Comparación de un programa de ejercicio intradiálisis frente a ejercicio domiciliario sobre capacidad física funcional y nivel de actividad física

Introducción: El ejercicio durante la hemodiálisis es beneficioso, aunque son pocas las unidades de hemodiálisis que ofrecen un programa de ejercicio adaptado a estos pacientes. Por ello es necesario encontrar alternativas más económicas para realizar ejercicio. El objetivo es comparar los efectos de un programa de ejercicio intradiálisis frente a ejercicio domiciliario, sobre la adherencia al programa, la capacidad física funcional y el nivel de actividad física. Métodos: 17 pacientes en hemodiálisis de un centro de Valencia fueron aleatorizados dividiéndoles en un grupo de ejercicio intradiálisis (n=9) y un grupo domiciliario (n=8). Ambos programas incluían ejercicio aeróbico y de fuerza durante 4 meses. Se valoró una amplia batería de pruebas funcionales (Short Physical Performance Battery, equilibrio monopodal, Timed Up and Go, Sit To Stand to sit test 10 y 60, dinamometría de mano, fuerza de tríceps, 6 minutos marcha) y dos cuestionarios de nivel de actividad física (Human Activity Profile y Physical Activity Scale for Elderly). Resultados: 2 pacientes del grupo intradiálisis y 5 pacientes de ejercicio domiciliario finalizaron el programa y fueron analizados. Se observó un efecto significativo del factor tiempo en el caso del Human Activity Profile (P<.017). En las pruebas funcionales no se encontró ninguna diferencia significativa. En cuanto a la adherencia al ejercicio los pacientes del grupo intradiálisis cumplieron el 92.7% y el grupo domiciliario el 68.7% del total de las sesiones. Conclusiones: En ambos grupos se observa un aumento del nivel de actividad física. Sin embargo, es necesario modificar factores, tanto en el personal sanitario como en los propios pacientes, para conseguir mayor adherencia a los programas de ejercicio.

Non-use of Formal Health Services in Malawi: Perceptions from Non-users

Background The study upon which this paper is based was undertaken to understand users’ and non-users’ perceptions concerning facilitators and barriers to equitable and universal access to health care in resource-poor countries such as Malawi. In this study, non-users of health services were defined as people who were not in need of health services or those who had stopped using them due to significant barriers. Methods A total of 80 interviews with non-users of health services were conducted in Rumphi, Ntchisi, Phalombe and Blantyre Districts of Malawi. Interviews focused on why informants were not using formal health services at the time of data collection. In order to identify non-users, snowballing was used health surveillance assistants, village headmen and community members also helped. One focus group discussion was also conducted with non-users of health services who were members of the Zion Church. Results Informants described themselves as non-users of health services due to several reasons: cost of health services; long distances to health facilities; poor attitude of health workers; belief in the effectiveness of traditional medicines; old age and their failure to walk. Others were non-users due to their disability; hence they could not walk over long distances or could not communicate effectively with health providers. Some of these non-users were complete non-users, namely members of the Zion Church and those who believed in traditional medicine, and they stated that nothing could be done to transform them into users of health services. Other non-users stated that they could become users if their challenges were addressed e.g. for those who were non-users of health services due to poor attitudes of health workers, they stated that if these health workers were transferred they would be able to access health services. Conclusions Public health education targeting both health workers and non-users, ensuring a functional outreach program and addressing other health system challenges such as shortage of drugs and human resources would assist in transforming non-users into users of health services.

Aerobic endurance in HIV-positive young adults and HIV-negative controls in Malawi

Background Aerobic endurance is an important aspect of physical fitness that enables individuals living with HIV to endure in the work place as well as in agricultural operations in order to earn a living and improve their quality of life. However, despite high HIV prevalence rates, the aerobic endurance status of young Malawians living with HIV remains unknown. The objective of this study was to determine the difference in VO2max between HIV-negative and HIV-positive individuals in Blantyre, Malawi. Methods Fifty five participants (17 males and 38 females) who have HIV and were not taking antiretroviral medication and 78 HIV-negative participants (45 males and 33 females) performed the Rockport submaximal treadmill exercise test. Measures of body weight, post-exercise heart rate and time to walk one mile were obtained and used to predict VO2max. Comparisons between groups were adjusted for age differences using analysis of covariance (ANCOVA). Results VO2max was significantly lower in HIV-positive subjects [31.1, 28.7 - 33.5mL.kg-1.min-1(mean, 95% CI)] compared with HIV-negative subjects [56.2, 54.3 - 58.1mL.kg-1.min-1]. Conclusion Aerobic endurance was markedly reduced in HIV-positive participants compared with HIV-negative participants. Findings of the current study implicate factors associated with the HIV infection as contributors to a decreased aerobic endurance in people living with HIV.

Efeitos do treinamento resistido com máquinas pneumáticas e resistência elástica progressiva na força, capacidade funcional e equilíbrio em mulheres idosas : um ensaio clínico randomizado

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Educação Física, Programa de Pós-Graduação Strictu-Sensu em Educação Física, 2015.

Pedonalidade, solução estratégica para as condições de acessibilidade na cidade : 2ª Circular, como suporte urbano

Dissertação para obtenção do grau de Mestre em Arquitectura com Especialização em Urbanismo, apresentada na Universidade de Lisboa - Faculdade de Arquitectura.

Mobility and satisfaction with lower-limb prostheses and orthoses among users in Sierra Leone: A cross-sectional study

Objectives: To investigate patients' mobility and satisfaction with their lower-limb prosthetic or orthotic device and related service delivery in Sierra Leone; to compare groups of patients regarding type and level of assistive device, gender, area of residence, income; and to identify factors associated with satisfaction with the assistive device and service. Methods: A total of 139 patients answered questionnaires, including the Quebec User Evaluation of Satisfaction with Assistive Technology questionnaire (QUEST 2.0). Results: Eighty-six percent of assistive devices were in use, but half needed repair. Thirty-three percent of patients reported pain when using their assistive device. Patients had difficulties or could not walk at all on: uneven ground (65%); hills (75%); and stairs (66%). Patients were quite satisfied with their assistive device and the service (mean 3.7 out of 5 in QUEST), but reported 886 problems. Approximately half of the patients could not access services. In relation to mobility and service delivery, women, orthotic patients and patients using above-knee assistive devices had the poorest results. The general condition of the assistive device and patients' ability to walk on uneven ground were associated with satisfaction with the assistive devices and service. Conclusion: Patients reported high levels of mobility while using their device although they experienced pain and difficulties walking on challenging surfaces. Limitations in the effectiveness of assistive devices and limited access to follow-up services and repairs were issues desired to be addressed.

Análise do efeito da fadiga muscular no senso de posição articular do joelho

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia

Quand les interactions avec les professionnels orientent le choix des sources de soutien des proches aidants accompagnant à domicile une personne âgée atteinte d’un trouble de l’humeur

Méthodologie: Théorisation ancrée, Interactionnisme symbolique

Effet de la douleur expérimentale tonique sur l’acquisition et la rétention d’une adaptation locomotrice

Introduction : Une proportion importante des individus ayant recours à des services de réadaptation physique vit avec de la douleur et des incapacités locomotrices. Plusieurs interventions proposées par les professionnels de la réadaptation afin de cibler leurs difficultés locomotrices nécessitent des apprentissages moteurs. Toutefois, très peu d’études ont évalué l’influence de la douleur sur l’apprentissage moteur et aucune n’a ciblé l’apprentissage d’une nouvelle tâche locomotrice. L’objectif de la thèse était d’évaluer l’influence de stimulations nociceptives cutanée et musculaire sur l’acquisition et la rétention d’une adaptation locomotrice. Méthodologie : Des individus en santé ont participé à des séances de laboratoire lors de deux journées consécutives. Lors de chaque séance, les participants devaient apprendre à marcher le plus normalement possible en présence d’un champ de force perturbant les mouvements de leur cheville, produit par une orthèse robotisée. La première journée permettait d’évaluer le comportement des participants lors de la phase d’acquisition de l’apprentissage. La seconde journée permettait d’évaluer leur rétention. Selon le groupe expérimental, l’apprentissage se faisait en présence d’une stimulation nociceptive cutanée, musculaire ou d’aucune stimulation (groupe contrôle). Initialement, l’application du champ de force provoquait d’importantes déviations des mouvements de la cheville (i.e. erreurs de mouvement), que les participants apprenaient graduellement à réduire en compensant activement la perturbation. L’erreur de mouvement moyenne durant la phase d’oscillation (en valeur absolue) a été quantifiée comme indicateur de performance. Une analyse plus approfondie des erreurs de mouvement et de l’activité musculaire a permis d’évaluer les stratégies motrices employées par les participants. Résultats : Les stimulations nociceptives n’ont pas affecté la performance lors de la phase d’acquisition de l’apprentissage moteur. Cependant, en présence de douleur, les erreurs de mouvement résiduelles se trouvaient plus tard dans la phase d’oscillation, suggérant l’utilisation d’une stratégie motrice moins anticipatoire que pour le groupe contrôle. Pour le groupe douleur musculaire, cette stratégie était associée à une activation précoce du muscle tibial antérieur réduite. La présence de douleur cutanée au Jour 1 interférait avec la performance des participants au Jour 2, lorsque le test de rétention était effectué en absence de douleur. Cet effet n’était pas observé lorsque la stimulation nociceptive cutanée était appliquée les deux jours, ou lorsque la douleur au Jour 1 était d’origine musculaire. Conclusion : Les résultats de cette thèse démontrent que dans certaines circonstances la douleur peut influencer de façon importante la performance lors d’un test de rétention d’une adaptation locomotrice, malgré une performance normale lors de la phase d’acquisition. Cet effet, observé uniquement avec la douleur cutanée, semble cependant plus lié au changement de contexte entre l’acquisition des habiletés motrices et le test de rétention (avec vs. sans douleur) qu’à une interférence directe avec la consolidation des habiletés motrices. Par ailleurs, malgré l’absence d’influence de la douleur sur la performance des participants lors de la phase d’acquisition de l’apprentissage, les stratégies motrices utilisées par ceux-ci étaient différentes de celles employées par le groupe contrôle.

Emprendimiento NORNA

La creación de Norna Ltda., motivada por la expansión mundial de la idea del cuidado por el planeta, junto con el avance económico de Colombia se implanta como la base de un movimiento social y cultural que pretende expandirse por el país. Para la empresa, el objetivo principal es realzar el valor de la conservación del medio ambiente, a través de un bien tangible, para evitar la perpetuación de la sostenibilidad ecológica e inclusión social como una idea impalpable. Para confrontar el Statu Quo de la moda rápida que regularmente se encuentra acompañada por condiciones laborales lamentables, Norna ltda., confecciona y distribuye chaquetas a base de algodón orgánico a través de su página virtual en Colombia.

Malattie immunomediate del cane e del gatto: aspetti diagnostici e terapeutici

La presente tesi di dottorato affronta alcune delle più comuni malattie immunomediate del cane e del gatto. Il manoscritto è incentrato sugli aspetti diagnostici e terapeutici in corso di: anemia emolitica immunomediata (Immune-mediated hemolytic anemia, IMHA), trombocitopenia immunomediata (Immune-mediated thrombocytopenia, ITP) e poliartrite immunomediata (Immune-mediated polyarthritis, IMP). Il capitolo 1 costituisce un’introduzione all’argomento delle malattie immunologiche; vengono sottolineati alcuni aspetti patogenetici delle singole malattie immunomediate e riassunte le difficoltà diagnostiche e terapeutiche. Il capitolo 2 riporta uno studio riguardante una popolazione di gatti con diagnosi, o sospetto diagnostico, di IMHA che evidenziava una discrepanza tra i test diagnostici per il virus della leucemia felina (Feline Leukemia Virus, FeLV). La positività FeLV al test point of care, non confermata dalla PCR del DNA provirale, lascia spazio a diverse interpretazioni. Il capitolo 3 mostra i dati relativi al confronto tra tre diversi protocolli immunosoppressivi (glucocorticoidi, glucocorticoidi+ciclosporina, glucocorticoidi+micofenolato mofetile) in una popolazione di cani con IMHA non associativa. Il confronto verteva, principalmente, sulla risposta ematologica dei pazienti, che non si è dimostrata differente tra i tre gruppi terapeutici. Il capitolo 4 riporta una revisione della letteratura riguardante l’ITP del cane e del gatto. Si tratta di una malattia eterogenea in cui le manifestazioni cliniche appaiono variabili: alcuni pazienti sono asintomatici, altri presentano dei sanguinamenti spontanei. La mancanza di criteri diagnostici standardizzati, porta il clinico a considerare l’ITP una diagnosi “ad esclusione”. Le strategie terapeutiche non si basano purtroppo su linee guida condivise, pertanto il target della terapia rimane, ad oggi, sconosciuto. Nel capitolo 5 viene posta l’attenzione su alcuni interrogativi diagnostici e terapeutici che riguardano l’IMP del cane e del gatto. La sintomatologia clinica, caratterizzata da zoppia, febbre e riluttanza al movimento, talvolta può essere subdola. Anche in questa malattia, non vi sono evidenze scientifiche circa il regime immunosoppressivo più corretto ed indicato.

Il trattamento riabilitativo e il recupero precoce dopo intervento di “wedge resection” polmonare per secondarismi da tumore osseo: uno studio osservazionale

Background. Il recupero funzionale precoce dopo intervento di wedge resection polmonare non è studiato in maniera approfondita, in particolare, sono carenti i dati relativi al recupero postoperatorio precoce dei pazienti sottoposti a tele procedura chirurgica in seguito a metastasi polmonari per tumore osseo primitivo. Obiettivo. Lo scopo di questo studio osservazionale è quello di descrivere il percorso fisioterapico dopo intervento di wedge resection polmonare, evidenziando il possibile recupero funzionale nel breve termine e ricercandone i possibili fattori prognostici. Metodi. Per valutare il recupero funzionale si è utilizzato il 1 minute sit to stand test (1MSTS), che è stato somministrato in sesta giornata postoperatoria. Per descrivere l’andamento del recupero il test è stato somministrato in fase preoperatoria e in tutte le giornate postoperatorie. Sono state condotte analisi di univariata per valutare l’associazione delle variabili demografiche, anamnestiche e cliniche con l’outcome primario. Risultati. Sono stati reclutati 13 pazienti, per un totale di 17 osservazioni poiché alcuni pazienti hanno ripetuto l’operazione. Nella sesta giornata il 41,2% dei pazienti aveva eseguito lo stesso o un numero maggiore di verticalizzazioni del 1MSTS fatte nella fase preoperatoria. Nella sesta giornata postoperatoria il 100% dei pazienti era riuscito ad eseguire il 1MSTS almeno una volta dopo l’intervento. All’outcome primario risultavano associarsi con una significatività statistica il livello di autonomia, misurato con la TESS, (p=0,01) e il 1MSTS (p=0,001) misurati nella fase preoperatoria. Conclusioni. Il recupero funzionale postoperatorio è possibile fin dalle prime giornate postoperatorie per i pazienti sottoposti a wedge resection. Il livello di autonomia e il numero di verticalizzazioni del 1MSTS eseguite in fase preoperatoria sono possibili fattori prognostici del recupero funzionale postoperatorio.

Generalization of the persistent random walk to dimensions greater than 1

We propose a generalization of the persistent random walk for dimensions greater than 1. Based on a cubic lattice, the model is suitable for an arbitrary dimension d. We study the continuum limit and obtain the equation satisfied by the probability density function for the position of the random walker. An exact solution is obtained for the projected motion along an axis. This solution, which is written in terms of the free-space solution of the one-dimensional telegraphers equation, may open a new way to address the problem of light propagation through thin slabs.

Geometric stopping of a random walk and its applications to valuing equity-linked death benefits

We study discrete-time models in which death benefits can depend on a stock price index, the logarithm of which is modeled as a random walk. Examples of such benefit payments include put and call options, barrier options, and lookback options. Because the distribution of the curtate-future-lifetime can be approximated by a linear combination of geometric distributions, it suffices to consider curtate-future-lifetimes with a geometric distribution. In binomial and trinomial tree models, closed-form expressions for the expectations of the discounted benefit payment are obtained for a series of options. They are based on results concerning geometric stopping of a random walk, in particular also on a version of the Wiener-Hopf factorization.