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OBJECTIVE: Chagas cardiomyopathy (ChC) is the most severe clinical form of Chagas disease and, in association with psychosocial factors, can compromise the health-related quality of life (HRQoL) of affected patients. To date, there is no specific instrument to assess the HRQoL of these patients, and the Minnesota Living with Heart Failure Questionnaire (MLwHFQ), specific for heart failure, is being used both in research and current clinical practice. Therefore, we aimed to verify the validity of the MLwHFQ in the assessment of HRQoL of patients with ChC. METHODS: Fifty patients with ChC (50.6 ± 10.1 years, NYHA I-III) were evaluated. The MLwHFQ, Short-Form of Health Survey (SF-36), Beck Depression Inventory (BDI), and Human Activity Profile (HAP) were applied. All patients underwent echocardiography and Cardiopulmonary Exercise Testing (CPET). RESULTS: The MLwHFQ score correlated with almost all SF-36 domains (with r-value ranging from -0.38 to -0.69), except pain (p = 0.118). The MLwHFQ score also correlated with the BDI score (r = 0.748; p < 0.001), HAP score (r = -0.558; p = 0.001), peak oxygen uptake (r = -0.352; p = 0.01), and left ventricular ejection fraction (r = -0.329; p = 0.021). There was no significant difference in the score found on the MLwHFQ among NYHA classes (p = 0.101), as well as between patients with systolic dysfunction (n = 30) and preserved cardiac function (n = 20) (p = 0.058). Similarly, there was no significant difference in the score found on the physical (p = 0.423) and mental (p = 0.858) components of SF-36 between patients with systolic dysfunction and preserved cardiac function (p = 0.271 and p = 0.609, respectively). There was also no difference in the mental component of SF-36 among NYHA classes (p = 0.673). However, the HRQoL using the physical component of SF-36 was worse in advanced NYHA classes (p = 0.014). CONCLUSION: MLwHF correlated with most SF-36 HRQoL domains, depressive symptoms, physical activity, and systolic function and seems to be valid in assessing the HRQoL of ChC patients.
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Cardiomiopatia Chagásica , Insuficiência Cardíaca , Humanos , Qualidade de Vida/psicologia , Cardiomiopatia Chagásica/complicações , Volume Sistólico , Função Ventricular Esquerda , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The purpose of this study was to evaluate the feasibility of a randomized controlled trial investigating the effectiveness of a multimodal program (PAT-Back) compared to best practice advice on pain and disability in older adults with chronic low back pain (LBP) in primary care. METHODS: This feasibility study took place in Fortaleza, Northeast Brazil. The PAT-Back intervention consisted of a program including exercises, pain education, and motivational text messages for the in-home component. The control group received an evidence-based educational booklet. Feasibility outcomes were recruitment, adherence and retention rates, level of difficulty of the education and intervention content, perception of utility of mobile technology, and adverse events. The feasibility criteria were previously defined. RESULTS: A total of 248 people were screened, of which 46 older adults were eligible. The retention rate was high (100% in the PAT-Back group and 95% in the control group). The adherence rate to intervention was partially met (60%), whereas the adherence rate to unsupervised exercises was adequate (75%), and perception about safety to perform home exercise was partially acceptable (70%) in the PAT-Back group. In addition, 100% of older adults reported which text messages motivated them to perform the exercises in the PAT-Back group. Difficulty reported by participants in understanding and performing the intervention was small in both groups. Six participants reported transient adverse events in both groups. CONCLUSION: Older adults accepted both interventions. Results demonstrated that the program is feasible, although minor changes targeting adherence and safety in home exercise are needed. IMPACT: This feasibility study supports progression to a full trial investigating the effectiveness of a multimodal program (PAT-Back) on pain and disability in older adults with chronic LBP within a primary health care setting in low to middle income countries where such data from the older population are scarce and the burden of LBP is increasing.
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Dor Lombar , Envio de Mensagens de Texto , Humanos , Idoso , Estudos de Viabilidade , Exercício Físico , Terapia por Exercício/métodos , Dor Lombar/terapiaRESUMO
BACKGROUND: Functional impairment can be detected from the onset of heart disease in patients with Chagas cardiomyopathy (ChC) and the prognostic value of the end-tidal carbon dioxide at peak exercise (PETCO2 peak) should be investigated. OBJECTIVE: To verify the prognostic value of PETCO2 peak in patients with ChC. METHODS: Seventy-six patients with ChC (49.2 ± 9.8 years, NYHA I-III) were evaluated by echocardiography and Cardiopulmonary Exercise Testing. Patients were followed up to four years and the end-point was defined as cardiovascular death, stroke, or cardiac transplantation. RESULTS: At the end of the follow-up period (29.0 ± 16.0 months), 16 patients (21%) had experienced adverse events. The area under the receiver operating characteristic (ROC) curve to identify the risk of adverse events by PETCO2 peak in patients with ChC was 0.83 (95% CI: 0.69 to 0.97), and the value of 32 mmHg was the optimal cut point (70% of sensitivity and 85% of specificity). In the Kaplan-Meier diagram, there was a significant difference (p<0.001) between patients with reduced (≤ 32 mmHg) and preserved PETCO2 peak (>32 mmHg). In the final Cox multivariate model, only reduced PETCO2 peak (HR 4.435; 95% CI: 1.228 to 16.016, p = 0.023) and VO2peak (HR 0.869; 95% CI: 0.778 to 0.971, p = 0.013) remained as independent predictors of poor outcome in ChC patients. CONCLUSION: Reduced PETCO2 peak and VO2peak demonstrated valuable prognostic value in patients with ChC. The cutoff points for both functional variables can be used during risk stratification and may help in the development of therapeutic strategies in ChC patients.
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INTRODUCTION: Understanding the different transmission routes of SARS-CoV-2 is crucial in planning effective interventions in healthcare institutions. This study aimed to evaluate the presence of SARS-Cov-2 genome on inanimate surfaces in COVID-19 intensive care unit and emergency care cohorts. METHODS: This is a prospective cross-sectional study. Samples of the environmental surface of objects and furniture were collected between July 15 and October 15, 2020, at COVID-19 intensive and emergency care units. The presence of SARS-CoV-2 genome was determined by quantitative RT-qPCR. The positivity rate for SARS-Cov-2 genome is presented as the arithmetic mean of the sum of the values obtained in each collection. Values of 1.0, 0.5, and 0.0 were assigned for positive, indeterminate, and negative events, respectively. RESULTS: In the intensive care unit, 86% of samples collected at the stethoscope and bed rail surfaces were positive. In the emergency care unit, 43% of bathroom tap, bed rails, and bedside table samples were positive. SARS-CoV-2 genome was not detected at the computer mouse and keyboard. At the emergency care unit, 14.3% of the samples from the collection room armchair were positive. CONCLUSIONS: SARS-CoV-2 genome can be found at the environmental surface of objects and furniture at COVID-19 care units. They can represent a potential source of indirect transmission pathway for COVID-19, especially within health service institutions.
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COVID-19 , Serviços Médicos de Emergência , Estudos Transversais , Humanos , Unidades de Terapia Intensiva , Estudos Prospectivos , RNA Viral/genética , SARS-CoV-2/genéticaRESUMO
Abstract Aim: Low back pain (LBP) is disabling in older adults. Although physical activity interventions positively affect LBP, older adults are underrepresented in the literature. We aim to investigate the feasibility of conducting a study to evaluate a primary care program of exercise therapy and pain education, supported by mobile technology, for older adults with chronic LBP (compared to best practice advice). Methods: In this parallel, two-arm randomized pilot trial, we will recruit adults aged 60 years and older with chronic LBP. The experimental group (Physical Activity supported by low-cost mobile technology for Back pain-PAT-Back) will consist of an 8-week group exercise program based on pain education, exercises, graded activities, and in-home physical activity. Text messages will be sent to promote adherence to home exercises. The control group will receive an evidence-based educational booklet given during one individual consultation. Outcomes will include recruitment rate, adherence and retention rates, level of understanding of the intervention content, perception of the utility of mobile technology, compliance with the accelerometer in a sub-sample of patients, and adverse events. Discussion: The results of this study will form the basis for a large randomized controlled trial. This innovative approach to managing LBP in the primary care setting for older adults, if proven to be effective, can bring an important advance in the knowledge of chronic LBP management to this population.
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The therapeutic benefits of LED in wound care have been reported since the 1990s. Nevertheless, studies directly related to the effects of LED phototherapy on the venous and arterial circulation and the healing process of pressure injuries are scarce in literature. Thus, the aim of this study was to evaluate the efficacy of a LED phototherapy prototype in participants with pressure injuries. In this pilot study 15 participants were randomized into three therapeutic groups. The experimental groups received applications of 630 and 940 nm LED three times a week for 8 weeks, with a dose of 6 J/cm2 in Group I. In group II, a dose of 8 J/cm2 in addition to the standard treatment. Group III (control group) received only daily standard treatment which consisted of cleaning the lesioned area with physiological solution, followed by application of an alginate hydrogel dressing over a period of 8 weeks. Pressure injuries were photographed and the area was measured by the Quantikov® image analyzer software. There was no statistically significant difference (p > 0.05) between the three groups when assessing the initial lesion area. At the end of 2 months, the median and interquartile ranges of the injuries were 5.90 (0.79-9.5) cm2 for group I, 0.54 (0.47-1.16) cm2 for group II and 26.76 (17.25-41.05) for group III. There was a statistically significant difference between treatment types (I x III and II x III) for pressure injuries over the 21 sessions. However, there was no significant difference between groups I x II that received different doses of LED phototherapy. The initial hypothesis was supported given that the combination of two wavelengths in the LED phototherapy with different doses may be helpful in accelerating the healing of pressure injuries.
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Fototerapia , Úlcera por Pressão , Cicatrização , Humanos , Fototerapia/métodos , Projetos Piloto , Cicatrização/fisiologiaRESUMO
A função de gestor hospitalar é invariavelmente complexa, independentemente da região, de fato que, ainda em certos aspectos, os serviços de saúde são mais desafiadores em alguns países, devido à regulação de leitos, financiamento e tecnologias à disposição. Acrescenta-se à extensa relação de demandas gerenciais, a exigência por conhecimentos específicos na gestão dos recursos humanos e físicos. A influência do modelo fragmentado de organização do trabalho, em que cada profissional realiza parcelas do trabalho sem uma integração com as demais áreas envolvidas, tem sido apontada como uma das razões que dificultam a realização de um trabalho em saúde mais integrador e de melhor qualidade, tanto na perspectiva daqueles que o realizam como para aqueles que dele usufruem. A partir do momento em que profissionais de saúde, que trabalham diretamente com o paciente, ocupam coordenações, na medida em que ascendem na organização, passam a desempenhar mais tarefas administrativas. Como exemplo, é possível perceber que uma enfermeira ou médico que coordenam uma unidade de internamento, realizam mais funções administrativas e quase nenhuma técnica, usando seus conhecimentos técnicos para atuar na chefia. Esses profissionais, ao ocupar determinados cargos, nem sempre entendem das atividades administrativas. Com isso, o hospital perde um bom técnico e pode não ganhar um bom chefe. Este trabalho tem uma descrição reflexiva acerca do processo de gestão hospitalar.(AU)
The role of hospital manager is invariably complex, regardless of the region. In some countries, health services are even more challenging due to the regulation of beds, financing, and technologies available. In addition to the extensive list of managerial demands, there is also the requirement for specific knowledge in the management of human and physical resources. The influence of the fragmented model of work organization, where each professional performs portions of the work without integration with the other involved areas, has been pointed out as one of the reasons hindering the accomplishment of a more integrating and better-quality health work, both from the perspective of those who perform it and of those who use it. From the moment health professionals, who work directly with the patient, occupy managerial positions, as they ascend in the organization, they inevitably start to have more administrative tasks. As an example, it is possible to notice that a nurse or doctor who coordinates an inpatient unit performs more administrative functions and almost no technical ones. They use their technical expertise to act in managerial positions. These professionals, when occupying certain positions, are not always fully trained to understand administrative activities. Thus, the hospital ends up losing a good technician worker and may not always get a good manager in return. This work presents a reflexive description on the hospital management process.(AU)
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Gestão de Recursos Humanos , Planos e Programas de Saúde/organização & administração , Demandas Administrativas em Assistência à Saúde , Administração Hospitalar/tendências , Pessoal de Saúde/organização & administraçãoRESUMO
Angiotensin-converting enzyme 2 (ACE2) is the host cellular receptor that locks onto the surface spike protein of the 2002 SARS coronavirus (SARS-CoV-1) and of the novel, highly transmissible and deadly 2019 SARS-CoV-2, responsible for the COVID-19 pandemic. One strategy to avoid the virus infection is to design peptides by extracting the human ACE2 peptidase domain α1-helix, which would bind to the coronavirus surface protein, preventing the virus entry into the host cells. The natural α1-helix peptide has a stronger affinity to SARS-CoV-2 than to SARS-CoV-1. Another peptide was designed by joining α1 with the second portion of ACE2 that is far in the peptidase sequence yet grafted in the spike protein interface with ACE2. Previous studies have shown that, among several α1-based peptides, the hybrid peptidic scaffold is the one with the highest/strongest affinity for SARS-CoV-1, which is comparable to the full-length ACE2 affinity. In this work, binding and folding dynamics of the natural and designed ACE2-based peptides were simulated by the well-known coarse-grained structure-based model, with the computed thermodynamic quantities correlating with the experimental binding affinity data. Furthermore, theoretical kinetic analysis of native contact formation revealed the distinction between these processes in the presence of the different binding partners SARS-CoV-1 and SARS-CoV-2 spike domains. Additionally, our results indicate the existence of a two-state folding mechanism for the designed peptide en route to bind to the spike proteins, in contrast to a downhill mechanism for the natural α1-helix peptides. The presented low-cost simulation protocol demonstrated its efficiency in evaluating binding affinities and identifying the mechanisms involved in the neutralization of spike-ACE2 interaction by designed peptides. Finally, the protocol can be used as a computer-based screening of more potent designed peptides by experimentalists searching for new therapeutics against COVID-19.
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Enzima de Conversão de Angiotensina 2/metabolismo , Antivirais/farmacologia , Tratamento Farmacológico da COVID-19 , Desenho de Fármacos , Peptídeos/farmacologia , Glicoproteína da Espícula de Coronavírus/metabolismo , Antivirais/química , COVID-19/metabolismo , Humanos , Modelos Moleculares , Peptídeos/química , Ligação Proteica/efeitos dos fármacos , Domínios Proteicos/efeitos dos fármacos , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave/efeitos dos fármacos , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave/metabolismo , SARS-CoV-2/efeitos dos fármacos , SARS-CoV-2/metabolismo , Síndrome Respiratória Aguda Grave/tratamento farmacológico , Síndrome Respiratória Aguda Grave/metabolismoRESUMO
Understanding which aspects contribute to the thermostability of proteins is a challenge that has persisted for decades, and it is of great relevance for protein engineering. Several types of interactions can influence the thermostability of a protein. Among them, the electrostatic interactions have been a target of particular attention. Aiming to explore how this type of interaction can affect protein thermostability, this paper investigated four homologous cold shock proteins from psychrophilic, mesophilic, thermophilic, and hyperthermophilic organisms using a set of theoretical methodologies. It is well-known that electrostatics as well as hydrophobicity are key-elements for the stabilization of these proteins. Therefore, both interactions were initially analyzed in the native structure of each protein. Electrostatic interactions present in the native structures were calculated with the Tanford-Kirkwood model with solvent accessibility, and the amount of hydrophobic surface area buried upon folding was estimated by measuring both folded and extended structures. On the basis of Energy Landscape Theory, the local frustration and the simplified alpha-carbon structure-based model were modeled with a Debye-Hückel potential to take into account the electrostatics and the effects of an implicit solvent. Thermodynamic data for the structure-based model simulations were collected and analyzed using the Weighted Histogram Analysis and Stochastic Diffusion methods. Kinetic quantities including folding times, transition path times, folding routes, and Φ values were also obtained. As a result, we found that the methods are able to qualitatively infer that electrostatic interactions play an important role on the stabilization of the most stable thermophilic cold shock proteins, showing agreement with the experimental data.
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Proteínas e Peptídeos de Choque Frio/química , Dobramento de Proteína , Homologia de Sequência de Aminoácidos , Eletricidade Estática , Temperatura , Proteínas e Peptídeos de Choque Frio/metabolismo , Cinética , Modelos Moleculares , Conformação Proteica , Estabilidade ProteicaRESUMO
STUDY DESIGN: Secondary analysis of data from a randomized controlled trial. BACKGROUND: Treatment based on the Movement System Impairment-Based classification for chronic low back pain results in the same benefit when compared to other forms of exercise. It is possible that participant's characteristics measured at baseline can identify people with chronic low back pain who would respond best to a treatment based on the Movement System Impairment model. OBJECTIVES: To assess if specific characteristics of people with chronic low back pain measured at baseline can modify the effects of a treatment based on the Movement System Impairment model on pain and disability. METHODS: Four variables assessed at baseline that could potentially modify the treatment effects of the treatment based on the Movement System Impairment model were selected (age, educational status, physical activity status and STarT back tool classification). Separate univariate models were used to investigate a possible modifier treatment effect of baseline participant's characteristics on pain and disability after the treatment. Findings of interaction values above 1 point for the outcome mean pain intensity or above 3 points for disability (Roland Morris questionnaire) were considered clinically relevant. RESULTS: Linear regression analyses for the outcomes of pain and disability did not show interaction values considered clinically relevant for age, educational status, physical activity status and STarT back tool classification. CONCLUSION: Age, educational status, physical activity status and STarT back tool classification did not modify the effects of an 8-week treatment based on the Movement System Impairment model in patients with chronic low back pain. Registered at www.clinicaltrials.gov: NCT02221609 (https://clinicaltrials.gov/ct2/show/NCT02221609).
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Dor Crônica/terapia , Dor Lombar/terapia , Dor Crônica/fisiopatologia , Humanos , Dor Lombar/fisiopatologia , Movimento , Medição da Dor , Inquéritos e Questionários , Resultado do TratamentoRESUMO
Objetivo: relatar a experiência acerca da estruturação das ações adotadas no enfrentamento a pandemia da Covid-19. Metodologia: estudo descritivo, do tipo relato de experiência, tendo como referência o Método do Arco de Charlez Maguerez. A experiência foi vivenciada por líderes que compõem a equipe de enfrentamento à Covid-19, durante os meses de fevereiro a abril de 2020, em um hospital de médio porte, referência macrorregional de média e alta complexidade do Vale do Jequitinhonha em Minas Gerais. Resultados: descreveu-se a implantação das práticas recomendadas ao combate à disseminação do novo Coronavírus baseadas em cinco eixos a saber: revisão dos fluxos operacionais de serviço, educação na saúde como estratégia de enfrentamento à pandemia, ampliação dos leitos e das equipes para atendimento da Covid-19 e saúde mental dos profissionais durante a pandemia. Considerações Finais: as estratégias adotadas para o enfrentamento da Covid-19 na instituição permitiram que as orientações definidas pela Organização Mundial de Saúde e Ministério da Saúde fossem implementadas de acordo com a realidade local. Enfatiza-se diante da pandemia a relevância da manutenção de contínua atualização técnico científica. (AU)
Objective: to report the experience about the structuring of actions adopted to cope with the Covid-19 pandemic. Method: descriptive study, of experience-report type, taking as a reference the Arch Method, of Charlez Maguerez. The experience was lived by leaders who make up the team to cope with the Covid-19, during the months of February to April 2020, in a medium-sized hospital, macro-regional reference of medium and high complexity in Vale do Jequitinhonha in Minas Gerais. Results: the implementation of best practices to combat the spread of the new Coronavirus was described based on five axes, namely: review of operational flows of service, health education as a strategy to cope with the pandemic, expansion of beds and the team to meet the Covid-19 and mental health professionals during the pandemic. Final Consideratioins: strategies for coping with the Covid-19 in the institution allowed implementing the guidelines set by the World Health Organization and the Ministry of Health in accordance with the local reality. Before the pandemic, the ongoing maintenance of scientific-technical update is extremely relevant. (AU)
Objetivo: reportar la experiencia acerca de la estructuración de las medidas adoptadas para el enfrentamiento de la pandemia de Covid-19. Metodo: estudio descriptivo, del tipo informe de experiencia, tomando como referencia el Método del Arco, de Charlez Maguerez. La experiencia fue vivenciada por los líderes que conforman el equipo para enfrentar el Covid-19, durante los meses de febrero a abril de 2020, en un hospital de tamaño medio, referencia macro-regional de mediana y alta complejidad del Vale do Jequitinhonha en Minas Gerais. Resultados: se describió la aplicación de las mejores prácticas para combatir la propagación del nuevo Coronavirus basada en cinco ejes, a saber: revisión de flujos operacionales de servicio, educación en salud como estrategia para enfrentar la pandemia, la expansión de las camas y el equipo para el atendimiento de la Covid-19 y los profesionales de la salud mental durante la pandemia. Consideraciones Finales: las estrategias para enfrentar la Covid-19 en la institución permitió la implantación de los lineamientos establecidos por la Organización Mundial de la Salud y el Ministerio de Salud en conformidad con la realidad local. Se destaca en el rostro de la pandemia, la pertinencia del mantenimiento permanente de actualización técnica y científica. (AU)
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Infecções por Coronavirus , Riscos Ocupacionais , Técnicas de Planejamento , Prevenção de Doenças , PandemiasRESUMO
OBJETIVO: determinar o perfil sociodemográfico e clínico dos idosos internados em uma instituição filantrópica no interior de Minas Gerais. MÉTODOS: estudo documental, retrospectivo, descritivo, em que foram analisados os prontuários dos idosos internados no período de janeiro a outubro de 2017. O cálculo amostral foi realizado pelo teorema central dos limites, resultando em 400. Na análise de mediana utilizou-se a estatística não paramétrica de Mann-Whitney. Para a análise das variáveis categóricas usou-se o teste qui-quadrado de Pearson. Foi adotado de forma fixa o nível de significância 5%. Quanto aos dados sociodemográficos, 35% dos idosos eram maiores de 80 anos, 52,7% do sexo masculino, 36% casados, 74,8% com comorbidades e 70,9% faziam uso de medicamentos. RESULTADOS: a associação entre comorbidades e uso de medicamentos foi significativa (p=0,0002). Quanto aos dados clínicos, os principais diagnósticos de internação relacionavam-se ao sistema cardiovascular (26,8%), sendo a associação entre o diagnóstico de internação e a evolução clínica significativa (p<0,001). A taxa de reinternação foi de 42,5%. O tempo de permanência prevaleceu entre um e 10 dias (79%) e a evolução clínica para a alta (74,8%) prevaleceu quando se comparou ao óbito (19,8%). A associação entre tempo de permanência e a evolução clínica foi significativa (p=0,005). CONCLUSÃO: este estudo pode gerar implicações positivas para a melhora da qualidade do atendimento dos idosos, uma vez que o perfil sociodemográfico e clínico desses pacientes possibilita a geração de indicadores de saúde, essenciais para a redução do tempo de internação, taxas de morbimortalidade e reinternações.(AU)
Objective: to determine the socio-demographic and clinical profile of the elderly population in a philanthropic institution in the interior of Minas Gerais. Methods: this is a documentary, retrospective, descriptive study, in which the medical records of the older adults hospitalized from January to October 2017 were analyzed. The sample calculation was performed by the central limit theorem, resulting in 400. The nonparametric MannWhitney statistics were used in the median analysis. For the analysis of categorical variables, Pearson's chi-square test was used. The significance level was set at 5%. Regarding the socio-demographic data, 35% of the elderly participants were older than 80 years old, 52.7% were male, 36% were married, 74.8% had comorbidities, and 70.9% were on medication. Results: the association between comorbidities and medication use was significant (p = 0.0002). Regarding clinical data, the main hospitalization diagnoses were related to the cardiovascular system (26.8%), and the association between hospitalization diagnosis and significant clinical evolution (p <0.001). The readmission rate was 42.5%. The length of stay prevailed between one and ten days (79%) and clinical evolution to discharge (74.8%) prevailed when compared to death (19.8%). The association between length of stay and clinical evolution was significant (p = 0.005). Conclusion: this study may have positive implications to improve the quality of care of the elderly population since the socio-demographic and clinical profile of these patients enables the generation...(AU)
Objetivo: determinar el perfil sociodemográfico y clínico de los ancianos internados en una institución filantrópica del interior de Minas Gerais. Método: estudio documental, retrospectivo, descriptivo en el que se analizaron los registros médicos de los ancianos internados entre enero y octubre de 2017. El cálculo de la muestra se realizó mediante el teorema del límite central, cuyo resultado fue 400. En el análisis de la mediana utilizamos las pruebas estadísticas no paramétricas de Mann-Whitney. Para el análisis de variables categóricas se utilizó la prueba chi-cuadrado de Pearson. El nivel de significancia se estableció en 5%. En cuanto a los datos sociodemográficos el 35% de los ancianos era mayor de 80 años; 57,7% eran varones; 36% casados; el 74,8% con comorbilidades y el 70,9% tomaba medicamentos. Resultados: la asociación entre comorbilidades y uso de medicamentos fue significativa (p=0,0002). En cuanto a los datos clínicos, los principales diagnósticos de internación se relacionaron con el sistema cardiovascular (26,8%); la asociación entre el diagnóstico de internación y la evolución clínica fue significativa (p<0,001).La tasa de readmisión fue del 42,5%. La duración de la estancia en el hospital prevaleció entre uno y 10 días (79%) y prevaleció la evolución clínica pera el alta hospitalaria (74,8%) en comparación con el deceso (1,8%). La asociación entre la duración de la estancia en el hospital y la evolución clínica fue significativa (p=0,005). Conclusión: el presente estudio podría tener implicaciones positivas para mejorar la atencion de los ancianos ya que el perfil clínico y sociodemográfico de estos pacientes permite elaborar indicadores de salud esenciales para reducir la duración de la internación, las tasas de morbilidad y mortalidad y los reingresos.(AU)
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Humanos , Idoso , Idoso de 80 Anos ou mais , Assistência a Idosos , Perfil de Saúde , Saúde do Idoso Institucionalizado , Enfermagem Geriátrica , Serviços de Saúde para Idosos , Fatores Socioeconômicos , Estudos RetrospectivosRESUMO
BACKGROUND: Crepitus is a common clinical feature of knee osteoarthritis. However, the importance of crepitus in the overall clinical presentation of individuals with knee osteoarthritis is unknown. OBJECTIVE(S): (A) To compare function, pain and quality of life between individuals with knee osteoarthritis with and without crepitus; (B) to compare whether individuals with knee osteoarthritis in both knees, but crepitus in just one, differ in terms of function pain, and knee strength. METHODS: Setting: Observational study. PARTICIPANTS: (A) A total of 584 participants with crepitus who had the same Kellgren-Lawrence grade on both knees were matched for gender, body mass index and Kellgren-Lawrence grade to participants without crepitus on both knees. (B) 361 participants with crepitus in only one knee and with the same Kellgren-Lawrence grade classification on both knees were included. MAIN OUTCOME MEASURE(S): A - Self-reported function, pain, quality of life, 20-m walk test and chair-stand test. B -Knee extensor and flexor strength, self-reported function and pain. RESULTS: A - Individuals with crepitus had lower self-reported function, quality of life and higher pain compared to those without crepitus (3-11%; small effect=0.17-0.41, respectively). No difference was found in objective function between groups. B - Self-reported function was lower in the limb with crepitus compared to the limb without crepitus (15%; trivial effect=0.09). No difference was found in pain and knee strength between-groups. CONCLUSION(S): Individuals with knee osteoarthritis and knee crepitus have slightly lower self-reported physical function and knee-related quality of life (small or trivial effect). However, the presence of knee crepitus is not associated with objective function or knee strength.
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Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Humanos , Dor/fisiopatologia , Qualidade de Vida , AutorrelatoAssuntos
Dor Crônica/terapia , Terapia por Exercício/métodos , Dor Lombar/terapia , Adulto , Brasil , Dor Crônica/classificação , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Dor Lombar/classificação , Masculino , Pessoa de Meia-Idade , Movimento , Manejo da Dor/métodos , Medição da Dor/métodos , Exame Físico/métodos , Estudos Prospectivos , Método Simples-Cego , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Resultado do TratamentoRESUMO
OBJECTIVE: Low back pain (LBP) is little explored in the aging population especially when considering age-relevant and culturally dependent outcomes. We aimed to describe socio-demographic and clinical characteristics of Brazilian older people with a new episode of LBP presenting to primary care. METHODS: We sourced baseline information on socio-demographic, pain-related and clinical characteristics from 602 older adults from the Brazilian Back Complaints in the Elders (Brazilian BACE) study. We analyzed differences in pain, disability, functional capacity and psychosocial factors between sub-groups based on age (i.e. participants aged 55-74 or ≥75 years), education (i.e. those with four years or less of schooling or those with more than four years of schooling) and income (i.e. participants who reported earning two or less minimal wages or three and more). RESULTS: Participants presented severe LBP (7.18/10, SD: 2.59). Younger participants were slightly more disabled (mean difference 1.29 points, 95% confidence interval [CI]: 0.03/5.56), reporting poorer physical health, and less fall-related self-efficacy (mean difference of 2.41, 95% CI 0.35/4.46). Those less educated, and those with income equal or less than two minimum wages had more disability, pain catastrophizing and worse functional capacity. CONCLUSIONS: This was the first study showing that Brazilian older adults with LBP present high levels of functional disability and psychological distress, especially those with low socioeconomic status.
Assuntos
Dor Lombar/epidemiologia , Idoso , Brasil/epidemiologia , Avaliação da Deficiência , Humanos , Dor Lombar/diagnóstico , Dor Lombar/psicologia , Pessoa de Meia-Idade , Medição da Dor , Atenção Primária à Saúde , Psicologia , Fatores Socioeconômicos , Estresse PsicológicoRESUMO
BACKGROUND: Low back pain (LBP) is a major health and economic problem worldwide. Graded activity and physiotherapy are commonly used interventions for nonspecific low back pain. However, there is currently little evidence to support the use of one intervention over the other in the medium-term. OBJECTIVE: To compare the effectiveness of graded activity exercises to physiotherapy-based exercises at mid-term (three and six months' post intervention) in patients with chronic nonspecific LBP. METHODS: Sixty-six patients were randomly allocated to two groups: graded activity group (n=33) and physiotherapy group (n=33). These patients received individual sessions twice a week for six weeks. Follow-up measurements were taken at three and six months. The main outcome measurements were intensity pain (Pain Numerical Rating Scale) and disability (Rolland Morris Disability Questionnaire). RESULTS: No significant differences between groups after three and six month-follow ups were observed. Both groups showed similar outcomes for pain intensity at three months [between group differences: -0.1 (95% confidence interval [CI]=-1.5 to 1.2)] and six months [0.1 (95% CI=-1.1 to 1.5)], disability at three months was [-0.6 (95% CI=-3.4 to 2.2)] and six months [0.0 (95% CI=-2.9 to 3.0)]. CONCLUSION: The results of this study suggest that graded activity and physiotherapy have similar effects in the medium-term for patients with chronic nonspecific low back pain.
Assuntos
Dor Lombar/terapia , Modalidades de Fisioterapia , Doença Crônica , Exercício Físico , Terapia por Exercício , Seguimentos , Humanos , Resultado do TratamentoRESUMO
Abstract Introduction: Chronic neck pain is associated with significant health costs and loss of productivity at work. Objective: to assess pain and disability in individuals with chronic neck pain. Methods: 31 volunteers with chronic neck pain, mean age 29, 65 years, were assessed using the McGill Pain Questionnaire in Brazilian version (Br-MPQ) and Neck Disability Index (NDI). The Br-MPQ analysis was performed based on the numerical values associated with the words selected to describe the experience of pain (Pain Rating Index - PRI), and present pain intensity (PPI). NDI was used to evaluate the influence of neck pain in performance of everyday tasks. Finally, we investigated the association between PPI and NDI. Results: PRI revealed that the most significant dimension was the sensory pain (70%), and the number of chosen words was 10 (2,62) out of 20 words. Mean PPI value was 1,23 (0,76) in five points; 40% of participants described pain intensity as moderate. NDI score was 9,77 (3,34), indicating mild disability. There was a positive association between disability and pain intensity (r = 0,36; p =0,046). Pain intensity and duration of pain were not associated. Conclusions: Findings of this study identified important information related to neck pain experienced by patients when suffering from chronic neck pain, moreover, the association between disability and pain intensity reinforces the importance of complementary investigation of these aspects to optimize function in them.
Resumo Introdução: A cervicalgia crônica está associada a importantes gastos em saúde e à perda de produtividade no trabalho. Objetivo: Avaliar aspectos de dor e incapacidade de indivíduos com cervicalgia crônica. Métodos: Trinta e um voluntários com cervicalgia crônica, com média de idade de 29, 65 anos, foram avaliados por meio do questionário de dor de McGill em versão brasileira-Br-MPQ (Br-MPQ) e pelo Índice de Incapacidade Relacionada ao Pescoço (NDI). A análise do Br-MPQ foi realizada baseando-se nos valores numéricos associados com as palavras de descrição da experiência da dor (Pain Rating Index - PRI), e na intensidade da dor presente (Present Pain Index - PPI). O NDI foi utilizado para avaliar a interferência da cervicalgia pelos participantes no desempenho de tarefas cotidianas. Finalmente, foi investigada a associação entre o PPI e o NDI. Resultados: A dimensão mais significativa de dor no PRI foi sensorial (70%), e número de descritores escolhidos para descrevê-la foi 10 (2,62) em 20. O valor médio do PPI de 1,23 (0,76) em cinco pontos; 40% dos participantes descreveram a intensidade de dor como moderada. A pontuação do NDI foi de 9,77 (3,34), indicando incapacidade leve. Houve associação positiva entre intensidade de dor e incapacidade (r=0,36; p=0,046); mas não entre intensidade e duração da dor. Conclusão: Os resultados identificaram características importantes diante da experiência de pacientes com cervicalgia crônica e, além disso, a associação entre incapacidade e dor observada reforça a importância da abordagem destes itens de maneira complementar destes fatores para favorecer a funcionalidade destes pacientes.
RESUMO
BACKGROUND: Currently, there is poor evidence of the effect of hydrotherapy alone on patients with hip or knee osteoarthritis. OBJECTIVES: The study aimed to assess the impact of hydrotherapy on pain, function, and muscle function in older women with knee osteoarthritis. METHODS: A randomized controlled trial was conducted to evaluate the efficacy of hydrotherapy in women with knee osteoarthritis. Seventy-three women aged 65 and older were randomized to hydrotherapy (n=36) or a control group (n=37). The hydrotherapy group received the intervention program in a heated pool (twice per week for six weeks) and an educational protocol while the control group received an educational protocol only. Primary outcomes (before and post-treatment) were pain intensity (0-100) and function (0-100), assessed with the WOMAC questionnaire. Secondary outcomes (before and post-treatment) were knee extensor and knee flexor muscle performance (strength, power, and endurance), assessed by an isokinetic dynamometer. The magnitude of change between the groups for the outcomes was calculated using linear regression models adjusted by baseline outcome values. RESULTS: The hydrotherapy group had better outcomes for pain (adjusted mean difference=11 points, 95% CI: 3-18) and function (adjusted mean difference=12 points, 95% CI: 5-18). Patients receiving hydrotherapy had better performance for knee flexor and extensor strength, knee flexor power, and knee extensor endurance. CONCLUSION: Older women with knee osteoarthritis are likely to have benefits from a course of hydrotherapy exercises. Registry of clinical trials (Trial number RBR-8F57KR) - http://www.ensaiosclinicos.gov.br/rg/RBR-8f57kr/.
Assuntos
Terapia por Exercício/métodos , Exercício Físico/fisiologia , Hidroterapia , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Idoso , Feminino , Humanos , Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Inquéritos e QuestionáriosRESUMO
Introdução: Conhecer a satisfação do paciente com os cuidados de enfermagem possibilita ao enfermeiro avaliar e planejar a assistência no sentido de atender às necessidades da clientela atendida. Objetivo: Este trabalho objetivou analisar a satisfação do paciente quanto à assistência de enfermagem hospitalar por meio da dimensão educacional. Método: Trata-se de um estudo descritivo realizado em um hospital privado, filantrópico, com 223 pacientes internados, utilizando o Instrumento de Satisfação do Paciente (ISP). Resultados: Encontrou-se a média de 3,62 no ISP. Para 70,9% dos pacientes, o enfermeiro preocupa-se em explicar sobre a doença; 77,6% discordam de que o enfermeiro faça muitas perguntas sem utilidade; 85,7% relatam que esses profissionais não utilizam uma linguagem simples, uma vez que 83,9% não entendem o que é falado por eles; 83,3% acham que os enfermeiros falam muito rápido; 68,6% gostariam que o enfermeiro desse explicações completas e suficientes acerca da solicitação de exames, e 48%, dos resultados desses. Conclusão: Há necessidade de implementar ações de educação em saúde na instituição hospitalar, melhorar a comunicação entre pacientes e enfermeiros, para, assim, obter resultados benéficos que ajudem no tratamento do paciente e na qualidade assistencial. (AU)
patients. Objective: This study aimed to analyze the patient's satisfaction in the hospital nursing care through educational dimension. Method: This is a descriptive study in a philanthropic hospital. The sample was composed of 223 hospitalized patients using the Patient Satisfaction Instrument (PSI). Results: We found an average of 3.62 at the PSI. To 70.9% of patients, the nurse is concerned to explain the disease, 77.6% disagree that the nurse asks many questions useless, 85.7% reported that professionals do not use simple language, and 83. 9% do not understand that is spoken by nurses, 83.3% feel that nurses speak very fast and 68.6% would like the nurse to give a complete and sufficient explanation of the examination request and 48% of these results. Conclusion: There is the necessity of implementing the activities of health education to improve the communication between patients and nurses to get better outcomes in the patient's care. (AU)
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Satisfação do Paciente , Qualidade da Assistência à Saúde , Educação em Saúde , Educação em Enfermagem , Cuidados de EnfermagemRESUMO
Controlling microbial growth is crucial for many biomedical, pharmaceutical and food industry applications. In this paper, we used a femtosecond laser to microstructure the surface of chitosan, a biocompatible polymer that has been explored for applications ranging from antimicrobial action to drug delivery. The influence of energy density on the features produced on chitosan was investigated by optical and atomic force microscopies. An increase in the hydrophilic character of the chitosan surface was attained upon laser micromachining. Patterned chitosan films were used to observe Staphylococcus aureus (ATCC 25923) biofilm formation, revealing an increase in the biofilm formation in the structured regions. Our results indicate that fs-laser micromachining is an attractive option to pattern biocompatible surfaces, and to investigate basic aspects of the relationship between surface topography and bacterial adhesion.