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Made available in DSpace on 2020-12-12T02:01:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-04-01 Associação Brasileira de Saúde Coletiva Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background and objective In the present study, we compared the effect of diabetic pregnancy on the rectus abdominis muscle (RAM) in humans and rats. We hypothesized that our animal model could provide valuable information about alterations in the RAM of women with Gestational Diabetes (GDM). Method Newborns female rats (n = 10/group) were administered streptozotocin (100 mg/kg body weight) subcutaneously and were mated on reaching adulthood, to develop the mild hyperglycemic pregnant (MHP) rat model. At the end of pregnancy, the mothers were sacrificed, and the RAM tissue was collected. Pregnant women without GDM (non-GDM group; n = 10) and those diagnosed with GDM (GDM group; n = 8) and undergoing treatment were recruited, and RAM samples were obtained at C-section. The RAM architecture and the distribution of the fast and slow fibers and collagen were studied by immunohistochemistry. Results No statistically significant differences in the maternal and fetal characters were observed between the groups in both rats and women. However, significant changes in RAM architecture were observed. Diabetes in pregnancy increased the abundance of slow fibers and decreased fast fiber number and area in both rats and women. A decrease in collagen distribution was observed in GDM women; however, a similar change was not observed in the MHP rats. Conclusion Our results indicated that pregnancy- associated diabetes- induced similar structural adaptations in the RAM of women and rats with slight alterations in fiber type number and area. These findings suggest that the MHP rat model can be used for studying the effects of pregnancy-associated diabetes on the fiber structure of RAM. Perinatal Diabetes Research Center University Hospital Botucatu Medical School Univ. Estadual Paulista-UNESP Department of Gynecology and Obstetrics São Paulo State University (UNESP) Botucatu Medical School Department of Physiotherapy and Occupational Therapy São Paulo State University (UNESP) School of Philosophy and Sciences Department of Health Sciences Universidade Sagrado Coração Department of Anatomy São Paulo State University (UNESP) Institute of Biosciences Department of Biostatistics São Paulo State University (UNESP) Bioscience Institute Universidade Estadual Paulista Case Western Reserve University Pontificia Universidad Catolica de Chile Imperial College London Universidade Federal de São Paulo Universidade Católica de Pernambuco Faculdade de Medicina de Marília Maastrich University Charité Universitätsmedizin Berlin Universidade do Sagrado Coração Faculdades Integradas de Bauru Perinatal Diabetes Research Center University Hospital Botucatu Medical School Univ. Estadual Paulista-UNESP Department of Gynecology and Obstetrics São Paulo State University (UNESP) Botucatu Medical School Department of Physiotherapy and Occupational Therapy São Paulo State University (UNESP) School of Philosophy and Sciences Department of Anatomy São Paulo State University (UNESP) Institute of Biosciences Department of Biostatistics São Paulo State University (UNESP) Bioscience Institute Universidade Estadual Paulista FAPESP: #2014/26852-6 FAPESP: #2016/01743-5 FAPESP: #2016/09710-9

OBJECTIVES: Multidisciplinary teamwork is increasingly recognized as a critical factor of success in vocational rehabilitation. Although its clinical implementation is still challenging, the International Classification of Functioning, Disability and Health (ICF) has shown to be a useful framework to facilitate communication between stakeholders, to help structure rehabilitation plans and for setting goals and clarifying team roles. With this in mind, the objective of this teaching case study is to illustrate an application of ICF-based tools in a multidisciplinary return to work (RTW) program for patients with non-specific low back pain (NLBP) from the perspective of the physiotherapist. PARTICIPANT: The participant is a 42-year-old kindergarten teacher, who was on sick leave for 10 weeks due to NLBP. METHODS: This case study describes the use of ICF-based tools such as the Rehabilitation Management Sheet (RehabManagement-Sheet) to guide the rehabilitation process and facilitate team-based and physiotherapist goal setting and documentation in a multidisciplinary RTW program for NLBP. RESULTS: Utilizing ICF tools, we defined long-term and short-term goals, documented improvements in the patient's impairments, activity limitations, and participation restrictions and formulated action steps. CONCLUSION: The use of ICF-based tools in multidisciplinary rehabilitation allows for a comprehensive assessment, common goal setting and coordinated intervention planning. ICF-based tools like the RehabManagement-Sheet support the physiotherapist's role within the rehabilitation team by enhancing transparency in goal setting and intervention planning across disciplines. Copyright (c) 2014 John Wiley & Sons, Ltd.

This chapter will introduce the reader to an example on how an assessment instrument, based on the international classification of functioning, disability, and health can be developed. It lines out the reasoning behind the development of the new instrument as well as the methodology that was used. The instrument is a questionnaire designed to evaluate functioning in vocational rehabilitation – the work rehabilitation questionnaire (worq).in a further step the strengths and weaknesses of a generic instrument as the worq and the need for disease-specific or symptom-specific instruments and their respective roles in the vocational rehabilitation process will be discussed.in this context we also reflect on the role of environmental and personal factors when evaluating functioning in vocational rehabilitation.

Fecale incontinentie is een groot gezondheidsprobleem, dat vooral gepaard gaat met schaamtegevoelens en dat 5 tot 10 procent van de zelfstandig wonende volwassenen treft (Norton & Cody, 2012). Bij 1 tot 2 procent heeft dit significante impact op de algemeen dagelijkse activiteiten. Vanwege evidente onderrapportage zijn de genoemde prevalentiecijfers waarschijnlijk slechts het topje van de ijsberg (Whitehead, 2005).

Background There is ongoing debate about whether fusion or arthroplasty is superior in the treatment of single level cervical degenerative disc disease. Mainly because the intended advantage of arthroplasty over fusion, that is, the prevention of symptoms due to adjacent segment degeneration in the long term, is not confirmed yet. Until sufficient long‐term results become available, it is important to know whether results of one of the two treatments are superior to the other in the first one to two years. Objectives To assess the effects of arthroplasty versus fusion for radiculopathy or myelopathy, or both due to single level cervical degenerative disc disease. Search methods We searched the following databases for randomised controlled trials (RCTs): CENTRAL (The Cochrane Library 2011, Issue 2), MEDLINE, EMBASE, and EBMR. Additionally, we searched the System for Information on Grey Literature (SIGLE), subheading Biological and Medical Sciences, the US Food and Drug Administration (FDA) database on medical devices, and Clinicaltrials.gov to identify trials in progress. We also screened the reference list of all selected papers. Date of search: 25 May 2011. Selection criteria We included RCTs that directly compared any type of cervical fusion with any type of arthroplasty, with at least one year of follow‐up. Primary outcomes were arm pain, neck pain, neck‐related functional status, patient satisfaction, neurological outcome, and global health status. Secondary outcomes were the presence of (radiological) fusion, revision surgery at the treated level, secondary surgery on adjacent levels, segmental mobility of treated and adjacent levels, and work status. Data collection and analysis Study selection was performed independently by three review authors, and 'Risk of bias' assessment and data extraction were performed by two review authors. In case of missing data or insufficient information for a judgement about risk of bias, we tried to contact the study authors or the study sponsor. The data were entered into RevMan by one review author and subsequently checked by a second review author. We assessed the quality of evidence using GRADE. We analysed heterogeneity and performed sensitivity analyses for the pooled analyses. Main results We included nine studies (2400 participants), five of which had a low risk of bias. Eight of these studies were industry sponsored. The most important results showed low‐quality evidence for a small but significant difference in alleviation of arm pain at one to two years in favour of arthroplasty (mean difference (MD) ‐1.54; 95% confidence interval (CI) ‐2.86 to ‐0.22; 100‐point scale). A small study effect could not be ruled out for this outcome in the sensitivity analyses. This means that smaller studies (or small published subsets of larger studies) showed larger differences for this outcome, which may indicate publication bias. Also, moderate‐quality evidence showed a small difference in neck‐related functional status at one to two years in favour of arthroplasty (MD ‐2.79; 95% CI ‐4.73 to ‐0.85; 100‐point scale) and a small difference in neurological outcome in favour of arthroplasty (risk ratio (RR) 1.05; 95% CI 1.01 to 1.09). These two outcomes were robust to sensitivity analyses. For none of the primary outcomes, was a clinically relevant difference shown. Additionally, there was high‐quality evidence for a large, statistically significant difference in segmental mobility at one to two years (measured as degrees segmental range of motion) at the treated level (MD 6.90; 95% CI 5.45 to 8.35). There was low‐quality evidence that there was no statistically significant difference in secondary surgery at the adjacent levels at one to two years (RR 0.60; 95% CI 0.35 to 1.02). The latter was not robust to sensitivity analyses. Authors' conclusions There was a tendency for clinical results to be in favour of arthroplasty; often these were statistically significant. However, differences in effect size were invariably small and not clinically relevant for all primary outcomes. Significance was often gained or lost in the varying sensitivity analyses, probably owing to the relatively small number of studies, in combination with the small differences that were found. Given the fact that all of the included studies were not blinded, this could be due to patient or carer expectations. However, at this time both treatments can be seen as valid options with respect to results at a maximum of one to two years. Given the current absence of truly long‐term results, use of these mobile disc prostheses should still be limited to clinical trials. There was high‐quality evidence that the goal of preservation of segmental mobility in arthroplasty was met. A statistically significant effect on the incidence of secondary symptoms at adjacent levels, the primary goal of arthroplasty over fusion, was not found at one to two years. If there was a protective effect, this should become clearer over time. A future update, when studies with 'truly long‐term' results (five years or more) become available, should focus on this issue.

Background: When developing Physiotherapy guidelines and/or statements one focuses on description of proven effective physiotherapy fitting to the needs of patients. However, research shows that therapists find it hard to make appropriate choices in the clinical reasoning process, predominantly[for full text, please go to the a.m. URL], G-I-N Conference 2012