The workforce for rehabilitation in primary health care in Brazil.

BACKGROUND: Studies on the workforce in rehabilitation in primary health care services are still unusual in health systems analysis. Data on the health worker density at the subnational level in rehabilitation in primary health care are not commonly observed in most health systems. Nevertheless, these data are core for the system's planning and essential for finding the balance between the composition, distribution, and number of workers for rehabilitation actions. OBJECTIVE: This study aims to analyze the temporal space distribution of health professionals with higher education who performed rehabilitation actions in primary health care in Brazil from 2007 to 2020. METHOD: This is an ecological, time-series study on the supply of physiotherapists, audiologists, psychologists, and occupational therapists in primary health care, vis-a-vis the implementation of the Brazilian health policy denominated the Integrated Health Service Network for People with Disabilities. The data were obtained from the National Registry of Health Facilities. The period of analysis was from 2007 to 2020. The health worker density coefficient was calculated per 10,000 inhabitants annually, considering the five geographic regions of Brazil. The time trends of the coefficient of health professionals per year in Brazil and geographic regions were analyzed. For this purpose, joinpoint regression analysis was carried out. The average annual percentage variation was estimated, considering the respective confidence interval of 95%. RESULTS: In 2007, there were 0.12 physiotherapists/10,000 inhabitants (2326), 0.05 audiologists/10,000 inhabitants (1024), and 0.205 psychologists/10,000 inhabitants (3762). In 2020, there was an increase in the coefficient of professionals/10,000 inhabitants in all professional categories to 0.47 psychologists (> 268.1%), 0.46 physiotherapists (> 424.8%), 0.14 audiologists (> 297.1%), and 0.04 occupational therapists (> 504.5%). There was a significant increase in the supply of physiotherapists (AAPC: 10.8), audiologists (AAPC: 7.6), psychologists (AAPC: 6.8), and occupational therapists (AAPC: 28.3), with little regional variation. CONCLUSION: Public health policies for rehabilitation have contributed to an increase in the workforce caring for people with disabilities in primary health care services. An increase in the workforce of physiotherapists, audiologists, psychologists, and occupational therapists was observed throughout the period studied in all regions.

The physiotherapy workforce in the Brazilian Unified Health Care System.

BACKGROUND: Maintaining sufficient health care workforce is a global priority to achieve universal health coverage. Therefore this study addresses the availability of physiotherapists in Brazil. OBJECTIVE: To describe secular trends of the physiotherapy workforce-to-population ratio in the Unified Health System, considering public and private sector and care level (primary, secondary, tertiary) in Brazil and its regions. METHOD: Descriptive exploratory quantitative study based on secondary sources. All data related to the distribution of physiotherapists between August 2007 and September 2016 regarding facilities types, location and public and private sectors was obtained from the Brazilian National Registry of Health Care Facilities. Data related to the population of Brazil was extracted from Brazilian Institute of Geography and Statistics. The physiotherapy workforce-to-population ratio was calculated by the number of physiotherapists per 1000 population (public and private sector and care level) by ANOVA test. The distribution trends are represented on maps. Annual growth rates were estimated with Prais-Winsten linear regression models, with a significance level of 0.05, autocorrelation was checked by the Durbin-Watson test. RESULTS: The physiotherapists ratio in Brazil was 0.22/1000 population in 2007 and 0.41 in 2016, showing growth of 86%, with an increasing trend of 0.5% on an annual average. The public sector had the biggest physiotherapy workforce in the country in 2007 and 2016. The primary health care had the smallest physiotherapy workforce-to-population ratio (2007: p > 0.001 and 2016: p = 0.003), even though it had the largest growth trend in annual average (0.9% p > 0.001), followed by public and private tertiary health care sectors (0.8% p > 0.001). The workforce in secondary health care was bigger in the private sector than in the public sector (0.6% p > 0.001 vs. 0.2% p = 0.004). Overall, all regions had greater growth of physiotherapy workforce-to-population ratio in public primary and tertiary health care sectors, and private secondary health care sector, mainly the Southeast, South and Central-West regions. CONCLUSION: Although the physiotherapy workforce in Brazil is relatively small, there was a trend towards growth with differences among care levels, and public and private sectors. The physiotherapy workforce-to-population ratio is bigger in the private secondary health care sector, followed by public tertiary, secondary and primary health care sectors. Sub-national regions show similar trends to the national estimates, with minor variations by region.

Posture Alignment of Adolescent Idiopathic Scoliosis: Photogrammetry in Scoliosis School Screening.

OBJECTIVE: The objective of this study was to describe the posture patterns of adolescents diagnosed with adolescent idiopathic scoliosis (AIS) in a scoliosis school screening (SSS). METHODS: Two-dimensional photogrammetry was used to assess the posture of 37 adolescents diagnosed with scoliosis (scoliosis group, SG) (Cobb angle ≥10°) and 76 adolescents with a false positive diagnosis (false positive group, FPG) (Cobb angle <10°, angle of trunk rotation ≥7°). In total, 2562 10- to 14-year-old adolescents were enrolled in the SSS, which was performed in public schools in the cities of Amparo, Pedreira, and Mogi Mirim in the state of São Paulo, Brazil. Their posture was analyzed using Postural Analysis Software. Continuous variables were tested using Student t test, and categorical variables were tested using a χ2 test. The SG, FPG, simple curve group, and double curve group were all compared. Bivariate analysis was used to identify associations between postural deviations and scoliosis. The adopted significance level was α = .05. RESULTS: The SG (2.7 ± 1.9°) had greater shoulder obliquity than the FPG (1.9 ± 1.4°) (P = .010), and this deviation was associated with scoliosis (odds ratio [95% CI] P = 1.4 [1.1-1.8] 0.011). The SG had asymmetry between the right- and left-side lower limb frontal angle, shoulder sagittal alignment, and knee angle. The double curve group (3 ± 1.7°) presented a greater value of the vertical alignment of the torso than the simple curve group did (1.9 ± 1°; P = .032). CONCLUSIONS: Adolescents diagnosed with AIS in an SSS had greater shoulder obliquity and asymmetry between the right and left sides. Shoulder obliquity was the only postural deviation associated with AIS.

The rehabilitation workforce in Brazil.

BACKGROUND: The surge in individuals facing functional impairments has heightened the demand for rehabilitation services. Understanding the distribution of the rehabilitation workforce is pivotal for effective health system planning to address the population's health needs. OBJECTIVE: To investigate the spatial and temporal dispersion of physical therapists, speech therapists, psychologists and occupational therapists across various tiers of care within Brazil's Unified Health System and its regions. METHOD: This is an ecological time series study on the supply of rehabilitation professionals. Data were obtained from the National Register of Health Establishments from 2007 to 2020. The density of professionals was calculated per 10,000 inhabitants annually for Brazil and its five regions. The Joinpoint regression model was used to analyze the temporal trends of the density of professionals, considering a 95% confidence interval. RESULTS: In 2020, the most notable concentrations of psychologists, speech therapists, and occupational therapists in Brazil were observed in the domain of Specialized Health Care, with densities of 0.60, 0.20, and 0.16 professionals per 10,000 inhabitants, respectively. Conversely, the highest density of physical therapists was found within Hospital Health Care, with a density of 1.19 professionals per 10,000 inhabitants. Notably, variations in professional dispersion across different regions were apparent. Primary Health Care exhibited the highest density of professionals in the Northeast region, while the Southern region accounted for the highest densities in all professional categories within Specialized Health Care. The southeast region exhibited the largest workforce within Hospital Health Care. A marked upsurge in professional availability was noted across all categories, notably in the occupational therapy sector within hospital care (AAPC: 30.8), despite its initial low density. CONCLUSION: The implementation of public health policies played a significant role in the expansion of the rehabilitation workforce at all three levels of care in Brazil and its various regions from 2007 to 2020. Consequently, regional disparities and densities of professionals have emerged, mirroring patterns observed in low-income countries.

Space-temporal analysis of the Specialized Services of the Health Care Network for Persons with Disabilities in Brazil.

Considering the institution of the Care Network for People with Disabilities (RCPD) in Brazil, this study analyzed the spatial distribution and the temporal trend of implementing specialized services that received financial support in the first eight years of this policy. We realized an ecological study based on the National Register of Health Facilities data from April/2012 to March/2020. A joinpoint regression was used for temporal trend analysis, and thematic maps were produced for spatial analysis of rehabilitation modalities and types of services. The most available services were physical and intellectual rehabilitation. The Southeast and Northeast regions had a higher concentration of specialized services. Despite the lower number of services, there was an average annual growth between 9.6% and 41.3%. This finding indicates an increase in specialized services for people with disabilities in the period analyzed, but care gaps are still being verified in the macro-regions of Brazil.

Amigos de Fibro (Fibro Friends): validation of an e-book to promote health in fibromyalgia.

BACKGROUND: Educational strategies are necessary for the care of patients with fibromyalgia. The objective was to develop and validate an e-book to promote the health of individuals with fibromyalgia. METHODS: Methodological research in which, initially, through a bibliographic survey, the available publications on the subject were analyzed. Then, this knowledge was used to build the theoretical content addressed, and the art and layout of the e-book were elaborated. In the third phase, validation of the constructed material, content specialists (n = 23), technicians (n =  23) and design specialists (n = 23), and individuals with fibromyalgia (n = 45) evaluated the e-book through the Delphi technique. For data collection, different questionnaires were used, according to the evaluation focus of each participant group, analyzed for reliability using Cronbach's Alpha (αC) and agreement using the Content Validity Index (CVI). RESULTS: In the global assessment of agreement from all groups of judges, the CVI presented a considerable minimum: content (0.79), technical (0.89), design (0.92), and target audience (0.97). Regarding reliability, all groups also had a αC within the acceptable range: content (0.960), technical (0.963), design (0.977), and target audience (1.08). CONCLUSIONS: The e-book was developed and validated in terms of content and relevance and can be used to promote the health of individuals with fibromyalgia.

[Evaluation of the implementation of the Care Network for People with Disabilities in the Brazilian Unified National Health System: a multiple case study]. / Avaliação da implantação da Rede de Cuidados à Pessoa com Deficiência no Sistema Único de Saúde: um estudo de casos múltiplos.

The Care Network for People with Disabilities (RCPCD) was implemented in 2012 as a consequence of the actions of the Viver sem Limite (Living without Limits) plan and has been the research object of recent studies. However, no published studies address the degree of implementation of this network. This study aimed to evaluate the degree of implementation of the RCPCD in eight states in the five regions of Brazil. This multiple case study performed evaluative research of the degree of implementation of the RCPCD in the states of Amazonas, Bahia, Espírito Santo, Mato Grosso do Sul, Minas Gerais, Paraíba, Rio Grande do Sul, and São Paulo. A logical model of the policy and a measurement matrix were developed. The degree of implementation of seven states was moderate, but Amazonas had an incipient degree of implementation. The evaluation of each stage of the process showed important differences, as the regional diagnosis and network adhesion stages presented moderate to advanced degrees of implementation in most states. In the service contracting stage, no state had an advanced degree of implementation, and the stage of follow-up and monitoring of the RCPCD was not even reached. The measurement matrix helps evaluate the degree of implementation of the RCPCD, and, by recognizing its results, the state steering groups and technical area recommend its use. Actions to improve this implementation, such as strengthening regionalization, establishing regional steering groups, ensuring contracting mechanisms, and defining criteria for certification of the care points, are necessary.

A Rede de Cuidados à Pessoa com Deficiência (RCPCD) foi implantada em 2012 como desdobramento das ações do Plano Viver sem Limite, sendo objeto de pesquisas recentes, entretanto, não foram encontrados estudos de avaliação do grau de implantação dessa rede. O objetivo deste artigo foi avaliar o grau de implantação da RCPCD em oito estados nas cinco regiões geográficas brasileiras. Realizou-se estudo de casos múltiplos mediante pesquisa avaliativa do grau de implantação da RCPCD nos estados/casos: Amazonas, Bahia, Espírito Santo, Mato Grosso do Sul, Minas Gerais, Paraíba, Rio Grande do Sul e São Paulo. Para tanto, desenvolveu-se um modelo lógico da política e uma matriz de medidas. O grau de implantação de sete estados foi classificado como moderado, somente o Amazonas obteve grau de implantação incipiente. Foram identificadas diferenças importantes na avaliação de cada fase desse processo, as fases de diagnóstico regional e adesão à rede obtiveram grau de implantação de moderado a avançado na maioria dos estados. Na fase da contratualização dos serviços, nenhum estado alcançou o grau avançado de implantação e a fase de acompanhamento e monitoramento da RCPCD basicamente não ocorreu em todos os estados. A matriz de medidas permite avaliar o grau de implantação da RCPCD. Ainda, o reconhecimento dos resultados do grau de implantação pelos grupos condutores e áreas técnicas estaduais referendou o uso desse instrumento. Salienta-se a necessidade de ações para o aprimoramento dessa implantação, tais como: fortalecer a regionalização, instituir grupos condutores regionais, garantir mecanismos de contratualização e definir critérios para certificação dos pontos de atenção.

La Red de Atención a Personas con Discapacidad (RCPCD) se implementó en 2012 en el Sistema Único de Salud como resultado de las acciones del Plan Vivir sin Límite, y es objeto de una investigación reciente; sin embargo, no hay estudios de evaluación del grado de implementación de esta red. El objetivo de este estudio fue evaluar el grado de implementación de la RCPCD en ocho estados de las cinco regiones geográficas brasileñas. Se realizó un estudio de caso múltiple mediante una investigación evaluativa sobre el grado de implementación de la RCPCD en los estados/casos: Amazonas, Bahia, Espírito Santo, Mato Grosso do Sul, Minas Gerais, Paraíba, Rio Grande do Sul y São Paulo. Para ello, se elaboraron un modelo lógico de la política y una matriz de medidas. El grado de implementación de siete estados se clasificó como moderado, solamente Amazonas obtuvo un grado de implementación incipiente. Se identificaron diferencias importantes en la evaluación de cada fase de este proceso, las fases de diagnóstico regional y adhesión a la red lograron un grado de implementación de moderado a avanzado en la mayoría de los estados. En la fase de contratación de los servicios, ningún estado alcanzó el nivel avanzado de implementación, y la fase de seguimiento y monitoreo de la RCPCD básicamente no se realizó en todos los estados. La matriz de medidas permite evaluar el grado de implementación de la RCPCD, y el reconocimiento de los resultados del grado de implementación por parte de los grupos de dirección y el área técnica de los estados avaló su uso. Son necesarias más acciones para mejorar esta implementación, tales como: fortalecer la regionalización, establecer grupos de dirección regional, garantizar mecanismos de contratación y definir criterios para la certificación de puntos de atención.

Risk Factors for the Impairment of Ambulation in Older People Hospitalized with COVID-19: A Retrospective Cohort Study.

(1) Background: Some older people hospitalized with COVID-19 have experienced reduced ambulation capacity. However, the prevalence of the impairment of ambulation capacity still needs to be established. Objective: To estimate the prevalence of, and identify the risk factors associated with, the impairment of ambulation capacity at the point of hospital discharge for older people with COVID-19. (2) Methods: A retrospective cohort study. Included are those with an age > 60 years, of either sex, hospitalized due to COVID-19. Clinical data was collected from patients' medical records. Ambulation capacity prior to COVID-19 infection was assessed through the patients' reports from their relatives. Multiple logistic regressions were performed to identify the risk factors associated with the impairment of ambulation at hospital discharge. (3) Results: Data for 429 older people hospitalized with COVID-19 were randomly collected from the medical records. Among the 56.4% who were discharged, 57.9% had reduced ambulation capacity. Factors associated with reduced ambulation capacity at discharge were a hospital stay longer than 20 days (Odds Ratio (OR): 3.5) and dependent ambulation capacity prior to COVID-19 (Odds Ratio (OR): 11.3). (4) Conclusion: More than half of the older people who survived following hospitalization due to COVID-19 had reduced ambulation capacity at hospital discharge. Impaired ambulation prior to the infection and a longer hospital stay were risks factors for reduced ambulation capacity.

A web-based educational therapy intervention associated with physical exercise to promote health in fibromyalgia in Brazil: the Amigos De Fibro (Fibro Friends) study protocol.

BACKGROUND: Health education is one of the main items to enable health promotion to patients with fibromyalgia. The objective of the study "Amigos de Fibro (Fibro Friends)" is to evaluate the impact of an educational intervention associated with physical exercise based on the web in promoting health and quality of life of patients with fibromyalgia in Brazil. METHODS: A study with a randomized controlled trial approach will be carried out. The sample will consist of 24 participants, divided into two groups, with 12 individuals each. The experimental group will participate in meetings with lectures, debates, conversation rounds and exercises by a multidisciplinary team. Physical exercises will also be performed in an online environment. On the other hand, the control group will receive an e-book of education and self-care. Primary outcomes will be quality of life. The secondary outcomes will be sociodemographic and health profile, pain intensity, sleep quality, self-care agency, usage and costs of health and social care services, viability of the program and program participation. In addition, a qualitative evaluation process will be carried out with the participants. After the intervention, the data of both groups will be collected again, as well as after 3, 6, and 12 months to verify the effect and the maintenance of the intervention. DISCUSSION: The results will provide data for studies to consider the use of this tool in the future by professionals working in the field of rheumatology. TRIAL REGISTRATION: The protocol was registered in the Brazilian Registry of Clinical Trials RBR-3rh759 ( https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-3rh759 ). Date of registration: 07/02/2020].

Functional impact on adults and older people after hospitalization by Covid-19.

BACKGROUND AND OBJECTIVES: Hospitalization by Covid-19 can cause persistent functional consequences after hospital discharge due to direct and indirect effects of SARS-COV-2 in several organs and systems of the body added to post-intensive care syndrome and prolonged bed rest. These impacts can lead to dependency in activities of daily living, mainly in older people due to aging process and functional decline. This study aimed to compare the effects of hospitalization by Covid-19 on functional capacity of adults and older people and to identify its associated factors. METHODS: Cross-sectional observational study of 159 survivors of hospitalization by Covid-19 after 1 month from discharge at Hospital das Clínicas of the University of São Paulo, divided into groups: adults (aged < 60 years) and older people (aged ≥ 60 years). Those who did not accept to participate, without availability or without ability to understand the questionnaires were excluded. Functional capacity was assessed by the Barthel Index and patients were classified according to their scores. Data analysis was performed in JASP Statistics program and the sample was compared between the age groups. Wilcoxon test was applied to compare before and after periods, Mann-Whitney test was used for between groups comparison. We adopted alpha = 0.05. RESULTS: The total Barthel Index median score was lower 1 month after hospital discharge than in the pre-Covid-19 period. Older people had worse functional status than adults before and also showed greater impairment after hospital discharge. Both groups showed lower Barthel Index classification than before, and older people presented more functional dependence than adults in both periods. Age, sarcopenia and frailty were associated factors. DISCUSSION: Hospitalization by Covid-19 impacts functional capacity after 1 month from discharge, especially in older people. Age, sarcopenia and frailty are associated factors. These results suggest need for care and rehabilitation of Covid-19 survivors.

Amigos de Fibro (Fibro Friends): Validation of an Educational Program to Promote Health in Fibromyalgia.

Health education is one of the main items to enable the promotion of health for individuals with fibromyalgia (FM) in Primary Health Care (PHC) in Brazil. The purpose of this study was to validate a multidisciplinary educational health promotion program called Amigos de Fibro (Fibro Friends) for individuals with FM. Methodological research involving 23 health professionals (expert judges) and 45 individuals with FM (target audience) used an instrument to assess the objectives, proposed themes and initiatives, relevance, writing style, and structure of the program through the Delphi technique. The content validity index (CVI) ≥ 0.78 and coefficient kappa ≥ 0.61 were used for data analysis. All 25 items evaluated in both groups presented considerable minimum CVI by CVI and the kappa coefficient. In the global evaluation of Amigos de Fibro, the CVI of the specialist judges was 0.90, while the values of the target audience judges were 0.95. The kappa coefficient of the expert judges was 0.90 and that of the target audience judges was 0.85. Amigos de Fibro, a light technology in health, was considered with adequate content validity and internal consistency and is, therefore, valid in the use by health professionals with the target audience in PHC, making it possible for them to act as health-promoting agents.

Amigos de Fibro (Fibro Friends): development of an educational program for the health promotion of fibromyalgia patients.

BACKGROUND: Educational practices are indicated to promote the health of people with fibromyalgia in primary health care. We aimed to develop an educative interdisciplinary program intended at the health promotion of individuals with fibromyalgia. METHODS: It is a study protocol that was developed following three phases in the city of São Paulo city, Brazil. Qualitative research was carried out, through a focal group, with 12 individuals with fibromyalgia and 10 health professionals. A thematic content analysis was made according to the content proposed by Bardin. RESULTS: Fibro Friends is an interdisciplinary program with educational approaches that must be performed in 15 meetings, once a week for 1 h and 20 min. Participants were the following professionals: a Physiotherapist, a Doctor, a Psychologist, a Nutritionist, a Nurse, a Pharmacist/Druggist, a Speech Therapist, an Occupational Therapist, a Naturopath, and a Social Worker. A physical exercise program will also be carried out. The professionals must discuss in a lecture, conversation hearing, and/or group dynamic, about strategies to promote health and pain control in fibromyalgia. CONCLUSION: Fibro Friends is a program presenting educational interdisciplinary information to individuals with fibromyalgia, being considered a trend to future care. Fibro Friends is a practical guide, logical, and efficient to patients with fibromyalgia at the basic attention to health.

Ambulation capacity, age, immunosuppression, and mechanical ventilation are risk factors of in-hospital death in severe COVID-19: a cohort study.

IMPORTANCE: Despite ambulation capacity being associated with a decreased level of physical activity and survival may be influenced by the functional capacity, studies have not addressed the association between ambulation capacity and death in patients hospitalized by COVID-19. OBJECTIVE: To verify the functional, clinical, and sociodemographic risk factors associated with in-hospital death in individuals with severe COVID-19. METHODS: It is a cohort retrospective study performed at a large tertiary hospital. Patients 18 years of age or more, of both sexes, hospitalized due to severe COVID-19 were included. Cases with dubious medical records and/or missing essential data were excluded. Patients were classified according to their ambulation capacity before the COVID-19 infection. Information regarding sociodemographic characteristics, in-hospital death, total hospital stays, Intensive Care Unit (ICU) stays, and the necessity of Mechanical Ventilation (MV) were collected from medical records and registered in a RedCap database. Multiple logistic regression analysis was used to identify possible factors associated with the in-hospital death rate. RESULTS: Data from 1110 participants were included in the statistical analysis. The median age of the patients was 57 (46‒66) years, 58.42% (n = 590) were male, and 61.73% (n = 602) were brown or black. The case fatality rate during hospitalization was 36.0% (n = 363). In-hospital death was associated with ambulation capacity; dependent ambulators (OR = 2.3; CI 95% = 1.2-4.4) and non-functional ambulation (OR = 1.9; CI 95% = 1.1-3.3), age [older adults (OR = 3.0; CI 95% = 1.9‒4.), ICU stays (OR = 1.4; CI 95% = 1.2‒1.4), immunosuppression (OR = 5.5 CI 95% = 2.3‒13.5) and mechanical ventilation (OR = 27.5; CI 95% = 12.0-62.9). CONCLUSION AND RELEVANCE: Decreased ambulation capacity, age, length of ICU stay, immunosuppression, and mechanical ventilation was associated with a high risk of in-hospital death due to COVID-19.

Neurodevelopment in the third year of life in children with antenatal ZIKV-exposure.

We report cognitive, language and motor neurodevelopment, assessed by the Bayley-III test, in 31 non-microcephalic children at age 3 with PCR-confirmed maternal Zika virus exposure (Rio de Janeiro, 2015-2016). Most children had average neurodevelopmental scores, however, 8 children (26%) presented delay in some domain. Language was the most affected: 7 children (22.6%) had a delay in this domain (2 presenting severe delay). Moderate delay was detected in the cognitive (3.2%) and motor (10%) domains. Maternal illness in the third trimester of pregnancy and later gestational age at birth were associated with higher Bayley-III scores. Zika-exposed children require long-term follow-up until school age.

Increase in fall-related hospitalization, mortality, and lethality among older adults in Brazil.

OBJECTIVE To estimate the trends of fall-related hospitalization, mortality, and lethality among older adults in Brazil and regions. METHODS This is a descriptive study based on data from the Hospital Information System of the Brazilian Unified Health System. We included records of every older adult, aged 60 years or older, hospitalized for accidental fall from January, 1998 to November, 2015 in all Brazilian regions. We selected the codes E885, E886, E880, E884, E884 from the International Classification of Diseases, 9th revision, and W01, W03, W10, W17, W18 from the 10th revision, and calculated fall-related hospitalization and mortality rates per 100,000 inhabitants, as well as lethality. To estimate trends, we applied the Prais-Winsten regression for time series analysis. RESULTS During the period, 1,192,829 fall-related hospitalizations occurred, among which 54,673 had a fatal outcome; lethality was 4.5%. Hospitalization rates showed upward trends, with seasonality, in Brazil (11%), and in the Northeast (44%), Midwest (13%), and South regions (14%). The North showed a decreasing hospitalization rate (48%), and the Southeast a stationary one (3%). CONCLUSIONS In Brazil, fall-related hospitalizations, mortality, and lethality among older adults showed an upward trend from 1998 to 2015, with seasonal peaks in the second and third quarters. Considering we are in plain demographic transition, to improve hospital healthcare and encourage falls prevention programs among older adults is essential.

Prevalence of hot flashes in women of 40 to 65 years of age with metabolic syndrome.

OBJECTIVE: Hot flashes have a negative impact on the quality of life of women during the menopausal transition and thereafter. The progressive reduction in gonadal estrogen levels associated with aging promotes an accumulation of abdominal fat, dyslipidemia, and arterial hypertension, all of which are components of metabolic syndrome (MetS). The objective of the present study was to estimate the prevalence of hot flashes and evaluate their relationship with MetS in women ≥ 40 years of age. METHODS: This was a cross-sectional study involving women aged between 40 and 65 years. We used the Kupperman index to quantify the climacteric symptoms and the National Cholesterol Education Program Adult Treatment Panel III criteria for the diagnosis of MetS. RESULTS: 1,435 women were initially selected, and we obtained information from 647. The mean age at menopause was 45.99 years (SD 6.61 years) and the prevalence of hot flashes and MetS were 55.83% (95% CI: 52.35-59.25%) and 46.29% (95% CI: 44.75-52.53%), respectively. We identified a positive association between MetS and hot flashes (OR 1.16; 95% CI: 1.01-1.33). CONCLUSIONS: In women ≥ 40 years of age, hot flashes are highly prevalent and appear to be associated with MetS.

Accidental falls in middle-aged women.

OBJECTIVE: To estimate the prevalence of accidental falls in women and to identify possible associations of sociodemographic, clinical and lifestyle variables with falls, in 2007 and 2014. METHODS: Two cross-sectional studies were performed, in 2007 and 2014, within the Projeto de Saúde de Pindamonhangaba (PROSAPIN - Pindamonhangaba Health Project), with women aged between 35 to 75 years. Probabilistic samples were selected among women living in the municipality and participating in the Health Family Strategy. Data collection included: face-to-face interview, anthropometric examination and blood test. The outcome variable "have you fallen in the last six months?" was raised during the interview. The prevalence of falls in 2007 and 2014 were estimated by score with a 95% confidence interval (95%CI). Multiple logistic regression models were constructed to identify the association of independent variables with the occurrence of falls for each year based on the odds ratio (OR). We used the Stata 14.0 software for statistical analysis. RESULTS: The prevalence of accidental falls were: 17.6% (95%CI 14.9-20.5) in 2007 and 17.2% (95%CI 14.8-19.8) in 2014. In 2007, factors associated with falls were: aged 50-64 years (OR = 1.81; 95%CI 1.17-2.80), high school (OR = 1.76; 95%CI 1.06-2.93), hyperuricemia (OR = 3.74; 95%CI 2.17-6.44), depression (OR = 2.07; 95%CI 1.31-3.27), poor sleep (OR = 1.78; 95%CI 1.12-2.82) and daytime sleepiness (OR = 1.86; 95%CI 1.16-2.99). In 2014, they were: aged 50-64 years (OR = 1.64; 95%CI 1.04-2.58), hyperuricemia (OR = 1.91; 95%CI 1.07-3.43) and depression (OR = 1.56; 95%CI 1.02-2.38), plus metabolic syndrome (OR = 1.60; 95%CI 1.03-2.47) and musculoskeletal pain (OR = 1.81; 95%CI 1.03-3.18). CONCLUSIONS: Falls occur significantly in women aged 50 years or over, indicating that they are not restricted to older adults and that there is a need to initiate preventive measures earlier. Both studies showed similar magnitudes of occurrence of accidental falls and reinforced their multifactorial nature. In addition, hyperuricemia may be a potential new factor associated with falls.

Prevalence of hypovitaminosis D in postmenopausal women: a systematic review.

BACKGROUND: Hypovitaminosis D is considered a global public health issue. Knowledge of its true dimensions will allow us to design interventions and plan preventive measures that can have a significant impact on human health. OBJECTIVES: The aim of this study was to evaluate the prevalence of hypovitaminosis D, defined as a serum 25-hydroxyvitamin D concentration < 30 ng/ml, in postmenopausal women around the world, as well as to identify the potential associated factors. METHODS: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses recommendations. Specific search terms were consulted in Medline, Excerpta Medica, and Latin-American and Caribbean Health Sciences Literature databases, with no restriction for the year or language of publication. RESULTS: Of 451 studies initially identified, 32 were selected for analysis. Collectively, those 32 studies evaluated 21,236 postmenopausal women, of whom 16,440 (77.4%) had serum 25-hydroxyvitamin D concentrations < 30 ng/ml. The reported prevalence of hypovitaminosis D ranged from 29% (in the United States) to 99.4% (in China). In six of the studies, the prevalence was above 90%. CONCLUSIONS: If the criterion is the 30 ng/ml cut-off point, the majority of postmenopausal women in the world could be classified as having hypovitaminosis D. Among the studies evaluated, the lowest prevalence reported was nearly 30%. Neither latitude, region of the world, nor laboratory methodology were found to be associated with the prevalence of hypovitaminosis D.

Space-temporal analysis of the Specialized Services of the Health Care Network for Persons with Disabilities in Brazil / Análise espaço-temporal dos serviços especializados da Rede de Cuidados à Pessoa com Deficiência no Brasil

Abstract Considering the institution of the Care Network for People with Disabilities (RCPD) in Brazil, this study analyzed the spatial distribution and the temporal trend of implementing specialized services that received financial support in the first eight years of this policy. We realized an ecological study based on the National Register of Health Facilities data from April/2012 to March/2020. A joinpoint regression was used for temporal trend analysis, and thematic maps were produced for spatial analysis of rehabilitation modalities and types of services. The most available services were physical and intellectual rehabilitation. The Southeast and Northeast regions had a higher concentration of specialized services. Despite the lower number of services, there was an average annual growth between 9.6% and 41.3%. This finding indicates an increase in specialized services for people with disabilities in the period analyzed, but care gaps are still being verified in the macro-regions of Brazil.

Resumo Considerando a instituição da Rede de Atenção à Pessoa com Deficiência (RCPD) no Brasil, o estudo analisa a distribuição espacial e a tendência temporal da implantação de serviços especializados que receberam apoio financeiro nos primeiros oito anos dessa política. Realizamos um estudo ecológico com base nos dados do Cadastro Nacional de Estabelecimentos de Saúde no período de abril/2012 a março/2020. Uma regressão joinpoint foi usada para análise de tendência temporal e mapas temáticos foram produzidos para análise espacial de modalidades de reabilitação e tipos de serviços. Os serviços mais disponíveis foram reabilitação física e intelectual. As regiões Sudeste e Nordeste apresentaram maior concentração de serviços especializados. Apesar do menor número de serviços, houve crescimento médio anual entre 9,6% e 41,3%. Esse achado indica aumento de serviços especializados para pessoas com deficiência no período analisado, mas ainda se verificam lacunas assistenciais nas macrorregiões do Brasil.

[Trends of AIDS incidence and mortality among women in menopause transition and post-menopause in Brazil, 1996 - 2005]. / Tendência da incidência e da mortalidade por aids em mulheres na transição menopausal e pós-menopausa no Brasil, 1996-2005.

OBJECTIVE: To describe the incidence and mortality by AIDS in Brazil involving women in the menopause transition and post-menopause stage. METHODS: Retrospective study conducted from 1996 to 2005, using secondary data provided by the DATASUS Health Information System - Ministry of Health. The population was extracted from the "Demographic and Socio-economic" database, incidence from "Epidemiology and Morbidity" and mortality from "Vital Statistics". Specific coefficients for incidence and mortality by AIDS (for 100,000 women) were calculated for each age ranging from 30 to 69 (30-39, 40-49, 50-59, 60-69) as this includes the population of interest; i.e. women in menopause transition and post-menopause, that is to say from 35 to 65 years of age. RESULTS: There was an increase in the incidence of AIDS between 1996 and 1998, followed by a slight downward trend until 2000 and then an increment up to 2004. In 2005, the coefficient returns to values close to those of 1997. Mortality fell in all age ranges from 1996 to 1997 and afterwards coefficients remained virtually stable until 1999, except for ages from 30-39, which continue stable until 2005. For women older than 40, the mortality coefficient increased between 1999 and 2005. CONCLUSION: There was an increase in the number of new cases of AIDS in women over 30 and the same was true for mortality. The increase and "aging" of epidemics among Brazilian women show that health supporting measures, disease prevention and early diagnoses as well as effective care must be provided for women in the 30-69 age group considering personal characteristics, family context and social role played by women of this age.