The impact of the COVID-19 pandemic on neuropsychiatric and sleep disorders, and quality of life in individuals with neurodegenerative and demyelinating diseases: a systematic review and meta-analysis of observational studies.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has affected the mental health, sleep and quality of life, especially in individuals with chronic disease. Therefore, the purpose of this systematic review and meta-analysis was to investigate the impact of the COVID-19 pandemic on neuropsychiatric disorders (depression, anxiety, stress), sleep disorders (sleep quality, insomnia) and quality of life in individuals with Parkinson's disease (PD), Multiple Sclerosis (MS) and Alzheimer's disease (AD) compared to healthy controls. METHODS: Seven databases (Medline, Embase, ScienceDirect, Web of Science, The Cochrane Library, Scielo and Lilacs) were searched between March 2020 and December 2022. Observational studies (i.e., cross-sectional, case-control, cohort) were included. GRADE approach was used to assess the quality of evidence and strength of the recommendation. Effect size was calculated using standardized mean differences (SMD; random effects model). A customized Downs and Black checklist was used to assess the risk of bias. RESULTS: Eighteen studies (PD = 7, MS = 11) were included. A total of 627 individuals with PD (healthy controls = 857) and 3923 individuals with MS (healthy controls = 2432) were analyzed. Twelve studies (PD = 4, MS = 8) were included in the meta-analysis. Individuals with PD had significantly elevated levels of depression (very low evidence, SMD = 0.40, p = 0.04) and stress (very low evidence, SMD = 0.60, p < 0.0001). There was no difference in anxiety (p = 0.08). Individuals with MS had significantly higher levels of depression (very low evidence, SMD = 0.73, p = 0.007) and stress (low evidence, SMD = 0.69, p = 0.03) and low quality of life (very low evidence, SMD = 0.77, p = 0.006). There was no difference in anxiety (p = 0.05) and sleep quality (p = 0.13). It was not possible to synthesize evidence in individuals with AD and sleep disorder (insomnia). CONCLUSION: In general, the COVID-19 pandemic negatively impacted individuals with PD and MS. Individuals with PD showed significantly higher levels of depression and stress; and individuals with MS presented significantly higher depression and stress levels, as well as significantly lower quality of life when compared to healthy controls. Further studies are needed to investigate the impact of the COVID-19 pandemic in individuals with AD.

Predictive factors for extubation success in very low and extremely low birth weight preterm infants.

Background: Although invasive mechanical ventilation (IMV) has contributed to the survival of preterm infants with extremely low birth weight (ELBW), it is also associated with unsatisfactory clinical outcomes when used for prolonged periods. This study aimed to identify factors that may be decisive for extubation success in very low birth weight (VLBW) and extremely low birth weight (ELBW) preterm infants. Methods: The cohort study included preterm infants with gestational age (GA) <36 weeks, birth weight (BW) <1500 grams who underwent IMV, born between 2015 and 2018. The infants were allocated into two groups: extubation success (SG) or failure (FG). A stepwise logistic regression model was created to determine variables associated with successful extubation. Results: Eighty-three preterm infants were included. GA and post-extubation arterial partial pressure of carbon dioxide (PaCO2) were predictive of extubation success. Infants from FG had lower GA and BW, while those from SG had higher weight at extubation and lower post-extubation PaCO2. Discussion: Although we found post-extubation PaCO2 as an extubation success predictor, which is a variable representative of the moment after the primary outcome, this does not diminish its clinical relevance since extubation does not implicate in ET removal only; it also involves all the aspects that take place within a specified period (72 hours) after the planned event. Conclusion: GA and post-extubation PaCO2 were predictors for extubation success in VLBW and ELBW preterm infants. Infants who experienced extubation failure had lower birth weight and higher FiO2 prior to extubation.

Are the Effects of High-Intensity Exercise Training Different in Patients with COPD Versus COPD+Asthma Overlap?

PURPOSE: This study aimed to investigate whether patients with chronic obstructive pulmonary disease (COPD) presenting asthma overlap (ACO) benefit similarly in comparison to patients with only COPD after a 12-week high-intensity exercise training (ET) program. METHODS: Subjects with a diagnosis of COPD alone or ACO were evaluated and compared before and after a high-intensity ET program composed of walking and cycling plus strengthening exercises of the upper and lower limbs (3 days/week, 3 months, 36 sessions). Assessments included spirometry, bioelectrical impedance, 6-min walk test (6MWT), London Chest Activity of Daily Living Scale (LCADL), Hospital anxiety and depression Scale, modified Medical Research Council Scale (mMRC), Saint George Respiratory Questionnaire (SGRQ), and respiratory and peripheral muscle strength [manovacuometry and 1-repetition maximum test (quadriceps femoris, biceps and triceps brachialis), respectively]. ACO was defined according to Sin et al. (Eur Respir J 48(3):664-673, 2016). RESULTS: The sample was composed of 74 subjects (57% male, age 67 ± 8 years, BMI 26 (21-32) kg/m2, FEV1 47 ± 17%predicted), and 12 (16%) of them were classified as presenting ACO. Both groups improved pulmonary function, 6MWT, peripheral and inspiratory muscle strength, LCADL, and SGRQ after ET (p < 0.005 for all). There were no significant interactions between ACO and COPD on ET effects (p > 0.05 for all). Likewise, there was no difference in the proportion of patients achieving the minimum clinical important difference for 6MWT and mMRC. CONCLUSION: High-intensity exercise training generates similar benefits in patients with COPD regardless of whether presenting asthma overlap or not.

Functional Status of Patients with COPD Assessed by London Chest Activity of Daily Living Scale: Gender Association and Validity of a Cutoff Point.

PURPOSE: Whether the difference in the impact of chronic obstructive pulmonary disease (COPD) on the functional status of men and women stems from clinical distinctions or to the measuring instrument used is unclear. Like most instruments for assessing functional limitation in COPD, the interpretation of the results of the London Chest Activity of Daily Living (LCADL) scale is limited because a lack of a valid cutoff point to this scale. For that, this study sought to compare the functional status between men and women with COPD; and propose a cutoff point for LCADL capable of discriminating the prognosis of these individuals. METHODS: A sample of 138 subjects with moderate-severe COPD was evaluated by the LCADL. The percentage of the individual maximum score was used to obtain a cutoff point capable of discriminating patients with the worse prognosis according to the BODE Index. The cutoff point was also tested in an independent sample (n = 70). RESULTS: Regarding the total score, domestic and leisure domains of the LCADL, men had better scores than women (P ≤ 0.01). The cutoff point found was 37% (area under the curve = 0.70, 95% confidence interval = 0.60-0.80, sensitivity = 0.55 and specificity = 0.74). Individuals who scored ≥ 37% had a worse prognosis and level of physical activities of daily living than those who scored below (P ≤ 0.02). CONCLUSION: When evaluated by the LCADL, men and women with COPD present difference in the functional status. The established cutoff point (37%) adequately discriminates individuals regarding the prognosis, contributing to improve the interpretation capacity of the LCADL.

Cluster analysis identifying patients with COPD at high risk of 2-year all-cause mortality.

The objective of the article is to identify clusters of patients with COPD according to factors known to be associated with mortality and to verify whether clusters' assignment is associated with 2-year mortality. Patients ( n = 141) were evaluated by bioelectrical impedance, maximal inspiratory pressure (MIP), one-repetition maximum test of the quadriceps femoris (1RMQF) and BODE index (body mass index; airflow obstruction (spirometry); dyspnea (modified Medical Research Council scale); and exercise capacity (6-minute walk test (6MWT) distance). Vital status was retrospectively checked 2 years after the assessments, and time to death was quantified for those deceased in this period. K-means analysis identified two clusters. Patients in cluster one (CL I, n = 69) presented an impaired clinical status in comparison to cluster two (CL II, n = 72). Receiver operating characteristics curves identified the cutoffs discriminating patients composing CL I: forced expiratory volume in the first second <44%pred; 6MWT <479 m; 1RMQF <19 kg; and maximum inspiratory pressures <73 cmH2O (area under the curve range 0.750-0.857). During the follow-up, 19 (13%) patients deceased, 15 in CL I (22%) and 4 in CL II (0.06%) ( p = 0.005). CL I was associated with a higher risk of 2-year mortality (hazard ratio (95% confidence interval): 4.3 (1.40-12.9), p = 0.01). A cluster of patients with COPD highly associated with 2-year mortality was statistically identified, and cutoffs to identify these subjects were provided.

Simple Lower Limb Functional Tests in Patients With Chronic Obstructive Pulmonary Disease: A Systematic Review.

OBJECTIVES: To evaluate the characteristics and available evidence on the measurement properties of the gait speed (GS) test, timed Up and Go test (TUG), sit-to-stand (STS) test, and step test; to investigate their relation with clinical outcomes in chronic obstructive pulmonary disease (COPD); and to provide recommendations for clinical practice and future research. DATA SOURCES: Studies were systematically identified from a literature search using PubMed, PEDro, CINAHL, and Cochrane Library databases and the reference lists of the included articles. STUDY SELECTION: Studies including ≥1 of these 4 lower limb functional tests (GS test, TUG, STS test, and step test) as an outcome in patients with COPD were selected. No limits were applied for language and study design. DATA EXTRACTION: Two researchers independently performed data extraction and, by using the COnsensus-based standards for the Selection of health status measurement INstruments, assessed the quality of those studies that described measurement properties. DATA SYNTHESIS: Forty-two articles met the selection criteria. GS test, STS test, and step test are valid, reproducible, and responsive tests, especially the 4-meter GS, 5-repetition STS test, and 6-minute step test (6MST). The TUG is reliable; however, studies on other measurement properties of this test are lacking. Outcomes of these tests are correlated with mortality, physical activity in daily life, exercise capacity, dyspnea, and quality of life. CONCLUSIONS: Simple and functional lower limb tests provide information about important clinical outcomes in patients with COPD. The 4-meter GS, 5-repetition STS test, and 6MST are tests with well-established psychometric properties, whereas the properties of the TUG need to be studied further.

Relationship between sniff nasal inspiratory pressure and BODE index in patients with COPD.

PURPOSE: The aims of this study were to investigate the relationship between sniff nasal inspiratory pressure (SNIP) and severity of chronic obstructive pulmonary disease (COPD) as defined by the BODE index, and to investigate the capacity of different SNIP cutoffs to predict a BODE index score ≥5 (i.e., worse disease severity). METHODS: Thirty-eight subjects with COPD (21 men, 66 ± 8 years, forced expiratory volume in the first second (FEV(1)) 42 ± 16 % predicted) underwent assessments of SNIP, airflow limitation, body mass index (BMI), dyspnea (Medical Research Council scale), and exercise capacity (6-min walking test, 6MWT). The BODE index was calculated, and patients were separated into two groups according to the BODE quartiles (1 and 2, or 3 and 4). RESULTS: Patients from quartiles 3 and 4 presented lower values of SNIP than patients from quartiles 1 and 2 (73 ± 18 vs 56 ± 21 cmH(2)O, respectively; p = 0.01). There was significant and inverse correlation between SNIP and the BODE index (r = -0.62; p<0.001). A logistic regression model revealed that a SNIP value below 63 cmH(2)O presented higher sensitivity and specificity (70 and 67 %, respectively) for predicting a BODE score equivalent to quartiles 3 or 4. CONCLUSION: SNIP is moderately and significantly related to COPD severity as assessed by the BODE index. Moreover, the cutoff point of 63 cmH2O showed the best combination of sensitivity and specificity for predicting worse scores in the BODE index.

Grasping the meaning of perinatal palliative care for the multiprofessional team.

OBJECTIVE: To grasp the meaning of perinatal palliative care for the multidisciplinary team. METHODS: This is a qualitative study guided by content analysis. The study included 56 health professionals working in maternal and child units of a public university hospital. A semi-structured interview was conducted, which was recorded and subsequently fully transcribed. The collection took place from June 2018 to May 2019. Data were entered and exported to Atlas ti: The Qualitative Date Analysis & Research Software, version 23.1.1.0. RESULTS: Four thematic categories emerged from the data analysis: palliative care and eligible public in the view of professionals; communication between family and team in decision-making; assistance in palliative care; humanized care. CONCLUSIONS: The professionals think of palliative care in Perinatology in a similar way and perceive the difficulties of communication with the family and decision-making. They agree that it is necessary to provide greater support to the family, and to provide comfort measures, either for the non-viable fetus or for the baby eligible for palliative care.

Association of IGF-1 and IGF-2 genotypes with respiratory muscle strength in individuals with COPD: A cross-sectional study.

Introduction: Chronic obstructive pulmonary disease is a systemic disease characterized not only by respiratory symptoms but also by physical deconditioning and muscle weakness. One prominent manifestation of this disease is the decline in respiratory muscle strength. Previous studies have linked the genotypes of insulin-like growth factor 1 and 2 (IGF-1 and IGF-2) to muscle weakness in other populations without this disease. However, there is a notable knowledge gap regarding the biological mechanisms underlying respiratory muscle weakness, particularly the role of IGF-1 and IGF-2 genotypes in this pulmonary disease. Therefore, this study aimed to investigate, for the first time, the association between IGF-1 and IGF-2 genotypes with respiratory muscle strength in individuals with chronic obstructive pulmonary disease. In addition, we analyzed the relationship between oxidative stress, chronic inflammation, and vitamin D with respiratory muscle strength. Methods: A cross sectional study with 61 individuals with chronic obstructive pulmonary disease. Polymerase chain reaction of gene polymorphisms IGF-1 (rs35767) and IGF-2 (rs3213221) was analyzed. Other variables, related to oxidative stress, inflammation and Vitamin D were dosed from peripheral blood. Maximal inspiratory and expiratory pressure were measured. Results: The genetic polymorphisms were associated with respiratory muscle strength ( 3.0 and 3.5; = 0.57). Specific genotypes of IGF-1 and IGF-2 presented lower maximal inspiratory and expiratory pressure (<0.05 for all). Oxidative stress, inflammatory biomarkers, and vitamin D were not associated with respiratory muscle strength. Conclusion: The polymorphisms of IGF-1 and IGF-2 displayed stronger correlations with respiratory muscle strength compared to blood biomarkers in patients with chronic obstructive pulmonary disease. Specific genotypes of IGF-1 and IGF-2 were associated with reduced respiratory muscle strength in this population.

Introducción: La enfermedad pulmonar obstructiva crónica es una enfermedad sistémica caracterizada no solo por síntomas respiratorios, sino también por el deterioro físico y la debilidad muscular. Una manifestación destacada de esta enfermedad es el declive en la fuerza de los músculos respiratorios. Estudios previos han vinculado los genotipos de factor de crecimiento insulínico 1 y 2 (IGF-1 e IGF-2) con la debilidad muscular en poblaciones sin esta enfermedad. Sin embargo, existe un vacío de conocimiento con respecto a los mecanismos biológicos subyacentes a la debilidad de los músculos respiratorios, en particular el papel de los genotipos IGF-1 e IGF-2 en esta enfermedad pulmonar. Por lo tanto, este estudio tuvo como objetivo investigar, por primera vez, la asociación de los genotipos IGF-1 e IGF-2 con la fuerza de los músculos respiratorios en individuos con enfermedad pulmonar obstructiva crónica. Además, analizamos la relación entre el estrés oxidativo, la inflamación crónica y la vitamina D con la fuerza de los músculos respiratorios. Métodos: Un estudio transversal con 61 individuos con enfermedad pulmonar obstructiva crónica. Se analizó la reacción en cadena de la polimerasa de los polimorfismos genéticos IGF-1 (rs35767) e IGF-2 (rs3213221). Otras variables relacionadas con el estrés oxidativo, la inflamación y la vitamina D se dosificaron a partir de muestras de sangre periférica. Se midieron las presiones inspiratorias y espiratorias máximas. Resultados: Los polimorfismos genéticos están asociados con la fuerza de los músculos respiratorios (F: 3.0 y 3.5; R2= 0.57). Genotipos específicos de IGF-1 e IGF-2 presentaron bajos valores en las presiones inspiratorias y espiratorias (p<0.05 en todos los casos). El estrés oxidativo, los biomarcadores inflamatorios y la vitamina D no se asociaron con la fuerza de los músculos respiratorios. Conclusión: Los polimorfismos de IGF-1 e IGF-2 mostraron correlaciones más sólidas con la fuerza de los músculos respiratorios en pacientes con enfermedad pulmonar obstructiva crónica en comparación con los biomarcadores sanguíneos. Genotipos específicos de IGF-1 e IGF-2 se asociaron con una disminución de la fuerza de los músculos respiratorios en esta población.

Comparison of Two Frailty Assessment Methods and Their Association with Functionality in Subjects with Exacerbation of COPD.

Objectives: To verify the prevalence of frailty in patients hospitalized with acute exacerbation of COPD; to compare two frailty assessment methods: Edmonton Scale and the Fried Frailty Phenotype, and to associate frailty with functioning in these patients. Methods: Patients hospitalized due to an acute exacerbation of COPD were included. The assessment of pulmonary function, frailty, and functioning was performed. Frailty assessment was performed by the Edmonton Scale and Fried Frailty Phenotype. Individuals were classified into "frail," "pre-frail" and "non-frail." Functioning was evaluated by the one sit-to-stand test. Results: Thirty-five individuals were included (17 male, 69 ± 9 years; FEV1/FVC 47 ± 10%; FEV1 34 (24-52) % predicted). Participants scored 3 (3-4) points on the Edmonton Scale and 7 (5-9) points on the Fried Frailty Phenotype. According to the Fried model, 17% were considered prefrail and 83% frail and in the Edmonton scale, 20% were classified as nonfrail, 29% prefrail, and 51% frail. There was a positive moderate correlation between the two methods (r = 0.42; p=0.011); however, there was no agreement between them (p=0.20). This probably occurs because they assess the same construct, i.e., frailty; however, they are different in their components. There was a negative and moderate correlation between the Fried Frailty Phenotype and functioning (r = -0.43; p=0.009). Conclusion: Most hospitalized individuals with exacerbated COPD with severe and very severe airflow limitation are frail and the assessment methods correlate, but there is no agreement. Additionally, there is association between frailty and functioning in this population.

Pulmonary function is associated with frailty, hospitalization and mortality in older people: 5-year follow-up.

BACKGROUND: The relationship between pulmonary impairment and frailty has rarely been studied in community-dwelling older adults. OBJECTIVE: This study aimed to analyze the association between pulmonary function and frailty (prevalent and incident), identifying the best cut-off points to detect frailty and its association with hospitalization and mortality. METHODS: A longitudinal observational cohort study with 1188 community-dwelling older adults was taken from the Toledo Study for Healthy Aging. The forced expiratory volume in the first second (FEV1) and the forced vital capacity (FVC) were measured with spirometry. Frailty was evaluated using the Frailty Phenotype and Frailty Trait Scale 5. Associations between pulmonary function and frailty, hospitalization and mortality in a 5-year follow-up and the best cut-off points for FEV1 and FVC were analyzed. RESULTS: FEV1 and FVC were associated with frailty prevalence (OR from 0.25 to 0.60), incidence (OR from 0.26 to 0.53), and hospitalization and mortality (HR from 0.35 to 0.85). The cut-off points of pulmonary function identified in this study: FEV1 (≤1.805 L for male and ≤1.165 L for female) and FVC (≤2.385 L for male and ≤1.585 L for female) were associated with incident frailty (OR: 1.71-4.06), hospitalization (HR: 1.03-1.57) and mortality (HR: 2.64-5.17) in individuals with and without respiratory diseases (P < 0.05 for all). CONCLUSION: Pulmonary function was inversely associated with the risk of frailty, hospitalization and mortality in community-dwelling older adults. The cut-off points for FEV1 and FVC to detect frailty were highly associated with hospitalization and mortality in the 5-year follow-up, regardless of the existence of pulmonary diseases.

Quantification of changes in functional capacity and muscle strength in patients: a burn intensive care unit cohort study.

BACKGROUND: Regular functional status and muscle strength assessments should be performed with burn victims. OBJECTIVE: To evaluate the functionality and peripheral muscle strength of burn patients admitted to the hospital. METHODS: A longitudinal and prospective study was conducted from March to November 2019, including adult burn victims who were admitted to the ICU and discharged from the hospital. Patients were assessed on admission, every 10 days, at discharge from the ICU and from the hospital. Functionality was assessed using the Chelsea Critical Care Physical Assessment (CPAx) and the Functional Independence Measure (FIM). Muscle strength was assessed using the Medical Research Council (MRC) scale and handgrip dynamometry. RESULTS: 41 patients were included, 27 men and 14 women, with a median age of 41 (IQR [28-56]) years, mean TBSA of 19 (SD ± 12) percent, mean Abbreviated Burn Severity Index (ABSI) of 6 (SD ± 2) and the mean ICU time was 29 (SD ± 9) days. The CPAx, FIM and MRC evaluations improved (P < 0.0001) when compared to admission to the ICU and at hospital discharge, while the dynamometry showed no statistical difference. The ABSI only showed an association with the length of stay. CONCLUSION: The CPAX scale was sensitive to changes in functionality throughout the hospital stay in severely burned patients, in the present study. The assessment of global muscle strength was more sensitive than handgrip strength and the ABSI was associated with length of stay in this population.

Resistance training prevents deterioration in quadriceps muscle function during acute exacerbations of chronic obstructive pulmonary disease.

RATIONALE: Exacerbations of chronic obstructive pulmonary disease (COPD) acutely reduce skeletal muscle strength and result in long-term loss of functional capacity. OBJECTIVES: To investigate whether resistance training is feasible and safe and can prevent deteriorating muscle function during exacerbations of COPD. METHODS: Forty patients (FEV(1) 49 +/- 17% predicted) hospitalized with a severe COPD exacerbation were randomized to receive usual care or an additional resistance training program during the hospital admission. Patients were followed up for 1 month after discharge. Primary outcomes were quadriceps force and systemic inflammation. A muscle biopsy was taken in a subgroup of patients to assess anabolic and catabolic pathways. MEASUREMENTS AND MAIN RESULTS: Resistance training did not yield higher systemic inflammation as indicated by C-reactive protein levels and could be completed uneventfully. Enhanced quadriceps force was seen at discharge (+9.7 +/- 16% in the training group; -1 +/- 13% in control subjects; P = 0.05) and at 1 month follow-up in the patients who trained. The 6-minute walking distance improved after discharge only in the group who received resistance training (median 34; interquartile range, 14-61 m; P = 0.002). In a subgroup of patients a muscle biopsy showed a more anabolic status of skeletal muscle in patients who followed training. Myostatin was lower (P = 0.03) and the myogenin/MyoD ratio tended to be higher (P = 0.08) in the training group compared with control subjects. CONCLUSIONS: Resistance training is safe, successfully counteracts skeletal muscle dysfunction during acute exacerbations of COPD, and may up-regulate the anabolic milieu in the skeletal muscle. Clinical trial registered with www.clinicaltrials.gov (NCT00877084).

Impact of physical and functional fitness on mortality from all causes of physically independent older adults.

OBJECTIVE: To provide reference values for functional fitness tests (PFFT) and verify the capability of these tests alone and grouped into a general index (GFFI-6), to predict mortality from all causes, during seven years of follow-up of physically independent older adults. METHODS: The sample consisted of 422 older adults, evaluated at baseline using six PFFTs, as well as sociodemographic, behavioral, anthropometric, and comorbidity variables. Mortality from all causes was followed for seven subsequent years. The sample was subdivided into four groups according to sex and age. Performances in the PFFT and GFFI-6 tests were ranked into "low", "regular", and "high". RESULTS: Cox proportional regression, with the adjustment of variables, indicated that the Unipedal Balance Test (BAL), Body Agility (AGI), Sit and Stand-up (SIT-SD) tests, and GFFI-6 were able to significantly predict mortality, indicating that older adults with "low" performance have, respectively, a 2.7 (CI=1.54-4.89, p = 0.01), 4.2 (CI=2.10-8.41), 2.5 (CI=1.44-4.65, p = 0.01), and 4.7 (CI=2.10-10.81, p<0.01) times higher risk of death, compared to older adults with "high" performance. CONCLUSION: BAL, AGI, and SIT-SD tests alone and tests grouped in the GFFI-6 were strong predictors of all-cause mortality in physically independent older adults.

The impact of chronic obstructive pulmonary disease in patients' lives: The perception of the health professionals.

INTRODUCTION: The perception of health professionals about chronic obstructive pulmonary disease (COPD) has not been thoroughly investigated. OBJECTIVE: To analyze the perception of health professionals about the impact of COPD on the lives of affected individuals. MATERIALS AND METHODS: Qualitative and cross-sectional study with five health professionals: two nurses, two physiotherapists, and one medical doctor. They participated in a focus group (FG) session, with semistructured questions covering: definition of COPD, activities of daily living (ADL), and physical activity of daily living (PADL), as well as the importance of these outcomes in the lives of individuals with COPD. DATA ANALYSIS: The FG was recorded, transcribed, and analyzed according to the content analysis. RESULTS: The FG highlighted four main themes: physical-functional and emotional impairment of individuals, the importance of patient-health professional contact, repercussions of COPD on the patients' physical activity, and strategies for promoting physical activity. Based on the four themes exposed, the health professionals reported that there is a progression in the lives of individuals' with COPD, which is divided into three phases: adaptation, reluctance, and dependence. CONCLUSION: There was a negative perception of the health professionals regarding the functionality and emotion of patients with COPD. Emotional aspects, family support, and architectural structure can positively or negatively influence patients' ADL and PADL. Finally, there was a perception of progression in the life of patients with COPD, since their initial adaptation, evolving to physical and emotional dependence.

NOVEL antioxidant and oxidant biomarkers related to sarcopenia in COPD.

BACKGROUND: The relation between oxidative stress (OS) and sarcopenia in COPD remains unknown. OBJECTIVE: To analyze OS levels and its association with sarcopenia in COPD. METHODS: Thirty-nine individuals with COPD (69±7years; 41%female) and thirty-five for the control group (69±7years; 43%female) were included. Advanced oxidation protein products (AOPP), paraoxonase-1 (PON1), superoxide dismutase activity (SOD), catalase dismutase activity (CAT), sulfhydryl group (SH), nitric oxide metabolites (NOX), total radical trapping antioxidant parameter (TRAP) were analysed. OS markers were correlated with handgrip and quadriceps strength, gait speed, skeletal muscle mass index, fat-free mass index, maximum inspiratory and expiratory pressure. European criteria were used to identify sarcopenia. RESULTS: In COPD, antioxidant capacity was correlated with muscle mass and strength (r from 0.5 to 0.64) P<0.05 for all. TRAP≤ 850 µM/trolox and AOPP≤65 µM/l were associated with sarcopenia (OR:8.3; 95% CI: 1.4-49.6 and OR:14; 95%CI: 2.2-87.1, respectively; P<0.05 for both). CONCLUSION: OS is associated with sarcopenia in COPD.

Estimation of maximal work rate based on the 6-minute walk test and fat-free mass in chronic obstructive pulmonary disease.

OBJECTIVE: To propose a predictive equation of the maximal work rate (Wmax) in patients with chronic obstructive pulmonary disease (COPD) based on the product of 6-minute walking test (6MWT) and fat-free mass (FFM) and to compare it with a previously proposed equation based on the product of 6MWT and body weight (BW). DESIGN: Descriptive (cross-sectional) study. SETTING: University-based rehabilitation center. PARTICIPANTS: Patients with COPD (N=53; 30 men; forced expiratory volume in 1 second, 45%±15% predicted). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three Wmax were produced: Wmax_real (obtained from the maximal cycle ergometry test), Wmax_BW (estimated from the product of 6MWT and BW), previously proposed by Hill et al. (Arch Phys Med Rehabil 2008; 89(9):1782-7); and Wmax_FFM (estimated from the product of 6MWT and FFM). RESULTS: The equation derived from a regression model to estimate Wmax_FFM was as follows: -27.9717+3.7792*(6MWT*FFM). Wmax_real correlated better with Wmax_FFM (r=.64) than with Wmax_BW (r=.54). There was no difference between Wmax_FFM (median [interquartile range], 41 [29-50] W) and Wmax_real (40 [20-50] W, P=.88), whereas Wmax_BW (60 [52-69] W) significantly overestimated Wmax_real (P<.0001). CONCLUSIONS: In patients with COPD, Wmax is better estimated by an equation including the product of 6MWT and FFM than by a previously proposed equation including the product of 6MWT and body weight.

Are there differences in muscular activation to maintain balance between individuals with chronic obstructive pulmonary disease and controls?

BACKGROUND: The mechanisms underlying impaired balance in chronic obstructive pulmonary disease (COPD) are poorly understood, which makes it difficult to choose the best therapeutic approaches. Therefore, this study aimed to investigate patterns of muscular activation to maintain balance and its determinants in this population. METHODS: Thirty-three subjects with COPD and 33 controls were assessed by a force platform in four tasks: standing with eyes opened (FHEO) and closed (FHEC); standing on unstable surface (SUS) and one-legged stance (OLS). Electromyographic activity of lower limb, trunk and neck muscles was concomitantly recorded. To asses functional balance, Brief-balance evaluation systems and timed up & go (TUG) tests were applied. Lung function, exercise capacity and muscle force were also assessed. RESULTS: Subjects with COPD presented worse balance and higher scalene activation than controls in OLS (mean difference 23.0 [95%CI 1.7-44.3] %Δ µVRMS; P = 0.034), besides presenting also higher activation of gluteus medius during FHEC task (mean difference 1.5 [95%CI 0.2-2.8] %Δ µVRMS; P = 0.023) and taking longer to complete the TUG (mean difference 0.6 [95%CI 0.1-1.2] seconds; P = 0.042). Exercise capacity and peripheral muscle force were determinants of functional balance (r2 = 0.505), whereas age (OR = 1.24; 95%CI 1.02-1.52) and total lung capacity (OR = 2.42; 95%CI 1.05-5.56) were determinants of static balance. CONCLUSION: Individuals with COPD have worse static and functional balance in comparison with controls, besides presenting higher activation of scalene and gluteus medius during static balance tasks. Exercise capacity and peripheral muscle force emerged as determinants of functional balance, whereas age and lung hyperinflation contributed to poor static balance.

Grasping the meaning of perinatal palliative care for the multiprofessional team / Significando os cuidados paliativos perinatais para a equipe multiprofissional

ABSTRACT Objective: To grasp the meaning of perinatal palliative care for the multidisciplinary team. Methods: This is a qualitative study guided by content analysis. The study included 56 health professionals working in maternal and child units of a public university hospital. A semi-structured interview was conducted, which was recorded and subsequently fully transcribed. The collection took place from June 2018 to May 2019. Data were entered and exported to Atlas ti: The Qualitative Date Analysis & Research Software, version 23.1.1.0. Results: Four thematic categories emerged from the data analysis: palliative care and eligible public in the view of professionals; communication between family and team in decision-making; assistance in palliative care; humanized care. Conclusions: The professionals think of palliative care in Perinatology in a similar way and perceive the difficulties of communication with the family and decision-making. They agree that it is necessary to provide greater support to the family, and to provide comfort measures, either for the non-viable fetus or for the baby eligible for palliative care.

RESUMO Objetivo: Apreender o significado dos cuidados paliativos perinatais para a equipe multiprofissional. Métodos: Trata-se de um estudo qualitativo orientado pela análise de conteúdo. Participaram do estudo 56 profissionais de saúde atuantes em unidades materno-infantis de um hospital universitário público. Foi realizada uma entrevista semiestruturada, a qual foi gravada e posteriormente transcrita na íntegra. A coleta ocorreu no período de junho de 2018 a maio de 2019. Os dados foram digitados e exportados para o software Atlas ti: The Qualitative Date Analysis & Research Software, versão 23.1.1.0. Resultados: Quatro categorias temáticas emergiram da análise dos dados: cuidados paliativos e público elegível na visão dos profissionais; comunicação entre família e equipe na tomada de decisão; assistência no cuidado paliativo; cuidado humanizado. Conclusões: Os profissionais significam os cuidados paliativos em perinatologia de modo semelhante e percebem as dificuldades de comunicação com a família e a tomada de decisão. Concordam que é necessário fornecer maior apoio à família e proporcionar medidas de conforto, seja para o feto inviável, seja para o bebê elegível para cuidados paliativos.

Association of IGF-1 and IGF-2 genotypes with respiratory muscle strength in individuals with COPD: A cross-sectional study / Asociación de los genotipos de IGF-1 e IGF-2 con la fuerza muscular respiratoria en individuos con EPOC: estudio transversal

Introduction Chronic obstructive pulmonary disease is a systemic disease characterized not only by respiratory symptoms but also by physical deconditioning and muscle weakness. One prominent manifestation of this disease is the decline in respiratory muscle strength. Previous studies have linked the genotypes of insulin-like growth factor 1 and 2 (IGF-1 and IGF-2) to muscle weakness in other populations without this disease. However, there is a notable knowledge gap regarding the biological mechanisms underlying respiratory muscle weakness, particularly the role of IGF-1 and IGF-2 genotypes in this pulmonary disease. Therefore, this study aimed to investigate, for the first time, the association between IGF-1 and IGF-2 genotypes with respiratory muscle strength in individuals with chronic obstructive pulmonary disease. In addition, we analyzed the relationship between oxidative stress, chronic inflammation, and vitamin D with respiratory muscle strength. Methods A cross sectional study with 61 individuals with chronic obstructive pulmonary disease. Polymerase chain reaction of gene polymorphisms IGF-1 (rs35767) and IGF-2 (rs3213221) was analyzed. Other variables, related to oxidative stress, inflammation and Vitamin D were dosed from peripheral blood. Maximal inspiratory and expiratory pressure were measured. Results The genetic polymorphisms were associated with respiratory muscle strength ( 3.0 and 3.5; = 0.57). Specific genotypes of IGF-1 and IGF-2 presented lower maximal inspiratory and expiratory pressure (<0.05 for all). Oxidative stress, inflammatory biomarkers, and vitamin D were not associated with respiratory muscle strength. Conclusion The polymorphisms of IGF-1 and IGF-2 displayed stronger correlations with respiratory muscle strength compared to blood biomarkers in patients with chronic obstructive pulmonary disease. Specific genotypes of IGF-1 and IGF-2 were associated with reduced respiratory muscle strength in this population.

Introducción La enfermedad pulmonar obstructiva crónica es una enfermedad sistémica caracterizada no solo por síntomas respiratorios, sino también por el deterioro físico y la debilidad muscular. Una manifestación destacada de esta enfermedad es el declive en la fuerza de los músculos respiratorios. Estudios previos han vinculado los genotipos de factor de crecimiento insulínico 1 y 2 (IGF-1 e IGF-2) con la debilidad muscular en poblaciones sin esta enfermedad. Sin embargo, existe un vacío de conocimiento con respecto a los mecanismos biológicos subyacentes a la debilidad de los músculos respiratorios, en particular el papel de los genotipos IGF-1 e IGF-2 en esta enfermedad pulmonar. Por lo tanto, este estudio tuvo como objetivo investigar, por primera vez, la asociación de los genotipos IGF-1 e IGF-2 con la fuerza de los músculos respiratorios en individuos con enfermedad pulmonar obstructiva crónica. Además, analizamos la relación entre el estrés oxidativo, la inflamación crónica y la vitamina D con la fuerza de los músculos respiratorios. Métodos Un estudio transversal con 61 individuos con enfermedad pulmonar obstructiva crónica. Se analizó la reacción en cadena de la polimerasa de los polimorfismos genéticos IGF-1 (rs35767) e IGF-2 (rs3213221). Otras variables relacionadas con el estrés oxidativo, la inflamación y la vitamina D se dosificaron a partir de muestras de sangre periférica. Se midieron las presiones inspiratorias y espiratorias máximas. Resultados Los polimorfismos genéticos están asociados con la fuerza de los músculos respiratorios (F: 3.0 y 3.5; R2= 0.57). Genotipos específicos de IGF-1 e IGF-2 presentaron bajos valores en las presiones inspiratorias y espiratorias (p<0.05 en todos los casos). El estrés oxidativo, los biomarcadores inflamatorios y la vitamina D no se asociaron con la fuerza de los músculos respiratorios. Conclusión Los polimorfismos de IGF-1 e IGF-2 mostraron correlaciones más sólidas con la fuerza de los músculos respiratorios en pacientes con enfermedad pulmonar obstructiva crónica en comparación con los biomarcadores sanguíneos. Genotipos específicos de IGF-1 e IGF-2 se asociaron con una disminución de la fuerza de los músculos respiratorios en esta población