9 research outputs found
Health surveillance and agribusiness: the impact of pesticides on health and the environment. Danger ahead!
ANALYSIS OF FUNCTIONAL CAPACITY IN INDIVIDUALS WITH AND WITHOUT CHRONIC LOWER BACK PAIN
TILT TRAINING COMO TRATAMENTO DA SÍNCOPE
Objetivos: O objetivo desse estudo foi realizar uma revisão sistemática para avaliar a efetividade do Tilt Training como tratamento da Síncope Neurocardiogênica. Métodos: A pesquisa foi realizada nos bancos de dados virtuais Medline, Lilacs e Cochrane, acessados via Bireme e Pubmed, utilizando os seguintes palavras- chave: Neurocardiogenic Syncope and Tilt Training. Foram inclusos apenas artigos com estudos intervencionais em pacientes portadores de Síncope Neurocardiogênica, diagnosticados por meio do Tilt Test, independentemente do protocolo utilizado, escritos em língua portuguesa, inglesa e espanhola e que versavam sobre o tratamento com Tilt Training, associado ou não a orientações, podendo ser comparativo ou não a terapias farmacológicas em pessoas de qualquer sexo e idade. Resultados: Foram encontrados pelo sistema de busca trinta e três artigos, dos quais treze preencheram os critérios de inclusão, pois cinco eram escritos em outras línguas, que não as citadas, treze eram revisões bibliográficas, um encontravase em andamento e não disponibilizava o resumo e um não tratava de Tilt Training. Dos artigos que foram incluídos na amostra, oito puderam ser classificados como Estudos clínicos não controlados, dois Ensaios clínicos aleatórios, dois Relatos de casos e um Estudo quase experimental. Conclusão: Pode-se concluir pelos artigos analisados que o Tilt Training tem-se mostrado eficaz no tratamento da Síncope Neurocardiogênica, porém é necessária a realização de novos ensaios clínicos aleatórios, para que se possa ter uma comprovação metodológica
ANALYSIS OF FUNCTIONAL CAPACITY IN INDIVIDUALS WITH AND WITHOUT CHRONIC LOWER BACK PAIN
<div><p>ABSTRACT Objective: The objective of this study was to analyze the functional status of adult and older adult individuals with lower back pain . Methods: Eighty-three individuals were recruited, 42 older adults (20 with lower back pain and 22 control group) and 41 younger adults (21 with lower back pain and 20 control group). Functional capacity was assessed using the following tests: Timed Up and Go (TUG), Five Times Sit-to-Stand (FTSTS), six-minute walking test (SMWT), and sitting-rising test (SRT) . Results: In the younger adults, there was no difference in functional capacity between the groups (p>0.05). On the other hand, when statistical analysis was adjusted using body mass index (BMI) as a covariate, the lower back pain group performed more poorly on the SRT (p<0.004). Furthermore, poorer physical capacity was seen in the older adults with back pain via the SRT test (p=0.001), and when the BMI was adjusted, a statistical difference was seen in the SRT as well as the SMWT (p<0.05) . Conclusion: Older individuals with lower back pain have poorer physical performance, and the sitting-rising test is the most discerning for assessment of functional status in individuals with lower back pain. Level of Evidence III, Retrospective Comparative Study.</p></div
Effect of lung recruitment and titrated Positive End-Expiratory Pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome - A randomized clinical trial
IMPORTANCE: The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. OBJECTIVE: To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS. INTERVENTIONS: An experimental strategy with a lung recruitment maneuver and PEEP titration according to the best respiratory-system compliance (n = 501; experimental group) or a control strategy of low PEEP (n = 509). All patients received volume-assist control mode until weaning. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality until 28 days. Secondary outcomes were length of ICU and hospital stay; ventilator-free days through day 28; pneumothorax requiring drainage within 7 days; barotrauma within 7 days; and ICU, in-hospital, and 6-month mortality. RESULTS: A total of 1010 patients (37.5% female; mean [SD] age, 50.9 [17.4] years) were enrolled and followed up. At 28 days, 277 of 501 patients (55.3%) in the experimental group and 251 of 509 patients (49.3%) in the control group had died (hazard ratio [HR], 1.20; 95% CI, 1.01 to 1.42; P = .041). Compared with the control group, the experimental group strategy increased 6-month mortality (65.3% vs 59.9%; HR, 1.18; 95% CI, 1.01 to 1.38; P = .04), decreased the number of mean ventilator-free days (5.3 vs 6.4; difference, −1.1; 95% CI, −2.1 to −0.1; P = .03), increased the risk of pneumothorax requiring drainage (3.2% vs 1.2%; difference, 2.0%; 95% CI, 0.0% to 4.0%; P = .03), and the risk of barotrauma (5.6% vs 1.6%; difference, 4.0%; 95% CI, 1.5% to 6.5%; P = .001). There were no significant differences in the length of ICU stay, length of hospital stay, ICU mortality, and in-hospital mortality. CONCLUSIONS AND RELEVANCE: In patients with moderate to severe ARDS, a strategy with lung recruitment and titrated PEEP compared with low PEEP increased 28-day all-cause mortality. These findings do not support the routine use of lung recruitment maneuver and PEEP titration in these patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01374022