Associação de dinapenia, sarcopenia, aptidão física e capacidade funcional em adultos fisicamente ativos no Brasil

Contexto e objetivo: O envelhecimento está associado a diversas alterações fisiológicas que podem afetar a aptidão física e a capacidade funcional, como a sarcopenia e a dinapenia. O presente estudo teve como objetivo descrever e comparar aspectos físicos e funcionais de adultos em relação aos critérios de sarcopenia e dinapenia. Desenho e local: Os participantes faziam parte do Projeto Misto Longitudinal de Aptidão Física e Capacidade Funcional de São Caetano do Sul, que busca avaliar e acompanhar a saúde e o desempenho físico de idosos na região. A amostra foi composta por 1480 participantes com idade acima de 50 anos e média de 66,5 anos. Métodos: Para a classificação da sarcopenia e dinapenia, foram adotados os critérios do Asian Working Group for Sarcopenia e do European Working Group on Sarcopenia in Older People. Uma análise estatística foi realizada utilizando a análise de covariância ANCOVA não paramétrica, ajustada pelo sexo, idade e índice de massa corporal (IMC), buscando comparar a capacidade funcional entre os grupos. Foi adotado um nível de significância de P < 0,05 e o software utilizado para as análises foi o SPSS versão 25. Resultados: A prevalência de sarcopenia na amostra foi de 3% e de dinapenia, 62,3%. Foram identificadas diferenças estatisticamente significativas nas variáveis de aptidão física e capacidade funcional. Conclusão: A massa muscular isoladamente pode não ser um critério adequado para definir sarcopenia em adultos, pela não-linearidade da relação entre massa muscular e capacidade físico-funcional.

Tumor-induced osteomalacia: A systematic literature review.

Introduction: Tumor-induced osteomalacia (TIO), is a rare acquired paraneoplastic syndrome characterized by defective bone mineralization, caused by the overproduction of fibroblast growth factor 23 (FGF23) by a tumor. Material and methods: We conducted a systematic review to identify all case reports of TIO, focusing on those associated with mesenchymal tumors. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) consensus, and we included patients with a diagnosis of TIO and histological confirmation of phosphaturic mesenchymal tumors or resolution of the condition after treatment of the tumor. Bibliographical searches were carried out until December 2023 in the Cochrane Library, Medline and Embase, as well as congress abstracts online. Results: We identified 769 articles with 1979 cases reported. Most patients were adults, with a higher incidence on men. Disease duration before diagnosis is a mean of 4.8 years. Most tumors were histologically classified as PMT. Lower limbs were the predominant location. Hypophosphatemia was present in 99.8 % of patients. The FGF23 was elevated at diagnosis in 95.5 %. Resection of the tumor was the treatment of choice in most of patients. After resection, there was a clinical improvement in 97.6 % of cases, and serum phosphorus and FGF23 levels returned to normal ranges in 91.5 % and 81.4 % of the patients, respectively. Conclusion: TIO is usually misdiagnosed with rheumatological or musculoskeletal disorders. The diagnosis should be suspected in patients with hypophosphatemic osteomalacia, and the measurement of serum FGF23 can be useful for diagnosis and management.

Analgesia por láser de baja potencia en pacientes con tratamiento ortodóncico / Low power laser analgesia in patients with orthodontic treatment i: en

Introducción: El dolor es el síntoma más común luego de la primera activación de la aparatología ortodóncica. El tratamiento analgésico más utilizado es el paracetamol; sin embargo, su uso inhibe la actividad de la ciclooxigenasa y la síntesis de prostaglandinas, lo que puede afectar el mecanismo del movimiento dental y el remodelado óseo. Objetivo: Evaluar la efectividad del láser de baja potencia para el alivio del dolor en pacientes con tratamiento ortodóntico. Métodos: Se realizó un estudio cuasiexperimental de intervención terapéutica, desde enero hasta diciembre de 2020, en 40 pacientes atendidos en la consulta de ortodoncia del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, en quienes se aplicaría fuerza ortodóncica por primera vez. Estos fueron distribuidos de forma aleatoria en 2 grupos de 20 integrantes cada uno: el de estudio, tratado con láser de baja potencia, y el de control, que recibió medicación convencional (paracetamol). Para la validación estadística de la información se emplearon el porcentaje y la prueba de la t de Student para muestras independientes, con 95 % de confiabilidad. Resultados: Luego de tres sesiones terapéuticas, 90,0 % del grupo de estudio refirió no presentar dolor o sentirlo de forma leve, mientras que del grupo de control solo 10,0 % de los pacientes fue ubicado en cualquiera de las dos categorías anteriores. Existió diferencia significativa entre ambos grupos (p=0,00). Conclusiones: Se demostró que el láser, como terapia alternativa, fue más efectivo que el paracetamol.

Introduction: Pain is the most common symptom after the first activation of orthodontic appliance. The most widely used analgesic treatment is paracetamol; however, its use inhibits cyclooxygenase activity and prostaglandin synthesis, which can affect the mechanism of tooth movement and bone remodeling. Objective: To evaluate the effectiveness of low power laser for pain relief in patients with orthodontic treatment. Methods: A quasi-experimental study of therapeutic intervention was carried out, from January to December 2020, in 40 patients treated at the orthodontic clinic of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, in whom orthodontic force was applied for the first time. These were randomly distributed into 2 groups of 20 members each: the study group, treated with low-power laser, and the control group, that received conventional medication (paracetamol). For statistical validation of data, the percentage and the Student's t test for independent samples were used, with 95 % confidence interval. Results: After three therapeutic sessions, 90.0% of the study group reported not presenting pain or feeling it slightly, while only 10.0% of patients in control group were put in any of the two previous categories. There was a significant difference between both groups (p=0.00). Conclusions: Laser, as an alternative therapy, was shown to be more effective than paracetamol.

Fatores associados à baixa capacidade funcional em idosos institucionalizados: um estudo transversal / Factors associated with low functional capacity in institutionalized elderly: a cross-sectional study

Contexto: Há alta prevalência de dependência funcional entre os idosos institucionalizados, entretanto, poucos estudos utilizaram testes de desempenho físico para mensurar a capacidade funcional do idoso. Objetivo: Analisar a prevalência e os fatores associados à baixa capacidade funcional em idosos institucionalizados. Tipo de estudo e local: Estudo transversal, com amostra por conveniência composta por 153 idosos residentes de seis instituições de longa permanência filantrópica do município de São Caetano do Sul. Métodos: Para determinar a escala de capacidade funcional, foi utilizada a circunferência da perna, flexão de cotovelo, velocidade de andar e marcha estacionária. As variáveis independentes foram sexo, idade, tempo de internação, medicamentos, depressão, estado cognitivo e nível de atividade física. Utilizou-se análise de regressão de Poisson com variância robusta para estimar a razão de prevalência (RP). Resultados: A prevalência de baixa capacidade funcional foi de 57%. A faixa etária > 80 anos (RP: 1,66; intervalo de confiança, IC 95%: 1,13­2,44), presença de déficit cognitivo (RP: 2,19; IC 95%:1,08­4,41), e baixo número de passos (RP: 5,39; IC 95%: 1,44­20,10) se associaram diretamente com a baixa capacidade funcional. No entanto, o excesso de peso (RP: 0,59; IC 95%: 0,39­0,89) e a obesidade (RP: 0,42; IC 95%:0,22­0,81) se associaram inversamente com a baixa capacidade funcional. Conclusão: O nível de atividade física, o estado cognitivo e a idade foram associados à baixa capacidade funcional. O índice de massa corporal foi inversamente associado com a baixa capacidade funcional.

Aplicación del láser de baja potencia para el alivio del dolor en pacientes con tratamiento ortodóncico / Application of low power laser for pain relief in patients with orthodontic treatment

Introducción: El dolor es el principal síntoma que refieren los pacientes después de la colocación y activación de los aparatos ortodóncicos. Objetivo: Evaluar la efectividad del láser de baja potencia en el alivio del dolor en pacientes con tratamiento de ortodoncia. Métodos: Se realizó un estudio cuasiexperimental de intervención terapéutica en 30 pacientes que se encontraban en los inicios de la fase de distalización de los caninos superiores (previa extracción de los primeros premolares de la misma arcada), los cuales fueron atendidos en el Servicio de Ortodoncia del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, de enero a diciembre de 2020. A tal efecto, se conformaron 2 grupos de forma aleatoria, por el orden de llegada, de 15 integrantes cada uno: el de estudio, que fue tratado con láser de baja potencia, y el de control, que recibió paracetamol como analgésico habitual. Para la validación estadística de la información se emplearon el porcentaje y la prueba de la T de Student para muestras independientes, con 95 % de confiabilidad. Resultados: Existieron diferencias significativas en cuanto a la remisión de la intensidad del dolor, pues el síntoma estuvo ausente o en grado leve en todos los integrantes del grupo de estudio luego de tres sesiones terapéuticas (p=0,00), mientras que solo 13,3 % de los pacientes del grupo de control se ubicaron en estas dos categorías. Conclusiones: Se demostró que la terapia alternativa con láser fue más efectiva para paliar el dolor que el paracetamol.

Introduction: The pain is the main symptom that patients refer after placing and activation of the orthodontic appliances. Objective: To evaluate the effectiveness of the low power laser for pain relief in patients with orthodontics treatment. Methods: A quasi-experiment study of therapeutic intervention was carried out in 30 patients that were in the beginnings of the distancing phase of the upper canine teeth (previous extraction of the same arch first premolars), who were assisted in the Orthodontics Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from January to December, 2020. To such an effect, 2 groups were conformed at random, by arrival order, of 15 members each one: the study group that was treated with low power laser, and the control group that received paracetamol as usual analgesic. For the statistical validation of the information the percentage and the Student´s t test were used for independent samples, with 95% of confidence. Results: There were significant differences as for the remission of pain intensity, because absence of this symptom or light pain was observed in all the members of the study group after three therapeutic sessions (p=0.00) while just 13.3 % of the control group patients was located in these two categories. Conclusions: It was demonstrated that the alternative therapy with laser was more effective to palliate the pain than the paracetamol.

High viral SARS-CoV-2 load in placenta of patients with hypertensive disorders after COVID-19 during pregnancy

IntroductionStudies described an increased frequency of hypertensive disorders of pregnancy after a COVID-19 episode. There is limited evidence about SARS-CoV-2 viral load in placenta. This study aimed to investigate the relationship between SARS-CoV-2 viral load in placenta and clinical development of HDP after COVID-19 throughout different periods of gestation. MethodsThis was a case-control study in women with and without gestational hypertensive disorders (HDP) after SARS-CoV-2 infection diagnosed by RT-PCR during pregnancy. Patients were matched by gestational age at the moment of COVID-19 diagnosis. We performed an analysis of SARS-CoV-2 RNA levels in placenta. ResultsA total of 28 women were enrolled. Sixteen patients were diagnosed with COVID-19 during the third trimester and the remaining twelve patients in the others trimesters. Ten placentas (35.7%) were positive for SARS-CoV-2, nine of them (90%) belonged to the HDP group versus one (10%) in control group (p=0.009). Those cases with the highest loads of viral RNA developed severe-preeclampsia. ConclusionThe presence of SARS-CoV-2 was more frequent in placentas of patients with HDP after COVID-19. There seems to be a relationship between high viral load in the placenta and the development of hypertensive disorders. We found SARS-CoV-2 viral load in placenta after birth in mothers infected at the first half of pregnancy, but with negative nasopharyngeal RT-PCR at delivery. Our data suggest that SARS-CoV-2 infection during pregnancy could trigger gestational hypertensive disorders through placenta-related mechanisms.

Medication persistence on biological therapies prescribed for the treatment of chronic inflammatory arthropathies: a real-world data study.

OBJECTIVES: Medication persistence, defined as the duration of time from its initiation to its discontinuation, is a surrogate for treatment effectiveness. The aim of the study was to evaluate persistence and causes of biological therapy (BT) suspension in patients with chronic inflammatory arthropathies: rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. METHODS: Single institution, descriptive, retrospective cohort study. Adult patients with chronic inflammatory arthropathies on BT between January 2009 and December 2016 were included. Persistence to BT was compared considering the type of pathology and treatment. The Kaplan-Meier test was used to analyse medication persistanence and factors associated with it. An analysis of reasons for therapy discontinuation was performed. RESULTS: Three hundred and sixty-two patients were included in the study, which comprised 478 BT lines. For all patients, the 12-month persistence rate was 71.3% (341 out of 478). At the end of the study, 45.2% of the patients continued on their initial BT. Median treatment persistence was 1489 days (CI 95% 1195 to 1783). Longer BT persistence was associated with naïve BT patients: 1945 days (95% CI 1523 to 2367; P<0.001) and ankylosing spondylitis diagnosis: 2402 days (95% CI 1604 to 3200; P=0.014). The most frequent causes of treatment discontinuation were therapeutic failure (47.6%) and adverse drug events (28.2%). CONCLUSIONS: We found good long-term persistence in patients with chronic inflammatory arthropathies treated with BT. Patients with rheumatoid arthritis had significantly shorter persistence compared with those with ankylosing spondylitis and psoriatic arthritis. Naïve BT was associated with longer persistence. Therapeutic failure was the main cause of BT withdrawal.

Direct costs in patients with chronic inflammatory arthropathies on biological therapy: a real-world data study.

OBJECTIVES: The aim of the study was to assess the direct costs for the Spanish Health System of patients with chronic inflammatory arthropathies treated with biological therapies in daily clinical practice and to establish possible factors associated with lower costs. METHODS: A descriptive, observational and retrospective study was conducted. Patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis who started a biological therapy between 1 January 2009 and 31 December 2016 were included. Variables related to socioeconomic status, disease and biological therapy were included. The annual cost of biological treatment and other direct medical costs were calculated for each disease. The analysis of costs was based on the National Health Service perspective. The time horizon comprised the 8-year long study period. RESULTS: A total of 422 biological therapy lines were analysed. The annual biological therapy cost per patient was €12,494±3,865 for rheumatoid arthritis, €11,248±2,763 for ankylosing spondylitis and €12,263±35,155 for psoriatic arthritis (p=0.008). The cost of biological therapies entailed about 80% of the total cost of these diseases. Hospital admission was a factor which contributed to an increasing cost in all these conditions. A longer duration of the biological therapy was associated with lower cost in all the diseases. CONCLUSIONS: The cost of ankylosing spondylitis is lower than that of rheumatoid arthritis and psoriatic arthritis. The biological therapy is the factor with the highest impact on the overall cost of these diseases. Preventing hospital admissions and a higher persistence to the biological therapy can contribute to lower costs for the system.

Biological therapy safety in chronic inflammatory arthropathy patients.

OBJECTIVE: The marketing of biological therapies transformed the treatment of rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. But there is still concern about patient safety and management in daily clinical practice. The aim of this study was to estimate risk factors of the adverse effects in a cohort of Spanish patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. METHODS: A single institution, descriptive, retrospective, cohort study was developed from January 2009 to December 2016. Patients diagnosed with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis on biological therapies were included. Undesirable events affecting patients during biological therapy, their clinical implications and the use of health resources related to adverse effects were collected. RESULTS: Three hundred and sixty-two patients corresponding to 478 biological therapy lines were analysed. It implied 1192 years of monitoring. There were 57 adverse effects per 100 biological patient-years and 4.8 serious adverse effects per 100 biological patient-years. The only significant factor for a likely serious adverse effect was having a Charlson Index ≥10, OR of 6.2 (CI 95%: 3.4-11.1, p<0.001). Around 15 % of patients with adverse effects were admitted to hospital and 25% received attention at the Emergency Department. CONCLUSION: Over half of the patients with arthropathies on biological therapy can suffer adverse effect during treatment but only 8.5% of these effects are serious. Special vigilance must be paid to patients with a higher number of comorbidities because they are more likely to experience serious adverse effects.

Biological therapy safety in chronic inflammatory arthropathy patients.

OBJECTIVE: The marketing of biological therapies transformed the treatment of rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. But there is still concern about patient safety and management in daily clinical practice. The aim of this study was to estimate risk factors of the adverse effects in a cohort of Spanish patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. METHODS: A single institution, descriptive, retrospective, cohort study was developed from January 2009 to December 2016. Patients diagnosed with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis on biological therapies were included. Undesirable events affecting patients during biological therapy, their clinical implications and the use of health resources related to adverse effects were collected. RESULTS: Three hundred and sixty-two patients corresponding to 478 biological therapy lines were analysed. It implied 1192 years of monitoring. There were 57 adverse effects per 100 biological patient- years and 4.8 serious adverse effects per 100 biological patient-years. The only significant factor for a likely serious adverse effect was having a Charlson Index ≥10, OR of 6.2 (CI 95%: 3.4-11.1, p<0.001). Around 15 % of patients with adverse effects were admitted to hospital and 25% received attention at the Emergency Department. CONCLUSION: Over half of the patients with arthropathies on biological therapy can suffer adverse effect during treatment but only 8.5% of these effects are serious. Special vigilance must be paid to patients with a higher number of comorbidities because they are more likely to experience serious adverse effects.

Prevalência e fatores associados à dinapenia em idosos institucionalizados. Um estudo transversal / Prevalence and factors associated with dynapenia in institutionalized elderly. A cross-sectional study

Introdução: A dinapenia é caracterizada pela redução da força muscular que acontece durante o processo de envelhecimento. Objetivo: Analisar a prevalência e os fatores associados à dinapenia em idosos institucionalizados. Métodos: Foram avaliados idosos institucionalizados de São Caetano do Sul. A dinapenia foi caracterizada pela reduzida força de preensão manual combinada com reduzida força de membros inferiores. As variáveis independentes avaliadas foram sexo, idade, tempo de institucionalização, medicamentos, satisfação com a vida, depressão, suspeita de deficit cognitivo e número de passos por dia. A análise de regressão logística estimou o odds ratio (OR) com intervalo de confiança de 95% (IC 95%). Resultados: A prevalência de dinapenia foi de 36% entre os idosos. Um dos fatores associados à dinapenia foi a pior satisfação com a vida. Idosos com menor circunferência de panturrilha apresentaram maior chance de dinapenia (OR = 2,44; IC 95%: 1,14-5,25); por outro lado, o excesso de peso mostrou-se um fator protetor para a dinapenia (OR = 0,09; IC 95%: 0,02-0,57). Além desses fatores, idosos com alterações nas atividades da vida diária apresentaram maior chance de dinapenia (OR: 3,73; IC 95%: 1,54-9,05). Conclusão: Idosos dinapênicos institucionalizados apresentaram redução nas atividades da vida diárias, na satisfação com a vida e a menor circunferência da panturrilha. Por outro lado, o excesso de peso mostrou ser importante fator protetor para a reduzida força muscular neste grupo.

Adherence to biological therapies in patients with chronic inflammatory arthropathies.

INTRODUCTION: The aims of the study were to quantify adherence, determine the factors that can  predict adherence and identify the consequences of poorer adherence in patients with chronic  inflammatory arthropathies treated with biological therapies in daily clinical practice. METHOD: A descriptive, observational and retrospective study was carried out. Patients with  rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis who started a biologic therapy  between 1 January 2009 and 31 December 2016 were included. Variables related to socioeconomic  status, the disease, the biological therapy and hospital resources were included. Adherence was  calculated by using the medication possession ratio. RESULTS: Three hundred and sixty-two patients and 423 lines of biological therapy were included.  Mean age ± standard deviation was 50.3 ± 13.9 years, and 228 (53.9%) were women. The  percentage of adherent patients was 187 out of 216 (87%) in rheumatoid arthritis, 91 out of 107  (85%) in ankylosing spondylitis and 84 out of 100 (84%) in psoriatic arthritis. Greater adherence was  associated with more frequent visits to the pharmacy service (odds ratio 1.2, 95% confidence  interval: 1.1-1.3 [p = 0.001]) and poorer adherence with a failure to attend scheduled appointments  at the rheumatology clinic (odds ratio 0.2, 95% confidence interval: 0.1-0.9 [p = 0.030]). There were  no differences between  adherent and non-adherent patients in terms of the number of hospital resources used. CONCLUSIONS: There are no differences in adherence to biological therapies among patients with  chronic inflammatory arthropathies. Adherence correlates with attendance at outpatient  appointments, but this does not imply an increase in the use of hospital resources.

Objetivo: Los objetivos del estudio fueron cuantificar la adherencia, determinar los factores  predictivos y conocer las consecuencias de una menor adherencia, en la práctica clínica diaria, en  pacientes con artropatías inflamatorias crónicas tratados con terapias biológicas. Método: Estudio descriptivo, observacional y retrospectivo. Se incluyeron pacientes con artritis  reumatoide, espondilitis anquilosante y artritis psoriásica que iniciaron una terapia biológica entre el 1  de enero de 2009 y el 31 de diciembre de 2016. Se recogieron variables sociodemográficas, relacionadas con la enfermedad, sobre las terapias biológicas y los recursos  hospitalarios. La adherencia se calculó mediante la ratio media de posesión.Resultados: Se incluyeron 362 pacientes y 423 líneas de terapia biológica. La media de edad ±  desviación estándar fue de 50,3 ± 13,9 años; 228 (53,9%) fueron mujeres. El porcentaje de  adherentes fue de 187 de 216 (87%) en artritis reumatoide, 91 de 107 (85%) en espondilitis  anquilosante y 84 de 100 (84%) en artritis psoriásica. La adherencia se relacionó con acudir con más  frecuencia a la consulta del servicio de farmacia(odds ratio de 1,2; intervalo de confianza 95%: 1,1- 1,3 [p = 0,001]) e inversamente con no acudir a las consultas de reumatología en la fecha prevista (odds ratio de 0,2; intervalo de confianza 95%: 0,1-0,9 [p = 0,030]). No hubo diferencias en  el número de recursos hospitalarios utilizados por pacientes adherentes y no adherentes.Conclusiones: La adherencia a las terapias biológicas entre las artropatías inflamatorias crónicas es  similar. Dicha adherencia se correlaciona con la frecuentación a consultas externas, pero no implica  un aumento del consumo de recursos.

Relação do padrão de marcha associado com a aptidão física e a capacidade funcional de residentes de instituições de longa permanência / Relationship of gait pattern with physical fitness and functional capacity in nursing home residents

Introdução: A locomoção do ser humano precisa da interação músculo-esquelética e neurológica para prover as demandas da idade, quando apresentadas alterações pode levar a problemas importantes de mobilidade e capacidade funcional de idosos institucionalizados. Objetivo: Verificar e analisar a associação da marcha, capacidade funcional e aptidão física em idosos institucionalizados. Métodos: foram avaliados 52 mulheres e 17 homens (66,6-85,4 anos) moradores de instituições de longa permanência de SCS-SP. As variáveis mensuradas foram: espaço-temporais da marcha (marcação plantar), capacidade funcional (mobilidade, equilíbrio dinâmico e estático), aptidão física (peso, estatura, força muscular de membros inferiores e superiores, potência aeróbica). A análise estatística aplicada foi a regressão linear com nível de significância adotado de p<0,05. Resultados: foi encontrado que massa muscular, força muscular, potência aeróbica, cadência e amplitude de passo estão correlacionadas positivamente e fortemente com o comprimento da passada e do passo, largura da passada e ângulo do pé. Conclusão: houve uma associação significativa entre as variáveis espaço-temporais da marcha, com a aptidão física e a capacidade funcional dos idosos institucionalizados de São Caetano do Sul. (AU)

Introduction: The human locomotion needs the skeletal muscle and neurological interaction to provide the demands of the age, which when it presents changes exposes important problems of mobility and functional capacity of the elderly nursing home resident. Objective: To analyze the association of gait patterns with variables of functional capacity and physical fitness among elderly nursing home residents. Methods: This study evaluated 52 women and 17 men (66.6­85.4 years) nursing home residents. The variables measured were: gait assessment (foot print record), functional capacity (mobility, dynamic and static balance,) physical fitness (anthropometry, muscular strength, and aerobic endurance). Linear regression test with significance level of p<.05 was used to analyze data. Results: linear regression showed that muscle mass variables, muscular strength, aerobic capacity, cadence and step average length correlated with the stride length and step width and foot angle. Conclusion: The measurement of gait is associated with physical fitness (muscular strength, arm curl and functional capacity (mobility - cadence), in nursing home residents. (AU)

Juvenile- and adult-onset systemic lupus erythematosus: a comparative study in a large cohort from the Spanish Society of Rheumatology Lupus Registry (RELESSER).

OBJECTIVES: We aimed to describe juvenile-onset systemic lupus erythematosus (jSLE) features and to establish its differences compared to adult-onset SLE (aSLE) from a large national database. METHODS: Data from patients (≥4 ACR criteria) included in Spanish Society of Rheumatology Lupus Registry (RELESSER) were analysed. Sociodemographic, clinical, serological, activity, treatment, cumulative damage, comorbidities and severity data were collected. Patients with disease onset <18 years were described and compared to those with disease onset ≥18 years. RESULTS: We reviewed 3,428 aSLE patients (89.6% women) and 484 jSLE patients (89.8% girls), 93% Caucasian (both groups). Mean age at diagnosis was 38.1±14 and 16.6±6.3 years (p<0.001) and mean age at the end of follow-up was 48.8±14.3 and 31.5±30 years (p<0.001), respectively. jSLE showed significantly more clinical (including lymphadenopathy, fever, malar rash, mucosal ulcers, pericarditis, pleuritis, Raynaud's phenomenon, lupus nephritis, recurrent nephritis, histologic nephritis changes, thrombocytopenia, haemolytic anaemia, thrombotic thrombocytopenic purpura, seizures, lupus headache and organic brain syndrome) and immunological (a-dsDNA and a-Sm antibodies, hypocomplementaemia) involvement than did aSLE, except for secondary Sjögren's syndrome, a-Ro antibodies, fibromyalgia and osteoporosis. jSLE also showed more SLE family history, longer diagnosis delay, higher SLEDAI and Katz scores, but lower Charlson scores than aSLE. Several specific domains were more frequently involved in SLICC/ACR DI in jSLE. jSLE patients more frequently underwent all SLE-related treatment and procedures, as well as dialysis and kidney transplantations. CONCLUSIONS: jSLE shares many clinical and serological features with aSLE. However, jSLE patients typically manifested more activity, severity, cumulative damage in certain areas, than their aSLE counterparts.

Grip strength predicts physical function in nursing home residents / A força de preensão manual prediz a função física de residentes de instituições de longa permanência para idosos

PURPOSE: To analyze the relationship of grip strength and physical function in institutionalized older people. METHODS: One hundred and fifty-seven nursing home residents of seven different long-stay institutions underwent evaluation of body composition, cognitive function, grip strength, mobility, balance (balance scale test BERG and single-leg stance test) and gait speed. RESULTS: Volunteers had no impairment of cognitive function, functional mobility, balance or gait speed. Men had higher grip strength and achieved higher scores in BERG. Fittest volunteers (i.e., P75 to P100) had better functional mobility, BERG and gait speed; less fit volunteers (i.e., P0 to P25) were taller and had better gait speed. The grip strength was independently associated with functional mobility and balance in the single-leg stance test only in females. The cognitive function (female, P25 to P75, male, total sample) and age (male, total sample) showed a tendency to be mediators of functional mobility. Age and body weight seem to confound the gait speed, especially for females (P25 to P75), while cognitive function confound it in males (P75 to P100). However, age and body weight are significantly associated with gait speed (female, total sample). CONCLUSION: We can conclude that grip strength was independently associated with functional mobility and balance of institutionalized older women.

OBJETIVO: O objetivo deste estudo foi analisar a relação da força de preensão manual com a função física em indivíduos idosos institucionalizados. MÉTODOS: Cento e cinquenta e sete idosos institucionalizados de ambos os sexos em sete diferentes instituições de longa permanência foram submetidos a avaliação da composição corporal, função cognitiva, forca de preensão manual (PREENSAO), mobilidade funcional, equilíbrio corporal (escala de equilíbrio de BERG e teste unipodal) e velocidade de caminhada (VELCAM). RESULTADOS: Em geral, os participantes deste estudo não apresentaram comprometimento da função cognitiva, mobilidade funcional, equilíbrio corporal ou da VELCAM. Os homens desenvolveram maior PREENSÃO e alcançaram maior escore em BERG. Os voluntários mais aptos (i.e., P75 a P100) apresentaram melhor função física, BERG e VeLcAM; os menos aptos (i.e., P0 a P25) apresentaram maior estatura e melhor VELCAM. A PREENSAO foi independentemente associada à função física e ao equilíbrio unipodal somente no sexo feminino (amostra total). A função cognitiva (feminino, P25 a P75; masculino, amostra total) e a idade (masculino, amostra total) demonstraram tendência de interferência em relação à avaliação da função física. A idade e o peso corporal parecem ser candidatos a preditores da VELCAM, sobretudo no P25 a P75 do sexo feminino, enquanto a função cognitiva é preditor de VELCAM no sexo masculino (P75 a P100). Por outro lado, a idade e o peso corporal são significativamente associados a VELCAM (feminino, amostra total). CONCLUSÃO: Os dados deste estudo piloto permitem concluir que a forca de preensão manual foi independentemente associada a função física de mulheres idosas institucionalizadas.

Body image in a representative sample of overweight, obese and normal weight active older women living in the community: associations with body composition, physical fitness and function / Imagem corporal numa amostra representativa de mulheres idosas fisicamente ativas com sobrepeso, obesidade e peso normal vivendo na comunidade: associações com a composição corporal, aptidão e função físicas

OBJECTIVE: To compare and examine relationships between body image (BI), body composition and physical function in overweight and normal weight active older women. METHOD: We measured body mass (BM), body mass index (BMI), waist circumference (WAIST), grip strength (GS), lower limb muscle strength [LLMS], arm curl, balance, step-in-place test (SIPT), usual walk (WALK), fast walking (fastWALK), single chair stand (CHAIRtime) and repeated chair stand (CHAIRreps) in 398 overweight or obese women (67.2 ± 8.5 years; BMI > 27 kg·m2) and 302 women with a BMI < 27 kg·m2 (67.3 ± 8.5 years). Current (CBI) and ideal body image (IBI), and body dissatisfaction (DS; current - ideal) were determined by participant's responses to standardized silhouettes. RESULTS: Multiple regression analyses verified positive (CBI) and negative associations (DS) for balance in obese category. A positive association with WALK and fastWALK was observed for current (normal weight and obesity categories) and IBI (overweight). There were positive associations for SIPT, arm curl and CHAIRreps. CONCLUSION: Physically active older women showed an elevated prevalence of dissatisfaction regardless of BMI which was mediated by age, and associated with worsened physical function; similar associations were seen for current body image.

OBJETIVO: Comparar e analisar as relações entre imagem corporal, composição coporal e função física em mulheres idosas fisicamente ativas com sobrepeso e peso normal. MÉTODOS: Medimos a massa corporal, índice de massa corporal (IMC), circunferência da cintura, força de preensão manual, força de membros inferiores, flexão de cotovelo, equilíbrio, marcha estacionária, velocidade normal e máxima de caminhada, levantar-se da cadeira em 700 mulheres idosas fisicamente ativas com sobrepeso (N: 398 [67.2 ± 8.5 years; IMC > 27 kg·m2]) e peso normal (N: 302 [67.3 ± 8.5 years; IMC < 27 kg·m2]). A imagem corporal atual (ICA) e ideal (ICI), assim como a insatisfação com a imagem corporal (IIC) foram determinadas pelas respostas das voluntarias de acordo com silhuetas padronizadas. RESULTADOS: A analise de regressão múltipla verificou associações positivas (ICA) e negativas (IIC) para equilíbrio na categoria obesidade. Foi observada associação positiva com a velocidade usual e máxima de caminhada para ICA (categorias peso normal e obesidade) e IIC (sobrepeso). Existiram associações positivas para o desempenho no teste de marcha estacionária, flexão de cotovelo e numero de repetições para levantar-se da cadeira. CONCLUSÃO: Mulheres idosas fisicamente ativas demonstram elevada prevalência de insatisfação com a imagem corporal independente do índice de massa corporal. Esse resultado é mediado pela idade, e está associado com pior função física; associações semelhantes foram observadas para a imagem corporal atual.

Melhoria da Atenção à Saúde dos Usuários Hipertensos e/ou Diabéticos na Unidade de Saúde da Família "bairro Nordeste", no Município de Natal/RN

GRANDE ESTÉVEZ, Jesús Rafael Benito. Melhoria da atenção à saúde dos usuários hipertensos e/ou diabéticos na Unidade de Saúde da Família "Bairro Nordeste", no município de Natal/RN. 2015. 107f. Trabalho de Conclusão de Curso (Curso de Especialização em Saúde da Família) - Departamento de Medicina Social, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, 2015. As doenças crônico-degenerativas têm assumido importância cada vez maior no elenco de ações programáticas típicas da Atenção Básica, tais como as doenças cardiovasculares. Desta maneira, as doenças cardiovasculares são patologias com altas taxas de prevalência e morbimortalidade, associadas a diversos fatores de risco (hipertensão, diabetes, tabagismo, etc.). Porém, trata-se em geral de fatores de risco modificáveis através de diversas medidas de intervenção (diagnóstico precoce, educação em saúde, legislação, etc.). Na UBS do Bairro Nordeste, não temos dados e registros adequados da população alvo, mas temos a evidência do dia-a-dia quanto a alta prevalência e morbimortalidade neste grupo de doenças. Por isso, no intuito de melhorar a atenção aos usuários hipertensos e diabéticos da nossa área, para assim garantir assistência adequada e com qualidade, de acordo com o preconizado pelo Ministério da Saúde (MS), iniciamos uma intervenção na UBS através do programa de atenção à HAS/DM. Essa ação foi realizada durante 12 semanas, de 12 de janeiro de 2015 a 12 de abril de 2015, por meio de ações que envolviam a capacitação técnica da equipe, o recadastramento da população alvo, o registro adequado, o monitoramento dos indicadores de cobertura e qualidade da assistência, o engajamento público, o acesso e a prática clínica baseada nos respectivos Cadernos de Atenção Básica do MS (CAB da HAS/2006 e CAB da DM/2006, ambos atualizados no ano 2013). Para acompanhar, monitorar, avaliar e reorganizar as ações, foram realizadas coletas de dados durante toda a intervenção, sendo que as mesmas se deram através da planilha fornecida pela UFPEL, sendo todos os dados monitorados periodicamente pela própria equipe de saúde. Assim, a intervenção - ainda que coincidisse com as obras de reforma da UBS - foi decisiva para a ampliação real da cobertura do programa, que chegou a 33,3% de hipertensos e 49% de diabéticos cadastrados (66/24 usuários, respectivamente), sendo um total de 70 indivíduos com 20 anos ou mais acompanhados, com predominância clara do sexo feminino (50 mulheres, para 20 homens) e com faixa etária predominante de idosos (38 pessoas com 60 anos ou mais). Além de ampliar a cobertura, a ação foi decisiva para a implementação do registro adequado dos usuários cadastrados e para a qualificação da atenção prestada. Também, é importante ressaltar que a intervenção conseguiu atingir a meta de 100% na maior parte das atividades relacionadas com a promoção da saúde (como alimentação saudável, exercício físico e luta contra o tabagismo) e impactou na qualidade da assistência. Por fim, vale ressaltar que após analisar e avaliar os indicadores obtidos, a equipe enfrenta o desafio de manter as conquistas, traçar novas metas e seguir melhorando a assistência prestada à população.