Short and long term effect of treatment non-pharmacological and lifestyle in patients with metabolic syndrome.

BACKGROUND: Metabolic syndrome (MS) is a complex disorder represented by a set of cardiovascular risk factors usually related to central fat deposition, insulin resistance, hypertension and dyslipidemia. It is associated with accelerated atherosclerosis in response to chronic inflammation and vascular endothelial dysfunction, increasing overall mortality. The objective to evaluate the short and long term effect of the comprehensive cardiac rehabilitation program and intensive lifestyle intervention in metabolic syndrome patients. METHODS: This is longitudinal interventional study. All patients underwent a 20-session cardiac rehabilitation program with aerobic and resisted exercises as well as an educational program for lifestyle changes and follow up 1 year. RESULTS: Forty seven patients participated in the present study, but only 28 concluded the follow up. 77.7% were females and the majority was older than 60 years (63.1%). After cardiac rehabilitation, the percentage of overweight (0.04) patients who controlled the SBP (0.04) increased, and obesity levels I and II were reduced, as well as a significant reduction in total cholesterol and triglycerides (0.01 and 0.05), all of these variables remained similar after 1 year of follow-up. After cardiac rehabilitation all participants were practicing the five factors of healthy lifestyle, and reduced to 73% after follow up. CONCLUSION: A comprehensive cardiac rehabilitation program and lifestyle change is an effective approach in the treatment of patients with MS mainly, it has positive short and long term effects on weight control, reducing total cholesterol and triglycerides.

Caracterização de atendimentos do serviço pré-hospitalar móvel de urgência: follow up 14 anos (2005-2018) / Characterization of emergency pre-hospital mobile service: follow up 14 years (2005-2018)

Conhecer o perfil da assistência prestada a determinada população pode auxiliar na definição de políticas públicas de saúde para o território. Este estudo tem o objetivo de caracterizar o perfil de atendimentos realizados pelo serviço de atendimento móvel de urgência no município de Palmas, Estado de Tocantins, Brasil. Trata-se de uma pesquisa retrospectiva, descritiva e quantitativa das ocorrências atendidas pelo serviço móvel de urgência da cidade entre 2005 e 2018. No período analisado, foram 222.278 atendimentos regulados, 141.944 ocorrências, 30.566 trotes e 47.757 orientações (telemedicina). Houve 124.575 ocorrências com envio de unidades móveis, das quais 12.746 (10%) atendidas por unidades de serviços avançados e 77.750 (62%) por unidades de serviços básicos. Quanto à natureza, 72.080 (44,3%) ocorrências não continham tal informação, 53.795 (33,1%) foram registros de natureza clínica, 22.710 (13,9%) atendimentos por causas externas (traumáticas), 8.787 (5,4%) casos ginecológico-obstétricos e 5.119 (3,1%) psiquiátricos. Conclui-se que o perfil dos atendimentos é de natureza clínica, com crescente número de atendimentos regulados e com alto número de trotes.

Knowing the profile of the assistance provided to a given population can assist in the definition of public health policies for the territory. This study aims to characterize the profile of calls made by the mobile emergency service in the city of Palmas, state of Tocantins, Brazil. It is about a retrospective, descriptive and quantitative research of the occurrences attended by the emergency mobile service of this city between 2005 and 2018. In the surveyed period there were 222,278 regulated attendances, 141,944 occurrences, 30,566 occurrences of hazing and 47,757 orientations (telemedicine). There were 124,575 occurrences with the sending of mobile units, of which 12,746 (10%) served by advanced service units, and 77,750 (62%) served by basic service units. Regarding the nature 72,080 (44.3%) occurrences did not report, 53,795 (33.1%) were records of a clinical nature, 22,710 (13.9%) visits due to external (traumatic) causes, 8,787 (5.4%) cases gynecological-obstetric and 5,119 (3.1%) psychiatric. It is concluded that the attendance profile is of a clinical nature, with an increasing number of regulated attendances and a high number of prank calls.

Perfil de estilo de vida de pacientes com doença renal crônica em hemodiálise / Lifestyle profile of patients with chronic renal disease in hemodialysis

O objetivo deste estudo foi avaliar o perfil de estilo de vida de pacientes com doença renal crônica em hemodiálise. Trata-se de investigação transversal de abordagem quantitativa, do tipo analítico-descritiva. A coleta de dados foi efetivada no Hospital Regional do Baixo Amazonas, no município de Santarém, Estado do Pará. Os participantes responderam questionário sociodemográfico e de fatores associados criado pelos autores da pesquisa, e para análise do estilo de vida utilizou-se o Instrumento Perfil de Estilo de Vida Individual. Foram avaliados 70 pacientes renais crônicos prevalentemente do sexo masculino e faixa etária entre 21 e 71 anos. A pontuação média do questionário de estilo de vida global foi 20,8±7 pontos, 15,7% apresentaram classificação do estilo de vida negativo, 72,2% regular e 8,5% positivo. Para 24,2% a doença tem um impacto importante na vida. Concluiu-se que houve prevalência de estilo de vida classificado como regular, bem como autorrelato de impacto importante da doença renal crônica sobre a vida do paciente, o que pode ser potencialmente atenuado por componentes de um estilo de vida promotor de saúde.

This study aimed to evaluate the lifestyle profile of patients with chronic kidney disease undergoing hemodialysis. This was a quantitative, cross-sectional, analytical and descriptive study. Data were collected at Baixo Amazonas Regional Hospital, in the municipality of Santarém, state of Pará. The participants answered a sociodemographic, associated factors questionnaire created by the authors, and for lifestyle analysis, the Individual Lifestyle Profile Instrument was used. Seventy chronic kidney patients, predominantly male and aged between 21 and 71 years, were evaluated. The average score of the global lifestyle questionnaire was 20.8 ± 7 points, 15.7% had a negative lifestyle rating, 72.2% regular and 8.5% positive. For 24.2%, the disease has an important impact on life. There was a prevalence of regular lifestyle, as well as self-report of important impact of chronic kidney disease on the patient's life, which can potentially be mitigated by components of a health-promoting lifestyle.

Estudo comparativo dos efeitos da hidroterapia e método Pilates sobre a capacidade funcional de pacientes portadores de fibromialgia / Comparativestudy of the effects of hydrotherapy and the Pilates method on the functional capacity of fibromyalgia patients

A síndrome da fibromialgia é complexa e a hidroterapia e os exercícios contido no método Pilates podem ser uma alternativa não farmacológico no tratamento destes pacientes. Objetivo: Avaliar os efeitos da hidroterapia e do método Pilates sobre a redução da dor, melhora da capacidade funcional e da qualidade do sono em pacientes com fibromialgia. Método: Estudo prospectivo no qual foram avaliados 80 pacientes do sexo feminino com diagnóstico clínico de SF, distribuídas aleatoriamente em dois grupos, o Grupo I realizava tratamento por meio da hidroterapia e o grupo II por meio do método Pilates. A dor foi avaliada por meio da EVA e da algometria, a qualidade de vida dos pacientes foi avaliada (QIF), qualidade do sono por meio (IQSP), o grau de sonolência durante oito atividades rotineiras por meio da escala de Epworth todos foram realizados antes e após tratamento. Resultados: 50 pacientes com SF fizeram parte do estudo, deste 30 foram para o GI e 20 para GII, média global da idade foi 50,8±12,5. Houve redução do impacto global da doença na vida dos pacientes de ambos os grupos. Ambos os grupos melhoraram igualmente qualidade do sono. Houve melhora da dor medida por ambos os métodos (p<0,0001) e (p=0,013) grupo I e II respectivamente. Conclusão: A hidroterapia e os exercícios do método Pilates se mostraram igualmente eficazes na redução do impacto global, melhora do sono e capacidade funcional em pacientes com fibromialgia

Fibromyalgia syndrome is complex and the hydrotherapy and Pilates exercises may be a non-pharmacological alternative in the treatment of these patients. Objective: To evaluate the effects of hydrotherapy and the Pilates method on pain reduction, improvement of functional capacity and sleep quality in fibromyalgia patients. Method: A prospective study in which 80 female patients with clinical diagnosis of DES were randomly assigned to two groups. Group I underwent treatment using hydrotherapy and group II under the Pilates method. Pain was assessed by VAS and algometry, patients' quality of life (QIF), sleep quality by PSQI, degree of sleepiness during eight routine activities using the Epworth scale were all performed. before and after treatment. Results: Fifty patients with DES were part of the study, of which 30 were for GI and 20 for GII; overall mean age was 50.8 ± 12.5. There was a reduction in the overall impact of the disease on patients' lives in both groups. Both groups also improved sleep quality. There was pain improvement measured by both methods (p <0.0001) and (p = 0.013) group I and II respectively. Conclusion: Touch hydrotherapy as Pilates solo exercises are effective in treating fibromyalgia patient

Comparative analysis between the alveolar recruitment maneuver and breath stacking technique in patients with acute lung injury.

OBJECTIVE: To compare the effectiveness of the alveolar recruitment maneuver and the breath stacking technique with respect to lung mechanics and gas exchange in patients with acute lung injury. METHODS: Thirty patients were distributed into two groups: Group 1 - breath stacking; and Group 2 - alveolar recruitment maneuver. After undergoing conventional physical therapy, all patients received both treatments with an interval of 1 day between them. In the first group, the breath stacking technique was used initially, and subsequently, the alveolar recruitment maneuver was applied. Group 2 patients were initially subjected to alveolar recruitment, followed by the breath stacking technique. Measurements of lung compliance and airway resistance were evaluated before and after the use of both techniques. Gas analyses were collected before and after the techniques were used to evaluate oxygenation and gas exchange. RESULTS: Both groups had a significant increase in static compliance after breath stacking (p=0.021) and alveolar recruitment (p=0.03), but with no significant differences between the groups (p=0.95). The dynamic compliance did not increase for the breath stacking (p=0.22) and alveolar recruitment (p=0.074) groups, with no significant difference between the groups (p=0.11). The airway resistance did not decrease for either groups, i.e., breath stacking (p=0.91) and alveolar recruitment (p=0.82), with no significant difference between the groups (p=0.39). The partial pressure of oxygen increased significantly after breath stacking (p=0.013) and alveolar recruitment (p=0.04), but there was no significant difference between the groups (p=0.073). The alveolar-arterial O2 difference decreased for both groups after the breath stacking (p=0.025) and alveolar recruitment (p=0.03) interventions, and there was no significant difference between the groups (p=0.81). CONCLUSION: Our data suggest that the breath stacking and alveolar recruitment techniques are effective in improving the lung mechanics and gas exchange in patients with acute lung injury.

Relações entre massa magra e estilo de vida em idosos longevos / Relationships between free fat mass and lifestyle in oldest-old / Relaciones entre masa magra y estilo de vida en ancianos longevos

Objetiva-se analisara relação entre a massa magra e o estilo de vida em idosos longevos.Como Métodos, estudo transversal, no qual foram avaliados 65 longevos, moradores do distrito de Capão Redondo da cidade de São Paulo(SP). Todos os participantes responderam ao questionário sociodemográfico e ao instrumento Perfil do Estilo de Vida Individual, além de terem realizado o exame de bioimpedância e o Teste de Caminhada. Como resultados, amédia de idade foi de 78,8±4,4, e o índice de massa corporal médio,de 27,4±5,6. Dentre os entrevistados, 61,6% eram mulheresea pontuação média do Perfil do Estilo de Vida Individualfoi de 32,12 pontos. Foi encontrada significante correlação entre componentes de estilo de vida com o índice de massa magra. Concluiu-se que foi encontrada correlação positiva entre componentes do estilo de vida e massa magra. A maioria dos longevos tinha excelente estilo de vida e composição corporal saudável, com significativo porcentual de massa magra.

Objective: To evaluate the lifestyle and its relations with fat free body mass in elderly people. Method: This was a cross-sectional study, in which 65 long-lived residents of São Paulocity (SP, Brazil)were evaluated. All participants answered the sociodemographic questionnaire and the ProfileLifestyleinstrument, in addition to performing the bioimpedance exam and Walking Test. Results: The mean age was 78.8±4.4, and the mean body mass indexwas 27.4±5.6. Of the respondents, 61.6% were women. The average lifestyle score was 32.12 points. A significant correlation was found between the lifestyle components and the fat freemass index. Conclusion: Significant positive correlation was found between lifestyle components and fat freemass. Most people have an excellent lifestyle and body composition is healthy, with a significant percentage of fat freemass.

El objetivo es analizar la relación entre masa magra y estilo de vida en ancianos longevos. Como Métodos, estudio transversal, en el que se evaluaron 65 residentes longevos del distrito de Capão Redondo en la ciudad de São Paulo (SP). Todos los participantes respondieron el cuestionario sociodemográfico y el instrumento Perfil de Estilo de Vida Individual, además de haber realizado el examen de bioimpedancia y el Test de Caminata. Como resultado, la edad media fue de 78,8 ± 4,4 y el índice de masa corporal medio fue de 27,4 ± 5,6. Entre los entrevistados, el 61,6% eran mujeres y la puntuación media del Perfil de Estilo de Vida Individual fue de 32,12 puntos. Se encontró una correlación significativa entre los componentes del estilo de vida y el índice de masa magra. Se concluyó que se encontró una correlación positiva entre los componentes del estilo de vida y la masa magra. La mayoría de las personas mayores tenían un estilo de vida excelente y una composición corporal saludable, con un porcentaje significativo de masa magra.

Malformações congênitas: um relato de reabilitação fisioterapêutica em paciente com transposição das grandes artérias / Congenital abnormalities: a physical therapy rehabilitation report in patient with transposition of great vessels

Objetivo: descrever uma abordagem fisioterapêutica na reabilitação neuropsicomotora e respiratória pediátrica em paciente com transposição das grandes artérias. Relato de caso: paciente R. S. C. R, sexo masculino, nascido de parto cesáreo, com diagnóstico clínico de malformações congênitas, portador de Transposição das Grandes Artérias ­ TGA, Comunicação Interatrial ­ CIA e Comunicação Interventricular Ampla ­ CIV. Avaliado aos 09 meses de idade com diagnóstico fisioterapêutico de atraso no desenvolvimento neuropsicomotor. Conclusão: esse relato de caso evidenciou efetiva abordagem fisioterapêutica na reabilitação neuropsicomotora e respiratória de uma criança com TGA + CIA + CIV em acompanhamento clínico, resultando em melhora neuropsicomotora identificada pelo melhor controle cervical e maior tempo na posição sentada, e melhora do desconforto respiratório passando de moderado para leve

Chest physiotherapy effectiveness to reduce hospitalization and mechanical ventilation length of stay, pulmonary infection rate and mortality in ICU patients.

INTRODUCTION: Although physiotherapy is an integral part of the multiprofessional team in most ICUs there is only limited evidence concerning the effectiveness of its procedures. The objectives of this study were to verify if physiotherapy care provided within 24 h/day for hospitalized patients in the ICU reduce the length of stay, mechanical ventilation support, pulmonary infection and mortality compared to a physiotherapy care provided within 6 h/day. METHODS: A cohort study was designed to assess differences between one hospital where patients were given physiotherapy care for 24 h/day and another hospital with only 6 h/day. We considered the following as outcome measurements: clinical diagnosis, medication in use, presence of associated diseases, APACHE II and SOFA scores, ICU and mechanical ventilation length of stay, development of pulmonary infections and survival. RESULTS: One hundred and forty-six patients were enrolled. Patients admitted in the service A presented a lower length of stay in mechanical ventilation (p < 0.0001), ICU stay (p = 0.0003), respiratory infections (p = 0.0043) than patients admitted in service B. No difference was found for APACHE II score (p = 0.8) and SOFA scores (p = 0.2) between groups. The mortality risk was OR 1.3 (1.01-2.33) (p = 0.04) for patients in the service B. CONCLUSION: The presence of a physiotherapist in the intensive care unit contributes decisively to the early recovery of the patient, reducing mechanical ventilation support need, number of hospitalization days, incidence of respiratory infection and risk of mortality.

O efeito da cinesioterapia e hidrocinesioterapia sobre a dor, capacidade funcional e fadiga em mulheres com fibromialgia / The effect of kinesiotherapy and hydrokinesiotherapy on pain, functional capacity and fatigue in women with fibromyalgia

Introdução: A Fibromialgia (SFM) é definida como uma síndrome clínica que se caracteriza por dor difusa pelo corpo todo. Objetivo: avaliar os efeitos da cinesioterapia no solo e da hidrocinesioterapia na melhora da dor, fadiga muscular, e capacidade funcional desses pacientes. Métodos: É um estudo prospectivo cegado, onde foram avaliadas 17 pacientes do sexo feminino com SFM, e divididas em dois grupos: grupo I (cinesioterapia), e grupo II (hidrocinesioterapia). Avaliados através da EVA, escala de Chalder e teste de caminhada de seis minutos. Resultados: Na avaliação da dor, a média da pré e pós reabilitação para Gi e GII foram 7,57±1,38 e 3,83±1,34 6,9±1,57 e 4,33±1,88 respectivamente. Quanto à capacidade funcional pré e pós reabilitação do GI foi 492,86±50,51 e 498,67±71,47. Para GII foi 460,30±46,09 546,17±56,16. Em relação a fadiga global pré pós reabilitação GI foi 3,5±0,5 e 1±1,5 do GII foi 3,5±0,5, e 2,5±0,95. Conclusão: Ambas as abordagens são eficazes no tratamento da SFM, porém, a cinesioterapia no solo foi mais eficaz na redução da dor e da fadiga. A melhora da capacidade funcional esteve mais relacionada a hidrocinesioterapia.

Introduction: Fibromyalgia (FMS) is defined as a clinical syndrome characterized by diffuse pain throughout the body. Objective: to evaluate the effects of kinesiotherapy in soil and hydrokinesiotherapy in improving pain, muscle fatigue, and functional capacity of these patients. Methods: This is a prospective blinded study in which 17 female patients with FMS were divided into two groups: group I (kinesiotherapy) and group II (hydrokinesiotherapy). Evaluated through EVA, Chalder's scale and six-minute walk test. Results: In the evaluation of pain, the mean pre and post rehabilitation for Gi and GII were 7.57 ± 1.38 and 3.83 ± 1.34, 6.9 ± 1.57 and 4.33 ± 1.88. respectively. The functional capacity before and after rehabilitation of the GI was 492.86 ± 50.51 and 498.67 ± 71.47. For GII it was 460.30 ± 46.09 546.17 ± 56.16. Regarding the global pre-post rehabilitation GI fatigue was 3.5 ± 0.5 and 1 ± 1.5 GII was 3.5 ± 0.5, and 2.5 ± 0.95. Conclusion: Both approaches are effective in the treatment of FMS; however, ground kinesiotherapy has been more effective in reducing pain and fatigue. The improvement in functional capacity was more related to hydrokinesiotherapy.

Sensibilidade e especificidade de testes para avaliar o equilíbrio corporal em diabéticos / Test sensitiveness and specificity to evaluate body equilibrium in people with diabetes

Esta investigação objetivou Avaliar sensibilidade e especificidade de testes para diagnosticar alteração do equilíbrio corporal em diabéticos com e sem histórico de quedas. Estudo transversal com 120 diabéticos tipo II. Utilizaram-se os instrumentos: escala de equilíbrio de Berg, avaliação da marcha e equilíbrio orientada pelo desempenho de Tinetti, Dynamics Gait Index e o Falls Efficacy Scale ­ International. A escala Falls Efficacy Scale ­ International foi quem apresentou maior área debaixo da curva quando analisada isoladamente para alteração do equilíbrio corporal. Quando analisado conjuntamente com todos os demais testes o instrumento de Tinetti teve maior área debaixo da curva. Em relação à sensibilidade os instrumentos apresentaram resultados semelhantes e a escala de equilíbrio de Berg, seguido do Dynamics Gait Index, apresentaram menor especificidade respectivamente para esta amostra. Assim quando analisados individualmente os instrumentos, estes apresentaram-se semelhantemente sensíveis. Entretanto, quando analisados simultaneamente a escala de Tinetti se apresentou mais discriminante apesar de não haver diferença significante entre os instrumentos. Sugere-se ainda que para a população diabética pontos de corte ótimo parecem ser distintos dos preconizados tradicionalmente pela literatura.

Test sensitiveness and specificity were assessed by a transversal study of 120 people with diabetes 2, to diagnose alterations on body equilibrium, with or without a history of falls. Berg Balance Scale, Tinetti Balance and Gait Evaluation, Dynamics Gait Index and Falls Efficacy Scale ­ International were employed. The Falls Efficacy Scale ­ International had the largest area below the curve when analyzed alone for the alteration of body balance. When analyzed together with the other tests, Tinetti´s tool had the greatest area under the curve. Results were similar with regard to sensitiveness: Berg Balance Scale had the lowest specificity for the sample, followed by Dynamics Gait Index. Thus, when the instruments were individually analyzed, they were similarly sensitive. However, when analyzed simultanously, Tinetti´s scale was more discriminating, in spite of lack of significant difference among the tools. It may be suggested that, in the case of people with diabetes, the best cut-off points seemed to be distinct from those in the literature.

Effect of hydrotherapy on quality of life, functional capacity and sleep quality in patients with fibromyalgia.

INTRODUCTION: Fibromyalgia affects 8% of the population over the age of 40 years, and 75% of the patients with fibromyalgia have poor sleep quality. OBJECTIVE: To assess the effects of hydrotherapy on the physical function and sleep quality of patients with fibromyalgia. METHODS: Patients were under clinical care at the UNASP Outpatient Clinic. This study assessed 60 female patients with fibromyalgia aged between 30 and 65 years. Out of the 60 patients assessed, 20 were excluded and 10 left the study because they could not comply with the time schedule. All patients completed the following questionnaires: Fibromyalgia Impact Questionnaire (FIQ); Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. Training sessions were performed twice a week for two months, each session lasting 60 minutes. RESULTS: Patients' mean age was 45 years, 66% were active workers, and 34% had quit work. Right after the hydrotherapy program, the patients improved the following aspects assessed by use of the FIQ: physical function, work absenteeism, ability to do job, pain intensity, fatigue, morning tiredness, stiffness (P < 0.0001), anxiety (P = 0,0013), and depression (P < 0.0001). Sleep quality (P < 0.0001) and daytime sleepiness (P = 0.0003) also improved. CONCLUSION: Hydrotherapy improves sleep quality, physical function, professional status, psychological disorders and physical symptoms in patients with fibromyalgia.

WITHDRAWN: Respiratory Muscle Assessment in Predicting Extubation Outcome in Patients With Stroke.

The Publisher regrets that this article is an accidental duplication of an article that has already been published, doi:10.1016/j.arbr.2012.06.007. The duplicate article has therefore been withdrawn.

Dieta enteral prescrita versus dieta infundida / Dieta enteral prescrita versus dieta infundida / Diet enteral prescribed versus diet infused

Objective: To evaluate the prescribed volume of enteral feeding versus the volume infused, identifying the diet for interruption, and expenses generated by these interruptions. Methods: Observational study with adults and elderly patients receiving enteral nutrition in a private hospital in São Paulo. Data collection was performed by means of electronic medical records. Results: The infused volume was significantly lower than the amount prescribed in the five days of monitoring in the entire sample. The main complication in the experimental diet was diarrhea. Spending on non-diet administration amount to 41.4% of the amount spent for this service. Conclusion: This study contributes to the performance and nutritionist performance in conjunction with the multidisciplinary team in Nutrition Therapy aiming at the improvement of the patient.

Objetivo: Avaliar o volume prescrito de dieta enteral versus o volume infundido, identificando as causas de interrupção da dieta e os gastos gerados por essas interrupções. Métodos: Estudo observacional, com pacientes adultos e idosos, recebendo nutrição enteral em um hospital particular de São Paulo. A coleta de dados foi realizada por meio de prontuário eletrônico. Resultados: O volume infundido foi significantemente menor que o volume prescrito, nos cinco dias de acompanhamento, em toda a amostra. A principal intercorrência na administração da dieta foi a diarreia. Os gastos com a não administração da dieta somam 41,4% do valor despendido para esse serviço. Conclusão: Este estudo contribui para a atuação e desempenho do nutricionista em conjunto com a Equipe Multidisciplinar em Terapia Nutricional visando a melhora do paciente.

Objetivo: Evaluar el volumen prescrito de la alimentación enteral en comparación con el volumen infundido, la identificación de la dieta para la interrupción y gastos generados por estas interrupciones. Métodos: Estudio observacional con pacientes adultos y ancianos que reciben nutrición enteral en un hospital privado de Sao Paulo. La recolección de datos se realizó por medio de registros médicos electrónicos. Resultados: El volumen infundido fue significativamente menor que la cantidad prescrita en los cinco días de monitoreo en toda la muestra. La complicación principal de la dieta experimental fue la diarrea. El gasto en cantidad de administración no dietética al 41,4% de la cantidad gastada por este servicio. Conclusión: Este estudio contribuye al rendimiento y desempeño en nutrición en conjunto con el equipo multidisciplinario en el tratamiento nutricional destinado a la mejora del paciente.

Premature childbirth: pregnant women's characteristics of a population in the South area of São Paulo / Parto prematuro: características das gestantes de uma população da zona sul de São Paulo

Abstract Objectives: to identify the characteristics of pregnant women who had premature child-birth (PPT) in the South region of São Paulo city. Methods: a cross-sectional observational study with a data collection of 122 medical files on pregnant women who had PPT in 2013. The collected data were analyzed by a statistical package, Graphpad Prism 6. As for the variables that were shown to be significant in the multivariate regression, an analysis was performed in a dichotomous form by odds ratio. Results: the mean age of the pregnant women was 24.9 years old. Of the 122 pregnant women, 34.4% were included in the age group considered to be at risk by the Ministry of Health. The predominant race was mixed (46.2%). 41.8% were high school graduates. Regarding to personal background, the history on urinary infection was mostly mentioned (37.5%). In relation to family history regarding clinical conditions, 43% had diabetes history and 61% had hypertension. As for gynecological history, 37.5% reported having dysmenorrhea during menstrual cycles. Multivariate analysis was performed and found that particularly hypertension and dysmenorrhea were the most significant. Conclusions: Regarding to women´s risk factors for premature childbirth, the most determining factor was dysmenorrhea, followed by hypertension.

Resumo Objetivos: identificar as características das gestantes que tiveram parto prematuro (PPT) na região sul da cidade de São Paulo. Métodos: estudo observacional transversal com coleta de dados de 122 prontuários de gestantes que tiveram PPT em 2013. Os dados coletados foram analisados pelo pacote estatístico Graphpad Prism 6. Para as variáveis que se mostraram significantes dentro da regressão multivariada foi feita análise de forma dicotômica por meio odds ratio. Resultados: a média de idade das gestantes foi de 24,9 anos. Das 122 gestantes, 34,4% estavam na faixa etária considerada de risco pelo Ministério da Saúde. A raça predominante foi parda (46,2%). 41,8% finalizaram o ensino médio. Em relação aos antecedentes pessoais, o que mais se destacou foi o histórico de infecção urinária (37,5%) . Em relação aos antecedentes familiares em relação à condições clínicas, 43% possuíam antecedentes com diabetes e 61% com hipertensão arterial. Quanto aos antecedentes ginecológicos, 37,5% relataram apresentar dismenorreia durante os ciclos menstruais. Ao ser realizada análise multivariada, foi verificado que a hipertensão arterial e principalmente a dismenorreia foram as mais significantes. Conclusões: em relação aos fatores de risco das mulheres para parto prematuro das mulheres, a dismenorreia foi o fator mais determinante, seguido de hipertensão arterial.

Profile of lifestyle of older elderly persons / Perfil do estilo de vida de longevos

Abstract Introduction: Lifestyle has been widely studied in recent years, especially in the context of longevity and aging well. Objective: The aim of this study was to analyze the lifestyle profile of older elderly persons and the relationship between lifestyle and chronic diseases. Method: A cross-sectional study evaluating 132 older persons aged over 74.6 years, who were resident of the Capão Redondo district of São Paulo, was carried out. The study was conducted in 23 institutions such as churches, community centers, parks, nursing homes and residences. All participants completed two questionnaires, with the first based on lifestyle and the second on socio-economic classification, and also answered some questions about the presence and control of non-communicable chronic diseases (NCDs). Result: the mean age was 78.8(±4.5) years and the respondents had a mean BMI of 25.5(±5.5). Most were women from social classes C and D. A total of 46 were former smokers, seven were smokers, and 82 had NCDs, with heart diseases the most prevalent. The mean lifestyle questionnaire score was 30.2(±3.5). There was no statistical difference in scores between those with NCDs and those that did not suffer from such diseases. The physical activity component had the lowest score, followed by the nutrition component. The prevalence of NCDs was significantly higher for smokers and former smokers than for those who had never smoked. Conclusion: The majority of older persons demonstrated an excellent lifestyle with healthy habits. Even those with a diagnosed NCD had a good lifestyle. Cardiovascular diseases were the most prevalent in this population. The risk of NCD was greater for smokers and former smokers than for those who had never smoked. AU

Resumo Introdução: O estilo de vida tem sido objeto de estudo nos últimos anos, haja vista poder estar relacionado ao processo de envelhecimento construído através da longevidade saudável. Objetivo: analisar o perfil do estilo de vida em longevos e a relação entre estilo de vida e doenças crônicas não transmissíveis. Método: trata-se de um estudo transversal, no qual foram avaliados 132 longevos maiores de 74,6 anos, moradores do distrito de Capão Redondo em São Paulo. Todos os participantes responderam a questionários sobre estilo de vida, classificação socioeconômica e questões sobre a presença e controle de doenças crônicas não transmissíveis (DCNT). Resultados: a média da idade foi de 78,8(±4,5) anos; IMC de 25,5(±5,5) a maioria era do sexo feminino e das classes sociais C e D; 46 eram ex-fumantes e sete fumantes; 82 tinham DCNT; dentre estas, as doenças cardíacas foram as mais prevalentes. A pontuação média do questionário de estilo de vida foi 30,2(±3,5). Não houve diferença estatística da pontuação entre os que tinham e não tinham DCNT. O componente "atividade física" foi o de menor pontuação. A prevalência de DCNT foi significantemente maior para o grupo de fumante e ex-fumantes, em relação aqueles que nunca fumaram. Conclusão: a maioria dos longevos tem excelente estilo de vida com hábitos saudáveis. Mesmo aqueles que tem diagnóstico de alguma DCNT apresentam um bom estilo de vida. As doenças cardiovasculares são as de maior prevalência para essa população. O risco para DCNT esteve aumentado para fumante e ex-fumantes em relação aos que nunca fumaram. AU

Impacto de um programa estruturado de hidrocinesioterapia em pacientes com osteoartrite de joelho / Impact of a structured aquatic therapy program on patients with knee osteoarthritis

A osteoartrite é uma doença articular degenerativa, reumática crônica, multifatorial de alta prevalência, atinge 10% da população com mais de 65 anos. Afeta igualmente ambos os sexos, sendo que na mulher a incidência é maior após o período da menopausa. Esta doença compreende 65% das causas de incapacidade, atrás somente de doenças cardiovasculares e mentais. A reabilitação do paciente com artrose é um processo complexo que envolve procedimentos especializados Objetivo: Avaliar os efeitos de um programa de hidrocinesioterapia sobre a capacidade de realização de atividades da vida diária em pacientes com osteoartrite. Métodos: Este é um estudo prospectivo, onde vinte e seis pacientes com histórico de osteoartrite de joelho foram submetidos a um programa de tratamento em hidrocinesioterapia, com frequência de duas vezes por semana com duração de 50 minutos cada sessão. O programa consistia de quatro fases, sendo elas: aquecimento, alongamento, fortalecimento e relaxamento. Estes pacientes foram avaliados pré e pós-tratamento. Utilizando como método de avaliação a goniometria, escala de dor EVA e Teste de Caminhada de Seis Minutos. Resultados: Houve melhora significante da amplitude de movimento ao realizar flexão dos joelhos acometidos, também foi visto diminuição significativa da dor e melhora significante na capacidade de realização das atividades de vida diária avaliada por meio da distância percorrida no teste de caminhada de seis minutos. Conclusão: Houve melhora da capacidade de realizar AVD e da capacidade física, assim como redução do quadro álgico e aumento da amplitude de movimento

Osteoarthritis is a pervasive, chronic rheumatic, multifactorial, degenerative joint disease, afflicting 10% of the population over 65 years of age. It affects both genders, and in women the incidence is higher after menopause. This disease comprises 65% of the causes of disability, exceeded only by cardiovascular and mental disorders. The rehabilitation of patients with osteoarthritis is a complex process that involves specialized procedures Objective: To evaluate the effects of a hydrotherapy program on the ability to perform activities of daily living in patients with osteoarthritis. Method: This is a prospective study where twenty-six patients with knee osteoarthritis history underwent a treatment program in aquatic therapy, often twice a week lasting 50 minutes each session. The program consisted of four phases, namely: warming up, stretching, strengthening, and relaxation. These patients were evaluated before and after treatment. Assessments were done with the goniometer, EVA pain scale, and Six Minute Walk Test. Results: There was significant improvement in range of motion when performing flexion of the affected knees, as well as a significant decrease in pain and a significant improvement in the ability to perform the activities of daily living, assessed by the distance walked in the six-minute walk test. Conclusion: There was an improved ability to perform ADLs and inn physical capacity, as well as reduced pain and increased range of motion

Como o estilo de vida tem sido avaliado: revisão sistemática / How life style has been evaluated: a systematic review

O estilo de vida corresponde ao conjunto de hábitos e costumes que são influenciados e modificados que podem contribuir para a promoção da saúde. Objetivo: Realizar uma revisão sobre os métodos que têm sido utilizados para a avaliação do estilo de vida, assim como identificar o que tem sido considerado como estilo de vida saudável. Método: Este estudo consistiu em uma revisão sistemática sobre os possíveis métodos de avaliação do estilo de vida e hábitos que são considerados estilo de vida saudável. A pesquisa foi realizada nas bases de dados nacionais e internacionais: LILACS, MEDLINE, PubMed e SciELO, e busca livre no Google acadêmico, como os seguintes descritores: "estilo de vida" "estilo de vida saudável". Resultados: foram encontrados 142 artigos, sobre estilo de vida saudável, 105 não preencheram os critérios estabelecidos, 28 foram considerados elegíveis e foram incluídos no estudo, 10 tinham amostra randomizados, e um pseudo-randomizada, 17 não havia aleatorização no processo. Entre os artigos selecionados havia quatro propostas para validar instrumentos de avaliação de estilo de vida, e uma revisão sistemática. Os instrumentos utilizados nestes estudos não eram muito confiáveis para avaliar estilo de vida, os métodos destes apresentaram baixa responsividade. Conclusão: Podemos concluir que o estilo de vida saudável deve ser iniciado precocemente e continuar durante toda a vida, e as principais ações relacionadas a um estilo de vida saudável, controle de parâmetros metabólico, realizar atividades física, e alimentação saudável, entretanto os instrumentos de avaliação do estilo de vida ainda são pobre na capacidade de resposta

The term lifestyle corresponds to the set of habits and customs that can be influenced and modified and which can contribute to promoting health. Objective: This study was to make a systematic review on the subject of lifestyle, what methods have been used to evaluate lifestyle, and what is considered a healthy lifestyle. Method: This study consisted of a systematic review on the possible methods of evaluating the lifestyle and habits of what is considered healthy lifestyle. The survey was conducted in electronic databases, national and international, LILACS, MEDLINE, PubMed, and SciELO, and free search on Google Brazil, by consulting the following descriptors: "life style" associated with "healthy. Results: We found 142 articles published between 1990 and 2012, 105 of which did not meet the established criteria, 28 were considered eligible and were included in the study, 10 used randomized and pseudo-randomized samples, and 17 were not randomized. Among the articles selected, there were four proposals to validate lifestyle-assessment instruments, and one systematic review. The instruments used were not very reliable for assessing lifestyle, and their methods were not responsive. Conclusion: These studies demonstrate the importance of a healthy lifestyle and that it be started early and continued throughout life; they define the main actions related to a healthy lifestyle as well as control of metabolic parameters, physical activities, and healthy eating, but the lifestyle-evaluation instruments are still poor in responsiveness

Aspectos sociais relacionados ao tabagismo em idosos assistidos de Saúde da Família / Social aspects related to smoking in an elderly population attending the health family program

O aumento do consumo do tabaco ocorreu no séc. XX, mais difundido nas décadas de 50-60, havendo, no Brasil, decréscimo do seu uso na década de 1990. O objetivo deste estudo é investigar os aspectos sociais relacionados ao uso do tabaco em idosos e avaliar os principais fatores sociais que levaram a este hábito. Incluídos neste estudo 160 indivíduos com 60 anos ou mais, divididos em dois grupos: não tabagistas (G1) (N=80) e tabagistas (G2) (N=80), estes com história de tabagismo superior a 20 maços/ano, e que não apresentavam demência ou condições que os impossibilitassem responder aos instrumentos de coleta de dados. Todos os participantes recebiam atendimento no Programa de Saúde da Família da região do Capão Redondo, cidade de São Paulo (SP), Brasil. A média da idade foi de 66,7+ 5,95 e 67+13 anos, e a idade mínima e máxima, de 60 e 80 anos, nos G1 e G2, respectivamente. A média de moradores por residência foi de 3,45 + 1,57 e 4,6 +2,1, nos G1 e G2, respectivamente. Havia mais idosos fumantes com menor acesso a recursos financeiros e à educação, sendo o risco para um indivíduo analfabeto se tornar fumante foi significantemente maior do que para aquele portador de curso superior, também foi visto que pais e amigos que fumam foram os fatores de risco significantemente mais fortes para que os idosos tivessem começado a fumar. O tabagismo traz repercussão social importante sobre as famílias.

Smoking habits increase occurred in the XX century, especially in the 50-60ths decades; countries like Brazil and Spain, among others, saw a significant decrease of its consume in the 1990ths decade; however, social repercussions were harmful for a long period of time. Objectives: Assess the social aspects related in an elderly population; evaluate the main social factors that led to smoking.One hundred and sixty subjects with 60 or more years were included into two groups: non-smoking (G1) (N=80) and smoking (G2)(N=80) groups; both had a smoking history over 20 packs/years, e.g., equivalent of one smoked pack per day for 20 years; and also those who did not present dementia or any condition that would not allow them to respond the questionnaires applied in the study. All subjects included attended the health family program in the Capão Redondo region, São Paulo (SP) city, Brazil. Mean age was: 66.7+ 5.95 and 67+13 years G1 and G2, minimum and maximum age was 60 and 80 years old, respectively. Mean house residents were: 3.45 + 1.57 and 4.6 +2.1 of G1 and G2, respectively, having more smokers with lower financial and educational resources; an illiterate presented a significant higher risk then a subject with completed undergraduation. Smoking brings important social repercussions over families; parents/friends that smoke are significant stronger related risk factors for other people to start smoking.

Análise comparativa entre a manobra de recrutamento alveolar e a técnica de breath stacking em pacientes com lesão pulmonar aguda / Comparative analysis between the alveolar recruitment maneuver and breath stacking technique in patients with acute lung injury

Objetivo: Comparar a eficácia da manobra de recrutamento alveolar e a técnica de breath stacking, na mecânica pulmonar e na troca gasosa, em pacientes com lesão pulmonar aguda. Métodos: Trinta pacientes foram distribuídos em dois grupos: Grupo 1 - breath stacking e Grupo 2 - manobra de recrutamento alveolar. Após receberem atendimento de fisioterapia convencional, todos os pacientes receberam ambos os tratamentos, com intervalo de 1 dia entre eles. No primeiro grupo foi aplicada primeiramente a técnica de breath stacking e, posteriormente, a manobra de recrutamento alveolar. Já os pacientes do segundo Grupo 2 foram submetidos inicialmente ao recrutamento alveolar e, após, a técnica de breath stacking. Foram avaliadas as medidas de complacência pulmonar e de resistência de vias aéreas antes e após a aplicação de ambas as técnicas. Foram coletadas gasometrias arteriais pré e pós-técnicas para avaliar a oxigenação e a troca gasosa. Resultados: Ambos os grupos apresentaram aumento significativo da complacência estática após breath stacking (p=0,021) e recrutamento alveolar (p=0,03), mas não houve diferença entre eles (p=0,95). A complacência dinâmica não aumentou para os grupos breath stacking (p=0,22) e recrutamento alveolar (p=0,074), sem diferença entre os grupos (p=0,11). A resistência de vias aéreas não diminuiu para ambos os grupos: breath stacking (p=0,91) e recrutamento alveolar (0,82), sem diferença entre os grupos p=0,39. A pressão parcial de oxigênio aumentou significantemente após breath stacking (p=0,013) e recrutamento alveolar (p=0,04); mas entre os grupos não houve diferença (p=0,073). A diferença alvéolo arterial de O2 diminuiu para ambos os grupos após intervenções breath stacking (p=0,025) ...

Objective: To compare the effectiveness of the alveolar recruitment maneuver and the breath stacking technique with respect to lung mechanics and gas exchange in patients with acute lung injury. Methods: Thirty patients were distributed into two groups: Group 1 - breath stacking; and Group 2 - alveolar recruitment maneuver. After undergoing conventional physical therapy, all patients received both treatments with an interval of 1 day between them. In the first group, the breath stacking technique was used initially, and subsequently, the alveolar recruitment maneuver was applied. Group 2 patients were initially subjected to alveolar recruitment, followed by the breath stacking technique. Measurements of lung compliance and airway resistance were evaluated before and after the use of both techniques. Gas analyses were collected before and after the techniques were used to evaluate oxygenation and gas exchange. Results: Both groups had a significant increase in static compliance after breath stacking (p=0.021) and alveolar recruitment (p=0.03), but with no significant differences between the groups (p=0.95). The dynamic compliance did not increase for the breath stacking (p=0.22) and alveolar recruitment (p=0.074) groups, with no significant difference between the groups (p=0.11). The airway resistance did not decrease for either groups, i.e., breath stacking (p=0.91) and alveolar recruitment (p=0.82), with no significant difference between the groups (p=0.39). The partial pressure of oxygen increased significantly after breath stacking (p=0.013) and alveolar recruitment (p=0.04), but there was no significant difference between the groups (p=0.073). The alveolar-arterial O2 difference decreased for both groups after the breath stacking (p=0.025) and alveolar recruitment (p=0.03) interventions, and there was no significant difference between the groups (p=0.81). Conclusion: Our data suggest that the breath stacking and alveolar ...

Comparative analysis of respiratory systems compliance in three different positioning (lateral, dorsal and sitting) in patients in prolonged invasive mechanical ventilation. / Análise comparativa da complacência do sistema respiratório em três diferentes posições no leito (lateral, sentada e dorsal) em pacientes submetidos à ventilação mecânica invasiva prolongada.

OBJECTIVES: This study is justified by the fact that in clinical practice, changes occur in patient's positioning in the bed during hospitalization in intensive care unity, it's necessary better understanding about possible adverse effects that such changes might cause mainly on the respiratory system condition. The objective this study was to evaluate if the patients positioning in bed can to alter the pulmonary complacency. METHODS: All included patients were submitted to mechanical ventilation and were sedated and curarized respiratory system compliance was assessed in three different positioning: lateral, dorsal and sitting. After an alveolar recruitment maneuver, patients were placed to a position throughout two hours, and in the last five minutes the data was collected from the mechanical ventilator display. RESULTS: twenty eight patients were prospectively assessed. Values of respiratory system compliance in the lateral position were 37,07 ± 12,9 in the dorsal were 39,2 ± 10,5 and in the sitting 43,4 ± 9,6 mL/cmH2O. There were a statistical difference when we compared to the sitting and dorsal with lateral positioning for respiratory system compliance (p = 0.0052) and tidal volume (p < 0.001). There was a negative correlation between mean values of positive end expiratory pressure a respiratory system compliance (r = 0.59, p = 0.002). The FIO2 administered was 0.6 for the lateral positioning and 0.5 for the dorsal and sitting positioning (p = 0.049). CONCLUSIONS: That body positioning in patients restrained to a bed and submitted to invasive mechanical ventilation leads to pulmonary compliance, tidal volume and SpO2 oscillations. In the sitting position the pulmonary compliance is higher than in others positions.