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The aim was to evaluate the effects of Nest Positioning (NP) on motor development, sleep patterns, and weight gain in preterm newborns (PTNB) hospitalized in a neonatal intensive care unit (NICU). This study was constructed based on PRISMA guideline criteria. Systematic research was carried out in electronic databases: MEDLINE via PubMed, Web of Science, Scopus, and VHL-BIREME following the PICOS strategy. Studies with PTNB populations who were hospitalized in the NICU and received therapeutic NP as an intervention strategy in this population were included in this study. We sought outcomes related to sleep patterns, weight gain, and motor development. After selection, 12 studies were included in this systematic review, of which 5 (41.7%) evaluated motor development as their primary outcome, 6 (50%) sleep-wake cycle patterns, and 1 (8.3%), weight gain and, subsequently, hospital discharge. Qualitative results indicate that prolonged exposure to decubitus variations may favor PTNB hospitalized in NICUs acquiring flexor postures, stimulate their midline, and increase their total sleep time. Studies reported no adverse effects regarding the use of NP. Evidence suggests that NP benefits motor development and sleep pattern in PTNB hospitalized in NICUs. IMPACT: Nest positioning improves sleep quality in preterm newborns hospitalized in neonatal intensive care unit. Nest positioning improves motor development in preterm newborns hospitalized in neonatal intensive care unit. No evidence of nest positioning on weight gain was observed. Half of the included clinical studies showed good methodological quality. Nesting positioning is a secure and cost-effective method.
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Desarrollo Infantil , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Sueño , Aumento de Peso , Humanos , Recién Nacido , Sueño/fisiología , Cuidado del Lactante/métodosRESUMEN
OBJECTIVES: The objective of this systematic review was to identify and describe the psychometric properties of neonatal pain scales that were translated into Brazilian Portuguese and to verify the methodological quality of these translation, transcultural adaptations and validation. DESIGN: The present study is a systematic review. A systematic search in the literature included studies of development, validation, and transcultural adaptation of neonatal pain scales to Brazilian Portuguese. The instruments must have been developed for health care professionals to evaluate neonatal pain and stress in full-term and preterm newborns. DATA SOURCES: The search strategy was conducted in PubMed, Web of Science, Scopus, and Scielo databases following The PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). REVIEWâ¯/ANALYSIS METHODS: A total of 1,479 publications were identified and 5 fulfilled the inclusion criteria, with 4 instruments evaluated. For the methodological quality analysis of the measurement properties of the instruments the Consensus-based Standards for Health Measurement Instruments (COSMIN) Risk of Bias checklist was used. The psychometric properties verified were internal consistency, content validity, reliability, and construct validity. RESULTS: Three instruments reviewed were inadequate and one was doubtful. CONCLUSIONS: The neonatal pain scales wich were cross culturally adapted to Brazilian Portuguese were shown to be of low methodological quality based on COSMIM checklist. Caution should be considered for clinical decisions about pain management judgment coming from these instruments.
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Dolor , Traducción , Brasil , Humanos , Recién Nacido , Psicometría , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
Aim: To verify if there is a difference between the percentile ranks for Brazilian infants compared with norms for Canadian infants on the Alberta Infant Motor Scale (AIMS). Method: A cross-sectional study in which 322 Brazilian infants, 2 to 15 months old, were administered the AIMS. Percentile ranks were calculated using norms for Canadian infants and norms from two studies of Brazilian infants. The Friedman test compared the AIMS percentile ranks for the entire sample. For reliability analysis, the interclass correlation coefficient (ICC) was used. Bland Altman's analysis was applied to compare percentile ranks. Results: Of the 322 evaluations analyzed, there were significant differences (p<.001) between the three percentile ranks compared. The Canadian norms presented the lowest average rating. There was good reliability between the percentile ranks (ICC > 0.75) but low agreement (Bland Altman; p<.001). Conclusion: There are differences between the Brazilian and Canadian percentile ranks and between the Brazilian percentile ranks of 2014 and 2016, and these differences may influence identification of motor development.
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Desarrollo Infantil , Destreza Motora , Alberta , Brasil , Estudios Transversales , Humanos , Lactante , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVES: To systematically review the literature regarding the effectiveness of different positioning methods for procedural pain relief in neonates admitted to the Neonatal Intensive Care Unit (NICU). DESIGN: A systemized search of the literature was carried out by means of two independent evaluators through the systematic search of electronic index databases. DATA SOURCES: A search for relevant studies was performed in four databases (Medline, Web of Science, Scopus, and BVS-BIREME). REVIEW/ANALYSIS METHODS: Manual searches were conducted on suitable references from the included articles, and 1,941 publications were eligible for the analysis. The flowchart for the articles' selection was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, and in relation to bias risks according to the Physiotherapy Evidence Database (PEDro) scale. RESULTS: Based on the inclusion criteria, only 20 publications remained. According to the PEDro scale, 75% of the studies presented good methodological quality, with scores between 6 and 8, and 5% scored ≤4 points. None of them were blinded in relation to the therapies, but all of them performed intergroup statistical comparisons. According to the results of this review, we recommend facilitated tucking by parents (FTP) in NICU of at least 30 minutes duration, starting 15 minutes before, during the painful procedure, and 15 minutes after to relieve pain and to stabilize the physiological, hormonal, and behavioral responses of the newborns. CONCLUSIONS: Positioning should be used as a nonpharmacological strategy for procedural pain relief in newborns. This review showed that facilitated tucking by parents for 30 minutes was the best position for pain relief in premature newborns during procedures in the NICU. Positioning is recommended as a nonpharmacological method for pain relief; FTP of at least 30 minutes duration should be the first positioning choice during procedures in the NICU.
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Unidades de Cuidado Intensivo Neonatal , Dolor Asociado a Procedimientos Médicos , Humanos , Recién Nacido , Dolor/prevención & control , Manejo del Dolor , Dolor Asociado a Procedimientos Médicos/prevención & controlRESUMEN
BACKGROUND: The use of technology is an increasingly common practice among preschoolers. Little is known about the relationship between screen time exposure (STE) and aspects related to family and the environment. AIM: The aim is to characterize STE in Brazilian children aged between 3 and 5 years. Furthermore, the objective of this study is to associate the STE of children and of their parents with sociodemographic variables. METHODS: Children aged between 3 and 5 years from southern Brazil and their parents participated in this study. To investigate STE, the researchers developed a specific questionnaire. To compare STE between age groups, the Kruskal-Wallis test was performed, followed by Dunn's post hoc test. Spearman's correlation and linear regression were used to correlate the variables. RESULTS: Children (n = 237) spend an average of 3.7 ± 0.8 h/day in front of screens. The STE of children had a moderately positive correlation with the STE of their parents (r = 0.4; p-value < 0.001). Only the variables of the children's and parents' STE had a significant and positive association. The model is significant (F = 6164, p-value < 0.001) and the residuals of the model met the necessary assumptions, with normal distribution, constant variance and without the presence of outliers. CONCLUSION: Children in southern Brazil remain in front of screens four times longer than the recommended amount of time. It was also found that the STE of parents directly influences that of their children.
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Tiempo de Pantalla , Brasil/epidemiología , Niño , Preescolar , Humanos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To determine whether the impact of inspiratory muscle weakness on inspiratory muscle training (IMT) affects inspiratory function and exercise capacity in chronic heart failure (CHF) patients. DATA SOURCES: Electronic searches were performed using the Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Cochrane Systematic Review, Embase, MEDLINE, and Physiotherapy Evidence Database (PEDro) databases up to August 2013. STUDY SELECTION: Articles were included if participants had CHF and were >18 years old; the design was a randomized controlled trial; intervention was IMT; measurements were of inspiratory muscle function or exercise capacity; and the articles were published in English, Portuguese, or Spanish. Of the 1455 articles identified in the database searches, 9 studies met the inclusion criteria. DATA EXTRACTION: Two independent reviewers selected and extracted information from articles and assessed the quality of the studies using the PEDro scale. The 2 reviewers discussed disagreements until consensus was achieved. DATA SYNTHESIS: Meta-analyses compared IMT with controls/sham for maximal inspiratory pressure, sustained maximal inspiratory pressure, 6-minute walk distance, peak oxygen consumption, and minute ventilation after IMT. Subgroup analyses compared those with and without muscle weakness. CHF with inspiratory muscle weakness showed greater gains in the 6-minute walk distance and peak oxygen consumption compared with those with normative maximal inspiratory pressure. The mean quality analysis score was 7.1, and scores ranged from 6 to 10. CONCLUSIONS: The results emphasize the importance of evaluating the inspiratory muscles to identify patients with CHF and inspiratory muscle weakness; subgroup that showed better results after IMT.
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Terapia por Ejercicio , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/rehabilitación , Inhalación/fisiología , Debilidad Muscular/fisiopatología , Músculo Esquelético/fisiopatología , Enfermedad Crónica , Prueba de Esfuerzo , Tolerancia al Ejercicio , Humanos , Consumo de Oxígeno , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
OBJECTIVE: To perform a cross-cultural adaptation and assess the content validity of the Neonatal Medical Index (NMI) for the Brazilian context. METHODS: The cross-cultural adaptation was completed in six steps, including translation, synthesis of translations, back translation, submission to an expert committee, testing of the prefinal version, and appraisal by the original author. The expert committee assessed the equivalence between versions based on the percentage of agreement, and content validity was evaluated using the content validity index (CVI) for each item of the scale (I-CVI) and for the overall scale (S-CVI) in terms of representativeness and clarity. Participants of the prefinal version also evaluated the CVI for clarity. RESULTS: After two evaluation rounds of the expert committee it was attained 98% agreement, attesting to the equivalence between the instrument versions, maximum values for representativeness I-CVI and S-CVI/Ave (1.00), and high values for clarity I-CVI (all items ≥0.97) and S-CVI/Ave (0.98). The expert committee members defined that the Brazilian version of the instrument would be called Índice Clínico Neonatal (NMI-Br). The NMI-Br reached high values of CVI for clarity (all I-CVI ≥0.86 and S-CVI/Ave=0.99) among the participants of the prefinal version. CONCLUSIONS: The NMI-Br is the Brazilian version of the NMI, obtained in a rigorous cross-cultural validation process, counting with adequate values of content validity.
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Comparación Transcultural , Traducciones , Humanos , Brasil , Recién Nacido , Reproducibilidad de los Resultados , Características Culturales , Encuestas y Cuestionarios , Enfermedades del Recién Nacido/diagnósticoRESUMEN
BACKGROUND: The non-invasive assessment of maximal respiratory pressures (MRP) reflects the strength of the respiratory muscles. OBJECTIVE: To evaluate the studies which have established normative values for MRP in healthy children and adolescents and to synthesize these values through a meta-analysis. METHODS: The searches were conducted until October 2023 in the following databases: ScienceDirect, MEDLINE, CINAHL, SciELO, and Web of Science. Articles that determined normative values and/or reference equations for maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in children and adolescents published in English, Portuguese, or Spanish regardless of the year of publication were included. Two reviewers selected titles and abstracts, in case of conflict, a third reviewer was consulted. Articles that presented sufficient data were included to conduct the meta-analysis. RESULTS: Initially, 252 studies were identified, 28 studies were included in the systematic review and 19 in the meta-analysis. The sample consisted of 5798 individuals, and the MIP and MEP values were stratified by sex and age groups of 4-11 and 12-19 years. Values from females 4-11 years were: 65.8 cmH2O for MIP and 72.8 cmH2O for MEP, and for males, 75.4 cmH2O for MIP and 84.0 cmH2O for MEP. In the 12-19 age group, values for females were 82.1 cmH2O for MIP and 90.0 cmH2O for MEP, and for males, they were 95.0 cmH2O for MIP and 105.7 cmH2O for MEP. CONCLUSIONS: This meta-analysis suggests normative values for MIP and MEP in children and adolescents based on 19 studies.
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Presiones Respiratorias Máximas , Músculos Respiratorios , Humanos , Adolescente , Niño , Músculos Respiratorios/fisiología , Valores de Referencia , Masculino , FemeninoRESUMEN
BACKGROUND: The measurement of maximal respiratory pressure (MRP) is a procedure widely used in clinical practice to evaluate respiratory muscle strength through the maximal inspiratory pressure (P(Imax)) and maximal expiratory pressure (P(Emax)). Its clinical applications include diagnostic procedures and evaluating responses to interventions. However, there is great variability in the equipment and measurement procedures. Understanding the impacts of the characteristics of different interfaces can augment the repeatability of this method and help to establish widely applicable predictive equations. The aim of this study was to evaluate the influence of 4 different interfaces on a subject's capacity to generate MRP and the impact of these interfaces on the repeatability of these measurements. METHODS: Fifty healthy subjects (mean ± SD age 26.36 ± 4.89 y) with normal spirometry were evaluated. MRP was measured by a digital manometer connected to 4 interfaces using different combinations of mouthpieces and tubes. The following variables were analyzed: maximum mean pressure, peak pressure, plateau pressure, and plateau variation. Analysis of variance for repeated measures or a Friedman test was used to compare the 4 interfaces, with P < .008 after Bonferroni adjustment considered significant. RESULTS: There was no significant difference between the 4 interfaces with respect to maximum mean pressure, peak pressure, plateau pressure, or plateau variation for P(Imax) (P ≥ .49) or P(Emax) (P ≥ .11), nor did the number of tests performed to fulfill the criteria of repeatability for P(Imax) (P = .69) or P(Emax) (P = .47) differ among the 4 interfaces. CONCLUSIONS: P(Imax) and P(Emax) values seem not to be influenced by the different interfaces studied, suggesting that patient comfort and availability of interfaces can be considered.
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Manometría/instrumentación , Fuerza Muscular/fisiología , Pruebas de Función Respiratoria/instrumentación , Músculos Respiratorios/fisiología , Adulto , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Presión , Reproducibilidad de los ResultadosRESUMEN
CONTEXT: The instrument used to assess neonatal pain must be adequate regarding the type of pain, population, country, and language to provide the best evidence-based clinical strategies; however, few neonatal pain instruments have been translated and validated for the Brazilian population. OBJECTIVE: The aim was to perform a cross-cultural adaptation of the COMFORTneo scale into Brazilian Portuguese and to evaluate the content validity of the adapted scale. METHODS: The cross-cultural adaptation process followed six main steps: translation, synthesis of the translations, back-translation, submission to the expert committee, final version pretest, being that 65 individuals participated in this stage, including both healthcare professionals and students, and submission to the committee for process appraisal. Additionally, an equivalence form composed of a four-point Likert scale was sent to each committee participant to calculate the content validity index (CVI). The CVI was obtained as the sum of the items ranked as three or four by the experts divided by the total number of experts. RESULTS: No difficulties were reported in the production of translated versions. The CVI for the final version of the translated instrument was 0.99. The final version was reviewed to correct any possible grammatical errors. The layout was modified as necessary, and instructions on scale scoring were added to facilitate the application, resulting in the COMFORTneo Brazil scale. CONCLUSION: The COMFORTneo scale was properly and cross-culturally adapted into Brazilian Portuguese, reaching semantic, idiomatic, experimental, and conceptual equivalence with the original instrument, and a good CVI.
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Comparación Transcultural , Lenguaje , Recién Nacido , Humanos , Brasil , Encuestas y Cuestionarios , Traducciones , Dolor/diagnóstico , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Incentive spirometers (ISs) are clinical devices used in respiratory physical therapy to increase alveolar ventilation and functional residual capacity. OBJECTIVES: To investigate factors that influence physical therapists from Minas Gerais in selecting a type of IS and the scientific background behind the use of ISs by physical therapists who work with patients with respiratory dysfunctions. METHODS: Physical therapists from 13 hospital and non-hospital institutions (public/private) completed a self-administered questionnaire based on the current evidence on ISs. RESULTS: Indications and contraindications of ISs are not fully understood by most of the 168 physical therapists who completed the questionnaire. Volume-oriented IS was preferred over flow-oriented IS. However, only half of the physical therapists have a scientific background to justify the choice of one IS type rather than the other. CONCLUSIONS: Most physical therapists from Minas Gerais do not fully understand the indications and contraindications for ISs. Despite physical therapists stating their preference for volume-oriented IS, this choice is not necessarily based on current scientific evidence. The development of strategies to bring physical therapists closer to evidence-based practice is necessary to ensure best patient care.
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Fisioterapeutas , Brasil , Estudios Transversales , Humanos , Motivación , Modalidades de Fisioterapia , Encuestas y CuestionariosRESUMEN
ABSTRACT Objective: To perform a cross-cultural adaptation and assess the content validity of the Neonatal Medical Index (NMI) for the Brazilian context. Methods: The cross-cultural adaptation was completed in six steps, including translation, synthesis of translations, back translation, submission to an expert committee, testing of the prefinal version, and appraisal by the original author. The expert committee assessed the equivalence between versions based on the percentage of agreement, and content validity was evaluated using the content validity index (CVI) for each item of the scale (I-CVI) and for the overall scale (S-CVI) in terms of representativeness and clarity. Participants of the prefinal version also evaluated the CVI for clarity. Results: After two evaluation rounds of the expert committee it was attained 98% agreement, attesting to the equivalence between the instrument versions, maximum values for representativeness I-CVI and S-CVI/Ave (1.00), and high values for clarity I-CVI (all items ≥0.97) and S-CVI/Ave (0.98). The expert committee members defined that the Brazilian version of the instrument would be called Índice Clínico Neonatal (NMI-Br). The NMI-Br reached high values of CVI for clarity (all I-CVI ≥0.86 and S-CVI/Ave=0.99) among the participants of the prefinal version. Conclusions: The NMI-Br is the Brazilian version of the NMI, obtained in a rigorous cross-cultural validation process, counting with adequate values of content validity.
RESUMO Objetivo: Realizar a adaptação transcultural e avaliar a validade de conteúdo do Neonatal Medical Index (NMI) para o contexto brasileiro. Métodos: A adaptação transcultural foi realizada em seis etapas, incluindo tradução, síntese das traduções, retrotradução, submissão a um comitê de especialistas, teste da versão pré-final e avaliação do autor original. O comitê de especialistas avaliou a equivalência entre as versões com base na porcentagem de concordância, e a validade de conteúdo foi avaliada por meio do índice de validade de conteúdo (IVC) para cada item da escala (I-IVC) e para a escala geral (S-IVC) em termos de representatividade e clareza. Os participantes da versão pré-final também avaliaram o IVC quanto à clareza. Resultados: Após duas rodadas de avaliação do comitê de especialistas obteve-se 98% de concordância, atestando a equivalência entre as versões do instrumento, valores máximos para representatividade I-IVC e S-IVC/Ave (1,00) e altos valores para clareza I-IVC (todos os itens ≥0,97) e S-IVC/Ave (0,98). Os membros do comitê de especialistas definiram que a versão brasileira do instrumento se chamaria Índice Clínico Neonatal (NMI-Br). O NMI-Br alcançou altos valores de IVC para clareza (todos I-IVC ≥0,86 e S-IVC/Ave=0,99) entre os participantes da versão pré-final. Conclusões: O NMI-Br é a versão brasileira do NMI, obtido em rigoroso processo de validação transcultural, contando com valores adequados de validade de conteúdo.
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BACKGROUND: Chronic obstructive pulmonary disease (COPD) leads to peripheral and respiratory muscle dysfunctions. Nowadays, inspiratory muscle training can be geared toward strength or endurance gains. This study aims to investigate the effects of an inspiratory muscle training (IMT) protocol using different therapeutic modalities to be implemented in pulmonary rehabilitation programs. The effects of IMT on exercise capacity were considered as the primary endpoint, and the effects of IMT on inspiratory muscle function, health-related quality of life, and daily physical activity level were considered as the secondary outcomes. METHODS: This study is a blinded-investigator randomized controlled clinical trial. Sixty subjects will be randomly allocated into three groups: (1) pulmonary rehabilitation (PR) associated with inspiratory muscle training without any load (PRWIMT), (2) PR associated with inspiratory muscle training with a linear load (PRIMTLL), and (3) PR associated with inspiratory muscle training with isocapnic voluntary hyperpnea (PRIMTIVH). The protocol will be performed 5 days a week (3 days with supervision) for 10 weeks. The study will assess anthropometric data, lung function, respiratory muscle strength, and functional capacity by the Incremental Shuttle Walking Test and the Six-Minute Walk Test, lung volumes during the submaximal endurance test, peripheral muscle strength of the upper and lower limbs, dyspnea, and quality of life related to health, before and after the training protocol. Normality will be tested using the Kolmogorov-Smirnov test, and variables will be compared by two-way analysis of variance. The significance level was set at p < 0.05. Ethics approval was obtained from the Institutional Ethics Committee in Research (1.663.411). The study results will be disseminated through presentation at specific scientific conferences and publication in peer-reviewed journals. DISCUSSION: The different IMT protocols used in our study will be able to guide respiratory therapists to understand and to include in conventional PR programs the most effective respiratory muscle training type in subjects with COPD. TRIAL REGISTRATION: Brazilian Clinical Trials Registry, RBR-94v6kd . Registered on 11 March 2017.
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Ejercicios Respiratorios/métodos , Inhalación , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Músculos Respiratorios/fisiopatología , Actividades Cotidianas , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Tolerancia al Ejercicio , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Factores de Tiempo , Resultado del TratamientoRESUMEN
Introduction: Institutionalized young people may exhibit impaired development due to lack of support, correct guidance regarding their physiological changes, and knowledge about postural changes. Methods: This is a longitudinal observational case series study. Adolescents residing in shelters who could understand the entire protocol were invited to participate in the study. Ten meetings were held, once a week, with 8 theoretical-practical interventions and 2 pre and post-PEP evaluations. The evaluations were: static posture, dynamic balance, handgrip strength, self-esteem, quality of life, and a theoretical questionnaire on general knowledge. Results: From 18 adolescents, 11 (7 boys and 4 girls), with an average age of 14.8 (±1.3) years concluded the study. After the PEP intervention, a significant improvement was found in the knee angles (3.56º vs. 2.28º) and hip (-12.03º vs. -4.18º) in its plane lateral. The scores of the theoretical questionnaire were 4.75 vs. 11.63 and the handgrip strength was 22.91 vs. 28.54 kgf and 21.55 vs. 26.82 kgf for the right and left limbs. In the quality of life and self-esteem questionnaires, no statistically significant differences were obtained. Conclusion: PEP imparts benefits to socially vulnerable adolescents for postural angles, handgrip strength and theoretical knowledge. Self-esteem and quality of life did not change, probably due to their high vulnerability.
Introdução: Jovens institucionalizados podem apresentar comprometimento do desenvolvimento por falta de apoio, orientação correta quanto às suas alterações fisiológicas e conhecimento sobre alterações posturais. Métodos: Trata-se de um estudo observacional longitudinal de série de casos. Foram convidados a participar do estudo adolescentes residentes em abrigos que conseguissem compreender todo o protocolo. Foram realizados dez encontros, uma vez por semana, com 8 intervenções teórico-práticas e 2 avaliações pré e pós-PEP. (programa de educação postural). As avaliações foram: postura estática, equilíbrio dinâmico, força de preensão manual, autoestima, qualidade de vida e questionário teórico de conhecimentos gerais. Resultados: Dos 18 adolescentes, 11 (7 meninos e 4 meninas), com idade média de 14,8 (±1,3) anos, concluíram o estudo. Após a intervenção PEP, foi encontrada melhora significativa nos ângulos do joelho (3,56º vs. 2,28º) e quadril (-12,03º vs. -4,18º) no seu plano lateral. As pontuações do questionário teórico foram 4,75 vs. 11,63 e a força de preensão manual foi 22,91 vs. 28,54 kgf e 21,55 vs. 26,82 kgf para os membros direito e esquerdo. Nos questionários de qualidade de vida e autoestima não foram obtidas diferenças estatisticamente significativas. Conclusão: A PEP traz benefícios aos adolescentes em situação de vulnerabilidade social quanto aos ângulos posturais, força de preensão manual e conhecimento teórico. A autoestima e a qualidade de vida não se alteraram, provavelmente devido à sua elevada vulnerabilidade.
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Comparar o tempo de exposição a telas de lactentes entre os períodos pré e durante a pandemia da COVID-19 e averiguar fatores relacionados a exposição de tela durante esse período. Responderam ao "Questionário tempo de exposição a telas", 63 responsáveis de lactentes, em dois períodos: pré e durante a pandemia COVID-19. Para a comparação entre os períodos, foi utilizado o teste de Wilcoxon Rank. Durante a pandemia da COVID-19, aumentou-se significativamente o tempo de telas, passando de mediana de 4 para 7 horas semanais, destacando-se a televisão como dispositivo mais utilizado. Observou-se a correlação entre idade do lactente e tempo de exposição a telas. Houve aumento do tempo de exposição a telas durante a pandemia da COVID-19 nos lactentes avaliados. O tempo total de telas apresentou uma correlação proporcional com a idade nos períodos avaliados, porém não se correlacionou com a realização de home-office dos responsáveis.
To compare the infants' time exposure to screens between pre- and during the COVID-19 pandemic and to investigate factors related to screen exposure during this period. The "Screen exposure time questionnaire" was answered by 63 caregivers of infants, in two periods: before and during the COVID-19 pandemic. For comparison between periods, the Wilcoxon Rank test was used. During the COVID-19 pandemic, infants' time exposure to screens increased significantly, from a median of 4 to 7 hours per week, with television being the most used device. A correlation was observed between infant age and time exposure to screens. There was an increase in infants' time exposure to screens during the COVID-19 pandemic. Total screen time showed a proportional correlation with age in the evaluated periods; however, it did not correlate with the home-office performance of those responsible.
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OBJECTIVES: To evaluate the agreement between the measured peak oxygen uptake (VO2peak) and the VO2peak estimated by four prediction equations based on the six-minute walk test (6MWT) in chronic heart failure patients. METHOD: Thirty-six chronic heart failure patients underwent cardiopulmonary exercise testing and the 6MWT to assess their VO2peak. Four previously published equations that include the variable six-minute walk distance were used to estimate the VO2peak: Cahalin, 1996a (1); Cahalin, 1996b (2); Ross, 2010 (3); and Adedoyin, 2010 (4). The agreement between the VO2peak in the cardiopulmonary exercise testing and the estimated values was assessed using the Bland-Altman method. A p-value of <0.05 was considered statistically significant. RESULTS: All estimated VO2peak values presented moderate correlation (ranging from 0.55 to 0.70; p<0.001) with measured VO2peak values. Equations 2, 3, and 4 underestimated the VO2peak by 30%, 15.2%, and 51.2%, respectively, showing significant differences from the actual VO2peak measured in the cardiopulmonary exercise testing (p<0.0001 for all), and the limits of agreement were elevated. The VO2peak estimated by equation 1 was similar to that measured by the cardiopulmonary exercise testing, and despite the agreement, bias increased as VO2peak increased. CONCLUSIONS: Only equation 1 showed estimated VO2peak similar to the measured VO2peak; however, a large limits of agreement range (â¼3 METs) does not allow its use to estimate maximal VO2peak.
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Enfermedad Crónica/terapia , Prueba de Esfuerzo/métodos , Insuficiencia Cardíaca/patología , Consumo de Oxígeno/fisiología , Prueba de Paso/métodos , HumanosRESUMEN
RESUMO A prematuridade é fator de risco para atraso do desenvolvimento motor, e recomenda-se o acompanhamento desses lactentes nos primeiros dois anos de vida. Verificar a confiabilidade intra e interexaminadores da Escala Motora Infantil de Alberta (EMIA) em ambulatório de seguimento de recém-nascidos de risco de uma maternidade pública. Estudo prospectivo realizado em ambulatório de seguimento de recém-nascidos de risco. As avaliações do desenvolvimento motor foram realizadas por meio da EMIA, por dois avaliadores previamente treinados. O Coeficiente de Correlação Intraclasse (CCI) foi utilizado para análise das confiabilidades. Para a comparação entre as avaliações intraexaminadores foi realizado o Teste T pareado ou Teste de Wilcoxon. O Teste T independente foi utilizado para comparar as avaliações interexaminadores. A correlação entre as variáveis foi analisada a partir do Teste de Pearson ou Spearman. Para avaliar a concordância entre os escores foi realizada análise de Bland Altman. Foram avaliados 31 recém-nascidos pré-termo (RNPT) com idade corrigida média de 8,47 ± 4,49. Não houve diferença significativa entre as avaliações intraexaminadores e interexaminadores. Os valores de CCI se mantiveram acima de 0,88 para a confiabilidade intraexaminadores e interexaminadores. Os escores apresentaram alta concordância, analisada por meio do teste de Bland Altman. EMIA apresentou adequada confiabilidade intra e interexaminadores para avaliação e acompanhamento de RNPT até 18 meses em ambulatório de seguimento de lactentes de risco.
RESUMEN La prematuridad es un factor de riesgo de retraso en el desarrollo motor de los lactantes y se recomienda la monitorización de ellos durante los dos primeros años de vida. Verificar la fiabilidad intraevaluadores e interevaluadores de la Escala Motora Infantil de Alberta (EMIA) en un seguimiento ambulatorio de recién nacidos de riesgo en una maternidad pública brasileña. Estudio prospectivo realizado en un seguimiento ambulatorio de recién nacidos de riesgo. Para evaluar el desarrollo motor, la EMIA fue empleada por dos evaluadores previamente capacitados. Se utilizó el coeficiente de correlación intraclase (CCI) para analizar la fiabilidad. Para comparar las evaluaciones intraevaluadores, se utilizó la prueba T pareada o la prueba de Wilcoxon. La prueba T independiente se utilizó para comparar las evaluaciones interevaluadores. La correlación entre las variables se analizó mediante la prueba de Pearson o Spearman. Para evaluar la concordancia entre los puntajes, se aplicó el análisis de Bland Altman. Se evaluaron a 31 recién nacidos pretérmino (RNPT) con un promedio de edad media corregida de 8,47 ± 4,49. No hubo diferencias significativas entre las evaluaciones intraevaluadores e interevaluadores. Los valores de CCI se mantuvieron por encima de 0,88 para la fiabilidad intraevaluadores e interevaluadores. Los puntajes mostraron un alto nivel de concordancia, que se analizó mediante el Bland Altman. La EMIA apuntó una adecuada fiabilidad intra e interevaluadores para evaluar y monitorear los RNPT hasta 18 meses en seguimiento ambulatorio de lactantes de riesgo.
ABSTRACT Prematurity is a risk factor for delayed motor development, and it is recommended to monitor these infants in the first two years of life. To verify the properties of intra and inter-examiner measurements of AIMS in an outpatient follow-up clinic for newborns at risk in a public maternity hospital. Prospective study conducted in an outpatient follow-up of high-risk newborns. The Intraclass Correlation Coefficient (ICC) was used to analyze reliability. To compare the intra-examiner evaluations, the paired T-test or Wilcoxon test was performed. The independent T-test was used to compare inter-examiner assessments. The correlation between variables was analyzed using the Pearson or Spearman test. The Bland Altman test was performed to assess the concordance between the scores. 31 preterm infants with 8,47 ± 4,49 of corrected age were evaluated. There was no significant difference between the evaluations intra and inter-examiner. The ICC values remained above 0.88 for both intra and inter-examiner evaluation. The scores showed high agreement. AIMS has intra- and inter-examiner reliability for assessing and monitoring preterm newborns for up to 18 months in a follow-up clinic.
RESUMEN
PURPOSE: To investigate (1) the validity of using the Human Activity Profile (HAP) in patients with heart failure (HF) to estimate functional capacity; (2) the association between the HAP and 6-Minute Walk Test (6MWT) distance; and (3) the ability of the HAP to differentiate between New York Heart Association (NYHA) functional classes. METHODS: In a cross-sectional study, we evaluated 62 clinically stable patients with HF (mean age, 47.98 years; NYHA class I-III). Variables included maximal functional capacity as measured by peak oxygen uptake ((Equation is included in full-text article.)O2) using a cardiopulmonary exercise test (CPET), peak (Equation is included in full-text article.)O2 as estimated by the HAP, and exercise capacity as measured by the 6MWT. RESULTS: The difference between the measured (CPET) and estimated (HAP) peak (Equation is included in full-text article.)O2 against the average values showed a bias of 2.18 mL/kg/min (P = .007). No agreement was seen between these measures when applying the Bland-Altman method. Peak (Equation is included in full-text article.)O2 in the HAP showed a moderate association with the 6MWT distance (r = 0.62; P < .0001). Peak (Equation is included in full-text article.)O2 in the HAP was able to statistically differentiate NYHA functional classes I, II, and III (P < .05). CONCLUSIONS: The estimated peak (Equation is included in full-text article.)O2 using the HAP was not concordant with the gold standard CPET measure. On the contrary, the HAP was able to differentiate NYHA functional class associated with the 6MWT distance; therefore, the HAP is a useful tool for assessing functional performance in patients with HF.
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Estado de Salud , Insuficiencia Cardíaca/fisiopatología , Actividades Humanas , Encuestas y Cuestionarios , Adulto , Estudios Transversales , Tolerancia al Ejercicio , Femenino , Humanos , Masculino , Persona de Mediana Edad , Consumo de Oxígeno , Prueba de PasoRESUMEN
Introdução: A falha no processo de retirada da ventilação mecânica invasiva (VMI) está associada a desfechos adversos, como alta mortalidade hospitalar e custos elevados. Objetivo: Conhecer os fatores de risco para falha na extubação em adultos internados em UTI submetidos à VMI. Secundariamente, conhecer a taxa de reintubação orotraqueal (Re-TOT). Métodos: Estudo prospectivo, observacional, realizado em prontuários eletrônicos em um período de 11 meses em uma UTI adulto. Os testes Qui-quadrado ou Exato de Fischer compararam a Re-TOT, sexo e faixas etárias. Resultados: Prontuários de 224 adultos foram analisados, com média de idade 61,9±16,9 anos e 48,2% do sexo masculino. O principal motivo de internação foi por insuficiência respiratória aguda (33%). Mulheres foram susceptíveis à falha na extubação comparadas aos homens (21,5% vs. 10%, p= 0,019; respectivamente), e idade avançada. A Re-TOT foi de 31,5%. Conclusão: Sexo feminino e idade avançada foram fatores de risco para falha na extubação. A Re-TOT foi mais elevada que outros índices da literatura
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Extubación Traqueal/efectos adversos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Insuficiencia Respiratoria/complicaciones , Desconexión del Ventilador , Factores Sexuales , Estudios Prospectivos , Factores de EdadRESUMEN
RESUMO O objetivo deste estudo foi avaliar e comparar respostas metabólicas, cardiovasculares e ventilatórias do incremental shuttle walk test (ISWT) e do Glittre activities of daily living test (Glittre-ADL test). Trata-se de um estudo transversal, realizado com indivíduos saudáveis. A capacidade funcional (CF) foi avaliada pela distância percorrida e consumo de oxigênio pico (VO2pico) no ISWT e pelo tempo gasto e VO2 no Glittre-ADL test. Trinta indivíduos percorreram 656,67 (IC95%:608,8-704,5) metros no ISWT e executaram o Glittre-ADL test em 2,4 (IC95%:2,2-2,6) minutos. O VO2 pico do ISWT foi 27,8 (IC95%25,6-29,9) versus 22,2 (IC95%20,5-24,1)mL×kg−1×min−1 (p<0,001) no estado estável (EE) do Glittre-ADL test. As correlações entre distância percorrida no ISWT e o tempo gasto no Glittre-ADL test, o VO2pico do ISWT e o VO2 no EE do Glittre-ADL test e a FC no pico do ISWT e no EE do Glittre-ADL test foram de moderada a alta magnitude. O Glittre-ADL test apresenta menores respostas metabólicas, cardiovasculares e ventilatórias se comparado ao ISWT.
RESUMEN El presente estudio tuvo el objetivo de evaluar y comparar las respuestas metabólicas, cardiovasculares y ventilatorias de incremental shuttle walk test (ISWT) y de Glittre activities of daily living test (Glittre-ADL test). Es un estudio transversal realizado con individuos sanos. La capacidad funcional (CF) se evaluó utilizando la distancia recorrida y consumo máximo de oxígeno (VO2máx) en el ISWT y el tiempo empleado y VO2 en el Glittre-ADL test. Treinta individuos caminaron 656,67 (IC95%:608,8-704,5) metros en el ISWT y realizaron el Glittre-ADL test en 2,4 (IC95%:2,2-2,6) minutos. El VO2 máx del ISWT fue de 27,8 (IC95%25,6-29,9) versus 22,2 (IC95%20,5-24,1)mL×kg−1×min−1 (p<0,001) en el estado estable (EE) del Glittre-ADL test. Las correlaciones entre la distancia recorrida en el ISWT y el tiempo empleado en el Glittre-ADL test, el VO2máx del ISWT y el VO2 en el EE de Glittre-ADL test y la FC en el máximo del ISWT y en el EE de Glittre-ADL test fueron de moderada a alta magnitud. El Glittre-ADL test presenta respuestas metabólicas, cardiovasculares y ventilatorias más bajas en comparación con el ISWT.
ABSTRACT The aim of the study was to assess and compare the cardiovascular, ventilatory and metabolic responses of the Incremental Shuttle Walk test (ISWT) and Glittre Activities of Daily Living test (Glittre-ADL test). This is a cross-sectional study with individuals. The functional capacity (FC) was evaluated by distance and peak oxygen consumption (VO2peak) in the ISWT and time spent and VO2 in Glittre-ADL test. Thirty individuals went through 656.67 (CI95%:608.8-704.5) meters at the ISWT and performed the Glittre-ADL test in 2.4 (CI95%:2.2-2.6) minutes. The peak VO2 of the ISWT was 27.8 (CI95%25.6-29.9) vs. 22.2 (CI95%20.5-24.1) mL×kg−1×min−1 (p<0.001) in the steady state (SS) of the Glittre-ADL test. Correlations between distance traveled in the ISWT and the time spent in Glittre-ADL test, VO2 peak of ISWT and VO2 in SS of Glittre-ADL test and HR at the ISWT peak and at the Glittre-ADL test SS were moderate to high magnitude. The Glittre-ADL test has lower metabolic, cardiovascular and ventilatory responses compared to ISWT, despite correlations between variables.