Cultivable Fungi from Amazon River Dolphins Engaged in Wildlife Ecotourism in the Anavilhanas National Park, Brazil.

Amazon River dolphins are an important flagship species in the Anavilhanas National Park, Brazil, where they interact with visitors. This study aimed to quantify and identify fungi isolated from dolphin skin and oral samples and their surrounding environment in this unique ecosystem. Samples were collected from three dolphins and water samples from Flutuante dos Botos and the Novo Airão city harbor. Fungi were isolated using culture media and identified through micromorphology assays and ITS region sequencing. Oral swab samples resulted in culture of Trichosporon montevideense and Exophiala dermatitidis. Skin samples from one dolphin revealed Toxicocladosporium irritans and Diaporthe lithocarpus. Water samples exhibited higher fungal counts and diversity, with Rhodotorula mucilaginosa, Exophiala dermatitidis, Penicillium citrinum, Fomitopsis meliae, and Nectria pseudotrichia identified at the collection site and Candida spencermartinsiae and Penicillium chermesinum at the city harbor. This study provides important insights into the fungal diversity associated with Amazon River dolphins and their environment, enhancing our understanding of the public health and ecological dynamics in the Anavilhanas National Park.

Association of physical performance and sarcopenia with use of health services in elderly people living in rural riverside areas in the Amazon: a cross-sectional study.

INTRODUCTION: Access is considered one of the necessary conditions for achieving effectiveness and quality in health services. However, it represents a complex construct, with several interpretations, and can be understood as the ease or degree of difficulty with which people obtain effective and timely care. Barriers to access can be related to individual characteristics and those of health systems and services. Regarding elderly people living in rural riverine localities, these limitations are exacerbated due to the territorial dispersion of households and the difficulty of obtaining the necessary care near their homes. The aim of this study was to describe and test the association of sarcopenia and physical performance with primary healthcare attributes and the use of health services by elderly people living in rural riverside areas in the Amazon, Brazil. METHODS: This cross-sectional observational study was carried out in households with individuals aged 60 years or older living in nine communities located on the left bank of the Negro River, in the rural riverside area of the municipality of Manaus, Amazonas, Brazil. The study evaluated socioeconomic and demographic conditions, health services utilization and the primary care attributes related to the use of and access to services, assessed by components of the Primary Care Assessment Tool instrument (PCATool-Brazil), a reduced version validated for Brazilian adult users. Physical performance was assessed using the Short Physical Performance Battery scale, and handgrip strength was also assessed, according to a dynamometer. The Sarcopenia Formulary (SARC-F) and calf circumference (CC) were used to assess sarcopenia (SARC-CalF). The association of sarcopenia and physical performance with the study outcomes was evaluated using hierarchical logistic regression for health services utilization (having had a medical consultation in the last year), and hierarchical linear regression for the continuous outcomes of the PCATool-Brazil (total score and each of the domains). The sociodemographic variables were inserted in model 1 and the clinical variables in model 2. Variables with p<0.20 were kept in the models. RESULTS: A total of 98 elderly people (55.1% men; mean age 70±7.4 years) were included in the study. Low physical performance and suggestive signs of sarcopenia were observed in 52.5% and 28.9% of the study participants, respectively. Elderly with better physical performance reported more health services utilization (odds ratio (OR)=1.37; 95% confidence interval (CI)=1.03-1.81) and higher scores in the affiliation (β=1.67; 95%CI=0.37-2.98), utilization (β=1.19; 95%CI=0.06-2.33) and longitudinality (β=0.99; 95%CI=0.09-1.90) domains of the PCATool-Brazil. CONCLUSION: The study findings showed high prevalence of impairment in physical performance and suggestive signs of sarcopenia in elderly people living in the studied rural riverside localities. Better physical performance was associated with use of health services in the previous year and with better evaluation of some primary care attributes.

Effects of physical training on functional, clinical, morphological, behavioural and psychosocial outcomes in post-COVID-19 infection: COVID-19 and REhabilitation study (CORE-study)-a study protocol for a randomised controlled clinical trial.

BACKGROUND: The COVID-19 pandemic remains ongoing, with a significant number of survivors who have experienced moderate to severe clinical conditions and who have suffered losses of great magnitude, especially in functional capacity, triggering limitations to daily autonomy and quality of life. Among the possibilities of intervention for disease rehabilitation, physical exercise training stands out, which can benefit several health outcomes and favours the adoption of healthier behaviours. Therefore, the aim of the study will be to analyse the effects of physical training on the functional, clinical, morphological, behavioural and psychosocial status in adults and the elderly following COVID-19 infection. METHODS: A randomised controlled clinical trial is to be conducted in parallel, with the experimental group undergoing an intervention involving a multicomponent physical rehabilitation programme, carried out at the Sports Center in partnership with the Academic Hospital of the Federal University of Santa Catarina, in Florianópolis, Brazil. Participants will be adults and the elderly, of both sexes, in a post-COVID-19-infection state, who were hospitalised during the infection. The intervention will have a total duration of 24 weeks and will include a multicomponent physical training programme, which will have gradual progression in frequency, duration and intensity over time. Regarding the outcomes, before, at the 12th and after 24 weeks of intervention, functional (primary outcome = functional index of aerobic capacity), clinical, morphological, behavioural and psychosocial outcomes will be assessed. DISCUSSION: This study will contribute to a greater understanding of the safety, adherence and benefits of physical training in the rehabilitation of post-COVID-19 patients. The results of this study will be disseminated through presentations at congresses, workshops, peer-reviewed publications and local and international conferences, especially with a view to proposing a post-COVID-19 rehabilitation care protocol. TRIAL REGISTRATION: ReBEC, RBR-10y6jhrs . Registered on 22 February 2022. 2015.

Symptoms of Gastroesophageal Reflux Disease and Dysphagia in Patients with Chronic Obstructive Pulmonary Disease: Associated Factors / Sintomas da Doença do Refluxo Gastroesofágico e de Disfagia em Pacientes Portadores de Doença Pulmonar Obstrutiva Crônica: Fatores Associados

To analyze the presence of gastroesophageal reflux disease (GERD) and dysphagia in patients with chronic obstructive pulmonary disease (COPD) and evaluate associated factors. Cross-sectional study part of a large cohort study. The Dysphagia Handicap Index (DHI), Gastroesophageal Reflux Disease Symptoms Questionnaire (QS-GERD) and The Eating Assessment Tool (EAT-10) were applied. A medical consultation, spirometry examination, and health status assessments (by modified Medical Research Council scale - mMRC, COPD Assessment Test - CAT, Saint George Respiratory Questionnaire - SGRQ) were performed on the same day as the DHI, QS-GERD and EAT-10. Thirty-four individuals participated in the study, with a mean age of 65.2 (SD=7.9) complete years with COPD, 52.9% being female, and a body mass index of 26.6 (SD=6.3) kg/m2. Eleven individuals were classified as having risk for dysphagia. The evaluation of gastroesophageal reflux symptoms through the QS-DRGE showed moderate correlation with EAT-10. The GERD SQ instrument showed moderate correlation with the SGRQ, as well as in the three domains, finding that the presence of GERD symptoms is a factor that is associated with worsening quality of life. It is concluded that patients with COPD present symptoms of dysphagia and gastroesophageal reflux. In this study, it was found that the presence of GERD symptoms and swallowing disorders are factors associated with worsening quality of life. (AU)

Avaliar a presença de sintomas da doença do refluxo gastroesofágico (DRGE) e disfagia em pacientes portadores de doença pulmonar obstrutiva crônica (DPOC) e analisar os fatores associados. Estudo transversal aninhado a um estudo de coorte. Foram aplicados os instrumentos Índice de Desvantagem da Deglutição (IDD), Questionário de Sintomas na Doença do Refluxo Gastroesofágico (QS-DRGE) e o Instrumento de Autoavaliação da Alimentação (EAT-10). No mesmo dia da aplicação dos instrumentos foram realizadas a consulta médica, exame espirometria e avaliação do estado de saúde e qualidade de vida, avaliados por meio do Saint George Respiratory Questionnaire (SGRQ). Participaram do estudo 34 indivíduos com média de idade de 65,2 (DP=7,9) anos completos portadores de DPOC, sendo 52,9% do sexo feminino e índice de massa corporal de 26,6 (DP= 6,3) kg/m2. Onze indivíduos ficaram classificados como tendo risco para disfagia. A avaliação dos sintomas de refluxo gastroesofágico através do QS-DRGE apontou correlação moderada com EAT-10. O instrumento QSDRGE apresentou correlação moderada com o SGRQ, assim como nos três domínios, constatando-se que a presença de sintomas de DRGE é um fator que está associado à piora da qualidade de vida. Conclui-se que pacientes com DPOC apresentam sintomas de disfagia e de refluxo gastroesofágico. Nesse estudo, constatou-se que a presença de sintomas de DRGE e os distúrbios da deglutição são fatores que estão associado à piora da qualidade de vida. (AU)

Self-reported chronic back pain in the elderly living in rural riverine areas in the Amazon.

INTRODUCTION: The present study aimed to estimate the prevalence of self-reported chronic low back pain and to identify the associated factors in elderly people living in rural riverside areas in the Amazon. METHODS: Data from a cross-sectional home-based survey performed in 38 riverside rural locations along the left bank of the Negro River, in the municipality of Manaus, Amazonas, Brazil, were analyzed. The selected elderly people answered a questionnaire comprising items related to the living conditions, socioeconomic and demographic characteristics, health status and utilization of health services. The outcome was self-reported chronic back pain or problem. The association between the outcome and the independent variables was assessed using logistic regression, estimating the odds ratios and respective 95% confidence intervals (CIs). RESULTS: One hundred and six residents aged 60 years or older out of a total of 277 were included in the study. The prevalence of chronic back pain among the elderly residents was 57.5% (63.3% among men and 50.0% among women). Most of them did not have any treatment related to their chronic condition (77.0%). Occupation in activities other than agricultural activities was protective for the outcome (odds ratio (OR)=0.1, 95%CI=0.0-0.9). The chronic low back pain was also associated with worse self-perceived health (OR=10.3, 95%CI=1.6-67.5). CONCLUSION: The high prevalence of chronic low back pain in elderly people living in rural riverside areas, along with limited access to treatment and the different impacts on the performance of daily activities and the quality of life, reveals the relevance of this condition as a public health problem.

Presence of trypanosomatids, with emphasis on Leishmania, in Rodentia and Didelphimorphia mammals of a rural settlement in the central Amazon region.

BACKGROUND: Trypanosomatids are widespread and cause diseases - such as trypanosomiasis, sleeping sickness, Chagas disease, and cutaneous and visceral leishmaniasis - in animals and humans. These diseases occur in both rural and urban regions due to unplanned growth and deforestation. Thus, wild and synanthropic reservoir hosts living in residential areas are risk factors. OBJECTIVE: We aimed to evaluate the diversity of small mammals (rodents and marsupials), and the occurrence of trypanosomatids, especially Leishmania, in the rural settlement of Presidente Figueiredo, Amazonas. METHODS: Animals were collected using Sherman, Tomahawk, and Pitfall traps along 16 trails in four landscapes: continuous forest, forest with planting, planting, and peridomiciliar. Leishmania sp. was detected in liver samples by polymerase chain reaction targeting kDNA. FINDINGS: Diversity was higher in forests with planting and lower around residences. In total, 135 mammals (81 rodents and 54 marsupials covering 14 genera) were captured. Rodents presented infection rates (IR) of 74% and marsupials of 48%. Rodents in domicile landscapes presented a higher IR (92.9%), while marsupials showed a higher IR in forests (53.3%). MAIN CONCLUSIONS: The results suggest high prevalence of trypanosomatids across 12 mammalian genera possibly involved as reservoir hosts in the enzootic transmission of leishmaniasis in the Amazon's rural, peridomiciliar landscape.

Brazilian version of the Clinical COPD Questionnaire, administered by interview: reliability and validity measurement properties.

OBJECTIVE: To test the reliability, validity, and interpretability of the Brazilian version of the Clinical COPD Questionnaire (CCQ) in patients with COPD. METHODS: Fifty patients with COPD completed the CCQ by interview on two occasions. At the first visit, the CCQ was administered twice, by two different raters, approximately 10 min apart; the patients also underwent spirometry and were administered the COPD Assessment Test, the modified Medical Research Council scale, and Saint George's Respiratory Questionnaire (SGRQ). At the second visit (1-2 weeks later), the CCQ was readministered. We tested the hypothesis that the CCQ total score would correlate positively with the total and domain SGRQ scores (r ≥ 0.5). RESULTS: Of the 50 patients, 30 (60%) were male. The mean age was 66 ± 8 years, and the mean FEV1 was 44.7 ± 17.9% of the predicted value. For all CCQ items, Cronbach's alpha coefficient (95% CI) was 0.93 (0.91-0.96). To analyze the interrater reliability and test-retest reliability of the CCQ, we calculated the two-way mixed effects model/single measure type intraclass correlation coefficient (0.97 [95% CI: 0.95-0.98] and 0.92 [95% CI: 0.86-0.95], respectively); the agreement standard error of measurement (0.65 for both); the smallest detectable change at the individual level (1.81 and 1.80, respectively) and group level (0.26 and 0.25, respectively); and the limits of agreement (-0.58 to 0.82 and -1.14 to 1.33, respectively). The CCQ total score correlated positively with all SGRQ scores (r ≥ 0.70 for all). CONCLUSIONS: The Brazilian version of the CCQ showed an indeterminate measurement error, as well as satisfactory interrater/test-retest reliability and construct validity.

Brazilian version of the Clinical COPD Questionnaire, administered by interview: reliability and validity measurement properties / Versão brasileira do Clinical COPD Questionnaire, aplicado por meio de entrevista: propriedades de medida de confiabilidade e validade

ABSTRACT Objective: To test the reliability, validity, and interpretability of the Brazilian version of the Clinical COPD Questionnaire (CCQ) in patients with COPD. Methods: Fifty patients with COPD completed the CCQ by interview on two occasions. At the first visit, the CCQ was administered twice, by two different raters, approximately 10 min apart; the patients also underwent spirometry and were administered the COPD Assessment Test, the modified Medical Research Council scale, and Saint George's Respiratory Questionnaire (SGRQ). At the second visit (1-2 weeks later), the CCQ was readministered. We tested the hypothesis that the CCQ total score would correlate positively with the total and domain SGRQ scores (r ≥ 0.5). Results: Of the 50 patients, 30 (60%) were male. The mean age was 66 ± 8 years, and the mean FEV1 was 44.7 ± 17.9% of the predicted value. For all CCQ items, Cronbach's alpha coefficient (95% CI) was 0.93 (0.91-0.96). To analyze the interrater reliability and test-retest reliability of the CCQ, we calculated the two-way mixed effects model/single measure type intraclass correlation coefficient (0.97 [95% CI: 0.95-0.98] and 0.92 [95% CI: 0.86-0.95], respectively); the agreement standard error of measurement (0.65 for both); the smallest detectable change at the individual level (1.81 and 1.80, respectively) and group level (0.26 and 0.25, respectively); and the limits of agreement (−0.58 to 0.82 and −1.14 to 1.33, respectively). The CCQ total score correlated positively with all SGRQ scores (r ≥ 0.70 for all). Conclusions: The Brazilian version of the CCQ showed an indeterminate measurement error, as well as satisfactory interrater/test-retest reliability and construct validity.

RESUMO Objetivo: Testar a confiabilidade, validade e interpretabilidade da versão brasileira do Clinical COPD Questionnaire (CCQ) em pacientes com DPOC. Métodos: Cinquenta pacientes com DPOC preencheram o CCQ por meio de entrevista em duas ocasiões. Na primeira visita, o CCQ foi aplicado duas vezes, por dois avaliadores, com intervalo de aproximadamente 10 min; os pacientes também foram submetidos a espirometria e aplicação do COPD Assessment Test, da escala modificada do Medical Research Council e do Saint George's Respiratory Questionnaire (SGRQ). Na segunda visita (1-2 semanas depois), o CCQ foi reaplicado. Testamos a hipótese de que a pontuação total no CCQ se correlacionaria positivamente com a pontuação total e a pontuação nos domínios do SGRQ (r ≥ 0,5). Resultados: Dos 50 pacientes, 30 (60%) eram do sexo masculino. A média de idade foi de 66 ± 8 anos, e a média do VEF1 foi de 44,7 ± 17,9% do valor previsto. Para todos os itens do CCQ, o coeficiente alfa de Cronbach (IC95%) foi de 0,93 (0,91-0,96). Para analisar a confiabilidade interavaliadores e teste-reteste do CCQ, calculamos o coeficiente de correlação intraclasse de duas vias modelo de efeitos mistos para medidas únicas (0,97 [IC95%: 0,95-0,98] e 0,92 [IC95%: 0,86-0,95], respectivamente); erro-padrão de medida do tipo concordância (0,65 para ambas); a mínima mudança detectável individual (1,81 e 1,80, respectivamente) e no grupo (0,26 e 0,25, respectivamente); e os limites de concordância (−0,58 a 0,82 e −1,14 a 1,33, respectivamente). A pontuação total no CCQ correlacionou-se positivamente com todas as pontuações no SGRQ (r ≥ 0,70 para todas). Conclusões: A versão brasileira do CCQ apresentou erro de medida indeterminado, assim como confiabilidade interavaliadores/teste-reteste e validade de construto satisfatórias.

Clinical, laboratory, and functional characteristics of asthma-COPD overlap in patients with a primary diagnosis of COPD / Características clínicas, laboratoriais e funcionais da sobreposição asma-DPOC em pacientes previamente diagnosticados com DPOC

ABSTRACT Objective: To evaluate the frequency of asthma-COPD overlap (ACO) in patients with COPD and to compare, from a clinical, laboratory, and functional point of view, patients with and without ACO, according to different diagnostic criteria. Methods: The participants underwent evaluation by a pulmonologist, together with spirometry and blood tests. All of the patients were instructed to record their PEF twice a day. The diagnosis of ACO was based on the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (PLATINO, Latin American Project for the Investigation of Obstructive Lung Disease) criteria, the American Thoracic Society (ATS) Roundtable criteria, and the Spanish criteria. We investigated patient histories of exacerbations and hospitalizations, after which we applied the COPD Assessment Test and the modified Medical Research Council scale, to classify risk and symptoms in accordance with the GOLD criteria. Results: Of the 51 COPD patients, 14 (27.5%), 8 (12.2%), and 18 (40.0) were diagnosed with ACO on the basis of the PLATINO, ATS Roundtable, and Spanish criteria, respectively. The values for pre-bronchodilator FVC, post-bronchodilator FVC, and pre-bronchodilator FEV1 were significantly lower among the patients with ACO than among those with COPD only (1.9 ± 0.4 L vs. 2.4 ± 0.7 L, 2.1 ± 0.5 L vs. 2.5 ± 0.8 L, and 1.0 ± 0.3 L vs. 1.3 ± 0.5 L, respectively). When the Spanish criteria were applied, IgE levels were significantly higher among the patients with ACO than among those with COPD only (363.7 ± 525.9 kU/L vs. 58.2 ± 81.6 kU/L). A history of asthma was more common among the patients with ACO (p < 0.001 for all criteria). Conclusions: In our sample, patients with ACO were more likely to report previous episodes of asthma and had worse lung function than did those with COPD only. The ATS Roundtable criteria appear to be the most judicious, although concordance was greatest between the PLATINO and the Spanish criteria.

RESUMO Objetivo: Avaliar a frequência de asthma-COPD overlap (ACO, sobreposição asma-DPOC) em pacientes com DPOC e comparar, do ponto de vista clínico, laboratorial e funcional, os pacientes com e sem essa sobreposição conforme diferentes critérios diagnósticos. Métodos: Os participantes foram submetidos à avaliação com pneumologista, espirometria e exame sanguíneo, sendo orientados a manter o registro do PFE duas vezes ao dia. O diagnóstico de ACO deu-se através dos critérios Projeto Latino-Americano de Investigação em Obstrução Pulmonar (PLATINO), American Thoracic Society (ATS) Roundtable e Espanhol. Foram investigados os históricos de exacerbações e hospitalizações e aplicados os instrumentos COPD Assessment Test e escala Medical Research Council modificada, utilizados para a classificação de risco e sintomas da GOLD. Resultados: Entre os 51 pacientes com DPOC, 14 (27,5%), 8 (12,2%) e 18 (40,0) foram diagnosticados com ACO segundo os critérios PLATINO, ATS Roundtable e Espanhol, respectivamente. Pacientes com sobreposição significativamente apresentaram pior CVF pré-broncodilatador (1,9 ± 0,4 L vs. 2,4 ± 0,7 L), CVF pós-broncodilatador (2,1 ± 0,5 L vs. 2,5 ± 0,8 L) e VEF1 pré-broncodilatador (1,0 ± 0,3 L vs. 1,3 ± 0,5 L) quando comparados a pacientes com DPOC. Os níveis de IgE foram significativamente mais elevados em pacientes com sobreposição diagnosticados pelo critério Espanhol (363,7 ± 525,9 kU/L vs. 58,2 ± 81,6 kU/L). O histórico de asma foi mais frequente em pacientes com a sobreposição (p < 0,001 para todos os critérios). Conclusões: Nesta amostra, pacientes com ACO relataram asma prévia com maior frequência e possuíam pior função pulmonar quando comparados a pacientes com DPOC. O critério ATS Roundtable aparenta ser o mais criterioso em sua definição, enquanto os critérios PLATINO e Espanhol apresentaram maior concordância entre si.

Clinical, laboratory, and functional characteristics of asthma-COPD overlap in patients with a primary diagnosis of COPD.

OBJECTIVE: To evaluate the frequency of asthma-COPD overlap (ACO) in patients with COPD and to compare, from a clinical, laboratory, and functional point of view, patients with and without ACO, according to different diagnostic criteria. METHODS: The participants underwent evaluation by a pulmonologist, together with spirometry and blood tests. All of the patients were instructed to record their PEF twice a day. The diagnosis of ACO was based on the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (PLATINO, Latin American Project for the Investigation of Obstructive Lung Disease) criteria, the American Thoracic Society (ATS) Roundtable criteria, and the Spanish criteria. We investigated patient histories of exacerbations and hospitalizations, after which we applied the COPD Assessment Test and the modified Medical Research Council scale, to classify risk and symptoms in accordance with the GOLD criteria. RESULTS: Of the 51 COPD patients, 14 (27.5%), 8 (12.2%), and 18 (40.0) were diagnosed with ACO on the basis of the PLATINO, ATS Roundtable, and Spanish criteria, respectively. The values for pre-bronchodilator FVC, post-bronchodilator FVC, and pre-bronchodilator FEV1 were significantly lower among the patients with ACO than among those with COPD only (1.9 ± 0.4 L vs. 2.4 ± 0.7 L, 2.1 ± 0.5 L vs. 2.5 ± 0.8 L, and 1.0 ± 0.3 L vs. 1.3 ± 0.5 L, respectively). When the Spanish criteria were applied, IgE levels were significantly higher among the patients with ACO than among those with COPD only (363.7 ± 525.9 kU/L vs. 58.2 ± 81.6 kU/L). A history of asthma was more common among the patients with ACO (p < 0.001 for all criteria). CONCLUSIONS: In our sample, patients with ACO were more likely to report previous episodes of asthma and had worse lung function than did those with COPD only. The ATS Roundtable criteria appear to be the most judicious, although concordance was greatest between the PLATINO and the Spanish criteria.

The Brazilian Portuguese-language version of the Manchester Respiratory Activities of Daily Living questionnaire: construct validity, reliability, and measurement error.

OBJECTIVE: To test the construct validity, reliability, and measurement error of the Brazilian Portuguese-language version of the Manchester Respiratory Activities of Daily Living (MRADL) questionnaire in patients with COPD. METHODS: We evaluated 50 patients with COPD, among whom 30 were men, the mean age was 64 ± 8 years, and the median FEV1 as a percentage of the predicted value (FEV1%predicted) was 38.4% (interquartile range, 29.1-57.4%). Pulmonary function and limitations in activities of daily living (ADLs) were assessed by spirometry and by face-to-face application of the MRADL, respectively. For the construct validity analysis, we tested the hypothesis that the total MRADL score would show moderate correlations with spirometric parameters. We analyzed inter-rater reliability, test-retest reliability, inter-rater measurement error, and test-retest measurement error. RESULTS: The total MRADL score showed moderate correlations with the FEV1/FVC ratio, FEV1 in liters, FEV1%predicted, and FVC%predicted, all of the correlations being statistically significant (r = 0.34, r = 0.31, r = 0.42, and r = 0.38, respectively; p < 0.05 for all). For the reliability and measurement error of the total MRADL score, we obtained the following inter-rater and test-retest values, respectively: two-way mixed-effects model intraclass correlation coefficient for single measures, 0.92 (95% CI: 0.87-0.96) and 0.89 (95% CI: 0.81-0.93); agreement standard error of measurement, 1.03 and 0.97; smallest detectable change at the individual level, 2.86 and 2.69; smallest detectable change at the group level, 0.40 and 0.38; and limits of agreement, -2.24 to 1.96 and -2.65 to 2.69. CONCLUSIONS: In patients with COPD in Brazil, this version of the MRADL shows satisfactory construct validity, satisfactory inter-rater/test-retest reliability, and indeterminate inter-rater/test-retest measurement error.

The Brazilian Portuguese-language version of the Manchester Respiratory Activities of Daily Living questionnaire: construct validity, reliability, and measurement error / Versão em português do Brasil do questionário Manchester Respiratory Activities of Daily Living: validade de construto, confiabilidade e erro de medida

ABSTRACT Objective: To test the construct validity, reliability, and measurement error of the Brazilian Portuguese-language version of the Manchester Respiratory Activities of Daily Living (MRADL) questionnaire in patients with COPD. Methods: We evaluated 50 patients with COPD, among whom 30 were men, the mean age was 64 ± 8 years, and the median FEV1 as a percentage of the predicted value (FEV1%predicted) was 38.4% (interquartile range, 29.1-57.4%). Pulmonary function and limitations in activities of daily living (ADLs) were assessed by spirometry and by face-to-face application of the MRADL, respectively. For the construct validity analysis, we tested the hypothesis that the total MRADL score would show moderate correlations with spirometric parameters. We analyzed inter-rater reliability, test-retest reliability, inter-rater measurement error, and test-retest measurement error. Results: The total MRADL score showed moderate correlations with the FEV1/FVC ratio, FEV1 in liters, FEV1%predicted, and FVC%predicted, all of the correlations being statistically significant (r = 0.34, r = 0.31, r = 0.42, and r = 0.38, respectively; p < 0.05 for all). For the reliability and measurement error of the total MRADL score, we obtained the following inter-rater and test-retest values, respectively: two-way mixed-effects model intraclass correlation coefficient for single measures, 0.92 (95% CI: 0.87-0.96) and 0.89 (95% CI: 0.81-0.93); agreement standard error of measurement, 1.03 and 0.97; smallest detectable change at the individual level, 2.86 and 2.69; smallest detectable change at the group level, 0.40 and 0.38; and limits of agreement, −2.24 to 1.96 and −2.65 to 2.69. Conclusions: In patients with COPD in Brazil, this version of the MRADL shows satisfactory construct validity, satisfactory inter-rater/test-retest reliability, and indeterminate inter-rater/test-retest measurement error.

RESUMO Objetivo: Testar a validade de construto, a confiabilidade e o erro de medida da versão em português do Brasil do questionário Manchester Respiratory Activities of Daily Living (MRADL) em pacientes com DPOC. Métodos: Avaliamos 50 pacientes com DPOC, 30 dos quais eram homens. A média de idade foi de 64 ± 8 anos, e a mediana do VEF1 em porcentagem do previsto (VEF1%previsto) foi de 38,4% (intervalo interquartil: 29,1-57,4%). A função pulmonar e limitações experimentadas durante a realização de atividades cotidianas foram avaliadas por meio de espirometria e da aplicação presencial do MRADL, respectivamente. Para a análise de validade de construto, testamos a hipótese de que haveria correlações moderadas entre a pontuação total no MRADL e parâmetros espirométricos. Analisamos a confiabilidade e o erro de medida entre avaliadores e entre teste e reteste. Resultados: Houve correlações moderadas e estatisticamente significativas entre a pontuação total no MRADL e VEF1/CVF, VEF1 em litros, VEF1%previsto e CVF%previsto (r = 0,34, r = 0,31, r = 0,42 e r = 0,38, respectivamente; p < 0,05 para todas). No tocante à confiabilidade e ao erro de medida para a pontuação total no MRADL entre avaliadores e entre teste e reteste, respectivamente, foram obtidos os seguintes valores: coeficiente de correlação intraclasse de duas vias e efeitos mistos para medidas únicas = 0,92 (IC95%: 0,87-0,96) e 0,89 (IC95%: 0,81-0,93); erro-padrão de medida do tipo concordância = 1,03 e 0,97; mínima mudança detectável no indivíduo = 2,86 e 2,69; mínima mudança detectável no grupo = 0,40 e 0,38; limites de concordância = −2,24 a 1,96 e −2,65 a 2,69. Conclusões: Em pacientes com DPOC, a versão brasileira do MRADL apresenta validade de construto satisfatória, confiabilidade interavaliadores/teste-reteste satisfatória e erro de medida interavaliadores/teste-reteste indeterminado.

American Tegumentary Leishmaniasis in the Brazilian Amazon from 2010 to 2014.

American tegumentary leishmaniasis (ATL) is one of the most important but neglected infectious diseases, and can cause severe deformities. ATL incidence remains high in forest regions, such as in the Amazonas State, Brazil. However, differences within the State and over time have been observed, since infection patterns are not homogeneous, and these aspects need to be clarified. This study aimed to identify the epidemiological profile of ATL and its spatial and temporal distribution in the Brazilian Amazon, from 2010 to 2014. Data were extracted from the Information System for Notifiable Diseases, which descriptively evaluates the incidence rate, as well as the temporal and spatial distribution of the disease. The highest prevalence of ATL was found in men and in the age group of 20-40 years. Approximately 95% of the cases were of cutaneous ATL and they were identified through direct examination. The spatial analysis has shown that ATL was widely distributed, both in rural and urban areas, and more concentrated in the Southern part of the State. Moreover, although there was an expansion in the spatial distribution and an increasing incidence of ATL in Amazonas, the epidemiological profile remained unchanged, suggesting that other factors must be responsible for its widespread distribution and increasing incidence.

[Visceral leishmaniasis and its relationship with climate and environmental factors in the State of Tocantins, Brazil, from 2007 to 2014]. / Leishmaniose visceral e sua relação com fatores climáticos e ambientais no Estado do Tocantins, Brasil, 2007 a 2014.

Visceral leishmaniasis (VL) may be influenced by climate and environmental factors. Tocantins is the state with the highest incidence in Brazil, contributing to the increase in the number of cases in the North macro-region. This study seeks to identify the correlation between VL incidence rates and climate and environmental factors in the municipalities of the State of Tocantins between 2007 and 2014. Correlations between crude VL incidence rates and the variables elevation, precipitation, Enhanced Vegetation Index (EVI) and temperature were tested using the Global and Local Moran Indexes, while also identifying clusters of VL incidence. We tested a variance analysis for linear trend between variable means in each rate category. Results show an increase in incidence rates with an increase in values of annual precipitation, humidity, EVI and nighttime temperature; and an inverse relationship with elevation and daytime temperature. The clusters we identified show that climate and environmental variables are related to VL incidence. Other studies are needed that adjust for individual-related factors in order to gauge how much the environment, or human influence over it, impact the disease.

Leishmaniose visceral e sua relação com fatores climáticos e ambientais no Estado do Tocantins, Brasil, 2007 a 2014 / Visceral leishmaniasis and its relationship with climate and environmental factors in the State of Tocantins, Brazil, from 2007 to 2014 / Leishmaniasis visceral y su relación con factores climáticos y ambientales en el Estado de Tocantins, Brasil, 2007 a 2014

Resumo: A leishmaniose visceral (LV) pode ser influenciada por fatores climáticos e ambientais. Tocantins é o estado com mais incidência no Brasil, contribuindo para o aumento dos casos na macrorregião Norte. Este estudo tem objetivo de identificar a correlação entre a taxa de incidência de LV e fatores climáticos e ambientais, nos municípios do Estado do Tocantins de 2007 a 2014. As correlações entre a taxa de incidência bruta de LV e as variáveis elevação, precipitação, Índice de Vegetação Melhorado (EVI - Enhanced Vegetation Index) e temperatura foram testadas por meio dos índices de Moran Global e Local, identificando também clusters de incidência de LV. A análise de variância para tendência linear foi testada entre as médias das variáveis em cada categoria da taxa. Os resultados apontam aumento nas taxas de incidência, na medida em que aumentam os valores de precipitação anual, umidade, EVI e temperatura noturna; e uma relação inversa para a elevação e temperatura diurna. Os clusters identificados evidenciam que variáveis climáticas e ambientais se relacionam à incidência de LV, devendo haver outros estudos que ajustem os fatores associados aos sujeitos, a fim de dimensionar o quanto o ambiente ou a influência do homem nele impacta na doença.

Abstract: Visceral leishmaniasis (VL) may be influenced by climate and environmental factors. Tocantins is the state with the highest incidence in Brazil, contributing to the increase in the number of cases in the North macro-region. This study seeks to identify the correlation between VL incidence rates and climate and environmental factors in the municipalities of the State of Tocantins between 2007 and 2014. Correlations between crude VL incidence rates and the variables elevation, precipitation, Enhanced Vegetation Index (EVI) and temperature were tested using the Global and Local Moran Indexes, while also identifying clusters of VL incidence. We tested a variance analysis for linear trend between variable means in each rate category. Results show an increase in incidence rates with an increase in values of annual precipitation, humidity, EVI and nighttime temperature; and an inverse relationship with elevation and daytime temperature. The clusters we identified show that climate and environmental variables are related to VL incidence. Other studies are needed that adjust for individual-related factors in order to gauge how much the environment, or human influence over it, impact the disease.

Resumen: La leishmaniasis visceral (LV) puede estar influenciada por factores climáticos y ambientales. Tocantins es el estado con más incidencia en Brasil, contribuyendo al aumento de casos en la macrorregión Norte. Este estudio tiene como objetivo identificar la correlación entre la tasa de incidencia de LV y los factores climáticos y ambientales, en municipios del Estado de Tocantins de 2007 a 2014. Las correlaciones entre la tasa de incidencia bruta de LV y las variables elevación, precipitación, Índice Mejorado de Vegetación (EVI - Enhanced Vegetation Index) y temperatura se comprobaron mediante los Índices de Moran Global y Local, identificando también clústeres de incidencia de LV. El análisis de varianza para la tendencia lineal se probó entre las medias de las variables en cada categoría de la tasa. Los resultados apuntan un aumento en las tasas de incidencia, a medida que aumentan los valores de precipitación anual, humedad, EVI y temperatura nocturna; y una relación inversa respecto a la elevación y temperatura diurna. Los clústeres identificados evidencian qué variables climáticas y ambientales se relacionan con la incidencia de LV, para lo que deben existir otros estudios que ajusten los factores asociados a los sujetos, con el fin de dimensionar lo mucho que el ambiente o la influencia del hombre impacta en la enfermedad.

Validation of a bioelectrical impedance analysis system for body composition assessment in patients with COPD.

OBJECTIVE: To investigate the validity of an eight-contact electrode bioelectrical impedance analysis (BIA) system within a household scale for assessing whole body composition in COPD patients. METHODS: Seventeen patients with COPD (mean age = 67 ± 8 years; mean FEV1 = 38.6 ± 16.1% of predicted; and mean body mass index = 24.7 ± 5.4 kg/m2) underwent dual-energy X-ray absorptiometry (DEXA) and an eight-contact electrode BIA system for body composition assessment. RESULTS: There was a strong inter-method correlation for fat mass (r = 0.95), fat-free mass (r = 0.93), and lean mass (r = 0.93), but the correlation was moderate for bone mineral content (r = 0.73; p < 0.01 for all). In the agreement analysis, the values between DEXA and the BIA system differed by only 0.15 kg (-6.39 to 6.70 kg), 0.26 kg (-5.96 to 6.49 kg), -0.13 kg (-0.76 to 0.50 kg), and -0.55 kg (-6.71 to 5.61 kg) for fat-free mass, lean mass, bone mineral content, and fat mass, respectively. CONCLUSIONS: The eight-contact electrode BIA system showed to be a valid tool in the assessment of whole body composition in our sample of patients with COPD.

Functional capacity measurement: reference equations for the Glittre Activities of Daily Living test / Avaliação da capacidade funcional: equações de referência para o teste Glittre Activities of Daily Living

ABSTRACT Objective: To develop reference equations for the Glittre Activities of Daily Living test (Glittre ADL-test) on the basis of anthropometric and demographic variables in apparently healthy individuals. A secondary objective was to determine the reliability of the equations in a sample of COPD patients. Methods: This was a cross-sectional study including 190 apparently healthy individuals (95 males; median age, 54.5 years [range, 42-65]; median FEV1 = 97% [range, 91-105.2]; and median FVC = 96% [range, 88.5-102]) recruited from the general community and 74 COPD patients (55 males; mean age, 65 ± 8 years; body mass index [BMI] = 25.9 ± 4.7 kg/m2; FEV1 = 36.1 ± 14.1%; and FVC = 62.7 ± 16.1%) recruited from a pulmonary rehabilitation center. Results: The mean time to complete the Glittre ADL-test was 2.84 ± 0.45 min. In the stepwise multiple linear regression analysis, age and height were selected as Glittre ADL-test performance predictors, explaining 32.1% (p < 0.01) of the total variance. Equation 1 was as follows: Glittre ADL-testpredicted = 3.049 + (0.015 × ageyears) + (−0.006 × heightcm). Equation 2 included age and BMI and explained 32.3% of the variance in the test, the equation being as follows: Glittre ADL-testpredicted = 1.558 + (0.018 × BMI) + (0.016 × ageyears). Conclusions: The reference equations for the time to complete the Glittre ADL-test were based on age, BMI, and height as independent variables and can be useful for predicting the performance of adult individuals. The predicted values appear to be reliable when applied to COPD patients.

RESUMO Objetivo: Elaborar equações de referência para o teste Glittre Activities of Daily Living (Glittre ADL) com base em variáveis antropométricas e demográficas em indivíduos aparentemente saudáveis. O objetivo secundário foi determinar a confiabilidade das equações em uma amostra composta por pacientes com DPOC. Métodos: Estudo transversal com 190 indivíduos aparentemente saudáveis [95 homens; mediana de idade: 54,5 anos (variação: 42-65); mediana de VEF1 = 97% (variação: 91-105,2); mediana de CVF = 96% (variação: 88,5-102)] recrutados na comunidade geral e 74 pacientes com DPOC [55 homens; média de idade: 65 ± 8 anos; índice de massa corporal (IMC) = 25,9 ± 4,7 kg/m2; VEF1 = 36,1 ± 14,1%; CVF = 62,7 ± 16,1%] recrutados em um centro de reabilitação pulmonar. Resultados: A média do tempo necessário para completar o teste Glittre ADL foi de 2,84 ± 0,45 min. Na análise de regressão linear múltipla passo a passo (stepwise), a idade e a estatura foram selecionadas como preditores do desempenho no teste Glittre ADL, explicando 32,1% (p < 0,01) da variância total. A equação 1 foi a seguinte: Glittre ADLprevisto = 3,049 + (0,015 × idadeanos) + (−0,006 × alturacm). A equação 2 incluiu idade e IMC e explicou 32,3% da variância do teste: Glittre ADLprevisto = 1,558 + (0,018 × IMC) + (0,016 × idadeanos). Conclusões: As equações de referência para o tempo necessário para completar o teste Glittre ADL basearam-se na idade, IMC e estatura como variáveis independentes e podem ser úteis para prever o desempenho de indivíduos adultos. Os valores previstos são aparentemente confiáveis quando aplicados em pacientes com DPOC.

Validation of a bioelectrical impedance analysis system for body composition assessment in patients with COPD / Validação de um sistema de análise de impedância bioelétrica para a avaliação da composição corporal de pacientes com DPOC

ABSTRACT Objective: To investigate the validity of an eight-contact electrode bioelectrical impedance analysis (BIA) system within a household scale for assessing whole body composition in COPD patients. Methods: Seventeen patients with COPD (mean age = 67 ± 8 years; mean FEV1 = 38.6 ± 16.1% of predicted; and mean body mass index = 24.7 ± 5.4 kg/m2) underwent dual-energy X-ray absorptiometry (DEXA) and an eight-contact electrode BIA system for body composition assessment. Results: There was a strong inter-method correlation for fat mass (r = 0.95), fat-free mass (r = 0.93), and lean mass (r = 0.93), but the correlation was moderate for bone mineral content (r = 0.73; p < 0.01 for all). In the agreement analysis, the values between DEXA and the BIA system differed by only 0.15 kg (−6.39 to 6.70 kg), 0.26 kg (−5.96 to 6.49 kg), −0.13 kg (−0.76 to 0.50 kg), and −0.55 kg (−6.71 to 5.61 kg) for fat-free mass, lean mass, bone mineral content, and fat mass, respectively. Conclusions: The eight-contact electrode BIA system showed to be a valid tool in the assessment of whole body composition in our sample of patients with COPD.

RESUMO Objetivo: Este estudo teve como objetivo investigar a validade de um sistema de bioelectrical impedance analysis (BIA, análise de impedância bioelétrica) com oito eletrodos de contato presente em uma balança doméstica para a avaliação da composição corporal total de pacientes com DPOC. Métodos: Dezessete pacientes com DPOC (média de idade = 67 ± 8 anos; média do VEF1 = 38,6 ± 16,1% do previsto; média de índice de massa corpórea = 24,7 ± 5,4 kg/m2) foram submetidos à avaliação da composição corporal por dual-energy X-ray absorptiometry (DEXA, absorciometria por dupla emissão de raios X) e por um sistema BIA com oito eletrodos de contato. Resultados: Houve forte correlação intermétodos para massa gorda (r = 0,95), massa livre de gordura (r = 0,93) e massa magra (r = 0,93), mas correlação moderada para conteúdo mineral ósseo (r = 0,73; p < 0,01 para todos). Na análise de concordância, os valores entre DEXA e o sistema BIA diferiram em apenas 0,15 kg (−6,39 a 6,70 kg), 0,26 kg (−5,96 a 6,49 kg), −0,13 kg (−0,76 a 0,50 kg) e −0,55 kg (−6,71 a 5,61 kg) para massa livre de gordura, massa magra, conteúdo mineral ósseo e massa gorda, respectivamente. Conclusões: O sistema BIA com oito eletrodos de contato mostrou-se uma ferramenta válida na avaliação da composição corporal total em nossa amostra de pacientes com DPOC.

Functional capacity measurement: reference equations for the Glittre Activities of Daily Living test.

OBJECTIVE: To develop reference equations for the Glittre Activities of Daily Living test (Glittre ADL-test) on the basis of anthropometric and demographic variables in apparently healthy individuals. A secondary objective was to determine the reliability of the equations in a sample of COPD patients. METHODS: This was a cross-sectional study including 190 apparently healthy individuals (95 males; median age, 54.5 years [range, 42-65]; median FEV1 = 97% [range, 91-105.2]; and median FVC = 96% [range, 88.5-102]) recruited from the general community and 74 COPD patients (55 males; mean age, 65 ± 8 years; body mass index [BMI] = 25.9 ± 4.7 kg/m2; FEV1 = 36.1 ± 14.1%; and FVC = 62.7 ± 16.1%) recruited from a pulmonary rehabilitation center. RESULTS: The mean time to complete the Glittre ADL-test was 2.84 ± 0.45 min. In the stepwise multiple linear regression analysis, age and height were selected as Glittre ADL-test performance predictors, explaining 32.1% (p < 0.01) of the total variance. Equation 1 was as follows: Glittre ADL-testpredicted = 3.049 + (0.015 × ageyears) + (-0.006 × heightcm). Equation 2 included age and BMI and explained 32.3% of the variance in the test, the equation being as follows: Glittre ADL-testpredicted = 1.558 + (0.018 × BMI) + (0.016 × ageyears). CONCLUSIONS: The reference equations for the time to complete the Glittre ADL-test were based on age, BMI, and height as independent variables and can be useful for predicting the performance of adult individuals. The predicted values appear to be reliable when applied to COPD patients.

Changes in the epidemiology of visceral leishmaniasis in Brazil from 2001 to 2014.

INTRODUCTION: Visceral leishmaniasis (VL) is a neglected disease, with territorial expansion and regional differences in Brazil that require explanation. This study aimed to describe changes in the epidemiology of VL in Brazil from 2001 to 2014. METHODS: The incidence rates, sociodemographic and clinical data, and case evolution were subgrouped from 2001 to 2006 and from 2007 to 2014 and presented descriptively. Spatial distribution of disease incidence rates and changes in the spatial and temporal pattern were examined. RESULTS: In total, 47,859 VL cases were reported in Brazil between 2001 and 2014, with predominance in the Northeast macroregion (55%), though the incidence rate in this region declined between the two study periods. The State of Tocantins had the highest crude rate (26.2/100,000 inhabitants), which was responsible for VL increasing in the North macroregion. VL predominated in the urban zone (70%), in children under 4 years (34%); however, an increase in the incidence of VL in adults older than 40 years was identified, with 12.3% and 31% in the first and second period, respectively. The mapping of crude rates and autochthonous canine cases showed territorial expansion. The temporal distribution of VL was consistent in Brazil in general, with no pattern observed, but regional differences were found. CONCLUSIONS: The incidence of VL is increasing in Brazil. In addition to the State of Tocantins, which had the highest rate, new outbreaks of VL have occurred in the South macroregion of Brazil with small decreases identified in the incidence rate in the Northeast.