Multilevel analysis of social determinants of advanced stage colorectal cancer diagnosis.

The advanced stage at diagnosis of colorectal cancer (CRC) may be related to individual factors, socioeconomic conditions, and healthcare service availability. The objective of the study was to analyze the prevalence of advanced stage CRC at the time of diagnosis and its association with individual, contextual, socioeconomic, and healthcare service indicators. An observational, cross-sectional study was conducted, analyzing cases of malignant neoplasms of the colon and rectum in individuals of both sexes, aged between 18 and 99 years, diagnosed between 2010 and 2019 in Brazil (n = 69,047). Data were collected from the Hospital Cancer Registry (HCR), Atlas of Human Development in Brazil, and from the National Registry of Health Institutions (NRHI). A Multilevel Poisson Regression model with random intercept was used. The prevalence of advanced stage CRC at diagnosis was 65.6%. Advanced stage was associated with older age groups prevalence ratio (PR) 4.40 and younger age groups (PR 1.84), low Human Development Index (HDI) (PR 1.22), and low density of family health strategy teams (PR 1.10). The study highlights the unequal distribution of social determinants of health in the diagnosis CRC in Brazil, revealing the need to evaluate and redirect public policies aimed at improving early detection and prevention of CRC in the country.

Incidence of depression among community-dwelling older adults: A systematic review.

We aimed to synthesise information related to the incidence of depression and depressive symptoms (DDS) in a community-dwelling older adult population at a global level. In this systematic review, we included articles with a cohort study design that evaluated the incidence of depression or depressive symptoms in older adults aged 60 years or more in a community-dwelling environment. Six databases were used: Web of Science, PubMed, Scopus, LILACS, SciELO, and Cochrane, and the entire selection process was independently performed by peers. We divided the included articles into subgroups according to the DDS assessment instrument: (i) Geriatric Depression Scale; (ii) Center for Epidemiologic Studies Depression Scale; (iii) miscellaneous scales; and (iv) diagnostic interviews. Each cumulative incidence value obtained per item was adjusted for a 1-year follow-up period, which generated an annual cumulative incidence (AcI). From 46 articles, 42 used scales to evaluate the depressive variable, with an AcI estimate of around 4.5%. The articles that assessed depression categorically observed a variation in AcI between 0.2% and 7.0%. Among all the materials included, the group that used the Geriatric Depression Scale observed the lowest and the highest AcI, 1.3% and 26.6% respectively. Most of the productions were from countries in the Asian continent (52.2%), followed by Europe (30.4%), the Americas (13%), and Oceania (4.4%). Despite the variation of AcI, we found a frequent occurrence of DDS in older adults in the community-dwelling environment, which highlights the need for preventive actions and better-targeted early care, especially in terms of primary health care.

Sleep quality is associated with Disability and Quality of life in breast cancer survivors: a cross-sectional pilot study.

PURPOSE: To evaluate the sleep quality and its association with disability, fatigue and quality of life of breast cancer survivors. METHODS: This is a cross-sectional pilot study developed with breast cancer survivors. The data collection instruments consisted of general and clinical information on the disease and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0); Pittsburgh Sleep Quality Index (PSQI); Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F); and Disabilities of the arm and Shoulder (DASH). Descriptive statistical analysis, correlation tests, tests for means comparison and linear regression were performed. Cohen's d analysed the effect size. The significance was set at p < 0.05. RESULTS: 71,9% of women had poor sleep quality. Subjective poor sleep quality was a predictor of worse scores for fatigue (p = 0.007), quality of life by FACT-G (p = 0.010) and FACIT-F (p = 0.004), the functional performance of upper limbs (p = 0.001) and disability (p = 0.003). CONCLUSIONS: Breast cancer survivors with subjective poor sleep quality had more fatigue, less upper limb-related functional performance, more disability and worse quality of life.

Is Constipation Associated with Worse Functioning in Adult Women? A Cross-Sectional Study.

OBJECTIVE: The aim of this study is to analyze the relationship between intestinal constipation and functioning in adult women living in a municipality in the interior of northeast Brazil. MATERIALS AND METHODS: This is a cross-sectional study conducted with 195 adult women in the city of Santa Cruz-RN. Constipation was diagnosed using the Rome III criteria. Functioning was measured through WHODAS 2.0. Social conditions, habits and lifestyle were also investigated. Inferential analysis was performed using the chi-squared test and the Mann-Whitney U-test, and the effect size was determined by eta squared (η2). Multivariate analysis was performed using multiple linear regression to analyze the relationship between the WHODAS total score and constipation, being adjusted by covariates with p≤0.20 in the bivariate. A statistical significance level of p<0.05 was considered. RESULTS: Most of the participants in this study were aged 19 to 39 years (69.7%) and had an income of up to 1 minimum monthly salary (79.5%). WHODAS scores showed that women with constipation had more disability in the cognitive (p <0.001), mobility (p <0.002), self-care (p <0.001), and participation (p <0.001) domains, as well as the total score (p <0.001). After multiple linear regression analysis, the total WHODAS score remained associated with constipation (p <0.001), in which this condition increases the score by nine points. CONCLUSION: The results of this study show that there is a reduction in functioning associated with the presence of constipation in adult women, mainly affecting the cognition, mobility, self-care and participation domains, in addition to the total score.

PREVALENCE AND FACTORS ASSOCIATED WITH CONSTIPATION IN PREMENOPAUSAL WOMEN: A COMMUNITY-BASED STUDY.

BACKGROUND: Intestinal constipation is characterized by problems related to evacuation, and presents high prevalence in the female gender. This condition has demonstrated negative effects on the development of daily activities, causing damage to the physical and emotional well-being of individuals who are diagnosed with it. Studies that investigate what health impairments intestinal constipation can cause are scarce in the literature. OBJECTIVE: This study aimed to verify the prevalence and factors associated with intestinal constipation in premenopausal women living in Northeastern Brazil. METHODS: It is a cross-sectional study. This was carried out in the northeast of Brazil. Participated 195 women, adult and middle age. Social conditions, habits and lifestyle, clinical aspects and obstetric history were investigated. Constipation was diagnosed using the Rome III Criteria. Multivariate analysis was conducted using Poisson Regression with robust variance to analyze the relationship between intestinal constipation and independent variables. A statistical significance level of P<0.05 was considered. RESULTS: Most of the women were between 25 and 39 years old (49.2%) and had an income of up to one minimum wage (79.5%). The intestinal constipation prevalence was 35.4%. In the final multivariate regression model, hemorrhoid clinical aspects (P=0.01), pain (P=0.001) and a burning sensation (P=0.01) on bowel movement, and sexual dysfunction (P=0.03) remained associated with constipation. CONCLUSION: The present study found a significant prevalence of constipation among premenopausal women and clinical factors such as hemorrhoids, pain and a burning sensation, and sexual dysfunction were associated with intestinal constipation.

Prevalência e fatores associados à constipação em mulheres na pré-menopausa: um estudo de base comunitária / Prevalence and factors associated with constipation in premenopausal women: a community-based study

ABSTRACT BACKGROUND: Intestinal constipation is characterized by problems related to evacuation, and presents high prevalence in the female gender. This condition has demonstrated negative effects on the development of daily activities, causing damage to the physical and emotional well-being of individuals who are diagnosed with it. Studies that investigate what health impairments intestinal constipation can cause are scarce in the literature. OBJECTIVE: This study aimed to verify the prevalence and factors associated with intestinal constipation in premenopausal women living in Northeastern Brazil. METHODS: It is a cross-sectional study. This was carried out in the northeast of Brazil. Participated 195 women, adult and middle age. Social conditions, habits and lifestyle, clinical aspects and obstetric history were investigated. Constipation was diagnosed using the Rome III Criteria. Multivariate analysis was conducted using Poisson Regression with robust variance to analyze the relationship between intestinal constipation and independent variables. A statistical significance level of P<0.05 was considered. RESULTS: Most of the women were between 25 and 39 years old (49.2%) and had an income of up to one minimum wage (79.5%). The intestinal constipation prevalence was 35.4%. In the final multivariate regression model, hemorrhoid clinical aspects (P=0.01), pain (P=0.001) and a burning sensation (P=0.01) on bowel movement, and sexual dysfunction (P=0.03) remained associated with constipation. CONCLUSION: The present study found a significant prevalence of constipation among premenopausal women and clinical factors such as hemorrhoids, pain and a burning sensation, and sexual dysfunction were associated with intestinal constipation.

RESUMO CONTEXTO: A constipação intestinal é caracterizada por problemas relacionados à evacuação, e apresenta alta prevalência no gênero feminino. Essa condição tem demonstrado efeitos negativos no desenvolvimento das atividades diárias, causando prejuízos no bem-estar físico e emocional dos indivíduos que são diagnosticados com ela. Estudos que investiguem quais prejuízos à saúde a constipação intestinal pode ocasionar são escassos na literatura. OBJETIVO: Este estudo teve como objetivo verificar a prevalência e os fatores associados à constipação intestinal em mulheres na pré-menopausa residentes no nordeste do Brasil. MÉTODOS: Estudo transversal realizado no Nordeste do Brasil. Participaram 195 mulheres adultas e de meia idade. Condições sociais, hábitos e estilo de vida, aspectos clínicos e história obstétrica foram investigados. A constipação foi diagnosticada através dos Critérios de Roma III. A análise multivariada foi conduzida através da Regressão de Poisson com variância robusta, para analisar a relação entre constipação intestinal e variáveis independentes. Considerou-se o nível de significância estatística de P≤0,05. RESULTADOS: A maioria das mulheres estava na faixa etária de 25 a 39 anos (49,2%) e possuía renda de até um salário mínimo (79,5%). A prevalência da constipação intestinal foi de 35,4%. No modelo final da regressão multivariada, os aspectos clínicos hemorroidas (P<0,01), dor (P<0,001) e ardor (P<0,01) ao evacuar e disfunção sexual (P<0,03) permaneceram associados à constipação. CONCLUSÃO: O presente estudo encontrou uma prevalência significativa de constipação entre mulheres na pré-menopausa e fatores clínicos como hemorroidas, dor e ardor na evacuação, e disfunção sexual se associaram a constipação intestinal.

Condições de saúde e estado Nutricional de agentes comunitários de Saúde no interior do nordeste Brasileiro / Health conditions and nutritional status of community health agents in the interior of the Brazilian Northeast / Condiciones de salud y condiciones nutricionales de agentes de salud comunitarios en el noreste de Brasil

Introdução:A saúde do trabalhador é um campo de relevância, mas que ainda está sendo consolidado no âmbito do sistema único de saúde (SUS). Partindo dessa compreensão, esse estudo teve como objetivo avaliaro estado nutricional e as condições de saúde dos agentes comunitários de saúde do município de Currais Novos-RN.Métodos: Trata-se de um estudo transversal,realizado com80 indivíduos de ambos os sexos. Condições sociais e de saúde, estilo de vida e estado nutricional foram investigados.A análise bivariada foi conduzida através do teste Qui-quadrado, para analisar a associação entre o estado nutricional e as variáveis independentes. Considerou-se o nível de significância estatística de p ≤0,05. Resultados:A maioria dos participantes encontravam-se na faixa etária de 41 a 58 anos (52, 5%), possuía renda maior que 1 salário mínimo (77,5%) e encontrava-secom Sobrepeso/Obesidade (63,8%). Apenas as variáveis antropométricas percentual de gordura (p<0,02), relação cintura/quadril (p<0,02) e satisfação com peso (p<0,01) se associaram ao estado nutricional. Conclusão: O presente estudo verificou que a maioria dos indivíduos estudados apresenta sobrepeso/obesidade, que os dados referentes a condições sociais e de saúde, como também estilo de vida não se associaram ao desfecho que foi analisado. As variáveis antropométricas apresentaram diferença significativa na análise bivariada, demonstrando que estas exercem influência no estado nutricional.(AU).

Introduction:Occupational health is a relevant field, but it is still being consolidated within the scope of the single health system (SUS).From this understanding, this study aimed to evaluate the nutritional status and health conditions of community health agents in the city of Currais Novos-RN.Methods:This is a cross-sectional study, conducted with 80 individuals of both sexes.Social and health conditions, lifestyle and nutritional status were investigated.Bivariate analysis was conducted using the Chi-square test to analyze the association between nutritional status and independent variables. The level of statistical significance of p ≤0,05 was considered.Results:Most participants were between 41 and 58 years old (52,5%), had an income higher than 1 minimum wage (77,5%) and were overweight / obese (63,8%).Only the anthropometric variables percentage of fat (p <0,02), waist / hip ratio (p <0,02) and weight satisfaction (p <0,01) were associated with nutritional status.Conclusion:The present study found that most of the individuals studied were overweight / obese, that data regarding social and health conditions, as well as lifestyle, were not associated with the outcome that was analyzed.The anthropometric variables showed a significant difference in the bivariate analysis, demonstrating that they influence the nutritional status.(AU).

Introducción: La salud ocupacional es un campo relevante, pero aún se está consolidando dentro del alcance delsistema único de salud (SUS).En base a esta comprensión, este estudio tuvo como objetivo evaluar el estado nutricional y las condiciones de salud de los agentes de salud comunitarios en la ciudad de Currais Novos-RN. Métodos:Este es un estudio transversal realizado con 80 individuos de ambos sexos.Se investigaron las condiciones sociales y de salud, el estilo de vida y el estado nutricional.El análisis bivariado se realizó mediante la prueba de Chi-cuadrado para analizar la asociación entre el estado nutricional y las variables independientes.Se consideró el nivel de significación estadística de p ≤0.05. Resultados:La mayoría de los participantes tenían entre 41 y 58 años (52.5%), tenían un ingreso superior a 1 salario mínimo (77.5%) y teníansobrepeso / obesidad (63.8%). Solo las variables antropométricas porcentaje de grasa (p <0.02), relación cintura / cadera (p <0.02) y satisfacción con el peso (p <0.01) se asociaron con el estado nutricional.Solo las variables antropométricas porcentaje de grasa (p <0.02), relación cintura / cadera (p <0.02) y satisfacción con el peso (p <0.01) se asociaron con el estado nutricional.Conclusión:El presente estudio encontró que la mayoría de los individuos estudiados tenían sobrepeso / obesidad, y los datos sobre las condiciones sociales y de salud, así como el estilo de vida, no se asociaron con el resultado que se analizó.Las variables antropométricas mostraron una diferencia significativa en el análisis bivariado, lo que demuestra que influyen en el estado nutricional.Palabras clave:Agente de salud comunitaria; Salud ocupacional; Condiciones de salud; Estado nutricional.(AU).

Prevalência da Deficiência e Associações Clínicas em Mulheres Sobreviventes ao Câncer de Mama: um Estudo-Piloto / Prevalence of Disability and Clinical Associations in Breast Cancer Women Survivors: a Pilot Study / Prevalencia de Discapacidad y Asociaciones Clínicas en Mujeres que Sobreviven al Cáncer de Mama: un Estudio Piloto

Introdução: O tratamento do câncer de mama proporciona aumento da sobrevida e reduz a mortalidade, mas traz limitações funcionais e efeitos colaterais que comprometem a sobrevida. Objetivo: Avaliar a prevalência da deficiência e sua associação com capacidade física, sono, fadiga e qualidade de vida em mulheres sobreviventes ao câncer de mama. Método: Trata-se de um estudo-piloto envolvendo 32 mulheres com, pelo menos, um ano após o tratamento clínico. Os dados da pesquisa foram obtidos por meio de questionários e um teste de caminhada de seis minutos. Resultados: A prevalência de deficiência na amostra foi >90%. O World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) revelou boa consistência interna (α=0,874). A deficiência correlacionou-se forte e positivamente com cognição (rs=0,758), mobilidade (rs=0,709), atividade domésticas/trabalho (rs=0,718) e participação (r=0,701); e moderada e negativamente com fadiga (r=-0,621) e o Functional Assessment of Cancer Therapy-Fatigue (FACT-F) (r=-0,672); e positivamente com o Disabilities of the Arm and Shoulder (DASH) (r=0,639). Comparando-se os grupos de deficiência, observou-se diferença significativa com piores escores para o DASH (d=1,62), FACT-F (d=1,47), fadiga (d=1,21) e o índice de qualidade do sono de Pittsburgh (PSQI) (d=0,98). Conclusão: Mulheres sobreviventes ao câncer de mama apresentaram algum nível de deficiência associada à fadiga, à pior qualidade do sono e à qualidade de vida, demonstrando impactos importantes na saúde dessas mulheres

Introduction: The treatment of breast cancer improves survival and reduces mortality, but brings functional limitations and side effects that compromise survival. Objective: To evaluate the prevalence of disability and its association with physical capacity, sleep, fatigue and quality of life in women surviving breast cancer. Method: Pilo study involving 32 women at least one year after clinical treatment. The study data were obtained through questionnaires and a six-minute walk test. Results: The prevalence of disability in the sample was >90%. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) revealed good internal consistency (α=0.874). Disability correlated strongly and positively with cognition (rs=0.758), mobility (rs=0.709), household/work activity (rs=0.718) and participation (r=0.701) and moderately and negatively with fatigue (r=-0.621) and Functional Assessment of Cancer Therapy-Fatigue (FACT-F) (r=-0.672) and positively with the Disabilities of the Arm and Shoulder (DASH) (r=0.639). Comparing the disability groups, a significant difference was observed with worse scores for DASH (d=1.62), FACT-F (d=1.47), fatigue (d=1.21) and the Pittsburgh Sleep Quality Index (PSQI) (d=0.98). Conclusion: Women who survived breast cancer had some level of disability associated to fatigue, poor sleep quality and quality of life, demonstrating important impacts on the health of these women

Introducción: El tratamiento del cáncer de seno mejora la supervivencia y reduce la mortalidad, pero aún conlleva limitaciones funcionales y efectos secundarios que comprometen la supervivencia. Objetivo: Evaluar la prevalencia de discapacidad y su asociación con la capacidad física, el sueño, la fatiga y la calidad de vida en mujeres sobrevivientes de cáncer de seno. Método: Este es un estudio piloto con 32 mujeres al menos un año después del tratamiento clínico. Los datos de la encuesta se obtuvieron mediante cuestionarios y una prueba de caminata de seis minutos. Resultados: La prevalencia de discapacidad en la muestra fue >90%. El Programa de Evaluación de Discapacidad de la Organización Mundial de la Salud 2.0 (WHODAS 2.0) reveló una buena consistencia interna (α=0,874). La discapacidad se correlacionó fuertemente y positivamente con la cognición (rs=0,758), la movilidad (rs=0,709), la actividad del hogar/trabajo (rs=0,718) y la participación (r=0,701) y moderada y negativamente con la fatiga (r=-0,621) y lo Functional Assessment of Cancer Therapy-Fatigue (FACT-F) (r=-0,672) y positivamente con lo Disabilities of the Arm and Shoulder(DASH) (r=0,639). Comparando los grupos de discapacidad, se observó una diferencia significativa con peores puntajes para DASH (d=1,62), FACT-F (d=1,47), fatiga (d=1,21) y el índice de calidad del sueño de Pittsburgh (PSQI) (d=0,98). Conclusión: Las mujeres que sobrevivieron al cáncer de seno tenían algún nivel de discapacidad asociada con la fatiga y la mala calidad del sueño y la calidad de vida, lo que demuestra importantes impactos en la salud de estas mujeres