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BACKGROUND: Evidence has demonstrated that endurance training (ET) reduces the motor signs of Parkinson's disease (PD). However, there has not been a comprehensive meta-analysis of studies to date. OBJECTIVE: The aim of this study was to compare the effect of ET versus nonactive and active control conditions on motor signs as assessed by either the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) or Movement Disorder Society-UPDRS-III (MDS-UPDRS-III). METHODS: A random-effect meta-analysis model using standardized mean differences (Hedges' g) determined treatment effects. Moderators (e.g., combined endurance and physical therapy training [CEPTT]) and meta-regressors (e.g., number of sessions) were used for sub-analyses. Methodological quality was assessed by the Physiotherapy Evidence Database. RESULTS: Twenty-seven randomized controlled trials (RCTs) met inclusion criteria (1152 participants). ET is effective in decreasing UPDRS-III scores when compared with nonactive and active control conditions (g = - 0.68 and g = - 0.33, respectively). This decrease was greater (within- and between-groups average of - 8.0 and - 6.8 point reduction on UPDRS-III scores, respectively) than the moderate range of clinically important changes to UPDRS-III scores (- 4.5 to - 6.7 points) suggested for PD. Although considerable heterogeneity was observed between RCTs (I2 = 74%), some moderators that increased the effect of ET on motor signs decreased the heterogeneity of the analyses, such as CEPTT (I2 = 21%), intensity based on treadmill speed (I2 = 0%), self-perceived exertion rate (I2 = 33%), and studies composed of individuals with PD and freezing of gait (I2 = 0%). Meta-regression did not produce significant relationships between ET dosage and UPDRS-III scores. CONCLUSIONS: ET is effective in decreasing UPDRS-III scores. Questions remain about the dose-response relationship between ET and reduction in motor signs.

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BACKGROUND: Deficits in the cerebellar locomotor region (CLR) have been associated with loss of gait automaticity in individuals with freezing of gait in Parkinson's disease (freezers); however, exercise interventions that restore gait automaticity in freezers are lacking. We evaluated the effects of the adapted resistance training with instability ([ARTI] complex exercises) compared with traditional motor rehabilitation (without complex exercises) on gait automaticity and attentional set-shifting. We also verified associations between gait automaticity change and CLR activation change previously published. METHODS: Freezers were randomized either to the experimental group (ARTI, n = 17) or to the active control group (traditional motor rehabilitation, n = 15). Both training groups performed exercises 3 times a week for 12 weeks. Gait automaticity (dual-task and dual-task cost [DTC] on gait speed and stride length), single-task gait speed and stride length, attentional set-shifting (time between Trail Making Test parts B and A), and CLR activation during a functional magnetic resonance imaging protocol of simulated step initiation task were evaluated before and after interventions. RESULTS: Both training groups improved gait parameters in single task (P < 0.05), but ARTI was more effective than traditional motor rehabilitation in improving DTC on gait speed, DTC on stride length, dual-task stride length, and CLR activation (P < 0.05). Changes in CLR activation were associated with changes in DTC on stride length (r = 0.68, P = 0.002) following ARTI. Only ARTI improved attentional set-shifting at posttraining (P < 0.05). CONCLUSIONS: ARTI restores gait automaticity and improves attentional set-shifting in freezers attributed to the usage of exercises with high motor complexity. © 2020 International Parkinson and Movement Disorder Society.

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RESUMO O presente estudo teve como objetivo analisar as práticas de atenção à saúde desenvolvidas por Agentes Comunitários de Saúde (ACS), no âmbito da visita domiciliar, com famílias atendidas pela Estratégia Saúde da Família (ESF), no município de Montes Claros (MG). Estudos no campo da promoção da saúde vêm indicando que tais práticas podem assumir, por vezes, posturas mais prescritivas, disciplinares, culpabilizantes, normativas, voltadas mais diretamente para a mudança comportamental do indivíduo, ou, de forma distinta, podem ser mais dialógicas e interativas na relação com as famílias atendidas, pautadas em uma concepção de atenção integral em saúde. O presente estudo analisou as práticas dos ACS com o objetivo de compreender como eles vêm abordando aspectos da vida privada e da dimensão pública do processo em saúde e quais as distintas posturas que adotam nas interações com as famílias. Foram realizadas entrevistas semiestruturadas com usuários da ESF e ACS de três equipes, e observadas 20 visitas domiciliares realizadas pelos ACS no ano de 2013. Concluiu-se que as práticas dos ACS assumem, por vezes, características que apontam para a imposição de um saber-poder biomédico e, por outras, que consideram aspectos da subjetividade do indivíduo/comunidade.

ABSTRACT The present study aimed at analyzing the health care practices developed by Community Health Workers, within the scope of the home visit, with families assisted by the Family Health Strategy (FHS), in the municipality of Montes Claros (MG). Studies in the field of health promotion have indicated that such practices may, sometimes, assume more prescriptive, disciplinary, guilty-apportioning, normative attitudes, aimed more directly at the behavioral change of the individual, or, in a different way, may be more dialogic and interactive in relation with families assisted, based on a concept of integral health care. The study analyzed the practices of the CHW in order to understand how they have been addressing aspects of private life and the public dimension of the health process and what different postures they adopt in interactions with families. Semi-structured interviews were carried out with users of FHS and CHW from three teams, and 20 home visits conducted by CHW were observed in the year 2013. It was concluded that the practices of CHW, sometimes, assume characteristics that point to the imposition of a biomedical know-power and, on the other hand, that they consider aspects of the subjectivity of the individual/community.

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Care teams are formed by physicians of different specialties who take care of the same patient. Hence, if we find physicians that share patients with each other probably they configure an informal care team. Thus, the objective of this work is to explore the possibility of finding care teams using Social Network Analysis techniques in physician-physician networks where the physicians have patients in common. For this, we used healthcare insurance claims to build the network. There was the agreement on the metrics of degree and eigenvalue and of betweenness and closeness, also physicians with the 5 highest eigenvalues are highly interconnected. We discuss that the analysis of the physician-physician network with metrics of centrality is promising to reveal informal care teams. The high potential in calculating these metrics is verified from the results to evaluate member's performance and with that how to take actions to improve the work of the team.

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O objetivo é analisar os relacionamentos entre médicos que possuem pacientes em comum a partir de sinistros de seguradora de saúde. Utilizou-se a técnica de analítica de grafos para modelar os relacionamentos e foram calculadas métricas de centralidades para encontrar a importância relativa dos médicos. Houve a concordância das métricas de grau e auto valor e de betweenness e closeness (10% a 15% no top 100 médicos). Além disso, os 5 médicos com maior valor na métrica de auto valor estão altamente conectados entre si. Conclui-se que as métricas captaram o relacionamento entre os médicos desta comunidade que coincidem com a literatura indicando que é possível encontrar médicos que colaboram entre si no cuidado do paciente dentro e fora do hospital. Além disso, os médicos de maior auto valor indicam que são referência para outros médicos e médicos que estão conectados com muitos outros sugerem que estes influenciam nas decisões de seus pacientes.

The aim of this work is to analyze the relationship between physicians from a health insurance company,who attend the same patient. We use graph analytics to model the physician's relationship. Centrality metrics were calculated to find the relative importance of the physicians. There was the agreement on the metrics of degree and eingenvalue and of betweenness and closeness (10% to 15% in the top 100 physicians). In addition, physicians with5 highest eigenvalue in the metric are highly interconnected. We conclude that the metrics captured the relations hipbetween the physicians in this community that coincide with the literature, indicating that we can find physicians who collaborate on patient care within and outside the hospital. In addition, physicians with largest eigenvalue indicate thatthey are reference to other physicians, and physicians who are connected to many others, suggest, that they influence their patients' decisions.

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