Efeitos do treino em esteira com suporte parcial de peso e do método de facilitação neuromuscular proprioceptiva na marcha hemiparética: estudo comparativo

Objective: To compare the effects of the treadmill training with partial body-weight support (TPBWS) and Proprioceptive Neuromuscular Facilitation (PNF) method on gait of subjects with chronic stroke. Design: Quasi-experimental study. Setting: Laboratorial research. Participants: Twenty-three subjects (13 men and 10 women), with a mean age of 56,7 ± 8,0 years and a mean time since the onset of the stroke of 27,7 ± 20,3 months, and able to walk with personal assistance or assistive devices. Interventions: Two experimental groups underwent gait training based on PNF method (PNF group, n=11) or using the TPBWS - Gait Trainer System 2, Biodex, USA (TPBWS group, n=12), for three weekly sessions, during four weeks. Measures: Evaluation of motor function - using the Stroke Rehabilitation Assessment of Movement (STREAM) and the motor subscale of the Functional Independence Measure (motor FIM) -, and kinematic gait analyze with the Qualisys System (Qualisys Medical AB, Gothenburg, Sweden) were carried out before and after the interventions. Results: Increases in the STREAM scores (F=49.189, P<0.001) and in motor FIM scores (F=7.093, P=0.016), as well as improvement in symmetry ratio (F=7.729, P=0.012) were observed for both groups. Speed, stride length and double-support time showed no change after training. Differences between groups were observed only for the maximum ankle dorsiflexion over the swing phase (F=6.046, P=0.024), which showed an increase for the PNF group. Other angular parameters remain unchanged. Conclusion: Improvement in motor function and in gait symmetry was observed for both groups, suggesting similarity of interventions. The cost-effectiveness of each treatment should be considered for your choice

Tradução, adaptação cultural e avaliação psicométrica da prova cognitiva de leganés em uma população idosa brasileira com baixo nível de escolaridade

Introdução: The scales of cognitive screening are important tools for early detection of dementia, creating the possibility of developing measures to slow this process and assist in the management of the disease. Objective: To validate the Leganés Cognitive Test (Prueba Cognitive de Leganés) (PCL) for cognitive screening in low educated elderly Brazilians. Methods: The study sample was composed of 59 elderly residents from the city of Santa Cruz, Brazil with low schooling levels. Reliability was analyzed with a 2-day interval between assessments, and concurrent validity was assessed using the Mini Mental State Examination (MMSE). Results: According to the PCL, the prevalence of dementia was 11.8%. The scale items showed a moderate to strong correlation between domains (p <0.01), and inter-rater reliability exhibited ICC = 0.81, 95% CI (0.72-0.88). Factor analysis resulted in two factors: memory and orientation. Interscale agreement was considered poor (k = - 0.02), supporting the hypothesis of an educational impact on final MMSE scores. Conclusion: The results suggest that PCL has acceptable levels of reliability for use in low educated elderly Brazilians

Desfechos clínicos e mortalidade de sujeitos submetidos à cirurgia bariátrica no Rio Grande do Norte

Introduction: Actually the obesity is a public health problem throughout the world. Bariatric surgery has been an efficient method of weight reduction body in severe obesity, reducing its associated effects and presenting low levels of immediate and late postoperative complications. In Brazil, bariatric surgery asa recent therapeutic that has been growing recently. Being Brazil a country with continental dimensions and with a huge diversity socioeconomic and cultural, it is essential to understand the reality of patients undergoing bariatric surgery in less economically privileged regions of Brazil. Objectives: To evaluate the epidemiological, clinical outcomes and mortality of patients undergoing videolaparoscopic bariatric surgery through the public health system in the Brazilian state of Rio Grande do Norte- Brazil. Methods: Observational descriptive study of a prospective, carried out from February 2009 to February 2011, the Clinic Obesity and Bariatric Surgery at Universitary Hospital Onofre Lopes - Federal University of Rio Grande do Norte (HUOL-UFRN). Anthropometric measures, comorbidity and deaths register were made in the postoperative period. Results: Seventy patients (54 women) with low income aged 22 to 63 years completed the study. We recorded the death of three patients during the study period. The results show significant decrease anthropometric parameters, especially in relation to body weight, waist circumference and hipin both sexes. Only Waist / Hip ratio showed no difference after intervention in male patients It had a resolution of comorbidities. No significant differences in reports of daily sleepiness and the snoring male patients. Conclusion: Our findings attest laparoscopic bariatric surgery as an effective method reducing weight and comorbidities in morbidly obese patients

A Short Physical Performance Battery (SPPB) como preditora da fragilidade em idosos residentes na comunidade

Introduction: The SPPB provides information about physical function and is a predictor of adverse events in the elderly. Frailty is a multidimensional syndrome that increases susceptibility to diseases and disability. However it may be possible to prevent or postpone frailty if is identified early. Our objective is to analyze SPPB s ability in screening for frailty a community-dwelling young elderly from cities with distinct socioeconomic conditions. Methods: Data were originated from community dwelling adults (65-74 years old) in Canada (Saint Bruno; n = 60) and Brazil (Santa Cruz; n = 64). SPPB was used to assess physical performance. Frailty was defined as the presence of ≥ 3 of these criteria: weight loss, exhaustion, weakness, mobility limitation and low physical activity. One point was given for each criterion met, totalizing a frailty score ranged from 0 to 5. The Linear Regression and Receiver Operating Characteristics analyses were performed to evaluate the SPPB s screening ability. Results: Mean age was 69.48, 10.0% of the Saint Bruno s sample and 28.1% of Santa Cruz s were frail (p = 0.001), the SPPB score means were 9.6 and 8.5 respectively (p = 0.01). SPPB correlated with the frailty score (R2 = 0.33), with better results for Saint Bruno. A cutoff of 9 in SPPB had good sensitivity and specificity in discriminating frail from non frail in Saint Bruno (AUC = 0.81) but showed fair results in Santa Cruz (AUC = 0.61). Conclusion: The SPPB has moderate ability in predicting frailty among older adult s population, and is an useful test to identify people with good functionality and low frailty when SPPB scores are ≥9

Equações preditivas para as pressões respiratórias máximas de crianças brasileiras

I ntroduction: The assessment of respiratory muscle strength is important in the diagnosis and monitoring of the respiratory muscles weakness of respiratory and neuromuscular diseases. However, there are still no studies that provide predictive equations and reference values for maximal respiratory pressures for children in our population. Aim: The purpose of this study was to propose predictive equations for maximal respiratory pressures in healthy school children. Method: This is an observational cross-sectional study. 144 healthy children were assessed. They were students from public and private schools in the city of Natal /RN (63 boys and 81 girls), subdivided in age groups of 7-8 and 9-11 years. The students presented the BMI, for age and sex, between 5 and 85 percentile. Maximal respiratory pressures were measured with the digital manometer MVD300 (Globalmed ®). The maximal inspiratory pressure (MIP) and maximal expiratory pressures (MEP) were measured from residual volume and total lung capacity, respectively. The data were analyzed using the SPSS Statistics 15.0 software (Statistical Package for Social Science) by assigning the significance level of 5%. Descriptive analysis was expressed as mean and standard deviation. T'Student test was used for unpaired comparison of averages of the variables. The comparison of measurements obtained with the predicted values in previous studies was performed using the paired t'Student test. The Pearson correlation test was used to verify the correlation of MRP's with the independent variables (age, sex, weight and height). For the equations analysis the stepwise linear regression was used. Results: By analyzing the data, we observed that in the age range studied MIP was significantly higher in boys. The MEP did not differ between boys and girls aged 7 to 8 years, the reverse occurred in the age between 9 and 11 years. The boys had a significant increase in respiratory muscle strength with advancing age. Regardless sex and age, MEP was always higher than the MIP. The reference values found in this study are similar to a sample of Spanish and Canadian children. The two models proposed in previous studies with children from other countries were not able to consistently predict the values observed in this studied population. The variables sex, age and weight correlated with MIP, whereas the MEP was also correlated with height. However, in the regression models proposed in this study, only gender and age were kept exerting influence on the variability of maximal inspiratory and expiratory pressures. Conclusion: This study provides reference values, lower limits of normality and proposes two models that allow predicting, through the independent variables, sex and age, the value of maximal static respiratory pressures in healthy children aged between 7 and 11 years old

Sono e síndrome da fragilidade em idosos residentes em instituições de longa permanência

Introduction: The aging process causes quantitative and qualitative changes in sleeping. Such changes affects more than half of the adults above 65 years old, that live in the community and 70% of the institutionalized, a great negative impact in their quality of life. One of the pathological displays of aging, that share some characteristics with sleeping disorders and predict similar results, is the Frailty Syndrome, that characterize the most weakened and vulnerable elderly. The way sleeping disorders play a role in the frailty pathogeneses remains uncertain. Objective: Evaluate the relation between the sleeping and the frailty syndrome on institutionalized elderly. Methodology: A transversal study was performed with 69 elderly in institutions in the city of João Pessoa PB. Were used the Pittsburgh Sleeping Quality Index and actigraphy to subjective and objective variables, respectively, and questionnaires and specific tests to frailty phenotype variant (Fried Frailty Criteria). In the statistic analysis were used the Pearson correlation test, Chi Square and One-way ANOVA test, with Tukey-Krammer posttest. Subsequently, a Simple Linear Regression model was built. On every statistical analysis were considered a confidence interval of 95% and a p < 0,05. Results: The sample was characterized by the prevalence of the frail (49,3%), women (62,3%), single (50,7%) and 77,52 (±7,82).The frail elderly obtained the worst sleeping quality 10,37 (±4,31) (f = 4,15, p = 0,02), when compared with the non-frail. The sleep latency influenced more the frailty (R2 = 0,13, β standard = 1,76, β = 0,41, p = 0,001). Weren t found differences between the standard resting-activity variable and the frailty phenotype categories. Conclusion: Sleeping alterations, including bad sleeping quality, prolonged sleep latency, low sleep efficiency and day drowsiness, influenced the frailty in institutionalized elderly

Avaliação da cinemática do complexo tóracoabdominal durante repouso e endurance muscular respiratória em obesos

Background: Obesity may affect the respiratory system, causing changes in respiratory function and in the pulmonary volumes and flows. Objectives: To evaluate the influence of obesity in the movement of thoracoabdominal complex at rest and during maximal voluntary ventilation (MVV), and the contribution between the different compartments of this complex and the volume changes of chest wall between obese and non-obese patients. Materials and Methods: We studied 16 patients divided into two groups: the obese group (n = 8) and group non-obese (n = 8). The two groups were homogeneous in terms of spirometric characteristics (FVC mean: 4.97 ± 0.6 L - 92.91 ± 10.17% predicted, and 4.52 ± 0.6 L - 93.59 ± 8.05%), age 25.6 ± 5.0 and 26.8 ± 4.9 years, in non-obese and obese respectively. BMI was 24.93 ± 3.0 and 39.18 ± 4.3 kg/m2 in the groups investigated. All subjects performed breathing calm and slow and maneuver MVV, during registration for optoelectronic plethysmography. Statistical analysis: we used the unpaired t test and Mann-Whitney. Results: Obese individuals had a lower percentage contribution of the rib cage abdominal (RCa) during breathing at rest and VVM. The variation of end expiratory (EELV) and end inspiratory (EILV) lung volumes were lower in obese subjects. It has been found asynchrony and higher distortion between compartments of thoracoabdominal complex in obese subjects when compared to non-obese. Conclusions: Central obesity impairs the ventilation lung, reducing to adaptation efforts and increasing the ventilatory work

Correlação entre os parâmetros do cortisol salivar e o fenótipo de fragilidade em idosos institucionalizados

Introduction: The Frailty Syndrome is characterized by the decrease of energy reserve and the reduced resistance to stressors. Studies indicate that the neuroendocrine markers can be related to the appearance of this syndrome. The main endocrine answer to stress is the increase of cortisol levels. Objective: To analyze the correlation between the frailty syndrome the salivary cortisol in elderly residing in nursing homes. Method: A traversal study was accomplished, in João Pessoa city, PB, with a sample composed by 69 institutionalized elderly. The collected data refer to the frailty phenotype (weight loss, exhaustion, slowness, weakness, and lower level of physical activity) and to salivary cortisol parameters (first measure - 6-7h; second measure - 11-12h; third measure - 16-17h). In the statistical analysis the Pearson s correlation test was used, Chi square Test and Anova and Simple Linear Regression analyses. Results: The sample was composed by 37.7% of men and 62.3% of women, with age average of 77.52 (±7.82). There was a percentile of 45.8% frail elderly. The frail elderly obtained higher cortisol values in the third measure (p=0.04) and the frailty load was significantly associated to the first measure (r=0.25, p=0.04). The simple linear regression analysis presented a determination rate (R2=0.05) between frailty load and first cortisol measure. Conclusion: The largest cortisol values in the morning and before sleeping among the frail elderly supply indications that can have a relationship of cortisol increase levels and the frailty presence in elderly from nursing homes.