Predictive value of functional disability scales among stroke survivors: A long-term mortality evaluation in a Brazilian stroke cohort.

OBJECTIVE: To assess the influence of two functional scales- Modified Rankin Scale (m-RS) and Modified Katz Index (m-Katz Index) on long-term mortality in a stroke cohort. MATERIAL AND METHODS: Among 760 stroke survivors (median age: 66 (IQR:56-75), 56.4 % women) m-Katz Index and m-RS scales applied at 1 and 6 months after stroke, were investigated in relation to 12-years of all-cause mortality. Kaplan-Meier survival curves were computed, and time-varying covariate Cox regression models were fitted to calculate hazard ratios (HRs) with 95 % confidence intervals (CIs) in all sample and by sex. The prognostic ability of the fitted models was computed for each model by six different measures. RESULTS: After 12 years of follow-up (median survival time: 7.3 years), 311 participants died. Overall survival curves show lower survival rates among those with the highest levels of disability/dependence (all log-rank p-values <0.0001). These findings were confirmed in all regression models for both sexes, particularly in men who had higher levels of dependence on Activities of Daily Living (ADLs) by m-Katz Index and severe disability by m-RS and presented the highest HR of dying (HR: 3.34 (95 %CI: 2.27-4.92) and HR: 4.94 (95 % CI: 3.15-7.75), respectively). CONCLUSIONS: Both the m-Katz Index and the m-RS scale were good predictors of long-term mortality, which is of importance for guiding the functional rehabilitation of stroke patients. Besides, high levels of disability and dependence were implicated with high mortality risks, regardless of sex.

Construção do mapa de grávidas como ferramenta de controle no enfrentamento da covid-19 em belém-PA: relato de experiência / Construction of the pregnant women map as a control tool in the confrontation of covid-19 in the municipality of Belém-PA: an experience report / Construcción del mapa de embarazadas como herramienta de control en enfrentamiento-19 en el municipio de Belém-PA: informe de experiencia

Introdução:No início de 2020 a Organização Mundial da Saúde declarou o período pandêmico pelo novo coronavírus, SARS-COV-2, agente etiológico da Covid-19, o qual tem se propagado pelo mundo. Diante disso, faz-se necessário refletir sobre as complicações durante a gestação a fim de superar esses desafios que perpassam esse contexto. Objetivo:Possibilitar o controle das gestantes por meio da tecnologia educacional do tipo mapa de grávidas. Metodologia:Trata-se de um estudo descritivo, do tipo relato de experiência com abordagem qualitativa. Resultados:A ideia inicial identificava as grávidas de acordo como o sexo do bebê, sendo que a produção dessas grávidas se dava a partir da utilização da folha do Etil, Vinil e Acetato.Logo, a gravida da cor verde indicava que o profissional não tinha conhecimento do sexo do bebê, a rosa identificava o sexo feminino e a azul o sexo masculino, porém ao longo das oficinas, este método de identificação foi modificado.Conclusões:A experiência de vivenciar este projeto observando o empenho dos profissionais que compõe a equipe da unidade de saúde, como enfermeira, técnica de enfermagem, agentes comunitários de saúde e médico e dentistas em construir seu mapa e levar isso para sua unidade, foi bastante satisfatória, uma vez que, permite que os profissionaise discentes fortaleçam a autonomia do cuidar e consequentemente a prática laboral (AU).

Introduction:TheIn early 2020, the World Health Organization declared a pandemic period by the new coronavirus, SARS-COV-2, etiologic agent of Covid-19, which has been spreading around the world. Therefore, it is necessary to reflect on the complications during pregnancy and the importance of nurses' care in order to overcome these challenges that permeate this context. Objective:Permitir el control de las mujeres embarazadas a través de la tecnología educativa del tipo de mapa de las mujeres embarazadas. Methodology:This is a descriptive study, of the experience report type, with a qualitative approach. Results:The initial idea was to identify pregnant women according to the sex of the baby, and the production of these pregnant women was done through the use of theEthyl, Vinyl and Acetate. Thus, the green gravida indicated that the professional had no knowledge of the sex of the baby, pink identified the female sex and blue the male sex, but throughout the workshops, this method of identification was modified. Conclusions:The experience of living this project, observing the professionals' effort to build their map and take it to their unit, was very satisfying and enhanced the student's experience (AU).

A principios de 2020, la Organización Mundial de la Salud (OMS) declaró un periodo de pandemia por el nuevo coronavirus, SARS-COV-2, agente etiológico del Covid-19, que se ha extendido por todo el mundo. Por lo tanto, es necesarioreflexionar sobre las complicaciones durante el embarazo y la importancia de los cuidados de las enfermeras para superar estos retos que impregnan este contexto. Objetivo: Permitir el control de las mujeres embarazadas a través de la tecnología educativa del tipo de mapa de las mujeres embarazadas. Metodología: Se trata de un estudio descriptivo, del tipo informe de experiencias con un enfoque cualitativo. Resultados: La idea inicial era identificar a las embarazadas según el sexo del bebé, y la elaboración de estas embarazadas se hacía mediante el uso de la hoja de Etilo, Vinilo y Acetato. Así, el verde gravida indicaba que el profesional no tenía conocimiento del sexo del bebé, el rosa identificaba el sexo femenino y el azul el masculino, pero a lo largo de los talleres, este método de identificación se fue modificando. Conclusiones: La experiencia de vivir este proyecto observando el compromiso de los profesionales en la construcción de su mapa y llevándolo a su unidad, fue muy satisfactoria y mejoró la experiencia del estudiante (AU).

Images that speak: A Portuguese Photovoice study on the psychosocial experience of a migrant population from Cape Verde after a first episode of psychosis.

Several migrant populations have been identified worldwide as high-risk groups for psychosis because of their experience of social adversity. Recent evidence suggests that the local contexts in which these populations live should be addressed in their complexity to take into account individual and larger societal environmental aspects. This study aimed to assess the lived experiences of a group of migrant Cape Verdean patients, who had been recently hospitalized for a first episode of psychosis in a mental health service on the outskirts of Lisbon, Portugal. The study used Photovoice, a qualitative participatory research method in which people's experiences are documented through photography. Six individuals were recruited, and five weekly sessions were conducted to collect data that were analyzed thematically. Emergent themes addressed two main categories of well-being and illness. Participant concepts of well-being were rooted in a definition of freedom encompassing cultural expression, conveyed by familiar environments and supporting communities. Cultural differences may be experienced as important obstacles for well-being and can be associated with feelings of oppression and guilt. Participants' accounts focused on positive aspects of life despite illness and on personal concepts of recovery. The study findings contribute to knowledge of the dynamics of migrants' social experience and underscore the importance of socially and culturally informed mental healthcare institutions.

Impaired flexibility in patients with tropical spastic paraparesis/HTLV-associated myelopathy: evaluation via pendulum fleximeter.

BACKGROUND: Flexibility is crucial to the harmonious execution of joint movements. While skeletal muscle dysfunction in patients with HTLV-1 can interfere with mobility, it is unclear whether these patients experience reduced flexibility. OBJECTIVE: To evaluate the differences in flexibility between HTLV-1-infected individuals with and without myelopathy compared with uninfected controls. We also investigated whether age, sex, body mass index (BMI), physical activity level, or lower back pain influence flexibility in HTLV-1-infected individuals. METHODS: The sample consisted of 56 adults, of which 15 did not have HTLV-1, 15 had HTLV-1 without myelopathy, and 26 had TSP/HAM. Their flexibility was assessed using the sit-and-reach test and a pendulum fleximeter. RESULTS: No differences in flexibility were observed between the groups with and without myelopathy and controls without HTLV-1 infection using the sit-and-reach test. The pendulum fleximeter results of individuals with TSP/HAM presented the lowest flexibility among the groups with respect to trunk flexion, hip flexion and extension, knee flexion, and ankle dorsiflexion, even after adjusting for age, sex, BMI, level of physical activity, and lower back pain using multiple linear regression models. Additionally, HTLV-1-infected individuals without myelopathy demonstrated reduced flexibility in movements: knee flexion, dorsiflexion, and ankle plantar flexion. CONCLUSIONS: Individuals with TSP/HAM demonstrated reduced flexibility in most of the movements evaluated by the pendulum fleximeter. Additionally, HTLV-1-infected individuals without myelopathy demonstrated reduced knee and ankle flexibility, potentially representing a marker of myelopathic development.

ANTECEDENTES: A flexibilidade é fundamental para a execução harmoniosa dos movimentos articulares. Embora a disfunção do músculo esquelético em pacientes com HTLV-1 possa interferir na mobilidade, não está claro se esses pacientes apresentam flexibilidade reduzida. OBJETIVO: Avaliar as diferenças de flexibilidade entre os indivíduos infectados com e sem mielopatia e o grupo controle sem infecção HTLV-1. Também investigamos se idade, sexo, índice de massa corporal (IMC), nível de atividade física ou dor lombar influenciam a flexibilidade em indivíduos infectados pelo HTLV-1. MéTODOS: A amostra foi composta por 56 adultos, dos quais 15 não possuíam HTLV-1, 15 possuíam HTLV-1 sem mielopatia e 26 possuíam TSP/HAM. A flexibilidade foi avaliada por meio do teste de sentar e alcançar e do flexímetro de pêndulo. RESULTADOS: Não foram observadas diferenças na flexibilidade entre os grupos com e sem mielopatia no teste de sentar e alcançar. Os resultados do flexímetro pendular dos indivíduos com TSP/HAM apresentaram a menor flexibilidade entre os grupos em relação à flexão do tronco, flexão e extensão do quadril, flexão do joelho e dorsiflexão do tornozelo, mesmo após ajuste para idade, sexo, IMC, nível de atividade física e dor lombar usando modelos de regressão múltipla linear. Além disso, os indivíduos infectados pelo HTLV-1 sem mielopatia demonstraram redução da flexibilidade nos movimentos de flexão do joelho, dorsiflexão e flexão plantar do tornozelo. CONCLUSãO: Indivíduos com TSP/HAM demonstraram redução da flexibilidade na maioria dos movimentos avaliados pelo flexímetro pendular. Além disso, indivíduos infectados pelo HTLV-1 sem mielopatia demonstraram redução da flexibilidade do joelho e tornozelo, representando potencialmente um marcador de desenvolvimento mielopático.

LOCUS (LOng Covid-Understanding Symptoms, events and use of services in Portugal): A three-component study protocol.

Approximately 10% of patients experience symptoms of Post COVID-19 Condition (PCC) after a SARS-CoV-2 infection. Akin acute COVID-19, PCC may impact a multitude of organs and systems, such as the cardiovascular, respiratory, musculoskeletal, and neurological systems. The frequency and associated risk factors of PCC are still unclear among both community and hospital settings in individuals with a history of COVID-19. The LOCUS study was designed to clarify the PCC's burden and associated risk factors. LOCUS is a multi-component study that encompasses three complementary building blocks. The "Cardiovascular and respiratory events following COVID-19" component is set to estimate the incidence of cardiovascular and respiratory events after COVID-19 in eight Portuguese hospitals via electronic health records consultation. The "Physical and mental symptoms following COVID-19" component aims to address the community prevalence of self-reported PCC symptoms through a questionnaire-based approach. Finally, the "Treating and living with Post COVID-19 Condition" component will employ semi-structured interviews and focus groups to characterise reported experiences of using or working in healthcare and community services for the treatment of PCC symptoms. This multi-component study represents an innovative approach to exploring the health consequences of PCC. Its results are expected to provide a key contribution to the optimisation of healthcare services design.

Impaired flexibility in patients with tropical spastic paraparesis/HTLV-associated myelopathy: evaluation via pendulum fleximeter / Flexibilidade prejudicada em pacientes com paraparesia espástica tropical/mielopatia associada ao HTLV: avaliação via flexímetro pendular

Abstract Background Flexibility is crucial to the harmonious execution of joint movements. While skeletal muscle dysfunction in patients with HTLV-1 can interfere with mobility, it is unclear whether these patients experience reduced flexibility. Objective To evaluate the differences in flexibility between HTLV-1-infected individuals with and without myelopathy compared with uninfected controls. We also investigated whether age, sex, body mass index (BMI), physical activity level, or lower back pain influence flexibility in HTLV-1-infected individuals. Methods The sample consisted of 56 adults, of which 15 did not have HTLV-1, 15 had HTLV-1 without myelopathy, and 26 had TSP/HAM. Their flexibility was assessed using the sit-and-reach test and a pendulum fleximeter. Results No differences in flexibility were observed between the groups with and without myelopathy and controls without HTLV-1 infection using the sit-and-reach test. The pendulum fleximeter results of individuals with TSP/HAM presented the lowest flexibility among the groups with respect to trunk flexion, hip flexion and extension, knee flexion, and ankle dorsiflexion, even after adjusting for age, sex, BMI, level of physical activity, and lower back pain using multiple linear regression models. Additionally, HTLV-1-infected individuals without myelopathy demonstrated reduced flexibility in movements: knee flexion, dorsiflexion, and ankle plantar flexion. Conclusions Individuals with TSP/HAM demonstrated reduced flexibility in most of the movements evaluated by the pendulum fleximeter. Additionally, HTLV-1-infected individuals without myelopathy demonstrated reduced knee and ankle flexibility, potentially representing a marker of myelopathic development.

Resumo Antecedentes A flexibilidade é fundamental para a execução harmoniosa dos movimentos articulares. Embora a disfunção do músculo esquelético em pacientes com HTLV-1 possa interferir na mobilidade, não está claro se esses pacientes apresentam flexibilidade reduzida. Objetivo Avaliar as diferenças de flexibilidade entre os indivíduos infectados com e sem mielopatia e o grupo controle sem infecção HTLV-1. Também investigamos se idade, sexo, índice de massa corporal (IMC), nível de atividade física ou dor lombar influenciam a flexibilidade em indivíduos infectados pelo HTLV-1. Métodos A amostra foi composta por 56 adultos, dos quais 15 não possuíam HTLV-1, 15 possuíam HTLV-1 sem mielopatia e 26 possuíam TSP/HAM. A flexibilidade foi avaliada por meio do teste de sentar e alcançar e do flexímetro de pêndulo. Resultados Não foram observadas diferenças na flexibilidade entre os grupos com e sem mielopatia no teste de sentar e alcançar. Os resultados do flexímetro pendular dos indivíduos com TSP/HAM apresentaram a menor flexibilidade entre os grupos em relação à flexão do tronco, flexão e extensão do quadril, flexão do joelho e dorsiflexão do tornozelo, mesmo após ajuste para idade, sexo, IMC, nível de atividade física e dor lombar usando modelos de regressão múltipla linear. Além disso, os indivíduos infectados pelo HTLV-1 sem mielopatia demonstraram redução da flexibilidade nos movimentos de flexão do joelho, dorsiflexão e flexão plantar do tornozelo. Conclusão Indivíduos com TSP/HAM demonstraram redução da flexibilidade na maioria dos movimentos avaliados pelo flexímetro pendular. Além disso, indivíduos infectados pelo HTLV-1 sem mielopatia demonstraram redução da flexibilidade do joelho e tornozelo, representando potencialmente um marcador de desenvolvimento mielopático.

Association between perception of COVID-19 risk, confidence in health services and avoidance of emergency department visits: results from a community-based survey in Portugal.

OBJECTIVES: To examine the association between the perception of COVID-19 risk, confidence in health services and avoidance of emergency department (ED) visits in Portugal during the COVID-19 pandemic. DESIGN: Community-based, cross-sectional survey. SETTING: Volunteer sample that completed the online survey between April 2020 and May 2021. PARTICIPANTS: 987 participants who perceived needing ED care. Of those, 242 reported avoiding ED visits. OUTCOME MEASURES: Logistic regression models for ED avoidance were conducted to estimate the effect of risk perception and confidence in health services, adjusted for sociodemographics, health status and time. RESULTS: The adjusted odds for ED avoidance were higher for participants lacking confidence in health service response to non-COVID-19 conditions (adjusted OR: 6.39; 95% CI 3.19 to 12.82) and COVID-19 (1.81; 1.19 to 2.77) and lower for those perceiving a low risk of being infected at a health provider (0.16; 0.07 to 0.38). CONCLUSION: In our sample, confidence in health services and risk perception of infection at a health provider were associated with the decision to avoid the ED. These results suggest that policymakers and care providers need to mitigate the negative consequences of delayed healthcare; be aware of the implications of distrust and fear from those in need of healthcare and provide equally distributed safe alternatives to ED care.

Cultural Adaptation and Validity Testing of the Portuguese Version of the Health Literacy Questionnaire (HLQ).

BACKGROUND: Health literacy is considered a determinant of self-management behaviors and health outcomes among people with diabetes. The assessment of health literacy is central to understanding the health needs of a population. This study aimed to adapt the Health Literacy Questionnaire (HLQ) to the Portuguese context and to examine the psychometric properties of a population of people with diabetes. METHODS: Data were collected using a self-administrated questionnaire from 453 people with diabetes in a specialized diabetes care unit. Analysis included item difficulty level, composite scale reliability, and confirmatory factor analysis (CFA). RESULTS: The HLQ showed that the items were easily understood by participants. Composite reliability ranged from 0.74 to 0.83. A nine-factor CFA model was fitted to the 44 items. Given the very restricted model, the fit was quite satisfactory [χ2wlsmv = 2147.3 (df = 866), p = 0.001; CFI = 0.931, TLI = 0.925, RMSEA = 0.057 (90% C.I. 0.054-0.060), and WRMR = 1.528]. CONCLUSION: The Portuguese version of the HLQ has shown satisfactory psychometric properties across its nine separate scales in people with diabetes. Given the strong observed properties of the HLQ across cultures, languages, and diseases, the HLQ is likely to be a useful tool in a range of Portuguese settings.

Factors Associated with COVID-19 Vaccine Hesitancy after Implementation of a Mass Vaccination Campaign.

An online cross-sectional study on COVID-19 vaccination adhesion was conducted in Portugal nine months after vaccination rollout (September-November 2021). Logistic regression was used to identify factors associated with hesitancy to take the COVID-19 vaccine in the community-based survey, "COVID-19 Barometer: Social Opinion". Hesitancy was 11%; however, of those, 60.5% stated that they intended to take the vaccine. Hesitancy was associated with factors such as lower monthly household income; no intention of taking the flu vaccine this year; perceived reasonable health status; having two or more diseases; low confidence in the health service response; worse perception of the adequacy of anti-COVID-19 government measures; low or no perceived risk of getting COVID-19; feeling agitated, anxious or sad some days; and lack of trust in the safety and efficacy of the vaccines. Confidence in vaccines, namely against COVID-19, is paramount for public health and should be monitored during vaccination rollout. Clear communication of the risks and benefits of vaccination needs improvement to increase adherence and public confidence.

Factors Associated with the Patient's Decision to Avoid Healthcare during the COVID-19 Pandemic.

The COVID-19 pandemic has resulted in changes in healthcare use. This study aimed to identify factors associated with a patient's decision to avoid and/or delay healthcare during the COVID-19 pandemic. We used data from a community-based survey in Portugal from July 2020 to August 2021, "COVID-19 Barometer: Social Opinion", which included data regarding health services use, risk perception and confidence in health services. We framed our analysis under Andersen's Behavioural Model of Health Services Use and utilised Poisson regression to identify healthcare avoidance associated factors. Healthcare avoidance was high (44%). Higher prevalence of healthcare avoidance was found among women; participants who reported lower confidence in the healthcare system response to COVID-19 and non-COVID-19; lost income during the pandemic; experienced negative emotions due to physical distancing measures; answered the questionnaire before middle June 2021; and perceived having worse health, the measures implemented by the Government as inadequate, the information conveyed as unclear and confusing, a higher risk of getting COVID-19, a higher risk of complications and a higher risk of getting infected in a health institution. It is crucial to reassure the population that health services are safe. Health services should plan their recovery since delays in healthcare delivery can lead to increased or worsening morbidity, yielding economic and societal costs.

Validade e reprodutibilidade do Teste Avaliativo de DTM: um estudo de acurácia diagnóstica / Validity and reproducibility of the TMD Assessment Test: diagnostic accuracy study

INTRODUÇÃO: Disfunções temporomandibulares (DTM) são distúrbios na ATM, sendo de origem muscular, articular ou mista, e com íntima relação com alterações posturais. Instrumentos de diagnóstico apresentam lacunas quanto à aplicação clínica e não associam à postura. OBJETIVO: Validar o Teste Avaliativo de DTM (TAvDTM) quanto à acurácia diagnóstica e reprodutibilidade. MATERIAIS E MÉTODOS: Estudo de acurácia diagnóstica com indivíduos entre 18 e 59 anos avaliados pelo Índice Anamnésico de Fonseca (IAF), questionário sociodemográfico e TAvDTM, este último realizado por três examinadores diferentes e treinados. O resultado da categorização do diagnóstico do IAF foi comparado com o resultado do TAvDTM. Para acurácia diagnóstica utilizou-se teste Qui-Quadrado. Valores Preditivos Positivos (VPP) e Negativos (VPN) foram determinados. A reprodutibilidade entre os três examinadores foi feita por meio do Kappa de Cohen, para análise 2x2 e de Fleiss. Todos os testes com significância de 5%. RESULTADOS: Dos 10 participantes avaliados, o IAF identificou 8 com diagnóstico de DTM, enquanto o TAvDTM verificou 9 participantes com presença desta disfunção. A sensibilidade foi de 100%, especificidade de 50%, VPP de 88% e VPN de 50%. O Kappa de Fleiss evidenciou confiabilidade razoável (K = 0,26 [IC 95%: -0,099 ­ 0,617]; p>0,05). O Kappa de Cohen mostrou reprodutibilidade insignificante entre os avaliadores 1 e 2 (K=-0,11; p>0,05; discordância=80%), e 1 e 3 (K= -0,11; p>0,05; discordância=80%), reprodutibilidade perfeita entre os avaliadores 2 e 3 (K=1,00; p<0,05; concordância=100%). CONCLUSÃO: O TAvDTM apresenta alta sensibilidade e baixa especificidade, porém com baixa capacidade de reprodução até o presente momento.

INTRODUCTION: Temporomandibular disorders are TMJ disorders of muscular, articular, or mixed origin and closely related to postural alterations. Diagnostic tools have gaps regarding clinical application and do not associate posture. OBJECTIVE: Validate the TMD Assessment Test (TMDAsT) regarding its diagnostic accuracy and reproducibility. MATERIALS AND METHODS: Diagnostic accuracy study with individuals between 18 and 59 years old evaluated by the Fonseca Assessment Index (FAI), sociodemographic questionnaire, and TMDAsT, the latter performed by three different trained examiners. The result of FAI diagnosis categorization was compared with the result of TMDAsT. A Chi-square test was used for diagnostic accuracy. Positive predictive values (PPV) and negative predictive values (NPV) were determined. The Kappa of Fleiss did the reproducibility between three examiners. Cohen's Kappa, for 2x2 analysis. All tests with 5% significance. RESULTS: Of the 10 participants assessed, FAI identified 8 participants with a TMD diagnosis while the TMDAsT verified 9 participants with this dysfunction. Sensitivity was 100%, specificity 50%, PPV 88% and NPV 50%. Fleiss' Kappa showed reasonable reliability (K = 0.26 [95% CI: -0.099 - 0.617]; p>0.05). Cohen's Kappa showed insignificant reproducibility between observers 1 and 2 (K=-0.11; p>0.05; discordance=80%), and 1 and 3 (K= -0.11; p>0.05; discordance=80%), perfect reproducibility between observers 2 and 3 (K=1.00; p<0.05; concordance=100%). CONCLUSION: TMDAsT presents high sensitivity and low specificity but with low reproducibility until the present moment.

Migrant Communities at the Center in Co-design of Health Literacy-Based Innovative Solutions for Non-communicable Diseases Prevention and Risk Reduction: Application of the OPtimising HEalth LIteracy and Access (Ophelia) Process.

The drivers of high prevalence of non-communicable diseases (NCD) among migrants are well-documented. Health literacy is regarded as a potential tool to reduce health inequalities and improve migrant's access to and quality of health care. Yet, little is known about the health literacy needs among these groups and how to address them. This paper outlines the protocol for a migrant community-based co-design project that seeks to optimize health literacy, health promotion, and social cohesion in support of prevention of NCDs among migrants in Lisbon using the OPtismizing HEalth LIteracy and Access (Ophelia) process. This participatory implementation research project starts with a mixed-methods needs assessment covering health literacy strengths, weaknesses and needs of migrants, and local data about determinants of health behaviors, service engagement, and organizational responsiveness. Diverse migrant groups will be engaged and surveyed using the Health Literacy Questionnaire and questions on sociodemographic and economic characteristics, health status, use of health services, and perceived impact of the COVID-19 pandemic. Semi-structured interviews with migrants will also be conducted. Based on data collected, vignettes will be developed representing typical persons with diverse health literacy profiles. Migrants and stakeholders will participate in ideas generation workshops for depth co-creation discussions in simulated real-world situations based on the vignettes, to design health literacy-based multisectoral interventions. Selected interventions will be piloted through quality improvement cycles to ensure ongoing local refinements and ownership development. Through a genuine engagement, the project will evaluate the uptake, effectiveness and sustainability of the interventions. This protocol takes a grounded approach to produce evidence on real health literacy needs from the perspective of key stakeholders, especially migrants, and embodies strong potential for effective knowledge translation into innovative, locally relevant, culturally and context congruent solutions for prevention of NCDs among migrants. Given the diverse communities engaged, this protocol will likely be adaptable to other migrant groups in a wide range of contexts, particularly in European countries. The scale-up of interventions to similar contexts and populations will provide much needed evidence on how health literacy interventions can be developed and applied to reduce health inequality and improve health in diverse communities.

Pregnancy-lactation cycle: how to use imaging methods for breast evaluation.

Pregnancy and lactation constitute states of intense hormonal variation with secretory and structural changes in the breast parenchyma. These changes translate into important features on breast imaging, as well as the emergence of specific benign and malignant lesions. This literature review aims to discuss the safety of the use of breast imaging methods (mammography, ultrasound, and magnetic resonance imaging) during the pregnancy-lactation cycle, and to present the expected physiological changes and imaging appearance of the main breast diseases that may occur in this period, such as galactocele, lactating adenoma, fibroadenoma, puerperal mastitis, and pregnancy-associated breast cancer.

A gravidez e a lactação são estados de intensa variação hormonal e mudanças estruturais e secretórias no parênquima mamário. Essas alterações se traduzem em características importantes nos aspectos de imagem da mama, bem como propiciam o surgimento de lesões benignas e malignas específicas. A presente revisão de literatura tem por objetivo discutir a segurança da utilização dos métodos imagem da mama (mamografia, ultrassonografia e ressonância magnética) durante o ciclo gravídico-lactacional e apresentar as alterações fisiológicas esperadas e os aspectos de imagem das principais doenças mamárias que podem ocorrer nesse período, como galactocele, adenoma lactacional, fibroadenoma, mastites puerperais e câncer de mama relacionado à gestação.

Pregnancy-lactation cycle: how to use imaging methods for breast evaluation / Ciclo gravídico-lactacional: como utilizar os métodos de imagem na avaliação da mama

Abstract Pregnancy and lactation constitute states of intense hormonal variation with secretory and structural changes in the breast parenchyma. These changes translate into important features on breast imaging, as well as the emergence of specific benign and malignant lesions. This literature review aims to discuss the safety of the use of breast imaging methods (mammography, ultrasound, and magnetic resonance imaging) during the pregnancy-lactation cycle, and to present the expected physiological changes and imaging appearance of the main breast diseases that may occur in this period, such as galactocele, lactating adenoma, fibroadenoma, puerperal mastitis, and pregnancy-associated breast cancer.

Resumo A gravidez e a lactação são estados de intensa variação hormonal e mudanças estruturais e secretórias no parênquima mamário. Essas alterações se traduzem em características importantes nos aspectos de imagem da mama, bem como propiciam o surgimento de lesões benignas e malignas específicas. A presente revisão de literatura tem por objetivo discutir a segurança da utilização dos métodos imagem da mama (mamografia, ultrassonografia e ressonância magnética) durante o ciclo gravídico-lactacional e apresentar as alterações fisiológicas esperadas e os aspectos de imagem das principais doenças mamárias que podem ocorrer nesse período, como galactocele, adenoma lactacional, fibroadenoma, mastites puerperais e câncer de mama relacionado à gestação.

Palmilhas de reprogramação postural na diminuição da pressão arterial e do desalinhamento postural em indivíduos hipertensos: ensaio clínico randomizado / Postural reprogramming insoles for blood pressure fall and posture misalignment in hypertensive individuals: randomized clinical trial

Testar a hipótese que Palmilhas de Reprogramação Postural (PRP) melhoram a postura e podem modificar média e picos de pressão arterial (PA) em indivíduos hipertensos. DESENHO DE ESTUDO: ECR, registrado no Clinical Trials (NCT02401516), com 24 indivíduos hipertensos. CONFIGURAÇÃO: Todos foram submetidos à Monitorização Ambulatorial da Pressão Arterial (MAPA) e avaliação da postura (SAPO) no início e após seis semanas. INTERVENÇÃO: grupo intervenção (GI) utilizou PRP e grupo controle (GC) SHAM. DESFECHO PRIMÁRIO: Médias da PA. DESFECHOS SECUNDÁRIOS: Picos de PA, durante vigília e sono e ângulo posturais. A melhora da postura ocorreu quando valores angulares diminuíram ou chegaram a zero. Para comparar a PA, foram utilizados os testes t de Student, pareado e não-pareado, com nível de significância de 5%. O tamanho do efeito (TDE) foi avaliado com D de Cohen. Para postura, Wilcoxon e Mann-Whitney. Variáveis categóricas, através do teste do Qui-quadrado. RESULTADOS: As variáveis de linha de base não diferiram entre grupos. Foram obtidos os seguintes deltas: pico da PAS em vigília (+9,3mmHgVs-7,5mmHg) (p<0,05, grande TDE); pico da PAS no sono (+2,3mmHgVs-6,8mmHg) (p<0,05, TDE moderado); e pico da PAD durante vigília (+3,2mmHgVs-4,7mmHg) (p<0,05, grande TDE), GC e GI respectivamente. Para os ângulos posturais, 33% da PAS foram explicados pelo deslocamento anterior do corpo. Para a PAD, 46% e 55%, pelos ângulos de Joelho e Tornozelo, respectivamente. CONCLUSÕES: A PRP reduziu picos de PAS e PAD durante vigília, sem efeito na média da PA. Embora PRP não tenha mostrado melhora na postura geral, o deslocamento anterior do corpo e os ângulos de joelho e tornozelo explicaram 33-55% da PA mais alta.

To test the hypothesis that Postural Reprogramming Insoles (PRI) improves posture and the effect of PRI on average and peaks of blood pressure (BP) in hypertensive individuals. DESIGN: RCT, registered at the Clinical Trials (NCT02401516), with 24 hypertensive individuals. SETTING: All patients underwent Ambulatory Blood Pressure Monitoring (ABPM) and posture assessment (PAS/SAPO software) at the beginning and the end of six weeks. INTERVENTION: intervention group (IG) used PRI and control group (CG) SHAM. MAIN OUTCOME MEASURES: BP averages. SECONDARY OUTCOMES: BP peaks, during awake and asleep periods. Improvement of posture was determined when the angle values assessed decreased or reached zero (perfect alignment). To compare BP, paired, and unpaired Student's t-tests were used, significance level of 5%. Effect size (ES) was assessed with Cohen's D. For posture assessment, Wilcoxon and Mann-Whitney were applied to analysis. Categorical variables, through Chi-square test. RESULTS: Baseline variables did not differ between groups. The following deltas were obtained-SBP peak in awake period (+9.3mmHgVs-7.5mmHg) (p<0.05, great ES); SBP peak during sleeping period (+2.3mmHgVs-6.8mmHg) (p<0.05, moderate ES); and DBP peak during awake period (+3.2mmHgVs-4.7mmHg) (p<0.05, great ES), in control and intervention groups, respectively. For postural angles, 33% of SBP were explained by anterior body shift. For DBP, 46% and 55% were explained by Knee and Ankle Angles, respectively. CONCLUSIONS: PRI reduced SBP and DBP peaks during awake period, with no effect on BP average. Even though PRI has not shown any improvement in overall posture, anterior body displacement and knee and ankle angles would solely explain 33-55% of the highest BP.

Effect of Aerobic Exercise on Peak Oxygen Consumption, VE/VCO2 Slope, and Health-Related Quality of Life in Patients with Heart Failure with Preserved Left Ventricular Ejection Fraction: a Systematic Review and Meta-Analysis.

PURPOSE OF REVIEW: The aim of this study was to determine the effects of aerobic exercise on peak oxygen uptake (peak VO2), minute ventilation/carbon dioxide production (VE/VCO2 slope), and health-related quality of life (HRQoL) among patients with heart failure (HF) and preserved ejection fraction (HFpEF). RECENT FINDINGS: We conducted a Cochrane Library, MEDLINE/PubMed, Physiotherapy Evidence Database, and SciELO search (from 1985 to May 2019) for randomized controlled trials that evaluated the effects of aerobic exercise in HFpEF patients. We calculated the mean differences (MD) and 95% confidence interval (CI). Ten intervention studies were included providing a total of 399 patients. Compared with control, aerobic exercise resulted in improvement in peak VO2 MD 1.9 mL kg-1 min-1 (95% CI 1.3 to 2.5; N = 314) and HRQoL measured by Minnesota Living with Heart Failure MD 5.4 (95% CI - 10.5 to - 0.2; N = 256). No significant difference in VE/VCO2 slope was found between participants in the aerobic exercise group and the control group. The quality of evidence for peak VO2 and HRQoL was assessed as being moderate. Aerobic exercise moderately improves peak VO2 and HRQoL and should be considered a strategy of rehabilitation of HFpEF individuals.

Distância percorrida em indivíduos hipertensos: estudo de corte transversal / Distance travelled in hypertensive subjects: cross-sectional study

INTRODUÇÃO: A hipertensão arterial sistêmica é uma condição clínica ocasionada por diversos fatores que acarretam na elevação dos níveis de pressão arterial de forma sustentada, sendo importante avaliar a capacidade funcional desses indivíduos, visando ter-se um diagnóstico precoce, além de ser um meio de prevenção das repercussões da hipertensão. Um dos instrumentos utilizados é o teste de caminhada de seis minutos (TC6) que é executado em nível submáximo, possibilitando a análise das respostas dos sistemas envolvidos durante as atividades. OBJETIVOS: Verificar a distância percorrida dos indivíduos hipertensos. MATERIAIS E MÉTODOS: Estudo de corte transversal, com população de hipertensos, entre 30 e 60 anos. O TC6 foi realizado de acordo com protocolo padronizado pela ATS e calculada a distância prevista através da equação preditiva de Enright e Sherrill. Foi utilizado o teste T de Student para comparação das médias de distância e calculado o percentual da diferença entre os valores percorridos e previstos. RESULTADOS: 44 sujeitos de ambos os sexos foram avaliados e observou-se média de idade de 48,80±7,08 anos, 56,8% dos indivíduos apresentaram pressão controlada, 81,8% estavam em uso regular da medicação anti-hipertensiva. A média da distância obtida nos indivíduos que alcançaram os valores previstos foi de 503±38,6 metros. Sendo que a maioria dos indivíduos percorreram em média 86,3±7,2% da distância prevista. CONCLUSÃO: Indivíduos com hipertensão arterial apresentam diminuição da distância percorrida, independente da pressão arterial estar controlada ou não.

INTRODUCTION: Systemic arterial hypertension is a clinical condition caused by several factors that cause the elevation of blood pressure levels in a sustainable way, it is important to assess the functional capacity of these individuals, aiming to have an early diagnosis, in addition being a means of preventing the effects of hypertension. One of the instruments used is the six-minute walk test (6MWT) that runs in the submaximal level, enabling the analysis of the responses of the systems involved during the activities. OBJECTIVES: To determine the distance travelled of hypertensive individuals. MATERIALS AND METHODS: A cross-sectional study, with a population of hypertensive patients, between 30 and 60 years. The TC6 was performed according to a standardized protocol by the ATS and calculated the distance provided by the predictive equation of Enright and Sherril. The Student T test was used for comparison of the average distance and calculated the percentage difference between the values driven and laid down. RESULTS: 44 subjects of both genders were assessed, with an average age of 48.80±7.08 years, 56.8% of the individuals presented controlled pressure, 81.8% were in regular use of anti-hypertensive medication. The average distance obtained in individuals who have achieved the expected values was 503±38.6 meters. The majority of individuals have traveled on average 86.3±7.2% of the expected distance. CONCLUSION: Individuals with arterial hypertension have distance travelled reduced, whether blood pressure is controlled or not.

Retrospective analysis of computed tomography-guided percutaneous nephrostomies in cancer patients.

OBJECTIVE: To establish an overview of computed tomography (CT)-guided percutaneous nephrostomy performed at a referral center for cancer, addressing the characteristics of patients submitted to this intervention, as well as the indications for it, the technical specificities of it, and its main complications. MATERIALS AND METHODS: This was a retrospective study involving a review of the electronic medical records and images of patients submitted to CT-guided percutaneous nephrostomy at a referral center for cancer between 2014 and 2016. RESULTS: A total of 201 procedures were evaluated. In most cases, the obstruction was caused by a malignant neoplasm. Complications occurred in 9.5% of the cases, and an additional intervention was required (typically for catheter repositioning) in 36.6%. Post-procedure complications were not found to be significantly associated with the type of previous cancer treatment, the technique used, the caliber of the drain used in the procedure, or the degree of dilatation of the collection system prior to the procedure. CONCLUSION: In cancer patients, CT-guided percutaneous nephrostomy is an effective treatment, with success rates and complication rates similar to those reported in the general population.

OBJETIVO: Estabelecer o perfil da nefrostomia percutânea guiada por tomografia computadorizada (TC) em um centro de referência oncológico, conhecendo as características do paciente submetido a esta intervenção, indicações e especificidades técnicas do procedimento, além das complicações mais frequentes. MATERIAIS E MÉTODOS: Foi realizada revisão dos prontuários eletrônicos e das imagens de pacientes submetidos a nefrostomia percutânea guiada por TC entre os anos de 2014 e 2016 em um centro de referência oncológico. RESULTADOS: Foram avaliados 201 procedimentos. As doenças neoplásicas malignas foram as principais causas da obstrução. Houve necessidade de reabordagem em 36,6% dos casos, em sua maioria para reposicionamento do cateter, e ocorreram complicações em 9,5% dos casos. Não houve associação estatisticamente significante entre as complicações pós-nefrostomia percutânea e o tipo de tratamento oncológico prévio, a técnica empregada, o calibre do dreno utilizado no procedimento, ou o grau de dilatação do sistema coletor prévio ao procedimento. CONCLUSÃO: A nefrostomia percutânea guiada por TC é eficaz em pacientes oncológicos, com taxas de sucesso e complicações semelhantes às observadas na população geral na literatura.

Retrospective analysis of computed tomography-guided percutaneous nephrostomies in cancer patients / Análise retrospectiva das nefrostomias percutâneas guiadas por tomografia computadorizada em pacientes oncológicos

Abstract Objective: To establish an overview of computed tomography (CT)-guided percutaneous nephrostomy performed at a referral center for cancer, addressing the characteristics of patients submitted to this intervention, as well as the indications for it, the technical specificities of it, and its main complications. Materials and Methods: This was a retrospective study involving a review of the electronic medical records and images of patients submitted to CT-guided percutaneous nephrostomy at a referral center for cancer between 2014 and 2016. Results: A total of 201 procedures were evaluated. In most cases, the obstruction was caused by a malignant neoplasm. Complications occurred in 9.5% of the cases, and an additional intervention was required (typically for catheter repositioning) in 36.6%. Post-procedure complications were not found to be significantly associated with the type of previous cancer treatment, the technique used, the caliber of the drain used in the procedure, or the degree of dilatation of the collection system prior to the procedure. Conclusion: In cancer patients, CT-guided percutaneous nephrostomy is an effective treatment, with success rates and complication rates similar to those reported in the general population.

Resumo Objetivo: Estabelecer o perfil da nefrostomia percutânea guiada por tomografia computadorizada (TC) em um centro de referência oncológico, conhecendo as características do paciente submetido a esta intervenção, indicações e especificidades técnicas do procedimento, além das complicações mais frequentes. Materiais e Métodos: Foi realizada revisão dos prontuários eletrônicos e das imagens de pacientes submetidos a nefrostomia percutânea guiada por TC entre os anos de 2014 e 2016 em um centro de referência oncológico. Resultados: Foram avaliados 201 procedimentos. As doenças neoplásicas malignas foram as principais causas da obstrução. Houve necessidade de reabordagem em 36,6% dos casos, em sua maioria para reposicionamento do cateter, e ocorreram complicações em 9,5% dos casos. Não houve associação estatisticamente significante entre as complicações pós-nefrostomia percutânea e o tipo de tratamento oncológico prévio, a técnica empregada, o calibre do dreno utilizado no procedimento, ou o grau de dilatação do sistema coletor prévio ao procedimento. Conclusão: A nefrostomia percutânea guiada por TC é eficaz em pacientes oncológicos, com taxas de sucesso e complicações semelhantes às observadas na população geral na literatura.