Intervenção mediada por gamificacão para promoção do cuidado a cuidadores de idosos: relato de experiência no PROFSAÚDE ­UFMA / An intervention for the caregivers of the elderly: conceptual map and gamification at Profsaúde­UFMA

Nosso objetivo aqui é relatar uma experiência em que se realizou uma intervenção mediada por gamificacão para a promoção do cuidado aos cuidadores de idosos no Mestrado Profissional em Saúde da Família da Universidade Federal do Maranhão (PROFSAÚDE­UFMA). Nesse percurso, o PROFSAÚDE­UFMA atuou com suas disciplinas na compreensão da magnitude dos problemas pelos quais passam os cuidadores de idosos, proporcionando vivências em um diagnóstico situacional real de uma unidade de saúde da família na capital do Maranhão. Nesse local, ocorreu uma experiência exitosa, com a gamificação,que surgiu como produto de uma intervenção em vídeo para a melhoria dos cuidados aos cuidadores. Além disso, desenvolveu-se um mapa conceitual com a integração das disciplinas no PROFSAÚDE, demostrando a importância da produção do conhecimento seja na amplificação do potencial da educação em saúde de forma significativa e permanente, seja para a melhoria do planejamento e da avaliação dos serviços de saúde. Pretende-se, com a disseminação do conhecimento aqui exposto, proporcionar o envolvimento dos sujeitos e o apoio dos serviços de saúde na oferta de cuidados aos cuidadores de idosos.

Our objective here is to report an experience in which an intervention mediated by gamification was carried out to promote care for elderly caregivers atthe Professional Master's in Family Health at the Federal University of Maranhão(PROFSAÚDE­UFMA). Along this path, PROFSAÚDE­UFMAworked with its disciplines to understand the magnitude of the problems faced by caregivers of the elderly, providing experiences in a real situational diagnosis of a family health unit in the capital of Maranhão. There was a successful experience in this place, with gamification that emerged as a product of a video intervention to improve care for caregivers, and, in addition, a conceptual map was developed with the integration of disciplines in Profsaúde. It demonstrated the importance of knowledge production both by amplifying the potential of health education in a meaningful and permanent way and by improving the planning and evaluation of health services. We intend, through the dissemination of knowledge here exposed, to show the subjects' involvement and to support health services in providing care to the caregivers of the elderly

Morphological changes in the temporomandibular joints in women with fibromyalgia and myofascial pain: A case series.

Objective: This study investigated the temporomandibular joint (TMJ) morphological changes in women with fibromyalgia (FM) through clinical and tomographic evaluation.Methods: Ten women diagnosed with myofascial pain who were being treated for FM in a university hospital were included in this study. The data were collected through clinical examination and cone beam computed tomography evaluation of the TMJ in closed and open mouth positions.Results: All patients had crackling in the joint, a habit of grinding teeth during sleep, muscle stiffness, and tinnitus. The tomographic findings revealed a higher frequency of condylar bone wear, reduction of joint space, and posterior positioning of the mandibular condyle. The temporomandibular disorders with the highest prevalence were osteoarthritis and disc displacement with reduction.Conclusion: The findings suggest that women with FM have a high frequency of TMD related to the displacement of the articular disc, condyle position, and occurrence of osteoarthritis.

Oropharyngeal examination as a predictor of obstructive sleep apnea: pilot study of gag reflex and palatal reflex.

UNLABELLED: Obstructive sleep apnea (OSA) has high prevalence and may cause serious comorbidities. The aim of this trial was to show if simple noninvasive methods such as gag reflex and palatal reflex are prospective multivariate assessments of predictor variables for OSA. METHOD: We evaluate gag reflex and palatal reflex, of fifty-five adult patients, and their subsequent overnight polysomnography. RESULTS: Forty-one participants presented obstructive sleep apnea. The most relevant findings in our study were: [1] absence of gag reflex on patients with severe obstructive apnea (p=0.001); [2] absence of palatal reflex on moderate obstructive apnea patients (p=0.02). CONCLUSION: Gag reflex and palatal reflex, a simple noninvasive test regularly performed in a systematic neurological examination can disclose the impact of the local neurogenic injury associated to snoring and/or obstructive sleep apnea syndrome.

Oropharyngeal examination as a predictor of obstructive sleep apnea: pilot study of gag reflex and palatal reflex / Avaliação orofaríngea como preditor da apneia obstrutiva do sono: estudo piloto dos reflexos nauseoso e palatal

Obstructive sleep apnea (OSA) has high prevalence and may cause serious comorbities. The aim of this trial was to show if simple noninvasive methods such as gag reflex and palatal reflex are prospective multivariate assessments of predictor variables for OSA. METHOD: We evaluate gag reflex and palatal reflex, of fifty-five adult patients, and their subsequent overnight polysomnography. RESULTS: Forty-one participants presented obstructive sleep apnea. The most relevant findings in our study were: [1] absence of gag reflex on patients with severe obstructive apnea (p=0.001); [2] absence of palatal reflex on moderate obstructive apnea patients (p=0.02). CONCLUSION: Gag reflex and palatal reflex, a simple noninvasive test regularly performed in a systematic neurological examination can disclose the impact of the local neurogenic injury associated to snoring and/or obstructive sleep apnea syndrome.

A síndrome da apneia obstrutiva do sono (SAOS) possui alta prevalência e pode causar sérias comorbidades. O objetivo deste estudo foi mostrar se métodos não invasivos como os reflexos nauseoso e palatal podem ser avaliações prospectivas multivariadas preditoras para SAOS. MÉTODO: Avaliamos os reflexos palatal e nauseoso em 55 pacientes adultos, com exame polissonográfico subsequente. RESULTADOS: 41 pacientes apresentaram SAOS. Os achados mais relevantes em nosso estudo foram: [1] ausência do reflexo nauseoso em pacientes com SAOS grave (p=0,001); [2] ausência do reflexo palatal em pacientes com SAOS moderada (p=0,02). CONCLUSÃO: Os reflexos nauseoso e palatal, um simples exame não invasivo, aplicado em uma avaliação neurológica rotineira, pode revelar o impacto de lesões neurogênicas locais associadas ao ronco e/ou a SAOS.

Swallowing dysfunction related to obstructive sleep apnea: a nasal fibroscopy pilot study.

PURPOSE: Patients with obstructive sleep apnea (OSA) may have subclinical swallowing abnormalities due to progressive mechanical trauma of the pharyngeal tissues caused by snoring. There are few trials on swallowing among OSA patients, and most of them used videoradiography. The aim of this trial was to show swallowing function in OSA patients by nasal fibroscopy. METHOD: Eleven patients with OSA diagnosed by polysomnography, with a mean age of 48 ± 14 years, without spontaneous complaints of swallowing, and 14 non-snoring volunteers, with a mean age of 47 ± 12 years, without spontaneous complaints of swallowing, participated in the study. The participants were evaluated using nasal fibroscopy. Each participant was offered diet boluses (5 and 10 ml) such as thin liquids, purée, and solids, and their swallowing function was determined according to the following criteria: (1) premature oral leakage to the pharynx; (2) laryngeal penetration; (3) tracheal aspiration; and (4) pharyngeal stasis. RESULTS: Sixty-four percent of the OSA patients presented premature oral leakage, 55% presented pharyngeal stasis of the bolus after swallowing, and we did not observe laryngeal penetration or tracheal aspiration. There were no subclinical manifestations in the control group. CONCLUSION: OSA patients presented subclinical manifestations of abnormal swallowing, when analyzed using nasal fibroscopy, possibly associated with neuromuscular injury caused by snoring.

The pharmacological treatment for uremic restless legs syndrome: evidence-based review.

Restless legs syndrome (RLS) is a common and often misdiagnosed entity among the general population and it may be more common among dialysis patients, with an estimated prevalence of 6.6 to 21.5%. The treatment for uremic RLS has been controversial and therefore a systematic synthesis of the evidence is needed in order to evaluate the effectiveness and safety of treatments for uremic RLS. This was a systematic review of randomized or quasi-randomized double-blind trials on treatments for uremic RLS. The outcomes considered were relief of RLS symptoms marked on a validated scale, subjective sleep quality, sleep quality measured using night polysomnography and actigraphy, quality of life measured subjectively, and adverse events associated with these treatments. Six eligible clinical trials were included. The results from subjective analyses in these studies were divergent, although objective analyses in one trial showed that there was a statistically significant improvement in periodic leg movement while asleep in the treatment group. No combined analysis (meta-analysis) was performed. The most common adverse event seen was gastrointestinal symptoms. Only a few therapeutic trials on patients with uremia with RLS have been published, and there is insufficient scientific evidence to favor any specific therapeutic regimen for uremic-associated RLS. Therapy using levodopa, dopaminergic agonists, anticonvulsants, and clonidine tend to be effective, but further studies are needed.

Methods for increasing upper airway muscle tonus in treating obstructive sleep apnea: systematic review.

OBJECTIVE: Treatment of obstructive sleep apnea (OSA) using methods for increasing upper airway muscle tonus has been controversial and poorly reported. Thus, a review of the evidence is needed to evaluate the effectiveness of these methods. DESIGN: The design used was a systematic review of randomized controlled trials. DATA SOURCES: Data sources are from the Cochrane Library, Medline, Embase and Scielo, registries of ongoing trials, theses indexed at Biblioteca Regional de Medicina/Pan-American Health Organization of the World Health Organization and the reference lists of all the trials retrieved. REVIEW METHODS: This was a review of randomized or quasi-randomized double-blind trials on OSA. Two reviewers independently applied eligibility criteria. One reviewer assessed study quality and extracted data, and these processes were checked by a second reviewer. The primary outcome was a decrease in the apnea/hypopnea index (AHI) of below five episodes per hour. Other outcomes were subjective sleep quality, sleep quality measured by night polysomnography, quality of life measured subjectively and adverse events associated with the treatments. DATA SYNTHESIS: Three eligible trials were included. Two studies showed improvements through the objective and subjective analyses, and one study showed improvement of snoring, but not of AHI while the subjective analyses showed no improvement. The adverse events were reported and they were not significant. CONCLUSIONS: There is no accepted scientific evidence that methods aiming to increase muscle tonus of the stomatognathic system are effective in reducing AHI to below five events per hour. Well-designed randomized controlled trials are needed to assess the efficacy of such methods.

Methods to increase muscle tonus of upper airway to treat snoring: systematic review.

BACKGROUND: Snoring is the noise caused by vibration during the in-breath; and which structure actually vibrates depends on many factors. OBJECTIVE: The treatment of snoring with methods to increase muscle tonus of upper airway has been controversial, and poorly reported, thus a review of evidence is necessary to evaluate the effectiveness of these methods. METHOD: A review of randomized or quasi-randomized, double blind trials on snoring treatment that have employed any method to increase muscle tonus of upper airway like phonotherapy or physical therapy among others. OUTCOMES: decrease or completely stop of snoring, sleep quality, quality of life, and adverse events. RESULTS: Three eligible trials were potentially analyzed, but none of them could provide good scientific evidence favoring the intervention. The objective analyses of one study showed improvement of snoring, although the objective sub-analyses and subjective analyses showed controversial results. The adverse events were not reported. CONCLUSION: There is no enough evidence to support the recommendation of methods to increase muscle tonus of upper airways in treatment of snoring. Well designed randomized clinical trials are needed to asses the efficacy of such methods, and a standard and worldwide accepted method for snoring assessment would be useful for future researches.

Methods to increase muscle tonus of upper airway to treat snoring: systematic review / Métodos para aumentar o tônus muscular da via aérea superior no tratamento do ronco: revisão sistemática

BACKGROUND: Snoring is the noise caused by vibration during the in-breath; and which structure actually vibrates depends on many factors. OBJECTIVE: The treatment of snoring with methods to increase muscle tonus of upper airway has been controversial, and poorly reported, thus a review of evidence is necessary to evaluate the effectiveness of these methods. METHOD: A review of randomized or quasi-randomized, double blind trials on snoring treatment that have employed any method to increase muscle tonus of upper airway like phonotherapy or physical therapy among others. Outcomes: decrease or completely stop of snoring, sleep quality, quality of life, and adverse events. RESULTS: Three eligible trials were potentially analyzed, but none of them could provide good scientific evidence favoring the intervention. The objective analyses of one study showed improvement of snoring, although the objective sub-analyses and subjective analyses showed controversial results. The adverse events were not reported. CONCLUSION: There is no enough evidence to support the recommendation of methods to increase muscle tonus of upper airways in treatment of snoring. Well designed randomized clinical trials are needed to asses the efficacy of such methods, and a standard and worldwide accepted method for snoring assessment would be useful for future researches.

CONTEXTO: O ronco é o ruído causado pela vibração durante a inspiração, cujas estruturas vibratórias, dependem atualmente de vários fatores. OBJETIVO: O tratamento do ronco com métodos para aumentar o tônus muscular da via aérea superior tem sido controverso e pouco relatado, portanto uma revisão de evidências é necessária para avaliar a efetividade destes métodos. MÉTODO: Revisão sistemática de ensaios clínicos randomizados ou quasi-randomizados, duplo-cegos para o tratamento do ronco, com métodos visando o aumento do tônus da via aérea superior, tais como fonoterapia e fisioterapia. Desfechos: diminuição ou cura do ronco, qualidade do sono, qualidade de vida e efeitos adversos. RESULTADOS: Três estudos elegíveis foram potencialmente analisados, porém nenhum deles demonstrou evidência científica de qualidade favorecendo a intervenção. As análises subjetivas em um estudo mostrou melhora do ronco, entretanto as sub-análises objetivas demonstraram resultados controversos. Os efeitos adversos não foram relatados. CONCLUSÃO: Não existe evidência científica suficiente para sustentar a recomendação de métodos para aumentar o tônus muscular da via aérea superior no tratamento do ronco. Ensaios clínicos randomizados bem elaborados são necessários para avaliarmos a eficácia de tais métodos e uma padronização de métodos para intervir no ronco mundialmente aceitos se tornariam úteis em pesquisas futuras.

Anticonvulsants to treat idiopathic restless legs syndrome: systematic review.

BACKGROUND: Restless legs syndrome (RLS) is a sensory motor disorder characterized by a distressing urge to move the legs and sometimes also other parts of the body usually accompanied by a marked sense of discomfort or pain in the leg or other affected body part. Many treatments have been used to minimize the discomfort of the disease, among them the anticonvulsant therapy. AIM: This review aims to evaluate the efficacy and safety of anticonvulsant treatment for idiopathic RLS. METHOD: Systematic review of randomized or quasi-randomized, double blind trials on anticonvulsant treatment for RLS. OUTCOMES: relief of RLS symptoms, subjective and objective sleep quality, quality of life, and adverse events associated with the treatments. RESULTS: A total of 231 patients were randomized in three cross over studies and one parallel study. Three studies with carbamazepine, one with sodium valproate, and one with gabapentin, and they were very heterogeneous so we could not perform a meta-analysis. CONCLUSIONS: There is no scientific evidence on RLS treatment with anticonvulsants for clinical practice.

Anticonvulsants to treat idiopathic restless legs syndrome: systematic review / Anticonvulsivantes para a síndrome das pernas inquietas idiopática: revisão sistemática

BACKGROUND: Restless legs syndrome (RLS) is a sensory motor disorder characterized by a distressing urge to move the legs and sometimes also other parts of the body usually accompanied by a marked sense of discomfort or pain in the leg or other affected body part. Many treatments have been used to minimize the discomfort of the disease, among them the anticonvulsant therapy. AIM: This review aims to evaluate the efficacy and safety of anticonvulsant treatment for idiopathic RLS. METHOD: Systematic review of randomized or quasi-randomized, double blind trials on anticonvulsant treatment for RLS. Outcomes: relief of RLS symptoms, subjective and objective sleep quality, quality of life, and adverse events associated with the treatments. RESULTS: A total of 231 patients were randomized in three cross over studies and one parallel study. Three studies with carbamazepine, one with sodium valproate, and one with gabapentin, and they were very heterogeneous so we could not perform a metanalyses. CONCLUSIONS: There is no scientific evidence on RLS treatment with anticonvulsants for clinical practice.

CONTEXTO: A síndrome das pernas inquietas (SPI ) é uma desordem caracterizada por um impulso de mover as pernas e as vezes outras partes do corpo acompanhado geralmente por desconforto ou da dor nas pernas ou em outra parte afetada. Muitos tratamentos tem sido utilizados para aliviar o desconforto causado pela doença entre eles os anticonvulsivantes. OBJETIVO: Este estudo objetivou avaliar a eficácia e segurança do tratamento da SPI com as drogas anticonvulsivantes. MÉTODO: Revisão sistemática de ensaios clínicos randomizados ou quasi-randomizados, duplo-cegos para o tratamento com anticonvulsivantes para SPI. Desfechos: alívio dos sintomas da SPI, qualidade subjetiva e objetiva do sono, qualidade de vida e efeitos adversos relacionados ao tratamento. RESULTADOS: Um total de 231 pacientes foram randomizados em três estudos cross-over e um estudo paralelo. Três estudos avaliaram a carbamazepina, um estudo avaliou o ácido valpróico e o outro a gabapentina, eles eram muito heterogêneos, o que impossibilitou a metanálise dos resultados. CONCLUSÃO: Não existe evidência científica, que o tratamento da SPI com anticonvulsivantes é eficaz e seguro, para a prática clínica.

Levodopa for idiopathic restless legs syndrome: evidence-based review.

Restless legs syndrome (RLS) is a sensory motor disorder characterized by a distressing urge to move the legs and sometimes also other parts of the body usually accompanied by a marked sense of discomfort or pain in the leg or other affected body part. The prevalence of RLS is estimated at 2.7 to 5% of adults and it is more common in women. The treatment of RLS with levodopa has been reported thus a systematic synthesis of evidence is necessary to evaluate the effectiveness and safety of levodopa for RLS. Systematic review of randomized or quasi-randomized, double blind trials on levodopa. Relief of restless legs symptoms marked on a validated scale, subjective sleep quality, sleep quality measured by night polysomnography and actigraphy, quality of life measured by subjective measures, adverse events associated with the treatments. Nine eligible clinical trials were included. The subjective analyses of these studies showed contradictory results, although the objective analyses showed that treatment group had a statistically significant improvement of periodic leg movement (PLM) index, favoring the treatment group. The most commonly adverse event seen was gastrointestinal symptoms. The short-term treatment with levodopa was demonstrated effective and safety for PLM, but there was only few trials assessing long-term treatment and the augmentation phenomenon in RLS. Further long-term randomized controlled trials using standard follow-up measurements as the International RLS Study Group Rating Scale are necessary.