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1.
Coimbra; s.n; 20210201. tab, ilus.
Tese em Português | BDENF - Enfermagem | ID: biblio-1178099

RESUMO

A patologia cardiovascular é uma das principais causas de morte no mundo, particularmente o Enfarte Agudo do Miocárdio (EAM), o qual apresenta uma taxa de mortalidade entre 17% a 45% dos doentes admitidos em instituições hospitalares. Numa fase inicial, o doente encontra-se confinado no leito com limitações na realização das Atividades de Vida Diária (AVD), evidenciando frequentemente fadiga, incapacidade funcional, medo e ansiedade. É necessário, no entanto, que a pessoa retome gradualmente a realização de atividade física. Neste sentido, e partindo do desenvolvimento de dois protótipos do dispositivo Ablefit, concebido para a realização de exercício físico no leito, pretende-se avaliar a sua usabilidade para doentes com EAM e identificar as principais limitações dos protótipos, visando apresentar recomendações para a sua melhoria e aperfeiçoamento. Utilizou-se uma metodologia mista, tendo sido recolhida informação através de três grupos focais e aplicação do questionário de usabilidade System Usability Scale a 16 Enfermeiros Especialistas em Enfermagem de Reabilitação (EEER). Efetuada a análise dos dados quantitativos com recurso ao SPSS v25 e recurso ao ATLAS.ti v7 para análise dos grupos focais, segundo a metodologia proposta por Bardin (2016). A Análise Fatorial Exploratória evidenciou três dimensões, com saturações fatoriais superiores a 0,50: D1 ? Funcionalidade e Aprendizagem; D2 ? Intencionalidade e Aprendizagem; D3 ? Complexidade e Aprendizagem, com valores de consistência superiores a 0,60 e com scores médios de MAlfaD1 = 4 + 0,64; MAlfaD2 = 4,3 + 0,73 e MAlfaD3 = 4,3 + 0,68 e MBetaD1 = 4 + 0,79; MBetaD2 = 4,3 + 0,67; e MBetaD3 = 4,3 + 0,67, numa escala de Likert (1 a 5), evidenciando-se avaliações positivas. Como resultados globais dos grupos focais, os participantes consideram ambos os protótipos seguros, fáceis de usar e de aprendizagem rápida, evidenciando a necessidade de hibridizar num protótipo único a integração das características de ambos, nomeadamente cicloergometria e resistência progressiva (bandas elásticas). Salientam-se parâmetros importantes a integrar como a oximetria e frequência cardíaca. O estudo, para além de permitir testar a usabilidade do Ablefit, permitiu também tecer recomendações importantes para o desenvolvimento de futuros protótipos, contribuindo para a eficácia e qualidade dos cuidados de Enfermagem de Reabilitação.


Assuntos
Enfermagem em Reabilitação , Projetos de Desenvolvimento Tecnológico e Inovação , Reabilitação Cardíaca , Infarto do Miocárdio , Repouso em Cama
2.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33547096

RESUMO

A 34-year-old woman presented with an unrelenting headache which had been ongoing since discharge from hospital 4 days before. She initially presented 2 weeks earlier with a 7 days history of severe headache, for which she had a CT scan, lumbar puncture and treatment for possible viral meningitis. The headache got worse 4 days after the lumbar puncture. Despite analgesics and bed rest, the headache persisted. A subsequent magnetic imaging scan demonstrated bilateral subdural effusions. She was given supportive treatment, which included advice concerning strict bed rest and analgesia. The headache took several months to abate. A third of patients suffer from post lumbar puncture headaches and this should be explained during informed consenting and post procedure. Not all post lumbar puncture headaches are simple headaches. A post lumbar puncture headache continuing for more than 7-14 days after the procedure requires further investigation to exclude life-threatening intracranial complications.


Assuntos
Hipotensão Intracraniana/complicações , Cefaleia Pós-Punção Dural/etiologia , Punção Espinal/efeitos adversos , Derrame Subdural/diagnóstico por imagem , Derrame Subdural/etiologia , Adulto , Analgésicos/uso terapêutico , Repouso em Cama , Diagnóstico Tardio , Feminino , Humanos , Cefaleia Pós-Punção Dural/terapia
3.
Rev. enferm. UERJ ; 28: e50968, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1122751

RESUMO

Objetivo: descrever as práticas culturais de cuidado no puerpério de mulheres quilombolas. Método: estudo descritivo, de abordagem qualitativa e delineado por meio da Teoria da Diversidade e Universalidade do Cuidado de Madeleine Leininger. Participaram do estudo quatorze mulheres quilombolas que já tinham vivenciado o período puerperal. A coleta das informações ocorreu de junho a setembro de 2018. Projeto aprovado por Comitê de Ética em Pesquisa. Resultados: observou-se a manutenção das crenças e valores, considerando a cultura local relacionada às práticas de cuidado de puérperas quilombolas. Considerações finais: as práticas de cuidado desenvolvidas por mulheres quilombolas no pós-parto se caracterizam por receber influência das crenças, valores e modos de vida que foram transmitidas por meio da oralidade por outras mulheres que já tinham vivenciado esse período.


Objective: to describe cultural practices of health care for quilombola women in puerperium. Method: this qualitative, descriptive study was framed by Madeleine Leininger's Theory of Culture Care Diversity and Universality. Fourteen quilombola women who had already experienced the puerperal period participated in the study. Information was collected from June to September 2018. The project was approved by the research ethics committee. Results: beliefs and values were observed to be maintained in the local culture as regards practices of care for puerperal quilombola women. Final considerations: the postpartum care practices applied by quilombola women were characteristically influenced by the beliefs, values and ways of life transmitted orally by other women who had already experienced puerperium.


Objetivo: describir las prácticas culturales de atención a la salud de las mujeres quilombolas en el puerperio. Método: este estudio cualitativo y descriptivo fue enmarcado por la Teoría de la Cultura Cuidado de la Diversidad y Universalidad de Madeleine Leininger. Participaron del estudio catorce mujeres quilombolas que ya habían pasado por el puerperio. La información se recopiló de junio a septiembre de 2018. El proyecto fue aprobado por el comité de ética en investigación. Resultados: se observó el mantenimiento de creencias y valores en la cultura local en cuanto a prácticas de cuidado de las puérperas quilombolas. Consideraciones finales: las prácticas de atención posparto aplicadas por las mujeres quilombolas estuvieron característicamente influenciadas por las creencias, valores y formas de vida transmitidas oralmente por otras mujeres que ya habían experimentado el puerperio.


Assuntos
Humanos , Feminino , Grupos Étnicos , Características Culturais , Período Pós-Parto , Saúde Materna , Repouso em Cama , Brasil , Higiene , Epidemiologia Descritiva , Pesquisa Qualitativa , Comportamento Alimentar , Normas Sociais
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2715-2718, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018567

RESUMO

Arterial stiffness is an important indicator for vascular aging and an independent predictor for cardiovascular diseases. During space flights or simulated space flights by prolonged head-down tilt bed rest, major cardiovascular alterations occur. However, the changes in arterial stiffness are not fully understood yet. Thus, we aimed to develop a setup for the measurement of arterial stiffness during prolonged head-down tilt bed rest, which incorporates several combinations of biosignals and measurement locations for the determination of pulse transit times. By performing measurements using this setup on female and male subjects, we intend to deepen the understanding of changes in arterial stiffness during prolonged head-down tilt bed rest. This work describes and visualizes the complete setup as well as our measurement protocols and algorithms used. The result section shows the successful recording of baseline signals before the bed rest study and visualizes the synchronized recordings of pulse waves measured on different sides of the body. Thus, it is feasible to use the presented setup in bed rest studies.


Assuntos
Decúbito Inclinado com Rebaixamento da Cabeça , Voo Espacial , Rigidez Vascular , Repouso em Cama , Feminino , Humanos , Masculino , Análise de Onda de Pulso
5.
Medicine (Baltimore) ; 99(39): e22471, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991485

RESUMO

RATIONALE: Patients with long term bed rest in intensive care unit after neurosurgery could experience splanchnic hypoperfusion. These patients have several other medical conditions that exacerbate splanchnic hypoperfusion during treatment and the splanchnic hypoperfusion could result in "stress-induced intestinal necrosis", which could cause massive hematochezia. We report here the experience of life-threatening hematochezia in 3 patients who underwent brain surgery in our institution. PATIENTS CONCERNS: One female patient (72-year-old) and 2 male patients (58- and 35-year-old) were admitted to our institution because of traumatic intracerebral hemorrhage, subarachnoid hemorrhage due to a ruptured anterior communicating artery, and subarachnoid hemorrhage with unknown cause respectively. All patients underwent emergency brain surgery for diagnosis and treatment. After surgery, they all experienced long-term bed rest in intensive care unit. Hematochezia occurred on postoperative day 15, 17, and 49, respectively. DIAGNOSES: All of the patients were assessed by abdomen/pelvis computed tomography and underwent a colonoscopy. INTERVENTIONS: The female patient underwent embolization through pelvic arteriography and epinephrine injection through colonoscopy, but a total colectomy and ileostomy was performed due to refractory hematochezia. 58-year-old male patient had a laparoscopic ileostomy for the bowel rest. The other patient underwent nil per os and conservative treatment for 2 weeks. OUTCOMES: The female patient was discharged without further treatment plan, 58-year-old male patient survived after laparoscopic ileostomy, while the other patient survived after 2 weeks of nil per os. LESSON: Abdominal symptoms, such as hematochezia, should be actively managed in neurosurgical patients who are undergoing long-term bed rest in an intensive care unit under physiologically stressful medical conditions.


Assuntos
Repouso em Cama/efeitos adversos , Hemorragia Gastrointestinal/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Adulto , Idoso , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios X
6.
J Stroke Cerebrovasc Dis ; 29(10): 105112, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912565

RESUMO

BACKGROUND: Medical complications often occur, particularly in the acute phase of severe stroke, and lead to poor outcomes. However, it is unclear whether out-of-bed mobilization (OM) reduces such complications or not in the acute phase of severe stroke. Thus, we investigated the association between OM and complications of immobility in the acute phase of severe stroke. METHODS: We enrolled 407 patients diagnosed with ischemic stroke or intracerebral hemorrhage and patients with modified Rankin Scale 5 at discharge in this study. Patients were divided into two groups: OM (303 patients) and bed rest (BR; 104 patients) at discharge based on their medical records. Complications of immobility (such as pneumonia, urinary tract infection, pressure sore, and falls) during hospitalization in each group were recorded. RESULTS: The total complication rate of immobility, incidence of pneumonia, and the incidence of pressure sores were significantly lower in the OM group than in the BR group [60.7% vs. 88.5%, 45.5% vs. 62.5%, and 3.6% vs. 12.5%; odds ratio, 0.20, 0.50, and 0.26; and 95% confidence intervals, 0.11-0.39, 0.32-0.79, and 0.11-0.61, respectively]. Urinary tract infection and falls did not differ significantly between the two groups. CONCLUSIONS: In the acute phase of severe stroke, OM was significantly associated with a lower risk of total complication rate of immobility, incidence of pneumonia, and incidence of pressure sore without increasing falls.


Assuntos
Repouso em Cama/efeitos adversos , Isquemia Encefálica/reabilitação , Deambulação Precoce , Hemorragias Intracranianas/reabilitação , Limitação da Mobilidade , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Acidentes por Quedas/prevenção & controle , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/fisiopatologia , Avaliação da Deficiência , Deambulação Precoce/efeitos adversos , Humanos , Incidência , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/fisiopatologia , Japão/epidemiologia , Alta do Paciente , Pneumonia/epidemiologia , Pneumonia/prevenção & controle , Lesão por Pressão/epidemiologia , Lesão por Pressão/prevenção & controle , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/efeitos adversos , Resultado do Tratamento
7.
PLoS One ; 15(9): e0239228, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32946482

RESUMO

Artificial gravity through short-arm centrifugation has potential as a multi-system countermeasure for deconditioning and cranial fluid shifts that may underlie ocular issues in microgravity. However, the optimal short-arm centrifugation protocol that is effective whilst remaining tolerable has yet to be determined. Given that exposure to centrifugation is associated with presyncope and syncope and in addition motion sickness an intermittent protocol has been suggested to be more tolerable. Therefore, we assessed cardiovascular loading and subjective tolerability of daily short arm centrifugation with either an intermittent or a continuous protocol during long-term head-down bed rest as model for microgravity exposure in a mixed sex cohort. During the Artificial Gravity Bed Rest with European Space Agency (AGBRESA) 60 day 6° head down tilt bed rest study we compared the tolerability of daily +1 Gz exposure at the center of mass centrifugation, either performed continuously for 30 minutes, or intermittedly (6 x 5 minutes). Heart rate and blood pressure were assessed daily during centrifugation along with post motion sickness scoring and rate of perceived exertion. During bed rest, 16 subjects (6 women, 10 men), underwent 960 centrifuge runs in total. Ten centrifuge runs had to be terminated prematurely, 8 continuous runs and 2 intermittent runs, mostly due to pre-syncopal symptoms and not motion sickness. All subjects were, however, able to resume centrifuge training on subsequent days. We conclude that both continuous and intermittent short-arm centrifugation protocols providing artificial gravity equivalent to +1 Gz at the center of mass is tolerable in terms of cardiovascular loading and motion sickness during long-term head down tilt bed rest. However, intermittent centrifugation appears marginally better tolerated, albeit differences appear minor.


Assuntos
Centrifugação , Gravidade Alterada/efeitos adversos , Enjoo devido ao Movimento , Repouso em Cama , Pressão Sanguínea , Estudos de Coortes , Feminino , Decúbito Inclinado com Rebaixamento da Cabeça , Voluntários Saudáveis , Frequência Cardíaca , Humanos , Masculino
9.
Am J Obstet Gynecol ; 223(2): B2-B10, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32360110

RESUMO

Despite current recommendations against its use, activity restriction remains a common intervention used to prevent preterm birth in multiple clinical settings. Hypertensive disorders of pregnancy, preterm premature rupture of membranes, multiple gestations, vaginal bleeding, short cervical length, placenta previa, and fetal growth restriction are also common reasons for antepartum hospital admission and frequently lead to a recommendation for activity restriction. However, numerous reports have shown that activity restriction does not prevent adverse obstetrical outcomes but does confer significant physical and psychosocial risks. This consult reviews the current literature on activity restriction and examines the evidence regarding its use in obstetrical management. The recommendations by the Society for Maternal-Fetal Medicine are as follows: (1) we recommend against the routine use of any type of activity restriction in pregnant women at risk of preterm birth based on preterm labor symptoms, arrested preterm labor, or shortened cervix (GRADE 1B); (2) we recommend against the use of routine inpatient hospitalization and activity restriction for the prevention of preterm birth in women with multiple gestations (GRADE 1A); and (3) given the lack of data definitively demonstrating that activity restriction improves perinatal outcome in pregnancies complicated by fetal growth restriction, preterm premature rupture of membranes, or hypertensive diseases of pregnancy, coupled with evidence of adverse effects of activity restriction, we suggest that activity restriction not be prescribed for the treatment of pregnancies complicated by fetal growth restriction, preterm premature rupture of membranes, or hypertensive disease (GRADE 2B).


Assuntos
Repouso em Cama , Trabalho de Parto Prematuro/prevenção & controle , Nascimento Prematuro/prevenção & controle , Feminino , Retardo do Crescimento Fetal , Ruptura Prematura de Membranas Fetais , Humanos , Hipertensão Induzida pela Gravidez , Recém-Nascido , Gravidez , Hemorragia Uterina
10.
Complement Ther Clin Pract ; 38: 101079, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32056815

RESUMO

BACKGROUND: and purpose: In recent years, yoga practitioners have joined forces with medical programs to approach patients' well-being holistically. This study is a randomized controlled trial to assess the effects of a specialized adapted yoga program on anxiety and depression for high-risk expectant mothers on bedrest in a hospital setting. MATERIALS AND METHODS: Seventy-nine pregnant subjects on physician ordered hospitalized bedrest were randomized into two groups: receiving biweekly yoga sessions (intervention group) or receiving no yoga (control group). Data collection tool was the Hospital Anxiety and Depression Scale (HADS) to assess outcomes after delivery. RESULTS: Yoga, even as little as three sessions, showed significant impact in reducing anxiety and depression high-risk pregnant women on hospitalized bedrest. Perceived anxiety and depression overall scores were lower in the intervention group than in the control group (p < 0.001). CONCLUSION: Results demonstrated that yoga is an effective intervention to decrease anxiety and depression in high-risk antepartum women on hospitalized bedrest.


Assuntos
Ansiedade/terapia , Repouso em Cama/psicologia , Depressão/terapia , Ioga , Adulto , Feminino , Humanos , Gravidez , Adulto Jovem
11.
J Laparoendosc Adv Surg Tech A ; 30(5): 520-524, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32027216

RESUMO

Purpose: To investigate the feasibility of retroperitoneal laparoscopic ipsilateral nephrectomy of a benign nonfunctional kidney after percutaneous nephrostomy, and to compare this method with open surgery. Materials and Methods: Data from 70 patients who underwent simple nephrectomy from January 2014 to October 2018 at three large centers were retrospectively analyzed. All patients underwent percutaneous nephrostomy because of renal or ureteral calculi with severe hydronephrosis or pyonephrosis. Simple nephrectomy was performed via retroperitoneal laparoscopic surgery (retroperitoneal laparoscopic group; n = 33) or open surgery (open group; n = 37). The retroperitoneal laparoscopic and open groups were compared regarding preoperative variables (age, sex, location of surgery, hypertension, diabetes, BMI, preoperative serum creatinine level, American Society of Anesthesiologists (ASA) grade, fistula duration, fistula size, number of fistulae, and urinary tract infection), and perioperative variables (operation time, intraoperative blood loss, postoperative drainage volume, catheter indwelling time, gastrointestinal function recovery time, duration of bedrest, duration of postoperative hospitalization, postoperative hemoglobin decline, perioperative transfusion, and postoperative complications). Results: The retroperitoneal laparoscopic group included more patients with hydronephrosis, while the open group included more patients with pyonephrosis. There were no significant differences between the two groups in age (P = .813), sex (P = .729), location of surgery (P = .345), hypertension (P = .271), diabetes (P = .394), BMI (P = .798), preoperative serum creatinine level (P = .826), ASA grade (P = .820), fistula duration (P = .108), fistula size (P = .958), number of fistulae (P = .925), urinary tract infection (P = .111), or operative time (P = .851). The retroperitoneal laparoscopic group had significantly lesser intraoperative blood loss (P = .007), postoperative drainage volume (P = .008), shorter catheter indwelling time (P = .002), gastrointestinal function recovery time (P < .001), duration of bedrest (P < .001), and duration of postoperative hospitalization (P < .001), and lesser postoperative hemoglobin decline (P = .035) compared with the open group. Conclusions: Retroperitoneal laparoscopic ipsilateral nephrectomy is feasible for a benign nonfunctional kidney after percutaneous nephrostomy. The surgical method should be selected based on the surgeon's experience and the specific situation of the patient.


Assuntos
Nefrectomia/métodos , Espaço Retroperitoneal/cirurgia , Adulto , Repouso em Cama , Perda Sanguínea Cirúrgica , Estudos de Viabilidade , Feminino , Trato Gastrointestinal/fisiopatologia , Humanos , Hidronefrose/etiologia , Hidronefrose/cirurgia , Cálculos Renais/complicações , Cálculos Renais/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Nefrostomia Percutânea , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Pionefrose/etiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Cálculos Ureterais/complicações , Cálculos Ureterais/cirurgia
12.
PLoS One ; 15(1): e0226332, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31923203

RESUMO

BACKGROUND: Approximately half of hospitalized patients suffer functional decline due to spending the vast majority of their time in bed. Previous studies of early mobilization have demonstrated improvement in outcomes, but the interventions studied have been resource-intensive. We aimed to decrease the time hospital inpatients spend in bed through a pragmatic mobilization protocol. METHODS: This prospective, non-blinded, controlled clinical trial assigned inpatients to the study wards per routine clinical care in an urban teaching hospital. All subjects on intervention wards were provided with a behavioral intervention, consisting of educational handouts, by the nursing staff. Half of the intervention wards were supplied with recliner chairs in which subjects could sit. The primary outcome was hospital length of stay. The secondary outcome was the '6-Clicks' functional score. RESULTS: During a 6-month study period, 6082 patient encounters were included. The median length of stay was 84 hours (IQR 44-175 hours) in the control group, 80 hours (IQR 44-155 hours) in the group who received the behavioral intervention alone, and 88 hours (IQR 44-185 hours) in the group that received both the behavioral intervention and the recliner chair. In the multivariate analysis, neither the behavioral intervention nor the provision of a recliner chair was associated with a significant decrease in length of stay or increase in functional status as measured by the '6-Clicks' functional score. CONCLUSION: The program of educational handouts and provision of recliner chairs to discourage bed rest did not increase functional status or decrease length of stay for inpatients in a major urban academic center. Education and physical resources must be supplemented by other active interventions to reduce time spent in bed, functional decline, and length of stay. TRIAL REGISTRATION: ClinicalTrials.gov, HS-16-00804.


Assuntos
Terapia Comportamental/métodos , Tempo de Internação , Adulto , Idoso , Repouso em Cama/métodos , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos
13.
JAMA Ophthalmol ; 138(2): 165-172, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31876939

RESUMO

Importance: Optic disc edema develops in astronauts during long-duration spaceflight and is a risk for all future astronauts during spaceflight. Having a ground-based analogue of weightlessness that reproduces critical features of spaceflight-associated neuro-ocular syndrome will facilitate understanding, preventing, and/or treating this syndrome. Objective: To determine whether the ocular changes in individuals exposed to an analogue of weightlessness are similar to the ocular changes in astronauts exposed to a duration of spaceflight comparable to this analogue of weightlessness. Design, Setting, and Participants: This cohort study, conducted from 2012 to 2018, investigated 11 healthy test participants before, during, and after 30 days of strict 6° head-down tilt bed rest as well as 20 astronauts before and during approximately 30 days of spaceflight. Data were collected at NASA Johnson Space Center, the German Aerospace Center, and on board the International Space Station. Statistical analysis was performed from February 13 to April 24, 2019. Main Outcomes and Measures: Peripapillary total retinal thickness and peripapillary choroid thickness quantified from optical coherence tomography images. Results: Peripapillary total retinal thickness increased to a greater degree among 11 individuals (6 men and 5 women; mean [SD] age, 33.4 [8.0 years]) exposed to bed rest than among 20 astronauts (17 men and 3 women; mean [SD] age, 46.0 [6.0] years), with a mean difference between groups of 37 µm (95% CI, 13-61 µm; P = .005). Conversely, choroid thickness did not increase among the individuals exposed to bed rest but increased among the astronauts, resulting in a mean difference between groups of 27 µm (95% CI, 14-41 µm; P < .001). Conclusions and Relevance: These findings suggest that strict head-down tilt bed rest produces a different magnitude of edema than occurs after a similar duration of spaceflight, and no change in choroid thickness. It is possible that a mild, long-term elevation in intracranial pressure experienced by individuals exposed to bed rest is greater than the intracranial pressure experienced by astronauts during spaceflight, which may explain the different severity of optic disc edema between the cohorts. Gravitational gradients that remain present during bed rest may explain the lack of increase in choroid thickness during bed rest, which differs from the lack of gravitational gradients during spaceflight. Despite the possibility that different mechanisms may underlie optic disc edema development in modeled and real spaceflight, use of this terrestrial model of spaceflight-associated neuro-ocular syndrome will be assistive in the development of effective countermeasures that will protect the eyes of astronauts during future space missions.


Assuntos
Astronautas , Repouso em Cama , Corioide/patologia , Papiledema/etiologia , Voo Espacial , Adulto , Dióxido de Carbono/análise , Estudos de Coortes , Feminino , Humanos , Pressão Intracraniana , Masculino , Pessoa de Meia-Idade
15.
J Pediatr Orthop ; 40(5): 251-258, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31425401

RESUMO

BACKGROUND: Femoral shaft fractures in children are common in low and middle income countries. In high-income countries, patient age, fracture pattern, associated injuries, child/family socioeconomic status, and surgeon preference dictate fracture management. There is limited literature on treatment patterns for pediatric femur fractures in resource-limited settings. This study surveys surgeons from low (LIC), lower-middle (LMIC), and upper-middle income (UMIC) countries regarding treatment patterns for pediatric femur fractures. METHODS: Surgeons completed an electronic survey reporting surgeon demographics and treatment preference for pediatric femur fractures. Treatment preferences and indications for treatment were separated into 4 groups: infant (0 to 6 mo); toddler (7 mo to 4 y); child (5 to 12 y); adolescent (12 to 17 y). The survey was available in English, Spanish, and French. Analysis was completed with t test and χ test for continuous and categorical variables, respectively, and weighted Pearson correlation (P<0.05). RESULTS: Survey respondents consisted of 413 surgeons from 83 countries (20 LIC, 33 LMIC, 30 UMIC). The majority of respondents were fellowship trained (83%) most commonly in pediatrics (26%) and trauma (43%). Most treated >10 pediatric femur fractures per year (68%). Respondents reported treating infant femur fractures nonoperatively using Pavlik harness (19%), spica cast (60%), or traction with delayed spica cast (14%). Decreasing socioeconomic status was associated with higher nonoperative treatment rate in toddlers, children, and adolescents. Respondents commonly utilize bed rest and traction for child femur fractures in LICs (63%) and LMICs (65%) compared with UMICs (35%) (UMIC vs. LMIC P<0.001; UMIC vs. LIC P<0.001). Surgeries in children more commonly involve open reduction with internal fixation (UMIC 19%, LMIC 33%, LIC 40%; P<0.05 between UMIC-LMIC and UMIC-LIC). CONCLUSION: This is one of the largest surveys describing treatment patterns for pediatric femur fractures in low and middle income countries. Differences are evident including lower operative treatment rate in younger children and lower intramedullary fixation rates in older children. Future studies should investigate the value of treatment options in resource-limited settings. LEVEL OF EVIDENCE: Level II-prospective comparative study.


Assuntos
Países em Desenvolvimento , Fraturas do Fêmur/terapia , Cirurgiões/estatística & dados numéricos , Tração/estatística & dados numéricos , Adolescente , Repouso em Cama/estatística & dados numéricos , Moldes Cirúrgicos/estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Diáfises/lesões , Fixação Interna de Fraturas/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Redução Aberta/estatística & dados numéricos , Padrões de Prática Médica , Estudos Prospectivos , Inquéritos e Questionários
16.
World Neurosurg ; 134: e951-e955, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31734429

RESUMO

OBJECTIVE: To evaluate the incidence and outcomes of incidental durotomy in transforaminal endoscopic spine surgery. METHODS: Transforaminal lumbar endoscopic procedures were performed by 2 surgeons in 907 patients over a period of 4 years from 2014 to 2018. Patient data were evaluated retrospectively in these patients with a minimum follow-up of 1 year. RESULTS: In 907 patients over 4 years there were 5 durotomies: 4 incidental and 1 intentional. The rate for incidental durotomy was therefore 0.4%. There were no adverse outcomes from the incidental durotomies, and only 1 patient noted a headache. CONCLUSIONS: Incidental durotomy is a rare complication of transforaminal lumbar endoscopic spine surgery and appears to occur more likely in patients who have undergone previous spine surgery at the site of the endoscopic procedure, not unexpectantly. Glues, patches, and bedrest were among the various methods used after durotomy. In this series there were no cases of symptomatic spinal fluid leakage or pseudomeningocele seen. Only 20% of patients who had durotomies noted a headache in the immediate postoperative period.


Assuntos
Vazamento de Líquido Cefalorraquidiano/epidemiologia , Dura-Máter/lesões , Cefaleia/epidemiologia , Complicações Intraoperatórias/epidemiologia , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adesivos , Adulto , Idoso de 80 Anos ou mais , Repouso em Cama , Vazamento de Líquido Cefalorraquidiano/etiologia , Discotomia/efeitos adversos , Feminino , Foraminotomia/efeitos adversos , Cefaleia/etiologia , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Fusão Vertebral/efeitos adversos
17.
World Neurosurg ; 134: e956-e967, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31756501

RESUMO

OBJECTIVE: In this retrospective comparative study, the efficacy and clinical outcomes of long posterior instrumentation, with or without laminectomy, were evaluated and the necessity of the second stage of anterior debridement in the treatment of spinal tuberculosis (TB) was discussed. METHODS: This retrospective study included 41 patients who were diagnosed with spinal TB between January 2010 and June 2016. A total of 18 patients had received long posterior instrumentation, with or without laminectomy (group A), whereas the other 23 patients had posterior instrumentation plus anterior debridement and autogenous bone grafting (group B). The surgical information, clinical effectiveness, laboratory tests, and imaging results were compared between the 2 groups. RESULTS: One patient in group B died. Sinus drainage and incomplete bone fusion were discovered 1 year postoperatively. TB symptoms were significantly improved after surgery compared with those before surgery (P < 0.05), and there was no significant difference in the treatment efficacy between the 2 groups at the final follow-ups (P > 0.05). Compared with those of group B, the surgical time, bed-rest time, and hospitalization time of group A were all significantly shorter (P < 0.05), whereas the times before abscesses disappeared, bone graft fusion, and erythrocyte sedimentation rate returning to normal were all significantly longer (P < 0.05). CONCLUSIONS: Single-stage long posterior instrumentation, with or without laminectomy, is a safe, effective, and feasible method for the treatment of spinal TB. The second stage of anterior debridement surgery may not be necessary for every spinal TB treatment.


Assuntos
Desbridamento/métodos , Fusão Vertebral/métodos , Tuberculose da Coluna Vertebral/cirurgia , Adulto , Idoso , Repouso em Cama , Transplante Ósseo/métodos , Feminino , Humanos , Laminectomia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
Kinesiologia ; 39(1): 35-38, 2020.
Artigo em Espanhol | LILACS | ID: biblio-1123443

RESUMO

La evidencia científica actual ha permitido el desarrollo de diversas guías y protocolos clínicos para el manejo de la enfermedad COVID-19, los cuales en general, no han desarrollado en profundidad las indicaciones para el manejo ambulatorio del cuadro clínico leve. La Organización Mundial de la Salud señala en estos casos, un tratamiento sintomático, incluyendo antipiréticos, analgésicos, además de nutrición y rehidratación adecuadas. Sumado a lo anterior, se debe realizar aislamiento inmediato, el que debe incluir el seguimiento sobre la evolución de síntomas y necesidad de atención médica. El cumplimiento de estas indicaciones es fundamental para una mejor evolución del cuadro; la correcta hidratación y nutrición permiten optimizar la respuesta inmunológica durante la fase aguda de la enfermedad. Se suma, además, la importancia de mantenerse activo y evitar el reposo absoluto en cama, considerando los efectos deletéreos que esto genera sobre diversos sistemas, incluyendo el cardiorrespiratorio. Es evidente que una persona deshidratada, malnutrida, y que genera complicaciones pulmonares asociadas al reposo en cama, tiene mayor riesgo de requerir hospitalización. Todo lo anterior implica que las personas con COVID-19 leve sean educadas respecto al manejo de la enfermedad en casa, haciéndolas parte activa de su tratamiento, considerando además el impacto sobre la salud mental que implica el diagnóstico. En este artículo se desarrollan los fundamentos del manejo sintomático no farmacológico de la enfermedad leve, visibilizando la importancia de su cumplimiento y haciendo responsable a las autoridades y al equipo de salud sobre la educación a la población en este ámbito.


Current scientific evidence has allowed the development of various clinical guidelines and protocols for the management of COVID-19, which in general has not in depth developed indications for ambulatory care of the mild clinic presentation. The World Health Organization indicates in these cases, a symptomatic treatment, including analgesic, antipyretics, as well an adequate nutrition and rehydration. Besides, immediate isolation must be performed, which must include monitoring the symptoms' evolution and the need of medical attention. The correct following of these indications is essential for a better disease evolution; correct hydration and nutrition allow optimizing the immune response during the acute phase of the disease. In addition, the importance of staying active and avoiding absolute bed rest is added, considering the deleterious effects that this generates on various systems, including the cardiorespiratory one. It is evident that a person who is dehydrated, malnourished, and those who generates pulmonary complications associated with bed rest, has a greater risk of requiring hospitalization. All of the above implies that people with mild COVID-19 must be educated about the management of the disease at home, making them an active part of their treatment, also considering the impact on mental health that the diagnosis implies. This article develops the foundations of a non-pharmacological symptomatic management of mild disease, making visible the importance of its achievement and making the authorities and the health team responsible for educating the population in this area.


Assuntos
Humanos , Pneumonia Viral/terapia , Infecções por Coronavirus/terapia , Assistência Ambulatorial , Repouso em Cama , Pandemias
19.
Compr Physiol ; 10(1): 171-196, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31853963

RESUMO

The mechanical unloading of spaceflight elicits a host of physiological adaptations including reductions in muscle mass, muscle strength, and muscle function and alterations in central interpretation of visual, vestibular, and proprioceptive information. Upon return to a terrestrial, gravitational environment, these result in reduced function and performance, the potential consequences of which will be exacerbated during exploration missions to austere and distant destinations such as the moon and Mars. Exercise is a potent countermeasure to unloading-induced physiological maladaptations and has been employed since the early days of spaceflight. In-flight exercise hardware has evolved from rudimentary and largely ineffective devices to the current suite onboard the International Space Station (ISS) comprised of a cycle ergometer, treadmill, and resistance exercise device; these contemporary devices have either fully protected or significantly attenuated neuromuscular degradation in spaceflight. However, unlike current microgravity operations on the ISS, future exploration missions will include surface operations in partial gravity environments, which will require greater physiological capacity and work output of their crews. For these flights, it is critical to identify physiological thresholds below which task performance will be impaired and to develop exercise countermeasures-both pre- and in-flight-to ensure that crewmembers are able to safely and effectively complete physically demanding mission objectives. © 2020 American Physiological Society. Compr Physiol 10:171-196, 2020.


Assuntos
Exercício Físico , Doenças Neuromusculares/prevenção & controle , Voo Espacial , Animais , Repouso em Cama , Humanos , Músculo Esquelético/fisiologia
20.
Sci Rep ; 9(1): 16610, 2019 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-31719552

RESUMO

The neurobehavioral risks associated with spaceflight are not well understood. In particular, little attention has been paid on the role of resilience, social processes and emotion regulation during long-duration spaceflight. Bed rest is a well-established spaceflight analogue that combines the adaptations associated with physical inactivity and semi-isolation and confinement. We here investigated the effects of 30 days of 6 degrees head-down tilt bed rest on affective picture processing using event-related potentials (ERP) in healthy men. Compared to a control group, bed rest participants showed significantly decreased P300 and LPP amplitudes to pleasant and unpleasant stimuli, especially in centroparietal regions, after 30 days of bed rest. Source localization revealed a bilateral lower activity in the posterior cingulate gyrus, insula and precuneus in the bed rest group in both ERP time frames for emotional, but not neutral stimuli.


Assuntos
Afeto/fisiologia , Repouso em Cama/efeitos adversos , Potenciais Evocados/fisiologia , Imobilização/efeitos adversos , Percepção Visual/fisiologia , Adulto , Repouso em Cama/psicologia , Estudos de Casos e Controles , Eletroencefalografia , Emoções/fisiologia , Potenciais Evocados Visuais/fisiologia , Humanos , Imobilização/fisiologia , Masculino , Estimulação Luminosa
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