Predictors of quality of life of individuals living in Brazil with spinal cord injury/disease.

STUDY DESIGN: A cross-sectional, descriptive study. OBJECTIVES: To investigate the demographic, clinical behavioral, and rehabilitation predictors of the quality of life (QoL) of people with spinal cord injury/disease (SCI/D) in a middle-income country. METHOD: Ninety-five participants living in the community were evaluated with the following instruments: World Health Organization Quality of Life - Bref; International SCI Core DataSet; Clinical Interview; Spinal Cord Secondary Conditions Scale and Patient Health Questionnaire; Numerical Pain Intensity Scale; Short-Form 12 Health Survey - Item 8 (how much pain hinders activities); Patient Health Questionnaire 2, Numerical Fatigue Scale. Data were analyzed via Spearman correlation, univariate analysis, and multiple regression to explain the effects associated with quality-of-life predictors. RESULTS: The main factors that decreased quality of life were fatigue (by 11.5%), depression (by 5.5-12.8%), pain (by 1.3 in total life quality, in the physical domain by 8.6-9.6%), sores (15.6% in the physical domain only). The practice of sports increased the total quality of life by 14.4%, in the physical domain by 11.9%, in the psychological domain by 17.2%, and in the social domain by 23.7%. CONCLUSIONS: Fatigue, risk of depression, pain, and the presence of sores are predictors of poor quality of life, and sports are a predictor of a better quality of life, for people with spinal cord injury. Multidisciplinary rehabilitation, in addition to policies, to increase accessibility and social inclusion, and incentives or subsidies for the practice of sports could improve QoL following SCI/D.

Links between Shared Reading and Play, Parent Psychosocial Functioning, and Child Behavior: Evidence from a Randomized Controlled Trial.

OBJECTIVE: To investigate pathways by which interventions that promote shared reading and play help prevent child behavior problems. We examined whether family processes associated with the family investment pathway (eg, parental cognitive stimulation) and the family stress pathway (eg, mothers' psychosocial functioning) mediated impacts of a pediatric-based preventive intervention on child behavior. STUDY DESIGN: The sample included 362 low-income mothers and their children who participated in a randomized controlled trial of the Video Interaction Project, a pediatrics-based preventive intervention that promotes parent-child interactions in the context of shared reading and play. Parent-child dyads were randomly assigned to group at birth. Three mediators-parental cognitive stimulation, maternal stress about the parent-child relationship, and maternal depressive symptoms-were assessed at child ages 6 and 36 months. The outcome, child externalizing behaviors, was assessed at 36 months. We used a series of path analytic models to examine how these family processes, separately or together, mediated the impacts of the Video Interaction Project on child behavioral outcomes. RESULTS: Intervention impacts on child behavior were mediated by enhancements in cognitive stimulation and by improvements in mothers' psychosocial functioning. A sequential mediation model showed that Video Interaction Project impacts on cognitive stimulation at 6 months were associated with later decreases in mothers' stress about the parent-child relationship and that this pathway mediated intervention impacts on child behavioral outcomes at 3 years of age (P = .023). CONCLUSIONS: Using an experimental design, this study identifies pathways by which parent-child interactions in shared reading and play can improve child behavioral outcomes. TRIAL REGISTRATION: Clinicaltrials.gov: NCT00212576.

Interset Stretching vs. Traditional Strength Training: Effects on Muscle Strength and Size in Untrained Individuals.

Evangelista, AL, De Souza, EO, Moreira, DCB, Alonso, AC, Teixeira, CVLS, Wadhi, T, Rauch, J, Bocalini, DS, Pereira, PEDA, and Greve, JMDA. Interset stretching vs. traditional strength training: effects on muscle strength and size in untrained individuals. J Strength Cond Res 33(7S): S159-S166, 2019-This study compared the effects of 8 weeks of traditional strength training (TST) and interset stretching (ISS) combined with TST on muscular adaptations. Twenty-nine sedentary, healthy adults were randomly assigned to either the TST (n = 17; 28.0 ± 6.4 years) or ISS (n = 12; 26.8 ± 6.1 years) group. Both groups performed 6 strength exercises encompassing the whole body (bench press, elbow extension, seated rows, biceps curl, knee extension, and knee flexion) performing 4 sets of 8-12 repetition maximum (RM) with a 90-second rest between sets. However, the ISS group performed static passive stretching, at maximum amplitude, for 30 seconds between sets. Both groups performed training sessions twice a week on nonconsecutive days. Muscle strength (i.e., 1RM) and hypertrophy (i.e., muscle thickness [MT] by ultrasonography) were measured at pre-test and after 8 weeks of training. Both groups increased 1RM bench press (p ≤ 0.0001): ISS (23.4%, CIdiff: 4.3 kg-11.1 kg) and TST (22.2%, CIdiff: 5.2 kg-10.9 kg) and 1RM knee extension (p ≤ 0.0001): ISS (25.5%, CIdiff: 5.6 kg-15.0 kg) and TST (20.6%, CIdiff: 4.4 kg-12.3 kg). Both groups increased MT of biceps brachii (BIMT), triceps brachii (TRMT), and rectus femoris (RFMT) (p ≤ 0.0001). BIMT: ISS (7.2%, CIdiff: 1.14-3.5 mm) and TST (4.7%, CIdiff: 0.5-2.5 mm), TRMT: ISS (12.3%, CIdiff: 1.1-4.4 mm) and TST (7.1%, CIdiff: 0.3-3.1 mm), and RFMT: ISS (12.4%, CIdiff: 1.1-2.9 mm) and TST (9.1%, CIdiff: 0.7-2.2 mm). For vastus lateralis muscle thickness (VLMT) and sum of the 4 muscle thickness sites (ΣMT), there was a significant group by time interaction (p ≤ 0.02) in which ISS increased VLMT and ΣMT to a greater extent than TST. Vastus lateralis muscle thickness: ISS (17.0%, CIdiff: 1.5-3.1 mm) and TST (7.3%, CIdiff: 0.7-2.1 mm), and ΣMT: ISS (10.5%, CIdiff: 6.5-9.0 mm) and TST (6.7%, CIdiff: 3.9-8.3 mm). Although our findings might suggest a benefit of adding ISS into TST for optimizing muscle hypertrophy, our data are not sufficient enough to conclude that ISS is superior to TST for inducing muscle hypertrophic adaptations. More studies are warranted to elucidate the effects of ISS compared with TST protocols on skeletal muscle. However, our findings support that adding ISS to regular TST regimens does not compromise muscular adaptations during the early phase of training (<8 weeks) in untrained individuals.

Metabolic and hormonal responses to different resistance training systems in elderly men.

OBJECTIVE: To compare acute and sub-acute responses in hormonal profile and metabolic parameters in elderly people who participated in two methods of strength training (ST) with equalized loads. METHODS AND MATERIALS: A total of 12 elder individuals (65 ± 3 years) were randomly assigned to two training methods: constant intensity (CI, 3 sets of 10 repetitions with 75% of 1RM) and variable intensity (VI, 1st set: 12 repetitions at 67% of 1RM > 2nd set: 10 repetitions at 75% of 1RM and 3rd set: 8 repetitions at 80% of 1RM). Both methods included the following exercises: leg press, knee extension, and squat with 1 min rest intervals between sets. Free speed of execution and maximum range of movement were encouraged throughout each set for both protocols. Blood samples were analyzed included glucose, testosterone (T), cortisol (C), T/C rate, growth hormone (GH), and lactate at 2 and 24 h post intervention. RESULTS: There were no observed differences in glucose, testosterone, GH, and lactate concentrations both at 2 and 24 h after the execution of the two training methods. However, significant increases in the levels of T/C rate and decrease on cortisol were observed immediately post exercise for both protocols. CONCLUSIONS: Although no significant differences were observed between the two interventions in relation to the hormonal and metabolic parameters analyzed, both training methods promoted a favorable response, with a slight superiority noted for the CI method relative to the hormonal profile.

Cultural Variables Underlying Obesity in Latino Men: Design, Rationale and Participant Characteristics from the Latino Men's Health Initiative.

Overweight and obesity are associated with significant health problems and rates of obesity are high among Latino men. This paper describes the design, rationale and participant characteristics of the key demographic variables assessed in an NIH-funded study (R21-CA143636) addressing culture and several obesity-related variables (diet, physical activity, and body image) among Mexican and Puerto Rican men using a community-based participatory research framework. Participants completed objective measures (height, weight, body fat, hip, waist), a health and culture interview, a diet questionnaire, and used an accelerometer to measure their level of physical activity. A total of 203 participants completed the measures and the health and culture interview and 193 completed all study components. Puerto Ricans were older than Mexicans (p < .0001) and there were significant differences in marital status (p < .05), country of birth (p < .05), smoking (p < .05) and work status (p < .001). There were no significant differences in religion, education, health insurance, Body Mass Index, body fat, hip and waist measurements, and the language preference of the interview. Results have implications for the development of a future intervention that incorporates the role of cultural factors into a community participatory obesity intervention for Latino men.

EFFECTS OF TREADMILL GAIT TRAINING ON BALANCE IN PARKINSON'S PATIENTS AFTER DEEP BRAIN STIMULATION.

Objective: After deep brain stimulation (DBS), patients with Parkinson's disease (PD) typically still present significant gait and postural stability problems, and thus additional interventions are needed. In this way, our purpose was evaluate the comparative effectiveness of treadmill training, with and without body weight support, on balance outcomes among patients with PD after DBS. Methods: Eleven patients with PD that were using bilateral subthalamic nucleus DBS were evaluated using Time Up and Go test (TUG); Berg Balance Scale (BBS) and Static Posturography. In phase 1, all subjects participated in 8-weeks of treadmill training in conjunction with conventional physiotherapy. After six weeks (wash-out), each patient then participated in a subsequent 8-weeks of treadmill training with partial body weight support. Results: After the phase 1, there were improvements on the cognitive TUG performance (Before: 15.7 ± 1,8 sec; After: 13.7 ± 3.1 sec; p < 0.01) and an increase of anteroposterior and medio-lateral body oscillation with eyes closed. After the phase 2, there were improvements in conventional (Before: 12.3 ± 2.0 sec; After: 10.7 ± 1.7 sec; p < 0.01) and cognitive (Before: 14.6 ± 3.5 sec; After: 12.5 ± 1.6 sec; p < 0.05) TUG performances. There were no significant changes in the Berg Balance Scale following either training protocol. Conclusion: Both trainings improved static and dynamic balance and had similar results; however, supported treadmill training seemed to be a potentially superior option, as patients tended to feel safer. Level of Evidence II, therapeutic studies - investigation of treatment outcomes.

Objetivo: Mesmo após a estimulação cerebral profunda (ECP), os pacientes com doença de Parkinson (DP) muitas vezes ainda apresentam problemas significativos de marcha e estabilidade postural, e, portanto, intervenções adicionais são necessárias. Avaliar a eficácia comparativa do treinamento em esteira, com e sem suporte de peso corporal, nos resultados de equilíbrio de pacientes com DP após ECP. Métodos: Onze pacientes com DP em uso de ECP bilateral do núcleo subtalâmico foram avaliados pelos testes Time Up and Go (TUG), escala de equilíbrio de Berg (EEB) e posturografia estática. Na fase 1, todos participaram de oito semanas de treinamento em esteira em conjunto com fisioterapia convencional. Após seis semanas (wash-out), cada paciente participou de oito semanas subsequentes de treinamento em esteira com suporte parcial de peso corporal. Resultados: Depois da fase 1, houve melhora no desempenho cognitivo do TUG (antes: 15,7 ± 1,8 s; depois: 13,7 ± 3,1 s; p < 0,01) e aumento da oscilação anteroposterior e médio-lateral do corpo com os olhos fechados. Após a fase 2, os resultados do TUG convencional (antes: 12,3 ± 2,0 seg; depois: 10,7 ± 1,7 seg; p < 0,01) e cognitivo (antes: 14,6 ± 3,5 s; depois: 12,5 ± 1,6 s; p < 0,05) demonstraram melhora. Os protocolos de treinamento não causaram mudanças significativas na EEB.. Conclusão: Ambos os treinos melhoraram o equilíbrio estático e dinâmico e tiveram resultados semelhantes; no entanto, o treinamento em esteira com suporte é uma opção potencialmente superior, uma vez que os pacientes tendiam a se sentir mais seguros. Nível de Evidência II, estudos terapêuticos - investigação de resultados de tratamento.

Advanced glycation end products consumption and the decline of functional capacity in patients with Parkinson's disease: Cross-sectional study.

INTRODUCTION: Advanced Glycation End-Products (AGEs) are a diverse group of highly reactive molecules that play a vital role in the development of neurodegenerative disorders, such as Parkinson's Disease (PD), leading to a decline in functional and cognitive capacity. The objective of this study was to assess the intake and quantification of AGEs in individuals with PD and to correlate them with their functional and cognitive abilities. METHODS: This was a cross-sectional study involving 20 PD patients and 20 non-PD individuals as the Control group (C). The autofluorescence reader was used to evaluate skin AGEs, while food recall was used to quantify AGEs consumed for three different days. The Montreal Cognitive Assessment, Short Physical Performance Battery, and handgrip tests were used. PD patients demonstrated greater impairment in functional capacity compared to the control group. RESULTS: Dominant Handgrip (p = 0.02) and motor performance, in the sit and stand test (p = 0.01) and Short Physical Performance Battery (SPPB) (p = 0.01) were inferior in PD patients than the control group. Although PD patients tended to consume less AGEs than the control group, AGE intake was negatively correlated with handgrip strength in individuals with PD (r = -0.59; p < 0.05). CONCLUSION: PD patients had lower strength and functional capacity, suggesting that the effects of AGEs might be exacerbated during chronic diseases like Parkinson's.

CORRELATION OF THE SAGITTAL BALANCE WITH POSTURAL ANALYSIS OF THE PELVIS AND LUMBAR SPINE.

Objective: Evaluate and correlate the sagittal balance parameters with the postural of the pelvis and lumbar spine. Methods: 80 individuals of both sexes, aged between 20 and 35 years, were evaluated. Biophotogrammetry was done with the SAPO software program. Measurements of the sagittal balance parameters were obtained by analyzing a lateral view panoramic radiography of the vertebral column, in which the anatomical points of reference were digitally marked. The calculation of the angles was done automatically by the Keops program. Results: In Keops assessment, 17.5% of the sample had high pelvic incidence angles (> 60°), 31.5% had low pelvic incidence angles (< 45°), and 51.2% had medium pelvic incidence angles (between 46° and 59°). SAPO showed 12,5% lordosis, 40% retroversion, and 47,5% normal curvature. In the right lateral view, pelvic incidence angle had a moderate and positive correlation with vertical alignment of the trunk and with vertical alignment of the body, and a negative and moderate correlation with horizontal alignment of the pelvis. Conclusion: Differences were found between vertical alignment measurements from the postural evaluation system (SAPO). A positive correlation was found between PI from Keops and pelvic anteversion from SAPO. Level of Evidence II; Prospective Study.

Objetivo: Avaliar e correlacionar o equilíbrio sagital com parâmetros posturais da pelve e coluna lombar. Métodos: Foram avaliados 80 indivíduos de ambos os sexos, com idade entre 20 e 35 anos. A biofotogrametria foi realizada com o software SAPO. As medidas dos parâmetros do equilíbrio sagital foram obtidas pela análise de uma radiografia panorâmica em perfil da coluna vertebral, na qual os pontos anatômicos de referência foram marcados digitalmente. O cálculo dos ângulos foi feito automaticamente pelo programa Keops. Resultados: Na avaliação Keops, 17,5% da amostra apresentavam ângulos de incidência pélvicos altos (> 60°), 31,5% tinham ângulos de incidência pélvicos baixos (< 45°) e 51,2% apresentavam ângulos de incidência pélvicos médios (entre 46° e 59°). O SAPO apresentou 12,5% de lordose, 40% de retroversão e 47,5% de curvatura normal. Na vista lateral direita, o ângulo de incidência da pelve apresentou correlação moderada e positiva com o alinhamento vertical do tronco e com o alinhamento vertical do corpo e negativa e moderada com o alinhamento horizontal da pelve. Conclusão: Foram encontradas diferenças entre as medidas de alinhamento vertical do sistema de avaliação postural (SAPO). Uma correlação positiva foi encontrada entre IP de Keops e anteversão pélvica de SAPO. Nível de Evidência II; Estudo Prospectivo.

Multifactorial assessment of braking time predictors in a driving simulator among older adults according to gender.

CONTEXT: Vehicle driving depends on the integration of motor, visual, and cognitive skills to respond appropriately to different situations that occur in traffic. OBJECTIVES: To analyze a model of performance predictor for braking time in the driving simulator, using a battery of tests divided by gender. METHODS: Selected were 100 male drivers with a mean age of 72.6 ± 5.7 years. Sociodemographic variables, braking time in the driving simulator, and motor, visual, and cognitive skills were evaluated. RESULTS: Comparing genders, men were older than women (p = 0.002) and had longer driving times (p = 0.001). Men had more strength in hand grip (p ≤ 0.001). In the linear regression analysis, the model explained 68 % of the braking time in men and 50.8 % in women. In the stepwise multiple linear regression analysis, the variable that remained in the model was the strength of the right plantar flexors, which explained 13 % of the braking time in women and men, and the cognitive variables explained 38.9 %. CONCLUSION: Sociodemographic, motor, visual, and cognitive variables, explained a substantial portion of the variability in braking time for both older women and men, the specific variables driving this performance differed between the sexes. For older women, factors such as muscle strength emerged as critical determinants of braking ability, highlighting the importance of physical health in maintaining driving skills. On the other hand, cognitive conditions emerged as the primary predictor of braking performance in older men, underscoring the role of mental acuity and decision-making processes in safe driving.

The decline in postural balance has a negative impact on the performance of functional tasks in individuals with Parkinson's Disease.

INTRODUCTION: An accurate assessment of balance problems is critical for decreasing the risk of falling in patients with Parkinson's Disease (PD). Reliable diagnostic tools such as Computerized Dynamic Posturography (CDP) are not feasible for the clinical setting. Therefore, the present study's aim was to assess the correlation between the clinical Balance Evaluation Systems Test (BESTest) and CDP. METHODS: 20 male older adults with Parkinson's Disease (PD) were included in this study. Participants first executed the Sit-To-Stand (STS), Step/Quick turn (SQT), and Step Up and Over (SUO) tests on a Balance Master® force platform, followed by a clinical balance evaluation using the BESTest. RESULTS: Four outcomes of the CDP were negatively correlated with one or more BESTest domains or total BESTest score: STS sway velocity was negatively correlated with the anticipatory postural adjustment (p = 0.02) and sensory orientation (p = 0.01) domains. SQT turn time was negatively correlated with biomechanical restriction (for turns to the left, p = 0.01, and right, p = 0.03, respectively), postural response (p = 0.01, p = 0.01), dynamic balance during gait (p = 0.007, p = 0.001), and total score (p = 0.02, p = 0.01). Step over time to the right in SUP was negatively correlated with the limits of the stability domain (p = 0.002) and total BESTest score (p = 0.020). SUO impact index was negatively correlated with the anticipatory postural adjustment domain (p = 0.01). CONCLUSION: This study shows that several BESTest domains are significantly correlated with CDP outcomes, demonstrating that the BESTest can be used as a more clinically feasible alternative for computerized posturography, without loss of information.

Importance of muscle strength to maintain mobility, but not to maintain postural balance in older women: Cross-sectional study.

BACKGROUND: Acknowledging the relationship between postural control and muscle strength in lower limbs is important to find persons with high fall risk and to design fall prevention exercise programs. OBJECTIVE: To investigate the connection between knee muscle strength, semi-static postural balance, and functional mobility in irregularly active older women. METHODS: One hundred and ten older women aged 60 to 85 years underwent a semi-static postural balance test in a force and functional mobility measured by Timed Up & Go (TUG) with and without Cognitive Tasks (CT). Muscle strength of the knee was assessed by isokinetic dynamometry at 60°/s. RESULTS: A negative correlation between the functional mobility (TUG with and without CT) and the muscular strength of the knee was observed. Regarding semi-static balance, there was a low negative correlation with peak torque corrected for body weight of the extensors with the following variables with eyes open: Mean Velocity Dominant limb (D) (r = -0.19; p = 0.03); and anteroposterior range Non-Dominant limb (ND) (r = -0.19; p = 0.04); with eyes closed: mediolateral range ND limb (r = -0.21; p = 0.02) and Mean Velocity ND limb (r = -0.18; p = 0.05). CONCLUSIONS: This study found that better functional mobility was associated with greater muscle strength in the knee in elderly women. There were weak negative correlations between knee extensor strength and some measures of semi-static postural balance, suggesting that different motor control actions are required to maintain semi-static balance and mobility. In the case of semi-static balance, a lower level of muscle response is required than in functional mobility.

Factors Contributing to Traffic Accidents in Hospitalized Patients in Terms of Severity and Functionality.

Trauma-related injuries in traffic-accident victims can be quite serious. Evaluating the factors contributing to traffic accidents is critical for the effective design of programs aimed at reducing traffic accidents. Therefore, this study identified which factors related to traffic accidents are associated with injury severity in hospitalized victims. Factors related to traffic accidents, injury severity, disability and data collected from blood toxicology were evaluated, along with associated severity and disability indices with data collected from toxicology on victims of traffic accidents at the largest tertiary hospital in Latin America. One hundred and twenty-eight victims of traffic accidents were included, of whom the majority were young adult men, motorcyclists, and pedestrians. The most frequent injuries were traumatic brain injury and lower-limb fractures. Alcohol use, hit-and-run victims, and longer hospital stays were shown to lead to greater injury severity. Women, elderly individuals, and pedestrians tend to suffer greater disability post-injury. Therefore, traffic accidents occur more frequently among young male adults, motorcyclists, and those who are hit by a vehicle, with trauma to the head and lower limbs being the most common injury. Injury severity is greater in pedestrians, elderly individuals and inebriated individuals. Disability was higher in older individuals, in women, and in pedestrians.

Adaptation to the driving simulator and prediction of the braking time performance, with and without distraction, in older adults and middle-aged adults.

CONTEXT: Many studies show the importance of evaluating the adaptation time of subjects in a virtual driving environment, looking forwards to a response as closest as a possible real vehicle. OBJECTIVES: This study aimed to identify and analyze the adaptation to the driving simulator in older adults and middle-aged adults with and without a distraction, and a secondary aim was to identify predictors of safe performance for older adults' drives. DESIGN: Male and female middle-aged adults (n = 62, age = 30.3 ± 7.1 years) and older adults (n = 102, age = 70.4 ± 5.8 years) were evaluated for braking time performance in a driving simulator; cognition performance assessment included the Mini-Mental State Examination; motor evaluation included ankle flexor muscle strength with the isokinetic dynamometer and handgrip strength; the postural balance was evaluated with Timed Up and Go test, with and without a cognitive distraction task. RESULTS: Older adults (men and women) and middle-aged adult women require more time to adapt to the driving simulator. The distractor increases the adaptation time for all groups. The main predictors of braking time for older women are age, muscle strength, and postural balance associated with distraction, and for older men, muscle strength. CONCLUSIONS: Age, sex, and distractor interfere in the adaptation of the virtual task of driving in a simulator. The evaluation model developed with multi-domains demonstrated the ability to predict which skills are related to braking time with and without the presence of the distractor.

Quality of life and socio-demographic factors associated with nutritional risk in Brazilian community-dwelling individuals aged 80 and over: cluster analysis and ensemble methods.

Introduction: The aim of the present study was to use cluster analysis and ensemble methods to evaluate the association between quality of life, socio-demographic factors to predict nutritional risk in community-dwelling Brazilians aged 80 and over. Methods: This cross-sectional study included 104 individuals, both sexes, from different community locations. Firstly, the participants answered the sociodemographic questionnaire, and were sampled for anthropometric data. Subsequently, the Mini-Mental State Examination (MMSE) was applied, and Mini Nutritional Assessment Questionnaire (MAN) was used to evaluate their nutritional status. Finally, quality of life (QoL) was assessed by a brief version of World Health Organizations' Quality of Life (WHOQOL-BREF) questionnaire and its older adults' version (WHOQOL-OLD). Results: The K-means algorithm was used to identify clusters of individuals regarding quality-of-life characteristics. In addition, Random Forest (RF) and eXtreme Gradient Boosting (XGBoost) algorithms were used to predict nutritional risk. Four major clusters were derived. Although there was a higher proportion of individuals aged 80 and over with nutritional risk in cluster 2 and a lower proportion in cluster 3, there was no statistically significant association. Cluster 1 showed the highest scores for psychological, social, and environmental domains, while cluster 4 exhibited the worst scores for the social and environmental domains of WHOQOL-BREF and for autonomy, past, present, and future activities, and intimacy of WHOQOL-OLD. Conclusion: Handgrip, household income, and MMSE were the most important predictors of nutritional. On the other hand, sex, self-reported health, and number of teeth showed the lowest levels of influence in the construction of models to evaluate nutritional risk. Taken together, there was no association between clusters based on quality-of-life domains and nutritional risk, however, predictive models can be used as a complementary tool to evaluate nutritional risk in individuals aged 80 and over.

Crash Risk Predictors in Older Drivers: A Cross-Sectional Study Based on a Driving Simulator and Machine Learning Algorithms.

The ability to drive depends on the motor, visual, and cognitive functions, which are necessary to integrate information and respond appropriately to different situations that occur in traffic. The study aimed to evaluate older drivers in a driving simulator and identify motor, cognitive and visual variables that interfere with safe driving through a cluster analysis, and identify the main predictors of traffic crashes. We analyzed the data of older drivers (n = 100, mean age of 72.5 ± 5.7 years) recruited in a hospital in São Paulo, Brazil. The assessments were divided into three domains: motor, visual, and cognitive. The K-Means algorithm was used to identify clusters of individuals with similar characteristics that may be associated with the risk of a traffic crash. The Random Forest algorithm was used to predict road crash in older drivers and identify the predictors (main risk factors) related to the outcome (number of crashes). The analysis identified two clusters, one with 59 participants and another with 41 drivers. There were no differences in the mean of crashes (1.7 vs. 1.8) and infractions (2.6 vs. 2.0) by cluster. However, the drivers allocated in Cluster 1, when compared to Cluster 2, had higher age, driving time, and braking time (p < 0.05). The random forest performed well (r = 0.98, R2 = 0.81) in predicting road crash. Advanced age and the functional reach test were the factors representing the highest risk of road crash. There were no differences in the number of crashes and infractions per cluster. However, the Random Forest model performed well in predicting the number of crashes.

The Influence of Whey Protein on Muscle Strength, Glycemic Control and Functional Tasks in Older Adults with Type 2 Diabetes Mellitus in a Resistance Exercise Program: Randomized and Triple Blind Clinical Trial.

OBJECTIVES: To evaluate the effect of whey protein (WP) supplementation associated with resistance training (RT) on glycemic control, functional tasks, muscle strength, and body composition in older adults living with type 2 diabetes mellitus (T2DM). Secondly, to evaluate the safety of the protocol for renal function. METHODS: The population comprised twenty-six older men living with T2DM (68.5 ± 11.5 years old). The participants were randomly assigned to the Protein Group (PG) and the Control Group (CG). The handgrip test and evolution of exercise loads, according to the Omni Resistance Exercise Scale, evaluated muscle strength. Functional tasks were assessed by force platform in three different protocols: Sit-to-Stand, Step/Quick Turn, and Step Up/Over. Body composition was evaluated by bioimpedance and glycemic control and renal function were assessed by biochemical analyses. Both groups performed RT for 12 weeks, twice a week, prioritizing large muscle groups. Protein supplementation was 20 g of whey protein isolate and the CG was supplemented with an isocaloric drink, containing 20 g of maltodextrin. RESULTS: There was a significant difference in muscle strength, according to the evolution of the exercise loads, but it was not confirmed in the handgrip test. However, there was no significant difference between the groups, regarding performance in functional tasks, glycemic control, or body composition. Renal function showed no alteration. CONCLUSION: The intake of 20 g of WP in older male adults living with T2DM did not increase the effect of RT on muscle strength, functional tasks, and glycemic control. The intervention was proven safe regarding renal function.

Clustering of Health Risk Behaviors in Mexican and Puerto Rican Men: Results from the Latino Men's Health Initiative.

Engaging in multiple health risk behaviors simultaneously may increase the risk for cardiometabolic diseases. This study examined the prevalence and clustering of three health behaviors (physical activity, fruit and vegetable consumption, and smoking) among Latino men. The participants were 99 Mexican and 104 Puerto Rican men who participated in a study addressing culture- and obesity-related factors. The health behaviors were obtained from self-reported and anthropometric assessments through objective measurements. Among all participants, 5% had no health risk behaviors, 30% had one, 47% had two, and 18% had all three; their most common health risk behavior cluster was low physical activity and low fruit and vegetable consumption (28%). Among Puerto Rican men, 7% had no health risk behaviors, 24% had one, 51% had two, and 18% had all three; their most common health risk behavior cluster was current smoker and low fruit and vegetable consumption (28%). Among Mexican men, 3% had no health risk behaviors, 36% had one, 43% had two and 19% had all three; their most common health risk behavior cluster was low physical activity and low fruit and vegetable consumption (33%). The findings highlight the need for lifestyle interventions that target multiple health risk behaviors related to cardiometabolic diseases in Latinos.

Recommender System Based on Collaborative Filtering for Personalized Dietary Advice: A Cross-Sectional Analysis of the ELSA-Brasil Study.

This study aimed to predict dietary recommendations and compare the performance of algorithms based on collaborative filtering for making predictions of personalized dietary recommendations. We analyzed the baseline cross-sectional data (2008-2010) of 12,667 participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The participants were public employees of teaching and research institutions, aged 35-74 years, and 59% female. A semiquantitative Food Frequency Questionnaire (FFQ) was used for dietary assessment. The predictions of dietary recommendations were based on two machine learning (ML) algorithms-user-based collaborative filtering (UBCF) and item-based collaborative filtering (IBCF). The ML algorithms had similar precision (88-91%). The error metrics were lower for UBCF than for IBCF: with a root mean square error (RMSE) of 1.49 vs. 1.67 and a mean square error (MSE) of 2.21 vs. 2.78. Although all food groups were used as input in the system, the items eligible as recommendations included whole cereals, tubers and roots, beans and other legumes, oilseeds, fruits, vegetables, white meats and fish, and low-fat dairy products and milk. The algorithms' performances were similar in making predictions for dietary recommendations. The models presented can provide support for health professionals in interventions that promote healthier habits and improve adherence to this personalized dietary advice.

Influence of invertor and evertor muscle fatigue on functional jump tests and postural control: A prospective cross-sectional study.

OBJECTIVE: Fatigue of the ankle's stabilizing muscles may influence the performance of functional activities and postural control. The purpose of this study was to evaluate the performance of healthy young adults using functional jump tests and static posturography control under pre- and post-fatigue conditions of the ankle invertor and evertor muscles. METHODS: Thirty physically active healthy male and female (15 male and 15 female) volunteers (24.3 years) were enrolled in this prospective cross-sectional study. Participants performed tests on one day under a non-fatigued state of invertor and evertor muscles and on the second day in a fatigued state. Tests included static posturography on a force platform in a bipedal stance with eyes open and closed and in one-legged support with eyes open and functional jump tests (figure-of-8, side hop, 6-m crossover hop, and square hop). Fatigue of the ankle invertor and evertor muscles was induced using isokinetic dynamometry with 30 repetitions at 120°/s. RESULTS: Participants had an average age of 24.3 years (SD ± 2.08), the height of 1.73 m (SD ± 0.08), and a weight of 68.63 kg (SD ± 10.29). The average Body Mass Index (BMI) was 22.88 (SD ± 2.46). A decrease in performance was observed in functional activities and postural control under all conditions after the induction of muscle fatigue, except for the speed at a bipedal stance with eyes open. CONCLUSIONS: Functional jump tests are low cost and useful for clinical practice and evaluation of the effects of muscle fatigue and could be used in clinical practice.

The variability of isokinetic ankle strength is different in healthy older men and women.

CONTEXT: In the elderly, weak lower limb muscles impair functional tasks' performance. OBJECTIVE: To evaluate the healthy elderly's ankle dorsiflexion and plantarflexion maximum torque and its variability in two sets of 5 RM isokinetics evaluation. METHOD: 50 women (68.0 ± 4.6 years old) and 50 men (72.7 ± 8.5 years old) did two sets of ankle plantar flexor and dorsiflexor isokinetic tests at 30°/s. Peak torque, total work, and coefficient of variation were analyzed. RESULTS: Men did the strongest plantarflexion torque (p < 0.05) and dorsiflexion torque (p < 0.05); their highest peak torque occurred at set 2 (p < 0.05), while the largest plantarflexion torque variability (p < 0.05), dorsiflexion torque variability (p < 0.05), and the largest plantarflexion torque variability occurred at set 1 (p < 0.05). Men did the highest plantarflexion and dorsiflexion total work (p < 0.05) at set 2 (p < 0.05). CONCLUSION: Older men are stronger than older women. The torque variability, in men, was higher during the first set, suggesting an adaptation to the isokinetics evaluation. Clinicians and researchers should consider that different muscles might need different numbers of sets and trials to measure their maximal muscle strength.