Bioelectrical Impedance Analysis (BIA) for the Assessment of Body Composition in Oncology: A Scoping Review.

Bioelectrical Impedance Analysis (BIA) is a reliable, non-invasive, objective, and cost-effective body composition assessment method, with high reproducibility. This scoping review aims to evaluate the current scientific and clinical evidence on BIA for body composition assessment in oncology patients, under active treatment. Literature search was conducted through MEDLINE, CINAHL, Scopus and Web of Science databases, following PRISMA-ScR Guidelines. Inclusion criteria comprised studies reporting the use of BIA for body composition evaluation in adults with cancer diagnosis. Studies including non-cancer pathology or only assessing nutritional status were excluded. This scoping review comprised a total of 36 studies: 25 were original studies including 18 prospective studies, six cross-sectional studies and one retrospective study and 11 were systematic reviews. Population size for the included original articles ranged from 18 to 1217 participants, comprising a total of 3015 patients with cancer with a mean baseline Body Mass Index (BMI) ranging from 20.3 to 30.0 kg/m2 and mean age ranging between 47 and 70 years. Review articles included a total of 273 studies, with a total of 78,350 participants. The current review considered studies reporting patients with head and neck cancer (HNC) (n = 8), breast cancer (BC) (n = 4), esophageal cancer (EC) (n = 2), liver cancer (n = 2), pancreatic cancer (PC) (n = 3), gastric cancer (GC) (n = 3), colorectal cancer (CRC) (n = 8), lung cancer (LC) (n = 1), skin cancer (SK) (n = 1) and multiple cancer types (n = 6). BIA is a suitable and valid method for the assessment of body composition in oncology. BIA-derived measures have shown good potential and relevant clinical value in preoperative risk evaluation, in the reduction of postoperative complications and hospital stay and as an important prognostic indicator in persons with cancer. Future research on the diagnostic value and clinical applications of BIA and BIA-derived phase angle (PhA) should be conducted in order to predict its impact on patient survival and other clinical outcomes.

Physical Therapists' Choices, Views and Agreements Regarding Non-Pharmacological and Non-Surgical Interventions for Knee Osteoarthritis Patients: A Mixed-Methods Study.

Objective/Aims: The aims of this study are to collect the most common non-pharmacological and non-surgical interventions used by the Portuguese physical therapists in their knee osteoarthritis patients, and to deeper understand the factors associated to their intervention choices. Methods: This study incorporated a mixed-methods design. For the quantitative data it was choose an e-survey (with 25 close-end questions, plus general information of the study and a clinical vignette), retrieving sociodemographic and self-reported practice on knee osteoarthritis information. It was analysed response frequencies and associations between variables with logistic regression analyses. For the qualitative data, it was chosen to perform semi-structured interviews in purposefully selected physical therapists to include different sociodemographic factors and survey responses regarding the physical therapists' interventions chosen. After the interviews, the audios were collected, anonymised, transcribed verbatim, and the texts explored by the thematic approach. Results: From the 277 PTs that shown interest in participating in the study, 120 fully completed the questionnaire and, from those, 10 participated in the interviews. The most chosen interventions included Resistance Exercise, Manual Therapy, Nutrition/Weight Loss, Self-care/Education, Stretching and Aquatic Exercise. Furthermore, it seems that PTs' individual characteristics (age, experience, and clinical reasoning), patient's characteristics (clinical findings and preferences), and work-related factors (facility type, work environment and available resources) are the main actors responsible for an intervention chosen. Conclusions: In the Portuguese PTs context the most important interventions are Exercise, Manual Therapy, Nutrition/Weight Loss, and Self-care/Education; these interventions chosen may be influenced by PT, patient and work-related factors.

Analysing the Effects of Different Types of Exercise on Dyspnoea and Fatigue in Adults through COPD-Systematic Review and Meta-Analysis of Randomised Clinical Trials.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition, the main symptoms of which are dyspnoea and fatigue. Though exercise has been recommended for subjects with COPD, its benefits remain unclear. The aim of this study was to summarise, through a systematic review and meta-analysis, the available evidence on the effects of aerobic, resistance, stretching, and combined exercise on the main symptoms of COPD. METHODS: Search was performed using the electronic databases PubMed and Web of Science. Randomised controlled trials (RCTs) with interventions based on aerobic, resistance and/or combined exercise published until July 2022 were identified. The effects were summarised based on standardised mean differences (95% confidence intervals) using random and fixed effect models. RESULTS: Eight studies were selected, including a total of 375 subjects. The results obtained showed that resistance exercise, aerobic exercise and combined exercise seem to improve dyspnoea and fatigue symptoms in COPD subjects. CONCLUSIONS: In general, we can conclude that exercise-based interventions appear to improve the main COPD symptoms and may benefit quality of life in this population.

Differences in visual search behavior between expert and novice team sports athletes: A systematic review with meta-analysis.

Background: For a long time, in sports, researchers have tried to understand an expert by comparing them with novices, raising the doubts if the visual search characteristics distinguish experts from novices. Therefore, the aim of the present study was to review and conduct a meta-analysis to evaluate the differences in visual search behavior between experts and novices in team sports athletes. Methods: This systematic review with meta-analysis followed the PRISMA 2020 and Cochrane's guidelines. Healthy team athletes were included, which engaged in regular practice, from any sex or competitive level, specifically classified a priori as expert or novice in the original research (i.e., if they were classified after the experiment, based on one of the tests, the study would be excluded). We considered only research published in peer-reviewed journals, with no limitations regarding date or language. It was considered healthy team sport athletes engaged in regular practice. The scenarios could be in situ or film-based. The databases of EBSCO (Academic Search Complete, Academic Search Ultimate, APA PsycArticles, and APA PsycINFO), PubMed, Scopus, SPORTDiscus, and Web of Science were used to perform the searches. The risk of bias was calculated through the RoBANS tool. Results: From a total of 6,257 records, of which 985 were duplicates, titles and abstracts of 5,272 were screened, and 45 required full-text analysis. Of those, 23 were excluded due to not fulfilling the eligibility criteria regarding participants. In the end, 22 studies were selected, however, as two studies were part of the same trial and were analyzed conjointly. Discussion: Experts showed to be older and with more years of practice. The ability to distinguish experts from novices was not so clear regarding the variables analyzed. This could be due to the strategies chosen in each study, which were specific to each scenario, and when grouping all together, it was lost information within non-representative averages. The distinction between experts and novices was not clear, showing a lot of heterogeneity in the included studies. The expert classification itself may have been the conditioning aspect for these results, retaining the doubt and the need for more studies in the field. Systematic review registration: The protocol was pre-registered in OSF (project https://osf.io/3j4qv/, register https://osf.io/dvk2n).

Older Women Who Practiced Physical Exercises before the COVID-19 Pandemic Present Metabolic Alterations and Worsened Functional Physical Capacity after One Year of Social Isolation.

BACKGROUND: Because the consequences of the lifestyle changes in older adults associated with the social isolation imposed in response to the COVID-19 pandemic are not fully understood, here, we investigated the effects of one year of social isolation imposed by COVID-19 on the metabolic parameters and functional physical capacity of older women who regularly practiced physical exercises before the pandemic. METHODS: Systemic lipid and protein profiles, estimated creatinine clearance (ECC), and functional physical capacity (FPC) were assessed before (January-February 2020) and 12 months after social isolation in 30 older women (mean age 73.77 ± 6.22) who were engaged in a combined-exercise training program for at least 3 years before the COVID-19 pandemic. RESULTS: In this group, we observed increased plasma levels of triglycerides and creatinine, an increase in the time necessary to perform gait speed and time-up-and-go tests, and reduced muscle strength assessed by the handgrip test and ECC post-COVID-19 pandemic relative to values recorded pre-pandemic. In addition, we observed significant correlations (both negative and positive) between anthropometric, some metabolic parameters, and physical tests. CONCLUSION: One year of interruption of physical exercise practice imposed in response to the COVID-19 pandemic significantly altered some systemic metabolic parameters and worsened ECC and FPC in older women.

Promoting Physical Activity in Older Adults With Type 2 Diabetes via an Anthropomorphic Conversational Agent: Development of an Evidence and Theory-Based Multi-Behavior Intervention.

Introduction: Anthropomorphic conversational agents (ACA) are a promising digital tool to support self-management of type 2 diabetes (T2D), albeit little explored. There is a dearth of literature on the detailed content of these interventions, which may limit effectiveness and replication. Our aim is to describe the development of an evidence and theory-based intervention to improve physical activity in older adults with T2D, subsumed in a multi-behavior intervention via a mobile application with an ACA. Methods: Overall decisions on the multi-behavior intervention design, such as the use of standardized behavior change techniques (BCTTv1), guided the development of the physical activity component. Firstly, recommendations on ambulatory activity were used to select the target behavior (walking). Meta-research on effective behavior change techniques (BCTs) was then identified. One meta-analysis linked effective BCTs with the three basic psychological needs of the self-determination theory (SDT). This meta-analysis, taken together with additional evidence on SDT, led to the selection of this theory to inform the design. BCTs were extracted from meta-research; we selected the most appropriate to be operationalized via the conversational agent through multidisciplinary discussions. Rules governing the dialogue flow and BCTs tailoring, taking the form "if some conditions hold then execute some action," were derived based on the Basic Psychological in Exercise Scale (competence, autonomy, and relatedness scores), in conjunction with published evidence and multidisciplinary discussions. Results: Thirteen BCTs were implemented in the prototype via the ACA (e.g., goal setting behavior 1.1). Six if-then rules were derived and depicted in the dialogue steps through process flow diagrams, which map how the system functions. An example of a rule is "If competence score ≤ 10 then, apply BCT 1.1 with 500 steps increments as options for the daily walking goal; If competence score > 10 then, apply BCT 1.1 with 1,000 steps increments as options for the daily walking goal." Conclusion: Evidence and SDT were translated into a mobile application prototype using an ACA to promote physical activity in older adults with T2D. This approach, which includes 13 BCTs and six if-then rules for their tailoring, may leverage the efforts of others in developing similar interventions.

Vertical Jump Tests: A Safe Instrument to Improve the Accuracy of the Functional Capacity Assessment in Robust Older Women.

Age-related decreases in muscle function lead to disabilities and are associated with negative health outcomes in older people. Although several physical tests can be used to assess physical performance, muscle strength, and power, their interpretation can be hampered by the ceiling effect of some of them. The aim of this study was to assess whether vertical jump tests are safe in terms of physical integrity and whether they are useful in assessing physical performance in forty-one robust older women. The investigation entailed an assessment of anthropometric characteristics, physical functioning tests (Short Physical Performance Battery (SPPB), sit-to-up 5 times and sit-to-up 30 s, gait speed, time-up-to-go test (TUGT)), and tests evaluating muscle strength and power (handgrip, lower limb isokinetic tests, and vertical jumping tests). Significant negative correlations were found between vertical jumping tests and BMI, body fat percentage, sit-to-up 5 times and TUGT. In addition, significant positive correlations were observed between vertical jumping tests and SPPB, gait speed, handgrip, and concentric isokinetic tests of knee muscles. No adverse events in volunteers' physical integrity were reported during and after the performance of all physical tests. Thus, the study results showed that vertical jumping tests are safe and accurate for assessing physical performance and are useful for monitoring age-related loss of muscle performance in robust older women.

Measuring evidence-based practice in physical therapy: a mix-methods study.

BACKGROUND: Evidence-based practice (EBP) is considered the "holy grail" to manage patients by health practitioners (such as physical therapists). However, sometimes, patients are not treated with the best interventions for their condition. Although studies already explored the facilitators and barriers for this issue, they increase in the level of importance if the information gathered are context appropriated. As the profession is relatively new in Portugal, currently little is known about the implementation of EBP in Portuguese physical therapists context. So, the aim of this study is to know if the Portuguese physical therapists use an EBP, and collect and deeper understand the factors, barriers and facilitators associated with EBP. METHODS: This study incorporated a mixed-methods design (quantitative and qualitative). In an attempt to ensure the correct population sample, a national professional association e-mail database and the e-mails of past students from national schools were requested. For the quantitative data it was choose an e-survey, adapted from the EBP: Beliefs, Attitudes, Knowledge, and Behaviors of Physical Therapists Portuguese version questionnaire, consisted of 55 close-ended questions. It was analyzed response frequencies and associations between variables with logistic regression analyses. For the qualitative data, it was choose to perform semi-structured interviews in purposefully selected physical therapists to include different sociodemographic factors (especially those found to be statistically significant in the logistic regression) and survey responses regarding the physical therapists' beliefs, attitudes, knowledge, and behaviors. The interviews were performed in an online software, where only audio contact was performed. The audios were anonymized and verbatim transcribed, and the texts explored by the thematic approach. RESULTS: From the 277 physical therapists that shown interest in participating in the study, 193 fully completed the questionnaire and, from those, 10 participated in the interviews. The Portuguese physical therapists reported positive beliefs, attitudes, knowledge, and behaviors regarding EBP. Among the physical therapists characteristics it seems that age (younger therapists), education (participating in continuing education courses; belonging to practice-orientated organizations; having a doctorate degree; pursuing a higher academic degree; and being a clinical instructor), and workplace (working for someone else account; and academic sector) are the main factors in the Portuguese EBP implementation. The Portuguese physical therapists, beyond the physical therapists individual characteristics and workplace, also stated that evidence, patients, clinical experience, schools, country and physical therapy characteristics, may behave as facilitators or barriers when performing an EBP.

Protein intake and muscle mass maintenance in patients with cancer types with high prevalence of sarcopenia: a systematic review.

RATIONALE: Cancer is associated with muscle wasting. However, optimal protein intake has not been determined, limiting the efficacy of nutritional interventions. This systematic review aims to assess the effect of protein intake on muscle mass of patients with cancer types with high prevalence of sarcopenia during treatment, in longitudinal studies. METHODS: MEDLINE, CINAHL, and Scopus databases were searched following PRISMA guidelines. Longitudinal studies written in English, including adults with high sarcopenia prevalence cancer diagnosis, submitted to (chemo)radiotherapy, with assessment of protein intake and muscle changes during treatment, published until 4 October 2020 were included. Studies including supplementation with substances, such as n-3 fatty acids, specific amino acids, or proteins, were excluded. Study appraisal was independently conducted by two reviewers, and a qualitative research synthesis was performed. RESULTS: Overall, 575 records were identified, of which, eight studies were included (one randomized clinical trial and seven uncontrolled before and after studies). Patients with head and neck (n = 5), lung (n = 2), and esophageal cancer (n = 1) were included, comprising a total of 554 participants. The studies presented heterogeneous methodologies, objectives, and methods to assess body composition. Overall, participant groups with a mean protein intake below 1.2 g/kg presented muscle wasting, with one exception, while those reporting a mean intake above 1.4 g/kg, maintained muscle during treatment. CONCLUSIONS: Our findings show that protein intakes below 1.2 g/kg, even when within the recommendations, have been associated with muscle wasting during treatment. Only intakes above 1.4 g/kg have been associated with muscle maintenance. High-quality research is needed to establish an optimal dose response.

Effect of exercise on phase angle in cancer patients: a systematic review.

INTRODUCTION: Body composition is one of the main variables of interest in clinical practice in cancer patients. Specific markers from bioelectrical impedance analysis, such as phase angle (PhA), have been assuming increasing relevance in this population. The aim of the present systematic review was to study and systematise the effect of exercise on PhA in cancer survivors, as compared to control conditions, namely usual care, with no exercise. The effect of exercise on PhA in the population of cancer survivors is not yet established. EVIDENCE ACQUISITION: This systematic review was conducted on October 13, 2021, through PubMed, Web of Science, Wiley Online Library, Directory of Open Access Journals, Science Direct and JSTOR, following PRISMA guidelines and PICOS model that include: cancer survivors with ≥18 years; intervention of any exercise program for the target group; comparison between intervention group and control group that followed control conditions, namely usual care, with no exercise; outcome related to PhA; and studies of randomized control trials. EVIDENCE SYNTHESIS: We founded a total of 1244 publications, using selected keywords. Eight studies were included in this systematic review, after inclusion/exclusion criteria considered. Compared with the control conditions, exercise training programs seem associated with a positive effect on PhA, both in solid tumours and haematologic cancer types, but only when using resistance exercise alone. According to the best evidence synthesis criteria, we could not conclude the superiority of any exercise program analysed in the value of the PhA. CONCLUSIONS: There were several exercise details that may have potential to be beneficial for PhA in cancer patients, including an early start of the exercise intervention (during treatment and immediately after discharge from hospital), the use of resistance exercise or/and aerobic exercise, and mainly a long follow-up period (≥ 4 months) to verify the structural effects of exercise on the PhA. However, there were no effects on the PhA value immediately after the intervention, regardless of the type of protocol and the intervention time.

Relationship between Heart Rate Variability and Functional Fitness in Breast Cancer Survivors: A Cross-Sectional Study.

BACKGROUND: Breast cancer is the most common malignancy among women worldwide. The treatments may also cause neuromuscular and skeletal disorders; therefore, the aim of this study was to verify the existence of a relationship between heart rate variability and different functional fitness parameters in women survivors of breast cancer. METHODS: This cross-sectional study included 25 women survivors of breast cancer, with a mean ± SD age, height, and body mass of 50.8 ± 8.8 years, 1.6 ± 0.7 m, and 67.1 ± 12.3 kg, respectively. Patients underwent measurements of heart rate variability with time and frequency domain analyses, as well as a "30 s chair-stand test", "6 min walking test", "timed up and go test", and "ball throwing test". RESULTS: A multiple linear regression analysis showed that from the heart rate variability frequency domain, high frequency explained 21% (R2 = 0.21) of the "30 s chair-stand test" performance. CONCLUSION: The findings of this study highlight high frequency as a predictor of "30 s chair-stand test" performance, regardless of age and time after diagnosis, suggesting its usefulness as a clinical indicator of functionality in breast cancer survivors. This study presents a straightforward and non-invasive methodology predicting functional fitness in women breast cancer survivors potentially applicable to clinical practice.

Phase angle cutoff value as a marker of the health status and functional capacity in breast cancer survivors.

Accurate predictive tools are key factors for cancer care. Phase angle (PhA) has been proposed as a marker of cellular health, particularly of cell-membrane integrity. Cutoff values have been proposed, including for cancer survivors. This study aimed to assess the usefulness of the proposed PhA cutoff, as a marker of bioelectrical impedance analysis (BIA) assessed health-status, and functional capacity in breast cancer (BC) survivors. This cross-sectional study included 25 women (50.6 ± 8.6 yrs) survivors of BC, divided into two groups according to the PhA reference value of 5.6° (group 1 [G1]: PhA ≤ 5.6° [n=13]; group 2 [G2]: PhA > 5.6° [n=12]) (Gupta et al. 2008). BIA-assessed health status parameters included: extracellular water (ECW), intracellular water (ICW), total body water (TBW), PhA, body mass, fat-free mass, muscle mass, body cell mass (BCM). Four functional tests were performed: 30 s chair-stand test, timed up and go test, ball throw test and 6-minute walking test. Results showed G2 had lower ECW/ICW ratio (p=0.001; ES=1.2), ECW/BCM ratio (p=0.001; ES=3.2) and ECW/TBW ratio (p=0.001; ES=4.8). There was no difference in functional capacity between groups. The results of the present study show that patients with higher PhA values have a higher ICW values and preservation in the ECW/ICW ratio, suggesting it's a better cell membrane quality and integrity. Relation of both PhA and cell membrane integrity with functional capacity warrants further research.

Critical incidents in physical education / Acidentes críticos em educação física

ABSTRACT Evaluate the student's satisfaction in Physical Education (PE) classes can contribute to help teachers in developing strategies to better planning and get students more motivated. The aim of this study is to describe what students' value most and why in a PE class. It was used a qualitative and descriptive approach of the critical incidents in a PE classroom interviewing 278 Portuguese students. The results reveal in the satisfaction striking moments, playing and compete, getting individually and collective success in a satisfactory class climate. The less welcome striking moments were a mixture of playing, compete and failure. The warmup and negative class climate also were reported as not very gratifying. The fun moments reported were personal realization, pleasure and sharing. The teacher appreciation reveals pedagogical interactions, specific knowledge and personal conduct. The students like PE classes. Planning by the PE teacher should maximize opportunities of enjoyable situations by the students, in order to improve their motivation.

RESUMO Avaliar a satisfação do aluno nas aulas de Educação Física (EF) pode contribuir para ajudar os professores no desenvolvimento de estratégias para melhor planear e motivar os alunos. O objetivo deste estudo é descrever o que os alunos valorizam e porquê numa aula de EF. Utilizou-se uma abordagem qualitativa e descritiva dos incidentes críticos numa aula de EF entrevistando 278 alunos portugueses. Os resultados revelam satisfação nos momentos marcantes no jogar e na competição, obtendo sucesso individual e coletivo num clima de classe satisfatório. Os momentos menos bem-vindos foram uma mistura de jogo, competição e fracasso. O aquecimento e um clima de classe negativo também foi relatado como não muito gratificante. Os momentos divertidos relatados foram a realização pessoal, o prazer e o compartilhamento. A valorização do professor revela interações pedagógicas, conhecimentos específicos e conduta pessoal. Os alunos gostam de aulas de EF. O planeamento do professor de EF deve maximizar as oportunidades de situações agradáveis por parte dos alunos a fim de melhorar a motivação deles.

The physiological effects of a low-impact Bodyattack (TM) class / Caracterización fisiológica de una clase de Bodyattack (TM) de bajo impacto

OBJECTIVE: To estimate total energy expenditure and intensity of a low impact BodyattackTM session using combined heart rate and movement sensing technology. METHOD: Participants were 10 (8 males) normal-weight adults (33 ± 3 years-old). Maximal oxygen capacity and heart rate were determined by the performance on a treadmill maximal exercise test using indirect calorimetric method. Heart rate and energy expenditure values were monitored during a Bodyattack™ routine using a combined heart rate and movement sensor. The manufacturer's combined activity and heart rate algorithm was used to estimate Total and Physical activity energy expenditure. RESULTS: A 60 min low impact BodyattackTM session demands a Total energy expenditure of 469.4 ± 170.8 kcal at an average intensity of 64% of maximal heart rate, from which approximately 27.2 min are spent at moderate to vigorous physical activity intensities. Compared to a high impact BodyattackTM session as reported by the trademark company, Total energy expenditure was lower in the low impact option (-194.8 Kcal, p = 0.006), but no significant differences were found in average intensity (-9.4%, p = 0.707). CONCLUSION: Bodyattack™ routines performed at a low impact option may be sufficient to meet minimal recommendations for developing and maintaining cardiorespiratory fitness, if practiced beyond three days.week-1. Although appropriate for untrained individuals and those with orthopedic limitations, energy requirements of low impact Bodyattack™ may not be enough to elicit an effective weight loss

OBJETIVO: Estimar el gasto total de energía y la intensidad de una rutina de BodyattackTM de bajo impacto. MÉTODOS: Los participantes fueron 10 adultos de peso normal (33 ± 3 años). La potencia máxima de oxígeno y la frecuencia cardíaca (FC) se determinaron por el rendimiento en una prueba de ejercicio máxima utilizando el método calorimétrico indirecto. Los valores de la frecuencia cardíaca y del gasto total de energía se monitorearon durante una rutina utilizando un sensor combinado de frecuencia cardíaca y movimiento. RESULTADOS: Una clase de BodyattackTM de bajo impacto de 60 minutos exige un gasto total de energía de 469.4 ± 170.8 kcal a una intensidad promedio del 64% de la frecuencia cardíaca máxima, de los cuales 27.2 minutos se gastan en actividad física de intensidad moderada a vigorosa. En comparación con una clase de alto impacto, el gasto total de energía fue menor en la opción de bajo impacto (-194.8 Kcal, p = 0.006), pero no se encontraron diferencias en la intensidad promedio (-9.4%, p = 0.707). CONCLUSIÓN: Las clases de Bodyattack™ de bajo impacto pueden cumplir con las recomendaciones mínimas para desarrollar y mantener la aptitud cardiorrespiratoria, si se practican más de tres días por semana. Sin embargo, los requisitos de energía de Bodyattack ™ de bajo impacto pueden no provocar una pérdida de peso efectiva

Development and validation of a complex intervention: A physical exercise programme aimed at delaying the functional decline in frail older adults.

Aim: To develop and validate a physical exercise programme aimed at delaying the functional decline in frail older adults. Design: The revised guideline of Criteria for Reporting the Development and Evaluation of Complex Interventions in health care was followed. Methods: The physical exercise programme was designed and validated by exercise specialists to be implemented by healthcare professionals. The physical exercise programme underwent three stages of development, piloting and evaluation. It includes a portfolio of exercises in different support materials (posters, e-book and website). A testing intervention was delivered to the target population. Results: The Criteria for Reporting the Development and Evaluation of Complex Interventions in health care process has the potential to help practitioners in developing and planning complex interventions, such as an exercise programme. Its components can be adjusted to the context and to the characteristics of the target population. A study protocol and a pilot study will be developed to test the effectiveness of the physical exercise programme on delaying the functional decline of frail older adults.

Development of a Complex Intervention to Improve Adherence to Antidiabetic Medication in Older People Using an Anthropomorphic Virtual Assistant Software.

Introduction: Improving adherence to antidiabetic medication is crucial, resulting in improved health outcomes, cost reduction, and minimization of waste. A lack of underlying theory in existing interventions may explain the limited success in sustaining behavior change. This paper describes the development of a theory and evidence-based complex intervention to improve adherence to oral antidiabetics in older people via a software prototype with an anthropomorphic virtual assistant. Methods: The Behavior Change Wheel (BCW) was used to develop a theoretical understanding of the change process, corresponding to the first phase of the Medical Research Council Framework for developing and evaluating complex interventions. At the BCW core is a model of human behavior (COM-B), which posits that human behavior (B) results from the interaction between capabilities (C), opportunities (O), and motivation (M). Literature-derived medication adherence determinants were mapped onto COM-B components. Then, intervention functions (IFs) were selected employing the APEASE criteria. Finally, standardized behavior change techniques (BCTs) were chosen based on their suitability and their effectiveness on medication adherence trials. The prototype was developed for android devices; its core was implemented in Unity3D, using a female 3D virtual assistant, named Vitória. Results: Two COM-B components were identified as main targets for behavior change-psychological capability and reflective motivation; these were linked with four IFs-education, persuasion, enablement, and environmental restructuring. Eleven BCTs were, in turn, linked with the IFs. An example of a BCT is "problem solving"; it requires users to pinpoint factors influencing non-adherence and subsequently offers strategies to achieve the desired behavior. BCTs were operationalized into the dialogues with Vitória and into supplementary software features. Vitória communicates with users verbally and non-verbally, expressing emotions. Input options consist of buttons or recording values, such as medication taken. Conclusion: The present approach enabled us to derive the most appropriate BCTs for our intervention. The use of an explicit bundle of BCTs, often overlooked in interventions promoting medication adherence, is expected to maximize effectiveness and facilitates replication. The first prototype is being refined with users and health professionals' contributions. Future work includes subjecting the prototype to usability tests and a feasibility trial.

The acute effect of maximal exercise on central and peripheral arterial stiffness indices and hemodynamics in children and adults.

This study compared the effects of a bout of maximal running exercise on arterial stiffness in children and adults. Right carotid blood pressure and artery stiffness indices measured by pulse wave velocity (PWV), compliance and distensibility coefficients, stiffness index α and ß (echo-tracking), contralateral carotid blood pressure, and upper and lower limb and central/aortic PWV (applanation tonometry) were taken at rest and 10 min after a bout of maximal treadmill running in 34 children (7.38 ± 0.38 years) and 45 young adults (25.22 ± 0.91 years) having similar aerobic potential. Two-by-two repeated measures analysis of variance and analysis of covariance were used to detect differences with exercise between groups. Carotid pulse pressure (PP; η(2) = 0.394) increased more in adults after exercise (p < 0.05). Compliance (η(2) = 0.385) decreased in particular in adults and in those with high changes in distending pressure, similarly to stiffness index α and ß. Carotid PWV increased more in adults and was related to local changes in PP but not mean arterial pressure (MAP). Stiffness in the lower limbs decreased (η(2) = 0.115) but apparently only in those with small MAP changes (η(2) = 0.111). No significant exercise or group interaction effects were found when variables were adjusted to height. An acute bout of maximal exercise can alter arterial stiffness and hemodynamics in the carotid artery and within the active muscle beds. Arterial stiffness and hemodynamic response to metabolic demands during exercise in children simply reflect their smaller body size and may not indicate a particular physiological difference compared with adults.

Waist-to-Hip Ratio is Related to Body Fat Content and Distribution Regardless of the Waist Circumference Measurement Protocol in Nonalcoholic Fatty Liver Disease Patients.

Central accumulation and distribution of body fat (BF) is an important cardiometabolic risk factor. Waist-to-hip ratio (WHR), commonly elevated in nonalcoholic fatty liver disease (NAFLD) patients, has been endorsed as a risk related marker of central BF content and distribution, but no standardized waist circumference measurement protocol (WCmp) has been proposed. We aimed to investigate whether using different WCmp affects the strength of association between WHR and BF content and distribution in NAFLD patients. BF was assessed with dual energy X-ray absorptiometry (DXA) in 28 NAFLD patients (19 males, 51 ± 13 years, and 9 females, 47 ± 13 years). Waist circumference (WC) was measured using four different WCmp (WC1: minimal waist; WC2: iliac crest; WC3: mid-distance between iliac crest and lowest rib; WC4: at the umbilicus) and WHR was calculated accordingly (WHR1, WHR2, WHR3 and WHR4, respectively). High WHR was found in up to 84.6% of subjects, depending on the WHR considered. With the exception of WHR1, all WHR correlated well with abdominal BF (r = .47 for WHR1; r = .59 for WHR2 and WHR3; r = .58 for WHR4) and BF distribution (r = .45 for WHR1; r = .56 for WHR2 and WHR3; r = .51 for WHR4), controlling for age, sex and body mass index (BMI). WHR2 and WHR3 diagnosed exactly the same prevalence of high WHR (76.9%). The present study confirms the strong relation between WHR and central BF, regardless of WCmp used, in NAFLD patients. WHR2 and WHR3 seemed preferable for use in clinical practice, interchangeably, for the diagnosis of high WHR in NAFLD patients.

Acompanhar o fim de vida: dilemas éticos dos enfermeiros / Accompanying the end-of-life: ethical dilemmas of nurses

Face aos avanços da ciência e da medicina, os profissionais de saúde e nomeadamente os enfermeiros, deparam-se com dilemas éticos no seu quotidiano do cuidar no que se refere à terminalidade da vida. Se por um lado a evolução da medicina permite curar doenças e prolongar a vida, por outro não deixa que a morte aconteça de forma natural. Sabe-se que o direito à vida è inerente a condição de ser Pessoa, conduzindo os enfermeiros a encarar a ultima etapa da vida como algo que não deve acontecer, levantando questões muitas vezes sem resposta, porque efetivamente envolve valores, direitos universais próprias de cada sociedade com a sua cultura e hábitos religiosos e espirituais. Neste sentido, colocou-se a questão de investigação: Quais os dilemas éticos que se colocam aos enfermeiros no cuidar do doente terminal numa unidade de cuidados paliativos da região norte? Tendo como objetivo geral: conhecer os dilemas éticos que se colocam aos Enfermeiros quando cuidam o doente terminal em unidades de cuidados paliativos da região Norte com a intencionalidade de contribuir para processos de mudança e melhoria da qualidade de cuidados. Estudo qualitativo, exploratório descritivo; recolha de dados: entrevista semiestruturada. Participantes: enfermeiros de uma unidade de cuidados paliativos do norte do país. Efetuada análise de conteúdo segundo o referencial de Bardin (2011). O estudo respeitou o princípio ético moral. Verificamos que os cuidados prestados pelos enfermeiros ao doente terminal se situam a vários níveis: assegurar as funções fisiológicas; o controlo de sintomas; os aspetos psicológicos, espirituais e comunicacionais e promover a distração. Os resultados obtidos evidenciam ainda, que os enfermeiros se questionam perante a terminalidade da vida: Eu devo sedar o doente? O doente tem direito à tomada de decisão sobre a própria morte? Eu devo respeitar o testamento vital? As estratégias adotadas por eles na gestão dos dilemas éticos perante o doente terminal situam-se fundamentalmente em ser Advogado do doente; Manter a confidencialidade da informação; Estabelecer uma comunicação interpessoal; Respeitar os valores de cada doente. Salientam que os seus dilemas se relacionam com o lidar com o sofrimento; com as emoções e sentimentos da família; com a conspiração do silêncio; com as divergênciasentre as diferentes abordagens profissionais; com o desrespeito da dignidade humana e com o desrespeito á autodeterminação do doente Destacam o modelo biomédico; insuficiência de recursos humanos; défice de trabalho em equipa; défice de autonomia na tomada de decisão como aspetos potenciadores do desenvolvimento de dilemas éticos. Alguns dos enfermeiros consideram que o doente tem direito à tomada de decisão sobre a própria morte, entendem ser ético encurtar a vida em situações de sofrimento intolerável. No que se refere ao testamento vital também não é consensual a sua opinião, para alguns é um documento importante para a prática clínica, para outros não tem importância. Verificamos, que os enfermeiros à medida que desenvolvem as suas capacidades de intervenção, mais dificuldades enfrentam na tomada de decisão, pois aproximam-se cada vez mais das situações limite, o que por vezes se torna difícil, pela atitude paternalista que adotam. É necessário humanizar o processo de morrer.

Due to scientific and medical progress, health care professionals, namely nurses, in their everyday care,find themselves confronted with ethical dilemmas surrounding the finitude of life. If, on one hand, medical evolution has made it possible to cure diseases and extend life, on the other it forestalls death from its natural course. It is known that the right to life is intrinsic to the human condition, leaving nurses to face the last chapter of life as one that should not exist,raising questions that often have no answer, because it does, undeniably, involve values, universal rights set on each society's culture,religious and spiritual habits. In this regard, the following research question arose: What ethical dilemmas do nurses, who care for terminal patients in a palliative care facility in the north region, face? The aim was: to realize the ethical dilemmas that nurses are challenged by when caring for terminal patients in palliative care facilities in the north region, with the intention of further contributing to change processes and quality of care improvement. Qualitative, descriptive and exploratory study; data collection: semi-structured interview. Participants: nurses working in a palliative care facility in the north region of the country. content analysis from the Bardin referential (2011). Moral ethical issues were respected. It was found that the care nurses provide for terminal patients, lie on various levels: ensuring physiologic functions; symptom management; psychological, spiritual and communication aspects as well as promotion of distraction. The results obtained also emphasize that nurses question themselves in face of the finitude of life: Should I sedate the patient? Does the patient have the right to end-of-life decision-making? Should I respect the living will? In face of a terminal patient, the strategies adopted by these nurses when managing ethical dilemmas, are fundamentally being the Patient´s advocate; Guaranteeing information confidentiality; Establishing interpersonal communication; Respect for every patient´s values. They underline that the dilemmas they face are related with the handling of suffering; with the family´s feelings and emotions; with the conspiracy of silence; with thedifference of professional approaches; with the disrespect for human dignity and disrespect for patient self-determination. They point out the biomedical model of health; insufficient human resources; deficient teamwork and lacking of decision-making autonomy as enhancing aspects in the development of ethical dilemmas. Some nurses consider that the patient is entitled to the right of decision-making regarding its own death, as well as consider it ethical to shorten life in case of unbearable suffering. Their opinion regarding the living will is not consensual, for some, it is an important document for clinical practice ,while for others, it is not. It was found that as nurses develop their intervention capacities they face more difficulties in decision-making, for they come more and more close to extreme situations,which proves to be sometimes demanding, due to the paternalistic attitude that they assume. It is imperative to humanize the dying process

Finding the Best Waist Circumference Measurement Protocol in Patients With Nonalcoholic Fatty Liver Disease.

BACKGROUND: Central fat accumulation is important in nonalcoholic fatty liver disease (NAFLD) etiology. It is unknown whether any commonly used waist circumference measurement protocol (WCmp), as a whole and central fat accumulation marker, is preferable for patients with NAFLD. The present study sought to find a preferable WCmp to be used in patients with NAFLD, based on 3-fold criteria. METHODS: Body fat (BF) was assessed through dual-energy x-ray absorptiometry in 28 patients with NAFLD (19 men, 51 ± 13 years; 9 women, 47 ± 13 years). WC was measured with 4 types of WCmp: WC1, narrowest torso; WC2, just above iliac crest; WC3, middistance between iliac crest and last rib; WC4, at the umbilicus. RESULTS: All WC measurements were highly correlated with central BF depots, including trunk BF (r = 0.78, r = 0.82, r = 0.82, r = 0.84 for WC1, WC2, WC3, and WC4, respectively), abdominal BF (r = 0.78, r = 0.78, r = 0.80, r = 0.72 for WC1, WC2, WC3, and WC4, respectively), and central abdominal BF (r = 0.76, r = 0.77, r = 0.78, r = 0.68 for WC1, WC2, WC3, and WC4, respectively), controlling for age, sex, and body mass index. There were no differences between the correlation coefficients obtained between all studied waist circumference measurements and each whole and central analyzed BF variable. CONCLUSIONS: All studied WCmps seem suitable for use in patients with NAFLD, particularly as a central BF clinical assessment tool, though not interchangeably. Hence, biological and precision criteria alone did not sanction the superiority of any WCmp. Practical criteria may endorse WC measured at the iliac crest.