Made available in DSpace on 2015-07-22T20:50:54Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-10-28. Added 1 bitstream(s) on 2015-08-11T03:26:00Z : No. of bitstreams: 1 Publico-11922.pdf: 2026305 bytes, checksum: 6748d516ad453759f76cc254710a50b1 (MD5) / OBJETIVO: avaliar o efeito de um programa de treinamento de força muscular progressiva e propriocepção, na força muscular do quadríceps, no equilíbrio, na qualidade de vida e na redução do risco de quedas em mulheres com osteoporose pós-menopausa. MÉTODOS: Foram selecionadas cem mulheres sedentárias com idade entre 55 e 75 anos com osteoporose pós-menopausa, randomizadas em dois grupos: grupo intervenção composto por 50 pacientes submetidas a 18 semanas de treinamento de força muscular progressiva do quadríceps (a 50%, 60%, 70% até 80% de 1-RM – uma repetição máxima), e de propriocepção, associados ao tratamento clínico medicamentoso para osteoporose; e grupo controle também composto por 50 pacientes que receberam apenas o tratamento clínico medicamentoso. Força muscular, equilíbrio, mobilidade funcional e qualidade de vida foram avaliados no início e ao final da pesquisa através do Teste de Uma Repetição Máxima (1-RM), Berg Balance Scale (BBS), Timed Up & Go Test (TUG) e SF-36. Número de quedas foi avaliado 6 meses que antecederam à pesquisa e nos 6 meses seguintes. RESULTADOS: 85 pacientes concluíram a pesquisa. Os valores para SF-36 melhoraram em todas as oito sub-escalas no grupo intervenção (p ≤ 0.0018), Timed Up & Go Test (p < 0,0001), do teste de 1-RM (p < 0,0001), da Berg Balance Scale (p < 0,0001), e, ainda, uma redução do risco de quedas no grupo intervenção comparada ao grupo controle (IRR 0.263, 95% IC 0.10, 0.68). CONCLUSÃO: A associação do treinamento de força muscular progressiva para quadríceps e o treinamento proprioceptivo é efetivo na redução do risco de quedas, no aumento da força muscular do quadríceps, na melhora do equilíbrio estático e dinâmico, na melhora da capacidade funcional e da qualidade de vida em mulheres com osteoporose pós-menopausa. / OBJECTIVE: To evaluate the effect of a progressive muscular strength and proprioception training program on the muscle strength of the quadriceps, balance, quality of life and reduction in the risk of falls in postmenopausal women with osteoporosis. METHODS: One hundred sedentary postmenopausal women with osteoporosis, ages ranging from 55 to 75, were selected and randomized into two groups: the intervention group comprised of 50 patients who underwent a 18-week of progressive load training for the quadriceps muscle (50%, 60%, 70% up to 80% of 1- RM – one maximum repetition) and proprioception training associated to a drug treatment of osteoporosis and the control group that included 50 patients who only underwent a drug treatment of osteoporosis. The muscular strength, balance, functional mobility and quality of life were evaluated in the beginning and end of the research through the One Maximum Repetition Test (1-RM), Berg Balance Scale (BBS), Timed Up & Go Test (TU & GT) and SF-36. The number of falls was evaluated 6 months preceding the research and in the following six months. Results: Eighty-five patients concluded the research. The program promoted a significant difference among the groups for SF-36 in the eight sub-scales (p ≤ 0.0018), Timed Up & Go Test (p < 0.0001), 1-RM test (p < 0.0001), Berg Balance Scale (p < 0.0001) and also a decrease in the number of falls in the intervention group compared to control (IRR 0.263, 95% CI 0.10, 0.68). Conclusion: The association of progressive strength training for the quadriceps and the proprioceptive training is effective for the prevention of falls, increasing the muscle power, the static and dynamic balance and increasing the speed of the motor responses, therefore improving the performance of daily activities. / TEDE / BV UNIFESP: Teses e dissertações

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-08-17T17:42:08Z No. of bitstreams: 1 carlakarolinepiresgeneroso.pdf: 14361490 bytes, checksum: 84df5809af87f48f3b7f1313923e54f8 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-08-18T11:01:38Z (GMT) No. of bitstreams: 1 carlakarolinepiresgeneroso.pdf: 14361490 bytes, checksum: 84df5809af87f48f3b7f1313923e54f8 (MD5) / Made available in DSpace on 2017-08-18T11:01:38Z (GMT). No. of bitstreams: 1 carlakarolinepiresgeneroso.pdf: 14361490 bytes, checksum: 84df5809af87f48f3b7f1313923e54f8 (MD5) Previous issue date: 2017-04-06 / As quedas configuram-se como um evento prevalente entre os idosos e em virtude de sua dimensão física, psicológica, social e econômica é considerada um grave problema de saúde pública. Subjacente aos fatores de risco já conhecidos, enfatizamos neste estudo fatores comportamentais como a autopercepção e a influência de déficits visual, sobretudo o auditivo autopercebidos relacionados à queda e quedas recorrentes. Considera-se a importância de conhecer os serviços de saúde que esses indivíduos têm acesso e utilizam após ocorrência desse evento. Portanto, o objetivo deste estudo foi estimar a prevalência e recorrência de queda e sua associação com a déficit visual e auditivo autopercebidos, descrever o acesso e gravidade relativo a este evento em idosos do município de Juiz de Fora. Estudo de delineamento transversal, que avaliou 315 idosos comunitários ≥ 60 anos, de ambos os sexos por meio de inquérito domiciliar. Os dados foram analisados pelo programa Stata 13,0 verificando as Razões de Prevalência com respectivos Intervalos de Confiança de 95% (IC 95%) e α = 0,10. Nas análises multivariadas ajustaram-se modelos de Regressão de Poisson e Multinomial. Os resultados serão apresentados em dois estudos. No primeiro a prevalência de quedas foi de 34,3% e 10,8% de recorrência. A prevalência de quedas nos indivíduos com deficiência auditiva autopercebida foi de 45,6%. Esteve associada à queda: faixa etária de 70 a 79 anos sexo feminino e não uso de dispositivos para correção visual e a Quedas recorrentes: idade ≥ 80 anos e Deficiência visual e Deficiência auditiva autopercebidas. No segundo estudo observamos que idade superior a 80 anos, necessidade de internação em pronto atendimento ou internação e maior percentual de perda de consciência após a queda esteve mais associada à queda recorrente que foi considerada mais grave que as quedas sofridas pelos idosos que caíram uma vez. Ambos os grupos declararam ter mais acesso aos serviços públicos, apesar de grande parcela ter pelo menos algum plano de saúde. As quedas caracterizaram-se como domiciliares e diurnas, porém idosos que relatam uma queda caíram mais na escada e varanda diferente da queda recorrente que ocorreu em locais mais restritos como quarto e sala. Os resultados indicam importante relação entre déficit auditivo autopercebido e queda além de informações relevantes sobre as características e gravidade da queda entre idosos comunitários. Considerando a partir disso a necessidade de investigação ampla da relação entre déficits auditivos e as adaptações que são feitas aos idosos que escutam pouco e que segundo nosso estudo tem pouco acesso aos dispositivos de correção auditiva poderiam auxiliar em estratégias para a prevenção deste evento. Além de salientar a importância da prevenção através de um acesso mais eficaz à atenção primaria e assim como a oferta de visitas domiciliares pelas equipes de Estratégias de Saúde da Família que poderiam auxiliar em orientações a fim de diminuir a ocorrência de quedas nos locais mais prevalentes e o impacto do medo de quedas recorrentes entre os idosos da comunidade. / The falls are a prevalent event among the elderly and because of their physical, psychological, social and economic dimension, it is considered a serious public health problem. Underlying the already known risk factors, we emphasize in this study behavioral factors such as self-perception and the influence of visual deficits, especially the self-perceived auditory hearing related to fall and recurrent falls. It is considered the importance of knowing the health services that these individuals have access to and use after this event occurs. Therefore, the objective of this study was to estimate the prevalence and recurrence of falls and their association with selfperceived visual and auditory deficit, to describe the access and severity related to this event in the elderly in the city of Juiz de Fora. A cross - sectional study, which evaluated 315 community - dwelling elderly individuals ≥ 60 years of age, of both sexes by means of a household survey. Data were analyzed by the Stata 13.0 program, checking the Prevalence Ratios with 95% Confidence Intervals (95% CI) and α = 0.10. In the multivariate analyzes, the Poisson and Multinomial Regression models were fitted. The results will be presented in two studies. In the first, the prevalence of falls was 34.3% and 10.8% of recurrence. The prevalence of falls in individuals with self-perceived hearing loss was 45.6%. It was associated with the fall: age group of 70 to 79 years female and no use of devices for visual correction and recurrent falls: age ≥ 80 years and Visual Deficiency and Self-perceived Deficiency. In the second study, we observed that age greater than 80 years, need for hospitalization at the prompt or hospitalization, and greater percentage of loss of consciousness after the fall was more associated with the recurrent fall that was considered more severe than the falls suffered by the elderly who fell once. Both groups reported having more access to public services, although a large portion had at least some health insurance. The falls were characterized as domiciliary and diurnal, but elderly people reporting a fall fell more on the staircase and balcony different from the recurring fall that occurred in more restricted places such as bedroom and living room. The results indicate an important relation between selfperceived hearing deficit and fall besides relevant information about the characteristics and severity of falls among community-dwelling elders. Considering from this the need for a broad investigation of the relationship between auditory deficits and the adaptations that are made to the elderly who listen poorly and who according to our study have little access to hearing correction devices could help in strategies for the prevention of this event. In addition to highlighting the importance of prevention through more effective access to primary care and the provision of home visits by Family Health Strategy teams that could assist in guidelines to reduce the occurrence of falls in the most prevalent places and the impact of the fear of recurrent falls among the elderly in the community.

This thesis presents the results of a study conducted to determine the math capabilities of mentally challenged students attending Reagan Junior High School in Wichita Falls, Texas. Survey results are used to determine needed curriculum changes.

One and a half million people are currently living in residential care facilities; as the baby boomer generation ages, this number will increase to 3 million. Approximately 3 out of 4 residents of these facilities fall each year, and 10% to 20% of those falls result in serious injuries such as fractures, disability, and a decreased quality of living. The BOUNCE Back fall initiative is a multifactorial program that uses a systematic approach starting on admission and to re-evaluate a resident following a fall. Nursing and therapy uses the Morse Fall Scale and the Elderly Mobility Scale to assess and categorize the resident's risk for falls. Guided by Lewin's theory of change, this project was designed to assess the effectiveness of the fall initiative as a quality improvement 60-day (August 2016- September 2016) pilot study in a skilled nursing and rehabilitation facility as a potential means to reduce the number of resident falls. Sixty residents (aged 64 to 98, mean age 81) were assessed at a minimum 2 time points to determine their level of fall risk and needed intervention, within 60 minutes of admission to the facility and 7 days postadmission. De-identified pre- and post-implementation data were provided from the corporate quality measure database, entered into a spreadsheet, and numbers were compared. As a result of the fall prevention pilot, for August 2016, 5 falls occurred with no repeat fallers; September 2016, 3 falls with 1 repeat faller which is a significant decrease from 14-22 falls occurring per month for 2 consecutive years. Following implementation, the facility scored 3%-5% for the number of falls, which is below the 7% threshold set forth by the pilot facility's corporate office. Prior to the implementation of the initiative, the facility had not met the 7% fall threshold in 2 years

published_or_final_version / Community Medicine / Master / Master of Public Health

Basin-hosted stratigraphy in volcanic arc settings reflects the interplay between ancient environments, volcanism, magmatism and tectonism. Lithostratigraphic variations within basins can be used to identify the location and timing of the processes contributing to their evolution. However, when deposits are hydrothermally altered, the use of many traditional analytical techniques for assessing their volcanic origin become impracticable, making analysis challenging. Examination then relies on an integrated mix of detailed macroscopic assessment and techniques utilising remaining stable magmatic phases. The Huka Group at Wairakei-Tauhara Geothermal Field (Wairakei-Tauhara) is primarily comprised of volcanic deposits preserving ~300 kyr of evolution in the Taupo Volcanic Zone (TVZ), New Zealand. Intensive geothermal well drilling in the field has identified the distribution and variation comprising its Waiora and Huka Falls Formations. The volcanic, structural and environmental history of the Huka Group, however, remains poorly understood. This thesis is concerned with identifying the stratigraphic and geothermal significance of the Huka Group from recent drill core samples at Wairakei-Tauhara. Drill core facies analysis confirm a spatially and temporally complex depositional history at the site. Deposits forming Waiora Formation were sourced from local explosive and effusive eruptions over ~100 kyrs within extensional basins hosting paleo-Lake Huka. Lacustrine and fluvial deposition prevailed for the following ~200 kyrs, as volcanism ceased, depositing the Huka Falls Formation. Frequent drilling of Huka Falls Formation has identified and thoroughly constrained facies variations of a local pyroclastic member, the Middle Huka Falls Formation. This eruption evolved as a series of water-supported, eruption-fed density currents from a sublacustrine vent in Tauhara transported beneath Lake Huka. Examined Huka Group core samples were hydrothermally altered and required the use of novel assessment techniques for comprehensive stratigraphic assessment. This alteration provided an opportunity to locally date the geothermal system within the Huka Group reservoir. Stratigraphic variations of resistant magmatic phenocrysts (feldspar) and immobile elements (Ti, Zr, V and Y) added new details of depositional processes and lithostratigraphy. Regional magmatic immobile element comparisons identified geochemical similarities within Huka Group ignimbrites that may have implications for the longevity and recurrence of caldera magma systems in TVZ. Geothermal activity in the Waiora Formation reservoir was dated using pristine hydrothermal adularia and 40Ar/39Ar dating methods. Results recognised a young phase of the system’s evolution (<30 ka) and the applicability of 40Ar/39Ar dating for use in geothermal chronology. Lastly, a conceptual evolutionary model for the Huka Group presents ~300 kyr of depositional processes, landscapes and structural events at Wairakei-Tauhara. The long-lived lacustrine setting is recognised to have been continually modified by episodic volcanism and gradual tectonism. Variations in Huka Group stratigraphy between the Wairakei and Tauhara Fields identify contemporaneous, but separate evolution of the underlying controlling horst (ridge) and graben (basin) structure. This study highlights the unique tectonic, magmatic, volcanic and sedimentary processes forming basins in the TVZ and improve our understanding on the geological evolution of geothermal systems. Techniques trialled in the study are demonstrated to be suitable for investigating altered volcanic materials and can be utilised elsewhere in the TVZ or other geothermal settings.

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

The elderly population is estimated to increase worldwide. One of the major health determinants identified in this population are injuries where one of the most prevalent causes are falls. The overall aim of this thesis was to describe and explore visual impairment and falls of inpatients and independently living elderly in the community and how daily life activities were influenced by visual ability and risk of falling. Methods in the studies were a quantitative retrospective descriptive design for study I followed by two quantitative retrospective and explorative studies where in study II perceived vision related quality of life and in study III performance-based visual ability were investigated. Study IV was a qualitative explorative study using classic grounded theory. In study I all falls of inpatients at a medical clinic 65 years and older (n=68) were registered during one year. In study II and III a random sample (n=212) of independently living elderly between 70 and 85 years of age participated in both studies. In study IV seven women and six men between 73 and 85 years of age from the two previous studies and six visual instructors (n=19) participated. The data in study I was collected during 2004, study II and III between February 2009 to March 2010 and study IV December 2009 to January 2013. The results in study I showed that most falls in five hospital wards occurred at night and those most affected had an established visual impairment. Almost half the population in study II and III fell at least once. Perceived vision when performing daily life activities showed a positive association between visual impairment and falls in men but not in women (II). No associations were found between performance-based measured visual ability and falls (III). Visually impaired elderly did not consider risk of falling as a problem (􀀪􀀷). Their main concern is to remain themselves as who they used to be which is managed by self- preservation while maintaining their residual selves and resisting self decay. Maintaining residual self is done by living in the past mostly driven by inertia while resisting self decay is a proactive and purposeful driven strategy. It is a complex issue to do fall risk assessments and planning fall preventive action where the individual’s entire life situation has to be taken into consideration.

Introduction: Aging, comorbid conditions, and use of medications render older adults more susceptible to alcohol-disease or alcohol-drug interactions that may lead to harmful outcomes. In this dissertation project the risk profile of alcohol and medications use among older adults was investigated. Considering the rise in CNS-acting medication use and the adverse effect profile linked to CNS-acting medications, it was also of interest to find if older adults were at risk of falling due to interactions between alcohol and CNS-acting medication. Objectives: The objectives were as follows: 1) to determine the prevalence, pattern and factors associated with at-risk drinking, 2) to determine the prevalence and pattern of potential concurrent use of CNS-acting medication and alcohol, and to identify factors associated with alcohol use among CNS-acting medication users, 3) to assess the effects of potential concurrent use of CNS-acting medications and alcohol on the risk for falls in older adults. Methods: The study population comprised a nationally representative sample of community-dwelling older adults aged 65 years or older. The 2009 Medicare Current Beneficiary Survey (MCBS) data (n=7163) were employed to determine at-risk drinking based on the Comorbidity Alcohol Risk Evaluation Tool (CARET) and to assess the effects of potential concurrent use of CNS-acting medication and alcohol on the risk for falls. The National Health and Nutrition Examination Survey (NHANES) 2005-2010 data (n=3220) were employed to determine potential concurrent use of alcohol and CNS-acting medications. The effect of combined use of alcohol and CNS-acting medications on risk of falls was assessed using logistic regression modeling and adjusting for confounders. Alcohol consumption was measured by the quantity-frequency method and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommended drinking limits were utilized in all analyses. Results: In the MCBS study, 5.6% of the older adults were identified as at-risk drinkers. Adults aged between 65-74 years, being male, non-married, former or current smoker, and having no comorbid conditions were factors associated with at-risk drinking. In the NHANES study, 8.9% reported potential concurrent use of alcohol and CNS-acting medication. Use of at least one CNS-acting medication and drinking excessive alcohol, or binge drinking, was significantly associated with odds of falling. Conclusion: Hazardous alcohol use is common among older adults. A substantial proportion of older adults may concomitantly consume alcohol and CNS-acting medications. Odds of falling are greater in the presence of high alcohol intake and CNS-acting medication use. It is important for health care professionals to warn patients against excessive alcohol consumption. Increasing awareness of this issue among older adults and caregivers may help prevent falls. Contributions from healthcare professionals in the form of screening for potentially harmful alcohol use, prescription monitoring, and initiating counseling may help to reduce older adults’ risk for falls or other adverse effects.

The work presented in this dissertation focuses on the association between sleep medication use, poor sleep, and falls in community-dwelling adults 65 years or older. Sleep complaints and the consumption of medications to aid sleep are common in older adults. Psychotropic medications, such as sedative hypnotics, are associated with risk of falls in older adults. However, very few studies have assessed the impact of poor sleep and sleep medication use on the risk of falls in community-dwelling older adults. In the first project, a cross-sectional analysis of the Health and Retirement Study (HRS) 2010 data was conducted to determine the prevalence of sleep problems, sleep medication use and falls; and to evaluate the association between sleep problems, sleep medication use, and falls in community-dwelling older adults. A multiple logistic model adjusted for covariates was used. In the sample of community-dwelling older adults, 35.8% had reported a fall and 40.8% had reported sleep problems in the past two years. Sleep medication use was reported by 20.9% of the older adults. Older adults who had sleep problems and took sleep medications had a significantly higher risk of falls compared with older adults who did not have sleep problems and did not take sleep medications. The other two groups, older adults who had sleep problems and did not take sleep medications, and those who did not have sleep problems and took sleep medications also had a significantly greater risk for falls. The second project was a prospective cohort study of independently-living older adults from senior congregate housing. The effect of combined poor sleep quality and sleep medication use on risk of falls was assessed using logistic regression modeling. In this study of 113 community-dwelling older adults, 46.9% had at least one fall, and 62.8% had poor sleep quality. Sleep medication use was reported by 44.2% of the older adults. Older adults with poor sleep quality and sleep medication use had a significantly increased risk of falls compared with older adults with good sleep quality and no sleep medication use. Older adults with good sleep quality and sleep medication use, and those with poor sleep quality and no sleep medication use did not have a significantly greater risk for falls. In conclusion, poor sleep added to sleep medication use significantly increased the risk of falls in community-dwelling older adults. The research undertaken in this dissertation was the first to evaluate the associations between poor sleep, use of sleep medications, and falls in community-dwelling older adults.