Sleep duration and quality during the COVID-19 pandemic and the association with physical activity and screen time among Brazilian college students.

BACKGROUND: As a result of social isolation during the COVID-19 pandemic, changes in sleep patterns have been observed in many countries, as well as changes in physical activity and screen time. The objective was to investigate sleep duration and quality during the COVID-19 pandemic and its association with physical activity and screen time. METHODS: Cross-sectional study with students from a University in Rio de Janeiro who answered an online questionnaire between August 2020 and March 2021. Physical activity was assessed using IPAQ-SF. Sleep was investigated based on questions about duration and sleep quality change, and screen time through self-reported questions. Multinomial logistic regression was performed to assess the association between physical activity and screen time with sleep duration and quality. Secondary analyses investigated the influence of the isolation time on this association. The confounding factors used were diagnosis of COVID-19, time of isolation, anxiety, depression, skin color, and gender. RESULTS: A total of 771 college students with a mean age of 24.5 years (±8.6) answered the questionnaire. About 75% reported more than 8 h of screen time per day and 49.8% were physically inactive. Regarding sleep, 54.9% had worsening sleep, while 40.6% had inadequate sleep duration during the pandemic. Physical activity was associated with improved sleep quality (Odds ratio (OR) 1.72; confidence interval (95% CI) 1.05-2.97). Also, physically active students who spent more than 14 weeks in social isolation demonstrated improved sleep quality (OR 1.99; 95% CI 1.02-3.78) compared to physically inactive individuals. No association was observed for sleep duration. No association was observed between screen time and sleep quality, or sleep duration. CONCLUSION: During the COVID-19 pandemic, there was considerable worsening of sleep quality, and physical activity was positively associated with improved sleep quality.

Panorama of risky sexual behaviors in the Brazilian adult population - PNS 2019.

OBJECTIVE: To describe the risky sexual behaviors of Brazilian adults according to socioeconomic, demographic, and regional characteristics. METHODS: Data from the 2019 National Health Survey, referring to the population aged 18 years or older, were analyzed. Risky sexual behaviors were considered: early sexual initiation, before the age of 15 years, and nonuse of condoms in the last sexual intercourse. Prevalence and respective confidence intervals were calculated for the subgroups of interest. RESULTS: Early sexual initiation among adult individuals was 24% among men and 11% among women, being higher among young people with lower levels of education and household income. The nonuse of condoms was higher among married/cohabiting partners, no schooling or with some elementary school, and among older people. The prevalence of nonuse of condoms among married/cohabiting partners was the same in both sexes (75%). However, among non-cohabiting partners, gender disparity was relevant, as 39.1% of women did not use condoms in the last sexual intercourse, while among men this result was 26.9%. CONCLUSIONS: Higher prevalence of early sexual initiation for younger generations is noteworthy, especially among women. Concerning the nonuse of condoms, there are important gender disparities in the group of non-cohabiting partners, in addition to the high prevalence among older people, which should be considered in the formulation of public policies. The results of the present study are extremely relevant for understanding the adult population currently more vulnerable to sexually transmitted infections, after over five years without official statistics on this matter at the national level.

Trend in the prevalence of depressive symptoms in Brazil: results from the Brazilian National Health Survey 2013 and 2019.

This study aims to evaluate national variation in depression prevalence and in different sociodemographic groups, health behaviors, and macroregions of Brazil from 2013 to 2019. Data were obtained from two nationwide Brazilian surveys - Brazilian National Health Survey 2013 and 2019. Participants aged 18 years or older were included, totaling 60,202 individuals in 2013 and 88,531 in 2019. Depression was evaluated with the Patient Health Questionnaire-9 (PHQ-9). All estimations accounted for the population weights and the complex sampling. The findings showed that during the six years between the two surveys, the prevalence of depression in Brazil increased by 36.7%, going from 7.9% in 2013 to 10.8% in 2019, and this increase is higher among unemployed young adults, aged 18 to 24 years, with the increase in the prevalence of depression almost tripled (3.7 in 2013 and 10.3 in 2019), an increase of 178.4%. Those dwelling in urban areas had a higher increase in the prevalence of depression in the six-year period (39.8%) when compared to residents in rural areas (20.2%). There was an increase in the prevalence of depression from 2013 to 2019 for the worst categories of the three health behaviors included in the study for both men and women: heavy drinking, smoking, and not exercising the recommended level of physical activity. Our results show a significant increase in the prevalence of depression over the six years between the two surveys, mainly among the younger and unemployed men. The country's economic recession during this period may explain these findings.

Trend in the prevalence of depressive symptoms in Brazil: results from the Brazilian National Health Survey 2013 and 2019 / Tendência na prevalência de sintomas depressivos no Brasil: resultados da Pesquisa Nacional de Saúde, 2013 e 2019 / Tendencia en la prevalencia de síntomas depresivos en Brasil: resultados de las Encuesta Nacional de Salud de 2013 y 2019

This study aims to evaluate national variation in depression prevalence and in different sociodemographic groups, health behaviors, and macroregions of Brazil from 2013 to 2019. Data were obtained from two nationwide Brazilian surveys - Brazilian National Health Survey 2013 and 2019. Participants aged 18 years or older were included, totaling 60,202 individuals in 2013 and 88,531 in 2019. Depression was evaluated with the Patient Health Questionnaire-9 (PHQ-9). All estimations accounted for the population weights and the complex sampling. The findings showed that during the six years between the two surveys, the prevalence of depression in Brazil increased by 36.7%, going from 7.9% in 2013 to 10.8% in 2019, and this increase is higher among unemployed young adults, aged 18 to 24 years, with the increase in the prevalence of depression almost tripled (3.7 in 2013 and 10.3 in 2019), an increase of 178.4%. Those dwelling in urban areas had a higher increase in the prevalence of depression in the six-year period (39.8%) when compared to residents in rural areas (20.2%). There was an increase in the prevalence of depression from 2013 to 2019 for the worst categories of the three health behaviors included in the study for both men and women: heavy drinking, smoking, and not exercising the recommended level of physical activity. Our results show a significant increase in the prevalence of depression over the six years between the two surveys, mainly among the younger and unemployed men. The country's economic recession during this period may explain these findings.

O estudo objetiva avaliar a variação nacional na prevalência geral da depressão e em diferentes grupos sociodemográficos, comportamentos de saúde e macrorregiões do Brasil entre 2013 e 2019. Os dados foram obtidos de dois inquéritos brasileiros de abrangência nacional, a Pesquisa Nacional de Saúde (PNS) 2013 e a 2019. Entre os participantes com idade de 18 anos ou mais, houve 60.202 indivíduos em 2013 e 88.531 em 2019. A depressão foi avaliada com o Questionário de Saúde do Paciente-9 (PHQ-9). Todas as estimativas levaram em conta os pesos populacionais e a amostragem complexa. Os achados mostraram que durante os seis anos entre as duas edições da PNS, a prevalência de depressão no Brasil aumentou em 36,7%, de 7,9% em 2013 para 10,8% em 2019, com um aumento ainda maior em adultos jovens, no grupo etário de 18 a 24 anos, e naqueles que não estavam trabalhando, onde houve um aumento de quase três vezes na prevalência de depressão (3,7% em 2013 e 10,3% em 2019), ou seja, um aumento de 178,4%. Indivíduos residindo em áreas urbanas tiveram um aumento maior na prevalência de depressão ao longo do período de seis anos (39,8%), em comparação com os residentes em áreas rurais (20,2%). Houve um aumento na prevalência de depressão entre 2013 e 2019 para as piores categorias dos três comportamentos de saúde incluídos no estado, tanto em homens quanto em mulheres: etilismo, tabagismo e sedentarismo. Nossos resultados mostram um aumento significativo na prevalência de depressão nos seis anos entre as duas edições da PNS, principalmente entre homens mais jovens e desempregados. A recessão econômica no Brasil durante o período pode explicar esses achados.

El objetivo de este estudio es evaluar la variación nacional en la prevalencia general de depresión, así como en diferentes grupos sociodemográficos, comportamientos de salud, y macrorregiones del país entre 2013-2019. Los datos se obtuvieron de dos encuestas nacionales brasileñas -Encuesta Nacional de Salud 2013 y 2019-. Los participantes con edades entre los 18 años y con más edad incluyeron a 60 202 personas en 2013 y 88 531 en 2019. La depresión se evaluó mediante el Cuestionario de Salud del Paciente-9 (PHQ-9). Todas las estimaciones justificaron los pesos de la población y el muestreo complejo. Los resultados mostraron que durante seis años entre las dos encuestas, la prevalencia de depresión en Brasil se incrementó en un 36,7%, yendo de un 7,9% en 2013 a un 10,8% en el 2019, y este incremento es mayor entre adultos jóvenes, de 18 a 24 años de edad, que no estaban trabajando, donde casi había un incremento tres veces superior en la prevalencia de depresión (3,7 en 2013 y 10,3 en 2019), un incremento de un 178,4%. Aquellos que vivían en áreas urbanas tenían un incremento mayor en la prevalencia de depresión durante el período de seis años (39,8%), cuando se comparó con los residentes en áreas rurales (20,2%). Hubo un incremento en la prevalencia de depresión entre 2013-2019 para las peores categorías de los tres comportamientos de salud incluidos en el estudio para tanto hombres como mujeres: consumo excesivo de alcohol, fumar, y no practicar deporte al nivel recomendado de actividad física. Nuestros resultados muestran un significado incremento en la prevalencia de depresión durante los seis años entre las dos encuestas, principalmente entre los hombres más jóvenes y desempleados. La recesión económica del país durante este periodo puede explicar estos resultados.

Panorama of risky sexual behaviors in the Brazilian adult population - PNS 2019 / Panorama dos comportamentos sexuais de risco na população adulta brasileira - PNS 2019

ABSTRACT OBJECTIVE To describe the risky sexual behaviors of Brazilian adults according to socioeconomic, demographic, and regional characteristics. METHODS Data from the 2019 National Health Survey, referring to the population aged 18 years or older, were analyzed. Risky sexual behaviors were considered: early sexual initiation, before the age of 15 years, and nonuse of condoms in the last sexual intercourse. Prevalence and respective confidence intervals were calculated for the subgroups of interest. RESULTS Early sexual initiation among adult individuals was 24% among men and 11% among women, being higher among young people with lower levels of education and household income. The nonuse of condoms was higher among married/cohabiting partners, no schooling or with some elementary school, and among older people. The prevalence of nonuse of condoms among married/cohabiting partners was the same in both sexes (75%). However, among non-cohabiting partners, gender disparity was relevant, as 39.1% of women did not use condoms in the last sexual intercourse, while among men this result was 26.9%. CONCLUSIONS Higher prevalence of early sexual initiation for younger generations is noteworthy, especially among women. Concerning the nonuse of condoms, there are important gender disparities in the group of non-cohabiting partners, in addition to the high prevalence among older people, which should be considered in the formulation of public policies. The results of the present study are extremely relevant for understanding the adult population currently more vulnerable to sexually transmitted infections, after over five years without official statistics on this matter at the national level.

RESUMO OBJETIVO Descrever os comportamentos sexuais de risco dos adultos brasileiros segundo características socioeconômicas, demográficas e regionais. MÉTODOS Foram analisados dados da Pesquisa Nacional de Saúde 2019, referente à população de 18 anos de idade ou mais. Considerou-se como comportamentos sexuais de risco: a iniciação sexual precoce, antes dos 15 anos, e o não uso de preservativo na última relação sexual. Foram calculadas as prevalências e respectivos intervalos de confiança para os subgrupos de interesse. RESULTADOS A iniciação sexual precoce entre indivíduos adultos foi de 24% entre os homens e 11% entre as mulheres, sendo mais alta entre jovens com menores níveis de instrução e rendimento domiciliar. O não uso de preservativo se mostrou maior entre os casados/coabitantes, sem instrução ou com nível fundamental incompleto, e entre os mais velhos. A prevalência do não uso de preservativo entre casados/coabitantes foi igual em ambos os sexos (75%). No entanto, entre os não coabitantes, a disparidade entre os sexos se mostrou relevante uma vez que 39,1% das mulheres não usaram preservativo na última relação sexual, enquanto entre os homens esse resultado foi de 26,9%. CONCLUSÃO Nota-se, especialmente entre as mulheres, maiores prevalências de iniciação sexual precoce para as gerações mais novas. No que se refere ao não uso de preservativo, há disparidades de sexo importantes no grupo dos não coabitantes, além da alta prevalência entre os mais velhos, que devem ser consideradas na elaboração das políticas públicas. Os resultados do presente estudo são extremamente relevantes para compreensão da população adulta atualmente mais vulnerável às infecções sexualmente transmissíveis, após mais de cinco anos sem estatísticas oficiais a respeito em âmbito nacional.

Trend in the prevalence of depression and correlates in Brazil: results from the National Health Surveys 2013 and 2019

This study aims to evaluate national variation in depression prevalence overall and in different socioeconomic and demographic groups, health behaviors, and macro-regions of the country, between 2013 and 2019. Data were obtained from the National Health Surveys ­ PNS 2013 and 2019, which are cross-sectional surveys of the Brazilian general population. Participants aged 18 years and older included 60,202 individuals in 2013 and 88,531 in 2019. Depression was evaluated through the Patient Health Questionnaire-9 (PHQ-9). Calculations were carried out population-weighted. Additional age-standardized analyses were conducted to account for demographic changes. The results showed that in the six-year period between the two surveys, the prevalence of depression in Brazil increased by 36.7%, going from 7.9% in 2013 to 10.8% in 2019, this increase is more marked among young adults, 18 to 24 years old, who were not working, where there was a significant and almost three-fold absolute difference increase in the prevalence of depression (3.7 in 2013 and 10.3 in 2019), an increase of 178.4%. Those living in urban areas of the country had a greater increase in the prevalence of depression in the six-year period (39.8%) when compared to residents in rural areas (20.2%). There was an increase in the prevalence of depression between 2013 and 2019 for the worst categories of the three health behaviors under study, for both sexes: heavy drinking, smoking, and lack of physical activity, following the pattern observed for the general population. Our results show evidence of a significant increase in the prevalence of depression over the six-year period between the two surveys, mainly among the younger and unemployed men. The country´s economic context of recession during this period may be an explanation for this finding.

Neighborhood physical disorder and common mental disorders in adolescence.

OBJECTIVE: The aim of this study is to estimate the association between observed indicators of neighborhood physical disorder and common mental disorders in adolescents. METHODS: The study population included 2506 adolescents from three Brazilian state capitals (Rio de Janeiro, Porto Alegre, and Fortaleza) who participated in the Cardiovascular Risk Study in Adolescents (ERICA), a cross-sectional school-based study conducted in 2013-2014. Common mental disorders were assessed using the 12-item General Health Questionnaire. Measures of neighborhood physical disorder were based on the 2010 Brazilian census data and were derived using principal component analysis. RESULTS: Although associations were found between some exposure components and CMD, there were no clear or consistent trends across exposure quartiles. CONCLUSION: Overall, there was no evidence of an association between observed indicators of neighborhood physical disorder and common mental disorders. Future studies should explore alternative tools for measuring neighborhood physical disorder to minimize the likelihood of exposure misclassification.

Incidence, persistence and risk factors of fear of falling in older adults: cohort study (2008-2013) in Rio de Janeiro, Brazil.

OBJECTIVE: To evaluate the incidence and persistence of fear of falling in older adults and the clinical/functional, psychosocial and lifestyle-related risk factors. METHODS: A longitudinal study with 393 community-dwelling older adults aged 65 years and over (110 men/ 283 women) resident in the North Zone of the city of Rio de Janeiro, Brazil. The fear of falling was assessed by the Falls Efficacy Scale-I-BR. The explanatory variables assessed were: number of comorbidities and medicines, history of falls, fracture from falling, use of walking aids, functional dependence in basic and instrumental activities of daily living, hearing and visual impairment, hand grip strength, walking speed, self-rated health, body mass index, depressive symptoms, cognitive impairment, living alone and activity level. Incidence, persistence and risk factors were estimated. Multivariate analysis was performed using Poisson Regression, obtaining relative risks (RR) and corresponding to 95% confidence intervals. RESULTS: Among the 393 participants, fear of falling occurred in 33.5% and was persistent in 71.3%. Incidence was found to associate with using seven or more medicines and reporting worse activity level than the prior year. Risk factors for persistent fear were: using seven or more medicines, a history of one or two falls, reduced walking speed, hearing impairment, cognitive impairment, depressive symptoms and poor or very poor self-rated health. CONCLUSION: Fear of falling is a frequent and persistent condition. Many factors related to persistent fear showed no association with the incidence of fear, emphasizing the need for focused strategies to reduce risk factors that may be associated with the chronification of fear of falling.

Incidence, persistence and risk factors of fear of falling in older adults: cohort study (2008-2013) in Rio de Janeiro, Brazil

ABSTRACT OBJECTIVE To evaluate the incidence and persistence of fear of falling in older adults and the clinical/functional, psychosocial and lifestyle-related risk factors. METHODS A longitudinal study with 393 community-dwelling older adults aged 65 years and over (110 men/ 283 women) resident in the North Zone of the city of Rio de Janeiro, Brazil. The fear of falling was assessed by the Falls Efficacy Scale-I-BR. The explanatory variables assessed were: number of comorbidities and medicines, history of falls, fracture from falling, use of walking aids, functional dependence in basic and instrumental activities of daily living, hearing and visual impairment, hand grip strength, walking speed, self-rated health, body mass index, depressive symptoms, cognitive impairment, living alone and activity level. Incidence, persistence and risk factors were estimated. Multivariate analysis was performed using Poisson Regression, obtaining relative risks (RR) and corresponding to 95% confidence intervals. RESULTS Among the 393 participants, fear of falling occurred in 33.5% and was persistent in 71.3%. Incidence was found to associate with using seven or more medicines and reporting worse activity level than the prior year. Risk factors for persistent fear were: using seven or more medicines, a history of one or two falls, reduced walking speed, hearing impairment, cognitive impairment, depressive symptoms and poor or very poor self-rated health. CONCLUSION Fear of falling is a frequent and persistent condition. Many factors related to persistent fear showed no association with the incidence of fear, emphasizing the need for focused strategies to reduce risk factors that may be associated with the chronification of fear of falling.

Acurácia da versão brasileira do Functional Activities Questionnaire no rastreio de demência / Accuracy of the Brazilian version of the Functional Activities Questionnaire in the screening of dementia / Precisión de la versión brasileña del Functional Activities Questionnaire en el seguimiento de la demencia

Enquadramento: Instrumentos de aferição da capacidade funcional do idoso, como o Functional Activities Questionnaire, podem ser utilizados para a deteção e predição de demência. Objetivo: Avaliar a acurácia da versão brasileira do Functional Activities Questionnaire (FAQ-BR) no rastreio de demência. Metodologia: Estudo transversal realizado com 265 idosos e seus respetivos informantes. O desempenho do FAQ-BR foi comparado ao diagnóstico clínico de demência e a sua pontuação comparada à de instrumentos de rastreio de declínio cognitivo/demência. A curva receiver operating curve (ROC) foi utilizada para determinar a sensibilidade e a especificidade do melhor ponto de corte. Resultados: A área sob a curva ROC indicou acurácia de 79,7% com ponto de corte = 14, que mostrou as máximas sensibilidade (80,0%) e especificidade (72,0%). A pontuação do FAQ-BR apresentou correlações altas com as pontuações dos instrumentos de rastreio de declínio cognitivo/demência. Conclusão: A área sob a curva ROC, a sensibilidade e a especificidade do FAQ-BR mostraram-se inapropriadas, não permitindo recomendar o seu uso no rastreio de demência.

Background: Instruments for measuring functional disability of the elderly, such as the Functional Activities Questionnaire, can be used for the detection and prediction of dementia. Objective: To evaluate the accuracy of the Brazilian version of the Functional Activities Questionnaire (FAQ-BR) in dementia screening. Methodology: Cross-sectional study with 265 elderly and their respective informants. The performance of the FAQ-BR was compared to the clinical diagnosis of dementia and their score compared to screening instruments for cognitive decline/dementia. The receiver operating curve (ROC curve) was used to determine the sensitivity and specificity of the best cutoff. Results: The area under the ROC curve indicated an accuracy of 79.7% with cutoff point = 14, which showed the highest sensitivity (80.0%) and specificity (72.0%). The FAQ-BR score showed high correlations with the scores of the cognitive decline/dementia screening instruments. Conclusion: The area under the ROC curve, sensitivity and specificity of the FAQ-BR were found to be inappropriate, and it was not possible to recommend its use in dementia screening.

Marco contextual: Los instrumentos para evaluar la capacidad funcional de los ancianos, como el Functional Activities Questionnaire, pueden utilizarse para detener y predecir la demencia. Objetivo: Evaluar la precisión de la versión brasileña del Functional Activities Questionnaire (FAQ-BR) en el seguimiento de la demencia. Metodología: Estudio transversal realizado con 265 ancianos y sus respectivos informantes. El rendimiento del FAQ-BR se comparó con el diagnóstico clínico de demencia y su puntuación con la de los instrumentos de seguimiento del deterioro cognitivo/demencia. La curva de característica operativa del receptor (ROC, en inglés) se utilizó para determinar la sensibilidad y especificidad del mejor punto de corte. Resultados: El área bajo la curva ROC indicó una precisión del 79,7% con punto de corte = 14, que mostró sensibilidad máxima (80,0%) y especificidad (72,0%). La puntuación del FAQ-BR mostró altas correlaciones con las puntuaciones de los instrumentos de seguimiento del deterioro cognitivo/demencia. Conclusión: En el área bajo la curva ROC, la sensibilidad y la especificidad del FAQ-BR resultaron ser inapropiadas, por lo que no se pudo recomendar su uso en el seguimiento de la demencia.

Reliability of triage systems for paediatric emergency care: a systematic review.

OBJECTIVE: To present a systematic review on the reliability of triage systems for paediatric emergency care. METHODS: A search of MEDLINE, Cochrane Library, Latin American and Caribbean Health Sciences Literature, Scientific Electronic Library Online, Nursing Database Index and Spanish Health Sciences Bibliographic Index for articles in English, French, Portuguese or Spanish was conducted to identify reliability studies of five-level triage systems for patients aged 0-18 years published up to April 2018. Two reviewers performed study selection, data extraction and quality assessment as recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS: Twenty studies on nine triage systems were selected: the National Triage System (n=1); the Australasian Triage Scale (n=3); the paediatric Canadian Triage and Acuity Scale (PedCTAS) (n=5); the Manchester Triage System (MTS) (n=1); the Emergency Severity Index (ESI) (n=5); an adaptation of the South African Triage Scale for the Princess Marina Hospital in Botswana (n=1); the Soterion Rapid Triage System (n=1); the Rapid Emergency Triage and Treatment System-paediatric version (n=2); the Paediatric Risk Classification Protocol (n=1). Ten studies were performed with actual patients, while the others used hypothetical scenarios. The studies were rated low (n=14) or moderate (n=6) quality. Kappa was the most used statistic, although many studies did not specify the weighting. PedCTAS, MTS and ESI V.4 exhibited substantial to almost perfect agreement in moderate quality studies. CONCLUSIONS: There is some evidence on the reliability of the PedCTAS, MTS and ESI V.4, but most studies are limited to the countries where they were developed. Efforts are needed to improve the quality of the studies, and cross-cultural adaptation of those tools is recommended in countries with different professional qualification and sociocultural contexts.

VALIDITY AND RELIABILITY OF A NEW TRIAGE SYSTEM FOR PEDIATRIC EMERGENCY CARE: CLARIPED. / VALIDADE E CONFIABILIDADE DE UM NOVO SISTEMA DE CLASSIFICAÇÃO DE RISCO PARA EMERGÊNCIAS PEDIÁTRICAS: CLARIPED.

OBJECTIVE: To assess the validity and reliability of a triage system for pediatric emergency care (CLARIPED) developed in Brazil. METHODS: Validity phase: prospective observational study with children aged 0 to 15 years who consecutively visited the pediatric emergency department (ED) of a tertiary hospital from July 2 to 18, 2013. We evaluated the association of urgency levels with clinical outcomes (resource utilization, ED admission rate, hospitalization rate, and ED length of stay); and compared the CLARIPED performance to a reference standard. Inter-rater reliability phase: a convenience sample of patients who visited the pediatric ED between April and July 2013 was consecutively and independently double triaged by two nurses, and the quadratic weighted kappa was estimated. RESULTS: In the validity phase, the distribution of urgency levels in 1,416 visits was the following: 0.0% red (emergency); 5.9% orange (high urgency); 40.5% yellow (urgency); 50.6% green (low urgency); and 3.0% blue (no urgency). The percentage of patients who used two or more resources decreased from the orange level to the yellow, green, and blue levels (81%, 49%, 22%, and 2%, respectively, p<0.0001), as did the ED admission rate, ED length of stay, and hospitalization rate. The sensitivity to identify patients with high urgency level was 0.89 (confidence interval of 95% [95%CI] 0.78-0.95), and the undertriage rate was 7.4%. The inter-rater reliability in 191patients classified by two nurses was substantial (kw2=0.75; 95%CI 0.74-0.79). CONCLUSIONS: The CLARIPED system showed good validity and substantial reliability for triage in a pediatric emergency department.

OBJETIVO: Avaliar a validade e a confiabilidade de um sistema de classificação de risco para emergências pediátricas (CLARIPED) desenvolvido no Brasil. MÉTODOS: Fase de validade: estudo observacional prospectivo em crianças de 0 a 15anos atendidas consecutivamente no serviço de emergência pediátrica (SEP) de um hospital terciário entre 2 e 18de julho de 2013. Avaliou-se a associação dos níveis de urgência com desfechos clínicos (utilização de recursos, taxa de admissão no SEP, taxa de hospitalização e tempo de permanência no SEP); e comparou-se o desempenho do CLARIPED com um padrão de referência. Fase de confiabilidade interobservadores: uma amostra de conveniência de pacientes atendidos entre abril e julho de 2013 foi submetida a duas classificações de risco consecutivas e independentes, e estimou-se o Kappa ponderado quadrático. RESULTADOS: Em 1.416 atendimentos realizados na fase de validade, a distribuição de níveis de urgência foi: 0,0% vermelho/emergência; 5,9% laranja/muito urgente; 40,5% amarelo/urgente; 50,6% verde/pouco urgente; e 3,0% azul/sem urgência. Ospercentuais de pacientes que usaram dois ou mais recursos diminuíram do nível laranja para o amarelo, verde e azul (81, 49, 22 e 2%, respectivamente, p<0,0001), assim como a taxa de admissão no SEP, o tempo de permanência no SEP e a taxa de admissão hospitalar. Asensibilidade para discriminar pacientes muito urgentes foi de 0,89 (intervalo de confiança de 95%- IC95% 0,78-0,95), e a taxa de subtriagem foi de 7,4%. Aconfiabilidade interobservadores em 191 pacientes classificados por duas enfermeiras foi substancial (kw2=0,75; IC95% 0,74-0,79). CONCLUSÕES: O sistema CLARIPED mostrou boa validade e substancial confiabilidade para classificação de risco em um serviço de emergência pediátrica.

Validade e confiabilidade de um novo sistema de classificação de risco para emergências pediátricas: clariped / Validity and reliability of a new triage system for pediatric emergency care: clariped

RESUMO Objetivo: Avaliar a validade e a confiabilidade de um sistema de classificação de risco para emergências pediátricas (CLARIPED) desenvolvido no Brasil. Métodos: Fase de validade: estudo observacional prospectivo em crianças de 0 a 15anos atendidas consecutivamente no serviço de emergência pediátrica (SEP) de um hospital terciário entre 2 e 18de julho de 2013. Avaliou-se a associação dos níveis de urgência com desfechos clínicos (utilização de recursos, taxa de admissão no SEP, taxa de hospitalização e tempo de permanência no SEP); e comparou-se o desempenho do CLARIPED com um padrão de referência. Fase de confiabilidade interobservadores: uma amostra de conveniência de pacientes atendidos entre abril e julho de 2013 foi submetida a duas classificações de risco consecutivas e independentes, e estimou-se o Kappa ponderado quadrático. Resultados: Em 1.416 atendimentos realizados na fase de validade, a distribuição de níveis de urgência foi: 0,0% vermelho/emergência; 5,9% laranja/muito urgente; 40,5% amarelo/urgente; 50,6% verde/pouco urgente; e 3,0% azul/sem urgência. Ospercentuais de pacientes que usaram dois ou mais recursos diminuíram do nível laranja para o amarelo, verde e azul (81, 49, 22 e 2%, respectivamente, p<0,0001), assim como a taxa de admissão no SEP, o tempo de permanência no SEP e a taxa de admissão hospitalar. Asensibilidade para discriminar pacientes muito urgentes foi de 0,89 (intervalo de confiança de 95%- IC95% 0,78-0,95), e a taxa de subtriagem foi de 7,4%. Aconfiabilidade interobservadores em 191 pacientes classificados por duas enfermeiras foi substancial (kw2=0,75; IC95% 0,74-0,79). Conclusões: O sistema CLARIPED mostrou boa validade e substancial confiabilidade para classificação de risco em um serviço de emergência pediátrica.

ABSTRACT Objective: To assess the validity and reliability of a triage system for pediatric emergency care (CLARIPED) developed in Brazil. Methods: Validity phase: prospective observational study with children aged 0 to 15 years who consecutively visited the pediatric emergency department (ED) of a tertiary hospital from July 2 to 18, 2013. We evaluated the association of urgency levels with clinical outcomes (resource utilization, ED admission rate, hospitalization rate, and ED length of stay); and compared the CLARIPED performance to a reference standard. Inter-rater reliability phase: a convenience sample of patients who visited the pediatric ED between April and July 2013 was consecutively and independently double triaged by two nurses, and the quadratic weighted kappa was estimated. Results: In the validity phase, the distribution of urgency levels in 1,416 visits was the following: 0.0% red (emergency); 5.9% orange (high urgency); 40.5% yellow (urgency); 50.6% green (low urgency); and 3.0% blue (no urgency). The percentage of patients who used two or more resources decreased from the orange level to the yellow, green, and blue levels (81%, 49%, 22%, and 2%, respectively, p<0.0001), as did the ED admission rate, ED length of stay, and hospitalization rate. The sensitivity to identify patients with high urgency level was 0.89 (confidence interval of 95% [95%CI] 0.78-0.95), and the undertriage rate was 7.4%. The inter-rater reliability in 191patients classified by two nurses was substantial (kw2=0.75; 95%CI 0.74-0.79). Conclusions: The CLARIPED system showed good validity and substantial reliability for triage in a pediatric emergency department.

[Dimensional structure of the Brazilian version of the Functional Activities Questionnaire (FAQ-BR)]. / Estrutura dimensional da versão brasileira do Functional Activities Questionnaire (FAQ-BR).

This study aimed to assess the dimensional structure and internal consistency of the Brazilian version of the Functional Activities Questionnaire (FAQ-BR) for measurement of functional capacity in the elderly, based on the informant's report. This was a cross-sectional study with 525 non-institutionalized elderly informants, in which confirmatory factor analyses (CFA) and exploratory/confirmatory factor analyses (E/CFA) modeled according to CFA principles were used to identify the most parsimonious model and that with the best fit. The internal consistency of the FAQ-BR was assessed by composite reliability, and correlations between its dimensions were examined to investigate discriminant factor validity. CFA did not corroborate the unidimensional structure as originally proposed. Next, E/CFA fit a bidimensional structure that was reassessed by CFA, displaying a model without cross loads as the most parsimonious and with adequate fit indices. The internal consistency of FAQ-BR was considered satisfactory, and the correlation between its dimensions was acceptable. These findings are important, since they demonstrate the scale's capacity to capture the elderly's functional capacity construct in a different sociocultural context from that in which it was originally developed. The FAQ-BR can thus be considered an appropriate bidimensional instrument for measuring the elderly's functional capacity based on the informant's report, and its use in studies with similar populations is recommended.

Este estudo teve por objetivo avaliar a estrutura dimensional e a consistência interna da versão brasileira do Functional Activities Questionnaire (FAQ-BR) para aferição da capacidade funcional do idoso, com base no relato de informante. Trata-se de um estudo seccional desenvolvido com 525 informantes de idosos não institucionalizados, em que análises fatoriais confirmatórias (AFC) e análises fatoriais exploratórias (AFC/E), modeladas segundo os princípios da AFC, foram usadas para identificar o modelo mais parcimonioso e mais bem ajustado. A consistência interna do FAQ-BR foi avaliada pela confiabilidade composta, e correlações entre suas dimensões foram examinadas a fim de investigar validade fatorial discriminante. A AFC não corroborou a estrutura unidimensional originalmente proposta. Em seguida, a AFC/E ajustou uma estrutura bidimensional que foi reavaliada por AFC, evidenciando um modelo sem cargas cruzadas como o mais parcimonioso e com adequados índices de ajuste. A consistência interna do FAQ-BR foi considerada satisfatória, e a correlação entre suas dimensões, aceitável. Esses achados são importantes, pois revelam a capacidade de a escala capturar o construto capacidade funcional do idoso em um contexto sociocultural distinto daquele em que foi desenvolvido. Portanto, o FAQ-BR pode ser considerado um instrumento bidimensional apropriado para aferir a capacidade funcional do idoso com base no relato do informante, e seu uso em pesquisas com populações semelhantes é recomendado.

El objetivo de este artículo fue evaluar la estructura dimensional y la consistencia interna de la versión brasileña del Functional Activities Questionnaire (FAQ-BR) para la valoración de la capacidad funcional del anciano, en base al relato del informante. Se trata de un estudio seccional, desarrollado con 525 informantes de ancianos no institucionalizados, donde los análisis factoriales confirmatorios (AFC) y análisis factoriales exploratorios (AFC/E), fueron modelados según los principios de la AFC, así como usados para identificar el modelo más parsimonioso y más bien ajustado. La consistencia interna del FAQ-BR se evaluó por la fiabilidad compuesta, y se examinaron las correlaciones entre sus dimensiones, a fin de investigar la validez factorial discriminante. La AFC no corroboró la estructura unidimensional originalmente propuesta. En seguida, la AFC/E ajustó una estructura bidimensional que se reevaluó por parte de la AFC, evidenciando un modelo sin cargas cruzadas como el más parsimonioso y con adecuados índices de ajuste. La consistencia interna del FAQ-BR se consideró satisfactoria, y la correlación entre sus dimensiones, aceptable. Estos hallazgos son importantes, pues revelan la capacidad de la escala de aprehender el constructo capacidad funcional del anciano en un contexto sociocultural distinto de aquel en el que se desarrolló. Por ello, el FAQ-BR puede ser considerado un instrumento bidimensional, apropiado para evaluar la capacidad funcional anciano, basándose en el relato del informante, y se recomienda su uso en investigaciones con poblaciones semejantes.

Estrutura dimensional da versão brasileira do Functional Activities Questionnaire (FAQ-BR) / Dimensional structure of the Brazilian version of the Functional Activities Questionnaire (FAQ-BR) / Estructura dimensional de la versión brasileña del Functional Activities Questionnaire (FAQ-BR)

Resumo: Este estudo teve por objetivo avaliar a estrutura dimensional e a consistência interna da versão brasileira do Functional Activities Questionnaire (FAQ-BR) para aferição da capacidade funcional do idoso, com base no relato de informante. Trata-se de um estudo seccional desenvolvido com 525 informantes de idosos não institucionalizados, em que análises fatoriais confirmatórias (AFC) e análises fatoriais exploratórias (AFC/E), modeladas segundo os princípios da AFC, foram usadas para identificar o modelo mais parcimonioso e mais bem ajustado. A consistência interna do FAQ-BR foi avaliada pela confiabilidade composta, e correlações entre suas dimensões foram examinadas a fim de investigar validade fatorial discriminante. A AFC não corroborou a estrutura unidimensional originalmente proposta. Em seguida, a AFC/E ajustou uma estrutura bidimensional que foi reavaliada por AFC, evidenciando um modelo sem cargas cruzadas como o mais parcimonioso e com adequados índices de ajuste. A consistência interna do FAQ-BR foi considerada satisfatória, e a correlação entre suas dimensões, aceitável. Esses achados são importantes, pois revelam a capacidade de a escala capturar o construto capacidade funcional do idoso em um contexto sociocultural distinto daquele em que foi desenvolvido. Portanto, o FAQ-BR pode ser considerado um instrumento bidimensional apropriado para aferir a capacidade funcional do idoso com base no relato do informante, e seu uso em pesquisas com populações semelhantes é recomendado.

Abstract: This study aimed to assess the dimensional structure and internal consistency of the Brazilian version of the Functional Activities Questionnaire (FAQ-BR) for measurement of functional capacity in the elderly, based on the informant's report. This was a cross-sectional study with 525 non-institutionalized elderly informants, in which confirmatory factor analyses (CFA) and exploratory/confirmatory factor analyses (E/CFA) modeled according to CFA principles were used to identify the most parsimonious model and that with the best fit. The internal consistency of the FAQ-BR was assessed by composite reliability, and correlations between its dimensions were examined to investigate discriminant factor validity. CFA did not corroborate the unidimensional structure as originally proposed. Next, E/CFA fit a bidimensional structure that was reassessed by CFA, displaying a model without cross loads as the most parsimonious and with adequate fit indices. The internal consistency of FAQ-BR was considered satisfactory, and the correlation between its dimensions was acceptable. These findings are important, since they demonstrate the scale's capacity to capture the elderly's functional capacity construct in a different sociocultural context from that in which it was originally developed. The FAQ-BR can thus be considered an appropriate bidimensional instrument for measuring the elderly's functional capacity based on the informant's report, and its use in studies with similar populations is recommended.

Resumen: El objetivo de este artículo fue evaluar la estructura dimensional y la consistencia interna de la versión brasileña del Functional Activities Questionnaire (FAQ-BR) para la valoración de la capacidad funcional del anciano, en base al relato del informante. Se trata de un estudio seccional, desarrollado con 525 informantes de ancianos no institucionalizados, donde los análisis factoriales confirmatorios (AFC) y análisis factoriales exploratorios (AFC/E), fueron modelados según los principios de la AFC, así como usados para identificar el modelo más parsimonioso y más bien ajustado. La consistencia interna del FAQ-BR se evaluó por la fiabilidad compuesta, y se examinaron las correlaciones entre sus dimensiones, a fin de investigar la validez factorial discriminante. La AFC no corroboró la estructura unidimensional originalmente propuesta. En seguida, la AFC/E ajustó una estructura bidimensional que se reevaluó por parte de la AFC, evidenciando un modelo sin cargas cruzadas como el más parsimonioso y con adecuados índices de ajuste. La consistencia interna del FAQ-BR se consideró satisfactoria, y la correlación entre sus dimensiones, aceptable. Estos hallazgos son importantes, pues revelan la capacidad de la escala de aprehender el constructo capacidad funcional del anciano en un contexto sociocultural distinto de aquel en el que se desarrolló. Por ello, el FAQ-BR puede ser considerado un instrumento bidimensional, apropiado para evaluar la capacidad funcional anciano, basándose en el relato del informante, y se recomienda su uso en investigaciones con poblaciones semejantes.

Validade de construto da versão brasileira do functional activities questionnaire / Construct validity of the Brazilian version of the Functional Activities Questionnaire

Objetivo: Investigar a validade de construto da versão brasileira do Functional Activities Questionnaire (FAQ-BR) para aferição da capacidade funcional do idoso, com base no relato do informante. Métodos: Estudo seccional realizado com 525 idosos não institucionalizados e seus respectivos informantes. Os coeficientes de correlação (r) de Pearson e tau de Kendall, com nível de significância estatística < 0,05, foram utilizados para avaliar a correlação entre a pontuação do FAQ-BR e outras variáveis sociodemográficas e de condições de saúde teoricamente relevantes. Resultados: Todas as correlações mostraram-se compatíveis com a teoria subjacente, com significância estatística (valor p < 0,001): idade (r = 0,522), renda (r = - 0,148), anos de estudo (r = - 0,191), morar só (r = - 0,175), autopercepção de saúde (r = - 0,149), doenças crônicas autorrelatadas (r = 0,125) e déficit cognitivo (r = 0,350). Conclusão: Embora o FAQ-BR tenha apresentado validade de construto, estudos futuros deverão complementar a avaliação de sua pertinência para aferição da capacidade funcional do idoso, com base no relato do informante.

Objective: To investigate the construct validity of the Brazilian version of the Functional Activities Questionnaire (FAQ-BR), which measures the functional capacity of the elderly, based on an informant's report. Methods: A cross-sectional study was performed with 525 non-hospitalized elderly and their respective informants. Pearson's and Kendall's tau correlation coefficients with a statistical significance level of < 0.05 were used to evaluate the correlation between the FAQ-BR score and sociodemographic and health condition variables. Results: All correlations were compatible with the underlying theory, with a statistical significance (p value < 0.001): age (r = 0.522); income (r = - 0.148); years of schooling (r = - 0.191); living alone (r = - 0.175); self-rated health (r = - 0.149); chronic self-reported diseases (r = 0.125) and; cognitive impairment (r = 0.350). Conclusion: Although the FAQ-BR demonstrates construct validity, future complementary studies should be done to further measure elderly people's functional capacity, based on an informant's report.