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1.
Eur J Phys Rehabil Med ; 50(3): 255-64, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24429918

RESUMO

BACKGROUND: Traditional rehabilitation improves pain and function in patients with shoulder impingement syndrome. Neurocognitive rehabilitation has shown to be highly effective after surgical reconstruction of the anterior cruciate ligament. However, its effects in patients with shoulder impingement syndrome have not yet been established. AIM: The aim of the study was to compare the effects of neurocognitive therapeutic exercise, based on proprioception and neuromuscular control, on pain and function in comparison to traditional therapeutic exercise in patients with shoulder impingement syndrome. DESIGN: Single-blind randomized, non-inferiority clinical trial. SETTING: Outpatient clinic of Geriatrics and Physiatrics, University Hospital. POPULATION: Forty-eight patients with shoulder impingement syndrome (Neer stage I) and pain lasting for at least three months. METHODS: Participants were randomly allocated (1:1) to either neurocognitive therapeutic exercise or traditional therapeutic exercise. Both treatments were provided one-hour session, three times a week for five weeks. The primary outcome measure was the short form of the Disability of the Arm, Shoulder and Hand Questionnaire (Quick-DASH questionnaire) for the assessment of physical ability and symptoms of the upper extremity. SECONDARY OUTCOME MEASURES: Constant-Murley shoulder outcome score for the determination of range of motion, pain and strength; American Shoulder and Elbow Surgeons Society standardized shoulder assessment form for the evaluation of physical ability in daily-living tasks; a visual analogue scale for pain assessment at rest and during movements; Likert score for the estimation of participant satisfaction. ENDPOINTS: before treatment, end of treatment, 12 and 24 weeks after the completion of each intervention for all outcome measures, except for the Likert score that was evaluated only at the end of treatment. FOLLOW-UP: 24 weeks. RESULTS: At the end of treatment and at follow-up, both treatment groups experienced improvements in all outcomes measures relative to baseline values, except for the visual analogue scale at rest that was unaffected by traditional therapeutic exercise. For all outcome measures, changes over time were greater in the neurocognitive therapeutic exercise group relative to the traditional therapeutic exercise group. The level of satisfaction with treatment was higher for participants in the neurocognitive therapeutic exercise group. CONCLUSION: Neurocognitive rehabilitation is effective in reducing pain and improving function in patients with shoulder impingement syndrome, with benefits maintained for at least 24 weeks. CLINICAL REHABILITATION IMPACT: skills and function of the shoulder can greatly benefit from neurocognitive rehabilitation.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Terapia por Exercício/métodos , Ambulatório Hospitalar , Amplitude de Movimento Articular/fisiologia , Síndrome de Colisão do Ombro/reabilitação , Articulação do Ombro/fisiopatologia , Dor de Ombro/reabilitação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Síndrome de Colisão do Ombro/complicações , Síndrome de Colisão do Ombro/psicologia , Dor de Ombro/etiologia , Dor de Ombro/fisiopatologia , Método Simples-Cego , Resultado do Tratamento
2.
Integr Comp Biol ; 53(4): 660-70, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23660590

RESUMO

The injection of anthropogenically-produced CO2 into the atmosphere will lead to an increase in temperature and a decrease in pH at the surface of the oceans by 2100. Marine intertidal organisms possess the ability to cope in the short term with environmental fluctuations exceeding predicted values. However, how they will cope with chronic exposure to elevated temperature and pCO2 is virtually unknown. In addition, individuals from the same species/population often show remarkable levels of variation in their responses to complex climatic changes: in particular, variation in metabolic rates often is linked to differences in individuals' performances and fitness. Despite its ecological and evolutionary importance, inter-individual variation has rarely been investigated within the context of climatic changes, and most investigations have typically employed orthogonal experimental designs paired to analyses of independent samples. Although this is undoubtedly a powerful and useful approach, it may not be the most appropriate for understanding all alterations of biological functions in response to environmental changes. An individual approach arguably should be favored when trying to describe organisms' responses to climatic change. Consequently, to test which approach had the greater power to discriminate the intensity and direction of an organism's response to complex climatic changes, we investigated the extracellular osmo/iono-regulatory abilities, upper thermal tolerances (UTTs), and metabolic rates of individual adults of an intertidal amphipod, Echinogammarus marinus, exposed for 15 days to combined elevated temperature and pCO2. The individual approach led to stronger and different predictions on how ectotherms will likely respond to ongoing complex climatic change, compared with the independent approaches. Consequently, this may call into question the relevance, or even the validity, of some of the predictions made to date. Finally, we argue that treating individual differences as biologically meaningful can lead to a better understanding of the physiological responses themselves and the selective processes that will occur with complex climatic changes; selection will likely play a crucial role in defining species' responses to future environmental changes. Individuals with higher metabolic rates were also characterized by greater extracellular osmo/iono-regulative abilities and higher UTTs, and thus there appeared to be no evolutionary trade-offs between these functions. However, as individuals with greater metabolic rates also have greater costs for maintenance and repair, and likely a lower fraction of energy available for growth and reproduction, trade-offs between life-history and physiological performance may still arise.


Assuntos
Aclimatação/fisiologia , Anfípodes/fisiologia , Mudança Climática , Estuários , Osmorregulação/fisiologia , Estresse Fisiológico/fisiologia , Análise de Variância , Animais , Dióxido de Carbono/análise , Metabolismo Energético/fisiologia , Inglaterra , Concentração de Íons de Hidrogênio , Masculino , Oceanos e Mares , ATPase Trocadora de Sódio-Potássio/metabolismo , Temperatura
3.
J Endocrinol Invest ; 36(8): 617-21, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23511311

RESUMO

BACKGROUND: As lowering glycated hemoglobin (HbA1c) levels is still the main goal of insulin treatment, severe hypoglycemia (SH) remains a common experience in children with Type 1 diabetes mellitus (T1DM) and their families. AIM: This study aims to evaluate the incidence and the clinical features of SH episodes in our Centre in the last 20 yr. SUBJECTS AND METHODS: We analyzed SH incidence in 269 patients (pts) diagnosed from 1990 to 2010 (total follow-up 2212.9 pts/yr). Inclusion criteria were at least 3 visits/yr and 1-yr follow- up. SH episode was defined as any condition of low blood glucose requiring third-party assistance. RESULTS: 50.2% of patients experienced at least 1 SH episode for a total of 345 episodes. Whole incidence was 15.6/100 pts/yr, slightly different between first and second decade (12.6 vs 16.5, p=0.047). HbA1c at the time of SH was lower in the non-basal bolus group (7.4±1.3 vs 8.2±1.4; p=0.0001) and worsened 3 months later (p=0.0001). Impaired awareness was the main or only symptom in 43.5%. SH occurred at night in 32% of patients; they were significantly younger than those with SH at other times. Five SH episodes or more occurred in 8.1% of patients who presented a lower HbA1c, a younger age and shorter disease duration than the other patients. HbA1c at first SH was negatively correlated with number of SH (r=-0.20; p=0.05). CONCLUSIONS: Despite the advent of new insulin regimens, we confirm that SH still represents a relevant risk and a current threat for patients with T1DM and their families.


Assuntos
Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/complicações , Hemoglobina A Glicada/metabolismo , Hipoglicemia/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Hipoglicemia/induzido quimicamente , Incidência , Lactente , Itália/epidemiologia , Masculino , Estudos Retrospectivos , Adulto Jovem
4.
Eur J Phys Rehabil Med ; 48(3): 467-73, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22820820

RESUMO

BACKGROUND: The influence of spirituality and religious beliefs on health-related quality of life and disability in the rehabilitation field is discussed in literature. AIM: To describe the role of spiritual belief on functional recovery and health-related quality of life in acute inpatient rehabilitation ward. DESIGN: Observational cross sectional study. SETTING: Inpatients clinic of Physical Medicine and Rehabilitation Department, University Hospital. POPULATION: One hundred and four patients admitted to an inpatient acute rehabilitation ward, after a neurological or orthopedic disease. METHODS: Anamnestic and demographic data were reported on a standardized form. The Royal Free Interview for Spiritual and Religious Beliefs (RFI) and Cumulative Illness Rating Scale (CIRS) were performed on admission (T0). SF-36 item Short Form Health Survey Questionnaire (SF36) and the Barthel index (BI) were performed on admission (T0) and on discharge (T1). RESULTS: Statistical analysis was performed on 102 patients with spiritual belief divided in strong (55 cases) and weak (47 cases) spiritual belief. Change from baseline (T1-T0) of SF36 domains between groups showed a significant higher improvement in Physical Role and Physical Composite Score in the weak belief group than in the strong belief group. The latter presented an improvement (without statistical significance) in almost every emotional score. We found no significant difference in change from baseline of Barthel index between the groups. CONCLUSION: Strength of spiritual belief seems to influence some aspects of quality of life of acute inpatient in the rehabilitation setting. It seems that patients with less spiritual belief showed more improvement in physical role, after acute rehabilitation.


Assuntos
Avaliação da Deficiência , Pessoas com Deficiência/reabilitação , Pacientes Internados/psicologia , Qualidade de Vida , Recuperação de Função Fisiológica , Centros de Reabilitação , Religião , Idoso , Estudos Transversais , Pessoas com Deficiência/psicologia , Feminino , Humanos , Masculino , Alta do Paciente/tendências , Estudos Retrospectivos , Inquéritos e Questionários
5.
Eur J Phys Rehabil Med ; 48(4): 549-59, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22820824

RESUMO

BACKGROUND: Deep heating therapy (DHT) has shown to improve pain and function in patients with knee osteoarthritis (OA) in the short term. Benefits of superficial heating therapy (SHT) are controversial. Long-term effects of both heating modalities have not yet been investigated. AIM: To compare the effects of DHT and SHT in patients with symptomatic knee OA, and to determine the long-term effects of heat therapy. DESIGN: Double-blind randomized clinical trial. SETTING: Outpatient clinic of Geriatrics and Physiatrics, University Hospital. POPULATION: Fifty-four patients with radiologically established diagnosis of moderate knee OA (Kellgren-Lawrence grade II or III) and pain lasting for at least three weeks. METHODS: DHT: local microwave diathermy (three 30-min sessions a week for four weeks); SHT: application of hot packs (three 30-min sessions a week for four weeks). PRIMARY OUTCOME MEASURE: Western Ontario and McMaster Universities (WOMAC) index for the assessment of joint pain, stiffness and physical function limitations. SECONDARY OUTCOME MEASURES: British Medical Research Council (BMRC) rating scale for the evaluation of muscle strength, and a visual analogue scale (VAS) for pain assessment. Follow up: 24 weeks for all outcome measures; 12 months for the primary outcome. RESULTS: Intention-to-treat analyses showed a treatment effect in favor of DHT for all outcome measures. No clinically relevant changes were observed in the SHT group. Benefits of DHT were maintained over 12 months of follow-up. CONCLUSIONS: DHT via localized microwave diathermy improves pain, muscle strength and physical function in patients affected by knee OA, with benefits maintained over the long term. No clinically relevant improvements were observed in patients who underwent SHT. CLINICAL REHABILITATION IMPACT: DHT via microwave diathermy delivered three times a week for four weeks significantly improves pain and function in patients affected by moderate knee OA, with benefits retained for at least 12 months. No clinically relevant changes are observed in knee OA patients treated with SHT.


Assuntos
Artralgia/terapia , Diatermia/métodos , Osteoartrite do Joelho/reabilitação , Manejo da Dor/métodos , Idoso , Artralgia/etiologia , Método Duplo-Cego , Feminino , Temperatura Alta/uso terapêutico , Humanos , Itália , Masculino , Micro-Ondas , Pessoa de Meia-Idade , Força Muscular , Osteoartrite do Joelho/fisiopatologia
6.
G Ital Med Lav Ergon ; 32(4 Suppl): 172, 2010.
Artigo em Italiano | MEDLINE | ID: mdl-21438251

RESUMO

The evolution of social and health setting in its demographic, productive and welfare elements make work as a finalized activity oriented to different tasks, from individual indepencence to social integration. In this context, the word "re-habilitation" has a double value; on one hand consideration of lifetime acquired abilities; on the other hand recovery of residual activities, consistent with the disablement. In Italy, for years, rehabilitation activities were performed by physiotherapists, who had inadequate occupational knowledge and preferred technical skills of non-finalized function recovery. The acknowledgment of Occupational Therapist took place in the end of the '90s, so that the few organizations sensitive to Occupational Therapy, as "Fondazione Maugeri" and "Fondazione Don Gnocchi", found "prepared ad hoc" personnel only abroad, above all in Spain and Switzerland. Nowadays we have specific first degree courses, but what really obstacles the development of this field is the economic crisis which afflicts healthcare services and avoids the growth of new sectors.


Assuntos
Acidentes de Trabalho , Terapia Ocupacional , Ferimentos e Lesões/reabilitação , Humanos
7.
Eur J Phys Rehabil Med ; 45(3): 327-34, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19209135

RESUMO

AIM: The aim of this study was to investigate the balance of the standing position and the motor responses by means of dynamic posturography (DP) in patients affected by hip osteoarthritis and treated by total hip replacement (THR). METHODS: Data obtained from THR patients were compared with those of control adult groups ofage-matched subjects with normal hearing and no history of audio-vestibular symptoms. The statistical tests used were paired and unpaired Student's t-test. Significance was set for P<0.05. The study was carried out at the Department of Otorhinolaryngology and Department of Physiatrics and Rehabilitation of the A. Gemelli University Hospital of Rome (Italy). Twenty-three consecutive patients, without cochleo-vestibular or neurological pathologies (screened by accurate case-history), affected by hip osteoarthritis and treated by THR were enrolled. The main outcome measure were Sensory Organization Test (SOT), Motor control test (MCT) and Adaptation test (AT) obtained by means of Equi-Test Dynamic Posturography System by NeuroCom (Int. Inc., Clackamas, OR, USA). RESULTS: When analysing the SOT and MCT, no statistically significant differences were observed between patients and controls. In the AT, the sway energy score decreased in the course of the test in an up and down perturbation both in healthy and in THR patients. CONCLUSIONS: These data confirm a normal postural control and symmetrical responses in THR patients and confirm the absence of a detectable relationship between balance problems and fall risk. These results could be justified by an irrelevant role of intracapsular proprioceptors in maintaining balance. Moreover DP could be useful in osteo-articular diseases for understanding balance, evaluating surgical outcome and monitoring the rehabilitation program.


Assuntos
Artroplastia de Quadril , Osteoartrite do Quadril/cirurgia , Equilíbrio Postural/fisiologia , Células Receptoras Sensoriais/fisiologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Destreza Motora/fisiologia , Exame Neurológico
8.
Clin Rehabil ; 22(10-11): 977-86, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18955429

RESUMO

OBJECTIVE: To examine the effect of pre-operative physiotherapy before hip arthroplasty in patients with end-stage hip osteoarthritis. DESIGN: A prospective randomized controlled study. SETTING: Physical medicine and rehabilitation and orthopaedic departments of Policlinico Gemelli of Rome. SUBJECTS: Twenty-three patients randomized in study and control groups. INTERVENTION: The study group took part in an educational and physiotherapy programme one month before surgery. Both groups took part in the same inpatient rehabilitation programme after surgery. MAIN OUTCOME MEASURES: Both groups were evaluated one month (T0) and the day before arthroplasty (T1), after 15 days (T2), four weeks (T3) and three months (T4) post surgery, using the Barthel Index, the Short Form-36 (SF-36), the Western Ontario and McMaster Osteoarthritis Index (WOMAC), the Hip Harris Score (HHS), visual analogue scale (VAS), the British Medical Research Council (BMRC) measures of hip abductor and quadriceps strength and range of hip abduction and external rotation. RESULTS: There were no significant differences between groups with regard to the Barthel Index, SF-36, WOMAC and HHS at T4. The study group presented significant improvements of the SF-36 physical composite score at T1. The hip external rotation was significantly higher in the study group at each evaluation and the visual analogue scale values were lower at T1, T3 and T4. CONCLUSION: Pre-operative physiotherapy in patients undergoing hip arthroplasty does not improve impairment and health-related quality of life after intervention. Physiotherapy and educational therapy may be useful for end-stage osteoarthritis.


Assuntos
Artroplastia de Quadril/reabilitação , Osteoartrite do Quadril/cirurgia , Cuidados Pré-Operatórios/métodos , Idoso , Terapia por Exercício/métodos , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Cuidados Pré-Operatórios/educação , Estudos Prospectivos , Qualidade de Vida , Sensibilidade e Especificidade , Resultado do Tratamento
9.
Eur J Phys Rehabil Med ; 44(3): 277-81, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18762736

RESUMO

AIM: The aim of this study was to describe the baseline characteristics of a sample of stroke patients admitted to rehabilitation settings with the use of a standardised stroke assessment named ''Protocollo di Minima per l'ictus cerebrale'' (PMIC), to verify the usefulness of the application of PMIC and to compare the data of the authors with the international literature. METHODS: An observational cross sectional study was conducted on a sample of 102 first-time stroke patients (mean age: 71.9 [+/-11.6], 54 men), in three inpatient rehabilitation centres. MEASUREMENT: PMIC. RESULTS: Most patients were enrolled within 14 days of stroke onset. PMIC assessment took on average 20 minutes and provided the following information: 35% had architectural barriers in their homes; 82% of the cases had 1 or more family assistants; the educational level was low for 53%; 72% were retired; most cases were ischemic stroke without any side predominance being shown; 44% had partial anterior circulation infarcts (PACI) ischemic stroke; 18.6% presented dysphagia; 73% had sphincteral incontinence; there was no hypertone in more than 50% of the cases; 87% required assistance; the median Motricity Index Side Score (Miss) value was 44.1; 38% was affected by mood tone alteration. CONCLUSION: PMIC appeared to be a useful tool for a standardized evaluation of stroke patients. These results provide data with a high correspondence in international reports.


Assuntos
Atividade Motora/fisiologia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Testes Diagnósticos de Rotina , Avaliação da Deficiência , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Admissão do Paciente , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/psicologia
10.
Clin Rehabil ; 21(4): 299-314, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17613571

RESUMO

OBJECTIVE: To assess the effectiveness of conservative therapy in carpal tunnel syndrome. DATA SOURCES: A computer-aided search of MEDLINE and the Cochrane Collaboration was conducted for randomized controlled trials (RCTs) from January 1985 to May 2006. REVIEW METHODS: RCTs were included if: (1) the patients, with clinically and electrophysiologically confirmed carpal tunnel syndrome, had not previously undergone surgical release, (2) the efficacy of one or more conservative treatment options was evaluated, (3) the study was designed as a randomized controlled trial. Two reviewers independently selected the studies and performed data extraction using a standardized form. In order to assess the methodological quality, the criteria list of the Cochrane Back Review Group for systematic reviews was applied. The different treatment methods were grouped (local injections, oral therapies, physical therapies, therapeutic exercises and splints). RESULTS: Thirty-three RCTs were included in the review. The studies were analysed to determine the strength of the available evidence for the efficacy of the treatment. Our review shows that: (1) locally injected steroids produce a significant but temporary improvement, (2) vitamin B6 is ineffective, (3) steroids are better than non-steroidal anti-inflammatory drugs (NSAIDs) and diuretics, but they can produce side-effects, (4) ultrasound is effective while laser therapy shows variable results, (5) exercise therapy is not effective, (6) splints are effective, especially if used full-time. CONCLUSION: There is: (1) strong evidence (level 1) on efficacy of local and oral steroids; (2) moderate evidence (level 2) that vitamin B6 is ineffective and splints are effective and (3) limited or conflicting evidence (level 3) that NSAIDs, diuretics, yoga, laser and ultrasound are effective whereas exercise therapy and botulinum toxin B injection are ineffective.


Assuntos
Síndrome do Túnel Carpal/terapia , Corticosteroides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Diuréticos/uso terapêutico , Terapia por Estimulação Elétrica , Terapia por Exercício , Humanos , Injeções Intra-Articulares , Ensaios Clínicos Controlados Aleatórios como Assunto , Contenções , Terapia por Ultrassom , Vitamina B 6/uso terapêutico , Complexo Vitamínico B/uso terapêutico
11.
Eura Medicophys ; 43(1): 49-54, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17021588

RESUMO

AIM: Low back pain (LBP) is the main symptom of most lumbar spine diseases. This symptom, due to physical, psychological and social factors, is correlated to a real disability which can affect the quality of life (QoL.) The aim of this study is to evaluate the QoL and the disability in patients with LBP and to correlate them to clinical patterns. METHODS: In this prospective multidimensional study, 108 patients underwent the following protocol: 1. collection of patient-oriented and disability data with the use of SF-36 and North American Spine Society (NASS); 2. collection of clinical, anamnestic and instrumental data (MRI, CT) with the use of DOVAC files; 3. assessment of disability with the use of Barthel index (BI) and deambulation index (DI). RESULTS: A significant correlation was found between the BI and the physical composite score (PCS), but no significant correlation was noticed between BI and the mental composite score (MCS). DI was not correlated to the SF-36. A positive Lasegue and the absence of the osteo-tendinous reflexes are significantly correlated to the disability and QoL. CONCLUSIONS: This study shows that there is no simple, linear correlation between QoL and disability.


Assuntos
Avaliação da Deficiência , Dor Lombar/fisiopatologia , Qualidade de Vida , Perfil de Impacto da Doença , Doenças da Coluna Vertebral/complicações , Doença Aguda , Adulto , Fatores Etários , Idoso , Doença Crônica , Feminino , Humanos , Itália , Dor Lombar/etiologia , Dor Lombar/psicologia , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Sexuais , Inquéritos e Questionários
12.
Neurol Sci ; 27(1): 40-6, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16688598

RESUMO

The purposes of this study were: (1) to evaluate the relationship between disability and Quality of Life (QoL) in stroke outpatients undergoing rehabilitation and (2) to determine whether and how demographic and social features of the patient, duration of disease and concomitant diseases influence the disability and QoL of the stroke outpatients. We performed a prospective study using several conventional disability measurements (Barthel Index, Functional Independence Measure, Modified Rankin Scale and Deambulation Index) and a validated patient-oriented measurement of QoL (SF-36). Sixty-eight outpatients were evaluated consecutively. As expected, all disability measurements were related to Physical Function: patients with higher disability, according to the physician's perspective, complained of higher deterioration of physical performance. Unexpectedly, patients with higher disability from the physician's point of view perceive that they were not able to do some daily activities not only because of physical problems but also because of emotional problems, and complained of higher deterioration of mental health. Multivariate analysis showed that higher disability is associated with higher age, depression and lower educational level. Physical Composite Score appeared to be deteriorated in patients with lower educational level who lived with family; on the contrary, Mental Composite Score appeared deteriorated in patients with higher educational level who lived alone. The current study provides interesting data about the relationship, not always expected, between disability and QoL for stroke patients and about the influence of patients' characteristics on disability and QoL. Our results showed that in a rehabilitation programme we should consider not only disability assessment but also QoL, which is more relevant for the patient.


Assuntos
Avaliação da Deficiência , Qualidade de Vida/psicologia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Progressão da Doença , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Modalidades de Fisioterapia/estatística & dados numéricos , Estudos Prospectivos , Apoio Social , Acidente Vascular Cerebral/psicologia
13.
Neurol Sci ; 26(6): 430-4, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16601936

RESUMO

Over the last 3 years we have observed 5 cases of median nerve schwannoma that clinically simulated carpal tunnel syndrome (CTS). We describe the atypical clinical-neurophysiological picture indicating to perform ultrasonography (US). We retrospectively re-evaluated 5 cases of schwannoma that clinically simulated CTS. Five consecutive patients were referred to the neurophysiopathology laboratory. All patients complained of symptoms and had a neurophysiological examination that might have indicated CTS. Nevertheless we performed US because of some incongruous aspects. In cases of atypical abnormalities at neurophysiological and clinical examination, or dissociation between neurophysiological and clinical findings, physicians should consider the presence of a median nerve tumour. Here, US evaluation is very useful as supporting diagnostic methodology to assess the anatomopathological condition of the nerve lesion and must not be limited to the wrist.


Assuntos
Síndrome do Túnel Carpal/diagnóstico , Neuropatia Mediana/diagnóstico , Neurilemoma/diagnóstico , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Adulto , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Exame Neurológico , Estudos Retrospectivos
14.
Med Lav ; 96 Suppl 2: 5-26, 2005.
Artigo em Italiano | MEDLINE | ID: mdl-16454479

RESUMO

BACKGROUND AND OBJECTIVE: In a preliminary consensus document the authors proposed criteria and methods to identify upper limb work-related MSDs due to biomechanical overload. With this document they intend to define severity according to shared models and procedures so as to fit behaviours to diagnostic procedures and their medical-legal assessment. This becomes especially important in view of Ministerial Decree of April 27 2004 fixing the new lists of diseases having a possible work-related origin that must be reported by law in accordance with art. 139 of law n. 1124, and also on account of the impact of such diseases which, for the first time in Italy, are regulated by law. CONTENTS: The working group, which included INAIL and ISPESL experts and was fully supported by SIMFER (Italian Society of Physical Medicine and Rehabilitation) and SINC (Italian Society of Clinical Neurophysiology), defined a general clinical procedure (anamnesis, objective examination and instrumental assessment) regarding each portion of the concerned upper limb (shoulder, elbow and wrist/hand). Once the presence and characteristics of anatomic and functional damages are established, the results allow a classification scheme to be proposed of upper limb diseases (tendon disorders and entrapment neuropathy) divided into 6 increasing severity stages: initial, medium, medium-severe, severe and extremely severe. Special attention was paid to two instrumental examinations that proved to be of great clinical interest, at least in occupational health: echography of soft tissues (in appendix) and electroneurography for entrapment neuropathy. The limitations of this proposal are discussed but the main goal was achieved: to standardize terms and provide homogeneous criteria to achieve classification of upper limb damage due to biomechanical overload for increasing severity levels. The working group research activity is part of a research project funded by ISPESL.


Assuntos
Transtornos Traumáticos Cumulativos/classificação , Doenças Musculoesqueléticas/classificação , Doenças Profissionais/classificação , Saúde do Trabalhador/legislação & jurisprudência , Extremidade Superior , Fenômenos Biomecânicos , Transtornos Traumáticos Cumulativos/diagnóstico , Transtornos Traumáticos Cumulativos/etiologia , Transtornos Traumáticos Cumulativos/terapia , Prova Pericial , Humanos , Itália , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/etiologia , Doenças Musculoesqueléticas/terapia , Doenças Profissionais/diagnóstico , Doenças Profissionais/etiologia , Doenças Profissionais/terapia , Exposição Ocupacional/efeitos adversos , Medicina do Trabalho/legislação & jurisprudência , Medicina do Trabalho/normas , Índice de Gravidade de Doença , Sociedades Médicas , Avaliação da Capacidade de Trabalho
15.
In. Bordignon, Andrea; Calveyra, Griselda; Ricciardi, Marta. Salud mental: Epoca y subjetividad. Rosario, Homo Sapiens Ediciones, octubre de 2000. p.221-227. (99499).
Monografia em Espanhol | BINACIS | ID: bin-99499
16.
Gen Hosp Psychiatry ; 21(4): 310-7, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-10514955

RESUMO

In order to evaluate the extent and quality of consultation-liaison (C-L) activity in Italy, a multicenter investigation was conducted in 17 general hospitals. All of the hospitalized patients referred to C-L psychiatry during a 1-year period were assessed by means of a specific instrument (Patient Registration Form, PRF-SF). Of 518,212 patients, 4182 were referred to C-L services (referral rate = 0.72%). Typical consultations were for female patients (60.1%), admitted to medical wards (71.5%), aged 55-75 years. Most interventions were carried out within 2 days; a minority (22%) were urgent requests. Gastrointestinal and cardiovascular disorders, and unexplained medical symptoms were the most frequent ICD-9 somatic diagnoses at admission. One-third of the patients were not informed of having been referred to C-L and half of them had a lifetime history of psychiatric disturbances. Most frequent ICD-10 psychiatric diagnoses were neurotic, stress-related, and somatoform syndromes (33.1%), affective syndromes (19.4%), and organic mental syndromes (10.7%). Two-thirds of the patients were given only one consultation whereas the reminder received two to four follow-up visits. The rate of transfer to psychiatric wards was low (2.1%). Psychopharmacological treatment was suggested in 65% of cases, and 75.5% of the patients were referred to community psychiatric care at discharge. The implications of the findings are discussed.


Assuntos
Serviços de Saúde Mental/normas , Psiquiatria , Encaminhamento e Consulta , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Itália , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
17.
Ann Allergy Asthma Immunol ; 81(6): 601-7, 1998 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9892033

RESUMO

BACKGROUND: Epithelial cells and fibroblasts play an important role in allergic inflammation. Modulation of surface expression of adhesion molecules on epithelial cells by antiallergic drugs has been shown by both in vivo and in vitro studies. OBJECTIVE: The aim of the study was to evaluate the effect exerted by terfenadine and fexofenadine on adhesion molecules expression (CD54/ICAM-1 and CD29) of a human continuously cultured conjunctival epithelial cell line (WK) and a fibroblast cell line (HEL). METHODS: By means of flow cytometry analysis, we evaluated ICAM-1 and CD29 expression by WK and HEL epithelial cells in basal condition (at baseline) or after IFN gamma or TNF alpha stimulation in the presence or in the absence of terfenadine and fexofenadine. We also performed immunoenzymatic assays in order to evaluate soluble ICAM-1 released by WK cells and procollagen type I and III and IL6 released by HEL cells. RESULTS: Terfenadine and fexofenadine significantly reduced ICAM-1 basal expression on WK cells at the concentration of 1 microg/mL and 50 microg/mL, respectively. In addition, both terfenadine and fexofenadine were able to decrease soluble ICAM-1 levels in IFN gamma-stimulated WK cells. On HEL fibroblasts, fexofenadine only was able to inhibit ICAM-1 upregulation induced by IFN gamma. Concerning the release of fibroblast products, we observed a dose-dependent decrease of spontaneous IL6 release only in the presence of fexofenadine. CONCLUSION: This study shows that terfenadine and fexofenadine exert a biologic effect directly on epithelial cells and fibroblasts reducing ICAM-1 expression and partially reducing soluble ICAM-1 release.


Assuntos
Antagonistas dos Receptores Histamínicos/farmacologia , Molécula 1 de Adesão Intercelular/biossíntese , Molécula 1 de Adesão Intercelular/efeitos dos fármacos , Terfenadina/análogos & derivados , Terfenadina/farmacologia , Linhagem Celular/efeitos dos fármacos , Linhagem Celular/metabolismo , Humanos , Integrina beta1/biossíntese , Integrina beta1/efeitos dos fármacos , Interferon gama/farmacologia , Interleucina-6/metabolismo , Pró-Colágeno/efeitos dos fármacos , Pró-Colágeno/metabolismo , Células Tumorais Cultivadas
18.
Psychosom Med ; 59(3): 313-7, 1997.
Artigo em Inglês | MEDLINE | ID: mdl-9178342

RESUMO

OBJECTIVE: The effects of a visual training technique on changes in myopia, visual acuity, and psychological distress were studied in a controlled prospective study. METHOD: A group of 33 female students with myopia < or = 3.50 diopters (D) underwent visual training using an acoustic biofeedback technique. A group of 22 female students with myopia and a group of 27 students with emmetropia formed the two control groups, matched for school, age, sex, and refractive error. Manifest and cycloplegic refraction, visual acuity, personality profile (CPI), and psychological distress (SCL-90) were measured at the baseline (T0), at 10 weeks (T1), and after 12 months (T2). RESULTS: At T2, myopia significantly progressed both in the treated and in the untreated students with myopia. Visual acuity improved only in the treated myopia group (despite refraction objectively being worse). No differences were found among the personality profiles in the three groups. All items indicative of psychological suffering improved in the group treated for myopia whose visual acuity was ameliorated. CONCLUSIONS: The visual training technique led to no improvement in objective measures of visual acuity, but did lead to an improvement in one relatively subjective measure of visual acuity and a parallel improvement in psychological conditions. The students with myopia who were treated consequently had a greater sense of general well-being.


Assuntos
Nível de Alerta , Biorretroalimentação Psicológica , Miopia/terapia , Acuidade Visual , Acomodação Ocular , Estimulação Acústica , Adaptação Psicológica , Adolescente , Adulto , Feminino , Humanos , Miopia/psicologia , Inventário de Personalidade , Estudos Prospectivos , Refração Ocular , Resultado do Tratamento , Seleção Visual
19.
J Allergy Clin Immunol ; 99(3): 301-7, 1997 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-9058684

RESUMO

BACKGROUND: Azelastine is a topical antihistamine, clinically demonstrated to be effective in allergic rhinitis. OBJECTIVE: We evaluated the clinical efficacy and the antiallergic activity of azelastine nasal spray, administered 0.56 mg per day, 0.28 mg per day, or on demand over a 3-month period during natural allergen exposure, in a double-blind, placebo-controlled fashion. METHODS: Thirty patients, sensitized to grass or Parietaria pollen, were allocated to three treatment groups: those receiving the standard dosage (0.14 mg/nostril two times a day), half the dosage (0.07 mg/nostril two times a day), or placebo daily for 3 months. All patients were allowed to take additional doses of azelastine when needed. Evaluation parameters were as follows: clinical symptoms recorded on a diary card, number of additional, on-demand azelastine puffs, nasal inflammatory cell count, intercellular adhesion molecule-1 expression on nasal epithelial cells, and pollen count. RESULTS: This study showed the following: (1) the half dose (0.28 mg/day) and the standard dose (0.56 mg/day) were equally effective in reducing clinical symptoms (p = NS), although the standard dosage required fewer additional puffs during times of peak pollen counts (p < 0.05); (2) both dosages were able to reduce the allergic inflammation (p < 0.05 vs placebo); and (3) on-demand use achieved acceptable clinical control but did not significantly reduce allergic inflammation. CONCLUSION: Continuous treatment was more effective than on-demand use as assessed by both clinical evaluation and antiinflammatory action.


Assuntos
Antagonistas dos Receptores Histamínicos H1/administração & dosagem , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Ftalazinas/administração & dosagem , Ftalazinas/uso terapêutico , Rinite Alérgica Sazonal/tratamento farmacológico , Administração Intranasal , Adolescente , Adulto , Método Duplo-Cego , Células Epiteliais , Epitélio/imunologia , Feminino , Antagonistas dos Receptores Histamínicos H1/efeitos adversos , Humanos , Imuno-Histoquímica , Molécula 1 de Adesão Intercelular/análise , Contagem de Leucócitos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Mucosa Nasal/citologia , Mucosa Nasal/efeitos dos fármacos , Mucosa Nasal/imunologia , Neutrófilos/efeitos dos fármacos , Neutrófilos/imunologia , Ftalazinas/efeitos adversos , Pólen/imunologia , Teste de Radioalergoadsorção , Testes Cutâneos
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