Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-07-12T15:08:18Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Dissertação_Luana Prado_digital.pdf: 1685713 bytes, checksum: e1e056c8dd45056eda6306999941d592 (MD5) / Made available in DSpace on 2017-07-12T15:08:18Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Dissertação_Luana Prado_digital.pdf: 1685713 bytes, checksum: e1e056c8dd45056eda6306999941d592 (MD5) Previous issue date: 2016-03-15 / CAPES / As úlceras maleolares (UMs) são manifestações cutâneas frequentes na anemia falciforme (AF). Cursam com alta taxa de recorrência, retardo na cicatrização e maior probabilidade de tornarem-se crônicas. Os mecanismos desencadeantes envolvem episódios hemolíticos e vaso-oclusivos, e mais recentemente, foram apontados polimorfismos em genes regulatórios da via do TGF-β como contribuintes deste processo. Polimorfismos nos genes que regulam esta via mostram-se alvos moleculares promissores na elucidação da fisiopatologia das UMs. Com isso, nosso objetivo foi investigar a relação de polimorfismos nos genes SMAD7 e SMURF1 na ocorrência de UMs em pacientes com AF. O estudo foi realizado em duas coortes independentes, composta por 331 pacientes de Pernambuco (131 com UM e 200 sem UM) e 197 pacientes do estado do Rio de Janeiro (108 com UM e 89 sem UM). As genotipagens dos polimorfismos SMAD7 C>T (rs736839) e SMURF1 C>G) (rs219825) foram realizadas por PCR em tempo real. Empregando o modelo de análise recessivo, foi encontrada associação entre os homozigotos variantes (TT; GG) e a maior ocorrência de UM nos pacientes das duas coortes avaliadas, para SMAD7 e SMURF1 em Pernambuco (P=0.001 e P=0.050) e Rio de Janeiro (P=0.029 e P=0.006). Ademais, avaliando a coorte de Pernambuco os pacientes com genótipo TT apresentaram uma maior taxa de desenvolvimento das UMs (70%) em relação aos com genótipos CC + CT (45%) (P<0,0001) para a SMAD7, e os pacientes com genótipo GG para SMURF1 apresentaram uma maior taxa de desenvolvimento das UMs (65%) em relação aos genótipos CC+CG (46%) (P=0.009). Sumariamente, nossos resultados mostram que os polimorfismos estudados estão envolvidos na ocorrência das UMs nas coortes de pacientes com anemia falciforme, mostrando-se como potenciais moduladores fenotípicos na doença falciforme. / Leg ulcers are one of the most common clinical manifestations of sickle cell anemia (SCA). They present a high rate of reoccurrence, delayed wound healing and a higher probability of becoming chronical. The triggering mechanisms involve hemolytic and vaso-occlusive episodes, and polymorphisms in regulatory genes of the TGF-β pathway were identified recently as contributors of this process. Polymorphisms in genes that regulate this pathway are considered as promising molecular targets in the elucidation of the pathophysiology of leg ulcers. Therefore, our aim was to investigate the relationship of the polymorphisms in SMAD7 and SMURF1 genes with the occurrence of leg ulcers in patients with SCA. The study was conducted in two independent cohorts consisting of 331 patients from Pernambuco (131 with leg ulcer and 200 without leg ulcer) and 197 patients from Rio de Janeiro (108 with leg ulcer and 89 without leg ulcer). The genotyping of SMAD7 C>T (rs736839) and SMURF1 C> G (rs219825) were performed by real time PCR. Using the recessive model of analysis, we found an association between homozygous variants (CC; GG) and the higher incidence of leg ulcers in patients from the two evaluated cohorts for SMAD7 and SMURF1 in Pernambuco (P = 0.001 and P = 0.050) and Rio de Janeiro (P = 0.029 and P = 0.006). Moreover, assessing the cohort of Pernambuco, patients with CC genotype had a higher rate of leg ulcers development (70%), compared to those with CC + CT genotypes (45%) (P <0.0001) for SMAD7, and patients with GG genotype for SMURF1 showed a higher rate of development of leg ulcers (65%) compared to CC + CG genotype (46%) (P = 0.009). In summary, our results demonstrated that the studied polymorphisms are involved in the occurrence of leg ulcers in cohorts of patients with sickle cell anemia, showing up as potential phenotypic modulators of sickle cell disease.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The ulcers of the lower limbs are cited as the main cutaneous manifestation of sickle cell anemia, presenting a chronic course, with pain and many complications. Treatment of sickle ulcers is complex, involving care wound bed, management of anemia, pain management and treatment of opportunistic infections, among the various proposed treatments highlight the use of covers with inelastic bandage impregnated with zinc, the boot Unna. However there are still no controlled trials to prove the efficacy of treatment. Objective: Compare treatment with conventional dressing to the use of Unna boot in patients with sickle cell anemia and ulcers in the limbs. Methodology: This is a randomized clinical trial, which analyzed patients with sickle cell ulcers that took the Unna boot , comparing them with patients with sickle cell ulcers who used the conventional dressing . Treatments were performed in a period of six weeks. Statistically analyzed the areas of lesions in three periods: at baseline (D0) in the third week (D3) and the sixth week (D6). Results: Participated in this study 19 patients with a mean age of 35.9 years (95% CI 29.1 to 42.8), 53% (10/19) were male. In these individuals was analyzed the healing of ulcers in 40 lower limbs of people with sickle cell anemia 57% (23/40) in the experimental group and 43% (17/40) in the control group. There was a mean variation in lesion area when used Unna boot of 20.2 cm2 at T0 time, 17.9 cm2 in time T3 and 6.2 cm2 in time T6 (P < 0.001), mean percentage of total reduction of 77 1%, obtained by Tarajad index, when used as a simple dressing ranged from 31.3 cm2 35.8 cm2 33.9 cm2 at times T0, T3 and T6, respectively (P <0.001) and an average percentage of 22.8 %. Conclusion: The results suggest that the use compression therapy with Unna boot is an effective treatment of lower limb ulcers in patients with sickle cell anemia, aimed at reducing ulcer area, improvement of the injury aspect and pain alleviation. / As úlceras em membros inferiores são citadas como a principal manifestação cutânea da anemia falciforme, apresentando um curso crônico, com dor e muitas complicações. O tratamento das úlceras falcêmicas é complexo, envolvendo cuidados com o leito da lesão, manejo da anemia, controle da dor e tratamento de infecções oportunistas, dentre os diversos tratamentos propostos destaca-se o uso de coberturas com bandagem inelástica impregnada com zinco, a bota de Unna. No entanto ainda não existem ensaios clínicos que comprovem a eficácia do tratamento. Objetivo: Comparar o tratamento com curativo convencional à utilização de bota de Unna em pacientes com anemia falciforme e úlceras em membros inferiores. Método: Trata-se de um ensaio clínico randomizado, onde foram analisados pacientes com úlcera falcêmica que fizeram uso da bota de Unna, comparando-os com pacientes com úlceras falcêmicas que fizeram uso do curativo convencional. Os tratamentos foram realizados em um período de seis semanas. Foram analisadas estatisticamente as áreas das lesões em três períodos: no momento inicial (D0), na terceira semana (D3) e na sexta semana (D6). Resultados: Participaram dessa pesquisa 19 pacientes com idade média de 35,9 anos (IC95% = 29,1 a 42,8), sendo 53% (10/19) do sexo masculino. Nesses indivíduos foi analisada a cicatrização de 40 úlceras em membros inferiores de pessoas com diagnóstico de anemia falciforme sendo 57% (23/40) no grupo experimental e 43% (17/40) no grupo controle. Houve uma variação média da área lesional quando utilizado bota de Unna de 20,2 cm2 no tempo T0, 17,9 cm2 no tempo T3 e 6,2 cm2 no tempo T6 (P<0,001), com média percentual de redução total de 77,1%, obtido através do índice de Tarajad, enquanto quando se usou o curativo simples teve uma variação de 31,3 cm2, 35,8 cm2, 33,9 cm2, nos tempos T0, T3 e T6 respectivamente (P<0,001), e um percentual médio de 22,8%. Conclusão Os resultados sugerem que a utilização da terapia compressiva com bota de Unna constitui um tratamento efetivo das úlceras de membros inferiores em pacientes portadores de anemia falciforme, atuando na redução da área da úlcera e na melhora do aspecto lesional.

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第23122号 / 人健博第84号 / 新制||人健||6(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 黒木 裕士, 教授 青山 朋樹, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

This thesis seeks to simulate the impact on the human foot on the car bumper. The opening section deals with requirements as to the current passive safety features aiming to mitigate the consequences of such impact. The thesis also describes the construction of a human foot impactor, its certification via both static and dynamic tests, a simulation of the cash test and its evaluation. The designed model as well as the simulation procedure have been led according to the current Euro NCAP specifications.

Bakgrund: I Sverige lever närmare en procent av befolkningen med venösa bensår. Såren uppstår på grund av venös insufficiens. Venösa bensår är ett stort folkhälsoproblem i hela världen. Personer som har ett stillasittande levnadssätt och är överviktiga har en högre risk än genomsnittsbefolkningen att utveckla venösa bensår. Såren är svårläkta och drabbar främst äldre personer. Sjuksköterskan har det yttersta ansvaret för patientens omvårdnad. Syfte: Syftet var att belysa personers upplevelser av att leva med venösa bensår. Metod: En litteraturöversikt har använts som metod. Ur databaserna PubMed och CINAHL Complete hämtades tio stycken vetenskapliga artiklar som grundar sig på forskning enligt kvalitativ metod. Resultat: Tre huvudteman och tre underteman identifierades. Det första huvudtemat var Smärta och dess hantering. Det andra huvudtemat var Påfrestningar till följd av odör och exsudat. Det tredje huvudtemat var Ett förändrat liv och har följande underteman; Beroende, Behandling och läkning samt Kunskapsbrist. Diskussion: I metoddiskussionen diskuterades litteraturöversiktens styrkor och svagheter. Resultatfynd associeras till vårdkontext och diskuteras i relation till bakgrund, ny forskning samt Katie Erikssons teori där lidande och vårdprocessen fokuseras. / Background: Nearly one percent of the Swedish population lives with venous leg ulcers. Venous leg ulceration is caused by venous insufficiency. This is a big public health problem worldwide. People who live their lives sedentary and are overweight suffers a greater risk of evolving venous leg ulcers. These types of ulcers are slow-healing and mostly affects elderly people.  The responsibility for patient care is the nurse. Aim: The aim of the study was to enlighten people’s experiences of living with venous leg ulcers. Method: A literature review was used as method. PubMed and CINAHL Complete were used as databases. Ten scientific qualitative articles were found. Results: Three main topics and three subtopics were identified. The first main topic was Pain and its management. The second main topic was Strains following odour and exudate. The third main topic was A different life with following subtopics; Dependence, Treatment and healing and Knowledge deficit. Discussion: The strengths and weaknesses of the literature review is discussed in the method discussion. The results are discussed in nursing context and is related to background, new research and Katie Eriksson’s theory with suffering and care process.

Ankle sprains are one of the most common injuries within athletics in the United States with approximately one-million student athletes experiencing ankle sprains each year. Studies argue excessive or rapid ankle inversion occurring from jump landings may cause ankle sprains. Also, the effect of limb dominance on risk of ankle sprain is not well documented. The aim of this study was to determine if there is an affect of leg dominance on landing mechanism of the ankle joint that predisposes either ankle joint to greater risk of ankle sprain. Twelve recreationally active subjects were recruited and completed four maximal vertical jumps. Ground reaction force, marker position data and maximal vertical jump height were collected using two Bertec Force plates, a 10-camera motion capture system, and a Vertec Vertical Jump Trainer, respectively. Cortex and Visual3D software programs were used to process the motion capture data and to calculate peak vertical ground reaction forces(vGRF), loading rate, and ankle joint moments. There were no statistically significant differences in ankle joint moment or loading rate between limbs, but peak vGRF were significantly higher (p < 0.05) in the non-dominant ankle. The results suggest the non-dominant ankle displays higher injury potential, as the non-dominant leg accumulates a larger peak landing force.

Author: Bc. Ondřej Martínek Title: Physical activity and its quality in children with ADHD Objectives: The aim of the theoretical part of the work was to process the issue of ADHD, especially in children of younger school age. The work also aimed to present the possibilities of testing and therapy in physiotherapeutic practice. The aim of the practical part was to obtain information about the subjective evaluation of children's motor skills by the DCDQ questionnaire from the point of view of their parents, to get an idea of leisure activities and physiotherapy care and to compare test results (One Leg Stance Test and The Ladder Agility Test) of experimental group with control group. Methods: The research group consisting of 22 probands and the control group of 25 probands completed 2 standardized tests (The Ladder Agility Test, One Leg Stance Test). Their parents completed The Developmental Coordination Disorder Questionnaire and answered 2 open questions. The obtained data were evaluated in Microsoft Excel. A two-sample t-test (Welch version) was used for statistical processing. Results: Statistically significant differences were found in the evaluation of probands by their parents with the ADHD questionnaire, but in practical motor tests no significant differences were found between the...

Orientador: Luciana Patrícia Fernandes Abbade / Resumo: Introdução: Úlceras crônicas de membros inferiores são muito prevalentes. O tratamento local é feito através do uso de curativos específicos e outros produtos tópicos. A utilização destes podem causar dermatite de contato alérgica, aumentando a morbidade relacionada à doença e retardo da cicatrização. Objetivos: Identificar a frequência e principais substâncias alergênicas relacionadas à dermatite de contato nos pacientes portadores de úlceras crônicas nos membros inferiores. Métodos: Estudo observacional, com desenho transversal, realizado em 64 pacientes com diagnóstico de úlcera crônica de membros inferiores ativa ou cicatrizada independente da etiologia. Em todos os participantes foi realizado o teste de contato com a bateria padrão e com os curativos e produtos frequentemente utilizados para tratamento destas úlceras. Foram avaliadas variáveis clínicas e as relacionadas ao teste de contato. Resultados: Eczema peri-úlcera estava presente em 50 pacientes (78,1%). O teste de contato padrão foi positivo em 28 participantes (43,8%), sendo o paraben mix, sulfato de níquel e lanolina as substâncias do teste padrão que mais positivaram. O teste de contato com os curativos e produtos foi positivo em 17 participantes (25,6%) e os principais alérgenos foram, em ordem decrescente: colagenase com cloranfenicol (16%), sulfadiazina de prata (13%) e bota de Unna (6%). Eczema peri-úlcera relacionou-se positivamente com o uso de colagenase e hidratantes. Conclusão: A positividade ao teste... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Chronic leg ulcers are very prevalent and the local treatment is done through the use of specific dressings and other topical products. The use of these can cause allergic contact dermatitis, increasing disease-related morbidity and delayed healing. Objective: To identify the frequency and the main allergenic substances related to contact dermatitis in patients with chronic leg ulcers. Methodology: Observational study, with transversal design, performed with 64 patients diagnosed with active or healed chronic leg ulcers regardless of etiology were included. Patch tests were performed with all the patients, including the standard battery and the dressings and products frequently used on the treatment. Clinical variables and those related to the patch test were evaluated. Results: Peri-wound eczema was present in 50 patients (78.1%). The standard patch test was positive in 28 (43.8%) participants, with paraben mix, nickel sulfate and lanolin being the most positive substances. The patch test with dressings and products was positive in 17 (25.6%) participants and the main allergens were, in decreasing order: collagenase with chloramphenicol (16%), silver sulfadiazine (13%) and Unna's boot (6%). Peri-wound eczema was positively related to the use of collagenase and moisturizers. Conclusion: Positive patch test in patients with chronic leg ulcers is still high and peri-wound eczema, an important comorbidity that delays healing, is at increased risk in patients using ... (Complete abstract click electronic access below) / Mestre

Förmågan att generera kraft kan korrelera med individens prestationsförmåga i idrotter, sprint- och hoppträning kan gynna prestationsförmågan inom vissa idrotter. Syftet med denna studie var att undersöka huruvida det fanns korrelation mellan prestation i 5RM knäböj med skivstång och enbenslängdhopp. Vidare undersöktes även hur 5RM relaterat till kroppsvikt påverkade hopplängd, skillnader mellan män och kvinnor och skillnad i hopplängd mellan dominant och ickedominant ben. Totalt 37 motionärer rekryterades, 15 kvinnor och 22 män (35 ± 11 år), alla var erfarna av knäböj med skivstång. Deltagarna fick efter uppvärmning utföra en maxprestation i horisontella enbenshopp, vila 8 minuter och hitta sitt 5 RM i knäböj. Resultatet visade på svag positiv, statistiskt signifikant korrelation mellan hopplängd och muskelstyrka mätt i 5 RM knäböj (r= 0,4 p&lt;0,05), samt svag icke signifikant korrelation (r= 0,21, p&gt;0,05) då hänsyn till kroppsvikt togs.  Män hoppade 310,2 ± 39,6 cm vilket var signifikant (p&lt;0,05) längre än kvinnor som hoppade 266,3 ± 47,3 cm, mellan dominant och ickedominant ben visades ingen signifikant skillnad i hopplängd. Resultaten visade på ett signifikant svagt samband mellan 5 RM knäböjtest och enbenstest för hoppförmåga. Resultaten kan tolkas som att testen mäter olika fysiska förmågor dock har muskelstyrkan betydande inverkan på hoppförmågan. / The performance in sports may be determined by the ability to generate power. Sprinting and jumping in training can be beneficial to the athletes´ ability to perform explosive type of sports. The aim of this study was to examine the relationship between single leg hop for distance and a) back squat strength, 5 Repetition Maximum and b) back squat 5 Repetition Maximum correlated to body weight. A secondary aim was to examine the hop performance of dominant and non-dominant leg between males and females. 37 recreational individuals participated in the study, 15 women and 22 men (35 ±11years), all subjects were used to squatting. After warm up, the subjects were told to make a single leg hop for max distance, (3 tries) rest 8 minutes before squatting up to a 5 RM back squat.  The results showed that there was a positive correlation between total jump length (right + left leg) and 5 RM max weight (r= 0,4 p&lt;0,05) and a significant difference in total jump length between males and females (p&lt;0,05) but no difference in jump length between dominant and non-dominant leg between the subjects. Participants´ familiarity of jumping activities may have influence the outcome of this study.

In Sweden there is no legal regulation for the obligations and responsibilities between the contracting parties within the construction, civil engineering and installation sector. To clarify uncertainties regarding the liability, actors from theses sectors have agreed upon a voluntary regulation, called the General Conditions of Contract. When insurance companies want to enter the Swedish construction insurance market, they face a regulatory framework that not only regulates the construction market, it also imposes requirements on terms and conditions that must be included in the construction insurance. These terms are perceived as ambiguities and create difficulties and inhibit the ability for these insurance companies to offer competitive insurances. One of the terms that create these difficulties is the guarantee period, which is period of time starting from handing over the construction project to the employer, during this period the contractor still has the responsibility for the construction project. The guarantee period regulated by the General Condition of Contracts differs from the international use of the term both in length and in content. The purpose of this thesis is to expose the differences and similarities between the term "guarantee" in comprehensive all risk insurance regulated by the General Conditions of Contract; AB 04 and ABT 06 with two international used insurance policies from reinsurance companies Munich Re and Swiss Re and defect exclusions LEG and DE. The problem discussed in this thesis is whether the exposure of risk for the insurance companies during the guarantee period is comparable or if they deviate? The results presented in this thesis indicates that the guarantee period regulated by AB 04 represents a lower risk exposure than the guarantee period regulated by ABT 06 and that the guarantee period regulated by ABT 06 is most comparable to guarantee period compared in this thesis. The result presented partially confirms simultaneously partially refutes the apprehension insurance companies have regarding the guarantee period according to the General Conditions of Contract, this knowledge about the guarantee period can be used so that more insurance companies can establish on the Swedish construction insurance market. / I Sverige finns ingen lag som reglerar skyldigheter och det ansvar parterna har i entreprenader inom bygg-, anläggnings- och installationssektorn. För att lösa ansvarsfrågan har byggsektorns aktörer enats om en frivillig reglering, Allmänna Bestämmelser. När försäkringsbolag vill ta sig in på den svenska entreprenadförsäkringsmarknaden ställs de inför ett regelverk som inte bara reglerar entreprenadmarknaden utan även ställer krav och villkor på vad entreprenadförsäkringar måste innehålla. Dessa villkor upplevs som främmande och skapar problem för försäkringsbolagen och hämmar möjligheten att erbjuda konkurrensmässiga försäkringar. Ett av dessa villkor som skapar problem är garantitiden, den tid efter avlämnandet, då entreprenören fortfarande har ett ansvar för entreprenaden. Denna garantitid skiljer sig från de internationellt använda försäkringarna både i tid och i omfattning. Syftet med arbetet är att frilägga skillnader och likheter mellan begreppet "garantitid" i allriskförsäkringar enligt Allmänna Bestämmelser AB 04 och ABT 06 respektive två internationellt använda försäkringar från återförsäkringsbolagen Munich Re och Swiss Re och defektundantagen LEG och DE. Frågeställningen som behandlats är om riskexponering är jämförbar i de olika försäkringars garantitider eller om de skiljer sig åt? Resultaten som presenteras i arbetet visar att garantitiden i AB 04 innebär en lägre riskexponering än vad garantitiden i ABT 06 gör och att ABT 06 är den garantitid som är mest jämförbar med garantitider i de jämförande försäkringarna. Genom att detta resultat kan presenteras som delvis bekräftar samtidigt delvis motbevisar den farhåga försäkringsbolag har angående garantitiden enligt AB kan denna kunskap om garantitiden innebära att fler försäkringsbolag kan ta sig in på den svenska entreprenadförsäkringsmarknaden.