New Brazilian variant of the SARS-CoV-2 (P1/Gamma) of COVID-19 in Alagoas state.

Since the beginning of 2020, health authorities have been monitoring the cases of Coronavirus Disease 2019 (COVID-19), which has grown every day in Brazil and around the world, becoming pandemic. The new coronavirus, also called SARS-CoV-2 by scientists spreads rapidly, causing fear, deaths, and threats for the economy of several countries. This work aimed to describe the clinical characterization of the first cases of a new Brazilian variant of SARS-CoV-2 (P1) in the State of Alagoas, which occurred on February 16th, 2021. Two cases are described: first, a person infected in Amazonas State, where the new variant P1 was first described, who migrated to Alagoas State, and second, a case of probable community transmission within Alagoas, since the patient had no history of recent travel. In both confirmed cases the symptoms were mild. Further studies are necessary to better understand the clinical behavior of P1 SARS-CoV-2 variant and also the associated sequelae in the context of COVID-19.

Profile of non-suicidal self-injury in adolescents: interface with impulsiveness and loneliness

Abstract Objective: Comprehend the profile and prevalence of non-suicidal self-injury (NSSI) in adolescents and its association with impulsiveness and loneliness. Methods: Cross-sectional study carried out in 2017 in Maceió-Alagoas, Northeast Brazil, in the households of 505 adolescents aged 12-17 years, using a sample stratified and randomized by gender and neighborhood. The following instruments were used: a sociodemographic questionnaire, Brazilian version of Functional Assessment of Self-Mutilation (FASM), the Brazilian Barratt Impulsiveness Scale (BIS-11), and the Brazilian Loneliness Scale (UCLA-BR). Results: A prevalence of 6.53% was found for non-suicidal self-injury disorder (DSM-5). Significant differences ( p ≤ 0.05) were observed regarding: the most frequently used forms of NSSI were the items "cut oneself" and "scratch oneself"; engaging in three or more different forms of self-injurious behavior (66.67%) and, reporting as reasons, "to relieve feelings of emptiness or indifference" and "to stop bad feelings/sensations." Significance was also related to the sociodemographic profile: 72.73% were females and 63.54% had family income below one minimum wage. Individuals with self-injurious behavior also had higher impulsiveness and loneliness scores (p ≤ 0.05). Conclusions: The study identified a direct association between NSSI and impulsiveness and loneliness among adolescents, being more prevalent in females and in young individuals with socioeconomic vulnerability. The data provide support for improving public health policies, aimed at education, prevention, and treatment of adolescents with NSSI.

Profile of non-suicidal self-injury in adolescents: interface with impulsiveness and loneliness.

OBJECTIVE: Comprehend the profile and prevalence of non-suicidal self-injury (NSSI) in adolescents and its association with impulsiveness and loneliness. METHODS: Cross-sectional study carried out in 2017 in Maceió-Alagoas, Northeast Brazil, in the households of 505 adolescents aged 12-17 years, using a sample stratified and randomized by gender and neighborhood. The following instruments were used: a sociodemographic questionnaire, Brazilian version of Functional Assessment of Self-Mutilation (FASM), the Brazilian Barratt Impulsiveness Scale (BIS-11), and the Brazilian Loneliness Scale (UCLA-BR). RESULTS: A prevalence of 6.53% was found for non-suicidal self-injury disorder (DSM-5). Significant differences ( p ≤ 0.05) were observed regarding: the most frequently used forms of NSSI were the items "cut oneself" and "scratch oneself"; engaging in three or more different forms of self-injurious behavior (66.67%) and, reporting as reasons, "to relieve feelings of emptiness or indifference" and "to stop bad feelings/sensations." Significance was also related to the sociodemographic profile: 72.73% were females and 63.54% had family income below one minimum wage. Individuals with self-injurious behavior also had higher impulsiveness and loneliness scores (p ≤ 0.05). CONCLUSIONS: The study identified a direct association between NSSI and impulsiveness and loneliness among adolescents, being more prevalent in females and in young individuals with socioeconomic vulnerability. The data provide support for improving public health policies, aimed at education, prevention, and treatment of adolescents with NSSI.

Influence of isostretching on patients with chronic low back pain. A randomized controlled trial.

Objective: This study investigated the influence of isostretching on patients with chronic low back pain. Methods: It was a randomized, controlled trial with concealed allocation, intention-to-treat analysis, and blind assessment. Fifty-four patients with chronic low back pain were randomized to an experimental group and a control group. The experimental group performed isostretching twice a week for 45 days, while the control group remained on the waiting list for physical therapy. Patients were submitted to evaluations at baseline, after 20 and 45 days of treatment with regard to pain, quality of life, functional capacity, and satisfaction. Results: The experimental group exhibited statistically significant improvements in comparison to the control group with regard to pain (p = .003), functional capacity (p = .026), patient satisfaction (p < .001), and quality of life as determined by the functional capacity (p = .012), physical aspects (p = .011) and pain (p = .006) subscales of the SF-36. The experimental group used a significantly lesser amount of pain medication than the control group (p = .03). Conclusion: Isostretching was effective in reducing pain and in improving function, patient satisfaction and some aspects of quality of life in patients with chronic low back pain.

New Brazilian variant of the SARS-CoV-2 (P1/Gamma) of COVID-19 in Alagoas state

ABSTRACT Since the beginning of 2020, health authorities have been monitoring the cases of Coronavirus Disease 2019 (COVID-19), which has grown every day in Brazil and around the world, becoming pandemic. The new coronavirus, also called SARS-CoV-2 by scientists spreads rapidly, causing fear, deaths, and threats for the economy of several countries. This work aimed to describe the clinical characterization of the first cases of a new Brazilian variant of SARS-CoV-2 (P1) in the State of Alagoas, which occurred on February 16th, 2021. Two cases are described: first, a person infected in Amazonas State, where the new variant P1 was first described, who migrated to Alagoas State, and second, a case of probable community transmission within Alagoas, since the patient had no history of recent travel. In both confirmed cases the symptoms were mild. Further studies are necessary to better understand the clinical behavior of P1 SARS-CoV-2 variant and also the associated sequelae in the context of COVID-19.

Expansão de vagas e qualidade dos cursos de Medicina no Brasil: Em que pé estamos? / Expansion of vacancies and quality of medical courses in Brazil: Where do we stand?

Resumo: Introdução: A educação médica no Brasil vem enfrentando um importante processo de expansão. Essa realidade foi fortemente influenciada por programas e políticas educacionais implementados principalmente nas últimas décadas. Objetivo: O estudo teve como objetivo traçar um panorama da formação e da avaliação dos cursos de graduação em Medicina no contexto nacional. Método: Foi realizada uma pesquisa documental e descritiva, de abordagem quantitativa. O levantamento de dados ocorreu por meio de dados provenientes da Sistemática de Avaliação Nacional da Educação Superior do Ministério da Educação disponibilizado pelo Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira, órgão que coordena e gerencia dados relativos aos processos de regulação, avaliação e supervisão da educação superior no sistema federal de educação. Foram analisados 20 anos de oferta de cursos de Medicina no Brasil (2000-2019). Resultados: No período em estudo, o número de escolas médicas apresentou um crescimento de 214,9%. No total, analisaram-se 337 cursos de graduação em Medicina em atividade vinculados a instituições de ensino superior públicas (35%) e privadas (65%), perfazendo 34.585 vagas anuais ofertadas. Os cursos estão distribuídos nas 27 unidades federativas brasileiras, com maior e menor concentração de vagas e escolas médicas nas Regiões Sudeste e Norte, respectivamente. A média nacional do número de vagas/ano foi de 1.280,9 vagas/ano e da razão vagas/habitantes foi de 16,5 vagas/100 mil habitantes. A maioria dos cursos obteve conceito três nos indicadores de qualidade propostos pelo Ministério da Educação. Conclusão: O ensino da Medicina no Brasil vem passando por importante processo de expansão, e este é fundamentalmente privado e mal distribuído pelo país, e apresenta indicadores de qualidade mínimos para manutenção do seu funcionamento.

Abstract: Introduction: Medical education in Brazil is facing an important expansion process. This reality has been strongly influenced by educational programs and policies implemented mainly in the last few decades. Objective: The study aimed to provide an overview of the formation and evaluation of undergraduate medical courses in the national context. Method: A documentary and descriptive study was conducted, with a quantitative approach. Data was collected from the National Higher Education Assessment System of the Ministry of Education, made available by the Anísio Teixeira National Institute of Educational Studies and Research, the body that coordinates and manages data related to the regulation, evaluation and supervision processes of higher education in the federal education system. Twenty years of medical courses offered in Brazil (2000-2019) were analyzed. Results: In the period under study, the number of Medical Schools grew by 214.9%. In total, 337 active undergraduate medicine courses linked to public (35%) and private (65%) higher education institutions were analyzed, totaling 34,585 annual vacancies offered. The courses are distributed in the 27 Brazilian federative units, with a higher and lower concentration of places and Medical Schools in the Southeast and North regions, respectively. The national average number of vacancies/year was 1280.9 vacancies/year and the vacancy/inhabitants ratio was 16.5 vacancies/100 thousand inhabitants. Most of the courses obtained a grade three in the quality indicators proposed by the Ministry of Education. Conclusion: It was concluded that: i) the teaching of Medicine in Brazil has been going through an important expansion process, ii) that it is fundamentally private, iii) poorly distributed throughout the country, and iv) it presents minimum quality indicators for maintaining its operation.

Risco de doenças cardiovasculares em pescadores de uma comunidade / Risk of cardiovascular disease in fishermen in a community

Pescadores compõem um grupo de trabalhadores predominantemente do gênero masculino no Brasil. Atrelado ao gênero e à ocupação existem outros fatores de risco como tabagismo, consumo excessivo de álcool, baixo nível de escolaridade e socioeconômicos para desenvolvimento de doença cardiovascular que se constitui na principal causa de morte por doenças não transmissíveis. OBJETIVO: Avaliar a prevalência de doença cardiovascular em pescadores na comunidade Pontal da Barra, Maceió-AL. MÉTODOS: Estudo observacional transversal realizado no período de outubro a novembro de 2016. A amostra foi composta por pescadores cadastrados na Unidade de Saúde da Família Tarcísio Palmeira. Foram avaliados: pressão arterial, circunferência abdominal, índice de massa corpórea, perfil lipídico, glicemia em jejum e um questionário com perguntas sobre hábitos diários e aspectos socioeconômicos. A Síndrome Metabólica foi avaliada conforme a NCEP-ATP III. Para avaliar fatores de risco para eventos cardiovasculares nos próximos 10 anos, foi aplicado o escore de Framingham. As variáveis foram apresentadas em média, desvio padrão, números absolutos e porcentagem em tabelas e gráficos de frequência. RESULTADOS: A amostra foi composta por 37 pescadores, todos do gênero masculino, com idade de 58,37 ± 13,77 anos e com renda mensal de 1 a 2 salários mínimos (89%). A Síndrome Metabólica foi diagnosticada em 49% dos participantes. Segundo o escore de Framingham, 22% apresentaram alto risco de desenvolver eventos cardiovasculares. CONCLUSÃO: Os resultados encontrados revelaram que os pescadores na comunidade Pontal da Barra, apresentam um risco moderado para o desenvolvimento de doenças cardiovasculares nos próximos 10 anos.

Cardiovascular diseases are part of the chronic non-transmissible diseases, which are characterized as the main causes of death in Brazil and around the world. Against this fact, a continuous study is necessary in order to evaluate the risks that lead to cardiovascular diseases. OBJECTIVE: To evaluate the risk of cardiovascular disease in fishermen in the community of Pontal da Barra, Maceió-AL. METHODS: This is an observational, descriptive and cross-sectional study that was carried out from October to November 2016. The sample was defined by fishermen enrolled in Family Health of the unit Tarcísio Palmeira. Blood pressure, abdominal circumference, body mass index, lipid profile and fasting blood glucose were evaluated, and a questionnaire was applied that included questions related to their daily habits and socioeconomic aspects. Metabolic Syndrome was evaluated according to NCEP-ATP III. To evaluate the risk factors for cardiovascular events over the next 10 years, the Framingham score was applied. In the descriptive statistics the quantitative variables were presented such as standard deviation and percentage and the qualitative variables were presented in tables and frequency charts. RESULTS: The sample consisted of 37 male fishermen, aged 58.37 ± 13.77 years, with the majority having a monthly income of 1 to 2 minimum wages 89%. Metabolic syndrome was diagnosed in 49% of participants. Following the Framingham score, 22% had a high risk of developing cardiovascular events. CONCLUSION: The fishermen of the study do an intense work activity with the fishing, in addition to the food habit almost daily with the consumption of fish, which contributed to the classification as low risk of cardiovascular events.

Clinical and epidemiological characterization of patients receiving home care in the city of Maceió, in the state of Alagoas, Brazil / Caracterização clínica e epidemiológica dos pacientes em atendimento domiciliar na cidade de Maceió, AL, Brasil

Abstract Objective: To clinically and epidemiologically characterize patients receiving home care in the city of Maceio, in the state of Alagoas, Brazil. Methods: An observational, cross-sectional study with a sample of 859 patients was carried out, based on data obtained from the medical records of institutions that provide a home care service. A total of 445 patients were from a public service and 414 were from a private service. Descriptive analysis was used for the demographic, clinical and functional variables. Results: Most patients were elderly, female, bedridden, fed orally and had neurological disorders, with stroke the most common diagnosis. Regarding patient evolution, 16.8% of individuals were discharged from home care, 45% of patients died and 24% were hospitalized during the period of home care. A total of 9% of patients had a tracheostomy, 84.7% breathed room air, 9.3% used oxygen, 4% used noninvasive mechanical ventilation, 1.9% used invasive mechanical ventilation, and 24.9% of patients had pressure ulcers. All patients received medical visits, with 693 receiving nursing care, 767 undergoing physiotherapy, 233 receiving speech therapy sessions, 665 patients accompanied by a nutritionist, 64 undergoing occupational therapy sessions and 98 receiving counseling. Conclusion: It was noted that some results differed from literature and between the public and private service. This divergence could be related to the specific epidemiology of each region and the type of insurance paying for care (Unified Health Service or Private). AU

Resumo Objetivo: Caracterizar clínica e epidemiologicamente os pacientes em atendimento domiciliar no município de Maceió, AL, Brasil. Métodos: Tratou-se de um estudo observacional de caráter transversal com a amostra de 859 pacientes, obtidos através de prontuários de instituições que prestam Serviço de Assistência Domiciliar, sendo 445 pacientes do serviço público e 414 do privado. Utilizou-se análise descritiva para as variáveis sociodemográficas, clínicas e funcionais. Resultados: A maioria dos pacientes são idosos, do sexo feminino, acamados, alimentavam-se via oral, com quadro de doenças neurológicas, sendo o diagnóstico mais comum o Acidente Vascular Encefálico (AVE). Em relação à evolução do quadro: 16,8% pacientes receberam alta do atendimento domiciliar, 45% pacientes foram a óbito e 24% apresentaram internação hospitalar durante a assistência domiciliar. Em relação ao quadro clínico: 9% representa a totalidade de pacientes traqueostomizados, 84,7% pacientes respiravam em ar ambiente, 9,3% utilizavam oxigênio, 4% utilizavam o auxílio da Ventilação Mecânica não Invasiva, 1,9% faziam uso da Ventilação Mecânica Invasiva e 24,9% dos pacientes apresentava úlcera por pressão. Em relação ao atendimento domiciliar: todos os pacientes receberam visita médica, 693 pacientes recebiam os cuidados da enfermagem, 767 pacientes realizavam sessões de fisioterapia, 233 faziam acompanhamento fonoaudiológico, 665 pacientes faziam acompanhamento nutricional, 64 pacientes realizavam sessões de terapia ocupacional e 98 faziam acompanhamento psicológico. Conclusão: Pode-se observar que alguns resultados divergiram da literatura, e entre o serviço público e o privado. Essa divergência pode estar relacionada à epidemiologia específica de cada região e ao tipo de seguro pagador da assistência (SUS ou Privado). AU

Comprometimento cognitivo e funcional em pacientes acometidos de acidente vascular encefálico: Importância da avaliação cognitiva para intervenção na Terapia Ocupacional / Cognitive and functional impairment in patients suffering from stroke: the importance of cognitive assessment for Occupational Therapy intervention

Introduction: Stroke (CVA) can generate motor, sensory and cognitive development deficits, affecting the individual's performance in daily activities. Changes in any cognitive area can affect the individual's occupational engagement. Objective: To evaluate the cognitive and functional capacity in patients suffering from stroke, showing the importance of cognitive assessment for occupational therapy intervention. Method: A comparative study with cross-sectional sampling of 44 subjects aged 30-80 years, both sexes. The subjects were divided in three groups: Adult: 11 individuals affected by stroke, 30-59 years old; Elderly: 10 individuals affected by stroke, 60-80 years old; Control: 23 normal subjects, 30-80 years old. Tests applied: MMSE, Clock Test, Test of tracks A and B, and functional capacity (BOMFAQ). Results: Cognitive changes were identified in the Adult and Elderly groups. The Adult group showed poorer performance on the Clock test (visuospatial and executive functions) compared with the Control group. The Adult and Elderly groups presented worse performance in the Track A test (attention) compared with the Control group. In the Track B test (visual attention, graphomotor skills, and mental flexibility), applied with absolute numbers, no significant differences were observed between the Adult and Elderly groups and the Control group, but cognitive impairment was perceived when the test was applied with categories. The Adult group showed higher prevalence of moderate/severe impairment in the carrying out of daily activities. Conclusion: As a rule, individuals suffering from stroke, in addition to having impaired functional capacity, present cognitive impairments that can negatively impact the performace of daily tasks, whether they are occupational, leisure or self-care activities. Accordingly, we observed the need to evaluate cognitive rehabilitation for better targeting and quality of life improvement.(AU)

Introdução: Acidentes vasculares encefálicos (AVE) podem gerar déficits motor, sensorial e cognitivo, repercutindo no desempenho do indivíduo nas atividades cotidianas. Alteração em qualquer área cognitiva afeta o engajamento ocupacional do indivíduo. Objetivo: Avaliar a capacidade cognitiva e funcional em pacientes acometidos de AVE, mostrando a importância da avaliação cognitiva para a intervenção do terapeuta ocupacional. Método: Estudo comparativo de delineamento transversal com amostra de 44 indivíduos entre 30 e 80 anos, de ambos os sexos. Os sujeitos foram distribuídos em três grupos: grupo Adulto: 11 indivíduos acometidos por AVE, com idade entre 30 e 59 anos; grupo Idoso: 10 indivíduos acometidos por AVE, com idade entre 60 e 80 anos; grupo Controle: 23 indivíduos normais, com idade entre 30 e 80 anos. Testes avaliados: MEEM, teste do relógio, teste das trilhas A e B e da capacidade funcional (BOMFAQ). Resultados: Alterações cognitivas foram identificadas nos grupos Adulto e Idoso. O grupo Adulto mostrou pior desempenho no teste do relógio quando comparado ao grupo Controle. Os grupos Adulto e Idoso foram piores no desempenho do teste trilha A (atenção). Ao utilizarem-se números absolutos do teste trilha B (atenção visual, habilidade grafomotora e flexibilidade mental), não houve diferença significativa nos grupos Adulto e Idoso em relação ao grupo Controle. O grupo Adulto apresentou maior prevalência de comprometimento moderado/grave na realização das atividades cotidianas. Conclusão: Indivíduos acometidos de AVE, na grande maioria, além de apresentarem comprometimento da capacidade funcional apresentam alterações cognitivas que repercutem de modo negativo na realização das tarefas cotidianas, sejam elas ocupacionais, de lazer ou de autocuidado. Verificou-se a necessidade da avaliação cognitiva para melhor direcionamento da reabilitação e melhora na qualidade de vida.(AU)

Comprometimento cognitivo e funcional em pacientes acometidos de acidente vascular encefálico: importância da avaliação cognitiva para intervenção na terapia ocupacional / Cognitive and functional impairment in patients suffering from stroke: the importance of cognitive assessment for occupational therapy intervention

Stroke (CVA) can generate motor, sensory and cognitive development deficits, affecting the individual's performance in daily activities. Changes in any cognitive area can affect the individual's occupational engagement. Objective: To evaluate the cognitive and functional capacity in patients suffering from stroke, showing the importance of cognitive assessment for occupational therapy intervention. Method: A comparative study with cross-sectional sampling of 44 subjects aged 30-80 years, both sexes. The subjects were divided in three groups: Adult: 11 individuals affected by stroke, 30-59 years old; Elderly: 10 individuals affected by stroke, 60-80 years old; Control: 23 normal subjects, 30-80 years old. Tests applied: MMSE, Clock Test, Test of tracks A and B, and functional capacity (BOMFAQ). Results: Cognitive changes were identified in the Adult and Elderly groups. The Adult group showed poorer performance on the Clock test (visuospatial and executive functions) compared with the Control group. The Adult and Elderly groups presented worse performance in the Track A test (attention) compared with the Control group. In the Track B test (visual attention, graphomotor skills, and mental flexibility), applied with absolute numbers, no significant differences were observed between the Adult and Elderly groups and the Control group, but cognitive impairment was perceived when the test was applied with categories. The Adult group showed higher prevalence of moderate/severe impairment in the carrying out of daily activities. Conclusion: As a rule, individuals suffering from stroke, in addition to having impaired functional capacity, present cognitive impairments that can negatively impact the performace of daily tasks, whether they are occupational, leisure or self-care activities. Accordingly, we observed the need to evaluate cognitive rehabilitation for better targeting and quality of life improvement.

Acidentes vasculares encefálicos (AVE) podem gerar déficits motor, sensorial e cognitivo, repercutindo no desempenho do indivíduo nas atividades cotidianas. Alteração em qualquer área cognitiva afeta o engajamento ocupacional do indivíduo. Objetivo: Avaliar a capacidade cognitiva e funcional em pacientes acometidos de AVE, mostrando a importância da avaliação cognitiva para a intervenção do terapeuta ocupacional. Método: Estudo comparativo de delineamento transversal com amostra de 44 indivíduos entre 30 e 80 anos, de ambos os sexos. Os sujeitos foram distribuídos em três grupos: grupo Adulto: 11 indivíduos acometidos por AVE, com idade entre 30 e 59 anos; grupo Idoso: 10 indivíduos acometidos por AVE, com idade entre 60 e 80 anos; grupo Controle: 23 indivíduos normais, com idade entre 30 e 80 anos. Testes avaliados: MEEM, teste do relógio, teste das trilhas A e B e da capacidade funcional (BOMFAQ). Resultados: Alterações cognitivas foram identificadas nos grupos Adulto e Idoso. O grupo Adulto mostrou pior desempenho no teste do relógio quando comparado ao grupo Controle. Os grupos Adulto e Idoso foram piores no desempenho do teste trilha A (atenção). Ao utilizarem-se números absolutos do teste trilha B (atenção visual, habilidade grafomotora e flexibilidade mental), não houve diferença significativa nos grupos Adulto e Idoso em relação ao grupo Controle. O grupo Adulto apresentou maior prevalência de comprometimento moderado/grave na realização das atividades cotidianas. Conclusão: Indivíduos acometidos de AVE, na grande maioria, além de apresentarem comprometimento da capacidade funcional apresentam alterações cognitivas que repercutem de modo negativo na realização das tarefas cotidianas, sejam elas ocupacionais, de lazer ou de autocuidado. Verificou-se a necessidade da avaliação cognitiva para melhor direcionamento da reabilitação e melhora na qualidade de vida.

Factors associated with functional loss in the elderly living in the city of Maceió, Northeastern Brazil.

OBJECTIVE: To identify factors associated with functional loss in older adults living in the urban area. METHODS: A cross-sectional study was carried out with a population-based sample of 319 elderly individuals from the municipality of Maceió (Northeastern Brazil), in 2009. To obtain the functional impairment data the Brazilian Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire was used. A descriptive analysis, the chi-square test and a regression analysis for crude prevalence ratio were used, and the significance level that was adopted was p <0.05. RESULTS: The majority of participants were females (65.8%) and the mean age was 72 years (SD = 8.83). The prevalence of moderate/severe impairment was 45.5%, and the associated factors were being 75 years old or older, having up to four years of schooling, reporting two or more chronic diseases and being single. CONCLUSIONS: The characteristics of the elderly with functional impairment reflect inequalities and potential impacts of this population segment on the health services.

Fatores associados à perda funcional em idosos residentes no município de Maceió, Alagoas / Factors associated with functional loss in the elderly living in the city of Maceió, Northeastern Brazil / Factores asociados a la pérdida funcional en ancianos residentes en el municipio de Maceió, Noreste de Brasil

OBJETIVO: Identificar fatores associados à perda funcional em idosos residentes na zona urbana. MÉTODOS: Foi realizado estudo de delineamento transversal com amostra populacional de 319 idosos do município de Maceió, AL, em 2009. Para os dados de comprometimento funcional foi utilizada a escala Functional Brazilian Older American Resources and Services Multidimensional Functional Assessment Questionnaire. Foi utilizada análise descritiva, qui-quadrado e análise de regressão para razão de prevalência bruta, sendo o nível de significância adotado de p < 0,05. RESULTADOS: A maioria dos participantes era do sexo feminino (65,8 por cento) e a média de idade foi de 72 anos (dp = 8,83). A prevalência de comprometimento moderado/grave foi de 45,5 por cento, tendo como fatores associados a idade de 75 anos ou mais, até quatro anos de escolaridade, relatar ter duas ou mais doenças crônicas e ser solteiro. CONCLUSÕES: As características dos idosos com comprometimento funcional refletem desigualdades e potenciais impactos desse segmento populacional sobre os serviços de saúde.

OBJECTIVE: To identify factors associated with functional loss in older adults living in the urban area. METHODS: A cross-sectional study was carried out with a population-based sample of 319 elderly individuals from the municipality of Maceió (Northeastern Brazil), in 2009. To obtain the functional impairment data the Brazilian Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire was used. A descriptive analysis, the chi-square test and a regression analysis for crude prevalence ratio were used, and the significance level that was adopted was p <0.05. RESULTS: The majority of participants were females (65.8 percent) and the mean age was 72 years (SD = 8.83). The prevalence of moderate/severe impairment was 45.5 percent, and the associated factors were being 75 years old or older, having up to four years of schooling, reporting two or more chronic diseases and being single. CONCLUSIONS: The characteristics of the elderly with functional impairment reflect inequalities and potential impacts of this population segment on the health services.

OBJETIVO: Identificar factores asociados a la pérdida funcional en ancianos residentes en la zona urbana. MÉTODOS: Se realizó estudio de delineamiento transversal con muestra poblacional de 319 ancianos del municipio de Maceió, Noreste de Brasil, en 2009. Para los datos de comprometimiento funcional fue utilizada la escala Functional Brazilian Older American Resources and Services Multidimensional Functional Assessment Questionnaire. Se utilizó análisis descriptivo, chi-cuadrado y análisis de regresión para coeficiente de prevalencia bruto, siendo el nivel de significancia adoptado de p<0,05. RESULTADOS: La mayoría de los participantes era del sexo femenino (65,8 por ciento) y el promedio de edad fue de 72 años (de = 8,83). La prevalencia de comprometimiento moderado/grave fue de 45,5 por ciento, teniendo como factores asociados la edad de 75 años o más, hasta cuatro años de escolaridad, relatar tener dos o más enfermedades crónicas y ser soltero.

Perfil da saúde vocal de cantores amadores de igreja evangélica / Vocal health profile of amateur singers from an evangelical church

OBJETIVO: Investigar o perfil de saúde vocal de cantores amadores de louvores evangélicos com relação a queixas, hábitos e dificuldades vocais vivenciados durante a prática do canto em indivíduos dos gêneros masculino e feminino. MÉTODOS: Participaram 55 sujeitos, com idade entre 18 e 50 anos, os quais responderam a um questionário auto-aplicável sobre identificação de hábitos vocais e possíveis queixas de voz falada e cantada. RESULTADOS: Os cantores religiosos evangélicos amadores relataram queixas relacionadas à voz, tais como rouquidão constante (43,6 por cento), pigarro constante (43,6 por cento), falhas na voz (34,5 por cento), perda de voz (18,1 por cento), garganta seca (18,1 por cento), voz fraca (14,5 por cento) e dor no pescoço e na nuca (12,7 por cento). Durante a atividade de canto, as queixas mais reportadas foram as de dificuldades de alcançar notas agudas (45,4 por cento), rouquidão (30,9 por cento) e falhas na voz (29 por cento). Os hábitos vocais expostos pelos cantores foram os relativos a falar muito (63,6 por cento), ingerir gelado habitualmente em excesso (43,6 por cento), falar alto (40 por cento) e gritar com frequência (20 por cento). Com relação à variável gênero, foram observadas diferenças significativas entre os grupos, relacionadas às variáveis falhas na voz, consumo de gelados e falar alto. CONCLUSÃO: Os cantores religiosos amadores, de ambos os gêneros, apresentam percentual expressivo de queixas e hábitos vocais que podem estar associados à falta de informações sobre os hábitos saudáveis de produção vocal e que podem contribuir para o desenvolvimento de alterações laríngeas e disfonia.

PURPOSE: To investigate the vocal health profile of male and female gospel amateur singers regarding vocal complaints, habits and difficulties during singing practice. METHODS: Participants were 55 subjects with ages between 18 and 50 years, who answered a self-assessment questionnaire regarding the identification of vocal habits and possible complaints of spoken and sung voice. RESULTS: Amateur gospel singers reported vocal complaints, such as continuous hoarseness (43.6 percent), constant throat clearing (43.6 percent), voice failure (34.5 percent), voice loss (18.1 percent), dry throat (18.1 percent), weak voice (14.5 percent), and neck and cervix pain (12.7 percent). During singing activity, the most reported complaints were difficulties in reaching high notes (45.4 percent), hoarseness (30.9 percent) and voice failure (29 percent). The vocal habits the singers reported regarded excessive talking (63.6 percent), immoderate icy beverages intake (43.6 percent), loud talking (40 percent), and repeatedly shouting (20 percent). Significant differences were found between genders regarding the variables voice failure, icy beverages intake, and loud talking. CONCLUSION: Amateur religious singers of both genders showed an expressive percentage of vocal complaints and habits that might be associated to lack of information about healthy vocal habits, which can contribute to the development of laryngeal alterations and voice disorders.

O papel da dieta cetogênica no estresse oxidativo presente na epilepsia experimental / The role of the ketogenic diet on oxidative stress present in experimental epilepsy

INTRODUÇÃO: A epilepsia é um dos transtornos neurológicos mais comuns, sendo definido como uma condição de crises recorrentes espontâneas. Existe uma importante relação entre radicais livres e enzimas antioxidantes no fenômeno epiléptico, e as espécies reativas de oxigênio (EROs) têm sido implicadas na neurodegeneração induzida pelas crises. OBJETIVO: A presente revisão teve como objetivo investigar a relação existente entre o estresse oxidativo e a epilepsia, destacando o efeito da dieta cetogênica sob condições experimentais. MATERIAL E MÉTODOS: Procedeu-se a pesquisa em artigos científicos publicados nos Bancos de Dados Medline, PubMed, Periódicos CAPES, ScienceDirect e Scielo. As palavras-chave selecionadas para a pesquisa incluíram epilepsia, status epilepticus, pilocarpina, estresse oxidativo, espécies reativas de oxigênio, disfunção mitocondrial. RESULTADOS E DISCUSSÃO: Terapia dietética tem sido utilizada, como é o caso da dieta cetogênica (DC), a qual é rica em lipídeos e pobre em carboidratos e utilizada por mais de oito décadas para o tratamento de epilepsia refratária, principalmente em crianças. A DC modula a bionergética mitocondrial, diminui a formação de EROs, aumenta a capacidade antioxidante celular e ainda, previne alterações do DNA mitocondrial. CONCLUSÃO: Evidências de atuação da DC na disfunção mitocondrial, como ocorre na epilepsia, são muitas e demonstram claramente efeitos benéficos dessa terapêutica.

INTRODUCTION: Epilepsy is a neurological disorder more common, being defined as a condition of spontaneous recurrent seizures. An important relationship exists between free radicals and antioxidant enzymes in epileptic phenomena and reactive oxygen species (ROS) have been implicated in neurodegeneration induced by crises. AIM: This review aimed to investigate the relationship between oxidative stress and epilepsy, highlighting the effect of the ketogenic diet under experimental conditions. METHODS: There has been research papers published in the databases Medline, PubMed, CAPES journals, ScienceDirect and Scielo. The keywords selected for the study included epilepsy, status epilepticus, pilocarpine, oxidative stress, reactive oxygen species, mitochondrial dysfunction. RESULTS AND DISCUSSION: Dietary therapy has been used, such as the ketogenic diet (KD), which is rich in fat and low in carbohydrates and used by more than eight decades for the treatment of refractory epilepsy, especially in children. The KD modulates mitochondrial bioenergetic, decreases the formation of ROS, increases the antioxidant capacity and also prevents changes in mitochondrial DNA. CONCLUSION: Evidence of activity of KD in mitochondrial dysfunction, as epilepsy, are many and clearly demonstrate the beneficial effects of the therapy.

Acute tryptophan administration impairs cortical spreading depression propagation in REM sleep deprived and non-deprived adult rats

The enhanced availability of tryptophan in the brain, as a consequence of exogenous tryptophan administration, can increase neuronal serotonin synthesis and this can interfere with brain function. REM sleep deprivation (D) constitutes another external factor that can change brain excitability, facilitating, in some cases, the manifestation of neurological diseases like epilepsy. Here we used cortical spreading depression (CSD) as a neurophysiological parameter to investigate the effects of a single L-tryptophan intraperitoneal injection combined or not with 72h D-condition (water-tank technique) in rats. A 1h baseline CSD-recording was performed under urethane+chloralose (1g/kg + 40mg/kg) anesthesia and revealed increased CSD propagation velocities in D rats, as compared with non-deprived (ND), or pseudo-deprived (Pseudo) controls. After the baseline CSD recording, L-tryptophan was immediately injected (125 mg/kg ip, dissolved in water at pH about 3) and this was followed by a significant decrease of CSD propagation velocities, as compared to the baseline values in the same animals of the Pseudo, ND and D condition. In an additional control group (ND rats injected with the vehicle), no CSD propagation change was seen. Our findings indicate an important acute antagonistic influence of tryptophan on CSD propagation, which is not affected by REM sleep deprivation. We suggest that this tryptophan effect may be due to a serotonin-mediated action, probably caused by increased serotonin synthesis as a consequence of enhanced tryptophan availability in the brain.(AU)

Acute tryptophan administration impairs cortical spreading depression propagation in REM sleep deprived and non-deprived adult rats

The enhanced availability of tryptophan in the brain, as a consequence of exogenous tryptophan administration, can increase neuronal serotonin synthesis and this can interfere with brain function. REM sleep deprivation (D) constitutes another external factor that can change brain excitability, facilitating, in some cases, the manifestation of neurological diseases like epilepsy. Here we used cortical spreading depression (CSD) as a neurophysiological parameter to investigate the effects of a single L-tryptophan intraperitoneal injection combined or not with 72h D-condition (water-tank technique) in rats. A 1h baseline CSD-recording was performed under urethane+chloralose (1g/kg + 40mg/kg) anesthesia and revealed increased CSD propagation velocities in D rats, as compared with non-deprived (ND), or pseudo-deprived (Pseudo) controls. After the baseline CSD recording, L-tryptophan was immediately injected (125 mg/kg ip, dissolved in water at pH about 3) and this was followed by a significant decrease of CSD propagation velocities, as compared to the baseline values in the same animals of the Pseudo, ND and D condition. In an additional control group (ND rats injected with the vehicle), no CSD propagation change was seen. Our findings indicate an important acute antagonistic influence of tryptophan on CSD propagation, which is not affected by REM sleep deprivation. We suggest that this tryptophan effect may be due to a serotonin-mediated action, probably caused by increased serotonin synthesis as a consequence of enhanced tryptophan availability in the brain.

Serotonin depletion effects on the pilocarpine model of epilepsy.

The monoamine content in cerebral structures has been related to neuronal excitability and several approaches have been used to study this phenomenon during seizure vulnerability. In the present work, we have described the effects of serotonin (5-HT) depletion after the administration of 5,7-dihydroxytryptamine (5,7-DHT) into the median raphe nucleus in rats submitted to the pilocarpine model of epilepsy. Susceptibility to pilocarpine-induced status epilepticus as well as the spontaneous seizure frequency during the chronic period of the model was determined. Since the hippocampus is one of the main structures in the development of this epilepsy model, the 5-HT levels in this region were also determined after drug administration. Sixty-three percent of 5,7-DHT pre-treated rats (15/24) and only 33.4% of those receiving the control solution (9/24) progressed to motor limbic seizures evolving to status epilepticus, following the administration of pilocarpine. The frequency of seizures during the chronic period, in epileptic rats that received 5,7-DHT, showed a significant (58%) increase after the treatment, when compared with control group. Our data showed that serotonin may play an important role on seizure activity which seems to be exerted by its inhibitory action on the expression of overt behavior seizures departing from an established focus in the limbic system.

Monoaminas e epilepsia: estudo através do modelo experimental induzido pela pilocarpina / Monoanines and epilepsy: study by pilocarpinr epilepsy model

O modelo de epilepsia experimental induzido pela pilocarpina tem sido amplamente usado no estudo das epilepsias em virtude de sua semelhança fisiopatológica com a epilepsia do lobo temporal. Esse tipo de síndrome epiléptica, acomete cerca de 40 por cento dos casos de epilepsia em humanos e é responsável pelo surgimento de crises parciais complexas de difícil controle. O modelo da pilocarpina foi dividido em 3 fases: período agudo, no qual os animais apresentam crises límbicas evoluindo para status epilepticus; período silencioso, com duração de 4 a 44 dias, caracterizado pela ausência de sinais comportamentais e eletrográficos de atividade epiléptica; e período crônico, que inicia-se com a primeira crise espontânea durando por toda a vida do animal (LEITE, et ai., 1990; CAVALHEIRO et ai., 1991). Estudos experimentais realizados já há alguns anos evidenciaram o envolvimento dos sistemas monoaminérgicos (noradrenalina, serotonina e dopamina) na expressão ou na regulação das epilepsias. O presente trabalho teve como objetivo estudar os efeitos da depleção dos sistemas monoaminérgicos: noradrenalina (NA), serotonina (5-HT) e dopamina (DA) sobre o modelo de epilepsia induzido pela injeção de pilocarpina. As depleções das monoaminas foram obtidas pela injeção de cloroetii-etil-bromobenzilamina (DSP-4); i.p.); 6-hidroxidopamina (6-HODA; intracerebral na substância negra) e 5,7-dihidroxitriptamina (5,7-DHT; intracerebral no núcleo mediano da rafe) para depletar os sistemas noradrenérgico, dopaminérgico e serotonérgico, respectivamente. Os experimentos foram divididos em duas fases: Fase I na qual os animais eram previamente depletados de cada monoamina e em seguida eram injetados com pilocarpina. Nessa fase do experimento foram analisados: latência para as primeiras crises convulsivas, latência para o status epilepticus (SE), evolução para SE e gravidade das crises convulsivas. Na Fase II, na qual os animais eram inicialmente injetados com pilocarpoina e recebiam a neurotoxina quando encontravam-se na fase crônica do modelo. Nessa fase do experimento foram avaliados; gravidade e freqüência das crises convulsivas. A depleção dos níveis cerebrais de noradrenalina durante a Fase I do experimento facilitou a evolução para SE ao mesmo tempo em que aumentou a gravidade das crises convulsivas resultando em maior mortalidade dos animais. Durante a Fase II, por outro lado, a depleção cerebral de NA não promoveu ...(au)