Prevalence and factors associated with inadequate work ability among community health workers in Montes Claros, Minas Gerais state, Brazil: a cross-sectional study, 2018.

OBJECTIVE: To estimate the prevalence and analyze factors associated with inadequate work ability among community health workers (CHWs). METHODS: This was a cross-sectional study conducted with CHWs, from July to October 2018, in Montes Claros, state of Minas Gerais, Brazil; work ability, sociodemographic, occupational, and clinical factors were investigated; prevalence ratios (PRs) with 95% confidence intervals (95%CI) were calculated using Poisson regression. RESULTS: Of the 675 CHWs, 25.8% (95%CI 22.7;29.2) showed inadequate work ability; length of service greater than five years (PR = 1.64; 95%CI 1.24;2.18), poor health status (PR = 2.10; 95%CI 1.56;2.83), depressive symptoms (PR = 1.98; 95%CI 1.54;2.55) and voice disorders (PR = 1.85; 95%CI 1.26;2.73) were associated with the event. CONCLUSION: There was a high prevalence of inadequate work ability, associated with occupational and clinical factors. MAIN RESULTS: There was a high prevalence of inadequate work ability among community health workers (CHWs), associated with occupational and clinical factors. IMPLICATIONS FOR SERVICES: This study can contribute to the planning of preventive actions and the promotion of the work ability of CHWs, with repercussions on the quality of service provided by these professionals. PERSPECTIVES: Longitudinal studies are strongly recommended in order to establish cause-and-effect relationships between the variables investigated.

Factors associated with survival in patients with visceral leishmaniasis treated at a reference hospital in northern Minas Gerais - Brazil.

BACKGROUND: Visceral leishmaniasis (VL) is a public health problem and is a relevant cause of death in developing countries. This study aimed to evaluate the 20-year survival and predictors of worse prognosis in patients with VL admitted to a reference hospital for the treatment of infectious diseases between 1995 and 2016 in northern Minas Gerais, an area of high endemicity for VL. METHODS: This retrospective cohort study was conducted at a hospital in northern Minas Gerais, Brazil. All patients with VL were evaluated over a 20-year period. The medical records were thoroughly analyzed. Cox regression analysis was performed to estimate factors associated with the probability of survival. RESULTS: The cohort included 972 individuals, mostly male children <10 years old, from urban areas who presented at admission with the classic triad of fever, hepatosplenomegaly, and skin pallor. The mean hemoglobin level was 7.53 mg/dl. The mean interval between symptom onset and hospital admission was 40 days. The instituted therapies ranged from pentavalent antimonates to amphotericin, or both. The probability of survival was reduced to 78% one year after symptom onset. Hemoglobin levels and age were strongly associated with the probability of survival. CONCLUSIONS: Regardless of the mechanism underlying the reduction in hemoglobin and the non-modifiable factors of age, early initiation of drug treatment is the most appropriate strategy for increasing survival in patients with VL, which challenges health systems to reduce the interval between the onset of symptoms and hospital admission.

Factors associated with survival in patients with visceral leishmaniasis treated at a reference hospital in northern Minas Gerais - Brazil

ABSTRACT Background: Visceral leishmaniasis (VL) is a public health problem and is a relevant cause of death in developing countries. This study aimed to evaluate the 20-year survival and predictors of worse prognosis in patients with VL admitted to a reference hospital for the treatment of infectious diseases between 1995 and 2016 in northern Minas Gerais, an area of high endemicity for VL. Methods: This retrospective cohort study was conducted at a hospital in northern Minas Gerais, Brazil. All patients with VL were evaluated over a 20-year period. The medical records were thoroughly analyzed. Cox regression analysis was performed to estimate factors associated with the probability of survival. Results: The cohort included 972 individuals, mostly male children <10 years old, from urban areas who presented at admission with the classic triad of fever, hepatosplenomegaly, and skin pallor. The mean hemoglobin level was 7.53 mg/dl. The mean interval between symptom onset and hospital admission was 40 days. The instituted therapies ranged from pentavalent antimonates to amphotericin, or both. The probability of survival was reduced to 78% one year after symptom onset. Hemoglobin levels and age were strongly associated with the probability of survival. Conclusions: Regardless of the mechanism underlying the reduction in hemoglobin and the non-modifiable factors of age, early initiation of drug treatment is the most appropriate strategy for increasing survival in patients with VL, which challenges health systems to reduce the interval between the onset of symptoms and hospital admission.

Prevalence and factors associated with inadequate work ability among community health workers in Montes Claros, Minas Gerais state, Brazil: a cross-sectional study, 2018 / Prevalencia y factores asociados a la capacidad laboral inadecuada entre los trabajadores comunitarios de salud en Montes Claros, Minas Gerais, Brasil: estudio transversal, 2018 / Prevalência e fatores associados à capacidade inadequada para o trabalho entre agentes comunitários de saúde de Montes Claros, Minas Gerais: estudo transversal, 2018

ABSTRACT Objective To estimate the prevalence and analyze factors associated with inadequate work ability among community health workers (CHWs). Methods This was a cross-sectional study conducted with CHWs, from July to October 2018, in Montes Claros, state of Minas Gerais, Brazil; work ability, sociodemographic, occupational, and clinical factors were investigated; prevalence ratios (PRs) with 95% confidence intervals (95%CI) were calculated using Poisson regression. Results Of the 675 CHWs, 25.8% (95%CI 22.7;29.2) showed inadequate work ability; length of service greater than five years (PR = 1.64; 95%CI 1.24;2.18), poor health status (PR = 2.10; 95%CI 1.56;2.83), depressive symptoms (PR = 1.98; 95%CI 1.54;2.55) and voice disorders (PR = 1.85; 95%CI 1.26;2.73) were associated with the event. Conclusion There was a high prevalence of inadequate work ability, associated with occupational and clinical factors.

RESUMEN Objetivo Estimar la prevalencia y analizar factores asociados a la inadecuada capacidad para el trabajo entre los agentes comunitarios de salud (ACSs). Métodos Estudio transversal realizado con ACS, de julio a octubre de 2018, en Montes Claros, Minas Gerais, Brasil; se investigó la capacidad de trabajo y factores sociodemográficos, ocupacionales y clínicos; las razones de prevalencia (RP) con intervalos de confianza del 95% (IC95%) se calcularon mediante regresión de Poisson. Resultados De los 675 ACS, el 25,8 % (IC95% 22,7;29,2) presentó capacidad laboral inadecuada; tiempo de servicio superior a 5 años (RP = 1,64; IC95% 1,24;2,18), mal estado de salud (RP = 2,10; IC95% 1,56;2,83), síntomas depresivos (RP = 1,98; IC95% 1,54;2,55) y trastornos de la voz (RP = 1,85; IC95% 1,26;2,73) estaban relacionados con el evento. Conclusión Hubo alta prevalencia de capacidad inadecuada para el trabajo, asociada a factores laborales y clínicos.

RESUMO Objetivo Estimar a prevalência e analisar fatores associados à capacidade inadequada para o trabalho entre agentes comunitários de saúde (ACS). Métodos Estudo transversal realizado com ACS, no período de julho a outubro de 2018, em Montes Claros, Minas Gerais, Brasil; foi investigada a capacidade para o trabalho, fatores sociodemográficos, laborais e clínicos; razões de prevalência (RPs) com intervalos de confiança de 95% (IC95%) foram calculadas por regressão de Poisson. Resultados Dos 675 ACS estudados, 25,8% (IC95% 22,7;29,2) apresentaram capacidade inadequada para o trabalho; tempo de serviço superior a cinco anos (RP = 1,64; IC95% 1,24;2,18), percepção do estado de saúde ruim (RP = 2,10; IC95% 1,56;2,83), sintomas depressivos (RP = 1,98; IC95% 1,54;2,55) e distúrbios da voz (RP = 1,85; IC95% 1,26;2,73) estiveram associados ao evento. Conclusão Houve prevalência elevada de capacidade inadequada para o trabalho, associada a fatores laborais e clínicos.

Psychometric properties of the Providers Survey in the Brazilian context of mental health: a validation study

ABSTRACT BACKGROUND: Precisely determining the aspects related to an instrument's validity and reliability measures allows for greater assurance of the quality of the results. OBJECTIVES: To analyze the psychometric properties of The Providers Survey in the Brazilian context of mental health services. DESIGN AND SETTING: The instrument validation study was conducted in Montes Claros, Minas Gerais, Brazil. METHODS: The validation study was conducted using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist to analyze its validity and reliability. RESULTS: A committee of expert judges performed content validation after which the Content Validity Index was calculated. Construct validation took place through Exploratory Factor Analysis using the Kaiser-Meyer-Olkin Test criterion and Bartlett's Sphericity Test. Reliability was verified using test-retest reliability. The significance level adopted for the statistical tests was 5% (P < 0.05). The final instrument comprised 54 questions. The Content Validity Index was 97%. Exploratory Factor Analysis identified a Kaiser-Meyer-Olkin index of 0.901 and Bartlett's Sphericity Test with P < 0.001. We obtained a Cronbach's alpha coefficient of 0.95 and an intraclass correlation coefficient of 0.849. CONCLUSIONS: The Providers Survey, translated and adapted into Portuguese, was named the Work Assessment Instrument for the Recovery of Mental Health. It presented adequate psychometric properties for evaluating work-related practices for the recovery of psychosocial care network users.

Working conditions and mental health of community health workers in the COVID-19 pandemic. / Condições de trabalho e saúde mental de agentes comunitários de saúde na pandemia de COVID-19.

This study examined the prevalence of anxiety and depression associated with Community Health Workers' (CHWs') working conditions in the context of the COVID-19 pandemic. This cross-sectional study was carried out in the north of Minas Gerais, Brazil by applying a questionnaire addressing sociodemographic conditions, command of technologies and working conditions during the pandemic, as well as the State-Trait Anxiety Inventory and the Patient Health Questionnare-9 (PHQ-9). Descriptive and multiple Poisson regression analyses were performed with robust variance, to a 5% level of significance (p < 0.05) for the final model. A total of 1,220 CHWs from 36 municipalities participated in the study. Prevalences were 41.8% and 31.6% for anxiety and depression, respectively, while 22.5% of the group displayed symptoms of both conditions. Being female, up to 40 years old, having more than 500 users registered for monitoring, and inadequate supply of personal protective equipment were associated with anxiety and depression among the CHWs. Prevalence of anxiety and depression was high among CHWs during the pandemic and working conditions figured prominently among the associated factors.

O objetivo deste estudo foi analisar a prevalência de ansiedade e depressão associada às condições de trabalho dos agentes comunitários de saúde (ACS) no contexto da pandemia de COVID-19. Estudo transversal, realizado no norte de Minas Gerais. Foi aplicado um questionário que abordava condições sociodemográficas, domínio de tecnologias e condições de trabalho durante a pandemia, além do Inventário de Ansiedade Traço-Estado e do Patient Health Questionnare-9 (PHQ-9). Foram realizadas análises descritivas e de regressão múltipla de Poisson com variância robusta, considerando um nível de significância de 5% (p < 0,05) para o modelo final. Participaram do estudo 1.220 ACS de 36 municípios. A prevalência foi de 41,8% e 31,6% para ansiedade e depressão, respectivamente, e 22,5% para ambas as condições. O sexo feminino, idade até 40 anos, ter mais de 500 usuários cadastrados para acompanhamento e oferta inadequada de equipamentos de proteção individual estiveram associados à ansiedade e à depressão. Registrouse uma elevada prevalência de ansiedade e depressão entre ACS no período da pandemia, com destaque para as condições de trabalho entre os fatores associados.

Condições de trabalho e saúde mental de agentes comunitários de saúde na pandemia de COVID-19 / Working conditions and mental health of community health workers in the COVID-19 pandemic

Resumo O objetivo deste estudo foi analisar a prevalência de ansiedade e depressão associada às condições de trabalho dos agentes comunitários de saúde (ACS) no contexto da pandemia de COVID-19. Estudo transversal, realizado no norte de Minas Gerais. Foi aplicado um questionário que abordava condições sociodemográficas, domínio de tecnologias e condições de trabalho durante a pandemia, além do Inventário de Ansiedade Traço-Estado e do Patient Health Questionnare-9 (PHQ-9). Foram realizadas análises descritivas e de regressão múltipla de Poisson com variância robusta, considerando um nível de significância de 5% (p < 0,05) para o modelo final. Participaram do estudo 1.220 ACS de 36 municípios. A prevalência foi de 41,8% e 31,6% para ansiedade e depressão, respectivamente, e 22,5% para ambas as condições. O sexo feminino, idade até 40 anos, ter mais de 500 usuários cadastrados para acompanhamento e oferta inadequada de equipamentos de proteção individual estiveram associados à ansiedade e à depressão. Registrouse uma elevada prevalência de ansiedade e depressão entre ACS no período da pandemia, com destaque para as condições de trabalho entre os fatores associados.

Abstract This study examined the prevalence of anxiety and depression associated with Community Health Workers' (CHWs') working conditions in the context of the COVID-19 pandemic. This cross-sectional study was carried out in the north of Minas Gerais, Brazil by applying a questionnaire addressing sociodemographic conditions, command of technologies and working conditions during the pandemic, as well as the State-Trait Anxiety Inventory and the Patient Health Questionnare-9 (PHQ-9). Descriptive and multiple Poisson regression analyses were performed with robust variance, to a 5% level of significance (p < 0.05) for the final model. A total of 1,220 CHWs from 36 municipalities participated in the study. Prevalences were 41.8% and 31.6% for anxiety and depression, respectively, while 22.5% of the group displayed symptoms of both conditions. Being female, up to 40 years old, having more than 500 users registered for monitoring, and inadequate supply of personal protective equipment were associated with anxiety and depression among the CHWs. Prevalence of anxiety and depression was high among CHWs during the pandemic and working conditions figured prominently among the associated factors.

Psychometric properties of the Providers Survey in the Brazilian context of mental health: a validation study.

BACKGROUND: Precisely determining the aspects related to an instrument's validity and reliability measures allows for greater assurance of the quality of the results. OBJECTIVES: To analyze the psychometric properties of The Providers Survey in the Brazilian context of mental health services. DESIGN AND SETTING: The instrument validation study was conducted in Montes Claros, Minas Gerais, Brazil. METHODS: The validation study was conducted using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist to analyze its validity and reliability. RESULTS: A committee of expert judges performed content validation after which the Content Validity Index was calculated. Construct validation took place through Exploratory Factor Analysis using the Kaiser-Meyer-Olkin Test criterion and Bartlett's Sphericity Test. Reliability was verified using test-retest reliability. The significance level adopted for the statistical tests was 5% (P < 0.05). The final instrument comprised 54 questions. The Content Validity Index was 97%. Exploratory Factor Analysis identified a Kaiser-Meyer-Olkin index of 0.901 and Bartlett's Sphericity Test with P < 0.001. We obtained a Cronbach's alpha coefficient of 0.95 and an intraclass correlation coefficient of 0.849. CONCLUSIONS: The Providers Survey, translated and adapted into Portuguese, was named the Work Assessment Instrument for the Recovery of Mental Health. It presented adequate psychometric properties for evaluating work-related practices for the recovery of psychosocial care network users.

Different criteria for body mass index classification for excess weight screening in children aged six to ten years.

OBJECTIVE: To evaluate the agreement between body mass index (BMI) parameters applied to children aged six to ten years in the city of Montes Claros (MG), Brazil with national and international criteria, also calculating their sensitivity and specificity regarding excess weight screening. METHODS: A sample comprising 4151 children aged six to ten years was assessed, with height and body mass determined for BMI calculation. The obtained values were classified according to cutoff points established by the World Health Organization (WHO), International Obesity Task Force (IOTF), Centers for Disease Control and Prevention (CDC), Conde & Monteiro, and a recent local proposal. The agreement index between the mentioned criteria was calculated and thereafter the sensitivity and specificity. RESULTS: The local proposal was proven to be highly consistent in most combinations, especially concerning the excess weight criteria of the World Health Organization (WHO) (k=0.895). Regarding excess weight, the local proposal presented sensitivity and specificity values of 0.8680 and 0.9956, respectively, indicating high BMI discrimination power. CONCLUSIONS: The locally applied BMI parameters for children aged six to ten years represent a valid, highly viable and practical proposal for excess weight screening in this population group, improving professional decision-making in their follow-up.

Body morphology and bone age in girls with obesity and without obesity aged 8 to 15 years: a cross-sectional study / Morfologia corporal e idade óssea em meninas com obesidade e sem obesidade de 8 a 15 anos: um estudo transversal

Introduction: childhood obesity is one of the main public health problems worldwide, leading to health status repercussions and growth and maturation process implications in both children and adolescents. Objective: the aim of this study was to verify body morphology and bone age variations in girls with obesity and without obesity. Methodology: this comprises a cross-sectional study conducted with 140 girls aged 8 to 15 years old, 70 with obesity and 70 without obesity. Hip and waist circumferences, body mass, height and and Body Mass Index (BMI) were determined. For maturation status determinations, bone ages were determined by a left wrist and hand radiography employing the Fels method. Results: the findigs indicate significant correlations between nutritional and maturation statuses (r=0.80; p˂0.01). Girls with obesity presented higher weight and BMI values, larger waist and hip circumferences and more advanced bone age compared to girls without obesity (p˂0.01). The same significant differences (p˂0.01) were noted in the contrasting maturational group analysis, where girls presenting advanced maturation always exhibited the highest parameter values. Conclusion: nutritional status is associated to maturation status, and girls with obesity exhibit more advanced bone age than girls without obesity.

Introdução: a obesidade infantil é um dos principais problemas de saúde pública mundial, com repercussões no estado de saúde e implicações no processo de crescimento e maturação de crianças e adolescentes. Objetivo: verificar a variação da morfologia corporal e da idade óssea em meninas com e sem obesidade. Metodologia: estudo transversal conduzido com 140 meninas de 8 a 15 anos de idade, sendo 70 meninas com obesidade e 70 sem obesidade. Foram mensuradas as circunferências do quadril e da cintura, massa corporal, altura e o Índice de Massa Corporal (IMC). Para o status maturacional foi determinada a idade óssea por meio de radiografia de punho e mão esquerdos pelo Método Fels. Resultados: os resultados apontaram a existência de correlação entre o status nutricional e o status maturacional (r=0,80; p˂0,01). As meninas com obesidade apresentaram maior peso, IMC mais elevado, circunferências maiores e idade óssea mais avançada quando comparadas às meninas sem obesidade (p˂0,01). Na análise dos grupos maturacionais contrastantes as mesmas diferenças se apresentaram com valores significativos (p˂0,01), sendo as meninas avançadas maturacionalmente sempre com valores superiores. Conclusão: o status nutricional apresentou correlação com o status maturacional, e as meninas com obesidade apresentam idade óssea mais avançada que aquelas sem obesidade

Análise dos indicadores de prazer e sofrimento no trabalho associados a ansiedade e depressão entre agentes comunitários de saúde / Analysis of indicators of pleasure and suffering at work associated with anxiety and depression among community health agents

RESUMO Objetivo Analisar os indicadores de prazer e sofrimento no trabalho associados a depressão e ansiedade entre agentes comunitários de saúde (ACSs). Métodos Estudo transversal, no qual variáveis dependentes foram a presença de sintomas de ansiedade e depressão, avaliadas com o Patient Health Questionnaire (PHQ-9) e com o Inventário de Ansiedade de Traço-Estado (IDATE). As variáveis independentes foram avaliadas com um questionário sociodemográfico e a Escala de Indicadores de Prazer e Sofrimento no Trabalho (EIPST) do Inventário do Trabalho e Riscos de Adoecimento (ITRA). As associações entre as variáveis foram testadas com o uso de regressão logística multinominal. Resultados Participaram do estudo 675 ACSs, sendo a maioria mulheres (83,7%), com até 40 anos (51,3%). As chances de apresentar sintomas de ansiedade foram maiores entre ACSs efetivos (1,61 [1,10-2,36]), e avaliações críticas ou graves nos fatores realização (Crítica 1,87 [1,30-2,68]; Grave 4,16 [2,06-8,40]) e esgotamento profissional (Crítica 2,60 [1,78-3,80]; Grave 3,97 [2,53-6,21]). Sexo feminino (2,12 [1,03-4,40]), idade de até 40 anos (1,741 [1,05-2,89]), tempo de serviço superior a cinco anos (1,88 [1,18-2,99]), avaliações crítica ou grave nos fatores realização (Crítica 2,53 [1,55-4,10]; Grave 6,07 [2,76-13,38]), esgotamento profissional (Crítica 5,21 [2,30-11,80]; Grave 15,64 [6,53-37,44]) e falta de reconhecimento (Crítica 1,93 [1,13-3,28]) estiveram associados a maiores chances de sintomas depressivos. Conclusões Apesar de se tratar de estudo transversal, que não permite inferir causalidade, os achados sugerem importante associação entre aspectos laborais dos ACS e os sintomas de ansiedade e depressão. Sexo feminino e possuir 40 anos ou menos também mostraram relação com o aumento dos sintomas de depressão.

ABSTRACT Objective To analyze indicators of pleasure and suffering at work associated with depression and anxiety among community health workers (CHW). Methods Crosssectional study in which the dependent variables were the presence of anxiety and depression symptoms, assessed using the Patient Health Questionnaire (PHQ-9) and State-Trait Anxiety Inventory (STAI). The independent variables were evaluated using the Scale of Indicators of Pleasure and Suffering at Work (EIPST) of the Inventory of Work and Risks of Illness (ITRA). Associations between dependent and independent variables were tested using multinomial logistic regression. Results 675 CHW participated in the study, the majority being women (83.7%), aged up to 40 years (51.3%). The chances of presenting anxiety symptoms were higher among effective CHW (OR=1.61; 95%CI: 1.10-2.36), and critical or severe assessments in the achievement factors (Critical OR=1.87; 95%CI: 1.30-2.68; Severe OR=4.16; 95%CI: 2.06-8.40) and professional exhaustion (Critical OR=2.60; 95%CI: 1.78-3.80; Severe OR=3.97; 95% CI: 2.53-6.21). Female gender (OR=2.12; 95%CI: 1.03-4.40), age up to 40 years (OR=1.74; 95%CI: 1.05-2.89), length of service greater than five years (OR=1.88; 95%CI: 1.18-2.99), critical or severe ratings on achievement factors (Critical OR=2.53; 95%CI: 1.55-4.10; Severe OR= 6.07; 95%CI: 2.76-13.38), professional exhaustion (Critical OR=5.21; 95%CI: 2.30-11.80; Severe OR=15.64; 95%CI: 6.53 -37.44) and lack of recognition (Critical OR=1.93; 95%CI: 1.13-3.28) were associated with greater chances of depressive symptoms. Conclusions Despite being a cross-sectional study, which does not allow inferring causality, the findings suggest an important association between the work aspects of the CHW and the symptoms of anxiety and depression. Female gender and being 40 years old or younger also showed a relationship with increased symptoms of depression.

Congenital syphilis: associated factors in a follow-up outpatient clinic.

OBJECTIVE: This study aimed to describe the characteristics of mothers and children assisted in a follow-up clinic for congenital syphilis and identify the factors associated with the confirmation of the diagnosis. METHODS: This is a prospective study conducted from 2016 to 2019 in Montes Claros, Northern Minas Gerais, Brazil. Specific forms addressing maternal sociodemographic, behavioral, and lifestyle habit characteristics, as well as characteristics related to access to healthcare, were used. Hierarchical Poisson regression analysis was performed to define the factors associated with diagnostic confirmation, including the calculation of the prevalence ratios (PR) and respective 95% confidence intervals (95%CI). RESULTS: A total of 200 binomials (mother-child) who attended at least one appointment as part of the follow-up after discharge from the maternity hospital were eligible for the study. The mothers were mostly young (79.0%), with a low educational level (43.0%), and black (89.5%). Nearly half of the mothers reported not having a steady sexual partner (42.5%). About a quarter attended less than six prenatal appointments (27.5%). Nearly half did not treat the disease adequately during pregnancy (24.5%). The diagnosis of congenital syphilis was confirmed for 116 children. The following factors were associated with the diagnostic confirmation after multiple analyses: low maternal educational level (PR 1.30; 95%CI 1.05-1.60), maternal risky sexual behavior (PR 1.34; 95%CI 1.07-1.66), inadequate treatment of the mother (PR 3.16; 95%CI 2.42-4.47), and lack of treatment of the partner (PR 1.44; 95%CI 1,18-1.81). CONCLUSIONS: Syphilis remains a major challenge. The results highlight the social inequities associated with congenital syphilis and the lack of proper management of pregnant women and their partners.

Internações pediátricas por condições sensíveis à atenção primária no norte de Minas Gerais, Brasil: reavaliação após 10 anos / Pediatric hospitalizations due to primary care sensitive conditions in northern Minas Gerais, Brazil: reassessment after 10 years

Resumo Introdução As internações por condições sensíveis à atenção primária (ICSAP) representam um importante indicador de saúde, que pode orientar sobre o acesso e a qualidade da assistência à saúde no âmbito da atenção primária. Objetivo Avaliar a prevalência e os fatores associados às ICSAP em crianças de zero a 10 anos incompletos, no norte de Minas Gerais, comparando o indicador com estudo similar realizado há dez anos. Métodos Estudo transversal com amostra aleatória de hospitalizações pediátricas selecionadas entre junho/2016 e agosto/2017. As variáveis associadas às ICSAP foram identificadas após análise múltipla, por meio da regressão de Poisson, com variância robusta. Resultados Foram analisadas 376 hospitalizações. A proporção de ICSAP foi de 29,0%, significativamente menor do que o estudo anterior, com proporção de 41,4%. As variáveis sexo masculino (RP = 0,91; IC95%:0,86-0,97), baixo peso de nascimento (PR = 0,91; IC 95%: 0,85-0,97) e escolaridade materna inferior a oito anos (RP = 0,93; IC 95%: 0,88-0,98) foram identificados como fatores protetores. Conclusão Registrou-se prevalência ainda elevada para as ICSAP, mas com importante redução em dez anos. Apenas variáveis sociodemográficas se mostraram associadas às ICSAP.

Abstract Background Hospitalizations due to primary care sensitive conditions (HPCSC) represent an important health indicator, which can guide the access and quality of health care in the context of primary care. Objective To assess the prevalence and factors associated with HPCSC in children aged 0 to 10 years old, in northern Minas Gerais, comparing the indicator with a similar study carried out 10 years ago. Methods Cross-sectional study with a random sample of selected pediatric hospitalizations from June/2016 and august/2017 was carried out. The variables associated with HPCSC were identified after multiple analysis, using Poisson Regression, with robust variance. Results 376 hospitalizations were analyzed. The proportion of HPCSC was 29.0%, significantly lower than the previous study, with a proportion of 41.4%. The variables male gender (PR = 0.91; 95% CI: 0.86 - 0.97), low birth weight (PR = 0.91; 95% CI: 0.85 - 0.97) and maternal education below eight years (PR = 0.93; 95% CI: 0.88 - 0.98) were identified as protective factors. Conclusion There was still a high prevalence for HPCSC, but with an important reduction in 10 years. Only socio-demographic variables were shown to be associated with HPCSC.

Different criteria for body mass index classification for excess weight screening in children aged six to ten years / Diferentes critérios de classificação do índice de massa corporal para o rastreio do excesso de peso em crianças de seis a dez anos

ABSTRACT Objective: To evaluate the agreement between body mass index (BMI) parameters applied to children aged six to ten years in the city of Montes Claros (MG), Brazil with national and international criteria, also calculating their sensitivity and specificity regarding excess weight screening. Methods: A sample comprising 4151 children aged six to ten years was assessed, with height and body mass determined for BMI calculation. The obtained values were classified according to cutoff points established by the World Health Organization (WHO), International Obesity Task Force (IOTF), Centers for Disease Control and Prevention (CDC), Conde & Monteiro, and a recent local proposal. The agreement index between the mentioned criteria was calculated and thereafter the sensitivity and specificity. Results: The local proposal was proven to be highly consistent in most combinations, especially concerning the excess weight criteria of the World Health Organization (WHO) (k=0.895). Regarding excess weight, the local proposal presented sensitivity and specificity values of 0.8680 and 0.9956, respectively, indicating high BMI discrimination power. Conclusions: The locally applied BMI parameters for children aged six to ten years represent a valid, highly viable and practical proposal for excess weight screening in this population group, improving professional decision-making in their follow-up.

RESUMO Objetivo: Analisar a concordância dos parâmetros de índice de massa corporal (IMC) para crianças com idade de seis a dez anos da cidade de Montes Claros/MG com os demais critérios de abrangência nacional e internacional, bem como sua sensibilidade e especificidade no rastreio do excesso de peso. Métodos: Foi utilizada uma amostra de 4.151 crianças de seis a dez anos, sendo mensuradas estatura e massa corporal para a determinação do IMC. Os valores obtidos foram classificados de acordo com os pontos de corte da World Health Organization (WHO), International Obesity Task Force (IOTF), Centers for Disease Control and Prevention (CDC), Conde & Monteiro e uma recente proposta local. Calculou-se o índice de concordância entre os critérios mencionados e, em seguida, a sensibilidade e a especificidade. Resultados: A proposta local mostrou-se altamente concordante na maioria das combinações, principalmente para o excesso de peso com a WHO (k=0,895). Com relação ao excesso de peso, a proposta local apresentou valores de 0,8680 e 0,9956 para a sensibilidade e especificidade respectivamente, mostrando alto poder de discriminação do IMC. Conclusões: Conclui-se que os parâmetros locais de IMC para crianças de seis a dez anos representam uma proposta válida, altamente viável e utilizável para o rastreio do excesso de peso desse grupo populacional, melhorando a tomada de decisão profissional no acompanhamento de tais indivíduos.

Comparação da fragilidade em pessoas idosas longevas pelo Índice de Vulnerabilidade Clínico-Funcional-20 (IVCF-20) e pela Edmonton Frail Scale (EFS) / Comparison of frailty in oldest-old people using the Clinical-Functional Vulnerability Index-20 (IVCF-20) and Edmonton Frail Scale (EFS)

Resumo Objetivo Comparar os escores do Índice de Vulnerabilidade Clínico-Funcional-20 (IVCF-20) e da Edmonton Frail Scale (EFS) entre pessoas idosas com 80 anos ou mais de idade que vivem na comunidade, considerando a prevalência e o grau de concordância. Método Trata-se de estudo transversal, aninhado a uma coorte de base populacional. A amostragem na linha de base foi probabilística, por conglomerados, em dois estágios. No primeiro, utilizou-se como unidade amostral o setor censitário. No segundo, definiu-se o número de domicílios segundo a densidade populacional de pessoas idosas. Foram determinados a sensibilidade, a especificidade e os valores preditivos. A estatística Kappa analisou o grau de concordância entre os instrumentos. Resultados Foram avaliadas 92 pessoas idosas longevas. A prevalência do alto risco de vulnerabilidade clínico-funcional, considerado pessoa idosa frágil, foi de 45,7% pelo IVCF-20 e a prevalência de fragilidade pela EFS foi de 44,6%. Os valores de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo foram, respectivamente, 88,23%, 87,80%, 90,0% e 85,71%. A acurácia foi de 88,04%. A estatística Kappa foi 0,759 (p<0,001). Conclusão Os instrumentos IVCF-20 e EFS possuem boa acurácia e concordância forte, quando aplicado em pessoas idosas longevos que vivem na comunidade. A identificação da fragilidade foi superior, quando utilizado o IVCF-20. O resultado indica que os instrumentos avaliados possuem similaridade na prevalência da fragilidade em pessoas idosas longevas comunitárias.

Abstract Objective To compare Clinical-Functional Vulnerability Index-20 (IVCF-20) and Edmonton Frail Scale (EFS) scores among community-dwelling older people aged ≥80 years for prevalence and degree of agreement. Method A cross-sectional study nested within a population-based cohort, was conducted. Baseline sampling was probabilistic by two-stage clustering. In the first stage, the census tract was used as the sampling unit. In the second stage, the number of households was defined according to the population density of individuals aged ≥60 years. Sensitivity, specificity and predictive values ​​were determined and Kappa statistics expressed degree of agreement between the instruments. Results 92 oldest-old people were evaluated. The prevalence of high risk of clinical and functional vulnerability on the IVCF, indicating frailty, was 45,7%, whereas the prevalence of frailty using the EFS was 44,6%. Sensitivity, specificity, positive predictive value and negative predictive values were 88,23%, 87,80%, 90,0% and 85,71%, respectively. Accuracy was 88,04% and the Kappa statistic 0.759 (p<0.001). Conclusion The IVCF-20 and EFS instruments showed good accuracy and strong agreement when applied to community-dwelling oldest-old people. The identification of frailty was superior using the IVCF-20. These results show that the instruments detected similar frailty prevalence in community-dwelling oldest-old people.

Comprometimento cognitivo e fatores associados em uma população de idosos / Cognitive impairment and associated factors in a population of aged people

Resumo Introdução: O envelhecimento populacional está entre as transformações globais mais importantes. Na população idosa, há prevalência aumentada de condições crônicas que comprometem a autonomia relacionadas ao comprometimento cognitivo. Objetivo: Este estudo buscou estimar a prevalência de comprometimento cognitivo e os fatores associados em uma população de idosos. Método: Trata-se de pesquisa transversal analítica envolvendo idosos com 60 anos ou mais, cadastrados na Estratégia Saúde da Família de Montes Claros, Minas Gerais, Brasil. Para caracterização dos fatores sociodemográficos, hábitos de vida e condições de saúde, utilizou-se o instrumento Brazilian Older Americans Researches and Service Multidimensional Function Assessment Questionnaire; para avaliação cognitiva, o Mini Exame do Estado Mental, e os resultados, ajustados por escolaridade na análise de regressão logística binária, com apresentação de odds ratio (OR) e intervalos de confiança (IC) de 95%. Resultados: Dos 1.746 idosos avaliados, 11,5% apresentaram comprometimento cognitivo. Os fatores de risco associados foram idosos acima de 80 anos (OR=4,463; IC95% 3,160-6,304); analfabetos (OR=3,996; IC95% 2,716-5,791); sem companheiro (OR=1,989; IC95% 1,388-2,850); sedentários (OR=1,777; IC95% 1,208-2,613) e com histórico de Acidente Vascular Cerebral (OR=3,635; IC95% 2,213-5,971). Conclusões: Comprometimento cognitivo foi associado a variáveis passíveis de ações preventivas, como o acesso à escolarização e hábitos de vida saudáveis.

Abstract Background: Population aging is among the most important global transformations. In the elderly population, there is an increased prevalence of chronic conditions that compromise autonomy, related to cognitive impairment. Objective: This study sought to estimate the prevalence of cognitive impairment and associated factors in an elderly population. Method: This is a cross-sectional and analytical survey involving elderly people aged 60 years old or older, registered with the Family Health Strategy of Montes Claros, Minas Gerais, Brazil. To characterize sociodemographic factors, life habits and health conditions, the Brazilian Older Americans Researches and Service Multidimensional Function Assessment Questionnaire was used; for cognitive evaluation, the Mini Mental State Examination, and the results adjusted for education in the binary logistic regression analysis, with the presentation of odds ratios (OR) and 95% confidence intervals (CI). Results: Of the 1,746 aged individuals evaluated, 11.5% presented cognitive impairment. The associated risk factors were elderly over 80 years old (OR=4.463; 95%CI 3.160-6.304); illiterate (OR=3.996; 95%CI 2.716-5.791); without companion (OR=1.989; 95%CI 1.388-2.850); sedentary (OR=1.777; 95%CI 1.208-2.613), and with a history of stroke (OR=3.635; 95%CI 2.213-5.971). Conclusions: Cognitive commitment was associated with variables susceptible to preventive actions, such as access to schooling and healthy living habits.

Condições de saúde e sobrecarga de trabalho entre cuidadores informais de pessoas idosas com síndromes demenciais / Health conditions and workload burden among informal caregivers of elderly individuals with dementia syndromes

Resumo Objetivo estimar a prevalência de sobrecarga de trabalho, identificando fatores associados entre cuidadores informais de pessoas idosas com demência. Método Estudo transversal e analítico, com amostra de cuidadores de pessoas idosas assistidas em um centro de referência à saúde do idoso. A sobrecarga entre os cuidadores foi avaliada pela escala de Zarit. Foram investigadas características sociodemográficas e associadas às condições de saúde e de atenção à pessoa idosa. Para análise dos dados utilizou-se a regressão de Poisson com variância robusta, a partir de modelo hierarquizado, assumindo-se nível de significância de 5%. Resultados Participaram do estudo 436 cuidadores, sendo a maioria do sexo feminino (88,1%). A prevalência de sobrecarga entre os cuidadores foi de 32,8%. No modelo múltiplo, mostraram-se associados à maior prevalência de sobrecarga entre os cuidadores: idade de 40 a 59 anos (RP=1,20; IC95%=1,02-1,39), situação conjugal com companheiro (RP=1,18; IC95%=1,02-1,36), ser filho ou cônjuge da pessoa idosa (RP=1,16; IC95%=1,01-1,33), ter autopercepção negativa da saúde (RP=1,30; IC95%=1,10-1,52), fazer uso de medicamentos (RP=1,24; IC95%=1,06-1,45), não ter medidas de autocuidado (RP=1,49; IC95%=1,17-1,89), suporte à pessoa idosa nas atividades de integração familiar (RP=1,41; IC95%=1,05-1,89), nas atividades culturais (RP=1,36; IC95%=1,08-1,72) e na administração de medicamentos (RP=1,13; IC95%=1,01-1,25). Conclusão A elevada prevalência de sobrecarga entre os cuidadores de pessoas idosas alerta para a necessidade de políticas específicas para esse grupo e representa um aspecto a ser regularmente avaliado pelos profissionais de saúde que lidam diretamente com pessoas com demência e seus familiares.

Abstract Objective To estimate the prevalence of caregiver burden and identify associated factors among informal caregivers of elderly individuals with dementia. Method Cross-sectional and analytical study with a sample of caregivers of elderly individuals receiving care at a reference center for elderly health. Caregiver burden was assessed using the Zarit scale. Sociodemographic characteristics and factors related to the health and care of the elderly person were investigated. Data analysis was performed using Poisson regression with robust variance, based on a hierarchical model, with a significance level of 5%. Results A total of 436 caregivers participated in the study, the majority of whom were female (88.1%). The prevalence of caregiver burden was 32.8%. In the multiple model, the following factors were associated with a higher prevalence of caregiver burden: age between 40 and 59 years (PR=1.20; 95% CI=1.02-1.39), being in a marital relationship (PR=1.18; 95% CI=1.02-1.36), being a child or spouse of the elderly person (PR=1.16; 95% CI=1.01-1.33), having a negative self-perception of health (PR=1.30; 95% CI=1.10-1.52), using medication (PR=1.24; 95% CI=1.06-1.45), not practicing self-care measures (PR=1.49; 95% CI=1.17-1.89), providing support to the elderly person in family integration activities (PR=1.41; 95% CI=1.05-1.89), cultural activities (PR=1.36; 95% CI=1.08-1.72), and medication administration (PR=1.13; 95% CI=1.01-1.25). Conclusion The high prevalence of caregiver burden among caregivers of elderly individuals highlights the need for specific policies for this group and represents an aspect to be regularly evaluated by healthcare professionals who work directly with people with dementia and their families.

Fatores associados ao controle da hipertensão arterial entre usuários atendidos na estratégia saúde da família / Factors associated with the control of arterial hypertension among users assisted in the family health strategy / Factores asociados al control de la hipertensión arterial entre los usuarios asistidos en la estrategia de salud de la família

Objetivo: analisar o percentual de pacientes sob tratamento anti-hipertensivo que apresentam níveis de pressão arterial controlados e fatores associados. Método: estudo transversal e analítico. A seleção de pacientes ocorreu por amostragem probabilística, por conglomerados tratados de forma descritiva e analítica. Participaram do estudo 720 indivíduos. Resultados: após regressão logística, permaneceram associadas ao não controle da pressão arterial as variáveis sexo, adesão à terapia medicamentosa, história pregressa de doença cardíaca e automedicar-se. Conclusão: a prevalência de controle da pressão arterial foi de 54,3 %, as dificuldades no tratamento anti-hipertensivo relacionam-se a fatores como aspectos pessoais, ao ambiente de vida, ao acesso aos cuidados de saúde, destacando-se como variável modificável a não adesão medicamentosa. Reforça-se a necessidade de incentivo das políticas públicas para o estabelecimento de novas estratégias para abordagem dos fatores modificáveis no manejo da hipertensão

Objectives: to analyze the percentage of patients under antihypertensive treatment who have controlled blood pressure levels and associated factors. Method: cross-sectional and analytical study. The selection of patients occurred by probabilistic sampling, by clusters treated descriptively and analytically. A total of 720 individuals participated in the studys. Results: after logistic regression, the variables gender, adherence to drug therapy, previous history of heart disease and self-medicating remained associated with non-control of blood pressure. Conclusion: the prevalence of blood pressure control was 54.3%, the difficulties in antihypertensive treatment are related to factors such as personal aspects, the living environment, access to health care, highlighting as a modifiable variable non-medication adherence. The need to encourage public policies to establish new strategies to address modifiable factors in the management of hypertension is reinforced

Objetivos: analizar el porcentaje de pacientes en tratamiento antihipertensivo que tienen niveles controlados de presión arterial y factores asociados. Método: estudio transversal y analítico. La selección de los pacientes ocurrió por muestreo probabilístico, por conglomerados tratados descriptiva y analíticamente. Un total de 720 individuos participaron en el estudio. Resultados: después de la regresión logística, las variables sexo, adhesión a la terapia medicamentosa, historia previa de cardiopatía y automedicación permanecieron asociadas al no control de la presión arterial. Conclusión: la prevalencia de control de la presión arterial fue de 54,3%, las dificultades en el tratamiento antihipertensivo se relacionan con factores como aspectos personales, el ambiente de vida, el acceso a la atención de salud, destacando como variable modificable la adhesión a la medicación. Se refuerza la necesidad de impulsar políticas públicas para establecer nuevas estrategias para abordar factores modificables en el manejo de la hipertensión

Diagnostic performance of anthropometric indicators used to assess excess body fat in adolescence / Desempenho diagnóstico dos indicadores antropométricos na avaliação do excesso de gordura corporal na adolescência

Abstract Objective: To compare the performance of anthropometric indicators that identify excess body fat (BF) in adolescents. Methods: This is a methodological study that used probability cluster sampling through school and class draws. Data collection included sociodemographic characteristics and anthropometric measures. Body mass index (BMI), waist-to-height ratio (WtHR), conicity index (C index), and waist circumference (WC) were calculated. Body fat percentage (BF%) was calculated from skinfold thickness and used as the gold standard. To analyze the data, descriptive statistics, Student's t-test, Receiver Operating Characteristic (ROC) curve, and Youden's index were used, in addition to correlation coefficient calculation between the indicators and BF%. Results: A total of 997 adolescents enrolled in municipal secondary schools participated in the study. By calculating the BMI, we found that 10.6% of adolescents were overweight, and 4.7% were obese. BMI, WC, and WtHR had the highest accuracy to predict body fatness. All the anthropometric indicators had higher specificity than sensitivity to diagnose excess BF in males. WC had the highest sensitivity in both genders. C index had the smallest area under the ROC curve and the lowest sensitivity in both genders, but its specificity was equivalent to that of the other indicators. Conclusions: BMI, WtHR, and WC were the best anthropometric indicators to predict excess BF in adolescents and had the best correlation coefficients. These tools can be considered in the screening to detect excess BF in adolescents.

RESUMO Objetivo: Comparar o desempenho de indicadores antropométricos para identificar o excesso de gordura corporal (GC) em adolescentes. Métodos: Estudo metodológico com amostragem probabilística por conglomerados, por sorteio das escolas e turmas. A coleta de dados incluiu características sociodemográficas e medidas antropométricas. O índice de massa corporal (IMC), a relação cintura-estatura (RCE), o índice de conicidade (IC) e a circunferência da cintura (CC) foram calculados. O percentual de gordura corporal (%GC) foi calculado com base na espessura das dobras cutâneas e utilizado como padrão-ouro. Para analisar os dados, foram utilizadas estatísticas descritivas, teste t de Student, curva Receiver Operating Characteristic (ROC) e índice de Youden. Foi calculado o coeficiente de correlação entre os indicadores e o %GC. Resultados: Participaram do estudo 997 adolescentes de escolas municipais. Identificou-se, pelo IMC, que 10,6% dos adolescentes apresentavam sobrepeso e 4,7%, obesidade. O IMC, a CC e a RCE apresentaram a maior acurácia para predizer a gordura corporal. Todos os indicadores antropométricos apresentaram especificidade superior à sensibilidade para diagnosticar excesso de GC no sexo masculino. A CC apresentou a maior sensibilidade em ambos os sexos. O IC apresentou a menor área sob a curva ROC e a menor sensibilidade em ambos os sexos, mas especificidade equivalente aos demais indicadores. Conclusões: IMC, RCE e CC apresentaram a melhor capacidade de predizer excesso de GC em adolescentes e os melhores coeficientes de correlação. Essas ferramentas podem ser consideradas formas de rastreamento na identificação do excesso de GC em adolescentes.

Representações sociais de médicos da Atenção Primária sobre a atenção à saúde para pessoas com deficiência / Representaciones sociales de médicos de la atención primaria sobre la atención de la salud para personas con discapacidad / Social representations of primary care physicians about health care for people with disabilities

O presente artigo objetivou analisar as representações sociais de médicos atuantes na Estratégia Saúde da Família sobre atendimento à saúde para pessoas com deficiência (PcD). Utilizou-se a Teoria das Representações Sociais, com abordagem estrutural da Teoria do Núcleo Central, a partir da técnica de evocação de palavras analisadas pelos softwares Evoc® e Iramutec®. Participaram da pesquisa 109 médicos, predominantemente jovens e mulheres. A atenção às PcD se orienta por uma prática incompleta, insegura e permeada pelo receio de médicos que referem lacunas no processo de formação profissional, além de haver dificuldades de comunicação com pacientes identificados como PcD. Poucos médicos apresentam relatos mais inclusivos na assistência de PcD. Predominam as percepções restritas ao corpo, normatizadas pelo modelo biomédico e que ignoram as estruturas sociais. (AU)

El objetivo fue el análisis de las Representaciones Sociales de médicos actuantes en la Estrategia Salud de la Familia sobre atención de la salud para personas con discapacidad (PcD). Se utilizó la Teoría de las Representaciones Sociales, con abordaje estructural de la Teoría del Núcleo Central a partir de la técnica de evocación de palabras analizadas por los softwares EVOC® e IRAMUTEC®. Participaron 109 médicos, predominantemente jóvenes y mujeres. La atención a las PcD se orienta por una práctica incompleta, insegura, atravesada por el recelo de médicos que refieren lagunas en el proceso de formación profesional, además de dificultades de comunicación con pacientes identificados como PcD. Pocos médicos presentan relatos más inclusivos en la asistencia de PcD. Predominan las percepciones restringidas al cuerpo, normalizadas por el modelo biomédico y que ignoran las estructuras sociales.(AU)

The objective was to analyze the Social Representations of physicians working in the Family Health Strategy on health care for people with disabilities (PwD). The Theory of Social Representations was used, with a structural approach of the Central Nucleus Theory based on the technique of evoking words analyzed by the EVOC® and IRAMUTEC® software. 109 physicians participated, predominantly younger individuals and women. Care to PwD is guided by an incomplete, unsafe practice, permeated by the fear of doctors who mention gaps in the professional training process, in addition to communication difficulties with patients identified as PwD. Few physicians have more inclusive reports on PwD care. The predominant perceptions are restricted to the body, standardized by the biomedical model and ignoring social structures.(AU)