[Evaluation of the implementation of the Care Network for People with Disabilities in the Brazilian Unified National Health System: a multiple case study]

The Care Network for People with Disabilities (RCPCD) was implemented in 2012 as a consequence of the actions of the Viver sem Limite (Living without Limits) plan and has been the research object of recent studies. However, no published studies address the degree of implementation of this network. This study aimed to evaluate the degree of implementation of the RCPCD in eight states in the five regions of Brazil. This multiple case study performed evaluative research of the degree of implementation of the RCPCD in the states of Amazonas, Bahia, Espírito Santo, Mato Grosso do Sul, Minas Gerais, Paraíba, Rio Grande do Sul, and São Paulo. A logical model of the policy and a measurement matrix were developed. The degree of implementation of seven states was moderate, but Amazonas had an incipient degree of implementation. The evaluation of each stage of the process showed important differences, as the regional diagnosis and network adhesion stages presented moderate to advanced degrees of implementation in most states. In the service contracting stage, no state had an advanced degree of implementation, and the stage of follow-up and monitoring of the RCPCD was not even reached. The measurement matrix helps evaluate the degree of implementation of the RCPCD, and, by recognizing its results, the state steering groups and technical area recommend its use. Actions to improve this implementation, such as strengthening regionalization, establishing regional steering groups, ensuring contracting mechanisms, and defining criteria for certification of the care points, are necessary.

Prevalence of musculoskeletal symptoms in obese patients candidates for bariatric surgery and its impact on health related quality of life

OBJECTIVE

This study was designed to identify the major musculoskeletal symptoms of individuals with obesity, to assess their health-related quality of life, and to evaluate the correlation between the musculoskeletal symptoms and the individuals' health-related quality of life.

MATERIALS AND METHODS

Cross-sectional study.

INSTRUMENTS USED

"Nordic Musculoskeletal Questionnaire" and "The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)".

RESULTS

In total, 41 subjects were evaluated, of which 90.15% were female. The mean age of the subjects was 40.78 ± 9.85 years and their mean body-mass index was 46.87 ± 8.08. All subjects reported musculoskeletal pain in at least one anatomical region and 80.49% had pain in three or more regions. The activity limitations due to pain were reported by 75.61% of them. The most affected regions by pain were the ankles and/or feet, lower back, knees and wrists/hands/fingers. The most associated regions with activity limitations due to pain were the ankles and/or feet, knees and lower back. The presence of pain showed a negative correlation with the domains physical functioning (PF), role-physical (RP) and body pain (BP). The activity limitations showed a negative correlation with the domains PF, BP, social functioning (SF) and role-emotional (RE).

CONCLUSION

Our data showed a high prevalence of musculoskeletal pain and limitation in activities due to pain in obese subjects. The musculoskeletal symptoms had negative correlations with physical and mental components of the health-related quality of life, highlighting the importance of ensuring that patients with obesity have access to interdisciplinary care, for the prevention and rehabilitation of musculoskeletal disorders.

Diferenças de gênero no limiar sensitivo para estimulação elétrica nervosa em adultos jovens

OBJETIVO: Investigar diferenças de gênero no limiar neuronal sensitivo (LNS) para estimulação elétrica nervosa transcutânea (TENS) entre adultos jovens, e os presumíveis efeitos da termoterapia prévia. MÉTODOS: Foram divididos por gênero, 30 estudantes jovens sadios (15 homens e 15 mulheres entre 6/11 ciclo estral) com 22±2 anos de idade. TENS foi aplicada simultaneamente nos joelhos direito e esquerdo dos sujeitos com frequência de 20 Hz e duração de pulso 230µs. A amplitude da corrente elétrica (mǺ) foi aumentada gradativamente para registro do limiar de percepção (LS) e tolerância (LT), antes/após termoterapia. O aquecimento no joelho-D foi realizado por luz infravermelha (250 W) à 0≈70 cm perpendicularmente, e o resfriamento do joelho-E por compressa de gelo, ambos realizados durante 15 minutos. A temperatura tecidual foi registrada por termometria digital. Os dados foram analisados e diferenças estabelecidas em p<0.05. RESULTADOS: A temperatura tecidual após termoterapia foi diferente (p<0.05) entre gêneros. No LS basal para TENS não houve diferenças entre gêneros, porém, a termoterapia alteou o LS em ambos os sexos. O LT basal foi menor (p<0.05) em mulheres, entretanto, após a termoterapia aumentou (p<0.05) em ambos os sexos. CONCLUSÃO: Os LNS para TENS são gênero-termo-dependentes em jovens sadios.