To characterize scapular kinematics and shoulder muscle activity in patients with subacromial impingement syndrome, with and without visually identified scapular dyskinesis.
Cross-sectional study.
...Laboratory.
Participants with subacromial impingement syndrome (N=38) were visually classified using a scapular dyskinesis test with obvious scapular dyskinesis (n=19) or normal scapular motion (n=19).
Not applicable.
An electromagnetic motion capture system measured 3-dimensional kinematics of the thorax, humerus, and scapula. Simultaneously, surface electromyography was used to measure muscle activity of the upper, middle, and lower trapezius; serratus anterior; and infraspinatus during ascending and descending phases of weighted shoulder flexion. Separate mixed-model analyses of variance for the ascending and descending phases of shoulder flexion compared kinematics and muscle activity between the 2 groups. Shoulder disability was assessed with the Pennsylvania Shoulder Score (Penn).
The group with obvious dyskinesis reported 6 points lower on Penn shoulder function (0-60 points), exhibited a main group effect of less scapular external rotation of 2.1° during ascent and 2.5° during descent, and had 12.0% higher upper trapezius muscle activity during ascent in the 30° to 60° interval.
Patients with obvious dyskinesis and subacromial impingement syndrome have reduced scapular external rotation and increased upper trapezius muscle activity, along with a greater loss of shoulder function compared with those without dyskinesis. These biomechanical alterations can lead to or be caused by scapular dyskinesis. Future studies should determine if correction of these deficits will eliminate scapular dyskinesis and improve patient-rated shoulder use.
To estimate the prevalence of rheumatic diseases in residents of Montes Claros, Brazil, of both sexes, aged above 16 years, using the COPCORD questionnaire.
This was a cross-sectional study of 3038 ...people; the sample was probabilistic, by conglomerates, multiple stages, within homogeneous strata, the sampling unit being the domicile. The COPCORD questionnaire was used for all subjects, and a rheumatologist evaluated those patients who presented pain and/or functional disability. Laboratory tests and radiographs of small and large joints were done in some patients to confirm the diagnosis. Subjects were identified by socioeconomic level in quintiles A, B, C, D, and E, A being the highest.
Two hundred nineteen patients were identified with rheumatic diseases, mean age 37 (SD 27) years, with female predominance. Seventy-seven (35.2%) were unemployed and socioeconomic level D was the most prevalent. Of all patients with rheumatic disease, osteoarthritis (OA) was observed in 126 (57.5%) patients, fibromyalgia (FM) in 76 (34.7%), rheumatoid arthritis (RA) in 14 (6.4%), and lupus in 3 (1.4%). Women were predominant in all diseases except OA. The mean (SD) age was 56 (12.7) years for OA, 43.2 (9.1) for FM, 53.4 (13.9) for RA, and 40 (14) for lupus.
The prevalence of rheumatic diseases evaluated by the COPCORD questionnaire was 4.14% for OA, 2.5% for FM, 0.46% for RA, and 0.098% for lupus.
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.
The Indian Takayasu Clinical Activity Score (ITAS2010) was developed in 2010 as an assessment tool for disease activity in patients with Takayasu arteritis (TA). It has since been widely used in ...different studies and in clinical practice for the management of patients with TA. The present study aims to translate the ITAS2010 into Brazilian Portuguese language and to validate it for use in clinical practice in Brazil.
For this cross-sectional study, the ITAS2010 was translated in accordance with the guidelines described by Beaton et al. and then applied with 27 patients with TA on three assessments by two rheumatologists working independently. To measure interrater agreement, the assessments were performed on the same day within approximately 1 hour. One of the rheumatologists performed a second evaluation of patients with TA within 7 to 14 days to measure intrarater agreement.
The correlation coefficient for the ITAS2010 score between the two raters was high (r = 0.916; p < 0.0001), as well as the intraclass correlation coefficient (ICC) 0.918 with a 95% confidence interval (95CI): 0.828-0.962. The correlation coefficient and the ICC for intrarater agreement were moderate for ITAS2010 (r = 0.633; p < 0.0001 and ICC = 0.594; 95CI: 0.292-0.790). The ITAS2010 at baseline was compared with the physician's global assessment (PGA) and with Kerr's criteria for detecting disease activity in TA. Higher ITAS2010 scores were observed in patients with active and grumbling/persistent disease than in those presenting inactive disease according to the PGA 1.5 (0.0-3.0) vs. 0.0 (0.0-0.0); p = 0.0025. Patients with active disease according to the Kerr's criteria had also higher ITAS2010 scores than those considered in remission 3.0 (3.0-7.0) vs. 0.0 (0.0-0.0); p = 0.0068.
The Brazilian Portuguese version of the ITAS2010 is a valid and reproducible tool for the assessment of disease activity in TA and it is an additional tool for the routine evaluation of Brazilian patients with TA.
To evaluate the methodological steps currently proposed in translation and cultural adaptation of quality of life questionnaires.
Fifty patients with rheumatoid arthritis were invited to participate. ...Two versions each of the Stanford Health Assessment Questionnaire (HAQ), the MOS 36 Item Short-Form Health Survey (SF-36), and the Arthritis Impact Measurement Scales 2 (AIMS-2) were administered: version 1 was a literal translation of the questionnaire; version 2 resulted from a process of translation and cultural adaptation following internationally accepted guidelines. For each patient we applied 2 questionnaires before and after consultation. The questionnaire, the order of administration, and the version were randomly assigned. The interviews were performed by a single interviewer. Several clinical and laboratory outcome measures were assessed simultaneously. Descriptive statistical analysis was used to characterize the data. Spearman and intraclass correlation coefficients were used to evaluate reliability and validity of each version of each questionnaire.
Patients' mean (SD) age was 47 (12) years and mean (SD) disease duration was 10 (7) years. The differences of the mean in the physical and affective AIMS-2 components between the literal and adapted versions (0.21 and 0.11, respectively) were similar to the differences in the intraobserver application of the same version of culturally adapted AIMS-2 components (0.03 and 0.20) (the component scores range from 0 to 10). The same results were observed when considering other components of AIMS and SF-36, as well as HAQ scores. Version 1 and 2 presented a similar clinically and statistically significant correlation with clinical and laboratory measures used in the validation process of the questionnaires.
The complex methodologies proposed in the translation and validation of the questionnaires should be carefully reevaluated. The simplification of this methodology should be studied.
The concepts of health access Sanchez, Raquel Maia; Ciconelli, Rozana Mesquita
Revista panamericana de salud pública
31, Issue:
3
Journal Article
Peer reviewed
Open access
This article describes four dimensions of health access-availability, acceptability, ability to pay and information-correlating these dimensions to indicators and discussing the complexity of the ...concept of access. For a study of these four dimensions, searches were conducted using the PubMed/MEDLINE, LILACS, SciELO, and World Health Organization Library & Information Networks for Knowledge (WHOLIS) databases. Large-circulation media vehicles, such as The Economist, The Washington Post, and the BBC network were also searched. The concept of health access has become more complex with time. The first analyses, carried out in the 1970s, suggested a strong emphasis on geographical (availability) and financial (ability to pay) aspects. More recently, the literature has focused on less tangible aspects, such as cultural, educational, and socioeconomic issues, incorporating the element of acceptability into the notion of health access. The literature also shows that information provides the starting point for access to health, in association with health empowerment and literacy for health care decision-making. The study concludes that improvements in access to health and the guarantee of equity will not be achieved by initiatives focusing on health care systems alone, but rather will depend on intersectoral actions and social and economic policies aimed at eliminating income and education differences.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Indirect Costs of Rheumatoid Arthritis in Brazil de Azevedo, Ana Beatriz Cordeiro, MD, PhD Student; Ferraz, Marcos Bosi, MD, PhD; Ciconelli, Rozana Mesquita, MD, PhD
Value in health,
September/October 2008, Volume:
11, Issue:
5
Journal Article
Peer reviewed
Open access
Abstract Objective The present study aimed to determine indirect costs of rheumatoid arthritis (RA) in a sample of patients followed at a public health-care facility in Brazil. Factors potentially ...associated with higher indirect costs in these patients were also investigated. Methods This cross-sectional study included patients between 18 and 65 years old with RA according to the American College of Rheumatology criteria. Patients who were working, on sick leave or retired early due to RA were invited to participate in the survey. A systematic structured interview was conducted in all patients including demographic, socioeconomic, and clinical variables and an experienced rheumatologist examined all patients. Estimates of the indirect costs in the preceding 12 months were performed using the human-capital approach based on the society perspective. Multiple linear regression models were used to determine the variables associated with higher indirect costs. Results A total of 192 patients were included in the study. Forty-seven of them (24.5%) had retired early due to RA, 62 others (32.3%) were on sick leave due to RA while 83 patients (43.2%) were working at the time of the interview. Estimated indirect cost for this population was US$ 466,107.81 or US$ 2,423.51 per patient per year. Factors associated with higher costs were RA poor functional class, high socioeconomic status and male patients (p < 0.001). Conclusions Estimated costs found in our population are similar to that described in more developed countries. Indirect costs were higher in patients with poor functional classes, high socioeconomic status, and men.
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BFBNIB, DOBA, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, UILJ, UKNU, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
O objetivo deste artigo e avaliar o impacto da doenca cronica na qualidade de vida de idosos da comunidade no municipio de Sao Paulo (SP). Trata-se de um estudo transversal de individuos acima de 60 ...anos, com aplicacao de um questionario clinico-demografico padronizado e do questionario generico de qualidade de vida ShortForm 36 items (SF-36). Foram feitas analise estatistica descritiva dos dados clinicos e demograficos e analise de variancia (ANOVA) para correlacao das medias dos dominios do SF-36 com a idade e o numero de morbidades. Avaliaram-se 353 individuos. A media de idade foi de 71,6anos, com 48,7% de homens e 51,3% de mulheres. O sexo feminino apresentou os piores niveis de qualidade de vida em todos os dominios avaliados. A analise de variancia revelou uma variacao significativa da qualidade de vida, em varios dominios, conforme o aumento do numero de morbidades. O dominio mais comprometido foi limitacao por aspectos fisicos (p<0,05). A mesma analise, aplicada as medias dos dominios por faixa etaria, mostrou uma relacao inversa do dominio capacidade funcional (p<0,05) com a idade. O aumento do numero de morbidades e o aumento da idade influenciam de modo significativo varios dominios da qualidade de vida dos idosos. O SF-36 apresenta-se como um instrumento valido para a avaliacao de qualidade de vida da populacao idosa brasileira.
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. Palavras-chave: acesso aos servicos de saude; equidade em saude; politicas publicas de saude. This article describes four dimensions of health access--availability, acceptability, ability to pay and information--correlating these dimensions to indicators and discussing the complexity of the concept of access. For a study of these four dimensions, searches were conducted using the PubMed/MEDLINE, LILACS, SciELO, and World Health Organization Library & Information Networks for Knowledge (WHOLIS) databases. Large-circulation media vehicles, such as The Economist, The Washington Post, and the BBC network were also searched. The concept of health access has become more complex with time. The first analyses, carried out in the 1970s, suggested a strong emphasis on geographical (availability) and financial (ability to pay) aspects. More recently, the literature has focused on less tangible aspects, such as cultural, educational, and socioeconomic issues, incorporating the element of acceptability into the notion of health access. The literature also shows that information provides the starting point for access to health, in association with health empowerment and literacy for health care decision-making. The study concludes that improvements in access to health and the guarantee of equity will not be achieved by initiatives focusing on health care systems alone, but rather will depend on intersectoral actions and social and economic policies aimed at eliminating income and education differences. Key words: health services accessibility; equity in health; health public policy.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Purpose We report the cultural adaptation and psychometric properties of the Quality of Life in Epilepsy-31 Inventory (QOLIE-31) for the Portuguese language and Brazilian culture. Methods ...This study involved 150 outpatients: 50 presurgical patients with refractory temporal lobe epilepsy (TLE) related to mesial temporal sclerosis (MTS), 50 patients with juvenile myoclonic epilepsy (JME), and 50 seizure-free patients with TLE. They completed the QOLIE-31, Nottingham Health Profile (NHP), Beck Depression Inventory (BDI), and Adverse Events Profile (AEP) and underwent a neuropsychological evaluation (NE). Internal consistency reliability, interrater and test–retest reliability, and construct validity were assessed. Results QOLIE-31 mean scores were 33.1 (Social Function), 68.9 (Overall Quality of Life), 56.5 (Seizure Worry), 64.1 (Emotional Well-Being), 63.7 (Energy/Fatigue), 38.9 (Cognitive Function), and 49.7 (Medication Effects). Internal consistency was high (Cronbach’s α), as were the associations between QOLIE-31 and the BDI, NHP, AEP, and NE. Conclusion The Portuguese/Brazilian version of the QOLIE-31 inventory showed good reliability, validity, and construct validity.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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