Introdução: Alterações de parâmetros clinico-funcionais e parâmetros biomecânicos da marcha, são características marcantes na Doença de Parkinson (DP). Tais alterações são incapacitantes para a realização das atividades de vida diária (AVDS), pois representam um alto risco de quedas e comprometem a qualidade de vida (QV) desta população. Embora o exercício físico seja preconizado com um modelo de intervenção terapêutica eficaz para minimizar os sintomas da doença, pouco se sabe sobre os efeitos da caminhada nórdica sobre sintomas motores e não motores em pacientes com DP. Objetivo: o objetivo do presente estudo foi avaliar e comparar os efeitos de um programa de treinamento de caminhada nórdica e de caminhada livre sobre parâmetros clínico-funcionais e biomecânicos da marcha de pessoas com DP. Desenho Experimental: ensaio clínico controlado randomizado (ECR). Local da Pesquisa: Escola de Educação Física da Universidade Federal do Rio Grande do Sul e Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brasil. Métodos: Participaram deste estudo 33 voluntários, com idade acima de 50 anos, de ambos os sexos, com diagnóstico clínico de DP idiopática, com o estadiamento entre 1 a 4 na escala Hoehn e Yahr (H&Y). Voluntários com DP receberam dois tipos de intervenções: treinamento de caminhada nórdica (CN, N = 16) e caminhada livre (CL, N = 17), durante seis semanas. Com o intuito de avaliar os efeitos do treinamento, avaliações foram realizadas: Baseline: avaliação inicial pré-treinamento + préfamiliarização (T1); avaliação pós-familiarização + pré-treinamento (T2); avaliação pós-treinamento (T3). Desfechos do estudo A: Sintomas motores: estadiamento e gravidade da DP, equilíbrio (EEB), mobilidade funcional da caminhada, velocidade autosselecionada da caminhada (VAS), e índice de reabilitação (IR). Sintomas não motores: função cognitiva, sintomas depressivos e qualidade de vida. Desfechos do estudo B: Parâmetros cinemáticos (espaço-temporais e estabilidade dinâmica da caminhada) e parâmetros neuromusculares (amplitude do sinal eletromiográfico, limiar inicial e final de ativação, duração de ativação e índice de co-contração dos músculos: vasto lateral (VL), bíceps femural (BF), tibial anterior (TA) e gastrocnêmio medial (GM)). Análise Estatística: Os dados de descrição da amostra, no baseline, foram comparados aplicando-se ANOVA one-way. Os desfechos foram analisados utilizando as Equações de Estimativas Generalizadas (GEE), para a comparação entre os grupos (CN e CL) e os momentos (T1, T2 e T3). Utilizou-se um post-hoc de Bonferroni, para identificar as diferenças entre os efeitos e interações. Os dados foram apresentados em “model-based adjusted means”, e foram analisados com o software Statistical Package for the Social Sciense (SPSS) v.20.0. Adotou-se um nível de significância de α=0,05. Resultados: A intervenção proposta no presente estudo proporcionou um efeito benéfico significativo após o período de treinamento, para todos os domínios da CIF (função e estrutura corporal, atividade e relações sociais e ambientais). No estudo A, para os desfechos dos sintomas motores, houve uma redução da UPDRS III (p < 0,001), aumento nos escores da EEB (p < 0,035), incremento da mobilidade funcional da caminhada por meio da redução do TUGVAS (p < 0,001), TUGVR (p < 0,001), VAS (p < 0,001) e IR (p < 0,001), bem como para os desfechos dos sintomas não motores: aumento na função cognitiva (p < 0,046), redução dos sintomas depressivos (p < 0,001), e aumento para os domínios de QV geral (p < 0,001), físico (p < 0,037), psicológico (p < 0,019), participação social (p < 0,007) e intimidade (p < 0,033), independente do grupo de treinamento. O grupo da CN apresentou melhora, estatisticamente significativa, no domínio autonomia (p < 0,001), quando comparado ao grupo da CL. No estudo B, para os desfechos cinemáticos, houve uma redução do tempo de contato tempo de contato (TC), tempo de balanço (TB), comprimento (CP) e frequência de passada (FP) para a CN quando comparada a CL (p < 0,05). Em relação aos parâmetros neuromusculares, houve um aumento na amplitude do sinal EMG do VL e BF, redução do limiar final de ativação (offset) do VL e GM (p < 0,05), redução da ativação do VL e BF (p< 0,05) e índice de co-contração do TA e GM (p < 0,05), enquanto que o grupo da CL apresentou melhoras significativas somente na amplitude do GM quando comparado ao grupo da CN. Conclusão: Conclui-se que os programas de treinamento de CN e CL, promoveram melhora sem diferença entre os grupos, em todos os domínios da funcionalidade propostos pela CIF (estrutura e função corporal, atividade e relação social, e meio ambiente), após a intervenção proposta. Entretanto, o uso de bastões através da técnica da CN em comparação ao treinamento de caminhada sem bastões (CL), mostrou vantagens na mobilidade funcional e parâmetros neuromusculares pontuais (índice de co-contração de membros inferiores, offset dos músculos TA e GM) ao mesmo tempo em que melhorou aspectos clínico-funcionais, fundamentais para a saúde e QV dos indivíduos com DP. / Introduction: Changes in clinical, functional and biomechanical parameters of gait are remarkable features in Parkinson's disease (PD). Such changes are disabling for the performance of daily living activities (DLAs) as they represent a high risk of falls and impair quality of life (QL) in this population. Although exercise is recommended as an effective model of therapeutic intervention, to minimize the symptoms of this disease, little is known about the effects of Nordic walking on motor and non-motor symptoms in patients with PD. Purpose: The aim of this study was to evaluate and compare the effects of a Nordic and free walking training program on clinical, functional and biomechanical parameters of gait, in people with PD. Experimental Design: Randomized controlled clinical trial (RCT). Study Site: Physical Education School of the Federal University of Rio Grande do Sul and the Clinical Hospital of Porto Alegre, in Porto Alegre, Rio Grande do Sul, Brazil. Methods: The sample comprised 33 participants, aged above 50 years, of both sexes, with a clinical diagnosis of idiopathic PD, with the staging of 1-4 in the Hoehn and Yahr scale (H&Y). The participants received two types of intervention: Nordic walking training program (NW, n = 16) and free walking training program (FW, n = 17), during six weeks. Aiming to evaluate the effects of the training program, the participants underwent the tests in the following period: pre-training + prefamiliarization (T1); post-familiarization + pre-training (T2); post-training (T3). Outcomes of Study A: Motor symptoms: Staging and severity of PD, balance, walking functional mobility, self selected walking velocity, and rehabilitation index. Non-Motor symptoms: Cognitive function, depressive symptoms and QL. Outcomes of Study B: Kinematic parameters (spatiotemporal and dynamic stability of walking) and neuromuscular parameters (amplitude of the EMG signal, initial and final activation threshold, activation time and co-contraction index, of the following muscles: Vastus Lateralis (VL), Biceps Femoris (BF), Tibialis Anterior (TA), Gastrocnemius Medialis (GM). Statistical Analysis: Sample characteristics, at baseline, were compared by applying the One Way ANOVA. Outcomes were analyzed using the Generalized Estimates Equations (GEE), to compare groups (NW and FW) and moments (T1, T2 and T3). The Bonferroni post-hoc was used to identify differences between effects and interactions. Data were presented in a “model-based adjusted means”, and analyzed using the Statistical Package for Social Sciences (SPSS, v.20.0) software. A significance level of α=0.05, was adopted. Results: The intervention proposed in this study provided a significant beneficial effect after the training period, for all ICF domains (body function and structure, activity, and social and environmental relations). Regarding study A, for motor symptoms outcomes, there was a reduction in UPDRS III (p < 0,001), increase in EEB scores (p < 0,035), increase in walking functional mobility through TUGVAS reduction (p < 0,001), as well as TUGVR (p < 0,001), VAS (p < 0,001) e IR (p < 0,001) reduction. For non-motor symptoms outcomes, there was an increase in cognitive function (p < 0,046), reduction of the depressive symptoms (p < 0,001), and increase in the overall QL domain (p < 0,001), as well as in the physical (p < 0,037), psychological (p < 0,019), social participation (p < 0,007) and intimacy (p < 0,033) domains, independent of the training group. The NW group showed significant improvement in the autonomy domain (p < 0,001), when compared to the FW group. Regarding study B, for kinematic outcomes, there was a reduction in contact time (CT), swing time (ST), stride length (SL) and stride frequency (FP), for NW when compared to FN (p <0.05 ). Regarding the neuromuscular parameters, an increase in the amplitude of the VL and BF EMG signal, reduction of the final activation threshold (offset) of the VL and GM (p <0.05), reduction in the activation of the VL and BF (p <0.05) and reduction in the co-contraction index of the TA and GM (p <0.05), were found for the NW group, whereas the FW group showed statistically significant improvements only on the amplitude of GM when compared to the CN group. Conclusion: The NW and FW training programs provided improvement, without difference between groups, in all functionality domains proposed by ICF (body function and structure, activity and social relationships, and environment), after the intervention. However, the use of sticks in the technique of NW compared to the free walking without the sticks (FW training), showed advantages in functional mobility and neuromuscular specific parameters (index of co-contraction of lower limbs, offset of muscles TA and GM), improving, as well, clinical and functional aspects, that are imperative to health and QL of individuals with PD.

institutochedraui@gmail.com / Objective: To assess predictors of sexual function in mid-aged women. Methods: We analyzed data of 262 healthy sexually active women (40–59 years) who filled out the Female Sexual Functioning Index (FSFI), the Menopause Rating Scale (MRS) and a general questionnaire containing female/partner data. Correlations between these two measures were also analyzed. Results: Significant inverse correlations were found between all FSFI and MRS scores. This was most evident for the MRS urogenital score in relation to FSFI total, pain and lubrication scores. Multiple linear regression analysis determined best model predicting total FSFI index scores that explained a 66% of the variance. In this model, MRS urogenital score was an important predictor of female sexual function (total FSFI scores) with a significant inverse relation. Additionally total FSFI scores displayed a significant positive correlation with female educational level and HT use and an inverse relation with partner age and female parity. Conclusion: Several female/partner factors predicted female sexual function in this mid-aged series. MRS urogenital scores significantly correlated with total FSFI scores.

Introduction and objectives Sleep disorders are one of the most common comorbidities among patients on hemodialysis. The aims of this study were to determine the prevalence of poor sleep quality as well as to establish potential factors associated with poor sleep quality. Materials and methods A cross-sectional study was performed enrolling patients with chronic kidney disease on hemodialysis. The outcome was sleep quality evaluated using the Pittsburgh Scale, whereas the exposure variables were time on hemodialysis, history of type-2 diabetes and hypertension, depressive symptoms, anemia, and uremia. We used Poisson regression model to determine the association of interest, reporting prevalence ratios (PR) and 95% confidence intervals (95%CI). Results A total of 450 patients were enrolled, 259 (57.5%) were male, aged from 18 to 97 years. The prevalence of poor sleep quality was 79.3% (95%CI: 75.6%–83.1%). Poor sleep quality was associated with depressive symptoms (PR = 1.28; 95%CI: 1.17-1.39), anemia (PR = 1.18; 95%CI: 1.04-1.34) and uremia (PR = 1.26; 95%CI: 1.17-1.36) after controlling for potential confounders. Conclusions The presence of depressive symptoms, anemia and uremia were positively associated with poor sleep quality among patients with chronic kidney disease on hemodialysis. A great proportion of this population had poor sleep quality. Strategies are needed to improve sleep quality in these patients. / brucepemar@gmail.com / Introducción y objetivos Los trastornos del sueño son una de las comorbilidades más comunes en pacientes en hemodiálisis. Los objetivos del estudio fueron determinar la prevalencia de mala calidad de sueño y establecer los potenciales factores asociados a ella. Materiales y métodos Estudio transversal analítico que enroló a pacientes con enfermedad renal crónica en hemodiálisis. La variable resultado fue calidad de sueño evaluada mediante la escala de Pittsburgh, mientras que las variables de exposición fueron el tiempo en hemodiálisis, la historia de diabetes mellitus tipo 2 y de hipertensión arterial, la presencia de sintomatología depresiva, la presencia de anemia y el compromiso urémico. Se usó el modelo de regresión de Poisson para verificar las asociaciones de interés, reportándose razones de prevalencia (RP) e intervalos de confianza al 95% (IC 95%). Resultados Fueron enrolados un total de 450 pacientes, de los cuales, 259 (57,5%) fueron varones, y con una edad entre 18 y 97 años. La prevalencia de mala calidad de sueño fue de 79,3% (IC 95%: 75,6-83,1%). Se encontró asociación significativa entre mala calidad de sueño y sintomatología depresiva (RP = 1,28; IC 95%: 1,17-1,39), anemia (RP = 1,18; IC 95%: 1,04-1,34) y compromiso urémico (RP = 1,26; IC 95%: 1,17-1,36) después de controlar por potenciales confusores. Conclusiones La presencia de sintomatología depresiva, anemia y el compromiso urémico estuvieron positivamente asociados a mala calidad de sueño en pacientes con enfermedad renal crónica en hemodiálisis. Un gran porcentaje de esta población sufre de mala calidad de sueño. Se sugiere desarrollar estrategias para mejorar la calidad de sueño en estos pacientes. / Revisión por pares

Introduktion: Beteendemässiga och psykiska symptom (BPSD) är vanligt förekommande hos personer med Alzheimers sjukdom. Det påverkar den enskilde, närstående och vårdgivare negativt. Läkemedelsbehandling ska inte ses som ett förstahandsalternativ utan fokus ska istället ligga på omvårdnadsinterventioner. Syftet var att beskriva omvårdnadsinterventioner som kan lindra beteendemässiga och psykiska symptom hos personer med Alzheimers sjukdom. Metoden var litteraturstudie där tio artiklar inkluderades efter kritisk granskning. Artiklarnas innehåll analyserades och sex kategorier med omvårdnadsinterventioner bildades: musikterapi, fysisk aktivitet, ljusterapi, kognitiv rehabilitering, terapeutiska samtal samt djurterapi. Resultatet visade att det fanns omvårdnadsinterventioner som påverkade BPSD för stunden men inget som varade över tid. Slutsats: Studien visar att det finns begränsat med forskning där omvårdnadsinterventioner ger god effekt på BPSD hos personer med Alzheimers sjukdom. / Introduction: Behavioral and Psychological Symptoms of Dementia (BPSD) are common in people with Alzheimer’s disease. This affects the individual, family members and caregivers adversely. Drug treatment should not be seen as a first choice, but the focus should instead be on nursing interventions. The aim was to describe nursing interventions that can alleviate behavioral and psychological symptoms in people with Alzheimer's disease. The method was a literature review in which ten articles after critical review were included. The contents of the articles were analyzed and six categories of nursing interventions were formed: music therapy, physical activity, light therapy, cognitive rehabilitation, therapeutic conversation and animal assisted activity. The results showed that there were nursing interventions that affected BPSD for the moment but nothing that lasted over time. Conclusion: The study shows that there is limited research in which nursing interventions gives good effect on BPSD in people with Alzheimer's disease.

Sjukdomar i hjärtats kranskärl och dess komplikationer förorsakar 23% av alla dödsfall hos kvinnor i Sverige där akut hjärtinfarkt ensam står för 6% av fallen. Atypiska och diffusa symtom är en av orsakerna till att kvinnor med hjärtinfarkt inte alltid kommer till sjukhus i tid. Syftet med denna litteraturstudie är att belysa kvinnors upplevelser av hjärtinfarkt i det akuta skedet. Vi vill även få klarhet i varför kvinnor ofta väntar med att söka vård och dessutom riskerar att inte bli tagna på allvar. Vi har valt metod i form av en litteraturstudie där vi analyserar kvalitativ forskning som bygger på nio vårdvetenskapliga artiklar. I vårt resultat kom vi fram till följande teman och subteman: Kvinnor söker inte vård i tid, Tar inte signalerna på allvar, Relaterar symtomen till andra orsaker, Vill inte var till besvär för andra och hjärtinfarkt drabbar inte mig, Något är fel i min kropp, Sökande av råd och stöd och Upplevelser av symtomen i det akuta skedet, samt Kvinnor blir inte alltid tagna på allvar, Risk för felaktig diagnos – felaktig behandling och Blir inte tagna på allvar. Vi ser det som ett stort problem att många kvinnor underskattar risken att drabbas av akut hjärtkärlsjukdom. Likaså att de vid det akuta insjuknandet relaterar sina hjärtinfarktsymtom till något annat och därför väntar med att söka medicinsk hjälp. Vår förhoppning är att kvinnor blir mer uppmärksamma på kroppens signaler och inte tvekar att söka vård om de känner sig osäkra eller oroliga. / <p>Program: Sjuksköterskeutbildning</p><p>Uppsatsnivå: C</p>

Orientador: João Eduardo Guarnetti / Banca: Luiz Gonzaga Campos Porto / Banca: Alberto de Vitta / Resumo: Apesar dos avanços da tecnologia, e a mecanização das tarefas, muitas atividades continuam sendo realizadas manualmente. A incidência de lombalgias ocupacionais causadas por sobrecarga sobre a coluna tem aumentado, pois até os dias de hoje, cargas além dos limites tolerados são manuseados e movimentadas pleo homem. O presente estudo tem como objetivo identificar posturas prejudiciais e correlacionar com possíveis queixas de desconforto músculo esquelético em trabalhadores que descarregam caminhões de melancia no CEASA de Bauru. Para a realização deste estudo foi utilizada a seguinte metodologia em 10 sujeitos que descarregavam caminhões de melancia: observação do posto de trabalho, aplicação de questionário 01, entrevista, aplicação de questionário 02 e 03, preenchimento do Diagrama de Desconforto Músculo-esquelético de Corlett (1980) e análise postural pelo método OWAS. Os resultados obtidos foram: a atividade de trabalho dos sujeitos que transportam manualmente a melancia mais prejudicial à saúde, de acordo com as observações do posto e com os questionários, foi o descarregamento do caminhão de melancia: a prevalência dos sintomas músculos esqueléticos entre os trabalhadores deste estudo foi de 100% e as regiões com maiores sintomas foram a coluna lombar, coluna cervical e joelhos; de acordo com a metodologia de análise postular, o método OWAS, foi possível observar que o trabalhador permanece 73% do tempo de durante o descarregamento do caminhão com a coluna rodada e fletida, 66% com ambos os braços acima do nível do ombro e 31% com os dois joelhos semi-flexionados diagnosticando que 52% de todas as posturas adotadas por esses trabalhadores necessitam de uma atenção imediata. Os sintomas músculos esqueléticos encontrados neste estudo apresentam indício de relação com a atividade dos profissionais decorrentes de fatores biomecânicos e organizacionais. / Abstract: Despite advances in technology, and mechanization tasks, many activities are still performed manually. The incidence of occupational back pain caused by overload on the column is increased, because even these days, beyond the limits permited loads are handled and moved by man. This study aims to identify harmful postures and correlate with possible complaints of discomfort in skeletal muscle of workers who unload trucks of watermelons in CEASA bauru. For this study the following methodology was used in 10 subjects who discharged trucks of watermelon: observations of the job, application of 01 questionnaire, interview, application of questionaries 02 and 03, complete the diagram of muscle-sekeletal discomfort of Corlett (1980) and by postural analysis method OWAS. The results were: the work activity of the subjects carrying the watermelon manually more harmful to health in accordance with the comments made and the questionnaires, was the removed watermelon of the truck, the prevalence of musculoskeletal symptoms among workers this study was 100% and regions with more symptoms were lumbar spine, cervical spine and knees, according to the methodology of postural analysis, the method OWAS was possible to observe that the worked is 73% of the time during unloading of the truck with the column and bent round, 66% with both arms avobe the shoulder and 31% with the two semi-flexed knee diagnosed that 52% of all the postures adopted by these workers need immediate attention. Musculoskeletal systems in this study show strong evidence of relationship with the activity of professionals from biomechanical and organizational factors. / Mestre

A disfunção temporomandibular (DTM) abrange vários problemas clínicos que envolvem a musculatura da mastigação, a articulação temporomandibular (ATM) e estruturas associadas, cujas características são: dor crônica, fadiga, sensibilidade nos músculos da mastigação, ruídos e limitação de movimento. Este estudo teve por objetivo verificar presença e intensidade de características clínicas como sintomas, mobilidade articular, atividade eletromiográfica e sensibilidade dolorosa nos principais músculos mastigatórios e estabilizadores cervicais, qualidade de vida e curvatura cervical de portadores de DTM miogênica, Helkimo III. Foram selecionadas para esta pesquisa 46 mulheres, divididas em dois grupos. O Grupo I, composto por 28 mulheres com DTM e média de idade de 30,1 (5,8) anos; e o Grupo II, controle, composto por 18 mulheres saudáveis com idade média de 23,4 (5,5) anos. O Grupo com DTM foi subdividido em um grupo com e um sem alteração da curvatura cervical, para verificar a relação entre a curvatura e a DTM. A intensidade dos sintomas foi avaliada por meio de escala analógica visual, a sensibilidade dolorosa com dolorímetro, a amplitude dos movimentos da mandíbula com um paquímetro, a qualidade de vida foi mensurada pelo Questionário de Qualidade de Vida SF-36 e a curvatura cervical avaliada por inspeção de radiografias. Os resultados mostraram que indivíduos com DTM, têm maior intensidade dos sintomas avaliados, sensibilidade dolorosa e atividade eletromiográfica dos músculos masseter, temporal anterior, trapézio superior e esternocleidomastoideo e qualidade de vida, estatisticamente diferentes do grupo controle (p<0,05). Não houve diferenças estatisticamente significantes na abertura da mandíbula e em relação aos sintomas, sensibilidade dolorosa e atividade eletromiográfica, das pacientes com e sem alterações da curvatura cervical (p>0,05). Foi possível concluir que, mulheres com DTM miogênica, têm maior intensidade dos sintomas avaliados, sensibilidade dolorosa e atividade eletromiográfica nos músculos mastigatórios e cervicais, pior qualidade de vida quando comparadas com mulheres saudáveis. Não foi possível estabelecer relação entre intensidade de sintomas, sensibilidade dolorosa e atividade eletromiográfica com a postura cervical destas pacientes / Temporomandibular disfunction (TMD) embraces different clinical problems which include the muscles of mastigation, temporomandibular articulation (TMA) and associated structures. Their characteristics are chronicle pain, fatigue, sensibility in the muscles of mastigation, noise, limited motion. The aim of this study is to examine the presence and intensity of clinical characteristics such as symptoms, articular mobility electromyographic activity and painful sensibility in the main muscles of mastigation and cervical stabilizer, quality of life and cervical curvature in miogenic TMD, HelKimo III carrier. For this research, there were 46 women selected. They were shared in two groups. In group 1, there were 28 women with TMD, 30,1 (5,8) years old. The group 2 control was constituted by 18 healthy women 23,4 (5,5) years old. The TMD group was subdivided in a group with cervical curvature alteration and one without it, in order to confirm the relationship between the TMD and the curvature. The intensity of the symptoms was evaluated by a visual analogic scale, to painful sensibility with a algometer, the largeness of the mandible movements with a caliper, the quality of life was measured by SF-36 Quality of Life Questionary and the cervical curvature evaluated by radiography examination. The results showed that TMD persons present severe intensity of the evaluated symptoms, painful sensibility and electromyographic activity of masseter, anterior temporal, superior trapezoid and sternocleidomastoid muscles and in statistics different quality of life from control group (p<0,05). In statistics there weren`t any signicative differences in the largeness of the mandible considering symptoms, pain sensibility and electromiographic activity in patients with and without cervical curvature alterations. It follows that miogenic TMD women present severe intensity of the evaluated symptoms, painful sensibility and electromiographic activity in the cervical and mastigation muscles, the quality of life is worse than in healthy women. It was not possible to stablish relationship between the intensity of the symptoms, aching sensibility and electromyographic activity with cervical posture in these patients

Background Dementia has been a global priority for over a decade, with a recognition that it presents a growing challenge for all those directly affected, as well as for health and social care services. For those who are caring for a relative at home, carer burden has been found to be predictive of physical and mental health problems, and can impact on the decision to place a relative in fulltime residential care. Gaining a fuller understanding of factors that impact on caregiver burden may help inform the development of effective interventions for this population. This thesis comprises a systematic review of the literature on individual behavioural and psychological symptoms of dementia (BPSD) and their impact on carer burden, a cross-sectional study of one hundred and ten dementia caregivers, exploring the impact of executive functioning deficits, and potential mediating mechanisms, on carer burden and positive gain, and a development and feasibility study of an Acceptance and Commitment Therapy (ACT) group intervention for dementia caregivers. Systematic Review Twenty-one studies measured the association between at least one individual symptom, or symptom cluster, and carer burden, and are included in the review. All studies found at least one symptom to be significantly associated with burden. However, due to the heterogeneity of studies in this field, there was insufficient evidence to establish whether any symptoms are more closely associated than others. Issues regarding the conceptualisation of burden and measurement of BPSD are highlighted and suggestions for addressing this in future studies proposed. Method One hundred and ten dementia caregivers completed five self-report questionnaires as part of a cross-sectional design, aiming to explore the role of executive functioning deficits, dementia management strategies and experiential avoidance in 2 the development of carer burden and positive gain. Drawing on these findings, a group intervention, based on ACT, was developed and delivered to twenty-three dementia caregivers. Data on attendance, attrition and qualitative feedback was collected as an indication of acceptability, and a quasi-experimental design, involving four pre, post and follow-up measures was employed to provide preliminary data on effectiveness. The measures used in both studies were the Dysexecutive Questionnaire (DEX) (study 1 only), Zarit Burden Interview (ZBI), Positive Aspects of Caregiving Questionnaire (PAC), Dementia Management Strategies Scale (DMSS) and Experiential Avoidance in Caregiving Questionnaire (EACQ). Results & Conclusions In study one, executive functioning deficits were found to account for most variance in burden. The use of negative management strategies and Active Avoidant Behaviour (a subscale of the EACQ), were also associated with higher levels of burden, while positive management strategies were associated with positive gain. The results suggest that management strategies and experiential avoidance could be potential mediating mechanisms in the development of carer burden, and so were targeted in the ACT group intervention in study two. Findings from study two indicate that the group intervention was feasible and acceptable to caregivers, with subjective change reported in understanding of behavioural changes in the care-recipient, ability to handle negative emotions and valued living. Suggestions are made regarding alternative outcome measures for future studies in order to capture participants’ experience more fully, as there was little statistically significant change in this study. Suggestions are also made regarding future directions for the intervention.

Introdução: O câncer de pulmão é a causa mais comum de morte por câncer no mundo. Objetivo: Descrever os achados clínicos ecomparar as características do câncer de pulmão em relação ao sexo, à idade e à história tabágica. Métodos: Estudo histórico com revisão de prontuários de 460 pacientes com câncer de pulmão. Resultados: A média de idade foi de 61±10 anos, sendo 359 (78%) homens. A história tabágica foi positiva em 93,7% dos pacientes. Dos 28 pacientes não tabagistas, 23 eram mulheres. Doença pulmonar obstrutiva crônica (DPOC) foi observada em 325 pacientes (70,7%) e pneumonia obstrutiva em 31,5% dos pacientes. Os principais sintomas e sinais respiratórios foram tosse, dispneia, dor torácica e hemoptise em respectivamente, 78,3%, 61,5%, 53,9% e 37,4% dos casos. Os sintomas sistêmicos mais comuns foram emagrecimento em 71,1%, anorexia em 54,1% e febre em 25,4% dos pacientes. Os tipos histológicos mais frequentes foram adenocarcinoma, carcinoma escamoso e carcinoma de células pequenas em respectivamente, 44,4%, 35% e 13,9% dos pacientes. O estádio tumoral foi IA/IB em 10% dos pacientes e IIIB/IV em 65,6% dos casos. Em 16,7% dos casos o tratamento foi cirúrgico. Dor torácica e síndrome da veia cava superior foram mais frequentes nos pacientes com menos de 50 anos. Adenocarcinoma predominou nos pacientes não tabagistas (75% vs 42,1%; p<0,01), e nas mulheres (60,4% vs 39,8%; p<0,005). Não houve diferença significativa em relação ao estádio ou tratamento quando comparados pacientes de acordo com sexo, idade e história tabágica. Conclusões: A prevalência de DPOC entre os pacientes com câncer de pulmão foi elevada. Os sintomas mais comuns foram tosse e emagrecimento e a maioria dos casos era de doença avançada. O tipo histológico mais frequente foi o adenocarcinoma, com prevalência aumentada em mulheres e não tabagistas. Sexo, idade e tabagismo não influenciaram no estadiamento e tratamento. / Introduction: Lung cancer is the most common cause of cancer death worldwide. Aim: To describe clinical findings and to compare the characteristics of lung cancer accordingto gender, age and smoking history. Methods: Retrospective chart reviewof 460 patients with lung cancer. Results: The mean age was 61 ± 10 years; 359 of the patients (78%) were men. The smoking history was positive in 93.7% of the patients. Of the 28 non-smoking patients, 23 were women. Chronic obstructive lung disease (DPOC) was found in 325 patients (70.7%) and obstructive pneumonia in 31.5% of the cases. The most frequent respiratory complains were cough, dyspnea, thoracic pain and hemoptysis in 78.3%, 61.5%, 53.9% and 37.4% of the cases, respectively. The common systemic symptoms were weight loss in 71.1%, anorexia in 54.1% and fever in 25.4%. The most frequent histological types were adenocarcinoma, squamous cell carcinoma and small cell carcinoma in 44.4%, 35% and 13.9%, respectively. The cancer staging was IA/IB in 10% and IIIB/IV in 65.6% of the patients. In 16.7% of the cases the lung cancer was treated by surgery. Thoracic pain and superior vena cava syndrome were more frequent in patients £ 50 years old. The frequency of adenocarcinoma was significantly higher in non-smokers (75% vs 42.1%; p<0.01) and in women (60.4% vs 39.8%; p<0.005). There were no differences in relationship to the cancer staging or treatment when patients were compared according to gender, age and smoking history. Conclusions: The prevalence of COPD was high among patients with lung cancer. The commonest symptoms were cough and weight loss and most of the patients had advanced disease. The most frequent histological type was adenocarcinoma, highly prevailing in non-smoking women. Cancer staging and treatment was not related to gender, age and smoking history.

Orientador: Renato Passini Junior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-11-27T12:24:46Z (GMT). No. of bitstreams: 1 Couto_EvelynRegina_D.pdf: 4555639 bytes, checksum: 07486cfe591a36481600d34a037a01b8 (MD5) Previous issue date: 2006 / Doutorado / Ciencias Biomedicas / Doutor em Tocoginecologia