Associação entre funcionalidade e tempo de permanência de pacientes críticos em UTI / Association between functionality and length of stay of critical ICU patients

Introdução: A imobilidade no leito de pacientes em unidades de terapia intensiva (UTI) favorece o maior tempo de permanência na unidade. Objetivos: Comparar a funcionalidade na admissão e na alta da UTI segundo a especialidade médica e correlacionar a funcionalidade na alta com o tempo de internação na UTI. Métodos: Estudo exploratório, longitudinal, realizado na UTI Geral de um hospital escola. Os pacientes foram divididos em grupos de acordo com a especialidade de internação: neurologia, pneumologia, gastroenterologia, politrauma e outros. O estado funcional prévio à internação foi obtido por meio da medida de independência funcional (MIF). Na alta foi aplicada a escala de mobilidade funcional em UTI (EMU). Resultados: Amostra de 174 pacientes, 53% do sexo masculino. O grupo politrauma apresentou idade significativamente menor que os outros grupos (p < 0,0001). O tempo médio de internação para os grupos neurologia e pneumologia apresentou correlação inversamente proporcional com p = 0 ,02 / r = -0,5 e p = 0,009 / r = - 0,4 respectivamente. Não houve diferença significativa entre as médias da MIF na admissão (p = 0,11) e da EMU na alta (p = 0,24) entre as especialidades médicas em que os pacientes foram admitidos. Conclusão: Quanto maior o tempo de internação na UTI, menor a funcionalidade na alta em pacientes neurológicos e pneumopatas. (AU)

Introduction: Patients on bed rest in intensive care units (ICU) prolong length of stay in the unit. Objectives: To compare ICU admission and discharge functionality according to medical specialty, and to correlate ICU discharge functionality with ICU length of stay. Methods: Longitudinal exploratory study, performed at the General ICU of a teaching hospital. The patients were divided into groups according to the hospitalization specialty: neurology, pneumology, gastroenterology, polytrauma and others. The functional status prior to hospitalization was obtained through the functional independence measure (FIM). At discharge, the ICU functional mobility scale (FMS) was applied. Results: A sample of 174 patients, 53% male. The polytrauma group was significantly younger than the other groups (p < 0.0001). The mean length of stay for the neurology and pneumology groups was inversely proportional to p = 0.02 / r = -0.5 and p = 0.009 / r = -0.4, respectively. There was no significant difference between the mean FIM at admission (p = 0.11) and FMS at discharge (p = 0.24) between the medical specialties at which patients were admitted. Conclusion: The longer the patient stays in the IC, the lower functionality at discharge in neurological and lung disease patients. (AU)

Evaluation of Respiratory Muscular Strength Compared to Predicted Values in Patients with Stroke.

The purpose of this study was to evaluate the inspiratory and expiratory muscle strength of individuals affected by stroke and to compare it with the predicted values in the literature considering their corresponding age. Respiratory muscle strength was evaluated in 22 elderly people who had sequels of stroke, four with right hemiparesis, 16 with left hemiparesis and two with bilateral, of ages ranging from 34 to 82 years. The collected data were submitted to statistical analysis using a Mann-Whitney test to evaluate if there was a significant difference in the average data collected when compared with a mean of the predicted data in the literature. Fourteen men and eight women were evaluated, who obtained mean values of 71.85 cmH2O and 57.75 cmH2O, respectively, for a maximal inspiratory pressure (MIP), and when compared to the predicted values for men and women, 105.41 cmH2O (p-value 0.0019) and 80.57 cmH2O (p-value 0.00464) were significantly lower. For a maximal expiratory pressure (MEP), the mean value obtained for men was 62.28 cmH2O and 49.5 cmH2O for women, whereas the predicted values in the literature were 114.79 cmH2O (p-value < 0.0001) and 78, 46 cmH2O (p-value 0.0059), respectively. In the statistical analysis, it was possible to notice that the studied population did not reach the predicted age indexes and that there was a significant difference between the median columns. In conclusion, there is a weakness in the respiratory muscles of hemiparetic men and women due to stroke.

Relationship between strength and flexibility levels in young soccer players / Relación entre los niveles de fuerza y flexibilidad en jóvenes jugadores de fútbol

INTRODUCTION: Balance of strength and flexibility between the dominant (DL) and non-dominant limbs (NDL) in young soccer players is essential, since it can minimize the possible injury-triggering mechanisms and their negative influence on performance. The aim of this study was to evaluate and compare the unilateral and bilateral strength and flexibility between the DL and NDL in young soccer players. MATERIAL AND METHODS: The sample consisted of 30 individuals (aged 15.97 ± 0.67 years). The isokinetic strength was measured at the velocities of 60°s and 180°s in the concentric action of the quadriceps and hamstrings as well as eccentric of the hamstrings, and in the conventional and functional ratios, along with hip flexion range of motion. RESULTS: The results showed the athletes had an eccentric strength of the hamstrings at 60°s in the DL significantly (p < 0.05) stronger than in the NDL, and the DL had a significant H/Q ratio (p < 0.05) more balanced than the NDL. CONCLUSIONS: Young soccer athletes may present a non-standard isokinetic results. These results are observed because of the difference in muscle strength of the posterior thigh compared to DL and NDL and the balance relation between the quadriceps and the hamstrings, generating an asymmetry of strength between the limbs and on the same member. It is necessary to monitor and devise training strategies to avoid these imbalances in order to prevent injuries

INTRODUCCIÓN: El equilibrio de la fuerza y de la flexibilidad entre las piernas dominantes (PD) y no dominantes (PND) en jóvenes jugadores de fútbol es imprescindible, pues puede minimizar los posibles mecanismos desencadenantes de lesiones y su influencia negativa en el desempeño. El objetivo de este estudio fue evaluar y comparar la fuerza y la flexibilidad uni y bilateral entre las PD y PND en jóvenes jugadores de fútbol. MATERIAL Y MÉTODOS: La muestra fue compuesta por 30 individuos (con edad entre 15,97 ± 0,67 años). Se evaluó la fuerza isocinética a las velocidades de 60°/s y 180°/s en la acción concéntrica del cuádriceps e isquiotibiales y excéntrica de los isquiotibiales, y en las razones convencional y funcional, además de la goniometría para la flexión de cadera. RESULTADOS: Los resultados demostraron que los atletas poseían una acción excéntrica de los isquiotibiales en 60°/s en las PD significativamente (p < 0,05) más fuerte que en las PND, además de las PD tener una relación I/Q significativamente (p < 0,05) más equilibrada que las PND. CONCLUSIONES: Los atletas jóvenes de fútbol pueden presentar resultados isocinéticos no estandarizados. Estos resultados se observan debido a la diferencia en la fuerza muscular del muslo posterior con relación a las PD y PND y la relación de equilibrio entre el cuádriceps y los isquiotibiales, generando una asimetría de fuerza entre los miembros y en el mismo miembro. Es necesario monitorear y elaborar estrategias de entrenamiento para evitar estos desequilibrios, a fin de evitar lesiones

Recovery periods during repeated stress impact corticosterone and behavioral responses differently in house sparrows.

A number of studies have shown that chronic stress can negatively impact both physiology and behavior in a variety of organisms. What has yet to be extensively explored is whether these changes permanently alter an animal's functioning, or if they can be reversed. In this study, we used wild-caught house sparrows (Passer domesticus) to assess how recovery periods influence the physiological and behavioral impacts of an initial four days and subsequent four days of repeated stressors. Birds were randomly assigned to a recovery group and either experienced 0, 24, or 72 h of recovery between the two sets of stressors (cage rolling and cage tapping). We measured the regulation of the hypothalamic pituitary adrenal (HPA) axis by quantifying baseline and stress-induced corticosterone as well as negative feedback strength. We also assessed behavior using neophobia trials to measure how birds altered their approach towards novel objects and their overall activity. Both behavior and corticosterone responses were assessed before the experiment, after the recovery time, and following the final 4 days of stressors. We found that birds that experienced 24 h of recovery had reduced stress-induced corticosterone, but enhanced negative feedback relative to the pre-experiment sample. Additionally, 4 days of stressors was enough to significantly reduce approach latency towards novel objects; however, pre-experiment levels returned with longer periods of recovery. Finally, recovery time did not significantly influence responses to the second 4 days of stressors. Our results indicate that brief recovery periods partially ameliorate the hormonal and behavioral effects of repeated stress.

Clinical profiles associated with LRRK2 and GBA mutations in Brazilians with Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disorder characterized by remarkable phenotypic variability. Accumulated evidence points that the manifestation of PD clinical signs might be differentially modified by genetic factors, as mutations in LRRK2 and GBA genes. In this sense, the clarification of the genotype-phenotype correlations in PD has important implications in predicting prognosis and can contribute to the development of specific therapeutic approaches. METHODS: Here, we conducted the first comparative analysis of motor and non-motor features in 17 LRRK2 and 22 GBA mutation carriers and 93 non-carriers unrelated PD patients from Brazil, a highly admixed population. RESULTS: Significant differences were found between the three groups. LRRK2 PD patients presented more occurrence of familiar history. Resting tremor was observed in a lower frequency in GBA mutation carries. In contrast, gait freezing and dysautonomia was present in lower frequencies in LRRK2 carriers. Besides that, LRRK2 and GBA mutation carriers showed a higher incidence of depressive symptoms and a younger age at onset, when compared to non-carriers. CONCLUSION: Our results suggest that specific mutations in GBA and LRRK2 influence the clinical signs of the disease, with significant implications for handling of specific patient groups.

Perfil antropométrico, composición corporal y somatotipo de jóvenes futbolistas brasileños de diferentes categorías y posiciones / Perfil antropométrico, composição corporal e somatotipo de jovens atletas de futebol brasileiros de diferentes categorías e posições / Anthropometric profile, body composition and somatotype of brazilian youth soccer players of different categories and positions

El objetivo de este estudio es identificar y describir las medidas antropométricas, composición corporal y somatotipo de futbolistas brasileños en varias categorías y posiciones de accionamiento en el campo. La muestra de este estudio está conformada por un grupo de 1.115 jugadores de fútbol masculino y divididos en ocho grupos: Sub 07 (n=60); Sub 09 (n=75); Sub 11 (n=140); Sub 13 (n=182); Sub 15 (n=184); Sub 17 (n=166); Sub 20 (n=144) y Profesionales (n=164). Se utilizó una estadística descriptiva (media ± desviación estándar) a través del SSPS y utlilizando v21 "One-way ANOVA" complementando la prueba "Bonferroni" de significância, considerando um valor p<0,05. Las variables antropométricas relacionados con la composición corporal: peso corporal, altura, porcentaje de grasa corporal, SDC (suma de los pliegues cutáneos), mostraron la evolución perfecta entre las categorías analizadas, lo que significa que existe una armonía en el proceso de evolución entre los grupos.

Objetivo: identificar e descrever as medidas antropométricas, de composição corporal e do somatotipo de jogadores brasileiros em diversas categorias e posições no campo. Método: a amostra consistiu em 1.115 jogadores de futebol do sexo masculino e divididos em oito grupos: Under 07(n = 60); Sub-09 (n = 75); Sub 11 (n = 140); Sub 13 (n = 182); Sub 15 (n =184); Sub 17 (n = 166); Sub-20 (n = 144) e Professional (n = 164). Estatística descritiva (média ± desvio padrão) foi utilizada através do SPSS, utilizandov21 “one-way ANOVA”, complementar “Bonferroni” significado, um teste considerando o valor de p <0,05. Resultado: as variáveis antropométricas relacionadas à composição corporal: massa corporal, estatura, percentual de gordura corporal, SDC (somatório das dobras cutâneas) mostraram a evolução perfeita entre as categorias analisadas. Conclusão: há harmonia no processo de evolução entre grupos.

Objective: To identify and describe the anthropometric measurements,body composition and somatotype of Brazilian players in various categories and positions in the field. Method: The sample consisted of 1,115 malesoccer players and divided into eight groups: Under 07 (n = 60); Sub-09(n = 75); Sub 11 (n = 140); Sub 13 (n = 182); Sub 15 (n = 184); Under 17(n = 166); U-20 (n = 144) and Professional (n = 164). Descriptive statistics(mean ± standard deviation) was used through SPSS, using v21 “one-wayANOVA”, complementary “Bonferroni” significance test considering thevalue of p <0.05. Results: Anthropometric variables related to body composition:body weight, height, body fat percentage, SDC (sum of skin folds)showed the perfect evolution of the categories analyzed. Conclusion: thereis harmony in the evolution process between groups.

Qualidade de Vida de pacientes hipertensos e comparação entre dois instrumentos de medida de QVRS / Quality of life of hypertensive patients and comparison of two instruments of HRQOL measure

FUNDAMENTO: Medir Qualidade de Vida (QV) relacionada à saúde auxilia na avaliação da eficiência de um tratamento e identifica problemas de maior impacto na QV do paciente. No entanto, essas medidas são mais seguras se avaliadas por instrumentos genéricos e específicos conjuntamente, fazendo-se necessário verificar se há compatibilidade entre esses e evitar repetições e contradições entre os domínios. OBJETIVO: Descrever o perfil de qualidade de vida de pacientes hipertensos e avaliar a compatibilidade de um instrumento específico (MINICHAL) e outro genérico (SF-36). MÉTODOS: Cem pacientes hipertensos adultos em tratamento ambulatorial entrevistados. A média da QVRS medida pelo MINICHAL foi de 6,64 (DP 6,04) no estado mental e média de 5,03 (DP 4,11) no estado manifestações somáticas. As médias para o instrumento SF-36 foram por ordem de classificação: limitação por aspectos físicos 47,3 (DP 42,9), vitalidade 57,4 (DP 19,7), limitação por aspectos emocionais 58 (DP 44,7), capacidade funcional 58,7 (DP 27,8), dor 60,4 (DP 26,3), estado geral de saúde 60,7 (DP 22,7), saúde mental 66,8 (DP 22,1) e aspectos sociais 78 (DP 26,1). RESULTADOS: O MINICHAL apresentou correlação significativa (p < 0,001) com o SF-36 em todos os domínios. CONCLUSÃO: O MINICHAL provou ser um instrumento útil na avaliação da QVRS em pacientes hipertensos. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).

BACKGROUND: Measuring health-related quality of life (QOL) helps evaluating the efficiency of a treatment and identifies problems with major impact on the patient's QOL. However, these measures are safer if assessed by generic and specific instruments together, where it is necessary to check for compatibility between these and avoid repetitions and contradictions between the domains. OBJECTIVE: To describe the quality of life of hypertensive patients and to evaluate the compatibility of a specific instrument (MINICHAL) and a generic instrument (SF-36). METHODS: One hundred adult hypertensive under outpatient care were interviewed. The mean HRQOL as measured by MINICHAL was 6.64 (SD 6.04) in mental status and average of 5.03 (SD 4.11) in the state of somatic manifestations. The means for the instrument SF-36 were in ranking order: limitation due to physical aspects 47.3 (SD 42.9), vitality 57.4 (SD 19.7), limitation due to emotional aspects 58 (SD 44.7), functional capacity 58.7 (SD 27.8), pain 60.4 (SD 26.3), general health condition 60.7 (SD 22.7), mental health 66.8 (SD 22.1) and social aspects 78 (SD 26.1). RESULTS: The MINICHAL significantly correlated (p <0.001) with the SF-36 in all domains. CONCLUSION: The MINICHAL proved to be a useful tool in the assessment of HRQOL in patients with hypertension. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).

Quality of life of hypertensive patients and comparison of two instruments of HRQOL measure.

BACKGROUND: Measuring health-related quality of life (QOL) helps evaluating the efficiency of a treatment and identifies problems with major impact on the patient's QOL. However, these measures are safer if assessed by generic and specific instruments together, where it is necessary to check for compatibility between these and avoid repetitions and contradictions between the domains. OBJECTIVE: To describe the quality of life of hypertensive patients and to evaluate the compatibility of a specific instrument (MINICHAL) and a generic instrument (SF-36). METHODS: One hundred adult hypertensive under outpatient care were interviewed. The mean HRQOL as measured by MINICHAL was 6.64 (SD 6.04) in mental status and average of 5.03 (SD 4.11) in the state of somatic manifestations. The means for the instrument SF-36 were in ranking order: limitation due to physical aspects 47.3 (SD 42.9), vitality 57.4 (SD 19.7), limitation due to emotional aspects 58 (SD 44.7), functional capacity 58.7 (SD 27.8), pain 60.4 (SD 26.3), general health condition 60.7 (SD 22.7), mental health 66.8 (SD 22.1) and social aspects 78 (SD 26.1). RESULTS: The MINICHAL significantly correlated (p <0.001) with the SF-36 in all domains. CONCLUSION: The MINICHAL proved to be a useful tool in the assessment of HRQOL in patients with hypertension.

Compliance barriers in glaucoma: a systematic classification.

PURPOSE: To systematically identify and describe common obstacles to medication adherence (i.e., compliance) for patients with glaucoma. METHODS: A prospective case series of structured interviews were conducted with 48 patients with glaucoma. The subjects' responses were recorded verbatim on interview forms as well as recorded on audiotapes. Situational obstacles to medication adherence were elicited. Using hierarchical cluster analysis, the situational descriptions were stratified, grouped, and analyzed by frequency distribution. RESULTS: Seventy-one unique situational obstacles were reported. These were then grouped into 4 defined and separate categories: situational/environmental factors (35 of 71 situations; 49%), medication regimen (23 of 71; 32%), patient factors (11 of 71; 16%), and provider factors (2 of 71; 3%). CONCLUSION: Significant barriers to compliance exist for patients with glaucoma in addition to those cited by previous ophthalmic studies. A systematic classification (i.e., taxonomy) of these barriers was formulated to assist in optimizing patient education and problem-solving regarding prescribed therapeutic regimens.