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We aimed to synthesise information related to the incidence of depression and depressive symptoms (DDS) in a community-dwelling older adult population at a global level. In this systematic review, we included articles with a cohort study design that evaluated the incidence of depression or depressive symptoms in older adults aged 60 years or more in a community-dwelling environment. Six databases were used: Web of Science, PubMed, Scopus, LILACS, SciELO, and Cochrane, and the entire selection process was independently performed by peers. We divided the included articles into subgroups according to the DDS assessment instrument: (i) Geriatric Depression Scale; (ii) Center for Epidemiologic Studies Depression Scale; (iii) miscellaneous scales; and (iv) diagnostic interviews. Each cumulative incidence value obtained per item was adjusted for a 1-year follow-up period, which generated an annual cumulative incidence (AcI). From 46 articles, 42 used scales to evaluate the depressive variable, with an AcI estimate of around 4.5%. The articles that assessed depression categorically observed a variation in AcI between 0.2% and 7.0%. Among all the materials included, the group that used the Geriatric Depression Scale observed the lowest and the highest AcI, 1.3% and 26.6% respectively. Most of the productions were from countries in the Asian continent (52.2%), followed by Europe (30.4%), the Americas (13%), and Oceania (4.4%). Despite the variation of AcI, we found a frequent occurrence of DDS in older adults in the community-dwelling environment, which highlights the need for preventive actions and better-targeted early care, especially in terms of primary health care.
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Depressão , Vida Independente , Idoso , Humanos , Depressão/diagnóstico , Depressão/epidemiologia , Incidência , Meio SocialRESUMO
Breast cancer treatment leads to physical and psychological changes. The aim of this study was to analyze the incidence of sexual dysfunction and its risk factors in women diagnosed with breast cancer. This retrospective cohort study included women diagnosed and treated for breast cancer (exposed group, n = 90) and healthy women (non-exposed group, n = 93). Data were collected from February 2019 to October 2021 in the state of Rio Grande do Norte (Northeast Brazil), from medical records and using the Female Sexual Function Index (FSFI) questionnaire. Data were collected from medical records and using the Female Sexual Function Index (FSFI) questionnaire. Primary outcomes were analyzed using binary logistic regression. The Mann-Whitney test was used to analyze FSFI domains between groups. The exposed group had a 74% incidence of sexual dysfunction and 3.9 times increased chances of having sexual dysfunction compared with the non-exposed group (OR 3.9, CI 1.8 to 8.2, p < 0.001). Presence of comorbidities increased the chances of sexual dysfunction by 2.5 times (OR 2.5, CI 1.2 to 4.9, p = 0.009). Women diagnosed and treated for breast cancer had a higher incidence of sexual dysfunction than healthy women. Furthermore, comorbidities also increased the chances of sexual dysfunction regardless of exposure to breast cancer.
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Neoplasias da Mama , Disfunções Sexuais Fisiológicas , Disfunções Sexuais Psicogênicas , Feminino , Humanos , Neoplasias da Mama/complicações , Neoplasias da Mama/epidemiologia , Estudos Retrospectivos , Estudos Longitudinais , Brasil/epidemiologia , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Inquéritos e Questionários , Disfunções Sexuais Psicogênicas/etiologia , Comportamento SexualRESUMO
OBJECTIVE: The aim of this study was to analyze the bidirectional association between handgrip strength (HGS) and cognitive performance in different cognitive functions in a European population and to evaluate the predictive validity of HGS for the risk of future cognitive impairment in aging individuals. METHODS: This was a prospective cohort study conducted using data on individuals over 50 years of age from the Survey of Health, Aging and Retirement in Europe (SHARE). HGS measures and scores in numeracy, recall, and verbal fluency were repeated and analyzed biannually for 4 years and were used in generalized estimating equations to test the bidirectional association, categorized by sex. RESULTS: Of the 8236 individuals included, 55.73% were women with a mean age of 67.55 (standard deviation [SD] = 8.4) years and 44.27% were men with a mean age of 68.42 (SD = 7.7) years. HGS predicted cognitive decline in both sexes, except for numeracy in men, even after adjustments. The strongest association with HGS in women was in verbal fluency (ß = .094; 95% CI = 0.039 to 0.151), whereas the strongest association with HGS in men was in delayed verbal recall (ß = .095; 95% CI = 0.039 to 0.151). Conversely, the greatest cognitive predictor of HGS decline was verbal fluency in men (ß = .796; 95% CI = 0.464 to 1.128), and in women (ß = .801; 95% CI= 0.567 to 1.109). CONCLUSION: There is a significant and bidirectional association between HGS and different cognitive functions in a European multicentric population. This bidirectional association differed between sexes. IMPACT: Both men and women who presented with cognitive decline also showed early changes in their HGS measures, and vice versa, but there still were differences between the sexes. These findings reinforce that HGS may be a simple and inexpensive method to identify early signs of cognitive decline, and that studies and rehabilitation strategies should be more sex specific.
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Disfunção Cognitiva , Força da Mão , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Estudos Prospectivos , Envelhecimento , CogniçãoRESUMO
INTRODUCTION: Physical function is considered an important marker of adverse health outcomes. Postmenopausal women seem to have worse physical function, but conflicting results have been reported in the literature. The aim of this systematic review is to assess the association between menopausal status and physical function in community-dwelling women. METHODS: Cross-sectional and/or longitudinal studies which objectively or subjectively assess physical function at different menopausal stages will be included. Studies conducted in institutionalized populations or with any specific medical condition that may have induced menopause (i.e. cancer or degenerative diseases) will be excluded. This systematic review protocol follows the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The searches will be carried out in the Pubmed, Embase, SciELO (Scientific Electronic Library Online), LILACS (Latin American and Caribbean Literature on Health Sciences), VHL (Virtual Health Library), Scopus and Web of Science databases, using the search equation "Menopause AND (Physical Performance OR Function)". The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies will be considered to assess the methodological quality of the included studies. The selection and evaluation of the methodological quality of the studies will be carried out by independent researchers and the discrepancies will be resolved by a separate researcher. ETHICS AND DISCLOSURE: Ethical approval is not required as this is a study using secondary data. The results will be published in a scientific journal. We intend to contribute to the expansion of knowledge regarding physical function of women according to the menopause status, thus helping in the perspective of improving health and functioning. This systematic review started in January 2022 and all steps are expected to be finished by October 2022. PROSPERO REGISTRATION NUMBER: CRD42021289899.
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Menopausa , Projetos de Pesquisa , Humanos , Feminino , Estudos Transversais , Revisões Sistemáticas como Assunto , Metanálise como AssuntoRESUMO
BACKGROUND: Several factors affect sexual function, including cancer development and treatment. This study summarized the risk of women with cancer of developing sexual dysfunctions. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched the EMBASE, PubMed, LILACS, SciELO, CINAHL, Scopus, and Web of Science databases using the descriptors cancer, neoplasms, sexual dysfunction, sexual function, and women. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies assessed the quality of studies. RESULTS: Sixteen studies were included in this review. Women with cancer presented sexual dysfunctions in 14 out of 16 included studies. The incidence of sexual dysfunctions ranged from 30% to 80%, while the risk of developing sexual dysfunction increased 2.7- and 3.5-fold in women with cervical and breast cancer, respectively. CONCLUSION: Different cancer treatments increase the risk of developing sexual dysfunction in women, especially desire, arousal, and orgasm, leading to biopsychosocial changes in the health of this population.
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Neoplasias da Mama , Disfunções Sexuais Fisiológicas , Disfunções Sexuais Psicogênicas , Neoplasias da Mama/complicações , Neoplasias da Mama/epidemiologia , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/epidemiologia , Disfunções Sexuais Psicogênicas/etiologia , Disfunções Sexuais Psicogênicas/terapiaRESUMO
Objective: To analyze the prevalence of access to prenatal care in the first trimester of pregnancy among black women compared to other races/ethnicities through a systematic review and meta-analysis. Methods: Searches were carried out at PUBMED, LILACS, Web of Science, Scopus, CINAHL, and in the grey literature. The quality of the studies and the risk of bias were analyzed using the Joanna Briggs Critical Appraisal Checklist for Analytical Cross-Sectional Studies instrument. The extracted data were tabulatesd and analyzed qualitatively and quantitatively through meta-analysis. Results: Black women had the lowest prevalence of access to prenatal services in the first trimester, with prevalence ranging from 8.1% to 74.81%, while among white women it varied from 44.9 to 94.0%; 60.7% of black women started prenatal care in the first trimester, while 72.9% of white women did so. Conclusion: Black women compared to other racial groups had lower prevalence of access to prenatal care, with less chance of access in the first trimester, and it can be inferred that the issue of race/skin color is an important determinant in obtaining obstetric care. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020159968_, PROSPERO CRD42020159968.
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Objective: To identify the frequency of vitamin A deficiency in children aged 6 months to 5 years hospitalized for pneumonia. Methods: An integrative literature review was carried out, where searches were made by two independent researchers, with no language limits or publication time in the databases PubMed, LILACS, Web of Science, Scopus and CINAHL, and in the gray literature-OpenGrey, Proquest and Google Scholar. In the eligibility phase, the screened studies were read in full and those that did not answer the research question were excluded. Methodological quality was assessed using the Downs & Black (1998) checklist. Results: 1642 articles were identified, after all stages of screening and selection, 10 studies were included, of which 5 were longitudinal, 4 were intervention and 1 transversal. All studies identified subclinical vitamin A deficiency in children hospitalized with pneumonia; the highest frequency of subclinical vitamin A deficiency was 93.2%. All studies evaluated showed frequencies of subclinical vitamin A deficiency >20%. Conclusion: There is a high frequency of subclinical vitamin A deficiency in children with pneumonia; these data need to be further explored in terms of their associations. For this reason, new studies that evaluate this topic are of fundamental importance.
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BACKGROUND AND PURPOSE: Mobility is a basic human need, and its limitation compromises health status, especially in older adults from developing countries and residing in nursing homes. This study aims to determine the prevalence and factors associated with mobility limitation in older adults residing in nursing homes. METHODS: A cross-sectional study was conducted with 305 older adults (≥60 years) residing in 10 nursing homes in Northeast Brazil. Mobility limitation was evaluated using the "walking" item of the Barthel index. Sociodemographic/economic data concerning the participants and institutions, as well as conditions that could influence the mobility state of the older adults, were collected. The χ2 test and multiple logistic regression were performed using a significance level of 5%. RESULTS AND DISCUSSION: The prevalence of mobility limitation was 65.6% (95% confidence interval [CI], 59.6-70.4). Walking dependence was identified in 39.7% of the sample (26.9% wheelchair users and 12.8% bedridden), while 25.9% walked with assistance (16.7% with maximal assistance and 9.2% with minimal assistance). Mobility limitation was significantly associated with malnutrition/risk of malnutrition (1.86, 95% CI, 1.54-2.26, P < .001) and age ≥81 years (1.35, 95% CI, 1.12-1.63, P = .002). CONCLUSION: Mobility limitation has a high prevalence among older adults residing in nursing homes in Brazil, and is associated with advanced age and poor nutritional status. Health professionals should advocate for the maintenance of mobility and adequate nutritional support.
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Desnutrição , Limitação da Mobilidade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Humanos , Desnutrição/epidemiologia , Casas de Saúde , Estado NutricionalRESUMO
RESUMO O objetivo do estudo foi analisar o cumprimento do uso de, no mínimo, 30% dos recursos do Programa Nacional de Alimentação Escolar (PNAE) para a aquisição dos gêneros alimentícios provenientes da agricultura familiar no Brasil, no período de 2013 a 2016. Trata-se de uma pesquisa com delineamento ecológico e longitudinal. A coleta de dados foi realizada por meio de dados públicos disponibilizados no Fundo Nacional de Desenvolvimento da Educação (FNDE). Construíram-se mapas temáticos e de correlação espacial para análise da distribuição espacial da compra e realizou-se análise de tendência. Verificou-se que o percentual de municípios que cumprem com a exigência legal de compra passou de 34,3% em 2013 para 43,7% em 2016, com maior número de municípios no Sul com 72,5%, enquanto apenas 26,1% no Centro-Oeste, 27,4% no Norte e 31,6% no Nordeste. A região Sul se destaca quando comparada às regiões Norte, Nordeste e Centro-Oeste (p=<0,001). Já a análise de tendência dos recursos orçamentários anuais da união mostrou um crescimento médio de 30,8% (IC = 13,2-51,1), porém com declínio entre 2015 e 2016. Conclui-se que houve um aumento progressivo na compra direta de alimentos da agricultura familiar para alimentação escolar no Brasil de 2013 a 2016, embora de maneira desigual nas diferentes regiões do País.
ABSTRACT The study aims to analyze the fulfillment of the use of at least 30% of the National School Feeding Program (PNAE) resources for the acquisition of food from family agriculture in Brazil, from 2013 to 2016. This is a longitudinal ecological research. Data was collected through public data available at the National Education Development Fund (FNDE). Thematic and spatial correlation maps were constructed for analysis of the spatial distribution of the purchase and trend analysis. It was verified that the percentage of municipalities that comply with the legal purchase requirement increased from 34.3% in 2013 to 43.7% in 2016, with the largest number of municipalities in the Southern region of the country with 72.5%, while only 26.1% in the Midwest, 27.4% in the North and 31.6% in the Northeast. The South region stands out when compared to the North, Northeast and Midwest (p =<0.001). The trend analysis of the union's annual budget resources showed an average growth of 30.8% (CI = 13.2-51.1), but with a decline between 2015 and 2016. It is concluded that there has been a progressive increase in the direct purchase of food from family farms for school feeding in Brazil from 2013 to 2016, although in unequal manner in different regions of the country.
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INTRODUCTION: Faced with the continuous growth in the number of older people at a global level, some concerns are raised about the way people age. Health conditions such as depressive symptoms and depression have a direct or indirect impact on the quality of life of this population segment. The objective of this study is to verify the incidence of the various presentations of the depressive spectrum in the community-dwelling older population, as well as to analyse the predictive factors. METHODS AND ANALYSIS: This systematic review and meta-analysis protocol follows the recommendation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Searches will be conducted in PubMed, Web of Science, Scopus, Latin-American and Caribbean Literature on Health Sciences, Scientific Electronic Library Online and Cochrane databases, as well as grey literature. The search strategy involves terms related to ageing and the depressive spectrum found in observational studies. There will be no language restriction and the material included will be the ones whose publications took place until December 2020. ETHICS AND DISSEMINATION: Formal ethical approval is not required on this research, since it only aims secondary data. After publishing the results in a scientifically supported journal, our findings may be disseminated to fill in the gaps and guide the production of more effective public policies directed at a more adequate care to the older population at a global level. The search process began in January 2021 and it is expected that all stages of the review will be completed by 30 November 2021. PROSPERO REGISTRATION NUMBER: CRD42019121616.
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Depressão , Vida Independente , Idoso , Região do Caribe , Depressão/epidemiologia , Humanos , Incidência , Metanálise como Assunto , Qualidade de Vida , Projetos de Pesquisa , Revisões Sistemáticas como AssuntoRESUMO
Low- and moderate-impact physical activity (PA) is associated with the prevention of urinary incontinence (UI). The objective of the cross-sectional study presented herein is to analyze the factors associated with UI in physically older active women who participate in senior community groups. The variable UI was measured by the International Consultation Incontinence Questionnaire Short Form (ICIQ-SF). Socioeconomic variables were also collected, along with data on life habits and clinical history. The multivariate analysis employed Poisson's Regression with robust variance for factors associated with UI. Of the 106 participants evaluated, 54.7% presented UI, of which stress incontinence was more frequent, with 40.6%. UI presented a statistically significant association with dizziness/loss of balance during Activities of Daily Living (ADL) (prevalence ratio-PR 1.48; 95% CI 1.06-2.07) and nocturia (PR 1.63; 95% CI 1.05-2.55). Despite PA being a protection factor, UI presented an elevated prevalence in the older population, and therefore, other biological, social, and cultural aspects could also contribute to the occurrence of UI in this age group. Moreover, physically active older women with UI presented nocturia and dizziness/loss of balance during ADL, regardless of education levels and the number of births. These findings can help improve multi-professional programs aimed at promoting, preventing, and managing UI in the public.
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Atividades Cotidianas , Incontinência Urinária , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Prevalência , Qualidade de Vida , Inquéritos e Questionários , Incontinência Urinária/epidemiologiaRESUMO
AIMS: To estimate the prevalence of multimorbidity among European community-dwelling adults, as well as to analyse the association with gender, age, education, self-rated health, loneliness, quality of life, size of social network, Body Mass Index (BMI) and disability. METHODS: A cross-sectional study based on wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) was conducted, and community-dwelling participants aged 50+ (n = 63,844) from 17 European countries were selected. Multimorbidity was defined as presenting two or more health conditions. The independent variables were gender, age group, educational level, self-rated health, loneliness, size of network, quality of life, BMI and disability (1+ limitations of basic activities of daily living). Poisson regression models with robust variance were fit for bivariate and multivariate analysis. RESULTS: The prevalence of multimorbidity was 28.2% (confidence interval-CI 95%: 27.5.8-29.0) among men and 34.5% (CI95%: 34.1-35.4) among women. The most common health conditions were cardiometabolic and osteoarticular diseases in both genders, and emotional disorders in younger women. A large variability in the prevalence of multimorbidity in European countries was verified, even between countries of the same region. CONCLUSIONS: Multimorbidity was associated with sociodemographic and physical characteristics, self-rated health, quality of life and loneliness.
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Doenças Ósseas/epidemiologia , Doenças das Cartilagens/epidemiologia , Depressão/epidemiologia , Pessoas com Deficiência/estatística & dados numéricos , Vida Independente/estatística & dados numéricos , Síndrome Metabólica/epidemiologia , Atividades Cotidianas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Pessoas com Deficiência/reabilitação , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Multimorbidade , Prevalência , Qualidade de VidaRESUMO
BACKGROUND: The objective of this work was to analyse the prevalence trends of multimorbidity among European community-dwelling adults. METHODS: A temporal series study based on waves 1, 2, 4, 5, 6 and 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE) was conducted, and community-dwelling participants aged 50+ (n = 274,614) from 15 European countries were selected for the period 2004-2017. Prevalence, adjusted by age, Average Annual Percentage Change (APC) and 95% confidence interval (95% CI) were all calculated. Trend analyses were realised by period, age groups and groups of diseases. RESULTS: The results showed a large variability in the prevalence of multimorbidity in adults aged 50 and over among European countries. Increase in the prevalence of multimorbidity in the countries of central Europe (Austria, Belgium, Czech Republic, France, Germany and Switzerland) and Spain in both sexes, and in the Netherlands among men. Stability was observed in northern and eastern European countries. Musculoskeletal and neurodegenerative groups showed more significant changes in the trend analyses. CONCLUSIONS: This information can be useful for policy makers when planning health promotion and prevention policies addressing modifiable risk factors in health.
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Vida Independente , Multimorbidade , Adulto , Idoso , Áustria , Bélgica , República Tcheca/epidemiologia , Europa (Continente)/epidemiologia , Feminino , França , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Espanha , SuíçaRESUMO
IMPORTANCE: Menopause at younger ages is associated with a greater risk of adverse health outcomes such as osteoporosis, chronic diseases, and death. However, the association with physical function has not been well established. OBJECTIVE: Assess the association between timing of menopause and different measures of physical function. EVIDENCE REVIEW: Searches on the PubMed, Cochrane Library, SciELO, LILACS, and Web of Science databases were conducted. Observational studies on the association between age at menopause and measures of physical function were included, with no restriction for publication date or language. Methodological quality was assessed by the "Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies." FINDINGS: Four cross-sectional studies were included, totaling 13,846 participants. These investigated five measures of physical function: gait speed, grip strength, standing balance, chair stand, and self-reported functional limitations. Poor physical function was associated with premature (<40 y) or early menopause (<45 y) in all the studies, with significant results only for grip strength, gait speed, and functional limitation. Premature and early menopause were associated with weaker grip strength [between 2.58 kg (95% CIâ=â0.74 to 4.43) and 5.21 kg (2.18 to 8.25)], and lower gait speed [between 0.03âm/s (0.01 to 0.06) and 0.06âm/s (0.02 to 0.09)]. Menopause after the age of 50 is associated with less likelihood of functional limitation [OR between 0.52 (95% CIâ=â0.29 to 0.95) and 0.61 (0.40 to 0.95)] compared with premature and early menopause. Two measures of physical function (chair stand test and standing balance) were not significantly associated with age at menopause. CONCLUSION: Only four cross-sectional studies showed that earlier ages at menopause are associated with poor physical function (grip strength, gait speed, and self-reported functional limitations), but given the high heterogeneity of the studies, no consensus is possible. Longitudinal studies are needed to explore the association between age at menopause and different measures of physical function as well as the influence of different socioeconomic conditions between countries on functioning.
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Menopausa Precoce , Equilíbrio Postural , Estudos Transversais , Feminino , Força da Mão , Humanos , Estudos Longitudinais , MenopausaRESUMO
This study aimed to verify the prevalence of the use of Potentially Inappropriate Medications (PIM) for elderly living in Long-Term Care Institutions for the Elderly (LTCIE), as well as the types of medications and their associated factors. This is a cross-sectional study carried out in 10 LTCIEs in the city of Natal in the period October-December 2013. Potentially inappropriate medications were classified according to the 2015 American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults - 2015. Sociodemographic, LTCIE-related and health-related variables were considered. Univariate and multivariate analyses were performed between the primary variable (PIM use) and the independent variables using Poisson regression. The sample consisted of 321 older people, of whom 304 used medications. The prevalence of PIM use was 54.6% (95% CI: 48.9-60.2) and was associated with polypharmacy and dementia in the final model. The most common PIMs were antipsychotics and benzodiazepines. The study revealed a high prevalence of PIM use among the elderly of the LTCIEs, evidencing the need to adopt indicators on the use of these drugs and the implementation of strategies that make drug therapy safer and more adequate for older adults.
Este trabalho teve como objetivo verificar a prevalência do uso de medicamento potencialmente inapropriado (MPI) para idosos residentes em Instituições de Longa Permanência para Idosos (ILPI), assim como os tipos de medicamentos e seus fatores associados. Trata-se de estudo transversal realizado em 10 ILPI da cidade do Natal, entre outubro e dezembro de 2013. Os medicamentos inapropriados foram classificados de acordo com os Critérios de Beers da American Geriatric Society 2015. Foram analisadas variáveis sociodemográficas, relacionadas à ILPI e às condições de saúde. Para as análises univariada e multivariada entre a variável principal (uso de MPI) e as demais foi utilizada a regressão de Poisson. A amostra foi composta por 321 idosos e, destes, 304 utilizavam medicamentos. A prevalência de uso de MPI foi de 54,6% (IC 95%: 48,9-60,2) e no modelo final esteve associada à polifarmácia e à demência. As classes terapêuticas de MPI mais identificadas foram antipsicóticos e benzodiazepínicos. O estudo revelou alta prevalência de MPI entre os idosos das ILPI, configurando a necessidade de adoção de indicadores do uso destes medicamentos e a implantação de estratégias que tornem a farmacoterapia mais segura e adequada aos idosos.
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Prescrição Inadequada , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Estudos Transversais , Humanos , Polimedicação , Prevalência , Fatores de RiscoRESUMO
This study aimed to verify the prevalence of low social support (LSS) and associated factors in women submitted to breast cancer (BC) treatment. A cross-sectional study was carried out with 101 female residents of the municipality of Natal (Northeast Brazil), diagnosed with BC and submitted to oncological treatment. Data collection took place between July/2015 and May/2016 from medical records and individuals' interviews, and from the Medical Outcome Study-Social Support Survey. Descriptive, bivariate and multivariate statistics were carried out through Poisson's regression with robust variance and significance level 0.05. Prevalence of LSS in women with BC was 22.8% with confidence interval 14.6-39.94. Type of access to public services (p < .03), prevalence ratio (PR) 1.84 and negative self-rated health (p < .001), PR 4.47 were associated with LSS. These results were obtained after adjustments by the variables age and presence of chronic diseases. The associations established herein could have been mostly related to fragilities of the Brazilian health system, and can contribute to the planning of actions directed to the studied population.
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Neoplasias da Mama/terapia , Atenção à Saúde/métodos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Apoio Social , Adulto , Brasil/epidemiologia , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/psicologia , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Prevalência , Fatores SocioeconômicosRESUMO
Resumo Objetivo Avaliar a incidência de hospitalização e seus fatores de risco em pessoas idosas institucionalizadas no follow-up de 12 meses na cidade de Natal, RN, Brasil. Método Estudo de coorte concorrente composto por idosos com 60 anos ou mais e que residiam nas 10 Instituições de Longa Permanência para Idosos (ILPI) participantes do estudo. Nos 320 participantes foram aferidas informações sobre condições sociodemográficas (idade, estado civil, filhos, plano de saúde, tipo de instituição, tempo de institucionalização e se foi por motivo de doença, relação do número de idosos por cuidador e, condições de saúde), estado nutricional (MAN), capacidade funcional (Índice de KATZ), estado cognitivo (teste de Pfeiffer), fraqueza muscular (Dinamômetro). Considerou-se um nível de significância de 5% (p < 0,05) e intervalo de confiança (IC) de 95% na análise bivariada e multivariada. Resultados 20,6% (IC 95%: 16,5-25,4), do total de participantes, foram hospitalizados, com a permanência média de 16,1 dias (dp: 17,1) ao final dos 12 meses. A principal causa da hospitalização foram as doenças pulmonares (30,3%). A presença de desnutrição ou risco de desnutrição (p=0,016; IC95%: 1,17-4,96) e fazer uso de medicamentos para o sistema cardiovascular (p=0,003; IC95%: 1,43-5,77) foram fatores de risco para a hospitalização, após ajustes das variáveis sociodemográficas e clínicas. Conclusão A hospitalização teve uma alta incidência entre os idosos. Além disto, a desnutrição ou risco de desnutrição e o uso de medicamentos cardiovasculares foram considerados fatores de risco para a hospitalização no período de 12 meses.
Abstract Objective To evaluate the incidence of hospitalization and its risk factors in institutionalized elderly people during a 12-month follow-up in the city of Natal, RN, Brazil. Methods Concurrent cohort study composed of elderly people aged 60 years or over and residing in the 10 Long-term Care Institutions for the elderly participating in the study. Of the 320 participants, data regarding sociodemographic conditions (i.e., age, marital status, children, health insurance plan, type of institutions, length of institutionalization and if it was due to illness, the ratio of the number of elderly people per caregiver, and health conditions), nutritional status (MAN), functional capacity (KATZ index), cognitive status (Pfeiffer test), and muscle weakness (dynamometer) were collected. A significance level of 5% (p<0.05) and a 95% confidence interval (CI) were considered in the bivariate and multivariate analyses. Results 20.6% (95%CI: 16.5-25.4) of the total number of participants were hospitalized, with an average length of stay of 16.1 days (SD: 17.1) at the end of the 12 months. The main cause of hospitalization was lung disease (30.3%). The presence of malnutrition or risk of malnutrition (p=0.016, 95%CI: 1.17-4.96) and use of drugs for the cardiovascular system (p=0.003; 95%CI: 1.43-5.77) were risk factors for hospitalization, after adjusting for sociodemographic and clinical variables. Conclusion Hospitalization had a high incidence among the elderly. Also, malnutrition or risk of malnutrition and the use of cardiovascular drugs were considered risk factors for hospitalization in the 12 months.
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Resumo Este trabalho teve como objetivo verificar a prevalência do uso de medicamento potencialmente inapropriado (MPI) para idosos residentes em Instituições de Longa Permanência para Idosos (ILPI), assim como os tipos de medicamentos e seus fatores associados. Trata-se de estudo transversal realizado em 10 ILPI da cidade do Natal, entre outubro e dezembro de 2013. Os medicamentos inapropriados foram classificados de acordo com os Critérios de Beers da American Geriatric Society 2015. Foram analisadas variáveis sociodemográficas, relacionadas à ILPI e às condições de saúde. Para as análises univariada e multivariada entre a variável principal (uso de MPI) e as demais foi utilizada a regressão de Poisson. A amostra foi composta por 321 idosos e, destes, 304 utilizavam medicamentos. A prevalência de uso de MPI foi de 54,6% (IC 95%: 48,9-60,2) e no modelo final esteve associada à polifarmácia e à demência. As classes terapêuticas de MPI mais identificadas foram antipsicóticos e benzodiazepínicos. O estudo revelou alta prevalência de MPI entre os idosos das ILPI, configurando a necessidade de adoção de indicadores do uso destes medicamentos e a implantação de estratégias que tornem a farmacoterapia mais segura e adequada aos idosos.
Abstract This study aimed to verify the prevalence of the use of Potentially Inappropriate Medications (PIM) for elderly living in Long-Term Care Institutions for the Elderly (LTCIE), as well as the types of medications and their associated factors. This is a cross-sectional study carried out in 10 LTCIEs in the city of Natal in the period October-December 2013. Potentially inappropriate medications were classified according to the 2015 American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults - 2015. Sociodemographic, LTCIE-related and health-related variables were considered. Univariate and multivariate analyses were performed between the primary variable (PIM use) and the independent variables using Poisson regression. The sample consisted of 321 older people, of whom 304 used medications. The prevalence of PIM use was 54.6% (95% CI: 48.9-60.2) and was associated with polypharmacy and dementia in the final model. The most common PIMs were antipsychotics and benzodiazepines. The study revealed a high prevalence of PIM use among the elderly of the LTCIEs, evidencing the need to adopt indicators on the use of these drugs and the implementation of strategies that make drug therapy safer and more adequate for older adults.
Assuntos
Humanos , Idoso , Prescrição Inadequada , Lista de Medicamentos Potencialmente Inapropriados , Prevalência , Estudos Transversais , Fatores de Risco , PolimedicaçãoRESUMO
Resumo Objetivo Adaptar culturalmente o Short Portable Mental Status Questionnaire (SPMSQ) de Pfeiffer para uso no Brasil. Métodos O processo envolveu as seguintes fases: tradução inicial; síntese das traduções; retrotradução; revisão por um comitê de especialistas com experts da área para analisar a validade aparente e de conteúdo, contemplando as equivalências semântica, idiomática, cultural, conceitual e clareza e, por fim, um pré-teste com a população alvo. Resultados Na tradução inicial e na retrotradução ocorreram discordâncias entre os tradutores, em 19 e 7 itens respectivamente, que posteriormente foram discutidos e conciliados pelo comitê. O comitê de especialistas sugeriu modificações desde o layout até adequações de termos técnicos para facilitar a aplicabilidade dos profissionais e para tornar o instrumento final mais claro e compreensível para a população-alvo. No pré-teste, 36,6% dos avaliados demonstraram dificuldades no entendimento de um item do questionário; o item foi substituído, a escala foi reaplicada obtendo 100% de compreensão. Conclusão O estudo demonstrou que a versão brasileira do SPMSQ estabelecida como Breve Escala de Capacidade Cognitiva apresentou-se transculturalmente adaptada, com seus itens considerados claros e compreensíveis pelos especialistas e pela população-alvo. O instrumento adaptado contribui por se tratar de uma ferramenta breve de avaliação disponível para rastrear a capacidade cognitiva dos idosos. É recomendado a análise das propriedades psicométricas, estabelecendo o grau de validade e confiabilidade, o qual já está em desenvolvimento pelos autores deste estudo.
Abstract Objective Culturally adapt Pfeiffer's Short Portable Mental Status Questionnaire (SPMSQ) for use in Brazil. Methods The process involved the following phases: initial translation; synthesis of translations; back-translation; review by a committee of experts in the field to analyze the apparent and content validity, considering the semantic, idiomatic, cultural, conceptual and clarity equivalences and, finally, a pre-test with the target population. Results In the initial translation and in the back-translation, there were disagreements between the translators, in items 19 and 7 respectively, which were later discussed and reconciled by the committee. The expert committee suggested changes from the layout to adjustments to technical terms to facilitate the applicability of professionals and to make the final instrument clearer and more understandable to the target population. In the pre-test, 36.6% of those evaluated showed difficulties in understanding an item in the questionnaire; the item was replaced, the scale was reapplied obtaining 100% understanding. Conclusion The study demonstrated that the Brazilian version of the SPMSQ established as a Brief Cognitive Capacity Scale was cross-culturally adapted, with its items considered clear and understandable by specialists and the target population. The adapted instrument contributes because it is a brief assessment tool available to track the cognitive ability of old people. The analysis of psychometric properties is recommended, establishing the degree of validity and reliability, which is already under development by the authors of this study.
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AIMS: To verify the incidence of urinary continence decline and the probability of maintaining urinary continence, as well as identify the prognostic factors of urinary continence decline in institutionalized older people. METHODS: A 2-year longitudinal study (with five 6-month waves) was conducted with subjects ≥60 years old who lived in 10 nursing homes in the city of Natal-RN (Brazil). Urinary incontinence was assessed by the Minimum Data Set version 3.0. Sociodemographic, institution-related and health-related variables were considered to establish the baseline. Time-dependent variables included cognitive decline, functional decline, and incidences of falls, hospitalizations, and fractures during the period. The actuarial method, the log-rank test, and Cox's regression were applied as statistical methods. RESULTS: Among the cohort of 196 older adults, 105 (53.6%) individuals maintained the continence status during the period, 21 (10.7%) improved it at one or more assessments, and 76 (38.8%) subjects declined. The cumulative probability of maintaining continence status was 82.6% (confidence interval [CI], 95%: 76.5%-87.3%), 74.7% (CI, 95%: 67.8%-80.4%), 66.9% (CI, 95%: 59.4%-73.2%), and 49.3% (CI, 95%: 40.1%-57.9%) at 6, 12, 18, and 24 months, respectively. Predicting factors for continence decline were: disability (hazard ratio [HR] = 4.03; P < 0.001), functional decline (HR = 3.02; P = 0.001) and potentially inappropriate medication (HR = 1.84; P = 0.008). CONCLUSIONS: The incidence of continence decline and the cumulative probability of maintaining continence status in institutionalized older adults was approximately 39% and 49%, respectively, at the 2-year follow-up. Disability and potentially inappropriate drugs at baseline and functional decline across the period predicted continence decline in this cohort.