Evaluation of upper limb sensitivity in patients with lymphedema after radical mastectomy

O objetivo deste trabalho foi avaliar a sensibilidade de membros superiores com linfedema pós- mastectomia radical. Foram avaliadas nove pacientes, com média de idade de 60,7 anos, para verificar se ocorre diferença de sensibilidade entre o membro com linfedema e o membro sem linfedema. Para o teste de sensibilidade foram utilizados 6 monofilamentos de Semmens-Weinstes (modelo de bolso) “sensi kit”. As áreas testadas foram aquelas correspondentes aos dermátomos ligados à distribuição dos nervos ulnar, mediano e radial. Como resultados tivemos que o tempo decorrido desde a cirurgia foi em média de 8,9 anos, e o aparecimento do linfedema ocorreu em média 5,5 anos após a cirurgia. Utilizou-se a estatística não-paramétrica, empregando-se o Teste de Fisher para pequenas amostras, das freqüências encontradas. Para cada lado testado evidenciou que a freqüência de pacientes que apresentaram sensibilidade no lado acometido foi significativamente menor (0,0045; p>0,005) do que a observada no lado controle, quando testado o Ponto 1, cor verde; não houve diferenças estatisticamente importantes entre os lados avaliados nos demais pontos e cores testados; com relação ao grau de incapacidade, conforme o Ministério da Saúde, não houve qualquer diferença significativa entre os lados acometido e controle em qualquer dos sete pontos testados.The objective of this work was to evaluate the sensitivity of upper limbs with lymphoedema after radical mastectomy. Nine patients were evaluated, whose mean age was 60.7 years, to verify the presence of sensitivity difference between the limb with lymphedema and the control limb. For the sensitivity test, a six-monofilament Semmens-Weinstes "sensi kit" (pocket model) was used. The tested areas were those that corresponded to the dermatomes connected to the distribution of the ulnar, medianus and radialis nerves. Our results showed that the elapsed time since the surgery was on average 8.9 years and that the onset of lymphedema occurred on average 5.5 years after the surgery. Statistical analysis was non-parametrical and used Fisher's Test for small samples of the observed frequencies. For each tested side it was evidenced that the frequency of patients who presented sensitivity in the affected side was significantly smaller (0.0045; p>0.005) than the one observed in the control side, when Point 1, green color, was tested; there were no statistically significant differences between the evaluated sides in the remaining tested points and colors; regarding the incapacity degree, according to the Health Ministry, there were no significant differences between the affected and control sides in any of the seven tested points

Changes in postural balance associated with a woman's aging process

Context: Aging causes a progressive worsening in postural balance, affecting functional independence and increasing the risk of falls. Objective: The aim of the study was to evaluate the effect of aging on the static balance in women from 50-years to 89-years of age. Design: This was a cross-sectional study, with 400 irregularly active women were evaluated and grouped by age: Group 6th decade (age 50 to 59) ‒ 58 participants; Group 7th decade (age 60 to 69) ‒ 214 participants; Group 8th decade (age 70 to 79) ‒ 92 participants; Group 9th decade (age 80 to 89) ‒ 36 participants. Postural balance was evaluated using a portable force platform in a standard standing position, with Eyes Open (EO) and Eyes Closed (EC). Results: In the two measurement conditions, the elderly women in Group 9th decade presented mediolateral displacement and range, and mean velocity greater than the women's values in Groups 6th and 7th decade. In the EO e EC situation, the displacement was higher in the elderly Group 9th decade compared to younger groups. Group 8th has a mean velocity greater than Group 6th decade in the EO situation. Conclusions: Posturography showed a decline in postural balance with advancing age, suggesting that the 9th decade of life is a borderline age to this detriment due to an increase in postural instability

Metodologia para estimativa de custos de cuidados com saúde: Análise dos fatores de gravidade e recomendações para redução dos custos

The aim of this study was to evaluate the contributing factors to the severity of traffic accidents in Brazilian highways and to establish correlations between the severity of accidents and injuries with data regarding the victim, the accident, pre-hospital, hospital and post-hospital care, and road infrastructure, and to verify which of these factors contributed to the severity of injuries, by use of the database of 565 interviews with people involved in accidents built in the project Social and Economic Impacts of the Traffic Accidents in Brazilian Highways and the database of traffic accidents from the Federal Road Policy (Datatran). The analysis of the data was useful as pilot project, but not enough to establish with statistical confidence which factors are aggravating to an accident or to point out priorities for public policies to the reduction of the morbimortality of accidents. To this intent, a specific study was recommended, focusing on the severity of injuries and factors associated to it, as well as a complementary research with data from autopsies, in order to evaluate, among others, if some deaths could have been prevented by proper pre-hospital care

Metodologia para Estimativa de Custos de Cuidados com Saúde: Análise dos Fatores de Gravidade e Recomendações para Redução dos Custos

Este estudo objetiva avaliar os fatores contributivos para a gravidade dos acidentes de trânsito nas rodovias brasileiras, e estabelecer algumas correlações entre a gravidade do acidente e das lesões com dados da vítima, do acidente, do atendimento préhospitalar, hospitalar e pós-hospitalar, e da infra-estrutura viária, assim como verificar quais destes fatores foram contributivos para a gravidades das lesões das vítimas. As fonte de informações foram o banco de dados do projeto Impactos Sociais e Econômicos dos Acidentes de Trânsito nas Rodovias Brasileiras – proveniente de 565 entrevistas com pessoas envolvidas em acidentes – e o banco de dados de acidentes de trânsito da Polícia Rodoviária Federal (Datatran). A análise dos dados foi útil como estudo-piloto, mas não suficiente para estabelecer com segurança quais os fatores agravantes de um acidente e apontar com clareza as prioridades de políticas públicas na redução da morbimortalidade dos acidentes. Para isso, recomenda-se um estudo específico voltado às questões da gravidade das lesões e seus fatores associados, bem como uma pesquisa complementar com dados de necrópsias, para, entre outros, avaliar se algumas mortes poderiam ter sido evitadas com um atendimento préhospitalar adequado. The aim of this study was to evaluate the contributing factors to the severity of traffic accidents in Brazilian highways and to establish correlations between the severity of accidents and injuries with data regarding the victim, the accident, pre-hospital, hospital and post-hospital care, and road infrastructure, and to verify which of these factors contributed to the severity of injuries, by use of the database of 565 interviews with people involved in accidents built in the project Social and Economic Impacts of the Traffic Accidents in Brazilian Highways and the database of traffic accidents from the Federal Road Policy (Datatran). The analysis of the data was useful as pilot project, but not enough to establish with statistical confidence which factors are aggravating to an accident or to point out priorities for public policies to the reduction of the morbimortality of accidents. To this intent, a specific study was recommended, focusing on the severity of injuries and factors associated to it, as well as a complementary research with data from autopsies, in order to evaluate, among others, if some deaths could have been prevented by proper pre-hospital care.

Effects of different physical exercises on body composition in individuals over fifty years-old

OBJECTIVE: This study aimed to investigate the effects of different physical exercise protocols on body composition and body density in individuals over years-old in S&atilde;o Carlos (SP), Brazil. METHODS: The study consisted of 81 volunteers (51 women and 30 men), who were equally divided into three groups: multicomponent training group, resistance training group and control group, which was not submitted to any intervention. The protocols lasted six months. Fat percentage, waist circumference and body mass index were collected before the intervention period and after six months. Statistical analysis was conducted using software MINITAB. RESULTS: The Anova single factor showed no significant difference between the groups in any variable, however the test power was low. Using paired t-test to determine differences between the first and the second assessments within each group, we found a significant decrease of body mass index in women from multicomponent group and waist circumference in women from the resistance group. A two sample t-test demonstrated only significant difference between genders at the same group in fat percentage, with high values in women for all groups. CONCLUSION: The present study showed long term effects of multicomponent and resistance protocols. Both protocols were able to maintain body composition and body density in six months in senescent individuals; however an additional nutritional intervention and the use of more sophisticated assessments could enhance the benefits.</p

CORRELAÇÕES ENTRE MOBILIDADE E INDEPENDÊNCIA FUNCIONAL EM IDOSOS INSTITUCIONALIZADOS E NÃO-INSTITUCIONALIZADOS

Alterações na independência funcional e na mobilidade são problemas que afetam parte importante dos idosos, gerando limitações na execução das atividades de vida diária e reduzindo sua qualidade de vida. Este estudo teve como objetivo comparar e correlacionar a mobilidade e a independência funcional de idosos institucionalizados e não-institucionalizados. Participaram 35 idosos com idade média de 70 (+7,2) anos, sendo 18 residentes na comunidade (88% do sexo feminino e 11,9% do masculino) e 17 residentes em instituição (82,4% do sexo masculino e 17,6% do feminino). Foram utilizados o Teste Timed Up and Go (TUG) para a avaliação da mobilidade e a Medida de Independência Funcional (MIF) para avaliar a capacidade funcional. A análise estatística de variância foi feita por meio dos testes Mann-Whitney, Wilcoxson e T-Student e foi utilizada a Correlação de Pearson para correlacionar as variáveis em estudo. Foram observadas diferenças significativas entre os grupos nos itens autocuidado, transferências e locomoção, e também no tempo de realização do TUG. Foi encontrada correlação diretamente proporcional entre a MIF motora e a MIF cognitiva e correlação relativa inversamente proporcional entre a MIF Motora e o TUG (p=0,003). A independência funcional dos idosos institucionalizados participantes é menor que dos idosos nãoinstitucionalizados e é possível inferir que alterações da cognição podem estar relacionadas às alterações na execução das atividades que determinam a capacidade funcional

EXERCÍCIO RESISTIDO, ANSIEDADE E DEPRESSÃO EM PORTADORES DE ESCLEROSE MÚLTIPLA

The benefits of performing resistance exercises are long known, and the participation on this type of exercise by Multiple Sclerosis patients is not contra-indicated if properly oriented and supervised. However, participation in such exercises and in physical activity in general promotes fear and insecurity in these patients. The aim of this research was to verify the depression and anxiety level of Multiple Sclerosis patients regarding their participation on resistance exercises; to verify anxiety impact about performing resistance exercises; and to grade insecurity factor regarding participation on resistance exercises of Multiple Sclerosis patients. Thirty Multiple Sclerosis diagnosed patients were assessed and responded to the following questionnaires: Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI), and also an adapted questionnaire. The results obtained with the inventories demonstrated that 66.6% of the patients did not present any type of depression, and 66% presented moderate level of anxiety in both STAI-Trait and STAI-State. Regarding their participation in physical activity, it was observed that 86.6% of these patients did not participated in any type of activity, and only 13% were engaged in physical activity. A great portion of the patients who did not participate in physical activities (46.6%) were counseled not to do so by a health professional. It was concluded that most patients presented moderate level of anxiety and no types of depression, and insecurity when performing exercises, especially resistance exercises