O exercício físico é componente fundamental na abordagem terapêutica não medicamentosa da hipertensão, mas pouco se conhece sobre a manipulação dos componentes da carga do treino aeróbio sobre a magnitude e duração da Hipotensão Pós-exercício (HPE) e redução crônica da Pressão Arterial (PA). Este estudo de abordagem quase-experimental teve o objetivo de avaliar as respostas hemodinâmicas de idosos hipertensos aos treinos intervalados de longa e de curta duração. A amostra foi composta por 33 idosos hipertensos que participam de atividades promovidas por um Programa de Integração Comunitária (PIC) de um município do interior paulista. As variáveis estudadas foram agrupadas nas categorias: sociodemográficas, antropométricas e hemodinâmicas. Após avaliação ergométrica, cada participante foi submetido a duas sessões de exercício físico, com intervalo de uma semana entre os treinos. Na sessão de treino intervalado de longa duração os participantes realizaram sete séries de quatro minutos a 90% da Frequência Cardíaca (FC) máxima por dois minutos de recuperação a 60% da FC máxima, com a duração total de 47 minutos. Na sessão de treino intervalado de curta os participantes realizaram três séries de quatro minutos a 90% da FC máxima por dois minutos de recuperação a 60% da FC máxima, no tempo total de 23 minutos. Para obtenção dos dados hemodinâmicos (FC, PA e Duplo Produto), os participantes realizaram três exames de Monitorização Ambulatorial da Pressão Arterial (MAPA), com duração de 24 horas: MAPA controle, MAPA após exercício intervalado de longa duração e MAPA após exercício intervalado de curta duração. Na sua maioria, a amostra foi composta por indivíduos do sexo feminino (63,6%), com 67,79 ± 4,72 anos de idade, de cor branca (75,6%), convivendo com companheiro (63,6%), com 9,42 ± 1,88 anos de estudo, aposentados (100%). A média de Índice de Massa Corporal (IMC) foi igual a 29,6 ± 2,24 Kg/m2 e de Circunferência Abdominal (CA) igual a 92,7 ± 6,01 cm. Os valores médios de Pressão Arterial Sistólica (PAS) (142 ± 10,86 mmHg) e Pressão Arterial Diastólica (PAD) (85 ± 8,99 mmHg) no período de 24 horas, obtidos pelo exame de MAPA controle (basal), mostraram-se superiores aos índices de normalidade preconizados pela 7ª Diretriz Brasileira de Hipertensão Arterial. Quando comparamos os resultados dos exames de MAPA após as sessões de treinos intervalados de curta e de longa duração com os valores resultantes da MAPA controle, encontramos diferença estatisticamente significante (p<0,001) para todos as variáveis clínicas investigadas, com redução dos parâmetros nos períodos de vigília, sono e 24 horas, após ambos os tipos de treinamento. Houve diferença (p=0,027) na magnitude de redução da PAS após treino intervalado de longa duração (114 ± 7,13 mmHg) em relação ao treino intervalado de curta duração (118 ± 5,22 mmHg), no período de 24 horas. Também observamos diferença (p=0,044) na redução da PAD após treino intervalado de longa duração (63 ± 6,22 mmHg) em comparação aos valores obtidos após treino intervalado de curta duração (65 ± 4,46 mmHg) no período de sono. Na primeira hora após as sessões de treinos intervalados de curta e longa duração houve expressiva HPE, constatada pela redução estatisticamente significante da PAS e da PAD (p<0,001) em relação aos valores préexercício, nas medidas obtidas em todos os intervalos (10, 20, 30, 40, 50 e 60 minutos). O decréscimo de PA na primeira hora após o exercício de curta duração foi igual a 27 mmHg e, após o treino de longa duração, igual a 29 mmHg. Os resultados apontaram diferença quando comparados os valores da PA resultantes dos treinos intervalados de alta intensidade e curta duração e de alta intensidade e longa duração, observadas na PAS (p<0,001) a partir dos 20 minutos após os treinamentos até os 60 minutos e na PAD, dos 40 aos 60 minutos (p<0,001). Os resultados de nosso estudo nos permitem concluir que, tanto o método de treino intervalado de longa duração como o intervalado de curta duração promovem diminuição da PAS, da PAD e redução da sobrecarga cardíaca em idosos hipertensos, ao longo das 24 horas subsequentes às sessões de treino, comparado ao dia em que não houve a prática de exercício físico. Salientamos que o treino de curta duração possibilita o incremento da adesão individual aos programas de exercícios. A persistência dos benefícios fisiológicos ao longo das 24 horas minimiza a necessidade de treino diário e fornece condições de maior aderência à prática. Em hipertensos, essa modalidade de treinamento impacta no controle da PA com consequente redução do risco cardiovascular, sendo uma alternativa valiosa no tratamento não medicamentoso da HA ou de outras doenças cardiovasculares / Physical exercise is a fundamental component in nonpharmacological approaches of hypertension, however little is known about the manipulation of aerobic training load components on post-exercise hypotension (PEH) magnitude, duration and in the chronic reduction of arterial pressure (AP). In this study we performed experiments to evaluate the hemodynamic responses on hypertensive elderly patients after long and short-interval training. The sample consisted of 33 hypertensive elderly who participated in activities provided by a philanthropic entity in a country side town of Sao Paulo state. In the studied variables the following categories were considered: sociodemographic, anthropometric and hemodynamic. After ergometric test, each subject underwent two sessions of dynamic exercises at a minimum one week interval between sessions. During the long interval training session - 47 minutes total exercise volume - each participant performed seven bouts of 4 minutes at 90% maximal heart rate (MHR) separated by 2 minutes recovery phase at 60% maximal heart rate (MHR). At the same time, during the short-interval training session - 23 minutes total exercise volume - each participant performed three bouts of 4 minutes at 90% maximal heart rate (MHR) separated by 2 minutes recovery phase at 60% maximal heart rate (MHR). For hemodynamic data (HR, AP and DP) the participants underwent three ambulatory blood pressure monitoring (ABPM) exams during 24 hours: ABPM control, ABPM after long interval training and ABPM after short-interval training. For the most part, the sample consisted of female participants (63,6%), aged 67,79 ± 4,72 years, white participants (75,6%), 63,6% of women had a partner, 100% were retired and the duration of the study was 9,42 ± 1,88 years. The mean body mass index (BMI) was 29,6 ± 2,24 Kg/m2 and the abdominal circumference (AC) was 92,7 ± 6,01 cm. The average level of the systolic blood pressure (SBP: 142 ± 10,86 mmHg) and the diastolic blood pressure (DBP: 85 ± 8,99 mmHg) recorded during 24 hours ABPM control were higher than the ideal blood pressure recommended by the VII Brazilian Guidelines on Ambulatory Blood Pressure Monitoring. When comparing ABPM exams results after long and short-intervals training sessions with the results of ABPM control, all clinical variables investigated differ significantly (p<0,001). Both training sessions revealed reduction of parameters during 24 hours, awaken and sleeping period. There was difference (p=0,027) in the reduction magnitude of SBP after long interval training (114 ± 7,13 mmHg) when compared to short-interval training data (118 ± 5,22 mmHg) within 24 hours. During the sleeping period we also observed that there was a difference (p=0,044) in the DBP after long interval training (63 ± 6,22 mmHg) when compared to short-interval training data (65 ± 4,46 mmHg). In the first hour after the long and short-interval training sessions there was a striking PEH that was verified by the statistically significant reduction of SBP and DBP (p<0,01) compared to data pre-exercise. This result was obtained in all intervals (10, 20, 30, 40, 50 and 60 minutes). The decrease in AP in the first hour after short-interval training corresponded to 27mmHg and after long interval training it was 29 mmHg. We noticed that there was difference between the values of AP when the long term high intensity interval training was compared to the short term high intensity interval training. For SBP (p<0,001) the difference was from 20 minutes up to 60 minutes and for DBP (p<0,001) the difference was from 40 minutes up to 60 minutes. In conclusion we show that short and long interval training leads to a reduction in SBP, DBP and decline in cardiovascular overload of hypertensive elderly in the 24 hours following exercise practice when compared to the day of no physical activity. We point out that the short-interval training encourages patients\' adherence to exercise programs. Since the physiological benefits of the short and long interval training lasts 24 hours it eliminates the need for their daily exercise routine. This training approach can be particularly useful for hypertensive individuals as it leads to AP control with subsequently reduction in cardiovascular risk becoming a valuable alternative in nonpharmacological treatment of AH and other cardiovascular diseases

Les secouristes, par la nature et le cadre de leurs missions, interviennent en environnement à risque et mettent parfois leur santé en danger. Afin de minimiser ce risque, de nouveaux Equipements de Protection Individuelle (veste, tee-shirt et bottes) ont été conçus par un consortium européen de 23 partenaires réunis autour du programme de recherche ProeTEX. Ces travaux de thèse s’inscrivent dans le cadre de ce projet et ont pour objectif de développer un système de monitoring ambulatoire des paramètres thermiques du pompier qui sera intégré aux vêtements intelligents destinés aux secouristes. L’intérêt de cette intégration est le prépositionnement des capteurs afin de réduire le temps de préparation du secouriste. La surveillance s’opère à deux niveaux : l’interface Homme-environnement et le corps. Afin d’évaluer le risque thermique encouru, les paramètres faisant l’objet d’un suivi sont : la température interne, mesurée depuis le tee-shirt, et la température externe et le flux thermique, mesurés dans la veste. Ces paramètres permettent d’apprécier la contrainte thermique imposée par l’environnement et l’état de santé du pompier. Deux méthodes de mesure des paramètres thermiques dans la veste ont été développées. Le projet a abouti au développement de prototypes fonctionnels dont les performances ont été attestées en centre de validation. Des tests ont été conduits en laboratoire et en conditions extrêmes sur le terrain à la Brigade de Sapeurs-Pompier de Paris et au « International Firefighting, Survival and Rescue at Sea Training Center » de Pavie, Italie, pour démontrer la fonctionnalité des EPI en conditions réelles. / Rescuers, within the framework of their missions, operate in hazardous condition and sometimes put their health at risk. To minimize this risk, new personal protective equipment (jacket, t-shirt and boots) were designed by a 23 European partners’ consortium within the research program ProeTEX. This thesis is part of this project and aims to develop an ambulatory monitoring system for firefighters’ thermal parameters; It will be integrated into smart clothes for rescuers. Monitoring is taking place at two levels: Human-environment interface and body. To evaluate the thermal hazard involved, the parameters being monitored are: internal temperature, measured from the tee-shirt and external temperature and heat flux, in the jacket. These parameters are used to assess heat stress imposed by the environment and the health status of the fire-fighter. Two methods of measurement of thermal parameters in the jacket were developed. The project resulted in the development of functional prototypes whose performances have been vouched in validation center. Tests took place in the laboratory and during field trails in extreme conditions.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2009. / Härtill 5 uppsatser.

No description available.

No description available.

Catchment populations and cross-boundary flow characteristics of health facilities in Natal and KwaZulu have not previously been determined. As this information is essential to objective health service planning the present study was undertaken. Utilization. cross-boundary flow and catchment populations were determined in 1986 for each hospital and clinic in Natal and KwaZulu. All of the 61 hospitals and 178 clinics in Natal and KwaZulu which are operated by the public sector were included in the study. The ratio of clinics-to-hospitals was 2.9 1. The overall average population per hospital and clinic was 106775 and 36591 respectively. The size of the catchment populations of hospitals varied from 334972 to 272 and of clinics from 253159 to 877. Factors associated with these variations are discussed. Inter-regional cross-boundary flow of patients varied appreciably. The greatest influx of patients was experienced by the Durban sub-region where the teaching hospital is situated while the greatest influx of patients was experienced in the Port Shepstone sub-region. Attendance rates per person per annum. according to racial group, were 0.9, 2.1, 1.7 and 0.8 respectively for Blacks, Coloureds, Indians and Whites. Recommendations in respect of the distribution of health facilities and the routine collection and use of health information relevant to the management process are submitted. / Thesis (M.Med.)-University of Natal, Durban, 1987.

Hintergrund: Die wachsende Anzahl älterer multimorbider Patienten und der damit zunehmende Versorgungsbedarf am Lebensende erfordern eine gut funktionierende Basisversorgung mit dem Hausarzt als zentralem Ansprechpartner. Hausärzte versorgen ihre Patienten zumeist über mehrere Jahre und bis ans Lebensende. Darüber gibt es jedoch bisher keine ausreichenden Kenntnisse. Ziel der Studie: Die Versorgungssituation und Charakteristika hausärztlich versorg-ter Patienten in der letzten Lebensphase aus hausärztlicher Sicht, durch eine retro-spektive Erhebung abzubilden. Methode: Im Raum Hannover und Göttingen wurden 30 Hausärzte (Teilnehmerrate: 19%) mittels eines selbst entwickelten standardisierten Erhebungsbogen zu ihren in den letzten 12 Monaten eines natürlichen Todes verstorbenen Patienten (n = 451) befragt. Erfasst wurden vor allem Daten zur Soziodemographie und Betreuungssituation, zu den Erkrankungen, den Symptomen und der Symptomkontrolle. Neben einer rein deskriptiven Darstellung der Ergebnisse erfolgte ein Vergleich mit Daten aus der Hospiz- und Palliativerfassung (HOPE) 2010. Ergebnisse: Im Mittel hatte jeder teilnehmende Hausarzt 15 Patienten (SD: 7,3; Me-dian: 14,5; Range: 4-36), für die er Angaben im Erhebungsbogen machte. Das durchschnittliche Sterbealter betrug 78,5 Jahren (SD: 12,9; Median: 81; Range: 19-102), 55% der Patienten waren Frauen, der Großteil der Patienten (60%) lebte zu-letzt in der eigenen Wohnung beziehungsweise im eigenen Haus. Obwohl die meisten Patienten sich ein Versterben in häuslicher Umgebung wünschen, verstarben 41% der Patienten im Krankenhaus und nur 22% zu Hause beziehungsweise in einer Alten- oder Pflegeeinrichtung. Das Krankheitsspektrum war vielfältig und zeigte eine Dominanz der chronischen Erkrankungen (beispielsweise des Herz-Kreislauf-Systems und der Psyche). Im Vergleich mit den HOPE-Daten zeigten sich im Spektrum der Erkrankungen und in der Häufigkeit der Symptome deutliche Unterschiede. Die meisten Verstorbenen wurden im Rahmen der allgemeinen hausärztlichen Basisversorgung in der letzten Lebensphase betreut. Die Häufigkeit der Arzt-Patienten-Kontakte nahm zum Lebensende zu. Bei 48% der Patienten war der Hausarzt auch in den letzten 48 Stunden vor dem Tod noch in die Versorgung involviert. Eine palliativmedizinisch spezialisierte ärztliche Betreuung erhielten in der HAVEL-Studie nur 10% der Patienten. Neben der ärztlichen Betreuung spielten Angehörige (bei 49% der Patienten), Pflegedienste (bei 29%) und Pflegeheimpersonal (bei 33%) eine bedeutende Rolle in der ambulanten Versorgung in den letzten Lebensmonaten. Schlussfolgerung: Hausärzte sind unabhängig vom Sterbeort maßgeblich in die Betreuung ihrer Patienten bis ans Lebensende involviert. Die Unterschiede in den Patientencharakteristika sowie in den Versorgungsformen zwischen hausärztlicher und spezialisierter Versorgung am Lebensende sollten in der ärztlichen Aus- und Weiterbildung stärker berücksichtigt werden. Um der aktuellen Versorgungssituation auch in der Forschung gerecht zu werden und über die Qualität der ambulanten Versorgung am Lebensende Aussagen treffen zu können, sind weitere Untersuchungen erforderlich.

Emotions are an integral part of the human experience and their interpretation can provide valuable but also misleading clues about oneself and other people’s state of mind. Negative emotional states can be perceived as uncomfortable and – when experienced chronically – can develop into anxiety and mood disorders. The more pervasive these disorders the more severely they affect and disable a person’s everyday functioning and often their sleep as well. According to Lang and colleagues (1998), emotions may be expressed verbally, behaviorally, and physiologically, i.e., emotions can be reported, observed, and objectively measured. Each measurement approach provides important, unique, and often conflicting information that can be used in the assessment and treatment evaluation of psychological disorders affecting the emotions. Autonomic measures have been used to indicate the physiological components of emotions, such as those along the worry-anxiety-fear-panic spectrum. Worry has been shown to suppress cardiac responses to imaginal feared material (see Borkovec, Alcaine, & Behar, 2004) and reduce autonomic variability (Hoehn-Saric, McLeod, Funderburk, & Kowalski, 2004; Hoehn-Saric, McLeod, & Zimmerli, 1989). Results for panic and anticipatory anxiety are less conclusive but theoretically these states should go along with increased autonomic arousal. Abnormal autonomic arousal might also be present during sleep as both panic disorder and worrying have been associated with sleeping difficulties. However, most empirical research has been confined to the laboratory where high internal validity is achieved at the cost of poor ecological validity. Thus, the purpose of this doctoral dissertation is to extend and validate laboratory findings on worry, anticipatory anxiety, and panic using ambulatory monitoring. Twenty-four hour monitoring not only can give valuable insights into a person’s daytime emotional experience but also allows observing how these emotions might affect their sleep in their natural environment. In the following chapter, the reader will be introduced to a conceptual framework that ties together worry, anxiety, fear, and panic, and related anxiety disorders (section 2.1), to autonomic arousal and electrodermal and cardiac arousal in particular (section 2.2), to sleep and its relation to autonomic arousal and anxiety disorders (section 2.3), and to ambulatory monitoring (section 2.4). After illustrating the aims of this thesis (chapter 3), chapters 4 to 6 present the results of three empirical studies conducted as part of this doctoral research. The first study deals solely with electrodermal monitoring and how it is affected by confounding variables in an ambulatory context (chapter 4). The next study then seeks to investigate the relationship between electrodermal arousal and anticipatory anxiety and panic in a sample of panic disorder patients and healthy controls. The last study focuses primarily on the effect of trait and state worry on subjective and objective sleep and electrodermal and cardiac arousal in a group of high and low worriers. Chapters 7 to 9 summarize and integrate the findings from these three empirical studies, discuss methodological limitations, and provide an outlook into future research.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 5 uppsatser.

Thesis (M.S.P.H.)--University of South Florida, 2008. / Title from PDF of title page. Document formatted into pages; contains 26 pages. Includes bibliographical references.