Variabilidade na coordenação motora: uma abordagem centrada no delineamento gemelar

O propósito deste estudo foi estimar a contribuição dos fatores genéticos e ambientais na variabilidade do desempenho interindividual na coordenação motora. A amostra foi constituída por 64 pares de gêmeos portugueses, com idades entre cinco e 14 anos. Avaliou-se o desempenho da coordenação através das quatro provas da bateria KTK: equilíbrio à retaguarda (ER); saltos monopedais (SM); transposição lateral (TL); saltos laterais (SL). Calculou-se o coeficiente de correlação intraclasse (t), sendo estimada a contribuição dos fatores genéticos (a²), ambientais comuns (c²) e únicos (e²). Os resultados mostram valores de t mais elevados entre gêmeos monozigóticos, sugerindo presença de fatores genéticos. Entretanto, estimativas de a² foram baixas, variando entre 15% (TL) e 41% (SM), enquanto para c² situaram-se entre 46% (SL) e 58% (TL), e para e² entre 11% (SM) e 28% (TL). Conclui-se que fatores ambientais são responsáveis pela maior parcela de influência na variabilidade do desempenho na coordenação motora.El objetivo del presente estudio fue estimar la contribución de los factores genéticos y ambientales en la vEl objetivo del presente estudio fue estimar la contribución de los factores genéticos y ambientales en la variabilidad del desempeño interindividual en la coordinación motora. La muestra fue constituida por 64 pares de gemelos portugueses, con edades entre 5 y 14 años. Se evaluó el desempeño de la coordinación a través de las cuatro pruebas de la batería KTK: equilibrio a la retaguardia (ER); saltos monopedales (SM); transposición lateral (TL); saltos laterales (SL). Se calculó el coeficiente intraclase (t), siendo estimada la contribución de los factores genéticos (a²), ambientales comunes (c²) y únicos (e²). Los resultados muestran valores t mas elevados entre gemelos monocigóticos, sugiriendo la presencia de factores genéticos. Por otro lado, estimaciones de a² fueron bajas, variando entre 15% (TL) y 41% (SM), mientras para c² se sitúan entre 46% (SL) y 58% (TL), y para e² entre 11% (SM) y 28% (TL). Se concluye que factores ambientales son responsables por la mayor porción de influencia de la variabilidad del desempeño en la coordinación motora.The purpose of this study was to estimate the contribution of environmental and genetic factors on the variability of interindividual performance in motor coordination. Sample comprised 64 twin pairs, aged 5 to 14 years old, from Portugal. Motor coordination was evaluated by KTK battery: backward balance (ER); hopping on one leg (SM); shifting platforms (TL); jumping sideways (SL). Intraclass correlation coefficient (t) was calculated. Contributions of genetic (a²), shared (c²) and unique environmental (e²) factors were estimated. Our results showed t values higher in monozygotic twins, suggesting the presence of genetic factors. Nevertheless, a² estimates were low, ranging from 15% (TL) to 41% (SM), while to common environment (c²) ranged from 46% (SL) to 58% (TL), and unique effects ranged from 11% (SM) to 28% (TL). These results suggest that environmental factors are responsible for the greatest part of influence on variability of interindividual performance in motor coordination tests

Inheritance of quantitative expression of erythrocyte glucose-6-phosphate dehydrogenase activity in the Negro—a twin study

Studies have been conducted on eight sets of monozygous and nine sets of dizygous female Negro twins, both members of whom were heterozygous for G-6-PD deficiency. Twins were studied both by assay of erythrocytic G-6-PD activity and by the methemoglobin elution test (MET). The MET is a procedure which identifies histochemically cells with appreciable G-6-PD activity and permits accurate determination of the percentage of such cells in heterozygotes. Monozygous twins showed significantly less “within-pair” variation than dizygous twins with both the MET and G-6-PD assay.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44115/1/10528_2004_Article_BF00487735.pd

Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury

BackgroundWe aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators.MethodsA preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool.ResultsThe expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N=24, 48%) and neurosurgeons (N=7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N=49, 98%) and indicated routine measurement in registries (N=41, 82%), benchmarking (N=42, 84%), and quality improvement programs (N=41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N=48, 98%).ConclusionsThis Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future