Evaluation of post-stroke functionality based on the International Classification of Functioning, Disability, and Health: a proposal for use of assessment tools.

This study aimed to identify the International Classification of Functioning, Disability, and Health categories addressed by the assessment tools commonly used in post-stroke rehabilitation and characterize patients based on its evaluation model. [Subjects and Methods] An exploratory, descriptive, cross-sectional study was conducted involving 35 individuals with chronic post-stroke hemiparesis. Handgrip strength was assessed to evaluate body functions and structures. The 10-meter gait speed test and Timed Up and Go test were administered to evaluate activity. The Stroke Specific Quality of Life scale was used to evaluate participation. Moreover, a systematic review of the literature was performed to identify studies that have associated these assessment tools with the International Classification of Functioning, Disability, and Health categories. [Results] The tools employed in this study for evaluating function addressed 63 International Classification of Functioning, Disability, and Health categories: 24 related to body functions and structures; 36 related to activity and participation; and 3 related to environmental factors. [Conclusion] The assessment tools employed in this study addressed 63 International Classification of Functioning, Disability, and Health categories and allowed a more complete evaluation of stroke survivors with hemiparesis. Use of this classification can therefore be more easily incorporated into clinical practice.

[Estimation of cancer incidence in the state of São Paulo, Brazil, based on real data]. / Estimativa da incidência de câncer no Estado de São Paulo, Brasil, a partir de dados reais.

This study aims to evaluate the feasibility of applying a method of estimating the incidence of cancer to regions of the state of São Paulo, Brazil, from real data (not estimated) and retrospectively comparing the results obtained with the official estimates. A method based on mortality and on the incidence to mortality (I/M) ration was used according to sex, age, and tumor location. In the I/M numerator, new cases of cancer were used from the population records of Jaú and São Paulo from 2006-2010; in the denominator, deaths from 2006-2010 in the respective areas, extracted from the national mortality system. The estimates resulted from the multiplication of I/M by the number of cancer deaths in 2010 for each region. Population data from the 2010 Demographic Census were used to estimate incidence rates. For the adjustment by age, the world standard population was used. We calculated the relative differences between the gross incidence rates estimated in this study and the official ones. Age-adjusted cancer incidence rates were 260.9/100,000 for men and 216.6/100,000 for women. Prostate cancer was the most common in males, whereas breast cancer was most common in females. Differences between the rates of this study and the official rates were 3.3% and 1.5% for each sex. The estimated incidence was compatible with the officially presented state profile, indicating that the application of real data did not alter the morbidity profile, while it did indicate different risk magnitudes. Despite the over-representativeness of the cancer registry with greater population coverage, the selected method proved feasible to point out different patterns within the state.

Este estudo teve como objetivos avaliar a viabilidade de aplicação do método de estimativa da incidência de câncer nas regiões do Estado de São Paulo, Brasil, a partir de dados reais (ou seja, não estimados), e comparar, retrospectivamente, os resultados obtidos com as estimativas oficiais. Utilizou-se método baseado na mortalidade e nas razões de incidência e mortalidade (I/M), segundo sexo, idade e localização do tumor. No numerador da I/M, utilizaram-se casos novos de câncer dos registros populacionais de Jaú e São Paulo de 2006 a 2010; no denominador estão os óbitos de 2006 a 2010 nas respectivas áreas, extraídos do sistema de mortalidade nacional. As estimativas resultaram da multiplicação das I/M pelo número de óbitos por câncer em 2010 em cada região. Dados populacionais do Censo Demográfico de 2010 foram usados para o cálculo de taxas de incidência. Para o ajuste por idade, utilizou-se a população padrão mundial. Calculamos diferenças relativas entre as taxas brutas de incidência estimadas neste estudo e as oficiais. As taxas de incidência de câncer ajustadas por idade foram de 260,9/100 mil em homens e de 216,6/100 mil em mulheres. O câncer de próstata foi o mais incidente no sexo masculino, e no feminino o câncer de mama. As diferenças entre as taxas deste estudo e as oficiais foram de 3,3% e 1,5% em cada sexo. A incidência estimada mostrou-se compatível com o perfil estadual apresentado oficialmente, indicando que a aplicação de dados reais não alterou o perfil de morbidade, mas indicou a magnitudes de riscos distintos. Apesar da super representatividade do registro de câncer de maior cobertura populacional, o método selecionado mostrou-se viável para apontar diferentes padrões intraestaduais.

Este estudio tuvo por objetivo evaluar la viabilidad de aplicar un método para estimar la incidencia de cáncer en las regiones del estado de São Paulo, Brasil, a partir de datos reales (no estimados) y comparar retrospectivamente los resultados obtenidos con las estimaciones oficiales. Se aplicó un método que se basa en la mortalidad y las razones de incidencia y mortalidad (I/M) según sexo, edad y localización del tumor. En el numerador de la I/M se pusieron los casos nuevos de cáncer de los registros de población de Jaú y São Paulo entre 2006 y 2010; y en el denominador, las defunciones en 2006-2010 en las respectivas áreas, extraída la información del sistema nacional de mortalidad. Las estimaciones provienen de multiplicar las I/M por el número de muertes por cáncer en 2010 en cada región. Los datos poblacionales del Censo Demográfico de 2010 se utilizaron para calcular las tasas de incidencia. Para el ajuste por edad se utilizó la población estándar mundial. Se calcularon la diferencia relativa entre la tasa bruta de incidencia estimada en este estudio y la oficial. Las tasas de incidencia de cáncer ajustadas por edad fueron 260,9/100.000 en hombres y 216,6/100.000 en mujeres. El cáncer de próstata fue el más frecuente en varones, y el cáncer de mama en mujeres. Las diferencias entre las tasa de este estudio y la oficial fueron del 3,3% y el 1,5% para cada género. La incidencia estimada fue compatible con el perfil del estado presentado oficialmente, lo que indica que la aplicación de datos reales no modificó el perfil de morbilidad, pero apuntó magnitudes de riesgo diferentes. A pesar de la sobrerrepresentación del registro de cáncer con mayor cobertura poblacional, el método seleccionado demostró ser viable para identificar diferentes patrones entre estados.

Identification of categories of the International Classification of Functioning, Disability and Health in functional assessment measures for stroke survivors: a systematic review.

Objective: Perform a systematic review to identify the categories of the International Classification of Functioning, Disability and Health linked to the concepts measured by functional assessment tools validated for Brazilian Portuguese: Timed Up and Go test, Functional Independence Measure, Barthel Index, and Rivermead Mobility Index and Modified Rankin Scale.Methods: The Medline, Embase and CINAHL databases were consulted using a standardized search strategy. The studies were summarized using a pre-established set of specific criteria for the adequate linkage between the concepts identified in the assessment measures and the International Classification of Functioning, Disability and Health categories. Two independent reviewers performed the selection of the studies, data extraction and evaluation of the results.Results: The search of the databanks led to the retrieval of 99 studies. However, only six articles were included in the present review. The linkage results of the studies included in the review were divergent, likely due to the taxonomic complexity of the International Classification of Functioning, Disability and Health, the difficulty in clearly relating the concepts of the assessment measures to the classifications and the fact that not all linkage rules were followed. "Activities and participation" was the most evaluated component, with mobility the most frequently covered category in the measures, followed by self-care. Among the measures analyzed, the Functional Independence Measure addresses a greater number of categories and therefore has the most concepts related to the International Classification of Functioning, Disability and Health, followed by the Barthel Index, Modified Rankin Scale, Rivermead Mobility Index and Timed Up and Go test. The Modified Rankin Scale was the assessment tool that most evaluated categories related to environmental factors.Conclusion: The Functional Independence Measure has more concepts related to the International Classification of Functioning, Disability and Health, since it addresses a greater number of categories. These findings can help guide health professionals in the selection of assessment tools for the evaluation of post-stroke functioning, making viable the use of the International Classification of Functioning, Disability and Health categories in clinical practice and public health services.Implications for rehabilitationThis study standardized identification of the International Classification of Functioning, Disability and Health categories in the main outcome measures used to assess post-stroke functional capacity.Functional Independence Measure has more concepts related to the International Classification of Functioning, Disability and Health compared to other functional assessment instruments.Findings can enable physiotherapists and researchers choose the most appropriate measure that best corresponds to their field of interest.These results facilitate the implementation of the International Classification of Functioning, Disability and Health in clinical practice.Use of International Classification of Functioning, Disability and Health categories can standardize information on functional health.

The World Health Organization Disability Assessment Schedule 2 (WHODAS 2.0): remarks on the need to revise the WHODAS.

Functioning and disability are concepts in increasing use in clinical settings and in public health. From the public health perspective, the use of functioning as a third health indicator could show more than the frequency of a disease and its death rates, offering information on how the population performs its activities and participation. Clinically, the functioning assessment can provide information for patient-centered health care and specific clinical interventions according to their functioning profile. WHODAS 2.0 is a generic tool to assess health and functioning according to the ICF functioning model. It is an alternative to assess functioning in a less time-consuming way, whereas the duration of the application is one of the main ICF critiques. This paper aims to present some of WHODAS 2.0 inconsistencies and weaknesses as well as strategies to cope with them. In this paper, we present some weaknesses related to the WHODAS layout; wording and scoring process. Some suggestions for strategies to correct these weaknesses are presented, as well.

WHODAS 2.0-BO: normative data for the assessment of disability in older adults.

OBJECTIVE: To examine the normative data of WHODAS 2.0-BO for older Brazilians (World Health Disability Assessment Schedule - Brazilian version for older people) and its distribution according to sex, age, health, subjective health perception, performance in a mobility test and presence of chronic diseases and depression. METHODS: Cross-sectional study, with 350 participants with 60 years of age or older, men and women, patients of a geriatric specialized center for medical consultations or rehabilitation. The older adults were evaluated using a semi-structured questionnaire containing demographic and clinical data (WHODAS 2.0-BO) and the geriatric depression scale (GDS), having been subsequently subjected to a mobility test (Timed Up and Go). The data were analyzed via their distribution in percentiles of the population and via analysis of variance. RESULTS: Two-hundred and sixty-six (76%) participants were women, and the average age was 71.8 (DP = 6.7) years old. The average score in WHODAS 2.0-BO was 4.3 (DP = 5.2) points, the highest value found having corresponded to 33 points. The average time for the Timed Up and Go test was 10.0 (SD = 3.2) seconds. About 30% of the older adults did not report any difficulties in the tasks evaluated by WHODAS 2.0-BO and half of the sample scored up to two points. CONCLUSIONS: A score corresponding to 12 points in the 90 percentile on a scale from zero to 40 was observed, which suggests severe disability. The score in WHODAS 2.0-BO increased with the advance in age, as well as in the presence of comorbidities, negative health perception, depression, high blood pressure, visual and hearing impairment and mobility impairment.

Identification of relevant categories for inpatient physical therapy care using the International Classification of Functioning, Disability and Health: a Brazilian survey.

BACKGROUND: Hospitalized patients are at risk for the loss of function and impairment. Physical therapists aim to improve functionality and prevent disabilities. The International Classification of Functioning, Disability and Health (ICF) propose a universal language to classify the functionality of patients across different health care settings and over diverse health conditions. OBJECTIVES: To identify the International Classification of Functioning, Disability and Health categories that describe most common and relevant patient problems managed by physical therapists in Brazilian hospitals in the acute and post-acute care settings. SUBJECTS: The participants were physical therapists who worked in hospitals with a minimum work experience of two years. METHODS: A consensus-building, two-round, emailed survey was conducted using the Delphi technique. RESULTS: For the development of an ICF short list, 47 physical therapists from the acute care setting and 30 physical therapists from the post-acute care setting responded to the Delphi exercise. Most of the professionals were from the cardiorespiratory physical therapy area. A 80% level of consensus or higher was established for the selection of the categories of the ICF components (Body Functions, Body Structures, Activities and Participation, and Environmental Factors). We obtained two short lists to be used in clinical practice comprising 39 ICF categories for acute care settings and 53 for post-acute care settings. CONCLUSION: This study is the first to identify the most relevant aspects for physical therapy in Brazilian hospitals using the ICF framework. Our results can help to promote the adoption of the ICF in physical therapy clinical practice in the hospital setting.

Estimativa da incidência de câncer no Estado de São Paulo, Brasil, a partir de dados reais / Estimation of cancer incidence in the state of São Paulo, Brazil, based on real data / Estimación de incidencia de cáncer en el estado de São Paulo, Brasil, con base en datos reales

Este estudo teve como objetivos avaliar a viabilidade de aplicação do método de estimativa da incidência de câncer nas regiões do Estado de São Paulo, Brasil, a partir de dados reais (ou seja, não estimados), e comparar, retrospectivamente, os resultados obtidos com as estimativas oficiais. Utilizou-se método baseado na mortalidade e nas razões de incidência e mortalidade (I/M), segundo sexo, idade e localização do tumor. No numerador da I/M, utilizaram-se casos novos de câncer dos registros populacionais de Jaú e São Paulo de 2006 a 2010; no denominador estão os óbitos de 2006 a 2010 nas respectivas áreas, extraídos do sistema de mortalidade nacional. As estimativas resultaram da multiplicação das I/M pelo número de óbitos por câncer em 2010 em cada região. Dados populacionais do Censo Demográfico de 2010 foram usados para o cálculo de taxas de incidência. Para o ajuste por idade, utilizou-se a população padrão mundial. Calculamos diferenças relativas entre as taxas brutas de incidência estimadas neste estudo e as oficiais. As taxas de incidência de câncer ajustadas por idade foram de 260,9/100 mil em homens e de 216,6/100 mil em mulheres. O câncer de próstata foi o mais incidente no sexo masculino, e no feminino o câncer de mama. As diferenças entre as taxas deste estudo e as oficiais foram de 3,3% e 1,5% em cada sexo. A incidência estimada mostrou-se compatível com o perfil estadual apresentado oficialmente, indicando que a aplicação de dados reais não alterou o perfil de morbidade, mas indicou a magnitudes de riscos distintos. Apesar da super representatividade do registro de câncer de maior cobertura populacional, o método selecionado mostrou-se viável para apontar diferentes padrões intraestaduais.

This study aims to evaluate the feasibility of applying a method of estimating the incidence of cancer to regions of the state of São Paulo, Brazil, from real data (not estimated) and retrospectively comparing the results obtained with the official estimates. A method based on mortality and on the incidence to mortality (I/M) ration was used according to sex, age, and tumor location. In the I/M numerator, new cases of cancer were used from the population records of Jaú and São Paulo from 2006-2010; in the denominator, deaths from 2006-2010 in the respective areas, extracted from the national mortality system. The estimates resulted from the multiplication of I/M by the number of cancer deaths in 2010 for each region. Population data from the 2010 Demographic Census were used to estimate incidence rates. For the adjustment by age, the world standard population was used. We calculated the relative differences between the gross incidence rates estimated in this study and the official ones. Age-adjusted cancer incidence rates were 260.9/100,000 for men and 216.6/100,000 for women. Prostate cancer was the most common in males, whereas breast cancer was most common in females. Differences between the rates of this study and the official rates were 3.3% and 1.5% for each sex. The estimated incidence was compatible with the officially presented state profile, indicating that the application of real data did not alter the morbidity profile, while it did indicate different risk magnitudes. Despite the over-representativeness of the cancer registry with greater population coverage, the selected method proved feasible to point out different patterns within the state.

Este estudio tuvo por objetivo evaluar la viabilidad de aplicar un método para estimar la incidencia de cáncer en las regiones del estado de São Paulo, Brasil, a partir de datos reales (no estimados) y comparar retrospectivamente los resultados obtenidos con las estimaciones oficiales. Se aplicó un método que se basa en la mortalidad y las razones de incidencia y mortalidad (I/M) según sexo, edad y localización del tumor. En el numerador de la I/M se pusieron los casos nuevos de cáncer de los registros de población de Jaú y São Paulo entre 2006 y 2010; y en el denominador, las defunciones en 2006-2010 en las respectivas áreas, extraída la información del sistema nacional de mortalidad. Las estimaciones provienen de multiplicar las I/M por el número de muertes por cáncer en 2010 en cada región. Los datos poblacionales del Censo Demográfico de 2010 se utilizaron para calcular las tasas de incidencia. Para el ajuste por edad se utilizó la población estándar mundial. Se calcularon la diferencia relativa entre la tasa bruta de incidencia estimada en este estudio y la oficial. Las tasas de incidencia de cáncer ajustadas por edad fueron 260,9/100.000 en hombres y 216,6/100.000 en mujeres. El cáncer de próstata fue el más frecuente en varones, y el cáncer de mama en mujeres. Las diferencias entre las tasa de este estudio y la oficial fueron del 3,3% y el 1,5% para cada género. La incidencia estimada fue compatible con el perfil del estado presentado oficialmente, lo que indica que la aplicación de datos reales no modificó el perfil de morbilidad, pero apuntó magnitudes de riesgo diferentes. A pesar de la sobrerrepresentación del registro de cáncer con mayor cobertura poblacional, el método seleccionado demostró ser viable para identificar diferentes patrones entre estados.

How many AIDS epidemics can occur in São Paulo city?

OBJECTIVE An ecological study describring the spatial characteristics of AIDS in São Paulo city between 2001 and 2010 according to the place of residence of reported cases in adults. METHODS The AIDS reported cases (28,146), grouped by sex, were geocodified (25,969) and linked with a census tract database (18,953). Case and population at risk data supplied spatial cluster identification and relative risk estimate by the scan method, using the discrete Poisson model. Incidence rate and proportional distribution allowed comparing people living in the high-risk clusters areas to other locations by age, race/ethnicity, schooling and transmission category. RESULTS The AIDS incidence rate decreased in both sexes except among young men and older people. The identification of spatial high-risk clusters showed that the decrease of AIDS did not occur in the same way in the city. Clusters located in the central area presented the highest AIDS incidence rates (245.7/100,000 men), especially among black women (RR = 7.9), men who have sex with men (66.2%) and injection drug users (10.7%) participation. In peripheral clusters, identified only in the female population, the epidemic can be related to the poverty of these women (22.5% low education level). Residents in the north and central-south areas of the city are generally black, with little schooling, and predominantly heterosexually infected. CONCLUSIONS The study of spatial clusters using a census tract helps to determine epidemiological patterns inside the city and in specific populations. Spatial stratification and key population epidemiological patterns were identified in four regions in São Paulo city.

Adaptação transcultural e análise da confiabilidade da versão brasileira do questionário de reabilitação para o trabalho - WORQ / Cross-cultural adaptation and reliability analysis of the Brazilian version of the Work Rehabilitation Questionnaire (WORQ)

Resumo Introdução O Work Rehabilitation Questionnaire (WORQ) é um instrumento internacional baseado na Classificação Internacional de Funcionalidade, Incapacidade e Saúde para avaliar a capacidade funcional em pessoas com deficiência para o trabalho. Objetivo Realizar adaptação transcultural e análise da confiabilidade para a população brasileira. Métodos A adaptação transcultural consistiu em tradução, síntese das traduções, retrotraduções, análise do comitê de juízes, pré-teste e teste piloto. Os resultados foram obtidos pelo cálculo da taxa de concordância para equivalência semântica, idiomática, experiencial e conceitual. A confiabilidade foi testada por análise de estabilidade, equivalência e consistência interna por meio do cálculo de α-Cronbach e Coeficiente de Correlação Intraclasse (ICC). Resultados Participaram da primeira etapa 05 tradutores, 08 juízes e 14 possíveis usuários no pré-teste. A taxa de concordância foi menor que 90% apenas na equivalência idiomática, resultando em ajustes ortográficos sem alterar o construto do instrumento. A confiabilidade foi testada em 34 trabalhadores com deficiência, idade média de 40,3 (±4,2) anos, ambos os sexos, funcionários de uma instituição de ensino de São Paulo inseridos pela lei de cotas (8.213/91). A Consistência Interna apresentou valores superiores a 80% em todos os domínios e foi maior que 90% para o escore total. Após 15 dias da primeira avaliação, foram sorteados 20 desses participantes para reavaliação. O ICC para estabilidade foi 82,5% (p=0,008) e equivalência foi 95,4% (p<0,001). Conclusão O questionário WORQ foi traduzido e adaptado transculturalmente para o português brasileiro e apresentou confiabilidade para responder aos domínios da CIF. A versão brasileira está disponível na home page do WORQ, no endereço eletrônico http://www.myworq.org/questionnaire_en.php.

Abstract Introduction The Work Rehabilitation Questionnaire (WORQ) is an international instrument, based on the International Classification of Functioning, Disability and Health (ICF), used to assess the functional capacity of people with work disabilities. Objective To perform a cross-cultural adaptation and a reliability analysis of this instrument for the Brazilian population. Method The cross-cultural adaptation consisted of translation, synthesis of translations, back translations, analysis by the committee of judges, pre-test, and pilot test. The results were obtained by calculating the agreement rate for semantic, idiomatic, experiential, and conceptual equivalence. Reliability was tested by analysis of stability, equivalence, and internal consistency by calculating Cronbach's Alpha and Intraclass Correlation Coefficient (ICC). Results Five translators, eight judges, and 14 possible users in the pre-test participated in the first stage. The agreement rate was <90% only for idiomatic equivalence, resulting in orthographic adjustments without changing the instrument construct. The reliability was tested on 34 workers with disabilities, with a mean age of 40.3 (±4.2) years, of both sexes, employees of an educational institution in the state of São Paulo, Brazil, hired through the Quotas Law (8,213/91). The internal consistency showed values >80% in all domains and was >90% for the total score. Fifteen days after the first assessment, 20 of these participants were randomly selected for reassessment. The ICC values for stability and equivalence were 82.5% (p=0.008) and 95.4% (p<0.001), respectively. Conclusion The WORQ was translated and cross-culturally adapted to Brazilian Portuguese and reliably responded to the ICF domains. The Brazilian version of the WORQ is available at http://www.myworq.org/questionnaire_en.php.

[Black and non-Black women and vulnerability to HIV/AIDS in São Paulo, Brazil]. / Mulheres negras e não-negras e vulnerabilidade ao HIV/Aids no estado de São Paulo, Brasil.

OBJECTIVE: To analyze the characteristics related to individual vulnerability among HIV seropositive women, according to skin color. METHODS: A multicenter study carried out between 1999 and 2000 in health services specialized in STI/Aids in the state of São Paulo, involving 1,068 women living with HIV who are aged 18 or above. Sociodemographic data and characteristics relating to infection and healthcare were obtained by means of individual interviews based on standardized questionnaire. The variable race/color was self-reported and women who referred to themselves as black or mixed-race were grouped together as black. The definition of variables by race/color was done using central tendency and proportions, and an association analysis using the chi2 Pearson test. RESULTS: The differences between black and non-black women were statistically significant with regards to: schooling; monthly, individual and family income per capita; number of direct dependents; opportunities to see a nutritionist, gynecologist or other medical professional; understanding what the infectologist said; speaking with the infectologist or gynecologist about her sex life; having correct knowledge about CD4 exams and viral load; the sexual means of exposure. CONCLUSIONS: The use of race/color as an analytical category provides opportunities to understand better how social interactions, in the context of gender and socioeconomic conditions, create and recreate disadvantages for black women and their exposure to health risks, and also impose limits on the way they use of resources for their healthcare.

[HIV infection, hepatitis B and C and syphilis in homeless people, in the city of São Paulo, Brazil]. / Infecção pelo HIV, hepatites B e C e sífilis em moradores de rua, São Paulo.

OBJECTIVE: To estimate the prevalence of HIV infections, as well as hepatitis B and C and syphilis viruses in homeless people. METHODS: Cross-sectional study with educational intervention, conducted in the city of São Paulo, between 2002 and 2003. A convenience sample of homeless people who used night shelters was selected, according to the following criteria: aged 18 or older and not showing psychiatric disturbances. During interviews, sociodemographic and behavioral data were gathered and HIV, hepatitis B and C and syphilis laboratorial tests and post-test counseling were carried out. RESULTS: A total of 330 shelter users participated, with an average age of 40.2 years, 80.9% of them male, having lived on the streets for one year in average. Prevalences of 1.8% for HIV, 8.5% for hepatitis C virus, 30.6% for previous hepatitis B infection, 3.3% for chronic or acute infection by hepatitis B virus, and 5.7% for syphilis. The consistent use of condoms was referred to by 21.3% of interviewees and the use of injecting drugs by 3% of them. Positivity was 10% for HIV and 50% for hepatitis C virus among injectable drug users, versus 1.5% for HIV and 7.3% for hepatitis C among the others, showing an association between the virus and the use of injecting drugs. Previous imprisonment was referred to by 7.9% of women and 26.6% of men, with a prevalence of 2.6% for HIV and 17.1% for hepatitis C virus. CONCLUSIONS: The high prevalences of HIV and hepatitis B and C viruses require prevention programs based on vaccination against hepatitis B, early diagnosis of these infections and placement of homeless people into health services.

[Hepatitis B and C among injecting drug users living with HIV in São Paulo, Brazil]. / Hepatites B e C em usuários de drogas injetáveis vivendo com HIV em São Paulo, Brasil.

OBJECTIVE: To describe the profile of injecting drug users living with HIV/AIDS and estimate hepatitis B and hepatitis C prevalence rates within this group. METHODS: Cross-sectional study conducted with 205 injecting drug users living with HIV/AIDS receiving attention in three public health clinics in the city of Sao Paulo, in 2003. A non-probabilistic sample of volunteers was selected consecutively on the days respondents appeared for their appointments at the clinics. Personal data and information on sexual behavior, drug use and knowledge of hepatitis was collected through interviews. Tests were conducted to detect infections of the hepatitis B and C viruses. RESULTS: Out of the interviewees, 81% were men and 19% women, with an average age of 39 (SD=6.1) and six years of formal education (SD=2.0). There was no difference in marital status between the sexes, of which 48% were single, 42% were married, and 8% were divorced. The average ages for first use of tobacco, alcohol and illegal drugs were 13, 15 and 18, respectively. Hepatitis B and C prevalence were 55% (95% CI: 49;63) and 83%(95% CI: 78;88), respectively. Eighty percent of respondents had not heard of Hepatitis B and C prior to the first time they used injecting drugs. CONCLUSIONS: The high prevalence rates of Hepatitis B and C and low level of knowledge regarding the diseases justify the inclusion of information about hepatitis infections and the hepatitis B vaccines in HIV harm reduction strategies.

[Challenges of treatment adherence by people living with HIV/AIDS in Brazil]. / Desafios da adesão ao tratamento de pessoas vivendo com HIV/Aids no Brasil.

OBJECTIVE: To analyze the difficulties related to treatment adherence by patients living with HIV/AIDS in highly active antiretroviral therapy. METHODS: Qualitative research based on 34 interviews with patients under treatment in several outpatient services in the state of São Paulo, in 1998-1999. The group was comprised of people from different socioeconomic levels, gender, length of treatment and varied adherence levels, according to healthcare staff perception. The interviews focused on the patient's narrative about his/her disease. The content analysis classified the difficulties as follows: related to social factors and life styles, including the stigma; related to beliefs about the use of medication; and directly related to the use of medication. RESULTS: All the interviewees reported having difficulties concerning the stigma of living with HIV/AIDS. The difficulties related to the use of medication were the most important among patients with the best adherence level. Patients with average adherence level presented all three types of difficulties. CONCLUSIONS: Social and cultural factors are more difficult to be overcome in order to achieve treatment adherence than those related to taking medication, thus making the role played by the health sector important, supported by clear public social policies. These dimensions must be faced not only in the health sector, but also on social and political levels.

[Evaluation of the organizational structure of HIV/AIDS outpatient care in Brazil]. / Avaliação da estrutura organizacional da assistência ambulatorial em HIV/Aids no Brasil.

OBJECTIVE: In the context of universal access to antiretroviral treatment, the results of the Brazilian AIDS Program will depend on the quality of the care provided. The aim of the present study was to evaluate the healthcare provided by outpatient services for the treatment of AIDS patients. METHODS: The present study was carried out in seven Brazilian States between 2001 and 2002. We evaluated the quality of the care provided to AIDS patients from the standpoint of resource availability and care process organization. A questionnaire comprising 112 structured questions addressing these aspects was sent to 336 services. RESULTS: Response rate was 95.8% (322). Greater adequacy is seen for indicators of resource availability than for those of work organization. The supply of antiretroviral medication is sufficient in 95.5% of services. CD4 and viral load tests are available at adequate amounts in 59 and 41% of services, respectively. In 90.4% of services there is at least one non-medical professional (psychologist, nurse, or social worker). As to work organization, 80% scheduled the date but not the time of medical appointments; 40.4% scheduled more than 10 appointments per period; 17% did not have exclusive managers; and 68.6% did not hold systematic staff meetings. CONCLUSIONS: The results indicate that, in addition to ensuring the more homogeneous distribution of resources, the program must invest in the training and dissemination of care management skills, as confirmed by the results of care process organization.

Prevalence and factors associated with Chlamydia trachomatis infection among women with HIV in São Paulo.

INTRODUCTION: This study aimed to estimate the prevalence and risk factors associated with Chlamydia trachomatis (CT) infection among women with HIV in São Paulo. METHODS: This cross-sectional study included women with HIV who were receiving care from sixteen public health services in São Paulo (October 2013 to March 2014). All participants answered a questionnaire regarding their sociodemographic, behavioral, and clinical characteristics. A urine sample was tested for CT and Neisseria gonorrhoeae (NG) using the polymerase chain reaction. The chi-square test and a logistic regression model were used to test the associations with CT or NG infections. RESULTS: We evaluated 853 women and ultimately included 836 (98%) women. The mean age was 40.5 ± 0.34 years, and the prevalences of CT and NG infections were 1.8% and 0.5%, respectively. CT infection was associated with CD4+ T-cell counts of <350 cells/mm3 [adjusted odds ratio (ORadj): 24.5], age of 18-25 years (ORadj: 23.2), the non-use of condoms during the last 6 months (ORadj: 10.2), a self-reported history of a sexually transmitted infection (ORadj: 9.4), and having two or more sexual partners during the last year (ORadj: 6.1). CONCLUSIONS: Although we observed a low prevalence of CT infection among women with HIV, younger age was associated with a high risk of infection. Therefore, it may be appropriate to include screening for CT as part of the routine care for this population.

Sexually transmitted disease/HIV risk behaviour among women who have sex with women.

OBJECTIVE: To analyse the epidemiological aspects of sexually transmitted diseases (STD) among women who have sex with women (WSW) in São Paulo, Brazil. METHOD: A cross-sectional study with interviews and analysis of clinical and gynaecological tests in women, by means of a convenience sample. Characteristics were gathered according to age, sociobehavioural profile, reproductive life and sexuality. RESULTS: The study included 145 women. They started sexual activity at an average age of 16.9 years, and 23.4% of them had had heterosexual relations during the preceding year, with a relatively low frequency of condom use. In sexual relations with women, 54.5% used condoms when they shared sex toys. A previous STD was reported by 38% of them. The following STD were diagnosed: trichomonas (3.8%), bacterial vaginosis (33.8%), fungi (25.6%), Chlamydia (1.8%), hepatitis B (7%), hepatitis C (2.1%), abnormal Pap smear (7.7%), human papillomavirus (6.2%) and HIV (2.9%). CONCLUSION: In this study, many WSW did not report a single risk behaviour, but often reported a combination of several potential risk factors. Therefore, one cannot speak of high or low-risk behaviour for STD/HIV, but rather of multiple-risk behaviour. It is evident that there is a need for healthcare professionals to be correctly informed and sensitive towards the healthcare of WSW.

Automatic coding and selection of causes of death: an adaptation of Iris software for using in Brazil.

OBJECTIVE: To prepare a dictionary in Portuguese for using in Iris and to evaluate its completeness for coding causes of death. METHODS: Iniatially, a dictionary with all illness and injuries was created based on the International Classification of Diseases - tenth revision (ICD-10) codes. This dictionary was based on two sources: the electronic file of ICD-10 volume 1 and the data from Thesaurus of the International Classification of Primary Care (ICPC-2). Then, a death certificate sample from the Program of Improvement of Mortality Information in São Paulo (PRO-AIM) was coded manually and by Iris version V4.0.34, and the causes of death were compared. Whenever Iris was not able to code the causes of death, adjustments were made in the dictionary. RESULTS: Iris was able to code all causes of death in 94.4% death certificates, but only 50.6% were directly coded, without adjustments. Among death certificates that the software was unable to fully code, 89.2% had a diagnosis of external causes (chapter XX of ICD-10). This group of causes of death showed less agreement when comparing the coding by Iris to the manual one. CONCLUSION: The software performed well, but it needs adjustments and improvement in its dictionary. In the upcoming versions of the software, its developers are trying to solve the external causes of death problem.

Biopsychosocial model in health care: reflections in the production of functioning and disability data / O modelo biopsicossocial no cuidado a saúde: reflexões sobre a produção de dados sobre funcionalidade e incapacidade/deficiência / El modelo biopsicossocial en el cuidado a la salud: reflexiones sobre la producción de datos sobre funcionalidad e incapacidad/discapacidad

Abstract Introduction: In the last decade, the inclusion of a functioning indicator in health care has been discussed on the international agenda. The strategies related to the implementation of these indicators are issues that involve health education, governance, and medical records. Objective: study aims to discuss the International Classification of Functioning, Disability and Health (ICF) potential as a useful tool to produce information on health care services. Method: As theoretical assumptions, the universal model of the ICF based on the biopsychosocial model was used. Results: When used as a health indicator, functioning data can measure the real effect of some health conditions in different life domains. Based on the reflections carried out and theoretical foundations accessed, the study shows that the implementation of functioning indicators in periodical population health surveys and protocols of clinical documentation regardless the level of health service would be relevant for Patient Care Planning. Note that the group of functioning indicators should be proposed in a universal language and, therefore, ICF represents the most comprehensive model. Conclusion: Information regarding health status can be useful to enable health care management. Furthermore, ICF are essential to improve the documentation service of the health system and also can be used in planning and monitoring health care. It can also be used to collect disability data in surveys ensuring comparison among different surveys.

Resumo Introdução: Na última década, a inclusão de indicadores de funcionalidade na atenção à saúde tem sido discutida na agenda internacional. As estratégias relacionadas à implementação de indicadores de funcionalidade são uma questão que envolve educação, gestão e assistência à saúde. Objetivo: Este ensaio teórico tem como objetivo discutir o potencial da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) como ferramenta útil na produção de informação para os serviços de saúde. Método: Utilizamos como pressupostos teóricos o modelo universal, a CIF. Nosso pressuposto baseia-se no modelo biopsicossocial do binômio saúde-doença. Resultados: Indicadores de funcionalidade podem medir o real impacto das condições de saúde em diferentes domínios da vida. A partir das reflexões realizadas e alicerces teóricos acessados, percebe-se que a implementação de indicadores de funcionalidade nos inquéritos populacionais periódicos em saúde e protocolos de registro para informação clínica, independentemente do nível de serviço de saúde, seria de grande interesse. Vale ressaltar que o grupo de indicadores de funcionalidade deve ser proposto em uma linguagem universal e, portanto, a CIF representa o modelo mais abrangente. Conclusão: O indicador de funcionalidade pode ser útil para o gerenciamento da saúde. As informações sobre funcionalidade são essenciais para melhorar o planejamento e a qualidade dos serviços de saúde e podem ser usadas no planejamento e monitoramento dos cuidados de saúde; podem ser coletadas em pesquisas de saúde da população por ferramentas específicas; e poderiam ser produzidas usando a CIF como uma estrutura na coleta diária de informações sobre saúde.

Resumen Introducción: En la última década, la inclusión de indicadores de funcionamiento en la atención de salud se ha discutido en la agenda internacional. Las estrategias relacionadas con la implementación de los indicadores de funcionamiento son un tema que involucra educación, gestión y atención médica. Objetivo: Este ensayo teórico tiene como objetivo discutir el potencial de Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF) como una herramienta útil para producir información en los servicios de atención médica. Método: Utilizamos como suposiciones teóricas el modelo universal de la CIF con base en el modelo biopsicosocial del binomio salud-enfermedad. Resultados: Los indicadores de funcionamiento pueden medir el impacto real de las condiciones de salud en diferentes dominios de la vida. Con base en las reflexiones realizadas y los fundamentos teóricos, se observa que sería esencial la implementación de indicadores de funcionamiento en las encuestas periódicas de salud de la población y en los protocolos de registro para la información clínica, independiente del nivel del servicio de salud. Vale la pena mencionar que el grupo de indicadores de funcionamiento debe proponerse en un lenguaje universal y, por lo tanto, CIF representa el modelo más completo. Conclusión: El indicador de funcionamiento puede ser útil para la gestión de la salud. Las informaciones sobre funcionamiento son esenciales para mejorar la planificación y la calidad de los servicios de salud y se puede utilizarlas para planificar y monitorear los cuidados en salud; y se puede recopilarlas en encuestas de salud de la población mediante herramientas específicas; y podría recopilarse utilizando la CIF como herramienta en la recopilación diaria de información sobre salud.

Building partnerships to respond to HIV/AIDS: non-governmental organizations and universities.

BACKGROUND: In the second decade of the AIDS epidemic in Brazil, public sector and non-governmental organization (NGO) initiatives multiplied, fostered by state AIDS Control Programmes. A growing gap between capacity and a need for programme evaluation and the dissemination of findings from experience in the field, combined with the failure of traditional training approaches to bridge this gap adequately, inspired this non-degree research training programme at a major Brazilian university. OBJECTIVES: To train health professionals and activists working with HIV/AIDS prevention and services to evaluate and disseminate their experiences, and to enable them to multiply this training in their organizations, working in a collaborative process with graduate students and senior researchers. PROCEDURES: As part of a 9-month research methods course, 52 representatives from NGO and public health services produced research protocols that were reviewed and strengthened through a formal peer review process. Eleven protocols judged to be the best received funding and close mentorship over the next 21 months for their implementation, analysis, and dissemination. LESSONS LEARNED: Participants increased their ability to master and review critically the AIDS literature, to conduct a research protocol and to disseminate the results of their studies. After completion of the 30-month process, many participants were able to present their findings at scientific conferences or publish their results in peer-reviewed scientific journals. This model of close NGO-university successful collaboration may inspire other models of research training for those in the front-lines of the fight against the epidemic.