Maintenance Of Functional Capacity Research Articles

Prevalence and outcomes of fear of falling in older adults with falls at the emergency department: a multicentric observational study.

Fear of falling (FOF) may result in activity restriction and deconditioning. The aim of the study was to identify factors associated with FOF in older patients and to investigate if FOF influenced long-term outcomes. Multicentric, observational, prospective study including patients 65years or older attending the emergency department (ED) after a fall. Demographical, patient- and fall-related features were recorded at the ED. FOF was assessed using a single question. The primary outcome was all-cause death. Secondary outcomes included new fall-related visit, fall-related hospitalisation, and admission to residential care. Logistic regression and Cox regression models were used for statistical analyses. Overall, 1464 patients were included (47.1% with FOF), followed for a median of 6.2years (2.2-7.9). Seven variables (age, female sex, living alone, previous falls, sedative medications, urinary incontinence, and intrinsic cause of the fall) were directly associated with FOF whereas use of walking aids and living in residential care were inversely associated. After the index episode, 748 patients (51%) died (median 3.2years), 677 (46.2%) had a new fall-related ED visit (median 1.7years), 251 (17.1%) were hospitalised (median 2.8years), and 197 (19.4%) were admitted to care (median 2.1years). FOF was associated with death (HR 1.239, 95% CI 1.073-1.431), hospitalisation (HR 1.407, 95% CI 1.097-1.806) and institutionalisation (HR 1.578, 95% CI 1.192-2.088), but significance was lost after adjustment. FOF is a prevalent condition in older patients presenting to the ED after a fall. However, it was not associated with long-term outcomes. Future research is needed to understand the influence of FOF in maintenance of functional capacity or quality of life.

Improving Physical Abilities And The Most Efficient Methods In Adults Over 40 Years Old

Only a small percentage of adults engage in regular physical activity, which means a decline in quality of life and a very poor result compared to Europe (Osiński, 2013). The purpose of this literature review is to find the most contemporary methods from the most ranked scientific works on the improvement of physical abilities and the most efficient methods in adults over 40 years old. Digital databases such as Scopus, Medline, JStore, Embase, Cochrane Central, PsycInfo, Schoolar, and SPORTDiscus were used in this literature review. Inclusion criteria are: individuals must be healthy and average age at least 40 years old. Many other studies such as (Skelton et al., 1994; Foldvari et al., 2000; Bean et al., 2007) report that physical functions are more related to muscle power than to muscle strength or mass. Strength training has many benefits on physical function in older adults compared to traditional strength training (Tschopp et al., 2011; Da Rosa., 2019). Harmonization or proper use of variables such as exercise selection, breaks, number of sets, number of repetitions, frequency affect the increase in the level of muscular fitness. Strength, muscular endurance, muscular strength and muscular hypertrophy are the characteristics that should be trained (Ratamess et al., 2009). While in an all-inclusive program resistance training improves the cardiovascular system (Fleck. 1988), limits the risk of coronary heart disease (Goldberg. 1989; Hurley & Kokkinos, 1987), helps prevent osteoporosis (Layne & Nelson. 1999), removes the risk of diabetes (Miller et al., 1984), promotes maintaining a healthy weight and losing excess weight (Evans. 1999), reduces the risk of cancer in the spine (Koffler et al., 1992), helps in psychological/mental well-being (Ewart. 1989) as well as improves dynamic stability and maintenance of functional capacity (Evans. 1999). In conclusion from the study of Balachandran et al. (2022) found that strength training leads to improvements in physical function more than traditional strength training. Keywords: fitness, aging, power, strength, exercises

Perceptions of Healthy Aging Among Community-Dwelling Older Persons in an Urban Slum in Ibadan, Nigeria

Background: Healthy Ageing is the process of the development and maintenance of functional capacity which allows well-being at an older age. This understanding is comprehensive and relevant for all older persons. Despite the global attention being given to healthy ageing, there is limited information on the perceptions of this concept among older persons in low resource settings like Nigeria, hence the need for this study. Methods: In depth interviews were conducted among older persons aged 60 years and above residing in Idikan Community, an urban slum area in Ibadan, Nigeria. Using an interview guide, perceptions of older persons on meanings of healthy ageing, factors related to healthy ageing and experience of ageing were explored. Results: A total number of 24 interviews were conducted. Slightly more than half of the respondents were females. The majority of the respondents were of the opinion that healthy ageing is about being “ strong” and able to move around, without being dependent on anyone for mobility and activities of daily living. In their opinion, healthy ageing is related to different health dimensions: biological (adoption of healthy habits and behaviors with self-responsibility, psychological (feelings of optimism and happiness), spiritual (faith and religiosity) and family and social support (healthy and well children, friends and family). Conclusion: Urban Community dwelling older persons’ perception of healthy ageing was positive and incorporating their opinions on healthy aging from the perspective of the older persons can support the activities of professionals who work with this population group.

The Role of Nutritional Status on Polypharmacy, Cognition, and Functional Capacity of Institutionalized Elderly: A Systematic Review.

Adequate nutritional status is necessary for the proper management of polypharmacy, the prevention of cognitive decline, and the maintenance of functional capacity in activities of daily living. Although several studies validate this fact for the general elderly population, data on institutionalized seniors concerning this relation are scarce. A systematic review was performed according to the PRISMA guidelines, aiming to study the potential correlation between nutritional status and polypharmacy, cognitive decline, and functional performance in institutionalized elders. The search was limited to studies in English or Portuguese in the last decade. Inclusion criteria relied on the PICO method. Five studies explored the relationship of nutritional status with cognitive performance in the institutionalized elderly, and nine prospective observational studies reported significant positive associations between appropriate nutritional status and physical abilities. Nutritional status was primarily measured by MNA. Adequate nutritional status was described as an important parameter in preventing cognitive and functional decline in the institutionalized elderly. No studies were found describing the impact of nutritional status on the prevention of polypharmacy. Given the strong impact of malnutrition found in the studies in cognition and functional abilities in the institutionalized elderly, an evaluation of nutritional status of the elders is crucial to prevent health problems and allow early intervention programs in order to further prevent health decline.

Functional Cardiological Changes Resulting from Thoracoscopic Thoracic Sympathectomy: Systematic Review

Hyperhidrosis is a condition resulting from a systemic sympathetic hyperactivity. The gold standard treatment is the resection or surgical ablation of the paravertebral sympathetic chain: the endoscopic thoracoscopic sympathectomy (ETS). Non-cardiac thoracic surgeries carry a considerable incidence of pathological postoperative cardiac events, raising attention to possible worsen cardiac functional capacity after the resection of a pair of thoracic sympathetic ganglia. The aim of this study is to investigate literature evidences of postoperative cardiovascular functional changes on patients submitted to ETS as treatment for hyperidrosis. This is a systematic review of the literature. Clinical studies published between January 1999 and April 2019 were analyzed. The PICO strategy was used to construct the question of systematic reviews research. The process of selecting articles was organized according to PRISMA Diagram. The search in electronic databases resulted in seven articles, of which one was excluded for being out of scope of the research, leaving six articles. All studies showed a pattern of heart rate (HR) reduction after endoscopic thoracic sympathectomy. It was suggested a relation between the extension of the procedure and the presence of cardiac functional alterations. There was an improvement in myocardial physical conditioning and maintenance of functional capacity. To elucidate the real mechanisms involved in the maintenance of myocardial function, and even its improvement, it is necessary to develop further studies that directly evaluate them.

Assessing the engagement in a post-discharge phone Follow-Up project

Introduction: The article describes a post-discharge telephone Follow-Up pilot project that was activated in 2018 in the city of Trieste.
 Methods: The pilot project, in addition to the interception of possible situations of discomfort to be reported to social services and to ensure informative support to guide people to an optimal use of services, aimed to investigate the conditions, 1 and 3 months after discharge, of people not followed by the community services, in particular: a) maintenance of functional capacity; b) self-assessment of the patient with respect to health conditions and level of engagement; c) state of the relationships network; d) use of public, private and/or third sector health or welfare resources.
 Results and Conclusions: The Telephone Follow-Up has made it possible to experiment a “light” way of taking care of people discharged from a hospital or rehabilitation facility, to intercept situations of discomfort, reporting them to the Local District and social services and facilitating the appropriate use of local assistance services.

A Phase I Study Evaluating the Safety and Persistence of Allorestricted WT1-TCR Gene Modified Autologous T Cells in Patients with High-Risk Myeloid Malignancies Unsuitable for Allogeneic Stem Cell Transplantation

Background:Patients with acute myeloid leukemia (AML), myelodysplasia (MDS) or tyrosine kinase inhibitor resistant chronic myeloid leukemia (CML) who are unsuitable for consolidative allogeneic stem cell transplantation (alloSCT) have high relapse rates following chemotherapy. Wilms' tumor 1 (WT1) is highly expressed in the majority of acute myeloid leukemias (AML) and in many subtypes of myelodysplasia (MDS) as well as other hematological and solid tumors. WT1 is an intracellular antigen, which makes it difficult to target using current Chimeric Antigen Receptor (CAR)-T cell technologies. The use of genetically modified T cells expressing WT1-specific α/β T cell receptors can re-direct T cell specificity via the recognition of intracellular peptides presented by MHC molecules on the malignant cell surface. Phase I clinical trials of WT1-TCR gene-modified T cells have been conducted in the settings of relapsed disease and post-alloSCT and preliminary data suggests this treatment approach is safe and potentially clinically effective in these cohorts (Tawara et al. Blood. 2017;130(18):1985-94; Chapuis et al, Nat Med. 2019;25(7):1064-72). Methods:We report a phase I/II safety and dose escalation study evaluating WT1-TCR gene-modified autologous T cells in HLA-A*0201 positive patients with AML, MDS and CML, unsuitable for alloSCT (NCT02550535) (Fig 1A). Patient T cells were harvested by leucapheresis and transduced with a retroviral vector construct encoding the codon optimised variable and constant a and bchains of the human pWT126-specific TCR separated by a self-cleaving 2A sequence (Fig 1B). Bulk transduced T cells were analysed by flow cytometry (CD3, CD8 and Vb2.1) prior to infusion and at regular intervals post-infusion. A quantitative PCR assay was developed to identify WT1-TCR expressing T cells in the peripheral blood post infusion. Patients received minimal conditioning with fludarabine and methylprednisolone prior to transfer of transduced T cells. All subjects were followed for a minimum of 12 months or until death. Results:A total of 10 patients (6 AML, 3 MDS and 1 TKI- resistant CML) were recruited. The mean age was 71.3 years (range 64-75) and all had high risk disease (by cytogenetic or clinical criteria). All AML patients were in complete morphological remission at the time of trial entry, whilst MDS patients had ≤ 15% blasts on bone marrow examination. All 10 patients received the gene-modified T cells in dose escalation cohorts (seven patients received £2x107/kg and three patients received £1x108/kg bulk WT1 TCR transduced cells). No adverse events directly attributable to the investigational product were recorded apart from one possible cytokine release syndrome, which was managed without tociluzimab. Transferred T cells demonstrated in vivoproliferation commensurate with maintenance of functional capacity despite ex vivo manipulation (Fig 1C and 1D). The TCR-transduced T cells were detectable in all patients at 28 days and in 7 patients persisted throughout the study period (Fig 1E). All 6 AML patients were alive at last follow up (median 12 months; range 7-12.8 months). The 3 patients with MDS had a median survival of 3 months (range 2.1-3.96 months) post T cell infusion. 2 died from progressive disease and one from other causes. 2 patients discontinued the study early due to disease progression. Conclusions: This is the second reported phase I/II clinical trial of autologous WT1-TCR gene-modified T cells for treatment of AML and MDS in a high-risk cohort of patients not suitable for alloSCT. We have shown that the WT1-TCR T cells demonstrated a strong safety profile without detectable on-target, off-tumour toxicity and no severe adverse events in the ten patients treated. An important cause of treatment failure for adoptive cellular therapies is the lack of persistence of transferred T cells leading to loss of disease specific effects. We demonstrated that autologous WT1-TCR T cells proliferated in vivoand persisted for many months. Recent work within our group (in press) has shown that TCRs modified to include key framework residues, show increased TCR expression and functional improvement. These modifications could be incorporated into future studies to improve efficacy. This data supports the rationale for a larger, phase II trial of WT1-TCR T cells in myeloid malignancies in patients for whom alloSCT is not appropriate, in order to assess clinical efficacy. Figure 1 Disclosures Morris: Quell Therapeutics: Consultancy, Other: Scientific Founder,stock; Orchard Therapeutics: Consultancy. Qasim:CellMedica: Research Funding; Bellicum: Research Funding; UCLB: Other: revenue share eligibility; Autolus: Equity Ownership; Orchard Therapeutics: Equity Ownership; Servier: Research Funding. Mount:Gamma Delta Therapeutics: Employment. Inman:Cellmedica: Employment. Gunter:Cellmedica: Employment. Stauss:Cell Medica: Other: I have stock; Quell Therapeutics: Consultancy, Other: I have stock.

Capacidade funcional no idoso longevo: revisão integrativa.

Este artigo tem como objetivo analisar, tanto a produção científica que versa sobre a manutenção da capacidade funcional em idosos longevos, quanto aquela que trata dos possíveis agravantes à saúde desse grupo etário. Para tanto, foi realizada uma revisão integrativa; houve, porém, muita dificuldade em encontrar literatura cientifica voltada para este grupo etário. Pode-se observar que, além das doenças que acometem estes idosos, fatores psicossociais, como a depressão e o isolamento são responsáveis pela perda de autonomia e independência deste grupo.Palavras-chave: Idosos longevos; Capacidade funcional em idosos longevos; Idoso com 80 ou mais anos.

Maintenance of Gains, Morbidity, and Mortality at 1 Year Following Cardiac Rehabilitation in a Middle-Income Country: A Wait-List Control Crossover Trial.

BackgroundDespite the epidemic of cardiovascular diseases in middle‐income countries, few trials are testing the benefits of cardiac rehabilitation (CR). This trial assessed (1) maintenance of functional capacity, risk factor control, knowledge, and heart‐health behaviors and (2) mortality and morbidity at 6 months following CR in a middle‐income country.Methods and ResultsEligible Brazilian coronary patients were initially randomized (1:1:1 concealed) to 1 of 3 parallel arms (comprehensive CR [exercise plus education], exercise‐only CR, or wait‐list control). The CR programs were 6 months in duration, at which point follow‐up assessments were performed. Mortality and morbidity were ascertained from chart and patient or family report (blinded). Controls were then offered CR (crossover). Outcomes were again assessed 6 months later (blinded). ANCOVA was performed for each outcome at 12 months. Overall, 115 (88.5%) patients were randomized, and 62 (53.9%) were retained at 1 year. At 6 months, 23 (58.9%) of those 39 initially randomized to the wait‐list control elected to attend CR. Functional capacity, risk factors, knowledge, and heart‐health behaviors were maintained from 6 to 12 months in participants from both CR arms (all P>0.05). At 1 year, knowledge was significantly greater with comprehensive CR at either time point (P<0.001). There were 2 deaths. Hospitalizations (P=0.03), nonfatal myocardial infarctions (P=0.04), and percutaneous coronary interventions (P=0.03) were significantly fewer with CR than control at 6 months.Conclusions CR participation is associated with lower morbidity, long‐term maintenance of functional capacity, risk factors, and heart‐health behaviors, as well as with greater cardiovascular knowledge compared with no CR.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02575976.

Exercise and The Cancer Patient

Each year, approximately 1.6 million Americans are diagnosed with cancer. The consequences of cancer and its associated treatment include elevations in cardiovascular risk, deteriorating body composition, and diminishing physical function. Exercise is an effective countermeasure; however, limitations in adherence may compromise the magnitude of improvement experienced. PURPOSE: To evaluate cardiovascular, anthropometric, and functional adaptations to an exercise program in cancer survivors. METHODS: We conducted a 10-week exercise intervention on 157 cancer survivors; 58 were retained through follow-up. At baseline, we recorded demographic, anthropometric, cardiovascular, and functional data. Anthropometric measurements were weight, body mass index (BMI), and body fat percent (BF%). Cardiovascular measurements were blood pressure and heart rate. Functional tests were VO2 max, six-minute walk, timed up-and-go, chair stand, sit-to-stand, arm curl, grip strength, Universal Machine (UM) push and pull, epic lift, sit-and-reach, functional reach, and back scratch. Paired-samples t tests measured changes from baseline to follow-up. RESULTS: Anthropometric variables did not change: body weight (p=0.585), BMI (p=0.477), and BF% (p=0.367). Cardiovascular variables did not change: systolic blood pressure (p=0.560), diastolic pressure (p=0.292), and heart rate (p=1.000). Improvement was detected in 11 of 13 functional tests: VO2 max (p=0.005), six-minute walk (p<0.001), timed up-and-go (p<0.001), chair stand (p<0.001), sit-to-stand (p=0.005), arm curl (p<0.001), grip strength (p<0.001), UM push (p<0.001), UM pull (p<0.001), epic lift (p=0.005), and functional reach (p=0.001). Mean values improved in sit-and-reach (p=0.321) and back-scratch (p=0.099), but pre-post comparisons were not significant. CONCLUSION: Exercise had no effect on anthropometric or cardiovascular profiles, but physical functioning improved in nearly every domain. In this population, maintenance of functional capacity can help preserve the ability to perform tasks of daily living, and it associates with survival. Although we found exercise to improve strength, aerobic capacity, and flexibility, the high rate of attrition is a potential limitation; further research is necessary to confirm our findings.

AGING AND INDIVIDUAL VULNERABILITY: A PANORAMA OF OLDER ADULTS ATTENDED BY THE FAMILY HEALTH STRATEGY

ABSTRACT Objective: identifying conditions of individual vulnerability in older adults and investigating the relationship with health indicators through a household survey. Method: a descriptive cross-sectional study conducted with 368 older adults attended by the Family Health Strategy. Data collection was performed through a structured interview, supported by instruments that include sociodemographic characterization, health indicators and the Vulnerable Elders Survey. A descriptive data analysis and Person's chi-square test were also performed. Results: a prevalence of 52.2% individual vulnerability was found among older adults, in addition to an association with health problems, negative self-perception of health, difficulty with mobility and in performing activities of daily living. Conclusion: identifying vulnerability among the aged population is a relevant initiative for the adequacy of health policies and programs that prioritize the promotion of aging with the maintenance of functional capacity.

Capacidade funcional de idosos institucionalizados: revisão integrativa

O envelhecimento é um processo universal e multifatorial que acontece em um contexto de grandes mudanças, principalmente na configuração dos arranjos familiares, com repercussão na busca por Instituições de Longa Permanência para Idosos (ILPIs). O sedentarismo é um fator marcante nas ILPIs, levando idosos rapidamente ao estado de dependência e incapacidade funcional. O objetivo deste estudo foi identificar a produção científica a respeito de fatores relacionados à capacidade funcional de idosos residentes de ILPIs, por meio de artigos indexados nas bases de dados eletrônicas LILACS e SciELO, no período compreendido entre 2010 e 2014. Foram selecionados 11 artigos. Foi observado que os estudos tendem a ser descritivos e transversais, sendo que apenas um artigo teve intervenção com a prática de atividade física. Outro fator notório foi a presença de doenças crônicas não transmissíveis, bem como a predominância do sexo feminino. Os estudos relatam também um menor desempenho cognitivo e uma aptidão funcional baixa, alta incidência de quedas, dependência nas atividades de vida diária e aumento de peso. A intervenção com equipe multidisciplinar é indispensável para a melhoria e manutenção da capacidade funcional e independência de idosos institucionalizados. Destaca-se a necessidade de desenvolvimento de novos estudos e produções científicas com essa temática, uma vez que a população idosa no Brasil deve continuar aumentando e, consequentemente, tende a crescer também o número de institucionalizações.

Maintenance of functional capacity in cognitive stimulation subgroups.

To evaluate the improvement of the elderly's functional capacity before intervention in cognitive stimulation workshops, according to subgroups. uantitative study, by before and after evaluation, following during one year the cognitive stimulation intervention, conducted according to recommendations of NIC (Nursing Interventions Classification) Domain 3 - Behavior, Class P, Cognitive Therapy "interventions to reinforce or promote desirable behaviors or to change undesirable behaviors". Participants were 67 people, with ages between 60 and 88. The criteria for subgroups were: healthy= memory complaint and Mini Mental State Exam (MMSE) score above or equal to 26 (n = 20); low education level = memory complaint and up to 5 years of study (n = 11); depression = memory and humor complaint, and Geriatric Depression Scale (GDS) score ≥ 4 (n = 25); and the control group (n = 11), which did not receive the intervention, just the conventional treatment. Although statistically significant differences have been observed in specific scores at each subgroup: MMSE (greater improvement in healthy elderly); GDS (greater improvement in the depression group); and the Word recall test (lower at the "low education level" group); it was noticed that at all intervention subgroups the functional capacity was maintained when compared to the control group. The cognitive stimulation workshops were useful to the elderly, who received the nursing intervention, the cognitive therapy. It is recommended adoption of the intervention in specific subgroups, according to their own cognitive limitations.

Autoavaliação do estado de saúde e fatores associados em idosos cadastrados na Estratégia Saúde da Família de Campina Grande, Paraíba

Resumo Objetivo: Verificar a associação entre autoavaliação negativa de saúde e variáveis socioeconômicas, demográficas e de saúde em idosos cadastrados na Estratégia Saúde da Família de Campina Grande-PB. Método: Estudo transversal, de base domiciliar com coleta de dados primários, realizado com idosos de ambos os sexos. Foram estudadas variáveis demográficas e socioeconômicas, número de doenças crônicas não transmissíveis (DCNT) referidas e grau de dependência nas atividades básicas de vida diária (ABVD). Os possíveis fatores associados à avaliação da saúde foram verificados por meio de regressão logística múltipla. Resultados: Foram avaliados 420 idosos (68,1% mulheres), cuja média etária foi 71,57 anos. Foi verificada associação positiva entre a avaliação negativa do estado de saúde e idosos acometidos por duas ou três DCNTs (OR=2,70; IC95%:1,47-4,96); acometidos por quatro ou mais DCNTs (OR=4,35; IC95%:1,58-12,01); com grau de dependência leve (OR=2,34; IC95%:1,13-4,87); dependência moderada (OR=2,11; IC95%:1,07-4,17) e com aqueles casados (OR=2,46; IC95%:1,01-6,01). Conclusão: Os resultados mostram que a avaliação negativa do estado de saúde esteve associada com o número de DCNTs referidas e com o grau de dependência nas ABVDs, assim como houve tendência de associação com idosos casados. Os resultados encontrados sugerem a necessidade de ações voltadas à prevenção e diagnóstico de doenças crônicas, assim como promoção e manutenção da capacidade funcional e prevenção ou tratamento de incapacidades.

Visão da equipe multidisciplinar sobre a atuação da fisioterapia em um programa de atendimento domiciliar público

Public home care seeks to ensure integral care to individuals by promoting continuity of care and the expansion of theirautonomy. This assistance can be provided as part of health promotion, prevention and treatment of illness and rehabilitation.Within this model of care named Home Care Program of the Bedridden (PADA), which involves multidisciplinaryhealth care. In this context, the aim of this work is to characterize the population served by home physical therapy aswell as the profile of caregivers, and assess, in view of the multidisciplinary team, the role of physiotherapy in PADA. Aquantitative and transversal study was conducted by collecting data from patients and caregivers in evolution files. Theexploratory and descriptive qualitative part of the study took place by means of interviews with the seven components ofPADA professionals, which were asked about the contribution of physiotherapy performance for the individuals served.The population served is predominantly old people and have chronic diseases, and are cared mostly by family caregivers,most of them old. After analysis, the objectives found for home physical therapy were: functionality, improved posture,vestibular rehabilitation, respiratory focus, prevention, guidelines and adhesion to family care. The contribution of physicaltherapy was divided into the following categories: improved quality of life, emotional aspects, respiratory focus, improvedpositioning in bed, decreased muscle pain, motor function, prevention and ergonomic issues. For the multidisciplinaryteam, physical therapy the home care program is beneficial for maintaining or acquiring functionality of patients to avoidepisodes of hospitalization for those having respiratory ailments, in addition to allowing aid to caregivers by means of theguidelines. One can infer that the role of physiotherapy in PADA is vital for the maintenance of functional capacity in respiratoryand motor aspects of users, and it also helps caregivers’ performance in order to avoid an overload of home care.However, the role of physiotherapy must focus on rehabilitation and comprehensive health care, and integral perspectivesare still incipient as regards primary health care

Burden of disease in patients with Morquio A syndrome: results from an international patient-reported outcomes survey

BackgroundMorquio A syndrome (or mucopolysaccharidosis IVa) is an ultra-rare multi-organ disease, resulting in significantly impaired functional capacity, mobility and quality of life (QoL).MethodsThis patient-reported outcomes survey evaluated the global burden of Morquio A among adults (≥18 years, N = 27) and children (7-17 years, N = 36), including the impact on mobility, QoL, pain and fatigue. QoL was assessed using the general Health-Related Quality of Life (HRQoL) questionnaire (the EuroQol [EQ]-5D-5L). Pain and pain interference with daily activities were assessed using the Brief Pain Inventory Short Form (BPI-SF) in adults and the Adolescent Pediatric Pain Tool (APPT) in children. Fatigue was assessed by questioning the patients on the number of evenings in a week they felt extremely tired.ResultsThe clinical data showed a wide heterogeneity in clinical manifestations between patients, with the majority of patients showing differing levels of endurance, short stature, bone and joint abnormalities, abnormal gait and eye problems. Mobility was considerably impaired: 44.4% of children and 85.2% of adult patients were using a wheelchair. High wheelchair reliance significantly reduced QoL. This was mainly driven by reduced scores in the Mobility, Self-care, and Usual Activity domains. The HRQoL utility values were 0.846, 0.582 and 0.057 respectively in adults not using a wheelchair, using a wheelchair only when needed and always using a wheelchair; values were 0.534, 0.664 and –0.180 respectively in children. Employed adult patients had a better HRQoL than unemployed patients (HRQoL utility value 0.640 vs. 0.275, respectively).64% of children and 74% of adult patients had joint pain; fatigue was reported by 69% of children and 63% of adults. Overall, increased mobility was associated with more severe and widespread pain and more fatigue.ConclusionsThe HRQoL of Morquio A patients is mainly driven by the ability to remain independently mobile without becoming wheelchair dependent. Their QoL reduces dramatically if they always have to use their wheelchair. Even a slightly better mobility (wheelchair use only when needed) greatly improves QoL. Maintenance of functional capacity and mobility paired with better pain management are likely to improve QoL.

The association between the functional incapacity of the older adult and the family caregiver's burden

To identify the association between the older adult's functional capacity and the caregiver's burden. A cross-sectional, quantitative study, undertaken in a municipality in the north of the Brazilian state of Paraná, with 178 older adults with functional incapacity, and their caregivers. The Functional Independence Measure was used for evaluating the older adults' functional capacity, and the Zarit Burden Interview was used for evaluating the caregiver burden, with the results being analyzed quantitatively. The majority of the older adults were females, widowed, with a mean age of 79.9 years old, and needing assistance for up to 50% of the daily living tasks. The majority of the caregivers were females, daughters, married, and had a mean age of 56.7 years old. The majority of the caregivers reported moderate burden; the men presented higher probabilities of lower burden than the women; and the more independent the older adult was, the higher the probabilities of the caregiver having low burden. Encouraging actions directed at the promotion of active and healthy ageing centered on the maintenance of functional capacity and the older adult's autonomy, and implanting strategies for the organizing of care in the home which include the caregiver's health, can contribute to minimizing the effects of burden and improve quality of life.

Prevenção de doenças em idosos: os equívocos dos atuais modelos

The Brazilian population is aging significantly within a context of gradual improvement in the country's social and economic indicators. Increased longevity leads to increased use of health services, pressuring the public and social welfare health services, generating higher costs, and jeopardizing the system's sustainability. The alternative to avoid overburdening the system is to invest in policies for disease prevention, stabilization of chronic diseases, and maintenance of functional capacity. The current article aims to analyze the difficulties in implementing preventive programs and the reasons for the failure of various programs in health promotion, prevention, and management of chronic diseases in the elderly. There can be no solution to the crisis in financing and restructuring the health sector without implementing a preventive logic. Scientific research has already correctly identified the risk factors for the elderly population, but this is not enough. We must use such knowledge to promote the necessary transition from a healthcare-centered model to a preventive one.

One-year cardiac morphological and functional evolution following permanent pacemaker implantation in right ventricular septal position in chagasic patients

The septal position is an alternative site for cardiac pacing (CP) that is potentially less harmful to cardiac function. Patients with Chagas disease without heart failure submitted to permanent pacemaker (PP) implantation at the Clinics Hospital of the Triângulo Mineiro Federal University (UFTM), were selected from February 2009 to February 2010. The parameters analyzed were ventricular remodeling, the degree of electromechanical dyssynchrony (DEM), exercise time and VO2 max during exercise testing (ET) and functional class (NYHA). Echocardiography was performed 24 to 48 h following implantation and after one year follow-up. The patients were submitted to ET one month postprocedure and at the end of one year. Thirty patients were included. Patient mean age was 59 ± 13 years-old. Indication for PP implantation was complete atrioventricular (AV) block in 22 (73.3%) patients and 2nd degree AV block in the other eight (26.7%). All patients were in NYHA I and no changes occurred in the ET parameters. No variations were detected in echocardiographic remodeling measurements. Intraventricular dyssynchrony was observed in 46.6% of cases and interventricular dyssynchrony in 33.3% of patients after one year. The findings of this work suggest that there is not significant morphological and functional cardiac change following pacemaker implantation in septal position in chagasic patients with normal left ventricular function after one year follow-up. Thus, patients may remain asymptomatic, presenting maintenance of functional capacity and no left ventricular remodeling.

Aptidão física de idosos institucionalizados: um estudo interinstitucional

Objetivos: Analisar a aptidão física de residentes em instituições de longa permanência para idosos de baixa renda. Métodos: Realizou-se um estudo em seis instituições localizadas em três regiões do Brasil. A amostra foi composta de 78 idosos, com média de idade de 77,4 anos (DP=7,9). Aplicou-se o teste de aptidão funcional da AAHPERD adaptado para idosos institucionalizados. Resultados: Flexibilidade, coordenação, agilidade e resistência aeróbia foram consideradas, em média, como regulares; apenas a força, como boa. Já o índice de aptidão física geral, em média, foi regular. Quanto maior o grau de dependência dos idosos, menor é a força e o resultado do índice de aptidão física geral; e quanto melhor coordenação e agilidade, melhor o nível de independência. Conclusão: Deve-se incentivar a prática de exercícios físicos aos idosos institucionalizados, pois auxiliará a manter e/ou melhorar as aptidões físicas que contribuirão para a manutenção da capacidade funcional dessa população.