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BACKGROUND: COVID-19 is characterized by a rapid change in the patient's condition, with major changes occurring over a few days. We aimed to develop and evaluate an emergency system for monitoring patients with COVID-19, which may be useful in hospitals where more severe patients stay in their homes. METHODOLOGY/PRINCIPAL FINDINGS: The system consists of the home-based patient unit, which is set up around the patient and the hospital unit, which enables the medical staff to telemonitor the patient's condition and help to send medical recommendations. The home unit allows the data transmission from the patient to the hospital, which is performed using a cell phone application. The hospital unit includes a virtual instrument developed in LabVIEW® environment that can provide a real-time monitoring of the oxygen saturation (SpO2), beats per minute (BPM), body temperature (BT), and peak expiratory flow (PEF). Abnormal events may be fast and automatically identified. After the design details are described, the system is validated by a 30-day home monitoring study in 12 controls and 12 patients with COVID-19 presenting asymptomatic to mild disease. Patients presented reduced SpO2 (p<0.0001) and increased BPM values (p<0.0001). Three patients (25%) presented PEF values between 50 and 80% of the predicted. Three of the 12 monitored patients presented events of desaturation (SpO2<92%). The experimental results were in close agreement with the involved pathophysiology, providing clear evidence that the proposed system can be a useful tool for the remote monitoring of patients with COVID-19. CONCLUSIONS: An emergency system for home monitoring of patients with COVID-19 was developed in the current study. The proposed system allowed us to quickly respond to early abnormalities in these patients. This system may contribute to conserving hospital resources for those most in need while simultaneously enabling early recognition of patients under acute deterioration, requiring urgent assessment.

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OBJECTIVE: To evaluate the relationship between respiratory muscle strength and grip strength in institutionalized and communitydwelling older adults. METHODS: This convenience sampled cross-sectional study had 64 voluntary participants with a good general health status and without limiting chronic diseases: 33 were institutionalized and 31 lived in the community. Maximal inspiratory pressure, maximal expiratory pressure, peak expiratory flow, grip strength, anthropometric data, and physical activity level were assessed. The data were subjected to descriptive analysis, Pearson's correlation test, and linear regression analysis. RESULTS: In the institutionalized group, there was no between respiratory variables and grip strength, but maximal expiratory pressure was the respiratory predictor most strongly associated with grip strength (p = 0.04). In the community-dwelling group, there was a correlation between maximal inspiratory pressure and grip strength (r = 0.54), maximal expiratory pressure and grip strength (r = 0.62), and peak expiratory flow and grip strength (r = 0.64); peak expiratory flow and maximal expiratory pressure were the respiratory predictors most strongly associated with grip strength (p < 0.05). In a joint group analysis, there was an association between maximal inspiratory pressure and grip strength (r = 0.40), maximal expiratory pressure and grip strength (r = 0.57), and peak expiratory flow and grip strength (r = 0.57); peak expiratory flow and maximal expiratory pressure were the respiratory predictors most strongly associated with grip strength (p < 0.05). CONCLUSIONS: Peak expiratory flow and maximal expiratory pressure seem to be good predictors of grip strength in community-dwelling older adults, but this relationship does not seem to be maintained in institutionalized patients, possibly because of a greater loss of respiratory function.

OBJETIVO: Avaliar a relação entre força muscular respiratória e força de preensão palmar em idosos institucionalizados e da comunidade. METODOLOGIA: Caracteriza-se por um estudo transversal com 64 voluntários, sendo 33 institucionalizados e 31 da comunidade. Avaliou-se a pressão inspiratória máxima, pressão expiratória máxima, pico de fluxo expiratório, força de preensão palmar, dados antropométricos e nível de atividade física.Os dados foram submetidos a uma análise descritiva, teste de correlação de Pearson e análise de regressão linear. RESULTADOS: No grupo de institucionalizados, não houve correlação entre as variáveis respiratórias e as de força de preensão palmar, porém o preditor respiratório mais fortemente associado à força de preensão palmar foi a pressão expiratória máxima (p = 0,04). No grupo da comunidade, verificou-se correlação entre pressão inspiratória máxima e força de preensão palmar (r = 0,54), pressão expiratória máxima e força de preensão palmar (r = 0,62), pico de fluxo expiratório e força de preensão palmar (r = 0,64), e o preditor respiratório mais fortemente associado à força de preensão palmar foi pico de fluxo expiratório e pressão expiratória máxima (p < 0,05). Na análise conjunta dos grupos, verificou-se associação entre pressão inspiratória máxima e força de preensão palmar (r = 0,40), pressão expiratória máxima e força de preensão palmar (r = 0,57), pico de fluxo expiratório e força de preensão palmar (r = 0,57), e o preditor respiratório mais fortemente associado à força de preensão palmar foi pico de fluxo expiratório e pressão expiratória máxima (p < 0,05). CONCLUSÕES: Em idosos da comunidade, o pico de fluxo expiratório e a pressão expiratória máxima parecem ser bons preditores da força de preensão palmar, enquanto, em institucionalizados, essa relação parece não se manter possivelmente por conta de maior acentuação de perda da função respiratória.

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OBJECTIVES: to compare the obtained and predicted peak expiratory flow (PEF) values between frail, pre-frail, and non-frail older adults; verify the association between PEF and FS; and establish cut-off points for PEF as determinants of frailty syndrome (FS). DESIGN: Cross-sectional study. LOCATION: Macapá, Amapá, Brazil. PARTICIPANTS: Community-based study community-dwelling older people. METHODS: PEF was evaluated using a peak-flow meter and FS was evaluated using Fried's frailty phenotype. The statistical analyses performed included a multinomial logistic regression model and Receiver Operating Characteristic (ROC) curves to establish cut-off points for discriminating FS. RESULTS: 409 older adults with a mean age of 70.09±7.22 years were evaluated; of these, 58.7% were pre-frail, and 12.7% were frail. PEF was lower in frail than in pre-frail participants, and lower in pre-frail than in non-frail. Frail and pre-frail older adults obtained lower PEF values than predicted. PEF (% Predicted) was inversely associated with frailty and pre-frailty even after adjustment. Cut-off points were established to discriminate the presence of frailty in older men (PEF≤350L/min; AUC=0.669; sensitivity=76.92%; specificity=52%) and women (PEF≤220L/min; AUC=0.597; sensitivity=71.79%; specificity=46.98%). CONCLUSIONS: Frail and pre-frail older adults presented significantly lower PEF than non-frail participants, and these values were lower than predicted. PEF was inversely associated with frailty and pre-frailty. PEF cut-off points can be used as a complementary method to indicate frailty in community-dwelling older adults.

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Objective: We compare physical performance from three U.S. national surveys and nationally representative surveys in England, Taiwan, and Costa Rica. Method: For each performance test, we use local mean smoothing to plot the age profiles by sex and survey wave and then fit a linear regression model to the pooled data, separately by sex, to test for significant differences across surveys controlling for age and height. Results: Age profiles of performance vary across U.S. surveys, but levels of lung function (peak expiratory flow) and handgrip strength in the United States are as high as they are in the other three countries. Americans also perform as well on the chair stand test as the English and Costa Ricans, if not better, but exhibit slower gait speed than the English at most ages. Discussion: With the exception of walking speed, we find little evidence that older Americans have worse physical performance than their peers.

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ABSTRACT Objective: To determine whether different levels of CPAP improve the lung volumes and capacities of healthy subjects immersed in water. Methods: This was a randomized clinical trial, conducted between April and June of 2016, involving healthy female volunteers who were using oral contraceptives. Three 20-min immersion protocols were applied: control (no CPAP); CPAP5 (CPAP at 5 cmH2O); and CPAP10 (CPAP at 10 cmH2O). We evaluated HR, SpO2, FVC, FEV1, the FEV1/FVC ratio, peak expiratory flow rate (PEFR), and FEF25-75%) at three time points: pre-immersion; 10 min after immersion; and 10 min after the end of each protocol. Results: We evaluated 13 healthy volunteers. The CPAP10 protocol reversed the restrictive pattern of lung function induced by immersion in water, maintaining pulmonary volumes and capacities for a longer period than did the CPAP5 protocol. Conclusions: When the hemodynamic change causing a persistent lung disorder, only the application of higher positive pressures is effective in maintaining long-term improvements in the pulmonary profile.

RESUMO Objetivo: Verificar se continuous positive airway pressure (CPAP, pressão positiva contínua nas vias aéreas) em diferentes pressões melhora os volumes e capacidades pulmonares de sujeitos saudáveis em imersão em água. Métodos: Estudo clínico randomizado realizado entre abril e junho de 2016 com voluntárias saudáveis em uso de anticoncepcional oral. Foram aplicados três protocolos em imersão em água, todos com duração de 20 min: controle (sem aplicação de CPAP); CPAP5 (CPAP de 5 cmH2O); e CPAP10 (CPAP de 10 cmH2O). Avaliaram-se FC, SpO2, CVF, VEF1, relação VEF1/CVF em % do previsto, taxa de pico de fluxo expiratório e FEF25-75% em três momentos distintos: pré-imersão, 10 min após a imersão e 10 min após o final dos protocolos. Resultados: Foram avaliadas 13 voluntárias saudáveis. O protocolo CPAP10 foi capaz de reverter o padrão restritivo pulmonar induzido pela imersão em água em indivíduos saudáveis, mantendo normais os volumes e as capacidades pulmonares por um período mais prolongado quando comparado ao protocolo CPAP5. Conclusões: Nossos resultados indicam que, em condições cuja alteração hemodinâmica causadora do distúrbio pulmonar seja persistente, apenas a aplicação de pressões positivas mais elevadas é efetiva para manter as melhoras no quadro pulmonar por um maior tempo após a sua aplicação.

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ABSTRACT Objective This study sought to investigate the effects of vitamin D supplementation and aquatic exercise on pulmonary function in postmenopausal women. Materials and methods This prospective and controlled study included 104 women (62 ± 6.5 years) divided into three groups: a control group lacking vitamin D and calcium supplementation which remained sedentary (CG; n = 17); a control group receiving vitamin D and calcium supplementation which remained sedentary (CDG, n = 33); and a group that completed aquatic exercises three times a week and received vitamin D and calcium supplementation (DTG, n = 54). Data before and after 6 months of the study were analyzed, including serum 25-hydroxyvitamin D (25(OH)D) and calcium concentrations, peak expiratory flow (PEF), forced vital capacity (FVC), and cirtometry. Results We observed significant increases in 25(OH)D concentrations in CDG (52.9 ± 2.4 to 69.1 ± 2.2; nmol/L; p < 0.0001) and DTG groups (55.5 ± 3 to 71.5 ± 3 nmol/L; p < 0.0001). PEF increased by 7 ± 2% (p = 0.0080) in CDG group and 11 ± 2% (p < 0.0001) in DTG group, whereas FVC increased by 7 ± 2% (p = 0.0016) in the CDG group and 10 ± 2% (p < 0.0001) in the DTG group, whereas CG had no changes in any of these parameters. The increment value of cirtometry in DTG group (+43 ± 3%) were significantly (p < 0.0001) higher than those in CG (−4 ± 8%) and CDG (+4 ± 9%) groups. Conclusion Our data suggest that vitamin D supplementation improves pulmonary function parameters in postmenopausal women.

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OBJECTIVE: This study sought to investigate the effects of vitamin D supplementation and aquatic exercise on pulmonary function in postmenopausal women. MATERIALS AND METHODS: This prospective and controlled study included 104 women (62 ± 6.5 years) divided into three groups: a control group lacking vitamin D and calcium supplementation which remained sedentary (CG; n = 17); a control group receiving vitamin D and calcium supplementation which remained sedentary (CDG, n = 33); and a group that completed aquatic exercises three times a week and received vitamin D and calcium supplementation (DTG, n = 54). Data before and after 6 months of the study were analyzed, including serum 25-hydroxyvitamin D (25(OH)D) and calcium concentrations, peak expiratory flow (PEF), forced vital capacity (FVC), and cirtometry. RESULTS: We observed significant increases in 25(OH)D concentrations in CDG (52.9 ± 2.4 to 69.1 ± 2.2; nmol/L; p < 0.0001) and DTG groups (55.5 ± 3 to 71.5 ± 3 nmol/L; p < 0.0001). PEF increased by 7 ± 2% (p = 0.0080) in CDG group and 11 ± 2% (p < 0.0001) in DTG group, whereas FVC increased by 7 ± 2% (p = 0.0016) in the CDG group and 10 ± 2% (p < 0.0001) in the DTG group, whereas CG had no changes in any of these parameters. The increment value of cirtometry in DTG group (+43 ± 3%) were significantly (p < 0.0001) higher than those in CG (-4 ± 8%) and CDG (+4 ± 9%) groups. CONCLUSION: Our data suggest that vitamin D supplementation improves pulmonary function parameters in postmenopausal women.

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OBJECTIVE: To determine whether different levels of CPAP improve the lung volumes and capacities of healthy subjects immersed in water. METHODS: This was a randomized clinical trial, conducted between April and June of 2016, involving healthy female volunteers who were using oral contraceptives. Three 20-min immersion protocols were applied: control (no CPAP); CPAP5 (CPAP at 5 cmH2O); and CPAP10 (CPAP at 10 cmH2O). We evaluated HR, SpO2, FVC, FEV1, the FEV1/FVC ratio, peak expiratory flow rate (PEFR), and FEF25-75%) at three time points: pre-immersion; 10 min after immersion; and 10 min after the end of each protocol. RESULTS: We evaluated 13 healthy volunteers. The CPAP10 protocol reversed the restrictive pattern of lung function induced by immersion in water, maintaining pulmonary volumes and capacities for a longer period than did the CPAP5 protocol. CONCLUSIONS: When the hemodynamic change causing a persistent lung disorder, only the application of higher positive pressures is effective in maintaining long-term improvements in the pulmonary profile.

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OBJECTIVE: The aim of the present study was to verify if there is sex difference in the associations among handgrip strength, peak expiratory flow (PEF) and timed up and go (TUG) test results. METHODS: The sample included 288 consecutive elderly men (n=93) and women (n=195). Functional capacity was measured using the TUG test, and muscle strength was measured based on handgrip. Moreover, as a measure of current health status, PEF was evaluated. Linear regression procedures were performed to analyze the relationships between handgrip and both PEF and TUG test results, with adjustment for confounders, and to identify the possible mediating role of PEF in the association between handgrip strength and TUG test results. RESULTS: In men, handgrip strength was associated with both PEF and TUG performance (p<0.01). After adjustment for PEF, the relationship between handgrip strength and TUG performance remained significant. In women, handgrip strength was also associated with both PEF and TUG performance (p<0.01). However, after adjustment for PEF, the relationship between handgrip strength and TUG performance was no longer significant. CONCLUSION: Mobility in the elderly is sex dependent. In particular, PEF mediates the relationship between handgrip strength and TUG performance in women, but not in men.

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