INTRODUÇÃO: Frente ao aumento gradativo de quedas da própria altura com o avançar da idade, torna-se imprescindível conhecer os fatores de risco implicados na sua ocorrência em mulheres na transição e após menopausa, com o intuito de contribuir com estratégias de prevenção e promoção da saúde no cotidiano. OBJETIVO: Estimar a prevalência de quedas referidas e caracterizar a associação entre as quedas com variáveis clínicas e epidemiológicas das mulheres da Estratégia de Saúde da Família do Município de Pindamonhangaba, SP. MÉTODOS: Em estudo com delineamento observacional do tipo transversal vinculado ao Projeto de Saúde de Pindamonhangaba (PROSAPIN), foram utilizados dados secundários randomizados de 875 mulheres com idade entre 35 a 65 anos e investigadas por meio de um inquérito domiciliar e medidas antropométricas. A variável queda foi incluída como dependente, enquanto que as independentes foram representadas pela idade, estado civil, renda, escolaridade, raça, ocupação, histórico ginecológico, doenças crônicas referidas e mensuradas, medicamentos, obesidade (índice de massa corpórea), hábito alimentar, consumo de bebidas alcoólicas, tabagismo, sono, depressão e atividade física habitual. RESULTADOS: Participaram do estudo 749 mulheres com média de 47,7 anos (com desvio padrão de 8,1); a prevalência de quedas da própria altura foi de 17,6 por cento (IC de 14,9 - 20,5), sendo a maioria (54,6 por cento) na pós menopausa. Das mulheres que caíram, a prevalência de recorrência foi de 45,2 por cento. As principais causas foram escorregões (29,4 por cento) e tropeços (19,8 por cento). Após análise multivariada constatou-se associação das quedas com a idade (p=0,018), qualidade do sono ruim (0,007) e comorbidades como a hipertensão arterial (p=0,032) e depressão (p=0,003). As comorbidades hipertensão arterial (p=0,055) e depressão (p=0,001) associaram-se também as quedas recorrentes, bem como restrições às atividades de vida diária (p=0,000). CONCLUSÃO: A maior prevalência de quedas ocorreu após a menopausa e entre os principais fatores associados à sua gênese emergiram a idade, hipertensão arterial, depressão e sono ruim / INTRODUCTION: Faced the gradual increase of falls from height with advancing age, it becomes essential to know the risk factors of the falls on women in transition and after menopause, in order to contribute with strategies for prevention and health promotion in their daily routine. OBJECTIVE: To estimate the prevalence of referred falls and characterize the association between falls and clinical and epidemiological variables of women of the Family Health Strategy of Pindamonhangaba City, SP. METHODS: In a study with observational design of the type cross-sectional linked to Health Project of Pindamonhangaba (PROSAPIN), it was used secondary randomized data from 875 women from 35 to 65 years old and they were investigated through a household survey and anthropometric measurements. The falls were included as a dependent variable and age, marital status, income, education, race, occupation, gynecologic history, chronic disease and those measured, medicines, obesity (body mass index), dietary habits, alcohol consumption, smoking, sleep, depression and physical activity. RESULTS: There were 749 women investigated with average age of 47.7 years (standard deviation 8.1); the prevalence of falls from height was 17.6 percent (95 percentCI: 14.9 - 20.5), the majority (54.2 percent) of the fallers were in the post menopausal. Of the women who fell, the prevalence of recurrence was 45.2 percent. The main causes were slipping (29.4 percent) and setbacks (19.8 percent). After multivariate analysis, it was found an association of falls with age (p=0.018), poor sleep quality (p=0.007) and comorbidities as hypertension (p=0.032) and depression (p=0.003). The comorbidities hypertension (p=0.055) and depression (p=0,001) associated too with recurrent falls, as well restricted the activities of daily living (p=0.000). CONCLUSION: The highest prevalence of falls occurred after the menopause and among the main factors associated its genesis emerged the age, hypertension, depression and bad sleep

Made available in DSpace on 2014-10-09T12:53:29Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T13:59:04Z (GMT). No. of bitstreams: 0 / A fim de propor alguns procedimentos para evitar erros em radioterapia baseados em lições aprendidas de exposições acidentais e de acordo com informações contidas em relatórios internacionais elaborados pela International Atomic Energy Agency (IAEA) e do banco de dados disponibilizado pelo grupo europeu Radiation Oncology Safety Information System (ROSIS) sobre os eventos, realizou-se uma investigação dos erros ocorridos. Para a avaliação dos incidentes foi criado um banco de dados baseado no ROSIS e acrescentado mais um parâmetro “tipo de erro”. Todos os dados armazenados possibilitaram a avaliação dos 839 incidentes em termos de freqüência do tipo de erro, o processo de detecção, o número de pacientes atingidos e o grau de severidade. Dos 50 tipos de erros encontrados, o tipo de erro que apresentou maior freqüência foi “coordenadas de tratamento incorreto”, confirmado com os dados da literatura e correspondendo a 28,96% do total dos incidentes. Os resultados mostraram que 44,44% são descobertos no momento do tratamento e que o processo de verificação da ficha ou revisão clínica do paciente é uma verificação mais segura e ocorrida em 43,33% dos eventos pesquisados. Os resultados indicaram que mais de 50% dos incidentes o grau de severidade é nulo e em aproximadamente 62% um paciente é afetado durante a realização do tratamento de radioterapia. Este trabalho mostrou que analisar o banco de dados segundo a metodologia proposta por Klein et al.; por Reason, e Dunscombe et al. é interessante inserir características mais detalhadas no banco de dados tais como: o número de frações por paciente afetado, número de campos de tratamento por fração que foi afetado, desvio da dose prescrita e desvio do volume prescrito em todos os eventos cadastrados. Existem várias causas que podem conduzir a erros quando pacientes são submetidos à irradiação em radioterapia. Algumas medidas podem ser tomadas para que esses erros não ocorram tais como: realizar dosimetria in vivo “off-axis” com diodo para reduzir o uso da direção incorreta da cunha; utilizar valores da distância vertical com indicador de distância óptica (SSD) para evitar erro de distância de tratamento; empregar o sistema de transferência de dados DICOMRT entre as estações de trabalho do planejamento de tratamento e a simulação, aumentando a eficiência e acurácia no tratamento; considerar a redundância nas verificações dos cálculos realizados por computador ou manualmente; empregar um sistema computadorizado de registro e verificação do tratamento; evitando-se erros nos tratamentos diários devidos à seleção incorreta dos parâmetros de tratamento; implantar um cartão magnético de identificação do paciente com foto, número de identificação, nome da instituição, nome do departamento, a data da primeira emissão e médico responsável para se evitar erros de identificação e registro e poderá ser utilizado em todo o processo do tratamento. Desta forma, esses procedimentos podem evitar mais incidentes em radioterapia e enfatizar a cultura de segurança. / Dissertação (Mestrado) / IPEN/D / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

Abstract Parkinson’s disease (PD) is a chronic and progressive neurodegenerative disease which is characterized by resting tremor, rigidity, bradykinesia and postural instability. Advanced PD is often complicated by falls, immobilisation and progressive deterioration of overall physical capability that may jointly contribute to a reduced quality of life and even to increased mortality. The purpose of this study was to identify risk factors for falls and mortality in PD, to assess the clinical correlates of balance and mobility, and to evaluate the association between orthostatic hypotension (OH), balance and mobility. From a total population of approximately 205 000 inhabitants, 125 patients with idiopathic PD were included in the study. Baseline medical data including occurrence of recent falls were collected, and patients were clinically tested for balance, mobility and orthostatic blood pressure reactions. Falls were thereafter prospectively recorded for two years using fall diaries and follow-up calls. Mortality was documented by reviewing the hospital charts four years after the baseline examination. In the cross-sectional part of the study, one-third of the patients reported recent falling. Disease duration and severity, recent falling and use of a walking aid were predictors of increased postural sway in PD. Advanced age and severity of the disease were related to impaired balance and mobility in PD patients. Severity of the disease and increased postural sway were independent risk factors for recent falling in PD, whereas measures of mobility were less important in this manner. Fifty-three percent of the patients had OH in the orthostatic test. Patients with OH had significantly increased postural sway in standing compared to patients without OH. On the contrary, OH was not associated with mobility and walking speed. In the present data, OH was not associated with the risk of falling in PD. Sixty-three percent of the study patients experienced falls and almost half of the subjects fell recurrently during the two-year follow-up. History of falling and disease severity indicated increased risk of recurrent falls in PD, while patients with slow walking speed had an increased risk of mortality. The results show that balance impairment and falls are common features in PD. Slow walking speed may be associated with increased mortality in PD.

Class of 2011 Abstract / OBJECTIVES: Accidental ingestions of medications in children under five years old are an increasing problem faced by parents and caregivers. This study will determine which medications are most commonly ingested and which cause more harmful side effects. METHODS: A descriptive, retrospective study was performed by obtaining data from electronic patient charts from the Arizona Poison and Drug Information Center (APDIC). Subjects were selected if they were younger than five years old and had ingested a medication during 2009. Age and gender were analyzed by calculating percentages and means and comparing them using an independent t-test. Adverse effects of medications were compared using a Chi Square test. RESULTS: A total of 4,373 cases met inclusion criteria for analysis, including 2,019 females and 2,354 males. The average age of patients was 2.2 years. Of 3,275 cases (74.4%) involving OTC medications, 119 patients (3.6%) developed minor effects and 20 patients (0.6%) developed moderate effects. Of 1,129 children (25.6%) ingesting prescription medications, 78 patients (6.9%) developed minor effects, 35 patients (3.1%) developed moderate effects and 1 patient (0.1%) developed a major effect (p=0.003). CONCLUSION: Males were more likely to have unintentional ingestions than females. The incidence of OTC ingestions was higher than prescription ingestions. Toddlers tended to have more ingestions than infants or older children. Unintentional prescription medication ingestions resulted in significantly more adverse effects than unintentional OTC ingestions.

Background: Non-accidental Trauma (NAT) is a major cause of morbidity and mortality in children. Children less than 2 years old are at greater risk of NAT than older children. A skeletal survey is a series of X-rays of all the bones in the body, or at least the axial skeleton and the large cortical bones used to identify NAT in children. In this observational study, we examined the association between a child’s age, frequency of positive skeletal surveys, and the types of injuries discovered in pediatric patients undergoing a trauma work-up. Methods: The study sample consisted of all pediatric trauma patients ≤3 years old who had skeletal surveys performed at a single tertiary care center in Central Massachusetts between 2005 and 2015. Patients were divided into two age groups: ≤6months old (n=98) and >6months old (n=86). The utilization of a skeletal survey, frequency of confirmed NAT, and injuries were compared between these 2 age groups. Results: The average age of the sample was 8.4 months, 56.0% were boys, and 62.5% were Caucasian. A positive skeletal survey was found in 14.3% of patients ≤6months old and 18.6% of patients >6months old (p=0.43). The most common fractures identified were long bone (50.0%), torso (30.4%), and skull (13.0%). Similar frequencies of NAT were observed between those less than and older than 6 months (58.2% vs. 57.0%). Head computed tomography (CT) scans were performed in the majority (95.9%) of patients ≤6 months old while in only 66.3% of patients > 6 months old (p < 0.01). Conclusions: Skeletal surveys identify injuries at comparable rates in pediatric trauma patients regardless of age. Advanced imaging differs in younger and older pediatric trauma patients undergoing skeletal survey.

No description available.

No description available.

Among elderly people, falls lead to a considerable amount of immobility, morbidity, and mortality. The purpose of this study was to develop and evaluate methods for predicting falls, and to evaluate a fall prevention program among elderly people living in residential care facilities. A fall was defined as any event in which the resident unintentionally came to rest on the floor or the ground regardless of whether or not an injury was sustained. In developing the prediction methods, it was hypothesised that older persons showing difficulties in performing a familiar second task while walking were more likely to fall within six months. For residents who stopped walking when talking, the relative risk of falling was 3.5 (95% CL2.0-6.2) compared to those who continued walking. For residents with a time difference (diffTUG) of at least 4.5 seconds between two performances of the Timed Up&amp;Go test, with and without carrying a glass, the hazard ratio for falls was 4.7 (95% Cl: 1.5-14.2) compared to those with a shorter diffTUG. A screening tool, the Mobility Interaction Fall (MIF) chart, was developed and evaluated, then validated in a new sample. This tool included a mobility rating, ‘Stops walking when talking’, ‘diffTUG’, a test of vision, and a concentration rating. In the first sample, the hazard ratio was 12.1 (95% 0:4.6-31.8) for residents classified as ‘high-risk’ compared to ‘low-risk’. The positive predictive value was 78%, and the negative predictive value, the sensitivity, and the specificity were above 80% for falling in six months. In the second sample the prediction accuracy of the MIF chart was lower (hazard ratio 1.7, 95% Cl: 1.1-2.5) and a 6-month fall history or a global rating of fall risk by staff were at least equally valuable. A combination of any two of the methods - the MIF chart, staff judgement, fall history - was more accurate at identifying high risk residents than any method alone. Half of the residents classified by two methods as ‘high risk’ sustained a fall within 6 months. In a randomised study a prevention program directed to residents, staff, and environment resulted in a significant reduction in the number of residents falling (44% vs. 56%; odds ratio 0.62, 95% CF0.41-0.92), the incidence of falls (incidence rate ratio IRR 0.80, 95% CF0.69-0.94) and of femoral fractures (IRR 0.25, 95% 0:0.08-0.82) in the intervention compared to the control group. In conclusion, a combination of any two of the staff judgement, fall history or MIF chart has the potential to identify a large proportion of residents at particular high fall risk. A multidisciplinary and multifactorial fall prevention program directed to residents, staff, and the environment can reduce the numbnumber of residents falling, of falls and of femoral fractures. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 2000,, härtill 5 uppsatser</p> / digitalisering@umu

La mer est un moyen important de transport et du commerce international surtout le transport des produits pétroliers.Mais le transport maritime surtout le transport des hydrocarbures ne peut pas se concevoir sans l'intervention de risques de pollution pétrolière.Certaines zones comme la mer méditerranée sont exposées au trafic maritime très dense qui menace leurs écosystèmes. La mer méditerranée est une route importante pour le transport maritime et elle est un espace de transite.Mais le trafic maritime est une des principales causes de pollutions pétrolières de la mer méditerranée.Cette pollution des navires pourra être de deux types. Il pourra s'agir d'une pollution accidentelle ou d'une pollution opérationnelle.Heureusement la communauté internationale a adopté des règles juridiques pour la répression et la prévention contre la pollution pétrolière provenant des navires. Du fait de sa spécificité, la Méditerranée bénéficiera d'une règlementation particulière.Mais malheureusement il existe actuellement une hétérogénéité entre les pays Méditerranéens dans la mise en œuvre des normes internationales et régionales pertinentes. Cette hétérogénéité est attribuée à deux raisons :- Le régime international et régional contient des lacunes juridiques qui réduisent de son efficacité ;- La géopolitique de la mer méditerranée qui se traduit par l'inégalité économique et technologique entre les pays du Nord riches et les pays du Sud pauvres. / The sea is an important means of international trade and transportation especially the transportation of petroleum products.in fact, the maritime transport of hydrocarbons may in many cases lead to the risk of oil pollution.Some areas like the Mediterranean Sea are exposed to traffic that threatens their very dense ecosystems. The Mediterranean is an important route for shipping and it is a place of transit.But shipping is a major cause of oil pollution in the Mediterranean Sea. This pollution may be of two types. It may be a incident pollution or operational pollution.Fortunately, the international community adopted legal rules for preventing oil pollution from ships. Because of its specificity, the Mediterranean will enjoy a special regulation.But unfortunately there is a current heterogeneity among Mediterranean countries concerning the implementation of relevant international and regional standards. This heterogeneity is attributed to two main reasons:First, the plan may contain regional and international legal shortcomings that reduce its effectiveness.Second, the Geopolitics of the Mediterranean Sea that lead to technological and economic inequality between the rich northern countries and poor southern countries.

By using a pragmatic paradigm, different research methodologies were employed in this thesis. MS-related symptoms may be exaggerated due to heatsensitivity and it is supposed that cooling garments relieve the symptoms. The effects of wearing a Rehband® vest were evaluated in a sample of 42 persons with MS in a randomised controlled crossover study. Both objective and subjective statistically significant improvements were found when a cooled Rehband® vest was worn compared to the wearing of a room-tempered vest. Using a repeated-measures design, 10m and 30m timed walks and Timed Up and Go were studied in 42 persons with MS. Reproducibility was investigated within and between test points. High reproducibility was found both within (r=0.97–0.98) and between measure points (r=0.91–0.93). The correlation between the three tests was high (r=0.85). Differences at –23% to +40% were established as being needed to detect genuine changes. Severity of MS infl uenced the size of the differences, especially for the 30m timed walk test. The 12-item MS Walking Scale was translated and used in a cross-sectional study. Out of 81 persons with MS, 89–96% perceived limitations in standing or walking. The internal consistency of the scale was acceptable for nine items (0.69–0.84). The concurrent validity between the 12-item MS Walking Scale and the investigated objective tests was low: Berg Balance Scale (r=–0.368**), Four Square Step Test (r=0.338**) and Timed Up and Gocognitive (r=0.319*). A prevalence of falling was found at 63% in a longitudinal cohort study with prospectively registered falls including 76 persons with MS. The odds of falling were fi ve fold when there was a reported need of using a walking aid indoors and outdoors and by 2.5 to 15.6 times while there was disturbed proprioception, depending on severity. The highest sensitivity was found for the Berg Balance Scale (94%) and the highest specifi city was found for the 12-item MS Walking Scale (82%). Positive predictive values at 70–83% were found for the Berg Balance Scale, Timed Up and Gocognitive, the Four Square Step Test and the 12-item MS Walking Scale. Finally, we explored and described factors that persons with MS perceive as related to accidental falls. A content analysis with a deductive approach was chosen. By conducting interviews, we found previously untargeted factors: divided attention, reduced muscular endurance, fatigue and heat-sensitivity. The content of the interviews also gave support to previously reported risk factors such as changes in gait pattern, walking disability, impaired proprioception and vision, and spasticity.