Association between vitamin D insufficiency and depressive symptoms, and functional disability in community-dwelling Brazilian older adults: results from ELSI-Brazil study.

Low serum 25(OH)D levels (< 30 nmol/L) have been associated with increased depressive symptom scores over time, and it is believed that functionality may play a mediating role in the relationship between 25(OH)D and depressive symptoms. To comprehend the association between these factors could have significant implications for public health policy. The aim of this study was to verify the association between simultaneous vitamin D insufficiency and depressive symptoms, and functional disability in community-dwelling older adults. This was a cross-sectional study with data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), collected between 2015 and 2016. The outcomes were functional disability assessed through basic activities of daily living (ADL) and instrumental activities of daily living (IADL). The exposures were vitamin D insufficiency (< 30 nmol/L) and depressive symptoms (≥ 4 points in 8-item version of the Center for Epidemiological Studies-Depression). Crude and adjusted Poisson regression was performed to estimate associations. A total of 1781 community-dwelling older adults included in this study, 14.6% had disability in ADL and 47.9% in IADL; 59.7% had vitamin D insufficient levels, and 33.2% depressive symptoms. The concomitant presence of vitamin D insufficient and depressive symptoms increased the prevalence of ADL by 2.20 (95% CI: 1.25; 3.86) and IADL by 1.54 (95% CI: 1.24; 1.91), respectively. Therefore, preventive strategies to keep older adults physically and socially active, with a good level of vitamin D, are essential to avoid depression and functional disability.

Análise de instrumento orientador: contribuições para a simulação realística em saúde / Guiding instrument analysis: contributions to realística simulation in healthcare / Análisis de instrumentos rectores: contribuciones a la simulación realista en salud

Objetivo: analisar um instrumento orientador para a Simulação Realística em Saúde utilizado por uma Instituição de Ensino Superior. Método: estudo descritivo, qualitativo com participação de 23 profissionais com Graduação na área da saúde e experiência em simulação realística. A coleta de dados, via questionário on-line, ocorreu no período de março a junho de 2020. Utilizou-se a análise de conteúdo temático-categorial. Resultados: o instrumento contempla as etapas necessárias para o cotidiano do ensino em simulação. A categoria "Itens imprescindíveis para o planejamento da simulação" engloba.: preparo do cenário simulado; atuação dos docentes/facilitadores no briefing e no desenvolvimento do cenário simulado; atuação dos docentes/facilitadores no debriefing; e avaliação da simulação. Conclusão: o desenvolvimento desta pesquisa possibilitou adequação das dimensões do Isimula favorecendo clareza às etapas necessárias à simulação e contribui para apoiar docentes/facilitadores no planejamento, desenvolvimento e avaliação da simulação, em diferentes contextos de atenção à saúde.

Objective: to analyze a guiding instrument for Realistic Simulation in Health used by a Higher Education Institution. Method: this was a descriptive, qualitative study involving 23 professionals with a degree in healthcare and experience in realistic simulation. Data was collected via an online questionnaire between March and June 2020. Thematic-categorical content analysis was used. Results: the instrument covers the necessary steps for day-to-day simulation teaching. The category "Essential items for planning the simulation" includes: preparing the simulated scenario; the role of teachers/facilitators in briefing and developing the simulated scenario; the role of teachers/facilitators in debriefing; and evaluating the simulation. Conclusion: the development of this research enabled the dimensions of Isimula to be adapted, favoring clarity in the stages necessary for simulation and helping to support teachers/facilitators in the planning, development and evaluation of simulation in different healthcare contexts.

Objetivos:analizar un instrumento de orientación para la Simulación Realista en Salud utilizado por una Institución de Enseñanza Superior. Método: estudio descriptivo y cualitativo en el que participaron 23 profesionales con titulación sanitaria y experiencia en simulación realista. Los datos se recogieron a través de un cuestionario online entre marzo y junio de 2020. Se utilizó análisis de contenido temático-categorial. Resultados: el instrumento recoge los pasos necesarios para el día a día de la enseñanza de la simulación. La categoría "Elementos esenciales para la planificación de la simulación" incluye: la preparación del escenario simulado; el papel de los profesores/facilitadores en la información y el desarrollo del escenario simulado; el papel de los profesores/facilitadores en el debriefing; y la evaluación de la simulación. Conclusión: el desarrollo de esta investigación permitió adaptar las dimensiones de Isimula, favoreciendo la claridad en las etapas necesarias para la simulación y ayudando a apoyar a los profesores/facilitadores en la planificación, desarrollo y evaluación de la simulación en diferentes contextos sanitarios.

Socioemotional Factors and Cardiovascular Risk: What Is the Relationship in Brazilian Older Adults?

Background and Objectives: Cardiovascular risk is composed of several modifiable factors that cannot be explained only at the individual level. The aim of this study was to investigate the association between socioemotional factors and cardiovascular risk in older adults. Research Design and Methods: A cross-sectional study with data from The Brazilian Longitudinal Study of Aging (Estudo Longitudinal de Saúde dos Idosos Brasileiros, ELSI-Brazil), population based with data collected between 2015 and 2016. Cardiovascular risk-the study outcome-was assessed using the WHO/ISH Cardiovascular Risk Prediction Charts. The exposure variables were perceived social support from those who would receive help in situations and productive and leisurely social participation carried out in the last 12 months. We used crude and adjusted logistic regression for socioeconomic conditions, health conditions, and lifestyle habits to estimate odds ratio (OR) and 95% confidence intervals (CIs) for the occurrence of the outcome. Results: There were 6,005 participants between 50 and 74 years old with complete data. Of these, 18.7% (95% CI: 16.9-20.6) had high cardiovascular risk. Being in the highest tertile of greater social participation is associated with a lower prevalence of high cardiovascular risk (OR: 0.69; 95% CI: 0.50-0.95), adjusted for all variables, when compared to the lowest tertile. Furthermore, the absence of perceived social support is associated with a higher prevalence in different models. Perceived social support from close family members (son/daughter, son-in-law, and daughter-in-law) for material issues is associated with a higher prevalence, whereas having support from friends for affective resources is associated with a lower prevalence of high cardiovascular risk. Discussion and Implications: Socioemotional factors such as lack of perceived social support and social participation were significantly associated with cardiovascular risk. This suggested that the development of strategies aimed at reducing cardiovascular risk during aging needs to consider socioemotional factors and social relationships.

Is the combination of depression symptoms and multimorbidity associated with the increase of the prevalence of functional disabilities in Brazilian older adults? A cross-sectional study.

Introduction: Functional disabilities are more prevalent in older adults with multimorbidity and depression. However, few studies have investigated the combination of multimorbidity and depression with functional disability. This study aims to verify whether symptoms of depression and multimorbidity combined increase the prevalence of functional disability in Brazilian older adults. Material and methods: This is a cross-sectional study conducted with data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) baseline examination in 2015-2016 in adults aged 50 years and older. The variables included were basic (BADL) and instrumental activities of daily living (IADL), depressive symptoms, multimorbidity (≥2 chronic diseases), sociodemographic variables, and lifestyle. Logistic regression was performed to estimate crude and adjusted odds ratios. Results: A total of 7,842 participants over 50 years of age were included. Of these, 53.5% were women and 50.5% were between 50 and 59 years old, 33.5% reported ≥4 depressive symptoms, 51.4% had multimorbidity, 13.5% reported difficulty in performing at least one BADL, and 45.1% reported difficulty in performing the IADL. In the adjusted analysis, the prevalence of difficulty on BADL was 6.52 (95% CI: 5.14; 8.27) and on IADL was 2.34 (95% CI: 2.15; 2.55), higher for those with depression and multimorbidity combined when compared with those without these conditions. Conclusion: The combination of symptoms of depression and multimorbidity may increase functional impairments in the BADL and IADL of Brazilian older adults, impairing self-efficacy, independence, and autonomy. Early detection of these factors benefits the person, their family, and the healthcare system for health promotion and disease prevention.

Perfil do absenteísmo dos servidores públicos de um município do Extremo Sul Catarinense

O objetivo do presente estudo foi verificar o perfil do absenteísmo dos servidores públicos de um município do extremo sul catarinense. A pesquisa é de natureza observacional e transversal, utilizando-se de dados fornecidos pela prefeitura municipal estudada. Foram analisados 578 servidores públicos municipais que afastaram-se entre 2015 e 2020. Dentre os servidores em afastamento, aponta-se que 77,3% eram do sexo feminino, 31,5% tinham entre os 29 aos 38 anos de idade, 53,3% eram servidores estatutários, e 65,1% ocorreram nos primeiros 5 anos de trabalho. Os Auxiliares de Ensino de Educação, foram os profissionais que mais se afastaram, e entre as secretarias, foi a Secretaria de Educação. Como principais causas de afastamento foram identificadas as doenças causadas por transtornos mentais e comportamentais, doenças do sistema osteomuscular, doenças do sistema respiratório e fatores que influenciam o estado de saúde e o contato com os serviços de saúde. Conclui-se que as causas de afastamentos são preocupantes, e provocam alterações nos processos de trabalho. Dessa forma, é importante compreender essa dinâmica, contribui para planejar medidas para reduzir os índices de absenteísmo no município.

Palliative Care in Heart Failure: An Integrative Review of Nurse Practice.

Introduction: Because it is a chronic disease of progressive evolution, heart failure requires nursing attitudes and practices that are articulated with palliative care, implemented in an interdisciplinary team along with patients and their families. Objective: Identifying nurses' attitudes and practices in palliative care in cardiology. Method: Integrative literature review. The searches were carried out in the following bases: Google Scholar, Virtual Health Library, LILACS, SciELO, Embase, MEDLINE, CINAHL, and Scopus; through the terms Palliative Care AND Cardiology AND Nursing. Results: We identified 1298 studies published in the last five years, 14 of which have been selected for the scope of this review. Nurse attitudes and practices were characterized as: approach to symptom control; promotion of comfort and well-being; integrality of care and family orientation; effective communication among patients, family members and nursing team; timely evaluation for palliative care. Most of the studies included in this review have evidence level 2C (n = 7) and 2B (n = 4). Therefore, the results can be interpreted as reliable. Conclusions: This study makes important contributions to the practice of nurses in palliative care for heart failure. Based on the evidence collected, nurses can develop actions with the nursing team and with the interdisciplinary team related to direct patient and family care, as well as professional training. However, the field lacks studies showing the practices and actions implemented by the nursing team.

Telessimulação como método remoto de ensino em reanimação cardiopulmonar: relato de experiência / Telesimulation as a remote teaching method for cardiopulmonary resuscitation: experience report / Telesimulación como método de enseñanza a distancia en reanimación cardiopulmonar: informe de experiencia

RESUMO Objetivo: descrever a experiência na elaboração e implementação de um curso remoto sobre Reanimação Cardiopulmonar para profissionais de saúde por meio da Telessimulação. Desenvolvimento: relato de experiência de um curso para capacitação em Reanimação Cardiopulmonar, desenvolvido com 227 profissionais de saúde entre junho e julho de 2021, de forma remota e síncrona, no estado do Rio de Janeiro - Brasil. O curso foi ministrado para 35 turmas por meio da aplicação de: pré-teste; videoaula e pós-teste 1; e Telessimulação e pós-teste 2 com avaliação de percepção. Na avaliação, a Telessimulação se destacou como estratégia de motivação para maior aprendizado sobre o tema, evidenciado pelo aumento do número de acertos entre os testes. Conclusão: o curso teve interesse dos participantes e se mostrou como estratégia de aprendizagem, sendo, ainda, considerado uma possibilidade de inovação para a educação permanente em saúde.

ABSTRACT Objective: to describe the experience in the elaboration and implementation of a remote course on Cardiopulmonary Resuscitation for health professionals by means of Telesimulation. Development: an experience report about a course for Cardiopulmonary Resuscitation training, developed remotely and synchronously with 227 health professionals between June and July 2021 in the state of Rio de Janeiro - Brazil. The course was taught for 35 groups of students by applying the following: pre-test, video class and post-test 1; and Telesimulation and post-test 2 with perception assessment. In the assessment, Telesimulation stood out as a motivation strategy for improved learning about the topic, evidenced by the increase in the number of correct answers between the tests. Conclusion: the participants showed interest in the course, which proved to be a learning strategy, also considered as an innovation possibility for permanent education in health.

RESUMEN Objetivo: describir la experiencia en la elaboración e implementación de un curso a distancia de Reanimación Cardiopulmonar para profesionales de la salud mediante Telesimulación. Desarrollo: informe de experiencia de un curso de capacitación en Reanimación Cardiopulmonar, realizado con 227 profesionales de la salud entre junio y julio de 2021, de forma remota y sincrónica, en el estado de Río de Janeiro, Brasil. Se dictó el curso a 35 grupos y se los sometió a: pretest; video clase y postest 1; y Telesimulación y postest 2 con evaluación de la percepción. En la evaluación, la Telesimulación se destacó como estrategia para motivar un mayor aprendizaje sobre el tema, como revela el aumento del número de aciertos entre los tests. Conclusión: el curso fue de interés para los participantes y demostró ser una estrategia de aprendizaje, además de ser considerado una posibilidad de innovación para la educación permanente en salud.

Consulta de enfermagem na perceção da pessoa com doença cardiovascular / Nursing consultation from the perspective of the person with cardiovascular disease / Consulta de enfermería en la percepción de la persona con enfermedad cardiovascular

Resumo Enquadramento: A consulta de enfermagem é uma ação que potencializa a mudança de comportamentos nas pessoas com doença cardiovascular a serem seguidas em ambulatório. Objetivo: Conhecer a perceção das pessoas com doença cardiovascular sobre a consulta de enfermagem em ambulatório. Metodologia: Estudo transversal, qualitativo, com aplicação de entrevista semiestruturada a pessoas com doença cardiovascular seguidas em ambulatório. As entrevistas foram gravadas e transcritas e aplicou-se a análise de conteúdo temático categorial. Resultados: Foram incluídas 20 pessoas no estudo. Três categorias emergiram de 160 unidades de registo: 1) Expectativas para a consulta de enfermagem; 2) Compreensão sobre a consulta de enfermagem; e 3) Experiência - consulta de enfermagem. Conclusão: Os usuários que não passaram pela consulta de enfermagem não conhecem o que é a consulta nem a reconhecem como parte do cuidado longitudinal. Entretanto, aqueles que já vivenciaram a experiência da consulta, reconhecem-na como um espaço de vínculo, de possibilidade de realizar mudanças efetivas de comportamentos relacionados com a saúde e de esclarecimento de dúvidas.

Abstract Background: The nursing consultation promotes behavioral changes in the outpatient follow-up of people with cardiovascular diseases. Objective: To know the perceptions of people with cardiovascular diseases about the outpatient nursing consultation. Methodology: A cross-sectional, qualitative study was carried out using semi-structured interviews with people with cardiovascular diseases in outpatient follow-up. The interviews were recorded and transcribed, and the thematic-categorical content analysis method was applied. Results: Twenty people were included in the study. Three categories emerged from 160 registration units: 1) Expectations about the nursing consultation; 2) Understanding of the nursing consultation; and 3) Nursing consultation experience. Conclusion: Patients who have not experienced a nursing consultation are not familiar with what the consultation is nor recognize it as part of longitudinal care. However, those who have already experienced the consultation recognize it as a space for bonding, making effective changes in health-related behaviors, and clearing doubts.

Resumen Marco contextual: La consulta de enfermería es una acción que potencia el cambio de conducta en las personas con enfermedades cardiovasculares a las que se hará un seguimiento en las consultas externas. Objetivo: Conocer la percepción de las personas con enfermedades cardiovasculares sobre la consulta externa de enfermería. Metodología: Estudio transversal, cualitativo, en el que se aplicó la entrevista semiestructurada a personas con enfermedad cardiovascular a las que se hizo un seguimiento en una consulta externa. Las entrevistas se grabaron y transcribieron, y se aplicó el análisis de contenido categórico temático. Resultados: Se incluyeron 20 personas en el estudio. De las 160 unidades de registro surgieron tres categorías: 1) Expectativas de la consulta de enfermería; 2) Comprensión sobre la consulta de enfermería, y 3) Experiencia - consulta de enfermería. Conclusión: Los usuarios que no han pasado por una consulta de enfermería no saben lo que es la consulta ni la reconocen como parte de la atención longitudinal. Sin embargo, quienes ya han pasado por la consulta la reconocen como un espacio de vinculación, de posibilidad de realizar cambios efectivos en las conductas relacionadas con la salud y de aclaración de dudas.

Centrais de Regulação e Consórcios Intermunicipais de Saúde: a Percepção de Gestores Catarinenses

Objetivo: Analisar a percepção dos gestores dos consórcios intermunicipais de saúde e das comissões intergestores regionais do sul de Santa Catarina sobre a incorporação das centrais de regulação nos procedimentos eletivos de média e alta complexidade, inseridos nos consórcios intermunicipais de saúde do estado. Métodos: Trata-se de um estudo descritivo como abordagem mista, realizado com representantes legais de consórcios intermunicipais de saúde e gestores municipais representantes da Comissão Intergestores Regional do sul de Santa Catarina, totalizando 6 participantes. A coleta de dados se deu através de entrevista semiestruturada. A análise ocorreu por método de condensação de significados com auxílio do programa SPSS versão 23.0. Resultados: Foi possível obter a percepção dos representantes legais e gestores acerca dos mecanismos de regulação, legislação vigente, sua eficácia e seu conhecimento prévio a respeito dos mesmos. Além disso, conseguiu-se traçar as características do perfil profissional dos respectivos indivíduos. Conclusões: Os resultados obtidos apontam uma percepção positiva dos gestores acercada regulação e o auxílio que a mesma trouxe aos municípios em relação à continuidade na linha de cuidado e a garantia do acesso aos pacientes com critérios clínicos mais graves. Evidenciou-se também a necessidade de melhorias na eficiência e fiscalização das legislações vigentes, além da necessidade dos gestores receberem capacitações acerca de características pontuais dos mecanismos legais.

The combined effect of anemia and dynapenia on mortality risk in older adults: 10-Year evidence from the ELSA cohort study.

BACKGROUND/OBJECTIVE: Anemia and dynapenia can occur simultaneously. Separately, both conditions increase the mortality risk with advancing age. However, there is no epidemiological evidence on the combined effect of these conditions on mortality in older adults. We investigated whether combined anemia and dynapenia increase the mortality risk, and whether there are gender differences. METHODS: A 10-year follow-up study was conducted involving 5,310 older adults from the English Longitudinal Study of Ageing (ELSA). According to the diagnosis of anemia (hemoglobin concentration < 13.0 g/dL in men and < 12.0 g/dL in women) and dynapenia (grip strength < 26 kg for men and < 16 kg for women), individuals at baseline were categorized as "non-anemic/non-dynapenic", "dynapenic", "anemic" and "anemic/dynapenic". The outcome was all-cause mortality during the follow-up period. RESULTS: A total of 984 deaths were computed during the follow-up (63.7% in non-anemic/non-dynapenic, 22.8% in dynapenic, 7.5% in anemic and 6.0% in anemic/dynapenic). Adjusted Cox proportional hazard models stratified by sex showed that anemia and dynapenia combined was associated with an increased mortality risk in men (HR: 1.64; 95% IC 1.08 - 2.50) and women (HR: 2.17; 95% CI 1.44 - 3.26). Anemia in men (HR: 1.68; 95% CI 1.22 - 2.32) and dynapenia in women (HR: 1.37; 95% CI 1.09 - 1.72) were also risk factors for mortality. CONCLUSIONS: The coexistence of anemia and dynapenia increases the mortality risk, highlighting the need for early identification, prevention, and treatment of these conditions to reduce their complications and the mortality risk.

Tobacco-related neoplasms: survival analysis and risk of death of population data from Florianópolis, SC.

OBJECTIVE: To estimate the probability of survival and prognostic factors for tobacco-related neoplasms in a population-based cohort. METHODS: This is a cohort with data from the Population-Based Cancer Registry of Florianópolis, southern Brazil, from 2008 to 2012. The Stata 16.0 software was used to estimate the probabilities of survival in five years after diagnosis, by the Kaplan Meier method, and the risk of death, by the Cox regression. RESULTS: A total of 2,829 cancer records related to smoking were included, more prevalent among males, over 70 years of age, nine years or more of schooling, white, with a partner and metastatic diagnosis. The most frequent groupings were colon and rectum (28.7%), trachea, bronchi and lungs (18.6%) and stomach (11.8%). At follow-up, 1,450 died. Pancreatic cancer had the worst probability of survival (14.3%), followed by liver cancer (19.4%). CONCLUSION: Risk factors for death and survival rates differ across the 13 types of tobacco-related cancers. Early diagnosis and primary prevention are strategies that must be improved to improve survival and decrease the burden related to these types of cancer.

Esperança e desespero: reflexões sobre o acesso na Atenção Primaria à Saúde / Hope and despair: reflections on access in Primary Health Care / Esperanza y desesperación: reflexiones sobre el acceso en la Atención Primaria de Salud

Objetivo: refletir sobre o acesso na Atenção Primária à Saúde (APS) através de analogias entre dois programas televisivos brasileiros. Método: trata-se de uma reflexão teórica sustentada em elementos da cultura televisiva popular brasileira, a partir dos programas: a porta da esperança e a porta dos desesperados. Resultados: o acesso à saúde no âmbito da APS pode ser analisado na perspectiva de três portas: esperança, na solução de suas necessidades; desespero, voltada aqueles que não conseguem encontrar soluções as suas demandas; e a prioritária, pautada nas atribuições que lhe constitui e no direito à saúde. Conclusão: a APS precisa superar a tipologia de porta da esperança e dos desesperados para efetivação da sua atribuição ordenadora da rede de atenção à saúde.

Objective: to reflect on access in Primary Health Care (PHC) through analogies of two Brazilian television shows. Method: this is a theoretical reflection based on elements of Brazilian popular television culture, based on the shows: the door of hope and the door of the desperate. Results: the access to health within the scope of PHC can be analyzed from the perspective of three doors: hope, in the solution of their needs; despair, aimed at those who cannot find solutions to their demands; and the priority, based on the attributions that constitute it and the right to health. Conclusion: PHC needs to overcome the typology of the door of hope and of the desperate for the achievement of its ordering attribution of the health care network.

Objetivo: reflexionar sobre el acceso en la Atención Primaria de Salud (APS) a través de analogías entre dos programas de televisión brasileños. Método: se trata de una reflexión teórica a partir de elementos de la cultura popular televisiva brasileña, a partir de los programas: la puerta de la esperanza y la puerta de los desesperados. Resultados: el acceso a la salud en el ámbito de la APS puede analizarse desde la perspectiva de tres puertas: la esperanza, en la solución de sus necesidades; la desesperación, dirigida a quienes no encuentran solución a sus demandas; y la prelación, con base en las atribuciones que la constituyen y el derecho a la salud. Conclusión: la APS necesita superar la tipología de la puerta de la esperanza y del desesperado para cumplir su tarea de organización de la red de atención a la salud.

Mães com Deficiência e Maternidade: Cotidiano, Redes de Apoio e Relação com a Escola / Mothers with Disabilities and Motherhood: Everyday Life, Support Networks and Relationship with School

RESUMO: Cerca de metade das pessoas com deficiência no Brasil são mulheres e uma parte delas torna-se mãe. Entretanto, não há dados na literatura sobre as necessidades específicas dessa população. Assim sendo, este artigo tem por objetivo apresentar as percepções de mulheres com deficiência física e visual sobre si mesmas, sobre o cotidiano da maternidade, as redes de apoio e a relação da família com a escola. A pesquisa seguiu a metodologia qualitativa e utilizou narrativas como forma de coletar dados. Participaram do estudo seis mulheres, sendo três com deficiência visual e três com deficiência física. Os resultados estão apresentados em duas categorias: 1) concepções das mulheres sobre sua deficiência, que reúne falas sobre como a interação com a sociedade afeta a concepção que elas têm de si mesmas; e 2) cotidiano da maternidade, que discute os relatos sobre o cotidiano e as experiências dessas mulheres como mães, incluindo suas redes de apoio formal e informal, os desafos diários e as adaptações necessárias no cuidado com seus filhos, as relações com a escola e a comunidade e a maneira como as crianças se desenvolvem e se organizam frente às limitações da mãe. As narrativas trouxeram elementos importantes do cotidiano dessas mulheres que são invisíveis perante a sociedade e os profssionais que atuam junto às pessoas com deficiência, indicando a necessidade de fomentar práticas profssionais e mais pesquisas sobre o tema, com a perspectiva de promover uma sociedade mais inclusiva.

ABSTRACT: About half of the people with disabilities in Brazil are women, and some of them become mothers. However, there is no data in literature about the specific needs of this population. Tus, this paper aims to present the perceptions of women with physical and visual disabilities about themselves, about everyday life as mothers, about support networks and the relationship between family and school. The research followed a qualitative methodology and used narratives as a means of data collection. Six women participated in the study, three with visual impairment and three with physical disability. The findings are presented in two categories: 1) women's conceptions of their disability, which summarizes their expressions about interactions with society that affect their self-image; and 2) daily life of motherhood, which addresses the accounts of these women's daily lives and experiences as mothers, including their formal and informal support networks, daily challenges and necessary adjustments in caring for their children, relationships with school and the community, and how the children develop and self-organize in the face of their mother's limitations. The narratives brought to light important elements of these women's daily lives that are invisible to society and to professionals working with people with disabilities. This shows the need to promote professional practices and more research on the subject in order to create a more inclusive society.

Overall survival analyses of female malignancies in Southern Brazil during 2008-2017: A closer look at breast, cervical and ovarian cancer.

Background: The aim of this study was to report the overall survival and baseline factors associated with OS for breast, cervical and ovarian cancer in Florianópolis, Southern Brazil, a region with quality-of-life indicators comparable to high-income countries. Methods: Cohort study was performed from probabilistic record linkage of the Mortality Information System and the Population-based cancer registry of Florianópolis. It was included breasts, cervical and ovarian cancer diagnosis during the period of 2008-2012 with a follow up of 60 months. Cox regression and Kaplan-Meier method were used for associations with overall survival and risk factors. Findings: 1857 cases of the three malignancies were included in the analysis. We identified 202 deaths in breast cancer subjects, 53 for cervical cancer and 51 for ovarian cancer. Metastatic disease at diagnosis was present in 31%, 9.6%, and 55% of the cases, respectively. Overall survival was statistically correlated with age, educational level and stage for breast cancer; age and stage for cervical cancer; age and stage for ovarian cancer. Interpretation: Metastatic disease and age are the main prognostic factors for the malignancies studied, as they were associated with both overall survival and risk of death. Better screening and preventive tests for early diagnosis are needed. Funding: Support of Research and Innovation in the State of Santa Catarina, Research Program for the Unified Health System (FAPESC/MS-DECIT/CNPQ/SES-SC-PPSUS); the Brazilian National Research Council (CNPq); and the Coordination for the Improvement of Higher Education Personnel (CAPES).

Percepção dos usuários sobre a atenção primária em saúde: estudo transversal em um município de grande porte / Users' perception about primary health care: a cross-sectional study in a large municipality

O objetivo deste estudo foi avaliar o nível de satisfação dos usuários da Atenção Primária em Saúde de um município de grande porte. Trata-se de um estudo transversal, do tipo censitário e com amostra por conveniência, visto que foram incluídas todas as unidades de saúde e entrevistados os usuários que estavam na sala de espera no dia da coleta e aceitaram participar da pesquisa. Toda a coleta de dados foi realizada por meio de questionários, e,posteriormente,tabulada e analisada no software Stata 14.0. Os usuários relataram satisfação com a unidade e equipe, e com serviços assistenciais. Entretanto, usuários que manifestaram que trocariam de unidade caso isto fosse possível, tinham razões atribuídas à organização do cuidado e agendamento de consultas. Concluímos que a satisfação com os cuidados exercidos pelos profissionais e com o acolhimento de informações de cunho afetivo foram evidentemente altas, ao passo que a insatisfação com a organização do cuidado é aparente.

This study aimed to assess the level of satisfaction of users of PrimaryHealth Care in a large city. This is a cross-sectional, census-type study with a convenience sample, as all health units were included and users who were in the waiting room on the day of collection and who agreed to participate in the survey were interviewed. All data collection was performed through questionnaires, and later tabulated and analyzed using the Stata 14.0 software. Users reported satisfaction with the unit and team, and with care services. However, users who stated that they would change units if this was possible had reasons attributed to the organization of care and appointment scheduling. We conclude that satisfaction with the care provided by professionals and with the reception of information of an affective nature were evidently high, while dissatisfaction with the organization of care is apparent.

Incidência de câncer nas regiões brasileiras e suas associações às Políticas de Saúde / Incidence of cancer in the regions of Brazil and their associations with Health Policies

A incidência de câncer em todo o Brasil expressa o quadro sanitário no qual se encontra o país, o que requer um sistema um sistema de saúde capaz de interferir positivamente em tais situações. Foram analisadas as taxas de incidência de câncer de pulmão, traqueia, brônquios, esófago, estômago, cólon, reto, anus, próstata, lábio, cavidade oral, melanoma maligno da pele e outras neoplasias malignas de pele verificando a tendência nas regiões brasileiras, e a relação com as políticas públicas existentes neste período. Estudo transversal retrospectivo com dados obtidos no DATASUS e do Instituto Nacional do Câncer (INCA). Observa-se diferentes padrões de incidência dos principais tipos de cânceres entre as regiões brasileiras, com as maiores taxas para o câncer de próstata, de mama, de pele e cólon, reto e ânus, que permaneceram em ascensão no período analisado. O câncer de pulmão, brônquio e traqueia tem apresentado tendência de estabilidade e no de estômago, houve redução para o sexo masculino na região sudeste. Assim, são reconhecidos limites no processo de controle do câncer, mas também êxitos, o que condiz com bons resultados das políticas de saúde implementadas, em especial, as relacionadas às ações da atenção básica.

The incidence of cancer throughout Brazil expresses the sanitary condition in which the country finds itself, which requires a health system capable of positively interfering with such situations. The incidence rates of lung, tracheal, bronchus, esophagus, stomach, colon, rectum, anus, prostate, lip, and oral cavity cancer, malignant skin melanoma, and other malignant skin neoplasias were analyzed, verifying the tendencies in the Regions of Brazil and their relationship with existing public policies in this period. This cross-sectional retrospective study was conducted with data obtained from DATASUS and the National Cancer Institute (INCA). Different incidence patterns of the main types of cancer were observed between the Regions of Brazil, with higher rates of prostate, breast, skin, colon, rectum, and anus cancer, which continuously increased in the period analyzed. Lung, bronchus, and tracheal cancer tended to stabilize, while stomach cancer decreased among males in the Southeast Region. Hence, limitations are recognized in the cancer control process, although there are successes as well ­ which agrees with the good results in the implemented health policies, especially those related to primary health care actions.

Depressive symptoms as an independent risk factor for mortality

Objective: To evaluate the relationship between presence of depressive symptoms and risk of death in older adults residing in a municipality in Southern Brazil. Methods: Between 2009 and 2014, 1,391 people participated in the EpiFloripa Aging Cohort Study, a population-based longitudinal study. Depressive symptoms were assessed through the Geriatric Depression Scale. The initial time was considered the age at the first interview, and the end time, the age at the last contact or death. Cox regression models were used to estimate the mortality risk associated with depressive symptoms, adjusted by sex, education, income, paid work, smoking status, alcohol consumption, morbidities, medication use, physical activity, disability, cognitive impairment, and body mass index. Results: The prevalence of depressive symptoms was 23.5% (95%CI 20.4-26.9). On crude analysis, the risk of mortality was 1.86 (95%CI 1.35-2.55) for individuals with depressive symptoms; in adjusted models, the risk of mortality was 1.67 (95%CI 1.15-2.40). Conclusion: Depressive symptoms are an independent risk factor for mortality in older Brazilian adults. Our findings highlight the importance of screening this population for depression and the practice of preventive actions.

Racial inequities in tooth loss among older Brazilian adults: A decomposition analysis.

OBJECTIVE: To determine the extent to which racial inequities in tooth loss and functional dentition are explained by individual socioeconomic status, smoking status and frequency/reason for the use of dental services. METHODS: Data came from the Brazilian Longitudinal Study of Ageing, a nationally representative sample of community-dwelling people aged 50 years and over. Tooth loss and functional dentition (ie 20+ natural teeth) were the outcomes. The main explanatory variable was self-classified race. Covariates included dental visits in the past 12 months, dental visits for check-ups only, smoking status, self-reported chronic conditions, depression and cognitive function. Logistic regression and Blinder-Oaxaca decomposition analysis were used to estimate the share of each factor in race-related tooth loss inequities. RESULTS: The analytical sample comprised of 7126 respondents. While the prevalence of functional dentition in White Brazilians was 37% (95% CI: 33.5;40.9), it was 29% (95% CI: 26.4;31.6) among Browns and 30% (95% CI: 25.1;35.4) among Blacks. The average number of lost teeth among Whites, Browns and Blacks were 18.7 (95% CI: 17.8;19.6), 20.4 (95% CI: 19.7;21.1) and 20.8 (95% CI: 19.5;22.0), respectively. Decomposition analysis showed that the selected covariates explained 71% of the racial inequalities in tooth loss. Dental visits in the previous year and smoking status explained nearly half of race-related gaps. Other factors, such as per capita income, education and cognitive status, also had an important contribution to the examined inequalities. The proportion of racial inequities in tooth loss that was explained by dental visits (frequency and reason) and smoking status decreased from 40% for those 50-59 years of age to 22% among participants aged 70-79 years. CONCLUSIONS: Frequency and reason for dental visits and smoking status explained nearly half of the racial inequity in tooth loss among Brazilian older adults. The Brazilian Family Health Strategy Program should target older adults from racial groups living in deprived areas.

Depressive symptoms as an independent risk factor for mortality.

OBJECTIVE: To evaluate the relationship between presence of depressive symptoms and risk of death in older adults residing in a municipality in Southern Brazil. METHODS: Between 2009 and 2014, 1,391 people participated in the EpiFloripa Aging Cohort Study, a population-based longitudinal study. Depressive symptoms were assessed through the Geriatric Depression Scale. The initial time was considered the age at the first interview, and the end time, the age at the last contact or death. Cox regression models were used to estimate the mortality risk associated with depressive symptoms, adjusted by sex, education, income, paid work, smoking status, alcohol consumption, morbidities, medication use, physical activity, disability, cognitive impairment, and body mass index. RESULTS: The prevalence of depressive symptoms was 23.5% (95%CI 20.4-26.9). On crude analysis, the risk of mortality was 1.86 (95%CI 1.35-2.55) for individuals with depressive symptoms; in adjusted models, the risk of mortality was 1.67 (95%CI 1.15-2.40). CONCLUSION: Depressive symptoms are an independent risk factor for mortality in older Brazilian adults. Our findings highlight the importance of screening this population for depression and the practice of preventive actions.

Inclusão de pessoas com deficiência no trabalho: estudo da comunicação / Work inclusion of people with disabilities: a communication study

Este estudo buscou compreender o processo de comunicação entre pessoas com e sem deficiência no contexto de trabalho e, a partir disso, descrever a comunicação como uma dimensão a ser considerada para a construção de um clima organizacional facilitador da inclusão. Trata-se de uma pesquisa exploratória descritiva com abordagem qualitativa. Participaram do estudo nove trabalhadores com deficiência. Os dados foram coletados por entrevistas semiestruturadas e analisados de acordo com o método de análise de conteúdo temática. Foram elencadas quatro categorias analíticas que permitiram aprofundar o conhecimento sobre as dinâmicas de comunicação e de inclusão/exclusão, sendo elas: cotidiano de trabalho, processo seletivo, barreiras para permanência no trabalho, e engajamento no trabalho. Esta pesquisa constatou que os desafios para a inclusão no mercado de trabalho permanecem e apontou a comunicação como um componente a ser considerado no processo. A comunicação é uma ferramenta estratégica para a inclusão das pessoas com deficiência no trabalho, mas que ainda persistem barreiras que precisam ser superadas e facilitadores que podem ser potencializados

This study aims to understand the process of communication between people with and without disabilities in the workplace and, from that, describe communication as a dimension to be considered in the construction of an inclusive organizational climate. This is an exploratory descriptive research with a qualitative approach. Nine workers with disabilities participated in the study. Data were collected through semi-structured interviews and analyzed according to the to the method of content analysis. Four analytical categories were listed that allowed a deeper understanding about the dynamics of communication and inclusion/exclusion, namely: daily work, selection process, barriers to the permanence at work and work engagement. This research has evidenced that the challenges for inclusion in the labor market remain and referred to communication as a component to be considered in the process. Communication is a strategic tool for the inclusion of people with disabilities at work, but there are still barriers that need to be overcome and facilitators that can be potentialized