A intervenção fisioterapêutica no ambulatório de cuidado a pessoa com síndrome de Down no Instituto de Medicina Física e Reabilitação HC FMUSP

Down Syndrome (SD) is the most common chromosomopathy in humans. It is known that, if properly stimulated, these people have the potential for full social inclusion. The objective of this study is to show the work done with this population by the Physiotherapy service provided by the multiprofessional team at the Clinic for the Care of Persons with DS at the Institute of Physical Medicine and Rehabilitation at HC FMUSP. This clinic develops therapeutic activities for persons up to 18 years of age. The work is carried out in models, which are subdivided into: a DS General Stimulation Model which serves patients up to three years of age whose objectives are focused on the acquisition of motor marks, essential for neuropsychomotor development; a DS Child Development Model which helps children from four to eleven years of age that focuses on the development of more advanced motor skills, strength, posture, improvement of mobility, balance, and proprioception to optimize cerebellar activity and the consequent enhancement of static and dynamic balance; a DS Adolescent Model for those aged twelve to eighteen; and a DS Adult Model starting at age nineteen aimed at orthopedic and postural restoration in addition to providing health guidance. Physiotherapeutic monitoring is fundamental within the clinic for the care of a person with DS, for it stimulates the motor development of these children, along with the multiprofessional team and the family, respecting their time and favoring their potentials, in addition to acting to educate the family on health so as to prevent problems and promote the health of the person with DS and their nuclear family.A Síndrome de Down (SD) é a cromossosmopatia mais comum do ser humano. Sabe-se que estas pessoas quando estimuladas adequadamente apresentam potencial para uma plena inclusão social. O objetivo deste texto é divulgar o trabalho realizado junto a esta população pelo serviço de Fisioterapia que compõem a equipe multiprofissional do Ambulatório de Cuidado a Pessoa com SD do Instituto de Medicina Física e Reabilitação - HC FMUSP. Tal ambulatório desenvolve atividades terapêuticas com pessoas entre zero e 18 anos de idade. Os trabalhos são realizados em modelos que são subdivididos em: Modelo de Etimulação Global, que atende de zero a três anos cujos os objetivos são voltados a aquisição dos marcos motores, essenciais para o desenvolvimento neuropsicomotor; Modelo de Desenvolvimento Infantil que aborda crianças dos quatro aos onze anos e estão focados no desenvolvimento de habilidades motoras mais avançadas, força, estruturação postural, aprimoramento da motricidade, equilíbrio e propriocepção para otimização da atividade cerebelar e consequente melhora do equilíbrio estático e dinâmico; Modelo Adolescentes Down dos doze aos dezoito anos e Modelo Adulto Down a partir de dezenove anos que visa tratar do reestabelecimento ortopédico e postural, além de fornecer orientações de promoção e prevenção em saúde. O acompanhamento fisioterapêutico é fundamental dentro do ambulatório do cuidado à pessoa com SD pois estimula junto à equipe mustiprofissional e à família, o desenvolvimento motor destas crianças, respeitando o seu tempo e valorizando suas potencialidades, além de atuar como educador em saúde junto á família, com objetivo de prevenção e promoção da saúde da pessoa com SD e seu núcleo familiar

Protocolo de cuidado à saúde da pessoa com Síndrome de Down - IMREA/HCFMUSP

A Síndrome de Down (SD) ou trissomia do cromossomo 21 é a cromossomopatia mais comum no ser humano, acontece independente de sexo, etnia ou classe social. No Brasil, nasce aproximadamente uma criança com SD para cada 700 nascimentos. Sabe-se que as pessoas com síndrome de Down, quando bem atendidas e estimuladas, têm potencial para plena inclusão social. Este protocolo foi elaborado pela equipe multiprofissional de Cuidado à Saúde da Pessoa com síndrome de Down do Instituto de Medicina Física e Reabilitação do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Objetivo: Oferecer orientações para o cuidado à saúde da pessoa com Síndrome de Down, nos diferentes níveis de atenção a saúde, em todo o seu ciclo vital. Método: A elaboração do protocolo de cuidado integral à saúde da pessoa com síndrome de Down baseou-se em buscas no sistema PubMed, SciELO e no Cochrane Database of Systematic Reviews utilizando como palavras chaves: “Down Syndrome” e “Síndrome de Down”; “Trisomy 21”, “Trisomíadel Cromosoma 21” e “Trissomia do Cromossomo 21” e “Growth”, “Desarollo” e “Crescimento”. Resultados: Os artigos revistos foram publicados no período de 1972 a 2011 e limitados às línguas: inglesa, espanhola e portuguesa. Priorizamos revisões sistemáticas e metanálises. Foram incluídos também registros prévios a 1972 considerados históricos. Conclusão: Os dados foram analisados por um grupo de especialistas que discutiu os resultados e elaborou este protocolo.The Down syndrome (DS) or chromosome 21 trisomy is the most common chromosomopathy in human beings, it occurs regardless of gender, ethnicity, or social class. In Brazil, there is approximately one child born with DS for every 700 births. It is known that people with Down syndrome well cared-for and stimulated have potential for full social inclusion. This protocol was prepared by the Down Syndrome Personal Health Care multiprofessional team at the IMREA/HCFMUSP. Objective: Is to offer orientation in the health care of a person with Down Syndrome, in the different levels of attention to health, throughout his/her life. Method: The preparation of the total care protocol for the health of a person with Down syndrome was based on searches in the PubMed and SciELO systems and on the Cochrane Database of Systematic Reviews using the keywords: Down syndrome and Syndrome of Down, Trisomy 21, "Trisomía del Cromosoma 21", Chromosome 21 trisomy, Growth, "Desarollo", and "Crescimento". Results: The articles reviewed were published from 1972 to 2011 and limited to the languages: English, Spanish, and Portuguese. Records previous to 1972 were also included for being considered historical. Conclusion: The data was analyzed by a group of specialists that discussed the results and prepared this protocol

Acidente vascular cerebral crônico: reabilitação

This study revised articles from the MEDLINE (PubMed) databases and other research sources, with no time limit. To do so, the search strategy adopted was based on (P.I.C.O.) structured questions (from the initials "Patient"; "Intervention"; "Control" and "Outcome". As keywords were used: (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism and thrombosis) AND exercise therapy AND upper extremity; (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism and thrombosis) AND restraint induced therapy; stroke AND exercise therapy AND upper extremity; (intracranial arteriosclerosis OR intracranial embolism and thrombosis OR stroke OR cerebrovascular disorders) AND electric stimulation therapy AND upper extremity; (intracranial arteriosclerosis OR intracranial embolism and thrombosis OR stroke OR cerebrovascular disorders) AND (orthotic devices OR splints) AND upper extremity;knowledge of Results OR biofeedback OR electromyography AND stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism and thrombosis AND rehabilitation; stroke AND upper extremity AND functional laterality; stroke AND upper extremity AND robotics AND physical therapy modalities; stroke AND body weight supports treadmill training AND floor walking; stroke AND gait disorders AND (treadmill exercises OR floor walking); stroke AND postural balance AND physical therapy modalities; stroke AND postural balance AND feedback, sensory; (stroke OR hemiplegia) AND gait disorders, neurologic AND orthotic devices; (stroke OR hemiplegia) AND gait disorders, neurologic AND (feedback, sensory OR proprioception). stroke AND (TENS OR transcutaneous electric stimulation); (stroke OR hemiplegic) AND electric stimulation therapy AND muscle spasticity; hemiplegic AND electric stimulation therapy AND spasticity; stroke AND (virtual reality OR wii game); (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism OR thrombosis) AND resistance training AND recovery function; stroke AND biofeedback, psychology AND Electromyography AND gait; (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism and thrombosis) AND biofeedback, psychology AND (gait OR gait disorders, neurologic).Este estudo revisou artigos nas bases de dados do MEDLINE (Pub-Med) e demais fontes de pesquisa, sem limite de tempo. Para tanto, adotou-se a estratégia de busca baseada em perguntas estruturadas na forma (P.I.C.O.) das iniciais: "Paciente"; "Intervençao"; "Controle" e "Outcome". Como descritores utilizaram-se: (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism and thrombosis) AND exercise therapy AND upper extremity; (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism and thrombosis) AND restraint induced therapy; stroke AND exercise therapy AND upper extremity; (intracranial arteriosclerosis OR intracranial embolism and thrombosis OR stroke OR cerebrovascular disorders) AND electric stimulation therapy AND upper extremity; (intracranial arteriosclerosis OR intracranial embolism and thrombosis OR stroke OR cerebrovascular disorders) AND (orthotic devices OR splints) AND upper extremity;knowledge of Results OR biofeedback OR electromyography AND stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism and thrombosis AND rehabilitation; stroke AND upper extremity AND functional laterality; stroke AND upper extremity AND robotics AND physical therapy modalities; stroke AND body weight supports treadmill training AND floor walking; stroke AND gait disorders AND (treadmill exercises OR floor walking); stroke AND postural balance AND physical therapy modalities; stroke AND postural balance AND feedback, sensory; (stroke OR hemiplegia) AND gait disorders, neurologic AND orthotic devices; (stroke OR hemiplegia) AND gait disorders, neurologic AND (feedback, sensory OR proprioception). stroke AND (TENS OR transcutaneous electric stimulation); (stroke OR hemiplegic) AND electric stimulation therapy AND muscle spasticity; hemiplegic AND electric stimulation therapy AND spasticity; stroke AND (virtual reality OR wii game); (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism OR thrombosis) AND resistance training AND recovery function; stroke AND biofeedback, psychology AND Electromyography AND gait; (stroke OR cerebrovascular disorders OR intracranial arteriosclerosis OR intracranial embolism and thrombosis) AND biofeedback, psychology AND (gait OR gait disorders, neurologic)

SEXUALIDADE NA TERCEIRA IDADE À LUZ DA CULTURA BRASILEIRA: REVISÃO INTEGRATIVA

Objective: to analyze sexuality in the elderly in the context of Brazilian culture. Method: this is an integrative review of the literature, carried out in the databases, CINAHL, Cochrane, CUIDEN, LILACS, PubMed, Scopus and in the SciELO virtual library, using the descriptors Sexuality, Aging, Culture, Elderly and Brazil. Results: the final sample consisted of 15 original articles, published in English, Portuguese and Spanish. All presented a level of evidence 4. From the results it was possible to list three thematic axes:The sexuality of the elderly is permeated by myths and prejudices;Sexuality of the elderly is a question of gender; and Unpreparedness of health professionals to address the theme. Conclusion: The study revealed that the perception of Brazilian culture about sexuality in the elderly is permeated by myths and prejudices; that the sexuality of women and elderly men are experiences in different ways in Brazil; and that health professionals are not prepared to address the theme with this clientele.Objetivo: analizar la sexualidad en los ancianos en el contexto de la cultura brasileña. Método: se trata de una revisión integradora de la literatura, realizada en las bases de datos de bibliotecas virtuales CINAHL, Cochrane, CUIDEN, LILACS, PubMed, Scopus y scielo, utilizando los descriptores Sexualidad, Envejecimiento, Cultura, Ancianos y Brasil. Resultados: la muestra final consistió en 15 artículos originales, publicados en inglés, portugués y español. Todos presentaron un nivel de evidencia 4. A partir de los resultados, se pudieron enumerar tres ejes temáticos: La sexualidad de los ancianos está impregnada de mitos y prejuicios; La sexualidad de los ancianos es una cuestión de género; y Falta de preparación de los profesionales de la salud para abordar el tema. Conclusión: El estudio reveló que la percepción de la cultura brasileña sobre la sexualidad en los ancianos está impregnada de mitos y prejuicios; que la sexualidad de las mujeres y los ancianos son experiencias de diferentes maneras en Brasil; y que los profesionales de la salud no están preparados para abordar el tema con esta clientela.Objetivo: analisar a sexualidade na terceira idade no contexto da cultura brasileira. Método: trata-se de uma revisão integrativa da literatura, realizada nas bases de dados CINAHL, Cochrane, CUIDEN, LILACS, PubMed, Scopus e na biblioteca virtual SciELO, utilizando os descritores Sexualidade, Envelhecimento, Cultura, Idoso e Brasil. Resultados: a amostra final foi constituída de 15 artigos originais, publicados em inglês, português e espanhol. Todos apresentaram um nível de evidência 4. A partir dos resultados foi possível elencar três eixos temáticos: A sexualidade dos idosos é permeada por mitos e preconceitos; A sexualidade dos idosos é uma questão de gênero; e Despreparo dos profissionais de saúde para abordar a temática. Conclusão: O estudo revelou que a percepção da cultura brasileira acerca da sexualidade na terceira idade é permeada por mitos e preconceitos; que a sexualidade da mulher e do homem idoso são experiências de maneiras distintas no Brasil; e que os profissionais de saúde não estão preparados para abordar a temática junto a esta clientela

SEXUALIDADE NA TERCEIRA IDADE À LUZ DA CULTURA BRASILEIRA: REVISÃO INTEGRATIVA

Objective: to analyze sexuality in the elderly in the context of Brazilian culture. Method: this is an integrative review of the literature, carried out in the databases, CINAHL, Cochrane, CUIDEN, LILACS, PubMed, Scopus and in the SciELO virtual library, using the descriptors Sexuality, Aging, Culture, Elderly and Brazil. Results: the final sample consisted of 15 original articles, published in English, Portuguese and Spanish. All presented a level of evidence 4. From the results it was possible to list three thematic axes:The sexuality of the elderly is permeated by myths and prejudices;Sexuality of the elderly is a question of gender; and Unpreparedness of health professionals to address the theme. Conclusion: The study revealed that the perception of Brazilian culture about sexuality in the elderly is permeated by myths and prejudices; that the sexuality of women and elderly men are experiences in different ways in Brazil; and that health professionals are not prepared to address the theme with this clientele.Objetivo: analizar la sexualidad en los ancianos en el contexto de la cultura brasileña. Método: se trata de una revisión integradora de la literatura, realizada en las bases de datos de bibliotecas virtuales CINAHL, Cochrane, CUIDEN, LILACS, PubMed, Scopus y scielo, utilizando los descriptores Sexualidad, Envejecimiento, Cultura, Ancianos y Brasil. Resultados: la muestra final consistió en 15 artículos originales, publicados en inglés, portugués y español. Todos presentaron un nivel de evidencia 4. A partir de los resultados, se pudieron enumerar tres ejes temáticos: La sexualidad de los ancianos está impregnada de mitos y prejuicios; La sexualidad de los ancianos es una cuestión de género; y Falta de preparación de los profesionales de la salud para abordar el tema. Conclusión: El estudio reveló que la percepción de la cultura brasileña sobre la sexualidad en los ancianos está impregnada de mitos y prejuicios; que la sexualidad de las mujeres y los ancianos son experiencias de diferentes maneras en Brasil; y que los profesionales de la salud no están preparados para abordar el tema con esta clientela.Objetivo: analisar a sexualidade na terceira idade no contexto da cultura brasileira. Método: trata-se de uma revisão integrativa da literatura, realizada nas bases de dados CINAHL, Cochrane, CUIDEN, LILACS, PubMed, Scopus e na biblioteca virtual SciELO, utilizando os descritores Sexualidade, Envelhecimento, Cultura, Idoso e Brasil. Resultados: a amostra final foi constituída de 15 artigos originais, publicados em inglês, português e espanhol. Todos apresentaram um nível de evidência 4. A partir dos resultados foi possível elencar três eixos temáticos: A sexualidade dos idosos é permeada por mitos e preconceitos; A sexualidade dos idosos é uma questão de gênero; e Despreparo dos profissionais de saúde para abordar a temática. Conclusão: O estudo revelou que a percepção da cultura brasileira acerca da sexualidade na terceira idade é permeada por mitos e preconceitos; que a sexualidade da mulher e do homem idoso são experiências de maneiras distintas no Brasil; e que os profissionais de saúde não estão preparados para abordar a temática junto a esta clientela

The physical activity and the quality of life among brazilian medical students

Objetivo: Avaliamos a associação entre o volume de de atividade física (VAF) realizado em hora de lazere a percepção da qualidade de vida em estudantes de medicina. Nossa hipótese foi que haveria uma associação entre o volume de atividade física em tempo de lazer e os domínios dos questionários de qualidade de vida. Métodos: Os dados foram avaliados a partir de uma amostra de 1350 de estudantes de medicina de 22 escolas brasileiras. As informações dos participantes incluiram respostas dos questionários de qualidade de vida da OMS-versão abreviada (WHOQOL-BREF), um questionário especifico de avaliação de qualidade de vida em estudantes de medicina (VERAS-Q), questões de auto avaliação da qualidade de vida global e no curso e questões sobre atividade física em hora de lazer. Conforme a quantidade de equivalentes metabólicos (METs) dispendido durante a atividade física, os voluntários foram distribuidos em quatro grupos conforme o volume de atividade físca: (a)nenhum V AF; (b)baixo VAF, 540 MET min/sem; (c) VAF moderado, from 541 to 1260 MET min/sem and (d)alto VAF, > 1261 MET min/sem. Resultados: quarenta por cento dos estudantes de medicina relataram nenhum VAF (46,0% das mulheres e 32,3% dos homens). Em contrapartida, 27,2% foram classificados no grupo de alto VAF (21,0% das mulheres e 34,2% dos homens). Encontramos associação positive entre volumes moderados e altos de VAF er melhor percepção da qualidade de vida em todos os questionários avaliados. Para os baixos VAF, essa associação também foi significativa para a maioria dos domínios dos questionários avaliados com excessão do domínio físico(p=0,08) e relações sociais (p=0,26). Conclusão: Houve associação positiva entre o volume de atividade física em tempo de lazer e melhor percepção da qualidade de vida entre os estudantes de medicina. Observamos uma forte relação dose-efeito entre o VAF em tempo de lazer e a percepção da qualidade de vida dos estudantes de medicina tanto homens como mulheresAim: We evaluated the association between the volume of leisure time physical activity (PA) and quality of life (QoL) in medical students. Our hypothesis was that there was a positive association between volume of PA and various domains of perception of QoL. Methods: Data were evaluated from a random sample of 1350 medical students from 22 Brazilian medical schools. Information from participants included the WHO Quality of Life questionnaire-short form (WHOQOL-BREF), a questionnaire specifically designed to evaluate QoL in medical students (VERAS-Q) and questions for both global QoL self-assessment and leisure time PA by a electronic platform on internet. According to the amount of metabolic equivalents (METs) spend during PA, volunteers were divided into four groups, according to the volume of PA: (a) no PA; (b) low PA, 540 MET min/week; (c) moderate PA, from 541 to 1260 MET min/week and (d) high PA, > 1261 MET min/week. Results: Forty per cent of the medical students reported no leisure time PA (46.0% of females and 32.3% of males). In contrast, 27.2% were classified in the group of high PA (21.0% of females and 34.2% of males). We found significant associations between moderate and high levels of PA and better QoL perception for all measurements. For low volumes of PA, this association was also significant for most QoL measurements, with the exceptions of WHOQOL physical health (p=0.08) and social relationships (p=0.26) domains. Conclusion: There was a positive association between volume leisure time PA and better perception of quality of life among medical students. We observed a strong dose-effect relationship between the volume of leisure time PA and QoL in both male and female medical student

Exercise training ameliorates adrenergic control in spontaneously hypertensive rats

The goal of this study was to examine vascular control after sympathetic stimulation by tyramine infusion in hypertensive rats submitted to swimming training. To this end, male rats were assigned to the following groups: sedentary (SN) and trained normotensive (TN), sedentary (SH) and trained hypertensive (TH). Arterial pressure (AP), heart rate (HR), HR variability (HRV), AP variability (APV), and cardiac autonomic function were recorded. Following, infusion of tyramine was administrated. The TN and TH showed a lower resting HR compared with their respective sedentary groups (p < .05). Pressure levels were less in TH than SH (p < .05). The TH showed a higher HRV together with a lower APV in comparison to SH (p < .05). The sympathetic modulation of HRV and APV was lower in TH than in SH (p < .05). Both trained groups presented an increased parasympathetic modulation of HRV compared with their respective sedentary groups (p < .05). The TN and TH groups had a higher vagal effect in comparison with their respective sedentary groups (p < .001). The sympathetic effect was lower in TH than in SH (p < .001). Pressor and HR responses to tyramine in different doses were attenuated in TH (p < .001). Further analysis showed a significant association between infusion of tyramine and normalized LF component of HRV (r = 0.84, p < .001), systolic APV (r = 0.58, p < .001) and diastolic APV (r = 0.49, p < .001). In conclusion, exercise training provokes less pressor response variation by tyramine infusion in hypertensive animals suggesting sympathetic nerve endings adjustments and decrease of the vasoconstrictor effect attenuates injury caused by hypertension improving cardiovascular autonomic dysfunction, which can be associated with sympathetic attenuation

Ecological drivers of sustained enzootic yellow fever virus transmission in Brazil, 2017-2021.

Beginning December 2016, sylvatic yellow fever (YF) outbreaks spread into southeastern Brazil, and Minas Gerais state experienced two sylvatic YF waves (2017 and 2018). Following these massive YF waves, we screened 187 free-living non-human primate (NHPs) carcasses collected throughout the state between January 2019 and June 2021 for YF virus (YFV) using RTqPCR. One sample belonging to a Callithrix, collected in June 2020, was positive for YFV. The viral strain belonged to the same lineage associated with 2017-2018 outbreaks, showing the continued enzootic circulation of YFV in the state. Next, using data from 781 NHPs carcasses collected in 2017-18, we used generalized additive mixed models (GAMMs) to identify the spatiotemporal and host-level drivers of YFV infection and intensity (an estimation of genomic viral load in the liver of infected NHP). Our GAMMs explained 65% and 68% of variation in virus infection and intensity, respectively, and uncovered strong temporal and spatial patterns for YFV infection and intensity. NHP infection was higher in the eastern part of Minas Gerais state, where 2017-2018 outbreaks affecting humans and NHPs were concentrated. The odds of YFV infection were significantly lower in NHPs from urban areas than from urban-rural or rural areas, while infection intensity was significantly lower in NHPs from urban areas or the urban-rural interface relative to rural areas. Both YFV infection and intensity were higher during the warm/rainy season compared to the cold/dry season. The higher YFV intensity in NHPs in warm/rainy periods could be a result of higher exposure to vectors and/or higher virus titers in vectors during this time resulting in the delivery of a higher virus dose and higher viral replication levels within NHPs. Further studies are needed to better test this hypothesis and further compare the dynamics of YFV enzootic cycles between different seasons