigo, (um relato de experiência) descrevemos as condições necessárias para a prática do TCC e o programa de treinamento de forma detalhada. Concluindo, o TCC é uma prática corporal utilizada para a promoção da saúde. Acreditamos ser possível sua inserção na APS trazendo, desta forma, benefícios na melhora do equilíbrio de idosos da comunidade. / Falls in the elderly is a significant problem in public health, since this type of accident can result in fractures, decreased mobility and increased mortality. In this context, the Tai Chi Chuan (TCC) can be seen as a promising body practice in Primary Health Care (PHC). In this dissertation, two articles have been produced. In the first article, we evaluated the relationship between the practice of TCC, as a group activity in a Health Unit in static and dynamic balance in elderly people. In order for this to happen, 80 community elderly (≥ 60 years) were invited to participate in interviews and evaluations of balance and as well as in a TCC group (convenience sample). Participants were evaluated before and six months after the training of “24 simplified TCC forms” (based on Yang style), 1x/week. The 19 people who attended ≥ 8 classes were considered practitioners. During the study, 26 lessons were conducted, with an average of 18 participants. There was an improvement of approximately two points on the Berg scale of balance performance (p <0.001) in the group of practitioners and 100% of these, either maintained or improved their previous scores. This is one of the first evaluations of the practice of TCC within the PHC, in Brazil. In the second article (an experience report) we described the necessary conditions for the practice of TCC and the training program in detail. In conclusion, TCC is a body practice that is used to promote health. We believe it is possible its insertion into the PHC bringing thus benefits in improving balance of older adults.
154

Efficacy of low-magnitude high-frequency vibration on preventing fall and muscle loss in community elderly.

January 2014 (has links)
跌倒和肌肉減少症是威脅老年人身體健康和生命安全的兩個重要問題。肌肉減少症所致的肌肉力量減弱和平衡能力下降是導致老年人跌倒的最主要原因。老年人跌倒最普遍和最嚴重的後果是脆性骨折。跌倒所致的脆性骨折是常見老年病,同時也是導致老年人生活品質下降和死亡的最主要原因之一。高頻低幅振動(LMHFV)是一種非侵入性生物物理干預手段,通過給予全身物理震動刺激,可有效提高肌肉功能和改善骨質。由此推測高頻低幅振動治療有望應用於預防跌倒/骨折及延緩肌肉減少。 / 本研究的目的在於,採用臨床隨機對照研究方法,通過對社區老年人進行高頻低幅振動治療,探索高頻低幅振動治療在預防跌倒/骨折、降低骨折發生率以及延緩肌肉量下降的作用。本研究假設高頻低幅振動治療可有效提高肌肉力量和改善骨質,從而降低骨折風險、跌倒率以及骨折發生率。本研究將分成兩部分進行以驗證此假說。 / 第一部分研究中,710名60歲或以上的社區老年人按社區中心為單位隨機分成振動治療組和對照組。振動治療組給予35Hz,0.3g的振動治療,並以每天20分鐘,每週5 天,持續18 個月;對照組則如常生活而不予振動治療。18個月治療過程中,振動治療組的跌倒率低於對照組46% (p=0.001)。同時,治療組的在平衡力測試中的反應時間、移動速度,和最遠移動距離也都有明顯改善 (所有指標 p<0.001)。在高頻低幅振動治療停止一年後,振動治療組的主導腿和非主導腿肌肉力量仍高於接受振動治療前 (p=0.029, p=0.002)。在平衡力測試中,治療組的反應時間、移動速度以及最遠移動距離也明顯優於對照組 (p=0.001,p=0.014,p=0.007)。在停止治療的一年期間,兩組受試者的肌肉力量,平衡能力以及生活品質均有下降的趨勢,但兩組的下降率並無明顯的差異。 / 第二部分的設計是基於第一部分的研究成果,目的在於更深入研究高頻低幅振動治療對肌肉功能、肌肉量以及肌肉質素的影響。60名社區老人隨機分成對照組和振動治療組。振動治療組給予35Hz,0.3g的高頻低幅振動治療,並以每天20分鐘,每週5天,持續9個月; 對照組則如常生活而不予振動治療。9個月後,治療組的主導腿和非主導腿的肌肉力量明顯高於對照組 (p<0.001,p=0.003)。在用以評估肌肉力量以及平衡力的計時起立坐下測試中,振動治療組用以完成連串起立及坐下動作的時間明顯低於對照組 (p=0.009)。振動治療組的下肢功能尺度問卷評估結果也明顯優於對照組 (p=0.002)。雖然兩組間的身體成份及肌電圖測試結果並無明顯差異,但治療組的肌肉量和肌電圖平均頻率均有上升的趨勢。而且,在兩部分實驗中,受試者對高頻低幅振動治療均有良好的耐受性,目前並沒有發現對受試者身體產生不利影響。因此,高頻低幅振動治療可安全地應用於社區老年人。 / 總括而言研究結果證明高頻低幅振動治療可明顯降低老年人跌倒發生率。9至18個月的振動治療可明顯改善老年人下肢功能和平衡力。在完成為期18個月高頻低幅振動治療後的1年,肌肉功能仍高於對照組,表明高頻低幅振動治療具有長期療效。因此,高頻低幅振動治療應在社區推廣作為老年人跌倒的預防方案之一。 / Fall and sarcopenia are two major problems among elderly. Poor muscle strength and balancing ability resulted from sarcopenia are the major causes of fall incidences. Fragility fracture is one of the most common and serious consequences of falls, which accounts for most of the deaths, as well as morbidity and poor quality of life. Low magnitude high frequency vibration (LMHFV) treatment is a non-invasive biophysical modality to provide a whole-body mechanical stimulation, which was previously shown to improve muscle performance and bone quality implying the potential application for fall/fracture prevention and reducing muscle loss. / The objectives of this study were to conduct prospective randomized controlled clinical trials to investigate the effect of LMHFV treatment on fall/fracture prevention, fracture risks and muscle loss among community elderly. It was hypothesized that LMHFV treatment could enhance muscle performance and bone quality, thus reducing the fracture risks, fall incidence and fracture rate. Two parts of studies were designed to testify the hypotheses. / In the Part I study, a total of 710 community elderly who were aged 60 years or above were recruited and randomized into vibration or control group on center-basis. The subjects in vibration group received LMHFV treatment (35Hz, 0.3g) 20min/day and 5days/week for 18 months, while control group remained sedentary. During the 18-month study period, the vibration group had reported 46% lower fall incidence rate when compared with control group (p=0.001). Significant improvements were found in reaction time, movement velocity and maximum excursion of balancing ability assessment, and also the quadriceps muscle strength (p<0.001 to all). After ceasing the LMHFV for 1 year, the muscle strength of dominant and non-dominant legs in vibration group were still significantly better than the baseline assessed before intervention (p=0.029 and 0.002 respectively), as compared with the control. In balancing ability test, the reaction time, movement velocity and maximum excursion of vibration group also remained significantly improved, as compared with the control group (p=0.001, 0.014 and 0.007 respectively). During the 1 year post-intervention period, both groups had shown a decreasing trend of muscle strength, balancing ability and quality of life but the rate of changes were not significantly different between two groups. / With reference to the results of Part I study, the Part II study was designed to investigate further the effects of LMHFV on muscle performance, mass and quality. 60 community elderly were recruited and randomized into either vibration or control group. Vibration group subjects received LMHFV treatment (35Hz, 0.3g) 20min/day, 5days/week for 9 months, while control group remained sedentary. Significant enhancement of dominant and non-dominant leg muscle strength was observed in the vibration group after 9 months LMHFV (p<0.001 and =0.003 respectively). In the chair rising test assessing muscle power and balancing ability, vibration group showed significantly shorter time needed for sit-to-stand cycles than the control (p=0.009). Significant increase of the lower extremity functional scale was also observed in the vibration group (p=0.002). No significant findings were found in the body composition and vibromyography (VMG) assessment, however, a trend of increasing lean mass and VMG mean frequency were observed. Also, minimal adverse effects were documented in both parts of study; all subjects were well-tolerated for LMHFV treatment. LMHFV is therefore safe and applicable to elderly in the community setting. / LMHFV was demonstrated to reduce fall incidences significantly. Significant effects on improving lower limbs function and balancing ability were observed as early as 9 months after treatment. Enhancement of muscle performance still remained significant 1 year after completion of 18-month LMHFV treatment, indicating strong residual effects of LMHFV. Use of LMHFV in the community as an effective fall prevention program is recommended. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Li, Chi Yu. / Thesis (Ph.D.) Chinese University of Hong Kong, 2014. / Includes bibliographical references (leaves 154-167). / Abstracts also in Chinese.
155

Analyse de sensibilité paramétrique d’un outil de modélisation des conséquences de scénarios d’accidents. Application à la dispersion atmosphérique de rejets avec le logiciel Phast / Parametric sensitivity analysis of a modelling tool for consequence estimation. Application to the atmospheric dispersion of accidental releases with the Phast software

Pandya, Nishant 01 December 2009 (has links)
L’objectif de la thèse est d’effectuer l’analyse de sensibilité paramétrique du logiciel Phast de modélisation de la dispersion atmosphérique de gaz toxiques et/ou inflammables. La technique a consisté à coupler Phast et l’outil d’analyse de sensibilité SimLab, ce qui permet d’exécuter automatiquement un grand nombre de simulations en faisant varier l’ensemble des paramètres du modèle de façon simultanée. La méthode d’analyse de sensibilité globale choisie, E-FAST, est basée sur l’analyse de la variance des sorties du modèle pour le calcul des indices de sensibilité. Nous avons étudié des scénarios de rejet continus pour six produits différents (monoxyde d’azote, ammoniac, chlore, azote, n-hexane et fluorure d’hydrogène), sélectionnés pour couvrir une large gamme de caractéristiques physiques et de conditions de stockage. L’analyse du modèle de dispersion de Phast, Unified Dispersion Model, a été séparée en deux étapes : étape de « screening » avec pour but de comparer l’influence de l’ensemble des paramètres puis étude de l’influence globale des paramètres de modélisation, autres que les paramètres météo et du terme source, sur une plage large de valeurs. Pour chaque produit, nous avons décomposé les scénarios de base en sous-scénarios correspondant à des conditions de rejet différentes. Ce travail a notamment permis de classifier les paramètres du modèle selon leur degré d’influence sur la variabilité de différentes sorties et d’effectuer une analyse comparative par produit indiquant, pour des conditions de rejet données, quels paramètres sont les plus influents sur les sorties. Une étude complémentaire a consisté à effectuer une analyse de sensibilité locale de ces paramètres autour de leur valeur par défaut. / We have undertaken a parametric sensitivity analysis of the Phast software tool’s models for atmospheric dispersion of toxic and/or inflammable gases. We have coupled Phast with the sensitivity analysis tool SimLab, and have automated the execution of a large number of simulations while varying simultaneously selected model parameters. The global sensitivity analysis method used, E-FAST, is based on analysis of the variance of model outputs, and allows us to estimate sensitivity indices. We have studied continuous release scenarios for six different products (nitric oxide, ammonia, chlorine, nitrogen, n-hexane and hydrogen fluoride), which were chosen to cover a wide range of physical characteristics and storage conditions. Our analysis of Phast’s Unified Dispersion Model comprises two phases: a screening phase which allows the sensitivity of a wide range of parameters to be compared, followed by a phase focusing on the sensitivity of internal model parameters (excluding weather and source term variables), over a wide input range. For each product, we have broken down base-case scenarios into a number of sub-scenarios corresponding to different release conditions. This work has allowed us to rank model parameters according to their influence on the variability of a number of model outputs. It also includes a per-product comparative analysis indicating, for each release condition studied, which parameters have the most influence on the outputs. In the final part of the work, we have analyzed the local sensitivity of these parameters in a narrow range around their default values.
156

Interação com a pesca: implicações na conservação da toninha, Pontoporia blainvillei (Cetacea, Pontoporiidae) no litoral do estado de São Paulo, SP / Fisheries interactions: implications on the conservation of franciscana, Pontoporia blainvillei (Cetacea, Pontoporiidae) in the coastal area of São Paulo state

Carolina Pacheco Bertozzi 14 December 2009 (has links)
Este trabalho tem por objetivo investigar a interação da pescaria de espera e as capturas acidentais de Pontoporia blainvillei, bem como a implicação da atividade na conservação da espécie. Para tanto, foram descritas e analisadas a atividade pesqueira, avaliadas as capturas acidentais, estimadas a mortalidade e estudados alguns aspectos da estrutura populacional, como a estimativa da idade, do crescimento e de parâmetros de algumas variáveis reprodutivas das toninhas acidentalmente capturadas no litoral do Estado de São Paulo. O monitoramento sistemático da frota pesqueira do município da Praia Grande durante o período de julho de 1999 a dezembro de 2008 permitiu uma avaliação temporal das capturas acidentais e dos índices de captura por unidade de esforço de pesca. Cinco tipos de redes de espera e um tipo de rede de arrastão de praia foram utilizados pela frota pesqueira da Praia Grande, sendo observadas capturas em quatro tipos de redes de espera. Um total de 91 toninhas foram acidentalmente capturadas e os valores de CPUE indicam que as redes de superfície boeira e a rede demersal fundo grossa são as responsáveis pelos maiores valores de captura nos meses de outono e inverno. Ao longo de todo o litoral paulista foi verificado o uso de redes de emalhe de espera em áreas costeiras, totalizando cerca de 1.192 embarcações operando redes de emalhe. A partir do monitoramento sistemático de quatro comunidades pesqueiras estimou-se um esforço de pesca total para a frota de emalhe do Estado de São Paulo em 4.684.981 km x dia de pesca, o qual foi multiplicado pela captura por unidade de esforço de pesca média (0,00008 toninhas/km x dia de pesca) resultando em uma estimativa de mortalidade de 372 toninhas para o período de junho de 2004 a abril de 2005. As idades estimadas dos animais capturados variaram de 0 a 14 anos, sendo que 80,0 % possuíam idade entre 0 e 3 anos. As fêmeas tiveram distribuição de idade 0 a 7 anos e os machos de 0 a 14 anos. O comprimento máximo assintótico estimado pelo modelo de von Bertalanffy ajustado aos dados de comprimento total e idade foi de 117,5 cm para machos e 135,6 cm para fêmeas 135,6 cm. O valor da taxa de crescimento estimado para os machos (0,859) foi superior ao das fêmeas (0,779). Não foi constatada diferença significativa entre comprimento, peso e largura entre as gônadas do mesmo animal, confirmado a hipótese de simetria. Os valores médios das medidas macroscópicas das gônadas, assim como o Índice de Maturidade Testicular (IMT) e Ovariano (IMO) foram significativamente diferentes entre indivíduos maduros, púberes e imaturos e apresentaram nítido aumento dos valores para os indivíduos maduros, demonstrando o aumento em tamanho e peso das gônadas com a chegada da maturidade gonadal. A análise microscópica de 45 testículos revelou que 33,3% dos machos eram imaturos, 15,6% púberes e 51,1% maduros. A análise microscópica dos ovários de 42 fêmeas resultou uma proporção de 54,8% fêmeas imaturas, 4,8% púberes e 40,5% maduras. Do total de fêmeas maduras capturadas nove estavam prenhas e apresentaram corpo lúteo de gravidez de grande dimensão. O número máximo de corpos albicans e lúteos observados nos ovários das fêmeas maduras foi três, ocorrendo 61,9% no ovário esquerdo. O comprimento médio e a idade média de maturidade para os machos foram estimados em 103,6 e 107,83 cm e 1,31 e 1,48 anos, respectivamente e para as fêmeas em 119 cm e 1,2 a 1,83 anos, dependo do método utilizado. O tempo de gestação estimado 10,22 meses, taxa de prenhez anual de 0,56, comprimento de nascimento de 72,05 cm, taxa de crescimento fetal de 0,27 cm/dia e o intervalo reprodutivo de 1,77 anos. Os resultados obtidos para o litoral do estado de São Paulo indicam que a pescaria de emalhe incide principalmente nos indivíduos imaturos de ambos os sexos, com 0 a 2 anos de idade, mas que um percentual significativo de adultos maduros também vem sendo capturados. Além disso, foi constatado que não há padrão latitudinal das variáveis estudadas. / The scope of this study is to investigate the interactions of gillnet fishing and the accidental captures of the Pontoporia blainvillei, as well as the implications of this activity in species conservation. Therefore, fishing activities are described and analyzed, accidental captures are evaluated, mortality is estimated and some aspects of population structure are studied, such as growth and age estimates, besides criteria estimates of reproduction variables in franciscana dolphin accidentally caught on the coast of the State of São Paulo. Continuous monitoring of the fishing boats in Praia Grande County, from July 1999 to December 2008 allowed both the chronological evaluation of accidental catching and capture per unit effort. Five different types of gillnets and one of trawl net for shallow areas were used by the fishing boats in Praia Grande, of which four types of gillnets registered catching. A total number of 91 franciscana dolphins were accidentally captured and the values of catch per unit effort (CPUE) indicate that \"boeira\" surface nets and \"bottom thick\" demersal nets are responsible for the highest capture numbers during autumn and winter time. The use of drift nets was observed along the coast of the São Paulo State where a total of 1,192 boats have used such nets. Through the systematic monitoring of four fishing communities, the total fishing effort concerning drift nets, in the State of São Paulo, was 4,684,981 km per fishing day. This value was then multiplied by the catch per unit of average fishing (0.00008 Franciscana dolphins/km x fishing day), which resulted in an estimate mortality of 372 dolphins between June 2004 and April 2005. Estimated age of captured animals varied from 0 to 14 years, 80.0% ranged between 0 and 3 years. Age distribution among female dolphins was from 0 to 7 years, while among male dolphins it was from 0 to 14 years. The maximum asymptotic lenght, estimated according to the von Bertalanffy model and adjusted to the length and age data, was of 117.5 cm for males and 135.6 cm for females. The estimated growth rate for males (0.859) was higher than for females (0.779). No significant difference regarding length, weight, and width between the gonads of the same animal was noticed, confirming the symmetry hypothesis. The average values of the gonads macroscopic measures, as well as both the Testicular (TIM) and Ovarian (OIM) Index of Maturity were significantly different among mature, pubescent and immature individuals. There was a clear increase in value for mature individuals, which demonstrates the gonads size and weight increase as they reach maturity. Microscopic analysis of 45 testicles showed that 33.3% of males were immature, 15.6% pubescent, and 51.1% mature. Microscopic analysis of 42 female ovaries showed that 54.8% of females were immature, 4.8% pubescent, and 40.5% mature. Nine out of the total mature females captured were pregnant and presented a pregnancy corpus luteum of greater size. The maximum corpus albicans and corpus luteum numbers observed in mature female ovaries was three - 61.9% occurring in the left ovary. Both average length and average sexual maturity age for male individuals were estimated between 103.6 107.83 cm and 1.31 1.48 years, respectively. For female individuals these numbers were 119 cm and 1.2 1.83 years, depending on the method used. The estimated pregnancy period was 10.22 months; the annual pregnancy rate was 0.56; the birth length was 72.05 cm; the fetal growth rate was 0.27 cm/day, and the reproduction interval was 1.77 year. The results obtained in the State of São Paulo indicate that drift nets affect mainly immature individuals of both sexes, from 0 to 2 years old. However, a significant percentage of mature adults have also been captured. Besides, no latitude pattern in the variables studied was confirmed.
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Validação da escala avaliativa do risco de quedas (EARQUE) em pessoas idosas que vivem na comunidade / Validation of risk of falling evaluative scale (EARQUE) in elderly people that live in the community

Lucélia Terra Chini 03 August 2017 (has links)
O presente estudo teve como objetivo geral validar a Escala de Avaliação do Risco de Quedas (EARQUE) em pessoas idosas que vivem na comunidade e, como específicos avaliar a validade de face e de conteúdo da EARQUE por especialistas (juízes) da área; a validade semântica da EARQUE na população-alvo e a validade de critério concorrente da EARQUE, a partir QuickScreen® como referência padrão. Realizou-se um estudo transversal, do tipo metodológico. Para a construção e validação do instrumento de rastreio do risco de quedas na pessoa idosa que vivem na comunidade, empregaram-se os procedimentos propostos por Pasquali (2010), a saber: teórico, empírico e analítico. O presente estudo enfatizou a análise teórica dos itens (última parte dos procedimentos teóricos), os procedimentos empíricos e analíticos. Cabe destacar que a construção da EARQUE foi realizada em estudo anterior, no entanto, neste estudo passou por um refinamento antes de prosseguir com a análise teórica. A análise teórica envolve dois momentos. No primeiro, na análise de validade de face e de conteúdo, foram eleitos juízes, ou seja, especialistas na área de saúde da pessoa idosa e do método em questão, os quais julgaram se os itens estavam ou não relacionados ao construto risco de quedas em pessoas idosas. Já no segundo, na análise semântica, a escala foi aplicada em 20 pessoas idosas selecionadas por conveniência no sentido de verificar se todos os itens eram compreensíveis para as mesmas. No delineamento principal, ou seja, nos procedimentos empíricos foi realizado um estudo do tipo Screening avaliativo, de delineamento transversal. A amostra desta etapa foi composta por 854 pessoas idosas. Além da versão piloto da EARQUE, foi aplicado o instrumento QuickScreen® como padrão-ouro. Os idosos foram divididos em dois grupos (I e II) conforme resultados do QuickScreen®, distribuídos da seguinte forma: idosos que pontuaram de 0 a 3 fatores de risco foram alocados para o Grupo I (grupo controle) e aqueles que pontuaram 4 ou mais foram alocados para o Grupo II (grupo de risco (casos). Com a finalidade de caracterizar a amostra, foram realizadas análises descritivas, utilizando medidas de tendência central (média e mediana), de variabilidade (desvio padrão) e distribuição de frequência. Para verificar diferenças de proporções entre os itens da EARQUE com os grupos obtidos a partir da aplicação do QuickScreen® foi utilizado o teste qui-quadrado (X2). Como medida de efeito foi empregada a razão de prevalência (RP) e seu respectivo Intervalo de Confiança a 95% (IC95%). Foram consideradas associações significativas àquelas que apresentavam valor de p0,05. A terceira etapa consistiu na realização de análises multivariadas por regressão logística, com o objetivo de identificar a associação entre os vários itens da EARQUE e o maior risco de quedas em pessoas idosas. Assim, inicialmente todas as variáveis da EARQUE foram incluídas na análise multivariada, e à medida que as variáveis se associavam aos itens do QuickScreen® (p0,05), estas eram selecionadas para novas análises multivariadas, consequentemente, as que apresentaram valor de p<0,05 permaneceram no modelo final da escala. Por fim, para avaliação da validade da EARQUE foram utilizadas medidas de precisão: sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo. Para representação dos valores de sensibilidade e especificidade e para identificação do melhor ponto de corte, utilizou-se a curva ROC (Receiver Operating Characteritic). Os dados foram organizados no Excel e analisados no software estatístico Med Calc versão 16.4.1. Para todas as análises realizadas considerou-se nível de significância de 5%. Ao final dos procedimentos teóricos, a EARQUE dispunha de 44 itens. Com relação às características sociodemográficas, a maioria das pessoas idosas era do sexo feminino (492; 57,6%), com média de idade de 71,87 anos. Após análises comparativas entre os grupos, 27 itens foram inseridos no modelo de regressão. Por fim, nas análises multivariadas por regressão logística, evidenciou-se que apenas 10 itens da EARQUE contribuíram para o maior risco de quedas em pessoas idosas e foram eles: queda anterior, uso de dispositivo de auxílio à marcha, polifarmácia, uso de psicotrópicos, dificuldade para subir ou descer uma ladeira, dificuldade para andar 100 metros, déficit visual e auditivo, baixa atividade física e ambiente mal iluminado. Este modelo de avaliação de risco assume valores de sensibilidade de 91,3% e especificidade de 73,4%. A EARQUE se caracteriza como instrumento válido, simples, de baixo custo e de fácil e rápida aplicação, podendo ser empregado por todos os profissionais de saúde da atenção básica, inclusive por agentes comunitários de saúde, o que se configura como uma contribuição inédita. Dessa forma, esta ferramenta discrimina pessoas idosas com menor e maior risco de quedas e, poderá indicar a necessidade de uma avaliação mais abrangente e mais detalhada, conforme sua classificação de risco - 0 a 2 pontos: baixo risco de quedas; 3 pontos: moderado risco de quedas e 4 ou mais pontos: alto risco de quedas. / The main objective of the present study was to validate the Risk of Falling Evaluative Scale (EARQUE) in elderly people that live in the community and its specific aims were to evaluate the EARQUE face and content validity by experts (judges) of the field; the EARQUE semantic validity in the target population; the EARQUE concurrent validity associating its results with the results obtained from the QuickScreen® application. A methodological cross-sectional study that addresses the development. For the construction and the validation of the risk of falling assessment tool in elderly people that live in the community, the procedures proposed by Pasquali (2010) were used, namely: theoretical, empirical and analytical. This study emphasized the theoretical analysis of the items (last part of the theoretical procedures), the empirical an analytical procedures. It should be noted that the construction of EARQUE was carried out in a previous study, however, in this study it went through a refinement before proceeding with the theoretical analysis. The theoretical analysis involves two moments. In the first one, in the face and content validity analysis some judges were chosen, in other words experts from the elderly health field and of the relevant method, that established if the items were related or not to the construct \"risk of falling in elderly people\". In the second, regarding the semantic analysis, the Scale was applied on 20 elderly people selected for convenience with the aim of verifying if all of the items were comprehensible by them. In the empirical procedure a Diagnostic and Screening Test Validation study was carried out. The sample of this stage was composed by 854 elderly people selected by a stratified random sampling procedure with a proportional distribution. Besides the EARQUE pilot version, the QuickScreen® instrument was applied - considering the \"gold-standard\" in this study. The elderly people were divided in two groups (I and II) according to the gold-standard test results and to the QuickScreen® and distributed as follows: elderly people that scored from 0 to 3 risk factors were allocated to the Group I (control group) and those who scored 4 or more than 4 were allocated to the Group II (risk group (cases). With the aim of characterizing the sample, descriptive analyses were realized using measures of central tendency (mean and median), of variability (standard deviation) and of frequency distribution. In order to verify differences of proportions between the EARQUE items and the groups obtained starting from the QuickScreen® application the chi-square test was used (X2). As a measure having an equivalent effect the ratio of prevalence (RP) with its respective Confidence Interval at 95% (IC95%) was used. The significant associations were considered those which showed p values0,05. The third stage consisted in the realization of multivariate logistic regression analyses, with the aim of identifying the association between the EARQUE various items and the higher falling risk in elderly people. Therefore, initially all the EARQUE variables were included in the multivariate analysis and with their association to the QuickScreen® items (p0,05) they were selected for new multivariate analyses and consequently those which showed p values<0,05 remained in the final model of the scale. Finally, for the EARQUE validity evaluation precision measurement were used: sensitivity, specificity, positive predictive value and negative predictive value. Concerning the representation of the sensitivity and the specificity values and for the identification of the best cut-off point, the ROC curve (Receiver Operating Characteristic) was used. The data were organized in Excel and analyzed in the Med Calc statistic software version 16.4.1. For all the analyses realized a significance level of 5% was considered. At the end of the theoretical procedures, EARQUE had 44 items. Regarding the socio-demographic characteristics, the majority of the elderly people were female (492; 57,6%) with an average age of 71,87 years. After comparative analyses between the groups, 27 items were inserted in the regression model. Finally, the multivariate logistic regression analyses showed that only 10 EARQUE items contribute for the increase of risk of falling in elderly people and these are referred to the following risk factors: previous falls, use of a walking aid device, polypharmacy, use of psychotropic substances, difficulty to ascend and descend a slope, difficulty to walk for a distance of 100 meters, visual and auditory deficit, a low physical activity and a badly illuminated environment. This stratification model of risk assumes sensitivity values of 91,3% and specificity values of 73,4%. EARQUE is defined as a valid, simple, low-cost and of easy and rapid application instrument, and it can be used by all the primary health care professionals, including by community health agents, which represents an unpublished contribution. Therefore, this tool discriminates elderly people with higher or lower risk of falling and it will be able to initiate a more comprehensive and detailed evaluation, according to the risk classification - from 0 to 2 points: low risk of falling; 3 points: moderate risk of falling and 4 or more than 4: high risk of falling.
158

Airbag system for hip-fracture protection due to falls: mechanical system design and development.

January 2007 (has links)
Chan Cheung Shing. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 88-90). / Abstracts in English and Chinese. / Abstract --- p.ii / Acknowledgements --- p.iv / Table of Contents --- p.v / List of Figures --- p.viii / List of Tables --- p.xii / Abbreviations and Notations --- p.xiii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Background and Objective --- p.1 / Chapter 1.2 --- Contribution --- p.4 / Chapter 1.3 --- Thesis Outline --- p.5 / Chapter Chapter 2 --- System Architecture --- p.6 / Chapter 2.1 --- Conceptual Design --- p.6 / Chapter 2.2 --- Sensing Device and Fall-Detection Algorithm --- p.7 / Chapter 2.3 --- Mechanical Part --- p.10 / Chapter Chapter 3 --- Mechanical Design --- p.11 / Chapter 3.1 --- Similar Products --- p.11 / Chapter 3.1.1 --- Airbag Restraining Systems in Automobiles --- p.11 / Chapter 3.1.2 --- Airbag Jackets for Motorcycle and House Riders --- p.12 / Chapter 3.2 --- Mechanism adopted --- p.12 / Chapter 3.2.1 --- Time Requirement of Inflator --- p.12 / Chapter 3.2.2 --- Mechanism and Design --- p.13 / Chapter 3.2.3 --- Actuator --- p.14 / Chapter 3.2.4 --- Punch --- p.15 / Chapter 3.2.5 --- Airbags --- p.18 / Chapter 3.2.6 --- Other Mechanisms Tried --- p.19 / Chapter 3.3 --- Prototype --- p.21 / Chapter 3.3.1 --- Implementation --- p.21 / Chapter 3.3.2 --- Demonstration --- p.23 / Chapter Chapter 4 --- Inflation Estimation --- p.25 / Chapter 4.1 --- Theory and Model --- p.25 / Chapter 4.2 --- Validation of Model --- p.28 / Chapter 4.2.1 --- Testing Equipment --- p.28 / Chapter 4.2.2 --- Preprocessing of Pressure Sensor Outputs --- p.28 / Chapter 4.2.3 --- Validation for Basic Equations --- p.29 / Chapter 4.2.4 --- Adjustment of Discharge Coefficients --- p.36 / Chapter 4.2.5 --- Validation for Discharging to a Fixed Volume --- p.40 / Chapter 4.2.6 --- Estimation of the Size of Airbag's Leakage Hole --- p.45 / Chapter 4.2.7 --- Validation for Discharging to an Airbag --- p.47 / Chapter 4.2.8 --- Time Delay due to Addition of a Pipe --- p.52 / Chapter 4.3 --- Summary of Experiments --- p.53 / Chapter 4.4 --- Limitation of Model --- p.54 / Chapter 4.5 --- Prediction of Inflation Time and Airbag Pressure --- p.55 / Chapter 4.5.1 --- Effects of Orifice Size and Vent Size on Airbag Pressure and Volume --- p.55 / Chapter Chapter 5 --- Force Attenuation Estimation --- p.58 / Chapter 5.1 --- Theory and Model --- p.58 / Chapter 5.1.1 --- Kelvin-Voigt Model --- p.59 / Chapter 5.1.2 --- Standard Linear Solid Support Model --- p.59 / Chapter 5.2 --- Simple Testing for Validation --- p.61 / Chapter 5.3 --- Summary of Experiment --- p.64 / Chapter 5.4 --- Estimation --- p.64 / Chapter 5.4.1 --- Force Attenuation Ability of Prototype --- p.64 / Chapter 5.4.2 --- Minimum Airbag Volume and Pressure Required to Reduce the Force --- p.65 / Chapter Chapter 6 --- Future Work --- p.66 / Chapter 6.1 --- Impact Test for Airbag System --- p.66 / Chapter 6.2 --- The Effective Mass of the Target User --- p.67 / Chapter 6.3 --- The Motion Data Collection --- p.68 / Chapter 6.4 --- Modification in the Inflator --- p.69 / Chapter Chapter 7 --- Conclusion --- p.70 / Appendix A Review of Basic Thermodynamics and Fluid Dynamics --- p.72 / Chapter A.1 --- Thermodynamics --- p.72 / Chapter A.2 --- Fluid Mechanics: Incompressible and Compressible Flow --- p.75 / Appendix B Derivation of Equations --- p.77 / Chapter B.1 --- Mass Flow Rate Equations --- p.77 / Chapter B.2 --- Relationship between Rate of Changes of Airbag Pressure and Volume --- p.80 / Chapter B.3 --- Pressure Change of Compressed Gas Cylinder --- p.82 / Chapter B.4 --- Dominating Factors in the Mass Flow Rate Equation --- p.83 / Appendix C Dimensions of Inflator --- p.85 / Appendix D Experimental Data --- p.86
159

Fatores associados à  alteração do equilíbrio postural e predição de quedas em pacientes com doença pulmonar obstrutiva crônica / Factors associated with postural balance impairment and prediction of falls in patients with chronic obstructive pulmonary disease

Pereira, Ana Carolina Alves Caporali 07 February 2018 (has links)
Introdução: A presença de doença crônica e de várias comorbidades, somados à mobilidade reduzida e fraqueza muscular são fatores frequentemente associados ao risco de quedas em idosos, sendo o dano do equilíbrio um dos mais importantes preditores de quedas. Atualmente, há uma crescente evidência de que pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) são bastante suscetíveis a quedas visto que têm apresentado importantes déficits de equilíbrio. Há alguns estudos que avaliam o papel de fatores isolados deste déficit, contudo, a avaliação de múltiplos fatores na mesma população de pacientes ainda não foi muito investigada, assim como o impacto desta alteração de equilíbrio na predição de quedas nesta população ainda é pouco conhecido. Objetivos: Determinar que fatores estão associados à alteração de equilíbrio postural em pacientes com DPOC e avaliar o impacto desta alteração do equilíbrio na predição de quedas nesta população. Métodos: Este estudo prospectivo de coorte incluiu 70 pacientes ambulatoriais com diagnóstico prévio de DPOC. Para a avaliação do equilíbrio os pacientes foram submetidos ao Mini-BESTest (Balance Evaluation Systems Test). As variáveis sexo, idade, frequência de exacerbações / hospitalizações decorrentes da doença respiratória no último ano foram coletados a partir de entrevista pessoal e de registros clínicos. A presença de comorbidades foi avaliada por meio da aplicação de uma escala denominada Functional Comorbidity Index (FCI). O nível de atividade física foi mensurado por meio de um sensor de movimento (acelerômetro), a força isométrica muscular máxima de membros inferiores foi avaliada por um dinamômetro, a qualidade do sono mensurada por meio do questionário Pittsburgh Sleep Quality Index, a dispneia pela modified Medical Research Council (mMRC) dyspnoea scale, o medo de quedas pela escala Falls Efficacy Scale-International (FES-I) e a função pulmonar por meio da prova de função pulmonar completa. Além disso, a incidência de quedas nos pacientes foi seguida por um ano sendo avaliada mensalmente por um diário de autorrelato de quedas, entregue ao paciente após a avaliação inicial, e confirmada por ligações telefônicas. Para a análise estatística foram utilizados modelos de análise de regressão e análise de poder discriminativo através da Receiver operator characteristic curve (ROC curve). O nível de significância foi ajustado para todas as análises e foi de 5% (p < 0,05). Resultados: Verificou-se que o equilíbrio postural (Mini-BESTest - pontuação total) esteve independentemente associado à força muscular de quadríceps, ao medo de queda (FES-I) e à idade, ajustados pela inatividade física (p < 0,001, r2 ajustado=0,49). Ao analisar cada domínio correspondente a um sistema do controle postural separadamente pudemos verificar também que o equilíbrio postural esteve independentemente associado a: idade e inatividade física, ajustados pelo índice de massa corpórea (IMC) no domínio \"Ajustes Posturais Antecipatórios\" (p=0,001, r2 ajustado=0,22); idade, força muscular de quadríceps e pressão inspiratória máxima (PImáx), ajustados pelo aprisionamento aéreo no domínio \"Respostas Posturais Reativas\" (p < 0,001, r2 ajustado=0,47); medo de queda e força muscular de dorsiflexores de tornozelo no domínio \"Orientação Sensorial\" (p=0,001, r2 ajustado=0,16); e qualidade do sono, inatividade física, idade e força muscular de plantiflexores de tornozelo no domínio \"Estabilidade na marcha\" (p < 0,001, r2 ajustado=0,24). Além disso, 37,3% dos pacientes apresentaram pelo menos um evento de queda em um período de 12 meses de seguimento. Verificou-se também que um melhor desempenho no controle postural, avaliado pelo Mini-BESTest esteve associado a um menor risco de queda [Odds ratio (OR)=0,50] e que o Mini-BESTest mostrou ser um bom instrumento para predizer quedas futuras em pacientes com DPOC [Area under the curve (AUC)=0,87, sensibilidade=84% e especificidade=73,8%]. Conclusões: A alteração do equilíbrio postural nesta população de pacientes com DPOC está associada à idade, fraqueza muscular de membros inferiores, medo de queda, qualidade do sono, inatividade física e à função pulmonar. Além disso, a alteração no equilíbrio postural é um bom preditor de quedas futuras nesta população, sendo o Mini-BESTest um bom instrumento para identificar os pacientes com maior risco de quedas. A implementação de programas de reabilitação que incluam treinamento de equilíbrio específico e prevenção de queda pode ser necessária para estes pacientes / Introduction: The presence of chronic disease and several comorbidities, added to reduced mobility and muscle weakness are often associated with the risk of falls in the elderly, with balance impairment being one of the most important predictors of falls. Currently, there is growing evidence that patients with chronic obstructive pulmonary disease (COPD) are quite susceptible to falls since they have presented significant balance deficits. There are some studies that evaluate the role of isolated factors in this deficit, however, the evaluation of multiple factors in the same sample of patients has not yet been much investigated, as well as the impact of this balance impairment in the prediction of falls in this population is not clear in the literature. Objectives: To determine the factors that are associated with postural balance impairment in patients with COPD and to evaluate the impact of this impairment on the prediction of falls in this population. Methods: This prospective cohort study included 70 outpatients with a previous diagnosis of COPD. Postural balance was evaluated by the Mini-BESTest (Balance evaluation systems test). Gender, age, frequency of exacerbations / hospitalizations resulting from respiratory disease in the last year were collected from an initial interview and patients\' medical records. The presence of comorbidities was evaluated using the scale of Functional Comorbidity Index (FCI). The level of physical activity was measured using a motion sensor (accelerometer type), the maximal isometric muscle strength of the lower limbs was assessed using a dynamometer, the sleep quality measured by the Pittsburgh Sleep Quality Index, the dyspnea by the modified Medical Research Council (mMRC) dyspnoea scale, the fear of falling by the Falls Efficacy Scale-International scale (FES-I) and the lung function obtained by the Complete Pulmonary Function Test. In addition, the incidence of falls was followed for one year, assessed monthly by a calendar of self-reports of falls, given to the patient after the initial assessment, and confirmed by telephone calls. For the statistical analysis, regression analyses models and discriminative power analysis by receiver operator characteristic curve (ROC) were used. The level of significance was adjusted for all analyses and was 5% (p < 0.05). Results: Postural balance (Mini-BESTest) was independently associated with quadriceps muscle strength, fear of falling (FES-I) and age, adjusted for physical inactivity (p < 0.001, adjusted r2=0.49). When analyzing each domain corresponding to a postural control system separately, we could also verify that the postural balance was independently associated with: age and physical inactivity, adjusted by the body mass index (BMI) in the domain \"Postural Anticipatory Adjustments\" (p=0.001, adjusted r2=0.22); age, quadriceps muscle strength and maximal inspiratory pressure (MIP), adjusted by air trapping in the \"Postural Reactive Responses\" domain (p < 0.001, adjusted r2=0.47); fear of falling and ankle dorsiflexors muscle strength in the domain \"Sensory Orientation\" (p=0.001, adjusted r2=0.16); and sleep quality, physical inactivity, age and ankle plantiflexors muscle strength in the domain \"Balance during gait\" (p < 0.001, adjusted r2=0.24). In addition, 37.3% of patients had at least one fall event over a 12-month follow-up period. It was also verified that a better performance in postural control evaluated by Mini-BESTest was associated with a lower risk of fall [Odds ratio (OR) = 0.50] and that Mini-BESTest was showed to be a good tool to predict future falls in patients with COPD [Area under the curve (AUC)= 0.87, sensitivity = 84% and specificity = 73.8%]. Conclusions: Postural balance impairment in patients with COPD is associated with age, lower limb muscle weakness, fear of falling, sleep quality, physical inactivity and lung function. In addition, the postural balance impairment is a good predictor of future falls in this population, and Mini-BESTest is a good tool to identify patients at greater risk of falls. The implementation of rehabilitation programs that include specific balance training and fall prevention may be required for these patients
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Interação com a pesca: implicações na conservação da toninha, Pontoporia blainvillei (Cetacea, Pontoporiidae) no litoral do estado de São Paulo, SP / Fisheries interactions: implications on the conservation of franciscana, Pontoporia blainvillei (Cetacea, Pontoporiidae) in the coastal area of São Paulo state

Bertozzi, Carolina Pacheco 14 December 2009 (has links)
Este trabalho tem por objetivo investigar a interação da pescaria de espera e as capturas acidentais de Pontoporia blainvillei, bem como a implicação da atividade na conservação da espécie. Para tanto, foram descritas e analisadas a atividade pesqueira, avaliadas as capturas acidentais, estimadas a mortalidade e estudados alguns aspectos da estrutura populacional, como a estimativa da idade, do crescimento e de parâmetros de algumas variáveis reprodutivas das toninhas acidentalmente capturadas no litoral do Estado de São Paulo. O monitoramento sistemático da frota pesqueira do município da Praia Grande durante o período de julho de 1999 a dezembro de 2008 permitiu uma avaliação temporal das capturas acidentais e dos índices de captura por unidade de esforço de pesca. Cinco tipos de redes de espera e um tipo de rede de arrastão de praia foram utilizados pela frota pesqueira da Praia Grande, sendo observadas capturas em quatro tipos de redes de espera. Um total de 91 toninhas foram acidentalmente capturadas e os valores de CPUE indicam que as redes de superfície boeira e a rede demersal fundo grossa são as responsáveis pelos maiores valores de captura nos meses de outono e inverno. Ao longo de todo o litoral paulista foi verificado o uso de redes de emalhe de espera em áreas costeiras, totalizando cerca de 1.192 embarcações operando redes de emalhe. A partir do monitoramento sistemático de quatro comunidades pesqueiras estimou-se um esforço de pesca total para a frota de emalhe do Estado de São Paulo em 4.684.981 km x dia de pesca, o qual foi multiplicado pela captura por unidade de esforço de pesca média (0,00008 toninhas/km x dia de pesca) resultando em uma estimativa de mortalidade de 372 toninhas para o período de junho de 2004 a abril de 2005. As idades estimadas dos animais capturados variaram de 0 a 14 anos, sendo que 80,0 % possuíam idade entre 0 e 3 anos. As fêmeas tiveram distribuição de idade 0 a 7 anos e os machos de 0 a 14 anos. O comprimento máximo assintótico estimado pelo modelo de von Bertalanffy ajustado aos dados de comprimento total e idade foi de 117,5 cm para machos e 135,6 cm para fêmeas 135,6 cm. O valor da taxa de crescimento estimado para os machos (0,859) foi superior ao das fêmeas (0,779). Não foi constatada diferença significativa entre comprimento, peso e largura entre as gônadas do mesmo animal, confirmado a hipótese de simetria. Os valores médios das medidas macroscópicas das gônadas, assim como o Índice de Maturidade Testicular (IMT) e Ovariano (IMO) foram significativamente diferentes entre indivíduos maduros, púberes e imaturos e apresentaram nítido aumento dos valores para os indivíduos maduros, demonstrando o aumento em tamanho e peso das gônadas com a chegada da maturidade gonadal. A análise microscópica de 45 testículos revelou que 33,3% dos machos eram imaturos, 15,6% púberes e 51,1% maduros. A análise microscópica dos ovários de 42 fêmeas resultou uma proporção de 54,8% fêmeas imaturas, 4,8% púberes e 40,5% maduras. Do total de fêmeas maduras capturadas nove estavam prenhas e apresentaram corpo lúteo de gravidez de grande dimensão. O número máximo de corpos albicans e lúteos observados nos ovários das fêmeas maduras foi três, ocorrendo 61,9% no ovário esquerdo. O comprimento médio e a idade média de maturidade para os machos foram estimados em 103,6 e 107,83 cm e 1,31 e 1,48 anos, respectivamente e para as fêmeas em 119 cm e 1,2 a 1,83 anos, dependo do método utilizado. O tempo de gestação estimado 10,22 meses, taxa de prenhez anual de 0,56, comprimento de nascimento de 72,05 cm, taxa de crescimento fetal de 0,27 cm/dia e o intervalo reprodutivo de 1,77 anos. Os resultados obtidos para o litoral do estado de São Paulo indicam que a pescaria de emalhe incide principalmente nos indivíduos imaturos de ambos os sexos, com 0 a 2 anos de idade, mas que um percentual significativo de adultos maduros também vem sendo capturados. Além disso, foi constatado que não há padrão latitudinal das variáveis estudadas. / The scope of this study is to investigate the interactions of gillnet fishing and the accidental captures of the Pontoporia blainvillei, as well as the implications of this activity in species conservation. Therefore, fishing activities are described and analyzed, accidental captures are evaluated, mortality is estimated and some aspects of population structure are studied, such as growth and age estimates, besides criteria estimates of reproduction variables in franciscana dolphin accidentally caught on the coast of the State of São Paulo. Continuous monitoring of the fishing boats in Praia Grande County, from July 1999 to December 2008 allowed both the chronological evaluation of accidental catching and capture per unit effort. Five different types of gillnets and one of trawl net for shallow areas were used by the fishing boats in Praia Grande, of which four types of gillnets registered catching. A total number of 91 franciscana dolphins were accidentally captured and the values of catch per unit effort (CPUE) indicate that \"boeira\" surface nets and \"bottom thick\" demersal nets are responsible for the highest capture numbers during autumn and winter time. The use of drift nets was observed along the coast of the São Paulo State where a total of 1,192 boats have used such nets. Through the systematic monitoring of four fishing communities, the total fishing effort concerning drift nets, in the State of São Paulo, was 4,684,981 km per fishing day. This value was then multiplied by the catch per unit of average fishing (0.00008 Franciscana dolphins/km x fishing day), which resulted in an estimate mortality of 372 dolphins between June 2004 and April 2005. Estimated age of captured animals varied from 0 to 14 years, 80.0% ranged between 0 and 3 years. Age distribution among female dolphins was from 0 to 7 years, while among male dolphins it was from 0 to 14 years. The maximum asymptotic lenght, estimated according to the von Bertalanffy model and adjusted to the length and age data, was of 117.5 cm for males and 135.6 cm for females. The estimated growth rate for males (0.859) was higher than for females (0.779). No significant difference regarding length, weight, and width between the gonads of the same animal was noticed, confirming the symmetry hypothesis. The average values of the gonads macroscopic measures, as well as both the Testicular (TIM) and Ovarian (OIM) Index of Maturity were significantly different among mature, pubescent and immature individuals. There was a clear increase in value for mature individuals, which demonstrates the gonads size and weight increase as they reach maturity. Microscopic analysis of 45 testicles showed that 33.3% of males were immature, 15.6% pubescent, and 51.1% mature. Microscopic analysis of 42 female ovaries showed that 54.8% of females were immature, 4.8% pubescent, and 40.5% mature. Nine out of the total mature females captured were pregnant and presented a pregnancy corpus luteum of greater size. The maximum corpus albicans and corpus luteum numbers observed in mature female ovaries was three - 61.9% occurring in the left ovary. Both average length and average sexual maturity age for male individuals were estimated between 103.6 107.83 cm and 1.31 1.48 years, respectively. For female individuals these numbers were 119 cm and 1.2 1.83 years, depending on the method used. The estimated pregnancy period was 10.22 months; the annual pregnancy rate was 0.56; the birth length was 72.05 cm; the fetal growth rate was 0.27 cm/day, and the reproduction interval was 1.77 year. The results obtained in the State of São Paulo indicate that drift nets affect mainly immature individuals of both sexes, from 0 to 2 years old. However, a significant percentage of mature adults have also been captured. Besides, no latitude pattern in the variables studied was confirmed.

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