Major depression and associated factors in institutionalized older adults.

This quantitative epidemiological study aimed to analyze the prevalence of major depression in 237 older adults aged 60 to 104 years living in long-term care facilities in a large city in the state of Ceará, Northeastern Brazil. A sociodemographic questionnaire (age, gender, education, duration of institutionalization) was administered and the DSM-IV-TR was used as a reference for the clinical assessment of major depression. The Katz scale was used to classify dependence in activities of daily living and the Pfeffer scale was used to classify dependence in instrumental activities of daily living. The Mini Mental State Examination and the Category Fluency Test were used to assess cognitive function. Data underwent descriptive and analytical statistics with a significance level of 5%. The participants' mean age was 75.3 ± 8.6 years. Of these, 82 older adults (34.6%) presented a diagnosis of major depression. Major depression was significantly associated family visits (p = 0.036). The prevalence of major depression in institutionalized older adults is high. The assessment of the prevalence of major depression should be carried out based on internationally accepted clinical criteria rather than on depressive symptoms screening tests since the diagnosis itself is what will determine the non-drug or drug therapy.

Clinical and epidemiological differences in diabetes: A cross-sectional study of the Brazilian population compared with the French GERODIAB cohort.

AIMS: This study aimed to compare the sociodemographic and epidemiological profiles between Brazilian and French older people with type 2 diabetes mellitus. METHODS: Quantitative analytical study of 248 type 2 diabetes patients aged 65+ years receiving care in a center for integrated diabetes and hypertension care. The data were compared with the GERODIAB study conducted in France. RESULTS: The participants' mean age was 73.16 ± 6.4 years, with 162 (65.4%) participants aged less than 75 years and 38 (15.3%) over 80 years old. Almost all the participants (99.2%) lived at home, 35 (14.1%) were uneducated, and 17 (6.9%) had completed higher education. The majority (232 older people) were retired. Most of the median values of the variables differed statistically (p < 0.001) between the two populations. Peripheral vascular disease, diabetic neuropathy, foot wound, amputation, hypoglycemia, hyperosmolarity and other intercurrent infections differed statistically (p < 0.001) between the two populations. Most of the medication use variables differed significantly (p < 0.05) between Brazilians and the French. CONCLUSIONS: The statistically significant differences between the two populations reveal better conditions among the French participants, which highlights the importance of the scientific evidence found in the French study for developing public health actions targeted at Brazilian diabetic older people.

Factors associated with inadequate follow-up of children with congenital syphilis.

OBJECTIVE: To analyze factors associated with outpatient follow-up of children with congenital syphilis. METHODS: A non-concurrent cohort study performed in primary care units and three reference maternity hospitals in Fortaleza (Ceará State). Data were collected from September 2013 to September 2016 in the notification forms and in the medical records of hospitalization and outpatient follow-up, and they were presented considering an adequate and inadequate follow-up. Children who attended the primary care unit or referral outpatient clinic during the period recommended by the Ministry of Health were considered adequately followed up and performed the recommended examinations. Pearson's chi-square and Fisher's exact tests were used in the comparative analysis. The estimated risk of adequate non-follow-up was verified by simple and multiple logistic regression. RESULTS: The total of 460 children with congenital syphilis were notified, of which 332 (72.2%) returned for at least one appointment and were part of the study. Exactly 287 (86.4%) children attended the primary health unit; however, there was no reference to congenital syphilis in 236 (71.1%) medical records and no information on the venereal disease research laboratory (VDRL) test was found in 264 (79.5%) children. There was nonadherence to subsequent appointments by 272 (81.9%) individuals. The following variables had a statistically significant association with the non-adequate follow-up of the children: marital status of the mothers, number of prenatal appointments, number of pregnancies, blood count, and radiography of long bones. CONCLUSIONS: Most children with congenital syphilis attended primary care for follow-up, but the services do not meet the recommendations of the Brazilian Ministry of Health for adequate follow-up.

Nutritional assessment of older adults with diabetes mellitus.

AIMS: We aimed to screen the nutritional status of older adults with diabetes mellitus, seeking to outline the needs of this population group considering their socioeconomic status. METHODS: Cross-sectional study of 246 diabetic people aged 65-94 years in Northeastern Brazil. Semi-structured questionnaires were used to collect sociodemographic, general health and lifestyle data. The Mini Nutritional Assessment was used to screen nutritional status. RESULTS: Participants' mean age was 73 ±â€¯6.4 years, and there was a predominance of women (56.5%). The mean duration of diabetes was 14.1 years (±9.6 years). Patients aged 80 years or older presented a 3.7-fold higher risk of malnutrition (p < 0.001), and those who were uneducated exhibited a 5.8-fold higher risk of malnutrition (p = 0.040). Patients with BMI of 18.6-24.9 km/m2 presented a 2.2-fold higher risk of malnutrition than overweight or obese patients (p < 0.001). Nutritional status was significantly associated with coronary artery disease (p = 0.010) and stroke (p < 0.001). Malnourished patients exhibited a 2.2-fold higher occurrence of infection in the past 6 months (p = 0.017) and 2-fold higher occurrence of foot injuries (p = 0.028) than their well-nourished peers. CONCLUSION: Malnutrition in older diabetic patients exacerbates underlying diseases and contributes to unfavorable prognosis, particularly in the oldest old and in individuals with low levels of education.

Factors associated with inadequate follow-up of children with congenital syphilis / Fatores associados ao seguimento não adequado de crianças com sífilis congênita

ABSTRACT OBJECTIVE To analyze factors associated with outpatient follow-up of children with congenital syphilis. METHODS A non-concurrent cohort study performed in primary care units and three reference maternity hospitals in Fortaleza (Ceará State). Data were collected from September 2013 to September 2016 in the notification forms and in the medical records of hospitalization and outpatient follow-up, and they were presented considering an adequate and inadequate follow-up. Children who attended the primary care unit or referral outpatient clinic during the period recommended by the Ministry of Health were considered adequately followed up and performed the recommended examinations. Pearson's chi-square and Fisher's exact tests were used in the comparative analysis. The estimated risk of adequate non-follow-up was verified by simple and multiple logistic regression. RESULTS The total of 460 children with congenital syphilis were notified, of which 332 (72.2%) returned for at least one appointment and were part of the study. Exactly 287 (86.4%) children attended the primary health unit; however, there was no reference to congenital syphilis in 236 (71.1%) medical records and no information on the venereal disease research laboratory (VDRL) test was found in 264 (79.5%) children. There was nonadherence to subsequent appointments by 272 (81.9%) individuals. The following variables had a statistically significant association with the non-adequate follow-up of the children: marital status of the mothers, number of prenatal appointments, number of pregnancies, blood count, and radiography of long bones. CONCLUSIONS Most children with congenital syphilis attended primary care for follow-up, but the services do not meet the recommendations of the Brazilian Ministry of Health for adequate follow-up.

RESUMO OBJETIVO Analisar fatores associados ao seguimento ambulatorial não adequado de crianças notificadas com sífilis congênita. MÉTODOS Estudo de coorte não concorrente, realizado em unidades de atenção primária e três maternidades de referência de Fortaleza (Ceará). Os dados foram coletados de setembro de 2013 a setembro de 2016 nas fichas de notificação e nos prontuários médicos de internamento e de seguimento ambulatorial, e apresentados considerando o seguimento adequado e não adequado. Foram consideradas adequadamente seguidas as crianças que compareceram à unidade de atenção primária ou ao ambulatório de referência no período recomendado pelo Ministério da Saúde e realizaram os exames preconizados. Utilizou-se os testes qui-quadrado de Pearson e exato de Fisher na análise comparativa. O risco estimado de não seguimento adequado foi verificado por regressão logística simples e múltipla. RESULTADOS Foram notificadas 460 crianças com sífilis congênita, das quais 332 (72,2%) retornaram para pelo menos uma consulta e fizeram parte do estudo. Compareceram à unidade primária de saúde 287 (86,4%) crianças; entretanto, não havia referência à sífilis congênita em 236 (71,1%) prontuários e não foram encontradas informações acerca da solicitação do exame venereal disease research laboratory (VDRL) em 264 (79,5%). Houve não adesão às consultas subsequentes por parte de 272 (81,9%) indivíduos. As seguintes variáveis apresentaram associação estatisticamente significativa com o seguimento não adequado das crianças: estado civil das genitoras, número de consultas no pré-natal, número de gestações, hemograma e radiografia de ossos longos. CONCLUSÕES A maioria das crianças notificadas com sífilis congênita comparecem à atenção primária para seguimento, porém os serviços não atendem às recomendações do Ministério da Saúde para o seguimento adequado.

Idosos com depressão: uma análise dos fatores de institucionalização e apoio familiar / Depressed older adults: an analysis of factors related to institutionalization and family support / Mayores con depresión: un análisis de los factores de la institucionalización y del apoyo familiar

OBJETIVO: Identificar a prevalência de depressão de idosos residentes em instituições de longa permanência (ILPI) e sua relação com os motivos de institucionalização. MÉTODOS: Estudo quantitativo e transversal realizado em Fortaleza, Ceará, que utilizou um instrumento de coleta de dados elaborado para realizar avaliação clínica concernente à depressão maior, utilizando os critérios diagnósticos do Diagnostical and statistical manual of mental disorders (DSM-IV-TR). Serviu também para registrar os dados secundários obtidos dos prontuários dos pacientes idosos no intuito de complementar as informações relativas ao contexto da institucionalização. RESULTADOS: Do total de idosos pesquisados, 82 (34,6%) apresentaram diagnóstico de Depressão Maior segundo os critérios do DSM-IV-TR. No diagnóstico de depressão por ILPI, verifica-se significância estatística entre as duas ILPI (p=0,042). Na associação verificada entre depressão e tempo de institucionalização (p=0,001), é importante destacar o maior percentual entre os idosos com até três anos de institucionalização (37,8% dos casos de depressão), levando se a considerar que o pouco tempo de afastamento familiar e o processo de adaptação ao novo tipo de moradia possam constituir fatores de risco para a doença. CONCLUSÃO: Os achados acima descritos aludem à ideia de que o tempo de institucionalização, a carência das relações interpessoais, a solidão e o fato de o idoso receber visitas de familiares neste período constituem fatores de risco para a depressão.

OBJECTIVE: To identify the prevalence of depression in older adults living in long-term care (LTC) facilities and its association with the reasons for institutionalization. METHODS: Quantitative, cross-sectional study carried out in Fortaleza, Ceará, using a data collection instrument designed to perform clinical assessment of major depression, based on the Diagnostical and statistical manual of mental disorders (DSM-IV-TR) diagnostic criteria. It was also used to record secondary data obtained from the medical records of the older adult patients in order to complement information on the institutionalization context. RESULTS: Of all older adults analyzed, 82 (34.6%) presented a diagnosis of major depression according to DSM-IV-TR criteria. As for the diagnosis of depression related to the LTC facility, there was a statistically significant difference between the two LTC facilities (p=0.042). With regard to the association between depression and institutionalization duration (p=0.001), it is important to highlight a higher percentage among older adults with up to three years of institutionalization (37.8% of the cases of depression), which suggests that a short period of separation from family and the process of adaptation to the new type of housing may constitute risk factors for the disease. CONCLUSION: The findings described above allude to the idea that institutionalization duration, lack of interpersonal relationships, loneliness and the fact that the older adults receive visits from family members in this period are risk factors for depression.

OBJETIVO: Identificar la prevalencia de depresión de mayores que viven en instituciones de larga permanencia (ILP) y su relación con los motivos de la institucionalización. MÉTODOS: Estudio cuantitativo y transversal realizado en Fortaleza, Ceará, que utilizó un instrumento para la recogida de datos que ha sido elaborado para realizar la evaluación clínica de la depresión mayor utilizando los criterios diagnósticos del Diagnostical and statistical manual of mental disorders (DSM-IV-TR). Ha servido también para registrar los datos secundarios de los historiales clínicos de los pacientes mayores para complementar las informaciones relativas al contexto de la institucionalización. RESULTADOS: Del total de mayores investigados, 82 (34,6%) presentaron el diagnóstico de Depresión Mayor según los criterios del DSM-IV-TR. En el diagnóstico de depresión por ILP se verifica la significación estadística entre las dos ILP (p=0,042). En la asociación verificada entre la depresión y el tiempo de institucionalización (p=0,001) se puede destacar el mayor porcentual entre los mayores de hasta tres años de institucionalización (37,8% de los casos de depresión) considerándose que el poco tiempo de alejamiento familiar y el proceso de adaptación al nuevo tipo de vivienda pueden ser factores de riesgo para la enfermedad. CONCLUSIÓN: Los hallazgos descritos indican la idea de que el tiempo de institucionalización, la carencia de las relaciones interpersonales, la soledad y el hecho del mayor recibir visitas de los familiares en ese periodo son factores de riesgo para la depresión.