Efeitos do treinamento de marcha sobre superfícies inclinadas em indivíduos com hemiparesia crônica: ensaio clínico controlado randomizado

Among the therapeutic approaches that can be used to achieve this goal is the gait training on sloping surfaces, but there are few scientific findings that elucidate the results of this practice. OBJECTIVE: To evaluate the effects of training on sloping surfaces on the gait of subjects with chronic hemiparesis. MATERIALS AND METHODS: A controlled, randomized, blinded clinical trial was conducted. Concluded the study twenty-four subjects with age between 40 and 70 years (54,91±9,3). Their neurological function, functional independence, motor function and balance assessed, besides the gait evaluation through kinemetry. The subjects were allocated into two groups: control group (CG) underwent gait training on treadmill with partial body weight support (PBWS) without inclination; and the experimental group (EG) submitted to gait training on treadmill with PBWS and inclination of 10%. Twelve training sessions were performed. The paired t Student test and Wilcoxon test were used in statistical analysis to compare findings before and after training for each group, and the t student test for independent samples and Mann-Whitney.test were used to compare the to groups. RESULTS: After training within-group changes were observed on balance recovery, motor function and functionality, in both experimental conditions. The EG showed changes after training on speed, stride length, step length of paretic and non-paretic side, paretic single support, double support time and non-paretic swing time. The CG the differences were detected on double support, paretic single support and hip range of movement. The EG showed better results when compared to CG on the variables: speed (p=0,034), non-paretic single support (p=0,02) and paretic swing time (p=0,02). CONCLUSION: gait training on sloping surfaces represents a promising strategy for gait training of subjects with chronic hemiparesis since it is can influence a greater number of gait variables, when compared with gait training on flat surface

Efeitos da adição de carga no treino de marcha na esteira em indivíduos com Doença de Parkinson: ensaio clínico controlado randomizado

Introduction: The intrinsic gait disorders in individuals with Parkinson's disease (PD) are one of the most disabling motor symptoms. Among the therapeutic approaches used in attempts to improve the motor function, especially the gait pattern of individuals, stands out the treadmill gait training associated with the addition of load. However, there are few findings that elucidate the benefits arising from such practice. Objective: To assess the effects of adding load on the treadmill gait training in individuals with PD. Material and Methods: A controlled, randomized and blinded clinical trial, was performed with a sample of 27 individuals (18 men and 9 women) with PD, randomly assigned to three experimental conditions, namely: treadmill gait training (n=9), treadmill gait training associated with addition of 5% load (n=9) and treadmill gait training associated with addition of 10% load (n=9). All volunteers were assessed, during phase on of Parkinson's medication, regarding to demographic, clinical and anthropometric (identification form) data, level of disability (Hoehn and Yahr Modified Scale), cognitive function (Mini Mental State Examination), clinical functional - in those areas activity of daily living and motor examination (Unified Parkinson's Disease Rating Scale - UPDRS) and gait cinematic analysis was performed through Qualisys Motion Capture System®. The intervention protocol consisted of gait training in a period of 4 consecutive weeks, with three weekly sessions, lasting 30 minutes each. The post-intervention assessment occurred the next day after the last training session, which was performed cinematic analysis of gait and the UPDRS. Data analysis was performed using the software Statistical Package for Social Sciences® (SPSS) 17.0. Results: The age of volunteers ranged from 41 to 75 years old (62,26 ± 9,07) and the time of clinical diagnosis of PD between 2 to 9 years (4,56 ± 2,42). There was a reduction regarding the score from motor exam domain (p=0,005), only when training with the addition of a 5% load. As for the space-time variables there was no significant difference between groups (p>0,120); however, the training with addition of 5% load presented the following changes: increase in stride length (p=0,028), in step length (p=0,006), in time balance of the most affected member (p=0,006) and reduction in support time of the referred member (p=0,007). Regarding angular variables significant differences between groups submitted to treadmill gait training without addition load and with 5% of load were observed in angle of the ankle at initial contact (p=0,019), in plantar flexion at toe-off (p=0,003) and in the maximum dorsiflexion in swing (p=0,005). While within groups, there was a reduction in amplitude of motion of the ankle (p=0,048), the only workout on the treadmill. Conclusion: The treadmill gait training with addition of 5% load proved to be a better experimental condition than the others because it provided greater gains in a number of variables (space-time and angular gait) and in the motion function, becoming a therapy capable of effectively improving the progress of individuals with PD

Custos e benefícios de um programa de exercício aeróbios na doença pulmonar obstrutica crônica: ensaio cliníco aleatório controlado

Pulmonary Rehabilitation, especially due to aerobic exercise, positive impact in reducing morbidity/mortality of patients with COPD, however the economic impact with costs of implementing simple programs of aerobic exercise are scarce. This is a blind randomized clinical trials, which aimed to evaluate the costs and benefits of a simple program of aerobic exercise in individuals with COPD, considering the financial costs of the Public Health System and its secondary endpoints. We evaluated lung function, the distance walked during six minutes of walking, the respiratory and peripheral muscle strength, quality of life related to health (QLRH), body composition and level of activity of daily living (ADL) before and after eight weeks of an aerobic exercise program consisting of educational guidance for both groups, control and intervention and supervised walks to the intervention group. The health costs generated in both groups were calculated following table Brazilian Public Health System. The sample consisted of forty patients, two being excluded in the initial phase of desaturation during the walk test six minutes. Were randomized into control and intervention group thirty-eight patients, three were excluded from the control group and one was excluded from the intervention group. At the end, thirty-four COPD comprised the sample, 16 in the control group and 18 in the intervention group (FEV1: 50.9 ± 14% pred and FEV1: 56 ± 0.5% pred, respectively). After for intervention, the intervention group showed improvement in meters walked, the sensation of dyspnea and fatigue at work, BODE index (p <0.01) in QLRH, ADL level (p <0.001) as well as increased strength lower limbs (p <0.05). The final cost of the program for the intervention group was R $ 148.75, including: assessments, hiking supervised by a physiotherapist and reassessments. No patient had exacerbation of IG, while 2 patients in the CG exacerbated, generating an average individual cost of R $ 689.15. The aerobic exercises in the form of walking showed significant clinical benefits and economic feasibility of its implementation, due to low cost and easy accessibility for patients, allowing them to add their daily practice of aerobic exercises

Controle profissional de biofilme dentário como estratégia para manutenção da saúde periodontal de pacientes com aparelho ortodôntico fixo: análise comparativa entre diferentes períodos

The presence of fixed orthodontics appliances interfere on sanitation, allowing periodontal diseases to appear, despite the fact patients keep on visiting the dentist every month. This research aims to determine a protocol for the mechanical control of the dental biofilm performed by the professional. A protocol that was able to maintain the periodontal health of the patients under orthodontic treatment with fixed appliances, and in order to do so, it used a non-controlled, randomized and blind clinical essay. The sample involved 40 adolescents who were under the installation of fixed orthodontics appliances and it was divided in three groups, as follows: monthly controlled group (group 1) composed of 11 patients, the quarterly controlled group (group 2) with 16 patients and the semestrial controlled group (group 3) with 13 patients. For data collection, an interview and clinical exams with probing depth measurement, quantity of keratinized mucosa, Gingival Index and the Plaque Index were used. On the initial exam all patients received brushing guidelines as well as the professional control of dental biofilm, with periodontal scaler, Robinson s brush and prophylactic paste. However, Group 1 returned every month for control procedures; Group 2 every three months and Group 3 after six months. The intervention had a six-month duration (for all the three groups), when all the exams were repeated by another examiner who did not know which group each patient was inserted in. Finally, the research concluded that despite the fact there is no statistically significant difference among the three groups, clinically the patients from the monthly group presented a better response to professional control, with less accumulation of dental biofilm and less rate of gingival inflammation. Thus, the mechanical control of the dental biofilm performed by the professional could not avoid gingival increase, characterized by the raise of probing depth measurement, neither the quantity of keratinized mucosa

Avaliação clínica e comparativa da oclusão balanceada bilateral e desoclusão com guia canino sobre a função mastigatória de usuários de prótese total removível

The maintenance of masticatory function is especially important for patients who wear complete dentures due to the limitations of this type of prosthesis. Thus, the bilateral balanced occlusion (BBO) is used to achieve, besides other advantages, greater masticatory efficiency. However, analyzing critically the literature, it is observed that there is not enough scientific evidence that support the BBO as the most appropriate occlusal concept in complete dentures. This way, the purpose of the present study was to verify if complete dentures wearers with BBO present better masticatory efficiency and capacity than those with canine guidance (CG). A double-blind controlled crossover clinical trial was conducted. The sample was made of 24 completely edentulous patients. The subjects wore sets of complete dentures with both occlusal concepts for equal periods of 3 months. Objective data were collected through the masticatory efficiency test, performed by the colorimetric method, in which capsules of a synthetic material enclosing fuchsine- containing granules were used. Subjective data were recorded by patient´s ratings of their chewing function, which is the masticatory ability. No significant statistical difference was found for masticatory efficiency (p=0,0952) and masticatory ability (x2=0,5711/ p=0,4498) between the two occlusal concepts studied, as well as there was no correlation between these two variables (p=0,2985). Based on these results, it seems reasonable to use CG for the setup of complete dentures, since it is an easier and quicker technical procedure, until that future researches can come to complement this question

Algumas considerações sobre o ensino e a aprendizagem do conceito de energia

Neste artigo procuramos abordar alguns aspectos relevantes sobre o ensino e a aprendizagem do conceito de energia, tais como as concepções de energia do senso comum e as relações entre transformações de energia e meio ambiente, bem como destacar a viabilidade da utilização de textos com abordagens históricas e, finalmente, analisamos um texto interdisciplinar que relaciona energia e meio ambiente. Com relação ao referido texto, discutimos a possibilidade de o mesmo levar o estudante a um entendimento das noções fundamentais de energia, mediante a contextualização histórica, social, política, econômica e ambiental dessas noções.

Reflexões sobre a formação clínica fenomenológico-existencial na era da técnica

Phenomenology is the focus of this study for its critique of the limits of positivist science, which guides most of the fields of study including Psychology. The clinical formation process in Psychology courses is especially difficult for students-interns who adopt phenomenology as their clinical framework. Such difficulty is due to the incompatibility between theory provided in Psychology courses a science traditionally based on paradigms of scientism , and the theoretical-methodological proposal adopted by the aforementioned approach. As a backdrop for our study, we carefully examined the thought of philosopher Martin Heidegger, especially the Era of Technique. This contemporary technicism society was studied so that we could understand the socio-cultural status where this formation lies. Thus, we questioned if this panorama upon which Clinical Psychology rests favors the development of a phenomenological attitude and a special look at the meanings of existence, as defined in phenomenological clinical practice. Knowing such limits, our research aimed at understanding the experience of formation of clinical psychologists who take part in internships in the field of phenomenology-existentialism. Such study was, then, a phenomenological-hermeneutic research based on Heideggerian ontology and used a semi-structured interview as access tool. Six students of the UFRN higher-degree Psychology course who were doing their supervised internship in clinical psychology and the referred approach took part in this research. The research revealed that the phenomenological-existential formation phase opens a door to discoveries on the part of the intern that transcend the dimension of the other, for they show a self disclosure while a person in the word. Despite the initial discomforts caused by the course curriculum itself and by the freedom for clinical practice, so characteristic of phenomenology, the narratives demonstrate that such difficulties may start a process of search for new meanings, which show a search for sharpening their practices and for a path in balance with the existence of the other

O pátio escolar do ensino fundamental como ambiente de brincar segundo as crianças usuárias

The intention of the present study was to analyze the adequacy of the playground of elementary schools, according to the point of view of the child student, direct user of this type of environment, what estimated its critical in respect to these spaces and aimed at to contribute for its improvement. Many studies have analyzed the quality of the physical environment available for activities of leisure in specific places for children, focusing in the influence of the physical space in the interpersonal relationships and the comfort and satisfaction generated by the physical characteristics of these spaces. Concern with scholar environment, specially the interest on playgrounds, has been subject of recent studies; however, little attention has been given to the opinion of the user-child in relation to this school environment. In this inquiry of the playground of two state schools of 1ª to 4ª series of elementary school in the city of Piracicaba, SP, was used: assystematics observations, photographic register of the studied environments, interviews with child-users and behavioral mapping. The main subjects resulting from the analysis of the interviews content were: adaptation, density and interpersonal relationships, and infantile confinement. The results revealed the unsatisfactory conditions of the courtyards, in respect to person-environment relationship. The children demonstrated to be critical, creative and responsible when answering questions related to the quality of the school courtyard. This finding confirms previous studies and leads to the conclusion that the child, as the direct user, should be included as an excellent source of consultation in the planning of the constructed environment

Considerações sobre metodologia interativa aplicada à disciplinas de química orgânica de alguns cursos da UFRN

The aiming of this work is linked to chemical education, focusing organic chemistry classes of Chemical Engineering, Pharmacy and Zootechny graduate courses of the Federal University of Rio Grande do Norte. For that, teaching-learning process related to basic chemical subjects which support the understanding of organic chemistry concepts was evaluated in a research period of two years. The education proposal linked to the theoretical content of the cited classes, pointed out the process of knowledge construction, in which educational commitment as well as dedication in the teaching-learning process was also valued. In that approach several didactic tools were applied, among them scientific articles were used as supplementary studies of the basic organic chemistry concepts and related. The acceptability of students, as well as their motivation, performance and learning process was justified by the data collection of the applied teaching methodology. The acceptability and commitment of the students facing this teaching interactive approach, which transversely contributed to the intellectual maturity growth of the students, as well their professional development, were evidenced by satisfactory obtained results that will be herein discussed

Análise comparativa na influência da técnica de moldagem funcional em arcos parcialmente edêntulos sobre os pontos de contato oclusais, a integridade da fibromucosa e a extensão da base da prótese

There is a lack of clinical studies evaluating techniques of functional impression for partially edentulous arches. The aim of this double-blind non-randomized controlled clinical trial was to compare the efficacy of altered cast impression (ACI) and direct functional impression (DFI) techniques. The efficacy was evaluated regarding the number of occlusal units on denture teeth, mucosa integrity at 24-hour follow-up and denture base extension. The sample included 51 patients (female and male) with mean age of 58.96 years treated at Dental Department of UFRN. The patients, exhibiting edentulous maxilla and mandibular Kennedy class I, were divided into two groups (group ACI, n=29; group DFI, n=22). Clinical evaluation was based on the number of occlusal units on natural and/or artificial teeth, mucosa integrity at 24-hour follow-up, and denture base extension. Statistical analysis was conducted using the software SPSS 17.0® (SPSS Inc., Chicago, Illinois). Student T-test was used to reveal association between number of occlusal units and impression technique while chi-square test showed association between mucosa integrity and impression technique. Fischer s exact test was applied for association between denture base extension and impression technique at 95% level of significance. No significant difference was observed between the groups regarding number of occlusal units, mucosa integrity and denture base extension. The altered cast technique did not provide significant improvement in comparison to the direct technique when the number of occlusal units, mucosa integrity and denture base extension

Notas sobre o problema da explicação e da experiência no ensino da Filosofia

Apesar do esforço dos defensores do ensino da Filosofia para que essa disciplina volte a fazer parte do Ensino Médio, observamos, atualmente, seu abandono nos cursos universitários. Notamos que hoje, na sociedade normalizada e no espaço educacional, não é mais valorizado o desenvolvimento integral do pensamento, mas a transmissão de uma série de conteúdos que, supostamente, dão condições para a integração do estudante no quadro do progresso tecnológico e proporcionam sua entrada no mercado de trabalho. Circunscrevendo-se nesse contexto, neste texto pretende-se investigar o espaço em que o ensino da Filosofia se desenvolve na atualidade. Delineando os contornos de um problema que emerge nos espaços institucionais universitários onde o ensino da Filosofia ainda persiste, procurou-se evidenciar em que bases a Filosofia é ensinada. Procurou-se, ainda, compreender quais consequências os modos de compreender o ensino da Filosofia trazem para o aprendizado do filosofar. Uma consideração a que se pode chegar, a partir deste estudo, é a de que o ensino da Filosofia além de não privilegiar, e muitas vezes negar, a experiência de pensamento que o aluno pode fazer e ter com o texto filosófico, contribui para o empobrecimento dessa mesma experiência do e com o filosofar.

Discurso de paraninfo

O presente texto é o discurso de paraninfo pronunciado para os formandos da turma de 2001 da Faculdade de Filosofia e Ciências da Universidade Estadual Paulista, Campus de Marília/SP. Constitui-se em pequena reflexão sobre o momento da formatura, a passagem para a vida profissional e os problemas mais candentes que a vida acadêmica enfrenta hoje no Brasil.

Romifidine or xylazine combined with ketamine in dogs premedicated with methotrimeprazine

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Mastalgia cíclica pré-menstrual: placebo versus outras drogas

Os autores definem mastalgia cíclica pré-menstrual, (MCPM), repassam os principais mecanismos do ciclo celular da mama, e com base nestes conhecimentos propõem a sua classificação em três tipos, segundo a fisiologia do ciclo mamário: tipo 1 - caracterizado pela distensão localizada de ductos e adensamento do tecido conjuntivo em volta de pequenas dilatações. tipo II - caracterizado pelo edema intersticial, e tipo III - caracterizado pela combinação dos dois processos etiopatogênicos. OBJETIVO: Por meio de estudo prospectivo, aleatório, triplo cego e controlado, comparar a ação de placebo com associação de vitaminas A-D-E e doses baixas de ácido acetilsalicílico. MÉTODOS: Foram observadas 259 portadoras de MCPM, acompanhadas durante seis meses para estudo comparativo das drogas empregadas no alívio da dor. Destas, foram selecionadas 81 pacientes por critérios rigorosos, divididas em três grupos de 27, que receberam, respectivamente, aspirina, associação de vitaminas e placebo. A dor foi classificada em grau I (sem dor), grau II (dor moderada) e grau III (dor intensa). Os métodos estatísticos realizados mostraram que o número de pacientes em cada grupo era satisfatório. Foi empregado o teste de Tukey para comparação dos resultados e significância a 5%. RESULTADOS: As características clínicas, idade, peso, altura e IMC, antecedentes obstétricos e duração da amamentação foram semelhantes nos três grupos. Houve redução de intensidade da dor nos três grupos, principalmente naquele que recebeu placebo. CONCLUSÃO: O estudo realizado, segundo metodologia aceitável, porque foi prospectivo, controlado, triplo cego e aleatório, não mostrou diferenças significativas no tratamento da mastalgia cíclica pré-menstrual entre aspirina e associação de vitaminas, mas revelou superioridade do placebo.

O ensino de pediatria na atenção básica em saúde entre as fronteiras do modelo biomédico e a perspectiva da integralidade do cuidado: a visão dos médicos supervisores

Trata-se de estudo sobre educação médica, focalizado no ensino de pediatria na atenção básica, com o objetivo de analisar a contribuição da disciplina de Pediatria Social e Comunitária no 4º ano de graduação em medicina da Faculdade de Medicina de Botucatu, Universidade Estadual Paulista.Utilizou-se metodologia qualitativa de pesquisa, tendo como estratégia o estudo de caso. A análise foi fundamentada na abordagem sócio-histórica, subsidiada pelos estudos de Vigotski. Identificou-se o que os supervisores consideraram como aprendizados relevantes a sua contribuição no processo de mediação para que os estudantes aprendam sobre o processo de trabalho na atenção básica, o que não poderiam alcançar sozinhos. As entrevistas transcritas revelaram núcleos de significação comuns: importância da diversificação de cenários de ensino, aprendizado dos principais problemas de saúde, integralidade no atendimento da criança, com ênfase no vínculo e oportunidade do estudante aprender sobre promoção da saúde.