ESTIMATED MUSCLE FORCES ANALYZES DURING CONCENTRIC-ECCENTRIC SHOULDER EXTERNAL AND INTERNAL ROTATION

The purpose of this study was to analyze the muscle force production during eccentric/concentric shoulder internal and external rotation with 90° of abduction. Six male subjects performed five repetitions of maximal concentric and eccentric contractions rotation without interval, with a mean angular speed of 60°/sec. A biomechanical model was implemented to estimate muscle force and moment. Infraspinatus, supraspinatus and teres minor presented the larger peak moment values during external rotation (concentric and eccentric). Subscapularis, pectoralis major and teres minor presented the larger peak moment values during internal rotation (concentric and eccentric). The eccentric contraction allowed larger peak muscle forces and moments and the correspondent angles were altered, if compared to concentric conditions. The results presented are useful as guidelines for shoulder rehabilitation programs

Using a collaborative robot to the upper limb rehabilitation

Rehabilitation is a relevant process for the recovery from dysfunctions and improves the realization of patient's Activities of Daily Living (ADLs). Robotic systems are considered an important field within the development of physical rehabilitation, thus allowing the collection of several data, besides performing exercises with intensity and repeatedly. This paper addresses the use of a collaborative robot applied in the rehabilitation field to help the physiotherapy of upper limb of patients, specifically shoulder. To perform the movements with any patient the system must learn to behave to each of them. In this sense, the Reinforcement Learning (RL) algorithm makes the system robust and independent of the path of motion. To test this approach, it is proposed a simulation with a UR3 robot implemented in V-REP platform. The main control variable is the resistance force that the robot is able to do against the movement performed by the human arm.info:eu-repo/semantics/publishedVersio

Análise por dinâmica inversa, um complemento da avaliação fisioterapêutica do ombro

O objetivo do estudo é caracterizar as forças em atuação na articulação do ombro durante o movimento de elevação do membro superior no plano escapular por meio do método de dinâmica inversa, aqui sugerido como um meio complementar da avaliação fisioterapêutica. Esse método permite determinar os picos de momento proximal resultante (MPR) e da força proximal resultante (FPR) do ombro durante o movimento, possibilitando assim a avaliação objetiva das cargas impostas à articulação. Participaram do estudo 21 indivíduos do sexo masculino, cuja movimentação do ombro foi analisada por videogrametria em três diferentes situações de carga: sem carga, com peso livre e com resistência elástica. Um modelo matemático tridimensional foi utilizado para o cálculo do MPR e da FPR, permitindo caracterizar a evolução dessas variáveis ao longo da elevação do membro superior nas três situações de carga nos eixos póstero-anterior, caudal-cranial e médio-lateral, determinando seus respectivos picos. O método da dinâmica inversa revelou-se capaz de fornecer informações objetivas sobre as cargas impostas à articulação do ombro nas diversas amplitudes e situações de carga do movimento estudado, podendo tais informações servir como uma base concreta no planejamento de um programa de reabilitação do ombro.The purpose of this study was to describe forces acting on the shoulder joint during upper limb elevation at the scapular plane by means of the inverse dynamics method, here suggested as a complementary means of physiotherapeutic assessment of the shoulder. The method allows for determining proximal net moment (PNM) and proximal net force (PNF) peaks during movements, hence providing an objective assessment of loads on the joint. Twenty-one male subjects were studied, their shoulder movements being analysed by videogrammetry in three load situations: with and without load, and with elastic resistance. A three-dimensional mathematic model was used to calculate PNM and PNF peak values, as well as to describe their evolution during movement along the anterior-posterior, superior-inferior, and lateral-medial axes. The inverse dynamics method was thus shown to provide objective information on the loads which shoulder joint is submitted to at the diverse ranges of motion and load situations during arm elevation; such information may be taken as a factual basis for planning shoulder rehabilitation programs

Exploring factors influencing low back pain in people with non-dysvascular lower limb amputation: a national survey

Background: Chronic low back pain (LBP) is a common musculoskeletal impairment in people with lower limb amputation. Given the multifactorial nature of LBP, exploring the factors influencing the presence and intensity of LBP is warranted. Objective: To investigate which physical, personal, and amputee-specific factors predicted presence and intensity of low back pain (LBP) in persons with non-dysvascular transfemoral (TFA) and transtibial amputation (TTA). Design: A retrospective cross-sectional survey. Setting: A national random sample of people with non-dysvascular TFA and TTA. Participants: Participants (N = 526) with unilateral TFA and TTA due to non-dysvascular aetiology (i.e. trauma, tumours, and congenital causes) and a minimum prosthesis usage of one year since amputation were invited to participate in the survey. The data from 208 participants (43.4% response rate) were used for multivariate regression analysis Methods (Independent variables): Personal (i.e. age, body mass, gender, work status, and presence of comorbid conditions), amputee-specific (i.e. level of amputation, years of prosthesis use, presence of phantom limb pain, residual limb problems, and non-amputated limb pain), and physical factors (i.e. pain provoking postures including standing, bending, lifting, walking,sitting, sit-to stand, and climbing stairs). Main outcome measures (Dependent variables): LBP presence and intensity. Results: A multivariate logistic regression model showed that the presence of two or more comorbid conditions (prevalence odds ratio (POR) = 4.34, p = .01), residual limb problems (POR 22 = 3.76, p<.01), and phantom limb pain (POR = 2.46, p = .01) influenced the presence of LBP. Given the high LBP prevalence (63%) in the study, there is a tendency for overestimation of PORand the results must be interpreted with caution. In those with LBP, the presence of residual limb problems (beta = 0.21, p = .01), and experiencing LBP symptoms during sit-to-stand task (beta = 0.22, p = .03) were positively associated with LBP intensity, while being employed demonstrated a negative association (beta = - 0.18, p = .03) in the multivariate linear regression model. Conclusions: Rehabilitation professionals should be cognisant of the influence that comorbid conditions, residual limb problems, and phantom pain have on the presence of LBP in people with non-dysvascular lower limb amputation. Further prospective studies could investigate the underlying causal mechanisms of LBP

Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI

Edentulism in Brazil: trends, projections and expectations until 2040

Abstract The aim of this study was to examine the edentulism rates in Brazil and make projections for the next years. Data were collected from three national oral health surveys. The percentage of edentulous jaws was calculated. Projections were made for the years 2020, 2030 and 2040, assuming that edentulism follows a logistic function. Population projections were also performed. Annual change in proportion of edentulous jaws was -0.04% for teenagers, -0.96% for adults and 0.76% for the elderly. By 2040, edentulous jaws will be virtually zero among teenagers, 1.77% among adults and 85.96% among the elderly. Teenagers will slightly decrease in number; adults will increase and subsequently decrease; the elderly will continue to increase. In teenagers and adults, the number of edentulous jaws will decrease, being approximately 616,000 in 2040. In the elderly, it will increase alarmingly, reaching over 64 million in 2040. Edentulism is declining in Brazil among teenagers and middle-aged adults, but is still increasing and will continue to increase for the next decades among the elderly

(Des)vinculações de Planos Municipais de Educação metropolitanos com outros instrumentos de gestão local da educação

Resumo É possível afirmar que são poucos os estudos sobre os Planos Municipais de Educação (PMEs) aprovados no Brasil ao longo do período de vigência do PNE 2001-2010, especialmente os relativos às Regiões Metropolitanas (RMs), cuja necessidade de conhecimento se torna mais evidente em face dos desafios postos pelo PNE 2014-2024 à reformulação desses planos locais. Assim, o presente artigo visa à análise das vinculações previstas em PMEs em relação a outros instrumentos de gestão local da educação, tomando por base empírica os planos pertencentes a dez municípios da RM do estado do Rio de Janeiro, aprovados no período 2001-2012, com vistas ao delineamento de eventuais problemas internos, também relacionados ao planejamento em escala metropolitana. Trata-se de um estudo de caráter exploratório, metodologicamente ancorado na análise de conteúdo de documentos legislativos, cujas conclusões mais gerais apontam, de um lado, nítidas desvinculações em relação ao conjunto de instrumentos de gestão considerados nas análises, e, de outro, ausência de um enfoque regional-metropolitano nesses mesmos planos. Evidencia, ainda, que essas desarticulações locais e regionais constituem importantes reptos a serem superados com vistas à adequação desses planos ao novo PNE, postulando que tais enlaces são passíveis de previsão a partir da compreensão de que um plano de educação não constitui um instrumento independente e suficiente de gestão e, embora se afigure numa espécie de registro de coordenação e sistematização das decisões previstas para a condução das políticas educacionais no município, é parte integrante dessas mesmas políticas e não estranho a elas

Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51–12·1) deaths (19·2% [16·9–21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12–9·31) deaths (15·4% [14·6–16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253–350) DALYs (11·6% [10·3–13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0–9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10–24 years, alcohol use for those aged 25–49 years, and high systolic blood pressure for those aged 50–74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public

Sex Differences in Revascularization, Treatment Goals, and Outcomes of Patients With Chronic Coronary Disease: Insights From the ISCHEMIA Trial

Background: Women with chronic coronary disease are generally older than men and have more comorbidities but less atherosclerosis. We explored sex differences in revascularization, guideline-directed medical therapy, and outcomes among patients with chronic coronary disease with ischemia on stress testing, with and without invasive management. Methods and results: The ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial randomized patients with moderate or severe ischemia to invasive management with angiography, revascularization, and guideline-directed medical therapy, or initial conservative management with guideline-directed medical therapy alone. We evaluated the primary outcome (cardiovascular death, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest) and other end points, by sex, in 1168 (22.6%) women and 4011 (77.4%) men. Invasive group catheterization rates were similar, with less revascularization among women (73.4% of invasive-assigned women revascularized versus 81.2% of invasive-assigned men; P<0.001). Women had less coronary artery disease: multivessel in 60.0% of invasive-assigned women and 74.8% of invasive-assigned men, and no ≥50% stenosis in 12.3% versus 4.5% (P<0.001). In the conservative group, 4-year catheterization rates were 26.3% of women versus 25.6% of men (P=0.72). Guideline-directed medical therapy use was lower among women with fewer risk factor goals attained. There were no sex differences in the primary outcome (adjusted hazard ratio [HR] for women versus men, 0.93 [95% CI, 0.77-1.13]; P=0.47) or the major secondary outcome of cardiovascular death/myocardial infarction (adjusted HR, 0.93 [95% CI, 0.76-1.14]; P=0.49), with no significant sex-by-treatment-group interactions. Conclusions: Women had less extensive coronary artery disease and, therefore, lower revascularization rates in the invasive group. Despite lower risk factor goal attainment, women with chronic coronary disease experienced similar risk-adjusted outcomes to men in the ISCHEMIA trial. Registration: URL: http://wwwclinicaltrials.gov. Unique identifier: NCT01471522