Exercícios respiratórios para asma: revisão sistemática com metanálise

Introdução: A asma se tornou um problema de saúde pública devido aos seus grandes custos em cuidados de saúde. Os exercícios respiratórios constituem uma intervenção não farmacológica de baixo custo e baixo risco que vem sendo utilizada por fisioterapeutas em diferentes países no tratamento de pacientes asmáticos. Objetivo: Avaliar a eficácia dos exercícios respiratórios no tratamento de pacientes adultos com asma nos seguintes desfechos: qualidade de vida, sintomas da asma, número de exacerbações agudas, episódios de hospitalização, mensurações fisiológicas (função pulmonar e capacidade funcional), número de consultas médicas, número de faltas no trabalho devido a exacerbações da doença, avaliação subjetiva do paciente em relação à intervenção. Método: Revisão sistemática de estudos controlados randomizados com metanálise realizada em parceria com a Colaboração Cochrane. As seguintes bases de dados foram consultadas: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, e PsycINFO, além de busca manual em revistas da área e em resumos de congressos. Os seguintes termos foram utilizados: (breath*) and (exercise* or retrain* or train* or re-educat* or educat* or physiotherap* or "physical therap*" or "respiratory therapy" or buteyko ). As listas de referências dos estudos selecionados e registros de ensaios clínicos também foram consultados. A seleção dos estudos e a avaliação do risco de viés dos estudos incluídos foram realizadas de maneira independente por dois revisores. O software Review Manager foi utilizado para análise dos dados, no qual o modelo de efeito fixo foi utilizado. As variáveis contínuas foram expressas como diferença de média ponderada com um intervalo de confiança de 95%. A heterogeneidade dos resultados dos estudos incluídos foi realizada por meio da análise dos Forest plots. O teste qui-quadrado (Chi2) com um P valor de 0.10 foi utilizado para indicar significância estatística. O Índice de heterogeneidade (I2) foi implementado com um valor acima de 50% como um nível substancial de heterogeneidade. Resultados: 13 estudos envolvendo 906 pacientes estão atualmente incluídos na revisão. Os seguintes desfechos foram mensurados pelos estudos incluídos: qualidade de vida, sintomas da asma, número de exacerbações agudas e função pulmonar. Os estudos relataram uma melhora na qualidade de vida, sintomas da asma e número de exacerbações agudas. Seis dos onze estudos que avaliaram função pulmonar mostraram uma diferença significativa favorável aos exercícios respiratórios. Não houve relato de efeitos adversos. Devido à heterogeneidade substancial encontrada entre os estudos, metanálise foi possível apenas para sintomas da asma, a qual incluiu dois estudos e mostrou uma diferença significativa favorável aos exercícios respiratórios. A avaliação do risco de viés foi prejudicada devido ao relato incompleto de aspectos metodológicos pela maioria dos estudos incluídos. Conclusão: Embora os resultados encontrados pelos estudos incluídos demonstraram individualmente que os exercícios respiratórios podem ser importantes no tratamento da asma, não há evidência conclusiva nesta revisão para suportar ou refutar a eficácia desta intervenção no tratamento de pacientes asmáticos. Este fato foi devido às diferenças metodológicas entre os estudos incluídos e à ausência de relato de aspectos metodológicos por parte da maioria dos estudos incluídos. Não há dados disponíveis em relação aos efeitos dos exercícios respiratórios nos seguintes desfechos: episódios de hospitalização, número de consultas médicas, número de faltas no trabalho devido a exacerbações da doença, e avaliação subjetiva do paciente em relação à intervenção

Treinamento muscular inspiratório para asma: revisão sistemática com metanálise

In asthmatic, the lung hyperinflation leaves the inspiratory muscle at a suboptimal position in length-tension relationship, reducing the capacity of to generate tension. The increase in transversal section area of the inspiratory muscles could reverse or delay the deterioration of inspiratory muscle function. Objective: To evaluate the evidence for the efficacy of inspiratory muscle training (IMT) with an external resistive device in patients with asthma. Methods: A systematic review with meta-analysis was carried out. The sources researched were the Cochrane Airways Group Specialised Register of trials, Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 11 of 12, 2012), MEDLINE, EMBASE, PsycINFO, CINAHL, AMED, ClinicalTrials.gov and reference lists of articles. All databases were searched from their inception up to November 2012 and there was no restriction on the language of publication. Randomised controlled trials that involved the use of an external inspiratory muscle training device versus a control (sham or no inspiratory training device) were considered for inclusion. Two reviewers independently selected articles for inclusion, evaluated risk of bias in studies and extracted data. Results: A total of five studies involving 113 asthmatic patients were included. Three clinical trials were produced by the same group. The included studies showed a significant increase in maximal inspiratory pressure (MD 13.34 cmH2O, 95% CI 4.70 to 21.98), although the confidence intervals were wide. There was no statistically significant difference between the IMT group and the control group for maximal expiratory pressure, peak expiratory flow rate, forced expiratory volume in one second, forced vital capacity, sensation of dyspnea and use of beta2-agonist. There were no studies describing exacerbation events that required a course of oral and inhaled corticosteroids or emergency department visits, inspiratory muscle endurance, hospital admissions and days of work or school. Conclusions: There is no conclusive evidence in this review to support or refute inspiratory muscle training for asthma, once the evidence was limited by the small number of studies included, number of participants in them together with the risk of bias. More well conducted randomized controlled trials are needed, such trials should investigate respiratory muscle strength, exacerbation rate, lung function, symptoms, hospital admissions, use of medications and days off work or school. IMT should also be assessed in the context of more severe asthma

Fisioterapia respiratória em crianças com pneumonia: revisão sistemática

Introduction: Pneumonia is an inflammatory lung disease and it is the greatest cause of deaths in children younger than five years of age worldwide. Chest physiotherapy is widely used in the treatment of pneumonia because it can help to eliminate inflammatory exudates and tracheobronchial secretions, remove airway obstructions, reduce airway resistance, enhance gas exchange and reduce the work of breathing. Thus, chest physiotherapy may contribute to patient recovery as an adjuvant treatment even though its indication remains controversial. Objectives: To assess the effectiveness of chest physiotherapy in relation to time until clinical resolution in children (from birth up to 18 years old) of either gender with any type of pneumonia. Methods: We searched CENTRAL 2013, Issue 4; MEDLINE (1946 to May week 4, 2013); EMBASE (1974 to May 2013); CINAHL (1981 to May 2013); LILACS (1982 to May 2013); Web of Science (1950 to May 2013); and PEDro (1950 to May 2013). We consulted the ClinicalTrials.gov and the WHO ICTRP registers to identify planned, ongoing and unpublished trials. We consulted the reference lists of relevant articles found by the electronic searches for additional studies. We included randomised controlled trials (RCTs) that compared chest physiotherapy of any type with no chest physiotherapy in children with pneumonia. Two review authors independently selected the studies to be included in the review, assessed trial quality and extracted data. Results: Three RCTs involving 255 inpatient children are included in the review. They addressed conventional chest physiotherapy, positive expiratory pressure and continuous positive airway pressure. The following outcomes were measured: duration of hospital stay, time to clinical resolution (observing the following parameters: fever, chest indrawing, nasal flaring, tachypnoea and peripheral oxygen saturation levels), change in adventitious sounds, change in chest X-ray and duration of cough in days. Two of the included studies found a significant improvement in respiratory rate and oxygen saturation whereas the other included study failed to show that standardised respiratory physiotherapy and positive expiratory pressure decrease the time to clinical resolution and the duration of hospital stay. No adverse effects related to the interventions were xvi described. Due to the different characteristics of the trials, such as the duration of treatment, levels of severity, types of pneumonia and the techniques used in children with pneumonia, as well as differences in their statistical presentation, we were not able to pool data. Two included studies had an overall low risk of bias whereas one included study had an overall unclear risk of bias. Conclusion: Our review does not provide conclusive evidence to justify the use of chest physiotherapy in children with pneumonia due to a lack of data. The number of included studies is small and they differed in their statistical presentation

Efeitos do tratamento com Hidrogel na cicatrização de úlceras venosas de membros inferiores: revisão sistemática

Chronic venous disease (CVD) is evident among the chronic diseases and affects the elderly population and primarily is responsible for leg ulcers in this population. The use of dressings in the care of a venous ulcer is a fundamental part of the treatment for healing, however, evidence to assist in choosing the best dressing is scarce. The main objective of this study was to evaluate the effectiveness of treatment with hydrogel in the healing of venous ulcers using search methods, synthesis of information and statistical research through a systematic review and meta-analysis. Randomized controlled trials were selected in the following databases: CENTRAL; DARE; NHS EED; MEDLINE; EMBASE; CINAHL. Beyond these databases three websites were consulted to identify ongoing studies: ClinicalTrials.gov, OMS ICTRP e ISRCTN. The primary outcomes were analyzed: complete wound healing, incidence of wound infection and the secondary were: changes in ulcer size, time to ulcer healing, recurrence of ulcer, quality of life of participants, pain and costs of treatment. Four studies are currently included in the review with a total of 250 participants. The use of hydrogel appears to be superior to conventional dressing, gauze soaked in saline, for the healing of venous leg ulcers; 16/30 patients showed complete healing of ulcers (RR 5,33, 95%CI [1,73,16,42]). The alginate gel was shown to be more effective when compared to the hydrogel dressing in reduction of the wound area; 61,2% (± 26,2%) with alginate e 19,4% (± 24,3%) with hydrogel at the end of four weeks of treatment. Manuka honey has shown to be similar to the hydrogel dressings in percentage of area reduction. This review demonstrated that there is no evidence available about the effectiveness of the hydrogel compared to other types of dressings on the healing of venous leg ulcers of the lower limbs, thus demonstrating the need of future studies to assist health professionals in choosing the correct dressing.

Compromisso social do psicólogo em artigos publicados em periódicos científicos no Brasil

Psychologist s social commitment in scientific articles published in scientific papers in Brazil. A situation analysis of the scientific production concerning psychologist s social commitment can aid the historical constitution of this theme and also subsidize reflections about the course of this profession in Brazil. In order to contribute to this debate, the theme social commitment of psychologist was analyzed in the scientific literature concerning psychologist profession in the country. Specifically, papers about the profession that mentioned the theme social commitment were characterized and their approach of this matter was analyzed. In order to accomplish these goals, two research stages were fulfilled: first, in a systematic search for scientific literature in internet databases, studies about the psychologist profession in the country were gathered; in the second stage, scientific papers relating to social commitment in their titles, abstracts or keywords were selected. 61 papers were retrieved, organized in electronic database and full-text analyzed, based in two axis: scientometric and thematic. The papers were identified, in general, as recent, of theoretic character and aligned with several Psychology subareas; mainly produced in public universities, in country s southwest; were of conjunctural interest to the authors research projects, individually published, by professors in touch with post-graduation; published in open access journals, with high Qualis evaluation. It was verified that there is no consensus on the meaning of the theme, prevailing definitions concerning the understanding of the social reality, to the majority of people or to a progressive-aligned professional performance. Are adduced as committed agents: the psychologist (sometimes together with other kinds of professionals or with users), the academia, and the representative entities of the profession. Depending on the subareas and the nature of study, all papers mentioned at least one of the following criteria: expansion of target-audience, renewal of practices, political direction, defined theoretical approach or adequate technical competence, sometimes relating each other. In short, psychologist s social commitment is a contradictory issue which have earned projection in scientific literature, reiterating the historical custom of evaluate the psychologist profession. As conclusion, it is regarded as indispensable to intensify the reflection about the role whose psychologist plays in a class-cleaved society and the limits and potentials of his performing in that framework.

Psicologia e pobreza no Brasil: limites e perspectivas da produção de conhecimento e atuação do psicólogo

Poverty is a main theme in Brazil: according to official data, poverty reachs 70 million Brazilian people, and, between them, 20 million are unable to provide their basic needs. Psychology, as a welfare profession, and given its historical concerns with social actions, could not be away from this theme. Based on this, we ask: Which answers Psychology can provide, toward both the production of knowledge and the practice about social reality? The purpose of this paper is to investigate the psychological scientific production on poverty and the propositions, limits and impacts of psychological actions. We carried out a three stages documental based study analyzing Brazilian psychological literature: (1) online databases survey (312 papers identified); (2) 109 scientific abstracts accessed and coded; (3) selected 47 scientific papers read and analyzed. Results are presented in three sections: general description of the selected scientific production; characterization of the role of poverty in psychological literature; and themes presented at the papers. The academic production about the main theme (poverty) is dispersed, heterogeneous, and related to other fields of knowledge. Poverty is presented at these studies in many ways, such as: a criterium for sample design and the assessment of its psychological impacts; reports on professional experience with poor population; descriptions of this population group; relationship between poverty and others social themes; developmental and learning problems of poor children. In general, it appears that Psychology has improved the scientific production and experiences with poor population. However, it is necessary to build up theories and technical innovations and also to understand structural boundaries for professional practice with this population group

Uma nova forma de calcular os centros dos Clusters em algoritmos de agrupamento tipo fuzzy c-means

Clustering data is a very important task in data mining, image processing and pattern recognition problems. One of the most popular clustering algorithms is the Fuzzy C-Means (FCM). This thesis proposes to implement a new way of calculating the cluster centers in the procedure of FCM algorithm which are called ckMeans, and in some variants of FCM, in particular, here we apply it for those variants that use other distances. The goal of this change is to reduce the number of iterations and processing time of these algorithms without affecting the quality of the partition, or even to improve the number of correct classifications in some cases. Also, we developed an algorithm based on ckMeans to manipulate interval data considering interval membership degrees. This algorithm allows the representation of data without converting interval data into punctual ones, as it happens to other extensions of FCM that deal with interval data. In order to validate the proposed methodologies it was made a comparison between a clustering for ckMeans, K-Means and FCM algorithms (since the algorithm proposed in this paper to calculate the centers is similar to the K-Means) considering three different distances. We used several known databases. In this case, the results of Interval ckMeans were compared with the results of other clustering algorithms when applied to an interval database with minimum and maximum temperature of the month for a given year, referring to 37 cities distributed across continents

Algoritmos de agrupamento aplicados a dados de expressão gênica de câncer: um estudo comparativo

The use of clustering methods for the discovery of cancer subtypes has drawn a great deal of attention in the scientific community. While bioinformaticians have proposed new clustering methods that take advantage of characteristics of the gene expression data, the medical community has a preference for using classic clustering methods. There have been no studies thus far performing a large-scale evaluation of different clustering methods in this context. This work presents the first large-scale analysis of seven different clustering methods and four proximity measures for the analysis of 35 cancer gene expression data sets. Results reveal that the finite mixture of Gaussians, followed closely by k-means, exhibited the best performance in terms of recovering the true structure of the data sets. These methods also exhibited, on average, the smallest difference between the actual number of classes in the data sets and the best number of clusters as indicated by our validation criteria. Furthermore, hierarchical methods, which have been widely used by the medical community, exhibited a poorer recovery performance than that of the other methods evaluated. Moreover, as a stable basis for the assessment and comparison of different clustering methods for cancer gene expression data, this study provides a common group of data sets (benchmark data sets) to be shared among researchers and used for comparisons with new methods

Uma Análise de métodos de distriubuição de atributos em comitês de classificadores

The objective of the researches in artificial intelligence is to qualify the computer to execute functions that are performed by humans using knowledge and reasoning. This work was developed in the area of machine learning, that it s the study branch of artificial intelligence, being related to the project and development of algorithms and techniques capable to allow the computational learning. The objective of this work is analyzing a feature selection method for ensemble systems. The proposed method is inserted into the filter approach of feature selection method, it s using the variance and Spearman correlation to rank the feature and using the reward and punishment strategies to measure the feature importance for the identification of the classes. For each ensemble, several different configuration were used, which varied from hybrid (homogeneous) to non-hybrid (heterogeneous) structures of ensemble. They were submitted to five combining methods (voting, sum, sum weight, multiLayer Perceptron and naïve Bayes) which were applied in six distinct database (real and artificial). The classifiers applied during the experiments were k- nearest neighbor, multiLayer Perceptron, naïve Bayes and decision tree. Finally, the performance of ensemble was analyzed comparatively, using none feature selection method, using a filter approach (original) feature selection method and the proposed method. To do this comparison, a statistical test was applied, which demonstrate that there was a significant improvement in the precision of the ensembles

Abordagem de construção de arquitetura homogênea para comitês via meta-aprendizagem

In the world we are constantly performing everyday actions. Two of these actions are frequent and of great importance: classify (sort by classes) and take decision. When we encounter problems with a relatively high degree of complexity, we tend to seek other opinions, usually from people who have some knowledge or even to the extent possible, are experts in the problem domain in question in order to help us in the decision-making process. Both the classification process as the process of decision making, we are guided by consideration of the characteristics involved in the specific problem. The characterization of a set of objects is part of the decision making process in general. In Machine Learning this classification happens through a learning algorithm and the characterization is applied to databases. The classification algorithms can be employed individually or by machine committees. The choice of the best methods to be used in the construction of a committee is a very arduous task. In this work, it will be investigated meta-learning techniques in selecting the best configuration parameters of homogeneous committees for applications in various classification problems. These parameters are: the base classifier, the architecture and the size of this architecture. We investigated nine types of inductors candidates for based classifier, two methods of generation of architecture and nine medium-sized groups for architecture. Dimensionality reduction techniques have been applied to metabases looking for improvement. Five classifiers methods are investigated as meta-learners in the process of choosing the best parameters of a homogeneous committee.

Análise das medidas de boa e má diversidade na construção de comitês de classificadores através de metaheurísticas de otimização multiobjetivo

Committees of classifiers may be used to improve the accuracy of classification systems, in other words, different classifiers used to solve the same problem can be combined for creating a system of greater accuracy, called committees of classifiers. To that this to succeed is necessary that the classifiers make mistakes on different objects of the problem so that the errors of a classifier are ignored by the others correct classifiers when applying the method of combination of the committee. The characteristic of classifiers of err on different objects is called diversity. However, most measures of diversity could not describe this importance. Recently, were proposed two measures of the diversity (good and bad diversity) with the aim of helping to generate more accurate committees. This paper performs an experimental analysis of these measures applied directly on the building of the committees of classifiers. The method of construction adopted is modeled as a search problem by the set of characteristics of the databases of the problem and the best set of committee members in order to find the committee of classifiers to produce the most accurate classification. This problem is solved by metaheuristic optimization techniques, in their mono and multi-objective versions. Analyzes are performed to verify if use or add the measures of good diversity and bad diversity in the optimization objectives creates more accurate committees. Thus, the contribution of this study is to determine whether the measures of good diversity and bad diversity can be used in mono-objective and multi-objective optimization techniques as optimization objectives for building committees of classifiers more accurate than those built by the same process, but using only the accuracy classification as objective of optimization

Novos métodos determinísticos para gerar centros iniciais dos grupos no algoritmo fuzzy C-Means e variantes

Data clustering is applied to various fields such as data mining, image processing and pattern recognition technique. Clustering algorithms splits a data set into clusters such that elements within the same cluster have a high degree of similarity, while elements belonging to different clusters have a high degree of dissimilarity. The Fuzzy C-Means Algorithm (FCM) is a fuzzy clustering algorithm most used and discussed in the literature. The performance of the FCM is strongly affected by the selection of the initial centers of the clusters. Therefore, the choice of a good set of initial cluster centers is very important for the performance of the algorithm. However, in FCM, the choice of initial centers is made randomly, making it difficult to find a good set. This paper proposes three new methods to obtain initial cluster centers, deterministically, the FCM algorithm, and can also be used in variants of the FCM. In this work these initialization methods were applied in variant ckMeans.With the proposed methods, we intend to obtain a set of initial centers which are close to the real cluster centers. With these new approaches startup if you want to reduce the number of iterations to converge these algorithms and processing time without affecting the quality of the cluster or even improve the quality in some cases. Accordingly, cluster validation indices were used to measure the quality of the clusters obtained by the modified FCM and ckMeans algorithms with the proposed initialization methods when applied to various data sets

Algoritmos de agrupamentos fuzzy intervalares e índice de validação para agrupamento de dados simbólicos do tipo intervalo

Symbolic Data Analysis (SDA) main aims to provide tools for reducing large databases to extract knowledge and provide techniques to describe the unit of such data in complex units, as such, interval or histogram. The objective of this work is to extend classical clustering methods for symbolic interval data based on interval-based distance. The main advantage of using an interval-based distance for interval-based data lies on the fact that it preserves the underlying imprecision on intervals which is usually lost when real-valued distances are applied. This work includes an approach allow existing indices to be adapted to interval context. The proposed methods with interval-based distances are compared with distances punctual existing literature through experiments with simulated data and real data interval

Percepção e ações educativas em ambientes escolares: enfoques aos documentos legais determinantes em área de proteção ambiental

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Estudo geológico e geofísico da falha de carnaubais, Bacia Potiguar-RN, e implicações neotectônicas

The segment of Carnaubais Fault located in the southeasthern portion of Guamaré Graben (Potiguar Basin) was studied. Several structures were detected and some of them strongly suggest that the last movements in Carnaubais Fault are of Neotectonic age. The study comprises an integrated interpretation of geologic, geomorphologic and geophysical data (gravimetry, magnetometry, resistivity, and self potential methods). According to the size of the studied areas, two approaches were used in this research. The first approach is of a regional nature and was conducted in an area, hereafter named Regional Area, having approximately 6,000 km2 and localized in the northern portion of Rio Grande do Norte state, around Macau city. The second approach comprises detailled studies of two small areas inside the Regional Area: the Camurupim and São Bento areas. Gravimetric and topographic data were used in the Regional Area. A separation into regional and residual components were conducted both on gravimetric and topographic data. The interpretation of the residual component of the gravimetric data allows a precise mapping of the borders of the Guamaré Graben. The regional component features of the topographic data are controlled by the pair of conjugate faults composed by the Carnaubais Fault (NE direction) and the Afonso Bezerra Fault (NW direction). On the other hand, the residual component of the topographic data shows that river valleis of NW direction are sharply interrupted where they intersect Carnaubais Fault. This fact is interpreted as an evidency that the last significant moviments occured in the Carnaubais Fault. Geologic, geomorphologic and geophysical data (magnetometry, resistivity, and self potential methods) were used in the Camurupim Area. The geologic mapping allows to identify five lithophacies unities. The first two unities (from base to top) were interpreted as composing a marine (or transitional) depositional sequency while the other were interpreted is composing a continental depositional sequence. The two sequences are clearly separated of an erosional discordance. The unities grouped in the marine sequence are composed by calcarenites (Unity A) and mudstones (Unity B). Unity A was deposited in a shalow plataform while Unity B, in a tidal flat. The unities grouped in the continental sequence are composed of conglomerate (Unity C) and sandstones (Unities D and E). Unities C and D are fluvial deposits while unity E is an eolian deposit. Unities A and B can be stratigraphycally correlated with Guamaré Formation. Unities C and D present three possible correlations. They may be correlated with Tibau Formation; or with Barreiras Formation; or with a clastic sediment deposit, commonly found in some rivers of Rio Grande do Norte state, and statigraphycally positioned above Barreiras Formation. Based on the decrease of the grain sizes from base to top both on unities C and D, it is proposed that these unities are correlated with the clastic sediment above mentioned. In this case, these unities would have, at least, Pleistocenic age. Finally, it is proposed that Unity E represent an eolian deposit that sufferred recent changes (at least in the Quaternary). The integrated interpretation of hydrographic, morphologic and geophysical data from Camurupim Area shows that Carnaubais Fault is locally composed by a system of several paralel subvertical faults. The fault presenting the larger vertical slip controls the valley of Camurupim river and separates the area in two blocks; in the nothern block the top of the Jandaira limestone is deeper than in the southern block. In addition, at least one of the faults in the northern block is cutting the whole sedimentary section. Because unities C , D, and/or E may be of Quaternary age, tectonic moviments possibly occured in Carnaubais Fault during this period. Detailled geologic mapping were conducted in beachrocks found in São Bento Area. This area is located at the intersection of the coast line with the Carnaubais Fault. The detected structures in the beachrocks are very similar to those caused by fragile deformations. The structures mapped in the beachrocks are consistent with a stress field with maximun compressional stress in E-W direction and extensional stress in the N-S direction. Since the Carnaubais Fault has a NE direction, it is optimally positioned to suffer tectonic movements under the action of such stress field. In addition, the shape of the coastal line appear to be controlled by the Carnaubais Fault. Furthemore, the observed structures in Camurupim Área are consistent with this stress field. These facts are interpreted as evidences that Carnaubais Fault and beachrocks suffered coupled tectonic movements. These moviments are of Neotectonic age because the beachrocks present ages less than 16,000 years