JULIA MARIA D ANDREA GREVE
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Ortopediae Traumatologia, Faculdade de Medicina - Docente
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Predictors of quality of life of individuals living in Brazil with spinal cord injury/disease(2023) CHRISTOFI, Alice A. S. N.; TATE, Denise G.; WITTER, Carla; ALONSO, Angelica Castilho; GREVE, Julia Maria D'AndreaStudy designA cross-sectional, descriptive study.ObjectivesTo investigate the demographic, clinical behavioral, and rehabilitation predictors of the quality of life (QoL) of people with spinal cord injury/disease (SCI/D) in a middle-income country.MethodNinety-five participants living in the community were evaluated with the following instruments: World Health Organization Quality of Life - Bref; International SCI Core DataSet; Clinical Interview; Spinal Cord Secondary Conditions Scale and Patient Health Questionnaire; Numerical Pain Intensity Scale; Short-Form 12 Health Survey - Item 8 (how much pain hinders activities); Patient Health Questionnaire 2, Numerical Fatigue Scale. Data were analyzed via Spearman correlation, univariate analysis, and multiple regression to explain the effects associated with quality-of-life predictors.ResultsThe main factors that decreased quality of life were fatigue (by 11.5%), depression (by 5.5-12.8%), pain (by 1.3 in total life quality, in the physical domain by 8.6-9.6%), sores (15.6% in the physical domain only). The practice of sports increased the total quality of life by 14.4%, in the physical domain by 11.9%, in the psychological domain by 17.2%, and in the social domain by 23.7%.ConclusionsFatigue, risk of depression, pain, and the presence of sores are predictors of poor quality of life, and sports are a predictor of a better quality of life, for people with spinal cord injury. Multidisciplinary rehabilitation, in addition to policies, to increase accessibility and social inclusion, and incentives or subsidies for the practice of sports could improve QoL following SCI/D.
article Transcranial direct current stimulation is safe and effective in autoimmune myopathies: a randomised, double-blind, sham-controlled trial(2023) SOUSA, L. F. A. de; MISSE, R. G.; SANTOS, L. M. dos; TANAKA, C.; GREVE, J. M. A.; BAPTISTA, A. F.; SHINJO, S. K.Objective We aimed to assess the safety and efficacy of transcranial direct current stimulation (tDCS) in patients with systemic autoimmune myopathies (SAMs).Methods This prospective, randomised, sham-controlled, double-blind, study included 20 patients with SAMs allocated to receive sham or active tDCS (2mA, 20 minutes, 3 days). Electrodes were positioned with the anode over the C1 or C2, whereas the cathode was placed over the Fp2 or Fp1, respectively. The groups were evaluated in four periods with specific questionnaires and functional tests: pre-stimulation and after 30 minutes, three weeks, and eight weeks post-tDCS.Results Two patients from the sham group withdrew after the three sessions. The demographic data, type of myositis, disease duration, and disease status were comparable between the active and sham tDCS groups. After interventions, in the active tDCS group, the physical aspects of SF-36 in week eight, mean and better timed up-and-go test at each evaluation, peak torque of stimulated inferior limb extension improved significantly (p<0.05). The emotional aspect of SF-36 decreased only in the active tDCS group (p<0.001). The patients' adherence to the protocol was 100% and no serious adverse event was reported, including disease relapses.Conclusion This study evidences the safety of tDCS, as well as its potential efficacy in improving muscle strength and function in SAMs patients. More studies with a larger sample and longer tDCS sessions are necessary to corroborate the results of the present study.- Crash Risk Predictors in Older Drivers: A Cross-Sectional Study Based on a Driving Simulator and Machine Learning Algorithms(2023) SILVA, V. C.; DIAS, A. S.; GREVE, J. M. D.; DAVIS, C. L.; SOARES, A. L. D. S.; BRECH, G. C.; AYAMA, S.; JACOB-FILHO, W.; BUSSE, A. L.; BIASE, M. E. M. de; CANONICA, A. C.; ALONSO, A. C.The ability to drive depends on the motor, visual, and cognitive functions, which are necessary to integrate information and respond appropriately to different situations that occur in traffic. The study aimed to evaluate older drivers in a driving simulator and identify motor, cognitive and visual variables that interfere with safe driving through a cluster analysis, and identify the main predictors of traffic crashes. We analyzed the data of older drivers (n = 100, mean age of 72.5 ± 5.7 years) recruited in a hospital in São Paulo, Brazil. The assessments were divided into three domains: motor, visual, and cognitive. The K-Means algorithm was used to identify clusters of individuals with similar characteristics that may be associated with the risk of a traffic crash. The Random Forest algorithm was used to predict road crash in older drivers and identify the predictors (main risk factors) related to the outcome (number of crashes). The analysis identified two clusters, one with 59 participants and another with 41 drivers. There were no differences in the mean of crashes (1.7 vs. 1.8) and infractions (2.6 vs. 2.0) by cluster. However, the drivers allocated in Cluster 1, when compared to Cluster 2, had higher age, driving time, and braking time (p < 0.05). The random forest performed well (r = 0.98, R2 = 0.81) in predicting road crash. Advanced age and the functional reach test were the factors representing the highest risk of road crash. There were no differences in the number of crashes and infractions per cluster. However, the Random Forest model performed well in predicting the number of crashes.
- Heart rate response to exercise and cardiorespiratory fitness of young women at high familial risk for hypertension: effects of interval vs continuous training(2011) CIOLAC, Emmanuel G.; BOCCHI, Edimar A.; GREVE, Julia M. D.; GUIMARAES, Guilherme V.Exercise training is an effective intervention for treating and preventing hypertension, but its effects on heart rate (HR) response to exercise and cardiorespiratory fitness (CRF) of non-hypertensive offspring of hypertensive parents (FH+) has not been studied. We compared the effects of three times per week equal-volume high-intensity aerobic interval (AIT) and continuous moderate-intensity exercise (CME) on HR response to exercise and CRF of FH+. Forty-four young FH+ women (25.0 +/- 4.4 years) randomized to control (CON; n = 12), AIT (80-90% of VO2MAX; n = 16), or CME (50-60% of VO2MAX; n = 16) performed a graded exercise test (GXT) before and after 16 weeks of follow-up to evaluate HR response to exercise and several parameters of CRF. Resting, maximal, and reserve HR did not change after the follow-up in all groups. HR recovery (difference between HRMAX and HR at 1 minute of GXT recovery phase) improved only after AIT (11.8 +/- 4.9 vs. 20.6 +/- 5.8 bpm, p < 0.01). Both exercise programmes were effective for improving CRF parameters, but AIT was more effective than CME for improving oxygen consumption at the respiratory compensation point (VO2RCP; 22.1% vs. 8.8%, p = 0.008) and maximal effort (VO2MAX; 15.8% vs. 8.0%, p = 0.036), as well as tolerance time (TT) to reach anaerobic threshold (TTAT; 62.0 vs. 37.7, p = 0.048), TTRCP (49.3 vs. 32.9, p = 0.032), and TTMAX (38.9 vs. 29.2, p = 0.042). Exercise intensity was an important factor in improving HR recovery and CRF of FH+women. These findings may have important implications for designing exercise-training programmes for the prevention of an inherited hypertensive disorder.
- RELATIONSHIP OF FORCE PLATFORM WITH THE CLINICAL BALANCE EVALUATION SYSTEMS TEST IN OLDER ADULTS(2020) ERNANDES, Rita De Cassia; BRECH, Guilherme Carlos; LUNA, Natalia Mariana Silva; NUNES, Michele Figueira; GREVE, Julia Maria D'Andrea; LEME, Luiz Eugenio Garcez; ALONSO, Angelica CastilhoThe aging process can alter the organization of postural control causing instability; literature shows several equipment and clinical tests whose purpose is to measure postural balance, involving different protocols and methodologies. Objective: To evaluate postural balance during the task to walk over the force platform (turn and return) and its relationship with clinic balance test (BESTest) in older adults. Methods: 60 older people of both sexes, aged 60 to 79 years, were tested in the force platform (NeuroCom Balance) and BESTest to evaluate postural balance. Results: negative correlations were found when comparing domains of the clinical test with stabilometric parameters in time and velocity variables of the tests Step/Quick turn. The highest correlations were in the total score (time spent to perform the task - 0.41, and in the velocity left side - 0.33/right side - 0.43), as well as in the stability limit (time spent to perform the task left side - 0.34/right side - 0.37, and the equilibrium velocity left side - 0.37/right side - 0.43). Conclusion: There are slim correlations between the clinical test and force platform variables, showing that each test measures different parameters.
- DYNAMIC POSTURAL BALANCE IS MEDIATED BY ANTHROPOMETRY AND BODY COMPOSITION IN OLDER WOMEN(2021) BRECH, Guilherme Carlos; FREITAS, Jessica Sillas de; GOUVEA, Marcia; MACHADO-LIMA, Adriana; BASTOS, Marta Ferreira; TAKAYAMA, Liliam; PEREIRA, Rosa Maria Rodrigues; GREVE, Julia Maria D'Andrea; ALONSO, Angelica CastilhoObjective: To investigate the relationship between anthropometry and body composition with dynamic postural balance in elderly women with low bone mineral density (BMD). Methods: 45 older women (>= 60 years), low BMD and nutritional diagnosis of low weight to overweight. For the assessment of body composition, Dual energy X-ray emission densitometry and anthropometric examination were used to measure: body mass (kg), height (cm) and BMI (k/m(2)). The assessment of dynamic postural balance was performed by the mini Balance Master Evaluation System clinical test and the computerized Balance Master (R) System test by the Sit to Stand and Step Up/Over tests. Results: There was a negative correlation between miniBESTest (r = - 0.566; p = 0.001) and time to ascend and descend step (r = - 0.393; p = 0.007) with fat mass, and positive correlation with miniBESTest (r = 0.526; p =0.001) and time to go up and down a step with muscle mass (r = 0.297; p = 0.04). As for anthropometric variables, only height showed a positive correlation (r = 0.296; p = 0.04) with the speed in the sit and stand test. Conclusion: Lean mass reduces postural oscillations; in contrast, fat mass negatively interfered with dynamic postural balance in women with low BMD. Height was related to dynamic postural balance, the taller the elderly, the worse their balance.
- Knee muscles isokinetic evaluation in short distance elite swimmers: A comparison between symmetric and asymmetric swimming styles(2011) SECCHI, Leonardo L. B.; MURATT, Mavi Diehl; CIOLAC, Emmanuel G.; GREVE, Julia M. D.Objective: To compare knee extension-flexion isokinetic performance between elite swimmers of simultaneous (SS butterfly and breaststroke) and alternated swimming (AS - front crawl and backstroke) styles. Method: Nineteen short distance elite swimmers (50 m, 100 m and 200 m events), divided into SS (n = 7; 23.3 +/- 5.6 years) and AS (n = 12; 22.6 +/- 1.4 years) were tested for knee extension-flexion isokinetic strength at 60 degrees/s (4 repetitions) and endurance at 300 degrees/s (30 repetitions). Results: There were no significant differences between groups or legs for concentric knee extension and flexion variables. However, the agonist/antagonist (HQ) ratio was lower (p = 0.032) in AS than SS group for both legs. Conclusion: These results indicate the need for training programs to improve strength balance between hamstrings and quadriceps muscles in short distance elite swimmers.
- The social dimension of quality of life following spinal cord injury or disease: an international ICF-linking study(2024) WIND, Aline J. Hakbijl-van der; ROHN, Edward J.; TATE, Denise G.; LEEUWEN, Christel M. C. van; FORCHHEIMER, Martin; STOLWIJK-SWUSTE, Janneke M.; CHARLIFUE, Susan; GREVE, Julia M. D.; NEW, Peter W.; POST, Marcel W. M.Study designInternational Classification of Functioning, Disability and Health (ICF) linking study.ObjectiveAnalyze cognitive interview data using the ICF as an analytic framework, to examine aspects of social life relevant to quality of life (QoL) according to people with spinal cord injury or disease (SCI/D). This study builds upon results of an international study about the cross-cultural validity of the International SCI QoL Basic Data Set (QoL-BDS).SettingFour specialized outpatient clinics in SCI/D rehabilitation, from the US, Brazil and Australia.MethodsAnalysis of qualitative data from 39 cognitive interviews with SCI/D patients at least one year post onset. Participants were asked to define their concept of QoL, overall life satisfaction, physical health and psychological health, and other relevant matters. Four independent researchers coded text fragments related to the items, and fragments were linked to ICF chapters d6-d9, following established linking rules.ResultsThe proportion of text referring to social life was 35.8% (definition QoL), 24.9% (QoL life as whole), 6.0% (physical health) and 34.9% (psychological health). The most frequent ICF categories were d760 Family relationships, d770 Intimate relationships and d920 Recreation and leisure. Most frequent responded social topics to the 'other issues' item were d770 Intimate relationships, d760 Formal relationships, and d870 Economic self-sufficiency.ConclusionThe importance of social life aspects to the QoL was highlighted based on responses of SCI/D patients, clearly demonstrated through the ICF linking process. Adding a satisfaction with social life item to the QoL-BDS has made this instrument a more comprehensive measure.
- Translation and validation into Portuguese of the international spinal cord injury pulmonary function basic data set(2022) FREITAS, Simone Ferreira de; PIRES, Cristhiane Valerio Garabello; ASA, Sabrina Kyoko; GREVE, Julia Maria D'AndreaINTRODUCTION Spinal cord injury (SCI) is a serious disabling syndrome, and the clinical picture depends on the level and extent of the injury. The International Spinal Cord Society (ISCoS) and the American Spinal Cord Association (ASIA) have developed instruments (Data Sets) to assess the various aspects of the SCI. In 2012, the International SCI Pulmonary Function Basic Data Set was elaborated. It is composed of four questions and spirometry for the collection of lung function basic data. OBJECTIVE The objective was to translate and validate the International SCI Pulmonary Function Basic Data Set to the Portuguese language. METHODS The entire methodology followed the recommendations of the ISCoS and ASIA. Two translations of the original version into Portuguese were performed, and after consensus among the translators, the Portuguese version was sent for back-translation. After back-translation and comparison with the original version, the final Portuguese version was obtained. For the second phase of the study, 30 SCI individuals were selected. Two interviewers applied the questionnaire in two distinct moments. RESULTS All results presented constant, excellent, or perfectly concordant data, except for the third question in the inter-rater comparison, where the Kappa coefficient showed value reasonable in the first interview and good in the second. CONCLUSION The translation into Brazilian Portuguese of the ""International SCI Pulmonary Function Basic Data Set "" created a valid and highly reliable instrument, like the original without linguistic and cultural disagreements that allow its use in the evaluation of patients with SCI in Brazil.
- Contemporary reflection on the educational levels of high-performance soccer players in Brazil(2023) SANTOS-SILVA, Paulo Roberto; GREVE, Julia Maria D'Andrea; SILVA, Renato Luis da; SPINOLA, Marcelo MesquitaObjective: As the soccer culture in Brazil is more popular than schooling, this study reflected on the formal education levels of soccer (football) players through descriptive and quantitative analyses. Methods: We evaluated 179 national soccer players playing various positions on different teams across six seasons (2012, 2013, 2014, 2015, 2016, and 2022). Data were collected using a questionnaire comprising the following variables: age, position in the pitch, age of professionalization, and education (years of study). The data were distributed according to the pitch position. Results: The mean age, length of professional career, and professionalization age were 23 +/- 6 years, 7 +/- 5 years, and 17 +/- 2 years, respectively. In terms of education, 121 athletes (67%) completed high school, equivalent to 11 years of study. Only 5.5% completed higher education, with defensive players (goalkeepers and defenders) being the most educated at 37% (66/179). According to 2017 figures from the Pesquisa Nacional por Amostra de Domicilios Continua of the Federal Government of Brazil, the schooling rate is 31.7%, wherein 46.1% of Brazilians aged 25 years or over have completed education. In this study of 179 athletes, 67% had completed high school. Thus, players outrank the Brazilian population in terms of achieving a high school education. There were marked disparities in the relative proportions of goalkeepers (85%), defensive players (68%), midfielders (63%), and forward players (64%) in terms of their education. Conclusion: Our survey revealed that attending higher education remains a distant reality in Brazil.