<p>Physical inactivity has become a global health concern and is among the 10 leading causes of death and disability. This has led to increased concern for chronic diseases of lifestyle (CDL).&nbsp / Studies have revealed that regular physical activity is effective in combating several CDL such as cardiovascular disease, diabetes, cancer, hypertension and obesity. Physiotherapists are in a&nbsp / position to combat inactivity and effectively promote physical activity to their clients. Studies however have shown that participation in physical activity among physiotherapists could have an&nbsp / impact on the promotion of physical activity and their health practices. This study therefore sought to establish the relationship between physical activity levels of physiotherapists and their&nbsp / physical&nbsp / activity promotion strategies and barriers to promoting physical activity. Sequential Mixed Method Design was used in this study. Data was collected by means of a self administered&nbsp / questionnaire and a total of 92 physiotherapists voluntarily answered the questionnaire. A focus group discussion comprising of 10 purposively selected physiotherapists was conducted. The&nbsp / questionnaire assessed physical activity levels&nbsp / and physical activity promoting strategies of the participants while the focus groupdiscussion looked at the barriers to promoting physical&nbsp / activity. The Statistical Packages for Social Sciences (SPSS) version 18 was used for data capturing and analysis. Descriptive statistics were employed to summarize demographic information&nbsp / as means, standard deviation, frequencies and percentages. Inferential statistics (chi-square) was used to test the associations between different categorical variables (p&lt / 0.05). For the qualitative data, focus group discussions were used to collect data. Tape recorded interviews were transcribed verbatim, field notes typed, sorting and arranging data was done and themes&nbsp / &nbsp / were generated. Thematic analysis was then done under the generated themes. Ethical issues pertaining to informed consent, anonymity, confidentiality and the right to withdraw from the&nbsp / study were respected in this current study. The findings in the current study revealed that a big number of the participants were physical active both at work and recreation domains. However,&nbsp / there was no statistically significant association between physical activity and the demographicvariables. The results in this study revealed that the majority of participants were good&nbsp / physical activity promoting practices, although there was no significant association between physical activity levels and the physical activity promoting practices. The finding in this study revealed that discussing physical&nbsp / activity and giving out information regarding physical activity to their clients were the most common methods used in promoting physical activity. However, participants also highlighted barriers they&nbsp / ace in promotion of physical activity such as policies on physical activity, cultural influence, nature of work, time management as well as environmental barriers. The study demonstrates the&nbsp / need for all stakeholders to come up with solutions to break the barriers to promotion of physical activity. In return it will bring about enormous health&nbsp / benefits to the general population.</p>

Chronic disease is rising globally, but LMICs may require novel approaches to management suited to a low-resource setting. Private health care providers in LMICs have experimented and developed new models for organizing, financing, and delivering care. This thesis examines some of the innovations that have emerged in LMICs to manage chronic disease. Using a common performance measurement framework and drawing from a database of over 1200 innovative health programs, I identify and evaluate 46 programs addressing chronic disease in LMICs. I then go on to identify, innovative practices used by the subset of 19 diabetes focussed programs and catalogue them according to the Chronic Care Model (CCM). Delivery system design is the most commonly used domain of the CCM, which even earlier has shown to have great potential to impact health outcomes. Few of the identified innovations may also have the potential for ‘Reverse innovation’ in high income countries.

[Truncated abstract] Asthma is a chronic and complex disorder and despite our increase in the understanding of the genetics, pathology and mechanisms underlying asthma a gold standard definition of asthma does not exist. A criterion for recognising and diagnosing asthma in epidemiological studies is crucial in order to determine risk factors for disease. Prospective longitudinal birth cohort studies have increased our understanding of the natural history and risk factors for asthma, yet we are still not able to accurately predict which children will go on to have asthma as adults. It is during the transition from childhood to adolescence where factors underlying asthma change and the prevalence of asthma shifts between the sexes. There are inconsistencies regarding risk factors for the development and persistence of disease during this transitional period. Risk factors predicting the development and persistence of asthma and intermediate phenotypes (BHR, airway inflammation and atopy) may be influenced by gender and risk factors predicting disease may differ between childhood and adolescence. Aims 1. To identify risk factors for Asthma, BHR and Atopy at 14yrs of age. 2. To determine risk factors for persistence of asthma between 6 and 14 years. 3. To examine the influence of gender on risk factors during adolescence. Method The West Australian Pregnancy Cohort is a longitudinal birth cohort. The cohort initially consisted of 2868 live births with follow-ups at 1, 2, 3, 6, 8, 10 and 14 years of V age. ... Strong associations were seen with BHR and new diagnosis of wheeze and asthma in VI teenagers. Interestingly having either a cat or dog inside was protective for persistence of disease; in particular stronger associations were seen in teenage girls not in boys. During this transitional period the risk factors for asthma and intermediate phenotypes differ between the sexes. Different mechanisms are likely to be involved in determining asthma in boys and girls during adolescence and shed new light on the recognised switch in the gender balance in asthma prevalence from the male predominance in childhood to the female predominance in adult life. Our understanding of the natural course of disease from the prenatal period to adulthood and the identification of the various asthma phenotypes has the potential to change prognosis and planning of therapeutic strategies. Identifying those at high risk for persistence of disease in the early stages of life will allow therapeutic interventions to be more appropriately targeted.

Thesis (M.A.)--Carleton University, 2008. / Includes bibliographical references (p. 118-130). Also available in electronic format on the Internet.

p. 1-114 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-09T20:28:38Z No. of bitstreams: 1 Jacqueline C Dias-Seg.pdf: 520708 bytes, checksum: d26bf0657bfc6b37cc18adb1185c5ed4 (MD5) / Approved for entry into archive by Rodrigo Meirelles(rodrigomei@ufba.br) on 2013-04-10T14:02:58Z (GMT) No. of bitstreams: 1 Jacqueline C Dias-Seg.pdf: 520708 bytes, checksum: d26bf0657bfc6b37cc18adb1185c5ed4 (MD5) / Made available in DSpace on 2013-04-10T14:02:58Z (GMT). No. of bitstreams: 1 Jacqueline C Dias-Seg.pdf: 520708 bytes, checksum: d26bf0657bfc6b37cc18adb1185c5ed4 (MD5) Previous issue date: 2009 / A dislipidemia é definida como uma doença crônica não transmissível (DCNT’s) cuja ocorrência era mais freqüente na idade adulta, mas que na atualidade vem sendo observada em nível crescente também na infância. Assim, com o estudo “Promoção da alimentação saudável e a concentração de lipídeos séricos de crianças e adolescentes: uma intervenção em nível individual e familiar” objetivou-se avaliar a relação entre estratégias promotoras de alimentação saudável desenvolvidas no âmbito individual e familiar sobre a concentração dos lipídios séricos em crianças e adolescentes adotando-se as recomendações da Estratégia Global, conforme recomendada pelo Ministério da Saúde. Elegeu-se a criança e o adolescente como receptores da intervenção por creditar à estes uma maior receptividade às informações e assim absorverem as ações intervencionistas com mais desprendimento, além de mostrarem a capacidade para promover mudanças de hábitos alimentares também em seus familiares.O estudo teve duração de 12 meses e um desenho quase experimental do tipo antes e depois. A amostra foi constituída por 540 escolares de 7 a 14 anos de idade e demonstrou ter poder de 99,9% para avaliar a mudança de 10% na média dos níveis séricos de colesterol total, LDLc, HDLc e de 97,9% para o mesmo nível de mudança nos níveis de triglicérides, ao longo do seguimento. Para o cálculo da amostra do estudo adotou-se o nível significância (a) de 0,05 e testes bi-caudais. Na análise estatística foi utilizado o modelo linear de efeitos mistos para dados repetidos. / Salvador

Made available in DSpace on 2015-12-06T23:46:10Z (GMT). No. of bitstreams: 0 Previous issue date: 2013 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A populacao indigena brasileira passa por profundas mudancas ecologicas, sociais e economicas, que podem trazer consequencias diretas sobre os padroes nutricionais. Objetivo: este estudo transversal teve como objetivo principal verificar a coexistencia de doencas cronicas, em adultos, e de deficits nutricionais, em menores de 5 anos (familia ampliada), bem como suas relacoes com a condicao socioeconomica dos indigenas Khisedje que vivem no Parque indigena do Xingu (Brasil Central). Metodos: foram realizados exames fisicos (peso, estatura, perimetro abdominal e pressao arterial) e bioquimicos (glicemia, colesterol total e fracoes e triglicerides) em 179 adultos (20 a 89 anos de idade); dados de peso e estatura de 61 criancas menores de cinco anos foram avaliados a partir das fichas individuais ja existentes e a condicao socioeconomica foi avaliada por meio de questionario padrao, aplicado em cada domicilio com o auxilio de um interprete. Na descricao dos dados utilizaram-se medidas de tendencia central e de dispersao (variaveis quantitativas) e porcentagens (variaveis qualitativas). A existencia de relacao entre as presencas dos desfechos de interesse (condicao nutricional ou doencas cronicas) segundo sexo ou situacao socioeconomica foi avaliada pelo coeficiente de correlacao de Pearson. Resultados: Observou-se, entre os adultos, prevalencias de 42,4% de sobrepeso e de 98% de doencas cronicas (diabetes, hipertensao arterial ou dislipidemia), principalmente dislipidemia (84%). Entre as criancas a prevalencia de desnutricao foi 36% (A/I <-2 escore-z). Porem, essas condicoes nao se associaram a condicao socioeconomica de cada familia. Conclusao: Novos estudos sao necessarios no sentido de se identificar possiveis variaveis que possam, de fato, discriminar a condicao socioeconomica dos indigenas que vivem em aldeias / The Brazilian indigenous population also undergoes profound ecological changes, social and economic, that can bring direct consequences on nutritional standards. Objective: This cross-sectional study aimed to verify the coexistence of chronic diseases in adults, and nutritional deficits in children under 5 years (extended family), as well as its relations with the socio economic condition of the indigenous people who live in the Park Khisêdjê indigenous Xingu (Central Brazil). Methods: We performed physical examinations (weight, height, waist circumference and blood pressure) and biochemical (glucose, total cholesterol and fractions and triglycerides) in 179 adults (20-80 years old); data on weight and height in 61 children under five years were evaluated from individual records already exist and socioeconomic status was assessed using a standard questionnaire, applied to each household with the aid of an interpreter. In the description of the data we used measures of central tendency and dispersion (quantitative variables) and percentages (qualitative variables). The existence of a relationship between the presence of the outcomes of interest (nutritional status or chronic) by sex or socioeconomic status was assessed by the Pearson correlation coefficient. Results: Observed among adults, prevalence of 42.4% of overweight and 98% of chronic diseases (diabetes, hypertension or dyslipidemia), especially dyslipidemia (84%). Among children the prevalence of stunting was 36% (H/A <-2 z-score). However, these conditions were not associated with socioeconomic status of each family Conclusion: Further studies are needed in order to identify possible variables that may, in fact, discriminate socioeconomic status of indigenous people living in villages / BV UNIFESP: Teses e dissertações

Submitted by ELEN CRISTIANE DONÁ DE OLIVEIRA null (elendona@hotmail.com) on 2017-04-08T20:19:10Z No. of bitstreams: 1 Dissertação Correção final 28.03 (3).pdf: 929334 bytes, checksum: 5b5215beabf519320dfaa708b08ed015 (MD5) / Approved for entry into archive by Luiz Galeffi (luizgaleffi@gmail.com) on 2017-04-11T18:38:27Z (GMT) No. of bitstreams: 1 oliveira_ecd_me_bot.pdf: 929334 bytes, checksum: 5b5215beabf519320dfaa708b08ed015 (MD5) / Made available in DSpace on 2017-04-11T18:38:28Z (GMT). No. of bitstreams: 1 oliveira_ecd_me_bot.pdf: 929334 bytes, checksum: 5b5215beabf519320dfaa708b08ed015 (MD5) Previous issue date: 2017-02-03 / Introdução: A esquizofrenia é uma doença crônica e o tratamento acontece com utilização de fármacos antipsicóticos de modo prolongado. As medicações controlam os sintomas da doença, melhoram o bem-estar do indivíduo e elevam a chance de adaptação ao meio social, em contrapartida, acarretam vários efeitos adversos, sendo a alteração dos componentes da síndrome metabólica a mais comum. Objetivo: Avaliar o efeito da suplementação de farelo de aveia sobre o peso corporal, circunferência abdominal e componentes da síndrome metabólica de pacientes psicóticos institucionalizados em um hospital psiquiátrico. Método: Trata-se de um estudo quantitativo com intervenção em indivíduos psicóticos crônicos. A partir da medida de peso e estatura calculou-se o índice de massa corporal (IMC) para classificação do estado nutricional nos 4 momentos do estudo, início, 90 e180 dias de suplementação e 180 dias após o término da suplementação. Foram avaliados os componentes da síndrome metabólica: circunferência abdominal, glicemia de jejum, HDL-colesterol, triglicerídeos, antes e ao final da suplementação e após 180 dias sem suplementação. Resultados: Foram estudados todos os 45 moradores do local, destes, 62% eram do sexo masculino, com a média de idade de 55,5± 13,2 anos, todos há mais de cinco anos internados. Na sua totalidade faziam uso de medicação antipsicótica, 75% deles apresentaram risco cardiovascular, 46,7% eram obesos, 33,3% apresentaram colesterol total elevado, 50% hipertrigliceridemia, 28,9% apresentaram hipertensão arterial e 88,9% não apresentavam diagnóstico de síndrome metabólica no início do estudo. Em relação a suplementação com 20 gramas de farelo de aveia durante 180 dias, houve diferença estatística nos valores dos níveis de colesterol total, HDL-colesterol e triglicérides, mostrando a eficácia desta suplementação. Observou-se correlação significativa entre os valores de triglicérides séricos com IMC, circunferência abdominal, colesterol total, HDL-colesterol e glicemia, e IMC com a circunferência abdominal. Conclusão: Apesar da baixa prevalência de Síndrome Metabólica no grupo estudado, verificou-se que metade dos apresentava obesidade e 1/3 aumento da gordura abdominal, fator de risco importante para doenças cardiovasculares e que o uso de suplementação de farelo de aveia foi favorável para melhora dos níveis de colesterol total e triglicérides. Produto: Incluir na rotina alimentar diária dos pacientes a fibra alimentar. / Introduction: Schizophrenia is a chronic disease and treatment occurs with prolonged use of antipsychotic drugs. The medications control the symptoms of the disease, improve the well-being of the individual and increase the chance of adaptation to the social environment. On the other hand, medications have several adverse effects, and the alteration of the components of the metabolic syndrome is the most common. Objective: To evaluate the effect of supplementation of oat bran on body weight, abdominal circumference and components of the metabolic syndrome of institutionalized psychotic patients in a psychiatric hospital. Method: This is a quantitative study with intervention in chronic psychotic individuals. Body mass index (BMI) was calculated from the body mass index (BMI) for the classification of the nutritional status in the 4 study moments, beginning, 90 and 180 days of supplementation and 180 days after the end of the supplementation. The components of the metabolic syndrome: abdominal circumference, fasting glucose, HDL-cholesterol, triglycerides, before and at the end of the supplementation, and after 180 days without supplementation, were evaluated. Results: All 45 residents were studied. Of these, 62% were male, with a mean age of 55.5 ± 13.2 years, all of whom had been hospitalized for more than five years. 75% of them had a cardiovascular risk, 46.7% were obese, 33.3% had high total cholesterol, 50% had hypertriglyceridemia, 28.9% had arterial hypertension and 88.9% did not Diagnosis of metabolic syndrome at the start of the study. Regarding supplementation with 20 grams of oat bran for 180 days, there was a statistical difference in the levels of total cholesterol, HDL-cholesterol and triglycerides, showing the efficacy of this supplementation. A significant correlation was observed between serum triglyceride levels with BMI, waist circumference, total cholesterol, HDL-cholesterol and glycemia, and BMI with waist circumference. Conclusion: Despite the low prevalence of Metabolic Syndrome in the studied group, it was verified that half of them presented obesity and 1/3 increase of abdominal fat, an important risk factor for cardiovascular diseases and that the use of oat bran supplementation was favorable for Improved levels of total cholesterol and triglycerides. Product: Include dietary fiber in the daily diet of patients.

A participação ativa na autogestão da saúde individual tem sido associada com resultados positivos tanto para o indivíduo como para as instituições de saúde. O instrumento Patient Activation Measure (PAM) tem sido utilizado para mensurar a ativação, constructo que engloba o conhecimento, a habilidades e a confiança do indivíduo para realizar ativamente comportamentos saudáveis. Este estudo metodológico teve como objetivos adaptar culturalmente as versões PAM13 e PAM22 e avaliar as propriedades psicométricas das versões adaptadas em uma amostra de indivíduos com doenças crônicas. O processo de adaptação cultural ocorreu de acordo com recomendações da literatura: tradução, retrotradução e conciliação das versões traduzidas, avaliação por um comitê de juízes, avaliação semântica dos itens, obtenção das versões adaptadas e avaliação psicométrica. Os dados foram coletados entre junho e dezembro de 2014, no Ambulatório Central do Hospital de Clínicas da Universidade Federal de Uberlândia. Participaram do estudo 513 indivíduos de ambos os sexos, com diagnóstico de doenças crônicas há pelo menos seis meses, com idade entre 18 e 80 anos e que estavam em acompanhamento clínico regular no ambulatório. O PAM é respondido em uma escala ordinal com cinco pontos, que varia de discordo totalmente (1 ponto) até concordo totalmente (4 pontos), além da opção não se aplica (0 pontos). O intervalo possível do PAM22 é de 22 a 88 pontos e do PAM13 de 13 a 52 pontos. Os valores do escore bruto obtidos devem ser convertidos para uma pontuação de ativação, que varia de 0 a 100 pontos. Maiores pontuações indicam maior ativação. A validade de constructo do PAM foi avaliada pelas correlações entre as medidas de ativação e autoestima (Escala de Auto-Estima de Rosenberg), ansiedade e depressão (Hospital Anxiety and Depression Scale) e estado de saúde percebido (Escala Visual analógica); pela técnica de grupos conhecidos (sexo, idade, renda, escolaridade, tempo de diagnóstico e número de comorbidades) e sua dimensionalidade, pela variante da análise fatorial confirmatória que utiliza a análise dos caminhos, denominada de Modelagem de Equações Estruturais (MEE). A confiabilidade foi avaliada pela consistência interna e pela confiabilidade teste-reteste, num intervalo de tempo de 15 dias. O nível de significância adotado foi de 0,05. A maioria dos participantes foi do sexo feminino (62,0%), a média de idade foi 49,8 anos (DP=14,57; variação 18-80 anos). O tempo médio de ensino formal foi de oito anos (DP=4; variação 0-20 anos). Os participantes apresentaram diversificadas doenças crônicas e 75% haviam sido diagnosticados há mais de dois anos. O escore de ativação médio do PAM22 foi de 60,2 (DP=12,7) e do PAM13 foi de 63,0 (DP=15,9). Foi verificado efeito teto em todos os itens do PAM13 e PAM22. As propriedades psicométricas de validade e confiabilidade do PAM de 13 itens (PAM13) e de 22 itens (PAM22) foram consideradas adequadas. A consistência interna foi de ?= 0,83 para o PAM13 e de ?=0,86 para o PAM22. A confiabilidade teste-reteste foi de fraca a moderada magnitude para ambos os instrumentos (p<0,05). A correlação entre os escores das duas versões do PAM com as medidas de autoestima, de ansiedade e depressão e do estado de saúde percebido foram de magnitude fraca a moderada (p<0,05). No que se refere aos grupos conhecidos, nenhuma das variáveis apresentou diferença estatística, no entanto a medida de ativação correlacionou com a escolaridade e com o numero de comorbidades (p<0,05). A modelagem de equações estruturais indicou a necessidade de exclusão de alguns itens, para que em as versões adaptadas do PAM se ajustassem ao modelo da unidimensionalidade. Concluímos que as versões brasileiras PAM13 e PAM22 apresentaram adequadas e aceitáveis propriedades psicométricas para medir a ativação de pacientes brasileiros com doenças crônicas. Portanto, as versões adaptadas do PAM podem ser utilizadas na prática clínica e em pesquisas de intervenção em pacientes com doenças crônicas / The active participation in the individual health self-management has been associated with positive outcomes as for the individual as for the health institutions. The Patient Activation Measure (PAM) instrument has been used for measuring the activation, a construct which includes the knowledge, skills and confidence of the individual to actively accomplish healthy behaviors. This methodological study aimed adapting culturally the PAM13 and PAM22 versions and evaluating the psychometric properties of the adapted versions in a sample of subjects with chronic diseases. The cultural adaptation process occurred according to literature recommendations: translation, back translation and conciliation of translated versions, an evaluation by a committee of judges, a semantics evaluation of the items, the obtainment of the adapted versions of the PAM and psychometric assessment. The data were collected between June and December of 2014, in the Central Ambulatory of Hospital de Clínicas of the Federal University of Uberlândia. The study included 513 subjects of both genders, with a diagnosis of chronic diseases for at least six months, with ages between 18 and 80 years old and that had regular medical monitoring in the ambulatory. The PAM is answered in an ordinal scale with five points, ranging from disagree strongly (1 point) to agree strongly (4 points) and the option does not apply (0 points).The possible range in the PAM22 is 22 to 88 points and of PAM13 is 13 to 52 points. The values obtained raw score must be converted to an activation score, ranging from 0 to 100 points. High scores indicate greater activation. The construct validity of the PAM was evaluated by the correlations between by activation measures and self-esteem (Rosenberg Self- Esteem Scale), anxiety and depression (Hospital Anxiety and Depression Scale) and perceived health status (Analogical Visual Scale); by the known groups techniques (sex, age, income, education, time of diagnosis and number of comorbidities) and its dimensionality, by the confirmatory factorial analysis variation which uses the paths analysis, called Structural Modeling Equations (SEM). The reliability was assessed through the internal consistency and through the test-retest reliability, in a time of 15 day interval. The significance level adopted was of 0.05. The majority of the subjects were female (62.0%), the age average was 49.8 years old (DP=14.57; variation 18-80 years). The study average was eight years (DP=4; variation 0-20 years). The participants presented diverse chronic diseases and 75% had been diagnosed for more than two years. The average activation score of PAM22 was of 60.2 (DP=12.7) and of PAM13 was of 63.0 (DP=15.9). The ceiling effect was verified in all items of PAM13 and PAM22. The psychometric properties of validity and reliability of PAM of 13 items (PAM13) and of 22 items (PAM22) were considered adequate. The internal consistency was of ?= 0.83 to PAM13 and of ?= 0.86 to PAM22. The test-retest reliability was from weak to moderate magnitudes for both instruments (p<0.05). The correlation between the scores of the Brazilian versions of the PAM with the measures of self steem, anxiety and depression and the perceived health status was the weak and moderate magnitudes (p<0.05). Concerning known groups validity, none of the variables presented statistics difference, however the activation measure correlated to the education and the number of comorbidities (p<0.05). The structural equations modeling indicated the exclusion need of some items, so that in adapted PAM versions adjusted themselves to the one- dimensionality model. We conclude that the Brazilian versions of PAM13-B and PAM22-B presented adequate and acceptable psychometric properties to measure the activation of Brazilian patients with chronic diseases. Therefore, the adapted versions of PAM can be used in clinical practice and intervention studies in patients with chronic diseases

Orientadora: Anita Liberalesso Neri / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-16T20:33:56Z (GMT). No. of bitstreams: 1 Costa_TaiguaraBertelli_M.pdf: 1369321 bytes, checksum: 78945da5e1a216c11d3b1a5b9212e966 (MD5) Previous issue date: 2010 / Resumo: Existe consenso quanto a importância da atividade física para a promoção da saúde dos idosos, mas ha controvérsias a respeito dos métodos para avaliá-la, assim como ha dificuldades para discriminar entre os efeitos de variáveis de saúde e de variáveis comportamentais sobre sua pratica. Objetivo: Investigar relações entre fragilidade indicada por perda de peso, fadiga, baixa forca de preensão, lentidão da marcha e comorbidades, e níveis de atividade física avaliados por dois diferentes critérios, em idosos recrutados na comunidade, agrupados por gênero, idade e nível de renda familiar. Métodos: Participaram 689 idosos selecionados por desempenho superior a nota de corte no Mini-Exame do Estado Mental, de amostra de 900 idosos recrutados em domicilio, em setores censitários urbanos de Campinas sorteados ao acaso. A media de idade foi 72,28 + 5,40 e a renda mensal media de 4,72 salários mínimos + 5,27; 68,21% eram mulheres. Os níveis de atividade física foram aferidos por meio de versão adaptada do Minnesota Leisure Time Physical Activity Questionnaire. Perda de peso não intencional nos últimos 12 meses, exaustão e doenças crônicas diagnosticadas por medico, foram avaliadas por autorrelato. Forca de preensão manual em Kgs/forca correspondeu a media de três tentativas com dinamômetro Jamar, na mão dominante. Velocidade de marcha foi indicada pelo tempo médio gasto para percorrer 4,6 metros (três tentativas). O nível de atividade física foi indicado por dois critérios: pratica semanal regular e acumulada de 150 min. de exercícios físicos moderados ou de 120 min. de exercícios físicos vigorosos e taxa semanal de gasto calórico superior ao primeiro quintil da distribuição dos valores obtidos pela pratica de exercícios físicos e de atividades domesticas, ajustados por peso e por sexo. Pontuaram para fragilidade os idosos que perderam pelo menos 4,5 kg ou 5% do peso corporal; que responderam sempre ou quase sempre a qualquer um de dois itens escalares sobre fadiga; que pontuaram abaixo do 1º quintil no teste de preensão e acima do percentil 80 no teste de marcha, e que relataram ter pelo menos 3 doenças crônicas. Resultados: a prevalência de idosos que perderam peso foi 15,09%; dos que apresentaram fadiga, 17,13%; baixa forca de preensão, 16,96%; lentidão de marcha, 15,87%, e 3 ou mais doenças crônicas, 43,02%. A freqüência de ativos pelo critério de gasto calórico foi de 83,55%; pelo critério de regularidade da pratica de exercícios físicos, 45,27%. Houve associações positivas entre baixo nível de gasto calórico e baixa forca de preensão, lentidão de marcha e idade avançada; entre sedentarismo quanto a pratica de exercícios físicos e comorbidades. Conclusões: As diferentes relações encontradas entre os dois tipos de medida de atividade física e os indicadores de fragilidade podem ser atribuídas a questões metodológicas, a condições de saúde e a influencia de atitudes, valores e motivações sobre a adesão de homens e mulheres idosos a pratica de exercícios físicos e ao desempenho de atividades domesticas. Políticas publicas de incentivo a pratica regular de exercícios físicos e de atividades produtivas em casa, por idosos, devem levar em conta questões comportamentais e culturais, de modo especial quando o alvo for a população com menor renda e com saúde mais precária / Abstract: There is consensus on the importance of physical activity for health promotion for older people, but there is controversy about the methods to evaluate it, just as there are difficulties to discriminate between the effects of health variables and and behavioral variables on your practice. Objective: Examining relationships between frailty indicated by weight loss, fatigue, low grip strength, slow gait and comorbidities, and physical activity levels assessed by two different criteria, recruited in the elderly in the community, grouped by gender, age and income level familiar. Methods: 689 subjects selected for performance above the cutoff score on the Mini-Mental State Examination, a sample of 900 elderly people recruited from home in urban census tracts of Campinas drawn at random. The average age was 72.28 + 5.40 and the average monthly income of 4.72 minimum wages + 5.27; 68.21% were women. The physical activity levels were measured by the adapted version of the "Minnesota Leisure Time Physical Activity Questionnaire". Unintentional weight loss over the past 12 months, depletion and chronic diseases diagnosed by a physician, were assessed by self-reported. Handgrip strength in kgs/force corresponded to the average of three attempts with Jamar dynamometer in the dominant hand. Gait speed was indicated by the average time spent to travel 4.6 meters (three attempts). The level of physical activity was indicated by two criteria: regular weekly practice and accumulated 150 minutes of moderate exercise or 120 minutes of vigorous physical exercise and weekly rate of caloric expenditure above the first quintile of the distribution of values obtained by exercise physical and domestic activities, adjusted for weight and sex. Scored for fragile elderly people who have lost at least 4.5 kg or 5% of body weight; respondents always or almost always either of two scale items on fatigue, which scored below the first quintile of the test and hold above the percentile 80 in the test running, and who reported having at least three chronic diseases. Results: The prevalence of elderly people who lost weight was 15,09% of those with fatigue, 17.13%, low grip strength, 16.96%, slow gait, 15.87%, and three or more chronic diseases, 43.02%. The frequency of assets by the criterion of calorie expenditure was 83.55% by the criterion of regular physical exercise, 45.27%. There were positive associations between low caloric and low grip strength, slow gait and age, as between a sedentary lifestyle with exercise and physical comorbidities. Conclusions: The different relationships observed between the two types of measurement of physical activity and indicators of frailty can be attributed to methodological issues, the health conditions and the influence of attitudes, values and motivations on the accession of elderly men and women to practice physical exercise and performance of household chores. Public policies to encourage regular exercise and physical productive activities at home for the elderly, should take into account cultural and behavioral issues, especially when the target is people with lower income and poorer health / Mestrado / Mestre em Gerontologia

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The presence of single nucleotide polymorphisms (SNPs) in the ZnT8 gene in pancreatic β-cells can affect zinc homeostasis, increasing the risk of developing type 2 diabetes mellitus (T2DM). Combined with zinc, the minerals calcium, potassium and magnesium play an important role in insulin metabolism and glycemic control. The objective of this study was to evaluate the relationship of SNP rs11558471 (A/G) in the ZnT8 gene in the nutritional status of zinc and glycemic control, as well as to associate the concomitant mineral intake with glycemic markers in individuals with T2DM. For this, 110 adult subjects with T2DM were evaluated for the presence of the studied SNP, food intake and zinc status, glycemic and lipid markers. The ANOVA or Kruskal-Wallis tests were applied to evaluate the variables according to the genotype (AA, AG and GG). The usual intake was estimated by the Multiple Source Method and adjusted by the residual method. The individuals were grouped into two groups (clusters) based on the similarities of zinc, potassium, calcium and magnesium intake by the hierarchical grouping analysis, the difference being evaluated by Student's t-test for independent samples or Mann-Whitney. The Pearson correlation test was applied and multiple linear regression and logistic regression models were constructed. P-values <0.05 and between 0.05 and 0.10 were considered significant and marginally significant, respectively. Individuals with AA genotype had better pancreatic β-cell function when compared to those with G allele, and this difference was marginally significant. No differences were observed among the genotypes and the other variables. HOMA2-%B was associated with variations of SNP rs11558471 in the ZnT8 gene (β = -0.185, p = 0.048) and C-peptide (β = 0.243, p = 0.012), being sex dependent. The risk of altering %HbA1c (> 7%) was associated with the presence of the AA risk genotype (OR = 3.263, 95% CI = 1.154, 9.229, p = 0.026), depending on the diagnosis time. Regarding zinc nutritional status, it was observed that 68.3% and 72.4% of the individuals evaluated showed deficiency of zinc in plasma and erythrocytes, respectively, in addition to a high prevalence of zinc intake. The intake of the other minerals also showed a high probability of inadequacy. The group with the lowest concomitant intake of the four minerals (cluster 1) had higher %HbA1c (p = 0.006) and serum triglyceride concentration (p = 0.010). In addition, the risk of altering %HbA1c was associated with lower intake of these minerals (Cluster 1) (OR = 3.041, 95% CI = 1.131, 8.175, p = 0.028). Potassium (β = -0.001, p = 0.017) and magnesium intake (β = -0.007, p = 0.015) were inversely associated with %HbA1c, being sex and diagnostic time dependent. Thus, the SNP rs11558471 was not related to the nutritional status relative to zinc and to the glycemic control variables in subjects with T2DM. However, variations in the genotype of this SNP were associated with reduced pancreatic β-cell function, and the AA genotype was a predictor of changes in %HbA1c. In addition, the reduced concomitant intake of zinc, potassium, calcium and magnesium was associated with the risk of glycemic control deficient, with the magnesium and potassium minerals predicting the increase in %HbA1c. / A presença de polimorfismos de nucleotídeo único (SNPs) no gene do ZnT8 nas células β pancreáticas pode afetar a homeostase de zinco, aumentando o risco de desenvolvimento de diabetes mellitus tipo 2 (DM2). Em conjunto com o zinco, os minerais cálcio, potássio e magnésio possuem papel importante no metabolismo da insulina e no controle glicêmico. Diante disso, o estudo teve como objetivo avaliar a relação do SNP rs11558471 (A/G) no gene do ZnT8 no estado nutricional relativo ao zinco e no controle glicêmico, bem como associar a ingestão concomitante de minerais com os marcadores glicêmicos em indivíduos com DM2. Para isso, 110 indivíduos adultos com DM2 foram avaliados quanto à presença do SNP estudado, ingestão alimentar e marcadores do status de zinco, glicêmicos e lipídicos. Aplicaram-se os testes de ANOVA ou de Kruskal-Wallis para avaliar as variáveis de acordo com o genótipo (AA, AG e GG). A ingestão habitual foi estimada pelo Multiple Source Method e ajustada pelo método dos resíduos. Os indivíduos foram agrupados em dois grupos (clusters) com base nas semelhanças da ingestão alimentar de zinco, potássio, cálcio e magnésio pela análise hierárquica de agrupamento, sendo a diferença avaliada pelo teste t de Student para amostras independentes ou Mann-Whitney. O teste de correlação de Pearson foi aplicado e modelos de regressão linear múltipla e regressão logística binária foram construídos. P-valores < 0,05 e entre 0,05 e 0,10 foram considerados significativos e marginalmente significativos, respectivamente. Os indivíduos com genótipo AA apresentaram melhor função das células β pancreáticas quando comparados àqueles com alelo G, sendo essa diferença marginalmente significativa. Não foram observadas diferenças entre os genótipos quanto as demais variáveis. O HOMA2-%B foi associado às variações do SNP rs11558471 no gene do ZnT8 (β = -0,185, p = 0,048) e ao peptídeo C (β = 0,243, p = 0,012), sendo dependente do sexo. O risco de alterar o %HbA1c (>7%) foi associado à presença do genótipo de risco AA (OR = 3,263; IC 95% = 1,154; 9,229; p = 0,026), dependente do tempo de diagnóstico. Quanto ao estado nutricional relativo ao zinco, observou-se que 68,3% e 72,4% dos indivíduos avaliados apresentaram deficiência desse mineral no plasma e eritrócitos, respectivamente, além de elevada prevalência de inadequação na ingestão de zinco. A ingestão dos demais minerais também se mostrou com elevada probabilidade de inadequação. O grupo com menor ingestão concomitante dos quatro minerais (cluster 1) apresentou maiores %HbA1c (p = 0,006) e concentração sérica de triglicerídeos (p = 0,010). Além disso, o risco de alterar o %HbA1c foi associado a menor ingestão desses minerais (Cluster 1) (OR = 3,041, IC 95% = 1,131;8,175, p = 0,028). A ingestão de potássio (β = -0,001, p = 0,017) e magnésio (β = -0,007, p = 0,015) foi inversamente associada ao %HbA1c, sendo dependente do sexo e tempo de diagnóstico. Assim, o SNP rs11558471 não se relacionou com o estado nutricional relativo ao zinco e com as variáveis de controle glicêmico em indivíduos com DM2. No entanto, as variações no genótipo desse SNP foram associadas à redução da função das células β pancreáticas, e o genótipo AA mostrou-se preditor de alterações no %HbA1c. Além disso, a reduzida ingestão concomitante de zinco, potássio, cálcio e magnésio foi associada ao risco de controle glicêmico deficiente, sendo os minerais magnésio e potássio preditores do aumento no %HbA1c. / Aracaju