Constraint Induced Movement Therapy Increases Functionality and Quality of Life after Stroke.

This blind randomized clinical trial evaluated the effect of CIMT on the functionality and quality of life (QOL) of chronic hemiparetics. Thirty volunteers were divided into two groups: Control (CG) and CIMT (CIMTG); evaluated before and after 12 and 24 intervention sessions. The scales used were: adapted Fugl-Meyer Motor Assessment (FMA), Modified Ashworth, Stroke Specific Quality Of Life (SS-QOL) and the Functional Reach Test (FRT). The scores for all FMA variables in the CIMTG increased until the 24th session, differing from the pre-treatment. In the CG, the scores increased for pain, coordination/ speed and sensitivity. In the FRT there was an increase in the scores in both groups; after the 12th and 24th sessions, the result of the CIMTG was superior to the CG. For the SS-QOL in the CIMTG, the general score and most of the variables increased, as well as in the CG. Muscle tone in CIMTG was lower compared to CG after 24 sessions. Both protocols used in the study were effective, the CIMT protocol showed benefits in recovering the functionality of the paretic upper limb, in the functional range and in reducing muscle tone, with a consequent improvement in quality of life.

Impact of physical activity levels on musculoskeletal symptoms and absenteeism of workers of a metallurgical company.

INTRODUCTION: Physical inactivity is the fourth biggest risk factor for global mortality. In Brazilian metallurgical industries, workers present a high incidence of musculoskeletal symptoms as one of the main causes of absenteeism. OBJECTIVES: To investigate the impact of physical activity levels and leisure-time physical exercise on musculoskeletal symptoms and absenteeism among administrative and production workers of a metallurgical industry. METHODS: This is a transversal study that included 206 workers. We applied the Modified Baecke Questionnaire, leisure-time physical activity and leisure-time physical exercise domains), as well as the Nordic Musculoskeletal Questionnaire regarding symptom occurrence and severity scores (1-4), and compared levels of absenteeism. Our sample was divided into 2 groups: production and office workers. RESULTS: We observed a significant difference between the groups regarding symptom severity score 3 (p = 0.03) and absenteeism (p = 0.02); the production group presented higher results. There was a correlation between leisure-time physical exercise and absenteeism (r = -0.57, p = 0.01) and between leisure-time physical activity and absenteeism (r = -0.55, p = 0.01) in the production worker group, whereas in the office worker group, leisure-time physical activity and symptom severity score 4 were correlated (r = 0.63, p = 0.02). CONCLUSIONS: Production workers presented higher occurrences of symptom severity score 3 and absenteeism; increased levels of leisure-time physical activity and physical exercise reduced absenteeism. Leisure-time physical activity was correlated with severity score 4 in the office worker group.

Inspiratory loading exercises on respiratory muscle function in post-operative gastroplasty patients: a randomized clinical trial / Exercícios com carga inspiratória na função muscular respiratória no pós-operatório de gastroplastia: um ensaio clínico randomizado / Ejercicios con carga inspiratoria en la función muscular respiratoria en el postoperatorio de gastroplastia: un ensayo clínico aleatorizado

Abstract Introduction: The gastroplasty post-operative period can alter respiratory mechanics and predispose patients to respiratory complications. Objective: The objective was to evaluate the effects of exercises with inspiratory load on respiratory muscle function and on the prevalence of atelectasis after gastroplasty. Method: 40 participants were randomly allocated into two groups: Control Group (CG), its members underwent conventional respiratory physical therapy (CRP) and the Inspiratory Load Group (ILG), its members performed exercises with linear inspiratory pressure load, with 40% of the maximum inspiratory pressure (MIP), associated with CRP. Therapy procedures were conducted twice during the immediate post-operative period and thrice on the first post-operative day. In addition to evaluating the MIP, the nasal inspiratory pressure (NIP) and the sustained maximum inspiratory pressure (SMIP) were evaluated before and after treatment. Analysis of variance followed by the Bonferroni correction were applied considering a 5% significance level (p < 0.05). Results: There was no significant difference in NIP and SMIP values when the pre- and post-operative periods were compared for the ILG; however, these values were significantly lower for the CG, also with intergroup differences in NIP values. Atelectasis prevalence was 5% for ILG and 15% for CG, with no intergroup difference. Conclusion: The inspiratory muscle strength and resistance of the respiratory muscles were maintained in the group that performed exercises with inspiratory load associated with CRP, with a low rate of atelectasis after gastroplasty.

Resumo Introdução: O pós-operatório de gastroplastia pode alterar a mecânica respiratória e predispor a complicações respiratórias. Objetivo: Avaliar os efeitos de exercícios com carga inspiratória na função muscular respiratória e na prevalência de atelectasias após gastroplastia. Método: 40 voluntárias foram alocadas randomicamente em: Grupo Controle (GC), que recebeu Fisioterapia Respiratória Convencional (FRC) e Grupo Carga Inspiratória (GCI), que executou exercícios com carga inspiratória linear pressórica com 40% da pressão inspiratória máxima (PImáx), associados à FRC. Os tratamentos foram realizados duas vezes no pós-operatório imediato e três vezes no primeiro dia pós-operatório. Além da PImáx, foram avaliadas a pressão inspiratória nasal (PIN) e a pressão inspiratória máxima sustentada (PImáxS) antes e após o tratamento. Foi realizada análise de variância seguida de ajuste de Bonferroni, e o nível de significância estatística foi de 5% (p < 0,05). Resultados: Não houve diferença significativa nos valores de PIN e na PImáxS no GCI quando comparados o pré e pós-operatório, diferentemente do GC, no qual esses valores foram significativamente menores além de diferença entre os grupos no valor de PIN. A prevalência de atelectasias foi de 5% para GCI e 15% para GC, sem diferenças intergrupos. Conclusão: Houve manutenção da força muscular inspiratória e da resistência dos músculos respiratórios no grupo que realizou exercícios com carga inspiratória, associado a FRC com baixo índice de atelectasias após gastroplastia.

Resumen Introducción: El postoperatorio de gastroplastia puede alterar la mecánica respiratoria y predisponer a complicaciones respiratorias. Objetivo: Evaluar los efectos de ejercicios con carga inspiratoria en la función muscular respiratoria y en la prevalencia de atelectasias después de la gastroplastia. Método: 40 voluntarias fueron asignadas en: Grupo Control (GC), que recibió Fisioterapia Respiratoria Convencional (FRC) y Grupo Carga Inspiratoria (GCI), que ejecutó ejercicios con carga inspiratoria, realizados con carga lineal inspiratoria con un 40% de la presión inspiratoria máxima (PIM) asociados a la FRC. Ambos tratamientos se realizaron dos veces en el postoperatorio inmediato y tres veces en el primer día postoperatorio. Además de la PIM, se evaluaron la presión inspiratoria nasal (PIN) y la presión inspiratoria máxima sostenida (PImáxS) antes y después del tratamiento. Se realizó el análisis de varianza seguida de ajuste de Bonferroni. Se adoptó nivel de significancia estadística del 5% (p < 0,05). Resultados: No hubo diferencia significativa en los valores de PIN y en la PImáxS en el GCI cuando se compararon en el pre y en postoperatorio, a diferencia del GC, en el cual estos valores fueron significativamente menores más allá de diferencia entre los grupos en el valor de PIN. La prevalencia de atelectasias fue de 5% para GCI y 15% para GC, sin diferencia entre grupos. Conclusión: Hubo mantenimiento de la fuerza muscular inspiratoria y de la resistencia de los músculos respiratorios en el grupo que realizó ejercicios con carga inspiratoria, asociados a la FRC, con bajo índice de atelectasias tras gastroplastia.

(Des) Valorização da atividade física na pré-escola por professores / (No) Valorization of physical activity in early schools by teachers / (Des)valorización de la actividad física en educación preescolar por parte de los maestros

Resumo O objetivo deste estudo foi analisar a importância e a frequência de atividades cotidianas, dadas pelos professores de pré-escolas, em dois estados brasileiros. Eles preencheram um questionário sobre as atividades feitas pelas crianças. A maioria dos professores (90%) considerou tais atividades importantes, mas apenas 15% indicaram frequência diária de atividades físicas. As atividades que tendem ao sedentarismo foram as mais frequentes e as mais importantes e não há oferta suficiente de atividades físicas. Estratégias de intervenção e diálogo entre professores, pais, governos, bem como outros setores da sociedade, precisam ser implantadas para elevar os níveis de atividade física na pré-escola e combater o estilo de vida sedentário.

Abstract The goal of this study was to analyze importance and frequency of daily activities given by preschool teachers from two Brazilian states. They completed a questionnaire about the activities carried out by children. Most of them (90%) considered such activities as important but just 15% of them indicated a daily frequency of physical activity. Sedentary activities were more often and more important and they do not offer enough physical activities. Intervention strategies and dialogue among teachers, parents, government as well other communities sectors are need to be implanted in order to elevate physical activities levels in preschool children and combat sedentary lifestyle.

Resumen El objetivo de este estudio fue analizar la importancia y la frecuencia de las actividades diarias impartidas por los maestros de preescolar en dos estados brasileños. Los maestros completaron un cuestionario sobre las actividades feitas por los niños. La mayoría de profesores (90%) considera que esas actividades son importantes aunque solo el 15% señalaron que la frecuencia de las actividades físicas era diaria. Las actividades que tienden hacia un estilo de vida sedentario son los más frecuentes y las más importantes, y no hay suficiente oferta de actividades físicas. Deben implantarse estrategias de intervención y diálogo entre maestros, padres, gobierno y otros sectores de la sociedad para aumentar los niveles de actividad física en preescolar y combatir el estilo de vida sedentario.

AIRWAY POSITIVE PRESSURE VS. EXERCISES WITH INSPIRATORY LOADING FOCUSED ON PULMONARY AND RESPIRATORY MUSCULAR FUNCTIONS IN THE POSTOPERATIVE PERIOD OF BARIATRIC SURGERY.

BACKGROUND: Bariatric surgery can trigger postoperative pulmonary complications due to factors inherent to the procedure, mainly due to diaphragmatic dysfunction. AIM: To evaluate and compare the effects of two levels of positive pressure and exercises with inspiratory load on lung function, inspiratory muscle strength and respiratory muscle resistance, and the prevalence of atelectasis after gastroplasty. METHODS: Clinical, randomized and blind trial, with subjects submitted to bariatric surgery, allocated to two groups: positive pressure group, who received positive pressure at two levels during one hour and conventional respiratory physiotherapy and inspiratory load group, who performed exercises with load linear inspiratory pressure, six sets of 15 repetitions, in addition to conventional respiratory physiotherapy, both of which were applied twice in the immediate postoperative period and three times a day on the first postoperative day. Spirometry was performed for pulmonary function analysis, nasal inspiratory pressure for inspiratory muscle strength and incremental test of respiratory muscle resistance for sustained maximal inspiratory pressure, both preoperatively and on hospital discharge on the second postoperative day. RESULTS: There was no significant difference (p> 0.05) in the expiratory reserve volume and in the tidal volume in the pre and postoperative periods when compared intra and intergroup. There was no significant difference (p>0.05) in the nasal inspiratory pressure and the maximal inspiratory pressure maintained in the inspiratory load group in the intragroup evaluation, but with a significant difference (p<0.05) compared to the positive pressure group. The prevalence of atelectasis was 5% in both groups with no significant difference (p>0.05) between them. CONCLUSION: Both groups, associated with conventional respiratory physiotherapy, preserved expiratory reserve volume and tidal volume and had a low atelectasis rate. The inspiratory loading group still maintained inspiratory muscle strength and resistance of respiratory muscles.

Airway positive pressure vs. exercises with inspiratory loading focused on pulmonary and respiratory muscular functions in the postoperative period of bariatric surgery / Pressão positiva nas vias aéreas versus exercícios com carga inspiratória na função pulmonar e na função muscular respiratória no pós-operatório de cirurgia bariátrica

ABSTRACT Background: Bariatric surgery can trigger postoperative pulmonary complications due to factors inherent to the procedure, mainly due to diaphragmatic dysfunction. Aim: To evaluate and compare the effects of two levels of positive pressure and exercises with inspiratory load on lung function, inspiratory muscle strength and respiratory muscle resistance, and the prevalence of atelectasis after gastroplasty. Methods: Clinical, randomized and blind trial, with subjects submitted to bariatric surgery, allocated to two groups: positive pressure group, who received positive pressure at two levels during one hour and conventional respiratory physiotherapy and inspiratory load group, who performed exercises with load linear inspiratory pressure, six sets of 15 repetitions, in addition to conventional respiratory physiotherapy, both of which were applied twice in the immediate postoperative period and three times a day on the first postoperative day. Spirometry was performed for pulmonary function analysis, nasal inspiratory pressure for inspiratory muscle strength and incremental test of respiratory muscle resistance for sustained maximal inspiratory pressure, both preoperatively and on hospital discharge on the second postoperative day. Results: There was no significant difference (p> 0.05) in the expiratory reserve volume and in the tidal volume in the pre and postoperative periods when compared intra and intergroup. There was no significant difference (p>0.05) in the nasal inspiratory pressure and the maximal inspiratory pressure maintained in the inspiratory load group in the intragroup evaluation, but with a significant difference (p<0.05) compared to the positive pressure group. The prevalence of atelectasis was 5% in both groups with no significant difference (p>0.05) between them. Conclusion: Both groups, associated with conventional respiratory physiotherapy, preserved expiratory reserve volume and tidal volume and had a low atelectasis rate. The inspiratory loading group still maintained inspiratory muscle strength and resistance of respiratory muscles.

RESUMO Racional : A cirurgia bariátrica pode desencadear complicações pulmonares no pós-operatório devido a fatores inerentes ao procedimento, sobretudo pela disfunção diafragmática. Objetivo : Avaliar e comparar os efeitos da aplicação de dois níveis de pressão positiva e dos exercícios com carga inspiratória na função pulmonar, força muscular inspiratória e resistência muscular respiratória e na prevalência de atelectasia após gastroplastia. Métodos : Ensaio clínico, randomizado e cego, com sujeitos submetidos à cirurgia bariátrica, alocados em dois grupos: grupo pressão positiva, que recebeu pressão positiva em dois níveis, durante uma hora e fisioterapia respiratória convencional e grupo carga inspiratória, que realizou exercícios com carga linear pressórica inspiratória, seis séries de 15 repetições, além da fisioterapia respiratória convencional, sendo ambos aplicados duas vezes no pós-operatório imediato e três vezes ao dia no primeiro dia de pós-operatório. Foram realizados espirometria para análise da função pulmonar, pressão inspiratória nasal para força muscular inspiratória e teste incremental de resistência muscular respiratória para pressão inspiratória máxima sustentada, no pré-operatório e no dia da alta hospitalar, no segundo dia de pós-operatório. Resultados : Não houve diferença significativa (p>0,05) no volume de reserva expiratório e no volume corrente no pré e no pós-operatório quando comparados intra e intergrupo. Não houve diferença significativa (p>0,05) na pressão inspiratória nasal e na pressão inspiratória máxima sustentada no grupo carga inspiratória na avaliação intragrupo, mas com diferença significativa (p<0,05) comparada ao grupo pressão positiva. A prevalência de atelectasias foi de 5% em ambos os grupos sem diferença significativa (p>0,05) entre eles. Conclusão : Ambos os grupos, associados à fisioterapia respiratória convencional, preservaram o volume de reserva expiratório e o volume corrente e apresentaram baixo índice de atelectasias. O grupo carga inspiratória ainda manteve a força muscular inspiratória e a resistência dos músculos respiratórios.

Analysis of the prevalence of atelectasis in patients undergoing bariatric surgery / Análise da prevalência de atelectasia em pacientes submetidos à cirurgia bariátrica

Abstract Background and objective: To observe the prevalence of atelectasis in patients undergoing bariatric surgery and the influence of the body mass index (BMI), gender and age on the prevalence of atelectasis. Method: Retrospective study of 407 patients and reports on chest X-rays carried out before and after bariatric surgery over a period of 14 months. Only patients who underwent bariatric surgery by laparotomy were included. Results: There was an overall prevalence of 37.84% of atelectasis, with the highest prevalence in the lung bases and with greater prevalence in women (RR = 1.48). There was a ratio of 30% for the influence of age for individuals under the age of 36, and of 45% for those older than 36 (RR = 0.68). There was no significant influence of BMI on the prevalence of atelectasis. Conclusion: The prevalence of atelectasis in bariatric surgery is 37% and the main risk factors are being female and aged over 36 years.

Resumo Justificativa e objetivo: Observar a prevalência de atelectasia em pacientes submetidos à cirurgia bariátrica e a influência do índice de massa corporal (IMC), do sexo e da idade sobre a prevalência de atelectasia. Método: Estudo retrospectivo de 407 pacientes e laudos de radiografias de tórax feitas antes e após a cirurgia bariátrica durante 14 meses. Apenas os pacientes submetidos à cirurgia bariátrica por laparotomia foram incluídos. Resultados: Houve uma prevalência geral de atelectasia de 37,84%, com maior prevalência nas bases pulmonares e em mulheres (RR = 1,48). Houve uma proporção de 30% para a influência da idade nos indivíduos com menos de 36 anos e de 45% naqueles com mais de 36 anos (RR = 0,68). Não houve influência significativa do IMC sobre a prevalência de atelectasia. Conclusão: A prevalência de atelectasia em cirurgia bariátrica é de 37% e os principais fatores de risco são sexo feminino e idade superior a 36 anos.

Analysis of the prevalence of atelectasis in patients undergoing bariatric surgery.

BACKGROUND AND OBJECTIVE: To observe the prevalence of atelectasis in patients undergoing bariatric surgery and the influence of the body mass index (BMI), gender and age on the prevalence of atelectasis. METHOD: Retrospective study of 407 patients and reports on chest X-rays carried out before and after bariatric surgery over a period of 14 months. Only patients who underwent bariatric surgery by laparotomy were included. RESULTS: There was an overall prevalence of 37.84% of atelectasis, with the highest prevalence in the lung bases and with greater prevalence in women (RR=1.48). There was a ratio of 30% for the influence of age for individuals under the age of 36, and of 45% for those older than 36 (RR=0.68). There was no significant influence of BMI on the prevalence of atelectasis. CONCLUSION: The prevalence of atelectasis in bariatric surgery is 37% and the main risk factors are being female and aged over 36 years.

[Analysis of the prevalence of atelectasis in patients undergoing bariatric surgery]. / Análise da prevalência de atelectasia em pacientes submetidos à cirurgia bariátrica.

BACKGROUND AND OBJECTIVE: To observe the prevalence of atelectasis in patients undergoing bariatric surgery and the influence of the body mass index (BMI), gender and age on the prevalence of atelectasis. METHOD: Retrospective study of 407 patients and reports on chest X-rays carried out before and after bariatric surgery over a period of 14 months. Only patients who underwent bariatric surgery by laparotomy were included. RESULTS: There was an overall prevalence of 37.84% of atelectasis, with the highest prevalence in the lung bases and with greater prevalence in women (RR=1.48). There was a ratio of 30% for the influence of age for individuals under the age of 36, and of 45% for those older than 36 (RR=0.68). There was no significant influence of BMI on the prevalence of atelectasis. CONCLUSION: The prevalence of atelectasis in bariatric surgery is 37% and the main risk factors are being female and aged over 36 years.

Use of positive pressure in preoperative and intraoperative of bariatric surgery and its effect on the time of extubation / Utilização da pressão positiva no pré e no intraoperatório de cirurgia bariátrica e seus efeitos sobre o tempo de extubação / Utilización de la presión positiva en el pre- y en el intraoperatorio de cirugía bariátrica y sus efectos sobre el tiempo de extubación

BACKGROUND AND OBJECTIVE: To investigate the influence of intraoperative and preoperative positive pressure in the time of extubation in patients undergoing bariatric surgery. METHOD: Randomized clinical trial, in which 40 individuals with a body mass index between 40 and 55 kg/m2, age between 25 and 55 years, nonsmokers, underwent bariatric surgery type Roux-en-Y gastric bypass by laparotomy and with normal preoperative pulmonary function were randomized into the following groups: G-pre (n = 10): individuals who received treatment with noninvasive positive pressure before surgery for 1 h; G-intra (n = 10): individuals who received positive end-expiratory pressure of 10 cm H2O throughout the surgical procedure; and G-control (n = 20): not received any preoperative or intraoperative intervention. Following were recorded: time between induction of anesthesia and extubation, between the end of anesthesia and extubation, duration of mechanical ventilation, and time between extubation and discharge from the post-anesthetic recovery. RESULTS: There was no statistical difference between groups. However, when applied to the Cohen coefficient, the use of positive end-expiratory pressure of 10 cm H2O during surgery showed a large effect on the time between the end of anesthesia and extubation. About this same time, the treatment performed preoperatively showed moderate effect. CONCLUSION: The use of positive end-expiratory pressure of 10 cm H2O in the intraoperative and positive pressure preoperatively, influenced the time of extubation of patients undergoing bariatric surgery. .

JUSTIFICATIVA E OBJETIVO: investigar a influência do uso da pressão positiva nas vias aéreas intraoperatória e pré-operatória no tempo de extubação de pacientes submetidos à cirurgia bariátrica. MÉTODO: Trata-se de ensaio clínico randomizado, no qual 40 indivíduos com índice de massa corporal entre 40 e 55 kg/m2, idade entre 25 e 55 anos, não tabagistas, submetidos à cirurgia bariátrica do tipo derivação gástrica em Y de Roux por laparotomia e com prova de função pulmonar pré-operatória dentro da normalidade foram randomizados nos seguintes grupos: G-pré (n = 10): indivíduos que receberam tratamento com pressão positiva não invasiva antes da cirurgia, durante uma hora, G-intra (n = 10): indivíduos que receberam Positive End-expiratory Pressure de 10 cm H2O durante todo o procedimento cirúrgico e G-controle (n = 20): não receberam qualquer tipo de intervenção pré ou intraoperatória. foram anotados os seguintes tempos: tempo decorrido entre a indução anestésica e a extubação, entre o término da anestesia e extubação, tempo de ventilação mecânica, e tempo entre a extubação e a alta da Recuperação Pós-Anestésica. RESULTADOS: Não houve diferença estatística entre os grupos, porém quando aplicado ao Coeficiente de Cohen, o uso da Positive End-expiratory Pressure de 10 cm H2O no intraoperatório mostrou um efeito grande sobre o tempo entre o término da anestesia e a extubação. Sobre este mesmo tempo, o tratamento realizado no pré-operatório apresentou efeito moderado. CONCLUSÃO: O uso da Positive End-expiratory Pressure de 10 cm H2O no intraoperatório e da pressão positiva no pré-operatório, pode influenciar o tempo de extubação de pacientes submetidos à cirurgia bariátrica. .

JUSTIFICACIÓN Y OBJETIVO: Investigar la influencia del uso de la presión positiva en las vías aéreas intraoperatoria y preoperatoria en el tiempo de extubación de pacientes sometidos a la cirugía bariátrica. MÉTODO: Se trata de un ensayo clínico aleatorizado, en el cual 40 individuos con IMC entre 40 y 55 kg/m2, edad entre 25 y 55 años, no fumadores, sometidos a cirugía bariátrica del tipo derivación gástrica en Y de Roux por laparotomía y con prueba de función pulmonar preoperatoria dentro de la normalidad fueron aleatorizados en los siguientes grupos: G-pre (n = 10): individuos que recibieron tratamiento con presión positiva no invasiva antes de la cirugía durante una hora; G-intra (n = 10): individuos que recibieron PEEP de 10 cm H2O durante todo el procedimiento quirúrgico y G-control (n = 20): no recibieron ningún tipo de intervención pre- o intraoperatoria. Fueron anotados los siguientes tiempos: tiempo trascurrido entre la inducción anestésica y la extubación, entre el fin de la anestesia y la extubación, tiempo de ventilación mecánica, y tiempo entre la extubación y el alta de la sala de recuperación postanestésica. RESULTADOS: No hubo diferencia estadística entre los grupos, sin embargo cuando se aplicó el coeficiente de Cohen, el uso de la PEEP de 10 cm H2O en el intraoperatorio mostró un efecto importante sobre el tiempo entre el término de la anestesia y la extubación. Sobre ese mismo tiempo, el tratamiento realizado en el preoperatorio presentó un efecto moderado. CONCLUSIÓN: El uso de la PEEP de 10 cm H2O en el intraoperatorio y de la presión positiva en el preoperatorio puede influir en el tiempo de extubación de pacientes sometidos a cirugía bariátrica. .

[Use of positive pressure in pre and intraoperative of bariatric surgery and its effect on the time of extubation]. / Utilização da pressão positiva no pré e no intraoperatório de cirurgia bariátrica e seus efeitos sobre o tempo de extubação.

BACKGROUND AND OBJECTIVE: to investigate the influence of intraoperative and preoperative airway positive pressure in the time of extubation in patients undergoing bariatric surgery. METHOD: Randomized clinical trial, in which 40 individuals with a body mass index between 40 and 55kg/m(2), age between 25 and 55 years, nonsmokers, underwent bariatric surgery type Roux-en-Y gastric bypass by laparotomy and with normal preoperative pulmonary function were randomized into the following groups: G-pre (n = 10): individuals who received treatment with noninvasive positive pressure before surgery for one hour, G-intra (n = 10): individuals who received positive end-expiratory pressure of 10cm H2O throughout the surgical procedure and G-control (n = 20): not received any pre or intraoperative intervention. Following were recorded: time between induction of anesthesia and extubation, between the end of anesthesia and extubation, duration of mechanical ventilation, and time between extubation and discharge from the Post-Anesthetic Recovery. RESULTS: there was no statistical difference between groups. However, when applied to the Cohen coefficient, the use of positive end-expiratory pressure of 10cm H2O during surgery showed a large effect on the time between the end of anesthesia and extubation. About this same time, the treatment performed preoperatively showed moderate effect. CONCLUSION: The use of positive end-expiratory pressure of 10cm H2O in the intraoperative and positive pressure preoperatively, influenced the time of extubation of patients undergoing bariatric surgery.

Análise comparativa da flexibilidade de mulheres idosas ativas e não ativas / Comparative analysis of flexibility in active and inactive elderly women

Com o envelhecimento ocorre um declínio na aptidão física, uma variável muito atingida é a flexibilidade, e a prática de exercícios físicos pelos idosos é um importante fator para a manutenção da saúde e aptidão física no decorrer do processo de envelhecimento. Objetivo: Comparar a flexibilidade de mulheres idosas praticantes hidroginástica, treinamento combinado e não ativas. Participaram 60 voluntárias, idade entre 60 e 80 anos, agrupadas em: ativas praticantes de hidroginástica (G1) 20 voluntárias; ativas praticantes de treinamento combinado (G2) 20 voluntárias; não ativas (G3) 20 voluntárias. Métodos: As voluntárias foram submetidas à avaliação antropométrica com medidas de massa corporal, estatura e circunferência da cintura e da flexibilidade com medidas da distância alcançada no teste de sentar e alcançar e da amplitude da flexão e extensão do quadril através do goniômetro. Foram verificados os pressupostos de normalidade por meio do teste de Shapiro-Wilk, para a comparação entre os grupos (G1, G2, G3) foram realizados o teste Anova one way, seguido do post hoc de Tukey para os dados com distribuição paramétrica, e o teste de Friedman para amostras com distribuição não paramétrica. Aplicou-se o nível de significância de p < 0,05. Resultados: Nas variáveis antropométricas não foram encontradas diferenças significativas entre grupos. Na flexibilidade, foi encontrada diferença significativa na flexão e na extensão de quadril, os grupos G1 e G2 apresentaram maiores valores que o G3, não houve diferença significativa entre G1 e G2, não existindo outras diferenças significativas entre os grupos. Conclusão: Os resultados sugerem que os treinamentos de hidroginástica e combinado proporcionaram melhora na flexão e extensão do quadril das mulheres idosas, sem influência nas outras variáveis estudadas.

With aging there comes a decline in physical fitness, including decreasing flexibility, and the practice of physical activity by older adults is an important factor for maintaining health and physical fitness during the aging process. Objective: To compare the flexibility of elderly women who practice either hydrogymnastics or combination exercise training with those who are not active. Sixty females participated in the study, aged between 60 and 80 years and divided into three groups: 20 subjects who actively practiced hydrogymnastics (G1), 20 subjects who actively practiced combination exercise training (G2), and 20 subjects who were not-active (G3). Methods: The subjects underwent anthropometric measurements consisting of weight, height, waist circumference, and flexibility. Measurements were taken with distance reached in the sit and reach test and the extent of flexion and hip extension by means of a goniometer. The assumptions of normality using the Shapiro-Wilk test for comparison between groups (G1, G2, G3) were checked, the one way ANOVA test, followed by the Tukey post hoc for the data with parametric distribution, and the Friedman test for samples with non-parametric distribution were performed. A significance level of p < 0.05 was assumed. Results: The anthropometric variables revealed no significant differences between groups. In the analysis of flexibility, significant differences were found in hip flexion and extension; the G1 and G2 groups showed greater values than the G3, and there were no significant differences between G1 and G2 nor between groups. Conclusion: The results suggest that hydrogymnastics and combination exercise training provided improvements in flexion and hip extension in elderly women, with no influence on the other variables studied.

Avaliação da atenção primária no município de Piracicaba, SP, Brasil / Assement of Primary Health Care in the municipality of Piracicaba, SP, Brazil

Este estudo teve por objetivo avaliar o funcionamento da rede de Atenção Básica do município de Piracicaba, SP. Foram realizadas 69 entrevistas, 37 com profissionais de saúde das Unidades de Saúde da Família (USF), 23 das Unidades Básicas de Saúde (UBS) e nove gestores, utilizando-se o Primary Care Assessment Tool (PCATool). As USF apresentaram maiores valores que as UBS para vínculo, elenco de serviços, enfoque familiar, orientação para comunidade e total da Atenção Básica. Os gestores apresentaram maior valor para acesso que os profissionais das unidades. As USF apresentam melhor funcionamento que as UBS, mas os resultados para acesso sugerem que esta dimensão não foi melhorada com a USF.

The aim of this study was to evaluate the functioning of the primary care network in the municipality of Piracicaba, SP. 69 interviews were conducted - 37 with health professionals of Family Health Units (USF), 23 with Basic Health Units (UBS) and nine managers-, using the Primary Care Assessment Tool (PCATool). The USF scored higher in compost indexes to linkages, comprehensiveness, family focusing, community advising and primary care index than UBS. The managers had higher score of access index than the units professionals. It was concluded that the USF presented a better functioning than the UBS, but the results for access suggest that this dimension was not improved with the USF.

Perfil sociodemográfico e ocupacional de trabalhadores com LER/DORT: estudo epidemiológico / Perfi sociodemoggráfico y laboral de los trabajadores con LER/TMOL: estudio epidemiológico / Sociodemographic and occupacional profile of workers with RSI/WRMSD: epidemiological study

Analisou-se o perfil sociodemográfico e ocupacional de trabalhadores com lesões por esforços repetitivos (LER) ou disfunções osteomusculares relacionados ao trabalho (DORT) em Piracicaba, São Paulo, avaliando-se a associação desse perfil com a ocorrência de dor, bem como a associação de risco para LER/DORT. Dados de 1.007 prontuários foram submetidos à análise descritiva (p<0,05). A LER/DORT predominou em mulheres, na idade produtiva, com baixo grau de instrução e baixos salários, com função de doméstica, cozinheira, serviços gerais, auxiliar de produção e costureira; a dor predominou no membro superior e estava associada à função, ao gênero feminino, ao baixo grau de instrução e ao estado civil; houve associação de risco entre organização e ergonomia no trabalho e dor no membro superior. A compreensão das relações do trabalhador com o ambiente de trabalho e com o trabalho pode favorecer medidas de vigilância e promoção de saúde.

The socio-demographic and occupational profile of workers with repetitive strain injury (RSIs) or work-related musculoskeletal disorders (WRMSDs) in Piracicaba, São Paulo, Brazil, were analyzed. The association of this profile with the occurrence of pain as well as the risk association for RSI/WRMSD were evaluated. Data from 1,007 medical records underwent descriptive analysis (p<0.05). RSI/WRMSD was predominant in women in their productive age, with low education level and low wages, working mainly in domestic roles, cook, general services, production assistant and seamstress; pain was predominant in the upper limb and it was associated with the function, the female gender, low education level and marital status; there was risk association between organization and workplace ergonomics and pain in upper limb. The understanding of the relationship between the worker, the work environment, and the work may favor surveillance measures and health promotion.

Se analizó el perfil sociodemográfico y laboral de los trabajadores con lesiones por esfuerzo repetitivo (LER) o trastornos musculoesqueléticos de origen laboral (TMOL) en Piracicaba, São Paulo, Brasil, evaluando la asociación de ese perfil con la aparición de dolor, así como la asociación de riesgo de LER/TMOL. Los datos de 1.007 manuales se sometieron a análisis descriptivo (p<0,05). Las LER/TMOL predominaron en las mujeres en edad productiva, con bajo nivel educativo y bajos salarios, que trabajaban principalmente en los roles domésticos, cocinera, servicios generales, asistente de producción y costurera; el dolor predominó en la extremidad superior y se asoció con la función, el género femenino, el bajo nivel de educación y el estado civil; hubo asociación de riesgo entre la organización y la ergonomía en el trabajo y el dolor en la extremidad superior. La comprensión de las relaciones del trabajador con el ambiente de trabajo y con el trabajo puede favorecer las medidas de vigilancia y promoción de la salud.

Carga para a aplicação de testes de 1-RM em exercícios de membros superiores em mulheres jovens treinadas e não treinadas / Load to the application of 1-RM tests in upper limbs of young women trained and untrained / Cargo por el uso de las pruebas de 1-RM en el miembro superior de las mujeres jóvenes entrenados y no entrenados

O objetivo do estudo foi propor valores de referência para a aplicação dos testes de 1-RM em mulheres jovens treinadas e não treinadas. 90 mulheres, de 18 a 31 anos, agrupadas em: 43 Treinadas (GT) e 47 Não Treinadas (GNT) foram submetidas aos testes de 1-RM nos seguintes exercícios: supino reto, desenvolvimento, rosca direta e tríceps testa. O GT apresentou maiores valores em relação ao GNT, em termos absolutos e relativos: supino reto (GT = 36,44 kg/0,63 e GNT = 27,34 kg/0,46), desenvolvimento (GT = 27,93 kg/0,49 e GNT = 22,70 kg/0,38), rosca direta (GT = 21,63 kg/0,37 e GNT = 15,57 kg/0,26) e tríceps testa (GT = 18,09 kg/0,31 e GNT = 12,55 kg/0,21). Os valores encontrados no estudo podem ser utilizados como referências de cargas para a aplicação dos testes de 1-RM.

The purpose of this study was to propose reference values to application of the 1-RM tests in young women trained and untrained. 90 women, 18-31 years, grouped into: 43 Trained (GT) and 47 Untrained (GNT) were submitted to 1-RM tests in the following exercises: bench press, shoulder press, biceps curl and lying triceps extension. GT showed higher values than GNT in absolute and relative terms: bench press (GT = 36.44 kg/0.63 and GNT = 27.34 kg/0.46), shoulder press (GT = 27.93 kg/0.49 and GNT = 22.70 kg/0.38), biceps curl (GT = 21.63 kg/0.37 and GNT = 15.57 kg/0.26) and lying triceps extension (GT = 18.09 kg/0.31 and GNT = 12.55 kg/0.21). The values found in this study can be used as references of load to application of 1-RM tests.

El objetivo del estudio fue proponer puntos de referencia para la aplicación de las pruebas de 1RM en mujeres jóvenes entrenados y no entrenados. 90 mujeres, 18-31 años, agrupados en: 43 entrenados (GT) y 47 no entrenados (GNT), se probaron para las pruebas de 1RM en los siguientes ejercicios: prensa de banca, prensa de hombros, curl con barra y extensión de tríceps. GT mostró valores más altos en comparación con el GNT en términos absolutos y relativos: prensa de banca (GT = 36,44 kg/0,63 y GNT = 27,34 kg/0,46), prensa de hombros (GT = 27,93 kg/0,49 y GNT = 22,70 kg/0,38), curl con barra (GT = 21,63 kg/0,37 y GNT = 15,57 kg/0,26) y extensión de tríceps (GT = 18,09 kg/0,31 y GNT = 12,55 kg/0,21). Los valores encontrados en el estudio pueden ser utilizados como referencia de cargo para la aplicación de las pruebas de 1RM.

Lung age in women with morbid obesity / Idade pulmonar em mulheres com obesidade mórbida

OBJECTIVE: To investigate the influence of morbid obesity on the lung age in women and to correlate with body mass, body mass index (BMI), and ventilatory variables. METHODS: This was a cross-sectional study with 72 morbidly obese women and a control group consisting of 37 normal weight women. The subjects performed a pulmonary function test to determine lung age, and the results were correlated to anthropometric variables and lung volumes. RESULTS: The morbidly obese group had significantly higher lung age (50.1 ± 6.8 years) than the control group (38.8 ± 11.4 years). There was no difference in chronological age between groups. There was a significant positive correlation among chronological age, body mass, BMI, and lung age (r = 0.3647, 0.4182, and 0.3743, respectively). There was a negative correlation among forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, expiratory reserve volume (ERV), and lung age (r = -0.7565, -0.8769, -0.2723, and -0.2417, respectively). CONCLUSION: Lung age is increased in morbidly obese women and is associated with increased body mass and BMI.

OBJETIVO: Verificar a influência da obesidade mórbida na idade pulmonar de mulheres e correlacionar com a massa corporal, índice de massa corporal (IMC) e variáveis ventilatórias. MÉTODOS: Estudo longitudinal realizado com 72 obesas mórbidas e grupo controle constituído de mulheres eutróficas. As voluntárias realizaram um teste de função pulmonar para determinação da idade pulmonar e os resultados foram correlacionados com as variáveis antropométricas e volumes pulmonares. RESULTADOS: As obesas mórbidas apresentaram uma idade pulmonar significativamente superior (50,1 ± 6,8 anos) às eutróficas (38,8 ± 11,4 anos). Não houve diferença entre a idade cronológica entre os grupos. Houve uma correlação significativa e positiva entre idade cronológica, massa corporal e IMC com a idade pulmonar (r = 0,3647, 0,4182, 0,3743, respectivamente). Houve uma correlação negativa entre a capacidade vital forçada (CVF), volume expiratório forçado no primeiro segundo (VEF1), razão (VEF1/CVF) e volume de reserva expiratório (VRE) com a idade pulmonar (r = -0.7565, -0.8769, -0.2723, -0.2417, respectivamente). CONCLUSÃO: A idade pulmonar das obesas mórbidas encontra-se aumentada e está associada com o aumento da massa corporal e IMC.

Respostas cardiopulmonares agudas de mulheres no treinamento de força / Acute cardiopulmonary responses of women in strength training

OBJETIVO: Investigar as respostas cardiopulmonares de uma sessão de treinamento de força em mulheres jovens. MÉTODO: Participaram do estudo 23 mulheres, com idade entre 18 e 29 anos. Todas as voluntárias foram submetidas aos seguintes testes: cardiopulmonar e de uma repetição máxima (1-RM). O protocolo de treinamento de força teve ênfase em hipertrofia muscular, três séries de oito a 12 repetições a 70% de 1-RM, com intervalos de um minuto e 30 segundos entre as séries. Durante a sessão de treinamento foi realizada a medida das variáveis cardiopulmonares por meio de analisador de gases metabólicos e módulo de telemetria. RESULTADOS: Os resultados do consumo de oxigênio da sessão de treinamento foram de 8,43 ± 1,76 ml/kg/min e da frequência cardíaca de 108,08 ± 15,26 bpm. Os resultados do consumo de oxigênio e da frequência cardíaca do treino foram inferiores (p < 0,01) ao do limiar ventilatório e das reservas do consumo de oxigênio e da frequência cardíaca. CONCLUSÃO: Os dados obtidos indicam que o presente protocolo de treinamento de força proporcionou pequena sobrecarga ao sistema cardiorrespiratório de mulheres jovens.

OBJETIVE: Investigate the cardiopulmonary responses of one strength training session in young women. METHOD: Twenty-three women aged between 18 and 29 years participated in this study. All the volunteers were submitted to the following tests: cardiopulmonary and one-repetition maximum (1-RM). The strength training protocol had emphasis on muscular hypertrophy, three sets from eight to twelve repetitions under 70% of 1-RM, with a one minute thirty-second break between sets. During the training session, the cardiopulmonary variables were measured with a metabolic gas analyzer and a telemetry module. RESULTS: The results of the oxygen consumption in the training session were from 8.43 + 1.76 ml/kg/min and of the heart rate of 108.08 + 15.26 bpm. The results of the oxygen consumption and of the heart rate in the training were lower (p < 0.01) than in the ventilatory threshold and of the oxygen consumption and the heart rate reserves. CONCLUSION: The obtained data show that the present protocol of strength training provided low overload to the cardiopulmonary system of young women.

Immediate and lasting improvements in weight distribution seen in baropodometry following a high-velocity, low-amplitude thrust manipulation of the sacroiliac joint.

The biomechanics of the sacroiliac joint makes the pelvic segment responsible for proper weight distribution between lower extremities; however, it is known to be susceptible to altered mobility. The objective of this study was to analyze baropodometric responses following thrust manipulation on subjects with sacroiliac joint restrictions. Twenty asymptomatic subjects were submitted to computerized baropodometric analysis before, after, and seven days following sacroiliac manipulation. The variables peak pressure and contact area were obtained at each of these periods as the average of absolute values of the difference between the right and left foot based on three trials. Data revealed significant reduction only in peak pressure immediately after manipulation and at follow-up when compared to pre-manipulative values (p < 0.05). Strong correlation was found between the dominant foot and the foot with greater contact area (r = 0.978), as well as between the side of joint restriction and the foot with greater contact area (r = 0.884). Weak correlation was observed between the dominant foot and the foot with greater peak pressure (r = 0.501), as well as between the side of joint restriction and the foot with greater peak pressure (r = 0.694). The results suggest that sacroiliac joint manipulation can influence peak pressure distribution between feet, but contact area does not seem to be related to the biomechanical aspects addressed in this study.