Chronic rhinosinusitis with nasal polyps and allergic rhinitis as different multimorbid treatable traits in asthma.

Background: Respiratory multimorbidities are linked to asthma, such as allergic rhinitis (AR) with early allergic asthma and chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) with late nonallergic asthma. Objective: Our aim was to investigate the association of asthma severity and control with specific upper airway phenotypes. Method: Patients with asthma were prospectively recruited from 23 pulmonology and ear, nose, and throat clinics. Asthma severity and control, as well as upper airway comorbidities (AR and non-AR [NAR], CRSwNP, and CRS without nasal polyps [CRSsNP]) were assessed according to international consensus guidelines definitions. Results: A total of 492 asthmatic patients were included. Half of the asthmatic patients (49.6%) had associated rhinitis (37.0% had AR and 12.6% had NAR) and 36.2% had CRS (16.7% had CRSsNP and 19.5% had CRSwNP), whereas 14.2% had no sinonasal symptoms. Most cases of AR (78%) and NAR (84%) were present in patients with mild-to-moderate asthma, whereas CRSwNP was more frequent in patients with severe asthma (35% [P < .001]), mainly nonatopic asthma (44% [P < .001]). Patients with severe asthma with CRSwNP had worse asthma control, which was correlated (r = 0.249 [P = .034]) with sinus occupancy. Multiple logistic regression analysis showed that late-onset asthma, intolerance of aspirin and/or nonsteroidal anti-inflammatory drugs, and CRSwNP were independently associated with severe asthma. Conclusion: Severe asthma is associated with CRSwNP, with sinus occupancy affecting asthma control. This study has identified 2 main different upper airway treatable traits, AR and CRSwNP, which need further evaluation to improve management and control of patients with asthma.

Coping in soccer athletes: a systematic review / Enfrentamento em atletas de futebol: uma revisão sistemática

ABSTRACT Objective: Review the studies that investigated coping in soccer. Methods: A systemic search was carried out in the following databases: Pubmed, Web of Science, Scielo, Scopus, PsychINFO and SPORTDiscus. The descriptors related to the terms (Coping skills, Sport and Football) were verified in the MeSH (Medical Subject Headings) database. The inclusion criteria used were: Empirical studies published in journals peer-reviewed scientific papers; b) Studies published from December 2014 to December 2019; c) with at least one quantitative measure; d) Studies with samples of soccer athletes; and e) Articles with specific reference to the topic 'Coping skills'. Results: The results showed that coping skills interact with important variables for good performance in elite soccer, such as competitive level, sports talent, psychopathologies, age group and sex. More specifically, it was noted that the development of some coping strategies, such as facing adversity, trust/motivation and performance under pressure, are potentially common to these variables. Conclusion: It is concluded that the development of some coping strategies is fundamental to the elite athlete, since it is positively associated with the optimal development of most of the variables analyzed in the synthesized studies.

RESUMO Objetivo: Revisar sistematicamente os estudos que investigaram o coping no futebol. Métodos: Foi realizada busca sistêmica nas seguintes bases de dados: Pubmed, Web of Science, Scielo, Scopus, PsychINFO e SPORTDiscus. Os descritores relacionados aos termos (Habilidades de enfrentamento, Esporte e Futebol) foram verificados na base de dados MeSH (Medical Subject Headings). Os critérios de inclusão utilizados foram: Estudos empíricos publicados em periódicos artigos científicos revisados por pares; b) Estudos publicados de dezembro de 2014 a dezembro de 2019; c) com pelo menos uma medida quantitativa; d) Estudos com amostras de atletas de futebol; e e) Artigos com referência específica ao tema 'Habilidades de enfrentamento'. Resultados: Os resultados mostraram que as habilidades de enfrentamento interagem com variáveis importantes para o bom desempenho no futebol de elite, como nível competitivo, talento esportivo, psicopatologias, faixa etária e sexo. Mais especificamente, notou-se que o desenvolvimento de algumas estratégias de enfrentamento, como enfrentar adversidades, confiança/motivação e desempenho sob pressão, são potencialmente comuns a essas variáveis. Conclusão: Conclui-se que o desenvolvimento de algumas estratégias de enfrentamento é fundamental para o atleta de elite, pois está positivamente associado ao desenvolvimento ótimo da maioria das variáveis analisadas nos estudos sintetizados.

Effect of joint mobilization on chronic instability of the ankle:a systematic review with meta-analysis / Efecto de la movilización articular sobre la inestabilidad crónicadel tobillo: una revisión sistemática con metaanálisis

The present work aims to analyze the effect of joint mobilization in patients with chronic ankle instability on the outcomes ofpain and dorsiflexion range of motion of the ankle after systematic review study with meta-analysis. The period for developingthe research and collection was from August 2022. The databases used for collection were CENTRAL, MEDLINE/PUBMED,EMBASE, CINAHL, PEDro and SPORTDiscus, and only randomized controlled trials were included. Studies that included theclinical question by PICO (P = chronic ankle instability; I = joint mobilization; C = placebo and minimal intervention; O = painand range of motion). The analysis was performed using the Review Manager 5.4.1. The I2 test was used for heterogeneity ofthe studies. A total of 6 studies were selected for the meta-analysis in which they measured the range of motion. The findingswere statistically significant for range of motion of dorsiflexion (mean difference – MD = 0.86, 95%CI = 0.06;1.66, p = 0.04),however the findings became insignificant after the sensitivity analysis (MD = 0.58, 95%CI = -0.07;1.23, p = 0.08). There wasnot enough literature for the pain outcome. The study obtained a satisfactory result for joint mobilization when all studies inthe literature were grouped, but the result did not obtain statistical significance using better quality studies. Therefore, thereis a need for better quality of evidence for the joint mobilization technique, as well as studies with better methodologicalquality so that we can more accurately state the real effects of this technique. Systematic Review Registration: Prospectivelyregistered with PROSPERO (CRD42020193292).(AU)

El presente trabajo tiene como objetivo analizar el efecto de la movilización articular en pacientes con inestabilidad crónicadel tobillo sobre los resultados del dolor y el rango de movimiento de dorsiflexión del tobillo después de un estudio de revisión sistemática con metaanálisis. El período para el desarrollo de la investigación y la colección fue de Agosto de 2022. Lasbases de datos utilizadas para la recopilación fueron CENTRAL, MEDLINE / PUBMED, EMBASE, CINAHL, PEDro y SPORTDiscus,y solo se incluyeron ensayos controlados aleatorios. Estudios que incluyeron la pregunta clínica por PICO (P = inestabilidadcrónica del tobillo; I = movilización articular; C = placebo e intervención mínima; O = dolor y rango de movimiento). El análisisse realizó utilizando Review Manager 5.4.1. Se utilizó la prueba de I2 para determinar la heterogeneidad de los estudios. Seseleccionaron un total de 6 estudios para el metaanálisis en el que midieron el rango de movimiento. Los hallazgos fueronestadísticamente significativos para el rango de movimiento de la dorsiflexión (diferencia de medias - DM = 0,86, IC del95% = 0,06; 1,66, p = 0,04), sin embargo, los resultados se volvieron insignificantes después del análisis de sensibilidad(DM = 0,58, IC del 95% = -0,07; 1,23, p = 0,08). No hubo suficiente literatura sobre el resultado del dolor. El estudio obtuvo unresultado satisfactorio para la movilización articular cuando se agruparon todos los estudios de la literatura, pero el resultado noobtuvo significación estadística utilizando estudios de mejor calidad. Por lo tanto, se necesita una mejor calidad de evidenciapara la técnica de movilización articular, así como estudios con mejor calidad metodológica para que podamos enunciar conmayor precisión los efectos reales de esta técnica. Registro de revisión sistemática: PROSPERO (CRD42020193292).(AU)

Avaliação postural: avaliação quantitativa da postura estática de crianças de seis a dez anos de idade / Postural assessment: quantitative evaluation of static posture in children from six to ten years old

A avaliação da postura corporal estática de crianças permite identificar e prevenir desordens musculoesqueléticas no estágio inicial. Objetivo: Avaliar a postura estática de alunos de uma escola pública, comparando a postura entre as faixas etárias e entre os sexos. Métodos: A amostra foi composta por 130 escolares (62 do sexo masculino e 68 do sexo feminino), os quais tinham entre 6 e 10 anos de idade. Cada escolar foi fotografado nas vistas anterior, posterior e lateral direita, e o registro fotográfico foi analisado por meio do Software de Avaliação Postural (SAPo). Resultados: Somente foi encontrada diferença entre os sexos no ângulo do tornozelo, além de interação entre sexo e faixa etária. Em relação à idade, o alinhamento horizontal dos acrômios e o alinhamento horizontal da cabeça foram diferentes entre 6-7 e 9 anos. O alinhamento horizontal da cabeça, o alinhamento horizontal das espinhas ilíacas ântero-superior (EIAS) e o alinhamento sagital do membro inferior também apresentaram interação significativa entre sexo e idade. Conclusão: Em média, a maioria dos resultados demonstra que há um alinhamento vertical e uma simetria horizontal nos ângulos analisados, com exceção do alinhamento sagital do membro inferior, do ângulo do tornozelo e do alinhamento sagital do corpo que não demostraram um alinhamento próximo do ideal. Logo, os escolares avaliados apresentam uma boa saúde musculoesquelética.

Static postural evaluation of children allows for identifying and preventing musculoskeletal disorders in the early stages. Objective:To evaluate the static posture of students at a public school, comparing age groups and sex. Methods:The sample consisted of 130 schoolchildren (62 males and 68 females) who were 6-10 years old. Each student was photographed at the anterior, posterior, and right lateral views, and the photographic records were analyzed with the Software Postural Assessment (SAPo). Results:The ankle angle was different between sexes, presenting interaction between sex and age group. Regarding age groups, the horizontal alignment of acromion processes and horizontal alignment of the head were different between 6-7 and 9 years. The horizontal alignment of the head, the horizontal alignment of the anterior superior iliac spines, and the sagittal alignment of the lower limb also showed a significant interaction between sex and age group. Conclusion:On average, most results show a vertical alignment and a horizontal symmetry in the analyzed angles. However, the sagittal alignment of the lower limb, ankle angle, and sagittal alignment of the body did not maintain satisfactory alignment. The participants of our study presented good musculoskeletal health.

Efeito da facilitação neuromuscular proprioceptiva em meio terrestre e aquático na flexibilidade de adultos / Effect of proprioceptive neuromuscular facilitation in land and aquatic environments on adult flexibility

O objetivo do presente estudo foi analisar o efeito da facilitação neuromuscular proprioceptiva (FNP), realizada em meio terrestre e aquático, na flexibilidade de posteriores da coxa e extensores do quadril em adultos saudáveis. Trata-se de um ensaio clínico aleatorizado. A amostra foi composta por 16 adultos (18 a 35 anos) de ambos os sexos, randomizados em dois grupos: experimental (GE, n=08), submetido ao alongamento por FNP no meio aquático; e controle (GC, n=08), que recebeu a FNP no meio terrestre. A intervenção foi realizada durante seis semanas, com duas sessões semanais. Pré e pós-intervenção a flexibilidade do quadril foi avaliada pela amplitude de movimento (ADM) utilizando um goniômetro posicionado sobre essa articulação. E para determinar a flexibilidade dos músculos posteriores da coxa foi utilizado o teste sentar e alcançar. Ambas as intervenções, propiciaram um aumento significativo na flexibilidade do GE e GC (p<0,05), entretanto não houve efeito significativo de ambiente (p>0,05).

The aim of the present study was to analyze the effect of proprioceptive neuromuscular facilitation (PNF), performed in land and aquatic environments, on the flexibility of the posterior thigh and hip extensors in healthy adults. This is a randomized clinical trial. The sample was composed of 16 adults (18 to 35 years old) of both sexes, randomized into two groups: experimental (EG, n=08), submitted to PNF stretching in the aquatic environment; and control (CG, n=08), which received PNF on land. The intervention was performed during six weeks, with two weekly sessions. Before and after the intervention, hip flexibility was assessed by range of motion (ROM) using a goniometer positioned over this joint. And to determine the flexibility of the posterior thigh muscles, the sit and reach test was used. Both interventions provided a significant increase in flexibility in the EG and CG (p<0.05), however there was no significant effect on the environment (p>0.05).

Quality of coach-athlete relationship and coping as associated factors of stress, anxiety, burnout, and depression symptoms of soccer players in transition to professional: a prospective study

Abstract Aims: The present study investigated the quality of coach-athlete relationship (CAR) and coping as associated factors stress, anxiety, burnout, and depression symptoms of soccer players in the transition to professional. Methods: Twenty-three athletes from four teams of the 2019 under-20 Bahia State Championship participated in the study. The instruments used were the Coach-Athlete Relationship Questionnaire, the Coping Strategic Athletic Inventory, the Daily Analysis of Life Demands in Athletes, the Competitive State Anxiety Inventory-2R, the Burnout Questionnaire for Athletes, and the Major Depression Inventory. Data analysis was conducted using Generalized Estimation Equations, Pearson's Correlation, and Linear Multiple Regression (p < 0.05). Results: Our findings show that from the beginning to the end of the season, CAR and coping strategies were predictors of psychic occurrences. For CAR, the symptoms of anxiety associated with self-confidence and stress symptoms were predicted by Proximity and Complementarity, respectively. As for coping strategies, only the symptoms of stress were predicted by the dimension of facing adversity. Conclusion: From the beginning to the end of the season, the magnitude of the predicting factors over some psychopathologies is enhanced in youth soccer players going through a career transition stage.

A review on muscle activation behaviour during gait in shallow water and deep-water running and surface electromyography procedures.

BACKGROUND: Surface electromyography (sEMG) can provide information on muscle activation patterns during gait. OBJECTIVES: To characterize electromyographic activity during gait in shallow water and during deep-water running compare to on land and to review and analyse underwater surface-electromyographic (sEMG) procedures. SEARCH METHODS: Eight databases (MEDLINE, EMBASE, WEB OF SCIENCE, SPORT Discus, CINAHL, SCOPUS, SCIELO, and LILACS) were searched from their inception to the December of 2019. SELECTION CRITERIA: The selected studies had to be related to electromyographic analysis of gait in an aquatic environment. DATA COLLECTION AND ANALYSIS: The studies that met the inclusion criteria were reviewed by two independent reviewers and divided into four groups. RESULTS: Ten studies met the inclusion criteria. Lower muscle activation was found with treadmill water walking compared to treadmill land walking. With deep-water running, the leg muscles (tibialis anterior and gastrocnemius lateralis) have lower muscle activation when compared to on land running, but the trunk and thigh muscles have higher activation. CONCLUSION: If gait is performed on an aquatic treadmill, the muscles assessed had lower muscle activation when compared to land. During deep-water running activities, lower activation of the distal leg muscles and a higher activation thigh muscles were found when compared to on land. Studies did not follow standard processes in sEMG procedures.

Improving cognitive and physical function through 12-weeks of resistance training in older adults: Randomized controlled trial.

We performed a randomized, controlled trial to analyse the effects of resistance training (RT) on cognitive and physical function among older adults. Fifty participants (mean age 67 years, ~60% woman) were randomly assigned to an RT program or a control group. Participants allocated to RT performed three sets of 10-15RM in nine exercises, three times per week, for 12-weeks. Control group did not perform any exercise. Variables included cognitive (global and executive function) and physical function (gait, mobility and strength) outcomes. At completion of the intervention, RT was shown to have significantly mitigated the drop in selective attention and conflict resolution performance (Stroop test: -494.6; 95%CI: -883.1; -106.1) and promoted a significant improvement in working memory (digit span forward: -0.6; 95%CI: -1.0; -0.1 and forward minus backward: -0.9; 95% CI: -1.6; -0.2) and verbal fluency (animal naming: +1.4, 95%CI 0.3, 2.5). No significant between-group differences were observed for other cognitive outcomes. Regarding physical function, at completion of the intervention, the RT group demonstrated improved fast-pace gait performance (-0.3; 95% CI: -0.6; -0.0) and 1-RM (+21.4 kg; 95%CI: 16.6; 26.2). No significant between-group differences were observed for other mobility-related outcomes. In conclusion, RT improves cognitive and physical function of older adults.

Errors in the Use of Inhalers by Health Care Professionals: A Systematic Review.

BACKGROUND: Inefficient inhaler technique (IT) compromises the optimal delivery of medication. However, the IT knowledge of health care professionals (HCPs) has received scant attention. OBJECTIVE: The objective of this study was to perform a systematic review of published reports assessing the IT proficiency of HCPs in using pressurized metered dose (pMDI) and dry powder (DPI) inhalers. METHODS: Studies published between 1975 and 2014 that directly assessed the IT skills of HCPs were selected according to predefined selection criteria. RESULTS: Data were extracted from 55 studies involving 6,304 HCPs who performed 9,996 tests to demonstrate their IT proficiency. Overall, the IT was considered correct in 15.5% of cases (95% confidence interval [CI], 12-19.3), decreasing over time from 20.5% (95% CI, 14.9-26.8) from the early period (defined as 1975-1995) to 10.8% (95% CI, 7.3-14.8) during the late period (1996-2014). The most common errors in the use of pMDIs were as follows: not breathing out completely before inhalation (75%; 95% CI, 56-90), lack of coordination (64%; 95% CI, 29-92), and postinhalation breath-hold (63%; 95% CI, 52-72). The most common errors using DPI were deficient preparation (89%; 95% CI, 82-95), not breathing out completely before inhalation (79%; 95% CI, 68-87), and no breath-hold (76%; 95% CI, 67-84). CONCLUSIONS: HCPs demonstrated inadequate knowledge of the proper use of inhalers. The poor understanding of the correct use of these devices may prevent these professionals from being able to adequately assess and teach proper inhalation techniques to their patients.

Anticholinergics for asthma: a long history.

PURPOSE OF REVIEW: To provide a fast overview about the introduction and development of anticholinergic drugs in Western medicine to their current indications particularly in asthma. RECENT FINDINGS: Although short-acting muscarinic antagonists have been positioned in the last 15 years for the treatment of adults and children with moderate-to-severe acute asthma in the emergency setting (reducing the risk of hospital admissions and improving lung function), a growing body of evidence has recently emerged that positions the long-acting muscarinic anticholinergic tiotropium bromide as add-on therapy to at least inhaled corticosteroids (ICS) maintenance therapy in adults, adolescents, and children with symptomatic asthma. Thus, the addition of tiotropium bromide to ICS alone or ICS and another controller was associated with significant improvements in spirometric measures and asthma control, and a significantly decrease in the rate of asthma exacerbations. SUMMARY: Short-acting muscarinic antagonists and tiotropium bromide have a well established role in the treatment of different phases of asthma. Further data are needed to provide more evidence on other selective long-acting muscarinic antagonists in addition to tiotropium as potential treatment options.

Efficacy and safety of tiotropium in school-age children with moderate-to-severe symptomatic asthma: A systematic review.

BACKGROUND: Recently published data support the benefits and safety of the once-daily (OD) long-acting anticholinergic tiotropium bromide bronchodilator for the treatment of uncontrolled moderate-to-severe asthma in adults and adolescents. However, its role for the treatment of school-age asthmatics has not yet been clearly defined. The aim of this systematic review was to assess the efficacy and safety of tiotropium Respimat® in children aged 6-11 years with moderate-to-severe symptomatic asthma. METHODS: Randomized, placebo-controlled trials were included. Primary outcomes were peak forced expiratory volume in 1 s measured within 3 h post-dosing) [FEV1 (0-3 h) ] and trough FEV1 measured at the end of the dosing interval. RESULTS: Three studies (more than 900 patients) were selected. Tiotropium was associated with significant improvements in FEV1 peak (mean change from baseline) by 102 mL (P<.0001) and trough by 82 mL (P<.0001) compared with placebo. Tiotropium 5 µg dose presented a trend (statistically non-significant) toward a greater bronchodilation in comparison with 2.5 µg dose. Tiotropium significantly increased the rate of the Asthma Control Questionnaire (ACQ-7) responders compared with placebo (82.2% vs 75.4%, number needed to treat for benefit [NNTB]=15) and significantly decreased the number of patients with at least one exacerbation in comparison with placebo (29.1% vs. 39.8%, with a NNTB of 10). There were no significant differences in rescue medication use, withdrawals, and adverse events. CONCLUSIONS: OD tiotropium Respimat® is efficacious and well tolerated as an add-on to inhaled corticosteroids plus one or more controller medications in school-age symptomatic asthmatics.

NOMAD spectrometer on the ExoMars trace gas orbiter mission: part 2-design, manufacturing, and testing of the ultraviolet and visible channel.

NOMAD is a spectrometer suite on board the ESA/Roscosmos ExoMars Trace Gas Orbiter, which launched in March 2016. NOMAD consists of two infrared channels and one ultraviolet and visible channel, allowing the instrument to perform observations quasi-constantly, by taking nadir measurements at the day- and night-side, and during solar occultations. Here, in part 2 of a linked study, we describe the design, manufacturing, and testing of the ultraviolet and visible spectrometer channel called UVIS. We focus upon the optical design and working principle where two telescopes are coupled to a single grating spectrometer using a selector mechanism.

LABA/LAMA combinations versus LAMA monotherapy or LABA/ICS in COPD: a systematic review and meta-analysis.

BACKGROUND: Randomized controlled trials (RCTs) indicate that long-acting bronchodilator combinations, such as ß2-agonist (LABA)/muscarinic antagonist (LAMA), have favorable efficacy compared with commonly used COPD treatments. The objective of this analysis was to compare the efficacy and safety of LABA/LAMA with LAMA or LABA/inhaled corticosteroid (ICS) in adults with stable moderate-to-very-severe COPD. METHODS: This systematic review and meta-analysis (PubMed/MEDLINE, Embase, Cochrane Library and clinical trial/manufacturer databases) included RCTs comparing ≥12 weeks' LABA/LAMA treatment with LAMA and/or LABA/ICS (approved doses only). Eligible studies were independently selected by two authors using predefined data fields; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. RESULTS: Eighteen studies (23 trials) were eligible (N=20,185). LABA/LAMA significantly improved trough forced expiratory volume in 1 second (FEV1) from baseline to week 12 versus both LAMA and LABA/ICS (0.07 L and 0.08 L, P<0.0001), with patients more likely to achieve clinically important improvements in FEV1 of >100 mL (risk ratio [RR]: 1.33, 95% confidence interval [CI]: [1.20, 1.46] and RR: 1.44, 95% CI: [1.33, 1.56], respectively, the number needed to treat being eight and six, respectively). LABA/LAMA improved transitional dyspnea index and St George's Respiratory Questionnaire scores at week 12 versus LAMA (both P<0.0001), but not versus LABA/ICS, and reduced rescue medication use versus both (P<0.0001 and P=0.001, respectively). LABA/LAMA significantly reduced moderate/severe exacerbation rate compared with LABA/ICS (RR 0.82, 95% CI: [0.75, 0.91]). Adverse event (AE) incidence was no different for LABA/LAMA versus LAMA treatment, but it was lower versus LABA/ICS (RR 0.94, 95% CI: [0.89, 0.99]), including a lower pneumonia risk (RR 0.59, 95% CI: [0.43, 0.81]). LABA/LAMA presented a lower risk for withdrawals due to lack of efficacy versus LAMA (RR: 0.66, 95% CI: [0.51, 0.87]) and due to AEs versus LABA/ICS (RR: 0.83, 95% CI: [0.69, 0.99]). CONCLUSION: The greater efficacy and comparable safety profiles observed with LABA/LAMA combinations versus LAMA or LABA/ICS support their potential role as first-line treatment options in COPD. These findings are of direct relevance to clinical practice because we included all currently available LABA/LAMAs and comparators, only at doses approved for clinical use.

Asthma-chronic obstructive pulmonary disease overlap syndrome: a controversial concept.

PURPOSE OF REVIEW: To illustrate the scant evidence and the shortcomings of the concept of 'asthma-COPD overlap syndrome' (ACOS) in terms of clinical utility. RECENT FINDINGS: Asthma and chronic obstructive pulmonary disease (COPD) are considered as two distinct and heterogeneous diseases. For many years, physicians have been aware that asthma and COPD can coexist in some patients. Recently, the term ACOS has been applied when a person has clinical features of both asthma and COPD. However, the lack of an accurate diagnosis has led to inconsistent data regarding reported prevalence, prognosis and therapeutics. Even today, it has not been possible to establish a phenotypic characterization of ACOS, although it is part of the overall complexity and heterogeneity of COPDs. No high quality data exist on which to base treatment recommendations for ACOS. Consequently, in clinical practice, treatment is extrapolated from the available evidence on asthma and COPD. SUMMARY: The current concept of ACOS seems clinically irrelevant because it has no influence on the prognosis and treatment of these patients. The authors concluded that the term ACOS should be avoided in the case of patients with features of both asthma and COPD.

A systematic review with meta-analysis of fluticasone furoate/vilanterol combination for the treatment of stable COPD.

BACKGROUND: Current guidelines recommend the use of inhaled corticosteroids/long-acting beta2-agonists as first-line therapy for COPD patients at risk for acute exacerbations and/or severe airflow limitation. This systematic review assesses available evidence on the efficacy and safety of fluticasone furoate/vilanterol (FF/VI) combination versus each alone, for the treatment of patients with severe to very severe stable COPD. METHODS: Randomized, placebo-controlled trials of >8 weeks of duration were included. Primary end points were pulmonary function, COPD exacerbations and serious adverse events. FF/VI was compared with its mono-components. RESULTS: Five reports with six trials (n = 15,515 patients) met the entry criteria. FF/VI was associated with significant increases in trough FEV1 compared with vilanterol (VI) and fluticasone furoate (FF) (45 mL and 90 mL respectively). FF/VI significantly reduced the number of subjects with at least one moderate to severe exacerbation compared with VI (number needed to treat for benefit [NNTB] = 21) and with FF (NNTB = 26). There were no statistical differences in the rates of serious adverse events, cardiac events and all-cause mortality. On the contrary, FF/VI showed a significant 52% increase in the rate of pneumonia compared with VI monotherapy (5.3% vs. 3.5%). However, there was no difference in the rate of pneumonia when FF/VI was compared with FF alone. CONCLUSIONS: FF/VI combination was associated with a decrease of the rate of COPD exacerbations, without affecting mortality or cardiovascular outcomes in patients with moderate to severe stable COPD. Also, the use of FF was associated with an increased risk of pneumonia.

Postural Sway, Balance Confidence, and Fear of Falling in Women With Knee Osteoarthritis in Comparison to Matched Controls.

BACKGROUND: Osteoarthritis (OA) is a chronic degenerative disease that commonly affects the knee joints. Individuals older than 65 years of age with knee OA have a greater risk of falls. However, there has been limited examination of the parameters of postural sway (increased time, speed, and postural sway area [center of pressure{CoP}]), and OA of the knee. OBJECTIVES: The primary objective of this study was to determine whether the CoP variables discriminate between patients with knee OA and matched healthy volunteers, and to correlate the CoP variables with the Activities-Specific Balance Confidence Scale (ABC) and Falls Self-Efficacy Scale (FES). The secondary objective was to compare the CoP of older women with OA with a control group in bipedal support condition with eyes opened and closed. DESIGN: Cross-sectional study. SETTING: University Biomechanics Laboratory. PARTICIPANTS: A total of 22 participants were divided into the following 2 groups of 11 participants each: an OA group (mean = 68 years, standard deviation = 7.4 years) and a control group (mean = 66 years, standard deviation = 4.4 years). METHODS: Static postural balance was measured by a portable force platform. Data were collected in both visual conditions (eyes open and closed), in random order. Three attempts of 30 seconds were allowed for each participant on the force platform, with a 1-minute interval between attempts. MAIN OUTCOME MEASURE: Variables were the CoP total displacement of sway (TDS, in centimeters), anteroposterior amplitude displacement (APAD, in centimeters), medial-lateral amplitude displacement (MLAD, in centimeters), total mean velocity (TMV, in centimeters per second), and dispersion of the center of pressure (AREA, in centimeters squared). RESULTS: The postural sway analysis found statistically significant differences in the eyes open condition for the TDS (P = .020), APAD (P = .042), TMV (P = .010), and AREA (P = .045). In the discriminant analysis, none of the CoP variables were able to classify the groups (P = .15). The correlation analysis showed that only the AREA with eyes closed was associated with the ABC Scale (rho = -0.42). CONCLUSIONS: Women with knee OA had greater postural sway when compared with a control group for the eyes open condition. CoP variables could not discriminate between the groups. The AREA was negatively correlated with the ABC Scale, when the eyes were closed. LEVEL OF EVIDENCE: III.

Reliability of ground reaction forces in the aquatic environment.

The aim of this study was to verify the reliability of the kinetic parameters of gait using an underwater force platform. A total of 49 healthy participants with a median age of 21years were included. The kinetic gait data were collected using a 0.6×0.6×0.1m aquatic force plate (Bertec®), set in a pool (15×13×1.30m) with a water depth of 1.20m and water temperature of 32.5°C. Participants walked 10m before reaching the platform, which was fixed to the ground. Participants were instructed to step onto the platform with their preferred limb and data from three valid attempts were used to calculate the average values. A 48-h interval between tests was used for the test-retest reliability. Data were analyzed using interclass correlation coefficients (ICC) and results demonstrated that reliability ranged from poor to excellent, with ICC scores of between 0.24 and 0.87 and mean differences between (d¯)=-0.01 and 0.002. The highest reliability values were found for the vertical (Fz) and the lowest for the mediolateral components (Fy). In conclusion, the force platform is reliable for assessing the vertical and anteroposterior components of power production rates in water, however, caution should be applied when using this instrument to evaluate the mediolateral component in this environment.

Peso e modo de transporte do material escolar no ensino fundamental I: efeito dos anos escolares e do sexo / Peso y modo de transporte de útiles escolares en una escuela primaria: efecto de los años escolares y del sexo / Weight and mode of carrying schoolbags at elementary school: effect of the school grades and sex

RESUMO O peso do material escolar e o modo de transportá-lo podem contribuir para desvios posturais e dor nas costas. Por isso, o objetivo foi verificar e comparar, entre os anos escolares e os sexos, o peso do material escolar em relação ao peso corporal e o modo de transporte do material de alunos do Ensino Fundamental I, os quais deixam os seus livros em estantes na escola. Participaram 191 escolares. O peso do material escolar e o peso corporal dos alunos foram verificados com uma balança, e o modo de transporte do material foi avaliado por meio de fotos. Observou-se que 47,7% dos alunos transportavam um peso acima do limite estabelecido (10% do peso corporal do aluno), sendo que o 1º ano transportava um menor peso do que os 2º, 3º e 5º anos, mas não houve diferença entre os sexos. Foi encontrado predomínio do uso da mochila de duas alças. Contudo, apesar de a escola já ter uma estratégia para reduzir o peso do material, quase metade dos escolares transportava um peso superior a 10% do peso corporal. Logo, outras medidas para alertar os envolvidos são necessárias.

RESUMEN El peso y el modo de transporte de útiles escolares pueden contribuir con desviaciones posturales y con dolores de espalda. Por lo tanto, el objetivo fue verificar y comparar, entre los años escolares y entre los sexos, el peso de útiles escolares en relación con el peso corporal y el modo de transporte de los útiles de alumnos de una escuela primaria que dejan sus libros en estantes en la escuela. Participaron 191 alumnos. El peso de los útiles escolares y el peso corporal de los alumnos fueron verificados con balanza, y el modo de transporte fue avaluado con fotos. Entre los alumnos, 47,7% transportaban un peso mayor que el límite establecido (10% del peso corporal de los alumnos), y el 1º año transportaba menos peso que los 2º, 3º y 5º años, pero no hubo diferencia entre los sexos. Fue encontrado un predominio de mochilas con dos correas. Sin embargo, aunque la escuela ya tiene una estrategia para reducir el peso de los útiles, casi la mitad de los alumnos transportaba un peso mayor que 10% del peso corporal. Por lo tanto, son necesarias otras medidas para alertar a las personas.

ABSTRACT Schoolbag weight and mode of carrying it can contribute to postural deviations and back pain. Therefore, our objective was to determine and compare, among the school grades and between sexes, the schoolbag weight relative to body weight and the mode of carrying it of Elementary School students, who leave their books on bookcases at the school. A total of 191 students participated in the study. Schoolbag weight and students body weight were determined with a scale, and the mode of carrying the schoolbags was evaluated by means of photographs. We observed that 47.7% of the students carried a weight above the limit established (10% of the student's body weight), and the first grade students carried less weight than the 2nd, 3rd, and 5th grade students; however, no difference was observed between sexes. We observed the prevalence of using double-strap backpack. However, despite the school had a strategy to reduce the schoolbag weight, almost half of the school children carried a weight of more than 10% of body weight. Thus, other measures to raise awareness of those involved are necessary.

Once-daily fluticasone furoate and vilanterol for adolescents and adults with symptomatic asthma: A systematic review with meta-analysis.

BACKGROUND: Fluticasone furoate and vilanterol is a new inhaled corticosteroid (ICS) and long-acting ß2-agonist (LABA) combination developed for once-daily administration via a dry powder inhaler. OBJECTIVE: To assess the efficacy and safety of fluticasone furoate-vilanterol in adolescents and adults with symptomatic asthma compared with ICS monotherapy or twice-daily ICS-LABA formulations. METHODS: Randomized, placebo-controlled trials with longer than 8 weeks of treatment duration were included. Primary outcome was pulmonary function (forced expiratory volume in 1 second [FEV1] or peak expiratory flow rate [PEF]). RESULTS: Seven published randomized clinical trials were included (5,668 patients). Fluticasone furoate-vilanterol was associated with significant increases in trough FEV1 and morning and evening PEF compared with fluticasone furoate, 100 µg, monotherapy (90 mL, 20.1 L/min, and 18.9 L/min respectively). Fluticasone furoate-vilanterol reduced significantly the rate of severe asthma exacerbations (number need to treat for benefit = 24). Fluticasone furoate-vilanterol also produced significant increases in weighted FEV1 and morning and evening PEF (140 mL, 32.6 L/min, and 25.7 L/min, respectively) compared with fluticasone propionate, 500 µg twice daily. Fluticasone furoate-vilanterol presented a nonsignificant increase in the frequency of cardiac events (6.4% vs 1.8%) compared with fluticasone propionate. No differences were found between both available doses of fluticasone furoate-vilanterol (200/25 µg and 100/25 µg) in terms of efficacy. However, patients receiving fluticasone furoate-vilanterol, 200/25 µg, had a trend toward an increased risk of cardiac events. CONCLUSION: Fluticasone furoate-vilanterol combination was associated with an increase in trough FEV1 compared with fluticasone furoate-fluticasone propionate; however, observed differences may not be clinically significant. Studies comparing fluticasone furoate-vilanterol with fixed twice-daily ICS-LABA combinations are required.

Weight of school material and back pain in students leaving their books at school / Peso do material escolar e dor nas costas em alunos que deixam seus livros na escola

ABSTRACT BACKGROUND AND OBJECTIVES: The prevalence of back pain in children and adolescents has been reason for school health concern. Among different causes, school material weight is highlighted since studies have shown that it exceeds recommended values. So, strategies to decrease material weight have been adopted, such as the availability of cabinets or shelves to leave the books at school. However, it is not well explained whether such strategies would solve the problem. This study aimed at observing the association between school material weight and back pain in students who leave their material at school. METHODS: Sample was made up of 48 students of the 5th year of Basic Education of a municipal school of Petrolina-PE. Students and their materials were weighed. The back pain and body posture evaluation instrument was used to evaluate back pain. RESULTS: Mean school material weight was 10.8±3.9% of body weight, without difference between genders. From 48 students, 20 have reported back pain and there has been no association between back pain and gender or school material weight. CONCLUSION: Among students, 41.67% have reported back pain, while 52.09% carried weight above 10% of body weight, but there has been no association between school material weight and back pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: A prevalência de dor nas costas em crianças e adolescentes tem sido motivo de preocupações no âmbito da saúde escolar. Entre as diferentes causas, o peso do material escolar destaca-se, uma vez que pesquisas mostram que este excede os valores recomendados. Assim, estratégias para reduzir o peso do material têm sido adotadas, como a disponibilidade de armários ou de estantes para deixar os livros na escola. Contudo, não está bem esclarecido se essas estratégias solucionam o problema. O objetivo deste estudo foi verificar a associação entre o peso do material escolar e a presença de dor nas costas em alunos de uma escola, os quais deixam seus livros na escola. MÉTODOS: A amostra foi composta por 48 alunos do 5º ano do Ensino Fundamental de uma escola municipal de Petrolina-PE. Os alunos e seus materiais foram pesados. Para avaliar a presença de dor nas costas, foi utilizado o questionário de Avaliação da Postura Corporal e Dor nas Costas. RESULTADOS: O peso médio do material escolar foi 10,8±3,9% do peso corporal, não sendo encontrada diferença entre os gêneros. Dos 48 alunos, 20 relataram sentir dor nas costas e não foi encontrada associação da presença de dor nas costas com o gênero e com o peso do material escolar. CONCLUSÃO: Entre os alunos, 41,67% relataram sentir dor nas costas, enquanto que 52,09% transportam um peso superior a 10% do peso corporal, mas não foi encontrada associação entre o peso do material escolar e a presença de dor nas costas.