Avaliação do modo respiratório por meio da termografia: um estudo piloto / Breathing mode assessment with thermography: a pilot study

RESUMO Objetivo Apresentar um método de análise do modo respiratório por meio da termografia infravermelha. Método Estudo transversal exploratório de 38 imagens térmicas que representavam o momento da inspiração e da expiração durante a respiração nasal e durante a simulação da respiração oral de quatro voluntárias respiradoras nasais sem queixas respiratórias. Para a extração da temperatura das regiões de interesse (nariz e boca) foram utilizadas três formas de seleção distintas de dados (linha, retângulo e elipse) e três medidas de temperatura (mínima, média e máxima) por meio do software FLIR Tools®. Resultados Dentre as três formas de seleção houve maior variabilidade nas medidas obtidas pela linha, revelando limitações nessa medida. Não houve diferenças entre as medidas do retângulo e elipse, mostrando que ambas as formas de seleção apresentam resultados semelhantes para a extração das temperaturas. Na comparação entre as temperaturas do nariz e da boca na inspiração e expiração, os resultados indicaram que houve diferença com relevância estatística em todas as medidas realizadas, exceto para as medidas de temperatura média da inspiração, usando o retângulo e a elipse. Percebe-se diferenciação do modo respiratório tanto na inspiração quanto na expiração quando utilizada a temperatura média da boca com o retângulo e a elipse. Conclusão Sugere-se para avaliação do modo respiratório a avaliação da boca, por meio da elipse, com análise da temperatura média durante a inspiração.

ABSTRACT Purpose To present a method for analyzing breathing modes with infrared thermography. Methods This exploratory cross-sectional study used 38 thermal images of inspiration and expiration with nasal breathing and simulated mouth breathing in four nasal breathers without respiratory complaints. Three different data selection forms (line, rectangle, and ellipse) were used to extract the minimum, mean, and maximum temperatures of the regions of interest (nose and mouth) using the FLIR Tools® software. Results Among the three selection forms, there was greater temperature variability obtained with the line, revealing limitations in this measurement. There were no differences between the rectangle and ellipse values, showing that both selection forms present similar temperature extraction results. The comparison results between nose and mouth temperatures during inspiration and expiration indicated a statistically significant difference between all measurements, except for mean inspiration temperatures with the rectangle and ellipse. The breathing mode can be distinguished in both inspiration and expiration when using mean mouth temperatures with the rectangle and ellipse. Conclusion Breathing modes should be assessed based on mean mouth temperatures during inspiration, using the ellipse.

Evaluation of the breathing mode by infrared thermography

Abstract Objectives: To analyze breathing modes with infrared thermography. Methods: Cross-sectional observational exploratory study conducted in 20 female participants with a mean age of 26.0-years. The thermograms were made following the principles of the American Academy of Thermology and the Brazilian Thermology Society. The camera FLIR A315 (FLIR Inc., Santa Barbara, CA) was used for the tests. The recordings consisted of the participants breathing normally through the nose for 2 min and simulating oral/oronasal breathing for another 2min. The thermograms were analyzed with the FLIR Tools software. An ellipse was placed between the nostrils and the lip commissures to obtain the mean temperatures. The collection was made by two independent researchers, and the normalized non-dimensional temperature was calculated. Results: The temperature in nasal breathing is higher than in oral/oronasal breathing both for inhaling and exhaling when measured in the region of the mouth. The exhaling temperatures were higher than the inhaling ones in oral/oronasal breathing (through the nose and the mouth) and nasal breathing (only through the nose). The temperature difference between exhaling and inhaling (ΔT) was greater in oral/oronasal breathing when measured in the region of the mouth. Conclusion: The thermographic assessment of breathing modes may be made by comparing the mean temperatures of the mouth, using an ellipse. Level of evidence: Study without consistently applied reference standards.

A possible contribution to improving the therapeutic potentials of Babor's Typology of Alcohol Dependent Patients / Uma possível contribuição para incrementar o potencial terapêutico da classificação Tipo A/Tipo B de Dependentes de Alcoólicos

ABSTRACT Objective The objective of this study was to replicate Babor's Typology and to explore clinical features related to personality traits that may underlie this classification, in order to improve its therapeutic possibilities. Methods Observational prospective study on a group of 273 male alcoholics. After a replication of Babor's variables, Cluster Analysis, Chi-Square – applied on clinical variables related to a Lappda Tipology – and Kappa tests were performed. Results The study identified two distinct clusters that held similar features to those described for the Type A/Type B classification. Besides presenting a lower socio-economic situation, Cluster 2 patients were associated with higher vulnerability and severe clinical features and also differed from Cluster 1 in their response to treatment. These replicated clusters retained connections and also differences in relation to the variables derived from the Lappda Typology. Conclusion Considering that each of the two replicated clusters seem to be associated to different personality traits – according to their correlations to the affective, cognitive and behavioral dimensions brought forward by the Lappda Typology – it is acceptable that this study may contribute to the development of more comprehensive and effective therapeutic strategies specifically tailored to target more specific personality traits of these subgroups of alcoholic patients.

RESUMO Objetivo O objetivo deste estudo foi replicar a tipologia do Babor e explorar características clínicas relacionadas a traços de personalidade que podem estar subjacentes a essa classificação, a fim de melhorar suas possibilidades terapêuticas. Métodos Estudo observacional prospectivo em um grupo de 273 alcoolistas masculinos. Depois de uma replicação das variáveis de Babor, foram realizados Análise de Cluster, testes de Qui-quadrado — aplicados em variáveis clínicas relacionadas com uma tipologia desenvolvida pelo Lappda — e testes Kappa. Resultados O estudo identificou dois clusters distintos que mantiveram características semelhantes àquelas descritas na classificação Tipo A/Tipo B. Além de apresentar uma pior situação socioeconômica, os pacientes do Cluster 1 foram associados a maior vulnerabilidade e a características clínicas de maior gravidade; e também diferiram do Cluster 2 em sua resposta ao tratamento. Esses clusters replicados mantiveram conexões e também diferenças em relação às variáveis derivadas da tipologia do Lappda. Conclusão Considerando que cada um dos dois clusters replicados parece estar associado a diferentes traços de personalidade - de acordo com suas correlações a dimensões afetivas, cognitivas e comportamentais identificadas pela tipologia Lappda - é aceitável que este estudo possa contribuir para o desenvolvimento de estratégias terapêuticas mais abrangentes e eficientes, especificamente dirigidas a traços da personalidade mais específicos desses subgrupos de pacientes alcoolistas.

Evaluation of healing of pressure ulcers through thermography: a preliminary study

Introduction Thermography is a surface thermal radiation measurement technique whose application has been expanding in the healthcare field. The unhealed wound is a serious public health problem because it intervenes in the quality of life of patients and may cause emotional and psychological losses. The wound temperature can provide quantitative data that allow for the healing process to be monitored. The aim of this study was to verify whether thermography can be used as a method to evaluate the healing of pressure ulcers. Methods Eight participants with sacral pressure ulcers were recruited and randomly divided into two groups: A (control) and B (experimental). Both groups received standard treatment for a period of four weeks, which consisted of a daily cleaning of the pressure ulcers with physiological saline (sodium chloride 0.9%) followed by an alginate hydrogel dressing. The group B received light-emitting diode (LED) phototherapy in addition to standard treatment, three times a week, yielding a total of 12 sessions. Photographs and thermograms of each pressure ulcer were obtained in all sessions in both groups. Results Pressure ulcers treated with LED phototherapy were healed. The pressure ulcer area of group B decreased over the 12 treatment sessions, whereas the pressure ulcer area of group A increased. The ulcer temperature of group B was higher than that of group A during the treatment (temperature difference up to 7.6%). Discussion The present study suggests a relationship between the temperature and area of pressure ulcers and proposes thermography as an adjunctive method for the evaluation of healing processes.

Análise de Cluster e Análise Heurística na construção de uma tipologia de alcoolistas / Cluster Analysis and Heuristic Analysis in building a typology of alcoholics

Objetivos Desenvolver e avaliar uma tipologia binária de alcoolistas. Métodos Analisados registros de 329 alcoolistas acompanhados em estudo prospectivo e observacional. Análise de Correspondência foi aplicada para selecionar o menor número de variáveis capazes de representar a máxima variabilidade dos sujeitos; Análise de Cluster para identificar dois subtipos; e Análise Heurística para organizar as variáveis selecionadas em grupos de sentido. Análises Bivariadas foram utilizadas para testar possíveis associações com 51 variáveis demográficas ou clinicamente relevantes. Resultados A Análise de Correspondência selecionou 20 variáveis, posteriormente categorizadas em três grupos de sentidos por meio de Análise Heurística: “comportamentos”, “crenças” e “sentimentos”. Os pacientes do subgrupo 1 possuem perfil de maior gravidade clínica, psicopatológica e social. Sentimentos e crenças identificados se associaram a variáveis de consumo e recaída e os comportamentos com repercussão social. Conclusões Os resultados deste estudo permitem supor que a tipologia aqui apresentada possa contribuir para o tratamento desses subtipos de alcoolistas identificados por meio de estratégias teórico-práticas adaptadas às necessidades desses sujeitos. .

Objectives To develop and to describe a binary typology of alcoholics. Methods Data derived from 329 patients followed in an observational study. Correspondence Analysis was applied to identify the least number of variables capable of representing the maximum variability of the subjects; Cluster Analysis was performed to identify two subgroups; and Heuristic Analysis performed with the objective of organizing the variables into groups of meaning. Bivariate Analyses were used to test possible associations of Clusters to 51 variables – demographic or of clinical relevance. Results Correspondence Analysis derived 20 variables, afterwards categorized into three groups of meaning through Heuristic Analysis: “behaviors”, “beliefs” and “feelings”. The results indicate that subgroup 1 patients present a more severe clinical, psychopathological and social profile. Identified feelings and beliefs were associated to drinking and relapsing variables, and behaviors to social repercussions. Conclusions The results of this study suggest that the typology here presented may contribute to the treatment of these alcoholics subtypes by means of therapeutic strategies adapted to the identified characteristics of each subgroup of patients. .

Identificação de fatores associados à adesão a um programa ambulatorial de tratamento de alcoolistas por meio de regressão logística / Identification of factors associated to adherence to an outpatient treatment program for alcoholics by means of logistic regression

Adesão é uma medida prática de avaliação de resultado de tratamento. Buscou-se identificar características dos pacientes, associadas à adesão a um programa ambulatorial de tratamento de alcoolistas. O estudo foi de coorte naturalístico, no qual foram incluídos todos os 300 pacientes alcoolistas, que concluíram a fase de avaliação do programa. Inicialmente, foi testada a associação de variáveis relativas a aspectos sociodemográficos, econômicos, crenças, sentimentos, comportamentos, sintomas e tratamentos, incluídas no protocolo de avaliação dos pacientes com a variável adesão, utilizando o Teste do Qui-quadrado de Pearson (p< 0,1). Posteriormente, foi realizada regressão logística das variáveis, primeiro, dentro de cada dimensão de características, selecionando-se as que seriam incluídas numa análise multidimensional. No modelo final, as variáveis que se associaram significativamente à adesão superior foram: tempo de união acima da média do grupo; receber mais que um salário mínimo; ter apresentado dor abdominal nos 30 dias antes da avaliação; apresentar tremores se não bebia no horário habitual; apresentar pressão arterial sistólica menor ou igual a 130mmHg; costumar beber sozinho à avaliação. Espera-se que a identificação de características associadas à adesão ao tratamento contribua para o desenvolvimento de estratégias de abordagem de pacientes que respondem mal à prática habitual. O foco na modificação ou reforço destas características poderá contribuir para resultados mais favoráveis no tratamento de alcoolistas.

Adherence is a practical measure of treatment results assessment. This naturalistic cohort study aimed to identify patient's characteristics associated to adherence to an outpatient treatment program for alcoholics. This study included all the 300 alcoholics that concluded the program´s assessment stage. Firstly, crosstabs were used to verify possible association of adherence to treatment to other variables related to sociodemographic, economic, belief, feeling, behavior, symptom e treatment aspects used for patient assessment in the program, using Pearson´s Quisquare test (p < 0.1). Later, logistic regression was performed; initially within each dimension of characteristics, and then using the selected variables in a multidimensional model. In the final model, variables significantly associated to adherence were: stable matrimonial relationship; to perceive more than one Brazilian minimum wage; abdominal pain on the last 30 days before evaluation; to tremble if did not drink at regular timing; systolic blood pressure less or equal 130mmHg; solitary consumption. The identification of characteristics associated to greater adherence is expected to contribute to the development of strategies of care of patients that are usually poor responders to regular approaches. A focus on the changing or reinforcement of these characteristics may contribute to improve results in the treatment of alcoholics.