Atividade sexual, aptidão física e capacidade funcional em indivíduos acima de 50 anos de idade fisicamente ativos / Sexual activity, physical fitness and functional capacity in physically active individuals over 50 years of age

Contexto e objetivo: No envelhecimento ocorre um declínio na aptidão física e capacidade funcional do indivíduo e a prática da atividade física pode reduzir os riscos causados por este deletério. A atividade sexual é adotada como parte importante do ciclo de vida desse indivíduo, portanto, o objetivo do estudo foi comparar a aptidão física e a capacidade funcional de acordo com a atividade sexual de pessoas > 50 anos. Desenho e local: estudo transversal do Projeto Longitudinal de Envelhecimento e Aptidão Física de São Caetano do Sul. Método: Amostra de 531 mulheres e 62 homens. A aptidão física e a capacidade funcional foram medidas por: força de membros superiores, força de membros inferiores, flexibilidade, endurance cardiovascular, mobilidade, equilíbrio, mobilidade geral e agilidade. A atividade sexual foi medida por uma anamnese. Análise estatística: dados apresentados em média e desvio padrão, comparação feita por teste de Ancova, ajustada por idade, adotado P < 0,05. Resultados: Comparado o grupo sexualmente ativo com o grupo sexualmente inativo, é possível verificar que houve diferenças significativas na aptidão física e na capacidade funcional e força muscular dos membros superiores, equilíbrio e mobilidade geral nas mulheres, e força de membros inferiores e mobilidade geral para homens. Conclusão: Foi observada uma melhor aptidão física e capacidade funcional tanto em mulheres como nos homens no grupo sexualmente ativo.

Prognostic value of the duke activity Status Index Questionnaire in predicting mortality in patients with chronic heart failure: 36-month follow-up study.

BACKGROUND: The Duke Activity Status Index (DASI) questionnaire has been the focus of numerous investigations - its discriminative and prognostic capacity has been continuously explored, supporting its use in the clinical setting, specifically during rehabilitation in patients with chronic heart failure (CHF).However, studies exploring optimal DASI questionnaire threshold scores are limited. OBJECTIVE: To investigate optimal DASI questionnaire thresholds values in predicting mortality in a CHF cohort and assess mortality rates based on the DASI questionnaire using a thresholds values obtained. METHODOLOGY: This is a prospective cohort study with a 36-month follow-up in patients with CHF. All patients completed a clinical assessment, followed by DASI questionnaire, pulmonary function, and echocardiography. The Receiver Operating Characteristic (ROC) curve analysis was used to discriminate the DASI questionnaire score in determining the risk of mortality. For survival analysis, the Kaplan-Meier model was used to explore the impact of ≤/>23 points on mortality occurring during the 36-month follow-up. RESULTS: One hundred and twenty-four patients were included, the majority being elderly men. Kaplan Meier analysis revealed that ≤/> 23 was a strong predictor of CHF mortality over a 36-month follow-up. CONCLUSION: A score of ≤/>23 presents good discriminatory capacity to predict mortality risk in 36 months in patients with CHF, especially in those with reduced or mildly reduced ejection fraction. Age, ejection fraction, DASI questionnaire score and use of digoxin are risk factors that influence mortality in this population.

Caregiver burden, hopelessness, and anxiety: Association between sociodemographic and clinical profiles of patients with stroke.

OBJECTIVES: This study aimed to evaluate the association between the sociodemographic characteristics of caregivers and patients with stroke, clinical data on stroke, and disability with caregiver burden, hopelessness, and anxiety. MATERIALS AND METHODS: This cross-sectional study included patients with stroke of either sex, aged >18 years. Data were collected between January 2020 and July 2021. Patient demographic included age, sex, stroke type, severity, etiology, topography, treatment, and stroke recurrence. Stroke disability was assessed using the modified Rankin Scale and Barthel Index at 90 days post-discharge. Additionally, caregiver burden, hopelessness, and anxiety were evaluated during patient consultations using the Zarit Burden Interview (ZBI), Beck Hopelessness Scale (BHS), and Beck Anxiety Inventory (BAI). RESULTS: We included 104 patients with stroke and their caregivers. Overall caregiver burden was moderate (ZBI: 24 [25]), with mild hopelessness (BHS: 4 [4]) and minimal to mild anxiety (BAI: 8 [13]). The linear regression model presented in Table 3 showed that female caregivers scored up to 11 points higher on the Zarit Burden Interview (p = 0.011). Additionally, increased patient age was associated with a higher caregiver burden (p = 0.002) on the Zarit Burden Interview. Posterior circulation stroke and total anterior circulation stroke were also associated with higher Zarit Burden Interview scores compared to lacunar stroke (p = 0.017). Age was not associated with caregiver burden in the entire sample. However, an association between age and caregiver burden was found only in the female group. Furthermore, women aged 65 years and older experienced a more severe burden than women aged 18 to 64 years (p<0.001). Stroke disability was not associated with caregiver burden. CONCLUSIONS: Older female caregivers were significantly affected when caring for stroke patients. Total anterior circulation stroke and Posterior circulation stroke increased Zarit Burden Interview scores. However, no association was observed between stroke disability and the caregiver burden.

Clinical trajectories of critically ill patients discharged directly from a critical unit to a postacute care facility: retrospective cohort.

OBJECTIVE: To describe the clinical trajectories of patients discharged directly from a critical unit to a postacute care facility. METHODS: This was a retrospective cohort study of patients who were transferred from an intensive care unit or intermediate care unit to a postacute care facility between July 2017 and April 2023. Functional status was measured by the Functional Independence Measure score. RESULTS: A total of 847 patients were included in the study, and the mean age was 71 years. A total of 692 (82%) patients were admitted for rehabilitation, while 155 (18%) were admitted for palliative care. The mean length of stay in the postacute care facility was 36 days; 389 (45.9%) patients were discharged home, 173 (20.4%) were transferred to an acute hospital, and 285 (33.6%) died during hospitalization, of whom 263 (92%) had a do-not-resuscitate order. Of the patients admitted for rehabilitation purposes, 61 (9.4%) had a worsened functional status, 179 (27.6%) had no change in functional status, and 469 (63%) had an improved functional status during hospitalization. Moreover, 234 (33.8%) patients modified their care goals to palliative care, most of whom were in the group that did not improve functional status. Patients whose functional status improved during hospitalization were younger, had fewer comorbidities, had fewer previous hospitalizations, had lower rates of enteral feeding and tracheostomy, had higher Functional Independence Measure scores at admission to the postacute care facility and were more likely to be discharged home with less complex health care assistance. CONCLUSION: Postacute care facilities may play a role in the care of patients after discharge from intensive care units, both for those receiving rehabilitation and palliative care, especially for those with more severe illnesses who may not be discharged directly home.

Post-pulmonary embolism syndrome: A reminder for clinicians.

Acute pulmonary embolism (APE) is one of the leading causes of cardiovascular emergencies and the third leading cause of death. Although efforts focus on treating the acute event, patients who survive APE may develop long-term sequelae. Research reveals that approximately half of patients who have suffered an APE do not regain their previous level of function and experience a reduction in their quality of life for several years after the episode. Acute pulmonary embolism can be classified according to the risk of short-term mortality, with most mortality and morbidity concentrated in high-risk and intermediate-risk cases. The first-line treatment for APE is systemic anticoagulation. However, identifying and more aggressively treating people with intermediate to high risk, who have a more favorable risk profile for reperfusion treatments, could reduce short-term mortality and mitigate post-pulmonary embolism syndrome (PPES). Post-pulmonary embolism syndrome refers to a variety of persistent symptoms and functional limitations that occur after an APE. The presence of persistent dyspnea, functional limitations, and/or decreased quality of life after an APE has been recently termed "PPES," although this entity encompasses different manifestations. The most severe cause of persistent dyspnea is chronic thromboembolic pulmonary hypertension, where increased pulmonary artery pressure is due to the fibrotic organization of unresolved APE. Post-PE Syndrome is not always systematically addressed in management guidelines, and its prevalence may be underestimated. More research is needed to fully understand its causes and risk factors. Interventions such as cardiopulmonary rehabilitation have been suggested to improve the quality of life of patients with PPES. A comprehensive, evidence-based approach is essential to effectively prevent and manage PPES and improve the long-term outcomes and well-being of affected patients.

Social relationships and their association with the functional capacity of older Chilean adults: longitudinal evidence.

BACKGROUND: Functional capacity is recognized as a central factor for health in old age and not all studies that seek to clarify the role of social relationships in functional capacity are conclusive. The subject has only been studied in a limited way in Latin America, a region that is aging prematurely, with evidence primarily from developed countries, which have experienced a more gradual aging of their population. This longitudinal study aimed to determine how aspects of social relationships impact the functionality of older Chileans. METHODOLOGY: We conducted a cohort study of 2,265 people aged 60 years or older who lived in the community and resided in Greater Santiago, Chile. Five aspects of social relationships were considered at baseline (participation in groups, clubs, or organizations; number of people in the household; participation in recreational activities; perception of material support, help or advice, and marital status), from which a cluster analysis by conglomerate was performed and used as the exposure of interest. Functional limitation (FL) was the dependent variable, classified as a limitation in at least 1 basic activity of daily living or 1 instrumental activity or 2 advanced activities. The control variables considered were: sex, age, educational level, multimorbidity, depression and years of follow-up. Survival analyses using a Cox proportional hazard regression and multilevel logistic regressions (person level and follow-up wave level) were performed. RESULTS: The identified clusters were four: "without social participation and does not live alone"; "without a partner and without social participation"; "no perception of support and no social participation"; "with participation, partner and perception of support". Social relationship clusters predicted FL incidence and FL reporting during follow-up. Being in the clusters "without social participation and does not live alone" and "without partner and without social participation" were risk factors for incident FL and report of FL during follow-up, compared to being in the reference cluster "with participation, partner and perception of support. CONCLUSIONS: In summary, our study showed that participating in social organizations, not living alone and having a partner are protective factors for presenting and developing functional limitation in old age for community-living Chileans in an urban area.

Malnutrition contribution to the functional status and health related quality of life after COVID-19, a correlational follow-up study.

To assess malnutrition contribution to the functional status and health related quality of life after hospitalization due to COVID-19 pneumonia, 66 selected adults referred for physical rehabilitation accepted to participate in the study; none of them required oxygen supply or had history of lung/musculoskeletal/neurological/immune/rheumatic disease or trauma, or contraindication for respiratory-function tests. At three evaluations, with 3 months in-between, assessments included: self-report of functional status, the St. George's Respiratory Questionnaire, spirometry, the 6-min-walk-test, the MRC-scale, the 30-s sit-to-stand-test, the timed-up-and-go-test, nutritional status, and ultrasound imaging (vastus medialis and diaphragm). At referral, patients had nutritional deficits with protein deficiency, which gradually improved; while muscle thickness (of both vastus medialis and diaphragm) increased, along with muscle strength and mobility (ANOVA, p < 0.05). Contrarywise, the distance covered during the 6-min-walk-test decreased (ANOVA, p < 0.05), with a negative influence from excess body mass. During rehabilitation, health-related quality of life and functional status improved, with negative influence from a history of tobacco use and referral delay, respectively. After hospitalization due to COVID-19, early diagnosis of both protein deficiency and decrease of skeletal muscle thickness could be relevant for rehabilitation, while pondering the negative impact of excess body mass on submaximal exercise performance.

Morbidity and mortality of emergency surgery in octogenarian patient.

OBJECTIVE: To evaluate the health outcomes (postoperative morbidity and mortality) and the functional status at discharge of elderly patients older than 80 years who underwent emergency surgery. METHOD: Patients > 80 years of age who underwent emergency surgery during one year at the Marqués de Valdecilla University Hospital, Santander, Spain. Preoperative data (age, sex, type of surgery, comorbidity) and postoperative data (complications) were evaluated, as well as in-hospital mortality, at 30 days and 6 months after surgery. RESULTS: Five-hundred-sixty-eight patients underwent emergency surgery between 2018 and 2019. After the review, 407 patients were included in the study. Average age: 86.9 years. Women 61.7%. Mean hospital stay: 10.4 days. Traumatic interventions 41.3%, vascular surgery 19.7%, general-digestive surgery 25.3%. Medium ASA risk: 2.88. Functional status at discharge: 3.15. Postoperative complications: Clavien-Dindo I 40.8%, II 40.3%, IIIA 3.4%, IIIB 2.5%, IVA 3.9%, IVB 2.0% and V 7.1%. Hospital mortality 7.1%, 30-day mortality 10.3%, mortality at 6 months 24.6%. CONCLUSIONS: Patients > 80 years of age undergoing urgent surgery have high preoperative comorbidity, postoperative complications, and high mortality at 30 days and 6 months after surgery. This mortality is more significant in those ASA IV, nonagenarians and those undergoing high-risk surgery.

OBJETIVO: Evaluar los resultados en salud (morbilidad y mortalidad posoperatorias) y el estado funcional al alta de los pacientes mayores de 80 años sometidos a cirugía de urgencia. MÉTODO: Pacientes de edad > 80 años sometidos a cirugía de urgencia durante 1 año en el Hospital Universitario Marqués de Valdecilla, Santander, España. Se evaluaron datos preoperatorios (edad, sexo, tipo de cirugía, comorbilidad) y posoperatorios (complicaciones), así como mortalidad hospitalaria, a los 30 días y a los 6 meses de la cirugía. RESULTADOS: En 2018-2019 fueron operados de urgencia 568 pacientes, de los cuales 407 fueron incluidos en el estudio. Edad media: 86.9 años. El 61.7% fueron mujeres. Estancia media hospitalaria: 10.4 días. El 41.3% fueron intervenciones traumatológicas, el 19.7% cirugía vascular, el 25.3% cirugía general-digestiva. Riesgo ASA medio: 2.88. Estado funcional al alta: 3.15. Complicaciones posoperatorias: Clavien-Dindo I 40.8%, II 40.3%, IIIA 3.4%, IIIB 2.5%, IVA 3.9%, IVB 2.0% y V 7.1%. Mortalidad: hospitalaria 7.1%, a los 30 días 10.3% y a los 6 meses 24.6%. CONCLUSIONES: Los pacientes > 80 años sometidos a cirugía urgente presentan elevada comorbilidad preoperatoria, complicaciones posoperatorias y elevada mortalidad a 30 días y 6 meses de la cirugía. Esta mortalidad es más significativa en los ASA IV, nonagenarios y sometidos a cirugía de alto riesgo.

Long-term outcomes of patients affected by Guillain-Barré syndrome in Colombia after the Zika virus epidemic.

BACKGROUND: Guillain-Barré Syndrome (GBS) can lead to significant functional impairments, yet little is understood about the recovery phase and long-term consequences for patients in low- and medium-income countries. OBJECTIVE: To evaluate the functional status and identify factors influencing outcomes among patients with GBS in Colombia. METHODS: Telephone interviews were conducted with GBS patients enrolled in the Neuroviruses Emerging in the Americas Study between 2016 and 2020. The investigation encompassed access to health services and functional status assessments, utilizing the modified Rankin Scale (mRS), GBS Disability Score (GDS), Barthel Index (BI), and International Classification of Functioning (ICF). Univariate analysis, principal component analysis, linear discriminant analysis, and linear regression were employed to explore factors influencing functional status. RESULTS: Forty-five patients (mean age = 50[±22] years) with a median time from diagnosis of 28 months (IQR = 9-34) were included. Notably, 22% and 16% of patients did not receive rehabilitation services during the acute episode and post-discharge, respectively. Most patients demonstrated independence in basic daily activities (median BI = 100, IQR = 77.5-100), improvement in disability as the median mRS at follow-up was lower than at onset (1 [IQR = 0-3] vs. 4.5 [IQR = 4-5], p < 0.001), and most were able to walk without assistance (median GDS = 2, IQR = 0-2). A shorter period from disease onset to interview was associated with worse mRS (p = 0.015) and ICF (p = 0.019). Negative outcomes on GDS and ICF were linked to low socioeconomic status, ICF to the severity of weakness at onset, and BI to an older age. CONCLUSIONS: This study underscores that the functional recovery of GBS patients in Colombia is influenced not only by the natural course of the disease but also by socioeconomic factors, emphasizing the crucial role of social determinants of health.

Avaliação e fatores associados aos sistemas funcionais mobilidade e comunicação de idosos na atenção domiciliar / Assessment and factors associated with the functional systems mobility and communication of the elderly in home care / Evaluación y factores asociados a los sistemas funcionales movilidad y comunicación de los ancianos en la atención domiciliaria

Objetivo: Identificar as características sociodemográficas e analisar a associação das variáveis sociodemográficas com os sistemas funcionais mobilidade e comunicação de idosos vinculados à Atenção Domiciliar da Atenção Básica. Métodos: Trata-se de uma pesquisa transversal e analítica, realizada via contato telefônico com 108 idosos. Utilizou-se um questionário sociodemográfico e o instrumento Índice de Vulnerabilidade Clínico Funcional-20. Aplicou-se análise bivariada. Resultados: A idade média constatada foi de 78,7 anos, com predomínio do sexo feminino (71,3%), estado civil casado (44,4%), ensino fundamental incompleto (65,7%), renda domiciliar total inferior a dois salários-mínimos (58,3%) e alto índice de presença de comorbidade (98,1%). Referente aos sistemas funcionais mobilidade e comunicação, grande parte era independente para a maioria dos indicadores de vulnerabilidade, exceto o indicador referente a dificuldade para caminhar (63%). Constatou-se associação significativa entre problemas de audição e sexo (p=0,024) e com faixa etária (p=0,015). Conclusão: A partir disso, é possível traçar estratégias de cuidados aos idosos visando reduzir incapacidades e ampliar a independência. (AU)

Objective: Identify the sociodemographic characteristics and analyze the association of sociodemographic variables with the functional systems mobility and communication of the elderly linked to the Home Care of Primary Care. Methods: This is a cross-sectional and analytical research, carried out via telephone contact with 108 elderly people. We used a sociodemographic questionnaire and the instrument Functional Clinical Vulnerability Index-20. Bivariate analysis was applied. Results: The mean age was 78,7 years, with a predominance of females (71,3%), married (44,4%), incomplete elementary school education (65,7%), total household income of less than two minimum wages (58,3%) and a high presence of comorbidities (98,1%). Regarding the functional mobility and communication systems, most were independent for most of the vulnerability indicators, except for the indicator referring to difficulty to walk (63%). A significant association was found between hearing problems and gender (p=0,024) and also with age (p=0,015). Conclusion: From this, it is possible to outline strategies for elderly care aimed at reducing disability and increasing independence. (AU)

Objetivo: Identificar las características sociodemográficas y analizar la asociación de las variables sociodemográficas con los sistemas funcionales de movilidad y comunicación de los ancianos vinculadas a la Atención Domiciliaria de Atención Primaria. Métodos: Se trata de una investigación transversal y analítica, realizada vía telefónica con 108 personas. Se utilizó un cuestionario sociodemográfico y el instrumento Índice de Vulnerabilidad Clínico Funcional-20. Se aplicó un análisis bivariante. Resultados: La edad media constatada fue de 78,7 años, con predominio del sexo femenino (71,3%), estado civil casado (44,4%), educación fundamental incompleta (65,7%), renta domiciliaria total inferior a dos salarios mínimos (58,3%) y alto índice de presencia de comorbilidad (98,1%). En cuanto a los sistemas funcionales de movilidad y comunicación, la mayoría eran independientes para la mayoría de los indicadores de vulnerabilidad, excepto el indicador referido a la dificultad para caminar (63%). Se encontró una asociación significativa entre los problemas de audición y el género (p=0,024) y también con el grupo de edad (p=0,015). Conclusión: A partir de ahí, es posible trazar estrategias de atención a los ancianos con el fin de reducir las incapacidades y ampliar la independencia. (AU)

Acute clinical outcomes predict both generic and specific health-related quality of life six and 12 months after stroke: A one-year prospective study developed in a middle-income country.

OBJECTIVE: To identify acute predictors of generic and specific health-related quality of life (HRQoL) six and 12 months after stroke in individuals from a middle-income country. MATERIAL AND METHODS: This was a prospective study. The dependent outcomes assessed during six and 12 months after stroke included both generic and specific HRQoL (Short Form Health Survey-36 [SF-36] and stroke-specific quality of life [SSQOL]). The predictors were age, sex, education level, length of hospital stay, current living arrangement, stroke severity, functional independence, and motor impairment. RESULTS: 122 (59.9±14 years) and 103 (59.8±14.71 years) individuals were evaluated six and 12 months after stroke, respectively. Functional independence and sex were significant acute predictors of both generic and specific HRQoL. Functional independence was the strongest predictor (0.149≤R2≤0.262; 20.01≤F≤43.96, p<0.001), except for generic HRQoL at 12 months, where sex was the strongest predictor (R2=0.14; F=17.97, p<0.001). CONCLUSION: Generic and specific HRQoL in chronic individuals six and 12 months after stroke, from a middle-income country, can be predicted based on functional independence, the strongest predictor, assessed in the acute phase, except for generic HRQoL at 12 months. Functional independence can be modified by rehabilitation strategies and thus should be considered for HRQoL prognoses at chronic phase.

Relação da mobilidade, força de preensão palmar e capacidade funcional com o escore grace de pacientes internados em uma unidade coronária / Relationship of mobility, handgrip strength and functional capacity with the grace score of patients admitted to a coronary unit

FUNDAMENTO: Estabelecer critérios funcionais de avaliação para o paciente isquêmico estratificado quanto ao risco de mortalidade. Objetivo: Verificar o perfil funcional por meio da mobilidade (Tempo de Perme), força de preensão palmar (FPP) e capacidade funcional (CF) e relacionar tais desfechos com o risco de mortalidade e tempo de internação. MÉTODOS: Estudo transversal, com 65 pacientes admitidos em Unidade Coronária (UCO), diagnosticados com Síndrome Coronariana Aguda, com idade a partir de 18 anos, estratificados pelo Global Registry of Acute Coronary Events (GRACE) e avaliados por meio do Escore Perme ­ Tempo de Perme, Dinamometria, Teste de Caminhada de 6 minutos. Foram aplicados testes correlação e utilizados modelos lineares para regressão logística A medida de efeito foi dada pela razão de chances e razão de médias. Um p < 0,05 foi adotado como significante. RESULTADOS: 74% dos pacientes foram do sexo masculino, com idade média (DP) de 62.4 (12) anos, no geral classificados com alto risco de mortalidade. O tempo de internação foi de 7.1 (5.4) dias, enquanto o Tempo de Perme foi em média 5.3 (3.9) dias. FPP (p<=33, se risco alto, é 17 vezes a chance de FPP<=33 se baixo risco (IC95% 2.60,340; p=0,012). Em relação à CF, a chance de distância <=387, se risco alto, é 9.92 vezes a chance de distância <=387 se baixo risco (IC95% 1.82,80; p=0,014). CONCLUSÕES: Quanto maior o risco cardíaco, maior foi o tempo para alcançar melhor mobilidade, maior o tempo de internação, e menor a força de preensão palmar e capacidade funcional. Se estratificado com alto risco cardíaco, a probabilidade de obter menor FPP e percorrer menor distância foi significantemente maior quando comparado ao baixo risco cardíaco.

Efeitos do treinamento multicomponente na capacidade intrínseca de idosos residentes na comunidade: protocolo de estudo quase-experimental / Effects of multicomponent training on the intrinsic capacity of communitydwelling older adults: quasi-experimental study protocol

Objetivo: Protocolo para avaliar os efeitos de exercícios multicomponentes na capacidade intrínseca de idosos. Metodologia: Pessoas idosas (≥ 60 anos) cadastradas em um programa de treinamento multicomponente de Porto Alegre (RS) serão selecionados para avaliação da capacidade intrínseca nos seus cinco domínios: vitalidade (teste de força de preensão manual (FPM), índice de massa corpórea (IMC) e nutrição) sensorial (perguntas autorrelatadas), psicológico (Escala de Depressão Geriátrica, GDS-15), cognitivo (MoCA teste) e locomotor (teste de sentar e levantar e TUG). A pontuação composta da capacidade intrínseca será realizada por meio da soma dos domínios em escore de 0 a 10 pontos. Ao fim de 12 semanas de intervenção com exercícios multicomponentes, os participantes serão reavaliados. Para comparar os efeitos do treinamento multicomponente na capacidade intrínseca composta e por domínio serão utilizados os testes t de Student e ANOVA para comparar os efeitos de diversos tipos de treinamento. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa sob parecer no 5.517.315. Resultados esperados: Ao fim de 12 semanas de intervenção com os exercícios multicomponentes, esperamos um aumento na pontuação composta da capacidade intrínseca e em seus domínios, especialmente o locomotor. Relevância: O risco de dependência, quedas e mortalidade aumenta com o declínio da capacidade intrínseca, suscitando a necessidade de implementar intervenções para limitar esses desfechos negativos. A prática de exercícios multicomponentes é uma estratégia simples, eficaz, com boa adesão e amplamente recomendada para evitar o declínio da capacidade intrínseca e melhorar a saúde e a funcionalidade das pessoas idosas. (AU)

Objective: This is a protocol for assessing the effects of multicomponent exercise on the intrinsic capacity of older adults. Methods: Older adults (≥ 60 years old) will be selected for a multicomponent training program in Porto Alegre, RS, Brazil to evaluate the 5 domains of intrinsic capacity: vitality (handgrip strength, body mass index, and nutrition) sensory perception (self-reported questions), psychology (the 15-item Geriatric Depression Scale), cognition (the Montreal Cognitive Assessment) and locomotion (the sit-to-stand test and the Timed Up and Go test). The composite intrinsic capacity score will be obtained by summing the domains, with total scores ranging from 0 to 10 points. After 12 weeks of the multicomponent exercise intervention, the participants will be reassessed. Student's t-test and ANOVA will be used to compare the effects of different types of training on intrinsic capacity. This study was approved by the research ethics committee of the involved institution. Expected results: After the 12-week multicomponent exercise intervention, we expect scores for composite intrinsic capacity and its domains, especially locomotion, to increase. Relevance: The risk of dependence, falls, and mortality increases with reduced intrinsic capacity, indicating a need for interventions to limit these negative outcomes. Multicomponent exercise, a simple, widely recommended, and effective strategy with good adherence, is designed to prevent intrinsic capacity decline in older people and improve their health and functionality. (AU)

Physical inactivity and sedentary behavior in individuals with stable COPD non-infected by SARS-CoV-2 during the COVID-19 pandemic / Inatividade física e comportamento sedentário em indivíduos com DPOC estável não infectados pelo SARS-CoV-2 durante a pandemia de COVID-19

Objective: to identify factors associated to sedentary behavior and physical inactivity in individuals with stable chronic obstructive pulmonary disease (COPD) non-infected by SARS-CoV-2 during the COVID-19 pandemic, and to identify possible favorable conditions during social isolation in individuals who performed pulmonary rehabilitation in the pre-pandemic period. Method: time/day in sedentary activities and moderate/vigorous physical activities (SA and MVPA, respectively), history of previous rehabilitation, laboural activity, symptoms, insecurity and quality of life (Medical Outcomes Study 36-item Short-Form Health Survey [SF-36]) were assessed during strict social isolation due to the COVID-19 pandemic. Individuals were classified as sedentary if presenting time/day in SA >8.5 h/day and physically inactive if presenting time/day in MVPA <150 min/week. Result: The sample consisted of 33 individuals (69±7 years; 20 male). Regarding the SF-36, non-sedentary individuals presented better functional capacity than sedentary individuals (65 [38-73] vs. 33 [20-63] points; p=0.01) whereas physically active individuals presented better physical and social function than physically inactive individuals (100 [100-100] vs. 50 [25-100] points, p=0.049; and 100 [100-100] vs. 75 [69-100] points, p=0.022, respectively). Having a professional activity and working outside were associated with non-sedentary behavior (X2=5.93; p=0.025 and X2=7.03; p=0.009, respectively). Having undergone rehabilitation previously to the pandemic was associated with less insecurity to walk outside (X2=4.95; p=0.034) and better perception of symptoms' worsening (X2=5.46; p=0.033). Conclusion: non-sedentarism was associated with functional capacity and laboural activity; active lifestyle was associated with physical and social function; and previous rehabilitation was associated with better symptoms' recognition and less insecurity

Objetivo: identificar fatores associados ao comportamento sedentário e inatividade física em indivíduos com doença pulmonar obstrutiva crônica (DPOC) estável não-infectados pelo SARS-CoV-2 durante o isolamento social causado pela pandemia de COVID-19, e identificar eventuais condições favoráveis durante o isolamento social em indivíduos que realizaram reabilitação pulmonar pré-pandemia. Método: tempo/dia em atividades sedentárias e em atividades físicas moderadas/vigorosas (AS e AFMV, respectivamente), reabilitação prévia, atividade laboral, sintomas, insegurança e qualidade de vida (Medical Outcomes Study 36-item Short-Form Health Survey [SF-36]) foram avaliados durante a vigência de isolamento social devido à pandemia de COVID-19. Foram considerados sedentários aqueles que apresentassem tempo/dia em AS >8,5 h/dia e fisicamente inativos os que apresentassem tempo/dia em AFMV <150 min/semana. Resultado: a amostra consistiu em 33 indivíduos (69±7 anos; 20 homens). Pelo SF-36, indivíduos não-sedentários apresentaram melhor capacidade funcional do que sedentários (65 [38-73] vs. 33 [20-63] pontos; p=0,01) enquanto indivíduos fisicamente ativos apresentaram melhor função física e social do que os fisicamente inativos (100 [100-100] vs. 50 [25-100] pontos, p=0,049; e 100 [100-100] vs. 75 [69-100] pontos, p=0,022, respectivamente). Ter atividade profissional e trabalhar fora de casa associou-se com comportamento não-sedentário (X2=5,93; p=0,025 e X2=7,03; p=0,009, respectivamente). Ter participado de reabilitação pulmonar pré-pandemia associou-se com menos insegurança para caminhar em lugares públicos (X2=4,95; p=0,034) e melhor percepção de piora dos sintomas respiratórios (X2=5,46; p=0,033). Conclusão: não-sedentarismo associou-se com capacidade funcional e atividade laboral; ser fisicamente ativo associou-se com função física e social; e ter realizado reabilitação prévia com menos insegurança e melhor percepção dos sintomas

Factors Associated with the Deterioration of Intrinsic Capacity among Older Adults in Mexico and Colombia.

BACKGROUND: Intrinsic capacity (IC) is defined as "all the physical and mental attributes possessed by the older person." This concept has gained momentum in recent years because it provides insights into the changes in the functional capacity of individuals during their life. This study examined common factors associated with IC decline among older adults in Mexico and Colombia. METHODS: This cross-sectional, correlational study included 348 community-dwelling older adults. Sociodemographic, clinical, and family conditions were assessed as possible associated factors, and IC was analyzed across five domains: cognitive, locomotor, psychological, vitality (malnutrition through deficiency and excess), and sensory (visual and auditory). Parametric and non-parametric statistical analyses were performed. RESULTS: The common factors associated with impairment according to domain were family dysfunctionality (cognitive domain); myocardial infarction, family dysfunctionality, age >80 years, home occupation, and not having a partner (locomotor domain); dysfunctional family and risk of falls (psychological domain); age >80 years and not having a partner (malnutrition by deficiency domain); age 60-79 years, walking <7,500 steps/day, and peripheral vascular disease (malnutrition by excess domain); risk of falling and being female (visual sensory domain); risk of falling (auditory sensory domain); and dysfunctional family and risk of falling (total intrinsic capacity). CONCLUSION: Both populations had common sociodemographic, clinical, and familial factors that directly affected total IC stocks and their domains.

Prevalence of functional dependence and chronic diseases in the community-dwelling Brazilian older adults: an analysis by dependence severity and multimorbidity pattern.

BACKGROUND: Despite the advancements in knowledge about health care for older adults, essential gaps persist regarding the effects of chronic diseases as epidemiological markers of the state of functional dependence. This study aimed to identify the prevalence of moderate and severe functional dependence in Brazilian older adults and its association with chronic diseases and verify the multimorbidity patterns by dependence status. METHODS: This cross-sectional analytical study used data from 11,177 community-dwelling Brazilian older adults from the 2013 National Health Survey conducted in Brazil. The dependent variables were moderate and severe functional dependence in basic activities of daily living (BADLs) and instrumental ADLs (IADLs). The independent variables were defined based on the questions applied to measure each morbidity in a self-reported manner and asked, "Has a doctor ever diagnosed you as having (each disease)? Multimorbidity was simultaneously considered present for older adults with ≥ 2 chronic morbidities. The association between functional dependence on BADLs and IADLs separately by severity and the independent variables was verified from crude and adjusted estimates of the point prevalence ratios and their 95% confidence intervals using the regression model Poisson with robust variance. To group diseases into patterns, exploratory factor analysis was used. RESULTS: The prevalences of moderate and severe BADL dependence were 10.2% (95% CI, 9.6-10.7) and 4.8% (95% CI, 4.4-5.2), respectively. Moderate and severe IADL dependence prevalences were 13.8% (95% CI, 13.1-14.4) and 15.6% (95% CI, 14.9%-16.2), respectively. When changing the condition from moderate to severe dependence in BADLs, in the presence of other mental illnesses and stroke, the probability of dependence increased more than four times in the case of other mental illnesses and more than five times for stroke. There was a linear trend for dependence severity, both moderate and severe, whereas, for severe dependence on IADLs, this same factor maintained a linear trend toward an increase in probability as the number of diseases simultaneously increased. CONCLUSIONS: Chronic diseases are associated with functional dependence, with greater emphasis on mental illnesses and stroke in severe disability, considering their acute adverse effects.

Functional Dependence Prior to ICU Admission is Associated with Worse Clinical and Functional Outcomes in Individuals with COVID-19: A Prospective Observational Study.

Objectives: To determine whether low functional capacity (FC) prior to intensive care unit (ICU) admission due to coronavirus disease 2019 (COVID-19) might be associated with worse clinical outcomes. To monitor FC until discharge from the ICU. To identify associations between physical outcomes and decreased FC at discharge from the ICU. Design: Prospective observational study conducted from March to August 2021. Setting: ICU for adult patients with COVID-19. Participants: Adults (≥18 years) with COVID-19. Interventions: Not applicable. Main outcome measures: Clinical and demographic data were obtained from medical records. At ICU admission, evaluation was made of FC using the Barthel index (BI), and of the level of mobility using the ICU mobility scale. At ICU discharge, FC and mobility level were reassessed, and muscle strength was measured using the Medical Research Council (MRC) scale and the handgrip test. Results: The study was performed with 108 individuals. At the initial assessment, 73.1% of the patients were functionally independent. Length of hospital stay (odds ratio [OR] = 1.05; 95%confidence interval [CI] = 1.00-1.10) and death (OR = 5.27; 95%CI = 1.37-20.28) were related to functional status prior to ICU admission. Between ICU admission and discharge, the BI evaluation indicated a functional decline of 22.5 points. Low mobility level (P = .003) and low muscle strength assessed by the MRC scale (P < .001), measured at ICU discharge, were associated with a greater decrease of FC during the ICU stay. Conclusions: Patients with COVID-19 who were functionally dependent prior to ICU admission presented worse clinical outcomes, with low functional status being associated with longer hospitalization and higher mortality. However, irrespective of the initial functionality status, the surviving individuals suffered from functional decline at ICU discharge. Greater functional decline during the ICU stay was associated with lower muscle strength and lower mobility level at ICU discharge.

Independência funcional, aspectos clínicos e fatores sociodemográficos em pacientes na fase aguda do Acidente Vascular Cerebral: uma análise de associação / Functional independence, clinical aspects, and sociodemographic factors in patients in the acute phase of stroke: an association analysis

RESUMO Objetivo Analisar a associação da independência funcional com aspectos clínicos de comprometimento neurológico, a localização e extensão do dano neuronal e os fatores sociodemográficos em pacientes na fase aguda do AVC. Método Estudo analítico de recorte transversal, realizado com 90 pacientes adultos e idosos acometidos por AVC isquêmico, que tiveram admissão no ambiente hospitalar nas primeiras 24 horas após o evento vascular. A coleta dos dados referentes aos aspectos clínicos e fatores sociodemográficos foi realizada pelo prontuário eletrônico e/ou entrevista para descrever o perfil dos pacientes, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale e a Medida de Independência Funcional. Resultados O comprometimento neurológico, de acordo com a National Institute of Health Stroke Scale, foi associado à funcionalidade nas primeiras 24 horas após o AVC. Além disso, a presença de hipertensão arterial, idade, trabalho inativo, tabagismo e extensão do dano neuronal estiveram associados à dependência funcional, mas não permaneceram no modelo final deste estudo. Conclusão A dependência funcional está associada à hipertensão arterial, idade, trabalho inativo, tabagismo, extensão do dano neuronal e grau de comprometimento neurológico nas primeiras 24 horas após o evento vascular. Além disso, um nível mais elevado de comprometimento neurológico foi independentemente associado a níveis aumentados de dependência funcional.

ABSTRACT Purpose To analyze the association of functional independence with clinical aspects of neurological impairment, the location and extent of neuronal damage and sociodemographic factors in patients in the acute phase of stroke. Methods Analytical cross-sectional study in 90 adult and older patients affected by ischemic stroke, admitted to the hospital within 24 hours of the vascular event. Sociodemographic factors and clinical aspects data were collected from electronic medical records and/or interviews in order to depict the patients'profile, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale, and Functional Independence Measure. Results Neurological impairment, according to the National Institute of Health Stroke Scale, was associated with functioning in the first 24 hours after the stroke. Furthermore, the presence of arterial hypertension, age, inactive work, smoking and extent of neuronal damage were associated with functional dependence, but did not remain in the final model of this study. Conclusion Functional dependence is associated with arterial hypertension, age, inactive work, smoking, extent of neuronal damage, and degree of neurological impairment in the first 24 hours after the vascular event. Furthermore, a higher level of neurological impairment was independently associated with increased levels of functional dependence.

Distal Radial Fractures with Scaphoid Fractures / Fraturas do rádio distal associadas à fratura do escafoide

Abstract Objective This study evaluated the epidemiological data and functional outcomes from patients with concomitant distal radial and scaphoid fractures treated in a single center specialized in hand surgery. Functional outcomes analysis used validated instruments. Methods Patients diagnosed with distal radial and scaphoid fractures treated from January 2011 to December 2021 underwent assessments using the Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), Visual Analog Scale (VAS) for pain, goniometry, radiographic consolidation, and complications six months after surgery. Results The study included 23 patients, 73.9% men and 26.1% women. Most (56.5%) fractures occurred on the right side, and 43.5% happened on the left side. Treatment of most (56%) distal radial fractures used a locked volar plate. Functional assessment by PRWE resulted in a mean score of 35.9 points (range, 14 to 71 points), while DASH showed a mean score of 37.8 points (range, 12 to 78 points). The mean VAS was 2.33 during activities (range, 0.6 to 6.2). Conclusion Distal radial fractures associated with scaphoid fractures resulted from high-energy trauma, and most patients were males. There was a low rate of complications with surgical treatment, and the patients had satisfactory functional evolution with a low level of pain.

Resumo Objetivo Avaliar os resultados epidemiológicos e funcionais dos pacientes que apresentaram fraturas concomitantes do rádio distal e do escafoide e foram tratados em um único centro especializado em cirurgia da mão, através de instrumentos validados para analisar os desfechos funcionais desses pacientes. Métodos Foram avaliados os pacientes com diagnóstico de fratura do rádio distal e escafoide tratados de janeiro de 2011 até dezembro de 2021, através dos questionários Disabilities of the Arm, Shoulder and Hand (DASH), Patient Rated Wrist Evaluation (PRWE) e Escala Visual Analógica da dor (EVA); goniometria; consolidação radiográfica; complicações em seis meses de pós-operatório. Resultados Vinte e três pacientes foram incluídos no estudo, sendo 73,9% homens e 26,1% mulheres; 56,5% das fraturas ocorreram à direita e 43,5% à esquerda. A maioria das fraturas do rádio distal foi tratada com placa volar bloqueada, totalizando 56%. Na avaliação funcional pelo PRWE, obteve-se média de 35,9 pontos (variação de 14 a 71 pontos) e pelo DASH média de 37,8 pontos (variação de 12 a 78 pontos). A EVA apresentou uma média de 2,33 durante a atividade (variação de 0,6 a 6,2). Conclusão Verificou-se que as fraturas do rádio distal associadas a fraturas do escafoide foram causadas por traumas de alta energia, com o sexo masculino mais acometido. Houve baixo índice de complicações com tratamento cirúrgico e os pacientes tiveram evolução funcional satisfatória, com baixo índice de dor.

Equilíbrio postural e fatores associados ao risco de quedas em idosos com diabetes mellitus tipo 2 / Postural balance and associated factors with the fall risk assessed in older adults with type 2 diabetes mellitus

Resumo Objetivo Identificar os fatores clínico-funcionais associados ao risco de quedas, avaliado pelo Mini-BESTest, em idosos com diabetes mellitus tipo 2 (DM2). Método Trata-se de um estudo transversal. Um total de 145 idosos com idade =60 anos foram avaliados por meio das variáveis sociodemográficas (sexo, faixa etária, estado civil, nível de educação e percepção geral da saúde, audição e visão) Mini-BESTest, Mini-Mental State Examination (MMSE), Escala de Depressão Geriátrica (GDS-15) e o teste Timed Up and Go (TUG) (dupla tarefa). Foi utilizado um modelo de regressão logística múltipla. Resultados O domínio de orientação sensorial apresentou a pontuação média mais elevada, seguido pelos domínios estabilidade na marcha, ajustes posturais antecipatórios e respostas posturais. Os fatores associados ao risco de quedas em idosos foram: percepção visual ruim/muito ruim OR 3.40 (1,50-7,72); presença de doenças respiratórias OR 8.00 (1,32-48,46); sensação de tontura OR 2.53 (1,10-5,80); e tempo do teste Timed Up and Go (TUG) (dupla tarefa) igual ou superior a 13,5 segundos OR 3.31 (1,03-10,64). Conclusão Os idosos deste estudo apresentaram um equilíbrio postural comprometido, principalmente no domínio das respostas posturais. O conhecimento dos fatores associados ao risco de quedas em idosos com DM2 permite uma orientação mais eficaz na avaliação, prevenção e intervenção, visando minimizar a ocorrência de quedas e preservar ou otimizar o equilíbrio postural. Diversos fatores influenciaram esse resultado, tais como sobrepeso, baixa atividade física e nível educacional, várias comorbidades, polifarmácia, diagnóstico de DM2 por mais de dez anos, percepção negativa da saúde geral e da visão, e sintomas depressivos.

Abstract Objective Identify clinical-functional factors associated to the risk of falls, assessed by Mini-BESTest in older adults with type 2 diabetes mellitus (T2DM). Method This cross-sectional study. A total of 145 older adults aged ≥60 years were evaluated through sociodemographic variables (sex, age group, married, education level, general health status hearing and vision), Mini-BESTest, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15) and dual-task Timed Up and Go Test (TUG) Multiple logistic regression model was used. Results The sensory orientation domain presented the highest average score, followed by the gait stability, anticipatory postural adjustments and postural responses domains. Factors associated to the risk of falls in older adults are: poor/very poor visual perception OR 3.40 (1.50-7.72); have respiratory diseases OR 8.00 (1.32-48.46); feeling dizzy OR 2.53 (1.10-5.80); and TUGT (dual task) time equal to or greater than 13.5 seconds OR 3.31 (1.03-10.64). Conclusion Older adults in this study presented impaired postural balance, mainly in the postural responses domain. The knowledge of the factors associated with the risk of falls in older adults with T2DM allows for better guidance in prevention, assessment and intervention, in order to minimize the occurrence of falls and maintain or optimize postural balance. Several factors influenced this outcome, such as overweight, low physical activity and education, several comorbidities, polypharmacy, T2DM diagnosis for more than ten years, negative perception of general health and vision, and depressive symptoms.