A evolução da Distrofia Muscular de Duchenne (DMD) culmina na morte dos pacientes por problemas respiratórios, que aparentemente estão relacionados com a fraqueza de sua musculatura. O propósito deste estudo foi avaliar o efeito de três exercícios respiratórios de ioga na função respiratória em pacientes com DMD. A escolha dos exercícios foi motivada pelo fato de não se encontrar similares nos procedimentos fisioterápicos atuais no ocidente e por poderem ser praticados sem a necessidade de aparatos ou ajuda externa, facilitando sua execução diária. Os exercícios foram ensinados individualmente no ambulatório do Hospital das Clínicas da Universidade de São Paulo em dias regulares de consultas dos pacientes. As séries, bem como a sua progressão, levaram em consideração as limitações individuais. Foi realizada uma avaliação inicial das condições respiratórias (função pulmonar e pressões respiratórias) em 85 pacientes com idade entre 6 e 14 anos. Estas avaliações foram repetidas a cada 5 meses (em média) ao longo do treinamento. Os dados foram analisados de diferentes maneiras: pacientes que fizeram todas as avaliações ao longo de 10 meses (N=39); ao longo de 20 meses (N=18) e com os resultados dos pacientes que fizeram pelo menos uma avaliação além da inicial ao longo de 10 meses (N=70). Os grupos foram divididos por faixa etária em dois subgrupos (6 a 9 anos e 10 a 14 anos de idade). Constatou-se na análise com N=39 e N=70 que os pacientes mais novos que executaram os exercícios aplicados, apresentaram depois de 10 meses de treinamento, elevação nos valores absolutos e relativos da capacidade vital forçada (CVF), volume expiratório forçado em 1 segundo (VEF1) e pressão expiratória máxima (PEmax) e que os pacientes mais velhos, depois de 10 meses de treinamento, apresentaram melhora nos índices de pressão expiratória máxima (PEmax) em valores absolutos e relativos. Na análise com N=18 observou-se que os pacientes obtiveram melhora nos valores absolutos da função pulmonar (CVF e VEF1) até os 20 meses de treinamento quando comparamos com os valores do início e para a PEmax em valores absolutos, os resultados aumentam até 10 meses de treinamento e depois se mantém estáveis. Observou-se diminuição no declínio dos índices de função pulmonar dos pacientes quando comparados com crianças normais (porcentagem do predito). Constatou-se na análise determinada pela curva dos resultados da PEmax por faixa etária em valores relativos, que após 10 meses de prática dos exercícios de ioga, o declínio de seus valores foi retardado. O grande fator de melhora destes pacientes foi o aumento da força muscular expiratória forçada conseguido especialmente com a prática da técnica denominada kapalabhati. Recomendamos que estes exercícios sejam incorporados à prática clínica dos pacientes com DMD com a intenção de minimizar os danos causados pela perda da capacidade respiratória. / Duchenne Muscular Dystrophy (DMD) has a progression that culminates in the death of the patients for respiratory problems, which are apparently related to the weakness of the respiratory muscles. The objective of this study was to investigate the effects of three respiratory techniques of yoga in the respiratory function of patients with DMD. The selection of the exercises was conducted taking into account that there are no similar ones in the actual western physiotherapeutic procedures, and due to the fact that all of them may be practiced without the need of any apparatus or external help, making their daily practice easy. The exercises were taught individually in the Ambulatory of the General Hospital of the University of São Paulo during the regular appointments of the patients. The series of exercises, as well as their progressions, took into consideration the individual limitations. In order to establish the respiratory conditions (FVC, FEV1, PImax, and PEmax) of the group, an initial evaluation was conducted with 85 patients between 6 and 14 years old. The follow-up evaluations were carried out on an average 5-month interval, during the training period. Data were analyzed in different ways: subjects which had all the evaluations during 10 months of training (N=39); during 20 months of training (N=18) and with the results of patients that had at lest one evaluation besides the initial in the first 10 months (N=70). Furthermore, the total group was divided by age into 2 subgroups: (from 6 to 9 years old, and from 10 to 14 years old). The analysis of the groups with N=39, and N=70 revealed that, after 10 months of training, the younger subjects had increased their absolute and relative values of forced vital capacity (FVC), expiratory forced volume in 1 sec (FEV1), and maximal expiratory pressure (PEmax) , and that the older subjects, after the same period, had their absolute and relative PEmax also increased. In the analysis of the subgroup with N=18, there was an increase in the absolute values for pulmonary function (FVC and FEV1) until 20 months of training, while for PEmax this increase was seen only until 10 months, and afterwards there was a maintenance of its values. There was a reduction in the decline of the pulmonary function indexes of the patients when compared with healthy subjects (percentage of the predicted). The curve results of relative PEmax according to age revealed that after 10 months of practicing the prescribed exercises, the decline of its values was postponed. The greatest improvement in these children was found in the expiratory muscle power, attained through the practice of the technique called kapalabhati. We recommend the inclusion of these exercises to the clinical treatment of the DMD patients with the intention of minimizing the damage caused by the loss of respiratory capacity.

Orientador: Prof. Dr. Breno Arsioli Moura / Dissertação (mestrado) - Universidade Federal do ABC, Programa de Pós-Graduação em Ensino, História, Filosofia das Ciências e Matemática, Santo André, 2018. / O presente trabalho tem como objetivo explorar a contribuição do uso da História da Ciência como recurso pedagógico para a discussão de aspectos da Natureza da Ciência (NdC), por meio de dois episódios da História da Química: a teoria vital (vitalismo) e a síntese da ureia. O pensamento vitalístico pode ser encontrado desde o tempo dos gregos e postula que a vida não é meramente resultado de forças físicas e químicas, mas que estas são guiadas por meio de uma força vital intrínseca à própria vida. Algumas narrativas sugerem que, durante o século XIX, um grande debate surgiu quando Friedrich Wöhler (1800-1882) sintetizou a ureia, até então considerada uma substância orgânica, que só poderia ser produzida a partir de organismos vivos. Essa descoberta, feita no ano de 1828, tornou-se mais uma anedota que propaga a ideia de descobertas geniais da ciência, em que apenas uma pessoa foi responsável por todo o desenvolvimento de determinado conhecimento. Isso vem sendo perpetuado nas salas de aula que geralmente reproduzem uma versão simplificada e inadequada da História da Ciência. Problematizamos esses episódios no Ensino Médio por meio de uma adaptação da Abordagem Multicontextual da História da Ciência (AMHIC). A AMHIC foi originalmente desenvolvida para um contexto de formação de professores. Ao adaptar sua estrutura principal, foi possível inserir conteúdos históricos de forma contextualizada também no Ensino Médio. A proposta de ensino foi aplicada em uma turma de terceiro ano de uma escola pública no município de São Caetano do Sul. As atividades propiciaram discussões sobre o desenvolvimento da Química Orgânica, do conceito de isomeria e de aspectos da Natureza da Ciência (NdC). Após a intervenção, a análise dos dados nos permitiu concluir que os alunos atuaram ativamente no processo de ensino aprendizagem, se apropriaram dos conceitos de NdC de forma a se expressar por meio de uma visão menos ingênua da Ciência, além de terem aprimorado habilidades em relação à leitura e à escrita. / The purpose of this research is to explore the role of the History of Science as a pedagogic resource for the discussion of NOS, from the study of two episodes of History of Chemistry: the vital theory (vitalism) and the urea synthesis. Vitalistic thinking can be found since the time of the Greeks and claims that life is not merely the result of physical and chemical forces, but that they are ruled by a vital force intrinsic to life itself. Some narratives propose that during the nineteenth-century, an intense debate arose when Friedrich Wöhler (1800-1882) synthesized urea, until then a substance considered to be organic and that could only be produced from living organisms. This discovery, made in 1828, became another anecdote that propagates the idea of miraculous discoveries of science, in which only one person was responsible for the whole development of certain knowledge. This idea has been perpetuated in classrooms and textbooks, which generally reproduce a simplified and inadequate version of the History of Science. We problematized these episodes in classroom situations by adapting the Multicontextual Approach of History of Science (MCAHS). MCAHS was originally developed to be used in teacher education. By adapting its main structure, we used the idea of contextual teaching to introduce historical content also in high school classes. The teaching proposal was applied in a third grade of High School a public school in the city of São Caetano do Sul. The activities provided discussions on the development of Organic Chemistry, the concept of isomerism and aspects of the Nature of Science (NOS). After the intervention, the analysis of the data allowed us to conclude that the students had an active role in the learning process, appropriated the concepts of NOS in order to express themselves through a less naive view of Science, in addition to having improved skills in reading and writing.

The development of internet-based technologies, the design and adoption of wireless wearable and smart devices have been a growing study spot in all domains. The healthcare sector as many others is making technological progress to improve healthcare services and patients wellbeing and avoid or minimize the use of manual and traditional practices such as the use of paper notes to record the vital signs parameters data. The vital signs parameters are the most monitored physiology features, they produce a big amount of data and request a close follow up to define the health condition of a patient. Continuous vital signs monitoring involves the usage of different devices and systems, which if appropriate positively impact the activities involved, by enabling the continuous generation of data and information about the overall health status of patients and contribute to the wellbeing of individuals, in terms of preventing and reducing fatal risks. To investigate this situation, this research’s focus was in three parts; first, investigate recent research about patient’s health predictions based on vital signs parameters and the impacts of continuous monitoring on the care given. Second, explore the availability in terms of i.e. sensors used in devices that can continuously track vital signs parameters. Last, to provide a possible design recommendation to improve and/or replace the existing devices for vital signs parameters measuring and monitoring in emergency and post-operative care. A qualitative approach and participatory design approach were used to collect data. The qualitative part was achieved through interviews and the participatory design part was accomplished by the future workshop and two prototyping techniques, paper and digital prototypes. The findings of this research were analysed using conceptual analysis, and also discussed using those concepts. Together with the participants, this research resulted in three design suggestions which if implemented shall improve the vital signs continuous monitoring activities, by facilitating the healthcare professionals in their clinical responsibilities and improving the patients wellbeing while admitted in Emergency and Post-operative wards.

No description available.

Call number: LD2668 .T4 1984 R62 / Master of Arts

BACKGROUND:Heart failure is sometimes incorrectly listed as the underlying cause of death (UCD) on death certificates, thus compromising the accuracy and comparability of mortality statistics. Statistical redistribution of the UCD has been used to examine the effect of misclassification of the UCD attributed to heart failure, but sex- and race-specific redistribution of deaths on coronary heart disease (CHD) mortality in the United States has not been examined.METHODS:We used coarsened exact matching to infer the UCD of vital records with heart failure as the UCD from 1999 to 2010 for decedents 55years old and older from states encompassing regions under surveillance by the Atherosclerosis Risk in Communities (ARIC) Study (Maryland, Minnesota, Mississippi, and North Carolina). Records with heart failure as the UCD were matched on decedent characteristics (five-year age groups, sex, race, education, year of death, and state) to records with heart failure listed among the multiple causes of death. Each heart failure death was then redistributed to plausible UCDs proportional to the frequency among matched records.RESULTS:After redistribution the proportion of deaths increased for CHD, chronic obstructive pulmonary disease, diabetes, hypertensive heart disease, and cardiomyopathy, P<0.001. The percent increase in CHD mortality after redistribution was the highest in Mississippi (12%) and lowest in Maryland (1.6%), with variations by year, race, and sex. Redistribution proportions for CHD were similar to CHD death classification by a panel of expert reviewers in the ARIC study.CONCLUSIONS:Redistribution of ill-defined UCD would improve the accuracy and comparability of mortality statistics used to allocate public health resources and monitor mortality trends.

In this paper the concept of a ?human right? is analysed and clarified. Some justifications for human rights ? such as natural rights theory, contractarianism, utilitarianism and rights as vital interests ? are explored with respect to their emphasis on rights as protected choices or protected interests. Finally, a vital interests view is defended in which the rights to subsistence, security, and liberty of movement and political participation form the set of our basic rights without which we cannot enjoy our other rights.

Bakgrund: Att tidigt upptäcka symtom på allvarlig klinisk försämring hos en patient är av stor vikt för att minska lidande och förhindra allvarliga komplikationer. För detta har flera skattningsinstrument utvecklats, däribland olika early warning score-system. Dessa har implementerats på flera håll i världen men det finns indikationer på att det brister i följsamheten till dessa. Syfte: Studiens syfte var att undersöka följsamheten till Early Warning Scores samt de faktorer som påverkar följsamheten. Metod: Studien genomfördes som en litteraturöversikt där 14 vetenskapliga artiklar inkluderades. Studierna hade kvantitativa, kvalitativa och blandade ansatser. Artiklarna söktes i databaserna PubMed, CINAHL och Web of Science. En innehållsanalys av studiernas resultat genomfördes och resultatet sammanställdes i ett antal kategorier. Resultat: Följsamheten visade sig vara högre till observationer av patientens vitalparametrar än till de åtgärdsriktlinjer som finns. Faktorer som påverkar följsamheten var sjuksköterskans kliniska erfarenhet, samarbete mellan professioner, bemanning, felkalkylering, dokumentation och rapportering. Konklusion: Följsamhet till EWS brister på många sätt och flera faktorer påverkar följsamheten. Faktorerna som påverkade följsamheten är sjuksköterskans kliniska erfarenhet, samarbete mellan professioner, felkalkylering, bemanning, dokumentation och rapportering. / Background: Early recognition of serious clinical deterioration is of great importance for minimizing suffering and serious adverse events. For early recognition, several physiological track and trigger systems have been developed, among them the early warning scores. These have been implemented in many places across the world but there is uncertainty about adherence to these systems. Aim: The aim of this study was to investigate adherence to Early warning score-systems and to evaluate what factors affect this adherence. Method: The study was conducted as a literature review including 14 articles with quantitative, qualitative and mixed-methods approaches. Searches were made in the PubMed, CINAHL and Web of Science databases. Content-analysis was used to identify themes. Results: Adherence seems higher to observations than to clinical responses. The main factors affecting adherence are the clinical experience of nurses, collaboration between professions, staffing, miscalculation, documentation and reporting. Conclusion: Adherence to EWS is lacking in many ways and several causes for this have been accounted for. Factors affecting adherence was the clinical experience of nurses, cooperation between professions, staffing, miscalculation, documentation and reporting.

The objective of the present article is the approach of 2010 ECC & CPR Guidelines and their principal modifications. Guidelines are the result of scientific evidence and clinical research that support statements and new recommendations. Some important changes in 2010 present in the Chain of Survival which includes aspects of Postresuscitation Care1,2. CPR Guidelines were published and uploaded on-line (Resuscitation and Circulation publication) in October 18th, 20109,10. One of the most important training and learning strategies is the dissemination of concepts from ILCOR CPR and ECC Guidelines which had extended into ERC and AHA. This has allowed the medical personnel to treat patients victims of cardiac arrest or cardiac emergency efficiently. We are convinced that interactive methodology and clinical simulation are essential for training and learning. We cannot know cardiopulmonary resuscitation without discussion of science and performance of lively clinical scenery cases for each of the main topics in CPR and ECC / El presente artículo busca como objetivo primordial, una aproximación a las Guías 2010 y principales cambios; estamos convencidos que el entrenamiento y aprendizaje de ella se basa en los conceptos de metodología activa y simulación clínica, no podemos tener un conocimiento de la ciencia y protocolos de reanimación cardiopulmonar sin antes no haber experimentado la discusión de temas y desarrollo de casos escenarios vivenciales, para cada uno de los tópicos descritos a continuación. Una de las estrategias más importantes es la diseminación de los conceptos contenidos en las Guías ILCOR de Reanimación Cardiopulmonar que se han consensuado en la ERC y AHA. Ello ha permitido que el personal de salud trate a los pacientes victimas de paro cardiaco o emergencias cardiacas con mayor eficiencia. Las guías actuales fundamentan todos sus aspectos en investigación y recomendaciones, los cambios se iniciaron con una variación sustantiva de la cadena de supervivencia incorporando conceptos de integración de cuidados postparo1,2. Las Guías de Reanimación Cardiopulmonar fueron publicadas y puestas on-line (Resuscitation y American Heart Association) en Octubre 18, 20109,10.

Title: Comparison of respiratory function in school age children Objectives: The main aims of this study were to estimate influence of age, anthropometric measures, and a type of physical activity on forced vital capacity (FVC), and additionally to create reference values of FVC for children aged 5 to 10 years. Methods: 281 girls and 345 boys were enrolled in this cross-sectional study. Data were obtained during the sport propagation event called Sportacek 2016. Descriptive statistics and regression models were carried out in data processing. Results: Statistically significant influence of body height as well as influence of physical activity in boys' gymnastics on FVC was found. Keywords: respiration, dependence, body height, forced vital capacity