Barriers and facilitators of domain-specific physical activity: a systematic review of reviews.

BACKGROUND: Knowing what facilitates and hinders physical activity behaviour across domains (leisure, travel, work or education, and household) is central for the development of actions for more active lifestyles. Thus, the aim of this systematic review of reviews was to summarize the evidence on barriers and facilitators of domain-specific physical activity. METHODS: We included systematic reviews with or without meta-analysis that investigated the association between modifiable barriers and facilitators and levels of domain-specific physical activity. Reviews published until September 2020 were retrieved from PubMed, ISI Web of Science, Scopus, Regional Library of Medicine (BIREME), and PsycNET, and from the reference list of selected articles. Each review was screened by two independent reviewers for eligibility. Data extracted from selected papers included methodological aspects (number of primary studies, study designs, and age groups); physical activity domains and barriers and facilitators investigated; and direction of association. For each pair of barrier/facilitator and domain-specific physical activity, we recorded the number of positive, negative, and null associations reported across reviews. Quality assessment of each systematic review was performed using the AMSTAR-2 tool. RESULTS: Forty-four systematic reviews were selected. The evidence base was largest for leisure-time followed by travel-related physical activity. A very small number of reviews included physical activity in work, educational and domestic settings. Across all physical activity domains, factors related to the built environment were more abundant in the reviews than intra and interpersonal factors. Very consistent positive associations were observed between a range of intrapersonal factors and leisure-time physical activity, as well as moderately consistent evidence of positive association for general social support and support from family members. Evidence of moderate consistency was found for the positive association between transport-related physical activity and positive beliefs about consequences, walkability, and existence of facilities that support active travel. Evidence on barriers and facilitators for physical activity at work, educational, and domestic settings was limited in volume and consistency. CONCLUSIONS: Efforts and resources are required to diversify and strength the evidence base on barriers and facilitators of domain-specific physical activity, as it is still limited and biased towards the leisure domain and built environment factors. TRIAL REGISTRATION: PROSPERO CRD42020209710.

Multimodality Screening of Hepatic Nodules in Patients With Congenital Heart Disease After Fontan Procedure: Role of Ultrasound, ARFI Elastography, CT, and MRI.

OBJECTIVE: Currently, there is no consensus in the literature regarding the screening of hepatic nodules in patients who have undergone the Fontan procedure. The objectives of this study are to evaluate in this population the frequency of hepatic nodules at ultrasound (US), CT, and MRI; to measure liver stiffness using acoustic radiation force impulse (ARFI) elastography; and to investigate predictive factors for hepatic nodules. SUBJECTS AND METHODS: In this cross-sectional study, 49 patients who underwent the Fontan procedure were prospectively recruited from August 2014 through June 2016. These patients underwent clinical evaluation for hepatic disorders, ARFI elastography, US, CT, and MRI. RESULTS: Most of the patients had no symptoms, and hepatic nodules were detected in three of 49 (6.1%) patients at US, 14 of 44 (31.8%) patients at CT, and 19 of 48 (39.6%) patients at MRI. Liver stiffness at ARFI elastography was significantly higher in patients with hepatic nodules than in patients without such nodules (2.64 ± 0.81 m/s vs 1.94 ± 0.49 m/s; p = 0.002) and was a significant predictor of hepatic nodule (AUC, 0.767; p = 0.002). No clinical or laboratory data had any significant correlation with the existence of hepatic nodules, including time since Fontan procedure. CONCLUSION: In our study, more than one-third of patients had hepatic nodules at CT or MRI, but US did not detect most hepatic nodules. Liver stiffness at ARFI elastography was significantly higher in patients with hepatic nodules, and it may help guiding which patient should be further imaged with CT or MRI.

Physical frailty and gait speed in community elderly: a systematic review. / Fragilidade física e velocidade da marcha em idosos da comunidade: uma revisão sistemática.

OBJECTIVE: To identify the outcomes of studies on gait speed and its use as a marker of physical frailty in community elderly. METHOD: Systematic review of the literature performed in the following databases: LILACS, SciELO, MEDLINE/PubMed, ScienceDirect, Scopus and ProQuest. The studies were evaluated by STROBE statement, and the PRISMA recommendations were adopted. RESULTS: There were 6,303 studies, and 49 of them met the inclusion criteria. Of the total number of studies, 91.8% described the way of measuring gait speed. Of these, 28.6% used the distance of 4.6 meters, and 34.7% adopted values below 20% as cutoff points for reduced gait speed, procedures in accordance with the frailty phenotype. Regarding the outcomes, in 30.6% of studies, there was an association between gait speed and variables of disability, frailty, sedentary lifestyle, falls, muscular weakness, diseases, body fat, cognitive impairment, mortality, stress, lower life satisfaction, lower quality of life, napping duration, and poor performance in quantitative parameters of gait in community elderly. CONCLUSION: The results reinforce the association between gait speed, physical frailty and health indicator variables in community elderly.

[Handgrip strength and physical activity in frail elderly]. / Força de preensão manual e atividade física em idosos fragilizados.

OBJECTIVE: To investigate the association between handgrip strength (HS) and physical activity in physical frailty elderly. METHOD: Cross-sectional quantitative study with a sample of 203 elderly calculated based on the population estimated proportion. Tests were applied to detect cognitive impairment and assessment of physical frailty. Descriptive statistics and multivariate analysis by binary logistic regression were used, and also Student's t-test and Fisher's exact test. RESULTS: A total of 99 (64.3%) elderly showed decreased handgrip strength and 90 (58.4%) elderly presented decrease in physical activity levels. There was a statistically significant difference between these two components (p=0.019), in which elderly who have decreased HS have lower levels of physical activity. For low levels of physical activity and decreased HS, there was no evidence of significant difference in the probability of the classification as frail elderly (p<0.001). CONCLUSION: The components handgrip strength and physical activity are associated with the frail elderly. The joint presence of low levels of physical activity and decreased handgrip strength leads to a significantly higher probability of the elderly to be categorized as frailty.

Prevalence of Left Ventricular Dyssynchrony in Patients with Congenital Atrioventricular Block and Long-Term Pacing: A Three-Dimensional Echocardiographic Study.

BACKGROUND: Left ventricular (LV) dysfunction is the major reason for poor outcomes in patients with congenital complete atrioventricular block (CCAVB) and pacemaker. Long-term pacing has been associated with LV mechanical dyssynchrony. However, the relationship of dyssynchrony and LV dysfunction is not clear. OBJECTIVE: We sought to evaluate the prevalence of LV dyssynchrony by real time three-dimensional echocardiography (RT3DE) in patients with CCAVB and its association with LV dysfunction. In addition, we evaluated the agreement between RT3DE and tissue Doppler imaging (TDI) for detecting LV dyssynchrony. METHOD: We studied 50 patients [median age 20 years old (5 months to 62 years), 68% women] with CCAVB and pacemaker who underwent complete two-dimensional echocardiography and RT3DE. LV dyssynchrony was considered if the systolic dyssynchrony index (SDI) was ≥ 5%. Intraventricular mechanical delay was defined by TDI when differences in electromechanical activation between LV walls were > 65 msec. RESULTS: LV systolic dysfunction was present in 16 patients (32%) by two-dimensional and in 20 patients (40%) by RT3DE. There was a good correlation between LV ejection fraction by two-dimensional and RT3DE (r = 0.75; P < 0.001). Fourteen (28%) patients had intraventricular dyssynchrony by TDI, while 12 (24%) had intraventricular dyssynchrony by RT3DE. There was a good agreement between LV dyssynchrony by TDI and RT3DE (Kappa = 0.735; P < 0.001). There was a negative correlation between LV ejection fraction and SDI obtained by RT3DE (r = -0.58; P < 0.001) CONCLUSIONS: In patients with CCAVB and long-term pacing, LV dyssynchrony occurred in one-third of patients and was related to LV dysfunction. There was a good correlation between dyssynchrony obtained by RT3DE and TDI.

Handgrip strength in older adults and driving aptitude.

OBJECTIVE: to analyze handgrip strength as a predictor of the inability to drive in older adults. METHOD: a cross-sectional study conducted in traffic clinics with 421 older adults in Curitiba-Paraná from January 2015 to December 2018. A sociodemographic and clinical questionnaire, handgrip strength test, and queries from the National Registry of Qualified Drivers form were applied. RESULTS: Reduced handgrip strength was not a predictor of inaptitude for vehicular driving (p=0.649). The predictors of inaptitude were: low education (p=0.011), incomplete elementary education (p=0.027), and cognition (p=0.020). CONCLUSION: reduced handgrip strength was not shown to predict for loss of driving skills in older adults. Low education level and reduced cognition level are conditions that were shown to be predictors for loss of vehicular driving license.

Frailty and delirium in hospitalized older adults: A systematic review with meta-analysis.

OBJECTIVE: to estimate the prevalence and synthesize diverse evidence about the relationship between frailty and delirium in hospitalized older adults. METHOD: a systematic review with meta-analysis in which observational studies conducted with older adults about frailty, delirium and hospitalization, were selected without time of language restrictions. The search was conducted in the MEDLINE, EMBASE, CINAHL, Scopus, Web of Science and CENTRAL databases during August 2021. The precepts set forth by the Joanna Briggs Institute (JBI) - Evidence Synthesis Groups were followed. The meta-analysis model estimated the relative risk corresponding to the prevalence of frailty and delirium. The inverse variance method for proportions was used to estimate the prevalence values and relative risks for binary outcomes. RESULTS: initially, 1,244 articles were identified, of which 26 were included in the meta-analysis (n=13,502 participants), with 34% prevalence of frailty (95% CI:0.26-0.42; I 2=99%; t 2=0.7618, p=0) and 21% for delirium (95% CI:0.17-0,25; I 2=95%; t 2=0.3454, p<0.01). The risk for hospitalized older adults to develop delirium was 66% (RR: 1.66; 95% CI:1.23-2.22; I2=92%; t2=0.4154; p<0.01). CONCLUSION: 34% prevalence of frailty and 21% of delirium in hospitalized older adults, with frailty being an independent risk factor for developing delirium, with an increased chance of 66% when compared to non-frail individuals.

Barriers and facilitators for physical activity domains in Brazil: a systematic review. / Barreiras e facilitadores para a prática de atividade física em diferentes domínios no Brasil: uma revisão sistemática.

This study aimed to systematically review scientific evidence on the barriers and facilitators of physical activity (PA) among the Brazilian population, considering different domains (leisure, travel, work/study, and household). The search was conducted in the MEDLINE/PubMed, ISI Web of Science, SCOPUS, BIREME/LILACS, and APA PsycNET databases and was limited to papers published between 2010 and 2020. A manual search of the Brazilian Journal of Physical Activity & Health was also conducted. The selection process consisted of screening titles and abstracts, followed by the analysis of full texts. Each paper was assessed by two independent reviewers, and when discrepancies arose, a third reviewer was consulted. Leisure, environmental barriers and facilitators were the most investigated domains in the 78 included studies. There was consistency in the positive associations between six different intrapersonal and social facilitators for leisure PA and one environmental factor for travel. There have been a small number of investigations on the work/study and household domains, and future investigations on intrapersonal and social barriers and facilitators in the travel domain are important.

O objetivo foi revisar sistematicamente as evidências científicas sobre as barreiras e os facilitadores para a prática de atividade física (AF) na população brasileira, considerando os diferentes domínios (lazer, deslocamento, trabalho/estudo e tarefas domésticas). A busca foi conduzida nas bases de dados MEDLINE/PubMed, ISI Web of Science, Scopus, BIREME/LILACS e APA PsycNET, considerando o período de 2010 a 2020. Posteriormente, foi incluída a busca na Revista Brasileira de Atividade Física e Saúde. O processo de seleção consistiu na leitura de títulos e resumos, seguida de textos na íntegra. A avaliação foi realizada por pares e, mediante discrepância, um terceiro revisor era consultado. O domínio do lazer e as barreiras e os facilitadores ambientais foram os mais investigados nos 78 artigos incluídos. Houve consistência nas associações positivas de seis diferentes facilitadores pessoais e sociais para o lazer e um fator ambiental para o deslocamento. Encontrou-se um número reduzido de investigações sobre os domínios de trabalho/estudo e tarefas domésticas, sendo importante o incentivo a futuras investigações acerca das barreiras e dos facilitadores pessoais e sociais relacionados à AF de deslocamento.

Incor Residency Program in Adult Cardiology in 2022: 40 Years Preparing Cardiologists for the Demands in Brazil. / Programa de Residência Médica em Cardiologia de Adultos do InCor em 2022: 40 Anos Formando Cardiologistas para as Demandas do Brasil.

BACKGROUND: Considering demographic data related to the cardiologist's fields of work in Brazil, the administrative board of the InCor medical residency program decided for an update of its curriculum content, to adapt the educational process to the cardiologist's work reality. OBJECTIVE: This article aimed to describe the recent updates applied to the InCor medical residency program. METHODS: In the article, we described the recent updates on the InCor residency program, and compared the current curriculum track with the previous one. We also presented the rationale for these changes, based on the literature on the participation of cardiologists in the labor market. RESULTS: There was a reduction in the working hours of residents in training in the intensive care unit, and an increase in the outpatient activities of primary and secondary prevention. Also, the didactic content was reformulated and became organized by the corresponding division. CONCLUSION: The update of the curriculum track of the InCor medical residency program was required in order to adapt it to the Brazilian labor market. The commission in charge of this update is aware that this is a dynamic process that may need changes over time.

FUNDAMENTO: Diante de dados demográficos referentes às áreas de atuação dos cardiologistas no Brasil, a coordenação do Programa de Residência Médica em Cardiologia do Instituto do Coração (PRM INCOR) entendeu a necessidade de uma atualização de seu conteúdo programático, a fim de adaptar o processo de formação à realidade profissional do cardiologista. OBJETIVO: O presente artigo tem como objetivo descrever à comunidade científica as atualizações recentemente implementadas no PRM INCOR. MÉTODOS: No artigo, descrevemos as atualizações recentes do PRM INCOR, comparando a grade teórica pregressa e a atual. Expomos também o racional por trás de tais mudanças com dados de literatura relacionados à atuação do médico cardiologista no mercado de trabalho. RESULTADO: Houve uma redução da carga horária destinada a estágios de terapia intensiva, e um incremento nas atividades ambulatoriais relacionadas a medidas de prevenção primária e secundária. Além disso, o programa passou por uma reformulação de seu conteúdo didático, organizado agora por núcleos de competência. CONCLUSÃO: A atualização da grade curricular decorre da necessidade de adequar o PRM INCOR à realidade atual do mercado de trabalho brasileiro. O grupo envolvido na atualização está ciente que se trata de um processo dinâmico e que pode exigir modificações no decorrer do tempo.

Aerobic exercise and inspiratory muscle training increase functional capacity in patients with univentricular physiology after Fontan operation: A randomized controlled trial.

BACKGROUND: The effect of exercise training and its mechanisms on the functional capacity improvement in Fontan patients (FP) are virtually unknown. This trial evaluated four-month aerobic exercise training and inspiratory muscle training on functional capacity, pulmonary function, and autonomic control in patients after Fontan operation. METHODS: A randomized controlled clinical trial with 42 FP aged 12 to 30 years and, at least, five years of Fontan completion. Twenty-seven were referred to a four-months supervised and personalized aerobic exercise training (AET) or an inspiratory muscle training (IMT). A group of non-exercise (NET) was used as control. The effects of the exercise training in peak VO2; pulmonary volumes and capacities, maximal inspiratory pressure (MIP); muscle sympathetic nerve activity (MSNA); forearm blood flow (FBF); handgrip strength and cross-sectional area of the thigh were analyzed. RESULTS: The AET decreased MSNA (p = 0.042), increased FBF (p = 0.012) and handgrip strength (p = 0.017). No significant changes in autonomic control were found in IMT and NET groups. Both AET and IMT increased peak VO2, but the increase was higher in the AET group compared to IMT (23% vs. 9%). No difference was found in the NET group. IMT group showed a 58% increase in MIP (p = 0.008) in forced vital capacity (p = 0.011) and forced expiratory volume in the first second (p = 0.011). No difference in pulmonary function was found in the AET group. CONCLUSIONS: Both aerobic exercise and inspiratory muscle training improved functional capacity. The AET group developed autonomic control, and handgrip strength, and the IMT increased inspiratory muscle strength and spirometry. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02283255.

Causes of death and cardiovascular complications in adolescents and adults with congenitally malformed hearts: an autopsy study of 102 cases.

OBJECTIVES: To identify the causes of death and main cardiovascular complications in adolescents and adults with congenitally malformed hearts. DESIGN: Retrospective review of 102 necropsy reports from a tertiary centre obtained over a period of 19 years. METHODS: The diagnosis, the operated or non-operated state of the main defect, the cause of death, and main complications were related to the age and gender. Other clinically relevant conditions, and identifiable sequels of previous diseases, were also noted. RESULTS: The ages ranged from 15 to 69 years, with a mean of 31.1 and a median of 28 years, with no difference detected according to the gender. Of the patients, two-thirds had been submitted to at least one cardiac surgery. The mean age of death was significantly higher in non-operated patients (p = 0.003). The most prevalent cause of death in the whole group was related to recent surgery, found in one-third. From them, two-fifths corresponded to reoperations. Among the others, cardiac failure was the main terminal cause in another third, and the second cause was pulmonary thromboembolism in just over one-fifth, presenting a significant association with histopathological signs of pulmonary hypertension (p = 0.011). Infection was the cause of death in 7.8% of the patients, all previously operated. Acute infective endocarditis was present or was the indication for the recent surgery in one-tenth of the patients, this cohort having a mean age of 27.8 years. There was a statistically significant association between the occurrence of endocarditis and defects causing low pulmonary blood flow (p = 0.043). CONCLUSIONS: Data derived from necropsies of adults with congenital heart defects can help the multidisciplinary team refine both their diagnosis and treatment.

Gait speed associated factors in elderly subjects undergoing exams to obtain the driver's license. / Fatores associados à velocidade da marcha em idosos submetidos aos exames para habilitação veicular.

OBJECTIVE: to analyze the factors associated with gait speed in elderly subjects undergoing physical and mental fitness tests to obtain a driver's license. METHOD: a cross-sectional quantitative study conducted in transit agencies. The probabilistic sample included 421 elderly (≥ 60 years old). The study was developed through application of questionnaires and tests that assess the frailty phenotype. For evaluating gait speed, the time spent by each participant to walk a 4.6 meter distance at normal pace on a flat surface was timed. Data were analyzed by using multiple linear regression and the stepwise method. The R statistical program version 3.4.0 was adopted. RESULTS: there was a significant association between gait speed and paid work (<0.0000), body mass index (<0.0000), Mini-Mental State Examination (=0.0366), physical frailty (pre-frail =0.0063 and non-frail <0.0000), age (<0.0000), sex (=0.0255), and manual grip strength (<0.0000). CONCLUSION: elderly drivers who do not work, women of advanced age, high body mass index, low score in the Mini-Mental State Examination, low hand grip strength, and frail tend to decrease gait speed and should be a priority of interventions.

Pregnancy in Women with Complex Congenital Heart Disease. A Constant Challenge.

BACKGROUND: The improvement in surgical techniques has contributed to an increasing number of childbearing women with complex congenital heart disease (CCC). However, adequate counseling about pregnancy in this situation is uncertain, due to a wide variety of residual cardiac lesions. OBJECTIVES: To evaluate fetal and maternal outcomes in pregnant women with CCC and to analyze the predictive variables of prognosis. METHODS: During 10 years we followed 435 consecutive pregnancies in patients (pts) with congenital heart disease. Among of them, we selected 42 pregnancies in 40 (mean age of 25.5 ± 4.5 years) pts with CCC, who had been advised against pregnancy. The distribution of underlying cardiac lesions were: D-Transposition of the great arteries, pulmonary atresia, tricuspid atresia, single ventricle, double-outlet ventricle and truncus arteriosus. The surgical procedures performed before gestation were: Fontan, Jatene, Rastelli, Senning, Mustard and other surgical techniques, including Blalock, Taussing, and Glenn. Eight (20,0%) pts did not have previous surgery. Nineteen 19 (47.5%) pts had hypoxemia. The clinical follow-up protocol included oxygen saturation recording, hemoglobin and hematocrit values; medication adjustment to pregnancy, anticoagulation use, when necessary, and hospitalization from 28 weeks, in severe cases. The statistical significance level considered was p < 0.05. RESULTS: Only seventeen (40.5%) pregnancies had maternal and fetal uneventful courses. There were 13 (30.9%) maternal complications, two (4.7%) maternal deaths due to hemorrhage pos-partum and severe pre-eclampsia, both of them in women with hypoxemia. There were 7 (16.6%) stillbirths and 17 (40.5%) premature babies. Congenital heart disease was identified in two (4.1%) infants. Maternal and fetal complications were higher (p < 0.05) in women with hypoxemia. CONCLUSIONS: Pregnancy in women with CCC was associated to high maternal and offspring risks. Hypoxemia was a predictive variable of poor maternal and fetal outcomes. Women with CCC should be advised against pregnancy, even when treated in specialized care centers.

Fatores sociodemográficos e clínicos associados à força de preensão manual de idosos condutores de veículos / Sociodemographic and clinical factors associated with handgrip strength in elderly automobile drivers / Factores sociodemográficos y clínicos asociados a la fuerza de prensión de la mano en conductores de vehículos de ancianos

Objetivo: investigar a associação entre força de preensão manual e características sociodemográficas e clínicas de idosos condutores de veículos automotores. Método: estudo transversal, realizado em clínicas de medicina de tráfego na cidade de Curitiba/Paraná, com 421 idosos (≥ 60 anos). Realizou-se análise estatística pelo modelo de Regressão Logística e Teste de Wald, considerando intervalo de confiança de 95% e valores de p <0,05 como significativos. Resultados: oitenta e quatro (20%) idosos apresentaram força de preensão manual reduzida. A força de preensão manual reduzida foi associada à faixa etária (p=0,001) e à hospitalização no último ano (p=0,002). Conclusão: houve associação significativa entre a força de preensão manual de idosos motoristas e as variáveis idade e hospitalização no último ano. Dessa forma, torna-se essencial a inclusão de avaliações específicas, centradas nas variáveis sociodemográficas e clínicas próprias da pessoa idosa, durante o exame de aptidão para dirigir veículos automotores.(AU)

Objective: to investigate the association between handgrip strength and sociodemographic and clinical characteristics of elderly automobile drivers. Method: cross-sectional study, carried out in traffic medicine clinics in the city of Curitiba/Paraná, with 421 elderly people (≥ 60 years old). Statistical analysis was performed using the Logistic Regression model and the Wald Test, considering a 95% confidence interval and p values <0.05 as significant. Results: eighty-four (20%) seniors had reduced handgrip strength. Reduced handgrip strength was associated with age group (p=0.001) and hospitalization in the last year (p=0.002). Conclusion: there was a significant association between the handgrip strength of elderly drivers and the variables age and hospitalization in the last year. Thus, it is essential to include specific assessments, centered on sociodemographic and clinical variables specific to the elderly person, during the aptitude test to drive automobiles.(AU)

Objetivo: investigar la asociación entre la fuerza de prensión de la mano y las características sociodemográficas y clínicas de los ancianos conductores de vehículos automotores. Método: estudio transversal, realizado en clínicas de medicina de tránsito de la ciudad de Curitiba/Paraná, con 421 ancianos (≥ 60 años). El análisis estadístico fue realizado por el modelo de Regresión Logística y Test de Wald, considerando intervalo de confianza de 95% y valores de p <0,05 como significativos. Resultados: 84 (20%) sujetos ancianos presentaron reducción de la fuerza de prensión de la mano. La reducción de la fuerza de prensión de la mano se asoció al grupo de edad (p=0,001) y a la hospitalización en el último año (p=0,002). Conclusión: hubo una asociación significativa entre la fuerza de prensión de la mano de los conductores ancianos y las variables edad y hospitalización en el último año. Así pues, es esencial incluir evaluaciones específicas, centradas en las variables sociodemográficas y clínicas de los ancianos, durante el examen de aptitud para conducir vehículos automotores.(AU)

Handgrip strength in older adults and driving aptitude / Fuerza de prensión manual y aptitud para conducción vehicular de adultos mayores / Força de preensão manual em idosos e a aptidão para condução veicular

ABSTRACT Objective: to analyze handgrip strength as a predictor of the inability to drive in older adults. Method: a cross-sectional study conducted in traffic clinics with 421 older adults in Curitiba-Paraná from January 2015 to December 2018. A sociodemographic and clinical questionnaire, handgrip strength test, and queries from the National Registry of Qualified Drivers form were applied. Results: Reduced handgrip strength was not a predictor of inaptitude for vehicular driving (p=0.649). The predictors of inaptitude were: low education (p=0.011), incomplete elementary education (p=0.027), and cognition (p=0.020). Conclusion: reduced handgrip strength was not shown to predict for loss of driving skills in older adults. Low education level and reduced cognition level are conditions that were shown to be predictors for loss of vehicular driving license.

RESUMEN Objetivo: analizar la fuerza de prensión manual como factor predictivo de inaptitud para la conducción vehicular de adultos mayores. Método: se trata de un estudio transversal llevado a cabo en clínicas de tránsito de Curitiba, Paraná, entre 421 adultos mayores, de enero de 2015 a diciembre de 2018. Se aplicaron los cuestionarios sociodemográfico y clínico, la prueba de fuerza de prensión manual y se consultó el formulario del Registro Nacional de Conductores Habilitados. Resultados: la fuerza de prensión manual reducida no fue un factor predictivo de la incapacidad para conducir (p=0,649). Los predictores de inaptitud fueron: baja educación (p=0,011), estudios primarios incompletos (p=0,027) y cognición (p=0,020). Conclusión: la fuerza de prensión manual reducida no demostró ser predictora de la pérdida de habilidades de conducción vehicular en adultos mayores. El nivel de escolaridad bajo y el nivel cognitivo reducido despuntaron como predictores de la pérdida de habilitación en la conducción vehicular.

RESUMO Objetivo: analisar a força de preensão manual como preditora de inaptidão para condução veicular de idosos. Método: estudo transversal realizado em clínicas de trânsito com 421 idosos em Curitiba-Paraná de janeiro de 2015 a dezembro de 2018. Aplicaram-se questionários sociodemográfico e clínico, teste de força preensão manual e consultas ao formulário de Registro Nacional de Condutores Habilitados. Resultados: A força de preensão manual reduzida não se mostrou preditora de inaptidão para a direção veicular (p=0,649). Os preditores de inaptidão foram: baixa escolaridade (p=0,011), ensino primário incompleto (p=0,027) e cognição (p=0,020). Conclusão: a força de preensão manual reduzida não se mostrou preditora para perda da habilitação na condução veicular de idosos. O baixo nível de escolaridade, o nível de cognição reduzida, são condições que se mostraram preditoras para a perda da habilitação na condução veicular.

Non-frail elderly people and their license to drive motor vehicles.

OBJECTIVE: to analyse the link between the non-frailty condition and the results of driving license for elderly people to drive motor vehicles. METHOD: cross-sectional study with data collection in the sample period from August 2015 to March 2016. Study performed with 347 elderlies (≥60 years). RESULTS: 180 (51.9%) of the participants were classified as non-frail. 48 (26.7%) of them were considered capable to drive, 121 (67.2%) capable to drive with restrictions and 11 (6.1%) temporarily uncapable. No significant relation was found between the non-frailty conditions and the results of the motor vehicles driving license study (p=0.557). CONCLUSION: The absence of physical frailty does not necessarily points out that the elderly are able to drive motor vehicles. Tracking the frailty subsidizes preventive interventions, which seek to interfere positively in the act of driving. This is an unprecedented study in nursing and it highlights an essential field for the performance of gerontological nursing.

Blunted peripheral blood supply and underdeveloped skeletal muscle in Fontan patients: The impact on functional capacity.

BACKGROUND: Changes in circulatory physiology are common in Fontan patients due to suboptimal cardiac output, which may reduce the peripheral blood flow and impair the skeletal muscle. The objective of this study was to investigate the forearm blood flow (FBF), cross-sectional area (CSA) of the thigh and functional capacity in asymptomatic clinically stable patients undergoing Fontan surgery. METHODS: Thirty Fontan patients and 27 healthy subjects underwent venous occlusion plethysmography, magnetic resonance imaging of the thigh musculature and maximal cardiopulmonary exercise testing. Muscle sympathetic nerve activity (MSNA), norepinephrine measures, cardiovascular magnetic resonance, handgrip strength and 6-minute walk test were also performed. RESULTS: Fontan patients have blunted FBF (1.59 ±â€¯0.33 vs 2.17 ±â€¯0.52 mL/min/100 mL p < 0.001) and forearm vascular conductance (FVC) (1.69 ±â€¯0.04 vs 2.34 ±â€¯0.62 units p < 0.001), reduced CSA of the thigh (81.2 ±â€¯18.6 vs 116.3 ±â€¯26.4 cm2p < 0.001), lower peak VO2 (29.3 ±â€¯6 vs 41.5 ±â€¯9 mL/kg/min p < 0.001), walked distance (607 ±â€¯60 vs 701 ±â€¯58 m p < 0.001) and handgrip strength (21 ±â€¯9 vs 30 ±â€¯8 kgf p < 0.001). The MSNA (30 ±â€¯4 vs 22 ±â€¯3 bursts/min p < 0.001) and norepinephrine concentration [265 (236-344) vs 222 (147-262) pg/mL p = 0.006] were also higher in Fontan patients. Multivariate linear regression showed FVC (ß = 0.653; CI = 0.102-1.205; p = 0.022) and stroke volume (ß = 0.018; CI = 0.007-0.029; p = 0.002) to be independently associated with reduced CSA of the thigh adjusted for body mass index. The CSA of the thigh adjusted for body mass index (ß = 5.283; CI = 2.254-8.312; p = 0.001) was independently associated with reduced peak VO2. CONCLUSION: Patients with Fontan operation have underdeveloped skeletal muscle with reduced strength that is associated with suboptimal peripheral blood supply and diminished exercise capacity.

Physical frailty and fitness of older driver.

AIM: to analyze the association between physical frailty and the results of fitness capacity exams for driving vehicles among elder Brazilians. METHODS: this is a cross sectional study, performed in traffic medicine clinics of the city of Curitiba (Brazil). The data was collected through the physical frailty tests, the use of a structured questionnaire, and searches on the records of the Brazilian National Register of Qualified Drivers.To analyze the information, the authors used descriptive statistics and non-parametrical tests. RESULTS: One hundred seventy two elderly people, of whom 56.4% pre-fragile and 43.6% non-fragile. 25.0% were considered fit for driving, 68.6% were considered fit, but with some restrictions, and 6.4% were placed as temporarily unfit for driving. There was no association between frailty condition and the final results for driving fitness (p= 0.8934). Physical frailty was significantly associated to the restrictions observed for those who were fit under restrictions (p= 0.0313), according to the weekly amount of kilometers traveled (p= 0.0222), and to car accidents occurred after the age of 60 (p= 0.0165). CONCLUSION: Physical frailty was significantly associated to the restrictions related to driving, reason to which makes important to manage frailty over this group of drivers. However, no association observed between physical frailty and the final result for driving vehicles.

OBJETIVO: Analizar la asociación entre la fragilidad física y los resultados del examen de aptitud para conducir un vehículo, en ancianos brasileños. MÉTODOS: Estudio cuantitativo transversal, realizado en las clínicas de medicina de tráfico de Curitiba/PR (Brasil). Se recopilaron datos mediante pruebas de evaluación de la fragilidad física, aplicación de cuestionario estructurado y búsqueda en el formulario de Registro Nacional de Conductores Habilitados. Se utilizaron pruebas descriptivas y no paramétricas. RESULTADOS: Ciento setenta y dos individuos de edad avanzada participaron en el estudio, de los cuales 56.4% fueron ancianos pre-frágiles y 43.6% no frágiles. Para conducir estaban aptos el 25.0% de los ancianos, 68.6% aptos con restricción y 6.4% no aptos temporarios. No hubo asociación entre la condición de fragilidad y los resultados finales para aptitud vehicular (p= 0.8934). La fragilidad física estuvo significativamente asociada a las restricciones impuestas para aptos con restricciones (p= 0.0313), al número de kilómetros conducidos semanalmente (p= 0.0222) y a los accidentes ocurridos después de los 60 años (p= 0.0165). CONCLUSIONES: La fragilidad física estuvo significativamente asociada a las restricciones impuestas para aptos con restricciones, razón por la cual, es importante la gestión de la fragilidad en este grupo de conductores. Sin embargo no se observó una asociación entre la fragilidad física y el resultado final para conducir un vehículo.

Frailty and delirium in hospitalized older adults: A systematic review with meta-analysis / Fragilidade e delirium em idosos hospitalizados: revisão sistemática com metanálise / Fragilidad y delirium en adultos mayores hospitalizados: revisión sistemática con metanálisis

Abstract Objective: to estimate the prevalence and synthesize diverse evidence about the relationship between frailty and delirium in hospitalized older adults. Method: a systematic review with meta-analysis in which observational studies conducted with older adults about frailty, delirium and hospitalization, were selected without time of language restrictions. The search was conducted in the MEDLINE, EMBASE, CINAHL, Scopus, Web of Science and CENTRAL databases during August 2021. The precepts set forth by the Joanna Briggs Institute (JBI) - Evidence Synthesis Groups were followed. The meta-analysis model estimated the relative risk corresponding to the prevalence of frailty and delirium. The inverse variance method for proportions was used to estimate the prevalence values and relative risks for binary outcomes. Results: initially, 1,244 articles were identified, of which 26 were included in the meta-analysis (n=13,502 participants), with 34% prevalence of frailty (95% CI:0.26-0.42; I 2=99%; t 2=0.7618, p=0) and 21% for delirium (95% CI:0.17-0,25; I 2=95%; t 2=0.3454, p<0.01). The risk for hospitalized older adults to develop delirium was 66% (RR: 1.66; 95% CI:1.23-2.22; I2=92%; t2=0.4154; p<0.01). Conclusion: 34% prevalence of frailty and 21% of delirium in hospitalized older adults, with frailty being an independent risk factor for developing delirium, with an increased chance of 66% when compared to non-frail individuals.

Resumo Objetivo: estimar a prevalência e sintetizar evidências sobre a relação entre fragilidade e delirium em idosos hospitalizados. Método: revisão sistemática com metanálise na qual foram selecionados estudos observacionais realizados com idosos sobre fragilidade, delirium e hospitalização, sem recortes temporais e de idioma. A busca foi realizada nas bases de dados MEDLINE, EMBASE, CINAHL, Scopus, Web of Science e CENTRAL durante o mês de agosto de 2021. Foram seguidos os preceitos estabelecidos pelo Joanna Briggs Institute (JBI) - Grupos de Síntese de Evidências.. O modelo de metanálise estimou risco relativo da prevalência de fragilidade e delirium. Utilizou-se método da variância inversa para proporções para estimar as prevalências e risco relativo para desfechos binários. Resultados: identificaram-se, inicialmente, 1.244 artigos, 26 incluídos na metanálise (n=13.502 participantes), sendo a prevalência de fragilidade 34% (IC 95% 0,26 a 0,42; I 2=99%; t 2= 0,7618, p=0) e delirium 21% (IC 95% 0,17 a 0,25; I 2=95%; t 2= 0,3454, p<0,01). O risco do idoso frágil hospitalizado desenvolver delirium foi de 66% (RR 1,66; IC 95% 1,23 a 2,22; I2=92%; t2=0,4154; p<0,01). Conclusão: prevalência de 34% de fragilidade e 21% de delirium em idosos hospitalizados, sendo a fragilidade um fator de risco independente para desenvolvimento de delirium, com um aumento de chance de 66% comparado aos não frágeis.

Resumen Objetivo: estimar la prevalencia y sintetizar evidencias sobre la relación entre fragilidad y delirium en adultos mayores hospitalizados. Método: revisión sistemática con metanálisis en el que se seleccionaron estudios observacionales realizados con adultos mayores sobre fragilidad, delirium y hospitalización, sin recorte temporal ni de idioma. La búsqueda se realizó en las bases de datos MEDLINE, EMBASE, CINAHL, Scopus, Web of Science y CENTRAL en agosto de 2021. Se siguieron los preceptos del Instituto Joanna Briggs (Joanna Briggs Institute, JBI) - Evidence Synthesis Groups. El modelo de metanálisis estimó el riesgo relativo de la prevalencia de fragilidad y delirium. Se utilizó el método de la varianza inversa para proporciones para estimar la prevalencia y el riesgo relativo de los desenlaces binarios. Resultados: inicialmente se identificaron 1.244 artículos, se incluyen en el metanálisis 26 (n=13.502 participantes), la prevalencia de fragilidad fue del 34% (IC 95% 0,26 a 0,42; I 2=99%; t 2= 0,7618, p=0) y de delirium del 21% (IC 95% 0,17 a 0,25; I 2=95%; t 2= 0,3454, p<0,01). El riesgo de que el adulto mayor frágil hospitalizado desarrolle delirium fue del 66% (RR 1,66; IC 95% 1,23 a 2,22; I2=92%; t2=0,4154; p<0,01). Conclusión: los adultos mayores hospitalizados tienen una prevalencia de fragilidad del 34% y de delirium del 21%, la fragilidad es un factor de riesgo independiente para el desarrollo de delirium, cuando se compara a los frágiles con los no frágiles, la probabilidad de delirium de los primeros es de un 66% más.