Evaluation of the properties of WHODAS-12 measurements in individuals with Chagas disease in Brazil.

Numerous tests employed to predict cardiac and functional status are expensive and not widely accessible for a considerable number of patients, particularly those diagnosed with Chagas disease (CD) residing in remote and endemic regions. To date, there is no knowledge of studies that have validated instruments that address functionality in an expanded way, including the biopsychosocial factors in patients with CD. This study aims to evaluate the psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS 2.0), in its 12-item shortened version (WHODAS-12) when applied to patients with CD. This is a cross-sectional study of a prospective cohort that follows individuals with CD (SaMi-Trop). Data collection took place between October 2019 and March 2020. In the interviews, sociodemographic information, life habits, clinical information, and indicators of disability measured by WHODAS-12 were collected. Descriptive analysis, internal consistency and construct validity of the instrument were performed. A total of 628 patients with CD were interviewed, most were women (69.5%), their mean age was of 57 years, and most declared an average self-perception of health (43.4%). The 12 items of WHODAS-12 were distributed into three factors, which together account for 61% of the variance. The Kaiser-Meyer-Olkin (KMO) index was 0.90, indicating adequacy of the sample for factor analysis. The internal consistency of the global scale showed alpha = 0.87. The percentage of incapacity was 16.05%, indicating mild incapacity for the evaluated patients. WHODAS-12 is a valid and reliable measure to assess the disability of the Brazilian population with CD.

Can a Single Trial of a Thoracolumbar Myofascial Release Technique Reduce Pain and Disability in Chronic Low Back Pain? A Randomized Balanced Crossover Study.

Although manual therapy for pain relief has been used as an adjunct in treatments for chronic low back pain (CLBP), there is still the belief that a single session of myofascial release would be effective. This study was a crossover clinical trial aimed to investigate whether a single session of a specific myofascial release technique reduces pain and disability in subjects with CLBP. 41 participants over 18 years old were randomly enrolled into 3 situations in a balanced and crossover manner: experimental, placebo, and control. The subjects underwent a single session of myofascial release on thoracolumbar fascia and the results were compared with the control and placebo groups. The outcomes, pain and functionality, were evaluated using the numerical pain rating scale (NPRS), pressure pain threshold (PPT), and Oswestry Disability Index (ODI). There were no effects between-tests, within-tests, nor for interaction of all the outcomes, i.e., NPRS (η 2 = 0.32, F = 0.48, p = 0.61), PPT (η2 = 0.73, F = 2.80, p = 0.06), ODI (η2 = 0.02, F = 0.02, p = 0.97). A single trial of a thoracolumbar myofascial release technique was not enough to reduce pain intensity and disability in subjects with CLBP.

Evaluation of the properties of WHODAS-12 measurements in individuals with Chagas disease in Brazil

ABSTRACT Numerous tests employed to predict cardiac and functional status are expensive and not widely accessible for a considerable number of patients, particularly those diagnosed with Chagas disease (CD) residing in remote and endemic regions. To date, there is no knowledge of studies that have validated instruments that address functionality in an expanded way, including the biopsychosocial factors in patients with CD. This study aims to evaluate the psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS 2.0), in its 12-item shortened version (WHODAS-12) when applied to patients with CD. This is a cross-sectional study of a prospective cohort that follows individuals with CD (SaMi-Trop). Data collection took place between October 2019 and March 2020. In the interviews, sociodemographic information, life habits, clinical information, and indicators of disability measured by WHODAS-12 were collected. Descriptive analysis, internal consistency and construct validity of the instrument were performed. A total of 628 patients with CD were interviewed, most were women (69.5%), their mean age was of 57 years, and most declared an average self-perception of health (43.4%). The 12 items of WHODAS-12 were distributed into three factors, which together account for 61% of the variance. The Kaiser-Meyer-Olkin (KMO) index was 0.90, indicating adequacy of the sample for factor analysis. The internal consistency of the global scale showed alpha = 0.87. The percentage of incapacity was 16.05%, indicating mild incapacity for the evaluated patients. WHODAS-12 is a valid and reliable measure to assess the disability of the Brazilian population with CD.

Análise da linha de cuidado para pacientes com diabetes mellitus e hipertensão arterial: a experiência de um município de pequeno porte no Brasil / Analysis of the care of patients with Diabetes Mellitus and Hypertension: the experience of a small municipality in Brazil / Análisis de la línea de cuidado para pacientes con diabetes mellitus e hipertensión arterial: la experiencia de un municipio pequeño en Brasil

O artigo avalia a linha de cuidado de uma coorte de 260 indivíduos com diabetes mellitus e 295 indivíduos com hipertensão arterial sistêmica antes, durante e após a implantação do Laboratório de Inovações na Atenção às Condições Crônicas (LIACC). Essa intervenção buscou fortalecer a atenção primária à saúde, implantando o modelo de atenção às condições crônicas no município de Santo Antônio do Monte, Minas Gerais, Brasil, entre 2013 e 2014. Trata-se de um estudo observacional longitudinal que utiliza informações clínicas e laboratoriais dos prontuários dos pacientes dessas duas condições crônicas entre 2012 e 2017. Os desfechos avaliados foram baseados nas linhas guias da Secretaria de Estado de Saúde de Minas Gerais. Os resultados evidenciam o LIACC associado à universalização de macroprocessos da atenção primária, como o cadastramento e a classificação do risco familiar. Para pacientes com diabetes houve melhora em diversos marcadores no período, como o aumento da realização de consulta (de 90% em 2012 para 92% em 2017) e diminuição dos pacientes com exames fora das faixas de normalidade. Já para indivíduos com hipertensão, mesmo sendo observado um crescimento acentuado da realização de consultas (de 80% em 2012 para 84% em 2017), as melhorias clínicas foram menos evidentes. Conclui-se que o LIACC se configura como uma promissora intervenção para a melhoria do manejo de pacientes com doenças crônicas na atenção primária à saúde.

This article evaluates the care of a cohort of 260 individuals with diabetes and 295 individuals with hypertension before, during and after the implementation of the Innovative Care Laboratory for Chronic Conditions (LIACC). This intervention sought to strengthen Primary Health Care by implementing the Chronic Care Model in Santo Antônio do Monte, Minas Gerais, Brazil, between 2013 and 2014. This is a longitudinal observational study that uses clinical and laboratory information from medical records of patients with these two chronic conditions between 2012 and 2017. The outcomes evaluated were based on the guidelines of the Department of Health of Minas Gerais State. The results show the LIACC associated with the universalization of primary care macro-processes such as registration and classification of family risk. For patients with diabetes, there was an improvement in several markers in the period, such as increased consultation (from 90% in 2012 to 92% in 2017) and a decrease in patients with examinations outside the normal range. For individuals with hypertension, although there is a marked increase in medical appointments (from 80% in 2012 to 84% in 2017), clinical improvements were less evident. It can be concluded that LIACC is a promising intervention to improve the management of patients with chronic diseases in Primary Health Care.

El artículo evalúa la línea de cuidado de una cohorte de 260 individuos con diabetes mellitus y de 295 individuos con hipertensión arterial sistémica antes, durante y después de la implantación del Laboratorio de Innovación en Atención a las Condiciones Crónicas (LIACC). Esta intervención buscó fortalecer la Atención Primaria en Salud implantando el Modelo de Atención a las Condiciones Crónicas en el municipio de Santo Antônio do Monte, Minas Gerais, Brasil, entre 2013 y 2014. Se trata de un estudio observacional longitudinal con informaciones clínicas y de laboratorio de registros médicos de los pacientes con las dos condiciones crónicas entre 2012 y 2017. Los desenlaces evaluados se basaron en las líneas guía de la Secretaría de Salud del estado de Minas Gerais. Los resultados evidencian el LIACC asociado con la universalización de los macroprocesos de atención primaria como el registro y la clasificación del riesgo familiar. Para los pacientes con diabetes se observó una mejora en muchos marcadores en el período, como el aumento de las consultas (de 90 % en 2012 a 92 % en 2017) y la disminución de los pacientes con exámenes fuera de los rangos normales. Aunque para las personas con hipertensión se ha observado un notable aumento en la concreción de las consultas (de 80 % en 2012 a 84 % en 2017), las mejorías clínicas fueron menos pronunciadas. Se concluye que el LIACC es una prometedora intervención para la mejora del manejo de pacientes con enfermedades crónicas en la atención primaria.