Risk stratification for frailty, impairment and assessment of sleep disorders in community-dwelling older adults.

BACKGROUND: Frailty is associated with an increased susceptibility to functional decline, impairment, hospitalization, and mortality among the older adults. However, the potential reversibility of frailty lies in identifying modifiable factors that could prevent, mitigate, or interrupt its progression. While there is a suggestion that sleep disorders may increase the risk of frailty and impairment, the risk stratification of this relationship remains inconclusive. OBJECTIVE: Stratify the risk of frailty and impairment and investigate potential connections with sleep quality, excessive daytime sleepiness, and the risk of obstructive sleep apnea in older adults dwelling in the community. METHODS: This was a quantitative cross-sectional investigation. Frailty risk and impairment were stratified using the Frail Non-disabled Questionnaire (for impairment) and the FRAIL Scale (for Frailty). The assessment of excessive daytime sleepiness, sleep quality, and the risk of obstructive sleep apnea involved the employment of the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and the STOP-BANG questionnaire, respectively. RESULTS: A total of 109 older adults living in the urban area (86 %, p = 0.010), females (61 %; p = 0.030), median age 68 (64-75) years, with overweight (36 %, p < 0.010) and self-identified as belonging to other racial or ethnic categories (71 %, p < 0.010). According to the impairment assessment, 32 % of participants were classified as disable (p < 0.01). Conversely, as per the frailty evaluation, 33 % were pre-frail and 25 % were identified as frail. Additionally, a substantial proportion experienced poor sleep quality (80 %, p = 0.010), exhibited a moderate risk of obstructive sleep apnea (49 %, p < 0.010), and showed no signs of excessive daytime sleepiness (62 %, p < 0.010). There was a modest correlation between frailty and impairment with poor sleep quality (rho = 0.39; p < 0.001) and the risk of obstructive sleep apnea (rho = 0.26; p = 0.000). However, the was no significant relationship was observed between frailty and impairment and excessive daytime sleepiness (rho = 0.04; p = 0.660). Similarly, a modest correlation was observed between sleep quality (rho = 0.33; p < 0.001), the risk of obstructive sleep apnea (rho = 0.27; p = 0.001), and frailty. Conversely, no correlation was found with excessive daytime sleepiness (rho = 0.05; p = 0.590). Also, the poor sleep quality and the risk of obstructive sleep apnea explain 14 % of the risk of frailty in the population of community-dwelling older adults (r2 = 0.14; p = 0.04). CONCLUSION: This study reveals a modest risk of frailty and impairment with sleep quality and the risk of obstructive sleep apnea, but not with excessive daytime sleepiness in community-dwelling older adults.

Impacts of Sociodemographic Factors, Screening, and Organization of Health Services on Breast Cancer Mortality in Brazil: An Ecological Study of 20 Years.

Background: Breast cancer mortality is increasing in Brazil. This study examines the impact of sociodemographic factors, screening procedures, and primary healthcare (PHC) on breast cancer mortality. Methods: An ecological study analyzed secondary data of women diagnosed with breast cancer who died between 2000 and 2019. Sociodemographic factors, screening procedures, and PHC were examined in relation to breast cancer mortality. Statistical analyses included normality tests, Kruskal-Wallis and one-way ANOVA tests with post hoc comparisons, Pearson and Spearman correlation tests, age-period-cohort analysis, Kaplan-Meier analysis, and Cox regression analysis. Significance was set at p < 0.05. Results: Mortality rates were higher in the southeast (15.77) and south (15.97) regions compared to the north (5.07) (p < 0.0001). Survival rates were longer in the southeast (70.3 ± 0.05) and south (70.6 ± 0.09) than in the north (63.98 ± 0.053) (p ≤ 0.001). Mortality increased with age after 32 years (p ≤ 0.001). Brown and indigenous women had lower mortality and survival rates. Increased coverage of PHC, ultrasound, and biopsy did not reduce mortality. However, improved cytopathologic analysis led to a decrease in mortality. Conclusions: Sociodemographic factors, screening procedures, and PHC are specific predictors of breast cancer mortality in Brazil.

Translation, transcultural adaptation, and validation of the Brazilian Portuguese version of the Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) questionnaire.

PURPOSE: To analyse the psychometric properties of the translated and cross-culturally adapted version of the OSAKA (Obstructive Sleep Apnea Knowledge and Attitudes) questionnaire in the Brazilian Portuguese language. METHODS: The OSAKA instrument was translated by two independent translators, and the back-translated conciliated version was presented and approved by Washington University, which holds the intellectual property for the OSAKA questionnaire. Physicians from different specialties electronically completed the OSAKA instrument and the ASKME (Assessment of Sleep Knowledge in Medical Education) questionnaire, which was used as an auxiliary instrument to analyse the construct validity. RESULTS: The questionnaire was tested with 176 physicians. The items from the knowledge and attitudes domains presented acceptable internal consistency values, with McDonald's omega coefficients (Ω) of 0.70 and 0.73, respectively. The OSAKA questionnaire showed a moderate correlation with the ASKME instrument (r = 0.60, p < 0.001) and excellent retest reliability, with an intraclass correlation coefficient of 0.81. There were differences in knowledge between the medical specialties (p < 0.001). Regarding attitudes, most respondents considered obstructive sleep apnoea and its diagnosis to be important and felt confident in identifying it, but the same majority did not feel confident in treating the disease. CONCLUSION: The OSAKA instrument, as a translated and cross-culturally adapted Brazilian Portuguese version, presented psychometric properties with adequate reliability and validity.

Five-year survival rate and prognostic factors in women with breast cancer treated at a reference hospital in the Brazilian Amazon.

Breast cancer is the most prevalent malignant neoplasm and the leading cause cancer of death among women globally. In Brazil, survival rates vary according to the region and few studies have been conducted on breast cancer survival in less developed areas, such as the Amazon region. The aim of this study was to analyze the five-year survival rate and prognostic factors in women treated for breast cancer in the city of Belém in northern Brazil. A retrospective hospital-based cohort study was conducted (2007-2013). Sociodemographic, clinical/tumor, and treatment variables were obtained from the records at the Ophir Loyola Hospital. Survival analysis involved the Kaplan-Meier statistical method and Cox regression analysis was performed. The significance level was 5% (p <0.05). A total of 1,430 cases were analyzed. Mean survival time was 51.71 (± 17.22) months, with an estimated overall survival of 79.4%. In the multivariate analysis, referral from the public health care system, advanced clinical stage, lymph node involvement and metastasis were associated with worse prognosis and lower survival rate. Radiotherapy and hormone therapy were associated with increased survival. These findings can contribute to the development of regional strategies for early detection of breast cancer, reducing the incidence and mortality rates and increasing survival time.

Musculoskeletal symptoms and presentism among professionals of public health management of Belém-PA, Brazil / Sintomas osteomusculares e presenteísmo entre profissionais da gestão de saúde pública do município de Belém-PA, Brasil

INTRODUCTION: Work-related musculoskeletal disorders affect the performance of workers and can increase presenteeism, a condition in which the employee comes to the workplace but does not produce satisfactory results because he is ill. OBJETIVOS: To identify the prevalence of musculoskeletal symptoms and its association with presenteeism among public health management professionals of Belem-PA, Brazil. METHODS: Cross-sectional study carried out with 88 professionals from the Municipal Health Department of Belem. A sociodemographic questionnaire was used to characterize the sample; the Nordic Musculoskeletal Questionnaire to identify the prevalence of pain, numbness, and tingling symptoms in the body; and the Stanford Presenteeism Scale to characterize presenteeism. Associations between variables were analyzed using a 5% significance level. RESULTS: Musculoskeletal symptoms in the upper and lower back were the most prevalent. Presenteeism was significantly associated with daily workload, physical activity, and the presence of diagnosed musculoskeletal diseases or injuries. In the past 12 months, musculoskeletal symptoms in the neck, upper and lower back, wrists/hands, and hips/thighs have been associated with presenteeism. In the past 7 days, presenteeism has been associated with symptoms in the upper back and lower back. CONCLUSION: The most prevalent musculoskeletal disorders in health management professionals are associated with presenteeism.

INTRODUÇÃO: Os distúrbios osteomusculares relacionados ao trabalho afetam o desempenho de trabalhadores e podem elevar o presenteísmo, condição em que o empregado comparece ao local de trabalho, mas não produz satisfatoriamente por estar doente. OBJETIVO: Identificar a prevalência de sintomas osteomusculares e sua associação com o presenteísmo entre profissionais da gestão de saúde pública do município de Belém-PA, Brasil. MÉTODOS: Estudo transversal, desenvolvido com 88 profissionais da Secretaria Municipal de Saúde de Belém. Utilizou-se questionário sociodemográfico para caracterizar a amostra, o Questionário Nórdico de sintomas osteomusculares para identificar a prevalência de sintomas de dor, dormência e formigamento no corpo, e o Stanford Presenteeism Scale para caracterizar o presenteísmo. As associações entre as variáveis foram realizadas utilizando um nível de significância de 5%. RESULTADOS: Os sintomas osteomusculares nas partes superior e inferior das costas foram os mais prevalentes. O presenteísmo teve associação significante com carga-horária diária, prática de atividade física e presença doenças ou lesões osteomusculares diagnosticadas. Nos últimos 12 meses, os sintomas osteomusculares em pescoço, parte superior e inferior das costas, punhos/mãos e quadril/coxas foram associados com o presenteísmo. Nos últimos 7 dias, o presenteísmo foi associado aos sintomas em parte superior das costas e parte inferior das costas. CONCLUSÃO: Os distúrbios osteomusculares mais prevalentes em profissionais da gestão de saúde estão associados ao presenteísmo.

Static balance in older adults with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation / Equilíbrio estático em idosos com doença pulmonar obstrutiva crônica participantes de reabilitação pulmonar

OBJECTIVE: To compare balance between older adults with and without chronic obstructive pulmonary disease (COPD) in tasks involving proprioceptive changes and respiratory muscle load, and to investigate the association between balance, functional capacity, and peripheral and respiratory muscle strength. METHODS: Fourteen older adults with COPD undergoing pulmonary rehabilitation and nine older adults without pulmonary disease were evaluated for static balance on a force platform under four conditions: eyes open, eyes closed, eyes closed on foam, and eyes open with respiratory overload. Differences between groups, among conditions and group/condition interactions, were tested using two-way ANOVA. Associations were explored using Pearsons correlation coefficient. RESULTS: No differences in the posturographic variables were found in the group/condition interactions (p ≥0.23). The COPD group exhibited greater total displacement (F = 8.79, p = 0.003), mediolateral sway (F = 4.01, p = 0.04) and anteroposterior velocity (F = 4.28, p = 0.04) in the group effect analysis. Significant differences were found between eyes closed on foam and other conditions for all posturographic variables: anteroposterior sway (F = 13.39), mediolateral sway (F = 28.58), total displacement (F = 59.4), area (F = 37.68), anteroposterior velocity (F = 26.42), and mediolateral velocity (F = 33.29), in the condition effect analysis (p <0.001, post-hoc). In the COPD group, significant correlations were found between the Glittre-ADL test, anteroposterior sway (r = 0.68, p = 0.01), and anteroposterior velocity (r = 0.67, p = 0.009); the 6MWT was also correlated with anteroposterior velocity (r = 0.59, p = 0.03). CONCLUSION: Older adults with COPD present balance deficits compared to healthy individuals. The unstable surface caused greater postural instability compared to other conditions in both groups. Impaired balance was associated with reduced physical function and exercise capacity.

OBJETIVO: Comparar o equilíbrio entre idosos com e sem doença pulmonar obstrutiva crônica (DPOC) em tarefas envolvendo alterações proprioceptiva e sobrecarga muscular respiratória além de investigar a associação entre equilíbrio, capacidade funcional e força muscular respiratória e periférica. METODOLOGIA: Quatorze idosos com DPOC participantes de reabilitação pulmonar e nove idosos sem doença pulmonar tiveram seu equilíbrio estático avaliado em uma plataforma de força em quatro condições: olhos abertos, olhos fechados, olhos fechados com espuma e olhos abertos com sobrecarga respiratória. As diferenças entre os grupos, condições e interações grupo/condição foram testadas utilizando a ANOVA bidirecional. As associações foram testadas utilizando o coeficiente de correlação de Pearson. RESULTADOS: Não foram observadas diferenças nas variáveis posturográficas nas interações grupo/condição (p ≥0,23). O grupo com DPOC apresentou maior deslocamento total (F = 8,79, p = 0,003), oscilação médio-lateral (F = 4,01, p = 0,04) e velocidade anteroposterior (F = 4,28, p = 0,04) na análise do efeito grupo. Foram encontradas diferenças significativas entre a condição de olhos fechados com espuma e as demais condições em todas as variáveis posturográficas: oscilação anteroposterior (F = 13,39) e médio-lateral (F = 28,58), deslocamento total (F = 59,4), área (F = 37,68), velocidade anteroposterior (F = 26,42) e médio-lateral (F = 33,29), na análise do efeito condição (p <0,001, post-hoc). No grupo DPOC, foram observadas correlações significativas entre o teste Glittre-AVD, oscilação anteroposterior (r = 0,68, p = 0,01) e velocidade anteroposterior (r = 0,67, p = 0,009); o TC6m também foi correlacionado com a velocidade anteroposterior (r = -0,59, p = 0,03). CONCLUSÃO: Os idosos com DPOC apresentaram déficits de equilíbrio em relação aos indivíduos saudáveis. A superfície instável provocou maior instabilidade postural em comparação às outras condições em ambos os grupos. O equilíbrio prejudicado está associado ao desempenho funcional reduzido e à baixa capacidade de exercício.

Physiological response to the Glittre-ADL test in elderly COPD patients / Resposta fisiológica ao teste AVD-Glittre em idosos com DPOC

Abstract Introduction: The Glittre-ADL (TGlittre) test was developed to assess functional capacity in a group of activities of daily living, but little is known about the physiological responses expected during its implementation. Objective: To evaluate the physiological responses induced by TGlittre in COPD patients and compare them with those induced by the 6-minute walk test (6MWT). Method: This is a cross-sectional study involving 15 elderly patients with COPD (70±6 years and predicted FEV1 of 47±16%). The TGlittre and 6MWT were performed on two different days, evaluating heart rate, peripheral oxygen saturation and perceived exertion in the 1st, 4th and 6th minutes of the 6MWT and at the start, after each lap and the end of TGlittre. After the normality test (Shapiro-Wilk), the Wilcoxon test was applied to compare the functional tests, and Spearman's correlation coefficient to assess the association between variables. Results: At the end of TGlittre, heart rate was faster than in the 6MWT (106.7±21.9 vs 96.4±16.2bpm, p = 0.02). The other physiological variables were similar at the end of both tests. Heart rate at the end of TGlittre correlated with the final heart rate in the 6MWT (r = 0.69; p = 0.002). Conclusion: TGlittre induced a faster heart rate than in the 6MWT, with increased metabolic demand, but with similar ventilatory responses.

Resumo Introdução: O Teste AVD-Glittre (TGlittre) foi desenvolvido para avaliar a capacidade funcional por meio de um grupo de atividades de vida diária, porém ainda pouco se sabe sobre as respostas fisiológicas esperadas durante a sua execução. Objetivo: Avaliar as respostas fisiológicas induzidas pelo TGlittre em pacientes idosos com DPOC em comparação as respostas induzidas pelo Teste de Caminhada de 6 Minutos (TC6m). Método: Estudo observacional transversal. Participaram 15 pacientes idosos com DPOC (70±6 anos, VEF1: 47±16% do previsto). Em dois dias diferentes, realizou-se o TGlittre e o TC6m, registrando-se a frequência cardíaca, saturação periférica de oxigênio e a percepção de esforço no 1º, 4º e 6º minutos do TC6m e no início, após cada volta e ao final do TGlittre. Após a análise de normalidade (Shapiro-Wilk), utilizou-se o teste de Wilcoxon para comparações entre as variáveis fisiológicas em resposta aos testes funcionais e o coeficiente de correlação de Spearman para verificar a associação entre as variáveis. Resultados: Ao final do TGlittre, a frequência cardíaca foi superior à do TC6m (106,7±21,9 vs 96,4±16,2 bpm, p = 0,02). As demais variáveis fisiológicas foram similares ao final em ambos os testes. A frequência cardíaca final do TGlittre correlacionou-se com a frequência cardíaca final do TC6m (r = 0,69; p = 0,002). Conclusão: O TGlittre foi capaz de induzir a uma frequência cardíaca superior em relação ao TC6m, com maior demanda metabólica, porém com respostas ventilatórias similares no grupo estudado.

Five-year survival and associated factors in women treated for cervical cancer at a reference hospital in the Brazilian Amazon.

Cervical cancer (CC) is the most common type of cancer in women and is the third leading cause of death in most developing countries, causing more than 288,000 deaths in women worldwide each year. The most favourable survival rate is in developed countries, since CC mortality has recently declined in those countries. The purpose of this study was to determine the survival rate and associated factors of CC patients at a reference hospital in the Amazon region. The patient sample included records of 339 patients with cervical cancer who had been hospitalized in Belém, Pará, Brazil from January 2005 to December 2010; the socioeconomic and clinical data were collected between June and September 2016. A survival rate of approximately 84% was observed, and it was found that disease stage (p <0.01), metastasis (p <0.01) and readmission (p <0.01) had significant influences on patient outcome. The impact of these factors on the general survival rate was higher in the Amazon region compared with other regions of Brazil, and the primary survival factors were associated with earlier stages of the disease. However, more national studies are needed on this subject. Our findings may contribute to the development of regional strategies for the prevention of cervical cancer, a reduction in its incidence and mortality rate, an increase in survival time and an improvement in the quality of life of these women.

THE IMPACT OF PHYSICAL THERAPY ON THE QUALITY OF LIFE OF WOMEN AFTER BREAST CANCER SURGERY / A influência da fisioterapia na qualidade de vida de mulheres após o tratamento cirúrgico do câncer de mama

Objective: To evaluate the impact of physical therapy on the quality of life of patients after breast cancer surgery. Methods: We included 16 female patients who underwent breast cancer surgery in this clinical, longitudinal, prospective, and convenience sample study. The patients underwent a mastectomy or a quadrantectomy through an axillary approach and were evaluated before and after 20 sessions of physical therapy. Quality of life was assessed by the European Organization for Research and Quality of Life Questionnaire C-30 (EORTC QLQ C-30) and the Breast Cancer Module (EORTC QLQ BR-23) questionnaire. For the statistical analysis, we used the Shapiro-Wilk test to evaluate the distribution of quality of life data. The data from before and after physical therapy was compared through the Wilcoxon test. Results: After participating in physical therapy, there was a significant improvement in physical function (p=0.023), cognitive function (p=0.033), social function (p=0.013), pain (p=0.025), fatigue (p=0.001), financial difficulty (p=0.007), and body image (p<0.001). Conclusion: According to the data presented in this study, we suggest that a physiotherapeutic approach positively impacts the quality of life of patients after breast cancer surgery.

Objetivo: Avaliar a influência da fisioterapia na qualidade de vida de pacientes após o tratamento cirúrgico do câncer de mama. Metodologia: Neste estudo clínico, longitudinal, prospectivo e de amostra por conveniência foram incluídas 16 pacientes que realizaram tratamento cirúrgico do câncer de mama, submetidas à mastectomia ou quadrantectomia, associada à abordagem axilar. Elas foram avaliadas antes e depois de 20 sessões de fisioterapia. A qualidade de vida foi examinada pelos questionários European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30 (EORTC QLQ C-30) e Breast Cancer Module (EORTC QLQ BR-23). Para análise estatística, foi utilizado o teste de Shapiro-Wilk, para avaliação da distribuição dos dados sobre a qualidade de vida, sendo estes comparados antes e depois da fisioterapia por meio do teste de Wilcoxon. Resultados: Após a intervenção fisioterapêutica, houve melhora significativa em relação à qualidade de vida na função física (p=0,023), função cognitiva (p=0,033), função social (p=0,013), dor (p=0,025), fadiga (p=0,001), dificuldade financeira (p=0,007) e imagem corporal (p<0,001). Conclusão: De acordo com os dados apresentados no estudo, pode-se sugerir que a abordagem fisioterapêutica influencia positivamente na qualidade de vida de pacientes após o tratamento cirúrgico do câncer de mama.

Circulatory and Ventilatory Power: Characterization in Patients with Coronary Artery Disease.

BACKGROUND: Circulatory power (CP) and ventilatory power (VP) are indices that have been used for the clinical evaluation of patients with heart failure; however, no study has evaluated these indices in patients with coronary artery disease (CAD) without heart failure. OBJECTIVE: To characterize both indices in patients with CAD compared with healthy controls. METHODS: Eighty-seven men [CAD group = 42 subjects and healthy control group (CG) = 45 subjects] aged 40-65 years were included. Cardiopulmonary exercise testing was performed on a treadmill and the following parameters were measured: 1) peak oxygen consumption (VO2), 2) peak heart rate (HR), 3) peak blood pressure (BP), 4) peak rate-pressure product (peak systolic HR x peak BP), 5) peak oxygen pulse (peak VO2/peak HR), 6) oxygen uptake efficiency (OUES), 7) carbon dioxide production efficiency (minute ventilation/carbon dioxide production slope), 8) CP (peak VO2 x peak systolic BP) and 9) VP (peak systolic BP/carbon dioxide production efficiency). RESULTS: The CAD group had significantly lower values for peak VO2 (p < 0.001), peak HR (p < 0.001), peak systolic BP (p < 0.001), peak rate-pressure product (p < 0.001), peak oxygen pulse (p = 0.008), OUES (p < 0.001), CP (p < 0.001), and VP (p < 0.001) and significantly higher values for peak diastolic BP (p = 0.004) and carbon dioxide production efficiency (p < 0.001) compared with CG. Stepwise regression analysis showed that CP was influenced by group (R2 = 0.44, p < 0.001) and VP was influenced by both group and number of vessels with stenosis after treatment (interaction effects: R2 = 0.46, p < 0.001). CONCLUSION: The indices CP and VP were lower in men with CAD than healthy controls.

Circulatory and Ventilatory Power: Characterization in Patients with Coronary Artery Disease / Potência Circulatória e Ventilatória: Caracterização em Pacientes com Doença Arterial Coronariana

Background: Circulatory power (CP) and ventilatory power (VP) are indices that have been used for the clinical evaluation of patients with heart failure; however, no study has evaluated these indices in patients with coronary artery disease (CAD) without heart failure. Objective: To characterize both indices in patients with CAD compared with healthy controls. Methods: Eighty-seven men [CAD group = 42 subjects and healthy control group (CG) = 45 subjects] aged 40–65 years were included. Cardiopulmonary exercise testing was performed on a treadmill and the following parameters were measured: 1) peak oxygen consumption (VO2), 2) peak heart rate (HR), 3) peak blood pressure (BP), 4) peak rate-pressure product (peak systolic HR x peak BP), 5) peak oxygen pulse (peak VO2/peak HR), 6) oxygen uptake efficiency (OUES), 7) carbon dioxide production efficiency (minute ventilation/carbon dioxide production slope), 8) CP (peak VO2 x peak systolic BP) and 9) VP (peak systolic BP/carbon dioxide production efficiency). Results: The CAD group had significantly lower values for peak VO2 (p < 0.001), peak HR (p < 0.001), peak systolic BP (p < 0.001), peak rate-pressure product (p < 0.001), peak oxygen pulse (p = 0.008), OUES (p < 0.001), CP (p < 0.001), and VP (p < 0.001) and significantly higher values for peak diastolic BP (p = 0.004) and carbon dioxide production efficiency (p < 0.001) compared with CG. Stepwise regression analysis showed that CP was influenced by group (R2 = 0.44, p < 0.001) and VP was influenced by both group and number of vessels with stenosis after treatment (interaction effects: R2 = 0.46, p < 0.001). Conclusion: The indices CP and VP were lower in men with CAD than healthy controls. .

Fundamento: Os índices da Potência Circulatória (PC) e Potência Ventilatória (PV) têm sido utilizados para avaliação clínica de pacientes com insuficiência cardíaca, mas nenhum estudo avaliou esses índices em pacientes com Doença Arterial Coronariana (DAC). Objetivo: Caracterizar ambos os índices em pacientes com DAC comparados a indivíduos saudáveis. Métodos: Oitenta e sete homens [grupo DAC = 42 sujeitos e, grupo controle (GC) = 45 sujeitos] com idade entre 45 e 65 anos foram incluídos. Um Teste de Exercício Cardiopulmonar (TECP) foi realizado em esteira e as seguintes variáveis foram obtidas: 1) consumo de oxigênio (VO2) pico; 2) Frequência Cardíaca (FC) pico; 3) Pressão Arterial (PA) pico; 4) duplo produto pico (PA sistólica pico x FC pico); 5) pulso de oxigênio pico (VO2 pico dividido pela FC pico); 6) eficiência ventilatória para o consumo de oxigênio (OUES); 7) eficiência ventilatória para a produção de dióxido de carbono (VE/VCO2 slope); 8) PC (VO2 pico x PA sistólica pico); e 9) PV (PA sistólica pico dividido pelo VE/VCO2 slope). Resultados: O grupo DAC apresentou valores significativamente menores das seguintes variáveis no pico do exercício: VO2 (p < 0,001), FC (p < 0,001), PA sistólica (p < 0,001), duplo produto (p < 0,001), pulso de oxigênio (p = 0,008), OUES (p < 0,001), PC (p < 0,001) e PV (p < 0,001), e valores significativamente maiores de PA diastólica (p = 0,004) e VE/VCO2 slope (p < 0,001) em relação ao GC. Uma análise de regressão pelo método stepwise mostrou que a PC foi influenciada pelo grupo (R2 = 0,44, p < 0,001) e a PV tanto pelo grupo quanto pelo número de vasos com estenose pós tratamento (efeito de interação: R2 = 0,46, p < 0,001). Conclusion: Os índices da PC e PV foram menores em homens com DAC comparados ao GC, podendo dessa forma ser utilizados na caracterização dessa população. .

Cardiovascular disease prevention and implications for worksite health promotion programs in Brazil.

Economic growth, an aging population, and changes in lifestyle patterns have contributed to the rise in cardiovascular disease (CVD) in Brazil. Worksite health and wellness programs are viewed as a potentially viable means to address the increase in disease burden in Brazil. The purpose of the present review is to investigate actions proposed by the Brazilian Government for CVD prevention and the current state of worksite health promotion. Our review of literature found that the Brazilian Government has been showing a growing interest in developing and promoting CVD preventive strategies, primarily through better control of known risk factors (i.e. smoking, obesity, physical inactivity, high cholesterol, high blood pressure, and high blood glucose). Current initiatives are considered positive steps toward better CVD prevention in Brazil. With respect to worksite health and wellness, additional work is needed to determine optimal program delivery models, financial implications and individual/population compliance with healthier lifestyle choices.

Tradução e adaptação cultural do Duke activity status index para a língua portuguesa / Translation and cross-cultural adaptation of the Duke activity status index to Brazilian Portuguese

INTRODUCTION: The limited number of valid and reliable questionnaires for the evaluation of exercise tolerance has stimulated the development of simple international assessment tools for this purpose, one of the most widely used of which is the Duke Activity Status Index (DASI). However, this index has not yet been translated and adapted to the Portuguese language. OBJECTIVE: To develop a Brazilian version of the DASI and cross-culturally adapt it for the evaluation of cardiorespiratory fitness among patients with cardiovascular disease in Brazil. MATERIALS AND METHODS: The translation process involved four stages: initial translation, back-translation, multidisciplinary committee review and pre-test with 16 subjects (8 cardiac patients and 8 healthy individuals). Patients were screened from outpatient Cardiac Surgery, São Paulo Hospital. The Mann-Whitney and chi-square tests were employed to determine differences between controls and individuals with heart disease. RESULTS: The sample was characterized by individuals aged ≥ 50 years who were mainly from the southeastern region of Brazil (62.5%) and were non-smokers (56.2%). Less than half of the cohort was considered physically active (43.75%). The level of non-understanding was less than 10% of the sample. Doubts were prevalent among individuals with heart disease (75%) regarding the level of fatigue caused when performing a task. CONCLUSION: The present findings demonstrate that the DASI was successfully translated and adapted to Brazilian Portuguese.

INTRODUÇÃO: A limitação quanto ao uso rotineiro e em escala populacional dos métodos de maior acurácia para avaliação da capacidade incentivou o desenvolvimento de questionários de estimativa. O questionário Duke Activity Status Index (DASI) é um dos mais utilizados, no entanto ainda não traduzido e adaptado para língua portuguesa. OBJETIVO: Desenvolver uma versão brasileira do DASI e adaptá-lo culturalmente para avaliação da capacidade cardiorrespiratória de cardiopatas no Brasil. MATERIAIS E MÉTODOS: Foram realizadas quatro etapas metodologicamente recomendadas para esta finalidade: tradução inicial, tradução reversa, revisão por comitê multidisciplinar e pré-teste de verificação com 16 indivíduos (oito cardiopatas e oito saudáveis). Os pacientes foram triados no ambulatório da Cirurgia Cardíaca do Hospital São Paulo. Para verificar as possíveis diferenças entre os indivíduos saudáveis e cardiopatas foram utilizados os testes α Mann-Whitney ou qui-quadrado. RESULTADOS: A amostra foi caracterizada por indivíduos procedentes da região Sudeste (62,5%), não tabagistas (56,2%), ativos (43,75%) e com idade ≥ 50 anos. O nível de não compreensão aceitável foi de até 10% dos entrevistados. As dúvidas foram predominantes nos cardiopatas (75%) em relação ao grupo saudável (12,5%), sendo concentradas na consideração ou não do nível de cansaço para realizar a tarefa. CONCLUSÃO: Os resultados demonstram que o DASI foi satisfatoriamente traduzido e adaptado para a lingua portuguesa.

Pressão expiratória positiva nas vias aéreas não reproduz as respostas de frequência cardíaca à manobra de Valsalva em homens jovens saudáveis / Expiratory positive airway pressure does not reproduce heart rate responses to Valsalva maneuver in healthy young men

A pressão expiratória positiva nas vias aéreas (EPAP) é um recurso terapêutico que compreende uma inspiração seguida de expiração contra resistência. Sua aplicação promove ajustes no sistema cardiovascular, de maneira similar ao observado durante a manobra de Valsalva (MV). O objetivo deste estudo foi analisar a resposta da frequência cardíaca (FC) à MV e às diferentes formas de aplicação de EPAP a fim de identificar se e em qual condição esta técnica reproduz a resposta da FC observada na MV, em homens jovens aparentemente saudáveis. Foram estudados 10 sujeitos (24±3 anos; 25±3 kg/m2) que realizaram os procedimentos de MV e EPAP, aleatoriamente em dias diferentes. Na MV o esforço expiratório foi sustentado por 15 s (pressão oral de 40 mmHg [53,4 cmH2O]). Empregou-se duas técnicas de EPAP (isolada e terapêutica) contra 3 níveis de pressão (10, 15 e 20 cmH2O), aplicados aleatoriamente. As manobras foram repetidas três vezes com intervalo de cinco minutos. Considerou-se o maior valor de variação da FC (DFC) de cada manobra para análise. Empregou-se o teste Shapiro-Wilk para verificar a distribuição dos dados e ANOVA para medidas repetidas, com post-hoc de Fisher, considerando-se α<0,05. Os valores de DFC observados na MV foram maiores (p<0,05) que os encontrados nas diferentes técnicas de EPAP, independentemente do nível pressórico empregado. A aplicação de EPAP, nos três níveis pressóricos, gera menor sobrecarga cardíaca e não reproduz as respostas da FC observadas na MV.

The expiratory positive airway pressure (EPAP) is a therapeutic resource that comprises an inspiration followed by expiration against resistance. During its application there were adjustments in the cardiovascular system, similar to those observed during the Valsalva maneuver (VM). The aim of this study was to analyze the heart rate (HR) response to VM and to different ways of EPAP application to identify if and in which condition this technique reproduces the HR response observed in the VM, in apparently healthy young men. Ten subjects (24±3 years, 25±3 kg/m2) performed randomly the VM and EPAP procedures on different days. The expiratory effort in VM was sustained for 15 s (oral pressure of 40 mmHg [53.4cm H2O]). Two EPAP techniques were employed (alone and therapeutic) against three pressure levels (10, 15 and 20 cmH2O), randomly applied. The maneuvers were repeated three times with five minutes interval. It was considered the greatest value of HR variation (DHR) for each maneuver analysis. Were used the Shapiro-Wilk test to analyze the data distribution and the ANOVA for repeated measures, with Fisher's post-hoc, considering α<0.05. The DHR values observed in VM were higher (p<0.05) than those found in the different EPAP techniques, regardless the pressure level employee. The EPAP application, in these three level pressures, generates less cardiac overload and does not reproduce HR responses observed in the VM.

Relationship between inspiratory muscle capacity and peak exercise tolerance in patients post-myocardial infarction.

OBJECTIVE: The study objective was to evaluate inspiratory muscle endurance in patients post-myocardial infarction without respiratory muscle weakness and its correlation with peak exercise capacity. METHODS: Ten patients who recently had a myocardial infarction (recent infarction group [RIG]), 9 patients who less recently had a myocardial infarction (less recent infarction group [LIG]), and 12 healthy subjects (control group [CG]) underwent a cardiopulmonary exercise test and respiratory endurance protocol. Analysis of variance with post hoc Dunn comparisons was used to contrast performances on all tests, and Pearson's correlation was used to determine associations between variables. RESULTS: The RIG presented lower maximal incremental pressure and oxygen consumption than the CG (P < .01). There was a positive correlation between peak oxygen uptake and both maximal inspiratory pressure (.68, P < .001) and maximal incremental pressure (.65, P < .001) in the RIG. CONCLUSION: The RIG showed lower maximal incremental pressure, which is related to peak exercise capacity. This novel relationship in functional capacity can indicate the need to improve muscle endurance in these patients even in the absence of inspiratory muscle weakness.

Desafios da integralidade: revisitando as concepções sobre o papel do fisioterapeuta na equipe de Saúde da Família / Challenges of integrality: revisiting concepts about the physical therapist's role in the Family Health Team / Desafíos de la integridad: revisión de las concepciones sobre el papel del fisioterapeuta en el equipo de Salud de la Familia

A estratégia prioritária nacional na Saúde Coletiva é a Saúde da Família (PSF), no entanto, é incipiente a participação de outros profissionais de saúde na atenção primária, além da Medicina e Enfermagem. O objetivo deste estudo foi realizar uma revisão sistemática da visão acadêmica do papel do fisioterapeuta na equipe de saúde da família (ESF). Foi realizada pesquisa bibliográfica no portal da Biblioteca Virtual em Saúde (BVS/Bireme/OPAS/OMS), de janeiro de 1994 a julho de 2009. A estratégia adotada foi o cruzamento dos seguintes descritores: Programa Saúde da Família, Saúde da Família, Saúde Coletiva, Saúde Pública, Fisioterapia (especialidades), Fisioterapia (técnicas), modalidades de fisioterapia. Dos 51 trabalhos localizados, 14 não estavam disponíveis. O restante foi analisado e sete foram selecionados por contemplarem os critérios de inclusão. Conclui-se que, apesar dos esforços, a fisioterapia ainda não possui uma definição clara em relação a sua atuação no PSF.

Brazil's main strategy in public health is the Family Health Program; however, the participation of healthcare professionals other than physicians and nurses in primary care activities is incipient. The aim of this study was to perform a systematic review of the academic opinion regarding the physical therapist's role in the family health team. We performed searches in the Health Virtual Library (BVS/Bireme/PAHO/WHO) from January 1994 to July 2009. The adopted strategy was the intersection of the descriptors: Family Health Program, Family Health, Public Health, Physical therapy (specialties), Physical therapy (modalities). Of the 51 located studies, 14 were not available. The remaining studies were analyzed and seven were selected for respecting the inclusion criteria. It was concluded that, despite the efforts, the actions developed by the physical therapist in the Family Health Program are not clearly defined yet.

La estrategia prioritaria nacional en la salud colectiva es la Salud de la Familia (PSF); sin embargo es incipiente la participación de otros profesionales de salud en la atención primaria más allá de Medicina y Enfermería. Este estudio realiza una revisión sistemática de la visión académica del papel del fisioterapeuta en el equipo de la Salud de la Familia con una investigación bibliográfica en el portal de la Biblioteca Virtual en Salud (BVS/Bireme/OPAS/OMS) de enero 1994 a julio 2009. La estrategia ha sido el cruce de los siguientes descriptores: Programa Salud de la Familia, Salud de la Familia, Salud Colectiva, Salud Pública, Fisioterapia (especialidades), Fisioterapia (técnicas), modalidades de fisioterapia. Los siete trabajos seleccionados muestran que, pese a los esfuerzos, la fisioterapia todavía no cuenta con una definición clara en relación a su actuación en PSF.

Tradução e adaptação cultural para a língua portuguesa do questionário scoring of patellofemoral disorders: estudo preliminar / Translation and cross-cultural adaptation of the scoring of patellofemoral disorders into portuguese: preliminary study

OBJETIVO: Traduzir e adaptar culturalmente para língua portuguesa o questionário Scoring of Patellofemoral Disorders. MÉTODOS: 40 participantes foram selecionados entre fisioterapeutas e indivíduos leigos. O procedimento de tradução para língua portuguesa foi baseado em métodos padronizados. A escala original passou por 7 etapas até se obter a versão final em português da Escala de Desordens Patelofemorais. Em cada teste participaram 40 indivíduos, sendo 20 indivíduos leigos e 20 fisioterapeutas. O nível de não compreensão aceitável foi de até 10 por cento dos entrevistados. RESULTADOS: No 1º teste apenas as questões 3 não foram compreendidas por mais de 10 por cento dos participantes entrevistados, ocasionando a reaplicação do questionário. Já no 2° teste, apenas duas questões foram compreendidas por 90 por cento dos entrevistados e as demais questões compreendidas por mais de 90 por cento, não ocorrendo dúvidas entre os fisioterapeutas. Utilizou-se então a 2ª versão em português como versão final para a Escala de Desordens Patelofemorais. CONCLUSÃO: A escala Scoring of Patellofemoral Disorders foi traduzida e a adaptada culturalmente para língua portuguesa, tendo como título em português, Escala de Desordens Patelofemorais. Nível de Evidência II. Estudos diagnósticos, Investigação de um exame para diagnóstico.

OBJECTIVE: The aim of this study was to translate and culturally adapt the questionnaire Scoring of Patellofemoral Disorders for the Portuguese language.METHODS: 40 participants were selected, including physiotherapists and lay individuals. The process of translating the questionnaire into Portuguese was based on standardized methods. The original scale passed through seven stages, before reaching the final version in Portuguese. 40 subjects took part in each test: 20 lay individuals and 20 physiotherapists. The level acceptable of non-comprehension was up to 10% of the interviewees.RESULTS: In the first test, only three questions were not understood by more than 10% of the subjects interviewed, leading to a reapplication of the questionnaire. In the second test, only two questions were understood by 90% of the interviewees, while the remaining questions were understood by more than 90% of the interviewees, and there were no doubts among the physiotherapists. The 2nd version of the test was therefore selected as the final Portuguese version of Scoring of Patellofemoral Disorders.CONCLUSION: The Scoring of Patellofemoral Disorders scale was translated and adapted culturally for the Portuguese language, with title, in Portuguese, of Escala de Desordens Patelofemorais. Level of Evidence: Level II, development of diagnostic criteria on consecutive patients.

Conhecimento de fisioterapeutas sobre a atuação em suporte básico de vida / Physical therapists' knowledge on basic life support

O estudo visou avaliar o conhecimento de fisioterapeutas e graduandos em Fisioterapia sobre diagnóstico e atendimento de urgência à parada cardiorrespiratória. A amostra foi composta de 72 estudantes e 108 fisioterapeutas, dos quais 64 atuam no ambiente extra-hospitalar e 44 no ambiente hospitalar. Foi aplicado aos participantes um questionário sobre ressuscitação cardiopulmonar (RCP) baseado nas diretrizes da American Heart Association de 2005. As respostas foram analisadas estatisticamente. Quanto ao diagnóstico da parada cardíaca, os grupos comportaram-se de maneira semelhante, optando pela avaliação da “presença de pulso e respiração”. Quanto à seqüência de atendimento da RCP, a seqüência preconizada foi corretamente indicada por 52,8% do grupo estudante, 65,9% do subgrupo hospitalar e 40,6% do subgrupo extra-hospitalar. Quanto à relação compressão/ventilação, apenas 4,1% do grupo estudante, ninguém do extra-hospitalar e 25% do subgrupo hospitalar indicaram a relação preconizada atualmente. Quase todos (94%) os participantes reconheceram a importância do conhecimento em RCP para o fisioterapeuta. Assim, a maioria dos atuais e futuros fisioterapeutas reconhecem a importância da RCP para sua atuação profissional, mas têm conhecimento insuficiente sobre o tema e apenas uma pequena parcela busca atualizar-se...

This study aimed at assessing undergraduates' and physical therapists' knowledge on diagnosing and emergency treating cardiopulmonary arrest. Subjects were 72 students and 108 physical therapists – of which 64 were active in non-hospital environment and 44 in hospitals – who answered a questionnaire on cardiopulmonary resuscitation (CPR) based on the American Heart Association 2005 guidelines. Answers were statistically analysed. As to diagnosing cardiopulmonary arrest, groups behaved similarly, having chosen the option “absence of consciousness, pulse and breath”. Concerning the pattern of CPR assistance, the recommended ABCD sequence was recognized by 52.8% of the students, 65.9% of the hospital subgroup, and 40.6% of the non-hospital subgroup; nobody of the latter, only 4.1% of the students, and 25% of hospital professionals indicated the currently recommended compression/ventilation ratio. Almost all (94%) participants acknowledged the importance of CPR knowledge in physical therapy practice. Thus, though most current and future physical therapists recognize the importance of CPR for their professional role, they have insufficient knowledge about the subject and only few of them seek to update their knowledge...