Thirty-day readmissions in children with complex chronic conditions.

INTRODUCTION: The rate of hospital readmission within 30 days of discharge is a quality indicator in health care. Paediatric patients with complex chronic conditions have high readmission rates. Failure in the transition between hospital and home care could explain this phenomenon. OBJECTIVES: To estimate the incidence rate of 30-day hospital readmission in paediatric patients with complex chronic conditions, estimate how many are potentially preventable and explore factors associated with readmission. MATERIALS AND METHOD: Cohort study including hospitalised patients with complex chronic conditions aged 1 month to 18 years. Patients with cancer or with congenital heart disease requiring surgical correction were excluded. The outcomes assessed were 30-day readmission rate and potentially preventable readmissions. We analysed sociodemographic, geographic, clinical and transition to home care characteristics as factors potentially associated with readmission. RESULTS: The study included 171 hospitalizations, and 28 patients were readmitted within 30 days (16.4%; 95% CI, 11.6%-22.7%). Of the 28 readmissions, 23 were potentially preventable (82.1%; 95% CI, 64.4%-92.1%). Respiratory disease was associated with a higher probability of readmission. There was no association between 30-day readmission and the characteristics of the transition to home care. CONCLUSIONS: The 30-day readmission rate in patients with complex chronic disease was 16.4%, and 82.1% of readmissions were potentially preventable. Respiratory disease was the only identified risk factor for 30-day readmission.

Pain symptoms and physical performance in older adults: cross-sectional findings from the International Mobility in Aging Study (IMIAS).

PURPOSE: To analyze the associations between pain and physical performance in different aging contexts. METHODS: Data from 1725 older adults from Canada, Brazil, Colombia, and Albania from the 2014 wave of the IMIAS were used to assess the associations between Back Pain (BP) or Lower Limb Pain (LLP) and physical performance by the Short Physical Performance Battery (SPPB). Three binary logistic regression models adjusted for sex, age, study site, education, income sufficiency, BMI, depressive symptoms, and chronic conditions were used to estimate the associations between LLP or BP and SPPB. The SPPB was classified into good performance (8 points or more) and poor physical performance (< 8 points). RESULTS: The mean age of the older men was 71.2 (± 3.0) and the mean age of the women was 71.2 (± 2.8) years. Older men (72.8%, p < 0.05) and women (86.1%, p-value < 0.05) from Albania had the highest frequencies of self-reported general pain. Older women in Colombia had the highest frequencies of LLP or BP (33.5%, p-value < 0.05). In the fully adjusted logistic regression model, LLP or BP was significantly associated with poor SPPB (OR = 0.48, 0.35 to 0.66 95% CI, p < 0.01). CONCLUSIONS: Pain symptoms are associated with reduced physical performance in older people, even when adjusted for other clinical and sociodemographic factors. Protocols for aiming to increase the level of physical activity to manage pain should be incorporated into health care strategies.

Efficacy of mHealth Interventions for Improving the Pain and Disability of Individuals With Chronic Low Back Pain: Systematic Review and Meta-Analysis.

Background: Low back pain is one of the main causes of disability worldwide. Individuals with chronic conditions have been widely affected by the COVID-19 pandemic. In this context, mobile health (mHealth) has become popular, mostly due to the widespread use of smartphones. Despite the considerable number of apps for low back pain available in app stores, the effectiveness of these technologies is not established, and there is a lack of evidence regarding the effectiveness of the isolated use of mobile apps in the self-management of low back pain. Objective: We summarized the evidence on the effectiveness of mHealth interventions on pain and disability for individuals with chronic low back pain. Methods: We conducted a systematic review and meta-analysis comparing mHealth to usual care or no intervention. The search terms used were related to low back pain and mHealth. Only randomized controlled trials were included. The primary outcomes were pain intensity and disability, and the secondary outcome was quality of life. Searches were carried out in the following databases, without date or language restriction: PubMed, Scopus, Embase, Physiotherapy Evidence Database (PEDro), the Cochrane Library, and OpenGrey, in addition to article references. The risk of bias was analyzed using the PEDro scale. Data were summarized descriptively and through meta-analysis (pain intensity and disability). In the meta-analysis, eligible studies were combined while considering clinical and methodological homogeneity. The certainty of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) criteria. Results: A total of 5 randomized controlled trials were included, totaling 894 participants (447 allocated to the mHealth group and 445 to the usual care group), and they had similar methodological structure and interventions. Follow-up ranged from 6 weeks to 12 months. The studies did not demonstrate significant differences for pain intensity (mean difference -0.86, 95% CI -2.29 to 0.58; P=.15) and disability (standardized mean difference -0.24, 95% CI -0.69 to 0.20; P=.14) when comparing mHealth and usual care. All studies showed biases, with emphasis on nonconcealed allocation and nonblinding of the outcome evaluator. The certainty of evidence was rated as low for the analyzed outcomes. Conclusions: mHealth alone was no more effective than usual care or no treatment in improving pain intensity and disability in individuals with low back pain. Due to the biases found and the low certainty of evidence, the evidence remains inconclusive, and future quality clinical trials are needed.

Whole-Body Vibration Training on Oxidative Stress Markers, Irisin Levels, and Body Composition in Women with Fibromyalgia: A Randomized Controlled Trial.

(1) Background: Mitochondrial dysfunction and redox imbalance seem to be involved in fibromyalgia (FM) pathogenesis. The results of our previous studies suggest that whole-body vibration training (WBVT) would improve redox status markers, increase blood irisin levels, and ameliorate the body composition of women with FM. (2) Objective: The current study aimed to investigate WBVT on oxidative stress markers, plasma irisin levels, and body composition in women with FM. (3) Methods: Forty women with FM were randomized into WBVT or untrained (UN) groups. Before and after 6 weeks of WBVT, body composition was assessed by dual-energy radiological absorptiometry (DXA), and inflammatory marker activities were measured by enzymatic assay. (4) Results: Body composition, blood irisin levels, and oxidative stress markers were similar between UN and WBVT groups before the intervention. After 6 weeks of intervention, the WBVT group presented higher irisin levels (WBVT: 316.98 ± 109.24 mg·dL³, WBVT: 477.61 ± 267.92 mg·dL³, p = 0.01) and lower TBARS levels (UN: 0.39 ± 0.02 nmol MDA/mg protein, WBVT: 0.24 ± 0.06 nmol MDA/mg protein, p = 0.001) and visceral adipose tissue mass (UN: 1.37 ± 0.49 kg, WBVT: 0.69 ± 0.54 kg, p = 0.001) compared to the UN group. (5) Conclusions: Six weeks of WBVT improves blood redox status markers, increases irisin levels, and reduces visceral adipose tissue mass, favoring less cell damage and more outstanding oxidative balance in women with FM.

Disposição de enfermeiros para o uso do telemonitoramento em usuários com condições crônicas: estudo transversal / Nurses' willingness to resort to telemonitoring in users with chronic conditions: a cross-sectional study

OBJETIVO: Verificar a disposição de enfermeiros da Atenção Primária em utilizar o telemonitoramento no acompanhamento de usuários com hipertensão arterial e/ou diabetes mellitus. MÉTODO: Estudo transversal realizado com enfermeiros atuantes nos municípios da 15ª Regional de Saúde do Paraná. Dos 289 convidados, 65 responderam ao questionário online disponibilizado em maio e junho de 2021 no Google Forms. Foram incluídos os enfermeiros que atuavam nas unidades de saúde da 15ª Regional de Saúde e que responderam ao questionário enviado. Não foi adotado nenhum critério de exclusão, mesmo quando o enfermeiro deixava alguma questão em branco. Na análise, foram utilizados os testes Qui-quadrado, Exato de Fisher e Razão de Prevalência. RESULTADOS: Entre as variáveis analisadas, observou-se associação entre ter menos idade e menor tempo de formado e a percepção de que o telemonitoramento sem atendimento presencial é insuficiente para acompanhar os usuários, e das variáveis "telemonitoramento favorece a comunicação com o paciente" e "é possível" com "otimiza o trabalho da equipe". E também maior disposição para uso foi observada entre os que receberam capacitação. CONCLUSÃO: Ausência de capacitações e insuficiência de equipamentos e recursos humanos são fatores que afetam e podem inviabilizar o uso do telemonitoramento.

OBJECTIVE: To verify Primary Care nurses' willingness to resort to Telemonitoring in the follow-up of users with arterial hypertension and/or diabetes mellitus. METHOD: A cross-sectional study conducted with nurses working in the municipalities from the 15th Health Region of Paraná. Of all the 289 individuals invited, 65 answered the online questionnaire made available in May and June 2021 via Google Forms. The nurses included were those working in the health units from the 15th Health Region and who answered the questionnaire sent. No exclusion criteria were adopted, even when a nurse left some questions unanswered. Chi-square, Fisher's Exact and Prevalence Ratio tests were used in the analysis. RESULTS: An association was observed between less time since graduation and the perception that Telemonitoring without in-person assistance is insufficient to follow up the users; in addition, it was noticed that the Telemonitoring variables favor communication with the patients and can streamline the work performed by the team. More willingness to use Telemonitoring was perceived among those who underwent training. CONCLUSION: The absence of training sessions and the insufficiency of devices and human resources affect and may preclude Telemonitoring.

Prevalence of children with special healthcare needs: An epidemiological survey in Brazil.

PURPOSE: We aimed to estimate the prevalence and delineate the profile of children with special healthcare needs (CSHCN) in the three municipalities of Brazil's southern and southeastern regions from 2015 to 2017. DESIGN AND METHODS: This cross-sectional study included 6853 children aged 0-11 years. Participants were selected through complex sampling in 32 primary healthcare units. The Brazilian version of the Children with Special Healthcare Needs Screener© and a questionnaire were used to identify sociodemographic and family characteristics, health status, and health services utilization. Simple and multiple logistic regression models were used to evaluate the association between family and child characteristics and prevalence (P < 0.05). RESULTS: The prevalence of CSHCN was 25.3% (95% confidence interval: 21.0-30.0). Most participants required health services or were on long-term medication for a current chronic condition; approximately 53% of CSHCN had no formally recorded diagnoses. The most frequent health problems were respiratory conditions, asthma, and allergies. Approximately 60% of the CSHCN patients underwent follow-up examinations of the specialties pneumology, pediatrics, otorhinolaryngology, speech therapy, neurology, and psychology. Children of school age, of male sex, with premature birth, with a history of recurrent hospitalization, from non-nuclear families, and from underprivileged social classes were identified as risk factors for classification as CSHCN. PRACTICE IMPLICATION: These results contribute to the unprecedented mapping of these children in healthcare networks in Brazil. CONCLUSION: The high prevalence of CSHCN in medium and large municipalities in the southern and southeastern regions was associated with the child's previous health conditions and family structure.

Clinical Health Outcomes of Siblings of Children with Chronic Conditions: A Systematic Review and Meta-Analysis.

OBJECTIVE: The objective of the study was to assess clinical mental and physical health outcomes of siblings of children with chronic health condition(s) compared with siblings of healthy children or normative data. STUDY DESIGN: We searched Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL through August 9, 2021. We included English-language studies that reported clinically diagnosable mental or physical health outcomes among siblings of children (<18 years old) with a chronic health condition, included a comparison group, and used an experimental or observational study design. Two reviewers extracted data and independently assessed risk of bias using the Newcastle Ottawa Scale. RESULTS: Of 9899 screened studies, 34 were included; 28 studies reported on mental health, 3 reported on physical health, and 3 reported on mortality. Siblings of children with chronic conditions had greater depression rating scale scores than their comparison groups (standardized mean difference = 0.53; 95% CI = 0.38-0.68; P < .001 [6 studies]), whereas anxiety scores were not substantially increased (standardized mean difference = 0.21; 95% CI = -0.02 to 0.43; P = .07 [7 studies]). The effects for confirmed psychiatric diagnoses (7 studies), mortality (3 studies), or physical health outcomes (3 studies) could not be meta-analyzed given the limited number of studies and between-study heterogeneity. CONCLUSION: Siblings of children with chronic health conditions may be at an increased risk of depression. Our findings suggest the need for targeted interventions to support the psychological well-being of siblings of children with chronic health conditions.

Spatial Clusters of Chronic Childhood Conditions in the State of Paraíba, Brazil / Aglomerados espaciais de condições crônicas infantis no estado da Paraíba, Brasil

Introduction:chronic conditions are complex health problems that require continuous and multidisciplinary care. When they affect children/adolescents, they require hospitalizations and periodic and long-term follow-up. Understanding the geographical distribution of these conditions will provide greater visibility to the problem and support the decision-making process.Objective: detect the spatial clusters of chronic health conditions affecting children and adolescents in the state of Paraíba, Brazil.Methods: ecological, retrospective, study employing secondary data from the Information System of Children and Adolescents with Chronic Disease from a reference hospital in the state of Paraíba, Brazil, covering the period from 2015 to 2017. The Spatial Incidence Ratio and the Spatial Scan statistic were used for the data analysis.Results: a concentration of spatial clusters was observed in the Mata Paraibana mesoregion, an area where the public hospital service is located, which functions as a reference in the recurrent hospitalizations of this population with chronic conditions.Conclusion: the detection of spatial clusters can help public managers to recognize the priority areas for the monitoring of chronic conditions in children and adolescents.

Introdução: as condições crônicas são problemas de saúde complexos que exigem tratamento contínuo e multiprofissional. Quando se referem às crianças/adolescentes, demandam internações hospitalares e acompanhamentos periódicos e duradouros. A compreensão da distribuição geográfica desses agravos proporcionará uma maior visibilidade ao problema e subsídios para o processo de tomada de decisão.Objetivo: detectar os aglomerados espaciais das condições crônicas de saúde que acometem crianças e adolescentes no estado da Paraíba, Brasil.Método: trata- se de estudo ecológico, retrospectivo com dados secundários do Sistema de Informação de Crianças e Adolescentes com Doença Crônica provenientes de um hospital de referência do estado da Paraíba, Brasil, no período de 2015 a 2017. Para análise dos dados foram estimadas Razão de Incidências Espaciais e a estatística Scan espacial.Resultados: foi verificada uma concentração de aglomerados espaciais na mesorregião da mata paraibana, área onde se encontra o serviço hospitalar público que atua como referência estadual nas recorrentes internações dessa população em condição de cronicidade.Conclusão: a detecção dos aglomerados espaciais pode ajudar gestores públicos a reconhecer as áreas prioritárias para o monitoramento dos casos de condições crônicas em crianças e adolescentes.

Percepção dos estudantes de Medicina sobre as habilidades de autogestão adquiridas durante a vigência do ensino remoto / Medical students' perception about the self-management skills acquired during remote learning

Resumo: Introdução: A pandemia da Covid-19 trouxe diversos desafios para as instituições de ensino superior (IES) de todos os países. Nesse contexto, destacou-se a necessidade de reestruturação do processo de ensino-aprendizagem de forma a garantir a aquisição real de conhecimentos, bem como o desenvolvimento de métodos de estudo para que os discentes conseguissem conviver com o ensino remoto emergencial (ERE) e seus contratempos. Objetivo: Este estudo teve como objetivo investigar como ocorreu o estudo dirigido e a percepção dos discentes quanto aos ganhos de habilidades de autogestão durante o ERE. Método: Trata-se de um estudo transversal quantitativo e qualitativo, realizado com 93 estudantes de Medicina de diferentes IES brasileiras. Utilizou-se questionário semiestruturado para a coleta dos dados. Os dados foram processados no software Iramuteq, e utilizaram-se análise de similitude e nuvem de palavras, além de estatística descritiva. Resultado: Em relação ao tempo dedicado ao estudo dirigido, 59,1% dos estudantes relataram que o estabeleceram, e 57,0% afirmaram que traçaram estratégias para melhor geri-lo; 68,8% mencionaram que perceberam diferenças ao compararem os métodos de fixação de conteúdo utilizados antes e durante no ERE, e, desses, 70,3% consideraram que essas novas técnicas foram eficientes. Na análise qualitativa, analisaram-se seis corpora monotemáticos, relacionados à opinião sobre o que auxiliou e o que prejudicou a gestão das emoções e do tempo, quais estratégias de fixação de conteúdo foram utilizadas e quais habilidades de autogestão foram desenvolvidas no período do ERE. Conclusão: Evidenciou-se que, apesar das dificuldades encontradas, elas foram superadas com a adoção de estratégias centradas no desenvolvimento de habilidades de autogestão de tempo, emoções e fixação de conteúdo por parte dos estudantes, e, dessa forma, pode-se inferir que eles perceberam o desenvolvimento de algumas das habilidades essenciais para superar os novos e recentes desafios impostos pelas mudanças no planeta, como organização pessoal, dos estudos e do tempo, além das relacionadas às emoções e ao gerenciamento de recursos tecnológicos.

Abstract: Introduction: The Covid-19 pandemic presented several challenges to Higher Education Institutions (HEIs) in all countries. In this context, there is a prominent need to restructure the teaching-learning process in order to guarantee genuine knowledge acquisition, as well as the development of study methods to enable students to deal with the emergency remote teaching (ERT) and its setbacks. Objective: To investigate directed study was implemented and how students viewed the gains in self-management skills during ERT. Method: Quantitative and qualitative cross-sectional study, conducted with 93 medical students from different Brazilian HEIs. A semi-structured questionnaire was used for data collection. The data were processed using the IRAMUTEQ software, similarity analysis and word cloud, in addition to the use of descriptive statistics. Results: In relation to the time dedicated to directed study, 59.1% of the students reported having established it and 57.0% said they had outlined strategies to better manage this time; 68.8% reported having perceived differences when comparing the learning consolidation methods used before and during ERT and, of these, 70.3% considered that these new techniques were efficient. In the qualitative analysis, six monothematic corpora were analysed, relating to opinions on what helped and what hindered emotional and time management, which learning consolidation strategies were used and which self-management skills were developed during ERT. Conclusion: It was demonstrated that the difficulties encountered were overcome through the adoption of strategies to help students develop self-management skills in relation to time, emotions and learning consolidation. It can therefore be inferred that students successfully mastered some of the essential skills to overcome new and recent challenges imposed by changes in the world, such as their personal organization, studies and time, in addition to those related to emotions and management of technological resources.

Glimpsing the raging seas that stop swans: A qualitative look at living with multimorbidity and pain in patients from a tertiary care service.

Multimorbidity requires complex and ongoing care. Understanding the subjective illness experience is critical to effective care. Literature isn't clear about illness perception in patients with multimorbidity followed in services of high complexity. This study aims to investigate the illness experience based on narratives about daily living and symptoms of patients with multimorbidity and pain in a tertiary health care service. METHODS: Qualitative narrative inquiry design with framework analysis from semi-structured interviews at a tertiary internal medicine outpatient clinic. Patients with Elixhauser comorbidity index ≧3 or and pain during the last week were included. Framework analysis was performed using 3 main patterns of illness experience from a previous study: "Gliding swan" (Resilience); "Stormy Seas" (Vulnerability); and "Stuck adrift" (Disruption); and identifying subthemes. One case study was selected from each main category. 43 patients, 14 classified as "gliding swan," 12 as "stormy seas" and 17 as "stuck adrift." Within the "gliding swan" group, positive examples of how to navigate through physical and emotional factors to sustain their wellbeing based on comprehension; In the "stormy seas" group, themes revolved around vulnerability, burden and ambiguity in relation to the health team. In the "stuck adrift" group the main content was about overwhelmed feelings and limitations. CONCLUSIONS: Narratives brought the content about lacking personalized understanding of diseases, with great emotional repercussion. Some meaningful anchors were highlighted. This study reinforces multimorbidity and pain interact and that healthcare professional should be aware of the turbulences that can disturb navigation in the raging seas of long-term multimorbid conditions.

Poor Sleep quality and health-related quality of life impact in adolescents with and without chronic immunosuppressive conditions during COVID-19 quarantine

OBJECTIVE: To assess the possible factors that influence sleep quality in adolescents with and without chronic immunosuppressive conditions quarantined during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This cross-sectional study included 305 adolescents with chronic immunocompromised conditions and 82 healthy adolescents. Online surveys were completed, which included questions on socio-demographic data and self-rated healthcare routine during COVID-19 quarantine and the following validated questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Pediatric Quality of Life Inventory 4.0 (PedsQL4.0), and Pediatric Outcome Data Collection Instrument (PODCI). RESULTS: The median current age [14 (10-18) vs. 15 (10-18) years, p=0.847] and frequency of female sex (62% vs. 58%, p=0.571) were similar in adolescents with chronic conditions compared with healthy adolescents. The frequency of poor sleep quality was similar in both groups (38% vs. 48%, p=0.118). Logistic regression analysis, including both healthy adolescents and adolescents with chronic conditions (n=387), demonstrated that self-reported increase in screen time (odds ratio [OR] 3.0; 95% confidence interval [CI] 1.3-6.8; p=0.008) and intrafamilial violence report (OR 2.1; 95% CI 1.2-3.5; p=0.008) were independently associated with poor sleep quality in these adolescents. However, the PODCI global function score was associated with a lower OR for poor sleep quality (OR 0.97; 95% CI 0.94-0.99; p=0.001). Further logistic regression, including only adolescents with chronic conditions (n=305), demonstrated that self-reported increase in screen time (OR 3.1; 95% CI 1.4-6.8; p=0.006) and intrafamilial violence report (OR 2.0; 95% CI 1.2-3.4; p=0.011) remained independently associated with poor quality of sleep, whereas a lower PODCI global function score was associated with a lower OR for sleep quality (OR 0.96; 95% CI 0.94-0.98; p<0.001). CONCLUSION: Self-reported increases in screen time and intrafamilial violence report impacted sleep quality in both healthy adolescents and those with chronic conditions. Decreased health-related quality of life was observed in adolescents with poor sleep quality.

Factores que impactan sobre la percepción de la menstruación en las adolescentes / Factors that impact on the perception of menstruation among female adolescents

Introducción. Se ha descrito que la menstruación se percibe como un evento natural pero molesto, con un impacto negativo en la vida diaria de la mujer. El objetivo del estudio fue identificar la percepción de la menstruación en adolescentes y los factores que podían influir sobre esta.Material y métodos. Estudio transversal observacional comparativo en adolescentes posmenárquicas con y sin enfermedades crónicas, en 2 hospitales pediátricos y 2 escuelas de nivel primario y secundario. Se recabaron los datos de edad, escolaridad, tipo de población, fecha de menarca y presencia de dismenorrea. Se aplicó un cuestionario previamente validado para evaluar la percepción sobre la menstruación.Resultados. Se incluyó un total de 346 adolescentes. Se encontró que la percepción más frecuente hacia la menstruación fue la negativa en un 65,6 % (n = 227), positiva en el 16 % (n = 55), sigilosa en el 13 % (n = 45) e indeterminada en el 5,4 % (n = 19). La presencia de enfermedad crónica demostró ser un factor protector de la percepción negativa de la menstruación (odds ratio 0,4 [intervalo de confianza del 95 %: 0,20-0,78], p = 0,007).Conclusiones. Más de la mitad de las adolescentes presentaron una actitud negativa hacia la menstruación, pero la presencia de una enfermedad crónica la mejoró

Introduction. It has been described that menstruation is perceived as a natural but cumbersome event, with a negative impact on women's daily life. The objective of this study was to identify the perception of menstruation among female adolescents and the factors that may affect it.Material and methods. Observational, cross-sectional, comparative study in postmenarcheal adolescents with and without chronic conditions in two children's hospitals and two primary and secondary schools. Age, education level, type of population, date of menarche, and presence of dysmenorrhea were recorded. A previously validated questionnaire was administered to assess the perception of menstruation. Results. A total of 346 female adolescents were included. The most common perception of menstruation was negative in 65.6 % (n = 227), positive in 16 % (n = 55), discreet in 13 % (n = 45), and indefinite in 5.4 % (n = 19). The presence of a chronic condition demonstrated to be a protective factor against a negative perception of menstruation (odds ratio: 0.4 [95 % confidence interval: 0.20-0.78], p = 0.007).Conclusions. More than half of female adolescents had a negative attitude toward menstruation, but the presence of a chronic condition improved it.

Factors that impact on the perception of menstruation among female adolescents. / Factores que impactan sobre la percepción de la menstruación en las adolescentes.

INTRODUCTION: It has been described that menstruation is perceived as a natural but cumbersome event, with a negative impact on women's daily life. The objective of this study was to identify the perception of menstruation among female adolescents and the factors that may affect it. MATERIAL AND METHODS: Observational, crosssectional, comparative study in postmenarcheal adolescents with and without chronic conditions in two children's hospitals and two primary and secondary schools. Age, education level, type of population, date of menarche, and presence of dysmenorrhea were recorded. A previously validated questionnaire was administered to assess the perception of menstruation. RESULTS: A total of 346 female adolescents were included. The most common perception of menstruation was negative in 65.6 % (n = 227), positive in 16 % (n = 55), discreet in 13 % (n = 45), and indefinite in 5.4 % (n = 19). The presence of a chronic condition demonstrated to be a protective factor against a negative perception of menstruation (odds ratio: 0.4 [95 % confidence interval: 0.20-0.78], p = 0.007). CONCLUSIONS: More than half of female adolescents had a negative attitude toward menstruation, but the presence of a chronic condition improved it.

Introducción. Se ha descrito que la menstruación se percibe como un evento natural pero molesto, con un impacto negativo en la vida diaria de la mujer. El objetivo del estudio fue identificar la percepción de la menstruación en adolescentes y los factores que podían influir sobre esta. Material y métodos. Estudio transversal observacional comparativo en adolescentes posmenárquicas con y sin enfermedades crónicas, en 2 hospitales pediátricos y 2 escuelas de nivel primario y secundario. Se recabaron los datos de edad, escolaridad, tipo de población, fecha de menarca y presencia de dismenorrea. Se aplicó un cuestionario previamente validado para evaluar la percepción sobre la menstruación. Resultados. Se incluyó un total de 346 adolescentes. Se encontró que la percepción más frecuente hacia la menstruación fue la negativa en un 65,6 % (n = 227), positiva en el 16 % (n = 55), sigilosa en el 13 % (n = 45) e indeterminada en el 5,4 % (n = 19). La presencia de enfermedad crónica demostró ser un factor protector de la percepción negativa de la menstruación (odds ratio 0,4 [intervalo de confianza del 95 %: 0,20-0,78], p = 0,007). Conclusiones. Más de la mitad de las adolescentes presentaron una actitud negativa hacia la menstruación, pero la presencia de una enfermedad crónica la mejoró.

Prescrição e cuidado no contexto da condição crônica / Prescription and care in the context of the chronic condition / Prescripción y cuidado en el contexto de la condición crónica

O adoecimento crônico se apresenta atualmente como uma problemática de enorme relevância para as políticas públicas de saúde. Este artigo relata uma investigação realizada com médicos de um serviço especializado no atendimento a pessoas com condições crônicas de adoecimento em um hospital público no Rio de Janeiro. Partindo dos conceitos de Canguilhem sobre saúde e doença foram entrevistados cinco médicos deste serviço especializado de modo a analisar os projetos terapêuticos voltados às condições de cronicidade. No discurso dos entrevistados ressalta-se a referência a diferentes ordens de dificuldades observadas por eles no universo dos pacientes atendidos. Dificuldades de adesão ao tratamento causadas pela angústia diante da ausência da perspectiva de cura, poucos recursos para acesso a uma alimentação saudável e mesmo para a locomoção ao hospital, impossibilitam, segundo os entrevistados, o cuidado necessário ao trabalho de normatividade de um corpo acometido de uma doença crônica.

Chronic illness is currently a problem of enormous relevance for public health policies. This article reports an investigation carried out with physicians of a specialized service in the care of people with chronic conditions of illness in a public hospital in Rio de Janeiro. Based on the concepts of Canguilhem on health and illness, five physicians of this specialized service were interviewed in order to analyze the therapeutic projects focused on the conditions of chronicity. In the interviewees' speech the reference to different orders of difficulties observed by them in the universe of the patients attended is highlighted. Difficulties of adherence to treatment caused by anguish in the absence of the prospect of cure, few resources for access to a healthy diet and even for the locomotion to the hospital, make it impossible, according to the interviewees, to take care of the normative work of a body affected by a chronic disease.

La enfermedad crónica se presenta actualmente como una problemática de enorme relevancia para las políticas públicas de salud. Este artículo relata una investigación realizada con médicos de un servicio especializado en la atención a personas con condiciones crónicas de enfermedad en un hospital público en Río de Janeiro. A partir de los conceptos de Canguilhem sobre salud y enfermedad fueron entrevistados cinco médicos de este servicio especializado para analizar los proyectos terapéuticos orientados a las condiciones de cronicidad. En el discurso de los entrevistados se resalta la referencia a diferentes órdenes de dificultades observadas por ellos en el universo de los pacientes atendidos. Dificultades de adhesión al tratamiento causadas por la angustia ante la ausencia de la perspectiva de curación, pocos recursos para acceder a una alimentación sana e incluso para la locomoción al hospital, imposibilitan, según los entrevistados, el cuidado necesario al trabajo de normatividad de un cuerpo acometido de un cuerpo una enfermedad crónica.

Influence of adipose tissue mass on bone mass in an overweight or obese population: systematic review and meta-analysis.

CONTEXT: The scientific literature shows conflicting evidence about the relationship between adiposity and bone mass in overweight and obese populations. The aim of this review was to quantify the correlation between adipose mass (absolute and relative) and bone mineral density (BMD) in overweight and obese populations. Three databases were searched electronically. In addition, reference lists of relevant articles were screened. A total of 16 studies, comprising 2587 participants and 75 correlation coefficients were selected for inclusion in the review. Data were extracted from each study using a standardized form. Multilevel modeling indicated opposing relationships between BMD and adiposity: absolute adiposity correlated positively, and relative adiposity negatively, with BMD. Sex and age were the primary moderators of these relationships. Strong evidence supported a negative relationship between relative adipose mass and BMD in men (R = -0.37; 95%CI, -0.57 to -0.12) and in those aged less than 25 years (R = -0.28; 95%CI, -0.45 to -0.08). To prevent bone loss in overweight and obese populations, nutrition- and exercise-based interventions that focus on a controlled reduction of adipose mass with concomitant preservation of lean mass are recommended. : PROSPERO no. CRD42015024313.

Dual burden of chronic physical diseases and anxiety/mood disorders among São Paulo Megacity Mental Health Survey Sample, Brazil.

BACKGROUND: We assessed comorbid associations of 12-month DSM-IV mood/any anxiety disorders with chronic physical conditions within the São Paulo (SP) Megacity Mental Health cross-sectional survey of 5037 participants and explored whether strength of comorbid associations were modified when controlling for demographics. METHODS: Chi-square tests and logistic regressions were used to examine comorbid associations of DSM-IV mood/anxiety disorders as measured by the WHO Composite International Diagnostic Interview (CIDI 3.0), and self-reported chronic physical conditions among adults from the SP Megacity Mental Health Survey. RESULTS: Among those with any mood or anxiety disorder, chronic pain disorder was the most common physical condition (48.9% and 44.9%, respectively). Significant unadjusted odds ratios (OR) of comorbidity were found between diagnosis of two or more physical conditions and any mood disorders (3.08, 95% CI: 2.27-4.17), and any anxiety disorders (2.49, 95% CI: 1.95-3.17). Comorbidities remained significant when stratified by gender and controlling for marital status, household income, and education (latter two only included within anxiety models). LIMITATIONS: These results cannot be generalized to other cities or rural populations. Homeless and institutionalized populations were not surveyed. Due to cross-sectional study design, the direction of association between chronic disease/chronic disease risk factors and mood disorders is unclear. CONCLUSIONS: Dual burden of chronic physical conditions and mood/anxiety disorders is a notable problem among the São Paulo Megacity Survey population, with enhanced comorbidity experienced by community members with multiple physical conditions. Clinicians should consider these findings in understanding healthcare delivery for individuals suffering from both psychiatric disorders and chronic physical conditions.

Validación español-argentina del cuestionario de transición a la atención médica del adulto en adolescentes con enfermedades crónicas / Validation of the Argentine Spanish version of Transition Readiness Assessment Questionnaire for adolescents with chronic conditions

Introducción. El pasaje de adolescentes con enfermedades crónicas al seguimiento como adultos es un proceso complejo y creciente. Los pacientes necesitan adquirir conocimientos y habilidades que aseguren la continuidad de su cuidado. El objetivo fue llevar a cabo la validación del instrumento Transition Readiness Assessment Questionnaire (TRAQ) 5.0, versión en español argentino, en adolescentes y adultos jóvenes con enfermedades crónicas. Población y métodos. Estudio descriptivo, transversal y cuantitativo. Se incluyeron pacientes mayores de 14 años con enfermedad crónica atendidos en el Hospital Garrahan. El TRAQ incluye 20 ítems en 5 subescalas (medicación, asistencia a citas, seguimiento de problemas de salud, comunicación con profesionales, manejo de actividades cotidianas) y se responde de modo autoadministrado. Los pacientes completaron el TRAQ, una encuesta de opinión sobre su uso y otra escala de autopercepción de autonomía; sus médicos, una escala sobre el compromiso de la enfermedad. Se registraron variables sociodemográficas, clínicas y relacionadas con el TRAQ. Resultados. Participaron 191 pacientes. El TRAQ 5.0 pudo ser comprendido y completado por la mayoría de los pacientes (96,3%), en forma autoadministrada, en poco tiempo (mediana: 5 minutos) y con poca o ninguna ayuda (81%). Presentar pobreza o escolaridad no acorde aumentó la necesidad de ayuda. La consistencia interna (alfa de Cronbach) para la puntuación total fue 0,81. Se demostró validez de construcción al testear diferentes hipótesis (todas p < 0,05): discriminación según edad ≥ 16 años (3,01 vs. 3,34), sexo (mujeres: 3,38 > varones: 3,12) y presencia de proyecto futuro (sin: 3,01 < con: 3,34); correlación con escala de autopercepción (r: 0,49). Conclusión. El TRAQ 5.0 queda disponible para ser utilizado en adolescentes argentinos con enfermedades crónicas.

Introduction. The transition of adolescents with chronic conditions to adult follow-up care is an increasingly complex process. Patients need to acquire knowledge and skills that ensure continuity of their care. The goal of this study was to validate the Argentinian Spanish version of the Transition Readiness Assessment Questionnaire (TRAQ) 5.0 tool in adolescents and young adults with chronic conditions. Population and methods. Descriptive, crosssectional, quantitative study. Patients with chronic conditions aged 14 years or older treated at Hospital Garrahan were included. The TRAQ is made up of 20 items divided into 5 subscales (Managing Medication, Appointment Keeping, Tracking Health Issues, Talking with Providers, Managing Daily Activities), and is designed to be self-administered. Patients completed the TRAQ, as well as an opinion survey about its use and a self-perceived autonomy scale; their physicians answered a scale about patients' health impairment due to the condition. Sociodemographic, clinical and TRAQ-related variables were recorded. Results. A total of 191 patients participated. The majority of patients (96.3%) understood the TRAQ 5.0 questionnaire and completed it correctly, in self-administered modality, in a short time (median: 5 minutes), with little or no help (81%). Patients who live in poverty or have a lower education level than the one expected for their age needed more help. Internal consistency (Cronbach's alpha) for the overall score was 0.81. Construct validity was demonstrated by testing different hypotheses (all p < 0.05): discriminationby age ≥ 16 years (3.01 vs. 3.34), sex (women: 3.38 > men: 3.12) and having plans for the future (without plans: 3.01 < with plans: 3.34); correlation with self-perception scale (r= 0.49). Conclusion. The TRAQ 5.0 tool is available for use inArgentinianadolescents with chronic conditions.

Validation of the Argentine Spanish version of Transition Readiness Assessment Questionnaire for adolescents with chronic conditions. / Validación español-argentina del cuestionario de transición a la atención médica del adulto en adolescentes con enfermedades crónicas.

INTRODUCTION: The transition of adolescents with chronic conditions to adult follow-up care is an increasingly complex process. Patients need to acquire knowledge and skills that ensure continuity of their care. The goal of this study was to validate the Argentinian Spanish version of the Transition Readiness Assessment Questionnaire (TRAQ) 5.0 tool in adolescents and young adults with chronic conditions. POPULATION AND METHODS: Descriptive, crosssectional, quantitative study. Patients with chronic conditions aged 14 years or older treated at Hospital Garrahan were included. The TRAQ is made up of 20 items divided into 5 subscales (Managing Medication, Appointment Keeping, Tracking Health Issues, Talking with Providers, Managing Daily Activities), and is designed to be self-administered. Patients completed the TRAQ, as well as an opinion survey about its use and a self-perceived autonomy scale; their physicians answered a scale about patients' health impairment due to the condition. Sociodemographic, clinical and TRAQ-related variables were recorded. RESULTS: A total of 191 patients participated. The majority of patients (96.3%) understood the TRAQ 5.0 questionnaire and completed it correctly, in self-administered modality, in a short time (median: 5 minutes), with little or no help (81%). Patients who live in poverty or have a lower education level than the one expected for their age needed more help. Internal consistency (Cronbach's alpha) for the overall score was 0.81. Construct validity was demonstrated by testing different hypotheses (all p < 0.05): discrimination by age ≥ 16 years (3.01 vs. 3.34), sex (women: 3.38 > men: 3.12) and having plans for the future (without plans: 3.01 < with plans: 3.34); correlation with self-perception scale (r= 0.49). CONCLUSION: The TRAQ 5.0 tool is available for use in Argentinian adolescents with chronic conditions.

Introducción. El pasaje de adolescentes con enfermedades crónicas al seguimiento como adultos es un proceso complejo y creciente. Los pacientes necesitan adquirir conocimientos y habilidades que aseguren la continuidad de su cuidado. El objetivo fue llevar a cabo la validación del instrumento Transition Readiness Assessment Questionnaire (TRAQ) 5.0, versión en español argentino, en adolescentes y adultos jóvenes con enfermedades crónicas. Población y métodos. Estudio descriptivo, transversal y cuantitativo. Se incluyeron pacientes mayores de 14 años con enfermedad crónica atendidos en el Hospital Garrahan. El TRAQ incluye 20 ítems en 5 subescalas (medicación, asistencia a citas, seguimiento de problemas de salud, comunicación con profesionales, manejo de actividades cotidianas) y se responde de modo autoadministrado. Los pacientes completaron el TRAQ, una encuesta de opinión sobre su uso y otra escala de autopercepción de autonomía; sus médicos, una escala sobre el compromiso de la enfermedad. Se registraron variables sociodemográficas, clínicas y relacionadas con el TRAQ. Resultados. Participaron 191 pacientes. El TRAQ 5.0 pudo ser comprendido y completado por la mayoría de los pacientes (96,3%), en forma autoadministrada, en poco tiempo (mediana: 5 minutos) y con poca o ninguna ayuda (81%). Presentar pobreza o escolaridad no acorde aumentó la necesidad de ayuda. La consistencia interna (alfa de Cronbach) para la puntuación total fue 0,81. Se demostró validez de construcción al testear diferentes hipótesis (todas p < 0,05): discriminación según edad ≥ 16 años (3,01 vs. 3,34), sexo (mujeres: 3,38 > varones: 3,12) y presencia de proyecto futuro (sin: 3,01 < con: 3,34); correlación con escala de autopercepción (r: 0,49). Conclusión. El TRAQ 5.0 queda disponible para ser utilizado en adolescentes argentinos con enfermedades crónicas.

Exclusion of patients with concomitant chronic conditions in ongoing randomised controlled trials targeting 10 common chronic conditions and registered at ClinicalTrials.gov: a systematic review of registration details.

OBJECTIVES: To systematically assess registration details of ongoing randomised controlled trials (RCTs) targeting 10 common chronic conditions and registered at ClinicalTrials.gov and to determine the prevalence of (1) trial records excluding patients with concomitant chronic condition(s) and (2) those specifically targeting patients with concomitant chronic conditions. DESIGN: Systematic review of trial registration records. DATA SOURCES: ClinicalTrials.gov register. STUDY SELECTION: All ongoing RCTs registered from 1 January 2014 to 31 January 2015 that assessed an intervention targeting adults with coronary heart disease (CHD), hypertension, heart failure, stroke/transient ischaemic attack, atrial fibrillation, type 2 diabetes, chronic obstructive pulmonary disease, painful condition, depression and dementia with a target sample size ≥100. DATA EXTRACTION: From the trial registration records, 2 researchers independently recorded the trial characteristics and the number of exclusion criteria and determined whether patients with concomitant chronic conditions were excluded or specifically targeted. RESULTS: Among 319 ongoing RCTs, despite the high prevalence of the concomitant chronic conditions, patients with these conditions were excluded in 251 trials (79%). For example, although 91% of patients with CHD had a concomitant chronic condition, 69% of trials targeting such patients excluded patients with concomitant chronic condition(s). When considering the co-occurrence of 2 chronic conditions, 31% of patients with chronic pain also had depression, but 58% of the trials targeting patients with chronic pain excluded patients with depression. Only 37 trials (12%) assessed interventions specifically targeting patients with concomitant chronic conditions; 31 (84%) excluded patients with concomitant chronic condition(s). CONCLUSIONS: Despite widespread multimorbidity, more than three-quarters of ongoing trials assessing interventions for patients with chronic conditions excluded patients with concomitant chronic conditions.

Emergency Department Visits and Readmissions among Children after Gastrostomy Tube Placement.

OBJECTIVES: To define the incidence of 30-day postdischarge emergency department (ED) visits and hospital readmissions following pediatric gastrostomy tube (GT) placement across all procedural services (Surgery, Interventional-Radiology, Gastroenterology) in 38 freestanding Children's Hospitals. STUDY DESIGN: This retrospective cohort study evaluated patients <18 years of age discharged between 2010 and 2012 after GT placement. Factors significantly associated with ED revisits and hospital readmissions within 30 days of hospital discharge were identified using multivariable logistic regression. A subgroup analysis was performed comparing patients having the GT placed on the date of admission or later in the hospital course. RESULTS: Of 15 642 identified patients, 8.6% had an ED visit within 30 days of hospital discharge, and 3.9% were readmitted through the ED with a GT-related issue. GT-related events associated with these visits included infection (27%), mechanical complication (22%), and replacement (19%). In multivariable analysis, Hispanic ethnicity, non-Hispanic black race, and the presence of ≥3 chronic conditions were independently associated with ED revisits; gastroesophageal reflux and not having a concomitant fundoplication at time of GT placement were independently associated with hospital readmission. Timing of GT placement (scheduled vs late) was not associated with either ED revisits or hospital readmission. CONCLUSIONS: GT placement is associated with high rates of ED revisits and hospital readmissions in the first 30 days after hospital discharge. The association of nonmodifiable risk factors such as race/ethnicity and medical complexity is an initial step toward understanding this population so that interventions can be developed to decrease these potentially preventable occurrences given their importance among accountable care organizations.