Fatores sociodemográficos e clínicos associados à força de preensão manual de idosos condutores de veículos / Sociodemographic and clinical factors associated with handgrip strength in elderly automobile drivers / Factores sociodemográficos y clínicos asociados a la fuerza de prensión de la mano en conductores de vehículos de ancianos

Objetivo: investigar a associação entre força de preensão manual e características sociodemográficas e clínicas de idosos condutores de veículos automotores. Método: estudo transversal, realizado em clínicas de medicina de tráfego na cidade de Curitiba/Paraná, com 421 idosos (≥ 60 anos). Realizou-se análise estatística pelo modelo de Regressão Logística e Teste de Wald, considerando intervalo de confiança de 95% e valores de p <0,05 como significativos. Resultados: oitenta e quatro (20%) idosos apresentaram força de preensão manual reduzida. A força de preensão manual reduzida foi associada à faixa etária (p=0,001) e à hospitalização no último ano (p=0,002). Conclusão: houve associação significativa entre a força de preensão manual de idosos motoristas e as variáveis idade e hospitalização no último ano. Dessa forma, torna-se essencial a inclusão de avaliações específicas, centradas nas variáveis sociodemográficas e clínicas próprias da pessoa idosa, durante o exame de aptidão para dirigir veículos automotores.(AU)

Objective: to investigate the association between handgrip strength and sociodemographic and clinical characteristics of elderly automobile drivers. Method: cross-sectional study, carried out in traffic medicine clinics in the city of Curitiba/Paraná, with 421 elderly people (≥ 60 years old). Statistical analysis was performed using the Logistic Regression model and the Wald Test, considering a 95% confidence interval and p values <0.05 as significant. Results: eighty-four (20%) seniors had reduced handgrip strength. Reduced handgrip strength was associated with age group (p=0.001) and hospitalization in the last year (p=0.002). Conclusion: there was a significant association between the handgrip strength of elderly drivers and the variables age and hospitalization in the last year. Thus, it is essential to include specific assessments, centered on sociodemographic and clinical variables specific to the elderly person, during the aptitude test to drive automobiles.(AU)

Objetivo: investigar la asociación entre la fuerza de prensión de la mano y las características sociodemográficas y clínicas de los ancianos conductores de vehículos automotores. Método: estudio transversal, realizado en clínicas de medicina de tránsito de la ciudad de Curitiba/Paraná, con 421 ancianos (≥ 60 años). El análisis estadístico fue realizado por el modelo de Regresión Logística y Test de Wald, considerando intervalo de confianza de 95% y valores de p <0,05 como significativos. Resultados: 84 (20%) sujetos ancianos presentaron reducción de la fuerza de prensión de la mano. La reducción de la fuerza de prensión de la mano se asoció al grupo de edad (p=0,001) y a la hospitalización en el último año (p=0,002). Conclusión: hubo una asociación significativa entre la fuerza de prensión de la mano de los conductores ancianos y las variables edad y hospitalización en el último año. Así pues, es esencial incluir evaluaciones específicas, centradas en las variables sociodemográficas y clínicas de los ancianos, durante el examen de aptitud para conducir vehículos automotores.(AU)

The use of the functional independence measure in elderly. / O emprego da medida de independência funcional em idosos.

OBJECTIVES: To analyze in scientific publications how the Functional Independence Measure (FIM) has been employed to evaluate the elderly. METHODS: Integrative review of periodical publications between 2011 and 2015, available online in full-text in Portuguese, English and Spanish. RESULTS: 129 articles were found; after the application of the criteria, they resulted in 21. The studies were categorized into two groups: A) follow or compare scores in FIM (cohort studies, case-control, clinical trials), focusing on rehabilitation, evaluation of programs and changes in the functional level after procedures/interventions; and B) measure/associate the functionality of the elderly (cross-sectional studies), focused on evaluation protocols in elderly health and associations to the caregiver burden, hospital stay, balance, satisfaction with life, cognition and clinical/socio-demographic aspects. CONCLUSION: The FIM was used in several scenarios of healthcare for the elderly, particularly in rehabilitation and outpatient clinics or health centers.

O emprego da medida de independência funcional em idosos / El uso de la medida de independencia funcional en ancianos / The use of the functional independence measure in elderly

Resumo OBJETIVOS Analisar em publicações científicas como a Medida de Independência Funcional (MIF) tem sido empregada para avaliar idosos. MÉTODOS Revisão integrativa de publicações periódicas entre os anos de 2011 e 2015, disponíveis online com texto completo em português, inglês e espanhol. RESULTADOS Foram encontrados 129 artigos e, após a aplicação de critérios, resultaram em 21. Os estudos foram categorizados em dois grupos: A) acompanhar ou comparar pontos na MIF (estudos de coorte, caso controle, ensaios clínicos), centrando na reabilitação, avaliação de programas e alterações no nível funcional após procedimentos/intervenções; e B) mensurar/associar a funcionalidade dos idosos (estudos transversais), com foco em protocolos de avaliação da saúde do idoso e associações à sobrecarga do cuidador, tempo de internação, equilíbrio, satisfação com a vida, cognição e aspectos clínicos/sociodemográficos. CONCLUSÃO Empregou-se a MIF em diversos cenários de atenção à saúde do idoso, com destaque para reabilitação e ambulatórios ou centros de saúde.

Resumen OBJETIVOS Analizar en las publicaciones científicas cómo la medida de la independencia funcional (MIF) ha sido utilizada para evaluar a los ancianos. MÉTODOS Revisión integradora de las publicaciones periódicas entre los años 2011 y 2015, disponibles en línea, en texto completo, escritas en portugués, inglés o español. RESULTADOS Se encontraron 129 artículos, y después de la aplicación ciertos criterios, el resultado fue 21. Los estudios fueron separados en dos grupos: a) supervisar o comparar los puntajes de MIF (estudios de cohortes, casos y controles, estudios clínicos), se centrando en la rehabilitación, la evaluación de programas y variaciones en el nivel funcional después de los procedimientos o intervenciones; y B) medir o asociar la funcionalidad de los ancianos (estudios transversales), enfocándose en los protocolos de evaluación de la salud de los ancianos y asociaciones de sobrecarga del cuidador, duración de la estancia, equilibrio, satisfacción con la vida, cognición y aspectos clínicos-demográficos. CONCLUSIÓN Se utilizó el MIF en varios escenarios del cuidado de la salud de los ancianos, en particular clínicas de rehabilitación y ambulatorios o centros de salud.

Abstract OBJECTIVES To analyze in scientific publications how the Functional Independence Measure (FIM) has been employed to evaluate the elderly. METHODS Integrative review of periodical publications between 2011 and 2015, available online in full-text in Portuguese, English and Spanish. RESULTS 129 articles were found; after the application of the criteria, they resulted in 21. The studies were categorized into two groups: A) follow or compare scores in FIM (cohort studies, case-control, clinical trials), focusing on rehabilitation, evaluation of programs and changes in the functional level after procedures/interventions; and B) measure/associate the functionality of the elderly (cross-sectional studies), focused on evaluation protocols in elderly health and associations to the caregiver burden, hospital stay, balance, satisfaction with life, cognition and clinical/socio-demographic aspects. CONCLUSION The FIM was used in several scenarios of healthcare for the elderly, particularly in rehabilitation and outpatient clinics or health centers.

Barriers related to non-adherence in a mammography breast-screening program during the implementation period in the interior of São Paulo State, Brazil.

Mammography is the best exam for early diagnosis of breast cancer. Developing countries frequently have a low income of mammography and absence of organized screening. The knowledge of vulnerable population and strategies to increase adherence are important to improve the implementation of an organized breast-screening program. A mammography regional-screening program was implemented in a place around 54.238 women, aged 40-69 years old. It was proposed to perform biannual mammography free of cost for the women. We analyze the first 2 years of the implementation of the project. Mammography was realized in 17.964 women. 42.1% of the women hadn't done de mammography in their lives and these women were principally from low socio-economic status (OR=2.99), low education (OR=3.00). The best strategies to include these women were mobile unit (OR=1.43) and Family Health Program (OR=1.79). The incidence of early breast tumors before the project was 14.5%, a fact that changed to 43.2% in this phase. Multivariate analysis showed that the association of illiterate and the mobile unit achieve more women who had not performed mammography in their lives. The strategies to increase adherence to mammography must be multiple and a large organization is necessary to overpass the barriers related to system health and education.

The introduction of new interventional procedures in the British National Health Service--a qualitative study.

OBJECTIVES: To investigate how interventional procedures (IPs) are introduced into the British National Health Services and identify areas for improvement in the current process. METHODS: Qualitative study using one to one semi-structured interviews. Using the framework approach, the data generated from 14 participants were analysed with coding of emergent themes. Data were analysed separately for providers and commissioner organisations. RESULTS: Variations were observed in how IPs are introduced from both the provider and commissioner perspectives. Patterns of approaches allowed the development of models reflecting practice at each type of organisation: very structured in some places to, unstructured or almost non-existent in others. Factors affecting the decision to introduce a procedure include: immediate costs and benefits, numbers of people affected, training requirements, NICE guidance, nature of procedure, support from colleagues, incentives, public or policy-maker pressure, and aims of the institution. Monitoring was seen as a key area for improvement by many. CONCLUSIONS: These variations indicate that the process of introducing new IPs in the NHS can be improved. Factors affecting decision-making and problems have been identified. The results of our study could inform and help shape future processes of managing and the introduction of new procedures into the NHS.

Local decision-makers views' of national guidance on interventional procedures in the UK.

OBJECTIVES: To identify how decision-makers in the NHS perceive and manage interventional procedures guidance and to determine whether additional information would be useful. METHODS: Qualitative study using semi-structured interviews with seven providers, six commissioners and one policy-maker. The framework approach was used to analyse transcribed data, and emergent themes coded. Data were analysed separately for providers and commissioner organizations. RESULTS: Perceptions about how guidance is managed in provider organizations varied. Some decision-makers considered that guidance is handled very well whereas others think it is suboptimal and haphazard. It is unclear whether clinicians follow procedure for cautionary guidance. In commissioner organizations, guidance is not seen as a priority by most and is not considered an area that will soon enter routine clinical practice. Moreover, commissioners felt that guidance lacked relevance as there is no consideration of whether procedures are cost-effective or affordable. Despite this, respondents perceived that the content and quality of guidance is satisfactory. Useful additional information for inclusion in guidance would be: prevalence, incidence, cost, patients' views, consequences of using the new intervention, comparative information, effectiveness and cost-effectiveness. CONCLUSIONS: Management of interventional procedures guidance in the NHS can be improved. It is important to understand the ways in which guidance meets and fails to meet decision-makers' needs.