Rozana Mesquita Ciconelli

Nutrient intakes related to osteoporotic fractures in men and women – The Brazilian Osteoporosis Study (BRAZOS)

BackgroundAdequate nutrition plays an important role in bone mass accrual and maintenance and has been demonstrated as a significant tool for the prevention of fractures in individuals with osteoporosis.ObjectiveThe aim of the present study was to evaluate bone health-related nutrients intake and its association with osteoporotic fractures in a representative sample of 2344 individuals aged 40 years or older in Brazil.MethodsIn a transversal population-based study, a total of 2420 individuals over 40 years old were evaluated from March to April 2006. Participants were men and women from all socio-economic classes and education levels living around the Brazilian territory Individuals responded a questionnaire including self reported fractures as well a 24-hour food recall. Nutrient intakes were evaluated by Nutrition Data System for Research software (NDSR, University of Minnesota, 2007). Low trauma fracture was defined as that resulting of a fall from standing height or less. Nutrient intakes adequacies were performed by using the DRIs proposed values. Statistical analysis comprises Oneway ANCOVA adjusted by age and use of nutritional supplements and multiple logistic regression. SAS software was used for statistical analysis.ResultsFractures was reported by 13% of men and 15% of women. Women with fractures presented significantly higher calcium, phosphorus and magnesium intakes. However, in all regions and socio-economical levels mean intakes of bone related nutrients were below the recommended levels. It was demonstrated that for every 100 mg/phosphorus increase the risk of fractures by 9% (OR 1.09; IC95% 1.05–1.13, p < 0.001).ConclusionThe results demonstrated inadequacies in bone related nutrients in our population as well that an increase in phosphorus intake is related to bone fractures.

Tradução e adaptação cultural do instrumento de avaliação de qualidade de vida para pacientes renais crônicos (KDQOL-SF TM)

BACKGROUND: The objective of this study was to translate from English into Portuguese and to perform cultural adaptation of the Kidney Disease Quality of Life Short Form - KDQOL-SFTM to make possible its validation in Brazil. METHODS: This instrument was translated from the original English version into Portuguese language by the authors and it was also translated by a certified translator and revised by a specialized translator who evaluated the level of difficulty for translation. Thirty end-stage renal disease patients undergoing dialysis were randomly selected to participate in the study. RESULTS: The mean age of patients was 47±9 years (23 to 60 yr), and the predominant education level was incomplete elementary school (1st to 8th grade=53%); 60% of the patients were female. The majority of patients (63%) were undergoing hemodialysis and the period of treatment within the last 30 days was 12 hours or more per week. The time of dialysis treatment was 0-2 years for 70% of the patients. The feasibility of the instrument and the difficulties found by the patients were evaluated by a panel of experts and changes were made regarding difficulties of comprehension. Some activities were substituted since they were not regular for the Brazilian population. There were modifications in expressions of translation for terms suggested by patients and Brazilian experts and, for five items it was suggested to include an explanation in parentheses. Common words used in the Portuguese language were chosen. CONCLUSIONS: The translation and cross-cultural adaptation of the KDQOL questionnaire to Portuguese were concluded, having been accomplished this important stage for its validation and use in our environment.

Quality of life of children and adolescents from São Paulo: reliability and validity of the Brazilian version of the Pediatric Quality of Life InventoryTM version 4.0 Generic Core Scales

OBJECTIVES To evaluate the reliability and validity of the Brazilian version of the Pediatric Quality of Life Inventory (PedsQL 4.0) Generic Core Scales and measure the quality of life of healthy children and adolescents and patients with rheumatic diseases. METHODS We followed the translation methodology proposed by the developer of the original English version of the PedsQL 4.0. The instrument was administered by interviews in two groups: 240 apparently healthy children and adolescents from São Paulo (SP, Brazil) and 105 patients with chronic rheumatic diseases matched by age, as well as their respective parents or caregivers. The parent proxy-report was administered to the childrens parents or caregivers separately on the same day. RESULTS Cronbachs alpha values were between 0.6 and 0.9 for all dimensions, demonstrating adequate internal consistency. Patients with rheumatic diseases reported significantly lower PedsQL scores on all dimensions when compared to the healthy control group (p < 0.0001). Construct validity of the Brazilian Portuguese version of the PedsQL 4.0 was also confirmed. Parent proxy-report of patients with rheumatic diseases highly correlated with child self-report for physical functioning (r = 0.77, p < 0.001) and school functioning (r = 0.73, p < 0.001). Lower correlations were observed for emotional and social functioning (r = 0.40 and 0.59, respectively, p < 0.001). CONCLUSIONS The tool demonstrated reliability, validity, and the administration was fast and easy. Quality of life in patients with rheumatic diseases was significantly lower than in the healthy control group, supporting the necessity of a comprehensive approach to rheumatic disease management, focused on the psychosocial dimensions.

Impact of chronic disease on quality of life among the elderly in the state of São Paulo, Brazil: a population-based study

OBJECTIVES To assess the impact of chronic disease and the number of diseases on the various aspects of health-related quality of life (HRQOL) among the elderly in São Paulo, Brazil. METHODS The SF-36 Health Survey was used to assess the impact of the most prevalent chronic diseases on HRQOL. A cross-sectional and population-based study was carried out with two-stage stratified cluster sampling. Data were obtained from a multicenter health survey administered through household interviews in several municipalities in the state of São Paulo. The study evaluated seven diseases--arthritis, back-pain, depression/anxiety, diabetes, hypertension, osteoporosis, and stroke--and their effects on quality of life. RESULTS Among the 1 958 elderly individuals (60 years of age or older), 13.6% reported not having any of the illnesses, whereas 45.7% presented three or more chronic conditions. The presence of any of the seven chronic illnesses studied had a significant effect on the scores of nearly all the SF-36 scales. HRQOL achieved lower scores when related to depression/anxiety, osteoporosis, and stroke. The higher the number of diseases, the greater the negative effect on the SF-36 dimensions. The presence of three or more diseases significantly affected HRQOL in all areas. The bodily pain, general health, and vitality scales were the most affected by diseases. CONCLUSIONS The study detected a high prevalence of chronic diseases among the elderly population and found that the degree of impact on HRQOL depends on the type of disease. The results highlight the importance of preventing and controlling chronic diseases in order to reduce the number of comorbidities and lessen their impact on HRQOL among the elderly.

Questionário específico para sintomas do joelho "Lysholm Knee Scoring Scale": tradução e validação para a língua portuguesa

inTRoDUcTion Knee joint internal disturbances are uncountable, presenting variable consequences for an individual’s function and quality of life. The increasing search for physical activities associated to a complex and so vulnerable anatomy of knee joint led to an increase of the number of ligament injuries on this joint, especially on anterior cruciate ligament. Joint instability is reported by patients complaining about missing steps and lack of confidence upon certain movements. Chronic anterior instability evolves with a large incidence of X-ray degenerative changes, as well as meniscal and chondral injuries. Current trend for patients intending to resume sports practice is the indication of knee ligament reconstruction. Knee surgery advancement has been assessed by means of the development of new surgical techniques, new instruments, as well as of surgeons’ specialization. Previously, empirical assessments were made for checking the effectiveness of an established treatment. Many times, those assessments provided wrong conclusions regarding the evolution and quality of the employed techniques. The complexity of knee joint and the number of criteria for evaluating its function and symptoms make measurements and quantification of employed treatments difficult. In 1955, O’Donoghue(1) was the first to develop a system for assessing outcomes. An objective examination and a questionnaire totaling 100 score points was used for assessing outcomes on knee ligament repairs. The answers to each question were “yes” (10 points) or “no” (0 point) kind. Assessment was supplemented by adding subjective criteria, such as stroke, disability, and functional evaluation. Slocum and Larson(2) recognized the need to assess rotational instability and comparative values preand postoperatively. Larson(3) developed a scale of 100 score points based on subjective, objective and functional criteria. At functional aspect, it was concerned to assess an individual’s conditions to walk, run, jump, and squat. Marshall et al.(4), emphasized that the adequate method of assessment should allow a surgeon to determine anatomical injuries and correspondent functional damages. On this ground, they developed, in 1977, the scale “Hospital for Special Surgery Knee Score (HSSKS)”(5), the first specific method used for assessing knee ligament injuries. The HSSKS includes subjective symptoms, subjective function, and SpEciFic QUESTionnaiRE FoR KnEE SYMpToMS THE “LYSHoLM KnEE ScoRinG ScaLE” – TRanSLaTion anD VaLiDaTion inTo poRTUGUESE

Qualidade de vida de crianças e adolescentes de São Paulo: confiabilidade e validade da versão brasileira do questionário genérico Pediatric Quality of Life InventoryTM versão 4.0

OBJECTIVES: To evaluate the reliability and validity of the Brazilian version of the Pediatric Quality of Life InventoryTM (PedsQLTM 4.0) Generic Core Scales and measure the quality of life of healthy children and adolescents and patients with rheumatic diseases. METHODS: We followed the translation methodology proposed by the developer of the original English version of the PedsQLTM 4.0. The instrument was administered by interviews in two groups: 240 apparently healthy children and adolescents from Sao Paulo (SP, Brazil) and 105 patients with chronic rheumatic diseases, matched by age, as well as to their respective parents or caregivers. The parent proxy-report was administered to the childrens parents or caregivers separately on the same day. RESULTS: Cronbachs alpha values were between 0.6 and 0.9 for all dimensions, demonstrating adequate internal consistency. Patients with rheumatic diseases reported significantly lower PedsQLTM scores on all dimensions when compared to the healthy control group (p < 0.0001). Construct validity of the Brazilian Portuguese version of the PedsQLTM 4.0 was also confirmed. Parent proxy-report of patients with rheumatic diseases highly correlated with child self-report for physical functioning (r = 0.77, p < 0.001) and school functioning (r = 0.73, p < 0.001). Lower correlations were observed for emotional and social functioning (r = 0.40 and 0.59, respectively, p < 0.001). CONCLUSIONS: The tool demonstrated reliability, validity and the administration was fast and easy. Quality of life of patients with rheumatic diseases was significantly lower than the healthy control group, supporting the necessity of a comprehensive approach to rheumatic disease management, focused on the psychosocial dimensions.

Health related quality of life among the elderly: a population-based study using SF-36 survey

As life expectancy continues to rise, one of the greatest challenges of public health is to improve the quality of later years of life. The aim of this present study was to analyze the quality of life profile of the elderly across different demographic and socioeconomic factors. A cross-sectional study was carried out in two stages, involving 1,958 individuals aged 60 years or more. Health related quality of life (HRQOL) was assessed using the SF-36 questionnaire. The lowest scores were found among measures for vitality, mental health and general health and the highest among factors including social functioning and role limitations due to emotional and physical factors. HRQOL was found to be worse among women, in individuals at advanced ages, those who practiced evangelical religions and those with lower levels of income and schooling. The greatest differences in SF-36 scores between the categories were observed in functional capacity and physical factors. The results suggest that healthcare programs for the elderly should take into account the multi-dimensionality of health and social inequalities so that interventions can target the most affected elements of HRQOL as well as the most vulnerable subgroups of the population.

Conceitos de acesso à saúde

Esse artigo descreve quatro dimensoes de acesso a saude - disponibilidade, aceitabilidade, capacidade de pagamento e informacao, correlacionado-as aos seus indicadores e tecendo consideracoes sobre a complexidade do conceito de acesso. Para a revisao desses conceitos foram pesquisadas as bases de dados PubMed/MEDLINE, LILACS, SciELO e World Health Organization Library & Information Networks for Knowledge (WHOLIS). Veiculos de grande circulacao, como a revista The Economist, o jornal The Washington Post e os arquivos da rede BBC tambem foram pesquisados. O conceito de acesso a saude modificou-se ao longo do tempo, tomando uma forma mais complexa. As primeiras analises, datadas da decada de 1970, sugeriam uma forte relacao do acesso com o aspecto geografico (disponibilidade) e financeiro (capacidade de pagamento). A literatura mais recente procura abordar aspectos menos tangiveis, como os aspectos cultural, educacional e socioeconomico, incorporando o elemento aceitabilidade nas analises. A literatura mostra ainda que ter informacao esta na base do acesso a saude, estando essa nocao associada aos conceitos de empoderamento e de letramento para a tomada de decisoes de saude. Concluiu-se que a melhoria do acesso a saude e a garantia de uma maior equidade nao serao obtidas com acoes cujo foco se limite aos sistemas de saude. Em vez disso, dependem de acoes inter-setoriais e politicas sociais e economicas que permitam dissipar diferencas de renda e educacao.

Risk factors for recurrent falls among Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS)

The objective of the study was to estimate the frequency of recurrent falls and identify the main associated risk factors. The BRAZOS is the first epidemiological study performed on a representative sample of the Brazilian population. Anthropometric data, living habits, previous fractures, falls, dietary intake, physical activity and quality of life were evaluated in 2,420 individuals aged 40 and older. Recurrent falls were reported by 15.5% of men and 25.6% of women. Among women, the risk factors significantly associated to recurrent falls were age, previous fracture, sedentary lifestyle, poor quality of life, diabetes mellitus and current use of benzodiazepine. In men, the risk factors were age, poor quality of life, intake of alcoholic beverages, diabetes mellitus, previous fracture and use of benzodiazepine. A greater intake of vitamin D had a protector effect on the risk of recurrent falls. These findings demonstrated the high prevalence of recurrent falls and emphasize that a multidisciplinary approach is necessary to minimize recurrent falls and their consequences, including osteoporotic fractures.

The burden of osteoporosis in Brazil: regional data from fractures in adult men and women - The Brazilian Osteoporosis Study (BRAZOS)

INTRODUCAO/OBJETIVOS: O BRAZOS (The Brazilian Osteoporosis Study) e um estudo epidemiologico, de base populacional, realizado em amostra representativa de mulheres e homens brasileiros, de idade superior a 40 anos, com o objetivo de identificar os principais fatores clinicos de risco associados com fratura por baixo impacto. Nesse artigo sao apresentados os principais resultados do estudo, de acordo com cada regiao do pais. PACIENTES E METODOS: Um total de 2.420 individuos, provenientes das cinco regioes do pais e de todas as classes socioeconomicas foram incluidos no estudo. Foram avaliados dados antropometricos, bem como aspectos relacionados aos habitos de vida, fraturas, ingestao alimentar, atividade fisica, quedas e qualidade de vida por meio de entrevista individual e quantitativa. Fratura por baixo impacto foi definida como aquela decorrente de queda da propria altura ou menos. Valor de P < 0,05 foi considerado como estatisticamente significante. RESULTADOS: Nao houve diferenca estatisticamente significativa da prevalencia de fratura nas cinco regioes do Brasil, de acordo com o sexo ou classe social. No entanto, nas mulheres, houve maior ocorrencia de fraturas na regiao metropolitana do que nos municipios do interior dos estados e tendencia a maior frequencia de fraturas em homens da regiao nordeste. Nao foi verificada diferenca estatisticamente significativa de fraturas se os homens eram provenientes das capitais ou do interior dos estados. CONCLUSOES: De acordo com os nossos resultados, nao foi observada diferenca significativa da prevalencia de fraturas por baixo impacto nem da frequencia ou relevância de fatores de risco entre as cinco regioes do Brasil.OBJECTIVES The BRAZOS (The Brazilian Osteoporosis Study) study is the first epidemiological and population-based study carried out in a representative sample of Brazilian men and women, 40 years or older, with the objective of identifying the prevalence and main clinical risk factors (CRF) associated with low-impact fractures. This report shows the main results according to each region of the country. PATIENTS AND METHODS A total of 2,420 subjects (70% women) from 150 different cities in five geographic regions in Brazil, and from all different socio-economical classes were included in this study. Anthropometrical data, as well life style, previous fractures, nutritional status, physical activity, falls, and quality of life were evaluated by a quantitative individual survey. Low-impact fracture was defined as that resulting from a fall no greater than standing height of an individual. A P < 0.05 was considered significant. RESULTS Statistically significant differences in the prevalence of fractures among the five Brazilian regions according to gender or social class were not observed. However, in women, a higher incidence of fractures was observed in metropolitan areas than in rural areas, and a tendency for a higher frequency of fractures was observed in men from Northeastern states. Statistically significant differences among men from metropolitan areas or rural areas were not observed. CONCLUSIONS Significant differences in the prevalence of low-impact fractures among the five different regions of Brazil were not observed, as well as its frequency or relevance of risk factors.