Presbyvestibulopathy, Comorbidities, and Perception of Disability: A Cross-Sectional Study

Objective: To assess the perception of disability in patients with presbyvestibulopathy and to determine the factors (demographic, balance test scores, and comorbidities) that determine higher levels of disability. Material and Methods: This was a cross-sectional study conducted in a tertiary university hospital. There were 103 patients who fulfilled the diagnostic criteria for presbyvestibulopathy and were included. Dizziness Handicap Inventory (DHI) score was the main variable used to quantify disability. Influence on DHI score, sex, age, time of evolution, equilibriometric parameters (posturographic scores and timed up and go test), history of falls, comorbidities (high blood pressure, diabetes, and dyslipidemia), psychotropic drug use, tobacco or alcohol use, living environment (urban or rural), and active lifestyle were analyzed. Results: Most of the DHI scores showed a moderate (46 patients, 44.7%) or severe (39 participants, 37.9%) handicap. DHI scores were higher in women (59.8 vs. 36.1, p < 0.001), patients with obesity (58.92 vs. 48.68; p = 0.019), benzodiazepine (59.9 vs. 49.1, p = 0.008) or other psychotropic drug (60.7 vs. 49.2, p = 0.017) users, and fallers (57.1 vs. 47.3, p = 0.048). There was also a significant positive correlation between DHI score, time (Rho coefficient: 0.371, p < 0.001), and steps (Rho coefficient: 0.284, p = 0.004) used in the TUG and with the short FES-I questionnaire (a shortened version of the Falls Efficacy Scale-International) score (Rho coefficient: 0.695, p < 0.001). DHI scores were lower in alcohol consumers than in non-drinkers (46.6 vs. 56, p = 0.048). No significant correlation was found between DHI scores and age, time of evolution, posturographic scores, comorbidities, environment (rural or urban), or active lifestyle. Conclusion: Most patients with presbyvestibulopathy show an important subjective perception of disability in relation to their symptoms. This perception is substantially higher in women than in men. The most influential factors are difficulties in walking, fear of falling, and obesity. Unique Identifier: NCT03034655, www.clinicaltrials.gov

Modified Timed Up and Go Test for Tendency to Fall and Balance Assessment in Elderly Patients With Gait Instability

Objective: To compare the results from the modified Timed Up and Go Test (TUG) with posturographic variables, the subjective perception of disability due to gait instability, and the number of falls in a sample of the elderly population with imbalance, to confirm that the TUG Test is a useful clinical instrument to assess the tendency to fall in individuals of this age group. Materials and Methods: Cross-sectional study conducted in a tertiary university hospital, in 174 people aged 65 years or older with gait instability. Modified TUG Test was performed; time, step count and the need for support during the test were the analyzed variables. They were compared with the number of falls, Computerized Dynamic Posturography scores, and questionnaires scores (Dizziness Handicap Inventory and a shortened version of the Falls Efficacy Scale-International). Results: The average time to complete the TUG Test was 21.24 +/- 8.18 s, and the average step count was 27.36 +/- 7.93. One hundred two patients (58.6%) required no support to complete the test, whereas the other 72 (41.4%) used supports. The time taken to complete the Test was significantly related with having or not having fallen in the previous year, with the scores of the questionnaires, and with various parameters of dynamic posturography. A higher percentage of patients who took more than 15 s had fallen in the previous year than those who took up to 15 s to complete the test [P = 0.012; OR = 2.378; 95% CI (1.183, 4.780)]. No significant correlation was found between the step count and the number of falls in the previous year, with falling during the test or not, or with being a single or a frequent faller. No relation was found between the need for supports and the number of falls, with having or not having fallen in the previous year, or with being a single or frequent faller. Conclusion: The modified TUG Test is in relation with the presence or absence of falls. Time is the essential parameter for analyzing the risk of falling and the 15-s threshold is a good value to differentiate elderly patients at high risk of falling. Unique Identifier: NCT03034655, www.clinicaltrials.gov

The Modified Dynamic Gait Index and Limits of Stability in Myotonic Dystrophy Type 1

INTRODUCTION: The purpose of this study was to describe and compare the performance of balance and walking tests in relation to self-reported fall history in adults with myotonic dystrophy type 1 (DM1). METHODS: Twenty-two (13 male) participants with DM1 completed, a 6-month fall history questionnaire, the modified Dynamic Gait Index (mDGI), limits of stability (LoS) testing, and 10-m walking tests. RESULTS: Mean (SD) falls in 6 months was 3.7 (3.1), and 19 (86%) participants reported at least 1 fall. Significant differences in mDGI scores (P = 0.006) and 10-m fast walking gait velocity (P = 0.02) were found between those who had been classified as fallers and those who had been classified as nonfallers. Significant correlations were found between mDGI scores and 10-m walking time. DISCUSSION: Falls are common in DM1, and the mDGI may have potential to distinguish fallers from nonfallers, whereas the LoS failed to detect such impairment. Future studies should further explore use of the mDGI in DM1

Biogenesis and functions of bacterial S-layers.

The outer surface of many archaea and bacteria is coated with a proteinaceous surface layer (known as an S-layer), which is formed by the self-assembly of monomeric proteins into a regularly spaced, two-dimensional array. Bacteria possess dedicated pathways for the secretion and anchoring of the S-layer to the cell wall, and some Gram-positive species have large S-layer-associated gene families. S-layers have important roles in growth and survival, and their many functions include the maintenance of cell integrity, enzyme display and, in pathogens and commensals, interaction with the host and its immune system. In this Review, we discuss our current knowledge of S-layer and related proteins, including their structures, mechanisms of secretion and anchoring and their diverse functions

Consequences of post-fascism in security policies in Spain

The paper analyses the features of the Spanish criminal justice system from the perspective of the late -democratisation condition of the Spanish polity. The text sees an almost uninterrupted expansion ism and a relatively high level of severity as basic traits of the evolution of the Spanish criminal justice system. Consequently, the paper examines those features from the viewpoints of legal reforms, institutional practices and collective perceptions and expectations experienced since the end of the autocratic period. Finally, the article investigates some reasons which may explain the relatively high punitiveness of the Spanish criminal justice system, before adding a coda on the changes of the penal system fostered by the Great Recession

Melhorando os resultados do transplante renal. Medidas comportamentais na redução da não adesão: estudo prospectivo controlado

Introdução: Os receptores de transplante de órgãos sólidos apresentam elevada incidência de não adesão medicamentosa. Existem poucos estudos de intervenção com abordagens visando o aumento da adesão. Objetivo: Avaliar o impacto da estratégia educacional e comportamental na adesão de transplantados renais no período dos três primeiros meses após o transplante. Métodos: Estudo prospectivo de pacientes incidentes em transplante renal. Os pacientes foram randomizados em dois grupos: Grupo controle de orientações usuais da equipe médica e grupo intervenção de orientações usuais somadas à educação complementar (orientações sobre a importância dos imunossupressores e modificações comportamentais com duração de 30 minutos). A adesão foi avaliada pelo questionário de adesão ITAS ao fim de três meses. Foram avaliadas a função renal aos 3, 6 e 12 meses e a incidência de rejeição. Resultados: A não adesão foi de 46,4% no grupo controle e 14,5% no grupo de tratamento (p=0,001). O razão de chance para não adesão foi 2,59 (IC: 1,38 - 4,88) vezes maior no grupo controle. A análise multivariada mostrou que pertencer ao grupo controle aumentou o risco de não adesão em 5,84 vezes (IC: 1,8 - 18,8, p=0,003). Não houve diferenças na função renal e nas taxas de rejeição entre os grupos. Conclusão: A não adesão é elevada nos três primeiros meses do transplante. A estratégia comportamental e educativa objetivando maior esclarecimento da importância do uso dos imunossupressores aumentou significantemente à adesão a terapia imunossupressor

Avaliação da qualidade de vida antes e após a doação renal

Qualidade de vida (QV) é um conceito recente na avaliação de saúde, composto por domínios: físico, psicológico e social. Com o aumento da expectativa de vida da população, mensurar QV passou a ser de grande valia para as áreas da saúde, pois, juntamente com a longevidade, as doenças crônicas também aumentaram, entre elas, a Insuficiência Renal Crônica (IRC), é considerada um grande problema de saúde pública, devido as suas elevadas taxas de mortalidade, morbidade e alto custo ao Sistema Único de Saúde. O transplante renal é a melhor opção de tratamento para IRC terminal, pois oferece melhor qualidade de vida, maior reabilitação profissional, maior sobrevida e menor custo que a diálise. Devido à escassez de órgãos provenientes de doadores falecidos e demanda de pacientes em listas de espera, o transplante com doadores vivos passou a ser bastante encorajado pela literatura, pois a nefrectomia unilateral é considerado um procediemnto seguro sob o ponto de vista físico, porém, poucos estudos relatam a QV do doador. Diante deste fato, este trabalho objetivou avaliar e comparar a QV dos doadores renais antes e após a nefrectomia. Pacientes e método: estudo prospectivo, longitudinal, com avaliação de 50 doadores consecutivos por um período de 2 anos no HC UNESP - Botucatu. Utilizou-se 2 questionários: um com perguntas específicas sobre todo o processo de doação (aplicado antes e 3 meses após doação), e o validado SF-36 (aplicado antes, com 3 meses e com mais de 6 meses após doação). Resultados: sexo feminino 62%, idade média 41 anos, escolaridade: 62% ensino fundamental, grau de parentesco: irmãos 42%, evolução do receptor 94% saudáveis, 2 óbitos, 1 perda de enxerto. Motivo da doação: 66% dos doadores sensibilizados pelo sofrimento do receptor, mais de 90% dos doadores não apresentaram limitações gerais, no trabalho, psicológicas...Not availableCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES