Made available in DSpace on 2015-04-14T14:48:13Z (GMT). No. of bitstreams: 1 443808.pdf: 142765 bytes, checksum: 51fd651ab3f99d1d6667f27bfbfb671b (MD5) Previous issue date: 2012-09-25 / This thesis starts from the idea of authorship in criminal law and has its main focus in the so-called theory of the domain of fact as guideline for delimitation of authorship. The hypothesis that is followed is that the theory of the domain of fact, presented by the German doctrine, does not present appropriate guidelines to define the authorship, especially in complex cases such as those practiced by business organizations. The result is a reformulation of the concept of domain of fact, in light of the onto-anthropological paradigm and overlooking the normative guidelines established by the Brazilian legislature. Accordingly, is proceeded to a theoretical and dogmatic review of the concept of authorship and their arrangements, in light of a new concept of domain of fact, overlooking the business crime and the aporias that underlie the complex social relationships that underpin. It is concluded that the concept of domain of fact, pragmatically useful, must start from the understanding of crime as relational and legal phenomenon and it should be guided by the idea of the result, as the offense to the legal interest. / A presente tese parte da ideia de autoria em direito penal e tem como foco principal a chamada teoria do dom?nio do fato, como crit?rio para delimita??o da autoria. Parte-se da hip?tese de que a teoria do dom?nio do fato, apresentada pela doutrina alem?, n?o apresenta crit?rios apropriados para delimitar a autoria, sobretudo, em casos complexos, como aqueles praticados por meio de organiza??es empresariais. Disso resulta a reformula??o do conceito de dom?nio do fato, ? luz do paradigma onto-antropol?gico e com vista aos crit?rios normativos estabelecidos pelo legislador brasileiro. Nesse sentido, procede-se a uma revis?o te?rico-dogm?tica do instituto da autoria e suas respectivas modalidades, ? luz de uma nova concep??o de dom?nio do fato, elaborada com vista ? criminalidade empresarial e ?s aporias que subjazem as complexas rela??es sociais que as sustentam. Conclui-se que um conceito de dom?nio do fato, pragmaticamente ?til, deve ter em vista a compreens?o do crime como fen?meno jur?dico relacional e se orientar pela ideia de resultado, enquanto ofensa ao bem jur?dico.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-04-22T12:11:40Z No. of bitstreams: 1 467314.pdf: 1610100 bytes, checksum: aa3bb34f2885150a63290c0e7a0dc4b5 (MD5) / Made available in DSpace on 2015-04-22T12:11:41Z (GMT). No. of bitstreams: 1 467314.pdf: 1610100 bytes, checksum: aa3bb34f2885150a63290c0e7a0dc4b5 (MD5) Previous issue date: 2015-01-15 / Cigarette smoking during pregnancy has several impacts on fetal development, including teratogenic effects. The objective of this study was to assess whether the toxic substances (cotinine and polycyclic aromatic hydrocarbons) found in pregnant smokers are transmitted to their fetuses. The outcomes were analyzed measuring cotinine and 1-hydroxypyrene in the amniotic fluid and maternal urine, benzopyrene and cotinine in the umbilical cord blood.Through a controlled cross-sectional design, 125 pregnant women were selected and classified according to their smoking status: 37 current smokers, 25 passive smokers and 63 non-smokers (controls). We performed highperformance liquid chromatography to measure substances? concentrations. A post-hoc Tukey?s test was used to analyze the differences between the groups. All variables were significantly different between controls and smokers. The mean ratios between the concentration of cotinine in smokers compared to controls were as follows: 5.9 [2.5 - 13.5], p < 0.001 in the urine; 25 [11.9 - 52.9], p < 0.001 in the amniotic fluid; and 2.6 [1.0- 6.8], p = 0.044 in the umbilical cord blood.The mean ratios of 1-hydroxypyrene concentration between smokers and controls were 7.3 [1.6 - 29.6], p = 0.003 in the urine and 1.3 [1.0 - 1.7], p = 0.012 in the amniotic fluid, and of benzopyrene in umbilical cord blood was 2.9 [1.7 - 4.7], p < 0.001. There were no significant differences between controls and passive smokers. When comparing the three groups together, there were statistical differences between all variables.Thus, the fetuses of pregnant smokers are exposed to toxic and carcinogens substances. To our knowledge, this is the first study to measure 1- hydroxypyrene in the amniotic fluid and benzopyrene in umbilical cord blood by high-performance liquid chromatography when considering pregnant women in relation to smoking exposure only. / O tabagismo na gesta??o tem sido associado a in?meras altera??es, impactando em v?rias fases do desenvolvimento fetal, incluindo efeito teratog?nico. O objetivo deste estudo foi avaliar se a exposi??o materna a algumas subst?ncias t?xicas existentes na fuma?a do cigarro (cotinina, 1-hidroxipireno e benzopireno) s?o transmitidas ao feto.Atrav?s de delineamento transversal controlado, foram selecionadas 125 gestantes internadas no Centro Obst?trico do Hospital S?o Lucas da PUCRS, em Porto Alegre. As volunt?rias foram classificadas conforme seu status tab?gico: 37 tabagistas ativas, 25 tabagistas passivas e 63 n?o fumantes (controles). Foram realizadas as dosagens de cotinina e 1-hidroxipireno na urina materna e l?quido amni?tico; cotinina e benzopireno no sangue do cord?o umbilical atrav?s de cromatografia l?quida de alta efici?ncia. Para estimar a diferen?a proporcional das vari?veis assim?tricas entre os grupos utilizou-se a raz?o das m?dias (RM) e intervalo de confian?a de 95%. Para o c?lculo das diferen?as entre os grupos foi utilizado o teste post-hoc de Tukey.Todas as vari?veis estudadas apresentaram diferen?a estatisticamente significativa entre os grupos controle e tabagista. N?o foi observada diferen?a significativa entre os grupos controle e tabagista passivo. A concentra??o de cotinina foi cerca de 6 vezes maior na urina das gestantes tabagistas, RM: 5,92 [2,59 - 13,55], p<0,001 em rela??o aos controles; no l?quido amni?tico a concentra??o foi 25 vezes maior que a do grupo controle, RM: 25,09 [11,9 - 52,91], p<0,001; e no sangue do cord?o umbilical foi 2,6 vezes maior nos fetos das gestantes tabagistas, RM: 2,64 [1,02-6,84], p=0,044.A concentra??o de 1-hidroxipireno foi sete vezes maior na urina das gestantes tabagistas, quando comparadas ao grupo controle, RM: 7,3 [1,64 - 29,69], p=0,003. No l?quido amni?tico, o grupo tabagista apresentou concentra??o 30% maior que o grupo controle, RM: 1,3 [1,05 - 1,7], p=0,012. A concentra??o de benzopireno foi cerca de 3 vezes maior no sangue do cord?o umbilical dos fetos de m?es tabagistas, RM: 2,9 [1,76 - 4,79], p<0,001 quando comparadas ao grupo controle. Desse modo, conclui-se que fetos de gestantes tabagistas est?o mais expostos a subst?ncias reconhecidamente t?xicas e carcinog?nicas. Pelo nosso conhecimento, este estudo ? o primeiro que dosou o 1-hidroxipireno no l?quido amni?tico e benzopireno isolado no sangue do cord?o umbilical por cromatografia l?quida de alta efici?ncia, comparando gestantes somente em rela??o ? exposi??o ao tabagismo.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-04-23T12:39:18Z No. of bitstreams: 1 467601 - Texto Completo.pdf: 684935 bytes, checksum: 82cce47fb2c9d3e147c76b79015ba426 (MD5) / Made available in DSpace on 2015-04-23T12:39:18Z (GMT). No. of bitstreams: 1 467601 - Texto Completo.pdf: 684935 bytes, checksum: 82cce47fb2c9d3e147c76b79015ba426 (MD5) Previous issue date: 2015-02-09 / The Brazilian population aging has been a reality, occurring in unprecedented levels. This epidemiologic profile has been arousing the interest of researchers in several social, cultural and physiological changes of the elderly. Among the most common health complaints, the low back pain has been highlighted, and, it is estimated that 70% of the adults suffer from chronic or recurrent lumbar pain. Therefore, this study aims mainly to relate the degree of low back pain with the functionality of the elderly, determining the main pathologies according to gender and age group. This study was outlined in a transversal way counting on a prospective data collection with an observational feature. In addition, this research has evaluated patients above 60 years old complaining on having lumbar pain and by considering their image tests. The participants were evaluated through the following instruments: 1. Mini Mental Test, 2.The Oswestry Quiz; 3.The Lawton Instrumental Activities of Daily Living; 4.Katz Index of Independence in Activities of Daily Living, and 5. Roland-Morris Incapacity Quiz. Furthermore, the statistical analysis has described the quantitative variables by mean and standard deviation as well as the categories through absolute and relative frequencies. The association among the indexes used Spearman?s correlation, and, when comparing Oswestry Quiz with Katz Index, Mann-Whitney test was, then, utilized. The level of significance adopted was of 5% and the analyses were carried out through SPSS 21.0 program. The sample was compounded by 140 patients, however, 22 (15.7%) were excluded by cognitive deficit. Thus, this study counted on 118 patients with mean age of 67.1 years (? 5.6). Referring to the age groups, 90 (76.3%) patients were between 60-69 years old, 22 (18.6%) between 70-79 years old and 6 (5.1%) above 80 years old, while women predominated (n=92; 78%). Related to the tests, 66 (55.9%) realized X-ray, 6 (5.1%) computerized tomography and 46 (39%) magnetic resonance. When the diagnoses were evaluated by magnetic resonance, the three most prevalent ones were, respectively: arthrosis facet (80%), degenerative disc disease (75.6%) and foraminal stenosis (42.2%), considering that the patients with degenerative disc disease presented higher scores in Oswestry Quiz and lower scores in Lawton Instrumental. There was no significant difference among the prevalence of diagnosis by magnetic resonance in accordance to gender and age group. There was an inverse significant association between Oswestry score and Lawton functional score (r= -0.538; p<0.001), although the higher Oswestry values, the lower the functional capacity in IADLs was. Hence, Oswestryscores were significantly lower in patients demonstrating independence in activities of daily living, evaluated through Katz index. There was a significant direct association between Oswestry score and Roland-Morris score (r=0.720; p<0.001), while the higher the Oswestry score, the higher the Roland Morris one was.It can be concluded, then, that the low back pain seems to have impact on the functionality of the elderly; it does not seem to exist any considerable difference between the prevalence of diagnoses, within the predominant age group of this study, and the mean age of 67.5 years. Thereby, the degenerative disc disease and the foraminal stenosis seem to cause low back pain with higher correlation in relation to the decrease of the functionality of the elderly. / O envelhecimento da popula??o brasileira ? uma realidade e est? ocorrendo em n?veis sem precedentes. Este perfil epidemiol?gico vem despertando o interesse de pesquisadores em diversas altera??es sociais, culturais e fisiol?gicas do idoso. Entre as queixas m?dicas comuns aos idosos, destaca-se a lombalgia. Estima-se que 70% dos adultos sofram de dor lombar cr?nica ou recorrente. Este estudo tem como objetivo principal relacionar o grau da lombalgia com a funcionalidade do idoso, e determinar as principais patologias de acordo com a faixa et?ria e g?nero. Esse estudo foi delineado de forma transversal com coleta prospectiva de dados de car?ter observacional. A pesquisa avaliou os pacientes acima de 60 anos com queixa de dor lombar e com exames de imagem. Os participantes foram avaliados atrav?s dos seguintes instrumentos: 1. Mini Mental, 2. Question?rio de Oswestry 3. Atividades Instrumentais da Vida di?ria de Lawton 4. Escala de atividades de vida di?ria Katz 5. Question?rio de incapacidade de Roland-Morris. A an?lise estat?stica descreveu as vari?veis quantitativas por m?dia e desvio padr?o e as categ?ricas por freq??ncias absolutas e relativas. Associa??o entre as escalas utilizou o teste da correla??o de Spearman. Na compara??o entre Oswestry com a Escala de Katz o teste de Mann- Whitney foi utilizado. O n?vel de signific?ncia adotado foi de 5% e as an?lises foram realizadas no programa SPSS 21.0. A amostra foi composta por 140 pacientes, no entanto 22 (15,7%) foram exclu?dos por d?ficit cognitivo. Assim, o estudo contou com 118 pacientes com m?dia de idade de 67,1 anos (? 5,6). Quanto ?s faixas et?rias, 90 (76,3%) pacientes tinham entre 60-69 anos, 22 (18,6%) entre 70-79 anos e 6 (5,1%) acima de 80 anos. A predomin?ncia foi de mulheres (n=92; 78%). Quanto aos exames realizados, 66 (55,9%) realizaram Raio-X, 6 (5,1%) tomografia computadorizada e 46 (39%) resson?ncia magn?tica. Quando avaliados os diagn?sticos por Resson?ncia Magn?tica, os tr?s mais prevalentes foram respectivamente: artrosefacet?ria (80%), discopatia degenerativa (75,6%) e estenose foraminal (42,2%), sendo que os pacientes com discopatia degenerativa apresentaram maiores escores de Oswestry e menores de Lawton. N?o houve diferen?a significativa entre as preval?ncias de diagn?stico por Resson?ncia Magn?tica conforme g?nero e faixa et?ria. Houve associa??o inversa significativa entre o Escore de Oswestry com o escore funcional de Lawton (r=-0,538; p<0,001), sendo que quanto maior os valores de Oswestry, menor a capacidade funcional nas AIVDs. Os escores de Oswestry foram significativamente mais baixos nos pacientes com independ?ncia nas atividades de vida di?ria, avaliado pelo Katz. Houve associa??o direta significativa entre o escore de Oswestry com o de Roland Morris (r=0,720; p<0,001), sendo que quanto maior o de Oswestry, maior o de Roland Morris. Concluiu-se que a lombalgia parece ter impacto na funcionalidade dos idosos. N?o parece existir diferen?a consider?vel entre as preval?ncias de diagn?sticos dentro da faixa et?ria predominante do estudo com idade media de 67,5. A discopatia degenerativa e a estenose foraminal parecem ser as causas de lombalgia com maior correla??o em rela??o a diminui??o de funcionalidade no idoso.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-05-05T11:56:20Z No. of bitstreams: 1 467970 - Texto Completo.pdf: 1347522 bytes, checksum: 93776b58ac05be71adf68fee7381621e (MD5) / Made available in DSpace on 2015-05-05T11:56:20Z (GMT). No. of bitstreams: 1 467970 - Texto Completo.pdf: 1347522 bytes, checksum: 93776b58ac05be71adf68fee7381621e (MD5) Previous issue date: 2015-03-06 / CONTEXT : Probiotics have emerged as a promising intervention for the prevention of respiratory infections in children, according to several randomized controlled trials.OBJECTIVE : Critically assess the effect of probiotics on prevention of respiratory tract infections in children and adolescents.METHODS: Data Sources: Searches were conducted on February 24, 2014 in the following databases: MEDLINE, EMBASE, LILACS, SCIELO, CINAHL, SCOPUS, and Web of Science. The following combinations of terms were used: ?respiratory tract infections? AND probiotics. Study selection: Randomized clinical trials assessing the effect of probiotics on respiratory tract infections (RTIs) in children and adolescents were included. Studies involving children with chronic diseases or other pre-existing comorbidities and those that did not specifying the type of probiotic were excluded. Data extraction and Synthesis: Two reviewers, working independently, screened all titles and abstracts to identify studies that met the eligibility criteria. Pairwise and network analyses were performed to identify the effects of probiotics on respiratory infections. Main outcomes and Measures: Main and secondary outcomes were respiratory tract infections and adverse effects, respectively.RESULTS : Twenty-one trials with 6.603 participants were included. Direct comparison analysis suggested that Lactobacillus casei rhamnosus (LCA) was the only effective probiotic to the rate of respiratory infections compared to placebo (RR0.38; Crl 0.19-0.45). Network analysis showed that the Lactobacillus casei rhamnosus probiotic exhibited a 54.7% probability of being classified in first, while the probability of Lactobacillus fermentum CECT5716 (LFC) being last in the ranking was 15.3%. Lactobacillus casei rhamnosus showed no better effect compared to other probiotic strains by indirect analysis. CONCLUSION : This systematic review found a lack of evidence to support the effect of probiotic supplementation on the incidence rate of respiratory tract infections in children and adolescents. / INTRODU??O: Os probi?ticos ganhando espa?o como uma interven??o promissora para a preven??o de infec??es respirat?rias em crian?as e adolescentes, de acordo com v?rios ensaios cl?nicos randomizados controlados.OBJETIVOS : Avaliar criticamente o efeito de diferentes probi?ticos na preven??o de infec??es do trato respirat?rio em crian?as e adolescentes.M?TODOS : Busca dos dados: Foram realizadas buscas em 24 de fevereiro de 2014 nas seguintes bases de dados: MEDLINE, EMBASE, LILACS, SCIELO, CINAHL, Scopus e Web of Science. Foram utilizadas as seguintes combina??es de termos: ?infec??es do trato respirat?rio? e probi?ticos. Sele??o dos estudos: foram inclu?dos ensaios cl?nicos randomizados que avaliaram o efeito dos probi?ticos em infec??es do trato respirat?rio (ITR) em crian?as e adolescentes. Estudos envolvendo crian?as com doen?as cr?nicas ou outras comorbidades pr?-existentes e aqueles que n?o especificaram o tipo do probi?ticos administrado foram exclu?dos. Extra??o e s?ntese dos dados: dois revisores, trabalhando de forma independente, revisaram todos os t?tulos e resumos dos estudos para identificar estudos que preenchiam os crit?rios de elegibilidade. Foram realizadas an?lises de pares e de rede para identificar os efeitos dos probi?ticos sobre as infec??es respirat?rias. Principais desfechos: os desfechos prim?rios e secund?rios foram infec??es do trato respirat?rio e efeitos adversos, respectivamente.RESULTADOS : vinte e um ensaios com 6.603 participantes foram inclu?dos. A an?lise de compara??o direta sugeriu que o Lactobacillus casei rhamnosus (LCA) foi o ?nico probi?ticos eficaz na redu??o da incid?ncia de infec??es respirat?rias em compara??o com o placebo (RR 0,38; Crl 0,19-0,45). A an?lise de rede mostrou que o Lactobacillus casei rhamnosus apresentou probabilidade de 54,7% de estar classificado em primeiro lugar, enquanto a probabilidade do Lactobacillus fermentum CECT5716 (LFC) estar em ?ltimo lugar no ranking de efetividade foi de 15,3%. O Lactobacillus casei rhamnosus n?o apresentou melhor efeito em compara??o com outras cepas probioticas pelas an?lises indiretas. CONCLUS?O : Esta revis?o sistem?tica e meta-an?lise encontrou falta de evid?ncia para suportar o efeito da suplementa??o de probi?ticos na redu??o da incid?ncia de infec??es respirat?rias em crian?as e adolescentes.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-05-12T13:01:46Z No. of bitstreams: 1 468410 - Texto Completo.pdf: 2047741 bytes, checksum: afaf70991c827a282ac9545f01d4a085 (MD5) / Made available in DSpace on 2015-05-12T13:01:46Z (GMT). No. of bitstreams: 1 468410 - Texto Completo.pdf: 2047741 bytes, checksum: afaf70991c827a282ac9545f01d4a085 (MD5) Previous issue date: 2015-03-11 / With the increase in life expectancy there is a higher prevalence of chronic diseases and functional limitations that are common in aging. Musculoskeletal disorders (MSD?s) are in the group of chronic diseases that most affect the elderly, being characterized by pain and decrease in function. When associated with pain these disorders are among the most disabling diseases and are associated with considerable functional, psychological and social limitations. To analyze the impact of musculoskeletal diseases is important to measure the problems associated with them, like pain, emotional factors and quality of life. Therefore, the goals of this study are to measure the levels of anxiety and depression symptoms and quality of life in elderly women with chronic musculoskeletal pain and compare them with elderly women without pain, and to measure the influence of pain?s intensity in these variables. This was a cross-sectional study among women who were 60 years old or older, who were members of mothers' clubs in the city of Caxias do Sul, Brazil. The elderly women were separated into two groups, group G1 consisted of women with chronic musculoskeletal pain for over three months and group G2 consisted of women with no musculoskeletal pain for over three months.To measure anxiety symptoms, depression symptoms, quality of life and pain intensity the following instruments were used, respectively: Beck Anxiety Inventory (BAI); Beck Depression Inventory- II (BDI-II); WHOQOL-bref; and visual analogue scale (VAS). 178 elderly women participated on this research, of which four were excluded since they did not meet all the inclusion criteria. Of the 174 remaining, 95 were included in G1 and 79 in G2. The mean age was 70 years old in G1 and 70,3 years old in G2. The G1 group showed higher levels of anxiety symptoms (p<0,001) and depression symptoms (p<0,001) and worse quality of life in all domains of WHOQOL-BREF (p<0,05) when compared with group G2. The pain intensity was negatively correlated with the levels of anxiety symptoms (p<0,001) and the physical domain of the WHOQOL-BREF (p <0.05). Therefore, it is concluded that chronic musculoskeletal pain is frequent in the elderly and is associated with higher incidence of depressive and anxiety symptoms, and it also affects negatively the quality of life. It is suggested that new researches explore more deeply this relation through longitudinal studies made with different populations. / Com o aumento da expectativa de vida h? maior preval?ncia de doen?as cr?nicas e limita??es funcionais pr?prias do envelhecimento humano. As doen?as musculoesquel?ticas (ME) est?o entre as patologias cr?nicas que mais acometem idosos, sendo caracterizadas por dor e diminui??o da fun??o. Quando associadas ? dor, est?o entre as doen?as mais incapacitantes e est?o relacionadas a consider?veis limita??es funcionais, psicol?gicas e sociais. Para analisar o impacto das doen?as ME ? importante mensurar os problemas associados com elas que s?o a dor, os fatores emocionais e a qualidade de vida. Sendo assim, este estudo teve como objetivo avaliar os n?veis de sintomas de ansiedade e depress?o e a qualidade de vida em idosas com dores ME cr?nicas e comparar com idosas sem dores, como tamb?m relacionar a intensidade ?lgica com essas vari?veis. Trata-se de um estudo transversal, realizado com mulheres com 60 anos ou mais, participantes dos clubes de m?es da cidade de Caxias do Sul/RS. As idosas foram separadas em dois grupos, grupo G1 composto por mulheres com dor ME cr?nica h? mais de tr?s meses e grupo G2 composto por mulheres com aus?ncia de dor ME h? mais de tr?s meses.Para avaliar os sintomas de ansiedade foi utilizado o Invent?rio de Ansiedade de Beck (BAI), para os sintomas de depress?o o question?rio de Depress?o de Beck II (BDI-II), para a qualidade de vida o WHOQOL-bref e para avaliar a intensidade ?lgica foi utilizada a escala visual anal?gica (EVA). Participaram do estudo 178 idosas, sendo que 4 idosas foram exclu?das por n?o se adequarem em todos os crit?rios de inclus?o. Das 174 restantes, 95 foram inclusas do grupo G1 e 79 no grupo G2. A m?dia de idade do G1 foi de 70 anos e do G2 de 70,3 anos. As mulheres do G1 apresentaram n?veis mais elevados de sintomas de ansiedade (p<0,001) e depress?o (p<0,001) e pior qualidade de vida em todos os dom?nios do WHOQOL-bref que as mulheres do G2 (p<0,05). A intensidade ?lgica correlacionou-se negativamente com os n?veis de sintomas de ansiedade (p<0,001) e com o dom?nio f?sico do WHOQOL-bref (p<0,05). Conclui-se, portanto, que a dor ME cr?nica ? frequente na popula??o idosa e est? associada com maior incid?ncia de sintomas depressivos e ansiosos, al?m de afetar negativamente a qualidade de vida dos indiv?duos acometidos. Sugerem-se novas pesquisas que aprofundem esta rela??o atrav?s de estudos longitudinais e que sejam realizados com diferentes popula??es.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-10-21T17:41:25Z No. of bitstreams: 1 475831 - Texto Completo.pdf: 1316173 bytes, checksum: 64789fc45b950fe6aa4f2838868214bd (MD5) / Made available in DSpace on 2015-10-21T17:41:25Z (GMT). No. of bitstreams: 1 475831 - Texto Completo.pdf: 1316173 bytes, checksum: 64789fc45b950fe6aa4f2838868214bd (MD5) Previous issue date: 2015-08-04 / Introduction : Physical activity and martial arts have a major influence on cognitive performance of elderly, and can be important tools for preventing the development of cognitive decline and improve intervention strategies. Martial arts, especially Karate-Do, our object of study, are considered forms of complete exercise, which besides bringing benefits to physical health, contribute to stimulate motor and cognitive skills, improved quality of life and emotional aspects of their practitioners. Objective : to determine the effectiveness of a Karate-Do training, Wado-ryu style, on cognition in healthy elderly. Methods : A randomized controlled clinical trial was conducted with 33 elderly divided into two groups: Karate group (n = 16) and Control group (n = 17). In the pre and post-intervention phases, the elderly answered a sociodemographic questionnaire, a battery of neuropsychological tests (evaluation of attention, memory, language, perception, visoconstruction abilities and executive functions), subjective cognitive complaints and mood scales (anxiety and depression). Intervention with Karate-Do was conducted twice a week, lasting 60 minutes each session, for 12 weeks. The exercises consisted of kihon, kata and kumite typical of Karate-Do. Control group did not perform any physical activity or cognitive stimulation during the intervention period. Data analysis was conducted using descriptive and inferences statistics. A comparison of performance neuropsychological tests and subjective complaints scales, within and between-groups in the pre- and post-intervention, was performed using the Mann-Whitney test and Wilcoxon test. Results : the groups showed no statistically significant differences in the sociodemographic and clinical data in the pre-intervention phase. In intra-group comparison, at the end of the intervention, Karate Group achieved better performance in visual memory (Mpre: 11,78; sdpre: 6,12 / Mpost: 14,38; sdpost: 5,35 / p: 0,041), alternating attention (Mpre: 146,98; sdpre: 92,74 / Mpost: 121,39; sdpost: 70,71; p: 0,017), episodic verbal memory (Mpre: 43,88; sdpre: 7,74 / Mpost: 49,06; sdpost: 8,06; p: ?0,001), executive functions tasks (Mpre: 21,88; sdpre: 15,07 / Mpost: 31,88; sdpost: 14,91; p: 0,024) and reduction of subjective memory complaints by relatives (Mpre: 24,63; sdpre: 3,12 / Mpost: 19,69; sdpost: 5,61; p: 0,003). Control Group showed no significant differences in cognitive performance between pre- and post-intervention. In between-groups analysis at post-intervention phase, Karate group had higher scores than the Control Group in visual memory task (MGK: 14,38; sdGK: 5,35 / MGC: 10,03; sdGC: 3,43; p: 0,019) and reduction of subjective memory complaints by relatives (MGK: 19,69; sdGK: 5,61 / MGC: 24,41; sdGC: 5,12; p: 0,008). Conclusions : The Karate-Do training, Wado-ryu style, was effective in cognitive stimulation in healthy elderly, especially in tasks of attention, memory and executive functions. / Introdu??o : a atividade f?sica e artes marciais possuem uma grande influ?ncia no desempenho cognitivo de idosos, e podem ser ferramentas importantes de preven??o do desenvolvimento de decl?nio cognitivo e incrementar estrat?gias de interven??o. As artes marciais, especialmente o Karate-Do, nosso objeto de estudo, s?o consideradas formas de exerc?cio completas, que al?m de trazerem benef?cios ? sa?de f?sica, contribuem para estimular habilidades motoras e cognitivas, melhora da qualidade de vida e de aspectos emocionais de seus praticantes. Objetivo : verificar a efic?cia de um treinamento de Karate-Do, estilo Wado-ryu, sobre a cogni??o de idosos saud?veis. M?todo : realizou-se um ensaio cl?nico controlado e randomizado com 33 idosos divididos em dois grupos: Grupo Karate (n = 16) e Grupo Controle (n = 17). Nas etapas pr? e p?s-interven??o os idosos responderam a um question?rio sociodemogr?fico, a uma bateria de testes neuropsicol?gicos (avalia??o de aten??o, mem?ria, linguagem, percep??o, habilidades visuoconstrutivas e fun??es executivas) e a escalas de queixas cognitivas subjetivas e de humor (ansiedade e depress?o). A interven??o foi conduzida duas vezes por semana, com dura??o de 60 minutos/aula, por 12 semanas. Os exerc?cios eram compostos de kihon, kata e kumite t?picos de Karate-Do. O Grupo Controle n?o realizou nenhuma atividade f?sica ou de estimula??o cognitiva durante o per?odo de interven??o. A an?lise dos dados foi realizada com estat?sticas descritivas e de infer?ncias. A compara??o de desempenho nos testes neuropsicol?gicos e nas escalas de queixas subjetivas intra e entre-grupos, nos per?odos pr? e p?s-interven??o, foi realizada atrav?s do Teste U de Mann-Whitney e Wilcoxon. Resultados : os grupos n?o apresentaram diferen?as estatisticamente significativas com rela??o aos dados sociodemogr?ficos e cl?nicos na etapa pr?-interven??o. Na compara??o intra-grupos, ap?s a interven??o, o Grupo Karate demonstrou diferen?a significativa nas tarefas de mem?ria visual (Mpr?: 11,78; dppr?: 6,12 / Mp?s: 14,38; dpp?s: 5,35 / p: 0,041), aten??o alternada (Mpr?: 146,98; dppr?: 92,74 / Mp?s: 121,39; dpp?s: 70,71; p: 0,017), mem?ria verbal epis?dica (Mpr?: 43,88; dppr?: 7,74 / Mp?s: 49,06; dpp?s: 8,06; p: ?0,001), fun??es executivas (Mpr?: 21,88; dppr?: 15,07 / Mp?s: 31,88; dpp?s: 14,91; p: 0,024) e queixas de mem?ria pelo familiar (Mpr?: 24,63; dppr?: 3,12 / Mp?s: 19,69; dpp?s: 5,61; p: 0,003). N?o foram encontradas diferen?as significativas de desempenho cognitivo do Grupo Controle entre os per?odos pr? e p?s-interven??o. Na compara??o entre-grupos no ap?s a interven??o, o Grupo Karate apresentou escores mais elevados nas tarefas de mem?ria visual (MGK: 14,38; dpGK: 5,35 / MGC: 10,03; dpGC: 3,43; p: 0,019) e redu??o nas queixas subjetivas de mem?ria pelo familiar em compara??o ao Grupo Controle (MGK: 19,69; dpGK: 5,61 / MGC: 24,41; dpGC: 5,12; p: 0,008). Conclus?o : O treinamento de Karate-Do estilo Wado-ryu mostrou-se eficaz na estimula??o cognitiva de idosos saud?veis, especialmente em tarefas de aten??o, mem?ria e fun??es executivas.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-11-24T11:33:35Z No. of bitstreams: 1 476412 - Texto Parcial.pdf: 1327214 bytes, checksum: 641c0c6140859480f5f2d22d545e8ff8 (MD5) / Made available in DSpace on 2015-11-24T11:33:35Z (GMT). No. of bitstreams: 1 476412 - Texto Parcial.pdf: 1327214 bytes, checksum: 641c0c6140859480f5f2d22d545e8ff8 (MD5) Previous issue date: 2015-06-30 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Depression, along with cognitive disorders, has been a concern among mental health services due to the high injury rate in functionality and quality of life of this population. However, still remains open understanding of cognitive changes due to depression and difficult differential diagnosis with mild cognitive impairment (MCI). It is known that the performance on cognitive tests are strongly influenced by education, however, few studies have been conducted on very low education populations. Objective: To evaluate the performance Addenbrooke's Cognitive Examination-Revised (ACE-R) and his cognitive domains in low schooling elderly, without dementia, and compare those with a diagnosis of Major Current Depression Episode (MCDE) with those without depression.Method: analytical, retrospective cross-sectional study using the medical records of patients treated at the Brain Aging Clinic (BAC) of the Hospital S?o Lucas. It included 116 individuals with low education (<8 years of study) and aged between 60 and 84 years (69.6 ? 6.7) with MCDE (N = 41) and controls (N = 75). Results: When comparing the means of ACE-R, MMSE and from the five cognitive domains, between the control group and the group with MCDE, there was no significant difference. There was no difference between groups when analyzed separately the results of the clock drawing test, the categorical and phonological verbal fluency and naming test. Discussion: Unlike what happens with the more educated elderly, depressive symptoms do not change the values of the tests performed on ACE-R of older people with low education. / Depress?o, juntamente com os transtornos cognitivos, tem sido uma preocupa??o entre os servi?os de sa?de mental, devido ao alto ?ndice de preju?zo na funcionalidade e qualidade de vida desta popula??o. Contudo, ainda permanece em aberto a compreens?o das altera??es cognitivas decorrentes da depress?o e de dif?cil diagn?stico diferencial com o comprometimento cognitivo leve (CCL). Sabe-se que o desempenho nos testes cognitivos s?o fortemente influenciados pela escolaridade, no entanto, poucos estudos tem sido realizados em popula??es de muito baixa escolaridade. O presente trabalho teve como objetivo avaliar o desempenho no Addenbrooke?s Cognitive Examination-Revised (ACE-R) e seus dom?nios cognitivos em idosos de baixa escolaridade, sem dem?ncia, e comparar aqueles que possuem diagn?stico de Epis?dio de Depress?o Maior Atual (EDMA), com os que n?o apresentam tal diagn?stico.M?todo: Estudo transversal anal?tico, retrospectivo, atrav?s dos prontu?rios dos pacientes atendidos no Ambulat?rio de Envelhecimento Cerebral (AMBEC) do Hospital S?o Lucas da PUCRS. Foram inclu?dos 116 idosos com baixa escolaridade (< 8 anos de estudo) e idade entre 60 e 84 anos (69,6?6,7), 41 com EDMA e 75 controles. Na compara??o das m?dias do ACE-R e dos cinco dom?nios cognitivos e do MEEM, entre o grupo controle e o grupo com EDMA, n?o foi observada diferen?a significativa. Tamb?m n?o houve diferen?a entre os grupos quando analisado separadamente os resultados do teste do rel?gio, da flu?ncia verbal categ?rica e fonol?gica e do teste de nomea??o. Diferente do que acontece com os idosos mais escolarizados, os sintomas depressivos n?o modificam os valores dos testes realizados no ACE-R de idosos com baixa escolaridade.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-12-01T10:30:54Z No. of bitstreams: 1 476508 - Texto Completo.pdf: 2272243 bytes, checksum: 4ba343814611baa515a889610cb2a13a (MD5) / Made available in DSpace on 2015-12-01T10:30:54Z (GMT). No. of bitstreams: 1 476508 - Texto Completo.pdf: 2272243 bytes, checksum: 4ba343814611baa515a889610cb2a13a (MD5) Previous issue date: 2015-09-29 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Study the medical education process is part of a worldwide movement of health review, motivating important initiatives, represented in Brazil by the national curriculum guidelines of the courses in this area, presented by the Ministry of Education in 2001. In order to compare the effects of content learning/retention (outcome) of dialogued lecture (factor under study), we carried out a randomized controlled trial by groups, blinded to the research subjects with medical students from the 7th and 8 th semester from a private university in southern Brazil, with grade five assigned by the Higher Education Personal Improvement Commission (CAPES). 150 subjects were evaluated between March 2012 and June 2014, average age 24.7 years and a predominance of females (62.7%); 69 (46%) allocated for dialogued lecture (intervention group) and 81 (54%) to traditional lecture (control group). The performance of groups was evaluated by the same theoretical knowledge test administered before and after class, where students in the control group showed greater variation between the first and second test (8.6 vs. 6.7 p = 0.0001) result reinforced by the magnitude of the effect also higher in this group (2,526 vs. 1,350). In the pretest, without distinction by group, the overall student achievement was 50%, with a higher average score of the intervention group (p = 0.003) and those students tested in the 7th semester. In this study, the expository dialogue-class determined final results similar to traditional classroom (20.2 vs. 20.0 points in the final test) no impairment in short-term learning was noticed. / Estudar o processo de educa??o m?dica ? parte de um movimento mundial de revis?o da sa?de, motivando iniciativas importantes, representadas no Brasil pelas diretrizes curriculares nacionais dos cursos desta ?rea, apresentadas pelo Minist?rio da Educa??o no ano de 2001. Com o objetivo de comparar os efeitos de aprendizagem/reten??o de conte?do (desfecho) da aula expositiva dialogada (fator em estudo), realizou-se um estudo controlado randomizado por grupos, cegado para os sujeitos de pesquisa com alunos do 7? e 8? semestre do curso de medicina de uma Faculdade privada do sul do Brasil, com conceito cinco atribu?do pela Comiss?o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES). Foram avaliados 150 sujeitos, entre mar?o de 2012 e junho de 2014, m?dia de idade de 24,7 anos e predom?nio do sexo feminino (62,7%); 69 (46%) alocados para a aula expositiva dialogada (grupo interven??o) e 81 (54%) para aula expositiva tradicional (grupo controle). O desempenho dos grupos foi avaliado por um mesmo teste te?rico de conhecimento aplicado antes e ap?s a aula, onde os alunos do grupo controle demonstraram maior varia??o entre o primeiro e segundo teste (8,6 vs. 6,7 p=0,0001) resultado refor?ado pela magnitude do efeito tamb?m maior neste grupo (2,526 vs. 1,350). No pr?-teste, sem distin??o por grupo, o aproveitamento geral dos alunos foi de 50%, sendo maior a pontua??o m?dia do grupo submetido ? interven??o (p=0,003) e daqueles alunos testados no 7? semestre. Neste estudo, a aula expositiva dialogada determinou resultados finais similares ? aula tradicional (20,2 vs. 20,0 pontos no teste final) n?o sendo observado preju?zo na aprendizagem de curto prazo.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-01-14T16:18:00Z No. of bitstreams: 1 DIS_ST?FANI_RIBEIRO_RODRIGUES_COMPLETO.pdf: 1850672 bytes, checksum: fb7fe168f40514a0d72f0f240c308fd2 (MD5) / Made available in DSpace on 2016-01-14T16:18:00Z (GMT). No. of bitstreams: 1 DIS_ST?FANI_RIBEIRO_RODRIGUES_COMPLETO.pdf: 1850672 bytes, checksum: fb7fe168f40514a0d72f0f240c308fd2 (MD5) Previous issue date: 2015-07-24 / The body balance is the capacity of standing or generate acceleration movements and body rotations without oscillations or falls. For this to happen, it is necessary the integrity of different structures and systems, especially visual, proprioceptive and vestibular systems. The aim of this study was to evaluate the sensorial systems involved in body balance maintenance in young, adults and old people using the Foam-Laser Dynamic Posturography. We evaluated 69 subjects, in which 34% of the sample represented by women, 34% by young, 34% by adults and 32% by old people. The elderly group performed significantly better in visual system than other groups. The young group showed visual preference significantly higher than other groups. We concluded that there are differences in the performance of the sensorial systems involved in body balance maintenance among the evaluated age groups, although those differences had a straighter relation with diseases and lifestyle than with the aging process itself. / O equili?brio corporal e?a capacidade do ser humano de manter-se ereto ou executar movimentos de acelerac?a?o e rotac?a?o do corpo sem oscilac?o?es ou quedas. Para que isso ocorra, v?rias estruturas e sistemas necessitam estar ?ntegros, entre eles o sistema vestibular, o proprioceptivo e a vis?o. O objetivo dessa pesquisa que foi avaliar as diferen?as no desempenho dos sistemas sensoriais envolvidos na manuten??o do equil?brio corporal de jovens, adultos e idosos. Utilizando a Posturografia Din?mica foam-laser, 69 sujeitos foram avaliados, sendo que as mulheres representavam 66,1% da amostra, os indiv?duos jovens representavam 34%, os adultos 34% e os idosos 32% da amostra estudada. Os sujeitos idosos apresentavam desempenho significativamente melhor do sistema visual que as pessoas jovens e adultas. O grupo dos jovens apresentava prefer?ncia visual significativamente maior que os demais grupos. Concluiu-se que existem diferen?as no desempenho dos sistemas sensoriais envolvidos na manuten??o do equil?brio corporal entre as faixas et?rias avaliadas, por?m estas diferen?as apresentam-se associadas muito mais as doen?as e h?bitos de vida que ao envelhecimento.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-02-10T12:59:12Z No. of bitstreams: 1 TES_VERA_ELIZABETH_CLOSS_PARCIAL.pdf: 344877 bytes, checksum: 83c1713273477d9c1c0fb821d224a93c (MD5) / Made available in DSpace on 2016-02-10T12:59:12Z (GMT). No. of bitstreams: 1 TES_VERA_ELIZABETH_CLOSS_PARCIAL.pdf: 344877 bytes, checksum: 83c1713273477d9c1c0fb821d224a93c (MD5) Previous issue date: 2015-08-27 / Population ageing has been the focus of many studies as it reflects an important transformation of society that creates a reality with new challenges to be faced. The ageing process can be categorized in two forms: normal ageing or ageing per se or senescence (with associated molecular, anatomical and physiological alterations) and usual ageing or senility (associated with diseases and disabilities). The frailty syndrome is among the most discussed current themes. Frailty is a condition in which the individual presents increased vulnerability to the development of dependency, hospitalization, institutionalization, fall-risk and mortality, among other adverse outcomes, when exposed to a stressor. Various pathophysiological processes involved in frailty are closely related to nutritional and body composition aspects, and anthropometry presents as a useful technique for evaluating these conditions. Given that frailty in its early stages is commonly seen in the elderly community and that available instruments for its identification (such as the widely used Fried Phenotype) are complex and difficult to apply in primary care, the search for simple tools becomes important. In this thesis, three original articles are presented. In the first, article, AGING INDEX DEVELOPMENT IN BRAZIL, REGIONS, AND FEDERATIVE UNITS FROM 1970 TO 2010, we sought to address the ageing index, the parameter through which to evaluate the expansion process of the elderly segment of total population in relation to the relative change in young age group. To this end, data from the Demographic Census and Social Indicators of the Brazilian Institute of Geography and Statistics (IGBE) were analysed. It was evidenced that the Brazilian population is undergoing a rapid ageing process. For the second article, DESCRIPTION OF ANTHROPOMETRIC MEASUREMENTS AND ANALYSIS OF THEIR ASSOCIATION WITH GENDER, AGE, AND FRAILTY SYNDROME IN ELDERLY ASSISTED AT THE FAMILY HEALTH STRATEGY: DATA FROM THE EMI-SUS, data from 583 elderly participants of a cross-sectional study ?Clinical and Epidemiological Study of the Elderly Attended at the Family Health Strategy (FHS) in the City of Porto Alegre (EMI-SUS)?, were analyzed. The frequency of frailty (diagnosed by Fried Phenotype) was observed to be 21.5% and pre-frailty 51.1%, and that only one of the 41 evaluated anthropometric measures was not associated with at least one of the investigated dependent variables (gender, age group or frailty). In the third article, PERFORMANCE OF ANTHROPOMETRIC MEASURES IN PREDICTING FRAILTY IN THE ELDERLY: LOGISTIC REGRESSION AND ARTIFICIAL NEURAL NETWORK MODELS, we sought to investigate the performance of 26 anthropometric measurements in predicting frailty and to develop a tool for their identification. Data from 583 participants of the EMI-SUS were analyzed, randomly divided into a learning sample (n=439) and test sample (n=144). Logistic regression and artificial neural network models were used. The neural network demonstrated a superior predictive performance to the logistic regression model and resulted in a reliable tool for identifying frailty in the elderly. The anthropometric measures of weight, biceps skinfold, sagittal abdominal diameter and waist circumference, grouped, proved to be good predictors of frailty in the elderly. / O envelhecimento da popula??o tem sido foco de muitos estudos por se tratar de uma transforma??o importante da sociedade e que implica uma realidade com novos desafios a serem enfrentados. O processo de envelhecimento pode ser categorizado em dois padr?es: o envelhecimento normal ou envelhecimento per se ou senesc?ncia (com altera??es moleculares, anat?micas e fisiol?gicas associadas) e o envelhecimento usual ou senilidade (associado a doen?as e incapacidades). Dentre as tem?ticas mais abordadas atualmente, encontra-se a s?ndrome da fragilidade. Fragilidade ? uma condi??o na qual o indiv?duo apresenta uma maior vulnerabilidade para o desenvolvimento de depend?ncia, hospitaliza??o, institucionaliza??o, queda e mortalidade, dentre outros desfechos negativos, quando exposto a um estressor. V?rios processos fisiopatol?gicos envolvidos na fragilidade t?m estreita rela??o com aspectos nutricionais e de composi??o corporal e que, na avalia??o destas condi??es, a antropometria se apresenta como uma t?cnica ?til. Considerando que est?gios iniciais de fragilidade s?o comumente observados em idosos da comunidade e que instrumentos dispon?veis para a identifica??o de fragilidade (como o fen?tipo de Fried que ? amplamente utilizado) s?o complexos e de dif?cil aplica??o na aten??o b?sica, a busca por ferramentas simples torna-se importante. Na presente tese, s?o apresentados tr?s artigos originais. No primeiro artigo, A EVOLU??O DO ?NDICE DE ENVELHECIMENTO NO BRASIL, NAS SUAS REGI?ES E UNIDADES FEDERATIVAS NO PER?ODO DE 1970 A 2010, buscou-se abordar o ?ndice de envelhecimento, par?metro atrav?s do qual se avalia o processo de amplia??o do segmento idoso na popula??o total em rela??o ? varia??o relativa no grupo et?rio jovem. Para tanto, foram pesquisados dados dos Censos Demogr?ficos e dos Indicadores Sociais do IBGE. Evidenciou-se que a popula??o brasileira se encontra em franco processo de envelhecimento. Para o segundo artigo, DESCRI??O DE MEDIDAS ANTROPOM?TRICAS E AN?LISE DE SUA ASSOCIA??O COM G?NERO, IDADE E S?NDROME DA FRAGILIDADE EM IDOSOS ASSISTIDOS NA ESTRAT?GIA SA?DE DA FAM?LIA: DADOS DO EMI-SUS, foram analisados os dados de 583 idosos participantes de um estudo transversal denominado ?Estudo Epidemiol?gico e Cl?nico dos Idosos Atendidos na Estrat?gia Sa?de da Fam?lia (ESF) do Munic?pio de Porto Alegre (EMI-SUS)?. Observou-se que a frequ?ncia de fragilidade (diagnosticada pelo Fen?tipo de Fried) foi 21,5% e de pr?-fragilidade, 51,1% e que, das 41 medidas antropom?tricas avaliadas, somente uma n?o se mostrou associada com pelo menos uma das vari?veis dependentes investigadas (sexo, faixa et?ria ou fragilidade). No terceiro artigo, PERFORMANCE OF ANTHROPOMETRIC MEASURES IN PREDICTING FRAILTY IN ELDERLY: LOGISTIC REGRESSION AND ARTIFICIAL NEURAL NETWORK MODELS, buscou-se investigar a performance de 26 medidas antropom?tricas na predi??o de fragilidade e formular uma ferramenta para sua identifica??o. Foram analisados os dados de 583 idosos participantes do EMI-SUS, divididos randomicamente em uma amostra de aprendizado (n=439) e uma amostra teste (n=144). Foram utilizados modelos de regress?o log?stica e rede neural artificial. A rede neural mostrou performance preditiva superior ? regress?o log?stica e resultou em uma ferramenta confi?vel na identifica??o de fragilidade em idosos. As medidas antropom?tricas peso, dobra cut?nea bicipital, di?metro abdominal sagital e circunfer?ncia da cintura, agrupadas, mostraram-se bons preditores de fragilidade em idosos.