ABSTRACT
BACKGROUND: Exergaming is a fun, engaging, and interactive form of exercising that may help overcome some of the traditional exercise barriers and help improve adherence on the part of older adults, providing therapeutic applications for balance recovery and functional mobility. The purpose of this systematic review is to summarize the effects of exergames on mobility and balance in older adults. METHODS: The PRISMA guidelines for systematic reviews were followed. The following databases were searched from inception to August 2019: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PEDro, CINAHL, and INSPEC. We selected randomized controlled trials that assessed the effects of exergames on balance or mobility of older adults without neurological conditions, in comparison to no intervention or health education. Two review authors independently screened the trials' titles and abstracts and identified trials for inclusion according to the eligibility criteria. An almost perfect agreement between the authors was observed with respect to interrater reliability of trial selection (kappa = 0.84; P < 0.001). We performed descriptive analysis of the quantitative data to summarize the evidence. Meta-analysis was carried out using RevMan. A random effects model was used to compute the pooled prevalence with 95% confidence intervals. RESULTS: After screening 822 records, 12 trials comparing exergames with no intervention were included. A total of 1520 older adults participated in the studies, with a mean age of 76 ± 6 years for the experimental group and 76 ± 5 years for the control group. Quantitative synthesis showed significant improvements in balance and mobility based on the center of pressure sway (SMD = - 0.89; 95%CI = - 1.26 to - 0.51; P = 0.0001; I2 = 58%), Berg Balance Scale (MD = 2.15; 95%CI = 1.77 to 2.56; P = 0.0001; I2 = 96%), and on Timed Up and Go test (MD = - 2.48; 95%CI = - 3.83 to - 1.12; P = 0.0003; I2 = 0). CONCLUSIONS: Exergames improved balance and mobility in older adults without neurological disorders and motivate patients to keep performing balance exercises. High quality studies with standardized assessment protocols are necessary to improve the strength of the evidence.
Subject(s)
Exercise Therapy , Postural Balance , Aged , Aged, 80 and over , Exercise , Humans , Reproducibility of Results , Time and Motion StudiesABSTRACT
Recently, horse breeding has achieved greater prominence in the Brazilian society and now it started to appear as a part of the Brazilian agribusiness. The state of Minas Gerais stands out as the main producer of equidae in Brazil. The aim of this work was to characterize the breeding of equidae in this State in order to support future researches in this sector. By the evaluation of records from 1990 to 2009 provided by the "Brazilian Institute of Geography and Statistics" (IBGE) and also 967 interviews with breeders of equidae, it was possible to characterize some important points. It was observed that equidae breeding in this State moves over R$1,500,000,000 per year and employs 86,000 people. The main investments of the properties are made in purchasing saddles, accessories and commercial feeds. The main goal of equidae breeders in Minas Gerais has been the work in rural properties (49.49%) complementing many farming activities, especially the work with cows. Although Minas Gerais holds the main herd of equidae in the country, the number of animals has decreased. On the one hand, the equidae breeding sector has demonstrated its social and economic importance in agribusiness; on the other, hand further researches are needed to develop public policies to improve the breeding of equidae in Minas Gerais.(AU)
Subject(s)
Animals , Horses/anatomy & histology , Horses/growth & developmentABSTRACT
Recently, horse breeding has achieved greater prominence in the Brazilian society and now it started to appear as a part of the Brazilian agribusiness. The state of Minas Gerais stands out as the main producer of equidae in Brazil. The aim of this work was to characterize the breeding of equidae in this State in order to support future researches in this sector. By the evaluation of records from 1990 to 2009 provided by the "Brazilian Institute of Geography and Statistics" (IBGE) and also 967 interviews with breeders of equidae, it was possible to characterize some important points. It was observed that equidae breeding in this State moves over R$1,500,000,000 per year and employs 86,000 people. The main investments of the properties are made in purchasing saddles, accessories and commercial feeds. The main goal of equidae breeders in Minas Gerais has been the work in rural properties (49.49%) complementing many farming activities, especially the work with cows. Although Minas Gerais holds the main herd of equidae in the country, the number of animals has decreased. On the one hand, the equidae breeding sector has demonstrated its social and economic importance in agribusiness; on the other, hand further researches are needed to develop public policies to improve the breeding of equidae in Minas Gerais.
Subject(s)
Animals , Horses/anatomy & histology , Horses/growth & developmentABSTRACT
OBJECTIVE: To evaluate the prevalence and characteristics of disability benefits due to musculoskeletal disorders (MSD) granted to Brazilian private sector workers. METHODS: This was a population-based epidemiological study of MSD-related benefits among registered private sector workers (n=32â959â329). The prevalence (benefits/10â000 workers/year) of work disability benefits was calculated by gender, age, state, Human Development Index (HDI), economic activity, MSD type and work-relatedness. RESULTS: The prevalence of MSD-related benefits in Brazil among registered private sector workers in 2008 was 93.6/10â000 workers. The prevalence increased with age, and was higher for women (112.2) than for men (88.1), although the former had shorter benefit duration. The gender-adjusted prevalence by state varied from 16.6 to 90.3 for non-work-related, and from 7.8 to 59.6 for work-related benefits. The Brazilian states with a high-very high HDI had the highest prevalence. The top four most common types of MSD-related benefits were due to back pain, intervertebral disc disorders, sinovitis/tenosynovitis and shoulder disorders. CONCLUSION: MSD is a frequent cause of work disability in Brazil. There were differences in prevalence among economic activities and between states grouped by HDI. This study demonstrates that further evaluation of the contributing factors associated with MSD-related disability benefits is required. Factors that should be considered include production processes, political organisation, socioeconomic and educational characteristics, the compensation and recording systems, and employee-employer power relationships. These factors may play an important role in the prevalence of MSD-related disability benefits, especially in countries with large socioeconomic iniquities such as Brazil.
ABSTRACT
Fanconi anemia is a rare hereditary disease showing genetic heterogeneity due to a variety of mutations in genes involved in DNA repair pathways, which may lead to different clinical manifestations. Phenotypic variability makes diagnosis difficult based only on clinical manifestations, therefore laboratory tests are necessary. New advances in molecular pathogenesis of this disease led researchers to develop a diagnostic test based on Western blot for FANCD2. The objective of the present study was to determine the efficacy of this method for the diagnosis of 84 Brazilian patients with Fanconi anemia, all of whom tested positive for the diepoxybutane test, and 98 healthy controls. The FANCD2 monoubiquitinated isoform (FANCDS+/FANCD2L-) was not detected in 77 patients (91.7%). In 2 patients (2.4%), there was an absence of both the monoubiquitinated and the non-ubiquitinated proteins (FANCD2S-/FANCD2L-) and 5 patients (5.9%) had both isoforms (FANCD2S+/FANCD2L+). This last phenotype suggests downstream subtypes or mosaicism. All controls were diepoxybutane negative and were also negative on the FANCD2 Western blot. The Western blot for FANCD2 presented a sensitivity of 94% (79/84) and specificity of 100% (98/98). This method was confirmed as an efficient approach to screen Brazilian patients with deleterious mutations on FANCD2 (FANCD2S-/FANCD2L-) or other upstream genes of the FA/BRCA pathway (FANCDS+/FANCD2L-), to confirm the chromosome breakage test and to classify patients according to the level of FA/BRCA pathway defects. However, patients showing both FANCD2 isoforms (FANCD2S+/FANCD2L+) require additional studies to confirm mutations on downstream Fanconi anemia genes or the presence of mosaicism.
Subject(s)
Fanconi Anemia Complementation Group D2 Protein/analysis , Fanconi Anemia Complementation Group D2 Protein/genetics , Fanconi Anemia/diagnosis , Adolescent , Adult , Blotting, Western , Case-Control Studies , Child , Child, Preschool , Chromosome Breakage , Epoxy Compounds , Fanconi Anemia/genetics , Female , Genetic Markers/genetics , Humans , Male , Phenotype , Sensitivity and Specificity , Young AdultABSTRACT
Fanconi anemia is a rare hereditary disease showing genetic heterogeneity due to a variety of mutations in genes involved in DNA repair pathways, which may lead to different clinical manifestations. Phenotypic variability makes diagnosis difficult based only on clinical manifestations, therefore laboratory tests are necessary. New advances in molecular pathogenesis of this disease led researchers to develop a diagnostic test based on Western blot for FANCD2. The objective of the present study was to determine the efficacy of this method for the diagnosis of 84 Brazilian patients with Fanconi anemia, all of whom tested positive for the diepoxybutane test, and 98 healthy controls. The FANCD2 monoubiquitinated isoform (FANCDS+/FANCD2L-) was not detected in 77 patients (91.7 percent). In 2 patients (2.4 percent), there was an absence of both the monoubiquitinated and the non-ubiquitinated proteins (FANCD2S-/FANCD2L-) and 5 patients (5.9 percent) had both isoforms (FANCD2S+/FANCD2L+). This last phenotype suggests downstream subtypes or mosaicism. All controls were diepoxybutane negative and were also negative on the FANCD2 Western blot. The Western blot for FANCD2 presented a sensitivity of 94 percent (79/84) and specificity of 100 percent (98/98). This method was confirmed as an efficient approach to screen Brazilian patients with deleterious mutations on FANCD2 (FANCD2S-/FANCD2L-) or other upstream genes of the FA/BRCA pathway (FANCDS+/FANCD2L-), to confirm the chromosome breakage test and to classify patients according to the level of FA/BRCA pathway defects. However, patients showing both FANCD2 isoforms (FANCD2S+/FANCD2L+) require additional studies to confirm mutations on downstream Fanconi anemia genes or the presence of mosaicism.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Young Adult , /analysis , /genetics , Fanconi Anemia/diagnosis , Blotting, Western , Case-Control Studies , Chromosome Breakage , Epoxy Compounds , Fanconi Anemia/genetics , Genetic Markers/genetics , Phenotype , Sensitivity and Specificity , Young AdultABSTRACT
OBJETIVO: O objetivo do presente artigo foi revisar criticamente os conceitos e tipos de confiabilidade, validade e responsividade de medidas, e discutir suas implicações para a pesquisa em reabilitação e para a prática clínica de qualidade.MÉTODO: Uma revisão crítica da literatura foi realizada considerando as vantagens, as limitações e o uso adequado das propriedades de medida em reabilitação.RESULTADOS E DISCUSSÃO: A qualidade das medidas é avaliada por critérios tais como confiabilidade, validade e responsividade. Muitos estudos publicados não apresentam estas propriedades de medida as quais estão relacionadas e algumas vezes sobrepõe-se sendo freqüentemente confundidas. Este artigo de revisão esclareceu os conceitos e tipos de confiabilidade, validade e responsividade. Exemplos relevantes para a área de reabilitação foram apresentados. Discutiu-se como as propriedades de medida interagem entre si e influenciam o tamanho do efeito e o poder dos estudos. CONCLUSÕES: Medidas são essenciais na pesquisa em reabilitação e na avaliação clínica. As propriedades de medida devem ser apresentadas para permitir que o leitor possa avaliar a qualidade dos resultados apresentados. Os esclarecimentos das propriedades de medida apresentados neste artigo podem contribuir para a padronização das definições e para a melhoria da qualidade da pesquisa em reabilitação e da prática clínica.
Subject(s)
Weights and Measures , Physical Therapy Modalities , Rehabilitation , Reproducibility of ResultsABSTRACT
Varios fatores individuais e ocupacionais podem atuarfacilitando a ocorrencia e/ou o agravamento das lombalgias relacionadas ao trabalho, dentre os quais: manuseio de cargas, repeticao e flexao anterior do tronco. Portanto, a quantificacao dos movimentos do tronco e importante para avaliar os riscos epropor intervencos de controle. Diferentes metodos de registro de movimentos, desde os mais sofisticados e precisos ate os mais simles e acessiveis, tem sido utilizados nessa tarefa. O objetivo deste estudo foi avaliar, comparativamente, um novo metodo simples de medida linear da flexao lombar, o distanciometro, utilizando como referencia um equipamento preciso, o eletrogoniometro. Participaram do estudo 12 sujeitos saudaveis, do sexo masculino, com idade entre 18 e 25 anos, altura de 1,65 a 1,80m, peso de 60 a 80 kg e indeice de massa corporal de 20 a 26 Kg/m2. Os angulos preestabelecidos e utilizados como referencia para a comparaco pela correlacao de Pearso(r), e as faixas de amplitude, pelo teste de Friedman. Os valores da correlacao entre os angulos foram elevados (r=0,960, indicando alta confiabilidade paralela do distanciometro em relacao ao eletrogoniometro, enquanto os resultados do teste de Friedaman indicaram ausencia de diferencas significativas ao longo das faixas dea mplitude avaliadas (p=0,342), sugerindo consistencia das medidas ao longo de toda a faixa de amplitude. Finalmente, apesar de o distanciometro encontrar-se ainda em fase de prototipo e necessitando de estudos futuros para aprimoramento, o mesmo indicou potencialidade para medicao da flexao lombar no que tange a seus custos e a confiabilidade paralela
Subject(s)
Cumulative Trauma Disorders , Low Back Pain , WorkABSTRACT
A elevada incidencia de desordens lombares representa altos custos pessoais e sociais par o Estado. O movimento extremo flexao lombar e fundamental para o desenvolvimento e agravamento da dor nessa regiao. desta forma, a quantificacao precisa desse movimento e importante para prevencao e tratamento dessas desordens. O proposito deste trabalho foi avaliar a confiabilidade paralela do duplo fleximetro (FLM) da marca FLEXIMETER por intermedio da utilizacao de um eletrogoniometro (EGM) flexivel, considerado altamente preciso, durante as medidas do movimento de flexao anterior da coluna lombar. Foram estudados doze sujeitos saudaveis (sexo masculino, idade media de 21,2 anos, altura media de 1,73m, massa corporal media de 72,3kg, IMC entre 20 e 30 kg/m2). Apos triados por uma avaliacao postural, os sujeitos foram familiarizados com a situacao de teste e preparados para a coleta. Tres posicoes preestabelecidas ao longo do movimento de flexao anterior da coluna lombar (15o., 30o., e 45o.) foram registrados pelo EGM e utilizadas como parametro para as medidas etuadas simultanamente com o duplo fleximetro. Os resultados do teste t emparelhado para as medias dos valores angulares do FLM mostraram os p-valores 0,0052 e 0,17, respectivamente, para as posicoes 15o., 30o. e 45o. registradas pelo EGM. Apenas para o angulo de 45o. (p>0,05) as medidas registradas pelos dois aparelhos foram equivalentes e , portanto, confiaveis. Apesar de a confiabiliade do FLM tender a aumentar com o aumento da amplitude de movimento, de maneira geral, o FLM da marca FLEXIMETER nao pode ser considerado confiavel para a amostra estudada
Subject(s)
Low Back Pain , Lumbar VertebraeABSTRACT
Lombalgias sao frequentes na populacao em geral e no contexto do trabalho em particular. Os fatores biomecanicos, o risco e maior a medida que a flexao anterior do tronco aumenta. Uma nova tecnica de quantificacao angular da flexao anterior do tronco foi utilizada neste estudo - marcadores perpendiculares - para o calculo do angulo entre linhas tracadas sobre marcadores perpendiculares para a coluna toraco-lombar e analisar a confiabilidade intra e interobservadores para tres metodos de registro ngular, sendo eles a tecnica Chaffin Modificada (CM), Whistance (W) e marcadores perpendiculares (MP). Os resultados indicaram boa confiabilidade intra-observador para tres tecnicas (ICC entre 0,94 e 0,95). Ja paraa confiabilidade interobservadores, a tecnica de CM nao apresentou confiabilidade (ICC=0,54), enquanto as demais tecnicas apresentaram boa confiabilidade. Os valores angulares obtidos pela tecnica de CM (116,65+_ 11,09) foram estatisticamente diferentes daqueles obtidos pelas tecnicas W e MP, 72,31+-6,89 e 67,89+-14,32, respectivamente. A tecnica CM parece se aproximar dos valores estabelecidos para a flexao anterior do tronco (110 a 140), porem, superestima a flexao da coluna vertebral por incluir movimentos do quadril. As tecnicas W e MP mostraram maior ompatibilidade com valores encontrados para a flexao da coluna vertebral descritos na literatura cinesiologica, sem a participacao do quadril que ocorre no final do movimento