Resistance Training Improves Sleep and Anti-Inflammatory Parameters in Sarcopenic Older Adults: A Randomized Controlled Trial.

Sleep and exercise have an important role in the development of several inflammation-related diseases, including sarcopenia. Objective: To investigate the effects of 12 weeks of resistance exercise training on sleep and inflammatory status in sarcopenic patients. Methods: A randomized controlled trial comparing resistance exercise training (RET) with a control (CTL) was conducted. Outcomes were obtained by physical tests, polysomnography, questionnaires, isokinetic/isometric dynamometry tests, and biochemical analysis. Results: Time to sleep onset (sleep latency) was reduced in the RET group compared to the CTL group (16.09 ± 15.21 vs. 29.98 ± 16.09 min; p = 0.04) after the intervention. The percentage of slow-wave sleep (N3 sleep) was increased in the RET group (0.70%, CI: 7.27−16.16 vs. −4.90%, CI: 7.06−16.70; p = 0.04) in an intention to treat analysis. Apnea/hour was reduced in the RET group (16.82 ± 14.11 vs. 7.37 ± 7.55; p = 0.001) and subjective sleep quality was improved compared to the CTL (−1.50; CI: 2.76−6.14 vs. 0.00; CI: 1.67−3.84 p = 0.02) in an intention-to-treat analysis. Levels of interleukin-10 (IL-10) (2.13 ± 0.80 vs. 2.51 ± 0.99; p < 0.03) and interleukin-1 receptor antagonist (IL-1ra) (0.99 ± 0.10 vs. 0.99 ± 0.10 ng/mL; p < 0.04; delta variation) were increased in the RET group. Conclusions: RET improves sleep parameters linked to muscle performance, possibly due to an increase in anti-inflammatory markers in older sarcopenic patients.

Sleep in Older Adults and Its Possible Relations With COVID-19.

Since the beginning of the COVID-19 pandemic, older adults have been found to be a highly vulnerable group, with a higher prevalence of severe cases and negative outcomes. Research has focused on the reasons why older adults are at greater risk; Sleep-related factors have been suggested as one possible explanation for this. An individual's sleep pattern undergoes significant changes over the course of their life. In older adults a specific sleep profile can be observed, one characterized by advanced sleep timing, a morningness preference, longer sleep-onset latency, shorter overall sleep duration, increased sleep fragmentation, reduced slow-wave sleep and, increased wake time after sleep onset. Additionally, an increased prevalence of sleep disorders can be observed, such as obstructive sleep apnea and insomnia. Previous research has already linked sleep disorders (especially sleep apnea) with COVID-19, but few studies have focused specifically on the older population. We believe that the intrinsic sleep patterns of older adults, and the prevalence of sleep disorders in this population, may be important factors that could explain why they are at a greater risk of negative COVID-19 outcomes. In this review, we discuss the relationship between sleep and COVID-19 among older adults, focusing on three different aspects: (1) Sleep-related issues that might increase the likelihood of getting infected by SARS-COV-2; (2) Sleep disturbances that might increase the predisposition to worse COVID-19 prognosis and outcomes; and (3) COVID-19-related aspects affecting community-dwelling older adults, such as social isolation, quarantine, and home confinement, among others, that might impact sleep.

Teste de concordância de scripts: uma proposta para a avaliação do raciocínio clínico em contextos de incerteza / Script concordance test: an approach to the evaluation of clinical reasoning in uncertain contexts

A avaliação do raciocínio clínico em situações de incerteza é pouco pesquisada na educação médica. Os testes escritos mais aplicados são de múltipla escolha, capazes de avaliar como se lida com problemas bem definidos. Porém, a maioria das situações contém incertezas. Um método de avaliação do raciocínio clínico em contextos de incerteza foi desenvolvido a partir da teoria de scripts, com situações em geriatria. Um grupo de especialistas e um grupo de estudantes de graduação resolveram o teste. Acomparação entre os resultados trouxe indícios da validade do instrumento, capaz de diferenciar o raciocínio relacionado ao nível de experiência profissional. A média dos escores dos especialistas (80,41) foi superior à dos estudantes (70,71), p < 0,001. As análises de consistência interna e um estudo G forneceram resultados que estão de acordo com metodologias que buscam avaliar uma competência profissional. Concluiu-se que uma proposta de teste de concordância de scripts em língua portuguesa aplicado em uma instituição de ensino brasileira pode ser uma alternativa para a avaliação do raciocínio clínico em contextos de incerteza.

Little research has been done in Brazilian medical education on the evaluation of clinical reasoning in situations of uncertainty. The most common tests are still multiple-choice, which are capable of evaluating skills when dealing with well-defined problems. However, in practice the majority of situations involve uncertainties. A method for the evaluation of clinical reasoning in contexts of uncertainty was developed on the basis of the cognitive script theory in relation to professional reasoning. The objectives of the research were to develop, apply, and analyze this methodology in a Brazilian educational setting, based on clinical situations in Geriatrics that involved diagnostic, therapeutic, or ethical dilemmas. A group of specialists in this area and a group of undergraduate students that were completing their training in the Geriatrics internship took the test. Comparison of the results led to evidence of the instrument's validity, capable of distinguishing clinical reasoning according to the participants' level of experience. The mean score for the specialists (80,41) was higher than that of students (70,71) (p < 0,001). In addition, analyses of the internal consistency and a G study design furnished results that are consistent with a scoring system that seeks to evaluate a professional skill. In conclusion, a proposal for a script concordance test in the Portuguese language, applied in a Brazilian teaching institution, may be a viable alternative for evaluating clinical reasoning in contexts of uncertainty.