Pain Patterns of the Temporomandibular Joint Dysfunction and Implications of Stress-Related Behaviors: A Pilot Study / Patrones de Dolor de la Disfunción de la Articulación Temporomandibular e Implicaciones de los Comportamientos Relacionados con el Estrés: Un Estudio Piloto

SUMMARY: Temporomandibular joint dysfunction interferes with the quality of life and activities of daily living among patients. The symptoms of temporomandibular dysfunction, including pain and clicking and popping sounds, are worsened during stressful events, and patients report increased pain around the temporomandibular joint. Stress-related behaviors, such as teeth clenching and teeth grinding, are commonly reported as increasing during stress. The prevalence of temporomandibular dysfunction and stress-related behaviors is reported differently in the literature. Stress in higher education is common. The purpose of this pilot study was to investigate the prevalence of temporomandibular joint dysfunction and stress-related behaviors among staff members at a local University. The study also sought to explore pain patterns described by people experiencing temporomandibular joint dysfunction and the relationship between stress-related behaviors and pain symptoms experienced. Further, the impact of stress on symptoms experienced by people with temporomandibular dysfunction was investigated in this pilot study.

La disfunción de la articulación temporomandibular interfiere con la calidad de vida y las actividades de la vida diaria entre los pacientes. Los síntomas de la disfunción temporomandibular, incluidos el dolor y los chasquidos, empeoran durante los eventos estresantes, y los pacientes informan un aumento del dolor alrededor de la articulación temporomandibular. Los comportamientos relacionados con el estrés, como apretar y rechinar los dientes, suelen aumentar durante el estrés. La prevalencia de la disfunción temporomandibular y los comportamientos relacionados con el estrés se informa de manera diferente en la literatura. El estrés en la educación superior es común. El propósito de este estudio piloto fue investigar la prevalencia de la disfunción de la articulación temporomandibular y los comportamientos relacionados con el estrés entre los miembros del personal de una universidad local. El objetivo del estudio además fue explorar los patrones de dolor descritos por personas que experimentan disfunción de la articulación temporomandibular y la relación entre los comportamientos relacionados con el estrés y los síntomas de dolor experimentados. Además, en este estudio piloto se investigó el impacto del estrés en los síntomas que experimentan las personas con disfunción temporomandibular.

Influence of foot pain on frailty symptoms in an elderly population: a case-control study

ABSTRACT BACKGROUND: Frailty is a condition that can increase the risk of falls. In addition, foot disorders can negatively influence elderly people, thus affecting their condition of frailty. OBJECTIVE: To determine whether foot pain can influence a greater degree of frailty. DESIGN AND SETTING: Cross-sectional descriptive study conducted at the University of Valencia, Valencia, Spain. METHODS: A sample older than 60 years (n = 52), including 26 healthy subjects and 26 foot pain patients, was recruited. Frailty disability was measured using the 5-Frailty scale and the Edmonton Frailty scale (EFS). RESULTS: There were statistically significant differences in the total EFS score and in most of its subscales, according to the Mann-Whitney U test (P < 0.05). In addition, foot pain patients presented worse scores (higher 5-Frailty scores) than did healthy patients, regarding matched-paired subjects (lower EFS scores). With regard to the rest of the measurements, there were no statistically significant differences (P > 0.05). The highest scores (P < 0.001) were for fatigue on the 5-Frailty scale and the EFS, and for the subscale of independence function in EFS. CONCLUSIONS: These elderly patients presented impairment relating to ambulation and total 5-Frailty score, which seemed to be linked to the presence of frailty syndrome and foot disorders.

Ergonomía en cirugía laparoscópica ginecológica / Ergonomics and gynecologic laparoscopic surgery

INTRODUCCIÓN Y OBJETIVOS: Están demostradas las ventajas de la cirugía laparoscópica para el paciente en términos de dolor, rápida recuperación y precisión quirúrgica, sin embargo, no existen estudios nacionales respecto al impacto en los cirujanos. El objetivo de este trabajo es realizar un estudio prospectivo de evaluación ergonómica de ginecólogos que operan cirugía laparoscópica. MÉTODOS: Se utilizaron métodos de evaluación específica por ergónomo experto y percepción de los participantes. Se evaluaron, carga global de trabajo (NASA-tlx), carga bio-mecánica (REBA) y la percepción de molestias músculo-esqueléticas (Escala de Discomfort Corporal). Se recogieron datos personales y de la cirugía, para explorar la existencia de dificultades técnicas. RESULTADOS: 86,7% de los ginecólogos evidenciaron altos niveles de carga global de trabajo, siendo las variables esfuerzo y rendimiento, las de mayor puntaje. El nivel de riesgo bio-mecánico, fue catalogado como medio en la totalidad de la población. 60% manifestó discomfort corporal durante la cirugía. En cuanto a las dificultades técnicas, el efecto fulcrum estuvo presente en el 46% de los cirujanos, el mismo porcentaje tuvo síntomas de ojo seco. El 68% alguna vez accionó el pedal equivocado y ha sentido parestesia del pulgar. CONCLUSIONES: La cirugía laparoscópica ginecológica, presenta una elevada carga global de trabajo. El ginecólogo percibe un importante discomfort corporal y algunas dificultades técnicas. Es necesario incorporar medidas ergonómicas, para minimizar y/o disminuir los factores de riesgo mental y físicos, y así prevenir el desgaste precoz y lesiones a futuro en los cirujanos.

INTRODUCTION AND OBJECTIVES: Laparoscopic surgery had demonstrated advantages such as less pain, rapid recovery and surgical precision. There are no national data regarding the impact on surgeon's health. This is a prospective study on ergonomic evaluation and laparoscopic surgery performed by gynecologists. METHODS: Specific evaluation methods were used such as Global workload (NASA-tlx), bio-mechanical load (REBA) and the perception of musculoskeletal discomfort (Body Part Discomfort Scale). Personal opinions and surgery data were collected to explore the existence of technical difficulties. RESULTS: 86.7% of gynecologists cataloged surgery as high level of global workload. Effort and performance variables were most important. Bio-mechanical risk level was classified as medium in the entire population. 60% showed body discomfort during surgery. Regarding technical difficulties, fulcrum effect was present in 46% of surgeons, the same percentage had dry eye symptoms. 68% have a pedal error activation during surgery and felt paresthesia of the thumb. CONCLUSIONS: Gynecological laparoscopic surgery has a high overall workload. The gynecologist perceives an important body discomfort and some technical difficulties. It is necessary to incorporate ergonomic measures, to minimize and / or reduce mental and physical risk factors, and thus prevent early wear and future injuries in surgeons.

Neonatal pain: characterization of the physiotherapist's perception in the neonatal intensive care unit / Dor neonatal: caracterização da percepção do fisioterapeuta na unidade de terapia intensiva neonatal

ABSTRACT Objective: To describe the perception of physiotherapists in neonatal units regarding pain, the use of measurement scales and strategies that minimize pain. Methods: Interviews were conducted with physiotherapists in hospitals with neonatal units between 2013 and 2015 in Rio de Janeiro. The questions concerned the knowledge of the feeling of pain, from its recognition to its care or treatment. The description of the results was done by comparing public and private hospitals (Fisher''s Exact exact Testtest), considering p<0.05 as significant. Results: 27 hospitals were visited. All the professionals interviewed (n=27) stated that the newborns feel pain, with facial expression being the most cited and known sign for pain. 26% of physiotherapists believe that newborns experience pain at the same magnitude as adults. Among the scales, the Neonatal Infant Pain Scale (NIPS) was the most well known, but only 37% of the units had routine pain assessment protocols. IV cannulation and blood collection were the most mentioned procedures as a cause of pain and there was no difference between public and private hospitals. Conclusions: There is a gap in the knowledge about neonatal pain and how to evaluate it among the participating physiotherapists, with no systematization of care routines involving this assessment.

RESUMO Objetivo: Descrever a percepção dos fisioterapeutas de unidades neonatais sobre a dor, a utilização de escalas de mensuração e estratégias que a minimizem. Métodos: Entrevistas foram realizadas com chefes ou rotinas de fisioterapia em hospitais com unidades neonatais entre 2013 e 2015, no Rio de Janeiro. As perguntas versaram sobre o conhecimento da sensação dolorosa, desde seu reconhecimento até seu cuidado ou tratamento. Foi realizada a descrição dos resultados, comparando-se os dados dos hospitais públicos com os privados (teste exato de Fisher), considerando-se p<0,05 como significante. Resultados: Vinte e sete hospitais foram visitados. Todos os profissionais entrevistados (n=27) afirmaram que os recém-nascidos sentem dor, sendo a expressão facial o sinal de dor mais conhecido. Do total de fisioterapeutas entrevistados, 26% acreditam que os neonatos sentem dor na mesma magnitude que o adulto. Entre as escalas, a Neonatal Infant Pain Scale (NIPS) era a mais conhecida, e apenas 37% das unidades possuíam protocolos de avaliação da dor na rotina. As coletas e as punções foram os procedimentos mais mencionados como causa de dor, e não houve diferença entre os hospitais públicos e privados. Conclusões: Constatou-se uma lacuna no conhecimento sobre dor neonatal e como avaliá-la entre os fisioterapeutas participantes, com ausência de sistematização de rotinas assistenciais que envolvam essa aferição.

Peripheral nerve block and rebound pain: literature review / Bloqueio de nervos periféricos e dor rebote: revisão de literatura

Abstract Background and objectives: To investigate, describe, and assess the phenomenon of "rebound pain" as a clinically relevant problem in anesthetic practice. Content: The phenomenon of "rebound pain" has been demonstrated and described as a very severe pain, which occurs after a peripheral nerve block resolution with the recovery of sensitivity. The incidence of rebound pain is unknown. Usually, it occurs between 12 and 24 hours after surgery and, adversely affecting sleep quality. It is not yet possible to establish a mechanism as a definitive cause or trigger factor of rebound pain. Studies suggest that rebound pain is a side effect of peripheral nerve blocks, despite their effectiveness in pain control. Currently, the extent and clinical significance of rebound pain cannot be well determined due to the lack of large prospective studies. Conclusion: Rebound pain assessment should always be considered in clinical practice, as it is not a rare side effect of peripheral nerve blocks. There are still many challenging questions to be answered about rebound pain, so large prospective studies are needed to address the issue. For prevention, the use of peripheral nerve block techniques that avoid nerve damage and adequate perioperative analgesia associated with patient education on the early administration of analgesics, even during the period of analgesia provided by peripheral nerve block, is recommended. A better understanding of the "rebound pain" phenomenon, its pathophysiology, associated risk factors, and long-term consequences may help in developing more effective preventive strategies.

Resumo Justificativa e objetivos: Investigar, descrever e avaliar o fenômeno da "dor rebote" como um problema clinicamente relevante na prática anestésica. Conteúdo: O fenômeno da "dor rebote" foi demonstrado e descrito como uma dor muito intensa que ocorre após a resolução do bloqueio de nervo periférico com o retorno da sensibilidade. A incidência de dor rebote é desconhecida. Normalmente ela ocorre entre 12 a 24 horas após a cirurgia e afeta negativamente a qualidade do sono. Ainda não é possível estabelecer um mecanismo como causa definitiva ou fator desencadeante da dor rebote. Estudos sugerem que a dor rebote seja um efeito colateral dos bloqueios de nervos periféricos, apesar destes terem eficácia no controle álgico. Atualmente, a extensão e a significância clínica da dor rebote não podem ser bem determinadas, devido à falta de grandes estudos prospectivos. Conclusão: A avaliação da dor rebote deve ser sempre considerada na prática clínica, pois não é um efeito colateral raro dos bloqueios de nervo periféricos. Ainda existem muitas questões desafiadoras a serem respondidas sobre a dor rebote, portanto fazem-se necessários amplos estudos prospectivos sobre a temática. Para a sua prevenção recomenda-se o uso de técnicas de bloqueio de nervo periférico que evitem a lesão do nervo e uma adequada analgesia perioperatória associada à orientação do paciente sobre a administração precoce de analgésicos mesmo na vigência da analgesia proporcionada pelo bloqueio de nervo periférico. A melhor compreensão do fenômeno "dor rebote", sua fisiopatologia, seus fatores de risco associados e suas consequências em longo prazo poderá ajudar na elaboração de estratégias preventivas mais eficazes.

Prevalencia de dolor en la internación en un hospital de alta complejidad de Argentina / Prevalence of pain among patients admitted to a clinical hospital

Background: Pain prevalence during hospital admission is variable, with estimates ranging from 32 to 77%. Aim: To determine pain prevalence during admission to a clinical hospital. Material and Methods: Patients admitted to medical and surgical wards were interrogated about the presence of pain within 48 to 72 hours after admission. Subjective pain was analyzed using a scale ranging from 0 to 10. Data was analyzed separately for medical, surgical, and obstetrical patients. Results: A total of 736 patients aged 18 to 94 years (416 women) were recruited. Pain prevalence at 48 hours after admission was 56% (95% confidence intervals (CI (52.7 to 60.1). Pain prevalence in medical, surgical and obstetric patients was 37% (95% CI 31.4 to 42.1), 70% (95% CI 64.5 to 75.5) and 77% (95% CI 68.6 to 84), respectively. The median pain intensities in medical, surgical, and obstetrical patients were 7 (interquartile range (IQR) 6-8), 7 (IQR 5-8) y 7 (IQR 5-8), respectively. Conclusions: The prevalence of pain among patients admitted to the hospital is high, especially in obstetric and surgical units.

A experiência da dor em bailarinas clássicas: significados emergentes num estudo qualitativo / The experience of pain among classical dance ballerinas: meanings derived from a qualitative study

Resumo Este artigo apresenta os resultados de um estudo centrado no significado que a dor assume no discurso de um grupo de bailarinas de dança clássica. Para tal acedemos às suas experiências e vivências através de uma entrevista semiestruturada de forma a entender a dor que faz parte suas rotinas antes, durante e após estarem a dançar. O estudo sustenta-se nos discursos que emergiram num grupo de dez bailarinas, com mais de seis anos de formação, e o método para aceder aos significados providenciados pelas suas vozes foi a "Grounded Analysis" ou Análise Sustentada nos Dados. A análise dos discursos recolhidos revelou que o evoluir no percurso da dança implica dificuldades que aumentam as exigências experienciadas pelas bailarinas, paralelamente ao desejo de querer permanecer no mundo do espetáculo. Assim são os treinos excessivos e os movimentos repetitivos que fazem surgir a dor e as lesões, que são ocultadas, negadas, de modo a poder continuar no foco de querer alcançar a perfeição. Em geral, os resultados obtidos salientam a paixão pela dança que configura a dor como aliada desta prática, e obriga as bailarinas a várias estratégias de confronto. Paralelamente, a dor liga-se ao medo da lesão, ao fim do percurso como bailarina e ao abdicar de um sonho.

Abstract This article presents the results of a study focused on the meaning that pain assumes in the discourse of a group of classical dance ballerinas. To achieve this, we accessed their experiences and perceptions through a semi-structured interview, to better understand the pain that is an integral part of their routines before, during and after a performance. This study is based on the discourses which emerged from a group of ten ballerinas with six or more years of training, and the method chosen to tap into the underlying meanings was Grounded Analysis or Sustained Data Analysis. The analysis of the discourses collected revealed that pursuing a dancing career involves obstacles that increase the demands felt by the ballerinas, in parallel with their desire to remain in the world of performance. Thus, it is the excessive practicing and repetitive movements which give rise to pain and injuries, which are concealed and denied so as not to impede the focus of attaining perfection. In general, the results obtained emphasize the passion for dance that involves pain as an ally to this career and force the ballerinas to varied confrontation strategies. In tandem, pain is linked to fear of injury, to the end of a career as a ballerina and the relinquishment of a dream.

Dor, ansiedade e qualidade de vida relacionada à saúde bucal de pacientes atendidos no serviço de urgência odontológica / Pain, anxiety and quality of life related to the oral health of patients treated in a dental emergency clinic

Resumo O objetivo deste estudo foi avaliar associação entre dor pré-operatória, ansiedade e impacto da condição bucal na qualidade de vida dos pacientes atendidos no serviço de Urgência Odontológica da Universidade Federal dos Vales do Jequitinhonha e Mucuri. Estudo transversal retrospectivo foi conduzido avaliando dados clínicos de 240 prontuários de pacientes com idades entre 18 e 65 anos. A dor foi mensurada pela Heft-Parker Visual Analogue Scale; ansiedade, pela Corah's Detal Anxiety Scale e qualidade de vida, pelo Oral Health Impact Profile (OHIP-14). Associações foram analisadas pelo Teste qui-quadrado de Pearson (p < 0,05). Foi observada associação estatisticamente significante entre dor e pior qualidade de vida, com impacto nos domínios desconforto psicológico (p < 0,001), incapacidade física (p < 0,001), psicológica (p < 0,001) e social (p < 0,001). Ansiedade influenciou na pior qualidade de vida, com impacto nos domínios desconforto psicológico (p = 0,009), incapacidade fisica (p = 0,016), psicológica (p = 0,011) e desvantagem social (p = 0,028). Esse estudo é relevante para o planejamento de ações voltadas para a saúde bucal dos pacientes atendidos nos serviços de urgência odontológica, priorizando aqueles com maiores impactos psicossociais decorrentes dos problemas bucais.

Abstract The scope of this study was to assess the association between preoperative pain, anxiety and the impact of the oral condition on the quality of life of patients treated at the Dental Emergency Service at the Federal University of the Jequitinhonha and Mucuri Valleys. A retrospective cross-sectional study was conducted evaluating data from 240 patient charts aged from 18 to 65 years. Pain was measured by the Heft-Parker Visual Analog Scale; dental anxiety by Corah's Dental Anxiety Scale; and oral health-related quality of life by the Oral Health Impact Profile (OHIP-14). Associations were analyzed using Pearson's Chi-square test (p < 0.05). A statistically significant association was observed between pain and poorer quality of life, with impacts on psychological discomfort (p < 0.001), physical incapacity (p < 0.001) and the psychological (p < 0.001) and social (p < 0.001) domains. Anxiety influenced poorer quality of life, with impacts on the psychological discomfort (p = 0.009), physical disability (p = 0.016), psychological disability (p = 0.011) and social disadvantage (p = 0.028) domains. This study is relevant for the planning of programs and actions aimed at the oral health of patients treated in dental emergency services, prioritizing those with the greatest psychosocial impact arising from oral problems.

Prevalencia de artrosis de rodilla en una muestra aleatoria poblacional en personas de 40 y más años de edad / Prevalence of knee osteoarthritis in a random population sample in people aged 40 and over

Resumen Introducción: La artrosis es la enfermedad osteoarticular con mayor prevalencia en todo el mundo. En los países industrializados, 80 % de la población > 65 años la padece. Objetivos: Determinar la prevalencia de artrosis sintomática en rodilla en una muestra aleatoria poblacional, las variables asociadas y su repercusión en el dolor y funcionalidad. Método: Análisis descriptivo y multivariado de regresión logística realizado en el Centro de Salud de Cambre, A Coruña. Se incluyó una muestra de 707 pacientes. Se estudiaron variables antropométricas, comorbilidad y exploración clínica de rodillas. Para evaluar el dolor y la funcionalidad se utilizaron los cuestionarios validados WOMAC y Lequesne. Resultados: 56.3 % de los pacientes eran mujeres y la media de edad de 61.75 años. La prevalencia de artrosis sintomática en al menos una rodilla fue de 29.3 %. Las personas con artrosis presentaron puntuaciones más altas en las dimensiones dolor, rigidez y capacidad funcional del cuestionario WOMAC (30 ± 35.7, 33.8 ± 40.5 y 25.4 ± 40.1, respectivamente), así como puntuaciones más altas en el cuestionario de Lequesne (9.0 ± 8.8). Conclusiones: Se ha determinado alta prevalencia de personas con artrosis que se modifica con el sexo, la edad y el índice de masa corporal.

Abstract Introduction: Osteoarthritis is the osteoarticular disease with the highest prevalence worldwide. In industrialized countries, 80% of the population > 65 years suffers from it. Objectives: To determine the prevalence of symptomatic osteoarthritis of the knee in a random population sample, its associated variables and its impact on pain and functionality. Methods: Descriptive and multivariate logistic regression analysis carried out at the Cambre Health Center, A Coruña. A sample of 707 patients was included. Anthropometric variables, comorbidity and clinical examination of the knees were assessed. The validated WOMAC and Lequesne questionnaires were used to assess pain and functionality. Results: 56.3% of the patients were females, and mean age was 61.75 years. The prevalence of symptomatic osteoarthritis in at least one knee was 29.3%. People with osteoarthritis had higher scores in the pain, stiffness and functional capacity dimensions of the WOMAC questionnaire (30.0 ± 35.7, 33.8 ± 40.5 and 25.4 ± 40.1, respectively) and had higher scores in the Lequesne questionnaire as well (9.0 ± 8.8). Conclusions: A high prevalence of people with osteoarthritis has been determined, which is modified with gender, age and body mass index.

A Saúde bucal está associada à presença de sintomas depressivos em idosos? / Is oral health associated with the presence of depressive symptoms among the elderly?

Resumo O objetivo do estudo foi descrever a prevalência de sintomas depressivos medidos por meio da Escala de Depressão Geriátrica-EDG - 15 e testar a associação de variáveis de saúde bucal com sintomas depressivos em uma população de idosos vinculados a onze unidades de saúde da família do Sul do Brasil. Estudo transversal com 439 idosos. Foi utilizado questionário padronizado para a obtenção das variáveis socioeconômicas e de saúde bucal. As variáveis clínicas de saúde bucal foram obtidas por um dentista treinado. Os sintomas depressivos desfecho do estudo foram obtidos por meio da Escala de Depressão Geriátrica-EDG - 15. A prevalência dos sintomas depressivos foi de 18,3% (IC95% 14,6-21,8). Analisando as variáveis de exposição e os sintomas depressivos, por meio da análise regressão de Poisson ajustada, os indivíduos com 1 a 9 dentes (RP = 1,68; IC95%1,06-2,64, p = 0,012), com percepção de boca seca (RP = 2,23; IC95%1,52-3,28, p < 0,001) e de dor na boca (RP = 2,11; IC95% 1,10-4,07, p = 0,036) tiveram maiores prevalências de sintomas depressivos. O estudo identificou uma prevalência importante de sintomas depressivos e que as variáveis de saúde bucal estão associadas à presença dos mesmos na população idosa.

Abstract The scope of this study was to describe the prevalence of depressive symptoms measured by the Geriatric Depression Scale-EDG - 15 and test the association of oral health variables and depressive symptoms in a population of the elderly linked to eleven Family Health Units in the south of Brazil. It involved a cross-sectional study with 439 elderly individuals. A standardized questionnaire was used to obtain socio-economic and oral health variables of the study. The clinical variables of oral health were obtained by a qualified dentist. The symptoms of depression, which was the scope of the study, were obtained by the Geriatric Depression Scale-EDG −15. The prevalence of depressive symptoms was 18.3% (CI95% 14.6-21.8). Analyzing the exposure variables and depressive symptoms through adjusted Poisson regression analysis, individuals with 1 to 9 teeth (PR = 1.68; CI95% 1.06-2.64, p = 0.012), with a perception of dry mouth (PR = 2.23; CI95% 1.52-3.28, p < 0.001) and perception of pain in the mouth (PR = 2.11; CI95% 1.10-4.07, p = 0.036) have a higher prevalence of depressive symptoms. The study identified a significant prevalence of depressive symptoms and that oral health variables are associated with the presence of depressive symptoms in the elderly population.

Qualidade de vida e níveis de atividade física de moradores de residências terapêuticas do sul do Brasil / Quality of life and levels of physical activity of residents living in therapeutic residential care facilities in Southern Brazil

Resumo O interesse na qualidade de vida de pessoas com transtornos mentais moradores de residências terapêuticas é um importante indicador para a avaliação da intervenção terapêutica na área da saúde. A atividade física pode contribuir para uma boa qualidade de vida. Avaliamos a qualidade de vida e os níveis de atividade física em moradores das residências terapêuticas da grande Porto Alegre. Estudo de série de casos (n = 68), tendo como instrumentos SF-36, EuroQol, IPAQ e questões sociodemográficas. Os resultados obtidos pelo SF-36 demonstraram que o domínio do estado geral de saúde foi o menor (57,47 ± 14,27). Os maiores scores encontrados foram nos aspectos sociais (77,39 ± 20,21) e nos físicos (77,57 ± 39,71). Ao menos um problema (moderado ou extremo), em no mínimo uma dimensão, foi evidenciado em 82% dos moradores por meio do EuroQol. Os níveis de atividade física mostraram que a maioria dos moradores são insuficientemente ativos (48,5%) e 14,7% sedentários. Os domínios dor e mobilidade sugerem que os moradores não são incentivados suficientemente à atividade física. Conhecer a percepção da qualidade de vida dos moradores das residências terapêuticas é fundamental para estabelecer políticas públicas eficazes.

Abstract Interest in the quality of life of people with mental disorders living in therapeutic residential care facilities is an important indicator for the evaluation of therapeutic interventions in the area of health. Physical activity can contribute to a good quality of life. This study evaluated the quality of life and levels of physical activity of people living in therapeutic residential care facilities in the metropolitan area of Porto Alegre. This case series study (n = 68) used SF-36, EuroQol and IPAQ and social-demographic questions. The SF-36 results showed that the domain of general health received the lowest scores (57.47 ± 14.27). The highest scores were in terms of social aspects (77.39 ± 20.21) and physical aspects (77.57 ± 39.71). When using EuroQol, at least one problem (mild or extreme) in at least one dimension was evident among 82% of the residents. The physical activity levels showed that most of the participants were insufficiently active (48.5%) and 14.7% were sedentary. The domains of pain and mobility suggested that the residents were not being encouraged enough to perform physical activities. Knowledge about the perceptions of those living in therapeutic residential care facilities is critical in order to establish effective public policies.

Quality of life in adults with sickle cell disease: an integrative review of the literature / Cualidad de vida en adultos con enfermedad falciforme: revisión integradora de la literatura / Qualidade de vida em adultos com doença falciforme: revisão integrativa da literatura

ABSTRACT Objective: To identify the available evidence in the literature on health-related quality of life in adults with sickle cell disease. Method: integrative review of MEDLINE, CUMED, LILACS and SciELO databases, from articles developed in this area, published between 2005 and 2015, in English, Portuguese or Spanish. Results: 22 articles were included, six scales were used to evaluate health-related quality of life scores: three generic and three specific. No specific scale for adults with sickle cell disease has been adapted to Brazilian Portuguese so far. Patients affected by frequent painful crises, with low adherence to treatment, had a compromised quality of life. Conclusion: Selected studies have shown that patients with sickle cell disease have worse scores than the general population. These indicators should be instrumental to the nurse in the proposal of interventions and strategies of assistance and socio-educational, with a view to improving the quality of life of this clientele.

RESUMEN Objetivo: Identificar las evidencias disponibles en la literatura sobre cualidad de vida relacionada a la salud en adultos con enfermedad falciforme. Método: revisión integradora en las bases de datos MEDLINE,CUMED,LILACS y SciELO, de artículos provenientes de estudios desarrollados en esta temática, publicados entre 2005 y 2015, en inglés, portugués o español. Resultados: fueron incluidos 22 artículos, siendo utilizadas seis escalas para evaluar las puntuaciones de cualidad de vida relacionada a la salud: tres genéricas y tres específicas. Ninguna escala específica para adultos con enfermedad falciforme fue adaptada para el portugués brasileño hasta el momento. Pacientes acometidos por crisis dolorosas frecuentes, con baja adhesión al tratamiento, presentaron comprometimiento de la cualidad de vida. Conclusión: Los estudios seleccionados evidenciaron que los pacientes con enfermedad falciforme tienen peores puntuaciones que la población en general. Esos indicadores deberían instrumentalizar el enfermero en la proposición de intervenciones y estrategias asistenciales y socioeducativas, con vistas a mejorar la cualidad de vida de esta clientela.

RESUMO Objetivo: Identificar as evidências disponíveis na literatura sobre qualidade de vida relacionada à saúde em adultos com doença falciforme. Método: revisão integrativa nas bases de dados MEDLINE, CUMED, LILACS e SciELO, de artigos provenientes de estudos desenvolvidos nesta temática, publicados entre 2005 a 2015, em inglês, português ou espanhol. Resultados: foram incluídos 22 artigos, sendo utilizadas seis escalas para avaliar os escores de qualidade de vida relacionada à saúde: três genéricas e três específicas. Nenhuma escala específica para adultos com doença falciforme foi adaptada para o português brasileiro até o momento. Pacientes acometidos por crises dolorosas frequentes, com baixa adesão ao tratamento, apresentaram comprometimento da qualidade de vida. Conclusão: Os estudos selecionados evidenciaram que os pacientes com doença falciforme têm piores escores do que a população em geral. Esses indicadores deveriam instrumentalizar o enfermeiro na proposição de intervenções e estratégias assistenciais e socioeducativas, com vistas a melhorar a qualidade de vida desta clientela.

Dolor en niños y adolescentes hospitalizados en un centro de referencia / Pain in children and adolescents hospitalized in a center of reference

Resumen: Introducción: La evaluación y tratamiento del dolor en niños hospitalizados, continúa siendo un importante problema de salud. Objetivo: Conocer la prevalencia, características y prácticas de abor daje del dolor en niños y adolescentes hospitalizados en salas de cuidados moderados del Hospital Pediátrico, Centro Hospitalario Pereira Rossell (HP-CHPR), centro de referencia en Uruguay. Pa cientes y Método: Estudio transversal, mediante encuesta y revisión de historias clínicas el 13/09/16. Se incluyeron todos los menores de 19 años hospitalizados. Variables: edad, sexo, motivo de ingreso, presencia de trastorno cognitivo, prevalencia de dolor en algún momento de la hospitalización, en las últimas 24 h y durante la entrevista, causa de máximo dolor, intensidad, tratamiento farmacológico y no farmacológico. Resultados: se incluyó 97,4% (152/156) de los niños hospitalizados. Prevalencia de dolor en algún momento de la hospitalización: 51,3% (78/152; IC 95%: 43,2-59,3); en las 24 h previas: 39,5% (60/152; IC 95%: 31,7- 47,2); durante la entrevista: 15,8% (24/152; IC 95%: 10 - 21,5). Intensidad: leve 13/24, moderado-severo 11/24. Máximo dolor referido en internación: punciones con agujas 48,5% (38/78). Tenían alguna indicación analgésica 47,3%. Inadecuado intervalo inter dosis: 45,8% de las prescripciones; dosis adecuada 98,9%; vía de administración intravenosa: 43,7%; tenía contraindicación a la vía oral: 40,5%. Conclusiones: de los niños y adolescentes hospitalizados, 39,5% reportó dolor en las 24 h previas a la entrevista y 15,8% durante la misma. El máximo dolor referido durante la hospitalización se debió a punciones con agujas. Se continúa detectando niños con dolor con prescripciones analgésicas inadecuadas.

Abstract: Introduction: The evaluation and treatment of pain in hospitalized is still an important health pro blem. Objective: To know the prevalence, characteristics and approaches to pain management in children and adolescents hospitalized in the Pediatric Hospital of the Pereira Rossell Center (HP-CH- PR), a pediatric reference center in Uruguay. Patients and Method: Cross-sectional study, through survey and review of clinical records on 09/13/16. All hospitalized children under the age of 19 were included. Variables: age, gender, reason for admission, presence of cognitive disorder, the prevalen ce of pain at some time during hospitalization, in the last 24 hours and during the interview, cause of maximum pain, intensity, pharmacological and non-pharmacological treatment. Results: 97.4% (152/156) hospitalized children were included. Pain prevalence at some point during hospitalization: 51.3% (78/152, 95% CI: 43.2-59.3); in the previous 24 hours: 39.5% (60/152, 95% CI: 31.7-47.2); during the interview: 15.8% (24/152, 95% CI: 10-21.5). Intensity: mild 13/24, moderate-severe 11/24. Maximum pain referred during hospitalization: needle punctures 48.5% (38/78). They had some analgesic prescription 47.3% of them had some analgesic prescription. Inadequate interdose inter val: 45.8%; adequate dose 98.9%; intravenous administration: 43.7%; contraindication to oral route: 40.5%. Conclusions: Regarding children and adolescents hospitalized, 39.5% reported pain 24 hours before being the interviewed and 15.8% reported pain during the interview. The maximum pain reported during hospitalization was due to needle punctures. Children in pain with inappropriate analgesic prescriptions are still detected.

Desconfortos associados às cirurgias de extração dentária e construção de instrumento de medida (QCirDental). Parte I: impactos e consistência interna / Discomfort associated with dental extraction surgery and development of a questionnaire (QCirDental). Part I: Impacts and internal consistency

Resumo O estudo objetivou criar um instrumento de medida que pudesse quantificar os desconfortos associados ao procedimento cirúrgico de pacientes submetidos a cirurgias dento-alveolares (QCirDental). O instrumento QCirDental foi desenvolvido em duas etapas iniciais: (1) geração e seleção das perguntas ou itens e, (2) teste do instrumento com avaliação das propriedades de medida (consistência interna e responsividade). A amostra foi composta por 123 pacientes. Nenhum deles apresentou qualquer dificuldade em entender o QCirDental. O instrumento mostrou excelente consistência interna com coeficiente alfa de Cronbach de 0,83. A análise de componentes principais (Kaiser-Meyer-Olkin Measure of Sampling Adequacy 0,72 e Bartlett's Test of Sphericity com p < 0,001) mostrou seis (6) dimensões do instrumento que explicam 67,5% da variância. O QCirDental possui excelente consistência interna, sendo um instrumento de fácil leitura e interpretação compatível com uma adequada validade semântica e de conteúdo. Mais de 80% dos pacientes submetidos a extrações dentárias de rotina odontológica apresentam algum desconforto ou incomodo no período transoperatório o que ressalta a necessidade de utilização de um instrumento para avaliação de cuidados.

Abstract The scope of this study was to develop and validate a questionnaire (QCirDental) to measure the impacts associated with dental extraction surgery. The QCirDental questionnaire was developed in two steps; (1) question and item generation and selection, and (2) pretest of the questionnaire with evaluation of the its measurement properties (internal consistency and responsiveness). The sample was composed of 123 patients. None of the patients had any difficulty in understanding the QCirDental. The instrument was found to have excellent internal consistency with Cronbach's alpha reliability coefficient of 0.83. The principal component analysis (Kaiser-Meyer-Olkin Measure of Sampling Adequacy 0,72 and Bartlett's Test of Sphericity with p < 0.001) showed six (6) dimensions explaining 67.5% of the variance. The QCirDental presented excellent internal consistency, being a questionnaire that is easy to read and understand with adequate semantic and content validity. More than 80% of the patients who underwent dental extraction reported some degree of discomfort within the perioperative period which highlights the necessity to assess the quality of care and impacts of dental extraction surgery.

Problemas de sono em idosos estão associados a sexo feminino, dor e incontinência urinária / Sleep disturbances in older adults are associated to female sex, pain and urinary incontinence

RESUMO: Objetivos: A prevalência de problemas de sono em idosos, como insônia, é uma questão relevante em nossa sociedade. A má qualidade do sono, por exemplo, é vista por muitos como um resultado inevitável do envelhecimento. Neste contexto, este estudo teve como objetivo estimar a prevalência e os fatores associados a distúrbios do sono em homens e mulheres idosos (60 anos ou mais). Métodos: O presente trabalho é parte do estudo de coorte Saúde, Bem-Estar e Envelhecimento (SABE), realizado em São Paulo, Brasil. A amostra deste estudo transversal constituiu-se de 1.334 idosos com 60 anos ou mais. Os distúrbios foram avaliados com base nas respostas dos participantes, levando em conta se eles tinham experimentado qualquer perturbação do sono no mês anterior. Resultados: Dentre os avaliados, 44,9% indicaram distúrbios do sono em geral, sendo esses mais frequentes em mulheres (51,5%) e na faixa etária de 75 a 79 anos (48,2%). De acordo com a análise de regressão, gênero, doenças articulares, noctúria e incontinência urinária foram associados aos distúrbios, sobre os quais também foi verificado que seu aumento não é linearmente dependente da idade. Conclusões: Sexo, dor, incontinência urinária e noctúria são fatores associados a distúrbios do sono em idosos. Assim, concluímos que a sua ausência está associada ao gênero e ao estado de saúde.

ABSTRACT: Objectives: The prevalence of sleep problems in elderly, such as insomnia, is a relevant issue in our society. Poor sleep quality is viewed by many as an inevitable result of aging. In this context, this study aimed to estimate the prevalence and associated factors of sleeping disturbances in elderly men and women (60 years and older). Methods: The present study is part of SABE Study (Health, Well-being and Aging), a cohort conducted in São Paulo, Brazil. The sample included in the present cross-sectional study comprised 1,334 elderly people aged 60 years or older. Sleep disturbances were assessed based on responses of study participants on whether they had experienced any sleep disturbance in the past month. Results: Among the elderly assessed, 44.9% had overall sleep disturbances, which were more frequent in women (51.5%) and in 75 to 79 years old (48.2%). According to the regression analysis, the variables gender, joint diseases, as well as nocturia and urinary incontinence, were associated with sleep disorders. Increase in sleep disturbances was found not to be linearly age-dependent. Conclusions: Gender, pain, urinary and nocturia incontinence were factors associated with sleep disorders. Thus, we might conclude that the absence of sleep disturbances in older adults depends on gender and health status.

Frecuencia y características del cáncer de vesícula biliar en un hospital de referencia al sur del Perú, 2009-2014: estudio descriptivo / Frequency and characteristics of gallbladder cancer at a referral hospital in southern Peru, 2009-2014: a descriptive study

INTRODUCCIÓN: El cáncer de vesícula biliar es una neoplasia poco común, y su frecuencia es variable en las regiones de Perú. OBJETIVO: Determinar la frecuencia y describir las características clínicas del cáncer de vesícula biliar en un hospital de referencia al sur de Perú. MÉTODOS: Estudiamos los informes de todas las muestras de colecistectomías realizadas entre los años 2009 y 2014, en el servicio de anatomía patológica del Hospital Regional Honorio Delgado. Además, revisamos las historias clínicas de los pacientes que tuvieran algún resultado compatible con cáncer de vesícula biliar. RESULTADOS: De 2991 colecistectomías, 75 (2,5%) tuvieron cáncer de vesícula biliar. El síntoma más frecuente en ambos grupos fue el dolor (96,7%), seguido de náusea (87,5%) y vómitos (65,0%). La mayoría de pacientes fueron mujeres (83,3%) mayores de 60 años (65,0%). El tipo histológico más frecuente fue el adenocarcinoma (80,0%). CONCLUSIÓN: La frecuencia de cáncer de vesícula biliar en un hospital de referencia del sur de Perú, es de 2,5% mayor a la reportada en otros estudios en las regiones centro y norte del país.

INTRODUCTION: Gallbladder cancer is a rare neoplasm, its frequency is variable in the regions of Peru. OBJECTIVE: To determine the frequency and describe the clinical characteristics of gallbladder cancer in southern Peru. METHODS: The reports of the anatomopathological department of the Honorio Delgado Regional Hospital were selected from all samples of cholecystectomies performed between 2009 and 2014 and those that had some result compatible with gallbladder cancer were looked for. Subsequently, the clinical histories were searched to obtain the characteristics of these patients. RESULTS: Of 2991 cholecystectomies, 75 (2.5%) had gall bladder cancer. The most frequent symptom in both groups was pain (96.7%), followed by nausea (87.5%) and vomiting (65.0%). The majority of patients were women (83.3%) older than 60 years (65.0%). The most frequent histological type was the adenocarcinoma (80.0%). CONCLUSION: The frequency of gallbladder cancer in a reference hospital in southern Peru is 2.51%, higher than that reported in other studies in the central and northern regions of Peru.

Dança sênior - efeitos benéficos à qualidade de vida, à incidência de dor em idosas / Senior dance - beneficial effects to quality of life, the incidence of pain in elderly women / Baile para mayores: efectos beneficiosos para calidad de vida, la incidência de dolor en mujeres de edad avanzada

Trata-se de um estudo quase-experimental, exploratório-descritivo, longitudinal-prospectivo e com abordagem quantitativa, que avaliou os efeitos benéficos da dança sênior sobre a qualidade de vida, e incidência da dor de 12 idosas que participaram de oito semanas de dança. Os resultados demonstraram diferença estatisticamente significativa em seis quesitos do questionário Short-Form Health Survey; e redução da intensidade da dor em praticamente todos os segmentos corporais, conforme Escala de Avaliação de Corlett.

This is a prospective-longitudinal, almost-experimental, exploratory-descriptive study with a quantitative approach, which assessed the beneficial effects of senior dance on the quality of life and incidence of pain in 12 elderly women who participated in 8 weeks of dance. The results showed a statistically significant difference in 6 questions of the Short-Form Health Survey and reduction of pain intensity in almost all body segments, according to Corlett's Rating Scale.

Es un estudio cuasi-experimental, exploratorio-descriptivo, longitudinal-prospectivo con un enfoque cuantitativo, que evaluó los efectos beneficiosos del baile de adultos mayores sobre la calidad de vida y la incidência del dolor en 12 mujeres mayores que participaron en 8 semanas de baile. Los resultados mostraron una diferencia estadísticamente significativa en 6 ítems del cuestionario Short-Form Health Survey y redujeron la intensidad del dolor en prácticamente todos los segmentos del cuerpo, de acuerdo con la escala de calificación de Corlett.

Qualidade de vida de professores do ensino fundamental de urna escola da rede pública / Quality of life of teachers from a public basic school

RESUMO: Este estudo busca avaliar a qualidade de vida dos professores do ensino fundamental de uma escola da rede pública brasileira. Trata se de um estudo transversal realizado com 26 professores. Utilizou-se um questionário sociodemográfico, o SF-36, Questionário Nórdico e o Inventário de Depressão de Beck. Observou-se a preva lência do sexo feminino (69,6%) e com cônjuge (60,9%). A maioria possuía apenas graduação (56,5%). Considerando a dor musculoesquelética, foi encontrada maior ocorrência nos membros inferiores (34,8%) e na coluna (47,8%), sendo que apenas 34,8% dos docentes entrevistados relataram algum tipo de afastamento por queixa de dor em algum dos segmentos. Apenas 5,35% dos professores apre sentaram algum indicativo de depressão. Quanto à qualidade de vida, constatou-se um escore mínimo de 56,04 para “Estado geral de saúde” e o máximo de 84,38 para o domínio “Capacidade fun cional”, sendo o domínio “Limitações por aspectos físicos” o mais afetado quando comparado dor com diminuição da qualidade de vida. Houve uma depreciação da qualidade de vida dos docentes que relataram dores, principalmente nas costas, nos últimos 12 meses. Constata-se haver comprometimento de todos os domínios do SF-36, portanto infere-se que a sintomatologia dolorosa e depressiva contribui para uma redução da qualidade de vida do docente.

ABSTRACT: This study aims to evalue the quality of life of teachers of a Brazilian public basic school. This is a cross-sectional study done with 26 teach ers. It was used a social-demographic questionnaire, the SF36, the Nordic Questionnaire and the Inventory of Beck Depression. It was observed that most teachers are female (69,6%) and married (60,9%). Most of them have only graduation (56,5%). Considering the muscu loskeletal pain, it was found higher occurrence in lower members (34,8%) and in column (47,8%), and only 34,8% of them related some kind of sick leave because of pain in some of the segments. The study showed that 5,35% of the teachers have an indicative of depression. About quality of life, it was detected a minimum score of 56,04 for "general state of health" and the maximum of 84,38 for the domain "functional capacity", with the domain "limitations for physical aspects" being the most affected when compared pain with loss of quality of life. It was observed a quality of life depreciation on the teachers that reported pain, most of them in their backs, through the last 12 months. All the domains of SF-36 were engaged, then we can infer that the painful and depressive symptomatology contributes to a reduction of teachers' quality of life.

Factors associated with pain in individuals infected by human T-cell lymphotropic virus type 1 (HTLV-1)

Abstract Introduction Despite the high prevalence of chronic pain in individuals infected with HTLV-1, predictive and protective factors for its development are still unclear. Objective To identify factors associated with chronic pain in individuals with HTLV-1. Methods This cross-sectional study was conducted in a reference center for treatment of patients infected with HTLV-1 in Salvador, Bahia, Brazil. The study included individuals infected with HTLV-1, over 18 years, and excluded those with difficulty to respond the pain protocol. Data on sociodemographic, health behavior, and clinical characteristics were collected in a standardized way. The prevalence ratio (PR) of pain is described, as well as the factors independently associated with the presence of pain, which were assessed by multiple logistic regression. Results A total of 142 individuals were included in the study, mostly female (62.7%), aged 20–64 years (73.2%), married (61.3%), with less than eight years of education (54.2%), and with a steady income (79.6%). Multivariate analysis showed that being symptomatic for HTLV-1 – sensory manifestations, erectile dysfunction, overactive bladder, and/or HAM/TSP (PR = 1.21, 95% CI: 1.05 to 1.38), self-medication (PR = 1.29, 95% CI: 1.08–1.53), physiotherapy (PR = 1.15, 95% CI: 1.02–1.28), and depression (PR = 1.14, 95% CI: 1.01–1.29) were associated with an increased likelihood of presenting pain. On the other hand, physical activity (PR = 0.79, 95% CI: 0.67–0.93) and religious practice (PR = 0.83, 95% CI: 0.72–0.95) were associated with a decreased likelihood of having pain. Conclusion The use of self-medication, physiotherapy and the presence of depression are independently associated with neurological symptoms in HTLV-1 infected patients. Religious practice and physical activity are both protective for the development of pain.

Health related quality of life in Turkish polio survivors: impact of post-polio on the health related quality of life in terms of functional status, severity of pain, fatigue, and social, and emotional functioning / Qualidade de vida relacionada com a saúde em sobreviventes turcos da pólio: impacto pós-pólio na saúde relacionada com a qualidade de vida em termos de estado funcional, gravidade da dor, fadiga e funcionamento social e emocional

ABSTRACT Objective: To determine the impact of postpolio-syndrome on quality of life in polio survivors. Methods: Forty polio survivors were included in the study. Twenty-one patients fulfilling the Halstead's postpolio-syndrome criteria participated in postpolio-syndrome group. The remaining nineteen patients formed non-postpolio-syndrome group. Control group was composed of forty healthy subjects. Quality of life was evaluated by Nottingham Health Profile, depression by Beck Depression Scale and fatigue by Fatigue Symptom Inventory. Isometric muscle strength was measured by manual muscle testing. Results: Total manual muscle testing score was 26.19 ± 13.24 (median: 29) in postpolio-syndrome group and 30.08 ± 8.9 (median: 32) in non-postpolio-syndrome group. Total manual muscle testing scores of non-postpolio-syndrome group were significantly higher than that of postpolio-syndrome group. Patients with postpolio-syndrome reported significantly higher levels of fatigue and reduced quality of life in terms of physical mobility, pain and energy when compared with patients without postpolio-syndrome and control group. It was not reported a statistically significant difference in social and emotional functioning and sleep quality between postpolio-syndrome, non-postpolio-syndrome and control groups. Also it was not found any statistically significant difference in Beck Depression Scale scores among the groups. Conclusions: Postpolio-syndrome has a negative impact on quality of life in terms of functional status, severity of pain and energy. The identification, early recognition and rehabilitation of postpolio-syndrome patients may result in an improvement in their quality of life.

RESUMO Objetivo: Determinar o impacto da síndrome pós-pólio na qualidade de vida nos sobreviventes da pólio. Métodos: Quarenta sobreviventes da pólio foram incluídos no estudo. Participaram do grupo de síndrome pós-pólio 21 pacientes que atenderam aos critérios de síndrome pós-pólio de Halstead. Os 19 restantes formaram o grupo não síndrome pós-pólio. O grupo controle foi composto por 40 indivíduos saudáveis. A qualidade de vida foi avaliada pelo Nottingham Health Profile, a depressão pela Escala de Depressão de Beck e a fadiga pelo Inventário de Sintomas de Fadiga. A força muscular isométrica foi medida por teste muscular manual. Resultados: O escore total do teste muscular manual foi 26,19 ± 13,24 (mediana: 29) no grupo de síndrome pós-pólio e 30,08 ± 8,9 (mediana: 32) no grupo não síndrome pós-pólio. Escores totais de teste muscular manual de grupo não síndrome pós-pólio foram significativamente maiores do que os do grupo de síndrome pós-pólio. Os pacientes com síndrome pós-pólio relataram níveis significativamente maiores de fadiga e qualidade de vida reduzida em termos de mobilidade física, dor e energia quando comparados com pacientes sem síndrome pós-pólio e grupo controle. Não se relatou uma diferença estatisticamente significativa no funcionamento social e emocional e na qualidade do sono entre grupos de síndrome pós-pólio, não síndrome pós-pólio e controle. Além disso, não se encontrou diferença estatisticamente significativa nos escores da Escala de Depressão de Beck entre os grupos. Conclusões: A síndrome pós-pólio tem um impacto negativo na qualidade de vida em termos de estado funcional, gravidade da dor e energia. A identificação, o reconhecimento precoce e a reabilitação dos pacientes com síndrome pós-pólio podem resultar em uma melhoria da qualidade de vida.