[Multimorbidity and utilization of health services in the city of São Paulo, Brazil: prevalence and associated factors]. / Multimorbidade e utilização de serviços de saúde no município de São Paulo, Brasil: prevalência e fatores associados.

The scope of this paper was to estimate the prevalence of multimorbidity in the city of São Paulo and to verify the factors associated with the utilization of the health services. It involved a population based cross-sectional study based on data from the Health Survey in the city of São Paulo, in which descriptive analysis was conducted, and logistic regression models were developed using multimorbidity and sociodemographic independent variables, living conditions and use of health services as the outcome. A total of 3,184 individuals aged 20 years or older participated, with a mean age of 43.8 years. The prevalence of multimorbidity was 50.7% among women, 62.5% among those who reported some health problem and 55.1% among those who had recourse to health services in the last 2 weeks. A higher prevalence was identified among those who used the health service due to a mental health problem (66.1%), and in those who reported higher health expenditures in the preceding month (55.4%). Multimorbidity was more frequently associated with aging, in the population with a higher economic status, with worse self-rated health, who frequented health services for 6 months or less, who reported a health problem, or who had a health plan and opted for polypharmacy.

O objetivo foi estimar a prevalência de multimorbidade no município de São Paulo e verificar os fatores associados à utilização de serviços de saúde. Estudo transversal de base populacional a partir do Inquérito de Saúde do Município de São Paulo (ISA-Capital 2015), em que foi realizada análise descritiva e foram elaborados modelos de regressão logística utilizando como desfecho a multimorbidade e variáveis independentes sociodemográficas, de condições de vida e utilização de serviços de saúde. Participaram 3.184 indivíduos com 20 anos ou mais, idade média de 43,8 anos. A prevalência de multimorbidade foi de 50,7% entre as mulheres, 62,5% entre os que relataram algum problema de saúde e 55,1% entre os que utilizaram serviços de saúde nas duas últimas semanas. Foi identificada maior prevalência nos indivíduos que usaram serviço de saúde por problema de saúde mental (66,1%) e que informaram maiores despesas com saúde no último mês (55,4%). A multimorbidade foi mais frequente com o envelhecimento, na população com nível econômico mais elevado, com pior autoavaliação de saúde, que utilizou serviços de saúde há seis meses ou menos, que relatou problema de saúde, que tinha plano de saúde e fazia uso da polifarmácia.

Reliability and validity of the Brazilian version of the world health organization disability assessment schedule (WHODAS 2.0) questionnaire for women with urinary incontinence.

PURPOSE: To analyze the reliability and validity of the WHODAS 2.0 instrument for women with urinary incontinence (UI). METHODS: This is a methodological study with Brazilian women with complaints of urge, stress or mixed UI, over 18 years old, without cognitive disorders. The WHODAS 2.0 (36-item version) and the auxiliary instruments were applied through face-to-face and telephone interviews after 7-14 d. The psychometric properties evaluated were: Cronbach's alpha for internal consistency, intraclass correlation coefficient (ICC) for intra-rater test-retest, Spearman's correlation coefficient (rho) for construct validity of WHODAS 2.0 with auxiliary instruments; and ANOVA for discriminative validity with UI severity. RESULTS: 101 women with UI with a mean age of 50.71 ± 10.39 were included. WHODAS 2.0 showed good reliability in all domains and excellent reliability in the total score (>0.80). The intra-evaluator test-retest showed ICC values between 0.59 and 0.87 (p < 0.001). We observed a positive correlation between the WHODAS 2.0 domains and the instruments recommended by International Continence Society (ICS), with greater emphasis on moderate correlation with the Urinary Impact Questionnaire (IUQ-7) subscale (rho = 0.730 p < 0.001). CONCLUSION: The WHODAS 2.0 instrument is a reliable and valid questionnaire for investigating the functioning and disability of women with UI.

The WHODAS 2.0 is a valid and reliable tool for future functioning research with women with urinary incontinence.The WHODAS 2.0 can be used in clinical practice to assess disabilities in women with urinary incontinence.The validation of WHODAS 2.0 reinforces the need for rehabilitation based on the functioning needs of each patient with urinary incontinence.The WHODAS 2.0 assesses functioning based on the biopsychosocial model, supported by the ICF (International Classification of Functioning, Disability and Health).

Standardization use of the international classification of functioning, disability and health in the determination of health status in patients with post-acute COVID-19 syndrome.

PURPOSE: To propose a standardized method for the use of the International Classification of Functioning, Disability and Health (ICF) to describe the health status in Post-Acute COVID-19 Syndrome (PACS) and investigate interrater agreement in the linking process in instruments and clinical exams using the ICF categories. MATERIALS AND METHODS: Cross-sectional and interrater agreement study that followed the Guidelines for Reporting Reliability and Agreement Studies. Two raters performed the linking coding process in instruments of quality of life, anxiety and depression, fatigue and pulmonary function, inspiratory muscle strength and cardiopulmonary exercise testing. The codes were qualified by standards defined to each instrument and exams. RESULTS: The instrument with the lowest Cohen's Kappa coefficient was anxiety and depression (k = 0.57). Forty ICF codes were linked to clinical instruments and exams. The fatigue instrument presented a higher degree of disability by the qualification process, from severe to complete, in the linked codes. CONCLUSION: The study presents a standardized method for the assessment of the health status of patients with PACS through ICF. Restriction in work performance, socialization and family relationships as well as disabilities in physical endurance, fatigue and exercise tolerance were found in the sample. The agreement between the raters was moderate to perfect, demonstrating that the method can be reproducible.

The body structures and functions, environmental factors, activities and participation in a person's environment are determinant aspects of his health.Ways to measure these aspects are key to assessing health not only as absence of disease, so the International Classification of Disability and Functional Health demonstrates the ability to fully describe health.This study proposes a standardization in the use of the tool to facilitate usability in clinical practice.

Impairments, health conditions and health risk behaviors: occurrence and associations, in the National Health Survey, Brazil, 2019.

OBJECTIVE: To analyze association of visual, hearing, mental/intellectual, physical and multiple impairments with health conditions and health risk behaviors in Brazil. METHODS: This was a cross-sectional study, using data from the 2019 National Health Survey; associations between impairments and presence of cardiovascular disease (CVD), hypertension, diabetes mellitus (DM), high cholesterol, alcohol abuse and smoking were estimated using logistic regression, thus obtaining the odds ratios (OR). RESULTS: Impairment was reported by 7.6% of the 90,846 participants. Having a impairment was associated with greater odds of reporting chronic conditions, especially CVD (OR = 2.11; 95%CI 1.76;2.54) and DM (OR = 1.78; 95%CI 1.56;2.02 ); visual impairment was associated with greater odds of smoking (OR = 1.52; 95%CI 1.28;1.81); mental/intellectual impairment was inversely related to smoking (OR = 0.45; 95%CI 0.30;0.67) and alcohol abuse (OR = 0.13; 95%CI 0.06;0.26). CONCLUSION: Having any of the impairments studied may be associated with greater odds of having chronic health conditions. MAIN RESULTS: Positive association was identified between having one or more impairments, and health conditions and health risk behaviors. The higher the prevalence of mental/intellectual, physical and multiple impairments, the lower alcohol abuse and smoking. IMPLICATIONS FOR SERVICES: As this population is vulnerable to chronic health conditions, health services need strategies to reduce barriers to access, as well as health promotion actions, such as health education, adapted for people with impairments. PERSPECTIVES: Topics for future studies, examining the inverse relationship between impairments and alcohol abuse and smoking, in addition to acting on the causal chain, so as to prevent health conditions and health risk behaviors.

Relationship between personal and environmental factors and prevalence of acquired physical impairment in Brazil - a population-based study. / Relação de fatores pessoais e ambientais com a prevalência de deficiências físicas adquiridas no Brasil - estudo de base populacional.

The aim of this study was to estimate the relationship between personal and environmental factors and the prevalence of acquired physical impairment in adults and older persons in Brazil. We conducted a cross-sectional study using data from the 2013 National Health Survey. The response variable was self-reported acquired physical impairment. The explanatory variables were sex, race/skin color, education level, social class, paid employment, private health insurance, running water, and connection to a sewer network. The strength of association between the explanatory variables and response variable and respective 95% confidence intervals were estimated using Poisson Regression. Physical impairment was reported by 1.25% of the study population (n=55,369). After complete adjustment, being male and non-white, having a lower level of education, living alone, not being in paid employment, not having private health insurance, not having running water, and not living in a house connected to a sewer network were associated with higher prevalence of acquired physical impairment. The findings show that prevalence of physical impairment was higher among vulnerable groups and that personal and environmental factors are important elements that need to be assessed at the population level.

Objetivou estimar a relação de fatores pessoais e ambientais com a prevalência de deficiência física adquirida em adultos e idosos brasileiros. Realizado um estudo transversal com dados da Pesquisa Nacional de Saúde (PNS) 2013. A variável resposta foi: autorrelato deficiência física adquirida. As variáveis explicativas de interesse foram: sexo, raça/cor, escolaridade, classe social, trabalho remunerado, plano de saúde, água canalizada e rede de esgoto. As magnitudes das associações e seus respectivos intervalos de confiança (95%) foram estimadas utilizando a Regressão de Poisson. O autorrelato de deficiência física foi encontrado em 1,25% dos 55.369 participantes. Após completo ajustamento, o sexo masculino, raça/cor não branca, menores níveis de escolaridade, viver sozinho, não ter trabalho remunerado, plano de saúde, água canalizada e rede de esgoto foram associados a maiores prevalências de deficiência física adquirida. Esses achados evidenciam que a população mais vulnerável apresenta maior prevalência de deficiência física e os fatores pessoais e ambientais são importantes de serem avaliados em nível populacional.

Association of social factors and health conditions with capacity and performance.

OBJECTIVE: Determine and measure the association of social factors and health conditions with worse capacity and performance levels. METHODS: Dependent variables consisted of performance and capacity; independent variables comprised age, gender, level of education, personal income, and health conditions. Means (95%CI) of performance and capacity were presented according to the independent variables. Generalized linear models, using a mutual adjustment for all variables considered statistically significant (p < 0.05), measured the associations between each exposure and outcomes. Study population included 12,265 individuals. RESULTS: Older women with lower education and income levels and with some health condition showed the worst performance and capacity. CONCLUSION: Results showed that the capacity and performance levels of the Chilean population changed according to social demographic characteristics and health conditions.

Brazilian practice guidelines for stroke rehabilitation: Part II.

The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.

As Diretrizes Brasileiras de Reabilitação do Acidente Vascular Cerebral (AVC) - Parte II, desenvolvida pelo Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia é voltada para intervenções específicas de técnicas de reabilitação de déficits neurológicos e incapacidades. Seguindo o mesmo modelo da Parte I, a Parte II também se baseia em estudos randomizados, revisões sistemáticas, metanálises e outras diretrizes sobre o mesmo tema. A segunda parte aborda os distúrbios da comunicação, disfagia, controle postural e equilíbrio, ataxias, espasticidade, reabilitação do membro superior, marcha, cognição, negligência espacial unilateral, déficits sensoriais, reabilitação domiciliar, aderência ao uso de medicamentos, cuidados paliativos, o futuro da reabilitação no AVC, e websites de orientação sobre AVC para pacientes e cuidadores. Nosso objetivo é fornecer aos profissionais envolvidos na reabilitação conhecimento atualizado e recomendações para um melhor cuidado no pós-AVC.

Validation of the Brazilian version of the World Health Organization Disability Assessment Schedule 2.0 for individuals with HIV/AIDS. / Validação da versão brasileira do World Health Organization Disability Assessment Schedule 2.0 em indivíduos HIV/AIDS.

The WHODAS 2.0 (World Health Organization Disability Assessment Schedule) is an instrument developed by the WHO (World Health Organization) for functioning and disability assessment based on the biopsychosocial framework, fully supported by the theoretical-conceptual framework of the ICF (International Classification of Functioning, Disability and Health). To validate the Brazilian version of the WHODAS 2.0 for individuals with HIV/AIDS. 100 individuals with diagnosis of HIV/AIDS participated in the study. Two assessment instruments were used: the 36-item version of WHODAS 2.0 and the WHOQOL-HIV-BREF (World Health Organization Quality of Life assessment in persons infected with HIV, shorter version). The psychometric properties tested were internal consistency and criterion validity. Internal consistency was adequate for all domains, with the exception of Life Activities (α = 0.69) and Self-care (α = 0.32). Criterion validity was adequate, with moderate correlations between the WHODAS 2.0 and the WHOQOL-HIV-BREF domains. The results indicated the WHODAS 2.0 instrument as a valid tool for assessing functioning of individuals with HIV/AIDS. The use of data from the Self-care domain should be carefully considered.

O WHODAS 2.0 (World Health Organization Disability Assesment Schedule) é um instrumento criado pela OMS (Organização Mundial da Saúde) para medida de funcionalidade e deficiência, fundamentado no modelo biopsicossocial e totalmente amparado no arcabouço teórico-conceitual da CIF (Classificação Internacional de Funcionalidade, Incapacidade e Saúde). O objetivo deste artigo é validar a versão brasileira do WHODAS 2.0 para o uso em pessoas com HIV/AIDS. Participaram 100 pessoas com diagnóstico de HIV/AIDS. Foram utilizados dois instrumentos de avaliação, o WHODAS 2.0 na versão de 36 itens e o WHOQoL-HIV-Bref (World Health Organization Quality of Life em pessoas com HIV, versão abreviada). As propriedades psicométricas testadas foram consistência interna e validade de critério. A consistência interna foi adequada para todos os domínios, com exceção do domínio Atividades de Vida (α = 0,69) e Autocuidado (α = 0,32). A validade de critério foi adequada, com correlações moderadas aos domínios do WHODAS 2.0 com os domínios do WHOQoL-HIV-Abreviado. Os resultados indicaram o instrumento WHODAS 2.0 como válido para avaliação da funcionalidade de pessoas com HIV/AIDS. O uso dos dados do domínio de Autocuidado deve ser cuidadosamente considerado.

PREVALENCE AND FACTORS ASSOCIATED WITH CONSTIPATION IN PREMENOPAUSAL WOMEN: A COMMUNITY-BASED STUDY.

BACKGROUND: Intestinal constipation is characterized by problems related to evacuation, and presents high prevalence in the female gender. This condition has demonstrated negative effects on the development of daily activities, causing damage to the physical and emotional well-being of individuals who are diagnosed with it. Studies that investigate what health impairments intestinal constipation can cause are scarce in the literature. OBJECTIVE: This study aimed to verify the prevalence and factors associated with intestinal constipation in premenopausal women living in Northeastern Brazil. METHODS: It is a cross-sectional study. This was carried out in the northeast of Brazil. Participated 195 women, adult and middle age. Social conditions, habits and lifestyle, clinical aspects and obstetric history were investigated. Constipation was diagnosed using the Rome III Criteria. Multivariate analysis was conducted using Poisson Regression with robust variance to analyze the relationship between intestinal constipation and independent variables. A statistical significance level of P<0.05 was considered. RESULTS: Most of the women were between 25 and 39 years old (49.2%) and had an income of up to one minimum wage (79.5%). The intestinal constipation prevalence was 35.4%. In the final multivariate regression model, hemorrhoid clinical aspects (P=0.01), pain (P=0.001) and a burning sensation (P=0.01) on bowel movement, and sexual dysfunction (P=0.03) remained associated with constipation. CONCLUSION: The present study found a significant prevalence of constipation among premenopausal women and clinical factors such as hemorrhoids, pain and a burning sensation, and sexual dysfunction were associated with intestinal constipation.

Quality of life, sociodemographic and occupational factors of working women. / Qualidade de vida, fatores sociodemográficos e ocupacionais de mulheres trabalhadoras.

This article aims to evaluate the quality of life of working women and its relationship with sociodemographic and occupational aspects. Cross-sectional study in a sample of 579 working women in a city with a population of 318,000. Data was collected by means of questionnaires for sociodemographic, occupational and WHOQOL-BREF characteristics. For the analysis, we used descriptive statistics, t-student test and the Pearson correlation. The working women on average were 42.70 ±13.74 years old; there was a predominance of Caucasians with 9 to 12 years of formal education and an individual monthly minimum-wage income at a single job as a registered employee or civil servant. The average Quality of Life was 72.87, with a better result in the area of Social Relations and the lowest in the area of Environment. The Environment domain was significantly more compromised in women who did not have rest breaks during work, those who did not have good relationships with their coworkers, had more diseases or injuries, less formal education and lower monthly income. The Social Relations domain was significantly compromised by the number of injuries or diseases.

O objetivo deste artigo é avaliar a qualidade de vida da mulher trabalhadora e verificar a suas relações com aspectos sociodemográficos e ocupacionais. Estudo transversal, em uma amostra de 579 mulheres trabalhadoras de um município de 318.000 habitantes. Os dados foram coletados por meio de questionário para caracterização sociodemográfica, ocupacional e do WHOQOL-BREF. Para análise utilizou-se estatística descritiva, Teste t-student e correlação de Pearson. As mulheres trabalhadoras apresentaram 42,70 ±13,74 anos, houve predomínio de escolaridade entre 09 a 12 anos, cor da pele branca, renda individual mensal de até um salário mínimo, com apenas um emprego com vínculo celetista ou funcionalismo público. A média da Qualidade de Vida foi de 72,87, com melhor resultado no domínio das Relações Sociais e o menor do Meio Ambiente. O domínio Meio Ambiente foi significativamente comprometido nas mulheres que não tinham pausas para descanso durante o trabalho, não tinham bom relacionamento com os colegas, apresentavam maior número de doenças ou lesões, possuíam menor escolaridade e renda mensal. O Domínio das Relações sociais foi significativamente afetado pelo número de lesões ou doenças.

Multimorbidade e utilização de serviços de saúde no município de São Paulo, Brasil: prevalência e fatores associados / Multimorbidity and utilization of health services in the city of São Paulo, Brazil: prevalence and associated factors

Resumo O objetivo foi estimar a prevalência de multimorbidade no município de São Paulo e verificar os fatores associados à utilização de serviços de saúde. Estudo transversal de base populacional a partir do Inquérito de Saúde do Município de São Paulo (ISA-Capital 2015), em que foi realizada análise descritiva e foram elaborados modelos de regressão logística utilizando como desfecho a multimorbidade e variáveis independentes sociodemográficas, de condições de vida e utilização de serviços de saúde. Participaram 3.184 indivíduos com 20 anos ou mais, idade média de 43,8 anos. A prevalência de multimorbidade foi de 50,7% entre as mulheres, 62,5% entre os que relataram algum problema de saúde e 55,1% entre os que utilizaram serviços de saúde nas duas últimas semanas. Foi identificada maior prevalência nos indivíduos que usaram serviço de saúde por problema de saúde mental (66,1%) e que informaram maiores despesas com saúde no último mês (55,4%). A multimorbidade foi mais frequente com o envelhecimento, na população com nível econômico mais elevado, com pior autoavaliação de saúde, que utilizou serviços de saúde há seis meses ou menos, que relatou problema de saúde, que tinha plano de saúde e fazia uso da polifarmácia.

Abstract The scope of this paper was to estimate the prevalence of multimorbidity in the city of São Paulo and to verify the factors associated with the utilization of the health services. It involved a population based cross-sectional study based on data from the Health Survey in the city of São Paulo, in which descriptive analysis was conducted, and logistic regression models were developed using multimorbidity and sociodemographic independent variables, living conditions and use of health services as the outcome. A total of 3,184 individuals aged 20 years or older participated, with a mean age of 43.8 years. The prevalence of multimorbidity was 50.7% among women, 62.5% among those who reported some health problem and 55.1% among those who had recourse to health services in the last 2 weeks. A higher prevalence was identified among those who used the health service due to a mental health problem (66.1%), and in those who reported higher health expenditures in the preceding month (55.4%). Multimorbidity was more frequently associated with aging, in the population with a higher economic status, with worse self-rated health, who frequented health services for 6 months or less, who reported a health problem, or who had a health plan and opted for polypharmacy.

Applying the ICF linking rules to compare population-based data from different sources: an exemplary analysis of tools used to collect information on disability.

BACKGROUND: Data on disability are regularly collected by different institutions or ministries using specific tools for different purposes, for instance to estimate the prevalence of disability or eligibility of specific populations for social benefits. The interoperability of disability data collected in countries is essential for policy making and to monitor the implementation of the Convention on the Rights of Persons with Disabilities. The first objective of this paper is to map and compare tools that collect data on disability for different purposes, more specifically the Brazilian National Health Survey and the Brazilian Functioning Index to the World Health Organization (WHO) and the World Bank Model Disability Survey (MDS), currently recommended as a standard tool for disability measurement. The second objective is to demonstrate the usefulness and value of the International Classification of Functioning, Disability and Health Linking Rules to map and compare population-based surveys and other content-related tools collecting data on disability, even when these have already been developed based on the International Classification of Functioning, Disability and Health. METHODS: Disability information collected with the three different tools was mapped and compared using the International Classification of Functioning, Disability and Health Linking Rules. RESULTS: Although the disability module in the Brazilian National Health Survey is fundamentally different from the MDS, the mapping disclosed that several modules of the Brazilian National Health Survey already cover many aspects necessary to estimate prevalence and understand disability as currently recommended by the WHO and the World Bank. The Brazilian Functioning Index and the MDS are both based on the International Classification of Functioning, Disability and Health and are very similar in the approach and content of their questions on functioning. Specific information on environmental factors is essential to identify needs and barriers, as well as to devise procedures to reduce injustice and inequalities. This information is still not targeted broadly enough in both the Brazilian National Health Survey and the Brazilian Functioning Index. CONCLUSIONS: Overall, this mapping exercise showed that applying the International Classification of Functioning, Disability and Health linking rules to population-based data coming from different sources provides researchers and stakeholders involved in decision-making with standardized and straightforward information about overlaps and gaps. Implications for Rehabilitation Data on functioning and disability regularly collected with different purposes and by different institutions or ministries within a country can be compared using the International Classification of Functioning, Disability and Health as a reference framework and the International Classification of Functioning, Disability and Health linking rules. The recently published refinements of the International Classification of Functioning, Disability and Health Linking Rules go beyond the sole linking to International Classification of Functioning, Disability and Health categories and provide standardized procedures to document the perspective of linked questions or the categorization of response options. They are therefore useful to compared tools that have been developed based on the International Classification of Functioning, Disability and Health. The current disability module of the Brazilian Health Survey needs a revision to be suitable to collect data on disability that is Convention on the Rights of Persons with Disabilities conform and guarantees interoperability with disability data from other sources in Brazil, especially from disability assessment for social benefits and implementation of policies.

Breast cancer screening practice and associated factors: Women's Health Survey in Uberaba MG Brazil, 2014. / Prática de exames de rastreio para câncer de mama e fatores associados ­ Inquérito de Saúde da Mulher em Uberaba MG, Brasil, 2014.

This study aimed to characterize women's socioeconomic and epidemiological profile in Uberaba according to the breast cancer screening practice and identify associated factors with this practice. This is a cross-sectional research part of the Women's Health Survey in Uberaba (MG). Data was collected by home interview, referring to socioeconomic and epidemiological issues and breast cancer screening practice, from a sample of 1,520 women above 20 years of age. After processing the data, we performed statistical analysis with measures of association by the Chi-square test, bivariate and multivariate Poisson regression, with a significance level of 5%. The results showed a profile of breast cancer screening practice with white women (66%), high schooling and per capita income, in common-law marriage (67,5%), non-heads of households (64,4%) and non-smokers (64,6%). Factors associated with higher practice were the age groups 40-49 and 50-69 years (PR = 0.7 and 0.64), per capita income higher than one minimum wage (PR = 1.17) and public or health plan mammography coverage (PR = 1.98 and 1.94). We can conclude that factors associated with breast cancer screening practice have been identified in the studied sample.

Os objetivos deste estudo foram caracterizar o perfil socioeconômico e epidemiológico das mulheres em Uberaba, segundo a prática de exames de rastreio para câncer de mama, bem como verificar os fatores associados à prática. Pesquisa transversal de base populacional, parte do Inquérito de Saúde da Mulher em Uberaba MG. Coleta por entrevista domiciliar, referentes à questões socioeconômicas, epidemiológicas e prática de exames de rastreio para câncer de mama. Amostra foi composta por 1.520 mulheres acima de 20 anos. Após o processamento dos dados, foi realizada análise estatística com medidas de associação pelo teste Qui-Quadrado; regressão bivariada e multivariada de Poisson, significância de 5%. Os resultados demonstraram um perfil de prática de exames de rastreio para câncer de mama com mulheres de raça/cor branca (66%), escolaridade e renda per capita elevada, estado conjugal "em união" (67,5%), não chefes de família (64,4%) e não tabagistas (64,6%). Os fatores associados à maior prática dos exames foram a faixa etária de 40-49 e 50-69 anos (RP = 0,7 e 0,64), renda per capita maior que um salário mínimo (RP = 1,17) e fonte de pagamento da mamografia pública ou por plano de saúde (RP = 1,98 e 1,94). Conclui-se que existem fatores relacionados à prática de exames de rastreio na amostra estudada.

Deficiências, condições de saúde e comportamentos de risco à saúde: ocorrência e associações, na Pesquisa Nacional de Saúde, Brasil, 2019 / Impairments, health conditions and health risk behaviors: occurrence and associations, in the National Health Survey, Brazil, 2019 / Discapacidades, condiciones de salud y conductas de riesgo para la salud: ocurrencia y asociaciones, en la Encuesta Nacional de Salud, Brasil, 2019

Objective To analyze association of visual, hearing, mental/intellectual, physical and multiple impairments with health conditions and health risk behaviors in Brazil. Methods This was a cross-sectional study, using data from the 2019 National Health Survey; associations between impairments and presence of cardiovascular disease (CVD), hypertension, diabetes mellitus (DM), high cholesterol, alcohol abuse and smoking were estimated using logistic regression, thus obtaining the odds ratios (OR). Results Impairment was reported by 7.6% of the 90,846 participants. Having a impairment was associated with greater odds of reporting chronic conditions, especially CVD (OR = 2.11; 95%CI 1.76;2.54) and DM (OR = 1.78; 95%CI 1.56;2.02 ); visual impairment was associated with greater odds of smoking (OR = 1.52; 95%CI 1.28;1.81); mental/intellectual impairment was inversely related to smoking (OR = 0.45; 95%CI 0.30;0.67) and alcohol abuse (OR = 0.13; 95%CI 0.06;0.26). Conclusion Having any of the impairments studied may be associated with greater odds of having chronic health conditions.

Objetivo Analizar la asociación entre discapacidad visual, auditiva, mental/intelectual, física y discapacidad múltiple con condiciones y conductas de riesgo para la salud en Brasil. Métodos Estudio transversal utilizando datos de la Encuesta Nacional de Salud de 2019; se estimaron, mediante regresión logística, las asociaciones entre discapacidad con la presencia de enfermedades cardiovasculares (ECV), hipertensión, diabetes, colesterol alto, consumo de alcohol y tabaquismo, obtención del odds ratio (OR). Resultados De los 90.846 participantes, el 7,6% refirió discapacidad. Tener una discapacidad se asoció con una mayor probabilidad de reportar enfermedades crónicas, especialmente ECV (OR = 2,11; IC95% 1,76;2,54) y diabetes (OR = 1,78; IC95% 1,56;2,02); la discapacidad visual se asoció con una mayor probabilidad de fumar (OR = 1,52; IC95% 1,28;1,81); la discapacidad mental/intelectual mostró una relación inversa con el tabaquismo (OR = 0,45; IC95% 0,30;0,67) y el consumo de alcohol (OR = 0,13; IC95% 0,06;0,26). Conclusión Se observó que tener alguna de las discapacidades estudiadas puede estar asociado con mayores posibilidades de tener condiciones crónicas de salud.

Objetivo Analisar a associação de deficiências visual, auditiva, mental/intelectual, física e deficiência múltipla com as condições e comportamentos de risco à saúde no Brasil. Métodos Estudo transversal, utilizando-se dados da Pesquisa Nacional de Saúde de 2019; associações entre deficiências e presença de doença cardiovascular (DCV), hipertensão arterial, diabetes mellitus (DM), colesterol alto, consumo abusivo de álcool e tabagismo foram estimados por regressão logística, obtendo-se a razão de chances (RC). Resultados Dos 90.846 participantes, 7,6% reportaram deficiência. Ter deficiência associou-se a maiores chances de relatar condições crônicas, especialmente DCV (RC = 2,11; IC95% 1,76;2,54) e DM (RC = 1,78; IC95% 1,56;2,02); deficiência visual associou-se a maior chance de tabagismo (RC = 1,52; IC95% 1,28;1,81); deficiência mental/intelectual apresentou relação inversa com tabagismo (RC = 0,45; IC95% 0,30;0,67) e consumo abusivo de álcool (RC = 0,13; IC95% 0,06;0,26). Conclusão Apresentar alguma das deficiências estudadas pode-se associar a maiores chances de ter condições crônicas de saúde.

Limitation of activity and restriction of social participation in relation to age range, gender, and education in people with leprosy.

BACKGROUND: In Brazil, 38,000 new cases of leprosy are discovered each year, making it a public health problem. OBJECTIVE: To identify whether or not there is an association between activity limitations and the restriction of social participation with some demographic data (age range, gender, and education) of the patients in a Basic Health Unit (BHU), diagnosed with leprosy. METHODS: The SALSA scale was used to assess activity limitations, whereas the Participation scale was used to assess the restriction of social participation. RESULTS: The assessments were conducted with 31 BHU patients diagnosed with leprosy. Males were the most affected by leprosy, the multibacillary was the most prevalent, and education proved to be an important factor when related to the disease injuries among the evaluated individuals. Regarding activity limitations and the restriction of social participation, the percentage of individuals without limitations and without restrictions was greater in both scales. STUDY LIMITATIONS: The main limitation is the small study sample. CONCLUSION: It can be concluded that, for the studied sample, no association was observed between the activity limitations, evaluated by the Salsa scale, nor the restriction of social participation, evaluated by the Participation Scale, with the analyzed demographic data.

Relação de fatores pessoais e ambientais com a prevalência de deficiências físicas adquiridas no Brasil - estudo de base populacional / Relationship between personal and environmental factors and prevalence of acquired physical impairment in Brazil - a population-based study

Resumo Objetivou estimar a relação de fatores pessoais e ambientais com a prevalência de deficiência física adquirida em adultos e idosos brasileiros. Realizado um estudo transversal com dados da Pesquisa Nacional de Saúde (PNS) 2013. A variável resposta foi: autorrelato deficiência física adquirida. As variáveis explicativas de interesse foram: sexo, raça/cor, escolaridade, classe social, trabalho remunerado, plano de saúde, água canalizada e rede de esgoto. As magnitudes das associações e seus respectivos intervalos de confiança (95%) foram estimadas utilizando a Regressão de Poisson. O autorrelato de deficiência física foi encontrado em 1,25% dos 55.369 participantes. Após completo ajustamento, o sexo masculino, raça/cor não branca, menores níveis de escolaridade, viver sozinho, não ter trabalho remunerado, plano de saúde, água canalizada e rede de esgoto foram associados a maiores prevalências de deficiência física adquirida. Esses achados evidenciam que a população mais vulnerável apresenta maior prevalência de deficiência física e os fatores pessoais e ambientais são importantes de serem avaliados em nível populacional.

Abstract The aim of this study was to estimate the relationship between personal and environmental factors and the prevalence of acquired physical impairment in adults and older persons in Brazil. We conducted a cross-sectional study using data from the 2013 National Health Survey. The response variable was self-reported acquired physical impairment. The explanatory variables were sex, race/skin color, education level, social class, paid employment, private health insurance, running water, and connection to a sewer network. The strength of association between the explanatory variables and response variable and respective 95% confidence intervals were estimated using Poisson Regression. Physical impairment was reported by 1.25% of the study population (n=55,369). After complete adjustment, being male and non-white, having a lower level of education, living alone, not being in paid employment, not having private health insurance, not having running water, and not living in a house connected to a sewer network were associated with higher prevalence of acquired physical impairment. The findings show that prevalence of physical impairment was higher among vulnerable groups and that personal and environmental factors are important elements that need to be assessed at the population level.

Association of social factors and health conditions with capacity and performance

ABSTRACT OBJECTIVE Determine and measure the association of social factors and health conditions with worse capacity and performance levels. METHODS Dependent variables consisted of performance and capacity; independent variables comprised age, gender, level of education, personal income, and health conditions. Means (95%CI) of performance and capacity were presented according to the independent variables. Generalized linear models, using a mutual adjustment for all variables considered statistically significant (p < 0.05), measured the associations between each exposure and outcomes. Study population included 12,265 individuals. RESULTS Older women with lower education and income levels and with some health condition showed the worst performance and capacity. CONCLUSION Results showed that the capacity and performance levels of the Chilean population changed according to social demographic characteristics and health conditions.

Symptomatic perception of patients affected by chronic chikungunya: a qualitative perspective / Percepção dos sintomas de pacientes acometidos por chikungunya crônica: um olhar qualitativo

Objective: To understand the demands caused by chikungunya in the chronic phase and their impacts on patients' mental health and quality of life. Materials and methods: This is a qualitative study, performed from November 2019 to January 2020. Focus groups and deep interviews were carried out. Then, the Discourse Analysis was performed. Results: Chronic pain was the main clinical manifestation reported by the participants, being responsible for affecting aspects related to quality of life and mental health. As for psycological view, this study showed that chronic pain was also reported as one of the main symptoms related to anxiety and depression among research subjects. Conclusion: this study demonstrated how the chronic illness caused by Chikungunya impacted the subjects' perception in the domains related to quality of life and mental health. Furthermore, we seek to focus on the management of disease in a holistic way, putting the patients' own awareness of the impacts of the disease on their lives in a relevant level of their treatment.

Objetivo: Compreender as demandas causadas pela chikungunya em sua fase crônica e seus impactos na saúde mental e na qualidade de vida dos pacientes. Métodos: Trata-se de um estudo com abordagem qualitativa, realizado entre novembro de 2019 a janeiro de 2020. Inicialmetne, foram realizados grupos focais e entrevistas em profundidade; seguidas da Análise do Discurso. Resultados: A dor crônica foi a principal manifestação clínica relatada pelos participantes, sendo responsável por afetar aspectos relacionados à qualidade de vida e saúde mental. Quanto ao aspecto psicológico, este estudo mostrou que a dor crônica também foi relatada como um dos principais sintomas relacionados à ansiedade e depressão entre os sujeitos da pesquisa. Conclusão: este estudo demonstrou como a doença crônica causada pela chikungunya impactou na percepção dos sujeitos em seus domínios relacionados à qualidade de vida e saúde mental. Além disso, procuramos centrar-nos na gestão da doença de forma holística, colocando a consciência dos próprios doentes sobre os impactos da doença nas suas vidas num nível relevante do seu tratamento.

Brazilian practice guidelines for stroke rehabilitation: part II / Diretrizes brasileiras para reabilitação no acidente vascular cerebral: parte II

Abstract The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.

Resumo As Diretrizes Brasileiras de Reabilitação do Acidente Vascular Cerebral (AVC) - Parte II, desenvolvida pelo Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia é voltada para intervenções específicas de técnicas de reabilitação de déficits neurológicos e incapacidades. Seguindo o mesmo modelo da Parte I, a Parte II também se baseia em estudos randomizados, revisões sistemáticas, metanálises e outras diretrizes sobre o mesmo tema. A segunda parte aborda os distúrbios da comunicação, disfagia, controle postural e equilíbrio, ataxias, espasticidade, reabilitação do membro superior, marcha, cognição, negligência espacial unilateral, déficits sensoriais, reabilitação domiciliar, aderênciaao usode medicamentos, cuidados paliativos,ofuturodareabilitação no AVC, e websites de orientação sobre AVC para pacientes e cuidadores. Nosso objetivo é fornecer aos profissionais envolvidos na reabilitação conhecimento atualizado e recomendações para um melhor cuidado no pós-AVC.

Histórico familiar para câncer de mama em mulheres: estudo populacional em Uberaba (MG) utilizando o Family History Screen-7 / Family history of breast cancer in women: a population-based study in Uberaba (MG) using the Family History Screen-7

RESUMO Objetiva-se determinar a prevalência de mulheres com risco de desenvolvimento de câncer de mama pelo histórico familiar em Uberaba (MG), e essa prevalência nas diferentes condições socioeconômicas e epidemiológicas. Pesquisa quantitativa, analítica, observacional e transversal de base populacional. Amostra com 1.520 mulheres a partir de 20 anos. Dados coletados por entrevistas domiciliares sobre informações socioeconômicas e epidemiológicas. A avaliação do risco hereditário de câncer de mama foi realizada pelo Family History Screen-7 (FHS-7). Como resultado, 28,6% da amostra apresentaram risco hereditário para câncer de mama. Houve associação significativa do risco de câncer quanto a: faixa etária, sendo nas mulheres com idade de 70 anos ou mais a maior proporção com risco (33,5%); etnia, sendo a maior proporção entre mulheres de etnia branca (31,2%); renda familiar, com maior ocorrência para renda per capita > 2,5 salários-mínimos (31,6%); prática de exames preventivos (30,6%); e alterações benignas na mama (46,7%). Conclui-se que, a partir do histórico familiar pelo FHS-7, o risco de as mulheres desenvolverem câncer mostrou-se significativamente associado com maior faixa etária, etnia branca e maior renda per capita, com a prática de exames preventivos em dia e alterações benignas na mama. Tais resultados possibilitam melhores direcionamentos de políticas públicas.

ABSTRACT The objective is to determine the prevalence of women at risk of developing breast cancer by family history in Uberaba (MG), and this prevalence in different socioeconomic and epidemiological conditions. Quantitative, analytical, observational and cross-sectional population-based research. Sample with 1.520 women aged 20 years and over. Data collected by household interviews on socioeconomic and epidemiological information. The assessment of the hereditary risk of breast cancer was performed using the Family History Screen-7 (FHS-7). As a result, 28.6% of the sample had a hereditary risk for breast cancer. There was a significant association between the risk of cancer regarding: age group, with women aged 70 years or older being the highest proportion at risk (33.5%); ethnicity, with the highest proportion among women of white ethnicity (31.2%); family income, with a higher occurrence for per capita income > 2.5 minimum wages (31.6%); practice of preventive exams (30.6%); and benign changes in the breast (46.7%). It is concluded that, based on the family history by FHS-7, the risk of women developing cancer was significantly associated with older age, white ethnicity and higher per capita income, with the practice of preventive exams up to date and benign alterations in the breast. Such results make it possible to better direct public policies.