Eficácia dos exercícios para ombro nas complicações loco-regionais em mulheres submetidas a radioterapia para câncer de mama: ensaio clínico

OBJECTIVE: To investigate the effect of shoulder exercises during radiotherapy in relation to prevention of locoregional physical complications: limitation of range of motion (ROM) and functional capacity, arm circumference and scar tissue adhesion. METHODS: Sixty-six women without shoulder ROM impairment following breast cancer surgery that included complete axillary dissection were allocated to one of two groups: 32 in the physical therapy group (PG) (52.7±10.2 years), who underwent an exercise program; and 34 in the control group (CG) (48±10.1 years). Shoulder ROM, upper-limb circumference and functional capacity and scar tissue adhesion were evaluated at the beginning and end of radiotherapy and six months after completing radiotherapy. RESULTS: The PG showed improvements in flexion and abduction ROM between the first and third evaluations (flexion from 164.77°±8.9° to 167.98°±9.5° and abduction from 168.56°±10.0° to 175.62°±10.2°), which was not observed in the CG (flexion from 167.06±06° to 165.16°±9.2° and abduction from 169.71°±10.1° to 169.53°±12.8°). There was a statistically significant increase in ROM in the PG in relation to the CG (flexion, p=0.02; and abduction, p=0.004). The circumference and functional capacity were similar between the groups and the frequency of scar tissue adhesion in the CG was twice that observed in the PG (48% versus 24%, p=0.04). CONCLUSIONS: These results suggest that shoulder exercises favor maintenance of flexion and abduction ROM of the shoulder and minimize the incidence of scar tissue adhesion in women undergoing radiotherapy for breast cancer treatment.OBJETIVO: Verificar o efeito da realização de exercícios para o ombro durante a radioterapia na prevenção de complicações físicas loco-regionais: limitação da amplitude de movimento (ADM) e da capacidade funcional, circunferência do braço e aderência cicatricial. MÉTODOS: Sessenta e seis mulheres sem comprometimento de ADM de ombro no pós-operatório de cirurgia para câncer de mama com dissecção axilar completa foram alocadas em dois grupos, sendo 32 no grupo de fisioterapia (GF) (52,7±10,2 anos), o qual foi submetido a um programa de exercícios, e 34 no grupo controle (GC) (48±10,1 anos). A ADM do ombro, a circunferência e capacidade funcional dos membros superiores e a aderência cicatricial foram avaliados no início e no final da radioterapia e seis meses após seu término. RESULTADOS: O GF apresentou melhora da ADM de flexão e abdução entre a primeira e terceira avaliação (Flexão: de 164,77°±8,9° para 167,98°±9,5° e Abdução: 168,56°±10° para 175,62°±10,2°), o que não se observou no GC (Flexão: 167,06°±6° para 165,16°±9,2° e Abdução: 169,71°±10,1° para 169,53°±12,8°), demonstrando uma melhora significativa do GF em relação do GC (Flexão: p=0,02 e Abdução: p=0,004). A circunferência e a capacidade funcional foram similares entre os grupos e a frequência de aderência cicatricial no GC foi o dobro daquela observada no GF (48% e 24%, p=0,04). CONCLUSÕES: Esses resultados sugerem que exercícios para o ombro favorecem a manutenção da ADM de flexão e abdução de ombro e minimizam a incidência de aderência cicatricial em mulheres submetidas à radioterapia para tratamento por câncer de mama.13614

As Contribuições do Episcopado Brasileiro na III Conferência Geral do Episcopado Latino Americano em Puebla (1979)

The purpose of this article is to point out the relationship between the Third General Conference of Latin American Episcopate held in late January and early February 1979 in Puebla de Los Angeles (Mexico) and the Bishops of Brazil. Pointing out the bishops of Brazil who took part in Puebla and in what aspects they contributed. Such collaboration will be expressed in two parts. On the one hand, the contribution of the bishops of Brazil as National Episcopal Conference; On the other hand, the personal collaboration of prelates especially Aloísio Lorscheider and Luciano Mendes de Almeida who either by their natural leadership in the Latin American episcopate or by their ecclesiological options and testimonies have profoundly influenced positions assumed in the Final Document.   Key Words: Puebla - Bishops of Brazil - Contribution - Final Document.Este artículo pretende presentar la relación entre el Episcopado brasileño y la III Conferencia General del Episcopado latinoamericano celebrada a fines de enero y principios de febrero de 1979 en Puebla de Los Ángeles. Igualmente, se indicarán quiénes fueron los obispos de Brasil que participaron en Puebla, en qué aspectos su fue relevante presencia y en qué aspectos contribuyeron. Dicha colaboración se expresará de dos maneras. Por un lado, la contribución de los Obispos de Brasil como Conferencia Episcopal Nacional y, por otro lado, la colaboración personal de los prelados, especialmente Aloísio Lorscheider y Luciano Mendes de Almeida, quienes, ya sea por su liderazgo natural en el episcopado latinoamericano o por sus opciones y testimonios eclesiológicos, tuvieron una profunda influencia en las posiciones tomadas en el Documento Final.O presente artigo tem por objetivo apontar a relação entre a III Conferência Geral do Episcopado Latino Americano celebrada no final de janeiro e início de fevereiro de 1979 em Puebla de Los Angeles (México) e os Bispos do Brasil. Apontando quem foram os Bispos do Brasil que de Puebla tomaram parte e em quais aspectos eles contribuíram. Tal colaboração será externada em duas vertentes. De um lado, a contribuição dos Bispos do Brasil enquanto Conferência Episcopal Nacional; De outro, a colaboração pessoal de prelados especialmente Aloísio Lorscheider e Luciano Mendes de Almeida que ou por sua liderança natural no episcopado Latino Americano ou por suas opções e testemunhos eclesiológicas, influíram profundamente em posições assumidas no Documento Final. &nbsp

Effect of Facial Massage on Static Balance in Individuals with Temporomandibular Disorder – a Pilot Study

Introduction: The influence of the neuromuscular system on the cervical region and mastication is directly associated with mandibular movements and neck posture. Normal occlusal homeostasis depends on complex sensory feedback mechanisms of the periodontal ligament, temporomandibular joint and other structures of the stomatognathic system. This feedback serves as a regulatory mechanism that helps determine the force and nature of muscle contractions. Alterations in the muscles of mastication, neck muscles, and occlusal characteristics constitute causal factors of imbalances in the postural muscle chains, leading to alterations in the center of pressure (CoP) of the feet. Thus, therapies that seek occlusal reestablishment, such as muscle relaxation techniques, may lead to a restructuring of the global equilibrium of the neuromuscular system and an improvement in body posture. Purpose: The aim of the present pilot study was to investigate the immediate effect of facial massage on the CoP in the anteroposterior (CoPAP) and mediolateral (CoPML) directions in individuals with temporomandibular disorder (TMD). Methods: Twenty individuals with a diagnosis of TMD based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were submitted to a facial massage technique. CoPAP and CoPML were evaluated using a force plate. Evaluations were performed under two visual conditions (eyes open and eyes closed) prior to resting in dorsal decubitus (baseline), after 10 minutes of rest (premassage) and after the administration of the massage technique (postmassage). Results: No significant differences were found regarding CoPAP velocity with eyes open or the following aspects under either visual condition (eyes open or closed): CoPML velocity, RMS of CoPAP, RMS of CoPML, and sway area. The only significant difference was found for mean CoPAP velocity with eyes closed. Conclusions: While the results of the present study demonstrate the reliability of the reproduction of the data, facial massage had no immediate influence on postural control in individuals with TMD

Benefits of the flipped classroom in health education - a systematic review / Benefícios da sala de aula virada ao contrário na educação sanitária - uma revisão sistemática interrelationship

Introduction: The flipped classroom method is characterized by its contents presentation to the learners before classes and online, reserving the face-to-face meetings to deepen and apply these contents. Objective: To search through literature for the most recent flipped classroom method benefits in the health area. Method: The guidelines for the preparation of systematic reviews were followed, collecting relevant studies, searching for published data sources, selecting the terms for the research, evaluating the eligibility of studies, and extracting relevant data. Results and Discussion: 20 articles published between 2016 and 2020 were selected from the PUBMED, SCIELO, ERIC and MEDLINE databases, according to the eligibility criteria. The main benefits of flipped classroom for students were language development, greater interaction between learners, greater engagement in activities and involvement in projects, flexibility in learning styles, better use of time and better performance in assessments. The professors agreed with such benefits but pointed out that a longer time for the preparation of activities would be a limitation. Conclusion: Flipped classroom method has shown itself to be a promising strategy with many health benefits. More research is needed on its implementation in the current context of the Coronavirus Pandemic in 2020. 

A visita domiciliar sob olhar do usuário da atenção primária

Analisar a visita domiciliar, integrada ao contexto teórico e prático da atenção primária à saúde das pessoas, tendo como área de estudo o município de Guanambi, no sudoeste da Bahia. Foi realizada uma investigação qualitativa e exploratória, na qual foram entrevistados 30 usuários das Unidades Básicas de Saúde da Família, entre os meses de fevereiro e março de 2019, através do uso de questionários estruturados e flexíveis, para a coleta de dados. Reconhecer a existência de uma dissociação entre aquilo que é preconizado pelo contexto teórico, de um lado, e a experiência vivenciada pelos usuários da atenção primária, do outro, foi a constatação central deste estudo, já que a abordagem da visita domiciliar é centrada na doença, essencialmente restritiva e limitadora de um diálogo mutualístico, o que contribui negativamente na formação perceptiva da sua importância para os usuários finais. Estes resultados mostram que as ações de visita domiciliar clamam por um redimensionamento em seu método de abordagem, centrado na promoção de um atendimento multiprofissional e com vistas a considerar o contexto social, cultural, educacional, econômico e ambiental em que se está inserido o paciente, bem como na construção de uma melhor visão teórico/prática dos profissionais das unidades de saúde

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700