Avaliação dos efeitos da reeducação postural global (rpg) em pacientes com espondilite anquilosante

The Ankylosing Spondylitis (AS) is a chronic inflammatory disease that primarily affects the axial skeleton, leading to limitation of spine mobility and functional disability. Physical therapy, especially exercise, is an important part in your treatment. The Global Postural Reeducation(GPR),a method that uses stretching based on evaluation of muscular chains, with significant interference in postural changes may be a complementary alternative for the treatment of this disease. The aim was to evaluate the effects of Global Postural Reeducation (GPR) in patients with Ankylosing Spondylitis (AS) and compare GPR with group conventional segmental self-stretching and breathing exercises. This is a controlled interventional study of 38 patients divided into 2 groups: a GPR group (n = 22) and a control group (n = 16). Both groups were treated over four months. With the GPR group patients, positions that stretched the shortened muscle chains were used. With the control group patients, conventional segmental self-stretching and breathing exercises were performed. The variables analyzed were: pain intensity, morning stiffness, spine mobility, chest expansion, functional capacity (Health Assessment Questionnaire - Spondyloarthropathies - HAQ-S), quality of life (Medical Outcome Study Short Form 36 Healthy Survey-SF-36), and disease activity (Bath Ankylosing Spondylitis Disease Activity Index - BASDAI). Statistical analysis was used with a significance level of p < 0.05. There was a statistically significant difference for all the parameters analyzed between pre and post-treatment in both groups. In the inter-group comparison the GPR group showed a statistically significant improvement in morning stiffness (p = 0.01), spine mobility parameters, except finger-floor distance (p = 0.11), in chest expansion (p = 0.02), and in the physical aspect component of the SF-36 (p = 0.00).Finally, we observed that this sample of patients with AS ,treatment with RPG 60 seems to have a better response in some clinical measures, than the conventional self stretching performed in groups. Further studies are needed to further evaluate this therapeutic alternative in the EA

Política de turismo e desenvolvimento: uma avaliação do prodetur ii em Parnamirim/RN (2005-2012)

A dissertação avalia a efetividade do Programa de Desenvolvimento do Turismo na segunda fase (2005-2012) no município de Parnamirim/RN, busca-se verificar se este contribui para o desenvolvimento. Especificamente objetivou: a) Descrever as características e as ações do Programa de Desenvolvimento do Turismo no município de Parnamirim/RN; b) Identificar as percepções dos gestores públicos; da iniciativa privada e da sociedade civil a respeito da efetividade das ações do PRODETUR em Parnamirim e das repercussões do programa na qualidade de vida da população local; e c) Identificar as efetivações do PRODETUR na vida da população local que tenha participado de alguma ação do programa. Para tais pretensões, o percurso envolvendo a emergência e a consolidação do fenômeno turístico no seio da sociedade moderna, bem como o momento de intervenção do Estado no setor foi importante para verificar quais características estão imbuídas nas políticas públicas de turismo. Aliado a discussão do desenvolvimento para além do viés economicista, tendo as contribuições de Amartya Sen (desenvolvimento como liberdade) eixo norteador. Para a avaliação propriamente dita foram utilizadas as falas dos diversos atores locais envolvidos com o programa, compreendendo: gestão pública do turismo, iniciativa privada, sociedade civil e população local. Além de dados secundários coletados em instituições como IBGE e Secretaria Municipal/ Estadual de Turismo. Os resultados encontrados com a pesquisa nos mostraram que o PRODETUR II contribui com alguns elementos que podem cooperar para o desenvolvimento de Parnamirim/RN, pois este ocasiona efetivações significativas em cada bairro pesquisado. No entanto, é relevante observar que esses elementos estão aquém das reais possibilidades, uma vez que os resultados do programa poderiam ter sido mais substanciais. Neste sentido, ressaltamos que o fortalecimento da gestão pública e a mobilização da população local são elementos imprescindíveis para maior efetividade do PRODETUR nas próximas etapas

Uma análise sociodemográfica dos cuidadores formais de idosos institucionalizados no município de Natal/RN, 2012

The aging population and individual have been the subject of a multitude of studies nowadays. This is probably due to the impact of this phenomenon in various sectors of society, like social security, social assistance and public health. The process of aging of the individual imply the demand for specific services, considering the limitations and vulnerabilities of the individual at that stage of life cycle. The growth of the elderly contingent in the last decades raises challenges for policymakers, the family and also for the society at large. In this scenario, long-stay institutions for the elderly (LSIEs) appear as an option to aid and support the elderly and their family, assisting in all or part in the activities of daily living and self-care. Inside these LSIEs we find the professional responsible for the direct care of the elderly, the formal caregiver. In this context, this dissertation presents two main objectives: an analysis of the phenomenon of population aging in a given brazilian municipality Natal / RN, based on the Demographic Censuses of 2000 e 2010; and a social, demographic and economic characterization of the Formal caregiver for the institutionalized elderly in the municipality, evaluating aspects of his quality of life and also analyzing the institutions where they are inserted. Furthermore, we intend to identify demographic, socioeconomic and quality of life factors that are correlated with caregivers quitting the job. The data used in the second part of this work comes from the research project named Long-Stay Institutions for Elderly: abandonment or a family need? . This survey interviewed 92 caregivers in eleven LSIEs in Natal/RN. In the data treatment logistic regressions, cluster analysis and statistical tests were used. The survey revealed that aging in Natal is more pronounced in the older, more traditional districts: Petrópolis, Lagoa Seca and Tirol. It also allowed a broad characterization of the formal caregivers in LSIEs. Most of these professionals are female. The educational level is predominantly complete high school and more. Most caregivers reported being married or in union, or have ever been in a union. Family monthly income is under three times the minimum wage. The mean age is of 37.4 years. The mean time of work as a caregiver was 5.93 years. The associations showed that being woman, not being single, having caregiving training and physical limitations (regarding quality of life) are related to wanting to quit the caregiving job. As for the characterization of the LSIEs, it was found that the philanthropic ones are older and have most (62.5%) of the institutionalized elderly. The institutions managers gave social interaction and affinity with the elderly as the main criteria with which to evaluate and hire caregivers. It is intended with this study to contribute to improving the quality of life of the elderly and their caregiver, providing information on aspects of institutionalization of elderly both in the philanthropic and particular institutions, in Natal/RN; this dissertation may also be used as a starting point for later works

O licenciamento ambiental como instrumento de um desenvolvimento verdadeiramente sustentável

Since the second half of the 20th century, mankind concerns about life quality and environment preservation began to grow. In Brazil, the edition of the Law nº 6.938/81, that instituted the National Policy of the Environment (Política Nacional do Meio Ambiente PNMA), contributing significantly to the singular treatment towards the environment by the Federal Constitution of 1988 (Constituição Federal de 1988), can be appointed as a landmark of this awareness. The Law nº 6.938/81, following the line observed on the legislation of some Brazilian States, predicted on its 9th article the instruments of PNMA, among which the environmental licensing can be highlighted. This instrument presents itself as indispensable to the construction, installation, extension and operation of enterprises and activities that utilize environmental resources, seen as effective and potentially polluter industries, or even to those that can cause environment degradation. On a parallel way and as a consequence of this awareness, the concept of development begins to acquire a new shape. The development of a country or a region begins to consider not only economical factors, but also environmental, political, cultural and social aspects. Ecodevelopment, or sustainable development, then, arises. In this way, through research on legislation and on theme related doctrine, this work has the intention of analyzing environmental licensing as a PNMA instrument responsible for uniting economical development and the right to an ecologically balanced environment, that is, by the consecution of a truly sustainable development

Devido processo penal: uma análise acerca dos direitos fundamentais sob a perspectiva do processo eletrônico

The current study presents an analysis about the automation of the lawsuits in Brazil, which opens a new direction to be followed by the National Secretary of Justice, applied indistinctively to the civil, criminal and labor lawsuits, as well as to the special court houses at any degree of juridisdiction. It treats, specifically, about the transition from the classic lawsuit with bureaucratic aspects to the electronic one, based on the simplicity of the functions, the quality of the oral and the readiness. The light of the constitutional principle of the reasonable duration of the lawsuit, while fundamental rigth of the defendant and, under de protection of the democratic guarantee, it investigates, from the theory of the fundamental rights to the reform movement of the lawsiut, in the scenery of the alien law and national law, the latter, mostly because it has the automation as a necessary improvement claimed by modernity, yet without forgetting of the humane character inherent to the criminal lawsuit. It faces the issue of of the disruption of the paradigm of the written formality of the Brazilian lawsuit, the problem of the resistance to the new automized method, the use of the video conference for the inquest of the witnesses as well as for the questioning of the defendant, the advancements of the virtual lawsuit on the Superior Courts, Federal Supreme Court and Superior Court of Justice, it treats also about the role of the National Council of Justice - CNJ - to uniformize the legal proceedings in the country. Without neglecting the effective respect to the fundamental rights, it focuses the cultural change necessary so that the electronic technology can be, in fact, in the indictment system, the means to reach with excellency the citizenship by the simplification of the legal proceedings, transposing the baseless bureaucracy and assuring an effective judicial service assistance in order to have a better quality of life

Direitos da personalidade: uma análise acerca da concretização da tutela constitucional

It dares to ensure that the Constitution of the Republic strengthened the rights of personality. No longer considering the denial of protection to intangible rights, against the imperative command coming from the art. 5 ° of our highest law, relevant to items V and X. Overlooking these emerge with precision, those rights of personality. Innocuous have been isolated attempts of the opposition to this constitutional protection. Deny it, or rather to restrict it, as it has done insignificant part of the doctrine and isolated judgmental pronouncements, no longer prove appropriate. Today, more than before, there is pointed out that if the human being has personal rights acquired from the design, adding to this other identity elements that allow the projection of a particular social personality. Such rights, it is worth mentioning, there are bases on the principle of human dignity that is considered general provision for the protection of personality. Based on the demonstration of this fact, after climbing into the general theory of personal rights and demonstrate the legal protection that has been present in his favor, it is hoped will, general objective, to show the effectiveness of this constitutional protection. At that point, will be reserved for special to the procedural tools that it has made a decisive contribution to the realization and effectiveness of the rights of the personality, a reality that must be imposed for the benefit of the dignity of the human person, presented here as basic foundation of the Democratic State of Law. The brazilian legal system provides the normative basis needed to provide an adequate protection to personality, from the general clause of the protection of the personality. For the achievement of its effectiveness, however, is an important update methodological and cultural of the Right as well as an effective deployment of public policies and private ensuring a better quality of life for citizens

Educação profissional: a expansão recente do IFRN e a absorção local dos egressos no mercado de trabalho

This study aims to analyze how IFRN s process of interiorization contributes to endogenization of local and territorial development, more precisely in terms of graduates absorption into the labor market, form of inclusion and increase of income and welfare. The research premise is that the policy of interiorization and expansion of professional and technology education, by decentralizing opportunities, create a differential for the educational and professional trajectory of part of the graduates. This training, however, retain a relative connection with the productive potentialities in the coverage territories. This study includes a review of the literature on education and labor market and a discussion about the role of technical and professional formation for the local development versus the logic of the free market, considering the expansion of public spending for this purpose. For this study two sets of information and data have been collected primarily, with qualitative and quantitative nature. The research with qualitative focus, entitled Pesquisa de Avaliação da Expansão (PAEX), is constituted by series of open interviews applied to institutional representatives, with the purpose of knowing aspects of the interiorization repercussion in the local development process. The research designed to quantity analysis, entitled of the Pesquisa de Acompanhamento de Egressos (PAE), have been put in practice by applying online questionnaire with closed questions to IFRN s former students, aiming to know the form of insertion of the graduates in the labor market and the formation capacity of increasing the welfare, among other things. Empirical data and information fully confirmed the hypothesis of this study, for they really demonstrated that the expansion policy decentralizes opportunities and constitutes an important differential for the professional trajectory of a significant portion of the graduates. However, the graduates employability in the labor market in their territories of coverage is below expectations, due to structural problems of the local economy related to scarcity of jobs, difficulty in wage growth and in professional development. Complementarily, it has been observed institutional difficulties related to the recent implantation process of the policy of professional and technical education in the various campuses of the Institution

Hipertensão arterial e fatores de risco em servidores atendidos pelo departamento de assistência da Universidade Federal do Rio Grande do Norte

Systemic arterial hypertension is a multifactorial disease that contributes to the country´s high cardiovascular morbi-mortality rates. Considering that hypertension affects individuals in their most productive age while facing work and living risk factors, it is important to investigate its occurrence and predisposing factors in different occupational segments. The objective of this study was to identify the prevalence of hypertension among workers attended to in a medical service of a public university, their hypertension levels, the risk factors present, and their knowledge of the factors that influence the arterial pressure. The epidemiologic study was conducted in the Health Department of the Federal University of Rio Grande do Norte with 102 workers that sought care in the medical clinic during the months of March to May 2009. Data were collected by means of a questionnaire and measurements of systolic and diastolic arterial pressure (SAP and DAP) that were classified in stages according to the Brazilian Society of Hypertension and the degree of risk for cardiovascular events according to the criteria of the Brazilian Society for Cardiology. Data were analyzed using descriptive statistics. The workers were, on average, 54 years of age; the majority (67%) was male and had primary or middle educational level; they worked mainly in supplemental units and deanship offices conducting different functions such as security guards, administrative assistants, health auxiliaries and constructions workers; 48 (47%) of the workers identified themselves as hypertensive for 8 years on average, with the majority executing hard labor and administrative functions. Among the workers with hypertension, the number of the pressure levels classified as pre-hypertensive, stage I and II were: (12% in the SAP and 20% in the DAP); (16% in the SAP and 9% in the DAP); and (15% in the SAP and 5% in the DAP), respectively. The workers that did not identify themselves as hypertensive presented classifications with greater frequencies were: normal (16% in the SAP and 30% in the DAP); and pre-hypertensive (21% in the SAP and 16% in the DAP). The risk factors identified in more than 50% of the workers were: tobacco smoking, alcohol consumption and indices of being overweight, although physical activities are also present. Of the 48 workers diagnosed as hypertensive, those that had 5 risk factors present and limitrophic pressure levels (12%), in stage I hypertension (16%) and stage II hypertension (15¨%) were categorized as being in high risk for vascular events. The number of workers that indicated they had knowledge of the factors that influence their hypertension was less than 39% for each factor. It is concluded that there is a high prevalence of systemic arterial hypertension in the university workers, even amongst those already under treatment. They constitute a population at risk considering their age group, their work functions, and their inadequate life habits. Health care of these hypertensive workers that seek attention in the Health Department is an important aspect of the internal workers health policy in the institution. Educational interventions are recommended for the improvement of quality of life and of work in these workers

Validação de protocolo de assistência para pessoas com úlcera venosa na atenção prim��ria

People with venous ulcers constitute as an important public health problem, its treatment is onerous and require assistance provided by trained professionals, systematized through protocols, however what lies in the assistance is that the management of this group of people differs from that preconized in the scientific literature, interfering with wound healing and quality of life of affected. In this sense, the construction of a assistance protocol specific to people with venous ulcers (VU) can help professionals of the Family Health Strategy both in patient assessment as and in establishment of quality assistance. Thus, this study aimed to analyse the validity of a multiprofessional assistance protocol for people with venous ulcers in primary care by health professionals using Delphi technique. This is a quantitative study, the methodological type conducted in two steps: first step related to integrative literature review to subsidize the development of the protocol, then these aspects were organized and proposed to the judges of the study through the Delphi technique. The study was initiated after approval by the Research Ethics Committee. The first step was performed between August and September 2012, in the virtual library of health, in the page of the Coordination of Improvement of Higher Education Personnel, of Municipal Health Secretariat and international guidelines of associations and in the subsequent step carried out between September 2012 to January 2013, was performed search by Lattes platform of the National Council of Technological and Scientific Development, in order to identify health professionals in Brazil who act as judges of the instrument and then, via online, the form was submitted to them.The sample for the second step was 51 judges in the first round and 35 for the second round Delphi. The analysis was done by adopting Kappa index ≥ 0.81 and Content Validity Index (CVI)> 0.80. In the first submission for the judges, items that did not reach Kappa and CVI established were: request / realization / test results, demographic data, medical history, risk factors, verification of pain / vital signs / pulse / infection signs / lesion location/ edema and pain treatment. After removal of items which have not obtained Kappa or CVI index established, it was found achieving optimal levels of these index for the categories. In the next step was the ressubmissão of protocol to judges through the Delphi technique in it was found that, of the 15 categories of the protocol, 12 presented higher scores in Delphi 2 phase and the other three categories remained the same Kappa and IVC of the previous phase. As for the average of evaluation requirements of the protocol was found that the scores assigned by the judges were higher in the second phase in nine of the 10 items, remaining the same in only one of the items indicating validity of the instrument before the consensus of the judges. Thus, we accepted the alternative hypothesis in this study, as they were obtained in the second Delphi phase the validity index greater than or equal to the Delphi 1 phase. The formulation of this assistance protocol valid and reproducible will enable a reorganization and redesign of assistance, with standardization of actions and continuity of care for persons with venous ulcers in primary health care

Diagnóstico ambiental da gestão e destinação dos resíduos da construção e demolição (RCD): análise das Construtoras Associadas ao SINDUSCON/RN e empresas coletoras atuantes no município de Parnamirim - RN

Surveys carried out in many Brazilian cities have shown that the CDW Construction and Demolition Waste, in some cases, represent more than 50% of the mass of urban solid residue. Municipalities have struggled to manage in an effective way huge quantities of CDW generated every day and solve the problem of the illegal dumping in an inadequate area, which compromise the quality of life of the population as a whole, thus causing serious problems concerning social-environmental and sanitary. This paperwork was meant it carry out environmental diagnosis of the management and the final destination of the CDW in the city of Parnamirim/RN. The methodology used in this work constituted in the bibliographical research, conducted to give support and fundaments to the subject in question, identification of the main places of legal and illegal dumping, identification of the environmental impacts caused by the irregular deposition of the CDW, valuation of quantity and quality of the CDW and perception according to the Environmental Legislation. The necessary data for the elaboration of this study were carried out through the appliance of questionnaires with open and closed questions, applied to 14 (fourteen) Real Estate developer companies associated with SINDUSCON/RN and 05 companies that deal with the transportation and collection of CDW, formal and informal interviews, exploitational visits and photographical records. The collected data went through a statistic treatment being organized into tables and graphs. The main results obtained from this research show that the interviewees hold a medium knowledge of the specific Environmental Legislation; do not have an effective model of environmental management, resorting to only reusing CDW; that the reusing of CDW is not substantial, as much as the possibility of recycling has a minimal consideration. It was also verified that a considerable percentage of interviewees affirmed to send CDW to illegal and inadequate locations. It is expected that such study can be used as an important tool to subsidize the public administration in the pursuit of solutions which could bring benefits to society and the environment

Diagnóstico para implantação do sistema de gestão ambiental em postos revendedores de combustíveis no município de Paranamirim RN: um estudo de caso

natural resources that still enjoy, in the certainty that if we do not, could culminate at the end of that remains. The environmental contamination by fuels in the retail service of oil and biofuels, has been a subject of growing research in Brazil, due to the large pollution potential of this activity. The aim of this study was to evaluate the importance of implementing the Environmental Management System (EMS) in fuel retail service stations in the city of Parnamirim-RN, but also describe the current situation the same as licensing and environmental characterization; identify existing barriers to implementation of EMS on the costs, technologies, knowledge, vision, present the potential benefits for the implementation of the EMS (social, economic and environmental), to identify the existence of plans for future action to implement the EMS , as a subsidy to promote the implementation of it. The methodology was developed through analysis of documents provided by the environmental agency responsible for licensing of retail service stations and fuel pala ANP. For data collection, we used the questionnaire was applied directly to managers or managers of sub-stations. Data were collected in 12 of 30 posts in the municipality. For purposes of data treatment was performed a descriptive analysis with respect to the opinion of twelve managers (respondents). The data acquired, according to the Likert scale were tabulated and analyzed using software SPSS 17.0 and Excel 2003, it was generated tables and graphs to observe the behavior of the data. The results showed that most respondents have a schooling level higher (58.3%) of the jobs surveyed 50% work on average 6 to 10 years and 41.6% are in operation for over 11 years , 75.0% do not have a license to operate and 12 stations, 58.3% were sued for not having a license to operate and are therefore in full commercial activity, 83% of jobs have some practice environmentally responsible, 75% agree in making planning future action to implement 8 the EMS in their ventures, 70% in full agreement that the high cost is a form of impediment to implementation of EMS; 66.67% agreed that resistance to change is an impediment to implementation of EMS; 90.91% agreed that the implementation of EMS is very complex, 80% of respondents agreed in a very significant environmental legislation is also a key factor preventing the implementation of EMS is noteworthy that 100% of respondents agreed that the knowledge about the use of the EMS will help to solve environmental problems in the fuel retail service stations, the implementation of the EMS will benefit with increased efficiency of resources applied to the findings by the agreement of 91.66% of respondents, where only 8, 33% disagreed, there was also a percentage of 100%, agreed that the company's image will be a great benefit, but also a contribution to solving environmental problems in the fuel retail service stations. Thus, the importance of the implementation of EMS in the fuel retail service stations in the city of Parnamirim-RN, with an urgent need to be deployed. And the bodies responsible for policy on state-run and supervise more tightly and action, this type of activity, in order to regulate the sustainable functioning of retail service stations of fuel, thus promoting a better quality of life for the population of the municipality of natal-RN

Diagnóstico Socioambiental da disposição final dos resíduos sólidos no distrito de Guajiru São Gonçalo do Amarante/RN, ressaltando a situação socioeconômica dos catadores

One of the concerns of this century is with the handling and the final destination of urban solid waste (RSU), where depending on the form as they will be made use, they can cause diverse problems, they are of ambient or social order, being able to generate the loss of the quality of life and illnesses to the population, of direct or indirect form. The objective of the present work was to diagnosis the environmental partner situation of the Final Destination of the urban solid residues in the District of Guajiru, city of São Gonçalo do Amarante/RN, standing out the partner-economic situation of the scavengers. The research was carried through in the period of March of 2008 the October of 2009, with a methodology developed through analyzes them of documents made available for the state ambient agency, the Air base of Christmas and managing agencies of the city. For collection of the date, it was used directly application of the questionnaire with 20 existing scavengers in points of destination of residues, evaluation of the old place of final destination through the use of the spread sheet of the IQR (Index of Quality of the Residues), developed for the CETESB, identification of the matter dump and photographic register. For effect of treatment of the data, a descriptive analysis with regard to the answers of the interviewed scavengers was carried through. The acquired date, Scale had been according to tabulated and analyzed in Excel 2003, where they had been generated graphical to observe the behavior of the data. The results show that of the twenty interviewed scavengers, 35% possess age between 20 and 30 years; 75% possess incomplete basic education; 60% inhabit in houses of waal or huts (cardboard or wood); 55% do not make use of system of water supply and system of sanitary exhaustion; with regard to income monthly for scavengers, 35% had presented income between R$ 200,00 and R$300,00 and 20% possess income above of R$ 500,00 for possessing another source of income; 80% of the interviewed ones, use some type of equipment of individual protection; In the year of 2009, confirming what it was informed by the State agency of Environment, during the field visit, we evidence that the city of Is Gonçalo do Amarante, currently, destines its residues in Sanitary landfill of São Region Metropolitan of Natal in the District of Massaranduba in the city of Ceará-Mirim, after some interventions of the State Public prosecution service. However, in the district of Guajiru some diggings still exist that today are used as final destination of RCD' s (Residues of Construction and Demolition) of the cities of Natal and São Gonçalo do Amarante, as well as private dumps that are used by scavengers that deviate the final destination (Sanitary landfill) of the residues of the great generators (supermarkets, shopping Center and hotels), with presence of urubus, generating a new ambient problem for the city and the aeroportuária security. Ahead of this scene, the study it suggests viable alternatives for the elimination of the private dumps and for the social situation of the escavengers, aiming at to improve its quality of life and 10 to minimize the ambient impacts caused by the inadequate destination of the solid waste in the community of Guajiru, São Gonçalo do Amarante/RN, being able to contribute so that the public managers carry through action in the handling and the control of the final destination of the urban solid waste

Percepção do corpo, medo da morte, religião e doação de órgãos

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

Exercícios respiratórios para asma: revisão sistemática com metanálise

Introdução: A asma se tornou um problema de saúde pública devido aos seus grandes custos em cuidados de saúde. Os exercícios respiratórios constituem uma intervenção não farmacológica de baixo custo e baixo risco que vem sendo utilizada por fisioterapeutas em diferentes países no tratamento de pacientes asmáticos. Objetivo: Avaliar a eficácia dos exercícios respiratórios no tratamento de pacientes adultos com asma nos seguintes desfechos: qualidade de vida, sintomas da asma, número de exacerbações agudas, episódios de hospitalização, mensurações fisiológicas (função pulmonar e capacidade funcional), número de consultas médicas, número de faltas no trabalho devido a exacerbações da doença, avaliação subjetiva do paciente em relação à intervenção. Método: Revisão sistemática de estudos controlados randomizados com metanálise realizada em parceria com a Colaboração Cochrane. As seguintes bases de dados foram consultadas: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, e PsycINFO, além de busca manual em revistas da área e em resumos de congressos. Os seguintes termos foram utilizados: (breath*) and (exercise* or retrain* or train* or re-educat* or educat* or physiotherap* or "physical therap*" or "respiratory therapy" or buteyko ). As listas de referências dos estudos selecionados e registros de ensaios clínicos também foram consultados. A seleção dos estudos e a avaliação do risco de viés dos estudos incluídos foram realizadas de maneira independente por dois revisores. O software Review Manager foi utilizado para análise dos dados, no qual o modelo de efeito fixo foi utilizado. As variáveis contínuas foram expressas como diferença de média ponderada com um intervalo de confiança de 95%. A heterogeneidade dos resultados dos estudos incluídos foi realizada por meio da análise dos Forest plots. O teste qui-quadrado (Chi2) com um P valor de 0.10 foi utilizado para indicar significância estatística. O Índice de heterogeneidade (I2) foi implementado com um valor acima de 50% como um nível substancial de heterogeneidade. Resultados: 13 estudos envolvendo 906 pacientes estão atualmente incluídos na revisão. Os seguintes desfechos foram mensurados pelos estudos incluídos: qualidade de vida, sintomas da asma, número de exacerbações agudas e função pulmonar. Os estudos relataram uma melhora na qualidade de vida, sintomas da asma e número de exacerbações agudas. Seis dos onze estudos que avaliaram função pulmonar mostraram uma diferença significativa favorável aos exercícios respiratórios. Não houve relato de efeitos adversos. Devido à heterogeneidade substancial encontrada entre os estudos, metanálise foi possível apenas para sintomas da asma, a qual incluiu dois estudos e mostrou uma diferença significativa favorável aos exercícios respiratórios. A avaliação do risco de viés foi prejudicada devido ao relato incompleto de aspectos metodológicos pela maioria dos estudos incluídos. Conclusão: Embora os resultados encontrados pelos estudos incluídos demonstraram individualmente que os exercícios respiratórios podem ser importantes no tratamento da asma, não há evidência conclusiva nesta revisão para suportar ou refutar a eficácia desta intervenção no tratamento de pacientes asmáticos. Este fato foi devido às diferenças metodológicas entre os estudos incluídos e à ausência de relato de aspectos metodológicos por parte da maioria dos estudos incluídos. Não há dados disponíveis em relação aos efeitos dos exercícios respiratórios nos seguintes desfechos: episódios de hospitalização, número de consultas médicas, número de faltas no trabalho devido a exacerbações da doença, e avaliação subjetiva do paciente em relação à intervenção

Efeitos do ultrassom terapêutico sobre parâmetros morfométricos e clínicos e método de extração de metaloproteinases em sujeitos com úlceras venosas

Venous wounds cause physical, psychological and financial problems that impact the quality of life of patients. Treatment alternatives are investigated in order to reduce healthcare costs and improve quality of life of people affected by this problem. Physical resources, such as therapeutic ultrasound (US), are being considered in the treatment of ulcers as a potential healing agent. This study aimed to investigate the application of US as a treatment for venous ulcers. Subjects were divided into two groups: US group, where treatment consisted of 5 sessions of pulsed US (3 MHz, 1W/cm²) associated with compression and kinesiotherapy; and sham group, where individuals went through the same procedures, but with sham US therapy. Subjects were evaluated for wound size by planimetry and digital photography, visual analogue scale for pain, quality of life by the questionnaires SF- 36 and VEINES-QoL/Sym and enzymatic activity of metalloproteinases 2 and 9 by zymography. It was observed mean reduction in wound area of 41.58±53.8% for the US group and 63.47±37.2% for the placebo group, maintenance of quality of life scores in the US group and significant improvement (p<0.05) in the placebo group by VEINES questionnaire. It was observed decreased perception of pain in the placebo group. Sample feasibility for analysis of the protein activity of metalloproteinases 2 and 9 by zymography collected by swab method was also confirmed. Our data did not give us evidence to support the theory that the US accelerates healing of venous ulcers in a short-term analysis. However, we observed that standard care associated with compression therapy and kinesiotherapy were able to significantly shorten the progression of chronic venous ulcers