Unsupervised physical activity interventions for people with COPD: A systematic review and meta-analysis.

INTRODUCTION AND OBJECTIVES: Unsupervised PA interventions might have a role in the management of chronic obstructive pulmonary disease (COPD) but their effectiveness is largely unknown. Thus, we aimed to identify and synthesise data on the effects of unsupervised PA interventions in people with COPD. MATERIAL AND METHODS: Databases were systematically searched in April 2020, with weekly updates until September 2021. Randomised controlled trials and quasi-experimental studies comparing unsupervised PA with usual care, were included. Primary outcomes were dyspnoea, exercise capacity and physical activity. The effect direction plot was performed to synthesise results. Meta-analysis with forest plots were conducted for the Chronic Respiratory Disease questionnaire - dyspnoea domain (CRQ-D), 6-minute walk distance (6MWD) and incremental shuttle walk distance (ISWD). RESULTS: Eleven studies with 900 participants with COPD (68±10 years; 58.8% male, FEV1 63.7±15.8% predicted) were included. All interventions were conducted at home, most with daily sessions, for 8-12 weeks. Walking was the most common component. The effect direction plot showed that unsupervised PA interventions improved emotional function, fatigue, health-related quality of life, muscle strength and symptoms of anxiety and depression. Meta-analysis showed statistical, but not clinical, significant improvements in dyspnoea (CRQ-D, MD=0.12, 95% CI 0.09-0.15) and exercise capacity, measured with 6MWD (MD=13.70, 95% CI 3.58-23.83). Statistical and clinical significant improvements were observed in exercise capacity, measured with ISWD (MD=58.59, 95% CI 5.79-111.39). None to minor adverse events and a high adherence rate were found. CONCLUSIONS: Unsupervised PA interventions benefits dyspnoea and exercise capacity of people with COPD, are safe and present a high adherence rate. Unsupervised PA interventions should be considered for people with COPD who cannot or do not want to engage in supervised PA interventions or as a maintenance strategy of PA levels.

Predictive equations of maximum respiratory mouth pressures: A systematic review.

BACKGROUND: Maximum inspiratory (Pimax) and expiratory (Pemax) mouth pressures are commonly used to detect respiratory muscle weakness resorting to predictive equations established for healthy people. There are several predictive equations, but they are widespread in the literature. This study aimed to review the existent predictive equations of maximum inspiratory (Pimax) and expiratory (Pemax) mouth pressures for adults. Additionally, we aimed to identify which ones were generated based on international standards. METHODS: A systematic review of predictive equations of Pimax and Pemax for healthy adults was conducted. A comprehensive search was performed of Cochrane Library, EBSCO, PubMed, Scopus and Web of Science to identify studies that presented at least one equation for Pimax or Pemax developed for healthy adults. The quality of studies was assessed by two reviewers with the Quality Assessment of Diagnostic Accuracy Studies (Quadas-2). RESULTS: Risk of bias was high in 8 of the 20 studies included. Forty-two Pimax and 34 Pemax equations were found, mostly using the variables age (n=39), weight (n=20) and height (n=8). These equations explained 3 to 96% of the Pimax/Pemax variance. They were developed with individuals from 11 countries (Portugal not included). Twelve Pimax and eight Pemax equations complied with international standards. CONCLUSIONS: This review gathered the predictive equations that have been developed for both Pimax and Pemax, however most were generated from unstandardized procedures. Future studies should explore the suitability of these equations for populations for which specific ones are not available, such as the Portuguese population, and develop new equations if necessary.

Enhancing the assessment of cardiorespiratory fitness using field tests.

OBJECTIVE: To establish normative values and reference equations of the 6-minute walk test (6MWT), incremental shuttle walk test (ISWT) and unsupported upper limb exercise test (UULEX) for Portuguese adults. DESIGN: Cross-sectional study. Descriptive statistics and differences between age decades and genders were explored using univariate general linear models to compute reference values. Reference equations were established with a forward stepwise multiple regression. SETTING: General community. PARTICIPANTS: In total, 645 adult volunteers without disabilities [43% male, mean age 55.1 (standard deviation 23.6) years] were recruited from the university campus and surrounding community. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Data on age, gender, height, weight, body mass index and smoking status were collected using a structured questionnaire. Physical activity was evaluated using the Brief Physical Activity Assessment Tool. Participants performed two repetitions of the 6MWT, ISWT and UULEX, and the best repetition was used for analysis. RESULTS: Overall, performance was better in males than in females, and decreased with age. Participants' performance was significantly reduced after the sixth decade of life compared with the other decades (P<0.001). Reference equations were: 6MWT=226.93-(5.00×age)+(360.41×height), R2=71%; ISWT=393.81-(17.98×age)+(185.64×gender)+(775.88×height), R2=83%; and UULEX=16.71-(0.14×age)+(2.66×gender), R2=57%. CONCLUSION: Leg or arm exercise field tests are affected significantly by age and gender. These results will aid health professionals to interpret the results of field tests obtained from healthy or diseased adult populations.

Práticas de socialização maternas e problemas externalizantes de pré-escolares: um estudo longitudinal / Maternal socialization practices and externalizing behaviors in preschoolers: a longitudinal study

Este estudo avaliou a estabilidade e as mudanças nas práticas de socialização maternas, nos problemas externalizantes e o impacto das práticas, aos 18 e 36 sobre os problemas externalizantes aos 36 e 48 meses da criança. Participaram do estudo 22 mães que responderam a uma entrevista sobre práticas e ao CBCL. Verificou-se um aumento de práticas coercitivas dos 18 para os 36 meses e uma redução nos problemas externalizantes dos 36 para os 48 meses. As punições verbais e físicas estiveram positivamente correlacionadas aos problemas externalizantes, enquanto explicações e negociações estiveram negativamente correlacionadas a essas queixas. Discute-se a influência do desenvolvimento da linguagem da criança sobre as práticas de socialização maternas, e a influência dessas práticas sobre os problemas externalizantes (AU)

Práticas de socialização maternas e problemas externalizantes de pré-escolares: um estudo longitudinal / Maternal socialization practices and externalizing behaviors in preschoolers: a longitudinal study

Este estudo avaliou a estabilidade e as mudanças nas práticas de socialização maternas, nos problemas externalizantes e o impacto das práticas, aos 18 e 36 sobre os problemas externalizantes aos 36 e 48 meses da criança. Participaram do estudo 22 mães que responderam a uma entrevista sobre práticas e ao CBCL. Verificou-se um aumento de práticas coercitivas dos 18 para os 36 meses e uma redução nos problemas externalizantes dos 36 para os 48 meses. As punições verbais e físicas estiveram positivamente correlacionadas aos problemas externalizantes, enquanto explicações e negociações estiveram negativamente correlacionadas a essas queixas. Discute-se a influência do desenvolvimento da linguagem da criança sobre as práticas de socialização maternas, e a influência dessas práticas sobre os problemas externalizantes

This study evaluated stability and changes in maternal socialization practices, in externalizing behaviors and the impact of maternal practices at 18 and 36 on externalizing behaviors at 36 and 48 months of child. Participants in the study were 22 mothers who answered an interview about practices and the CBCL. It was founded an increase of coercive practices from 18 to 36 months and a reduction in total externalizing behaviors from 36 to 48 months. Verbal and physical punishments were positively correlated with externalizing behaviors, while explanations and negotiations were negatively correlated to those complaints. The influence of language development in children on the maternal socialization practices, and the influence of these practices on externalizing problems are discussed

Prediction of the energy values of feedstuffs for broilers using meta-analysis and neural networks.

Several researchers have developed prediction equations to estimate the metabolisable energy (ME) of energetic and protein concentrate feedstuffs used in diets for broilers. The ME is estimated by considering CP, ether extract, ash and fibre contents. However, the results obtained using traditional regression analysis methods have been inconsistent and new techniques can be used to obtain better estimate of the feedstuffs' energy value. The objective of this paper was to implement a multilayer perceptron network to estimate the nitrogen-corrected metabolisable energy (AMEn) values of the energetic and protein concentrate feeds, generally used by the poultry feed industry. The concentrate feeds were from plant origin. The dataset contains 568 experimental results, all from Brazil. This dataset was separated into two parts: one part with 454 data, which was used to train, and the other one with 114 data, which was used to evaluate the accuracy of each implemented network. The accuracy of the models was evaluated on the basis of their values of mean squared error, R 2, mean absolute deviation, mean absolute percentage error and bias. The 7-5-3-1 model presented the highest accuracy of prediction. It was developed an Excel® AMEn calculator by using the best model, which provides a rapid and efficient way to predict the AMEn values of concentrate feedstuffs for broilers.

Reassessing the construct validity of a Brazilian version of the instrument Caregiver Abuse Screen (CASE) used to identify risk of domestic violence against the elderly.

BACKGROUND: Domestic violence against the elderly (DVAE) is an increasingly recognised problem and its appropriate detection is imperative. As part of an ongoing cross-cultural adaptation process, this study evaluates the construct validity of a Brazilian Portuguese version of the instrument Caregiver Abuse Screen (CASE). METHODS: A cross-sectional study comprising 507 pairs of caregivers/elderly patients was carried out in three geriatric outpatient units. A multidimensional questionnaire was completed for each pair of interviewees covering DVAE, sociodemographic characteristics and several theory-related variables (alcohol misuse, burden, depression, social support, cognitive status, instrumental activities of daily living, general health status and living arrangements). Sequential confirmatory and exploratory factor analyses (CFA/EFA) were implemented to assess construct validity through an in-depth exploration of the instrument's dimensional structure. Construct validity was also assessed through relationships with other variables. RESULTS: The initial CFA did not support the postulated two-factor solution. A one-dimensional solution suggested by an EFA was followed by a CFA, which showed adequate fit (WRMR = 0.985, RMSEA = 0.056, CFI = 0.967 and TLI = 0.969), internal consistency (rho(cr) = 0.85) and temporal stability (kappa(w) = 0.77). Yet, convergent validity was not achieved (average variance extracted <0.50; rho(ve) = 0.45). Using Kendall's Tau-b correlations, the CASE was positively associated with two other instruments assessing DVAE (H/S-EAST: tau(b) = 0.13; and CTS-1 subscales: tau(b) = 0.15-0.37); caregiver burden (Zarit BI: tau(b) = 0.40); and depression (GDS: tau(b) = 0.32). CONCLUSION: In spite of some remaining dimensionality issues needing refinement and the relatively restricted correlations with expected variables, the CASE may be reaffirmed as a promising detection tool for risk of abuse in clinical practice and applied research.