Uma perspectiva de extensão do modelo de aceitação de tecnologia para explicar o uso de linguagens de desenvolvimento WEB: pesquisa com desenvolvedores Pyton e Java

The spread of the Web boosted the dissemination of Information Systems (IS) based on the Web. In order to support the implementation of these systems, several technologies came up or evolved with this purpose, namely the programming languages. The Technology Acceptance Model TAM (Davis, 1986) was conceived aiming to evaluate the acceptance/use of information technologies by their users. A lot of studies and many applications have used the TAM, however, in the literature it was not found a mention of the use of such model related to the use of programming languages. This study aims to investigate which factors influence the use of programming languages on the development of Web systems by their developers, applying an extension of the TAM, proposed in this work. To do so, a research was done with Web developers in two Yahoo groups: java-br and python-brasil, where 26 Java questionnaires and 39 Python questionnaires were fully answered. The questionnaire had general questions and questions which measured intrinsic and extrinsic factors of the programming languages, the perceived usefulness, the perceived ease of use, the attitude toward the using and the programming language use. Most of the respondents were men, graduate, between 20 and 30 years old, working in the southeast and south regions. The research was descriptive in the sense of its objectives. Statistical tools, descriptive statistics, main components and linear regression analysis were used for the data analysis. The foremost research results were: Java and Python have machine independence, extensibility, generality and reliability; Java and Python are more used by corporations and international organizations than supported by the government or educational institutions; there are more Java programmers than Python programmers; the perceived usefulness is influenced by the perceived ease of use; the generality and the extensibility are intrinsic factors of programming languages which influence the perceived ease of use; the perceived ease of use influences the attitude toward the using of the programming language

Fatores da qualidade e satisfação na compra pela internet e sua influência na fidelidade dos consumidores

A presente pesquisa objetivou estudar as relações entre os fatores intervenientes para a satisfação no processo de compras baseadas na Internet e sua influência na fidelidade online (e-loyalty), na visão dos consumidores de varejo virtual. Para tanto, foi utilizado como instrumento de coleta de dados um questionário baseado em fatores de qualidade e fidelidade oriundos dos serviços convencionais, que foi adaptado para a realidade dos serviços digitais. A pesquisa caracteriza-se como exploratória, de natureza quantiqualitativa. A análise quantitativa descreveu e testou a relação de variáveis de qualidade do site e de preço dos produtos do site com as variáveis de satisfação. Neste caso, foram utilizadas técnicas estatísticas como distribuição de freqüência, médias e desvio-padrão e correlação de postos de Spearman. Já na abordagem qualitativa, foi empregada a análise de conteúdo para uma questão aberta relacionada com a identificação dos fatores que levam a fidelidade digital. A pesquisa de campo foi feita com uma amostra de 44 alunos de pós-graduação em nível de Especialização da Universidade Federal do Rio Grande do Norte. Os resultados da análise quantitativa evidenciaram que a qualidade está ligada à satisfação dos clientes em vários fatores, mas o preço não influencia muito na satisfação. Na análise qualitativa, a segurança do website e os preços oferecidos são fatores que potencialmente fidelizam os clientes digitais, segundo a perspectiva dos entrevistados. O fator segurança e confiança no website foi considerado o mais crítico para a fidelidade dos clientes que compram pela Internet

Fatores que afetam a satisfação e a fidelidade do cliente: um estudo com compradores de automóveis

This thesis presents a contribution to the study customer satisfaction models, analyzing the relationship between antecedent variables satisfaction and customer loyalty, through a survey with car s buyers in Natal. The theorical survey is focused in concepts of customer satisfaction and loyalty, and in the customer satisfaction index models. For the field survey, was applied a questionnaire, based on the Norwegian Customer Satisfaction Barometer (NCSB), considered by Johnson et al. (2001), with 106 customer of concessionary Fiat, the Pontanegra Automóveis. The main results obtained by the multiple regression analysis reveal that, considering the Fiat, the satisfaction is influencing by reliance degree in the firm seriousness and by complaining handling, the loyalty is influenced by possibility of again pay the same value if was again buy a car, the satisfaction degree with a car, affective commitment relationship firm customer of the own car and the complaining handling. Considering the concessionaire, the satisfaction is influenced by reliance degree in the firm seriousness, ability degree of the concessionaire in delivery service and by complaining handling, already the loyalty is influencing by possibility of again pay the same value if was again buy a car, affective commitment relations to be concessionaire s customer, by calculate commitment in relation the economic loss of bought this car of this firm and complaining handling

Um Estudo de Politicas e Práticas do uso do GNV no transporte público urbano do Brasil

The use of Natural Gas Vehicle has had a fast increase lately. However, in order to have a continuous success this Program needs to develop converting devices of Otto-cycle engines, gasoline or alcohol, to the use of NGV (Natural Gas Vehicle) that presents low cost, maintaining the same original development of the vehicle and low level of emissions, considering the PROCONVE rules. Due to the need to diversify the matrix in order to avoid energetic dependence and due to strict pollution control, it has increased in the Brazilian market the number of vehicles converted to the use of NGV. The recent regulation of the PROCONVE, determining that the converted engines with kits should be submitted to emission testing, comes to reinforce the necessity of the proposed development. Therefore, if we can obtain kits with the characteristics already described, we can reach a major trust in the market and obtain an increase acceptance of the vehicle conversion for NGV. The use of natural gas as vehicle fuel presents several advantages in relation to liquid fuels. It is a vehicle fuel with fewer indexes of emissions when compared to diesel; their combustion gases are less harmful, with a major level of safety than liquid fuels and the market price is quite competitive. The preoccupation that emerges, and the motivation of this project, is to know which are the main justifications for such technology, well accepted in other countries, with a low index or emission, with a high level of safety, where its maintenance becomes low, reminding that for this it is necessary that this technology has to be used properly, and once available in the market will not motivate interest in the urban transportation companies in Brazil, in research centers in general. Therefore this project exists to show the society in a general way the current vision of the main governmental factors, of the national research centers and of the private companies concerning the use of natural gas vehicles in urban transport vehicles, in order to give a major reliability to the population as well as to motivate national market competitiveness with a low cost and reliable product and to enrich the national technology

Modelagem de equações estruturais na análise de dados de serviços em comunicações móveis

In recent decades, changes have been occurring in the telecommunications industry, allied to competition driven by the policies of privatization and concessions, have fomented the world market irrefutably causing the emergence of a new reality. The reflections in Brazil have become evident due to the appearance of significant growth rates, getting in 2012 to provide a net operating income of 128 billion dollars, placing the country among the five major powers in the world in mobile communications. In this context, an issue of increasing importance to the financial health of companies is their ability to retain their customers, as well as turn them into loyal customers. The appearance of infidelity from customer operators has been generating monthly rates shutdowns about two to four percent per month accounting for business management one of its biggest challenges, since capturing a new customer has meant an expenditure greater than five times to retention. For this purpose, models have been developed by means of structural equation modeling to identify the relationships between the various determinants of customer loyalty in the context of services. The original contribution of this thesis is to develop a model for loyalty from the identification of relationships between determinants of satisfaction (latent variables) and the inclusion of attributes that determine the perceptions of service quality for the mobile communications industry, such as quality, satisfaction, value, trust, expectation and loyalty. It is a qualitative research which will be conducted with customers of operators through simple random sampling technique, using structured questionnaires. As a result, the proposed model and statistical evaluations should enable operators to conclude that customer loyalty is directly influenced by technical and operational quality of the services offered, as well as provide a satisfaction index for the mobile communication segment

Avaliação da secagem do bagaço de cajá usando planejamento fatorial composto central

This work deals with the kinetics assay of Cajá (Spondias mombin L.) bagasse drying by an experimental design using a tray dryer. In order to add-value to this product a kinetic study has been carried out. A central composite experimental design has been carried out to evaluate the influence of the operational variables: input air temperature (55; 65 e 75ºC); the drying air velocity (3.2; 4.6 e 6.0 m/s) and the fixed bed thickness (0.8; 1.2 e 1.6 cm) and as response variable the the moisture content (dry basis). The results showed that the diffusional Fick model fitted quite well the experimental data. The best condition found has been input air temperature of 75ºC, drying air velocity of 6.0 m/s as well as fixed bed thickness of 0.8 cm. The experimental design assay showed that the main effects as well as the second ones were significant at 95% confindance level. The best operational condition according to statistical planning was 75 oC input air temperature, 6.0 m.s-1 drying air velocity and 0.8 cm fixed bed thickness. In this case, the equilibrium moisture content (1.3% dry basis) occured at 220 minutes

Avaliação da eficiência de catalisadores comerciais na obtenção de biodiesel de algodão (Gossipium hisutum L.)

The increasing demand for energy and the environment consequences derived from the use of fossil energy, beyond the future scarcity of the oil that currently is the main power plant of the world, it stimulated the research around the production of biodiesel. In this work the synthesis of biodiesel of cotton in the methyl route was carried through, for had been in such a way used catalyst commercial homogeneous, Na-Methylat and the K-Methylat, aiming to the evaluation of the efficiency of them. An experimental planning 23 was elaborated aiming to evaluate the influence of the variable (molar reason oil/alcohol, % of catalyst and temperature) in the process as well as indicating the excellent point of operation in each case. The biodiesel was analyzed by gaseous chromatography, indicating a conversion of 96,79% when used Na-Methylat® as catalytic, and 95,65% when the K-Methylat® was used. Optimum result found with regard to the conversion was obtained at the following conditions: molar reason oil/alcohol (1:8), temperature of 40°C and 1% of catalyst Na-Methylat, reaching a 96,79% conversion, being, therefore, above of the established for the European norm (96.5%). The analysis of regression showed that the only significant effect for a confidence level of 95%, was of the changeable temperature. The variance analysis evidenced that the considered model is fitted quite to the experimental response, being statistically significant; however it does not serve inside for make forecasts of the intervals established for each variable. The best samples were analyzed by infra-red (IR) that identified the strong bands of axial deformation C=O of methylic ester, characterized through analyses physicochemical that had indicated conformity with the norms of the ANP, that with the thermal and rheological analyses had together evidenced that biodiesel can be used as combustible alternative in substitution to diesel

Extração de ferro da cera de carnaúba utilizando sistemas microemulsionados

The constant search for biodegradable materials for applications in several fields shows that carnauba wax can be a viable alternative in the manufacturing of biolubricants. Carnauba wax is the unique among the natural waxes to have a combination of properties of great importance. In previous studies it was verified the presence of metals in wax composition that can harm the oxidative stability of lubricants. Considering these factors, it was decided to develop a research to evaluate iron removal from carnauba wax, using microemulsion systems (Me) and perform the optimization of parameters, such as: extraction pH, temperature, extraction time, among others. Iron concentration was determined by atomic absorption and, to perform this analysis, sample digestion in microwave oven was used, showing that this process was very efficient. It was performed some analysis in order to characterize the wax sample, such as: attenuated total reflectance infrared spectroscopy (ATR-IR), thermogravimetry (TG), differential scanning calorimetry (DSC), energy dispersive X-ray fluorescence (EDXRF), scanning electron microscopy (SEM) and melting point (FP). The microemulsion systems were composed by: coconut oil as surfactant, n-butanol as cosurfactant, kerosene and/or heptanes as oil phase, distilled water as water phase. The pH chosen for this study was 4.5 and the metal extraction was performed in finite experiments. To evaluate Me extraction it was performed a factorial design for systems with heptane and kerosene as oil phase, also investigating the influence of temperature time and wax/Me ratio, that showed an statistically significant answer for iron extraction at 95% confidence level. The best result was obtained at 60°C, 10 hours contact time and 1: 10 wax/Me ratio, in both systems with kerosene and heptanes as oil phase. The best extraction occurred with kerosene as oil phase, with 54% iron removal

Extração, caracterização e avaliação bioativa do extrato de Rumex acetosa

Studies show the great influence of free radicals and other oxidants as responsible for aging and degenerative diseases. On the other hand, the natural phenolic compounds has shown great as antioxidants to inhibit lipid peroxidation and lipoxygenase in vitro. Among these, is highlighted trans-resveratrol ( 3,5,4 `- trihydroxystilbene ) phenolic compound , characterized as a polyphenol stilbene class. The vegetables popularly known as "Azedinha" (Rumex Acetosa) has trans-resveratrol in its composition and from this, the present work aimed to study on the supercritical extraction and conventional extraction (Soxhlet and sequential) in roots of Rumex Acetosa, evaluating the efficiency of extractive processes, antioxidant activity, total phenolic content and quantification of trans-resveratrol contained in the extracts. Extractions using supercritical CO2 as solvent, addition of co-solvent (ethanol) and were conducted by the dynamic method in a fixed bed extractor. The trial met a 23 factorial design with three replications at the central point, with the variable reply process yield and concentration of trans-resveratrol and pressure as independent variables, temperature and concentration of co-solvent (% v/v). Yields ( mass of dry extract / mass of raw material used ) obtained from the supercritical extraction ranged from 0,8 to 7,63 % , and the best result was obtained at 250 bar and 90 °C using the co-solvent 15% ethanol (% v/v). The value was calculated for YCER a flow rate of 1,0 ± 0,17 g/min resulting in 0,0469 CO2 ( g solute / g solvent ). The results of the mass yield varied between conventional extractions 0,78 % ( hexane) and 9,97 % (ethanol). The statistical model generated from the data of the concentration of trans-resveratrol performed as meaningful and predictive for a 95% confidence. GC analysis on HPLC (High Performance Liquid Chromatography), transresveratrol was quantified in all extracts and concentration values ranged between 0,0033 and 0,42 ( mg / g extract) for supercritical extracts and between 0,449 and 17,046 (mg / g extract) to conventional extractions and therefore, the Soxhlet extraction with ethanol for more selective trans-resveratrol than the supercritical fluid. Evaluation of antioxidant (radical method to sequester 2,2- diphenyl-1- picryl - hydrazyl - DPPH) the supercritical extracts resulted in EC50 values (concentration effective to neutralize 50% of free radicals) of between 7,89 and 18,43 mg/mL , while resulting in a Soxhlet extraction with EC50 values in the range of 6,05 and 7,39 mg/mL. As for quantification of the phenolic compounds (Method Spectrophotometer Folin-Ciocalteau) the supercritical extracts resulted in values between 85,3 and 194,79 mg GAE / g extract, whereas values derived from the Soxhlet extract resulted in values between 178,5 and 237,8 mg GAE / g extract. The high antioxidant activity can not be attributed solely to the presence of phenolic compounds, but the presence of other antioxidants in the existing Rumex acetosa

Mundos de letramento e agência na construção da identidade de seminaristas católicos

Atualmente, os conceitos de mundos de letramentos e agência social nos permitem observar o desenvolvimento de competências relacionadas às práticas sociais e às ações transformadoras que influenciam, de forma decisiva, a vida de jovens seminaristas e a vida das comunidades das quais fazem parte. Com este trabalho objetivamos contextualizar social e culturalmente os letramentos na esfera do lar e a influência da família na formação do seminarista bem como evidenciar o papel do grupo de jovens na formação pessoal e o fortalecimento do sentimento de autoestima produzido pela relação de confiança e pela delegação de responsabilidades. Procuramos, por fim, descrever os principais pilares formadores do Seminário, como agência de letramento, e sua importância na formação identitária do seminarista. Trata-se de pesquisa qualitativa de cunho etnográfico cuja metodologia baseia-se em análise de narrativas semiestruturadas e questionários sócio avaliativos. Os fundamentos teóricos que sustentam nossa pesquisa estão ancorados nos estudos de letramento (BARTON, HAMILTON, IVANI, 2000; STREET, 2003; OLIVEIRA, 2010), na Análise do Discurso (FAIRCLOUGH, 2001), no Realismo Crítico (ARCHER, 2000; AHEARN, 2001), na Sociologia (GIDDENS, 2003, 2005); (SZTOMPKA, 2005), no Interacionismo Simbólico (BERGER, P. L., LUCKMANN, 2009). A análise dos dados nos permitiu: 1) (re)afirmar o papel da instituição família como a principal guardiã do conjunto de ideias e valores, os quais fortalecem as representações sociais associadas a essa instituição, sendo responsáveis pela formação identitária de nossos colaboradores; 2) reconhecer o importante papel social desempenhado por instituições sociais informais que, com o objetivo de promover ações evangelizadoras e solidárias, proporcionam aos seus catequizados o desenvolvimento de múltiplas competências direcionadas à agência pessoal e social, dentre as quais destacamos as Pastorais como fortes aliadas nesse processo formador de identidades sociais positivas, porque os indivíduos que delas participam adquirem competências agentivas que são responsáveis por transformações de ordem pessoal e social; 3) descrever os processos formadores que permitem a manutenção da tradição dentro de uma instituição religiosa. Nossos achados apontam para a necessidade de compreendermos a sociedade como constituída e constituinte de muitos e diversos mundos de letramento, os quais estão a serviço de todo aquele que consegue se perceber como ser atuante no mundo

Avaliação muscular respiratória: adaptação do mano vacuômetro nacional para a avaliação da pressão inspiratória nasal e nível de intensidade da ventilação voluntária máxima em sujeitos saudáveis

The clinical importance of evaluating the respiratory muscles with a variety of tests has been proposed by several studies, once that the combination of several tests would allow a better diagnosis and therefore, a better clinical follow of disorders of the respiratory muscles. This study aimed to evaluate the feasibility of adapting a national electronic manovacuometer to measure the nasal inspiratory pressure (study 1) and analyze the level of load intensity of maximum voluntary ventilation, as well as the variables that may influence this maneuver in healthy subjects (study 2). We studied 20 healthy subjects by a random evaluation of two measures of SNIP in different equipments: a national and an imported. In study 2 it was analyzed the intensity of the load of MVV test, change in pressure developed during the maneuver, the possible differences between genders, and the correlations between the flow developed in the test and the result of MVV. In study 1 it was found the average for both measures of nasal inspiratory pressures: 125 ± 42.4 cmH2O for the imported equipment and 131.7 ± 28.7 cmH2O for the national one. Pearson analysis showed a significant correlation between the average, with a coefficient r = 0.63. The average values showed no significant differences evaluated by paired t test (p> 0.05). In the Bland-Altman analysis it was found a BIAS = 7 cmH2O, SD 32.9 and a confidence interval of - 57.5 cmH2O up to 71.5 cmH2O. In the second study it was found significant differences between the genders in the air volume moved, being higher in males 150.9 ± 13.1 l / min vs 118.5 ± 15.7 L / min for (p = 0.0002, 95% CI 44.85 to 20:05). Regarding the inspiratory and expiratory loading, they were significantly higher in men than in women, peak inspiratory pressure (34.7 ± 5.3 cmH2O vs 19.5 ± 4.2 cmH2O, 95% CI - 18.0 to -12.3, p <0.0001), peak expiratory (33.8 vs. 23.1 ± 5.9 cmH2O ± 5.4 cmH2O, 95% CI -17.1 to - 4.6, p <0.0001), and the delta pressure (59.7 ± 10 cmH2O vs 36.8 ± 8.3 cmH2O, 95% CI 14.5 to 31.2, p <0.0002). The Pearson correlation showed that the flow generated by the maneuver is strongly correlated with the delta-expiratory pressure / inspiratory (r2= 0.83,R = 0.91, 95%IC 0.72 a 0.97 e p< 0.0001).Through these results we suggest that the national electronic manovacuometer is feasible and safe to perform the sniff test in healthy subjects. For the MVV, there are differences between the genders in the intensity of pressure developed during the maneuver. We found a load intensity considered low during the MVV, and found a strong correlation between the flow generated in the test and the delta pressure expiratory / inspiratory

Sono e síndrome da fragilidade em idosos residentes em instituições de longa permanência

Introduction: The aging process causes quantitative and qualitative changes in sleeping. Such changes affects more than half of the adults above 65 years old, that live in the community and 70% of the institutionalized, a great negative impact in their quality of life. One of the pathological displays of aging, that share some characteristics with sleeping disorders and predict similar results, is the Frailty Syndrome, that characterize the most weakened and vulnerable elderly. The way sleeping disorders play a role in the frailty pathogeneses remains uncertain. Objective: Evaluate the relation between the sleeping and the frailty syndrome on institutionalized elderly. Methodology: A transversal study was performed with 69 elderly in institutions in the city of João Pessoa PB. Were used the Pittsburgh Sleeping Quality Index and actigraphy to subjective and objective variables, respectively, and questionnaires and specific tests to frailty phenotype variant (Fried Frailty Criteria). In the statistic analysis were used the Pearson correlation test, Chi Square and One-way ANOVA test, with Tukey-Krammer posttest. Subsequently, a Simple Linear Regression model was built. On every statistical analysis were considered a confidence interval of 95% and a p < 0,05. Results: The sample was characterized by the prevalence of the frail (49,3%), women (62,3%), single (50,7%) and 77,52 (±7,82).The frail elderly obtained the worst sleeping quality 10,37 (±4,31) (f = 4,15, p = 0,02), when compared with the non-frail. The sleep latency influenced more the frailty (R2 = 0,13, β standard = 1,76, β = 0,41, p = 0,001). Weren t found differences between the standard resting-activity variable and the frailty phenotype categories. Conclusion: Sleeping alterations, including bad sleeping quality, prolonged sleep latency, low sleep efficiency and day drowsiness, influenced the frailty in institutionalized elderly

Influência do método pilates na força e atividade elétrica dos músculos respiratórios de idosas - ensaio clínico controlado randomizado

The reduction of physiological capacity present in the process of aging causes a marked decline in lung function. The exercise does promote several positive changes in the physical health of people and protect the cardiorespiratory function. The aim of this study was to investigate the effects of a program of Pilates exercices on the strengh and electrical activity of respiratory muscles of elderly. This is a randomized, controlled clinical trial, evaluating 33 elderly aged 65 and 80 (70.88 ± 4.32), healthy, sedentary, without cognitive impairment and able the practice physical activity. The sample was divided into two groups, one experimental group with 16 elderly women who did Pilates exercises and a control group (17) that was not submitted to the exercises, but received educational booklets on aging and health care. The elderly were evaluated initially and after a period of three months, taking into account the Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP), obtained by Manovacuometry and intensity of EMG activity was measured using the values of Root Mean Square (RMS) for the diaphragm and rectus abdominis muscles, during the course of diaphragmatic breathing and MIP maneuver. Data were analyzed using SPSS version 17.0. For all tests, we used a significance level or p value < 0.05 and confidence interval 95%. RMS in diaphragm and rectus abdominis muscles in both tests increased, but the data were significant for the rectus abdominis during diaphragmatic breathing (p = 0.03) and the diaphragm during the MIP maneuver (p = 0.01). There was no significant variation of the MIP and MEP. Pilates exercises were responsible for increasing the electrical activation of the diaphragm and rectus abdominis muscles in a group of healthy elderly, but had no influence on changes in strength of respiratory muscles

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