Frequency and associated factors for swallowing impairment in community-dwelling older persons: a systematic review and meta-analysis.

INTRODUCTION: Swallowing impairment (SI) is an underdiagnosed dysfunction frequently seen as an expected condition of aging. However, SI can lead to health complications and considerable social impact. METHODS: The objective of this systematic review with meta-analysis was to evaluate the frequency and associated factors with SI in community-dwelling older persons. Searches were performed in 13 electronic databases including MEDLINE and EMBASE (from inception to September 18, 2021). Data extraction and methodological quality assessment of included studies were performed by two independent reviewers. Meta-analysis of proportions with 95% confidence interval (CI) and prediction interval (PI) was used to pool estimates. Subgroup analysis by Country and Assessment Method was performed. General meta-analysis was used to pool measures of association between potential risk factors and SI occurrence (odds ratio [OR] or prevalence ratio [PR]). RESULTS: The worldwide estimated frequency of SI in community-dwelling older persons was 20.35% (95%CI 16.61-24.68%, 95%PI 4.79-56.45, I2 99%, n = 33,291). This estimation varied across assessment methods and by country. The main factors associated with SI were a dry mouth (OR 8.1, 95%CI 4.9-13.4), oral diadochokinesis (OR 5.3, 95%CI 1.0-27.3), ≥ 80 years old (OR 4.9, 95%CI 2.6-9.2), genetic factor (SNPrs17601696) (OR 4.8, 95%CI 2.7-8.3), and partial dependence (OR 4.3, 95%CI 2.0-9.3). And the main factors associated with SI estimated by PR were dry mouth sensation (PR 4.1, 95%CI 2.6-6.5), oral sensorimotor alteration (PR 2.6, 95%CI 1.4-4.9), osteoporosis (PR 2.51, 95%CI 1.2-5.3), and heart diseases (PR 2.31, 95%CI 1.1-5.0). CONCLUSION: One in five older adults worldwide are expected to experience SI and factors associated with this underdiagnosed dysfunction included biological and physiological changes related to aging, physical and psychological conditions, and poor oral health. Early assessment is paramount for the prevention of future clinical complications and should be a high priority in health care practices.

Using Voice Change as an Indicator of Dysphagia: A Systematic Review.

Voice change post-swallow, observed during a clinical swallow examination, is often used as a clinical indicator of dysphagia risk. However, there has been limited research that evaluated the level of agreement between voice change and swallow dysfunction reported to date. This systematic review aims to investigate existing evidence relating to the relationship between vocal change post-swallow and swallow deficits identified on a Videofluoroscopic Swallow Study (VFSS). The studies were selected by two independent evaluators for inclusion, without restriction on language or date of publication and the methodological quality and the risk of bias were assessed using QUADAS-2. Following the PRISMA recommendation, 271 articles were analyzed, of which 17 were included in the study. Of these, the methodology described in five studies employed voice analyses using only acoustic methods, seven others conducted only auditory-perceptual analyses, and five other studies used both. Across the studies there was no homogeneity in the voice quality parameters assessed, analytic methods used, and results obtained. Forty seven per cent of the studies presented a high risk of bias in the analysis of vocal quality due to lack of clarity and blinding of VFSS. There was no homogeneity in the choice of consistencies evaluated during swallowing, as well as standardization of the outcome investigated in VFSS without a vocal parameter attributable to accurate detection in each outcome. It is not possible to obtain a consensus regarding the recommendation of the use of vocal evaluation as an accurate method for identifying swallowing alterations due to heterogeneity of the vocal evaluation methods, the outcomes evaluated in the VFSS examination, heterogeneity in food and liquid consistencies, and the methodological quality of the studies.

Swallowing impairment in older adults: association with sensorimotor peripheral nerve function from the Health, Aging and Body Composition study.

BACKGROUND: The purpose of this study was to examine whether impairments in sensorimotor peripheral nerve function are associated with a higher likelihood of swallowing impairment in older adults. METHODS: Health, Aging and Body Composition participants (n = 607, age = 75.8 ± 2.7 years, 55.8% women, 32.3% black) underwent peripheral nerve testing at Year 4 and 11 with swallowing difficulty assessed at Year 4 and 15. Nerve conduction amplitude and velocity were measured at the peroneal motor nerve. Sensory nerve function was assessed with the vibration detection threshold and monofilament (1.4-g/10-g) testing at the big toe. Symptoms of lower extremity peripheral neuropathy and difficulty swallowing were collected by self-report. Data analysis was performed using a hierarchical approach. Odds ratios (ORs) were estimated using non-conditional logistic regression. RESULTS: At Year 15 108 (17.8%) participants had swallowing impairments. In fully adjusted models, the peripheral nerve impairments associated with swallowing impairment were numbness (OR 4.67; 95%CI 2.24-9.75) and poor motor nerve conduction velocity (OR 2.26; 95%CI 1.08-4.70). Other peripheral nerve impairments were not related to swallowing. CONCLUSIONS: The association between slow motor nerve conduction velocity and numbness and a higher likelihood of swallowing difficulties a decade later in our prospective study identifies an important area for further investigation in older adults.

Factors associated with hyposalivation and xerostomia in older persons in South Brazil.

OBJECTIVE: This study aimed to investigate characteristics associated with xerostomia and hyposalivation in older persons. BACKGROUND: Saliva is one of the most important body fluids and plays an important role in food bolus formation, lubricating the oral mucosa and protecting teeth against demineralisation. MATERIALS AND METHODS: This is a cross-sectional study nested within a cohort and includes a sample of 872 older persons living independently in the community, both in rural and urban areas in Carlos Barbosa, Brazil. Data collection included standardised interviews to identify sociodemographic, behavioural and health-related variables, as well as oral clinical examination performed by two trained/calibrated dentists. Poisson regressions with robust variance were used to calculate the crude and adjusted prevalence ratios (PR) and their respective 95% confidence intervals. RESULTS: The mean age was 68.5 ± 6.7 years, and the majority of the sample consisted of women (65.3%). The prevalence of xerostomia, of low stimulated salivary flow rate and low at rest salivary flow rate were 338 (38.8%), 494 (56.6%), 320 (36.7%), respectively. In the final adjusted model, women had a significantly increased prevalence of xerostomia (PR = 1.34; 95% CI: 1.12-1.61), as well as participants taking medication continuously (PR = 1.45; 95% CI: 1.16-1.82) and those with depressive symptoms (PR = 1.49; 95% CI: 1.27-1.76). Lower at rest (PR = 1.45, 95% CI: 1.22-1.72) and lower stimulated salivary flow were more prevalent in women (PR = 1.27, 95% CI: 1.11-1.44), while lower stimulated salivary flow was more prevalent in older persons taking medication continuously (PR = 1.24, 95% CI: 1.07-1.43). CONCLUSION: Salivary hypofunction and xerostomia were more prevalent in women and in those with continuous medication use; however, depressive symptoms were associated only with xerostomia. Measures are required to promote oral comfort in cases of xerostomia, thereby reducing the unpleasant sensation of dry mouth and hyposalivation consequences in clinical practice.

Influence of dental factors on oropharyngeal dysphagia among recipients of long-term care.

OBJECTIVE: The study evaluated the association of the sociodemographic, behavioural variables and the oral conditions with the presence of oropharyngeal dysphagia in long-term care older persons. BACKGROUND: Due to the influence of ageing, swallowing may be altered both in people with natural teeth and in those who have dentures or tooth loss. MATERIALS AND METHODS: This cross-sectional study evaluated 115 individuals older than 60 years, living in long-term care institutions of the State of Rio Grande do Sul in 2016. The diagnosis of dysphagia happen using a clinical speech evaluation, based on the research of signals and symptoms of alterations during deglutition, and on an oral sensory-motor evaluation. The dental clinical evaluation examined the oral cavity, teeth and dental prostheses, including a Xerostomia assessment. Poisson Regressions with robust variance was calculated were used to estimate crude and adjusted Prevalence Ratios(PR) and their IC95%. RESULTS: The sample was mostly comprised of older women (67.0%), with more than 81 years of age (44.3%) and edentulous (54.3%). Diagnosis of oropharyngeal dysphagia was verified in 60.9% of the participants. In the final model, older persons who presented no pair (PR=1.52(CI95%=1.02-2.40)) had a highest prevalence of oropharyngeal dysphagia, when compared to older persons who presented 8 to 14 mixed pairs, as well as those older persons who had more complaints related to symptoms of Xerostomia (PR=2.86(CI95% 1.58-5.18)). CONCLUSION: Institutionalised older persons with a poor oral health condition are associated with a higher prevalence of oropharyngeal dysphagia, as well as with the presence of Xerostomia.

Association between number of teeth, dental prostheses, and self-reported dysphagia in brazilian old people: a population-based study. / Associação entre número de dentes, próteses dentárias e disfagia autorreferida em idosos brasileiros: estudo populacional.

PURPOSE: To investigate the association between the number of permanent teeth and the use of removable dental prostheses with self-reported dysphagia occurrence in individuals aged 60 years or older. METHODS: A population-based cross-sectional study was conducted with 5,432 old individuals who participated in the baseline of the Brazilian Longitudinal Study of Elderly Health (ELSI-Brazil). The outcome "dysphagia" was associated with the number of permanent teeth and the use of removable dental prostheses. Sociodemographic independent variables (age, sex, and race/ethnicity) and clinical history variables (no morbidity, one morbidity, or more than two morbidities) were analyzed using Poisson Regression with robust variance and their respective 95% confidence intervals (CI). RESULTS: The prevalence of self-reported dysphagia in non-institutionalized old individuals was 30%. The group of old individuals with 10 - 19 natural teeth showed a 52% increased risk of self-reported dysphagia complaint (PRadj 1,565 IC95% 1,34;1,826) compared to their counterparts with more teeth. CONCLUSION: An association was found between a lower number of teeth and removable prostheses with the occurrence of dysphagia.

OBJETIVO: Verificar a associação entre o número de dentes e uso de prótese dentária removível e a ocorrência de disfagia autorreferida em idosos de 60 anos ou mais. MÉTODO: Estudo transversal de base populacional com 5.432 idosos, que participaram da linha de base do Estudo Longitudinal da Saúde do Idoso (ELSI-Brasil). O desfecho "disfagia" foi associado ao número de dentes permanentes e ao uso de prótese dentária removível. As variáveis independentes sociodemográficas (idade, sexo e cor/raça) e de histórico clínico (nenhuma morbidade, uma morbidade ou mais de duas morbidades) utilizando Regressão de Poisson com variância robusta e seus respectivos intervalos de confiança (IC) de 95% foram analisados. RESULTADOS: A prevalência de disfagia autorreferida nos idosos não institucionalizados foi de 30%. O grupo de idosos com 10 ­ 19 dentes permanentes apresentou um risco de 52% de queixa de disfagia autorreferida (RPaj 1,565 IC95% 1,34;1,826) se comparado com seus pares com mais dentes. CONCLUSÃO: foi encontrada associação entre o menor número de dentes e próteses removíveis com a ocorrência de disfagia.

Self-reported discrimination against adults with hearing loss in Brazilian health services: results of the National Health Survey. / Discriminação social em adultos com deficiência auditiva nos serviços de saúde brasileiro: resultados da Pesquisa Nacional de Saúde.

This article aims to estimate the prevalence of self-reported discrimination against people with hearing loss in Brazilian health services and analyze associated factors. We conducted a cross-sectional population-based study using data from the 2013 National Health Survey. The final study sample comprised 1,464 individuals with self-reported hearing loss. Poisson regression was used to calculate crude and adjusted prevalence ratios (PR) and respective 95% confidence intervals. The overall prevalence of discrimination was 15%. Prevalence was higher among black people and respondents who reported experiencing limitations in activities of daily living. Prevalence of discrimination in Brazilian health services was highest in black people with limitations in activities of daily living. The implementation of policies and actions to address this problem is recommended, including strategies during the education and training of health professionals.

O artigo tem como objetivo estimar a prevalência de discriminação social autorreferida em pessoas com deficiência auditiva nos serviços de saúde brasileiros, verificando fatores associados à discriminação. Estudo transversal de base populacional, com dados de um inquérito epidemiológico domiciliar realizado ponderadamente em todo o território brasileiro no ano de 2013. A amostra final deste estudo compreendeu 1.464 adultos com perda auditiva autorreferida. Utilizou-se regressão de Poisson com variância robusta para cálculo de razões de prevalência (RP) brutas e ajustadas para a investigação das prevalências de discriminação autorreferida nos serviços de saúde e seus respectivos intervalos de confiança de 95%. A prevalência de discriminação em adultos com deficiência auditiva nos serviços de saúde brasileiros foi de 15%. Indivíduos de cor/raça preta e que relataram que a perda auditiva limita as suas atividades de vida diária apresentaram maior associação com discriminação. Pessoas com deficiência auditiva de cor/raça preta e que apresentam limitação nas atividades da vida diária em decorrência da perda auditiva relataram maior discriminação nos serviços de saúde. Estratégias de enfrentamento à discriminação de profissionais da área da saúde devem ser implementadas para que esse cenário seja modificado.

Challenges in operationalizing conceptual models in aetiological research.

Conceptual or theoretical models are crucial in developing causal hypotheses and interpreting study findings, but they have been underused and misused in aetiological research, particularly in dentistry and oral epidemiology. Good models should incorporate updated evidence and clarify knowledge gaps to derive logical hypotheses. Developing models and deriving testable hypotheses in operational models can be challenging, as seen in the four examples referred to in this commentary. One challenge concerns the theoretical validity of the model, while another relates to difficulties in operationalizing abstract concepts. A third challenge refers to the lack of sufficient information in the dataset to test partially or even the whole model. Finally, a common challenge is the application of a conceptual model to different contexts. Among the existing methodological approaches to operationalize conceptual models, causal graphs may be helpful, especially when combined with approaches from diverse disciplinary fields via triangulation.

Dysarthria in hereditary spastic paraplegia type 4.

OBJECTIVE: To describe the speech pattern of patients with hereditary Spastic Paraplegia type 4 (SPG4) and correlated it with their clinical data. METHODS: Cross-sectional study was carried out in two university hospitals in Brazil. Two groups participated in the study: the case group (n = 28) with a confirmed genetic diagnosis for SPG4 and a control group (n = 17) matched for sex and age. The speech assessment of both groups included: speech task recording, acoustic analysis, and auditory-perceptual analysis. In addition, disease severity was assessed with the Spastic Paraplegia Rating Scale (SPRS). RESULTS: In the auditory-perceptual analysis, 53.5% (n = 15) of individuals with SPG4 were dysarthric, with mild to moderate changes in the subsystems of phonation and articulation. On acoustic analysis, SPG4 subjects' performances were worse in measurements related to breathing (maximum phonation time) and articulation (speech rate, articulation rate). The articulation variables (speech rate, articulation rate) are related to the age of onset of the first motor symptom. CONCLUSION: Dysarthria in SPG4 is frequent and mild, and it did not evolve in conjunction with more advanced motor diseases. This data suggest that diagnosed patients should be screened and referred for speech therapy evaluation and those pathophysiological mechanisms of speech involvement may differ from the length-dependent degeneration of the corticospinal tract.

Factors associated with frailty in patients with neurodegenerative diseases. / Fatores associados a fragilidade em pacientes com doenças neurodegenerativas.

PURPOSE: To identify the factors associated with frailty in patients with neurodegenerative diseases. METHODS: Cross-sectional study, whose sample consisted of 150 patients diagnosed with neurodegenerative diseases seen at a speech-language therapy clinic in a reference hospital in southern Brazil. A secondary exploratory analysis of the medical records of patients treated at this clinic between April 2016 and May 2019 was performed. The information collected was sex, age, education, type of neurodegenerative disease, time of disease, frailty (Edmonton Frail Scale-EFS), swallowing (Northwestern Dysphagia Patient CheckSheet-NDPCS, Eating Assessment Tool-EAT 10), and cognition (Mini-Mental State Examination-MMSE and Montreal Cognitive Assessment-MoCA). Continuous quantitative variables were analyzed using mean and standard deviation and categorical quantitative variables from absolute and relative frequency, as well as their association with the outcome using the Chi-square test. Crude and adjusted Prevalence Ratios were assessed using Poisson regression with robust variance. All statistical tests were considered significant at a level of 5%. RESULTS: The significant factors associated with frailty were the presence of oropharyngeal dysphagia and altered cognitive performance. Individuals with frailty have a higher prevalence of oropharyngeal dysphagia (PR= 1.772(1.094-2.872)), while cognition alteration presented a lower prevalence (PR= 0.335(0.128-0.873). CONCLUSION: Oropharyngeal dysphagia can be an important clinical predictive factor for consideration in cases of frailty in patients with neurodegenerative diseases.

OBJETIVO: Identificar os fatores associados à fragilidade em pacientes com doenças neurodegenerativas. MÉTODO: Estudo transversal, cuja amostra foi composta por 150 pacientes com diagnóstico de doenças neurodegenerativas atendidos em um ambulatório de Fonoaudiologia de um hospital de referência no sul do Brasil. Foi realizada análise secundária exploratória dos prontuários dos pacientes atendidos neste ambulatório entre o período de abril de 2016 e maio de 2019. As informações coletadas foram: sexo, idade, escolaridade, tipo de doença neurodegenerativa, tempo de doença, fragilidade (Edmonton Frail Scale - EFS), deglutição (Northwestern Dysphagia Patient CheckSheet- NDPCS, Eating Assessment Tool-EAT 10) e cognição (Mini-Mental State Examination-MMSE e Montreal Cognitive Assessment-MoCA). As variáveis quantitativas contínuas foram analisadas a partir de média e desvio padrão e as quantitativas categóricas a partir de frequência absoluta e relativa, assim como analisou-se a associação destas com o desfecho pelo teste Qui-Quadrado. As Razões de Prevalência brutas e ajustadas foram avaliadas a partir da Regressão de Poisson com variância robusta. Todos os testes estatísticos foram considerados significativos a um nível de 5%. RESULTADOS: Os fatores significativos associados à fragilidade foram à presença de disfagia orofaríngea e desempenho cognitivo alterado. Indivíduos com a fragilidade apresentam maior prevalência de disfagia orofaríngea (RP=1,772(1,094-2,872)), enquanto a cognição alterada está associada a menor prevalência de fragilidade (RP=0,335(0,128-0,873). CONCLUSÃO: A disfagia orofaríngea pode ser um importante fator clínico preditivo a ser considerado em casos de fragilidade em pacientes com doenças neurodegenerativas.

Speech characteristics in individuals with myasthenia gravis: a case control study.

INTRODUCTION: Myasthenia Gravis (MG) is an autoimmune disease. The characteristic symptoms of the disease are muscle weakness and fatigue. These symptoms affect de oral muscles causing dysarthria, affecting about 60% of patients with disease progression. PURPOSE: Describe the speech pattern of patients with MG and comparing with healthy controls (HC). MATERIAL AND METHODS: Case-control study. Participants were divided in MG group (MGG) with 38 patients MG diagnosed and HC with 18 individuals matched for age and sex. MGG was evaluated with clinical and motor scales and answered self-perceived questionnaires. Speech assessment of both groups included: recording of speech tasks, acoustic and auditory-perceptual analysis. RESULTS: In the MGG, 68.24% of the patients were female, with average age of 50.21 years old (±16.47), 14.18 years (±9.52) of disease duration and a motor scale of 11.19 points (±8.79). The auditory-perceptual analysis verified that 47.36% (n = 18) participants in MGG presented mild dysarthria, 10.52% (n = 4) moderate dysarthria, with a high percentage of alterations in phonation (95.2%) and breathing (52.63%). The acoustic analysis verified a change in phonation, with significantly higher shimmer values in the MGG compared to the HC and articulation with a significant difference between the groups for the first formant of the /iu/ (p = <.001). No correlation was found between the diagnosis of speech disorder and the dysarthria self-perception questionnaire. CONCLUSION: We found dysarthria mild in MG patients with changes in the motor bases phonation and breathing, with no correlation with severity and disease duration.

Speech and swallowing characteristics in patients with facioscapulohumeral muscular dystrophy.

BACKGROUND: Although facial muscle weakness is common in patients with Facioscapulohumeral Muscular Dystrophy (FSHD), the literature is scarce on the speech and swallowing aspects. OBJECTIVE: To investigate speech and swallowing patterns in FSHD and assess the correlation with clinical data. METHODS: A cross-sectional study was conducted. Patients with clinical confirmation of FSHD and aged above 18 years were included and paired with healthy control individuals by age and gender. Individuals who had neurological conditions that could interfere with test results were excluded. The following assessments were applied: speech tests (acoustic and auditory-perceptual analysis); swallowing tests with the Northwestern Dysphagia Patient Check Sheet (NDPCS), the Eat Assessment Tool (EAT-10), the Speech Therapy Protocol for Dysphagia Risk (PARD), and the Functional Oral Intake Scale (FOIS); disease staging using the modified Gardner-Medwin-Walton scale (GMWS); and quality of life with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The correlation between test results and clinical data was verified by non-parametric statistics. RESULTS: Thirteen individuals with FSHD and 10 healthy controls were evaluated. The groups presented significant differences in the motor bases of phonation and breathing. Regarding swallowing, two (15%) individuals presented mild dysphagia and seven (53.8%) showed reduced facial muscles strength. These results were not correlated with duration of the disease, age at symptoms onset, and quality of life. Dysphagia was related to worsening disease severity. CONCLUSIONS: FSHD patients presented mild dysarthria and dysphagia. Frequent monitoring of these symptoms could be an important way to provide early rehabilitation and better quality of life.

Prevalence of speech-language and hearing disorders in elderly and younger adults according to sex and age: a population survey. / Prevalência de distúrbios fonoaudiológicos em adultos e idosos, segundo sexo e faixa etária: um estudo populacional.

PURPOSE: To verify the distribution of self-reported speech-language and hearing disorders and their association to sex and age in a representative sample of the population in southern Brazil. METHODS: Prevalence of speech-language and hearing disorders in elderly and younger adults according to sex and age: a population survey based on a household survey on Human Communication Disorders (DCH-POP Study). Standardized home interviews were conducted using a questionnaire with residents of the city of Porto Alegre between 2012 and 2014. The study outcome was self-reported "speech-language and hearing disorders", constituted from the variables: language, orofacial motricity, hearing, and balance. Analyses of absolute and relative frequencies were performed. Multivariable prevalence ratios were estimated in an adjusted analysis using Poisson Regression with robust variation and 95% confidence intervals. RESULTS: Of the 1246 individuals interviewed, 918 participants were eligible for this study. Most of them were female (58.1%), and the average age was 48.9 (± 19.6) years. The outcome of speech-language and hearing disorders was found in 364 (39.4%) individuals, and the most affected age group was 60 years old or more (54.4%), with a higher prevalence in men (58.9%) than in women (51.9%). The multivariate analysis showed a significant prevalence ratio only in elderly individuals aged 60 years or older (PR 1.84; 95% CI 1.50-2.26). CONCLUSION: In this study, we did not find significant differences between sexes in the prevalence of self-reported speech-language and hearing disorders in elderly and younger adults. However, elderly and younger adults presented a higher prevalence of these disorders.

OBJETIVO: Verificar a distribuição dos distúrbios fonoaudiológicos autorreferidos em relação ao sexo e à faixa etária em uma amostra representativa da população do sul do Brasil. MÉTODO: Estudo transversal em adultos e idosos com base em um inquérito populacional domiciliar autodeclarado sobre Distúrbios da Comunicação Humana (DCH-POP). Foram realizadas entrevistas domiciliares padronizadas com a aplicação de um questionário com residentes da cidade de Porto Alegre entre 2012 e 2014. O desfecho estudado foi "distúrbios fonoaudiológicos", constituído a partir dos dados das variáveis: linguagem, motricidade orofacial, audição e equilíbrio. Foram realizadas análises de frequência absoluta e relativa. Razões de prevalência multivariáveis foram estimadas em análise ajustada pela Regressão de Poisson com variância robusta e respectivos intervalos de confiança de 95%. RESULTADOS: Dos 1246 indivíduos entrevistados, 918 participantes foram elegíveis para este estudo. A maioria é do sexo feminino (58,1%) e a idade média foi de 48,9 (±19,6) anos. O desfecho distúrbio fonoaudiológico foi encontrado em 364 (39,4%) indivíduos, sendo que a faixa etária mais acometida foi a de 60 anos ou mais (54,4%), apresentando maior prevalência no sexo masculino (58,9%), do que no feminino (51,9%). Na análise multivariável ajustada verifica-se que há razão de prevalência significativa apenas em indivíduos idosos com 60 anos ou mais (RP 1,84 IC95% 1,50-2,26). CONCLUSÃO: Neste estudo não encontramos diferenças significativas entre os sexos na prevalência dos distúrbios fonoaudiológicos autorreferidos em adultos e idosos. Entretanto, pessoas mais velhas apresentam maior prevalência destes, especialmente aquelas com idade entre 60 anos ou mais.

Factors Associated with Tobacco Cessation in Primary Health Care.

Introduction Cigarettes are the main cause of preventable death in the world, and primary health care services can contribute to the management of this habit. Objective To describe and analyze the factors associated with tobacco cessation in groups of smokers in primary health care. Methods The present is a cross-sectional study conducted in 12 primary health care units from July 2016 to May 2017. We investigated sociodemographic and health variables, as well as smoking characteristics and different interventions for tobacco cessation, with the outcome being studied and analyzed after the fourth group care session. Results We evaluated 329 smokers, of which 182 quit smoking after the fourth interview. Most of the individuals who quit smoking were women ( n = 121, 66.5%), with a monthly income of 2 to 5 minimum wages ( n = 88, 77.9%). After the multivariable analysis, we observed that tobacco cessation was significantly associated with depression (prevalence ratio [PR] = 1.11; 95% confidence interval [95%CI] = 1.02 to 1.22), as well as with belonging to the groups which used as approaches motivational interviewing (PR = 1.21; 95%CI = 1.13 to 2.01), patches (PR = 1.36; 95%CI = 1.24 to 1.48), and bupropion (PR = 1.16; 95%CI = 1.03 to 1.31). Conclusion Primary health care is the ideal site for the reduction of smoking rates, given that different technologies may be applicable and useful for tobacco cessation. The comprehensiveness and longitudinal care offered in primary care may provide opportunities for health professionals to understand which is the best technology for each health system user, thus contributing to personalized care.

Self-rated health and hearing disorders: study of the Brazilian hearing-impaired population.

Hearing impairment (HI) is one of the most impacting handicaps related to social life, and 21% have intense limitation compromising daily activities. However, few studies have investigated SRH in HI. This article aims to verify the association between HI and SRH and factors related to hearing characteristics. Cross-sectional study data from National Health Survey (NHS, 2013) conducted with 1,100 hearing impaired adults (≥18 years old). The outcome was SHR, categorized as good or poor. Poisson regression with robust variance was used to calculate Prevalence Ratios. Sociodemographic variables and characteristics of HI, such as congenital or acquired HI, type of HI, wear hearing aids, and limitation were used in adjusted analysis. Poor SRH was more prevalent in acquired HI, limitation of daily activities, sociodemographic characteristics such as aging, female, black or other skin color, and lower schooling. Poor SRH is related to acquired HI, limitation of daily activities and sociodemographic conditions.

Caries experience in caregiver-intellectual deficient pair: Influence of caregiver's psychological morbidity.

OBJECTIVE: Evaluate how determinants of psychological morbidity were associated with dental caries experience in the caregiver-intellectual deficient pair. METHODS: A cross-sectional study with 299 pair, who had their oral health status assessed using the DMFT index (decayed, missing and filled teeth). Symptoms of anxiety, depression, stress, quality of sleep, and socioeconomic variables were measured in caregivers. Adjusted prevalence ratios were estimated using Poisson regression with the caregiver and children's caries index as outcome. RESULTS: The average prevalence of DMFT/dmft was 7.48 (SD ± 3.9) for students with ID and DMFT was 14.7 (SD ± 8.1) for their caregivers. For the caregiver's oral health, the following psychic comorbidities were associated with worse oral health condition: anxiety (PR = 1.48; 95%CI 1.07-2.06), depression (PR = 1.39; 95%CI 1.05-1.85), high level of stress (PR = 1.58; 95%CI 1.17-2.13) and sleep disorders (PR = 1.59; 95%CI 1.18-2.14). For people with ID, the caregiver's psychic comorbidities also showed association with a worse oral health condition, including anxiety (PR = 1.31; 95%CI 1.03-1.74), depression (PR = 1.28; 95%CI 1.01-1.67) and high level of stress (PR = 1.63; 95%CI 1.14-2.32), as well as mother's high level of DMFT (PR = 1.96; 95%CI 1.28-3.03). CONCLUSION: Symptoms of depression, anxiety and stress were associated with higher levels of dental caries experience for caregivers and for people with intellectual disabilities.

Factors associated with the initiation of breastfeeding in a maternity hospital in Lima, Peru. / Fatores associados ao início da prática do aleitamento em uma maternidade de Lima, Peru.

PURPOSE: To verify the anatomophysiological, psychological, and sociocultural factors of the mother-newborn binomial, as well as their association with the initiation of breastfeeding. METHODS: Cross-sectional study conducted in a maternity hospital in Lima, Peru. The sample consisted of 304 healthy neonates and their mothers. Breastfeeding performance was estimated by clinical assessment using the Clinical Evaluation of Breastfeeding Efficacy scale and maternal self-perception by the Breastfeeding Self-Efficacy Scale. Multivariate Prevalence Ratios (PR) were estimated by Poisson Regression with Robust Variance and 95% confidence intervals (CI). RESULTS: The prevalence of clinical low breastfeeding performance was 27.6%. Primiparous women were associated with higher prevalence of low performance when they did not trust to succeed [PR:2.02(95%CI:1.18-3.44)] and lower prevalence in having a good latch [PR:0.52(95%CI:0.29-0.95)], as well as in coping successfully [PR:0.59(95%CI:0.37-0.91)]. Multiparous women showed higher prevalence when they were not confident in staying motivated [PR:3.47(95%CI:1.67-7.22)] and in calming the neonate [PR:4.07(95%CI:1.83-9.95)]. There was lower prevalence in keeping the neonate awake [PR:0.32(95%CI:0.14-0.75)] and when they did not feel confident in the presence of their family [PR:0.29(95%CI:0.13-0.64)]. CONCLUSION: It is important that health professionals be aware of emotional, social, and cultural issues to promote quality breastfeeding.

OBJETIVO: Verificar os fatores anatomofisiológicos, psicológicos, socioculturais do binômio mãe neonato e sua associação com o início da prática do aleitamento materno. MÉTODO: Estudo transversal realizado em uma Maternidade de Lima Peru. A amostra foi de 304 neonatos sadios e suas respectivas mães. O desempenho na amamentação foi estimado por avaliação clínica utilizando-se a escala de Avaliação Clínica da Eficácia da Amamentação e a autopercepção materna pela Escala de Autoeficácia da Amamentação. Razões de Prevalência (RP) multivariadas foram estimadas pela Regressão de Poisson com Variância Robusta e intervalos de confiança (IC) de 95%. RESULTADOS: A prevalência de baixo desempenho clínico na amamentação foi de 27,6%. Primíparas associarem-se a maior prevalência de baixo desempenho quando não confiavam em ter sucesso [RP:2,02(IC95%:1,18-3,44)] e menor prevalência em ter boa pega [RP:0,52(IC95%:0,29-0,95)], assim como em enfrentar com êxito [RP:0,59(IC95%:0,37-0,91)]. As multíparas, apresentaram maior prevalência quando não confiavam em manter-se motivadas [RP:3,47(IC95%:1,67-7,22)] e em acalmar o neonato [RP:4,07(IC95%:1,83-9,95)]. Houve menor prevalência em manter o neonato acordado [RP:0,32(IC95%:0,14-0,75)] e quando não se sentiam confiantes na presença de seus familiares [RP:0,29(IC95%:0,13-0,64)]. CONCLUSÃO: É importante que profissionais da saúde estejam atentos às questões emocionais, sociais e culturais para a promoção de um aleitamento materno com qualidade.

Presence of ankyloglossia and breastfeeding in babies born in Lima, Peru: a longitudinal study.

PURPOSE: to evaluate the lingual frenulum and breastfeeding in infants from a maternal-perinatal referral center, as well as to monitor infants with ankyloglossia up to six months of age. METHODS: a cohort study conducted at the Instituto Nacional Materno Perinatal - Maternidad de Lima in Lima, Peru. The consecutive intentional sample consisted of 304 newborns and their respective mothers, evaluated during December 2017 and January 2018, which were the baseline of the study. A clinical evaluation of the lingual frenulum adapted and the Clinical Evaluation of Breastfeeding Efficacy (CEBE) scale, was performed. RESULTS: of the 304 newborns, 15 (4.9%) were considered with altered frenulum, and only 4 (26.7%) presented a low score in CEBE. The mean of the CEBE score was 9.3. (DP=1.35, Min=3, Max=10). Of the follow-up infants, only 2 (13.3%) persisted with breastfeeding difficulties for which frenotomy was indicated. CONCLUSION: This study demonstrates the low prevalence of ankyloglossia in infants, as it does not indicate a trend of difficulty or negative interference in breastfeeding.

Cognitive profile of patients with facioscapulohumeral muscular dystrophy.

Although it is predominantly a muscular disease, impairments in the central nervous system in patients with facioscapulohumeral muscular dystrophy (FSHD) have been described in the literature. Objective: To describe the cognitive profile of patients with FSHD and to correlate the impairments found with clinical variables and quality of life. Methods: Cross-sectional and case-control study that evaluated FSHD patients using a series of cognitive assessments (Mini-Mental State Examination - MMSE, Montreal Cognitive Assessment - MoCA, verbal fluency with phonological restriction - FAS, categorical verbal fluency - FAS-cat, trail-making test - TMT, and Rey's Verbal Auditory Learning Test); a neurological severity scale (Gardner-Medwin-Walton - GMWS); and a quality of life measurement tool (Medical Outcomes Study 36-Item Short-Form Health Survey). Results: Individuals with FSHD (13) and healthy controls (26) were paired by gender and age. Significant differences between case and control groups were found in MMSE, TMT A, and A7 (p≤0.05) and MOCA (p≤0.001) performances. A positive correlation was verified in long-term memory impairments and the age in which symptoms appear (r=-0.593, p=0.033). Regarding quality of life assessment, the emotional domain correlated to MEEM (r=0.657, p=0.015), TMT A (r=-0.601, p=0.030), and A7 (r=0.617, p=0.025) performances. Conclusions: Individuals with FSHD presented mild impairments in the performance of tasks that involve attention, planning, and long-term memory functions. Those impairments were associated neither with the disease duration nor with its neurological severity.

Embora seja uma doença predominantemente muscular, alterações no sistema nervoso central em pacientes com Distrofia Facioescapuloumeral (FSHD) têm sido descritas na literatura. Objetivo: Caracterizar o perfil cognitivo de pacientes com FSHD e correlacionar as alterações encontradas com variáveis clínicas e qualidade de vida. Métodos: Estudo transversal, caso-controle que avaliou pacientes com FSHD por meio de uma série de avaliações cognitivas (Mini Exame do Estado Mental ­ MEEM; Montreal Cognitive Assessment ­ MoCA; fluência verbal com restrição fonológica ­ FAS; fluência verbal categórica ­ FAS-cat; Trail Making Test ­ TMT; e Rey's Verbal Auditory Learning Test ­ RAVLT); uma escala de gravidade neurológica (Gardner-Medwin-Walton ­ GMWS); e um questionário (Medical Outcomes Study 36-Item Short-Form Health Survey ­ SF-36). Resultados: A amostra foi composta por 13 indivíduos com FSHD e 26 controles saudáveis, pareados por sexo e idade. A análise comparativa entre os grupos FSHD e controle mostrou diferenças significativas no desempenho cognitivo dos testes MEEM, TMT A e A7 (p≤0.05) e no MoCA (p≤0,001). Verificou-se uma correlação positiva com a idade de início dos sintomas e o prejuízo na memória de longo prazo (r=-0,593, p=0,033). Em relação à qualidade de vida, observou-se uma correlação entre o domínio de limitação emocional e os testes MEEM (r=0,657, p=0,015), TMT A (r=-0,601, p=0,030) e A7 (r=0,617, p=0,025). Conclusões: Pacientes com FSHD apresentaram alterações leves na realização de tarefas que envolvem as funções de atenção, planejamento e memória de longo prazo. Essas alterações não tiveram associação com o tempo de doença nem com sua gravidade neurológica.