Comparison of Bayesian Networks, G-estimation and linear models to estimate causal treatment effects in aggregated N-of-1 trials with carry-over effects.

BACKGROUND: The aggregation of a series of N-of-1 trials presents an innovative and efficient study design, as an alternative to traditional randomized clinical trials. Challenges for the statistical analysis arise when there is carry-over or complex dependencies of the treatment effect of interest. METHODS: In this study, we evaluate and compare methods for the analysis of aggregated N-of-1 trials in different scenarios with carry-over and complex dependencies of treatment effects on covariates. For this, we simulate data of a series of N-of-1 trials for Chronic Nonspecific Low Back Pain based on assumed causal relationships parameterized by directed acyclic graphs. In addition to existing statistical methods such as regression models, Bayesian Networks, and G-estimation, we introduce a carry-over adjusted parametric model (COAPM). RESULTS: The results show that all evaluated existing models have a good performance when there is no carry-over and no treatment dependence. When there is carry-over, COAPM yields unbiased and more efficient estimates while all other methods show some bias in the estimation. When there is known treatment dependence, all approaches that are capable to model it yield unbiased estimates. Finally, the efficiency of all methods decreases slightly when there are missing values, and the bias in the estimates can also increase. CONCLUSIONS: This study presents a systematic evaluation of existing and novel approaches for the statistical analysis of a series of N-of-1 trials. We derive practical recommendations which methods may be best in which scenarios.

Pain-coping types among older community-dwelling care receivers with chronic pain.

OBJECTIVES: There is a lack of knowledge on coping with pain and sub-group specific pain-coping profiles among older home care receivers with chronic pain. To describe pain-coping strategies, identify subgroups based on cognitive and behavioral pain-coping strategies and pain-related psychological impairment and to compare these groups with regard to socio-demographic, medical, pharmacological and psychological characteristics. METHOD: Data of 212 care receivers were examined using the German pain-coping questionnaire (FESV) to determine how they cope with pain. Subgroups were identified using hierarchic agglomerative cluster analysis, using Ward's algorithm and squared Euclidean distance, and characterized using socio-demographic, medical, pharmacological and psychological parameters. Multinomial logistic regression was used to identify variables associated with the subgroups. RESULTS: Older care receivers apply cognitive and behavioral strategies to manage pain. Three subgroups were identified: Cluster 1 (25.9%) with good coping competences and little psychological impairment, Cluster 2 (40.1%) with poor coping competences and high psychological impairment, and Cluster 3 (34%) with good coping competences and high psychological impairment. Significant differences between the clusters were observed for age, pain intensity, pain-related interference, daily activities, depression and resilience. Logistic regression demonstrated that belonging to Cluster 2 was associated with the number of pain-reducing medications, depression and resilience. Belonging to Cluster 3 was significantly linked to daily activities, the number of pain medications, depression and the level of care required. CONCLUSION: Differentiating between pain-coping profiles in the group of older care receivers with chronic pain necessitates target group-specific pain-oriented psychotherapeutic interventions, which can result in improved pain management.

[Pain management in nursing care in outpatient older adults in need of care]. / Pflegerisches Schmerzmanagement bei ambulant versorgten Pflegebedürftigen.

Pain management in nursing care in outpatient older adults in need of care Abstract. Background: International data report a prevalence rate for chronic pain of up to 50 % in community dwelling older adults (> 65 years). A national study reported a prevalence rate of 68,5 % among outpatient adults (≥ 18 years). Nursing care has an important meaning in pain management. However, previous research on the quality of pain management in nursing care is insufficient. Aim: The aim of this study is to evaluate the appropriateness of pain management in nursing care in our target group. Method: The cross-sectional study is based on data from ACHE. The study comprises 219 patients. Information on subjective pain experience and pain management were obtained by face-to-face interviews and nursing documentation. Results: Our findings indicate considerable deficits in terms of pain management in nursing care. Results show a lack of systematic pain assessment as well as missing documentation of therapeutic aims and pain management in nursing care. Conclusions: The identified deficits might be the result of current framework conditions that separate nursing pain treatment in Volume V and Volume XI of the German Social Security Code services. Appropriateness in pain management in nursing care can only be ensured if framework conditions are optimized.

[Pain situation among older adults in need of care in the outpatient care setting and cognitively or physically unable to respond : Challenges and recommendations]. / Schmerzgeschehen bei nichtauskunftsfähigen ambulant versorgten Pflegebedürftigen : Herausforderungen und Empfehlungen.

BACKGROUND: Self-reporting is the gold standard in pain assessment. However, this is not possible among adults who are unable to respond. Thus, the method of choice is to observe behavior in order to assess pain. Nurses rarely conduct pain observations because they do not feel educated enough to use such tools in vulnerable groups. The aim of the study is to analyze the pain situation among older adults (≥65 years) in need of care who are cognitively or physically unable to respond in the outpatient care setting. MATERIALS AND METHODS: Our cross-sectional study is based on data from ACHE, a study on pain in outpatient older adults in need of care. Of 355 care-dependent older adults with chronic pain, 81 (22.8%) who were unable to respond received a pain assessment with the Pain Assessment in Advanced Dementia (PAINAD, German: Beurteilung von Schmerz bei Demenz [BESD]) scale. RESULTS: The study population (n = 81) was very old (mean age = 84.2 years), female (77.8%), and widowed (50.0%). We observed pain-related behavior among 61.7% of older adults in need of care. The mean BESD score was 2.8 ± 2.5 (range 0-8). We identified a significant difference in the BESD score observed calmly (mean = 1.7 ± 2.5) and under mobilization (mean = 3.4 ± 2.3, p = 0.001). Moreover, only 21 older adults in need of care received a pain assessment 4 weeks prior to our study. CONCLUSION: Our findings indicate a deficit in regularly conducted pain assessment among older adults who are unable to respond and are in need of care in the outpatient care setting. An observation tool in that setting is urgently needed and would be a first step in optimizing pain assessment. We recommend conducting observations during regular nursing mobilization.

[The G-Score - a Short Questionnaire for the Measurement of Subjective Physical Health]. / Der G-Score ­ ein Screeninginstrument zur Erfassung der subjektiven körperlichen Gesundheit.

AIM: The measurement of subjective physical health is important in clinical settings as well as for research purposes. In the present paper, the psychometric properties of the G-Score, a 4 item screening questionnaire for the self-assessment of one's physical health, is explored. METHODS: The Objectivity, validity and reliability were estimated. Moreover, an item analysis and a suitable cut-off-value for the differentiation between healthy and presumably ill subjects were conducted. Data from the Saxony Longitudinal Study ("Sächsische Längsschnittstudie") 1998-2013 were analysed (N=324-417 healthy individuals). RESULTS: The objectivity of the G-Score is estimated as very good. As a cut off for the differentiation between healthy and presumably ill subjects, a G-Score of 4 is suggested. The content validity is slightly lacking. Correlations with associated and non-associated constructs hint an interaction of physical with psychological discomfort. A good predictive validity of the instrument is assessed. Reliability estimates show acceptably good results. This indicates a high sensitivity for changes in the measured construct. CONCLUSION: Putting all results into consideration, a use of the G-Score as a screening questionnaire in research is recommended. However, more psychometric investigations with representative samples and objective comparative data should be carried out.

Analyzing population-level trials as N-of-1 trials: An application to gait.

Studying individual causal effects of health interventions is important whenever intervention effects are heterogeneous between study participants. Conducting N-of-1 trials, which are single-person randomized controlled trials, is the gold standard for their analysis. As an alternative method, we propose to re-analyze existing population-level studies as N-of-1 trials, and use gait as a use case for illustration. Gait data were collected from 16 young and healthy participants under fatigued and non-fatigued, as well as under single-task (only walking) and dual-task (walking while performing a cognitive task) conditions. As a reference to the N-of-1 trials approach, we first computed standard population-level ANOVA models to evaluate differences in gait parameters (stride length and stride time) across conditions. Then, we estimated the effect of the interventions on gait parameters on the individual level through Bayesian repeated-measures models, viewing each participant as their own trial, and compared the results. The results illustrated that while few overall population-level effects were visible, individual-level analyses revealed differences between participants. Baseline values of the gait parameters varied largely among all participants, and the effects of fatigue and cognitive task were also heterogeneous, with some individuals showing effects in opposite directions. These differences between population-level and individual-level analyses were more pronounced for the fatigue intervention compared to the cognitive task intervention. Following our empirical analysis, we discuss re-analyzing population studies through the lens of N-of-1 trials more generally and highlight important considerations and requirements. Our work encourages future studies to investigate individual effects using population-level data.

The impact of guidance counselling on gender segregation: Major choice and persistence in higher education. An experimental study.

Gender segregation in higher education is considered one of the main drivers of persistent economic gender inequality. Yet, though there has been considerable research identifying and describing the underlying mechanisms that cause gendered educational choices in higher education, little is known about how gender segregation in higher education could be changed. Accordingly, this article aims to determine the potential of educational interventions during high school to foster gender desegregation in higher education. We focused on two different processes that contribute to gender segregation in majors among higher education graduates: first, the selection into specific majors and, second, the selection out of specific majors. We investigated whether an intensive counselling programme leads to more gender-atypical choices among high-school graduates and examined whether intensive counselling supports several indicators of students' persistence in gender-atypical majors. Based on data from an experimental study of a counselling programme for German high-school students (N = 625), we estimated the programme's effect with linear probability models and intention-to-treat analysis. Our results show that high-school graduates are more likely to choose a gender-atypical major if they have received intensive counselling. This applies more to men than to women. In addition, the programme improved some persistence indicators for students in gender-atypical majors. Although we found a significant programme effect only for perceived person-major fit and student satisfaction, the coefficients of all aspects of students' persistence show a trend indicating that the programme was beneficial for students in gender-atypical majors. As experimental studies can also be affected by various types of bias, we performed several robustness checks. All analyses indicated stable results. In conclusion, we suggest that intensive counselling programmes have the potential to reduce gender segregation in higher education. More students were motivated to choose a gender-atypical major, and different aspects of student persistence were supported by the programme for students in gender-atypical majors.

Interdisciplinary Physician-Pharmacist Medication Review for Outpatients With Heart Failure: A Subanalysis of the PHARM-CHF Randomized Controlled Trial.

Aims: Patients with chronic heart failure (CHF) require polypharmacy and are at increased risk for drug-related problems. Interdisciplinary physician-pharmacist medication review may improve drug treatment. Our goal was to analyze the changes from the physician-documented medication plan (MP) and patient-stated medication to an interdisciplinary consolidated MP (CMP). Methods: This pre-specified subanalysis of the PHARM-CHF randomized controlled trial analyzed the medication review of CHF patients in the pharmacy care group. Community pharmacists compared the MP with the drug regimen stated by the patient and consulted with physicians on identified discrepancies and other medication-related problems resulting in a CMP. Results: We analyzed 93 patients (mean 74.0 ± 6.6 years, 37.6% female), taking a median of ten (IQR 8-13) drugs. 80.6% of patients had at least one change from MP to CMP. We identified changes in 32.7% (303/926) of drugs. The most common correction was the addition of a drug not documented in the MP to the CMP (43.2%). We also determined frequent modifications in the dosing regimens (37.6%). The omission of a drug documented in the MP but left out of the CMP accounted for 19.1%. Comparing patient-stated medication to CMP, the current drug regimen of patients was changed in 22.4% of drugs. Conclusion: The medication review resulted in changes of medication between MP and CMP in most of the patients and affected one-third of drugs. Structured physician-pharmacist interdisciplinary care is able to harmonize and optimize the drug treatment of CHF patients.

High Prevalence of Multimorbidity and Polypharmacy in Elderly Patients With Chronic Pain Receiving Home Care are Associated With Multiple Medication-Related Problems.

Aim: To measure the extent of polypharmacy, multimorbidity and potential medication-related problems in elderly patients with chronic pain receiving home care. Methods: Data of 355 patients aged ≥65 years affected by chronic pain in home care who were enrolled in the ACHE study in Berlin, Germany, were analyzed. History of chronic diseases, diagnoses, medications including self-medication were collected for all patients. Multimorbidity was defined as the presence of ≥2 chronic conditions and levels were classified by the Charlson-Comorbidity-Index. Polypharmacy was defined as the concomitant intake of ≥5 medications. Potentially clinically relevant drug interactions were identified and evaluated; underuse of potentially useful medications as well as overprescription were also assessed. Results: More than half of the patients (55.4%) had moderate to severe comorbidity levels. The median number of prescribed drugs was 9 (range 0-25) and polypharmacy was detected in 89.5% of the patients. Almost half of them (49.3%) were affected by excessive polypharmacy (≥10 prescribed drugs). Polypharmacy and excessive polypharmacy occurred at all levels of comorbidity. We detected 184 potentially relevant drug interactions in 120/353 (34.0%) patients and rated 57 (31.0%) of them as severe. Underprescription of oral anticoagulants was detected in 32.3% of patients with atrial fibrillation whereas potential overprescription of loop diuretics was observed in 15.5% of patients. Conclusion: Multimorbidity and polypharmacy are highly prevalent in elderly outpatients with chronic pain receiving home care. Medication-related problems that could impair safety of drug treatment in this population are resulting from potentially relevant drug interactions, overprescribing as well as underuse.

Pain-Associated Clusters Among Nursing Home Residents and Older Adults Receiving Home Care in Germany.

CONTEXT: There are no available data regarding pain-associated clusters among nursing home residents (NHRs) and older adults receiving home care with chronic pain. OBJECTIVES: To identify and describe pain-associated clusters in NHRs and older adults receiving home care with chronic pain and to explore associations with clusters in both settings. METHODS: We surveyed 137 NHRs and 205 older adults receiving home care. Clusters were identified using hierarchical agglomerative cluster analysis, using Ward's method with squared Euclidean distances in the proximities matrix. The clusters were characterized based on sociodemographic and clinical characteristics. Multinomial logistic regression was used to identify variables associated with different clusters. RESULTS: In each setting, we identified three clusters: pain relieved, pain impaired, and suffering severe pain. In the nursing home study and home care study, respectively, the participant distributions were 46.72% and 11.71% in the pain-relieved cluster, 22.63% and 33.66% in the pain-impaired cluster, and 30.66% and 54.63% in the severe-pain cluster. Appropriate pain medication was only detected among pain-relieved NHRs. CONCLUSION: Overall, differences in pain management exist within the two care settings presented here. There is potential for improvement in both settings. Moreover, there exists a need for clinical interventions aiming at shifting from pain-affected clusters to pain-relieved status.

Deficits in pain medication in older adults with chronic pain receiving home care: A cross-sectional study in Germany.

OBJECTIVE: To analyze the pattern and appropriateness of pain medications in older adults receiving home care. METHODS: We performed a prospective cross-sectional study in patients ≥65 years old having chronic pain and receiving home care in Berlin, Germany. Data on prescribed pain medications were collected using self-reported information, nursing documents, and medication plans during interviews at home. Pain intensity was determined with the numeric rating scale (NRS) and the Pain Assessment In Advanced dementia (PAINAD) scale. The Pain Medication Appropriateness Scale score (SPMAS) was applied to evaluate inappropriateness (i.e. a score ≤67) of pain medication. RESULTS: Overall 322 patients with a mean age of 82.1 ± 7.4 years (71.4% females) were evaluated. The average pain intensity scores during the last 24 hours were 5.3 ± 2.1 and 2.3 ± 2.3 on NRS and PAINAD scale (range 0-10, respectively). Sixty (18.6%) patients did not receive any pain medication. Among the treated patients, dipyrone was the most frequently prescribed analgesic (71.4%), while 50.8% and 19.1% received systemic treatment with opioids and non-steroidal anti-inflammatory drugs, respectively. The observed median SPMAS was 47.6 (range 0-100) with 58 (18.0%) of patients achieving appropriate values. Half of the patients were treated with scheduled, while 29.9% were only treated with on-demand medications. Cognitive status had no effect on appropriateness of pain treatment. CONCLUSIONS: We observed substantial deficits in dosing patterns and appropriateness of pain medication in older adults with pain receiving home care. This applied to both patients with and without severe cognitive impairment.

Reduction of functional cardiovascular reserve in the stages of chronic kidney disease.

OBJECTIVE: Patients with chronic kidney disease (CKD) present reduced oxygen consumption at peak exercise (VO2 peak). No studies have evaluated objective measures of the cardiovascular reserve, besides VO2 peak and VO2 at the anaerobic threshold (VO2 AT), and compared these measures among ckd patients at different stages of the disease. METHODS: Fifty-eight patients [pre-dialysis group (PD)=26, hemodialysis group (HD)=20, and post-kidney transplant group (KT)=12] were included. The following measures of cardiovascular reserve were obtained: 1) peak heart rate (HR); 2) peak systolic blood pressure (SBP); 3) VO2 peak and % predicted; 4) VO2 AT and % of predicted VO2; 5) peak circulatory power; 6) ventilatory efficiency for the production of carbon dioxide (VE/VCO2 slope); 7) oxygen uptake efficiency slope (OUES); and 8) recovery of gas exchange. RESULTS: The VO2 peak and VO2 AT in the PD, HD, and KT groups were reduced to 86% and 69%, 70% and 57%, and 79% and 64% of the predicted value, respectively. Patients in the HD group had lower VO2 peak (17.5±5.9 vs. 23.2±8.2 [p-value=0.036]) and VO2 AT (14.0±5.2 vs. 18.3±4.7 [p-value=0.039]) compared to patients in the KT group. OUES was significantly lower in the HD group compared to the KT group (p-value=0.034). Age in the PD, HD, and KT groups and sedentary lifestyle in the KT group were predictors of VO2 peak. CONCLUSIONS: CKD patients presented a reduction in cardiovascular reserve regardless of the stage of the disease. However, hemodialysis patients presented a greater reduction of cardiovascular reserve when compared to post-kidney transplant patients.

Physical Exercise Combined With CPAP in Subjects Who Underwent Surgical Myocardial Revascularization: A Randomized Clinical Trial.

BACKGROUND: Aerobic exercise and CPAP benefit patients in the postoperative period of cardiac surgery. To our knowledge, the association of aerobic exercise on an exercise bicycle with CPAP has not yet been demonstrated. Therefore, we aimed to evaluate the effectiveness of physical exercise on a cycle ergometer combined with CPAP in the postoperative period after coronary artery bypass graft surgery. METHODS: This was a randomized clinical trial, with recruitment from May 2017 to December 2017 (registered in the Brazilian Clinical Trials Registry: RBR-69CDYF). The step group (n = 16 subjects) started rehabilitation in the immediate postoperative period with breathing exercises and passive mobilization in the sitting position, progressing to active exercises, ambulation, and stair training. For the intervention group (n = 15 subjects), dynamic exercises on a cycle ergometer combined with CPAP were added to the step program from the second to the fourth postoperative day in a single daily session. RESULTS: Functional capacity decreased in both groups, but this reduction was not significant in the intervention group (P = .11). The length of stay in ICU was lower in the intervention group (P = .050). In both groups there was a decrease in maximum inspiratory and expiratory pressure, as well as in the 1-min sit-to-stand test on the fourth postoperative day compared to the preoperative period. CONCLUSIONS: Physical exercise combined with CPAP promoted the maintenance of functional capacity and reduced the length of stay in the ICU.

A relação entre fobias específicas com ansiedade, impulsividade e depressão: um estudo exploratório / The relation of specific phobias with anxiety, impulsivity and depression: an exploratory study / La relación entre fobias específicas con ansiedad, impulsividad y depresión: um estudio exploratorio

Uma fobia específica é um medo irreal ou extremo de uma situação, objeto ou ambiente específico. Teorias iniciais sobre aquisição de fobias específicas favoreceram uma explicação no condicionamento do medo. Este artigo quantificou medos com um potencial ofensivo maior e menor para as espécies em uma amostra de 148 estudantes com média de idade de 21,5 anos (DP = 2,6). Além das diferenças estatisticamente significantes entre as duas categorias de medo, houve uma correlação de medos de uma menor ofensa potencial para humanos com ansiedade e depressão, estresse e impulsividade. Este trabalho pode ajudar a elucidar problemas relacionados a incidência de certas fobias

A specific phobiais an unrealistic or extreme fear of a specific situation, object, or setting. Initial theories regarding the acquisition of specific phobias favored a fear conditioningbased explanation. The present article quantifi ed fears with higher and lower off ensive potential for the human species in a sample of 148 students with an average age of 21,5 years (DP = 2,6). It In addition to statistically signifi cant diff erences between the two categories of fear, there was a correlation of fears of lower off ensive potential for humans with anxiety and depression, stress and impulsivity. This work may help to elucidate issues related to the incidence of certain phobias

Una fobia específica es un miedo poco realista o extremo a una situación, objeto o entorno específico. Teorías iniciales sobre la adquisición de fobias específicas favoreció una explicación basada en el condicionamiento del miedo. El presente artículo cuantifi có los temores con un potencial ofensivo mayor y menor para la espécie en una muestra de 148 estudiantes comum a edad media de 21, 5 años (DP= 2,6). Además de las diferencias estadísticamente significativas entre las dos categorías de miedo, hubo una correlación de los temores de un menor potencial ofensivo para los humanos con ansiedad y depresión, estrés e impulsividad. Este trabajo puede ayudar a dilucidar problemas relacionados con la incidencia de ciertas fobias

Personalidade, ansiedade social e adaptação às medidas de distanciamento durante a pandemia / Personality, social anxiety and adaptation to distancing measures during the pandemic / Personalidad, ansiedad social y adaptación a medidas de distanciamiento durante la pandemia

O impacto da pandemia de COVID-19 está mudando drasticamente a vida das pessoas. O distanciamento social representa evitar o contato durante o surto de uma doença para minimizar a exposição. Essa condição também pode contribuir para o agravamento de determinados transtornos mentais. O presente estudo teve como objetivo avaliar em que medida características de personalidade e ansiedade social podem contribuir para uma maior dificuldade em lidar com o distanciamento social. Foram avaliados 1.120 indivíduos por meio da Escala de Ansiedade Social de Liebowitz (LSAS), marcadores da personalidade. A análise de regressão logística mostrou que neuroticismo, ansiedade social e as horas adicionais em casa revelaram-se preditores significativos de uma maior dificuldade. Conclui-se que o transtorno de ansiedade social apresenta especificidades em sua manifestação durante a pandemia. (AU)

The impact of the COVID-19 pandemic has drastically changed people's lives. Social distancing means avoiding close contact with others during a contagious disease outbreak to minimize exposure. Such constraints may also contribute to the worsening of certain mental health disorders. The present study aimed to evaluate the extent to which personality features and social anxiety may contribute to greater difficulties in coping with social distancing practices. A total of 1120 individuals were assessed using the Liebowitz Social Anxiety Scale (LSAS) and personality mini-markers to assess personality traits. Logistic regression analysis revealed that neuroticism, social anxiety, and the number of additional hours one spends at home represent significant predictors of greater difficulty. Thus, results showed that social anxiety disorder had specific presentations during the course of the COVID-19 pandemic. (AU)

El impacto de la pandemia de COVID-19 está cambiando drásticamente la vida de las personas. El distanciamiento social significa evitar el contacto cercano con otras personas durante el brote de una enfermedad contagiosa para minimizar la exposición. Esta condición también puede contribuir al empeoramiento de algunos trastornos mentales. Este estudio tuvo como objetivo evaluar en qué medida las características de personalidad y la ansiedad social pueden contribuir a una mayor dificultad para soportar el distanciamiento social. Se evaluó un total de 1120 individuos mediante la Escala de Ansiedad Social de Liebowitz (LSAS) y marcadores reducidos para evaluar la personalidad. El análisis de regresión logística mostró que el neuroticismo, la ansiedad social y el número de horas adicionales en el hogar fueron predictores significativos de mayor dificultad. Se concluye que el trastorno de ansiedad social presenta manifestaciones específicas durante la pandemia. (AU)

Functional Capacity and Quality of Life in Patients with Chronic Kidney Disease In Pre-Dialytic Treatment and on Hemodialysis--A Cross sectional study.

INTRODUCTION: Chronic kidney disease (CKD) infers directly in functional capacity, independence and therefore quality of life (QOL). OBJECTIVE: To compare the physical fitness and quality of life of patients with chronic kidney disease submitted on hemodialysis (G1) and predialysis treatment (G2). METHODS: A cross-sectional study, 54 patients with CKD, 27 of the G1 group (58.15 ± 10.84 years), 27 of G2 group (62.04 ± 16.56 years). There were cardiovascular risk factors, anthropometric measurements, respiratory muscle strength was measured by the inspiratory pressure (MIP) and expiratory (MEP) maximum measured in the manometer, six-minute walk (TC6'), cardiopulmonary exercise test, sit and stand one minute test (TSL1') and the Short-Form Questionary (SF-36) to assess QOL. The patients presented disease of stage between 2 and 5. It was applied the Kolmogorov-Smirnov normality test and used the t (Student) test or the U (Mann Whitney) test to compare the means of quantitative variables and the chi-square Pearson test and Fisher's exact test for qualitative variables. Pearson's or Spearman's test was used to identify correlations. RESULTS: No statistically significant difference was found between G1 and G2 in VO2peak (p = 0,259) in TC6' (p = 0,433) in the MIPmáx (p = 0,158) and found only in the MEPmáx (p = 0,024) to G1. The scores of the SF-36 in both groups showed a worse health status as evidenced by the low score in scores for QOL. CONCLUSION: Patients with CKD had reduced functional capacity and QOL, and hemodialysis, statistically, didn't have showed negative repercussions when compared with pre-dialysis patients.

Reduction of functional cardiovascular reserve in the stages of chronic kidney disease

SUMMARY OBJECTIVE Patients with chronic kidney disease (CKD) present reduced oxygen consumption at peak exercise (VO2 peak). No studies have evaluated objective measures of the cardiovascular reserve, besides VO2 peak and VO2 at the anaerobic threshold (VO2 AT), and compared these measures among ckd patients at different stages of the disease. METHODS Fifty-eight patients [pre-dialysis group (PD)=26, hemodialysis group (HD)=20, and post-kidney transplant group (KT)=12] were included. The following measures of cardiovascular reserve were obtained: 1) peak heart rate (HR); 2) peak systolic blood pressure (SBP); 3) VO2 peak and % predicted; 4) VO2 AT and % of predicted VO2; 5) peak circulatory power; 6) ventilatory efficiency for the production of carbon dioxide (VE/VCO2 slope); 7) oxygen uptake efficiency slope (OUES); and 8) recovery of gas exchange. RESULTS The VO2 peak and VO2 AT in the PD, HD, and KT groups were reduced to 86% and 69%, 70% and 57%, and 79% and 64% of the predicted value, respectively. Patients in the HD group had lower VO2 peak (17.5±5.9 vs. 23.2±8.2 [p-value=0.036]) and VO2 AT (14.0±5.2 vs. 18.3±4.7 [p-value=0.039]) compared to patients in the KT group. OUES was significantly lower in the HD group compared to the KT group (p-value=0.034). Age in the PD, HD, and KT groups and sedentary lifestyle in the KT group were predictors of VO2 peak. CONCLUSIONS CKD patients presented a reduction in cardiovascular reserve regardless of the stage of the disease. However, hemodialysis patients presented a greater reduction of cardiovascular reserve when compared to post-kidney transplant patients.

RESUMO OBJETIVO Pacientes com doença renal crônica (DRC) apresentam redução no consumo de oxigênio no pico do exercício (VO2 pico). Nenhum estudo avaliou medidas objetivas da reserva cardiovascular, além do VO2 pico e do VO2 no limiar anaeróbio (LA), e comparou essas medidas entre pacientes com DRC nos diferentes estágios da doença. MÉTODOS Cinquenta e oito pacientes [grupo pré-diálise (PD)=26, grupo hemodiálise (HD)=20 e grupo pós-transplante (PT)=12] foram incluídos. As seguintes medidas da reserva cardiovascular foram obtidas: 1) frequência cardíaca (FC) pico; 2) pressão arterial sistólica (PAS) pico; 3) VO2 pico e % do predito; 4) VO2 LA e % do VO2 predito; 5) potência circulatória pico; 6) eficiência ventilatória para a produção de dióxido de carbono (VE/VCO2 slope); 7) eficiência ventilatória para o consumo de oxigênio (Oues); 8) recuperação das trocas gasosas. RESULTADOS O VO2 pico e o VO2 LA nos grupos PD, HD e PT foram reduzidos para 86% e 69%, 70% e 57%, e 79% e 64% do valor previsto, respectivamente. Pacientes do grupo HD obtiveram VO2 pico (17,5±5,9 vs. 23,2±8,2 [p=0,036]) e VO2 LA (14,0±5,2 vs. 18,3±4,7 [p=0,039]) mais baixo, comparado aos pacientes PT. A Oues foi significativamente menor no grupo HD comparado ao grupo PT (p=0,034). Idade nos grupos PD, HD e PT, e sedentarismo no grupo PT foram preditores do VO2 pico. CONCLUSÃO Pacientes com DRC apresentam redução da reserva cardiovascular independentemente do estágio da doença. No entanto, pacientes em hemodiálise apresentam uma redução mais acentuada da reserva cardiovascular quando comparados aos pacientes pós-transplante.

Avaliação física funcional na mortalidade em doentes renais crônicos / Physical functional evaluation on mortality in chronic renal patients / Evaluación física funcional acerca de la mortalidad en pacientes renales crónicos

Objetivo: verificar a associação avaliação físico funcional e a mortalidade de pacientes com Doença Renal Crônica. Método: estudo transversal realizado em 25 indivíduos com DRC em hemodiálise (HD), sendo 17 participantes vivos do G1 (56,29±7,76 anos) e oito que foram a óbito, participantes do G2 (58,63±17,13 anos). A coleta de dados foi realizada pelos testes físicos e após um ano foi verificado a mortalidade e os dados analisados no software PASW Statistics Data Editor. O projeto foi aprovado no Comitê de Ética em Pesquisa, parecer n 187.1/2011. Resultados: observou-se a incidência de 32% de óbitos. Não foram encontradas diferenças estatisticamente significativas entre vivos e óbitos no intervalo de um ano após a avaliação físico funcional no VO2pico (p:0,156), no TC6min (p:0,298), na PImax (p:0,062) e na PEmax (p:0,232). Conclusão: não foi encontrada associação entre a avaliação físico funcional e a mortalidade de pacientes com DRC.(AU)

Objective: verifying the evaluation of functional physico association and mortality of patients with Chronic Kidney Disease. Method: a cross-sectional study conducted with 25 patients with CKD on hemodialysis (HD), 17 living participants G1 (56,29±7,76 years old) and eight who died, participants G2 (58,63 ± 17,13 years old). Data collection was performed by physical tests and after a year it was observed mortality and data analyzed in PASW Statistics Data Editor Software. The project was approved by the Research Ethics Committee, Opinion n 187.1/2011. Results: there was the incidence of 32% of deaths. No statistically significant differences were found between the living and deaths within a year after the physical functional evaluation in VO2pico (p: 0,156), in the TC6min (p: 0,298), the PImax (p: 0,062) and PEmax (p: 0,232). Conclusion: no association was found between physical functional assessment and mortality of patients with CKD.(AU)

Objetivo: verificar la asociación evaluación físico funcional y la mortalidad de los pacientes con Enfermedad Renal Crónica. Método: un estudio transversal en el que 25 pacientes con ERC en hemodiálisis (HD), siendo 17 participantes vivos del G1 (56,29 ± 7,76 años) y ocho que murieron, los participantes del G2 (58,63±17,13 años). La recolección de datos se realizó mediante pruebas físicas y después de un año se observó la mortalidad y los datos analizados con el software PASW Statistics Data Editor. El proyecto fue aprobado por el Comité de Ética en la Investigación de Opinión n 187.1/2011. Resultados: se observó la incidencia de 32% de las muertes. No se encontraron diferencias estadísticamente significativas entre vivos y la muerte dentro de un año después de la evaluación física funcional en VO2pico (p: 0,156), en la TC6min (p: 0,298), el PImax (p: 0,062) y PEmax (p: 0,232). Conclusión: no se encontró asociación entre la evaluación física funcional y la mortalidad de los pacientes con ERC.(AU)