Efeito modulador do exerc?cio aer?bico sobre TNT-? e seus receptores sol?veis, IL-6,BDNF, c?lulas T e na funcionalidade de idosas da comunidade com osteartrite de joelho

?rea de concentra??o: Neuroimunoendocrinologia.A osteartrite de joelho (OAj) ? uma doen?a que afeta principalmente os idosos e pode levar a grandes limita??es f?sicas e funcionais. No entanto, os efeitos espec?ficos da terapia por exerc?cios, especialmente a caminhada sobre o sistema imunol?gico, s?o desconhecidas. Portanto, este estudo teve como objetivo analisar o efeito de 12 semanas de caminhada (3x / semana) no perfil de leuc?citos, nos n?veis plasm?ticos de interleucina (IL-6), do fator de necrose tumoral alfa (TNF-?), dos receptores sol?veis de TNF-? (sTNFR1 e sTNFR2), e do fator neurotr?fico derivado do c?rebro (BDNF) a partir de plasma retirado do sangue perif?rico de mulheres idosas com OAj. Al?m disso, as avalia??es cl?nicas e funcionais (teste de WOMAC, teste de caminhada de 6 minutos, SF-36, a percep??o da dor) foram realizadas. Dezesseis mulheres (idade: 67 ? 4 anos, ?ndice de massa corporal: 28,07 ? 4,16 kg/m2) participaram de um programa de caminhada (36 sess?es de fisioterapia) e de um esfor?o f?sico (01 sess?o de fisioterapia). As vari?veis foram avaliadas antes e ap?s 12 semanas de treinamento com dura??o (30-55 min) e intensidade (70-80% da FCm?x) progressivamente maiores. As amostras de sangue coletadas foram analisadas com um contador de c?lulas, cit?metro de fluxo e pelo m?todo ELISA. As sess?es de fisioterapia resultaram em um aumento de 47% da qualidade de vida (p <0,05) e um aumento de 21% no VO2max (p <0,0001) em mulheres idosas com OAj. Al?m disso, houve uma redu??o nas c?lulas T CD4 + (antes 46,59 ? 7%, depois 44,58 ? 9%, p = 0,0189) e uma intensidade de fluoresc?ncia mais elevada para CD18 + CD4 + (antes 45,30 ? 10, depois de 64,27 ? 33, p = 0,0256) e CD18 + CD8 + (antes: 64,2 ? 27, depois de 85,02 ? 35, p = 0,0130). A ET aumentou a concentra??o plasm?tica de sTNR1; no entanto, diminuiu a concentra??o de plasma de sTNFR2, quando comparado com os n?veis em repouso de pacientes. O exerc?cio agudo afetou diferencialmente os n?veis de sTNFR1 dependente de quando as amostras foram tomadas, antes e ap?s o treinamento aer?bico. No entanto, os n?veis de sTNFR2 n?o foram afetados pelo treinamento. O exerc?cio agudo aumentou os n?veis de BDNF apenas antes do per?odo de treinamento de 12 semanas (p <0,001). Al?m disso, houve aumento das concentra??es plasm?ticas de BDNF (p <0,0001) e melhora em par?metros cl?nicos (funcional p <0,001; percep??o da dor p <0,01). A varia??o dos n?veis de receptores sol?veis correlacionou-se com a melhora funcional; no entanto, os marcadores inflamat?rios de osteoartrite (IL-6 e TNF-?) n?o foram afetados pelas 36 sess?es de fisioterapia.Funda??o de Amparo ? Pesquisa do estado de Minas Gerais (FAPEMIG)Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (Capes)Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico (CNPq)Tese (Doutorado) ? Programa Multic?ntrico de P?s-Gradua??o em Ci?ncias Fisiol?gicas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2014.ABSTRACT Osteoarthritis of the knee (kOA) is a disease that mainly affects the elderly and can lead to major physical and functional limitations. However, the specific effects of exercise therapy (ET), specially walking and particularly on the immune system, are unknown. Therefore, this study aimed to analyze the effect of 12 weeks of walking (3x/week) on the leukocyte profile, levels of interleukin 6 (IL-6), tumor necrosis factor alpha, (TNF-?), soluble forms of the TNF-? receptor (sTNFR1 and sTNFR2), and brain-derived neurotrophic factor (BDNF) from plasma taken from the peripheral blood of elderly women with kOA. Additionally, clinical and functional assessments (WOMAC test, 6-min walk, SF-36, pain perception) were performed. Sixteen women (age: 67 ? 4 years, body mass index: 28.07 ? 4.16 kg/m2) participated in a walking program and physical exertion. The variables were assessed before and after 12 weeks of training with a progressively longer duration (30-55 min) and higher intensity (70-80% of HRmax). The blood samples were collected for analysis with a cell counter, the Scan Fac flow cytometer and were measured by ELISA. The ET resulted in a 47% enhancement of the self-reported quality of life (p <0.05) and a 21% increase in the VO2max (p <0.0001) in elderly women with kOA. Furthermore, there was a reduction in CD4+ cells (before 46.59?7%, after 44.58?9%, p=0.0189) and a higher fluorescence intensity for CD18+CD4+ (before 45.30 ? 10, after 64.27 ? 33, p=0.0256) and CD18+CD8+ (before: 64.2 ?27, after 85.02 ?35, p=0.0130). Aerobic training increased the plasma concentration of sTNR1; however, it decreased the plasma concentration of sTNFR2, when compared with levels of resting patients. Acute exercise differentially affects the levels of sTNFR1 dependent on when the samples were taken, before and after aerobic training. However, the levels of sTNFR2 were not affected by training. The acute exercise increased the levels of BDNF only before the 12-week training period (p<0.001). Moreover, the training augmented the plasma concentrations of BDNF (p<0.0001) and improved clinical parameters (functional p<0.001; pain perception p<0.01). The variation in the levels of soluble receptors correlated with functional improvement; however, the inflammatory osteoarthritis markers (IL-6 and TNF-?) were unaffected by the walking exercises, in physical therapy

Influência da estimulação aquática no desenvolvimento de crianças de 0 a 18 meses: um estudo piloto

Human development involves biological and environment factors that interact in a dynamic and complex way throughout life. For some authors, the aquatic environment may offer several benefits to infantile development, but studies on the relationship between aquatic stimulation and typical development are scarce. The purpose of this study was to assess the influence of a program of aquatic stimulation (a 50-minute session once a week during four to eight weeks) on the development of 12 children aged 0 to 18 months, with emphasis on motor development. Children were from middle class families, their mothers having high school or higher educational background. They were assessed before and after the program by two tests: Denver II, to assess global development, and the Alberta infant motor scale, to evaluate gross motor development. Data were statistically analysed. Results showed no significant score differences between tests applied before and after the program. Hence the program had no influence on children's development areas assessed. Although the aquatic environment offers the child many benefits, this study does not allow asserting that it favours infant development. Further studies must include a greater sample, longer lasting programs, and a control group.O desenvolvimento humano envolve fatores biológicos e ambientais que interagem de forma dinâmica e complexa ao longo da vida. Para alguns autores, o meio aquático pode oferecer diversos benefícios ao desenvolvimento infantil; no entanto, estudos sobre estimulação aquática e desenvolvimento típico são escassos. O objetivo deste estudo foi verificar a influência de um programa de estimulação aquática no desenvolvimento de crianças de 0 a 18 meses, com ênfase no desenvolvimento motor. Participaram do estudo 12 crianças de classe média com nível de escolaridade materna igual ou superior a ensino médio completo. As crianças foram submetidas a uma avaliação antes e após um programa de estimulação aquática de 50 minutos por semana, durante quatro a oito semanas. A avaliação consistiu na aplicação de dois testes: Denver II, para avaliar desenvolvimento global, e a escala motora infantil de Alberta (Aims), para avaliar desenvolvimento motor amplo. Os dados foram tratados estatisticamente. Não foram encontradas diferenças significativas entre os resultados dos testes antes e após o programa. Portanto, o programa de estimulação aquática infantil não teve influência nas áreas de desenvolvimento avaliadas. Embora o ambiente aquático forneça muitos benefícios para a criança, este estudo não permite afirmar que o estímulo precoce nesse meio favoreça o desenvolvimento infantil. Requerem-se novos estudos, com maior tempo de intervenção, grupo controle e maior número de participantes

A qualidade do ambiente domiciliar influencia nas habilidades funcionais de crianças na primeiríssima infância?

The literature extensively associates child development with the quality of environmental stimulation, however, there are few studies that verify this relationship with the child's functional abilities. Thus, this study aims to investigate which opportunities in the home environment are associated with and explain the functional mobility skills and social function of children in early childhood. This is a cross-sectional and exploratory study, with 74 infants aged 6 to 18 months. To assess the opportunities, present in the home environment, the instrument Affordances in the Home Environment Motor Development - Infant Scale was used, and to assess the functional abilities of children, the Pediatric Assessment of Disability Inventory was used. As a result, we find the mobility of children can be explained in 45.6% (adjusted R² = 0.45) and the social function was explained in 30% (adjusted R² = 0.30) by the amount of gross motor toys, equipment and by the variety of stimulation present in the home environment. It is concluded that positions, toys and materials that keep the child more restricted and less active exert a negative influence. On the other hand, toys that provide greater mobility and interaction favor the functional abilities of mobility and social function.| La literatura ha asociado ampliamente el desarrolloinfantil con la calidad de la estimulación en el entorno. Sin embargo,pocos estudios han verificado si esta asociación está relacionada conlas habilidades funcionales del niño. Este estudio tiene como objetivoanalizar y explicar qué oportunidades en el entorno del hogar estánasociadas con las habilidades funcionales de movilidad y función socialde niños en la primera infancia. Se trata de un estudio transversal yexploratorio, realizado con 74 niños de los 6 a los 18 meses de edad.Para evaluar las oportunidades presentes en el entorno del hogar,se utilizó el instrumento affordances in the home environment motordevelopment – infant scale. Para evaluar las habilidades funcionalesde los niños, se utilizó el inventario para la evaluación pediátrica dela discapacidad. Se observó que la movilidad de los niños se puedeexplicar en un 45,6% (R² ajustado=0,45) y la función social en un 30%(R² ajustado=0,30) por la cantidad de juguetes de motricidad gruesa,equipos y por la variedad de estimulación presente en el entornodel hogar. Se concluye que las posiciones, juguetes y materialesque mantienen al niño más restringido y menos activo ejercen unainfluencia negativa. Por otro lado, los juguetes que aportan mayormovilidad e interacción favorecen las habilidades funcionales demovilidad y función social del niñoA literatura, extensamente, associa o desenvolvimento infantil à qualidade da estimulação ambiental. Entretanto, são escassos os estudos que verificam esta relação com as habilidades funcionais da criança. Este estudo tem por objetivo investigar quais oportunidades no ambiente domiciliar estão associadas e explicar as habilidades funcionais de mobilidade e função social de crianças na primeiríssima infância. Trata-se de um estudo transversal e exploratório, com 74 crianças entre 6 e 18 meses. Para avaliar as oportunidades presentes no ambiente domiciliar, foi utilizado o instrumento Affordances in the Home Environment Motor Development - Infant Scale. Para avaliar as habilidades funcionais das crianças, foi utilizado o Inventário de Avaliação Pediátrica de Incapacidade. Observou-se que a mobilidade das crianças pode ser explicada em 45,6% (R² ajustado = 0,45) e a função social foi explicada em 30% (R² ajustado = 0,30) pela quantidade de brinquedos de motricidade grossa, equipamentos e pela variedade de estimulação presente no ambiente domiciliar. Conclui-se que posições, brinquedos e materiais que mantém a criança mais restrita e menos ativa exercem influência negativa. Por outro lado, brinquedos que oportunizam um maior deslocamento e interação favorecem as habilidades funcionais de mobilidade e função social

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Evaluation of clinical and radiographic measures and reliability of the quadriceps angle measurement in elderly women with knee osteoarthritis

Introduction: Knees osteoarthritis (OA) is a complex degenerative disease with intra-articular changes affecting the amplitude of the quadriceps angle (Q). To measure this variable, it is necessary to use reliable protocols aiming at methodological reproducibility. The objective was to evaluate the intra-examiner and inter-examiner reliability of clinical and radiographic measures of the Q angle and to investigate the 1 Study developed at Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM) and Santa Casa de Caridade. Diamantina, MG - Brazil. Financial Support: FAPEMIG and CNPq relationship between the degree of OA and the magnitude of this angle in the elderly. Materials and methods: 23 volunteers had the Q angle measured by two evaluators at 48-h interval. Clinical measurements were collected by using the universal goniometer in the same position adopted in the radiographic examination. Results: The intra-examiner reliability was good (0.722 to 0.763) for radiographic measurements and low (0.518 to 0.574) for clinical assessment, while inter-examiner reliability was moderate (0.634) for radiographic measurements and low (0.499) to the clinics. The correlation analysis between the radiographic values with the OA classification showed no correlation between them (p = 0.824 and r = -0.024). Conclusion: Clinically, it is suggested that the radiographic examination is preferable to evaluate the Q angle of elderly women with knee osteoarthritis. Moreover, the magnitude of this angle did not correlate with the degree of impairment of OA in this population

Evaluation of clinical and radiographic measures and reliability of the quadriceps angle measurement in elderly women with knee osteoarthritis

Introduction Knees osteoarthritis (OA) is a complex degenerative disease with intra-articular changes affecting the amplitude of the quadriceps angle (Q). To measure this variable, it is necessary to use reliable protocols aiming at methodological reproducibility. The objective was to evaluate the intra-examiner and inter-examiner reliability of clinical and radiographic measures of the Q angle and to investigate the relationship between the degree of OA and the magnitude of this angle in the elderly. Materials and methods 23 volunteers had the Q angle measured by two evaluators at 48-h interval. Clinical measurements were collected by using the universal goniometer in the same position adopted in the radiographic examination. Results The intra-examiner reliability was good (0.722 to 0.763) for radiographic measurements and low (0.518 to 0.574) for clinical assessment, while inter-examiner reliability was moderate (0.634) for radiographic measurements and low (0.499) to the clinics. The correlation analysis between the radiographic values with the OA classification showed no correlation between them (p = 0.824 and r = -0.024). Conclusion Clinically, it is suggested that the radiographic examination is preferable to evaluate the Q angle of elderly women with knee osteoarthritis. Moreover, the magnitude of this angle did not correlate with the degree of impairment of OA in this population

Respostas cardiovasculares agudas em ambiente virtualmente simulado pelo Nintendo Wii

Recentemente, tem sido verificada a utilização do Nintendo Wii no contexto da saúde. O objetivo do presente estudo foi analisar as respostas cardiovasculares agudas monitoradas por meio do comportamento da frequência cardíaca, pressão arterial sistólica, pressão arterial diastólica e duplo produto, em ambiente virtualmente simulado pelo console Nintendo Wii. A amostra foi composta por 18 universitários saudáveis, com média de idade de 22,07 ± 1,34 anos. As variáveis foram observadas com uso de deltas (valor final - inicial) após 25 arremessos de basquetebol em duas situações experimentais: (I) com o voluntário sentado e, (II) com o voluntário saltando verticalmente. Os resultados sugerem que a prática de atividade física em ambiente virtual emulado pelo Nintendo Wii é capaz de alterar as respostas cardiovasculares agudas, especialmente, quando realizada em associação a saltos verticais. Assim, os resultados sustentam a viabilidade do uso do Nintendo Wii em programas de treinamento e favorecem sua indicação de forma mais segura

<b> Acute cardiovascular responses in a virtual environment simulate by Nintendo Wii. </b> http://dx.doi.org/10.5007/1980-0037.2013v15n1p60

It has recently been verified using the Nintendo Wii in the health context. The aim of this study was to analyze the acute cardiovascular responses monitored by the behavior of heart rate, systolic blood pressure, diastolic blood pressure and double product in an environment virtually simulated by Nintendo Wii. The sample was consisted of 18 health college students with mean age 22.07 ± 1.34 years. The variables were observed with use of delta analysis (post value – prior value) after 25 basketball shoots in two experimental situations: (I) seating and (II) jumping vertically. The results suggest the physical activity in a virtual environment emulated by Nintendo Wii is able to change the acute cardiovascular responses, mainly when performed in association with vertical jumps. Thus, the results support the feasibility use of the Nintendo Wii in training programs and favor its indication more securely

Experiência de treinamento com Nintendo Wii sobre a funcionalidade, equilíbrio e qualidade de vida de idosas

O objetivo desse relato de experiência foi analisar a funcionalidade, equilíbrio e qualidade de vida em duas idosas não institucionalizadas, após serem submetidas a um protocolo de treinamento em Realidade Virtual composto por nove sessões com duração de 50 minutos cada e frequência de três vezes por semana. Para tanto, utilizou-se os jogos do software Wii Fit, bem como o acessório Balance Board do console Nintendo Wii, a partir de um programa de treinamento elaborado fundamentado em diretrizes gerais de agência de saúde, tais como o Colégio Americano de Medicina do Esporte (ASCM). A avaliação da funcionalidade foi realizada com o uso dos Testes de Aptidão Física para Idosos (TAFI), o equilíbrio foi avaliado com a Escala de Berg e a qualidade de vida foi mensurada com o questionário SF-36. Os resultados apontaram melhora nos valores absolutos de todos os testes analisados, permitindo concluir acerca do potencial do programa de treinamento elaborado para a melhora da independência funcional de idosos. Esperamos que este estudo auxilie pesquisadores a dar continuidade à pesquisa e às ações envolvendo o uso do Nintendo Wii como ferramenta assistiva a idosos