Fisioterapia pélvica em paciente infectada pelo vírus linfotrópico de células T humanas do tipo 1: Um relato de caso / Pelvic physiotherapy in a patient infected with human T-cell lymphotropic virus type 1: A case report

Introdução: O vírus linfotrópico de células T humanas do tipo 1 (HTLV-1) é o agente etiológico da Paraparesia Espástica Tropical/Mielopatia associada ao HTLV-1 (PET/MAH) que faz o indivíduo apresentar comprometimentos motores, sensoriais e disfunção do trato urinário. Métodos: Paciente feminina, 58 anos, residente de Belém/PA, com diagnóstico clínico de Paraparesia espástica tropical associada ao vírus linfotrópico de células T humana tipo 1 (HTLV-1) e doença de Parkinson, apresentava quadro disfuncional de bexiga neurogênica e realizou 10 sessões de um protocolo fisioterapêutico. Resultados: O protocolo de intervenção afetou positivamente na qualidade de vida da paciente, havendo diminuição nos valores de escore de 6 domínios avaliados pelo questionário King 's Health e nos sintomas urinários relatados pela paciente. Conclusão: Os resultados sugerem que a fisioterapia pélvica é uma opção viável na melhora da qualidade de vida de pacientes com bexiga neurogênica.

Occupational Therapy for People Living With Human T-Lymphotropic Virus 1: Importance and Effectiveness of an Intervention Plan at the Level of Prevention and Rehabilitation.

Introduction: Human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy (HAM) restricts activities of daily living (ADLs), affecting health and quality of life. Occupational therapy is used to promote independence during ADL in people living with HTLV (PLHTLV). Objective: To quantify the clinical aspects, levels of functionality, performance in ADLs and occupational roles of PLHTLV and propose an occupational therapeutic intervention. Method: A cross-sectional, descriptive, observational study was designed with 40 PLHTLV monitored at two referral laboratories of the Federal University of Pará. The Evandro Chagas Research Institute Neurological Disability Scale (EIPEC-2), the Barthel Index and the Occupational Roles Identification List were applied. The G test and Fisher's exact test (to identify associations between qualitative variables), the Mann-Whitney test (to identify associations between quantitative variables) and Pearson correlation analysis (to identify associations between the total Barthel Index and EIPEC-2 scores) were performed with Microsoft Excel and BioEstat 5.0, and the significance level was set at p ≤ 0.05. Results: Motor aspects, the presence of spasticity, sensory aspects, and pain in the lumbar region and lower limbs were significantly (p = 0.0002) higher among symptomatic individuals, who also had more difficulties urinating, traveling up and down stairs and transferring from a chair to a bed. Being a worker, performing housework and socializing (with friends or family members) were the most affected activities among HAM patients. Conclusion: The impact of HAM on PLHTLV should include an intervention plan with occupational therapists in rehabilitation programs to create an important third-level prevention initiative, which may help achieve short-, medium-, and long-term goals. Asymptomatic PLHTLV should also be able to prevent future ADL impairment.

Aquatic physiotherapy: a vestibular rehabilitation option / Fisioterapia aquática: uma opção de reabilitação vestibular

Abstract Introduction: Vestibular rehabilitation is a fundamental resource for vestibular symptom control. Its performance in the aquatic environment is considered safe for the physical activities of the elderly, because they act simultaneously on musculoskeletal disorders and balance improvement. Objective: To evaluate the effects of an aquatic physiotherapy protocol in individuals with peripheral vestibular alterations. Methods: This was an interventional case study with a paired intentional sample of four subjects, who were selected for convenience. The subjects, all of them diagnosed with peripheral vestibulopathy, were submitted to twelve sessions of aquatic physiotherapy for vestibular rehabilitation, being evaluated for dizziness in three moments: initial, after six sessions and at the end of the sessions. The tests applied were: unipodal support to measure static balance, the Fukuda stepping test, which estimates the dynamic balance and the dizziness handicap inventory protocol, aimed at verifying how dizziness influences daily life. Results: When analyzing the static balance, initially the individuals were in the adaptive and abnormal dimensions, and all reached normality at the end of the protocol. Regarding the dynamic balance, the individuals initially showed marked impairment in the angular deviation, mainly to the side of pathology (75% to the left and 25% to the right), achieving improvement at the end of the study. However, it failed to reach statistical significance. The dizziness handicap inventory showed a statistically significant difference in its totality (p = 0.0414), which addresses the physical, functional and emotional factors. Conclusion: In conclusion, the aquatic physiotherapy protocol for vestibular rehabilitation of patients with peripheral impairment was positively assessed by the participants, considering the improvement in dizziness (static and dynamic) and its impact on daily activities.

Resumo Introdução: A reabilitação vestibular se consolida como um recurso fundamental para o controle de sintomas vestibulares e sua feitura no meio aquático é considerada segura para as atividades físicas dos idosos, atua simultaneamente nas desordens musculoesqueléticas e na melhoria do equilíbrio. Objetivo: Avaliar os efeitos de um protocolo de fisioterapia aquática em indivíduos com alterações vestibulares periféricas. Método: Estudo de caso intervencional com amostra intencional pareada de quatro sujeitos, selecionados por conveniência, diagnosticados com vestibulopatias periféricas. Os sujeitos foram submetidos a 12 sessões de fisioterapia aquática para reabilitação vestibular. Foram avaliados quanto à tontura em três momentos: inicial, após seis sessões e ao término dos atendimentos. Os testes aplicados foram: o apoio unipodal para mensurar o equilíbrio estático, a prova dos passos de Fukuda que estima o equilíbrio dinâmico e o protocolo dizziness handicap inventory com o objetivo de verificar o quanto a tontura influencia na vida cotidiana. Resultados: Ao analisar o equilíbrio estático, inicialmente os indivíduos se encontravam nas dimensões adaptativas e anormais e ao término do protocolo todos atingiram a normalidade. Em relação ao equilíbrio dinâmico, os indivíduos inicialmente apresentavam grande comprometimento no desvio angular principalmente para o lado da patologia (75% à esquerda e 25% à direita), conseguiram uma melhoria no fim do estudo. Todavia, não conseguiu atingir a significância estatística. O dizziness handicap inventory obteve diferença estatisticamente significante em sua totalidade (p = 0,0414), onde aborda os fatores físicos, funcionais e emocionais. Conclusão: O protocolo de fisioterapia aquática voltado para reabilitação vestibular de pacientes com comprometimento periférico foi avaliado de forma positiva pelos participantes, considerando-se a melhoria no quadro de tontura (estática e dinâmica) e do seu impacto nas atividades cotidianas.

Fragilidade, desempenho cognitivo e sintomas depressivos de idosos ribeirinhos da Amazônia / Frailty, cognitive performance and depressive symptoms of elderly people bordering the Amazon / Fragilidad, desempeño cognitivo y sintomas depressivos de los ancianos ribeirinhos da Amazônia

A síndrome de fragilidade é uma condição clínica em que se observa um aumento no estado de vulnerabilidade do indivíduo envolvendo diversos fatores de ordem biopsicossociais. O objetivo foi investigar o desempenho cognitivo, sintomas depressivos e fragilidade entre idosos ribeirinhos amazônicos, bem como a associação entre essas variáveis. Trata-se de um estudo observacional do tipo transversal de abordagem quantitativa realizado no município de Cametá, Pará, Brasil. Participaram do estudo 108 idosos, a coleta de dados foi por meio do fenótipo de fragilidade postulado por Fried et al. (2001) modificado, Miniexame do Estado Mental (MEEM) e Escala de Depressão Geriátrica (EDG-15). Constatou-se que a maioria dos ribeirinhos foram classificados como idosos não frágeis, além disso, o comprometimento cognitivo e a presença de sintomas depressivos consolidaram-se como fatores associados à condição de fragilidade (p = 0.0468 e p = 0.0032). Por fim, destaca-se a importância da gestão da fragilidade em idosos de comunidades tradicionais brasileiras (AU).

The frailty syndrome is a clinical condition in which the individual´s state of vulnerability is increased, involving several biopsychosocial factors. The aim was to investigate the study cognitive performance, depressive symptoms and frailty among elderly riverside Amazonians, as well as the association between these variables. This is an observational cross-sectional study with a quantitative approach carried out in the city of Cametá, Pará, Brazil. 108 elderly people participated in the study. Data collection was performed using the frailty phenotype postulated by Fried et al. (2001) modified, Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-15). It was found that most riverside dwellers were classified as non-frail elderly, in addition, cognitive impairment and the presence of depressive symptoms were consolidated as factors associated with the frail condition (p = 0.0468 and p = 0.0032). Finally, the importance of management failty in the elderly in traditional Brazilian communities is highlighted (AU).

El síndrome de fragilidad es una condición clínica en la que se incrementa el estado de vulnerabilidad del individuo, involucrando varios factores biopsicosociales. El objetivo fue investigar el estudio del rendimiento cognitivo, los síntomas depresivos y la fragilidad en comunidades ancianas ribereñas de la Amazonía, así como la asociación entre estas variables. Se trata de un estudio observacional transversal con enfoque cuantitativo realizado en la ciudad de Cametá, Pará, Brasil. 108 personas mayores participaron en el estudio. La recolección de datos se realizó utilizando el fenotipo de fragilidad postulado por Fried et al. (2001) modificado, Mini Examen del Estado Mental (MMSE) y Escala de Depresión Geriátrica (GDS-15). Se encontró que la mayoría de los ribereños fueron clasificados como ancianos no frágiles, además, el deterioro cognitivo y la presencia de síntomas depresivos se consolidaron como factores asociados a la condición frágil (p = 0.0468 yp = 0.0032). Finalmente, se destaca la importancia de manejar em los ancianos en las comunidades brasileñas tradicionales (AU).

Uso da eletromiografia de superfície na resultância do treinamento muscular inspiratório com carga linear em portadores do vírus linfotrópico humano tipo 1 / Use of surface electromyography in results of inspiratory muscle training with linear load in patients with type 1 human lymphotropic virus

Este estudo visa avaliar por eletromiografia de superfície o comportamento dos músculos inspiratórios no treinamento muscular em voluntários com vírus linfotrópico de célula T humana do tipo 1. Trata-se de um ensaio clínico. Sete voluntários, com idade 58,85 ± 7,2) anos, realizaram treinamento muscular inspiratório domiciliar por 4 semanas, 3 vezes por semana, 30 minutos diários por meio de incentivador de carga linear. Para avaliação utilizou-se os dados de pressão inspiratória máxima e os dados da eletromiografia de superfície nas fases pré (T0), segunda semana (T2) e após a quarta semana (T4) de treinamento. Observou-se aumento progressivo da força muscular inspiratória de T0 a T4 (p = 0,007), assim como, aumento do recrutamento das unidades motoras pela análise da amplitude do sinal eletromiográfico, sendo mais evidente para o músculo esternocleidomastóideo (p = 0,12) em comparação ao músculo diafragma (p = 0,6). Verificou-se que no decurso do treinamento muscular ocorreu melhora significativa da força muscular inspiratória com maior recrutamento das fibras musculares dos músculos analisados na amostra. (AU)

This study aimed to evaluate by surface electromyography the behavior of inspiratory muscles in the muscle training of volunteers with human T-cell lymphotropic virus type 1. This was a clinical trial. Seven volunteers, 58,85 ± 7.21 years old, underwent inspiratory muscle training at home for 4 weeks, 3 times a week, 30 minutes daily by means of a linear load stimulator. The maximum inspiratory pressure data and the surface electromyography data were used for evaluation in the pre (T0), second week (T2) and after the fourth week (T4) training phases. There was a progressive increase in inspiratory muscle strength from T0 to T4 (p = 0.007), as well as an increase in the recruitment of motor units by analyzing the amplitude of the electromyographic signal, being more evident for the sternocleidomastoid muscle (p = 0.12) in comparison to the diaphragm muscle (p = 0.6). During the muscle training inspiratory muscle strength improves with greater recruitment of muscle fibers from the muscles analyzed in the sample. (AU)

Capacidade funcional e fragilidade de idosos com sequela de tuberculose pulmonar / Functional capacity and fragility of the elderly with pulmonar tuberculosis sequelae

INTRODUÇÃO: A tuberculose (TB) é uma doença de caráter infectocontagiosa, de evolução crônica, causada pela Mycobacterium tuberculosis, Uma vez considerada como doença crônica entre idosos por poder gerar sequelas e resultar em comprometimento da capacidade pulmonar, e desta forma contribuir para um quadro clínico de pior prognóstico é essencial estudar a relação da TB com a síndrome da fragilidade e a capacidade funcional em idosos. OBJETIVO: Analisar a capacidade funcional de idosos com seqüela de TB Pulmonar e investigar a ocorrência de fragilidade nesta população. MATERIAIS E MÉTODOS: Trata-se de um estudo transversal com método quantitativo-correlacional, realizado no período de agosto a novembro de 2017, no ambulatório de fisioterapia do Hospital Universitário João de Barros Barreto, Belém/PA. Avaliou-se a fragilidade pelo instrumento Tilburg Frailty Indicator (TFI) e a capacidade funcional pelo "Teste de AVD-Glittre" (TGlittre). Utilizou-se a "correlação de Spearman" entre TFI e TGlittre. Adotou-se p-valor≤0,05. RESULTADOS: Avaliaram-se 24 idosos com diagnóstico clínico de TB Pulmonar, apresentando alterações e/ou sequelas pulmonares. A média de idade foi de 68,37 ± 6,01anos, 66,7% era do sexo feminino. A presença de fragilidade foi de 70,5% (IC95% 48,9-87,4), com predomínio feminino (82,4%). A média do tempo no TGlittre foi de 5,77 ± 1,71 minutos. Houve correlação moderada positiva entre TFI e TGlittre (p=0.42, p= 0.03). CONCLUSÃO: Este estudo identificou a fragilidade e comprometimento funcional em idosos com sequela de TB pulmonar, com prevalência alta de fragilidade se comparada aos outros estudos brasileiros com a população idosa, além de apresenta correlação moderada positiva entre a capacidade funcional e fragilidade, mostrando que essa população merece atenção especial nos programas de reabilitação para a manutenção ou recuperação funcional.

INTRODUCTION: Tuberculosis (TB) is an infectious and contagious disease, with a chronic evolution that is caused by Mycobacterium tuberculosis, as it is considered a chronic disease among the aged because it can cause sequelae and result in impaired lung capacity and thus contribute to a clinical picture of worse prognosis it is interesting to study the relationship between TB and frailty syndrome and functional capacity in the old age. OBJECTIVE: To analyze the functional capacity of elderly people with pulmonary TB sequelae treated at a pulmonology service in Belém-PA, and to investigate the occurrence of frailty in this population. MATERIALS AND METHODS: This is a crosssectional study with the quantitative-correlational method, conducted from August to November 2017 at the physiotherapy outpatient clinic of the João de Barros Barreto University Hospital, Belém/PA. Frailty by the Tilburg Frailty Indicator (TFI) instrument and functional capacity by the "ADL-Glittre Test" (TGlittre) were evaluated. The "Spearman correlation" between TFI and TGlittre was used. P-value was adopted≤0.05. RESULTS: The average age was 68,37 ± 6.01years, 66.7% were female, all individ-uals were literate, the majority with incomplete primary education (45.8%). The presence of frailty was 70.5% (95% CI 48.9-87.4), with a female predominance (82.4%). The average time on TGlittre was 5,77 ± 1,71 minutes. There was a moderate positive correlation between TFI and TGlittre (p=0.42, p= 0.03). CONCLUSION: This study identified frailty and functional impairment in the elderly with pulmonary TB sequelae, with a high prevalence of frailty compared to other Brazilian studies with the elderly population, besides presenting a moderate positive correlation between functional capacity and frailty, suggesting that these aspects de-serve special attention in rehabilitation programs for functional maintenance or recovery in this profile of patients.

Percepção subjetiva de esforço e recuperação da fadiga pós-sessão fisioterapêutica em pacientes com paraparesia espástica tropical / Subjective effort perception and fatigue recovery after physical therapy session in patients with tropical spastic paraparesis

Introdução: Vírus Linfotrópico de Células T Humana do Tipo-1 (HTLV-1) é um retrovírus que afeta os linfócitos T humano e desencadeia inflamação na medula, levando à paraparesia espástica tropical/mielopatia associada ao HTLV-1 (PET/MAH) com prejuízos funcionais. Tais disfunções podem influenciar nos efeitos da fisioterapia, gerando diferentes níveis de fadiga. Objetivo: Avaliar a percepção subjetiva de esforço e de recuperação de indivíduos com PET/MAH após sessão única de fisioterapia. Métodos: Incluíram-se 12 participantes sintomáticos para PET/MAH, de ambos os sexos, que foram submetidos uma vez ao protocolo fisioterapêutico. Os instrumentos avaliativos foram: Escala Modificada de Borg, Escala de Percepção Subjetiva de Recuperação (1º, 5º e 10º minuto após a sessão) e Escala de Incapacidade Neurológica do Instituto de Pesquisa Clínica Evandro Chagas ­ 2 (EIPEC). Resultados: Encontrou-se correlação moderada entre idade e taxa de percepção subjetiva de recuperação ao 1º (r = - 0,4923) e 5º (r = - 0,4913) minuto e entre índice do EIPEC-2 e taxa de percepção subjetiva de recuperação ao 1º (r = 0,3592) e 5º (r = - 0,3772) minuto. Conclusão: Indivíduos deste estudo com maior idade e grau de incapacidade neurológica têm menor percepção subjetiva de recuperação. (AU)

Introduction: Human T-Cell Lymphotropic Virus Type-1 (HTLV-1) is a retrovirus that affects human T lymphocytes and triggers inflammation in the spinal cord, leading to tropical spastic paraparesis / HTLV-1 associated myelopathy (TSP/HAM) with functional impairments. Such dysfunctions can influence the effects of physical therapy, generating different levels of fatigue. Objective: To evaluate the subjective perception of effort and recovery of individuals with TSP/HAM after a single session of physical therapy. Methods: 12 symptomatic participants for TSP/HAM, of both sexes, who were submitted once to a physiotherapeutic protocol were included. The evaluative instruments were: Modified Borg Scale, Scale of Subjective Perception of Recovery (1st, 5th and 10th minute after the session) and Scale of Neurological Disability at the Evandro Chagas Clinical Research Institute - 2 (EIPEC). Results: A moderate correlation was found between age and subjective perception rate of recovery at the 1st (r = - 0.4923) and 5th (r = - 0.4913) minute and between the EIPEC-2 index and the subjective perception rate of recovery at the 1st (r = 0.3592) and 5th (r = - 0.3772) minute. Conclusion: Individuals in this study with older age and degree of neurological disability have less subjective perception of recovery. (AU)

Aquatic physiotherapy: a vestibular rehabilitation option.

INTRODUCTION: Vestibular rehabilitation is a fundamental resource for vestibular symptom control. Its performance in the aquatic environment is considered safe for the physical activities of the elderly, because they act simultaneously on musculoskeletal disorders and balance improvement. OBJECTIVE: To evaluate the effects of an aquatic physiotherapy protocol in individuals with peripheral vestibular alterations. METHODS: This was an interventional case study with a paired intentional sample of four subjects, who were selected for convenience. The subjects, all of them diagnosed with peripheral vestibulopathy, were submitted to twelve sessions of aquatic physiotherapy for vestibular rehabilitation, being evaluated for dizziness in three moments: initial, after six sessions and at the end of the sessions. The tests applied were: unipodal support to measure static balance, the Fukuda stepping test, which estimates the dynamic balance and the dizziness handicap inventory protocol, aimed at verifying how dizziness influences daily life. RESULTS: When analyzing the static balance, initially the individuals were in the adaptive and abnormal dimensions, and all reached normality at the end of the protocol. Regarding the dynamic balance, the individuals initially showed marked impairment in the angular deviation, mainly to the side of pathology (75% to the left and 25% to the right), achieving improvement at the end of the study. However, it failed to reach statistical significance. The dizziness handicap inventory showed a statistically significant difference in its totality (p = 0.0414), which addresses the physical, functional and emotional factors. CONCLUSION: In conclusion, the aquatic physiotherapy protocol for vestibular rehabilitation of patients with peripheral impairment was positively assessed by the participants, considering the improvement in dizziness (static and dynamic) and its impact on daily activities.

Limitations in daily activities, risk awareness, social participation, and pain in patients with HTLV-1 using the SALSA and Participation scales.

BACKGROUND: Tropical spastic paraparesis or HTLV-associated myelopathy (TSP/HAM) may prevent, limit or restrict the performance of daily living activities, and as a consequence, several aspects of life are affected. OBJECTIVE: The aim of this study was to evaluate activity limitations, risk awareness, social participation, quality of life, and pain in individuals infected with HTLV-1. METHODS: This was an observational, descriptive, analytical, cross-sectional study with a quantitative approach. An interview questionnaire, the Screening of Activity Limitation and Safety Awareness (SALSA) scale, the Participation scale, a quality of life questionnaire (SF-36) and the Brief Pain Inventory were used. RESULTS: A total of 55 patients with HTLV-1 were interviewed (62% asymptomatic and 38% symptomatic). In both groups, there was a higher frequency of patients aged 41-50 years old (35.3% asymptomatic and 38.1% symptomatic), with complete secondary education (47.1% asymptomatic and 42.9% symptomatic), and married (64.7% asymptomatic and 52.4% symptomatic). Of the symptomatic patients, 33.3% were retired; among asymptomatic patients, 20.6% performed domestic activities. The majority of patients in both groups had not received blood transfusions. Sexual intercourse was still practiced by patients. After assessment, asymptomatic patients had no activity limitations (64.7%), and symptomatic patients presented limitations (90.5%). None of the groups showed good risk awareness. There was no restriction on social participation in 97.1% of asymptomatic patients and in 52.4% among symptomatics. Both groups complained of pain, being more frequent in the lumbar spine in asymptomatic patients and in the knees in symptomatic patients. Pain was more severe in symptomatic patients and affected aspects of quality of life. CONCLUSION: The clinical follow-up instruments must be adopted by healthcare professionals to monitor new symptoms so as to avoid the onset of limitations identified in symptomatic patients, in addition to enabling continuous surveillance of asymptomatic patients.

Influência de um protocolo de fisioterapia pélvica na função urinária e sexual de mulheres infectadas com vírus linfotrópico de células T humano tipo 1 / Influence of a pelvic physiotherapy protocol in urinary and sexual function of women infected with human T-cell lymphotropic virus type 1

Objetivo: Avaliar a influência da fisioterapia pélvica na função urinária e sexual de mulheres infectadas com HTLV-1. Métodos: Estudo quasi-experimental, com protocolo de 16 sessões em nove mulheres, que foram categorizadas em grupo sintomático e assintomático. Realizou-se teste de força muscular do assoalho pélvico com esquema PERFECT modificado, aplicou-se os questionários King's Health Questionnaire (KHQ) e Female Sexual Function Index (FSFI). O protocolo de fisioterapia pélvica consistiu em eletroestimulação do nervo tibial, eletroestimulação transvaginal e exercícios de cinesioterapia pélvica. Resultados: No grupo assintomático, segundo esquema PERFECT houve melhora da Endurance e Resistência do assoalho pélvico. No KHQ, verificou-se melhora geral no impacto da incontinência na qualidade de vida. No FSFI, houve aumento significativo no escore geral (p = 0,01), com influência nos domínios Desejo, Excitação, Lubrificação e Orgasmo. No grupo sintomático, o esquema PERFECT obteve melhora significativa em todos os domínios, assim como nos domínios de Limitação física, Sono/Energia e Medidas de Gravidade do KHQ e dos domínios de Desejo, Excitação e o Escore geral (p = 0,01) do FSFI. Conclusão: Sugere-se que o programa de fisioterapia pélvica aplicado melhorou a funcionalidade do assoalho pélvico, a qualidade de vida, reduziu os sintomas urinários e aprimorou a função sexual. (AU)

Objective: To evaluate the influence of pelvic physical therapy on the urinary and sexual function of women infected with HTLV-1. Methods: A quasi-experimental study in 16 sessions with nine women, divided into a symptomatic and asymptomatic group. The muscle strength test was performed with modified PERFECT scheme and were applied the King's Health Questionnaire (KHQ) and the Female Sexual Function Index (FSFI). The protocol of pelvic physical therapy consisted of electrostimulation of the tibial nerve, transvaginal electrostimulation and pelvic kinesiotherapy exercises. Results: In the asymptomatic group, the main results in PERFECT scheme were the improvement of the endurance and pelvic floor strength. In relation to KHQ, we observed a general improvement in the impact of incontinence on quality of life. In the FSFI, there was a significant increase in the Overall Score (p = 0.01), with influence in the domains Desire, Excitation, Lubrication and Orgasm. In the symptomatic group, the PERFECT scheme obtained significant improvement in all domains. As well as in domains Physical Limitation, Sleep/Energy and Severity measures in KHQ and in domains Desire, Excitation and Overall Score (p = 0,01) of FSFI. Conclusion: The pelvic physical therapy protocol improved the pelvic floor functionality, quality of life, reduced urinary symptoms and improved the sexual function. (AU)

Fragilidade de idosos ribeirinhos amazônicos: das trajetórias metodológicas aos desafios em saúde pública / Weaknesses of elderly people living near the amazon rivers: from methodological trajectories to challenges in public health

Este estudo tem como objetivo descrever as particularidades teórico-metodológicas e discutir as experiências vivenciadas no processo de pesquisa sobre fragilidade biológica e condições de saúde de idosos ribeirinhos amazônicos. A pesquisa descritiva, de abordagem qualiquantitativa, realizada em 19 ilhas do município de Cametá, Pará, envolveu 108 idosos e permitiu alcançar tanto as proposições diretas sobre os marcadores de fragilidade e de saúde multidimensional, quanto os aspectos subjetivos referentes às particularidades do contexto histórico-cultural. A trajetória percorrida pelos pesquisadores nesse desafio foi marcada, especialmente, por uma arreigada estruturação metodológica, direcionada ao contexto peculiar da pesquisa, desde a inserção ecológica dos pesquisadores, ponto-chave para a concretização do arcabouço metodológico e do período de coleta de dados até a elaboração das propostas norteadoras em saúde pública considerando, sobretudo, as particularidades dos modelos de cuidado vigentes nessas comunidades amazônicas.

Experiences lived during the research on the biological fragility and health conditions of elderly river people on the Amazon are described. Descriptive, qualitative and quantitative research in 19 islands in Cametá, Pará, Brazil, involved 108 elderly people and attained direct propositions on fragility markers, multidimensional health, and the subjective aspects on particulars within the historical and cultural context. Researchers´ trajectory was marked by strict methodology, foregrounded on the peculiar context of research ranging from the ecological insertion of the researchers, a key point for the materialization of the methodological design. It also took into account the period of data retrieval until the elaboration of proposals in public health, with special attention to care models in Amazon communities.

Relação da função vesical e marcha em indivíduos com vírus linfotrópico de células t humana tipo 1 / Relation bet ween vesical function and gait in people with human t-lymphotropic virus type 1

Correlacionar a disfunção da bexiga e a necessidade de assistência na marcha em indivíduos com vírus linfotrópico de células T humana tipo 1. Trata-se de um estudo analítico, observacional e transversal, realizado com 16 pacientes de ambos os sexos, diagnóstico de Paraparesia Espástica Tropical/Mielopatia Associada ao HTLV-1 (PET/MAH) definitivo, avaliados pela Escala Ponderada de Paraplegia Espástica (EPPE) e caracterizados quanto ao grau de auxílio na marcha por meio dos dispositivos utilizados durante a deambulação. Todos os achados foram codificados pela Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF); aqueles relacionados à função vesical se converteram para o componente funções do corpo e quanto ao auxílio da marcha para atividade e participação. Utilizaram-se os testes G (Aderência), Qui-quadrado e o de correlação de Spearman para análise estatística (p≤0,05). A maioria apresentou problema ligeiro para função vesical (b6202.1) e nenhuma dificuldade (d465.0) ou moderada (d465.2) para a necessidade de auxílio na marcha. Houve correlação (p=0,009) entre o auxílio na marcha e a função da bexiga. Assim, os códigos da CIF mostraram que quanto maior a dificuldade de locomoção maior é o problema na função da bexiga.

Current analytic, observational and transversal study correlates bladder dysfunction and the need for gait aid in people with human T-lymphotropic virus type 1. Investigation was undertaken with 16 patients of both genders, with a definite diagnosis for Tropical Spastic Paraparesis/Mielopathy, associated with HTLV-1 (PET/ MAH), evaluated by the Spastic Paraplegia Rating Scale (SPRS) and characterized as to help degree in gait by devices employed during walking. Finding were codified by the International Classification for Functionality, Disability and Health (ICF). Findings related to vesical function were converted into component body functions; in the case of gait aid, they were converted into activity and participation. G test (adherence), chi-square and Spearman´s correlation for statistical analysis (p≤0.05) were employed. Most patients had a slight condition for vesical function (b6202.1), with no (d465.0) or only moderate difficulty (d465.2) for gait aid. There was a correlation (p=0.009) between gait aid and bladder function. ICF codes revealed that the greatest the difficulty in locomotion, the biggest the issue in bladder function.

Seroepidemiology of arbovirus in communities living under the influence of the lake of a hydroelectric dam in Brazil / Soroepidemiologia das arboviroses em comunidades que vivem sob a influência do lago de uma usina hidrelétrica no Brasil

Abstract Introduction The arbovirus proposes an important problem of public health in Brazil, especially in the Amazon, due to its capacity to cause outbreaks with high levels of morbidity-mortality in humans as well as in animals. Objective This paper had the objective to estimate the prevalence of antibodies to arbovirus in communities that live under the influence of the artificial lake of UHE Tucuruí in the State of Pará, Brazil. Method The analytical transversal study has selected 657 blood serum samples of individuals over 18, both genders, residents at the Sustainable Development Reserves (SDR) in the region of the lake of UHE Tucuruí. The epidemiological information has been registered in an instrument especially designed for such a study and the blood samples were collected in two periods of high and low tide of the lake. The blood serum tests were performed by the method of hemagglutination inhibition (HI). Results The results revealed a prevalence of positive antibodies to arbovirus of 85.0%, being 84.1% related to Flavivirus (vaccine strain of YFV), 25.5% related to Alphavirus and 34.6% to Bunyavirus. The results of serum prevalence to arbovirus between the periods of high tide and low tide have revealed significance amongst the Alphavirus, not observed in the other families. Conclusion In general, the data from this paper have suggested that the anthropoid actions on the environment of the lake have become determinant factors for the prevalence of arboviral antibodies.

Resumo Introdução Os arbovírus representam um importante problema de saúde pública no Brasil, especialmente na Amazônia, devido à sua capacidade de causar surtos em seres humanos e em animais. Objetivo Este trabalho teve o objetivo de estimar a prevalência de anticorpos para arbovírus em comunidades que vivem sob a influência do lago artificial de barragem hidrelétrica no Brasil. Método O estudo transversal analítico selecionou 657 amostras de sangue de indivíduos de ambos os sexos, residentes na região do lago. As informações epidemiológicas foram registradas em um instrumento concebido para este estudo e as amostras de sangue foram coletadas em períodos de maré alta e maré baixa do lago. Os testes sorológicos foram realizados pelo método de inibição da hemaglutinação (IH). Resultados Os resultados revelaram uma prevalência de anticorpos positivos para arbovírus de 85%, com 84,1% referentes ao Flavivirus (cepa vacinal de FA), 25,5% em relação ao Alphavirus e 34,6% para Orthobunyavirus. Os resultados de prevalência de anticorpos para arbovírus entre os períodos de maré alta e maré baixa revelaram significância entre os Alphavirus. Conclusão Em geral, os dados sugerem que as ações antrópicas no ambiente do lago tornaram-se fatores determinantes para a prevalência de anticorpos arbovirais.

Housing conditions and the degree of home satisfaction of elderly riverside residents of the Amazon region / Condições de habitação e grau de satisfação domiciliar entre idosos ribeirinhos amazônicos / Las condiciones de vivienda y el grado de satisfacción del hogar entre ribereños amazónicos ancianos

At the crossroads of environmental psychology and social gerontology, this descriptive and exploratory study investigates the housing conditions of the elderly who live close to an Amazonian river and assesses their degree of satisfaction with their housing. Using four instruments, we study 23 elderly residents of the river islands of the municipality of Cametá, Pará, Brazil. Despite high territorial isolation, low socioeconomic status, and largely inappropriate housing conditions, the results reveal the elderly's overall satisfaction with their home environment, except in relation to accessibility and safety. The data of this study give larger visibility to people's main needs in this context and provide relevant information for the planning of social and health policies aimed at bettering the quality of this stage of the life span.(AU)

Condições de habitação e grau de satisfação domiciliar entre idosos ribeirinhos amazônicos Resumo: À perspectiva da Psicologia Ambiental e da Gerontologia Social, este estudo de caráter descritivo e exploratório objetivou investigar as condições habitacionais de idosos ribeirinhos amazônicos, assim como, descrever o grau de satisfação dos mesmos quanto ao ambiente de moradia onde vivem. Utilizando-se de quatro instrumentos metodológicos, foram investigados 23 idosos residentes das ilhas fluviais do município de Cametá, Pará, Brasil. Os resultados revelaram que apesar do grande isolamento territorial, do baixo nível socioeconômico e das condições pouco adequadas de habitação dos idosos ribeirinhos amazônicos inqueridos, os mesmos denotam bom grau de satisfação em relação ao ambiente domiciliar, exceto em relação à acessibilidade e segurança. Os dados apresentados neste estudo dão maior visibilidade às principais carências desse contexto e fornece subsídios para o planejamento de políticas sociais e de saúde que visem melhor qualidade nesta etapa da vida e neste contexto.(AU)

Desde la perspectiva de la Psicología Ambiental y Gerontología Social, este estudio de carácter descriptivo y exploratorio tuvo como objetivo investigar las condiciones habitacionales entre ancianos ribereños amazónicos, así como describir el grado de satisfacción de los mismos, con relación al ambiente de la vivienda donde habitan.Usando cuatro instrumentos metodológicos se investigaron 23 ancianos residentes en las islas fluviales del municipio de Cametá, Pará, Brasil. Los resultados revelaron que a pesar del gran aislamiento territorial, del bajo nivel socio-económico y de las condiciones poco adecuadas de habitación, los ancianos demuestran buen grado de satisfacción con el ambiente domiciliar, excepto en lo que se refiere a accesibilidad y seguridad. Los datos presentados en este estudio dan mayor visibilidad a las principales carencias de este contexto y proporcionan subsidios para la planificación de políticas sociales y de salud, dirigidas a una mejor calidad de vida en esta etapa y en este contexto.(AU)

The perception of elderly riverside residents of the Amazon region: the empirical knowledge that comes from rivers / Percepção de idosos ribeirinhos amazônicos sobre o processo de envelhecimento: o saber empírico que vem dos rios

Abstract Objective: To study and identify the perception of elderly riverside people of the Amazon region regarding old age. Method: An exploratory, descriptive, qualitative study was performed. Data was collected through interviews with 14 elderly riverside residents of the city of Cametá, Pará, Brazil. A script consisting of characterization data and an interview with semi-structured questions was used, guided by the following questions: "What is aging for you?" and "Is aging good or bad?". The participant observation technique was also used, through a field diary. For data analysis, we opted for thematic-categorical content analysis. Results: Generally, the elderly had a heterogeneous perception of old age. However, all saw it as a process anchored to the naturalness of life, as well as death. Some of the elderly persons associated old age with a phase of life with negative repercussions due to the appearance of functional disorders and limitations and especially the reduction of availability for work. It can be conferred that the majority, even with while displaying some limitations in this stage of life, have clear and well defined coping strategies, such as the recognition of their limitations or family and religious support. Conclusion: The study found that aging is the shared result of the experiences and knowledge of the interaction of the elderly persons with the riverside environment around them, resulting in their cultural differentiation.

Resumo Objetivo: Conhecer e analisar a percepção de idosos ribeirinhos amazônicos acerca do processo de envelhecimento. Método: Estudo exploratório-descritivo de abordagem qualitativa. Os dados foram coletados por meio de entrevistas realizadas com 14 idosos ribeirinhos, moradores de sete ilhas fluviais do município de Cametá, Pará, Brasil. Utilizou-se roteiro constituído de dados de caracterização do idoso e entrevista com perguntas semiestruturadas, orientadas pelas seguintes questões norteadoras: "O que é o envelhecimento para o(a) senhor(a)?" e "Envelhecer é bom ou ruim?". Foi utilizada também a técnica observação-participante por meio de diário de campo. Para o exame dos dados, optou-se pela análise de conteúdo temático-categorial. Resultados: De modo geral, o grupo pesquisado destacou-se pela percepção heterogênea em relação à compreensão do envelhecimento. No entanto, todos referiram ser um processo ancorado à naturalidade da vida, assim como a morte. Parte desses idosos associou sua velhice a uma fase da vida com repercussões negativas, devido ao aparecimento das doenças e limitações funcionais e, principalmente, à redução da disponibilidade para o trabalho. Pôde-se constatar que a maioria, mesmo apresentando alguma limitação nessa fase, detém estratégias de enfrentamentos claras e bem definidas, como por exemplo: o reconhecimento das suas limitações, o suporte familiar e religioso. Conclusão: Com o estudo, constatou-se que envelhecer é o resultado compartilhado de experiências e saberes próprios da interação dos idosos com o ambiente ribeirinho que os rodeia, e tal circunstância os tornam culturalmente diferenciados.

Perfil clínico-epidemiológico de pacientes infectados pelo HTLV-1 em Belém/Pará / Clinical-epidemiological profile of HTLV-1 infected patients in Belém, Pará state, Brazil

ResumoObjetivoInvestigar o perfil clínico-epidemiológico de pacientes portadores do HTLV-1 em Belém, no Estado do Pará, Brasil, descrevendo as características de indivíduos infectados e atendidos no Laboratório de Clínica e Epidemiologia de Doenças Endêmicas (LCEDE) do Núcleo de Medicina Tropical (NMT) da Universidade Federal do Pará (UFPA).MetodologiaFoi um estudo descritivo de corte transversal, com coleta em prontuários de pacientes infectados pelo HTLV-1, matriculados no LCEDE do NMT da UFPA entre os anos 2000 a 2012. Foi aplicada a análise descritiva pelo programa Epi Info 3.2.5.ResultadosDos 182 prontuários, 35,2% eram do sexo masculino, e 64,8%, do sexo feminino. Houve predomínio de indivíduos casados (47,8%). A maioria (73,6%) tinha procedência do município de Belém-PA. Dentre os pacientes sintomáticos, 51% apresentavam sintomas neurológicos, 21%, queixas dermatológicas, 18%, queixas reumatológicas, e 10%, queixas autonômicas. Com relação aos pacientes com sintomas neurológicos, 16 (39,0%) foram diagnosticados com PET/MAH.ConclusõesHouve o predomínio do sexo feminino, na faixa etária entre 40 e 49 anos, casado, trabalho informal, procedentes de Belém, com queixas neurológicas e com retorno regular as consultas médicas.

AbstractObjectiveThe clinical-epidemiological profile of patients with HTLV-1 in Belém, Pará state, Brazil was investigated describing the characteristics of these patients at an outpatient service of the Clinical and Epidemiologic Laboratory of Endemic Diseases - LCEDE from the Tropical Medicine Center - NMT of the Federal University of Pará - UFPA.MethodologyIt was a descriptive, cross-sectional study with data collected from the records of HTLV-1 patients from 2000 to 2012. Descriptive analysis used Epi Info 3.2.5 software.ResultsOf the 182 patients, 35.2% were male and 64.8% female, with a predominance of married individuals (47.8%), approximately 73.6% were from Belém. Among the symptomatic patients, 51% presented neurological symptoms, 21% dermatological complaints, 18% rheumatologic complaints, and 10% autonomic complaints. Among the patients with neurological symptoms, 16 (39%) were diagnosed with HAM/TSP.ConclusionThere is predominance of females, aged 40-49 years, married, with informal jobs, from Belém, with neurological sings and regular return to medical visits.

Using the International Classification of Functioning, Disability and Health as a tool for analysis of the effect of physical therapy on spasticity in HAM/TSP patients.

INTRODUCTION: This study aimed to evaluate spasticity in human T-lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients before and after physical therapy using the International Classification of Functioning, Disability and Health (ICF). METHODS: Nine subjects underwent physical therapy. Spasticity was evaluated using the Modified Ashworth Scale. The obtained scores were converted into ICF body functions scores. RESULTS: The majority of subjects had a high degree of spasticity in the quadriceps muscles. According to the ICF codes, the spasticity decreased after 20 sessions of physical therapy. CONCLUSIONS: The ICF was effective in evaluating spasticity in HAM/TSP patients.

Relationship between growth factors and its implication in the pathogenesis of leprosy.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae which affects the skin and peripheral nervous system. The immune response of the host determines the clinical course of the disease. The tuberculoid form is the result of high cell-mediated immunity characterized by a Th1 response, whereas the lepromatous form is characterized by low cell-mediated immunity and a Th2 humoral response. The neural damage established produces marked changes in the expression of growth factors such as nerve growth factor (NGF) and its receptors (NGF-R). The expression of NGF, associated with the expression of Th1 and Th2 cytokines, might be involved in the tissue damage caused by the bacillus. Therefore, the objective of this study was to correlate the immunoexpression patterns of NGF and NGF-R in the different clinical forms of leprosy, and to associate the findings with the in situ expression of TGF-ß and clinical classification of the disease. TGF-ß, NGF and NGF-R immunoexpression was analyzed by immunohistochemistry in paraffin-embedded material. Most patients were males with a mean age of 40.7 years. TGF-ß levels were significantly higher in the lepromatous forms. No significant difference in the immunoexpression of NGF or NGF-R was observed between the clinical forms, but expression tended to be higher at the lepromatous pole. There was a significant positive correlation between NGF and NGF-R in the different clinical forms of leprosy. A significant positive correlation was observed between NGF, NGF-R and TGF-ß. It can be concluded that, even existing evidence on the role of these molecules in the clinical spectrum of leprosy.

[Prevalence of genital HPV infection in urban and rural women in the Eastern Brazilian Amazon]. / Prevalência de infecção genital pelo HPV em populações urbana e rural da Amazônia Oriental Brasileira.

This study investigated the prevalence and risk factors for genital infection with HPV in women from rural and urban areas in two different regions of the Eastern Brazilian Amazon. A cross-sectional survey was performed in Pap screening programs, with a total sample of 444 women (233 urban and 211 rural). Uterine cervical swabs were collected for the detection of HPV DNA with the established PCR assay using MY09-MY11. All volunteers answered an epidemiological questionnaire. Bivariate and multivariate logistic regression analyses were performed to identify risk factors associated with HPV infection. Overall prevalence of HPV infection was 14.6% (15% in urban women and 14.2% in rural). The only factor associated with HPV was marital status in the 13-25-year-old rural population, with higher HPV prevalence among single and divorced women and widows. The findings indicate the need for risk factor control strategies targeted specifically to women in rural and urban areas.

Prevalência de infecção genital pelo HPV em populações urbana e rural da Amazônia Oriental Brasileira / Prevalence of genital HPV infection in urban and rural women in the Eastern Brazilian Amazon

Foram investigados a prevalência e os fatores associados à infecção genital pelo HPV em mulheres de população urbana e rural de duas regiões da Amazônia Oriental brasileira. Foi um estudo transversal com 444 mulheres submetidas ao rastreamento para câncer cervical, sendo 233 urbanas e 211 rurais, de janeiro de 2008 a março de 2010. Coletaram-se amostras da cérvice uterina para a pesquisa de DNA do HPV pela PCR. Todas responderam a um formulário epidemiológico. Análise bivariada e por regressão logística foram empregadas na investigação dos fatores associados ao HPV. A prevalência geral de HPV foi de 14,6 por cento. Entre as populações, não houve diferença significativa, 15 por cento urbana e 14,2 por cento rural. O único fator de risco explorado no estudo significativamente associado ao HPV foi a situação conjugal de mulheres residentes na zona rural na faixa de 13 a 25 anos, com maior prevalência de infecção entre solteiras, separadas ou viúvas. Conclui-se que, apesar das prevalências entre as populações serem semelhantes, as estratégias preventivas a serem aplicadas seriam específicas para cada população.

This study investigated the prevalence and risk factors for genital infection with HPV in women from rural and urban areas in two different regions of the Eastern Brazilian Amazon. A cross-sectional survey was performed in Pap screening programs, with a total sample of 444 women (233 urban and 211 rural). Uterine cervical swabs were collected for the detection of HPV DNA with the established PCR assay using MY09-MY11. All volunteers answered an epidemiological questionnaire. Bivariate and multivariate logistic regression analyses were performed to identify risk factors associated with HPV infection. Overall prevalence of HPV infection was 14.6 percent (15 percent in urban women and 14.2 percent in rural). The only factor associated with HPV was marital status in the 13-25-year-old rural population, with higher HPV prevalence among single and divorced women and widows. The findings indicate the need for risk factor control strategies targeted specifically to women in rural and urban areas.