Shamyr Sulyvan de Castro

Acessibilidade aos serviços de saúde por pessoas com deficiência

OBJETIVO: Analisar as dificuldades de acessibilidade aos servicos de saude vividas por pessoas com deficiencia. PROCEDIMENTOS METODOLOGICOS: Estudo qualitativo realizado com pessoas que relataram ter algum tipo de deficiencia (paralisia ou amputacao de membros; baixa visao, cegueira unilateral ou total; baixa audicao, surdez unilateral ou total). Foram entrevistados 25 individuos (14 mulheres) na cidade de Sao Paulo, SP, de junho a agosto de 2007, que responderam perguntas referentes a deslocamento e acessibilidade aos servicos de saude. A metodologia utilizada para analise foi o discurso do sujeito coletivo e as analises foram conduzidas com recurso do programa Qualiquantisoft. ANALISE DOS RESULTADOS: A analise dos discursos sobre o deslocamento ao servico de saude mostrou diversidade quanto ao usuario ir ao servico sozinho ou acompanhado, utilizar carro particular, transporte coletivo, ir a pe ou de ambulância e demandar tempo variado para chegar ao servico. Com relacao as dificuldades oferecidas de acessibilidade pelos servicos de saude, houve relatos de demora no atendimento, problemas com estacionamento, falta de rampas, elevadores, cadeiras de rodas, sanitarios adaptados e de medicos. CONCLUSOES: As pessoas com algum tipo de deficiencia fizeram uso de meios de transporte diversificados, necessitando de companhia em alguns casos. Problemas na acessibilidade dos servicos de saude foram relatados pelos sujeitos com deficiencias, contrariando o principio da equidade, preceito do Sistema Unico de Saude.OBJETIVO: Analizar las dificultades de acceso a los servicios de salud vividas por personas con discapacidad. PROCEDIMIENTOS METODOLOGICOS: Estudio cualitativo realizado con personas que relataron tener algun tipo de discapacidad (paralisis o amputacion de miembros; baja vision, ceguera unilateral o total; baja audicion, sordera unilateral o total). Se entrevistaron 25 individuos (14 mujeres) en la ciudad de Sao Paulo, Sureste de Brasil, de junio a agosto de 2007, que respondieron preguntas relacionadas con el desplazamiento e el acceso a los servicios de salud. La metodologia utilizada para analisis fue el discurso del sujeto colectivo y los analisis fueron conducidos con recurso al programa Qualiquantisoft. ANALISIS DE RESULTADOS: El analisis de los discursos sobre el desplazamiento al servicio de salud mostro diversidad con relacion al usuario ir al servicio solo o acompanado, utilizar carro particular, transporte colectivo, ir a pie o de ambulancia y demandar tiempo variado para llegar al servicio. Con relacion a las dificultades ofrecidas de acceso por los servicios de salud, hubo relatos de demora en la atencion, problemas con estacionamiento, falta de rampas, elevadores, sillas de rueda, sanitarios adaptados y de medicos. CONCLUSIONES: Las personas con algun tipo de discapacidad hicieron uso de medios de transporte diversificados, necesitando de compania en algunos casos. Problemas con el acceso a los servicios de salud fueron relatados por los sujetos con discapacidades, contrariando el principio de la equidad, precepto del Sistema Unico de Salud.OBJECTIVE To analyze the difficulties in accessibility to health services experienced by persons with disabilities. METHODOLOGICAL PROCEDURES A qualitative study was performed with individuals who reported having a certain type of disability (paralysis or amputation of limbs; low vision, unilateral or total blindness; low hearing, unilateral or total deafness). A total of 25 individuals (14 women) were interviewed in the city of São Paulo, Southeastern Brazil, between June and August 2007, responding to questions about transportation and accessibility to health services. Collective Subject Discourse was the methodology used to analyze results and analyses were performed with the Qualiquantisoft software. ANALYSIS OF RESULTS The analysis of discourses on transportation to health services revealed a diversity in terms of the user going to the service alone or accompanied; using a private car, public transportation or ambulance or walking; and requiring different times to arrive at the service. With regard to the difficulties in accessibility to health services, there were reports of delayed service, problems with parking, and lack of ramps, elevators, wheelchairs, doctors and adapted toilets. CONCLUSIONS Individuals with a certain type of disability used various means of transportation, requiring someone to accompany them in some cases. Problems with accessibility to health services were reported by persons with disabilities, contradicting the principle of equity, a precept of the Brazilian Unified Health System.

Musculoskeletal pain, profile and quality of life of individuals with sickle cell disease

BACKGROUND Sickle cell disease is a prevalent condition in Brazil. Its clinical presentation includes vascular occlusion that result in ischemia, inflammation, dysfunctions, pain and chronic hemolysis, causing irreversible damage and compromising quality of life. OBJECTIVE The objectives of this study were to verify the relationship between musculoskeletal pain, from different body parts, with social economic characteristics and quality of life among individuals with sickle cell disease. METHODS 27 individuals with sickle cell disease were interviewed with the use of a structured questionnaire with questions about personal, social, economic and cultural variables, the Nordic musculoskeletal symptoms questionnaire and the SF-36 Health Survey. Data were analyzed descriptively using frequencies and percentages. The inferential Chi-Square test was used for dichotomous variables and the Student t- test for continuous variables, with a significance of 5%. A logistic regression was performed using all variables that correlated with pain as dependent variables. RESULTS The mean age was 31.77 years, predominantly male, black, registered active employment, with average education and income up to three minimum wages. The regions most affected by pain were hip/limbs, chest, lower back and arms. Physical Functioning from the SF-36 had the highest score and mental health the lowest score. Musculoskeletal pain was present in the arms, chest and lower back. Social Functioning was not associated with pain, indicating the influence of other factors. Arm pain was more frequent in black individuals and those with low education. CONCLUSION Body pain was associated with race and education and all pain areas were associated with the physical components of the SF-36. Pain was significantly associated with vitality and mental health components of the SF-36.

Lung function and six-minute walk test performance in individuals with sickle cell disease

Background Sickle Cell Disease (SCD), which is characterized by a mutation in the gene encoding beta hemoglobin, causes bodily dysfunctions such as impaired pulmonary function and reduced functional capacity. Objective To assess changes in pulmonary function and functional capacity in patients with SCD and to identify the relationships between these variables. Method We evaluated sociodemographic, anthropometric, lung function (spirometry), respiratory (manovacuometer), peripheral muscle strength (Handgrip strength - HS) and functional capacity (i.e., the six-minute walk test) parameters in 21 individuals with SCD (average age of 29±6 years). Shapiro-Wilk, paired Students, Wilcoxon, Pearson and Spearman correlation tests were used for statistical analyses, and the significance threshold was set at p<0.05. Results A total of 47.6% of the study subjects exhibited an altered ventilation pattern, 42.8% had a restrictive ventilatory pattern (RVP) and 4.8% exhibited a mixed ventilatory pattern (MVP). The observed maximal inspiratory pressure (MIP) values were below the predicted values for women (64 cmH2O), and the maximum expiratory pressure (MEP) values, HS values and distance walked during the 6MWT were below the predicted values for both men (103 cmH2O, 39 Kgf and 447 m, respectively) and women (64 cmH2O; 27 Kgf; 405 m, respectively). Positive correlations were observed between maximum voluntary ventilation (MVV) and MEP (r=0.4; p=0.046); MVV and BMI (r=0.6; p=0.003); and between HS and MIP (r=0.7; p=0.001), MEP (r=0.6; p=0.002), MVV (r=0.5; p=0.015), distance walked in the 6MWT (r=0.4; p=0.038) and BMI (r=0.6; p=0.004). Conclusions SCD promoted changes in lung function and functional capacity, including RVPs and a reduction in the distance walked in the 6MWT when compared to the predictions. In addition, significant correlations between the variables were observed.

Relationship of musculoskeletal pain with physical and functional variables and with postural changes in school children from 6 to 12 years of age.

BACKGROUND Painful disorders can affect children and adolescents, causing distress and significant demand for health services. OBJECTIVE To identify the prevalence of musculoskeletal pain and its relation to age, sex, body mass index (BMI), how to carry school supplies, postures used in ADLs, outside school physical exercises and postural changes in students. METHOD Cross-sectional exploratory study with a convenience sample consisted of 262 schoolchildren aged 6 to 12 years (137 female). Data collection was conducted by questionnaire containing personal data, presence and location of pain, means of transportation and illustrative figures for choosing the way of carrying school supplies and postures ADLs. Postural evaluation was performed by observational analysis and body mass index calculated from information on height, weight, age and sex. Descriptive analysis was carried out with numbers and percentages. For inferential statistics, comparison of average age according to the presence of pain was performed by Kruskal-Wallis with Dunns post-test. Categorical variables were compared with chi-square test. RESULTS The presence of musculoskeletal pain was reported by 51.1% of the students and 38.93% had pain in only one region. The most affected regions were legs, spine, arms and shoulders. The pain increased with age and with physical activity. CONCLUSIONS In the our sample, 51.1% of students reported pain and 38.93% reported pain in only one region. There was no association between the presence of pain and sex, BMI, how to carry school supplies, postures used in ADLs and postural changes. The increasing age and physical exercise influenced significantly the presence of pain.

The International Classification of Functioning, Disability and Health: progress and opportunities

The International Classification of Functioning, Disability and Health is a tool used to monitor individuals from a broad perspective, which considers not only their health but also the biopsychosocial aspects involved in the health-disease process. It offers a range of categories to describe the aspects of human functioning that interfere with the performance of activities, as well as the environmental aspects that facilitate or hamper participation, integration and consequently quality of life. This paper reports some of the experiments in the use of this classification as a way to foster its use and show the broad range of possibilities offered by this tool. The disclosure of usage strategies will make it more well-known and adopted, opening up new perspectives for the health care segment.

Dificuldades na comunicação entre pessoas com deficiência auditiva e profissionais de saúde: uma questão de saúde pública

ABSTRACT Purpose: To describe the occurrence of reports from people with hearing and/or multiple disabilities (hearing and visual and/or mo-bility) regarding hearing and understanding health professionals. Methods: Cross-sectional study through health survey, conducted with selected subjects from two population-based studies. Data collection took place at subjects’ homes, through interviews conducted by trained interviewers in the area of Sao Paulo. Information regarding difficulties to hear and understand what health professionals said in the last health service used were collected, besides demographic information (age, gender and race), economic data (head of household income), type of health service sought, use of private health insurance, and need of help when accessing the health service. Results: From the interviewees, 35% reported problems to hear and understand the health professionals in the last service visited; 30.6% (95%CI: 23.4-37.8) to understand the physicians; 18.1% (95%CI: 12.0-24.1) to understand the nurses; and 21.2% (95%CI: 14.8-27.6) to understand the other employees. There were no differences for the demographic variables, the need of help with bathing and dressing, eating, standing and/or walking, having or not private health insurance, and type of health service visited.

Accessibility to health services by persons with disabilities

OBJETIVO: Analisar as dificuldades de acessibilidade aos servicos de saude vividas por pessoas com deficiencia. PROCEDIMENTOS METODOLOGICOS: Estudo qualitativo realizado com pessoas que relataram ter algum tipo de deficiencia (paralisia ou amputacao de membros; baixa visao, cegueira unilateral ou total; baixa audicao, surdez unilateral ou total). Foram entrevistados 25 individuos (14 mulheres) na cidade de Sao Paulo, SP, de junho a agosto de 2007, que responderam perguntas referentes a deslocamento e acessibilidade aos servicos de saude. A metodologia utilizada para analise foi o discurso do sujeito coletivo e as analises foram conduzidas com recurso do programa Qualiquantisoft. ANALISE DOS RESULTADOS: A analise dos discursos sobre o deslocamento ao servico de saude mostrou diversidade quanto ao usuario ir ao servico sozinho ou acompanhado, utilizar carro particular, transporte coletivo, ir a pe ou de ambulância e demandar tempo variado para chegar ao servico. Com relacao as dificuldades oferecidas de acessibilidade pelos servicos de saude, houve relatos de demora no atendimento, problemas com estacionamento, falta de rampas, elevadores, cadeiras de rodas, sanitarios adaptados e de medicos. CONCLUSOES: As pessoas com algum tipo de deficiencia fizeram uso de meios de transporte diversificados, necessitando de companhia em alguns casos. Problemas na acessibilidade dos servicos de saude foram relatados pelos sujeitos com deficiencias, contrariando o principio da equidade, preceito do Sistema Unico de Saude.OBJETIVO: Analizar las dificultades de acceso a los servicios de salud vividas por personas con discapacidad. PROCEDIMIENTOS METODOLOGICOS: Estudio cualitativo realizado con personas que relataron tener algun tipo de discapacidad (paralisis o amputacion de miembros; baja vision, ceguera unilateral o total; baja audicion, sordera unilateral o total). Se entrevistaron 25 individuos (14 mujeres) en la ciudad de Sao Paulo, Sureste de Brasil, de junio a agosto de 2007, que respondieron preguntas relacionadas con el desplazamiento e el acceso a los servicios de salud. La metodologia utilizada para analisis fue el discurso del sujeto colectivo y los analisis fueron conducidos con recurso al programa Qualiquantisoft. ANALISIS DE RESULTADOS: El analisis de los discursos sobre el desplazamiento al servicio de salud mostro diversidad con relacion al usuario ir al servicio solo o acompanado, utilizar carro particular, transporte colectivo, ir a pie o de ambulancia y demandar tiempo variado para llegar al servicio. Con relacion a las dificultades ofrecidas de acceso por los servicios de salud, hubo relatos de demora en la atencion, problemas con estacionamiento, falta de rampas, elevadores, sillas de rueda, sanitarios adaptados y de medicos. CONCLUSIONES: Las personas con algun tipo de discapacidad hicieron uso de medios de transporte diversificados, necesitando de compania en algunos casos. Problemas con el acceso a los servicios de salud fueron relatados por los sujetos con discapacidades, contrariando el principio de la equidad, precepto del Sistema Unico de Salud.OBJECTIVE To analyze the difficulties in accessibility to health services experienced by persons with disabilities. METHODOLOGICAL PROCEDURES A qualitative study was performed with individuals who reported having a certain type of disability (paralysis or amputation of limbs; low vision, unilateral or total blindness; low hearing, unilateral or total deafness). A total of 25 individuals (14 women) were interviewed in the city of São Paulo, Southeastern Brazil, between June and August 2007, responding to questions about transportation and accessibility to health services. Collective Subject Discourse was the methodology used to analyze results and analyses were performed with the Qualiquantisoft software. ANALYSIS OF RESULTS The analysis of discourses on transportation to health services revealed a diversity in terms of the user going to the service alone or accompanied; using a private car, public transportation or ambulance or walking; and requiring different times to arrive at the service. With regard to the difficulties in accessibility to health services, there were reports of delayed service, problems with parking, and lack of ramps, elevators, wheelchairs, doctors and adapted toilets. CONCLUSIONS Individuals with a certain type of disability used various means of transportation, requiring someone to accompany them in some cases. Problems with accessibility to health services were reported by persons with disabilities, contradicting the principle of equity, a precept of the Brazilian Unified Health System.

Problems with accessibility to health services by persons with disabilities in São Paulo, Brazil

Purpose. To describe the occurrence of self-reported problems of accessibility to health services used by persons with disabilities in terms of social and health services variables. Methods. We performed a cross-sectional household survey designed to assess problems with accessibility to health services faced by persons with disabilities. We interviewed 333 persons in São Paulo city, in 2007. Variables related to the presence of accessibility problems, disabilities, gender, age, family head income, ethnicity, use of health services and others were analysed using frequencies, percentages, χ2-test, ANOVA and Poisson regression models. Results. 15.92%% of the interviewed persons reported problems with accessibility to health services. Persons having multiple (prevalence ratios; PR  ==  2.91) or mobility disability (PR  ==  6.46) had more problems with accessibility than persons with hearing disability. Persons younger than 78 years old had more problems with accessibility; those who needed help to go to the health service (PR  ==  3.01) also. Conclusions. Persons with multiple or mobility disability, younger than 78 years, and those who needed help of others to go to the health service were more likely to have problems with accessibility to health services. This information could be one of the first steps to the management and/or planning of appropriate health services for persons with disabilities.

Identification of common content between the questionnaire of the Health Survey (ISA-SP) and the International Classification of Functionality, Disability, and Health

The purpose of this paper was to identify the common contents between São Paulos Health Survey Questionnaire (Physical Disability and Emotional Health Blocks) and the International Classification of Functionality, Disability, and Health. The first stage of the research consisted of the search for the modules of São Paulos Health Survey, which addressed the issue of disability, and the passages about this theme were highlighted and inserted into a new file. In the second stage, the significant contents were extracted. In the last one, these contents were codified to the codes of the International Classification of Functionality, Disability, and Health by two independent researchers. For the descriptive statistical analysis, crude numbers, percentages, and simple frequencies were used. The degree of agreement between the two professionals was calculated using Kappas coefficient and the confidence interval. The most common domains were those about functions and body structures and about activities and participation, in which the domain of environmental factors presented a lower frequency of approach.

Leprosy incidence, characterization of cases and correlation with household and cases variables of the Brazilian states in 2010

BACKGROUND: Leprosy is millenary disease and still persists in several countries. OBJECTIVES: To estimate the incidence of leprosy in the Brazilian states and for the country in the year 2010; to describe the cases reported according to the studied variables; to verify the correlation between the overall incidence and the studied variables. METHODS: Ecological descriptive study, with population data from the 27 states, 2010. Information about reported cases were collected: gender, race, percentage of patients younger than 15 years old and living conditions. The analysis was performed using percentages, means, incidence rates and the Spearman correlation test. RESULTS: The states of Mato Grosso and Tocantins recorded the highest incidence rates; Rio Grande do Sul and Santa Catarina, the lowest; there was a higher incidence of leprosy among men; the incidence of leprosy increases proportionally with the nonwhites among the inhabitants; patients younger than 15 years; the average number of residents per household; and a decrease in coverage of water supply and presence of bathrooms. CONCLUSION: The incidence of leprosy is related to factors as gender, race and house conditions (p<0,05 for all).