Hintergrund: Eine negative Geburtserfahrung erhöht das Risiko, eine postpartale Depression (PPD) zu entwickeln. Veränderungen der Hypothalamus-Hypophysen-Nebennieren-Achse (HHNA) werden als ein zugrundeliegender Mechanismus diskutiert. Bisher gibt es nur wenig Forschung zu dem Zusammenhang zwischen negativen Geburtserfahrungen und langfristig integrierten Glukokortikoiden. Ziel der vorliegenden Arbeit war zu untersuchen, ob objektive und subjektive Geburtserfahrungen mütterliche Glukokortikoide, gemessen anhand der Haarsegmentanalyse, vor-hersagen können. Methoden: Acht Wochen nach der Geburt wurden Haarproben von 257 Müttern entnommen, die in der prospektiven Kohortenstudie DREAMHAIR teilnahmen. Die Haar-Glukokortikoide wurden in den kopfhautnahen 2cm Haarsegmenten mittels der Flüssigchromatographie-Massenspektrometrie quantifiziert. Die analysierten Haarsträhnen spiegeln die Stresshormonkonzentrationen von der Geburt bis zu zwei Monaten nach der Entbindung wider. Die objektive und subjektive Geburtserfahrung sowie die PPD-Symptome wurden mittels etablierter Fragebögen gemessen. Ergebnisse: Die Geburtserfahrung war kein signifikanter Prädiktor für Cortisol oder Cortisone und Letztere sagten PPD-Symptome nicht signifikant vorher. Allerdings sagte eine negative objektive und subjektive Geburtserfahrung eine signifikant höhere Cortisol/Cortisone Ratio voraus und die Cortisol/Cortisone Ratio wiederum war ein signifikanter Prädiktor von PPD-Symptomen. Der Zusammenhang zwischen einer subjektiven negativen Geburtserfahrung und PPD-Symptomen wurde teilweise durch die Cortisol/Cortisone Ratio erklärt. Schlussfolgerungen: Die Ergebnisse legen nahe, dass eine negative Geburtserfahrung mit einer höheren mütterlichen Cortisol/Cortisone Ratio assoziiert ist. Insbesondere die subjektive Geburtserfahrung ist ein wesentlicher Risikofaktor für Veränderungen des Glukokortikoid-Stoffwechsels, welche wiederum PPD-Symptome vorhersagen. Unsere Studie deutet darauf hin, dass die Cortisol/Cortisone Ratio ein vielversprechender Biomarker sein könnte, um Frauen mit einem erhöhten Risiko für die Entwicklung einer PPD zu identifizieren.:Theoretischer Hintergrund Methoden Diskussion

A challenging aspect of modern global development is to provide desired thermal environment for building occupants with optimum consideration of energy and occupants health and satisfaction, both physically and psychologically. The variation of activity level, health condition, needs, clothing habit and staying time of different categories of occupants in hospitals makes it critical where comfort level should be optimized. Now-a-days, tremendous changing on climate makes even more challenging to maintain optimum level of indoor thermal environment at low energy cost. Thermal comfort can be assessed by the well-established PMV- PPD model, and studies on the correlation with AMV ratings from the occupants can help to understand the exact scenario of the thermal comfort. Therefore, this research aims to estimate the thermal comfort level of healthcare occupants, compare PMV-PPD values with AMV for different categories of occupants, and analyze optimum operative temperature for energy savings. A combination of objective measurements and a field study with a semi-structured interview on comfort perception, following ISO-7726, 7730, 8996, 9920, 10551 and ASHARE- 55 regulations, were conducted, where a total number of 56 occupants, including 35 patients, 5 visitors and 16 medical staffs were participated from a health care center of a hospital in Stockholm, Sweden. The data was collected during the summertime. Based on studied thermal environment, both PMV (-1.59 to 1.01) and AMV range (-2 to 1) considering gender, indicated health care center of studied hospital toward slightly cold, where occupants wanted warmer indoor environment. Patients more than 60 years were most sensitive on thermal comfort and overall patients were more sensitive for warm indoor climate than medical staff due to health condition and age. But male respondents were less sensitive than female. PMV and AMV with optimum operative temperature provides the clear idea about optimum thermal environment for the hospitals occupant. Identifying an optimum thermal environment could be a sustainable solution if and only if energy can be reduced.

No description available.

No description available.

Purpose: During the summer, overheating in buildings is becoming more common, but at the same time the passive heat from the sun during the winter can be utilized. This project investigates which solar shading is the best alternative to use in new buildings in Kungsbacka municipality. Method: There are three main aspects that this project focuses on, which are economics, energy and thermal climate. To perform the examination in this project, two rooms in two different schools have been examined with four different solar shading options. The solar shading options are fixed solar shading with a 30 degree inclination, fixed solar shading with 45 degree inclination,  variable sun-controlled solar shading, and variable scheduled solar shading. Results: The results of the study shows that variable sun-controlled solar shading provides the best indoor climate from a thermal aspect, and provides the lowest cooling needs as it reduces the amount of passive energy supplied through the window. Variable solar shading is expensive to purchase, maintain and operate. Fixed solar shading types have a cheaper purchase price and have no operation or maintenance costs. Conclusions: you can say that the choice of solar shading types depends on the conditions one has. Given the results from the case studied in this project,  variable sun-controlled solar shading type is better than fixed solar shading but more costly. / Överhettning i byggnader blir med tiden alltmer vanligt under sommaren, men däremot vill man kunna utnyttjapassiva värmen från solen under vintertiden. Detta problem väcker intresse för vilka solskydd typer som ger bästa solavskärmning under sommaren och släpper in mest solvärme under vinter. I detta arbete undersöks vilka solskydd som skulle vara bäst att användas i nya byggnader i Kungsbacka kommun. Det finns tre huvudaspekter som detta arbete fokuserar på, och dessa är ekonomi, energi och termiskt klimat.För att utföra undersökningen i arbetet har två rum i två olika skolor undersökts med fyra olika solskyddsalternativ. De olika solskydd typer som har undersökts är, fast solskydd med 30 och 45 graders lutning samt rörliga solstyrda och schemalagda solskydd. Datainsamlingen i arbetet bygger mest på krav från beställare och myndigheter samt mätningar från rummen som har undersökts. För att studera de två fallen utfördes simuleringar i IDA-ICE i form av värde tabeller från modeller som har ritats med samma förutsättningar som rummen har. Resultatet av undersökningen visar att rörligt solstyrt solskydd ger bästa inomhusklimat ur termisk aspekt, samt ger lägsta kylbehov eftersom den minskar den tillförda passiva energimängden genom fönstret. Däremot är rörliga solskydd dyra i inköp, underhåll och drift. Men de har ganska lång livslängd som skulle genom tiden spara på energi om man har aktiv kylning i byggnaden. I detta arbete var termisk komfort utgående punkt för valet av solskydd då aktiv kylning saknades i både skolorna. Fasta solskydd typer är billigare i inköpspriset och har ingen drift eller underhållskostnader, men det visade sig att de inte är lika effektiva som rörliga solskydd typer när det gäller termisk komfort under sommaren. Valet av solskydd beror helt på vad man är intresserad av och ifall man har aktiv kylning eller inte. När det gäller transmissionsförluster genom fönstren vid användning av olika solskydd typer så visade det sig att det blev nästan samma förluster oavsett vilken solskydd typ som används. Det beror helt på själva fönstrets egenskaper som i både fallen var bra. Slutligen kan man säga att valet av solskydd typer beror på förutsättningarna man har. Resultaten från fallet som studerades i detta arbete är att rörliga solskydds typer är bättre än fast solskydd men dyrare. Det finns dock en kostnadsskillnad när det gäller kylning över längre perioder.

Då varje människa tillbringar större del av dagen inomhus så är det viktigt att ha en bra termisk komfort, efter som den termiska komforten påverkar upplevelsen på jobbet i hemmet eller i skolan. Människor kan påverkas negativt när den termiska komforten inte uppfyller kraven.   Syftet med undersökningen är att undersöka hur lågtemperaturssystemens förmåga är med avseende på termisk komfort och om de uppfyller kraven. Undersökningen använder beräknings data från tidigare utfört arbete då beräkningarna valideras av jämförelse mot andra undersökningar.   I detta arbete undersöker vi skillnader mellan golvvärme och luftvärme, där vi ser hur de olika systemen jämförs mot varandra under kontrollerade förhållanden med avseende på termisk komfort. De olika systemen som undersöks är luftvärme som är placerad under tak, luftvärme placerad under ett fönster, golvvärme som är jämnfördelad över golvet och golvvärme jämnfördelad med extra slingor under fönster. I undersökningen utförs en litteraturstudie som kommer att ligga till grund för vad ämnet för lågtemperatur innefattar samt hur de olika systemen fungerar och hur dessa kan användas som lågtemperaturssystem. Då i denna undersökningen så beaktas operativa temperaturen PMV, PPD och dragindex för att få en bra uppfattning hur den termiska komforten upplevs med avseende på golvvärme och luftvärme. Undersökningen har gett goda resultat då skillnaden i termisk komfort mellan de olika systemen har varit minimala och uppfyllt alla krav enligt BBR. Resultaten har jämförts mot tidigare gjorda undersökningar av lågtemperaturteknik och resultaten sammanfaller bra med små avvikelser. För att välja ett av de fyra systemen som har visats bättre resultat med hänsyn på termisk komfort så har golvvärme med extra slingor under fönster bevisats vara det bättre alternativet, då PMV och PPD samt drag ligger under rekommendationen för termisk komfort. / When most people spend a larger part of the day indoors, it is important to have a good thermal comfort, as the thermal comfort affects the experience that you perceive when you are at work, at home or at school. This may then affect the health if the thermal comfort does not meet the requirements. The purpose of the survey is to investigate low temperature system performance in terms of thermal comfort and if it meets the requirements. The survey uses calculation data from previously performed surveys, as the calculations are validated by comparison with other surveys. In this survey we explore the differences between floor heating and air heating, where we look at how the different systems are compared to each other under controlled conditions regarding thermal comfort. The different systems under investigation are air heating placed on the wall, air heating placed under a window, floor heating evenly distributed over the floor and floor heating that has extra loops under windows. The study will carry out a literature study that will be based on the topic of low temperature and how the different systems work and how they can be used at low temperatures. In this survey, the operating temperature PMV, PPD and DR-index are considered to get a good idea of how thermal comfort is experienced regarding floor heating or air heating. The survey has given good results, since the difference in thermal comfort between the different systems has been minimal and fulfilled all BBR requirements. The results have been compared to previous studies of low temperature technology, as the results coincide well with minor deviations. To choose one of the four systems that have been shown superior in terms of thermal comfort, floor heating with extra loops under windows has been proven to be the better option, as PMV and PPD as well as values are below the recommendation for thermal comfort.

This study try to understand which aspects were fundamental to indoor climate and how to obtain them in order to provide the best possible experience in the thermal comfort of individuals. Thus, arose the studies of Fanger, which was the seed for a new era of discoveries in the area and founded the knowledge our society have today in this globally used standards and norms. Referring to these fundamental aspects of the indoor comfort, data collection was taken in situ to show in details what was happening. This study was executed in order to demonstrate the differences between the data previous and after a process of retrofitting in dwellings built in the 60s and 70s of the century past, in the district of Tjärna Ängar, Borlänge, Sweden. The comparative results using criteria such as Predicted Mean Vote (PMV), Predicted Percentage Dissatisfied (PPD), Draft Rate (DR), air velocity, Mean Radiant Temperature (MRT), Relative Humidity (RH) and air temperature, showed an improvement in 6 of the 8 parameters analyzed. Confirming the expectation that through the retrofitting the residents will be more satisfied, obtain better quality of indoor climate comfort and also increase occupied area in these dwellings.

A depressão pós-parto (DPP), tal como o episódio depressivo maior, é uma manifestação psiquiátrica comum, caracterizada pela presença de alterações de humor, cognitivas, comportamentais, psicomotoras e vegetativas. Afeta a qualidade da interação mãe-bebê prejudicando a responsividade materna o que pode repercurtir negativamente na manutenção salutar do desenvolvimento da criança. Esta manifestação apresenta prevalência estimada entre 10 e 20%, considerando as mulheres que desenvolvem sintomas nas primeiras semanas depois do parto. As opções de tratamento incluem drogas antidepressivas e eletroconvulsoterapia (com anestesia). Porém, como ambas terapêuticas envolvem abordagens farmacológicas, há contra-indicação devido à toxidade que impediria a amamentação. Entretanto, existe uma preocupação sobre como garantir a eficácia do tratamento sem prejudicar o bebê. A Estimulação Magnética Transcraniana Repetitiva (EMTr), por ser uma técnica já consagrada quanto a eficácia antidepressiva, não toxicológica, indolor, não invasiva e bem tolerada para estimular o cérebro, parece ser uma boa alternativa de tratamento. Nos quadros depressivos em geral, são observados prejuízos substanciais a várias funções cognitivas cujas alterações cognitivas apresentadas são, em grande parte, semelhantes àquelas relacionadas a alterações do funcionamento do córtex pré-frontal. A função executiva é um dos principais domínios cognitivos afetados nos transtornos depressivos, geralmente avaliada por testes como Trail Making e o teste de Stroop. A presença de depressão em pacientes puerperais parece intensificar as alterações cognitivas, especialmente as funções associadas ao lobo frontal, além do que, também prejudicam o comportamento causando danos no funcionamento social global. No presente estudo, randomizado, controlado e duplo-cego, investigaram-se os possíveis efeitos da EMTr no funcionamento cognitivo e sua repercussão comportamental: Estimulação Magnética Transcraniana de repetição (EMTr) aplicada ao córtex prefrontal dorsolateral esquerdo (CPFDLE). Uma amostra inicial de dez pacientes com DPP foram distribuídos em dois grupos. Sete participantes de um dos grupos receberam EMTr ativa e três, do grupo controle, EMTr placebo. Os parâmetros utilizados na EMTr foram: freqüência de 5 Hz, intensidade de 120% do limiar motor, em intervalos de 10 segundos ligado e 20 segundos desligado, com 25 séries por dia (2500 pulsos), durante 20 dias (quatro semanas) com dois dias de pausa semanal. Os pacientes e os avaliadores eram cegos ao tipo de tratamento de cada grupo. A avaliação neuropsicológica se deu através de testes cognitivos relacionados às funções prejudicadas em quadros depressivos e com a área estimulada (CPFDLE). Foram também aplicadas as escalas de Adequação Social (EAS) de Weissmann e Bothwell para avaliar o comportamento funcional social global, de depressão de Hamilton, 17 itens, e de depressão pós-parto de Edinburgh. As avaliações foram realizadas em três momentos: antes do início do tratamento (T0), após 4 semanas (T2) e após 6 semanas (T3). Como principais resultados foram observadas: melhora significativa no quadro depressivo ao longo do tratamento e um melhor ajustamento comportamental no funcionamento social global geral, especialmente no contexto das relações familiares; ausência de efeitos negativos em todos os testes cognitivos após o tratamento com EMTr; desempenho superior do grupo EMTr ativa em comparação com o grupo EMTr placebo, principalmente no teste de Rey auditory Verbal Learning (RAVLT) evocação pós-interferência e tardia pós-trinta minutos, no teste Trail Making Parte A e no teste de Stroop Cores. Além disso, o melhor desempenho cognitivo observado no grupo EMTr ativa viii comparado ao grupo EMTr placebo, entre T0 e T4, foi mantido na semana 6 (T6) e por vezes até melhorou sutilmente, indicando que o efeito da estimulação mantém-se estável por, pelo menos 2 semanas após o término do tratamento. Discutem-se como possíveis fatores para esses resultados: ação local da EMTr, alteração dos níveis de alguns neurotransmissores como dopamina e serotonina, relação com a melhoria do quadro depressivo e possível efeito de aprendizado pela repetição em curto período de tempo entre as testagens. Concluí-se que, baseados em uma amostra de apenas 10 pacientes, a EMTr, no que diz respeito aos efeitos antidepressivos, no comportamento frente ao funcionamento social global e às funções cognitivas, não produziu efeitos negativos e sim, produziu alguns efeitos positivos. Esta melhora é de fundamental importância, para o bem estar da mãe e conseqüentemente para o desenvolvimento neuropsicomotor, afetivo e comportamental do bebê. Isto trará desdobramentos que poderão perdurar por toda uma vida para esta criança. Além disto, a segurança da EMT, já amplamente comprovada em outros estudos, poderá, em um futuro próximo, torná-la terapêutica de primeira escolha para este grupo de pacientes. / The postpartum depression (PPD) as the major depressive episode is a common psychiatric manifestation, characterized by the presence of mood, cognitive, behavioral, psychomotor and vegetative changes. It affects the quality of mother-infant interaction jeopardizing the maternal responsiveness, which may adversely affect the maintenance of a healthy development of children. This event presents the estimated dominance between 10 and 20%, taking into account women who develop symptoms in the first weeks after delivery. Treatment options include antidepressant drugs and electroconvulsive therapy (with anesthetic). However, as both treatments involve pharmacological approaches, there is counter-indication because of toxicity that would preclude breastfeeding. Nevertheless, there is concern about the efficiency of the treatment without causing any harm to the baby. The repetitive Transcranial Magnetic Stimulation (rTMS), as it is a technique already established for antidepressant efficacy, non-toxic, painless, non-invasive and well-tolerated to stimulate the brain, it seems to be a good alternative for treatment. For general depressive conditions, substantial damages have been noticed to several cognitive functions, in which the presented cognitive changes are, in large part, similar to those related to changes in the functioning of the pre-frontal cortex (PFC). The executive function is one of the major cognitive domains affected in depressive disorders, usually assessed by tests such as Trail Making and Stroop test. The presence of depression in puerperal patients seems to strengthen cognitive changes; especially those associated to frontal lobe functions, in addition to that, it also affects the behavior causing harm to the overall social functioning. In this study, randomized, controlled and double-blind, possible effects of rTMS in the cognitive functioning and its behavioral effect were assessed: Repetitive Transcranial Magnetic Stimulation (rTMS) applied to left-dorsum-lateral-prefrontal-cortex (LDLPC). An initial sample of ten patients with PPD was divided into two groups. Firstly, seven participants in one of the groups received active rTMS and, three, of the control group, placebo rTMS. The parameters used in rTMS were: frequency of 5 Hz, intensity of 120% of the motor threshold, at intervals of 10 seconds on and 20 seconds off, with 25 sets per day (2500 pulses), during 20 days (four weeks) with two days of rest per week. Patients and evaluators were blinded to the type of treatment for each group. The neuropsychological assessment was carried out by means of cognitive tests related to impaired functions in depressive conditions and with the stimulated area (LDLPC). Social Adjustment Scal (SAS-SR) of Weissmann & Bothwell was also applied to assess the overall social functional behavior, of Hamilton depression, 17 items, and Edinburg postpartum depression. Evaluations were performed on three occasions: before starting the treatment (T0), after 4 weeks (T2) and after 6 weeks (T3). The main results were: significant improvement regarding the depression condition throughout the treatment and a better behavioral adjustment in the general overall social functioning, especially in the context of family relationships, lack of negative effects on all cognitive tests after treatment with rTMS; superior performance of the active rTMS group compared to the placebo rTMS group, especially in the Rey Auditory Verbal Learning Test (RAVLT) post-interference and late evocation after thirty minutes in the Trail Making Test - Part A and the Colors - Stroop Test. Further, the best cognitive performance was observed in the active rTMS group compared to placebo rTMS group, between T0 and T4, was maintained at week 6 (T6) and sometimes even improved slightly, indicating that the effect of the stimulation remains stable by at least 2 x weeks after the end of the treatment. It has been discussed as possible factors for these results: local rTMS action, change in the levels of some neurotransmitters such as dopamine and serotonin, relationship with the improvement of the depressive condition and possible learning effect by repetition within a short period of time between tests. Ergo, based on a sample of only 10 patients, the rTMS, regarding antidepressant effects, the behavior compared to the overall social functioning and cognitive functions, it did not yield negative effects, however it rendered some positive effects. This improvement is of primary importance for the welfare of the mother hence to the babys neuro-psychomotor, emotional and behavioral development. This will bring further outcomes that may last for the whole life for this child. In addition, the safety of TMS, which has been already proven in other researches, may, in the near future, make it a first-choice therapy for this group of patients

Nas primeiras décadas do século XX, profissionais da área da saúde investiram em ambientes funcionais de trabalho, dando ênfase à implantação de equipamentos de alta tecnologia, sem se preocuparem com o grau de conforto proporcionado pelo ambiente físico. Trabalhos científicos nesta área classificaram esses espaços como estressantes e inadequados em razão de não observarem as carências emocionais e psicológicas dos usuários. O presente estudo avaliou a melhoria do conforto humano na Irmandade Santa Casa de Valinhos/SP-Brasil, proporcionado pela requalificação de áreas verdes existentes entre as alas de internação. Para avaliar o grau de conforto térmico proporcionado por essas áreas verdes requalificadas, utilizaram-se dois modelos preditivos de conforto: o Predicted Mean Vote - PMV (FANGER, 1970) e o Predicted Percentage of Disatisfied - PPD baseado na ISO 7730 (1994) para ambientes internos. A fim de se compararem os resultados obtidos com base nos modelos preditivos à percepção subjetiva do conforto térmico dos entrevistados, foram aplicados questionários contendo questões abertas e fechadas que possibilitaram uma análise dos benefícios terapêuticos proporcionados pelas áreas verdes requalificadas. Outro instrumento utilizado, o Inventário de Sintomas de Stress de LIPP, avaliou e comparou o nível de stress entre dois grupos de funcionários (com contato e sem contato com áreas verdes). Os resultados deste estudo demonstram que os espaços verdes requalificados, apesar de ainda não interferirem no grau de conforto térmico dos ambientes a eles adjacentes, cumprem um papel terapêutico na medida em que promovem maior bem-estar a todos que deles se usufruem. / In the first decades of the twentieth century, health professionals have invested into functional work environments, emphasizing the insertion of high-tech equipment and not concerned about the comfort provided by the physical environment. Scientific work in this area ranked these spaces as stressful and inappropriate in order not to observe the emotional and psychological necessities the users have. This study has evaluated the improvement of human comfort in Santa Casa de Valinhos / SP-Brazil, provided by the recovery of green areas between the internment wards at the hospital. To evaluate the thermal comfort degree provided by these recovered green areas, we have used two predictive comfort models: Predicted Mean Vote - PMV (FANGER, 1970) and Predicted Percentage of Disatisfied - PPD based on ISO 7730 (1994) for indoor environments. In order to compare the results based on predictive models to the subjective perception of the thermal comfort, questionnaires have been applied with open and closed questions which have allowed an analysis of therapeutic benefits provided by the recovered green areas. The other instrument used was Lipp Stress Symptom Inventory, which evaluated and compared the level of stress among two staff groups (with or without contact to the green areas). The results of this study have demonstrated that the recovered green spaces, while not influencing the thermal comfort degree of adjacent environments, which has a therapeutic role while promoting a greater well-being to all who enjoy them.

Tese de mestrado. Engenharia de Segurança e Higiene Ocupacionais. Faculdade de Engenharia. Universidade do Porto. 2011