Introduction: Aggregation of research evidence to guide clinical practice is one of the main reasons for conducting studies that provide a synthesis of the literature, but it is not the only reason. Systematic reviews are designed to be methodical, explicit and replicable. Such studies may help to guide project development, by indicating new directions for further investigations and identifying which research methods have been used within a given area. Methods: Systematic reviews require straightforward questions, search strategy definition, establishment of study inclusion and exclusion criteria and careful analysis of the selected literature. The development process for reviews of this type includes characterization of each selected study, evaluation of their quality, identification of important concepts, comparison of statistical analyses used and conclusions regarding what the literature tells us about a specific intervention. Such reviews also suggest problems/questions that need further investigation. Systematic review studies follow the structure of original articles. Conclusion: Good systematic reviews are important resources, in the light of the accelerated growth of scientific information. These studies help in producing syntheses of the evidence available in the literature on specific interventions, and may help clinicians and researchers in their work process.
Este estudo investigou a contribuição de cada domínio da qualidade de vida (físico, social, psicológico e ambiental) na qualidade de vida global e em que extensão esses domínios explicam a qualidade de vida global de idosos residentes no município de Teixeiras, na Região Sudeste do Brasil. Trata-se de um estudo observacional de corte transversal, sendo a amostragem aleatória estratificada por sexo, uso do Programa Saúde da Família e microárea de saúde (n = 211, indivíduos com idade igual ou superior a 60 anos), representando 14,28% do total de idosos do município em estudo. O instrumento utilizado foi o Word Health Organization Quality of Life Instrument Bref (WHOQOL-Bref), proposto pela Organização Mundial de Saúde, aplicado por um único entrevistador, devidamente treinado. As análises de regressão linear mostraram que nenhuma das variáveis sociodemográficas interferiu significativamente no domínio global da qualidade de vida, e, entre os quatro domínios, o que mais explicou a qualidade de vida global foi o físico, seguido do ambiental e do psicológico. O domínio social não mostrou contribuição significativa na qualidade de vida global. As possíveis explicações para os resultados encontrados foram discutidas.
Objectives: to assess the impact of preterm birth and family socioeconomic status (SES) as they relate to functional and routine tasks performance in three years old children.Methods: cross-sectional study including 40 children distributed into four groups according to biologic risk variables of high and low social risk. Children's abilities and independence were assessed by the standardized PEDI functional test in the areas of: selfcare, mobility and social function. Two-way ANOVA tested the interaction effect between biologic and social risks, and main effects of individual risk factors.Results: significant interaction factors in mobility functional ability and independence in social function were demonstrated between preterm and at term children with low SES. Preterm children scored lower in the two aspects of functional performance. There were no significant differences in the groups of children with high SES in the evaluated areas.Conclusions: social risk (moderating factor) changed the relationship between biologic and mobility abilities and social function independence. The interaction of biologic and social factors, and not only the presence of a sole risk factor impacts functional performance in three year old children. The results points towards increasing therapeutic actions favoring children exposed to biologic and social risk factors.
The theoretical discussion on disability is dichotomized IntroduçãoA transição epidemiológica brasileira, segundo alguns pesquisadores, teve início com a queda da taxa de mortalidade na década de 1940, passando pelas doenças infectocontagiosas até chegar às patologias de início insidioso e longa duração, cuja evolução é marcada por redução progressiva da capacidade do indivíduo de realizar as atividades do cotidiano e por dificuldades para desempenhar papéis socialmente esperados 1,2 . Em decorrência desses fatos, ao longo dos últimos anos, o foco na construção de indicadores de saúde se deslocou da mortalidade para a morbidade e, mais recentemente para as conseqüências das doenças crônicas 1 . Somada a isso, a evolução tecnológica nos cuidados em saúde tem possibilitado maior sobrevida às pessoas com deficiências congênitas, que nos últimos anos têm se organizado mundialmente para lutar por uma sociedade mais inclusiva. Em que pese a importância quantitativa e qualitativa do problema, demonstrada pelo número de estudos e o envolvimento de pesquisadores de diferentes áreas, no Brasil as discussões ainda são incipientes. A análise e os debates sobre as teorias existentes para explicar a funcionalidade e a incapacidade humana podem ajudar na concepção de indicadores de saúde mais específicos, direcionados para as conseqüências das doenças, bem como na elaboração de políticas públicas mais efetivas.REVISÃO REVIEW
, Sérgio Teixeira da Fonseca 9RESUMO -Objetivo: Comparar o desenvolvimento da função motora de crianças nascidas pré-termo com crianças nascidas a termo, aos 8 e 12 meses de idade. Investigar a relação entre a qualidade motora aos 8 meses e a habilidade motora aos 12 meses. Método: Trinta e duas crianças participaram deste estudo: 16 nascidas pré-termo (grupo de risco) e 16 nascidas a termo (grupo controle). A movimentação espontânea das crianças foi avaliada aos 8 meses e as habilidades e independência em mobilidade foram avaliadas aos 12 meses de idade (idades corrigidas para grupo pré-termo), utilizando-se testes infantis padronizados (AIMS e PEDI, respectivamente). Os dados foram analisados através dos textes t de Student para grupos independentes (comparação entre grupos) e de correlação de Pearson (comparação intra grupo). Resultados: Não foi evidenciada diferença significativa na comparação de crianças nascidas a termo com as pré-termo nem aos 8 nem aos 12 meses de idade. No grupo controle, foi observada relação significativa (r=0,67; p=0,004) entre movimentação aos 8 meses e habilidade de mobilidade aos 12 meses. No grupo de risco, houve relação significativa entre habilidade e independência em mobilidade aos 12 meses de idade corrigida (r=0,80; p=0,0001). Conclusão: Na ausência de outros distúrbios e com correção da idade em pré-termos, o desenvolvimento motor pode ser semelhante ao de crianças nascidas a termo. A forma pela qual as crianças nascidas pré-termo adquirem suas habilidades funcionais parece ocorrer de modo diferente da observada em crianças a termo. PALAVRAS-CHAVE: prematuro, desenvolvimento infantil, atividade motora. Study of motor function at 8 and 12 months of age in preterm and at term children ABSTRACT -Objective:To compare the development of motor function in children born preterm with those born at term, at 8 and 12 months of age. To investigate the relation of motor function quality at the age of 8 months with motor ability at 12 months. Method: Thirty-two children participated in this study: 16 were born preterm (risk group) and 16 were born at term (control group). The spontaneous movements of the children were assessed at 8 months and their mobility skills and independence were assessed at 12 months (corrected ages for the preterm group), using standardized developmental tests (AIMS and PEDI, respectively). Data were analysed using independent t-tests (between-group comparison) and Pearson correlation coefficients (within-group comparison). Results: There was no significant difference in motor function, between those born preterm with those born at term, either at 8 or at 12 months of age. In the control group, there was significant association (r=0.67; p=0.004) between movement at 8 months and mobility skills at 12 months. In the risk group, there was significant relationship between skills and independence in mobility, at 12 months corrected age (r=0.80; p=0.0001). Conclusion: Preterm born children, without other disorders and with age correction, might show a similar motor de...
The objective of the present study was to evaluate breathing pattern, thoracoabdominal motion and muscular activity during three breathing exercises: diaphragmatic breathing (DB), flow-oriented (Triflo II) incentive spirometry and volume-oriented (Voldyne) incentive spirometry. Seventeen healthy subjects (12 females, 5 males) aged 23 ± 5 years (mean ± SD) were studied. Calibrated respiratory inductive plethysmography was used to measure the following variables during rest (baseline) and breathing exercises: tidal volume (Vt), respiratory frequency (f), rib cage contribution to Vt (RC/Vt), inspiratory duty cycle (Ti/Ttot), and phase angle (PhAng). Sternocleidomastoid muscle activity was assessed by surface electromyography. Statistical analysis was performed by ANOVA and Tukey or Friedman and Wilcoxon tests, with the level of significance set at P < 0.05. Comparisons between baseline and breathing exercise periods showed a significant increase of Vt and PhAng during all exercises, a significant decrease of f during DB and Voldyne, a significant increase of Ti/Ttot during Voldyne, and no significant difference in RC/Vt. Comparisons among exercises revealed higher f and sternocleidomastoid activity during Triflo II (P < 0.05) with respect to DB and Voldyne, without a significant difference in Vt, Ti/Ttot, PhAng, or RC/Vt. Exercises changed the breathing pattern and increased PhAng, a variable of thoracoabdominal asynchrony, compared to baseline. The only difference between DB and Voldyne was a significant increase of Ti/Ttot compared to baseline. Triflo II was associated with higher f values and electromyographic activity of the sternocleidomastoid. In conclusion, DB and Voldyne showed similar results while Triflo II showed disadvantages compared to the other breathing exercises.
Cad. Saúde Pública, Rio de Janeiro, 26(5):918-928, mai, 2010As relações laborais no âmbito da municipalização da gestão em saúde e os dilemas da relação expansão/precarização do trabalho no contexto do SUS Labor relations under decentralized health management and dilemmas in the relationship between work expansion and casualization in the Brazilian Unifi ed National Health System
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