Pedi-R-MAPP: The development of a nutritional awareness tool for use in remote paediatric consultations using a modified Delphi consensus.

BACKGROUND & AIMS: The Remote Malnutrition Application (R-MAPP) was developed during the COVID-19 pandemic to provide support for health care professionals (HCPs) working in the community to complete remote nutritional assessments, and provide practical guidance for nutritional care. The aim of this study was to modify the R-MAPP into a version suitable for children, Pediatric Remote Malnutrition Application (Pedi-R-MAPP), and provide a structured approach to completing a nutrition focused assessment as part of a technology enabled care service (TECS) consultation. METHODS: A ten-step process was completed: 1) permission to modify adult R-MAPP, 2) literature search to inform the Pedi-R-MAPP content, 3) Pedi-R-MAPP draft, 4) international survey of HCP practice using TECS, 5) nutrition experts invited to participate in a modified Delphi process, 6) first stakeholder meeting to agree purpose/draft of the tool, 7) round-one online survey, 8) statements with consensus removed from survey, 9) round-two online survey for statements with no consensus and 10) second stakeholder meeting with finalisation of the Pedi-R-MAPP nutrition awareness tool. RESULTS: The international survey completed by 463 HCPs, 55% paediatricians, 38% dietitians, 7% nurses/others. When HCPs were asked to look back over the last 12 months, dietitians (n = 110) reported that 5.7 ± 10.6 out of every 10 appointments were completed in person; compared to paediatricians (n = 182) who reported 7.5 ± 7.0 out of every 10 appointments to be in person (p < 0.0001), with the remainder completed as TECS consultations. Overall, 74 articles were identified and used to develop the Pedi-R-MAPP which included colour-coded advice using a traffic light system; green, amber, red and purple. Eighteen participants agreed to participate in the Delphi consensus and completed both rounds of the modified Delphi survey. Agreement was reached at the first meeting on the purpose and draft sections of the proposed tool. In round-one of the online survey, 86% (n = 89/104) of statements reached consensus, whereas in round-two 12.5% (n = 13/104) of statements reached no consensus. At the second expert meeting, contested statements were discussed until agreement was reached and the Pedi-R-MAPP could be finalised. CONCLUSION: The Pedi-R-MAPP nutrition awareness tool was developed using a modified Delphi consensus. This tool aims to support the technological transformation fast-tracked by the COVID-19 pandemic by providing a structured approach to completing a remote nutrition focused assessment, as well as identifying the frequency of follow up along with those children who may require in-person assessment.

Comparison of the effect of two sports training methods on the flexibility of rhythmic gymnasts at different levels of biological maturation.

AIM: The present study aimed to assess the effects of two different sports training methods - traditional and maturational - on the flexibility of female rhythmic gymnasts at different levels of biological maturation. METHODS: The sample consisted of 120 children, randomly divided (by draw) into six groups of 20 children (eight and nine-years old): traditional training group (TG); maturational training group (MG); and the control group (CG). These were subdivided into early, normal and late, based on biological maturation assessment by hand/wrist X-ray examination. Flexibility was evaluated by angle goniometer testing, applying the LABIFIE protocol. A Lafayette Goniometer Set and Hoorn-Brasil exercise mat were used and the following exercises were performed: external shoulder rotation (ESR) and lumbar flexion (LF). Both the TG and MG participated in twice-weekly, 45-minute rhythmic gymnastics classes over 16 weeks. The TG used the traditional sports training method while the MG executed sporting activities according to biological maturation. The CG received no special treatment. RESULTS: The results showed a significant improvement (P<0.001) in the subgroups (late, normal and early) for both variables (∆ESR=7.54º and ∆LF=7.51º) in the eight and nine-year age groups. Moreover, in relation to division by biological maturity, better results were recorded in the early subgroups. CONCLUSION: Thus, it can be inferred that, due to the changes in important physical parameters as a result of maturation, selecting children for physical education should not be based solely on chronological, but primarily on biological maturation.

Força muscular respiratória e pico de fluxo expiratório de pacientes com bronquiectasia submetidos à reabilitação respiratória / Respiratory muscle strength and peak expiratory flow in patients with bronchiectasis underwent pulmonary rehabilitation / La fuerza muscular respiratoria y el flujo espiratorio máximo en pacientes con bronquiectasias en rehabilitación respiratoria

Este estudio tuvo como objetivo evaluar la fuerza muscular respiratoria y el flujo espiratorio máximo en pacientes con bronquiectasias en rehabilitación respiratoria. Método. Clínico, experimental, en el que, una vez verificados los criterios de inclusión y exclusión, la muestra se dividió aleatoriamente en: grupo experimental (GE, n = 13, edad = 60 ± 14,86 años) - que fueron tratados con rehabilitación respiratoria dos veces por semana, con una duración de 40 minutos por sesión, por 12 semanas y el grupo de control (GC, n = 13, edad = 58 ± 13,90 años) - los pacientes tratados con clínica conservadora de seguimiento permanecieron sin tratamiento durante el período de estudio, porque eran parte de una lista de espera para el servicio. Las variables dependientes del estudio fueron la fuerza muscular respiratoria (MIP - Presión de MIP-espiratorio - MEP) y el flujo espiratorio máximo (FEM), medida por el manómetro y el pico de flujo ®, respectivamente. El nivel de significación se fijó en p <0,05. Resultados. En la comparación dentro de los grupos, hubo un aumento significativo sólo en las variables de GE, a saber: MIP (cmH2O Δ = 18,08, p <0,001); MEP (cmH2O Δ = 12,31, p <0,001) y el FEM (Δ = 26,77 l / min, p = 0,016). En la comparación entre los grupos, hubo incremento satisfactorio en el post-test, el GE frente al GC en el MIP y la MEP (p = 0,005). Conclusiones. Por lo tanto, parece que la terapia física propuesta influencia en el aumento de la fuerza muscular respiratoria y del flujo espiratorio máximo en pacientes con bronquiectasia(AU)

Objetivo. Este estudio tuvo como objetivo evaluar la fuerza muscular respiratoria y el flujo espiratorio máximo en pacientes con bronquiectasias en rehabilitación respiratoria. Método. Clínico, experimental, en el que, una vez verificados los criterios de inclusión y exclusión, la muestra se dividió aleatoriamente en: grupo experimental (GE, n = 13, edad = 60 ± 14,86 años) - que fueron tratados con rehabilitación respiratoria dos veces por semana, con una duración de 40 minutos por sesión, por 12 semanas y el grupo de control (GC, n = 13, edad = 58 ± 13,90 años) - los pacientes tratados con clínica conservadora de seguimiento permanecieron sin tratamiento durante el período de estudio, porque eran parte de una lista de espera para el servicio. Las variables dependientes del estudio fueron la fuerza muscular respiratoria (MIP - Presión de MIP-espiratorio - MEP) y el flujo espiratorio máximo (FEM), medida por el manómetro y el pico de flujo®, respectivamente. El nivel de significación se fijó en p <0,05. Resultados. En la comparación dentro de los grupos, hubo un aumento significativo sólo en las variables de GE, a saber: MIP (cmH2O Δ = 18,08, p <0,001); MEP (cmH2O Δ = 12,31, p <0,001) y el FEM (Δ = 26,77 l / min, p = 0,016). En la comparación entre los grupos, hubo incremento satisfactorio en el post-test, el GE frente al GC en el MIP y la MEP (p = 0,005). Conclusiones. Por lo tanto, parece que la terapia física propuesta influencia en el aumento de la fuerza muscular respiratoria y del flujo espiratorio máximo en pacientes con bronquiectasia

Objective. This research aimed to evaluate the respiratory muscle strength and peak expiratory flow in patients with bronchiectasis undergoing respiratory rehabilitation. Method. Clinical trial where, after scrutiny of inclusion and exclusion criteria, the sample was divided randomly into experimental group (EG, n = 13, age = 60 ± 14.86 years) - who underwent treatment with respiratory rehabilitation twice week, lasting 40 minutes per session, at 12 weeks and control group (CG, n = 13, age = 58 ± 13.90 years) - patients with conservative clinical follow-up without therapy during the period of research because they were part of a waiting list for care. The dependent variables of the study were respiratory muscle strength (maximal inspiratory pressure - MIP- expiratory pressure - MEP) and peak expiratory flow (PEF), measured by the manometer and the peak flow®, respectively. The level of significance was set at p < 0.05. Results. In within groups comparison, there was a significant increase only in the EG variables, namely: MIP (Δ = 18.08 cm H2O, p < 0.001) and MEP (cmH2O Δ = 12.31, p < 0.001) and PEF (Δ = 26.77 l / min, p = 0.016). In the between groups comparison, increased satisfactory post-test, GE, compared to GC in MIP and MEP (p = 0.005). Conclusion. it appears that physical therapy influences the proposed increase in respiratory muscle strength and peak expiratory flow in patients with bronchiectasis(AU)

Concentración de la hidroxiprolina en la orina de jóvenes tras un programa de estiramientos estáticos y facilitación neuromuscular proprioceptiva / Concentration of hydroxyproline in urine of the young undergoing a static stretching program and proprioceptive neuromuscular facilitation

Introducción. La flexibilidad está en los debates sobre la actividad física y su prescripción. Es necesario identificar la forma de entrenamiento que aumente el catabolismo del colágeno locomotor generando la adaptación en los tejidos, llegando a la fase plástica del estiramiento. Objetivo. Comparar el nivel de hidroxiprolina (HP) entre jóvenes sedentarios sometidos a 2 tipos de estiramientos: a) estáticos pasivos (EP); y b) facilitación neuromuscular propioceptiva (FNP). Material y método. La muestra es de 30 sujetos distribuidos de forma aleatoria en: grupo FNP (GF, n = 15; edad: 22 ± 3 años; IMC: 24,12 ± 3,69), grupo EP (GA, n = 15; edad: 23 ± 4 años; IMC: 25 ± 4,33) y grupo control (GC, n = 15; edad: 24 ± 4 años; IMC: 23, 91 ± 3,09). El estiramiento (EP) se realizó con mantenimiento durante 6 segundos, mientras que el estiramiento por FNP se realizó por el método mantener y relajar. La intensidad de cada intervención fue controlada mediante la Escala de estrés percibido en la flexibilidad (PERFLEX). Resultados. Respecto al intra-grupo en GF (Δ = 3,55mg/24 horas; p = 0,0001) y GA (Δ = 3,47mg/24 horas; p = 0,002) y entre los grupos, entre GF y GC (Δ = 2,43mg/24 horas; p = 0,018) y entre GA y GC (Δ = 2,83mg/24 horas; p = 0,005), favorable a los dos grupos de entrenamiento. Podría estar relacionado que ambas metodologías obtuvieran resultados similares, aumentando el nivel de HP, lo que hace posible concluir que los resultados de este estudio no nos permiten afirmar cuál de los dos métodos es el más adecuado por tener menor riesgo de lesiones en lo que respecta a su prescripción(AU)

Introduction. Flexibility has been increasingly incorporated into discussions about physical activity and its prescription, creating the need for identifying the form of flexibility training that will increase catabolism of collagen in the locomotor system, thus forcing the conjunctive tissue to adapt and achieve the plastic phase of stretching. Objective. This study has aimed to compare hydroxyproline (HP) levels among sedentary young people submitted to two types of stretchings: static stretching (SS) and proprioceptive neuromuscular facilitation (PNF). Material and methods. The sample was randomly divided into PNF group (PG; n=15; age=22±3 years; BMI=24, 12±3.69); static stretching group (SG; n=15; age=23±4 years; BMI= 25±4.33) and control group (CG; n=15; age: 24±4 years; BMI: 23.91±3.09). Static stretching was done by passive straining during six seconds and PNF was done according to the hold-relax method. The intensity of each intervention was controlled with the Scale of Perceived Exertion in the Flexibility – PERFLEX. Results. The study found satisfactory results: intra-group, in PG (Δ = 3.55mg/24h; p = 0.0001) and in SG (Δ= 3.47mg/24h; p=0.002) and inter-groups, between PG and CG (Δ = 2.43mg/24h; p = 0.018) and between SG and CG (Δ = 2.83mg/24h; p = 0.005), both favorable to the training groups. It was possible to infer that both forms of training obtained satisfactory results, increasing the level of HP, which leads to the conclusion that the results of this study do not allow us to state that one of these forms of training is more adequate than the other in regards to the prescription of which one would entail the lowest risk of injuries(AU)

[The anatomical-functional characteristics of the pelvic floor and quality of life of women with stress urinary incontinence subjected to perineal exercises]. / Las características anatomofuncionales del suelo pélvico y la calidad de vida de mujeres con incontinencia urinaria de esfuerzo sometidas a ejercicios perineales.

OBJECTIVE: To determine the effects of exercise in anatomic abnormalities of the pelvic floor (SP) and the quality of life (QOL) of women with stress urinary incontinence (SUI). METHOD: An experimental study with 50 women with SUI, distributed randomly into two groups, experimental (GE, 49.24±7.37 years) and control group (CG; 45.25±5.60 years). The groups performed ultrasound evaluation of the SP, evidence of pelvic floor muscle strength by palpation bidigital, surface EMG motor activity and replied to the CV before and after treatment. The GE had 16 sessions of pelvic floor exercises twice a week for 30min. RESULTS: Comparison between the GE and GC revealed significant differences in favor of GE, namely: mobility of the bladder neck (Δ=-0.79mm, p=0.00), thickness of pelvic floor muscle (Δ=-0.04mm, p=0.00), EMG (Δ=0.05.V, p=0.00), muscle strength by the AFA (Δ=0.05 level, p=0.00), DOMI1 (Δ%=5.67%, p=0.00), DOMI2 (Δ%=18.00%, p=0.00), DOMI3 (Δ%=18.22%, p=0.00), DOMI4 (Δ%=4.45%, p=0.00), DOMI5 (Δ%=0.22%, p=0.00), DOMI6 (Δ%=2.00%, p=0.00), DOMI7 (Δ%=3.78%, p=0, 00), DOMI8 (Δ%=6.33%, p=0.00), DOMI9 (Δ%=4.03%, p=0.00). CONCLUSION: It was modified and improved anatomic features of the pelvic floor of women from GE through perineal exercises, which will positively influence the CV of these women.

Cholinergic agonism alters cognitive processing and enhances brain functional connectivity in patients with multiple sclerosis.

The aim of this study is to define mechanisms underlying the pharmacological effects of brain cholinesterase inhibition on cognitive function in patients with multiple sclerosis (MS). Both a Stroop task and an N-back task were used to probe the changes in brain activity using functional magnetic resonance imaging (fMRI) in a single (investigator)-blind, crossover treatment design studying 15 patients with multiple sclerosis (12 relapsing remitting, 3 secondary progressive) taking rivastigmine (4.5 mg po bid) and domperidone (10 mg po qd) or domperidone alone. Administration of rivastigmine increased Stroop functional magnetic resonance imaging activation in the right inferior frontal gyrus for the Stroop task (P < 0.05, corrected). Incremental functional magnetic resonance imaging activation with progressively greater N-back task difficulty was enhanced by rivastigmine in prefrontal and parietal cortical regions (P < 0.01, ANOVA). Functional connectivity analysis of the N-back functional magnetic resonance imaging data based on correlations between pair-wise interregional activations showed increased connectivity between left to right prefrontal, anterior cingulate to left prefrontal and right parietal to right prefrontal regions with rivastigmine (P < 0.05, corrected). Although there were no statistically significant changes in the neuropsychological task performance with rivastigmine in this small study, 11 of 15 patients showed improvements, whereas only 4 of 15 patients showed decline in performance (P = 0.07). With regard to the previous data, these findings suggest different patterns of brain response to lower dose acute and higher dose chronic administration of rivastigmine in patients with multiple sclerosis. They showed that rivastigmine enhances the prefrontal function and alters the functional connectivity associated with cognition. We interpret this as evidence for greater efficiency of brain information transfer that should increase confidence in a potentially beneficial clinical therapeutic effect.

Discordant white matter N-acetylasparate and diffusion MRI measures suggest that chronic metabolic dysfunction contributes to axonal pathology in multiple sclerosis.

Diffusion MRI and magnetic resonance spectroscopic measurements of selectively neuronally localised N-acetylaspartate (NAA) both have been used widely to assess white matter integrity and axonal loss. We have tested directly the relationship between changes in diffusion MRI parameters and NAA concentrations in the corpus callosum (CC) in an in vivo study of patients with MS. Fifteen MS patients (median EDSS 2.5, range 1-4) were studied with T(1) anatomical, T(2)-weighted, and diffusion-sensitised MRI and PRESS single-voxel MRS. A recently described method, tract-based spatial statistics (TBSS) [Smith, S.M., Jenkinson, M., Johansen-Berg, H., Rueckert, D., Nichols, T.E., Mackay, C.E. et al., 2006. Tract-based spatial statistics: voxelwise analysis of multi-subject diffusion data. Neuroimage 31, 1487-1505] also was used to perform exploratory voxelwise whole-brain analysis of white matter diffusion fractional anisotropy (FA). We found a strong correlation between callosal size and both mean FA (r=0.68, p<0.005) (related specifically to changes in the radial tensor component) and mean inter-hemispheric motor tract connectivity probability (r=0.74, p<0.001). TBSS confirmed that the diffusion anisotropies of white matter voxels specifically within the callosum were correlated with the callosal size. Individual patient global T(2) lesion volumes were correlated with both the probability of callosal connectivity (r=-0.69, p<0.005) and fractional anisotropy across the callosum (r=-0.76, p<0.001). However, absolute concentrations of NAA from the voxel showed no correlation with callosal cross-sectional area, mean connectivity or fractional anisotropy within the callosal pathway. We conclude that diffusion MRI shows changes consistent with sensitivity to axonal loss, but that relative NAA changes are not necessarily related directly to this. Axonal metabolic function, independent of structural integrity, may be a major determinant of NAA measures in MS.