Luciana Oliveira e Silva

Hydrotherapy Versus Conventional Land-Based Exercise for the Management of Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial

Background and Purpose: This study was designed to evaluate the effectiveness of hydrotherapy in subjects with osteoarthritis (OA) of the knee compared with subjects with OA of the knee who performed land-based exercises. Subjects and Methods: Sixty-four subjects with OA of the knee were randomly assigned to 1 of 2 groups that performed exercises for 18 weeks: a water-based exercise group and a land-based exercise group. The outcome measures included a visual analog scale (VAS) for pain in the previous week, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), pain during gait assessed by a VAS at rest and immediately following a 50-foot (15.24-m) walk test (50FWT), walking time measured at fast and comfortable paces during the 50FWT, and the Lequesne Index. Measurements were recorded by a blinded investigator at baseline and at 9 and 18 weeks after initiating the intervention. Results: The 2 groups were homogenous regarding all parameters at baseline. Reductions in pain and improvements in WOMAC and Lequesne index scores were similar between groups. Pain before and after the 50FWT decreased significantly over time in both groups. However, the water-based exercise group experienced a significantly greater decrease in pain than the land-based exercise group before and after the 50FWT at the week-18 follow-up. Discussion and Conclusion: Both water-based and land-based exercises reduced knee pain and increased knee function in participants with OA of the knee. Hydrotherapy was superior to land-based exercise in relieving pain before and after walking during the last follow-up. Water-based exercises are a suitable and effective alternative for the management of OA of the knee.

Prevalence of and risk factors for obstructive sleep apnea syndrome in Brazilian railroad workers

OBJECTIVE This study evaluated the prevalence of, and the risk factors for, obstructive sleep apnea syndrome (OSAS) among Brazilian railroad workers. METHODS Male railroad workers (745) from a railway company in Brazil were analyzed after responding to questionnaires about their demographics, sleep habits, excessive daytime sleepiness (Epworth), and the likelihood of having apnea (Berlin). We also performed polysomnography and measured anthropometric data for all of the railroad workers. RESULTS The results showed that 261 (35.03%) of the railroad workers presented with OSAS. These railroad workers were older (OSAS: 38.53±10.08 versus non-OSAS: 33.99±8.92 years), more obese according to body mass index (27.70±4.38 versus 26.22±3.92 kg/m(2)), and employed for a longer period of time (14.32±9.13 years) compared with those without OSAS (10.96±7.66 years). Among those with OSAS, 9.5% were smokers and 54.7% reported alcohol use. The associated risk factors were age (OR=2.51, 95% CI=1.76-3.57), BMI (OR=1.56, 95% CI=1.04-2.34), alcohol use (OR=1.28, 95% CI=0.90-1.81), and a high chance of having sleep apnea, as assessed by the Berlin questionnaire (OR=2.19, 95% CI=1.49-3.21). CONCLUSION The prevalence of OSAS in Brazilian railroad workers was higher than that observed in the general population but similar to that found in the population of the city of São Paulo, Brazil. These results suggest that age, BMI, a high risk of developing apnea through subjective self-reporting (Berlin), and alcohol use are associated with a higher risk of developing OSAS. These data reinforce the need to be more attentive to this population because they have a higher propensity for accidents.

Effects of hearing aids in the balance, quality of life and fear to fall in elderly people with sensorineural hearing loss

Summary Introduction: The aging process provokes structural modifications and functional to it greets, compromising the postural control and central processing. Studies have boarded the necessity to identify to the harmful factors of risk to aged the auditory health and security in stricken aged by auditory deficits and with alterations of balance. Objective: To evaluate the effect of auditory prosthesis in the quality of life, the balance and the fear of fall in aged with bilateral auditory loss. Method: Carried through clinical and experimental study with 56 aged ones with sensorineural auditory loss, submitted to the use of auditory prosthesis of individual sonorous amplification (AASI). The aged ones had answered to the questionnaires of quality of life Short Form Health Survey (SF-36), Falls Efficacy International Scale- (FES-I) and the test of Berg Balance Scale (BBS). After 4 months, the aged ones that they adapted to the use of the AASI had been reevaluated. Results: It had 50% of adaptation of the aged ones to the AASI. It was observed that the masculine sex had greater difficulty in adapting to the auditory device and that the variable age, degree of loss, presence of humming and vertigo had not intervened with the adaptation to auditory prosthesis. It had improvement of the quality of life in the dominance of the State General Health (EGS) and Functional Capacity (CF) and of the humming, as well as the increase of the auto-confidence after adaptation of auditory prosthesis. Conclusion: The use of auditory prosthesis provided the improvement of the domains of the quality of life, what it reflected consequently in one better auto-confidence and in the long run in the reduction of the fear of fall in aged with sensorineural auditory loss.

Avaliação do broncoespasmo induzido pelo exercício avaliado pelo Peak Flow Meter em adolescentes obesos

INTRODUCAO: Criancas e adolescentes com excesso de peso apresentam maior prevalencia de broncoespasmo induzido pelo exercicio (BIE), quando comparados a eutroficos. A espirometria e o peak flow meter sao importantes metodos avaliativos da funcao pulmonar. Porem, a aplicabilidade do medidor do pico de fluxo expiratorio (peak flow meter) na deteccao do BIE em criancas e adolescentes com excesso de peso nao e conhecida, o que justifica o desenvolvimento desta pesquisa. OBJETIVOS: Avaliar e comparar o desencadeamento de broncoespasmo induzido pelo exercicio (BIE) em criancas e adolescentes nao asmaticos com excesso de peso, avaliados pela espirometria e pelo peak flow meter (PFE). CASUISTICA E METODOS: Participaram do estudo 39 voluntarios acima do percentil 85o (OB) e 30 eutroficos (EU), de oito a 15 anos. A avaliacao da funcao pulmonar pre e pos-teste de broncoprovocacao foi realizada pela espirometria e peak flow meter, de acordo com o protocolo de Del Rio-Navarro et al., (2000). O BIE foi considerado positivo quando o voluntario apresentou uma reducao > 10% do VEF1 basal ou reducao > 20% do PFEPFM e/ou PFEE. RESULTADOS: Na deteccao do BIE, a prevalencia do grupo obeso foi de 26% avaliado pelo peak flow meter (PFEPFM) e 23% pelo VEF1. O tempo do BIE ocorreu nos primeiros 15 minutos pos-exercicio em ambos os parâmetros: (PFEPFM) e VEF1. CONCLUSAO: Os voluntarios obesos apresentaram tempo e prevalencias similares de BIE, quando avaliados por ambos os metodos de avaliacao pulmonar. O facil manejo e o baixo custo facilitam a maior acessibilidade para a populacao geral do peak flow meter, o que demonstra sua importância como parte integrante de um programa educacional no diagnostico inicial do BIE em vias aereas de grande calibre.

Avaliação antropométrica e do ângulo quadricipital na osteoartrite de joelho em mulheres obesas

Osteoarthritis (OA) is a degenerative joint disease characterized by inflammatory process, pain, and deformity; one of its main predictive factors is obesity. The aim of this study was to search for possible correlations between anthropometric measures, the Q angle and knee osteoarthritis. A sample of 50 obese women (30 with knee osteoarthritis and 20 with no joint disease), aged between 40 to 60 years, were assessed as to BMI (body mass index), abdominal circumference (AC), waist and hip perimeters (so as to calculate waist-hip ratio), and the Q angle; osteoarthritis was diagnosed by clinical exam and knee joint radiography. Results showed a positive, poor correlation between BMI and Q angle, as well as between time of obesity onset and degree of joint degeneration. AC was found to positively, though weakly, correlate with the degree of joint degeneration and of OA severity. Adjusted odds ratio for OA showed that women with BMI>34 kg/m 2 and AC>110 cm were respectively 3.7 and 7 times more likely to develop OA. The degree and duration of central obesity possibly contribute to incidence of knee OA in obese women. Abdominal circumference was the measure that most correlated with the degree of joint degeneration and of OA severity, which suggests it should be used in clinical evaluation.

AVALIAÇÃO RESPIRATÓRIA E DA CAPACIDADE FUNCIONAL DE PACIENTES COM SÍNDROME DA APNEIA OBSTRUTIVA DO SONO (SAOS) DE GRAU LEVE-UM ESTUDO PILOTO

Excessiva (SDE), que em geral atinge mais de 10% da população em geral. Estudantes de graduação possuem altas chances de apresentar Sonolência Diurna Excessiva, devido aos horários de aulas, demandas acadêmicas, estágios e principalmente os alunos do curso do noturno que passam o dia trabalhando. O objetivo deste trabalho consistiu avaliar a prevalência de sonolência diurna excessiva em acadêmicos 1°. ano do curso de ciências Biológicas, noturno, de uma universidade. O universo foi constituído por 25 graduandos. Utilizou-se a Escala de Sonolência de Epworth, sendo considerada com SDE quem apresentar 11 ou mais pontos. A amostra apresentou médiav total de 9,92 pontos (DP1⁄44,04). O valor médio dos universitários sem patologia foi de 5,5 pontos, e valor médio com patologia foi 13,15 pontos. A sonolência diurna excessiva patológica apresentou-se em 52% da amostra. A sonolência excessiva, dessa forma, influencia demodo significativo a vida do estudante universitário, comprometendo a consolidação da memória e, consequentemente, o êxito acadêmico.

Maquinistas ferroviários: trabalho em turnos e repercussões na saúde

Objective to describe the impact of shiftwork on the health, sleep and quality of life of railway drivers. Methods six hundred eleven railway drivers (schedule 4x1 and 6x2) were evaluated by polysomnography, Pittsburgh Sleep Quality Index, Insomnia Severity Index, Work Capacity Index, Quality of Life questionnaire (SF-36), Morningness-eveningness questionnaire (MEQ), and Epworth Sleepiness Scale. 
Results railway drivers assessed were 36.6 ± 15.1 years of age, 22% were obese, and 38.1% presented risks for cardiovascular disease. Poor sleep quality 64.2%, 11.6% had sleep disorders and 29.3% excessive sleepiness. The polysomnography results showed that 36.1% of them presented sleep apnea and 47.2% had significant reduction in sleep efficiency. The railway drivers showed low levels of quality of life, especially those working under the 4x1 schedule. Conclusion it is possible to assert that exposure to shiftwork, reverse rotation schedule, few days off, and working overtime are associated with impairment to well-being, health, sociability and workers’ sleep quality, and the factors related to shiftwork probably contribute to these findings.