Efeitos do treinamento de dupla tarefa no controle do equilíbrio dinâmico e estático de idosas pré-frágeis: um estudo piloto

The increasing world population of older individuals has become a subject of growing research for prevention and reversibility of the frailty because it is a major risk factor for the occurrence of falls, especially when it involves everyday situations of dual task. Some rehabilitation programs have already used the methods of dual-task with general exercises for improving gait and postural control, but has been reported that these interventions have little specificity with limited success to improve certain aspects of static and dynamic position during the performance of functional tasks. This study aimed to verify the measures of postural control in a group of elderly women with fragility phenotype after physical therapy intervention program based on dual-task treadmill training. We selected six pre-frail elderly subjects, with a minimum age of 65, female, living in the community and randomly assigned to two groups. The survey was conducted twice a week for 45 minutes, for four weeks. The simple task intervention consisted only in training on a treadmill and the dual task consisted of in treadmill training associated with visual stimuli. The assessments were made with the use of the Berg Balance Scale (BBS) and the Balance Master® computerized posturography, static and dynamically. The effects of retention were observed after one month, using the same instruments earlier used. The results showed a tendency toward improvement or maintenance of the balance after training on a treadmill, especially with respect to static equilibrium. Both groups showed the most notable changes in the variables related to gait, as the length and speed. The BBS scores and the baropodometric variables showed that the experimental group could keep all values similar or better even one month after completion of training unlike the control group. We concluded that the dual-task performance had no additional value in relation to the improvement of balance in general, but we observed that the effectiveness of visual stimulation occurred in the maintenance of short term balancevariables

Síndrome da fragilidade e fatores associados em idosos comunitários do município de Santa Cruz RN

The frailty in the elderly is characterized by decreased physiological reserves, and is associated with increased risk of disability and high vulnerability to morbidity and mortality. This study is part of a multicentric project on Frailty in Elderly Brazilians (REDE FIBRA). Aims: to investigate characteristics, prevalence and associated factors related to frailty. Metodology: We interviewed 391 elderly patients aged 65 years, selected randomly. Data collection was performed using a multidimensional questionnaire containing information about socio-demographic and clinical variables. To characterize the frail elderly, was considered the phenotype proposed by Fried. Data were analyzed using descriptive statistics, bivariate analysis (χ ²) and binary logistic regression. Results: The prevalence of frailty was 17.1%. In the final model of multivariate analysis, was obtained as factors associated with frailty: advanced chronological age (p <0.001), have comorbidity (p <0.035), show dependence on performing basic activities of daily living (p <0.010) and instrumental (p <0.003) and have poor perception of health status (p <0030). Conclusions: The factors associated with frailty suggest a predictive model helping to understand the syndrome, guiding actions that minimize adverse effects on the aging process

Velocidade da marcha como preditor de fragilidade em uma amostra populacional de idosos brasileiros

Gait speed has been described as a predictive indicator of important adverse outcomes in older populations. Among the criteria to evaluate frailty, gait speed has been identified as the most reliable predictor of fragility, practical and low cost. Objective: This study assesses the discriminating capability of gait speed in determining the presence of fragility in the elderly community in northeast of Brazil. Method: We performed an observational analytic study with a transversal character with a sample of 391 community-living elders, aged 65 years or older, of both sexes, in the city of Santa Cruz-RN. Participants were interviewed using a multidimensional questionnaire to obtain sociodemographic information, physical-related and mental health-related information. The unintentional weight loss, muscle weakness, self-reported exhaustion, slow gait and low-physical activity were considered to evaluate the frailty syndrome. Gait velocity was measured as the time taken to walk the middle 4,6 meters of 8,6 meters (excluding 2 meters to warm-up phase and 2 meters to deceleration phase).We calculate the sensitivity and specificity of gait speed test in different cutoff points for the test run time, from which ROC curve was constructed as a measure of test predictive value to identify frail elders. The prevalence of frailty in Santa Cruz-RN was 17.1%. The gait speed test accuracy was 71%when speed is below 0,91m/s. Among women, the gait speed test accuracy was 80%(gait speed below 0.77m/s) and among men, the test accuracy was 86% (gait spend below 0,82%) (p<0,0001).Conclusion: our findings have clinical relevance when we consider that the detection of frailty presence by the gait speed test can be observed in elderly men and women by a simple, cheap and efficient exam

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

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

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.

Apoio social e síndrome da fragilidade em idosos residentes na comunidade

Introduction: The frailty in the elderly is the result of a complex interplay between many social and clinical factors involved in its genesis. Although there is an understanding of its association with increased risk of adverse clinical outcomes, still it is unclear whether this syndrome can be aggravated due to lack of social support. So, the objective of this study was to analyze the association between social support and frailty syndrome in elderly community residents. Materials and methods: Observational analytical cross-sectional study, with a sample of 300 elderly living in the city of Natal-RN. Were collected informations about socialdemographic, economics and physical health data. The Social support was assessed by the status of cohabitation; marital status; contact frequency and diversity rate; received and given attendance frequency rate; and Map Minimum Relations of the Elderly. The frailty was assessed using the following criteria: unintentional weight loss, weakness, low physical activity, exhaustion and Slowness. To observe any possible associations, we performed the Pearson chi-square test, the Student t test and multivariate analysis using binary logistic regression, adopting a significance level of 5%. Results: It was observed that there were no associations of frailty with the social support variables, except for housekeeping mode (p = 0.046) of the MMRI. For the sociodemographic, economic, physical health and social support data, only age (p <0.001), sedentary lifestyle (p = 0.002) and poor perceived health (p = 0.001) were the ones that remained in the logistic regression model, with strong association for the presence of frailty. Conclusion: Among the variables related to social support, only to help with housekeeping was significantly associated with frailty. However, more studies need to be developed to characterize the social vulnerability, as well as health services need to recognize the importance of social support as an integral part of care for the elderly

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

Estimação de parâmetros genéticos para resistência à infecção por IMNV em camarões Litopenaeus vannamei por meio de análise de sobrevivência

The main specie of marine shrimp raised at Brazil and in the world is Litopenaeus vannamei, which had arrived in Brazil in the `80s. However, the entry of infectious myonecrosis virus (IMNV), causing the infectious myonecrosis disease in marine shrimps, brought economic losses to the national shrimp farming, with up to 70% of mortality in the shrimp production. In this way, the objective was to evaluate the survival of shrimps Litopenaeus vannamei infected with IMNV using the non parametric estimator of Kaplan-Meier and a model of frailty for grouped data. It were conducted three tests of viral challenges lasting 20 days each, at different periods of the year, keeping the parameters of pH, temperature, oxygen and ammonia monitored daily. It was evaluated 60 full-sib families of L. vannamei infected by IMNV in each viral challenge. The confirmation of the infection by IMNV was performed using the technique of PCR in real time through Sybr Green dye. Using the Kaplan-Meier estimator it was possible to detect significant differences (p <0.0001) between the survival curves of families and tanks and also in the joint analysis between viral challenges. It were estimated in each challenge, genetic parameters such as genetic value of family, it`s respective rate risk (frailty), and heritability in the logarithmic scale through the frailty model for grouped data. The heritability estimates were respectively 0.59; 0.36; and 0.59 in the viral challenges 1; 2; and 3, and it was also possible to identify families that have lower and higher rates of risk for the disease. These results can be used for selecting families more resistant to the IMNV infection and to include characteristic of disease resistance in L. vannamei into the genetic improvement programs

Avaliação genética da eficiência reprodutiva em vacas pardo-suíças por meio da análise de sobrevivência

Among the traits of economic importance to dairy cattle livestock those related to sexual precocity and longevity of the herd are essential to the success of the activity, because the stayability time of a cow in a herd is determined by their productive and reproductive lives. In Brazil, there are few studies about the reproductive efficiency of Swiss-Brown cows and no study was found using the methodology of survival analysis applied to this breed. Thus, in the first chapter of this study, the age at first calving from Swiss-Brown heifers was analyzed as the time until the event by the nonparametric method of Kaplan-Meier and the gamma shared frailty model, under the survival analysis methodology. Survival and hazard rate curves associated with this event were estimated and identified the influence of covariates on such time. The mean and median times at the first calving were 987.77 and 1,003 days, respectively, and significant covariates by the Log-Rank test, through Kaplan-Meier analysis, were birth season, calving year, sire (cow s father) and calving season. In the analysis by frailty model, the breeding values and the frailties of the sires (fathers) for the calving were predicted modeling the risk function of each cow as a function of the birth season as fixed covariate and sire as random covariate. The frailty followed the gamma distribution. Sires with high and positive breeding values possess high frailties, what means shorter survival time of their daughters to the event, i.e., reduction in the age at first calving of them. The second chapter aimed to evaluate the longevity of dairy cows using the nonparametric Kaplan-Meier and the Cox and Weibull proportional hazards models. It were simulated 10,000 records of the longevity trait from Brown-Swiss cows involving their respective times until the occurrence of five consecutive calvings (event), considered here as typical of a long-lived cow. The covariates considered in the database were age at first calving, herd and sire (cow s father). All covariates had influence on the longevity of cows by Log-Rank and Wilcoxon tests. The mean and median times to the occurrence of the event were 2,436.285 and 2,437 days, respectively. Sires that have higher breeding values also have a greater risk of that their daughters reach the five consecutive calvings until 84 months

Tontura em idosos institucionalizados da cidade do NATAL/RN: Um estudo caso-controle em vestibulopatas e não-vestibulopatas

the institutionalized elderly presents for being more fragile a lot of body balance s changes, which can induce falls and health frailty. One of the consequences of it is the appearance of dizziness, vestibular or not. This study aims to identify the risk factors related to dizziness in institutionalized elderly, with and without vestibular disorders, in the city of Natal-RN. Method: a case-control study realized in 12 regulated by Health Surveillance Long Term Care Institutions for the elderly in Natal-RN. Elected seniors with good cognitive level and able to walk, totaling 115 individuals, and of these, 102 were selected according to the presence of dizziness in the last year (n = 51) and their controls (n = 51), paired by sex and age. The 51 elderly patients with dizziness were divided into 3 groups case: case one, for elderly with dizziness and without vestibulopathy (n=38); case two, for elderly with dizziness and vestibulopathy (n=13) and case three, for all the seniors with dizziness, or added to the case 1 case 2 (n=51). The 51 seniors who served as controls were also divided into three groups, according to the number of individuals of each case: control 1, n = 38, control 2, n = 13 control and 3 (sum of 1 control with control 2), n = 51. As possible risk factors were analyzed variables related to characteristics of the institution, to the habits of life of older people and those concerned with the health of the elderly. For statistical analysis, we used the chi-square or Fisher exact test for a significance level of 5% and calculating the association magnitude between variables by measuring the Odds Ratio. Results: as risk factors for dizziness without vestibular disorders were found the presence of hypertension and cardiovascular disease, as well as the presence of three or more disorders for elderly and use of gastric protector drugs. For the elderly group from case two were found no associated risk factor. For elderly patients with dizziness in the case group three, we observed the same risk factors found for the elderly in the case group one, plus the presence of osteoarthritis pathology, which was also significant for this group. Conclusion: dizziness in institutionalized elderly is associated with systemic common diseases in this age group and the vestibulopathy presents itself as pathology on an isolated way, not being possible, with our data, associate it with non-risk factors

A música enquanto instrumento terapêutico na resposta clínica da criança em unidade de terapia intensiva pediátrica

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Apropriação da informação: um olhar sobre as políticas públicas sociais de inclusão digital

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Movimento Xingu Vivo Para Sempre: ações, reivindicações e estratégias

Esta dissertação desenvolve uma análise sobre um movimento social denominado Movimento Xingu Vivo Para Sempre, observado com base em suas ações e nas dos atores sociais que o integram. Como metodologia utilizamos o estudo de caso e como técnicas metodológicas para atingir nosso objetivo, optamos pelas entrevistas semi-estruturadas e observação-participante. A principal categoria analítica são os movimentos sociais, que analisamos sob a ótica dos Novos Movimentos Sociais, tendo por base autoras como Glória Gohn e Ilse Scherer-Warren. Além disso, utilizamos alguns conceitos, como: redes de movimentos sociais e estrutura de oportunidades, sendo o último desenvolvido por Tarrow. O objetivo principal foi produzir uma análise sobre o Movimento Xingu Vivo Para Sempre, a partir de suas ações, estratégias e reivindicações, atentando para a estrutura de oportunidades na qual esse processo ocorre. Como objetivos específicos tivemos: reflexão sobre a dinâmica do movimento social estudado a partir de sua história; análise da composição do movimento e sua forma de organização; e análise da relação entre o movimento e os vários segmentos sociais atingidos pela UHE Belo Monte; análise da relação entre o movimento e os distintos setores e instituições estatais. Ficou evidenciado em nossa pesquisa que o Movimento Xingu Vivo Para Sempre é uma rede de movimentos sociais que sofreu diversas transformações, com destaque para o rompimento e a saída da maior parte das entidades integrantes da rede em 2009. A histórica fragilidade institucional da região, que se reflete na carência de serviços públicos, contribui para a legitimação do movimento na condição de um canal de denúncias e contraposição. Todavia, mais do que apresentar um projeto de desenvolvimento alternativo, o movimento atua em uma conduta defensiva contra a construção de barragens na bacia do rio Xingu e Amazônia como um todo, através de outra rede denominada Aliança dos Rios Pan-amazônicos. Constatamos também que a relação com os distintos grupos sociais atingidos é prejudicada pela criminalização empreendida contra o movimento, bem como pelo pequeno número de militantes que o integram, desde as transformações ocorridas a partir de 2009. Por fim, analisamos que, não obstante a oposição frontal ao executivo, o movimento tem articulações em outras esferas estatais, especialmente no judiciário, com destaque para a Defensoria Pública do Pará e o Ministério Público Federal.

A condição humana na roda viva do tempo: reflexões psicanalíticas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)