Adaptación cultural y confiabilidad del instrumento Five-part questionnaire on hypermobility al contexto peruano / Cultural adaptation and reliability of the instrument Five-part questionnaire on hypermobility to the Peruvian context

Introducción Para el diagnóstico de hiperlaxitud articular se emplea comúnmente el Test de Beighton que requiere de un profesional para la exploración física. Por su parte, el instrumento es una herramienta autoadministrada que permite identificar de forma temprana la presencia de hiperlaxitud articular. Objetivos Realizar la adaptación cultural y confiabilidad test-retest del instrumento The Five-part questionnaire on hypermobility al contexto peruano, por medio de la traducción al español, adaptación lingüística y verificación de la confiabilidad test--retest en estudiantes de 13 a 17 años y docentes/administrativos de 24 a 60 años. Métodos Se realizó una traducción-retrotraducción con dos traductores, dos retrotraductores y la adaptación lingüística con 10 expertos. Obtenida la versión adaptada del cuestionario, se aplicó un análisis de comprensibilidad a 50 sujetos. Finalmente se estimó la confiabilidad test-retest en dos grupos: en adolescentes de 13 a 17 años y en adultos de 24 a 60 años. Resultados Se obtuvo la versión traducida del cuestionario, el cual pasó por un proceso de adaptación lingüística donde 10 expertos realizaron un análisis de concordancia (Coeficiente V de Aiken = 1) y un análisis de comprensibilidad con una escala de 0 a 10 que obtuvo una media de 10 puntos. Posteriormente, esta versión fue retro traducida y cotejada con el original. En el análisis de confiabilidad, los resultados de la aplicación del test-retest encontraron una confiabilidad alta entre el puntaje total de ambas aplicaciones tanto para el grupo de 65 adultos (Kappa 0,795; intervalo de confianza al 95%: de 0,777 a 0,819) y el de 71 adolescentes (Kappa 0,946; intervalo de confianza al 95%: de 0,908 a 0,982). Conclusiones Se adaptó el instrumento traducido cuestionario corto al contexto cultural de Perú y se encontró alta confiabilidad para los grupos de estudio de 13 a 17 años y de 24 a 60 años. Se recomienda la validación concurrente para considerar su aplicación en clínica y en investigación.

Introduction For the diagnosis of joint hypermobility, the Beighton test is commonly used; this requires a professional for the physical examination. The "Five- part questionnaire on hypermobility" is a self- administered tool that allows early identification of joint hypermobility. Objective To carry out the cultural adaptation and test- retest reliability of the "Five- part questionnaire on hypermobility" to the Peruvian context through translation into spanish, linguistic adaptation, and verification of test- retest reliability in students from 13 to 17 years of age and teachers/ad-ministrators from 24 to 60 years of age. Methods A translation and back- translation were performed with two translators and two back- translators, followed by a linguistic adaptation with ten experts. Once the adapted version of the question-naire was obtained, a comprehensibility analysis was carried out with 50 subjects. Finally, test- retest reliability was estimated in two groups: adolescents aged 13 to 17 and adults aged 24 to 60. Results The translated version of the questionnaire was obtained and underwent a linguistic adaptation process in which ten experts performed a concordance analysis (Aiken's V coefficient = 1), and a comprehensibility analysis with a scale of zero to ten obtained an average of ten points. Subsequently, this version was back- translated and checked against the original. In the reliability analysis, the results of the test- retest application found high reliability between the total score of both applications for both the group of 65 adults (Kappa 0.795; 95% CI: 0.777 to 0.819) and the group of 71 adolescents (Kappa 0.946; 95% CI: 0.908 to 0.982). Conclusions The translated instrument "Five- part questionnaire (5pq) on hypermobility" was adapted to the Peruvian cultural context, and high reliability was found for the study groups 13 to 17 years and 24 to 60 years. Concurrent validation is recommended to consider its application in clinical and research settings.

Autoavaliação de saúde e fatores relacionados ao trabalho dos professores da educação básica no Brasil / Self-rated health and factors related to the work of basic education's teachers in Brazil

Resumo O objetivo deste artigo é analisar a associação entre a autoavaliação de saúde dos professores e as condições que eles encontram para trabalhar nas escolas da Educação Básica no Brasil. Estudo transversal, realizado entre 2015 e 2016, representativo dos professores da Educação Básica do País, cuja variável desfecho foi a autoavaliação de saúde (AAS). As variáveis explicativas foram as características relacionadas ao trabalho. Para avaliar os fatores associados à AAS foi utilizado o Modelo de Regressão Logística de Chances Proporcionais. A prevalência de AAS ruim foi de 27%. A probabilidade de pior AAS foi significativamente maior para o grupo que informou episódios de violência verbal (OR=1,26; IC95% 1,09-1,44), pressão laboral (OR=1,18; IC95% 1,04-1,33), e deslocamento para escola superior a 50 minutos (OR=1,19; IC95% 1,03-1,38). A probabilidade de pior AAS foi significativamente menor para aqueles que relataram dispor de tempo suficiente para cumprir suas tarefas (OR=0,77; IC95% 0,64-0,92), apoio social (OR=0,79; IC95% 0,69-0,89) e satisfação com o próprio trabalho (OR=0,79; IC95% 0,69-0,91). Ações sobre o ambiente e a organização escolar e melhorias no transporte dos professores para o trabalho são desejáveis.

Abstract The scope of this article is to analyze the association between teachers' self-rated health and the conditions in which they work in Basic Education schools in Brazil. It involved a cross-sectional study, carried out between 2015 and 2016, representative of Basic Education teachers in the country, the outcome variable of which was self-rated health (SRH). The explanatory variables were the work-related characteristics. To assess the factors associated with SRH, the Proportional Odds Logistic Regression Model was used. The prevalence of poor SRH was 27%. The probability of poor SRH was significantly higher for the group that reported episodes of verbal violence (OR=1.26; 95%CI 1.09-1.44), work pressure (OR=1.18; 95%CI 1, 04-1.33), and a commute to school of more than 50 minutes (OR=1.19; 95%CI 1.03-1.38). The probability of poor SRH was significantly better for those who reported having enough time to complete their tasks (OR=0.77; 95%CI 0.64-0.92), social support (OR=0.79; 95%CI 0.69-0.89) and satisfaction with their workload (OR=0.79; 95%CI 0.69-0.91). Actions on the school environment and organization and improvements in the transport of teachers to work are desirable.

Negative self-perception of hearing and depression in older adults: a population-based study / Autopercepção negativa da audição e depressão em idosos: um estudo de base populacional

ABSTRACT OBJECTIVE To estimate the association between negative self-perception of hearing and depression in older adults in Southern Brazil. METHODS This is a cross-sectional study conducted with data from the third wave of the EpiFloripa Idoso 2017/19 study, a population-based cohort of older adults (60+). A total of 1,335 older adults participated in this wave. The dependent variable was self-reported depression, and the main exposure was self-perception of hearing (negative; positive). For both the crude (bivariate) and adjusted analysis, the odds ratio (OR) was used as a measure of association and estimated by means of binary logistic regression analysis. The exposure variable was adjusted by sociodemographic and health covariates. A p value < 0.05 was adopted as statistically significant. RESULTS The prevalence of negative self-perception of hearing and depression was 26.0% and 21.8%, respectively. In the adjusted analysis, the older adults with negative self-perception of hearing were 1.96 times more likely to report depression when compared to the ones with positive self-perception of hearing (p = 0.002). CONCLUSION The association between negative self-perception of hearing and depression reflects the importance of reviewing health care actions for older adults, incorporating hearing-related issues, to ensure comprehensive care for this growing segment of the population.

RESUMO OBJETIVO Estimar a associação entre a autopercepção negativa da audição e a depressão em idosos do sul do Brasil. MÉTODOS Trata-se de um estudo transversal realizado com dados da terceira onda do estudo EpiFloripa Idoso 2017/19, de coorte de base populacional de idosos (60+). Participaram desta onda 1.335 idosos. A variável dependente foi a depressão autorreferida e a exposição principal foi a autopercepção auditiva (negativa; positiva). Tanto para a análise bruta (bivariada) quanto para a ajustada, a odds ratio (OR) foi utilizada como medida de associação e estimada por meio da análise de Regressão Logística Binária. A variável de exposição foi ajustada pelas covariáveis sociodemográficas e de saúde. Adotou-se o valor de p < 0,05 como estatisticamente significativo. RESULTADOS A prevalência da autopercepção negativa da audição e depressão foi de 26,0% e 21,8%, respectivamente. Na análise ajustada, idosos com autopercepção negativa da audição apresentaram 1,96 vezes mais chance de referirem depressão quando comparados aos idosos com autopercepção positiva da audição (p = 0,002). CONCLUSÃO A associação encontrada entre a autopercepção negativa auditiva e a depressão reflete a importância de rever as ações de atenção à saúde do idoso, incorporando questões relacionadas à audição para a garantia da atenção integral a esta parcela crescente da população.

Is self-perception of oral health associated with expectations of employability?

Abstract The aim of this study was to develop and validate a questionnaire that allows a systematic evaluation of the impact of self-perceived oral health on expectations of getting a job on adult population seeking dental care, and to describe its associations with demographic characteristics, job related, and health coverage variables. We designed a descriptive cross-sectional study including men and women aged 18 to 65 years from a population seeking dental services in a walk-in clinic. In a first stage we design and validated an instrument on a sample of 100 subjects. The questionnaire was registered in a Likert scale, with higher scores represented higher impact of the oral status self-perception on employability. We calculated internal consistency, construct validity, and domains validation. The final instrument consisted in an 18-item questionnaire (Cronbach α = 0.814), grouped into two domains based on exploratory and confirmatory factor analysis. The total variance explained with values >1 was 66 percent, grouping questions into six components. One domain refers to oral health status and importance of dental aesthetics, while the other refers to specific job-seeking elements. In a second stage we applied the questionnaire on 800 participants from the same population of reference. Women, people who intended to change jobs, those younger than 40 years old, having health insurance, and higher educational level showed statistically significant higher scores than their counterparts (p<0.001). We developed a tool that enables evaluating the impact of self-perceived oral health on expectations of getting a job for adults seeking emergency care in a dental clinic.

Isolated and combined association of excessive screen time and physical inactivity with negative self-rated health in adolescents / Associação isolada e combinada do tempo de tela excessivo e da inatividade física com autopercepção de saúde negativa em adolescentes

Abstract Objective: The aim of this study was to analyze isolated and combined associations of physical inactivity excessive screen time with negative self-rated health, according to sex, among school adolescents. Methods: In this cross-sectional study conducted with 2,517 adolescents in Amazonas State, participants were asked about their self-rated health with the following question: How do you rate your health? Responses were dichotomized into positive (excellent and good) and negative (regular, bad, and terrible). Information on sex, age group, family income, physical activity, and screen time (watching TV, using a computer, or playing video games) was collected through a self-administered questionnaire. Adolescents simultaneously classified as physically inactive (<60 min/day) and having excessive screen time (>2 h/day) were considered to have two risk factors. Data was analyzed using binary logistic regression. Results: Out of every 10 adolescents, 2 had a negative self-rated health. After adjusting for age and family income, there were no isolated or combined associations between physical inactivity or excessive screen time and negative self-rated health in girls. In boys, negative self-rated health was associated with insufficient levels of physical activity (odds ratio [OR]: 2.39; 95% confidence interval [CI]: 1.03-5.59) and with the accumulation of two risk factors (OR: 1.61; 95%CI 1.10-2.34). Conclusions: Being insufficiently active and the combination of physical inactivity and excessive screen time become exposure factors to the negative self-rated health of adolescent boys.

RESUMO Objetivo: Analisar a associação isolada e combinada do tempo excessivo de tela e inatividade física com a autopercepção negativa de saúde, de acordo com o sexo, em adolescentes estudantes. Métodos: Estudo transversal conduzido em 2.517 adolescentes amazonenses, os quais foram questionados sobre a autopercepção de saúde: "Como você considera a sua saúde?", dicotomizada em positiva (excelente, boa) e negativa (regular, ruim, péssima). Informações sobre sexo, faixa etária, renda familiar, atividade física e tempo excessivo de tela (assistindo TV, usando o computador ou jogando videogame) foram coletadas mediante questionário autoadministrado. Aqueles classificados, simultaneamente, como fisicamente inativos (<60 min/dia) e com tempo excessivo de tela (>2 horas/dia) foram considerados com dois fatores de risco. Os dados foram analisados utilizando-se a regressão logística binária. Resultados: Dois em cada dez adolescentes apresentaram autopercepção negativa de saúde. Após o ajuste pelas variáveis idade e renda familiar, não foram observadas, no sexo feminino, associações da inatividade física e do tempo excessivo de tela, de maneira isolada ou agrupada, com a autopercepção negativa de saúde. No sexo masculino, a percepção negativa de saúde foi associada com os níveis insuficientes de atividade física (odds ratio — OR: 2,39; intervalo de confiança — IC95% 1,03-5,59) e com o acúmulo de dois fatores de risco (OR: 1,61; IC95% 1,10-2,34). Conclusões: Ser insuficientemente ativo e associar a inatividade física com tempo excessivo de tela tornam-se fatores de exposição à percepção negativa em saúde de meninos adolescentes.

Design, sensitivity and validity of wrist patient self-evaluation instrument / 中华骨科杂志

Objective:To design a patient self-rating wrist scale suitable for Chinese patients, and evaluate its reliability and validity.Methods:The primary entry pool was established by referring to the existing foreign scales and the opinions of domestic experts. Opinions of 11 hand surgeons and 10 patients with wrist diseases were referred to select better items into the primary scale. During September 2015 to November 2016, 100 inpatients with wrist diseases in the hand surgery department of Beijing Jishuitan Hospital were selected by convenient sampling method, and the primary scale was conducted on them. Eight indices including item response rate, item differentiation, item-dimension attribution, variability, responsiveness, overall item attribution, internal consistency and factor loading were summarized. All the 8 indices were evaluated to establish the wrist patient self-evaluation instrument for Chinese. Test-retest reliability, Cronbach coefficient, expert score, KMO value, explanatory power, χ 2/df, root mean square error of approximation (RMSEA) and comparative fit index (CFI) were used to evaluate the reliability and validity of the scale. Results:A total of 40 subjective items in the primary entry pool were selected to form the primary scale, including 32 items (A1-D4), and 4 dimensions (physiology, safety, pain and emotion). There were 92 valid scale results in 100 cases. All cases' response rate were over 90%. In terms of item differentiation, only the high grouping score [3.20±0.577 points (range, 1-3 points)] and the low grouping score [2.68±0.627 points (range, 2-5 points)] of item B10 had no statistical significance ( t=5.11, P=0.340). There were 17 items: A1, A2, A5, A6, A7, A8, A9, A10, A11, A12, B4, B6, B7, C5, D1, D2, and D3 were considered to be deleted according to the result of item-dimension attribution. A total of 11 items had a variation less than 0.65: A4 (0.645), A7 (0.593), B1 (0.590), B5 (0.617), B8 (0.578), B9 (0.612), B10 (0.526), D1 (0.644), D2 (0.320), D3 (0.169), D4 (0.526). A2, A4, A6, A8, B4, B6, D1, D2, D3, C2, C3, C4, C5, C6 did not meet the reactivity requirements. Items with factor loads less than 0.4: D2 (-0.051), D3 (-0.127), and D4 (0.267). C4 (0.026), C5 (0.023), D1 (0.103), D2 (0.434), D3 (0.387), D4 (0.062) did not meet the internal consistency requirements. In multiple linear regression analysis, 19 items were not included in the final regression equation. Based on the above analysis, D1, D2, and D3 were finally deleted and the rest 29 valid items were remained to form the wrist patient self-evaluation instrument for Chinese. Reliability and validity of the scale: the test-retest reliability of physiology, safety, pain, emotion dimensions were 0.984, 0.976, 0.985 and 0.802 ( P<0.001), respectively. Except for there was only one item in emotion dimension, the Cronbach coefficients of total score, physiology, safety and pain dimensions were 0.943, 0.973, 0.944 and 0.881, respectively. KMO was 0.894 ( P<0.001). Except for there was only one item in emotion dimension, whose validity could not be evaluated. The χ 2/df, CFI, RMSEA results were as follows, physiology: 5.152, 0.817, 0.022, respectively; safety: 5.378, 0.795, respectively; pain: 7.439, 0.865, 0.028, respectively. Conclusion:The wrist patient self-evaluation instrument for Chinese is consisted of 4 dimensions and 29 items. As a subjective wrist self-rating scale suitable for modern Chinese patients, the scale has good reliability and validity, and can be one of the choices of the subjective evaluation for Chinese patients with wrist diseases.

Self-assessed masticatory function and frailty in Brazilian older adults: the FIBRA Study

ABSTRACT OBJETIVE To investigate the relationship between the masticatory function and the frailty of older people. METHODS Exploratory cross-sectional study using secondary data from the FIBRA Project on the frailty conditions of older people living in urban areas of six Brazilian municipalities, from 2008 to 2009. The population consisted of older adults aged 65 and over with no cognitive impairment. A single session identification questionnaire and the Mini-Mental State Examination (MMSE) were applied, followed by collecting sociodemographic data and data on the participants' self-assessment of masticatory function, general health, and oral health. RESULTS 2,341 older people (164 frail older adults), of whom 63.2% reported not having seen a dentist in the last year, and approximately 26% of them had three or more functional feeding problems. Older participants (OR = 2.88; 95%CI: 2.01-4.13), who are retired (OR = 2.31; 95%CI: 1.18-5.53), those who were depressed (OR = 2.31; 95%CI: 1.58-3.38), and those who self-assessed their general health as worse compared to others of the same age (OR = 3.91; 95%CI: 2.39-6.40) were at higher risk of frailty. Three or more problems related to the functional aspects of mastication were associated with a greater chance of frailty (OR = 2.06; 95%CI: 1.25-3.41). CONCLUSION This study found an association between masticatory function and a greater chance of frailty among the studied population.

Fatores associados à autoavaliação negativa de saúde entre professores da educação básica / Factors associated with negative self-assessed health among school teachers / Factores asociados con la autoevaluación negativa de la salud de los profesores de educación básica

A autoavaliação da saúde tem sido utilizada como ferramenta de medida da saúde de indivíduos e grupos populacionais, especialmente por sua relativa facilidade de aplicação. Buscou-se investigar a prevalência e os fatores associados à autoavaliação negativa de saúde entre professores da educação básica. Elaborou-se um estudo transversal, conduzido em uma amostra probabilística de professores em atividade em escolas estaduais de um município de médio porte do Sudeste brasileiro. A variável dependente foi obtida por meio da questão: "como você classificaria seu estado de saúde atualmente?". As opções de respostas foram agrupadas em autoavaliação positiva (excelente e bom) e negativa (regular, ruim e muito ruim). A análise dos dados foi realizada por meio da regressão de Poisson com variância robusta, em modelos bivariados e multivariados. A prevalência de autoavaliação negativa de saúde foi de 32,9% (IC 95%=28,8-37,4). No modelo final ajustado, permaneceram associadas à autoavaliação negativa da saúde: superlotação das turmas, insatisfação com o trabalho, sedentarismo, obesidade, relatos de doenças crônicas e de uma ou mais queixas vocais. Os resultados indicam a necessidade de intervenções tanto individuais, por meio de programas de promoção da saúde dos professores, quanto organizacionais, que visem a proteção da saúde dessa categoria profissional.

Self-assessment of health has been used as a measuring tool by individuals and population groups, especially for its relative ease of application. This study sought to investigate the prevalence of negative self-assessed health and associated factors among schoolteachers. A cross-sectional research was conducted with a probabilistic sample of state schoolteachers from a medium-sized municipality in southeastern Brazil. Response variable was collected via the question "How would you rate your current health status?", and the response options were grouped into positive (excellent, good) and negative (regular, bad, very bad) self-assessment. Data analysis was performed using Poisson's regression with robust variance, in bivariate and multivariate models. Negative self-assessed health showed a prevalence of 32.9% (95% CI = 28.8-37.4). After adjustment, overcrowded classes, job dissatisfaction, physical inactivity, obesity, reports of chronic illnesses, and at least one vocal complaint remained factors associated with negative self-assessment. Results indicate the need for both individual interventions, such as teacher health promotion programs, and organizational improvements to protect the health of schoolteachers.

La autoevaluación de la salud se ha utilizado como una herramienta de medida de la salud de individuos y grupos de población, especialmente por su relativa facilidad de aplicación. Se pretendió investigar la prevalencia y los factores asociados a la autoevaluación negativa de la salud entre los profesores de educación básica. Este es un estudio transversal realizado sobre una muestra probabilística de profesores que laboran en escuelas públicas de un municipio de tamaño mediano del Sudeste de Brasil. Las respuestas se obtuvieron basadas en la pregunta: "¿Cómo calificaría su estado de salud hoy?". Las opciones de respuesta se agruparon en autoevaluación positiva (excelente, buena) y negativa (regular, mala, muy mala). El análisis de los datos se realizó mediante regresión de Poisson con varianza robusta, en modelos bivariados y multivariados. La prevalencia de autoevaluación negativa de la salud fue del 32,9% (IC 95%=28,8-37,4). En el modelo final ajustado, los siguientes ítems permanecieron asociados con una autoevaluación negativa de la salud: hacinamiento de clases, insatisfacción laboral, inactividad física, obesidad, informes de enfermedades crónicas y una o más quejas vocales. Los resultados indican la necesidad de intervenciones tanto individuales, por medio de programas de promoción de la salud docente, como organizacionales, dirigidas a proteger la salud de esta categoría profesional.

Condições de trabalho nas escolas brasileiras da educação básica e saúde dos professores: EDUCATEL, 2016 / Working conditions in Brazilian schools of basic education and teachers' health: EDUCATEL, 2016

Os professores são uma classe profissional bastante exposta ao risco de adoecimento, particularmente os da Educação básica. Nas últimas décadas, estudos sobre saúde do professor identificaram principalmente alta prevalência de distúrbios de voz, transtornos mentais e agravos osteomusculares. Porém, prevalecem os projetos investigativos locais sobre as relações entre condições de trabalho e saúde dos professores, enfocados no tradicional processo saúde-doença. A autoavaliação de saúde (AAS) é um indicador validado, amplamente utilizado em inquéritos epidemiológicos. É preditor de morbimortalidade porque sintetiza o quadro real de saúde de uma pessoa. Fatores individuais e clínicos podem influenciar a AAS de adultos, mas pouco se sabe sobre as associações relacionadas às características ocupacionais. OBJETIVO: O objetivo desse estudo foi verificar a associação entre fatores ocupacionais e a autoavaliação de saúde dos professores da Educação Básica brasileira. MÉTODOS: Inquérito telefônico, realizado entre 2015 e 2016, representativo dos professores da Educação Básica do país, cuja variável desfecho foi obtida por meio da pergunta "Em geral, você diria que a sua saúde é", com opções de respostas categorizadas em ruim (muito ruim, ruim, regular), boa e muito boa. As variáveis explicativas foram hierarquizadas em blocos específicos: características do trabalho, individuais e de saúde. Para avaliar os fatores associados à AAS foi utilizado o Modelo de Regressão Logística de Chances Proporcionais, devido ao caráter ordinal da variável resposta. RESULTADOS: A prevalência de AAS ruim foi de 27% (IC 95%: 26,9%­27,1%). A chance de pior AAS foi significativamente maior para os professores com 10 a 20 anos de tempo de serviço (OR=1,17; IC 95% 1,01-1,35); que trabalharam sob pressão laboral (OR=1,18; IC 95% 1,04-1,33), vivenciaram casos de violência verbal (OR=1,26; IC 95% 1,09-1,44) e indisciplina (OR=1,26; IC 95% 1,10-1,45) e com tempo de deslocamento até escola superior a 50 minutos (OR=1,19; IC 95% 1,03-1,38). A chance de pior AAS foi significativamente menor para aqueles que relataram exercer outro tipo de atividade remunerada (OR=0,78; IC 95% 0,65-0,94), ter tempo suficiente para cumprir suas tarefas (OR=0,77; IC 95% 0,64-0,92), apoio social (OR=0,79; IC 95% 0,69-0,89) e satisfação com o próprio trabalho (OR=0,79; IC95% 0,69-0,91). CONCLUSÃO: Sugere-se uma escuta ativa em oposição a avaliações rigorosas, consideração do tempo de deslocamento entre moradia e escola nas escalas e horários, promoção de ambientes de paz e justiça em âmbito escolar e seus entornos, fomento ao apoio entre colegas como medidas de enfrentamento aos desafios diários do cotidiano do professor.

Teachers are a professional class that is quite exposed to the risk of becoming ill, particularly those in basic education. In the last decades, study about teachers' health identified mainly high prevalence of voice, mental and musculoskeletal disorders. However, local investigative projects about relationship between working conditions and teachers' health prevail, focused on the traditional health-disease process. The self-rated health (SRH) is a validated indicator, widely used in epidemiologic surveys. SRH is predictor of morbity and mortality because it synthesizes a person's real health condition. Individual and clinical factors can influence SRH in adults, but little is known about its associations related to occupational characteristcs. OBJECTIVE: The aim of this study was to verify the association between occupational factors and the self-rated health of the Brazilian Basic Education's teachers. METHODS: Telephone survey, carried out between 2015 and 2016, representative of the Basic Education's teachers in the country, whose variable outcome was obtained through the question "In general, would you say your health is", with answer options categorized as bad (very bad, bad, regular), good and very good. The explanatory variables were hierarchized into specific blocks: work, individual and health characteristics. To assess the factors associated with SRH, the Proportional Chance Logistic Regression Model was used, due to the ordinal character of the response variable. RESULTS: The prevalence of poor SRH was 27% (CI 95%: 26,9%­27,1%). The chance of worse SRH was significantly higher for teachers with 10 to 20 years of service (OR = 1.17; 95% CI 1.01-1.35); who worked under work pressure (OR = 1.18; 95% CI 1.04-1.33), experienced cases of verbal violence (OR = 1.26; 95% CI 1.09-1.44) and indiscipline (OR = 1.26; 95% CI 1.10-1.45) and with travel time to school greater than 50 minutes (OR = 1.19; 95% CI 1, 03-1.38). The chance of worse SRH was significantly lower for those who reported exercising another type of paid activity (OR = 0.78; 95% CI 0.65-0.94), to have enough time to complete their tasks (OR = 0.77; 95% CI 0.64-0.92), social support (OR = 0.79; 95% CI 0.69-0.89) and satisfaction with their own work (OR = 0.79; 95% CI 0.69 -0.91). CONCLUSIONS: We suggest an active listening in opposition to rigorous evaluations, consideration of the time spent traveling between home and school in the scales and schedules, promotion of peace and justice environments in the school environment and its surroundings, encouraging support among colleagues as measures to confront daily challenges of the teacher's daily life.

A importância dos autotestes de HIV nas farmácias e drogarias no Brasil / The importance of HIV self tests in pharmacies and drugstores in Brazil

Muitas pessoas todos os anos são infectadas pelo HIV no Brasil e, quando infectadas, se tratadas precocemente têm mais chances de sucesso no tratamento, e assim evitam infectar outras pessoas com mudanças em seus hábitos comportamentais. Os autotestes de HIV que estão disponíveis em farmácias e drogarias de alguns países desde 1996 têm um papel fundamental na prevenção de propagação da doença. Apesar de o SUS oferecer gratuitamente a realização do teste às pessoas, é necessária a disponibilidade destes testes em farmácias e drogarias no Brasil. Esta modalidade de teste oferece resultados rápidos e seguros, porém com algumas advertências que poderão ser esclarecidas principalmente através do farmacêutico. Embora estes testes forneçam alta taxa de confiabilidade, são inúmeras as possibilidades de ocorrer um resultado falso negativo. Desta forma, é de extrema importância a orientação dos farmacêuticos junto ao consumidor. Com este artigo será possível identificar os tipos de testes disponíveis, quais as vantagens do autoteste bem como sua precisão, quais os grupos de risco que podem ser beneficiados e a abordagem social referente a este tipo de teste e como foi a experiência de se colocarem à disposição da população estes testes em outros países, como França e Estados Unidos

Many people every year are infected with HIV in Brazil and whe infected if treated early have a better chance of success in treatment, thus avoid infecting others with changes in their behavioral habits. The HIV self-tests that have been available in pharmacies and drugstores in some countries since 1996 play a key role in preventing the spread of the disease. Although the SUS offers the people free test, it is necessary the availability of these tests in pharmacies and drugstores in Brazil. This test mode offers quick and safe results, however with some warnings that can be clarified mainly through the pharmacist. Although these tests provide a high reliability rate, there are numerous possibilities of a false negative result, so the orientation of pharmacists to the consumer is extremely important. With this article it will be possible to identify the types of tests available, the advantages of self-testing as well as their accuracy, which groups of risk can benefit and the social approach to this type of test and how was the experience of putting them. These tests are available in other countries, such as France and the United States.

Correlação entre o autodiagnóstico de alergia alimentar e a presença de IgE específica / Correlation between self-diagnosis of food allergy and presence of specific IgE

Introdução: Nos últimos anos a prevalência de alergia alimentar tem aumentado, contudo, o número de autodiagnósticos errados, também. Essa superestimação dos diagnósticos, frequentemente, culmina em dietas restritivas desnecessárias que podem, muitas vezes, ocasionar mais danos do que benefícios para a saúde. Objetivo: Avaliar a relação entre o autodiagnóstico de alergia alimentar e a presença de IgE específica para o referido alimento. Método: Trata-se de um estudo transversal e observacional que avaliou 100 pacientes que aceitaram participar da pesquisa, com idade entre 18 e 75 anos, por meio de um questionário próprio para investigação do autodiagnóstico de doenças alérgicas e um teste cutâneo de leitura imediata ou prick test para detecção de IgE específica para alimentos que podem induzir a uma reação alérgica. Resultados: Foram aplicados e analisados 100 questionários em voluntários na faixa etária de 18 a 75 anos. Destes, 35 pacientes afirmaram ter alergia alimentar durante a aplicação do questionário. Apenas 10 tiveram resultado positivo ao prick test. A maioria dos resultados positivos no prick test estavam associados ao camarão, ao amendoim e ao caranguejo. Conclusão: O presente estudo evidenciou uma importante superestimação do número de autodiagnósticos de alergias alimentares, sendo o número de pacientes que se autodeclararam alérgicos a alimentos consideravelmente maior do que os resultados positivos no prick test. Constata-se que é necessário mais estudos que possuam em sua metodologia informações pré e pós-testes diagnósticos de alergia alimentar, para uma correta avaliação da proporção de casos.

Introduction: In recent years, the prevalence of food allergy has increased, as well as the number of incorrect self-diagnoses. This overestimation of diagnoses often culminates in unnecessary restrictive diets that may cause more harm than benefits to health. Objective: To evaluate the relationship between self-diagnosis of food allergy and the presence of specific IgE for that food. Method: This is a cross-sectional and observational study that evaluated 100 patients who agreed to participate in the research, aged between 18 and 75 years. A questionnaire was used to investigate the self-diagnosis of allergic diseases, and a skin prick test was used to detect food-specific IgE that may induce an allergic reaction. Results: One hundred questionnaires were administered and analyzed in volunteers aged from 18 to 75 years. Of these, 35 patients claimed to have food allergy during the administration of the questionnaire. Only 10 tested positive on the prick test. Most positive prick test results were associated with shrimp, peanut, and crab. Conclusion: The present study showed an important overestimation of the number of self-diagnosed food allergies, as the number of patients who self-reported being allergic to food was considerably greater than that of positive prick test results. More studies that have in their methods pre- and post-diagnostic information from food allergy tests are needed for a correct assessment of the proportion of cases.

Instrumento de autoevaluación de enfermería en la valoración de mujeres con preeclampsia en un hospital de segundo nivel / Nursing self-assessment instrument in the assessment of women with preeclampsia in a second level hospital

Introducción: la autoevaluacíón permite un monitoreo continuo del quehacer profesional para perfeccionar la competencia clínica. Por tal motivo se diseñó y validó un instrumento de autoevaluacíón de enfermería para la fase de valoración de mujeres con preeclampsia. Método: la validez de contenido se realizó con tres expertos en dos rondas. La investigación se llevó a cabo en los servicios de Gineco-Obstetricia, Unidad Toco Quirúrgica, Unidad de Cuidados Intensivos y Quirófano en un hospital de zona con 40 enfermeras. La consistencia interna se identificó con el índice de Alfa de Cronbach y se calculó la prueba de Spearman-Brown para identificar la correlación intra dimensiones del instrumento. Resultados: se obtuvo una validez de contenido con Alfa de Cronbach en la prueba piloto de 0.977 y en la aplicación final de 0.923; así como correlaciones estadísticamente significativas entre las dimensiones del instrumento. Conclusión: el instrumento permite un marco de referencia en autoevaluacíón diagnóstica de enfermería en la valoración en mujeres con preeclampsia. Se considera práctico, tiene propiedades psicométricas aceptables de consistencia interna y confiabilidad.

Introduction: The self-assessment allows continuous monitoring of professional work to improve clinical competence. For this reason, a nursing self-assessment instrument was designed and validated for the assessment phase of women with pre-eclampsia. Method: Content validity was performed with three experts in two rounds. The research was carried out in the Services of Gynecology-Obstetrics, Toco Surgical Unit, Intensive Care Unit and Operating Room ¡n an area hospital with 40 nurses. Internal consistency was identified with the Cronbach's Alpha índex and the Spearman-Brown test was calculated to identify the intra-dimensional correlation of the instrument. Results: Content validity was obtained with Cronbach's Alpha in the pilot test of 0.977 and in the final application of 0.907; as well as statistically significant correlations between instrument dimensions. Conclusión: The instrument allows a frame of reference in diagnostic nursing self-assessment in the assessment phase in women with preeclampsia. It is considered practical, it has acceptable psychometric properties of internal consistency and reliability.

Prevalência e fatores associados à autoavaliação negativa de saúde entre trabalhadores da rede municipal de saúde de Diamantina, Minas Gerais / Prevalencia y factores asociados a la autoevaluación negativa de salud entre trabajadores de la red municipal de salud de Diamantina, Minas Gerais, Brasil / Prevalence of negative self-rated health and associated factors among healthcare workers in a Southeast Brazilian city

Resumo Objetivo investigar a prevalência e os fatores associados à autoavaliação negativa de saúde entre trabalhadores da rede municipal de saúde de Diamantina, MG, Brasil. Métodos estudo transversal censitário, com emprego da regressão de Poisson. Resultados participaram 203 trabalhadores, 70,9% do sexo feminino e 57,1% com até 38 anos de idade; a prevalência de autoavaliação negativa de saúde foi de 28,6% (IC 95% 22,4%;34,8%); na análise múltipla, associaram-se ao desfecho a idade ≥39 anos (RP=1,56 - IC 95% 1,01;2,40), renda familiar mensal >3 salários mínimos (RP=0,63 - IC 95% 0,41;0,97), exercer outra atividade remunerada (RP=0,55 - IC 95% 0,34;0,89), baixa qualidade do sono (RP=1,99 - IC 95% 1,32;2,99), diagnóstico de morbidade (RP=2,33 - IC 95% 1,13;4,81) ou multimorbidades (RP=2,63 - IC 95% 1,32;5,24), ter sofrido agressão no trabalho (RP=1,92 - IC 95% 1,29;2,85) e participação frequente nas atividades domésticas (RP=0,55 - IC 95% 0,38;0,80). Conclusão a autoavaliação negativa da saúde teve prevalência elevada e associou-se a fatores sociodemográficos, ocupacionais, comportamentais e de situação de saúde.

Resumen Objetivo investigar la prevalencia de autoevaluación negativa de salud y factores asociados entre trabajadores del sistema municipal de salud de Diamantina, MG. Métodos estudio transversal censal por medio de la regresión de Poisson. Resultados entre 203 participantes, el 70,9% era de mujeres y el 57,1% tenía hasta 38 años de edad; la prevalencia de autoevaluación negativa de salud fue del 28,6% (IC 95% 22,4;34,8); a partir del análisis múltiple, se asoció el resultado a la edad de 39 años o superior (RP=1,56 - IC 95% 1,01;2,40), renta familiar mensual >3 salários mínimos (RP=0,63 - IC 95% 0,41;0,97), ejercer otras actividades remuneradas (RP=0,55 - IC 95% 0,34;0,89), mala calidad de sueño (RP=1,99 - IC 95% 1,32;2,99), diagnósticos de morbilidad (RP=2,33 - IC 95% 1,13;4,81) o multimorbilidades (RP=2,63 - IC 95% 1,32;5,24), agresión sufrida en el trabajo (RP=1,92 - IC 95% 1,29;2,85) y actividades domésticas frecuentes (RP=0,55 - IC 95% 0,38;0,80). Conclusión la prevalencia de la autoevaluación negativa de salud fue elevada y fue asociada a factores sociodemográficos, ocupacionales, conductuales y de salud.

Abstract Objective to investigate the prevalence of negative self-rated health and associated factors among municipal health service workers in Diamantina, MG, Brazil. Methods this was a cross-sectional census study using Poisson regression. Results 203 health workers took part in the study, 70.9% were female, and 57.1% were up to 38 years old; prevalence of negative self-rated health was 28.6% (95%CI22.4;34.8); in the multivariate analysis, the following were associated with the outcome: being 39 years old or more (PR=1.56 - 95%CI1.01;2.40), monthly family income >3 minimum wages (PR=0.63 - 95%CI0.41;0.97), having another paid occupation (PR=0.55 - 95%CI0.34;0.89), poor sleep quality (PR=1.99 - 95%CI1.32;2.99), diagnosis of one disease (PR=2.33 - 95%CI1.13;4.81) or multiple diseases (PR=2.63 - 95%CI1.32;5.24), suffering aggression at work (PR=1.92 - 95%CI1.29;2.85), and frequent participation in domestic activities (PR=0.55 - 95%CI0.38;0.80). Conclusion prevalence of negative self-rated health was high and was associated with sociodemographic, occupational, behavioral and health situation factors.

Propiedades psicométricas de la escala EMUN-AR determinadas mediante el análisis de Rasch / Psychometric variables of the EMUN-AR scale using Rasch analysis

Resumen Introducción. Las escalas de autorreporte se han considerado útiles para evaluar y vigilar los síntomas de la enfermedad maníaco-depresiva. Uno de estos instrumentos, la escala de medición de la enfermedad maníaco-depresiva mediante autorreporte (EMUN-AR), no se ha validado aún. Objetivo. Validar la escala EMUN-AR usando el modelo de Rasch. Materiales y métodos. La escala EMUN-AR mide 26 ítems que evalúan por dimensiones los síntomas de la enfermedad maníaco-depresiva en tres categorías: frecuencia, intensidad y grado de molestia causada. Para evaluar las propiedades psicométricas de la escala, se efectuaron análisis factoriales exploratorios con el fin de tener una aproximación de su estructura latente, y se usaron modelos de Rasch que incluyeron la 'unidimensionalidad', la confiabilidad, el ajuste de ítems, el ordenamiento de umbrales, y los mapas de personas e ítems. Resultados. Se seleccionó una muestra de 267 pacientes hospitalizados, 204 de los cuales había sufrido un episodio maníaco (76,4 %) y estaba recibiendo tratamiento farmacológico. Se encontró una estructura factorial que puede resumirse en cuatro dominios: activación, inhibición, ideas depresivas e inadaptación. El análisis de Rasch evidenció la unidimensionalidad en los factores, adecuados valores de confiabilidad, buen ajuste de los 26 ítems en general (excepto en el ítem que mide las ideas de muerte o suicidio), un funcionamiento deficiente del sistema de calificación de los ítems y un cubrimiento limitado de los síntomas de la enfermedad correspondientes a las formas atenuadas. Conclusión. Se modificó la escala original en dos aspectos: se ajustó un ítem cuyos indicadores marginales tenían mal ajuste y se redujo el número de categorías. En su forma actual, el instrumento es apropiado para medir las formas graves de la enfermedad maníaco-depresiva, mas no así las atenuadas.

Abstract Introduction: Self-report scales have been considered to be useful for evaluating and monitoring symptoms of manic-depressive illnesses. The EMUN-AR scale is one of such scales but it has not been validated. Objective: To validate the EMUN-AR scale using Rasch models. Materials and methods: The EMUN-AR scale measures 26 items to assess comprehensively symptoms of manic-depressive illnesses in three domains: Frequency, severity, and level of disturbance caused by the symptoms. To test the psychometric properties of this scale, we used the exploratory factorial and Rasch analyses. The Rasch analysis included unidimensionality, reliability, item fit, threshold ordering, and person-item maps. Results: The study included 267 hospitalized patients, most of them with a manic episode diagnosis (n=204, 76.4%), and receiving pharmacological treatment. The factor structure was summarized in four domains: Activation, inhibition, depressive ideation, and maladaptive behavior. The Rasch analysis supported unidimensionality of the EMUN-AR factors, satisfactory levels of reliability, and appropriate item fit, except for one of the items measuring death or suicidal thoughts. However, the scale did not measure adequately the mild forms of the illness given its redundant and unordered thresholds. Conclusion: The EMUN-AR was modified in two aspects: An item whose marginal indicators were poorly adjusted and the reduction in the number of categories. In its current form, the EMUN-AR is appropriate for measuring severe forms of the illnesses, but it does not adequately measure the mild forms of manic-depressive illnesses.

Bruxismo do sono: estudo de base populacional em pessoas com 18 anos ou mais na cidade de Rio Grande, Rio Grande do Sul / Sleep bruxism: population based study in people with 18 years or more in the city of Rio Grande, Brazil

RESUMO: Objetivos: Avaliar a prevalência do bruxismo do sono, bem como seus principais sinais e sintomas, na cidade de Rio Grande, Rio Grande do Sul. Avaliar a associação do bruxismo do sono com sexo, idade, escolaridade e estresse psicológico. Método: O estudo foi do tipo transversal. Uma amostra representativa da população (1.280 pessoas residentes na zona urbana da cidade com idade maior ou igual a 18 anos de idade) foi entrevistada. A avaliação do bruxismo do sono foi realizada por meio de questionário baseado nos critérios diagnósticos da Classificação Internacional de Distúrbios do Sono. Resultados: A prevalência de bruxismo do sono encontrada na população foi de 8,1% (intervalo de confiança de 95% - IC95% - 6,6 - 9,5). Entre os sinais e sintomas da disfunção utilizados para o diagnóstico de bruxismo do sono, o desgaste dentário (70,3%) e a dor nos músculos mastigatórios (44,5%) foram os mais frequentemente relatados pelas pessoas que declararam ranger os dentes durante o sono. Não houve diferença significativa na prevalência de bruxismo do sono entre os sexos. A faixa etária com mais de 40 anos teve maior prevalência de bruxismo do sono. A disfunção foi associada a um maior nível de escolaridade (razão de prevalência - RP = 1,92; IC95% 1,35 - 2,72) e de estresse psicológico (RP = 1,76; IC95% 1,11 - 2,81). Conclusão: O bruxismo do sono tem uma importante prevalência na população em geral, causando diversos danos ao sistema estomatognático. O estresse psicológico é um fator de risco para essa disfunção.

ABSTRACT: Objective: To evaluate the prevalence of sleep bruxism, as well as its principal signs and symptoms, in the city of Rio Grande. Evaluate the association of sleep bruxism with gender, age, education and psychological stress. Method: The study was cross-sectional type. A representative sample of the population (1280 people residing in the urban area of the city aged greater than or equal to 18 years old) were interviewed. The evaluation of sleep bruxism was by mean of questionnaire based on diagnostic criteria of the International Classification of Sleep Disorders. Results: The prevalence of sleep bruxism found in the population was 8,1% (confidence interval of 95% - 95%CI - 6,6 - 9,5). Among the signs and symptoms of dysfunction used for the diagnosis of sleep bruxism, tooth wear (70,3%) and pain in masticatory muscles (44,5%) were the most frequently reported by people who report teeth grinding during sleep. There was no significant difference in the prevalence of sleep bruxism between sexes. People older than 40 had a higher prevalence of sleep bruxism. The dysfunction was associated with a higher level of education (prevalence ratio - PR = 1.92; 95%CI 1,35 - 2,72) and psychological stress (PR 1,76; 95%CI 1,11 - 2,81). Conclusion: There was a significant prevalence of sleep bruxism in the general population, causing various damages to the Stomatognathic system. The psychological stress is a risk factor for this dysfunction.

Autopercepção negativa de saúde associada à violência escolar em adolescentes / Negative self-perceived health associated with school violence in adolescents

Resumo O objetivo deste artigo é verificar a associação entre autopercepção negativa em saúde e violência escolar em adolescentes estudantes do Município de Olinda - PE. Estudo transversal, analítico e de base escolar com amostra constituída por 2.614 adolescentes, selecionados por meio de uma estratégia de amostragem aleatória em conglomerados. As informações foram obtidas através do questionário "Youth Risk Behavior Survey" de onde foram retiradas as questões de violência bem como da autopercepção de saúde. Os dados foram tabulados pelo programa Epi-data versão 3.1 e transcrito para o SPSS versão 22. Utilizou-se os teste do Qui-quadrado e o modelo de regressão logística binária stepwise para análise dos dados. Observou-se que 26,7% dos adolescentes tinham uma autopercepção negativa em saúde, sendo maior entre as moças. Em relação à violência escolar, a autopercepção negativa esteve associada ao sentimento de tristeza, pensamento suicida, bullying na escola, roubado na escola e segurança na escola. Sexo e idade também se mantiveram associadas (p < 0.05). Reforça-se a necessidade de ações de cultura e paz na adolescência, envolvendo o ambiente escolar, a fim de refletir na analise de saúde pobre dos adolescentes reduzindo também o índice de violência.

Abstract Objective To verify the association between negative self-perception of health and school violence in adolescent students of the Municipality of Olinda (PE), Brazil. Methods This is a cross-sectional, analytical and school-based study with a sample consisting of 2,614 adolescents selected through a strategy of random sampling in conglomerates. The information was obtained through the questionnaire "Youth Risk Behavior Survey" from which the issues of violence and self-perceived health were retrieved. Data were tabulated by Epi-data version 3.1 program and transcribed for SPSS version 22. The Chi-square test and the stepwise binary logistic regression model were used for data analysis. Results We observed that 26.7% of adolescents had a negative self-perception of health, and this was greater among girls. Concerning school violence, negative self-perception was associated with feelings of sadness, suicidal thoughts, bullying at school, robbery at school and safety at school. Gender and age were also associated (p < 0.05). Conclusion We reinforce the need for culture and peace actions in adolescence, involving the school environment to reflect on poor health assessed by adolescents and reduce the rate of violence.

Condições pregressas e saúde no estudo "Saúde, Bem-Estar e Envelhecimento" (SABE) / Early life conditions and current health status as per the study "Health, Well-being and Aging" (SABE)

RESUMO: Introdução: Condições da infância podem influenciar peculiaridades individuais do desenvolvimento e assim afetar a saúde dos adultos. Objetivo: Avaliar associações entre condições pregressas e saúde, como informadas nas pesquisas SABE de 2000, de 2006 e de 2010. Métodos: Condições pregressas referem-se a situações anteriores aos 15 anos: a condição econômica, a fome, a avaliação da saúde, a presença de doenças e ter vivido em ambiente rural por mais de cinco anos. As variáveis de controle foram o sexo, a escolaridade e a renda. O desfecho é a autoavaliação da saúde nas categorias "Boa" e "Má". A análise abrangeu pessoas entre 60 e 65anos. Resultados: A análise bivariada mostrou associações segundo a origem nas três coortes. Foram ainda significantes a condição econômica e ter passado fome, para os entrevistados em 2006. Na análise multivariada pela regressão de Poisson, o elemento de comparação foi a razão de prevalência. Origem rural foi a única entre as condições pregressas a apresentar significância no modelo inicial. As variáveis de controle- sexo, coorte, escolaridade - também apresentaram significância. No modelo final, foram consideradas as variáveis significantes no inicial e uma interação entre origem rural e número de doenças. Permaneceram significantes a coorte, o sexo, a escolaridade e o número de doenças quando o indivíduo teve origem rural. Estenúmero não foi associado ao desfecho se a origem fosse urbana. Conclusão: Há conexões entre as condições pregressas e a saúde do idoso, o que constitui em importante instrumento para a atenção à saúde, tanto para o indivíduo como para a comunidade.

ABSTRACT: Introduction: Childhood conditions can influence some aspects of development of an individual and thus affect health in adult life. Objective: To evaluateassociations between early life conditions and health, as reported by the survey SABE in 2000, 2006, and 2010. Methods: Early or previous conditions refer to the situations before 15 years of age of the interviewees, such as economic condition, famine, health assessment, medical conditions, and having lived in the countryside for over 5 years. The control variables were gender, education, andincome. The outcome was self-reported health as "good" or "bad." This study focused on ages between 60 and 65years. Results: Bivariate analysis showed significant associations of the individual's origin in all the three cohorts. Economic and famine conditions were also significant for cohort B (2006). Multivariate Poisson regression was used with prevalence ratio as an element of comparison. Rural origin was the only significant early condition in the initial model. Thecontrol variables - gender, cohort, and education - were also significant. In the final model, the significant variables in the initial model were included, plus relation between rural origin and the number of diseases. Cohorts, gender, education, and the number of diseases were still significant factors when individuals had rural origin, but were not associated with the outcome if their origin was urban. Conclusion: There were connections between early conditions of life and the health of the elderly, and this might be an important tool for health care for both the individual and the community.

Individual and contextual factors associated to the self-perception of oral health in Brazilian adults

ABSTRACT OBJECTIVE To analyze how individual characteristics and the social context, together, are associated with self-perception of the oral health. METHODS A multilevel cross-sectional study with data from the Brazilian National Health Survey 2013, the United Nations Development Program, and the National Registry of Health Establishments. The explanatory variables for the "oral health perception" outcome were grouped, according to the study framework, into biological characteristics (sex, color, age), proximal social determinants (literacy, household crowding, and socioeconomic stratification), and distal (years of schooling expectancy at age 18, GINI, Human Development Index, and per capita income). The described analysis was performed, along with bivariate Poisson analysis and multilevel Poisson analysis for the construction of the explanatory model of oral health perception. All analyzes considered the sample weights. RESULTS Both the biological characteristics and the proximal and distal social determinants were associated with the perception of oral health in the bivariate analysis. A higher prevalence of bad oral health was associated to lower years of schooling expectancy (PR = 1.31), lower per capita income (PR = 1.45), higher income concentration (PR = 1.41), and worse human development (PR = 1.45). Inversely, oral health services in both primary and secondary care were negatively associated with oral health perception. All the biological and individual social characteristics, except reading and writing, made up the final explanatory model along with the distal social determinants of the Human Development Index and coverage of basic care in the multilevel analysis. CONCLUSIONS Biological factors, individual and contextual social determinants were associate synergistically with the population's perception of oral health. It is necessary to improve individual living conditions and the implementation of public social policies to improve the oral health of the population.

Analyzing Changes and Determinants of Self-rated Health during Adolescence: A Latent Growth Analysis

PURPOSE: The purpose of this study was to examine changes in the self-rated health of adolescents and to identify its predictors using longitudinal data from the KCYPS. METHODS: A sample of 2,351 adolescents who were in the first grade of middle school in 2010 was analyzed. The study employed latent growth analysis using data from 2010 to 2016. RESULTS: Results indicated that self-rated health of adolescents increased, following the form of a linear function. The analyses revealed that adolescent self-perception of health were conceptualized not only by their health-related behaviors, but also by personal, socioeconomic and psychological factors. Specifically, physical activity, passive leisure time activities, gender (initial: b=−.060, slope: b=.030), place of residence (initial: b=−.079), self-rated economic condition (b=.098), working status of mother (b=.016), monthly family income (b=−.001), aggression (b=.061), depression (initial: b=−.104, slope: b=.012), stress (initial: b=−.172, slope: b=.014, ego-resiliency (initial: b=.197, slope: b=−.021), and self-esteem (initial: b=.106, slope: b=−.017) had significant effects on the overall linear change of self-rated health (p < .05 for all estimators above). CONCLUSION: The findings of this study suggest that adolescents' self evaluation of their health is shaped by their total sense of functioning, which includes individual, health-related behavioral, socioeconomic, and psychological factors.

Subjective Health and Factors of Health-related Quality of Life in Elderly Haenyo

PURPOSE: To investigate the subjective health and health-related quality of life (HRQoL) in Haenyo. METHODS: Subjects were 100 elderly Haenyo in Jeju island who belonged to a fishing-village society. Main variables were activities of daily living (ADL), instrumental ADL (IADL), the HRQoL, subjective health, and depression. Subjective health and differences of HRQoL by variables were analyzed by t-test or ANOVA using IBM SPSS Statistics 23. Hierarchical multiple regression was executed to examine the effects of the major factors on the quality of life. RESULTS: The mean age was 69.9 years, the mean period for diving career was 51.5 years, and work hours per month were 37.8. Comorbidity of diseases was 2.74, and the common health problems were osteoporosis and headache/dizziness. HRQoL was significantly different by age (F=4.52, p=.013), education (F=6.10, p=.003), muljil work years (F=3.93, p=.050), depression (t=-3.04, p=.030), subjective health state (F=30.62, p < .01), and degenerative arthritis (F=-2.38, p=.019). In the final model by hierarchical multiple regression, ADL/IADL (β=.41, p < .001), depression (β=-.29, p < .001), and subjective health (β=.43~.51, p < .001) were significant and explained 63.5% of the total variance of HRQoL. CONCLUSION: Haenyo have specific health problems different from those of elderly women in general. ADL/IADL, depression and subjective health affected their HRQoL. It is clear that Haenyos' health problems need further study to improve their health.