Effects of treadmill slip and trip perturbation-based balance training on falls in community-dwelling older adults (STABILITY): study protocol for a randomised controlled trial.

INTRODUCTION: Falls among older adults are most frequently caused by slips and trips and can have devastating consequences. Perturbation-based balance training (PBT) have recently shown promising fall preventive effects after even small training dosages. However, the fall preventive effects of PBT delivered on a treadmill are still unknown. Therefore, this parallel-group randomised controlled trial aims to quantify the effects of a four-session treadmill-PBT training intervention on falls compared with treadmill walking among community-dwelling older adults aged 65 years or more. METHODS AND ANALYSIS: 140 community-dwelling older adults will be recruited and randomised into either the treadmill-PBT or the treadmill walking group. Each group will undergo three initial training sessions within a week and an additional 'booster' session after 26 weeks. Participants in the treadmill-PBT group will receive 40 slip and/or trip perturbations induced by accurately timed treadmill belt accelerations at each training session. The primary outcome of interest is daily life fall rates collected using fall calendars for a follow-up period of 52 weeks. Secondary outcomes include physical, cognitive and social-psychological fall-related risk factors and will be collected at the pre-training and post-training test and the 26-week and 52-week follow-up tests. All outcomes will be analysed using the intention-to-treat approach by an external statistician. A Poisson's regressions with bootstrapping, to account for overdispersion, will be used to compare group differences in fall rates. ETHICS AND DISSEMINATION: The study protocol has been approved by the North Denmark Region Committee on Health Research Ethics (N-20200089). The results will be disseminated in peer-reviewed journals and at international conferences. TRIAL REGISTRATION NUMBER: NCT04733222.

Avaliação das condições de saúde bucal de Portadores de Necessidades Especiais / Evaluation of oral health conditions of patients with Special Needs

Objetivo: O objetivo deste trabalho foi avaliar as condições de saúde bucal de Portadores de Necessidades Especiais (PNE) de uma Escola Especial da cidade de Patos-PB, bem como identificar as dificuldades apontadas por seus responsáveis para a manutenção da saúde bucal dos mesmos. Metodologia: A população-alvo deste estudo foi composta por 74 alunos, de ambos os sexos, regularmente matriculados, que preencheram os critérios de inclusão previamente estabelecidos e por seus responsáveis. O estudo foi conduzido em duas etapas: a primeira consistiu na aplicação de um formulário aos responsáveis pelos PNE, e a segunda, na realização de um exame clínico intrabucal, realizado por um examinador e anotador previamente calibrados, em que se avaliaram as condições de saúde bucal dos alunos por meio do Índice de Cárie Dentária (CPO-D), do Índice de Higiene Oral Simplificado (IHOS) e da presença de Trauma Dentário. Resultado: Observou-se que 75,4% dos alunos já haviam recebido algum tipo de tratamento odontológico; destes, 50,9% afirmaram ter sido na Unidade Básica de Saúde. O CPO-D médio foi de 12,6 (±8,4), 52% apresentaram higiene oral deficiente e o trauma dental foi observado em 19,3% dos alunos analisados. Com relação ao parto, 51% das mães relataram ter tido uma gestação normal e 54,4% nunca haviam sido orientadas com relação aos cuidados com a saúde bucal do filho. Entre as dificuldades relatadas pelos responsáveis para manter a saúde bucal do PNE, 33,3% afirmaram ser encontrar um Dentista que o atenda e 33,3% apontaram o custo do tratamento. Conclusão: Os altos índices revelados pelo CPO-D, bem como a higiene oral deficiente, somados às dificuldades relatadas em se realizar o acompanhamento odontológico ...

Objective: The aim of this study was to evaluate the oral health of patients with Special Needs (SN), and identify the difficulties pointed out by their parents for maintaining the oral health. Methodology: The population for this study was made up of 74 students, of both sexes, enrolled who met the inclusion criteria previously established and their parents. This study was conducted in two stages: the first was the application of a form to parents of the students with SN and the second, the achievement of an intraoral clinical examination, by an examiner and recorder calibrated, which evaluated the oral health status of students through the Caries index (CPO-D), Simplified Oral Hygiene Index (IHOS) and presence of dental trauma. Result: It's noted that 75.4% had received some form of dental treatment, of these, 50.9% said they had been in the Basic Health Unit. The caries index was 12.6 (±8,4), 52% had poor hygiene oral and the dental trauma was observed in 19.3% of analyzed students. With respect to delivery, 51% of mothers reported having had a normal pregnancy and 54.4% were never oriented in relation to the oral health care of the child. Among the difficulties reported by the parents for maintaining the oral health of the SN, 33.3% claimed to be finding a dentist that meets, and 33.3% pointed the cost of treatment. Conclusion: The high rates revealed by CPO-D, as well as poor oral higiene, added to the reported difficulty in performing the dental care of these individuals, show the need to implement more public policy that give more attention to these patients. .

Applicability of the Appropriate use Criteria for Myocardial Perfusion Scintigraphy / Aplicabilidade dos Critérios de Adequação em Cintilografia Miocárdica

Background: Appropriateness Criteria for nuclear imaging exams were created by American College of Cardiology (ACC) e American Society of Nuclear Cardiology (ASNC) to allow the rational use of tests. Little is known whether these criteria have been followed in clinical practice. Objective: To evaluate whether the medical applications of myocardial perfusion scintigraphy (MPS) in a private nuclear medicine service of a tertiary cardiology hospital were suitable to the criteria of indications proposed by the American medical societies in 2005 and 2009 and compare the level of indication of both. Methods: We included records of 383 patients that underwent MPS, November 2008 up to February 2009. Demographic characteristics, patient's origin, coronary risk factors, time of medical graduation and appropriateness criteria of medical applications were studied. The criteria were evaluated by two independent physicians and, in doubtful cases, defined by a medical expert in MPS. Results: Mean age was 65 ± 12 years. Of the 367 records reviewed, 236 (64.3%) studies were performed in men and 75 (20.4%) were internee. To ACC 2005, 255 (69.5%) were considered appropriate indication and 13 (3.5%) inappropriate. With ACC 2009, 249 (67.8%) were considered appropriate indications and 13 (5.2%) inappropriate. Conclusions: We observed a high rate of adequacy of medical indications for MPS. Compared to the 2005 version, 2009 did not change the results. .

Fundamento: Os critérios de adequação para os exames de imagem nuclear foram criados pelo American College of Cardiology (ACC) e pela American Society of Nuclear Cardiology (ASNC) com o objetivo de permitir o uso racional dos exames. Pouco se sabe se esses critérios têm sido seguidos nas indicações da prática clínica. Objetivo: Avaliar se os pedidos médicos de cintilografia de perfusão miocárdica (CPM), em serviço privado de medicina nuclear de um hospital cardiológico terciário, adequavam-se aos critérios de indicações propostos pelas sociedades médicas americanas em 2005 e 2009 e comparar o grau de indicação entre ambos. Métodos: Foram incluídos 383 prontuários de pacientes submetidos à CPM de novembro de 2008 a fevereiro de 2009. As características demográficas, a origem do paciente, os fatores de risco coronariano, o tempo de formatura do médico e os critérios de adequação dos pedidos foram considerados. Os critérios foram avaliados por dois médicos independentes e, nos casos duvidosos, definidos por um especialista em CPM. Resultados: A média de idade foi de 65 ± 12 anos. Dos 367 prontuários analisados, 236 (64,3%) exames foram realizados em homens e 75 (20,4%) foram em pacientes internados. Aplicando-se os critérios do ACC de 2005, 255 (69,5%) das indicações foram consideradas adequadas e 13 (3,5%) inadequadas. Aplicando-se os critérios do ACC de 2009, 249 (67,8%) das indicações foram consideradas adequadas e 13 (5,2%) inadequadas. Conclusões: Foi observada uma elevada taxa de adequação das indicações médicas de CPM. Comparada com a edição de 2005, a versão de 2009 não alterou a taxa de exames adequados ou inadequados. .

Applicability of the Appropriate use Criteria for Myocardial Perfusion Scintigraphy.

Background: Appropriateness Criteria for nuclear imaging exams were created by American College of Cardiology (ACC) e American Society of Nuclear Cardiology (ASNC) to allow the rational use of tests. Little is known whether these criteria have been followed in clinical practice. Objective: To evaluate whether the medical applications of myocardial perfusion scintigraphy (MPS) in a private nuclear medicine service of a tertiary cardiology hospital were suitable to the criteria of indications proposed by the American medical societies in 2005 and 2009 and compare the level of indication of both. Methods: We included records of 383 patients that underwent MPS, November 2008 up to February 2009. Demographic characteristics, patient's origin, coronary risk factors, time of medical graduation and appropriateness criteria of medical applications were studied. The criteria were evaluated by two independent physicians and, in doubtful cases, defined by a medical expert in MPS. Results: Mean age was 65 ± 12 years. Of the 367 records reviewed, 236 (64.3%) studies were performed in men and 75 (20.4%) were internee. To ACC 2005, 255 (69.5%) were considered appropriate indication and 13 (3.5%) inappropriate. With ACC 2009, 249 (67.8%) were considered appropriate indications and 13 (5.2%) inappropriate. Conclusions: We observed a high rate of adequacy of medical indications for MPS. Compared to the 2005 version, 2009 did not change the results.

Morbidity, mortality, and categorization of the risk of perioperative complications in lung cancer patients.

OBJECTIVE: To determine morbidity and mortality rates by risk category in accordance with the American College of Chest Physicians guidelines, to determine what role pulmonary function tests play in this categorization process, and to identify risk factors for perioperative complications (PCs). METHODS: This was a historical cohort study based on preoperative and postoperative data collected for cases of lung cancer diagnosed or suspected between 2001 and 2010. RESULTS: Of the 239 patients evaluated, only 13 (5.4%) were classified as being at high risk of PCs. Predicted postoperative FEV1 (FEV1ppo) was sufficient to define the risk level in 156 patients (65.3%); however, cardiopulmonary exercise testing (CPET) was necessary for identifying those at high risk. Lung resection was performed in 145 patients. Overall morbidity and mortality rates were similar to those reported in other studies. However, morbidity and mortality rates for patients at an acceptable risk of PCs were 31.6% and 4.3%, respectively, whereas those for patients at high risk were 83.3% and 33.3%. Advanced age, COPD, lobe resection, and lower FEV1ppo were correlated with PCs. CONCLUSIONS: Although spirometry was sufficient for risk assessment in the majority of the population studied, CPET played a key role in the identification of high-risk patients, among whom the mortality rate was seven times higher than was that observed for those at an acceptable risk of PCs. The risk factors related to PCs coincided with those reported in previous studies.

Morbidity, mortality, and categorization of the risk of perioperative complications in lung cancer patients / Mortalidade, morbidade e categorização de risco para complicações perioperatórias em pacientes com câncer de pulmão

OBJECTIVE: To determine morbidity and mortality rates by risk category in accordance with the American College of Chest Physicians guidelines, to determine what role pulmonary function tests play in this categorization process, and to identify risk factors for perioperative complications (PCs). METHODS: This was a historical cohort study based on preoperative and postoperative data collected for cases of lung cancer diagnosed or suspected between 2001 and 2010. RESULTS: Of the 239 patients evaluated, only 13 (5.4%) were classified as being at high risk of PCs. Predicted postoperative FEV1 (FEV1ppo) was sufficient to define the risk level in 156 patients (65.3%); however, cardiopulmonary exercise testing (CPET) was necessary for identifying those at high risk. Lung resection was performed in 145 patients. Overall morbidity and mortality rates were similar to those reported in other studies. However, morbidity and mortality rates for patients at an acceptable risk of PCs were 31.6% and 4.3%, respectively, whereas those for patients at high risk were 83.3% and 33.3%. Advanced age, COPD, lobe resection, and lower FEV1ppo were correlated with PCs. CONCLUSIONS: Although spirometry was sufficient for risk assessment in the majority of the population studied, CPET played a key role in the identification of high-risk patients, among whom the mortality rate was seven times higher than was that observed for those at an acceptable risk of PCs. The risk factors related to PCs coincided with those reported in previous studies. .

OBJETIVO: Determinar as taxas de morbidade e mortalidade por categoria de risco conforme as diretrizes do American College of Chest Physicians, verificar como exames funcionais participaram dessa categorização e identificar fatores de risco para complicações perioperatórias (CPOs). MÉTODOS: Estudo de coorte histórica a partir de avaliações pré e pós-operatórias de casos diagnosticados ou suspeitos de câncer de pulmão avaliados entre 2001 e 2010. RESULTADOS: Dos 239 pacientes avaliados, apenas 13 (5,4%) foram considerados como de alto risco para CPOs. O cálculo do VEF1 previsto para o pós-operatório (VEF1ppo) foi suficiente para a estratificação do risco em 156 pacientes (65,3%); entretanto, o teste de exercício cardiopulmonar (TECP) foi necessário para a identificação de alto risco. Foram operados 145 pacientes, e as taxas globais de morbidade e mortalidade encontradas foram semelhantes às de outros estudos. Entretanto, as taxas de morbidade e mortalidade para aqueles com risco aceitável foram de 31,6% e 4,3%, respectivamente, enquanto as taxas para aqueles com alto risco foram de 83,3% e 33,3%. Idade mais avançada, presença da DPOC, ressecção de um ou mais lobos e VEF1ppo mais baixo estiveram relacionados à ocorrência de CPOs. CONCLUSÕES: Embora a espirometria tenha sido suficiente para a determinação de risco na maioria da população estudada, o TECP teve papel fundamental na identificação de pacientes com risco alto, que apresentaram uma taxa de mortalidade sete vezes maior que os de risco aceitável. Os fatores de risco relacionados a CPOs coincidiram aos relatados em outros estudos. .

EMG amplitude and frequency parameters of muscular activity: effect of resistance training based on electromyographic fatigue threshold.

The present study aimed to evaluate the effect of a resistance training program based on the electromyographic fatigue threshold (EMG(FT), defined as the highest exercise intensity performed without EMG alterations), on the EMG amplitude (root mean square, RMS) and frequency (median frequency, MF) values for biceps brachii (BB), brachioradialis (BR), triceps brachii (TB) and multifidus (MT). Twenty healthy male subjects, (training group [TG], n=10; control group [CG], n=10), firstly performed isometric contractions, and after this, dynamic biceps curl at four different loads to determine the EMG(FT). The TG training program used the BB EMG(FT) value (8 weeks, 2 sessions/week, 3 exhaustive bouts/session, 2 min rest between bouts). No significant differences were found for the isometric force after the training. The linear regression slopes of the RMS with time during the biceps curl presented significant decrease after training for the BB, BR and TB muscles. For the MT muscle, the slope and MF intercept values changed with training. The training program based on the EMG(FT) influenced EMG the amplitude more than EMG frequency, possibly related to the recruitment patterns of the muscles, although the trunk extensor muscles presented changes in the frequency parameter, showing adaptation to the training program.

Lumbar muscles recruitment during resistance exercise for upper limbs.

The aim of this study was to evaluate the EMG activity of lumbar multifidus (MU), longissimus thoracis (LT) and iliocostalis (IC) muscles during an upper limb resistance exercise (biceps curl). Ten healthy males performed maximal voluntary isometric contraction (MVC) of the trunk extensors, after this, the biceps curl exercise was executed at 25%, 30%, 35% and 40% one repetition maximum during 1 min, with 10 min rest between them. EMG root mean square (RMS) and median frequency (MFreq) were calculated for each lifting and lowering of the bar during the exercise bouts, to calculate slopes and intercepts. The results showed increases in the RMS and decreases in the MFreq slopes. RMS slopes were no different between muscles, indicating similar fatigue process along the exercise irrespective of the load level. MU and LT presented higher RMS irrespective of the load level, which can be related to the specific function during the standing position. On the other hand, IC and MU presented higher MFreq intercepts compared to LT, demonstrating possible differences in the muscle fiber conduction velocity of these muscles. These findings suggest that trunk muscles are differently activate during upper limb exercises, and the fatigue process affects the lumbar muscles similarly.

Heavy-intensity aerobic exercise affects the isokinetic torque and functional but not conventional hamstrings:quadriceps ratios.

Running exercises are frequently related to muscular injuries, which may be a result of muscular imbalance. The present study aimed to verify the effects of heavy-intensity continuous running exercise on the functional and conventional hamstrings:quadriceps ratios, and also in the knee flexors and extensors EMG activity in active non-athletic individuals. Sixteen active males performed maximal isokinetic concentric and eccentric knee flexions and extensions at 60 degrees s(-1) and 180 degrees s(-1). In another session, the same procedure was conducted after a continuous running exercise at 95% onset of blood lactate accumulation. Torque and electromyographic ratios were calculated from peak torque and integrated electromyographic activity (knee flexor and extensors). Creatine kinase was measured before and 24h after running exercise. Eccentric torque (knee flexion and extension) decreased significantly after running only at 180 degrees s(-1) (p<0.05). No differences were found for the conventional torque ratios (p>0.05), however, the functional torque ratios at 180 degrees s(-1) decreased significantly after running (p<0.05). No effects on the electromyographic activity and electromyographic ratios were found (p>0.05). Creatine kinase increased slightly 24 h after running (p<0.05). Heavy-intensity continuous running exercise decreased knee flexor and extensor eccentric torque, and functional torque ratios under fast velocities (180 degrees s(-1)), probably as result of peripheral fatigue.

Electromyographic analisys of biceps brachii and erector spinae muscles before and after a fatiguing dynamic test / Análise eletromiográfica dos músculos bíceps do braço e eretores da espinha antes e após um teste isotônico fadigante

The increased number of musculoskeletal injuries can be caused by the lack attention to load level, as well as the posture and time of execution of an overloaded exercise. This way, the objective of this study was to analyze the effect of repetitive barbell biceps curl exercise over biceps brachii and erector spinae muscle electromyographic parameters. Ten healthy male subjects (20,91±1,37 years), without musculoskeletal diseases, performed the biceps curl exercise until fatigue, with 25%, 35% and 45% of 1 repetition maximum. The electromyographic activity of biceps brachii and erector spinae muscles was analyzed during isometric contraction performed before and immediately after fatiguing tests. The muscular fatigue was identified through the increase of root mean square and decrease of median frequency during isometric contractions. The results demonstrated these characteristics of fatigue after fatiguing test (p<0,05) for both muscles, showing a relationship time-load dependent for these electromyographic parameters. No significant differences were found between left and right muscles in the parameters analyzed. The experimental procedures allowed identify the muscular fatigue on biceps brachii muscles and erector spinae activity during barbell biceps curl and the dependence with load and number of repetition...