Adaptação Cultural e Linguística do Trunk Control Test: avaliação das propriedades psicométricas

Introdução: O controlo postural do tronco é um fator preditivo de autonomia, sendo fundamental a existência de instrumentos válidos e fiáveis a fim da sua avaliação na população portuguesa. Objetivo: Traduzir e adaptar o Trunk Control Test (TCT) para a população portuguesa em indivíduos após AVE e avaliar as suas propriedades psicométricas. Métodos: O TCT foi sujeito aos processos de tradução e retroversão para a população portuguesa por dois tradutores bilingues e realizadas duas reuniões com painel de peritos na área. Avaliou-se a validade, a fiabilidade, a sensibilidade, a especificidade e o poder de resposta em 19 indivíduos com AVE. Para avaliar a validade de critério os indivíduos foram adicionalmente submetidos à Escala de Equilíbrio de Berg (EEB), à Avaliação Motora de Rivermead (AMR) e à Escala de Comprometimento do Tronco (ECT). A fiabilidade inter-observadores foi garantida por uma segunda amostra de 25 fisioterapeutas, através da avaliação do desempenho de um participante no TCT. Os dados foram analisados no programa SPSS 22.0. Resultados: O TCT apresentou baixa consistência interna ( =0,523) e fiabilidade inter-observadores substancial (k=0,662). Obteve-se forte correlação do TCT com a ECT (r=0,885) e AMR (r=0,864), e correlação moderada com a EEB (r=0,700). A validade de construção aponta para uma moderada correlação entre itens (KMO=0,755; Bartlett=0,001). Não foi possível obter os valores de sensibilidade, especificidade e poder de resposta do TCT. Conclusão: O estudo demonstrou que o TCT é um instrumento válido e fiável na avaliação da população portuguesa após AVE.

Toward A Reliable Quality Control Test For Microneedle Insertion

Microneedles (MNs) are emerging devices that can be used for the delivery of drugs at specific locations1. Their performance is primarily judged by different features and the penetration through tissue is one of the most important aspects to evaluate. For detailed studies of MN performance different kind of in-vitro, exvivo and in-vivo tests should be performed. The main limitation of some of these tests is that biological tissue is too heterogeneous, unstable and difficult to obtain. In addition the use of biological materials sometimes present legal issues. There are many studies dealing with artificial membranes for drug diffusion2, but studies of artificial membranes for Microneedle mechanical characterization are scarce3. In order to overcome these limitations we have developed tests using synthetic polymeric membranes instead of biological tissue. The selected artificial membrane is homogeneous, stable, and readily available. This material is mainly composed of a roughly equal blend of a hydrocarbon wax and a polyolefin and it is commercially available under the brand name Parafilm®. The insertion of different kind of MN arrays prepared from crosslinked polymers were performed using this membrane and correlated with the insertion of the MN arrays in ex-vivo neonatal porcine skin. The insertion depth of the MNs was evaluated using Optical coherence tomography (OCT). The implementation of MN transdermal patches in the market can be improved by make this product user-friendly and easy to use. Therefore, manual insertion is preferred to other kind of procedures. Consequently, the insertion studies were performed in neonatal porcine skin and the artificial membrane using a manual insertion force applied by human volunteers. The insertion studies using manual forces correlated very well with the same studies performed with a Texture Analyzer equipment. These synthetic membranes seem to mimic closely the mechanical properties of the skin for the insertion of MNs using different methods of insertion. In conclusion, this artificial membrane substrate offers a valid alternative to biological tissue for the testing of MN insertion and can be a good candidate for developing a reliable quality control MN insertion test.

Anxiogenic-like effects of gamma-hydroxybutyric acid (GHB) in mice. 'Efectos ansiog??nicos del ??cido gamma-hidroxibut??rico (GBH) en ratones evaluados en el test del 'light-dark'

Resumen tomado de la publicaci??n

The effect of non-surgical periodontal therapy on peroxidase activity in diabetic patients: a case-control pilot study

Objective: To evaluate the effect of periodontal therapy on clinical parameters as well as on total salivary peroxidase (TSP) activity and myeloperoxidase (MPO) activity in the gingival crevicular fluid (GCF) of patients with type 2 diabetes mellitus (DM2) and of systemically healthy individuals.Material and Methods: Twenty DM2 subjects with inadequate metabolic control (test group) and 20 systemically healthy individuals (control group), both groups with chronic periodontitis, were enrolled. Periodontal clinical parameters, namely periodontal probing depth (PD), clinical attachment level (CAL), visible plaque index (VPI), bleeding on probing (BOP), gingival bleeding index (GBI) and presence of suppuration (SUP), as well as TSP activity and GCF MPO activity, were assessed before and 3 months after non-surgical periodontal therapy.Results: At baseline and 3 months post-treatment, the test group presented a higher percentage of sites with VPI and BOP (p < 0.01). MPO activity in the GCF presented lower values (p < 0.05) for the test group at both baseline and the post-treatment period. The periodontal treatment resulted in a significant improvement of most clinical and enzymatic parameters for both groups (p < 0.05).Conclusions: In both groups, the periodontal therapy was effective in improving most clinical parameters and in reducing salivary and GCF enzymatic activity. The diabetic individuals presented lower MPO activity in the GCF.

The Lactate Minimum Test protocol provides valid measures of cycle ergometer VO2 peak

Aim. The aim of the present study was to investigate the validity of the Lactate Minimum Test (LMT) for the determination of peak VO2 on a cycle ergometer and to determine the submaximal oxygen uptake (VO2) and pulmonary ventilation (VE) responses in an incremental exercise test when it is preceded by high intensity exercise (i.e., during a LMT).Methods. Ten trained male athletes (triathletes and cyclists) performed 2 exercise tests in random order on an electromagnetic cycle ergometer: 1) Control Test (CT): an incremental test with an initial work rate of 100 W, and with 25 W increments at 3-min intervals, until voluntary exhaustion; 2) LMT: an incremental test identical to the CT, except that it was preceded by 2 supramaximal bouts of 30-sec (similar to120% VO(2)peak) with a 30-sec rest to induce lactic acidosis. This test started 8 min after the induction of acidosis.Results. There was no significant difference in peak VO2 (65.6+/-7.4 ml.kg(-1).min(-1); 63.8+/-7.5 ml.kg(-1).min(-1) to CT and LMT, respectively). However, the maximal power output (POmax) reached was significantly higher in CT (300.6+/-15.7 W) than in the LMT (283.2+/-16.0 W).VO2 and VE were significantly increased at initial power outputs in LMT.Conclusion. Although the LMT alters the submaximal physiological responses during the incremental phase (greater initial metabolic cost), this protocol is valid to evaluate peak VO2, although the POmax reached is also reduced.

Nivel de control de asma bronquial en niños y adolescentes atendidos en cinco establecimientos de salud–ESSALUD de la ciudad de Chiclayo, período julio–diciembre 2013

Tesis de pregrado

Knowledge and use of asthma control measurement tools in the management of asthma: a survey of doctors working in family and internal medicine practice in Nigeria.

Objective: To investigate the knowledge and use of asthma control measurement (ACM) tools in the management of asthma among doctors working in family and internal medicine practice in Nigeria. Method: A questionnaire based on the global initiative on asthma (GINA) guideline was self-administered by 194 doctors. It contains 12 test items on knowledge of ACM tools and its application. The knowledge score was obtained by adding the correct answers and classified as good if the score ≥ 9, satisfactory if score was 6-8 and poor if < 6. Results: The overall doctors knowledge score of ACM tools was 4.49±2.14 (maximum of 12). Pulmonologists recorded the highest knowledge score of 10.75±1.85. The majority (69.6%) had poor knowledge score of ACM tools. Fifty (25.8%) assessed their patients’ level of asthma control and 34(17.5%) at every visit. Thirty-nine (20.1%) used ACM tools in their consultation, 29 (15.0%) of them used GINA defined control while 10 (5.2 %) used asthma control test (ACT). The use of the tools was associated with pulmonologists, having attended CME within six months and graduated within five years prior to the survey. Conclusion: The results highlight the poor knowledge and use of ACM tools and the need to address the knowledge gap.

Unpacking insanity defence standards: an experimental study of rationality and control tests in criminal law

The present study investigated the impact of different legal standards on mock juror decisions concerning whether a defendant was guilty or not guilty by reason of insanity. Undergraduate students (N = 477) read a simulated case summary involving a murder case and were asked to make an insanity determination. The cases differed in terms of the condition of the defendant (rationality deficit or control deficit) and the legal standard given to the jurors to make the determination (Model Penal Code, McNaughten or McNaughten plus a separate control determination). The effects of these variables on the insanity determination were investigated. Jurors also completed questionnaires measuring individualism and hierarchy attitudes and perceptions of facts in the case. Results indicate that under current insanity standards jurors do not distinguish between defendants with rationality deficits and defendants with control deficits regardless of whether the legal standard requires them to do so. Even defendants who lacked control were found guilty at equal rates under a legal standard excusing rationality deficits only and a legal standard excluding control and rationality deficits. This was improved by adding a control test as a partial defence, to be determined after a rationality determination. Implications for the insanity defence in the Criminal Justice System are discussed.

Efeitos de dois programas de exercício na endurance de tronco, controlo lombo-pélvico, perceção de dor lombar e fadiga, funcionalidade e qualidade de vida: Pilates Clínico vs Exercícios segundo McGill

Introdução: A lombalgia crónica assume uma elevada prevalência e graves repercussões a nível socioeconómico, sendo inúmeras as abordagens terapêuticas para o seu tratamento e prevenção. Existindo forte evidência da eficácia dos exercícios terapêuticos no seu tratamento, importa saber quais os mais efetivos. Objectivos: Comparar a efetividade de dois programas de exercício terapêutico na endurance do tronco, no controlo lombo-pélvico, na perceção de dor lombar e fadiga, na funcionalidade e na qualidade de vida em mulheres com lombalgia crónica não especifica, cuidadoras de idosos. Métodos: 24 mulheres foram divididas aleatoriamente em três grupos de 8. Durante 6 semanas, um grupo serviu de controlo (GC) e os outros dois grupos realizaram um programa de exercícios: Pilates Clínico (GP) ou exercícios segundo McGill (GM), com os outcomes medidos em ternos de endurance de tronco pelos testes de McGill, controlo lombo-pélvico pelos testes Active Straight Leg Raise e teste de controlo lombo-pélvico segundo McGill, dor lombar pela Numerical Rating Scale, fadiga pela escala de Borg, funcionalidade através do Questionário de Incapacidade de Roland Morris e qualidade de vida através do Questionário de Estado de Saúde (SF36-V2). Resultados: Relativamente à endurance, verificaram-se diferenças entre grupos no rácio flexores/extensores (p=0,005), e no rácio lateroflexores à esquerda/extensores (p=0,027), sendo que o GP apresentou um rácio estatisticamente inferior ao GC em ambos. Não existiram diferenças estatisticamente significativas entre os 3 grupos no controlo lombo-pélvico, perceção de dor, fadiga e funcionalidade, apesar das melhorias observadas intra-grupos. Relativamente à qualidade de vida, a dimensão saúde em geral aumentou significativamente no GP (p=0,020) e a função social no GM (p=0,045). Conclusão: A implementação dos programas de exercício Pilates Clínico e Exercícios segundo McGill numa amostra de cuidadoras de idosos com lombalgia crónica não especifica, parece ter um efeito positivo quando comparados com os do grupo de controlo sobre a endurance do tronco, controlo lombo-pélvico, perceção de dor lombar e fadiga, funcionalidade e qualidade de vida.

Adesão à terapêutica e controlo da doença na asma: papel das perceções de doença

Objetivo: Identificar perceções de doença e sua associação com a adesão e controlo da doença na asma. Metodologia: Estudo observacional-descritivo transversal, em que participaram 33 estudantes de ambos os sexos, 18-29 anos, que completaram o Illness Perception Questionnaire, a Medida de Adesão aos Tratamentos e o Asthma Control Test. Resultados: A maioria perceciona a asma como doença crónica cíclica, controlável pela sua ação ou tratamento, tem perceção adequada do controlo da sua asma e bom nível de adesão, embora refira comportamentos de não adesão. Foi encontrada correlação significativa negativa entre adesão e perceção de duração da doença e positiva entre perceção de controlo (tratamento) e nível de controlo da doença e entre sintomas e perceção de controlo. Discussão: Os resultados evidenciam o papel das perceções de doença na adoção de comportamentos de saúde, reforçando a necessidade de intervenções centradas no doente, que potenciem o seu envolvimento no controlo da asma.

Perceções de doença como determinantes de comportamentos de saúde na asma

Objetivos: Identificar e caracterizar perceções de doença e sua associação com níveis de adesão à terapêutica e controlo da doença na asma. Métodos: Estudo observacional-descritivo transversal cuja amostra é constituída por 33 estudantes asmáticos, de ambos os sexos e idade 18-29 anos (M=20,33; DP=2,04), que completaram o Illness Perception Questionnaire (IPQ-R), a Medida de Adesão aos Tratamentos (MAT) e o Asthma Control Test (ACT). Resultados: A maioria dos indivíduos percepciona a asma como doença crónica, cíclica, que pode ser controlada pela sua acção e/ou tratamento. A maioria apresenta um bom nível de controlo da asma, evidenciando 84,8% uma perceção adequada do controlo da sua doença. Embora apresentem um bom nível de adesão, apenas 28% toma medicação preventiva diariamente, referindo 45,2% já ter interrompido a medicação por se sentir melhor. Foram encontradas correlações significativas entre nível de adesão e perceção de duração cíclica da doença (rs (30)= -0,38; p<0,05), entre perceção de controlo através do tratamento e nível de controlo da doença (rs (33) = 0,386; p<0,05) e entre sintomas e perceção de controlo da doença (rs (33) = 0,737; p<0,01). Conclusões: Os resultados evidenciam o papel das perceções de doença na adoção de comportamentos de saúde na asma, nomeadamente a adesão à terapêutica, que vão traduzir-se no nível de controlo alcançado pelos doentes. Desenvolver intervenções individualizadas, centradas no doente, que contribuam para corrigir crenças inadequadas poderá, pois, potenciar um envolvimento ativo do doente no controlo da sua doença, contribuindo para uma melhoria da sua Qualidade de Vida.

Amostragem em auditoria

Dissertação apresentada ao Instituto Superior de Contabilidade para a obtenção do Grau de Mestre em Auditoria Orientada por Professor Doutor António Carvalho Pedrosa

Efficacy of a hip flexion assist orthosis in adults with hemiparesis after stroke.

Background During gait, the hip flexors generate 40% of the total power. Nevertheless, no device has been tested extensively for clinical purposes to cope with weakness in the hip flexors in patients with stroke. Objective The purpose of this study was to assess the efficacy and safety of a newly developed hip flexion assist orthosis in adult patients with hemiparesis after stroke. Design The study used a prospective, randomized, before-after trial design. The inclusion criteria were hemiparesis resulting from stroke (onset ≥8 weeks); ability to walk, even if with assistance; and hip flexion weakness (Medical Research Council Scale score ≤4).¦METHODS: /b> The main outcome measures were the 10-Meter Walk Test and the Six-Minute Walk Test. Patients also were evaluated with the Trunk Control Test, the Functional Ambulation Categories, the Motricity Index, and hip flexor strength on the Medical Research Council Scale. Sixty-two survivors of stroke were tested in random order with and without the orthosis. Any adverse event associated with its use was recorded.¦RESULTS: /b> Both the Six-Minute Walk Test and the 10-Meter Walk Test scores improved with the use of the orthosis. A significant negative correlation was found for improvement between scores on the 2 main outcome measures with the orthosis and the Functional Ambulation Categories scores. The improvement in Six-Minute Walk Test scores with the orthosis was related inversely to hip flexor strength.¦CONCLUSIONS: /b> The data showed that the use of a hip flexion assist orthosis can improve gait in patients with poststroke hemiparesis, particularly those with more severe walking impairment.

Physicochemical and sensory profile of rice bran roasted in microwave

The purpose of this study was to evaluate the physical, chemical, and sensory changes in bran from three rice cultivars according to microwave roasting time. This study analyzed three rice cultivars, BRS Sertaneja (S), BRS Primavera (P), and IRGA 417 (I) determining the color parameters (L*, a*, and b *) at 6, 9, 12, 15, and 18 minutes of roasting time. After applying the difference from control test, the rice brans with different characteristics aroma and flavor were selected: S and P roasted for 9 and 15 minutes and IRGA 417 roasted for 9, 12, and 15 minutes. These samples were characterized by Free-Choice Profile descriptive sensory analysis, and their chemical composition was also determined. The longer the roasting process, the higher the roasted flavor intensity and aroma. The IRG 417 cultivar roasted for 12 minutes showed a sweeter flavor and aroma. After roasting, the brans remained rich in protein and lipid and presented higher fiber content and lower reducing sugar and phytic acid content. Microwave roasting for 12 minutes can be a viable option for improving the sensory functional and nutritional characteristics of the rice bran considering its use in food products.

Anaerobic Digestibility of Microalgae : Fate and Limitations of Long Chain Fatty Acids in the Biodegradation of Lipids

La digestion anaérobie est un processus biologique dans lequel un consortium microbien complexe fonctionnant en absence d’oxygène transforme la matière organique en biogaz, principalement en méthane et en dioxyde de carbone. Parmi les substrats organiques, les lipides sont les plus productifs de méthane par rapport aux glucides et aux protéines; mais leur dégradation est très difficile, en raison de leur hydrolyse qui peut être l’étape limitante. Les algues peuvent être une source importante pour la production de méthane à cause de leur contenu en lipides potentiellement élevé. L’objectif de cette étude était, par conséquent, d’évaluer la production en méthane des microalgues en utilisant la technique du BMP (Biochemical méthane Potential) et d’identifier les limites de biodégradion des lipides dans la digestion anaérobie. Le plan expérimental a été divisé en plusieurs étapes: 1) Comparer le potentiel énergétique en méthane des macroalgues par rapport aux microalgues. 2) Faire le criblage de différentes espèces de microalgues d’eau douce et marines afin de comparer leur potentiel en méthane. 3) Déterminer l'impact des prétraitements sur la production de méthane de quelques microalgues ciblées. 4) Identifier les limites de biodégradation des lipides algaux dans la digestion anaérobie, en étudiant les étapes limitantes de la cinétique des lipides et de chacun des acides gras à longues chaines. Les résultats ont montré que les microalgues produisent plus de méthane que les macroalgues. Les BMP des microalgues d'eau douce et marines n'ont montré aucune différence en termes de rendement en méthane. Les résultats des prétraitements ont montré que le prétraitement thermique (microonde) semblait être plus efficace que le prétraitement chimique (alcalin). Les tests de contrôle du BMP faits sur l'huile de palme, l’huile de macadamia et l'huile de poisson ont montré que l'hydrolyse des huiles en glycérol et en acides gras à longues chaines n'était pas l'étape limitante dans la production de méthane. L'ajout de gras dans les échantillons de Phaeodactylum dégraissée a augmenté le rendement de méthane et cette augmentation a été corrélée à la quantité de matières grasses ajoutées.