Made available in DSpace on 2016-12-06T17:07:29Z (GMT). No. of bitstreams: 1 Rodrigo Knabben.pdf: 1171074 bytes, checksum: b9e985c555d50dc6327acd4fa0a00810 (MD5) Previous issue date: 2011-03-02 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study aimed to measure motor skills and functional upper limb (UL) in the acute phase and three months after stroke, to identify and observe the relationship of residual deficits (RD) rating in each of these variables as well as the gain between the two periods in patients with mild motor / moderate and severe MS in the acute phase. We evaluated 29 subjects (17 severe and 12 mild / moderate) adults (63.7 ± 14.3 years) of both sexes with squealed of hemiplegia / hemiparesis due to stroke in the acute phase (9.3 ± 3.4 days post-stroke) and three months after injury. In the evaluations were measured evolutions of the motor variables (spasticity - Modified Ashworth Scale, degree of motor and somatosensory deficits - Fugl-Meyer Scale-UL; grip strength - Chatannoga® hand dynamometer, digital dexterity - Nine Hole Peg Test / NHPT ) and the functional variable (level of independence in self-care - FIM). To examine and compare the motor deficit, the grip strength, dexterity and functional independence between the acute phase and 3 months in every group and sub-groups of patients severe and mild / moderate, we used the Wilcoxon test. For comparison between subgroups, we used the Mann-Whitney. The measurement of the strength of association between: a handgrip strength (mean of maximum force) and digital dexterity with the levels of motor deficit, level of independence in self-care, we used the Spearman correlation. To investigate the differences between the variables (motor impairment, grip strength and digital dexterity) in acute and sub-acute, we used the Student t-test. The highest correlation was with the RD force motor deficit in both the acute phase and at three months (ρ = 0.91 and 0.82 respectively) and the RD of digital dexterity was with the functional independence in self-care in acute and the motor deficit at three months (ρ = 0.72 and 0.78 respectively). The correlation between the RD strength and digital dexterity were higher at three months (ρ = 0.75) than the acute phase (ρ = 0.70). The knowledge of grip strength and dexterity in the first months after stroke may bring relevant information for planning of clinical practice and rehabilitation of upper limb aimed at the patient's functional independence. / Esta pesquisa teve o objetivo de mensurar variáveis motoras e funcionais do membro superior (MS) na fase aguda e nos três meses após um Acidente Vascular Encefálico (AVE), visando identificar e observar a relação dos déficits residuais (DR) destas variáveis em cada avaliação, assim como o ganho entre os dois períodos em pacientes com comprometimento motor leve/moderado e severo no MS na fase aguda. Foram avaliados 29 indivíduos (17 severos e 12 leve/moderados) adultos (63,7±14,3 anos) de ambos os sexos com seqüela de hemiplegia/hemiparesia devido ao AVE na fase de aguda (9,3±3,4 dias pós-AVE) e nos três meses após a lesão. Nas avaliações foram medidas as evoluções das variáveis motoras (espasticidade - Escala de Ashworth modificada; grau de déficit motor e somatossensorial - Escala de Fugl-Meyer-MS; força de preensão - dinamômetro manual Chatannoga®, destreza digital - Nine Hole Peg Test/NHPT) e da variável funcional (nível de independência nos auto-cuidados - MIF). Para verificar e comparar o déficit motor, a força de preensão manual, a destreza e a independência funcional entre a fase aguda e 3 meses em todo grupo e nos sub-grupos de pacientes severo e leve/moderado foi utilizado o Teste de Wilcoxon. Para a comparação entre sub-grupos, foi utilizado o Teste de Mann-Whitney. A mensuração da força da associação entre: a força de preensão manual (média da força máxima) e destreza digital com os níveis do déficit motor, e nível de independência nos auto-cuidados utilizou-se a correlação de Spearman. Para investigação das diferenças entre as variáveis estudadas (déficit motor, força de preensão e destreza digital) na fase aguda e sub-aguda, foi utilizado o teste-t de Student. As maiores correlações do DR força foi com déficit motor tanto na fase aguda como aos três meses (ρ=0,91 e 0,82 respectivamente) e do DR da destreza digital foi com a independência funcional nos auto-cuidados na fase aguda e com o déficit motor aos três meses (ρ=0,72 e 0,78 respectivamente). A correlação entre o DR da força e destreza digital apresentou-se maior aos três meses (ρ=0,75) em comparação a fase aguda (ρ=0,70). O conhecimento da evolução da força de preensão e destreza nos primeiros meses após o AVE poderá trazer informações relevantes para o planejamento da prática clínica e a reabilitação do membro superior parético visando a independência funcional do paciente.

Made available in DSpace on 2016-12-06T17:07:29Z (GMT). No. of bitstreams: 1 Fabio.pdf: 1333634 bytes, checksum: ba66af05f0145d83e4b237a603a81d74 (MD5) Previous issue date: 2011-03-02 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study aimed to examine the influence of the postural control in the handgrip strength modulation of the non paretic upper limb during activity to pick up an object and in individuals with hemiparesis after Stroke. We evaluated 15 subjects with hemiparesis (EG) and 15 healthy subjects (CG) aged 57.3 ± 55.5 and 10.17 ± 11.27 years old respectively. To characterize the EG, tests were performed for maximum grip strength, Fugl-Meyer, Semmes-Weinstein monofilament (SWM), sensitivity test moving touch-pressure (MTP) and balance testing BERG. The parameters for the control of grip strength were: force at the time of lifting the cup (Grip lift off), peak grip force (PGF), peak velocity (Pvel), latency (LT), static force (SF) and difference time (DT), made through an instrumented glass with a force sensor and a three axial accelerometer. The subjects performed a task of picking and lifting an object at a predetermined height and keep it statically suspended for a time and reposition it back on the table. For the parameter EF, LT and DT, any significant data was found. Grip strength parameters Grip lift off, Pvel were different between positions. The grip force modulation (PGF) was different between groups. When asked to raise the object the EG didn´t modulate the grip force in response to the withdrawal additional object weight. Through this study it was possible to determine the possible involvement in the control parameters of grip strength of non-paretic upper limb of subjects with hemiparesis. / Este trabalho teve como objetivo analisar a influência da condição postural sentado e em pé na adaptação do controle da força de preensão manual do membro superior não parético durante a atividade de pegar e levantar um objeto, em indivíduos com hemiparesia após acidente vascular encefálico (AVE). Foram avaliados 15 indivíduos com hemiparesia (GE) e 15 indivíduos saudáveis (GC) com idade de 57,3 ±10,17 e 55,5±11,27 anos respectivamente. Para caracterização do GE foram realizados os testes de força de preensão máxima, Fugl-Meyer, monifilamento de Semmes-Weinstein (MSW), teste de sensibilidade moving touch-pressure (MTP) e o teste de equilíbrio de BERG. Os parâmetros para o controle da força de preensão foram: força no momento de levantar o copo (FNML), pico da força de preensão (PFP), pico de velocidade (Pvel), latência (LT), força estática (FE) e diferença temporal (DT) realizado através de um copo instrumentado com um sensor de força e um acelerômetro triaxial. Os indivíduos realizaram uma tarefa de pegar e levantar um objeto uma altura pré-estabelecida, mantê-lo por um tempo e reposicioná-lo novamente a mesa realizaram 7 repetições com carga e 7 sem carga. A modulação da força de preensão nos parâmetros FNML e Pvel ocorreu de forma diferente nas posições sentado e em pé em ambos os grupos. A modulação da PFP foi diferente entre grupos. Ao levantar o objeto o GE não modulou a força de preensão em resposta a retirada do peso adicional do objeto. Para o parâmetro FE, LT e DT, não foram encontrados dados significantes. Através deste estudo foi possível verificar o possível comprometimento nos parâmetros do controle da força de preensão do membro superior não parético de indivíduos com hemiparesia.

L'étude de l'os est d'un intérêt majeur en Anthropologie. Constituant la charpente des vertébrés, le squelette est le reflet de l'activité motrice. En effet, chaque élément du squelette a une fonction dictée par sa forme et un rôle autorisé par sa morphologie. C'est l'illustration la plus visible de l'adaptation. Ce processus est largement étudié dans la lignée humaine et ce dogme est au cœur de nombreuses recherches en Anthropobiologie. Ces caractères sont inscrits dans la forme de l'os. Chaque courbure, apophyse ou crête témoignent au moins en partie de l'action d'un muscle ou d'une fonction dictée par un lent processus évolutif voire adaptatif. Cette évolution se fait par l'évolution de caractères externes de l'os par sa forme ou l'anatomie " visible " d'une part et par l'évolution de caractères plus internes, subtils et directement lié aux propriétés biomécaniques de l'os à savoir l'os trabéculaire. L'os trabéculaire est un matériau plus fragile, déformable que l'os cortical. Il constitue une trace indirecte des contraintes appliquées squelette. C'est ainsi que les activités locomotrices, alimentaires ou occupationnelle seront inscrite dans l'endostructure osseuse. C'est la théorie développée par Wolff dès 1870 dans " The law of bone remodelling ". Il développa cette conception d'un processus actif, évolutif par l'observation macroscopique des travées de l'extrémité supérieure du fémur chez l'homme. Si la contrainte exercée sur un os en particulier augmente, il va se remodeler pour devenir plus rigide et résister à la charge dans ce segment d'os particulier et pour cette force particulière de contrainte. Nous avons étudié cette théorie sur deux modèles chez le vivant au niveau du membre supérieur et au niveau du membre inférieur pour caractériser les contraintes asymétriques appliquées à l'os trabéculaires. La latéralité ou préférence manuelle est un exemple d'activité asymétrique. Ses effets sur l'os sont bien connus lors de la pratique de sports intensifs ou d'activités très latéralisées. Cependant peu de données existent sur les activités usuelles et la préférence manuelle de l'homme jeune sans activité particulière. Par une étude en microscanner avec des coupes de 41 microns, des volumes d'intérêt dans les os du squelette carpien radial ont été réalisés sur des individus d'âge jeune sans antécédent particulier de façon bilatérale. Plusieurs variables cliniques et anthropométriques ont également été recueillis. Nous avons pu mettre en évidence des caractères endostructuraux expliquant la variabilité interindividuelles en les comparant avec des éléments anthropomorphiques et la force de serrage manuelle. Par ailleurs, les défauts d'axe en varus ou en valgus exercent des contraintes asymétriques également sur les articulations portantes. La chirurgie prothétique du genou croit ces dernières années de façon exponentielle par un effet conjoint de l'amélioration des techniques, et l'augmentation de l'incidence de l'arthrose. / The study of bone is of major interest in Anthropology. The skeleton is an image of motor activity. Indeed, every element of the skeleton has a function dictated by its shape and role and then by its morphology. This illustrates the most visible adaptation of the bone. This process is widely studied in the human lineage. This theory is an important path of research in Anthropology. These characters are inscribed in the shape of the bone. Each curve, or crest reflect the action of a muscle or a function dictated by a slow evolutionary process. This change is by changing external characteristics of the bone by its form or anatomy "visible" on the one hand and by the evolution of more internal character, subtle and directly related to the biomechanical properties of bone namely trabecular bone. Trabecular bone is a more brittle material, deformable than cortical bone. It is an indirect trace of the stresses applied to the bone. Thus locomotion, feeding or occupational activities can be analyzed into the bone endostructure. This is the theory developed by Wolff in 1870 in "The law of bone remodeling." He developed this idea of ??an active, evolving process by macroscopic observation of the spans of the proximal femur in humans. If the stress on a particular bone increases, it will remodel to become more rigid and withstand the load in that particular bone segment and for this particular force of constraint. We studied this theory on two models in the living human being. One concerned the upper limb and the second the lower limb to characterize asymmetrical forces on trabecular bone. Laterality or handedness is an example of asymmetrical activity. Its effects on bone are well known in the practice of intensive sports or very lateralized activities. However, little data exist on the usual activities and the handedness of the young man with no particular activity. We performed a microCT study with cuts 41 microns slices. Volumes of interest in radial carpal bones were performed on both sides on young human adults without particular medical history. Several clinical and anthropometric variables were also collected. We were able to highlight endostructural patterns explaining the interindividual variability in comparison with anthropometric parameters and crush or pinch grip. Furthermore, axis deviations in varus or valgus exert asymmetric constraints also on weight-bearing joints. The prosthetic knee surgery increases exponentially in the last decades by a combined effect of improved techniques and the increased incidence of osteoarthritis. The OA is multifactorial but the weight has a major effect on cartilage wear. We further know that the morphology and deformation of members influence this phenomenon. We wanted to characterize the response of the bone to endostructure these asymmetrical stresses on the tibial plateau. We collected tibial plateaus during total joint replacement surgeries for knee and compare the bone under chondral internal and external with microCT 7.4 micron slices. Some parameters highlight the major effect weight and body mass such as bone volume fraction BV/TV, structure model index SMI, trabecular space Tb. and trabecular number Tb.N. Subchondral densification during osteoarthritis is associated with a reduction in its elastic modulus, which could increase cartilage stress, and accelerate cartilage loss.

Abstract Background/problem definition: Mental illness, such as anxiety, is a health problem affecting about 10-20% of adolescents worldwide. Studies have found a person’s physical fitness to be associated with their mental health, but most studies have been done in the western world and few have investigated sub-Saharan African (SSA) countries. It has also been found that SSA countries’ guidelines regarding physical activity are few and incomplete, although the importance of it is well known.   Aim: To investigate to what extent physical fitness: grip strength (GS), 20 meter shuttle run test (20MSRT), body mass index (BMI) and waist circumference (WC) correlate to self-assessed anxiety in South African students at the UWC.   Methods: The study had a quantitative, cross-sectional and correlational research design with a non-randomized convenience sampling. The physical fitness data were collected through a hydraulic grip strength dynamometer, 20MSRT and by measuring anthropometric measurements in order to calculate BMI and WC. An electronic version of the GAD-7 form was used for self-assessed anxiety.   Results: The results showed a significant positive correlation between BMI and levels of anxiety in women, but not in men. The correlation of anxiety related to WC, GS and 20MSRT showed no significance for the whole sample or related to gender, respectively. Conclusion: No significant correlation could be determined between physical fitness and anxiety. Severe anxiety affected 25% of the population, supporting previous research indicating that students are a group prone to anxiety. / Sammanfattning Bakgrund: Mental ohälsa, till exempel ångest, är ett hälsorelaterat problem som drabbar cirka 10-20% av ungdomar i världen över. Studier har visat att en persons fysiska kondition (physical fitness) kan kopplas till mental hälsa och välmående, men de flesta studier har gjorts i västvärlden och det råder brist på forskning i länder söder om Sahara. Dessutom har afrikanska länder söder om Sahara få och inkompletta riktlinjer gällande fysisk aktivitet trots att betydelsen av fysisk aktivitet är väl etablerad. Syfte: Att undersöka om och till vilken utsträckning fysisk kondition (innefattande grepp styrka, beep-test, BMI och midjemått) korrelerar med självskattad ångest (GAD-7) hos Sydafrikanska studenter vid University of the Western Cape (UWC).   Metod: En kvantitativ tvärsnittsdesign användes och korrelationer studerades. Deltagarna rekryterades genom ett icke randomiserat bekvämlighetsurval. Datan för fysisk kondition och hälsa samlades in genom en greppstyrka-dynamometer, beep-test samt genom antropometriska mätningar för att mäta midjemått och räkna ut BMI. Självskattad ångest samlades in genom en elektronisk version av GAD-7 formuläret.   Resultat: Resultaten visade en statistiskt signifikant, positiv korrelation mellan BMI och ångest bland kvinnor. Inga signifikanta korrelationer kunde i övrigt ses i gruppen som helhet eller hos kvinnor respektive män. Konklusion: Ingen signifikant korrelation fastslogs mellan fysisk kondition och ångest. Svår ångest rapporterades av 25% av deltagarna, vilket stödjer tidigare forskning på området som indikerar att studenter är en grupp utsatt för ångest.

For a wounded soldier to have as good a chance of survival as possible, an important variable during care is the time it takes for the wounded to get to a high-quality medical facility where there is expertise in surgery. If the injured person is to be transported with a stretcher carried by other soldiers, the speed for which this can be done is limited by the strength of the bearer in the hands and forearms.This study aims to explore how the speed and perceived ergonomics of those who carry a stretcher can change for a group if it is issued a relieving carrying system that redistributes the load of the stretcher to the hips, back and legs. The study is largely based on a study by Knapik et al (2000) where similar tests were done in a controlled indoor environment but where this study was done in a field environment with groups of 2 or 4 people carrying a stretcher.The study is done in the form of tests and experiments with conscripts from Skaraborg Wing, F 7. The conscripts carried a stretcher in a field-like environment where speed, comfort and usability were in focus. The study was also done with a questionnaire belonging to the experiments to value the experience.The study resulted in a relieving carrying system integrated in the Swedish Armed Forces' combat vest 2000 having an increased average speed with the median 30.7% when carrying a stretcher loaded with 100 kg. The analysis shows that it is above all women who benefit greatly from not carrying a stretcher with their hands. Something they are statistically worse at than men. The study also shows that there are tendencies that the comfort is improved for a soldier. / För att en sårad soldat ska ha så goda chanser till överlevnad som möjligt är en viktig variabel under omhändertagandet tiden det tar för den sårade att komma till en högkvalitativ sjukvårdsinrättning, där det finns expertis inom kirurgi. Om den skadade ska transporteras med sjukbår som bärs av andra soldater, är hastigheten för vilket detta kan göras begränsad av de bärandes styrka i händer och underarmar.Denna studie syftar till att utforska hur hastigheten samt den upplevda ergonomin för de som bär en sjukbår kan förändras för en grupp om den tillförs ett avlastande bärsystem som omfördelar lasten till höfter, rygg och benen. Studien baseras till stor del på en studie av Knapik med flera (2000) där liknande tester gjordes i en kontrollerad inomhusmiljö, men där denna studie är gjord i en fältmiljö med grupper om 2 eller 4 personer som bär en sjukbår.Studien är gjord i form av prov och försök med värnpliktiga ur Skaraborgs Flygflottilj, F 7, som bär en bår i en fältliknande miljö där hastigheten, komforten och användbarheten stod i fokus. Studien är även gjord med en enkätundersökning tillhörande försöken i syfte att skatta upplevelsen.Studien resulterade i att ett avlastande bärsystem integrerat i Försvarsmaktens stridsväst 2000 medförde en ökad snitthastighet, med medianen 30,7%, vid bärande av en sjukbår 2 lastad med 100 kg. Analysen påvisar att det framför allt är kvinnor som har stor nytta av att inte bära en sjukbår med händerna, något de statistiskt sett är sämre på än män. Studien visar även att det finns tendenser för att komforten förbättras för en soldat men användbarheten är oförändrad.

Elektroneurografi är en undersökningsmetod som används för att undersöka nervledingskapaciteten i perifera nerver. Det är en metod som ofta används på sjukhuskliniker vid diagnostisering av perifera nervsjukdomar. Syftet med studien är att undersöka om det finns en signifikant skillnad i motorisk och sensorisk nervledningshastighet, amplitud och F-respons mellan dominant och icke-dominant hand. I studien undersöktes det även om en korrelation finns mellan handgreppsstyrka och svarsamplitud från motorisk elektroneurografi.  I studien deltog 26 testpersoner från biomedicinska analytikerprogrammet i termin 6. Testpersonernas genomsnittsålder är 24 år (range 21-32 år), och testpersonernas kroppslängd är i genomsnitt 169 cm (range 155- 185). Elektroneurografi utfördes motoriskt och sensoriskt på nervus medianus bilateralt. Handgreppsstyrka undersöktes bilateralt med Jamar Hydraulic Hand dynamometer. För samtliga mätvariabler bestämdes signifikantnivån till α=0,05.  Resultatet visar att det finns en signifikant skillnad i sensorisk nervledningshastighet, motorisk amplitud och sensorisk amplitud mellan dominant och icke-dominant hand. Sensorisk nervledningshastighet är högre i icke-dominant hand, medan motorisk och sensorisk amplitud är högre i dominant hand. Däremot kan inte en signifikant skillnad påvisas i motorisk nervledningshastighet, FM-latens samt antalet F-svar mellan dominant och icke-dominant hand. Resultatet visar att det inte finns någon korrelation mellan handgreppsstyrka och amplitud i motorisk elektroneurografi. I dag används samma referensvärden för dominant och icke-dominant hand. Den här studien visar att det kan finnas ett värde i att utforma referensintervall som baseras på handdominans. / Electroneurography is an examination method used for examining the nerve conduction capacity of the peripheral nerve. The method is often used in hospitals in the diagnosis of peripheral nerve injuries. The aim of this study is to examine if there is a significant difference in motor and sensory nerve conduction velocity, amplitude, and F-response between dominant and non-dominant hands. The correlation between hand grip strength and the amplitude in motor electroneurography was also examined in this study.  The study involved 26 students from Biomedical Scientist Programme term 6. The average age of the participants is 24 years (range 21-32 years), and the participants body length is on average 169 cm (range 155-185 cm). Electroneurography was performed on the median nerve bilaterally. Hand grip strength was examined bilaterally with Jamar Hydraulic Hand dynamometer. For all measurement variables, the significant level was determined to α=0,05.  The result shows that there is a significant difference in sensory nerve conduction velocity, motor amplitude, and sensory amplitude between dominant and non-dominant hands. Sensory nerve conduction velocity is higher in non-dominant hand, while motor and sensory amplitude is higher in dominant hand. However, a significant difference cannot be detected in motor nerve conduction velocity, FM-latency, and the number of F-responses between dominant and non-dominant hands. The result shows no correlation between hand grip strength and the amplitude in motor electroneurography.  Today, the same reference values are used for dominant and non-dominant hands. This study shows that there may be a value in creating reference intervals based on hand dominance.

INTRODUCTION: Reaction time may be broadly defined as the time between stimulus presentation and a response. Analysis of reaction time in terms of rate of force development (RFD), peak force, and surface electromyography (EMG) may help bridge the gaps in knowledge pertaining to the neuromuscular system's role in reaction time. The purpose of the present study was to identify predictors of reaction time using digital hand grip dynamometry and EMG. It was hypothesized that RFD and rate of EMG rise (RER) at the onset of a contraction would correlate with reaction time. METHODS: For grip testing, participants were instructed to squeeze a handheld dynamometer with the right hand "…as hard and fast as possible" for 5 seconds upon hearing a "beep" from the computer. A total of 5 attempts were performed, with 1-minute rest periods. Bipolar surface EMG signals were detected from the right first dorsal interosseous (FDI) and flexor carpi radialis (FCR) muscles throughout grip testing. Bivariate correlations (Pearson r) were used to examine the statistical associations. The 95% confidence interval (CI) for each Pearson r was also computed. An alpha level of p ≤ 0.05 was used to reject the null hypothesis. RESULTS: Significant correlations were observed between reaction time and all other measures of grip force (r = -0.507 to -0.557, p= 0.016 to 0.042), except for time until peak force (r = 0.029, p = 0.915). As FDI EMG amplitude increased reaction time decreased (r = -0.664, p = .005). CONCLUSION: Many of the grip force variables were significantly associated with reaction time. Peak force and rapid force variables showed significant correlations with reaction time. While no significant correlations for any of the FDI RER or FCR variables were found, EMG amplitude from the FDI presented the strongest bivariate correlation. As FDI EMG amplitude, peak force, and rapid force variables increased reaction time decreased. These findings give some insight into the neuromuscular system's role in hand grip tasks and help broaden the current understanding of variables that may be used to assess or improve reaction time in the clinical setting.

No description available.

The main topic of my diploma thesis is the diagnosis and the therapy of handwriting training of hand grasp in preschool children. This diploma thesis describes and evaluates possibilities of using a handwriting tool, which was developed in cooperation with Centre for Biomedical Engineering and 1. Faculty of Medicine, for hand grasp testing. A handwriting tool measures fingers grip pinch while the fingers are used in hand grasp. The theoretic part comprehend useful findings about handwriting, its development. In detail it is focused on diagnosis and therapy of hand grasp, which is an important aspect in handwriting development. This theoretic part also includes description of handwriting disabilites in preschool children and description handwriting tools, which are used for correct hand grasp training. The conclusion of the theoretic part is focused on therapy of hand grasp and handwriting training from the ergotherapist point of view. The goal of the practical part is to find out fingers pinch in hand grasp in normal healthy preschool children using a specialy developed handwriting tool and to recommend another possibilites of using this new tool in handwriting training.

A morbidade por doenças cardiovasculares (DCV) é uma preocupação crescente em Saúde Pública. Um aumento na carga das DCV tem sido recentemente observado, principalmente em países de baixa e média renda, reflexo do aumento da expectativa de vida e do maior tempo de exposição aos fatores risco para as doenças crônicas. O aumento no número de anos vividos com alguma doença crônica tem se tornado uma das principais preocupações em saúde pública, destacando-se, nesse contexto, as doenças cardiovasculares, principal responsável por anos de vida perdidos ajustados por incapacidade em idosos. Dessa forma, a avaliação da carga das doenças crônicas na população, bem como o conhecimento de seus determinantes, representa um importante campo de estudo em Saúde Pública e no planejamento da atenção em saúde. Entretanto, estudos que analisaram tanto a mudança na prevalência de DCV na última década, como os determinantes individuais e contextuais das doenças cardiovasculares em idosos ainda são escassos no Brasil. Esta tese será apresentada sob a forma de três artigos científicos. O primeiro analisou o efeito dos determinantes individuais e contextuais na morbidade por DCV em idosos residentes do município de São Paulo em 2010. Foi observada uma maior presença de DCV entre os idosos que residiam em áreas com desigualdade de renda média-baixa (OR=1,35 IC95 por cento=1,15-1,59), média-alta (OR=2,71 IC95 por cento=2,18-3,36) e alta (OR=1,43 IC95 por cento=1,14-1,79), comparada ao nível mais baixo de desigualdade. Em relação às áreas com menor área verde por habitante, viver em áreas com maior cobertura vegetal esteve significantemente associado a uma menor chance de presença de DCV, mesmo após o ajuste estatístico para os fatores individuais e contextuais. O segundo artigo analisou a mudança na prevalência de DCV entre 2000 e 2010 e sua associação com os fatores socioeconômicos e fatores de risco em idosos. A prevalência de DCV em idosos foi igual a 17,9 por cento em 2000, 22,2 por cento em 2006 e 22,9 por cento em 2010. Em relação ao ano 2000, foi observado um aumento significativo da presença de DCV em 2006 (OR=3,20 IC95 por cento=1,93-5,31) e 2010 (OR=2,98 IC95 por cento=1,51-5,89). A presença de DCV também apresentou associação com maior faixa etária, histórico de tabagismo e presença de diabetes e hipertensão arterial, sendo observada uma associação inversa entre a presença de DCV e a ingestão de álcool. O terceiro artigo analisou a associação entre a força de preensão manual e a morbidade por doença cardiovascular em idosos. Foi observado que uma maior força de preensão manual esteve significativamente associada a uma menor presença de DCV em idosos (OR=0,47 IC95 por cento = 0,24 0,91), mesmo após o controle para as características individuais. / Cardiovascular disease morbidity (CVD) is a growing concern in Public Health. An increase in the burden of CVD has been recently observed, especially in low- and middle-income countries, due to increases in life expectancy and the longer exposure period to risk factors of chronic diseases. The increase of total years lived with a chronic disease is now considered as one of the main public health concerns, especially regarding cardiovascular diseases, the highest contributor to disability-adjusted life years among the elderly. Therefore, the assessment of the total burden of chronic diseases in the population and the identification of its determinants represents an important area of concern in Public Health and healthcare policies. However, studies that have analyzed both the evolution of the CVD prevalence in the last decade and the individual and contextual determinants of cardiovascular diseases among the elderly are still scarce in Brazil. This thesis is presented in the form of three papers. The first one analyzed the effect of individual and contextual determinants of morbidity of CVD in elderly residents of Sao Paulo, Brazil, in 2010. In comparison to elderly residents in areas with the lowest level of income inequality, higher odds of CVD presence was observed among those living in areas in the mediumlow (OR=1.35, 95 per cent CI 1.15 to 1.59), mediumhigh (OR=2.71, 95 per cent CI 2.18 to 3.36) and high (OR=1.43, 95 per cent CI 1.14 to 1.79) quartiles of income inequality. Regarding green spaces, those who live in areas with highest levels of vegetation coverage had a significantly lower risk of CVD, even after controlling for individual and contextual factors. The second paper analyzed the differences in the prevalence of CVD between 2000 and 2010 and its association with socioeconomic factors and risk factors among the elderly. The prevalence of CVD in the elderly was estimated to be 17.9 per cent in 2000, 22.2 per cent in 2006 and 22.9 per cent in 2010. Regarding the prevalence observed in 2000, there was a significant increase in presence of CVD in 2006 (OR = 3.20 95 per centCI = 1.93 to 5.31) and 2010 (OR = 2.98 95 per centCI = 1.51 to 5.89). The presence of CVD was also associated with older age, smoking history, presence of diabetes and hypertension, and an inverse association was observed between CVD presence and alcohol intake. The third paper analyzed the association between grip strength and cardiovascular disease morbidity in the elderly. A significantly lower presence of CVD was observed among the elderly with higher grip strength (OR = 0.47 95 per centCI = 0.24 to 0.91), even after controlling for individual characteristics.