Strength training increases walking tolerance in intermittent claudication patients: randomized trial

Objective: To analyse the effects of strength training (ST) in walking capacity in patients with intermittent claudication (IC) compared with walking training (WT) effects. Methods. Thirty patients with IC were randomized into ST and WT. Both groups trained twice a week for 12 weeks at the same rate of perceived exertion. ST consisted of three sets of 10 repetitions of whole body exercises. WT consisted of 15 bouts of 2-minute walking. Before and after the training program walking capacity, peak VO(2), VO(2) at the first stage of treadmill test, ankle brachial index, ischemic window, and knee extension strength were measured. Results: ST improved initial claudication distance (358 +/- 224 vs 504 +/- 276 meters; P < .01), total walking distance (618 +/- 282 to 775 +/- 334 meters; P < .01), VO(2), at the first stage of treadmill test (9.7 +/- 2.6 vs 8.1 +/- 1.7 mL . kg(-1) . minute; P < .01), ischemic window (0.81 +/- 1.16 vs 0.43 +/- 0.47 mm Hg minute meters(-1); P = .04), and knee extension strength (19 +/- 9 vs 21 +/- 8 kg and 21 +/- 9 vs 23 +/- 9; P < .01). Strength increases correlated with the increase in initial claudication distance (r = 0.64; P = .01.) and with the decrease ill VO(2) measured at the first stage of the treadmill test (r = -0.52; P = .04 and r = -0.55; P = .03). Adaptations following ST were similar to the ones observed after WT; however, patients reported lower pain during ST than WT (P < .01). Conclusion: ST improves functional limitation similarly to WT but it produces lower pain, suggesting that this type of exercise could be useful and should be considered in patients with IC. (J Vase Surg 2010;51:89-95.)

Non-exhaustive tests for critical power estimation

Objective. - The aim of this study was to propose a new method that allows for the estimation of critical power (CP) from non-exhaustive tests using ratings of perceived exertion (RPE). Methods. - Twenty-two subjects underwent two practice trials for ergometer and Borg 15-point scale familiarization, and adaptation to severe exhaustive exercise. After then, four exercise bouts were performed on different days for the estimation of CP and anaerobic work capacity (AWC) by linear work-time equation, and CP(15), CP(17), AWC(15) and AWC(17) were estimated using the work and time to attainment of RPE15 and RPE17 based on the Borg 15-point scale. Results. - The CP, CP(15) and CP(17) (170-177W) were not significantly different (P>0.05). However, AWC, AWC(15) and AWC(17) were all different from each other. The correlations between CP(15) and CP(17), with CP were strong (R=0.871 and 0.911, respectively), but the AWC(15) and AWC(17) were not significantly correlated with AWC. Conclusion. - Sub-maximal. RPE responses can be used for the estimation of CP from non-exhaustive exercise protocols. (C) 2009 Elsevier Masson SAS. All rights reserved.

Salivary immunoglobulin a responses in professional top-level futsal players

Moreira, A, Arsati, F, de Oliveira Lima-Arsati, YB, de Freitas, CG, and de Araujo, VC. Salivary immunoglobulin a responses in professional top-level futsal players. J Strength Cond Res 25(7): 1932-1936, 2011-The purpose of this study was to investigate the responses of salivary immunoglobulin A (SIgA) in 10 professional top-level Brazilian futsal players after 2 highly competitive games separated by 7 days. Unstimulated saliva was collected over a 5-minute period at PRE- and POST-match. The SIgA was measured by an enzyme-linked immunosorbent assay and expressed as the absolute concentration (SIgAabs) and secretion rate of IgA (SIgArate). Rate of perceived exertion and heart rate were used to monitor the exercise intensity. A 2-way analysis of variance with repeated measures showed nonsignificant differences between matches to SIgAabs, SIgArate, and saliva flow rate (p > 0.05). However, significant time differences were observed for all these parameters. In summary, we showed that a competitive training match induced a decrease in SIgA levels in top-level futsal players, which suggests an increment of the vulnerability to infections meditated by the training stimulus. This decrease suggests that the athletes were at an increased risk of developing an upper respiratory tract infection, and therefore, it could be necessary to take protective actions to minimize contact with cold viruses or even reduce the training load for athletes.

Resistance exercise and glycemic control in women with gestational diabetes mellitus

OBJECTIVE: The objective of the study was to evaluate the effect of a resistance exercise program with an elastic band on insulin requirement and glycemic control in patients with gestational diabetes mellitus (GDM). STUDY DESIGN: Sixty-four patients with gestational diabetes mellitus were randomly assigned into 2 groups: an exercise group (EG; n = 32) and a control group not submitted to the exercise program (CG; n = 32). RESULTS: A significant reduction in the number of patients who required insulin was observed in the EG (7/32) compared with the CG group (18/32) (P = .005). The percentage of time spent within the proposed target glucose range (of at least 80% of weekly measurements below the limits preestablished for the disease) was significantly higher in EG compared with the CG group (EG = 0.63 +/- 0.30; CG = 0.41 +/- 0.31; P = .006). CONCLUSION: The resistance exercise program was effective in reducing the number of patients with GDM who required insulin and in improving capillary glycemic control in this population.

Influence of self-perceived oral health and socioeconomic predictors on the utilization of dental care services by schoolchildren

The influence of socioeconomic factors and self-rated oral health on children's dental health assistance was assessed. This study followed a cross-sectional design, with a multistage random sample of 792 12-year-old schoolchildren from Santa Maria, a city in southern Brazil. A dental examination provided information on the prevalence of dental caries (DMFT index). Data about the use of dental service, socioeconomic status, and self-perceived oral health were collected by means of structured interviews. These associations were assessed using Poisson regression models (prevalence ratio; 95% confidence interval). The prevalence of regular use of dental service was 47.8%. Children from low socioeconomic backgrounds and those who rated their oral health as "poor" used the service less frequently. The distribution of the kind of oral healthcare assistance used (public/private) varied across socioeconomic groups. The better-off children were less likely to have used the public service. Clinical, socioeconomic, and psychosocial factors were strong predictors for the utilization of dental care services by schoolchildren.

Practice of walking and its association with perceived environment among elderly Brazilians living in a region of low socioeconomic level

Background: The aim of this study was analyze associations between the practice of walking and environmental perception among elderly Brazilians in a region of low socioeconomic level. Methods: A cross-sectional study was conducted among 385 elderly people aged 60 years and over. To evaluate walking, the International Physical Activity Questionnaire (IPAQ), long version (leisure and transport modules) was used. The environment was evaluated by means of the Neighborhood Environmental Walkability Scale (NEWS) (adapted Brazilian version). For the statistical analysis, multiple logistic regression models were created separately for men and women. The practice of at least 150 minutes a week of walking was the dependent variable, and the variables of environmental perception were the independent variables. All the models were controlled for schooling level and age. Results: The proportion of elderly people active in walking was 56.9% for the men and 26.4% for the women. The perception of the presence of soccer fields (OR = 4.12) and their proximity, within ten minutes' walk from home (OR = 3.43), were associated with the practice of walking among the men. The perception of the presence of public squares (OR = 4.70) and the proximity of primary healthcare units, within ten minutes' walk from home (OR = 3.71), were associated with the practice of walking among the women. An association with adequate perception of vehicle traffic remained at the threshold of significance for the women. Conclusion: Accessibility of leisure structures such as football fields and public squares and of health services such as primary healthcare units were important environmental variables associated with the practice of walking among elderly people living in a region of low socioeconomic level in Brazil. These variables need to be taken into consideration when aiming to promote the practice of walking among elderly people living in similar regions.

Association Between Physical Activity in Parks and Perceived Environment: A Study With Adolescents

Background: The purpose of this study was to analyze the relationship between adolescents' physical activity practice and their perception about the environment of urban parks. Methods: A school-based representative sample (n = 1,718; boys = 40.4%) of teenagers of Curitiba, Southern region of Brazil. A questionnaire was employed to identify perceived parks environmental features as well as physical activity practice in the parks (PAP), habitual physical activity (HPA) and demographics. The relationship between PAP and parks environments was analyzed through multivariate logistic regression controlling for age and socioeconomic status, HPA and parks distance. Results: After controlling for confounders PAP was associated with lack of space to be physically active, activities to choose from and equipments for both boys and girls, (odds ratio (OR)-ranging from 1.5 to 1.8). Among boys, having people of same age (OR = 1.5) and accessibility (OR = 2.0) showed association with PAP only in crude analysis. However, among girls, to be bulled or teased (OR = 1.4) and accessibility (OR = 1.7) were associated with PAP after confounding control. Conclusions: The results showed that specific attributes in parks may be considered and offered to increase the likelihood of physical activity practice among adolescents in such locations.

Sustainability certification of bioethanol: how is it perceived by Brazilian stakeholders?

This paper investigates whether initiatives for sustainability certification of Brazilian ethanol can be expected to stimulate a change among producers toward more sustainable production - and, if so, what those changes would likely be. Connected to this, several questions are raised including whether producers might prefer to target other markets with less stringent demands, and if certification might lead to structural changes in the sector because producers who lack the capacity to meet the new requirements cannot remain competitive. The analysis of interviews with a diverse group of stakeholders under the guidance of the Technological Innovation Systems framework allowed us identify different actions taken by the Brazilian sugarcane ethanol sector in response to requirements of sustainability. The interviewees agreed that sustainability certification is an important element for the expansion of biofuel production in Brazil. Brazilian stakeholders have created a platform for more competitive sustainable production and have initiated relevant processes in response to the development connected to sustainability certification. Yet, the certification activities have had a limited impact in terms of the number of involved stakeholders. But interview responses indicate that the sector may adapt to new certification requirements rather than leave markets where such requirements become established. Structural changes can be expected if certification requirements as they exist in many initiatives are introduced in unflexible ways. The social importance of the ethanol industry is large in Brazil and some adjustments for certification may be required. The paper concludes by suggesting some actions for the industry. (C) 2010 Society of Chemical Industry and John Wiley & Sons, Ltd

Perceived Self-Efficacy Among Liver Transplant Candidates and Recipients

Self-efficacy is defined as one`s belief that one can perform the necessary behaviors to achieve one`s goals. This belief is one of the most powerful motivational predictors of how well a person will perform at almost any endeavor. Limited information is available, however, about self-efficacy in the organ transplantation population. This study aimed to identify the self-efficacy belief among liver transplant candidates and recipients and compare these results with demographic characteristics. The authors analyzed 100 patients who were candidates and recipients for liver transplantation in a Brazilian center. The average self-efficacy score for the candidates was significantly lower than for the recipients. Future investigation is necessary to explore possible interventions to be taken before and after liver transplantation that could influence self-efficacy of the organ transplantation patients.

Desidratação e recomendações para a reposição hídrica em crianças fisicamente ativas

OBJETIVO: A prática de exercícios físicos, devido à produção inerente de calor, pode conduzir à desidratação. A maioria dos estudos que abordam os riscos da desidratação e fornecem recomendações de reposição hídrica é direcionada a indivíduos adultos residentes em regiões de clima temperado, porém, em regiões tropicais, pouco é conhecido sobre as necessidades de reposição hídrica em crianças fisicamente ativas. Esta revisão discute as recomendações para esta população e estabelece os riscos da prática esportiva em ambiente de clima tropical. FONTES DE DADOS: Análise sistemática com levantamento da literatura nacional (SciELO) e internacional (Medline) de artigos publicados entre 1972 e 2009, com os seguintes descritores isolados ou em combinação: hidratação, crianças, desidratação e reposição hídrica. Foram selecionados artigos publicados nas línguas portuguesa e inglesa. SÍNTESES DE DADOS: Observou-se que há riscos de desidratação e possível desenvolvimento de um quadro de hipertermia principalmente se as crianças são submetidas a condições climáticas desfavoráveis sem reposição hídrica adequada. O principal fator desencadeante da hipertermia é a menor adaptação das crianças aos extremos de temperatura, em comparação aos adultos, por possuírem área maior de superfície corporal e capacidade menor de termorregulação por evaporação. CONCLUSÕES: Conhecidos os fatores intervenientes da desidratação, a melhor recomendação, perante uma condição climática sabidamente desfavorável, é estabelecer um plano impositivo de hidratação com bebida com sabor e acréscimo de carboidratos e sódio, evitando-se uma perda hídrica significativa, diminuição da performance e, principalmente, com o objetivo de reduzir os riscos à saúde impostos pela hipertermia e desidratação a crianças fisicamente ativas.

Relação entre percepção e ação durante os movimentos de sentar e levantar em indivíduos idosos

A proposta deste estudo foi analisar o efeito do envelhecimento nos aspectos perceptivos e motores envolvidos com as ações de sentar e levantar de uma cadeira. Indivíduos jovens e idosos foram filmados enquanto sentavam/levantavam de uma cadeira em sete alturas diferentes do assento. Eles julgaram a dificuldade/facilidade encontrada para sentar e levantar em cada altura do assento. Os idosos exibiram mudanças na estratégia de controle usada para sentar na altura mais baixa do assento e superestimaram o nível de dificuldade/facilidade para realizar as tarefas de sentar e levantar. Em síntese, a percepção de execução fácil da tarefa de sentar pelos idosos não concorda com o grau de dificuldade exibido no desempenho motor na altura mais baixa do assento.

Autopercepção da saúde bucal em idosos e fatores associados em Campinas, SP, 2008-2009

OBJETIVO: Descrever a autopercepção de saúde bucal em idosos e analisar fatores sociodemográficos e clínicos associados. MÉTODOS: Estudo transversal com 876 participantes em amostra representativa de idosos (65 anos ou mais) de Campinas, SP, em 2008-2009. Os exames odontológicos seguiram critérios padronizados pela Organização Mundial da Saúde para levantamentos epidemiológicos de saúde bucal. A autopercepção da saúde bucal foi avaliada pelo índice Geriatric Oral Health Assessment Index (GOHAI). Os indivíduos foram classificados segundo características sociodemográficas, odontológicas e prevalência de fragilidade biológica. O estudo de associações utilizou análise de regressão de Poisson; a análise considerou os pesos amostrais e a estrutura complexa da amostra por conglomerados. RESULTADOS: A média de idade dos indivíduos foi de 72,8 anos; 70,1% eram mulheres. A proporção de indivíduos com mais de 20 dentes presentes foi 17,2%; 38,2% usavam prótese dentária total em ambos os arcos; 8,5% necessitavam desse recurso em ao menos um arco dentário. Em média, o índice GOHAI foi elevado: 33,9 (máximo possível 36,0). Manter 20 dentes ou mais, usar prótese total nos dois arcos, não necessitar desse tratamento, não apresentar alterações de mucosa oral e não apresentar fragilidade biológica foram os fatores significantemente associados com melhor autopercepção de saúde bucal (p < 0,05). CONCLUSÕES: A avaliação de autopercepção em saúde bucal permitiu identificar os principais fatores associados a esse desfecho. Esse instrumento pode contribuir para o planejamento de serviços odontológicos, orientando estratégias de promoção em saúde voltadas à melhora da qualidade de vida das pessoas desse grupo etário.

Validade e confiabilidade da versão brasileira do Índice de Capacidade para o Trabalho

OBJETIVO: Avaliar a validade e a confiabilidade da versão brasileira de índice de capacidade para o trabalho. MÉTODOS:Estudo transversal com amostra de 475 trabalhadores de empresa do setor elétrico no estado de São Paulo (dez municípios em Campinas e região), realizado em 2005. Foram avaliados os seguintes aspectos da versão brasileira do Índice de Capacidade para o Trabalho: validade de construto, por meio de análise fatorial confirmatória e da capacidade discriminante; validade de critério, correlacionado o escore do índice com medidas de saúde auto-referidas; e confiabilidade, por meio da análise da consistência interna utilizando o coeficiente alfa de Cronbach. RESULTADOS: A análise fatorial indicou três fatores do construto capacidade para o trabalho: questões relativas aos "recursos mentais" (20,6% da variância), à autopercepção da capacidade para o trabalho (18,9% da variância) e à presença de doenças e limitações decorrentes do estado de saúde (18,4% da variância). O índice discriminou os trabalhadores segundo nível de absenteísmo, identificando média estatisticamente significativa (p<0,001) entre aqueles com absenteísmo elevado (37,2 pontos) e baixo (42,3 pontos). A análise de critério mostrou correlação do índice com todas as dimensões do estado de saúde analisadas (p<0,0001). O índice apresentou boa confiabilidade com coeficiente alfa de Cronbach (0,72). CONCLUSÕES: A versão brasileira do Índice de Capacidade para o Trabalho mostrou propriedades psicométricas satisfatórias quanto à validade de construto, de critério e de confiabilidade, representando uma opção adequada para avaliação da capacidade para o trabalho em abordagens individuais e inquéritos populacionais.

Determinantes individuais da utilização de serviços odontológicos por adultos e idosos de baixa renda

A utilização de serviços odontológicos resulta da interação de determinantes biológicos com fatores socioculturais, familiares e comunitários, bem como de características dos sistemas de saúde. O objetivo deste estudo foi identificar os fatores individuais associados à utilização de serviços odontológicos por parte de adultos e idosos de baixa renda residentes na área de abrangência da Estratégia Saúde da Família, em Ponta Grossa, PR. A amostra constou de 246 indivíduos, com 35 anos de idade ou mais, que responderam a um questionário sobre condições socioeconômicas, necessidade percebida e acesso a serviços odontológicos. A análise dos dados foi realizada por meio de regressão logística, segundo referencial teórico baseado no Modelo Comportamental de Andersen, considerando a consulta odontológica não recente como variável dependente. Verificou-se elevada prevalência de problemas bucais auto-referidos e de perdas dentárias. Cerca de 40% dos adultos e 67% dos idosos não iam ao dentista há mais de três anos. Indivíduos que não residiam em domicílios próprios, realizavam higiene bucal com menor frequência e utilizavam próteses totais apresentaram maiores chances de haver utilizado os serviços odontológicos há mais tempo. O fato de possuir um dentista regular foi identificado como fator de proteção na análise. Concluindo, os determinantes individuais mostraram-se importantes indicadores de acesso aos serviços de saúde bucal. O modelo teórico confirmou a presença de desigualdades sociais e psicossociais na utilização de serviços odontológicos entre os adultos e idosos de baixa renda.

Color/race inequalities in oral health among Brazilian adolescents

This study assessed oral health outcomes (perceived dental treatment need, untreated dental caries, gingival bleeding, periodontal pockets, and pain in teeth and gums), in relation to color/race inequalities among adolescents in each Brazilian region. The database included dental examination and interview of 16,833 15-19-year-old adolescents, surveyed by the Brazilian health authority, from May 2002 to October 2003, in accordance with international diagnostic criteria standardized by the World Health Organization. Prevalence ratios estimated by Poisson regression, and controlled by socioeconomic status and access to fluoridated piped water, assessed oral health differentials among color/race groups and country's regions. Except for periodontal pockets, prevalence figures were higher in the North and Northeast: perceived dental treatment needs, untreated dental caries, gingival bleeding at probing and pain in teeth and gums varied between 80-83%, 75-76%, 38-43%, and 17-18%, respectively, in these regions. Adolescents living in the Southeast - the richest Brazilian region - presented a better general profile of oral health than their counterparts living in the remaining regions; they had a lower prevalence of untreated dental caries (54%) and unfavorable gingival status (29%). However, the Southeast presented color/race inequalities in all oral health outcomes, with a poorer profile systematically affecting browns or blacks, depending on the oral health condition under consideration. These results reinforce the need for expanding the amplitude of health initiatives aimed at adolescent oral health. Socially appropriate health programs should concurrently aim at the reduction of levels of oral disease and its inequalities.