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This study assessed the feasibility of pulmonary telerehabilitationâ§s (PTR) acceptability, implementation, practicality, and adaptation for people with Chronic Obstructive Pulmonary Disease (COPD) in Brazil. It also explored associations with clinical and socioeconomic features of Brazilians with COPD. This mixed-method study included thirty-one participants with COPD (age 62±10 years; FEV1= 72±14% predicted). Most participants (74.2%) reported good PTR session acceptability on the System Usability Scale and scores of 4.6±0.3 and 4.5±0.6 on a 1-5 Likert-type scale of implementation and practicality, respectively. Participants suggested adaptations for better comfort on the exercise bike and varying exercise modalities. PTR acceptability was associated with participants' younger age (rs=-0.57, p<0.01) and higher education (rs=0.51, p<0.01). PTR is feasible for people with COPD in Brazil regarding acceptability, implementation, practicality, and adaptation. Younger age and higher educational level are associated with greater PTR acceptability.
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OBJECTIVE: The objectives of this study were to translate and cross-culturally adapt the telehealth usability questionnaire into Brazilian Portuguese and to evaluate its psychometric properties. METHODS: This was a methodological validation study carried out in two phases. In phase 1, the telehealth usability questionnaire was cross-culturally adapted with 10 participants comprising the expert committee members, including 5 healthcare professionals with theoretical and practical knowledge of telehealth, 1 methodologist, and 4 translators. This phase was performed at Universidade Federal de Juiz de Fora Physiotherapy Clinic School. In phase 2, the psychometric properties of telehealth usability questionnaire Brazil were analyzed. This phase included in-person assessments at Márcio Cunha Hospital, Minas Gerais. The recruitment period for both phases was from April 2020 to February 2021. Content validity, reliability, internal consistency, and criterion validity were analyzed. The criterion validity was evaluated using correlation with a validated instrument: the system usability scale. RESULTS: The telehealth usability questionnaire was adequately translated and cross-culturally adapted. The telehealth usability questionnaire Brazil presented an excellent content validity index of 0.96 with percentages of understanding higher than 90%. The telehealth usability questionnaire Brazil demonstrated great internal consistency (α=0.94 and ω=0.94), excellent intra-rater reliability (intraclass correlation coefficient=0.85, 95%CI 0.75-0.91), no difference between the test and retest [T (0.425), p>0.673], and no proportional bias (p=0.205). There was a moderate correlation between telehealth usability questionnaire Brazil and the system usability scale (r=0.52, p<0.0001). CONCLUSION: The telehealth usability questionnaire was adequately translated and cross-culturally adapted into Brazilian Portuguese and showed adequate psychometric properties for use in telehealth clinical practice and research in Brazilian-Portuguese-speaking individuals.
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Comparação Transcultural , Telemedicina , Humanos , Brasil , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários , TraduçõesRESUMO
SUMMARY OBJECTIVE: The objectives of this study were to translate and cross-culturally adapt the telehealth usability questionnaire into Brazilian Portuguese and to evaluate its psychometric properties. METHODS: This was a methodological validation study carried out in two phases. In phase 1, the telehealth usability questionnaire was cross-culturally adapted with 10 participants comprising the expert committee members, including 5 healthcare professionals with theoretical and practical knowledge of telehealth, 1 methodologist, and 4 translators. This phase was performed at Universidade Federal de Juiz de Fora Physiotherapy Clinic School. In phase 2, the psychometric properties of telehealth usability questionnaire Brazil were analyzed. This phase included in-person assessments at Márcio Cunha Hospital, Minas Gerais. The recruitment period for both phases was from April 2020 to February 2021. Content validity, reliability, internal consistency, and criterion validity were analyzed. The criterion validity was evaluated using correlation with a validated instrument: the system usability scale. RESULTS: The telehealth usability questionnaire was adequately translated and cross-culturally adapted. The telehealth usability questionnaire Brazil presented an excellent content validity index of 0.96 with percentages of understanding higher than 90%. The telehealth usability questionnaire Brazil demonstrated great internal consistency (α=0.94 and ω=0.94), excellent intra-rater reliability (intraclass correlation coefficient=0.85, 95%CI 0.75-0.91), no difference between the test and retest [T (0.425), p>0.673], and no proportional bias (p=0.205). There was a moderate correlation between telehealth usability questionnaire Brazil and the system usability scale (r=0.52, p<0.0001). CONCLUSION: The telehealth usability questionnaire was adequately translated and cross-culturally adapted into Brazilian Portuguese and showed adequate psychometric properties for use in telehealth clinical practice and research in Brazilian-Portuguese-speaking individuals.
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Introduction: predictive equations to estimate body fat based on simple anthropometric parameters are easy to use in the clinical practice.Objective: to evaluate the relationship between predictive equations based on anthropometric parameters and bioelectrical impedance to estimate body fat in individuals undergoing bariatric surgery.Methods: a prospective and longitudinal study carried out with individuals undergoing bariatric surgery. Body weight, body mass index, waist circumference and body fat percentage estimated by anthropometric parameters and by impedance were evaluated at three moments, one month before, two and six months after surgery. Data were analyzed by one-way ANOVA for repeated measures with Holm-Sidak Ìs post hoc or Friedman test with Tukey Ìs post hoc, and Pearson or Spearman correlations, according to data distribution. Significance level adopted 5%.Results: twenty-five subjects composed the final sample. All anthropometric parameters reduced significantly over time (p<0.001). Except for Lean et al equation before surgery, the body fat percentage estimated by other formulas showed a strong correlation with impedance in all moments, with the highest correlation strength observed in Gómez-Ambrosi et al. equation.Conclusion: in the present study, the equations used showed a good correlation with bioelectrical impedance, and the Gómez-Ambrosi et al. equation as a better option to the use of bioimpedance to assess changes in body fat percentage of patients undergoing bariatric surgery for the treatment of severe obesity.
Introdução: Objetivos: analisar o consumo alimentar e os fatores associados ao estado nutricional de crianças menores de dois anos de vida.Método: Estudo de corte transversal realizado com uma amostra de 344 lactentes menores de dois anos de idade e suas respectivas mães, acompanhadas em Unidades de Saúde da Família. As variáveis sociodemográficas, antropométrica das mães e dos lactentes e o consumo alimentar dessas crianças foram avaliadas por meio de questionário estruturado. A força de associação entre as variáveis dependente e as independentes foi avaliada pelo odds ratio, tanto na análise univariada quanto na múltipla, com nível de significância de 5%.Resultados: A prevalência do estado nutricional inadequado foi de 38,08%. Observou que 29,09% das crianças menores de seis meses de idade não chegaram a receber leite materno de forma exclusiva ou o tempo de oferta foi inferior a 30 dias. Notou-se o consumo de alimentos ultraprocessados, principalmente, do suco industrializado no último mês [OR:1,96, IC 95%: 1,05-3,65], baixa ingestão de frutas e o hábito de comer assistindo televisão nos lactentes maiores de seis meses. Após ajuste para variáveis de confusão, permaneceram associadas ao estado nutricional: anemia gestacional [OR: 3,58 IC: 1,46-8,77] e trabalho materno [OR, 0,38, IC 95%: 0,18-0,80].Conclusão: A presença do estado nutricional inadequado, caracterizado pelo baixo ou excesso de peso, associou-se ao fato de a mãe trabalhar e à anemia gestacional. Ademais, constatou-se a participação precoce de alimentos ultraprocessados na alimentação das crianças menores de 24 meses de idade, substituindo alimentos considerados naturais e saudáveis, evidenciando assim práticas alimentares inadequadas frente às recomendações para a faixa etária.
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Babesia bovis and B. bigemina are tick-transmitted parasites causing bovine babesiosis, characterized by significant morbidity and mortality leading to economic losses to the livestock industry in tropical and subtropical regions worldwide. Animals that recover from acute infection remain carriers with low parasitemia acting as a source of transmission, and often escape detection. An improved diagnosis of a B. bovis and/or B. bigemina infection of carrier animals is enabled by the availability of detection methods with high sensitivity. To this end, two nested PCR assays targeting the cytochrome b (cytb) genes of B. bovis and B. bigemina (cytb-nPCR), have been recently developed and an increased sensitivity with respect to reference protocols has been shown (Romero-Salas et al., 2016). In this study, the specificity against a panel of hemoparasites that potentially co-occur with B. bovis and B. bigemina was demonstrated to ensure applicability of the cytb-nPCR assays in a wide range of regions where bovine babesiosis is endemic. Furthermore, we compared both reported cytb-nPCR assays with reference nPCR and qPCR protocols for (i) their capability to detect carrier animals in the field, and (ii) their reproducibility when performed in different laboratories by independent operators. We show that, in a panel of bovine field samples (n = 100), the cytb-nPCR assays detected a considerably higher number of 25% B. bovis and 61% B. bigemina-positive animals compared to 7% and 20% B. bovis and 55% and 49% B. bigemina-positive animals when tested by reference nPCR and qPCR protocols, respectively. Cytb-nPCRs were also found superior in the detection of carrier animals when field samples from Africa were analyzed. In addition, both the B. bovis and B. bigemina cytb-nPCR assays were independently validated in a single blinded study in three laboratories. Importantly, no significant differences in the number/percentage of infected animals was observed using cytb-nPCR assays. In summary, the cytb-nPCR assays detected a considerably higher number of chronically infected B. bovis and B. bigemina carrier animals compared to reference nPCR and qPCR protocols, when applied in different epidemiological field situations. Furthermore, a high reproducibility between laboratories could be demonstrated.
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Babesia bovis , Babesia , Babesiose , Doenças dos Bovinos , Carrapatos , Animais , Babesia/genética , Babesia bovis/genética , Babesiose/parasitologia , Bovinos , Doenças dos Bovinos/parasitologia , Reação em Cadeia da Polimerase em Tempo Real/veterinária , Reprodutibilidade dos Testes , Carrapatos/genéticaRESUMO
Introdução: A doença pulmonar obstrutiva crônica (DPOC) possui alta prevalência e gera altos custos aos sistemas de saúde. A reabilitação pulmonar (RP) é uma intervenção não-farmacológica que gera benefícios clínicos para os pacientes e economia de gastos para o sistema de saúde devido a redução do número de exacerbações da doença e internações hospitalares. Embora fortemente recomendada, a RP tem sido subutilizada havendo um baixo índice de indicações. Objetivo: Identificar as barreiras e os facilitadores para o encaminhamento de pacientes com DPOC à RP e à prática de atividade física. Métodos: Estudo qualitativo, realizado com médicos atuantes na atenção primária à saúde (APS) e uso de entrevistas semiestruturadas. As entrevistas foram gravadas e transcritas literalmente e submetidas a análise de conteúdo. Itens (trechos) identificados nos discursos e relacionados ao encaminhamento de pacientes com DPOC à RP e à prática de atividade física foram classificados como barreiras ou facilitadores. Tal classificação se baseou entre os quatorze domínios da Theoretical Domains Framework (TDF) e suas definições para identificar determinantes de comportamento entre os participantes relevantes para a mudança na prática clínica. Resultados: Setecentos e cinquenta e seis itens foram identificados nos discursos de vinte e um participantes e classificados como sendo barreiras (n= 279, 37%) ou facilitadores (n= 477, 63%) relacionados principalmente aos domínios da TDF de "Conhecimento" (n= 245, 32%), "Contexto e recursos ambientais" (n= 124, 16%) e "Papel e identidade social/profissional" (n= 107, 14%). Conclusão: As principais barreiras identificadas foram relacionadas aos programas de RP devido ao conhecimento restrito dos profissionais médicos sobre programas de RP, a disponibilidade reduzida de locais que oferecem estes programas e as dificuldades de acesso dos pacientes à RP. Os principais facilitadores identificados foram relacionados a orientação e o conhecimento pelos médicos sobre os benefícios da atividade física e a presença dos grupos de exercícios fornecidos na APS.
Introduction: Chronic obstructive pulmonary disease (COPD) has a high prevalence and entails high costs to health systems. Pulmonary rehabilitation (PR) is a non-pharmacological intervention that generates clinical benefits for patients and cost savings for the health system due to a reduced number of exacerbations and hospitalizations. Although strongly recommended, PR has been underutilized, with a low rate of indications. Objective: To identify barriers and facilitators for referring patients with COPD to PR and physical activity. Method: Qualitative study was carried out with medical staff working in primary health care using semi-structured interviews. The interviews were recorded, transcribed literally and underwent content analysis. Items (text excerpts) identified in the speeches and related to the referral of patients with COPD to PR and physical activity were classified according to as barriers or facilitators, and among the fourteen domains of the Theoretical Domains Framework (TDF) and its definitions; aiming to identify the determinants of behaviour which were relevant to change in clinical practice. Results: Seven hundred and fifty-six items were identified in the speeches of twenty-one participants and classified as barriers (n= 279, 37%) or facilitators (n= 477, 63%) mainly related to the TDF domains of "Knowledge" (n= 245, 32%), "Context and environmental resources" (n=124, 16%) and "Role and social/professional identity" (n= 107, 14%). Conclusion: The main barriers identified were related to referring patients PR due to lack of knowledge by medical staff about PR programs, the limited number of programs available, and the restricted access to PR program locations. The main facilitators were related to physical activity, mainly the medical staff's knowledge on physical activity benefits and availability of exercise group activities delivered at primary health care centres.
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Doença Pulmonar Obstrutiva Crônica , Atenção Primária à Saúde , Reabilitação , Exercício Físico , Prevalência , Recursos em SaúdeRESUMO
O objetivo foi analisar o Programa Bolsa-Atleta paralímpico no estado de Mato Grosso do Sul, a partir do número de bolsas, modalidades e categorias. Configurou-se como um estudo descritivo-exploratório, com análise de dados na Plataforma de Dados do Inteligência Esportiva, entre os anos 2004-2020. Foram identificados 114 atletas paralímpicos, 77 do gênero masculino e 37 do feminino, contemplados em 12 modalidades paralímpicas, com destaque para o atletismo. Somaram-se 484 bolsas distribuídas entre as categorias do programa, com o predomínio da categoria nacional (61,98%) e estudantil (12,39%). Do total, houve modificação dos atletas entre as categorias, 45,61% mantiveram a bolsa por quatro ou mais anos e 54,39% só tiveram a bolsa entre um e três anos. Conclui-se que o Programa Bolsa-Atleta paralímpico acompanhou os investimentos do governo federal, com o pico de bolsas durante o Plano Brasil Medalhas 2016 e baixa em 2020, em decorrência da pandemia e prioridade governamental. (AU)
The main goal was to analyze the Paralympic Athletes Scholarship Program at Mato Grosso do Sul state, Brazil, based on the number of scholarships, sports modalities and categories. The research was descriptive exploratory, with data from website Sport Intelligence, between the years 2004-2020. We identified 114 Paralympic athletes, 77 male and 37 female, contemplated in 12 Paralympic modalities, with emphasis on athletics. There were 484 scholarships distributed among the categories, predominance the national category (61.98%) and student category (12.39%). From these athletes, there were modifications from categories, 45.61% kept the scholarship for four years or more and 54.39% had the scholarship between one and three years. We concluded that the Paralympic Athletes Scholarship Program followed the Federal Government budget, with high investment with the Brazilian Medal Plan 2016, and the lower investment in 2020, due to the pandemic and government priority. (AU)
El objetivo fue analizar el Programa Beca-Atleta paralímpico en el Estado de Mato Grosso do Sul/Brasil, con base en el número de becas, modalidades y categorías. Se configuró como un estudio descriptivo-exploratorio, con análisis de datos en la Plataforma de Datos de Inteligencia Deportiva, entre los años 2004 y 2020. Se identificaron 114 atletas paralímpicos, 77 del género masculino y 37 del femenino, contemplados en 12 modalidades paralímpicas, donde destaca el atletismo. Se encontraron 484 becas distribuidas entre las categorías del programa, con predominio de la categoría nacional (61,98%) y estudiantil (12,39%). El el total, hubo modificación de los atletas entre las categorías, 45,61% mantuvieron la beca por cuatro o más años y 54,39% solo tuvieron la beca por entre uno y tres años. Se concluyó que el Programa Beca-Atleta paralímpico siguió la inversión del Gobierno Federal, con un pico de becas durante el Plan Brasil Medallas 2016 y el menor número de becas en 2020, como consecuencia del período pandémico y de la prioridad gubernamental. (AU)
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Humanos , Masculino , Feminino , Adulto JovemRESUMO
Among the subgenera of African tsetse-transmitted trypanosomes pathogenic to livestock, the least known is the subgenus Pycnomonas, which contains a single species, Trypanosoma suis (TSU), a pathogen of domestic pigs first reported in 1905 and recently rediscovered in Tanzania and Mozambique. Analysis by Fluorescent Fragment Length Barcoding (FFLB) revealed an infection rate of 20.3% (108 out of 530 tsetse flies) in a recent study in the Gorongosa and Niassa wildlife reserves in Mozambique, and demonstrated two groups of Pycnomonas trypanosomes: one (14.1%, 75 flies) showing an FFLB profile identical to the reference TSU from Tanzania, and the other (6.2%, 33 flies) differing slightly from reference TSU and designated Trypanosoma suis-like (TSU-L). Phylogenetic analyses tightly clustered TSU and TSU-L from Mozambique with TSU from Tanzania forming the clade Pycnomonas positioned between the subgenera Trypanozoon and Nannomonas. Our preliminarily exploration of host ranges of Pycnomonas trypanosomes revealed TSU exclusively in warthogs while TSU-L was identified, for the first time for a member of the subgenus Pycnomonas, in ruminants (antelopes, Cape buffalo, and in domestic cattle and goats). The preferential blood meal sources of tsetse flies harbouring TSU and TSU-L were wild suids, and most of these flies concomitantly harboured the porcine trypanosomes T. simiae, T. simiae Tsavo, and T. godfreyi. Therefore, our findings support the link of TSU with suids while TSU-L remains to be comprehensively investigated in these hosts. Our results greatly expand our knowledge of the diversity, hosts, vectors, and epidemiology of Pycnomonas trypanosomes. Due to shortcomings of available molecular diagnostic methods, a relevant cohort of trypanosomes transmitted by tsetse flies to ungulates, especially suids, has been neglected or most likely misidentified. The method employed in the present study enables an accurate discrimination of trypanosome species and genotypes and, hence, a re-evaluation of the "lost" subgenus Pycnomonas and of porcine trypanosomes in general, the most neglected group of African trypanosomes pathogenic to ungulates.
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Trypanosoma/genética , Tripanossomíase Africana/veterinária , Moscas Tsé-Tsé/parasitologia , Animais , Animais Selvagens , Interações Hospedeiro-Parasita , Gado/parasitologia , Moçambique/epidemiologia , Filogenia , RNA Ribossômico/genética , Ruminantes/parasitologia , Suínos , Doenças dos Suínos/parasitologia , Simpatria , Trypanosoma/patogenicidade , Tripanossomíase Africana/epidemiologiaRESUMO
Resumo Objetivo: Na presença de uma córnea irregular, como no queratocone, o epitélio tem uma distribuição diferente do normal, "mascarando" a irregularidade do estroma. A avaliação topográfica sem considerar o efeito do epitélio pode induzir uma avaliação menos correta, afetando a precisão de um eventual tratamento guiado por topografia. O objetivo deste trabalho é avaliar o efeito de "máscara" do epitélio no queratocone, comparando a tomografia corneana com e sem epitélio, no decurso da realização de Crosslinking (CXL). Métodos: Cinco olhos de 5 doentes com queratocone em progressão submetidos a CXL segundo o protocolo original de Dresden. Foi realizada tomografia corneana antes e durante o procedimento (imediatamente após a remoção do epitélio), e avaliados os valores da queratometria - K1, K2, K médio (Km), ponto de máxima curvatura (Kmax), valores paquimétricos e astigmatismo corneano. Resultados: Os valores médios de curvatura corneanas antes e após a remoção do epitélio foram de: K1: 43,50 ± 2,54D e 44,32±2,64D (p=0,080); K2: 46,64±2,35D e 49,38±2,86D (p=0,043); Km: 45,48±2,42D e 46,72±2,60D (p=0,042). Observou-se igualmente um aumento estatisticamente significativo do valor de queratometria máxima após a remoção do epitélio (p=0,043). Na paquimetria central observou-se uma redução média de 26,8µm de 524,8±33,0µm para 498,2±37,7µm (p= 0,042). Conclusão: Observou-se um aumento estatisticamente significativo nos valores do Kmax, K2, e Kmédio após remoção do epitélio. Este estudo demonstra o efeito de "máscara" que o epitélio exerce no queratocone.
Abstract Objective: In the presence of an irregular cornea, like in keratoconus, the corneal epithelium has a different profile "masking" the irregular corneal stroma surface. Topographical analysis without considering the epithelium effect can result in an incorrect assessment, affecting the accuracy of any topography guided treatment. The aim of this study was to evaluate the "masking" effect of the corneal epithelium on corneal curvature in patients with keratoconus, comparing topographical findings before and after removal of the epithelium during Crosslinking (CXL). Methods: Five eyes of 5 patients with progressive keratoconus submitted to CXL according to the original Dresden protocol. Corneal topography was performed before and during the procedure (immediately after epithelium removal) and values of keratometry: K1, K2, mean K (Km), maximum corneal apical curvature (Kmax), corneal thickness and corneal astigmatism were evaluated. Results: The average values of corneal curvature before and after epithelial remove were: K1: 43.50±2.54D and 44.32±2,64D (p=0.080); K2 46.64±2,35D and 49.38±2,86D (p=0.043); Km 45.48±2.42D and 46.72±2.60D (p=0.042). It was also observed a significant increase in the maximum values of corneal apical curvature after removal of the epithelium (p=0.043). In central corneal thickness there was seen a reduction of 26.8µm from 524.8±33.0µm to 498.2±37.7µm (p = 0.042). Conclusion: There was seen a significant increase in the values of Kmax, K2 and mean K. This study demonstrates the masking effect of corneal epithelium on corneal curvature in keratoconus.
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Humanos , Tomografia Computadorizada por Raios X , Topografia da Córnea , Reagentes de Ligações Cruzadas , Ceratocone/diagnóstico , Estudos Retrospectivos , Córnea/cirurgia , Epitélio/cirurgiaRESUMO
This study is about the inter- and intra-specific genetic diversity of trypanosomatids of the genus Angomonas, and their association with Calliphoridae (blowflies) in Neotropical and Afrotropical regions. Microscopic examination of 3,900 flies of various families, mostly Calliphoridae, revealed that 31% of them harbored trypanosomatids. Small subunit rRNA (SSU rRNA) barcoding showed that Angomonas predominated (46%) over the other common trypanosomatids of blowflies of genera Herpetomonas and Wallacemonas. Among Angomonas spp., A. deanei was much more common than the two-other species, A. desouzai and A. ambiguus. Phylogenetic analyses based on SSU rRNA, glycosomal glyceraldehyde-3-phosphate dehydrogenase (gGAPDH) and internal transcribed spacer rDNA (ITS rDNA) sequences revealed a marked genetic diversity within A. deanei, which comprised four infraspecific genotypes (Dea1-Dea4), and four corresponding symbiont genotypes (Kcr1-Kcr4). Host and symbiont phylogenies were highly congruent corroborating their co-divergence, consistent with host-symbiont interdependent metabolism and symbiont reduced genomes shaped by a long coevolutionary history. We compared the diversity of Angomonas/symbionts from three genera of blowflies, Lucilia, Chrysomya and Cochliomyia. A. deanei, A. desouzai, and A. ambiguus were found in the three genera of blowflies in South America. In Africa, A. deanei and A. ambiguus were identified in Chrysomya. The absence of A. desouzai in Africa and its presence in Neotropical Cochliomyia and Lucilia suggests parasite spillback of A. desouzai into Chrysomya, which was most likely introduced four decades ago from Africa into the Neotropic. The absence of correlation between parasite diversity and geographic and genetic distances, with identical genotypes of A. deanei found in the Neotropic and Afrotropic, is consistent with disjunct distribution due to the recent human-mediated transoceanic dispersal of Angomonas by Chrysomya. This study provides the most comprehensive data gathered so far on the genetic repertoires of a genus of trypanosomatids found in flies from a wide geographical range.