Implementation of physiotherapeutic shares in the prevention of diabetes complications in a Family Health Strategy

Introduction In the Family Health Strategy (FHS), the treatment of Diabetes Mellitus (DM) includes education and lifestyle change strategies. Physiotherapists have a key role in this health setting. Objectives To implement actions of evaluation and guidelines for patients with type 2 DM who attend a Family Health Strategy (FHS), regarding diabetic foot and the practice of regular physical exercise in the control and prevention of the complications of Diabetes Mellitus. Methods 17 individuals from an FHS were evaluated, with the following procedures: clinical and anthropometric parameters, inspection, a questionnaire on diabetic neuropathy, tests of vibratory and tactile sensitivity, muscle function, range of motion, functional analysis, questions about exercise practice and guidance regarding controlling blood glucose and foot care. Results Deformities, dry skin, calluses, dehydration, ulceration, cracking and brittle nails were found. Peripheral neuropathy was not observed; tactile sensitivity was altered in the heel region and the vibratory sense was absent in 5% of individuals. A decrease in functionality of ankle movements was verified. Of the participants, 76% were sedentary, 24% knew about the benefits of practicing regular exercise, 25% had undergone a medical evaluation prior to performing physical exercise and, of these, 25% were supervised by a qualified professional. Discussion The implementation of physiotherapy actions in diabetics from an FHS was important for highlighting the presence of risk factors for diabetic complications. Conclusions Individuals attending the FHS need more information and programs for the prevention of diabetic complications.

Caracterização biomecânica da conduta motora remada básica de passeio do esporte stand up paddle

Pós-graduação em Engenharia Mecânica - FEG

A articulação do quadril em uma perspectiva preditora da velocidade de marcha em idosas e como foco de intervenção de duas modalidades terapêuticas: Método Pilates e Haste Vibratória

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Análise de parâmetros neuromusculares e cinemáticos dos chutes Bandal Chagui e Dolhô Chagui do Taekwondo

Pós-graduação em Desenvolvimento Humano e Tecnologias - IBRC

A influência da fadiga nos músculos eversores durante a entorse lateral do tornozelo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A Pilot Study of the Relationship of Calcium Intake and Frequency of Injuries In High School Athletes

Little information is available related to adolescent calcium intake and relationships with injuries they might suffer from sport participation. To determine calcium intake of high school athletes, to assess their self reported injury rates, and to examine the relationship between the two over a 12 month period of time. Participants received a questionnaire at their school and completed it anywhere they found convenient. Adolescent athletes in the Lincoln Public School system (n=43) that participated in at least one sport in the past year. Four age groups participated in the study with sixteen year olds having a significantly higher calcium intake at 1297 mg that of fourteen year olds. A variety of sports were represented with largest number of respondents participating in baseball/or softball at (55%). The next most played sport was basketball at (18%). Median total diet calcium was 1144.5 mg with a mean of 1182 mg + 567 mg. For the frequency of injuries that caused a missed practice or game in the past year, ankle injuries were the most common (25%). Knee injuries were the second most common (17%), followed closely by hand injuries (8%). Mean total diet calcium of athletes with five or more injuries that caused a missed practice or game was significantly higher at 1966 mg (P<.05) than athletes mean diet calcium with zero, one, two, and three injuries. Total milk calcium of those who reported three injuries that resulted in broken or fractured bones or dislocated joints was significantly higher (P<.05) at 1286 mg of total milk calcium than those who reported having zero, one, or two breaks or fractures. Athletes with higher calcium intakes have a higher number of reported injuries. This may be the result of increased vigorous activity which leads to increased calorie and calcium consumption. More importantly, this increased activity leads to an increased chance of injury. The greater calcium intake correlated with greater number of injuries may also be because of third parties advising the athletes who get injured to drink more milk and get more calcium in their diets because they have been injuries already.

The effects of a water-based exercise program on strength and functionality of older adults

Objective: To analyze the effects of a water-based exercise program on peak torque (PT) and rate of torque development (RTD) during maximal voluntary ballistic isometric contractions of the lower limb muscles and the performance of a number of functional tests in the elderly. Method: Thirty-seven elderly were randomly assigned to water-based training (3 d/wk for 12 wk) or a control group. Extensor and flexor PT and RTD of the ankle, knee, and hip joints and functional tests were evaluated before and after training. Results: PT increased after training for the hip flexors (18%) and extensors (40%) and the plantar-flexor (42%) muscles in the water-based group. RTD increased after training for the hip-extensor (10%), knee-extensor (11%), and ankle plantar-flexor (27%) muscles in the water-based group. Functional tests also improved after training in the water-based group (p < .05). Conclusion: The water-based program improved PT and RTD and functional performance in the elderly.

Perioperative cardiovascular evaluation: heads or tails?

When dealing with surgical patients, a perioperative evaluation is essential to anticipate complications and institute measures to reduce the risks. Several algorithms and exams have been used to identify postoperative cardiovascular events, which account for more than 50% of perioperative mortality. However, they are far from ideal. Some of these algorithms and exams were proposed before important advances in cardiology, at a time when pharmacological risk reduction strategies for surgical patients were not available. New biomarkers and exams, such as C-reactive protein, brain natriuretic peptide, and multislice computed tomography have been used in cardiology and have provided important prognostic information. The ankle-brachial index is another significant marker of atherosclerosis. However, specific information regarding the perioperative context of all these methods is still needed. The objective of this article is to evaluate cardiovascular risk prediction models after noncardiac surgery.

Cardiovascular risk in Japanese-Brazilian subjects

Objective: To evaluate the prevalence of risk factors for cardiovascular disease in Japanese-Brazilian subjects. Subjects and methods: One hundred thirty-one residents of the Mombuca community were studied. Statistical analysis was based on the X-2 test, Fisher's Exact test, Student's t test, and ANOVA, at a 5% significance level. Results: The average age was 56.7 years-old; 76.3% had dyslipidemia, 24.4% pre-diabetes (PDM), 10.7% type 2 diabetes mellitus (T2DM), 46.6% hypertension, 52.7% abdominal obesity, and 35.8% metabolic syndrome (MS). There were significant correlations between HOMA-IR and MS diagnosis and obesity, while HOMA-beta levels were decreased in T2DM and PDM. The ankle-brachial index was positive for peripheral artery disease in 22.3% of the individuals. Electrocardiograms did not show increased evidence of myocardial ischemia. Conclusion: Subjects of this community are exposed to major cardiovascular risk factors, namely high prevalence of MS diagnoses and increased HOMA-IR. Arq Bras Endocrinol Metab. 2012; 56(9): 608-13

Functional Limitation and Intermittent Claudication: Impact of Blood Pressure Measurements

Background: Arterial hypertension is an important risk factor for Lower-Limb Occlusive Arterial Disease (LLOAD). However, the correlation between blood pressure and pulse pressure (PP) with LLOAD severity and functional impairment resulting from this disease is not well established in the Brazilian population. Objective: To verify whether there is a correlation between blood pressure, PP, LLOAD severity and functional capacity in patients with symptomatic LLOAD. Methods: A total of 65 patients (62.2 + 8.1 years, 56.9% males) were evaluated. They were divided into two groups: normal (A) and high (B) blood pressure. LLOAD severity was assessed using the ankle-brachial index (ABI) and functional capacity by the total and pain-free walking distance at the 6-minute walking test (6MWT). Results: Group A consisted of 17 (26.1%) patients. The systolic (SBP), diastolic blood pressure (DBP), and PP were, respectively, 125.4 +/- 11.7, 74.5 +/- 9.1 and 50.9 +/- 10.0 mmHg in group A and 160.7 +/- 19.6, 90.0 +/- 12.2 and 70.7 +/- 20.2 mmHg in group B. The ABI was significantly lower in group B (0.66 +/- 0.12 vs. 0.57 +/- 0.13, p < 0.05). SBP and PP correlated with LLOAD severity and the distances walked at the 6MWT. Patients with PP > 40 mmHg walked shorter distances. Conclusion: SBP and PP significantly correlated with the distances walked in the 6MWT, suggesting they are clinical markers of functional capacity impairment in patients with symptomatic LLOAD. (Arq Bras Cardiol 2012; 98(2): 161-166)

Biological monitoring of a promissory xenogenic pin for biomedical applications: a preliminary intraosseous study in rats

Objectives: Over the last years, it is known that in some cases metal devices for biomedical applications present some disadvantages suggesting absorbable materials (natural or synthetic) as an alternative of choice. Here, our goal was to evaluate the biological response of a xenogenic pin, derived from bovine cortical bone, intraosseously implanted in the femur of rats. Material and methods: After 10, 14, 30 and 60 days from implantation, the animals (n = 5/period) were killed and the femurs carefully collected and dissected out under histological demands. For identifying the osteoclastogenesis level at 60 days, we performed the immunohistochemisty approach using antibody against RANKL. Results: Interestingly, our results showed that the incidence of neutrophils and leukocytes was observed only at the beginning (10 days). Clear evidences of pin degradation by host cells started at 14 days and it was more intensive at 60 days, when we detected the majority of the presence of giant multinucleated cells, which were very similar to osteoclast cells contacting the implanted pin. To check osteoclastogenesis at 60 days, we evaluated RANKL expression and it was positive for those resident multinucleated cells while a new bone deposition was verified surrounding the pins in all evaluated periods. Conclusions: Altogether, our results showed that pins from fully processed bovine bone are biocompatible and absorbable, allowing bone neoformation and it is a promissory device for biomedical applications.

The spectrum of high-energy cosmic rays measured with KASCADE-Grande

The energy spectrum of cosmic rays between 10(16) eV and 10(18) eV, derived from measurements of the shower size (total number of charged particles) and the total muon number of extensive air showers by the KASCADE-Grande experiment, is described. The resulting all-particle energy spectrum exhibits strong hints for a hardening of the spectrum at approximately 2 . 10(16) eV and a significant steepening at approximate to 8 . 10(16) eV. These observations challenge the view that the spectrum is a single power law between knee and ankle. Possible scenarios generating such features are discussed in terms of astrophysical processes that may explain the transition region from galactic to extragalactic origin of cosmic rays. (C) 2012 Elsevier B.V. All rights reserved.

Ventilatory threshold is related to walking tolerance in patients with intermittent claudication

Background: This study assessed the relationship between lower limb hemodynamics and metabolic parameters with walking tolerance in patients with intermittent claudication (IC). Patients and methods: Resting ankle-brachial index (ABI), baseline blood flow (BF), BF response to reactive hyperemia (BFRH), oxygen uptake (VO2), initial claudication distance (ICD) and total walking distance (TWD) were measured in 28 IC patients. Pearson and Spearman correlations were calculated. Results: ABI, baseline BF and BF response to RH did not correlate with ICD or TWD. VO2 at first ventilatory threshold and VO(2)peak were significantly and positively correlated with ICD (r = 0.41 and 0.54, respectively) and TWD (r = 0.65 and 0.71, respectively). Conclusions: VO(2)peak and VO2 at first ventilatory threshold, but not ABI, baseline BF and BFHR were associated with walking tolerance in IC patients. These results suggest that VO2 at first ventilatory threshold may be useful to evaluate walking tolerance and improvements in IC patients.

Effects of a combined strengthening, stretching and functional training program versus usual-care on gait biomechanics and foot function for diabetic neuropathy: a randomized controlled trial

Background: Polyneuropathy is a complication of diabetes mellitus that has been very challenging for clinicians. It results in high public health costs and has a huge impact on patients' quality of life. Preventive interventions are still the most important approach to avoid plantar ulceration and amputation, which is the most devastating endpoint of the disease. Some therapeutic interventions improve gait quality, confidence, and quality of life; however, there is no evidence yet of an effective physical therapy treatment for recovering musculoskeletal function and foot rollover during gait that could potentially redistribute plantar pressure and reduce the risk of ulcer formation. Methods/Design: A randomised, controlled trial, with blind assessment, was designed to study the effect of a physiotherapy intervention on foot rollover during gait, range of motion, muscle strength and function of the foot and ankle, and balance confidence. The main outcome is plantar pressure during foot rollover, and the secondary outcomes are kinetic and kinematic parameters of gait, neuropathy signs and symptoms, foot and ankle range of motion and function, muscle strength, and balance confidence. The intervention is carried out for 12 weeks, twice a week, for 40-60 min each session. The follow-up period is 24 weeks from the baseline condition. Discussion: Herein, we present a more comprehensive and specific physiotherapy approach for foot and ankle function, by choosing simple tasks, focusing on recovering range of motion, strength, and functionality of the joints most impaired by diabetic polyneuropathy. In addition, this intervention aims to transfer these peripheral gains to the functional and more complex task of foot rollover during gait, in order to reduce risk of ulceration. If it shows any benefit, this protocol can be used in clinical practice and can be indicated as complementary treatment for this disease.