Da un protocollo sperimentale a un modello assistenziale per l’arteriopatia periferica: compliance, outcome riabilitativo e costo-efficacia di un programma originale di sport-terapia

Background Exercise training is an effective, low-cost yet underutilized therapy to improve the functional ability of patients with intermittent claudication. Its diffusion could be favoured by models of intervention that would help ensure functional and cardiovascular improvements, patient compliance and lower costs for the healthcare system. Recently an original model of sport therapy for peripheral arterial disease (PAD) prescribed at hospital and performed at home (Test in-Train out, Ti-To) showed to be more effective than a traditional home based training. Aim of the study The study aims to evaluate compliance, effect on rehabilitative outcomes and cost-effectiveness of the Ti-To model in its application as a health care model during a two- years period. Subjects and Methods 250 (age 70.5±9.2, M=191) out of 289 patients included in the Rehabilitation Program were recruited into the study . Compliance was evaluated by means of a score ranging from 0 to 4 (higher score indicates higher compliance). Rehabilitative outcomes, evaluated upon entry and at discharge, were: Ankle Brachial Index (ABI), Pain Threshold Speed (PTS) and Maximal Speed (Smax) measured by means of an incremental treadmill test, Initial Claudication Distance (ICD) and Absolute Claudication Distance (ACD) measured by means of a constant load treadmill test. Quality of life (QoL) was also evaluated in a sample composed of 90 patients by means of SF 36 questionnaire. Besides a cost effectiveness analysis was performed in order to determine the cost to walk an additional meter for ICD and ACD, the cost to gain 10% of ICD and ACD and to increase of 1 m/min the parameter PTS. The intervention was based on two 10 min-sessions/day of intermittent walking performed at home at an intensity 20%-30% lower than PTS and on serial check-ups at hospital to update the exercise program. The rehabilitative team included one doctor, a nurse and one expert of sport sciences. Results Average compliance score was 3.1±0.9. Functional parameters significantly improved (ABI: 0.60±0.16 a 0.64±0.18, p<0.0001; PTS (Km/h): 2.9±1.2 a 4.0±1.2 p<0.0001; Vmax (Km/h) 3.6±1.2 a 4.3±1.1; ICD (m) 79.2±47.8 a 115.8±53.4, p<0.0001; ACD (m): 125.3±69.6 a 179.9±71.9, p<0.0001). Baseline characteristics of patients who underwent QoL evaluation were not different from the whole population under study. All SF 36 subscales significantly improved (p<0.0001). Most of parameters showed a moderate to large Cohen’s d Effect Size. 1839 visits were performed (7.4±2.0/patient). The average cost of a visit and of a therapy cycle were € 68.93 and €507.20 respectively, with an average cost of €8,14 E to walk one additional meter before stopping and a cost to gain 10% of ICD and ACD and 1m/min of PTS respectively of 65.8 e € 72,2 e €23.56. Conclusion An original rehabilitative model for PAD based on exercise prescribed at hospital and performed at home showed a high compliance, effectiveness on improving functional capacity and QoL and a lower cost-effectiveness ratio compared to the available models of intervention in AOP

FATORES ASSOCIADOS AO BAIXO PESO AO NASCER NO ESTADO DE GOIÁS

Recém-nascidos de baixo peso ao nascer (RNBP) são considerados problemas de saúde pública pela associação com altas taxas de mortalidade e morbidade. Nenhum estudo prévio sobre fatores associados ao RNBP na região central do Brasil foi encontrado na literatura. Assim, este estudo teve como objetivo identificar as prevalências e os fatores associados ao baixo peso ao nascer entre nascidos vivos no Estado de Goiás, Brasil. Foi realizado um estudo transversal tendo como fonte de dados o Sistema de Informações de Nascidos Vivos ligado ao Ministério da Saúde. Examinou-se todos os 92.745 recém-nascidos de gestação única residentes no estado de Goiás, no ano 2000. Usou-se análise de regressão logística para identificar os fatores associados ao RNBP (< 2500 g). Em Goiás, os RNBP apresentaram uma prevalência de 5,96% e os fatores associados ao baixo peso ao nascer foram: prematuridade, baixa e avançada idade materna, mulheres não casadas, menos de sete consultas de pré-natal, parto não hospitalar e neonatos do sexo feminino. Ações intersetoriais são necessárias para reduzir as desigualdades da saúde materna e infantil

Solubilidad de Urea en mezclas de etanol-agua y etanol puro a temperaturas de 278,1K a 333,1K

This paper deals with the solubility of urea in ethanol-water mixtures in mole fractions of ethanol between 0.0901 and 1.000 at temperatures ranging from 278.1 to 333.1K. The investigation of solubility contributes to research in many others fields of study in chemical engineering, since there are several studies where the solubility of urea and its behavior in solution influence the system. The experiment was carried out at constant temperature, stirring for 2 hours and then leaving the solution at rest for 2 hours. After collecting the data, the solubility of urea was calculated based on the gravimetric method. The experimental results obtained were correlated with the temperature of the solvents using three equations based on the literature. The three models demonstrated results in line with the experimental data. It was observed that adding ethanol to the water decreased urea solubility in all cases. The differences between the predicted and the experimental values were on average 4.7%.Este artículo trata de la solubilidad de la urea en mezclas de etanol-agua en fracciones molares de etanol entre 0,0901 y 1,000 a temperaturas de 278,2 a 333,2K. La investigación de la solubilidad contribuye en muchos estudios en muchos otros campos de estudio en ingeniería química, ya que hay varios estudios en que la solubilidad de la urea y su comportamiento en solución influyen en el sistema. El experimento se llevó a cabo a temperatura constante, se agitó durante 2h y en seguida la solución se dejó en reposo también por 2h. Después de recoger los datos, la solubilidad de la urea se calculó basándose en el método gravimétrico. Los resultados experimentales obtenidos se correlacionaron con la temperatura de los disolventes usando tres ecuaciones basadas en la literatura. Los modelos han demostrado resultados en línea con los datos experimentales. Se observó que la adición de etanol al agua disminuye la solubilidad de la urea en todos los casos. Las diferencias entre los predichos y los valores experimentales fueron en promedio de 4,7%.Este artigo trata da solubilidade de uréia em misturas de etanol-água em frações molares de etanol entre 0,0901 e 1,000 e temperaturas que variam de 278,1 a 333,1K. A investigação de solubilidade contribui para a pesquisa em muitos outros campos de estudo em engenharia química, uma vez que&nbsp;há vários estudos em que a solubilidade da ureia e o seu comportamento em solução influenciam o sistema. O experimento foi realizado a uma temperatura constante com agitação de 2h e, em seguida, deixando a solução em repouso durante 2h. Depois de recolher os dados, a solubilidade da ureia foi calculada com base no método gravimétrico. Os resultados experimentais obtidos foram correlacionados com a temperatura dos solventes utilizando três equações com base na literatura. Os três modelos demonstraram resultados condizentes com os dados experimentais. Observou-se que a adição de etanol na mistura provoca diminuição na solubilidade ureia em todos os casos. As diferenças entre os valores previsto e os experimentais foram, em média, 4,7%

Elastic stockings effect on leg volume variability in healthy workers under prolonged gravitational gradient exposure

The aim of this study was to determine the elastic stockings effect on healthy workers (HW) who are exposed to a prolonged hydrostatic pressure overload for professional reasons. The cohort was composed by 20 HW who voluntarily underwent a water plethysmography test before and after eight hour of standing up in an operating room, wearing elastic stockings. After 8 h of gravity exposure, we demonstrated the absence of leg volume increase in case of elastic stockings use. In the morning measurement we found that the lower limb volume was 1967.5 mL±224, while in the evening it was 1962.5 mL±227 (P&lt;0.0828). The decreased volume is significantly correlated with the time that was spent under gravity forces for working purpose wearing elastic stockings (R2=0.99, P&lt;0.0001). Our experiment demonstrates that elastic stockings may effectively counteract the increased leg volume over time in workers who are exposed to prolonged gravitational gradient. Further longitudinal studies are needed to determine if the above effect could correct one of the major risk factors for the development of chronic venous insufficiency

A Dynamic Objective Evaluation of Peripheral Arterial Disease by Near-Infrared Spectroscopy

AbstractObjectivesNear-Infrared Spectroscopy (NIRS), suitable for dynamic measurements, is not routinely used for peripheral arterial disease (PAD). We propose a dynamic NIRS-based measurement to quantify variations in muscle metabolism in PAD.MethodSixty-seven consecutive PAD patients (males=56, age 71.6±8.7 years) and 28 healthy subjects (males=12, age 30.4±11.9 years) were studied. An echo-colour Doppler (ECD) was performed and the ankle–brachial index (ABI) was calculated. Participants performed an incremental treadmill test with NIRS probes on the gastrocnemius. Variations in oxygenated (HbO2), deoxygenated (HHb), total (tHb=HbO2+HHb), and differential (dHb=HbO2−HHb) haemoglobin were recorded and quantified as area-under-curve (AUC) within the range 1.7–3.0kmh−1. Heart rate was recorded, and the number of beats in the same interval was calculated (dHr).ResultsO2HbAUC, HHbAUC and dHbAUC differed between diseased and non-diseased legs (P<0.0001) and exhibited different patterns related to PAD severity according to the ABI value. A compensatory heart rate increase was observed in PAD patients. Compared with the ECD positivity for occlusions/stenoses or multiple plaques, only the receiver-operating characteristic (ROC) analysis of dHbAUC (area=0.932, P<0.0001) showed a sensitivity/specificity of 87.6/93.4 for values ≤−197 (LR+LR−: 13.36/0.13).ConclusionThe dynamic NIRS-based test, quantifying muscle metabolic response according to presence and degree of PAD, allows the evaluation of patients with walking disabilities

A specifically designed aquatic exercise protocol to reduce chronic lower limb edema

Objective Despite the fact that muscle pump activation is known to positively impact chronic lower limb edema, objective measurements of standardized exercises for venous-lymphatic rehab are lacking. The aim of this investigation is to determine the effectiveness of an addressed physical activity exploiting the advantages of an aquatic environment.Material and methods Thirty-two lower limbs of 16 patients affected by bilateral chronic leg swelling were included (12 females, 4 males). All the patients underwent a protocol of five sessions of physical exercises specifically conceived inside a pool. Volumetry, subcutaneous thickness, ankle range of motion and symptomatology were assessed as outcome measures.Results One week after the end of the protocol, the average reduction in lower limb volume was 303.1369.72ml (p=0.00002) and 334.38 +/- 62.50ml (p=0.000003) in the right and left legs, respectively. Ankle range of motion and feeling of heaviness significantly improved.Conclusion A specifically designed aquatic protocol is able to positively impact chronic leg swelling offering a first line rehab for this medical condition

Histologic and sonographic features of holmium laser in the treatment of chronic venous disease

A new holmium laser (HOL) has been introduced to the market. The device is able to reduce the great saphenous vein (GSV) caliber in a tumescence-free procedure, favoring an effective sclerotherapy of large vessels. Aim of the present investigation is to provide the first in vivo data about the effect of HOL on GSV histology

Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis

BACKGROUND: The extracranial venous outflow routes in clinically defined multiple sclerosis (CDMS) have never been investigated. METHODS: Sixty-five patients affected by CDMS, and 235 controls composed, respectively, of healthy subjects, healthy subjects older than CDMS patients, patients affected by other neurological diseases, and older controls not affected by neurological diseases but scheduled for venography (HAV-C), blindly underwent a combined transcranial and extracranial Color-Doppler high-resolution examination (TCCS-ECD) aimed at detecting at least two of five parameters of anomalous venous outflow. According to the TCCS-ECD screening, patients and HAV-C further underwent selective venography of the azygous and jugular venous system with venous pressure measurement. RESULTS: CDMS and TCCS-ECD venous outflow anomalies were dramatically associated (OR 43, 95% CI 29-65, p<0.0001). Subsequently, venography demonstrated in CDMS, and not in controls, the presence of multiple severe extracranial stenosis, affecting the principal cerebrospinal venous segments; it configures a picture of chronic cerebrospinal venous insufficiency (CCSVI) with four different patterns of distribution of stenosis and substitute circle. Moreover, relapsing-remitting and secondary progressive courses were associated to CCSVI patterns significantly different from those of primary progressive (p<0.0001). Finally, the pressure gradient measured across the venous stenosies was slightly but significantly higher. CONCLUSION: CDMS is strongly associated with CCSVI, a picture never been described so far, characterized by abnormal venous haemodynamics determined by extracranial multiple venous strictures of unknown origin. The location of venous obstructions plays a key role in determining the clinical course of the disease

Qualidade de vida de idosos que participam de grupo de promoção da saúde

Introduction: Population aging sets as worldwide phenomenon, therefore, it is essential to implement activities that contribute to a healthy and active aging. This research aimed to describe the Quality of Life (QoL) of elderly participants of a group of health promotion.Methodology: This is a descriptive research with quantitative approach, with elderly enrolled in a Primary Care -Family Health Unit (UABSF), participating in a group of health promotion. Data collection took place from June to October 2012, through a sociodemographic questionnaire, the WHOQOL-BREF and WHOQOL-OLD. Data were analyzed using Stata software, version 11.0. Numerical variables were explored by descriptive measures of centrality and dispersion and the categorical by simple absolute and percentage frequencies. The WHOQOL-BREF and the facet of the WHOQOL-OLD were represented by mean, standard deviation and confidence interval.Results: The mean age of the elderly is 71.0 years (SD: 7.2). Most seniors assessed their QoL as good or very good (20; 76.9%), but almost all of them were not satisfied with their health (24; 92.4%) (Table 2).Conclusion: The assessment of QoL sets up strategy that can be used by the health professional that coordinates groups to identify aspects of life of the most committed elderly by the aging process and, thus, enables the implementation of effective interventions to the demands of these clients.Introducción: El envejecimiento de la población se configura como un fenómeno mundial, por lo que es esencial para poner en práctica actividades que contribuyan a un envejecimiento saludable y activo. Este estudio tuvo como objetivo describir la calidad de vida (CV) de los mayores participantes de un grupo de promoción de la salud. Metodología: Se trata de un estudio de abordaje cuantitativo, con mayores inscritos en una Unidad de Atención Primaria de Salud de la Familia (UABSF), que participan de un grupo de promoción de la salud. La recolección de datos ocurrió entre junio y octubre de 2012, utilizando un cuestionario socio demográfico, del WHOQOL-BREF y WHOQOL-OLD. Los datos fueron analizados en el software Stata versión 11.0. Las variables numéricas fueron exploradas por medidas descriptivas de centralidad y de dispersión y las categóricas por frecuencias simpes absolutas y porcentajes. Los dominios del WHOQOL-BREF y la faceta del WHOQOL OLD fueron representados por media, desviación estándar e intervalo de confianza. Resultados: La edad media de los mayores es 71,0 años (DE: 7,2). La mayoría de las personas mayores evaluaron su CV como buena o muy buena (20, 76,9%), pero casi todos ellos no estaban satisfechos con su salud (24, 92,4%) (Tabla 2). Conclusión: La evaluación de la CV se configura en estrategia que puede ser utilizada por profesionales de la salud que coordinan grupos para identificar los aspectos de la vida de los mayores más afectados por el proceso de envejecimiento y, por lo tanto, permite la implementación de intervenciones efectivas a las necesidades de esta clientela.Introdução: O envelhecimento populacional configura-se em fenômeno mundial, sendo assim, torna-se imprescindível implementar atividades que contribuam para um envelhecimento saudável e ativo. Essa pesquisa objetivou descrever a Qualidade de Vida (QV) de idosos participantes de um grupo de promoção da saúde. Metodologia: Trata-se de uma pesquisa descritiva de abordagem quantitativa, com idosos cadastrados em uma Unidade de Atenção Básica à Saúde da Família (UABSF), que participam de um grupo de promoção da saúde. A coleta de dados ocorreu de junho a outubro de 2012, por meio de um questionário sociodemográfico, do WHOQOL-BREF e WHOQOL-OLD. Os dados foram analisados no software Stata versão 11.0. As variáveis numéricas foram exploradas pelas medidas descritivas de centralidade e de dispersão e as categóricas por frequências simples absolutas e percentuais. Os domínios do WHOQOL-BREF e as faceta do WHOQOL-OLD foram representados por média, desvio-padrão e intervalo de confiança.Resultados: A idade média dos idosos é de 71,0 anos (DP: 7,2). A maioria dos idosos avaliou sua QV como boa ou muito boa (20; 76,9%), mas quase totalidade deles não estava satisfeita com sua saúde (24; 92,4%) (Tabela 2). Conclusão: A avaliação da QV configura-se em estratégia que pode ser usada pelo profissional de saúde que coordena grupos para identificar aspectos da vida dos idosos mais comprometidos pelo processo de envelhecimento e, dessa maneira, possibilita a implementação de intervenções efetivas às demandas dessa clientela