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The purpose of this article is to synthesize the evidence on advance care planning (ACP), determine what is applicable to the home health (HH) setting, and find where gaps in knowledge may exist. An integrative review methodology was chosen. Although there is ample literature on the topic of ACP, most research has been conducted in the acute care, outpatient, and general community settings. There is limited literature regarding ACP with patients living with chronic cardiovascular and pulmonary illnesses, who comprise the majority of the HH population. Some literature has been published regarding the interprofessional team's role in ACP in the HH setting. A gap in knowledge exists regarding ACP in HH, and recommendations for future research are provided.

Bakgrund: Digitala kontaktvägar har fått en framträdande roll inom primärvården. Genom digitala kontaktvägar ska individen stå i centrum och öka förmågan att hantera sin sjukdom. Egenvårdsråd är högt prioriterade för patienter med kroniskt obstruktiv lungsjukdom och syftar till att minska symtom, förebygga exacerbationer, öka fysisk aktivitet, förhindra sjukdomsprogression och minskad dödlighet. Syftet: var att belysa vilka erfarenheter patienter med KOL har av egenvårdsråd genom en digitaliserad kontakt med vården. Utifrån litteraturöversiktens 14 kvalitativa artiklar framkom tre huvudkategorier: från fysiska till digitala kontaktvägar, erfarenheter av att möta distriktssköterskan på skärmen och digitala egenvårdsråd. Metod: Studien genomfördes som en systematisk litteraturstudie med induktiv ansats. Resultat: Digitala egenvårdsråd ansågs vara ett användbart komplement, inte som en ersättning till fysiska besök hos distriktssköterskan. Konklusion: Den samlade kunskapen från föreliggande studie kan ligga till grund för att distriktssköterskor och verksamhetschefer inom primärvården får en bättre förståelse kring hur egenvårdsråd uppfattas av patienterna, i takt med att deras kunskaper och upplevelser förändras med den digitala utvecklingen. Det vetenskapliga underlaget är begränsat och framtida forskning bör fokusera på en större enkätundersökning för att kunna dra slutsatser av hur digitala egenvårdsråd påverkar patienter med kroniskt obstruktiv lungsjukdom. / Backround: Digital contact path have gained a prominent role in primary care. Through digital contact path, the individual should be at the center of attention and increase the ability to manage their illness. Self-management is a high priority in COPD care and aims to reduce symptoms, prevent exacerbations, increase physical activity, prevent disease progression and reduce mortality. The aim: was to investigate COPD patients' experiences of self-management advice through digitally mediated care. Based on the literature review's 14 qualitative articles, three main categories emerged: from physical to digital contact paths, experiences of meeting the district nurse on the screen and digital self-management advice. Methods: The method used was a systematic literature review with an inductive approach. Results: Digital self-management advice was considered a useful supplement, but never a substitute for physical visits to the district nurse. Conclusion: The collected knowledge from the study could contribute to district nurses and operational managers within primary care gaining a better understanding of how patients perceive self-management advice, as their knowledge and experiences change with digital development. The scientific basis is limited, future research should focus on a larger survey to be able to draw conclusions about how digital self-management advice affects COPD patients.

Bakgrund Kronisk obstruktiv lungsjukdom är ett pågående folkhälsoproblem som främst drabbar personer som röker. Det finns även andra faktorer, som passiv rökning samt exponering för luftföroreningar, som kan öka risken att framskrida sjukdomen. Egenvård är mycket viktigt i detta tillstånd, eftersom det i nuläget inte finns något botemedel mot sjukdomen. Syfte Syftet är att belysa patienters upplevelse av att leva med kronisk obstruktiv lungsjukdom. Metod Litteraturöversikt som baserades på tio kvalitativa vetenskapliga artiklar från Cinahl och PubMed. Resultat Resultatet visade att KOL påverkar människor på olika sätt, både psykiskt och fysiskt. Patienterna kan uppleva trötthet och andnöd i vardagen. Sjukdomen kan orsaka känslor som skuld, skam och ensamhet, vilket har visat sig leda till isolering. Slutsats På grund av att KOL är en kronisk sjukdom som varar livet ut är det viktigt att behandlingen effektivt hanterar patientens symtom. Sjuksköterskans uppgift är att identifiera samt förstå patientens unika behov och skräddarsy behandlingen utifrån dennes behov. Sammantaget är vårdens kvalitet en nyckelfaktor som formar relationen mellan sjuksköterska och patient. / Background Chronic obstructive pulmonary disease is an ongoing public health issue primarily affecting individuals who smoke. There are other factors, such as passive smoking and exposure to air pollution, which can also increase the risk of developing the disease. Self-care is crucial in this condition as there is currently no cure for the disease. Aim The aim is to illuminate individuals’ experience of living with chronic obstructive pulmonary disease. Method A literature review based on ten qualitative studies from Cinahl and PubMed. Results The results showed that COPD affects people in various ways, both mentally and physically. Patients may experience fatigue and shortness of breath in their daily lives. The disease can trigger emotions such as guilt, shame, and loneliness, which has been found to lead to isolation. Conclusions Due to COPD being a chronic disease that lasts a lifetime, it is crucial for treatment to effectively manage the patient’s symptoms. The nurse’s responsibility is to identify and comprehend the patient’s unique needs and tailor the treatment accordingly. Overall, the quality of care is a key factor that shapes the relationship between the nurse and the patient.

For the past few decades, the popularity of graphene oxide (GO) nanomaterials (NMs) has increased exceedingly due to their biomedical applications in drug delivery of anti-cancer drugs. Their unique physicochemical properties such as high surface area and good surface chemistry with unbound surface functional groups (e.g. hydroxyl - OH, carboxyl /ketone C=O, epoxy/alkoxy C-O, aromatic group C=C, etc) which enable covalent bonding with organic molecules (e.g. RNA, DNA) make GO NMs as excellent candidates in drug delivery nanocarriers. Despite the overwhelming biomedical applications, there are concerns about their genotoxicity on human DNA. Published genotoxicity studies on GO NMs were performed using non-commercial GO with 2-3 layers of GO sheets, synthesized in various laboratories with the potential for inter-laboratory variabilities. However, what has not been studied before is the effects of the commercial GO (15-20 sheets; 4-10% edge-oxidized; 1 mg/mL) in vitro on DNA damage in human whole blood and peripheral blood lymphocytes (PBL) from real-life patients diagnosed with chronic pulmonary diseases [asthma, chronic obstructive pulmonary disease (COPD), and lung cancer], and genotoxic endpoints compared with those from healthy control individuals to determine whether there are any differences in GO sensitivity. Thus, in the present study, we had characterized GO NMs using Zetasizer Nano for Dynamic Light Scattering (DLS) and zeta potential (ZP) in the aqueous solution, and electron microscopy using the Scanning Electron Microscope (SEM) and Transmission Electron Microscope (TEM) in the dry state, respectively. Cytotoxicity studies were conducted on human PBL from healthy individuals and patients (asthma, COPD, and lung cancer) using the Methylthiazolyldiphenyl-tetrazolium bromide (MTT) and Neutral Red Uptake (NRU) assays, respectively. The genotoxicity (DNA damage) and cytogenetic effects (chromosome aberration parameters) induced by GO NMs on human whole blood from healthy individuals and patients were studied using the Alkaline Comet Assay and Cytokinesis-blocked Micronucleus (CBMN) assay, respectively. Our results showed concentration-dependent increases in cytotoxicity, genotoxicity, and chromosome aberrations, with blood samples from COPD and lung cancer patients being more sensitive to DNA damage insults compared with asthma patients and healthy control individuals. Furthermore, the relative gene and protein expressions of TP53, CDKN1A/p21, and BCL-2 relative to GAPDH on human PBL were studied using the Reverse Transcription Quantitative Polymerase Chain Reaction (RT-qPCR) and Western Blot techniques, respectively. Our results have shown altered gene and protein expression levels. Specifically, GO-induced cytotoxicity, genotoxicity, and micronuclei aberrations were associated with TP53 upregulation - a biomarker of DNA damage - in both patients and healthy individuals. These effects show that GO NMs have promising roles in drug delivery applications when formulated to deliver drug payload to COPD and cancer cells. However, the fact that cytotoxicity, genotoxicity, chromosome instability, and gene/protein expressions - biomarkers of cancer risk - were observed in healthy individuals are of concern to public health, especially in occupational exposures at micro levels at the workplace.

Bakgrund: Kronisk obstruktiv lungsjukdom är en folkhälsosjukdom som drabbar miljontals människor och är det tredje vanligaste dödsorsaken i världen. För att kunna bemöta patienterna som drabbas av sjukdom krävs stort ansvar av sjukvården och främst sjuksköterskor som har en betydande roll av att främja hälsa och minska symtomlidande. Patienter behöver kontinuerlig uppföljning och utbildning kring sjukdomen för att kunna få en förståelse av innebörden samt utveckla egenvårdsåtgärder. Syfte: Syftet var att belysa individens upplevelser av att leva med kronisk obstruktiv lungsjukdom. Metod: Litteraturöversikt som utgick från 13 kvalitativa originalartiklar. Resultat: I resultatet presenterades patientupplevelsen med hjälp av övergripande teman som: “fysiska utmaningar”, “psykologiska utmaningar hos patienter med KOL", “Självkänsla och Stigma”, “Acceptans och Hanteringsstrategier” samt “Förlust och begränsningar”.   Slutsats: Litteraturöversikten om kroniskt obstruktiv lungsjukdom (KOL) visar komplexa fysiska och psykologiska utmaningar. Fysiska hinder som trötthet och andnöd påverkar vardagslivet, medan psykologiska utmaningar som självkänsla och stigma kan leda till depression och social isolering. Vikten av socialt och psykologiskt stöd framhävs för att komplettera medicinsk vård och underlätta hanteringen av KOL:s påverkan på livskvaliteten. / Background: Chronic obstructive pulmonary disease is a public health ailment affecting millions of people and is the third leading cause of death worldwide. To effectively address patients affected by the disease, a significant responsibility falls on healthcare, particularly on nurses who play a crucial role in promoting health and alleviating symptoms. Patients require continuous monitoring and education about the disease to gain an understanding of its implications and develop self-care measures. Aim: The aim was to illustrate individuals' experiences of living with chronic obstructive pulmonary disease. Method: Literature review based on 13 qualitative original articles. Results: In the results, patient experiences were presented using overarching themes such as: “physical challenges”, “psychological challenges in COPD patients”, “Self-esteem and Stigma”, “Acceptance and Coping Strategies” and “Loss and Limitation”. Conclusions: The literature review on chronic obstructive pulmonary disease (COPD) highlights complex physical and psychological challenges. Physical barriers, such as fatigue and breathlessness, impact daily activities, while psychological challenges, including self-esteem and stigma, may lead to depression and social isolation. The importance of social and psychological support is emphasized to complement medical care and facilitate coping with the impact of COPD on quality of life.

Introduction: There is a growing interest in how technology can be used in order to provide efficient healthcare. Aim: The aim is to explore perceptions on the use of home telemonitoring in patients with COPD.                                                                                                                             Method: Semi-structured individual interviews were carried out with eight women and five men who were part of a larger project aiming to develop and evaluate a telemonitoring system. Participants were interviewed after having used the system for two to four months. Interview transcripts were analysed with qualitative content analysis. Results: The analysis resulted in the theme a transition towards increased control and security and the categories: facing enablers or barriers, increasing control over the disease, providing easy access to care and affecting technical confidence or concern. Participants expressed initial feelings of insecurity, both in practical aspects using the telemonitoring system as well as regarding their disease. The telemonitoring system could reinforce and confirm the participants´ feelings of their current state of health, and the practical management of the telemonitoring system became easier with time.     Conclusion: Telemonitoring can be a valuable complement to healthcare with the potential to contribute to equity in care. However, in order to improve further development and implementation of telemonitoring, several actions are needed such as improved patient education and the use of co-creation. Additional research is needed particularly in the design of user-friendly systems as well as tools to predict which patients are most likely to find the equipment useful as it may result in reduced costs and increased empowerment. / Introduktion: Intresset för hur teknologi kan användas för att erbjuda effektiv sjukvård ökar. Syfte: Syftet är att utforska KOL-patienters upplevelse av att använda ett webbaserat rapporteringssystem i hemmet. Metod: Semi-strukturerade individuella intervjuer med åtta kvinnor och fem män som deltog i ett större projekt med syfte att utveckla och utvärdera ett webbaserat rapporteringssystem. De intervjuades efter att ha använt systemet två till fyra månader. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i temat en övergång till ökad kontroll och trygghet samt kategorierna: möta möjligheter eller hinder, ökad kontroll över sjukdomen, skapar lättillgänglig vård samt påverkar teknisk självkänsla eller oro. Deltagarna uttryckte till en början osäkerhetskänslor, både vad gäller praktiska aspekter i användandet av rapporteringssystemet samt kring själva sjukdomen. Det webbaserade rapporteringssystemet kunde förstärka och bekräfta deltagarnas egna känsla av mående och det praktiska hanterandet av rapporteringssytemet blev lättare med tiden. Konklusion: Webbaserade rapporteringssystem kan vara ett värdefullt komplement till sjukvården med potential att bidra till jämlik vård. I syfte att förbättra fortsatt utveckling och implementering bör förbättrad patientinformation samt vikten av att ta med användarna i utformningen beaktas. Mer forskning behövs för att optimera användarvänlighet samt att identifiera de patienter som har bäst nytta av systemet då det kan ge hälsoekonomiska vinster och inte minst öka patienters delaktighet.

Background: Advancements in machine learning (ML) techniques and voice technology offer the potential to harness voice as a new tool for developing decision-support tools in healthcare for the benefit of both healthcare providers and patients. Motivated by technological breakthroughs and the increasing integration of Artificial Intelligence (AI) and Machine Learning (ML) in healthcare, numerous studies aim to investigate the diagnostic potential of ML algorithms in the context of voice-affecting disorders. This thesis focuses on respiratory diseases such as Chronic Obstructive Pulmonary Disease (COPD) and explores the potential of a decision support tool that utilizes voice and ML. This exploration exemplifies the intricate relationship between voice and overall health through the lens of applied health technology (AHT. This interdisciplinary nature of research recognizes the need for accurate and efficient diagnostic tools. Objective: The objectives of this licentiate thesis are twofold. Firstly, a Systematic Literature Review (SLR) thoroughly investigates the current state of ML algorithms in detecting voice-affecting disorders, pinpointing existing gaps and suggesting directions for future research. Secondly, the study focuses on respiratory health, specifically COPD, employing ML techniques with a distinct emphasis on the vowel "A". The aim is to explore hidden information that could potentially be utilized for the binary classification of COPD vs no COPD. The creation of a new Swedish COPD voice classification dataset is anticipated to enhance the experimental and exploratory dimensions of the research. Methods: In order to have a holistic view of a research field, one of the commonly utilized methods is to scan and analyze the literature. Therefore, Paper I followed the methodology of an SLR where existing journal publications were scanned and synthesized to create a holistic view in the realm of ML techniques employed to experiment on voice-affecting disorders. Based on the results from the SLR, Paper II focused on the data collection and experimentation for the binary classification of COPD, which was one of the gaps identified in the first study. Three distinct ML algorithms were investigated on the collected datasets through voice features, which consisted of recordings collected through a mobile application from participants 18 years old and above, and the most utilized performance measures were computed for the best outcome.  Results: The summary of findings from Paper I reveals the dominance of Support Vector Machine (SVM) classifiers in voice disorder research, with Parkinson's Disease and Alzheimer's Disease as the most studied disorders. Gaps in research include underrepresented disorders, limited datasets in terms of number of participants, and a lack of interest in longitudinal studies. Paper II demonstrates promising results in COPD classification using ML and a newly developed dataset, offering insights into potential decision support tools for COPD diagnosis. Conclusion: The studies covered in this dissertation provide a comprehensive literature summary of ML techniques used to support decision-making on voice-affecting disorders for clinical outcomes. The findings contribute to understanding the diagnostic potential of using ML on vocal features and highlight avenues for future research and technology development. Nonetheless, the experiment reveals the potential of employing voice as a digital biomarker for COPD diagnosis using ML.

Made available in DSpace on 2016-06-02T20:18:12Z (GMT). No. of bitstreams: 1 2946.pdf: 2432239 bytes, checksum: 38088e144c053efcf31c8e90a089b74f (MD5) Previous issue date: 2010-04-07 / Universidade Federal de Sao Carlos / Patients with chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) present significant exertional dyspnea. The peripheral muscle dysfunction appears to be the greatest impact on the inability to perform physical exercise. Additionally, there is respiratory muscle weakness caused by a limited supply of O2 and alteration of mechanical ventilation. In this context, in order to better understand the manifestations of these disorders and to establish management strategies, we have proposed the development of three studies. The first study was entitled Deep breathing heart rate variability is associated with respiratory muscle weakness in patients with chronic obstructive pulmonary disease . The purpose of the present investigation was to evaluate the influence of respiratory muscle strength on autonomic control of heart rate variability (HRV) in these patients. Ten COPD patients (69±9 years; forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) 59±12% and FEV1 41±11% predicted) and nine age-matched healthy male volunteers (64±5 years) participated in this study. The maximal inspiratory pressure was obtained in the sitting position. Then, electrocardiography signal was obtained in three conditions: 1) lying position for 15 min; 2) lying position during the respiratory sinusal arrhythmia maneuver (RSA-M) for 4 min; and 3) sitting position for 15 min. Data was analyzed by the time (RMSSD and SDNN indexes) and the frequency domains, in total power, low frequency (LF), high frequency (HF) absolute (ab) and normalized (nu) units and LF/HF ratio. Regarding the RSA-M indexes, the expiratory/inspiratory ratio (E/I) and the inspiratory/expiratory difference (&#916;IE) were calculated. The patients with COPD demonstrated significantly impaired cardiac autonomic modulation at rest and during RSA-M when compared with healthy subjects (ratio E/I: 1.1±0.06 vs. 1.2±0.1 e &#916;IE: 7.0±3.5 vs 12.7±4.2, respectively). Moreover, significant and positive correlations between maximal inspiratory pressure (MIP) and the inspiratory-expiratory difference (&#916;IE) (r = 0.60, p<0.01) were found. In conclusion, patients with COPD presented impaired sympathetic-vagal balance at rest and during RSA-M. In addition, cardiac autonomic control of heart rate was associated with inspiratory muscle weakness in chronic obstructive pulmonary disease. Based on this evidence, future research applications of respiratory muscle training may bring to light a potentially valuable target for rehabilitation. The second study was entitled to Deep breathing heart rate variability xviii is able to reflect the respiratory muscle weakness in chronic heart failure . The purpose of the present investigation was to evaluate the influence of respiratory muscle strength on autonomic control in these patients. Ten CHF (62 ± 7 years left ventricle eject fraction of 40 ± 5% and NYHA class I-III) and nine matched-age healthy volunteers (64±5 years) participated in this study. Heart rate variability (HRV) was obtained at rest and during RSA-M by electrocardiograph (as previously described). CHF patients demonstrated impaired cardiac autonomic modulation at rest and during RSA-M when compared with healthy subjects (p<0.05). Moreover, significant and positive correlations between MIP and IE-differences (r: 0.79), E/I ratio (r: 0.83), RMSSD (r: 0.77), SDNN (r: 0.77), LFab (r: 0.77), HFab (r: 0.70) were found during RSA-M. At rest, significant correlations were also found. Patients with CHF presented impaired sympathetic-vagal balance at rest. In addition, cardiac autonomic control of heart rate was associated with inspiratory muscle weakness in CHF. Based on this evidence, recommendations for future research applications of respiratory muscle training can bring to light a potentially valuable target for rehabilitation. Finally, the third study: "Behavior of heart rate on determination of anaerobic threshold in healthy men: comparison with cardiopulmonary exercise testing and near-infrared spectroscopy" aimed to identify the anaerobic threshold (AT) obtained from the V-slope method , visual method on oxihemoglobin (O2Hb) and deoxihemoglobin (HHb) and compare the method with heteroscedastic (HS) applied to VCO2, HR and HHb data. Secondly, to assess the degree of agreement between the methods for determination of AT. Fourteen healthy men were subjected to incremental cardiopulmonary test (CPT) in the electromagnetic cycle-ergometer until physical exhaustion. At the same time they obtained the following biological signals: (i) ventilatory and metabolic variables - a breath to breath - measured by the Cardio2 System (Medical Graphics Corporation, St. Paul, MO, USAI), (ii) spectroscopy, quasiinfrared rays - NIRS (NIRO 300 - Hamamatsu Photonics, Japan), and (iii) heart rate through cardiofrequencymeter (Polar S810i). We observed temporal equivalence and similar values of power (W), absolute O2 consumption (mL/min) and relative O2 consumption (mL/kg/min) and HR (bpm) on determination of AT by the methods performed. In addition, by the Bland-Altman plot, HR (bpm) confirmed the good agreement between the methods with biases between -1.3 and 3.5. In conclusion: (i) all methods were sensitive in identifying the AT1, including the HS applied to FC, and (ii) the methods showed a good correlation in the identification of AT1. Thus the xix results support the FC, a methodology that is simple and economically feasible, seems to be a valid parameter in determining the AT of the individuals in our study. Therefore it remains to be clarified if these results can be replicated in patients with chronic cardiopulmonary disorders, contributing in safe, individualized and adequate prescribing physical exercise in rehabilitation programs. / Pacientes com insuficiência cardíaca crônica (ICC) e doença pulmonar obstrutiva crônica (DPOC) apresentam significativa dispnéia exercional. A disfunção muscular periférica parece ser a causa de maior impacto na incapacidade de realização de exercício físico. Adicionalmente, pode coexistir a fraqueza muscular respiratória provocada pela limitada oferta de O2 e a alteração da mecânica ventilatória. Neste contexto, com intenção de compreender melhor as manifestações dessas disfunções e estabelecer estratégias de manejo, foi proposto o desenvolvimento de três estudos. O primeiro intitulado por Deep breathing heart rate variability is associated with respiratory muscle weakness in patients with chronic obstructive pulmonary disease teve como objetivo, avaliar a influência da fraqueza muscular inspiratória sobre a o controle autonômico da frequência cardíaca (FC) de homens com DPOC. Foram estudados 10 pacientes (69±9 anos; FEV1/FVC 59±12% and FEV1 41±11% do predito) e 9 homens saudáveis (64±5 anos). Na posição sentada, foi medida a pressão inspiratória máxima (PIMax) dos voluntários. Na sequência, em repouso, o sinal eletrocardiográfico foi obtido em três situações: 1) 15 min na posição supina; 2) quatro min durante a manobra de acentuação da arritmia sinusal respiratória (MASR) na posição supina; e 3) 15 min na posição sentada. Os dados foram analisados no domínio do tempo (índices RMSSD e SDNN) e da freqüência, pela densidade espectral total (DET), bandas de baixa (BF) e alta freqüências (AF) - absolutas (ab) e normalizadas (un), e a razão BF/AF. Durante M-ASR foram calculadas a razão expiração/inspiração (E/I) e a diferença inspiração/expiração (&#916;IE). Os pacientes com DPOC apresentaram valores significativamente menores da variabilidade da frequência cardíaca (VFC) quando comparados ao grupo controle em repouso e durante a M-ASR (razão E/I: 1,1±0,06 vs. 1,2±0,1 e &#916;IE: 7,0±3,5 vs 12,7±4,2, respectivamente). Adicionalmente, foi observado correlação positiva entre PIMax e &#916;IE (r = 0.60, p<0.01). Em conclusão: (i) pacientes com DPOC apresentam prejuízos da modulação autonômica da FC em repouso e durante a M-ASR; e (ii) a fraqueza muscular inspiratória parece influenciar no desbalanço simpato-vagal desses pacientes. Em similaridade, no segundo estudo, intitulado com Deep breathing heart rate variability is able to reflect the respiratory muscle weakness in chronic heart failure o objetivo foi avaliar a influência da PIMax no controle autonômico da FC de pacientes com ICC. Foram estudados 10 pacientes com ICC xv (62±7 anos Fração de Ejeção do ventrículo esquerdo de 40 ± 5% e classificação IIII da NYHA). Seguindo a metodologia descrita no estudo anterior, os resultados mostraram que os pacientes com ICC também apresentaram menores valores da VFC em repouso e durante a M-ASR e correlações positivas e significativas entre PIMax e diferença expiração-inspiração (r: 0,79), razão expiração/inspiração (r: 0,83), RMSSD (r: 0,77), SDNN (r: 0,77), BF (r: 0,77), AF (r: 0,70). Em conclusão: (i) pacientes com ICC apresentam prejuízos da modulação autonômica da FC em repouso e durante a M-ASR; e (ii) a fraqueza muscular inspiratória parece influenciar no desbalanço simpato-vagal desses pacientes. Por fim, o terceiro estudo: Comportamento da frequência cardíaca na determinação do limiar de anaerobiose em homens saudáveis: análise comparativa com o teste cardiopulmonar e a espectroscopia por raios quasi-infravermelhos objetivou identificar do limiar de anaerobiose (LA) obtido pelo método padrão-ouro, método visual pelo comportamento da oxihemoglobina (O2Hb) e deoxihemoglobina (HHb) e comparar com o método heteroscedástico (HS) aplicado aos dados de VCO2, HHb e da FC. Secundariamente, avaliar o grau de concordância entre os métodos de determinação do limiar de LA. Quatorze homens saudáveis foram submetidos ao teste cardiopulmonar (TCP) incremental em cicloergômetro de frenagem eletromagnética até a exaustão física. Concomitantemente foram obtidos os seguintes sinais biológicos: (i) variáveis ventilatórias e metabólicas respiração a respiração - medida pelo sistema CardiO2 System (Medical Graphics Corporation, St. Paul, MO, USAi); (ii) espectroscopia por raios quasi-infravermelhos - NIRS (NIRO 300 Hamamatsu Photonics, Japan); e (iii) frequência cardíaca por meio do cardiofreqüencímetro (Polar S810i). Foram observadas equivalências temporais e das variáveis potência (W), consumo de O2 absoluto (mL/min) e relativo (mL/kg/min) e FC (bpm) na determinação do LA pelos métodos empregados. Em adição, pela análise de Bland-Altman, a FC (bpm) confirmou a boa concordância entre os médotos com viéses entre -1,3 e 3,5. Em conclusão: (i) todos os métodos mostraram-se sensíveis na identificação do LA1, inclusive o HS aplicado a FC; e (ii) os médotos apresentaram boa correlação na identificação do LA1. Assim os resultados suportam que a FC, uma metodologia mais simples e economicamente viável, parece ser um parâmetro válido na determinação do LA dos indivíduos do nosso estudo. Agora, basta saber se estes resultados podem ser replicados em pacientes com disfunções cardiorrespiratórias crônicas, contribuíndo na prescrição xvi segura, individualizada e adequada de exercício físico em programas de reabilitação.

Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Student: Terezie Poláková Supervisor of master thesis: PharmDr. Miroslav Kovařík, Ph.D. Title of master thesis: Assessment of energy metabolism in patients with chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease (COPD) is the name for lung disease with systemic consequences. Besides the respiratory symptoms there are also described changes in body metabolism, which could lead to the development of serious metabolic syndrome called cachexia. The main aim of this study was to compare the resting energy expenditure (REE) and nutrition substrate utilization in 12 patients with advanced form of COPD from the Czech Multicentre Research Database of COPD (5 females and 7 males, mean age 68 ± 6 years) and in 9 patients of control group without respiratory impairment (5 females and 4 males, 62 ± 4 years). Assessment of body metabolism was determined by method of indirect calorimetry. Measured REE was then compared with prediction based on Harris-Benedict equation. The utilization of main nutrition substrates was determined from the respiratory quotient and urea nitrogen loss in urine. We found that measured REE in COPD patients was about 20 % higher than in control group....