Prevalence of functional dependence and chronic diseases in the community-dwelling Brazilian older adults: an analysis by dependence severity and multimorbidity pattern.

BACKGROUND: Despite the advancements in knowledge about health care for older adults, essential gaps persist regarding the effects of chronic diseases as epidemiological markers of the state of functional dependence. This study aimed to identify the prevalence of moderate and severe functional dependence in Brazilian older adults and its association with chronic diseases and verify the multimorbidity patterns by dependence status. METHODS: This cross-sectional analytical study used data from 11,177 community-dwelling Brazilian older adults from the 2013 National Health Survey conducted in Brazil. The dependent variables were moderate and severe functional dependence in basic activities of daily living (BADLs) and instrumental ADLs (IADLs). The independent variables were defined based on the questions applied to measure each morbidity in a self-reported manner and asked, "Has a doctor ever diagnosed you as having (each disease)? Multimorbidity was simultaneously considered present for older adults with ≥ 2 chronic morbidities. The association between functional dependence on BADLs and IADLs separately by severity and the independent variables was verified from crude and adjusted estimates of the point prevalence ratios and their 95% confidence intervals using the regression model Poisson with robust variance. To group diseases into patterns, exploratory factor analysis was used. RESULTS: The prevalences of moderate and severe BADL dependence were 10.2% (95% CI, 9.6-10.7) and 4.8% (95% CI, 4.4-5.2), respectively. Moderate and severe IADL dependence prevalences were 13.8% (95% CI, 13.1-14.4) and 15.6% (95% CI, 14.9%-16.2), respectively. When changing the condition from moderate to severe dependence in BADLs, in the presence of other mental illnesses and stroke, the probability of dependence increased more than four times in the case of other mental illnesses and more than five times for stroke. There was a linear trend for dependence severity, both moderate and severe, whereas, for severe dependence on IADLs, this same factor maintained a linear trend toward an increase in probability as the number of diseases simultaneously increased. CONCLUSIONS: Chronic diseases are associated with functional dependence, with greater emphasis on mental illnesses and stroke in severe disability, considering their acute adverse effects.

Association between self-perceived hearing status and cognitive impairment in the older Brazilian population: a population-based study. / Associação entre autopercepção auditiva e comprometimento cognitivo em idosos brasileiros: estudo populacional.

Cognitive health plays an important role in the quality of life and autonomy of older adults. and it is influenced by hearing ability. This article aims to analyze the association between self-perceived hearing status and cognitive impairment in Brazilian older adults. This cross-sectional population-based study was conducted with 4,977 older adults who participated in ELSI Brazil 2015. The cognitive impairment status (outcome. categorized as "yes" and "no") and variable of interest (self-perceived hearing status. categorized as "good" "fair" and "poor") were obtained using a self-report method. The following domains were considered for cognition: temporal orientation. memory (short and long term). and language (recent and late). Poisson regression with robust variance estimation was used to assess the self-perceived hearing status-cognitive impairment association in the crude and adjusted analyses. Sociodemographic. lifestyle. and medical history variables were used to adjust the analyses. We found that 31.8% of the participants reported fair or poor hearing and 42% had cognitive impairment. In the adjusted analysis. older adults with poor hearing were revealed to have a stronger association with cognitive impairment than their peers with good hearing. Therefore. in older Brazilian adults. lower self-perceived hearing status is associated higher levels of cognitive impairment.

Saúde cognitiva é um fator importante para qualidade de vida e a autonomia dos idosos, sendo influenciada pela capacidade auditiva. O objetivo deste artigo é analisar a associação entre autopercepção auditiva e comprometimento cognitivo em idosos brasileiros. Trata-se de um estudo transversal de base populacional com 4.977 idosos que participaram do ELSI Brasil 2015. Comprometimento cognitivo (desfecho, categorizado como sim e não) e a variável de interesse (autopercepção auditiva, categorizada como boa, regular e ruim), ambos obtidos de forma autorreferida. Para a cognição foram considerados os domínios orientação temporal, memória (curto e longo prazo) e linguagem (recente e tardia). Foi utilizada a regressão de Poisson com estimativa de variância robusta para aferir a associação nas análises bruta e ajustada. Variáveis sociodemográficas, de estilo de vida e de histórico clínico foram utilizadas para ajuste das análises. Dos participantes, 31,8% relataram audição regular ou ruim e 42% apresentaram comprometimento cognitivo. Na análise ajustada, idosos com audição ruim apresentaram maior força de associação com comprometimento cognitivo, em comparação com seus pares com audição boa. Em idosos brasileiros, quanto pior a autopercepção auditiva, maior a associação com o comprometimento cognitivo.

Associação entre autopercepção auditiva e comprometimento cognitivo em idosos brasileiros: estudo populacional / Association between self-perceived hearing status and cognitive impairment in the older Brazilian population: a population-based study

Resumo Saúde cognitiva é um fator importante para qualidade de vida e a autonomia dos idosos, sendo influenciada pela capacidade auditiva. O objetivo deste artigo é analisar a associação entre autopercepção auditiva e comprometimento cognitivo em idosos brasileiros. Trata-se de um estudo transversal de base populacional com 4.977 idosos que participaram do ELSI Brasil 2015. Comprometimento cognitivo (desfecho, categorizado como sim e não) e a variável de interesse (autopercepção auditiva, categorizada como boa, regular e ruim), ambos obtidos de forma autorreferida. Para a cognição foram considerados os domínios orientação temporal, memória (curto e longo prazo) e linguagem (recente e tardia). Foi utilizada a regressão de Poisson com estimativa de variância robusta para aferir a associação nas análises bruta e ajustada. Variáveis sociodemográficas, de estilo de vida e de histórico clínico foram utilizadas para ajuste das análises. Dos participantes, 31,8% relataram audição regular ou ruim e 42% apresentaram comprometimento cognitivo. Na análise ajustada, idosos com audição ruim apresentaram maior força de associação com comprometimento cognitivo, em comparação com seus pares com audição boa. Em idosos brasileiros, quanto pior a autopercepção auditiva, maior a associação com o comprometimento cognitivo.

Abstract Cognitive health plays an important role in the quality of life and autonomy of older adults. and it is influenced by hearing ability. This article aims to analyze the association between self-perceived hearing status and cognitive impairment in Brazilian older adults. This cross-sectional population-based study was conducted with 4,977 older adults who participated in ELSI Brazil 2015. The cognitive impairment status (outcome. categorized as "yes" and "no") and variable of interest (self-perceived hearing status. categorized as "good" "fair" and "poor") were obtained using a self-report method. The following domains were considered for cognition: temporal orientation. memory (short and long term). and language (recent and late). Poisson regression with robust variance estimation was used to assess the self-perceived hearing status-cognitive impairment association in the crude and adjusted analyses. Sociodemographic. lifestyle. and medical history variables were used to adjust the analyses. We found that 31.8% of the participants reported fair or poor hearing and 42% had cognitive impairment. In the adjusted analysis. older adults with poor hearing were revealed to have a stronger association with cognitive impairment than their peers with good hearing. Therefore. in older Brazilian adults. lower self-perceived hearing status is associated higher levels of cognitive impairment.

Association between impairment and self-rated heath: a brazilian population study considering type, origin, and degree of limitation.

BACKGROUND: Perceived health is a well-known, low-cost measure in public health, and has been used in several studies on individuals with impairment. Although many studies have related impairment to self-rated health (SRH), few have considered the origin and degree of limitation of the impairment. This study examined whether physical, hearing, or visual impairments-when analyzed according to origin (congenital or acquired) and degree of limitation (with or without)-are associated with the SRH status. METHODS: This cross-sectional study used data of 43,681 adult individuals from the Brazilian National Health Survey (NHS, 2013). The outcome SRH was dichotomized into poor (including the regular, poor, and very poor responses) or good (including the good and very good responses). Crude and adjusted (for socio-demographic characteristics and chronic diseases history) prevalence ratios (PR) estimates were evaluated using Poisson regression models with the robust variance estimator. RESULTS: Poor SRH prevalence was estimated at 31.8% (95%CI:31.0-33.0) among the non-impaired population, 65.6% (95%CI:60.6-70.0) among individuals with physical impairment, 50.3% (95%CI:45.0-56.0) for people with hearing impairment, and 55.3% (95%CI:51.8-59.0) for the visually impaired. Individuals with congenital physical impairment-with or without limitations-presented the strongest association with the poorest SRH status. Participants with non-limiting, congenital hearing impairment showed a protective factor to poor SRH (PR = 0.40 95%CI: 0.38-0.52). Individuals with acquired visual impairment with limitations demonstrated the strongest association with poor SRH (PR = 1.48 95%CI:1.47-1.49). Among the impaired population, middle-aged participants showed a stronger association with poor SRH than older adult participants. CONCLUSIONS: Impairment is associated with poor SRH status, especially among people with physical impairment. The origin and degree of limitation of each type of impairment differently impacts SRH among the impaired population.

Self-reported discrimination against adults with hearing loss in Brazilian health services: results of the National Health Survey. / Discriminação social em adultos com deficiência auditiva nos serviços de saúde brasileiro: resultados da Pesquisa Nacional de Saúde.

This article aims to estimate the prevalence of self-reported discrimination against people with hearing loss in Brazilian health services and analyze associated factors. We conducted a cross-sectional population-based study using data from the 2013 National Health Survey. The final study sample comprised 1,464 individuals with self-reported hearing loss. Poisson regression was used to calculate crude and adjusted prevalence ratios (PR) and respective 95% confidence intervals. The overall prevalence of discrimination was 15%. Prevalence was higher among black people and respondents who reported experiencing limitations in activities of daily living. Prevalence of discrimination in Brazilian health services was highest in black people with limitations in activities of daily living. The implementation of policies and actions to address this problem is recommended, including strategies during the education and training of health professionals.

O artigo tem como objetivo estimar a prevalência de discriminação social autorreferida em pessoas com deficiência auditiva nos serviços de saúde brasileiros, verificando fatores associados à discriminação. Estudo transversal de base populacional, com dados de um inquérito epidemiológico domiciliar realizado ponderadamente em todo o território brasileiro no ano de 2013. A amostra final deste estudo compreendeu 1.464 adultos com perda auditiva autorreferida. Utilizou-se regressão de Poisson com variância robusta para cálculo de razões de prevalência (RP) brutas e ajustadas para a investigação das prevalências de discriminação autorreferida nos serviços de saúde e seus respectivos intervalos de confiança de 95%. A prevalência de discriminação em adultos com deficiência auditiva nos serviços de saúde brasileiros foi de 15%. Indivíduos de cor/raça preta e que relataram que a perda auditiva limita as suas atividades de vida diária apresentaram maior associação com discriminação. Pessoas com deficiência auditiva de cor/raça preta e que apresentam limitação nas atividades da vida diária em decorrência da perda auditiva relataram maior discriminação nos serviços de saúde. Estratégias de enfrentamento à discriminação de profissionais da área da saúde devem ser implementadas para que esse cenário seja modificado.

Discriminação social em adultos com deficiência auditiva nos serviços de saúde brasileiro: resultados da Pesquisa Nacional de Saúde / Self-reported discrimination against adults with hearing loss in Brazilian health services: results of the National Health Survey

Resumo O artigo tem como objetivo estimar a prevalência de discriminação social autorreferida em pessoas com deficiência auditiva nos serviços de saúde brasileiros, verificando fatores associados à discriminação. Estudo transversal de base populacional, com dados de um inquérito epidemiológico domiciliar realizado ponderadamente em todo o território brasileiro no ano de 2013. A amostra final deste estudo compreendeu 1.464 adultos com perda auditiva autorreferida. Utilizou-se regressão de Poisson com variância robusta para cálculo de razões de prevalência (RP) brutas e ajustadas para a investigação das prevalências de discriminação autorreferida nos serviços de saúde e seus respectivos intervalos de confiança de 95%. A prevalência de discriminação em adultos com deficiência auditiva nos serviços de saúde brasileiros foi de 15%. Indivíduos de cor/raça preta e que relataram que a perda auditiva limita as suas atividades de vida diária apresentaram maior associação com discriminação. Pessoas com deficiência auditiva de cor/raça preta e que apresentam limitação nas atividades da vida diária em decorrência da perda auditiva relataram maior discriminação nos serviços de saúde. Estratégias de enfrentamento à discriminação de profissionais da área da saúde devem ser implementadas para que esse cenário seja modificado.

Abstract This article aims to estimate the prevalence of self-reported discrimination against people with hearing loss in Brazilian health services and analyze associated factors. We conducted a cross-sectional population-based study using data from the 2013 National Health Survey. The final study sample comprised 1,464 individuals with self-reported hearing loss. Poisson regression was used to calculate crude and adjusted prevalence ratios (PR) and respective 95% confidence intervals. The overall prevalence of discrimination was 15%. Prevalence was higher among black people and respondents who reported experiencing limitations in activities of daily living. Prevalence of discrimination in Brazilian health services was highest in black people with limitations in activities of daily living. The implementation of policies and actions to address this problem is recommended, including strategies during the education and training of health professionals.

Frequency and associated factors for swallowing impairment in community-dwelling older persons: a systematic review and meta-analysis.

INTRODUCTION: Swallowing impairment (SI) is an underdiagnosed dysfunction frequently seen as an expected condition of aging. However, SI can lead to health complications and considerable social impact. METHODS: The objective of this systematic review with meta-analysis was to evaluate the frequency and associated factors with SI in community-dwelling older persons. Searches were performed in 13 electronic databases including MEDLINE and EMBASE (from inception to September 18, 2021). Data extraction and methodological quality assessment of included studies were performed by two independent reviewers. Meta-analysis of proportions with 95% confidence interval (CI) and prediction interval (PI) was used to pool estimates. Subgroup analysis by Country and Assessment Method was performed. General meta-analysis was used to pool measures of association between potential risk factors and SI occurrence (odds ratio [OR] or prevalence ratio [PR]). RESULTS: The worldwide estimated frequency of SI in community-dwelling older persons was 20.35% (95%CI 16.61-24.68%, 95%PI 4.79-56.45, I2 99%, n = 33,291). This estimation varied across assessment methods and by country. The main factors associated with SI were a dry mouth (OR 8.1, 95%CI 4.9-13.4), oral diadochokinesis (OR 5.3, 95%CI 1.0-27.3), ≥ 80 years old (OR 4.9, 95%CI 2.6-9.2), genetic factor (SNPrs17601696) (OR 4.8, 95%CI 2.7-8.3), and partial dependence (OR 4.3, 95%CI 2.0-9.3). And the main factors associated with SI estimated by PR were dry mouth sensation (PR 4.1, 95%CI 2.6-6.5), oral sensorimotor alteration (PR 2.6, 95%CI 1.4-4.9), osteoporosis (PR 2.51, 95%CI 1.2-5.3), and heart diseases (PR 2.31, 95%CI 1.1-5.0). CONCLUSION: One in five older adults worldwide are expected to experience SI and factors associated with this underdiagnosed dysfunction included biological and physiological changes related to aging, physical and psychological conditions, and poor oral health. Early assessment is paramount for the prevention of future clinical complications and should be a high priority in health care practices.

Net Survival in Survival Analyses for Patients with Cancer: A Scoping Review.

Population-based net survival is an important tool for assessing prognostic advances. The unbiased Pohar Perme Estimator (PPE) was suggested in 2012 and soon established itself as the gold standard for estimating net survival. This scoping review aims to know in which context this estimator is being used in the oncology area, what the authors point out as a justification for its use, and the limitations found. We searched PubMed, and the grey literature to answer the question: Have studies involving patients diagnosed with cancer used the PPE to estimate cancer-specific survival? How do they justify the use of the PPE and what are the limitations pointed out? Out of 295 screened, 85 studies were included in this review. The two main characteristics of the PPE mentioned by the studies as justification were the fact that it is an unbiased estimator (83.5%) and that it produces comparable estimates among populations with different mortality rates from causes other than cancer (36.47%). No study pointed to a limitation due to the use of PPE. As a conclusion, the Pohar Perme Estimator is the gold standard for estimating net survival and should be more used in oncology, especially when dealing with population-based studies where the follow-up time is long, making high the probability of death from causes other than cancer.

[Racial inequalities in access to rehabilitation after a stroke: study of the Brazilian population]. / Iniquidades raciais no acesso à reabilitação após acidente vascular cerebral: estudo da população brasileira.

This article aims to verify the association between race/skin color and access to post-stroke rehabilitation services. It is a cross-sectional population-based study including 966 post-stroke adults (≥18 years) that responded to the National Health Survey (PNS). The outcome, access to rehabilitation, and exposure (race/skin color) were collected in a self-reported manner. Socio-demographic variables, clinical history, healthcare plan and post-stroke limitation were considered for the adjustment. Poisson regression with robust variance estimation was used to estimate the association in the crude and adjusted analyses. Based on the sample, 51.8% are self-declared black and 61.4% require rehabilitation, with only 20% having access to the rehabilitation service. Difficulty in accessing rehabilitation was reported by 57.5% of other self-declared races, 43% blacks, and 35.4% whites. In the adjusted analysis, 4% of self-declared black (PR 1.04, CI95%1.00-1.08) and 17% of self-declared yellow and indigenous (PR 1.17, IC95%1.13-1.20) have less access to rehabilitation than their white peers. In Brazil, self-declared black and yellow and indigenous people have worst access to post-stroke rehabilitation in comparison with self-declared white people, highlighting racial inequities in rehabilitation in stroke survivors.

O objetivo deste artigo é verificar a associação raça/cor e acesso a serviços de reabilitação pós-AVC. Estudo transversal de base populacional com 966 adultos (≥18 anos) pós-AVC, respondentes da Pesquisa Nacional de Saúde. Desfecho, acesso à reabilitação, e exposição (raça/cor) foram coletados de modo autorreferido. Variáveis sociodemográficas, histórico clínico, plano de saúde e limitação pós-AVC foram considerados para o ajuste. Regressão de Poisson com estimativa de variância robusta foi utilizada para estimar a associação nas análises bruta e ajustada. Da amostra total, 51,8% são autodeclarados negros ou outras raças, 61,4% demandam por reabilitação, sendo que apenas 20% têm acesso ao serviço de reabilitação. Dificuldade em acessar reabilitação foi referida por 57,5% dos autodeclarados amarelos ou indígenas, 43% dos negros, e 35,4% dos brancos. Na análise ajustada, negros têm 4% menos acesso à reabilitação se comparados com seus pares brancos (RP 1,04, IC95% 1,00-1,08). Pessoas da raça amarela ou indígena 17% menos acesso que brancos (RP 1,17, IC95% 1,13-1,20). No Brasil, autodeclarados negros, amarelos, indígenas e outros têm pior acesso à reabilitação pós-AVC quando comparados aos autodeclarados brancos, apontando iniquidades raciais na reabilitação em sobreviventes de AVC.

Iniquidades raciais no acesso à reabilitação após acidente vascular cerebral: estudo da população brasileira / Racial inequalities in access to rehabilitation after a stroke: study of the Brazilian population

Resumo O objetivo deste artigo é verificar a associação raça/cor e acesso a serviços de reabilitação pós-AVC. Estudo transversal de base populacional com 966 adultos (≥18 anos) pós-AVC, respondentes da Pesquisa Nacional de Saúde. Desfecho, acesso à reabilitação, e exposição (raça/cor) foram coletados de modo autorreferido. Variáveis sociodemográficas, histórico clínico, plano de saúde e limitação pós-AVC foram considerados para o ajuste. Regressão de Poisson com estimativa de variância robusta foi utilizada para estimar a associação nas análises bruta e ajustada. Da amostra total, 51,8% são autodeclarados negros ou outras raças, 61,4% demandam por reabilitação, sendo que apenas 20% têm acesso ao serviço de reabilitação. Dificuldade em acessar reabilitação foi referida por 57,5% dos autodeclarados amarelos ou indígenas, 43% dos negros, e 35,4% dos brancos. Na análise ajustada, negros têm 4% menos acesso à reabilitação se comparados com seus pares brancos (RP 1,04, IC95% 1,00-1,08). Pessoas da raça amarela ou indígena 17% menos acesso que brancos (RP 1,17, IC95% 1,13-1,20). No Brasil, autodeclarados negros, amarelos, indígenas e outros têm pior acesso à reabilitação pós-AVC quando comparados aos autodeclarados brancos, apontando iniquidades raciais na reabilitação em sobreviventes de AVC.

Abstract This article aims to verify the association between race/skin color and access to post-stroke rehabilitation services. It is a cross-sectional population-based study including 966 post-stroke adults (≥18 years) that responded to the National Health Survey (PNS). The outcome, access to rehabilitation, and exposure (race/skin color) were collected in a self-reported manner. Socio-demographic variables, clinical history, healthcare plan and post-stroke limitation were considered for the adjustment. Poisson regression with robust variance estimation was used to estimate the association in the crude and adjusted analyses. Based on the sample, 51.8% are self-declared black and 61.4% require rehabilitation, with only 20% having access to the rehabilitation service. Difficulty in accessing rehabilitation was reported by 57.5% of other self-declared races, 43% blacks, and 35.4% whites. In the adjusted analysis, 4% of self-declared black (PR 1.04, CI95%1.00-1.08) and 17% of self-declared yellow and indigenous (PR 1.17, IC95%1.13-1.20) have less access to rehabilitation than their white peers. In Brazil, self-declared black and yellow and indigenous people have worst access to post-stroke rehabilitation in comparison with self-declared white people, highlighting racial inequities in rehabilitation in stroke survivors.

Factors associated with the professional use of social media by speech-language therapists and audiologists working in Brazil: a web-based survey / Fatores associados ao uso profissional de mídias sociais por fonoaudiólogos que atuam no Brasil: inquérito populacional via web

ABSTRACT Purpose: to verify personal and work factors, and specialties of Brazilian speech-language therapists and audiologists who use social media profiles, professionally. Methods: an online questionnaire was used to carry out a population survey with working speech-language therapists and audiologists in Brazil, in 2020. The outcome of "How would you describe your use of social media?" was recategorized into "personal use" and "professional use". Absolute and relative frequencies were calculated. Multivariate prevalence ratios were adjusted using the Poisson regression model with robust variance and 95% confidence intervals. Results: out of the 442 respondents, 93.7% were females, with a mean age of 38.0 years (± 11.1). The primary outcome, "professional use of social media", occurred for 64.7% of the participants. In the multivariate analysis, private employment, participants in the 31-45 age range, and >26 years of work history after graduation were significantly associated with the professional use of social media. Conclusion: social media are used by approximately two-thirds of Brazilian speech-language therapists and audiologists. This finding suggests a need for reflection and discussion about the proper use of social media for work purposes.

RESUMO Objetivo: verificar os fatores individuais, laborais e a região de atuação dos fonoaudiólogos atuantes no Brasil, com perfil em redes sociais e que as utilizam profissionalmente. Métodos: inquérito populacional via Web, realizado com fonoaudiólogos atuantes no Brasil no ano de 2020, por meio de um questionário on-line. O desfecho "Como você descreveria seu uso das mídias sociais?" foi recategorizado em "uso pessoal" e "uso profissional". As frequências absolutas e relativas e análises multivariáveis ajustadas por Regressão de Poisson com variância robusta com seus respectivos intervalos de confiança de 95% são apresentados. Resultados: dos 442 entrevistados, 93,7% eram do sexo feminino, com média de idade de 38,0 anos (± 11,1). O desfecho "usar mídias sociais profissionalmente" foi encontrado em 64,7% dos entrevistados. Na análise multivariável, a relação de trabalho privada, idade entre 31 e 45 anos e mais de 26 anos de formação na graduação foram aspectos associados significantemente com o uso profissional das mídias sociais. Conclusão: aproximadamente dois terços dos fonoaudiólogos brasileiros com perfis em mídias sociais as utilizam profissionalmente, isso sugere a necessidade de reflexão e discussão sobre os caminhos desejáveis e aceitos em relação a adequada utilização destes meios para o trabalho.

A script for the telepractice of speech-language therapy and audiology services - what was learnt from the COVID-19 pandemic / Roteiro pré, durante e pós teleconsulta fonoaudiológica - o que aprendemos com a pandemia da COVID-19

ABSTRACT In this study, a script for the telepractice of speech language pathology and audiology services for adult patients at home, is presented. This tool was developed in three stages and used for a community project during the COVID-19 pandemic. A literature search was performed to identify the facilitators and barriers to remote patient care before implementing telepractice at a primary health care unit. This practical experience led to further discussions about the facilitators of clinical performance and different ways to remotely offer quality assessments and rehabilitation. Divided into three sections, the final script was organized into twenty items. To provide comprehensive patient care, detailed discussions were held about each item to verify the effectiveness and quality of the teleconsultations, for the script to be written. This guide is intended to be used as a tool for speech language pathology and audiology telepractice. However, it must be adapted to the cultural and social realities of the professionals and patients who use it. Additionally, it does not constitute a closed set of practices and procedures and should be updated as new procedures and technologies become available.

RESUMO Apresenta-se um roteiro de atuação em telessaúde para atendimento fonoaudiológico de pacientes adultos em domicílio que foi aplicado em um projeto comunitário durante a Pandemia da COVID-19. O roteiro foi desenvolvido em três etapas distintas. A partir de uma revisão de literatura para a identificação de facilitadores e barreiras para o atendimento de pacientes via telessaúde, foi feita a implementação de um serviço de telefonoaudiologia em uma Unidade Básica de Saúde, possibilitando a experiência para a discussão mediante a prática de facilitadores para a atuação clínica e maneiras de qualificar a teleconsulta fonoaudiológica. Por fim, deu-se a elaboração do roteiro, organizado em 20 itens, divididos em três seções. A sua elaboração incluiu, além da escrita, a discussão detalhada de cada item elencado, considerando a efetividade das ações propostas, qualificação das teleconsultas e integralidade do atendimento do paciente. O roteiro apresentado se propõe a ser suporte para a atuação em telefonoaudiologia. Entretanto, deve ser adaptado à realidade cultural e social dos profissionais e pacientes que a esta forma de atuação forem expostos. Visto que não se trata de um conjunto de práticas e procedimentos fechados em si, deverá ser atualizado conforme novos procedimentos e tecnologias estejam acessíveis para a atuação em telefonoaudiologia.

Self-rated health and hearing disorders: study of the Brazilian hearing-impaired population.

Hearing impairment (HI) is one of the most impacting handicaps related to social life, and 21% have intense limitation compromising daily activities. However, few studies have investigated SRH in HI. This article aims to verify the association between HI and SRH and factors related to hearing characteristics. Cross-sectional study data from National Health Survey (NHS, 2013) conducted with 1,100 hearing impaired adults (≥18 years old). The outcome was SHR, categorized as good or poor. Poisson regression with robust variance was used to calculate Prevalence Ratios. Sociodemographic variables and characteristics of HI, such as congenital or acquired HI, type of HI, wear hearing aids, and limitation were used in adjusted analysis. Poor SRH was more prevalent in acquired HI, limitation of daily activities, sociodemographic characteristics such as aging, female, black or other skin color, and lower schooling. Poor SRH is related to acquired HI, limitation of daily activities and sociodemographic conditions.

Prevalence of speech-language and hearing disorders in elderly and younger adults according to sex and age: a population survey. / Prevalência de distúrbios fonoaudiológicos em adultos e idosos, segundo sexo e faixa etária: um estudo populacional.

PURPOSE: To verify the distribution of self-reported speech-language and hearing disorders and their association to sex and age in a representative sample of the population in southern Brazil. METHODS: Prevalence of speech-language and hearing disorders in elderly and younger adults according to sex and age: a population survey based on a household survey on Human Communication Disorders (DCH-POP Study). Standardized home interviews were conducted using a questionnaire with residents of the city of Porto Alegre between 2012 and 2014. The study outcome was self-reported "speech-language and hearing disorders", constituted from the variables: language, orofacial motricity, hearing, and balance. Analyses of absolute and relative frequencies were performed. Multivariable prevalence ratios were estimated in an adjusted analysis using Poisson Regression with robust variation and 95% confidence intervals. RESULTS: Of the 1246 individuals interviewed, 918 participants were eligible for this study. Most of them were female (58.1%), and the average age was 48.9 (± 19.6) years. The outcome of speech-language and hearing disorders was found in 364 (39.4%) individuals, and the most affected age group was 60 years old or more (54.4%), with a higher prevalence in men (58.9%) than in women (51.9%). The multivariate analysis showed a significant prevalence ratio only in elderly individuals aged 60 years or older (PR 1.84; 95% CI 1.50-2.26). CONCLUSION: In this study, we did not find significant differences between sexes in the prevalence of self-reported speech-language and hearing disorders in elderly and younger adults. However, elderly and younger adults presented a higher prevalence of these disorders.

OBJETIVO: Verificar a distribuição dos distúrbios fonoaudiológicos autorreferidos em relação ao sexo e à faixa etária em uma amostra representativa da população do sul do Brasil. MÉTODO: Estudo transversal em adultos e idosos com base em um inquérito populacional domiciliar autodeclarado sobre Distúrbios da Comunicação Humana (DCH-POP). Foram realizadas entrevistas domiciliares padronizadas com a aplicação de um questionário com residentes da cidade de Porto Alegre entre 2012 e 2014. O desfecho estudado foi "distúrbios fonoaudiológicos", constituído a partir dos dados das variáveis: linguagem, motricidade orofacial, audição e equilíbrio. Foram realizadas análises de frequência absoluta e relativa. Razões de prevalência multivariáveis foram estimadas em análise ajustada pela Regressão de Poisson com variância robusta e respectivos intervalos de confiança de 95%. RESULTADOS: Dos 1246 indivíduos entrevistados, 918 participantes foram elegíveis para este estudo. A maioria é do sexo feminino (58,1%) e a idade média foi de 48,9 (±19,6) anos. O desfecho distúrbio fonoaudiológico foi encontrado em 364 (39,4%) indivíduos, sendo que a faixa etária mais acometida foi a de 60 anos ou mais (54,4%), apresentando maior prevalência no sexo masculino (58,9%), do que no feminino (51,9%). Na análise multivariável ajustada verifica-se que há razão de prevalência significativa apenas em indivíduos idosos com 60 anos ou mais (RP 1,84 IC95% 1,50-2,26). CONCLUSÃO: Neste estudo não encontramos diferenças significativas entre os sexos na prevalência dos distúrbios fonoaudiológicos autorreferidos em adultos e idosos. Entretanto, pessoas mais velhas apresentam maior prevalência destes, especialmente aquelas com idade entre 60 anos ou mais.

Caries experience in caregiver-intellectual deficient pair: Influence of caregiver's psychological morbidity.

OBJECTIVE: Evaluate how determinants of psychological morbidity were associated with dental caries experience in the caregiver-intellectual deficient pair. METHODS: A cross-sectional study with 299 pair, who had their oral health status assessed using the DMFT index (decayed, missing and filled teeth). Symptoms of anxiety, depression, stress, quality of sleep, and socioeconomic variables were measured in caregivers. Adjusted prevalence ratios were estimated using Poisson regression with the caregiver and children's caries index as outcome. RESULTS: The average prevalence of DMFT/dmft was 7.48 (SD ± 3.9) for students with ID and DMFT was 14.7 (SD ± 8.1) for their caregivers. For the caregiver's oral health, the following psychic comorbidities were associated with worse oral health condition: anxiety (PR = 1.48; 95%CI 1.07-2.06), depression (PR = 1.39; 95%CI 1.05-1.85), high level of stress (PR = 1.58; 95%CI 1.17-2.13) and sleep disorders (PR = 1.59; 95%CI 1.18-2.14). For people with ID, the caregiver's psychic comorbidities also showed association with a worse oral health condition, including anxiety (PR = 1.31; 95%CI 1.03-1.74), depression (PR = 1.28; 95%CI 1.01-1.67) and high level of stress (PR = 1.63; 95%CI 1.14-2.32), as well as mother's high level of DMFT (PR = 1.96; 95%CI 1.28-3.03). CONCLUSION: Symptoms of depression, anxiety and stress were associated with higher levels of dental caries experience for caregivers and for people with intellectual disabilities.

Swallowing impairment in older adults: association with sensorimotor peripheral nerve function from the Health, Aging and Body Composition study.

BACKGROUND: The purpose of this study was to examine whether impairments in sensorimotor peripheral nerve function are associated with a higher likelihood of swallowing impairment in older adults. METHODS: Health, Aging and Body Composition participants (n = 607, age = 75.8 ± 2.7 years, 55.8% women, 32.3% black) underwent peripheral nerve testing at Year 4 and 11 with swallowing difficulty assessed at Year 4 and 15. Nerve conduction amplitude and velocity were measured at the peroneal motor nerve. Sensory nerve function was assessed with the vibration detection threshold and monofilament (1.4-g/10-g) testing at the big toe. Symptoms of lower extremity peripheral neuropathy and difficulty swallowing were collected by self-report. Data analysis was performed using a hierarchical approach. Odds ratios (ORs) were estimated using non-conditional logistic regression. RESULTS: At Year 15 108 (17.8%) participants had swallowing impairments. In fully adjusted models, the peripheral nerve impairments associated with swallowing impairment were numbness (OR 4.67; 95%CI 2.24-9.75) and poor motor nerve conduction velocity (OR 2.26; 95%CI 1.08-4.70). Other peripheral nerve impairments were not related to swallowing. CONCLUSIONS: The association between slow motor nerve conduction velocity and numbness and a higher likelihood of swallowing difficulties a decade later in our prospective study identifies an important area for further investigation in older adults.

Synchronous teleconsultation in the management of temporomandibular disorder

ABSTRACT Purpose: to analyze synchronous teleconsultation as a support tool in the management of temporomandibular disorders in primary health care and to identify which factors have an impact on decisions about teleconsultation. Methods: retrospective study perfomed in TelessaúdeRS, between May 2018 to May 2020. This study used primary data from synchronous teleconsultation, requested by primary health care professionals and carried out by multiprofessional teleconsultants. The data collected were the information reported by the requester, the teleconsultant's suggestions and if there was referral of the patient for specialized care after teleconsultation. The statistical association was investigated between patient characteristics and decision of teleconsultation; and teleconsultation conduct suggestions and decision of teleconsultation, using Fisher's exact test and modeling was performed using binary logistic regression considering 5% of significance (p≤0.05). Results: during the period, 56 teleconsultations had a temporomandibular diagnostic hypothesis, these 79.2% patients were female and the average age was 43.7 years. In 59.1% of teleconsultations, primary care management was suggested, with 72.4% of patients being managed. An association was found between the decision of teleconsultation and referral to specialized care (p <000.1). The trauma report (p = 0.004) was associated with a greater chance of being referred for special care and suggestions for pharmacological (p <0.001) and non-pharmacological (p = 0.007) treatments were introduced among the teleconsultation managed in primary care. Conclusion: teleconsultation helped to manage the majority of temporomandibular disorder, streamlining care and having the potential to avoid unnecessary referrals to special care.

Prevalência de distúrbios fonoaudiológicos em adultos e idosos, segundo sexo e faixa etária: um estudo populacional / Prevalence of speech-language and hearing disorders in elderly and younger adults according to sex and age: a population survey

RESUMO Objetivo Verificar a distribuição dos distúrbios fonoaudiológicos autorreferidos em relação ao sexo e à faixa etária em uma amostra representativa da população do sul do Brasil. Método Estudo transversal em adultos e idosos com base em um inquérito populacional domiciliar autodeclarado sobre Distúrbios da Comunicação Humana (DCH-POP). Foram realizadas entrevistas domiciliares padronizadas com a aplicação de um questionário com residentes da cidade de Porto Alegre entre 2012 e 2014. O desfecho estudado foi "distúrbios fonoaudiológicos", constituído a partir dos dados das variáveis: linguagem, motricidade orofacial, audição e equilíbrio. Foram realizadas análises de frequência absoluta e relativa. Razões de prevalência multivariáveis foram estimadas em análise ajustada pela Regressão de Poisson com variância robusta e respectivos intervalos de confiança de 95%. Resultados Dos 1246 indivíduos entrevistados, 918 participantes foram elegíveis para este estudo. A maioria é do sexo feminino (58,1%) e a idade média foi de 48,9 (±19,6) anos. O desfecho distúrbio fonoaudiológico foi encontrado em 364 (39,4%) indivíduos, sendo que a faixa etária mais acometida foi a de 60 anos ou mais (54,4%), apresentando maior prevalência no sexo masculino (58,9%), do que no feminino (51,9%). Na análise multivariável ajustada verifica-se que há razão de prevalência significativa apenas em indivíduos idosos com 60 anos ou mais (RP 1,84 IC95% 1,50-2,26). Conclusão Neste estudo não encontramos diferenças significativas entre os sexos na prevalência dos distúrbios fonoaudiológicos autorreferidos em adultos e idosos. Entretanto, pessoas mais velhas apresentam maior prevalência destes, especialmente aquelas com idade entre 60 anos ou mais.

ABSTRACT Purpose To verify the distribution of self-reported speech-language and hearing disorders and their association to sex and age in a representative sample of the population in southern Brazil. Methods Prevalence of speech-language and hearing disorders in elderly and younger adults according to sex and age: a population survey based on a household survey on Human Communication Disorders (DCH-POP Study). Standardized home interviews were conducted using a questionnaire with residents of the city of Porto Alegre between 2012 and 2014. The study outcome was self-reported "speech-language and hearing disorders", constituted from the variables: language, orofacial motricity, hearing, and balance. Analyses of absolute and relative frequencies were performed. Multivariable prevalence ratios were estimated in an adjusted analysis using Poisson Regression with robust variation and 95% confidence intervals. Results Of the 1246 individuals interviewed, 918 participants were eligible for this study. Most of them were female (58.1%), and the average age was 48.9 (± 19.6) years. The outcome of speech-language and hearing disorders was found in 364 (39.4%) individuals, and the most affected age group was 60 years old or more (54.4%), with a higher prevalence in men (58.9%) than in women (51.9%). The multivariate analysis showed a significant prevalence ratio only in elderly individuals aged 60 years or older (PR 1.84; 95% CI 1.50-2.26). Conclusion In this study, we did not find significant differences between sexes in the prevalence of self-reported speech-language and hearing disorders in elderly and younger adults. However, elderly and younger adults presented a higher prevalence of these disorders.