Disability In Brazil Research Articles

Inequalities in basic activities of daily living among older adults: ELSI-Brazil, 2015.

ABSTRACTOBJECTIVE To evaluate the magnitude of wealth-related inequalities in basic activities of daily living among community-dwelling Brazilian older adults and to determine the contribution of demographic, socioeconomic, and health conditions to the inequality.METHODS We used data from the 2015 Brazilian Longitudinal Study of Aging (ELSI-Brazil) with a nationally representative sample of adults aged 50 years or older. We assessed wealth-related inequalities in basic activities of daily living by the concentration index. Concentration index was decomposed to determine the contribution of demographic, health, and socioeconomic factors to wealth-related inequalities in basic activities of daily living.RESULTS The prevalence of disability in the sample was 15.7% (95%CI 14.9–17.6). The concentration index was -0.145 (95%CI -0.194– -0.097), which indicates that disability is concentrated in the poorest individuals in Brazil. Inequalities in basic activities of daily living disability are primarily explained by socioeconomic status (wealth and own education) not by demographic or health factors.CONCLUSIONS There are avoidable wealth-related inequities for those with a disability in Brazil. The strong contribution of the socioeconomic status highlights the need for new public health policies that promote equity, universality, and integrality, in addition to the expansion of home nursing public services.

Abstract WP364: Local Guideline And Protocol For Carotid Revascularization: Reduction Of Complications And Costs

Introduction: Stroke is the leading cause of disability in Brazil. It is estimated that carotid atherosclerotic disease accounts for 10% to 20% of all strokes. Carotid revascularization procedures, to be considered beneficial, should be performed in centers with low complication rates and in carefully selected patients. Objective: To compare the rates of neurological complications (stroke or transient ischemic attack (TIA) before and after implementation of a hospital protocol based on the best scientific evidence with the multidisciplinary participation of all professionals involved in the care of these patients and to compare costs of the procedures after implementation of this protocol. Method: A hospital guideline and protocol based on the best scientific evidence were developed and implemented in May 2015. We compared the complication rates pre and post implementation of the guideline (2009 to 2012), as well as the costs associated with procedures in both periods. Results: Pre-protocol analysis: of the 38 patients undergoing endarterectomy, 73% (n = 28) were males and the mean age was 74 years. A total of 8% (n = 3) presented stroke or TIA in the postoperative period. Of the 31 patients undergoing carotid angioplasty, 77% (n = 24) were males and the mean age was 75 years. A total of 16% (n = 5) presented stroke or TIA in the postoperative period. Post-protocol period analysis: Of the 48 patients who underwent a carotid revascularization procedure, 27 underwent endarterectomy and 21 underwent carotid angioplasty. The mean age was 73 years for both groups. There were no post-procedure neurological complications after the implementation of the protocol, either after carotid endarterectomy or carotid angioplasty . There was a decrease in the average ticket of endarterectomies (from $ 20213 to $ 18.010, p=0.4) and of angioplasties (from $ 36935 to $ 25.327, p=0.06), a reduction of the mean cost of endarterectomies of 11% and 31 % for angioplasties. Conclusion: In conclusion, the implementation of a carotid disease protocol in a tertiary Brazilian hospital has guaranteed patient safety with improvement of the immediate postoperative outcomes, in addition to the reduction of costs related to the procedures.

Risk factors for the development of coronary artery disease in civil construction professionals

In In order to estimate the severity of cardiovascular disease, so-called risk scores for the analysis and identification of risk factors have been created and improved considerably by studies each year. Cardiovascular diseases are the main cause of mortality and disability in Brazil. The Framingham study (1948) to date is responsible for most of the risk markers for the development of heart diseases, and their score was chosen for this research. Workers’ health is a milestone in the conquest of Brazilian workers, and civil construction is responsible for a relatively large portion of the jobs of the lower purchasing power sectors, carrying out heavy activities that demand greater energy expenditure and, theoretically, higher risk markers of developing cardiovascular diseases, and studies with this working class are rare. Considering the facts reported, this research aimed to identify the risk factors for the development of coronary artery diseases in construction workers, in the city of Manaus - Amazonas / Brazil, in order to know the epidemiological profile of the class and to contribute positively to the prevention of the same. The study was carried out in January of the year 2016 over five days, the participants were divided between the construction site and the administrative sector of the participating company, totaling 50 workers. A majority were males and were classified according to the low risk score, but the risk scores were not satisfactory in the prediction of cardiovascular events, and may evolve to the onset of the disease in some years.

P741 IBD-related work disability in Brazil

P741 IBD-related work disability in Brazil

Pessoas com Deficiência em Áreas Rurais da Metade Sul do RS

O presente artigo analisa dados do Censo de 2010, realizado pelo IBGE, relacionados às pessoas com deficiência em áreas rurais de 8 municípios da Metade Sul do RS. O objetivo está centrado na discussão da metodologia do Censo e a forma como os dados foram gerados, buscando o entendimento acerca do termo deficiência. Para compreender a perspectiva dos levantamentos censitários sobre a incidência ou não de deficiências foi realizada pesquisa documental na legislação federal, o que permitiu concluir que o número de pessoas com deficiência, tanto em áreas rurais quanto urbanas, aumentou em relação aos Censos anteriores, devido à definição utilizada pelo IGBE, baseado na legislação. Analisando a variável gênero, os dados demonstram que o número de mulheres com algum tipo de deficiência é consideravelmente maior que o de homens, tanto em áreas urbanas quanto rurais. Mas no que diz respeito à frequência de pessoas com deficiência, nas áreas rurais os dados são superiores aos números encontrados em áreas urbanas, independente do gênero. Nesse sentido, os resultados indicam que as áreas rurais são mais vulneráveis, elaborando-se reflexões sobre as responsabilidades do poder público na construção de políticas públicas que levem em consideração tais variáveis em prol do desenvolvimento social dessas regiões.

Shifting notions of disability in Brazil

Purpose – The purpose of this paper is to comment on the article by Forrester-Jones and Carvalho and examine some issues on notions of disability in Brazil. Design/methodology/approach – Analysis of the specialized literature and a critical appraisal of key issues regarding notions of disability in Brazil. Findings – The authors focus on three issues: what could be characterized as learning disability in Brazil and how social movements, institutions and public policies shape and are shaped by local conceptions of disability; the limits of individual autonomy, independence and freedom in the case of learning disabilities and the social and historical particularities of the Brazilian case; and the role of the APAES and Pestalozzi Society both as a site of social exclusion and, more recently, as a source of expertise in the movement toward the development of “inclusive special education.” Originality/value – The commentary highlights some of the complexities of the local field of disability in Brazil.

Country profile: intellectual disability in Brazil

Purpose – The purpose of this paper is to provide a contextual overview of learning disability (LD) in Brazil. Design/methodology/approach – The paper uses an historical approach, providing a critical appraisal of the key theories and treatment of people with LD from the sixteenth century to the present. Findings – Brazil has experienced a different historical trajectory in terms of treatment and practice for people with LD compared to Europe, the UK and the USA. Originality/value – Brazil is one of the most rapidly developing, globally important countries with an emerging major economy. There are opportunities now for people with LD to be included in their country’s development, yet their needs should be highlighted.

A qualitative study analyzing access to physical rehabilitation for traffic accident victims with severe disability in Brazil

Purpose To identify access barriers to physical rehabilitation for traffic accident (TA) victims with severe disability and build a theoretical model to provide guidance towards the improvement of these services. Methods Qualitative research carried out in the city of Natal (Northeast Brazil), with semi-structured interviews with 120 subjects (19 key informer health professionals and 101 TA victims) identified in a database made available by the emergency hospital. The interviews were analyzed using Alceste software, version 4.9. Results The main barriers present in the interviews were: (1) related to services: bureaucratic administrative practises, low offer of rehabilitation services, insufficient information on rehabilitation, lack of guidelines that integrate hospital and ambulatory care and (2) related to patients: financial difficulties, functional limitations, geographic distance, little information on health, association with low education levels and disbelief in the system and in rehabilitation. Conclusion The numerous access barriers were presented in a theoretical model with causes related to organizational structure, processes of care, professionals and patients. This model must be tested by health policy-makers and managers to improve the quality of physical rehabilitation and avoid unnecessary prolongation of the suffering and disability experienced by TA survivors.Implications for rehabilitationTraffic accidents (TAs) are a global health dilemma that demands integrality of preventive actions, pre-hospital and hospital care and physical rehabilitation (PR). This study lays the foundation for improving access to PR for TA survivors, an issue of quality of care that results in preventable disabilities.The words of the patients interviewed reveal the suffering of victims, which is often invisible to society and given low priority by health policies that relegate PR to a second plan ahead of prevention and urgent care.A theoretical model of the causes of the problem of access to PR was built. The identified barriers are potentially preventable through the intervention of health policy-makers, managers, regulators and rehabilitation professionals, and by encouraging the participation of patients.Addressing timely access barriers involves the expansion of the supply of services and rehabilitation professionals, regulation and standardization of referencing practises and encouraging the provision of information to patients about continuity of care and their health needs.

Dorsalgias e incapacidades funcionais relacionadas ao trabalho: registros do sistema de informação de agravos de notificação (SINAN/DATASUS)

Resumo Introdução: dorsalgias e incapacidades são problemas de saúde do trabalhador com repercussões econômicas e sociais. Objetivo: descrever os casos notificados de dorsalgia e de incapacidade funcional no Brasil. Métodos: estudo de casuística das dorsalgias relacionadas ao trabalho registradas como Distúrbios Osteomusculares Relacionados ao Trabalho (DORT) no Sistema de Informação de Agravos de Notificação (SINAN), Ministério da Saúde, no Brasil, de 2007 a 2012. Calcularam-se as frequências das variáveis sociodemográficas e ocupacionais e os coeficientes de incidência (CI) para as dorsalgias e incapacidades permanentes. Resultados: foram registrados 8.172 casos de dorsalgias no período. O CI da dorsalgia foi 1,1 por 100.000 trabalhadores em 2007 e 1,9 por 100.000 em 2012 e o da incapacidade funcional relacionada ao trabalho foi 0,12 por 100.000 em 2007 e 0,10 por 100.000 em 2012. Trabalhadores de bens e serviços industriais e trabalhadores de serviços/vendedores de loja apresentaram os maiores percentuais para dorsalgias (54,4% e 20,7%) e incapacidade funcional permanente (54,7% e 16,3%). Conclusões: O aumento das notificações das dorsalgias ocupacionais e a redução das incapacidades funcionais representam um avanço em relação ao reconhecimento, diagnóstico, notificação e atenção ao problema, mas continuam representando um desafio para a atenção à saúde dos trabalhadores.

Uncertain prophecies: How practitioners negotiate the prognostic ambivalence of 'disability' in prenatal diagnosis consultations: Commentary on I. Ville & V. Mirlesse, ‘prenatal diagnosis: From policy to practice. Two distinct ways of managing prognostic uncertainty and anticipating disability in Brazil and France’

This review examines intergenerational differences in birth weight among children born to first-generation and second-generation immigrant mothers and the extent to which they vary by country of origin and receiving country. We searched MEDLINE, EMBASE, Web of Science, PubMed, and ProQuest from inception to October 2014 for articles that recorded the mean birth weight (in grams) or odds of low birth weight (LBW) of children born to immigrant mothers and one subsequent generation. Studies were analyzed descriptively and meta-analyzed using Review Manager 5.3 software. We identified 10 studies (8 retrospective cohort and 2 cross-sectional studies) including 158,843 first and second-generation immigrant women. The United States and the United Kingdom represented the receiving countries with the majority of immigrants originating from Mexico and South Asia. Six studies were meta-analyzed for mean birth weight and seven for low birth weight. Across all studies, there was found to be no statistically significant difference in mean birth weight between first and second-generation children. However, the odds of being LBW were 1.21 [95% CI, 1.15, 1.27] times greater among second-generation children. Second-generation children of Mexican descent in particular were at increased odds of LBW (OR = 1.47 [95% CI, 1.28, 1.69]). In the United States, second-generation children were at 34% higher odds of being LBW (OR = 1.34 [95% CI, 1.13, 1.58]) when compared to their first-generation counterparts. This effect was slightly smaller in the United Kingdom (OR = 1.18 [95% CI, 1.13, 1.23]). In conclusion, immigration to a new country may differentially influence low birth weight over generations, depending on the mother's nativity and the country she immigrates to.

Prevalence of stroke and associated disability in Brazil: National Health Survey--2013.

There is scarce data about prevalence of stroke in Brazil. The National Health Survey (PNS) is a community-based epidemiological survey, with a nationally representative sample to assess the absolute numbers with respective prevalence rates of stroke and post-stroke disabilities. It was estimated 2,231.000 stroke and 568,000 stroke cases with severe disabilities. The point prevalences was 1.6% and 1.4% in men and women, respectively. The prevalences of post-stroke disabilities were 29.5% for men and 21.5% for women. Stroke prevalence rates increased with aging, low education level, among people living in urban areas with no difference according to self-reported skin color. The degree of post-stroke disability was not statistically different according to sex, race, education level or living area. This new data from PNS show high stroke prevalence rates especially in older individuals without formal education and urban dweller, but the degree of stroke disability was not determined by the sociodemographic characteristics of the Brazilian population.

The Effects Of Air Pollution On Acute Myocardial Infarction, By Gender

Introduction: Cardiovascular diseases, especially acute myocardial infarction, are the main cause of mortality and disability in Brazil and in the world. Several studies have shown evidence about the effects of air pollution on these diseases and their impact on health system. Objective: To assess the lag structure between air pollution exposure and over 50 year old cardiovascular diseases hospital admissions, by gender. The study period was January 1, 2012 to December 31, 2013, in São José dos Campos SP. Methods: This is a time series ecological study. The daily data of hospitalizations due to AMI (by gender), pollutants CO, O3, PM10, SO2 and NO2 were analyzed to estimate the association between hospitalizations due to AMI and air pollutants. It was fitted generalized linear Poisson regressions to assess the relative risk with lagged effects of air pollutants on hospital admissions up to 5 days after exposure, adjusted for time trend, minimum temperature, relative humidity and weekdays. Results: 1837 individuals were hospitalized in the period by AMI, with 636 women and 1201 men. For women, the risks were significant for CO in Lags 0 (RR = 1.31), Lag1 (RR = 1.28) and Lag 5 (RR = 1.44) and for SO2 in Lag 0 (RR = 1.05). For men there was significance for CO on Lag 5 (RR = 1.24). Regardless of gender was significant for CO on Lag 5 (RR = 1.30) and Lag 0 for SO2 (RR = 1.01). Discussion: There are few national studies that show the effects of CO exposure and hospitalizations for AMI. Our study demonstrates that the effects of CO exposure were higher and early among female group. SO2 was significant when both genders were analyzed, however when SO2 was categorized, remained significant only in the female gender. The data presented shows the important role of CO and SO2 in the genesis of admissions and it's suggested that studies about effects of air pollution should be categorized according to gender, because the risks changes according to gender, pollutant and lag.

Prenatal diagnosis: From policy to practice. Two distinct ways of managing prognostic uncertainty and anticipating disability in Brazil and in France

Prenatal diagnosis (PND) has gradually established itself as part of the pregnancy monitoring process, with a view to reducing the number of births of children exposed to disability by combining the use of biomedical tools with laws that authorise abortion in cases of foetal pathology. This article looks at how laws which vary from one country to another modulate the way in which PND practices are organised on a daily basis, determine the discourse of practitioners and lead them to adopt specific stances during prenatal consultations with couples coping with a foetal anomaly. We present a comparative ethnographic study, which took place between 2009 and 2011 in France and Brazil, in reference units, based on observation of consultations, professional meetings, and interviews with health practitioners. The fact that access to abortion due to foetal pathology is possible in France, and criminalised in Brazil, conditions how doctors analyse the framework of their medical practice and approach the issue of disability with couples during consultations. In France, practitioners would appear to be satisfied with a professional framework that they themselves created. Faced with prognostic uncertainty, the legal obligation to inform encourages them to discuss all of the potential complications of the diagnosed anomalies and leads them to provide probabilistic information about the life of the child to be, supported by evidence-based medicine. In Brazil, in the public service, the lack of access to abortion has created a malaise among practitioners who criticise this impediment to the objective nature of their practice and to the quality of the information that they provide. Some use prognostic uncertainty to direct the thoughts of women and couples towards the dynamics proper to each individual human trajectory within a given family and a specific social environment.

Impossible dances: Staging disability in Brazil

Abstract In this article I discuss the creative experiences of dance artists with disabilities and their relationship to an economy of social inclusiveness that animates the neo-liberal tendencies of democratic Brazil. I discuss dance performances that involve people with disabilities in the context of Brazil’s artistic communities and social policies. I begin with my experience as a dancer and director of Roda Viva Cia de Dança and then review other contemporary artists with disabilities from Brazil, such as Marcos Abranches, in order to reimagine not only the social but also the artistic implications that disability might have for dance in Brazil. My goal is to move ideologically beyond the inclusive model that allows everyone to dance and emphasize the ­importance of artistic voice and creative autonomy.

Cardioembolic sources in stroke patients in South of Brazil.

Background. Stroke is a leading cause of mortality and disability in Brazil and around the world. Cardioembolism is responsible for nearly 30% of the origins of ischemic stroke. Methods. We analyzed data of 256 patients with cardioembolic ischemic stroke (according to TOAST classification) who were admitted into the Hospital São Lucas-PUCRS from October 2011 to January 2014. The cardioembolic subtype was divided into six subgroups: arrhythmias, valvular heart disease, coronary artery disease, cardiomyopathy, septal abnormalities, and intracardiac injuries. The prevalence of the most important cardiovascular risk factors and medications in use for prevention of systemic embolism by the time of hospital admission was analyzed in each patient. Results. Among 256 patients aged 60.2 +/− 6.9 years, 132 males, arrhythmias were the most common cause of cardioembolism corresponding to 50.7%, followed by valvular heart disease (17.5%) and coronary artery disease (16%). Hypertension (61.7%) and dyslipidemia (43.7%) were the most common risk factors. Less than 50% of patients with arrhythmias were using oral anticoagulants. Conclusions. Identifying the prevalence of cardioembolic stroke sources subgroups has become an increasingly important role since the introduction of new oral anticoagulants. In this study, arrhythmias (especially atrial fibrillation) were the main cause of cardioembolism.

Description of domestic accidents during childhood

The childhood home accidents are an important source of concern, as they are growing causes of mortality and disabilityin Brazil. The aim of this study was to identify and describe childhood home accidents of a Health Community Agent Strategy(EACS) in Montes Claros, Minas Gerais, Brazil. This is a descriptive, retrospective, quantitative study accomplishedthrough a structured questionnaire applied with parents or guardians of children aged between zero and 12 years in thehome environment. The study included fifty parents or guardians. One hundred and four household accidents were recorded.Nineteen children (38.0%) were male and 31 (62.0%) were female. Regarding age, six accidents (12.0%) occurredamong children aged from three to eight months, 15 accidents (30.0%) involved children from eight months to less thanfour-years, 11 accidents (22.0%) occurred in children from four to less than eight years and 18 accidents (36.0%) occurredwith children from eight to 12 years. The study shows that the parents’ presence does not prevent accidents from occurring,since in 97 (93.3%) accidents the children were accompanied by the parents. The types of accidents registered wereelectric shock, impact, cuts, slips, poisoning, airway obstruction, fall and burn. Among these, falls were the most common.It was concluded that children are very vulnerable to accidents and that the home environment may involve risks or safety.

The use of the comprehensive International Classification of Functioning, Disability and Health core set for stroke for chronic outpatients in three Brazilian rehabilitation facilities

Purpose: Stroke is a leading cause of death and disability in Brazil. The multiple aspects of disability in these patients require proportionally comprehensive tools for their assessment. The International Classification of Functioning, Disability and Health (ICF) core set for stroke intends to comprehensively describe the experience of such patients with their functioning. This study aimed to empirically validate the ICF core set for stroke by checking the frequency of problems in each of its categories, thus verifying content validity. Method: A cross-sectional study in which data were collected from clinical charts, physical examination, tests, and interviews with 132 stroke outpatients under rehabilitation and their caregivers. Categories were considered “not validated” if less than 20% of the sample would present some degree of problems in them. Results: Only 20 categories (14 body functions, 5 body structures, and 1 activity and participation) were considered not validated. Neuromusculoskeletal functions and mobility were the aspects of functioning most often described with problems. All environmental factors were qualified as facilitators or barriers and acted as modulators of disability. Conclusions: The comprehensive ICF core sets for stroke can be used by multidisciplinary teams to classify the life experience of stroke survivors, although efforts to enable and enhance reproducibility are needed to warrant its reliable routine use.Implications for RehabilitationStroke is a cause of multiple impairments and disability.Multidisciplinary approaches are indicated for rehabilitation in this condition.The International Classification of Functioning, Disability and Health (ICF) provides a model to understand human functioning.The ICF core set for stroke provides a comprehensive framework to describe functioning and needs of stroke survivors.

A contribuição do modelo social da deficiência à psicologia social

O objetivo deste artigo é apontar a relevância de a psicologia social considerar a deficiência como uma categoria de análise nas pesquisas e na práxis psicossocial. Para a defesa dessa questão, primeiramente apresentar-se-ão indicativos sobre a deficiência no Brasil e no mundo e o modo como a deficiência se articula com categorias de análise como as de gênero, raça, geração e classe social, já consideradas nos estudos e análises psicossociais. Em seguida, dar-se-á visibilidade ao modelo social da deficiência, especialmente a proposta de compreensão transversal da deficiência, em intersecção com diferentes categorias. Por fim, explanar-se-á sobre a relevância de a psicologia social crítica, comprometida com a defesa dos direitos humanos e com a transformação social, integrar ao seu marco teórico os estudos sobre deficiência, considerando-a como uma categoria de análise e destacando-se a importância de tal opção para as políticas públicas.

Risk Factors among Stroke Subtypes in Brazil

Stroke is a leading cause of mortality and disability in Brazil. Among the risk factors for cerebrovascular disease, some have more influence than others in certain stroke subtypes. Little data are available in the literature on the prevalence of stroke subtypes in Latin America. We analyzed data from 688 patients with acute ischemic stroke (52.3% women; mean age, 65.7 years) who were enrolled in a stroke data bank. Standardized data assessment and stroke subtype classification were used. The most common stroke subtype was large-artery atherosclerosis (n = 223; 32.4%), followed by cardioembolism (n = 195; 28.3%), and microangiopathy (n = 127; 18.5%). Stroke risk factors differ among stroke subtypes. The population of South America is ethnically diverse, and few previous studies have describe the distribution of risk factors among stroke subtypes in this population. In this study, the most important risk factors were hypertension and dyslipidemia.

O cuidado de si no contexto da pessoa com deficiência

O dimensionamento da deficiência no Brasil é difícil em razão dos poucos dados e informações disponíveis de abrangência nacional. Trata-se de um tema relevante no âmbito da saúde pública, embora a assistência a essa população se insira marginalmente no sistema de saúde. O artigo objetiva, a partir do pensamento de Michel Foucault, considerar a problemática da pessoa com deficiência e a ética do cuidado de si no processo de subjetivação e na arte da sua existência. Dedica suas reflexões também na contextualização da deficiência ao longo da história até a contemporaneidade. Conclui-se ser necessário romper com o conceito de subjetividade, em defesa de uma perspectiva do cuidado de si, enquanto uma instância que oportuniza a relação e o desenvolvimento da pessoa com deficiência consigo e com os outros. Dessa forma, permitindo-se novos modos de viver e de pensar sobre si mesmo.