Factors Associated with Number of Prenatal Visits in Northeastern Brazil: A Cross-Sectional Study.

The aim of this study is to assess factors associated with the number of prenatal visits of women who delivered in a public maternity hospital in northeastern Brazil. This cross-sectional study focused on 380 puerperal women who gave birth at a public maternity hospital in northeastern Brazil. Prenatal and perinatal data were collected in the immediate postpartum period by interviewing mothers and using medical records. Chi-square/Fisher exact test compared the data, and a logistic regression model estimated the association between birth weight and number of prenatal visits. As a result, the sample was composed of 175 women with <37 weeks of gestational age and 205 women with ≥37 weeks of gestational age. Women with less than four prenatal visits were more likely to give birth to low birth weight (<2500 g) and preterm infants (<37 weeks of gestational age) than those with more than four prenatal visits (p = 0.001). The subjects with less than four prenatal visits had a 2.76-fold higher odds of giving birth to infants weighing less than 2500 g (p = 0.03; 95%CI = 1.05-7.30), without relation to maternal and gestational ages. In conclusion, women with less than four prenatal visits had higher odds of giving birth to low birth infants, independently of maternal and gestational ages, and were more likely to give birth to premature babies.

Hospitalization is associated with handgrip strength decline in older adults: a longitudinal study.

BACKGROUND: Hospitalization episodes in older people are considered critical events because they act in a complex interaction among immobilization effects. AIM: The purpose of this study was to evaluate the effects of hospitalization on older adults' handgrip strength (HGS) and to identify factors related to its performance on the test. METHODS: A cohort study was conducted in a hospital in Natal, Brazil, and enrolled all patients aged 60 years and older between January 2014, and April 2015. Cognitive (Leganés Cognitive Test) and functional status (Katz Index, Lawton Scale and Functional limitation Nagi), physical performance (HGS and gait speed) and depressive symptom assessment (GDS-15) were evaluated at admission and discharge time, as well as information about health and functional status prior to hospitalization. Linear Mixed Models were used to create a predictive model for handgrip strength. RESULTS: A total of 1168 hospitalized older adults were evaluated. A significant decrease in HGS means was observed between admission and discharge time for men (28.12 ± 10.35 and 20.22 ± 14.08 Kgf, p < 0.01) and for women (19.18 ± 7.87 and 14.88 ± 9.79 Kgf, p < 0.01). Undergoing surgery and basal values of the Katz Index were associated with worse HGS performance at discharge. CONCLUSION: A significant decline in handgrip strength during the hospitalization period was observed, which was more pronounced in men. Performing surgery during hospitalization was an important factor for HGS decline in men and women. This study reinforces the importance of early mobilization and muscle strength loss prevention protocols in hospitalized older patients.

Thoracoabdominal motion in newborns: Reliability between two interactive computing environments.

BACKGROUND: Quantifying the chest wall is useful in documenting thoracoabdominal synchrony during the neonatal period. Subjective measures are often used rather than gold-standard methods due to their practicality in clinical practice. The aim of the present study is to compare the reliability between a newly proposed method (video analysis in MATLAB) and image analysis using AutoCad tools, both applied to assess thoracoabdominal motion in newborns (NBs). MATERIALS AND METHODS: This is an observational cross-sectional study of full-term NBs. A digital camera was used to film thoracoabdominal motion for 2 minutes in the supine position, with movements measured by the two aforementioned methodologies. RESULTS: A total of 139 images were used, showing agreement between AutoCAD and MATLAB (BIAS = -1.68; CI = -6.59:3.22, Bland-Altman plot). CONCLUSION: The programs were interchangeable and the routine developed in MATLAB was simpler and faster, allowing dynamic analysis and suggesting its clinical utility in quantifying respiratory motion in NBs.

Chest circumference in full-term newborns: how can it be predicted?

BACKGROUND: Although over the years a number of studies have used chest circumference (CC) as a sensitive tool to identify the health status of infants, a particularly important aspect for this population is the lack of data on normal values and prediction equations. In order to facilitate and validate the interpretation of CC data in newborn (NB), the aim was to study the relation between CC and other anthropometric variables and develop a predictive equation for CC in a population of full-term newborns. METHODS: Cross-sectional study, carried out with full-term infants. The anthropometric (CC, head circumference - HC, length, age and weight) and hemodynamic variables were evaluated during the first 24 h of life. Bivariate analysis was performed between CC and HC, weight, length and type of delivery, followed by multiple linear regression analysis, including variables that were significant in the bivariate analysis. For data analysis, we used the SPSS program, considering p < 0.05 and 95% CI. RESULTS: The birth weight of the 120 NB varied between 2580 and 4225 g (mean 3360 g) and the gestational age between 37 and 42 weeks (mean 39 weeks). Approximately 61% of the sample were delivered vaginally and 67 (56%) were boys. The variables that remained statistically associated with CC after multivariate analysis were weight (ß 0.003, CI: 0.002: 0.003, p = 0.001) and HC (ß 0.287, CI: 0.156: 0.417, p = 0.001). For the linear regression model, the predictive equation of CC was 14.87+ (0.003 x weight) + (0.287 x HC), with a prediction of 76%. CONCLUSION: The results show a positive correlation between CC and weight, length and HC, and based on the linear regression model, the predictive equation for CC is based only on weight and HC.

Muscle impairment in neuromuscular disease using an expiratory/inspiratory pressure ratio.

BACKGROUND: Neuromuscular diseases (NMDs) lead to different weakness patterns, and most patients with NMDs develop respiratory failure. Inspiratory and expiratory muscle strength can be measured by maximum static inspiratory pressure (PImax) and maximum static expiratory pressure (PEmax), and the relationship between them has not been well described in healthy subjects and subjects with NMDs. Our aim was to assess expiratory/inspiratory muscle strength in NMDs and healthy subjects and calculate PEmax/PImax ratio for these groups. METHODS: Seventy (35 males) subjects with NMDs (amyotrophic lateral sclerosis, myasthenia gravis, and myotonic dystrophy), and 93 (47 males) healthy individuals 20-80 y of age were evaluated for anthropometry, pulmonary function, PImax, and PEmax, respectively. RESULTS: Healthy individuals showed greater values for PImax and PEmax when compared with subjects with NMDs. PEmax/PImax ratio for healthy subjects was 1.31 ± 0.26, and PEmax%/PImax% was 1.04 ± 0.05; for subjects with NMDs, PEmax/PImax ratio was 1.45 ± 0.65, and PEmax%/PImax% ratio was 1.42 ± 0.67. We found that PEmax%/PImax% for myotonic dystrophy was 0.93 ± 0.24, for myasthenia gravis 1.94 ± 0.6, and for amyotrophic lateral sclerosis 1.33 ± 0.62 when we analyzed them separately. All healthy individuals showed higher PEmax compared with PImax. For subjects with NMDs, the impairment of PEmax and PImax is different among the 3 pathologies studied (P < .001). CONCLUSIONS: Healthy individuals and subjects with NMDs showed higher PEmax in comparison to PImax regarding the PEmax/PImax ratio. Based on the ratio, it is possible to state that NMDs show different patterns of respiratory muscle strength loss. PEmax/PImax ratio is a useful parameter to assess the impairment of respiratory muscles in a patient and to customize rehabilitation and treatment.

Comparison between a national and a foreign manovacuometer for nasal inspiratory pressure measurement.

BACKGROUND: the measurement of nasal inspiratory pressure, known as the sniff test, was developed as a new test of inspiratory muscle strength, mainly used in neuromuscular conditions. The test is easy to be performed and noninvasive. Despite the clinical importance of assessment of nasal inspiratory pressure a national equipment is not available to assess it. OBJECTIVES: to compare a national with a foreign manovacuometer in assessing the nasal inspiratory pressure (sniff test) in healthy subjects. METHODS: 18 subjects were evaluated (age 21.44 ± 2.8 years, BMI 23.4 ± 2.5 kg/m² , FVC 102.1 ±1 0.3% pred, FEV1 98.4 ± 1% pred). We performed two measures of nasal inspiratory pressure using two different manovacuometer: a national and a foreign. All subjects performed the tests at the same time of day, in different days being the order of the testes established randomly. It was used the paired t test, Pearson correlation and the Bland-Altman plots for statistical analysis considering a 5% significance level. RESULTS: The averages observed for the two measures of nasal pressures were 125 ± 42.4 cmH2O for the foreign equipment, and 131.7 ± 2 8.7 cmH2O for the national equipment. The Pearson correlation showed significant correlation between the means with a coefficient of r=0.63. The t test showed no significant differences between both measurements (p>0,05). The BIAS ± SD found in Bland-Altman plot analysis was 7 cmH2O with limits of agreement between -57.5 cmH2O and 71.5 cmH2O. CONCLUSION: the results suggest that the national electronic device is feasible and safe to the sniff test measurement in healthy subjects.

Comparação entre o manovacuômetro nacional e o importado para medida da pressão inspiratória nasal / Comparison between a national and a foreign manovacuometer for nasal inspiratory pressure measurement

CONTEXTUALIZAÇÃO: A medida da pressão inspiratória nasal, conhecida como sniff teste, desenvolvida como um novo teste de força muscular inspiratória, utilizada principalmente em doenças neuromusculares, é de fácil realização e não invasiva. Apesar da importância clínica da avaliação da pressão inspiratória nasal, não existe um instrumento nacional disponível para realizá-la. OBJETIVOS: Comparar os manovacuômetros eletrônicos nacional e importado para a avaliação da pressão inspiratória nasal em pessoas saudáveis. MÉTODOS: Foram avaliados 18 voluntários saudáveis (idade 21,4±2,8 anos, IMC 23,4±2,5 Kg/m² , CVF 102,1±10,3 por centopred, VEF1 98,4±1 por centopred) por meio de duas medidas de pressão inspiratória nasal em dois equipamentos diferentes: um nacional e outro importado. Todos os sujeitos realizaram a manobra no mesmo horário do dia, em dias ocasionais, sendo a ordem determinada aleatoriamente. Para análise estatística, foi utilizado o teste t pareado, a correlação de Pearson e o Bland-Altman com nível de significância de 5 por cento. RESULTADOS: As médias encontradas durante as duas medidas das pressões nasais foram de 125±42,4 cmH2O para o aparelho importado e de 131,7±28,7 cmH2O para o nacional. A análise de Pearson demonstrou uma correlação significativa entre as médias, com um coeficiente r=0,63. Os valores médios não apresentaram diferenças significativas pelo teste t pareado (p>0,05). Na análise de Bland-Altman, encontrou-se um BIAS igual a 7 cm H2O, desvio-padrão de 32,9 cmH2O para o DP e um intervalo de confiança de -57,5 cmH2O até 71,5 cmH2O. CONCLUSÃO: Os resultados encontrados sugerem que o manovacuômetro eletrônico nacional é viável e seguro para realização do sniff teste em sujeitos saudáveis.

BACKGROUND: The measurement of nasal inspiratory pressure, known as the sniff test, was developed as a new test of inspiratory muscle strength, mainly used in neuromuscular conditions. The test is easy to be performed and noninvasive. Despite the clinical importance of assessment of nasal inspiratory pressure a national equipment is not available to assess it. OBJECTIVES: To compare a national with a foreign manovacuometer in assessing the nasal inspiratory pressure (sniff test) in healthy subjects. METHODS: 18 subjects were evaluated (age 21.44±2.8 years, BMI 23.4±2.5 kg/m² , FVC 102.1±10.3 percent pred, FEV1 98.4±1 percent pred). We performed two measures of nasal inspiratory pressure using two different manovacuometer: a national and a foreign. All subjects performed the tests at the same time of day, in different days being the order of the testes established randomly. It was used the paired t test, Pearson correlation and the Bland-Altman plots for statistical analysis considering a 5 percent significance level. RESULTS: The averages observed for the two measures of nasal pressures were 125±42.4 cmH2O for the foreign equipment, and 131.7±28.7 cmH2O for the national equipment. The Pearson correlation showed significant correlation between the means with a coefficient of r=0.63. The t test showed no significant differences between both measurements (p>0,05). The BIAS±SD found in Bland-Altman plot analysis was 7 cmH2O with limits of agreement between -57.5 cmH2O and 71.5 cmH2O. CONCLUSION: The results suggest that the national electronic device is feasible and safe to the sniff test measurement in healthy subjects.

Adaptation of the Threshold IMT with double spring load allows higher inspiratory pressure for muscle training.

PURPOSE: We aimed to evaluate the functionality of an adapted inspiratory muscle training device designed to allow pressures higher than 41 cmH(2)O that can be precisely controlled. The adaptation was made in a commercially available Threshold IMT device, and the opening pressures and linearity of load were evaluated in an experimental setting. METHODS: The original IMT Threshold device was modified by inserting a second spring load juxtaposed to the original spring and then the modified device was coupled to a system designed to assess the range of opening pressures. Linear regression was used to test the correlation between the visual pressure scale of the original device and the opening pressure load obtained from the adapted device. RESULTS: For the modified device, we found a range of load from 13.9 +/- 0.7 to 85.6 +/- 0.7 cmH(2)O. Linear regression analysis of our data found an excellent relation between the modified device's opening pressure and the preset opening pressure marked on the visual scale in the original device, y = -1.275 + 2.08x, r(2) = 0.99 and P = 0.0001. CONCLUSION: The Threshold IMT adaptation proposed here is simple, affordable, precise, safe and allows for a high degree of reproducibility. It also achieves pressures higher than 41 cmH(2)O that can be used when training inspiratory muscles.