New reference values for maximum respiratory pressures in healthy Brazilian children following guidelines recommendations: A regional study.

OBJECTIVE: To determine reference values for maximum static respiratory pressures in healthy children from a Brazilian region, following recommendations of the European Respiratory Society (ERS) and the Brazilian Society of Pneumology and Tisiology (SBPT). METHODS: A cross-sectional observational study was conducted with healthy children (6 to 11 years) of both sexes. The maximum inspiratory and expiratory pressures (PImax and PEmax, respectively) were measured using a digital manometer. Each child performed a minimum of three and a maximum of five maneuvers; three acceptable and reproducible maneuvers were considered for analysis. Minimum time for each maneuver was 1.5 seconds, with a one-second plateau, and one minute of rest between them. A stepwise multiple linear regression analysis was conducted for PImax and PEmax, considering correlations between independent variables: age, weight, and sex. RESULTS: We included 121 children (62 girls [51%]). Boys reached higher values for maximum respiratory pressures than girls. Respiratory pressures increased with age showing moderate effect sizes (PImax: f = 0.36; PEmax: f = 0.30) between the stratified age groups (6-7, 8-9, and 10-11 years). Age and sex were included in the PImax equation (PImax = 24.630 + 7.044 x age (years) + 13.161 x sex; R2 = 0.189). PEmax equations were built considering age for girls and weight for boys [PEmax (girls) = 55.623 + 4.698 x age (years) and PEmax (boys) = 82.617 + 0.612 x weight (kg); R2 = 0.068]. CONCLUSIONS: This study determined new reference equations for maximal respiratory pressures in healthy Brazilian children, following ERS and SBPT recommendations.

Measurement properties of the six-minute pegboard and ring test (6PBRT) in healthy adolescents.

OBJECTIVES: To investigate the cardiorespiratory responses to the 6-min pegboard and ring test (6PBRT) and to assess its reproducibility in healthy adolescents. METHODS: It was a cross-sectional study with 52 healthy adolescents (11-18 years old of both genders). The 6PBRT was performed twice on two different days by the same examiner. Intra-rater reliability, percentage of the minimal difference chance (MDC%) and agreement of the number of moving rings were analyzed. Also, cardiopulmonary parameters were collected before and after tests. RESULTS: Intraclass correlation coefficient (ICC) for the number of rings moved was 0.87 (95%CI 0.69-0.93). The mean number of moved rings during the second test was higher. The MDC% with a 95 % confidence interval was greater than acceptable values. Bland-Altman analysis did not show agreement between measurements (bias = 30.1); with upper and lower limits of agreement of -67.8 to 127.9, respectively. There was a significant increase in dyspnea, fatigue and HR values at the end of the tests (p < 0.0001). In both tests, participants reached HR equivalent to 48 % of the maximum predicted. CONCLUSION: Together, the results suggest that the 6PBRT is not a reliable measure for a population of healthy adolescents, which indicates the necessity to perform more than one test. The 6PBRT is suggested to be a submaximal test for this population.

The effect of a six-week osteopathic visceral manipulation in patients with non-specific chronic low back pain and functional constipation: study protocol for a randomized controlled trial.

BACKGROUND: The aim of the proposed study is to analyze the effect of a six-week osteopathic visceral manipulation (OVM) program on the flexion-relaxation phenomenon in individuals with non-specific chronic low back pain (LBP) and functional constipation. METHODS/DESIGN: An assessor-blinded, two-arm, randomized, placebo-controlled trial will be conducted. The sample will comprise 76 individuals with non-specific chronic LBP who have functional intestinal constipation, aged 18-65 years. The participants will be randomly allocated to two groups: (1) OVM and (2) sham OVM (SOVM). Evaluations will involve an interview, the Oswestry Disability Index, Fear-Avoidance Beliefs Questionnaire, functional constipation according to Rome III criteria, Biering-Sorensen test to normalize electromyographic (EMG) data, T12-L1 paraspinal level of the EMG signal during the flexion-relaxation phenomenon, 11-point numeric pain rating scale and fingertip-to-floor test. OVM and SOVM will be performed once per week for six weeks. Group 1 will receive OVM for 15 min and Group 2 will receive a sham visceral technique. Evaluations will be performed before and after the first session, after six weeks of treatment, and three months after randomization (follow-up). The findings will be analyzed statistically considering a 5% significance level (p ≤ 0.05). The limitation of the study is that the therapist will not be blinded. DISCUSSION: This will be the first trial to analyze the clinical response and electromyographic signals during the flexion-relaxation phenomenon after OVM. TRIAL REGISTRATION: Brazilian Clinical Trial Registry, RBR-7sx8j3 . Registered on 26 October 2017.

Performance and Reproducibility of the Continuous Scale Physical Functional Performance 10 Test in Patients With Chronic Obstructive Pulmonary Disease: A CONTROLLED CROSS-SECTIONAL STUDY.

PURPOSE: To compare the performances of patients with chronic obstructive pulmonary disease (COPD) and healthy individuals on the Continuous Scale Physical Functional Performance 10 (PFP10) test and, second, to test the reproducibility of the PFP10 test in these participants. METHODS: In a prospective, cross-sectional study, 28 patients with COPD (67 ± 9 y, FEV1: 44.3 ± 16.9% pred) and 12 healthy volunteers (healthy group) matched by age, body mass index, and sex were included. The participants performed 2 PFP10 tests 5 d apart. Main outcome measure was performance on the PFP10 test and included total score, score for specific domains, and total time to perform the PFP10 test. RESULTS: The functional performance of patients with COPD was worse than that of the healthy group on PFP10 total scores (43.9 ± 12.6 vs 63.5 ± 9.4, respectively; P < .001; effect size: 1.78) and time to complete the tasks (207.9 ± 36.1 sec vs 153.2 ± 12.1 sec, respectively; P < .001, effect size: 2.27). In addition, the COPD group had significantly worse performance in the domains of upper-body strength, lower-body strength, balance and coordination, and endurance. The test was highly reproducible (ICC: 0.98; 95% CI, 0.96-0.99 for both groups), and the mean difference (upper and lower limits of agreement) of the total scores was -3 (-9 to 3). CONCLUSIONS: The PFP10 test is a suitable and reproducible test for determining decreases in the functional performance of patients with COPD compared with healthy individuals.

Prevalence of rhinitis and associated factors in schoolchildren who live in the Amazon islands.

BACKGROUND: The prevalence of rhinitis has been reported to be higher in urban areas. OBJECTIVE: To determine the prevalence of rhinitis in schoolchildren who lived on two islands in the Brazilian Amazon, including a rural island and an urban island, and to identify the associated risk factors. METHODS: Four hundred children (200 per island) were evaluated by using the International Study of Asthma and Allergy in Childhood standard written questionnaire (rhinitis module). A convenience sample for both islands was selected based on the age group of the study (5-8 years). The children were assessed for potential risk factors (complementary written questionnaire) identified by logistic regression. RESULTS: The prevalence of active rhinitis was significantly higher in the children who lived on Outeiro Island compared with Combú Island (34.5% versus 18.0%, respectively). The associated risk factors for rhinitis symptoms on Combú Island included parental history of rhinitis (odds ratio [OR] 9.4 [95% confidence interval {CI}, 2.1-41.4]) and delivery by caesarean-section (OR 5.2 [95% CI, 1.2-21.9]), and for Outeiro Island included parental history of rhinitis (OR 4.5 [95% CI, 1.7-11.2]) and of asthma (OR 3.8 [95% CI, 1.5-9.8]), nocturnal cough in the previous year (OR 5.8 [95% CI, 2.1-16.0]), breast-feeding (≥6 months) (OR 9.6 [95% CI, 1.1-82.1]), moisture (OR 2.4 [95% CI, 0.9-6.4]), and consumption of fruit juice more than two times a week (OR 4.3 [95% CI, 1.2-15.0]). CONCLUSION: The different risk factors identified for rhinitis on each island indicated the role of the urban environment in the development of the disease.