Ivacaftor: Five-year outcomes in the West of Scotland cystic fibrosis population.

INTRODUCTION: Ivacaftor has shown to be effective in patients with cystic fibrosis (CF) with a G551D mutation. OBJECTIVES: This work aims to evaluate ivacaftor's effectiveness and safety in the real world, over 5 years, in the West of Scotland CF population. METHODS: We evaluated ivacaftor's effect on pulmonary function, body mass index (BMI), hospital bed occupancy, and adverse effects in patients ≥6 years with at least one G551D mutation. RESULTS: Statistically significant increases from baseline were observed in mean per cent predicted forced expiratory volume in 1 s (FEV1 ) at year 1 (which was maintained at years 2 and 5) and BMI over 5 years in our adolescent/adult cohort. Improvements were observed in per cent predicted FEV1 within the paediatric cohort with a suggestion of a plateau effect. The increase in paediatric BMI z-score was nonstatistically significant. There was a reduction in the number of pulmonary exacerbations requiring intravenous antibiotics and hospital bed occupancy. Ivacaftor was well tolerated. CONCLUSION: Ivacaftor was effective in our population.

Brazilian Portuguese version and content validity of the Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH).

INTRODUCTION: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) program is a personalized, progressive 12-week exercise program for people with hand problems due to rheumatoid arthritis (RA). Patients are provided with two guidance documents, the 'Patient Exercise Booklet' and the 'Personal Exercise Guide', to continue the exercises independently at home. OBJECTIVE: This study aimed to translate and culturally adapt the SARAH protocol into Brazilian Portuguese and validate its content. METHODS: The guidance documents 'Patient Exercise Booklet' and 'Personal Exercise Guide' of the SARAH program were translated and culturally adapted to Brazilian Portuguese. The content validity was obtained by calculating the content validity index (CVI). RESULTS: The Brazilian version of the SARAH protocol reached semantic, idiomatic, conceptual, and cultural equivalences. The CVI was greater than 0.8, corresponding to a satisfactory index. The verbal comprehension was 4.9, showing good verbal comprehension of the target population. CONCLUSION: The Brazilian Portuguese version of the SARAH protocol is available to Brazilian people with compromised hands due to RA with satisfactory content validity.

Brazilian Portuguese version and content validity of the Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH)

Abstract Introduction The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) program is a personalized, progressive 12-week exercise program for people with hand problems due to rheumatoid arthritis (RA). Patients are provided with two guidance documents, the 'Patient Exercise Booklet' and the 'Personal Exercise Guide', to continue the exercises independently at home. Objective This study aimed to translate and culturally adapt the SARAH protocol into Brazilian Portuguese and validate its content. Methods The guidance documents 'Patient Exercise Booklet' and 'Personal Exercise Guide' of the SARAH program were translated and culturally adapted to Brazilian Portuguese. The content validity was obtained by calculating the content validity index (CVI). Results The Brazilian version of the SARAH protocol reached semantic, idiomatic, conceptual, and cultural equivalences. The CVI was greater than 0.8, corresponding to a satisfactory index. The verbal comprehension was 4.9, showing good verbal comprehension ofthe target population. Conclusion The Brazilian Portuguese version of the SARAH protocol is available to Brazilian people with compromised hands due to RA with satisfactory content validity.

Nanocarriers as Active Ingredients Enhancers in the Cosmetic Industry-The European and North America Regulation Challenges.

"Flawless skin is the most universally desired human feature" is an iconic statement by Desmond Morris. Skin indicates one´s health and is so important that it affects a person's emotional and psychological behavior, these facts having propelled the development of the cosmetics industry. It is estimated that in 2023, this industry will achieve more than 800 billion dollars. This boost is due to the development of new cosmetic formulations based on nanotechnology. Nanocarriers have been able to solve problems related to active ingredients regarding their solubility, poor stability, and release. Even though nanocarriers have evident benefits, they also present some problems related to the high cost, low shelf life, and toxicity. Regulation and legislation are two controversial topics regarding the use of nanotechnology in the field of cosmetics. In this area, the U.S. FDA has taken the lead and recommended several biosafety studies and post-market safety evaluations. The lack of a global definition that identifies nanomaterials as a cosmetic ingredient is a hindrance to the development of global legislation. In the EU, the legislation regarding the biosafety of nanomaterials in cosmetics is stricter. "The cost is not the only important issue, safety and the application of alternative testing methods for toxicity are of crucial importance as well".

Platelet activation and antimicrobial activity of L-PRF: a preliminary study.

Leukocyte and platelet rich fibrin (L-PRF) is one of the platelet concentrates used to support regeneration and healing process. Many studies showed possible immunological and antibacterial properties of L-PRF. We perform an in vitro study to analyze the effect of L-PRF on platelet activation, platelet-leukocytes interactions and antimicrobial activity, important components in the healing process. Molecular biomarkers related with platelet activation and platelet-leukocyte interactions were analyzed by means of flow cytometry when L-PRF exudate was added to whole blood platelets. L-PRF membrane was used to evaluate antimicrobial activity using Enterococcus faecalis (ATCC 29212), Pseudomonas aeruginosa (ATCC 27853) and Candida albicans (ATCC 90028). Our experimental design allows to evaluate platelet activation and analyze molecular biomarkers of other immune cells and platelet-leukocyte interactions. From the results obtained we can conclude that L-PRF can be a valuable tool in healing process, efficient in activating platelets of whole blood and inhibiting microbial growth. In our opinion, the use of L-PRF exudate, in addition to L-PRF membrane, presents some advantages that have to be considered in clinical trials. Additional research on the characterization and quantification of cells and its products present in the L-PRF exudate, as well as on the temporal factor released. Also, further studies using strains isolated from clinical cases are needed.

Spasmodic cough preceding CANVAS phenotype in a family with biallelic repeat expansions in RFC1.

Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) is a late-onset, multisystem ataxia that remained only clinically defined, until recently, when the discovery of biallelic repeat expansion in the RFC1 gene allowed the genetic link. We describe the first Portuguese familial CANVAS harboring the pathogenic RFC1 expansion. Detail clinical features and course of four affected members are provided. Phenotype characterizations are important as the novel RFC1 mutation is expected to be a major cause of idiopathic late-onset ataxia.

Remnant oral biofilm and microorganisms after autoclaving sterilization of retrieved healing abutments.

OBJECTIVE: The purpose of this study was to evaluate the sterilization effectiveness against biofilms on retrieved healing abutments used in implant dentistry. BACKGROUND: A large number of clinicians reuse healing abutments to decrease treatment costs although it can promote infection due to the presence of remnant biofilm biomass. METHODS: One hundred and eighty-five titanium healing abutments previously used for 3 months in oral cavity were assessed in this study. Abutments were submitted to cleaning, chemical disinfection, and autoclave sterilization according to clinical guidelines. The abutments were aseptically placed into glass tubes containing specific bacterial growth medium and then incubated for 10 days. From glass tubes with bacterial growth, 100 µl medium was transferred to Schaedler's agar for morphological identification and counting of strict anaerobes and to Columbia blood agar for presumptive identification of facultative anaerobes after incubation. Isolated strains were then identified at species level by enzymatic and biochemical tests within API microorganism detection platform. Also, polymerase chain reaction (PCR) was performed for identification of undefined strains. RESULTS: After the standard cleaning and sterilization procedures, fifty-six (approximately 30%) retrieved abutments showed the presence of remnant biofilm biomass. The bacteria identified into the remnant biofilms covering the abutments were representative of the commensal oral microbiota including Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Enterococcus faecalis. CONCLUSION: Although some healing abutments did not reveal the existence of bacteria, organic components from biofilm biomass are still strongly adhered on the retentive micro-regions and surfaces of abutments and therefore that would support the accumulation of biofilm including pathogenic species leading to patients' cross-infections. Further studies should be performed on the assessment of different materials, design, and connections of the healing abutments associated with clinical disinfection procedures in implant dentistry.

Redox-Oligomeric State of Peroxiredoxin-2 and Glyceraldehyde-3-Phosphate Dehydrogenase in Obstructive Sleep Apnea Red Blood Cells under Positive Airway Pressure Therapy.

In this study, we examined the effect of six months of positive airway pressure (PAP) therapy on Obstructive Sleep Apnea (OSA) red blood cell (RBC) proteome by two dimensional difference gel electrophoresis (2D-DIGE) - based proteomics followed by Western blotting (WB) validation. The discovered dysregulated proteins/proteoforms are associated with cell death, H2O2 catabolic/metabolic process, stress response, and protein oligomerization. Validation by nonreducing WB was performed for peroxiredoxin-2 (PRDX2) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) by using antibodies against the sulfinylated/sulfonylated cysteine of these proteins to better evaluate their redox-oligomeric states under OSA and/or in response to PAP therapy. The results indicated that the redox-oligomeric state of GAPDH and PRDX2 involving overoxidation by sulfinic/sulfonic acids were differentially modulated in OSA RBC, which might be compromising RBC homeostasis. PAP therapy by restoring this modulation induced a higher oligomerization of overoxidized GAPDH and PRDX2 in some patients that could be associated with eryptosis and the chaperone "gain" of function, respectively. This varied response following PAP may result from the complex interplay between OSA and OSA metabolic comorbidity. Hence, information on the redox status of PRDX2 and GAPDH in RBC will help to better recognize OSA subtypes and predict the therapeutic response in these patients. GAPDH monomer combined with body mass index (BMI) and PRDX2 S-S dimer combined with homeostatic model assessment for insulin resistance (HOMA-IR) showed to be very promising biomarkers to predict OSA and OSA severity, respectively.

Pacientes asmáticos adultos recebem orientações sobre atividade física? Uma abordagem com métodos mistos / Do adult asthmatic patients receive guidance on physical activity? A mixed methods approach

Introdução: A asma é uma doença respiratória caracterizada por sintomas como sibilo à ausculta pulmonar, dispneia e tosse, causados por limitação variável ao fluxo aéreo expiratório. A prática de atividades física pode auxiliar o controle da doença. Objetivo: Investigar o nível de atividade física de asmáticos adultos, e como estes indivíduos reportam receber orientação dos profissionais de saúde quanto à realização de atividade física. Método: Este estudo de métodos mistos foi realizado com indivíduos asmáticos, com idade superior a 18 anos. Os participantes realizaram teste de função pulmonar, responderam questionários sobre atividade física e entrevista semiestruturada. A entrevista foi realizada com questões voltadas ao tema central da pesquisa, as respostas foram transcritas de forma literal e analisadas por meio de metodologia da análise de conteúdo. Resultados: Vinte e cinco indivíduos participaram do estudo, a maioria do sexo feminino (n = 18; 72,0%) e idade média de 36 anos. A maioria dos indivíduos eram "irregularmente ativos" dos tipos A e B (n = 13; 52,0%). Foram identificados sete temas principais nos discursos: "conhecimento sobre os efeitos da atividade física regular" (n = 23; 92,0%), "atividade física específica para pacientes asmáticos" (n = 21; 84,0%), e "influência da orientação de um profissional de saúde" (n = 20; 80,0%). Conclusão: Os indivíduos asmáticos reportaram receber orientações dos profissionais de saúde quanto aos benefícios da prática regular de atividade física. Porém, estas informações podem ser insuficientes quanto ao tipo e frequência dos exercícios, modalidades apropriadas, manejo de possíveis sintomas durante ou após a prática da atividade e como preveni-los. Orientações adequadas sobre a prática da atividade regular para indivíduos asmáticos podem contribuir para o automanejo da doença.

Introduction: Asthma is a respiratory disease characterized by symptoms of wheezing, dyspnea, and cough, caused by some degree of limitation to expiratory airflow. Engagement in regular physical activity can help control the disease. Objective: To assess physical activity levels in asthmatic adults and to investigate how these individuals report guidance received from health professionals regarding physical activity. Method: This mixed-methods study included asthmatic adults aged 18 years or over. Participants underwent pulmonary function tests, completed physical activity questionnaires, and did a semistructured interview. The interview consisted of questions focused on the central topic of interest, and responses were transcribed literally and then analyzed using content analysis methods. Results: Twenty-five individuals participated in the study, most were female (n=18; 72.0%), and mean age was 36 years. Most individuals were classified as "irregularly active" (n=8; 32.0%). Seven main topics were identified in content analysis, including "knowledge about the effects of regular physical activity" (n=23; 92.0%), "specific physical activity for asthmatic patients" (n=21; 84.0%), and "influence of guidance from a health professional" (n=20; 80.0%). Conclusion: Asthmatic individuals reported having received guidance from health professionals regarding the benefits of engagement in regular physical activity. However, there is insufficient information regarding type and frequency of exercise, appropriate modalities, and management of possible symptoms during or after the activity and how to prevent them. Adequate guidance on regular activity for asthmatic individuals may contribute to self-management of the disease.

A soft-chemistry approach to the synthesis of amorphous calcium ortho/pyrophosphate biomaterials of tunable composition.

The development of amorphous phosphate-based materials is of major interest in the field of biomaterials science, and especially for bone substitution applications. In this context, we herein report the synthesis of gel-derived hydrated amorphous calcium/sodium ortho/pyrophosphate materials at ambient temperature and in water. For the first time, such materials have been obtained in a large range of tunable orthophosphate/pyrophosphate molar ratios. Multi-scale characterization was carried out thanks to various techniques, including advanced multinuclear solid state NMR. It allowed the quantification of each ionic/molecular species leading to a general formula for these materials: [(Ca2+y Na+z H+3+x-2y-z)(PO43-)1-x(P2O74-)x](H2O)u. Beyond this formula, the analyses suggest that these amorphous solids are formed by the aggregation of colloids and that surface water and sodium could play a role in the cohesion of the whole material. Although the full comprehension of mechanisms of formation and structure is still to be investigated in detail, the straightforward synthesis of these new amorphous materials opens up many perspectives in the field of materials for bone substitution and regeneration. STATEMENT OF SIGNIFICANCE: The metastability of amorphous phosphate-based materials with various chain length often improves their (bio)chemical reactivity. However, the control of the ratio of the different phosphate entities has not been yet described especially for small ions (pyrophosphate/orthophosphate) and using soft chemistry, whereas it opens the way for the tuning of enzyme- and/or pH-driven degradation and biological properties. Our study focuses on elaboration of amorphous gel-derived hydrated calcium/sodium ortho/pyrophosphate solids at 70 °C with a large range of orthophosphate/pyrophosphate ratios. Multi-scale characterization was carried out using various techniques such as advanced multinuclear SSNMR (31P, 23Na, 1H, 43Ca). Analyses suggest that these solids are formed by colloids aggregation and that the location of mobile water and sodium could play a role in the material cohesion.

Igualdad, independientemente de lo que sea diferente: representaciones sociales sobre inclusión de jóvenes con deficiencia intelectual / Igualdade, independentemente do que seja diferente: representações sociais sobre inclusão de jovens com deficiência intelectual / Equality, regardless of what is different: social representations on inclusion of young people with intellectual disabilities

A presente pesquisa teve por objetivo analisar as representações sociais sobre inclusão de jovens com deficiência intelectual (DI) no segmento de ensino médio (EM), na perspectiva de Jovens Nativos na Pedagogia de Orientação Inclusiva (JNPOI), matriculados numa escola pública de ensino médio de Planaltina, Brasília-DF. Trata-se de uma pesquisa qualitativa, descritivo-interpretativa. Os dados foram obtidos a partir da aplicação do questionário de Livre Associação de Palavras a 186 jovens, dentre os quais, sete tinham DI. Realizamos a análise prototípica desses dados com ajuda do software Iramuteq. Os resultados sugerem que subjacente a uma representação social plenamente favorável à inclusão de pessoas com DI, no segmento de EM, está a busca por afirmar uma identidade compatível com normas, princípios constitucionais e procedimentos jurídicos que condenam firmemente a expressão do preconceito e das atitudes discriminatórias.

En la presente investigación se tuvo por objetivo analizar las representaciones sociales sobre inclusión de jóvenes con deficiencia intelectual (DI) en el segmento de enseñanza secundaria (EM), en la perspectiva de Jóvenes Nativos en la Pedagogía de Orientación Inclusiva (JNPOI), ingresados en una escuela pública de enseñanza secundaria de Planaltina, Brasília-DF. Se trata de una investigación cualitativa, descriptivo-interpretativa. Se obtuvo los datos a partir de la aplicación del cuestionario de Libre Asociación de Palabras a 186 jóvenes, entre los cuales, siete tenían DI. Realizamos el análisis prototípico de esos datos con ayuda del software Iramuteq. Los resultados sugieren que subyacente a una representación social plenamente favorable a la inclusión de personas con DI, en el segmento de EM, está la búsqueda por afirmar una identidad compatible con normas, principios constitucionales y procedimientos jurídicos que condenan firmemente la expresión del preconcepto y de las actitudes discriminatorias.

This research aimed to analyze social representations on the inclusion of young people with intellectual disabilities (ID) in the high school (HS) segment, from the perspective of Young Natives in Inclusion-Oriented Pedagogy (YNIOP) attending a public high school in Planaltina, Brasília-DF. It is a qualitative, descriptive-interpretative research. Data were obtained from the application of the Free Word Association Questionnaire to 186 young students, among which seven had ID. We prototyped this data with the help of the Iramuteq software. The results suggest that, underlying a social representation that is fully favorable to the inclusion of people with ID in the HS segment, there is the search for the affirmation of an identity compatible with norms, constitutional principles and legal procedures that strongly condemn expressions of prejudice and discriminatory attitudes.

Effects of the implementation of a hand hygiene education program among ICU professionals: an interrupted time-series analysis.

OBJECTIVE: To evaluate the effects that a hand hygiene education program has on the compliance of health professionals in an ICU. METHODS: This was a quasi-experimental study with an interrupted time-series design, conducted over a 12-month period: the 5 months preceding the implementation of a hand hygiene education program (baseline period); the 2 months of the intensive (intervention) phase of the program; and the first 5 months thereafter (post-intervention phase). Hand hygiene compliance was monitored by one of the researchers, unbeknownst to the ICU team. The primary outcome measure was the variation in the rate of hand hygiene compliance. We also evaluated the duration of mechanical ventilation (MV), as well as the incidence of ventilator-associated pneumonia (VAP) at 28 days and 60 days, together with mortality at 28 days and 60 days. RESULTS: On the basis of 959 observations, we found a significant increase in hand hygiene compliance rates-from 31.5% at baseline to 65.8% during the intervention phase and 83.8% during the post-intervention phase, corresponding to prevalence ratios of 2.09 and 2.66, respectively, in comparison with the baseline rate (p < 0.001). Despite that improvement, there were no significant changes in duration of MV, VAP incidence (at 28 or 60 days), or mortality (at 28 or 60 days). CONCLUSIONS: Our findings indicate that a hand hygiene education program can increase hand hygiene compliance among ICU professionals, although it appears to have no impact on VAP incidence, duration of MV, or mortality.

Effects of the implementation of a hand hygiene education program among ICU professionals: an interrupted time-series analysis / Efeitos da implementação de um programa de educação de higienização das mãos entre profissionais de uma UTI: análise de séries temporais interrompidas

ABSTRACT Objective: To evaluate the effects that a hand hygiene education program has on the compliance of health professionals in an ICU. Methods: This was a quasi-experimental study with an interrupted time-series design, conducted over a 12-month period: the 5 months preceding the implementation of a hand hygiene education program (baseline period); the 2 months of the intensive (intervention) phase of the program; and the first 5 months thereafter (post-intervention phase). Hand hygiene compliance was monitored by one of the researchers, unbeknownst to the ICU team. The primary outcome measure was the variation in the rate of hand hygiene compliance. We also evaluated the duration of mechanical ventilation (MV), as well as the incidence of ventilator-associated pneumonia (VAP) at 28 days and 60 days, together with mortality at 28 days and 60 days. Results: On the basis of 959 observations, we found a significant increase in hand hygiene compliance rates-from 31.5% at baseline to 65.8% during the intervention phase and 83.8% during the post-intervention phase, corresponding to prevalence ratios of 2.09 and 2.66, respectively, in comparison with the baseline rate (p < 0.001). Despite that improvement, there were no significant changes in duration of MV, VAP incidence (at 28 or 60 days), or mortality (at 28 or 60 days). Conclusions: Our findings indicate that a hand hygiene education program can increase hand hygiene compliance among ICU professionals, although it appears to have no impact on VAP incidence, duration of MV, or mortality.

RESUMO Objetivo: Avaliar os efeitos da implementação de um programa de educação sobre higienização das mãos e a adesão a essa prática entre profissionais de uma UTI. Métodos: Estudo quase-experimental com séries temporais interrompidas conduzido ao longo de 12 meses: 5 meses antes do programa de educação (período basal), 2 meses durante a fase intensiva do programa (período de intervenção) e 5 meses durante a fase de manutenção do programa (período pós-intervenção). A avaliação da adesão às práticas de higienização das mãos foi feita por um dos pesquisadores sem conhecimento da equipe da UTI. O desfecho primário foi a variação da taxa de adesão à higienização das mãos. Também foram avaliadas a duração da ventilação mecânica (VM), a incidência de pneumonia associada à ventilação mecânica (PAVM) em 28 e 60 dias e mortalidade nos mesmos momentos. Resultados: Com base em 959 observações, houve um aumento nas taxas de adesão à higienização das mãos de 31,5% no período basal para 65,8% no período de intervenção e para 83,8% no período pós-intervenção, representando uma razão de prevalência 2,09 e 2,66 maior que o período basal, respectivamente (p < 0,001). Apesar desse aumento, não houve diferenças significativas em relação à duração da VM ou à incidência de PAVM e taxa de mortalidade em 28 e 60 dias. Conclusões: Neste estudo, o programa de educação em higienização das mãos aumentou a adesão a esse procedimento durante o período de monitorização, sem alterar as taxas de PAVM, a duração da VM e a mortalidade.

Electrooculogram and submandibular montage to distinguish different eye, eyelid, and tongue movements in electroencephalographic studies.

OBJECTIVE: We propose an electrooculogram and submandibular montage that helps to discriminate eye/eyelid/tongue movements and to differentiate them from epileptiform activity or slowing on electroencephalography (EEG). METHODS: We analyzed different eye/eyelid and tongue movements in 6 and 4 patients, respectively. Six peri-orbitally and one submandibular electrodes were placed. We referred these electrodes to an indifferent reference (Cz/Pz) and we recorded eye/eyelid and tongue movements simultaneously with the 10-20 system EEG. Additionally, we analyzed 2 seizures with the electrooculogram montage. RESULTS: The electrooculogram deflections always showed an opposite phase direction when eye/eyelid movements occurred. Conversely, epileptiform activity produced deflections in the same phase direction in all electrooculogram electrodes. The electrooculogram montage was able to distinguish eye ictal semiology. Vertical tongue movements showed opposite phase deflections between the submandibular and the inferior ocular electrodes. Horizontal tongue movements revealed opposite phase reversal deflections between both inferior ocular electrodes. CONCLUSIONS: The proposed montage accurately defines different eye/eyelid and tongue movements from brainwave activity. Additionally, it is useful to differentiate eye/eyelid movements from epileptiform activity and to characterize ictal ocular semiology, which can help localize or lateralize the epileptogenic zone. SIGNIFICANCE: We propose this new montage to provide added value to prolonged video-EEG studies.

Effects of an unsupervised pedometer-based physical activity program on daily steps of adults with moderate to severe asthma: a randomized controlled trial.

Supervised exercise has shown benefits for subjects with asthma, but little is known about the effectiveness of unsupervised physical activity on this population. We investigated the effects of a 12-week unsupervised pedometer-based physical activity program on daily steps and on clinical and psychological parameters of adults with asthma. Clinically stable adults with moderate to severe asthma were encouraged to take daily 30-minute walks and were randomized to pedometer and control groups. The pedometer group received pedometers and individualized daily step targets. Changes in daily steps (average of steps taken during six consecutive days), six-minute walk test (6MWT), health-related quality of life, asthma control and anxiety and depression levels were assessed 12 weeks after intervention and 24-28 weeks after randomization. Thirty-seven participants were recruited and 30 completed the intervention. At 12 weeks, the groups differed significantly in daily steps (adjusted average difference, 2488 steps; 95% confidence interval [CI], 803 to 4172; p = 0.005) and in the 6MWT (adjusted average difference, 21.9 m; 95% CI, 6.6 to 37.3; p = 0.006). These differences were not significant 24-28 weeks after randomization. The program was effective in increasing daily steps of adults with moderate to severe asthma 12 weeks after intervention.

Objectively measured daily-life physical activity of moderate-to-severe Brazilian asthmatic women in comparison to healthy controls: A cross-sectional study.

Considering the complex relationship between asthma symptoms and exercise, asthmatics are usually believed to be less active in daily life than healthy subjects. However, few studies have objectively assessed daily-life physical activity (DLPA) of asthmatic adults. OBJECTIVE: To objectively assess DLPA of a sample of Brazilian asthmatic women in comparison to healthy controls, and to investigate the associations between DLPA and asthma control, health-related quality of life, anxiety and depression levels, and the Six-minute walk test (6MWT) in this population. METHODS: Sixty-six women were included, 36 in the asthma group (AG) and 30 in the control group (CG). The AG was composed by clinically stable moderate-to-severe asthmatics. The CG was composed by apparently healthy volunteers. All subjects underwent DLPA assessment (considered as the average of steps taken during six consecutive days measured by a pedometer) and performed the 6MWT. Additionally, participants in the AG were assessed using the Asthma Control Questionnaire, the Asthma Quality of Life Questionnaire (AQLQ), and the Hospital Anxiety and Depression Scale. RESULTS: There was no difference between the AG and the CG regarding DLPA (7490.3 ± 3330.2 vs 6876.4 ± 3242.1 steps respectively, p = 0.45), even after adjustment for covariates. DLPA was significantly correlated to the activity limitation domain of the AQLQ among asthmatics (r = 0.43, p < 0.01). CONCLUSION: Despite the association between self-perceived activity limitation and DLPA among asthmatics, there were no differences regarding DLPA between a sample of moderate-to-severe Brazilian asthmatic women and apparently healthy controls.

New concepts in palliative care in the intensive care unit. / Novos conceitos em cuidados paliativos na unidade de terapia intensiva.

Some patients admitted to an intensive care unit may face a terminal illness situation, which usually leads to death. Knowledge of palliative care is strongly recommended for the health care providers who are taking care of these patients. In many situations, the patients should be evaluated daily as the introduction of further treatments may not be beneficial to them. The discussions among health team members that are related to prognosis and the goals of care should be carefully evaluated in collaboration with the patients and their families. The adoption of protocols related to end-of-life patients in the intensive care unit is fundamental. A multidisciplinary team is important for determining whether the withdrawal or withholding of advanced care is required. In addition, patients and families should be informed that palliative care involves the best possible care for that specific situation, as well as respect for their wishes and the consideration of social and spiritual backgrounds. Thus, the aim of this review is to present palliative care as a reasonable option to support the intensive care unit team in assisting terminally ill patients. Updates regarding diet, mechanical ventilation, and dialysis in these patients will be presented. Additionally, the hospice-model philosophy as an alternative to the intensive care unit/hospital environment will be discussed.

Alguns dos pacientes admitidos em uma unidade de terapia intensiva podem enfrentar condições de doença terminal, que geralmente levam à morte. O conhecimento sobre cuidados paliativos é recomendado para os profissionais de saúde encarregados do cuidado destes pacientes. Em muitas situações, os pacientes devem ser avaliados diariamente, já que a introdução de novos tratamentos pode ou não ser benéfica para eles. As discussões entre os membros da equipe de saúde, relacionadas ao prognóstico e aos objetivos do tratamento, devem ser avaliadas cuidadosamente em cooperação com os pacientes e seus familiares. A adoção na unidade de terapia intensiva de protocolos relacionados a pacientes em final da vida é fundamental. É importante ter uma equipe multidisciplinar para determinar se é necessário deixar de iniciar ou mesmo retirar tratamentos avançados. Além disto, pacientes e familiares devem ser informados de que os cuidados paliativos envolvem o melhor tratamento possível para aquela situação específica, assim como respeitar suas vontades e considerar as bases sociais e espirituais dos mesmos. Assim, o objetivo desta revisão foi apresentar os cuidados paliativos como uma opção razoável para dar suporte à equipe da unidade de terapia intensiva na assistência a pacientes com doença terminal. São apresentadas atualizações com relação a dieta, ventilação mecânica e diálise nestes pacientes. Ainda, discutiremos o programa, comum nos Estados Unidos, conhecido como filosofia hospice, como alternativa ao ambiente da unidade de terapia intensiva/hospital.

Novos conceitos em cuidados paliativos na unidade de terapia intensiva / New concepts in palliative care in the intensive care unit

RESUMO Alguns dos pacientes admitidos em uma unidade de terapia intensiva podem enfrentar condições de doença terminal, que geralmente levam à morte. O conhecimento sobre cuidados paliativos é recomendado para os profissionais de saúde encarregados do cuidado destes pacientes. Em muitas situações, os pacientes devem ser avaliados diariamente, já que a introdução de novos tratamentos pode ou não ser benéfica para eles. As discussões entre os membros da equipe de saúde, relacionadas ao prognóstico e aos objetivos do tratamento, devem ser avaliadas cuidadosamente em cooperação com os pacientes e seus familiares. A adoção na unidade de terapia intensiva de protocolos relacionados a pacientes em final da vida é fundamental. É importante ter uma equipe multidisciplinar para determinar se é necessário deixar de iniciar ou mesmo retirar tratamentos avançados. Além disto, pacientes e familiares devem ser informados de que os cuidados paliativos envolvem o melhor tratamento possível para aquela situação específica, assim como respeitar suas vontades e considerar as bases sociais e espirituais dos mesmos. Assim, o objetivo desta revisão foi apresentar os cuidados paliativos como uma opção razoável para dar suporte à equipe da unidade de terapia intensiva na assistência a pacientes com doença terminal. São apresentadas atualizações com relação a dieta, ventilação mecânica e diálise nestes pacientes. Ainda, discutiremos o programa, comum nos Estados Unidos, conhecido como filosofia hospice, como alternativa ao ambiente da unidade de terapia intensiva/hospital.

ABSTRACT Some patients admitted to an intensive care unit may face a terminal illness situation, which usually leads to death. Knowledge of palliative care is strongly recommended for the health care providers who are taking care of these patients. In many situations, the patients should be evaluated daily as the introduction of further treatments may not be beneficial to them. The discussions among health team members that are related to prognosis and the goals of care should be carefully evaluated in collaboration with the patients and their families. The adoption of protocols related to end-of-life patients in the intensive care unit is fundamental. A multidisciplinary team is important for determining whether the withdrawal or withholding of advanced care is required. In addition, patients and families should be informed that palliative care involves the best possible care for that specific situation, as well as respect for their wishes and the consideration of social and spiritual backgrounds. Thus, the aim of this review is to present palliative care as a reasonable option to support the intensive care unit team in assisting terminally ill patients. Updates regarding diet, mechanical ventilation, and dialysis in these patients will be presented. Additionally, the hospice-model philosophy as an alternative to the intensive care unit/hospital environment will be discussed.

A avaliação interativa e o software alfabetização fônica: um estudo de caso / The Interactive Assessment and the Alfabetização Fônica Software: a Case Study / Evaluación Interactiva y Alfabetização Fônica Computadorizada: un Estudio de Caso

O trabalho verificou a eficácia ­ na perspectiva da avaliação interativa ­ de uma intervenção com o software Alfabetização Fônica no desenvolvimento linguístico de uma aluna com deficiência intelectual. A aluna, com 20 anos e multirrepetente, frequentava o 1º ano do ensino médio de uma escola pública; foi diagnosticada formalmente com deficiência intelectual e apresentava dificuldades linguísticas na expressão oral e escrita, na compreensão e na leitura. O método baseou-se numa análise longitudinal, a partir de uma avaliação de pré-teste do perfil cognitivo da aluna (PROLEC), seguido da realização de intervenções com o software Alfabetização Fônica e de uma avaliação de pós-teste. O PROLEC visa à avaliação dos processos de leitura e envolve as seguintes provas: a) Identificação de letras; b) Processos léxicos; c) Processos sintáticos; d) Processos semânticos. Diferenças significativas nos desempenhos entre os pré-testes e os pós-testes apontaram para a eficácia de intervenções com procedimentos computadorizados nas dimensões léxicas, sintáticas e semânticas da linguagem e na consciência fonológica.

The study aimed to verify the effectiveness - from interactive assessment approach - an intervention with the software Alfabetização Fônica in the language skills of a student with intellectual disability. The 20-year-old student after repeted the school year many times attended the first year of high school in a public school; she was diagnosed with intellectual disability and had linguistic difficulties in oral and written expression, comprehension and reading. The method was based on a longitudinal analysis based on a review of pre-test of the cognitive profile of the student through the WAIS-III, Raven, PROLEC and conducting interventions with the software and post-test evaluation. The PROLEC aims at the evaluation of reading processes and has the following proofs: a) Identification of letters; b) Lexical processes; c) Syntactic processes; d) Semantic processes. Significant differences the performances of the student between the pre and post-tests pointing to the effectiveness of interventions, especially in lexical, syntactic and semantic dimensions of language and phonological awareness indicators.

El trabajo verificó la eficacia - en la perspectiva de la evaluación interactiva - de una intervención con el software Alfabetização Fônica en el desarrollo lingüístico de una alumna con discapacidad intelectual. La alumna, con 20 años que había repetido el año muchas veces, frecuentaba el primer año de la enseñanza media de una escuela pública; fue diagnosticada formalmente con deficiencia intelectual y presentaba dificultades lingüísticas en la expresión oral y escrita, en la comprensión y en la lectura. El método se basó en un análisis longitudinal, a partir de una evaluación de pre test del perfil cognitivo de la alumna (PROLEC), seguida de la realización de intervenciones con el software Alfabetización Fónica y de una evaluación de post test. El PROLEC tiene como objetivo la evaluación de los procesos de lectura y aplica las siguientes pruebas: a) Identificación de letras; b) Procesos léxicos; c) Procesos sintácticos; d) Procesos semánticos. Diferencias significativas en los desempeños entre los pre test y las post-pruebas apuntaron a la eficacia de intervenciones con procedimientos computarizados en las dimensiones léxicas, sintácticas y semánticas del lenguaje y en la conciencia fonológica.