Test for clinical reasoning evaluation in Speech-Language Pathology: content validity. / Teste para avaliação do raciocínio clínico em Fonoaudiologia: validade de conteúdo.

PURPOSE: To validate the content of the Speech-Language Pathology Concordance Test called FonoTCS. METHODS: This is a content validation study of the instrument. Five speech-language pathologists, all with doctoral degrees and teaching experience, averaging 24.8 years of professional practice, participated in the development of FonoTCS and reached a consensus during the process. Thirty questions and 120 items were created, covering seven areas of speech-language pathology expertise across three domains. For content validation, FonoTCS was electronically sent to 15 evaluators to respond to a questionnaire with five questions, rated on a five-point scale, regarding the criteria of clarity, ethics, and relevance of the questions. The Corrected Content Validity Coefficient was calculated for all statements to analyze the responses. Questions with agreement percentages equal to or less than 80% were revised. RESULTS: Thirteen evaluators, all female, with an average age of 39.07 years, including eight with master's degrees and five with doctoral degrees, and an average clinical practice experience of 15.38 years, participated in the analysis. The average Corrected Content Validity Coefficient values for the clarity criterion were 0.93 and 0.95, for the relevance criterion 0.98 and 0.92, and for the ethics criterion 0.99. Two questions received scores of 0.78 and 0.80, both related to the audiology area in the assessment/diagnosis domain, specifically question 2 regarding the relevance criterion. These questions were reviewed and restructured by the judges. CONCLUSION: FonoTCS is a valid instrument from a content perspective.

OBJETIVO: validar o conteúdo do Teste de Concordância de Scripts em Fonoaudiologia, denominado FonoTCS. MÉTODO: Trata-se de estudo de validação de conteúdo de instrumento. Participaram da construção do FonoTCS cinco fonoaudiólogas, doutoras e docentes, com média de 24,8 anos de atuação profissional, que chegaram a um consenso durante o processo de construção do teste. Elaborou-se 30 questões e 120 itens contemplando as áreas de atuação fonoaudiológica. Em seguida, 15 fonoaudiólogas com titulação mínima de mestre, e com, no mínimo, 10 anos de atuação clínica generalista receberam eletronicamente o FonoTCS para validação de conteúdo por meio de questionário sobre critérios de clareza, ética e pertinência do conteúdo das questões. Para a análise das respostas calculou-se o Coeficiente de Validade de Conteúdo Corrigido de todas as afirmativas. Foram revisadas as questões com porcentagem de concordância igual ou inferior a 80%. RESULTADOS: 13 avaliadores responderam a análise, todos do sexo feminino, com média de idade de 39,07 anos, sendo oito mestres e cinco doutoras, com atuação clínica generalista média de 15,38 anos. Os valores médios do Coeficiente de Validade de Conteúdo Corrigido foram 0,93 e 0,95 para o critério de clareza; 0,98 e 0,92 para o critério de pertinência; e 0,99 para o critério de ética. Duas questões apresentaram notas de 0,78 e 0,80, sendo ambas da área de audiologia no domínio de avaliação/diagnóstico, para a questão relacionada ao critério de pertinência, sendo revisadas e reestruturadas pelos juízes. CONCLUSÃO: O FonoTCS é um instrumento válido do ponto de vista do conteúdo.

Teste para avaliação do raciocínio clínico em Fonoaudiologia: validade de conteúdo / Test for clinical reasoning evaluation in Speech-Language Pathology: content validity

RESUMO Objetivo validar o conteúdo do Teste de Concordância de Scripts em Fonoaudiologia, denominado FonoTCS. Método Trata-se de estudo de validação de conteúdo de instrumento. Participaram da construção do FonoTCS cinco fonoaudiólogas, doutoras e docentes, com média de 24,8 anos de atuação profissional, que chegaram a um consenso durante o processo de construção do teste. Elaborou-se 30 questões e 120 itens contemplando as áreas de atuação fonoaudiológica. Em seguida, 15 fonoaudiólogas com titulação mínima de mestre, e com, no mínimo, 10 anos de atuação clínica generalista receberam eletronicamente o FonoTCS para validação de conteúdo por meio de questionário sobre critérios de clareza, ética e pertinência do conteúdo das questões. Para a análise das respostas calculou-se o Coeficiente de Validade de Conteúdo Corrigido de todas as afirmativas. Foram revisadas as questões com porcentagem de concordância igual ou inferior a 80%. Resultados 13 avaliadores responderam a análise, todos do sexo feminino, com média de idade de 39,07 anos, sendo oito mestres e cinco doutoras, com atuação clínica generalista média de 15,38 anos. Os valores médios do Coeficiente de Validade de Conteúdo Corrigido foram 0,93 e 0,95 para o critério de clareza; 0,98 e 0,92 para o critério de pertinência; e 0,99 para o critério de ética. Duas questões apresentaram notas de 0,78 e 0,80, sendo ambas da área de audiologia no domínio de avaliação/diagnóstico, para a questão relacionada ao critério de pertinência, sendo revisadas e reestruturadas pelos juízes. Conclusão O FonoTCS é um instrumento válido do ponto de vista do conteúdo.

ABSTRACT Purpose To validate the content of the Speech-Language Pathology Concordance Test called FonoTCS. Methods This is a content validation study of the instrument. Five speech-language pathologists, all with doctoral degrees and teaching experience, averaging 24.8 years of professional practice, participated in the development of FonoTCS and reached a consensus during the process. Thirty questions and 120 items were created, covering seven areas of speech-language pathology expertise across three domains. For content validation, FonoTCS was electronically sent to 15 evaluators to respond to a questionnaire with five questions, rated on a five-point scale, regarding the criteria of clarity, ethics, and relevance of the questions. The Corrected Content Validity Coefficient was calculated for all statements to analyze the responses. Questions with agreement percentages equal to or less than 80% were revised. Results Thirteen evaluators, all female, with an average age of 39.07 years, including eight with master's degrees and five with doctoral degrees, and an average clinical practice experience of 15.38 years, participated in the analysis. The average Corrected Content Validity Coefficient values for the clarity criterion were 0.93 and 0.95, for the relevance criterion 0.98 and 0.92, and for the ethics criterion 0.99. Two questions received scores of 0.78 and 0.80, both related to the audiology area in the assessment/diagnosis domain, specifically question 2 regarding the relevance criterion. These questions were reviewed and restructured by the judges. Conclusion FonoTCS is a valid instrument from a content perspective.

Avaliação dos aspectos psicossociais do trabalho no Brasil no contexto da saúde do trabalhador: uma revisão de escopo / Assessment of psychosocial aspects of work in Brazil in the context of worker health: a scoping review

Resumo Objetivo: descrever dimensões da avaliação dos aspectos psicossociais do trabalho (APST) encontradas na literatura e em documentos normativos no Brasil. Métodos: revisão de escopo com busca de artigos nas bases Portal da Biblioteca Virtual em Saúde do Brasil, Web of Science e Medline, publicados de 2017 a 2021. Também incluíram-se documentos governamentais brasileiros com orientação ou indicação para avaliação dos APST. Resultados: foram selecionados 58 artigos e 22 documentos governamentais. Destes, 75,9% são estudos de delineamento quantitativo transversal. A área da saúde foi o principal campo de estudo, assim como a categoria dos profissionais de enfermagem. Dos documentos governamentais, 63,6% classificam-se como materiais de suporte técnico, a maioria voltada para saúde do trabalhador e vigilância. Discussão: a maior parte dos estudos compreende APST como aspectos relacionados ao estresse ocupacional, referenciando-se, sobretudo, no modelo demanda-controle. A associação com desfechos de saúde, principalmente burnout, se destacou entre os artigos. Mesmo apresentando fragilidade de delimitação conceitual e metodológica, os documentos governamentais têm na Ergonomia da Atividade e Psicodinâmica do Trabalho as principais referências teóricas. Conclusão: é preciso maior aproximação entre conhecimento acadêmico, normatização e suporte técnico sobre avaliação dos APST para fortalecimento da Vigilância em Saúde do Trabalhador e da Trabalhadora (Visatt).

Abstract Objective: to describe the dimensions of the assessment of psychosocial aspects of work (APST) in Brazil found in the literature and normative documents. Methods: this is a scoping review that included the of scientific papers in the Virtual Health Library of Brazil, Web of Science and Medline databases, published from 2017 to 2021. Gray literature was also included, being characterized by documents from the Brazilian government with guidance or indications to evaluate APST. Results: 58 articles and 22 government documents were included. Of these, 75.9% are cross-sectional quantitative studies. The health area stood out as the main field of study, as well as the category of nursing professionals. Regarding government documents, 63.6% were classified as technical support materials, most of which focused on worker's health and surveillance. Discussion: most of scientific studies understand APST as aspects related to occupational stress, mainly referring to the demand-control model. The association with health outcomes, especially burnout, stood out among the scientific papers. Despite presenting conceptual and methodological frailty regarding APST, government documents presented the Ergonomic Activity and Psychodynamics of Work as the main theoretical references. Conclusions: academic knowledge, legal standardization and technical support should be made closer on the evaluation of APST to strengthen VISATT.

Social Vulnerability of Brazilian Metropolitan Schools and Teachers' Absence from Work Due to Vocal and Psychological Symptoms: A Multilevel Analysis.

Teachers' voices and psychological symptoms are the main reasons for absence from work. The objectives of this study were: (i) to spatially represent, through a webGIS, the standardized rates of teachers' absences due to voice (outcome 1) and psychological symptoms (outcome 2) in each Brazilian Federative Unit (FU = 26 states plus Federal District) and (ii) to analyze the relationship between each national outcome rate and the Social Vulnerability Index (SVI) of the municipality where urban schools are located, adjusted for sex, age, and working conditions. This cross-sectional study comprised 4979 randomly sampled teachers working in basic education urban schools, of which 83.3% are women. The national absence rates were 17.25% for voice symptoms and 14.93% for psychological symptoms. The rates, SVI, and school locations in the 27 FUs are dynamically visualized in webGIS. The multilevel multivariate logistic regression model showed a positive association between voice outcome and high/very high SVI (OR = 1.05 [1.03; 1.07]), whereas psychological symptoms were negatively associated with high/very high SVI (OR = 0.86 [0.85 0.88]) and positively associated with intermediate SVI (OR = 1.15 [1.13; 1.16]), in contrast with low/very low SVI. Being a woman (voice: OR = 1.36 [1.35; 1.38]; psychological: 1.22 [1.21; 1.24]) and working in schools with various precarious conditions (17 variables) increased the odds of being absent due to voice and psychological symptoms. The results confirm the need for investments to improve working conditions in schools.

Sexual Orientation Disparities in Depression and Substance Use Among Adults: Results from the Brazilian National Health Survey 2019.

Purpose: We compared the prevalence of depression, hazardous alcohol use, daily tobacco use, and hazardous alcohol and tobacco use (HATU) by sexual orientation and sex among Brazilian adults. Methods: Data were obtained from a national health survey conducted in 2019. This study included participants aged 18 years and older (N = 85,859). Adjusted prevalence ratios (APRs) and confidence intervals were estimated using Poisson regression models stratified by sex to examine the association between sexual orientation, depression, daily tobacco use, hazardous alcohol use, and HATU. Results: After controlling for the covariates, gay men showed a higher prevalence of depression, daily tobacco use, and HATU compared with heterosexual men (APR ranged from 1.71 to 1.92). Furthermore, bisexual men showed a higher prevalence (almost three times) of depression compared with heterosexual men. Lesbian women showed a higher prevalence of binge and heavy drinking, daily tobacco use, and HATU compared with heterosexual women (APR ranged from 2.55 to 4.44). Among bisexual women, the results were significant for all analyzed outcomes (APR ranged from 1.83 to 3.26). Conclusions: This study was the first to use a nationally representative survey to assess sexual orientation disparities related to depression and substance use by sex in Brazil. Our findings highlight the need for specific public policies aimed at the sexual minority population and for greater recognition and better management of these disorders by health professionals.

Psychosocial factors at work and teachers' illness: a systematic review.

The aim of the present study is to analyze scientific evidence about associations between psychosocial factors at work and teachers' illness. A systematic literature review based on the PRISMA statement was conducted. Biblioteca Virtual em Saúde, Medical Literature Analysis and Retrievel System Online, Cumulative Index of Nursing and Allied Health Literature, Scopus, Web of Science, PsycINFO, and Excerpta Medica Database databases were searched. Articles in Portuguese, English and Spanish, published in the past 11 years, were of interest. In total, 861 articles were identified, but only 15 of them met all the eligibility criteria and were included in the review. Eleven articles (73.3%) used validated instruments to assess psychosocial factors, and the Job Content Questionnaire was the most cited one. Low social support, heavy workload, high job demands, and low job control were the most commonly investigated factors and showed statistically significant associations with teachers' illness.

O objetivo do presente estudo é analisar as evidências científicas sobre as associações entre os fatores psicossociais do trabalho e o adoecimento de professores. Desenvolveu-se uma revisão sistemática da literatura de acordo com a declaração PRISMA, nos bancos de dados Portal Biblioteca Virtual em Saúde, Medical Literature Analysis and Retrieval System Online, Cumulative Index of Nursing and Allied Health Literature, Scopus, Web of Science, PsycINFO e Excerpta Medica Database, em idioma português, inglês e espanhol e publicados nos últimos 10 anos. Foram identificados 861 estudos, dos quais 15 preencheram os critérios de seleção e foram incluídos na revisão. Onze estudos (73,3%) utilizaram instrumentos validados para avaliação dos fatores psicossociais, sendo o Job Content Questionnaire o mais citado. Os resultados indicam que o baixo apoio social, carga elevada de trabalho, alta demanda e baixo controle sobre o trabalho foram os fatores mais investigados e com presença de significância estatística quanto a associação com o adoecimento de professores.

Panorama of risky sexual behaviors in the Brazilian adult population - PNS 2019.

OBJECTIVE: To describe the risky sexual behaviors of Brazilian adults according to socioeconomic, demographic, and regional characteristics. METHODS: Data from the 2019 National Health Survey, referring to the population aged 18 years or older, were analyzed. Risky sexual behaviors were considered: early sexual initiation, before the age of 15 years, and nonuse of condoms in the last sexual intercourse. Prevalence and respective confidence intervals were calculated for the subgroups of interest. RESULTS: Early sexual initiation among adult individuals was 24% among men and 11% among women, being higher among young people with lower levels of education and household income. The nonuse of condoms was higher among married/cohabiting partners, no schooling or with some elementary school, and among older people. The prevalence of nonuse of condoms among married/cohabiting partners was the same in both sexes (75%). However, among non-cohabiting partners, gender disparity was relevant, as 39.1% of women did not use condoms in the last sexual intercourse, while among men this result was 26.9%. CONCLUSIONS: Higher prevalence of early sexual initiation for younger generations is noteworthy, especially among women. Concerning the nonuse of condoms, there are important gender disparities in the group of non-cohabiting partners, in addition to the high prevalence among older people, which should be considered in the formulation of public policies. The results of the present study are extremely relevant for understanding the adult population currently more vulnerable to sexually transmitted infections, after over five years without official statistics on this matter at the national level.

Trend in the prevalence of depressive symptoms in Brazil: results from the Brazilian National Health Survey 2013 and 2019.

This study aims to evaluate national variation in depression prevalence and in different sociodemographic groups, health behaviors, and macroregions of Brazil from 2013 to 2019. Data were obtained from two nationwide Brazilian surveys - Brazilian National Health Survey 2013 and 2019. Participants aged 18 years or older were included, totaling 60,202 individuals in 2013 and 88,531 in 2019. Depression was evaluated with the Patient Health Questionnaire-9 (PHQ-9). All estimations accounted for the population weights and the complex sampling. The findings showed that during the six years between the two surveys, the prevalence of depression in Brazil increased by 36.7%, going from 7.9% in 2013 to 10.8% in 2019, and this increase is higher among unemployed young adults, aged 18 to 24 years, with the increase in the prevalence of depression almost tripled (3.7 in 2013 and 10.3 in 2019), an increase of 178.4%. Those dwelling in urban areas had a higher increase in the prevalence of depression in the six-year period (39.8%) when compared to residents in rural areas (20.2%). There was an increase in the prevalence of depression from 2013 to 2019 for the worst categories of the three health behaviors included in the study for both men and women: heavy drinking, smoking, and not exercising the recommended level of physical activity. Our results show a significant increase in the prevalence of depression over the six years between the two surveys, mainly among the younger and unemployed men. The country's economic recession during this period may explain these findings.

Panorama of risky sexual behaviors in the Brazilian adult population - PNS 2019 / Panorama dos comportamentos sexuais de risco na população adulta brasileira - PNS 2019

ABSTRACT OBJECTIVE To describe the risky sexual behaviors of Brazilian adults according to socioeconomic, demographic, and regional characteristics. METHODS Data from the 2019 National Health Survey, referring to the population aged 18 years or older, were analyzed. Risky sexual behaviors were considered: early sexual initiation, before the age of 15 years, and nonuse of condoms in the last sexual intercourse. Prevalence and respective confidence intervals were calculated for the subgroups of interest. RESULTS Early sexual initiation among adult individuals was 24% among men and 11% among women, being higher among young people with lower levels of education and household income. The nonuse of condoms was higher among married/cohabiting partners, no schooling or with some elementary school, and among older people. The prevalence of nonuse of condoms among married/cohabiting partners was the same in both sexes (75%). However, among non-cohabiting partners, gender disparity was relevant, as 39.1% of women did not use condoms in the last sexual intercourse, while among men this result was 26.9%. CONCLUSIONS Higher prevalence of early sexual initiation for younger generations is noteworthy, especially among women. Concerning the nonuse of condoms, there are important gender disparities in the group of non-cohabiting partners, in addition to the high prevalence among older people, which should be considered in the formulation of public policies. The results of the present study are extremely relevant for understanding the adult population currently more vulnerable to sexually transmitted infections, after over five years without official statistics on this matter at the national level.

RESUMO OBJETIVO Descrever os comportamentos sexuais de risco dos adultos brasileiros segundo características socioeconômicas, demográficas e regionais. MÉTODOS Foram analisados dados da Pesquisa Nacional de Saúde 2019, referente à população de 18 anos de idade ou mais. Considerou-se como comportamentos sexuais de risco: a iniciação sexual precoce, antes dos 15 anos, e o não uso de preservativo na última relação sexual. Foram calculadas as prevalências e respectivos intervalos de confiança para os subgrupos de interesse. RESULTADOS A iniciação sexual precoce entre indivíduos adultos foi de 24% entre os homens e 11% entre as mulheres, sendo mais alta entre jovens com menores níveis de instrução e rendimento domiciliar. O não uso de preservativo se mostrou maior entre os casados/coabitantes, sem instrução ou com nível fundamental incompleto, e entre os mais velhos. A prevalência do não uso de preservativo entre casados/coabitantes foi igual em ambos os sexos (75%). No entanto, entre os não coabitantes, a disparidade entre os sexos se mostrou relevante uma vez que 39,1% das mulheres não usaram preservativo na última relação sexual, enquanto entre os homens esse resultado foi de 26,9%. CONCLUSÃO Nota-se, especialmente entre as mulheres, maiores prevalências de iniciação sexual precoce para as gerações mais novas. No que se refere ao não uso de preservativo, há disparidades de sexo importantes no grupo dos não coabitantes, além da alta prevalência entre os mais velhos, que devem ser consideradas na elaboração das políticas públicas. Os resultados do presente estudo são extremamente relevantes para compreensão da população adulta atualmente mais vulnerável às infecções sexualmente transmissíveis, após mais de cinco anos sem estatísticas oficiais a respeito em âmbito nacional.

Trend in the prevalence of depressive symptoms in Brazil: results from the Brazilian National Health Survey 2013 and 2019 / Tendência na prevalência de sintomas depressivos no Brasil: resultados da Pesquisa Nacional de Saúde, 2013 e 2019 / Tendencia en la prevalencia de síntomas depresivos en Brasil: resultados de las Encuesta Nacional de Salud de 2013 y 2019

This study aims to evaluate national variation in depression prevalence and in different sociodemographic groups, health behaviors, and macroregions of Brazil from 2013 to 2019. Data were obtained from two nationwide Brazilian surveys - Brazilian National Health Survey 2013 and 2019. Participants aged 18 years or older were included, totaling 60,202 individuals in 2013 and 88,531 in 2019. Depression was evaluated with the Patient Health Questionnaire-9 (PHQ-9). All estimations accounted for the population weights and the complex sampling. The findings showed that during the six years between the two surveys, the prevalence of depression in Brazil increased by 36.7%, going from 7.9% in 2013 to 10.8% in 2019, and this increase is higher among unemployed young adults, aged 18 to 24 years, with the increase in the prevalence of depression almost tripled (3.7 in 2013 and 10.3 in 2019), an increase of 178.4%. Those dwelling in urban areas had a higher increase in the prevalence of depression in the six-year period (39.8%) when compared to residents in rural areas (20.2%). There was an increase in the prevalence of depression from 2013 to 2019 for the worst categories of the three health behaviors included in the study for both men and women: heavy drinking, smoking, and not exercising the recommended level of physical activity. Our results show a significant increase in the prevalence of depression over the six years between the two surveys, mainly among the younger and unemployed men. The country's economic recession during this period may explain these findings.

O estudo objetiva avaliar a variação nacional na prevalência geral da depressão e em diferentes grupos sociodemográficos, comportamentos de saúde e macrorregiões do Brasil entre 2013 e 2019. Os dados foram obtidos de dois inquéritos brasileiros de abrangência nacional, a Pesquisa Nacional de Saúde (PNS) 2013 e a 2019. Entre os participantes com idade de 18 anos ou mais, houve 60.202 indivíduos em 2013 e 88.531 em 2019. A depressão foi avaliada com o Questionário de Saúde do Paciente-9 (PHQ-9). Todas as estimativas levaram em conta os pesos populacionais e a amostragem complexa. Os achados mostraram que durante os seis anos entre as duas edições da PNS, a prevalência de depressão no Brasil aumentou em 36,7%, de 7,9% em 2013 para 10,8% em 2019, com um aumento ainda maior em adultos jovens, no grupo etário de 18 a 24 anos, e naqueles que não estavam trabalhando, onde houve um aumento de quase três vezes na prevalência de depressão (3,7% em 2013 e 10,3% em 2019), ou seja, um aumento de 178,4%. Indivíduos residindo em áreas urbanas tiveram um aumento maior na prevalência de depressão ao longo do período de seis anos (39,8%), em comparação com os residentes em áreas rurais (20,2%). Houve um aumento na prevalência de depressão entre 2013 e 2019 para as piores categorias dos três comportamentos de saúde incluídos no estado, tanto em homens quanto em mulheres: etilismo, tabagismo e sedentarismo. Nossos resultados mostram um aumento significativo na prevalência de depressão nos seis anos entre as duas edições da PNS, principalmente entre homens mais jovens e desempregados. A recessão econômica no Brasil durante o período pode explicar esses achados.

El objetivo de este estudio es evaluar la variación nacional en la prevalencia general de depresión, así como en diferentes grupos sociodemográficos, comportamientos de salud, y macrorregiones del país entre 2013-2019. Los datos se obtuvieron de dos encuestas nacionales brasileñas -Encuesta Nacional de Salud 2013 y 2019-. Los participantes con edades entre los 18 años y con más edad incluyeron a 60 202 personas en 2013 y 88 531 en 2019. La depresión se evaluó mediante el Cuestionario de Salud del Paciente-9 (PHQ-9). Todas las estimaciones justificaron los pesos de la población y el muestreo complejo. Los resultados mostraron que durante seis años entre las dos encuestas, la prevalencia de depresión en Brasil se incrementó en un 36,7%, yendo de un 7,9% en 2013 a un 10,8% en el 2019, y este incremento es mayor entre adultos jóvenes, de 18 a 24 años de edad, que no estaban trabajando, donde casi había un incremento tres veces superior en la prevalencia de depresión (3,7 en 2013 y 10,3 en 2019), un incremento de un 178,4%. Aquellos que vivían en áreas urbanas tenían un incremento mayor en la prevalencia de depresión durante el período de seis años (39,8%), cuando se comparó con los residentes en áreas rurales (20,2%). Hubo un incremento en la prevalencia de depresión entre 2013-2019 para las peores categorías de los tres comportamientos de salud incluidos en el estudio para tanto hombres como mujeres: consumo excesivo de alcohol, fumar, y no practicar deporte al nivel recomendado de actividad física. Nuestros resultados muestran un significado incremento en la prevalencia de depresión durante los seis años entre las dos encuestas, principalmente entre los hombres más jóvenes y desempleados. La recesión económica del país durante este periodo puede explicar estos resultados.

Comportamentos sexuais de risco, orientação sexual, uso de substâncias e saúde mental: Um estudo de base populacional no Brasil / Risky sexual behaviors, sexual orientation, substance use, and mental health: A population-based study in Brazil

A presente tese trata-se de um estudo de prevalências e associações no âmbito da sexualidade e dos comportamentos sexuais. Foram utilizados os dados do novo módulo de atividade sexual incluído na Pesquisa Nacional de Saúde (PNS) em 2019 voltado para a população de 18 anos ou mais de idade (n=85.859). No primeiro artigo, foi traçado um panorama dos comportamentos sexuais de risco na população adulta relacionados ao não uso de preservativo na última relação sexual e à iniciação sexual precoce (antes dos 15 anos). Foram calculadas as prevalências, e respectivos intervalos de confiança (IC), dos desfechos segundo características socioeconômicas, demográficas e regionais da população. Observou-se que a iniciação sexual precoce é mais prevalente entre pessoas das gerações mais novas, com menores níveis de instrução e rendimento domiciliar. O não uso de preservativo foi mais prevalente entre mulheres, mais velhos e casados ou em coabitação. Foram observadas disparidades relevantes no não uso do preservativo entre os sexos no grupo dos que não coabitam com parceiro. No segundo artigo, avaliou-se a associação entre o consumo pesado de álcool e o uso inconsistente de preservativo entre pessoas de 18 a 59 anos solteiras, viúvas ou divorciadas que não coabitavam com parceiro (n=15.835). Foram estimadas razões de prevalências ajustadas (RPa) com modelos de regressão de Poisson estratificados por sexo e grupos de idade. Verificou-se que indivíduos de todas as faixas etárias e ambos os sexos com padrão de consumo pesado de álcool foram significativamente mais propensos ao uso inconsistente de preservativo que os demais. As estimativas obtidas não foram consideradas estatisticamente diferentes entre adultos jovens (RPa 1,32, IC 95%: 1,14-1,54) e de meia idade (RPa 1,31; IC 95%: 1,19-1,44 para pessoas de 25 a 39 e RPa 1,26; IC 95%: 1,13-1,40 para 40 a 59 anos). No terceiro e último artigo da presente tese, o uso de substâncias (álcool e tabaco) e a depressão foram analisados segundo a orientação sexual autoidentificada da população adulta. Foram estimadas as prevalências e razões de prevalência ajustadas por meio de modelos de regressão de Poisson estratificados por sexo para cada um dos desfechos analisados. Após controle por covariáveis, homens gays apresentaram maior prevalência de depressão, uso diário de tabaco e uso nocivo de álcool e tabaco (RPa entre 1,71 e 1,92) e homens bissexuais com maiores prevalências (quase três vezes) de depressão que homens heterossexuais. Mulheres lésbicas apresentaram maior prevalência de binge drinking, heavy drinking, uso diário de tabaco e uso nocivo de álcool e tabaco que mulheres heterossexuais (RPa entre 2,55 e 4,44). Entre as mulheres bissexuais os resultados foram significativos para todos os desfechos analisado (RPa variou entre 1,83 e 3,26). Sendo assim, essa tese fornece evidências relevantes para subsidiar ações em saúde pública que visem a redução de comportamentos sexuais de risco e das disparidades em saúde relacionadas a orientação sexual da população adulta brasileira.

This thesis is a study of prevalence and associations in the scope of sexuality and sexual behavior. Data are from the new module of sexual activity included in the National Health Survey (PNS, for its Portuguese acronym) in 2019, aimed at the population aged 18 and over (n=85,859). In the first article, a panorama of risky sexual behaviors in the adult population related to the non-use of condoms in the last sexual intercourse and early sexual initiation (before 15 years of age) was performed. Prevalence, and respective confidence intervals (CI), of the outcomes were calculated according to socioeconomic, demographic and regional characteristics of the population. It was observed that early sexual initiation is more prevalent among younger generations, with lower education levels and household income. Non-use of condoms was more prevalent among women, older people and married/cohabiting with a partner. Relevant disparities in non-use of condom between the sexes were observed in the non-cohabiting unmarried group. In the second article, the association between heavy alcohol consumption and inconsistent condom use was investigated among unmarried not cohabiting with a partner people aged 18 to 59 years (n=15,835). Adjusted prevalence ratios (APR) were estimated with Poisson regression models stratified by sex and age groups. It was observed that individuals from all age groups and both sexes who have heavy drinking pattern were significantly more likely to inconsistent condom use. The estimates were not considered statistically different between young (APR 1.32, 95% CI: 1.14-1.54) and middle-aged adults (APR 1.31; 95% CI: 1.19-1.44 for aged 25 to 39 and APR 1.26; 95% CI: 1.13-1.40 for aged 40 to 59 years). In the third and last article of this thesis, substance use (alcohol and tobacco) and depression were analyzed according to the self-identified sexual orientation of the adult population. Prevalence and adjusted prevalence ratios were estimated using Poisson regression models stratified by sex for each outcome. After controlling for covariates, gay men had a higher prevalence of depression, daily tobacco use and hazardous use of alcohol and tobacco (APR between 1.71 and 1.92) and bisexual men had a higher prevalence (almost three times) of depression than heterosexual men. Lesbian women had a higher prevalence of binge drinking, heavy drinking, daily tobacco use and hazardous use of alcohol and tobacco than heterosexual women (APR between 2.55 and 4.44). Among bisexual women, the results were significant for all outcomes analyzed (APR ranged between 1.83 and 3.26). Therefore, this thesis provides relevant evidence to support public health actions aimed at reducing risky sexual behavior and health disparities related to sexual orientation in the Brazilian adult population.

Trend in the prevalence of depression and correlates in Brazil: results from the National Health Surveys 2013 and 2019

This study aims to evaluate national variation in depression prevalence overall and in different socioeconomic and demographic groups, health behaviors, and macro-regions of the country, between 2013 and 2019. Data were obtained from the National Health Surveys ­ PNS 2013 and 2019, which are cross-sectional surveys of the Brazilian general population. Participants aged 18 years and older included 60,202 individuals in 2013 and 88,531 in 2019. Depression was evaluated through the Patient Health Questionnaire-9 (PHQ-9). Calculations were carried out population-weighted. Additional age-standardized analyses were conducted to account for demographic changes. The results showed that in the six-year period between the two surveys, the prevalence of depression in Brazil increased by 36.7%, going from 7.9% in 2013 to 10.8% in 2019, this increase is more marked among young adults, 18 to 24 years old, who were not working, where there was a significant and almost three-fold absolute difference increase in the prevalence of depression (3.7 in 2013 and 10.3 in 2019), an increase of 178.4%. Those living in urban areas of the country had a greater increase in the prevalence of depression in the six-year period (39.8%) when compared to residents in rural areas (20.2%). There was an increase in the prevalence of depression between 2013 and 2019 for the worst categories of the three health behaviors under study, for both sexes: heavy drinking, smoking, and lack of physical activity, following the pattern observed for the general population. Our results show evidence of a significant increase in the prevalence of depression over the six-year period between the two surveys, mainly among the younger and unemployed men. The country´s economic context of recession during this period may be an explanation for this finding.

Self-referred personal behavior profile of university professors: association with communicative and vocal self-evaluation. / Perfil de comportamento pessoal autorreferido por professores universitários: associação com a autoavaliação comunicativa e vocal.

PURPOSE: Describe the self-referred personal behavior profiles of university professors and verify the association of these profiles with the self-assessment of communicative aspects and vocal symptoms. METHODS: Study conducted with 334 professors at a public university who responded to an online questionnaire regarding voice use in teaching practice. Personal behavior profile classification was the response variable, which was divided into four types: pragmatic, analytical, expressive and affable. Explanatory variables were vocal self-perception, vocal resources, and communicative aspects. Descriptive data analysis was performed with application of the Pearson's Chi-squared and Fisher's Exact tests. RESULTS: University professors identified themselves more with the affable and expressive personal behavior profiles. Overall, professors presented good self-perception about vocal and communicative aspects, in addition to having reported few vocal symptoms. Profiles differed for some of the assessed variables, namely, pragmatic professors reported high speech velocity and sporadic eye contact; expressive professors demonstrated self-perception about their voice and strong voice intensity; those in the analytical profile self-reported negative perception about vocal quality, weak voice intensity, poor articulation and rapid speaking rate; the other professors mostly reported voice tiredness symptoms and difficulty projecting the voice. CONCLUSION: University professors identify themselves mostly with the affable and expressive profiles. Self-perception analysis of the personal behavior profile in university professors showed the influence of self-reported personality characteristics on communicative skills in the classroom.

OBJETIVO: Descrever o perfil de comportamento pessoal autorreferido por professores universitários, e verificar a associação destes perfis com a autoavaliação dos aspectos comunicativos e sintomas vocais. MÉTODO: Estudo realizado com 334 professores de uma universidade pública que responderam um questionário online referente ao uso da voz na docência. A variável resposta foi a classificação do perfil de comportamento pessoal, identificado em quatro tipos: pragmático, analítico, expressivo e afável, e as variáveis explicativas foram: autopercepção vocal, recursos vocais e aspectos comunicativos. Foi realizada a análise descritiva dos dados, além dos testes Quiquadrado de Pearson e Exato de Fisher. RESULTADOS: Os professores universitários se identificaram mais com os perfis de comportamento pessoal afável e expressivo. De forma geral, os docentes demonstraram boa autopercepção dos aspectos vocais e comunicativos, além de terem relatado poucos sintomas vocais. Os perfis se diferenciaram em algumas variáveis estudadas: o pragmático relatou velocidade de fala rápida e, às vezes, realizar contato de olhos; o expressivo demonstrou autopercepção positiva de sua voz e intensidade forte. Professores com perfil analítico autorreferiram percepção negativa da qualidade vocal, intensidade fraca, articulação ruim e velocidade de fala rápida e, entre os demais perfis, foi o que mais relatou sintomas de cansaço na voz e dificuldade para projetar a voz. CONCLUSÃO: Professores universitários se identificam predominantemente com os perfis afável e expressivo. A análise da autopercepção do perfil de comportamento pessoal em professores universitários mostra a influência das características da personalidade autorreferidas sobre as habilidades comunicativas em sala de aula.

Vocal Symptoms in University Professors: Their Association With Vocal Resources and With Work Environment.

AIM: Investigating the association among vocal symptoms, vocal resources, and work environment in university professors. METHODS: Online questionnaire answered by 334 professors from a federal public university in Belo Horizonte County, Brazil. The questionnaire addressed sociodemographic data, self-perception about one's voice, vocal resources and work environment, and included the Vocal Signs and Symptoms Questionnaire. Professors presenting five or more vocal symptoms were compared to those who reported fewer symptoms. The association between the number of symptoms and the other variables was assessed through univariate and multivariate logistic regression analyses. RESULTS: The mean of symptoms reported by the herein investigated professors was 3.1 (SD ± 2.75); 24% (n = 82) of them reported five or more vocal symptoms. Factors such as female sex, incidence of noise, high speaking rate, as well as high fundamental frequency and loud voice, were associated with the incidence of five or more vocal symptoms. CONCLUSIONS: University professors belonging to the female sex, who perceive the noise in the work environment as unsatisfactory, speak fast, or present high fundamental frequency and loud voice reported the largest number of vocal symptoms. It is recommended developing education programs focused on raising professors' awareness about voice-related risk factors and about the importance of improving their communicative performance.

Perfil de comportamento pessoal autorreferido por professores universitários: associação com a autoavaliação comunicativa e vocal / Self-referred personal behavior profile of university professors: association with communicative and vocal self-evaluation

RESUMO Objetivo Descrever o perfil de comportamento pessoal autorreferido por professores universitários, e verificar a associação destes perfis com a autoavaliação dos aspectos comunicativos e sintomas vocais. Método Estudo realizado com 334 professores de uma universidade pública que responderam um questionário online referente ao uso da voz na docência. A variável resposta foi a classificação do perfil de comportamento pessoal, identificado em quatro tipos: pragmático, analítico, expressivo e afável, e as variáveis explicativas foram: autopercepção vocal, recursos vocais e aspectos comunicativos. Foi realizada a análise descritiva dos dados, além dos testes Quiquadrado de Pearson e Exato de Fisher. Resultados Os professores universitários se identificaram mais com os perfis de comportamento pessoal afável e expressivo. De forma geral, os docentes demonstraram boa autopercepção dos aspectos vocais e comunicativos, além de terem relatado poucos sintomas vocais. Os perfis se diferenciaram em algumas variáveis estudadas: o pragmático relatou velocidade de fala rápida e, às vezes, realizar contato de olhos; o expressivo demonstrou autopercepção positiva de sua voz e intensidade forte. Professores com perfil analítico autorreferiram percepção negativa da qualidade vocal, intensidade fraca, articulação ruim e velocidade de fala rápida e, entre os demais perfis, foi o que mais relatou sintomas de cansaço na voz e dificuldade para projetar a voz. Conclusão Professores universitários se identificam predominantemente com os perfis afável e expressivo. A análise da autopercepção do perfil de comportamento pessoal em professores universitários mostra a influência das características da personalidade autorreferidas sobre as habilidades comunicativas em sala de aula.

ABSTRACT Purpose Describe the self-referred personal behavior profiles of university professors and verify the association of these profiles with the self-assessment of communicative aspects and vocal symptoms. Methods Study conducted with 334 professors at a public university who responded to an online questionnaire regarding voice use in teaching practice. Personal behavior profile classification was the response variable, which was divided into four types: pragmatic, analytical, expressive and affable. Explanatory variables were vocal self-perception, vocal resources, and communicative aspects. Descriptive data analysis was performed with application of the Pearson's Chi-squared and Fisher's Exact tests. Results University professors identified themselves more with the affable and expressive personal behavior profiles. Overall, professors presented good self-perception about vocal and communicative aspects, in addition to having reported few vocal symptoms. Profiles differed for some of the assessed variables, namely, pragmatic professors reported high speech velocity and sporadic eye contact; expressive professors demonstrated self-perception about their voice and strong voice intensity; those in the analytical profile self-reported negative perception about vocal quality, weak voice intensity, poor articulation and rapid speaking rate; the other professors mostly reported voice tiredness symptoms and difficulty projecting the voice. Conclusion University professors identify themselves mostly with the affable and expressive profiles. Self-perception analysis of the personal behavior profile in university professors showed the influence of self-reported personality characteristics on communicative skills in the classroom.

Potentially inappropriate medication use and frailty phenotype among community-dwelling older adults: A population-based study.

AIMS AND OBJECTIVES: To investigate the association between potentially inappropriate medication use and frailty phenotype among community-dwelling older adults and to identify factors associated with the use of these drugs according to frailty condition. BACKGROUND: There is insufficient evidence about the association between inappropriate medication use and the condition of frailty, particularly among community-dwelling older adults. Therefore, data obtained from population surveys should be made available in order to support the development of clinical guidelines about the prevention of frailty. DESIGN: This was a cross-sectional study conducted according to the STROBE Checklist. METHODS: This population-based study was conducted on 1,607 older adults. Potentially inappropriate medication use was assessed according to Beers criteria and frailty syndrome was determined according to the phenotype proposed by Fried and colleagues. Data were analysed statistically using multinomial or binary logistic regression models. RESULTS: About 13.6% of the subjects were frail, and 36.8% used at least one inappropriate medication. The adjusted model indicated that, the more potentially inappropriate medication use, the higher the prevalence of frailty, prefrailty and the walking slowness component. Female gender, one or more years of schooling, five or more reported morbidities, and instrumental dependence regarding daily life activities were factors associated with potentially inappropriate medication use in the nonfrail group. CONCLUSION: Inappropriate medication use was prevalent among community-living older adults, and its presence was associated with the occurrence of frailty. RELEVANCE TO CLINICAL PRACTICE: Primary care nurses are the professionals with the greatest contact with the older adults in the community. Thus, the results support the inclusion of the assessment of potentially inappropriate medication use in the routine of nursing consultation. In case of a positive screening, the older person should be referred to geriatric evaluation in order to optimise drug treatment for the prevention of frailty.

A teenage patient with autosomal recessive polycystic kidney disease, a splenorenal shunt, and congenital hepatic fibrosis: a case report / Doença renal policística autossômica recessiva, shunt esplenorrenal e fibrose hepática congênita em adolescente: relato de caso

ABSTRACT A 16-year-old female patient previously diagnosed with autosomal recessive polycystic kidney disease (ARPKD) presented with acute bilateral pneumonia, upper gastrointestinal bleeding caused by ruptured esophageal varices, ascites, and lower limb edema. She required intensive care and an endoscopic procedure to treat the gastrointestinal bleeding. The analysis of the differential diagnosis for chronic liver disease indicated she had a spontaneous splenorenal shunt. Ultrasound-guided biopsy revealed the patient had cirrhosis, as characteristically seen in individuals with ARPKD. She had no symptoms at discharge and was referred for review for a combined transplant.

RESUMO Relato de caso de uma paciente adolescente de 16 anos de idade com diagnóstico prévio de doença renal policística autossômica recessiva (DRPAR), que apresentou quadro agudo de pneumonia bilateral e hemorragia digestiva alta por ruptura de varizes esofágicas, bem como ascite e edema de membros inferiores. Necessitou de estabilização clínica intensiva e tratamento endoscópico do sangramento digestivo. Após investigação dos diagnósticos diferenciais da hepatopatia crônica, diagnosticou-se shunt esplenorrenal espontâneo, e realizou-se biópsia hepática guiada por ecografia com diagnóstico de cirrose, espectro típico da DRPAR. Recebeu alta hospitalar assintomática e foi encaminhada para avaliação de transplante duplo.

Queda entre idosos: preditores e distribuição espacial / Falls in older adults: predictors and space distribution / Caída entre personas mayores: predictores y distribución del espacio

RESUMO Objetivos Calcular a prevalência de quedas, nos últimos 12 meses, entre idosos da comunidade; verificar a ocorrência de quedas em idosos da comunidade, segundo características sociodemográficas e de saúde e identificar clusters de quedas, entre idosos no município de Uberaba. Métodos Estudo transversal conduzido com 612 idosos residentes na zona urbana de Uberaba. Procederam-se às análises descritiva e bivariada com o teste qui-quadrado (p<0,05). Para estimar a intensidade dos eventos utilizou-se o Kernel estimation. Projeto aprovado pelo Comitê de Ética em Pesquisa, parecer N° 573.833. Resultados Constatou-se que 24,7% dos idosos tiveram quedas nos últimos 12 meses. A maior proporção dos idosos que sofreu quedas era do sexo feminino (p=0,004); com 80 anos ou mais (p=0,001); sem escolaridade (p=0,026); morava só (p=0,049); sem companheiro (p=0,002); com autopercepção de saúde negativa (p<0,001); dependente para as ABVD (p=0,049) e AIVD (p=0,027); com menor participação nas AAVD (p=0,003); pré-frágeis/frágeis (p<0,001) e com desempenho físico baixo/ruim (p<0,001). Os maiores aglomerados de ocorrência de quedas foram na região centro-oeste do município, seguido pela região sudeste. Conclusão Conhecer o perfil e os fatores associados à ocorrência de quedas entre idosos possibilita que os profissionais de saúde desenvolvam ações direcionadas a prevenção, ao monitoramento e controle desses fatores.(AU)

ABSTRACT Objective This work seeks to calculate the prevalence of falls in the last 12 months among the elderly from the community of the city of Uberaba; verify the occurrence of falls in the elderly of the community according to sociodemographic and health characteristics; and identify and group the types of falls among the older individuals in the city of Uberba. Methods Cross-sectional study carried out with 612 elderly people living in the urban area of Uberaba. Descriptive and bivariate analyzes were performed using the chi-square test (p<0.05). The kernel density estimation was used to estimate the intensity of the events. This project was approved by the Research Ethics Committee through Protocol No. 573.833. Results It was found that 24.7% of the elderly had falls in the last 12 months. The highest proportion of the elderly who suffered falls was female (p=0.004); aged 80 years or more (p=0.001); illiterate (p=0.026); who lived alone (p=0.049); without partner (p=0.002); with negative self-perception of health (p<0.001); dependent for BADL (p=0.049) and IALD (p=0.027); with a lower participation in AADL (p=0.003); pre-fragile/fragile (p<0.001); and with low/poor physical performance (p<0.001). The clusters with the most frequently reported falls were in the center-west region of the city, followed by the southeast region. Conclusion To know the profile and the factors associated with the occurrence of falls among the elderly allows health professionals to develop actions directed to prevent, monitor and control these factors.(AU)

RESUMEN Objetivos Calcular la prevalencia de caídas en los últimos 12 meses entre los ancianos que viven en la comunidad; para verificar la ocurrencia de caídas en ancianos de la comunidad, de acuerdo con las características sociodemográficas y de salud, e identificar grupos de caídas, entre los ancianos en la ciudad de Uberaba. Métodos Estudio transversal realizado con 612 ancianos residentes en el área urbana de Uberaba. Se realizaron análisis descriptivos y bivariadas con la prueba de chi-cuadrado (p<0,05). Para estimar la intensidad de los eventos, utilizamos la estimación de Kernel. Proyecto aprobado por el Comité de Ética en Investigación, N°. 573,833. Resultados Se encontró que el 24,7% de los ancianos tuvieron caídas en los últimos 12 meses. La mayor proporción de ancianos que sufrieron caídas fueron mujeres (p=0,004); mayores de 80 años (p=0,001); sin educación (p=0,026); vivió solo (p=0,049); sin pareja (p=0,002); con salud negativa autovalorada (p<0,001); dependiente de ABVD (p=0,049) y IADL (p=0,027); con menor participación en AADL (p=0,003); pre-frágil / frágil (p<0,001) y con un rendimiento físico pobre/pobre (p<0,001). Los grupos más grandes de ocurrencia de caídas se encontraban en la región del medio oeste del municipio, seguidos por la región sureste. Conclusión Conocer el perfil y los factores asociados con la ocurrencia de caídas entre los ancianos permite a los profesionales de la salud desarrollar acciones dirigidas a la prevención, monitoreo y control de estos factores.(AU)

Violência contra idosos: preditores e distribuição espacial / Violence against theelderly people: predictors and space distribution

Objectives: to verify the prevalence of violence in the elderly people in the last 12 months; to describe the sociodemographic and economic characteristics of these people according to the type of violence suffered; to verify the factors associated with violence and to identify clusters of violence against the elderly individuals in the city of Uberaba, Minas Gerais.Methods: This was a cross-sectional and quantitative study carried out with 581 elderly individuals from the community of Uberaba, Minas Gerais. Statistical analyzes were performed: descriptive and multiple logistic regression (p≤0.05).Results: Physical and/or psychological violence obtained higher percentages among those with 15 years of schooling and who lived with children. The youngest age was associated with physical and/or psychological violence. The largest clusters were in the southeast region of the municipality. Conclusion: Younger elders suffer more episodes of physical and/or psychological violence, as well as those with less schooling, who live with their children and in the southeast region of the municipality.

Objetivos: verificar a prevalência de violência em idosos nos últimos 12 meses; descrever as características sociodemográficas e econômicas dos idosos segundo o tipo deviolência sofrida; verificar os fatores associados à violência e identificar os clustersde violência contra idosos no município de Uberaba, Minas Gerais.Métodos:Trata-se de um estudo transversal e quantitativo realizado com 581 idosos da comunidade de Uberaba, Minas Gerais.Procederam-seas análises estatísticas:descritiva e regressão logística múltipla (p≤0,05). Resultados:A violência física e/ou psicológica e a psicológica obtiveram maiores percentuais entre aqueles com 1├5 anos de estudo e que residiam com filhos. A menor idade associou-se à violência física e/ou psicológica. Os maiores aglomerados foram na região sudeste do município. Conclusão:Os idosos mais novos sofrem mais episódios de violência física e/ou psicológica, assim como aqueles com menor escolaridade, que residem com os filhos e na região sudeste do município

[Falls in older adults: predictors and space distribution]. / Queda entre idosos: preditores e distribuição espacial.

OBJECTIVE: This work seeks to calculate the prevalence of falls in the last 12 months among the elderly from the community of the city of Uberaba; verify the occurrence of falls in the elderly of the community according to sociodemographic and health characteristics; and identify and group the types of falls among the older individuals in the city of Uberba. METHODS: Cross-sectional study carried out with 612 elderly people living in the urban area of Uberaba. Descriptive and bivariate analyzes were performed using the chi-square test (p<0.05). The kernel density estimation was used to estimate the intensity of the events. This project was approved by the Research Ethics Committee through Protocol No. 573.833. RESULTS: It was found that 24.7% of the elderly had falls in the last 12 months. The highest proportion of the elderly who suffered falls was female (p=0.004); aged 80 years or more (p=0.001); illiterate (p=0.026); who lived alone (p=0.049); without partner (p=0.002); with negative self-perception of health (p<0.001); dependent for BADL (p=0.049) and IALD (p=0.027); with a lower participation in AADL (p=0.003); pre-fragile/fragile (p<0.001); and with low/poor physical performance (p<0.001). The clusters with the most frequently reported falls were in the center-west region of the city, followed by the southeast region. CONCLUSION: To know the profile and the factors associated with the occurrence of falls among the elderly allows health professionals to develop actions directed to prevent, monitor and control these factors.