Biopsychosocial factors associated with the state of disability after hemiparesis in the chronic phase of stroke: exploratory analysis based on the International Classification of Functioning, Disability and Health

OBJECTIVE

To identify the main biopsychosocial factors associated with disability level after stroke using the International Classification of Functioning, Disability and Health (ICF) model.

METHODS

A cross-sectional study was conducted with chronic stroke survivors. Disability was assessed using the World Health Disability Assessment Schedule 2.0. The independent variables were: Body functions: emotional functioning and whether the dominant upper limb was affected. For the Activities & Participation component, satisfaction regarding the execution of activities and participation were assessed using the SATIS-Stroke, as well as the locomotion ability for adults (ABILOCO), manual ability (ABILHAND) and the return to work. For environmental factors, income and facilitators and obstacles were assessed using the Measure of the Quality of the Environment (MQE). Personal factors: age and sex. Multiple Linear Regression was employed.

RESULTS

Limited locomotor ability (β = -0.281; t = -3.231 p = 0.002), dissatisfaction regarding activities and participation (β = -0.273; t = -3.070 p = 0.003), and the non-return to work (β = 0.162; t = 2.085 p = 0.04) were associated with disability.

CONCLUSION

The reduction in locomotor ability, dissatisfaction regarding activities and participation and the non-return to work were associated with disability in the chronic phase following a stroke.

Content analysis of the Measure of the Quality of the Environment by linkage with the International Classification of Functioning, Disability and Health

BACKGROUND

This study explores the linkage between the Measurement of Environmental Quality (MQE) and the International Classification of Functioning, Disability, and Health (ICF). Stemming from the Human Development Model-Disability Creation Process (HDM-DCP), MQE enhances understanding of how environmental quality impacts disability development across diverse socio-cultural contexts. Integrating MQE with ICF expands the perspective on disability formation beyond HDM-DCP, encompassing ICF's functioning approach.

OBJECTIVE

To link the MQE with the concepts and categories of the ICF.

METHODS

Two health professionals with adequate taxonomic knowledge of the ICF performed the initial linkage, which was based on updated standardized rules considering all hierarchical levels of the ICF. Linkage agreement between the first two assessors was measured using the Kappa (k) coefficient and respective 95% confidence intervals. In the absence of a consensus between the two assessors (k > 0.60), a third assessor was consulted to make the arbitrary decision of the final categories linked to the MQE.

RESULTS

Insufficient agreement between the two assessors was found for the linkage process (k = 0.52; p < 0.001), requiring the final decision from the third assessor. At the end of the process, 26 ICF categories were linked to the main concepts (MC) measured by the 26 items of the short version of the MQE. Ten ICF categories were linked to the additional concepts (AC) measured by the MQE. Moreover, the MQE addresses the five domains of the ICF component "environmental factors," with a predominance of the "services, systems and policies" domain (MC = 45.8% and AC = 40%).

CONCLUSION

The linkage of the concepts measured by the MQE to ICF categories enabled mapping the content of the MQE, identifying it as a promising tool for measuring environmental factors in accordance with ICF percepts.

Predictors of the Social Participation of Adults with Down Syndrome: An Analysis Based on the Biopsychosocial Model of the International Classification of Functioning, Disability, and Health

OBJECTIVE

The aim of the study is to identify the predictors of social participation in Down syndrome adults from the biopsychosocial model of the International Classification of Functioning, Disability, and Health.

METHODS

An exploratory, analytical, cross-sectional study was conducted with Down syndrome adults. The social participation was assessed using the Life Habits Assessment. The independent variables were determined using the International Classification of Functioning, Disability, and Health biopsychosocial model: body functions were assessed by body mass index, cognition function (Mini-Mental State Examination), and lower limbs muscle strength (Sit-to-Stand Test). Activities were assessed by the 8-Foot Up and Go Test. Environmental factors were assessed by the measure of the quality of the environment, and personal factors were assessed by age, sex, and education level.

RESULTS

The total Life Habits Assessment score indicates that individuals show moderate restriction in social participation, with major restriction in the education, employment, and responsibilities domains. The 8-Foot Up and Go Test was the best social participation predictor variable, followed by Mini-Mental State Examination, and the Sit-to-Stand Test. Contextual factors were not predictors of participation.

CONCLUSIONS

It was concluded that individuals with Down syndrome present the most restrictions to social participation in activities that involve social roles. The predictors influencing social participation are functional mobility, cognition, and lower limb muscle strength.

Disability after breast cancer surgery: Proposal of linkage between the International Classification of Functioning, Disability and Health and the Grocery Shelving Task Test

PURPOSE

To link the concepts measured by the Grocery Shelving Task Test (GST) to the codes and qualifiers of the activity and participation component of the International Classification of Functioning, Disability and Health (ICF).

METHODS

The linkage was performed by two professionals who applied the 10 standardized binding rules. The linking process was performed through the model of extraction and identification of the concepts that were found in each item of the GST Test.

RESULTS

The GST test includes 1 domain of the activity and participation component (d4 mobility). The link with the qualifiers allowed quantifying the impairment of the limitations of activities in the postoperative period, being observed that 21.27% of the sample did not present any problem, 61.70% presented the qualifier "0.1" (mild problem), 8.50% had a moderate problem (qualifier '0.2') and 8.50% had a severe problem (qualifier '0.3'). No complete impairment was observed in any study participant.

DISCUSSION

The linking of the GST to the ICF codes and qualifiers allowed quantifying the functional impairment in the postoperative period of breast cancer, allowing a comprehensive and standardized view, and being a guiding tool for treatment plans.

Additive effect of transcranial direct current stimulation (tDCS) in combination with multicomponent training on elderly physical function capacity: a randomized, triple blind, controlled trial

PURPOSE

To evaluate the additive effect of Transcranial Direct Current Stimulation (tDCS) associated with multi-component training (MT) on the functional capacity (FC) of older adults and to assess whether these effects remain after the end of training. The secondary objectives were to evaluate the locomotion capacity, balance, functional independence, and quality of life and correlate them with functional capacity.

METHODOLOGY

Twenty-eight older adults were randomized into two groups: experimental (MT associated with active tDCS - a-tDCS) and control (MT associated with sham tDCS - s-tDCS). The FC was measured by the Glittre-ADL test, locomotion capacity by the 6-minute walk test, balance by the BESTest, functional independence by the FIM, and quality of life by the WHQOL. The assessments were performed pre-, post-intervention, and 30-day follow-up.

RESULTS

There was a significant decrease in the time to the Glittre-ADL test when comparing the a-tDCS and s-tDCS groups after the interventions (139.77 ± 21.62, 205.10 ± 43.02, p < .001) and at the 30-day follow-up (142.74 ± 17.12, 219.55 ± 54.05, p < .001), respectively. There was a moderate correlation between FC and locomotion capacity and balance.

CONCLUSIONS

The addition of tDCS potentiated the results of MT to impact FC, maintaining the positive results longer. Locomotion and balance influenced the improvement of functional capacity.

Tele-assessment of activities and participation in chronic phase of stroke: Is use valid and viable in a developing country?

BACKGROUND

SATISPART-Stroke (SATIS-Stroke) is the most complete instrument for the assessment of activity and participation following a stroke. However, its use in a developing country has only been tested through in-person interviews.

OBJECTIVE

To determine the validity, reproducibility and viability of the SATIS-Stroke scale administered in two tele-assessment modalities: self-assessment of an electronic form versus videoconference.

METHODS

Methodological study with Brazilian chronic stroke survivors was conducted. Stage I comprised an in-person interview to apply the SATIS-Stroke and a self-assessment by completing an electronic form to respond to the SATIS-Stroke items. Step II occurred 6 to 8 months after Step I, during which SATIS-Stroke was administered again in-person and via videoconference. The order was randomized.

RESULTS

Ninety-five stroke survivors were recruited, but only 50 answered the electronic form (adherence: 52.6%). Mean scores were higher in the self-administration of electronic form compared to the in-person interview (mean difference = -0.36 ± 0.93; P = 0.009). Adequate reliability was found in the comparison of the in-person and self-assessment of electronic form (ICC_2,1 = 0.66; 95%CI: 0.40-0.81). Fifty stroke survivors participated in Step II, during which adequate reliability was found in the comparison of the in-person administration and videoconference (ICC_2,1 = 0.55; 95%CI: 0.21-0.74) and a moderate correlation was found between the assessment methods (r = 0.43; P = 0.02).

DISCUSSION

Adequate validity and reliability were found in the tele-assessment. Thus, this method is appropriate and viable for use in developing countries. Although reliable, the self-assessment did not have good adherence in the Brazilian population due to internet access problems, lack of familiarity with the digital form and lack of autonomy to answer the questions alone.

Validation and reproducibility of the Glittre activities of the daily living test for evaluation of functional capacity after a stroke

METHODS

Thirty patients with hemiparesis stemming from a stroke and 20 healthy peers were evaluated. Reproducibility was determined using the intraclass correlation coefficient (ICC), standard measurement error (SME), minimum detectable change (MDC), and Bland-Altman analysis. For construct validity, the Glittre ADL test was correlated with the Six-Minute Walk Test (6MWT), Timed Up and Go Test (TUG), and Functional Independence Measure (FIM), and analyzed based on convergent validity and the comparison of known groups (stroke survivors and healthy peers).

RESULTS

Intra- and inter-observer reliability were excellent (ICC_3,1 = 0.98; 0.96, respectively). Intra-observer SME ranged from 0.27 to 0.31 minutes and inter-observer SME was 0.45 minutes. Intra-observer MDC ranged from 1.44 to 1.54 minutes and inter-observer MDC was 1.86 minutes. Strong statistically significant correlations were found between time on the Glittre ADL test and time on the 6MWT (rh = -0.91; p < .001) and TUG test (rh = 0.82; p < .001), whereas a moderate correlation was found with the FIM (rh = -0.47; p < .008).

CONCLUSIONS

The Glittre ADL test is valid for assessing functional capacity in stroke patients. It demonstrated good convergent and construct validity and excellent intra- and inter-observer reproducibility.

Translation and cross-cultural adaptation of the Brazilian version of the PM-Scale: A specific measure of participation after stroke

BACKGROUND

The PM-Scale was developed specifically to assess participation in individuals after stroke based on the concepts contained in the International Classification of Functioning, Disability and Health. However, this measure is only available in English and French.

OBJECTIVE

To translate and cross-culturally adapt the PM-Scale to Brazilian Portuguese, followed by the validation and testing of reliability of the translated version.

METHODS

The translation process followed standard guidelines. Preliminary test-retest reliability was determined using the intraclass correlation coefficient (ICC_2,1). The Rasch model was employed to analyse the validity, unidimensionality, invariance, and internal consistency of the Brazilian version of the PM-Scale.

RESULTS

The final translated version of the PM-Scale presented appropriate semantic, idiomatic, cultural, and conceptual equivalence. The preliminary analysis revealed excellent intra-observer and inter-observer reliability (ICC_2,1 = 0.91; 95%CI: 0.83, 0.95 and ICC_2,1 = 0.81; 95%CI: 0.64, 0.89, respectively). The analysis of the Rasch model revealed only one erratic item. An excellent overall fit was found for items (mean ± SD = 0.01 ± 1.02) and adequate fit was found for persons (mean ± SD = 1.16 ± 0.88). Internal consistency was considered adequate (person separation index = 1.77, reliability = 0.76). No significant invariance was found with regards to the personal characteristics of the sample (p > 0.05).

CONCLUSION

The Brazilian version of the PM-Scale is a valid, unidimensional, linear, reliable scale for measuring participation in stroke survivors and can be administered in less than five minutes.

Predictors of access to healthcare services within 1 month after stroke in a developing country: A longitudinal prospective study

BACKGROUND

Globally, people with disabilities face difficulties accessing care, resulting in worse health outcomes and higher healthcare costs. However, information regarding access to healthcare services for stroke survivors in developing countries is scarce.

OBJECTIVE

To identify predictors of access to healthcare services within 1 month of hospital discharge in a developing country (Brazil).

METHODS

For six months, individuals from a stroke unit, aged ≥20 years, after their first stroke and without previous disability, were included and evaluated at hospital discharge for socio-demographic (sex, age, education, and socio-economic level) and clinical-functional (severity of stroke and level of disability) characteristics. The number and type of referrals to healthcare services provided by hospital staff were also recorded. One month after hospital discharge, data regarding access to healthcare services obtained by the subjects were collected. The Wilcoxon test was used to compare the number of referrals and access to healthcare services obtained by the subjects. To identify the predictors of access, a binary logistic regression was used (α = 5%).

RESULTS

A total of 78 individuals were evaluated one month after hospital discharge, all with at least one referral. The total access to healthcare services within 1 month of stroke was significantly lower than the total number of referrals (p < 0.001). Sex (odds ratios (OR) = 18.92; p = 0.01) and educational level (OR = 1.48; p = 0.04) were significant predictors of access.

CONCLUSIONS

Being female and having low education levels were predictors of access to healthcare services within 1 month of stroke in a developing country. In addition, the access was below expectations, compromising the integrality of care and national and international recommendations, which is a concern given the need for early care to obtain better results in health and functional outcomes.

Abnormal Activity of Masticatory Muscles in Patients with Diagnosis of Cerebral Palsy. A Systematic Review and Meta-Analysis of Observational Studies

AIMS

to map and synthesize the results from studies that assessed whether individuals diagnosed with cerebral palsy (CP) have abnormal masseter and temporal muscles activation during the masticatory cycle.

METHODS

Six databases were searched for comparative observational studies assessing masticatory muscles activation in individuals with CP through electromyography analysis. Methodological quality was evaluated using the Joanna Briggs Critical Appraisal Checklist. Outcome data were combined in meta-analysis using the Review Manager software.

RESULTS

We included five cross-sectional studies with an overall low risk of bias. Meta-analyses showed no difference between CP and healthy individuals regarding maximum voluntary isometric contraction: right masseter (Standard mean difference [SMD] - 0.95; 95% CI -2.03 to 0.13); left masseter (SMD -0.92; 95% CI -1.93 to 0.09); right temporal (SMD -0.72; 95% CI -1.63 to 0.18); and left temporal (SMD -0.68; 95% CI -1.76 to 0.40). Electrical activity amplitude in the inactive period was superior in the CP group, and maximum bite pressure presented higher values in the control group (Mean difference [MD] - 17.38; CI 95% -26.62 to -10.15).

CONCLUSIONS

Based on observational studies with a lower level of evidence, individuals with CP seem to present difficulties activating masticatory muscles. Future prospective cohort studies with rigorous methodology are still necessary to support these findings. PROSPERO register CRD42020208444.

Use of the International Classification of Functioning, Disability and Health (ICF) to expand and standardize the assessment of quality-of-life following a stroke: proposal for the use of codes and qualifiers

PURPOSE

Propose a way of coding and qualifying HRQoL following a stroke using the codes and qualifiers of the International Classification of Functioning, Disability and Health (ICF).

METHODS

An observational, cross-sectional study was conducted involving 51 individuals with hemiparesis resulting from a stroke. ICF codes related to the Stroke Specific Quality of Life (SS-QOL) scale were listed and subsequently classified using the generic ICF qualifiers, which range from .0 - no impairment to .4 - complete impairment. A simple mathematic calculation was proposed to convert the SS-QOL scores into ICF qualifiers.

RESULTS

The use of the ICF qualifiers revealed that the individuals exhibited a moderate level (.2) of quality of life, with mild impairment (.1) regarding upper limb function, language, self-care, and vision as well as severe impairment (.3) regarding social relations.

CONCLUSIONS

The proposal presented in this study allowed qualifying 43 ICF codes related to quality of life after a stroke in a simple, standardized manner, enabling the identification of different levels of impairment on each of the domains of the SS-QOL scale. This coding standardizes the evaluation, facilitates communication between healthcare providers, and systematizes the collection of data and information on health.Implications for rehabilitationProposal for qualifying concepts related to body functions, activity & participation, and environmental factors in a simple, standardized manner.The proposed mathematic calculation is simple and easy to understand, which minimizes the occurrence of errors.Possibility to identify different levels of impairment in each of the domains of the Stroke Specific Quality of Life scale, facilitating the establishment of individualized, longitudinal care.The ICF codes standardize the evaluation, facilitate communication between healthcare providers, and systematize the collection of data and information on health and functioning.

Shuttle walk test categorization according to the qualifiers of the International Classification of Functioning, Disability, and Health: proposal for use in patients with difficult-to-treat asthma, a cross-sectional study

AIM

To classify functional capacity of people with difficult-to-treat asthma based on the International Classification of Functioning, Disability and Health (ICF).

METHODS

Fifty-seven patients underwent the Incremental Shuttle Walk Test (ISWT) to assess functional capacity, in order to categorize them functionally we used the ICF qualifiers. To qualify ISWT results the individual's impairment (i.e. percentage of distance walked in relation to the percentage of predicted) was analyzed. Additionally, body mass index (BMI); physical activity level (IPAQ); and pulmonary function were evaluated. In order to analyze the difference between functional capacity levels, two groups were compared (i.e. mild/moderate vs. severe impairment); therefore, the participants were matched according to age and BMI and the unpaired Student t test was used.

RESULTS

Among the fifty-seven included individuals, only one (1.8%) presented mild functional capacity limitation, 12 (21.1%) moderate limitation and 44 (77.2%) severe limitation. There was a significant difference between the ISWT distance between groups (F = 0.217, p < .001). The other variables did not present differences between the mild/moderate and severe groups.

CONCLUSION

The ICF qualifiers were able to categorize the ISWT and classified the functional capacity limitation as mild, moderate and severe. Therefore, it has proved to be a useful clinical tool for evaluation, follow-up and clinical decision-making.

Impact of Environmental Factors on Post-Stroke Disability: An Analytical Cross-Sectional Study

OBJECTIVES

Identify how environmental barriers and facilitators are associated with disability in stroke survivors.

MATERIALS AND METHODS

An analytical, cross-sectional study was conducted involving individuals in the chronic stage of stroke. The dependent variable was disability, which was assessed using the World Health Organization Disability Assessment Schedule (WHODAS-2.0). Environmental factors (independent variable) were evaluated using the Measure of the Quality of the Environment (MQE). Multiple linear regression analysis was performed to estimate the impact of the environment on disability following a stroke.

RESULTS

Seventy-five individuals (mean age: 54.2 + 9.8 years) were analyzed. The most frequent environmental facilitators were related to technology, social networks, and public services. The main barriers were related to the physical environment. Environmental barrier was a predictor of both overall disability [F(1.73) = 4.24; R²=0.06; β = -0.23; t = -2.06; p=0.04] and participation [F(1.73) = 10.45; R²=0.13; β = -0.35; t = -3.23; p = 0.01]. Environmental facilitators were not correlated with disability.

CONCLUSION

Environmental barriers explained 13% of the variation in restrictions to social participation and were also a significant predictor of overall disability. The main barriers were related to the physical environment. Identifying environmental factors related to disability in stroke victims can assist in the planning of guided therapy.

Clinimetric properties of the SATIS-Stroke questionnaire in the Brazilian population: A satisfaction assessment measure addressing activities and participation after a stroke

BACKGROUND

SATIS-Stroke questionnaire has been translated and adapted for use in the Brazilian population, however, it is necessary to test the measurement properties in Brazilian population.

OBJECTIVE

To test the reliability, agreement, concurrent validity, and diagnostic accuracy of the SATIS-Stroke.

METHODS

Chronic stroke survivors were included. The calculations were made using scores in logits (Rasch Model). Reliability was tested using the intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman plots. Concurrent validity was analyzed using Spearman's correlation coefficient. For such, the correlation between SATIS-Stroke and Stroke Specific Quality of Life (SS-QOL) questionnaires was determined. Diagnostic accuracy was estimated based on the area under the receiver operating characteristic (ROC) curve with a 95% confidence interval and considering the sensitivity and specificity of SATIS-Stroke in differentiating different types of activity and participation.

RESULTS

Eighty stroke survivors were analyzed. Mean age was 57.98±13.85 years and 45.2% had severe impairment. Excellent reliability was found (intra-observer ICC2,1 = 0.90; 95% CI: 0.84, 0.93; inter-observer ICC2,1 = 0.89; 95% CI: 0.83, 0.93). The Bland-Altman plot demonstrated satisfactory agreement. In the analysis of concurrent validity, a strong, positive, significant correlation was found between SATIS-Stroke and SS-QOL (rs = 0.74; p <0.001 with an r2=0.44; p=0.001). Diagnostic accuracy was satisfactory, with 80.8% sensitivity and 85.2% specificity.

CONCLUSION

The Brazilian version of the SATIS-Stroke questionnaire exhibited adequate reliability, concurrent validity, and diagnostic accuracy. Therefore, this is a valid, reproducible measure for the assessment of satisfaction with regard to activities and participation following a stroke.

Linking of concepts measured by SATIS-Stroke and the PM-Scale to the international classification of functioning, disability and health

BACKGROUND

Rules have been developed to simplify the understanding of researchers/clinicians and standardize the linking process between concepts contained in the items on assessment measures and the International Classification of Functioning, Disability, and Health (ICF).

OBJECTIVE

Link the concepts of the SATISPART Stroke (SATIS-Stroke) and Participation Measurement Scale (PM-Scale) to ICF codes.

METHODS

Linking was performed by two evaluators with experience in the ICF taxonomy who applied the ten standard linking rules specifically developed and updated for this purpose. The level of agreement between the evaluators was determined using the Kappa coefficient with 95% confidence intervals.

RESULTS

The SATIS-Stroke and PM-Scale address the nine domains of the ICF "Activities and Participation" component. Adequate agreement was found between the researchers during the linking process, mainly between the 1º and 3º evaluators. Identified 41 ICF codes were found among the SATIS-Stroke items and 24 ICF codes were found among the items of the PM-Scale.

CONCLUSION

SATIS-Stroke addresses more issues regarding the domains of Learning and Applying Knowledge, Mobility, Self-Care, Domestic Life, and Major Life Areas, whereas the PM-Scale addresses more issues regarding the General Tasks and Demands, Communication, and Community, Social and Civic Life. Both instruments equally address issues related to Interpersonal Interactions and Relationships.

To Combine or Not to Combine Physical Therapy With tDCS for Stroke With Shoulder Pain? Analysis From a Combination Randomized Clinical Trial for Rehabilitation of Painful Shoulder in Stroke

Purpose: Transcranial Direct Current Stimulation (tDCS) is an intervention that seems to be an ideal tool to enhance the effects of rehabilitation therapies given it facilitates generation of plasticity in the stimulated brain area. In stroke this strategy has been highly utilized; however, the results have been mixed. In this trial we have evaluated the analgesic and functional effects of Transcranial Direct Current Stimulation (tDCS) combined with physiotherapy in stroke survivors with shoulder pain.

Methods: Twenty-six stroke surviving adults with shoulder pain received 10 sessions of passive mobilization and performed upper limb exercises using a cycle ergometer, combined with active or sham tDCS. The intensity of pain in the hemiplegic shoulder was measured using the Visual Analog Scale (VAS); secondary outcomes were the level of motor impairment, handgrip strength, range of motion, motor function of the upper limbs, and quality of life (QOL) assessed before and after 10 sessions and 1 month after the end of the treatment.

Results: A clinically important pain reduction (3 points) was found in both groups and was maintained at follow-up; there was no significant difference between groups (p = 0.3). Similarly, the shoulder range of motion improved, motor function and quality of life improved showed no significant differences between groups. One result that needs to be underscored is that both groups had a significant effect size toward improvement in all of these outcomes.

Conclusions: We discuss in this study that tDCS is not a useful combination strategy when the physical therapy has a large effect by itself and we also review other negative trials of combined therapy under this framework of ceiling effect of the main physical therapy.

Trial registry: Trial registration: Brazilian Registry of Clinical Trials, RBR-8F5MNY (http://www.ensaiosclinicos.gov.br/rg/RBR-8f5mny/). Registered on June 2, 2017.

Beginning of the recruitment of the volunteers: august, 2017.

Protocol for a controlled, randomized, blind, clinical trial to assess the effects of anodal transcranial direct current stimulation dorsolateral prefrontal cortex associated with balance training using games in the postural balance of older people

Aims: This study aims to evaluate the additional effect of anodal transcranial direct current stimulation (a-tDCS) applied on dorsolateral pré-frontal cortex on training postural balance with the use of video games in the aged.

Methods: This is a blinded, randomized, controlled clinical trial protocol, with older people of both genders. Participants will be randomized into three training groups: Group 1 (videogame balance training), group 2 (videogame balance training associated with anodal tDCS), group 3 (videogame balance training associated with sham tDCS). The training will be carried out twice a week for four weeks, totaling eight sessions, and will be performed with the Nintendo Wii videogame console, using games that stimulate the postural balance associated with tDCS, with anode applied over the left dorsolateral prefrontal cortex and cathode on the contralateral supraorbital region at 2 mA for 20 minutes. The postural balance will be assessed using the Mini Test of the Balance Assessment System and posturography. Evaluations will be carried out before and after eight training sessions and 30 days after the end of treatment.

Discussion: Some studies show favorable results from the use of video games in improving postural balance in older people; however, their effect does not remain long-term. TDCS associated with other therapies can potentiate and prolong the effects of these therapies owing to its ability to stimulate neurotrophins important for neurogenesis, facilitating tasks that require attention, and helping to consolidate learning and memory. The effect of the two associated techniques on balance has not yet been tested in this population.

Registration: Brazilian Registry of Clinical Trials ID U1111-1213-4266; registered on 15 October 2018.

Protocol for a controlled, randomized, blind, clinical trial to assess the effects of anodal transcranial direct current stimulation dorsolateral prefrontal cortex associated with balance training using games in the postural balance of older people

Aims: This study aims to evaluate the additional effect of anodal transcranial direct current stimulation (a-tDCS) applied on dorsolateral pré-frontal cortex on training postural balance with the use of video games in the aged. Methods: This is a blinded, randomized, controlled clinical trial protocol, with older people of both genders. Participants will be randomized into three training groups: Group 1 (videogame balance training), group 2 (videogame balance training associated with anodal tDCS), group 3 (videogame balance training associated with sham tDCS). The training will be carried out twice a week for four weeks, totaling eight sessions, and will be performed with the Nintendo Wii videogame console, using games that stimulate the postural balance associated with tDCS, with anode applied over the left dorsolateral prefrontal cortex and cathode on the contralateral supraorbital region at 2 mA for 20 minutes. The postural balance will be assessed using the Mini Test of the Balance Assessment System and posturography. Evaluations will be carried out before and after eight training sessions and 30 days after the end of treatment. Discussion: Some studies show favorable results from the use of video games in improving postural balance in older people; however, their effect does not remain long-term. TDCS associated with other therapies can potentiate and prolong the effects of these therapies owing to its ability to stimulate neurotrophins important for neurogenesis, facilitating tasks that require attention, and helping to consolidate learning and memory. The effect of the two associated techniques on balance has not yet been tested in this population. Registration: Brazilian Registry of Clinical Trials ID U1111-1213-4266; registered on 15 October 2018.

Seven years of evaluation of ectoparasites and vector-borne pathogens among ring-tailed coatis in an urban park in southeastern Brazil

Wild animals have been recognized as potential reservoirs of vector-borne pathogens. Proximity between these animals and urban areas increases the need to know which pathogens these are and whether they can infect domestic animals and humans. In Mangabeiras Municipal Park in Belo Horizonte, Brazil, coatis live near the urban area, which is mainly occupied by human residents and their domestic animals. Therefore, the objective of this study was to detect, through molecular and direct methods, the presence of ectoparasites and hemoparasites in coatis. A total of 216 samples were collected, of which 209 samples were from first-captures and seven were from recaptures. The following parasites were found: ticks of the genus Amblyomma, lice of the species Neotrichodectes pallidus and fleas of the species Rhopalopsyllus lutzi lutzi and Ctenocephalides felis felis. All the samples were negative for the family Anaplasmataceae and the species Leishmania sp. and Trypanosoma cruzi. The hemoparasites Trypanosoma evansi, Hepatozoon procyonis, Babesia sp. and Sarcocystis neurona were found. The area of the present study is not endemic for T. evansi, which therefore suggests that these coatis may be acting as reservoirs or sentinels of this parasite. This finding is of great epidemiological importance and should be investigated more closely. Thus, this study showed that there is a great variety of pathogens in the park that transit among coatis and, probably, among other animals that inhabit or live close to the park.

Effect of transcranial direct current stimulation and multicomponent training on functional capacity in older adults: protocol for a randomized, controlled, double-blind clinical trial

Introduction

When physical activity contains training of at least three components such as balance, coordination and strength, among others, it is called multicomponent training. This type of training is recommended for improving the functional capacity in elderly individuals but has no lasting effects. The association of transcranial direct current stimulation (tDCS) with other types of therapy has been shown to facilitate the enhancement and prolongation of therapy outcomes.

Aim

The objective of this study is to evaluate the effect of multicomponent training associated with active or sham tDCS on the performance of functional capacity in the elderly before treatment, after treatment and 30 days after the end of treatment. The secondary objective will be to correlate the performance of the primary outcome (functional capacity assessed by the Glittre Daily Life Activity Test) with walking capacity (by 6-min walk test), balance (with the mini-Balance Evaluation Systems Test), functional independence (by the Functional Independence Measure) and quality of life (with the World Health Organization Quality of Life Instrument).

Methods

Twenty-eight elderly people from the community will participate in the study, and will be randomized into two groups: 1) multicomponent training associated with active tDCS; and 2) multicomponent training associated with sham tDCS. The multicomponent training sessions will be held twice a week for 12 weeks, totaling 24 sessions. The tDCS will be administered over the dominant dorsolateral prefrontal cortex at the same time as multicomponent training, with an intensity of 2 mA, for 20 min. The evaluations will be made pretraining, after 24 training sessions and 30 days after the end of the training.

Discussion

We hypothesize that tDCS, when associated with multicomponent training, can potentiate and prolong the effects of this training on the functional capacity of the elderly. If this hypothesis is confirmed, this protocol may contribute to a longer-lasting physical rehabilitation of the elderly, encouraging them to maintain their independent daily activities for longer.

Trial registration

The study was registered in the Brazilian Clinical Trial Registry (RBR-2crd42) and received approval from the Human Research Ethics Committee of University Nove de Julho, São Paulo, Brazil (process number 3.077.953).

Discriminatory power of Stroke Specific Quality of Life questionnaire items to evaluate the participation component of the International Classification of Functioning, Disability and Health

Background/aims

This study aimed to estimate the discriminatory power of 26 items on the Stroke Specific Quality of Life Scale questionnaire to evaluate the participation component of the International Classification of Functioning, Disability and Health.

Methods

A prospective study was conducted using accuracy procedures based on the Standards for Reporting Diagnostic Accuracy Studies to evaluate individuals with hemiparesis stemming from a stroke. Discriminatory power was estimated based on the area under the receiver operating characteristic curve with a 95% confidence interval. Two groups were defined for the analysis: community-dwelling and institutionalised individuals. A 5% level of significance (α=0.05) was considered for all analyses.

Results

The area under the receiver operating characteristic curve was 0.888 (95% confidence interval: 0.794–0.949; P=0.001). Analysis indicated a cut-off point of ≥80 with 73.9% sensitivity and 100% specificity.

Conclusions

The 26 items of the Stroke Specific Quality of Life questionnaire that evaluate the participation component of the International Classification of Functioning, Disability and Health demonstrate adequate discriminatory power. A cut-off point of ≥80 seems to best discriminate the perception of participation between community-dwelling and institutionalised stroke survivors.

Força de preensão manual prediz moderadamente a recuperação sensório-motora avaliada pela escala Fugl-Meyer

RESUMO O acidente vascular encefálico pode deixar sequelas neurológicas, motoras e sensitivas. Para avaliar e acompanhar o prognóstico do paciente, são usados diversos instrumentos funcionais de medida, como a escala de Fugl-Meyer, que apesar de amplamente utilizada para estimar a recuperação sensório-motora, é uma avaliação longa e que exige treinamento. Diante disso, o objetivo deste estudo é analisar se a força de preensão manual, o timed up and go e a medida de independência funcional podem predizer os resultados da escala Fugl-Meyer, com o intuito de otimizar o tempo de avaliação da recuperação sensório-motora, tanto para o acompanhamento da resposta ao tratamento quanto para pesquisas científicas. Para tanto, avaliou-se a força de preensão manual de 35 hemiparéticos crônicos, e em seguida foram aplicadas à escala Fugl-Meyer, que avalia a recuperação motora, a medida de independência funcional nas atividades motoras e o timed up and go, indicativo de mobilidade funcional. Para análise estatística utilizou-se a regressão linear múltipla (r2). A força de preensão manual mostrou-se preditora da recuperação motora (r2=0,46; p=0,001), enquanto a mobilidade (r2=0,255; p=0,007) e a independência funcional (r2=0,054; p=0,2) não foram capazes de predizer os resultados da escala Fugl-Meyer. Após análise, pôde-se inferir que a força de preensão manual é preditora moderada da recuperação motora pós-acidente vascular encefálico, enquanto mobilidade e a independência funcional, não.

Identification of categories of the International Classification of Functioning, Disability and Health in functional assessment measures for stroke survivors: a systematic review

Objective: Perform a systematic review to identify the categories of the International Classification of Functioning, Disability and Health linked to the concepts measured by functional assessment tools validated for Brazilian Portuguese: Timed Up and Go test, Functional Independence Measure, Barthel Index, and Rivermead Mobility Index and Modified Rankin Scale.Methods: The Medline, Embase and CINAHL databases were consulted using a standardized search strategy. The studies were summarized using a pre-established set of specific criteria for the adequate linkage between the concepts identified in the assessment measures and the International Classification of Functioning, Disability and Health categories. Two independent reviewers performed the selection of the studies, data extraction and evaluation of the results.Results: The search of the databanks led to the retrieval of 99 studies. However, only six articles were included in the present review. The linkage results of the studies included in the review were divergent, likely due to the taxonomic complexity of the International Classification of Functioning, Disability and Health, the difficulty in clearly relating the concepts of the assessment measures to the classifications and the fact that not all linkage rules were followed. "Activities and participation" was the most evaluated component, with mobility the most frequently covered category in the measures, followed by self-care. Among the measures analyzed, the Functional Independence Measure addresses a greater number of categories and therefore has the most concepts related to the International Classification of Functioning, Disability and Health, followed by the Barthel Index, Modified Rankin Scale, Rivermead Mobility Index and Timed Up and Go test. The Modified Rankin Scale was the assessment tool that most evaluated categories related to environmental factors.Conclusion: The Functional Independence Measure has more concepts related to the International Classification of Functioning, Disability and Health, since it addresses a greater number of categories. These findings can help guide health professionals in the selection of assessment tools for the evaluation of post-stroke functioning, making viable the use of the International Classification of Functioning, Disability and Health categories in clinical practice and public health services.Implications for rehabilitationThis study standardized identification of the International Classification of Functioning, Disability and Health categories in the main outcome measures used to assess post-stroke functional capacity.Functional Independence Measure has more concepts related to the International Classification of Functioning, Disability and Health compared to other functional assessment instruments.Findings can enable physiotherapists and researchers choose the most appropriate measure that best corresponds to their field of interest.These results facilitate the implementation of the International Classification of Functioning, Disability and Health in clinical practice.Use of International Classification of Functioning, Disability and Health categories can standardize information on functional health.

Aspectos da sobrecarga e qualidade de vida de cuidadores de pacientes hospitalizados: uma análise baseada na Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF)

Resumo Objetivo: caracterizar o perfil e a relação entre sobrecarga e qualidade de vida (QV) de cuidadores de pacientes hospitalizados de acordo com o modelo biopsicossocial da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Analisar a correlação entre a sobrecarga do cuidador e o nível de dependência motora e cognitiva do paciente. Métodos: estudo transversal com 68 cuidadores de pacientes hospitalizados há 12 ou mais dias. Para avaliação da QV e da sobrecarga dos cuidadores foram utilizados, respectivamente, o Short Form Health Survey (SF-36) e a escala de Zarit (Zarit Burden Interview). Utilizou-se a Medida de Independência Funcional para caracterizar a dependência motora e cognitiva dos pacientes. Os resultados foram relacionados aos conceitos da CIF. Resultados: de acordo com os qualificadores da CIF, um comprometimento progressivo na QV dos cuidadores foi observado com o aumento da sobrecarga. Houve correlação negativa, estatisticamente significante e de fraca magnitude, entre a percepção de QV e sobrecarga. Não houve correlação entre a sobrecarga do cuidador e o nível de dependência do paciente. Conclusão: o SF-36 é capaz de analisar 13 categorias da CIF, permitindo avaliar o cuidador de forma integral, de acordo com o modelo biopsicossocial, e facilitando o uso da CIF na prática clínica.

Implicações da Adição de Própolis nas Propriedades Físico-Mecânicas do Cimento de Ionômero de Vidro

O objetivo do presente trabalho foi realizar uma revisão da literatura sobre as propriedades físico-mecânicas do cimento de ionômero de vidro (CIV) adicionado de própolis. Para essa finalidade, foi efetuada busca no banco de dados Medline/Pubmed, utilizando os descritores “propolis”, “glass ionomer cements” e “dental materials”, na língua inglesa, no período de 2009 a 2017. Foi encontrado um total de 7 artigos, dos quais foram selecionados 6 após leitura de títulos e resumos, considerando o idioma, o período e o grau de envolvimento do artigo com o tema em questão como critérios de inclusão/exclusão. Como resultados, verificou-se que, embora os estudos apontem melhora dos efeitos antimicrobianos a partir da associação entre a própolis e o CIV, seus efeitos sobre as propriedades físico-mecânicas do cimento ainda não são totalmente conhecidos. Nos artigos selecionados foram avaliadas propriedades como resistência à compressão, solubilidade e sorção de água, com alguns resultados controversos. Tendo em vista que o cimento de ionômero de vidro é um material muito útil e versátil na Odontologia e que a própolis tem sido cada vez mais adicionada a ele    em situações como no tratamento restaurador atraumático e na cimentação de bandas ortodônticas a fim de potencializar a ação antimicrobiana dos CIVs, ainda são necessárias pesquisas adicionais para melhor compreensão dessas peculiaridades.Palavras-chave: Propolis. Glass Ionomer Cements. Dental Materials.

Immediate effect of transcranial direct current stimulation combined with functional electrical stimulation on activity of the tibialis anterior muscle and balance of individuals with hemiparesis stemming from a stroke

[Purpose] The aim of the present study was to evaluate the immediate effects of transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) on activity of the tibialis anterior muscle (TA) and static balance of individuals with hemiparesis stemming from stroke. [Subjects and Methods] A randomized, double-blind, crossover, clinical trial conducted with 30 individuals with chronic post-stroke hemiparesis. Median frequency of electrical activity of the TA were determined using electromyography in five contractions concentrics and Static balance (body sway velocity and frequency), both before and immediately after the intervention. The participants were submitted to four 20-minute intervention protocols with 48-hour interval: anodal tDCS + sham FES; sham tDCS + active FES; anodal tDCS + active FES and sham tDCS + sham FES. Anodal tDCS was administered over C3 or C4, the cathode was positioned in the supraorbital region on the contralateral side and FES was administered to the affected TA. [Results] No significant differences among the protocols were found regarding electrical activity of the TA and static balance. [Conclusion] The results demonstrate that tDCS alone or in combination with FES had no immediate effect on electrical activity of the TA and static balance of the 30 individuals analyzed.

Computerized analysis of the distribution of occlusal contacts in individuals with Parkinson's disease and temporomandibular disorder

OBJECTIVES

The aims of the present study were to determine the prevalence of temporomandibular disorder (TMD) in a sample of patients with Parkinson's disease (PD) and to analyze the distribution of occlusal contacts.

METHOD

The sample was composed of patients with PD aged 50-75 years. Temporomandibular disorder was evaluated using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The distribution of occlusal contacts was determined using the portable T-Scan III^® occlusal analysis system during maximum voluntary clenching. Fisher's exact test was used to test the association between TMD and occlusal contact symmetry.

RESULTS

Forty-two individuals with PD were analyzed. The prevalence of TMD was 23.8%. No statistically significant association was found between TMD and occlusal contact symmetry. Moreover, no significant difference in the distribution of occlusal contacts was found between the groups with and without TMD.

DISCUSSION

The present data suggest no association between TMD and occlusal contact asymmetry in individuals with PD.

CONCLUSION

The results of this study identified a prevalence of 23.8% of TMD signs in subjects with PD and a high frequency of occlusal asymmetry in this sample.

Evaluation of post-stroke functionality based on the International Classification of Functioning, Disability, and Health: a proposal for use of assessment tools

This study aimed to identify the International Classification of Functioning, Disability, and Health categories addressed by the assessment tools commonly used in post-stroke rehabilitation and characterize patients based on its evaluation model. [Subjects and Methods] An exploratory, descriptive, cross-sectional study was conducted involving 35 individuals with chronic post-stroke hemiparesis. Handgrip strength was assessed to evaluate body functions and structures. The 10-meter gait speed test and Timed Up and Go test were administered to evaluate activity. The Stroke Specific Quality of Life scale was used to evaluate participation. Moreover, a systematic review of the literature was performed to identify studies that have associated these assessment tools with the International Classification of Functioning, Disability, and Health categories. [Results] The tools employed in this study for evaluating function addressed 63 International Classification of Functioning, Disability, and Health categories: 24 related to body functions and structures; 36 related to activity and participation; and 3 related to environmental factors. [Conclusion] The assessment tools employed in this study addressed 63 International Classification of Functioning, Disability, and Health categories and allowed a more complete evaluation of stroke survivors with hemiparesis. Use of this classification can therefore be more easily incorporated into clinical practice.

Impact in oral health and the prevalence of temporomandibular disorder in individuals with Parkinson's disease

The aims of the present study were to investigate the prevalence of temporomandibular disorder (TMD) in a group of patients with Parkinson’s disease (PD), and to analyze oral health according to the severity of the disease. [Methods] Signs and symptoms of TMD were evaluated using the Research Diagnostic Criteria for Temporomandibular Disorders, and oral health impact was measured using the Oral Health Impact Profile. The unpaired Student’s t-test was used to compare groups with and without TMD. Pearson’s correlation coefficients were calculated to determine correlations between the level of functional independence and oral health impact. Fisher’s exact test was used to test the association between TMD and the severity of symptoms of PD. [Results] Fifty-nine individuals with PD were analyzed. The prevalence of TMD was 20.33%. No statistically significant associations were found between TMD and the severity of PD. Oral health impact was considered weak, but a statistically significant difference between groups with and without TMD was found for psychological disability (p = 0.003). No significant correlation was found between the level of functional independence and oral health impact. [Conclusion] The prevalence of TMD among patients with Parkinson’s disease was 20.33%. A statistically significant difference between groups with and without TMD was found regarding the psychological disability domain.

Psychometric properties of the stroke specific quality of life scale for the assessment of participation in stroke survivors using the rasch model: a preliminary study

[Purpose] The aim of the present study was to analyze the psychometric properties of the Stroke Specific Quality of Life (SS-QOL) scale for the assessment of social participation following a stroke. [Methods] A preliminary analysis was performed of the SS-QOL items that address the participation category. For this, the scoring patterns of the answers of individuals and internal consistence were determined using the Rasch model. Reliability was assessed by intraclass correlation coefficients (ICC). [Results] The reliability coefficients analyzed by the Rasch model were 0.91 for the items and 0.87 for the patients. The separation index was 3.19 for the items and 2.58 for the patients. The findings indicate that the items separated the patients into three levels of participation: low, medium, and high. Among the 26 items addressing participation, three did not fit the model. All items showed adequate reliability (ICC ≥ 0.60). [Conclusion] The Rasch analysis detected three items with erratic behavior; however, the erratic patterns of these items may be explained by individual peculiarities among the patients. These items should be monitored to determine if the problems found in the present study persist. If so, the items should also be revised or possibly even eliminated.

Effects of bromopride on expression of metalloproteinases and interleukins in left colonic anastomoses: an experimental study

Anastomotic dehiscence is the most severe complication of colorectal surgery. Metalloproteinases (MMPs) and interleukins (ILs) can be used to analyze the healing process of anastomosis. To evaluate the effects of bromopride on MMP and cytokine gene expression in left colonic anastomoses in rats with or without induced abdominal sepsis, 80 rats were divided into two groups for euthanasia on the third or seventh postoperative day (POD). They were then divided into subgroups of 20 rats for sepsis induction or not, and then into subgroups of 10 rats for administration of bromopride or saline. Left colonic anastomosis was performed and abdominal sepsis was induced by cecal ligation and puncture. A colonic segment containing the anastomosis was removed for analysis of gene expression of MMP-1α, MMP-8, MMP-13, IL-β, IL-6, IL-10, tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ). On the third POD, bromopride was associated with increased MMP-1α, MMP-13, IL-6, IFN-γ, and IL-10 gene expression. On the seventh POD, all MMP transcripts became negatively modulated and all IL transcripts became positively modulated. In the presence of sepsis, bromopride administration increased MMP-8 and IFN-γ gene expression and decreased MMP-1, TNF-α, IL-6, and IL-10 gene expression on the third POD. On the seventh POD, we observed increased expression of MMP-13 and all cytokines, except for TNF-α. In conclusion, bromopride interferes with MMP and IL gene expression during anastomotic healing. Further studies are needed to correlate these changes with the healing process.

Cardiac effect of ischemic preconditioning and heparin following intestinal ischemia and reperfusion in rats

To study the role of heparin and ischemic preconditioning (IPC) in cardiac injury after intestinal ischemia (I) and reperfusion (R), 54 rats underwent 60 minutes of I, which was produced by occlusion of the superior mesenteric artery, and/or 120 minutes of R. The IPC group had the I procedure stimulation for 5 minutes and R for 10 minutes. The control group was subjected to sham surgery only, and the other groups were injected with saline solution (SS; 0.1 mL) or heparin (100 IU/kg) via the inferior cava vein 5 minutes before I and 5 minutes before R and 55 minutes after the R begins in I-R groups. In all animals, cardiac samples were stained with hematoxylin and eosin for optical microscopy analysis, and other sample was processed for lipid peroxidation determination. In I-R groups, both heparin and IPC showed significant protection compared to the SS group; conversely, in animals subjected only to I, no protection was observed. Moreover, when heparin was associated with IPC, I-R protection was compromised and the ischemic injury increased. Data showed that IPC and heparin attenuated cardiac dysfunction caused by intestinal I and I-R, but when used in association did not show beneficial effects.

Eight-point binding as a physical therapeutic resource for rehabilitation of functional performance after a stroke

A stroke may leave neurological, motor and sensory sequelae, interfering with the function of movements and culminating in gait and balance changes. Therefore, it is necessary to demonstrate the efficacy of eight-point binding, a low-cost technique that functions to provide proprioceptive information and promote the biomechanical alignment of the ankle, acting against mechanisms that lead to equinovarus foot. This study aims to determine the immediate effect of eight-point binding as a physical therapy resource for the rehabilitation of function performance after a stroke. To this end, 22 patients who were able to walk alone without an orthosis were evaluated, and performed the Timed Up and Go (TUG) functional mobility test, a gait speed assessment and the Berg Balance Scale, with and without the eight-point binding in the paretic lower limb. When comparing the results after the eight-point binding, it was possible to observe a statistically significant difference (p<0.05) in all of the studied variables. After analyzing the results, it was concluded that after a single application of eight-point binding, it is possible to identify statistically significant improvement in gait speed, functional mobility and balance after a stroke.

[Neurophysiological and functional assessment of patients with difficult-to-control asthma]

INTRODUCTION

Due to the inadequate response to inhaled corticoids, patients with difficult-to-control asthma (DCA) are submitted to oral corticoids or use of Omalizumab. Although it is necessary to treat these patients, a significant relationship between steroid usage and both peripheral and respiratory weakness muscle, results in implications such as loss of quality of life and compromised lung function. Nonetheless, it is not known whether these patients suffer neurophysiological changes due to drug effect.

OBJECTIVE

To investigate the neurophysiological and functional characteristics of patients with DCA in order to gain a better understanding of the condition.

METHOD

A cross-sectional study was carried out involving three groups of patients: DCA-C (use of oral corticosteroids), DCA-O (use of omalizumab) and CG (healthy controls matched for age). The assessment involved the six-minute walk test, sit-to-stand test, static balance on a pressure platform, patellar and Achilles reflexes and quadriceps strength in the dominant leg.

RESULTS

The results revealed no statistically significant differences between the control group and DCA groups in relation to neurophysiological aspects. However, the DCA groups exhibited a significant reduction in functional capacity [decreased muscle strength (p < 0.05), shorter distance covered on walk test (p < 0.05) and lesser number of repetitions on sit-to-stand test (p < 0.05)] in comparison to the control group.

CONCLUSION

Individuals with DCA exhibited a reduction in functional capacity. The DCA-C group also demonstrated a reduction in muscle strength when compared with control group, likely caused by the continual use of corticoids. However, no neurophysiological alterations were found in the studied population.

[Identification of ICF participation categories in quality-of-life instruments utilized in cerebrovascular accident victims]

OBJECTIVE

To identify the categories of the participation component of the International Classification of Functionality, Incapacity, and Health (ICF) which are currently related to Health-related Quality of Life (HRQOL) instruments commonly used in cerebrovascular accident (CVA) victims-Nottingham Health Profile (NHP), Short-Form Health Survey (SF-36), and Stroke Specific Quality of Life (SS-QOL)-and suggest the utilization of these instruments to assess and/or characterize that component in that population.

METHODS

Through searches in the Medline, SciELO, and Lilacs databases, a compilation of studies which associated the concepts measured by the NHP, SF-36, and SS-QOL items with the ICF components and categories, was carried out.

RESULTS

Of the 24 identified studies, four met the established criteria: two assessed the three HRQOL instruments, one assessed the NHP and SF-36, and the other just the SS-QOL. For each instrument, three studies were found which associated their concepts up to, at least, the second hierarchical level of the ICF categories. Considering the results that were in agreement between the three studies that assessed the same instrument, nine participation categories were associated with the NHP, seven with the SF-36, and 15 with the SS-QOL, although just one was specific to the NHP, one to the SF-36, and seven to the SS-QOL.

CONCLUSIONS

To assess the participation of CVA victims based upon the ICF framework, the SS-QOL appeared to be the most suitable instrument in that, in addition to assessing the greatest number of categories, it also assesses the greatest number of distinct categories, when compared to the other two HRQOL instruments, which added just one category to those measured by SS-QOL.

Basal forebrain neurons modulate the synthesis and expression of neuropeptides in the rat suprachiasmatic nucleus

We tested the hypothesis that efferents from the nucleus basalis magnocellularis (NBM) play a direct role in the regulation of neuropeptide synthesis and expression by neurons of the rat suprachiasmatic nucleus (SCN). Adult male rats in which the NBM was destroyed with quinolinic acid, either unilaterally or bilaterally, were compared with rats injected with physiological saline and with control rats. The estimators used to assess the effects of cholinergic deafferentation on the neuroanatomy and neurochemistry of the SCN were the total number of SCN neurons, the total number and somatic size of SCN neurons producing vasopressin (VP) and vasoactive intestinal polypeptide (VIP), and the respective mRNA levels. Bilateral destruction of the NBM did not produce cell death in the SCN, but caused a marked reduction in the number and somatic size of SCN neurons expressing VP and VIP, and in the mRNA levels of these peptides. The decrease in the number of VP- and VIP-producing neurons provoked by unilateral lesions was less striking than that resulting from bilateral lesions. It was, however, statistically significant in the ipsilateral hemisphere, but not in the contralateral hemisphere. The results show that the reduction of cholinergic inputs to the SCN impairs the synthesis, and thereby decreases the expression of neuropeptides by SCN neurons, and that the extent of the decline correlates with the amount of cholinergic afferents destroyed. This supports the notion that acetylcholine plays an important, and direct role in the regulation of the metabolic activity of SCN neurons.

Determination of lamotrigine simultaneously with carbamazepine, carbamazepine epoxide, phenytoin, phenobarbital, and primidone in human plasma by SPME-GC-TSD

A simple and rapid analytical method is presented for the determination of lamotrigine simultaneously with primidone, carbamazepine, carbamazepine epoxide, phenobarbital, and phenytoin in human plasma using solid-phase microextraction (SPME) and gas chromatography with thermionic specific detection. The best conditions for the SPME procedure is established as following: direct extraction on a 65-microm Carbowax-divinylbenzene fiber; 1.0 mL of a sample plasma matrix modified with 15% NaCl and 3 mL of a potassium phosphate buffer (pH 7.0); extraction temperature at 30 degrees C; and stirring at a rate of 2500 rpm for 15 min. The method shows good linearity between 0.05 and 40.0 microg/mL with regression coefficients ranging between 0.9965 and 0.9995 and a coefficient of variation of the points of the calibration curve lower than 10%. The lowest limit of quantitation for the plasma-investigated drugs varies from 0.05 to 0.20 microg/mL, according to the drug. The proposed method is sensitive enough to work into subtherapeutic and therapeutic concentrations, being that it is applied in pharmacokinetic studies and patient routine therapeutic drug monitoring.

Comparison between solid-phase extraction methods for the chromatographic determination of organophosphorus pesticides in water

A solid-phase microextraction (SPME) procedure has been developed to extract eight organophosphorus pesticides (OPs) in water and the method was compared with a conventional solid phase extraction (SPE) technique. The extracted OPs were analyzed by gas chromatography using thermionic specific detection. Both extraction methods presented linear calibration at least over the concentration range investigated (100 to 1000 ng x mL(-1) for SPE and 1 to 100 ng x mL(-1) for SPME). SPME method presented higher sensitivity than SPE. The quantitation limits were between 0.1 to 1.0 ng x mL(-1) for SPME depending upon the analyte, and 100 ng x mL(-1) for SPE. The precision, as measured by the standard deviations (RSD), were in the range 3.6% to 5.8% for SPME and 2.4% to 9.2% for SPE. Along with the feature of being a solvent - free sampling technique, SPME offers additional benefits due to its high sensitivity, simplicity, and small size sample required (typically: SPE - 500 mL, SPME - 5 mL).

Nerve growth factor restores mRNA levels and the expression of neuropeptides in the suprachiasmatic nucleus of rats submitted to chronic ethanol treatment and withdrawal

Chronic ethanol treatment and withdrawal from alcohol decrease the synthesis and expression of neuropeptides in the hypothalamic suprachiasmatic nucleus. Given the existing evidence that neurotrophins modulate the synthesis and expression of neurotransmitters/neuromodulators in the mature brain, we have hypothesized that such alterations might result from the reduced biological activity or brain content of neurotrophic factors. To test this possibility, nerve growth factor (NGF) was delivered intraventricularly, over a 4-week period, to rats submitted to ethanol treatment for 6 months and to withdrawn rats. Vasopressin (AVP) and vasoactive intestinal polypeptide (VIP), and the respective mRNAs were detected by immunocytochemistry and in situ hybridization histochemistry, and their levels estimated using stereological methods and densitometry. In ethanol-treated and withdrawn rats, NGF produced increases in the number of AVP- and VIP-immunostained neurons to values identical to those of controls. Corresponding variations were detected in AVP and VIP mRNA levels, which indicates that NGF restored the expression of AVP and VIP by enhancing neuropeptide synthesis. These findings show that NGF can correct the changes induced by chronic ethanol treatment and withdrawal in the gene expression and protein content of the neuropeptides synthesized by suprachiasmatic neurons. They also reveal that NGF plays an important role in the maintenance of the neurochemical phenotype of the suprachiasmatic nucleus in the adult rat. Because suprachiasmatic neurons do not express trkA, NGF might have exerted its effects either through direct signalling of suprachiasmatic neurons via p75(NTR) activation or, indirectly, by enhancing the activity of the cholinergic and/or glutamatergic afferents to the suprachiasmatic nucleus, or both.

CD4(+) T cells participate in the nephropathy of canine visceral leishmaniasis

Renal involvement in visceral leishmaniasis (VL) is very frequent. The renal lesions of humans and dogs are similar but their pathogenesis has not been clearly elucidated. There is growing evidence that the cellular immune response is involved in the pathogenesis of immunologically mediated glomerulonephritis. Since T cells could participate in the pathogenesis of nephropathy, in the present study we investigated the possible involvement of CD4(+) and CD8(+) T cells in the nephropathy of canine VL. Six dogs naturally infected with Leishmania (Leishmania) chagasi from the endemic area in the Northeast of Brazil, the town of Teresina in the State of Piauí, were studied. An expressive inflammatory infiltrate of CD4(+) T cells both in glomeruli and in interstitium was present in 4 animals and absent in 2. CD8(+) T cells were detected only in one animal. CD4(+) T cells alone were observed in 3 animals; when CD8+ T cells were present CD4(+) T cells were also present. CD4(+) T cells were observed in cases of focal segmental glomerulosclerosis, diffuse membranoproliferative glomerulonephritis, diffuse mesangial proliferative glomerulonephritis and crescentic glomerulonephritis. CD8(+) T cells were present only in a case of crescentic glomerulonephritis. Leishmania antigen was detected in glomeruli and in interstitial inflammatory infiltrate in 4 animals and immunoglobulins were observed in 4 dogs. In this study we observed that T cells, in addition to immunoglobulins, are present in the renal lesion of canine VL. Further studies are in progress addressing the immunopathogenic mechanisms involving the participation of immunoglobulins and T cells in canine VL nephropathy.