Introdução - Em pacientes com doença de Chagas a evolução para cardiomiopatia chagásica crônica (CCC) ocorre em cerca de 20-40%, e as principais causas de morte são insuficiência cardíaca (IC), morte súbita e eventos tromboembólicos. A CCC pode comprometer o sistema de condução, e representa uma das mais frequentes indicações de implante de marca-passo definitivo (MPD) no Brasil. Inúmeras variáveis já foram avaliadas na tentativa de estratificar o risco destes pacientes, no entanto, pacientes com CCC portadores de MPD foram excluídos dos principais estudos a esse respeito. Objetivos - Primário: 1. Determinar as variáveis clínico-funcionais preditoras de morte; 2. Elaboração de escore de risco de mortalidade total. Secundário - Determinar a taxa de eventos cardiovasculares. Métodos: Estudo prospectivo, unicêntrico, observacional, realizado em pacientes com CCC e MPD. Na inclusão, os pacientes foram submetidos a questionário clínico-funcional, eletrocardiograma, ecocardiograma e avaliação eletrônica do MPD. Os pacientes foram seguidos por pelo menos 24 meses. Regressão logística foi utilizada para identificação de preditores de mortalidade total. Resultados - Foram incluídos 493 pacientes e durante o seguimento, ocorreram 80 óbitos (16,2%). O modelo final de regressão logística múltipla apresentou calibração (teste de Hosmer Lemeshow 0,933), discriminação (área sob a curva 0,74) e performance global (escore de Brier 0,12) adequados, e identificou cinco preditores independentes de morte: classe funcional NYHA III/IV (OR [odds ratio] 4,33; IC95% 1,76-10,64; p=0,001), cardiomegalia avaliada pela radiografia de tórax (OR 2,31; IC95% 1,21-4,39; p=0,011), fração de ejeção do ventrículo esquerdo <= 40% (OR 2,32; IC95% 1,34-4,01; p=0,003), sexo masculino (OR 2,01; intervalo de confiança 95% [IC95%] 1,17-3,47; p=0,011) e fibrilação atrial (OR 1,78; IC95% 1,00-3,16; p=0,049). A pontuação para cada uma destas variáveis para composição do escore foi de 15, 8, 8, 7 e 6 pontos, respectivamente. Os pacientes foram divididos em três grupos de risco conforme pontuação total: baixo risco (0-7 pontos), médio risco (8-15 pontos) e alto risco ( > 16 pontos). A validação interna do modelo final foi efetuada pela técnica de reamostragem de bootstrap, baseado em 200 replicações. Conclusão: Este estudo identificou preditores independentes de morte e elaborou escore de risco de fácil aplicação clínica e específico para pacientes com CCC e MPD / Introduction - Chronic chagasic cardiomyopathy (CCC) develops in roughly 20-40% of Chagas disease patients and the main causes of death are heart failure, sudden death and thromboembolic events. CCC compromises the heart conduction system and represents a common indication for pacemaker implantation in Brazil. Studies aiming to identify risk factors to better stratify patients with CCC did not include pacemaker users. Objectives - Primary: 1. Identify predictors of death; 2. Create a risk score for mortality. Secondary - Determine the rate of cardiovascular events. Methods - Observational, unicentric and prospective study in CCC patients with pacemaker. The patients were submitted to clinical and pacemaker evaluation, electrocardiogram and echocardiogram. They were followed for at least 24 months. We applied logistic regression in order to identify predictors of death. Results - Four hundred ninety-three patients were included and during the follow-up, 80 patients (16.2%) died. The final multivariate logistic regression model yielded proper calibration (Hosmer Lemeshow test 0.933), discrimination (area under the curve 0.74) and global performance (Brier score 0.12). Five predictors of death were identified: heart failure functional class III or IV (OR [odds ratio] 4.33; 95% confidence interval [95%CI] 1.76- 10.64; p=0.001); cardiomegaly on radiography (OR 2.31; 95%CI 1.21-4.39; p=0.011); left ventricular ejection fraction <= 40% (OR 2.32; 95%CI 1.34-4.01; p=0.003); male gender (OR 2.01; 95%CI 1.17-3.47; p=0.011) and atrial fibrillation (OR 1.78; 95%CI 1.00-3.16; p=0.049). Each variable contributes to the risk score with 15, 8, 8, 7 and 6 points, respectively. We calculate risk scores for each patient and defined three groups: low risk (0-7 points), intermediate risk (8-15 points) and high risk ( > 16points). Internal validation was performed by means of bootstrap technique, based in 200 replications. Conclusions - This study identified predictors of death and created a simple and specific risk score for CCC patients with pacemaker

Introdução: Ansiedade, depressão, personalidade Tipo D e terapias de choque do cardioversor-desfibrilador implantável (CDI) são fatores de risco para pior ajuste psicossocial. Além da maior parte dos estudos serem realizados em países desenvolvidos, pouca atenção é dada a estes e outros fatores, assim como à influência na percepção de portadores de CDI quanto à sua cardiopatia de base. Estratégias de enfrentamento, diferença entre percepção do CDI e da doença, assim como percepção dos familiares também têm sido negligenciadas. Os objetivos deste estudo foram descrever o perfil psicossocial de portadores de CDI em nosso meio, avaliar a relação entre os fatores de risco supracitados, percepções do paciente quanto à doença cardíaca e CDI, a relação entre ocorrência e frequência das terapias de choque do CDI e a compreensão e percepção de familiares em relação ao CDI. Método: 250 portadores de CDI foram avaliados (54.10 ±15.15 anos, 67% sexo masculino) quanto à percepção de doença (Questionário Breve de Percepção de Doença [B-IPQ]); ansiedade, depressão, distress (Escala Hospitalar de Ansiedade e Depressão [HADS]); personalidade Tipo D (DS-14); ocorrência e frequência de choques do CDI desde implante e estratégias de enfrentamento. Representações emocionais e compressão de familiares dos pacientes também foram medidas. A análise estatística utilizou os métodos de Mann-Whitney, Wilcoxon e X2. Resultados: Noventa e nove pacientes (39,6%) apresentaram ansiedade, 62 (24.8%) depressão; 85(34%) distress, 84(34%) personalidade Tipo D e 72(29%) perceberam a doença cardíaca como ameaça. Ansiedade, distress, depressão e personalidade Tipo D foram associadas à percepção de cardiopatia como ameaçadora, OR=11 (p= <. 0001); 7.4 (p= <. 0001); 5.3 p= <. 0001); e 2.9 (p= 0.0001), respectivamente. A percepção da doença cardíaca como ameaça também foi influenciada pela presença de choques do CDI desde o implante, com OR= 2.2 (p= 0.007), 2.1 para >=3 choques em 24 horas (p= 0.03) e 2.4 para >= 5 choques desde o implante (p= 0.008). Pacientes ansiosos e Tipo D foram associados a pior percepção de doença, considerando: 1 - fortes crenças sobre consequências mais graves da doença; 2 - não serem capazes de controlar a doença; 3 - atribuem maior número de sintomas à doença; 4 - são mais preocupados e apresentam mais emoções negativas. As percepções de pacientes com distress ou depressivos são mais negativas em todas as subescalas, exceto compreensão. A maioria dos pacientes (68%) utilizou estratégias de enfrentamento focadas na emoção. Vinte e cinco por cento dos pacientes reportaram limitação imposta pela doença, enquanto 75% se sentiram limitados pelo CDI. Pacientes perceberam mais consequências negativas da doença que do CDI. Familiares apresentaram desgaste emocional e baixa compreensão quanto o uso e funcionamento do CDI. Conclusões: Portadores de CDI assistidos em hospital terciário de atenção cardiológica apresentaram: Elevada taxa de ocorrência de ansiedade; depressão, distress, personalidade Tipo D e percepção de doença como ameaça; Limitação das atividades da vida diária como a maior demanda vivenciada; Cardiopatia de base afetando mais a vida que o CDI, mas a maioria considerando o choque do CDI aversivo. Implicação: Intervenções psicossociais específicas são essenciais para melhor ajustamento de portadores de CDI e seus familiares / Introduction: Anxiety, depression, Type D personality, and implantable cardioverter-defibrillator (ICD) shocks are well-known risk factors for psychosocial maladjustment. Despite the fact that most of the studies were conducted in well-developed countries, little attention has been given to these and others factors and their influence on ICD patients\' perceptions of their heart disease. Coping strategies, the differences between ICD patient and heart disease patient perceptions, and the perception of family members has also been neglected. This project was aimed at describing the psychosocial profile of Brazilian ICD patients and evaluating the relationship between the aforementioned risk factors and patient perceptions about their heart disease and ICD, the temporal relation between occurrence and frequency of ICD shocks, and the understanding and perception of family members regarding the ICD. Methods: 250 ICD patients were evaluated (54.10 ±15.15 years, 67% male) regarding illness perception (Brief Illness Perception Questionnaire [B-IPQ]); anxiety, depression, distress (Hospital Anxiety and Depression Scale [HADS]); Type D personality (DS-14); occurrence and frequency of ICD shocks since implantation; and coping. Family members\' comprehension and emotional representations of the ICD were also assessed. Mann-Whitney, Wilcoxon and X2 were used for statistical analysis. Results: Ninety-nine patients (40%) had anxiety, 62 (25%) depression; 85 (34%) distress, 84 (34%) Type D personality, and 72 (29%) perceived the heart disease as a threat. Anxiety, distress, depression, and Type D personality were associated with perceiving heart disease as a health threat with odds ratios of 11 (p= <.0001); 7.4 (p= <.0001); 5.3 (p= <.0001); and 2.9 (p= 0.0001), respectively. Patients\' perceptions of their heart disease as a threat were also influenced by ICD shocks since implantation with odds ratios of 2.1 (p= 0.007), of 2.1 for >=3 shocks in 24 hours (p= 0.045) and of 2.4 for >= 5 shocks since implantation (p= 0.043). Anxious and Type D patients were also associated with poorer illness perceptions regarding: 1 - strong beliefs about more serious consequences of the illness; 2 - not being capable of controlling the disease on their own; 3 - a greater number of symptoms attributed to the illness; 4 - more concerns and negative reactions. Distressed or depressive patients\' perceptions are more negative on every item of the scale except for understanding. The majority of patients (68%) used emotion focused coping mechanisms. Twenty-five percent of the patients reported feeling limited by heart disease, while 75% reported feeling limited by having the ICD in place. Patients perceived more negative consequences with heart disease than with ICD placement. Family members manifested distress about the ICD and misunderstanding regarding its purpose and function. Conclusions: ICD patients treated in a tertiary heart center presented with incresead frequency of anxiety, depression, distress, Type D personality, and perception of their illness as threat. Limitation of activities of daily living was the most common complaint. Heart disease was reported as more debilitating than the ICD itself, but most patients still considered the device\'s shock aversive. Implication: Specific psychosocial interventions are essential for better adjustment of ICD patients and their families after ICD placement

Introdução: A promoção da atividade física e de hábitos de vida saudáveis é efetiva para prevenção de doenças crônicas. Os custos com problemas de saúde oneram desde instituições governamentais até empresas dos mais variados ramos. O principal objetivo do estudo foi verificar a associação do absenteísmo por problemas de saúde, presenteísmo e procura por atendimento médico com o escore de atividade física habitual (AFH) de Baecke e seus três componentes: atividade física ocupacional (AFO), exercício físico de lazer (EFL) e atividade de lazer e locomoção (ALL). Métodos: Estudo de desenho transversal com seleção amostral aleatória estratificada por função laboral (horistas, mensalistas e executivos), participando 620 funcionários da indústria automobilística General Motors do Brasil da unidade de São Caetano do Sul. Os participantes tinham no mínimo 12 meses de vínculo com a empresa, pertenciam à mesma unidade e atuavam no Brasil no momento do inquérito. Todos preencheram o questionário de Baecke para avaliação da AFH, além de questões sobre dados sócio-demográficos, uso de álcool, fumo, alimentação, índice de massa corporal, morbidade referida, absenteísmo por problemas com saúde, procura por atendimento médico e presenteísmo. Para a comparação de médias, utilizou-se ANOVA e, no caso de significância estatística (p<0,05), foram feitas as comparações múltiplas pelo método de Tukey. Para a comparação entre proporções foi utilizado o teste de Qui-Quadrado. Para os desfechos categóricos foi realizada a análise através de um modelo de regressão logística univariada. Todas as variáveis cujo nível de significância estatística tenha sido 0,10 (p0,10) foram selecionadas para entrarem no modelo de regressão logística multivariada. Após o processo backward foi apresentado o modelo final, com as variáveis com significância estatística (p<0,05). Para o desfecho presenteísmo (variável numérica) foi feita a comparação com as variáveis independentes através do método de correlação de Pearson. Para avaliar as associações foi utilizada razão de chances e intervalo de confiança de 95%. Resultados: A idade foi 38,5 ±10,2 anos e 89% do sexo masculino. Depois de controladas as covariáveis, o escore de AFH de Baecke não foi associado com os desfechos analisados e nem com morbidade referida. Os funcionários horistas apresentaram maior escore de AFH, maior escore de AFO e menor escore de EFL que os demais funcionários. O escore de AFO foi associado com absenteísmo (OR=1,63, IC95%=1,31-2,02) e apresentou proximidade à significância estatística (p=0,061) com a procura por atendimento médico (OR=1,25, IC95%=0,99-1,58), ambas na análise univariada e não confirmada no modelo multivariado. O escore de AFO também apresentou correlação com o presenteísmo (r=0,099, p=0,014). Não foi estatisticamente significante a associação do escore de ALL com absenteísmo (p=0,053), (OR=0,73, IC95%=0,58-1,00) e com procura por atendimento médico (p=0,067), (OR=0,76, IC95%=0,57-1,02). Os escores de AFO e EFL foram associados com a presença de morbidade referida, sendo respectivamente OR=1,3 (IC95%=1,06-1,61) e OR=0,67 (IC95%=0,54-0,82). Conclusão: O escore de AFH não foi associado com os desfechos estudados. Os funcionários horistas apresentaram maior escore de AFH por terem maior atividade física ocupacional a despeito do menor escore de exercício físico e esportes. Dentre os três escores avaliados, o ocupacional se mostrou mais próximo de associação com os desfechos estudados. O cálculo do poder estatístico das análises infere a necessidade de maior amostragem para a negação das hipóteses levantadas por este estudo. A utilização do questionário de Baecke, diferentemente de outros instrumentos que avaliam o gasto energético não levando em consideração os diferentes tipos de atividade física, questiona a possibilidade de que o maior gasto energético deva ser considerado fator de proteção para a saúde. / Background: By fostering physical activities and healthy life behavior, one can prevent chronic diseases. The health-related costs represent a heavy burden not only to the governmental entities but also to some private companies with many different levels of activities. The main objective of this study was to verify the association between absenteeism due to healthrelated problems, presenteeism, health care seek and the Baecke habitual physical activity score (HPA) and its three components: occupational physical activity (OPA), physical exercise in leisure (PEL) and leisure and locomotion activity (LLA). Methods: A cross-sectional study was done on a selected random sample which was stratified by job categories (hourly, salaried and executives) with the participation of 620 employees from General Motors Brazil, an automotive company located at São Caetano do Sul. The participants had a minimum of 12 months of company service, they worked for the same unit and all were active employees performing their jobs in Brazil at the time the questionnaire was applied. All of them filled out the Baecke questionnaire for the HPA evaluation, including specific questions on social-demographics data, intake of alcohol, tobacco, food, body mass index, referred morbidity, health-related absenteeism, health care seek and presenteeism. To compare averages, the ANOVA has been utilized and, when the statistical significance (p<0,05) was shown, multiples comparisons were made through the Tukeys Method. To compare proportions, the Chi- Square Test was utilized. For the categorical outcomes, it was carried out an analysis through the univariate logistic regression model. All variables which statistical significance level have been 0,10 (p0,10) were selected to be part of the multivariate logistic regression model. After the backward process, the final model has been presented with all variables that showed statistical significance (p<0,05). For the presenteeism (numerical outcome) a comparison has been made with the independent variables through the Pearson Correlation Coefficient. In order to evaluate the associations the odds ratio and 95% confidence intervals were calculated. Results: The age was 38,5 ± 10,2 years and 89% were men. After adjusting the covariates, the Baecke HPA score was neither associated with the analyzed outcomes or with the referred morbidity. The hourly employees have shown higher HPA, higher OPA and lower PEL scores when compared to remaining employee groups. The OPA score has been associated with absenteeism (OR=1,63, CI95%=1,31-2,02) and has presented a proximity to the statistical significance (p=0,061) with the health care seek (OR=1,25, CI95%=0,99-1,58), both at the univariate analysis but not confirmed in the multivariate model. The OPA score also showed correlation with the presenteesism (r=0,099, p=0,014). Statistically, it was not significant the association between the LLA score with absenteeism (p=0,053), (OR=0,73, CI95%=0,58-1,00) and health care seek (p=0,067), (OR=0,76, CI95%=0,57-1,02). The OPA and PEL scores have been associated with the presence of referred morbidity, being respectively OR=1,3 (CI95%=1,06-1,61) and OR=0,67 (CI95%=0,54-0,82). Conclusion: The HPA score did not show association with the studied outcomes. The hourly employees have shown higher HPA score once they have more occupational physical activity, regardlees the lower score of physical exercises and sports. Among the three scores evaluated, the occupational was closer to the association with the studied outcomes. The analysis statistic power calculation shows to the need of a higher sample to the denial of the raised hypothesis by this study. The Baecke questionnaire utilization, as opposed to the others instruments that evaluate the energy expenditure not taken into consideration the different types of physical activities, questions the possibility that the higher energy expenditure should be considered a health protector factor.

<p>UVOD: Egzekutivne funkcije predstavljaju integrisanu grupu mentalnih sposobnosti, uključenih u proizvodnju, monitoring i kontrolu pona&scaron;anja orijentisanih ka određenom cilju i prevashodno su zadužene za snalaženje u novim situacijama, sme&scaron;tenim izvan domena automatskih psihičkih procesa. Zloupotreba heroina tokom dužeg vremenskog perioda rezultira o&scaron;tećenjem egzekutivnih funkcija, &scaron;to se može značajno reflektovati na lično, profesionalno i socijalno funkcionisanje zavisnika. CILJ ISTRAŽIVANJA: Cilj ovog istraživanja je ispitivanje uticaja zloupotrebe opijata na egzekutivne kontrolne procese, ispitivanje postojanja specifičnog odnosa eventualnih deficita egzekutivne performance opijatskih zavisnika sa dužinom ekspozicije heroinu, kao i definisanje prediktora o&scaron;tećenja egzekutivnih funkcija kod opijatskih zavisnika. MATERIJAL I METODOLOGIJA: Istraživanje je izvr&scaron;eno po tipu studije preseka, a njime je obuhvaćeno 200 ispitanika, podeljenih u dve grupe. <em>Eksperimentalnu grupu</em> činilo je 150 zavisnika od heroina, starosti 18-35 godina, koji su u apstienenciji najmanje 3 nedelje. U<em> kontrolnu grupu</em> uvr&scaron;teno je 50 zdravih subjekata, ujednačenih po polu, obrazovanju i starosti sa ispitanicima eksperimentalne grupe. Za prikupljanje podataka kori&scaron;ćeni su sledeći instrumenti: <em>op&scaron;ti strukturisani upitnik</em> posebno konstruisan za potrebe ovog istraživanja, zasnovan na samoproceni, koji se odnosi na osnovne sociodemografske karakteristike ispitanika i adiktolo&scaron;ka obeležja;<em> test za procenu psihopatije</em>, za procenu (kontrolu) eventualnog uticaja structure ličnosti zavisnika na postignuće na testovima kojima se procenjuju egzekutivne funkcije; za procenu stanja egzekutivnih funkcija:<em> test verbalne fluentnosti - segment fonemska fluentnost, Vekslerov individualni test inteligencije, test praćenja-markiranja traga, Baretova skala za procenu impulsivnosti, Viskonsin test sortiranja karata, Iowa Gambling Task</em>. REZULTATI: Kod heroinskih zavisnika beleže se signifikantni deficiti u egzekutivnim domenima: ažuriranje i monitoring sadržaja radne memorije, inhibitorna kontrola, izmena mentalnog seta i dono&scaron;enje odluka. Faktori na osnovu kojih se može predvideti o&scaron;tećenje egzekutivnih funkcija su: ukupno trajanje konzumiranja heroina, prosečna dnevna doza heroina, broj apstinencija u odnosu na ukupno trajanje heroina i uzrast pri prvom kontaktu sa psihoaktivnim supstancama. ZAKLJUČAK: Konzumiranje heroina dovodi se u vezu sa značajnim o&scaron;tećenjem sistema egzekutivnih funkcija, &scaron;to rezultira te&scaron;koćama zavisnika da prevazilaze habitualne odgovore i prilagođavaju pona&scaron;anje zahtevima koje nudi nova situacija, kao i sklono&scaron;ću da donose visoko rizične odluke, koje rezultiraju trenutnom dobiti, bez obzira na neminovne kasnije negativne posledice.</p> / <p>INTRODUCTION: Executive functions represent an integrated set of mental abilities involved in the production, monitoring and controlling of the goal-oriented behavior. Primarily, they are responsible for managing new situations which are placed outside the domain of automatic mental processes. Heroin abuse over a longer period of time results in the damage of the executive functions which significantly reflects on personal, professional and social functioning of an addict. THE AIM OF THE STUDY: The aim of this study is investigating the impact of substance abuse on executive control processes, testing the existence of a specific relationship between possible deficits of executive performance of opiate addicts and heroin exposure length, as well as defining the damage predictors of executive functions in opiate addicts. MATERIALS AND METHODS: The study was conducted by the cross-sectional study and included 200 examinees divided into two groups. <em>The experimental group </em>consisted of 150 heroin addicts, aged from 18 to 35 years, who were abstinent for at least 3 weeks. <em>The control group </em>included 50 healthy examinees of the same sex, age and educational background as the examinees in the experimental group. To collect the data, the following instruments were used: <em>a general structured questionnaire</em> &ndash; specifically designed for the purposes of this study, based on self-assessment, which refers to the basic socio-demographic characteristics and addictological features of examinees; <em>Psychopathy Assessment Questionnaire</em> for evaluation (control) of the possible impact of personality structure of addicts on achievement on tests used to assess executive functions; for the assessment of condition of executive functions: Verbal Fluency Task - phonemic fluency, Wechsler Adult Intelligence Scale, Trail Making Test, Barratt impulsiveness Scale, Wisconsin Card Sorting Test, Iowa Gambling Task Iowa Gambling Task. RESULTS: In heroin addicts significant deficits in executive domains were recorded: updating, inhibition, shiffring and decision making. The damage of executive functions can be predicted on the basis of the following factors: total length of heroin abuse, the average daily dose of heroin, number of&nbsp; abstinence compared to the total duration of heroin abuse and age of addicts at their first contact with psychoactive substances. CONCLUSION: The consumption of heroin is associated with significant impairment of the system of executive functions. This results in addicts having difficulties to overcome habitual responses and adjust behavior to the requirements imposed by new situations, as well as in the tendency to make high-risk decisions that result in current gain, regardless of inevitable later negative consequences.</p>

Background: “Targeted health dialogues” is a preventive method that aims to reduce the risk of cardiovascular disease and type 2 diabetes. It includes a health-survey containing physical activity (PA)-questions. Health region Skåne introduced the method 2020 and decided to add additional questions about PA and sedentary behavior (SB). With the wish to replace current validated PA-questions with new validated questions and describe SB. Aim: Analyze concurrent validity between the answers of the original PA-questions (kcal/week) in the method and new answers (activity-minutes/last 7-days) and describe SB (hours/day). Method: Quantitative cross-sectional study with non-random, appropriate selection. Participants were 40-year-old health dialogue-participants that consented to research. Data on kcal/week, activity-minutes/last 7-days, sedentary hours/day and basic characteristics were retrieved from digital health-survey. Agreement between PA-questions was analyzed by Cohen´s weighted kappa and intraclass correlation-coefficient (ICC). SB was presented with descriptive statistics and analyzed by Chi2-test, Fisher's-exact-test and independent t-test. Result: Weak agreement between the PA-questions was found (Kw=0,378; ICC=0,273). Participants born in Sweden were more sedentary than those born outside Sweden (p&lt;0.001) and participants with high education were more sedentary compared with lower education (p=0.014). Significant associations were found between SB and BMI (p=0.028; dichotomized analysis). Sedentary participants (&gt;9 hours/d) also had higher mean BMI compared to those who were less sedentary (29,0(SD5,7) and 26,7(SD5,2) respectively; p=0,008). Conclusion: Current PA-questions cannot be replaced in favor of new questions in their current form. Further validation studies are warranted, preferably using objective PA-measures. SB was significantly associated with country of birth, education level and BMI. / Bakgrund: Riktade hälsosamtal är en preventiv metod med syfte att minska risken för hjärt-kärlsjukdom och diabetes typ 2. Metoden innehåller frågor om fysisk aktivitet (FA). Region Skåne införde 2020 metoden och valde att lägga till ytterligare frågor om FA samt stillasittande. Önskemålet var att ersätta tidigare validerade frågor om FA med nya validerade frågor och kartlägga stillasittandet. Syfte: Att undersöka samtidig validitet mellan svaren på de ursprungliga frågorna om FA (kcal/vecka) och svaren på de nya frågorna (aktivitetsminuter/senaste 7-dagarna) samt kartlägga stillasittandet (timmar/dag). Metod: Kvantitativ tvärsnittsstudie med icke-slumpmässigt, ändamålsenligt urval. Deltagarna utgjordes av 40-åringar som haft hälsosamtal samt lämnat forskningssamtycke. Data om kcal/vecka, aktivitetsminuter/senaste 7 dagarna, stillasittande timmar/dag samt bakgrundsinformation inhämtades från den digitala hälsoenkäten. Samstämmighet mellan svaren om FA analyserades genom beräkning av Cohens viktade kappa samt intraklass-korrelationskoefficient (ICC). Stillasittande beskrevs deskriptivt och jämförelseanalyser gjordes med Chi2-test, Fishers exakta-test och oberoende t-test. Resultat: Svag samstämmighet och överensstämmelse sågs mellan FA-frågorna (Kw =0,378; ICC=0,273). Deltagare födda i Sverige var mer stillasittande jämfört med dem födda utanför Sverige (p&lt;0.001) och deltagare med eftergymnasial utbildning var mer stillasittande jämfört med dem utan eftergymnasial utbildning (p=0,014). Signifikant samband sågs mellan stillasittande och BMI (p=0,028; dikotomiserad analys). Medelvärdet för BMI var högre i gruppen som var stillasittande &gt;9h/dag jämfört med ≤9 h/dag (29,0(SD5,7) respektive 26,7(SD5,2); p=0,008). Slutsats: Nuvarande frågor om FA kan inte rakt av bytas ut till förmån för de nya frågorna. Ytterligare valideringsstudier, företrädesvis med objektiva FA-mått, behövs. Nivån av stillasittande hade signifikanta samband med födelseland, utbildningsnivå och BMI.

Une mauvaise qualité de sommeil est souvent observée chez les personnes âgées. Diverses méthodes sont alors utilisées afin d’en évaluer les caractéristiques, notamment les questionnaires auto-recensés et la polysomnographie (PSG). Cependant, l’utilisation de la PSG étant dispendieuse et chronophage, le recours aux analyses par questionnaires auto-recensés en milieu clinique pourrait être privilégié et faciliterait grandement l’évaluation de la qualité du sommeil. Cette étude vise à valider la méthode par questionnaires auto-recensés lors de l’évaluation de la qualité de sommeil chez les personnes âgées et à comparer ces différents questionnaires aux mesures obtenues par une PSG. Le devis de l'étude est une une sous-analyse d’une étude d’essais cliniques randomisés. L’étude a été menée auprès de patients édentés de 65 ans et plus, recrutés entre décembre 2013 et août 2018. Les données ont été collectées à domicile avec une PSG et jumelées à divers questionnaires sur le sommeil : le questionnaire de Berlin (QB, plage de scores comprise entre 0 et 3), l’échelle de somnolence Karolinska (ESK, plage de scores 1-9), l’indice de qualité du sommeil de Pittsburgh (IQSP, plage de scores de 0 à 21), l’échelle de somnolence d’Epworth (ESE, plage de scores de 0 à 24). Les données obtenues par la PSG incluent : l'indice d'apnée-hypopnée (IAH), l'indice de désaturation en oxygène (IDO) et le pourcentage d'efficacité du sommeil. L’analyse des données a été effectuée par statistiques descriptives et tests statistiques bivariés. Chez les 130 patients ayant participé à l’acquisition de données de base (51 hommes et 79 femmes, âge moyen 75 ± 6 ans), il n'y a pas de forte corrélation entre les scores totaux de qualité du sommeil mesurés par les questionnaires et le pourcentage d'IAH, d'ODI et d'efficacité du sommeil obtenus par la PSG. Seuls deux des questionnaires utilisés ont eu une sensibilité distinctive, comportant toutefois des valeurs de seuil différentes de la norme utilisée chez les adultes : le QB et l’ESK. Nos résultats démontrent que les questionnaires auto-recensés disponibles s’avèrent limités pour le dépistage clinique chez les personnes âgées. Afin de développer un nouvel instrument de mesure fiable permettant le diagnostic d’AOS et l’évaluation de la qualité de sommeil chez cette population, il est nécessaire d’effectuer des études sur un plus grand échantillon et de créer un questionnaire spécifique destiné à la population âgée. / Poor sleep quality is often seen in the elderly. Various methods are then used to evaluate their characteristics, including self-reported questionnaires and polysomnography (PSG). However, since the use of PSG is expensive and time-consuming, the use of self-reported questionnaires in a clinical setting could be preferred and would greatly facilitate the assessment of sleep quality. This study aims to validate the self-reported questionnaire method used in the evaluation of sleep quality in the elderly and compare these different questionnaires to the measures obtained by a PSG. The study design is a sub-analysis of a randomized clinical trial study. The study was conducted in edentulous patients aged 65 years and older, recruited between December 2013 and August 2018. The data were collected at home with a PSG and combined with various sleep questionnaires: the Berlin questionnaire (BQ, range of scores from 0 to 3), the Karolinska sleepiness scale (KSS, range of scores from 1-9), the Pittsburgh Sleep Quality Index (PSQI, range of scores from 0 to 21), the Epworth sleepiness scale (ESS, range of scores from 0 to 24). Data obtained by PSG include: apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and sleep efficiency percentage. Data analysis was performed by descriptive statistics and bivariate statistical tests. Of the 130 patients who participated in baseline data acquisition (51 males and 79 females, mean age 75 ± 6 years), there was no strong correlation between the total sleep quality scores measured by the questionnaires and the IAH, ODI and sleep efficiency percentage achieved by PSG. Only two of the questionnaires used had a distinctive sensitivity, but with threshold values different from the norm used in adults: QB and ESK. Our results demonstrate that self-reported questionnaires available are limited for clinical screening for the elderly. In order to develop a new reliable measuring instrument for the diagnosis of obstructive sleep apnea (OSA) and the evaluation of sleep quality in this population, it is necessary to carry out studies on a larger sample and to create a specific questionnaire intended for the elderly population.

Objetivo: Determinar el nivel de conocimiento sobre salud periodontal en estudiantes de Ciencias de la Salud de una universidad privada de Lima- Perú Materiales y métodos: Se desarrolló un estudio descriptivo observacional transversal durante el periodo 2020-1 en 200 estudiantes del área de salud de una universidad privada. El nivel de conocimiento sobre salud periodontal fue evaluado mediante un cuestionario virtual (V de Aiken:0.95 y Alpha de Cronbach: 0.75), el cual consta de preguntas acerca de causas, signos, hábitos de prevención y relación con enfermedades sistémicas referidas a la enfermedad periodontal. El análisis de los datos fue proporciones para las variables cualitativas: nivel de conocimiento, sexo, carrera y ciclo académico, y media ±DE para la variable edad.  Resultados: El nivel de conocimiento fue medio en el 38%, alto en el 32.5% y bajo en el 29.5% de los estudiantes encuestados. La carrera con menor nivel de conocimiento es Terapia Física con el 61.9%. Por otro lado, 96.5% sabe que la enfermedad periodontal es prevenible; sin embargo, el 91.5% desconoce cuál es su principal signo clínico. Conclusiones: El nivel de conocimiento medio fue obtenido por la mayoría de los estudiantes de Ciencias de la Salud encuestados de una universidad privada de Lima- Perú. / Objective: Determine knowledge level of periodontal health in students of health science at a private university in Lima – Perú. Materials and Methods: A descriptive observational cross-sectional study was carried out during the period 2020-1 in 200 students from the health area of a private university. The knowledge level about periodontal health was evaluated through a virtual questionnaire (Aiken´s V: 0.95 and Cronbach's Alpha: 0.75), which consists in questions about causes, signs, prevention habits and relation between systemic diseases referred to periodontal disease. The data analysis was proportions for the qualitative variables: level of knowledge, sex, career, and academic cycle, and mean ±SD for the age variable. Results: The level of knowledge was medium in 38%, high in 32.5% and low in 29.5% of the surveyed students. The career with the lowest level of knowledge is Physical Therapy with 61.9%. On the other hand, 96.5% know that periodontal disease is preventable; however, 91.5% is clinically unaware is their main clinical sign. Conclusions: The level of knowledge medium was obtained by most of the health science students surveyed from a private university in Lima – Perú. / Tesis

Inledning: Bristfällig information till patienterna inför en MR-undersökning kan leda till att patienterna blir nervösa, stressade och känner obehag och därmed uteblir från bokade tider eller väljer att avbryta sina undersökningar i förtid. Med en tydlig information till patienten innan MR-Kaundersökningen startar ökar det patientens förståelse inför besöket. Det kan göra att patienterna kommer på sina bokade tider och därmed har möjlighet att få svar på oklara funderingar utifrån den skriftliga informationen med hjälp av en röntgensjuksköterska innan undersökningens start. Syfte: Syftet med studien var att sammanställa den information som ges till patienter inför en MR-undersökning samt betydelsen av informationen. Metod: Studien som genomförts är en allmän litteraturöversikt, där artiklarna hämtats från databaserna Pubmed och Cinahl. I studien ingår både kvantitativa och kvalitativa artiklar, som i sin tur har kvalitetsgranskats och analyserats utifrån syftet. Resultat: 10 stycken artiklar har delats in i tre kategorier som följer: skriftlig information, verbal information och digital information. Resultatet av studien visar på att oro och ångest hos patienterna kan ge rörelseartefakter med dålig bildkvalitet som följd, behov av upprepade undersökningar, att patienten väljer att avbryta eller vägrar att lägga sig i kameran. Detta kanresultera i försenad diagnos och behandling för patienten. Genom en kombination av skriftlig, verbal och digital information så ökar det förståelsen och tryggheten på ett bättre sätt än endast skriftlig information. Slutsats: Området är viktigt att belysa då information inför MRundersökning inte bara lindrar stress och ångest utan även ger trygghet till patienten och större möjlighet att få en så bra kvalitet på undersökning och bildframställning som möjligt. Studien tyder på att det finns ett behov av vidare forskning för att kunna utreda vilken information som patienten saknar inför sin MR-undersökning för att ge ökad trygghet. Men det finns stora möjligheter att kunna använda sig av förberedande information inför MR-undersökningar i form av appar och VR i framtiden. / Introduction: Inadequate information to patients prior to an MRI examination can lead to patients becoming nervous, stressed and feeling discomfort and thus absent from booked appointments or choosing to cancel their examinations. With clear information to the patient before the MRI examination starts, it increases the patient's understanding before the visit. This can mean that patients arrive at their booked times and thus have the opportunity to get answers to unclear thoughts based on the written information with the help of an X-ray nurse before the start of the examination. Aim: The purpose of the study was to compile the information given to patients prior to an MRI examination and the importance of the information. Method: The study conducted is a general literature review, where the articles were retrieved from the databases Pubmed and Cinahl. The study includes both quantitative and qualitative articles, which in turn have been quality reviewed and included in the work. Results: 10 articles have been divided into three categories:such as written information, verbal information and digital information. The results of the study show that anxiety and stress in patients may cause motion artifacts with poor image quality as a result, need for repeated examinations, that the patient chooses to interrupt or refuses to go to the camera. Through a combination of written, verbal and digital information, it increases understanding and security in a better way than just written information. Conclusion: The area is important to highlight as information prior to MRI examination not only relieves stress and anxiety but also provides security to the patient and greater opportunity to get the best quality of examination and imaging possible. The study indicates that there is a need for further research in order to be able to investigate what information the patient lacks prior to their MRI examination, in order to increase well-being. But there are great opportunities to be able to use preparatory information for MRI examinations in the form of apps and VR in the future.

Second language learners (SLLs) are students at risk for negative outcomes in preschool. Theoretical statements from systems theory and the ecological model of inclusive education indicate that a main focus of interest when supporting children should be the preschool environment that surrounds them. The purpose of this study is to describe and compare structures and processes in preschool settings that are presupposed by theory to have an impact on children’s functioning, along with children’s outcomes in preschool units with different proportions of SLLs. A combination of questionnaire data and data from observations were used in order to describe and compare the structure of child-teacher ratio, the process-related variables of teachers’ tone, children’s proximity and verbal interaction and lastly the outcomes of involvement and social interactions in different play types between the units. Data were analyzed with independent sample t-tests and the results revealed that units with different proportions of SLLs differ regarding processes and outcomes but not the structure of child-teacher ratio. Teachers’ tone in units with low proportion of SLLs was more positive and children were more verbal to the teacher while children in units with high proportions of SLL, had more self-talk/ private speech, less social-interactions and associative play, and lower levels of involvement. The differentiations in processes and children outcomes, along with the non-differences in child-teacher ratios between units with high and low proportions of SLLs highlight the need for further research in the field in order to investigate which environmental factors affect children outcomes in attempts to intervene and safeguard inclusiveness.

In umfangreichen Datenerhebungen zeigen sich webbasierte Applikationen als ein besonders flexibel einzusetzendes Instrument, welches zudem im Vergleich zu analogen Varianten u.a. hinsichtlich der Anzahl nicht beantworteter Fragen im Vorteil ist (Rada, 2014). Weiterhin kommen Deutskens et al. (2006) zu der Erkenntnis, dass die Ergebnisse zwischen Online- und Offline-Umfragen durchaus zu vergleichen sind. Die Art und Qualität der Antworten sind nicht von der Wahl der technischen Methodik abhängig (Tuten et al., 2002). Ferner wurde sogar gezeigt, dass Online-Befragungen umfassendere Informationen liefern als beispielsweise traditionelle Postumfragen (Ilieva u. a., 2002). Schon seit längerer Zeit werden solche webbasierten Fragebogen nun nicht mehr ausschließlich auf Desktop-Computern bearbeitet (Callegaro, 2010). Vielmehr ist eine klare Tendenz zur mobilen Nutzung erkennbar. Während im Jahre 2011 erst 4% der Teilnehmenden Smartphones zur Beantwortung von Online-Befragungen nutzten, waren es im Jahre 2014 bereits 18% (Sarraf et al., 2014) und im Jahre 2018 33,7% (Nissen & Janneck, 2018). Durch den stetig steigenden Gebrauch mobiler Geräte, wie insbesondere Smartphones, stellt sich die Frage, inwieweit Online-Fragebogen als spezifische Anwendung für eine mobile Nutzung geeignet sind. Einerseits scheinen mobile Geräte mit ihren eher kleineren Displays womöglich schlechter geeignet für die Bearbeitung von z.T. umfangreichen Fragebogen zu sein. Eine mangelnde Eignung zeigt sich beispielsweise in höheren Abbruchquoten (Sarraf et al., 2014; Lambert & Miller, 2015; Mavletova, 2013; Nissen & Janneck, 2018), längeren Bearbeitungszeiten (Lugtig et al., 2016; Mavletova, 2013; Horwitz, 2014; Nissen & Janneck, 2018) oder auch auffälligen Antwortmustern (Nissen & Janneck, 2018), die zu einer schlechteren Datenqualität führen können. Andererseits bieten Fragebogen auf Smartphones die Möglichkeit, sehr flexibel an Studien teilzunehmen und u.U. die Teilnahmequote zu erhöhen. Um diese Möglichkeit zu nutzen und eine Grundlage für künftige technische Entwicklungen zu bieten, wird in diesem Beitrag eine Untersuchung zu soziodemographischen Daten (Geschlecht und Alter) und dem zeitlichen und örtlichen Kontext der Bearbeitung von Web-Fragebogen – mit besonderem Fokus auf die mobile Nutzung – durchgeführt. [... aus der Einleitung] 91