Percorrer por autor "Fontes, Ana Paula"
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- Anterior femoral cut in total knee arthroplasty: a classification proposalPublication . Medeiros, Filipe; Duarte, António; Correia, Bruno; Carvalho, Maria; Vide, João; Fontes, Ana Paula; Sousa, João PauloBackground: The cut of the anterior femur (CAF) sets the rotation of the femoral component, which could affect patellar tracking, and influence the clinical results on total knee arthroplasty (TKA). The aim of this study was to suggest a classification for anterior femoral cut in TKA. Methods: Images of anterior femoral cuts were aggregated in different shapes and defined a classification. Onehundred femoral image’s cuts were analysed by 5 orthopaedic surgeons, which classified them twice. To analyse inter and intra-observer agreement, the Fleiss Kappa test was used. Results: The study proposes the following CAF classification, type 1 (one peak) and type 2 (two peaks); subtypes 1 (a) a central base peak, 1 (b) a lateral base peak, 2 (a) two peaks where the smallest is in the lower half, and 2 (b) two peaks where the smallest is in the upper half. In our study, type 2 (a) was the most common type (54.5%), followed by type 1 (b). The analysis showed good intra- and inter-observer agreements (mean K of 0.774 and 0.627, respectively). The intra and inter-observer concordance was statistically significant in all the analyses. Conclusions: The CAF classification system for TKA is considered a reproducible classification. To our knowledge, there is no study describing a shape’s classification of this cut. A slight rotation of the femoral cutting guide could change the axial rotation and positioning of the femoral component. An undesirable cut could lead to different patellofemoral offset and could consequently cause anterior pain and instability.
- Are there still sex differences in the functioning of the elderly?Publication . Fontes, Ana PaulaIntroduction: Sex is one of the demographic characteristics that better differentiates the independence of the elderly, despite this distinction not being consensual. Objective: To know the differences in functioning associated with sex in elderly people aged ≥ 65 years according to the International Classification of Functioning, Disability, and Health (ICF). Methods: This was an analytical and cross-sectional observational study with a sample of 451 subjects. The instruments were a sociodemographic questionnaire identical to a ICF checklist and the Biopsychosocial Assessment Method. The student t, Mann-Whitney, chi-square, and Spearman correlation tests were used considering p < 0.05. Results: The average age was between 79.5 ± 7.5 years with a female prevalence (62.1%). Of the 43 variables studied, sex differences were found in 17 (39.5%). In the personal factors, women showed greater vulnerability in conjugality (p ≤ 0.001), cohabitation (p = 0.037), and economic income (p = 0.002). Nonetheless, they showed healthier behaviors in all health-related habits. As for environmental factors and body functions, greater fragility was once again observed in women: the need for assistive devices (p < 0.001) and urinary incontinence (p = 0.021). In activities/participation, differences were found in mobility, where women experienced more restrictions, whereas men were more dependent on washing/drying clothes in domestic life (p = 0.022). Conclusion: Women are more unprotected in social and economic areas, while men showed more vulnerability in habits related to health. These differences are linked to demographic issues related to longevity, cultural differences, and socialization, and differences regarding activities/participation tend to dilute between sexes.
- Benefits of tranexamic acid in total knee arthroplasty: a classification and regression tree analysis in function of instrumentation, BMI, and genderPublication . Pereira, Eduardo; Carvalho, Maria Miguel; Oliveira, Tiago; Sacramento, Telmo; Cruz, Henrique; Viegas, Rui; Fontes, Ana Paula; Marreiros, Ana; Sousa, João PauloTranexamic acid (TXA) is an antifibrinolytic drug that reduces blood loss in patients that undergo Total knee arthroplasty (TKA). Few studies compare its effect on conventional instrumentation (CI) versus patient-specific instrumentation (PSI). The main objective of this study was to understand analytically how TXA usage in both instrumentations influenced blood loss in TKA differently and see if the differences seen could be explained by the patient’s body mass index (BMI) and gender. This nonrandomized retrospective study sample consisted of 688 TKA procedures performed on patients who had symptomatic arthrosis resistant to conservative treatment. Descriptive analysis was used to evaluate blood loss using hemoglobin (Hb) mean values and mean variation (%). The Classification and Regression Tree (CRT) method was applied to understand how the independent variables affected the dependent variable. Comparing patients submitted to the same instrumentation, where some received TXA and others did not, patients that received TXA had lower blood loss. Comparing patients who underwent TKA with different instrumentations and without the use of TXA, it was found that patients who underwent TKA with PSI had lower blood loss than those who underwent TKA with CI. However, when these same instruments were compared again, but associated with the use of TXA, the opposite was true with patients undergoing TKA with PSI showing greater blood loss than patients undergoing TKA with CI. TXA usage in TKA is significantly beneficial in minimizing blood loss and regardless of instrumentation. When using TXA, the lowest blood loss was obtained in patients with higher BMI and submitted to TKA with CI. This is most likely explained by the synergistic antifibrotic effect of TXA with adipokines, such as plasminogen activator inhibitor-1 (PAI-1), found in the femoral bone marrow which is perforated using CI. If, however, TXA wasn’t used, the lowest blood loss was obtained in patients submitted to TKA with PS
- A biopsychosocial evaluation method and the international classification of functioning, disability, and health (ICF)Publication . Fontes, Ana Paula; Botelho, Amália; Fernandes, AnaThis study evaluated the significant contents and concepts of the Biopsychosocial Assessment Method (MAB) as they relate to the International Classification of Functioning, Disability, and Health (ICF) and the connection between the Geriatric Core Set (GCS) and the different issues of the MAB. We linked the 56 items of the MAB to ICF and GCS categories according to published rules. The most significant concepts included in the MAB enabled the connection of 83 items to the ICF’s categories. It was possible to establish a connection with all the components of the ICF except the Body Structures component. Of the 123 categories in the GCS, about 30% did not establish connections with MAB items. The results of this study show that—much like the ICF—the MAB is a tool based on the biopsychosocial model, allowing for a comprehensive and integrated assessment of the different components of functioning. Now, the MAB is the most utilized tool for the evaluation of the geriatric population in Portugal. Thus, it is of the utmost importance that we analyze its results in order to enhance its capabilities. It can then contribute to the creation of a shortened Core Set by the World Health Organization (WHO).
- Comparing conventional and patient specific instrumentation in total knee arthroplasty: an early analysis of function and satisfactionPublication . Vaz Pinto, Goncalo; Dantas, Sofia Caldeira-Dantas; Bessa Magalhães, Tiago; Fontes, Ana Paula; Marreiros, Ana; Ribeiro De Sousa, João PauloBackground: Patient specific instrumentation (PSI) in TKA is a surgical technique created to improve the accuracy of implantation, surgical time, blood loss and workflow that has been a growing trend over the past decade. Our work aims to determine if there are improvements in patient satisfaction and functional results using PSI in comparison with conventional instrumentation (CI) in TKA. Methods: The authors evaluated 716 patients from the past 10 years that underwent TKA, either by PSI (n=456) or by CI (n=260). The authors recorded the WOMAC index, articular range of motion, and the six-minute walking test at preop and day 90 post-op. T-student and Mann-Whitney tests were used considering p<0.05. Results: The functional scores achieved 90 days after surgery were better for PSI compared to CI. The respective differences are found in the extension (p=0.022), gait distance (p=0.010) and in the pain and function WOMAC index (respectively p=0.018 and p=0.020). No statistical differences were found in satisfaction. Conclusions: 90 days after TKA, the functional scores achieved with PSI were better compared to CI. However, better results in this area did not translate to significantly higher satisfaction in the patients. There seems to be a tendency in favor of better functional results in patients that underwent TKA by PSI in comparison to those submitted to CI. These results seem to follow the tendencies demonstrated in available literature.
- Evaluation of health-related quality of life in a physically active senior populationPublication . Fontes, Ana Paula; Joaquim, Natércia; Pereira, TâniaBackground: Physical activity (PA) is a strong determinant of health and one of the most important predictors of healthy aging and health-related quality of life (HRQoL). The aim of the study was to understand the HRQoL of a senior population practicing PA and its association with some socio-demographic characteristics, the levels of PA, and functional independence. Methods: This is a correlational study with a sample of 376 individuals of both sexes. The data collection instruments were a socio-demographic and health questionnaire, the international PA questionnaire (IPAQ)-short version, the Katz index, the Lawton and Brody index, and the WHOQOL-OLD and WHOQOL-BREF questionnaires. Results: The sample revealed a good perception of HRQoL, especially in the “psychological” and “social relations” domains. Sex showed a greater association with quality of life (QoL) than age. Multiple linear regression revealed that the variables with the most significant influence on the individuals’ QoL were related to health (“Presence of chronic disease” and “habitual use of medication”). The QoL related to "social relationships" is the domain with more predictors, with a markedly socio-demographic focus. Conclusions: Practicing PA proved to be a HRQoL predictor, where “sensory function” and HRQoL related to “social relations” are included. Despite PA practice and socio-demographic characteristics being able to predict some HRQoL domains, health-related variables showed a more robust presence in this prediction.
- A funcionalidade dos mais idosos (>= 75 anos): conceitos, perfil e oportunidades de um grupo heterogéneoPublication . Fontes, Ana Paula; Botelho, Amália; Fernandes, Ana AlexandreConhecer a funcionalidade de dois grupos de idosos (75-84 anos e ≥85 anos) e sua associação com idade e gênero. Métodos: Trata-se de estudo observacional do tipo analítico e transversal, cuja amostra foi constituída por indivíduos de ambos os sexos com idade ≥75 anos. Foi recolhida informação relativa a condição de saúde e funcionalidade pré-morbilidade. Os instrumentos de coleta de dados foram um questionário de caracterização sociodemográfica e o Método de Avaliação Biopsicossocial. Resultados: A amostra foi constituída por 262 idosos com média de idade de 82,9 ± 4,86 anos, dos quais 161 (61,5%) eram mulheres. Os mais velhos (≥85 anos) viviam mais isolados (p=0,020) e tinham menores habilitações literárias (p=0,027), apresentando mais limitações em utilizar escadas (p=0,015), no banho (p=0,008), na continência fecal (p=0,015) e em todas as atividades instrumentais (p<0,031). As mulheres apresentavam maior vulnerabilidade no estado civil (p<0,001) e no status econômico (p=0,009), enquanto os homens tinham piores resultados nas quedas (p=0,003) e nos comportamentos de risco (p<0,001). O desempenho na locomoção e nas atividades básicas e instrumentais era semelhante entre os sexos. Conclusões: As variáveis de natureza social apresentaram-se diferentes quanto à idade e ao gênero. As componentes da funcionalidade – locomoção, atividades diárias básicas e atividades instrumentais – apresentaram maiores limitações nos idosos com idade ≥ 85 anos, sobretudo as instrumentais. Não se encontraram diferenças na funcionalidade em relação ao gênero.
- Funcionalidade e incapacidade: aspectos conceptuais, estruturais e de aplicação da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF)Publication . Fontes, Ana Paula; Fernandes, Ana Alexandre; Botelho, Maria AmáliaO objectivo principal do presente artigo é apresentar a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), que faz parte da “família” de classificações desenvolvidas pela Organização Mundial de Saúde. A CIF oferece uma linguagem unificada e normalizada, bem como um marco conceptual para descrever a saúde e os estados relacionados com a saúde, constituindo um valioso instrumento de utilidade prática em Saúde Pública. O modelo estabelece-se em duas grandes partes: a primeira que agrupa a Funcionalidade e a Incapacidade com duas componentes: a) Funções e Estruturas Corporais e b) Actividades e Participação. Uma segunda parte que engloba os Factores Contextuais, também com duas componentes: c) Factores Ambientais e d) Factores Pessoais. As componentes estão classificadas mediante categorias, organizadas numa estrutura hierárquica de 4 níveis. Neste trabalho analisamos o marco conceptual e a estrutura da CIF e descrevemos as linhas de acção relativamente à sua difusão e implementação.
- Functional evolution in total knee arthroplasty: first and second-generation patient-specific instrumentation compared with conventional instrumentationPublication . Fontes, Ana Paula; CINTRA, RUI; Gomes, Luis; João Paulo SousaBackground: This study compares the functional evolution between the first- and second-generation patient-specific instrumentation and conventional instrumentation pre-surgery and the third month post-surgery after TKA. We analyzed the functional outcomes achieved and the absolute gains of each study variable. In addition, we aimed to elucidate the results of the three surgical techniques regarding the surgery length of time, length of hospital stay, percentage drop in hemoglobin (Hg) at 24 h, and hip-knee-ankle angle post-surgery. Methods: We reported our experience in TKA using PSI Visionaire System® and CI technique in 688 procedures. The patients were divided into first (N=272) and second-generation (N=151) PSI designs. The control group (N=265) underwent TKA with the CI. The instruments for assessing the functioning were: visual analog scale, goniometry, 6- minute walk test (6MWT), and domains of the WOMAC Index. Results: The functioning achieved three months after surgery was lower in the CI than the first-generation PSI. The respective differences at absolute gains were found in the 6MWT and pain and function WOMAC scores (p=0.023, p=0.049, and p=0.018, respectively). The mean surgical time was higher in the CI compared to PSI designs (both p<0.001), and the mean hospital length of stay was higher in the CI compared to second-generation PSI (p=0.002). The percentual drop in Hg was higher in the first-generation PSI than with the CI (p=0.006). Conclusions: Three months after TKA, the functioning achieved with the first-generation PSI was greater than the CI. However, the functional results between second-generation PSI and CI were similar.
- Impact of age, gender and body mass index on the efficacy of tranexamic acid in total knee arthroplastyPublication . Viegas, Rui; Kumar, Abhishek; Carvalho, Maria M.; Vide, João; Fontes, Ana Paula; Sousa, João P.Background: Tranexamic acid (TXA) is effective and safe in decreasing blood loss and transfusion rate in total knee arthroplasty (TKA). Few studies focused on the role of patients’ characteristics on the efficacy of TXA in TKA. The purpose of this study was to conduct a retrospective analysis to investigate if age, gender and BMI influence the efficacy of TXA in reducing perioperative blood loss in TKA. Methods: We did an observational study including 366 consecutive patients undergoing TKA in Hospital Particular do Algarve between January 2011 and April 2019 which were divided in two groups: intraoperative administration of intravenous TXA (TXA Group) and no administration of TXA (Control Group). The perioperative blood loss between groups and their relation with age, gender and BMI was compared. Results: Of the 366 patients, 225 (61%) received TXA. In both groups, age did not correlate to the blood loss. Women in the TXA group had less perioperative blood loss than in the control group. No such difference was found for men. The normal weight group showed no difference in perioperative blood loss with or without TXA administration. However, there was a statistically significant difference in the overweight and obese groups. The mean perioperative blood loss was higher in the control group (854±342 ml) than in the TXA group (720±335 ml). Conclusions: TXA administration is efficient in controlling TKA associated hemorrhage in overweight and obese individuals and in women but it doesn’t have that effect in normal weight patients or in men.
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