Pelvic floor muscle training protocol for stress urinary incontinence in women: A systematic review

Strengthening exercises for pelvic floor muscles (SEPFM) are considered the first approach in the treatment of stress urinary incontinence (SUI). Nevertheless, there is no evidence about training parameters. To identify the protocol and/or most effective training parameters in the treatment of female SUI. A literature research was conducted in the PubMed, Cochrane Library, PEDro, Web of Science and Lilacs databases, with publishing dates ranging from January 1992 to March 2014. The articles included consisted of English-speaking experimental studies in which SEPFM were compared with placebo treatment (usual or untreated). The sample had a diagnosis of SUI and their age ranged between 18 and 65 years. The assessment of methodological quality was performed based on the PEDro scale. Seven high methodological quality articles were included in this review. The sample consisted of 331 women, mean age 44.4±5.51 years, average duration of urinary loss of 64±5.66 months and severity of SUI ranging from mild to severe. SEPFM programs included different training parameters concerning the PFM. Some studies have applied abdominal training and adjuvant techniques. Urine leakage cure rates varied from 28.6 to 80%, while the strength increase of PFM varied from 15.6 to 161.7%. The most effective training protocol consists of SEPFM by digital palpation combined with biofeedback monitoring and vaginal cones, including 12 week training parameters, and ten repetitions per series in different positions compared with SEPFM alone or a lack of treatment.info:eu-repo/semantics/publishedVersio

Can we rely on inflammatory biomarkers for the diagnosis and monitoring Crohn's disease activity?

Background: Small bowel capsule endoscopy (SBCE) is a very important tool in the diagnosis and monitoring of Crohn's disease (CD). The Lewis score (LS) and Capsule Endoscopy Crohn's Disease Activity Index (CECDAI) are used to quantify and standardize inflammatory activity observed in the SBCE. Aim: To evaluate the correlation between the LS and CECDAI scores and inflammation biomarkers (C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]). A secondary goal was to define thresholds for CECDAI based on thresholds already established for LS. Methods: This was a retrospective study of 110 patients with suspect or known CD, with involvement of small bowel. Linear regression was used to calculate thresholds of CECDAI corresponding to the thresholds already established for LS. A Pearson correlation (r) was used to calculate the correlation between the LS and CECDAI scores and biomarker levels. Only patients with exclusive involvement of the small bowel were selected (n = 78). Results: A moderate correlation was found between the endoscopic scores (r = 0.59, p < 0.001). CECDAI scores of 5.57 and 7.53 corresponded to scores of 135 and 790 in LS, respectively. There was a statistically significant correlation between CRP and the LS (r = 0.28, p = 0.014) and CECDAI (r = 0.29, p = 0.009). There was also a significant correlation between ESR and CECDAI (r = 0.29, p = 0.019), but not with LS. Conclusion: There is a moderate correlation between the two scores. This study allowed the calculation of thresholds for CECDAI based on those defined for LS. We found a weak correlation between SBCE endoscopic activity and inflammatory biomarkers.info:eu-repo/semantics/publishedVersio

Impact of the age of diagnosis on the natural history of ulcerative colitis

Background: Ulcerative colitis (UC) has a recognized phenotypic heterogeneity. Some studies suggest that age at diagnosis may influence features and natural history of the disease. Aim: This study aimed to compare patients', disease's and treatment's features between Portuguese patients diagnosed before and after the age of 40-years-old. Methods: Retrospective single-center study that included 310 patients with UC, divided in two groups: Those diagnosed before the age of 40-years-old (early onset UC) and those diagnosed later than that (late onset UC). In each group features of the patients (gender, family history, smoking), of the disease (duration, extension, severity, clinical course, hospitalization, extraintestinal manifestations), and of treatment (oral aminosalicylates, systemic steroids or immunomodulators) were analyzed. Statistical analysis was performed using SPSSv22.0. Univariate and multivariate analyses were performed to assess factors associated with early and late onset UC. Results: From the analyzed patients, 207 had UC diagnosed before the age of 40 years old (43.5% men; mean age at diagnosis 29.4 +/- 6.9 years) and 103 were diagnosed after that age (61.2% men; mean age at diagnosis 51.8 +/- 8.1 years). In the group diagnosed before 40 years old, female gender (p = 0.003), severe disease (p = 0.002), chronic intermittent clinical course (p = 0.026), and hospitalizations (p = 0.001) were significantly more frequent. The use of oral aminosalicylates (p = 0.032), systemic steroids (p = 0.003) and immunomodulators (p = 0.012) were also more common in the early onset UC group. No differences between groups were found in family history, smoking, disease's extension, extraintestinal manifestations, and use of biological agents. Multivariate analysis pointed early onset UC to be significantly associated with female gender (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.08-2.91; p = 0.024), chronic intermittent symptoms (OR, 2.34; 95% CI, 1.17-4.70; p = 0.016), and need of hospitalization (OR, 2.89; 95% CI, 1.46-5.72; p = 0.002). Conclusions: When diagnosed before the age of 40-years-old, UC preferably affects women and manifests as a more severe disease, with more frequent hospitalizations and chronic intermittent symptoms. These facts might have implications in planning timely and individualized future therapeutic strategies.info:eu-repo/semantics/publishedVersio

Estudantes e amigos: trajetórias de classe e redes de sociabilidade

O presente artigo dá conta de um conjunto de conceitos, campos de incidência analítica e resultados de investigação sobre a juventude universitária. Em primeiro lugar, discute-se o problema da caracterização de classe dos estudantes e a importância de alargar o campo de análise por meio de conceitos como os de trajetória social, relações de sociabilidade e redes sociais, aplicando-os a um conjunto de estudantes de várias universidades. Em seguida, apresentam-se análises respeitantes a dois segmentos importantes dos sistemas de disposições e das configurações culturais dos estudantes: as imagens de posicionamento social e os modelos de orientação pessoal. Conclui-se com a proposta de um modelo para a análise de classes

Behavioral profile of elementary school students related to the school backpack

Objetivo – Determinar e analisar o perfil comportamental dos estudantes do primeiro ciclo do ensino básico sobre o uso da mochila escolar. Método – Estudo observacional, analítico e transversal. A amostra foi constituída por 88 estudantes do 1º ciclo do ensino básico no concelho de Vila Nova de Famalicão (Portugal). Foi aplicado um questionário para avaliar o comportamento dos estudantes relativamente ao tipo, modo de transporte, organização do material escolar e peso da mochila. Resultados – Todas as mochilas apresentavam duas alças e eram reguláveis. A maioria dos estudantes de todos os anos letivos transportava a mochila de alças nos dois ombros. No geral, os estudantes do 1º ciclo distribuíam o material de forma desorganizada pelos compartimentos da mochila e colocavam o material mais pesado afastado da coluna vertebral, não se verificando diferenças significativas. O índice de proporção mostrou que os estudantes transportavam as mochilas com peso inferior a 10% do peso corporal, exceto os estudantes do 1º ano de escolaridade (p<0,05). O peso transportado nas mochilas era significativamente assimétrico durante os dias da semana e entre os níveis de escolaridade (p<0,05). Conclusões – A maioria dos estudantes do 1º ciclo transportava a mochila com as alças nos dois ombros; porém, desconheciam as características adequadas do tipo de mochila e da distribuição uniforme do material escolar. A variação da carga da mochila durante a semana entre os níveis de escolaridade era significativamente inconsistente, mostrando que o índice de proporção de carga era mais elevado no primeiro ano de escolaridade.ABSTRACT - Objectives – The aim of this study was to determine and analyze the behavioral profile of students in the use of school backpack in the first cycle of basic education. Methods – An observational, analytic and transversal study. The study sample included 88 students of all grades the 1st cycle of basic education school in Vila Nova de Famalicão (Portugal). The questionnaire was applied to evaluate the type, way of transportation, and weight and material organization in daily use of the school backpack by students. Results – All the backpacks had two handles and were adjustable, while the transport mode of the bag with two handles and both shoulders. Overall, all students of the 1st cycle distributed the material so disorganized by the compartments of the school backpack and put the heavier material away from the spine, without significant differences. The results of the proportion of index indicate that students carrying backpacks weighing less than 10% of body weight, except the students of the 1st cycle (p<0.05). The transported weight was significantly asymmetric during the days of the week and between the levels of schooling (p<0.05). Conclusions – Most of the 1st cycle students carrying the backpack with straps symmetrically on both shoulders, however, were unaware of the appropriate characteristics of the type of backpack and correct perception of uniform distribution of material. The variation of backpack load during the week and schooling levels were significantly inconsistent, with a higher proportion of indices in the first year of school.info:eu-repo/semantics/publishedVersio

Lewis Score - Prognostic value in patients with isolated small bowel Crohn's disease

Background and aims: Small bowel capsule endoscopy (SBCE) allows mapping of small bowel inflammation in Crohn’s disease (CD). We aimed to assess the prognostic value of the severity of inflammatory lesions, quantified by the Lewis score (LS), in patients with isolated small bowel CD. Methods: A retrospective study was performed in which 53 patients with isolated small bowel CD were submitted to SBCE at the time of diagnosis. The Lewis score was calculated and patients had at least 12 months of follow-up after diagnosis. As adverse events we defined disease flare requiring systemic corticosteroid therapy, hospitalization and/or surgery during follow-up. We compared the incidence of adverse events in 2 patient subgroups, i.e. those with moderate or severe inflammatory activity (LS =790) and those with mild inflammatory activity (135 = LS < 790). Results: The LS was =790 in 22 patients (41.5%), while 58.5% presented with LS between 135 and 790. Patients with a higher LS were more frequently smokers (p = 0.01), males (p = 0017) and under immunosuppressive therapy (p = 0.004). In multivariate analysis, moderate to severe disease at SBCE was independently associated with corticosteroid therapy during follow-up, with a relative risk (RR) of 5 (p = 0.011; 95% confidence interval [CI] 1.5–17.8), and for hospitalization, with an RR of 13.7 (p = 0 .028; 95% CI 1.3–141.9). Conclusion: In patients with moderate to severe inflammatory activity there were higher prevalences of corticosteroid therapy demand and hospitalization during follow-up. Thus, stratifying the degree of small bowel inflammatory activity with SBCE and LS calculation at the time of diagnosis provided relevant prognostic value in patients with isolated small bowel CD

Otimização da abordagem do risco na hemorragia digestiva alta: comparação de cinco scores na predição de sete outcomes

Although different scores have been suggested to predict outcomes in the setting of upper gastrointestinal bleeding (UGIB), few comparative studies between simplified versions of older scores and recent scores have been published. We aimed to evaluate the accuracy of pre- (PreRS) and postendoscopic Rockall scores (PostRS), the Glasgow-Blatchford score (GBS) and its simplified version (sGBS), as well as the AIMS65 score in predicting different clinical outcomes.(undefined)info:eu-repo/semantics/publishedVersio

Prognostic factors for recovery in Portuguese patients with Bell’s palsy

The main aim of this study was to identify the prognostic factors that contribute to complete recovery at 6 weeks and 6 months in patients with Bell’s palsy. Material and Methods: This is a prospective, longitudinal, and descriptive study that included 123 patients diagnosed with facial nerve palsy (FNP) at a hospital in Guimarães, Portugal. However, only 73 patients with Bell’s palsy (BP) were included in the assessment of recovery at 6 weeks and 6 months. We analyzed the demographic and clinical characteristics of the patients, including sex, age, paralyzed side, occupation, previous and associated symptoms, seasonal occurrence, familial facial palsy, patient perception, intervention options, and baseline grade according to the House-Brackmann facial grading system (HB-FGS). Of the 123 cases with FNP, 79 (64.2%) patients had BP. Age, sex, and baseline HB-FGS grades were significant predictors of complete recovery at 6 weeks. Patients with HB-FGS grade III or lower (6 weeks baseline) had significant recovery of function at 6 months. Baseline severity of BP, elderly patients, and male sex were early predictors of poor prognosis. Patients with mild and moderate dysfunction according to the HB-FGS achieved significant normal facial function at 6 months. Further prospective studies with longer observation periods and larger samples are needed to verify the results.info:eu-repo/semantics/publishedVersio