Fragilidade em pessoas idosas na comunidade: estudo comparativo de instrumentos de triagem / Frailty in community-dwelling older adults: a comparative study of screening instruments

Resumo Objetivo analisar a concordância entre as escalas de fragilidade Edmonton Frail Scale (EFS) e Índice de Vulnerabilidade Clínico Funcional (IVCF-20). Métodos estudo transversal durante o qual se aplicou, em domicílio, a Edmonton Frail Scale e o Índice de Vulnerabilidade Clínico Funcional para pessoas idosas cadastradas em unidades da Estratégia Saúde da Família de Montes Claros (MG) e selecionadas, aleatoriamente, por sorteio. Para avaliação da correlação e da concordância entre os instrumentos, foram calculados o coeficiente de correlação de Pearson e o Kappa ponderado, considerando-se três níveis de classificação da fragilidade, a saber: "robusto", "em fragilização" e "frágil" para o IVCF-20 e "não frágil", "vulnerável" e "frágil" para a EFS. Resultados Foram avaliadas 673 pessoas idosas, predominantemente pardas, com 60 a 74 anos e do sexo feminino. De acordo com o IVCF-20, 153 (22,7%) das pessoas idosas foram classificadas como "frágeis", 195 (29%) "em fragilização" e 325 (48,3%) como pessoas idosas "robustas". Conforme a EFS, 159 pessoas idosas (23,6%) foram classificadas como "frágeis"; 112 (16,6%) pessoas idosas "aparentemente vulneráveis" e 402 (59,7%) "sem fragilidade". O coeficiente de correlação de Pearson foi 0,865 (p<0,001) e mostrou haver forte correlação positiva entre os instrumentos. A estatística Kappa apresentou valor de 0,532 (p=0,027) e revelou concordância moderada. Conclusão Os instrumentos avaliados apresentaram concordância moderada e forte correlação positiva, apesar das diferenças entre alguns dos seus componentes. Ambos se mostraram compatíveis para a avaliação de fragilidade em pessoas idosas no contexto da Atenção Primária à Saúde.

Abstract Objective to analyze the agreement between the Edmonton Frail Scale (EFS) and the Clinical Functional Vulnerability Index (CFVI-20). Methods cross-sectional study, during which the Edmonton Frail Scale and the Clinical Functional Vulnerability Index were applied, at home, to older adults, registered in units of the Family Health Strategy of Montes Claros (MG) and randomly selected by lot. To evaluate the correlation and agreement between the instruments, Pearson's correlation coefficient and the weighted Kappa were calculated, considering three levels of frailty classification, as follows: "robust", "risk of frail" and "frail" for the IVCF-20 and "not frail", "vulnerable" and "frail'" for the EFS. Results We evaluated 673 older adults, predominantly brown, between 60 and 74 years old and female. According to the IVCF-20, 153 (22.7%) of the older adults were classified as "frail", 195 (29%) as "risk of frail" and 325 (48.3%) as "robust". According to the EFS, 159 older adults (23.6%) were classified as "frail"; 112 (16.6%) older adults "apparently vulnerable" and 402 (59.7%) "not frail". Pearson's correlation coefficient was 0.865 (p<0.001) and showed a positive correlation between the instruments and Kappa statistics showed a value of 0.532 (p=0.027), revealing moderate agreement. Conclusion The instruments evaluated showed moderate agreement and strong positive correlation, despite the differences between some of their components. Both showed to be compatible for the assessment of frailty in older adults in the context of Primary Health Care.

Percepção dos profissionais de saúde sobre a atuação de acadêmicos no contexto da Atenção Primária / Perception of health professionals on undergraduate students acting in the context of primary care

A Atenção Primária em Saúde (APS) é um cenário importante para a graduação dos cursos na área da saúde. Objetiva-se descrever e analisar a percepção dos profissionais da saúde de uma Unidade Básica de Saúde (UBS) sobre a atuação dos acadêmicos de enfermagem, medicina e odontologia. Trata-se de um estudo descritivo e exploratório de abordagem qualitativa, por meio da realização de entrevistas semiestruturadas aplicadas a profissionais atuantes na UBS em questão. A UBS apresentou recursos humanos adequados para atender às necessidades dos estudantes, mas uma insuficiência na estrutura física. A atuação dos estudantes traz contribuições para a organização do serviço e atendimento da população, apesar de diminuir a agilidade do serviço e limitar a longitudinalidade nos atendimentos. Conclui-se que a participação de estudantes na UBS agrega valor e é necessária para a formação acadêmica, como meio de ampliar a compreensão do processo saúde-doença e das possibilidades de cuidado.

Primary Health Care (PHC) is an important scenario for undergraduate health courses. The objective is to describe and analyse the perception of health professionals on undergraduate students on nursing, medicine, and dentistry acting in a Basic Health Unit (BHU). It is a descriptive and exploratory study of a qualitative approach with personal semi-structured interviews applied to professionals working in the BHU. The unit presents adequate human resources to attend to the students' needs, despite the physical structure being unsatisfying. The undergraduate students' performance brings contributions to the organization of the service and attendance of the population, although it can reduce and limit the agility and the longitudinality of the service. Through this study, the undergraduate students' participation in the BHU adds value and is essential for academic training as a means to broaden the understanding of the health-disease process and the treatment possibilities.

Validity and precision of the International Physical Activity Questionnaire for climacteric women using computational intelligence techniques.

This study aimed to evaluate the validity and precision of the International Physical Activity Questionnaire (IPAQ) for climacteric women using computational intelligence techniques. The instrument was applied to 873 women aged between 40 and 65 years. Considering the proposal to regroup the set of data related to the level of physical activity of climacteric women using the IPAQ, we used 2 algorithms: Kohonen and k-means, and, to evaluate the validity of these clusters, 3 indexes were used: Silhouette, PBM and Dunn. The questionnaire was tested for validity (factor analysis) and precision (Cronbach's alpha). The Random Forests technique was used to assess the importance of the variables that make up the IPAQ. To classify these variables, we used 3 algorithms: Suport Vector Machine, Artificial Neural Network and Decision Tree. The results of the tests to evaluate the clusters suggested that what is recommended for IPAQ, when applied to climacteric women, is to categorize the results into two groups. The factor analysis resulted in three factors, with factor 1 being composed of variables 3 to 6; factor 2 for variables 7 and 8; and factor 3 for variables 1 and 2. Regarding the reliability estimate, the results of the standardized Cronbach's alpha test showed values between 0.63 to 0.85, being considered acceptable for the construction of the construct. In the test of importance of the variables that make up the instrument, the results showed that variables 1 and 8 presented a lesser degree of importance and by the analysis of Accuracy, Recall, Precision and area under the ROC curve, there was no variation when the results were analyzed with all IPAQ variables but variables 1 and 8. Through this analysis, we concluded that the IPAQ, short version, has adequate measurement properties for the investigated population.

Abdominal obesity and association with sociodemographic, behavioral and clinical data in climacteric women assisted in primary care.

This study aims to investigate the prevalence and factors associated with abdominal obesity in climacteric women assisted at Family Health Strategy units of the city of Montes Claros, State of Minas Gerais, Brazil. It is a cross-sectional analytical study. The women were selected by probabilistic sampling from August 2014 to August 2015. A questionnaire containing information referring to sociodemographic and economic characteristics, behavioral characteristics and clinical data was used. To estimate abdominal obesity, the measure of circumference ≥ 88 cm was considered. To analyze the association between abdominal obesity and the independent variables, a bivariate analysis was performed by means of Pearson's chi-square test (p≤0.25). Subsequently, a multiple Poisson regression analysis with robust variance was performed, through which prevalence ratios with level of significance of 5% (p<0.05) were obtained. A total of 805 women were evaluated, aged 40 to 65 years, and the prevalence of women with abdominal obesity was 62.4%. The mean and median of abdominal circumference were 93.0 cm. The associated variables were being sedentary (PR = 1.44) or irregularly active (PR = 1.39), presenting altered total cholesterol (PR = 1.21), and being hypertensive (PR = 1.31). The abdominal obesity in climacteric women was associated with physical inactivity, total cholesterol and arterial hypertension. The measurement of abdominal circumference must be valued and adopted in the routine of professionals who work in Primary Care.

Correction: Health conditions associated with overweight in climacteric women.

[This corrects the article DOI: 10.1371/journal.pone.0218497.].

Health conditions associated with overweight in climacteric women.

This study aims to investigate the association between health conditions and overweight in climacteric women assisted by primary care professionals. It is a cross-sectional study conducted with 874 women from 40 to 65 years of age, selected by probabilistic sampling between August 2014 and August 2015. In addition to the outcome variable, overweight and obesity, other variables such as sociodemographic, reproductive, clinical, eating and behavioural factors were evaluated. Descriptive analyses of the variables investigated were performed to determine their frequency distributions. Then, bivariate analyses were performed through Poisson regression. For the multivariate analyses, hierarchical Poisson regression was used to identify factors associated with overweight and obesity in the climacteric period. The prevalence of overweight and obesity was 74%. Attending public school (PR: 1.30-95% CI 1.14-1.50), less schooling (PR: 1.11-95% CI 1.01-1.23), gout (PR: 1.18-95% CI 1.16-1.44), kidney disease (PR: 1.18-95% CI 1.05-1.32), metabolic syndrome (MS) (PR: 1.19-95% CI 1.05-1.34) and fat intake (PR: 1.12-95% CI 1.02-1.23) were considered risk factors for overweight. Having the first birth after 18 years of age (PR: 0.89-95% CI 0.82 to 0.97) was shown to be a protective factor for overweight and obesity. The presence of overweight and obesity is associated with sociodemographic, reproductive, clinical and eating habits.

Prevalência de sobrepeso e obesidade entre crianças de 7 a 10 anos atendidas em uma unidade de Estratégia Saúde da Família - ESF / Prevalence of overweight and obesity among children aged 7-10 years treated in a unit of the Family Health Strategy (ESF) / La prevalencia de sobrepeso y obesidad entre los niños de 7-10 años de edad tratados en una unidad de la Estrategia Salud de la Familia - ESF

Objetivos: Estabelecer a prevalência de sobrepeso e obesidade entre crianças cadastradas em unidade de Estratégia Saúde da Família. Métodos: Estudo descritivo, quantitativo, de corte transversal, com população alvo de 134 crianças de 7 a 10 anos de idade. Foi calculado o índice de massa corporal das crianças e aplicado questionário sobre práticas alimentares e atividade física. No tratamento estatístico dos dados foi usado o SPSS versão 19, utilizando-se os procedimentos: média, desvio padrão, frequência, teste t e Qui Quadrado. Usou-se Odds ratio de prevalência com intervalo de confiança de 95%. A importância relativa dos fatores estudados no risco da criança apresentar sobrepeso ou obesidade foi observada pelo ajuste do modelo regressão logística. Resultados: Foram avaliadas 86 crianças de ambos os sexos. A taxa de sobrepeso foi de 17,5% e de obesidade de 25% entre meninas e 4,3% de sobrepeso e 13% de obesidade entre meninos (p=0,061). Crianças matriculadas na rede particular tiveram 18,8% de sobrepeso e 37,5% de obesidade enquanto nas da rede pública as taxas foram de 8,6% e 14,3%, para sobrepeso e obesidade, respectivamente (p=0,058). As demais variáveis não foram estatisticamente significativas após a aplicação do modelo de regressão logística. Conclusão: Houve alta prevalência de sobrepeso e obesidade na população estudada, principalmente entre crianças matriculadas na rede particular e do sexo feminino.

Objectives: This study aimed to determine the prevalence of overweight and obesity among children enrolled in a unit of the Family Health Strategy. Methods: This descriptive, quantitative, and cross-sectional study included 134 children aged 7­10 years. The children's body mass indexes were calculated, and they were administered questionnaires on eating habits and physical activity. SPSS version 19 was used in the statistical analyses of the data, and the following were calculated: mean, standard deviation, frequency, t and chi-square test values, and prevalence odds ratio with 95% confidence interval. The relative importance of the factors studied affecting the risk of the child being overweight or obese was measured by adjusting the logistic regression model. Results: A total of 86 children of both sexes were evaluated. Among girls, 17.5% were overweight and 25% were obese, and among boys, 4.3% were overweight and 13% were obese (p = 0.061). Among children enrolled in private schools, 18.8% of children were overweight and 37.5% were obese, while in the public schools, 8.6% were overweight and 14.3% were obese (p = 0.058). The other variables were not statistically significant after applying the logistic regression model. Conclusion: There was a high prevalence of overweight and obesity in the population, especially among girls enrolled in private schools.

Objetivos: Determinar la prevalencia de sobrepeso y obesidad entre los niños inscritos en una unidad de la Estrategia de Salud Familiar. Métodos: estudio cuantitativo descriptivo, transversal, con población de 134 niños entre los 7 y 10 años de edad. Fue calculado el índice de masa corporal de los niños y aplicado el cuestionario sobre los hábitos alimentarios y la actividad física. El tratamiento estadístico de los datos se utilizó el programa SPSS versión 19, con los siguientes procedimientos: media, desviación estándar, frecuencia, prueba t y Qui Cuadrado. Se utilizó Odds ratio de prevalencia con intervalo de confianza del 95%. La importancia relativa de los factores estudiados en el riesgo de que el niño sea sobrepeso u obesidad se observó mediante el ajuste del modelo de regresión logística. Resultados: Se evaluaron 86 niños de ambos sexos. La tasa de sobrepeso fue del 17,5% y 25% de obesidad entre las niñas y el 4,3% de sobrepeso y el 13% de obesidad entre los niños (p=0,061). Los niños inscritos en escuelas privadas tuvieron el 18,8% de sobrepeso y 37,5 de obesidad, mientras que en las tarifas públicas fueron el 8,6% y el 14,3% para el sobrepeso y la obesidad, respectivamente (p=0,058). Las otras variables no fueron estadísticamente significativas después de aplicar el modelo de regresión logística. Conclusión: Hubo una alta prevalencia de sobrepeso y obesidad en la población, especialmente entre los niños matriculados en escuelas privadas y del sexo femenino.