891 resultados para functional capacity
Resumo:
The functional capacity of osseointegrated dental implants to bear load is largely dependent on the quality of the interface between the bone and implant. Sandblasted and acid-etched (SLA) surfaces have been previously shown to enhance bone apposition. In this study, the SLA has been compared with a chemically modified SLA (modSLA) surface. The increased wettability of the modSLA surface in a protein solution was verified by dynamic contact angle analysis. Using a well-established animal model with a split-mouth experimental design, implant removal torque testing was performed to determine the biomechanical properties of the bone-implant interface. All implants had an identical cylindrical shape with a standard thread configuration. Removal torque testing was performed after 2, 4, and 8 weeks of bone healing (n = 9 animals per healing period, three implants per surface type per animal) to evaluate the interfacial shear strength of each surface type. Results showed that the modSLA surface was more effective in enhancing the interfacial shear strength of implants in comparison with the conventional SLA surface during early stages of bone healing. Removal torque values of the modSLA-surfaced implants were 8-21% higher than those of the SLA implants (p = 0.003). The mean removal torque values for the modSLA implants were 1.485 N m at 2 weeks, 1.709 N m at 4 weeks, and 1.345 N m at 8 weeks; and correspondingly, 1.231 N m, 1.585 N m, and 1.143 N m for the SLA implants. The bone-implant interfacial stiffness calculated from the torque-rotation curve was on average 9-14% higher for the modSLA implants when compared with the SLA implants (p = 0.038). It can be concluded that the modSLA surface achieves a better bone anchorage during early stages of bone healing than the SLA surface; chemical modification of the standard SLA surface likely enhances bone apposition and this has a beneficial effect on the interfacial shear strength.
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Therapy has improved the survival of heart failure (HF) patients. However, many patients progress to advanced chronic HF (ACHF). We propose a practical clinical definition and describe the characteristics of this condition. Patients that are generally recognised as ACHF often exhibit the following characteristics: 1) severe symptoms (NYHA class III to IV); 2) episodes with clinical signs of fluid retention and/or peripheral hypoperfusion; 3) objective evidence of severe cardiac dysfunction, shown by at least one of the following: left ventricular ejection fraction<30%, pseudonormal or restrictive mitral inflow pattern at Doppler-echocardiography; high left and/or right ventricular filling pressures; elevated B-type natriuretic peptides; 4) severe impairment of functional capacity demonstrated by either inability to exercise, a 6-minute walk test distance<300 m or a peak oxygen uptake<12-14 ml/kg/min; 5) history of >1 HF hospitalisation in the past 6 months; 6) presence of all the previous features despite optimal therapy. This definition identifies a group of patients with compromised quality of life, poor prognosis, and a high risk of clinical events. These patients deserve effective therapeutic options and should be potential targets for future clinical research initiatives.
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Preoperative preparation of patients with cardiovascular disease is best initiated by the general practitioner. Updated Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery have been published by the American Heart Association und American College of Cardiology (2007). Individual cardiac evaluation must take into account active cardiac conditions, functional capacity, additional clinical risk factors and surgical risk. Stable, asymptomatic patients with normal functional capacity can proceed to elective anesthesia and surgery without further cardiac evaluation. Active cardiac conditions require evaluation and treatment by a cardiology service prior to elective surgery. In stable patients with poor (<4 metabolic equivalents, MET) or unknown functional capacity and clinical risk factors, who are scheduled for intermediate- or high-risk surgery, further cardiac evaluation and preparation is to be considered. Established indicated beta blocker and statin medication is to be continued; timely institution of beta blocker medication (target heart rate, <65 bpm) may be required depending on the risk of surgery, the presence of coronary heart disease, and the number of clinical risk factors present. Following percutaneous coronary intervention, specific waiting periods are required prior to elective surgery. In patients on antiplatelet therapy, the risk of stopping it should be weighed against the benefit of reduction in bleeding complications from the planned surgery.
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The present study reports on the surgical and prosthodontic rehabilitation of 46 patients, 31 male and 15 female, after resection of oral tumors. The treatment was carried out from 2004 to 2007 at the Department of Prosthodontics, University of Bern, with a follow-up time of 3 to 6 years. The average age at diagnosis was 54 years. 76% of all tumors were squamous cell carcinoma, followed by adenocarcinoma. Resection of the tumors including soft and/or hard tissues was performed in all patients. 80% of them additionally underwent radiotherapy and 40% chemotherapy. A full block resection of the mandible was perfomed in 23 patients, and in 10 patients, the tumor resection resulted in an oronasal communication. 29 patients underwent grafting procedures, mostly consisting of a free fibula flap transplant. To enhance the prosthetic treatment outcome and improve the prosthesis stability, a total of 114 implants were placed. However, 14 implants were not loaded because they failed during the healing period or the patient could not complete the final treatment with the prostheses. The survival rate of the implants reached 84.2% after 4 to 5 years. Many patients were only partially dentate before the tumors were detected, and further teeth had to be extracted in the course of the tumor therapy. Altogether, 31 jaws became or remained edentulous. Implants provide stability and may facilitate the adaptation to the denture, but their survival rate was compromised. Mostly, patients were fitted with removable prostheses with obturators in the maxilla and implant-supported complete dentures with bars in the mandible. Although sequelae of tumor resection are similar in many patients, the individual intermaxillary relations, facial morphology and functional capacity vary significantly. Thus, individual management is required for prosthetic rehabilitation.
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Background: Dementia is a multifaceted disorder that impairs cognitive functions, such as memory, language, and executive functions necessary to plan, organize, and prioritize tasks required for goal-directed behaviors. In most cases, individuals with dementia experience difficulties interacting with physical and social environments. The purpose of this study was to establish ecological validity and initial construct validity of a fire evacuation Virtual Reality Day-Out Task (VR-DOT) environment based on performance profiles as a screening tool for early dementia. Objective: The objectives were (1) to examine the relationships among the performances of 3 groups of participants in the VR-DOT and traditional neuropsychological tests employed to assess executive functions, and (2) to compare the performance of participants with mild Alzheimer’s-type dementia (AD) to those with amnestic single-domain mild cognitive impairment (MCI) and healthy controls in the VR-DOT and traditional neuropsychological tests used to assess executive functions. We hypothesized that the 2 cognitively impaired groups would have distinct performance profiles and show significantly impaired independent functioning in ADL compared to the healthy controls. Methods: The study population included 3 groups: 72 healthy control elderly participants, 65 amnestic MCI participants, and 68 mild AD participants. A natural user interface framework based on a fire evacuation VR-DOT environment was used for assessing physical and cognitive abilities of seniors over 3 years. VR-DOT focuses on the subtle errors and patterns in performing everyday activities and has the advantage of not depending on a subjective rating of an individual person. We further assessed functional capacity by both neuropsychological tests (including measures of attention, memory, working memory, executive functions, language, and depression). We also evaluated performance in finger tapping, grip strength, stride length, gait speed, and chair stands separately and while performing VR-DOTs in order to correlate performance in these measures with VR-DOTs because performance while navigating a virtual environment is a valid and reliable indicator of cognitive decline in elderly persons. Results: The mild AD group was more impaired than the amnestic MCI group, and both were more impaired than healthy controls. The novel VR-DOT functional index correlated strongly with standard cognitive and functional measurements, such as mini-mental state examination (MMSE; rho=0.26, P=.01) and Bristol Activities of Daily Living (ADL) scale scores (rho=0.32, P=.001). Conclusions: Functional impairment is a defining characteristic of predementia and is partly dependent on the degree of cognitive impairment. The novel virtual reality measures of functional ability seem more sensitive to functional impairment than qualitative measures in predementia, thus accurately differentiating from healthy controls. We conclude that VR-DOT is an effective tool for discriminating predementia and mild AD from controls by detecting differences in terms of errors, omissions, and perseverations while measuring ADL functional ability.
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BACKGROUND:
Robotics-assisted tilt table technology was introduced for early rehabilitation of neurological patients. It provides cyclical stepping movement and physiological loading of the legs. The aim of the present study was to assess the feasibility of this type of device for peak cardiopulmonary performance testing using able-bodied subjects.
METHODS:
A robotics-assisted tilt table was augmented with force sensors in the thigh cuffs and a work rate estimation algorithm. A custom visual feedback system was employed to guide the subjects' work rate and to provide real time feedback of actual work rate. Feasibility assessment focused on: (i) implementation (technical feasibility), and (ii) responsiveness (was there a measurable, high-level cardiopulmonary reaction?). For responsiveness testing, each subject carried out an incremental exercise test to the limit of functional capacity with a work rate increment of 5 W/min in female subjects and 8 W/min in males.
RESULTS:
11 able-bodied subjects were included (9 male, 2 female; age 29.6 ± 7.1 years: mean ± SD). Resting oxygen uptake (O
Resumo:
BACKGROUND: We evaluated the feasibility of an augmented robotics-assisted tilt table (RATT) for incremental cardiopulmonary exercise testing (CPET) and exercise training in dependent-ambulatory stroke patients. METHODS: Stroke patients (Functional Ambulation Category ≤ 3) underwent familiarization, an incremental exercise test (IET) and a constant load test (CLT) on separate days. A RATT equipped with force sensors in the thigh cuffs, a work rate estimation algorithm and real-time visual feedback to guide the exercise work rate was used. Feasibility assessment considered technical feasibility, patient tolerability, and cardiopulmonary responsiveness. RESULTS: Eight patients (4 female) aged 58.3 ± 9.2 years (mean ± SD) were recruited and all completed the study. For IETs, peak oxygen uptake (V'O2peak), peak heart rate (HRpeak) and peak work rate (WRpeak) were 11.9 ± 4.0 ml/kg/min (45 % of predicted V'O2max), 117 ± 32 beats/min (72 % of predicted HRmax) and 22.5 ± 13.0 W, respectively. Peak ratings of perceived exertion (RPE) were on the range "hard" to "very hard". All 8 patients reached their limit of functional capacity in terms of either their cardiopulmonary or neuromuscular performance. A ventilatory threshold (VT) was identified in 7 patients and a respiratory compensation point (RCP) in 6 patients: mean V'O2 at VT and RCP was 8.9 and 10.7 ml/kg/min, respectively, which represent 75 % (VT) and 85 % (RCP) of mean V'O2peak. Incremental CPET provided sufficient information to satisfy the responsiveness criteria and identification of key outcomes in all 8 patients. For CLTs, mean steady-state V'O2 was 6.9 ml/kg/min (49 % of V'O2 reserve), mean HR was 90 beats/min (56 % of HRmax), RPEs were > 2, and all patients maintained the active work rate for 10 min: these values meet recommended intensity levels for bouts of training. CONCLUSIONS: The augmented RATT is deemed feasible for incremental cardiopulmonary exercise testing and exercise training in dependent-ambulatory stroke patients: the approach was found to be technically implementable, acceptable to the patients, and it showed substantial cardiopulmonary responsiveness. This work has clinical implications for patients with severe disability who otherwise are not able to be tested.
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Objetivo: Examinar cómo se ve afecta la participación de las células progenitoras endoteliales (CPE) por la resistencia a la insulina (IR) asociada a un modelo experimental de síndrome metabólico (SM), generado por la administración crónica de fructosa a ratas espontáneamente hipertensas. Material y métodos: Ratas WKY y SHR, macho, distribuidas en 4 grupos (n=8 c/u): WKY: controles; FFR: WKY recibiendo fructosa en agua de bebida al 10 % (v/v) durante 6 semanas; SHR; FFHR: SHR recibiendo fructosa en agua de bebida al 10 % (v/v) durante 6 semanas. Al finalizar el protocolo se determinó: presión arterial sistólica, variables bioquímicas, índice HOMA, cuantificación por citometría de flujo de los niveles de CPE en sangre periférica y en médula ósea, inmunofluorescencia en cultivo celular, para identificar los marcadores CD34 y VEGFR-2, recuento de colonias de CPE y actividad de NAD(P)H-oxidasa en tejido aórtico. Resultados: Se confirmó el modelo experimental en base a las variables metabólicas analizadas. Se observó una disminución en los niveles de CPE; en sangre periférica y médula ósea, la que se hace más importante en los grupos de animales tratados con fructosa. En estos también hay menor número de colonias de CPE desarrolladas en cultivo celular y presentan un aumento en los niveles de estrés oxidativo, estimado por la actividad de NAD(P)H oxidasa. Conclusión: el SM causado por la administración crónica de fructosa en FFHR ha demostrado generar una disminución en los niveles de CPE, así como en su capacidad funcional. Los mecanismos intracelulares que producen este fenómeno podrían estar desencadenados por el grado de IR que presenta este modelo experimental.
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Este estudio tiene como objetivo estudiar la influencia de los factores del estilo de vida y funcionalidad sobre la calidad de vida relacionada con la salud (CVRS) en población con salud comprometida. Método: 139 sujetos formaron parte de este estudio divididos en cuatro grupos de enfermedades co-morbidas (sobrepeso-obesidad, diabetes, hipertensión e hiperlipidemias). El estilo de vida se determinó mediante la encuesta FANTASTIC, calidad de vida relacionada con la salud mediante el SF-36 y la funcionalidad con los Test Sentar y Lenvantar (TSL) e Ir y Venir (TIV). Los resultados nos muestras un estilo de vida excelente influye positivamente sobre la Compuesta Salud Física y Compuesta Salud Mental (p < 0.05) en relación estilo de vida inferiores (bueno, regular y bajos) y no influye sobre la capacidad funcional (TSL y TIV). Además, diferentes condiciones de enfermedades co-morbidas (SO vs SOD vs SODT vs ODTH) parecen no afectar la CVRS, y si la capacidad funcional (p < 0.05). Conclusiones: niveles excelentes de estilo de vida influyen positivamente sobre la CVRS específicamente sobre los aspectos físicos y mentales. Las pruebas funcionales de TSL y TIV parecen ser útiles para diferencias los niveles funcionales en población con salud comprometida o población con enfermedades co-morbidas
Resumo:
Este estudio tiene como objetivo estudiar la influencia de los factores del estilo de vida y funcionalidad sobre la calidad de vida relacionada con la salud (CVRS) en población con salud comprometida. Método: 139 sujetos formaron parte de este estudio divididos en cuatro grupos de enfermedades co-morbidas (sobrepeso-obesidad, diabetes, hipertensión e hiperlipidemias). El estilo de vida se determinó mediante la encuesta FANTASTIC, calidad de vida relacionada con la salud mediante el SF-36 y la funcionalidad con los Test Sentar y Lenvantar (TSL) e Ir y Venir (TIV). Los resultados nos muestras un estilo de vida excelente influye positivamente sobre la Compuesta Salud Física y Compuesta Salud Mental (p < 0.05) en relación estilo de vida inferiores (bueno, regular y bajos) y no influye sobre la capacidad funcional (TSL y TIV). Además, diferentes condiciones de enfermedades co-morbidas (SO vs SOD vs SODT vs ODTH) parecen no afectar la CVRS, y si la capacidad funcional (p < 0.05). Conclusiones: niveles excelentes de estilo de vida influyen positivamente sobre la CVRS específicamente sobre los aspectos físicos y mentales. Las pruebas funcionales de TSL y TIV parecen ser útiles para diferencias los niveles funcionales en población con salud comprometida o población con enfermedades co-morbidas
Resumo:
Este estudio tiene como objetivo estudiar la influencia de los factores del estilo de vida y funcionalidad sobre la calidad de vida relacionada con la salud (CVRS) en población con salud comprometida. Método: 139 sujetos formaron parte de este estudio divididos en cuatro grupos de enfermedades co-morbidas (sobrepeso-obesidad, diabetes, hipertensión e hiperlipidemias). El estilo de vida se determinó mediante la encuesta FANTASTIC, calidad de vida relacionada con la salud mediante el SF-36 y la funcionalidad con los Test Sentar y Lenvantar (TSL) e Ir y Venir (TIV). Los resultados nos muestras un estilo de vida excelente influye positivamente sobre la Compuesta Salud Física y Compuesta Salud Mental (p < 0.05) en relación estilo de vida inferiores (bueno, regular y bajos) y no influye sobre la capacidad funcional (TSL y TIV). Además, diferentes condiciones de enfermedades co-morbidas (SO vs SOD vs SODT vs ODTH) parecen no afectar la CVRS, y si la capacidad funcional (p < 0.05). Conclusiones: niveles excelentes de estilo de vida influyen positivamente sobre la CVRS específicamente sobre los aspectos físicos y mentales. Las pruebas funcionales de TSL y TIV parecen ser útiles para diferencias los niveles funcionales en población con salud comprometida o población con enfermedades co-morbidas
Resumo:
Este estudio tiene como objetivo estudiar la influencia de los factores del estilo de vida y funcionalidad sobre la calidad de vida relacionada con la salud (CVRS) en población con salud comprometida. Método: 139 sujetos formaron parte de este estudio divididos en cuatro grupos de enfermedades co-morbidas (sobrepeso-obesidad, diabetes, hipertensión e hiperlipidemias). El estilo de vida se determinó mediante la encuesta FANTASTIC, calidad de vida relacionada con la salud mediante el SF-36 y la funcionalidad con los Test Sentar y Lenvantar (TSL) e Ir y Venir (TIV). Los resultados nos muestras un estilo de vida excelente influye positivamente sobre la Compuesta Salud Física y Compuesta Salud Mental (p < 0.05) en relación estilo de vida inferiores (bueno, regular y bajos) y no influye sobre la capacidad funcional (TSL y TIV). Además, diferentes condiciones de enfermedades co-morbidas (SO vs SOD vs SODT vs ODTH) parecen no afectar la CVRS, y si la capacidad funcional (p < 0.05). Conclusiones: niveles excelentes de estilo de vida influyen positivamente sobre la CVRS específicamente sobre los aspectos físicos y mentales. Las pruebas funcionales de TSL y TIV parecen ser útiles para diferencias los niveles funcionales en población con salud comprometida o población con enfermedades co-morbidas
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A low capacity for regulation of extracellular Mg2+ has been proposed to exclude reptant marine decapod crustaceans from temperatures below 0°C and thus to exclude them from the high Antarctic. To test this hypothesis and to elaborate the underlying mechanisms in the most cold-tolerant reptant decapod family of the sub-Antarctic, the Lithodidae, thermal tolerance was determined in the crab Paralomis granulosa (Decapoda, Anomura, Lithodidae) using an acute stepwise temperature protocol (-1°, 1°, 4°, 7°, 10°, and 13°C). Arterial and venous oxygen partial pressures (Po2) in hemolymph, heartbeat and ventilation beat frequencies, and hemolymph cation composition were measured at rest and after a forced activity (righting) trial. Scopes for heartbeat and ventilation beat frequencies and intermittent heartbeat and scaphognathite beat rates at rest were evaluated. Hemolymph [Mg2+] was experimentally reduced from 30 mmol/L to a level naturally observed in Antarctic caridean shrimps (12 mmol/L) to investigate whether the animals remain more active and tolerant to cold (-1°, 1°, and 4°C). In natural seawater, righting speed was significantly slower at -1° and 13°C, compared with acclimation temperature (4°C). Arterial and venous hemolymph Po2 increased in response to cooling even though heartbeat and ventilation beat frequencies as well as scopes decreased. At rest, ionic composition of the hemolymph was not affected by temperature. Activity induced a significant increase in hemolymph [K+] at -1° and 1°C. Reduction of hemolymph [Mg2+] did not result in an increase in activity, an increase in heartbeat and ventilation beat frequencies, or a shift in thermal tolerance to lower temperatures. In conclusion, oxygen delivery in this cold-water crustacean was not acutely limiting cold tolerance, and animals may have been constrained more by their functional capacity and motility. In contrast to earlier findings in temperate and subpolar brachyuran crabs, these constraints remained insensitive to changing Mg2+ levels.
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Dissertação apresentada para a obtenção do grau de Mestre em Desporto com especialização em Condição Física e Saúde
Resumo:
É de extrema importância estudar a relação entre capacidade funcional e saúde bucal relacionado à qualidade vida, para auxiliar nos fatores intervenientes tanto no cuidado odontológico como em outras áreas de atenção à saúde do idoso, além de adequar planos de tratamento as reais necessidades de cada indivíduo, proporcionando melhor qualidade de vida. O objetivo desse estudo foi investigar a capacidade funcional e saúde bucal relacionada à qualidade de vida do idoso. Foram incluídos na pesquisa idosos acima de 65 anos que residem em área de cobertura da Estratégia Saúde da Família de Bauru. Foram investigadas, através de entrevistas, as variáveis capacidade funcional (Índice de Katz), saúde bucal relacionada à qualidade de vida (OHIP-14), condições socioeconômicas e comorbidades. Foram excluídos da pesquisa idosos que apresentavam alterações de compreensão e expressão da comunicação, Para a realização da análise estatística foi utilizado o Teste de Pearson ao nível de significância de 0,05 e a Regressão Linear Multivariada, ao nível de significância de p 0,01. Participaram da pesquisa 238 idosos com 65 anos ou mais, sendo que 56,3% tinham entre 65 e 74 anos e 43,7% tinham 75 anos ou mais, a média geral de idade foi 74,5 anos. Quanto ao sexo, 55,5% eram mulheres, houve predominância da raça branca (65,1%). Quanto a variável capacidade funcional, 8,8% apresentaram incapacidade funcional intermediária ou severa. Sobre os aspectos socioeconômicos, 61,3% dos idosos apresentaram renda mensal de até dois salários mínimos, 88,2% eram aposentados ou pensionistas, 68,9% tinham algum grau de escolaridade e 57,1% eram casados ou mantinham uma união estável. Quanto a saúde bucal relacionada à qualidade de vida, 20,6% dos entrevistados se sentiram desconfortáveis para mastigar alguns tipos de alimentos. A hipertensão arterial foi a comorbidade mais relatada pelos entrevistados (75,6%). As dimensões dificuldade para mastigar (0,21; p<0,05) e necessidade de parar as refeições (0,21; p<0,05) do instrumento OHIP-14 apresentaram correlação estatisticamente significante com o Índice de Katz. Através da análise multivariada, foi observado que quanto maior a incapacidade menos o idoso se preocupa com a saúde bucal. A alimentação é um aspecto importante da vida diária de qualquer pessoa, especialmente o idoso que apresenta doenças crônicas em maior quantidade e severidade conforme o envelhecimento acontece. Além disso, a incapacidade apresentou tendência de aumento com a idade, no entanto a literatura não permite concluir que o envelhecimento em si seja causa da incapacidade funcional. A maior limitação do estudo se relaciona ao próprio desenho epidemiológico, pois o estudo transversal não permite inferências de causalidade, no entanto a amplitude do grupo etário nesta pesquisa permite observar tendências sobre a capacidade funcional e a saúde bucal relacionada à qualidade de vida em idosos. A incapacidade funcional aumentou com a idade e apresentou tendência de maior impacto negativo na saúde bucal relacionada a qualidade de vida dificultando a realização de refeições.