Challenges for palliative care in times of COVID-19: a scoping review.

Introduction: Many of the essential practices in palliative care (PC) had to be adapted to the COVID-19 pandemic. This global spread of the infectious respiratory disease, caused by SARS-CoV-2, created unprecedented obstacles. The aim of this research was to comprehensively assess the experiences and perceptions of healthcare professionals, individuals, and families in palliative and end-of-life situations during the COVID-19 pandemic. Methods: A scoping review was conducted using the databases CINAHL Complete, MEDLINE, Scopus, SciELO, Cochrane Central Register of Controlled Trials, Psychology and Behavioral Sciences, MEDIClatina, and Portugal's Open Access Scientific Repository. The review followed the JBI® methodological approach for scoping reviews. Results: Out of the initially identified 999 articles, 22 studies were included for analysis. The deprivation of relationships due to the safety protocols required to control the spread of COVID-19 was a universally perceived experience by healthcare professionals, individuals in PC, and their families. Social isolation, with significant psychological impact, including depersonalization and despair, was among the most frequently reported experiences by individuals in palliative situation. Despite healthcare professionals' efforts to mitigate the lack of relationships, the families of these individuals emphasized the irreplaceability of in-person bedside contact. Systematic review registration: https://osf.io/xmpf2/.

Physical Exercise Program on Fall Prevention Using Technological Interface: Pretest Study.

BACKGROUND: Prevention of falls among older adults has boosted the development of technological solutions, requiring testing in clinical contexts and robust studies that need prior validation of procedures and data collection tools. OBJECTIVE: The objectives of our study were to test the data collection procedure, train the team, and test the usability of the FallSensing Games app by older adults in a community setting. METHODS: This study was conducted as a pretest of a future pilot study. Older adults were recruited in a day care center, and several tests were applied. Physical exercise sessions were held using the interactive FallSensing Games app. Nurse training strategies was completed. RESULTS: A total of 11 older adults participated. The mean age was 75.08 (SD 3.80) years, mostly female (10/11, 91%) and with low (3-6 years) schooling (10/11, 91%). Clinically, the results show a group of older adults with comorbidities. Cognitive evaluation of the participants through the Mini Mental State Examination showed results with an average score of 25.64 (SD 3.5). Functional capacity assessed using the Lawton Instrumental Activities of Daily Living Scale (overall score from 0-23, with lower scores reflecting worse capacity to perform activities) showed impairment in different instrumental activities of daily living (average score 14.27). The data collection tool proved to enable easy interpretation; however, its structure needed small adjustments to facilitate the data collection process. Despite the length of the questionnaire, its implementation took an average of 21 minutes. For the assessment of the prevalence of fear of falling, the need to add a question was identified. The performance of functional tests under the guidance and presence of rehabilitation nurses ensured the safety of the participants. The interactive games were well accepted by the participants, and the physical exercises allowed data collection on the functionality of the older adults, such as the number of repetitions in the tests, range of movement (angle), duration of the movements, and execution of each cycle. Concerning the training of the nurses, it was crucial that they had experience with the platform, specifically the position of the chair facing the platform, the position of the feet, the posture of participants, and the use of sensors. CONCLUSIONS: In the future pilot study, the researchers point out the need to design a study with mixed methods (quantitative and qualitative), thus enriching the study results.

A Technological-Based Platform for Risk Assessment, Detection, and Prevention of Falls Among Home-Dwelling Older Adults: Protocol for a Quasi-Experimental Study.

BACKGROUND: According to the United Nations, it is estimated that by 2050, the number of people aged 80 years and older will have increased by 3 times. Increased longevity is often accompanied by structural and functional changes that occur throughout an individual's lifespan. These changes are often aggravated by chronic comorbidities, adopted behaviors or lifestyles, and environmental exposure, among other factors. Some of the related outcomes are loss of muscle strength, decreased balance control, and mobility impairments, which are strongly associated with the occurrence of falls in the elderly. Despite the continued undervaluation of the importance of knowledge on fall prevention among the elderly population by primary care health professionals, several evidence-based (single or multifaceted) fall prevention programs such as the Otago Exercise Program (OEP) have demonstrated a significant reduction in the risk of falls and fall-related injuries in the elderly within community settings. Recent studies have strived to integrate technology into physical exercise programs, which is effective for adherence and overcoming barriers to exercise, as well as improving physical functioning. OBJECTIVE: This study aims to assess the impact of the OEP on the functionality of home-dwelling elderly using a common technological platform. Particularly, the impact on muscle strength, balance, mobility, risk of falling, the perception of fear of falling, and the perception of the elderly regarding the ease of use of technology are being examined in this study. METHODS: A quasi-experimental study (before and after; single group) will be conducted with male and female participants aged 65 years or older living at home in the district of Porto. Participants will be recruited through the network COLABORAR, with a minimum of 30 participants meeting the study inclusion and exclusion criteria. All participants will sign informed consent forms. The data collection instrument consists of sociodemographic and clinical variables (self-reported), functional evaluation variables, and environmental risk variables. The data collection tool integrates primary and secondary outcome variables. The primary outcome is gait (timed-up and go test; normal step). The secondary outcome variables are lower limb strength and muscle resistance (30-second chair stand test), balance (4-stage balance test), frequency of falls, functional capacity (Lawton and Brody - Portuguese version), fear of falling (Falls Efficacy Scale International - Portuguese version), usability of the technology (System Usability Scale - Portuguese version), and environmental risk variables (home fall prevention checklist for older adults). Technological solutions, such as the FallSensing Home application and Kallisto wearable device, will be used, which will allow the detection and prevention of falls. The intervention is characterized by conducting the OEP through a common technological platform 3 times a week for 8 weeks. Throughout these weeks, the participants will be followed up in person or by telephone contact by the rehabilitation nurse. Considering the COVID-19 outbreak, all guidelines from the National Health Service will be followed. The project was funded by InnoStars, in collaboration with the Local EIT Health Regional Innovation Scheme Hub of the University of Porto. RESULTS: This study was approved on October 9, 2020 by the Ethics Committee of Escola Superior de Enfermagem do Porto (ESEP). The recruitment process was meant to start in October, but due to the COVID-19 pandemic, it was suspended. We expect to restart the study by the beginning of the third quarter of 2021. CONCLUSIONS: The findings of this study protocol will contribute to the design and development of future robust studies for technological tests in a clinical context. TRIAL REGISTRATION: ISRCTN 15895163; https://www.isrctn.com/ISRCTN15895163. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/25781.

Double-lumen Aortic Arch: Persistence of the Fifth Aortic Arch?

Abstract Double-lumen aortic arch is a rare congenital anomaly related to persistence of the fifth aortic arch. It may be found alone or in association with other anatomical changes of the heart. We report a case of double-lumen aortic arch associated with coarctation of the aorta and patent ductus arteriosus in a child with a congenital malformation known as the VACTERL association (vertebral defects, imperforate anus, cardiopathy, tracheoesophageal fistula, renal abnormalities and limb anomalies).

Intervenções eficazes na prevenção ou redução da sobrecarga do familiar cuidador: revisão sistemática da literatura / Effective interventions for the prevention and reduction of the family caregiver burden: a systematic literature review

The family caregiver role is highly demanding and very likely to trigger burden. A systematic literature review was conducted in order to identify effective interventions for the prevention/reduction of the family caregiver burden. A search was conducted in SCOPUS, Web of Science and EBSCO databases from 2006 to 2016. Ten studies were selected involving different interventions (educational, psychoeducational, psycho-social and psycho-socio-educational). Despite the positive results of the different types of approach, the educational and multicomponent programmes revealed the most favorable outcomes. Considering the methodological heterogeneity observed, multicenter, longitudinal, prospective, controlled and mixed methodology studies should be carried out, leading to high-quality evidence-based results

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Impacte de um programa de exercício físico na capacidade funcional de idosos institucionalizados / Impact of a physical exercise program on the functional capacity of the institutionalized elderly

Introduction: Preventive, promotion and rehabilitation actions such as physical exercise have been able to improve the functional capacity of the institutionalized elderly. Aims: To evaluate the impact of a physical exercise program on the functional capacity of institutionalized elderly. Method: Quantitative study with a quasi-experimental design, without control group, with pre and post intervention evaluation, in a convenience sample of 23 elderly. The instrument for data collection was the form with outcome and independent variables. The study was approved by the Ethics Committee of the Escola Superior de Enfermagem do Porto. Results: The majority are female (60.9%), with a mean age of 82.4 years and a high prevalence of cerebrovascular disease (91.3%). ¾ of the sample (74%) is polymedicated. The occurrence of falls in the last 12 months was low (13%). There was a significant improvement in joint amplitude and muscular strength in all movements and joints of the upper and lower limbs. Palmar grip strength improved in both hands. A better performance was observed in the implementation of POMA I, and the number of risk-free elderly people with a high risk of falls increased. The repercussion of improvements in self-care capacity was not effective in some domains, although the mean scores obtained showed a slight improvement trend. Of the psychosocial effects, most participants (60.9%) agreed that they improved health and mood. Conclusions: The physical exercise program implemented to institutionalized elderly, without cognitive deficit, improved the functional and psychosocial capacity

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Conhecimento dos enfermeiros antes e após um programa educativo, sobre prevenção de quedas na população idosa em contexto comunitário / Knowledge of nurses before and after an educational program on prevention of falls in elderly population in a community context

Introduction: In good organizational practice, health professionals should be provided with training programs for fall prevention. Aims: To evaluate the impact of an educational program for nurses on the prevention of falls in the elderly population in a community context. Method: This study supports the intervention phase of an Action-Research investigation. Was implemented a training program, with two steps: sensitization (S) and formation (F) held in a group of North Health Centers of Portugal. In the S step, 154 professionals from different areas participated. In the F step, 67 nurses participated. The S step occurred between February and March of 2017. The satisfaction of the training was assesseded. The F step enrolled five sessions, performed between May and June 2017. The target group of this stage were only nurses. In addition to the assessment of training satisfaction, a questionnaire was useded (pre-test). We used descriptive analysis and comparison of means using the IBM SPSS 25.0 software. The Ethics Committee for North Health centers (nº 97/2014) approved the study. Results: In the S step, were represented all the professional areas, but the physi-cians (43.8%) were more representative. In F step, the sample of nurses is mostly female (80.6%), with an age between 32-60 years. The professional activity years of nurses vary between 8 and 36 years. In the overall assessment of training satisfaction, it was verified that the training dimension (mean 3.71 and mean 3.67), respectively in sessions 3 and 5, was the most valued. Conclusion: The program revealed improvement in nurses' knowledge

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Factores de riesgo de caída en la comunidad:basado en auto-reporte de personas mayores / Risk factors for falls in the community: based on self-report of elderly persons

Introduction: Several studies have shown independent risk factors for falling among community older people. However, there is few researches showing the importance of older person's perception of their own fall risk. Aims: The study purpose was to identify independent risk factors for falls and to explore predictive factors related to the occurrence of falls in community-dwelling older people. Method: A cross-sectional study was conducted from January to April 2015. All data were based on self-report of older persons. An study-specific questionnaire was used. Univariate and logistic regression analyses were used. Results: The sample comprised 562 men and 760 women. Among the participants, 24.5% reported having had falls in the previous six months, scoring a total of 467 falling events. Of the individuals who had fallen, 36.8% had experienced recurrent falls. The risk of fall was nearly twice as high in women than in men (OR=1.85; 95% CI: 1.40-2.43). Being 75 years old or older was associated with an increased risk of falling compared with being 65-74 years old (OR=2.38; 95% CI:1.82-3.11). The elderly who had fallen reported injuries (48.3%) associated with falls, and 36% required heal-th care. Conclusion: Six independent risk factors for falling into the community dwelling older people were identified, some of which are potentially modifiable

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Acetaminophen in low doses for closure of the ductus arteriosus of the premature.

OBJECTIVE: The objective of the study is to report the experience with acetaminophen in low doses as an alternative to the treatment of the ductus arteriosus of the preterm newborn. MATERIALS AND METHODS: Retrospective study including preterm newborns with patent ductus arteriosus who received oral acetaminophen because treatment with indomethacin had failed or is contraindicated. A dosage consisted of a first dose of 25 mg/kg and maintenance doses of 30 mg/kg/day, for 3 to 7 days. A second cycle was administered in cases of reopening of the ductus arteriosus. The rates of ductal closure and surgery were calculated. Patients were categorized into responder and nonresponder groups for acetaminophen, and the average values of ductal diameter, weight, gestational age, and postnatal age were compared. RESULTS: Eighty-seven preterm newborns, with a postnatal age from 3 to 27 days, with average values of ductus arteriosus equal to 2.5 ± 0.8 mm/kg, gestational age 27.2 ± 1.9 weeks, and birth weight 888.9 ± 241 g, received acetaminophen for 3 to 7 days. A second cycle was administered in 15 preterm newborns. The ductus closure rate, after one or two cycles, was 74.7%, and the recommendations for surgical closure were progressively reduced from 50% in the 1st year to 6.2% in the past year. Lower ductal closure rate occurred in the group of newborns with the lowest average weight (P = 0.018), the highest average ductal diameter (P = 0.002), and the lowest average gestational age (P = 0.09). Postnatal age at the start of acetaminophen use was shown to be irrelevant regarding the treatment (P = 0.591). CONCLUSIONS: Acetaminophen in low doses showed to be an effective alternative for the closure of the ductus arteriosus for preterm newborns in whom treatment with indomethacin or ibuprofen failed or was contraindicated.

El cuidado de familiares adultos. Cómo afecta a la salud y al bienestar del cuidador familiar? / Caring for adult relatives: what impact on health and well-being of the family caregiver

Introducción. El cuidado de un miembro de la familia con dependencia para los cuidados personales es un proceso complejo que afecta a la salud y al bien-estar del cuidador familiar. Objetivos. El objetivo de este estudio es identificar este impacto. Método. Se llevó a cabo una revisión integradora, respaldada por el Repositório Científico de Acesso Aberto de Portugal entre los años 2000 y 2012, en la que se tuvieron en cuenta todos los documentos completos accesibles. Se utilizó el método PI(CO)D. Para el análisis de los datos se solicitó la intervención de dos revisores independientes. Se utilizaron los indicadores del Joanna Briggs Institute para analizar la calidad metodológica de los estudios. Resultados. Se seleccionaron doce estudios principales. La mayoría de ellos se basaban en investigación observacional de tipo transversal/descriptivo, lo cual permite dibujar el perfil de los cuida-dores familiares e identificar sus necesidades y los factores relacionados con la carga. Los resultados muestran una mayor carga/estrés en los cuidadores familiares de personas con demencia y con un nivel elevado de dependencia. La mayor carga está relacionada con una mala percepción del estado de salud, de la satisfacción y de la calidad de vida del cuidador familiar. Los niveles de carga asociada, depresión emocional y estrés son más elevados en las mujeres que en los hombres. conclusiones. La naturaleza de los estudios utilizados permite identificar el impacto que supone el cuidado de un familiar con dependencia para los cui-dadores familiares. No obstante, es imposible analizar los resultados de mane-ra dinámica a lo largo de un periodo de tiempo. Es importante centrarse en la investigación basándose en los mejores datos clínicos disponibles para poten-ciar la toma de decisiones en la práctica clínica

IntroductIon. Caring for a family member dependent in self-care is a complex process with impact on health and well-being of the family caregiver. ObjectIve. This study aimed to identify this impact. Method. An integrative review was con-ducted supported on the Repositório Científico de Acesso Aberto de Portugal [Open Access Scientific Repository of Portugal], within the time period from 2000 to 2012 and considering all full text accessible documents. The PI(CO)D method was used. Two independent reviewers were invited to analyse data. The grids suggested by the Joanna Briggs Institute were used to analyse the methodological quality of the studies. Results. Twelve primary studies were selected. The majority of the studies were based on observational research of transversal/descriptive nature, enabling to trace the family caregivers' profile, to identify their needs and factors associated to bur-den. The results show increased burden/stress in family caregivers of persons with dementia and high dependency levels. Increased burden is associated with poor perception of the health status, satisfaction and quality of life of the family caregiver. Women show higher levels of associated burden, emotional depression and stress than men. Conclusions. The nature of the identified studies enables to identify the impact that caring for a dependent relative has on family caregivers. Notwithstanding, it is not possible to analyse the findings in a dynamic way throughout a period of time. It is important to focus on research based on the best clinical evidence available to enhance decision making in clinical practice

Neutrophil-to-lymphocyte ratio used as prognostic factor marker for dilated cardiomyopathy in childhood and adolescence.

OBJECTIVE: The objective of this study is to evaluate the neutrophil-to-lymphocyte ratio (NLR) and platelet-lymphocyte ratio, from the hemograms obtained from children and adolescents with dilated cardiomyopathy (DCM), and to correlate them with the levels of B-type natriuretic peptide (BNP) and with the clinical evolution of these patients in the long term. MATERIALS AND METHODS: Follow-up of 57 patients with DCM was made retrospectively, with hemogram and BNP level determination being performed after optimized therapy for heart failure. We compared the findings of the patients' examinations that progressed with stability in relation to the occurrence of transplant listing, cardiac transplantation, or evolution to death. RESULTS: The average age was 48 months, and the follow-up was 64 months. The average of the levels of neutrophils was greater in poor evolution group (7026 vs. 3903; P = 0.011) as well as the average of NLR (5.5 vs. 1.9; P = 0.034). The averages of hemoglobin, total leukocytes, lymphocytes, and platelets were similar in the groups. The area under the receiver operating characteristic curve for NLR in relation to the poor evolution was of 72.9%, being the best cutoff point of NLR ≥5.2 (sensitivity: 93.8% and specificity: 87.8%). Kaplan-Meier curves demonstrate that patients with NLR ≤5.2 (P = 0.001) and BNP <1000 pg/dl (P < 0.0001) presented greater survival. CONCLUSIONS: NLR (≥5.2) and lymphopenia (≤1000 lymphocyte/µL) were associated with a poor prognosis and a higher chance of evolution to death or cardiac transplant, similar to the findings for BNP.

Prognóstico da Cardiomiopatia dilatada com insuficiência cardíaca grave de acordo com escalas de classificação funcional na infância / Prognosis of dilated cardiomyopathy with severe heart failure according to functional classification scales in childhood

Fundamento: A insuficiência cardíaca é principal manifestação da cardiomiopatia dilatada na infância, e a avaliação sistematizada dos sinais e sintomas permite acompanhar o resultado do tratamento. Objetivo: Avaliar o uso de três escalas de classificação funcional da insuficiência cardíaca na evolução de crianças e adolescentes com cardiomiopatia dilatada. Métodos: Estudo longitudinal e observacional incluindo pacientes de zero a 18 anos com cardiomiopatia dilatada e insuficiência cardíaca inicial grave. Todos foram acompanhados por meio das escalas New York Heart Association (NYHA), The New York University Pediatric Heart Failure Index (The NYU PHFI) e Ross versão 2012. As análises estatísticas foram feitas com uso do Statistical Package for Social Science , versão 14.0, com teste de Mann-Whitney, teste qui quadrado ou de Fisher, aplicação da Curva Característica de Operação, teste de Wilcoxon e coeficiente de Kappa, para comparação das escalas, e curva Kaplan-Meier, para avaliação da sobrevida. O nível de significância adotado foi de 5%. Resultados: Foram incluídos 57 pacientes, com idade de 1 a 200 meses (média de 48,7 ± 55,9) e seguimento de 6 a 209 meses (média de 63,6 ± 48,4). Houve substancial concordância das escalas Ross 2012 e The NYU PHFI com a NYHA (Kappa = 0,71 e 0,82, respectivamente). A análise pareada pelo teste de Wilcoxon, comparando as escalas antes e após o tratamento, foi significativa (p < 0,0001). A sobrevida maior foi encontrada nos pacientes com classes I/II pela NYHA ou pontuação menor que 11 pontos nas outras. Conclusão: O uso das escalas de avaliação funcional da insuficiência cardíaca se mostrou útil no seguimento e na avaliação da resposta terapêutica. Pacientes que permaneceram em classes funcionais III ou IV de NYHA, ou com pontuação igual ou maior que 11 na Ross 2012 ou na The NYU PHFI tiveram pior prognóstico

DOI: 10.5935/2359-4802.20170085 12 International Journal of Cardiovascular Sciences. 2018;31(1)12-21 ARTIGO ORIGINAL Correspondência: Fátima Derlene da Rocha Araújo Rua Indiana, 789, Ap 301. CEP: 30460350, Jardim América, Belo Horizonte, MG ­ Brasil. E-mail: fatima.derlene@hotmail.com, cleverpsi@hotmail.com Prognóstico da Cardiomiopatia Dilatada com Insuficiência Cardíaca Grave de Acordo com Escalas de Classificação Funcional na Infância Prognosis of Dilated Cardiomyopathy with Severe Heart Failure according to Functional Classification Scales in Childhood Fátima Derlene da Rocha Araújo, Rose Mary Ferreira Lisboa da Silva, Henrique de Assis Fonseca Tonelli, Adriana Furletti M Guimarães, Sandra Regina Tolentino Castilho, Zilda Maria Alves Meira Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG ­ Brasil Artigo recebido em 14/02/2017; revisado em 17/04/2017; aceito em 05/06/2017 Resumo Fundamento: A insuficiência cardíaca é principal manifestação da cardiomiopatia dilatada na infância, e a avaliação sistematizada dos sinais e sintomas permite acompanhar o resultado do tratamento. Objetivo: Avaliar o uso de três escalas de classificação funcional da insuficiência cardíaca na evolução de crianças e adolescentes com cardiomiopatia dilatada. Métodos: Estudo longitudinal e observacional incluindo pacientes de zero a 18 anos com cardiomiopatia dilatada e insuficiência cardíaca inicial grave. Todos foram acompanhados por meio das escalas New York Heart Association (NYHA), The New York University Pediatric Heart Failure Index (The NYU PHFI) e Ross versão 2012. As análises estatísticas foram feitas com uso do Statistical Package for Social Science , versão 14.0, com teste de Mann-Whitney, teste qui quadrado ou de Fisher, aplicação da Curva Característica de Operação, teste de Wilcoxon e coeficiente de Kappa, para comparação das escalas, e curva Kaplan-Meier, para avaliação da sobrevida. O nível de significância adotado foi de 5%. Resultados: Foram incluídos 57 pacientes, com idade de 1 a 200 meses (média de 48,7 ± 55,9) e seguimento de 6 a 209 meses (média de 63,6 ± 48,4). Houve substancial concordância das escalas Ross 2012 e The NYU PHFI com a NYHA (Kappa = 0,71 e 0,82, respectivamente). A análise pareada pelo teste de Wilcoxon, comparando as escalas antes e após o tratamento, foi significativa (p < 0,0001). A sobrevida maior foi encontrada nos pacientes com classes I/II pela NYHA ou pontuação menor que 11 pontos nas outras. Conclusão: O uso das escalas de avaliação funcional da insuficiência cardíaca se mostrou útil no seguimento e na avaliação da resposta terapêutica. Pacientes que permaneceram em classes funcionais III ou IV de NYHA, ou com pontuação igual ou maior que 11 na Ross 2012 ou na The NYU PHFI tiveram pior prognóstico. (Int J Cardiovasc Sci. 2018;31(1)12-21) Palavras-chave: Cardiomiopatia Dilatada, Prognóstico, Insuficiência Cardíaca, Escalas, Criança, Adolescentes. Abstract Background: Heart failure is the main manifestation of dilated cardiomyopathy in childhood, and the systematic evaluation of signs and symptoms allows monitoring the treatment outcome. Objective: To evaluate the use of three functional classification scales of heart failure in children and adolescents with dilated cardiomyopathy. Methods: Longitudinal and observational study including patients from zero to 18 years with dilated cardiomyopathy and severe initial heart failure. All of them were followed up using the New York Heart Association (NYHA), The New York University Pediatric Heart Failure Index (The NYU PHFI) and Ross version 2012 scales. Statistical analyzes were done using Statistical Package for Social Science, version 14.0, with Mann-Whitney test, Chi-Square test or Fisher's test, application of the Operating Characteristic Curve, Wilcoxon test and Kappa coefficient for comparison of scales and Kaplan-Meier curve for survival evaluation. The level of significance adopted was 5%. Results: A total of 57 patients, aged from 1 to 200 months (mean of 48.7 ± 55.9) and follow-up of 6 to 209 months (mean of 63.6 ± 48.4) were included. There was substantial agreement between the Ross 2012 scales, The NYU PHFI and NYHA (Kappa = 0.71 and 0.82, respectively). Paired analysis by the Wilcoxon test, comparing the scales before and after treatment, was significant (p < 0.0001). The greatest survival was found in patients with class I/II by NYHA or scores lower than 11 points in the others. Conclusion: The use of functional assessment scales of heart failure proved to be useful in the follow-up and evaluation of the therapeutic response and there was no difference between them. Patients who remained in functional classification III or IV NYHA or scores ≥ 11 in Ross 2012 or The NYU PHFI had worse prognosis

Evolução Doppler Ecocardiográfica das Lesões Valvares Mitral e Aórtica em Crianças e Adolescentes com Cardite Reumática Subclínica e Leve / Doppler Echocardiographic Follow-Up of Mitral and Aortic Regurgitation in Children and Adolescents with Subclinical and Mild Rheumatic Carditis

Fundamento: As cardites reumáticas leve e subclínica se diferenciam basicamente pela ausculta de sopro regurgitativo mitral. A evolução destas formas não está bem estabelecida na literatura. Objetivo: Avaliar a evolução das cardites reumáticas leve e subclínica, considerando as valvites mitral e/ou aórtica (fase aguda) e a regressão, manutenção ou piora delas ao final do seguimento (fase crônica). Métodos: Estudo retrospectivo, longitudinal, incluindo pacientes com cardites reumáticas leve e subclínica. A evolução ecocardiográfica das valvites mitral e/ou aórtica foi comparada nos dois grupos, considerando a análise ao final do seguimento. Foram utilizados o teste qui quadrado e as curvas de sobrevida de Kaplan-Meier, com nível de significância p < 0,05. Resultados: Foram incluídos 125 pacientes, sendo 69 (55,2%) com cardite reumática subclínica e 56 (44,8%) com cardite reumática leve, com média de idade na fase aguda de 10,4 ± 2,6 anos e, ao final do estudo, de 19,9 ± 4,6 anos. O tempo de seguimento variou de 2 a 23 anos (média: 9,38 ± 4,3 anos). Na fase aguda, a regurgitação mitral leve/ moderada ou moderada foi mais frequente nos pacientes com cardite reumática leve (p = 0,001). A regurgitação aórtica leve ou leve/moderada também foi mais comum no grupo de cardite reumática leve (p = 0,045). Na fase crônica, observou-se que tanto a regurgitação mitral (p < 0,0001) quanto a regurgitação aórtica (p = 0,009) foram mais frequentes nos pacientes com cardite reumática leve, e a sobrevida livre de valvopatia residual foi maior no grupo de cardite reumática subclínica (p = 0,010). A regurgitação mitral residual foi maior no grupo de cardite reumática leve p < 0,0001), e a regurgitação aórtica residual foi semelhante nos dois grupos (p = 0,099). Conclusão: A resolução da regurgitação mitral foi maior nos pacientes com cardite reumática subclínica, e a involução da regurgitação aórtica foi menos frequente e semelhante nos dois grupos

Background: Mild rheumatic carditis (MRC) and subclinical rheumatic carditis (SRC) are basically differentiated through auscultation of mitral regurgitation murmur. The evolution of these forms is not well established in the literature. Objective: To evaluate the evolution of mild and subclinical rheumatic carditis, considering mitral and aortic regurgitation (acute phase) and regression, maintenance or worsening of these diseases at the end of follow-up (chronic phase). Methods: Retrospective, longitudinal study, including patients with mild and subclinical rheumatic carditis. The echocardiographic evolution of mitral and aortic regurgitation was compared in both groups, considering the analysis at the end of follow-up. The Chi-square test and Kaplan-Meier survival curves were used, with significance level established at p < 0.05. Results: A total of 125 patients were included, 69 (55.2%) with subclinical rheumatic carditis and 56 (44.8%) with mild rheumatic carditis, with a mean age in the acute phase of 10.4 ± 2.6 years and, at the end of study, 19.9 ± 4.6 years. The time of follow-up ranged from 2 to 23 years (mean: 9.38 ± 4.3 years). In the acute phase, mild/moderate or moderate mitral regurgitation was more frequent in patients with mild rheumatic carditis (p = 0.001). Mild or mild/moderate aortic regurgitation was also more common in the mild rheumatic carditis group (p = 0.045). In the chronic phase, we observed that both mitral (p < 0.0001) and aortic regurgitation (p = 0.009) were more frequent in patients with mild rheumatic carditis, and survival free of rheumatic heart disease was higher in the subclinical rheumatic carditis group (p = 0.010). Residual mitral regurgitation was higher in the mild rheumatic carditis group p < 0.0001), and residual aortic regurgitation was similar in both groups (p = 0.099). Conclusion: Mitral regurgitation resolution was higher in patients with subclinical rheumatic carditis, and the involution of aortic regurgitation was less frequent and similar in both groups

Nível de conhecimento e desidratação de jogadores juniores de futebol / Level of knowledge and dehydration of junior soccer players / Nivel de conocimiento y deshidratación en jugadores juveniles de fútbol

RESUMO Introdução: A desidratação é uma condição fisiológica que decorre de perda hídrica prolongada, com consequente elevação da temperatura corporal e redução do desempenho dos atletas. Objetivo: Avaliar o nível de conhecimento e o grau de hidratação de jogadores juniores de futebol. Métodos: Trata-se de um estudo transversal, envolvendo 14 jogadores de futebol, que foram avaliados quanto ao percentual de perda de peso após exercício (desidratação relativa), pH e densidade da urina e nível de conhecimento sobre hidratação. A análise estatística foi realizada por meio do software SPSS versão 18.0, utilizando um intervalo de confiança de 95%, com nível de significância com p < 0,05. Resultados: Pôde-se verificar que 92,85% dos jogadores apresentaram eutrofia e os valores médios de desidratação relativa, densidade urinária e pH foram de -0,89%, 1.034,43, e 5,64, respectivamente, com o que se revelou desidratação para as posições com maior desgaste físico e 48,9% dos jogadores apresentam conhecimento regular sobre hidratação. Conclusão: A desidratação encontrada em jogadores juniores pode ser influenciada por diferentes posições em campo e esquema tático do jogo.

ABSTRACT Introduction: Dehydration is a physiological condition that results from prolonged water loss, with consequent elevation of body temperature and reduced athletes' performance. Objective: To evaluate the level of knowledge and the degree of hydration of junior soccer players. Methods: This is a cross-sectional study involving 14 soccer players who were evaluated for weight loss after exercise (relative dehydration), pH and density of urine and the level of knowledge about hydration. Statistical analysis was performed using SPSS software version 18.0, using a 95% confidence interval, with significance level of p<0.05. Results: It was possible to verify that 92.85% of the players were eutrophic and the mean values of relative dehydration, urinary density and pH were of -0.89%, 1,034.43, and 5.64, respectively, revealing dehydration for positions with greater physical wear and 48.9% of the players had a regular knowledge about hydration. Conclusion: The dehydration found in junior players can be influenced by different positions in the field and tactical scheme of the game.

RESUMEN Introducción: La deshidratación es una condición fisiológica que resulta de la pérdida prolongada de agua, con la consiguiente elevación de la temperatura corporal y la reducción de rendimiento de los atletas. Objetivo: Evaluar el nivel de conocimiento y el grado de hidratación de jugadores de fútbol juvenil. Métodos: Se trata de un estudio transversal que incluyó a 14 jugadores de fútbol, que fueron evaluados para el porcentaje de pérdida de peso después del ejercicio (deshidratación relativa), el pH y la densidad de la orina y el nivel de conocimiento sobre la hidratación. El análisis estadístico se realizó mediante el software SPSS versión 18.0 usando un intervalo de confianza de 95%, con un nivel de significación de p < 0,05. Resultados: Se verificó que 92,85% de los jugadores eran eutróficos y los valores promedio de deshidratación relativa, densidad y pH urinario fueron -0,89%, 1.034,43, y 5,64, respectivamente, que reveló deshidratación en las posiciones con mayor desgaste físico y que el 48,9% de los jugadores tiene un conocimiento normal sobre la hidratación. Conclusión: La deshidratación encontrada en jugadores juveniles puede ser influenciada por diferentes posiciones en el campo y el juego táctico.

[Development of the short version of the informal caregiver burden assessment questionnaire]. / Desenvolvimento de uma versão reduzida do Questionário De Avaliação Da Sobrecarga do Cuidador Informal.

OBJETIVE: to create a reduced version of the QASCI, which is structurally equivalent to the long one and meets the criteria of reliability and validity. METHOD: Through secondary data from previous studies, the participants were divided into two samples, one for the development of reduced version and the second for study of the factorial validity. Participants responded to QASCI, the SF 36, the ADHS and demographic questions. RESULTS: A reduced version of 14 items showed adequate psychometric properties of validity and internal consistency, adapted to a heptadimensional structure that assesses positive and negative aspects of care. CONCLUSION: Confirmatory factor analysis revealed a good fit with the advocated theoretical model.

Development of the short version of the informal caregiver burden assessment questionnaire / Desarrollo De Una Versión Reducida Del Cuestionario De Evaluación De La Sobrecarga Del Cuidador Informal / Desenvolvimento de uma versão reduzida do Questionário de Avaliação da Sobrecarga do Cuidador Informal

OBJETIVE to create a reduced version of the QASCI, which is structurally equivalent to the long one and meets the criteria of reliability and validity. METHOD Through secondary data from previous studies, the participants were divided into two samples, one for the development of reduced version and the second for study of the factorial validity. Participants responded to QASCI, the SF 36, the ADHS and demographic questions. RESULTS A reduced version of 14 items showed adequate psychometric properties of validity and internal consistency, adapted to a heptadimensional structure that assesses positive and negative aspects of care. CONCLUSION Confirmatory factor analysis revealed a good fit with the advocated theoretical model. .

OBJETIVO Crear una versión reducida del Cuestionario de Evaluación de la Sobrecarga del Cuidador Informal (CESCI) que sea estructuralmente equivalente y que reúna criterios de fidelidad y validez. MÉTODO Mediante datos secundarios a estudios anteriores se constituyeron dos muestras, la primera para el desarrollo de la versión reducida y la segunda para estudiar la validez factorial. Los participantes respondieron al CESCI, el SF 36, la HAD y a preguntas sociodemográficas. RESULTADOS La versión reducida de 14 ítems demostró adecuadas propiedades psicométricas de validez y consistencia interna adaptadas a una estructura heptadimensional que evalúa los aspectos negativos y positivos del cuidar. CONCLUSIÓN El análisis factorial confirmatorio reveló un buen ajuste al modelo teórico preconizado. .

OBJETIVO Criar uma versão reduzida do Questionário de Avaliação da Sobrecarga do Cuidador Informal (QASCI), que seja estruturalmente equivalente e que reúna critérios de fidelidade e validade. MÉTODO Através de dados secundários a estudos anteriores constituíram-se duas amostras, uma para o desenvolvimento da versão reduzida e a segunda para estudar a validade fatorial. Os participantes responderam ao QASCI, ao SF 36, à EADH e a perguntas sociodemográficas. RESULTADOS A versão reduzida de 14 itens mostrou adequadas propriedades psicométricas de validade e consistência interna adaptada a uma estrutura heptadimensional que avalia aspetos negativos e positivos do cuidar. CONCLUSÃO A análise fatorial confirmatória revelou um bom ajustamento ao modelo teórico preconizado. .