Accuracy of different handgrip values to identify mobility limitation in older adults

BACKGROUND/OBJECTIVE: Mobility limitation is commonly the first sign of impaired physical function and predisposes older adults to disability. Moreover, recent epidemiological studies have classified neuromuscular strength as the best explanator of mobility limitation. However, existing cutoffs have not been adequately analyzed regarding accuracy. Therefore, our aims were to define and compare the accuracy of different cutoff points of handgrip strength for the identification of mobility limitation. METHODS: Cross-sectional study with 5783 participants from the SABE (Saúde, Bem-Estar e Envelhecimento [Health, Wellbeing and Aging]) and ELSA (English Longitudinal Study of Ageing) cohorts aged 60 years or older. Handgrip strength was measured using a dynamometer. Walking speed <0.8 m/s was considered mobility limitation. Receiver operating characteristic curves and probabilities of presenting mobility limitation were calculated. RESULTS: Handgrip strength <32 kg for men and <21 kg for women demonstrated good diagnostic accuracy for mobility limitation, with 49.1% sensitivity and 79.8% specificity for men and 58.6% sensitivity and 72.9% specificity for women. The fully adjusted models had an area under the curve of 0.82 for men and 0.83 for women, with odds of presenting mobility limitation of 1.88 [95% CI: 1.50 - 2.37] for men and 1.89 [95% CI: 1.57 - 2.27] for women. CONCLUSIONS: The results of this study support the accuracy of handgrip strength as a clinical marker of mobility limitation. Furthermore, manual dynamometry is easily incorporated into clinical practice, has a good cost-benefit, besides being a simple, valid, reliable and effective method for use in both the scientific community and outpatient practice

Brazilian practice guidelines for stroke rehabilitation: Part II

The Brazilian Practice Guidelines for Stroke Rehabilitation – Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke

Amazon forest biomass: intra- and interspecific variability in wood density drive divergences in Brazil’s far north

Wood density (WD) is an important functional trait of tree species. Understanding spatial WD variability as a function of environmental determinants improves our ability to estimate carbon stocks in the woody biomass of tropical forests. However, the role of each environmental variable affecting the intra- and interspecific variability of WD is not entirely clear for most forest ecosystems. In Amazonia there are recurrent uncertainties in estimates of regional woody biomass. The aim of the study was to investigate the effects of environmental conditions on the intra- and interspecific variability of WD for tree assemblages in forests of the northern Brazilian Amazon. A single sample was extracted from each of 680 individuals (108 species, 82 genera, 38 families; stem diameter ≥10 cm) dispersed among 129 plots distributed along a hydro-edaphic gradient. General community-averaged WD (0.703 ± 0.133 g cm-3; range: 0.203 to 1.102 g cm-3) was high in relation to other Amazonian areas because 62% of the species and 69% of the sampled individuals had high WD values (>0.650 g cm-3). Altitude (a proxy for drainage), clay and soil micronutrient content explained 23% of the spatial variation in WD. Partitioning WD variation into species-substitution (turnover) and intraspecific-variation components slightly increased the explanatory power to 26%. The analysis of interspecific variability showed that forests occurring in seasonally flooded areas are characterized by tree assemblages with species tolerant to P-poor soils, where mean WD (0.742 g cm-3) is about 4% higher than the mean (0.713 g cm-3) for tree assemblages on unflooded uplands where soils have less limitations from nutrient poverty. Our results represent an improvement in the estimates of biomass because they promote adjustments (1.4%-16.3%) to the previous estimates of woody biomass in the northern Brazilian Amazon forests considering different environmental conditions

Cristina Peri Rossi. Erotismo, transgresión y exilio: Las voces de Cristina Peri Rossi, Jesús Gómez-de-Tejada (coord.). Sevilla, Editorial Universidad de Sevilla, 2017

Obra ressenyada: Jesús GÓMEZ-DE-TEJADA (coord.), Cristina Peri Rossi. Erotismo, transgresión y exilio: Las voces de Cristina Peri Rossi. Sevilla: Editorial Universidad de Sevilla, 2017