Aline Cristina de Souza

Adaptação transcultural e análise das propriedades psicométricas da versão brasileira do Perfil de Atividade Humana

The aim of the present study was to evaluate the psychometric properties in the Brazilian version of the Human Activity Profile (HAP), an instrument for the assessment of daily functions and level of physical activity. The HAP was translated into Portuguese following the recommended methodology and applied to 230 community-dwelling elderly (66.32 +/- 8.5 years) from the city of Belo Horizonte, Minas Gerais State, Brazil. The data were submitted to Rasch analysis, which detected very easy and difficult items, making it possible to employ the instrument with both frail and highly functional individuals. The separation index of 3.1 indicated that the items divided the individuals into three levels of functional ability. Of the 94 HAP items, six (6.38%) did not fit the statistical model, which jeopardized its construct validity, since the items did not fit into a continuum. Therefore, caution should be taken when employing the HAP to individuals having similar characteristics. If HAP is applied to different samples and the proportion of erratic items is still more than 5%, modification, substitution, or exclusion of those items is suggested to guarantee that HAP measures a unidimensional construct.

Adaptação do Perfil de Saúde de Nottingham: um instrumento simples de avaliação da qualidade de vida

O objetivo deste estudo foi avaliar as propriedades psicometricas da versao brasileira do Perfil de Saude de Nottingham (PSN), um instrumento generico de avaliacao da qualidade de vida. O PSN foi traduzido para o portugues, segundo metodologia recomendada, e aplicado em 215 individuos, sendo 170 idosos da comunidade (66,3 ± 8,5 anos), 30 hemiplegicos cronicos (56,4 ± 10,9 anos) e 15 parkinsonianos (59,6 ± 10,2 anos). Os dados foram submetidos a analise Rasch. Dos 38 itens do PSN, apenas dois itens (5%) nao se enquadraram no modelo estatistico, indicando que os itens colaboram para medir um constructo unidimensional. Alguns itens do PSN, no entanto, foram muito faceis para os idosos, hemiplegicos e parkinsonianos, caracterizando um efeito teto, o que pode limitar o uso da escala para individuos com niveis mais altos de habilidade. Apesar dos resultados indicarem que o instrumento se enquadra no modelo estatistico de Rash, ha necessidade de revisao dos itens, de forma a tornar o instrumento mais util clinicamente.

Musculação e condicionamento aeróbio na performance funcional de hemiplégicos crônicos

The aim of the present study was to investigate the functional performance of chronic stroke patients, when submitted to a program of muscular strengthening, using exercise machines associated with aerobic conditioning. Thirty patients were recruited in the community according to the inclusion criteria and submitted to an established training program three times a week, for 10 weeks. The patients were assessed before and after training in the following functional parameters: gait speed, rate of stairclimbing, endurance (maximum gait speed e physiologic cost index), and symmetry in the sit to standing movement. Descriptive statistics and testes for normality (Shapiro-Wilk) were used for all outcome variables. Paired Student t-tests were used to investigate the impact of the training. Significant improvements (p <0,001) were observed for gait speed, rate of stair climbing, and maximum gait speed. No differences were found for the symmetry values and for the physiologic cost index. The findings demonstrated significant gains in functional performance measures after 10 weeks of a combined program of muscle strengthening and aerobic conditioning.

Depressive symptoms and disability in chagasic stroke patients: Impact on functionality and quality of life

INTRODUCTION Chagas disease (CD) is associated with stroke, which can result in significant long-term disability. Stroke has also been associated with depressive symptoms, which affect functional performance and quality of life (QOL). Few data are available on the effect of chagasic stroke on functional performance and QOL. OBJECTIVES This study aimed to investigate the correlation of stroke disability and depressive symptoms with functional performance and QOL in chagasic stroke patients. METHODS In this cross-sectional study, stroke sequelae were assessed using the Modified Rankin Stroke Scale (MRSS), depressive symptoms using the Beck Depression Inventory (BDI), functional performance using the Barthel Index (BI), and QOL using the WHOQOL-BREF. RESULTS Twenty-one patients with CD and a previous diagnosis of stroke were included. There was a correlation between the MRSS score and the BI score (r=-0.663, p=0.003), but not the scores of the WHOQOL-BREF subscales. The BDI score was correlated with the WHOQOL-BREF subscale scores (Physical: r=-0.733, p=0.001; Psychological: r=-0.581, p=0.012; Social: r=-0.713, p=0.001; Environmental: r=-0.659, p=0.003). However, the BDI score was not associated with the BI score (r=0.279, p=0.262). CONCLUSIONS QOL in patients with CD appears to be influenced more by depressive symptoms than by the motor-associated consequences of stroke. Conversely, motor sequelae impair the functionality of the patient more than depressive symptoms.

Excess Ventilation in Chronic Obstructive Pulmonary Disease–Heart Failure Overlap. Implications for Dyspnea and Exercise Intolerance

Rationale: An increased ventilatory response to exertional metabolic demand (high &OV0312;e/&OV0312;co2 relationship) is a common finding in patients with coexistent chronic obstructive pulmonary disease and heart failure. Objectives: We aimed to determine the mechanisms underlying high &OV0312;e/&OV0312;co2 and its impact on operating lung volumes, dyspnea, and exercise tolerance in these patients. Methods: Twenty‐two ex‐smokers with combined chronic obstructive pulmonary disease and heart failure with reduced left ventricular ejection fraction undertook, after careful treatment optimization, a progressive cycle exercise test with capillary (c) blood gas collection. Measurements and Main Results: Regardless of the chosen metric (increased &OV0312;e‐&OV0312;co2 slope, &OV0312;e/&OV0312;co2 nadir, or end‐exercise &OV0312;e/&OV0312;co2), ventilatory inefficiency was closely related to PcCO2 (r values from −0.80 to −0.84; P < 0.001) but not dead space/tidal volume ratio. Ten patients consistently maintained exercise PcCO2 less than or equal to 35 mm Hg (hypocapnia). These patients had particularly poor ventilatory efficiency compared with patients without hypocapnia (P < 0.05). Despite the lack of between‐group differences in spirometry, lung volumes, and left ventricular ejection fraction, patients with hypocapnia had lower resting PaCO2 and lung diffusing capacity (P < 0.01). Excessive ventilatory response in this group was associated with higher exertional PcO2. The group with hypocapnia, however, had worse mechanical inspiratory constraints and higher dyspnea scores for a given work rate leading to poorer exercise tolerance compared with their counterparts (P < 0.05). Conclusions: Heightened neural drive promoting a ventilatory response beyond that required to overcome an increased “wasted” ventilation led to hypocapnia and poor exercise ventilatory efficiency in chronic obstructive pulmonary disease‐heart failure overlap. Excessive ventilation led to better arterial oxygenation but at the expense of earlier critical mechanical constraints and intolerable dyspnea.

Assessment of the source of ischemic cerebrovascular events in patients with Chagas disease

☆ This study was partly supported by grants f Desenvolvimento Cientifico e Tecnologico (CNPq), Coord Pessoal de Nivel Superior (CAPES), Brasilia, Brazil, and Fu do Estado de Minas Gerais (FAPEMIG), Belo Horizonte, Br ⁎ Corresponding author at: Department of Internal Med Federal University ofMinasGerais, Av. Professor AlfredoBa 100 Belo Horizonte, MG, Brazil. Tel.: +55 31 34099746; fa E-mail address: mcarmo@waymail.com.br (M.C.P. Nun

Does Exercise Ventilatory Inefficiency Predict Poor Outcome in Heart Failure Patients With COPD

PURPOSE: To investigate whether the opposite effects of heart failure (HF) and chronic obstructive pulmonary disease (COPD) on exercise ventilatory inefficiency (minute ventilation [ E]-carbon dioxide output [ CO2] relationship) would negatively impact its prognostic relevance. METHODS: After treatment optimization and an incremental cardiopulmonary exercise test, 30 male patients with HF-COPD (forced expiratory volume in 1 second [FEV1] = 57% ± 17% predicted, ejection fraction = 35% ± 6%) were prospectively followed up during 412 ± 261 days for major cardiac events. RESULTS: Fourteen patients (46%) had a negative outcome. Patients who had an event had lower echocardiographically determined right ventricular fractional area change (RVFAC), greater ventilatory inefficiency (higher E/ CO2 nadir), and lower end-tidal CO2 (PETCO2) (all P < .05). Multivariate Cox models revealed that E/ CO2 nadir >36, &Dgr;PETCO2(PEAK-REST)≥2 mm Hg, and PETCO2PEAK⩽33 mm Hg added prognostic value to RVFAC⩽45%. Kaplan-Meyer analyses showed that although 18% of patients with RVFAC>45% had a major cardiac event after 1 year, no patient with RVFAC>45% and E/ CO2 nadir ⩽36 (or PETCO2PEAK>33 mm Hg) had a negative event. Conversely, although 69% of patients with RVFAC⩽45% had a major cardiac event after 1 year, all patients with RVFAC⩽45% and &Dgr;PETCO2(PEAK-REST)≥2 mm Hg had a negative event. CONCLUSION: Ventilatory inefficiency remains a powerful prognostic marker in HF despite the presence of mechanical ventilatory constraints induced by COPD. If these preliminary findings are confirmed in larger studies, optimal thresholds for outcome prediction are likely greater than those traditionally recommended for HF patients without COPD.

Exercise-induced ventricular arrhythmias and vagal dysfunction in Chagas disease patients with no apparent cardiac involvement

INTRODUCTION Exercise-induced ventricular arrhythmia (EIVA) and autonomic imbalance are considered as early markers of heart disease in Chagas disease (ChD) patients. The objective of the present study was to verify the differences in the occurrence of EIVA and autonomic maneuver indexes between healthy individuals and ChD patients with no apparent cardiac involvement. METHODS A total of 75 ChD patients with no apparent cardiac involvement, aged 44.7 (8.5) years, and 38 healthy individuals, aged 44.0 (9.2) years, were evaluated using echocardiography, symptom-limited treadmill exercise testing and autonomic function tests. RESULTS The occurrence of EIVA was higher in the chagasic group (48%) than in the control group (23.7%) during both the effort and the recovery phases. Frequent ventricular contractions occurred only in the patient group. Additionally, the respiratory sinus arrhythmia index was significantly lower in the chagasic individuals compared with the control group. CONCLUSIONS ChD patients with no apparent cardiac involvement had a higher frequency of EIVA as well as more vagal dysfunction by respiratory sinus arrhythmia. These results suggest that even when asymptomatic, ChD patients possess important arrhythmogenic substrates and subclinical disease.

Relationship between left ventricular ejection fraction and e/e' ratiowith functional capacity in chagas heart disease

Background: Left ventricular dysfunction and functional capacity (FC) are important markers of morbidity and mortality in Chagas heart disease (CHD), however, the relationship between these clinical parameters remains controversial. Objective: To verify the association between FC and systolic and diastolic functions of the left ventricle in CHD patients. Methods: Thirty-five CHD patients (47.11±8.15 years) underwent clinical evaluation, echocardiography and Cardiopulmonary Exercise Testing (CPET) and were classified into two groups: dilated group (dilated cardiomyopathy) and non-dilated group (preserved systolic function). The left ventricular ejection fraction (LVEF), E/e’ ratio and peak oxygen uptake (VO 2peak )were considered. Statistical analysis was carried outwith Pearson or Spearman correlation tests and backward multivariate linear regression analysis was performed to assess the effect of LVEF and E/e’ ratio on VO 2peak . Results: In the overall study population, there was a significant correlation between VO 2peak and LVEF (r=0.536; p=0.001) and a significant negative correlation between VO 2peak and E/e’ ratio (r=-0.399; Relationship between left ventricular ejection fraction and e /e’ ratiowith functional capacity in chagas heart disease Joice Coutinho de Alvarenga1, Pedro Damião Jansen1, Vitória Emilia Gomes Marques1, Henrique Silveira Costa2, Giovane Rodrigo de Sousa2, Aline Cristina de Souza2, Maria do Carmo Pereira Nunes2, Márcia Maria Oliveira Lima3, Manoel Otávio da Costa Rocha4 Relação entre a fração de ejeção do ventrículo esquerdo e razão e/e’ com a capacidade funcional na cardiopatia chagásica DOI: 10.5935/2238-3182.20140118

Balance and motor coordination in abstinent alcoholics

Introduction: Alcoholism is defined as a chronic, multifactorial syndrome. It is commonly associated with cerebellar degeneration and polyneuropathy, resulting in coordination and balance dysfunctions that represent the most disabling consequences associated with alcohol consumption. Objective: to describe the profile of abstinent alcoholics who participate in a center for living and to investigate the association between alcohol consumption and disorders of balance and motor coordination. Methods: Demographic data were collected followed by assessment of patients’ balance and motor coordination. Descriptive statistics was used to present the variables studied. The relationship between alcohol consumption and balance was investigated by means of multiple linear regression and the relationship between alcohol consumption and coordination was analyzed using the Mann-Whitney test and independent sample T-test. Results: Patients were mostly men; some also used other psychoactive drugs. There was no significant association between alcohol consumption and balance or between alcohol consumption and motor coordination (p>0.05). Although it was not the objective of this study, the regression model revealed a significant association between age and balance. Conclusion: Findings show the prevalence of chronic alcohol use in men and the concomitant use of other psychoactive drugs. The lack of association between alcohol consumption and deficits in balance Balance and motor coordination in abstinent alcoholics Aline Cristina de Souza1, Ediene Fernandes Gomes2, Tereza Cristina Pereira Vale2, Vivian Rodrigues Patrocinio2, Lidiane Aparecida Pereira de Sousa3 1 Professor Adjunto I do Centro Universitario Newton Paiva. Belo Horizonte, MG – Brasil. 2 Fisioterapeutas. Pontificia Universidade Catolica de Minas Gerais. Betim, MG – Brasil. 3 Professor Titular I do Centro Universitario Newton Paiva. Belo Horizonte, MG – Brasil. Equilibrio e coordenacao motora em alcoolicos abstinentes DOI: 10.5935/2238-3182.20130026