iSupport-Brasil: Cross-cultural adaptation of the content included in the iSupport program for caregivers of people who have dementia.

OBJECTIVE: Examine the process of culturally adapting the content of the World Health Organization iSupport program for family caregivers of people living with dementia in Brazil. METHOD: This is a multicenter and methodological study to cross-culturally adapt the iSupport program. Initially, the content of the iSupport program was translated into Brazilian Portuguese by professional translator trained in Psychology, with mastery of the original language of the content (English). Focus groups were then held with caregivers/former caregivers of people who have dementia (n = 24) and health professionals specialized in aging (n = 24). The participants had access to part of the iSupport material for analysis purposes. Semi-structured interviews were conducted between June and September 2019. All the interviews were recorded and transcribed in full for subsequent analysis. All the ethical aspects were respected. RESULTS: The translator implemented some cross-cultural adaptations, such as substituting 69 proper names used in the original version by names of different Brazilian regions. In relation to the analysis of the material and comments from the focus groups, in general, all the participants had positive opinions about the material included in iSupport. Some changes were suggested in relation to the terminology and examples given in the modules to better fit the Brazilian culture and health systems, and links to relevant pages of the local Alzheimer's association were included. All the linguistic and cultural adaptations proposed were systematically documented and duly justified in structured forms provided by the World Health Organization, which approved all of them after verification of fidelity. CONCLUSION: The product of this research is the first version of the iSupport-Brasil program and the inclusion of its content in a digital platform. For the most part, the content offered in iSupport proved to be an important online tool to provide support and diverse information to the caregivers of people who have dementia.

Vertical Jump Tests: A Safe Instrument to Improve the Accuracy of the Functional Capacity Assessment in Robust Older Women.

Age-related decreases in muscle function lead to disabilities and are associated with negative health outcomes in older people. Although several physical tests can be used to assess physical performance, muscle strength, and power, their interpretation can be hampered by the ceiling effect of some of them. The aim of this study was to assess whether vertical jump tests are safe in terms of physical integrity and whether they are useful in assessing physical performance in forty-one robust older women. The investigation entailed an assessment of anthropometric characteristics, physical functioning tests (Short Physical Performance Battery (SPPB), sit-to-up 5 times and sit-to-up 30 s, gait speed, time-up-to-go test (TUGT)), and tests evaluating muscle strength and power (handgrip, lower limb isokinetic tests, and vertical jumping tests). Significant negative correlations were found between vertical jumping tests and BMI, body fat percentage, sit-to-up 5 times and TUGT. In addition, significant positive correlations were observed between vertical jumping tests and SPPB, gait speed, handgrip, and concentric isokinetic tests of knee muscles. No adverse events in volunteers' physical integrity were reported during and after the performance of all physical tests. Thus, the study results showed that vertical jumping tests are safe and accurate for assessing physical performance and are useful for monitoring age-related loss of muscle performance in robust older women.

Functional magnetic resonance imaging response as an early biomarker of cognitive decline in elderly patients with metabolic syndrome.

OBJECTIVES: We assessed whether potential changes in brain activation patterns of elderly individuals with metabolic syndrome (MetS) who were cognitively healthy (without mild cognitive impairment or dementia) were associated with cognitive decline in executive function in the short-term. METHOD: We analyzed 43 individuals (23 MetS, 20 controls) using a global geriatric evaluation, a neuropsychological battery, and task-related (attention) fMRI exam. Correlation analysis between the fMRI signal at baseline and cognitive impairment after 1year was based on the voxel-based Pearson coefficient, corrected for multiple comparisons. RESULTS: At baseline, MetS patients showed reduced brain response in frontal and parietal regions compared to controls. After one year, the MetS group also showed a decline in verbal fluency performance. fMRI response in the right dorsolateral prefrontal cortex and bilateral parietal lobes was negatively correlated with verbal fluency decline in the MetS group. DISCUSSION: Our results provide an early biomarker of the possible development of cognitive impairment, particularly in the executive function, of elderly individuals suffering from MetS. These findings also point to an up or down regulation which could be interpreted as compensatory mechanism for possible brain tissue burden caused by MetS.

Physicians' Perception of Sickle-cell Disease Pain.

The aim of this study was to evaluate the physician's perception of pain experienced by patients with sickle-cell disease (SCD). Pain experiences reported by patients were compared with physicians' perception of the patient's pain, and the treatment decision-making process was evaluated. Fifty-two patient-physician pairs were assessed. Before the clinic visit, the patients completed a 3-item on pain experienced 24 h prior to the visit and the PHQ-9. After the patient visit, the physicians completed a questionnaire assessing their perception of the patient's pain and a questionnaire on the factors taken into consideration when evaluating the patient's pain experience. The physicians rated the patients' pain as more intense than did the patients themselves; and there was agreement between pain intensity measurements (p < 0.05). The physicians' perception was influenced by the pain intensity reported by the patient, results of blood count at the time of the patient visit, and medication availability in the public health services. However, these factors were not predictive of the patient's pain intensity perceived by the physician. Patients' depressive symptoms were not predictive factor of the physicians' perception. Biochemical, genetic and symptomatic characteristics of SCD influenced the physicians' perception of the patient's pain experience, while psychosocial aspects did not.

Evaluation of the use of laboratory tests in primary care / Avaliação da utilização dos recursos laboratoriais na atenção primária à saúde

ABSTRACT Introduction: The evaluation of the use of laboratory tests in primary care can improve the quality of care provided to the population. Objective: To evaluate the laboratory tests in primary health care. Methods: Tutorial groups were set to evaluate the reports of laboratory tests requested at 15 basic health units in the city of Botucatu during a 12-month period. The obtained information was evaluated as to the amount of tests requested per medical consultation and the proportions of tests with abnormal results. Results: The rate of laboratory tests requested in medical consultations is far above the recommended by the Ministry of Health, allowing us to infer that there are many unnecessary requests. The test that more often showed abnormal results was glycated hemoglobin, what indicates a possible inadequate management of diabetic patients. Conclusion: Knowing and monitoring laboratory attention enables health unit managers to enhance effectiveness and rational use of the scarce available resources.

RESUMO Introdução: A avaliação da utilização dos exames laboratoriais na atenção primária pode melhorar a qualidade do atendimento prestado à população. Objetivo: Avaliar a utilização de exames laboratoriais pelas unidades de atenção primária à saúde de Botucatu, São Paulo, Brasil. Métodos: Foram realizados grupos tutoriais para avaliação dos laudos de exames laboratoriais solicitados por 15 unidades básicas de saúde do município de Botucatu, no período de 12 meses. As informações obtidas foram avaliadas quanto a quantidade de exames solicitados por consulta médica e proporções de exames com resultado anormal. Resultados: A taxa de solicitação de exames laboratoriais nas consultas médicas encontra-se acima das recomendações do Ministério da Saúde, permitindo inferir que há muitas solicitações desnecessárias. O exame que se apresentou anormal com maior frequência foi hemoglobina glicada, indicando um possível controle inadequado dos pacientes diabéticos. Conclusão: Conhecer e monitorar a atenção laboratorial possibilita aos gestores de unidades de saúde maior efetividade e uso racional dos escassos recursos disponíveis.

Performance of a Brazilian population on the test of functional health literacy in adults / Desempenho de uma população brasileira no teste de alfabetização funcional para adultos na área de saúde

OBJECTIVE: To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS: The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS: The mean age of the sample was 47.3 years (SD=16.8) and the mean education was 9.7 years (SD=5; range: 1 ­ 17). A total of 32.4% of the sample showed literacy/numeracy defi cits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not signifi cant when the effects of education were held constant (rp=-0.031, p=0.584). A signifi cant association (B=3.877, Beta=0.733; p<0.001) was found between schooling and scores. Age was not a signifi cant predictor in this model (B=-0.035, Beta=-0.22; p=0.584). CONCLUSIONS: The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classifi ed as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare

OBJETIVO: Analisar os escores de instrumento que avalia habilidade de leitura e compreensão de materiais da área da saúde segundo escolaridade e idade. MÉTODOS: Foram avaliados 312 participantes saudáveis de diferentes idades por meio da versão reduzida do instrumento Test of Functional Health Literacy in Adults. O estudo foi realizado entre 2006 e 2007 na cidade de São Paulo (SP). O instrumento envolve materiais como frascos de medicamentos e cartões de agendamento de consultas, avaliando a compreensão de leitura e de conceitos numéricos. Os testes de correlação parcial e de Pearson e um modelo de regressão múltipla foram usados para verifi car a associação entre os escores no instrumento, escolaridade e idade. RESULTADOS: As médias de idade e de escolaridade da amostra foram respectivamente 47,3 (dp=16,8 ) e 9,7 (dp=5; de um a 17 anos de estudo). O total de 32,4% da amostra mostraram défi cits de alfabetização funcional/ uso de conceitos numéricos na área de saúde, com desempenho inadequado ou limítrofe no instrumento. Entre idosos (65 anos ou mais) esta taxa atingiu 51,6%. Encontrou-se correlação positiva entre anos de estudo e escores no instrumento (r=0,740; p<0,01) e correlação negativa entre idade e escores no instrumento (r=-0,259; p<0,01). A correlação entre escores no instrumento e idade não foi signifi cante quando os efeitos da escolaridade foram controlados (r=-0,031, p=0,584). Uma associação signifi cante (B=3,877, Beta=0,733; p<0,001) foi encontrada entre anos de estudo e escores no instrumento. A idade não foi uma variável preditiva no modelo (B=-0,035, Beta=-0,22; p=0,584). CONCLUSÕES: O instrumento é adequado para avaliar a alfabetização funcional em saúde na população brasileira. O elevado número de indivíduos classifi cados como analfabetos funcionais indica a importância de adoção de medidas especiais para ajudar estes indivíduos a compreenderem corretamente as orientações para cuidados de saúde.

Performance of a Brazilian population on the test of functional health literacy in adults.

OBJECTIVE: To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS: The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS: The mean age of the sample was 47.3 years(sd=16.8) and the mean education was 9.7 years(sd=5; range: 1 - 17). A total of 32.4% of the sample showed literacy/numeracy deficits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not significant when the effects of education were held constant (rp=-0.031, p=0.584). A significant association (B=3.877, Beta =0.733; p<0.001) was found between schooling and scores. Age was not a significant predictor in this model (B=-0.035, Beta=-0.22; p=0.584). CONCLUSIONS: The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classified as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare.

Influence of age, gender and educational level on performance in the Brief Cognitive Battery-Edu.

The Brief Cognitive Battery-Edu (BCB-Edu) contains nine tests, seven of which are related to the memory of drawings, and has good accuracy in the diagnosis of cognitive impairment. OBJECTIVES: To evaluate the influence of age, gender and educational level on the performance in tests related to memory of drawings of the BCB-Edu in healthy subjects. METHODS: Participants were adult volunteers; exclusion criteria were illiteracy, neurologic or psychiatric disorders, visual or hearing impairment, untreated chronic clinical conditions, alcoholism, use of drugs, and for those aged 65 or over, an informant report of cognitive or functional impairment. We evaluated 325 individuals (207 women), with a mean age of 47.1 (±16.8) years, ranging from 19 to 81, and a mean of 9.8 (±5.0) schooling-years. Univariate analyses, correlations and logistic regression were employed (α=0.05). RESULTS: There were significant negative correlations between age and the scores in four of the seven tests. However, schooling-years were positively correlated to the scores, where schooling-years decreased with age in this sample (rho= -0.323; p<0.001). Logistic regression confirmed that gender influenced the learning of drawings, where women performed better, while age influenced incidental memory, immediate memory, learning and delayed recall of the drawings, and schooling-years influenced visual identification, immediate memory, learning, delayed recall and recognition of the drawings. CONCLUSION: Gender, age and education influence the performance on the memory of drawings of the BCB-Edu, although the extent of these influences differs according to the nature of the test.

A Bateria Breve de Rastreio Cognitivo - Edu (BBRC-Edu) contém nove testes, sete dos quais relacionados à memória de desenhos. Tem uma boa acurácia no diagnóstico de comprometimento cognitivo. OBJETIVOS: Avaliar a influência da idade, sexo e nível educacional no desempenho nos testes relacionados à memória de desenhos da BBRC-Edu em sujeitos saudáveis. MÉTODOS: Os participantes foram voluntários; os critérios de exclusão foram: analfabetismo, doenças neurológicas ou psiquiátricas, perda auditiva ou visual, condições clínicas descompensadas, etilismo, uso de drogas, e para aqueles com idade igual ou superior a 65 anos, informação de acompanhante de presença de comprometimento cognitivo ou funcional. Foram avaliados 325 indivíduos (207 mulheres), com idade média de 47.1 (±16.8) anos, variando de 19 a 81 nos, média de 9.8 (±5.0) anos de escolaridade. Análise univariada, correlações e regressão logística foram empregadas (α=0.05). RESULTADOS: Houve correlações negativas significativas entre idade e os escores de quatro dos sete testes. A escolaridade correlacionou-se positivamente aos escores, embora a escolaridade diminua com a idade nesta amostra (rho= -0.323; p<0.001). Regressão Logística confirmou que o gênero tem influência no aprendizado, com melhor desempenho entre as mulheres, enquanto a idade influenciou a memória incidental, memória imediata, aprendizado e evocação das figuras; e a escolaridade influenciou a identificação, memória imediata, aprendizado, evocação e reconhecimento. CONCLUSÃO: Gênero, idade e educação tiveram influência no desempenho na memória de figuras da BBRC-Edu, embora de modo diferente entre os tipos de teste.