Effectiveness of a biomarker-based exclusion of ventilator-acquired pneumonia to reduce antibiotic use: protocol for a randomised controlled trial (VAPrapid-2):Study protocol for a randomised controlled trial

Background Ventilator-acquired pneumonia (VAP) is a common reason for antimicrobial therapy in the intensive care unit (ICU). Biomarker-based diagnostics could improve antimicrobial stewardship through rapid exclusion of VAP. Bronchoalveloar lavage (BAL) fluid biomarkers have previously been shown to allow the exclusion of VAP with high confidence. Methods/Design This is a prospective, multi-centre, randomised, controlled trial to determine whether a rapid biomarker-based exclusion of VAP results in fewer antibiotics and improved antimicrobial management. Patients with clinically suspected VAP undergo BAL, and VAP is confirmed by growth of a potential pathogen at > 104 colony-forming units per millilitre (CFU/ml). Patients are randomised 1:1, to either a ‘biomarker-guided recommendation on antibiotics’ in which BAL fluid is tested for IL-1β and IL-8 in addition to routine microbiology testing, or to ‘routine use of antibiotics’ in which BAL undergoes routine microbiology testing only. Clinical teams are blinded to intervention until 6 hours after randomisation, when biomarker results are reported to the clinician. The primary outcome is a change in the frequency distribution of antibiotic-free days (AFD) in the 7 days following BAL. Secondary outcome measures include antibiotic use at 14 and 28 days; ventilator-free days; 28-day mortality and ICU mortality; sequential organ failure assessment (SOFA) at days 3, 7 and 14; duration of stay in critical care and the hospital; antibiotic-associated infections; and antibiotic-resistant pathogen cultures up to hospital discharge, death or 56 days. A healthcare-resource-utilisation analysis will be calculated from the duration of critical care and hospital stay. In addition, safety data will be collected with respect to performing BAL. A sample size of 210 will be required to detect a clinically significant shift in the distribution of AFD towards more patients having fewer antibiotics and therefore more AFD. Discussion This trial will test whether a rapid biomarker-based exclusion of VAP results in rapid discontinuation of antibiotics and therefore improves antibiotic management in patients with suspected VAP.

Low-pathogenicity Mycoplasma spp. alter human monocyte and macrophage function and are highly prevalent among patients with ventilator-acquired pneumonia

Background
Ventilator-acquired pneumonia (VAP) remains a significant problem within intensive care units (ICUs). There is a growing recognition of the impact of critical-illness-induced immunoparesis on the pathogenesis of VAP, but the mechanisms remain incompletely understood. We hypothesised that, because of limitations in their routine detection, Mycoplasmataceae are more prevalent among patients with VAP than previously recognised, and that these organisms potentially impair immune cell function.
Methods and setting
159 patients were recruited from 12 UK ICUs. All patients had suspected VAP and underwent bronchoscopy and bronchoalveolar lavage (BAL). VAP was defined as growth of organisms at >104 colony forming units per ml of BAL fluid on conventional culture. Samples were tested for Mycoplasmataceae (Mycoplasma and Ureaplasma spp.) by PCR, and positive samples underwent sequencing for speciation. 36 healthy donors underwent BAL for comparison. Additionally, healthy donor monocytes and macrophages were exposed to Mycoplasma salivarium and their ability to respond to lipopolysaccharide and undertake phagocytosis was assessed.

Results
Mycoplasmataceaewerefoundin49%(95%CI 33% to 65%) of patients with VAP, compared with 14% (95% CI 9% to 25%) of patients without VAP. Patients with sterile BAL fluid had a similar prevalence to healthy donor BAL fluid (10% (95% CI 4% to 20%) vs 8% (95% CI 2% to 22%)). The most common organism identified was M. salivarium. Blood monocytes from healthy volunteers incubated with M. salivarium displayed an impaired TNF-α response to lipopolysaccharide ( p=0.0003), as did monocyte-derived macrophages (MDMs) (p=0.024). MDM exposed to M. salivarium demonstrated impaired phagocytosis ( p=0.005).

Discussion and conclusions
This study demonstrates a high prevalence of Mycoplasmataceae among patients with VAP, with a markedly lower prevalence among patients with suspected VAP in whom subsequent cultures refuted the diagnosis. The most common organism found, M. salivarium, is able to alter the functions of key immune cells. Mycoplasmataceae may contribute to VAP pathogenesis.

Das ER-lokalisierte Protein Farinelli und seine möglichen Interaktionspartner in der Spermatogenese von Drosophila melanogaster

Dem Farinelli-Protein wird eine Funktion als hodenspezifisches VAP-Protein zugesprochen (Renner, 2001). Mit Hilfe des ER-Markers PDI konnte Fan eindeutig dem ER zugeordnet werden. Fan stellt dabei ein integrales Membranprotein dar, welches nur durch Detergenz- Behandlung in Lösung zu bringen war. Durch den Einsatz zweier Fragment-Konstrukte (fan∆MSP-GFP und fanMSP-GFP) von Fan wurde die Relevanz der MSP-Domäne für die männliche Fertilität dokumentiert. Das Fusionsprotein Fan∆MSP-GFP lag aufgrund der verbliebenen Transmembrandomäne weiterhin im ER vor. Dennoch konnte der sterile Phänotyp der fanJo-Männchen, die keinerlei Fan-Protein enthalten, durch das Einbringen des Fusionskonstrukts nicht gerettet werden. MSP-GFP für sich allein konnte keine Verbindung mit dem ER eingehen und zeigte eine diffuse Fluoreszenz. Im Rahmen der Dissertation wurden mehrere, durch das yeast two hybrid-System ermittelte, mögliche Interaktionspartner von Fan analysiert. Das Protein CG5194 konnte als einziges wie Fan dem ER zugeordnet werden. Seine Expression beschränkte sich aber auf die Spermatocytenphase und ist somit kürzer als die von Farinelli. Nach Einkreuzen der GFP-Fusionskonstrukte in die fan-Nullmutante konnte CG5194 nicht mehr am ER der Spermatocyten beobachtet werden, sondern lag innerhalb des Cytoplasmas diffus verteilt vor. Auch bei der Western Blot-Analyse konnte das Protein von CG5194 nur noch in der Überstand-Fraktion mit den ungebundenen Proteinen nachgewiesen werden. Lag in der fan-Nullmutante ausschließlich das Fan∆MSP-GFP-Fusionsprotein vor, konnte die ER-Lokalisation von CG5194 ebenfalls nicht beibehalten werden. Mit Hilfe einer Fragment-Analyse konnte gezeigt werden, dass in den männlichen Gonaden das erste Exon von CG5194 für die Interaktion mit Fan entscheidend ist. Innerhalb der Ovarien dagegen ist das zweite Exon für die Lokalisation im ER notwendig. Demzufolge ist neben einem anderen Interaktionspartner als Fan auch eine andere Domäne im Protein für die ER-Lokalisation in der weiblichen Keimbahn entscheidend. Durch den Einsatz von antisense- und RNAi-Konstrukten konnte ein steriler Phänotyp bei den Männchen erzeugt werden. Überraschenderweise zeigten die Tiere erst einen Defekt während der Spermatiden-Differenzierung. Bereits während der Diplomarbeit wurde 98A im Kopfbereich der elongierten Spermatiden nachgewiesen. Mittels einer DNA-Färbung sowie durch die Colokalisation mit dem Akrosom-Protein Sneaky wurde 98A dem Bereich des Akrosoms zugeordnet. Sneaky taucht jedoch bereits früher als 98A in den Keimzellen auf. Die Erzeugung eines sterilen Phänotyps durch den Einfluss eines RNAi-Konstrukts gelang nicht. Entweder ist 98A für die Fertilität von Drosophila nicht relevant oder aber seine Funktion kann von anderen Proteinen übernommen werden.

Desenlaces de las infecciones respiratorias en la unidad de cuidado intensivo de la fundación neumologica colombiana

Las infecciones asociadas a ventilación mecánica (VM) son frecuentes en la unidad de cuidado intensivo (UCI). Existen dos infecciones: neumonía (NAV) y traqueobronquitis (TAV). NAV genera impacto negativo en los desenlaces de los pacientes al aumentar la morbilidad, mortalidad y los tiempos en UCI y VM, pero no se conoce el impacto de TAV. El objetivo de este estudio fue identificar si hay diferencias entre NAV y TAV. Materiales y métodos: Se realizó un estudio de cohortes entre 2009 y 2013 en la UCI de la Fundación Neumológica Colombiana. De los pacientes con NAV y TAV se obtuvieron datos demográficos, epidemiológicos, microbiológicos y desenlaces como tiempos de estancia en UCI, VM y de hospitalización y mortalidad. Se compararon estadísticamente mediante t de Student y Chi2 para datos normales y prueba de Mann-Whitney para datos no normales. Resultados: Los pacientes con NAV y TAV fueron similares en la condición de ingreso a UCI. Al diagnóstico de la infección hubo diferencias significativas entre grupos en la oxigenación y tiempo de estancia hospitalaria, en UCI y VM. La microbiología fue con predominio de gérmenes Gram negativos y presencia de multirresistencia en el 52.5% de casos, sin diferencias significativas entre grupos. En los desenlaces, se observó diferencias en los tiempos totales de estancia en UCI, hospitalización y VM, pero sin diferencia en ellos después del diagnóstico. No hubo diferencias significativas en mortalidad. Conclusiones: NAV y TAV son similares en el impacto sobre la evolución de los pacientes en cuanto a morbilidad, estancias y mortalidad.

Análisis de la calidad informativa en el cubrimiento de sentencias relacionadas con derechos de la población LGBTI, el diario El Tiempo 2007 - 2011.

El cubrimiento periodístico sobre el reconocimiento de derechos individuales y de parejas de la comunidad LGBTI en Colombia ha ido transformándose. Si bien el registro de las noticias sobre el tema se ha limitado solo a dichas decisiones judiciales, medios nacionales buscan informar y contextualizar la realidad de este sector poblacional bajo la premisa de la igualdad, el respeto y la inclusión. El diario El Tiempo realizó un cubrimiento de estos hechos jurídicos, teniendo en cuenta algunos de los parámetros de calidad indicados por la ONG Colombia Diversa. Pese a que persisten algunas fallas, tanto periodistas como activistas reconocen que estas corresponden a la dificultad de acceder a los protagonistas de la noticia y de desarrollar el tema desde otro punto de vista teniendo en cuenta la inmediatez que se maneja en los medios.

Evidensbaserad munvård för att förebygga ventilatorassocierad pneumoni hos ventilatorbehandlande patienter : en systematisk litteraturstudie

Utgångspunkten för denna litteraturstudie är att ventilatorassocierad pneumoni (VAP) går att förebygga. Syftet med detta arbete var att kartlägga olika evidensbaserade munvårdsmetoder som används av intensivvårdssjuksköterskor för att förebygga VAP hos ventilatorbehandlade patienter. Syftet var också att belysa vilka faktorer som påverkar intensivvårdssjuksköterskans utförande av evidensbaserad munvård till ventilatorbehandlade patienter. Studien utfördes som en systematisk litteraturstudie. Till resultatet användes 16 vetenskapliga artiklar. För att kunna bedöma artiklarnas vetenskapliga kvalitet granskades artiklarna utifrån en modifierad granskningsmall. Samtliga artiklar fick höga kvalitetspoäng, vilket innebär hög vetenskaplig relevans. Resultatet av litteraturstudien visar att i flera av de evidensbaserade munvårdsprotokoll som publicerats den senaste tiden finns några återkommande punkter. Dessa punkter är; bedömning av munhålans status, tandborstning med barntandborste, munsköljmedel och att munnen fuktas med ett intervall av två till sex timmar. Flera faktorer påverkar intensivvårdssjuksköterskans utförande av evidensbaserad munvård. Genom att införa ett evidensbaserat munvårdsprotokoll för ventilatorbehandlade intensivvårdspatienter och ge personalen utbildning i munvård kan incidensen av VAP minska. Resultatet visar också att generellt sett är kunskapsnivån låg hos intensivvårdssjuksköterskor gällande förebyggande åtgärder för att förhindra VAP. Om sjuksköterskan anser att hon/han har tid att utföra munvård blir resultatet av högre kvalitet och hon/han upplever också åtgärden som mindre obehaglig. Detta innebär att försök att förbättra omvårdnaden och därmed minska antalet vårdrelaterade infektioner även är en organisatorisk fråga.

Förebyggande åtgärder vid ventilatorassocierad pneumoni : En systematisk litteraturstudie

Syftet med litteraturstudien var att beskriva förebyggande omvårdnadsåtgärder vid ventilatorassocierad pneumoni (VAP), vilket är en form av pneumoni som är sjukhusförärvad och relaterad till att patienten är intuberad, så kallad nosokomial infektion. Längre vårdtid, ökad kostnad samt mortalitet ses vid VAP. Resultatet som framkom var att personal ska ha god handhygien vilket var en av viktigaste åtgärden för att förebygga VAP. Andra förebyggande omvårdnadsåtgärder är att vårdpersonal ska hjälpa patienten som vårdas i respirator med munvården och använda hjälpmedel för detta. Personal ska även hjälpa patienten med lämplig höjning på huvudgärden då detta också minskar riken för VAP, även sugning och befuktning av luftvägar är en åtgärd som patienten behöver hjälp med.

Fighting fatigue whilst fighting bushfire : an overview of factors contributing to firefighter fatigue during bushfire suppression

Aching muscles and joints, lethargy, and sleepiness are all signs of firefighter fatigue during bushfire suppression. If not managed, fatigue may lead to injury or illness for the individual, which may also compromise the safety and productivity of their crew. Understanding the many sources of firefighter fatigue is, therefore, fundamental for all Australian fire agencies. This article will briefly address  several factors thought to contribute to firefighter fatigue including; sleep loss, firefighter’s work activity, their hydration, and nutrition, the hot and smoky  working environment, firefighter’s physical fitness and their experience. This brief overview draws on findings from firefighting research and the broader scientific literature.

Photodarkening of amorphous selenium under high pressure

The photodarkening phenomena of amorphous Se have been studied by the optical absorption coefficient, sound velocity and attenuation measurements. The light illumination at low temperatures induces the photodarkening, and the photodarkened state is completely recovered by annealing near 306 K corresponding to the glass transition temperature. The photodarkening is enhanced by application of pressure. The sound velocity decreases and the sound attenuation increases by the illumination at low temperature. These suggest that a structural disorder increases in the photodarkened state. Three stages are observed for the recovery process of the photodarkened specimen. The photodarkening and the recovery process are discussed on the basis of VAP (valence alternative pair) model.

Factors to drive clinical practice improvement in a Malaysian intensive care unit : assessment of organisational readiness using a mixed method approach

This study assessed organisational readiness and factors to drive clinical practice improvement for VAP, CRBSI and PU in a Malaysian intensive care unit (ICU). A mixed method study approach was undertaken in a 16-bed ICU in regional Malaysia using an environmental scan, key informant interviews, staff surveys, and patient audit to elucidate factors contributing to planning for clinical practice improvement. Measurements of sustainability of practice and regard for the practice environment were assessed using validated measures. An environmental scan demonstrated high patient occupancy and case load. Nineteen percent of ICU patients developed complications according to validated measures. Survey results indicated that the majority of nurses had a good knowledge of strategies to prevent ICU complications and a positive attitude toward change processes. Engaging executive leadership was identified as crucial in priming the clinical site for practice change. Providing nurses with tools to monitor their clinical practice and empowering them to change practices are important in improving clinical outcomes.

Subsídios para a gestão dos planos de aplicação de vinhaça (PAV): um estudo de caso da região de Piracicaba

Concomitantemente à produção de etanol, a partir da fermentação de diferentes matérias-primas (cana-de-açúcar, beterraba, milho, trigo, batata, mandioca), produz-se a vinhaça. A vinhaça da cana-de-açúcar é gerada na proporção média de 12 litros para cada litro de etanol. O Brasil é o maior produtor mundial de cana-de-açúcar (570 milhões de toneladas, em 2009) com a produção de 27 bilhões de litros/ano de etanol, no ciclo 2009/2010, basicamente para fins carburantes, e, portanto, a quantidade de vinhaça produzida é da ordem de 320 bilhões de litros/ano. Dentre as possíveis soluções para a destinação da vinhaça, tais como: concentração, tratamento químico e biológico ou produção de biomassa, é sua aplicação no solo a forma mais usual de disposição. No entanto, sua aplicação no solo não pode ser excessiva nem indiscriminada, sob pena de comprometer o ambiente e a rentabilidade agrícola e industrial da unidade sucroalcooleira. A necessidade de medidas de controle sobre a aplicação de vinhaça no solo do Estado de São Paulo, que concentra a produção de 60% do etanol produzido no Brasil, levou à elaboração da Norma Técnica P4.231, em 2005. A constatação do cumprimento dos itens desta Norma é uma das ações do agente fiscalizador, no monitoramento da geração e destinação da vinhaça pelos empreendimentos produtores de etanol. Os itens 5.7.1 e 5.7.2, desta Norma, tornam obrigatório o encaminhamento à CETESB (Companhia Ambiental do Estado de São Paulo), para fins de acompanhamento e fiscalização, até o dia 02 de abril de cada ano, o PAV (Plano de Aplicação de Vinhaça). Com o intuito de proporcionar melhor entendimento da Norma P4.231, contribuir para otimização de sua aplicabilidade e melhoria e perceber a realidade prática da aplicação da vinhaça, foram analisados PAVs protocolados na Agência Ambiental de Piracicaba, licenças concedidas, processos de licenciamento e realizadas vistorias a campo. Conclui-se que a Norma P4.231 representa um avanço no gerenciamento do uso da vinhaça no Estado de São Paulo, por disciplinar a disposição de vinhaça no solo, tornando obrigatórios: demarcações de áreas protegidas e núcleos populacionais, caracterização de solo e da vinhaça, doses máximas a serem aplicadas, estudos da geologia e hidrogeologia locais, monitoramento das águas subterrâneas, impermeabilização de tanques e dutos. Estabelece critérios a serem obedecidos por lei, e todos são condutas de boas práticas de proteção ao meio, que repercutem em maior rentabilidade agrícola e industrial. A Norma P4.231 é bem elaborada, complexa e extensa, o que a torna de difícil execução. Para facilitar sua aplicabilidade, sugere-se o estabelecimento de um cronograma de prioridades: impermeabilização dos tanques e dutos, drenos testemunha com funcionamento otimizado e boa caracterização do que está sendo aplicado, se vinhaça pura ou se misturada a águas residuárias. Das oito empresas deste estudo, apenas quatro (as maiores) vêm protocolando os PAVs com regularidade, desde 2005. As informações apresentadas foram incompletas e, em alguns casos, precárias. Mesmo com lacunas, os dados fornecidos, desde o início da obrigatoriedade do PAV, foram de utilidade para esboçar o perfil da atividade sucroalcooleira na região estudada.

Uma intervenção educativa para profissionais de saúde na prevenção de pneumonia associada à ventilação mecânica

Quasi-experimental study, prospective with quantitative approach, performed at the Hospital do Coração in Natal, aimed at verified the existence of difference between the care given by health professionals to the patients under mechanical ventilation (MV) in the Intensive Care Unit, before and after an educative intervention. The population was of 31 professionals, with data collected between november 05 of 2007 to march 27 of 2008. The results show a yong population, female gender, middle level of education, nursing technique, working between 05 and 09 years on nursing profession, and 01 to 04 years on Intensive Care Unit; almost all, never had an kind of training over prevent pneumonia associated to mechanical ventilation; from those that had training, occur on the work place with duration from 12 to 24 hours. About endotracheal intubation, the cuff was tested with a sterilized syringe had a positive change after a educative intervention, increased from 75,0% to 100,0%; the sterile guide was used on 75,0% before and 100,0% after an educative intervention. Regarding endotracheal suction procedure, was not informed to the patient on 72,7% before, however was informed on 56,7% after; the hands was not previously washed 68,5% before, however was 63,3% after the procedure; mask was used on 74,2 % opportunities before and 76,7% after; the aspiration catheter had adequated size on 98,9% observation before and 100,0% after; the gaze was sterilized on 95,7% before and 100,0% after; the ventilator was connected to the patient during the aspiration intervals on 94,4% observation before and 100,0% after; the ambu bag was clean and protected on 76,1% before and 85,7% after; the aspiration catheter was discarded after be used on 98,9% before and 100,0% after; FIO2 was turned to the begging value on 32,9% observation before and 12,0% after; before the procedure 71,9% professions washed their hands and 73,3% after; before, notes of aspiration results were performed on 70,8% observation and 86,7% after. Regarding devices used on respiratory tract, aspirator flasks were not swapped on 84,6% observations before and 71,0% after; daily látex extention change was not performed on 93,6% observation before and 87,1% after; the ambu bag change was not performed on 50,0% observation before even if was duty or unprotected and on 75,8% opportunities was changed, after; nebulization was not prepared with sterile fluids or manipulated aseptically on 65,2% observation before, perhaps was on 71,7% after; before nebulizers were not changed on 65,2% observations, perhaps were on 60,9% after. Concerning ventilator breathing circuits, condense fluids cumulated on circuits were removed on 55,0% opportunities before, and 64,0% after; moisturizer was not filled with sterile water when already had small amount of liquid inside on 78,4% observations before, and 90,2% after; MV circuits were changed on 97,0% observations on presence of visible duty or when presents some kind of failure, before and 98,4% after. About body position, on 51,3% observations the decubitus position change were done before and 78,2% after; fowler position was maitened on 95,5% observations before and 98,2% after; Regarding respiratory physiotherapy, enteral diet was not interrupted before respiratory physiotherapy on 94,9% before and 90,0% after; respiratory physiotherapy devices were not disinfected or sterile on 69,6% observations before but they re on 60,0% after; before the cateter was not tested before introduction enteral diet or medications on 100,0% but after was done on 15,2%. About enteral feeding, intestine motility and measure of stomach contents were not done on 100,0% observations before, but was 15,2% after. We conclude that 05 of 07 valuated procedures in relation to MV, had a significant improvement on quality of care given after educative intervention, when compared before intervention

Prognostic value of canine frozen-thawed semen parameters on in vitro sperm-oocyte interactions

Combining the data from conventional semen analysis with oocyte penetration assays should improve the assessment of the fertilizing ability of a semen sample. Thus, the objective of the present study was to evaluate the prognostic value of various semen parameters on the in vitro interactions between frozen-thawed canine sperm and homologous oocytes. Ten ejaculates from five stud dogs (two ejaculates/dog) were collected by digital manipulation. Semen samples were evaluated, extended in Tris-egg yolk-glycerol, frozen and stored in liquid nitrogen, and thawed several weeks later. Samples were evaluated for motility and sperm populations by computer-aided semen analysis (CASA), plasma membrane integrity (carboxy-fluorescein diacetate and propidium iodide), and sperm morphology (Bengal Rose). Thawed spermatozoa were also incubated with homologous oocytes for 18 h in an atmosphere of 5% CO2 and 95% air at 38 degrees C and sperm-oocyte interactions were evaluated. Simple linear regression models were calculated, with sperm parameters as independent variables and sperm-oocyte interactions as the dependent variable. There were significant associations between: percentage of oocytes bound to spermatozoa and beat cross frequency (BCF; R-2 = 63%); percentage of oocytes that interacted with spermatozoa and BCF (R-2 = 73%); and number of penetrated spermatozoa and velocity average pathway (VAP; R-2 = 64%) and velocity straight line (VSL; R-2 = 64%). Although plasma membrane integrity and sperm morphology had little prognostic value for in vitro interactions between canine frozen-thawed sperm and homologous oocytes, some motility patterns (evaluated by CASA) were predictive of in vitro sperm-oocyte interactions. (c) 2005 Elsevier B.V. All rights reserved.

Parâmetros do controle postural em mulheres idosas com ou sem histórico de quedas associadas ou não à osteoartrite de joelhos

OBJETIVOS: Comparar parâmetros estabilométricos de mulheres idosas com ou sem histórico de quedas associadas ou não à osteoartrite (OA) de joelhos. MÉTODOS: Cinquenta e seis idosas apresentando ou não histórico de quedas (Q) e OA de joelho unilateral e bilateral foram distribuídas da seguinte maneira: grupo QOA (n = 10), idosas com histórico de queda e OA de joelho; grupo QSOA (n = 11), idosas com histórico de queda e sem OA de joelho; grupo SQOA (n = 14), idosas sem histórico de quedas (SQ) e com OA de joelho; e grupo SQSOA (n = 21), idosas sem histórico de quedas e sem OA de joelho. Para análise do equilíbrio semiestático usando uma plataforma de força, foram avaliados os deslocamentos anteroposterior (DAP) e mediolateral (DML), as velocidades de oscilação anteroposterior (VAP) e mediolateral (VML) em quatro situações na postura ereta. As situações avaliadas foram as seguintes: 1) PFOA: sobre superfície fixa e olhos abertos; 2) PFOF: sobre superfície fixa e olhos fechados; 3) PIOA: sobre superfície instável e olhos abertos; 4) PIOF: sobre superfície instável e os olhos fechados. RESULTADOS: As idosas com OA de joelho apresentaram maior DAP em todas as situações analisadas (P < 0,05), ao passo que idosas com histórico de quedas apresentaram maior DML (P < 0,05). Não houve diferenças entre os grupos para VAP e VML (P > 0,05). CONCLUSÕES: A OA de joelho, por si, é um fator prejudicial no aumento de oscilação do centro de pressão (COP) na direção anteroposterior, enquanto o histórico de quedas, independente da presença de OA de joelhos, traz prejuízos ao controle postural na direção mediolateral.