Avaliação do equilíbrio na doença de Alzheimer leve e moderada: implicações na capacidade funcional e na ocorrência de quedas

OBJECTIVE: To analyze the correlation between balance, falls and loss of functional capacity in mild and moderate Alzheimer's disease(AD). METHOD: 40 subjects without cognitive impairment (control group) and 48 AD patients (25 mild, 23 moderate) were evaluated with the Berg Balance Scale (BBS) and the Disability Assessment for Dementia (DAD). Subjects answered a questionnaire about falls occurrence in the last twelve months. RESULTS: Moderate AD patients showed poorer balance (p=0.001) and functional capacity (p <0.0001) and it was observed a correlation between falls and balance (r= -0.613; p=0.045). CONCLUSION: There is a decline of balance related to AD which is a factor associated to the occurrence of falls, albeit not the most relevant one. The loss of functional capacity is associated with the disease's progress but not to a higher occurrence of falls. The balance impairment did not correlate with functional decline in AD patients.OBJETIVO: Analisar a correlação entre déficit de equilíbrio, ocorrência de quedas e prejuízo funcional na doença de Alzheimer (DA). MÉTODO: 40 idosos sem comprometimento cognitivo (grupo controle) e 48 idosos com DA (25 leves e 23 moderados), avaliados através da Escala de Equilíbrio de Berg (EEB) e Escala de Avaliação de Incapacidade (EAI), e questionados quanto à ocorrência de quedas nos últimos doze meses. RESULTADOS: O equilíbrio no grupo DA moderada foi pior do que no grupo leve (p=0,001), bem como a capacidade funcional (p<0,0001), sem diferença na ocorrência de quedas entre os grupos. Na DA moderada, houve correlação entre ocorrência de quedas e EEB (r= -0,613; p=0,045). CONCLUSÃO: Há um declínio do equilíbrio associado à progressão da DA. O declínio da capacidade funcional não foi associado à maior ocorrência de quedas. O déficit de equilíbrio não se correlacionou ao declínio funcional na DA

O legislativo e a política externa do Chile (2006-2014)

A pergunta norteadora da pesquisa é: como votam os deputados chilenos em temas de política externa? O presente trabalho, por meio de uma análise das votações nominais do período de 2006-2014 da Cámara dos Diputados chilena, objetiva verificar a associação dos votos dos deputados chilenos em política externa com fatores comumente referidos pela literatura como estruturadores do voto em políticas públicas, incluindo os temas de política externa: o pertencimento ou não à coalizão de governo; e a ideologia do partido. O pano de fundo da pesquisa é a troca de coalizões partidárias no governo, que ocorreu no ano de 2010, depois de 20 anos de poder da Concertación. Este estudo utiliza um método que abrange análise quantitativa e qualitativa, com análise de dados descritivos produzidos das votações coletadas, análise dos pontos ideais dos deputados e análise de regressão binária/logística, conjuntamente com uma análise mais aprofundada de votações semelhantes nas duas legislaturas e uma revisão de literatura sobre a política externa chilena. As duas variáveis testadas apresentaram relação com o comportamento legislativo dos deputados analisados – demonstrado pela manutenção da polarização dos deputados nas coalizões e pela probabilidade de apoio ao presidente estar na direção dos partidos no governo. Confirmada a hipótese de comportamento ideológico, se mantém a afirmação de que no Chile não ocorre bipartisanship em temas de política externa. Estes resultados, então, indicaram que esses posicionamentos ideológicos significariam mudanças na política externa chilena, questão esclarecida com a relação feita com a etapa qualitativa, que mostrou linhas de continuidade pragmática, bem como redirecionamentos da política externa sob o governo de Piñera.The guiding question of this research is: how Chilean legislators voting foreign policy themes? This research, by means of roll call votes by 2006-2014 of the Cámara de Diputados de Chile, aim at found out the association between legislators vote in foreign policy themes and ordinary factors pointed by the literature as determinants in the roll call in public policies, including foreign policy: belong or not to government coalition; and the party ideology. The background of this research is the government coalition change, occurred in 2010, after 20 years of the Concertación in the power. The study use a method that involve quantitative and qualitative analysis, with descriptive roll call dates, ideal points analysis of the legislators and a logistic regression, jointly with a deep analysis of similar voting in both legislature and a literature revision of the Chilean foreign policy. Both of the variables presented relation with the legislative behavior – showed by the continuation of the legislator’s polarization in yours coalition and by the likely to support the president be in the direction of government parties. Confirmed the hypothesis of ideological behavior, this maintains the proposition that deny bipartisanship in foreign policy in Chile. These results, then, indicate that this ideological positions means foreign policy changes, question that was clarified with the qualitative analysis, which showed pragmatic continuum lines, as well as foreign policy redirections under Piñera’s government.A pergunta norteadora da pesquisa é: como votam os deputados chilenos em temas de política externa? O presente trabalho, por meio de uma análise das votações nominais do período de 2006-2014 da Cámara dos Diputados chilena, objetiva verificar a associação dos votos dos deputados chilenos em política externa com fatores comumente referidos pela literatura como estruturadores do voto em políticas públicas, incluindo os temas de política externa: o pertencimento ou não à coalizão de governo; e a ideologia do partido. O pano de fundo da pesquisa é a troca de coalizões partidárias no governo, que ocorreu no ano de 2010, depois de 20 anos de poder da Concertación. Este estudo utiliza um método que abrange análise quantitativa e qualitativa, com análise de dados descritivos produzidos das votações coletadas, análise dos pontos ideais dos deputados e análise de regressão binária/logística, conjuntamente com uma análise mais aprofundada de votações semelhantes nas duas legislaturas e uma revisão de literatura sobre a política externa chilena. As duas variáveis testadas apresentaram relação com o comportamento legislativo dos deputados analisados – demonstrado pela manutenção da polarização dos deputados nas coalizões e pela probabilidade de apoio ao presidente estar na direção dos partidos no governo. Confirmada a hipótese de comportamento ideológico, se mantém a afirmação de que no Chile não ocorre bipartisanship em temas de política externa. Estes resultados, então, indicaram que esses posicionamentos ideológicos significariam mudanças na política externa chilena, questão esclarecida com a relação feita com a etapa qualitativa, que mostrou linhas de continuidade pragmática, bem como redirecionamentos da política externa sob o governo de Piñera

ダイガクセイ ニオケル セッショク ショウガイ ケイコウ ト ジヘイショウ ケイコウ トノ カンレンセイ ニツイテ : タイジン コミュニケーション ノ シテン カラ

In recent years, clinical articles on the association of eating disorders and pervasive developmental disorders are often reported. The purpose of this study was to provide evidence relationship eating disorders to autism. Participants included 371 male and 278 female students. The methods were used self-administered questionnaires in Eating Disorder Inventory Japanese Version (EDI-J), the distortion level of body image, Autism Spectrum Quotient Japanese version (AQ-J). The students responded to three scales. The results were obtained that the scores were significantly higher females' than males' in body image distortion and EDI-J, and AQ-J was significantly higher in males than in females. The correlations between distortions of body image and EDI-J, and between AQ-J and EDI-J were significant. In other words, the higher tendency eating disorders were the higher tendency autism likely, the higher the tendency of eating disorders were larger distortions of body image. The discussion has been made that the relevance of the control eating and the difficulties of interpersonal communication about these results

Purification and pressure dependence of alanine racemase from the psychro- piezophilic bacterium shewanella violacea DSS 12

Shewanella violacea DSS12 (S. violacea) is a psychrophilic and piezophilic bacterium, isolated from mud of the Ryukyu Trench in Japan. The bacterium displays optimal growth at 8°C and 30 MPa. Alanine racemase is an enzyme which catalyses the interconversion of l-alanine and d-alanine, and is responsible for the synthesis of d-alanine contained in the peptidoglycan of bacterial cell wall. In this study, we purified alanine racemase from S. violacea and investigated the enzymological characteristics of alanine racemase. The bacterium was aerobically cultured using marine broth 2216 in a 5-liter medium bottle at 4°C for 3 days. The bacterial cells were lysed by applying of 100 MPa pressure using a French press, and the lysate was centrifuged. The supernatant obtained was ultracentrifuged at 141,000 g, and the supernatant obtained was applied to ammonium sulfate fractionation. The active fraction was dissolved and passed through a butyl-Toyopearl, phenyl-Sepharose, and shodex KW-200 columns to obtain a partially purified enzyme. Consequently, the enzyme was purified 540-fold and showed a specific activity of 2.68 μmol/min/mg. Alanine racemase exhibited high activity against l-Ala and l-Ser as substrates. The optimal pH and temperature of alanine racemase were 9.0 and 25°C, respectively. Please click Additional Files below to see the full abstract

認知症のある高齢者の施設生活環境における転倒に関する主観的事象の言語化の試み

本研究は，転倒につながる主観的事象をアセスメントできるレベルに表現できることを目的に，認知機能が低下している施設高齢者の生活環境における転倒に関する主観的事象の言語化を試みた。対象者は女性高齢者２名であった。研究方法は，行動と環境の相互作用があることを考慮し行動分析法を活用した観察と聞き取り，および照度や高さなどの客観的データも収集した。結果，Ａ氏からは〈歩行の方向は前向き以外となっていないか〉〈歩行時，身体の重心が支持基底面からはずれていないか〉などが，Ｂ氏からは〈不安があるため出歩いていないか〉〈歩行経路の照度は移動に十分な明るさか〉などが言語化された。Ｂ氏においては０～１Lx程度の照度のホールで，食事用の机を「材木」と錯覚した。これらのことから，言語化の際には運動学の専門的知識，ならびに個人の生活過程や価値観を含める必要があることがわかった。 The aim of this study was to describe subjective phenomena related to falls of elderly persons with dementia in a longterm care facility. The participants were two elderly women. The research was an observational study, but some objective data, such as degree of illumination and height of chair, were measured to gain additional explanations for subjective phenomena. Analyses were carried out based on an observational study of behavior, with advice from a mobility expert. Case A showed unstable sidesteps, indicating that the center of gravity was lateral to the body. Case B, who was wandering, mistook dining tables for logs in a dark hall where the degree of lux was zero to one. She might have experienced an optical illusion. The results of the study indicate that knowledge of not only human mobility as a science but also a perspective based on individual experience is required in order to describe subjective phenomena related to falls

療養型病床群における高齢者の転倒予防: EBNに基づいた運動プログラムの作成

【研究目的】本研究は療養型病床群の脆弱な高齢者を対象に移乗・移動にともなう筋力および身体バランスを高め、かつ転倒予防への自信を高めるためにEvidence-based Nursing(EBN)に基づいた、病棟生活に取り入れ可能な看護師が実施する運動プログラムを作成することであった。【研究方法と成果】EBNに基づいて試作した運動プログラムの内容は、(1)静的ストレッチング、(3)筋力・筋持久力運動、(4)バランス運動(足指トレーニング、固有受容性神経筋促通法の活用)、(5)整理体操であった。試作した運動プログラムは書面により同意が得られた介入群16名(対照群14名)に導入し、3ヶ月間実施した。結果、運動プログラムは,介入群と対照群の年齢,性,運動機能,知的レベル,転倒リスクに差がない状態において,筋力は向上できなかったが,移乗・移動能力の維持,重心動揺の軽減,および転倒率を減少することができ,かつ運動による損傷や発症を引き起こすことがなかった点で療養型病床群の脆弱な高齢者に有効と考えられた。そして、試作した運動プログラムの修正課題は、下肢筋力向上、上肢筋力維持または向上、転倒自己効力感の向上、精神活動の維持・向上について挙げられた。それらを踏まえてプログラム内容を修正し、同意が得られた介入群21名(対照群19名)に3ヶ月間実施した結果、プログラムの課題であった下肢筋力は向上できなかったが、上肢筋力は維持でき、転倒自己効力感は向上できたため、ある程度の修正ができたと考えられた。Our aim was to develop an exercise program for fall prevention, based on evidence-based nursing (EBN), to not only increase muscle strength in the lower extremities, balance, and mobility, but also to decrease fear of falling and to increase self-efficacy for fall prevention in the elderly in a long-term care institution. We developed an exercise program which consisted of a warm-up, static stretching exercise, muscle strengthening in the lower extremities, balance training (toe training and proprioceptive neuromuscular facilitation), and a cool-down, based on EBN. The study design was a clinical trial. We developed a program through two trials. In the first trial, the 30 elderly participants who agreed to our study were divided into an intervention group of 16 people and a control group of 14 people. The length of the program was three months, and we measured muscle strength, balance, mobility, fear of falling, self efficacy for fall, and the number of falls to evaluate the effectiveness of the program. As a result, the intervention group showed increased balance and mobility and a decreased number of falls, although muscle strength and self-efficacy for fall did not increase and arm strength decreased significantly. No training-related medical problems occurred. We modified the program to increase muscle strength in the lower extremities, to increase or maintain arm strength and self efficacy for fall. In the second trial, 40 elderly participants were divided into an intervention group of 21 people and a control group of 19 people. The results showed a maintaining of arm strength and an increase of self-efficacy for fall but no increase of muscle strength in the lower extremities. In conclusion, an exercise program for fall prevention in the elderly in a long-term institution may be useful.研究課題/領域番号:14572270, 研究期間(年度):2002-2004出典：「療養型病床群における高齢者の転倒予防: EBNに基づいた運動プログラムの作成」研究成果報告書　課題番号14572270 (KAKEN：科学研究費助成事業データベース（国立情報学研究所）)　　　本文データは著者版報告書より作

Myeloperoxidase-Antineutrophil Cytoplasmic Antibody-Negative Microscopic Polyangiitis with Pulmonary Haemorrhage and IgA Nephropathy

Aim: To report a case of a patient with myeloperoxidase-antineutrophil cytoplasmic antibody (ANCA)-negative microscopic polyangiitis (MPA) and IgA nephropathy associated with severe pulmonary haemorrhage. Case Report: A 59-year-old man presented with ANCA-negative systemic vasculitis accompanied by purpura, nephritis and pulmonary haemorrhage. A skin biopsy specimen revealed pandermal leucocytoclastic vasculitis without IgA deposition and a kidney biopsy showed mesangial nephritis with IgA deposition. Considering these findings, the patient was diagnosed as having MPA with IgA nephropathy. Discussion: In most cases, MPA presents with rapidly progressive necrotizing glomerulonephritis and sometimes lung haemorrhage, while IgA nephropathy is less common among MPA cases. As recent research suggested that in MPA immunoglobulin deposition in the kidney may be an exacerbating factor for renal dysfunction and poor prognosis, close observation is required in these cases