Translation and cross-cultural adaptation into Portuguese-Brazil of NuHISS, Enlight, and uMARS.

BACKGROUND: Easy access to the Internet enables the creation of many online applications. In this sense, questionnaires were developed to evaluate the usability of health area online applications: the National Usability-Focused Health Information System Scale (NuHISS), the Enlight, and the User Version of the Mobile Application Rating Scale (uMARS). Those scales do not have a Portuguese (Brazil) version which is adequate to Brazil's culture. As a consequence, they can not be properly used in Brazil. OBJECTIVE: To translate and cross-cultural adapt the NuHISS, Enlight, and uMARS to Portuguese (Brazil). METHODS: A methodological study involving the translation and cross-cultural adaptation of the questionnaires NuHISS, Enlight, and uMARS was conducted following international guidelines recommendations. The questionnaires pass trough an initial translation, translation synthesis, back translation, expert committee, and a pre-final version test. RESULTS: Thirdy-two health professionals analyzed NuHiss, Enlight, and uMARS translated and cross-cultural adapted Portuguese (Brazil) version. There was conceptual equivalence between the translated and original versions, and no significant adaptations were needed during the translation process. 93.8% of professionals assume that the language is cohesive and 96.9% of them consider that the content is cohesive. CONCLUSION: The NuHISS, Enlight, and uMARS were successfully translated and cross-culturally adapted to Portuguese (Brazil) and can be properly applied in Brazil. Brazilian health professionals should use the questionnaires NuHISS, Enlight, and uMARS to evaluate health area applications usability.

Electromyographic activity of pelvic floor muscles in different positions during the use an innovative vaginal educator: Cross-sectional study.

The pelvic floor requires an integrated anatomical structure owing to its multiple functions. Therefore, it is necessary to study methods for improving muscle recruitment during training. This study aimed to analyze the effect of using an innovative vaginal trainer on the bioelectrical activity of the pelvic floor muscles. Pelvic positioning and interference factors, such as age, childbirth, sexual activity, urinary incontinence, and menopause, were also analyzed. A cross-sectional study assessed 30 women using an evaluation form, International Consultation on Incontinence Questionnaire-Short Form, and surface electromyography. The root mean square of a 5-second contraction period, peak root mean square values, area values, % maximal voluntary contraction (root mean square normalized by peak signal), and median frequency were collected. These findings with and without the use of a vaginal educator were compared in the anteversion, neutral, and retroversion pelvic positions. The use of a vaginal educator was found to increase the electromyographic activity of the pelvic floor muscles in the neutral position. In this position, older women showed an increased peak contraction when using the educator. Multiparas also benefited from increased bioelectric activity (root mean square and area). Sexually active women increased their bioelectric activity in a neutral position when using the trainer, exerting less effort in retroversion (%-maximal voluntary contraction). Incontinent and menopausal women exhibited slower body-building activation (decreased frequency) with the device, which requires further investigation. Our innovative biofeedback device induced greater recruitment of muscle fibers, is more effective in the neutral pelvic position, and may be effective in training the pelvic floor muscles, even in women with a greater tendency toward pelvic floor dysfunction.

Forecasted Dementia Prevalence in Portugal (2020-2080).

Dementia is a global public health challenge, and its impact on Portugal is yet unclear. This study forecasts dementia prevalence in Portugal until 2080. Using the Gonçalves-Pereira et al (2021) method, we estimated dementia cases among older adults (≥65 years) in the community. Applying age-sex specific prevalence rates of the Gonçalves-Pereira study to population projections for Portugal between 2020-2080, based on the 10/66 Dementia Research Group criteria (10/66 DRG) and the Diagnostic and Statistical Manual of Mental Disorders IV criteria (DSM-IV), to Portugal's population projections (2020-2080) under various growth scenarios (low, medium, and high). We anticipate a more than 2-fold increase in dementia prevalence from 2020 to 2080, both for 10/66 DRG [2.1%-5.0%] and DSM-IV [.8%-2.0%]. By 2080, those aged ≥80 years are projected to constitute 75.0% (vs 59.0% in 2020) of all dementia cases, particularly affecting women. Addressing dementia growth in Portugal calls for a comprehensive global response, while country-level estimates facilitate informed public health planning, policy-making, and resource allocation.

Transcranial direct current stimulation to facilitate neurofunctional rehabilitation in children with autism spectrum disorder: a protocol for a randomized, sham-controlled, double-blind clinical trial.

Background: Anodal transcranial direct current stimulation (tDCS) over the primary motor cortex and cerebellum is gaining prominence in the literature due to its potential to favor learning and motor performance. If administered during motor training, tDCS is capable of increasing the effect of training. Considering the motor impairment presented by children with Autism Spectrum Disorders (ASD), atDCS applied during motor training may contribute to the rehabilitation of these children. However, it is necessary to examine and compare the effects of atDCS over the motor cortex and the cerebellum on the motor skills of children with ASD. This information may benefit future clinical indications of tDCS for rehabilitation of children with ASD. The aim of the proposed study is to determine whether anodal tDCS over the primary motor cortex and cerebellum can enhance the effects of gait training and postural control on motor skills, mobility, functional balance, cortical excitability, cognitive aspects and behavioral aspects in children with ASD. Our hypothesis is the active tDCS combined with motor training will enhance the performance of the participants in comparison to sham tDCS. Methods and design: A randomized, sham-controlled, double-blind clinical trial will be conducted involving 30 children with ASD that will be recruited to receive ten sessions of sham or ten sessions of active anodal tDCS (1 mA, 20 min) over the primary motor cortex or cerebellun combined with motor training. The participants will be assessed before as well as one, four and eight weeks after the interventions. The primary outcome will be gross and fine motor skills. The secondary outcomes will be mobility, functional balance, motor cortical excitability, cognitive aspects and behavioral aspects. Discussion: Although abnormalities in gait and balance are not primary characteristics of ASD, such abnormalities compromise independence and global functioning during the execution of routine activities of childhood. If demonstrated that anodal tDCS administered over areas of the brain involved in motor control, such as the primary motor cortex and cerebellum, can enhance the effects of gait and balance training in only ten sessions in two consecutive weeks, the clinical applicability of this stimulation modality will be expanded as well as more scientifically founded.Clinical trial registration February 16, 2023 (https://ensaiosclinicos.gov.br/rg/RBR-3bskhwf).

Evaluation of a Dementia Training Course for Staff of a Center of Dementia Care.

INTRODUCTION: Literature shows poor dementia training and competencies among health and social professionals. Due to the growing prevalence of people with dementia and all the related care demands, specialized training is increasingly needed but must be effective in terms of impact on knowledge, behaviors, and attitudes. We aimed to analyze the impact of a first-level dementia training course for staff of a new specialized center for people with dementia, considering the first three levels of Kirkpatrick's evaluation framework, namely, staff reaction (satisfaction), skills and learning (knowledge and dementia attitudes), and behavior changes. METHODS: This is a single-center group pre-post design study of a 12-session online course. An online questionnaire was administered to measure satisfaction, expectations, knowledge/learning, attitudes (Dementia Attitude Scale), and new behaviors/practices. We compared perceived knowledge (Wilcoxon signed-rank test) and attitudes (paired t test). Thematic analysis explored new behaviors/practices. RESULTS: Eighty-five professionals and 1 volunteer were included (median age 31, 92% female). Satisfaction with the training was high (median 4/5). Perceived knowledge improved (median 3-4; p < 0.001). The knowledge test median score was 70.8%. After training, participants showed better attitudes toward dementia (mean 116.5, SD 10.3, to mean 122.2, SD 11.5; p < 0.001). Most (93%) said their behavior/practice changed. Thematic analysis yielded four new behavior/practice dimensions: care provision/interaction, communication, family/caregivers, and self-confidence. CONCLUSIONS: The course improved all dimensions evaluated, suggesting it effectively provides first-level dementia training. This may be transferable to similar settings.

Impact of a Community-Based Pelvic Floor Kinesic Rehabilitation Program on the Quality of Life of Chilean Adult Women with Urinary Incontinence.

The pelvic floor forms the primary bottom tissue of the pelvic cavity. It comprises muscles that play a fundamental role in bowel and bladder emptying. Alterations of pelvic floor muscles will result in dysfunctions such as urinary incontinence (UI). Given the high prevalence of UI and its impact on the quality of life (QoL) in patients with pelvic floor muscle dysfunctions, it is necessary to implement public, community, and generalized programs focused on treating these dysfunctions. OBJECTIVE: To determine the effect of a community rehabilitation program on QoL, UI severity, and pelvic floor muscle strength in patients with UI. PATIENTS AND METHOD: A descriptive prospective cohort study. Twenty subjects between 44 and 75 years old with a diagnosis of UI, participants of a community kinesic rehabilitation program on the pelvic floor in Maipú, Santiago, Chile, were evaluated. These volunteers were intervened for six months, and QoL was measured with the 36-Item Short-Form Health Survey (SF-36) and International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) scales, UI severity with the Sandvick test, and pelvic floor muscle strength with the Oxford scale. Patients were followed up three months post-intervention. RESULTS: Significant improvements were observed in all scales after applying for the community kinesic rehabilitation program, and the changes were maintained at a 3-month follow-up. CONCLUSIONS: Since the improvement in QoL, UI severity, and pelvic floor muscle strength after the intervention, it is relevant to consider the implementation of community programs aimed at education, screening, and early rehabilitation of these patients.

Strength and Bioelectrical Activity of the Pelvic Floor Muscles and Sexual Function in Women with and without Stress Urinary Incontinence: An Observational Cross-Sectional Study.

Stress urinary incontinence (SUI) results from an increase in intravesical pressure, which exceeds the pressure at which the urethra remains closed. Symptoms cause social and sexual intercourse discomfort directly or indirectly, which affect health-related quality of life and are associated with pelvic floor muscle (PFM) dysfunction. We aimed to verify the variation in strength and PFM bioelectrical activity and sexual function in women with SUI. Additionally, we analyzed the impact of this dysfunction on quality of life. This was an observational cross-sectional study. Women aged 25−55 years with frequent sexual intercourse were included. Women with SUI were included in a study group (G2, n = 17), and those without any type of incontinence were included in a control group (G1, n = 16). Primary outcomes were level of strength and PFM bioelectrical activity and sexual function as determinants of worse SUI in the control group. Secondary outcomes were associated between the primary outcomes and severity of urinary loss, impact on daily life, and quality of life in women with SUI. In the domains evaluated in the Female Sexual Function Index (FSFI), only sexual desire was lower in women with SUI (G2) than in the controls (p = 0.033). During analysis of G1 variables, a positive and moderate correlation was observed between power/myoeletric activation and maximum voluntary contraction (MVC) (p < 0.01), peak (p < 0.01), and mean amplitudes (p = 0.017). There was a high positive correlation between sexual arousal and other variables, including vaginal lubrication, sexual orgasm, and total FSFI value (p < 0.001 for all analyses). During evaluation of G2 variables, the MVC was positively correlated with the peak and mean amplitudes (p < 0.0001). Additionally, there was a high and positive correlation between the mean amplitudes (%MVC) and personal relationships (KHQ) (p = 0.001); the same was observed between the total (ICIQ) and activities of daily living (ICIQ) (p < 0.0001). Therefore, women with SUI presented with lower sexual desire and bioelectric activity but were not related to PFM strength. Additionally, the domains of sexual function and certain variables of quality of life are aggravated by SUI.

Experimental evaluation of low-displacement compression ignited engines operating with hydroxy gas as a supplementary gaseous fuel.

A large proportion of annual production of worldwide greenhouses gases results from the use of internal combustion engines. This experimental work evaluates the influence of dual-fuel operation on the overall emissions of a low-displacement compression-ignition engine based on operational conditions such as torque, rotational speed, and load. Hydroxy gas is used as a supplementary gaseous fuel while using pure diespel or palm oil biodiesel as baseline fuels. The CO, CO2, NOx, and HC emissions levels were carefully characterized through experimental measurements and statistical analysis. The influence of hydroxy enrichment was also examined on the engine's fuel consumption. The study incorporates an in-house hydroxy generator to store and supply the gas in the intake air system using an electrolyzer. The results demonstrated that the ANOVA analysis provides accurate predictions compared to experimental measurements with less than 5% relative error. The use of hydroxy reduces the SFC by up to 25%, which represents an economic advantage of dual-fuel operation, additionally it decreases CO, HC, and CO2 emissions. However, with hydroxy enrichment, NOx emissions levels escalate at medium and high loads. Overall, hydroxy enrichment demonstrates to be a robust alternative from an environmental and economic perspective. Future research will be focused on evaluating the biodiesel - hydroxy dual operation, broadening the spectrum of biodiesel concentration percentages, and selecting different raw materials for biofuel production.

Brain activity and upper limb movement analysis in children with Down syndrome undergoing transcranial direct current stimulation combined with virtual reality training: study protocol for a randomized controlled trial.

BACKGROUND: Children with Down syndrome have poorer functional and sensory skills compared to children with typical development. Virtual reality (VR) training could help improve these skills. Moreover, transcranial direct current stimulation (tDCS) has achieved promising results in terms of enhancing the effects of physical and sensory therapy by modulating cortical excitability. METHODS/DESIGN: Two investigations are proposed: (1) an observational study with a convenience sample consisting of children with Down syndrome (group 1-cognitive age of 6 to 12 years according to the Wechsler Abbreviated Scale of Intelligence) and children with typical development 6 to 12 years of age (group 2). Both groups will undergo evaluations on a single day involving a three-dimensional analysis of upper limb movements, an analysis of muscle activity of the biceps and brachial triceps muscles and an analysis of visuospatial and cognitive-motor variables. (2) Analysis of clinical intervention: a pilot study and clinical trial will be conducted involving individuals with Down syndrome (cognitive age of 6 to 12 years according to the Wechsler Abbreviated Scale of Intelligence). The sample will be defined after conducting a pilot study with the same methodology as that to be used in the main study. The participants will be randomly allocated to two groups: An experimental group submitted to anodal tDCS combined with a VR game and a manual motor task and a control group submitted to sham tDCS combined with a VR game and a manual motor task. The training protocol will involve 10 sessions of active or sham tDCS during memory and motor task games. Three 20-min sessions will be held per week for a total of 10 sessions. Evaluations will be performed on three different occasions: pre-intervention, post-intervention (after 10 sessions) and follow-up (1 month after the intervention). Evaluations will consist of analyses of electroencephalographic signals, electromyographic signals of the biceps and triceps brachii, and the three-dimensional reconstruction of the reaching movement. The results will be analyzed statistically with the significance level set at 5% (p ≤ 0.05). DISCUSSION: The optimization of the results obtained with virtual reality training is believed to be related to the interactive experience with a wide range of activities and scenarios involving multiple sensory channels and the creation of exercises, the intensity of which can be adjusted to the needs of children. Therefore, the proposed study aims to complement the literature with further information on tDCS and VR training considering different variables to provide the scientific community with clinical data on this combination of interventions. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (REBEC) protocol number RBR-43pk59 registered on 2019 March 27 https://ensaiosclinicos.gov.br/rg/RBR-43pk59 and Human Research Ethics Committee number 3.608.521 approved on 2019 September 30. Protocol version 2021 October 20. Any changes to the protocol will be reported to the committees and approved. Informed consent will be obtained from all participants by the clinical research coordinator and principal investigator.

Adverse reactions and adherence to capecitabine: A prospective study in patients with gastrointestinal cancer.

INTRODUCTION: Capecitabine is an oral anticancer drug which can cause some adverse reactions and the great challenge for its use is to ensure the medication adherence. The aim of this study was to analyze adverse reactions and adherence to capecitabine in patients with gastrointestinal cancer. METHODS: A prospective study was performed in a tertiary teaching hospital in Brazil. Outpatients undergoing capecitabine treatment for colorectal or gastric cancer were followed for three cycles of treatment. Patient demographic and clinical characteristics data were collected. Adverse reactions were analyzed using Common Terminology Criteria for Adverse Events (CTCAE) v.4. Adherence to capecitabine were evaluated using Morisky-Green and MedTake tests. Statistical analysis was conducted using Chi-square, Fisher's exact and McNemer tests. RESULTS: One hundred and four patients were enrolled in this study, with a mean age was 58.5 ± 10.9 years; 51.0% were men and 51.0% Caucasian. Nausea and diarrhea were the most frequently reported adverse reactions (82.7% and 62.5%, respectively), followed by vomiting (54.8%), fatigue (54.8%), and hand-foot syndrome (53.9%). Nausea and diarrhea were also the most severe adverse reactions. Most patients were adherent to capecitabine in all cycles of treatment using the Morisky-Green test. Adherence increased significantly between cycle 1 and cycle 2 by MedTake test (p < 0.001). Some demographic and clinical characteristics were associated with adverse reactions (e.g., age and nausea, gender and nausea and vomiting) and capecitabine adherence (e.g., marital status and educational level) as well as some adverse reactions were associated with capecitabine adherence (hand-foot syndrome and nausea). CONCLUSIONS: Clinical oncology pharmacists must provide patient information on the correct use of capecitabine, manage adverse reactions, and monitor adherence to treatment. Strategies to prevent non-adherence to capecitabine must be adopted to ensure the success of pharmacotherapy.

Effects of Transcranial Direct Current Stimulation Combined with Treadmill Training on Kinematics and Spatiotemporal Gait Variables in Stroke Survivors: A Randomized, Triple-Blind, Sham-Controlled Study.

The present study assessed the effects of anodal transcranial direct current stimulation (tDCS) combined with treadmill training on spatiotemporal and kinematic variables in stroke survivors using gait speed as the primary outcome. A randomized, sham-controlled, triple-blind, study was conducted involving 28 patients with hemiparesis allocated to two groups. The experimental group was submitted to treadmill training combined with anodal tDCS over the primary motor cortex (M1) of the damaged hemisphere. The control group was submitted to treadmill training combined with sham tDCS. Stimulation was administered (2 mA, 20 min) five times a week for two weeks during treadmill training. No significant differences (p > 0.05) in spatiotemporal variables were found in the intra-group and inter-group analyses. However, the experimental group demonstrated improvements in kinematic variables of the knee and ankle (p < 0.05) and these results were maintained one month after the end of the intervention. The inter-group analysis revealed significant differences (p < 0.05) with regard to the pelvis, hip and knee. Anodal tDCS over M1 of the damaged hemisphere combined with treadmill training did not affect spatiotemporal variables, but promoted improvements in kinematic variables of the pelvis, hip, knee and ankle and results were maintained one month after treatment.

Sexual Function, Physical Activity, Mean Amplitudes and Maximal Voluntary Contraction of Pelvic Floor Muscles Are Related to Handgrip Strength: A Cross-Sectional Study.

Pelvic floor musculature assessment methods are generally invasive, subjective, and technologically expensive. Therefore, there is a need to identify other methods that can predict changes in the function of these muscles. This study aimed to verify whether the levels of strength and myoelectric activity of pelvic floor muscles (PFM) can be related to handgrip strength (HGS), to ensure faster and earlier identification of possible dysfunctions of this musculature. Furthermore, we verified whether these variables vary across different age groups. This was a cross-sectional observational study involving 44 healthy women. The women were divided into two groups: the young (18−35 years) and middle-aged (36−55 years) adult groups. Social, anthropometric, and clinical data were collected from the participants, and a functional assessment of their PFM was performed by bidigital palpation, electromyographic biofeedback (sEMG), and HGS (using a dynamometer). The levels of physical and sexual activity were measured using the International Physical Activity Questionnaire (IPAQ) and Sexual Quotient−Female version (SQ-F) questionnaire. There were no differences in HGS, power/pressure, sEMG, SQ-F score, or IPAQ score between the two groups (p > 0.05). Moderate correlation (r = 0.601; p = 0.019) was observed during multivariate analysis. HGS is related to mean amplitudes (p = 0.123), MVC (p = 0.043), sexual function (p = 0.049), and physical activity (p = 0.004). We therefore conclude that there were no differences between HGS and PFM strength in young adult and middle-aged women. Furthermore, HGS is related to the PFM functionality, sexual function, and physical activity.

Efeito da fisioterapia nos sintomas de síndrome da bexiga hiperativa decorrente do tratamento do câncer de colo de útero / Effect of physical therapy on symptoms of the hyperactive bladder arising from the treatment of cervical cancer

Introdução: A síndrome da bexiga hiperativa pode afetar as mulheres após o tratamento para câncer de colo do útero, interferindo diretamente a qualidade de vida e funcionalidade. Objetivo: Verificar os efeitos da Fisioterapia nos sintomas da síndrome da bexiga hiperativa em mulheres submetidas ao tratamento de câncer de colo do útero. Métodos: Trata-se de um ensaio clínico não controlado, com mulheres que realizaram o tratamento para câncer de colo do útero. Foi utilizada uma ficha de avaliação para verificar dados ginecológicos/obstétricos, assim como hábitos de vida das pacientes. Os sintomas da síndrome da bexiga hiperativa foram avaliados por meio do Incontinence Questionnaire Overactive Bladder. Para a intervenção fisioterapêutica foi utilizado o protocolo de Treinamento dos Músculos do Assoalho, Eletroestimulação Transcutânea do Nervo Tibial e Terapia Comportamental. Resultados: No pós-tratamento ocorreu decréscimo estatisticamente significativo na mediana dos sintomas da síndrome da bexiga hiperativa e no impacto da qualidade de vida em relação ao pré-tratamento, indicando melhora do quadro. Conclusão: Esta pesquisa concluiu que o protocolo fisioterapêutico utilizado apresentou eficácia na melhora dos sintomas da síndrome da bexiga hiperativa após tratamento para câncer de colo do útero. (AU)

Introduction: A hyperactive bladder syndrome can affect women after treatment for cervical cancer, directly interfering with quality of life and functionality. Objective: To verify the effects of physical therapy on the symptoms of hyperactive bladder syndrome in women undergoing treatment for cervical cancer. Methods: This is an uncontrolled clinical trial, with women who underwent treatment for cervical cancer. An evaluation form was used to check gynecological/obstetric data, as well as the patients' lifestyle. The symptoms of the hyperactive bladder syndrome were obtained through the hyperactive bladder questionnaire. For the physiotherapeutic intervention, the floor muscle training, transcutaneous electrostimulation of the tibial nerve and behavioral therapy protocol was used. Results: In the post-treatment there was a statistically significant decrease in the median of the symptoms of the hyperactive bladder syndrome and no impact on the quality of life in relation to the pre-treatment, an improvement indicated in the condition. Conclusion: This research concluded that the physical therapy protocol used showed improvement of symptoms of overactive bladder syndrome after treatment for cervical cancer. (AU)

Avaliação da função sexual e miccional de homens transexuais / Evaluation of sexual and urinary function of transexual men

A transexualidade trata da mudança dos indivíduos de seu sexo masculino ou feminino identificado no nascimento para viver em sociedade sob sua alternativa de identidade de gênero. Visando essa adequação são realizados procedimentos transexualizadores, no entanto, pouco se conhece sobre a função sexual e urinária após esses processos. Neste sentido, este estudo propôs avaliar as funções sexuais e miccionais de homens transexuais submetidos à terapia hormonal. Participaram do estudo 13 homens transexuais e foram utilizados os questionários: Escala de Desconforto Sexual Feminino (FSDS-R), Índice de função sexual feminina (FSFI), Teste de Três Perguntas sobre Incontinência (3IQ), Protection, Amount, Frequency, Adjustment, Bodyimage (PRAFAB). Foi utilizado o software Excel para entrada dos dados, confecção das tabelas e análise estatística descritiva. No FSDS-R, 10 (76,92%) dos homens trans apresentam-se desconfortáveis sexualmente. A pontuação média da FSFI foi de 14,8 pontos, sugerindo disfunção sexual. No teste de 3IQ, 25% relataram perder urinária, destes, 75% apresentam urgência miccional e 25% apresentam Incontinência Urinária (IU) por esforço. No score total do PRAFAB, 50% apresentaram IU leve e 50% obtiveram IU moderada. Portanto, a avaliação foi positiva para tendência a disfunções sexuais nesta população. No que concerne a função miccional, a minoria dos homens trans manifestaram alterações. (AU)

Transsexuality is about changing individuals of their male or female gender identified at birth to live in society under their alternative gender identity. Aiming at this adaptation, transsexualizing procedures are performed, however, little is known about the sexual and urinary function after these processes. In this sense, this study proposed to evaluate the sexual and urinary functions of transsexual men submitted to hormonal therapy. Thirteen transsexual men participated in the study and the questionnaires were used: Female Sexual Discomfort Scale (FSDS-R), Female Sexual Function Index (FSFI), Three Questions Incontinence Test (3IQ), Protection, Amount, Frequency, Adjustment, Body image (PRAFAB). Excel software was used for data entry, preparation of tables and descriptive statistical analysis. In FSDS-R, 10 (76.92%) of trans men are sexually uncomfortable. The average FSFI score was 14.8 points, suggesting sexual dysfunction. In the 3IQ test, 25% reported losing urine, of these, 75% had urinary urgency and 25% had urinary incontinence (UI) on exertion. In the total PRAFAB score, 50% had a mild UI and 50% had a moderate UI. Therefore, the assessment was positive for a tendency towards sexual dysfunction in this population. Regarding the voiding function, the minority of trans men showed changes. (AU)

Clinical pharmacy in onco-hematology and bone marrow transplant: A valuable contribution to improving patient safety.

INTRODUCTION: It is known that clinical pharmacists intercept prescribing errors and contribute to patient safety in several medical specialties. The aim of this study was to identify, quantify and classify prescribing errors and pharmacist interventions carried out in onco-hematology and bone marrow transplant inpatient units. METHODS: This was a prospective and quantitative study, conducted from February 2018 to July 2018 in onco-hematology and bone marrow transplant inpatient units of a tertiary teaching hospital in Brazil. A pharmacist detected prescribing errors and performed interventions. The type and incidence of prescribing errors, error severity, type of pharmacist interventions, potential impact of interventions in patient care, and intervention acceptance rates were evaluated. RESULTS: A total of 1172 prescriptions were evaluated, 9% of them contained errors (total of 135 errors), and the most common error was related to prescribing the wrong dose (31.8%). Wrong dose and omission of drug were the two most frequent errors in onco-hematology, while wrong dose followed by inappropriate dilution were the most frequent in bone marrow transplantation. The pharmacist performed 135 interventions and the most common intervention was related to the treatment regimen (41.5%). Serious errors and very significant pharmacist interventions were the most frequent in both inpatient units. The acceptance rate of pharmacist interventions was high (90%). CONCLUSIONS: Clinical pharmacy improves patient safety and quality of care in onco-hematology and bone marrow transplant inpatient units.

tDCS and motor training in individuals with central nervous system disease: A systematic review.

BACKGROUND: Transcranial direct current stimulation (tDCS) is a promising tool for patients with neurological disorders, as it increases cortical excitability, motor learning and functionality. The studies up to date have focused on the tDCS parameters while the effects of the motor training have not yet been fully addressed. The purpose of this study is to present a systematic review of all studies related to tDCS in conjunction with motor training (MT) to improve gait performance, functionality, mobility and balance in individuals with non-progressive central nervous system diseases. METHODS: Seven databases were searched for articles from inception to October 2018. The search strategy followed Collaboration guidelines. The Physiotherapy Evidence Database (PEDro) Scale and Cochrane Collaboration's tool for assessing the risk of bias were applied to evaluate methodological quality. RESULTS: Four hundred and sixteen recorded were screened. Ten studies met the inclusion criteria. All studies were randomized controlled trials, two of them had a crossover design and other two were pilot studies. Three paper analyzed children and adolescents with cerebral palsy, seven papers analyzed adults and elderly post stroke. tDCS with MT lead to significant results. CONCLUSIONS: This review found limited evidence for the use of tDCS with MT for in children with CP and adults post stroke, due to the small number of studies as well as their methodological heterogeneity. In the absence of more robust evidence, further studies with a consistent methodological design are needed to endorse the clinical application of tDCS with motor training.

Virtual reality in the rehabilitation process for individuals with cerebral palsy and Down syndrome: A systematic review.

BACKGROUND: Childhood neurological diseases result in neuromotor impairment, which affects selective motor control, compromising the acquisition of motor skills and functional independence. The positive results achieved with virtual reality are believed to be related to training in an interactive environment that provides a broad range of activities and scenarios with multiple sensory channels, enabling the creation of exercises at an intensity based on individual need. Therefore, a review was conducted to answer the following question: What are the possible effects of virtual reality for the pediatric population, specifically children with cerebral palsy and Down syndrome? OBJECTIVE: The objective of the present study was to conduct a systematic review of the literature to determine the possible effects of virtual reality therapy in children with cerebral palsy and Down's syndrome. METHODS: The PubMed, Bireme, Scielo and PEDro electronic databases were searched in the period from January to March 2016 using the following keywords: Down syndrome and virtual reality, virtual reality and cerebral palsy, virtual reality and neuropediatrics, and Down's syndrome and virtual reality. Only randomized controlled trials published in English in the previous 10 years (2007-2016) that addressed the specific purpose of this review and achieved a score of at least 4 points on the PEDro methodological quality scale were eligible for inclusion. RESULTS: The initial research led to the retrieval of 214 articles, which were analyzed considering the inclusion criteria. Eighteen articles were submitted to an appraisal of methodological quality using the PEDro scale, only five of which received a score of four or more points and were described in the present review. Three of the studies selected analyzed children with cerebral palsy and two analyzed children with Down syndrome. Despite the different physiopathological characteristics of the two conditions, the authors employed similar therapeutic methods and evaluations. The results of the studies demonstrated that virtual reality training either alone or combined with motor training leads to improvements in sensory-motor functions and can be used as a complement to other successful rehabilitation interventions in the two populations. CONCLUSION: Based on the results of the studies included in the present systematic review, despite differences in the characteristics of each population, the objectives and methods proposed by the authors were similar and virtual reality demonstrated promising effects for individuals with cerebral palsy and Down syndrome.

Fisioterapia nas complicações ginecológicas decorrentes do tratamento do câncer de colo de útero / Physical therapy in gynecological complications arising from the treatment of cervix cancer

Introdução: O tratamento do Câncer de Colo do Útero (CCU) traz consequências anátomofuncionais para o sistema genital. Objetivo: Verificar o efeito da fisioterapia nas complicações ginecológicas e na qualidade de vida (QV) das mulheres após o tratamento do CCU. Métodos: Ensaio clínico, com 16 mulheres que realizaram tratamento do CCU, alocadas em dois grupos: 10 para o Grupo ambulatorial (GAM) e 6 para o Grupo domiciliar (GDE). A intervenção consistiu em massagem perineal e treinamento dos músculos do assoalho pélvico por seis semanas, porém o GAM realizou o acompanhamento em ambulatório e o GDE em domicílio. Resultados: As complicações ginecológicas mais prevalentes encontradas em ambos os grupos foram a estenose, o ressecamento vaginal, o encurtamento vaginal, o estreitamento vaginal, a dispareunia e a diminuição da libido. Após o protocolo, o GAM apresentou melhora estatisticamente significante para a estenose, para o ressecamento, o encurtamento vaginal, estreitamento vaginal e para a diminuição da libido. Conclusão: Tanto as queixas ginecológicas, quanto a função muscular tiveram melhora estatisticamente significante no GAM e alguns domínios do questionário de função sexual e do questionário de QV apresentaram resultados similares de melhora em ambos os grupos. (AU)

Introduction: The treatment of Cervical Cancer (CC) has anatomofunctional consequences for the genital system. Objective: To verify the effect of physical therapy on gynecological complications and quality of life (QOL) in women after CC treatment. Methods: Clinical trial, with 16 women who underwent CC treatment, divided into two groups: 10 for the outpatient group (GAM) and 6 for the home group (GDE). The intervention consisted of perineal massage and training of the pelvic floor muscles for six weeks, with the GAM performed on an outpatient basis and the GDE at home. Results: The gynecological complications found in both groups were stenosis, vaginal dryness, vaginal shortening, vaginal narrowing, dyspareunia and decreased libido as the most prevalent in both groups. After the protocol, the GAM showed a statistically significant improvement for stenosis, dryness, vaginal shortening, vaginal narrowing and decreased libido. Conclusion: Both gynecological complaints and muscle function had a statistically significant improvement in GAM, while aspects related to some domains of the sexual function questionnaire and regarding the perception of QOL showed similar results in both groups. (AU)

Feasibility and impact of Fit & Strong! Program in Portuguese older adults with osteoarthritis: A pilot randomized controlled trial.

This pilot study used a small randomized trial to examine the feasibility and the impact of an 8-week multicomponent program among Portuguese older adults with osteoarthritis. Participants were identified from the electronic registers from three primary healthcare centers. Thirty-one older adults (50+ years) with osteoarthritis were randomly assigned to experimental (n= 23) and control conditions (n= 8). Acceptance, attendance and retention rates were measured. The effect of the program on physical performance, osteoarthritis symptomatology (pain and stiffness), functionality, physical activity, depression, anxiety and fear of movement were assessed at baseline, posttest, and 4-months. The acceptance rate was 34%, and 90.4% attended all sessions of the program. The posttest retention rate in experimental group was 69.6% and 100% in control group. Findings demonstrated benefits of the Program on physical performance, function, anxiety, and fear of movement among participants. In the future, it will be important to improve the acceptance rate, however, the high attendance rate and observed effects indicate that the program is an attractive and effective intervention for Portuguese older adults with osteoarthritis.

Participation in a randomised controlled trial for older adults with osteoarthritis in Portugal: Analysis of the acceptance factors.

Fit & Strong! is an evidence-based program that combines exercise with health education for older adults with lower extremity osteoarthritis. This paper explores the factors of acceptance to a randomised controlled trial that tested the Portuguese (Europe) version of Fit & Strong! and analysed the sociodemographic, lifestyle and health characteristics of people who agreed versus people who declined to participate. Patients were identified by General Practitioners at three healthcare centres during 4 months (May 2017 to July 2017). Patients who accepted the invitation and met the inclusion criteria are designated participants, and people who met the inclusion criteria, declined the opportunity to participate but agreed to answer a brief questionnaire are designated as non-participants. Data included sociodemographic, lifestyle behaviours, health, pain and ADLs from the Western Ontario and McMaster Universities Osteoarthritis. Data were analysed using descriptive analysis and the Wilcoxon-Mann-Whitney, Chi-Squared tests or Fisher's tests. The results showed that three out of 12 (25%) primary healthcare centres contacted about the new program accepted the invitation to participate in recruitment. Eighty-two patients were contacted, of whom 14 (17.2%) did not meet inclusion criteria and 32 (38.3%) met the inclusion criteria but declined to participate. The acceptance rate was 22%. Non-participants were older (U = 41.0; W = 212.0; p = .044) and experienced earlier osteoarthritis onset than participants (U = 26.0; W = 146.0; p = .031). In conclusion, younger age and a diagnosis of osteoarthritis more recent appear to predispose older adults with osteoarthritis to be more accepting of participation in a non-pharmacologic intervention designed to increase physical activity.