Maria Angela Fernandes Ferreira

Compensatory sweating after thoracoscopic sympathectomy: characteristics, prevalence and influence on patient satisfaction

OBJECTIVE This prospective study aimed at investigating predictive factors for compensatory sweating after thoracoscopic sympathectomy. METHODS From 2000 to 2002, 80 patients (53 females and 27 males) underwent thoracoscopic sympathectomy to treat hyperhidrosis. Patient ages ranged from 12 to 56 years, and the mean post-operative follow-up period was 42.51 +/- 5.98 months. Patient satisfaction with the results was evaluated through the use of a rating scale. The procedure was performed bilaterally: at the T2 level for facial hyperhidrosis; at the T3-T4 level for axillary hyperhidrosis; and at the T3 level for palmar hyperhidrosis. RESULTS Post-operatively, 68 patients (85.0%) presented compensatory sweating, which was classified as mild in 23 (33.8%), moderate in 23 (33.8%) and severe in 22 (32.4%). Considering the final surgical results, 70 patients (87.5%) were satisfied with the outcome of the operation, whereas 10 patients (12.5%) were dissatisfied. The level of patient satisfaction varied according to gender, age, body mass index (BMI) and extent of denervation. The compensatory sweating was more severe on the abdomen and back than on the legs. CONCLUSIONS Although compensatory sweating, which is a common adverse effect of sympathectomy, occurred in the majority of cases, the level of patient satisfaction was high. The best candidates for thoracoscopic sympathectomy are young adult women with a BMI < 24.9 kg/m(2).

A desigualdade espacial do Baixo Peso ao Nascer no Brasil

Various health complications have been identified among teachers and there is little information available about their lifestyle habits. The scope of this study was to investigate health conditions, lifestyles and occupational characteristics of municipal teachers in Bagé in the south of Brazil. A cross-sectional study involving 414 teachers was conducted by asking the teachers to fill out a standardized questionnaire. Descriptive and bivariate analysis techniques were employed. Most teachers were females (96.1%) and the mean age was 40.1 years (SD 9.4). Average teaching experience was 12.4 years (SD 9.5); 59% of the teachers had a degree; they taught many working hours per week (31.7 hours, SD 10.5) and 62% were absent from work at least once in the last 12 months. Self-rated heath was good (38.5%); 62.5% of them were physically active; 32.3% were overweight and 14.4% obese. They consumed hardly any fruit and vegetables (79.6%), had average stress levels of 14.9 points (SD 6.6) and 20.3% reported hypertension. Self-reported health was associated with teaching time, absenteeism, physical activity, number of meals per day, stress levels and hypertension. The prevalence of teachers who rated their health negatively was low, however several lifestyle issues were identified, which can be prejudicial to the health of these individuals.O baixo peso ao nascer (BPN) e fator de risco para a morbidade, mortalidade neonatal e infantil. No Brasil os maiores percentuais de baixo peso ao nascer ocorrem em regioes de melhor situacao socioeconomica. O objetivo deste artigo e conhecer a distribuicao espacial de taxas de baixo peso ao nascer e a correlacao com indicadores sociais e de servico. Desenho: ecologico, tendo os estados brasileiros como unidades de analise. Utilizou-se tecnica de analise espacial, dados de 2009 do SINASC, IPEA e IBGE. Taxas maiores de baixo peso ao nascer estao nos estados da regiao sul/sudeste, Moran Global: 0,267, p = 0,02. Aglomerados do tipo alto-alto na regiao Sudeste e baixo-baixo em estados da regiao da Amazonia Legal. A desigualdade espacial do baixo peso ao nascer reflete as condicoes socioeconomicas dos estados. Regioes mais desenvolvidas detem maiores taxas de baixo peso ao nascer, portanto, a presenca do servico e sua utilizacao fazem diminuir a mortalidade infantil e aumentar o BPN.

Desigualdade espacial da mortalidade neonatal no Brasil: 2006 a 2010

The objective of this study is to analyze the spatial distribution of neonatal mortality and its correlation with the biological and socioeconomic factors and maternal and child health care in the Brazilian states in the period from 2006 to 2010. Thematic and correlation (LISA) maps were created for verification of spatial dependence as well as multiple linear regression models. It was found that there is no specific spatial correlation for neonatal mortality in the Brazilian states (R = 0.002, p = 0.48). The majority of the variables were correlated (r > 0.3, p < 0.05) with neonatal mortality, forming clusters in the North and Northeast, with higher rates for teenage mothers, low household income per capita, lower prenatal consultations and less Neonatal Intensive Care Unit beds. The number of Neonatal ICU beds maintained an independent effect after regression analysis. The conclusion reached was that regional inequalities in living conditions and especially access to maternal and child health contribute to the unequal distribution of neonatal mortality in Brazil.

Desigualdade social e os estudos epidemiológicos: uma reflexão

Social indicators are now indispensable in the list of variables of epidemiological studies, based on the fact that the determination of health complaints is complex and multidimensional. From this perspective, social inequality has gained prominence as an explanatory factor for the health conditions of populations. The scope of this article is to discuss the different concepts that underpin the selection of the indicators used in epidemiological studies and examine the psychosocial effects on human beings caused by social inequality. A literature review of epidemiological studies that used social inequality and social capital indicators was conducted for a better understanding of health problems, as well as an investigation in the fields of sociology and social psychology. The research revealed that there is some controversy surrounding the effect of social inequality on health, possibly because these indicators are predominantly based on income and individual consumption capacity. Likewise, social capital indicators at cognitive and structural levels are too limited to understand the dynamism of social relations. Accordingly, further studies are needed for the construction of social indicators capable of examining the complexity of modern societies.

Desigualdade social no adoecimento e morte por câncer de boca e orofaríngeo no município de São Paulo, Brasil: 1997 a 2008

Occupation of geographical space is historically determined by the socioeconomic model and the dynamism of its social, political, and ideological relations. This study aimed to evaluate the spatial distribution of morbidity and mortality from cancer of the mouth and oropharynx and related socioeconomic variables in the city of Sao Paulo, Brazil, from 1997 to 2008. Data were collected from the Population-Based Cancer Registry and the Program for Improvement of Mortality Data (PRO-AIM) and were georeferenced using Terraview and GeoDa. The theoretical framework for evaluating the results was the work of Milton Santos. The incidence rates showed spatial autocorrelation with a Global Moran index of 0.226 and mortality rates of 0.337. Incidence of cancer of the mouth and oropharynx did not show a well-defined spatial pattern in the city of Sao Paulo, but mortality rates were highly unequal, concentrating the lowest rates in the central area of the city, which is wealthier and economically less unequal.

Tradução e adaptação transcultural do Northwestern Dysphagia Patient Check Sheet para o português brasileiro

PURPOSE To present the translation and cross-cultural adaptation of the Brazilian version of the Northwestern Dysphagia Patient Check Sheet (NDPCS). METHODS The translation to Portuguese was performed by two Brazilian bilingual speech language pathologists, followed by a back translation conducted by a bilingual native speaker of the original language. Afterwards, the three versions were compared by a committee of three speech language pathologists. Initially, the final translated version of the NDPCS was applied with 35 volunteers aged between 62 and 92 years old (74.77±7.08), who had no dementia or complaints of swallowing disorder. After some adjustments, the instrument was applied with other 27 volunteers aged between 60 and 87 years old (76.56±7.07) with the same profile. RESULTS There was divergence in semantic equivalence in relation to one item, which was modified in the translated version. The tasks requested for observation during deglutition were adapted in relation to the solid food and the volumes used in pudding and liquid consistencies. The instrument maintained the same structure as the original version, with five categories and into 28 items, three brief variables, and four closures. CONCLUSION The equivalence between the original and the translated version of the NDPCS was preserved after its translation and adaptation to Brazilian Portuguese. The validation process of the psychometric properties of the instrument is in progress.

Caracterização da pressão da língua em idosos

Purpose To characterize tongue pressure in elderly individuals. Methods This was a cross-sectional study involving 45 individuals aged between 61 and 96 years old (34 [75.6%] women; 11 [24.4%] men) with no neurological or cognitive disorders, no history of head or neck cancer, and no history of radiotherapy. The subjects were surveyed with a questionnaire that recorded the presence or absence of complaints about swallowing problems and an orofacial myofunctional evaluation, which examined the movement and tension of the tongue. The Iowa Oral Performance Instrument (IOPI) was used to measure tongue pressure. The data analysis was descriptive, with significance set at the 5% level. Results The mean pressure peak was 44.6 kPa (±16), with minimum and maximum values of 9 and 88 kPa, respectively. Pressure peak and age were moderately and negatively correlated. The oldest subject had the lowest average pressure peak, which was less than the normal range. The mean pressure peak differed according to the use of dentures, tongue pressure, and tongue mobility during clicking. Conclusion The pressure peak and the pressure of the tongue decreased moderately with increasing age, decreasing tongue tension, and mobility during clicking. In contrast, the pressure peak values were higher in the elderly who used dentures than those who did not.

As desigualdades sociais e a saúde bucal nas capitais brasileiras

Despite the improvement of the lives of Brazilians, still persists a panorama of iniquities in health in Brazil. This ecological study evaluated the relationship of socioeconomic conditions and public health policy with oral health conditions in Brazilian capitals. Factor analysis was performed with the socioeconomic indicators, revealing two common factors: economic deprivation and socio-sanitary condition. Then, was executed multiple linear regression analysis for the oral health indicators (average DMFT 12 years, mean missing teeth and rate of decay of free population) with two factors in common and fluoridation of water supply. Multiple linear regression analysis to the DMFT of the capitals was estimated by the socio-sanitary conditions and fluoridation, adjusted by economic deprivation; whereas the model for the average missing teeth was estimated only for flu-oridation and economic deprivation, and finally, the model for the rate of caries-free population in the Brazilian capitals was estimated by economic and sociosanitary condition set by fluoridated water supplies. Therefore, the results indicate the need for social actions that impact on peoples living conditions to reduce tooth decay.Despite the improvement of the lives of Brazilians, still persists a panorama of iniquities in health in Brazil. This ecological study evaluated the relationship of socioeconomic conditions and public health policy with oral health conditions in Brazilian capitals. Factor analysis was performed with the socioeconomic indicators, revealing two common factors: economic deprivation and socio-sanitary condition. Then, was executed multiple linear regression analysis for the oral health indicators (average DMFT 12 years, mean missing teeth and rate of decay of free population) with two factors in common and fluoridation of water supply. Multiple linear regression analysis to the DMFT of the capitals was estimated by the socio-sanitary conditions and fluoridation, adjusted by economic deprivation; whereas the model for the average missing teeth was estimated only for flu-oridation and economic deprivation, and finally, the model for the rate of caries-free population in the Brazilian capitals was estimated by economic and sociosanitary condition set by fluoridated water supplies. Therefore, the results indicate the need for social actions that impact on peoples living conditions to reduce tooth decay.

Screening for oropharyngeal dysphagia in older adults: A systematic review of self-reported questionnaires

BACKGROUND Oropharyngeal dysphagia is a swallowing disorder with signs and symptoms which may be present in older adults, but they are rarely noticed as a health concern by older people. The earliest possible identification of this clinical condition is needed by self-reported population-based screening questionnaire, which are valid and reliable for preventing risks to nutritional status, increased morbidity and mortality. OBJECTIVE The aim of this systematic review was to identify self-reported screening questionnaires for oropharyngeal dysphagia in older adults to evaluate their methodological quality for population-based studies. METHODS An extensive search of electronic databases (PubMed (MEDLINE), Ovid MEDLINE(R), Scopus, Cochrane Library, CINAHL, Web of Science (WOS), PsycINFO (APA), Lilacs and Scielo) was conducted in the period from April to May 2017 using previously established search strategies by the two evaluators. The methodological quality and the psychometric properties of the included studies were evaluated by the COSMIN (Consensus based Standards for the selection of health Measurement Instruments) checklist and the quality criteria of Terwee and colleagues, respectively. RESULTS The analysed information was extracted from three articles which had conducted studies on the prevalence of oropharyngeal dysphagia by self-reported screening questionnaires, showing poor methodological quality and flaws in the methodological description to demonstrate its psychometric properties. CONCLUSION This study did not find any self-reported screening questionnaires for oropharyngeal dysphagia with suitable methodological quality and appropriate evidence in its psychometric properties for elders. Therefore, the self-reported questionnaires within the diagnostic proposal require greater details in its process for obtaining valid and reliable evidence.