Teledermatology in Remote Parts of Chile: Experience in 4 Isolated Rural Areas. / Teledermatología aplicada en zonas extremas: experiencia de 4 centros asistenciales chilenos en ámbito rural y aislamiento extremo.

BACKGROUND: Teledermatology was introduced in Chile to make up for the lack of dermatologists and improve the primary care system's ability to resolve problems. This strategy was implemented in the province of Palena in 2013, but outcomes were not analyzed and reported until now. MATERIAL AND METHODS: Descriptive, cross-sectional study with analysis of inter-rater agreement on diagnoses. All the teledermatology consultations made on behalf of patients in Ayacara, Chaitén, Futaleufú, and Palena from 2013 through 2017 were analyzed. Data were extracted from the MINSAL platform. The κ statistic was used to assess diagnostic agreement. RESULTS: A total of 326 teledermatology consultations were made. The mean (SD) age of the patients was 35.8 (22.4) years. The majority (59.8%) were female. Palena generated the largest volume of cases (40.8%). The mean time until a teledermatology diagnosis was given was 12.6 (22.8) days. This response time decreased to 6.4 (5.2) days after a staff dermatologist from Hospital Puerto Montt joined the program (P=.0005). Diagnosis concordance between the general practitioner and the dermatologist was moderate (κ=0.5). Physical examination by the dermatologist at the hospital of reference (Puerto Montt) was necessary for 20.6% of the patients, and time until a definitive diagnosis for the patient took longer in such cases (25.7 [41.2] days) than for the cases that didn't need a physical evaluation at the Hospital of Puerto Montt (P<.0001). CONCLUSIONS: Teledermatology provides a necessary diagnostic and therapeutic resource for general practitioners in isolated locations. Diagnostic agreement is moderate between the generalist and the specialist, similar to agreement in international studies but lower than agreement reported in other Chilean studies. The reduction in diagnostic response time after incorporation of a dermatologist on staff at the hospital of Puerto Montt was significant. The significant difference between the time for diagnosis under teledermatology and the delay when physical examination is required at the hospital of Puerto Montt identifies an aspect of care management to improve.

Analysis of a decade of skin cancer prevention using a mobile unit in Brazil.

INTRODUCTION: For the past 10 years, skin cancer has been the most frequent malignant neoplasm in Brazil and worldwide. Each year, there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon. There were an estimated 188 000 new cases of skin cancer in Brazil in 2016. The prevention department of Barretos Cancer Hospital (BCH) runs some prevention programs for cancer such as breast, prostate, cervical, oral, colon and skin cancers. The skin cancer prevention program comprises educational activities and medical assistance conducted at the hospital and at a mobile unit (MU). The objective of this study is to evaluate the use of the MU as part of a skin cancer prevention program, 10 years after the implementation of this prevention program, using an MU in remote areas of Brazil. METHODS: The database of the BCH was used. These data refer to data collected by the BCH Prevention MU. A total of 45 872 patients with suspected skin cancer were evaluated at the MU from 2004 to 2013. Of these, 8954 surgical procedures (excisions and/or biopsy) were performed. RESULTS: This study demonstrated a significant number of skin cancer cases diagnosed and treated by the MU. CONCLUSIONS: This study showed that the MU positively contributes to the early diagnosis and treatment of skin cancer among populations residing in remote areas of Brazil.

Creating a preference for prevention: the role of universal health care in the demand for preventive care among Mexico's vulnerable populations.

The introduction of Seguro Popular (SP)- providing health insurance to over 50 million Mexicans since the early 2000s-represents a large shift in health care delivery to the Mexican population. And yet, its impact on Mexico's marginalized communities has been little studied, and its impact on health is unclear. Using a survey of poor urban Mexicans and Mexican Ministry of Health administrative data, this article investigates SP's effect on those at the most risk for health disparities by looking at the impact of the programme on demand for preventive care services, especially among women, children and the indigenous. Three outcomes important to Mexico's burden of disease are explored: general physical exams, diabetes screening, and cervical cancer screening. Ordinary least square regressions show that the introduction of SP is associated with an increase in demand for all three services, but these results are likely biased due to selection into the programme. I then use the staggered geographic roll out of SP between 2004 and 2007 to identify the causal impact of the programme on demand. I use length of exposure to SP as an instrumental variable to predict SP affiliation in 2009. Two stage least squares estimates of the causal impact of SP on demand for preventive care services finds that SP affiliation increases adult demand for physicals, but does not affect demand for diabetes screening. Additionally, I find that female and child SP affiliates are less likely to demand physicals, while affiliates who identify as indigenous are less likely to demand physicals but more likely to demand cervical cancer screenings.

Inter-examiner agreement of the systematic physical examination in patients with obstructive sleep disorders.

PURPOSE: The goal of this study was to investigate the agreement between examiners who were or were not trained in the physical examination of the upper airway (UA) and the craniofacial skeleton of individuals with obstructive sleep disorders (OSD). METHOD: A systematic assessment of the UA and craniofacial skeleton was performed on 55 individuals with OSD. The participants were consecutively assessed by three otorhinolaryngologists who specialized in sleep medicine for at least 1 year (trained examiners) and two doctors who were attending a residency program in otorhinolaryngology (untrained examiners). RESULTS: When analyzing all of the parameters assessed, the concordance was better in the trained group (k = 0.694, which is considered "good") compared to the untrained group (k = 0.475, "fair") (p < 0.001). The inter-examiner agreement was also better in the trained compared to the untrained group, as follows: craniofacial (k = 0.643 vs. 0.349), nasal (k = 0.657 vs. 0.614), and pharyngeal (k = 0.729 vs. 0.276) abnormalities (p < 0.05). CONCLUSION: The overall concordance of the physical examination of the UA and craniofacial skeleton was "good" among the trained specialists and "fair" among examiners without appropriate training, despite its subjectivity.

Clinical breast examination and mammography: inequalities in Southern and Northeast Brazilian regions. / Exame clínico das mamas e mamografia: desigualdades nas regiões Sul e Nordeste do Brasil.

OBJECTIVE: To evaluate the prevalence and associated factors of doing clinical breast examinations (CBE) and mammogram (MMG) in the Southern and Northeast Brazilian regions, focusing on some social inequalities. METHODS: This is a cross-sectional study using data from the 2008 National Household Sampling Survey (PNAD). We evaluated the prevalence of CBE during the last year and of the MMG in the last two years, which were analyzed based on demographic (age, skin color, and marital status) and socioeconomic (income and schooling) variables. Gross and adjusted prevalence ratios were obtained using Poisson regression models. All analyses were stratified by region. RESULTS: The sample comprised 27,718 women aged 40 to 69 years. Less than a half of the women followed the recommendation of annual CBE performance in both the regions. The MMG prevalence during the last two years was 58.6 and 45.5% for the Southern and Northeast regions, respectively. More than a quarter of the women had never had a MMG (26.5% in the Southern and 40.6% in the Northeast regions). Not having performed both examinations was almost two times higher in the Northeast region (29.7%) when compared with the Southern (15.9%). The risk for not having performed both examinations was greater among nonwhite women, aged 60 to 69 years, with lower schooling level and family income. CONCLUSION: Important inequalities were seen between the Southern and Northeast regions for CBE and MMG. Health public policies should prioritize the most vulnerable groups to reduce these inequalities.

Exame clínico das mamas e mamografia: desigualdades nas regiões Sul e Nordeste do Brasil / Clinical breast examination and mammography: inequalities in Southern and Northeast Brazilian regions

RESUMO: Objetivo: Avaliar a prevalência e os fatores associados à realização do exame clínico das mamas (ECM) e da mamografia (MMG) nas regiões Sul e Nordeste do Brasil, focando em algumas desigualdades sociais. Métodos: Estudo transversal, utilizando dados da Pesquisa Nacional por Amostra de Domicílios, de 2008. Foram avaliadas as prevalências de realização de ECM durante o último ano e de MMG nos últimos dois anos e analisadas conforme variáveis demográficas (idade, cor da pele e estado civil) e socioeconômicas (renda e escolaridade). As razões de prevalência brutas e ajustadas foram obtidas através de regressão de Poisson. As análises foram estratificadas por região. Resultados: Foram avaliadas 27.718 mulheres, entre 40 e 69 anos. Menos da metade das mulheres seguiu a recomendação de realização anual de ECM em ambas as regiões. A prevalência de realização de MMG nos últimos 2 anos foi de 58,6 e 45,5% para a região Sul e a Nordeste, respectivamente. Mais de um quarto das mulheres avaliadas de ambas as regiões nunca realizaram MMG (26,5% no Sul e 40,6% no Nordeste). Nunca ter realizado ambos os exames foi quase duas vezes mais prevalente na região Nordeste (29,7%) do que na região Sul (15,9%). O risco para a não realização de ambos os exames foi maior em mulheres com idades entre 60 e 69 anos, não brancas, com menor escolaridade e com menor renda familiar. Conclusão: Importantes desigualdades foram observadas entre as regiões Sul e Nordeste para o ECM e a MMG. Políticas públicas de saúde devem priorizar grupos mais vulneráveis para reduzi-las.

ABSTRACT: Objective: To evaluate the prevalence and associated factors of doing clinical breast examinations (CBE) and mammogram (MMG) in the Southern and Northeast Brazilian regions, focusing on some social inequalities. Methods: This is a cross-sectional study using data from the 2008 National Household Sampling Survey (PNAD). We evaluated the prevalence of CBE during the last year and of the MMG in the last two years, which were analyzed based on demographic (age, skin color, and marital status) and socioeconomic (income and schooling) variables. Gross and adjusted prevalence ratios were obtained using Poisson regression models. All analyses were stratified by region. Results: The sample comprised 27,718 women aged 40 to 69 years. Less than a half of the women followed the recommendation of annual CBE performance in both the regions. The MMG prevalence during the last two years was 58.6 and 45.5% for the Southern and Northeast regions, respectively. More than a quarter of the women had never had a MMG (26.5% in the Southern and 40.6% in the Northeast regions). Not having performed both examinations was almost two times higher in the Northeast region (29.7%) when compared with the Southern (15.9%). The risk for not having performed both examinations was greater among nonwhite women, aged 60 to 69 years, with lower schooling level and family income. Conclusion: Important inequalities were seen between the Southern and Northeast regions for CBE and MMG. Health public policies should prioritize the most vulnerable groups to reduce these inequalities.

Rater Reliability and Concurrent Validity of Single and Dual Bubble Inclinometry to Assess Cervical Lateral Flexion.

OBJECTIVE: The purpose of this study was to assess interrater and intrarater reliability and validity for single inclinometry (SI) and dual inclinometry (DI) assessment of cervical lateral flexion (CLF) range of motion and compare reliability in a practicing physical therapist (PT) and student PTs (SPTs). METHODS: Twenty-four subjects performed right and left CLF while SI, DI, and 3-dimensional kinematics were concurrently recorded. Subjects were reassessed by 2 SPTs and 1 PT using both SI and DI. Each subject was measured twice per rater in round-robin fashion. RESULTS: There were significant positive relationships between DI and motion capture for both right (r = 0.841; P < .01) and left lateral flexion (r = 0.838; P < .01). Single inclinometry also had a significant correlation with motion capture for right (r = 0.927, P < .01) and left (r = 0.834, P < .01) lateral flexion. Interrater reliability was good for both SI and DI methods. For SI, intraclass correlation coefficient (ICC) (3,1) was 0.905 and 0.870 for right and left CLF, respectively. For DI, ICC(3,1) was 0.803 and 0.757 for right and left CLF, respectively. Intrarater reliability was good for both methods. Average SI values were ICC(2,1) of 0.928 and 0.897 for right and left CLF, respectively. Average DI values were ICC(2,1) of 0.882 and 0.851 for left and right, respectively. Although not significant, the PT had slightly higher reliability in all measures (range, 0.881-0.935) compared to the SPTs (range, 0.880-0.925). CONCLUSIONS: Both SI and DI are acceptable for clinical use and both are reliable measurement methods for CLF between raters and for repeated measures. There are minimal differences in reliability between a PT with experience and SPTs with minimal experience.

[Health care for women over 50: programmatic vulnerability in the Family Health Strategy]. / Atenção à saúde da mulher após os 50 anos: vulnerabilidade programática na Estratégia Saúde da Família.

OBJECTIVE: To assess the health care process for women over 50 at a Family Health Unit based on the concept of programmatic vulnerability. METHOD: This study is inserted in the field of health care assessments. The framework proposed by Donabedian was used to analyze 90.5% of the 790 records of women registered at the unit. RESULTS: It was observed that none of the women that did not have a diagnosed pathology attended the recommended consultations or underwent the recommended tests. Of the total number of women with hypertension or diabetes, 20.7% were registered in the Hiperdia Programme and less than 1.0% had attended the consultations and undergone the necessary tests. Only 11.9% of the women had had a gynaecological examination, a clinical breast examination and a mammography the year before data collection. CONCLUSION: It is concluded that women over 50 are in a situation of programmatic vulnerability in terms of the indicators established in this study. Knowledge of this reality can help nurses provide care that is best suited for this group.

Visual Inspection for Caries Detection: A Systematic Review and Meta-analysis.

We aimed to perform a systematic review including a meta-analysis to evaluate the overall accuracy of visual methods for detecting carious lesions and to identify possible sources of heterogeneity among the studies included. Two reviewers searched PubMed, Embase, Scopus, and other sources through July 2014 to identify published and nonpublished studies in English. Studies of visual inspection were included that 1) assessed accuracy of the method in detecting caries lesions; 2) were performed on occlusal, proximal, or free smooth surfaces in primary or permanent teeth; 3) had a reference standard; and 4) reported sufficient data about sample size and accuracy of methods. The data were used to calculate the pooled sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristics curve. Heterogeneity of the studies was also assessed. A total of 102 manuscripts (from 5,808 articles initially identified) and 1 abstract (from 168) met the inclusion criteria. In general, the analysis demonstrated that the visual method had good accuracy for detecting caries lesions. Although laboratory and clinical studies have presented similar accuracy, clinically obtained specificity was higher. We also observed moderate to high heterogeneity and evidence of publication bias in most papers. Moreover, studies employing widely recognized visual scoring systems presented significantly better accuracy as compared to studies that used their own criteria. In conclusion, visual caries detection method has good overall performance. Furthermore, although the identified studies had high heterogeneity and risk of bias, the use of detailed and validated indices seems to improve the accuracy of the method.

An in vivo comparison of radiographic and clinical examination with separation for assessment of approximal caries in primary teeth.

AIM: To compare in vivo, clinical examination (CE) and bitewing radiographs (BW) for the detection of cavitations and initial approximal lesions in deciduous molars with validation after temporary separation (TS) and direct visual examination (DE) of the approximal surfaces. MATERIALS AND METHODS: Thirty children aged 4 to 8 years without visual cavitations or restorations and with at least one approximal contact. Two calibrated examiners evaluated 355 surfaces of primary molars, which were then validated through TS and DE. RESULTS: Of the 280 surfaces considered sound by CE, 24.6% were cavitated after separation. Comparing BW and DE, it was observed that, when the radiolucency involved the inner half of dentin, 68.4% of lesions were cavitated. The sensitivity and specificity of CE and BW were 0.14 and 0.43, and 0.80 and 0.75, respectively. CONCLUSION: DE identified a greater number of pre-cavitated lesions and cavities. BW were useful for detection of decayed surfaces, but with low specificity for diagnosis of sound surfaces, while detection of sound or decayed approximal areas by means of CE alone was not possible. The combination of methods was effective in obtaining an accurate diagnosis of caries in the primary dentition.

Reliability of the Balance Evaluation Systems Test (BESTest) and BESTest sections for adults with hemiparesis.

BACKGROUND: The Balance Evaluation Systems Test (BESTest) was recently created to allow the development of treatments according to the specific balance system affected in each patient. The Brazilian version of the BESTest has not been specifically tested after stroke. OBJECTIVE: To evaluate the intra- and inter-rater reliability and concurrent and convergent validity of the total score of the BESTest and BESTest sections for adults with hemiparesis after stroke. METHOD: The study included 16 subjects (61.1 ± 7.5 years) with chronic hemiparesis (54.5 ± 43.5 months after stroke). The BESTest was administered by two raters in the same week and one of the raters repeated the test after a one-week interval. Intraclass correlation coefficient (ICC) was calculated to assess intra- and interrater reliability. Concurrent validity with the Berg Balance Scale (BBS) and convergent validity with the Activities-specific Balance Confidence scale (ABC-Brazil) were assessed using Pearson's correlation coefficient. RESULTS: Both the BESTest total score (ICC=0.98) and the BESTest sections (ICC between 0.85 and 0.96) have excellent intrarater reliability. Interrater reliability for the total score was excellent (ICC=0.93) and, for the sections, it ranged between 0.71 and 0.94. The correlation coefficient between the BESTest and the BBS and ABC-Brazil were 0.78 and 0.59, respectively. CONCLUSIONS: The Brazilian version of the BESTest demonstrated adequate reliability when measured by sections and could identify what balance system was affected in patients after stroke. Concurrent validity was excellent with the BBS total score and good to excellent with the sections. The total scores but not the sections present adequate convergent validity with the ABC-Brazil. However, other psychometric properties should be further investigated.

Reliability of the Balance Evaluation Systems Test (BESTest) and BESTest sections for adults with hemiparesis

BACKGROUND: The Balance Evaluation Systems Test (BESTest) was recently created to allow the development of treatments according to the specific balance system affected in each patient. The Brazilian version of the BESTest has not been specifically tested after stroke. OBJECTIVE: To evaluate the intra- and inter-rater reliability and concurrent and convergent validity of the total score of the BESTest and BESTest sections for adults with hemiparesis after stroke. METHOD: The study included 16 subjects (61.1±7.5 years) with chronic hemiparesis (54.5±43.5 months after stroke). The BESTest was administered by two raters in the same week and one of the raters repeated the test after a one-week interval. Intraclass correlation coefficient (ICC) was calculated to assess intra- and interrater reliability. Concurrent validity with the Berg Balance Scale (BBS) and convergent validity with the Activities-specific Balance Confidence scale (ABC-Brazil) were assessed using Pearson's correlation coefficient. RESULTS: Both the BESTest total score (ICC=0.98) and the BESTest sections (ICC between 0.85 and 0.96) have excellent intrarater reliability. Interrater reliability for the total score was excellent (ICC=0.93) and, for the sections, it ranged between 0.71 and 0.94. The correlation coefficient between the BESTest and the BBS and ABC-Brazil were 0.78 and 0.59, respectively. CONCLUSIONS: The Brazilian version of the BESTest demonstrated adequate reliability when measured by sections and could identify what balance system was affected in patients after stroke. Concurrent validity was excellent with the BBS total score and good to excellent with the sections. The total scores but not the sections present adequate convergent validity with the ABC-Brazil. However, other psychometric properties should be further investigated. .

How are childhood thyroid nodules discovered: opportunities for improving early detection.

In a retrospective analysis of childhood thyroid nodules, 18% were radiographic incidentalomas and 41% were discovered by a clinician's palpation; 40% were discovered by patients' families. The latter group had the largest nodules and highest rates of thyroid cancer metastasis, suggesting opportunities for earlier detection through annual well-child visits.

[Correct utilization of breast cancer detection techniques in Mexican women]. / Utilización correcta de las técnicas de detección de cáncer de mama en mujeres mexicanas.

OBJECTIVE: Identify the characteristics associated with correct utilization of self examination (SE), clinical exam (CE) and mammography (MA) for breast cancer (BC) early detection. MATERIALS AND METHODS: Interviews were undertaken with 1 030 Mexican women (n=1 030), 20 to 88 years of age, regarding their reproductive and sociodemographic characteristics. An index of correct utilization was constructed based on the form and frequency practice of those techniques. RESULTS: The prevalence of correct utilization of SE was 11% and 5.4% for CE. Further, 7.6% of women 40-49 years of age with 2 or more BC risk factors had MA during the two years prior to the interview, and for 31.6% among women ≥50 years of age the MA was annually. The main determinant of MA utilization was having financial protection from either IMSS, ISSSTE or Seguro Popular. CONCLUSIONS: It is necessary to improve the correct utilization of BC detection techniques in Mexico.

[Intraclass reliability of the Alberta Infant Motor Scale in the Brazilian version]. / Confiabilidade intraclasse da Alberta Infant Motor Scale na versão brasileira.

This study had as its objective to analyze the intraclass reliability of the Alberta Infant Motor Scale (AIMS), in the Brazilian version, in preterm and term infants. It was a methodological study, conducted from November 2009 to April 2010, with 50 children receiving care in two public institutions in Fortaleza, Ceará, Brazil. Children were grouped according to gestational age as preterm and term, and evaluated by three evaluators in the communication laboratory of a public institution or at home. The intraclass correlation indices for the categories prone, supine, sitting and standing ranged from 0.553 to 0.952; most remained above 0.800, except for the standing category of the third evaluator, in which the index was 0.553. As for the total score and percentile, rates ranged from 0.843 to 0.954. The scale proved to be a reliable instrument for assessing gross motor performance of Brazilian children, particularly in Ceará, regardless of gestational age at birth.

[Physical exploration and morbidity of pelvic members in the diabetic patient type 2]. / Exploración física y morbilidad de miembros pélvicos en el paciente diabético tipo 2.

OBJECTIVE: to determine the prevalence of the physical exploration and morbidity on pelvic members in the type 2 diabetic patient. METHODOLOGY: cross-sectional study; 189 files of diabetic family medicine patients were analyzed. The sample was considered with the formula of proportions for a finite population. Sampling units were chosen by convenience and they were taken up again from each one of the family medicine physician's offices. Sociodemographic variables, pathologies, time of evolution of diabetes, glycemic control and consultations along a year were studied. Physical explorations were made and signs explored by the physicians. Descriptive statistic for the analysis of data was used. RESULTS: average age 58.89 years (CI 95 %, 57.1-60.7); women predominated with 61.9 % (CI 95 %, 55.0-68.8), mean time of evolution 10.60 years ± 7.29. In 74.1 % some sign in pelvic members was explored, and in 14.3 % some added problem was detected. Of these, 9 % suffered from onychomycosis. CONCLUSION: physical exploration of pelvic members it is not to be performed in all type 2 diabetic patients.

Objetivo: determinar la prevalencia de exploración física y morbilidad de miembros pélvicos en el paciente diabético tipo 2. Métodos: estudio transversal descriptivo. Se analizaron 189 expedientes de pacientes diabéticos de medicina familiar. La muestra se estimó con la fórmula de proporciones para población finita. Las unidades muestrales se eligieron por conveniencia y se retomaron de cada uno de los consultorios de medicina familiar. Se estudiaron variables sociodemográficas y de salud (patologías agregadas, tiempo de evolución de la diabetes, control glucémico y consultas al año). Del servicio se estudiaron exploraciones físicas realizadas y signos explorados por el médico en un año. Se utilizó estadística descriptiva para el análisis de datos. Resultados: edad promedio de 58.89 años (IC 95 %, 57.1-60.7), predominó el sexo femenino con 61.9 % (IC 95 %, 55.0-68.8), el promedio de tiempo de evolución fue de 10.60 ± 7.29 años. La mayoría tenía descontrol glucémico. En el 74.1 % se exploró algún signo en miembros pélvicos, al 14.3 % se le detectó algún problema agregado; de estos, 9.0 % padecía onicomicosis. Conclusión: la exploración física de los miembros pélvicos no se realiza en la totalidad de los pacientes diabéticos tipo 2.

Scoliometer measurements of patients with idiopathic scoliosis.

BACKGROUND: Patients with idiopathic scoliosis are exposed to approximately 25 radiographic examinations of their spine throughout the clinical follow-up using the Cobb angle. Several non-invasive and radiation-free methods have been proposed to measure scoliotic deformities, including the scoliometer. OBJECTIVES: To measure the intra- and interrater reliability of the scoliometer measurements, to assess the correlation of the values obtained by the scoliometer measurements with the Cobb angles obtained by radiography, and to assess the sensitivity and specificity of the scoliometer measurements for the different diagnostic criteria for the referral of idiopathic scoliosis. METHOD: Sixty-four patients were selected for the study: half with idiopathic scoliosis and half without. The 17 levels of the spine of each volunteer were measured with a scoliometer in the forward bending position. The measurements were performed three times on 42 volunteers by two different raters to obtain data for calculating the reliability values. Anteroposterior radiographs were taken to determine the Cobb angles, which were then compared with the highest trunk rotation value. Sensitivity and specificity were evaluated using radiograph criteria for referral: a Cobb angle of 10º and axial trunk rotation values between 5º and 10º. RESULTS: Excellent intrarater reliability values and very good interrater reliability values were obtained. The correlation between the scoliometer measurements and radiograph analyses was considered good (r=0.7, p<0.05). The highest sensitivity value was for a trunk rotation of 5º at 87%. CONCLUSIONS: The scoliometer measurements showed a good correlation with the radiographic measurements.

Scoliometer measurements of patients with idiopathic scoliosis

BACKGROUND: Patients with idiopathic scoliosis are exposed to approximately 25 radiographic examinations of their spine throughout the clinical follow-up using the Cobb angle. Several non-invasive and radiation-free methods have been proposed to measure scoliotic deformities, including the scoliometer. OBJECTIVES: To measure the intra- and interrater reliability of the scoliometer measurements, to assess the correlation of the values obtained by the scoliometer measurements with the Cobb angles obtained by radiography, and to assess the sensitivity and specificity of the scoliometer measurements for the different diagnostic criteria for the referral of idiopathic scoliosis. METHOD: Sixty-four patients were selected for the study: half with idiopathic scoliosis and half without. The 17 levels of the spine of each volunteer were measured with a scoliometer in the forward bending position. The measurements were performed three times on 42 volunteers by two different raters to obtain data for calculating the reliability values. Anteroposterior radiographs were taken to determine the Cobb angles, which were then compared with the highest trunk rotation value. Sensitivity and specificity were evaluated using radiograph criteria for referral: a Cobb angle of 10º and axial trunk rotation values between 5º and 10º. RESULTS: Excellent intrarater reliability values and very good interrater reliability values were obtained. The correlation between the scoliometer measurements and radiograph analyses was considered good (r=0.7, p<0.05). The highest sensitivity value was for a trunk rotation of 5º at 87%. CONCLUSIONS: The scoliometer measurements showed a good correlation with the radiographic measurements. .

Força de preensão palmar em idosos com demência: estudo da confiabilidade / Handgrip strength in elderly with dementia: study of reliability

CONTEXTUALIZAÇÃO: Instrumentos de medida devem ser analisados quanto a sua utilidade clínica e científica em diferentes populações. Apesar de o teste da força de preensão palmar (FPP) ser amplamente utilizado, pouco foi investigado quanto a sua confiabilidade ao ser utilizado em idosos com demência e em qual grau de demência seria inviabilizado o seu uso. OBJETIVO: Avaliar a confiabilidade teste-reteste da FPP em idosos com diferentes graus de demência. MÉTODO: Realizou-se uma avaliação dos aspectos cognitivos de 76 idosos com demência e uma entrevista com o cuidador, permitindo a classificação do idoso segundo os critérios da Escala Clínica de Demência (Clinical dementia rating - CDR). Para essas avaliações, foram utilizados o Miniexame do Estado Mental e os questionários Pfeffer, Lawton e Katz. Vinte idosos foram classificados como grau questionável (83,4±5,8 anos); 19, como leve (82,4±6,8 anos); 19, como moderado (85,8±5,6 anos) e 18, como grave (84,0±5,1 anos). Os idosos tiveram a FPP avaliada por meio de um dinamômetro hidráulico JAMAR e, após uma semana, foram reavaliados. A confiabilidade foi estimada pelo Coeficiente de Correlação Intraclasse (ICC). O nível de significância foi α=0,05. RESULTADOS: A confiabilidade teste-reteste foi excelente para os grupos que apresentaram o CDR questionável (ICC=0,975; p=0,001), leve (ICC=0,968; p=0,002) e moderado (ICC=0,964; p=0,001). A análise do grupo com CDR grave mostrou não haver uma significância estatística e um ICC baixo (ICC=0,415; p=0,376). CONCLUSÃO: O teste de FPP apresenta excelente confiabilidade ao ser utilizado em idosos com demências questionável, leve e moderada, viabilizando seu uso em pesquisas. Já em idosos classificados como graves, seu uso não é recomendado visto que a confiabilidade da medida é baixa e, portanto, sem relevância clínica para uso na prática.

BACKGROUND: Measuring instruments should have their scientific and clinical value evaluated in different populations. The handgrip strength test is widely used, however little has been investigated about its reliability when used in elderly with dementia and the right stage wich its use should be avoided. OBJECTIVES: To evaluate the test-retest reliability of the handgrip strength test in elderly with different ratings of dementia. METHOD: The cognitive function of 76 elderly subjects with dementia was measured, and the caregivers were interviewed to allow classification by the Clinical dementia rating (CDR). For these assessments the Mini-Metal State Examination and the Pfeffer, Lawton, and Katz scales were used. Twenty subjects were classified as borderline (83.4± 5.8 years), 19 as mild (82.4±6.8 years), 19 as moderate (85.8±5.6 years) and 18 as severe dementia (84.0±5.1 years). Handgrip strength was assessed with a JAMAR hydraulic dynamometer and after one week it was reevaluated. Reliability was analyzed by Intraclass Correlation Coefficient (ICC). The significance level was set at α=0.05. RESULTS: Test-retest reliability was excellent for groups with borderline (ICC=0.975; p=0.001), mild (ICC=0.968; p=0.002), and moderate (ICC=0.964; p=0.001) dementia. The analysis of the group with a severe CDR showed no statistical significance and a low ICC (ICC=0.415; p=0.376). CONCLUSION: The handgrip strength test has excellent reliability when used in elderly with borderline, mild, and moderate dementia, which enables its use in research. However, its use is not recommended in elderly classified with severe dementia due to the measure’s low reliability and subsequent irrelevance in clinical practice.

Handgrip strength in elderly with dementia: study of reliability.

BACKGROUND: Measuring instruments should have their scientific and clinical value evaluated in different populations. The handgrip strength test is widely used, however little has been investigated about its reliability when used in elderly with dementia and the right stage wich its use should be avoided. OBJECTIVES: To evaluate the test-retest reliability of the handgrip strength test in elderly with different ratings of dementia. METHOD: The cognitive function of 76 elderly subjects with dementia was measured, and the caregivers were interviewed to allow classification by the Clinical dementia rating (CDR). For these assessments the Mini-Metal State Examination and the Pfeffer, Lawton, and Katz scales were used. Twenty subjects were classified as borderline (83.4±5.8 years), 19 as mild (82.4±6.8 years), 19 as moderate (85.8±5.6 years) and 18 as severe dementia (84.0±5.1 years). Handgrip strength was assessed with a JAMAR hydraulic dynamometer and after one week it was reevaluated. Reliability was analyzed by Intraclass Correlation Coefficient (ICC). The significance level was set at α=0.05. RESULTS: Test-retest reliability was excellent for groups with borderline (ICC=0.975; p=0.001), mild (ICC=0.968; p=0.002), and moderate (ICC=0.964; p=0.001) dementia. The analysis of the group with a severe CDR showed no statistical significance and a low ICC (ICC=0.415; p=0.376). CONCLUSION: The handgrip strength test has excellent reliability when used in elderly with borderline, mild, and moderate dementia, which enables its use in research. However, its use is not recommended in elderly classified with severe dementia due to the measure's low reliability and subsequent irrelevance in clinical practice.