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- ItemEmbargoAvaliação do impacto na saúde da população em cenários de aumento da mobilidade e redução de emissões atmosféricas na Região Metropolitana de São Paulo(Universidade Federal de São Paulo, 2023-06-02) Leirião, Luciana Ferreira Leite [UNIFESP]; Simone, Georges El Khouri; http://lattes.cnpq.br/6423311971848669; http://lattes.cnpq.br/0185218541045231A mobilidade urbana, a poluição atmosférica e a saúde da população são temas pertencentes a diferentes disciplinas que carecem de uma visão integrada, principalmente em centros urbanos de países em desenvolvimento. Esta pesquisa partiu do objetivo de avaliar o impacto em saúde decorrente da expansão da rede de transportes sobre trilhos na Região Metropolitana de São Paulo (RMSP). Os resultados, no entanto, não se limitaram apenas a esse objetivo, refletindo na elaboração de oito artigos científicos envolvendo os temas supracitados. Dentre os artigos, destacase uma revisão bibliográfica sobre os impactos associados ao transporte sobre trilhos em diferentes âmbitos e um estudo sobre os fatores que mais influenciam a população da RMSP na escolha do transporte sobre trilhos. No primeiro artigo, notouse a ausência de estudos quantitativos que justifiquem e apoiem o elevado investimento inerente a esse modo de transporte. No segundo, percebeuse que a proximidade a uma estação é o principal fator que encoraja o uso do transporte sobre trilhos, assim, a expansão da rede poderia favorecer o uso desse modo de transporte em detrimento do automóvel particular. Ainda tendo o transporte sobre trilhos como objeto de estudo, realizouse uma análise comparativa da poluição atmosférica no município de São Paulo antes e depois da inauguração de estações de metrô e também uma análise preditiva sobre a redução de emissões de poluentes em decorrência da promoção do uso do transporte sobre trilhos por meio da expansão da rede. Ambos os artigos apontaram que a redução na poluição em decorrência do uso do transporte sobre trilhos não é muito expressiva em termos absolutos, possivelmente em decorrência da elevada contribuição dos veículos pesados nas emissões totais da RMSP. Assim, os artigos indicaram que políticas no âmbito de transporte visando uma melhora na qualidade do ar devem obrigatoriamente contemplar os veículos pesados, especialmente caminhões. Os impactos em saúde em decorrência da poluição atmosférica, causada essencialmente por veículos, foram contemplados em outros quatro artigos. Dois deles investigaram os efeitos positivos em termos de melhora na qualidade do ar e óbitos evitados em decorrência da redução de emissões durante a greve de caminhoneiros que ocorreu no Brasil em 2018. Os resultados expressivos obtidos nesses artigos reforçam a necessidade de políticas públicas voltadas ao transporte de carga para a redução da poluição atmosférica em grandes centros urbanos. Outro estudo envolvendo a poluição do ar e a saúde demonstrou que a constante exposição prévia a poluentes contribuiu para a letalidade da Covid19 durante a pandemia. Por fim, no último artigo, propôsse o uso de redes neurais artificiais para a associação da mortalidade cardiorrespiratória e a concentração de múltiplos poluentes. Nesse caso, o método proposto foi capaz de superar limitações inerentes a outros métodos, mantendo baixos erros associados. A partir da análise conjunta dos oito artigos, coloca-se como principais recomendações: a necessidade de implementação de políticas integradas ao invés de isoladas, a importância de o transporte de carga ser reestruturado e a necessidade de estudos quantitativos do tipo preditivo que antecedam a implementação de políticas.
- ItemSomente MetadadadosInstability Resistance Training Improves Neuromuscular Outcome in Parkinson's Disease(Lippincott Williams & Wilkins, 2017) Silva-Batista, Carla; Corcos, Daniel Montie; Barroso, Renato; David, Fabian J.; Kanegusuku, Helcio; Forjaz, Cláudia Lúcia de Moraes; Mello, Marco Tulio de [UNIFESP]; Roschel, Hamilton; Tricoli, Valmor; Ugrinowitsch, CarlosPurpose: This study compared the effects of resistance training (RT) and RT with instability (RTI) on neuromuscular and total training volume (TTV) outcomes obtained as part of the Instability Resistance Training Trial in Parkinson's disease. It also used a linear multiple regression (forward stepwise method) to identify the contribution of neuromuscular outcomes to previously published improvements in the timed-up-and-go test and the Unified Parkinson's Disease Rating Scale, motor subscale score. Methods: Thirty-nine patients with moderate to severe Parkinson's disease were randomly assigned to three groups: control (C), RT, and RTI. RT and RTI groups performed resistance exercises twice a week for 12 wk, and only the RTI group used unstable devices to perform resistance exercises. The following neuromuscular outcomes were assessed: quadriceps muscle cross-sectional area, root mean square and mean spike frequency of electromyographic signal, peak torque, rate of torque development, and half relaxation time of the knee extensors and plantarflexors during maximum ballistic voluntary isometric contractions. TTV was calculated for lower limb exercises. Results: From pre-to posttraining, RTI improved all of the neuromuscular outcomes (P < 0.05) except half relaxation time of the knee extensors (P = 0.068), despite the lower TTV than RT (P < 0.05). RTI was more effective than RT in increasing the root mean square values of vastus medialis, mean spike frequency of gastrocnemius medialis, and rate of torque development of plantarflexors (P < 0.05). Stepwise regression identified the changes in mean spike frequency of gastrocnemius medialis as the best predictor of improvements in timed-up-and-go test (R-2 = 0.58, P = 0.002) and on-medication Unified Parkinson's Disease Rating Scale, motor subscale scores (R-2 = 0.40, P = 0.020). Conclusion: RTI optimizes neuromuscular adaptations, which partially explains mobility and motor sign improvements in patients with Parkinson's disease.
- ItemSomente MetadadadosMobilidade da caixa torácica de crianças com paralisia cerebral durante a respiração(Universidade Federal de São Paulo, 2014-07-29) Cabo, Soraia Liborio [UNIFESP]; Carvalho, Raquel de Paula [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Cerebral palsy (CP) refers to a group of non-progressive disorders that occurs during the process of brain maturation. It has multifactorial and diversity of clinical etiologies. The respiratory system of children with CP is influenced by disturbances of tone, posture and movement that characterize this population. The aim of this study was to analyze the shape and mobility of thoracic cage in children with CP during quiet and forced breathing. Eighteen children aged from 8 to14 years old participated of this cross-sectional study. Nine children with typical motor development were included in the control group (CG) and nine children with spastic hemiparesis CP (levels I and II of the Gross Motor Function Classification System) were included in the group of CP (CPG). A three-dimensional kinematic analysis system (Dvideow) was used to describe spatial trajectories of 60 markers attached on anatomical landmarks. From the three-dimensional coordinates of the markers, the following experimental variables could be obtained: anteroposterior diameter (APD) and transverse (TD) and angles alpha (?), beta (?), gamma (?), theta (? ), lambda (?) and sigma (?). The results indicate that children with mild spastic hemiparesis CP (PCG) showed similar shape of the rib cage to typical children (CG) of the same age. The asymmetry between right and left ribs of CPG did not influence shape of the rib cage, and it was similar to CG. However, in relation to mobility, children with CP showed lower mobility of last rib when compared to CG. As the mobility of the lower thoracic region suggests measure of diaphragmatic excursion, we believe that these results may reflect the strength deficit, mainly the diaphragm and other respiratory muscles of children in this group.
- ItemSomente MetadadadosModalidade Ativa E Não Ativa No Município De Santos, Sp Um Modelo De Investigação(Universidade Federal de São Paulo (UNIFESP), 2017-10-30) Santana, Angelica Barbosa Neres [UNIFESP]; Ribeiro, Daniel Araki [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The percentages of obesity and overweight found in different countries are increasing, and simultaneously they have a decrease in active mobility practices. Studies are increasingly studying the factors related to displacement with approach in complex system, however, there are limitations when investigating only a part of the mobility and not her with a whole. In addition, there are in Brazil a database that provides crucial information for understanding this in different states of the country, known as National Household Sample Survey that have not been properly exploited for this purpose. In this way, the present study aims to propose a research model of mobility behavior, based on the comparison of scenarios in the city of Santos. For that, the parameters of the next phase were determined with the recruitment and descriptive statistical analysis of the Origin and Destination Survey of the city of Santos. In the construction of the model from the empirical data, the Bayes' Theorem was applied. For this, theoretical models of statistical distribution were tested to generate the Bayesian term of likelihood. With the generated model and the numerical data obtained by it, the internal validation was performed, considering the test of best fit of the resulting data with the original empirical data. Once validated, simulations were performed to explore its valid initial parameter space in order to explore the possible applications of the model in the study of scenarios of active mobility practice. The results obtained by the simulations indicate that the maximum practicable percentages of active mobility in the city are: 20% of walking and 20% of use of bicycle for daily trips Interregional and 80% of walking and 12.5% of bicycle use for the intra-regional daily trips, and the behavior of the modal has a selfregulation, since the arrows tend to point to the region where the modal are validated. Theviii present study brings a tool that can be constructed with few parameters and replicable for all cities where National Household Sample Survey are performed.
- ItemSomente MetadadadosResistance Training with Instability for Patients with Parkinson's Disease(Lippincott Williams & Wilkins, 2016) Silva-Batista, Carla; Corcos, Daniel Montie; Roschel, Hamilton; Kanegusuku, Helcio; Gobbi, Lilian Teresa Bucken; Piemonte, Maria Elisa Pimentel; Tavares Mattos, Eugenia Casella; Mello, Marco Tulio de [UNIFESP]; Forjaz, Cláudia Lúcia de Moraes; Tricoli, Valmor; Ugrinowitsch, CarlosPurpose: This randomized controlled trial compared the effects of resistance training (RT) and RT with instability (RTI) on the timed up and go test (TUG), on-medication Unified Parkinson's Disease Rating Scale part III motor subscale score (UPDRS-III), Montreal Cognitive Assessment (MoCA) score, Parkinson's Disease Questionnaire (PDQ-39) score, and muscle strength in the leg press exercise (one-repetition maximum) of patients with Parkinson's disease (PD). Methods: Thirty-nine patients with moderate to severe PD were randomly assigned to a nonexercising control group (C), RT group, and RTI group. The RT and RTI groups performed progressive RT twice a week for 12 wk. However, only the RTI group used high motor complexity exercises (i.e., progressive RT with unstable devices), for example, half squat exercise on the BOSU (R) device. The primary outcome was mobility (TUG). The secondary outcomes were on-medication motor signs (UPDRS-III), cognitive impairment (MoCA), quality of life (PDQ-39), and muscle strength (one-repetition maximum). Results: There were no differences between RTI and RT groups for any of the outcomes at posttraining (P > 0.05). However, there were differences between RTI and C groups in the TUG, MoCA, and muscle strength values at posttraining (P<0.05). Only the RTI group improved the TUG (-1.9 s), UPDRS-III score (-4.5 score), MoCA score (6.0 score), and PDQ-39 score (-5.2 score) from pre- to posttraining (P<0.001). Muscle strength improved for both training groups (P < 0.001). No adverse events were reported during the trial. Conclusions: Both training protocols improved muscle strength, but only RTI improved the mobility, motor signs, cognitive impairment, and quality of life, likely because of the usage of high motor complexity exercises. Thus, RTI may be recommended as an innovative adjunct therapeutic intervention for patients with PD.