Quality of life in patients with Chagas disease and the instrument used: an integrative review

Chagas disease (CD) is a neglected tropical highly morbid disease that can have a negative impact on the quality of life (QoL). The purpose of this study was to conduct an integrative review to analyze the QoL of patients with CD in the chronic phase of the disease, as well as the instruments used and the effect of different interventions. The review was carried out based on the criteria and recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guideline (PRISMA) using the PubMed, Scopus, Web of Science and Science Direct databases. An analysis of the reference list of the included articles was also carried out. Publications in all languages have been included. Two independent reviewers selected the eligible articles and extracted the data. A total of 1,479 articles were identified, and after applying the inclusion criteria 18 articles were included. Four different instruments were used to assess QoL and the most used was the Minnesota Living with Heart Failure Questionnaire (MLWHFQ) [33.3% (n = 6)]. Investigations involving intervention showed a positive impact on the patients’ QoL, and the Environment domain had the lowest score. Heterogeneity of instruments and lack of methodology standardization for assessing QoL was observed. QoL proved to be an important indicator for the planning and monitoring of patients with CD, however it is suggested that the instruments for its assessment should be the ones recommended by the validation studies. This process will allow the comparison of data between investigations

Evaluation of the properties of WHODAS-12 measurements in individuals with Chagas disease in Brazil

Numerous tests employed to predict cardiac and functional status are expensive and not widely accessible for a considerable number of patients, particularly those diagnosed with Chagas disease (CD) residing in remote and endemic regions. To date, there is no knowledge of studies that have validated instruments that address functionality in an expanded way, including the biopsychosocial factors in patients with CD. This study aims to evaluate the psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS 2.0), in its 12-item shortened version (WHODAS-12) when applied to patients with CD. This is a cross-sectional study of a prospective cohort that follows individuals with CD (SaMi-Trop). Data collection took place between October 2019 and March 2020. In the interviews, sociodemographic information, life habits, clinical information, and indicators of disability measured by WHODAS-12 were collected. Descriptive analysis, internal consistency and construct validity of the instrument were performed. A total of 628 patients with CD were interviewed, most were women (69.5%), their mean age was of 57 years, and most declared an average self-perception of health (43.4%). The 12 items of WHODAS-12 were distributed into three factors, which together account for 61% of the variance. The Kaiser–Meyer–Olkin (KMO) index was 0.90, indicating adequacy of the sample for factor analysis. The internal consistency of the global scale showed alpha = 0.87. The percentage of incapacity was 16.05%, indicating mild incapacity for the evaluated patients. WHODAS-12 is a valid and reliable measure to assess the disability of the Brazilian population with CD

A descentralização da Vigilância em Saúde em Minas Gerais: caracterização dos serviços municipais, 2014

Introduction: The Health Surveillance Strengthening Project implemented in 2012 in Minas Gerais -subsidized by a local diagnosis- aimed at decentralizing Health Surveillance. Objectives: To characterizes the local Health Surveillance services in the state of Minas Gerais in 2014. Method: Descriptive study that analyzed 527 (62%) out of a total of 853 counties. The common variables to the Health Surveillance areas were instruments of management, financing, professional category, qualification and information system. Specific variables to the Health Surveillance areas were characterized infrastructure, reference services and actions. Frequencies, medians, interquartile differences and Spearman’s coefficient (p< 0.05) were analyzed. Results: An association among mana-gement tools, availability of professional categories, information system and population size (p<0.001) was observed. Insufficient infrastructure in the Sanitary and Environmental Surveillance and predominance of programmatic actions against monitoring actions were observed. Conclusions: The challenge of Health Surveillance demands confrontations in the field of management, practices and financing.Introdução: O Projeto de Fortalecimento da Vigilância em Saúde implantado em 2012, em Minas Gerais, visava a descentralização da Vigilância Sanitária, subsidiada no diagnóstico local. Objetivos: Caracterizar os serviços municipais de Vigilância em Saúde no estado de Minas Gerais em 2014. Método: Estudo transversal que analisou diagnósticos de 527/853 (62%) municípios do total do estado de MG. As variáveis comuns às áreas da Vigilância em Saúde foram instrumentos de gestão, financiamento, categoria profissional, qualificação e sistema de informação. Aquelas específicas às áreas da Vigilância em Saúde caracterizaram infraestrutura, serviços de referência e ações. Analisaram-se frequências, medianas, diferenças interquartílicas e coeficiente de Spearman (p< 0,05). Resultados: Observou-se associação entre instrumentos de gestão, disponibilidade de categorias profissionais, sistema de informação e porte populacional (p<0,001). Identificou-se infraestrutura insuficiente nas Vigilâncias Sanitária e Ambiental e predomínio das ações programáticas frente àquelas de monitoramento. Conclusões: O desafio da Vigilância em Saúde demanda enfrentamentos no campo da gestão, das práticas e do financiamento

Overview of Chagas disease surveillance in an endemic region in Southeastern Brazil

Chagas disease (CD) is a neglected disease caused by the protozoan Trypanosoma cruzi. It has high morbidity and mortality rates and mainly affects socially vulnerable populations. This is a cross-sectional study, with retrospective and prospective data collection. Using questionnaires applied to environmental surveillance coordinators, we characterized the status of CD surveillance activities in municipalities endemic for the disease in Northern Minas Gerais State (MG) and Jequitinhonha Valley (Vale do Jequitinhonha). Moreover, we spatialized the vulnerability index for chronic CD in the study area. The population consisted of 22 environmental surveillance coordinators, active in 2020, from Northern MG and Jequitinhonha Valley, 21 municipalities included in the SaMi-Trop research project, and Montes Claros municipality. After applying the questionnaires to the coordinators, a descriptive analysis of the variables was performed. To characterize the active municipalities, the explanatory variables collected in the questionnaire were compared with the dichotomous variable. Bivariate descriptive analysis was performed. Finally, geoprocessing techniques were used to spatialize the data and prepare maps. Regarding the team of endemic combat agents (ECA), 90.9% reported the lack of a specific team for CD vector control actions. Of the 22 municipalities participating in this study, nine were active (41.1%). Only 25% (n=2) of active municipalities (9% of the municipalities studied) met the target of visiting 50% of households per year. Finally, 81.1% of the coordinators stated that in their municipality, they developed actions linked to primary health care (PHC). The implementation of CD surveillance activities weakened in the endemic region. Few municipalities have a surveillance team, with low regularity of active surveillance and noncompliance with the program’s goal. The results suggest insufficient recording of activities in the information system, considering that there are municipalities that report performing the activities, but no production record was observed in the system

Cohort profile update: the main and new findings from the SaMi-Trop Chagas cohort

The SaMi-Trop project is a cohort study conducted in 21 municipalities of endemic areas of Chagas disease, including 1,959 patients with chronic Chagas cardiomyopathy. In this article we updated the results of the project, adding information from the second cohort visit. Trypanosoma cruzi-seropositive patients were enrolled from the primary care Telehealth service in Minas Gerais State, Brazil. The eligibility criterium for the second visit was the participation in the baseline evaluation. Of 1,959 participants at the baseline assessment, 1,585 (79.9%) returned after two years for the second evaluation. The mortality rate was 6.7%, but varied from 0.9% to 18.2% when it was stratified by certain clinical characteristics. A lower age-adjusted NT-Pro-BNP level (less than 300) and a prior benznidazole treatment were associated with lower mortality. There was an improvement in most quality of life domain scores. Participants have also reported fewer signs and symptoms and greater use of medication. The second follow-up visit will be complete in Oct 2021

Factors associated with quality of life in patients with Chagas disease: SaMi-Trop project.

Trial registrationNCT02646943