Síndrome da fragilidade e fatores associados em idosos comunitários do município de Santa Cruz RN

The frailty in the elderly is characterized by decreased physiological reserves, and is associated with increased risk of disability and high vulnerability to morbidity and mortality. This study is part of a multicentric project on Frailty in Elderly Brazilians (REDE FIBRA). Aims: to investigate characteristics, prevalence and associated factors related to frailty. Metodology: We interviewed 391 elderly patients aged 65 years, selected randomly. Data collection was performed using a multidimensional questionnaire containing information about socio-demographic and clinical variables. To characterize the frail elderly, was considered the phenotype proposed by Fried. Data were analyzed using descriptive statistics, bivariate analysis (χ ²) and binary logistic regression. Results: The prevalence of frailty was 17.1%. In the final model of multivariate analysis, was obtained as factors associated with frailty: advanced chronological age (p <0.001), have comorbidity (p <0.035), show dependence on performing basic activities of daily living (p <0.010) and instrumental (p <0.003) and have poor perception of health status (p <0030). Conclusions: The factors associated with frailty suggest a predictive model helping to understand the syndrome, guiding actions that minimize adverse effects on the aging process

Validação do questionário Internacional de Atividade Física (IPAQ) através da acelerometria em idosas

Physical activity is one of the main components of a healthy lifestyle, responsible for many health benefits. Despite being considered important for both disease prevention and health promotion there is high prevalence of sedentary behavior in the elderly population. Questionnaires are practical and feasible instruments for assessing levels of physical activity. However, they may have limitations in older age ranges. Accelerometers, movement sensors that make physical activity data more objective, emerge as reliable measuring devices. Aim: Determine the validity of the International Physical Activity Questionnaire (IPAQ) adapted for elderly with accelerometry in elderly women. Methods: 57 elderly women, with mean age of 66.05 ± 5.98 years who took part in hypertension control and physical activity incentive programs were assessed in relation to objective and subjective measures of physical activity. The accelerometer was used for 07 consecutive days, 24 hours per day before the IPAQ was applied. Data were analyzed using measures of central tendency and dispersion to characterize the sample according to variables collected. To check the validity of the data we used the Spearman correlation test, considering a significance level of p <0.05. Results: With respect to the categories of physical activity obtained by IPAQ, 46.4% developed moderate physical activity, followed by a high (30.3%) and low level (23.2%). There was a negative correlation only between self-reported time spent sitting and time spent on light activities as measured by accelerometry (r = - 0.408; p = 0.003) and mean activity level (counts/min) with physical activity levels evaluated by IPAQ (r = 0.297; p = 0.036). Conclusion: The IPAQ used in elderly women shows moderate to low validity levels according to accelerometry measures. Assessment of sedentary activities exhibited acceptable levels compared to accelerometry; however, moderate (r = 0.096; p > 0.05) to vigorous (r = 0.098; p > 0.05) activities were not correlated, demonstrating the inability of IPAQ to evaluate this type of activity in elderly women

Influência da fadiga no comportamento neuromuscular do quadríceps femoral, após reconstrução do ligamento cruzado anterior

Muscle fatigue is a phenomenon that promotes physiological and biomechanical disorders and their changes in healthy subjects have been widely studied and have significant importance for care in preventing injuries, but we do not have many information about its effects in patients after ACL reconstruction. Thus, this study is to analyze the effects of fatigue on neuromuscular behavior of quadriceps after ACL reconstruction. To reach this objective, participants were forty men, twenty healthy (26,90 ± 6,29 years) and twenty after ACL reconstruction (29,75 ± 7,01 years) with a graft of semitendinosus and gracilis tendons, between four to six months after surgery. At first, there was an assessment of joint position sense (JPS) at the isokinetic dynamometer at a speed of 5°/s and target angle of 45° to analyze the absolute error of JPS. Next, we applied the a muscle fatigue protocol, running 100 repetitions of isokinetic knee flexion-extension at 90°/s. Concurrently with this protocol, there was the assessment of muscle performance, as the peak torque (PT) and fatigue index, and electromyographic activity (RMS and median frequency). Finally, we repeated the assessment of JPS. The statistical analysis showed that patients after ACL reconstruction have, even under normal conditions, the amended JPS compared with healthy subjects and that after fatigue, both have disturbances in the JPS, but this alteration is significantly exacerbated in patients after ACL reconstruction. About muscle performance, we could notice that these patients have a lower PT, although there are no differences between the dynamometric and EMG fatigue index. These findings show the necessity about the cares of pacients with ACL reconstruction in respect of the risks of articulate instability and overload in ligamentar graft

Saúde física e emocional de cuidadores da cidade de Santa Cruz-RN: perfil epidemiológico e fatores associados

Taking care for an impaired elderly is a hard and costly task that could affect directly the caregiver health. The purpose of this study was to evaluate the physical and mental health of elderly caregivers from the city of Santa Cruz-RN and analyze the potential correlated factors through an observational analytic design of a crosssectional. A multidimensional questionnaire was used to evaluation of the social demographics characteristics and those related to the care activity, as well as the caregivers´ physical and mental health. It was realized a descriptive analyze using frequency distribution and measures of the central tendency and dispersion to description of the caregivers. To verify the magnitude of the association between the variables was used the bivariate analysis through the Pearson and Spearman correlations and qui-square test. To evaluation of the association of the correlated factors to the adverse outcome with the caregivers´ physical and mental health was made a multivariate analysis by logistic binary regression and multiple linear regression models. The final sample was constituted by 304 persons, mostly women with a mean age of 50.3 ±16.8 years. The principal factors related to the physical health were age, stress and life satisfaction. Be a male caregiver, caring for a little while the elderly with cognitive deficit and not been spouse were related to worse mental health. Have worse physical health, high stress, depressive symptomatology, burden and low levels of satisfaction were also related to the mental health. After adjust through multiple linear regression was observed R2 values of R2=0,21 for Stress, R2 =0,17 for Depressive Symptomatology, R2 =0,21 for Burden and R2 =0,16 for Satisfaction. The attainment of the factors associated with caregiver´s health can help in the elaboration of specifics politics witch the goal is the integral attention to the elderly and his caregiver. The inability of continuous taking care could result in adverse outcomes such as institutionalization, impairment and death

Ánálise da capacidade funcional e da distribuição regional da ventilação pulmonar em pacientes com doença de chagas

INTRODUCTION: Cardiac and pulmonary manifestations of the Chagas disease (CD) affect between 20-30% of the infected subjects. The chronic Chagas cardiomyopathy (CCC) has some peculiarities such as arrhythmias and, especially heart failure (HF) and is potentially lethal due to left ventricular dysfunction. How respiratory disorders, patients get progressive loss of functional capacity, which contributes to a poor quality of life related to disease. Measurements of lung volume by the movement of the chest wall surface are an alternative evaluation of lung function and kinematics of complex thoracoabdominal for these patients. OBJECTIVE: evaluate the kinematics of the thoracoabdominal complex through the regional pulmonary volumes and to correlate with functional evaluation of the cardiorrespiratory system in patients with Chagas disease at rest. MATERIALS AND METHODS: a cross-section study with 42 subjects had been divided in 3 groups, 15 composed for patients with CCC, 12 patients with HF of different etiologies and 15 healthful presented control group. An optoelectronic plethysmography (POE), Minnesota questionnaire, six minute walk test, spirometer and manovacuometer was used. RESULTS: It was observed in the 6MWT where group CRL presented greater distance 464,93±44,63m versus Group HF with 399,58± 32,1m (p=0,005) and group CCC 404±68,24m (p=0,015), both the groups presented difference statistics with regard to Group CRL. In the manovacuometer 54,59±19,98; of the group CCC and 42,11±13,52 of group IC found group CRL presented 81,31±15,25 of the predicted versus, presenting in relation to group CRL. In the POE it observed a major contribution in abdominal compartment in patients with IC if compared like CCC and control groups. On the basis of the questionnaire of quality of life of Minessota, verified a low one groups CCC and IC 43,2±15,2 and 44,4±13,1, respectively (p<0,05) when compared with the control group (19,6±17,31). CONCLUSION: it seems that the patients with CCC possess same functional and respiratory characteristics, observed for the POE, 6MWT, manovacuometer and spirometer to the patients of group HF, being able to consider similar interventions for this complementary group as therapeutical of this neglected disease

Efeitos da eletroestimulação sobre os parâmetros eletromiográficos e dinamométricos do músculo quadríceps femoral

To analyze the effects of electrical stimulation at two frequencies on the EMG parameters (EMG) and dynamometer, in muscles with different typing. MATERIALS AND METHODS: This is a controlled clinical trial, randomized and double blind. Sixty healthy volunteers (23.6 ± 4.2anos; 54.2 ± 7.7kg, 1.62 ± 0.009 cm) of both sexes were divided randomly into three groups: control group (CG), experimental group 1 (SG1) with application of the current Russian 30 HZ and experimental group 2 (EG2) at 70 Hz The volunteers performed an initial assessment (AV1) on the isokinetic dynamometer with three repetitions maximum voluntary isometric (MVC) for knee extension concomitant uptake of EMG for the VM muscle, VL and RF. Later, after application of NMES, they underwent an experimental protocol of isometric fatigue using 70% of MVIC, ending with the completion of a final assessment (AV2) in the same manner as the AV1. RESULTS: By analyzing the profile of the 60 subjects in three broad, VM showed a higher value of RMS behavior when the VL and RF (p = 0.03 and p = 0.02). With respect to Fmed the RF muscle (p = 0.001) showed a higher value for the VM. The VM muscle showed significant increases of Fmed (p = 0.05) after electrical stimulation at 70 Hz when compared the AV1 AV2 and RF showed significant decreases (p = 0.009) after stimulation at 30 Hz during the fatigue showed an increase RMS in the VM and VL, with a reduction in RF. For the variable Fmed was observed in three broad decline during fatigue. CONCLUSION: Our findings provide evidence that the muscles VM, VL and RF fiber typing are different besides indicating that the frequency of NMES tend to relate to the muscle stimulated. Finally suggests the surface EMG as a noninvasive method for characterizing muscle

Tradução e adaptação transcultural do instrumento de avaliação prenatal selfevaluation questionnaire

Introduction: The human gestation period is 40 weeks. This is the essential time for maternal psychosocial adaptation, in which there is the intense transformation of a life without offspring into a life with one or more children. The Pregnancy Self-Evaluation Questionnaire (PSEQ) has 79 items, subdivided into seven subcategories: acceptance of pregnancy, identification with the maternal role, well-being of mother and baby, preparing for labor, control in labor, relationship with the mother and the relationship with the partner. Objective: To translate and cross-culturally adapt the instrument PSEQ to be used with Brazilian women. Methods: It is a cross-sectional observational study. We followed some methodological steps to achieve the cross-cultural adaptation of this measuring instrument. They are: translation, synthesis, back translation, analysis of the committee of specialists and pre-test. Another questionnaire was applied to characterize the socio-demographic and clinical status of the pregnant women (n = 36). The descriptive statistics was gotten through the average, standard deviation (SD), absolute and relative frequency. The statistical test used for the analysis of the internal consistency was Cronbach's alpha coefficient, using SPSS version 17.0. Results: The volunteers had low socioeconomic status, average age of 25.1 years (± 5.52), and average gestational age of 25.9 weeks (± 8.11). 58.3% of these volunteers had not planned their current pregnancy. The pretest showed that 75% of pregnant women found the questionnaire easy to understand. There was an average of 76.9 (± 3.23) answered items among the participants. Regarding the instrument PSEQ, the identification with the maternal role was the subcategory which showed the highest average 24.8 (± 5.6), while the relationship with the mother had the lowest average 15.4 (± 7.7). The internal consistency ranged from 0.52-0.89. Conclusion: The translation and cross-cultural adaptation of the PSEQ to Portuguese language were carried out with methodological rigor and can be considered an instrument with good internal consistency

Efeitos da eletroestimulação percutânea na incontinência urinária e qualidade de vida pós-prostatectomia: registro de seis casos

Introduction: Radical prostatectomy surgery is the best treatment currently adopted by detecting prostate cancer. The urinary incontinence is one more common and difficult to treat postoperative complications, which causes a negative impact on quality of life of the individual prostatectomy . The surface electrical nerve stimulation involves the transmission of electrical impulses from an external stimulator for peripheral nerve through surface electrodes attached to skin. It is an easy and efficient technique, widely used for pain relief, rehabilitation and muscle strengthening. Objective: To analyze the effect of T10-L2 percutaneous electrical stimulation, in individuals with urinary incontinence who underwent radical prostatectomy by the laparoscopic technique. Methods: Six patients had previously undergone radical prostatectomy were submitted to 20 sections of surface electrical stimulation with frequency of 4 Hz, pulse width of 1ms during 20 minutes. All subjects fillid a quality of life - International Consultation on Incontinence Questionnaire- Short FormI - ICIQ-SF questionnaire evaluating. Results: Results showed reduction in the use of the number of pads, number of leaks before and after treatment, and reduced voiding frequency and consequent improvement in quality of life. No side effects were reported. Conclusion: Percutanous electrical stimulation in T10-L2 may be an effective technique to treat urinary incontinence (UI) after radical prostatectomy video laparoscopy

Velocidade da marcha como preditor de fragilidade em uma amostra populacional de idosos brasileiros

Gait speed has been described as a predictive indicator of important adverse outcomes in older populations. Among the criteria to evaluate frailty, gait speed has been identified as the most reliable predictor of fragility, practical and low cost. Objective: This study assesses the discriminating capability of gait speed in determining the presence of fragility in the elderly community in northeast of Brazil. Method: We performed an observational analytic study with a transversal character with a sample of 391 community-living elders, aged 65 years or older, of both sexes, in the city of Santa Cruz-RN. Participants were interviewed using a multidimensional questionnaire to obtain sociodemographic information, physical-related and mental health-related information. The unintentional weight loss, muscle weakness, self-reported exhaustion, slow gait and low-physical activity were considered to evaluate the frailty syndrome. Gait velocity was measured as the time taken to walk the middle 4,6 meters of 8,6 meters (excluding 2 meters to warm-up phase and 2 meters to deceleration phase).We calculate the sensitivity and specificity of gait speed test in different cutoff points for the test run time, from which ROC curve was constructed as a measure of test predictive value to identify frail elders. The prevalence of frailty in Santa Cruz-RN was 17.1%. The gait speed test accuracy was 71%when speed is below 0,91m/s. Among women, the gait speed test accuracy was 80%(gait speed below 0.77m/s) and among men, the test accuracy was 86% (gait spend below 0,82%) (p<0,0001).Conclusion: our findings have clinical relevance when we consider that the detection of frailty presence by the gait speed test can be observed in elderly men and women by a simple, cheap and efficient exam

Efeitos da perda de peso induzida pela cirurgia bariátrica sobre a função respiratória

Background: Obesity leads to alteration of lung volumes and capacities due to accumulation of fat in the chest wall and abdomen. Few studies have shown that weight loss induced by surgery improves lung function. Our objective was to evaluate the anthropometric development, pulmonary function, respiratory muscle, strength and endurance after weight loss induced by bariatric surgery. Methods: We evaluated in pre and post operative period variables of weight, BMI, NC, WHR and spirometric and respiratory pressure. Results: 39 subjects were evaluated, with age mean 35.9 ± 10.9 years, predominantly by women (76.3%). The weight mean decreased from 124.8 ± 17.5 kg to 88.8 ± 14.28 kg in post operative. The mean BMI ranged from 47,9 ± 5,6 Kg/m² to 34,3 ± 4,75 Kg/m². There was a significant increase in FVC from 3,63 ± 0,94 to 4,01±1,03, FEV1 from 3,03 ± 0,72 to 3,39 ± 0,85, FEF 25-75% from 3,41 ± 0,72 to 3,82 ± 0,94, PEF from 6,56 ± 1,47 to 7,81 ± 1,69, ERV from 0,35 ± 0,39 to 0,66 ± 0,38, MVV ranged from 103,43 ± 22,21 to 137,27 ± 29,84, all of them to p<0,01. The MIP and MEP showed no significant difference in pre and post operative. It was noted that for every centimeter reduced in neck circumference, an increase of 0.06 in FVC and 5.98 in MVV is observed. This is also observed in weight and BMI. Conclusion: We conclude that weight loss induced by bariatric surgery in obese provides a significant improvement in lung function and reduction of fat around the neck is more important in the generation of lung volume than the reduction of BMI

Influência do biofeedback no treino de marcha de sujeitos hemiparéticos: ensaio clínico randomizado

BACKGROUND: Treadmill training with partial body weight support (BWS) has shown many benefits for patients after a stroke. But their findings are not well known when combined with biofeedback. OBJETIVE: The purpose of this study was to evaluate the immediate effects of biofeedback, visual and auditory, combined with treadmill training with BWS on on walking functions of hemiplegic subjects. METHODS: We conducted a clinical trial, randomized controlled trial with 30 subjects in the chronic stage of stroke, underwent treadmill training with BWS (control), combined with visual biofeedback, given by the monitor of the treadmill through the symbolic appearance of feet as the subject gave the step; or auditory biofeedback, using a metronome with a frequency of 115% of the cadence of the individual. The subjects were evaluated by kinematics, and the data obtained by the Motion Analysis System Qualisys. To assess differences between groups and within each group after training was applied to ANOVA 3 x 2 repeated measures. RESULTS: There were no statistical differences between groups in any variable spatio-temporal and angular motion, but within each group there was an increase in walking speed and stride length after the training. The group of visual biofeedback increased the stance period and reduced the swing period and reason of symmetry, and the group auditory biofeedback reduced the double stance period. The range of motion of the knee and ankle and the plantar flexion increased in the visual biofeedback group. CONCLUSION: There are no differences between the immediate effects of gait training on a treadmill with BWS performed with and without visual or auditory biofeedback. However, the visual biofeedback can promote changes in a larger number of variables spatiotemporal and angular gait

Efeitos do treino em esteira com suporte parcial de peso e do método de facilitação neuromuscular proprioceptiva na marcha hemiparética: estudo comparativo

Objective: To compare the effects of the treadmill training with partial body-weight support (TPBWS) and Proprioceptive Neuromuscular Facilitation (PNF) method on gait of subjects with chronic stroke. Design: Quasi-experimental study. Setting: Laboratorial research. Participants: Twenty-three subjects (13 men and 10 women), with a mean age of 56,7 ± 8,0 years and a mean time since the onset of the stroke of 27,7 ± 20,3 months, and able to walk with personal assistance or assistive devices. Interventions: Two experimental groups underwent gait training based on PNF method (PNF group, n=11) or using the TPBWS - Gait Trainer System 2, Biodex, USA (TPBWS group, n=12), for three weekly sessions, during four weeks. Measures: Evaluation of motor function - using the Stroke Rehabilitation Assessment of Movement (STREAM) and the motor subscale of the Functional Independence Measure (motor FIM) -, and kinematic gait analyze with the Qualisys System (Qualisys Medical AB, Gothenburg, Sweden) were carried out before and after the interventions. Results: Increases in the STREAM scores (F=49.189, P<0.001) and in motor FIM scores (F=7.093, P=0.016), as well as improvement in symmetry ratio (F=7.729, P=0.012) were observed for both groups. Speed, stride length and double-support time showed no change after training. Differences between groups were observed only for the maximum ankle dorsiflexion over the swing phase (F=6.046, P=0.024), which showed an increase for the PNF group. Other angular parameters remain unchanged. Conclusion: Improvement in motor function and in gait symmetry was observed for both groups, suggesting similarity of interventions. The cost-effectiveness of each treatment should be considered for your choice

Tradução, adaptação cultural e avaliação psicométrica da prova cognitiva de leganés em uma população idosa brasileira com baixo nível de escolaridade

Introdução: The scales of cognitive screening are important tools for early detection of dementia, creating the possibility of developing measures to slow this process and assist in the management of the disease. Objective: To validate the Leganés Cognitive Test (Prueba Cognitive de Leganés) (PCL) for cognitive screening in low educated elderly Brazilians. Methods: The study sample was composed of 59 elderly residents from the city of Santa Cruz, Brazil with low schooling levels. Reliability was analyzed with a 2-day interval between assessments, and concurrent validity was assessed using the Mini Mental State Examination (MMSE). Results: According to the PCL, the prevalence of dementia was 11.8%. The scale items showed a moderate to strong correlation between domains (p <0.01), and inter-rater reliability exhibited ICC = 0.81, 95% CI (0.72-0.88). Factor analysis resulted in two factors: memory and orientation. Interscale agreement was considered poor (k = - 0.02), supporting the hypothesis of an educational impact on final MMSE scores. Conclusion: The results suggest that PCL has acceptable levels of reliability for use in low educated elderly Brazilians

Desfechos clínicos e mortalidade de sujeitos submetidos à cirurgia bariátrica no Rio Grande do Norte

Introduction: Actually the obesity is a public health problem throughout the world. Bariatric surgery has been an efficient method of weight reduction body in severe obesity, reducing its associated effects and presenting low levels of immediate and late postoperative complications. In Brazil, bariatric surgery asa recent therapeutic that has been growing recently. Being Brazil a country with continental dimensions and with a huge diversity socioeconomic and cultural, it is essential to understand the reality of patients undergoing bariatric surgery in less economically privileged regions of Brazil. Objectives: To evaluate the epidemiological, clinical outcomes and mortality of patients undergoing videolaparoscopic bariatric surgery through the public health system in the Brazilian state of Rio Grande do Norte- Brazil. Methods: Observational descriptive study of a prospective, carried out from February 2009 to February 2011, the Clinic Obesity and Bariatric Surgery at Universitary Hospital Onofre Lopes - Federal University of Rio Grande do Norte (HUOL-UFRN). Anthropometric measures, comorbidity and deaths register were made in the postoperative period. Results: Seventy patients (54 women) with low income aged 22 to 63 years completed the study. We recorded the death of three patients during the study period. The results show significant decrease anthropometric parameters, especially in relation to body weight, waist circumference and hipin both sexes. Only Waist / Hip ratio showed no difference after intervention in male patients It had a resolution of comorbidities. No significant differences in reports of daily sleepiness and the snoring male patients. Conclusion: Our findings attest laparoscopic bariatric surgery as an effective method reducing weight and comorbidities in morbidly obese patients

A Short Physical Performance Battery (SPPB) como preditora da fragilidade em idosos residentes na comunidade

Introduction: The SPPB provides information about physical function and is a predictor of adverse events in the elderly. Frailty is a multidimensional syndrome that increases susceptibility to diseases and disability. However it may be possible to prevent or postpone frailty if is identified early. Our objective is to analyze SPPB s ability in screening for frailty a community-dwelling young elderly from cities with distinct socioeconomic conditions. Methods: Data were originated from community dwelling adults (65-74 years old) in Canada (Saint Bruno; n = 60) and Brazil (Santa Cruz; n = 64). SPPB was used to assess physical performance. Frailty was defined as the presence of ≥ 3 of these criteria: weight loss, exhaustion, weakness, mobility limitation and low physical activity. One point was given for each criterion met, totalizing a frailty score ranged from 0 to 5. The Linear Regression and Receiver Operating Characteristics analyses were performed to evaluate the SPPB s screening ability. Results: Mean age was 69.48, 10.0% of the Saint Bruno s sample and 28.1% of Santa Cruz s were frail (p = 0.001), the SPPB score means were 9.6 and 8.5 respectively (p = 0.01). SPPB correlated with the frailty score (R2 = 0.33), with better results for Saint Bruno. A cutoff of 9 in SPPB had good sensitivity and specificity in discriminating frail from non frail in Saint Bruno (AUC = 0.81) but showed fair results in Santa Cruz (AUC = 0.61). Conclusion: The SPPB has moderate ability in predicting frailty among older adult s population, and is an useful test to identify people with good functionality and low frailty when SPPB scores are ≥9