Functionality after hip surgery: correlation between balance, age, independence, and depression among the elderly

Objective: To determine correlations between age and balance, independence, and depression among the elderly who suffered hip fractures following a fall. Method: The consecutive sample included elderly who had suffered hip fractures within the past 24 months. We evaluated 14 elderly patients (12 women and two men); with an average age of 78 ± 6.9 years old. A questionnaire was applied to obtain general data, Timed Up and Go (TUG test), Berg Balance Scale (BBS), Geriatric Depression Scale - Short form (GDS-S), Barthel Index (BI), and Waist-hip ratio (WHR). We used the one-way ANOVA, t-test, and Pearson correlation tests with a significance levels of 5%. Results: Mean tests: BBS (35.38 ± 33.06), the TUG test (28.40 ± 10.59), the pre-fall GDS-S 6.33 ± 1.52, the post-fall GDS-S 7.66 ± 1.52, and the WHR 1.05 ± 0.35 for men and 0.92 ± 0.12 for women. The Barthel Index pre-fall was 16.20 ± 5.4 and the Barthel Index post-fall was 15.12 ± 6.78. The greater the age, the longer the stay, but there was no correlation between age and function. There was a negative correlation between age and balance, but age was not related to the level of depression. Conclusion: A positive correlation was found between age and length of stay and a negative correlation was found between age and balance. There was a decrease in the BBS, and an increase in the length of the TUG test and WHR.Objetivo: Verificar correlações entre a idade e o equilíbrio, a independência, tempo de internação, e a depressão em idosos que sofreram fratura do quadril após quedas. Método: Amostra consecutiva incluiu idosos que sofreram fratura de quadril há até 24 meses. Foram avaliados 14 idosos (12 mulheres e dois homens), com idade média de 78 anos ± 6,9. Foi aplicado um questionário para obtenção de dados gerais, Time Up and Go (TUG test), Escala de Equilíbrio Berg (EEB), Escala de Depressão Geriátrica Abreviada (EDGA), Índice de Barthel e Razão cintura-quadril (RCQ). Foi aplicado ANOVA one-way, teste t e teste de correlação de Pearson com um nível de significância de 5%. Resultados: As médias dos testes: EEB (35,38 ± 33,06), o TUG test (28,40 ± 10,59); a EDGA pré-queda 6,33 ± 1,52; a EDGA pós-queda 7,66 ± 1,52; o RCQ 1,05 ± 0,35 para homens e 0,92 ± 0,12 para mulheres. O Índice de Barthel pré-queda 16, 20 ± 5,4 e o Índice de Barthel pós-queda 15,12 ± 6,78. Quanto maior a idade, maior é o tempo de internação e que não há correlação entre idade e função (IC: 0,643; valor p ≤ 0,013). Houve correlação negativa entre idade e equilíbrio, mas a idade não está relacionada ao nível de depressão (IC: -0,556; valor p ≤ 0,048). Conclusão: Foi verificada correlação positiva entre idade e tempo de internação e correlação negativa entre idade e equilíbrio. Houve a diminuição da pontuação de EEB, aumento do tempo do TUG Test e aumento da RQC

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018

Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030

Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019

Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million 95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% 95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd

Adaptações sensório-motoras em curto prazo após uma única sessão de terapia robótica associada ao videogame

Robotic device deployment used for the recovery of people with hemiparesis is increasing. This resource can be associated to video games and different levels of assistance can be used for specific and oriented tasks. However, there are insufficient guidelines to prescribe rehabilitation therapy of the lower limbs. The first aim of study was to verify whether a single session of robotic therapy promotes short-term ankle motor adaptations, influencing the coordinate movements (sub-maximum torque maintenance of ankle – steadiness), maximal strength outcomes, such as torque, power and work and functional performance in chronic post-stroke individuals; and the second objective was to describe the analysis the metric data related to accuracy, speed, smoothness and movement initiated without assistance, as well as trajectory variation recorded during robotic ankle therapy protocol based on the criteria of increasing and decreasing impedance adjustments. Both studies had double-arm pilot design, on a convenience sample of participants with chronic stroke (n = 14) who had residual hemiparetic deficits and an equal number of age- and sex-matched non-disabled control subjects. In the first manuscript, balance, mobility and function were measured. Concentric isokinetic and steadiness tests were assessed using dynamometry. The maximum and minimum muscle activation peaks were recorded by electromyography simultaneously with concentric tests. For submaximal sensorimotor control analysis (Steadiness), the standard deviation, coefficient of variation and root mean standard error (RMSE) were recorded. In the second manuscript, game score, movement initiated without assistance, initiation time, mean speed, number of speed peaks and trajectory variation were variables recorded over seven blocks with variable assistance levels. A motivation questionnaire was given to the hemiparesis group. The main results were motor adaptations in sub maximum maintenance, which were identified preferentially during the dorsiflexion. The hemiparesis group showed greater dexterity, initial reaction and smoothness during dorsiflexion post-robotic assistance therapy. People with chronic hemiparesis presented short-term performance gains in submaximal torque maintenance, especially during dorsiflexion after a single robotic therapy session. The actual robotic therapy protocol promoted preservation and maintenance of neuromuscular performance when compared to the healthy control group. In addition, analyzing the metric data obtained during the robotic therapy session corroborated to identify motor adaptation related to the speed, accuracy and errors in the trajectory position. Moreover, impedance change strategy was effective to promote challenge and motor control adaptation.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)A inclusão de dispositivos robóticos em programas de reabilitação está aumentando. Este recurso pode ser associado a videogames. Diferentes níveis de assistência podem ser aplicados durante tarefas específicas e orientadas por metas com significados a fim de evocar movimentos coordenados em pacientes com hemiparesia. No entanto, não existem diretrizes suficientes para prescrever a terapia para a reabilitação dos membros inferiores. O primeiro objetivo deste trabalho foi verificar se uma única sessão de terapia robótica promove adaptação motora, influenciando a coordenação dos movimentos do tornozelo (manutenção do torque submáximo do tornozelo - Steadiness), as variáveis de força máxima concêntrica, como torque, potência e trabalho e o desempenho funcional de indivíduos hemiparéticos crônicos; e o segundo objetivo foi descrever as análises dos dados métricos relacionados à precisão, velocidade, suavidade e movimentos iniciados sem assistência, bem como a variação da trajetória registrada durante o protocolo de terapia do tornozelo robótico com base nos critérios de ajuste de aumento e diminuição da assistência robótica. O desenho experimental de ambos os estudos foi double-arm pilot, sendo uma amostra de conveniência de participantes com AVC crônico (n = 14) que apresentaram déficits hemiparéticos residuais e um número igual de sujeitos controle saudáveis pareados por idade e sexo. O equilíbrio, a mobilidade e a função foram avaliados. No primeiro manuscrito, os testes concêntrico isocinético e steadiness foram avaliados utilizando a dinamometria. Os picos máximos e mínimos de ativação muscular foram registados por eletromiografia simultaneamente com os testes concêntricos. No segundo manuscrito, a pontuação do jogo, o número de movimentos iniciados sem assistência, o tempo de iniciação, a velocidade média, o número de picos de velocidade e a variação da trajetória foram variáveis registradas em sete blocos de repetições com níveis variáveis de assistência. Um questionário de motivação foi dado ao grupo hemiparético. Os principais achados foram: adaptações motoras foram identificadas preferencialmente durante a dorsiflexão. O grupo hemiparético apresentou ganhos imediatos na manutenção do torque submáximo, maior destreza, melhor reação inicial e suavidade durante a dorsiflexão após a terapia robótica. O protocolo de terapia robótica promoveu a preservação e manutenção do desempenho neuromuscular quando comparado ao grupo controle saudável. Além disso, a análise dos dados métricos obtidos durante a sessão de terapia robótica corroborou para identificar adaptação motora relacionada à velocidade, precisão e erros na posição da trajetória. Além disso, a estratégia de mudança de impedância foi eficaz para promover um ambiente terapêutico desafiador e adaptações do controle motor

ABC-SPH risk score for in-hospital mortality in COVID-19 patients : development, external validation and comparison with other available scores

The majority of available scores to assess mortality risk of coronavirus disease 2019 (COVID-19) patients in the emergency department have high risk of bias. Therefore, this cohort aimed to develop and validate a score at hospital admission for predicting in-hospital mortality in COVID-19 patients and to compare this score with other existing ones. Consecutive patients (≥ 18 years) with confirmed COVID-19 admitted to the participating hospitals were included. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients admitted between March-July, 2020. The model was validated in the 1054 patients admitted during August-September, as well as in an external cohort of 474 Spanish patients. Median (25-75th percentile) age of the model-derivation cohort was 60 (48-72) years, and in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. Seven significant variables were included in the risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO/FiO ratio, platelet count, and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829-0.859), which was confirmed in the Brazilian (0.859 [95% CI 0.833-0.885]) and Spanish (0.894 [95% CI 0.870-0.919]) validation cohorts, and displayed better discrimination ability than other existing scores. It is implemented in a freely available online risk calculator (https://abc2sph.com/). An easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation was designed and validated for early stratification of in-hospital mortality risk of patients with COVID-19

ABC₂-SPH risk score for in-hospital mortality in COVID-19 patients

Objectives: The majority of available scores to assess mortality risk of coronavirus disease 2019 (COVID-19) patients in the emergency department have high risk of bias. Therefore, this cohort aimed to develop and validate a score at hospital admission for predicting in-hospital mortality in COVID-19 patients and to compare this score with other existing ones. Methods: Consecutive patients (≥ 18 years) with confirmed COVID-19 admitted to the participating hospitals were included. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients admitted between March–July, 2020. The model was validated in the 1054 patients admitted during August–September, as well as in an external cohort of 474 Spanish patients. Results: Median (25–75th percentile) age of the model-derivation cohort was 60 (48–72) years, and in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. Seven significant variables were included in the risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO2/FiO2 ratio, platelet count, and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829–0.859), which was confirmed in the Brazilian (0.859 [95% CI 0.833–0.885]) and Spanish (0.894 [95% CI 0.870–0.919]) validation cohorts, and displayed better discrimination ability than other existing scores. It is implemented in a freely available online risk calculator (https://abc2sph.com/). Conclusions: An easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation was designed and validated for early stratification of in-hospital mortality risk of patients with COVID-19.</p

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data