ESTIMATED MUSCLE FORCES ANALYZES DURING CONCENTRIC-ECCENTRIC SHOULDER EXTERNAL AND INTERNAL ROTATION

The purpose of this study was to analyze the muscle force production during eccentric/concentric shoulder internal and external rotation with 90° of abduction. Six male subjects performed five repetitions of maximal concentric and eccentric contractions rotation without interval, with a mean angular speed of 60°/sec. A biomechanical model was implemented to estimate muscle force and moment. Infraspinatus, supraspinatus and teres minor presented the larger peak moment values during external rotation (concentric and eccentric). Subscapularis, pectoralis major and teres minor presented the larger peak moment values during internal rotation (concentric and eccentric). The eccentric contraction allowed larger peak muscle forces and moments and the correspondent angles were altered, if compared to concentric conditions. The results presented are useful as guidelines for shoulder rehabilitation programs

Análise por dinâmica inversa, um complemento da avaliação fisioterapêutica do ombro

O objetivo do estudo é caracterizar as forças em atuação na articulação do ombro durante o movimento de elevação do membro superior no plano escapular por meio do método de dinâmica inversa, aqui sugerido como um meio complementar da avaliação fisioterapêutica. Esse método permite determinar os picos de momento proximal resultante (MPR) e da força proximal resultante (FPR) do ombro durante o movimento, possibilitando assim a avaliação objetiva das cargas impostas à articulação. Participaram do estudo 21 indivíduos do sexo masculino, cuja movimentação do ombro foi analisada por videogrametria em três diferentes situações de carga: sem carga, com peso livre e com resistência elástica. Um modelo matemático tridimensional foi utilizado para o cálculo do MPR e da FPR, permitindo caracterizar a evolução dessas variáveis ao longo da elevação do membro superior nas três situações de carga nos eixos póstero-anterior, caudal-cranial e médio-lateral, determinando seus respectivos picos. O método da dinâmica inversa revelou-se capaz de fornecer informações objetivas sobre as cargas impostas à articulação do ombro nas diversas amplitudes e situações de carga do movimento estudado, podendo tais informações servir como uma base concreta no planejamento de um programa de reabilitação do ombro.The purpose of this study was to describe forces acting on the shoulder joint during upper limb elevation at the scapular plane by means of the inverse dynamics method, here suggested as a complementary means of physiotherapeutic assessment of the shoulder. The method allows for determining proximal net moment (PNM) and proximal net force (PNF) peaks during movements, hence providing an objective assessment of loads on the joint. Twenty-one male subjects were studied, their shoulder movements being analysed by videogrammetry in three load situations: with and without load, and with elastic resistance. A three-dimensional mathematic model was used to calculate PNM and PNF peak values, as well as to describe their evolution during movement along the anterior-posterior, superior-inferior, and lateral-medial axes. The inverse dynamics method was thus shown to provide objective information on the loads which shoulder joint is submitted to at the diverse ranges of motion and load situations during arm elevation; such information may be taken as a factual basis for planning shoulder rehabilitation programs

Using a collaborative robot to the upper limb rehabilitation

Rehabilitation is a relevant process for the recovery from dysfunctions and improves the realization of patient's Activities of Daily Living (ADLs). Robotic systems are considered an important field within the development of physical rehabilitation, thus allowing the collection of several data, besides performing exercises with intensity and repeatedly. This paper addresses the use of a collaborative robot applied in the rehabilitation field to help the physiotherapy of upper limb of patients, specifically shoulder. To perform the movements with any patient the system must learn to behave to each of them. In this sense, the Reinforcement Learning (RL) algorithm makes the system robust and independent of the path of motion. To test this approach, it is proposed a simulation with a UR3 robot implemented in V-REP platform. The main control variable is the resistance force that the robot is able to do against the movement performed by the human arm.info:eu-repo/semantics/publishedVersio

Exploring factors influencing low back pain in people with non-dysvascular lower limb amputation: a national survey

Background: Chronic low back pain (LBP) is a common musculoskeletal impairment in people with lower limb amputation. Given the multifactorial nature of LBP, exploring the factors influencing the presence and intensity of LBP is warranted. Objective: To investigate which physical, personal, and amputee-specific factors predicted presence and intensity of low back pain (LBP) in persons with non-dysvascular transfemoral (TFA) and transtibial amputation (TTA). Design: A retrospective cross-sectional survey. Setting: A national random sample of people with non-dysvascular TFA and TTA. Participants: Participants (N = 526) with unilateral TFA and TTA due to non-dysvascular aetiology (i.e. trauma, tumours, and congenital causes) and a minimum prosthesis usage of one year since amputation were invited to participate in the survey. The data from 208 participants (43.4% response rate) were used for multivariate regression analysis Methods (Independent variables): Personal (i.e. age, body mass, gender, work status, and presence of comorbid conditions), amputee-specific (i.e. level of amputation, years of prosthesis use, presence of phantom limb pain, residual limb problems, and non-amputated limb pain), and physical factors (i.e. pain provoking postures including standing, bending, lifting, walking,sitting, sit-to stand, and climbing stairs). Main outcome measures (Dependent variables): LBP presence and intensity. Results: A multivariate logistic regression model showed that the presence of two or more comorbid conditions (prevalence odds ratio (POR) = 4.34, p = .01), residual limb problems (POR 22 = 3.76, p<.01), and phantom limb pain (POR = 2.46, p = .01) influenced the presence of LBP. Given the high LBP prevalence (63%) in the study, there is a tendency for overestimation of PORand the results must be interpreted with caution. In those with LBP, the presence of residual limb problems (beta = 0.21, p = .01), and experiencing LBP symptoms during sit-to-stand task (beta = 0.22, p = .03) were positively associated with LBP intensity, while being employed demonstrated a negative association (beta = - 0.18, p = .03) in the multivariate linear regression model. Conclusions: Rehabilitation professionals should be cognisant of the influence that comorbid conditions, residual limb problems, and phantom pain have on the presence of LBP in people with non-dysvascular lower limb amputation. Further prospective studies could investigate the underlying causal mechanisms of LBP

Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI

(Des)vinculações de Planos Municipais de Educação metropolitanos com outros instrumentos de gestão local da educação

Resumo É possível afirmar que são poucos os estudos sobre os Planos Municipais de Educação (PMEs) aprovados no Brasil ao longo do período de vigência do PNE 2001-2010, especialmente os relativos às Regiões Metropolitanas (RMs), cuja necessidade de conhecimento se torna mais evidente em face dos desafios postos pelo PNE 2014-2024 à reformulação desses planos locais. Assim, o presente artigo visa à análise das vinculações previstas em PMEs em relação a outros instrumentos de gestão local da educação, tomando por base empírica os planos pertencentes a dez municípios da RM do estado do Rio de Janeiro, aprovados no período 2001-2012, com vistas ao delineamento de eventuais problemas internos, também relacionados ao planejamento em escala metropolitana. Trata-se de um estudo de caráter exploratório, metodologicamente ancorado na análise de conteúdo de documentos legislativos, cujas conclusões mais gerais apontam, de um lado, nítidas desvinculações em relação ao conjunto de instrumentos de gestão considerados nas análises, e, de outro, ausência de um enfoque regional-metropolitano nesses mesmos planos. Evidencia, ainda, que essas desarticulações locais e regionais constituem importantes reptos a serem superados com vistas à adequação desses planos ao novo PNE, postulando que tais enlaces são passíveis de previsão a partir da compreensão de que um plano de educação não constitui um instrumento independente e suficiente de gestão e, embora se afigure numa espécie de registro de coordenação e sistematização das decisões previstas para a condução das políticas educacionais no município, é parte integrante dessas mesmas políticas e não estranho a elas

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : A systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC