Prevalence of swallowing difficulties in older people without neurological disorders: Swallowing profile of older people in the city of Santos, Brazil.

Several studies report that 40% to 60% of older people have some difficulty chewing and/or swallowing, which can lead to malnutrition, dehydration, weight loss, a lack of eating desire, etc. Identify older adults with swallowing difficulties in the city of Santos, Brazil, among users of the public healthcare system. A cross-sectional study was conducted with 100 individuals aged 60 to 90 years with no neurological disorders. Patient histories were taken, and stomatognathic evaluations were performed. The Mini Mental Health Examination (MMHE) and swallowing-related quality-of-life questionnaire (SWAL-QOL) were administered. The clinical swallowing assessment was performed with liquid, pasty and solid foods using two assessment protocols (Dysphagia Risk Evaluation Protocol and the Protocol for the Introduction and Transition of Foods)'. We found complaints of poorly adapted dentures among 49.3% of denture wearers and a high prevalence of hypofunction of oro-facial muscles. Sixty-five per cent of the respondents had facial muscle hypofunction, 51% exhibited lip hypofunction, and 49% exhibited tongue hypofunction. Moreover, 54% reported difficulty swallowing. On the SWAL-QOL questionnaire, 37% reported choking when eating food, 44% reported choking when drinking liquids, 29% reported coughing during meals, and 77% reported difficulty chewing. The present study revealed an important prevalence of complaints related to swallowing difficulties among older people in the city of Santos with structural and physiological changes characteristic of presbyphagia. The most prevalent conditions were poorly adapted dentures and hypofunction of oro-facial muscles, underscoring the importance of stomatognathic interventions in primary care.

Effects of concurrent training on muscle strength in older adults with metabolic syndrome: A randomized controlled clinical trial.

INTRODUCTION: Metabolic syndrome is highly prevalent among older adults. Concurrent training comprises muscle strengthening and aerobic exercise. OBJECTIVE: Determine the effects of a concurrent training program on muscle strength, walking function, metabolic profile, cardiovascular risk, use of medications and quality of life among older adults with metabolic syndrome. METHODS: A randomised, controlled, blind, clinical trial was conducted in the city of Santos, state of São Paulo, Brazil, involving 41 male and female older adults. The participants were randomly allocated to a control group (n = 18) and intervention group (n = 23) and were submitted to the following evaluations: strength - 1 maximum repetition (1MR) for 12 muscle groups; the Six-Minute Walk Test (6MWT); blood concentrations of cholesterol and glucose; the use of medications; and the administration of the SF-36 questionnaire. The intervention was conducted twice a week over a total of 24 sessions of concurrent training: 50 min of strength exercises (40-70% 1MR) and 40 min of walking exercises (70-85% maximum heart rate). RESULTS: Increases in muscle strength were found in the upper and lower limbs in the inter-group analysis and a greater distance travelled on the 6MWT was found in the intervention group (p = 0.001). The intervention group demonstrated a reduction in the consumption of biguanides (p = 0.002). No changes were found regarding metabolic profile, cardiovascular risk or self-perceived quality of life. CONCLUSION: The findings of this clinical trial can be used for the prescription of concurrent training for older adults with metabolic syndrome for gains in muscle strength and walking distance as well as a reduction in the use of biguanides.

Psychological aspects of juvenile fibromyalgia syndrome: a literature review.

Juvenile fibromyalgia syndrome (JFMS) is a non-inflammatory chronic pain condition that occurs mainly in girls aged 9-15 years. JFMS is characterized by constant widespread pain in different parts of the body, poor sleep quality, daytime sleepiness and an altered mood. Concomitant psychological and organic factors result in a diminished capacity to cope with pain. The quality of life of individuals with chronic pain and their caregivers is severely restricted and the occurrence of symptoms of anxiety and depression is common in this population. The aim of the present study was to perform a systematic review of the literature on psychosocial factors related to JFMS. The findings reveal differences in opinion between patients and family members regarding the effect of the condition, as mothers tend to classify JFMS as more severe than the patients themselves. Individuals with JFMS seem to share the same personality traits and there seems to be a type of family environment that is favorable to the occurrence of this condition. Psychological and functional aspects should be treated with methods that can help patients and family members alter their coping strategies regarding day-to-day problems, attenuate the dysfunctional consequences of pain and fatigue and diminish the risk of catastrophizing that individuals submitted to constant pain develop in relation to their surrounding environment.

Assessment of cervical pain and function in patients with rheumatoid arthritis.

Rheumatoid arthritis (RA) is characterized by inflammation of the synovial membrane, which can lead to deformities and functional disability. Unlike the dorsal and lumbar spine, the cervical spine is often affected by RA. The objective of this paper is to assess cervical pain and function in patients with RA and correlate these variables with overall function, quality of life, and radiographic findings on the cervical spine. One hundred individuals aged 18 to 65 years were divided into study group (50 patients with rheumatoid arthritis) and control group (50 healthy individuals, paired for gender and age). Patients with prior surgery, prior trauma or other symptomatic cervical spine condition were excluded. The visual analogue pain scale (VAS), Neck Pain and Disability Scale (NPDS), SF-36, HAQ and X-rays were used for evaluation purposes. Mean disease duration was 11.1 years. The cervical VAS was 2.4 cm and 1.3 cm for the study and control groups, respectively (p = 0.074). Statistical differences were found in NPDS scores, mean = 26.7 and 6.9, and HAQ scores, mean = 1.1 and 0.1, for the study and control groups, respectively (p < 0.001). SF-36 scores were statistically worse in the study group, except for the vitality, social aspects and mental health subscales. There was a positive correlation between the NPDS and VAS (r = 0.54) and between the NPDS and HAQ (r = 0.67). There was a negative correlation between the NPDS and SF-36 functional capacity domain (r = -0.53) and physical limitation domain (r = -0.58). The radiographic findings revealed more prevalent anterior atlanto-axial subluxation (p = 0.030), listhesis in neutral posture (p = 0.037), listhesis in extension (p = 0.007), degenerative alteration of C4-C5 segment (p = 0.023), size of C2 spinal canal (p = 0.002) and C3 spinal canal (p = 0.029) in the study group. Patients with RA have poorer cervical function than healthy individuals, although there is no difference in cervical pain.

Functional thumb orthosis for type I and II boutonniere deformity on the dominant hand in patients with rheumatoid arthritis: a randomized controlled study.

OBJECTIVE: To evaluate the effectiveness of a functional thumb orthosis on the dominant hand of patients with rheumatoid arthritis and boutonniere thumb. METHODS: Forty patients with rheumatoid arthritis and boutonniere deformity of the thumb were randomly distributed into two groups. The intervention group used the orthosis daily and the control group used the orthosis only during the evaluation. Participants were evaluated at baseline as well as after 45 and 90 days. Assessments were preformed using the O'Connor Dexterity Test, Jamar dynamometer, pinch gauge, goniometry and the Health Assessment Questionnaire. A visual analogue scale was used to assess thumb pain in the metacarpophalangeal joint. RESULTS: Patients in the intervention group experienced a statistically significant reduction in pain. The thumb orthosis did not disrupt grip and pinch strength, function, Health Assessment Questionnaire score or dexterity in either group. CONCLUSION: The use of thumb orthosis for type I and type II boutonniere deformities was effective in relieving pain.

Progressive resistance training in patients with shoulder impingement syndrome: a randomized controlled trial.

OBJECTIVE: To assess pain, function, quality of life, and muscle strength in patients with shoulder impingement syndrome who participated in muscle strengthening exercises. METHODS: A total of 60 patients diagnosed with shoulder impingement syndrome were selected from the clinics of the Federal University of São Paulo and randomly distributed into experimental and control groups. Patients were evaluated regarding pain, function, quality of life, muscle strength, and the number of antiinflammatory drugs and analgesics taken. Patients then participated in the progressive resistance training program for the musculature of the shoulder, which was held twice a week for 2 months, while the control group remained on a waiting list. RESULTS: Sixty patients were randomly allocated to the experimental group (21 women and 9 men, mean age 56.3 years) and control group (25 women and 5 men, mean age 54.8 years). Patients from the experimental group showed an improvement from 4.2 cm to 2.4 cm on a 10-cm visual analog scale (P < 0.001) regarding pain at rest and from 7.4 cm to 5.2 cm (P < 0.001) regarding pain during movement. Function went from 44.0 to 33.2 (P < 0.007) using the Disabilities of the Arm, Shoulder, and Hand assessment and domains from the Short Form 36. There was a statistically significant difference in improvement in pain and function between patients in the experimental group and those in the control group (P < 0.05). CONCLUSION: The progressive resistance training program for the musculature of the shoulder in patients with shoulder impingement syndrome was effective in reducing pain and improving function and quality of life.

Evaluation of pulmonary function and quality of life in women with osteoporosis.

Osteoporotic vertebral fractures generally result in an increased kyphotic angle, which in turn may lead to disturbances in pulmonary function. The objective of the present study was to evaluate pulmonary function and quality of life in a group of osteoporotic patients. Fifteen women with osteoporosis and thoracic vertebral fractures (group 1), 20 women with osteoporosis without vertebral fracture (group 2) and 20 control women (group 3) were submitted to spirometry using a Vitatrace-130 SL spirometer and to an SF-36 quality of life questionnaire. Women with osteoporosis and vertebral fractures showed an increased kyphotic angle (median=60 degrees) and decreased forced vital capacity (group 1 vs. group 2, P =0.020; group 1 vs. group 3, P =0.039) and forced expiratory volume in 1 s (group 1 vs. group 2, P =0.008; group 1 vs. group 3, P =0.014) when compared with women without vertebral fractures or osteoporosis. A negative correlation was observed between thoracic kyphosis and the predicted value of expiratory forced volume in 1 s ( r =-0.713, P =0.003). No differences in the quality of life were detected between the three groups studied. We conclude that women with thoracic vertebral fractures have an increased kyphotic angle and present a decrease in lung volume.

Evaluation of physical capacity and quality of life in osteoporotic women.

INTRODUCTION: Osteoporotic vertebral fractures result in increased kyphosis angle, an alteration that may lead to disturbance in physical capacity. OBJECTIVE: We sought to evaluate physical capacity and disability in a group of osteoporotic patients. MATERIAL AND METHODS: Fifteen women with osteoporosis and vertebral fractures (G1), 20 women with osteoporosis without vertebral fractures (G2), and 20 control women (G3) were selected. The variables of physical capacity were measured using a treadmill. The patients spent 4 min standing quietly, 4 min walking at 3 km/h, and 10 min walking at 4 km/h. The SF-36 questionnaire was also applied. RESULTS: The results showed that women with osteoporosis and vertebral fractures (G1) had increased kyphosis angle (median 60 degrees ), while the angle was 43.5 degrees for G2 and 37 degrees for G3. Oxygen consumption (VO(2) (kg)), METS (metabolic equivalent), and energy expenditure (kcal/h) during the standing period were higher in G1 than in G2 (G1 vs G2, p=0.016, p=0.017, and p=0.012, respectively), whereas no difference in these parameters was observed between groups during the walking period. The energy expenditure during walking at 3 km/h and at 4 km/h showed a correlation with thoracic kyphosis in G1 (p=0.01 and p=0.017, respectively). No difference in SF-36 scores was observed between the three groups. CONCLUSION: Energy expenditure showed a correlation with the angle of thoracic kyphosis. Patients with or without osteoporosis showed the same energy expenditure during the walking period. The SF-36 score was similar for the three groups.