Knowledge, attitudes, and practices towards COVID-19 among the population of the state of São Paulo, Brazil.

BACKGROUND: The population's adherence to COVID-19 preventive measures is influenced by their knowledge, attitudes, and practices (KAP) towards the disease, making research into people's awareness of the disease essential. The present survey was designed to assess KAP towards COVID-19 among the population of the state of São Paulo, Brazil. METHODS: An online questionnaire was disseminated via social media between September 14 and October 5, 2020. The intended population was Brazilians over the age of 18, living in the state of São Paulo. RESULTS: A total of 1,111 individuals completed the questionnaire. The majority were women (71.6%), 31.6% were aged 31-40 years old, and 82.8% had higher education. Among the participants, 17.5% reported that they had taken some medication without a medical prescription to prevent COVID-19. The participants showed good knowledge about the transmission and prevention of the disease. The knowledge mean score was lower among participants with complete high school or less, with poor self-perception of their health status, who almost never seek information about COVID-19, and those who are not sure to belong to a risk group for the disease. Only 51.3% of the participants believed that COVID-19 would finally be successfully controlled, and 56.6% were confident that Brazil could win the battle against the virus. CONCLUSIONS: Participants demonstrated good knowledge of COVID-19 but were pessimistic about the pandemic's future. The findings of this study can help in the development of effective health communication strategies to promote better knowledge and a positive attitude about prevention measures.

Panorama of COVID-19, risk perception and vaccine confidence in São Paulo State population, Southeast Brazil.

In 2021, the COVID-19 pandemic remained uncontrolled in Brazil, with more than 17.6 million cases diagnosed and more than a half a million deaths in total. It is known that an accurate risk perception by populations and a consequent adherence to preventive measures can increase the effectiveness of policies to contain the transmission of infectious diseases. The objective of this study was to draw a panorama of COVID-19 in São Paulo State and investigate the population's risk perception about the new coronavirus, attitudes regarding preventive measures and vaccine confidence through an open web survey. A total of 1111 individuals participated (71.6% females). Of those, 15% declared themselves unemployed, almost 6% lost their jobs during the pandemic, and more than 30% suffered a decrease in their monthly income. As for the COVID-19, almost 32% of the participants were tested sometime in 2020, and 11.3% reported a confirmed diagnosis for a level of hospitalisation of 5%. As for the risk perception, it was observed that situations with crowds of people were more frequently considered as of high risk and cause of greater concern with contamination of family members than with themselves. Almost 23% of the participants questioned whether they would take the vaccine when available and do not know if the COVID-19 vaccine will be safe for the population. Almost 70% disagreed with the statement that the actions of the country's health authorities are effective in combating COVID-19. Considering the Cramer's V coefficient, these variables were not associated with gender or educational level.

Brazilian Portuguese versions and cross-cultural adaptation of two instruments to assess knowledge, attitude, and practice regarding the COVID-19 pandemic in the Brazilian population.

INTRODUCTION: Studies based on knowledge, attitude, and practice (KAP) theory are conducted to identify ways to improve strategies aimed at preventing and combatting certain conditions or diseases, to understand the way how behavioral changes are assimilated by the populations, and to reorient interventions. In view of the coronavirus disease 2019 (COVID-19) pandemic, studies based on KAP theory have been useful to better understand certain behaviors, such as adherence to prevention measures and control of the spread of the virus. OBJECTIVE: To describe the process of cross-cultural adaptation of two complementary instruments for assessing KAP regarding the COVID-19 pandemic in the Brazilian population. METHODS: Two independent translators proposed a first Brazilian Portuguese version of the scales. The cultural adaptation and pre-test of the Brazilian Portuguese versions occurred at different stages, using a panel of specialists and a subsample of the target population, respectively. RESULTS: The pre-test of the adapted instruments involved 30 Brazilian adults (mean age = 41.8 years; standard deviation = 4.24) and was carried out to assess instrument understanding and applicability. The participants informed they did not have difficulties to self-complete the instruments and reported a high level of clarity and understanding. CONCLUSION: Both instruments can bring an opportunity to study behavioral constructs about COVID-19 in the Brazilian population, aiming to articulate strategies that enable the fulfillment of effective preventive measures.

Accuracy of spirometry for detection of asthma: a cross-sectional study.

BACKGROUND: Asthma is a chronic inflammatory disease with airway hyperresponsiveness. Spirometry is the most commonly used test among asthmatic patients. Another functional test used for diagnosing asthma is the bronchial challenge test. The aim of this study was to analyze the accuracy of spirometry for detecting asthma in the general population. DESIGN AND SETTING: Cross-sectional study with data analysis to evaluate the accuracy of spirometry through calculating sensitivity, specificity and predictive values and through the kappa agreement test. METHODS: Subjects who constituted a birth cohort were enrolled at the age of 23 to 25 years. Spirometric abnormality was defined as reduced forced expiratory volume in one second, i.e. lower than 80% of the predicted value. Measurement of bronchial responsiveness was performed by means of the bronchial challenge test with methacholine. The gold-standard diagnosis of asthma was defined as the presence of bronchial hyperresponsiveness in association with respiratory symptoms. RESULTS: Asthma was detected in 200 subjects (10.4%) out of the sample of 1922 individuals. Spirometric abnormality was detected in 208 subjects (10.9%) of the sample. The specificity of spirometric abnormality for detecting asthma was 90%, sensitivity was 23%, positive predictive value was 22%, and negative predictive value was 91%. The kappa test revealed weak agreement of 0.13 (95% confidence interval, CI: 0.07-0.19) between spirometry and the diagnosis of asthma. CONCLUSION: Spirometry, as a single test, has limitations for detecting asthma in the general population.

Accuracy of spirometry for detection of asthma: a cross-sectional study

ABSTRACT BACKGROUND: Asthma is a chronic inflammatory disease with airway hyperresponsiveness. Spirometry is the most commonly used test among asthmatic patients. Another functional test used for diagnosing asthma is the bronchial challenge test. The aim of this study was to analyze the accuracy of spirometry for detecting asthma in the general population. DESIGN AND SETTING: Cross-sectional study with data analysis to evaluate the accuracy of spirometry through calculating sensitivity, specificity and predictive values and through the kappa agreement test. METHODS: Subjects who constituted a birth cohort were enrolled at the age of 23 to 25 years. Spirometric abnormality was defined as reduced forced expiratory volume in one second, i.e. lower than 80% of the predicted value. Measurement of bronchial responsiveness was performed by means of the bronchial challenge test with methacholine. The gold-standard diagnosis of asthma was defined as the presence of bronchial hyperresponsiveness in association with respiratory symptoms. RESULTS: Asthma was detected in 200 subjects (10.4%) out of the sample of 1922 individuals. Spirometric abnormality was detected in 208 subjects (10.9%) of the sample. The specificity of spirometric abnormality for detecting asthma was 90%, sensitivity was 23%, positive predictive value was 22%, and negative predictive value was 91%. The kappa test revealed weak agreement of 0.13 (95% confidence interval, CI: 0.07-0.19) between spirometry and the diagnosis of asthma. CONCLUSION: Spirometry, as a single test, has limitations for detecting asthma in the general population.

Extracorporeal shockwaves therapy versus hyaluronic acid injection for the treatment of painful non-calcific rotator cuff tendinopathies: preliminary results.

BACKGROUND: Rotator cuff tendinopathy is the most common cause of painful shoulder. The treatment is mainly conservative and several therapeutic approaches have been proposed, including NSAIDs, physiotherapy, injections and physical therapies. The aim of the current study was to compare the clinical effectiveness of low molecular weight hyaluronic acid (LMW-HA) injection versus low-energy extracorporeal shock-wave therapy (ESWT) until 3 months of follow-up for the management of painful non-calcific rotator cuff tendinopathies, evaluating also the trend over time between the groups. METHODS: A total of 34 patients affected by painful rotator cuff tendinopathy were randomly divided into 2 groups of 17 individuals. The first group (group A; mean age 58.2 years) underwent 3 injections of LMW-HA (Hyalgan®, 500-730 kDa), while in the second group (group B; mean age 58.5 years) the treatment protocol consisted of 4 sessions of low-energy ESWT. Pain level and function were assessed with the DASH and Constant-Murley questionnaires. Parameters were evaluated at baseline (V0), at the end of the treatment (V1) and after 3 months of follow-up (V2). RESULTS: Patients of both groups achieved statistically significant improve in pain and function (P<0.0001). Clinical outcome shows a different trend in time between group A and group B for DASH and Constant-Murley questionnaires. CONCLUSIONS: LMW-HA and low-energy ESWT are effective and safe in patients suffering from non-calcific rotator cuff tendinopathy until 3 months of follow-up. Intra-articular injections of LMW-HA provide prompt clinical improvement compared to ESWT, which results in more gradual improvement over time.

Ultrasonography in myofascial neck pain: randomized clinical trial for diagnosis and follow-up.

OBJECTIVE: A definitive diagnosis of chronic neck pain (CNP) is sometimes not possible. The aim of this study was to understand the possible role of the deep fasciae in CNP and the utility of the ultrasonography in the diagnosis of myofascial neck pain. METHODS: The morphometric and clinical data of 25 healthy subjects and 28 patients with CNP were compared. For all subjects, the active and passive cervical range of motion (ROM) was analyzed and the neck pain disability questionnaire (NDPQ) was administered. The fascial thickness of the sternal ending of the sternocleidomastoid and medial scalene muscles was also analyzed by ultrasonography. RESULTS: There were significant differences between healthy subjects and patients with CNP in the thickness of the upper side of the sternocleidomastoid fascia and the lower and upper sides of the right scalene fascia both at the end of treatment as during follow-up. A significant decrease in pain and thickness of the fasciae were found. Analysis of the thickness of the sub-layers showed a significant decrease in loose connective tissue, both at the end of treatment and during follow-up. CONCLUSIONS: The data support the hypothesis that the loose connective tissue inside the fasciae may plays a significant role in the pathogenesis of CNP. In particular, the value of 0.15 cm of the SCM fascia was considered as a cut-off value which allows the clinician to make a diagnosis of myofascial disease in a subject with CNP. The variation of thickness of the fascia correlated with the increase in quantity of the loose connective tissue but not with dense connective tissue.

Knowledge of and technique for using inhalation devices among asthma patients and COPD patients.

OBJECTIVE: To evaluate knowledge of and techniques for using prescribed inhalation devices among patients with asthma or COPD treated at a tertiary teaching hospital. METHODS: Patients were assessed after medical visits, and their physicians were blinded to this fact. Patients were asked to demonstrate their inhaler technique and were then interviewed regarding their knowledge of inhalation devices, control of the disease and instructions received during medical visits. RESULTS: We included 120 volunteers: 60 with asthma and 60 with COPD. All of the asthma patients and 98.3% of the COPD patients claimed to know how to use inhaled medications. In the sample as a whole, 113 patients (94.2%) committed at least one error when using the inhalation device. Patients committed more errors when using metered-dose inhalers than when using the dry-powder inhalers Aerolizer (p < 0.001) or Pulvinal (p < 0.001), as well as committing more errors when using the Aerolizer inhaler than when using the Pulvinal inhaler (p < 0.05). Using the metered-dose, Pulvinal and Aerolizer inhalers, the COPD group patients committed more errors than did the asthma group patients (p = 0.0023, p = 0.0065 and p = 0.012, respectively). CONCLUSIONS: Although the majority of the patients claimed to know how to use inhalation devices, the fact that 94.2% committed at least one error shows that their technique was inappropriate and reveals a discrepancy between understanding and practice. Therefore, it is not sufficient to ask patients whether they know how to use inhalation devices. Practical measures should be taken in order to minimize errors and optimize treatment.

Técnica e compreensão do uso dos dispositivos inalatórios em pacientes com asma ou DPOC / Knowledge of and technique for using inhalation devices among asthma patients and COPD patients

OBJETIVO: Avaliar a compreensão e a técnica de uso dos dispositivos inalatórios prescritos de pacientes com asma ou DPOC atendidos em um hospital-escola terciário. MÉTODOS: Os pacientes foram avaliados na sala de pós-consulta sem que o médico soubesse do estudo. Foi solicitado que o paciente demonstrasse como utiliza a medicação inalatória e, em seguida, esse foi entrevistado sobre a compreensão dos dispositivos inalatórios, controle da doença e orientações recebidas durante as consultas. RESULTADOS: Foram avaliados 120 voluntários: 60 asmáticos e 60 com DPOC. Todos os asmáticos e 98,3 por cento do grupo DPOC relataram saber utilizar os medicamentos inalatórios. Na amostra como um todo, 113 pacientes (94,2 por cento) cometeram pelo menos um erro ao utilizar o dispositivo inalatório. Os pacientes cometeram mais erros ao utilizar aerossol dosimetrado do que ao utilizar os inaladores de pó seco Aerolizer® (p < 0,001) ou Pulvinal® (p < 0,001), assim como mais erros ao utilizar Aerolizer® do que ao utilizar Pulvinal® (p < 0,05). O grupo DPOC cometeu significativamente mais erros que o grupo asma ao utilizar o aerossol dosimetrado (p = 0,0023), Pulvinal® (p = 0,0065) e Aerolizer® (p = 0,012). CONCLUSÕES: Embora a maioria dos pacientes relatasse saber a técnica adequada de utilização dos dispositivos inalatórios, 94,2 por cento cometeu pelo menos um erro na utilização dos dispositivos, demonstrando técnica insatisfatória e discrepância entre a compreensão e a prática. Portanto, apenas questionar os pacientes sobre o uso dos dispositivos inalatórios não é suficiente. Medidas práticas devem ser tomadas a fim de diminuir os erros e otimizar a terapêutica.

OBJECTIVE: To evaluate knowledge of and techniques for using prescribed inhalation devices among patients with asthma or COPD treated at a tertiary teaching hospital. METHODS: Patients were assessed after medical visits, and their physicians were blinded to this fact. Patients were asked to demonstrate their inhaler technique and were then interviewed regarding their knowledge of inhalation devices, control of the disease and instructions received during medical visits. RESULTS: We included 120 volunteers: 60 with asthma and 60 with COPD. All of the asthma patients and 98.3 percent of the COPD patients claimed to know how to use inhaled medications. In the sample as a whole, 113 patients (94.2 percent) committed at least one error when using the inhalation device. Patients committed more errors when using metered-dose inhalers than when using the dry-powder inhalers Aerolizer® (p < 0.001) or Pulvinal® (p < 0.001), as well as committing more errors when using the Aerolizer® inhaler than when using the Pulvinal® inhaler (p < 0.05). Using the metered-dose, Pulvinal® and Aerolizer® inhalers, the COPD group patients committed more errors than did the asthma group patients (p = 0.0023, p = 0.0065 and p = 0.012, respectively). CONCLUSIONS: Although the majority of the patients claimed to know how to use inhalation devices, the fact that 94.2 percent committed at least one error shows that their technique was inappropriate and reveals a discrepancy between understanding and practice. Therefore, it is not sufficient to ask patients whether they know how to use inhalation devices. Practical measures should be taken in order to minimize errors and optimize treatment.

Computer-guided mental practice in neurorehabilitation.

Motor imagery is the mental simulation of a movement without motor output. In recent years, there has been growing interest towards the application of motor imagery-based training, or "mental practice", in stroke rehabilitation. We have developed a virtual reality prototype (the VR Mirror) to support patients in performing mental practice. The VR Mirror displays a three-dimensional simulation of the movement to be imagined, using data acquired from the healthy arm. We tested the system with nine post-stroke patients with chronic motor impairment of the upper limb. After eight weeks of training with the VR Mirror, remarkable improvement was noted in three cases, slight improvement in two cases, and no improvement in four cases. All patients showed a good acceptance of the procedure, suggesting that virtual reality technology can be successfully integrated in mental practice interventions.

Avaliação do conhecimento de pacientes com asma em relação ao uso de medicamentos inalatórios (PAP)

A asma é uma doença respiratória que apresenta elevada prevalência, presente em todos os países, independente do seu grau de desenvolvimento. Para o controle adequado dessa enfermidade é necessário um tratamento farmacológico, sendo os medicamentos inalatórios os mais freqüentemente utilizados, pois atuam diretamente nas vias aéreas, com uma maior concentração local e um menor risco de efeitos colaterais sistêmicos. Para que os medicamentos inalatórios tenham um efeito adequado, é fundamental a realização da técnica adequada de uso. O objetivo deste estudo é avaliar o conhecimento teórico e prático dos pacientes com asma atendidos nos ambulatórios de Pneumologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – USP em relação ao uso dos medicamentos inalatórios prescritos. Foram selecionados 60 voluntários com asma, que foram avaliados quanto ao uso dos medicamentos inalatórios. Apesar de todos os pacientes acharem que sabiam usar os dispositivos, mais de 90% deles cometeram ao menos um erro durante a execução da técnica. O erro mais comum encontrado foi a falta de expiração adequada antes da inalação do medicamento. Concluindo, é necessário não só perguntar ao paciente se ele usa a medicação, mas também ver ele usando em todas as consultas médicas.

A strategy for computer-assisted mental practice in stroke rehabilitation.

OBJECTIVE: To investigate the technical and clinical viability of using computer-facilitated mental practice in the rehabilitation of upper-limb hemiparesis following stroke. DESIGN: A single-case study. SETTING: Academic-affiliated rehabilitation center. PARTICIPANT: A 46-year-old man with stable motor deficit of the upper right limb following subcortical ischemic stroke. INTERVENTION: Three computer-enhanced mental practice sessions per week at the rehabilitation center, in addition to usual physical therapy. A custom-made virtual reality system equipped with arm-tracking sensors was used to guide mental practice. The system was designed to superimpose over the (unseen) paretic arm a virtual reconstruction of the movement registered from the nonparetic arm. The laboratory intervention was followed by a 1-month home-rehabilitation program, making use of a portable display device. MAIN OUTCOME MEASURES: Pretreatment and posttreatment clinical assessment measures were the upper-extremity scale of the Fugl-Meyer Assessment of Sensorimotor Impairment and the Action Research Arm Test. Performance of the affected arm was evaluated using the healthy arm as the control condition. RESULTS: The patient's paretic limb improved after the first phase of intervention, with modest increases after home rehabilitation, as indicated by functional assessment scores and sensors data. CONCLUSION: Results suggest that technology-supported mental training is a feasible and potentially effective approach for improving motor skills after stroke.

Micose fungóide: relato de um caso / Mycosis fungoides: report of a case

A micose fungóide consiste em uma transformaçao maligna dos elementos do sistema retículo-endotelial. Trata-se de uma patologia incomum, de etiologia nao totalmente conhecida, evoluçao lenta e que acomete mais mulheres do que homens. Os autores apresentam um relato de um caso de micose fungóide em uma paciente do sexo feminino e fazem uma breve revisao da literatura, dando ênfase à evoluçao clínica, diagnóstico e aspectos terapêuticos desta patologia.