Prevalence risk of sarcopenia in older Brazilian adults during the pandemic: A cross-sectional analysis of the Remobilize Study

ABSTRACT BACKGROUND: Social distancing has led to lifestyle changes among older adults during the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVES: This study aimed to estimate the prevalence risk of sarcopenia (RS) and investigate its associated factors during the COVID-19 pandemic in older Brazilian adults. DESIGN AND SETTING: Cross-sectional observational analysis of baseline data as part of the Remobilize Study. METHODS: Participants in the study were older adults (≥ 60 years), excluding those who were bedridden or institutionalized. The data collected consisted of answers about the RS (SARC-F), functional status, walking, sedentary behavior (SB), pain, comorbidity, and life space mobility. RESULTS: A total of 1,482 older adults (70 ± 8.14 years, 74% women) participated in the study, and an RS prevalence of 17.1% was found. (95% confidence interval [CI] 15.25-19.15%). The adjusted multivariate model showed a significant association between RS and functional limitation (odds ratio [OR]: 19.05; CI 13.00-28.32), comorbidity (OR: 5.11; CI 3.44-7.81), pain (OR: 4.56; CI 3.33-6.28), total walking (OR: 0.99; CI 0.99-1.00), SB of 8-10 hours (OR: 1.85; CI 1.15-2.93), and SB of > 10 hours (OR: 3.93; CI 2.48-6.22). RS was associated with mobility during the pandemic (OR: 0.97; CI 0.96-0.98). P < 0.05. CONCLUSIONS: During the pandemic, the prevalence of RS in older Brazilians was estimated at 17.1%. Moderate to severe functional limitation, comorbidities, presence of pain, walking, longer SB period, and reduced life space mobility significantly contributed to RS in older adults during the pandemic.

Prevalence risk of sarcopenia in older Brazilian adults during the pandemic: A cross-sectional analysis of the Remobilize Study.

BACKGROUND: Social distancing has led to lifestyle changes among older adults during the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVES: This study aimed to estimate the prevalence risk of sarcopenia (RS) and investigate its associated factors during the COVID-19 pandemic in older Brazilian adults. DESIGN AND SETTING: Cross-sectional observational analysis of baseline data as part of the Remobilize Study. METHODS: Participants in the study were older adults (≥ 60 years), excluding those who were bedridden or institutionalized. The data collected consisted of answers about the RS (SARC-F), functional status, walking, sedentary behavior (SB), pain, comorbidity, and life space mobility. RESULTS: A total of 1,482 older adults (70 ± 8.14 years, 74% women) participated in the study, and an RS prevalence of 17.1% was found. (95% confidence interval [CI] 15.25-19.15%). The adjusted multivariate model showed a significant association between RS and functional limitation (odds ratio [OR]: 19.05; CI 13.00-28.32), comorbidity (OR: 5.11; CI 3.44-7.81), pain (OR: 4.56; CI 3.33-6.28), total walking (OR: 0.99; CI 0.99-1.00), SB of 8-10 hours (OR: 1.85; CI 1.15-2.93), and SB of > 10 hours (OR: 3.93; CI 2.48-6.22). RS was associated with mobility during the pandemic (OR: 0.97; CI 0.96-0.98). P < 0.05. CONCLUSIONS: During the pandemic, the prevalence of RS in older Brazilians was estimated at 17.1%. Moderate to severe functional limitation, comorbidities, presence of pain, walking, longer SB period, and reduced life space mobility significantly contributed to RS in older adults during the pandemic.

Use of healthcare services and therapeutic measures associated with new episodes of acute low back pain-related disability among elderly people: a cross-sectional study on the Back Complaints in the Elders - Brazil cohort.

BACKGROUND: Patients with low back pain frequently undergo a variety of diagnostic and therapeutic interventions, but some of these have uncertain effectiveness. This highlights the importance of the association of healthcare services and therapeutic measures relating to disability. OBJECTIVE: To analyze the use of healthcare services and therapeutic measures among Brazilian older adults with disability-related low back pain. DESIGN AND SETTING: Observational cross-sectional study on baseline assessment data from the Back Complaints in the Elders - Brazil (BACE-B) cohort. METHODS: The main analyses were based on a consecutive sample of 602 older adult participants in BACE-B (60 years of age and over). The main outcome measurement for disability-related low back pain was defined as a score of 14 points or more in the Roland Morris Questionnaire. RESULTS: Visits to doctors in the previous six weeks (odds ratio, OR = 1.82; 95% confidence interval, CI 1.22-2.71) and use of analgesics in the previous three months (OR = 1.57; 95% CI 1.07-2.31) showed statistically significant associations with disability-related low back pain. The probability of disability-related low back pain had an additive effect to the combination of use of healthcare services and therapeutic measures (OR = 2.57; 95% CI 1.52-4.36). The analyses showed that this association was significant among women, but not among men. CONCLUSIONS: Occurrence of the combined of consultations and medication use was correlated with higher chance of severe disability among these elderly people with nonspecific low back pain. This suggested that overuse and "crowding-in" effects were present in medical services for elderly people.

Use of healthcare services and therapeutic measures associated with new episodes of acute low back pain-related disability among elderly people: a cross-sectional study on the Back Complaints in the Elders - Brazil cohort

ABSTRACT BACKGROUND: Patients with low back pain frequently undergo a variety of diagnostic and therapeutic interventions, but some of these have uncertain effectiveness. This highlights the importance of the association of healthcare services and therapeutic measures relating to disability. OBJECTIVE: To analyze the use of healthcare services and therapeutic measures among Brazilian older adults with disability-related low back pain. DESIGN AND SETTING: Observational cross-sectional study on baseline assessment data from the Back Complaints in the Elders - Brazil (BACE-B) cohort. METHODS: The main analyses were based on a consecutive sample of 602 older adult participants in BACE-B (60 years of age and over). The main outcome measurement for disability-related low back pain was defined as a score of 14 points or more in the Roland Morris Questionnaire. RESULTS: Visits to doctors in the previous six weeks (odds ratio, OR = 1.82; 95% confidence interval, CI 1.22-2.71) and use of analgesics in the previous three months (OR = 1.57; 95% CI 1.07-2.31) showed statistically significant associations with disability-related low back pain. The probability of disability-related low back pain had an additive effect to the combination of use of healthcare services and therapeutic measures (OR = 2.57; 95% CI 1.52-4.36). The analyses showed that this association was significant among women, but not among men. CONCLUSIONS: Occurrence of the combined of consultations and medication use was correlated with higher chance of severe disability among these elderly people with nonspecific low back pain. This suggested that overuse and "crowding-in" effects were present in medical services for elderly people.

[The prevalence of severe falls and associated factors among elderly Brazilians: Results of the 2013 National Health Survey]. / Prevalência de queda grave e fatores associados em idosos brasileiros: resultados da Pesquisa Nacional de Saúde, 2013.

The scope of this study was to estimate the prevalence and factors associated with severe falls among elderly Brazilians. It included a transversal study of 10,537 elderly individuals who participated in the National Health Survey (2013). The dependent variable was a report of severe falls in the past year. The independent variables comprised, hierarchically, socio-demographic factors, behavior, health status and functional capacity. Logistic regression was used to obtain the odds ratio (OR) and the confidence interval (95%CI), using the 13.1 Stata program. The prevalence of severe falls was 7.5% (95%CI: 6.7-8.3) and the highest odds were among women (OR: 1.35; 95%CI: 1.03-1.77), 70 to 79 years of age (OR: 1.47; 95%CI: 1.12-1.95) and 80 years and above (OR: 2.00; 95%CI: 1.46-2.74), living without a spouse/partner (OR: 1.37; 95%CI: 1.08-1.74), sedentary in leisure time (OR: 1.55; 95%CI: 1.06-2.26), having multimorbities (OR: 1.54; 95%CI: 1.19-2.00), sleeping difficulties (OR: 2.18; 95%CI: 1.65-2.88), limitations in daily activities (OR: 2.25; 95%CI 1.63 -3.10) and use of a walking aid (OR: 1.89; 95%CI: 1.30-2.73). The prevalence of severe falls was high and multifactorial, enabling the identification of profiles of greater vulnerability, which should be considered in public policies for specific interventions.

O objetivo foi estimar a prevalência e os fatores associados à queda grave em idosos brasileiros. Estudo transversal, incluindo 10.537 idosos participantes da Pesquisa Nacional de Saúde (2013). A variável dependente foi relato de queda grave último. As variáveis independentes incluíram, hierarquicamente, fatores sociodemográficos, comportamentais, condição de saúde e capacidade funcional. Foi utilizada regressão logística para obter os odds ratio (OR) e os respectivos intervalos de confiança (95%), utilizando-se o programa Stata 13.1. A prevalência de queda grave foi de 7,5% (IC95%: 6,7-8,3) e as maiores chances foram entre mulheres (OR: 1,35; IC95%: 1,03-1,77), 70 a 79 anos (OR: 1,47; IC95%: 1,12-1,95) e 80 anos e mais (OR: 2,00; IC95%: 1,46-2,74), vivendo sem cônjuge (OR: 1,37; IC95%: 1,08-1,74), sedentários no lazer (OR: 1,55; IC95%: 1,06-2,26), com multimorbidades (OR: 1,54; IC95%: 1,19-2,00), dificuldades no sono (OR: 2,18; IC95%: 1,65-2,88), limitações em atividades básicas de vida diária (OR: 2,25; IC95%: 1,63-3,10) e uso de dispositivo para marcha (OR: 1,89; IC95%: 1,30-2,73). A prevalência de queda grave foi elevada e multifatorial, permitindo a identificação de perfis de maior vulnerabilidade, o que deve ser considerado no direcionamento de políticas públicas para intervenções específicas.

Associação entre limitação funcional e deficit cognitivo em pacientes idosos hospitalizados / Association between functional disability and cognitive deficit in hospitalized elderly patients

Resumo Introdução A hospitalização é reconhecida como um fator de risco para o declínio funcional do idoso, bem como para o declínio cognitivo. Entretanto, a associação entre essas variáveis ainda não é bem estabelecida, sobretudo no contexto hospitalar. Objetivo Verificar a associação entre deficit cognitivo e limitação funcional em atividades básicas da vida diária entre idosos hospitalizados. Método Estudo seccional, com idosos internados em dois hospitais públicos. Foi verificada a presença de deficit cognitivo por meio do teste de rastreio Mini Exame do Estado Mental e a presença de limitação funcional pelo Índice Katz para Atividades Básicas de Vida Diária. Foi realizada análise descritiva da amostra e regressão logística, estimando-se os valores de odds ratio e respectivos intervalos de confiança (95%). Resultados A prevalência de deficit cognitivo foi de 51,5% (IC95%, 41,6-61,4) e 37,6% dos idosos apresentaram dependência em uma ou mais atividades básicas de vida diária. Os resultados mostraram que tanto o número de atividades comprometidas (p=0,002) quanto a classificação final do índice Katz (p=0,001) foram diferentes estatisticamente entre os grupos de idosos com e sem deficit cognitivo. Entre os idosos que eram dependentes parciais para as atividades, 14,9% apresentaram deficit cognitivo; já entre aqueles que eram dependentes totais, o valor foi de 13,9%. Os idosos dependentes nas atividades apresentaram 5,08 vezes (IC95%, 1,84-14,01) maior chance de deficit cognitivo. Conclusão: O deficit cognitivo foi associado à limitação funcional e os resultados colaboraram no direcionamento da sistematização da assistência precoce direcionada, a fim de minimizar perdas cognitivas e funcionais na hospitalização.

Abstract Introduction Hospitalization is recognized as a risk factor for the functional decline and cognitive decline of elderly people. However, the association between these variables is still well unestablished, especially in the hospital context. Objective To verify the association between cognitive deficit and functional disability in hospitalized elderly people. Method Cross-sectional study with elderly patients admitted to two public hospitals. The presence of cognitive deficit was verified through the Mini-Mental State Examination screening test and the presence of functional disability through the Basic Daily Life Activities Scale. Descriptive sample analysis of the sample and logistic regression was made, estimating the odds ratio values and respective intervals of confidence (95%). Results The prevalence of cognitive deficit was 51.5% (IC95%, 41,6-61,4) and 37.6% of the elderly had one or more basic activities in their daily living. The results showed that either the number of compromised activities (p=0,002) and the final classification of the Katz index (p=0.001) were statistically different between the groups of elderly people with or without a cognitive deficit. Among the elderly who were partially dependents for activities, 14.9% had a cognitive deficit and 13.9% among those who were fully dependent elderly. Most dependents elderly are 5,08 times (IC95%, 1,84-14,01) more likely to have a cognitive deficit. Conclusion Cognitive deficits were associated with functional disability and the results collaborate in directing the systematization of early care, to minimize cognitive and functional losses in hospitalization.

[Satisfaction with the organization of care among elderly users of the services assessed by the PMAQ]. / Satisfação com a organização do cuidado em idosos usuários dos serviços avaliados pelo PMAQ.

The scope of this study was to identify the levels of satisfaction of the elderly regarding the organization of services in primary health care services. It involved a cross-sectional survey of 18,671 users of the Unified Health System. Information on satisfaction with care was collected, categorized as satisfied (very good, good and average perception) and dissatisfied (poor and very poor). The aspects researched included: characteristics of the organization of care and the secondary data from the 1st cycle of the Brazilian Program for Improving Access and Quality in Primary Health Care (PMAQ-AB). Logistic regression was used to obtain the odds ratio (OR) and confidence interval (CI95%), adjusted for sociodemographic factors. The prevalence of satisfaction was 87%. The aspects associated with satisfaction (p<0.05), after analysis of factors that could distort the results, were access to the health unit, home visit and availability of medication - related to the organization of services; and, performing an active search, solving the problem in the unit, as well as the physical examination and consultation time - related to the organization of care. The analyses describe multiple aspects of the organization of care and services associated with the satisfaction of the elderly with basic health care services.

Satisfação com a organização do cuidado em idosos usuários dos serviços avaliados pelo PMAQ / Satisfaction with the organization of care among elderly users of the services assessed by the PMAQ

Resumo Este estudo objetivou identificar os preditores da satisfação dos idosos em relação à organização dos serviços e do cuidado na atenção básica à saúde. Delineamento seccional, entre 18.671 usuários da Atenção Básica do Sistema Único de Saúde. Foram coletadas informações sobre a satisfação com o cuidado, categorizada em satisfeito (percepção muito boa, boa e regular) e insatisfeito (ruim e muito ruim). As exposições pesquisadas incluíram: características da organização do serviço e do cuidado, a partir de dados secundários do 1º ciclo do PMAQ-AB. Foi utilizada regressão logística para obter os odds ratio (OR) e os respectivos intervalos de confiança (95%), ajustado por fatores sociodemográficos. A prevalência de satisfação foi de 87,0%. Os preditores associados (p<0,05) à satisfação, após análise por fatores que poderiam confundir os resultados, foram acesso à unidade de saúde, visita domiciliar e disponibilidade de medicamento - relacionados à organização dos serviços; e, realização de busca ativa, resolução do problema na unidade, assim como ao exame físico realizado e tempo da consulta - relacionados à organização do cuidado. Em síntese, as análises descrevem múltiplos preditores da organização do cuidado e dos serviços associados à satisfação dos idosos com os serviços da atenção básica.

Abstract The scope of this study was to identify the levels of satisfaction of the elderly regarding the organization of services in primary health care services. It involved a cross-sectional survey of 18,671 users of the Unified Health System. Information on satisfaction with care was collected, categorized as satisfied (very good, good and average perception) and dissatisfied (poor and very poor). The aspects researched included: characteristics of the organization of care and the secondary data from the 1st cycle of the Brazilian Program for Improving Access and Quality in Primary Health Care (PMAQ-AB). Logistic regression was used to obtain the odds ratio (OR) and confidence interval (CI95%), adjusted for sociodemographic factors. The prevalence of satisfaction was 87%. The aspects associated with satisfaction (p<0.05), after analysis of factors that could distort the results, were access to the health unit, home visit and availability of medication - related to the organization of services; and, performing an active search, solving the problem in the unit, as well as the physical examination and consultation time - related to the organization of care. The analyses describe multiple aspects of the organization of care and services associated with the satisfaction of the elderly with basic health care services.

Da formação ao exercício da tutoria em educação permanente em saúde / Training the exercise of tutoring in permanent health education / De la formación al ejercicio de tutoría en la educación permanente en salud

Este artigo tem como objetivo relatar uma experiência de percurso histórico-metodológico da formação e da tutoria em educação permanente em saúde (EPS). Trata-se da vivência na formação e atuação como tutor, na modalidade de ensino semipresencial, no curso destinado a trabalhadores do Sistema Único de Saúde (SUS). Envolveu seis docentes organizadores, 60 formadores, 600 tutores e 6 mil alunos. Foram 18 meses de curso, mediado por uma plataforma virtual, ao longo dos quais discuti o papel da EPS nos serviços de saúde, rastreei cenários de aprendizado e vivi relatos de experiência da EPS. Inicialmente, houve estranhamento com a proposta metodológica, com o exercício de identificar a partir da prática as bases teóricas do processo de trabalho, a construção coletiva do conhecimento em EPS e com o trabalho cotidiano e a lentidão na utilização da plataforma. A experiência constituiu-se em incentivo para a participação em novas iniciativas de EPS na modalidade de ensino a distância e presencial.

This article aims to report a historical-methodological experience with training and tutoring in permanent health education (PHE), through a blended course for workers of the Brazilian Unified Health System (SUS). Throughout the 18-month course mediated by a virtual platform and comprising six organizers, 60 teachers, 600 tutors, and 6,000 students, I discussed the role of EPS in health services, tracked learning scenarios, and lived experience reports of EPS. Initially, the methodological proposal addressed some strangeness in regard to identifying the theoretical basis of the work process from the practice and the collective construction of knowledge in EPS, as well as in our daily work and struggles in using the platform. In conclusion, the experiment encouraged participation in new EPS initiatives, be it at distance or in person.

Este artículo propone relatar una experiencia de formación histórico-metodológica y de tutoría en educación permanente en salud (EPS). Esta es una experiencia de formación y actuación como tutor en la modalidad semipresencial en el curso para los trabajadores del Sistema Único de Salud (SUS). Participaron seis profesores organizadores, 60 entrenadores, 600 tutores y 6.000 alumnos. La duración del curso fue de 18 meses, mediado por plataforma virtual en el cual se discute el papel de EPS en los servicios de salud, seguindo escenarios de aprendizaje y relatos de experiencias de EPS. Inicialmente hubo distanciamiento con la propuesta metodológica, con el ejercicio de identificación práctica de la base teórica del proceso de trabajo, la construcción colectiva del conocimiento en EPS y en el trabajo diario y lento uso de la plataforma. La experiencia consistió en incentivos para la participación en nuevas iniciativas de EPS en la modalidad de enseñanza remota y presencial.

Inflammatory markers and occurrence of falls: Bambuí Cohort Study of Aging.

OBJECTIVE: Analyze whether inflammatory markers are associated with falls among older adults living in Bambuí. METHODS: Study that analyzed baseline data from a Bambuí Cohort Study of Aging, involving 1,250 participants. Data about falls were collected from previous 12 months, classified as single or multiple occurrence and severity (participant seeking health services). Information about sociodemographic characteristics, health behaviors and health condition was also collected and used as confounding factors. The exposures of interest included interleukins (IL-1ß, IL-6, IL-8, IL-10, IL-12), tumor necrosis factor (TNF), ultra-sensitive C-reactive protein (us-CRP) and chemokines (CXCL9, CCL5, CCL10, MCP1). Data were processed through logistic regression, obtaining odds ratio and 95% confidence interval (95%CI). RESULTS: The prevalence of falls was 27.1%; 40.1% of the older adults reported multiple falls and 33.3% sought health services. After adjustments, the following elevated levels were associated with falls: us-CRP (OR = 1.46, 95%CI 1.04-2.03), CCL5 (OR = 1.38, 95%CI 1.01-1.90) and CXCL9 (OR = 1.43, 95%CI 1.02-2.02). An association was observed between the number of elevated markers and the occurrence of falls: two (OR = 1.47, 95%CI 1.02-2.12) and three (OR = 2.08, 95%CI 1.12-3.87) elevated biomarkers indicated fall probability of 32.0% and 39.4%, respectively. CONCLUSIONS: Elevated levels of us-CRP, CCL5 and CXCL9, which were associated with falls, may contribute to a proper understanding of the mechanism associated with the occurrence of falls among older people.

Inflammatory markers and occurrence of falls: Bambuí Cohort Study of Aging / Marcadores inflamatórios e ocorrência de quedas: coorte de idosos de Bambuí

ABSTRACT OBJECTIVE Analyze whether inflammatory markers are associated with falls among older adults living in Bambuí. METHODS Study that analyzed baseline data from a Bambuí Cohort Study of Aging, involving 1,250 participants. Data about falls were collected from previous 12 months, classified as single or multiple occurrence and severity (participant seeking health services). Information about sociodemographic characteristics, health behaviors and health condition was also collected and used as confounding factors. The exposures of interest included interleukins (IL-1β, IL-6, IL-8, IL-10, IL-12), tumor necrosis factor (TNF), ultra-sensitive C-reactive protein (us-CRP) and chemokines (CXCL9, CCL5, CCL10, MCP1). Data were processed through logistic regression, obtaining odds ratio and 95% confidence interval (95%CI). RESULTS The prevalence of falls was 27.1%; 40.1% of the older adults reported multiple falls and 33.3% sought health services. After adjustments, the following elevated levels were associated with falls: us-CRP (OR = 1.46, 95%CI 1.04-2.03), CCL5 (OR = 1.38, 95%CI 1.01-1.90) and CXCL9 (OR = 1.43, 95%CI 1.02-2.02). An association was observed between the number of elevated markers and the occurrence of falls: two (OR = 1.47, 95%CI 1.02-2.12) and three (OR = 2.08, 95%CI 1.12-3.87) elevated biomarkers indicated fall probability of 32.0% and 39.4%, respectively. CONCLUSIONS Elevated levels of us-CRP, CCL5 and CXCL9, which were associated with falls, may contribute to a proper understanding of the mechanism associated with the occurrence of falls among older people.

RESUMO OBJETIVO Analisar se marcadores inflamatórios estão associados a quedas em idosos vivendo na comunidade. MÉTODOS Estudo da coorte de idosos de Bambuí, envolvendo 1.250 participantes da linha de base do projeto. Foram coletadas informações sobre quedas nos últimos 12 meses, classificadas quanto à ocorrência (única ou múltipla) e gravidade (procura por serviços de saúde). O inquérito também continha informações a respeito das características sociodemográficas, comportamentais e condições de saúde, as quais foram utilizadas como fatores de confusão. As exposições pesquisadas incluíram: interleucinas (IL-1β, IL-6, IL-8, IL-10 e IL-12), fator de necrose tumoral (TNF), proteína C reativa ultrassensível (PCRus) e quimiocinas (CXCL9, CCL5, CCL10 e MCP1). O tratamento dos dados foi realizado por meio de regressão logística, obtendo-se odds ratio e intervalo de 95% de confiança (IC95%). RESULTADOS A prevalência de queda foi 27,1%; 40,1% dos idosos relataram quedas múltiplas e 33,3% procuraram serviços de saúde. Após ajustes, permaneceram associados às quedas os níveis elevados de PCRus (OR = 1,46; IC95% 1,04-2,03), CCL5 (OR = 1,38; IC95% 1,01-1,90) e CXCL9 (OR = 1,43; IC95% 1,02-2,02). Houve associação entre o número de marcadores elevados e a ocorrência de quedas: dois (OR = 1,47; IC95% 1,02-2,12) e três (OR = 2,08; IC95% 1,12-3,87) biomarcadores aumentados predisseram probabilidades de quedas iguais a 32,0% e 39,4%, respectivamente. CONCLUSÕES Os níveis elevados de PCRus, CCL5 e CXCL9, que estiveram associados a quedas, podem contribuir para o adequado entendimento do mecanismo associado à ocorrência desse evento em idosos.

Objective structured clinical examination in physiotherapy teaching: a systematic review / Exame clínico objetivo estruturado no ensino da fisioterapia: revisão sistemática / Examen clínico objetivo estructurado en la enseñanza de la fisioterapia: revisión sistemática

Abstract Introduction: Problems related to the clinical abilities of physiotherapy students are not always identified throughout the educational process and might only be observed when these future professionals have to treat patients. The Objective Structured Clinical Examination (OSCE) includes a problematization approach and can be used in Health Sciences teaching to help this identification before internship practices. However, there are few studies on its use in Physiotherapy. Objective: To gather evidence of the OSCE use to evaluate clinical abilities in Physiotherapy teaching. Method: Articles published from 2000 to 2016 were surveyed in the Biblioteca Virtual em Saúde (BVS) (Virtual Health Library), Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (BIREME) (Latin-American and Caribbean Health Sciences Information Center), PubMed, Scielo and Web of Science, using the descriptors "educational assessment", "assessment methods", "objective structured clinical examination", "clinical competence", "professional competence", "clinical skills", "student competence", "student skills", "physiotherapy" and the Booleans "OR" and "AND". Results: The initial number of identified publications was 3,242. From these, seven were included in this review. Two studies were developed in Brazil, four in Australia and one in Canada. The studies were scored 7 to 12 regarding methodologic quality, and 1B and 2B regarding scientific evidence. Conclusion: Students' clinical abilities were grouped into three classes: cognitive, psychomotor and affective, and four studies described their use. There is very little evidence of the use of OSCE, but the instrument can be applied to evaluate skills and competences in Physiotherapy teaching.

Resumo Introdução: No processo educacional, nem sempre se identificam problemas relacionados às habilidades clínicas dos estudantes, sendo estas observadas quando o futuro profissional está à frente do paciente. Para realizar essa identificação antes das práticas de estágio, foi desenvolvido o Objective Structured Clinical Examination (OSCE). Incluindo uma abordagem problematizadora, o OSCE pode ser usado no ensino de Ciências da Saúde. Contudo, há poucos estudos sobre seu uso na Fisioterapia. Objetivo: Sintetizar evidências acerca do uso do OSCE para avaliação de habilidades clínicas no ensino da Fisioterapia. Método: Foram selecionados artigos publicados no período de 2000 a 2016 e consultadas as bases de dados Biblioteca Virtual em Saúde (BVS), Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (BIREME), PubMed, Scielo e Web of Science, utilizando os descritores educational assessment, assessment methods, objective structured clinical examination, clinical competence, professional competence, clinical skills, student competence, student skills, physiotherapy, e os booleanos OR e AND. Resultados: O número de publicações identificadas foi de 3.242. Destas, sete foram incluídas nesta revisão. Dois estudos foram desenvolvidos no Brasil, quatro na Austrália e um no Canadá. Os estudos foram pontuados com notas de 7 a 12, relativas à qualidade metodológica, e classificados em 1b e 2b em relação à evidência científica. Conclusão: As habilidades clínicas dos estudantes foram agrupadas em três classes - cognitiva, psicomotora e afetiva -, e quatro estudos descreveram o uso das mesmas categorias. Há uma escassez de evidências sobre o OSCE, e o instrumento colabora na avaliação de habilidades e competências no ensino em Fisioterapia.

Resumen Introducción: En el proceso educativo, ni siempre se identifican problemas relacionados con las habilidades clínicas de los estudiantes. Estas son observadas cuando el futuro profesional está delante del paciente. Para realizar esta identificación antes de las prácticas, se desarrolló la Objective Structured Clinical Examination (OSCE). Incluyendo un abordaje problematizador, OSCE puede usarse en la enseñanza de las ciencias de la salud, pero hay pocos estudios sobre su uso en la Fisioterapia. Objetivos: Sintetizar evidencias acerca del uso del OSCE para evaluación de habilidades clínicas en la enseñanza de la Fisioterapia. Método: Se seleccionaron artículos publicados em el periodo de 2000 a 2016 y consultadas las bases de datos Biblioteca Virtual en Salud (BVS), Centro Latinoamericano y del Caribe de Información en Ciencias de la Salud (BIREME), PubMed, Scielo y Web of Science, utilizando los descriptores educational assessment, assessment methods, objective structured clinical examination, clinical competence, professional competence, clinical skills, student competence, student skills, physiotherapy, y los booleanos OR y AND. Resultados: El número de publicaciones identificadas fue de 3.242. De estos, siete fueron incluidos en esta revisión. Se desarrollaron dos estudios en Brasil, cuatro en Australia y uno en Canadá. Los estudios se calificaron de 7 a 12 con respecto a la calidad metodológica y se clasificaron 1b y 2b en relación con la evidencia científica. Conclusión: Las habilidades clínicas de los estudiantes fueron agrupadas en tres clases, a saber, cognitivo, psicomotor y afectivo, y cuatro estudios describieron el uso de las mismas. Hay una escasez de evidencias sobre el OSCE y el instrumento colabora en la evaluación de habilidades y competencias en la enseñanza en Fisioterapia.

Team-based learning in Physical therapy undergraduate course: experiment report / Aprendizado baseado em equipe na graduação em fisioterapia: relato de experiência / Aprendizaje basado en equipo en el grado en fisioterapia: informe de experiencia

Abstract Introduction: Active learning methods have shown positive results, mainly in terms of content learning and the development of communication skills, critical thinking, and collaborative practice. However, they are still unknown by most professors teaching in Physical therapy courses. Objective: To present the report of an experiment based on the application of the Team-Based Learning (TBL) method, in the Physical therapy undergraduate course. Method: This is a report of an experiment comparing traditional teaching and TBL with 61 students in the Physical therapy course. A comparison was performed between means, medians, approval ratio and satisfaction of the students who experienced the active methodology. Results: The results showed that the final average of the summative evaluations of the TBL group (71.9 ± 10.5 points) was statistically different (p = 0.003) from that of the traditional teaching group (63.7 ± 9.92 points). The proportion of approved students was not statistically different between the groups, 92.0% and 88.6%, respectively (p = 0.478). Conclusion: The overall satisfaction was that the method, although tiresome, according to the students, favored a greater understanding of the content and motivation to study. The study presents innovative results regarding the application of the team-based teaching method to the Physical therapy course.

Resumo Introdução: Metodologias de aprendizagem ativas de ensino têm mostrado resultados positivos, principalmente no que diz respeito à aprendizagem de conteúdos e à construção de habilidades de comunicação, pensamento crítico e prática colaborativa. Contudo, ainda mostram-se pouco conhecidos por professores de ensino em Fisioterapia. Objetivo: Apresentar um relato de experiência com base na aplicação do método Aprendizado Baseado em Equipe (TBL) no ensino de graduação em Fisioterapia. Método: Trata-se de um relato de experiência a partir do ensino tradicional e TBL com 61 estudantes do curso de Fisioterapia. Foram comparadas as médias, medianas, proporção de aprovação e satisfação dos estudantes que experimentaram a metodologia ativa. Resultados: Os resultados mostraram que a média final das avaliações somativas da turma que experimentou o TBL (71,9 ± 10,5 pontos) foi estatisticamente diferente (p = 0,003) quando comparado ao ensino tradicional (63,7 ± 9,92 pontos). A proporção de aprovados não diferiu estatisticamente entre os grupos, 92,0% e 88,6%, respectivamente (p = 0,478). Conclusão: A satisfação geral foi que o método embora cansativo, segundo os estudantes, favoreceu a maior compreensão do conteúdo e estímulo para estudar. O estudo apresenta resultados inovadores em relação à aplicação do método de ensino baseado em equipe para o curso de Fisioterapia.

Resumen Introducción: Los métodos activos de enseñanza han dado resultados positivos, principalmente en términos de aprendizaje de contenidos y de la construcción de habilidades de comunicación, pensamiento crítico y práctica colaborativa. Sin embargo, todavía se muestran poco conocidos por los docentes en Fisioterapia. Objetivo: Presentar un informe de experiencia con base en la aplicación del método Aprendizaje Basado en el Equipo (TBL), en el grado en Fisioterapia. Método: Se trata de un informe de experiencia desde la enseñanza tradicional y la TBL con 61 alumnos del curso de Fisioterapia. Se compararon los promedios, medianas, ratio de aprobación y satisfacción de estudiantes que habían experimentado la metodología activa. Resultados: Los resultados mostraron que el promedio final de las evaluaciones sumativas del grupo TBL (71,9 ± 10,5 puntos) fue estadísticamente diferente (p = 0,003) en comparación con la enseñanza tradicional (63,7 ± 9,92 puntos). La proporción de aprobados no difirió estadísticamente entre los grupos, con un 92,0% y un 88,6%, respectivamente (p = 0,478). Conclusión: La satisfacción general fue que el método, aunque agotador, según los estudiantes, les favoreció una mayor comprensión de los contenidos y el estímulo para estudiar. El estudio presenta resultados innovadores por la aplicación del método de enseñanza basado en equipo para el curso de Fisioterapia.

Fatores associados à ótima capacidade para o trabalho em servidores idosos de uma universidade no Sul do Brasil / Factors associated to excellent work ability of aged public servants from a university in southern Brazil

Resumo Objetivo: investigar a associação entre o índice de capacidade para o trabalho e os fatores sociodemográficos, ocupacionais, estilo de vida e saúde em idosos. Métodos: estudo transversal, com amostra de servidores idosos de uma instituição de ensino superior. Foram coletadas informações sociodemográficas e dados referentes a comportamento social, saúde, e trabalho. Utilizou-se análise uni e multivariada pelo Modelo de Regressão Logística para determinar os fatores associados à ótima capacidade para o trabalho. Resultados: na amostra prevaleceram os homens (57,8%), entre 60 e 64 anos (75,6%), com ensino superior (57,8%). A maioria declarou ser sedentária (89,1%) e com exigência mental de trabalho (62,8%). Mais da metade da amostra era de idosos em sobrepeso (53%), que relataram quedas (21,3%) e uso regular de múltiplos medicamentos (25,6%). As variáveis associadas à menor chance de ótima capacidade para o trabalho foram sexo feminino (OR=0,39; IC95%=0,18-0,83); cor não branca (OR=0,37; IC95%=0,16-0,84); exigência física para o trabalho (OR=0,40; IC95%=0,17-0,97); hospitalização (OR=0,14; IC95%=0,03-0,57); dificuldades no sono (OR=0,12; IC95%=0,04-0,43); autopercepção de saúde ruim (OR=0,22; IC95%=0,09-0,54); queixas de sintomas osteomusculares nos últimos 7 dias (OR=0,29, IC95%=0,10-0,87); e sintomas que comprometem o trabalho (OR=0,25; IC95%=0,08-0,82). Conclusão: fatores sociodemográficos, ocupacionais e condição de saúde comprometeram a ótima capacidade para o trabalho em idosos.

Abstract Objective: to investigate the association between work ability index and socio-demographic, occupational, lifestyle and health factors in aged people. Methods: cross-sectional study, with aged public servants from a higher education institution. Sociodemographic information and data on social behavior, health, and work were collected. Uni and multivariate analysis according to the logistic regression model was used to determine the factors associated with excellent work ability. Results: the sample showed a prevalence of men (57.8%), between 60 and 64 years (75.6%), with higher education (57.8%). Most claimed being sedentary (89.1%) and having mental work demands (62.8%). More than half of the sample was of overweight aged people (53%) who reported falls (21.3%) and regular use of multiple medications (25.6%). The variables associated with less chance of excellent work ability were female (OR=0.39; CI95%=0.18-0.83); non-white color (OR=0.37; CI95%=0.16-0.84); physical demand for the job (OR=0.40; CI95%=0.17-0.97); hospitalization (OR=0.14; CI95%=0.03-0.57); sleep difficulties (OR=0.12; CI95%=0.04-0.43); self-perception of poor health (OR=0.22; CI95%=0.09-0.54); complaints of musculoskeletal symptoms in the last 7 days (OR=0.29, CI95%=0.10-0.87); and symptoms that affect work (OR=0.25; CI95%=0.08-0.82). Conclusion: sociodemographic and occupational factors, as well as health conditions jeopardize aged people's excellent work ability.

Functional capacity associated with work ability in older university staff employed by the state / Capacidade funcional associada à capacidade para o trabalho em servidores idosos universitários

Abstract Introduction: The increase in numbers of older adults in the workplace and in the number of years they spend in work prior to retiring has challenged health professionals to provide enable health conditions such that they may undertake occupational activity. Objective: To analyze the variables for functional ability, associated with work ability, in older adults who were government employees at a university. Methods: A cross-sectional design, with older workers aged 60 years old or over, located in different university centers and departments. A structured sociodemographic questionnaire was used to characterize the sample, and the Work Ability Index was used as an outcome variable for the associations, using the Timed Up and Go test, the handgrip strength test, the walking speed test and the chair sit to stand test. The Chi-squared test and Pearson correlation coefficient were used in the statistical analysis. The association of the factors of functional capacity was based on the odds ratio and 95% confidence interval, calculated using the Logistic Regression Model, as part of the SPSS statistical package for Windows. Results: A total of 258 staff participated in the investigation, with men (57.7%) and a lower age range (60 to 62 years old) predominating. Women differed in relation to falls after the age of 60 (p = 0.007) and in the last 12 months (p = 0.017). The mean Work Ability Index was 39.70 ± 5.64 points and a statistical association was ascertained between performance in the chair sit to stand test (OR = 2.26; p = 0.043). Muscle strength (r = 0.72; p < 0.000) and the chair sit to stand test (r = 0.73; p < 0.000) showed excellent correlation with work ability. Conclusion: The variables for functional capacity were associated with work ability.

Resumo Introdução: O aumento e permanência no mundo do trabalho pelos idosos têm desafiado profissionais de saúde em proporcionar condições de saúde para realização da atividade ocupacional. Objetivo: Analisar as variáveis de capacidade funcional associadas à capacidade para o trabalho em idosos servidores públicos de uma universidade. Métodos: Delineamento transversal, com trabalhadores idosos de 60 anos ou mais, locados em diferentes centros e setores universitários. Foi utilizado um questionário sociodemográfico estruturado para caracterizar a amostra, o índice de capacidade para o trabalho como variável de desfecho para as associações com Timed Up and Go, força de preensão manual, velocidade de marcha e tese de sentar e levantar da cadeira. Na análise estatística foi utilizado o teste Qui-quadrado e coeficiente de correlação de Pearson. A associação dos fatores da capacidade funcional baseou-se na odds ratio e intervalo de confiança 95%, estimada pelo Modelo de Regressão Logística, por meio do pacote estatístico SPSS para Windows. Resultados: Participaram da investigação 258 servidores, predominando o sexo masculino (57,7%) e de menor faixa etária (60 a 62 anos). As mulheres diferiram em relação às quedas após 60 anos (p = 0,007) e últimos 12 meses (p = 0,017). O Índice de Capacidade para o Trabalho médio foi de 39,70 ± 5,64 pontos e verificou-se associação estatística com desempenho no teste de sentar e levantar da cadeira (OR = 2,26; p = 0,043). A força muscular (r = 0,72; p < 0,000) e o teste de sentar e levantar (r = 0,73; p < 0,000) apresentaram ótima correlação com capacidade de trabalho. Conclusão: As variáveis de capacidade funcional estiveram associadas à capacidade de trabalho.

Anthropometric indicators as screening instrument for falls in the elderly / Indicadores antropométricos como instrumento de triagem para quedas em idosos

Abstract Anthropometric indicators enable professionals for predicting risk of falls in the elderly; however, there is a gap in literature on reference values. This study analyzes anthropometric indicators such as screening tests for falls in the elderly. Cross-sectional population-based systematic sampling was conducted through a household survey and body composition assessment. Anthropometric measurements were performed using portable electronic scale and stadiometer. Bioimpedance device was used to measure body mass index, body fat and lean body mass. Falls were evaluated in the 12 months preceding the interview as a dependent variable. Discriminatory analysis was performed for falls through the ROC curve, sensitivity, specificity, positive and negative predictive values. Overall, 275 older adults participated in this study, whose prevalence of falls was 23.6%. The average body mass index was 27.8kg/cm2 and 52.1% of individuals were overweight. Among older men, height (ROC=0.68; 95%CI 0.54-0.78) and lean body mass (ROC=0.63, 95%CI 0.58-0.76) were associated to the occurrence of falls. When considering cutoff of 52.2kg and 166cm, sensitivity was obtained in 75% and high negative predictive values (88.1% and 89.1% respectively). For women, lean body mass (ROC=0.61, 95%CI 0.30-0.49) and body mass (ROC=0.60, 95%CI 0.53-0.72) were relevant from the optimal cutoff point of 28.9% and 57.2kg/m2. Lean body mass was more sensitive (63.2%) and body mass little more specific (64.3%), both with high negative predictive values (82.0% and 83.0%). The indicators used were able to discriminate older adults who have suffered from falls.

Resumo Indicadores antropométricos instrumentalizam profissionais para predizer risco de quedas em idosos, entretanto, há lacunas de evidências na literatura sobre valores de referência. O objetivo foi analisar os indicadores antropométricos como testes de rastreio para quedas em idosos. Estudo com delineamento transversal de base populacional, amostragem sistemática, realizado por meio de inquérito domiciliar e avaliação da composição corporal. As medidas antropométricas foram aferidas por meio de uma balança eletrônica e estadiomêtro portátil. Utilizou aparelho de Bioimpendância para análise das medidas do índice de massa corpórea, gordura corporal e massa corporal magra. Adotou-se queda nos 12 meses anteriores à entrevista como variável dependente. Foi realizada análise discriminatória para quedas por meio da curva ROC, sensibilidade, especificidade, valores preditivos positivos e negativos. Participaram 275 idosos, cuja prevalência de quedas foi de 23,6%. O índice de massa corporal médio foi igual a 27,8kg/cm2 e 52,1% estiveram em sobrepeso. Entre os homens idosos, a estatura (ROC=0,68; IC95%=0,54-0,78) e massa corporal magra (ROC=0,63; IC95%=0,58-0,76) foram associadas à ocorrência de queda. Ao considerar os pontos de corte 52,2kg e 166cm, obteve-se sensibilidade de 75% e altos valores preditivos negativos (88,1% e 89,1% respectivamente). Para as mulheres, a massa corporal magra (ROC=0,61; IC95%=0,30-0,49) e a massa corporal (ROC=0,60; IC95%=0,53-0,72) foram relevantes a partir do ponto de corte de 28,9% e 57,2kg/m2. A massa corporal magra foi mais sensível (63,2%) e a massa corporal pouco mais específica (64,3%), ambos com altos valores preditivos negativos (82,0% e 83,0%). Os indicadores adotados foram capazes de discriminar idosos que sofreram quedas.

Estresse e qualidade de vida em técnicos e auxiliares de enfermagem em instituições de longa permanência para idosos / Stress and quality of life in technical and auxiliary nursingin long term care institutions for elderly

Evidências apontam que profissionais envolvidos na assistência ao idoso sofrem de estresse e apresentam uma qualidadede vida comprometida. O objetivo do estudo foi avaliar o nível de estresse e a qualidade de vida dos técnicos e auxiliaresde enfermagem de uma instituição de longa permanência. Delineamento transversal, exploratório e quantitativo foramutilizados como método. Utilizou-se as escalas Job Stress Scal e WHOQOL e a correlação de Spearman, para avaliar arelação do estresse e qualidade de vida, considerando p<0,05 para todos os testes estatísticos realizados. A idade médiafoi de 37,95±8,2 anos. O componente psicológico controle foi relacionados com renda e período de sono. Ademais, aqualidade de vida foi negativamente correlacionada com renda e positivamente com a idade e nível de escolaridade.As variáveis renda, sono, idade, escolaridade e estresse podem instrumentalizar a busca por alternativas de promoçãoda qualidade de vida.(AU)

Evidence suggests that professionals involved in the care of the elderly suffer from stress and have an impaired qualityof life. The objective of study was to evaluate the level of stress and quality of life of technicians and nursing assistantsin a long-term care facility. Refinement transversal, exploratory and quantitative design used were as method. Weused the Job Stress Scal and Whoqol scales and the Spearman correlation to assess the relationship of stress andquality of life, considering p <0.05 for all statistical tests. The average age was of 37.95 ± 8.2 years. The psychologicalcomponent control was related with income and sleep period. Moreover, the quality of life was negatively correlatededwith income and positively with age and level of education. The income variables, sleep, age, education and stress caninstrumentalize the search for alternatives to promote of quality of life.(AU)