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BackgroundLong-lasting effects of COVID-19 may include cardiovascular, respiratory, skeletal muscle, metabolic, psychological disorders and persistent symptoms that can impair health-related quality of life (HRQoL). We investigated the effects of a home-based exercise training (HBET) programme on HRQoL and health-related outcomes in survivors of severe/critical COVID-19.MethodsThis was a single-centre, single-blinded, parallel-group, randomised controlled trial. Fifty survivors of severe/critical COVID-19 (5±1 months after intensive care unit discharge) were randomly allocated (1:1) to either a 3 times a week (~60–80 min/session), semi-supervised, individualised, HBET programme or standard of care (CONTROL). Changes in HRQoL were evaluated through the 36-Item Short-Form Health Survey, and physical component summary was predetermined as the primary outcome. Secondary outcomes included cardiorespiratory fitness, pulmonary function, functional capacity, body composition and persistent symptoms. Assessments were performed at baseline and after 16 weeks of intervention. Statistical analysis followed intention-to-treat principles.ResultsAfter the intervention, HBET showed greater HRQoL score than CONTROL in the physical component summary (estimated mean difference, EMD: 16.8 points; 95% CI 5.8 to 27.9; effect size, ES: 0.74), physical functioning (EMD: 22.5 points, 95% CI 6.1 to 42.9, ES: 0.83), general health (EMD: 17.4 points, 95% CI 1.8 to 33.1, ES: 0.73) and vitality (EMD: 15.1 points, 95% CI 0.2 to 30.1, ES: 0.49) domains. 30-second sit-to-stand (EMD: 2.38 reps, 95% CI 0.01 to 4.76, ES: 0.86), and muscle weakness and myalgia were also improved in HBET compared with CONTROL (p<0.05). No significant differences were seen in the remaining variables. There were no adverse events.ConclusionHBET is an effective and safe intervention to improve physical domains of HRQoL, functional capacity and persistent symptoms in survivors of severe/critical COVID-19.Trial registration numberNCT04615052.

To assess the effects of creatine supplementation, associated or not with strength training, upon emotional and cognitive measures in older woman. This is a 24-week, parallel-group, double-blind, randomized, placebo-controlled trial. The individuals were randomly allocated into one of the following groups (n=14 each): 1) placebo, 2) creatine supplementation, 3) placebo associated with strength training or 4) creatine supplementation associated with strength training. According to their allocation, the participants were given creatine (4 x 5 g/d for 5 days followed by 5 g/d) or placebo (dextrose at the same dosage) and were strength trained or not. Cognitive function, assessed by a comprehensive battery of tests involving memory, selective attention, and inhibitory control, and emotional measures, assessed by the Geriatric Depression Scale, were evaluated at baseline, after 12 and 24 weeks of the intervention. Muscle strength and food intake were evaluated at baseline and after 24 weeks. After the 24-week intervention, both training groups (ingesting creatine supplementation and placebo) had significant reductions on the Geriatric Depression Scale scores when compared with the non-trained placebo group (p = 0.001 and p = 0.01, respectively) and the non-trained creatine group (p < 0.001 for both comparison). However, no significant differences were observed between the non-trained placebo and creatine (p = 0.60) groups, or between the trained placebo and creatine groups (p = 0.83). Both trained groups, irrespective of creatine supplementation, had better muscle strength performance than the non-trained groups. Neither strength training nor creatine supplementation altered any parameter of cognitive performance. Food intake remained unchanged. Creatine supplementation did not promote any significant change in cognitive function and emotional parameters in apparently healthy older individuals. In addition, strength training per se improved emotional state and muscle strength, but not cognition, with no additive effects of creatine supplementation. Clinicaltrials.gov NCT01164020.

Background Little is known about the performance of severity indices for indicating intensive care and predicting mortality in the Intensive Care Unit (ICU) of trauma patients. This study aimed to compare the performance of severity indices to predict trauma patients’ ICU admission and mortality. Methods A retrospective cohort study which analyzed the electronic medical records of trauma patients aged ≥ 18 years, treated at a hospital in Brazil, between 2014 and 2017. Physiological [Revised Trauma Score (RTS), New Trauma Score (NTS) and modified Rapid Emergency Medicine Score (mREMS)], anatomical [Injury Severity Score (ISS) and New Injury Severity Score (NISS)] and mixed indices [Trauma and Injury Severity Score (TRISS), New Trauma and Injury Severity Score (NTRISS), Base-deficit Injury Severity Score (BISS) and Base-deficit and New Injury Severity Score (BNISS)] were compared in analyzing the outcomes (ICU admission and mortality) using the Area Under the Receiver Operating Characteristics Curves (AUC–ROC). Results From the 747 trauma patients analyzed (52.5% female; mean age 51.5 years; 36.1% falls), 106 (14.2%) were admitted to the ICU and 6 (0.8%) died in the unit. The ISS (AUC 0.919) and NISS (AUC 0.916) had better predictive capacity for ICU admission of trauma patients. The NISS (AUC 0.949), TRISS (AUC 0.909), NTRISS (AUC 0.967), BISS (AUC 0.902) and BNISS (AUC 0.976) showed excellent performance in predicting ICU mortality. Conclusions Anatomical indices showed excellent predictive ability for admission of trauma patients to the ICU. The NISS and the mixed indices had the best performances regarding mortality in the ICU.

ABSTRACT Objectives: to identify factors associated with the presence of emotional disorders and the quality of life of nursing professionals who provided care to patients with COVID-19. Methods: a quantitative study was conducted between February and March 2021, with a convenience sample of 11,477 nursing professionals from Brazilian institutions. The Self-Reporting Questionnaire-20 and the World Health Organization Quality of Life-bref were administered. Results: in the sample (86.24% women, mean age 33.27 years), female professionals belonging to a risk group for COVID-19, who worked in hospitals with a shortage of personal protective equipment, suffered verbal or physical aggression on public transportation, or were isolated from their families, presented higher levels of emotional disorders measured by the Self-Reporting Questionnaire-20 and reduced quality of life in all World Health Organization Quality of Life-bref domains. Conclusions: personal and institutional work conditions have impacted the mental health and quality of life of Brazilian nurses. RESUMEN Objetivos: identificar los factores asociados con la presencia de distrés emocional y la calidad de vida en profesionales de enfermería que atendieron a pacientes con COVID-19. Métodos: se realizó un estudio cuantitativo entre febrero y marzo de 2021, con una muestra por conveniencia de 11.477 profesionales de enfermería de instituciones de Brasil. Se administraron el Self-Reporting Questionnaire-20 y el World Health Organization Quality of Life-bref. Resultados: en la muestra (86,24% mujeres, edad media 33,27 años), las profesionales pertenecientes a un grupo de riesgo para COVID-19, que trabajaban en hospitales con falta de equipo de protección individual, sufrieron agresión verbal o física en el transporte público o estuvieron aisladas de sus familias, presentaron niveles más altos de trastornos emocionales medidos por el Self-Reporting Questionnaire-20 y una calidad de vida reducida en todos los dominios de la World Health Organization Quality of Life-bref. Conclusiones: las condiciones laborales personales e institucionales impactaron la salud mental y la calidad de vida de las enfermeras brasileñas. RESUMO Objetivos: identificar fatores associados à presença de transtorno emocional e qualidade de vida dos profissionais de enfermagem que prestaram assistência a pacientes com COVID-19. Métodos: estudo quantitativo, entre fevereiro e março de 2021, com amostra por conveniência de 11.477 profissionais de enfermagem de instituições do Brasil. O Self-Reporting Questionnaire-20 e o World Health Organization Quality of Life-bref foram aplicados. Resultados: na amostra (86,24% mulheres, idade média 33,27 anos), profissionais do sexo feminino, pertencentes a grupo de risco para COVID-19, que atuavam em hospitais onde houve carência de equipamento de proteção individual, sofreram agressão verbal ou física no transporte público ou afastamento familiar, apresentaram maiores níveis de transtornos emocionais mensurados pelo Self-Reporting Questionnaire-20 e redução da qualidade de vida em todos os domínios do World Health Organization Quality of Life-bref. Conclusões: condições pessoais e da instituição de trabalho impactaram a saúde mental e qualidade de vida da enfermagem brasileira.

\"Living Well with Lupus\" (LWWL) consisted of a lifestyle intervention program tailored for patients with systemic lupus erythematosus (SLE) and high cardiovascular risk. In the present study, we assessed the maintenance of behavior changes related to physical activity and healthy eating after the 6-month LWWL program. Semi-structured interviews were conducted with 25 participants from the intervention group between 7 and 28 months after the program ended. Using qualitative content analysis, themes regarding behavior maintenance and perceived effects were identified. Our findings suggest that maintaining the new lifestyle behaviors resulted in health benefits such as weight loss, pain reduction, and improved well-being; whereas worsening health, with increased anxiety, fatigue, and pain were reported among those that did not maintain the new behaviors over time. Most importantly, the main barriers to maintaining lifestyle changes included adverse weather conditions, family conflicts, health problems, and high work demands. On the other hand, family and professional support were highlighted as facilitators. These results suggest the importance of ongoing support to promote adherence to lifestyle changes in SLE patients. Integrated interventions with family and professional support are essential for sustaining these changes, highlighting the need for a holistic approach to health promotion for patients with chronic conditions.

Background Patients with rheumatoid arthritis spend most of their daily hours in sedentary behavior (sitting), a predisposing factor to poor health-related outcomes and all-cause mortality. Interventions focused on reducing sedentary time could be of novel therapeutic relevance. However, studies addressing this topic remain scarce. We aim to investigate the feasibility and efficacy of a newly developed intervention focused on reducing sedentary time, and potential clinical, physiological, metabolic and molecular effects in rheumatoid arthritis. Methods The Take a STAND for Health study is a 4-month, parallel-group, randomized controlled trial, in which postmenopausal patients with rheumatoid arthritis will set individually tailored, progressive goals to replace their sedentary time with standing and light-intensity activities. Patients will be recruited from the Clinical Hospital (School of Medicine, University of Sao Paulo) and will be assessed at baseline and after a 4-month follow up. Outcomes will include objectively measured sedentary behavior (primary outcome) and physical activity levels, clinical parameters, anthropometric parameters and body composition; aerobic fitness, muscle function, blood pressure, cardiovascular autonomic function, vascular function and structure, health-related quality of life, and food intake. Blood and muscle samples will be collected for assessing potential mechanisms, through targeted and non-targeted approaches. Discussion Findings will be of scientific and clinical relevance with the potential to inform new prescriptions focused on reducing sedentary behavior, a modifiable risk factor that thus far has been overlooked in patients with rheumatoid arthritis. Trial registration ClinicalTrials.gov, NCT03186924 . Registered on 14 June 2017.

Systemic autoimmune myopathies (SAMs) are a heterogeneous group of rare systemic autoimmune diseases that primarily affect skeletal muscles. Patients with SAMs show progressive skeletal muscle weakness and consequent functional disabilities, low health quality, and sedentary lifestyles. In this context, exercise training emerges as a non-pharmacological therapy to improve muscle strength and function as well as the clinical aspects of these diseases. Because many have feared that physical exercise exacerbates inflammation and consequently worsens the clinical manifestations of SAMs, it is necessary to evaluate the possible benefits and safety of exercise training among these patients. The present study systematically reviews the evidence associated with physical training among patients with SAMs.

Resumo Objetivo: identificar fatores associados à contaminação e internação hospitalar por COVID-19 em profissionais de enfermagem. Método: estudo transversal, realizado em hospital especializado em cardiologia, com 415 profissionais de enfermagem. Foram avaliadas as variáveis sociodemográficas, comorbidades, condições de trabalho e questões relacionadas ao adoecimento pela COVID-19. Na análise dos dados, utilizaram-se os testes Qui-Quadrado, Fisher, Wilcoxon, Mann-Whitney e Brunner Munzel, a razão de chances para internação hospitalar, além de regressão logística binária. Resultados: a taxa de profissionais de enfermagem acometidos pela COVID-19 foi de 44,3% e os fatores associados à contaminação foram o número de pessoas no mesmo domicílio com COVID-19 (OR 36,18; p<0,001) e o uso de transporte público (OR 2,70; p=0,044). Ter sintomas graves (OR 29,75), pertencer ao grupo de risco (OR 3,00), apresentar taquipneia (OR 6,48), falta de ar (OR 5,83), cansaço (OR 4,64), febre (OR 4,41) e/ou mialgia (OR 3,00) aumentou as chances de internação hospitalar dos profissionais com COVID-19. Conclusão: habitar o mesmo domicílio que outras pessoas com a doença e usar transporte público aumentou o risco de contaminação pelo novo coronavírus. Os fatores associados à internação hospitalar dos profissionais contaminados foram a presença de fatores de risco para doença, a gravidade e o tipo dos sintomas apresentados. Resumen Objetivo: identificar los factores asociados al contagio y la hospitalización por COVID-19 en los profesionales de enfermería. Método: estudio transversal, realizado en un hospital especializado en cardiología, con 415 profesionales de enfermería. Se evaluaron las variables sociodemográficas, comorbilidades, condiciones de trabajo y preguntas relacionadas con la enfermedad por COVID-19. En el análisis de los datos, se utilizaron las pruebas de Chi-Cuadrado, Fisher, Wilcoxon, Mann-Whitney y Brunner Munzel, la razón de chance para la hospitalización, además de la regresión logística binaria. Resultados: la tasa de profesionales de enfermería afectados por el COVID-19 fue del 44,3% y los factores asociados al contagio fueron el número de personas en una misma vivienda con COVID-19 (OR 36,18; p<0,001) y el uso de transporte público (OR 2,70; p=0,044). Presentar síntomas graves (OR 29,75), pertenecer al grupo de riesgo (OR 3,00), tener taquipnea (OR 6,48), dificultad para respirar (OR 5,83), cansancio (OR 4,64), fiebre (OR 4,41) y/o mialgia (OR 3,00) aumentó las chances de hospitalización de los profesionales con COVID-19. Conclusión: vivir en el mismo domicilio que otras personas que tienen la enfermedad y utilizar el transporte público aumentó el riesgo de contagio por el nuevo coronavirus. Los factores asociados a la hospitalización de los profesionales contagiados fueron la presencia de factores de riesgo para enfermarse, la gravedad y el tipo de síntomas presentados. Abstract Objective: to identify factors associated with infection and hospitalization due to COVID-19 in nursing professionals. Method: a cross-sectional study carried out with 415 nursing professionals in a hospital specialized in cardiology. The sociodemographic variables, comorbidities, working conditions and issues related to illness due to COVID-19 were evaluated. Chi-Square, Fisher’s, Wilcoxon, Mann-Whitney and Brunner Munzel tests were used in data analysis, as well as Odds Ratio for hospitalization, in addition to binary logistic regression. Results: the rate of nursing professionals affected by COVID-19 was 44.3% and the factors associated with infection were the number of people living in the same household infected by COVID-19 (OR 36.18; p<0.001) and use of public transportation (OR 2.70; p=0.044). Having severe symptoms (OR 29.75), belonging to the risk group (OR 3.00), having tachypnea (OR 6.48), shortness of breath (OR 5.83), tiredness (OR 4.64), fever (OR 4.41) and/or myalgia (OR 3.00) increased the chances of hospitalization in professionals with COVID-19. Conclusion: living in the same household as other people with the disease and using public transportation increased the risk of infection by the new coronavirus. The factors associated with the hospitalization of contaminated professionals were presence of risk factors for the disease, severity and type of the symptoms presented.

It has been suggested that the abrupt liposuction-induced decrease in adipose tissue could affect adipokine secretion pattern. We hypothesized that exercise training could positively impact adipokine metabolism following liposuction. The aim of this study was to investigate the effects of liposuction on inflammation-related adipokines in women who were either exercise-trained or remained sedentary after surgery. Thirty-six healthy normal-weight women underwent an abdominal liposuction and two months after surgery were randomly allocated into two groups: trained (TR, n = 18 , four-month exercise program) and nontrained (NT, n = 18 ). Inflammation-related adipokine serum levels (TNF-α, IL-6, IL-10, and adiponectin) and abdominal and thigh subcutaneous adipose tissue (scAT) mRNA levels were assessed before (PRE) and six months after surgery (POST6). TNF-α, IL-6, and IL-10 serum levels were unchanged in both groups. In contrast, TNF-α, IL-6, and IL-10 mRNA levels in scAT were increased, whereas adiponectin scAT mRNA and serum levels were decreased at POST6 ( P < 0.05 , main effect for time). No changes were observed in mRNA levels of MCP-1, CD14, and CD68 in any of the groups. In conclusion, liposuction downregulates adiponectin scAT gene expression and serum levels and upregulates scAT gene expression of inflammation-related genes six months after surgery in normal-weight women, irrespective of exercise training.

ObjectiveTo describe acute/postacute COVID-19 presentations in athletes.DesignSystematic review and meta-analysis.Data sourcesThe search was conducted in four databases (MEDLINE, EMBASE, SCOPUS, SPORTDiscus) and restricted to studies published from 2019 to 6 January 2022.Eligibility criteria for selecting studiesStudies were required to (1) include professional, amateur or collegiate/university athletes with COVID-19; (2) present data on acute/postacute COVID-19 symptoms and (3) have an observational design. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tools.Results43 studies with 11 518 athletes were included. For acute presentation, the pooled event rates for asymptomatic and severe COVID-19 were 25.5% (95% CI: 21.1% to 30.5%) and 1.3% (95% CI: 0.7% to 2.3%), respectively. For postacute presentations, the pooled estimate of persistent symptoms was 8.3% (95% CI: 3.8% to 17.0%). Pooled estimate for myocardial involvement was 5.0% (95% CI: 2.5% to 9.8%) in athletes undergoing any cardiac testing, and 2.5% (95% CI: 1.0% to 5.8%) in athletes undergoing MRI, although clinical symptoms were not characterised. None of the studies with a control group (eg, non-infected athletes) could confirm a causal relationship between COVID-19 and myocardial involvement.ConclusionThis broad characterisation of COVID-19 presentations in athletes indicates that ~94% exhibited mild or no acute symptoms. The available evidence did not confirm a causal relationship between COVID-19 and myocardial involvement. A small proportion of athletes experienced persistent symptoms while recovering from infection, which were mostly mild in nature, but could affect return-to-play decisions and timing.