Percepções de cuidadores sobre a vinculação de crianças com microcefalia na Atenção Básica de Saúde / Careful perceptions about the binding of children with microcephaly in Basic Health

A microcefalia é compreendida como uma alteração morfológica e funcional do sistema nervoso, em que o perímetro cefálico, verificado após o nascimento da criança, encontra-se inferior ao preconizado para a idade gestacional e o sexo. Esse parâmetro é essencial para o diagnóstico da malformação congênita1. Após constatada a microcefalia, faz-se necessário o acompanhamento do crescimento e desenvolvimento da criança nos primeiros anos de vida. O objetivo visa compreender as percepções de cuidadores acerca da vinculação de crianças com Síndrome Congênita do vírus Zika na Atenção Básica. Trata-se de uma pesquisa exploratória e descritiva, com abordagem qualitativa. Foram entrevistados nove cuidadores de crianças com Síndrome Congênita do vírus Zika, vinculadas ao Núcleo de Atenção Materno Infantil, que oferta atendimento a 14 crianças com microcefalia em Mossoró/RN. Todas as etapas para a realização desta pesquisa foram conduzidas de acordo com os preceitos éticos recomendados pela Resolução 466/12 do Conselho Nacional de Saúde. Como ferramenta para análise dos dados coletados, foi usada a análise do conteúdo. Os resultados mostraram que há pouca vinculação com a UBS por parte de algumas crianças, segundo o relato de certas cuidadoras e que os desafios no serviço público persistem, fazendo com que essas optem pelo plano de saúde. Fazem referência também à dificuldade financeira encontrada no dia a dia para custear inúmeras consultas com especialistas. Dessa forma, vale salientar a importância de sensibilizar profissionais e gestores acerca das dificuldades encontradas, a fim de haver melhorias na vinculação dessas crianças com a Unidade Básica de Saúde.

Chronic low back pain and physical activity among patients within the Brazilian National Health System: a cross-sectional study.

BACKGROUND: This study was based on filling a gap in our knowledge regarding the issue of what the protective effect of physical exercise on patients within the Brazilian National Health System could be, in relation to low back pain. OBJECTIVES: To determine the prevalence of chronic low back pain (CLBP) and to analyze the protective effect of physical exercise among patients over 50 years old attended at primary healthcare units (PHUs). DESIGN AND SETTING: Analytical cross-sectional study at Universidade Estadual Paulista (UNESP) that was conducted in two PHUs (Parque Cedral and Vila Real), located in different regions of the city of Presidente Prudente, Brazil. METHODS: In total, 327 patients were interviewed and evaluated at which retrospective characteristics covering the previous 12 months. The Nordic questionnaire was used to classify CLBP, and the Baecke questionnaire for physical activity level. The body mass index (kg/m2) was calculated using body mass and height values, both collected at the time of the interview. RESULTS: High prevalence of low back pain was found; 175 patients (53.5%) reported having had at least one episode of low back pain in the previous year. Of these, 71 (21.7%) answered yes to all four questions on the Nordic questionnaire and were classified as CLBP. Physical exercise remained associated with CLBP, independent of other factors (odds ratio = 0.35; 95% confidence interval = 0.15-0.80). CONCLUSION: High prevalence of low back pain was identified among PHU users. Physical exercise was associated as an independent protective factor against this pathological condition.

Chronic low back pain and physical activity among patients within the Brazilian National Health System: a cross-sectional study

BACKGROUND: This study was based on filling a gap in our knowledge regarding the issue of what the protective effect of physical exercise on patients within the Brazilian National Health System could be, in relation to low back pain. OBJECTIVES: To determine the prevalence of chronic low back pain (CLBP) and to analyze the protective effect of physical exercise among patients over 50 years old attended at primary healthcare units (PHUs). DESIGN AND SETTING: Analytical cross-sectional study at Universidade Estadual Paulista (UNESP) that was conducted in two PHUs (Parque Cedral and Vila Real), located in different regions of the city of Presidente Prudente, Brazil. METHODS: In total, 327 patients were interviewed and evaluated at which retrospective characteristics covering the previous 12 months. The Nordic questionnaire was used to classify CLBP, and the Baecke questionnaire for physical activity level. The body mass index (kg/m2) was calculated using body mass and height values, both collected at the time of the interview. RESULTS: High prevalence of low back pain was found; 175 patients (53.5%) reported having had at least one episode of low back pain in the previous year. Of these, 71 (21.7%) answered yes to all four questions on the Nordic questionnaire and were classified as CLBP. Physical exercise remained associated with CLBP, independent of other factors (odds ratio = 0.35; 95% confidence interval = 0.15-0.80). CONCLUSION: High prevalence of low back pain was identified among PHU users. Physical exercise was associated as an independent protective factor against this pathological condition.

Obesity Increases Costs With Productivity Loss Due to Disability Retirements, Independent of Physical Activity: A Cohort Study.

OBJECTIVE: Investigate whether obesity is responsible for costs due to productivity loss (PL) in adults, during 30 months of follow-up. METHODS: Absenteeism and disability retirement were considered as PL. For classification of obesity, body mass index (BMI) and waist circumference (WC) values were considered. The statistical software BioEstat (release 5.0) was used and the significance level was set at P value < 0.05. RESULTS: For the men, BMI and WC accounted for ∼60% and ∼30% of retirement due to disability (P = 0.001). For the women, this percentage represented ∼19% for BMI and ∼8% for WC, both P < 0.05. Physical activity was not a significant confounder in any of the analyses (P > 0.05). CONCLUSION: Total and abdominal obesity were responsible for increased costs from PL due to early retirement among adults aged 50 years or older.

Association between quality of life, physical activity, use of medication and costs of treatment for chronic diseases in Primary Care.

BACKGROUND: The aim of this study was to investigate the costs and the health outcomes of primary care treatments for chronic diseases and to analyze the association between domains of quality of life (QoL), physical activity and healthcare costs. METHODS: The sample encompassed 292 patients aged 50 years or more in Brazilian primary care facilities, categorized in three groups: no drug treatment or only regular physical activity, only drug treatment, and drug treatment with regular physical activity. Patients were assessed in relation to quality of life, healthcare costs, regular physical activity, and use of medications. RESULTS: Results indicate higher cost-utility ratio among primary care patients adopting only drug treatment (3.92), followed by drug treatment with regular physical activity (3.21), and no drug treatment or only regular physical activity (0.12). CONCLUSIONS: QoL was significantly associated with risk factors for chronic diseases, especially obesity, and limitations in mobility showed important increases in healthcare costs. The dominant strategy in terms of cost-utility ratio was identified among primary care patients without drug treatment or physically active, followed by patients in drug treatment combined with regular physical activity. Drug treatment without regular physical activity showed worst results in relation to other primary care strategies.

Perception of nursing workers on the care of hypertension in older adult.

OBJECTIVE: To understand how nursing workers perceive care of hypertension (HBP) in older adult within the scope of the Family Health Strategy. METHOD: A qualitative descriptive study carried out in the city of Natal/RN, with 20 nursing workers providing care to older adults with HBP. The data were obtained through a semi-structured interview and analysed by the Thematic Analysis, based on the theoretical support of the integrality, using Atlas.ti 7.0 software. RESULTS: The elements found as facilitators were: territorialization, partnerships, professional proactivity and the user's bond with the team. Among those found as barriers were: disease-centered care; academic education based on the biomedical model; lack of inter-sectorality and discontinuity of care in the care network. FINAL CONSIDERATIONS: Nursing workers perceive that health institutions lack articulated and innovative practices that incorporate new paradigms focused on integrality of care.

Impact of type 2 diabetes mellitus and physical activity on medication costs in older adults.

INTRODUCTION: The high prevalence of diabetes mellitus leads to high costs of medication for treatment and the practice of physical activity, as well as reducing the risks of diabetes mellitus is able to substantially mitigate costs. To investigate the impact of diabetes mellitus on costs of medication and identify whether physical activity can influence the relationship between diabetes mellitus and costs of medication. METHODS: The sample consisted of adults enrolled in five basic healthcare units. The presence of diabetes mellitus and habitual physical activity were assessed by a questionnaire, the quantity of medication used was evaluated according to the medical records, and medication costs, through receipts. FINDINGS: Individuals with diabetes mellitus from baseline presented higher body weight (P value = .001) and lower levels of physical activity (P value = .014). The presence of diabetes mellitus was positively related to costs of medication for diseases of the circulatory system (ß = 4.89), endocrine, nutritional, and metabolic diseases (ß = 109.72), and total costs of medication (ß = 113.41). The impact of diabetes mellitus was attenuated by physical activity. CONCLUSION: It was identified that diabetes mellitus has a significant impact on public costs with medication, and physical activity was effective in reducing health costs independently of diabetes mellitus by less than 1%.

Metabolic Syndrome, Physical Activity, and Medication-Related Expenditures: A Longitudinal Analysis.

BACKGROUND: Metabolic syndrome (MetS) is a combination of risk factors for cardiovascular disease and type 2 diabetes mellitus. The prevalence of MetS worldwide is increasing. There is no study investigating the economic burden of MetS, especially in developing countries, on medication-related expenditure. The aim of this study was to investigate the association of medication-related expenditures with MetS and to explore how physical activity (PA) may influence this association. METHODS: A total of 620 participants, 50 years or older, randomly selected in the city of Bauru, Brazil. Participants were followed from 2010 to 2014, and data on health care expenditure were collected annually. PA questionnaire was applied at baseline, 2 (2012), and 4 (2014) years later. RESULTS: Mean age was 64.7 (95% confidence interval, 64.1-65.3). MetS was associated with higher medication expenditure related to diseases of the circulatory (P <.01) and endocrine (P <.01) systems. MetS explained 17.2% of medication-related expenditures, whereas PA slightly attenuated this association, explaining 1.1% of all health care costs. CONCLUSION: This study demonstrates that MetS has a significant burden on health care expenditures among adults, whereas PA seems to affect this phenomenon significantly, but in low magnitude.

Health indicators and costs among outpatients according to physical activity level and obesity.

OBJECTIVE: How biochemical variables influence the costs of the Brazilian National Healthcare System, according to body composition and physical activity. METHODS: Participated in this study 168 patients. Biochemical variables were glucose, triglycerides, total cholesterol, high, low, very low density lipoprotein and C-reactive protein (CRP). For the cost analysis the medical records was analyzed. Physical activity was assessed through questionnaire. Body adiposity was assessed by body mass index. Four groups were defined according body adiposity and physical activity. RESULTS: The active obese group had higher values of very low density lipoprotein and triglycerides when compared to the inactive obese. The non-obese inactive group had lower values of non-high density lipoprotein compared to the inactive obese. The non-obese active group presented lower insulin value when compared to the inactive obese. The inactive obese group presented higher values in the CRP when compared to the non-obese active and inactive groups when compared to non-obese and active obese group. There was a positive correlation between insulin, glucose, CRP and drug and total costs. CONCLUSIONS: Biochemical variables were different according to body composition and physical activity. Insulin, glucose and CRP were related to cost in drugs and total costs.

Motor adjustments during time-constrained sit-to-walk in people with Parkinson's disease.

INTRODUCTION: Sit-to-walk (STW) is a sequential task and a merge of sit-to-stand (STS) and gait initiation that are impaired in people with Parkinson's disease (PD). Performing sequential task under time constraint (e.g., stand up and walk to answer an urgent call) might influence people with PD due to their deficits on internal regulation of continuous, rhythmic and fast movements. It is known the PD behavior during STS and gait initiation tasks are impaired, however, little is known regarding PD behavior on STW. Thus, the aim of this study was to assess the motor behavior of people with PD and healthy older adults during the STW task under time constraint. METHODS: Fourteen people with idiopathic PD and 14 healthy older adults (OA) participated in this study. They performed the STW task under a time constraint. STW performance (STW total duration, duration of each of the 4 phases of the STW, and the drop in the center of mass (COM) momentum, identified as Fluidity Index - FI), kinematics and kinetics outcomes were assessed throughout the task. RESULTS: The PD group showed increased STW total time and lower FI, longer seat-off (Phase 1) time and first step (Phase 4) when compared to the OA group. Furthermore, the PD group showed more motor impairments (kinematics and kinetics) than the OA group throughout the task from seat-off until heel-off. Also, people with PD exhibited larger mediolateral COM displacement in the standing phase (Phase 2) and greater ground reaction force (GRF) in Phases 1 and 3. CONCLUSIONS: We observed that people with PD exhibited more restrictions when compared with healthy older adults on their STW performance, COM and GRF parameters during the STW under time constraint. Some clinical impairments usually observed in people with PD might explain their STW performance such as, motor planning deficits, less automatic motor control and mediolateral balance impairments.

Phylogenomics and Morphological Reconstruction of Arcellinida Testate Amoebae Highlight Diversity of Microbial Eukaryotes in the Neoproterozoic.

Life was microbial for the majority of Earth's history, but as very few microbial lineages leave a fossil record, the Precambrian evolution of life remains shrouded in mystery. Shelled (testate) amoebae stand out as an exception with rich documented diversity in the Neoproterozoic as vase-shaped microfossils (VSMs). While there is general consensus that most of these can be attributed to the Arcellinida lineage in Amoebozoa, it is still unclear whether they can be used as key fossils for interpretation of early eukaryotic evolution. Here, we present a well-resolved phylogenomic reconstruction based on 250 genes, obtained using single-cell transcriptomic techniques from a representative selection of 19 Arcellinid testate amoeba taxa. The robust phylogenetic framework enables deeper interpretations of evolution in this lineage and demanded an updated classification of the group. Additionally, we performed reconstruction of ancestral morphologies, yielding hypothetical ancestors remarkably similar to existing Neoproterozoic VSMs. We demonstrate that major lineages of testate amoebae were already diversified before the Sturtian glaciation (720 mya), supporting the hypothesis that massive eukaryotic diversification took place in the early Neoproterozoic and congruent with the interpretation that VSM are arcellinid testate amoebae.

Perception of nursing workers on the care of hypertension in older adult / Percepción de trabajadores de enfermería sobre la atención del adulto mayor portador de hipertensión arterial sistémica / Percepção de trabalhadores de enfermagem sobre o cuidado ao idoso portador de hipertensão arterial sistêmica

ABSTRACT Objective: To understand how nursing workers perceive care of hypertension (HBP) in older adult within the scope of the Family Health Strategy. Method: A qualitative descriptive study carried out in the city of Natal/RN, with 20 nursing workers providing care to older adults with HBP. The data were obtained through a semi-structured interview and analysed by the Thematic Analysis, based on the theoretical support of the integrality, using Atlas.ti 7.0 software. Results: The elements found as facilitators were: territorialization, partnerships, professional proactivity and the user's bond with the team. Among those found as barriers were: disease-centered care; academic education based on the biomedical model; lack of inter-sectorality and discontinuity of care in the care network. Final considerations: Nursing workers perceive that health institutions lack articulated and innovative practices that incorporate new paradigms focused on integrality of care.

RESUMEN Objetivo: Comprender la percepción que los profesionales de enfermería tienen sobre la atención de los adultos mayores con hipertensión arterial sistémica (HTA) en el ámbito de la Estrategia de Salud Familiar. Método: Se trata de un estudio descriptivo y cualitativo llevado a cabo en la ciudad de Natal, Rio Grande del Norte, con 20 enfermeros que atienden a personas mayores con HTA. Los datos se obtuvieron mediante entrevistas semiestructuradas y fueron tratados mediante Análisis Temático, basado en el soporte teórico de la integridad, con la ayuda del software Atlas.ti 7.0. Resultados: Se identificaron como favorecedores de la atención los siguientes elementos: territorialización, alianzas, proactividad de los profesionales y vinculación del usuario con el equipo y entre los entorpecedores: atención centrada en la enfermedad, formación académica basada en el modelo biomédico, ausencia de intersectorialidad y discontinuidad de la atención en la red asistencial. Consideraciones Finales: Los trabajadores de enfermería perciben que las instituciones de salud carecen de prácticas articuladas e innovadoras que puedan incorporar nuevos paradigmas centrados en la integralidad de la atención.

RESUMO Objetivo: Compreender como os trabalhadores de enfermagem percebem o cuidado ao idoso portador de hipertensão arterial sistêmica (HAS) no âmbito da Estratégia Saúde da Família. Método: Estudo descritivo, de natureza qualitativa, realizado no município de Natal/RN, com 20 trabalhadores de enfermagem que prestam assistência a idosos portadores de HAS. Os dados foram obtidos através de entrevista semiestruturada e tratados pela Análise Temática. Estão fundamentados no suporte teórico da integralidade, com auxílio do software Atlas.ti 7.0. Resultados: Foram identificados como elementos que favorecem o cuidado: territorialização, parcerias, proatividade dos profissionais e vínculo do usuário com a equipe. Entre os que dificultam o cuidado: assistência centrada na doença, formação acadêmica pautada no modelo biomédico, inexistência de intersetorialidade e descontinuidade do cuidado na rede assistencial. Considerações Finais: Os trabalhadores de enfermagem percebem que as instituições de saúde carecem de práticas articuladas e inovadoras que incorporem novos paradigmas com foco na integralidade do cuidado.

Coordination of health care with the community in the clinical management of tuberculosis.

OBJECTIVE: determine the coordination of Primary Health Care with community resources in the clinical management of tuberculosis. METHOD: descriptive study, of quantitative approach, with participation of one hundred health professionals. Part of a questionnaire was used in evaluating local institutional capacity for the model of chronic conditions care, adapted for tuberculosis care. RESULTS: the coordination between health units, individuals with tuberculosis, and community organizations; the partnerships between institutions and local health councils/committees showed limited capacity. On the other hand, the component for the participation of the Community Health Agent presented more favorable capacity. CONCLUSION: the municipality has unfavorable capacity for coordination of health units and the community. It is reinforced the need to promote these coordinations in search of symptomatic cases in the communities, in the directly observed treatment, and in promoting the association between different social actors.

Coordination of health care with the community in the clinical management of tuberculosis / Estructuración de la salud con la comunidad en el manejo clínico de la tuberculosis / Articulação da saúde com a comunidade no manejo clínico da tuberculose

ABSTRACT Objective: determine the coordination of Primary Health Care with community resources in the clinical management of tuberculosis. Method: descriptive study, of quantitative approach, with participation of one hundred health professionals. Part of a questionnaire was used in evaluating local institutional capacity for the model of chronic conditions care, adapted for tuberculosis care. Results: the coordination between health units, individuals with tuberculosis, and community organizations; the partnerships between institutions and local health councils/committees showed limited capacity. On the other hand, the component for the participation of the Community Health Agent presented more favorable capacity. Conclusion: the municipality has unfavorable capacity for coordination of health units and the community. It is reinforced the need to promote these coordinations in search of symptomatic cases in the communities, in the directly observed treatment, and in promoting the association between different social actors.

RESUMEN Objetivo: identificar la estructuración de la Atención Primaria de Salud con los recursos comunitarios en el manejo clínico de la tuberculosis. Método: estudio descriptivo, de abordaje cuantitativo, en el cual participaron 100 profesionales de la salud. Se utilizó parte de un cuestionario en la evaluación de la capacidad institucional local para el modelo de atención a las condiciones crónicas, adaptado a la atención de la tuberculosis. Resultados: la estructuración entre las unidades de salud, las personas con tuberculosis y las organizaciones de la comunidad, las alianzas entre instituciones y consejos/comisiones locales de salud presentaron capacidad limitada. En contrapartida, el componente referente a la participación del Agente Comunitario de Salud presentó capacidad más favorable. Conclusión: la capacidad de estructuración de las unidades de salud y comunidad del municipio es desfavorable. Se refuerza la necesidad de promover esas articulaciones en la búsqueda de casos sintomáticos en las comunidades, en el tratamiento directamente observado y en la promoción del vínculo entre diferentes actores sociales.

RESUMO Objetivo: identificar a articulação da Atenção Primária à Saúde com os recursos comunitários no manejo clínico da tuberculose. Método: estudo descritivo, de abordagem quantitativa, do qual participaram cem profissionais da saúde. Utilizou-se parte de um questionário na avaliação da capacidade institucional local para o modelo de atenção às condições crônicas, adaptado para a atenção à tuberculose. Resultados: a articulação entre as unidades de saúde, as pessoas com tuberculose e as organizações da comunidade, as parcerias entre instituições e conselhos/comissões locais de saúde apresentaram capacidade limitada. Em contrapartida, o componente referente à participação do Agente Comunitário de Saúde apresentou capacidade mais favorável. Conclusão: o município possui capacidade desfavorável de articulação das unidades de saúde e comunidade. Reforça-se a necessidade de promover essas articulações na busca de casos sintomáticos nas comunidades, no tratamento diretamente observado e na promoção do vínculo entre diferentes atores sociais.

Changes in leisure physical activity, commuting and television watching in men and women users of the Brazilian National Health System in a middle-sized city: 18-months of follow-up / Mudanças na atividade física de lazer, locomoção e tempo de televisão entre homens e mulheres usuários do Sistema Único de Saúde em uma cidade de médio porte: seguimento de 18 meses

Abstract Given the importance of physical activity for health promotion and for the prevention of chronic non-communicable diseases, the Unified Health System (SUS) has changed its strategy of action in the last decades, trying to adopt preventive activities, seeking better quality of life of the Brazilian population and reduce costs with treatment of diseases. The aim of this study was to investigate changes in physical activity and sedentary behavior patterns in users of the Brazilian National Unified Health System during 18 months and the impact of sex and time on such variables. One hundred and ninety-eight participants (58 men and 140 women) were evaluated. Physical activity level was assessed using the Baecke questionnaire. Men had higher scores in all physical activity variables compared to women: walking (p-value= 0.013), cycling (p-value= 0.001) and commuting (p-value= 0.007), but not for TV watching (p-value= 0.362). After 18 months, in the overall sample, walking score increased 25.9% (95%CI= 10.6 to 41.1), but not cycling (1.5% [95%CI= -2.7 to 5.7]), commuting (14.4% [95%CI= -0.4 to 29.3]) and TV watching (1.6% [95%CI= -5.7 to 9.1]). Men were usually more active than women in active behaviors, but not in TV watching. However, differences over time were similar between sexes.

Resumo Dada a importância da atividade física para promoção da saúde, assim como para a prevenção de doenças crônicas não transmissíveis, o Sistema Único de Saúde (SUS) mudou a estratégia de atuação nas últimas décadas, procurando adotar atividades preventivas, buscando melhorar a qualidade de vida da população brasileira e diminuir gastos com tratamento de doenças. Objetivou-se investigar as mudanças na prática de atividade física e tempo de televisão em usuários do SUS durante um período de 18 meses e o impacto do sexo e tempo nessas variáveis. Foram avaliados 198 participantes (58 homens e 140 mulheres). Nível de atividade física foi mensurado através do questionário de Baecke. Homens apresentaram maiores escores em todas as variáveis de atividade física: caminhada (p-valor 0,013), ciclismo (p-valor 0,001) e locomoção (p-valor 0,007) do que mulheres, mas não para assistir televisão (p-valor= 0,362). Após 18 meses, em toda a amostra, o escore de caminhada aumentou 25,9% (IC95%= 10,6 - 41,1), mas não ciclismo (1,5% [95%CI= -2,7 - 5,7]), locomoção (14,4% [95%CI= -0,4 - 29,3]) e televisão (1,6% [95%CI= -5,7 - 9,1]). Entre usuários do SUS, homens foram usualmente mais ativos que mulheres em comportamentos ativos, mas não ao assistir televisão. Porém, diferenças ao longo do tempo foram similares entre os sexos.

Association between sleep disorders and chronic diseases in patients of the brazilian national health system / Associação entre distúrbios do sono e doenças crônicas em pacientes do sistema único de saúde

ABSTRACT Many factors are associated with sleep disorders, causing an increase in health spending. The objective of this study was to analyze the association of sleep disorders and non-communicablechronic diseases in patients over 50 years of age, attended by Basic Health Care Units of Presidente Prudente. In total, 363 patients participated. The history of diseases was self-reported through the use of a questionnaire, the level of physical activity was evaluated by the Baecke questionnaire, and sleep quality was assessed using the Mini-Sleep Questionnaire. Anthropometric and body composition data were collected using a stadiometer and scale; patients in the highest (75th) percentile were considered obese. Statistical analysis was performed using the Student t test, chi-square test, and binary logistic regression. The results showed that sleep disorders are associated with osteoporosis, arthritis/osteoarthritis, low back pain, depression, and obesity. Additionally, obesity and physical inactivity influence the occurrence of non-communicable chronic diseases.

RESUMO Inúmeros fatores estão associados aos distúrbios do sono ocasionando o aumento nos gastos com saúde. O objetivo do trabalho foi analisar a associação dos distúrbios do sono e doenças crônicas não transmissíveis em pacientes com idade superior a 50 anos atendidos por Unidades Básicas de Saúde de Presidente Prudente. Participaram 363 pacientes. O histórico de doenças foi auto relatada a partir da aplicação de questionário, o nível de atividade física foi verificado através do questionário de Baecke, e a qualidade do sono foi avaliada utilizando o Mini-Sleep questionnaire. Dados antropométricos e de composição corporal foram coletados utilizando estadiômetro e balança, foram considerados obesos os pacientes dentro do percentil 75. A análise estatística foi composta pelos testes t de Student, qui-quadrado, e regressão logística binária. Os resultados mostraram que o distúrbio do sono está associado as doenças osteoporose, artrite/artrose, dor lombar, depressão e obesidade. Adicionalmente obesidade e inatividade física influenciam na ocorrência de doenças crônicas não transmissíveis.

Association between osteoporosis, health-related productivity loss and use of hospital services in outpatients of the Brazilian National Health System

Aims: To analyze factors associated with osteoporosis among outpatients of the Brazilian National Health System and to identify their association with hospital and labor economic outcomes. Methods: Cross-sectional study carried out in the city of Presidente Prudente / SP. The sample consisted of 542 adults of both sexes and aged ≥ 50 years old. The occurrence of osteoporosis, health-related productivity loss, use of hospital services and level of physical activity were assessed using questionnaires. Statistical analysis was composed of chi-square test, binary logistic regression and Mann-Whitney test. The significance level adopted was p-value <0.05. Results: The prevalence of osteoporosis was 14.4% (95% CI: 11.4% - 17.3%) and it was associated with female sex (p = 0.001), lower economic status (p-value = 0.036) and obesity (p-value = 0.003). Participants with osteoporosis showed a higher incidence of surgery in the last 12 months (OR = 2.13 [1.04 to 4.35]), productivity loss (OR = 1.91 [1.13 to 3.42]) and disability retirement (OR = 2.03 [1.20 to 3.43]). Over the past 12 months, the sum of direct and indirect economic loss was R$ 1,382,630.00. Conclusion: The female sex, lower economic status and obesity were associated with a higher occurrence of osteoporosis, and consequent higher use of hospital services and significant economic losses.(AU)

Predictors of the functional reach test in people with parkinson's disease / Preditores do desempenho no teste de alcance funcional em pessoas com doença de parkinson

ABSTRACT Postural instability, a fundamental signal/symptom of Parkinson's disease (PD), is characterized by the association between postural alignment, joint range of motion, and muscular rigidity. The aim of the present study was to analyze the relationship between performance in the functional reach test (FRT) and associated factors such as joint range of motion and PD clinical features. Twenty-five people with PD in stages 1 and 1.5 of the Hoehn & Yahr scale participated in the study. The analyzed dependent variables were: FRT performance and scores in the items of clinical evaluation of the Unified Parkinson's Disease Rating Scale: pull-test, motor rigidity, and motor condition were used. The average distance in the FRT was 25.3 cm and the mean anterior-posterior displacement of the center of pressure was 2.69 cm. The ankle range of motion was associated with FRT performance, while postural stability was associated with the anterior-posterior displacement of the center of pressure during the FRT. We conclude that FRT performance in people with PD is determined by the individual level of balance and by the ankle joint amplitude and muscular rigidity and functional alterations due to aging are responsible for FRT performance.

RESUMO A instabilidade postural, um sinal/sintoma cardinal da doença de Parkinson (DP), é caracterizada pela associação entre alinhamento postural, amplitude de movimento e rigidez muscular. O objetivo foi analisar a relação entre o desempenho no teste de alcance funcional (TAF) e fatores relacionados a amplitude de movimento e aspectos clínicos da doença. Participaram 25 pessoas com DP nos estágios 1,0 e 1,5 da Hoehn e Yahr. As variáveis dependentes analisadas foram: desempenho no TAF e as pontuações nos itens da avaliação clínica da UnifiedParkinson'sDisease Rating Scale: teste de retropulsão, rigidez muscular e condição motora. A distância média no TAF foi de 25,3 cm e o deslocamento anteroposterior médio do centro de pressão foi de 2,69 cm. A amplitude de movimento articular do tornozelo está associada ao desempenho no TAF, enquanto a estabilidade postural está associada ao deslocamento anteroposterior do centro de pressão durante o TAF. Conclui-se que o desempenho no TAF em pessoas com DP é determinado pelo nível individual de equilíbrio e pela amplitude articular do tornozelo e a rigidez muscular e alterações funcionais do envelhecimento são responsáveis pelo desempenho no TAF.

Comparação do equilíbrio e da mobilidade funcional entre pacientes com doença de Parkinson ativos e inativos / Comparison of balance and functional mobility among active and inactive patients with Parkinson's disease

A doença de Parkinson compromete o equilíbrio e a mobilidade funcional. A atividade física tem um importante papel se contrapondo aos efeitos da doença, podendo promover benefícios na mobilidade de pacientes. O estudo teve como objetivo comparar o desempenho em equilíbrio e mobilidade funcional de pacientes com doença de Parkinson ativos e inativos. Participaram do estudo 41 pacientes distribuídos, em ativos (19) e inativos (22), de acordo com a pontuação obtida no questionário de Baecke modificados para idosos e confirmado pela quantidade de prática regular de atividade física. Todos os pacientes foram avaliados em relação ao equilíbrio através da escala de equilíbrio de Berg e em relação à mobilidade funcional através do Timed up and Go test. Não foram encontradas diferenças significativas em relação ao equilíbrio. Entretanto, pacientes ativos apresentaram melhores desempenhos (6,86 ± 1,16 s) na mobilidade funcional quando comparado com pacientes inativos (9,19 ± 4,40 s). Manter níveis ótimos de atividade física é um importante fator para a melhora da mobilidade de pacientes com doença de Parkinson, refletindo na realização das atividades diárias e na qualidade de vida.

Parkinson's disease affects the balance and mobility. Physical activity has an important role in minimizing the effects of the disease and may provide benefits in patient mobility. The study aimed to compare the balance and mobility performance of active and inactive patients with Parkinson's disease. The study included 41 patients distributed in active (19) and inactive (22) groups according to the score obtained in the Baecke questionnaire modified for the elderly and it was confirmed by amount of the practice of regular physical activity. All patients were assessed for the balance through the Berg balance scale and in relation to mobility through the Timed Up and Go test. There were no significant between group differences for balance. However, active patients were better (6.86 ± 1.16 s) in mobility when compared with inactive patients (9.19 ± 4.40 s). Maintaining optimal levels of physical activity is an important factor to improve the mobility performance of patients with Parkinson's disease, reflecting in daily activities and quality of life.

PARKINSON'S DISEASE PATIENTS WITH DOMINANT HEMIBODY AFFECTED BY THE DISEASE RELY MORE ON VISION TO MAINTAIN UPRIGHT POSTURAL CONTROL.

This study assesses the association between disease onset side (dominant or non-dominant) and vision on postural control of Parkinson's disease patients. Patient volunteers composed two groups, according to the onset side affected: Dominant group (n=9; M age=66.1 yr., SD=7.2; 6 women, 3 men) and Non-dominant group (n=9; M age=67.4 yr., SD=6.4; 6 women, 3 men). The groups' postural control was assessed by posturography during quiet upright stance in two conditions, Eyes open and Eyes closed. Two-way analyses of variance (ANOVAs; group×condition) with repeated measures for the second factor assessed the differences associated with affected hemibody and vision on postural control. Analyses indicated that patients with the dominant side affected also presented significantly greater variation in center of pressure than those with the non-dominant side affected, mainly in the Eyes closed condition. The results demonstrate a higher reliance on vision in the dominant side, possibly to compensate somatosensory system impairments. These results also highlight the importance of analyzing the hemibody affected by the disease when postural control is assessed in this population.