Shoulder pain in adolescent athletes: prevalence, associated factors and its influence on upper limb function.

BACKGROUND: Sports that require the constant use of an upper limb demand the maximum kinetic chain efficiency in this segment. Immaturity of the musculoskeletal system, followed by failure in motor skills can expose adolescents to major reports of pain complaints, particularly for the shoulder. OBJECTIVE: To evaluate the prevalence of shoulder pain in adolescent athletes and identify possible factors associated with the complaint. METHOD: A total of 310 athletes, of both sexes and aged between 10 and 19 years old participated on this study. The subjects filled out a questionnaire with personal, sports and upper limb function (Quick-DASH) questions. We evaluated the height, body mass, shoulder rotation range and stability of the upper limb using the CKCUES-test. The association between pain and the variables was analyzed using multilevel modeling logistic regression. We used the Mann-Whitney test for comparing between pain and function. RESULTS: The prevalence of shoulder pain was 43.5%. Athletes between 15 and 19 years, handball and judo practitioners, are 1.86, 2.14 and 3.07 more likely to report shoulder pain, respectively, when compared with other sports and ages. Shoulder pain reduced function scores (p<0.001) and increased changes in the range of motion (p<0.04). CONCLUSION: Shoulder pain is highly prevalent and is associated especially with older adolescent athletes of handball and judo, and affects the levels of function and the range of the shoulder.

Association between the number of sexual partners and alcohol consumption among schoolchildren / Associação entre número de parceiros sexuais e consumo de bebida alcoólica em escolares

Abstract Objective: To determine the association between the number of sexual partners and alcohol consumption in adolescents and young schoolchildren. Methods: The sample consisted of students from public schools aged 12-24 years who answered the Brazilian version of the Youth Risk Behavior Survey questionnaire. The analysis was performed by multinomial logistic regression model. Results: 1275 students were analyzed. For females, having two to five partners was associated with age ≥15 years (OR 14.58) and maternal education up to incomplete high school or lower educational level (OR 3.37). No consumption of alcohol decreased the chances of having more partners by 96%. For males, the associated variables were: age ≥15 years (OR 18.15); having no religion (OR 3.55); age at first dose ≤14 years (OR 3.48). Binge drinking increases the chances of having a higher number of sexual partners. Conclusion: Regardless of the number of partners, binge drinking and age of alcohol consumption onset are risk factors for vulnerable sexual behavior.

Resumo Objetivo: Determinar a associação entre número de parceiros sexuais e consumo de bebida alcoólica em adolescentes e jovens escolares. Métodos: A amostra foi composta por estudantes da rede estadual entre 12 e 24 anos, que responderam a versão brasileira do questionário Youth Risk Behavior Survey. A análise foi feita por modelo de regressão logística multinomial. Resultados: Foram analisados 1.275 estudantes. Para o sexo feminino ter entre dois a cinco parceiros esteve associado com idade ≥ 15 anos (OR 14,58) e escolaridade materna com ensino médio incompleto ou inferior (OR 3,37). Não fazer uso de bebida alcoólica diminuiu em 96% as chances de ter maior número de parceiros. Para o sexo masculino as variáveis associadas foram: idade ≥ 15 anos (OR 18,15); ausência de religião (OR 3,55); idade da primeira dose ≤ 14 anos (OR 3,48). O envolvimento em bebedeira demonstrou mais chances de ter maior número de parceiros sexuais. Conclusão: Independentemente do número de parceiros, a bebedeira e a idade de iniciação alcoólica são fatores de risco para comportamento sexual vulnerável.

Reliability and validity of the Brazilian version of the Pittsburgh Sleep Quality Index in adolescents / Confiabilidade e validade da versão brasileira do Índice de Qualidade do Sono de Pittsburgh em adolescentes

Abstract Objective: To evaluate the reliability and validity of the Brazilian version of the Pittsburgh Sleep Quality Index. Methods: 309 adolescents, subdivided into a sample of 209 subjects, of whom 25 were reassessed, and another sample of 100 adolescents. Reliability was assessed using Cronbach's α-values, intraclass correlation coefficient, Standard Error of Measure, Minimum Detectable Change, and Bland-Altman plotting. Exploratory analysis of the questionnaire components was performed based on the sample of 209 adolescents. Confirmatory factor analysis was performed with a sample of 100 individuals. Results: The sample of 209 participants had a mean age of 14.38 (±1.94) years, comprising 80 (38.3%) girls and 129 (61.7%) boys. The sample of 100 adolescents had a mean age of 13.66 (±2.35) years, comprising 51 (51%) girls and 49 (49%) boys. The questionnaire obtained a Standard Error of Measure = 1.12 and Minimum Detectable Change = 3.10. Cronbach's α was 0.71 and the Intraclass Correlation Coefficient was 0.65 (95% CI: 0.21-0.85). The factor analysis showed that the best model of components was the one that consisted of two factors, excluding the component on the use of sleep medications. Conclusion: The questionnaire showed high internal consistency and moderate reliability. Furthermore, a model with two factors seems to be the most appropriate to evaluate the quality of sleep in adolescents.

Resumo Objetivo: Avaliar a confiabilidade e validade da versão brasileira do Índice de Qualidade do Sono de Pittsburgh. Métodos: Uma amostra de 309 adolescentes, subdivididos em uma de 209 indivíduos, dos quais 25 foram reavaliados, e outra de 100 adolescentes. A confiabilidade foi avaliada por meio dos valores de α de Cronbach, coeficiente de correlação intraclasse, erro padrão da medida, mínima mudança detectável e plotado gráfico Bland-Altman. A análise exploratória dos componentes do questionário foi feita com base na amostra de 209 adolescentes. A análise fatorial confirmatória foi feita com a amostra de 100 indivíduos. Resultados: A amostra de 209 participantes teve uma média de 14,38 (± 1,94) anos, 80 (38,3%) meninas e 129 (61,7%) meninos. A amostra composta por 100 adolescentes teve uma média de 13,66 (± 2,35) anos, 51 (51%) meninas e 49 (49%) meninos. O questionário obteve erro padrão da medida = 1,12 e mudança mínima detectável = 3,10. O α de Cronbach foi de 0,71 e coeficiente de correlação intraclasse de 0,65 (IC95% 0,21-0,85). As análises fatoriais apontaram como melhor modelo de componentes aquele composto por dois fatores, com exclusão do componente sobre uso de medicamentos para dormir. Conclusão: O questionário obteve elevada consistência interna e confiabilidade moderada. Além disso, um modelo de dois fatores parece ser o mais adequado para avaliar a qualidade do sono em adolescentes.

Association between the number of sexual partners and alcohol consumption among schoolchildren.

OBJECTIVE: To determine the association between the number of sexual partners and alcohol consumption in adolescents and young schoolchildren. METHODS: The sample consisted of students from public schools aged 12-24 years who answered the Brazilian version of the Youth Risk Behavior Survey questionnaire. The analysis was performed by multinomial logistic regression model. RESULTS: 1275 students were analyzed. For females, having two to five partners was associated with age ≥15 years (OR 14.58) and maternal education up to incomplete high school or lower educational level (OR 3.37). No consumption of alcohol decreased the chances of having more partners by 96%. For males, the associated variables were: age ≥15 years (OR 18.15); having no religion (OR 3.55); age at first dose ≤14 years (OR 3.48). Binge drinking increases the chances of having a higher number of sexual partners. CONCLUSION: Regardless of the number of partners, binge drinking and age of alcohol consumption onset are risk factors for vulnerable sexual behavior.

Reliability and validity of the Brazilian version of the Pittsburgh Sleep Quality Index in adolescents.

OBJECTIVE: To evaluate the reliability and validity of the Brazilian version of the Pittsburgh Sleep Quality Index. METHODS: 309 adolescents, subdivided into a sample of 209 subjects, of whom 25 were reassessed, and another sample of 100 adolescents. Reliability was assessed using Cronbach's α-values, intraclass correlation coefficient, Standard Error of Measure, Minimum Detectable Change, and Bland-Altman plotting. Exploratory analysis of the questionnaire components was performed based on the sample of 209 adolescents. Confirmatory factor analysis was performed with a sample of 100 individuals. RESULTS: The sample of 209 participants had a mean age of 14.38 (±1.94) years, comprising 80 (38.3%) girls and 129 (61.7%) boys. The sample of 100 adolescents had a mean age of 13.66 (±2.35) years, comprising 51 (51%) girls and 49 (49%) boys. The questionnaire obtained a Standard Error of Measure=1.12 and Minimum Detectable Change=3.10. Cronbach's α was 0.71 and the Intraclass Correlation Coefficient was 0.65 (95% CI: 0.21-0.85). The factor analysis showed that the best model of components was the one that consisted of two factors, excluding the component on the use of sleep medications. CONCLUSION: The questionnaire showed high internal consistency and moderate reliability. Furthermore, a model with two factors seems to be the most appropriate to evaluate the quality of sleep in adolescents.

Low and high-frequency TENS in post-episiotomy pain relief: a randomized, double-blind clinical trial.

OBJECTIVE: To evaluate the effectiveness of low-frequency TENS (LFT) and high-frequency TENS (HFT) in post-episiotomy pain relief. METHOD: A randomized, controlled, double-blind clinical trial with placebo composed of 33 puerperae with post-episiotomy pain. TENS was applied for 30 minutes to groups: HFT(100 Hz; 100 µs), LFT (5 Hz; 100 µs), and placebo (PT). Four electrodes were placed in parallel near the episiotomy and four pain evaluations were performed with the numeric rating scale. The first and the second evaluation took place before TENS application and immediately after its removal and were done in the resting position and in the activities of sitting and ambulating. The third and fourth evaluation took place 30 and 60 minutes after TENS removal, only in the resting position. Intragroup differences were verified using the Friedman and Wilcoxon tests, and the intergroup analysis employed the Kruskal-Wallis test. RESULTS: In the intragroup analysis, there was no significant difference in the PT during rest, sitting, and ambulation (P>0.05). In the HFT and LFT, a significant difference was observed in all activities (P<0.001). In the intergroup analysis, there was a significant difference in the resting position in the HFT and LFT (P<0.001). In the sitting activity, a significant difference was verified in the second evaluation in the HFT and LFT (P<0.008). No significant difference was verified among the groups in ambulation (P<0.20). CONCLUSIONS: LFT and HFT are an effective resource that may be included in the routine of maternity wards.

Low and high-frequency TENS in post-episiotomy pain relief: a randomized, double-blind clinical trial

Objective: To evaluate the effectiveness of low-frequency TENS (LFT) and high-frequency TENS (HFT) in post-episiotomy pain relief. Method: A randomized, controlled, double-blind clinical trial with placebo composed of 33 puerperae with post-episiotomy pain. TENS was applied for 30 minutes to groups: HFT(100 Hz; 100 µs), LFT (5 Hz; 100 µs), and placebo (PT). Four electrodes were placed in parallel near the episiotomy and four pain evaluations were performed with the numeric rating scale. The first and the second evaluation took place before TENS application and immediately after its removal and were done in the resting position and in the activities of sitting and ambulating. The third and fourth evaluation took place 30 and 60 minutes after TENS removal, only in the resting position. Intragroup differences were verified using the Friedman and Wilcoxon tests, and the intergroup analysis employed the Kruskal-Wallis test. Results: In the intragroup analysis, there was no significant difference in the PT during rest, sitting, and ambulation (P>0.05). In the HFT and LFT, a significant difference was observed in all activities (P<0.001). In the intergroup analysis, there was a significant difference in the resting position in the HFT and LFT (P<0.001). In the sitting activity, a significant difference was verified in the second evaluation in the HFT and LFT (P<0.008). No significant difference was verified among the groups in ambulation (P<0.20). Conclusions: LFT and HFT are an effective resource that may be included in the routine of maternity wards. .

Effects of intensive arm training with an electromechanical orthosis in chronic stroke patients: a preliminary study.

OBJECTIVES: To evaluate the use of an electromechanical device, comprising an exoskeleton, a static orthosis, and a glove, for functional rehabilitation of the elbow and hand in patients with hemiparesis, and to compare it with physical therapy rehabilitation. DESIGN: Pretest-posttest design. SETTING: Rehabilitation laboratory. PARTICIPANTS: Volunteer sample of persons (N=12) with persistent hemiparesis from a single, unilateral stroke within the past 3 to 36 months. INTERVENTIONS: The volunteers were randomly divided into 2 groups. One group was treated with a conventional program of physiotherapy, and another group participated in a training program in which an electromechanical orthosis was used. All volunteers received 24 sessions, held 3 times a week for 8 weeks. MAIN OUTCOME MEASURES: Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), and electromyogram (EMG) amplitude. RESULTS: No statistical difference was found in the initial and final values of the MAS. Both groups showed a significant increase for the total scores of the FMA. However, only the group treated with the orthosis showed an increase in FMA scores related to the wrist and hand joint. The EMG analysis showed increased EMG amplitudes for all muscles in the group treated with the orthosis, whereas the group treated with physiotherapy showed gains in electromyographic activity only in the extensor digitorum communis. Intergroup comparison showed that the initial FMA scores of the wrist/hand were higher in the group treated with physiotherapy. However, after training, the scores in the group that used the orthosis were equivalent to those of the physiotherapy group. CONCLUSIONS: The results suggest that this device can be an auxiliary tool to help the conventional rehabilitation program of motor function of the affected upper extremity.

Activation of selected shoulder muscles during unilateral wall and bench press tasks under submaximal isometric effort.

STUDY DESIGN: Controlled laboratory study. OBJECTIVE: To assess the activation of 7 shoulder muscles under 2 closed kinetic chain (CKC) tasks for the upper extremity using submaximal isometric effort, thus providing relative quantification of muscular isometric effort for these muscles across the CKC exercises, which may be applied to rehabilitation protocols for individuals with shoulder weakness. BACKGROUND: CKC exercises favor joint congruence, reduce shear load, and promote joint dynamic stability. Additionally, knowledge about glenohumeral and periscapular muscle activity elicited during CKC exercises may help clinicians to design protocols for shoulder rehabilitation. METHODS: Using surface electromyography, activation level was measured across 7 shoulder muscles in 20 healthy males, during the performance of a submaximal isometric wall press and bench press. Signals were normalized to the maximal voluntary isometric contraction, and, using paired t tests, data were analyzed between the exercises for each muscle. RESULTS: Compared to the wall press, the bench press elicited higher activity for most muscles, except for the upper trapezius. Levels of activity were usually low but were above 20% maximal voluntary isometric contraction for the serratus anterior on both tasks, and for the long head triceps brachii on the bench press. CONCLUSIONS: Both the bench press and wall press, as performed in this study, led to relatively low EMG activation levels for the muscles measured and may be considered for use in the early phases of rehabilitation.

Electromyographic amplitude ratio of serratus anterior and upper trapezius muscles during modified push-ups and bench press exercises.

Imbalance and weakness of the serratus anterior and upper trapezius force couple have been described in patients with shoulder dysfunction. There is interest in identifying exercises that selectively activate these muscles and including it in rehabilitation protocols. This study aims to verify the UT/SA electromyographic (EMG) amplitude ratio, performed in different upper limb exercises and on two bases of support. Twelve healthy men were tested (average age = 22.8 +/- 3.1 years), and surface EMG was recorded from the upper trapezius and serratus anterior using single differential surface electrodes. Volunteers performed isometric contractions over a stable base of support and on a Swiss ball during the wall push-up (WP), bench press (BP), and push-up (PU) exercises. All SEMG data are reported as a percentage of root mean square or integral of linear envelope from the maximal value obtained in one of three maximal voluntary contractions for each muscle studied. A linear mixed-effect model was performed to compare UT/SA ratio values. The WP, BP, and PU exercises showed UT/SA ratio mean +/- SD values of 0.69 +/- 0.72, 0.14 +/- 0.12, and 0.39 +/- 0.37 for stable surfaces, respectively, whereas for unstable surfaces, the values were 0.73 +/- 0.67, 0.43 +/- 0.39, and 0.32 +/- 0.30. The results demonstrate that UT/SA ratio was influenced by the exercises and by the upper limb base of support. The practical application is to show that BP on a stable surface is the exercise preferred over WP and PU on either surfaces for serratus anterior muscle training in patients with imbalance between the UT/SA force couple or serratus anterior weakness.