Contribution of chronic conditions to functional limitations using a multinomial outcome: results for the older population in Belgium and Brazil.

BACKGROUND: The global phenomenon of population ageing is creating new challenges in both high and middle income countries, as functional limitations are expected to increase with age. The attribution method has been proposed to identify which conditions contribute most to disability using cross-sectional data. Although the original method was based on binary outcomes, we recently proposed an extension to multinomial responses, since different disability levels are often investigated in surveys. This is the first application of the extended method to evaluate differences in the contribution of chronic conditions to functional limitations in the older population of Brazil and Belgium. METHODS: Representative data from individuals aged ≥65 years who participated in the 2008 or 2013 Health Interview Surveys in Belgium (N = 4521) or in the 2008 National Household Sample Survey in Brazil (N = 28,437) were analysed. Individuals were classified as without, moderate or severe functional limitations, based on three activities of daily living: eating, showering, and toileting. Six chronic conditions common to the surveys - diabetes, heart diseases, musculoskeletal conditions, depression, chronic respiratory diseases, and cancer - were included in the analysis. Separate multinomial additive hazards models by gender for each country were fitted. RESULTS: The prevalence of moderate functional limitations was larger in men in Brazil (8.4%) compared to Belgium (6.0%) and similar in women (approximately 12.0%). Conversely, the severe prevalence in men was similar in the two countries (around 8.0%) and higher in women from Belgium (16.6%) than from Brazil (9.1%). Musculoskeletal conditions were the main contributors to the prevalence of functional limitations in men and women in Belgium but only in men and women with moderate functional limitations in Brazil. Depression and heart diseases contributed most to the severe prevalence of functional limitations in men and women in Brazil, respectively. CONCLUSIONS: Our findings provide a better understanding of differences in the prevalence of different levels of functional limitations in Brazil and Belgium. These differences can be related to differences in socioeconomic conditions, health care access and quality, disease diagnosis, stage of epidemiology transition, life expectancy, and the prevalence of lifestyle risk factors in the two countries.

Distribuição dos investimentos públicos em fisioterapia e cobertura da saúde suplementar no Brasil: série histórica de 2010 a 2015 / Distribución de las inversiones públicas en fisioterapia y cobertura de la salud suplementaria en Brasil: serie histórica de 2010 a 2015 / Distribution of public investment in physical therapy and supplementary health coverage in Brazil: historical series from 2010 to 2015

RESUMO Este estudo tem o objetivo de descrever o perfil dos investimentos públicos em fisioterapia e verificar a correlação desses investimentos com a taxa de cobertura de plano de saúde, nas grandes regiões brasileiras e nas unidades de federação, entre 2010 e 2015. Os dados referentes aos investimentos públicos aprovados por região e unidades de federação do país segundo atendimento em fisioterapia foram obtidos no setor de Sistema de Informações Ambulatoriais do Sistema Único de Saúde, no site do Departamento de Informática do Sistema Único de Saúde (Datasus). As informações correspondentes à taxa de cobertura por plano de saúde foram obtidas no setor de Informações de Saúde Suplementar, disponível no site da Agência Nacional de Saúde Suplementar. Os dados foram analisados, e, para verificar a correlação entre a distribuição dos investimentos e a taxa de cobertura por plano de saúde, realizou-se o teste de correlação de Spearman, com nível de significância de 5,00%. A média de aplicação per capita em reais no Brasil de recursos financeiros em atendimentos em fisioterapia ao longo dos cinco anos foi de R$ 117,16 (±3,52). Dentre as regiões e para o mesmo período, a região Sul apresentou a maior média per capita (R$ 129,95 ± 5,30), seguida em ordem decrescente pelas regiões Sudeste (R$ 124,22±3,69); Nordeste (R$ 118,98±7,53); Norte (R$ 89,43±3,01) e Centro-Oeste (R$ 77,09 ± 6,54). A média de cobertura de plano privado de saúde variou de 6,20% (Acre) a 43,35% (São Paulo). Parece não haver relação entre a cobertura por plano de saúde privado e o investimento público em atendimento em fisioterapia.

RESUMEN Este estudio tiene el objetivo de describir el perfil de las inversiones públicas en fisioterapia y certificar la correlación de esas inversiones con la tasa de cobertura de seguro de salud, en las grandes regiones brasileñas y en las unidades de federación, entre 2010 y 2015. Los datos referentes a las inversiones públicas aprobadas por región y unidades de federación del país según la atención en fisioterapia fueron obtenidos en el sector de Sistema de Informaciones Ambulatorias del Sistema Único de Salud, en el sitio del Departamento de Informática del Sistema Único de Salud (Datasus). Las informaciones correspondientes a la tasa de cobertura por seguro de salud fueron obtenidas en el sector de Informaciones de Salud Suplementaria, disponible en el sitio de la Agencia Nacional de Salud Suplementaria. Los datos fueron analizados, y, para certificar la correlación entre la distribución de las inversiones y la tasa de cobertura por seguro de salud, se realizó la prueba de correlación de Spearman, con nivel de significancia del 5,00%. Y el promedio de aplicación per cápita en reales en Brasil de ingresos financieros en atenciones en fisioterapia a lo largo de los cinco años fue de R$ 117,16 (± 3,52). De entre las regiones y para el mismo período, la región Sur presentó el promedio más grande per cápita (R$ 129,95 ± 5,30), luego en orden decreciente por las regiones Sudeste (R$ 124,22 ± 3,69); Noreste (R$ 118,98 ± 7,53); Norte (R$ 89,43 ± 3,01) y Centro Oeste (R$ 77,09 ± 6,54). El promedio de cobertura de seguro privado de salud varió del 6,20% (Acre) al 43,35% (São Paulo). Parece no haber relación entre la cobertura por seguro de salud privado y la inversión pública en atención en fisioterapia.

ABSTRACT This study aims to describe the profile of public investments in physical therapy and to verify the correlation between these investments and the health insurance coverage rate in major Brazilian regions and Federation units, between 2010 and 2015. Data concerning the approved public investments by region and Federation units according to physical therapy attendance were obtained in the Outpatient Information System of the Unified Health System, in the website of the Department of Informatics of the Unified Health System (Datasus). The information corresponding to the health insurance coverage rate was obtained in the Supplementary Health Information sector, available on the National Supplementary Health Agency website. Data were analyzed and the Spearman correlation test was held with a significance level of 5.00% to show a correlation between investment distribution and health insurance coverage rate. The mean per capita application in Brazil, in Brazilian Reais, of financial resources in physical therapy attendances, over the five years analyzed, was R$ 117.16 (±3.52). Among the regions, and for the same period, the South region presented the highest mean per capita (R$ 129.95±5.30), followed in descending order by the Southeast (R$ 124.22±3.69), Northeast (R$ 118.98±7.53), North (R$ 89.43±3.01), and Midwest (R$ 77.09±6.54) regions. The mean coverage by private health insurance varied from 6.20% (Acre) to 43.35% (São Paulo). Apparently, no correlation exists between private health insurance coverage and public investment in physical therapy services.

Saúde e surdez: instrumentos de pesquisas adaptados à língua de sinais – uma revisão sistemática / Health and hearing: research instruments adapted to sign language - a systematic review

Este estudo buscou fazer um levantamento bibliográfico dos instrumentos de pesquisas na área da saúde adaptados para o uso em língua de sinais. Metodologia: A partir das bases de dados BIREME, CINAHL, PubMED e ISI Web of Science foram utilizados os descritores deafness, sign language, scales e questionnaires localizando artigos publicados no período de 2008 a maio de 2013 nas línguas inglesa e portuguesa. Resultados: Foram localizados 168 artigos, dos quais somente 15 responderam aos critérios de inclusão. Nessas publicações, 29 instrumentos foram utilizados e 12 deles tiveram suas traduções em língua de sinais validadas. Observou-seque as publicações com instrumentos de pesquisas na área da saúde traduzidos, adaptados e validados para uso em populações surdas são ainda em quantidade reduzida. Conclusão: Esses achados evidenciam escassa literatura científica de apoio à pesquisa com surdos e a necessidade de tradução, adaptação e validação de mais instrumentos para que esse grupo populacional seja corretamente estudado e assistido...

This study was aimed at reviewing the literature of research instruments in health adapted for the use in sign language. Methodology: From BIREME, CINAHL, PubMED and ISI Web of Science database the descriptors deafness, sign language, scales and questionnaires were used locating articles published between 2008 and May 2013 in the English and Portuguese languages were used. Results: 168 articles were found, of which only 15 responded to the inclusion criteria. In these publications, 29 instruments were used and 12 of them had their translations in sign language validated. It was observed that publications with research instruments in health care translated, adapted and validated for use in deaf populations are still in reduced quantities. Conclusion: These findings show scarce scientific literature to support research with the deaf and the need for translation, adaptation and validation of new instruments for this population group so that it can be properly studied and watched...

Association of falls, fear of falling, handgrip strength and gait speed with frailty levels in the community elderly / Associação da queda, medo de cair, força de preensão palmar e velocidade da marcha com os níveis de fragilidade em idosos da comunidade

The Frailty Syndrome is not synonymous with disability, but may be a precursor of etiological and physiological dysfunction, which affects mobility before causing reduced functional capacity, explaining conditions of weakness, weight loss, and abnormal gait. Study design: This is an analytical, observational, cross-sectional study. Objective: To verify the association of handgrip strength, gait speed, fear of falling, and falls with the level of frailty. Methods: Study consisting of 54 participants, aged 65 and older,enrolled in a health care and monitoring government program in the municipality of Uberaba, Minas Gerais, Brazil. The volunteers were assessed for frailty, – non-frail group (NG), pre-frail group (PG), and frailgroup (FG) – according to the Fried criteria, and based on the outcomes of handgrip strength, gait speed, fear of falling, and falls. An inferential descriptive statistical analysis followed, with Chi-square and Kruskall Wallistests performed by the Stata11.0 software. Results: In the comparative analysis between the groups studied there was statistical significance relative to handgrip strength (FG and NG), gait speed (NG andFG / NG and PG), and fear of falling (NG and FG). There was no significant difference between the levels of frailty and falls. Conclusions: Frailty is associated with reduced muscle strength, decreased gait speed,and greater fear of falling in elderly people of the community...

A síndrome de fragilidade não é sinônimo de incapacidade, mas pode ser um precursor fisiológico e etiológico de disfunção, que afeta a mobilidade antes de causar redução da capacidade funcional, explicando condições de fraqueza, perda de peso e alterações de marcha. Modelo do estudo: Estudo analítico, observacional e transversal. Objetivo: Verificar a associação da força de preensão palmar, velocidade da marcha, medo de cair e quedas com os níveis de fragilidade. Métodos: Estudo composto por 54 participantes com idade igual ou superior à 65 anos cadastrados em um programa governamental de atendimento e acompanhamento em saúde no município de Uberaba – Minas Gerais.Os voluntários foram avaliados quanto à fragilidade (grupo não-frágil (GN), grupo pré-frágil (GP) e grupo frágil (GF), segundo os critérios de Fried e quanto aos desfechos força de preensão palmar, velocidade da marcha, medo de cair e quedas. Procedeu-se à análise estatística descritiva e inferencial com os testes Qui-quadrado e Kruskall-Wallis por meio do software Stata11.0. Resultados: Na análise de comparação entre os grupos estudados, houve significância estatística em relação à força de preensão palmar(GN e GF), velocidade da marcha (GN e GF, GN e GP) e medo de cair (GN e GF). Não houve significância entre os níveis de fragilidade e quedas. Conclusão: A fragilidade está associada à menor força muscular, diminuição da velocidade da marcha e maior medo de cair em idosos da comunidade...

Síndrome de fragilidade em idosos da comunidade: características sócio-econômicas e de saúde – um estudo observacional / Frailty in elderly community: socioeconomic and health characteristics – an observational study

Verificar a associação da síndrome de fragilidade com as condições socioeconômicas e de saúde em idosos residentes na comunidade. Metodologia: Amostra composta por 54 idosos adscritos à Equipe Saúde da Família do município de Uberaba/MG. A coleta de dados consistiu na avaliação do estado cognitivo, variáveis socioeconômicas, percepção de saúde, morbidades, número de medicamentos e fenótipo de fragilidade, categorizados em não frágil (GN) (nenhum item do fenótipo), pré-frágil (GP) (dois itens do fenótipo) e frágil (GF) (três ou mais itens do fenótipo). Resultados: Constatou-se que 11,1% dos idosos eram frágeis, 46,3% pré-frágeis e 42,6% não frágeis. Não houve diferença significativa para as variáveis socioeconômicas e de saúde entre os grupos, exceto para a maior proporção do número de medicamentos no grupo frágil quando comparado ao pré-frágil e não frágil (p<0,0028). O GF apresentou maior percentual de mulheres, sem escolaridade, viúvos e que moravam com filhos; enquanto que no GP observou-se que a maioria pertencia à faixa etária de 75 anos e mais, 1 a 4 anos de escolaridade e renda de até 1 salário mínimo. Conclusões: O consumo de medicamentos foi maior para os idosos frágeis, indicando a necessidade de atenção especial a essa característica, dado o perfil apresentado. Além disso, os achados da pesquisa ressaltam a relevância dos componentes socioeconômicos e de saúde do idoso em condição de fragilidade...

To investigate the association between frailty syndrome with socioeconomic and health conditions in elderly community residents. Material and Methods: A sample of 54 elderly ascribed to the Family Health Team of Uberaba/MG. Data collection consisted of the evaluation of cognitive status, record of socioeconomic, health perception, morbidities, number of medications and the frailty phenotype, categorized into non-frail (GN) (no items of the phenotype), pre-frail (GP) (two items of the phenotype) and frail (GF) (three or more items of the phenotype). Results: 11.1% of the group was classified as frail, 46.3% as pre-frail and 42.6% as non frail.There was no significant difference for the socioeconomic and health variables between groups. However, the frail group had lower education and income, greater number of morbidities and predominantly female. The use of drugs was statistically higher in the frail group compared to pre-frail and non frail with 100% of the frail group consuming 3 or more medications. Conclusions: Drug consumption was higher for the frail elderly, indicating the need for special attention to this characteristic, given the different consumption profile shown. Furthermore, the findings of the study emphasize the importance of social componentes in elderly health impact seen in frailty condition...

Physical disability, recent illnesses and health self-assessment in a population-based study in São Paulo, Brazil

Objectives: To investigate health self-assessment and to estimate the prevalence of chronic diseases and recent illnesses in people with and without physical disabilities (PD) in the state of São Paulo, southeastern Brazil...

Lung function and six-minute walk test performance in individuals with sickle cell disease.

BACKGROUND: Sickle Cell Disease (SCD), which is characterized by a mutation in the gene encoding beta hemoglobin, causes bodily dysfunctions such as impaired pulmonary function and reduced functional capacity. OBJECTIVE: To assess changes in pulmonary function and functional capacity in patients with SCD and to identify the relationships between these variables. METHOD: We evaluated sociodemographic, anthropometric, lung function (spirometry), respiratory (manovacuometer), peripheral muscle strength (Handgrip strength - HS) and functional capacity (i.e., the six-minute walk test) parameters in 21 individuals with SCD (average age of 29±6 years). Shapiro-Wilk, paired Student's, Wilcoxon, Pearson and Spearman correlation tests were used for statistical analyses, and the significance threshold was set at p<0.05. RESULTS: A total of 47.6% of the study subjects exhibited an altered ventilation pattern, 42.8% had a restrictive ventilatory pattern (RVP) and 4.8% exhibited a mixed ventilatory pattern (MVP). The observed maximal inspiratory pressure (MIP) values were below the predicted values for women (64 cmH2O), and the maximum expiratory pressure (MEP) values, HS values and distance walked during the 6MWT were below the predicted values for both men (103 cmH2O, 39 Kgf and 447 m, respectively) and women (64 cmH2O; 27 Kgf; 405 m, respectively). Positive correlations were observed between maximum voluntary ventilation (MVV) and MEP (r=0.4; p=0.046); MVV and BMI (r=0.6; p=0.003); and between HS and MIP (r=0.7; p=0.001), MEP (r=0.6; p=0.002), MVV (r=0.5; p=0.015), distance walked in the 6MWT (r=0.4; p=0.038) and BMI (r=0.6; p=0.004). CONCLUSIONS: SCD promoted changes in lung function and functional capacity, including RVPs and a reduction in the distance walked in the 6MWT when compared to the predictions. In addition, significant correlations between the variables were observed.

Lung function and six-minute walk test performance in individuals with sickle cell disease / Funcao pulmonar e teste de caminhada de seis minutos em individuos com doenca falciforme

Background: Sickle Cell Disease (SCD), which is characterized by a mutation in the gene encoding beta hemoglobin, causes bodily dysfunctions such as impaired pulmonary function and reduced functional capacity. Objective : To assess changes in pulmonary function and functional capacity in patients with SCD and to identify the relationships between these variables. Method: We evaluated sociodemographic, anthropometric, lung function (spirometry), respiratory (manovacuometer), peripheral muscle strength (Handgrip strength - HS) and functional capacity (i.e., the six-minute walk test) parameters in 21 individuals with SCD (average age of 29±6 years). Shapiro-Wilk, paired Student's, Wilcoxon, Pearson and Spearman correlation tests were used for statistical analyses, and the significance threshold was set at p<0.05. Results : A total of 47.6% of the study subjects exhibited an altered ventilation pattern, 42.8% had a restrictive ventilatory pattern (RVP) and 4.8% exhibited a mixed ventilatory pattern (MVP). The observed maximal inspiratory pressure (MIP) values were below the predicted values for women (64 cmH2O), and the maximum expiratory pressure (MEP) values, HS values and distance walked during the 6MWT were below the predicted values for both men (103 cmH2O, 39 Kgf and 447 m, respectively) and women (64 cmH2O; 27 Kgf; 405 m, respectively). Positive correlations were observed between maximum voluntary ventilation (MVV) and MEP (r=0.4; p=0.046); MVV and BMI (r=0.6; p=0.003); and between HS and MIP (r=0.7; p=0.001), MEP (r=0.6; p=0.002), MVV (r=0.5; p=0.015), distance walked in the 6MWT (r=0.4; p=0.038) and BMI (r=0.6; p=0.004). Conclusions : SCD promoted changes in lung function and functional capacity, including RVPs and a reduction in the distance walked in the 6MWT when compared to the predictions. In addition, significant correlations between the variables were observed. .

Contextualização: A doença falciforme (DF) caracteriza-se por mutação genética na cadeia Beta da hemoglobina, gerando disfunções no organismo, como comprometimento da função pulmonar e da capacidade funcional. Objetivo : Avaliar as alterações da função pulmonar e da capacidade funcional de indivíduos com DF assim como identificar a relação entre essas variáveis. Método : Foram avaliados 21 indivíduos com DF, (29±6 anos), segundo aspectos sociodemográficos, antropométricos, função pulmonar (espirometria), força muscular respiratória (manovacuometria) e periférica (força de preensão palmar - FPP) e capacidade funcional (teste de caminhada de seis minutos - TC6). Procedeu-se à análise estatística com os testes Shapiro-Wilk, t de Student pareado, Wilcoxon, Correlação de Pearson e Spearman (p<0,05). Resultados : 47,6% dos indivíduos apresentaram alteração da função pulmonar, sendo 42,8% com padrão ventilatório restritivo (PVR) e 4,8% com padrão ventilatório misto (PRM). A PImáx apresentou valor abaixo do previsto somente para as mulheres (64 cmH2O), enquanto a PEmáx, a FPP e a distância percorrida no TC6 apresentaram valores abaixo do previsto tanto para os homens (103 cmH2O; 39 Kgf; 447 m) quanto para as mulheres (64 cmH2O; 27 Kgf; 405 m). Observaram-se correlações positivas da ventilação voluntária máxima (VVM) com a PEmáx (r=0,4; p=0,046) e IMC (r=0,6; p=0,003) e da FPP com a PImáx (r=0,7; p=0,001), PEmáx (r=0,6; p=0,002), VVM (r=0,5; p=0,015), distância percorrida no TC6 (r=0,4; p=0,038) e IMC (r=0,6; p=0,004). Conclusões: A DF promoveu alterações na função pulmonar e na capacidade funcional, havendo predominância ...

Relationship of musculoskeletal pain with physical and functional variables and with postural changes in school children from 6 to 12 years of age.

BACKGROUND: Painful disorders can affect children and adolescents, causing distress and significant demand for health services. OBJECTIVE: To identify the prevalence of musculoskeletal pain and its relation to age, sex, body mass index (BMI), how to carry school supplies, postures used in ADLs, outside school physical exercises and postural changes in students. METHOD: Cross-sectional exploratory study with a convenience sample consisted of 262 schoolchildren aged 6 to 12 years (137 female). Data collection was conducted by questionnaire containing personal data, presence and location of pain, means of transportation and illustrative figures for choosing the way of carrying school supplies and postures ADL's. Postural evaluation was performed by observational analysis and body mass index calculated from information on height, weight, age and sex. Descriptive analysis was carried out with numbers and percentages. For inferential statistics, comparison of average age according to the presence of pain was performed by Kruskal-Wallis with Dunn's post-test. Categorical variables were compared with chi-square test. RESULTS: The presence of musculoskeletal pain was reported by 51.1% of the students and 38.93% had pain in only one region. The most affected regions were legs, spine, arms and shoulders. The pain increased with age and with physical activity. CONCLUSIONS: In the our sample, 51.1% of students reported pain and 38.93% reported pain in only one region. There was no association between the presence of pain and sex, BMI, how to carry school supplies, postures used in ADLs and postural changes. The increasing age and physical exercise influenced significantly the presence of pain.

Relationship of musculoskeletal pain with physical and functional variables and with postural changes in school children from 6 to 12 years of age / Relacao da dor musculoesqueletica com variaveis fisicas, funcionais e alteracoes posturais em escolares de seis a 12 anos

BACKGROUND: Painful disorders can affect children and adolescents, causing distress and significant demand for health services. OBJECTIVE: To identify the prevalence of musculoskeletal pain and its relation to age, sex, body mass index (BMI), how to carry school supplies, postures used in ADLs, outside school physical exercises and postural changes in students. METHOD: Cross-sectional exploratory study with a convenience sample consisted of 262 schoolchildren aged 6 to 12 years (137 female). Data collection was conducted by questionnaire containing personal data, presence and location of pain, means of transportation and illustrative figures for choosing the way of carrying school supplies and postures ADL's. Postural evaluation was performed by observational analysis and body mass index calculated from information on height, weight, age and sex. Descriptive analysis was carried out with numbers and percentages. For inferential statistics, comparison of average age according to the presence of pain was performed by Kruskal-Wallis with Dunn's post-test. Categorical variables were compared with chi-square test. RESULTS: The presence of musculoskeletal pain was reported by 51.1% of the students and 38.93% had pain in only one region. The most affected regions were legs, spine, arms and shoulders. The pain increased with age and with physical activity. CONCLUSIONS: In the our sample, 51.1% of students reported pain and 38.93% reported pain in only one region. There was no association between the presence of pain and sex, BMI, how to carry school supplies, postures used in ADLs and postural changes. The increasing age and physical exercise influenced significantly the presence of pain. .

CONTEXTUALIZAÇÃO: Afecções dolorosas podem acometer a criança e o adolescente, gerando sofrimento e importante demanda aos serviços de saúde. OBJETIVO: Identificar a prevalência de dor musculoesquelética e sua relação com idade, sexo, Índice de massa corporal (IMC), forma de carregar o material escolar, posturas utilizadas nas atividades da vida diária (AVDs), realização de exercícios físicos orientados fora do ambiente escolar e alterações posturais. MÉTODO: Pesquisa de campo com delineamento transversal e caráter exploratório, com amostra de conveniência de 262 escolares de seis a 12 anos (137 mulheres), realizada com questionário contendo dados pessoais, presença e localização de dor, meio de locomoção, forma de carregar material escolar e posturas adotadas nas AVDs. A avaliação postural ocorreu por análise observacional. Na análise descritiva, usou-se números brutos e porcentagens. Na estatística inferencial, a comparação da idade segundo a presença de dor foi realizada pelo Teste de Kruskal-Wallis com pós-teste de Dunn. As variáveis categóricas foram comparadas pelo teste de qui-quadrado. RESULTADOS: A presença de dor musculoesquelética foi relatada por 51,1% dos escolares e 38,93% apresentaram dor em uma região. As regiões mais acometidas foram pernas, coluna, braços e ombros. Verificou-se que a dor aumentou com a idade e com a prática de atividade física. CONCLUSÕES: Na amostra, 51,1% dos estudantes relataram dor, sendo que 38,93% reportaram dor em somente uma região. Não houve associação entre presença de dor e sexo, IMC, forma de carregar o material escolar, posturas ...

Musculoskeletal pain, profile and quality of life of individuals with sickle cell disease / Dor osteomuscular, perfil e qualidade de vida de indivíduos com doença falciforme

BACKGROUND: Sickle cell disease is a prevalent condition in Brazil. Its clinical presentation includes vascular occlusion that result in ischemia, inflammation, dysfunctions, pain and chronic hemolysis, causing irreversible damage and compromising quality of life. OBJECTIVE: The objectives of this study were to verify the relationship between musculoskeletal pain, from different body parts, with social economic characteristics and quality of life among individuals with sickle cell disease. METHODS: 27 individuals with sickle cell disease were interviewed with the use of a structured questionnaire with questions about personal, social, economic and cultural variables, the Nordic musculoskeletal symptoms questionnaire and the SF-36 Health Survey. Data were analyzed descriptively using frequencies and percentages. The inferential Chi-Square test was used for dichotomous variables and the Student t- test for continuous variables, with a significance of 5%. A logistic regression was performed using all variables that correlated with pain as dependent variables. RESULTS: The mean age was 31.77 years, predominantly male, black, registered active employment, with average education and income up to three minimum wages. The regions most affected by pain were hip/limbs, chest, lower back and arms. Physical Functioning from the SF-36 had the highest score and mental health the lowest score. Musculoskeletal pain was present in the arms, chest and lower back. Social Functioning was not associated with pain, indicating the influence of other factors. Arm pain was more frequent in black individuals and those with low education. CONCLUSION: Body pain was associated with race and education and all pain areas were associated with the physical components of the SF-36. Pain was significantly associated with vitality and mental health components of the SF-36.

CONTEXTUALIZAÇÃO: As doenças falciformes constituem um grupo frequente no Brasil. Suas alterações ocasionam vaso-oclusão, resultando em isquemia, inflamação, disfunções, dor e hemólise crônica, gerando danos irreversíveis, comprometendo a qualidade de vida. OBJETIVO: Verificar a relação entre a dor osteomuscular, considerando sua localização corporal, e características sociais, econômicas e de qualidade de vida em indivíduos com doença falciforme. MÉTODOS: Foram coletadas informações pessoais, sociais e econômicas, além de dados do Questionário Nórdico de Sintomas Osteomusculares (QNSO) e Short Form 36 em 27 indivíduos. Os dados foram analisados descritivamente por meio de frequências e porcentagens. A análise inferencial usou o teste do qui-quadrado (variáveis dicotômicas) e t de Student (variáveis contínuas), com significância de 5%. Análises de regressão logística utilizaram como variáveis dependentes cada uma das que se relacionaram com dor. RESULTADOS: A média de idade foi de 31,77 anos, predominando sexo masculino, negros, emprego ativo, escolaridade média e rendimento inferior a três salários mínimos. Quadril/membros inferiores, região dorsal, lombar e braços foram mais acometidos pela dor. A capacidade funcional apresentou o maior valor, e saúde mental, o menor. Aspectos físicos foram comprometidos pela dor nos braços, coluna dorsal e lombar. Aspectos sociais não se associaram com a dor, indicando influência de outros fatores. A dor nos braços foi mais frequente entre os negros e os com baixa escolaridade. CONCLUSÃO: A dor nas regiões corporais analisadas relacionou-se com a raça e a escolaridade e com todos os domínios referentes ao componente físico do SF-36. Os componentes vitalidade e saúde mental apresentaram associação significativa com a dor.

Musculoskeletal pain, profile and quality of life of individuals with sickle cell disease.

BACKGROUND: Sickle cell disease is a prevalent condition in Brazil. Its clinical presentation includes vascular occlusion that result in ischemia, inflammation, dysfunctions, pain and chronic hemolysis, causing irreversible damage and compromising quality of life. OBJECTIVE: The objectives of this study were to verify the relationship between musculoskeletal pain, from different body parts, with social economic characteristics and quality of life among individuals with sickle cell disease. METHODS: 27 individuals with sickle cell disease were interviewed with the use of a structured questionnaire with questions about personal, social, economic and cultural variables, the Nordic musculoskeletal symptoms questionnaire and the SF-36 Health Survey. Data were analyzed descriptively using frequencies and percentages. The inferential Chi-Square test was used for dichotomous variables and the Student t- test for continuous variables, with a significance of 5%. A logistic regression was performed using all variables that correlated with pain as dependent variables. RESULTS: The mean age was 31.77 years, predominantly male, black, registered active employment, with average education and income up to three minimum wages. The regions most affected by pain were hip/limbs, chest, lower back and arms. Physical Functioning from the SF-36 had the highest score and mental health the lowest score. Musculoskeletal pain was present in the arms, chest and lower back. Social Functioning was not associated with pain, indicating the influence of other factors. Arm pain was more frequent in black individuals and those with low education. CONCLUSION: Body pain was associated with race and education and all pain areas were associated with the physical components of the SF-36. Pain was significantly associated with vitality and mental health components of the SF-36.

Problems with accessibility to health services by persons with disabilities in São Paulo, Brazil.

PURPOSE: To describe the occurrence of self-reported problems of accessibility to health services used by persons with disabilities in terms of social and health services variables. METHODS: We performed a cross-sectional household survey designed to assess problems with accessibility to health services faced by persons with disabilities. We interviewed 333 persons in São Paulo city, in 2007. Variables related to the presence of accessibility problems, disabilities, gender, age, family head income, ethnicity, use of health services and others were analysed using frequencies, percentages, χ(2)-test, ANOVA and Poisson regression models. RESULTS: 15.92% of the interviewed persons reported problems with accessibility to health services. Persons having multiple (prevalence ratios; PR = 2.91) or mobility disability (PR = 6.46) had more problems with accessibility than persons with hearing disability. Persons younger than 78 years old had more problems with accessibility; those who needed help to go to the health service (PR = 3.01) also. CONCLUSIONS: Persons with multiple or mobility disability, younger than 78 years, and those who needed help of others to go to the health service were more likely to have problems with accessibility to health services. This information could be one of the first steps to the management and/or planning of appropriate health services for persons with disabilities.

Physical disability, recent illnesses and health self-assessment in a population-based study in São Paulo, Brazil.

OBJECTIVES: To investigate health self-assessment and to estimate the prevalence of chronic diseases and recent illnesses in people with and without physical disabilities (PD) in the state of São Paulo, southeastern Brazil. STUDY DESIGN: A cross-sectional study comprising two population-based health surveys conducted in 2002 and 2003. METHODS: A total of 8317 persons (165 with PD) were interviewed in the two studies. Variables concerning to health self-assessment; chronic disease and recent illness were compared in the people with and without PD. Negative binomial regression was used in the analysis. RESULTS: Subjects with PD more often assessed their health as poor/very poor compared to non-disabled ones. They reported more illnesses in the 15 days prior to interview as well as more chronic diseases (skin conditions, anaemia, chronic kidney disease, stroke, depression/anxiety, migraine/headache, pulmonary diseases, hypertension, diabetes, arthritis/arthrosis/rheumatic conditions and heart disease). This higher disease prevalence can be either attributed to disability itself or be associated to gender, age and schooling. CONCLUSIONS: Subjects with PD had more recent illnesses and chronic diseases and poorer health self-assessment than non-disabled ones. Age, gender, schooling and disability have individual roles in disease development among disabled people.