Patellofemoral pain syndrome in children and adolescents: A cross-sectional study.

OBJECTIVES: To assess the prevalence and associated factors of Patellofemoral Pain Syndrome (PFPS) in children and adolescents. METHOD: A population-based cross-sectional study was conducted with children and adolescents aged 10 to 18 years, who presented a history of peripatellar and/or retropatellar pain, attending elementary or high school in urban public schools in Natal, Brazil. The sample size was calculated based on a minimum outcome prevalence of 22%. RESULTS: A prevalence of 24.7% of PFPS was found. There was a positive association of PFPS with active students (p < 0.01; PR: 2.5; CI: 1.4-4.5), low functional capacity (p < 0.01; PR: 8.0; CI: 5.0-12.8), and those classified as pubertal (p < 0.03; PR: 1.8; CI: 1.0-3.2). CONCLUSION: There was a considerable prevalence of PFPS in children and adolescents, as well as an association between the level of sexual maturation and adjustable determinants, such as the level of physical activity and low functional capacity in this group.

Factors associated with waiting for physiotherapy service: analysis from the Access and Quality Improvement Program (PMAQ) / Fatores associados à espera para o serviço de fisioterapia: análise a partir do Programa de Melhoria do Acesso e da Qualidade (PMAQ)

Abstract Introduction Historically, the difficulty of referrals to specialized health services has been discussed. Objective To analyze the factors associated with waiting time for specialized physiotherapy services. Methods Cross-sectional, multilevel study, with secondary data, based on the external evaluation of the second cycle of the Access and Quality Improvement Program and the United Nations Development Program. The explanatory variables for the outcome "Estimated waiting time of users for specialized consultations - Physiotherapy" were grouped according to the characteristics of the family health teams and contextual factors. In the statistical analysis, Poisson's Multilevel Regression was used. A significance level of 5% was adopted (p < 0.05). Results Observed association of the time of referral to physiotherapy with the health teams that receive support for the planning of the work process (n = 25.476; 83,4%; p < 0.0001), that the management provides information about the health situation (n = 26.505; 86,8%; p < 0.0016), receives support for the discussion of monitoring data (n = 24.149; 79,1%; p < 0.0001), receives permanent institutional support (n = 25.140; 82,3%; p < 0.0001), gets feedback from the evaluation carried out by the specialists (n = 22.801; 76,6%; p < 0.0001) and in the teams that are supported by the NASF physiotherapist (n = 5.666; 18,6%; p < 0.0001), with an association for the Gini Index (p < 0.044) and the HDI (p < 0.0001). Conclusion The referral time to the specialized physiotherapy service was shown to be associated with both system organization and management factors, as well as contextual variables.

Resumo Introdução Historicamente, discute-se a dificuldade de encaminhamentos para o serviço especializado de saúde. Objetivo Analisar os fatores associados ao tempo de espera para os serviços especializados de fisioterapia. Métodos Estudo transversal, multinível, realizado a partir do Programa de Melhoria do Acesso e da Qualidade e do Programa das Nações Unidas para o Desenvolvimento. Adotou-se a variável desfecho: tempo estimado de espera dos usuários para atendimento especializado de consultas de fisioterapia. Na análise estatística, utilizou-se a regressão multível de Poisson e adotou-se nível de significância de 5% (p < 0,05). Resultados Observou-se associação do tempo de encaminhamento para fisioterapia com as equipes de saúde que recebem apoio para o planejamento do processo de trabalho (n = 25,48; 83,4%; p < 0,0001), como também para a gestão que disponibiliza informações sobre a situação de saúde (n = 26,55; 86,8%; p < 0,0016), recebe apoio para a discussão dos dados de monitoramento (n = 24,149; 79,1%; p < 0,0001), recebe apoio institucional permanente (n = 25,14; 82,3%; p < 0,0001) e obtém retorno da avaliação realizada pelos especialistas (n = 22,80; 76,6%; p < 0,0001). Nas equipes que são apoiadas por fisioterapeutas do Núcleo de Apoio à Saúde da Família (n = 5,67; 18,6%; p < 0,0001), verificou-se associação entre o Índice de Gini (p < 0,044) e o Índice de Desenvolvimento Humano (p < 0,0001). Conclusão O tempo de encaminhamento para o serviço especializado de fisioterapia mostrou-se associado tanto com fatores de organização e gestão do sistema quanto com variáveis contextuais.

Dynamic knee valgus prevalence in children and its association with pain intensity, foot mobility, and sex- A cross-sectional study.

Introduction: Knee pain can impact the performance of activities and sports participation in children. Dynamic knee valgus is a movement pattern commonly related to health conditions that may be associated with sex and foot kinematics in children. Objective: To assess the prevalence of dynamic knee valgus and its relationship with foot mobility, sex, and knee pain in children. Method: A cross-sectional observational study was carried out with 144 children (10-18 years old). The pain level was investigated using the Visual Analog Pain Scale and categorized into no pain/minor pain (≤2 cm), moderate pain (3-4,9 cm), and severe pain (≥5.0 cm). Foot mobility was assessed using the adapted navicular drop test and categorized into poor/adequate foot mobility (0.0 cm-0.9 cm) and greater foot mobility (≥1.0 cm). The dynamic knee valgus presence was checked using the step-down test. The association analysis was performed using simple tabulation considering the cluster effect. The Prevalence Ratios and the respective confidence intervals (95%) were estimated from Multiple Poisson Regression with robust variance. A significance level of 5% was adopted. Results: The dynamic knee valgus prevalence was 26.3% and 26.9% in the right and left lower limbs, respectively. Females presented greater dynamic knee valgus frequency in the left lower limb than males. The dynamic knee valgus presence in males was associated with foot mobility in right (p = 0.001) (Prevalence Ratio: 9.33 Confidence Interval: 2.93-29.72) and left lower limbs (p = 0.003) (Prevalence Ratio: 6.25 Confidence Interval: 1.7-22.62). Conclusion: Male and female children showed different relationships of the analyzed factors, suggesting that characteristics related to sex may impact the aspects linked to dynamic knee in children.

COVID-19 in Brazilian cities: Impact of social determinants, coverage and quality of primary health care.

BACKGROUND: Brazil, as many other countries, have been heavily affected by COVID-19. This study aimed to analyze the impact of Primary health care and the family health strategy (FHS) coverage, the scores of the National Program for Improving Primary Care Access and Quality (PMAQ), and socioeconomic and social indicators in the number of COVID-19 cases in Brazilian largest cities. METHODS: This is an ecological study, carried out through the analysis of secondary data on the population of all Brazilian main cities, based on the analysis of a 26-week epidemiological epidemic week series by COVID-19. Statistical analysis was performed using Generalized Linear Models with an Autoregressive work correlation matrix. RESULTS: It was shown that greater PHC coverage and greater FHS coverage together with an above average PMAQ score are associated with slower dissemination and lower burden of COVID-19. CONCLUSION: It is evident that cities with less social inequality and restrictions of social protection combined with social development have a milder pandemic scenario. It is necessary to act quickly on these conditions for COVID-19 dissemination by timely actions with high capillarity. Expanding access to PHC and social support strategies for the vulnerable are essential.

Primary health care and social isolation against COVID-19 in Northeastern Brazil: Ecological time-series study.

BACKGROUND: Brazil is witnessing a massive increase of corona virus disease (COVID-19). Its peculiar primary health care (PHC) system faces a burden due to the contagion occurring in the community environment. Then, the aim is to estimate the effect of the coverage of primary health care and social isolation on the evolution of confirmed cases and deaths by COVID-19, controlling sociodemographic, economic and health system aspects. METHODS: A time series design was designed with data on diagnosed cases of COVID-19 and their deaths as outcomes in the capital cities of the Northeast region of Brazil. Independent variables such as PHC coverage, hospital beds, social isolation, demographic density, Gini index and other indicators were analyzed. A Autoregressive Generalized Linear Model method was applied for model the relationship. RESULTS: We identified an exponential growth of cases (y = 0.00250.71x; p-value<0,001). However, there is a high variability in the occurrence of outcomes. PHC coverage≥75% (χ2 = 9.27; p-value = 0.01) and social isolation rate (χ2 = 365.99; p-value<0.001) proved to be mitigating factors for the spread of COVID-19 and its deaths. Capitals with hospital beds ≥ 3.2 per thousand inhabitants had fewer deaths (χ2 = 9.02; p-value = 0.003), but this was influenced by PHC coverage (χ2 = 30,87; p-value<0.001). CONCLUSIONS: PHC mitigates the occurrence of Covid-19 and its deaths in a region of social vulnerability in Brazil together with social isolation. However, it is not known until when the system will withstand the overload in view of the low adhesion to social isolation, the lack of support and appropriate direction from the government to its population.

Influence of physical activity and postural habits in schoolchildren with scoliosis.

BACKGROUND: Scoliosis is considered one of the main musculoskeletal changes in childhood, and is characterized by three-dimensional changes in the spine. Schoolchildren is a group who are directly exposed to this condition because they go through a rapid growth phase in adolescence, added to other external factors such as school environment and daily living habits such as little physical activity. This study aimed to identify the risk factors associated with scoliosis in schoolchildren. METHODS: An observational, retrospective case control study with a quantitative approach was carried out in the city of Santa Cruz/RN. The presence of scoliosis was assessed using the Adams test and physical activity by the Daily Physical Activity Index (IPAQ) and by a questionnaire on competitive sports practice, in addition to a questionnaire on postural habits in childhood and adolescence. Conditional multiple logistic regression was performed for statistical analysis, and the adjusted Odds Ratios (OR) and the respective confidence intervals (95%) of the outcome variable were estimated. RESULTS: A total of 156 schoolchildren participated in the study, with an average age of 13.9 years, with 55.1% being female and 44.9% male, attending between the 6th grade of elementary school and the 3rd year of high school. Furthermore, 42.9% of these participants were considered irregularly active and only 33.3% practiced physical activity on a regular basis. After bivariate analysis and conditional logistic regression, little physical activity was shown to be a risk factor for scoliosis (p = 0.041; OR: 2.81; 95% CI: 1.04-7.57), while the postural habits evaluated in this study did not show a statistical association with scoliosis. CONCLUSION: Low practice of physical activity and schoolchildren being classified as irregularly active were considered as risk factors for scoliosis, however postural habits do not seem to be associated with this condition.

Prevalência e fatores associados à Síndrome da dor Patelofemoral em escolares de Natal/RN / Prevalence and factors associated with Patellofemoral pain syndrome in schoolchildren from Natal/RN

Objetivo: Estimar a prevalência e analisar os fatores relacionados à Síndrome da dor Patelofemoral (SDPF) em escolares de ambos os sexos, entre 10 e 18 anos, matriculados no ensino público fundamental e médio do município de Natal/RN. Métodos: A pesquisa teve caráter exploratório descritivo, transversal e quantitativo realizada no município de Natal-RN. Foi avaliada a presença da SDPF, o nível de atividade física, a qualidade do movimento, o índice de massa corporal (IMC), o tipo de pé, o nível de dor e o comprometimento funcional. As prevalências foram calculadas a partir do desenho complexo de amostragem com a inclusão dos pesos e efeitos de cluster. Para a análise de associação, foram calculadas as Razões de Prevalência (RP) ajustadas e os respectivos intervalos de confiança (95%) do desfecho em relação às variáveis independentes e adotado um nível de significância de 5%. Resultados: Participaram da pesquisa 144 escolares, 51,4 % (IC:41,6 ­ 61,1) da amostra tem o sexo masculino. Foi observada uma prevalência de 29,7% (IC:21,5 ­ 39,4) da SDPF. No modelo ajustado a SDPF foi mais prevalente no sexo feminino (p = 0,02) (RP: 1,82 IC: 1,0 ­ 3,0), nos indivíduos ativos (p = 0,02) (RP:2,3 IC: 1,13 ­ 4,9), nos jovens abaixo do peso (p = 0,03) (RP: 1,9 IC:1,0 ­ 3,6). Quando avaliados por sexo, os homens apresentaram uma associação positiva entre a pobre qualidade do movimento do membro direito (p: 0,01) (RP: 6,0 IC: 1,3 ­ 26) e o desfecho e o sexo feminino obteve uma associação com a presença do valgo dinâmico do joelho esquerdo (p: 0,03) (RP: 2,4 IC:1,0 ­ 5,8). Conclusões: A prevalência da SDPF foi maior no sexo feminino, em jovens ativos, e com baixo peso, ao mesmo tempo, a pobre qualidade do movimento foi associada aos jovens homens com a síndrome e a presença do valgo dinâmico do joelho nas jovens (AU).

Objective: To estimate the prevalence and analysis the factors related to patellofemoral pain syndrome (PFPS) in schoolchildren of both genders, between 10 and 18 years old, enrolled in public elementary and high school in the city of Natal / RN. Methods: The research had an exploratory, descriptive, transversal, and quantitative character carried out in the city of NatalRN. The presence of PFPS was evaluated, as well as the level of physical activity through IPAQ, the quality of movement, body mass index, navicular drop test, pain level and Kujala questionnaire. The prevalence was calculated from the complex sampling design with the inclusion of weights and cluster effects. For an association analysis, adjusted Prevalence Ratios (PR) and the confidence intervals (95%) of the outcome in relation to the independent variables were calculated and a significance level of 5% was adopted. Results: 144 students participated in the research, 51.4% (CI: 41.6 - 61.1) of the sample is male. A prevalence of 29.7% (CI: 21.5 - 39.4) of PFPS was observed. In the adapted model, the PFPS was more prevalent in females (p = 0.02) (PR: 1.82 CI: 1.0 - 3.0), in physical active (p = 0.02) (PR: 2, 3 CI: 1.13 - 4.9), in underweight youth (p = 0.03) (PR: 1.9 CI: 1.0 - 3.6). When obtained by sex, men associated a positive association between poor quality of movement of the right limb (p: 0.01) (PR: 6.0 CI: 1.3 - 26) and the outcome and the female sex obtained an association with the presence of the dynamic valgus of the left knee (p: 0.03) (PR: 2.4 CI: 1.0 - 5.8). Conclusions: The prevalence of PFPS was higher in females, in active young people, and with low weight, at the same time, the poor quality of movement associated with young male people with the syndrome and the presence of dynamic knee valgus in young women (AU).

Hospitalization for ischemic stroke in Brazil: an ecological study on the possible impact of Hiperdia. / Hospitalização por acidente vascular encefálico isquêmico no Brasil: estudo ecológico sobre possível impacto do Hiperdia.

OBJECTIVE: The study evaluated the trend of hospitalization for ischemic stroke (HIS) and its hospital mortality in Brazil over the last 15 years as well as the impact of the Hiperdia program in this scenario. METHODS: An ecological study was designed with analytical approach and data collected in the Hospital Admission System on episodes of stroke, over the years 1998 to 2012. All data were stratified by sex and age, creating an indicator for HIS and proportion of hospital mortality. To estimate the trend of the data a polynomial curve fitting was created; and the Generalized Linear Model was applied to investigate the impact of Hiperdia on the endpoint HIS and hospital mortality. We adopted a 5% significance level to minimize an error type I. RESULTS: We observed a reduction of HIS from 37.57/105 inhabitants in 1998 to 2001 to 10.33/105 inhabitants in 2002 to 2005, declining 73.64%. The reduction occurred in both sexes and for all age groups. The mortality rate of ischemic stroke also declined in Brazil since 2002, in both men and women, therefore in less than 3%; and only in the groups aged between 0 and 14 and above 80 years, we did not detect trend. CONCLUSION: Therefore, the decline of HIS temporally coincided with the implementation of Hiperdia in 2002 and this trend continues today.

Hospitalização por acidente vascular encefálico isquêmico no Brasil: estudo ecológico sobre possível impacto do Hiperdia / Hospitalization for ischemic stroke in Brazil: an ecological study on the possible impact of Hiperdia

RESUMO: Objetivo: O estudo avaliou a tendência de hospitalização por acidente vascular encefálico isquêmico (HAVEI) e a sua mortalidade hospitalar no Brasil nos últimos 15 anos, assim como o impacto do programa Hiperdia nesse cenário. Métodos: Delineou-se um estudo ecológico com abordagem analítica e dados coletados no Sistema de Internação Hospitalar sobre episódios de AVEI, referentes aos anos de 1998 a 2012. Todos os dados foram estratificados por sexo e faixa etária, criando-se um indicador para HAVEI e proporção de mortalidade hospitalar. A fim de estimar a tendência dos dados criou-se uma curva polinomial de melhor aderência e para a averiguar o impacto do Hiperdia aplicou-se o Modelo Linear Generalizado tomados como desfecho a HAVEI e a mortalidade hospitalar. Adotou-se um nível de significância de 5% para minimizar um erro tipo I. Resultados: Foi evidenciada redução das HAVEI de 37,57/105 habitantes em 1998 a 2001 para 10,33/105 habitantes em 2002 a 2005, declinando 73,64%. A redução aconteceu em ambos os sexos, assim como para todas as faixas etárias. A mortalidade hospitalar por AVEI também declinou no Brasil a partir de 2002, tanto em homens como em mulheres, porém em menos de 3% e apenas nas faixas entre 0 e 14 anos e acima de 80 anos não detectamos tendência. Conclusão: Portanto, o declínio das HAVEI coincidiu temporalmente com a implementação do Hiperdia no ano de 2002 e essa tendência se mantém até hoje.

ABSTRACT: Objective: The study evaluated the trend of hospitalization for ischemic stroke (HIS) and its hospital mortality in Brazil over the last 15 years as well as the impact of the Hiperdia program in this scenario. Methods: An ecological study was designed with analytical approach and data collected in the Hospital Admission System on episodes of stroke, over the years 1998 to 2012. All data were stratified by sex and age, creating an indicator for HIS and proportion of hospital mortality. To estimate the trend of the data a polynomial curve fitting was created; and the Generalized Linear Model was applied to investigate the impact of Hiperdia on the endpoint HIS and hospital mortality. We adopted a 5% significance level to minimize an error type I. Results: We observed a reduction of HIS from 37.57/105 inhabitants in 1998 to 2001 to 10.33/105 inhabitants in 2002 to 2005, declining 73.64%. The reduction occurred in both sexes and for all age groups. The mortality rate of ischemic stroke also declined in Brazil since 2002, in both men and women, therefore in less than 3%; and only in the groups aged between 0 and 14 and above 80 years, we did not detect trend. Conclusion: Therefore, the decline of HIS temporally coincided with the implementation of Hiperdia in 2002 and this trend continues today.

Factors associated with scoliosis in schoolchildren: a cross-sectional population-based study.

BACKGROUND: The present study aimed to investigate the prevalence of scoliosis and to analyze the factors associated with scoliosis in schoolchildren aged between 7 and 17 years. METHODS: This is a cross-sectional and quantitative study with stratified random selection of public school students in the city of Santa Cruz, Brazil. The presence of scoliosis was examined, as well as the flexibility of the posterior muscle chain, socioeconomic characteristics, anthropometry, lifestyle habits, sexual maturation, and ergonomics of school furniture. In order to identify factors associated with scoliosis, the variables were divided in biological, socioeconomic, lifestyle, and ergonomic factors, and crude and adjusted prevalence ratios (PRs) were estimated by means of Poisson regression analysis. RESULTS: Two hundred and twelve pupils participated in this study (mean age 11.61 years, 58% female). The prevalence of scoliosis was 58.1% (n = 123) and associated with female sex (PR 2.54; 95% CI, 1.33-4.86) and age between 13 and 15 years (PR 5.35; 95% CI, 2.17-13.21). Sleeping in a hammock was inversely associated with scoliosis (PR 0.44; 95% CI, 0.23-0.81). CONCLUSIONS: Scoliosis seems to be positively associated with female sex and age between 13 and 15 years, whereas the habit of sleeping in a hammock is negatively associated with the onset of scoliosis.