Mari-Nilva Maia da Silva

Performance of a Brazilian population on the test of functional health literacy in adults

OBJECTIVE To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS The mean age of the sample was 47.3 years(sd=16.8) and the mean education was 9.7 years(sd=5; range: 1 - 17). A total of 32.4% of the sample showed literacy/numeracy deficits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not significant when the effects of education were held constant (rp=-0.031, p=0.584). A significant association (B=3.877, Beta =0.733; p<0.001) was found between schooling and scores. Age was not a significant predictor in this model (B=-0.035, Beta=-0.22; p=0.584). CONCLUSIONS The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classified as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare.OBJETIVO: Analisar os escores de instrumento que avalia habilidade de leitura e compreensao de materiais da area da saude segundo escolaridade e idade. METODOS: Foram avaliados 312 participantes saudaveis de diferentes idades por meio da versao reduzida do instrumento Test of Functional Health Literacy in Adults. O estudo foi realizado entre 2006 e 2007 na cidade de Sao Paulo (SP). O instrumento envolve materiais como frascos de medicamentos e cartoes de agendamento de consultas, avaliando a compreensao de leitura e de conceitos numericos. Os testes de correlacao parcial e de Pearson e um modelo de regressao multipla foram usados para verificar a associacao entre os escores no instrumento, escolaridade e idade. RESULTADOS: As medias de idade e de escolaridade da amostra foram respectivamente 47,3 (dp=16,8 ) e 9,7 (dp=5; de um a 17 anos de estudo). O total de 32,4% da amostra mostraram deficits de alfabetizacao funcional/ uso de conceitos numericos na area de saude, com desempenho inadequado ou limitrofe no instrumento. Entre idosos (65 anos ou mais) esta taxa atingiu 51,6%. Encontrou-se correlacao positiva entre anos de estudo e escores no instrumento (r=0,740; p<0,01) e correlacao negativa entre idade e escores no instrumento (r=-0,259; p<0,01). A correlacao entre escores no instrumento e idade nao foi significante quando os efeitos da escolaridade foram controlados (r=-0,031, p=0,584). Uma associacao significante (B=3,877, Beta=0,733; p<0,001) foi encontrada entre anos de estudo e escores no instrumento. A idade nao foi uma variavel preditiva no modelo (B=-0,035, Beta=-0,22; p=0,584). CONCLUSOES: O instrumento e adequado para avaliar a alfabetizacao funcional em saude na populacao brasileira. O elevado numero de individuos classificados como analfabetos funcionais indica a importância de adocao de medidas especiais para ajudar estes individuos a compreenderem corretamente as orientacoes para cuidados de saude.

Depressão em mulheres climatéricas: análise de mulheres atendidas ambulatorialmente em um hospital universitário no Maranhão

Introduction: The climacteric is a transition period between reproductive and non-reproductive ages that leads to biopsychossocial changes in women who experience it. However, association between a larger prevalence of depression in this period is still controversial. The objective of this study was to assess the prevalence of depression in climacteric women receiving care at a university hospital in a Northeastern Brazilian municipality and to identify associated factors. Method: A prospective, analytic study of 70 climacteric women was performed. Diagnosis of depression was performed according to the International Classification of Diseases diagnostic criteria through a minimal 3-month follow-up period. The following variables were investigated: educational level, marital status, personal income, Hamilton Depression Rating Scale, presence and intensity of climacteric symptoms, menopause (natural or surgical), financial dependence on the partner, family history of depression, previous history of postpartum depression, depressive episodes, premenstrual dysphoric disorder, sexual function disorders, and positive or negative attitudes toward menopause. Results: A percentage of 34.3% of the patients had depression, and 70.8% were classified as mild intensity according to Hamilton scale. There was no statistically significant association between socioeconomic variables, reduced sex drive and family history of depression and presence of depression. Conversely, presence of vasomotor symptoms (p = 0.03), insomnia (p < 0.001), menopause (p = 0.05), history of postpartum depression (p = 0.04), premenstrual dysphoric disorder (p = 0.05), and negative attitude toward menopause (p = 0.001) were statistically associated with depression. Conclusions: There was a high prevalence of depression in assessed women. Multiple factors (impact of menopause, psychiatric history and personal impressions of menopause) are responsible for its occurrence.

Short IQCODE as a screening tool for MCI and dementia Preliminary results

Reaching a diagnosis may be difficult in the initial stages of dementia, especially in low educated individuals, when informant reports may be useful. Objectives To compare the sensitivity and specificity of the IQCODE against cognitive tests applied in clinical practice and to evaluate the possible cut-off points in Brazil. Methods Individuals without dementia (CDR=0; N=5), with Mild Cognitive Impairment (MCI) (CDR=0.5; N=15) and demented (CDR≥1; N=29) were evaluated using the Short IQCODE, a 16-item questionnaire applied to an informant, and on standard cognitive and functional scales. Diagnosis was reached by a consensus team with expertise in dementia, according to DSM-IV criteria, which was blind to the IQCODE results. Results IQCODE scores were positively correlated to the CDR (r=0.65, p<0.001) and negatively correlated with years of schooling (r= –0.33, p=0.021). IQCODE scores were positively correlated with CDR controlled by age and education (r=0.61, p<0.001). Linear regression showed that age was associated with the IQCODE (p=0.016) whereas education was not associated (p=0.078). IQCODE means according to the CDR classification were: CDR 0–3.37; CDR 0.5–3.75; CDR 1–4.32; CDR 2–4.61; CDR 3–5.00. The area under the ROC curve for dementia vs. controls was 0.869 (p<0.001), MCI vs. controls, 0.821 (p<0.001); and according to the groups classified by the CDR was: CDR 0.5 vs. CDR 1=0.649 (p=0.089), CDR 1 vs. CDR 2=0.779 (p=0.009), and CDR 2 vs. CDR 3=0.979 (p=0.023). Conclusions These preliminary findings suggest that the short IQCODE can be used for the screening of MCI and dementia in Brazil.

Behavioral and activities of daily living inventories in the diagnosis of frontotemporal lobar degeneration and Alzheimer's disease

The differential diagnosis between frontotemporal lobar degeneration (FTLD) and Alzheimer’s disease (AD) is often challenging. Objectives To verify the usefulness of behavioral and activities of daily living inventories in the differential diagnosis between FTLD and AD. Methods Caregivers of 12 patients with FTLD (nine with frontotemporal dementia, two with semantic dementia and one with progressive non-fluent aphasia) and of 12 patients with probable AD were interviewed. The Brazilian version of the Frontal Behavioral Inventory (FBI) and Disability Assessment for Dementia (DAD ) were used. Results The mean of the MMSE score was 12.4±10.7for patients with FTLD and 11.9±6.2for patients with AD (p=0.93). Mean scores on the DAD were 33.7±27.7in patients with FTLD and 55.6±29.7in patients with AD (p=0.06), while for the FBI they were 42.6±10.0for FTLD and 16.7±11.7for AD (p<0.01). Conclusions In this study, FBI was found to be a helpful tool for the differential diagnosis between FTLD and AD. Although the DAD was not useful in differential diagnosis in our sample we believe it to be important for measuring the severity of the disease through quantitative and qualitative assessment of functional deficits of the patients.

Desempenho de uma população brasileira no teste de alfabetização funcional para adultos na área de saúde

OBJECTIVE To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS The mean age of the sample was 47.3 years(sd=16.8) and the mean education was 9.7 years(sd=5; range: 1 - 17). A total of 32.4% of the sample showed literacy/numeracy deficits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not significant when the effects of education were held constant (rp=-0.031, p=0.584). A significant association (B=3.877, Beta =0.733; p<0.001) was found between schooling and scores. Age was not a significant predictor in this model (B=-0.035, Beta=-0.22; p=0.584). CONCLUSIONS The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classified as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare.OBJETIVO: Analisar os escores de instrumento que avalia habilidade de leitura e compreensao de materiais da area da saude segundo escolaridade e idade. METODOS: Foram avaliados 312 participantes saudaveis de diferentes idades por meio da versao reduzida do instrumento Test of Functional Health Literacy in Adults. O estudo foi realizado entre 2006 e 2007 na cidade de Sao Paulo (SP). O instrumento envolve materiais como frascos de medicamentos e cartoes de agendamento de consultas, avaliando a compreensao de leitura e de conceitos numericos. Os testes de correlacao parcial e de Pearson e um modelo de regressao multipla foram usados para verificar a associacao entre os escores no instrumento, escolaridade e idade. RESULTADOS: As medias de idade e de escolaridade da amostra foram respectivamente 47,3 (dp=16,8 ) e 9,7 (dp=5; de um a 17 anos de estudo). O total de 32,4% da amostra mostraram deficits de alfabetizacao funcional/ uso de conceitos numericos na area de saude, com desempenho inadequado ou limitrofe no instrumento. Entre idosos (65 anos ou mais) esta taxa atingiu 51,6%. Encontrou-se correlacao positiva entre anos de estudo e escores no instrumento (r=0,740; p<0,01) e correlacao negativa entre idade e escores no instrumento (r=-0,259; p<0,01). A correlacao entre escores no instrumento e idade nao foi significante quando os efeitos da escolaridade foram controlados (r=-0,031, p=0,584). Uma associacao significante (B=3,877, Beta=0,733; p<0,001) foi encontrada entre anos de estudo e escores no instrumento. A idade nao foi uma variavel preditiva no modelo (B=-0,035, Beta=-0,22; p=0,584). CONCLUSOES: O instrumento e adequado para avaliar a alfabetizacao funcional em saude na populacao brasileira. O elevado numero de individuos classificados como analfabetos funcionais indica a importância de adocao de medidas especiais para ajudar estes individuos a compreenderem corretamente as orientacoes para cuidados de saude.

Neuroimaging of eye position reveals spatial neglect: a commentary

Sir, We read with great interest the recent paper published in Brain by Becker and Karnath (2010). We are particularly interested in the presence of unsustained gaze deviation during clinical assessment in their series. Recently, we reported a patient who presented with a left-sided facio-brachio-crural paresis, left hypoaesthesia, dysarthria and left-sided spatial neglect, scoring 7 on the National Institutes of Health Stroke Scale (NIHSS). The patient did not have sustained gaze deviation on neurological exam, but …

Desempeño de una población brasilera en la prueba de alfabetización funcional para adultos en el área de salud

OBJECTIVE To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS The mean age of the sample was 47.3 years(sd=16.8) and the mean education was 9.7 years(sd=5; range: 1 - 17). A total of 32.4% of the sample showed literacy/numeracy deficits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not significant when the effects of education were held constant (rp=-0.031, p=0.584). A significant association (B=3.877, Beta =0.733; p<0.001) was found between schooling and scores. Age was not a significant predictor in this model (B=-0.035, Beta=-0.22; p=0.584). CONCLUSIONS The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classified as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare.OBJETIVO: Analisar os escores de instrumento que avalia habilidade de leitura e compreensao de materiais da area da saude segundo escolaridade e idade. METODOS: Foram avaliados 312 participantes saudaveis de diferentes idades por meio da versao reduzida do instrumento Test of Functional Health Literacy in Adults. O estudo foi realizado entre 2006 e 2007 na cidade de Sao Paulo (SP). O instrumento envolve materiais como frascos de medicamentos e cartoes de agendamento de consultas, avaliando a compreensao de leitura e de conceitos numericos. Os testes de correlacao parcial e de Pearson e um modelo de regressao multipla foram usados para verificar a associacao entre os escores no instrumento, escolaridade e idade. RESULTADOS: As medias de idade e de escolaridade da amostra foram respectivamente 47,3 (dp=16,8 ) e 9,7 (dp=5; de um a 17 anos de estudo). O total de 32,4% da amostra mostraram deficits de alfabetizacao funcional/ uso de conceitos numericos na area de saude, com desempenho inadequado ou limitrofe no instrumento. Entre idosos (65 anos ou mais) esta taxa atingiu 51,6%. Encontrou-se correlacao positiva entre anos de estudo e escores no instrumento (r=0,740; p<0,01) e correlacao negativa entre idade e escores no instrumento (r=-0,259; p<0,01). A correlacao entre escores no instrumento e idade nao foi significante quando os efeitos da escolaridade foram controlados (r=-0,031, p=0,584). Uma associacao significante (B=3,877, Beta=0,733; p<0,001) foi encontrada entre anos de estudo e escores no instrumento. A idade nao foi uma variavel preditiva no modelo (B=-0,035, Beta=-0,22; p=0,584). CONCLUSOES: O instrumento e adequado para avaliar a alfabetizacao funcional em saude na populacao brasileira. O elevado numero de individuos classificados como analfabetos funcionais indica a importância de adocao de medidas especiais para ajudar estes individuos a compreenderem corretamente as orientacoes para cuidados de saude.