Is there a difference in balance between continent and incontinent women? / Existe diferença no equilíbrio entre mulheres continentes e incontinentes?

Abstract Introduction Urinary incontinence is defined as any involuntary loss of urine. An imbalance in the transmission of forces between the bladder and urethra, associated with deficient support of the pelvic floor muscles, contributes to an alteration in balance in women. Objective To compare balance between continent and incontinent women. Methods This was a cross-sectional study with 13 women divided into incontinent (age: 41.50 ± 9.13 years) and continent (age: 35.29 ± 4.99 years) groups. Balance assessments were performed using a force platform and electromyography: standing, with eyes open (BI_OA); standing, with eyes closed (BI_OF); standing on foam, with eyes open (ESP_OA) and closed (ESP_OF); and standing with unipedal support, with eyes open (UNI_OA). Statistical analysis was initiated after resampling of the original data using the bootstrap technique, with the α value set at 5% (p < 0.05). Results In the BI_OA task, no significant differences were found between the groups. In the BI_OF task, incontinent women showed greater displacement in the anteroposterior axis (p < 0.001), and continent women showed greater displacement in the mediolateral axis (p = 0.008). In the ESP_OA task, incontinent women showed greater displacement in both the COP_X (p = 0.003) and COP_Y (p = 0.001) axes; in the ESP_OF task, continent women showed greater displacement in the COP_X (p < 0.001) axis. In the UNI_OA task, greater anteroposterior displacement was observed among incontinent women (p = 0.008). Conclusion Continent women showed greater displacement in the mediolateral axis in the tasks with eyes closed, and incontinent women showed greater displacement in the anteroposterior axis in the BI_OF, ESP_OA, and UNI_OA tasks.

Resumo Introdução A incontinência urinária é definida como qualquer perda involuntária de urina. Um desequilíbrio na transmissão de forças entre bexiga e uretra, associado a um suporte deficitário dos músculos do assoalho pélvico, contribui para uma alteração no equilíbrio de mulheres. Objetivo Comparar o equilíbrio entre mu-lheres continentes e incontinentes. Métodos Trata-se de um estudo transversal, com 13 mulheres divididas em incontinentes (idade: 41,50 ± 9,13 anos) e continentes (idade: 35,29 ± 4,99 anos). A avaliação do equilíbrio foi realizada na plataforma de força associada à eletromi-ografia: em pé, com olhos abertos (BI_OA); em pé, com olhos fechados (BI_OF); em pé sobre uma espuma, com olhos abertos (ESP_OA) e fechados (ESP_OF); e em pé com apoio unipodal, com olhos abertos (UNI_OA). A análise estatística foi iniciada após a reamostragem dos dados originais pela técnica Bootstrap, com valor de α fixado em 5% (p < 0,05). Resultados Na avaliação do equilíbrio BI_OA, não foram encontradas diferenças significativas entre os grupos. No BI_OF, as mulheres incontinentes apresentaram maior deslocamento no eixo anteroposterior (p < 0,001), enquanto as continen-tes, no médio-lateral (p = 0,008). Na tarefa ESP_OA, as incontinentes apresentaram maior deslocamento em ambos os eixos COP_X (p = 0,003) e COP_Y (p = 0,001); já na ESP_OF, as continentes apresentaram maior deslocamento no COP_X (p < 0,001). Na tarefa UNI_OA, observou-se maior deslocamento anteroposterior entre as incontinentes (p = 0,008). Conclusão Mulheres continentes apresentaram maiores deslocamentos no eixo médio-lateral nas tarefas de olhos fechados, enquanto as incontinentes, no eixo anteroposterior nas tarefas BI_OF, ESP_OA, UNI_OA.

Gait variability and symmetry assessment with inertial sensors for quantitative discrimination of Trendelenburg sign in total hip arthroplasty patients: a pilot study based on convenience sampling

Abstract Introduction The aim of this pilot study based on convenience sampling was to analyze the feasibility to quantitatively discriminate Trendelenburg sign (TS), a characteristic drop in pelvic position during gait in hip disfunctions, in patients with total hip arthroplasty (THA), by assessing gait variability and symmetry using inertial sensors. Methods Thirteen patients with right THA, divided into two groups with (GTS, n=4) and without TS (GnTS, n=9) assessed by experienced physician, were enrolled in the study. Harris Hip Score was applied for specific evaluation of THA. The protocol consisted in walking on a level treadmill during 3 minutes with two inertial sensors attached at anterior superior iliac spine of both sides. For each left and right step, features were extracted from the Y-axis gyroscope signals: peak value, mean absolute value, standard deviation and range. For each feature, a symmetry ratio was calculated as the ratio between left and right side. Results No significant differences were found in Harris Hip Score between groups. The variability assessed by standard deviation for left step, contralateral to the replaced side, was significantly larger for GTS group (p<0.001). Significant differences in the symmetry ratios were found between GTS and GnTS for all features extracted from gyroscopes Y-axis (W=144, p<0.001). The symmetry ratios for GnTS group were approximately equal one (except for range), whereas for the GTS group they exceed the 10% criterion. Conclusion The variability and symmetry ratios of gait features extracted from inertial sensors were successful to discriminate TS in THA patients.

Kinematic and electromyographic analysis of school children gait with and without load in the backpack

AbstractIntroduction: Excessive load on the backpacks can lead to musculoskeletal injuries and gait alterations. The objective of this study was to analyze the electromyographic (EMG) activity in association to the kinematic during the stance and balance phases of gait performed with and without the use of the backpack. Methods Twelve volunteers have executed a gait cycle in 3 tasks: without the school backpack (SM), with a backpack with load equivalent to 10% (M10) and 20% (M20) of the body weight (BW). It was evaluated the ankle, knee and hip angular excursion (AE), linear displacement (LD) of the toe and ankle, knee, hip, shoulder, head and EMG activity of the tibialis anterior (TA), vastus medialis (VM), rectus abdominis (RA), gastrocnemius lateral (GL), biceps femoris (BF) and spinal erector (EE) muscles. Results In the LD in the stance phase there was an AP increase for the toe and ankle, hip and head (p<0.043). In the balance phase for VT (vertical) direction, the shoulder presented a smaller displacement as well as the toe, ankle, knee, hip, shoulder and head in the ML direction. In the AP direction, the toe displacement was smaller as well as the ankle (p < 0.038). The AE in both phases was smaller for the hip (p <0.006). In the balance phase the IEMG was higher for the RA (p = 0.034). Conclusion These results suggest that the transport of school backpacks with loads of more than 10%BW causes changes in the kinematic and in the muscular recruitment pattern.

A model for multidimensional efficiency analysis of public hospital management

Abstract Introduction Multidimensional efficiency analysis can provide important insights into the performance of hospitals. In this paper, we propose a multidimensional model based on Data Envelopment Analysis (DEA) to investigate and compare the efficiency of public hospitals in Brazil. Methods Data from 21 public hospitals were collected from public databases (OECD - Organization for Economic Co-operation and Development; SIH-SUS - SUS Hospital Information System, Datasus, Brazil). Four inputs (Number of medical and non-medical staff, Annual revenue, Number of beds, Average length of patient hospitalization), four Variables of Influence (Type of hospital, Accredited hospital, Number of medical specialties, Resources from government) and four Outputs (Number of outpatient care services, Number of hospitalizations, Number of surgeries, Number of exams) were used to feed the DEA model. Results Seven hospital units reach 100% efficiency and, according to DEA, can be considered efficient units. Two units were considered "almost efficient" and the remaining twelve units perform poorly, considering the data supplied to the DEA model. As a whole, the average efficiency of the hospitals investigated was 79% (0.79). Conclusion A very heterogeneous performance has been found among the Brazilian public hospitals investigated. Besides, the reasonably low average efficiency seems to indicate that the system has a large potential for improvement in almost all areas associated with the input and output variables investigated in this paper.

An investigative case study at local hospital into the current reliability of blood pressure sphygmomanometers

Abstract Introduction Arterial Blood Pressure is a significant indicator of the current health condition of an individual. The correct detection of hypertension is essential, where this health problem is considered as one of the greatest health risks factors that affect the heart and circulatory system. This paper presents the importance of the application of metrological criteria for the diagnosis of hypertension using a sphygmomanometer aneroid. Methods 72 mechanical aneroid sphygmomanometers were calibrated using a standard manometer and the indication error, hysteresis, air leakage and rapid exhaust were determined; readings of these sphygmomanometers were compared to a properly calibrated and adjusted aneroid sphygmomanometer to carry out pressure measurements as those made during the hypertension diagnosis; the uncertainty of measurement associated with the sphygmomanometers calibration, and pressure values was assessed according to the recommendations of the Guide to the Expression of Uncertainty in Measurement, defined by the Joint Committee for Guides in Metrology. Results The results obtained have shown that about 61% of the evaluated aneroid sphygmomanometers did not meet the specifications. The variable that most contributed to the final calibration uncertainty was the hysteresis of the standard manometer, with 53% of contribution, followed by the sphygmomanometer resolution with 27%. Conclusion The periodic verifications are essential to evaluate the performance of these devices. It was shown that uncertainty of measurement influences the final diagnosis of hypertension and the application of metrological criteria can increase the reliability of the final diagnosis.

Decomposição e análise dos potenciais evocados auditivos de tronco encefálico / Decomposition and analysis of auditory brainstem response

Os PEATEs são sinais resultantes da combinação de respostas de atividades neurais a estímulos sonoros no córtex. Caracteriza-se por ondas, sendo seus picos nomeados por algarismos romanos (I, II, III, IV, V, VI e VII). O processo clássico de identificação desses picos é baseado na visualização do sinal gerado pela promediação de cada amostra. Nele são identificadas as características morfológicas do sinal e os aspectos temporais relevantes constituídos pelas ondas de Jewett no qual cada onda tem uma relação anatômica com o sítio de origem. No entanto, durante esse processo de identificação visual surgem dificuldades que tornam a análise visual dos PEATE uma fonte constante de dúvidas em relação a fidedignidade e concordância de marcação dos picos pela subjetividade entre os examinadores. Com o objetivo de melhorar o processo de avaliação dos PEATE, foi desenvolvido um sistema de detecção automática para os picos, com capacidade de aprendizado que leva em consideração o perfil de marcação prévia realizado por examinadores, podendo ser considerado também, as marcações futuras de examinadores que utilizarão o software como auxílio em suas análises. Para a detecção de picos foi utilizada a Transformada Wavelet Contínua, associada a um Classificador Probabilístico construído a partir de marcações realizadas pelos examinadores. Para a avaliação do sistema foram utilizadas 748 amostras de PEATE de 11 sujeitos. A avaliação do sistema proposto apresentou uma taxa de acerto 74,3% a 99,7%, entre o sistema e a marcação manual, de acordo com o tipo de onda analisada. O presente estudo foi concebido com a intenção de ser uma ferramenta prática e por isso voltada para a aplicação clínica. Os resultados apresentados mostram uma técnica eficaz e capaz de aperfeiçoar o processo de avaliação dos PEATEs. A técnica proposta se mostra precisa mesmo na presença de ruído, característico de sinais biológicos especialmente no PEATE por ser um sinal de amplitude baixa.

Auditory Brainstem Response (ABR) results from the combination of neural activity responses in the presence of sound stimuli, detected by the cortex and characterized by peaks and valleys. They are identified by Roman numerals (I, II, III, IV, V, VI and VII). The identification of these peaks is carried out by the classical manual process of analysis, which is based on the visual/manual processing of the signals. The morphological and temporal characteristics of the signal carry relevant physiological and anatomical information regarding the auditory system. However, in this visual process of analysis some difficulties may occur, specifically, the results of the analysis may vary according to the type of protocol, settings of equipment employed, and the experience of the examiner. This makes the analysis of ABR subject to the influence of many variables that may interfere on the reliability and agreement of results obtained in distinct research centers and by different examiners. Therefore, the main propose of this study was to develop and assess a system capable of automatically detecting and classifying ABR waves, which are called Jewett waves. A relevant feature of the proposed tool is that it can learn from the experience of examiners continuously. In order to evaluate the system approximately 748 samples of ABR obtained from 11 subjects were analyzed by the automatic system. These results were compared to analyses obtained from five seasoned examiners, and they showed a high level of agreement, ranging for 74.3% to 99.7%, between responses given by the system and the examiners. Thus the proposed technique is proved to be accurate even in the presence of noise, especially characteristic of the ABR that is a sign of low amplitude.

Analysis of the relationship between EEG signal and aging through Linear Discriminant Analysis (LDA) / Análise das relações entre o sinal EEG e o envelhecimento através da Análise Discriminante Linear (ADL)

This paper aims to establish the correlation between statistical parameters and Electroencephalographic (EEG) signals as a function of age, in subjects without neurological disorders. EEG signals were recorded during the task of following an Archimedes spiral. There were 59 healthy subjects who voluntarily participated in this study which were divided into 7 groups, aging between 20 to 86  years from both gender, in order to identify differences and allow discrimination between the features of each group. Initially, comparisons were made among several features (F20, F50, F80, F95, Mean Frequency, Root Mean Square value, Zero Crossings, Square of the Power Spectrum, Kurtosis, Skewness, Variance, Standard Deviation and Approximate Entropy) seeking separation between young and elderly groups. Furthermore, it was sought to correlate the statistical parameters and the entire age range. For this purpose it was used Linear Discriminant Analysis  (LDA). The data were processed with MATLAB® software. Through the LDA, significant differences were observed over the distinct age ranges. The tool has satisfactorily performed the separation of discriminant features by classifying groups of subjects in function of their age range.

O objetivo deste trabalho é estabelecer as correlações entre parâmetros estatísticos e EEG em função da idade, em indivíduos não portadores de distúrbios neurológicos. Os sinais EEG foram registrados durante a tarefa de seguir uma espiral de Arquimedes. 59 indivíduos saudáveis participaram do estudo e foram divididos em 7 grupos, com idades entre 20 a 86 anos, de ambos os sexos, para identificar diferenças e permitir a discriminação entre as características de cada grupo. Inicialmente, foram feitas comparações entre as diversas variáveis (F20, F50, F80, F95, Frequência Média, RMS, Cruzamentos por zero, Quadrado do Espectro de Potência, Curtose, Assimetria, Variância, Desvio Padrão e Entropia Aproximada) procurando a separação entre os grupos jovem e idoso. Buscou-se ainda correlacionar os parâmetros estatísticos e toda a faixa etária. Para tal, a técnica de Análise Discriminante Linear (ADL) foi utilizada. Os dados foram processados com o software MATLAB®. Por meio da ADL foram observadas diferenças significativas ao longo da idade. Observou-se que a ferramenta executou de forma satisfatória a separação de características discriminantes, classificando cada grupo de indivíduos em função da idade.

A utilização de uma rede neural artificial para previsão da incidência da malária no município de Cantá, estado de Roraima / Use of an artificial neural network to predict the incidence of malaria in the city of Cantá, state of Roraima

INTRODUÇÃO: A malária é uma doença endêmica na Amazônia Legal Brasileira, apresentando riscos diferentes para cada região. O Município de Cantá, no Estado de Roraima, apresentou para todo o período estudado, um dos maiores índices parasitários anuais do Brasil, com valor sempre maior que 50. O presente estudo visa à utilização de uma rede neural artificial para previsão da incidência da malária nesse município, a fim de auxiliar os coordenadores de saúde no planejamento e gestão dos recursos. MÉTODOS: Os dados foram coletados no site do Ministério da Saúde, SIVEP - Malária entre 2003 e 2009. Estruturou-se uma rede neural artificial com três neurônios na camada de entrada, duas camadas intermediárias e uma camada de saída com um neurônio. A função de ativação foi à sigmoide. No treinamento, utilizou-se o método backpropagation, com taxa de aprendizado de 0,05 e momentum 0,01. O critério de parada foi atingir 20.000 ciclos ou uma meta de 0,001. Os dados de 2003 a 2008 foram utilizados para treinamento e validação. Comparam-se os resultados com os de um modelo de regressão logística. RESULTADOS: Os resultados para todos os períodos previstos mostraram-se que as redes neurais artificiais obtiveram um menor erro quadrático médio e erro absoluto quando comparado com o modelo de regressão para o ano de 2009. CONCLUSÕES: A rede neural artificial se mostrou adequada para um sistema de previsão de malária no município estudado, determinando com pequenos erros absolutos os valores preditivos, quando comparados ao modelo de regressão logística e aos valores reais.

INTRODUCTION: Malaria is endemic in the Brazilian Amazon region, with different risks for each region. The City of Cantá, State of Roraima, presented one of the largest annual parasite indices in Brazil for the entire study period, with a value always greater than 50. The present study aimed to use an artificial neural network to predict the incidence of malaria in this city in order to assist health coordinators in planning and managing resources. METHODS: Data were collected on the website of the Ministry of Health, SIVEP - Malaria between 2003 and 2009. An artificial neural network was structured with three neurons in the input layer, two intermediate layers and an output layer with one neuron. A sigmoid activation function was used. In training, the backpropagation method was used, with a learning rate of 0.05 and momentum of 0.01. The stopping criterion was to reach 20,000 cycles or a target of 0.001. The data from 2003 to 2008 were used for training and validation. The results were compared with those from a logistic regression model. RESULTS: The results for all periods provided showed that the artificial neural network had a smaller mean square error and absolute error compared with the regression model for the year 2009. CONCLUSIONS: The artificial neural network proved to be adequate for a malaria forecasting system in the city studied, determining smaller predictive values with absolute errors compared to the logistic regression model and the actual values.