Orientador: Laís Helena Navarro e Lima / Resumo: Introdução: A triagem e avaliação inicial de pacientes com hipovolemia são guiadas pela apresentação dos sintomas clínicos e pelas alterações nos sinais vitais. Frequência cardíaca (FC) e pressão arterial sistólica (PAS), isoladamente, nem sempre refletem com acurácia o início de quadros hipovolêmicos. Contudo, a combinação dos sinais vitais tradicionais (FC/PAS) origina o índice de choque (IC), que se postula ser indicador mais precoce de hipovolemia. Objetivo: A proposta deste estudo foi estabelecer a acurácia diagnóstica do IC para o diagnóstico inicial de hipovolemia decorrente de hemorragia, tanto em ambiente simulado, quanto em situações clínicas obstétricas. Método: Estudos transversais que incluíram dados de indivíduos adultos de qualquer idade ou sexo com suspeita de hemorragia, provenientes de estudos clínicos (obstétricos) ou simulados (doadores de sangue ou submetidos à LBNP – Low body negative pressure), que avaliaram a acurácia do IC e dos sinais vitais tradicionais (PA e FC) isolados no diagnóstico de hipovolemia foram incluídos no presente estudo. Valores considerados como hipovolêmicos foram IC > 0,7, FC > 100 bpm e/ou PAS < 100 mmHg. Obtiveram-se os estudos das seguintes bases de dados: CENTRAL, MEDLINE, EMBASE e LILACS, com os termos “shock index” e “hypovolemia” e suas variantes. Última pesquisa foi realizada em maio de 2016. A ferramenta QUADAS avaliou a qualidade metodológica. Metanálise proporcional foi realizada com variáveis dicotômicas e seus respect... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Yes / Objectives: To develop a logistic regression model to predict the risk of sepsis following emergency medical admission using the patient’s first, routinely collected, electronically recorded vital signs and blood test results and to validate this novel computer-aided risk of sepsis model, using data from another hospital. Design: Cross-sectional model development and external validation study reporting the C-statistic based on a validated optimized algorithm to identify sepsis and severe sepsis (including septic shock) from administrative hospital databases using International Classification of Diseases, 10th Edition, codes. Setting: Two acute hospitals (York Hospital - development data; Northern Lincolnshire and Goole Hospital - external validation data). Patients: Adult emergency medical admissions discharged over a 24-month period with vital signs and blood test results recorded at admission. Interventions: None. Main Results: The prevalence of sepsis and severe sepsis was lower in York Hospital (18.5% = 4,861/2,6247; 5.3% = 1,387/2,6247) than Northern Lincolnshire and Goole Hospital (25.1% = 7,773/30,996; 9.2% = 2,864/30,996). The mortality for sepsis (York Hospital: 14.5% = 704/4,861; Northern Lincolnshire and Goole Hospital: 11.6% = 899/7,773) was lower than the mortality for severe sepsis (York Hospital: 29.0% = 402/1,387; Northern Lincolnshire and Goole Hospital: 21.4% = 612/2,864). The C-statistic for computer-aided risk of sepsis in York Hospital (all sepsis 0.78; sepsis: 0.73; severe sepsis: 0.80) was similar in an external hospital setting (Northern Lincolnshire and Goole Hospital: all sepsis 0.79; sepsis: 0.70; severe sepsis: 0.81). A cutoff value of 0.2 gives reasonable performance. Conclusions: We have developed a novel, externally validated computer-aided risk of sepsis, with reasonably good performance for estimating the risk of sepsis for emergency medical admissions using the patient’s first, electronically recorded, vital signs and blood tests results. Since computer-aided risk of sepsis places no additional data collection burden on clinicians and is automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure. / Health Foundation

Accurate assessment of a child’s health is critical for appropriate allocation of medical resources and timely delivery of healthcare in both primary care (GP consultations) and secondary care (ED consultations). Serious illnesses such as meningitis and pneumonia account for 20% of deaths in childhood and require early recognition and treatment in order to maximize the chances of survival of affected children. Due to time constraints, poorly defined normal ranges, difficulty in achieving accurate readings and the difficulties faced by clinicians in interpreting combinations of vital signs, vital signs are rarely measured in primary care and their utility is limited in emergency departments. This thesis aims to develop a monitoring and data fusion system, to be used in both primary care and emergency department settings during the initial assessment of children suspected of having a serious infection. The proposed system relies on the photoplethysmogram (PPG) which is routinely recorded in different clinical settings with a pulse oximeter using a small finger probe. The most difficult vital sign to measure accurately is respiratory rate which has been found to be predictive of serious infection. An automated method is developed to estimate the respiratory rate from the PPG waveform using both the amplitude modulation caused by changes in thoracic pressure during the respiratory cycle and the phenomenon of respiratory sinus arrhythmia, the heart rate variability associated with respiration. The performance of such automated methods deteriorates when monitoring children as a result of frequent motion artefact. A method is developed that automatically identifies high-quality PPG segments mitigating the effects of motion on the estimation of respiratory rate. In the final part of the thesis, the four vital signs (heart rate, temperature, oxygen saturation and respiratory rate) are combined using a probabilistic framework to provide a novelty score for ranking various diagnostic groups, and predicting the severity of infection in two independent data sets from two different clinical settings.

Radars have been under steady development to track, identify, image, and classify targets. Modern radar systems, with the help of embedded systems, have additional comprehensive signal processing capabilities. They can extract useful information from very noisy data, e.g. interference from the environment and unwanted echoes which is collectively known as clutter in radar terms. Concerning the healthcare industry, radar applications for detection of vital signs, i.e. breathing and heart rate, have been extensively developed during the last few decades. Modern radar systems are expected to be a large part of non-intrusive monitoring in the coming smart home industry, where vital signs need to be monitored in the currently aging population. The research presented here is to break new ground in the radar-based healthcare technology, enabling detection of cold-induced shivering to such level that the micro-shivering can be clearly identified. To simplify the radar software optimization, a commercially available radar kit with demo application and a muscle model system using a vibration generator is used. The model is quantified through precise measurements. A simulated human body vital sign plus shivering is applied. By optimizing the radar software, the shivering amplitude and frequency are measured.

Made available in DSpace on 2016-04-27T18:12:09Z (GMT). No. of bitstreams: 1 Janaina de Alencar Nunes.pdf: 1200700 bytes, checksum: 9562c3ba48d89c4e421580a3a848bb23 (MD5) Previous issue date: 2015-07-07 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The feeding represents continuous challenge for the responsible ones for the nutrition of the premature (RNPT), a time that the specific alimentary techniques and the varied types of foods can affect the development, the morbidade and mortality, therefore, the OBJECTIVE of this research was to evaluate the techniques of feeding (cup and finger-feeding) used with RNPT, in relation the physiological parameters and the interaction mother and baby, by means of two complementary studies. To take care of to this proposal the thesis it was divided in two studies: 1. Physiological answers in premature babies in offer of the diet: comparison enters the techniques of cup and sounding finger-feeding, simultaneously to the breastfeeding (AM). 2. Physiological answers, level of estresse and interaction complementarily mother-baby of RNPT fed for cup and sounding finger-feeding, simultaneously to the AM. METHODS: Research approved for the committee of ethics in research, under the protocol nº. 448.410 (Brazil Platform). Study 1: One is about a simultaneous clinical assay. The sexos, interned in the Neonatal Intensive Care Unit (UTIN) of the State Public Hospital in the period of October of 2011 had been selected 25 RNPT of both the February of 2012 and that they were being suckled in the breast. The sample was divided in two groups: 8 RNPT that had received the diet in the cup (GCP) and 17 for the sounding finger-feeding (GSD). For the GCP the babies who had been born in day pair and for the GSD had been selected the ones that had been born in uneven day. During it offers of the diet had been written down the minimum and maximum values of the oxygen saturation (SatO2) and cardiac frequency (FC). Study 2: Clinical assay of the simultaneous type. Amongst 31 prematures, 19 RNPT, 9 in GCP and 10 in the GSD had been enclosed. During it offers of the diet had been written down the minimum and maximum values of SatO2 and FC. How much to the AM the contact between mother and premature was observed, aiming at to analyze the interaction enters díade in the three aspects (to hold, to look at and to touch the baby). RESULTS: Study 1 - It was observed how much the International Classification of illnesses (CID-10), SatO2 and FC had not had statistical significant difference between the groups, but when evaluating the factor time, the groups had presented some differences, not continuous in the SatO2 variable. For the weight, the main effect time only presented difference enters the beginning of the fonoaudiológicas interventions and the high one. Study 2- Bigger number of visit of the mothers of the GCP was observed. How much the relations between vital signals of the baby and presence materna, did not have statistical significant difference before enters the periods, during and after the AM between both the groups. In the relation to the interactive behaviors of díade during the AM the groups had not been observed statistical significant differences between both. In the specific evaluation of each group, it was verified that the statistical significant alteration in the state of estresse in the GCP. CONCLUSION: Study 1 In the comparison it enters the groups had not been observed significant differences how much to SatO2 and FC in the RNPT fed for the technique of the cup and sounding finger-feeding. However when evaluating the factor time, the groups had presented some differences, not continuous, that need other studies. Study 2 It did not have alterations in the vital signals and of the interactive behaviors between mother-baby, comparativily, between both the groups. Signals had been verified of estresse during only suck in the group the cup / A alimentação representa contínuo desafio para os responsáveis pela nutrição do prematuro, uma vez que as técnicas alimentares específicas e os tipos variados de alimentos podem afetar o desenvolvimento, a morbidade e a mortalidade, por isso, o OBJETIVO desta pesquisa foi avaliar as técnicas de alimentação (copo e sonda-dedo) utilizadas com RNPT, em relação a parâmetros fisiológicos e a interação mãe e bebê, por meio de dois estudos complementares. Para atender a essa proposta a tese foi dividida em dois estudos: 1. Respostas fisiológicas em bebês prematuros na oferta da dieta: comparação entre as técnicas de copo e sonda-dedo, simultaneamente ao aleitamento materno (AM). 2. Respostas fisiológicas, nível de estresse e interação mãe-bebê de RNPT alimentados complementarmente por copo e sonda-dedo, simultaneamente ao AM. MÉTODOS: Pesquisa aprovada pelo comitê de ética em pesquisa, sob o protocolo nº. 448.410 (Plataforma Brasil). Estudo 1: trata-se de um ensaio clínico simultâneo. Foram selecionados 25 RNPT de ambos os sexos, internados na Unidade de Terapia Intensiva Neonatal (UTIN) do Hospital Público Estadual no período de outubro de 2011 a fevereiro de 2012 e que estavam sendo amamentados no seio materno. A amostra foi dividida em dois grupos: 8 RNPT que receberam a dieta no copo (GCP) e 17 pela sonda-dedo (GSD). Para o GCP foram selecionados os bebês que nasceram em dia par e para o GSD os que nasceram em dia ímpar. Durante a oferta da dieta foram anotados os valores mínimos e máximos da saturação de oxigênio (SatO2) e frequência cardíaca (FC). Estudo 2: Ensaio clínico do tipo simultâneo. Dentre 31 prematuros, foram incluídos 19 RNPT, 9 no GCP e 10 no GSD. Durante a oferta da dieta foram anotados os valores mínimos e máximos da SatO2 e FC. Quanto ao AM foi observado o contato entre mãe e prematuro, visando analisar a interação entre a díade nos três aspectos (segurar, olhar e tocar o bebê). RESULTADOS: Estudo 1 - Observou-se quanto a Classificação Internacional de doenças (CID-10), SatO2 e FC não houveram diferença estatisticamente significativa entre os grupos, mas ao avaliar o fator tempo, os grupos apresentaram algumas diferenças, não contínuas na variável SatO2. Para o peso, somente o efeito principal tempo apresentou diferença entre o início das intervenções fonoaudiológicas e a alta. Estudo 2 - Observou-se maior número de visita das mães do GCP. Quanto as relações entre sinais vitais do bebê e presença materna, não houve diferença estatisticamente significativa entre os períodos antes, durante e depois do AM entre ambos os grupos. Na relação aos comportamentos interativos da díade durante o AM não foram observadas diferenças estatisticamente significativas entre ambos os grupos. Na avaliação específica de cada grupo, verificou-se que a alteração estatisticamente significativa no estado de estresse no GCP. CONCLUSÃO: Estudo 1 - Na comparação entre os grupos não foram observadas diferenças significativas quanto à SatO2 e FC nos RNPT alimentados pela técnica do copo e sonda-dedo. Contudo ao avaliar o fator tempo, os grupos apresentaram algumas diferenças, não contínuas, que necessitam de outros estudos. Estudo 2 - Não houve alterações nos sinais vitais e dos comportamentos interativos entre mãe-bebê, comparativamente, entre ambos os grupos. Verificaram-se sinais de estresse durante a mamada somente no grupo copo

Orientador: Dionei Ramos / Resumo: Introdução: Estima-se que um terço da população mundial inale involuntariamente a fumaça do cigarro, o que pode causar efeitos adversos como alteração dos sinais vitais, redução da função pulmonar e aumentar o risco de desenvolvimento de doenças respiratórias crônicas como a asma. Durante a exacerbação da asma, ocorre aumento da atividade dos músculos respiratórios acessórios e abdominais, o que pode resultar em adaptações musculares e desestabilização da coluna vertebral com consequente relato de dor lombar. Objetivos: O objetivo do primeiro estudo foi avaliar os efeitos do tabagismo passivo na função pulmonar e sinais vitais e correlacionar com fatores de exposição, bem como verificar os benefícios da cessação da exposição à fumaça do cigarro; já o segundo, foi investigar a associação entre dor lombar e asma em uma grande amostra de gêmeos. Métodos: Para o primeiro estudo, 42 indivíduos foram avaliados (19 no grupo exposto e 23 no grupo controle) em relação à função pulmonar, sinais vitais e histórico de exposição à fumaça do cigarro antes e após 8 semanas a cessação da exposição. Já para o segundo estudo, a amostra foi composta de 4.808 gêmeos adultos provenientes do registro de gêmeos da Austrália e de Murcia. Todos os gêmeos responderam a perguntas sobre prevalência de dor lombar, asma e histórico tabagístico. Resultados e Conclusões: O primeiro estudo evidenciou que a CVF de tabagistas passivos está reduzida em comparação a de indivíduos que nunca fumaram se encontra. C... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: It is estimated that one third of the world population involuntarily inhale cigarette smoke, which can cause adverse effects such as changes in vital signs, reduced lung function and increase the risk of developing chronic respiratory diseases such as asthma. During exacerbation of asthma, there is increased activity of respiratory accessories and abdominal muscles, which can result in muscle adaptations and destabilization of the spine, with consequent reporting back pain. Aims: The aim of the first study was to evaluate the effects of passive smoking on lung function and vital signs and correlate with exposure factors and verify the benefits of cessation of exposure to cigarette smoke; the aim of the second was to investigate the association between low back pain and asthma in a large sample of twins. Methods: For the first study, 42 subjects were assessed (19 in the exposed group and 23 in the control group) in relation to pulmonary function, vital signs and history of exposure to cigarette smoke before and after 8 weeks of the end of exposure. For the second study, the sample consisted of 4,808 adult twins from the record of twins from Australia and Murcia. All twins answered questions about the prevalence of low back pain, asthma, and Smoking status history. Results and Conclusions: The first study showed that FVC passive smokers is reduced compared to individuals who have never smoked is. However, the FVC values presented by passive smokers in this study a... (Complete abstract click electronic access below) / Mestre

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2016-06-15T15:02:13Z No. of bitstreams: 1 Cristofe Coelho Lopes da Rocha_.pdf: 1206259 bytes, checksum: 92abbbebe733f12b9fba88483243b093 (MD5) / Made available in DSpace on 2016-06-15T15:02:13Z (GMT). No. of bitstreams: 1 Cristofe Coelho Lopes da Rocha_.pdf: 1206259 bytes, checksum: 92abbbebe733f12b9fba88483243b093 (MD5) Previous issue date: 2016-03-18 / IFRR - Instituto Federal de Educação Ciência e Tecnologia de Roraima / Pacientes com insuficiência cardíaca e sem acompanhamento médico diário podem ter os sinais fisiológicos do coração comprometidos, causando graves problemas à saúde. Esse cenário recorrente diminui a qualidade de vida do paciente resultando em readmissões hospitalares, onerando assim o sistema de saúde. Considera-se que o emprego de cuidados ubíquos, usando sensores e wearables, pode melhorar esse processo, reduzindo sensivelmente o número de readmissões em sistemas de saúde. Nesse âmbito, esse trabalho propõe o modelo UbHeart, que emprega ciência da situação para identificar possíveis problemas cardíacos. Como contribuição científica o modelo provê o monitoramento da evolução da degradação dos sinais vitais do coração do paciente, por meio da detecção de possíveis situações de complicação cardíaca. A avaliação foi realizada por meio de um cenário prático com uso de um aplicativo móvel e um conjunto de 100 dados fisiológicos agrupados em cinco intervalos para a análise de dois pacientes de 72 e 23 anos. Os resultados foram positivos quanto à aplicação do modelo UbHeart, que possibilitou a compreensão da situação de forma distinta. Foram encontrados valores de 80% de grau envolvimento dos dois pacientes em relação ao risco quando considerado a média dos sinais fisiológicos no intervalo, e de 50% e 20% para os pacientes idoso e jovem, respectivamente, quando considerado a tendência lógica dos sinais fisiológicos no intervalo. / Patient with heart failure and without daily monitoring may have heart vital signals comitted becaming inevitable their hospitalization. This recurrent scene decreases the patient's life quality, resulting in hospital readmissions generating costs to health of system. The use of ubiquitous care, using sensors and wearables, can automate this process reducing the number of hospital admissions. In this context, we are proposing a model named Ubheart, which employs situation awareness to identify possible heart problems. As a scientific contribution the proposed model monitors the possible degradation of patient's heart vital signs, using the detection of situations of cardiac complications. The evaluation was performed by means of a practical scenario with use of a mobile application and a set of physiological data 100 grouped into five intervals for analysis two patients 72 and 23 years. The results were positive and the application of UbHeart model that allowed us to understand the situation differently. They found values of 80% degree of engagement of the two patients compared to the risk when considering the average of the physiological signals in range and 50% and 20% for elderly and young patients, respectively, when considered logical tendency of physiological signals in interval.

Total quality management (TQM) approach is often used to carry out company-wide continuous quality improvement plans in manufacturing and service industries. Similarly, TQM can also play a critical role for quality management in health care. Aiming to improve health care quality, experiences showed that major problems of non-patient care, patient records and vital signs monitoring are encountered. In this study, we aim to introduce TQM for quality improvement for intensive care unit (ICU) operations, including some solutions and the prototype of quality management. And vital signs monitoring at ICU is taken as an example of process. For quality improvement of non-patient care, Health Care Quality Development Life Cycle, including (1) quality requirement analysis, (2) quality specification review, (3) quality design, (4) quality implementation, (5) quality testing, (6) quality maintaining, and (7) quality validation, is discussed. The prototype of the first three phases for quality improvement at ICU is explored. Through quality requirement analysis, non-patient care quality at ICU is defined in areas of administration, facility and environment. For quality improvement of patient records maintaining, firstly, scope of health care information systems is categorized as administrative operational system, decision support system, clinical information system, and medical information system. According to this categorization and experience, some interesting result is found. For instance, the current applications of information systems for teaching hospitals in southern Taiwan surveyed are that most applications are administrative and clinical. And the essential information of patient records used in each information system is not complete or not easily accessed. Model of the patient record maintaining is introduced and the prototype design of patient records is recommended for quality improvement of patient records maintaining at ICU. To improve quality of vital signs monitoring is one essential requirement and specification for ICU quality improvement. Effective outcome measures of vital signs monitoring and early detecting of abnormal vital signs is considered important. For quality improvement of vital signs monitoring at ICU, heart rate graphs are taken as examples in our study through the heart rate graphs monitoring. Health professionals can understand the interactions of human autonomic nervous system. By use of digitizer, the computable heart rate data is acquired from each graph and grouped into mortality and near-to-normal cases. Then spectrum form of heart rate data, describing more about heart function, is used for statistical analysis. Several control chart methods have been experimented to detect small heart rate shifts from target, cumulative sum control chart (Cusum) is adopted in our study. The observable variable is the patient¡¦s heart rate, the purpose is to check the alarms pointed out by Cusum that could be partially be ascribed to changes of heart rate trend over time, and to a shift in the monitoring process mean. From summaries of nonconformities in the Cusum charts, mortality cases obviously have more nonconformities. It is obvious that Cusum control charts of mortality cases provide diagnostic information for vital signs monitoring process. In addition, Cusum charts may also inform ICU professionals that there is a small shift of patient heart rate, a continuously increasing or decreasing heart rate, and the adjustment of sympathetic nerve and parasympathetic nerve. In those cases, some special care is needed.

Submitted by GABRIEL FAUSTINO SANTA BRIGIDA null (gabrielfaustino_gf@hotmail.com) on 2016-09-10T00:49:18Z No. of bitstreams: 1 Texto Dissertação_final.pdf: 1386372 bytes, checksum: b7a980eac33c2f79eb4ffd155d3c0ee9 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-09-13T14:03:49Z (GMT) No. of bitstreams: 1 brigida_gfs_me_prud.pdf: 1386372 bytes, checksum: b7a980eac33c2f79eb4ffd155d3c0ee9 (MD5) / Made available in DSpace on 2016-09-13T14:03:49Z (GMT). No. of bitstreams: 1 brigida_gfs_me_prud.pdf: 1386372 bytes, checksum: b7a980eac33c2f79eb4ffd155d3c0ee9 (MD5) Previous issue date: 2016-05-25 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Introdução: Estima-se que um terço da população mundial inale involuntariamente a fumaça do cigarro, o que pode causar efeitos adversos como alteração dos sinais vitais, redução da função pulmonar e aumentar o risco de desenvolvimento de doenças respiratórias crônicas como a asma. Durante a exacerbação da asma, ocorre aumento da atividade dos músculos respiratórios acessórios e abdominais, o que pode resultar em adaptações musculares e desestabilização da coluna vertebral com consequente relato de dor lombar. Objetivos: O objetivo do primeiro estudo foi avaliar os efeitos do tabagismo passivo na função pulmonar e sinais vitais e correlacionar com fatores de exposição, bem como verificar os benefícios da cessação da exposição à fumaça do cigarro; já o segundo, foi investigar a associação entre dor lombar e asma em uma grande amostra de gêmeos. Métodos: Para o primeiro estudo, 42 indivíduos foram avaliados (19 no grupo exposto e 23 no grupo controle) em relação à função pulmonar, sinais vitais e histórico de exposição à fumaça do cigarro antes e após 8 semanas a cessação da exposição. Já para o segundo estudo, a amostra foi composta de 4.808 gêmeos adultos provenientes do registro de gêmeos da Austrália e de Murcia. Todos os gêmeos responderam a perguntas sobre prevalência de dor lombar, asma e histórico tabagístico. Resultados e Conclusões: O primeiro estudo evidenciou que a CVF de tabagistas passivos está reduzida em comparação a de indivíduos que nunca fumaram se encontra. Contudo, os valores da CVF apresentados pelos tabagistas passivos deste estudo estão dentro da normalidade. A redução da CVF está diretamente correlacionada com a quantidade de horas por dia de exposição; e que tabagistas passivos não apresentaram alteração dos índices espirométricos e sinais vitais após oito semanas da cessação da exposição à fumaça do cigarro. O segundo estudo evidenciou que a dor lombar está associada com a asma na amostra combinada de gêmeos (incluindo gêmeos australianos e espanhóis) e na amostra de gêmeos australianos, mesmo depois do ajuste para fatores de confusão como idade, sexo, índice de massa corporal e tabagismo. Contudo, fatores genéticos e ambientais mostraram atenuar a força dessa associação quando são controlados. Adicionalmente, a prevalência da doença e exposições geográficas específicas devem ser levadas em consideração, uma vez que esses fatores também podem influenciar esta associação. / Introduction: It is estimated that one third of the world population involuntarily inhale cigarette smoke, which can cause adverse effects such as changes in vital signs, reduced lung function and increase the risk of developing chronic respiratory diseases such as asthma. During exacerbation of asthma, there is increased activity of respiratory accessories and abdominal muscles, which can result in muscle adaptations and destabilization of the spine, with consequent reporting back pain. Aims: The aim of the first study was to evaluate the effects of passive smoking on lung function and vital signs and correlate with exposure factors and verify the benefits of cessation of exposure to cigarette smoke; the aim of the second was to investigate the association between low back pain and asthma in a large sample of twins. Methods: For the first study, 42 subjects were assessed (19 in the exposed group and 23 in the control group) in relation to pulmonary function, vital signs and history of exposure to cigarette smoke before and after 8 weeks of the end of exposure. For the second study, the sample consisted of 4,808 adult twins from the record of twins from Australia and Murcia. All twins answered questions about the prevalence of low back pain, asthma, and Smoking status history. Results and Conclusions: The first study showed that FVC passive smokers is reduced compared to individuals who have never smoked is. However, the FVC values presented by passive smokers in this study are within normal limits. The reduction in FVC is directly correlated with the amount of hours per day of exposure; and passive smokers showed no change in spirometric indices and vital signs after eight weeks of the end of exposure to cigarette smoke. The second study showed that low back pain is associated with asthma in the combined sample of twins (including australian and spanish twins) and the sample of australian twins, even after adjusting for confounding factors such as age, sex, body mass index and smoking. However, genetic and environmental factors showed attenuate the strength of this association when controlled. Additionally, the prevalence of the disease and specific geographical exposures should be taken into account, since these factors can also influence this association. / FAPESP: 2014/08950-0

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2016-09-28T11:42:24Z No. of bitstreams: 2 Dissertação - Rommell Guimaraes Caixeta - 2016.pdf: 1787149 bytes, checksum: 4187153e23c73bdc540c0032c99b52d3 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-09-28T12:28:10Z (GMT) No. of bitstreams: 2 Dissertação - Rommell Guimaraes Caixeta - 2016.pdf: 1787149 bytes, checksum: 4187153e23c73bdc540c0032c99b52d3 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-09-28T12:28:10Z (GMT). No. of bitstreams: 2 Dissertação - Rommell Guimaraes Caixeta - 2016.pdf: 1787149 bytes, checksum: 4187153e23c73bdc540c0032c99b52d3 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-09-09 / The analysis of physiological variables of a patient can improve the death risk classification in Intensive Care Units(ICU) and help decision making and resource management. This work proposes a computational approach to death prediction through physiological variables analysis in ICU. Physiological variables that compounds time-series(e.g., blood pressure) are represented as Dependent Gaussian Processes(DGP). Variables that do not represent time-series (e.g., age) are used to cluster DGPs with Decision Trees. Classification is made according to a distance measure that combines Dynamic Time Warping and Kullback-Leibler divergence. The results of this approach are superior to other method already used, SAPS-I, on the considered test dataset.The results are similar to other computational methods published by the research community. The results comparing variations of the proposed method show that there is advatage in using the proposed clustering of DGPs. / A análise das variáveis fisiológicas de um paciente pode melhorar a classificação do risco de óbito de um paciente em uma Unidade de Terapia Intensiva(UTI) e auxiliar na tomada de decisões e alocação de recursos disponíveis. Este trabalho propõe uma abordagem computacional de análise de variáveis fisiológicas para previsão de óbito de pacientes em UTI. Variáveis fisiológicas que compõem séries temporais(e.g., pressão arterial) são representadas como Processos Gaussianos Dependentes(PGDs). Variáveis que não representam séries temporais(e.g., idade) são utilizadas para agrupar os PGDs com Árvores de Decisão. A classificação é feita de acordo com uma medida de distância que combina Deformação Temporal Dinâmica e divergência Kullback-Leibler. O resultado desta abordagem quanto ao desempenho de classificação é superior ao método padronizado SAPS-I já utilizado em UTI no conjunto de dados considerado para testes. O resultado é similar à outros métodos computacionais publicados pela comunidade de pesquisa. Os resultados comparando variações da abordagem proposta também mostram que há vantagem em utilizar o agrupamento de PGDs descrito.