Validação da escala de fatigabilidade percebida para avaliação da fadiga em idosas

The term fatigability concerns the degree of fatigue associated with performing an activity of any type (physical, mental, emotional and / or social). Recently scales for assessing fatigue in the English language were created, however, gaps exist regarding the validity of these scales in relation to oxygen consumption and levels of perceived fatigue. Objective: To investigate the validity of perceived fatigability scale in older women frail and non-frail by the expired gases kinetics. Methods: This is a study of type validation, where were evaluated 48 elderly. The evaluation was conducted at two different sessions. In the first, data were collected demographic partners, as well as assessment of cognitive function, physical health, and the phenotype of frailty. The second was composed by the test 6-minute walk (6MWT) associated the expired gases kinects and assessment of perceived fatigability. Statistical analysis was performed a descriptive analysis and then we used the Pearson correlation test to evaluate the relationship between the measure of perceived fatigue and variables oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory exchange ratio (RER)before and after 6MWT. We used a linear regression model initially considering the following explanatory variable: age, Body Mass Index (BMI), presence of frailty, comorbidities, level of physical activity, distance covered in the 6MWT , the energy cost of walking and severity of fatigability on performance. Results: The final sample consisted of 44 elderly women, 4 elderly were excluded because they didn t complete all phases of this study. The mean age obtained was 75 years (± 7.2 years). There was no significant correlation between fatigability measures and the values of VO2 ( r = .09 , p = .56 ) , VCO2 ( r = .173 , p = .26 ) , RER ( r = - .121 , p = .43 ). The final linear regression model showed that the energy cost of walking, the usual level of physical activity and the performance severity of fatigability explained 83.5 % (R2 = 0.835, p < 0.01) of the variation in the perceived fatigability. Conclusion: Our findings indicate a relationship between greater severity of fatigability and lower levels of physical activity and increased energy cost in walking, suggesting that the fatigability analyses using a simple numeric scale is valid and viable for assessment of fatigue in older women

Estágio menopausal e níveis hormonais no desenvolvimento muscular e funcional em mulheres de meia idade: um estudo transversal

Introduction: Hypoestrogenism is the main characteristic of female aging. It promotes significant changes in body composition, both in fat mass as in lean body mass, leading to a decrease in muscle strength and physical performance. Objective: The aim of this study was to test whether menopausal status and hormone levels are associated with muscular strength and physical performance in middle-aged women. Methods: In a cross-sectional study it was collected sociodemographic data, gynecological history, anthropometric and biochemical measures in women aged 40 to 65 years in Parnamirim-RN. The menopause status (pre, peri and post menopause) was determined by menstrual history. All women underwent three dimensions of physical performance assessment: handgrip dynamometry, gait speed and chair stands test - Short Physical Performance Battery (SPPB). Categorical data were presented as absolute and relative frequencies. Quantitative data were showed as mean and standard deviation and the normality of distribution was verified with Kolmogorov-Smirnov (KS) test. Biochemical measures of estradiol and follicle-stimulating hormone (FSH) were transformed to log10. ANOVA with Tukey post-test for comparison of variables between the groups pre, peri and post-menopausal was performed and then multiple linear regression analyzes. Results: Two hundred and seventy eight women aged 50.2 (±5.58) years composed this study, being 50 women in premenopausal status (18%), 122 in perimenopausal (43.9%), and 106 postmenopausal stage (38.1%). The groups were different in age (p=0.001), marital relationship duration (p <0.001), number of pregnancies (p=0.001) and parity (p=0.001). Differences in biochemical measures were observed among the groups: estradiol (p<0.001), FSH (p<0.001), total cholesterol (p=0.001). There were no differences in gait velocity between menopausal status. Values in mean of grip strength decreased by postmenopausal women to perimenopausal and premenopausal ones (24.5 ± 5.1, 25.6 ± 5.4, 26.9 ± 4.9 for post-stage, pre and peri menopausas, respectively, p = 0.02) and the performance of chair stands test was better in premenopausal women compared with that in peri and postmenopausal status (p = 0.02). In multiple linear regression for muscle strength, the variables that remained were: age, estradiol and somatic symptoms measured by Menopause Rating Scale-MRS (R2=0.15). While for the xiv chair-stands test the predictors were number of births and FSH values (R2=0.04). Conclusion: There is a relationship between the stages of menopause and muscle performance in measures of grip strength and sit-up test and these are influenced by the fall of estrogens levels. Data suggest that the decrease in muscle strength and physical performance already appear in the transition to menopause stage, pointing to the need for more research in this area and appropriate preventive interventions

A percepção dos docentes da UFRN sobre o programa de apoio a planos de reestruturação e ampliação das universidades federais - REUNI

In recent decades higher education in Brazil has gone through several changes. The Programa de Reestruturação e Expansão das Universidades Federais REUNI has been the greatest overhaul performed by the government in public universities in the last years. REUNI is presented as the biggest reform in tertiary education in contemporary times, having as the main goal a gradual increase in the average rate of conclusion in live learning graduation courses up to 90%, as well as a rate expansion of graduating students in face to face classes per professor. This research aims at studying the perception of professors from UFRN concerning the REUNI program in execution from 2008 until 2012. The study seeks to understand how professors evaluate the program and what the dimensions that most influence in this evaluation are. The study made use of a research tool (survey) which was sent through the internal system of the university, SIGAdmin, to all professors of superior teaching from UFRN. The answers generated by the survey were processed using SPSS statistical software (Statistical Package for Social Science). Factorial Analysis and Multiple Linear Regression were used as an analysis technique. 180 answers were obtained, reaching all UFRN Centers and some academic units, as well as some campuses in the countryside of the state. Through the research was possible to analyze how professors from UFRN perceive the REUNI program implemented in the institution. The results point to the program approval by the professors. Statistical tests showed that the average values obtained in the Centers and academic units are basically the same. It was demonstrated that the extent that most influenced in the answers is linked to practical outcomes of the program, whereas the knowledge of REUNI goals was the least that impacted on the marks given to the program. Another dimension which influenced the perception of professors relates to the influence of REUNI in their activities. It was observed that professors from UFRN don t see REUNI as an impediment to them

Análise da influência dos diferentes tempos de polimerização por luz incandescente sobre a resistência ao desgaste abrasivo de resinas compostas

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

Características sociodemográficas, hábitos de sono, estado cognitivo e funcional após acidente vascular cerebral

ABSTRACT Introduction: The cerebrovascular accident (CVA) is an important cause of neurological impairment. Few data about the factors associated with morbidity of cerebrovascular accident are found in Brazil. Objectives: Evaluate sociodemographic characteristics, sleep habits, cognitive and functional status of patients with cerebrovascular accident. Methods: The patients evaluated through questionnaire Step 1 to survey the sociodemographic characteristics and Modified Rankin Scale for functional assessment. The neurological degree was evaluated by the National Institutes of Health Stroke Scale (NIHSS), the sleep Habits questionnaire for sleep and cognitive status by the Mini-Examination of the Mental State (MEMS). The data were analyzed using the chi-square test to determine differences in proportions of variables and linear regression analysis. Results: 305 patients were evaluated and the larger number of subjects was between 50 and 69 years (40%), most patients had no formal education (40.3%) and had ischemic type of cerebrovascular accident (72.5%). In the analysis of the functionality it was found that most patients had moderate impairment (55.1%). The results of the sleep habits showed that 63,6% of patients had one more person in the bedroom,12,3% complained about too much noise in the 11 room and 35% of too much light. From these patients 5,8% were smokers, 7,8% and 70,1% drank coffee drinkers, 28,6% had difficulty in initiate to sleep and woke up 37,6% in the middle of the night. Were showed complaints about nightmares (11%), feeling of suffocation (37,7%) and 35% felt very sleepy during the day. In addition, 95% were unemployed, 80,5% did not perform physical activities and 95,4% did not perform mental activities. The cognitive screening conducted a determined association of cognitive status with age and education level and neurological status. Conclusion: The study showed a high frequency of cases of cerebrovascular accident with functional dependence in a moderate degree, identified that many patients do not follow hygienic measures of sleep and found that the assessment of cognitive deficits must take into consideration the age, educational level and degree of neurological patients. We suggest the need for programs of assistance to victims of cerebrovascular accident patients, with a multidimensional approach including the rehabilitation team, the role of sleep medicine and Neuropsychology, so that patients have access to a more appropriate functional rehabilitation, develop a lifestyle that ensures a good sleep quality and are evaluated and rehabilitated with regard to cognitive impairment

Elaboração e validação de escala diagramática para quantificação da mancha alvo em folhas de acerola

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

Desigualdade regional da mortalidade neonatal no Brasil

In Brazil, despite the decline in infant mortality in recent decades it still has high rates going against recommended by WHO. Being the largest percentage of infant mortality rate composed of neonatal deaths. Objective: A study was conducted to analyze the spatial distribution of neonatal mortality and its correlation with the biological, socioeconomic and maternal and child health care in the Brazilian states in the period from 2006 to 2010. Method: The study made thematic maps and correlation (LISA) for verification of spatial dependence and multiple linear regression models. Results: Was found that there is no spatial autocorrelation for neonatal mortality in the Brazilian states (R = 0.002, p = 0.48). Most of variables were correlated (r> 0.3, p <0.05) with neonatal mortality, forming clusters in the North and Northeast, with the highest rates of teenage mothers, low household income per capita, lower prenatal appointments and beds of Neonatal Intensive Care Unit. The number of Neonatal UCI beds remained independent effect after regression analysis. Conclusion: The study concludes that regional inequalities in living conditions and especially the access to maternal and child health services contribute to the unequal distribution of neonatal mortality in Brazil

A relação entre os determinantes sociais em saúde e os investimentos setoriais e a mortalidade infantil em municípios brasileiros com mais de 80 mil habitantes

Investments in health have controversial influence on results of the health of populations, besides being subject rarely explored in literature. Moreover, from the 1970s, the social determinants of health have been consolidated in the disease process as multifactorial factors (social, economic, cultural, etc.) that directly or indirectly influence the occurrence of health problems of populations, as well as mortality rates. This study aimed to evaluate the influence of these investments and the social determinants of health on infant mortality and its neonatal and post-neonatal mortality. This is an ecological study, in which the sample was composed of Brazilians cities with over 80,000 inhabitants, avoiding fluctuations in mortality rates for common small populations, and ensure greater coverage of information systems on mortality and births Brazilians and, therefore, increase data consistency. To isolate the effect of investments in health, we used multiple linear regression. The socioeconomic indicators (p <0.001, p = 0.004, p <0.001), the inequality index (p <0.001, p = 0.001, p = 0.006) and coverage of prenatal visits (p <0.001, p <0.001; p = 0.005) were associated with infant mortality rate total, neonatal and post-neonatal, and the Gross Domestic Product per capita only influenced the overall infant mortality rate and neonatal (p=0.022; 0.045). Investments in health, in this model, lost statistical significance, showing no correlation with mortality rates among children under one year. We conclude that the social determinants of health has an influence on the variation in mortality rates of Brazilian cities, however the same was not observed for indicators of health investment

Relação das condições socioeconômicas com as condições de saúde bucal em capitais brasileiras

Despite the improvement of Brazilian s living conditions in recent decades, this improvement occurred in a polarized way between groups of better social position. Then, there is still a health inequity´s panorama in Brazil which encompasses the oral health state. This panorama instigated the attainment of this ecological study that aimed to evaluate the relationship of socioeconomic conditions, and public health policies with oral health status in Brazilian capitals. Thus, we performed factor analysis and linear regression using oral health indicators collected from SB Brasil 2010, of socioeconomic conditions from Brazilian Census 2010 and related to water´s supply fluoridation from SISAGUA. Factor analysis with indicators of living conditions revealed two common factors, economic deprivation and socio-sanitary condition. Economic deprivation showed statistically significant positive correlation with DMFT 12 years (p= 0,03) and mean missing teeth (p = 0,002) and negative correlation with caries-free population (p=0,012). Socio-sanitary negatively correlated with DMFT (p <0,0001) and a positive correlation with caries-free population (p = 0.002). Fluoridated water had a significant association with DMFT (p <0,0001), mean missing teeth (p <0,0001) and caries free population (p <0.0001). Multiple linear regression analysis for the DMFT of capital was estimated by socio-sanitary condition and fluoridation, adjusted by economic deprivation, whereas the model for the mean missing teeth was estimated only by fluoridation and economic deprivation, and finally the model the rate for the population free of caries in Brazilian capitals was estimated by economic and socio-sanitary status adjusted fluoridated water supply. Therefore, factors related to living conditions and public policies are intrinsically linked to tooth decay issues. Thus, actions, beyond dental care assistance, must be development to impact positively in social and economic conditions, especially, between the most vulnerable populations

Fatores socioeconômicos contextuais associados à condição bucal de adolescentes no Brasil

Many surveys are conducted comparing oral health conditions with individual variables, such as socioeconomic and demographic factors. However, in the same way that individuals differ among themselves, the groups also have their own characteristics and the effects of this differentiation must be researched. Brazil, despite being one of the major economic powers of the world and shows an improvement in the average value of its health indicators, is also one of the most unequal and remains among the countries with the greatest health inequities. The purpose of this study was to investigate the importance of social determinants on the contextual level oral health among Brazilian adolescents, population not much researched by the literature. The research was made using an ecological approach in order to identify possible inequalities between cities and capitals. Using data from SBBrasil 2010 it was evaluated less common outcomes (loss of first molar, dental care index and T-Health) which provide information on the degree of morbidity of caries and health level of dental tissues, in addition to analyze the related services. The association of these oral health indicators with socioeconomic factors such as income, employment, education and inequality, collected from Census 2010, was analyzed by simple and multiple linear regressions. The study included the 27 state capitals and four clusters representing the municipalities of the country. It was possible to see better access to services in locations with better income distribution. However, the strong association of contextual factors related to poverty, low levels of education and poor housing and jobs with poorer levels of oral health in adolescents seems to overshadow the effects of income inequalities on dental caries in the country. In some locations, particularly within the North and Northeast, whichever one keeps dentistry mutilating, whose effects are already noticeable in its adolescent population. Access to restorative services in Brazil remains limited and unequal. The results of this study highlight the inequities in oral health in the country and show the need of the inclusion of new perspectives on the traditional approach of Preventive Dentistry and education models in Dentistry. Tackling health inequalities in oral health in the country requires the cooperation of various actors involved in the process and the inclusion of oral health in the context of overall health. The social determinants approach, as well as evaluating the distribution of oral diseases in the country and its inclusion in the context of overall health, should guide the implementation of programs and oral health practices in order to contribute to the reduction of inequalities

Relação entre a esfericidade, a função ventricular e o tamanho do infarto em ratos

FUNDAMENTO: A esfericidade do ventrículo esquerdo (VE) é fator associado com disfunção ventricular, mas não está bem caracterizada no modelo de ratos infartados. OBJETIVO: Analisar a relação entre o índice de esfericidade, a função ventricular e a área infartada no modelo experimental em ratos. MÉTODOS: Seis meses após infarto (IAM, n=33) ou cirurgia simulada (SHAM, n=18), os animais foram submetidos a ecocardiograma. O índice de esfericidade foi obtido pela razão entre as áreas diastólicas nos eixos maior e menor do VE. RESULTADOS: O grupo IAM apresentou menor índice de esfericidade (1,32 × 0,23 vs 1,57 × 0,33; p=0,002), de função sistólica e espessura relativa (0,13 × 0,003 vs 0,18 × 0,04; p<0,001) e maior índice de estresse parietal (1,27 × 0,33 vs 0,88 × 0,25; p<0,001). Houve correlação significativa entre tamanho do infarto e esfericidade (p=0,046). Na análise de regressão linear, o tamanho de infarto (p=0,014), mas não a esfericidade (p=0,683) e o estresse parietal (p=0,176), foi fator de predição da função sistólica. Remodelação excêntrica (p=0,011), mas não a esfericidade (p=0,183) ou o tamanho de infarto (p=0,101), foi fator preditor do estresse parietal. Adicionalmente, o tamanho do infarto (p=0,046), mas não remodelação excêntrica (0,705), foi fator preditor da esfericidade. O tamanho do infarto (p=0,015) e o estresse parietal (p=0,011), mas não a esfericidade (p=0,705), foram preditores de remodelação excêntrica. CONCLUSÃO: A esfericidade está associada mas não é fator determinante do estresse parietal, da remodelação excêntrica e da função sistólica ventricular no modelo de infarto experimental em ratos.

Hipertireoidismo na gravidez: repercussões materno-fetais

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

Incidence and prevalence rates of inflammatory bowel diseases, in midwestern of São Paulo State, Brazil

CONTEXTO: No Brasil, a incidência e prevalência populacionais das doenças inflamatórias intestinais são desconhecidas. OBJETIVO: Neste trabalho, estimou-se esses parâmetros na área que abrange a antiga região de saúde DIR 11, no centro-oeste do Estado de São Paulo. MÉTODOS: Usou-se um registro sequencial de 115 pacientes (>15 anos de idade) com doenças inflamatórias intestinais, residindo na área de estudo, atendidos durante período de 20 anos (1986-2005) em hospital de referência. Estimou-se, para quatro períodos consecutivos de 5 anos, as incidências e prevalências de acordo com os tipos de doença e do sexo de doentes. As suas inter-relações foram analisadas utilizando o modelo de regressão linear de Poisson. RESULTADOS: Na região, as doenças inflamatórias intestinais foram predominantes em mulheres jovens, da raça branca, residindo na zona urbana.A incidência da retocolite foi maior que a da doença de Crohn e das colites não classificadas, e diferentemente dessas duas ultimas, mostrou decréscimo no último período (2001-2005). Neste mesmo período, a taxa da incidência para a retocolite foi de 4,48 casos/100.000 habitantes, para a doença de Crohn atingiu 3,50 casos/100.000 habitantes e a das colites não classificadas foi de 1,75 casos/100.000 habitantes. As prevalências atingiram os valores de 14,81 casos/100.000 habitantes para a retocolite, 5,65 casos/100.000 habitantes para a doenças de Crohn e 2,14 casos/100.000 habitantes. Considerando todas as doenças inflamatórias a prevalência atingiu o valor de 22,61 casos/100.000 habitantes. CONCLUSÃO:A incidência dessas doenças inflamatórias intestinais nessa região é baixa, igualando-se aos países da América Latina e do sul da Europa e sua crescente prevalência justifica políticas de saúde para as suas abordagens.

Relevância do estado de hidratação na interpretação de parâmetros nutricionais em diálise peritoneal

OBJETIVO: Identificar determinantes do estado de hidratação de pacientes em diálise peritoneal crônica, bem como investigar os efeitos da sobrecarga líquida sobre o estado nutricional. MÉTODOS: Foi feito estudo transversal, realizado em 2006, avaliando 27 pacientes em diálise peritoneal crônica, acompanhados no Hospital das Clínicas da Faculdade de Medicina de Botucatu (SP), quanto a parâmetros clínicos, dialíticos, laboratoriais, antropométricos e de bioimpedância elétrica. Para avaliar a influência de parâmetros sobre o estado de hidratação empregou-se modelo de regressão linear múltipla. A amostra foi estratificada quanto ao estado de hidratação pela relação entre água extracelular e água corporal total (0,47 para homens e 0,52 para mulheres), parâmetros obtidos por meio de bioimpedância elétrica. Comparações foram realizadas por análise de covariância, Mann-Whitney, Qui-quadrado ou teste exato de Fisher. Considerou-se significância estatística quando p≤0,05. RESULTADOS: Pacientes com maior volume urinário e em modalidade dialítica automatizada apresentaram melhor estado de hidratação. Pacientes com maior sobrecarga líquida, comparados àqueles com menor sobrecarga, apresentaram menor ângulo de fase (M=4,2, DP=0,9 vs M=5,7, DP=0,7º; p=0,006), menor albumina (M=3,06, DP=0,46 vs M=3,55, DP=0,52g/dL; p=0,05) e maior % prega cutânea tricipital (M=75,3, DP=36,9 vs M=92,1, DP=56,9%; p=0,058), sem outras evidências antropométricas. CONCLUSÃO: Pode-se sugerir que os níveis reduzidos de albumina e ângulo de fase nos pacientes com maior sobrecarga líquida não estiveram relacionados a pior estado nutricional. Para o diagnóstico nutricional em vigência de sobrecarga líquida, deve-se considerar o conjunto de variáveis obtidas por diversos métodos, buscando relacioná-las e interpretá-las de maneira abrangente, possibilitando um diagnóstico nutricional fidedigno.

Gestão Sustentável da água: um estudo da conscientização ambiental em atividades residenciais urbanas

The search for sustainable solutions through an appropriate environmental administration of the available natural resources, that comes from encounter to the aspirations of preservation of the environment and of the human being, in way to diagnose and to solve the environmental and social problems with the smallest possible impact to the nature and the man, it is the great challenge, so much for that generation, as for the future generations. The study of the environmental problems of the water and the participation and the social actors' environmental understanding as a whole, interferes in the field of the thematic environmental international, contemplating the strategic need of an appropriate administration of that very natural one, through a program returned to the diagnosis of the problems and in the search of compatible maintainable solutions, in a social and environmental politics of planning and environmental education, centered above all in the citizen's voice , user of that system. The present thesis she seeks to study the problem of the maintainable administration of the water, focusing the participation and the citizen's environmental understanding in the use of that very natural one for urban residential activities, in what concerns the approach and analyses of variables that treat of the measurement of general knowledge and you adapt, sense of community of the access to the means of information and of the attitudes and environmental behaviors, besides the variables of partner-demographic characterization or personal identification of the interviewed ones of an exploratory research of the type " survey ", accomplished through a stratified aleatory sampling, being the strata each one of the 4 (four) Political-Administrative Areas of the Natal city, having happened the collection of the data in the period of february to april/2002. The methodology used in this work it constitutes in the application of questionnaires with scales of the type Likert to measure the echo-varied of the study, besides a partner-demographic scale for the characterization of the studied sample. For the analysis of the results, it was made an exploratory descriptive study initially, followed by the use of techniques statistical multivariate s, such as, factorial analysis through the application of main components, besides the accomplishment of studies of multiple lineal regression. To complement this study, the accomplishment of Tests of Independence was proceeded through the Qui-square of Pearson, in way to verify the dependence of the associations between the partner-demographic variables and the principal selected variables and presents in the resulting factors of the factorial analysis. The results appear for a low level of environmental knowledge, of access to the information and community's sense, besides the verification that the principal factors resultants send for the need of feeling emphasis in the programs and administration actions addressed for the environmental understanding, the behaviors and attitudes that approach the information and the environmental education, besides the reuse of the water