Muscle strength is a crucial predictor of adverse outcomes and is essential for identifying kratopenia and physical limitations. Smoking can aggravate this condition, damaging the musculoskeletal system. Assessing muscle strength, especially with portable dynamometers, is essential for early detection of muscle dysfunction. Studies demonstrate the importance of standardizing protocols and defining cut-off points for peripheral muscle weakness in general. Thus, focusing on the effects of smoking on muscle function, the objective was to investigate cut-off points based on functional limitation and identify the presence of kratopenia in smokers. This cross-sectional study, composed of smokers (conventional cigarettes), regardless of gender, aged over 18 years, was conducted with a comprehensive approach. The volunteers were evaluated by personal data, carbon monoxide analysis (monoximetry), and physical-functional aspects such as lung function (spirometry), functional performance (6-minute walk test, sit-to-stand, fourmeter gate speed, and physical activity in daily life), and peripheral muscle strength (portable digital dynamometry). A total of 143 smokers were evaluated, with high levels of tobacco dependence and preserved lung function. Men showed significantly higher peripheral muscle strength across all variables (p < 0.05). ROC analysis revealed acceptable discrimination for detecting kratopenia from functional limitation: AUC of 70% for knee extension (p < 0.01) from the cut-off points identified for knee extension lower than 214.8Nw and 273.6Nw; and 70% for knee flexion (p < 0.01) lower than 125 Nw and 156.2Nw, women and men, respectively, to be loss of muscle strength and power. Kratopenia was present in > 50% of participants based on peak torque (Nw) (56% of knee extension and 52% of knee flexion), being more prevalent in women. Peak knee torque measurements, especially those of extension and flexion, can determine kratopenia in limited functional smokers. Determining specific cut-off points offers an effective tool to identify and prevent sarcopenia risk in smokers.

PURPOSE:This study aimed to compare objective sleep parameters in children who stutter (CWS) with those in children who do not stutter (CWNS) using actigraphy. Previous research, mainly relying on subjective methods such as questionnaires and sleep diaries, has highlighted the high prevalence of sleep disorders in individuals who stutter. METHODS:Sleep parameters, including sleep onset latency, sleep efficiency, sleep duration, and total sleep time, were objectively measured using actigraphy over 14 consecutive days. The study included 30 CWS (aged 4-12 years) and 21 CWNS (also aged 4-12 years). Data were analyzed with SPSS Statistics 28.0 software, expressed as medians with interquartile ranges (25-75 %). Group comparisons were conducted using the Mann-Whitney test. The significance level for all statistical tests was set at p < 0.05. RESULTS:CWS exhibited significantly longer sleep onset latency (p < 0.001) and lower sleep efficiency (p = 0.01) compared to CWNS. No significant differences were observed in total sleep time or sleep duration between the groups. DISCUSSION:This study provides objective evidence that CWS experience specific alterations in sleep parameters, particularly in sleep onset latency and sleep efficiency. This suggests a higher prevalence of sleep disturbances within this population. These findings highlight the importance of integrating sleep assessments into the clinical management of stuttering to improve therapeutic outcomes.

Objectives: Offer respiratory physiotherapeutic rehabilitation to individuals affected by COVID-19. Methods: The project was developed by the State University of Northern Paraná (UENP), patients were evaluated to ascertain their level of functional capacity and respiratory function and, based on the results obtained, treatment plans were prepared for each patient, lasting from 4 to 8 weeks. Resultados: The project lasted more than a year and treated 17 patients, with the participation of 21 students and 3 specialist professors. Patients show improvement after weeks of treatment, especially with regard to symptoms of fatigue severity and functional capacity according to the 6-minute walk test. Conclusion: In the social sphere, this project had a significant impact on patients, by promoting respiratory physiotherapeutic assistance aimed at post-COVID-19 rehabilitation, and on academics, by promoting knowledge and practical experience on outpatient cardiorespiratory rehabilitation in post-COVID-19. Key-words: COVID-19; rehabilitation; treatment outcome.

Introdução: A pneumonia associada à ventilação mecânica (PAV) é aquela que se instala após 48 horas de ventilação mecânica (VM), apresentando particularidades em relação à pneumonia hospitalar sem VM. Objetivo: Determinar o índice de prevalência da PAV em uma Unidade de Terapia Intensiva do Norte do Paraná, e seus fatores associados. Métodos: Foram coletados os dados de prontuários de 51 pacientes sob VM por mais de 24 horas consecutivas prospectivamente em um hospital universitário do Norte do Paraná. Resultados: Os achados revelam que eram: 37 homens e 4 mulheres, com idade de 72 [57-80] anos, 4 [3-7] dias de internação, 4 [3-6] dias de utilização da VM, risco de óbito APACHE II 73 [73-85]%, risco de mortalidade SOFA 40-50 [40-50 – 80]%. Observou-se a ocorrência de 11,7% de casos de PAV e 70,5% de óbitos. Em geral os pacientes que desenvolveram pneumonia associada a ventilação mecânica apresentaram idade elevada (61 [42-73] anos), permaneceram mais tempo internados (15 [9-19] dias), apresentaram maior permanência em ventilação mecânica (10 [5-11] dias) propiciando o desenvolvimento da PAV e quadros neurológicos associados (acidente vascular cerebral hemorrágico (1/6 – 16,6%); pós parada cardiorrespiratória, politrauma (1/6 – 16,6%); acidente vascular cerebral isquêmico (2/6 – 33,3%); ICE (1/6 – 16,6%); traumatismo crânio encefálico e morte encefálica (1/6 – 16,6%) e ocorrência de morte em 4 casos (66,6%). Conclusão: O índice de PAV foi significativamente baixo. Porém a amostra, foi considerada pequena, com alto índice de óbito, não dando tempo para o desenvolvimento da PAV.

Smartphones may provide a highly available access to simplified hypertension screening in environments with limited health care resources. Most studies involving smartphone blood pressure (BP) apps have focused on validation in static conditions without taking into account intraindividual BP variations. We report here the first experimental evidence of smartphone-derived BP estimation compared to an arterial catheter in a highly dynamic context such as induction of general anesthesia. We tested a smartphone app (OptiBP) on 121 patients requiring general anesthesia and invasive BP monitoring. For each patient, ten 1-min segments aligned in time with ten smartphone recordings were extracted from the continuous invasive BP. A total of 1152 recordings from 119 patients were analyzed. After exclusion of 2 subjects and rejection of 565 recordings due to BP estimation not generated by the app, we retained 565 recordings from 109 patients (acceptance rate 51.1%). Concordance rate (CR) and angular CR demonstrated values of more than 90% for systolic (SBP), diastolic (DBP) and mean (MBP) BP. Error grid analysis showed that 98% of measurement pairs were in no- or low-risk zones for SBP and MBP, of which more than 89% in the no-risk zone. Evaluation of accuracy and precision [bias ± standard deviation (95% limits of agreement)] between the app and the invasive BP was 0.0 ± 7.5 mmHg [− 14.9, 14.8], 0.1 ± 2.9 mmHg [− 5.5, 5.7], and 0.1 ± 4.2 mmHg [− 8.3, 8.4] for SBP, DBP and MBP respectively. To the best of our knowledge, this is the first time a smartphone app was compared to an invasive BP reference. Its trending ability was investigated in highly dynamic conditions, demonstrating high concordance and accuracy. Our study could lead the way for mobile devices to leverage the measurement of BP and management of hypertension.

Background: Few studies have examined the relationship of one's habitual physical activity level and autonomic nervous system (ANS) modulation on sleep quality in smokers. Objective: The aim of this study was to identify changes in the sleep quality of smokers and its relation with their habitual physical activity level and ANS modulation. Methods: Forty-two smokers were divided into two groups according to the 50th percentile of the moderate-to-vigorous physical activity (MVPA). Sleep quality was assessed using the Mini-sleep Questionnaire, and ANS modulation was assessed by indices of heart rate variability (HRV). To examine the possible mean differences, the analysis of covariance (ANCOVA) was used, adjusted for age, sex, body composition, pack-years, beta-blockers, anxiety, and depression in log base 10, not including qualitative data, such as sex and beta-blockers. Correlations were made by using the Spearman rank correlation. The statistical significance was set at 5% Results: The smokers who were less active showed poor sleep quality (p=0.048) and insomnia (p=0.045). Furthermore, the less active group presented decreased parasympathetic modulation [HF (un; p=0.049); RMSSD (ms; p=0.047) and SD1 (ms; p=0.047)] and an increased LF (un) index (p=0.033) and LF/HF ratio (p=0.040). A positive correlation between the total Mini-sleep score with LF (un) index (r=0.317, p=0.041) and LF/HF ratio (r=0.318, p=0.040) and negative correlation with HF (un) index (r= -0.322, p=0.038). Conclusions: Smokers with lower levels of habitual physical activity showed poor sleep quality and alterations in autonomic nervous system modulation;

Abstract Introduction Ambulatory blood pressure monitoring (ABPM) is increasingly used in clinical practice for the formal diagnosis of hypertension, and particularly indicated in cases of suspected white-coat effect, masked, or nocturnal hypertension. However, the use of cuffs for ABPM may be painful and cause discomfort, particularly at night, where it may even provoke arousal from sleep and lead to non-representative nighttime blood pressure (BP) values. Purpose To investigate the feasibility of using a cuffless watch-like photoplethysmographic (PPG) sensor for 24-hour ABPM by comparing the PPG-based BP estimates with conventional cuff-derived ABPM values. Methods Our study was approved by the local ethical committee and conducted in 70 participants (43±18 y, 35 with hypertension, 41 male) undergoing cuff-based ABPM. At the contralateral side of the cuff, a cuffless watch-like PPG sensor was worn at the wrist or upper arm. Systolic (SBP) and diastolic (DBP) BP values were estimated by pulse wave analysis on the measured PPG signals. Following a calibration procedure, the PPG-based daytime and nighttime BP estimates were compared to their cuff-based counterparts. The agreement between both methods was evaluated via the mean (bias) and standard deviation (SD) of their differences by Bland-Altman analysis. The agreement on the nocturnal dipping estimates of both devices was also assessed. Finally, the concordance rate (CR) was assessed as the percentage of dipping values showing a concordant direction (dipping vs. non-dipping) between both methods. Results The data of 4 participants were incomplete due to technical issues and had to be rejected prior to analysis. In 4 additional participants, the PPG data quality was insufficient to provide enough BP estimates, probably due to poor sensor tightening. In the remaining 62 participants, we found (see Figure 1) differences between the daytime PPG-based and cuff-based BP estimates of −0.9±3.6 mmHg and −1.4±2.9 mmHg for SBP and DBP, respectively. The differences between the nighttime estimates were −0.8±6.8 mmHg and 0.5±5.3 mmHg, resulting in dipping differences of 0.1±6.8% and −2.0±8.6% for SBP and DBP, respectively. CR on dipping was 97% for both SBP and DBP. Conclusions Good agreement was found between the PPG-based and the cuff-based daytime and nighttime BP averages, with generally negligible (∼1 mmHg) biases. The direction of dipping was highly concordant between both methods. The estimation of its amplitude showed a low bias (∼1%) but a non-negligible spread (SD), which can be in part attributed to the uncertainty on the cuff-based dipping estimates (95% confidence interval range of 12.5% and 16.5% on average for SBP and DBP, respectively), more than twice as large than their PPG-based counterparts (5.7% and 7.8%). Although our study was designed as a method-comparison feasibility study, these results encouragingly suggest that cuffless ABPM may soon become a clinical possibility. Funding Acknowledgement Type of funding sources: None. Figure 1

(1) Background: New cuffless technologies attempting blood-pressure measurements (BPM) offer possibilities to improve hypertension awareness and control. The aim of this study was to compare a smartphone application (app)-based algorithm with office BPM (OBPM). (2) Methods: We included consecutive patients with an indication for ambulatory BPM. The smartphone app (RIVA digital) acquired the pulse wave in the fingers’ arterial bed using the phone’s camera and estimated BP based on photoplethysmographic (PPG) waveforms. Measurements were alternatingly taken with an oscillometric cuff-based device and smartphone BPM (AppBP) on two consecutive days. AppBP were calibrated to the first OBPM. Each AppBP was compared to its CuffBP (mean of the previous/following OBPM). (3) Results: 50 participants were included, resulting in 50 AppBP values on Day 1 and 33 on Day 2 after exclusion of 225 AppBP due to insufficient quality. The mean ± SD of the differences between AppBP and CuffBP was 0.7 ± 9.4/1.0 ± 4.5 mmHg (p-value 0.739/0.201) on Day 1 and 2.6 ± 8.2/1.3 ± 4.1 mmHg (p-value 0.106/0.091) on Day 2 for systolic/diastolic values, respectively. There were no significant differences between the deviations on Day 1 and Day 2 (p-value 0.297/0.533 for systolic/diastolic values). Overall, there were 10 (12%) systolic measurement pairs differing by >15 mmHg. (4) Conclusions: In this pilot evaluation, the RIVA Digital app shows promising results when compared to oscillometric cuff-based measurements, especially regarding diastolic values. Its differences between AppBP–CuffBP have a good stability one day after calibration. Before clinical use, signal acquisition needs improvement and the algorithm needs to undergo formal validation against a gold-standard BPM method.

BACKGROUND:The specific benefits of aerobic exercises in smoking cessation are unclear, as they have different characteristics, intensities, and durations. The purpose of this systematic review with meta-analysis was to evaluate the effects of aerobic exercise, with or without co-interventions, compared with a control group of cognitive behavior treatment on smoking cessation.METHODS:This review was prospectively registered on PROSPERO, and the searches were performed from 2016 to 2018. Randomized controlled trials evaluating the effects of aerobic exercise, with or without nicotine therapy replacement, compared with usual care were included. The primary outcome was smoking cessation defined as the prevalence of those who quit or continuous abstinence. Meta-analysis was calculated using random effects model in the comprehensive meta-analysis software.RESULTS:The authors identified 18 trials reporting data for a total of 2815 participants. There was moderate-quality evidence that aerobic exercise was better than usual care in promoting smoking cessation at short term (11 trials, risk ratio 0.79; 95% confidence interval, 0.66-0.94). However, there were no differences between aerobic exercises and usual care at medium- or long-term follow-ups.CONCLUSIONS:According to review, aerobic exercise may be effective in promoting smoking cessation at short-term, but not at medium- and long-term follow-ups.

Abstract Introduction: Biosafety consists in the set of measures applied to prevent the spread of infectious agents. Through biosafety, it is possible to avoid and inhibit the risks that compromise the health of the individual, animals and the environment. Objective: To evaluate the knowledge about biosafety in undergraduate physiotherapy students and physiotherapists. Methods: The work was a field study with a defined universe, and classified as descriptive, exploratory, quantitative-qualitative. The sample consisted of 93 physiotherapy students from the Universidade Estadual do Norte do Paraná (State University of Northern Paraná), Jacarezinho, Brazil, and 10 professionals working in the region. Data were collected through a questionnaire on knowledge about biosafety and cross-infections. A statistical analysis was performed using SPPS software version 25.0, and the data was evaluated by the Shapiro-Wilk normality test, and the variables expressed as median and interquartile range (25% -75%). The chi-square test was applied to determine statistically significant differences between the different years of the physiotherapy course and the trained professionals. Through content analysis, open treatment and analysis of qualitative data were chosen. The level of significance used was 5%. Results: There was a small deficit in the knowledge of biosafety; however, this knowledge increased to some extent with the evolution of students in the course (p < 0.05). Conclusion: Most students and professionals have enough knowledge to control or even eradicate the risks of certain activities and prevent cross-infection in the practice of physiotherapy. The perceived deficit in knowledge in biosafety can be easily resolved with the adequate dissemination of knowledge on the subject.

PURPOSE To quantify and compare physical activity (PA) level of university students from different fields of study, and to investigate its correlates. METHODS 221 students (111 female, 20[18-23]years), from different study fields were cross-sectionally assessed for daily PA (pedometer), cardiorespiratory fitness (20m Shuttle Run Test-20mSRT), health-related quality of life (HRQoL), anxiety and depression symptoms. RESULTS In general, 60% of the students were physically active (> 8000 steps/day), presented good HRQoL an cardiorespiratory fitness, minimal symptoms of depression and moderate of anxiety. The highest PA level was observed in students from physical education and sport sciences, and the lowest in those from social sciences (median[IQR]: 9882[8435-13510] versus 7593[6070- 9753] steps/day, respectively; P < 0.01). Male students were more active than female. Steps/day was moderately associated with VO2max [r = 0.42], VO2%pred [r = 0.41] and distance achieved in the 20mSRT [r = 0.43] (P < 0.0001 for all), and weakly associated wit anxiety symptoms (r = -0.20; P = 0.004) and HRQoL domains (0.15 < r < 0.21; p < 0.05). Distance achieved in the 20mSRT was the only determinant of steps/day (adjusted R2 = 0.22; p < 0.0001). CONCLUSIONS Most university students can be considered as physically active. In these young adults, lower PA level correlates moderately with worse cardiorespiratory fitness and weakly with worse HRQoL and anxiety symptoms.

Human society is experiencing intense social changes caused by the new Coronavirus (SARSCoV-2) pandemic. The disease caused by the new Coronavirus (COVID-19) and facing a scenario of fear and high mortality rates, adaptations were necessary in several sectors, especially in health. COVID-19 causes acute respiratory distress syndrome (ARDS). The consequence for infected individuals is the search for medical services, and for more serious cases, it is admitted to an Intensive Care Unit (ICU), given the seriousness and compromise of the case. Based on all the signs and symptoms and evolution of COVID-19, strategies are necessary to alleviate and treat the individual's clinical condition. Thus, physiotherapy is able to significantly minimize the consequences of all sequelae resulting from the hospitalization process, promoting faster functional recovery and, if necessary, providing care to reverse the pulmonary impairment that the infected individual may have.

Objective: To determine the relationships that smoking history has with inflammatory markers, metabolic markers, body composition, muscle strength, and cardiopulmonary capacity in current smokers. Methods: This was a cross-sectional study involving 65 smokers (age range: 18-60 years). On three non-consecutive days, each participant was evaluated in terms of smoking history, pre-existing comorbidities, lung function (by spirometry), peripheral muscle strength (by dynamometry), body composition (by bioelectrical impedance analysis), levels of metabolic/inflammatory markers, and maximum cardiopulmonary capacity (by treadmill exercise test). We evaluated the relationships that smoking history has with inflammatory markers, metabolic markers, body composition, muscle strength, and cardiopulmonary capacity, using logarithmic transformation of the data and calculating Pearson's correlation coefficient and for partial correlations adjusted for age, gender, body mass index (BMI), and comorbidities. To identify the influence of smoking history on pre-existing comorbidities, we used a logistic regression model adjusted for age, BMI, and duration of smoking. Results: Smoking history correlated significantly, albeit weakly, with triglyceride level (r = 0.317; p = 0.005), monocyte count (r = 0.308; p = 0.013), and waist circumference (r = 0.299; p = 0.017). However, those correlations did not retain their significance in the adjusted analysis. In the logistic regression model, smoking more than 20 cigarettes/day correlated significantly with the presence of metabolic diseases (OR = 0.31; 95% CI: 1.009-1.701; p = 0.043). Conclusions: In this sample of smokers, smoking history correlated positively with the triglyceride level, the monocyte count, and waist circumference. The prevalence of metabolic disease was highest in those who smoked more than 20 cigarettes/day.