Socioeconomic determinants of cognition among older adults in the Brazilian longitudinal study of aging (ELSI-Brazil): a life-course approach.

BACKGROUND: The prevalence of cognitive impairment no dementia (CIND) and dementia appears to be higher in low- and middle-income countries (LMICs) compared to high-income economies. Yet few nationally representative studies from Latin American LMICs have investigated life-course socioeconomic factors associated with the susceptibility to these two cognitive conditions. Hence, the present study aimed to examine the associations of early- (education and food insecurity), mid- (employment stability), and late-life (personal income and household per capita income) socioeconomic determinants of CIND and dementia among older adults from Brazil, while simultaneously exploring whether sex plays an effect-modifier role on these associations. METHODS: This population-based study comprised a nationally representative sample of older adults (N = 5,249) aged 60 years and over from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). We fitted multinomial regressions and estimated odds ratios with the respective 95% confidence intervals (CIs). RESULTS: In multivariate analyses, participants with more years of early-life education (0.89, 95% CI [0.81, 0.97]) and mid-life employment stability (0.97, 95% CI [0.96, 0.99]) and higher late-life household per capita income (0.70, 95% CI [0.51, 0.95) were less likely to have dementia. Regarding CIND, more years of mid-life employment stability (0.97, 95% CI [0.96, 0.98]) was the only determinant to confer protection. Notably, secondary sex-based analyses showed the higher the early-life educational attainment, the lower the odds of dementia in women (0.81, 95% CI [0.75, 0.87]) but not in men (1.00, 95% CI [0.86, 1.16]). CONCLUSIONS: These findings may have implications for population health and health policy by advancing our understanding of socioeconomic determinants of CIND and dementia, especially in Latin America.

Quality of Care Transition for COVID-19 Patients in a University Hospital in Southern Brazil.

OBJECTIVE: To assess the quality of care transition from hospital to home for COVID-19 patients. METHOD: A cross-sectional study conducted at a University Hospital in Southern Brazil, involving 78 patients discharged after COVID-19 hospitalization. Data collection was performed via telephone using the Brazilian version of the Care Transitions Measure (CTM-15). Data were analyzed using descriptive and analytical statistics. RESULTS: The mean quality of care transition was 70.8 on a scale ranging from zero to 100, indicating moderate quality of care transition. The highest score was attributed to factor 1, "Preparation for self-management," and the lowest to factor 4, "Care Plan." CONCLUSIONS: It is important to enhance communication and support provided to patients during the transition process, especially regarding understanding prescribed medications and the development of clear care plans.

Age at natural menopause and its associated characteristics among Brazilian women: cross-sectional results from ELSI-Brazil.

OBJECTIVES: This study aimed to determine the median age at natural menopause and analyze lifestyle, anthropometric, and dietary characteristics associated with the age at natural menopause among Brazilian women. METHODS: This cross-sectional study involved 2,731 women 50 years and over, drawn from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2015/16). Nonparametric Kaplan-Meier cumulative survivorship estimates were used to assess the median timing of natural menopause. Cox proportional hazards regression models were employed to estimate the associations between age at natural menopause and exposure variables. RESULTS: The overall median age at natural menopause was 50 years. In the adjusted Cox model, current smoking (hazard ratio [HR], 1.11; 95% CI, 1.01-1.23) and underweight (HR, 1.34; 95% CI, 1.12-1.61) were associated with earlier natural menopause. Conversely, performing recommended levels of physical activity in the last week (HR, 0.88; 95% CI, 0.80-0.97), being overweight (HR 0.86; 95% CI, 0.74-0.99), and adhering to two or three healthy eating markers (HR, 0.80; 95% CI, 0.66-0.97; HR, 0.76; 95% CI, 0.61-0.94, respectively) were associated with later age at natural menopause. Binge drinking and waist circumference were not associated with age at natural menopause. CONCLUSIONS: Lifestyle, anthropometric, and dietary characteristics are significant factors that affect the age at natural menopause. Our findings can contribute to public policies targeted at Brazilian women's health.

A Peculiar Finding on the Ventrolateral Surface of the Tongue.

Phleboliths are reported as calcifications that occur in vascular malformations, associated with changes in blood flow dynamics, thrombus formation and subsequent calcifications. Radiological examination, such as cone beam computed tomography (CBCT) could help in demonstrating the presence of a calcifiied mass. A 45-year-old male was referred to our service with an asymptomatic nodular purplish lesion located on the ventrolateral tongue. Within the lesion, a stony mass was also evident on palpation. A digital dental radiograph demonstrated two circumscribed radiopaque structures. Phleboliths associated with vascular malformation was the main diagnostic hypothesis. The patient underwent a sclerotherapy protocol allowing surgical accessibility to the area. Phlebolyts were surgically removed using electrocoagulation. Histopathological examination revealed phleboliths in the context of a vascular malformation with intense fibrosis.

Association between self-perception of the neighborhood environment and sleep problems in older Brazilian adults: findings from ELSI-Brazil.

This study aimed to investigate associations between neighborhood perception and sleep problems in older Brazilian adults. A cross-sectional study was conducted with 5,719 community-dwelling older adults (≥ 60 years) from the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2019-2021). The outcomes were self-reported sleep problems: poor sleep quality, daytime sleepiness, primary insomnia complaints, difficulty staying asleep, and waking up at dawn. The exposure variables were questions about the perception of participants about the physical and social environment of the neighborhood. Logistic regression was used in data analysis. Garbage, rubbish, or tall grass on the streets and the desire to move were associated with higher odds of poor sleep quality. Concern about falling due to damaged sidewalks, concern about having difficulties taking transportation, and concern about having difficulties crossing the street were associated with higher odds of all sleep problems. Sound/noise of buses and cars was associated with higher odds of some sleep problems. Perceiving the neighborhood as a good place to live was associated with lower odds of daytime sleepiness and primary insomnia complaints. Trusting most people in the neighborhood and perceiving that kids and younger people treat adults with respect were associated with lower odds of daytime sleepiness, primary insomnia complaints, and waking up at dawn. Being a good place for kids to play and raise teenagers was associated with lower odds of daytime sleepiness. These results can assist public administrators in creating urban planning policies aimed at improving neighborhood environments as a means of health promotion.

Lifestyle and incident dementia: A COSMIC individual participant data meta­analysis.

INTRODUCTION: The LIfestyle for BRAin Health (LIBRA) index yields a dementia risk score based on modifiable lifestyle factors and is validated in Western samples. We investigated whether the association between LIBRA scores and incident dementia is moderated by geographical location or sociodemographic characteristics. METHODS: We combined data from 21 prospective cohorts across six continents (N = 31,680) and conducted cohort-specific Cox proportional hazard regression analyses in a two-step individual participant data meta-analysis. RESULTS: A one-standard-deviation increase in LIBRA score was associated with a 21% higher risk for dementia. The association was stronger for Asian cohorts compared to European cohorts, and for individuals aged ≤75 years (vs older), though only within the first 5 years of follow-up. No interactions with sex, education, or socioeconomic position were observed. DISCUSSION: Modifiable risk and protective factors appear relevant for dementia risk reduction across diverse geographical and sociodemographic groups. HIGHLIGHTS: A two-step individual participant data meta-analysis was conducted. This was done at a global scale using data from 21 ethno-regionally diverse cohorts. The association between a modifiable dementia risk score and dementia was examined. The association was modified by geographical region and age at baseline. Yet, modifiable dementia risk and protective factors appear relevant in all investigated groups and regions.

A nationwide study on immunosenescence biomarkers profile in older adults: ELSI-Brazil.

Immunosenescence is a phenomenon caused by changes in the immune system, and part of these changes involves an increase in circulating immunological biomarkers, a process known as "Inflammaging." Inflammaging can be associated with many diseases related to older people. As the older population continues to grow, understanding changes in the immune system becomes essential. While prior studies assessing these alterations have been conducted in countries with Caucasian populations, this investigation marks a pioneering effort. The object of the study is to describe for the first time that the distribution of cytokines, chemokines, and growth factors serum levels, assessed by Luminex platform, has been examined in a Brazilian population-based study of older adult females and males by age. Blood samples from 2111 participants (≥50 years old) were analyzed at the baseline (2015/2016) of the ELSI-Brazil study. The exploratory variables considered in the study were age, sex, educational level, residence area, geographic region, alcohol and smoking consumption, physical activity, and self-reported medical diagnoses of hypertension, diabetes, asthma, arthritis, and cancer. The association between serum biomarker levels and age was assessed by a quantile regression model adjusted in the total population and stratified by sex. The significance level considered in the analysis was 0.05. The mean age of the participants was 62.9 years, with a slight majority of female (52.7 %). Differences were found between the sexes in the median circulating levels of the CCL11, CXCL10, and FGF biomarkers. Eight biomarkers showed significant associations with age, including the pro-inflammatory CXCL10, TNF-α, IL-6, IL-17, and IL-2; and type 2/regulatory CCL11 and IL-4, showing positive associations, and anti-inflammatory IL-1Ra showing a negative association. The results suggest similar associations between the sexes, revealing an inflammatory profile characterized by types 1 and 2. Remarkably, these findings reinforce the concept of the Inflammaging process in Brazilian population. These findings add novel insights to about the immunosenescence aspects in middle-income countries and help define biomarkers capable of monitoring inflammation in older adults.

Comparing the effect of imputation reference panel composition in four distinct Latin American cohorts.

Genome-wide association studies have been useful in identifying genetic risk factors for various phenotypes. These studies rely on imputation and many existing panels are largely composed of individuals of European ancestry, resulting in lower levels of imputation quality in underrepresented populations. We aim to analyze how the composition of imputation reference panels affects imputation quality in four target Latin American cohorts. We compared imputation quality for chromosomes 7 and X when altering the imputation reference panel by: 1) increasing the number of Latin American individuals; 2) excluding either Latin American, African, or European individuals, or 3) increasing the Indigenous American (IA) admixture proportions of included Latin Americans. We found that increasing the number of Latin Americans in the reference panel improved imputation quality in the four populations; however, there were differences between chromosomes 7 and X in some cohorts. Excluding Latin Americans from analysis resulted in worse imputation quality in every cohort, while differential effects were seen when excluding Europeans and Africans between and within cohorts and between chromosomes 7 and X. Finally, increasing IA-like admixture proportions in the reference panel increased imputation quality at different levels in different populations. The difference in results between populations and chromosomes suggests that existing and future reference panels containing Latin American individuals are likely to perform differently in different Latin American populations.

[Differences between men and women in the prevalence of frailty and associated factors among older adults: evidence from ELSI-Brazil]. / Diferenças entre homens e mulheres na prevalência da fragilidade e fatores associados entre adultos mais velhos: evidências do ELSI-Brasil.

Based on a national representative sample of the population aged 50 years or older, this study aimed to estimate the prevalence of frailty among men and women, identify associated sociodemographic and health factors, and estimate the population attributable fraction. Data from the second wave (2019-2021) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) were used. Frailty was classified based on the number of positive items among unintentional weight loss, exhaustion, low level of physical activity, slow gait, and weakness. The main analyses were based on multinomial logistic regression stratified by sex. The prevalence of frailty was lower in men (8.6%; 95%CI: 6.9; 10.7) than in women (11.9%; 95%CI: 9.6; 14.8), with the most frequent item being the low level of physical activity in both. Age and schooling level were the sociodemographic factors associated with pre-frailty and fragility among men and women. The population attributable fraction was different for frailty between genders. In men, the highest population attributable fraction was due to not having a partner (23.5%; 95%CI: 7.7; 39.2) and low schooling level (18.2%; 95%CI: 6.6; 29,7). In women, higher population attributable fraction values were due to memory deficit (17.1%; 95%CI: 7.6; 26.6), vision deficit (13.4%; 95%CI: 5.1; 21.7), and diabetes mellitus (11.4%; 95%CI: 4.6; 18,1). Similar population attributable fraction levels were observed for heart disease (8.9%; 95%CI: 3.8; 14.1 in women and 8.8%; 95%CI: 2.0; 15.6 in men). Strategies aimed at physical activity have the potential to prevent frailty in both men and women, and the prevention of chronic conditions is more important in women.

Este trabalho, baseado em amostra nacional representativa da população com 50 anos ou mais, objetivou estimar a prevalência da fragilidade entre homens e mulheres, identificar fatores sociodemográficos e de saúde associados e estimar a fração atribuível populacional. Foram utilizados dados da segunda onda (2019-2021) do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil). A fragilidade foi classificada pelo número de itens positivos entre perda de peso não intencional, exaustão, baixo nível de atividade física, lentidão da marcha e fraqueza. As análises principais foram baseadas na regressão logística multinomial estratificada por sexo. A prevalência da fragilidade foi menor nos homens (8,6%; IC95%: 6,9; 10,7) do que nas mulheres (11,9%; IC95%: 9,6; 14,8), sendo o item mais frequente o baixo nível de atividade física em ambos. A idade e a escolaridade foram os fatores sociodemográficos associados à pré-fragilidade e à fragilidade entre homens e mulheres. Houve diferença da fração atribuível populacional para fragilidade entre os sexos. Nos homens, a maior fração atribuível populacional foi para não ter companheiro (23,5%; IC95%: 7,7; 39,2) e escolaridade baixa (18,2%; IC95%: 6,6; 29,7). Nas mulheres, maiores frações atribuíveis populacionais foram para déficit de memória (17,1%; IC95%: 7,6; 26,6), déficit da visão (13,4%; IC95%: 5,1; 21,7) e diabetes mellitus (11,4%; IC95%: 4,6; 18,1). Observou-se fração atribuível populacional semelhante para doença cardíaca (8,9%; IC95%: 3,8; 14,1, em mulheres; e 8,8%; IC95%: 2,0; 15,6, em homens). Estratégias voltadas para a prática de atividade física têm o potencial de prevenir a fragilidade em ambos os sexos, enquanto a prevenção de condições crônicas é mais importante nas mulheres.

Este estudio tuvo por objetivo estimar, utilizando una muestra nacional representativa de la población de 50 años o más, la prevalencia de la fragilidad entre hombres y mujeres, identificar los factores sociodemográficos y de salud asociados, y calcular la fracción atribuible a la población. Se utilizaron datos de la 2ª ola (2019-2021) del Estudio Longitudinal de Salud de los Ancianos Brasileños (ELSI-Brasil). La fragilidad se clasificó por el número de elementos positivos entre pérdida de peso no intencional, agotamiento, bajo nivel de actividad física, marcha lenta y debilidad. Los principales análisis se basaron en la regresión logística multinomial estratificada por sexo. La prevalencia de fragilidad fue menor en los hombres (8,6%; IC95%: 6,9; 10,7) que en las mujeres (11,9%; IC95%: 9,6; 14,8), y como ítem más frecuente el bajo nivel de actividad física en ambos. La edad y el nivel educativo fueron los factores sociodemográficos asociados a la pre-fragilidad y la fragilidad entre hombres y mujeres. Hubo una diferencia en fracción atribuible a la población para la fragilidad entre los sexos. Entre los hombres, la fracción atribuible a la población más elevada fue no tener pareja (23,5%; IC95%: 7,7; 39,2) y bajo nivel educativo (18,2%; IC95%: 6,6; 29,7). Entre las mujeres, las fracción atribuible a la población más elevadas fueron déficit de memoria (17,1%; IC95%: 7,6; 26,6), déficit de visión (13,4%; IC95%: 5,1; 21,7) y diabetes mellitus (11,4%; IC95%: 4,6; 18,1). Se observaron fracción atribuible a la población similares para enfermedades cardíacas (8,9%; IC95%: 3,8; 14,1 en mujeres, y 8,8%; IC95%: 2,0; 15,6 en hombres). Las estrategias dirigidas a la actividad física tienen el potencial de prevenir la fragilidad en ambos sexos, mientras que la prevención de enfermedades crónicas es más necesaria en las mujeres.

Pain management effectiveness in advanced cancer: palliative care unit inpatient study.

OBJECTIVES: The aim of this study is to evaluate pain management adequacy based on the Pain Management Index (PMI), and its association with the Brief Pain Inventory (BPI) in advanced cancer inpatients to a palliative care unit. METHODS: This is a quantitative study concerning advanced cancer inpatients in a specialised palliative care unit between June 2021 and February 2022. The BPI was applied, and analgesia was observed on the first (D1), third (D3) and seventh (D7) day of hospitalisation. Adequate analgesia was considered when PMI≥0. RESULTS: A total of 104 patients were evaluated on D1, 68 on D3 and 45 on D7, with a mean age of 53.6 years (SD±14.1), most of them female (65.4%), with the most frequent primary tumour site located in the gastrointestinal tract (22.1%). The observed analgesia was adequate (PMI≥0) in 52.9% of all patients on D1, 95.6% on D3 and 100% on D7 (p value=0.012). The number of patients with moderate to severe pain interference in general activities (p value 0.012), mood (p value 0.014), walking ability (p value 0.047), normal work (p value 0.038) and pleasure of living (p value 0.025) decreased during hospitalisation. CONCLUSIONS: Pain is a prevalent and impacting symptom in patients undergoing palliative care. Thus, objective analgesic adequacy assessments in specialised services are required. These findings reinforce the importance of effective pain control and corroborate the importance of employing objective tools in evaluating medical services and improving quality of life of patients.

[Sociodemographic characteristics associated with underweight and overweight in adults aged 50 years and over (ELSI-Brasil): differences between sexes]. / Características sociodemográficas associadas ao baixo peso e ao excesso de peso em adultos com 50 anos ou mais (ELSI-Brasil): diferenças entre sexos.

The objective were to describe the prevalence of underweight and overweight, assessed by body mass index (BMI), stratified by sex and age group, and to analyze the sociodemographic characteristics associated with BMI in older women and men. This is a cross-sectional analysis of 8,974 participants aged ≥ 50 years from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brasil, 2015-2016). BMI was classified as underweight, eutrophy, and overweight according to the participant's age. A multinomial logistic regression model was used, considering the sociodemographic characteristics of women and men. The results showed a higher prevalence of overweight in women compared to men (64.1% vs. 57.3%). In both sexes, the prevalence of underweight was higher in the longest-lived individuals, while overweight was lower. In women, the chance of underweight was higher than the chance of eutrophy in those who were single/widowed/divorced (OR = 1.95; 95%CI: 1.42-2.66) and in those living in rural areas (OR = 1.58; 95%CI: 1.01-2.49), while the chance of being overweight was lower than the chance of being eutrophy in those living in rural areas (OR = 0.78; 95%CI: 0.62-0.97) and in all geographic macro-regions related to the South Region. For men, the chance of being overweight was lower than the chance of being eutrophy among single/widowed/divorced individuals (OR = 0.58; 95%CI: 0.48-0.69). The richest had a lower chance of being underweight (OR = 0.59; 95%CI: 0.38-0.90), as well as a higher chance of being overweight (OR = 1.52; 95%CI: 1.20-1.92). In conclusion, the sociodemographic characteristics associated with BMI differed between the sexes.

Os objetivos foram descrever a prevalência de baixo peso e excesso de peso, avaliados pelo índice de massa corporal (IMC), estratificada por sexo e faixa etária, e analisar as características sociodemográficas associadas ao IMC em mulheres e homens mais velhos. Trata-se de uma análise transversal de 8.974 participantes com ≥ 50 anos da linha de base do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil, 2015-16). O IMC foi classificado em baixo peso, eutrofia e excesso de peso de acordo com a idade do participante. Foi utilizado modelo de regressão logística multinominal, considerando-se as características sociodemográficas de mulheres e homens. Os resultados evidenciaram maior prevalência de excesso de peso nas mulheres em comparação aos homens (64,1% vs. 57,3%). Em ambos os sexos, a prevalência de baixo peso foi maior nos mais longevos, enquanto que o excesso de peso foi menor. Nas mulheres, a chance de baixo peso foi maior do que a chance de eutrofia naquelas solteiras/viúvas/divorciadas (OR = 1,95; IC95%: 1,42-2,66) e nas residentes na área rural (OR = 1,58; IC95%: 1,01-2,49), ao passo que a chance de excesso de peso foi menor do que a chance de eutrofia nas residentes na área rural (OR = 0,78; IC95%: 0,62-0,97) e em todas as macrorregiões geográficas relativas à Região Sul. Para os homens, a chance de excesso de peso foi menor do que a chance de eutrofia entre solteiros/viúvos/divorciados (OR = 0,58; IC95%: 0,48-0,69). Os mais ricos apresentaram menor chance de baixo peso (OR = 0,59; IC95%: 0,38-0,90), bem como maior chance de excesso de peso (OR = 1,52; IC95%: 1,20-1,92). Em conclusão, as características sociodemográficas associadas ao IMC diferiram entre os sexos.

Los objetivos fueron describir la prevalencia de bajo peso y sobrepeso, evaluados a través del índice de masa corporal (IMC), estratificada por sexo y grupo de edad, y analizar las características sociodemográficas asociadas al IMC en mujeres y hombres mayores. Se trata de un análisis transversal de 8.974 participantes con ≥ 50 años de la línea de base del Estudio Longitudinal Brasileño sobre el Envejecimiento (ELSI-Brasil, 2015-2016). Se clasificó el IMC en bajo peso, eutrofia y sobrepeso conforme la edad del participante. Se utilizó el modelo de regresión logística multinomial, teniendo en cuenta las características sociodemográficas de mujeres y hombres. Los resultados evidenciaron una prevalencia más alta de sobrepeso en las mujeres en comparación con los hombres (64,1% vs. 57,3%). En ambos sexos, la prevalencia de bajo peso fue más alta en los grupos de mayor edad, mientras que la prevalencia del sobrepeso fue menor. La chance de bajo peso fue más alta que la chance de eutrofia en las mujeres solteras/viudas/divorciadas (OR = 1,95; IC95%: 1,42-2,66) y en las que viven en el área rural (OR = 1,58; IC95%: 1,01-2,49), mientras que la chance de sobrepeso fue menor que la chance de eutrofia en las que viven en el área rural (OR = 0,78; IC95%: 0,62-0,97) y en todas las macrorregiones geográficas relacionadas a la región Sur. La chance de sobrepeso fue menor que la chance de eutrofia entre los hombres solteros/viudos/divorciados (OR = 0,58; IC95%: 0,48-0,69). Los más ricos presentaron una chance menor de bajo peso (OR = 0,59; IC95%: 0,38-0,90), así como una chance más alta de sobrepeso (OR = 1,52; IC95%: 1,20-1,92). En conclusión, las características sociodemográficas asociadas al IMC difirieron entre los sexos.

Vagal dysautonomia in patients with Chagas disease and mortality: 14-year results of a population cohort of the elderly.

INTRODUCTION: Great part of Chagas disease (ChD) mortality occurs due to ventricular arrhythmias, and autonomic function (AF) may predict unfavorable outcomes. We aimed to evaluate the predictive value of AF indexes in ChD patients. METHODS: The Bambuí Study of Aging is a prospective cohort of residents ≥60 years at study onset (1997), in the southeastern Brazilian city of Bambuí (15,000 inhabitants). Consented participants underwent annual follow-up visits, and death certificates were tracked. AF was assessed by the maximum expiration on minimum inspiration (E:I) ratio during ECG acquisition and by heart rate variability indices: SDRR (standard deviation of adjacent RR intervals) and RMSSD (square root of the mean of the sum of squares of the differences between adjacent RR intervals)), calculated using a computer algorithm. Cox proportional hazards regression was performed to access the prognostic value of AF indexes, expressed as terciles, for all-cause mortality, after adjustment for demographic, clinical and ECG variables. RESULTS: From 1742 qualifying residents, 1000 had valid AF tests, being 321 with ChD. Among these, median age was 68 (64-74) years, and 32.5% were men. In Cox survival analyses, only SDRR was associated with all-cause mortality in non-adjusted models: SDRR (hazard ratio (HR): 1.26 (95% CI 1.08-1.47), p < 0.001), E:I ratio (HR: 1.13 (95% CI 0,98-1.31), p = 0.10) and RMSSD (HR: 0.99 (0.86-1.16), p = 0.95). After adjustment for sex and age, none of the indexes remained as independent predictors. CONCLUSION: Among elderly patients with ChD, AF indexes available in this cohort were not independent predictors of 14-year mortality.

Características sociodemográficas associadas ao baixo peso e ao excesso de peso em adultos com 50 anos ou mais (ELSI-Brasil): diferenças entre sexos / Sociodemographic characteristics associated with underweight and overweight in adults aged 50 years and over (ELSI-Brasil): differences between sexes / Características sociodemográficas asociadas al bajo peso y al sobrepeso en adultos de 50 años o más (ELSI-Brasil): diferencias entre sexos

Os objetivos foram descrever a prevalência de baixo peso e excesso de peso, avaliados pelo índice de massa corporal (IMC), estratificada por sexo e faixa etária, e analisar as características sociodemográficas associadas ao IMC em mulheres e homens mais velhos. Trata-se de uma análise transversal de 8.974 participantes com ≥ 50 anos da linha de base do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil, 2015-16). O IMC foi classificado em baixo peso, eutrofia e excesso de peso de acordo com a idade do participante. Foi utilizado modelo de regressão logística multinominal, considerando-se as características sociodemográficas de mulheres e homens. Os resultados evidenciaram maior prevalência de excesso de peso nas mulheres em comparação aos homens (64,1% vs. 57,3%). Em ambos os sexos, a prevalência de baixo peso foi maior nos mais longevos, enquanto que o excesso de peso foi menor. Nas mulheres, a chance de baixo peso foi maior do que a chance de eutrofia naquelas solteiras/viúvas/divorciadas (OR = 1,95; IC95%: 1,42-2,66) e nas residentes na área rural (OR = 1,58; IC95%: 1,01-2,49), ao passo que a chance de excesso de peso foi menor do que a chance de eutrofia nas residentes na área rural (OR = 0,78; IC95%: 0,62-0,97) e em todas as macrorregiões geográficas relativas à Região Sul. Para os homens, a chance de excesso de peso foi menor do que a chance de eutrofia entre solteiros/viúvos/divorciados (OR = 0,58; IC95%: 0,48-0,69). Os mais ricos apresentaram menor chance de baixo peso (OR = 0,59; IC95%: 0,38-0,90), bem como maior chance de excesso de peso (OR = 1,52; IC95%: 1,20-1,92). Em conclusão, as características sociodemográficas associadas ao IMC diferiram entre os sexos.

The objective were to describe the prevalence of underweight and overweight, assessed by body mass index (BMI), stratified by sex and age group, and to analyze the sociodemographic characteristics associated with BMI in older women and men. This is a cross-sectional analysis of 8,974 participants aged ≥ 50 years from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brasil, 2015-2016). BMI was classified as underweight, eutrophy, and overweight according to the participant's age. A multinomial logistic regression model was used, considering the sociodemographic characteristics of women and men. The results showed a higher prevalence of overweight in women compared to men (64.1% vs. 57.3%). In both sexes, the prevalence of underweight was higher in the longest-lived individuals, while overweight was lower. In women, the chance of underweight was higher than the chance of eutrophy in those who were single/widowed/divorced (OR = 1.95; 95%CI: 1.42-2.66) and in those living in rural areas (OR = 1.58; 95%CI: 1.01-2.49), while the chance of being overweight was lower than the chance of being eutrophy in those living in rural areas (OR = 0.78; 95%CI: 0.62-0.97) and in all geographic macro-regions related to the South Region. For men, the chance of being overweight was lower than the chance of being eutrophy among single/widowed/divorced individuals (OR = 0.58; 95%CI: 0.48-0.69). The richest had a lower chance of being underweight (OR = 0.59; 95%CI: 0.38-0.90), as well as a higher chance of being overweight (OR = 1.52; 95%CI: 1.20-1.92). In conclusion, the sociodemographic characteristics associated with BMI differed between the sexes.

Los objetivos fueron describir la prevalencia de bajo peso y sobrepeso, evaluados a través del índice de masa corporal (IMC), estratificada por sexo y grupo de edad, y analizar las características sociodemográficas asociadas al IMC en mujeres y hombres mayores. Se trata de un análisis transversal de 8.974 participantes con ≥ 50 años de la línea de base del Estudio Longitudinal Brasileño sobre el Envejecimiento (ELSI-Brasil, 2015-2016). Se clasificó el IMC en bajo peso, eutrofia y sobrepeso conforme la edad del participante. Se utilizó el modelo de regresión logística multinomial, teniendo en cuenta las características sociodemográficas de mujeres y hombres. Los resultados evidenciaron una prevalencia más alta de sobrepeso en las mujeres en comparación con los hombres (64,1% vs. 57,3%). En ambos sexos, la prevalencia de bajo peso fue más alta en los grupos de mayor edad, mientras que la prevalencia del sobrepeso fue menor. La chance de bajo peso fue más alta que la chance de eutrofia en las mujeres solteras/viudas/divorciadas (OR = 1,95; IC95%: 1,42-2,66) y en las que viven en el área rural (OR = 1,58; IC95%: 1,01-2,49), mientras que la chance de sobrepeso fue menor que la chance de eutrofia en las que viven en el área rural (OR = 0,78; IC95%: 0,62-0,97) y en todas las macrorregiones geográficas relacionadas a la región Sur. La chance de sobrepeso fue menor que la chance de eutrofia entre los hombres solteros/viudos/divorciados (OR = 0,58; IC95%: 0,48-0,69). Los más ricos presentaron una chance menor de bajo peso (OR = 0,59; IC95%: 0,38-0,90), así como una chance más alta de sobrepeso (OR = 1,52; IC95%: 1,20-1,92). En conclusión, las características sociodemográficas asociadas al IMC difirieron entre los sexos.

Diferenças entre homens e mulheres na prevalência da fragilidade e fatores associados entre adultos mais velhos: evidências do ELSI-Brasil / Differences between men and women in the prevalence of frailty and associated factors among older adults: evidence from ELSI-Brazil / Diferencias entre hombres y mujeres en cuanto a la prevalencia de fragilidad y los factores asociados entre adultos mayores: evidencia de ELSI-Brasil

Este trabalho, baseado em amostra nacional representativa da população com 50 anos ou mais, objetivou estimar a prevalência da fragilidade entre homens e mulheres, identificar fatores sociodemográficos e de saúde associados e estimar a fração atribuível populacional. Foram utilizados dados da segunda onda (2019-2021) do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil). A fragilidade foi classificada pelo número de itens positivos entre perda de peso não intencional, exaustão, baixo nível de atividade física, lentidão da marcha e fraqueza. As análises principais foram baseadas na regressão logística multinomial estratificada por sexo. A prevalência da fragilidade foi menor nos homens (8,6%; IC95%: 6,9; 10,7) do que nas mulheres (11,9%; IC95%: 9,6; 14,8), sendo o item mais frequente o baixo nível de atividade física em ambos. A idade e a escolaridade foram os fatores sociodemográficos associados à pré-fragilidade e à fragilidade entre homens e mulheres. Houve diferença da fração atribuível populacional para fragilidade entre os sexos. Nos homens, a maior fração atribuível populacional foi para não ter companheiro (23,5%; IC95%: 7,7; 39,2) e escolaridade baixa (18,2%; IC95%: 6,6; 29,7). Nas mulheres, maiores frações atribuíveis populacionais foram para déficit de memória (17,1%; IC95%: 7,6; 26,6), déficit da visão (13,4%; IC95%: 5,1; 21,7) e diabetes mellitus (11,4%; IC95%: 4,6; 18,1). Observou-se fração atribuível populacional semelhante para doença cardíaca (8,9%; IC95%: 3,8; 14,1, em mulheres; e 8,8%; IC95%: 2,0; 15,6, em homens). Estratégias voltadas para a prática de atividade física têm o potencial de prevenir a fragilidade em ambos os sexos, enquanto a prevenção de condições crônicas é mais importante nas mulheres.

Based on a national representative sample of the population aged 50 years or older, this study aimed to estimate the prevalence of frailty among men and women, identify associated sociodemographic and health factors, and estimate the population attributable fraction. Data from the second wave (2019-2021) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) were used. Frailty was classified based on the number of positive items among unintentional weight loss, exhaustion, low level of physical activity, slow gait, and weakness. The main analyses were based on multinomial logistic regression stratified by sex. The prevalence of frailty was lower in men (8.6%; 95%CI: 6.9; 10.7) than in women (11.9%; 95%CI: 9.6; 14.8), with the most frequent item being the low level of physical activity in both. Age and schooling level were the sociodemographic factors associated with pre-frailty and fragility among men and women. The population attributable fraction was different for frailty between genders. In men, the highest population attributable fraction was due to not having a partner (23.5%; 95%CI: 7.7; 39.2) and low schooling level (18.2%; 95%CI: 6.6; 29,7). In women, higher population attributable fraction values were due to memory deficit (17.1%; 95%CI: 7.6; 26.6), vision deficit (13.4%; 95%CI: 5.1; 21.7), and diabetes mellitus (11.4%; 95%CI: 4.6; 18,1). Similar population attributable fraction levels were observed for heart disease (8.9%; 95%CI: 3.8; 14.1 in women and 8.8%; 95%CI: 2.0; 15.6 in men). Strategies aimed at physical activity have the potential to prevent frailty in both men and women, and the prevention of chronic conditions is more important in women.

Este estudio tuvo por objetivo estimar, utilizando una muestra nacional representativa de la población de 50 años o más, la prevalencia de la fragilidad entre hombres y mujeres, identificar los factores sociodemográficos y de salud asociados, y calcular la fracción atribuible a la población. Se utilizaron datos de la 2ª ola (2019-2021) del Estudio Longitudinal de Salud de los Ancianos Brasileños (ELSI-Brasil). La fragilidad se clasificó por el número de elementos positivos entre pérdida de peso no intencional, agotamiento, bajo nivel de actividad física, marcha lenta y debilidad. Los principales análisis se basaron en la regresión logística multinomial estratificada por sexo. La prevalencia de fragilidad fue menor en los hombres (8,6%; IC95%: 6,9; 10,7) que en las mujeres (11,9%; IC95%: 9,6; 14,8), y como ítem más frecuente el bajo nivel de actividad física en ambos. La edad y el nivel educativo fueron los factores sociodemográficos asociados a la pre-fragilidad y la fragilidad entre hombres y mujeres. Hubo una diferencia en fracción atribuible a la población para la fragilidad entre los sexos. Entre los hombres, la fracción atribuible a la población más elevada fue no tener pareja (23,5%; IC95%: 7,7; 39,2) y bajo nivel educativo (18,2%; IC95%: 6,6; 29,7). Entre las mujeres, las fracción atribuible a la población más elevadas fueron déficit de memoria (17,1%; IC95%: 7,6; 26,6), déficit de visión (13,4%; IC95%: 5,1; 21,7) y diabetes mellitus (11,4%; IC95%: 4,6; 18,1). Se observaron fracción atribuible a la población similares para enfermedades cardíacas (8,9%; IC95%: 3,8; 14,1 en mujeres, y 8,8%; IC95%: 2,0; 15,6 en hombres). Las estrategias dirigidas a la actividad física tienen el potencial de prevenir la fragilidad en ambos sexos, mientras que la prevención de enfermedades crónicas es más necesaria en las mujeres.

Association between self-perception of the neighborhood environment and sleep problems in older Brazilian adults: findings from ELSI-Brazil / Associação entre autopercepção do ambiente da vizinhança e problemas de sono em idosos brasileiros: resultados do ELSI-Brasil / Asociación entre la autopercepción del entorno del vecindario y los problemas de sueño en ancianos brasileños: resultados del ELSI-Brasil

Abstract: This study aimed to investigate associations between neighborhood perception and sleep problems in older Brazilian adults. A cross-sectional study was conducted with 5,719 community-dwelling older adults (≥ 60 years) from the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2019-2021). The outcomes were self-reported sleep problems: poor sleep quality, daytime sleepiness, primary insomnia complaints, difficulty staying asleep, and waking up at dawn. The exposure variables were questions about the perception of participants about the physical and social environment of the neighborhood. Logistic regression was used in data analysis. Garbage, rubbish, or tall grass on the streets and the desire to move were associated with higher odds of poor sleep quality. Concern about falling due to damaged sidewalks, concern about having difficulties taking transportation, and concern about having difficulties crossing the street were associated with higher odds of all sleep problems. Sound/noise of buses and cars was associated with higher odds of some sleep problems. Perceiving the neighborhood as a good place to live was associated with lower odds of daytime sleepiness and primary insomnia complaints. Trusting most people in the neighborhood and perceiving that kids and younger people treat adults with respect were associated with lower odds of daytime sleepiness, primary insomnia complaints, and waking up at dawn. Being a good place for kids to play and raise teenagers was associated with lower odds of daytime sleepiness. These results can assist public administrators in creating urban planning policies aimed at improving neighborhood environments as a means of health promotion.

Resumo: Este estudo teve como objetivo investigar associações entre percepções da vizinhança e problemas de sono em idosos brasileiros. Foi realizado um estudo transversal com 5.719 idosos da comunidade (≥ 60 anos) do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil, 2019-2021). Os desfechos foram problemas de sono autorreferidos: má qualidade do sono, sonolência diurna, queixas de insônia primária, dificuldade em manter o sono e acordar na madrugada. As variáveis de exposição foram: questões sobre a percepção dos participantes sobre o ambiente físico e social da vizinhança. Regressão logística foi utilizada na análise dos dados. Lixo, sujeira ou grama alta nas ruas e o desejo de mudar de onde mora foram associados a maiores chances de má qualidade do sono. Preocupação em cair devido a calçadas em má condição, preocupação com dificuldades para usar os meios de transporte e preocupação com dificuldades para atravessar a rua foram associadas a maiores chances de todos os problemas de sono. O som/ruído dos ônibus e carros foi associado a maiores chances de alguns problemas de sono. A percepção da vizinhança como um bom lugar para morar foi associado a menores chances de sonolência diurna e queixas de insônia primária. A confiança na maioria das pessoas da vizinhança e a percepção de que crianças e jovens tratam os adultos com respeito foram associados a menores chances de sonolência diurna, queixas de insônia primária e acordar na madrugada. Um bom lugar para as crianças brincarem e para os adolescentes crescerem foi associado a menores chances de sonolência diurna. Esses resultados podem ajudar os gestores públicos na criação de políticas de planejamento urbano voltadas a melhorias nos ambientes da vizinhança como forma de promoção da saúde.

Resumen: Este estudio tuvo como objetivo investigar las asociaciones entre las percepcion del vecindario y los problemas de sueño en ancianos brasileños. Se realizó un estudio transversal con 5.719 ancianos de la comunidad (≥ 60 años) del Estudio Longitudinal de Salud de los Ancianos Brasileños (ELSI-Brasil, 2019-2021). Los desenlaces fueron los siguientes: problemas de sueño autoinformados: mala calidad del sueño, somnolencia diurna, quejas de insomnio primario, dificultad para permanecer dormido y despertarse durante la madrugada. Las variables de exposición fueron las siguientes: preguntas sobre la percepción de los participantes sobre el entorno físico y social del vecindario. En el análisis de datos se utilizó la regresión logística. La basura, la suciedad o el césped alto en las calles y el deseo de cambiar el lugar donde viven se asociaron con mayores probabilidades de tener una mala calidad del sueño. La preocupación por las caídas debido a aceras en mal estado, la preocupación por las dificultades para utilizar los medios de transporte y la preocupación por las dificultades para cruzar la calle se asociaron con mayores probabilidades de sufrir todos los problemas de sueño. El ruido producido por los autobuses y automóviles se asoció con una mayor probabilidad de sufrir algunos problemas de sueño. La percepción del vecindario como un buen lugar para vivir se asoció con menores probabilidades de sufrir somnolencia diurna y quejas de insomnio primario. La confianza en la mayoría de la gente del vecindario y la percepción de que los niños y jóvenes tratan a los adultos con respeto se asociaron con menores probabilidades de sufrir somnolencia diurna, quejas de insomnio primario y despertarse durante la madrugada. Un buen lugar para que los niños jugaran y para que los adolescentes crecieran se asoció con menores probabilidades de sufrir somnolencia diurna. Estos resultados pueden ayudar a los gestores públicos a crear políticas de planificación urbana dirigidas a mejorar los entornos vecinales como forma de promover la salud.

Subjective memory complaints: Prevalence, associated factors and sex differences in the ELSI-Brazil study.

BACKGROUND: Subjective memory complaints (SMCs) are a possible prodrome of cognitive decline but are understudied in low- and middle-income countries (LMIC). We aimed to estimate the prevalence of SMCs in a large, nationally representative sample of older adults from Brazil and to identify sociodemographic and health-related factors that are associated with SMCs independently of objective memory. METHODS: Baseline data (n = 7831) from the ELSI-Brazil study, a national representative sample of adults aged 50 and over. They were asked to rate their memory and then divided into two groups - having or not having SMCs. Logistic regression models were used to estimate the association of demographic characteristics, health related factors, objective memory performance and disability in basic (b-ADL), instrumental (i-ADL), and advanced (a-ADL) activities of daily living associated with SMCs. Whether sex was an effect modifier of the association between age and objective memory performance and SMCs was also tested. RESULTS: Of the sample, 42% (95% CI; 39.9-43.9) had SMCs, and it was higher among women (46.9%) than men (35.9%). SMC prevalence decreased with age among women and increased among men, and for both it decreased with better cognitive performance. Fully adjusted logistic regression model showed that older age, higher education, higher b-ADL scores, and better cognitive performance were associated with decreased SMCs, while being female, with higher number of chronic conditions, higher i-ADL scores, worst self-rated health, and an increased number of depressive symptoms were associated with increased SMCs. However, the interaction test (p < 0.001) confirmed that increased age was associated with decreased SMCs only among women, and that better objective memory performance was associated with decreased SMCs only among men. CONCLUSIONS: SMCs are common in the Brazilian older population and are associated with health and sociodemographic factors, with different patterns between men and women. There is a need for future studies looking at the cognitive trajectory and dementia risk in older adults with subjective cognitive complaints.

Continuity of care for patients recovering from Covid-19 under the angle of clinical management principles.

OBJECTIVE: To analyze the strategies used by nurses at a university hospital to ensure continuity of care at hospital discharge for patients recovered from Covid-19, under the angle of the principles of clinical management. METHOD: A descriptive study with a qualitative approach, carried out with seven nurses on duty in the medical and gynecology/obstetrics clinics of a university hospital in the Midwest region of the country. The data was processed using IRaMuTeQ software and analyzed using Content Analysis. RESULTS: The data resulted in five classes by the Descending Hierarchical Classification (DHC), which made up two categories: "Practices developed by nurses for continuity of care in the hospital environment" and "Continuity of care during discharge to the home". The strategies used by the nurses were: daily care systematized in the nursing process and guidance both for preparation and for the day of discharge. CONCLUSION: The absence of an institutional protocol for safe discharge, as well as the position of nurse coordinator to manage the discharge of patients with Covid-19, can compromise the continuity of care for these patients.

A nationwide study on sleep complaints and associated factors in older adults: ELSI-Brazil.

Sleep problems, such as difficulty falling asleep, staying asleep, early awakening with failure to continue sleep, and altered sleep-wake cycle, are common in the general population. This cross-sectional study with 6,929 older adults (≥ 60 years) aimed to estimate the prevalence of different types of sleep problems, their associated factors, and the population-attributable fraction of associated factors among older adults. The outcome variables consisted of self-reported sleep problems: insomnia (initial, intermediate, late, and any type of insomnia), poor sleep quality, and daytime sleepiness. The independent variables were sociodemographic and behavioral characteristics and health conditions. The prevalence proportions were initial insomnia (49.1%), intermediate insomnia (49.2%), late insomnia (45.9%), any type of insomnia (58.6%), poor sleep quality (15.6%), and daytime sleepiness (38.4%). Female sex, presence of two or more chronic diseases, not eating the recommended amount of fruits and vegetables, and regular and bad/very bad self-rated health were positively associated with the sleep problems investigated. Consuming alcohol once a month or more was inversely associated with initial insomnia. Population attributable fraction estimates ranged from 3% to 19% considering two or more chronic diseases, not eating the recommended amount of fruits and vegetables, and regular and bad/very bad self-rated health. High prevalence of self-reported sleep problems was evinced in older adults. These results can be useful to guide public health services in the creation of informational, evaluative, and screening strategies for sleep problems in older Brazilian adults.

Differences in determinants of active aging between older Brazilian and English adults: ELSI-Brazil and ELSA.

This study aimed to investigate differences in determinants of active aging between older Brazilian and English adults and to verify the association of behavioral, personal, and social determinants with physical health. This cross-sectional study was based on the ELSI-Brazil (2015-2016) and ELSA (2016-2017) cohorts. Active aging determinants included behavior (smoking, sedentary lifestyle, and poor sleep quality), personal (cognitive function and life satisfaction), and social determinants (education, loneliness, and volunteering), according to the World Health Organization. Physical health included activities limitation and multimorbidity. We estimated age- and sex-adjusted prevalence for each indicator and mean score, and used the negative binomial regression for statistical analysis. We included 16,642 participants, 9,409 from Brazil and 7,233 from England. Overall, all active aging determinants were worse in Brazil than in England, except for life satisfaction (no difference). The most remarkable difference was found for social determinants score in Brazil (mean difference of 0.18; p < 0.05), mainly due to a significantly lower education level in Brazil (70.6%; 95% confidence interval - 95%CI: 69.7-71.5) than England (37.1%; 95%CI: 35.1-39.1). All determinants (behavioral, personal, and social) were associated with health in Brazil and in England. However, the behavioral domain was stronger associated with health in England (coefficient = 2.76; 95%CI: 2.46-3.10) than in Brazil (coefficient = 1.38; 95%CI: 1.26-1.50; p < 0.001). Older English adults beneficiate more from healthier behaviors than Brazilians, which depend more on social policies.

Correlation Between Cancer Pain and Quality of Life in Patients With Advanced Cancer Admitted to a Palliative Care Unit.

INTRODUCTION: Cancer pain is one of the most prevalent manageable symptoms in patients with advanced cancer, and it has a negative impact on quality of life (QoL). OBJECTIVE: The aim of this study is to examine the correlation between cancer pain and QoL in patients with advanced cancer who are hospitalized in a palliative care unit. METHODS: This study is a cross-sectional analysis of patients with advanced cancer who were hospitalized with cancer pain at a specialized palliative care unit between June 2021 and February 2022. Pain intensity and its impact on daily activities were assessed using the Brief Pain Inventory (BPI), while the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 15 PAL (QLQ-C15-PAL) was used to evaluate QoL. RESULTS: A total of 104 patients with cancer pain were included, with a mean age of 53.6 years (±14.1). Most of the patients were female (65.38%), and the most common primary tumor site was in the gastrointestinal tract (22.11%). The most frequently reported site of cancer pain was the abdomen (32.69%). The mean duration of cancer pain was 52.3 days (±6.2). The domains of QoL most strongly correlated with cancer pain were weakness (coefficient = .52, P < .001), nausea (coefficient = .36, P < .001), and the physical domain (coefficient = -.30, P < .001). CONCLUSION: Cancer pain is strongly correlated with a deterioration in QoL in patients with advanced cancer, and its management should be pursued as a strategy for optimizing QoL.