Standardization use of the international classification of functioning, disability and health in the determination of health status in patients with post-acute COVID-19 syndrome.

PURPOSE: To propose a standardized method for the use of the International Classification of Functioning, Disability and Health (ICF) to describe the health status in Post-Acute COVID-19 Syndrome (PACS) and investigate interrater agreement in the linking process in instruments and clinical exams using the ICF categories. MATERIALS AND METHODS: Cross-sectional and interrater agreement study that followed the Guidelines for Reporting Reliability and Agreement Studies. Two raters performed the linking coding process in instruments of quality of life, anxiety and depression, fatigue and pulmonary function, inspiratory muscle strength and cardiopulmonary exercise testing. The codes were qualified by standards defined to each instrument and exams. RESULTS: The instrument with the lowest Cohen's Kappa coefficient was anxiety and depression (k = 0.57). Forty ICF codes were linked to clinical instruments and exams. The fatigue instrument presented a higher degree of disability by the qualification process, from severe to complete, in the linked codes. CONCLUSION: The study presents a standardized method for the assessment of the health status of patients with PACS through ICF. Restriction in work performance, socialization and family relationships as well as disabilities in physical endurance, fatigue and exercise tolerance were found in the sample. The agreement between the raters was moderate to perfect, demonstrating that the method can be reproducible.

The body structures and functions, environmental factors, activities and participation in a person's environment are determinant aspects of his health.Ways to measure these aspects are key to assessing health not only as absence of disease, so the International Classification of Disability and Functional Health demonstrates the ability to fully describe health.This study proposes a standardization in the use of the tool to facilitate usability in clinical practice.

Reliability and validity of the Brazilian version of the world health organization disability assessment schedule (WHODAS 2.0) questionnaire for women with urinary incontinence.

PURPOSE: To analyze the reliability and validity of the WHODAS 2.0 instrument for women with urinary incontinence (UI). METHODS: This is a methodological study with Brazilian women with complaints of urge, stress or mixed UI, over 18 years old, without cognitive disorders. The WHODAS 2.0 (36-item version) and the auxiliary instruments were applied through face-to-face and telephone interviews after 7-14 d. The psychometric properties evaluated were: Cronbach's alpha for internal consistency, intraclass correlation coefficient (ICC) for intra-rater test-retest, Spearman's correlation coefficient (rho) for construct validity of WHODAS 2.0 with auxiliary instruments; and ANOVA for discriminative validity with UI severity. RESULTS: 101 women with UI with a mean age of 50.71 ± 10.39 were included. WHODAS 2.0 showed good reliability in all domains and excellent reliability in the total score (>0.80). The intra-evaluator test-retest showed ICC values between 0.59 and 0.87 (p < 0.001). We observed a positive correlation between the WHODAS 2.0 domains and the instruments recommended by International Continence Society (ICS), with greater emphasis on moderate correlation with the Urinary Impact Questionnaire (IUQ-7) subscale (rho = 0.730 p < 0.001). CONCLUSION: The WHODAS 2.0 instrument is a reliable and valid questionnaire for investigating the functioning and disability of women with UI.

The WHODAS 2.0 is a valid and reliable tool for future functioning research with women with urinary incontinence.The WHODAS 2.0 can be used in clinical practice to assess disabilities in women with urinary incontinence.The validation of WHODAS 2.0 reinforces the need for rehabilitation based on the functioning needs of each patient with urinary incontinence.The WHODAS 2.0 assesses functioning based on the biopsychosocial model, supported by the ICF (International Classification of Functioning, Disability and Health).

Impairments, health conditions and health risk behaviors: occurrence and associations, in the National Health Survey, Brazil, 2019.

OBJECTIVE: To analyze association of visual, hearing, mental/intellectual, physical and multiple impairments with health conditions and health risk behaviors in Brazil. METHODS: This was a cross-sectional study, using data from the 2019 National Health Survey; associations between impairments and presence of cardiovascular disease (CVD), hypertension, diabetes mellitus (DM), high cholesterol, alcohol abuse and smoking were estimated using logistic regression, thus obtaining the odds ratios (OR). RESULTS: Impairment was reported by 7.6% of the 90,846 participants. Having a impairment was associated with greater odds of reporting chronic conditions, especially CVD (OR = 2.11; 95%CI 1.76;2.54) and DM (OR = 1.78; 95%CI 1.56;2.02 ); visual impairment was associated with greater odds of smoking (OR = 1.52; 95%CI 1.28;1.81); mental/intellectual impairment was inversely related to smoking (OR = 0.45; 95%CI 0.30;0.67) and alcohol abuse (OR = 0.13; 95%CI 0.06;0.26). CONCLUSION: Having any of the impairments studied may be associated with greater odds of having chronic health conditions. MAIN RESULTS: Positive association was identified between having one or more impairments, and health conditions and health risk behaviors. The higher the prevalence of mental/intellectual, physical and multiple impairments, the lower alcohol abuse and smoking. IMPLICATIONS FOR SERVICES: As this population is vulnerable to chronic health conditions, health services need strategies to reduce barriers to access, as well as health promotion actions, such as health education, adapted for people with impairments. PERSPECTIVES: Topics for future studies, examining the inverse relationship between impairments and alcohol abuse and smoking, in addition to acting on the causal chain, so as to prevent health conditions and health risk behaviors.

Relationship between personal and environmental factors and prevalence of acquired physical impairment in Brazil - a population-based study. / Relação de fatores pessoais e ambientais com a prevalência de deficiências físicas adquiridas no Brasil - estudo de base populacional.

The aim of this study was to estimate the relationship between personal and environmental factors and the prevalence of acquired physical impairment in adults and older persons in Brazil. We conducted a cross-sectional study using data from the 2013 National Health Survey. The response variable was self-reported acquired physical impairment. The explanatory variables were sex, race/skin color, education level, social class, paid employment, private health insurance, running water, and connection to a sewer network. The strength of association between the explanatory variables and response variable and respective 95% confidence intervals were estimated using Poisson Regression. Physical impairment was reported by 1.25% of the study population (n=55,369). After complete adjustment, being male and non-white, having a lower level of education, living alone, not being in paid employment, not having private health insurance, not having running water, and not living in a house connected to a sewer network were associated with higher prevalence of acquired physical impairment. The findings show that prevalence of physical impairment was higher among vulnerable groups and that personal and environmental factors are important elements that need to be assessed at the population level.

Objetivou estimar a relação de fatores pessoais e ambientais com a prevalência de deficiência física adquirida em adultos e idosos brasileiros. Realizado um estudo transversal com dados da Pesquisa Nacional de Saúde (PNS) 2013. A variável resposta foi: autorrelato deficiência física adquirida. As variáveis explicativas de interesse foram: sexo, raça/cor, escolaridade, classe social, trabalho remunerado, plano de saúde, água canalizada e rede de esgoto. As magnitudes das associações e seus respectivos intervalos de confiança (95%) foram estimadas utilizando a Regressão de Poisson. O autorrelato de deficiência física foi encontrado em 1,25% dos 55.369 participantes. Após completo ajustamento, o sexo masculino, raça/cor não branca, menores níveis de escolaridade, viver sozinho, não ter trabalho remunerado, plano de saúde, água canalizada e rede de esgoto foram associados a maiores prevalências de deficiência física adquirida. Esses achados evidenciam que a população mais vulnerável apresenta maior prevalência de deficiência física e os fatores pessoais e ambientais são importantes de serem avaliados em nível populacional.

Association of social factors and health conditions with capacity and performance.

OBJECTIVE: Determine and measure the association of social factors and health conditions with worse capacity and performance levels. METHODS: Dependent variables consisted of performance and capacity; independent variables comprised age, gender, level of education, personal income, and health conditions. Means (95%CI) of performance and capacity were presented according to the independent variables. Generalized linear models, using a mutual adjustment for all variables considered statistically significant (p < 0.05), measured the associations between each exposure and outcomes. Study population included 12,265 individuals. RESULTS: Older women with lower education and income levels and with some health condition showed the worst performance and capacity. CONCLUSION: Results showed that the capacity and performance levels of the Chilean population changed according to social demographic characteristics and health conditions.

Brazilian practice guidelines for stroke rehabilitation: Part II.

The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.

As Diretrizes Brasileiras de Reabilitação do Acidente Vascular Cerebral (AVC) - Parte II, desenvolvida pelo Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia é voltada para intervenções específicas de técnicas de reabilitação de déficits neurológicos e incapacidades. Seguindo o mesmo modelo da Parte I, a Parte II também se baseia em estudos randomizados, revisões sistemáticas, metanálises e outras diretrizes sobre o mesmo tema. A segunda parte aborda os distúrbios da comunicação, disfagia, controle postural e equilíbrio, ataxias, espasticidade, reabilitação do membro superior, marcha, cognição, negligência espacial unilateral, déficits sensoriais, reabilitação domiciliar, aderência ao uso de medicamentos, cuidados paliativos, o futuro da reabilitação no AVC, e websites de orientação sobre AVC para pacientes e cuidadores. Nosso objetivo é fornecer aos profissionais envolvidos na reabilitação conhecimento atualizado e recomendações para um melhor cuidado no pós-AVC.

Validation of the Brazilian version of the World Health Organization Disability Assessment Schedule 2.0 for individuals with HIV/AIDS. / Validação da versão brasileira do World Health Organization Disability Assessment Schedule 2.0 em indivíduos HIV/AIDS.

The WHODAS 2.0 (World Health Organization Disability Assessment Schedule) is an instrument developed by the WHO (World Health Organization) for functioning and disability assessment based on the biopsychosocial framework, fully supported by the theoretical-conceptual framework of the ICF (International Classification of Functioning, Disability and Health). To validate the Brazilian version of the WHODAS 2.0 for individuals with HIV/AIDS. 100 individuals with diagnosis of HIV/AIDS participated in the study. Two assessment instruments were used: the 36-item version of WHODAS 2.0 and the WHOQOL-HIV-BREF (World Health Organization Quality of Life assessment in persons infected with HIV, shorter version). The psychometric properties tested were internal consistency and criterion validity. Internal consistency was adequate for all domains, with the exception of Life Activities (α = 0.69) and Self-care (α = 0.32). Criterion validity was adequate, with moderate correlations between the WHODAS 2.0 and the WHOQOL-HIV-BREF domains. The results indicated the WHODAS 2.0 instrument as a valid tool for assessing functioning of individuals with HIV/AIDS. The use of data from the Self-care domain should be carefully considered.

O WHODAS 2.0 (World Health Organization Disability Assesment Schedule) é um instrumento criado pela OMS (Organização Mundial da Saúde) para medida de funcionalidade e deficiência, fundamentado no modelo biopsicossocial e totalmente amparado no arcabouço teórico-conceitual da CIF (Classificação Internacional de Funcionalidade, Incapacidade e Saúde). O objetivo deste artigo é validar a versão brasileira do WHODAS 2.0 para o uso em pessoas com HIV/AIDS. Participaram 100 pessoas com diagnóstico de HIV/AIDS. Foram utilizados dois instrumentos de avaliação, o WHODAS 2.0 na versão de 36 itens e o WHOQoL-HIV-Bref (World Health Organization Quality of Life em pessoas com HIV, versão abreviada). As propriedades psicométricas testadas foram consistência interna e validade de critério. A consistência interna foi adequada para todos os domínios, com exceção do domínio Atividades de Vida (α = 0,69) e Autocuidado (α = 0,32). A validade de critério foi adequada, com correlações moderadas aos domínios do WHODAS 2.0 com os domínios do WHOQoL-HIV-Abreviado. Os resultados indicaram o instrumento WHODAS 2.0 como válido para avaliação da funcionalidade de pessoas com HIV/AIDS. O uso dos dados do domínio de Autocuidado deve ser cuidadosamente considerado.

PREVALENCE AND FACTORS ASSOCIATED WITH CONSTIPATION IN PREMENOPAUSAL WOMEN: A COMMUNITY-BASED STUDY.

BACKGROUND: Intestinal constipation is characterized by problems related to evacuation, and presents high prevalence in the female gender. This condition has demonstrated negative effects on the development of daily activities, causing damage to the physical and emotional well-being of individuals who are diagnosed with it. Studies that investigate what health impairments intestinal constipation can cause are scarce in the literature. OBJECTIVE: This study aimed to verify the prevalence and factors associated with intestinal constipation in premenopausal women living in Northeastern Brazil. METHODS: It is a cross-sectional study. This was carried out in the northeast of Brazil. Participated 195 women, adult and middle age. Social conditions, habits and lifestyle, clinical aspects and obstetric history were investigated. Constipation was diagnosed using the Rome III Criteria. Multivariate analysis was conducted using Poisson Regression with robust variance to analyze the relationship between intestinal constipation and independent variables. A statistical significance level of P<0.05 was considered. RESULTS: Most of the women were between 25 and 39 years old (49.2%) and had an income of up to one minimum wage (79.5%). The intestinal constipation prevalence was 35.4%. In the final multivariate regression model, hemorrhoid clinical aspects (P=0.01), pain (P=0.001) and a burning sensation (P=0.01) on bowel movement, and sexual dysfunction (P=0.03) remained associated with constipation. CONCLUSION: The present study found a significant prevalence of constipation among premenopausal women and clinical factors such as hemorrhoids, pain and a burning sensation, and sexual dysfunction were associated with intestinal constipation.

Quality of life, sociodemographic and occupational factors of working women. / Qualidade de vida, fatores sociodemográficos e ocupacionais de mulheres trabalhadoras.

This article aims to evaluate the quality of life of working women and its relationship with sociodemographic and occupational aspects. Cross-sectional study in a sample of 579 working women in a city with a population of 318,000. Data was collected by means of questionnaires for sociodemographic, occupational and WHOQOL-BREF characteristics. For the analysis, we used descriptive statistics, t-student test and the Pearson correlation. The working women on average were 42.70 ±13.74 years old; there was a predominance of Caucasians with 9 to 12 years of formal education and an individual monthly minimum-wage income at a single job as a registered employee or civil servant. The average Quality of Life was 72.87, with a better result in the area of Social Relations and the lowest in the area of Environment. The Environment domain was significantly more compromised in women who did not have rest breaks during work, those who did not have good relationships with their coworkers, had more diseases or injuries, less formal education and lower monthly income. The Social Relations domain was significantly compromised by the number of injuries or diseases.

O objetivo deste artigo é avaliar a qualidade de vida da mulher trabalhadora e verificar a suas relações com aspectos sociodemográficos e ocupacionais. Estudo transversal, em uma amostra de 579 mulheres trabalhadoras de um município de 318.000 habitantes. Os dados foram coletados por meio de questionário para caracterização sociodemográfica, ocupacional e do WHOQOL-BREF. Para análise utilizou-se estatística descritiva, Teste t-student e correlação de Pearson. As mulheres trabalhadoras apresentaram 42,70 ±13,74 anos, houve predomínio de escolaridade entre 09 a 12 anos, cor da pele branca, renda individual mensal de até um salário mínimo, com apenas um emprego com vínculo celetista ou funcionalismo público. A média da Qualidade de Vida foi de 72,87, com melhor resultado no domínio das Relações Sociais e o menor do Meio Ambiente. O domínio Meio Ambiente foi significativamente comprometido nas mulheres que não tinham pausas para descanso durante o trabalho, não tinham bom relacionamento com os colegas, apresentavam maior número de doenças ou lesões, possuíam menor escolaridade e renda mensal. O Domínio das Relações sociais foi significativamente afetado pelo número de lesões ou doenças.

Applying the ICF linking rules to compare population-based data from different sources: an exemplary analysis of tools used to collect information on disability.

BACKGROUND: Data on disability are regularly collected by different institutions or ministries using specific tools for different purposes, for instance to estimate the prevalence of disability or eligibility of specific populations for social benefits. The interoperability of disability data collected in countries is essential for policy making and to monitor the implementation of the Convention on the Rights of Persons with Disabilities. The first objective of this paper is to map and compare tools that collect data on disability for different purposes, more specifically the Brazilian National Health Survey and the Brazilian Functioning Index to the World Health Organization (WHO) and the World Bank Model Disability Survey (MDS), currently recommended as a standard tool for disability measurement. The second objective is to demonstrate the usefulness and value of the International Classification of Functioning, Disability and Health Linking Rules to map and compare population-based surveys and other content-related tools collecting data on disability, even when these have already been developed based on the International Classification of Functioning, Disability and Health. METHODS: Disability information collected with the three different tools was mapped and compared using the International Classification of Functioning, Disability and Health Linking Rules. RESULTS: Although the disability module in the Brazilian National Health Survey is fundamentally different from the MDS, the mapping disclosed that several modules of the Brazilian National Health Survey already cover many aspects necessary to estimate prevalence and understand disability as currently recommended by the WHO and the World Bank. The Brazilian Functioning Index and the MDS are both based on the International Classification of Functioning, Disability and Health and are very similar in the approach and content of their questions on functioning. Specific information on environmental factors is essential to identify needs and barriers, as well as to devise procedures to reduce injustice and inequalities. This information is still not targeted broadly enough in both the Brazilian National Health Survey and the Brazilian Functioning Index. CONCLUSIONS: Overall, this mapping exercise showed that applying the International Classification of Functioning, Disability and Health linking rules to population-based data coming from different sources provides researchers and stakeholders involved in decision-making with standardized and straightforward information about overlaps and gaps. Implications for Rehabilitation Data on functioning and disability regularly collected with different purposes and by different institutions or ministries within a country can be compared using the International Classification of Functioning, Disability and Health as a reference framework and the International Classification of Functioning, Disability and Health linking rules. The recently published refinements of the International Classification of Functioning, Disability and Health Linking Rules go beyond the sole linking to International Classification of Functioning, Disability and Health categories and provide standardized procedures to document the perspective of linked questions or the categorization of response options. They are therefore useful to compared tools that have been developed based on the International Classification of Functioning, Disability and Health. The current disability module of the Brazilian Health Survey needs a revision to be suitable to collect data on disability that is Convention on the Rights of Persons with Disabilities conform and guarantees interoperability with disability data from other sources in Brazil, especially from disability assessment for social benefits and implementation of policies.

Breast cancer screening practice and associated factors: Women's Health Survey in Uberaba MG Brazil, 2014. / Prática de exames de rastreio para câncer de mama e fatores associados ­ Inquérito de Saúde da Mulher em Uberaba MG, Brasil, 2014.

This study aimed to characterize women's socioeconomic and epidemiological profile in Uberaba according to the breast cancer screening practice and identify associated factors with this practice. This is a cross-sectional research part of the Women's Health Survey in Uberaba (MG). Data was collected by home interview, referring to socioeconomic and epidemiological issues and breast cancer screening practice, from a sample of 1,520 women above 20 years of age. After processing the data, we performed statistical analysis with measures of association by the Chi-square test, bivariate and multivariate Poisson regression, with a significance level of 5%. The results showed a profile of breast cancer screening practice with white women (66%), high schooling and per capita income, in common-law marriage (67,5%), non-heads of households (64,4%) and non-smokers (64,6%). Factors associated with higher practice were the age groups 40-49 and 50-69 years (PR = 0.7 and 0.64), per capita income higher than one minimum wage (PR = 1.17) and public or health plan mammography coverage (PR = 1.98 and 1.94). We can conclude that factors associated with breast cancer screening practice have been identified in the studied sample.

Os objetivos deste estudo foram caracterizar o perfil socioeconômico e epidemiológico das mulheres em Uberaba, segundo a prática de exames de rastreio para câncer de mama, bem como verificar os fatores associados à prática. Pesquisa transversal de base populacional, parte do Inquérito de Saúde da Mulher em Uberaba MG. Coleta por entrevista domiciliar, referentes à questões socioeconômicas, epidemiológicas e prática de exames de rastreio para câncer de mama. Amostra foi composta por 1.520 mulheres acima de 20 anos. Após o processamento dos dados, foi realizada análise estatística com medidas de associação pelo teste Qui-Quadrado; regressão bivariada e multivariada de Poisson, significância de 5%. Os resultados demonstraram um perfil de prática de exames de rastreio para câncer de mama com mulheres de raça/cor branca (66%), escolaridade e renda per capita elevada, estado conjugal "em união" (67,5%), não chefes de família (64,4%) e não tabagistas (64,6%). Os fatores associados à maior prática dos exames foram a faixa etária de 40-49 e 50-69 anos (RP = 0,7 e 0,64), renda per capita maior que um salário mínimo (RP = 1,17) e fonte de pagamento da mamografia pública ou por plano de saúde (RP = 1,98 e 1,94). Conclui-se que existem fatores relacionados à prática de exames de rastreio na amostra estudada.

Impairments, health conditions and health risk behaviors: occurrence and associations, in the National Health Survey, Brazil, 2019 / Discapacidades, condiciones de salud y conductas de riesgo para la salud: ocurrencia y asociaciones, en la Encuesta Nacional de Salud, Brasil, 2019 / Deficiências, condições de saúde e comportamentos de risco à saúde: ocorrência e associações, na Pesquisa Nacional de Saúde, Brasil, 2019

ABSTRACT Objective To analyze association of visual, hearing, mental/intellectual, physical and multiple impairments with health conditions and health risk behaviors in Brazil. Methods This was a cross-sectional study, using data from the 2019 National Health Survey; associations between impairments and presence of cardiovascular disease (CVD), hypertension, diabetes mellitus (DM), high cholesterol, alcohol abuse and smoking were estimated using logistic regression, thus obtaining the odds ratios (OR). Results Impairment was reported by 7.6% of the 90,846 participants. Having a impairment was associated with greater odds of reporting chronic conditions, especially CVD (OR = 2.11; 95%CI 1.76;2.54) and DM (OR = 1.78; 95%CI 1.56;2.02 ); visual impairment was associated with greater odds of smoking (OR = 1.52; 95%CI 1.28;1.81); mental/intellectual impairment was inversely related to smoking (OR = 0.45; 95%CI 0.30;0.67) and alcohol abuse (OR = 0.13; 95%CI 0.06;0.26). Conclusion Having any of the impairments studied may be associated with greater odds of having chronic health conditions.

RESUMEN Objetivo Analizar la asociación entre discapacidad visual, auditiva, mental/intelectual, física y discapacidad múltiple con condiciones y conductas de riesgo para la salud en Brasil. Métodos Estudio transversal utilizando datos de la Encuesta Nacional de Salud de 2019; se estimaron, mediante regresión logística, las asociaciones entre discapacidad con la presencia de enfermedades cardiovasculares (ECV), hipertensión, diabetes, colesterol alto, consumo de alcohol y tabaquismo, obtención del odds ratio (OR). Resultados De los 90.846 participantes, el 7,6% refirió discapacidad. Tener una discapacidad se asoció con una mayor probabilidad de reportar enfermedades crónicas, especialmente ECV (OR = 2,11; IC95% 1,76;2,54) y diabetes (OR = 1,78; IC95% 1,56;2,02); la discapacidad visual se asoció con una mayor probabilidad de fumar (OR = 1,52; IC95% 1,28;1,81); la discapacidad mental/intelectual mostró una relación inversa con el tabaquismo (OR = 0,45; IC95% 0,30;0,67) y el consumo de alcohol (OR = 0,13; IC95% 0,06;0,26). Conclusión Se observó que tener alguna de las discapacidades estudiadas puede estar asociado con mayores posibilidades de tener condiciones crónicas de salud.

RESUMO Objetivo Analisar a associação de deficiências visual, auditiva, mental/intelectual, física e deficiência múltipla com as condições e comportamentos de risco à saúde no Brasil. Métodos Estudo transversal, utilizando-se dados da Pesquisa Nacional de Saúde de 2019; associações entre deficiências e presença de doença cardiovascular (DCV), hipertensão arterial, diabetes mellitus (DM), colesterol alto, consumo abusivo de álcool e tabagismo foram estimados por regressão logística, obtendo-se a razão de chances (RC). Resultados Dos 90.846 participantes, 7,6% reportaram deficiência. Ter deficiência associou-se a maiores chances de relatar condições crônicas, especialmente DCV (RC = 2,11; IC95% 1,76;2,54) e DM (RC = 1,78; IC95% 1,56;2,02); deficiência visual associou-se a maior chance de tabagismo (RC = 1,52; IC95% 1,28;1,81); deficiência mental/intelectual apresentou relação inversa com tabagismo (RC = 0,45; IC95% 0,30;0,67) e consumo abusivo de álcool (RC = 0,13; IC95% 0,06;0,26). Conclusão Apresentar alguma das deficiências estudadas pode-se associar a maiores chances de ter condições crônicas de saúde.

Limitation of activity and restriction of social participation in relation to age range, gender, and education in people with leprosy.

BACKGROUND: In Brazil, 38,000 new cases of leprosy are discovered each year, making it a public health problem. OBJECTIVE: To identify whether or not there is an association between activity limitations and the restriction of social participation with some demographic data (age range, gender, and education) of the patients in a Basic Health Unit (BHU), diagnosed with leprosy. METHODS: The SALSA scale was used to assess activity limitations, whereas the Participation scale was used to assess the restriction of social participation. RESULTS: The assessments were conducted with 31 BHU patients diagnosed with leprosy. Males were the most affected by leprosy, the multibacillary was the most prevalent, and education proved to be an important factor when related to the disease injuries among the evaluated individuals. Regarding activity limitations and the restriction of social participation, the percentage of individuals without limitations and without restrictions was greater in both scales. STUDY LIMITATIONS: The main limitation is the small study sample. CONCLUSION: It can be concluded that, for the studied sample, no association was observed between the activity limitations, evaluated by the Salsa scale, nor the restriction of social participation, evaluated by the Participation Scale, with the analyzed demographic data.

Relação de fatores pessoais e ambientais com a prevalência de deficiências físicas adquiridas no Brasil - estudo de base populacional / Relationship between personal and environmental factors and prevalence of acquired physical impairment in Brazil - a population-based study

Resumo Objetivou estimar a relação de fatores pessoais e ambientais com a prevalência de deficiência física adquirida em adultos e idosos brasileiros. Realizado um estudo transversal com dados da Pesquisa Nacional de Saúde (PNS) 2013. A variável resposta foi: autorrelato deficiência física adquirida. As variáveis explicativas de interesse foram: sexo, raça/cor, escolaridade, classe social, trabalho remunerado, plano de saúde, água canalizada e rede de esgoto. As magnitudes das associações e seus respectivos intervalos de confiança (95%) foram estimadas utilizando a Regressão de Poisson. O autorrelato de deficiência física foi encontrado em 1,25% dos 55.369 participantes. Após completo ajustamento, o sexo masculino, raça/cor não branca, menores níveis de escolaridade, viver sozinho, não ter trabalho remunerado, plano de saúde, água canalizada e rede de esgoto foram associados a maiores prevalências de deficiência física adquirida. Esses achados evidenciam que a população mais vulnerável apresenta maior prevalência de deficiência física e os fatores pessoais e ambientais são importantes de serem avaliados em nível populacional.

Abstract The aim of this study was to estimate the relationship between personal and environmental factors and the prevalence of acquired physical impairment in adults and older persons in Brazil. We conducted a cross-sectional study using data from the 2013 National Health Survey. The response variable was self-reported acquired physical impairment. The explanatory variables were sex, race/skin color, education level, social class, paid employment, private health insurance, running water, and connection to a sewer network. The strength of association between the explanatory variables and response variable and respective 95% confidence intervals were estimated using Poisson Regression. Physical impairment was reported by 1.25% of the study population (n=55,369). After complete adjustment, being male and non-white, having a lower level of education, living alone, not being in paid employment, not having private health insurance, not having running water, and not living in a house connected to a sewer network were associated with higher prevalence of acquired physical impairment. The findings show that prevalence of physical impairment was higher among vulnerable groups and that personal and environmental factors are important elements that need to be assessed at the population level.

Association of social factors and health conditions with capacity and performance

ABSTRACT OBJECTIVE Determine and measure the association of social factors and health conditions with worse capacity and performance levels. METHODS Dependent variables consisted of performance and capacity; independent variables comprised age, gender, level of education, personal income, and health conditions. Means (95%CI) of performance and capacity were presented according to the independent variables. Generalized linear models, using a mutual adjustment for all variables considered statistically significant (p < 0.05), measured the associations between each exposure and outcomes. Study population included 12,265 individuals. RESULTS Older women with lower education and income levels and with some health condition showed the worst performance and capacity. CONCLUSION Results showed that the capacity and performance levels of the Chilean population changed according to social demographic characteristics and health conditions.

Symptomatic perception of patients affected by chronic chikungunya: a qualitative perspective / Percepção dos sintomas de pacientes acometidos por chikungunya crônica: um olhar qualitativo

Objective: To understand the demands caused by chikungunya in the chronic phase and their impacts on patients' mental health and quality of life. Materials and methods: This is a qualitative study, performed from November 2019 to January 2020. Focus groups and deep interviews were carried out. Then, the Discourse Analysis was performed. Results: Chronic pain was the main clinical manifestation reported by the participants, being responsible for affecting aspects related to quality of life and mental health. As for psycological view, this study showed that chronic pain was also reported as one of the main symptoms related to anxiety and depression among research subjects. Conclusion: this study demonstrated how the chronic illness caused by Chikungunya impacted the subjects' perception in the domains related to quality of life and mental health. Furthermore, we seek to focus on the management of disease in a holistic way, putting the patients' own awareness of the impacts of the disease on their lives in a relevant level of their treatment.

Objetivo: Compreender as demandas causadas pela chikungunya em sua fase crônica e seus impactos na saúde mental e na qualidade de vida dos pacientes. Métodos: Trata-se de um estudo com abordagem qualitativa, realizado entre novembro de 2019 a janeiro de 2020. Inicialmetne, foram realizados grupos focais e entrevistas em profundidade; seguidas da Análise do Discurso. Resultados: A dor crônica foi a principal manifestação clínica relatada pelos participantes, sendo responsável por afetar aspectos relacionados à qualidade de vida e saúde mental. Quanto ao aspecto psicológico, este estudo mostrou que a dor crônica também foi relatada como um dos principais sintomas relacionados à ansiedade e depressão entre os sujeitos da pesquisa. Conclusão: este estudo demonstrou como a doença crônica causada pela chikungunya impactou na percepção dos sujeitos em seus domínios relacionados à qualidade de vida e saúde mental. Além disso, procuramos centrar-nos na gestão da doença de forma holística, colocando a consciência dos próprios doentes sobre os impactos da doença nas suas vidas num nível relevante do seu tratamento.

Brazilian practice guidelines for stroke rehabilitation: part II / Diretrizes brasileiras para reabilitação no acidente vascular cerebral: parte II

Abstract The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.

Resumo As Diretrizes Brasileiras de Reabilitação do Acidente Vascular Cerebral (AVC) - Parte II, desenvolvida pelo Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia é voltada para intervenções específicas de técnicas de reabilitação de déficits neurológicos e incapacidades. Seguindo o mesmo modelo da Parte I, a Parte II também se baseia em estudos randomizados, revisões sistemáticas, metanálises e outras diretrizes sobre o mesmo tema. A segunda parte aborda os distúrbios da comunicação, disfagia, controle postural e equilíbrio, ataxias, espasticidade, reabilitação do membro superior, marcha, cognição, negligência espacial unilateral, déficits sensoriais, reabilitação domiciliar, aderênciaao usode medicamentos, cuidados paliativos,ofuturodareabilitação no AVC, e websites de orientação sobre AVC para pacientes e cuidadores. Nosso objetivo é fornecer aos profissionais envolvidos na reabilitação conhecimento atualizado e recomendações para um melhor cuidado no pós-AVC.

Validation of the Brazilian version of WHODAS 2.0 for individuals with temporomandibular disorders / Validação da versão brasileira do WHODAS 2.0 para indivíduos com disfunção temporomandibular / Validación de la versión brasileña del WHODAS 2.0 para personas con trastornos temporomandibulares

ABSTRACT This study aims to validate the Brazilian version of World Health Organization Disability Assessment Schedule (WHODAS 2.0) for individuals with temporomandibular disorders (TMD), assessing its psychometric properties, including internal consistency, construct validity, and discriminant validity. In total, 100 female and male patients with TMD were included. Participants were assessed based on the Research Diagnostic Criteria for TMD (RDC/TMD). For statistical analyses, McDonald's omega coefficient was used to assess internal consistency; Spearman correlation, for construct validity; Kruskal-Wallis test and multiple comparisons (Dunn method), for discriminant validity. The results of internal consistency for the WHODAS 2.0 domains ranged from 0.70 to 0.94. The WHODAS 2.0 showed a moderate and significant correlation with the disability points of the RDC/TMD and with the WHOQOL-BREF domains. In the discriminant validity, significant differences were found in all domains of WHODAS 2.0 between grade 0 and grade III, between grade I and grade III, and between grade II and grade III from the chronic pain grading of the RDC/TMD. The results demonstrate that the instrument is reliable and valid for measuring the functioning of individuals with TMD, presenting acceptable psychometric properties for internal consistency, as well as for construct validity and discriminant validity.

RESUMO Este estudo metodológico teve como objetivo validar a versão brasileira do World Health Organization Disability Assessment Schedule (WHODAS 2.0) para indivíduos com desordem temporomandibular (DTM), avaliando suas propriedades psicométricas, incluindo consistência interna, validade de construto e validade discriminante. Um total de 100 pacientes do sexo feminino e masculino com DTM participaram do estudo e foram avaliados com base no Research Diagnostic Criteria for TMD (RDC/TMD). Para as análises estatísticas, o coeficiente ômega de McDonald foi usado para avaliar a consistência interna, a correlação de Spearman para a validade de construto, o teste de Kruskal-Wallis e comparações múltiplas (método de Dunn) para a validade discriminante. Os resultados de consistência interna para os domínios do WHODAS 2.0 variaram de 0,70 a 0,94. O WHODAS 2.0 apresentou correlação moderada e significativa com os pontos de incapacidade do RDC/TMD e com os domínios do WHOQOL-bref. Na validade discriminante, foram encontradas diferenças significativas em todos os domínios do WHODAS 2.0 entre os graus 0 e III, entre os graus I e III, e entre os graus II e III dos graus de dor crônica do RDC/TMD. Os resultados obtidos demonstram que o WHODAS 2.0 é um instrumento confiável e válido para mensurar a funcionalidade em indivíduos com DTM, apresentando propriedades psicométricas aceitáveis para consistência interna, bem como para validade de construto e validade discriminante.

RESUMEN Este estudio metodológico tuvo como objetivo validar la versión brasileña del Cuestionario para la Evaluación de la Discapacidad de la Organización Mundial de la Salud (WHODAS 2.0) para personas con trastorno temporomandibular (TTM), así como evaluar sus propiedades psicométricas, incluidas la consistencia interna, la validez de constructo y la validez discriminante. Participaron en el estudio un total de 100 pacientes de ambos sexos con TTM, quienes fueron evaluados con base en Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). En los análisis estadísticos, se utilizó el coeficiente omega de McDonald para evaluar la consistencia interna; la correlación de Spearman para la validez de constructo; y la prueba de Kruskal-Wallis y comparaciones múltiples (método de Dunn) para la validez discriminante. Los resultados de consistencia interna para los dominios de WHODAS 2.0 variaron de 0,70 a 0,94. El WHODAS 2.0 tuvo una correlación moderada y significativa con los puntos de incapacidad del RDC/TMD y con los dominios del WHOQOL-bref. En la validez discriminante, se encontraron diferencias significativas en todos los dominios de WHODAS 2.0 entre los grados 0 y 3, entre los grados 1 y 3 y entre los grados 2 y 3 de los grados de dolor crónico del RDC/TMD. Los resultados apuntan que el WHODAS 2.0 es fiable y válido para medir la funcionalidad de personas con TTM, presentando propiedades psicométricas aceptables para la consistencia interna, así como para la validez de constructo y la validez discriminante.

Validação da versão brasileira do World Health Organization Disability Assessment Schedule 2.0 em idosos institucionalizados / Validación de la versión brasileña del World Health Organization Disability Assessment Schedule 2.0 en ancianos institucionalizados / Validation of the Brazilian version of the World Health Organization Disability Assessment Schedule 2.0 for institutionalized older adults

RESUMO Fatores associados à institucionalização de idosos podem comprometer a funcionalidade desta população. São escassos os instrumentos que avaliam esse componente conforme o modelo biopsicossocial. Com vistas a medir a funcionalidade e a incapacidade, a Organização Mundial da Saúde (OMS) desenvolveu o World Health Organization Disability Assessment Schedule (WHODAS 2.0) amparada no modelo teórico-conceitual da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). O objetivo deste estudo foi verificar as propriedades de medida (confiabilidade, consistência interna e validade de critério) da versão brasileira do WHODAS 2.0 em idosos institucionalizados com diferentes condições de saúde. Cem idosos participaram do estudo. A consistência interna foi avaliada pelo alfa de Cronbach. O coeficiente de Spearman foi utilizado para analisar a confiabilidade teste-reteste, com a reaplicação do questionário WHODAS após sete dias da primeira entrevista. A validade de critério (convergente e divergente) foi analisada pelo coeficiente de Spearman através da correlação dos domínios do WHODAS com os domínios do WHOQoL-bref e WHOQoL-old, que avaliam qualidade de vida. Como resultado, obtivemos consistência interna adequada para todos os domínios (alfa de Cronbach ≥0,75) e forte confiabilidade de teste-reteste (r>0,85). Na validade de critério, obtivemos apenas correlações moderadas com o WHOQoL-bref e WHOQoL-old (r=-0,62; r=-0,61 respectivamente). Esses resultados mostraram que o WHODAS 2.0 é um instrumento válido e confiável como ferramenta de avaliação da funcionalidadepara idosos institucionalizados ao seguir os mesmos conceitos e princípios propostos pela OMS.

RESUMEN Los factores asociados a la institucionalización de los ancianos pueden afectar la funcionalidad de esta población. Existen pocos instrumentos que evalúan este componente según el modelo biopsicosocial. Para medir la funcionalidad y la discapacidad, la Organización Mundial de la Salud (OMS) desarrolló el World Health Organization Disability Assessment Schedule (WHODAS 2.0) con base en el modelo teórico-conceptual de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF). El objetivo de este estudio fue verificar las propiedades de medición (fiabilidad, consistencia interna y validez de criterio) de la versión brasileña de WHODAS 2.0 en ancianos institucionalizados con diferentes condiciones de salud. En el estudio participaron cien ancianos. La consistencia interna se evaluó mediante el alfa de Cronbach. Se utilizó el coeficiente de Spearman para analizar la fiabilidad test-retest, con la reaplicación del cuestionario WHODAS siete días después de la primera entrevista. Para evaluar la validez de criterio (convergente y divergente), se utilizó el coeficiente de Spearman mediante la correlación de los dominios WHODAS con los dominios de WHOQoL-bref y WHOQoL-old, que evalúan la calidad de vida. Como resultado, hubo una consistencia interna adecuada para todos los dominios (alfa de Cronbach≥0,75) y una gran fiabilidad test-retest (r>0,85). En la validez de criterio, hubo solo correlaciones moderadas con WHOQoL-bref y WHOQoL-old (r=-0,62; r=-0,61, respectivamente). Estos resultados apuntan que WHODAS 2.0 es un instrumento válido y fiable en la evaluación de ancianos institucionalizados siguiendo los mismos conceptos y principios propuestos por la OMS.

Abstract Factors associated with the institutionalization of older adults may interfere with the Functioning of this population. There are few instruments that evaluate this component according to the biopsychosocial model. The World Health Organization Disability Assessment Schedule (WHODAS 2.0) is an instrument developed by WHO (World Health Organization) to measure functioning and disability supported by the theoretical-conceptual model of the International Classification of Functioning, Disability and Health (ICF). This study aims to verify the reliability, internal consistency (IC) and criterion validity of the Brazilian version of the WHODAS 2.0 when applied to institutionalized older adults with different health conditions. In total, 100 older adults participated in the study. IC was assessed by Cronbach's alpha. Spearman's coefficient was used to analyze test-retest reliability, with the WHODAS questionnaire being reapplied seven days after the first interview. Criterion validity (convergent and divergent) was also analyzed by Spearman's coefficient by the correlation analysis with the WHOQOL-BREF and the WHOQOL-OLD. As a result, we obtained an IC that was adequate for all domains (Cronbach's alpha ≥0.75), with strong test-retest reliability (r> 0.85). In the criterion validity, we obtained only moderate correlations of the WHODAS 2.0 domains with the WHOQOL-BREF and WHOQOL-OLD domains (r=−0.62; r=−0.61 respectively). The psychometric properties tested indicated reliability - good internal consistency and strong test-retest reliability - and qualifications correlations in the criterion value. These results demonstrated that WHODAS 2.0 is a valid and reliable instrument, thus providing an assessment tool for institutionalized older adults following the concepts and principles proposed by WHO for assessing functioning.

Construct validation and reliability analysis of the self-assessment of occupational functioning instrument for deaf people in the Brazilian Sign Language / Validación de constructo y análisis de la confiabilidad del instrumento de autoevaluación del funcionamento ocupacional para personas sordos en el Lenguaje de Señas Brasileño / Validação de constructo e análise da confiabilidade do instrumento autoavaliação do funcionamento ocupacional para surdos em Língua Brasileira de Sinais

ABSTRACT Objective: to assess construct validity and reliability of the Self-Assessment of Occupational Functioning Scale in its Brazilian Sign Language version with deaf people. Methods: a methodological research study, with a sample of 121 deaf individuals, conducted virtually from January 2018 to July 2019 with dissemination throughout Brazil. Collection took place from the Self-Assessment of Occupational Functioning Scale in its transculturally adapted version for the Brazilian Sign Language. For the analysis of construct validation, the Student's t test for independent samples was used, while internal consistency was tested with the Kuder-Richardson test. Reproducibility was analyzed by means of the test-retest technique, using the McNemar test for the items and the Intraclass Correlation Coefficient and Pearson's correlation coefficient for the scores of the domains. Results: the Self-Assessment of Occupational Functioning Scale, in its version in Brazilian Sign Language, showed to be valid and reliable for the sum of the scores, and the mean of the domains obtained good internal consistency both in the total score (0.89) and for the items of the instrument. Conclusion: the instrument showed to be valid and reliable for deaf people. Offering a validated instrument to deaf individuals may provide this collective with the opportunity to expose their needs or demands regarding occupational functioning, allowing both health professionals and researchers in the area to plan care and research studies in a more inclusive and targeted manner, enabling benefits for the deaf.

RESUMEN Objetivo: evaluar la validez de constructo y la confiabilidad de la Escala de Autoevaluación del Funcionamiento Ocupacional en su versión en el Lenguaje de Señas Brasileño con personas sordas. Método: investigación metodológica, con una muestra de 121 personas sordas, realizada entre enero de 2018 y julio de 2019 de manera virtual con divulgación en la totalidad del territorio de Brasil. Los datos se recolectaron a partir da Escala de Autoevaluación del Funcionamiento Ocupacional en su versión adaptada transculturalmente para el Lenguaje de Señas Brasileño. Para el análisis de la validación de constructo, se utilizó la prueba t de Student para muestras independientes, mientras que la consistencia interna se evaluó mediante la prueba de Kuder-Richardson. La reproducibilidad se analizó por medio de la técnica test-retest, empleando la prueba de McNemar para los ítems y el Intraclass Correlation Coefficient y el coeficiente de correlación de Pearson para los puntajes de los dominios. Resultados: la Escala de Autoevaluación del Funcionamiento Ocupacional, en su versión en el Lenguaje de Señas Brasileño, demostró ser válida y confiable para la suma de los puntajes, y la media de los dominios obtuvo buena consistencia interna tanto en el puntaje total (0,89) como para los ítems del instrumento. Conclusión: el instrumento demostró ser válido y confiable para las personas sordas. Ofrecer un instrumento validado a las personas sordas podrá proporcionar a este segmento de la población la oportunidad de exponer sus necesidades o demandas en relación con el funcionamiento ocupacional, permitiendo así que tanto los profesionales de la salud como los investigadores del área planifiquen la atención y los estudios de investigación de manera más inclusiva y direccionada, viabilizando beneficios para la comunidad sorda.

RESUMO Objetivo: avaliar a validade de constructo e a confiabilidade da Escala de Autoavaliação do Funcionamento Ocupacional em sua versão em Língua Brasileira de Sinais com surdos. Método: pesquisa metodológica, com amostra de 121 surdos, no período de janeiro de 2018 a julho de 2019, realizada de maneira virtual com divulgação em todo o Brasil. A coleta foi realizada a partir da Escala de Autoavaliação do Funcionamento Ocupacional em sua versão adaptada transculturalmente para a Língua Brasileira de Sinais. Para a análise da validação de constructo, utilizou-se o teste t de Student para amostras independentes, enquanto a consistência interna foi testada por Kuder-Richardson. A reprodutibilidade foi analisada pela técnica teste-reteste, utilizando-se o teste de McNemar para os itens e o Intraclass Correlation Coefficient e o coeficiente de correlação de Pearson para os escores dos domínios. Resultados: a Escala Autoavaliação do Funcionamento Ocupacional, em sua versão em Língua Brasileira de Sinais, mostrou-se válida e confiável para a soma dos escores e a média dos domínios teve boa consistência interna no escore total (0,89) e boa consistência interna para os itens do instrumento. Conclusão: o instrumento mostrou-se válido e confiável para os surdos. Ofertar um instrumento validado aos surdos poderá proporcionar, a esse coletivo, a oportunidade de expor suas necessidades ou demandas no que concerne ao funcionamento ocupacional, permitindo, aos profissionais de saúde, assim como aos pesquisadores da área, planejar o cuidado e as pesquisas de forma mais inclusiva e direcionada, viabilizando benefícios à comunidade surda.