Determinantes do uso de serviço de fisioterapia entre indivíduos com doença de Parkinson que vivem no Brasil

Descrever a utilização do serviço de fisioterapia e identificar os fatores que determinam o uso desse serviço entre indivíduos com doença de Parkinson (DP) que vivem no Brasil. Métodos: No total, 479 indivíduos com DP idiopática, de ambos os sexos, em qualquer estágio da escala de Hoehn & Yahr (HY) e de sete capitais do Brasil foram recrutados durante 2014 a 2016. A análise de regressão logística multivariada foi a principal ferramenta de análise estatística. Para a construção do modelo logístico foi investigada a associação da variável dependente “fisioterapia” com variáveis independentes sociodemográficas, econômicas e clínicas: idade, educação, renda familiar, tempo de DP desde o início, HY, domínio motor e atividade de vida diária da Unified Parkinson´s Disease Rating Scale, aspectos cognitivos, sintomas depressivos, medo de queda, congelamento marcha, história de quedas, nível de atividade física, velocidade de marcha, capacidade de caminhar e equilíbrio. Resultados: 479 indivíduos apresentaram média de 65,2 ± 11,0 anos, 88% tiveram HY = I-III e 43,4% faziam fisioterapia para a DP. A análise identificou duas principais variáveis determinantes do uso da fisioterapia: educação (OR = 1,24) e capacidade de caminhada (OR = 0,82). A diminuição da capacidade de caminhar e maior nível educacional aumentam o uso da fisioterapia em indivíduos com doença de Parkinson vivendo no Brasil. Conclusões: O presente estudo mostra que indivíduos com DP, residentes de diferentes regiões do Brasil, têm acesso limitado aos serviços de fisioterapia. Além disso, o Sistema Brasileiro de Saúde Pública, bem como os programas locais, precisam atingir pessoas de DP com baixo nível educacional para melhorar seu acesso aos serviços de fisioterapia. Os objetivos devem ser para o desenvolvimento de programas de exercícios físicos para melhorar o desempenho funcional dos pacientes por um período mais longo.To identify the factors affecting the use of physiotherapy services among individuals with Parkinson's disease (PD) living in Brazil. Methods: Overall, 479 individuals with idiopathic PD, of both sexes, at any stage of the Hoehn & Yahr (HY) scale, and from seven capital cities in Brazil were recruited from 2014 to 2016. Multivariate logistic regression was the main statistical tool. For the construction of the logistic model, the association of the dependent variable “physiotherapy” with the independent sociodemographic/economic and clinical variables: age, education, family income, time of PD since onset, HY, the activities of daily living and motor subscales of the Unified Parkinson's Disease Rating Scale, cognitive aspects, depressive symptoms, fear of falling, freezing gait, history of falls, physical activity level, gait speed, walking performance and balance, were verified. Results: The 479 individuals had an average age of 65.2 ± 11.0 years, 88% were in the HY I-III stages and 43.4% were under physiotherapy treatment. The analysis identified two determinant variables related to the use of the physiotherapy service: level of education (OR = 1.24) and walking performance (OR = 0.82). Decreased walking performance and a higher educational level increased the use of a physiotherapy service in individuals with PD living in Brazil. Conclusions: The present study shows that individuals with PD, residents from different regions of Brazil, have limited access to physiotherapy services. In addition, the Brazilian Public Health Care System, as well as local programs, need to target PD individuals with a low educational level to improve their access to physiotherapy services. Goals should aim towards the development of physical exercise programs to improve the patients’ functional performance for a longer period

Parâmetros metabólicos, ventilatórios e cardiovasculares durante a realização de atividades funcionais em indivíduos com doença de Parkinson

Exportado OPUSMade available in DSpace on 2019-08-14T00:52:28Z (GMT). No. of bitstreams: 1 tese_raquel_lana.pdf: 3608418 bytes, checksum: 7f6baabb396f17c4fbc91845e4cd28d2 (MD5) Previous issue date: 16Embora o padrão diário de atividade física na fase inicial da doença de Parkinson (DP) pareça ser similar à dos controles, isso tende a mudar com a progressão da doença. Pesquisas recentes observaram que indivíduos com DP são 29% menos ativos que indivíduos saudáveis. Além disso, devido à bradicinesia, indivíduos com DP tendem a reduzir a quantidade e a variedade de atividade física regular que realizam. Entender os fatores relacionados à redução do nível de atividade física é de suma importância no manejo das complicações decorrentes da DP. A capacidade ao exercício de indivíduos com DP em fase iniciais da doença pode ser comparável à de indivíduos sem a doença quando os sujeitos envolvidos mantêm certo nível de atividade física regular. No entanto, o alcance do pico aeróbico na esteira ocorre em um nível de exercício significativamente menor (menor velocidade, menor intensidade ou menor tempo) indicando uma menor eficiência energética. Dados indicam que indivíduos com DP gastam aproximadamente 20% mais energia do que indivíduos saudáveis pareados em idade e sexo durante exercícios com carga semelhante. Levando em consideração tais achados na literatura, três objetivos foram traçados nesta tese: (a) investigar os fatores determinantes do nível de atividade física de indivíduos com a DP; (b) investigar se o Teste de Subir e Descer Escadas (TE) e o Teste de Caminhada de 6 Minutos (TC6) podem ser utilizados na avaliação da capacidade física de indivíduos com DP e (c) investigar se existe diferença na eficiência energética de indivíduos com DP, quando comparados a indivíduos controles pareados por idade, sexo e nível de atividade física. Inicialmente, 46 indivíduos (66 ± 12 anos) foram recrutados para investigação dos fatores determinantes do nível de atividade física em indivíduos com DP, utilizando o Perfil de Atividade Humana (PAH). Através de análises de regressão linear, dois modelos que explicaram 76% da variância do PAH foram observados. O primeiro compreende idade, habilidade de realizar Atividades de Vida Diária (AVD) e Estágios de Incapacidade de Hoehn e Yahr modificada (HY); e o segundo compreende idade, habilidade de realizar AVD, e bradicinesia. Dentre os indivíduos com DP recrutados, 20 (62 ± 8 anos) participaram dos estudos subsequentes. O número de degraus escalados em 5 minutos (degraus) no TE e distância do TC6 foram capazes de predizer 36% e 41% do pico de consumo de oxigênio (VO2 pico) do Teste de Esforço Cardiopulmonar (TECP). Degraus e tempo gasto para uma subida e descida (tempo) do TE e distância e velocidade do TC6 foram capazes de discriminar indivíduos com diferentes níveis funcionais de acordo com o PAH e a avaliação motora da Unified Parkinsons Disease Rating Scale (UPDRS). O TE foi considerado um teste de intensidade vigorosa, enquanto o TC6 apresentou intensidade moderada. Posteriormente, tais indivíduos foram pareados a controles e a diferença no consumo de oxigênio e parâmetros cardiorrespiratórios (frequência cardíaca FC, razão da troca respiratória RER, equivalente ventilatório VE/VCO2, pulso de oxigênio VO2/FC e duplo produto) e parâmetros clínicos do TECP (tempo, velocidade e inclinação), TE (tempo, degraus, distância) e TC6 (distância e velocidade) foram avaliados. O custo energético dos testes submáximos foi calculada dividindo-se o VO2 pico dos testes pela distância percorrida. O VO2 pico dos TECP, TE e TC6 foram semelhantes entre grupos. No TECP, a velocidade e inclinação atingidas no pico do exercício foram maiores no grupo controle (CT). No TE, o tempo foi menor no grupo CT e degraus e distância foram maiores. No TC6, a distância e velocidade foram maiores no grupo CT. O custo energético foi maior no grupo DP, no TE, mostrando que tais indivíduos gastam mais energia por metro percorrido que os controles. Fatores modificáveis como a habilidade de realizar AVD e bradicinesia foram identificados como preditores do nível de atividade física de indivíduos com DP. Variáveis clínicas do TE (intensidade vigorosa) e do TC6 (intensidade moderada) foram capazes de prever parcialmente a capacidade ao exercício máxima e discriminaram indivíduos com DP de diferentes níveis funcionais. Com a utilização de testes submáximos como o TE e o TC6, a avaliação da capacidade ao exercício e performance funcional pode ser incluída no processo de reabilitação da DP. Finalmente, indivíduos com DP apresentaram eficiência energética reduzida durante atividades submáximas e funcionais como subir e descer escadas e caminhada.Although the daily physical activity pattern in the early stages of Parkinson's disease (PD) appears to be similar to that of controls, it tends to change with the progression of the disease. Recent research observed that individuals with PD are 29% less active than healthy individuals. In addition, due to the bradykinesia, individuals with PD tend to reduce the quantity and variety of regular physical activity. Understanding the factors related to the reduction of the physical activity level is of major importance in the management of PD complications. The exercise capacity of individuals with early-stage PD can be comparable to that of individuals without the disease when the subject involved maintain a certain level of regular physical activity. However, reaching aerobic peak occurs in a significantly lower level of exercise (lower speed, lower intensity or shortest time) indicating a lower energy efficiency. Data indicate that individuals with PD spend approximately 20% more energy than age- and sex- matched healthy individuals during exercises with similar load. Taking into account such findings in the literature, three objectives were outlined in this thesis: (a) investigate the determining factors of the physical activity level of individuals with PD; (b) investigate whether the Stair Ascent and Descent Test (TE) and the 6-minute Walk Test (6MWT) can be used in the evaluation of physical capacity of patients with PD and (c) to investigate whether there is a difference in energy efficiency of individuals with PD, when compared to individuals controls matched by age, sex and physical activity level. Initially, 46 individuals (66 ± 12 years) were recruited to investigate the determinants of the physical activity level of individuals with PD, using the Human Activity Profile (HAP). Through linear regression analysis, two models that explained 76% of the variance of HAP were observed. The first comprises age, ability to perform Activities of daily living (ADL) and HY modified scale; and the second comprises age, ability to perform ADL, and bradykinesia. Among the PD patients recruited, 20 (62 ± 8 years) participated in the subsequent studies. The variables number of steps climbed during five minutes of the ST (steps) and distance of the 6MWT were able to predict 36% and 41% of peak oxygen expenditure (VO2 peak) of a Cardiopulmonary Exercise Test (CPET). Steps and time spent for one ascent and descent (time) of the ST and distance and speed of the 6MWT were able to discriminate between individuals with different functional levels according to the HAP and the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS). The TE was considered vigorous intensity test, while the 6MWT presented moderate intensity. Subsequently, such individuals were matched to controls and the difference in oxygen expenditure, other cardiorespiratory parameters (heart rate HR, respiratory exchange ratio - RER, ventilatory equivalent - VE/VCO2, oxygen pulse - VO2/FC and double product) and clinical parameters of the CPET (time, speed and inclination), ST (time, steps, distance) and 6MWT (distance and speed) were evaluated. Submaximal exercise tests' energy cost was calculated by dividing the VO2 peak of tests by distance. The VO2 peak of CPET, ST and 6MWT were similar between groups. The CPET' speed and inclination reached at peak exercise were higher in the control group (CT). In the ST, the time was lower in the CT group and steps and distance were greater. In the 6MWT, distance and speed were higher in the CT group. Energy cost value in the ST was higher in the PD group, showing that such individuals spend more energy per meter traveled than controls. Modifiable factors such as ability to perform ADL and bradykinesia have been identified as predictors of physical activity level of individuals with PD. Clinical variables of the ST (vigorous intensity) and the 6MWT (moderate intensity) were able to partially predict maximal exercise capacity and discriminated PD individuals with different functional levels. With the use of submaximal exercise tests as the ST and the 6MWT, assessment of exercise capacity and functional performance can be included in the rehabilitation process of PD. Finally, individuals with PD presented reduced energy efficiency during functional submaximal activities such as stair ascent and descent and overground walking

Main determinants of physical activity levels in individuals with Parkinson’s disease

ABSTRACT This study analyzed the relationship between patient characteristics, factors associated with Parkinson’s disease (PD), and physical activity level of individuals affected by the disease. Forty-six volunteers with mild-to-moderate idiopathic PD were assessed using sections II/III of the Unified Parkinson’s Disease Rating Scale and their motor functions were classified according to the modified Hoehn and Yahr (HY) scale. Data such as age, disease duration, the Human Activity Profile (HAP), the Fatigue Severity Scale were collected. Lower limb bradykinesia and clinical subtypes of PD were defined. Two models that explained 76% of the variance of the HAP were used. The first comprised age, ability to perform activities of daily living (ADL), and the HY scale; the second comprised age, ability to perform ADL, and lower limb bradykinesia. Possible modifiable factors such as the ability to perform ADL and lower limb bradykinesia were identified as predictors of physical activity level of individuals with PD

Knowledge and use of the ICF in clinical practice by physiotherapists and occupational therapists of Minas Gerais

<div><p>ABSTRACT This study aims to evaluate the profile and knowledge of physiotherapists and occupational therapists from Minas Gerais about the International Classification of Functioning, Disability and Health (ICF) application in professional practice, trying to understand the reason for the underutilization of this universal instrument in Brazil. Observational and cross-sectional study was conducted using an online questionnaire prepared by specialists. An email was sent to all physiotherapists and occupational therapists enrolled in the Regional Council of the 4th Region. Of 22,121 emails, 1,313 were answered. 53% of the sample had graduate certificate, 65% had between two to ten years of experience, and 62% reported that clinics and patients’ houses are the places where they work. 72% of the professionals knew the ICF and 84% correctly answered the meaning of the acronym. However, 71% of professionals are unaware of the fields that make up this classification. The first contact with the ICF happened during graduation to 50% of professionals, and 28% had never had contact with ICF. 74% reported not using it in clinical practice. However, 82% of the participants believed that the use of ICF is viable in clinical practice. Most professionals had graduate certificate, worked in clinics and patients’ homes and, although most of them claim to know the ICF, the largest portion of the sample reported they did not use this classification in their professional lives, even though believing the ICF use is feasible. The lack of knowledge about the ICF prevents professionals from complying with the recommendations of the World Health Organization (WHO), the Brazilian National Health Council (CNS) and COFFITO (Brazilian Federal Council of Physical Therapy and Occupational Therapy) on the adoption of this instrument in exchange of information about health and clinical practice.</p></div

Determinants of the use of physiotherapy services among individuals with Parkinson's disease living in Brazil

ABSTRACT To identify the factors affecting the use of physiotherapy services among individuals with Parkinson's disease (PD) living in Brazil. Methods: Overall, 479 individuals with idiopathic PD, of both sexes, at any stage of the Hoehn & Yahr (HY) scale, and from seven capital cities in Brazil were recruited from 2014 to 2016. Multivariate logistic regression was the main statistical tool. For the construction of the logistic model, the association of the dependent variable “physiotherapy” with the independent sociodemographic/economic and clinical variables: age, education, family income, time of PD since onset, HY, the activities of daily living and motor subscales of the Unified Parkinson's Disease Rating Scale, cognitive aspects, depressive symptoms, fear of falling, freezing gait, history of falls, physical activity level, gait speed, walking performance and balance, were verified. Results: The 479 individuals had an average age of 65.2 ± 11.0 years, 88% were in the HY I-III stages and 43.4% were under physiotherapy treatment. The analysis identified two determinant variables related to the use of the physiotherapy service: level of education (OR = 1.24) and walking performance (OR = 0.82). Decreased walking performance and a higher educational level increased the use of a physiotherapy service in individuals with PD living in Brazil. Conclusions: The present study shows that individuals with PD, residents from different regions of Brazil, have limited access to physiotherapy services. In addition, the Brazilian Public Health Care System, as well as local programs, need to target PD individuals with a low educational level to improve their access to physiotherapy services. Goals should aim towards the development of physical exercise programs to improve the patients’ functional performance for a longer period

A killed Leishmania vaccine with sand fly saliva extract and saponin adjuvant displays immunogenicity in dogs.

A vaccine against canine visceral leishmaniasis (CVL), comprising Leishmania braziliensispromastigote protein, sand fly gland extract (SGE) and saponin adjuvant, was eval-uated in dog model, in order to analyse the immunogenicity of the candidate vaccine. The vaccine candidate elicited strong antigenicity in dogs in respect of specific SGE andLeishmania humoral immune response. The major saliva proteins recognized by serum from immunized dogs exhibited molecular weights of 35 and 45 kDa, and were related to the resistance pattern against Leishmaniainfection. Immunophenotypic analysis revealed increased circulating CD21 + B-cells and CD5 + T-cells, reflected by higher counts of CD4 + and CD8 + T-cells. The observed interac-tion between potential antigen-presenting cells (evaluated as CD14 + monocytes) and lymphocyte activation status indicated a relationship between innate and adaptive immune responses. The higher frequency in L. chagasi antigen-specific CD8 + T-lymphocytes, and their positive association with intense cell proliferation, in addition to the progressively higher production of serum nitric oxide levels, showed a profile compatible with anti-CVL vaccine potential. Further studies on immunological response after challenge with L. chagasi may provide important information that will lead to a better understanding on vaccine trial and efficacy

A killed Leishmania vaccine with sand fly saliva extract and saponin adjuvant displays immunogenicity in dogs.

A vaccine against canine visceral leishmaniasis (CVL), comprising Leishmania braziliensispromastigote protein, sand fly gland extract (SGE) and saponin adjuvant, was eval-uated in dog model, in order to analyse the immunogenicity of the candidate vaccine. The vaccine candidate elicited strong antigenicity in dogs in respect of specific SGE andLeishmania humoral immune response. The major saliva proteins recognized by serum from immunized dogs exhibited molecular weights of 35 and 45 kDa, and were related to the resistance pattern against Leishmaniainfection. Immunophenotypic analysis revealed increased circulating CD21 + B-cells and CD5 + T-cells, reflected by higher counts of CD4 + and CD8 + T-cells. The observed interac-tion between potential antigen-presenting cells (evaluated as CD14 + monocytes) and lymphocyte activation status indicated a relationship between innate and adaptive immune responses. The higher frequency in L. chagasi antigen-specific CD8 + T-lymphocytes, and their positive association with intense cell proliferation, in addition to the progressively higher production of serum nitric oxide levels, showed a profile compatible with anti-CVL vaccine potential. Further studies on immunological response after challenge with L. chagasi may provide important information that will lead to a better understanding on vaccine trial and efficacy

Identification of priority groups for COVID-19 vaccination in Brazil

In a context of community transmission and shortage of vaccines, COVID-19 vaccination should focus on directly reducing the morbidity and mortality caused by the disease. It was thus essential to define priority groups for vaccination by the Brazilian National Immunization Program (PNI in Portuguese), based on the risk of hospitalization and death from the disease. We calculated overrisk according to sex, age group, and comorbidities using hospitalization and death records from severe acute respiratory illness with confirmation of COVID-19 (SARI-COVID) in all of Brazil in the first 6 months of the epidemic. Higher overrisk was associated with male sex (hospitalization = 1.1 and death = 1.2), age over 45 years for hospitalization (OvRag ranging from 1.1 to 8.5), and age over 55 year for death (OvRag ranging from 1.5 to 18.3). In the groups with comorbidities, chronic kidney disease, diabetes mellitus, cardiovascular disease, and chronic lung disease were associated with overrisk, while there was no such evidence for asthma. Chronic kidney disease or diabetes and age over 60 showed an even stronger association, reaching overrisk of death 14 and 10 times greater than in the general population, respectively. For all the comorbidities, there was higher overrisk at older ages, with a downward gradient in the oldest age groups. This pattern was reversed when examining overrisk in the general population, for both hospitalization and death. The current study provided evidence of overrisk of hospitalization and death from SARI-COVID, assisting the definition of priority groups for COVID-19 vaccination.Em um contexto de transmissão comunitária e escassez de vacinas, a vacinação contra a COVID-19 deve focar na redução direta da morbidade e da mortalidade causadas pela doença. Portanto, é fundamental a definição de grupos prioritários para a vacinação pelo Programa Nacional de Imunizações (PNI), baseada no risco de hospitalização e óbito pela doença. Para tal, calculamos o sobrerrisco por sexo, faixa etária e comorbidades por meio dos registros de hospitalização e óbito por síndrome respiratória aguda grave com confirmação de COVID-19 (SRAG-COVID) em todo o Brasil nos primeiros seis meses de epidemia. Apresentaram maior sobrerrisco pessoas do sexo masculino (hospitalização = 1,1 e óbito = 1,2), pessoas acima de 45 anos para hospitalização (SRfe variando de 1,1 a 8,5) e pessoas acima de 55 anos para óbitos (SRfe variando de 1,5 a 18,3). Nos grupos de comorbidades, doença renal crônica, diabetes mellitus, doença cardiovascular e pneumopatia crônica conferiram sobrerrisco, enquanto para asma não houve evidência. Ter doença renal crônica ou diabetes mellitus e 60 anos ou mais mostrou-se um fator ainda mais forte, alcançando sobrerrisco de óbito 14 e 10 vezes maior do que na população geral, respectivamente. Para todas as comorbidades, houve um sobrerrisco mais alto em idades maiores, com um gradiente de diminuição em faixas mais altas. Esse padrão se inverteu quando consideramos o sobrerrisco em relação à população geral, tanto para hospitalização quanto para óbito. O presente estudo forneceu evidências a respeito do sobrerrisco de hospitalização e óbito por SRAG-COVID, auxiliando na definição de grupos prioritários para a vacinação contra a COVID-19.En un contexto de transmisión comunitaria y escasez de vacunas, la vacunación contra la COVID-19 debe enfocarse en la reducción directa de la morbilidad y de la mortalidad causadas por la enfermedad. Por lo tanto, es fundamental la definición de grupos prioritarios para la vacunación por el Programa Nacional de Inmunizaciones (PNI), basada en el riesgo de hospitalización y óbito por la enfermedad. Para tal fin, calculamos el sobrerriesgo por sexo, franja de edad y comorbilidades mediante los registros de hospitalización y óbito por síndrome respiratorio agudo grave con confirmación de COVID-19 (SRAG-COVID) en todo Brasil, durante los primeros seis meses de epidemia. Presentaron mayor sobrerriesgo personas del sexo masculino (hospitalización = 1,1 y óbito = 1,2), personas por encima de 45 años para hospitalización (SRfe variando de 1,1 a 8,5) y personas por encima de 55 años para óbitos (SRfe variando de 1,5 a 18,3). En los grupos de comorbilidades, enfermedad renal crónica, diabetes mellitus, enfermedad cardiovascular y neumopatía crónica ofrecieron sobrerriesgo, mientras que para el asma no hubo evidencia. Sufrir una enfermedad renal crónica o diabetes mellitus y tener 60 años o más mostró un factor todavía más fuerte, alcanzando sobrerriesgo de enfermedad 14 y 10 veces mayor que en la población general, respectivamente. Para todas las comorbilidades, hubo un sobrerriesgo más alto en edades mayores, con un gradiente de disminución en franjas más altas. Este patrón se invirtió cuando consideramos el sobrerriesgo en relación con la población general, tanto para hospitalización como para óbito. El presente estudio proporcionó evidencias respecto al sobrerriesgo de hospitalización y óbito por SRAG-COVID, ayudando en la definición de grupos prioritarios para la vacunación contra la COVID-19