Research scenario in physiotherapy for people with human t-cell lymphotropic virus (HTLV): scientometric study / Cenário das pesquisas em Fisioterapia para pessoas com Human T-Cell Lymphotropic Virus (HTLV): estudo cientométrico

Introduction: Human T-Cell Lymphotropic Virus (HTLV) is a sexually transmitted retrovirus that can cause chronic pain of moderate to high intensity, spasticity and weakness in the lower limbs, balance, gait, urinary and sexual dysfunctions. Physiotherapy is a treatment that has been shown to be effective in improving symptoms and signs. However, research on the topic is scarce. Objective: Outline the research scenario in Physiotherapy aimed at people infected with HTLV-1. Methods: Scientometric study carried through Medline, Virtual Health Library, Scopus, Web of Science and Google Scholar databases. The metadata regarding the studies were tabulated and analyzed using descriptive statistics. The VOS.Viewer software was used for the analysis of quotes. Clinical studies were also analyzed considering meta-scientific impacts including analysis of conflicts of interest and methodological biases. Results: Initially 1160 studies were identified. After applying the eligibility criteria, 68 articles remained, of which 34 articles were observational studies, 21 on intervention, 9 on review, two on qualitative research and two on diagnostic accuracy. Brazil is responsible for 94.11% of the production on the theme. The sub-areas of Physiotherapy covered by the studies were neurofunctional and urogenital, using different exercise modalities, proprioceptive neuromuscular facilitation, biofeedback and non-invasive neuromodulation. Conclusion: On the topic of Physiotherapy for people with HTLV-1, Brazil occupies a prominent place in scientific production. Research on the subject receives little or no funding, requiring free of charge publications in journals, which affects its visibility

Oscilaciones del centro de gravedad en la mielopatía asociada al HTLV-1/paraparesia espástica tropical

[Abstract] Introduction: Postural control in individuals with HTLV-1-associated myelopathy or tropical spastic paraparesis (HAM/TSP) is usually compromised, which increases the risk of falls, makes it difficult to perform activities of daily living, and impairs the quality of life. The profile of the center of gravity oscillations in this population is unknown and may aid in clinical follow-up and research. Objective: To compare the stabilometric values between HAM/TSP and uninfected individuals and verify the existence of correlations between stabilometric variables and the Berg Balance Scale (BBS). Method: A cross-sectional observational study was performed with infected individuals, classified as defined and likely (WHO criteria), compared to accompanying persons and seronegative relatives. A baropodometry platform (Footwork®) was used to obtain the oscillation values of the body’s center of gravity in total oscillation area (TOA), anterior-posterior oscillation (APO) and lateral oscillation (LO). Mean values were correlated with BBS by Spearman’s Correlation (5% alpha). Approved by the ethical committee of Escola Bahiana de Medicina e Saúde Pública under Opinion 49634815.2.0000.5628. Results: An asymmetric distribution of all the stabilometric variables analyzed in the HAM/TSP population was found, different from the uninfected group (p < 0.05). It was also possible to verify strong to moderate and inverse correlations between the variables of center of gravity oscillation with the scores obtained in BBS, especially for TOA and LO. Conclusion: People with HAM/TSP presented higher values for the center of gravity oscillations and these were correlated with the BBS in the balance evaluation.[Resumo] Introdução: o controle postural em indivíduos com mielopatia associada ao HTLV-1 ou paraparesia espástica tropical (HAM/TSP) é geralmente comprometido, o que aumenta o risco de quedas, dificulta a realização de atividades de vida diária e prejudica a qualidade de vida. O perfil das oscilações do centro de gravidade nesta população é desconhecido e pode auxiliar no acompanhamento clínico e na pesquisa. Objetivo: comparar os valores estabilométricos entre pessoas com HAM/TSP e não infectados, e verificar a existência de correlações entre variáveis estabilométricas e a Escala de Equilíbrio Berg (EEB). Método: foi realizado um estudo observacional transversal com indivíduos infectados, classificados como definidos e prováveis (critérios da OMS), comparados com acompanhantes e familiares soronegativos. Uma plataforma de baropodometria (Footwork®) foi utilizada para obter os valores de oscilação do centro de gravidade do corpo em área de oscilação total (AOT), oscilação anteroposterior (OAP) e oscilação laterolateral (OLL). Os valores médios foram correlacionados com a BBS pela Correlação de Spearman (alfa 5%). Aprovado pelo Comitê de Ética da Escola Bahiana de Medicina e Saúde Pública sob o CAAE 49634815.2.0000.5628. Resultados: encontrou-se distribuição assimétrica de todas as variáveis estabilométricas analisadas na população com HAM/TSP, diferentes do grupo de não infectados (p < 0,05). Também foi possível verificar correlações de forte a moderada e inversas entre as variáveis de oscilação do centro de gravidade com os escores obtidos na EEB, especialmente para AOT e OLL. Conclusão: Pessoas com HAM/TSP apresentaram valores maiores para as oscilações do centro de gravidade e estas foram correlacionadas com a EEB na avaliação do equilíbrio.[Resumen] Introducción: El control postural en individuos con mielopatía asociada al HTLV-1 o paraparesia espástica tropical (HAM/TSP) suele estar comprometido, lo que aumenta el riesgo de caídas, les dificulta en las actividades de la vida diaria y perjudica su calidad de vida. Conocer el perfil de las oscilaciones del centro de gravedad en esta población puede ayudar en el seguimiento clínico y la investigación. Objetivo: Comparar los valores estabilométricos entre personas con HAM/TSP y personas no infectadas, y verificar la existencia de correlaciones entre las variables estabilométricas y la Escala de Equilibrio de Berg (BBS). Método: Se realizó un estudio observacional transversal con individuos infectados, clasificados como definidos y probables (criterios de la OMS), comparados a acompañantes y familiares seronegativos. Se utilizó una plataforma de baropodometría (Footwork®) para obtener los valores de oscilación del centro de gravedad del cuerpo en el área de oscilación total (AOT), oscilación antero-posterior (OAP) y oscilación lateral-lateral (OLL). Los valores medios se correlacionaron con la BBS por la correlación de Spearman (alfa 5%). Estudio aprobado por el Comité de Ética de la Escuela Bahiana de Medicina y Salud Pública bajo CAAE 49634815.2.0000.5628. Resultados: Se encontró una distribución asimétrica de todas las variables estabilométricas analizadas en la población HAM/TSP diferente en el grupo no infectado (p <0,05). También fue posible verificar correlaciones de fuertes a moderadas e inversas entre las variables de oscilación del centro de gravedad con las puntuaciones obtenidas en la BBS, especialmente para AOT y OLL. Conclusión: Las personas con HAM/TSP presentaron valores más altos en las oscilaciones del centro de gravedad, las cuales se correlacionaron con la BBS en la evaluación del equilibrio

Methods of preparation of health education materials for adults: an integrative review

Introdução – Uma boa comunicação entre profissionais de saúde e pacientes favorece vínculos e transmissão de conhecimento. Os materiais socioeducativos podem ampliar essa comunicação, complementar informações, favorecer a autonomia e serem consultados inúmeras vezes. Objetivo – Identificar a metodologia utilizada para a elaboração de materiais de educação em saúde impressos para adultos. Métodos – Foi realizada uma revisão integrativa, de acordo com o PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis), por dois investigadores independentes nas bases de dados PubMed e SciELO. A seleção envolveu a leitura de títulos, resumos e textos completos. Foram incluídos estudos reprodutíveis, sem delimitação de tempo e idioma; e foram excluídos os materiais para educação profissional, de crianças e duplicados. Resultados – Foram selecionados treze artigos que envolveram a aproximação do público-alvo e/ou pesquisa do tema na literatura nas bases PubMed, SciELO, Lilacs e literatura cinzenta. Houve um consenso quanto à necessidade de linguagem clara e compreensível, ilustrações e diagramação para facilitar a compreensão. Conclusões – A metodologia para elaboração de materiais educativos em saúde é diversa, baseia-se em revisão da literatura, aproximação com o público-alvo, mas nem sempre avalia o nível de alfabetização em saúde do público-alvo.ABSTRACT: Introduction – Good communication between health professionals and patients favors links and knowledge transfer. Socio-educational materials can extend or expand this communication, complement information, promote autonomy as well as the possibility to be consulted repeatedly. Objective – To identify the methodology used for the elaboration of printed health education materials for adults Methods – Integrative review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) was performed by two independent researchers in the Pubmed, and SciELO, and Lilacs, and gray literature databases. The selection involved reading titles, abstracts, and full texts. Reproducible studies were included, without confining time and language. Also, materials for professional and child education were excluded along with recurrences. Results – Thirteen articles selected involved the approximation to the target public and/or search of the topic in the literature. There was a consensus regarding the need for a clear and understandable language, illustrations and diagrams to ease understanding. Conclusion – Methodology for the elaboration of educational materials in the health area is diverse. It is based on a literature review together with an approach to the target audience, but it does not always evaluate the health literacy level of the targeted public.info:eu-repo/semantics/publishedVersio

Educação em saúde para indivíduos com dor crônica: ensaio clínico

https://creativecommons.org/licenses/by/4.0/BACKGROUND AND OBJECTIVES: The use of socio-educational booklets is recommended for assisting in the control of chronic pain (CP). However, the efficacy and safety of these light technologies have not yet been tested enough for widespread application, based on the model of scientific evidence. This study aimed to assess the effect of a health education program in individuals suffering from CP using the EducaDor booklet. METHODS: Randomized clinical trial conducted with CP patients from Unidades Básicas de Saúde (UBS – Primary Health Care Units) in Salvador, Bahia, Brazil. Assessments were performed using the Brief Pain Inventory (BPI), Visual Analog Scale of Pain (VAS-P) and World Health Organization Quality of Life instrument-Bref (WHOQoL-bref ), before and after the intervention, for intra and intergroup analyses: Test Group (Booklet) and Control Group (Conventional Care). The contents of the EducaDor booklet were presented didactically in six meetings with an interval of one week between them. RESULTS: The sample was composed of 10 individuals in each group (n = 20). In the Control Group, there was an increase in pain intensity (p=0.034), while the Test Group showed a reduction in pain intensity (p=0.015) and a lower level of interference in the physical, psychological, social relationships and environmental quality of life domains (p<0.05). In the intergroup comparisons, an improvement was observed in the domain of social relationships in the Test Group (p=0.015). CONCLUSION: EducaDor booklet has been shown to be effective and safe for the education of patients suffering from CP by reducing pain intensity and improving patients’ quality of life. JUSTIFICATIVA E OBJETIVOS: Recomenda-se a utilização de cartilhas socioeducativas para auxiliar no controle da dor crônica (DC). No entanto, a eficácia e a segurança dessas tecnologias leves foram pouco testadas para ampla aplicação, com base no modelo de evidências científicas. Este estudo teve como objetivo avaliar o efeito de um programa de educação em saúde em indivíduos com DC por meio da cartilha EducaDor. MÉTODOS: Ensaio clínico randomizado realizado com indivíduos que apresentam DC em Unidades Básicas de Saúde (UBS) de Salvador, Bahia, Brasil. Os participantes foram submetidos à aplicação do Inventário Breve de Dor (BPI), Escala Analógica Visual (EAV) e do instrumento de Qualidade de Vida da Organização Mundial da Saúde - Bref (WHOQoL-bref ), antes e após a intervenção, para análises intra e intergrupos: Grupo Teste (booklet) e Grupo Controle (cuidado convencional). O conteúdo da cartilha EducaDor foi apresentado didaticamente em seis encontros com intervalo de uma semana entre eles. RESULTADOS: A amostra foi composta por 10 pessoas em cada grupo (n = 20). No Grupo Controle, houve aumento da intensidade da dor (p=0,034), enquanto o Grupo Teste apresentou redução da intensidade de dor (p=0,015) e menor nível de interferência nos domínios de qualidade de vida físico, psicológico, social e ambiental (p<0,05). Nas comparações intergrupos, observou-se melhora no domínio relações sociais no Grupo Teste (p=0,015). CONCLUSÃO: A cartilha EducaDor mostrou-se eficaz e segura para a educação de pacientes com DC, por reduzir a intensidade da dor e melhorar a qualidade de vida dos pacientes.info:eu-repo/semantics/publishedVersio

The immediate effect of transcranial direct current stimulation combined with peripheral electrical stimulation in the control of temporomandibular pain in subjects with sickle cell disease: A protocol for one session randomized, crossover, double-blind clinical trial

INTRODUCTION: Temporomandibular disorder (TMD) is currently considered a central sensitization syndrome that belongs to the orofacial nociplastic pain group and offers great challenges for clinical practice. It can also be identified in individuals with sickle cell disease. Neuromodulation is a promising therapy that can help individuals with refractory chronic pain. To our knowledge, there is no treatment proposal for these individuals with chronic orofacial pain resulting from sickle cell disease. OBJECTIVE: This is a protocol of a randomized, double-blind, cross-over clinical trial. The purpose of this protocol is to investigate whether the immediate effect of transcranial direct current stimulation can be increased by adding the effect of peripheral sensory electrical stimulation. METHODS: Twenty women between 18 and 49 years of age will be screened to participate in this cross-over study where they will all receive the three types of protocol with a one-week washout. Active transcranial Direct Current Stimulation (tDCS) + active Peripheral Electrical Stimulation (PES); Active tDCS + PES sham and tDCS sham + PES sham. Stimulation with tDCS will be at 2 mA anodic over the motor cortex for 20 minutes ipsilateral to the most painful temporomandibular joint (TMJ). Peripheral electrical stimulation will be at 100 Hz over the most painful TMJ masseter muscle for 30 min. OUTCOME: The main outcome will be pain intensity assessed by VAS scale and by a pressure algometer in grams. In addition, endogenous pain modulation will be analyzed through the temporal summation of pain with Aesthesio precision tactile sensory filaments and conditioned pain modulation (CPM) evaluated by an algometer and thermal conditioned stimulus, as secondary outcomes. Data will be analyzed using ANOVA of repeated measures, controlling for confounding variables

Development of a quantitative health inspection instrument in food and nutrition services, Brazil

O estudo visou desenvolver um Instrumento Quantitativo para Inspeção Sanitária (IQIS) em serviços de alimentação e nutrição de grande porte no Brasil. Utilizou-se a tecnologia de inspeção, no Modelo de Avaliação do Risco Potencial (MARP) e legislação sanitária brasileira. Estruturaram-se 12 dimensões, 41 módulos, 57 indicadores de controle de riscos (críticos/não críticos), numa escala de 0-5, totalizando 1.512 índices com codificação de respostas fechadas. O IQIS foi validado com o Coeficiente de Kappa, com excelente concordância para atributos de clareza e relevância (k = 0,82 e k = 0,92) e boa concordância para o atributo aplicabilidade (k = 0,78). O teste de Kruskal-Wallis mostrou inexistir diferença significativa entre as avaliações (p = 0,423), o Coeficiente de Correlação Intraclasse foi satisfatório (CCI = 0,53), o Alpha de Cronbach (α = 0,71) aceitável. O resultado final possibilitou classificar o serviço como tendo risco sanitário inaceitável. Considera-se o IQIS com conteúdo validado, tendo confiabilidade e reprodutibilidade para avaliação higiênico-sanitária, sendo uma inovação tecnológica para serviços de alimentação e nutrição e vigilância sanitária, possibilitando inspeção detalhada e rigorosa.The study aimed to develop a Quantitative Instrument for Sanitary Inspection (QISI) in large food and nutrition services in Brazil. The inspection technology, based on the Potential Risk Assessment Model (PRAM) and Brazilian sanitary legislation, was used. 12 dimensions, 41 modules, and 57 risk control indicators (critical/non-critical) were associated with an interval scale of 0-5, totaling 1,512 indexes with closed response coding. The QISI was validated with the Kappa Coefficient, with excellent agreement for attributes of clarity and relevance (k = 0.82 and k = 0.92) and good agreement for the applicability attribute (k = 0.78). The Kruskal-Wallis test showed no statistically significant difference between the evaluations (p = 0.423), the Intraclass Correlation Coefficient was satisfactory (ICC = 0.53), the Cronbach's Alpha (α = 0.71) was considered acceptable, as well as the final result of the evaluation made it possible to classify the service as having an unacceptable health risk. The QISI was considered with validated content, having reliability and reproducibility to evaluate the hygienic-sanitary conditions, being a technological innovation for food and nutrition services and sanitary surveillance, allowing a detailed and rigorous inspection.info:eu-repo/semantics/publishedVersio

Effect of neuromodulation on pain and functional mobility in people with HTLV-1: randomized clinical trial protocol

BACKGROUND: The main symptoms of myelopathy associated with human T-cell lymphotropic virus type 1 or tropical spastic paraparesis (HAM / TSP) are the presence of high intensity pain in the lower back, spasticity and weakness in the lower limbs, loss of balance and difficulties in locomotion.  Pulsed Transcranial Magnetic Stimulation (rTMS) has been able to influence cortical plasticity, decreasing spasticity, increasing motor performance and promoting analgesia in several similar conditions.  OBJECTIVE: To analyze the effect of neuromodulation by pulsed transcranial magnetic stimulation (rTMS) on pain and functional mobility in individuals with HAM / TSP.  METHODOLOGY: A randomized clinical trial will be conducted in a sample made up of 40 participants randomly allocated into two groups: Sham Group (SG) with 20 and Test Group (TG) with 20 patients.  Individuals aged> 20 years, community walkers with or without orthosis, with chronic pain (? 6 months) in the lumbar region and / or lower limbs will be included.  Individuals with epilepsy, cancer, pregnant women, patients with cardiac pacemakers, metallic implants in the brain or skull, users of illicit drugs and / or use of controlled medications in the last six months will be excluded.  The protocol will be applied for 10 consecutive days with eight months of follow-up.  Our hypothesis is that when using rTMs according to the proposed procedure, it will be possible to relieve pain and improve the functional mobility of these individuals with a long-lasting effect.  CONCLUSION: We hope that rTMS is a promising treatment to reduce pain intensity and to improve functional mobility in individuals undergoing active modality. We declare this protocol a promising resource for the treatment of htlv-1 individuals in reducing pain and improving functional mobility. Yes, this protocol has already been applied to 6 patients. However, with the pandemic the study had to be discontinued. However, despite the small sample size and not being fully applied as suggested by the protocol, it was possible to notice a satisfactory result of the intervention. Thus, the application of this protocol can contribute to identify the result of this therapeutic modality in a safer way, as well as assist in the treatment of symptoms of this population, favoring a better quality of life

Local Nonparametric Estimation of Scalar Diffusions

This paper studies the functional estimation of the drift and diffusion functions for recurrent scalar diffusion processes from equally spaced observations using the local polynomial kernel approach. Almost sure convergence and a CLT for the estimators are established as the sampling frequency and the time span go to infinity. The asymptotic distributions follow a mixture of normal laws. This theory covers both positive and null recurrent diffusions. Almost sure convergence rates are sometimes path dependent but expected rates can always be characterized in terms of regularly varying functions. The general theory is specialized for positive recurrent diffusion processes, and it is shown in this case that the asymptotic distributions are normal. We also obtain the limit theory for kernel density estimators when the process is positive recurrent, namely, requiring only that the invariant probability measure exists. Nonetheless, it is also shown that such an estimator paradoxically vanishes almost surely when the invariant measure is fat tailed and nonintegrable, that is, in the null recurrent case

Sickle Cell Disease Chronic Joint Pain: Clinical Assessment Based on Maladaptive Central Nervous System Plasticity

Chronic joint pain (CJP) is among the significant musculoskeletal comorbidities in sickle cell disease (SCD) individuals. However, many healthcare professionals have difficulties in understanding and evaluating it. In addition, most musculoskeletal evaluation procedures do not consider central nervous system (CNS) plasticity associated with CJP, which is frequently maladaptive. This review study highlights the potential mechanisms of CNS maladaptive plasticity related to CJP in SCD and proposes reliable instruments and methods for musculoskeletal assessment adapted to those patients. A review was carried out in the PubMed and SciELO databases, searching for information that could help in the understanding of the mechanisms of CNS maladaptive plasticity related to pain in SCD and that presented assessment instruments/methods that could be used in the clinical setting by healthcare professionals who manage chronic pain in SCD individuals. Some maladaptive CNS plasticity mechanisms seem important in CJP, including the impairment of pain endogenous control systems, central sensitization, motor cortex reorganization, motor control modification, and arthrogenic muscle inhibition. Understanding the link between maladaptive CNS plasticity and CJP mechanisms and its assessment through accurate instruments and methods may help healthcare professionals to increase the quality of treatment offered to SCD patients

Applications of Non-invasive Neuromodulation for the Management of Disorders Related to COVID-19

Background: Novel coronavirus disease (COVID-19) morbidity is not restricted to the respiratory system, but also affects the nervous system. Non-invasive neuromodulation may be useful in the treatment of the disorders associated with COVID-19. Objective: To describe the rationale and empirical basis of the use of non-invasive neuromodulation in the management of patients with COVID-10 and related disorders. Methods: We summarize COVID-19 pathophysiology with emphasis of direct neuroinvasiveness, neuroimmune response and inflammation, autonomic balance and neurological, musculoskeletal and neuropsychiatric sequela. This supports the development of a framework for advancing applications of non-invasive neuromodulation in the management COVID-19 and related disorders. Results: Non-invasive neuromodulationmaymanage disorders associated with COVID- 19 through four pathways: (1) Direct infection mitigation through the stimulation of regions involved in the regulation of systemic anti-inflammatory responses and/or autonomic responses and prevention of neuroinflammation and recovery of respiration; (2) Amelioration of COVID-19 symptoms of musculoskeletal pain and systemic fatigue; (3) Augmenting cognitive and physical rehabilitation following critical illness; and (4) Treating outbreak-relatedmental distress including neurological and psychiatric disorders exacerbated by surrounding psychosocial stressors related to COVID-19. The selection of the appropriate techniques will depend on the identified target treatment pathway. Conclusion: COVID-19 infection results in a myriad of acute and chronic symptoms, both directly associated with respiratory distress (e.g., rehabilitation) or of yet-tobe- determined etiology (e.g., fatigue). Non-invasive neuromodulation is a toolbox of techniques that based on targeted pathways and empirical evidence (largely in non- COVID-19 patients) can be investigated in the management of patients with COVID-19