Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-19T18:00:13Z No. of bitstreams: 1 Maryjôse Carvalho Mello.pdf: 1188091 bytes, checksum: 04ca69726dabd228dc801e0754bbb389 (MD5) / Made available in DSpace on 2018-07-19T18:00:13Z (GMT). No. of bitstreams: 1 Maryjôse Carvalho Mello.pdf: 1188091 bytes, checksum: 04ca69726dabd228dc801e0754bbb389 (MD5) Previous issue date: 2017-12-18 / Asthma is a chronic inflammatory disease of the airways, such as children and adolescents. In this sense, active video games (VGA) and resistance exercise have been gaining prominence as a form of training in this age group, promoting adhesion, motivation, reduction of pulmonary inflammation, muscular strength gain and energy expenditure. Thus, the objective of this study was to evaluate whether the increase of aerobic (combined) exercise reduces a pulmonary inflammation and improves clinical control in children and adolescents as trainers more effectively than only aerobic training with VGA. This is a randomized, blinded clinical trial with no registry Clinical Trials.gov: NCT03014154, 30 children and adolescents were randomly assigned to a VGA group using XBOX 360 Kinect Adventure "Reflex Ridge" (VGA group) and unladen exercises and VGA group associated with resistance exercise (VGAR group) with intensity 3 sets of 15 repetitions, with 50% of 1 RM. The training period lasted 8 weeks and involved 2 weekly sessions of 1 hour and 10 minutes, 10 minutes. heating, 30 min. of VGA, 20 min. of exercises and 10 min. the elongation. Pulmonary inflammation, pulmonary function, peak flow, respiratory muscle strength, as anthropometric variables, clinical control questionnaires and quality of life, physical fitness and peripheral muscular strength of the participants before and after the training were evaluated. The results, involving 27 study participants (13 VGA and 14 VGAR) showed reduction in lung inflammation in both groups (clinically important) but the effect size (TE) for reduction of FeNO in the VGA group was 0 , 47 (small) and in the VGAR group was 0.68 (mean). In TCP it occurred in the test week, velocity, slope and distance traveled only in the VGA group. And in the VGAR group, improvement in physical fitness and rapid cardiovascular return to basal condition by HR recovery after the test (TE = 0.90) was higher in relation to the VGA group (TE = 0.41). Maximum load increase after 1RM test (MMSS from 2 kg to 4 kg (TE = 1,28) and MMII from 30 kg to 51 kg (TE = 1,09)) was also higher in the VGAR group. In both groups, there was improvement in quality of life and better clinical control of the disease, and no participants in both groups were not in exercise-induced bronchospasm during the sessions. These results allowed us to conclude that combined training is more effective in reducing pulmonary inflammation and allows an improvement in quality of life, clinical control of the disease, aerobic fitness, physical fitness and muscular strength in children and adolescents. / A asma é uma doença inflamatória crônica das vias aéreas, as crianças e os adolescentes asmáticos têm menor tolerância ao exercício físico. Neste sentido, os videogames ativos (VGA) e o exercício resistido vem ganhando destaque como forma de treinamento nesta faixa etária, promovendo adesão, motivação, redução da inflamação pulmonar, ganho de força muscular e gasto energético. Sendo assim, o objetivo deste estudo foi avaliar se o acréscimo do exercício resistido ao aeróbio (combinado) reduz a inflamação pulmonar e melhora o controle clínico em crianças e adolescentes asmáticos de forma mais eficaz do que apenas o treinamento aeróbio com VGA. Trata-se de um Ensaio clinico controlado, randomizado, cego, com registro no Clinical Trials.gov: NCT03014154, para tal, 30 crianças e adolescentes foram avaliados e alocados de forma randomizada, para um grupo de VGA utilizando o XBOX 360 Kinect Adventure “Reflex Ridge” (grupo VGA) e exercícios sem carga e um grupo de VGA associado a exercício resistido (grupo VGAR) com intensidade 3 séries de 15 repetições, com 50% de 1 RM. O período de treinamento durou 8 semanas e envolveu 2 sessões semanais de 1 hora e 10 minutos, sendo 10 min. de aquecimento, 30 min. de VGA, 20 min. de exercícios e 10 min. de alongamento. Foi avaliado a inflamação pulmonar, função pulmonar, peak flow, força muscular respiratória, as variáveis antropométricas, questionários de controle clinico e qualidade de vida, aptidão física e força muscular periférica dos participantes antes e após os treinamentos. Os resultados, provenientes de 27 participantes que completaram o estudo (13 VGA e 14 VGAR) mostraram redução na inflamação pulmonar em ambos os grupos (clinicamente importante) porém o tamanho do efeito (TE) para redução da FeNO no grupo VGA foi de 0,47 (pequeno) e no grupo VGAR foi de 0,68 (médio). No TCP houve aumento na duração do teste, velocidade, inclinação e distância percorrida apenas no grupo VGA. E no grupo VGAR, melhora do condicionamento físico e rápido retorno cardiovascular a condição basal pela recuperação da FC após o teste (TE=0,90) foi maior em relação ao grupo VGA (TE=0,41). O aumento da carga máxima após teste de 1RM (MMSS partindo de 2 kg para 4 kg (TE=1,28) e MMII de 30 kg para 51 kg (TE= 1,09)) também foi maior no grupo VGAR. Em ambos os grupos houve melhora da qualidade de vida e melhor controle clinico da doença, além de nenhum participante de ambos os grupos não apresentarem broncoespasmo induzido pelo exercício durante as sessões. Estes resultados permitiram concluir que o treinamento combinado é mais eficaz na redução da inflamação pulmonar e possibilita a melhora da qualidade de vida, controle clinico da doença, da aptidão aeróbia, condicionamento físico e aumenta da força muscular em crianças e adolescentes asmáticos.

Made available in DSpace on 2016-04-28T20:39:56Z (GMT). No. of bitstreams: 1 Alcides Erthal Ribeiro.pdf: 484055 bytes, checksum: 906a9faa5930593cbba6fa9ec21a158b (MD5) Previous issue date: 2008-12-11 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The asthma is one of the main causes of chronic morbidity and of mortality all over the world, especially among the children, and it has been recognized as a great problem of Public Health there are many years. The significant and growing increases of its prevalence cause concern, because the control of the asthma requests continuous care and long-term management. The present bibliographical study has had as objectives. (1) to verify and to quantify the presence of articles on asthma, published in the "Journal of Pediatrics", official organ of the Brazilian Society of Pediatrics, from 2005 to 2007, and (2) to analyze of the contents found in the articles under total vision regarding the asthmatic patient, in his/her biological psychological and social context. The articles were obtained through the web site (www.sbp.com.br) of the Brazilian Society of Pediatrics, in the link Journal of Pediatrics. The material regarding the years in study was selected using as key words: asthma and asthmatic child, not only in the title, but also in the body of the following types of article: Editorials, Special Editorials, Articles of Revision, Original Articles and Cases Reports. In the defined period 341 types articles were published, and in 39 of them the mentioned key words were found. The 39 selected articles were grouped in categories, for contextualization of the contents and for identification of possible emphases given by the authors in the proposition of the goals of the works, resulting in the following categories: diagnosis; treatment; prevalence; life quality; and environment. The quantitative analysis indicated that there is a real concern on the part of the authors, with the asthma in the childhood, demonstrated by 11,14% of the articles in the total amount of publications. The qualitative analysis indicated that the psychosomatic aspects related to the asthma in the childhood were scarcely referred and discussed. When we analyze the references of the Consensus of the Brazilian Society of Pediatrics in relation to the management of the children diseases, and of the Lipowski criteria, (we conclude that) the published articles haven t imputed due importance to the psychosomatic aspects in the asthmatic child's approach. A great challenge that we should emphasize is that the improvement of the quality of the medical service is closely related to the adaptation of the medical teaching to the modern vision of health, and in the indissolubility of the biological, psychological, social factors; environmental, habits and lifestyle in the attention to the population. It would be productive if the psychosocials aspects of each disease were introduced in a transdisciplinary way in the colloquiums and round tables in the activities curricular academic activities and in the incessant (continual/constant) medical education. With the popularization of this information, I believe that the pediatricians' interest in the search of comprehensive information regarding a holistic view of the pathologies in childhood would be fomented / A asma é uma das principais causas de morbidade crônica e de mortalidade em todo o mundo, especialmente entre as crianças, e vem sendo reconhecida como um grande problema de Saúde Pública há muitos anos. Os aumentos significantes e continuados da sua prevalência causam preocupação, pois o controle da asma requer cuidado continuado e monitoramento a longo prazo. O presente estudo bibliográfico teve como objetivos. (1) verificar e quantificar a presença de artigos sobre asma, publicados no Jornal de Pediatria , órgão oficial da Sociedade Brasileira de Pediatria, de 2005 a 2007, e (2) fazer uma análise dos conteúdos encontrados nos artigos sob olhar integral acerca do paciente asmático, em seu contexto biopsicossocial. Os artigos foram obtidos através do site (www.sbp.com.br) da Sociedade Brasileira de Pediatria, no link Jornal de Pediatria. O material referente aos anos em estudo foi selecionado utilizando como palavras chaves: asma e criança asmática, não apenas no título, mas também no corpo dos seguintes tipos de artigo: Editoriais, Editoriais Especiais, Artigos de Revisão, Artigos Originais e Relatos de Casos. No período definido, 341 tipos artigos foram publicados, e em 39 deles as palavras chaves mencionadas foram encontradas. Os 39 artigos selecionados foram agrupados em categorias, para contextualização dos conteúdos e para identificação de possíveis ênfases dadas pelos autores na proposição dos objetivos dos trabalhos, resultando nas seguintes categorias: diagnóstico; tratamento; prevalência; qualidade de vida; e meio ambiente. A análise quantitativa indicou que existe uma real preocupação, por parte dos autores com a asma na infância, demonstrada por 11,14% dos artigos do total das publicações. A análise qualitativa indicou que os aspectos psicossomáticos relativos à asma na infância foram pouco referenciados e debatidos. Ao analisarmos os referencias do Consenso da Sociedade Brasileira de Pediatria, quanto ao manejo das doenças infantis, e dos critérios de Lipowski, os artigos publicados não imputaram a devida importância aos aspectos psicossomáticos na abordagem da criança asmática. Um grande desafio que devemos ressaltar é que a melhora da qualidade do atendimento médico está intimamente relacionada com a adequação do ensino médico à visão moderna de saúde, e com a indissociabilidade dos fatores biológicos, psicológicos, sociais, ambientais, hábitos e estilo de vida na atenção à população. Seria produtivo se os aspectos psicossociais de cada doença fossem introduzidos de forma transdisciplinar nos colóquios e mesas redondas nas atividades curriculares acadêmicas e na educação médica continuada. Com a divulgação destas informações, acredito o interesse dos pediatras na busca de maiores informações a respeito de uma visão holística das patologias na infância seria fomentado

Thesis (Ph.D. in Analytic Health Sciences, Dept. of Preventive Medicine and Biometrics) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 57-59). Free to UCD Anschutz Medical Campus. Online version available via ProQuest Digital Dissertations;

Les patients psychosomatiques et ceux souffrant d’attaque de panique, ont de manifestations corporelles et de plus ils présentent une intense souffrance psychique. L’association libre se trouve interférée à cause de vécus traumatiques durant la période précoce de la constitution psychique.Phase 1A rétrospectiveLe groupe contrôle a été sélectionné à partir de 417 patients asthmatiques en cabinets extérieurs de la Division de Pneumologie de l’Hôpital des Cliniques « J. de San Martín ». A pu être établi l’association entre type d’asthme et type d’accomplissement (X2=53.42 significatif à 1 %). Pour tous les types d’asthme la probabilité la plus faible de s’améliorer correspondait aux patients discontinuant ≥ 3 jours et modifiant les doses de leur médicament. Les patients accomplissant correctement leur traitement ont 87% de probabilité d’améliorer leur trouble.Phase 1B Prospective. Patients asthmatiques en groupe de parole.Phase prospective. 33 patients asthmatiques sévères et presque fatals ont été évalués cliniquement sur un an dans un programme qui incluait le groupe de parole. Au début du groupe thérapeutique tous les patients présentaient un mauvais niveau d’observance du traitement. A la fin de l’année la proportion de patients n’accomplissant pas correctement leur traitement est descendue à 10%. L’asthme nocturne s’est vu associé aux variables de compliance et statistiquement significatif (p<0.001). L’association directe entre amélioration du spiromètre et des variables de compliance est significative (p<0.001).Phase II prospective. Patients asthmatiques en groupe Photolangage®.Dans cette phase j’ai incorporé une technique de médiation par des photos dans des groupes (dans l´Institute d´ Investigations Médicales Prof. A. Lanari) pour favoriser l’association libre, la croissance du préconscient et la symbolisation. L’approche psychologique en groupe Photolangage® pour un traitement intégral de patients asthmatiques est une variable capable d’influencer favorablement l’évolution et le pronostique de la maladie. Les patients n’ont pas eu recours aux services d’urgence ni à des hospitalisations. La souffrance psychique du patient psychosomatique est archaïque. Ils ont subi les effets d’une contenance maternelle brusquement changeante. Ils ont pu construire une identité plus autonome et dépasser les batailles de l’ambivalence.Phase III prospective. Patients atteints de crise de panique en groupePhotolangage®L’approche psychologique en groupes Photolangage® pour un traitement intégral de patients aux crises de panique a favorisée l’évolution et le pronostique de la maladie.Ces patients ont subi des châtiments, humiliations, et douleurs psychiques alors que l’appareil psychique était déjà formé et avait atteint un certain niveau de symbolisation. Ils ont pu construire un plus grand nombre de représentations préconscientes et bloquer, dépasser ou amoindrir le quantum d’angoisse insupportable. Ils ont pu établir la différence entre une situation particulière à caractéristiques mortifères et les autres, entre l’avant et le maintenant.Le groupe de Photolangage® établi la distance nécessaire pour créer les liaisons et représentations préconscientes qui favorisent la capacité de penser facilitant les processus de transcription à deux niveaux simultanés celui du groupe et celui de l’individu. Ce travail permet rencontrer le sens fondateur du symptôme. Ils ont pu construire une plus grande autonomie et ont accédé à certains niveaux d’altérité par des identifications vitales et un degré d’idéalisation possible. / Psychosomatic patients and those suffering from panic disorder have a history of medical treatments for their body ailments and they have also an intense psychological distress. This research is divided in three phases:Phase 1A retrospectiveA control group was selected from 417 asthmatic patients of the Hospital de Clinicas J. de San Martin (Buenos Aires, Argentine). It was established an association between asthma degree and type of compliance (X 2 = 53.42 significant at 1%). It was found that in all kinds of asthma, lower probability of improvement corresponds to patients who discontinued ≥ 3 days and/or or changed the dose of medication. Patients with good compliance have 87% of chance to improve and those with poor compliance only 38%.Prospective Phase 1B asthmatic word groups33 patients were evaluated with severe and almost fatal asthma for 1 year in a program that included word group. At the beginning of the therapeutic word group all patients had a bad compliance. At the end of the year, the proportion of patients who did not fulfil their treatment correctly was 10%. Nocturnal asthma is associated with compliance variables and is statistically significant (p <0.001).The direct association between improvement in spirometer and compliance variables is significant (p <0.001).Phase II prospective asthmatics patients in Photolanguage® groups.Psychological approach in Photolanguage® groups for asthma treatment is a variable able to influence favourably the evolution and prognosis of these patients as it improves compliance and favours free association, expanding preconscious and symbolization.Also they could turn a more complex psychic apparatus, and showed no emergencies or hospitalizations. The psychosomatic patient's psychic suffering began in archaic time and his mother´s continence was abruptly changing. Patients could built a more autonomous identity after many ambivalence battles.Phase III prospective. Patients with panic attack in Photolanguage® groups.The psychological approach to patients with panic disorder in Photolanguage® groups is a useful tool for the evolution and better prognosis, in addition to the necessary pharmacological indications. These patients have a history of punishment, humiliation and psychic pain, which occurred when their psychic apparatus had some level of symbolization. They showed no subsequent panic attacks without medication, unbearable anguish decreased. They could differentiate characteristics about deadly situations from those that are not and also between time before and now. A Photolanguage® group creates the necessary distance needed to create links favouring preconscious thinking ability and transcription processes. Psychic work isdone simultaneously over the group level and over their effects on the individual level.Number of preconscious representations increased, patients could build autonomy and certain otherness levels, with vital and possible identifications. Photolanguage ®produces personal work awareness (foundation sense) allowing each think and connect with their own history.

Current situation: Bronchial asthma is currently a civilization disease with a rapid increase in incidence and prevalence. The knowledge of its health, socioeconomic aspects can help us to predict, eliminate or support factors that will stabilize bronchial asthma. Subject: We have focused on the social situation of adult respondents with bronchial asthma associated with anti-asthmatic treatment. Objectives: According to the subject of research we have set partial objectives (to map out the current treatment of adult respondents with bronchial asthma, to map out the factors that cause the change of asthmatic problems from a health point of view, to map out the factors determining the change of asthmatic problems from a socio-economic point of view, to compare the importance of health and social factors within socially diverse groups of adult asthmatic patients, to identify, diagnose and monitor the use of social security for adult asthmatic patients in the Slovak Republic). Methodology: The following research methods were used - questionnaire, content analysis of documents, standardized asthma control test ACTTM. The obtained data were processed by qualitative and quantitative methods, fuzzy c-cluster analysis too. Research set: The set consisted of specifically selected 506 respondents aged 19 and over with a diagnosis of bronchial asthma in the pneumophysiologic ambulance of the Internal Clinic of the Faculty Hospital in Nitra from 1.5.2014 to 1.5.2015. Results: We have found that better socioeconomic conditions of respondent have positive impact on continuing with the treatment of bronchial asthma, with higher score in ACTTM. The stabilization of asthma getting worse by increased BMI. The cost of anti-asthmatic treatment was higher for obese respondents as well as any additional costs. We have confirmed that the socioeconomic situation of the respondent affects the healing costs of bronchial asthma. Treatment costs are positively reduced by lower age, higher education, higher income, psychical type of work. This shows in lower usage of hospitalization, sick leaves based on bronchial-asthma diagnoses. The stability of asthma is kept by older respondents by using spa treatments. It has been proven that the cost of treating bronchial asthma has increased due to several known allergens and risk factors. Because of impurities (dust, mites, moulds and feathers) there has been an increase in asthmatic complications. In addition, we experienced dyspnoea due to cold, humidity and seasonal changes in younger asthmatics who also were affected by air conditioning used mainly at work. With their knowledge and aimed elimination, asthmatic patients can achieve bronchial asthma stabilization as well as reduced treatment costs. Conclusion: Positive socioeconomic characteristics of asthma patients have a positive effect on their health status - control and stabilization of asthma.

Abstract The aim of this doctoral thesis is to provide an overall description of Finnish adult asthma patients in the year 2000, including their symptoms, treatment and the resulting costs. The implementation of treatment was evaluated from the perspective adopted in the National Asthma Programme 1994–2004. The research was based on questionnaire data acquired from a sample extracted from the Finnish Social Insurance Institution's asthma register, with which existing register data were combined, so that the eventual series comprised patients suffering from asthma and possibly other chronic obstructive pulmonary diseases. The majority of the asthma patients were women of working age. Smoking was most common among young adults (43% of the men and 35% of the women), while the number who had stopped smoking increased towards the older age groups among the men but remained constant among the women. The older age groups also had more serious asthma, more frequent cases of other chronic pulmonary and somatic illnesses, more problems in coping with everyday life and greater treatment needs than the younger patients. Early retirement for health reasons was common. More than half of the women and one in five of the men aged 65 years or over were living alone. The patients who suffered from asthma alone normally managed relatively well. Their symptoms could be kept under control with anti-inflammatory medication at a moderate overall cost, but concurrent obstructive pulmonary disease almost tripled the direct cost of asthma treatment and increased hospital costs practically five-fold. Smoking led to further expense in the case of those with asthma and obstructive pulmonary disease combined. The transfer of responsibility for asthma treatment from specialized care to the basic health care system would appear in general to be justified. Smoking and its associated chronic obstructive pulmonary diseases present a particular challenge for the management of asthma. / Tiivistelmä Tässä väitöskirjatyössä tutkittiin suomalaisen aikuisen astmapotilaan kokonaiskuva ja selvitettiin hänen oireiluaan, hoitoaan ja tästä aiheutuvia kustannuksia vuonna 2000. Astman hoidon toteutumista arvioitiin Valtakunnallinen astmaohjelma 1994–2004:n näkökulmasta. Tutkimuksessa käytettiin Kelan astmarekisteristä valtakunnallisesti poimitun potilasotoksen kyselyaineistoa rekisteritietoja siihen yhdistäen. Lopullisen tutkimusaineiston muodostivat astmaa ja sen lisäksi mahdollisesti muita pitkäaikaisia ahtauttavia keuhkosairauksia sairastavat potilaat. Enemmistö astmapotilaista oli naisia ja työikäisiä. Tupakointi oli yleisintä nuorilla aikuisilla miehillä (43 %) ja naisilla (35 %). Tupakoinnin lopettaneiden osuus suureni miehillä vanhempiin ikäryhmiin mentäessä, kun taas naisilla osuus pysyi samansuuruisena. Vanhemmissa ikäryhmissä astma oli vaikeampaa ja muu keuhko- ja somaattinen pitkäaikaissairastavuus, toimintakyvyn ongelmaisuus ja hoidon tarve nuorempia runsaampaa. Ennenaikainen eläköityminen oli yleistä. Kuusikymmentäviisi vuotta täyttäneistä ja sitä vanhemmista naisista useampi kuin joka toinen ja miehistä joka viides asui yksin. Pelkkää astmaa sairastava voi yleisesti arvioiden hyvin. Hänen oireilunsa oli hallittavissa anti-inflammatorisella lääkityksellä kohtalaisen vähäisin kokonaishoidon kustannuksin. Samanaikainen keuhkoahtaumatauti lähes kolminkertaisti astman hoidosta aiheutuneet suorat kustannukset ja lähes viisinkertaisti sairaalahoidosta aiheutuneet kustannukset. Astmaa ja keuhkoahtaumatautia sairastavilla tupakointi lisäsi edelleen kustannuksia. Astmapotilaan kokonaisuuden näkökulmasta hoidon päävastuun siirto erikoissairaanhoidosta perusterveydenhuoltoon vaikuttaa tarkoituksenmukaiselta. Tupakointi ja siihen liittyvät muut pitkäaikaiset ahtauttavat keuhkosairaudet muodostavat erityisen haasteen astman hoitojärjestelmälle.