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ABSTRACT OBJECTIVE: To assess the Functional Index Questionnaire (FIQ) structure using confirmatory factor analysis (CFA) in Brazilian patients with anterior knee pain. METHODS: Brazilian patients of both sexes (n = 100), aged ≥ 18 years, with anterior knee pain for at least 3 months were included. Eligible participants completed an online form that collected personal and clinical data as well as responses to the assessment tools. We used CFA and the following fit indices: chi-square/degrees of freedom (DF), comparative fit index (CFI), Tucker–Lewis index (TLI), root mean square error of approximation (RMSEA), and standardized root mean square residuals (SRMR). RESULTS: The majority of the respondents were women, young adults, overweight, with incomplete higher education, were physically active, and had pain in sitting or squatting positions. The mean duration of pain was 38.24 months, and the mean pain intensity was 4.54 points. The model fit indices were as follows: χ2/DF = 2.08, TLI = 0.978, CFI = 0.969, RMSEA = 0.104, and SRMR = 0.077. Therefore, the one-dimensional structure with eight items yielded an RMSEA value above the 0.08 cutoff point, suggesting a poorer fit and more residual error than is acceptable for a well-fitting model. Using the modification indices within the CFA, we observed a correlation between Items 2 (climbing up two flights of stairs [16 steps]) and 6 (climbing up four flights of stairs [32 steps]) and Items 3 (squatting) and 4 (kneeling), indicating the similarity in the response pattern for these items. After adding these correlations to the model, we obtained improved fit indices (χ2/DF = 1.51, TLI = 0.990, CFI = 0.985, RMSEA = 0.072, and SRMR = 0.061). CONCLUSION: This version of the FIQ should be used with caution, as the unidimensional model demonstrates substantial residuals, mainly because of item redundancy.

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ABSTRACT BACKGROUND: Percutaneous microelectrolysis (MEP) is a minimally invasive technique used for pain relief, inflammation control, and tissue repair. However, the optimal treatment protocol remains under debate. OBJECTIVE: To compare the effects of dry needling and MEP, with and without a treatment algorithm, on pain in individuals with active myofascial trigger points (MTrPs) in the upper trapezius muscle. Design and setting: Randomized controlled trial conducted at Maimónides University, Buenos Aires. METHODS: Eighty-eight participants with MTrPs in the upper trapezius muscle were enrolled. The presence of MTrPs was confirmed through physical examination and algometric measurement before intervention. Participants were randomly assigned to one of six groups: Sham, dynamic dry needling, static dry needling, dynamic MEP, static MEP, or algorithmic MEP. Active treatments were administered using 0.30 mm × 40 mm acupuncture needles. Pain was assessed using two tools: the Numerical Pain Rating Scale (NPRS) and the Pressure Pain Threshold (PPT). Both measures were recorded with participants at rest before the intervention and again at 10 min, 24 h, 48 h, and 7 days post-intervention. RESULTS: Significant post-intervention differences in NPRS scores were observed in all groups except dynamic dry needling when compared to Sham. The algorithmic MEP group achieved complete pain relief by day 7. In terms of PPT, the threshold values in the MEP groups were lower than those in the other groups. CONCLUSIONS: All needling techniques demonstrated analgesic effects on myofascial trigger points, with the algorithm-enhanced MEP showing the most notable improvement in self-reported pain. However, MEP was not superior to other methods in improving pressure pain thresholds. CLINICAL TRIALS: NCT05478928.

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ABSTRACT BACKGROUND: Sense of mastery has been described in the literature as a psychological resource potentially associated with reduced caregiver burden. However, there are no validated instruments in the Brazilian context that allow the evaluation of the sense of mastery as a possible outcome of interventions aimed at supporting unpaid caregivers of people with dementia. OBJECTIVE: To validate the construct of the Brazilian version of the Pearlin Mastery Scale among unpaid caregivers of people living with dementia. DESIGN AND SETTING: This methodological study was conducted with 100 unpaid caregivers of people living with dementia, cared for at home, and who resided in Brazil. METHODS: Evidence of validity was tested based on internal structure, reliability, and correlations with theoretically related constructs. Sociodemographic data on sense of mastery, burden, depressive symptoms, anxiety, and quality of life were collected. RESULTS: Difficulties involving burden (80%), depressive symptoms (70%), anxiety (65%), and low quality of life (62%) were reported. Satisfactory measures of adjustment were found in the factor analysis; however, by removing two inversely scored items, these measures improved, resulting in a Cronbach’s alpha of 0.75. Significant correlations were found between sense of mastery and burden scores (ρ = −.56), symptoms of depression (ρ = −.57), anxiety (ρ = −.57), and quality of life (ρ = .64). CONCLUSION: Evidence of validity was found for the Pearlin Mastery Scale Brazilian version based on the internal structure, reliability, and correlations with theoretically related constructs, indicating that it is a suitable instrument for use in Brazil.

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ABSTRACT BACKGROUND: What are the effects of walking training on the ground in an unsupervised manner and with different weekly durations after chronic stroke? OBJECTIVE: To compare the effects of unsupervised walking for 150 and 300 minutes per week on walking performance, speed, and functional mobility in individuals with chronic stroke. DESIGN AND SETTING: Randomized clinical trial was conducted at Rede Sarah Rehabilitation Hospital (São Luís, Brazil). METHODS: Individuals included (n = 40) were assessed using the 6-minute walk test (6MWT), functional mobility using the Timed Up and Go (TUG) test, and the Five Times Sit to Stand Test (FTSST). They were assigned to the two experimental groups and instructed to walk 150 (G150) or 300 minutes per week (G300) and to perform unsupervised gait training for the next eight weeks. RESULTS: No significant differences were observed between the group factors and no significant interaction was found for the group × time interaction, indicating that G150 and G300 changed similarly. The comfortable walking speed increased for both G150 and G300, resulting in a large effect size. Performance on the TUG and 6MWT also improved, but the effect size was small. For maximum walking speed, despite the improvement in performance in G150 and the G300, effect size was medium for both groups. The same was true for the FTSST. CONCLUSION: Unsupervised walking was effective in improving gait performance and functional mobility in individuals with chronic stroke regardless of the recommended weekly duration (150 or 300 minutes). CLINICAL TRIAL REGISTRATION: RBR-5g4g9bq (https://ensaiosclinicos.gov.br/rg/RBR-5g4g9bq).

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ABSTRACT BACKGROUND: Studies assessing the prevalence of mental disorders in the context of remote teaching in Brazil during the coronavirus disease (COVID-19) pandemic are scarce. OBJECTIVE: To estimate the prevalence of symptoms of anxiety and depression and their relationship with sociodemographic characteristics among university students during the COVID-19 pandemic. DESIGN AND SETTING: This multicenter cross-sectional study was conducted at eight Brazilian public universities. METHODS: This study was conducted on students regularly enrolled in undergraduate courses. Data were collected between October 2021 and February 2022 using an online self-administered questionnaire that addressed sociodemographic and academic characteristics, lifestyle habits, and health conditions. Anxiety and depression symptoms were assessed using the Depression, Anxiety, and Stress Scale-21. The variables were analyzed descriptively using frequency distribution, proportion, 95% confidence interval (95% CI), and Pearson’s chi-squared test. RESULTS: A total of 8,650 students participated, and most of them were women, white, heterosexual, cisgender, and unmarried, with a mean age of 23.9 (standard deviation: ± 6.34) years and living with family members. Symptoms of anxiety and depression were observed in 59.7% (95% CI: 58.7–60.7) and 63.0% (95% CI: 62.0–64.0) of the students, respectively. These symptoms were associated with sex, age, skin color, sexual orientation, gender identity, marital status, education of the head of the family, family income, decrease in income during the pandemic, and area of knowledge. CONCLUSION: Most university students showed symptoms of anxiety and depression during the suspension of face-to-face activities in universities, indicating the need for institutional actions and public policies aimed at promoting their health and mental well-being.

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ABSTRACT BACKGROUND: Pregnant women are at an increased risk of thromboembolism compared with non-pregnant women. Venous thrombosis is a manifestation of antiphospholipid syndrome (APS), an autoimmune thrombophilia associated with pregnancy morbidity. OBJECTIVES: This study was designed to compare gestational outcomes of pregnant patients with deep venous thrombosis (DVT) and primary APS with outcomes of patients with DVT and negative results for antiphospholipid antibodies (aPLs). DESIGN AND SETTING: This was a retrospective cohort study with data collected from patients with DVT who received prenatal care for autoimmunity and thrombophilia at Hospital Universitário Pedro Ernesto, Rio de Janeiro. METHODS: All patients with DVT were tested for aPLs. Those with positive results were tested again after 12 weeks and classified as having primary APS. Patients with systemic lupus erythematosus, superficial venous thrombosis without DVT, twin pregnancies, or fetuses with congenital malformations were excluded. RESULTS: This study included 171 patients (39 with APS, 132 with DVT and negative aPL results). Patients with primary APS and DVT had higher frequencies of miscarriages (P = 0.004) and stillbirths during previous pregnancies (P < 0.001). When obstetric outcomes were analyzed prospectively, APS patients had a lower birth weight (P = 0.001) and higher rates of oligohydramnios (P = 0.04), intrauterine growth restriction (P = 0.01), preeclampsia (P = 0.04), stillbirths (P = 0.02), and small-for-gestational-age newborns (P < 0.001) than patients with DVT and negative aPL results. The latter group had gestational outcomes similar to those of the general population. CONCLUSIONS: Patients with primary APS have adverse obstetric outcomes despite appropriate treatment, whereas those with DVT and negative for aPLs have favorable results.

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ABSTRACT BACKGROUND: Short and practical questionnaires and tests that assess premenstrual symptoms and premenstrual syndrome (PMS) are required. OBJECTIVES: This study aimed to investigate the cross-cultural adaptation, validity, and reliability of the Premenstrual Syndrome Impact Questionnaire (PMS-IQ) in Turkish women with PMS. DESIGN AND SETTING: The reliability and validity of the questionnaire were evaluated in Tokat, Türkiye. METHODS: A convenience sample of 146 individuals diagnosed with PMS was used to assess the reliability and validity of the Turkish version of the PMS-IQ. Test-retest analyses were performed in a subset of 96 individuals one week after the initial assessment. Construct validity was evaluated through convergent validity analysis using the Premenstrual Syndrome Scale (PMSS) and the Premenstrual Symptoms Impact Survey (PMSIS), and divergent validity analysis with the Big Five Inventory-10 (BFI-10). RESULTS: Cronbach’s α values for the total score and subscales ranged from 0.861 to 0.917, whereas the test-retest reliability values ranged from 0.755 to 0.847. Factor analysis indicated that the scale had a three-factor structure. The total PMS-IQ score was significantly correlated with both the PMSS (r = 0.718) and PMSIS (r = 0.774), but showed no significant correlation with the BFI-10 (r = 0.113). No floor or ceiling effects were observed for the total or subscale scores of the PMS-IQ. CONCLUSIONS: The Turkish version of the PMS-IQ demonstrated reliability and validity for evaluating individuals with PMS. CLINICAL TRIAL REGISTRATION: This study is registered at ClinicalTrials.gov (identifier: NCT05725447).

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ABSTRACT BACKGROUND: This study investigated factors that may determine longevity in older adults, aiming to prolong their life expectancy and improve projections from before the coronavirus disease 2019 pandemic. OBJECTIVE: To identify risk factors for mortality in older Brazilian adults. DESIGN AND SETTING: A prospective cohort study, part of the Estudo Longitudinal de Saúde do Idoso de Alcobaça. METHODS: This study included 332 older adults of both sexes who were followed up for over five years (2015–2020). Vital status was determined via telephone follow-up, information provided by family members, and death certificates. To identify the sociodemographic, health, functional, and behavioral factors associated with mortality risk among older adults, Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: The risk factors for mortality among older adults included the number of people living with them (HR = 1.22; 95%CI = 1.07–1.38) and the number of prescribed drugs (HR = 1.15; 95%CI = 1.00–1.32). Factors associated with a lower risk of mortality were greater time spent in physical activity (HR = 0.99; 95%CI = 0.90–0.99) and greater hip circumference (HR = 0.95; 95%CI = 0.31–0.99). CONCLUSIONS: Sociodemographic, health, functional, and behavioral factors are determinants of mortality risk among older adults. Regular screening of the older adult population should be conducted to assess their general health status, allowing for more appropriate interventions to increase their quality of life and improve aging.

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ABSTRACT BACKGROUND: Actinic keratosis is a common preneoplastic dermatosis and is the third most common reason for dermatological consultations. Identifying the associated factors, diagnosis, and early treatment of actinic keratosis are crucial for reducing the risk of developing skin cancer and costs to the healthcare system. OBJECTIVE: To evaluate the prevalence and factors associated with actinic keratosis in individuals treated at a public dermatology service. DESIGN AND SETTING: A cross-sectional observational study was conducted with 1346 patients treated by a public dermatology service. METHODS: The demographic and dermatological characteristics of patients were recorded. The presence of actinic keratosis was determined by clinical dermatological identification. RESULTS: Most participants were elderly, white, and exposed to the sun without protection or during occupational activity. The evolution time of cutaneous lesions was <1 year in 46.8% of participants. Actinic keratosis was the most common skin lesion, being present in 29.3% of participants. The main approach adopted was cryotherapy. Keratosis was associated with white skin color, elderly age, personal and family history of skin cancer, exposure to the sun without protection at work, and limb involvement. When the associated factors were analyzed using a regression model, skin color and affected body segments were the main predictors of actinic keratosis. CONCLUSIONS: The prevalence of actinic keratosis was 29.3%, being higher in people with fair skin, more than two affected segments, skin lesions on the limbs, older age, and unprotected sun exposure. These indicators are important for supporting decision-making and contributing to improving public policies.

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ABSTRACT BACKGROUND: Children with congenital Zika syndrome (CZS) present severe motor impairment that hinders their caregivers’ positioning during activities of daily living (ADLs). OBJECTIVE: To assess the posture of children with CZS and their caregivers during ADLs in the home environment. DESIGN AND SETTING: A cross-sectional pilot study conducted in Campina Grande (PB), Brazil. METHODS: Nine children with CZS (mean age = 36.77 ± 2.94 months) and their caregivers (n = 9, mean age = 27 years) were assessed. Data were collected at the support home of a center for children with microcephaly in Northeast of Brazil. For postural assessment, children and their caregivers were filmed while performing ADLs in the living room and kitchen of the support home. RESULTS: During the environmental interaction, all children predominantly maintained a sitting position, exhibiting neck and trunk asymmetry; 77.8% (n = 7) showed inadequate postures with elevated arms and shoulders, and none maintained the ankles in a neutral position with supported feet. During feeding, 88.9% (n = 8) of children were positioned on the lap of caregivers, 88.9% (n = 8) exhibited neck and trunk asymmetry, 66.7% (n = 6) displayed inadequate upper-limb posture, and none maintained their ankles in a neutral position. During this activity, 66.7% (n = 6) of caregivers presented with trunk and neck asymmetry, 66.7% (n = 6) did not provide support for the upper limbs, and 55.6% (n = 5) did not maintain their knees flexed at 90o. CONCLUSIONS: Children with CZS and their caregivers present with inadequate postures during ADLs in the home environment, which may represent health risks.

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ABSTRACT BACKGROUND: Burnout is a global problem, and resilience may support the well-being of healthcare workers (HCWs) in stressful conditions. OBJECTIVES: This study aimed to evaluate the association between burnout and resilience among HCWs in intensive care units (ICU) during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN AND SETTING: A cross-sectional study was conducted in the ICU of four public hospitals in Fortaleza, Brazil. METHODS: A face-to-face survey was conducted among HCWs in the ICUs of four public hospitals in Fortaleza between January and August 2023. The participants completed questionnaires on burnout and resilience. RESULTS: A total of 194 professionals, including physichians (24%), nurses (29%), nursing technicians (25%), and physiotherapists (22%), completed questionnaires on burnout and resilience through face-toface interviews. Most professionals (62%) presented with overall burnout symptoms, and an inverse association was observed between resilience and burnout. However, 16 of the 44 (34%) HCWs with the highest resilience scores experienced burnout. Furthermore, younger age and higher workload were associated with a higher prevalence of burnout. CONCLUSION: Determinants of burnout were identified among ICU staff members during the last year of the COVID-19 pandemic. Resilience helped HCWs cope with burnout. However, some of the most resilient HCWs presented with high levels of burnout. Efforts are necessary to implement resilience-building tools, yet public health policies to improve ICU organizational issues are more important and urgent for promoting sustainable well-being among professionals, particularly during challenges such as pandemics. Introducing resilience-building tools and implementing public health policies are necessary to improve ICU management and promote sustainable well-being among healthcare workers in high workload settings.

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ABSTRACT BACKGROUND: People with Autism Spectrum Disorder (ASD) experience phases of life beyond childhood, which increase the difficulties inherent in each cycle. In contrast, the scientific literature lacks broad reviews of developmental strategies regarding quality of life, even though ASD encompasses changes in social, communicative, and behavioral skills. OBJECTIVE: This study aimed to identify strategies for promoting and maintaining quality of life among adults diagnosed with autism. DESIGN AND SETTING: This integrative review was conducted in Brazil. METHODS: This review searched the Scopus and Web of Science databases, from strategies that combined the descriptors ("Autism Spectrum Disorder"), ("Autism"), ("Aging"), and ("Quality of life"). Original studies with the full text available in English published between 2018 and 2023 were included, if they responded to the eligibility criteria. RESULTS: In total, 3,098 studies were identified, of which 44 were selected to compose the bibliographic sample of this review. The population sample included 184,653 participants diagnosed with ASD, aged on average 43.5 years old. The following were described for adults with autism: 1) cognitive aspects, 2) aspects related to suffering/mental illness, and 3) strategies to promote quality of life. CONCLUSION: This research contributes to basic clinical practice and promotes responsible care that attends to the health needs of people with autism throughout life. Early interventions in autistic adults and the availability of support throughout life are essential for maintaining cognitive health and quality of life.