Evidências de validação de um protocolo para assistência às pessoas com úlceras venosas em serviços de alta complexidade

Venous ulcers are lesions resulting from chronic venous insufficiency, venous valvular abnormalities and venous thrombosis. Its occurrence has been growing with the increase in life expectancy of the world population. Considered as fundamental aspects in the approach to the person with venous ulcer care with the interdisciplinary approach, adoption of protocol-specific knowledge, technical skill, coordination between levels of care complexity of the Health System and active participation of patients and their families, a holistic perspective. The construction of a clinical protocol for people with venous ulcers can help professionals of high complexity services in patient assessment and the establishment of quality care in a systematic way and focused on the factors that interfere with wound healing. Thus, this study aimed to analyze the evidence of validation of a clinical protocol for people with venous ulcers treated at high-complexity services. This is a methodological study with a quantitative approach, developed in three stages: literature review, evidence of content validity and evidence of validation in the clinical context. Approved by the Federal University of Rio Grande do Norte Research Ethics Committee (Opinion: 147.452 and CAAE: 07556312.0.0000.5537). The literature review was conducted in August and September 2012, becoming the basis for the construction of the protocol. Then the evidence of content validity, which included 53 judges (experts) selected by the Lattes platform to evaluate the protocol items was performed. The judges were contacted by e-mail and rated the protocol via Google Docs . After analyzing the ratios obtained in this step, which reported kappa between 0.75 and 0.96 and between 0.80 and 0.98 IVC, and the suggestions of the judges, the protocol was adjusted and subjected to empirical evidence to validate the clinical setting at the University Hospital Onofre Lopes in Natal / RN. Evidence of validation in the clinical setting involved 4 judges who acted in pairs (paired) evaluated 32 patients with venous ulcers in the clinical context of high complexity. In both stages, we used the Kappa Index and Content Validity Index to analyze the responses of the judges. The parameters set as acceptable for these indices were: Kappa ≥ 0.61 and Content Validity Index > 0.80. Any evidence of content validity, as evidence of validation in the clinical context, the protocol items that have not reached Kappa and Content Validity Index established indices were excluded and some items were modified or added after suggestions. The process of content validation evidence and evidence of validation in the clinical setting allowed the improvement of the protocol for the care of people with venous ulcers initially proposed. The initial version of the protocol, built from the literature, contained 15 categories and 108 items; after evidence of content validity, remained the reduction to 15 categories with 91 items; the final version, clinically validated, is composed of the same 15 categories, 76 items. The protocol was validated in its content and in the clinical aspect, so we accepted the alternative hypothesis in the study. This protocol may contribute to the care system, allowing tailor behaviors and promote greater resolution in the treatment of people with venous ulcers in health services of high complexity

Diagnósticos de enfermagem em pacientes submetidos à hemodiálise: semelhanças entre o modelo de adaptação e a NANDA internacional

The nurses in the hemodialysis has an important role in the nursing process implementation, in the context of a theoretical referential. Among the nursing theories, highlights the Roy´s adaptations model, who considers a person as an holistic adaptive system that aims to adapt customers to different living conditions. Thus, it is believed that the Roy´s nursing process will guide nursing care to patients on dialysis. Therefore, the study aimed to analyze the nursing diagnosis present in patients with chronic kidney disease on hemodialysis based on the theoretical model of Roy and NANDA-International. Descriptive and cros-sectional study, performed at a dialysis center in a city in northeastern Brazil. Sample of 178 patients and consecutive sampling by convenience. Data collection ocurred from October/2011 until February/2012, through interview and physical examination forms. Data analysis was initiated by clinical reasoning, diagnosis judgment and similarity relation. Then, the data were entered into SPSS program, 16.0 version, generating descriptive statistics. The project was approved by the Ethics Research Committee (protocol nº 115/11) with a Presentation Certificate for Ethics Appreciation (in 0139.0.051.000-111) and was funded by the Universal edict MCT / CNPq 14/2010. The results revealed that most patients were male (52.2%), married (62.9%) and residents in the Natal´s metropolitan region (54.5%). The mean age was 46.6 years and the years of study, 8,5. Regarding nursing diagnosis obtained an average of 6.6, especially: Risk of Infection (100%), excessive fluid volume (99.4%) and hypothermia (61.8%). On the other hand the adaptive problems average was 6.4, and the most common: intracellular fluid retention (99.4%); Hyperkalemia (64.6%); Hypothermia (61.8%) and edema (53.9%). Were established 20 similarity relations between the NANDA-International nursing diagnosis and adaptive problems of Roy, namely: risk of falls / injury risk and potential for injury, impaired physical mobility and walking mobility and / or restricted coordination, dressing self-care deficit and loss of self-care ability; hypothermia and hypothermia; impaired skin integrity and impaired skin integrity; excessive fluid volume and intracellular fluid retention / Hyperkalemia / Hypocalcemia / edema; imbalanced nutrition: less than body requirements and Nutrition less than the body's needs; constipation and constipation, acute pain and acute pain, chronic pain and chronic pain, sensorial perception disturbed: visual, tactile and auditory disabilities and a primary sense: sight, hearing and tactile; sleep deprivation and insomnia, fatigue and intolerance to activities; ineffective self health and fails in the role; sexual dysfunction and sexual dysfunction; situational low self-esteem and low self-esteem, and diarrhea and diarrhea. We conclude that there is similarity between the typologies and was required a model´s analysis, because they present different ways to establish the nursing diagnosis. Moreover, the nursing process use, under the context of a theory and a classification system, subsidizes the care and contributes to the strengthening of nursing science

Integridade tissular de pacientes com úlceras venosas: um estudo baseado na Classificação dos Resultados de Enfermagem

The venous ulcer is an epidemiological problem of high prevalence, causing disability and dependence. Assess the tissue impairment level of patients with venous lesions, within a nursing referential, is relevant for the implementation of a directed assistance to specific clientele. Thus, this work aims to characterize the health status regarding the integrity the lower limbs skin of patients with venous ulcers, according to the of tissue integrity outcome indicators from the Nursing Outcomes Classification. A cross-sectional study conducted in a university hospital in Natal - Rio Grande do Norte. The sample consisted of 50 participants, selected through consecutive sampling. Data collection occurred through a interview and physical examination form and a operational definitions tool for indicators of the nursing Tissue Integrity outcome directed to patients with venous ulcer, applied from February to June 2012. Data analysis was done by descriptive statistics and nonparametric tests (Spearman, Kruskal-Wallis and Mann-Whitney tests). The project was approved by the Research Ethics Committee with protocol 608/11 and Presentation Certificate to Ethical Consideration No. 0038.0.294.000-11. The results were presented using three scientific articles derivatives of research. It was found that the indicators show moderate impairment, light and not impaired, as the median. The respondents had an average of 59.72 years, 66% female, 50% were retired, 60% with a partner, 44% had arterial hypertension, 26% allergies, 20% diabetes mellitus, 96% were sedentary, 14% drank alcohol and 6% were smokers. There was a statistically significant correlation of low intensity between age and hydration (p=0.032; rs=-0.304) and skin desquamation (p=0.026; rs=-0.316), family income and necrosis (p=0.012; rs=-0.353); Ankle Brachial Index and tissue perfusion (p=0,044; rs=-0,329); Diabetes Mellitus and texture (p=0.015) and tissue perfusion (p=0.026); allergy and texture (p=0.034), physical activity and hydration (p=0.034), smoking and thickness (p=0.018), and alcohol consumption and exudate (p=0.045). We conclude that the patients had light to moderate impairment, indicating a good state of health on the integrity of the skin of the lower limbs, according to the indicators of the outcome of tissue integrity Classification Nursing Outcomes valued in the present study. It is believed that the evaluation of impairment tissue using a self-nursing system and its relation with socioeconomic, clinical and risk factors are unique tools in the care planning and in the wound healing

Autoestima e qualidade de vida de pessoas com úlcera venosa atendidas na atenção primária

Venous ulcers (VU) is a chronic injury of the lower extremities and because of its high incidence and recurrence implies long and complex treatments, damaging the quality of life (QOL) and self-esteem (SE) of the people. This study aimed to analyze the association between self-esteem with the quality of life of people with venous ulcers treated in primary care. Cross sectional analytical study with a quantitative approach conducted with 44 people met with VU at 13 primary care units 2 and Mixed units in Natal/RN. The study was approved by the Ethics Committee in Research of the Federal University of Rio Grande do Norte (UFRN), CAAE: 07556312.0.0000.5537. Held data collection from February to April 2014 and used three instruments: a structured form covering sociodemographic, health care and clinical variables, the Rosenberg Self-Esteem Scale and the SF-36. The collected data were entered into a database and processed on computerized software for descriptive and inferential analyzes. The results showed a predominance of people with UV females (65,9%), with more than 60 years (59,1%), married or in a stable relationship (52,3%), low education (86,4%) without occupation (68,2%) and less than one minimum wage income (81,8%). Regarding assistance characteristics was observed that most patients performed the dressing with appropriate material (72,7%), professional or trained caregiver (61,4%) did not use compression therapy (81,8%), treating the injury for more than 6 months (77,3%), lack of guidelines for the use of compression therapy, elevation of legs, and regular exercise (77,3%) and consulting the angiologist last year (52,3% ). Regarding clinical features of the lesion was found that most of the recurrent lesions are (77,3%), over one year of current lesion (52,3%) medium to large lesions (54,8%), without signs of infection (61,3%) and pain (79,5%). The mean SE of respondents was 9,3 (± 5,1). The relations between the SE and the sociodemographic variables, health care and clinics showed that individuals without a partner (a) (p = 0,01), who did not wear compression therapy (p = 0,04), with more 6 months of treatment (p = 0,01) and larger lesions (p = 0,01) had a lower SE. The mean domain and the dimensions of the SF-36 were lower emphasizing the functional capacity 36.5 (± 27,6) and the physical aspects of 15.3 (± 30,6). There were significant correlations between AE people with VU and the domains and dimensions of the SF-36: physical functioning (r = -0,432), general health (r = -0,415), vitality (r = -0,573), aspects social (r = -0,517), mental health (r = -0,612) and mental health dimensions (r = -0,612) and physical health (r = -0,473). Based on these results it is concluded by rejecting the null hypothesis and accept the alternative proposed in the study in which it was found that there is a negative correlation between the SE and the QOL of people with venous ulcers

Avaliação da assistência à saúde dos portadores de úlceras venosas atendidos no programa saúde da família do município de Natal/RN

Descriptive research aimed at evaluating the assistance offered to patients with venous ulcers, on lower limbs, attended by the Family Health Program (FHP) team, from the municipality of Natal/RN. The target population was composed of 74 patients with venous ulcers (VU), attended by the FHP teams in the 31 FHUs. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (protocol n.55/05). The data collection was performed in patients homes and in the FHUs, through structured interviews and physical examinations of patients with VU and non-participant observation during the changing of wound dressings in these Units and in users homes. The data was organized into an Excel electronic table and transported into the SPSS 14.0 program, for descriptive analysis on 2x2 contingency tables and inferential (Qui-Square χ2, Spearman Correlation, Binomial Proportion Test and p-value <0.05). The prevalence of VU (0.36/1000) in the target population (over 20 years of age) was greater than in the population registered in FHP (0.25/1000). We detected a greater prevalence in the age area of over 60 years (2.22/1000), with 2.98/1000 for females and 1.3/1000 for males (p-value=0.008). The sociodemographical and health characteristics of patients with VU revealed predominance of females (74.5%), elders over 60 years of age (67.6%), with fundamental education (74.3%), family earnings of up to 2 minimum wages (68.9%), retired (90.5%), ortostatic position (23.0%), inadequate sleep (59,9%), presence of CVI (100.0%), hypertension (44.6%) and diabetes (25.7%). As for the time of existence of the VU, 64.9% had over 1 year, and 35.1% less than 1 year), with predominance of one wound (67.6%). The changing of wound dressings is performed mostly at home, in and inadequate way, especially with incorrect cleaning techniques, likewise incorrect use of products and substances, and reduced participation of the FHP team on the evaluation and application of the dressing and choosing of products and substances. The compressive therapy is not part of therapeutic conducts for treatment in the FHUs. As for the evaluation of assistance to patients with VU, 90.5% were inadequate and only 9.5% adequate. The main inadequacy factors were the absence of: diagnosis (47.3%), consultation with and angiologist (63.5%), compressive treatment (100.0%), adequate optical therapy (98.62%), adequate dressing kit (70.3%), training for the changing of dressings (67.6%), following by the FHP team (51.4%) and performed exams (55.4%). We ve concluded that patients with VU mostly present now socioeconomical level and associated chronic diseases. Considering that assistance offered by FHP is non-systematic, fragmented, with no diagnosis planning, continual evaluation and evolution, we qualify the assistance as inadequate and with low level of solution, directly interfering on the maintenance of the VUs chronic state

Análise da adesão ao tratamento e da qualidade de vida de pessoas com úlcera venosa

The therapeutic adherence is still a big problem among people with venous ulcers (VU) because the treatment is long, expensive and demand changes in lifestyle. In this context, this study aims to examine treatment adherence and quality of life (QOL) of people with VU assisted at primary health care. This is an analytical, cross-sectional study with a quantitative approach to treatment and data analysis. The study had the scenario 13 Family Health Units and 02 Units Mixed of Natal. The target population consisted of 44 persons with UV indicated by the teams of the Family Health Strategy between February and April 2014. Three instruments were used: an instrument to characterize the sociodemographic, health and care aspects, the Multidimensional Scale of Adherence Therapy composed of the dimensions: healthy lifestyle, compressive therapy and neurovascular monitoring and the Charing Cross Venous Ulcer Questionnaire (CCVUQ) that evaluates QOL in persons with VU composed by the domains: Total Score, Social Interaction, Domestic Activities, Aesthetics and Emotional State. The study was approved by the Ethics Committee in Research of the Federal University of Rio Grande do Norte, CAAE: 07556312.0.0000.5537. The data concerning the sociodemographic characteristics showed that there was a predominance of females (65.9%), age range as of 60 years (59.1%) and income of up to 1 minimum wage (81.8%). With the characterization of health, it was evident that most people reported chronic diseases (63.6%), sleep more than 6 hours (81.8%), present pain (81.8%), denying alcoholism (86 4%) and smoking (77.3%) and showed a number greater than or equal to 1 (77.3%) recurrences. Concerning the therapeutic adherence was found that in the dimension compressive therapy there poor adherence. No associations between the domains of adherence and sociodemographic and health variables were found. Was observed, however, better adherence among individuals without pain and with higher schooling. When analyzed the averages of the dimensions of therapeutic adherence with the care characteristics there was statistical significance between: adherence to compression therapy and guidance for use of compressive therapy (p = 0.002) and guidance for regular exercise (p = 0.026). Considering the mean of total score of CCVUQ (mean 51.47, SD 18.33) it is observed that the overall QOL of respondents has approximate value of the median of the scale (50). The mean of the domain Social Interaction (mean 44.23, SD 21.38) and Domestic Activities (mean 45.70, SD 23.21) were those who reported better QOL. There were weak correlations but significant between adherence to healthy lifestyle and Domains Total Score (p = 0.012), social interaction (p-value = 0.048), Aesthetics (p-value = 0.025) and Emotional State (0.017) of CCVUQ. From the data analysis it is concluded that among people with UV, there poor adherence to compressive therapy. Furthermore, we found no statistically significant association between treatment adherence and sociodemographic and health characteristics. It is added that there was a correlation between the healthy lifestyle dimension and domains CCVUQ

Aplicações da tomografia de ressonância magnética nuclear como método não-destrutivo para avaliar os efeitos de injúrias mecânicas em goiabas 'Paluma' e 'Pedro Sato'

Objetivou-se determinar o potencial do uso da tomografia de ressonância magnética, como método não-destrutivo, para avaliar os efeitos das injúrias mecânicas em goiabas. Foram utilizados frutos no estádio de maturação de vez das cultivares Paluma e Pedro Sato. Na injúria por impacto, os frutos foram deixados cair, em queda livre, de uma altura de 1,20 m, sofrendo dois impactos, em lados opostos de sua porção equatorial. Na injúria por compressão, os frutos foram submetidos a um peso de 29,4 N, por 15 minutos. Para a injúria por corte, foram efetuados dois cortes, no sentido longitudinal dos frutos, de exatamente 30 mm de comprimento por 2 mm de profundidade. Os frutos injuriados foram armazenados sob condições de ambiente (22 ± 2 °C e 40 %UR). Foram realizadas análises com tomógrafo de ressonância magnética Varian Inova de 2 Tesla. As imagens foram obtidas a partir da detecção dos prótons de hidrogênio (¹H). Para cada fruto, foram obtidos tomogramas simétricos a partir do centro do fruto. A tomografia de ressonância magnética nuclear mostrou-se uma ferramenta eficaz na detecção de injúrias internas de frutos. O estresse físico causado pelo impacto produziu um colapso interno nos lóculos desses frutos (internal bruising), levando à perda da integridade celular e a conseqüente liquefação dos tecidos placentários. A cultivar Pedro Sato mostrou uma suscetibilidade maior à injúria por impacto que a 'Paluma'. A injúria por compressão tornou-se mais evidente no pericarpo externo do fruto, de ambas as cultivares. A injúria por corte levou a lignificação dos tecidos no local injuriado e deformações superficiais devido à perda acentuada de matéria fresca no local da lesão, evidentes no sexto dia de avaliação.

Latent heat loss of Holstein cows in a tropical environment: a prediction model

Nove vacas Holandesas lactantes com 526 ± 5 kg de peso corporal (cinco predominantemente pretas e quatro predominantemente brancas), criadas em região tropical e manejadas em pastagens, foram observadas com os objetivos de determinar simultaneamente as taxas de evaporação cutânea e respiratória em ambiente tropical e desenvolver modelos de predição. Para a medição da perda de calor latente pela superfície corporal, utilizou-se uma cápsula ventilada e, para a perda por respiração, utilizou-se uma máscara facial. Os resultados mostraram que as vacas que tinham maior peso corporal (classe 2 e 3) apresentaram maiores taxas evaporativas. Quando a temperatura do ar aumentou de 10 para 36ºC e a umidade relativa do ar caiu de 90 para 30%, a eliminação de calor por evaporação respiratória aumentou de aproximadamente 5 para 57 W m-2 e a evaporação na superfície corporal passou de 30 para 350 W m-2. Esses resultados confirmam que a eliminação de calor latente é o principal mecanismo de perda de energia térmica sob altas temperaturas (>30ºC); a evaporação cutânea é a maior via e corresponde a aproximadamente 85% da perda total de calor, enquanto o restante é eliminado pelo sistema respiratório. O modelo para predizer o fluxo de perda de calor latente baseado em variáveis fisiológicas e ambientais pode ser utilizado para estimar a contribuição da evaporação na termorregulação, enquanto o modelo baseado somente na temperatura do ar deve ser usado apenas para a simples caracterização do processo evaporativo.

Análise e classificação de imagens de lesões da pele por atributos de cor, forma e textura utilizando máquina de vetor de suporte

The skin cancer is the most common of all cancers and the increase of its incidence must, in part, caused by the behavior of the people in relation to the exposition to the sun. In Brazil, the non-melanoma skin cancer is the most incident in the majority of the regions. The dermatoscopy and videodermatoscopy are the main types of examinations for the diagnosis of dermatological illnesses of the skin. The field that involves the use of computational tools to help or follow medical diagnosis in dermatological injuries is seen as very recent. Some methods had been proposed for automatic classification of pathology of the skin using images. The present work has the objective to present a new intelligent methodology for analysis and classification of skin cancer images, based on the techniques of digital processing of images for extraction of color characteristics, forms and texture, using Wavelet Packet Transform (WPT) and learning techniques called Support Vector Machine (SVM). The Wavelet Packet Transform is applied for extraction of texture characteristics in the images. The WPT consists of a set of base functions that represents the image in different bands of frequency, each one with distinct resolutions corresponding to each scale. Moreover, the characteristics of color of the injury are also computed that are dependants of a visual context, influenced for the existing colors in its surround, and the attributes of form through the Fourier describers. The Support Vector Machine is used for the classification task, which is based on the minimization principles of the structural risk, coming from the statistical learning theory. The SVM has the objective to construct optimum hyperplanes that represent the separation between classes. The generated hyperplane is determined by a subset of the classes, called support vectors. For the used database in this work, the results had revealed a good performance getting a global rightness of 92,73% for melanoma, and 86% for non-melanoma and benign injuries. The extracted describers and the SVM classifier became a method capable to recognize and to classify the analyzed skin injuries

Sistema auxiliar na análise de mamogramas digitais

This work proposes the development of a Computer System for Analysis of Mammograms SCAM, that aids the doctor specialist in the identification and analysis of existent lesions in digital mammograms. The computer system for digital mammograms processing will make use of a group of techniques of Digital Image Processing (DIP), with the purpose of aiding the medical professional to extract the information contained in the mammogram. This system possesses an interface of easy use for the user, allowing, starting from the supplied mammogram, a group of processing operations, such as, the enrich of the images through filtering techniques, the segmentation of areas of the mammogram, the calculation the area of the lesions, thresholding the lesion, and other important tools for the medical professional's diagnosis. The Wavelet Transform will used and integrated into the computer system, with the objective of allowing a multiresolution analysis, thus supplying a method for identifying and analyzing microcalcifications

Avaliação de métodos de inoculação de Phytophthora parasitica em plântulas e plantas jovens de citros

Este trabalho teve como objetivo avaliar métodos de inoculação de Phytophthoraparasitica em plântulas e plantas jovens de citros (Citrus spp.) visando sua utilização em estudos de resistência de porta-enxertos à gomose de Phytophthora. Os métodos de inoculação testados foram: contato planta sem ferimento-patógeno, casca destacada, inserção de disco de meio de cultura contendo micélio sob a casca, método do disco e inserção de agulha e palito infestados em plântulas e plantas jovens de citros. A resistência de genótipos à gomose pode ser avaliada em plântulas in vitro, através de inserção de agulha infestada. O método do disco e o da inserção sob casca foram os melhores quando utilizados em plantas jovens. A medida da área total da lesão é a variável ideal para avaliação da doença. No entanto, o comprimento da lesão pode ser utilizado na avaliação da doença em plântulas, plantas jovens e no campo.

Net melon resistance to Didymella bryoniae according to grafting and potassium levels

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Desenvolvimento de sistemas micro e nanoestruturados de quitosana/MDI para aplicações cosméticas

Currently, studies in the area of polymeric microcapsules and nanocapsules and controlled release are considerably advanced. This work aims the study and development of microcapsules and nanocapsules from Chitosan/MDI, using a new technique of interfacial polycondensation combined to spontaneous emulsification, for encapsulation of BZ-3. It was firstly elaborated an experimental design of 23 of the particle in white without the presence of BZ-3 and Miglyol, where the variables were the concentrations of MDI, chitosan and solvent. Starting from the data supplied by the experimental design was chosen the experiment with smaller particle diameter and only added like this BZ-3 and Miglyol. The suspension containing concentrations of 6.25 mg/mL, 12.5 mg/mL, 18.75 mg/mL, 25 mg/mL of BZ-3 were prepared, nevertheless, during the storage time, these formulations presented drug precipitates in the suspensions of 18.75 mg/mL and 25 mg/mL of BZ-3. This apparition of precipitate was attributed to the diffusion of BZ-3 for the aqueous phase without any encapsulation, suggesting so the use of the smaller concentrations of the BZ-3. The suspension containing 6.25mg/mL of BZ3 presented average size of 1.47μm, zeta potential of 61 mV, pH 5.64 and this sample showed an amount of BZ-3 and drug entrapment of 100 %. The suspension containing 12.5mg/mL of BZ-3 presented average size of 1.76μm, zeta potential of 47.4 mV, pH 5.71 and this sample showed an amount of BZ-3 and drug entrapment of 100 %. Then, showing such important characteristics, these two formulations were chosen for futher continuity to the study. These formulations were also characterized by the morphology, FTIR, stability for Turbiscan, DSC and a study of controlled release of the BZ-3 was elaborated in different receiving means

Influência da atividade e inatividade física na composição corporal e adiposidade central

To analyze influences of the physical activity and sedentary behaviors on indicators of both central and total body fat in male adolescents. Cross-sectional study with 60 male students of age range from 11 to 14 years old. It were evaluated the body mass, height, triceps skinfold, waist circumference, body fat percentage (bioelectrical impedance) and the physical activity level through questionnaire. The physical inactivity prevalence was of 35%, and the excessive total and central body fat were observed in 38.3% and 48.3% of the sample, respectively. There was association of the sedentary behaviors with the excessive total and central body fat (OR = 5.2 e OR = 6.4, respectively), however there was not for physical activity. The adoption of sedentary behaviors is associated at the development of the total and central obesity among male adolescents.

Características biomecânicas, ergonômicas e clínicas da postura sentada: uma revisão

A posição sentada é a mais adotada nos ambientes de trabalho, na escola e nas atividades de lazer. Porém, a manutenção prolongada dessa posição ocasiona a adoção de posturas inadequadas e sobrecarrega as estruturas do sistema musculoesquelético, o que pode acarretar dor e lesão na coluna lombar. A presente revisão teve como objetivo identificar os fatores biomecânicos, ergonômicos e clínicos envolvidos na sustentação da postura sentada. Para isso, foram consultadas as bases de dados ISI Web of Knowledge, Medline, Pubmed e EBSCO Host, sendo selecionados 72 artigos publicados entre 1965 e 2010. Foi possível identificar que na posição sentada não existe uma postura ideal a ser sustentada, mas algumas posturas são mais recomendadas do que outras, tal como a postura sentada ereta e a postura lordótica. As cadeiras influenciam o padrão da posição sentada: conforme seu design, pode permitir maior variedade de posturas. Modificações na cadeira e a utilização de exercícios para o aumento da resistência muscular e da propriocepção, bem como a reeducação postural, são intervenções úteis para reduzir o impacto causado pela posição sentada prolongada no sistema musculoesquelético.