Dissertações e Teses
URI permanente para esta coleçãohttps://repositorio.cmmg.edu.br/handle/123456789/6
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Resultados da Pesquisa
Item Caracterização funcional de idosos comunitários durante a pandemia por Covid-19 em uma capital brasileira(Faculdade Ciências Médicas de Minas Gerais, 2023-10-05) Vieira, Maria Carolina Santos; Barbosa, Maira Tonidandel; Leopoldino, Amanda Aparecida de OliveiraObjective: to compare functional behavior in elderly people aged over and under 85 years, considering a sample of community-dwelling older adults in a Brazilian capital during the COVID-19 pandemic. Methods: a cross-sectional study was carried out with self-administered questionnaires available through digital means, consisting of questions to assess the risk of functional decline, frailty, perception of the impact of social isolation on health and participation of the family member or caregiver in the daily activities of the participants. Results: 373 elderly people with a mean age of 76.8 9,4 years participated in this study. Most of the sample reported that health problems do not limit the performance of activities (63.5%), that their health problems do not force them to stay at home (77.7%) and that they do not regularly depend on walking devices (88.6%). There was a significant difference in the risk of functional decline: 22.5% in individuals aged 60-84 years old and 40.1% in individuals aged 85 years or older needed more care and support from their family members or caregivers to carry out their daily tasks. Conclusions: aging itself does not imply functional dependence, but is an important risk factor for that. In the present study, the group of elderly aged 85 years and older had a higher risk of functional decline, need for support and care from family members, use of walking aids and activity limitations. The data suggest that this group must be considered a priority in interventions to mitigate the impacts of social isolation during pandemic periods and in similar epidemiological, clinical and psychosocial circumstances.Item Validação do questionário Duke Activity Status Index (DASI) para avaliação da capacidade funcional, por meio de contato telefônico, em indivíduos com Doença de Parkinson(Faculdade Ciências Médicas de Minas Gerais, 2023-09-20) Thomazi, Maria Clara Bellavinha; Campelo, Raquel de Carvalho Lana; Leopoldino, Amanda Aparecida de OliveiraIntroduction: Parkinson's Disease (PD) is a chronic-degenerative and progressive disorder of the central nervous system, more prevalent in the elderly, characterized by both motor and non-motor changes. Given the decline in physical abilities and in carrying out activities of daily living, it is crucial to establish a suitable method for assessing functional capacity for this population. The Duke Activity Status Index (DASI) is an easily administered and low-cost questionnaire, capable of measuring the functional capacity of individuals. Currently, there are no studies validating the DASI in the PD population, especially through telephone calls. With the COVID-19 pandemic, there was a need to validate new ways of administering questionnaires, particularly remotely. Objective: To validate the DASI questionnaire for assessing the functional capacity of individuals with PD through telephone contact. Objective: To validate the DASI questionnaire for assessing the functional capacity of individuals with PD through telephone contact. Materials and Methods: This is a methodological study in which individuals diagnosed with PD were included. Sociodemographic and clinical data were initially obtained, and subsequently, the patients underwent the DASI on two occasions: face-to-face and by telephone, both conducted by the same examiner. To compare the mean differences in the total scores of the questionnaires administered face-to-face and by telephone, the Student's T-test was used, with a 95% confidence interval, to investigate the concurrent validity between the modes of application. The values obtained in each of the questionnaire items, administered face-to-face and by telephone, were compared using the Kappa coefficient. Results: Fifty-one PD patients were included in the study, with an average age of 66.9 (±8.5) years and an average diagnosis time of 106.7 (±65.0) months. No significant difference was observed between the averages of the scores obtained in both the face-to-face DASI application and via telephone contact (40.3±14.0 versus 40.7±13.5, respectively). Most of the questions showed substantial agreement (items 3, 5, 8, 10, and 12, 0.638 ≥ k ≤ 0.790) or almost perfect agreement (items 6, 7, and 9, 0.812 ≥ k ≤ 0.940) between the two DASI application routes, except for a single question which showed moderate agreement (item 11, k=0.497). Conclusions: The application of the DASI via telephone proved to be valid for assessing the functional capacity of individuals with PD.Item Achados ecocardiográficos em crianças de pacientes com diagnóstico de síndrome do PRKAG2(Faculdade Ciências Médicas de Minas Gerais, 2023-08-25) Santos Neto, Dinamar Amador; Pena, José Luiz BarrosBackground: PRKAG2 syndrome typically manifests in adolescence and early adulthood along with left ventricular hypertrophy, arrhythmias, and increased risk of sudden death. Echocardiographic marker findings before clinical manifestation in children of PRKAG2 parents can facilitate prevention strategies and therapeutic planning. Objective: Identify the existence of early echocardiographic findings in asymptomatic children of PRKAG2 parents. Methods: Cross-sectional observational study of seven children, aged between 9 months and 12 years, of PRKAG2 parents was compared to a control group matched by sex and age with no cardiovascular disease. All children underwent conventional and advanced echocardiographic techniques. Results: Conventional echocardiography showed higher values with statistical significance in the case group for left atrium, interventricular septum, left ventricular posterior wall, indexed ventricular mass, and relative wall thickness. Global longitudinal strain obtained from the two-dimensional examination showed no statistical significance between the groups. None of the parameters on the three dimensional echocardiogram showed statistical significance between the groups. Conclusion: Children diagnosed with PRKAG2 presented echocardiographic findings suggestive of a tendency to cardiac hypertrophy. Echocardiography can be a useful tool in the evaluation and follow-up of these patients before the onset of clinical manifestations.Item Comportamento alimentar, qualidade de vida e risco cardiovascular em crianças e adolescentes com obesidade e sobrepeso(Faculdade Ciências Médicas de Minas Gerais, 2024-03-28) Santos, Fernanda Gabriela Colombo Drumond; Machado, Maria da Glória Rodrigues; Rezende, Bruno AlmeidaINTRODUCTION: Eating habits are closely relate to the development of chronic diseases throughout life, such as obesity, diabetes, high blood pressure, dyslipidemia, among others. Adequate eating education and behavior contribute to good health and quality of life. Epidemiological studies show the increased occurrence of arterial hypertension during childhood and adolescence, probably due to the association of being overweight, obesity and lack of physical activity. OBJECTIVE: Evaluate the relationships between eating behaviors and their impact in body composition of children and teenagers, as well as possible association with quality of life (QoL) and early indicators of cardiovascular risk. METHODS: This is a transversal and observational that study which evaluated anthropometric, cardiovascular, QoL, and eating behavior parameters of 181 healthy children and teenagers, of both genders, and between the ages of 5 to 13, who are enrolled in the public education system in Belo Horizonte city, Minas Gerais, Brazil. They were fitted in three groups regarding body composition: Normal Weight, Overweight, and Obese. To determine these groups, the z-score for age-based body mass index (IMC/I) was used, and the children were classified according to the cutoff scores proposed by the World Health Organization (WHO). Anthropometry included weight, height, waist and hip circumferences, waist-hip ratio, and waist-height ratio. QoL was assessed using the Peds-QL 4.0 questionnaire, and eating behavior was assessed using the Children’s Eating Behaviour Questionnaire (CEBQ). Cardiovascular parameters were assessed using the Mobil-O-Graph® device, which measures the pulse wave velocity (PWV) and augmentation index (AIx@75) to estimate arterial stiffness (AS), which is considered an early marker of cardiovascular disease. RESULTS: In addition to the increase in anthropometric measurements (p < 0.001), the Obesity group exhibited behaviour related to food intake (p < 0.05). When analyzing QoL, a worsening in the social domain was also observed in the Obesity group (p < 0.05). However, PWV and AIx@75 did not differ between groups. CONCLUSION: Eating behaviour is related to the development of childhood obesity. However, early markers of cardiovascular risk related to AS did not change as a function of body composition in the children evaluated.Item Características epidemiológicas e clínicas de pacientes jovens com câncer de mama segundo o perfil mutacional(Faculdade Ciências Médicas de Minas Gerais, 2024-06-13) Corrêa, Daniela Beggiato; Rodrigues, Angélica NogueiraIntroduction: Breast cancer is the most common cancer in women and an important cause of death. Advanced age is directly proportional to the risk of developing the disease, but young women are more likely to develop breast cancer with worse clinicopathological charac teristics and more aggressive subtypes. It is essential to get to know the epidemiological pro file of young breast cancer (YBC) patients to better organize strategies to improve its control. Data from Brazilian YBC patients are scarce, especially regarding its association with a germline mutations with pathogenic potential. Objective: To compare epidemiological and clinical outcome data from non-mutated YBC patients to mutated ones. Material and meth ods: It is a cross-sectional retrospective study that included the analysis of medical records from two institutions in Minas Gerais/Brazil, focusing on YBC patients diagnosed between January 2012 to December 2020. The following variables were collected: sociodemographic profile of patients, tumor and patient-related characteristics, presence or absence of genetic mutation and variants of uncertain significance, follow-up time, and death. Binary logistic regression models were built to assess the association between traits and the occurrence of the mutation. This study was approved by the ethics committee of Hospital Felício Rocho before data collection began (4.553.583 / 2021). Results: 377 patients were included, 99.5% of them were women, mean age was 36 years, 63.7% were married at diagnosis, 62.5% with a com plete college education, and 89% had a private health insurance. Most of the sample (54.6%) underwent mastectomy, and 35.6% had sentinel lymph node involvement. Genetic testing was performed in 137 patients, and 29.9% of them presented a pathogenic or likely pathogenic mutation, predominantly in the BRCA1 gene (36.6%). Patients with a positive family history of cancer were more likely to be mutated (OR 1.92, IC 95% 0.90-4.16). Mutated patients un derwent more frequent mastectomies (OR 2.74, IC 95% 1.24-6.45) and contralateral prophy lactic surgery (OR 7.39, IC 95% 3.22-17.72). 36.3% of the tumors were luminal B and 43% stage II. Stage IV was scored in 6.7% of cases, locoregional recurrences in 11.9%, distant metastasis in 20.4%, and 10.9% deaths. 96,7% dos pacientes não mutantes e 100% dos mutantes estavam vivos em um acompanhamento médio de três anos (p 0,36). Conclusion: In this cohort of YBC has an un-favorable prognosis, with greater luminal subtype B, inter mediate histological grade, tumors larger than 2 cm with anatomical stage II, and 20,4% of patients, more than a fifth of the sample, progressing with distant metastases. We observed high rates of genetic mutation in this population and an increase in genetic testing over the years; patients with a genetic mutation with pathogenic potential were submitted more radical surgical procedures.Item Validação do questionário Duke Activity Status Index (DASI) em indivíduos após acidente vascular cerebral por meio telefônico(Faculdade Ciências Médicas de Minas Gerais, 2022-12-13) Melo, Camila Dias Campos; Torriani-Pasi, Camila; Polese, Janaine CunhaIntroduction: Stroke survivors present several disorders that consequently reflect on mobility and social participation, which directly affect the functional capacity of this population. Therefore, the functional capacity is an important outcome to be assessed once it can portray the functional deficits of individuals. Its assessment can be indirectly acquired by questionnaires, such as the Duke Activity Status Index (DASI). This stands out for being an easy and quick tool, with low cost and able to predict oxygen consumption during activities. Facing the pandemic of COVID-19, health professionals had to adapt and deal with the social distance. In this new context, there was the need to validate instruments by telephone-based administration, as well as those that assess the functional capacity of individuals after stroke. Objective: Investigate the validity of administer the Duke Activity Status Index (DASI) questionnaire to chronic stroke survivors through telephone call. Methods: This is a methodological study, based on the COSMIN recommendations, in which participants with chronic stroke (>1 year), aged ≥ 20 years, and able to walk independently were included. After recruitment, participants were subjected to an initial assessment and subsequently completed the DASI questionnaire in person. After 5 to 7 days, the questionnaire was reapplied by telephone. Student's t-test with 95% confidence interval was used to compare the mean differences in the total scores of the face-to-face and telephone questionnaires to investigate concurrent validity. The intraclass correlation coefficient (ICC) and kappa coefficient were used to verify the agreement between administration in person and by telephone call. Results: Fifty participants were included (52% women), with a mean age of 56 ± 17 years. 66% of the sample had a clinical diagnosis of ischemic stroke. In the results of the total score of the DASI questionnaire administered in person and by telephone call, no statistically significant differences were observed (MD= -0.88; SD=4.14; 95%CI, -2.06 to 0.28; p=0.13) and very high agreement was found between the applications (ICC = 0.99; 95%CI, 0.94 to 0.98; p<0.05). As for the agreement of the individual items, the kappa coefficient ranged from 0.390-1.000, with the first item "take care of yourself" showing the best agreement (k=1.000) and the fourth item "climb a flight of stairs or a slope" showing the most inferior agreement (k=0.390). Conclusion: The DASI questionnaire is valid to assess functional capacity and can be administered through telephone in chronic stroke survivors. O questionário DASI apresentou-se válido para a avaliação da capacidadeItem Influência da ventilação mecânica, idade e ocorrência de incidentes em pacientes com doenças crônicas internados em uma unidade de terapia intensiva(Faculdade Ciências Médicas de Minas Gerais, 2022-12-16) Faiad, Ana Flávia Nunes; Pessoa, Bruno Porto; Leopoldino, Amanda Aparecida de OliveiraIntroduction: Patient safety is one of the main health concerns in Brazil and worldwide. The occurrence of incidents especially affects the most vulnerable populations, especially patients with chronic diseases, using mechanical ventilation and of advanced age, and may even result in death. Given this, analyzing the rate of occurrence of these incidents by respiratory physiotherapists can promote patient safety. Objective: To investigate the influence of incidents monitored by physiotherapists in patients with chronic diseases admitted to an Intensive Care Unit (ICU). Methods: Retrospective cross-sectional study that included analysis of medical records of patients with chronic diseases, admitted to an ICU from January 2019 to April 2021 in a hospital in a Brazilian metropolitan capital. The following variables were collected: sex, age, chronic diseases, severity classification, use of mechanical ventilation, mortality, occurrence of incidents and their characteristics, and length of stay. To determine mortality, the Cox model was used, using hazard ratio, with α=0.05. Results: 343 medical records were included (56.3% male, 73.2% aged 60 years or older and 51.3% suffered at least one incident). Increased age (HR 1.02, 95% CI 1.00; 1.04), the use of mechanical ventilation, which increased the risk of death by seven times (HR 7.34, CI 95) represented a greater risk of death. %3.21; 16.81) and the occurrence of an incident (HR 2.66, 95% CI 1.65; 4.28). Physical therapists were the professionals who reported the most incidents, and those with serious damage were more common during the night, and in this same shift, the lowest incidence of notifications of notifiable circumstances was observed. Conclusion: The findings presented in this study suggest that the occurrence of incidents in patients with chronic diseases admitted to an ICU increase the length of stay and mortality.Item A intensidade da dor e a incapacidade afetam a qualidade de vida relacionada à saúde da pessoa idosa com dor lombar? Análise multinível entre Brasil e Holanda: estudo cross sectional do consórcio BACE(Faculdade Ciências Médicas de Minas Gerais, 2023-03-27) Grigorini, Adriana Estela de Oliveira; Pereira, Leani Souza Máximo; Leopoldino, Amanda Aparecida de OliveiraIntroduction: The prognosis of back pain (BP) in the elderly is less favorable than in adults and progress to adverse outcomes such as disability, falls, comorbidities, sleep disorders, psychosocial distress, and consequent worsening of health-related quality of life (HRQoL). Objective: To verify the association between the acute BP intensity, disability, and quality of life in elderly residents in Brazil and Netherlands. Methods: Data were collected from 602 Brazilian and 675 Dutch participants with a new episode of BP from the Back Complaints in Elders (BACE) consortium. For the present study, a cross section was used. Pain intensity and disability were assessed using the Numerical Rating Scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ), respectively. HRQoL was assessed using the Short Form Health Survey (SF-36) quality of life questionnaire. Age, sex, and education were descriptive variables. Pain intensity (NPS score) and country were the independent variables and quality of life assessed by each SF domain - 36 was the dependent variable. Analysis of models at the individual level was performed to verify the association between pain and disability, also HRQoL in Netherlands and Brazil in the total sample. The multilevel model was used to verify whether the elderly person's country of residence influenced this relationship. Results: The evaluated sample consisted of 1270 participants who were divided into two groups: Brazilians (n = 602, 67.7 ± 7.0 years) and Dutch (n = 668, 66.4 ± 7.57 years). As for sociodemographic characteristics, 908 (71.5%) of all participants were female and 362 (28.5%) were male, with a mean age of 67 (± 7.33 years). Brazilian elderly had lower educational levels and worse scores for disability (RMDQ) and pain intensity (NPS) compared to Dutch elderly. In the total sample, linear regression analysis adjusted for sex and age showed a significant association between BP intensity scores and HRQoL, for all domains, observing that Dutch elderly people had a greater impact of pain on quality of life as assessed by the SF-36. There was no association between disability and HRQoL. In the multilevel analysis, there was an association between BP intensity and HRQoL in all domains and an association between the country of residence and HRQoL, influencing the effect of pain, in all domains, except for the physical functioning. Conclusion: Socioeconomic and cultural aspects of Brazil and Netherlands can impact the perception of the elderly about their quality of life in the presence of BP. Pain and disability in Brazilian and Dutch elderly ones are experienced differently in relation to their quality of life.Item Fatores preditores de delirium e cognição em idoso com fratura de fêmur: pontos de corte para triagem cognitiva de 10 pontos (CS-10) e Mini-Cog que discriminam idosos com fratura de fêmur(Faculdade Ciências Médicas de Minas Gerais, 2023-12-05) Gusmão, Vanessa Patrícia do Valle; Avelar, Núbia Carelli Pereira; Leopoldino, Amanda Aparecida de OliveiraSummary: Delirium is a common complication in elderly people undergoing femoral fracture surgery. It is related to greater morbidity, mortality and functional and cognitive decline. Despite its relevance from a clinical, economic and social point of view, interventions to reduce its occurrence and severity remain neglected. Objectives: This study sought to establish cutoff points for the 10-point Cognitive Screening (CS-10) and Mini-Cog in elderly people after femoral fracture surgery and verify the association between cognitive decline and delirium, considering the points established cutoffs. Methods: 51 patients were evaluated in a prospective cohort study, with CS-10 and Mini-Cog tests performed before and after surgery. Delirium was assessed on admission and prospectively by the Confusion Assessment Method (CAM). Results: Analysis of the Receiver operator characteristic curve (ROC) determined cutoff points for CS-10 and Mini-Cog, which could discriminate delirium. Logistic regression reveals that elderly people with Cs-10 ≤5 points and Mini-Cog≤ 2 points were more likely to develop delirium, even after adjusting for sex, age and education. Conclusion: Patient with perioperative Cs-10 ≤5 and Cs-10 ≤5 was more likely to develop delirium. Stratification based on cognitive assessment can guide the implementation of cost effective prophylactic interventions in surgical patients with femoral fractures, aiming to improve clinical results and reduce costs in the healthcare system.Item Assistência fisioterapêutica 24 horas em doenças crônicas nos custos da Unidade de Terapia Intensiva nível III(Faculdade Ciências Médicas de Minas Gerais, 2022-12-20) Ferreira, Flávia de Paula Castro; Mourão, Lídia Miranda Barreto; Leopoldino, Amanda Aparecida de OliveiraIntroduction: The total cost per patient in the intensive care unit (ICU) is closely related to the severity of the disease, number of comorbidities and length of stay. Thus, the study aims to investigate the influence of the insertion of 24-hour physical therapy care (PT-24 hours) compared with 14-hour coverage (PT-14 hours) in the ICU level III in patients with mechanically ventilated chronic diseases. Methods: This is a retrospective cross-sectional study, composed of a convenience sample of patients using invasive mechanical ventilation (IMV) admitted to the ICU, from May 2020 to May 2022, in a public hospital. The following data were compiled to characterize the sample: age, gender, chronic diseases, classification of severity by diagnostics related group methodology, expected and performed hospital stay, occurrence of infectious and non-infectious incident, hospital outcome (death/non-death), IMV time and costs per patient. The variables were tested for normality by the Anderson Darling test. The Kruskal-Wallis tests followed by Pos hoc Conover and Mann Whitney were used to compare the differences between the medians. The significance level of p<0.05 was adopted. The R software (R Core Team, 4.2.1) was used to perform the analyses. Results: The sample consisted of 469 patients, PT-14 hours 267 and PT-24 hours 202 patients, with arterial hypertension being the most prevalent comorbidity in both coverage of therapeutic care, 73% and 76.7%, respectively. The severity classification was similar in both groups. The insertion of pt-24 hours in the ICU compared to the coverage of the PT-14 hours, did not present statistical difference (p<0,005), but with a reduction in the total gross cost of 23%. Conclusion: The insertion of pt-24 hours in the ICU resulted in a lower percentage of the total gross amount spent on the hospitalization of critically ill patients when compared to patients who were only assisted by the PT-14 hours.
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