RESUMEN
PURPOSE: This review aims to identify the barriers and facilitators to knowledge use and Knowledge Translation (KT) strategies in rehabilitation in low, lower-middle, and upper-middle-income countries (LMICs). MATERIALS AND METHODS: A scoping review of studies of KT in rehabilitation in LMICs contexts using the Arksey and O'Malley Framework was conducted. A comprehensive search of MEDLINE and 10 other databases was undertaken to identify studies conducted primarily in LMICs. RESULTS: From the initial 15.606 titles identified; 27 articles were included for final analysis. Our analysis identified the following themes: Professional culture and context; KT interventions; and the conceptualization and application of KT and Evidence Based Practice (EBP). Individual-level barriers to KT included lack of skills, knowledge about EBP and English language, lack of motivation, and decision-making power. Facilitators to KT included positive attitudes and motivation. Organization-level barriers included lack of time, lack of financial resources, limited access to scientific journals, and applicability of research to rural settings. Facilitators included adequate financial and physical resources, a supportive management environment, and the existence of training and continuing education programs. CONCLUSION: This review identified common and unique barriers and facilitators to KT in LMICs when compared to KT studies conducted in high-income settings.IMPLICATIONS FOR REHABILITATIONKnowledge Translation from academic institutions to rehabilitation clinical practice in low and upper-middle-income countries is important to support evidence-based practice and patient outcomes.Barriers at the individual level include professionals' ability to understand English and knowledge of the evidence-based practice.Organization-level barriers included lack of time to access and implement new practices, lack of financial and personal resources, limited access to scientific journals, and applicability of research to rural settings.Training and continuing education programs are needed to support rehabilitation professionals' efforts to achieve the application of evidence-based practice in clinical practice.
Asunto(s)
Países en Desarrollo , Ciencia Traslacional Biomédica , HumanosRESUMEN
This study investigated the effects of different concentrations of FSH (10, 50, 100 and 200 ng/ml) in supplemented MEM+ on the development of equine pre-antral follicles that were cultured in vitro for 2 or 6 days. The ovaries (n = 5) from mares in seasonal anoestrus were collected from a local abattoir. Ten ovarian tissue fragments of approximately 3 × 3 × 1 mm were obtained from each animal. The fragments were cultured in situ for 2 days (D2) or 6 days (D6) in MEM+ or MEM+ supplemented with FSH at four different concentrations, establishing the following 11 groups: control (D0); MEM + (D2); MEM + (D6); MEM + 10 ng/ml of FSH (D2); MEM + 10 ng/ml of FSH (D6); MEM + 50 ng/ml of FSH (D2); MEM + 50 ng/ml of FSH (D6); MEM + 100 ng/ml of FSH (D2); MEM + 100 ng/ml of FSH (D6); MEM + 200 ng/ml of FSH (D2); and MEM + 200 ng/ml of FSH (D6). Follicles were observed in only 9.65% (388 of 4,018) of the histological sections. Of the 861 follicles evaluated, 488 were in the primordial stage, and 373 were in various developmental stages; 59.7% were morphologically normal. Regarding the integrity of the pre-antral follicles, the groups with 100 ng/ml FSH of 2-days culture as well as 50, 100 and 200 ng/ml FSH of 6-days culture provided the best results. In conclusion, the in vitro culture of abattoir-derived equine ovarian fragments presented better morphological integrity when supplemented with FSH for 6 days, in comparison with the MEM culture group. However, no clear effects were observed with FSH regarding the promotion of activation from a primordial to a developing follicle.
Asunto(s)
Hormona Folículo Estimulante/farmacología , Caballos , Folículo Ovárico/efectos de los fármacos , Técnicas de Cultivo de Tejidos/veterinaria , Anestro , Animales , Medios de Cultivo , Femenino , Folículo Ovárico/crecimiento & desarrollo , Técnicas de Cultivo de Tejidos/métodosRESUMEN
The goal of this study was to determine the distribution of pre-antral follicles in the ovarian parenchyma of mares. For Experiment 1, each ovary was cut longitudinally at the greater curvature, performing two hemiovaries. After that, six fragments from each hemiovary were obtained, resulting in 12 fragments, which were divided into the innermost region of the parenchyma, the middle region and the outermost region. All the three obtained sections were cut transversally to obtain two fragments from each one. For Experiment 2, each ovary also submitted to a longitudinal cut on the greater curvature, forming two hemiovaries. Each hemiovary was sectioned into four symmetrical fragments, resulting in eight fragments per ovary. The fragments were related as being near to or far from the ovulatory fossa. The fragments of both experiments were immediately fixed in Carnoy for 12 hr and kept in 70% ethanol for 24 hr. Follicles were classified according to the stages of development and for morphological integrity according to oocyte morphology and granulosa cells. After the histological assessment, a total of 1,130 follicles were visualized from Experiment 1, being 1,054 (93.3%) primordial follicles and 76 (4.7%) follicles in development. The innermost region had the highest percentage of pre-antral follicles compared to the other regions (p < .05). The middle and outermost regions showed higher percentages of intact primordial and developing follicles than the innermost region (p < .05). Considering Experiment 2, 938 follicles were found, being 894 (95.3%) primordial and 44 (4.7%) follicles in development. The region near the ovulatory fossa presented higher (58.7%; 551 of 938) follicular concentration compared to the region far from the ovulatory fossa (41.3%; 387 of 938; p < .05). As a conclusion, distribution of pre-antral follicles in the equine ovary has a specific pattern through the parenchyma. Also, the follicular integrity differed in the studied ovarian areas.
Asunto(s)
Caballos , Folículo Ovárico/anatomía & histología , Ovario/anatomía & histología , Animales , Femenino , Células de la Granulosa , Oocitos , Folículo Ovárico/fisiologíaRESUMEN
BACKGROUND: Gait disturbance is common after stroke; however, there is no consensus regarding the optimal therapeutic rehabilitation of hemiparetic gait. AIM: 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: Randomized clinical trial, comparing two experimental groups (comparative study). SETTING: Laboratory for Human Movement Analysis of UFRN. POPULATION: Twenty-three subjects, 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, able to walk with personal assistance or assistive devices. METHODS: Two experimental groups underwent gait training based on PNF method (N.=11) or using the TPBWS (N.=12), for twelve sessions. Evaluation of motor function (using the STREAM and motor FIM), and kinematic gait analysis 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-swing time of the paretic leg/swing time of non-paretic leg--(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. However, the sample size should be carefully considered in generalizing the results to other populations. CLINICAL REHABILITATION IMPACT: The results showed some equivalence between these two approaches with regard to motor recovery, functionality and temporal symmetry of hemiparetic gait, suggesting that the cost-effectiveness of each treatment may have a important role in this choice.
Asunto(s)
Terapia por Ejercicio/métodos , Trastornos Neurológicos de la Marcha/rehabilitación , Espasticidad Muscular/rehabilitación , Ejercicios de Estiramiento Muscular/métodos , Paresia/rehabilitación , Rehabilitación de Accidente Cerebrovascular , Adulto , Anciano , Brasil , Enfermedad Crónica , Terapia por Ejercicio/instrumentación , Femenino , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Espasticidad Muscular/etiología , Paresia/etiología , Desempeño Psicomotor/fisiología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/fisiopatologíaRESUMEN
Avaliar os efeitos do treino em esteira eletrica com suporte parcial de peso associado a estimulacao eletrica funcional na marcha de sujeitos hemiplegicos por meio da analise de variaveis espaco-temporais. Metodo: para tal proposito foi utilizado o sistema A1-B-A2,no qual A1 e A2 correspondem ao treinamento em esteira eletrica com suporte parcial de peso e B, ao mesmo treinamento associado a estimulacao eletrica funcional. participaram deste estudo dois pacientes hemiparetcos cronicos que foram submetidos a treinamento durante 45 minutos, tres vezes por semana durante 9 semanas...