Biomechanical aspects that precede freezing episode during gait in individuals with Parkinson's disease: A systematic review.

BACKGROUND: The freezing episode (FE) management during gait in Parkinson's disease is inefficient with current medications, neurosurgery, and physical interventions. Knowing the biomechanical change patients suffer preceding FE would be the ultimate goal to measure, predict, and prevent these events. OBJECTIVE: We performed a systematic review to summarize the kinematic, kinetic, electromyographic, and spatio-temporal characteristics of the events that precede the FE during gait in Parkinson's disease. LITERATURE SURVEY: Databases searched included PubMed, Embase, and Cochrane and between 2001 to August 2021. METHODOLOGY: The present study was a systematic review registered in the PROSPERO database (CRD42021255082). Three reviewers searched and selected studies with methodologies involving biomechanical changes and kinetic, kinematic, electromyography, and spatiotemporal changes before FE in a patient with Parkinson's disease. The relevant articles that show the events preceding FE in patients with PD were identified. We excluded studies that describe or compare methods or algorithms to detect FE. Studies may include participants with all PD severity, time of disease, and age. SYNTHESIS: We selected ten articles for final evaluation. The most consistent results indicate a dramatic reduction of movement excursions with (1) decrease in stride length; (2) decreased gait speed; (3) postural instability with the increased double support phase; (4) incoordination of anterior tibial and gastrocnemius; (5) larger amplitude in the EMG of biceps femoris; (6) decreased range of motion in the sagittal plane at the ankle and hip joints; and (7) anterior pelvic tilt. CONCLUSION: FE is characterized by complex motor patterns than normal gait and mismatched gains in the perception and execution of the ongoing movement.

Pattern of alcohol consumption and associated factors among adolescents students of public schools in an inner city in Brazil.

OBJECTIVE: To identify issues related to alcohol consumption among students from an inner city in Southeastern Brazil. METHODS: In this cross-sectional study, 638 students from 13 to 17 years old, of which 355 (55.6%) were girls, were randomly selected in 13/40 (32.5%) public schools from November 2009 to August 2010. A structured questionnaire was used to collect personal/family data, and the Alcohol Use Disorders Identification Test (AUDIT) was used to evaluate alcohol consumption. Bivariate analysis and logistic regression were used. RESULTS: It was observed that 516 (80.9%) students have used alcohol in their lifetime, and 115 (18.4%) had hazardous drinking (AUDIT ≥ 8). By crude analysis, the hazardous drinking was associated with age range (16 - 17 years old), age at first alcohol consumption (≤ 12 years old), higher family income, conflicting family environment, absence of religion practice and parents that consume alcoholic beverages. By adjusted analysis, it was observed an association with the age at first alcohol consumption [≤ 12 years old, odds ratio (OR) = 2.5; 95% confidence interval (95%CI) 1.4 - 4.4]. Active sex life was more frequent among those that have used alcohol in their lifetime (OR = 3.3; 95%CI 2.0 - 5.3). Under the influence of alcohol, 22/103 (21.4%) students have not always used condoms. Among all, 25.4% believe that there is no risk in drinking, and 98% had already bought alcoholic beverages. Having the desire to drink after watching alcoholic beverage advertisements was more frequent among adolescents who had already consumed these beverages (OR = 1.7; 95%CI 1.1 - 2.6). CONCLUSION: The alcohol consumption is early and worrying among adolescents, emphasizing the need for awareness of students and their parents and carers to these risks, and also the compliance with the law prohibiting the sale of alcoholic beverages to minors.