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Simoes EJ, Ramos LR. The Role of Healthy Diet and Lifestyle in Centenarians. Nutrients 2023; 15:4293. [PMID: 37836577 PMCID: PMC10574171 DOI: 10.3390/nu15194293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Life expectancy at birth (hereafter, life expectancy) and longevity are established indicators of population health [...].
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Affiliation(s)
- Eduardo J. Simoes
- Department of Biomedical Informatics, Biostatistics and Medical Epidemiology, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Luiz R. Ramos
- Department of Preventive Medicine, Federal University of Sao Paulo, São Paulo 04024-002, Brazil;
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Liu ASLW, Neves FJ, Pinto J, Amorim PMS, Bonilha AC, Mapurunga M, Moscardi AVS, Demarzo M, Guerra-Shinohara EM, D Almeida V, Ramos LR, Andreoni S, Tomita LY. Reduced circulating folate among older adults caused by continuous work: nested cross-sectional study conducted in a country with folic acid fortification program. Nutr Res 2022; 108:43-52. [PMID: 36399976 DOI: 10.1016/j.nutres.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
Population aging is 1 of the biggest challenges facing public health today, and cognitive dysfunction is an important concern. Cognitive impairment may be associated with high folate concentrations and low vitamin B12 concentrations; the latter is a common problem among elderly people. Therefore, we hypothesized there was a high circulating folate concentration among older people living in a country with a mandatory folic acid fortification program. We conducted a cross-sectional study to investigate nutritional status of folate and vitamin B12 among aged people. Three dietary recalls, serum folate (sfolate), erythrocyte (red blood cell) folate (RBC folate), and serum vitamin B12 and homocysteine were collected. Linear regression models were used to investigate factors associated with circulating vitamins. We interviewed 169 participants. Half reported inadequate consumption of folate. However, RBC folate deficiency was observed in 27%, 13% in the serum, and a 10% excess of sfolate. One-quarter reported inadequate consumption of B12, but only 5% had deficiency. Factors negatively associated with circulating folate were continuous work and smoking, and positively associated with polyunsaturated fatty acid. Factor negatively associated with the circulating B12 were use of a dental prosthesis and intake of saturated fatty acid. Permanent investigation of excess of sfolate and B12 deficiency, especially among older adults living in countries exposed to a mandatory folic acid fortification program, is important because of the possible relation to the cognitive function.
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Affiliation(s)
- Angela S L W Liu
- Departament of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Felix Jesus Neves
- Departament of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; Center of Biological and Health Science, Universidade Federal do Oeste da Bahia, Barreiras, BA, Brazil
| | - Juliana Pinto
- Departament of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Patrícia M S Amorim
- School of Pharmaceutical Sciences, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Ana Cláudia Bonilha
- Departament of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo Mapurunga
- Departament of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alcione V S Moscardi
- Departament of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; Center for the Study of Aging, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo Demarzo
- Departament of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Vânia D Almeida
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luiz R Ramos
- Departament of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil; Center for the Study of Aging, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Solange Andreoni
- Departament of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luciana Y Tomita
- Departament of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Hidalgo KD, Mielke GI, Parra DC, Lobelo F, Simões EJ, Gomes GO, Florindo AA, Bracco M, Moura L, Brownson RC, Pratt M, Ramos LR, Hallal PC. Health promoting practices and personal lifestyle behaviors of Brazilian health professionals. BMC Public Health 2016; 16:1114. [PMID: 27776496 PMCID: PMC5078940 DOI: 10.1186/s12889-016-3778-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 10/15/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND This study was conducted to examine the lifestyle behaviors and health promoting practices of physicians, nurses, and community health workers in Brazil. METHODS A random sample of primary health care units in Brazil was selected, and a pretested questionnaire was administered via phone interviews, in 2011, to 182 physicians, 347 nurses, and 269 community health workers, totaling 798 health professionals. The total initial sample included 1600 eligible health professionals. Variables measured included physical activity, alcohol intake, hours of sleep, diet, and perceived self-efficacy to provide preventive counseling on related lifestyle behaviors. RESULTS More than 25 % of physicians, nurses, and community health workers reported eating 0-2 portions of fruits and vegetables per day. In terms of cervical and breast cancer, nurses reported to be 'very prepared' to advise patients on these topics more frequently than physicians. The prevalence of smoking ranged from 4.9 % among nurses to 7.4 % among community health workers. The proportion of physical inactivity ranged from 40.3 % among nurses to 52.1 % among community health workers. CONCLUSION A reasonably high proportion of physicians, nurses, and community health workers report not engaging in healthy lifestyle behaviors that impact chronic diseases, thus, they may be less likely to encourage such behaviors in their patients.
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Affiliation(s)
- Karen D. Hidalgo
- JFK Johnson Rehabilitation Institute, JFK Medical Center, Edison, NJ USA
| | - Grégore I. Mielke
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Diana C. Parra
- Program in Physical Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO USA
| | - Felipe Lobelo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Eduardo J. Simões
- School of Medicine, Department of Health Management and Informatics, University of Missouri, Columbia, MO USA
| | - Grace O. Gomes
- Gerontology Department, Federal University of Sao Carlos, São Carlos, SP Brazil
| | - Alex A. Florindo
- School of Arts, Sciences and Humanities, University of Sao Paulo, Sao Paulo, Brazil
| | - Mário Bracco
- Center of Studies and Research Dr. João Amorim, CEJAM, São Paulo, SP Brazil
| | | | - Ross C. Brownson
- Prevention Research Center in St. Louis, Washington University in St. Louis, Brown School, St. Louis, MO USA
- School of Medicine, Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO USA
| | - Michael Pratt
- Department of Family Medicine and Public Health, University of California, San Diego, CA USA
| | - Luiz R. Ramos
- Department of Preventive Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Pedro C. Hallal
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Burdick L, Mielke GI, Parra DC, Gomes G, Florindo A, Bracco M, Lobelo F, Simoes EJ, Pratt M, Ramos LR, Moura L, Brownson RC, Hallal PC. Physicians', nurses' and community health workers' knowledge about physical activity in Brazil: A cross-sectional study. Prev Med Rep 2015; 2:467-72. [PMID: 26844104 PMCID: PMC4721435 DOI: 10.1016/j.pmedr.2015.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To measure knowledge of current recommendations of physical activity and consequences of physical inactivity among healthcare providers throughout Brazil. METHODS A phone survey of 1600 randomly selected primary healthcare units in Brazil was conducted between January and July 2011. At each unit, a physician, nurse or community healthcare worker (n = 798) responded to a 40-minute survey, eliciting information about demographics, knowledge, and health behaviors pertaining to physical activity. RESULTS Among nurses and community healthcare workers, > 95% reported needing more information on physical activity guidelines. Among physicians this proportion was 80%. Nearly 40% of the professionals incorrectly believed 90-min of moderate-intensity physical activity per week is the recommended amount for health benefits; nearly 30% believed that 90-min of vigorous-intensity activity per week is needed for the same purpose. More than 75% of all groups reported that type II diabetes, hypertension, depression, and coronary heart disease might result from physical inactivity, but on average only 60% from each group are aware of osteoporosis as a possible consequence of physical inactivity. CONCLUSIONS Training health professionals in how to convey all relevant information about physical activity to their patients is critical for health promotion within the primary care system in Brazil.
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Affiliation(s)
- Laura Burdick
- Federal University of Pelotas, Postgraduate Program in Epidemiology, Pelotas, Brazil
| | - Gregore I. Mielke
- Federal University of Pelotas, Postgraduate Program in Epidemiology, Pelotas, Brazil
| | - Diana C. Parra
- Washington University in St. Louis, School of Medicine, Program in Physical Therapy, St. Louis, MO, USA
- Gerontology Department, Federal University of Sao Carlos, São Carlos, SP, Brazil
| | - Grace Gomes
- School of Arts, Sciences and Humanities, University of Sao Paulo, Sao Paulo, Brazil
| | - Alex Florindo
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Mario Bracco
- Hospital Municipal Dr. Moyses Deutsch, M'Boi Mirim, São Paulo, Brazil
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Felipe Lobelo
- University of Missouri, School of Medicine, Department of Health Management and Informatics, USA
| | - Eduardo J. Simoes
- Global Health Promotion Office, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Pratt
- Department of Preventive Medicine, Federal University of Sao Paulo, São Paulo, SP, Brazil
| | - Luiz R. Ramos
- Non-communicable Diseases Coordination and Field Epidemiology Training Program EPISUS, Health Surveillance Secretariat, Ministry of Health, Brasilia, Brazil
| | - Lenildo Moura
- Washington University in St. Louis, Brown School, Prevention Research Center in St. Louis, St. Louis, MO, USA
| | - Ross C. Brownson
- Washington University in St. Louis, School of Medicine, Division of Public Health Sciences, Alvin J. Siteman Cancer Center, St. Louis, MO, USA
| | - Pedro C. Hallal
- Federal University of Pelotas, Postgraduate Program in Epidemiology, Pelotas, Brazil
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Florindo AA, Brownson RC, Mielke GI, Gomes GA, Parra DC, Siqueira FV, Lobelo F, Simoes EJ, Ramos LR, Bracco MM, Hallal PC. Association of knowledge, preventive counseling and personal health behaviors on physical activity and consumption of fruits or vegetables in community health workers. BMC Public Health 2015; 15:344. [PMID: 25885709 PMCID: PMC4410462 DOI: 10.1186/s12889-015-1643-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 03/16/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is evidence that if a health professional is active and has a healthy diet, he/she is more likely to advise patients about the benefits of physical activity and healthy eating The aims of this study were to: (1) describe the personal physical activity, consumption of fruits and vegetables behaviors and nutritional status of community health workers; (2) evaluate the association between knowledge, delivery of preventive counseling and personal behaviors among community health workers. METHODS This was a cross-sectional study conducted in a nationally sample of health professionals working in primary health care settings in Brazil in 2011. This survey was part of the second phase of the Guide for Useful Interventions for Activity in Brazil and Latin America project, and data were collected through telephone interviews of 269 community health workers from the Unified Health Care system of Brazil. We applied questionnaires about personal reported behaviors, knowledge and preventive counseling in physical activity and consumption of fruits and vegetables. We calculated the prevalence and associations between the variables with logistic regression. RESULTS The proportion of community health workers that practiced 150 minutes per week of physical activity in leisure time or transportation was high (64.9%). Half of community health workers were overweight and only 26.2% reported consuming five portions/day of fruits or vegetables. Most community health workers reported counseling about physical activity for more than six months (59.7%), and most were not knowledgeable of the fruits and vegetables and physical activity recommendations. Meeting the fruits and vegetables recommendations was associated with correct knowledge (OR = 4.5; CI95% 1.03;19.7), with reporting 150 minutes or more of physical activity per week (OR = 2.0; CI95% 1.03;3.7) and with reporting physical activity in leisure time (OR = 2.0; CI95% 1.05;3.6). Regular physical activity counseling was associated with reporting 10-149 minutes per week (OR = 3.8; CI95% 1.1;13.3) and with more than 150 minutes of physical activity per week (OR = 4.9; CI95% 1.5;16.5). CONCLUSION Actions to promote physical activity and healthy eating and to improve knowledge among community health workers within the health care system of Brazil could have a potential positive influence on delivery of preventive counseling to patients on this topic.
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Affiliation(s)
- Alex A Florindo
- School of Arts, Sciences and Humanities, University of São Paulo, Rua Arlindo Bettio, 1.000, CEP: 03828-000, São Paulo, SP, Brazil.
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Division of Public Health Sciences and Alvin J. Siteman Cancer Center - Washington University in St. Louis, Missouri, USA.
| | - Gregore I Mielke
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil.
| | - Grace Ao Gomes
- Department of Gerontology, Federal University of São Carlos, São Carlos, SP, Brazil.
| | - Diana C Parra
- Program in Physical Therapy Surgery (Prevention and Control), School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
| | - Fernando V Siqueira
- School of Physical Education, Federal University of Pelotas, Pelotas, RS, Brazil.
| | - Felipe Lobelo
- Hubert Department of Global Health, Emory University - Rollins School of Public Health, Atlanta, USA.
| | - Eduardo J Simoes
- Department of Health Management and Informatics, School of Medicine, University of Missouri, Missouri, USA.
| | - Luiz R Ramos
- Department of Preventive Medicine, Federal University of Sao Paulo, São Paulo, SP, Brazil.
| | - Mário M Bracco
- Hospital Israelita Albert Einstein; Hospital Municipal Dr. Moysés Deutsch - M'Boi Mirim, São Paulo, SP, Brazil.
| | - Pedro C Hallal
- School of Physical Education, Federal University of Pelotas, Pelotas, RS, Brazil.
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Ramos LR, Perracini M, Rosa TE, Kalache A. Significance and management of disability among urban elderly residents in Brazil. J Cross Cult Gerontol 2014; 8:313-23. [PMID: 24389964 DOI: 10.1007/bf00972560] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Brazil's population is aging very rapidly, and the care for the elderly is an emerging priority. The results of a multidimensional functional assessment of elderly residents in Sao Paulo showed extreme poverty and massive cohabitation in multigenerational households. The health profile showed a high prevalence of chronic illnesses, mental disorders, and disability. Using a Guttman scale, a set of activities of daily living was validated as an indicator of dependency. Attention was given to the dependency associated factors, and in particular to the association between chronic illness and loss of independence among the aged. Fortunately, for the existing health care system in Brazil, cultural values are still keeping the family in the front line of caregiving, but this situation is not likely to withstand the increasing burden of a growing elderly population with an ever higher rate of disability.
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Affiliation(s)
- L R Ramos
- Center for the Study of Aging, Escola Paulista de Medicina, Rua dos Ottonis 731, 04025-002, Sao Paulo, Brazil
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da Silva PT, Master S, Andreoni S, Pontes P, Ramos LR. Acoustic and Long-Term Average Spectrum Measures to Detect Vocal Aging in Women. J Voice 2011; 25:411-9. [DOI: 10.1016/j.jvoice.2010.04.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 04/06/2010] [Indexed: 10/19/2022]
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Ferreira MT, Matsudo SMM, Ribeiro MCSA, Ramos LR. Health-related factors correlate with behavior trends in physical activity level in old age: longitudinal results from a population in São Paulo, Brazil. BMC Public Health 2010; 10:690. [PMID: 21067591 PMCID: PMC2992518 DOI: 10.1186/1471-2458-10-690] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 11/10/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Physical inactivity in leisure time is common among elderly in Brazil and this finding is particularly alarming considering that this population is greatly affected by chronic diseases. The identification of health factors that influence physical activity level (PAL) will help in the development of strategies for increasing PAL older adults. The current research aimed to identify variables that independently affect behavior trends in PAL over the course of two years among elderly. METHODS A survey entitled the Epidoso Project ("Epidemiology of aging") studied 1,667 community-based older individuals in São Paulo city, Brazil over the course of two years. Physical activity level was determined through questions about frequency and duration of physical activities. Body Mass Index was calculated; functional capacity was assessed through the ADL (activities of daily living) scale; cognition was assessed by Mini-Mental State Examination; and mental health was assessed through the Dysthymia Screening. Experiences of falls and fractures were also assessed. Subjects were divided into three groups according to their self-report of Physical Activity Level: a--Regularly Active; b--Insufficiently Active and c--Physically Inactive. Behavior trends in PAL were also measured after two years. Multivariate regression model methodology was used to test associations longitudinally. RESULTS Results from the final model demonstrated that the risk of a not favorable behavior trend in PAL, which included the group who remained physically inactive and the group that displayed decreased PAL, in this cohort of older adults was significantly increased if the individual was female (OR = 2.50; 95% CI = 1.60-3.89; P < 0.01), older (80 y vs. 65 y, OR = 6.29, 95% CI = 2.69-14.67; P < 0.01), dependent on help from others for activities in the ADL scale (moderate-severe = 4-7+ vs. 0 ADLs) (OR = 2.25, 95% CI = 1.20-4.21; P < 0.011) or had experienced a history of falls with consequences (OR = 6.88, 95% CI = 0.91-52.01; P < 0.062). CONCLUSIONS Age, gender, ADL scores and falls were associated with a not favorable behavior trend in PAL. Promotion programs should target these factors, reducing barriers to achieve desired changes in PAL.
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Affiliation(s)
- Marcela T Ferreira
- Department of Internal Medicine and Therapeutic, São Paulo Federal University, São Paulo, Brazil
| | - Sandra MM Matsudo
- Physical Fitness Research Laboratory from São Caetano do Sul, São Caetano do Sul, Brazil
| | - Manoel CSA Ribeiro
- Departament of Social Medicine, Santa Casa da Misericórdia, São Paulo, Brazil
| | - Luiz R Ramos
- Department of Preventive Medicine, São Paulo Federal University, São Paulo, Brazil
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Xavier AJ, Eleonora d'Orsi, Ramos LR, Sigulem D, Santos JB, Quialheiro A, Olivieri G, Pedroso LN, Berger R, Baldin M, Lida EK, Batista T. O4‐07‐03: Cognitive stimulation and rehabilitation mediated by computers and internet: A controlled study. Alzheimers Dement 2010. [DOI: 10.1016/j.jalz.2010.05.506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ribeiro IC, Parra DC, Hoehner CM, Soares J, Torres A, Pratt M, Legetic B, Malta DC, Matsudo V, Ramos LR, Simoes EJ, Brownson RC. School-based physical education programs: evidence-based physical activity interventions for youth in Latin America. Glob Health Promot 2010; 17:5-15. [PMID: 20587626 PMCID: PMC2904544 DOI: 10.1177/1757975910365231] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 09/09/2009] [Indexed: 11/15/2022]
Abstract
This article focuses on results of the systematic review from the Guide for Useful Interventions for Activity in Latin America project related to school-based physical education (PE) programs in Latin America. The aims of the article are to describe five school-based PE programs from Latin America, discuss implications for effective school-based PE recommendations, propose approaches for implementing these interventions, and identify gaps in the research literature related to physical activity promotion in Latin American youth. Following the US Community Guide systematic review process, five school-based PE intervention studies with sufficient quality of design, execution and detail of intervention and outcomes were selected for full abstraction. One study was conducted in Brazil, two studies were conducted in Chile and two studies were conducted on the US/Mexico border. While studies presented assorted outcomes, methods and duration of interventions, there were consistent positive increases in physical activity levels for all outcomes measured during PE classes, endurance and active transportation to school in all three randomized studies. Except for one cohort from one study, the non-randomized studies showed positive intervention effects for moderate and vigorous physical activity levels during PE classes. The core elements of these five interventions included capacity building and staff training (PE specialists and/or classroom teachers); changes in the PE curricula; provision of equipment and materials; and adjustment of the interventions to specific target populations. In order to translate the strong evidence for school-based PE into practice, systematic attention to policy and implementation issues is required.
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Affiliation(s)
- Isabela C Ribeiro
- Office of Workforce and Career Development, Air Pollution and Respiratory Health Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, USA.
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Ramos LR, Montaño MB. P3‐135: Incidence of dementia and rate of conversion of CDR=0.5 cases, in a cohort of elderly living in Sao Paulo, Brazil. Alzheimers Dement 2009. [DOI: 10.1016/j.jalz.2009.04.1110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Smith MAC, Silva MDA, Cendoroglo MS, Ramos LR, Araujo LMQ, Labio RW, Burbano RR, Chen ES, Payão SLM. TP53 codon 72 polymorphism as a risk factor for cardiovascular disease in a Brazilian population. ACTA ACUST UNITED AC 2008; 40:1465-72. [PMID: 17934643 DOI: 10.1590/s0100-879x2007001100007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Accepted: 07/31/2007] [Indexed: 11/21/2022]
Abstract
TP53, a tumor suppressor gene, has a critical role in cell cycle, apoptosis and cell senescence and participates in many crucial physiological and pathological processes. Identification of TP53 polymorphism in older people and age-related diseases may provide an understanding of its physiology and pathophysiological role as well as risk factors for complex diseases. TP53 codon 72 (TP53:72) polymorphism was investigated in 383 individuals aged 66 to 97 years in a cohort from a Brazilian Elderly Longitudinal Study. We investigated allele frequency, genotype distribution and allele association with morbidities such as cardiovascular disease, type II diabetes, obesity, neoplasia, low cognitive level (dementia), and depression. We also determined the association of this polymorphism with serum lipid fractions and urea, creatinine, albumin, fasting glucose, and glycated hemoglobin levels. DNA was isolated from blood cells, amplified by PCR using sense 5'-TTGCCGTCCCAAGCAATGGATGA-3' and antisense 5'-TCTGGGAAGGGACAGAAGATGAC-3' primers and digested with the BstUI enzyme. This polymorphism is within exon 4 at nucleotide residue 347. Descriptive statistics, logistic regression analysis and Student t-test using the multiple comparison test were used. Allele frequencies, R (Arg) = 0.69 and P (Pro) = 0.31, were similar to other populations. Genotype distributions were within Hardy-Weinberg equilibrium. This polymorphism did not show significant association with any age-related disease or serum variables. However, R allele carriers showed lower HDL levels and a higher frequency of cardiovascular disease than P allele subjects. These findings may help to elucidate the physiopathological role of TP53:72 polymorphism in Brazilian elderly people.
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Affiliation(s)
- M A C Smith
- Disciplina de Genética, Departamento de Morfologia e Genética, Escola Paulista de Medicina, Universidade Federal de São PauloSão Paulo, SP, Brasil.
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Sesso R, Prado F, Vicioso B, Ramos LR. Prospective study of progression of kidney dysfunction in community-dwelling older adults. Nephrology (Carlton) 2008; 13:99-103. [PMID: 18275496 DOI: 10.1111/j.1440-1797.2008.00919.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Few prospective studies have assessed renal dysfunction in older persons. We sought to define kidney dysfunction among a community-based cohort of elderly subjects and to determine the factors for its progression. METHODS The Epidemiologia do Idoso (EPIDOSO) Study is a prospective study of individuals > or =65 years old (mean 72.6 +/- 0.3), living in the community in the city of São Paulo. The creatinine clearance (CrCl) of 269 individuals of this cohort was estimated during 8 years of follow-up. The rate of decline in CrCl was calculated using linear regression analysis and dividing the group into tertiles of CrCl change. RESULTS Overall mean change in CrCl was -2.37 +/- 0.23 mL/min per year. Mean age increased with the greatest degree of decline in renal function (71.1 +/- 0.59, 72.5 +/- 0.54 and 74.3 +/- 0.58, for the first, second and third CrCl change tertiles, respectively, P < 0.01). A higher value of baseline CrCl was associated with progressive decline in CrCl (P < 0.01). Diastolic BP was greater in the second versus the first estimated glomerular filtration rate tertile (83 +/- 1 vs 80 +/- 1 mmHg, P < 0.05). High-density lipoprotein (HDL) cholesterol was inversely associated with CrCl decline (P < 0.05). CONCLUSION Progression of kidney dysfunction occurs in most community-dwelling elderly. Strategies aimed at slowing the progression should be considered for possible risk factors of older age, baseline CrCl, BP and HDL.
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Affiliation(s)
- Ricardo Sesso
- Division of Nephrology, Department of Medicine, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil.
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Sampaio LR, Simões EJ, Assis AMO, Ramos LR. Validity and reliability of the sagittal abdominal diameter as a predictor of visceral abdominal fat. ACTA ACUST UNITED AC 2007; 51:980-6. [DOI: 10.1590/s0004-27302007000600013] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 03/09/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVES: To evaluate the reliability of the sagittal abdominal diameter and its validity as a predictor of visceral abdominal fat, as well as to identify the most appropriate cut-off points to identify the area of visceral fat that is known to represent a risk factor for cardiovascular disease. DESIGN: Validation study. SUBJECTS: 92 healthy volunteers (57 women, 35 men), age: 20-83 y, body mass index: 19.3 to 35.9 kg/m². MEASUREMENTS: Sagittal abdominal diameter (SAD), weight, height, circumferences (waist, hip, and thigh), sub-scapular skinfold thickness, abdominal diameter index, and waist-hip ratio (WHR). METHOD OF CHOICE: Computed tomography (CT). STATISTIC: Receiver operating characteristic (ROC) curve. RESULTS: The reliability for SAD measurement was very high (Inter-class coefficient = 0.99). Visceral fat as measured by VAF through CT was highly correlated with SAD (women r = 0.80; men r = 0.64, p < 0.001), waist circumference (women r = 0.77; men r = 0.73, p < 0.001), and WHR (women r = 0.72; men r = 0.58, p < 0.001). The ROC curve indicated 19.3 cm and 20.5 cm as the threshold values for abdominal sagittal diameter in women and men (sensitivity 85% and 83%, specificity 77% and 82%, respectively). CONCLUSIONS: There was a high correlation between SAD and VAF. The cut-off values identified for SAD presented a sensitivity and specificity that were considered adequate.
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Chen ES, Cendoroglo MS, Ramos LR, Araujo LMQ, Carvalheira GMG, de Lábio RW, Burbano RR, Payão SLM, de A C Smith M. APO A-V–1131T→C polymorphism frequency and its association with morbidity in a Brazilian elderly population. Clin Chem Lab Med 2006; 44:32-6. [PMID: 16375582 DOI: 10.1515/cclm.2006.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractIdentification of genetic polymorphisms as risk factors for complex diseases affecting older people can be relevant for their prevention, diagnosis and management. The –1131T→C polymorphism of the apolipoprotein A-V gene (
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Affiliation(s)
- Elizabeth S Chen
- Disciplina de Genética, Departamento de Morfologia, Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP/EPM), Brazil
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Abstract
BACKGROUND Although physical fitness has been suggested to improve physical and psychosocial health for a variety of population profiles, there is a lack of information about the safety and effectiveness of aerobic exercise for adults with Down syndrome. OBJECTIVES To evaluate the effectiveness and safety of aerobic exercise training programmes for physiological and psychosocial outcomes in adults with Down syndrome. SEARCH STRATEGY Search terms and synonyms for "aerobic exercise" and "Down syndrome" were used within the following databases:CENTRAL (2005, Issue 2); MEDLINE (1966 to March 2005); EMBASE (2005 to April 2005); CINAHL (1982 to March 2005); LILACS (1982 to March 2005); PsycINFO (1887 to March 2005); ERIC (1966 to March 2005); CCT (March 2005); Academic Search Elite (to March 2005), C2- SPECTR (to March 2005 ), NRR (2005 Issue 1), ClinicalTrials.gov (accessed March 2005)and within supplements of Medicine and Science in Sports and Exercise. SELECTION CRITERIA Randomised or quasi-randomised controlled trials using supervised aerobic exercise training programmes with behavioral components accepted as co-interventions. DATA COLLECTION AND ANALYSIS Two reviewers selected relevant trials, assessed methodological quality and extracted data. Where appropriate, data was pooled using meta-analysis with a random effects model MAIN RESULTS The two studies included in this trial used different kinds of aerobic activity: walking/jogging and rowing training. One included study was conducted in the USA, the other in Portugal. In the meta-analyses, only maximal treadmill grade, a work performance variable, was improved in the intervention group after aerobic exercise training programmes (-4.26 [95% CI -6.45, -2.06]) grade. The other outcomes in the meta-analysis showed no significant differences between intervention and control groups, as expressed by weighted mean difference: VO(2) peak -0.30 (95% CI -377, 3.17) mL.Kg.min(-1); peak heart rate, -2.84 (95% CI -10.73, 5.05) bpm; respiratory exchange ratio, 0.01 (95% CI -0.04, 0.06); pulmonary ventilation, -5.86 (95% CI -16.06, 4.34) L.min(-1). 30 other measures including work performance, oxidative stress and body composition variables could not be combined in the meta-analysis. Trials reported no significant improvements in these measures. AUTHORS' CONCLUSIONS There is insufficient evidence to support improvement in physical or psychosocial outcomes of aerobic exercise in adults with Down syndrome. Although evidence exists which supports improvements in physiological and psychological aspects from strategies using mixed physical activity programmes, well-conducted research which examines long-term physical outcomes, adverse effects, psychosocial outcomes and costs are required before informed practice decisions can be made.
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Affiliation(s)
- R B Andriolo
- Department of Medicine, Federal University of São Paulo, Street of Ottonis, 731, São Paulo, (Southeast), Brazil, 04025-002.
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Smith MAC, Silva MDA, Araujo LQ, Ramos LR, Labio RW, Burbano RR, Peres CA, Andreoli SB, Payão SLM, Cendoroglo MS. Frequency of Werner helicase 1367 polymorphism and age-related morbidity in an elderly Brazilian population. Braz J Med Biol Res 2005; 38:1053-9. [PMID: 16007276 DOI: 10.1590/s0100-879x2005000700008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Werner syndrome (WS) is a premature aging disease caused by a mutation in the WRN gene. The gene was identified in 1996 and its product acts as a DNA helicase and exonuclease. Some specific WRN polymorphic variants were associated with increased risk for cardiovascular diseases. The identification of genetic polymorphisms as risk factors for complex diseases affecting older people can improve their prevention, diagnosis and prognosis. We investigated WRN codon 1367 polymorphism in 383 residents in a district of the city of São Paulo, who were enrolled in an Elderly Brazilian Longitudinal Study. Their mean age was 79.70 +/- 5.32 years, ranging from 67 to 97. This population was composed of 262 females (68.4%) and 121 males (31.6%) of European (89.2%), Japanese (3.3%), Middle Eastern (1.81%), and mixed and/or other origins (5.7%). There are no studies concerning this polymorphism in Brazilian population. These subjects were evaluated clinically every two years. The major health problems and morbidities affecting this cohort were cardiovascular diseases (21.7%), hypertension (83.7%), diabetes (63.3%), obesity (41.23%), dementia (8.0%), depression (20.0%), and neoplasia (10.8%). Their prevalence is similar to some urban elderly Brazilian samples. DNA was isolated from blood cells, amplified by PCR and digested with PmaCI. Allele frequencies were 0.788 for the cysteine and 0.211 for the arginine. Genotype distributions were within that expected for the Hardy-Weinberg equilibrium. Female gender was associated with hypertension and obesity. Logistic regression analysis did not detect significant association between the polymorphism and morbidity. These findings confirm those from Europeans and differ from Japanese population.
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Affiliation(s)
- M A C Smith
- Departamento de Morfologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brasil.
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Ejchel TF, Araújo LMQ, Ramos LR, Cendoroglo MS, de Arruda Cardoso Smith M. Association of the apolipoprotein A-IV: 360 Gln/His polymorphism with cerebrovascular disease, obesity, and depression in a Brazilian elderly population. Am J Med Genet B Neuropsychiatr Genet 2005; 135B:65-8. [PMID: 15806598 DOI: 10.1002/ajmg.b.30175] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The identification of genetic polymorphisms as risk factors for complex diseases can be relevant for their prevention, diagnosis, and prognosis. The apolipoprotein A-IV: 360 Gln/His polymorphism was investigated in 383 elderly individuals, who were participants of a longitudinal study commenced in 1991. The major morbidities that affect elderly people, such as cardiovascular diseases, diabetes, low cognitive function, depression, and obesity, were extensively investigated. DNA was isolated from blood cells, amplified by PCR, and digested with Fnu4HI. In this population the frequency of the His allele was 0.056 and the genotypes were distributed according to Hardy-Weinberg equilibrium. Logistic regression analysis showed a significant association between the presence of His allele and cerebrovascular disease and/or transitory ischemic attack (odds ratio) (OR = 3.070, P = 0.027), obesity (OR = 2.241, P = 0.047), and depression (OR = 2.879, P = 0.005). This study indicates that the presence of the rare allele in elderly people can play a significant role in the occurrence of multifactorial diseases. This is the first study analyzing this polymorphism in elderly people in Brazil. More studies should be encouraged to elucidate the mechanisms involved in these diseases.
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Affiliation(s)
- T F Ejchel
- Disciplina de Genética, Departamento de Morfologia, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
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19
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Abstract
The purpose of the present study was to translate and adapt the Berg balance scale, an instrument for functional balance assessment, to Brazilian-Portuguese and to determine the reliability of scores obtained with the Brazilian adaptation. Two persons proficient in English independently translated the original scale into Brazilian-Portuguese and a consensus version was generated. Two translators performed a back translation. Discrepancies were discussed and solved by a panel. Forty patients older than 65 years and 40 therapists were included in the cultural adaptation phase. If more than 15% of therapists or patients reported difficulty in understanding an item, that item was reformulated and reapplied. The final Brazilian version was then tested on 36 elderly patients (over age 65). The average age was 72 years. Reliability of the measure was assessed twice by one physical therapist (1-week interval between assessments) and once by one independent physical therapist. Descriptive analysis was used to characterize the patients. The intraclass correlation coefficient (ICC) and Pearson's correlation coefficient were computed to assess intra- and interobserver reliability. Six questions were modified during the translation stage and cultural adaptation phase. The ICC for intra- and interobserver reliability was 0.99 (P < 0.001) and 0.98 (P < 0.001), respectively. The Pearson correlation coefficient for intra- and interobserver reliability was 0.98 (P < 0.001) and 0.97 (P < 0.001), respectively. We conclude that the Brazilian version of the Berg balance scale is a reliable instrument to be used in balance assessment of elderly Brazilian patients.
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Affiliation(s)
- S T Miyamoto
- Division of Physical and Occupational Therapy, McGill University, Montreal, Canada
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Gomes LF, Alves AF, Sevanian A, Peres CDA, Cendoroglo MS, de Mello-Almada C, Quirino LM, Ramos LR, Junqueira VBC. Role of beta2-glycoprotein I, LDL-, and antioxidant levels in hypercholesterolemic elderly subjects. Antioxid Redox Signal 2004; 6:237-44. [PMID: 15025925 DOI: 10.1089/152308604322899305] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The levels of electronegative low-density lipoprotein (LDL-), LDL cholesterol oxidability, and plasma levels of molecular antioxidants and of beta(2)-glycoprotein I (beta(2) GPI) were studied in a group of 10 hypercholesterolemic (HC) and 10 normocholesterolemic (NC) elderly subjects. HC subjects showed significantly higher levels of cholesterol, LDL cholesterol, LDL-, and beta(2)GPI than NC, whereas high-density lipoprotein cholesterol and alpha-tocopherol levels were lower in HC as compared with NC subjects. Correlations among LDL- levels, LDL oxidation lag time, beta(2)GPI, and antioxidant plasma levels were studied in 100 HC elderly subjects. Lag time for in vitro LDL oxidation positively correlated with ubiquinol-10 levels (p = 0.008), but not with other antioxidants studied or beta(2)GPI. LDL- and alpha-tocopherol levels showed an inverse and significant correlation (p = 0.018). beta(2)GPI and LDL cholesterol levels were correlated (p = 0.001), whereas no significance was found between LDL- and beta(2)GPI levels (p = 0.057). The physiological significance of alpha-tocopherol and ubiquinol-10 levels on LDL- levels, and the presence of high levels of beta(2)-GPI, are discussed in terms of protective mechanisms operating during the overall atherosclerosis process.
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Affiliation(s)
- Ligia F Gomes
- Disciplina de Citologia Clínica, Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil.
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21
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Komatsu RS, Ramos LR, Szejnfeld VL. Incidence of proximal femur fractures in Marilia, Brazil. J Nutr Health Aging 2004; 8:362-7. [PMID: 15359353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND SETTING Three general hospitals in the town of Marília that have an orthopaedic and traumatologic unit. Marília is a Municipality with 161.000 inhabitants in the middle-east of São Paulo State, Brazil. PATIENTS/PARTICIPANTS All inpatients, living in Marília-SP, aged 20 years or more, with a diagnosis of proximal femur fracture (WHO, International Classification of Diseases, 9th.ed., code 820), in the period of January 01, 1994 and December 31, 1995. MAIN OUTCOME MEASURES The incidence rates of the proximal femur fractures in Marília-SP. Secondary Measurements: mean-age of the occurrence (male and female), in-hospital mortality, hospitalar costs to S.U.S. (Government Health System), the average length of hospital stay, seasonality, mean-interval between admission and surgical procedure, type of fracture: transcervical and pertrochanteric, content validity of S.I.H.-S.U.S data base report on proximal femur fractures, when compared with hospital registrations. OBJECTIVE To determine the incidence (crude, age-specific and age-adjusted) of fractures of the proximal femur in Marília-SP, Brazil, in 1994 and 1995. DESIGN Retrospective cohort study. RESULTS The crude incidence rate was 4.96/10,000 inhabitants/year in 1994 and 5.51/10,000 inhabitants/year in 1995; the age-specific incidence rate increased from 0.25/10,000 inhabitants 20-49 years/year to 100.27/10,000 inhabitants 70 years or more/year in 1995 among women; the age-adjusted incidence rate was 29.48/10,000 inhabitants 60 years or more/year in 1994, and 35.83/10,000 inhabitants 60 years or more/year in 1995. CONCLUSION The crude incidence rate of the proximal femur fractures in Marília-SP, Brazil was 4.96 / 10,000 inhabitants in 1994 and 5.51/10,000 inhabitants in 1995. It was significantly greater among women (7.2/10,000 inhabitants in 1994 and 8.6/10,000 inhabitants in 1995) and among the elderly, 70 year-old or more (female: 90.21/10,000 inhabitants in 1994 and 100.27/10,000 inhabitants in 1995; male: 25.46/10,000 inhabitants in 1994 and 45.66/10,000 inhabitants in 1995).
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Affiliation(s)
- R S Komatsu
- Division of Geriatrics and Gerontology, FAMEMA-Marilia Medical School, Brazil
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Carvalhaes-Neto N, Ramos LR, Suchecki D, Tufik S, Huayllas MK, Kater CE. The effect of hospitalization on the sleep pattern and on cortisol secretion of healthy elderly. Exp Aging Res 2003; 29:425-36. [PMID: 12959876 DOI: 10.1080/03610730303702] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to verify whether polysomnography represents a stressful situation by assessing cortisol levels and the sleep pattern of healthy community-living elderly admitted to a sleep disorder center (SDC). Subjects slept for two sequential nights at the SDC for polysomnographic recordings. Blood was sampled at 0800 h, 1600 h, and 2300 h and 24-h urine was collected for cortisol determination. Three months later, subjects were visited at home for blood and urinary collections. Cortisol levels were higher in the SDC than at home at 0800 h but were lower at 2300 h and similar at 1600 h. No differences were observed in urinary cortisol. Polysomnographic recordings indicated a poorer sleep pattern in the first night. Our data indicate that a short-term stay of healthy elderly in a SDC disrupts sleep pattern in the first of 2 nights, without representing a stressful experience, as evaluated by cortisol levels.
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Affiliation(s)
- Nelson Carvalhaes-Neto
- Division of Geriatrics, Department of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil.
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Carvalhaes-Neto N, Huayllas MK, Ramos LR, Cendoroglo MS, Kater CE. Cortisol, DHEAS and aging: resistance to cortisol suppression in frail institutionalized elderly. J Endocrinol Invest 2003; 26:17-22. [PMID: 12602529 DOI: 10.1007/bf03345117] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Convincing evidences has linked the hypothalamus-pituitary-adrenal (HPA) axis to aging patterns. F excess is implicated in the development of frailty characteristics whereas DHEAS is positively correlated to successful aging. We compared serum F and DHEAS levels of independent community-living (successful group, 19 M and 28 F, 69 to 87 yr) with those of institutionalized elderly (frail group, 20 M and 30 F, 65 to 95 yr). Serum F was determined at 1) baseline (08:00 h, 16:00 h and 23:00 h), 2) after 2 overnight dexamethasone (DEX) suppression tests (DST, using 0.25 and 1.0 mg doses), and 3) 60 min after ACTH stimulation (250 microg i.v. bolus); serum DHEAS was determined at 08:00 h. Basal serum F at 08:00 h, 16:00 h and 23:00 h and serum DHEAS levels were similar in both groups; however F: DHEAS ratio at 08:00 h was higher in the frail, compared to the successful group (mean +/- SD: 0.55 +/- 0.53 and 0.35 +/- 0.41, respectively; p = 0.04). In response to DST, F suppression was less effective in frail elderly after either 0.25 or 1.0 mg doses (9.0 +/- 6.0 and 2.0 +/- 0.9 microg/dl), as compared to the successful group (5.8 +/- 4.4 and 1.5 +/- 0.5 microg/dl) (p = 0.01). In addition, a significant correlation was observed between post-DEX F levels (both doses) and parameters of cognitive and physical frailty. Normal and similar F levels were observed after ACTH stimulation in both groups. Our data suggest a deficient feedback regulation of the HPA axis in frail institutionalized elderly, as demonstrated by a higher set point for F suppression. This augmented HPA tonus enforces the hypothesis that even milder F excess may be related to characteristics of frailty in the elderly.
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Affiliation(s)
- N Carvalhaes-Neto
- Division of Geriatrics, Department of Medicine Federal University of São Paulo, Brazil.
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24
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Abstract
The increased cortisol secretion that occurs with aging is associated with characteristics of frailty. In this study we investigated whether healthy elderly women excrete increased amounts of urinary free cortisol (UFC) when compared to younger women. Twenty-four-hour UFC levels were measured in 25 elderly (70 to 87 years of age; median: 74) and 24 younger (19 to 59 years of age; median: 46) community-living women. All subjects were healthy and cognition was unimpaired. No differences in 24-hr UFC were observed between elderly and younger women (54.2 +/- 28.0 and 45.1 +/- 15.6 micrograms/24 hr, respectively) and no correlation was found between 24-hr UFC and age. Also, elderly and younger women had similar 24-hr urinary volumes (1366 +/- 531 and 1514 +/- 412 ml 24 hr, respectively) that did not correlate with UFC. In conclusion, older and younger healthy women have similar 24-hr UFC levels, possibly reflecting a comparable adrenocortical secretion of cortisol.
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Affiliation(s)
- Nelson Carvalhaes-Neto
- Division of Geriatrics, Department of Medicine, Universidade Federal de São Paulo, Rua dos Ottonis 731, Vila Clementino, 04025-002 São Paulo, SP, Brazil.
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Ramos LR, Simoes EJ, Albert MS. Dependence in activities of daily living and cognitive impairment strongly predicted mortality in older urban residents in Brazil: a 2-year follow-up. J Am Geriatr Soc 2001; 49:1168-75. [PMID: 11559375 DOI: 10.1046/j.1532-5415.2001.49233.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To identify a set of predictors of mortality among residents in the community, before any physical, biochemical, or image examination is performed, that could be collected on a routine standardized basis, to help the clinician define a patient follow-up strategy and the health planner make decisions regarding the care of older people. DESIGN A household follow-up study, with an evaluation at baseline and 2 years later. SETTING Residential area, with a low rate of in- and outmigration, in Sao Paulo, a large industrialized urban center in southeastern Brazil. PARTICIPANTS One thousand six hundred sixty-seven older urban residents in the community (65+), from different socioeconomic backgrounds, enrolled after a study area census. INTERVENTION Structured home interview with Brazilian Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire, previously validated in Portuguese. MEASUREMENTS A logistic regression model for the risk of dying in the period was developed, having as independent variables, sociodemographic characteristics plus six other dimensions: subjective self-evaluation of health, past medical history, use of health services, dependence in activities of daily living (ADLs), mental health, and cognitive status. RESULTS There were 146 deaths (9%) in the cohort during the follow-up interval. The variables that appeared as independent predictors of death in the final logistic regression model were: gender (relative risk (RR) = 2.8 (males)), age (RR = 2.0 (80+ vs. 65-69)), hospitalization in the previous 6 months (RR = 2.4 (at least one)), dependence in ADLs (RR = 3.0 (assistance required for 7 vs. 0 ADLs)); and cognitive impairment (RR = 1.9 (Mini-Mental State Examination 18 vs. 30)). CONCLUSION These findings suggest that in developing countries such as Brazil, an assessment of dependence in daily living and cognitive status should be an essential part of any health evaluation of an older person, not only because these variables represent potentially high independent mortality risks, but also because they can be easily and reliably assessed, using well-validated instruments, and may be susceptible to intervention.
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Affiliation(s)
- L R Ramos
- Center for the Study of Aging, Geriatric Division, Federal University of Sao Paulo, Brazil
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Bertolucci PH, Okamoto IH, Brucki SM, Siviero MO, Toniolo Neto J, Ramos LR. Applicability of the CERAD neuropsychological battery to Brazilian elderly. Arq Neuropsiquiatr 2001; 59:532-6. [PMID: 11588630 DOI: 10.1590/s0004-282x2001000400009] [Citation(s) in RCA: 166] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There is a limited choice of psychometric tests for Portuguese speaking people which have been evaluated in well defined groups. A Portuguese version of CERAD neuropsychological battery was applied to a control group of healthy elderly (CG) (mean age 75.1 years/ education 7.9 years), 31 Alzheimer disease (AD) patients classified by clinical dementia rating (CDR) as CDR1 (71.4/ 9.0) and 12 AD patients CDR 2 (74.1/ 9.3). Cut-off points were: verbal fluency-11; modified Boston naming-12; Mini-mental State Examination (MMSE) -26; word list memory-13; constructional praxis-9; word recall-3, word recognition-7; praxis recall-4. There was a significant difference between CG and AD-CDR1 (p<0.0001) for all tests. There was a less significant difference for constructional praxis and no difference for Boston naming. Comparison between AD-CDR1 and AD-CDR2 showed difference only for MMSE, verbal fluency, and Boston naming. The performance of CG was similar to that of a US control sample with comparable education level. These results indicate that this adaptation may be useful for the diagnosis of mild dementia but further studies are needed to define cut-offs for illiterates/low education people.
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Affiliation(s)
- P H Bertolucci
- Setor de Neurologia do Comportamento, Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
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Abstract
OBJECTIVE To investigate the glomerular and proximal tubular renal function and the prevalence of urinary abnormalities in the elderly. DESIGN Cross-sectional study. SETTING General community in the city of São Paulo. PARTICIPANTS A population-based sample of 200 elderly subjects was randomly selected. Of these, 81 subjects (45 females and 36 males; mean +/- SD age: 73.7 +/- 6 years) accepted to undergo laboratory examination and were included in the study. MAIN OUTCOME MEASURES 24-h creatinine clearance (CCr), microalbuminuria, urinary retinol-binding protein (urRBP), leukocyturia, hematuria and total proteinuria. RESULTS CCr was lower than 80 ml/min/1.73 m2 in 68% of the subjects. The median (range) CCr was 65 ml/min/1.73 m2 (21-112) in males and 77 ml/min/1.73 m2 (27-107) in females (p = 0.14). No individual had serum creatinine greater than 1.5 mg/dl. urRBP determination was normal in 79 of 81 subjects. The prevalence of microalbuminuria (> 20 micrograms/ml) was 31% (n = 25, 19 men and 6 women). These individuals presented higher mean systolic blood pressure (147 +/- 20 vs. 135 +/- 22 mmHg, p = 0.02) and mean serum creatinine (1.13 +/- 0.20 vs. 0.96 +/- 0.20 mg/dl, p < 0.01) than those without microalbuminuria. The prevalence of leukocyturia (> 10,000/mm3), hematuria (> 10,000/mm3) and total proteinuria (> or = 0.3 mg/dl) was 19%, 28% and 5% in males and 33%, 27% and 4% in females. CONCLUSIONS Glomerular dysfunction and urinary abnormalities are frequent features in the elderly, however, proximal tubular dysfunction is uncommon in this population.
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Affiliation(s)
- P F Abreu
- Division of Nephrology, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
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Abstract
INTRODUCTION The population of Brazil is ageing very rapidly, and the care of the elderly is an emerging priority. Up to this date, there is no comprehensive study addressing the profile of the elderly in Northeastern Brazil. The objective is to compile the multidimensional profile of the elderly residents in a metropolitan area of Northeastern Brazil. METHODS Six hundred sixty-seven elderly (60 years and over), residents in the city of Fortaleza, Ceará, Brazil, constituting a multistage random sample stratified by socioeconomic status. The data was gathered by household survey using a multidimensional functional assessment questionnaire. RESULTS The majority of the elderly were living in multigenerational households (75,3%). More than half (51,9%) lived without the spouse; 92,4% mentioned at least one disease; 26,4% were considered psychiatric cases; 47,7% showed loss of autonomy; 6,6% were hospitalized, and 61,4% used health services within the twelve and six months preceding the interview, respectively. The prevalence of multigenerational households, loss of autonomy and psychiatric morbidity were higher in the poorest areas. CONCLUSIONS The elderly population in the city of Fortaleza lives mainly in multigenerational households, with physical and mental morbidity rates particularly high in poor areas, they represent special concern in terms of burden for the social and health services in the next decades
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Affiliation(s)
- J M Coelho Filho
- Departamento de Medicina Clínica da Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil.
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Abstract
INTRODUCTION Transmission of American trypanossomiasis by transfusion has been reduced by expansion of control measures of blood quality in Brazil. A research project was, therefore, undertaken to evaluate soropositivity for Trypanosoma cruzi infection on blood donors and to compare this rate with those found in 1958 and 1975 in blood banks. METHOD A transversal study was carried out on blood donors in Londrina, Paraná, Brazil. ELISA and Immunofluorescence were the serological test techniques used in the diagnosis of Trypanosoma cruzi infection. RESULTS AND CONCLUSION A serumprevalence rate of 1.3% was found with a tendency for positive serum findings for Trypanosoma cruzi infection on blood donors to decrease over Aime (1958, 1975, and 1995).
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Affiliation(s)
- A M Bonametti
- Centro de Ciências de Saúde da Universidade Estadual de Londrina, PR, Brasil.
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Bonametti AM, Castelo Filho A, Ramos LR, Camargo ED, Nakamura PM, Baldy JL, Matsuo T. Seroprevalence of Trypanosoma cruzi infection in students at the seven-fourteen age range, Londrina, PR, Brazil, in 1995. Mem Inst Oswaldo Cruz 1998; 93:727-32. [PMID: 9921291 DOI: 10.1590/s0074-02761998000600004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Seropositivity for Chagas disease was evaluated in 834 children aged between 7 and 14 from the Municipal Teaching System in the district of Londrina, State of Paraná. A seroprevalence rate of 0.1% was found through the use of an indirect immunofluorescent test and an enzyme-linked immunosorbent assay. This low rate of seroprevalence provides evidence that the vectorial transmission of Chagas disease has been eliminated in Londrina. The main reason for the elimination of vectorial transmission of Trypanosoma cruzi infection, as evaluated by serological tests, may be a remarkable change in the economic structure of the northern region of Paraná in the 1960's. At that time coffee production was almost completely replaced by soy beans, wheat and grazing in the rural areas. This change deeply affected the rural ecology and caused an exodus of the population from rural to urban areas as well as a decrease in the total number of the population of that region. The measures introduced for controlling the disease through the Program of Chagas Disease Control established by the Fundação Nacional de Saúde of the Brazilian Ministry of Health, certainly, had a positive impact on the reduction of American trypanosomiasis prevalence in the area under study. However, it does not seem that this was the most relevant factor responsible for the elimination of vectorial transmission of Chagas disease in Londrina.
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Affiliation(s)
- A M Bonametti
- Centro de Ciências da Saúde, Universidade Estadual de Londrina, PR, Brasil.
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Ramos LR, Toniolo J, Cendoroglo MS, Garcia JT, Najas MS, Perracini M, Paola CR, Santos FC, Bilton T, Ebel SJ, Macedo MB, Almada CM, Nasri F, Miranda RD, Gonçalves M, Santos AL, Fraietta R, Vivacqua I, Alves ML, Tudisco ES. Two-year follow-up study of elderly residents in S. Paulo, Brazil: methodology and preliminary results. Rev Saude Publica 1998; 32:397-407. [PMID: 10030055 DOI: 10.1590/s0034-89101998000500001] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Previous cross-sectional studies have shown a high prevalence of chronic disease and disability among the elderly. Given Brazil's rapid aging process and the obvious consequences of the growing number of old people with chronic diseases and associated disabilities for the provision of health services, a need was felt for a study that would overcome the limitations of cross-sectional data and shed some light on the main factors determining whether a person will live longer and free of disabling diseases, the so-called successful aging. The methodology of the first follow-up study of elderly residents in Brazil is presented. METHOD The profile of the initial cohort is compared with previous cross-sectional data and an in-depth analysis of nonresponse is carried out in order to assess the validity of future longitudinal analysis. The EPIDOSO ('Epidemiologia do Idoso') Study conducted a two-year follow-up of 1,667 elderly people (65+), living in S. Paulo. The study consisted of two waves, each consisting of household, clinical, and biochemical surveys. RESULTS AND CONCLUSIONS In general, the initial cohort showed a similar profile to previous cross-sectional samples in S. Paulo. There was a majority of women, mostly widows, living in multigenerational households, and a high prevalence of chronic illnesses, psychiatric disturbances, and physical disabilities. Despite all the difficulties inherent in follow-up studies, there was a fairly low rate of nonresponse to the household survey after two years, which did not actually affect the representation of the cohort at the final household assessment, making unbiased longitudinal analysis possible. Concerning the clinical and blood sampling surveys, the respondents tended to be younger and less disabled than the nonrespondents, limiting the use of the clinical and laboratory data to longitudinal analysis aimed at a healthier cohort. It is worth mentioning that gender, education, family support, and socioeconomic status were not important determinants of nonresponse, as is often the case.
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Affiliation(s)
- L R Ramos
- Centro de Estudos do Envelhecimento, Universidade Federal de São Paulo, Brasil.
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Taddei CF, Ramos LR, de Moraes JC, Wajngarten M, Libberman A, Santos SC, Savioli F, Dioguardi G, Franken R. [Multicenter study of elderly patients assisted at outpatient cardiology and geriatrics clinics in Brazilian institutions]. Arq Bras Cardiol 1997; 69:327-33. [PMID: 9609000 DOI: 10.1590/s0066-782x1997001100007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate epidemiological, clinical and therapeutic aspects of elderly patients with cardiovascular disease in Brazil. METHODS Elderly patients with cardiovascular disease treated in 36 centers of cardiology and geriatrics were investigated through a questionnaire applied to those who had an appointment during the analyzed period. RESULTS 2196 elderly patients ranging from 65 to 96 years of age were analyzed, 60% of which were females. The main risk factors were: sedentarism (74%); high blood pressure (53%), high LDL-cholesterol (33%), high total cholesterol (30%), obesity (30%), low HDL-cholesterol (15%), diabetes (13%) and smoking (6%). A higher prevalence of females existed among those with > or = 3 risk factors. The main reason for the medical appointment was high blood pressure (48%). Stress test and coronariography were requested more often in males. The most common diagnoses were hypertension (67%), and coronary disease (29%). The most often used medications were diuretics (42%). CONCLUSION There was high prevalence of risk factors (93%), mainly in females; sedentarism was the most common risk factor and prevalence increased with age; hypertension was the most common reason for a medical appointment. Diuretics were the most used drugs; congestive heart failure was the main disease associated to hospitalization (31%) and emergencies (10%).
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Affiliation(s)
- C F Taddei
- Instituto Dante Pazzanese de Cardiologia, São Paulo
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Dioguardi GS, Pimenta J, Knoplich J, Ghorayeb N, Ramos LR, Giannini SD. [Risk factors for cardiovascular diseases in physicians. Preliminary data from the VIDAM Project of the Paulista Medical Association]. Arq Bras Cardiol 1994; 62:383-8. [PMID: 7826227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To evaluate the frequency and other characteristics of some cardiovascular risk factors among physicians of São Paulo State, Brazil. METHODS From a questionnaire, 1395 voluntary physicians answered questions about personal and familial cardiovascular disease and risk factors, and blood pressure, serum total cholesterol, glucose, height and weight were recorded. RESULTS The frequency of familial history of ischemic heart disease was 24.4%; positive personal antecedent of hypercholesterolemia, 12.4%; serum total cholesterol > or = 240 mg/dl, 14.3%; positive personal antecedent of hypertension, 8.4%; systolic blood pressure > or = 140 mmHg or diastolic > or = 90 mmHg, 23.8%; current cigarette smokers, 17.4%; prior cigarette smokers, 19.1%; positive personal antecedent of diabetes, 0.8%; serum glucose > 120 mg%, 7.7%; sedentarism, 37%, and obesity, 17.2%. CONCLUSION Cigarette smoking was the only risk factor that was taken in account with emphasis by the physicians of São Paulo State in order to prevent themselves from cardiovascular disease.
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Affiliation(s)
- G S Dioguardi
- Instituto Dante Pazzanese de Cardiologia, Hospital do Servidor Público Estadual, São Paulo
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Najas MS, Andreazza R, de Souza AL, Sachs A, Guedes AC, Sampaio LR, Ramos LR, Tudisco ES. [Eating patterns among the elderly of different socioeconomic groups living in a urban area of southeastern Brazil]. Rev Saude Publica 1994; 28:187-91. [PMID: 7747076 DOI: 10.1590/s0034-89101994000300004] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Two hundred and eight three male and female elderly subjects were studied. They participated in the Multicentric project: "Health assessment of elderly people living in the urban area of S. Paulo", Brazil, and were stratified by socio-economic level in three areas of S. Paulo city. The food frequency questionnaire was applied in order to discover their food pattern. The results show that for the energy-producing foods more than 90% of the total sample eat tubers, rice, bread and pasta; however, only the rice and bread are consumed daily. As for protein, 70% or more of the elderly people eat beans, beef, poultry, milk and eggs but for the daily consumption there are differences between the 3 regions. More than 85% of the subjects eat fruits, leafy and other vegetables; nevertheless, the frequency of their daily consumption is bigger in the wealthier area. The dietetic information shows that the group analysed has the same food pattern as other population groups as far the energy-producing foods are concerned; there are, however, some difference as regards the protein foods and fruit and vegetables.
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Affiliation(s)
- M S Najas
- Departamento de Medicina Preventiva da Escola Paulista de Medicina, São Paulo, Brasil
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Abstract
The oral health status of people aged 60 years or over in S. Paulo in 1989 is discussed. According to data relating to dental caries, periodontal diseases, need and use of prosthesis and prevalence of hard and soft oral tissue pathologies, this study concludes that elder people present a very bad oral health status. The definition of a policy and dental care programs addressed to the aged are recommended.
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Affiliation(s)
- A G Rosa
- Departamento de Prática de Saúde Pública da Faculdade de Saúde Pública da Universidade de São Paulo, Brasil
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Abstract
As a part of a survey to study the health and living conditions of the elderly population, a random sample of residents aged 65 and over are examined using the Clinical Interview Schedule (CIS) in order to evaluate their psychiatric status. The aim of this study is to evaluate this standard method of assessment as a case-identification instrument in our country. The schedule was completed by 91 subjects. It is easily administered, easily scored, and economical on time. Its completion rate is high. The weighted total scores (WTS) range from 0 to 48. Using the case criteria defined by Cooper & Schwarz (1982), 27 subjects (30%) are considered cases and 64 (70%) are regarded as non-cases. The sensitivity coefficients for the WTS are examined against the overall severity rating at different cut-off points. The optimum cut-off can be anywhere between 16 and 20 points. The WTS has higher validity coefficients to detect the following diagnostic categories (sensitivity, specificity): normals (100%,-); personality (100%, 92%) and affective disorders (100%, 75%). In general the CIS items are given low ratings. Psychotic symptoms are rarely found in this sample. One main problem arose: the item depersonalization is misunderstood by some patients probably because of interpreting it as an upsetting memory disturbance.
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Affiliation(s)
- S L Blay
- Department of Psychiatry, Escola Paulista de Medicina, São Paulo, Brazil
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Rego RA, Berardo FA, Rodrigues SS, Oliveira ZM, Oliverira MB, Vasconcellos C, Aventurato LV, Moncau JE, Ramos LR. [Risk factors for chronic non-communicable diseases: a domiciliary survey in the municipality of São Paulo, SP (Brazil). Methodology and preliminary results]. Rev Saude Publica 1990; 24:277-85. [PMID: 2103645 DOI: 10.1590/s0034-89101990000400005] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The non-communicable chronic diseases are important causes of death in Brazil, mainly in the great urban centres. There are various risk factors related to these diseases, whose remotion or attenuation would contribute to a fall in mortality. The methodology of the first comprehensive multicenter study into risk factors of non-communicable chronic diseases carried out in Latin America is explained. In Brazil, this study was carried out in the cities of S. Paulo, SP and Porto Alegre, RS. Preliminary results from the city of S. Paulo as to the prevalence of arterial hypertension (22.3%), tabagism (37.9%), obesity (18.0%), alcoholism (7.7%) and sedentarism (69.3%) are presented. These results are compared with existing data from Brazil and other countries, and the relationship between various risk factors and the mortality from cardiovascular diseases in S. Paulo and some developed countries is discussed.
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Affiliation(s)
- R A Rego
- Secão de Moléstias Degenerativas do Instituto de Saúde, SUDS/SP, Brasil
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Ramos LR, Goihman S. Geographical stratification by socio-economic status: methodology from a household survey with elderly people in S. Paulo, Brazil. Rev Saude Publica 1989; 23:478-92. [PMID: 2641840 DOI: 10.1590/s0034-89101989000600006] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Considering that in most developing countries there are still no comprehensive lists of addresses for a given geographical area, there has always been a problem in drawing samples from the community, ensuring randomisation in the selection of the subjects. This article discusses the geographical stratification by socio-economic status used to draw a multistage random sample from a community-based elderly population living in a city like S. Paulo-Brazil. Particular attention is given to the fact that the proportion of elderly people in the total population of a certain area appeared to be a good discriminatory variable for such stratification. The validity of the stratification method is analysed in the light of the socio-economic results obtained in the survey.
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Abstract
A reduced version of the Face-Hand Test (FHT), the FHT-R, was applied to a random sample of 91 elderly subjects living in the community (S. Paulo-Brazil), to study the instrument's ability to detect Organic Brain Syndrome (OBS). The scores of the FHT-R test were then compared with a psychiatric assessment using the Clinical Interview Schedule. Five persons were regarded as OBS "cases" and 86 as OBS "non cases". At the cut-off point 0/1 the validity coefficients were as follows: Sensitivity 60%, Specificity 94%, Positive Predictive Value 38%, Negative Predictive Value 98% and Overall Misclassification Rate 8%. The usefulness of this clinical test to screen for OBS in epidemiological surveys is discussed.
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Abstract
A validity study of the Brazilian version of the 15-item Short Psychiatric Evaluation Schedule (SPES), included in the mental health assessment of Older Americans Resources and Services (OARS), designed to detect psychiatric disorders in the elderly, against the "caseness" criterion suggested by Cooper and Schwarz was carried out with a community sample, as part of a survey to study health and living conditions of the elderly in a large urban center of a developing country, São Paulo, Brazil. The screening questionnaire was completed by 292 subjects, and 91 were selected for the psychiatric interview. The validity coefficients were as follows: sensitivity 61%, specificity 89%, positive predictive value 66%, negative predictive value 87% and misclassification rate 18%. A discriminant analysis using a stepwise procedure was then applied to select the best item discriminators of the screening questionnaire. The best set of discrimination comprised six items leading to the following validity coefficients: sensitivity 82%, specificity 77%, positive predictive value 58%, negative predictive value 92% and misclassification rate 21%. The possible factors related to false positive and false negative responses on the screening are discussed.
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Affiliation(s)
- S L Blay
- Departamento de Psiquiatria e Psicologia Médica da Escola Paulista de Medicina, São Paulo, Brazil
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Ward LS, Zanella MT, Menabó E, Ramos LR, Castelo Filho A, Russo EM, Vieira JG, Maciel RM. [Estimation of the cost benefit relation of a program of early detection of congenital hypothyroidism]. AMB Rev Assoc Med Bras 1988; 34:106-10. [PMID: 3149786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
O envelhecimento populacional é hoje um fenômeno universal, característico tanto dos países desenvolvidos como, de modo crescente, do Terceiro Mundo. São apresentados dados que ilustram a verdadeira revolução demográfica desde o início do século e estimativas até o ano 2025. Os fatores responsáveis pelo envelhecimento são discutidos, com especial referência ao declínio tanto das taxas de fecundidade como das de mortalidade. Em conjunto, tais declínios levam a um menor ingresso de jovens em populações que passam a viver períodos mais longos. Esse processo gradativo é conhecido como "transição epidemiológica" e seus vários estágios são abordados. As repercussões para a sociedade, de populações progressivamente mais idosas são consideráveis, particularmente no que diz respeito à saúde. Os padrões de mortalidade e morbidade são discutidos e o conceito de autonomia, como uma forma de quantificar qualidade de vida, é introduzido. É proposta redefinição do próprio conceito de envelhecimento, refletindo a realidade médico-social do Terceiro Mundo. São formuladas questões sobre a interação envelhecimento-mudanças sociais em curso nos países subdesenvolvidos, cujas respostas podem ser grandemente facilitadas pelo uso do método epidemiológico.
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Abstract
São apresentados dados mostrando que tanto as taxas de mortalidade quanto as de fecundidade estão decaindo significativamente para a população brasileira, como um todo, desde 1940 e 1960, respectivamente. Pirâmides etárias por sexo são analisadas à luz das mudanças demográficas. Enfatiza-se o fato de que, desde 1940, é o grupo etário com 60 anos ou mais o que proporcionalmente mais cresce na população brasileira. De 1980 ao ano 2000 eles crescerão 107%, enquanto os menores de 15 anos crescerão apenas 14%. Comparando-se as taxas de crescimento dos idosos no Brasil e na Inglaterra, a tendência é haver um crescimento cada vez menor na Inglaterra (230% entre 1900-1960 e 80% entre 1960-2025) e um crescimento cada vez maior no Brasil (497% e 917% respectivamente). Os dados mostram que a expectativa de vida ao nascimento no Estado de São Paulo passou de 57 anos, em 1950, para 70 anos, em 1982. Já em 1982, uma mulher no Município de São Paulo podia aos 45 anos esperar viver mais do que uma mulher da mesma idade na Inglaterra. Em termos de sobrevida, 77% da coorte de mulheres nascidas no Município de São Paulo, em 1982 deverão estar vivas aos 65 anos, comparado com 85% na Inglaterra. Para os homens os dados são de 62% e 75%, respectivamente. Conclui-se que o Brasil, embora ainda longe de resolver os problemas relacionados à infância, já está tendo que enfrentar as implicações sociais e de saúde decorrentes de um processo de envelhecimento comparável àquele experimentado pelos países mais desenvolvidos.
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Abstract
São discutidas as transformações sociais e econômicas que incidem sobre a vida dos idosos decorrentes do aumento da população de 60 anos ou mais, no Brasil. O processo migratório e a intensa urbanização (em 1940 a população rural era de 68,8% e em 1980 de 32,4%) afetaram particularmente a população idosa dos grandes centros, ou daqueles que envelheceram nestas cidades. Esta nova organização social acentuou os problemas de solidão e pobreza dos idosos. Além desta perda de status social que exclui sua participação na sociedade moderna, o idoso teve também reduzido o suporte emocional no interior de sua família. Entre os fatores que concorrem para tal, destacam-se a mudança do padrão do modelo familiar, de extensa para nuclear, a maior mobilidade e o aumento do número de separações e divórcios. O maior período de vida da mulher e suas conseqüências (redução de renda, aumento do número de viúvas e maior freqüência de longos períodos de doenças crônicas), como também a mudança do papel social da mulher no mundo contemporâneo, fazem parte de uma discussão específica relativa à mulher e à velhice. A questão do trabalho, da aposentadoria e do custo social (coeficiente de dependência) é outro aspecto abordado.
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van Waes PF, Feldberg MA, Mali WP, Ruijs SH, Eenhoorn PC, Buijs PH, Kruis FJ, Ramos LR. Management of loculated abscesses that are difficult to drain: a new approach. Radiology 1983; 147:57-63. [PMID: 6828759 DOI: 10.1148/radiology.147.1.6828759] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Fourteen critically ill patients underwent percutaneous drainage of abdominal abscesses. All 14 had one or more relative contraindications to external drainage procedure: (a) multiloculated abscesses; (b) multiple abscesses; (c) abscesses that form fistulae to surrounding organs; (d) abscesses containing viscous fluid, debris, or necrotic material. A total of 32 cavities was drained, usually using a multiple trocar/catheter system. Biplane computed tomography demonstrated a safe drainage route in all patients. In those patients in whom the contents of the abscess were too viscous to permit drainage, the contents were liquefied with acetylcysteine. Nine of the 14 patients (64%) recovered completely following the drainage procedure.
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