O aumento no número de células inflamatórias, a produção anormal de citocinas pró-inflamatórias e o desequilíbrio entre a formação de radicais livres e a capacidade antioxidante geram alterações locais e sistêmicas na doença pulmonar obstrutiva crônica (DPOC), associada com disfunção e perda da massa muscular. A reabilitação pulmonar é uma modalidade de tratamento com evidência A, cujos desfechos são medidos através da melhora da capacidade de exercício físico e qualidade de vida, mas estudos recentes demonstram uma redução no estresse oxidativo induzido pelo exercício, o que potencialmente também reduziria o dano tecidual. A análise do dano de DNA em linfócitos de sangue periférico foi utilizada como possível medida de desfecho em 13 de 39 portadores de DPOC submetidos a um programa de reabilitação pulmonar (PRP) com duração de 4 meses. Todos os pacientes foram submetidos ao teste da caminhada dos seis minutos (TC6) e ao questionário de qualidade de vida Saint George (QQVSG), sendo que 13 pacientes coletaram sangue antes e depois do PRP para análise do dano de DNA pela técnica de micronúcleos. Do total de 39 portadores de DPOC, 69,23% eram do sexo masculino com idades de 63,33 ± 8,60 anos e média de VEF1 de 1,06 ± 0,55L. Após o PRP, ocorreu aumento significativo na distância percorrida no TC6 (366,84±108,42 [pré PRP] vs. 400,76±94,55 [pós PRP], p=0,001) e melhora em todos os domínios do QQVSG (Sintomas: 47,05±21,28 [pré PRP] vs. 35,28±16,92 [pós PRP], p=0,005; Atividades: 62,84±27,07 [pré PRP] vs. 56,02±24,09 [pós PRP], p=0,038; Impacto: 33,30±18,71 [pré PRP] vs. 19,97±12,11 [pós PRP], p<0,001; Total: 49,41±21,99 [pré PRP] vs. 37,61±18,96 [pós PRP], p<0,001). Quanto à avaliação do dano genético, obteve-se uma diminuição estatisticamente significativa (p=0,014) na freqüência de micronúcleos (5,53±2,14 [pré PRP] vs. 3,07±2,13 [pós PRP] ), o que não ocorreu na análise das pontes nucleoplasmáticas e buds nucleares (1,15±0,89 [pré PRP] vs. 0,76±1,01 [pós PRP], p=0,244 e 1,69±1,43 [pré PRP] vs. 1,69±2,13 [pós PRP], p=0,804, respectivamente). A redução na freqüência de micronúcleos demonstrou que o PRP não somente melhorou a qualidade de vida e o desempenho na capacidade de exercício, mas também foi capaz de reduzir o dano de DNA. / Pulmonary rehabilitation is a treatment supported by level A evidence, and its outcomes are measured by the improvement in physical exercise capacity and quality of life. The objective of this study is to investigate if pulmonary rehabilitation reduces DNA damage in peripheral blood of patients with chronic obstructive pulmonary disease. DNA damage in peripheral blood lymphocytes was used as an outcome measure in 13 of 39 patients with chronic obstructive pulmonary disease who underwent a 4-month pulmonary rehabilitation program. All patients underwent the 6- minute walk test and answered the Saint George’s respiratory questionnaire to assess quality of life. Blood was collected from 13 patients before and after pulmonary rehabilitation program to analyze DNA damage using the micronucleus technique. After pulmonary rehabilitation program, there was a significant increase in 6- minute walk distance and improvement in all the Saint George’s respiratory questionnaire domains. The evaluation of genetic damage revealed a statistically significant decrease (p = 0.014) of micronucleus frequency. No significant differences were found in the analysis of nucleoplasmic bridges or nuclear buds. The decrease of micronucleus frequency demonstrated that PRP not only improved quality of life and performance in work capacity exercises, but also reduced DNA damage.

O aumento no número de células inflamatórias, a produção anormal de citocinas pró-inflamatórias e o desequilíbrio entre a formação de radicais livres e a capacidade antioxidante geram alterações locais e sistêmicas na doença pulmonar obstrutiva crônica (DPOC), associada com disfunção e perda da massa muscular. A reabilitação pulmonar é uma modalidade de tratamento com evidência A, cujos desfechos são medidos através da melhora da capacidade de exercício físico e qualidade de vida, mas estudos recentes demonstram uma redução no estresse oxidativo induzido pelo exercício, o que potencialmente também reduziria o dano tecidual. A análise do dano de DNA em linfócitos de sangue periférico foi utilizada como possível medida de desfecho em 13 de 39 portadores de DPOC submetidos a um programa de reabilitação pulmonar (PRP) com duração de 4 meses. Todos os pacientes foram submetidos ao teste da caminhada dos seis minutos (TC6) e ao questionário de qualidade de vida Saint George (QQVSG), sendo que 13 pacientes coletaram sangue antes e depois do PRP para análise do dano de DNA pela técnica de micronúcleos. Do total de 39 portadores de DPOC, 69,23% eram do sexo masculino com idades de 63,33 ± 8,60 anos e média de VEF1 de 1,06 ± 0,55L. Após o PRP, ocorreu aumento significativo na distância percorrida no TC6 (366,84±108,42 [pré PRP] vs. 400,76±94,55 [pós PRP], p=0,001) e melhora em todos os domínios do QQVSG (Sintomas: 47,05±21,28 [pré PRP] vs. 35,28±16,92 [pós PRP], p=0,005; Atividades: 62,84±27,07 [pré PRP] vs. 56,02±24,09 [pós PRP], p=0,038; Impacto: 33,30±18,71 [pré PRP] vs. 19,97±12,11 [pós PRP], p<0,001; Total: 49,41±21,99 [pré PRP] vs. 37,61±18,96 [pós PRP], p<0,001). Quanto à avaliação do dano genético, obteve-se uma diminuição estatisticamente significativa (p=0,014) na freqüência de micronúcleos (5,53±2,14 [pré PRP] vs. 3,07±2,13 [pós PRP] ), o que não ocorreu na análise das pontes nucleoplasmáticas e buds nucleares (1,15±0,89 [pré PRP] vs. 0,76±1,01 [pós PRP], p=0,244 e 1,69±1,43 [pré PRP] vs. 1,69±2,13 [pós PRP], p=0,804, respectivamente). A redução na freqüência de micronúcleos demonstrou que o PRP não somente melhorou a qualidade de vida e o desempenho na capacidade de exercício, mas também foi capaz de reduzir o dano de DNA. / Pulmonary rehabilitation is a treatment supported by level A evidence, and its outcomes are measured by the improvement in physical exercise capacity and quality of life. The objective of this study is to investigate if pulmonary rehabilitation reduces DNA damage in peripheral blood of patients with chronic obstructive pulmonary disease. DNA damage in peripheral blood lymphocytes was used as an outcome measure in 13 of 39 patients with chronic obstructive pulmonary disease who underwent a 4-month pulmonary rehabilitation program. All patients underwent the 6- minute walk test and answered the Saint George’s respiratory questionnaire to assess quality of life. Blood was collected from 13 patients before and after pulmonary rehabilitation program to analyze DNA damage using the micronucleus technique. After pulmonary rehabilitation program, there was a significant increase in 6- minute walk distance and improvement in all the Saint George’s respiratory questionnaire domains. The evaluation of genetic damage revealed a statistically significant decrease (p = 0.014) of micronucleus frequency. No significant differences were found in the analysis of nucleoplasmic bridges or nuclear buds. The decrease of micronucleus frequency demonstrated that PRP not only improved quality of life and performance in work capacity exercises, but also reduced DNA damage.

В диссертационном исследовании рассмотрены причины спортивного травматизма, выявлены часто встречающиеся травмы в волейболе. Разработана комплексная реабилитационная программа при травмах плечевого сустава в волейболе. Сформулированы практические рекомендации, врачам – реабилитологам центров реабилитации, лечебно – профилактических учреждений, которые будут полезны в их работе. / In the dissertation research the causes of sports injuries, identified common injury in volleyball. Designed a comprehensive rehabilitation programme for injuries of the shoulder joint in volleyball. Practical recommendations are formulated, physicians – rehabilitation specialists of rehabilitation centers, medical institutions, which will be useful in their work.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-03-14T11:59:38Z No. of bitstreams: 1 Cláudia Cristina Góis.pdf: 2760317 bytes, checksum: 61e8d24264795415343fe07d9e5d2fd8 (MD5) / Made available in DSpace on 2018-03-14T11:59:39Z (GMT). No. of bitstreams: 1 Cláudia Cristina Góis.pdf: 2760317 bytes, checksum: 61e8d24264795415343fe07d9e5d2fd8 (MD5) Previous issue date: 2018-02-08 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The objective of this research was to analyze the Professional Rehabilitation Program – PRP of the county of Santana de Parnaíba as a part of a public health care policy for the worker, its representativeness and its meaning for the life of the individuals served, emphasizing the approach taken by the Social Work professional as a mediator of the process, seeking to guarantee the right to health advocated by the current legislation. The goal is comprehending the meaning of professional rehabilitation/ readaptation in addition to a service directed to the care of individuals that suffers with limitations in their bodies and minds, emphasizing that the biological is a continuous part of the social.Thus, for the purposes of this study, the Professional Reahabilitation Program is inserted Within a larger context: The National Occupational Safety and Health Policy. Qualitative and quantitative research was chosen as methodology, which was carried out in three moments: 1) exploratory research, elaborated through a specific questionnaire performed with servers and immediate leadership; 2) Targeted interviews with four readapted, intentionally chosen workers; 3) Analysis of previous medical records of workers that were served by the PRP in the period from 2006 to 2016. Throughout the study, the work category appears as a trigger for analysis, whose meaning for the participating subjects goes beyond the sphere of the economic profitability’s transformation nature. Work emerges as one that gives meaning to the existence of the social being, as one who paradoxically liberates, but also oppresses. The work of the Social Service in the field of PRP was also problematic, whose main banner of struggle in the field of worker’s health is be the substitution of the traditional medical model that dissociates work from life, reinforcing individualized behaviors, where illnesses are not linked to work. This study intended to contribute to the development of new experiences with the Professional Rehabilitation Program as a possibility to include the worker in the society. A inclusion thought on the well-being and not on capital production, breaking with the idea of framing the worker to the work system and acting in the field of the right to work with dignity. Reflections that, above all, in times of regression and dismantlement of hard-won rights are necessary / Objetivou-se com a pesquisa analisar o Programa de Readaptação Profissional – PRP do município de Santana de Parnaíba como parte de uma política pública de atendimento à saúde do trabalhador, sua representatividade e seu significado para a vida dos sujeitos atendidos, enfatizando a abordagem realizada pelo profissional de Serviço Social em mediação ao processo, visando a garantia do direito à saúde preconizado pela legislação em vigor. A intenção é compreender o significado da reabilitação/readaptação profissional para além de um serviço direcionado ao atendimento de indivíduos que sofrem com diversas limitações em seus corpos e mentes, enfatizando que o biológico é um contínuo entrelaçado com o social. Dessa forma, para efeitos deste estudo, o Programa de Readaptação Profissional é inserido dentro de um contexto maior: a Política Nacional de Segurança e Saúde do Trabalhador. Foi escolhida como metodologia a pesquisa qualitativa e quantitativa, que foi realizada em três momentos: 1) pesquisa exploratória, elaborada através de questionário específico realizado com servidores e chefia imediata; 2) entrevistas específicas com quatro trabalhadores readaptados, escolhidos de forma intencional; 3) análise documental dos prontuários dos trabalhadores atendidos pelo PRP no período de 2006 a 2016. Ao longo do estudo, a categoria trabalho aparece como disparador para análise, cujo significado para os sujeitos participantes vai além da esfera da transformação da natureza, da rentabilidade econômica. O trabalho emerge como aquele que dá significado à existência do ser social, como aquele que paradoxalmente liberta, mas também oprime. Problematizou-se também a atuação do Serviço Social no campo do PRP, cuja principal bandeira de luta no campo da saúde do trabalhador deve ser a substituição do modelo médico tradicional que desvincula o trabalho da vida, que reforça condutas individualizadas, onde os adoecimentos não são vinculados ao trabalho. Pretendeu-se com esse estudo na contribuição para que novas experiências com o Programa de Readaptação Profissional constituam-se como uma possibilidade de incluir o trabalhador na sociedade. Mas uma inclusão pensada para o seu bem-estar e não uma inclusão que tenha como foco a produção do capital, rompendo com a ideia de enquadramento do trabalhador ao sistema de trabalho e atuando no campo do direito ao trabalho com dignidade. Reflexões que, sobretudo, em tempos de retrocessos e desmontes de direitos duramente conquistados, constituem-se como necessárias

La recherche de méthodes permettant de lutter contre le déconditionnement neuromusculaire à la suite par exemple d’une opération chirurgicale ou d’une immobilisation prolongée intéresse la communauté scientifique depuis de nombreuses années. Ce projet visait à proposer la technique de vibration locale (LV) comme une méthode alternative aux méthodes classiquement utilisées (e.g. vibration corps entier, stimulation électrique neuromusculaire) pour lutter contre ce déconditionnement neuromusculaire. Le premier objectif de ce travail de thèse était de déterminer les effets d’une application aigüe de LV sur la fonction neuromusculaire des muscles fléchisseurs dorsaux et extenseurs du genou de sujets sains. Nos résultats montrent une modulation de l’excitabilité du système nerveux central en réponse à l’application aigüe de LV, ce qui nous a permis d’envisager de potentielles adaptations si cette technique était utilisée de façon répétée sur plusieurs semaines. Ainsi, la seconde orientation de ce travail était d’évaluer les effets d’une application chronique (entraînement) de LV sur les propriétés fonctionnelles (force, hauteur de saut) et nerveuses (mesurées par stimulation magnétique transcrânienne) de sujets sains, jeunes et âgés. Nos résultats ont montré qu’un entraînement par LV était efficace pour améliorer les capacités fonctionnelles de ces deux populations, ces gains s’accompagnant d’adaptations nerveuses. Ces travaux nous ont alors conduits à la mise en place d’une dernière étude (en cours) à visée clinique, qui évaluait l’efficacité de LV en rééducation post-ligamentoplastie du ligament croisé antérieur du genou. / There is a need to find new methods to limit neuromuscular deconditioning that occurs after a surgery or prolonged immobilization. This thesis aimed to assess local vibration (LV) training as an alternative to methods classically used (e.g. whole body vibration, neuromuscular electrical stimulation) to fight against neuromuscular deconditioning. The first aim of this project was to determine the effects of a 30-min acute exposure to LV on the neuromuscular function of dorsiflexor and knee extensor muscles in a healthy population. Our results showed that acute LV intervention changed central nervous system excitability, allowing us to consider long-term adaptations to prolonged LV. Thus, the second aim of this thesis was to assess the effects of a chronic application (training) of LV on functional (maximal strength, squat jump performance) and neural (assessed with transcranial magnetic stimulation) properties of healthy young and old subjects. Our results showed that 4 to 8 weeks of LV increase functional capacities that were due to neural adaptations. Based on these results, an on-going study assessing the effectiveness of LV during a rehabilitation program for subjects who suffered from anterior cruciate ligament lesion has been proposed.

Nowadays there is no unified method of prevention and correction of flat feet both in children in general, as well as in young athletes. The study was focused on development and justification of rehabilitation program of flat feet in young athletes of various specializations. Based on analyzed data, we formulated actuality of the above mentioned problem, studied anatomy of foot and described pathogenesis of foot deformation. 22 young athletes aged 5-6 years were recruited for the study. Questionnaire, planthography and analysis for vertical jumps with the use of force plate were applied. We developed rehabilitation program for young athletes with flat feet with the use of rough surfaces. Effectiveness of the proposed rehabilitation was confirmed during the experimental study. Guidelines and recommendations for trainers and physical therapists were developed for inclusion of this program into training process. / На сегодняшний день одной из важных проблем является отсутствие единой методики по профилактике и коррекции плоскостопия как среди детей, так и юных спортсменов. Цель исследования – разработать и обосновать программу реабилитации плоскостопия у юных спортсменов различной спортивной специализации. На основе проанализированных данных научной литературы была сформулирована актуальность проблемы, изучена анатомия стопы, описаны причины и механизм возникновения деформации. Исследование проводилось среди 22 спортсменов различной специализации в возрасте 5-6 лет с помощью опроса, плантографии и тензоплатформы. В результате исследования была разработана программа реабилитации при плоскостопии у юных спортсменов с использованием неровных поверхностей, проведен эксперимент. По результатам работы была выявлена эффективность программы реабилитации при плоскостопии. Были разработаны методические рекомендации для тренеров и специалистов в данной области по включению предлагаемой программы реабилитации в учебно-тренировочный процесс.

Auf der Suche nach Determinanten der erfolgreichen beruflichen Integration in den allgemeinen Arbeitsmarkt wurden Teilnehmer einer Integrationsmaßnahme für psychisch beeinträchtigte Menschen bei der REHAaktiv darr GmbH sowohl qualitativ als auch quantitativ untersucht. Es handelt sich um eine prospektive Längsschnitt- bzw. Kohortenstudie. Der umfangreichere Quantitative Teil der Arbeit beinhaltet die Auswertung erhobener demographischer, psychodiagnostischer und persönlicher (Freizeit, finanzielle Situation) Daten von n=206 Maßnahmeteilnehmern bezüglich der Zielvariablen erfolgreiche berufliche Integration direkt nach der Maßnahme, nach einem halben Jahr sowie nach einem Jahr und Abbruch der Maßnahme aus gesundheitlichen Gründen sowie Anzahl krankheitsbedingter Fehlzeiten während der Maßnahmedauer. Als Prädiktoren der erfolgreichen beruflichen Integration konnten ein hohes Intelligenzniveau, ein guter Schulabschluss, das Vorhandensein eines Partners, ein mittleres bis hohes Engagement, gute Kontrollstrategien innerhalb der Stressbewältigung sowie ein höheres Einkommen zu Maßnahmebeginn gefunden werden. Die Einnahme von Medikamenten, ein höheres Alter, eine vorhandene Berufsunfähigkeit sowie eine subjektiv höhere Einschätzung der psychosomatischen Beschwerden wurden als Prädiktoren des Maßnahmeabbruchs aus gesundheitlichen Gründen identifiziert. Die Anzahl krankheitsbedingter Fehlzeiten wurde durch die beiden Prädiktoren psychosomatische Beschwerden sowie das Fehlen der Diagnose Schizophrenie, vorher gesagt. Im zweiten Teil der Arbeit erfolgte die Auswertung der qualitativen Interviews von jeweils sechs erfolgreich integrierten und sechs nicht integrierten Maßnahmeteilnehmern. Als Ergebnis konnten die generellen Bedeutungsschwerpunkte Empfundene Unterstützung durch die Mitarbeiter, fehlende berufliche Orientierung sowie die große Bedeutung der Praktika und der Seminargruppe herausgestellt werden. Individuelle Unterschiede in Bezug auf den Integrationserfolg zeigten sich bezüglich der Bedeutung der Arbeit, der Fähigkeit zur Stressbewältigung, der Selbsteinschätzung und der Einstellung zur Maßnahme. / Searching for determinants for the successful integration into the general job market, participants in a rehabilitation program for the mental handicapped carried out by REHAaktiv darr GmbH were studied qualitatively und quantitatively. This was a prospective longitudinal or cohort study. The more extensive, quantitative part of the study consists of an analysis of the demographic, psychodiagnostic and personal (leisure time, financial situation) data ascertained from n=206 participants with regard to the variable objectives of the successful integration immediately after completion of the scheme, after six months and one year as well as after dropping out of the scheme for health reasons as well as the number of days absent for health reasons during the scheme. Predictors of a successful integration are high intelligence, high school graduation, the presence of a partner, a mid to high level of commitment, good strategies of control as soon as a higher income in the beginning of the program. Medication, advanced age, vocational disability and subjectively higher assessment of the psychosomatic troubles were identified as predictors for dropping out of the scheme for health reasons. The number of absences due to illness was predicted by the predictors psychosomatic disorders as well as the absence of a diagnosis schizophrenia. The second part of the study consisted of the assessment of the qualitative interviews with six participants who were successfully integrated and six who were not. The result that emerged emphasized the amount of support from the REHAaktiv personnel “felt” by the participants, a lack of career orientation on their part as well as the great importance of the practical training and the seminar group. Individual differences with respect to the success of the integration could be attributed to the importance of work, the ability to deal with stress and mental attitude to the scheme.

Профилактика остеопороза является актуальной задачей, решение которой способно значительно улучшить показатели продолжительности и качества жизни. Проблема состоит в поиске путей повышения минеральной костной массы у женщин на начальной стадии остеопороза в период постменопаузы. Цель исследования – Нормализовать состав тела женщины в постменопаузе. В соответствии с целью была выдвинута гипотеза: предполагается, что в ходе систематической, целенаправленной работы посредством комплексного использования идеомоторных упражнений, комплекса физических упражнений, массажа и правильного питания положительно повлияет на увеличение минеральной костной массы у женщин в период менопаузы. / Prevention of osteoporosis is a very important task and is aimed to improve indices of life-span and quality of life. The main issue is to search the pathways of increasing mineral bone mass in female population at early stage of osteoporosis in menopause. The objective of the study was to normalize body composition of women in postmenopause. It was suspected that implementation of complex systematic task-orientic work with the use of ideomotor exercise, set of physical exercise, massage and nutrition will benefit for increase of bone mineral mass in postmenopausal women.