Recomendaciones sobre programas de rehabilitación pulmonar en pacientes con enfermedad pulmonar obstructiva crónica de la Sociedad de Rehabilitación Cardiorrespiratoria / Recommendations of the Spanish Society of Cardiorespiratory Rehabilitation on pulmonary rehabilitation programmes in patients with chronic obstructive pulmonary disease

Introducción. La rehabilitación respiratoria (RR) es un componente primordial en el manejo de pacientes con enfermedades respiratorias crónicas. El objetivo de este documento de recomendaciones es proporcionar al equipo de rehabilitación una puesta al día de las principales intervenciones a realizar dentro de un programa de RR, haciendo especial énfasis en las evaluaciones previas al inicio del programa. Una valoración adecuada permitirá seleccionar las intervenciones según las necesidades individuales de cada paciente y mejorar la eficiencia de la RR. Métodos. Un comité de expertos que incluía a médicos y fisioterapeutas de la Sociedad de Rehabilitación Cardiorrespiratoria, y un reumatólogo especialista en osteoporosis de la Sociedad Española de Reumatología actualizaron la evidencia disponible en RR a partir de estudios de calidad (revisiones, metaanálisis y ensayos clínicos), incorporando nuevas estrategias e intervenciones complementarias al ejercicio físico. El resultado final del documento fue acordado por todos sus miembros. Resultados. Se proporciona información necesaria para realizar un abordaje multidisciplinario del paciente con enfermedad pulmonar obstructiva crónica que permita hacer una adecuada valoración individualizada y seleccionar las intervenciones a realizar dentro del programa de RR. Conclusiones. El entrenamiento físico sigue siendo la piedra angular de la RR. No obstante, existen diferentes intervenciones que pueden implementarse dentro de los programas de RR, de acuerdo con una valoración y selección adecuada de los pacientes (AU)

Introduction. Pulmonary rehabilitation (PR) is one of the key components in the management of patients with chronic respiratory disease. The goal of this guidance document is to provide rehabilitation team members with an update on the main interventions to be carried out within a PR programme, with special emphasis on the assessments that precede the start of the programme. An appropriate assessment will allow the interventions to be tailored to the patient's individual needs and will improve the overall efficiency of PR. Methods. An expert committee, which included physicians and physiotherapists of the Spanish Society of Cardio-Respiratory Rehabilitation, as well as a rheumatologist specialised in osteoporosis from the Spanish Society of Rheumatology updated the available evidence on PR based on high-quality studies (reviews, meta-analyses and clinical trials), incorporating new strategies and interventions that complemented physical exercise. The final draft of the document was agreed on by all of the members. Results. The document provides all the appropriate information to enable a multidisciplinary approach to the treatment of patients with chronic obstructive pulmonary disease, allowing appropriate individualised assessment and selection of interventions to be carried out within the PR programme. Conclusions. Exercise training remains the cornerstone of PR. Nevertheless, different interventions may be implemented within PR programmes, based on appropriate assessment and adequate patient selection (AU)

Rehabilitación cardíaca y reinserción laboral / No disponible

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Influencia de las técnicas de ahorro energético sobre la saturación de oxígeno en paciente con EPOC portador de oxígeno líquido / Influence of energy saving techniques on oxygen saturation in liquid oxygen carrier COPD patient

Presentamos el caso de un varón de 76 años diagnosticado de enfermedad pulmonar obstructiva crónica grave en fase de insuficiencia respiratoria crónica con criterios de oxigenoterapia domiciliaria, portador de un sistema portátil de oxigenoterapia. Durante el ejercicio presentaba desaturación grave que le limitaba todas las actividades de la vida diaria. El paciente se incluyó en un programa de rehabilitación respiratoria consistente en educación sanitaria, fisioterapia respiratoria, ejercicio físico y terapia ocupacional con técnicas de ahorro energético. Para la valoración de su discapacidad se le practicó la prueba de 6 minutos de marcha que mostró desaturación al esfuerzo, corrigiéndose parcialmente al realizarla respirando oxígeno suplementario. Se reevaluó al paciente con la misma prueba en dos ocasiones: una con oxígeno suplementario aplicando técnicas de ahorro energético y otra mediante marcha libre guiada por la sensación disneica. El análisis de los datos obtenidos reveló que la desaturación se corrigió sólo cuando se utilizaron técnicas de ahorro energético para la deambulación

We present the case of a 76-year-old male diagnosed of severe chronic obstructive pulmonary disease (COPD) in chronic respiratory insufficiency phases with home oxygen-therapy criteria, carrier of a portable oxygen therapy system. During exercise he presented desaturation that seriously limited all of his daily life activities. The patient was included in a respiratory rehabilitation program consisting of health care education, respiratory physical therapy, physical exercises and occupational therapy with energy saving techniques. In order to evaluate his disability, he underwent a 6 minute walking test that showed desaturation to the effort that was partially corrected when he was administered supplementary oxygen while performing it. The patient was revalued with the same test twice: one with supplementary oxygen applying energy saving techniques and other one of free walking guided by the dyspnea sensation. The analysis of the data obtained in this patient revealed that the desaturation was corrected only when energy saving techniques were used for the walking

Comentarios a la rehabilitación respiratoria: aproximación a la situación en España / No disponible

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Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation.

OBJECTIVES: To evaluate: (1) the associations between maternal psychological stress, distress and low birth weight (LBW), prematurity and intrauterine growth retardation (IUGR); (2) the interactions between maternal stress, distress and smoking, alcohol and coffee intake; (3) the prevalences of stress and distress in pregnancy. DESIGN: Longitudinal cohort study. SETTING: Jundiaí city, São Paulo state, Brazil. SUBJECTS: A total of 865 pregnant women who attended antenatal care between September 1997 and August 2000. METHODS: Measures of stress and distress were obtained, by interview, three times in pregnancy: at a gestational age (GA) lower than 16 weeks, from 20 to 26 weeks and from 30 to 36 weeks. Stress was investigated by the perceived stress scale, PSS, and distress by both the general health questionnaire, GHQ, and the State Trait Anxiety inventories, STAI. The outcomes were: LBW (birth weight <2500 g), prematurity (gestational age (GA) at birth <37 weeks) and IUGR (birth weight for GA

Social adjustment in depressed patients treated with venlafaxine and amitriptyline.

Social dysfunction is often associated with depressive disorders and its evaluation is an important measure of treatment outcome. The aim of this study was to assess the effect of two treatments, venlafaxine and amitriptyline, on the social functioning of depressed patients. Twenty-eight outpatients, meeting criteria for recurrent or single major depressive episodes, took part in a double-blind, 8-week trial with amitriptyline or venlafaxine (maximum of 150 mg/day) and were assessed by the Self-Report Social Adjustment Scale (SAS-SR) before and at the end of treatment. The scale was also applied to a carefully selected non-psychiatric sample. Both drugs showed the same efficacy on a clinical scale, but venlafaxine improved social functioning more than amitriptyline as only venlafaxine-treated patients reached SAS-SR values estimated for normal subjects. This effect might be linked to the higher rate of side-effects observed with amitriptyline.

Validation of the Portuguese version of the Social Adjustment Scale on Brazilian samples.

BACKGROUND: Social dysfunction is reported in several psychiatric diseases and its evaluation is becoming an important measure of treatment outcome. The aim of this study was to obtain normative data, to test the validity and the ability of the Portuguese version of the Self-Report Social Adjustment Scale (SAS-SR) to detect different clinical conditions. METHODS: The Portuguese version of the SAS-SR was applied to a carefully selected non-psychiatric sample, and to depressed, panic, bulimic and cocaine-dependent patients. Depressed and panic patients were evaluated in two different clinical conditions: acutely symptomatic and in remission. RESULTS: SAS overall and sub-scale scores of the normal sample were consistently lower than all patient groups, indicating better social adjustment in all areas. Panic patients were impaired to a lower level than depressed and cocaine-dependent patients in overall adjustment. Depressed patients in remission, although in better condition, were still impaired in relation to normal subjects in overall social functioning, leisure time and marital areas. In panic patients in remission, normalization was not achieved in overall functioning, work and marital areas. LIMITATIONS: Sample size was small in some groups and the evaluation was cross-sectional. CONCLUSIONS: The Portuguese version of SAS-SR is a useful instrument for detecting differences between psychiatric patients and normal subjects and for the evaluation of different clinical conditions, recommending its use in outcome studies.

Psychometric properties of the Portuguese version of the State-Trait Anxiety Inventory applied to college students: factor analysis and relation to the Beck Depression Inventory.

The psychometric properties of the Portuguese version of the trait form of the State-Trait Anxiety Inventory (STAI-T) and its relation to the Beck Depression Inventory (BDI) were evaluated in a large Brazilian college student sample containing 845 women and 235 men. STAI-T scores tended to be higher for women, singles, those who work, and subjects under 30 years. Factor analysis of the STAI-T for total sample and by gender yielded two factors: the first representing a mood dimension and the second being related to worrying or cognitive aspects of anxiety. In order to study the relation between anxiety and depression measures, factor analysis of the combination of the 21 BDI items and the 20 STAI-T items was also carried out. The analysis resulted in two factors that were analyzed according to the tripartite model of anxiety and depression. Most of the BDI items (measuring positive affectivity and nonspecific symptoms of depression) were loaded on the first factor and four STAI-T items that measure positive affectivity. The remaining STAI-T items, all of them measuring negative affect, remained in the second factor. Thus, factor 1 represents a depression dimension and factor 2 measures a mood-worrying dimension. The findings of this study suggest that, although widely used as an anxiety scale, the STAI-T in fact measures mainly a general negative affect.

Psychometric properties of the Portuguese version of the State-Trait Anxiety Inventory applied to college students: factor analysis and relation to the Beck Depression Inventory

The psychometric properties of the Portuguese version of the trait form of the State-Trait Anxiety Inventory (STAI-T) and its relation to the Beck Depression Inventory (BDI) were evaluated in a large Brazilian college student sample containing 845 women and 235 men. STAI-T scores tended to be higher for women, singles, those who work, and subjects under 30 years. Factor analysis of the STAI-T for total sample and by gender yielded two factors: the first representing a mood dimension and the second being related to worrying or cognitive aspects of anxiety. In order to study the relation between anxiety and depression measures, factor analysis of the combination of the 21 BDI items and the 20 STAI-T items was also carried out. The analysis resulted in two factors that were analyzed according to the tripartite model of anxiety and depression. Most of the BDI items (measuring positive affectivity and nonspecific symptoms of depression) were loaded on the first factor and four STAI-T items that measure positive affectivity. The remaining STAI-T items, all of them measuring negative affect, remained in the second factor. Thus, factor 1 represents a depression dimension and factor 2 measures a mood-worrying dimension. The findings of this study suggest that, although widely used as an anxiety scale, the STAI-T in fact measures mainly a general negative affect

Psychometric properties of the Portuguese version of the Beck Depression Inventory on Brazilian college students.

The psychometric properties of the Portuguese version of the Beck Depression Inventory were studied on a large Brazilian college student sample (N= 1,080; 845 women, 235 men). The BDI scores according to sociodemographic characteristics and mean individual item scores for total sample and by gender were compared. BDI scores tend to be higher for women, for those who work, and for the younger participants. The reliability of the inventory estimated by alpha coefficient was high for the total sample (.86) and subgroups. Factor analysis showed three factors for the total sample (low self-esteem, cognitive-affective, and somatic) and two for each gender. Women combined affective and low self-esteem whereas men combined somatic and low self-esteem in the same dimension. Discriminant analysis showed that BDI highly discriminates depressive symptomatology in college students and measures specific aspects of depression.

Variaçöes sazonais nas características do sêmen de garanhöes e sua relaçäo com a fertilidade do plantel / Seasonal variations in stallion sperm features and their relationship with fertility of the breeding stock

Foi estudada a influência da estaçäo do ano sobre a concentraçäo, a motilidade progressiva e a percentagem de anormalidades morfológicas em espermatozóides de garanhöes, tendo-se registrado também a fertilidade do plantel durante a estaçäo de monta inserida no período estudado. O sêmen de 7 garanhöes foi colhido mensalmente, durante 12 meses, para os exames microscópicos e as coberturas foram efetuadas por monta natural. A concentraçäo mais alta de espermatozóides foi observada no outono e no inverno e a mais baixa na primavera; dentre os meses, a maior concentraçäo foi registrada em julho e a menor em junho, mas as diferenças entre as estaçöes e entre os meses näo foram estatisticamente significantes. A maior taxa de motilidade progressiva foi registrada no veräo e a menor na primavera; dentre os meses, a taxa mais alta ocorreu em julho e a mais baixa em abril, tendo sido significativas as diferenças entre os meses (P<0,05 por cento) e entre as estaçöes (P<0,10). A maior proporçäo de espermatozóides anormais foi registrada no veräo (P<0,05); dentre os meses, a maior proporçäo ocorreu em janeiro e a menor em março, mas as diferenças näo foram estatisticamente significantes. Durante a estaçäo de monta, a fertilidade do plantel, medida pela percentagem de prenhez por ciclo, apresentou uma elevaçäo linear desde 29 por cento em outubro até 95 por cento em fevereiro, näo apresentando nenhuma relaçäo aparente com as características do sêmen estudadas

A manufacturing excellence team-based learning process for our foundation workers.

Foundation workers, people who do the daily tasks to serve customers, have long been ignored and misused in the productivity equation. Every person in a company can and must contribute to improved performance. Equipping out foundation workforce with knowledge and skills via a team-based education and training process is prerequisite to their effective engagement in the business management process.