Using spatial analysis to examine inequalities and temporal trends in food retail accessibility.

OBJECTIVE: In this paper, we examined whether there are inequalities in access to food retail (by type and healthiness) across local government areas (LGA) in Greater Melbourne and by LGA grouped based on their distance from the central business district and Growth Area designation. We also examined whether these inequalities persisted over time. DESIGN: This is a secondary analysis of a repeated cross-sectional census of food outlets collected at four time points (2008, 2012, 2014 and 2016) across 31 LGA. Using Geographical Information Systems, we present a spatial analysis of food retail environments in Melbourne, Australia, at these four times over eight years. SETTING: Greater Melbourne, Australia. PARTICIPANTS: 31 LGA in Greater Melbourne. RESULTS: Findings show significant inequalities in access to healthy food retail persisting over time at the LGA level. Residents in lower density urban growth areas had the least access to healthy food retail. Unhealthy food retail was comparatively more accessible, with a temporal trend indicating increased accessibility over time in urban growth areas only. CONCLUSION: Accessibility to food outlets, particularly healthy food outlets and supermarkets, in Greater Melbourne is not equal. To identify and address health inequalities associated with rapid urban growth, further understanding of how people interact with the food environment needs to be explored.

Sexual dysfunction, depression, and marital dissatisfaction among Brazilian couples.

BACKGROUND: Health professionals treating sexual dysfunction and relational dissatisfaction recognize that they are multifactorial phenomena, and depression can be bidirectionally associated with both. AIM: The purpose of this study was to investigate sexual dysfunction in heterosexual couples in relation to the quality of their marital relationship and depression symptoms. METHODS: The sample consisted of 100 heterosexual couples recruited in Brazil. Both partners of each couple completed the Golombok-Rust Inventory of Sexual Satisfaction and the Golombok-Rust Inventory of Marital Satisfaction, which were translated and adapted, and the Beck Depression Inventory, which was validated for the Brazilian population. Both partners completed their questionnaires separately, and the couple's surveys were linked to preserve conjugal data for dyadic analysis. The Actor-Partner Interdependence Model was used to understand how sexual dysfunction in couples is related to depression and relationship quality among and between partners. RESULTS: Sexual dysfunction was found to be strongly associated with dissatisfaction in the relationship (husbands, ß = 0.57, P < 0.001; wives, ß = 0.60, P < 0.001), and a positive association was found between depressive symptoms and marital dissatisfaction (husbands, ß = .32, P < .001; wives ß = .40, P < .001). CLINICAL IMPLICATION: The results suggest that it is important for health professionals to be aware of the dyadic impact of struggles with both sex and the relationship and the presence of depression symptoms in patients who seek care for sexual complaints or depression and who are in a marital relationship. STRENGTHS AND LIMITATIONS: The different results found for men and women may shed light on the biopsychosocial dimensions of human sexuality. When treated as a purely physical experience, sex is myopic. In this study we demonstrated psychosocial aspects associated with gender and sexuality, and the partner's variables were found to have a greater impact on women than they did on the men. A limitation of this study is that the sample is not generalizable as it is not demographically representative of all socioeconomic groups in Brazil. Furthermore, the participants in this sample did not have clinical levels of depression, so the results cannot be extended to couples in which one or both spouses have depressive disorder. CONCLUSION: It was found that sexual dysfunction is strongly associated with the quality of the couple relationship, and that the quality of relationship plays a mediating role between depression and marital quality, especially for the women.

Prevalence, consequences and factors associated with drug use among individuals over 50 years of age in the family perspective.

OBJECTIVES: The aim of this study was to investigate the prevalence, consequences and factors associated with drug use among individuals over 50 years of age, from the perspective of their families, with particularly reference to cocaine use. METHODS: Cross-sectional study based on secondary data with 624 family members of substance users who sought family support in 14 units of the Recomeço Família Program in São Paulo, Brazil. RESULTS: The participants were predominately men, aged 50 to 59 years (68%); cocaine users (inhaled and/ or smoked); living alone; with a low level of education and were unemployed. They were likely to use family money to pay for their substance use, with a history of theft and aggression against strangers, and were not in treatment. Unlike other participants [≥ 60 years (31.1%)]; who were better educated and retired. In this latter group, 32.8% are alcohol users, 14.8% cocaine users (inhaled and smoked), 32.6% has physically assaulted their family, 39.7% had assaulted someone else and 18.3% had stolen objects or money from home. CONCLUSIONS: The population has peculiar characteristics of vulnerability (cocaine use and violence) that remain under investigated; not only do routes into treatment for older adults (≥ 60) but appropriate treatment packages need to be developed too.

Mortality events resulting from Australia's catastrophic fires threaten aquatic biota.

The consequences of the 2019-2020 bushfires in Australia were also devastating for the aquatic biota. Following abnormal rainfall events in burnt areas, widespread mortality events including fish and invertebrates were recorded in estuarine and freshwater systems. Such negative impacts on aquatic resources highlight the need to include these ecosystems in bushfire recovery plans. Management should prioritise catchments at higher risks of further negative impacts and research must be conducted to understand the efficacy of actions post-fire.

Glomerular filtration rate change during chronic hepatitis C treatment with Sofosbuvir/Ledipasvir in HCV/HIV Coinfected patients treated with Tenofovir and a boosted protease inhibitor: an observational prospective study.

INTRODUCTION: Concomitant use of ledipasvir and boosted protease inhibitors (PIs) may increase the risk of tenofovir (TDF) nephrotoxicity, since both these drugs increase TDF levels. Our aim was to evaluate glomerular filtration rate (eGFR) evolution during HCV treatment with sofosbuvir/ledipasvir (SOF/LDV) in HCV/HIV coinfected patients, according to their antiretroviral treatment (ARV). METHODS: Observational prospective study of HCV/HIV coinfected patients treated with SOF/LDV. eGFR evolution was evaluated during and 12 weeks after HCV treatment. Patients were categorized in three groups based on ARV regimen: non TDF, non-boosted TDF and TDF + boosted PI. RESULTS: We included 273 patients: 145 were receiving a non-TDF regimen, 78 a non-boosted TDF scheme and 50 were receiving TDF + boosted PI. We observed a statistically significant decrease in eGFR during treatment in all groups (non TDF p = 0.03, 95%CI [0.23-3.86], non-boosted TDF p < 0.01, 95%CI [3.36-7.44], TDF + PI p = 0.01, 95%CI [1.09-7.53]). The decrease was more pronounced in those receiving unboosted TDF (- 5.40 ml/min/1.73m2), but differences in eGFR decrease between the three groups were small and not statistically different (p = 0.06). eGFR decrease was greater in patients treated for 24 weeks (p = 0.009) and in cirrhotic patients (p = 0.036). At the end of follow up a recovery of eGFR was observed in all groups. CONCLUSION: We observed a significant decrease in eGFR during treatment in all study groups, that was small and reversible after SOF/LDV discontinuation. TDF was not associated with an increase in renal toxicity.

Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets.

BACKGROUND: HIV-infected patients may present an unforeseen clinical worsening after initiating antiretroviral therapy known as immune reconstitution inflammatory syndrome (IRIS). This syndrome is characterized by a heightened inflammatory response toward infectious or non-infectious triggers, and it may affect different organs. Diagnosis of IRIS involving the central nervous system (CNS-IRIS) is challenging due to heterogeneous manifestations, absence of biomarkers to identify this condition, risk of long-term sequelae and high mortality. Hence, a deeper knowledge of CNS-IRIS pathogenesis is needed. CASE PRESENTATION: A 37-year-old man was diagnosed with AIDS and cerebral toxoplasmosis. Anti-toxoplasma treatment was initiated immediately, followed by active antiretroviral therapy (HAART) 1 month later. At 2 months of HAART, he presented with progressive hyposensitivity of the right lower limb associated with brain and dorsal spinal cord lesions, compatible with paradoxical toxoplasmosis-associated CNS-IRIS, a condition with very few reported cases. A stereotactic biopsy was planned but was postponed based on its inherent risks. Patient showed clinical improvement with no requirement of corticosteroid therapy. Routine laboratorial analysis was complemented with longitudinal evaluation of blood T cell subsets at 0, 1, 2, 3 and 6 months upon HAART initiation. A control group composed by 9 HIV-infected patients from the same hospital but with no IRIS was analysed for comparison. The CNS-IRIS patient showed lower percentage of memory CD4+ T cells and higher percentage of activated CD4+ T cells at HAART initiation. The percentage of memory CD4+ T cells drastically increased at 1 month after HAART initiation and became higher in comparison to the control group until clinical recovery onset; the percentage of memory CD8+ T cells was consistently lower throughout follow-up. Interestingly, the percentage of regulatory T cells (Treg) on the CNS-IRIS patient reached a minimum around 1 month before symptoms onset. CONCLUSION: Although both stereotactic biopsies and steroid therapy might be of use in CNS-IRIS cases and should be considered for these patients, they might be unnecessary to achieve clinical improvement as shown in this case. Immunological characterization of more CNS-IRIS cases is essential to shed some light on the pathogenesis of this condition.

Beliefs About Sexual Activity During Pregnancy: A Systematic Review of the Literature.

The aim of this review is to present the beliefs related to sexual activity during pregnancy. We identified 13 studies (3,122 participants). The main positive beliefs about sex in pregnancy were that it makes labor easier, promotes marital harmony, prevents infidelity, and improves fetal well-being. Negative beliefs were more frequent: that sex could harm the unborn child (cause injuries, miscarriage, or fetal infection) and endanger the pregnancy or maternal health (cause membrane rupture, bleeding, preterm labor, and maternal infection). These findings are useful to clinicians and educational program developers.

[Family dynamics in face of Alzheimer's in one of its member]. / A dinâmica familiar diante da doença de Alzheimer em um de seus membros.

OBJECTIVE: To understand the family dynamics when there is a member in the residence with Alzheimer's disease. METHOD: A study of qualitative approach, using the creative sensitive method (CSM), and with participation of two families who had a member with Alzheimer's disease at home. RESULTS: Three categories emerged: Effects of Alzheimer's disease and the family dynamics; Development process of Alzheimer's disease and Coping strategies in face of the disease. CONCLUSION: It was possible to know the manifestations and consequences of Alzheimer's disease in the family, such as mutual help, the mobilization of resources to activate memories of the past, spirituality and faith. There was also understanding of the structure of family dynamics.

Broad Scale Spatial Modelling of Wet Bulb Globe Temperature to Investigate Impact of Shade and Airflow on Heat Injury Risk and Labour Capacity in Warm to Hot Climates.

While shade and air flow are recognised factors that reduce outdoor heat exposure, the level of reduction in terms of labour capacity at varying air temperature and humidity levels is poorly understood. This study investigated cooling effects on the commonly used heat index, wet bulb globe temperature (WBGT), and subsequent impact on labour capacity, for a range of air flow and shade conditions in warm to hot climates. We modelled heat exposure using a physics-based method to map WBGT for a case study region which experiences a range of heat categories with varying levels of health risks for outdoor workers. Continent-scale modelling confirmed significant spatial variability in the effect of various shade and wind speed scenarios across a range of real-world mid-summer daytime conditions. At high WBGTs, increasing shade or air flow for outdoor workers lowered heat exposure and increases labour capacity, with shade giving the greatest benefit, but cooling varied considerably depending upon underlying air temperature and humidity. Shade had the greater cooling effect; reducing incident radiation by 90% decreased WBGT by 2-6 °C depending on location. Wind had a lower cooling effect in the hottest regions, with a decreasing exponential relationship between wind speed and WBGT observed.

Mycobacterium szulgai Pulmonary Infection in an Immunocompromised Patient.

Mycobacterium szulgai is a slow-growing nontuberculous mycobacterium (NTM). It was first described in 1972 and is responsible for less than 0.2% of all NTM infections. The most common presentation resembles pulmonary tuberculosis, but it may also present as an extrapulmonary disease. It primarily affects individuals with underlying lung disease or immunocompromising conditions. The increasing use of tumor necrosis factor-alpha inhibitors, such as adalimumab, is associated with an increased risk of serious infections. We report a case of Mycobacterium szulgai infection in a 23-year-old woman with a history of childhood pneumonia and Crohn's disease on adalimumab.

Effectiveness, durability and safety of dolutegravir and lamivudine versus bictegravir, emtricitabine and tenofovir alafenamide in a real-world cohort of HIV-infected adults.

OBJECTIVE: Dolutegravir plus lamivudine (2-DR) is suggested as an initial and switch option in HIV-1 treatment. The aim of this study was to analyze the effectiveness, durability, and safety of 2-DR compared to bictegravir/emtricitabine/tenofovir alafenamide (3-DR). PATIENTS AND METHODS: This was an observational, ambispective study that included all treatment-naïve (TN) and treatment-experienced (TE) people living with HIV/AIDS (PLWH), who started 2-DR or 3-DR between 01 July 2018, and 31 January 2022. The primary endpoint was non-inferiority, at 24 and 48 weeks, of 2-DR vs 3-DR regarding the percentage of PLWH with viral load (VL)<50 and 200 copies/mL in TN (12% margin) and VL≥50 and 200 copies/mL in TE (4% margin). Durability of response and safety were also measured. RESULTS: 292 PLWH were included (39 TN and 253 TE). In TN PLWH, non-inferiority was not achieved at 24 weeks (17; 95% CI -17 to 51 p = 0.348). By week 48, all PLWH on 3-DR maintained VL<50 copies/mL compared to 70% of PLWH on 2-DR although without reaching statistical significance (-33; 95% CI -60 to -10 p = 0.289). Non-inferiority was not achieved in TE PLWH either at 24 (0.4; 95% CI -9 to 10 p = 1) or at 48 weeks (4.5; 95% CI -0.5 to 9 p = 0.132). In TN, the risk of treatment discontinuation was similar between groups (HR: 0.31, p = 0.07); similar rates were also found in TE (HR: 1.3, p = 0.38). TE PLWH on 2-DR showed a better safety profile compared to 3-DR (p = 0.017). CONCLUSION: Our results did not show non-inferiority in terms of virological effectiveness. Additionally, durability and safety of 2-DR were confirmed to be similar to 3-DR.

Acute Attack of Glaucoma after Scleral Melting and Iris Blockage of the Surgical Ostium: A Case Report of a Complication Derived from a Mitomycin C Supplemented Trabeculectomy.

Aim: To describe a case of an acute attack of glaucoma due to scleral melting in the area where a trabeculectomy was previously done. This condition resulted from the blockage of the surgical opening due to an iris prolapse in an eye that was previously supplemented with mitomycin C (MMC) during a filtering surgery and bleb needling revision. Case description: A 74-year-old Mexican female with a prior glaucoma diagnosis who assisted to an appointment presenting an acute ocular hypertensive crisis after several months of adequately controlled intraocular pressure (IOP). Ocular hypertension had been regulated after undergoing a trabeculectomy and bleb needling revision; both supplemented with MMC. The severe IOP increase occurred due to uveal tissue blockage in the filtering site, related to melting of the sclera in the same area. The patient was successfully treated through the use of a scleral patch graft and the implantation of an Ahmed valve. Conclusion: An acute attack of glaucoma associated with scleromalacia after trabeculectomy and needling has not been previously reported and is currently attributed to MMC supplementation. Nevertheless, the use of a scleral patch graft and further glaucoma surgery seems to be an efficient way to treat this condition. Clinical significance: Even though this complication was appropriately managed with this patient, we want to prevent further cases like this through the judicious and careful use of MMC. How to cite this article: Paczka JA, Ponce-Horta AM, Tornero-Jimenez A. Acute Attack of Glaucoma after Scleral Melting and Iris Blockage of the Surgical Ostium: A Case Report of a Complication derived from a Mitomycin C Supplemented Trabeculectomy. J Curr Glaucoma Pract 2022;16(3):199-204.

The Perceptions of Domestic Violence by a Family Member Who Uses Crack or Cocaine: A Secondary Retrospective Cross-Sectional Study.

OBJECTIVE: To evaluate the relationship between crack/cocaine use and domestic violence perpetration from the perspective of substance users' families. A secondary retrospective cross-sectional study, with 3162 family members of crack/cocaine users seeking treatment in the Recomeço Família Programme in São Paulo/Brazil was undertaken. Family members of crack/cocaine users reported that their relatives were more involved in domestic violence such as stealing (money and objects) at home [Odds Ratio Adjusted ORA = 2.17 (CI 95% 1.87; 2.53)], the family gave money to the user to buy drugs [ORA = 1.27 (1.08; 1.48)], and having problems with the judiciary [ORA = 1.48 (CI 95% 1.28; 1.71)]. Relatives of snorted cocaine users reported that there was physical and interpersonal violence, such as fathers being assaulted [ORA = 2.50 (CI 95% 1.08; 5.82)], assaulted someone else [ORA = 1.86 (CI 95% 1.32; 2.60)], threats of violence fights, arguments when the family talk about problematic drug use [ORA = 1.50 (CI 95% 1.13; 1.96)] and threatened some family members [ORA = 1.52 (CI 95% 1.14; 2.04)]. In this sample, there was a connection between crack/cocaine use and the perpetuation of domestic violence, corroborating with important implications for public policies, substance use treatment and prevention of domestic violence interventions.

Vulnerability and quality of life of older persons in the community in different situations of family care.

OBJECTIVE: to correlate socio-contextual aspects, physical vulnerability and quality of life of older persons in the community in different situations of family care. METHODS: epidemiological, a cross-sectional and analytical study, with elderly people in the community (n=769), with application of the instruments: Vulnerable Elders Survey-13 (VES-13), World Health Organization Quality of Life for Older Persons (WHOQOL-OLD) and the World Health Organization Quality of Life (WHOQOL-BREF); and socio-contextual data questionnaire. RESULTS: the population assessed presented an average of regular quality of life in both the WHOQOL-BREF and the WHOQOL-OLD. Older non-vulnerable persons (62.2%) and those with close family contact (82.6%) have a better quality of life than the vulnerable (p<0.0001). CONCLUSION: lower quality of life scores and more distant families are related to vulnerable elderly people; thus, the assessment of family proximity and physical vulnerability of older persons is shown to be an important factor in improving quality of life.

Family members seeking compulsory hospitalization for drug-using members: profile, expectations and needs.

OBJECTIVE: to outline the profile and understand the expectations and needs of family members who seek compulsory hospitalization for drug-using members. METHOD: Mixed research; data collected involving 101 medical records and semi-structured interviews with 26 family members. SPSS software and content analysis was used. RESULTS: The sample was characterized predominantly by women. Most users had other treatment modalities. Significant associations were observed between the request for hospitalization, the presence of aggressiveness, and other behaviors typical of harmful drug use for requesting compulsory hospitalization. The categories were: The difficult coexistence with the user; the journey of family members to "bring the user back to life"; Expectations and needs regarding compulsory hospitalization. CONCLUSION: The study provided a broader view of the complexity and inter-subjectivities of family systems in the face of the drug cycle, promoting discussions and strategies for multidisciplinary services in the comprehensive care of these families.

Mindfulness-Based Versus Story Reading Intervention in Public Elementary Schools: Effects on Executive Functions and Emotional Health.

INTRODUCTION: In this study we compared the effects of a mindfulness-based intervention (MBI) with a story reading intervention (SI) on the executive functions and psychological profile of children in two different public schools in São Paulo, Brazil. METHODS: In this controlled clinical trial, 207 children aged 8 to 9 years old responded to the Five-Digit Test (FDT), stress levels, depression, anxiety, positive and negative affect, at baseline (T0) and 8 weeks later (T1). From T0 to T1, school 1 participated in MBI classes and school 2 in IS classes. RESULTS: In school 1 (MBI), children improved their scores on all tests except reading (errors) and counting (errors) compared with school 2. No differences were observed between groups in terms of emotional health. CONCLUSION: It is feasible to implement MBI or SI in Brazilian public schools. Students in the MBI group presented broader effects in executive functions, while students in the SI group showed a trend toward reduced negative affect and depression symptoms.

[Guideline for the Treatment and Prevention of Infections Associated with Immunosuppressive Therapy for Autoimmune Diseases]. / Protocolo de Prevenção e Tratamento de Infeções Associadas à Terapêutica Imunossupressora de Doenças Autoimunes.

We propose a guideline about the risk, prevention and treatment of infection in the patient under immunomodulatory or immunosuppressive therapy in the context of autoimmune or autoinflammatory disease. It is divided into three sections: drugs and associated risk of infection; immunizations; risk, prevention, and treatment of specific infections. The treatment of autoimmune diseases involves the use of immunosuppressive or immunomodulatory therapies, with an increasing number of new drugs being used. It is associated with an increased risk of infection, which may be present globally or only for specific agents, varying widely depending on the pharmacological class and even within the same class. The prevention strategy and clinical management need to be individually tailored and there are several key factors: characterization of the disease that prompts the immunosuppression, understanding of the mechanism of action of the immunosuppressive drug, knowledge of previous infections, recognition of risk factors, laboratory test results, vaccine administration, monitoring of clinical signs and symptoms and patient education.

O presente protocolo aborda o risco, prevenção e tratamento da infeção no doente sob terapêutica imunomoduladora ou imunossupressoraem contexto de doença autoimune ou autoinflamatória. Subdivide-se nas seguintes secções: fármacos e risco associado de infeção; imunizações; risco, prevenção e tratamento de infeções específicas. Com um número crescente de novos fármacos em utilização nos últimos anos, o tratamento de doenças autoimunes envolve a utilização de terapêuticas imunossupressoras ou imunomoduladoras e associa-se a aumento do risco de infeção, que pode estar presente de uma forma global ou apenas para infeções por agentes específicos, variando amplamente consoante a classe farmacológica e mesmo dentro desta. Na estruturação da estratégia preventiva são fundamentais a caracterização da patologia que motiva a imunossupressão, a compreensão do mecanismo de ação do imunossupressor, a aferição de infeções prévias, o reconhecimento de fatores de risco, a realização de rastreios laboratoriais, a administração de vacinas, a educação do doente e a monitorização de sintomas e sinais clínicos, na dependência de uma gestão clínica necessariamente individualizada.

[Ocular manifestations associated to CD4+ in patients with human immunodeficiency virus]. / Manifestaciones oculares asociadas a CD4+ en pacientes con virus de inmunodeficiencia humana.

BACKGROUND: Since the first cases of human immunodeficiency virus (HIV), ocular manifestations secondary to infection have been known and these have been related to the CD4+ lymphocyte count. OBJECTIVE: To describe the correlation between ocular manifestations in patients with HIV and the CD4+ lymphocyte count. MATERIAL AND METHODS: Analytical cross-sectional study of patients with HIV whose CD4+ count was correlated with the presence of ophthalmological manifestations. RESULTS: 21 patients between 26 and 67 years were studied. Only 3 patients were not on antiretroviral therapy. 67% of the patients presented some type of ocular manifestation, 42% presented non-infection related manifestations, 47% related manifestations and 24% both. Conjunctival microangiopathy was the most frequent ocular manifestation (35.7%). There was a statistically significant correlation (r = 0.76, p = 0.0001) between eye manifestations related to infection and CD4+ lymphocyte count. CONCLUSIONS: Patients with HIV frequently present ocular manifestations, the majority related to infection; there is a correlation between the presence of these with the CD4+ count. However, a similar number of manifestations not related to infection occurred without correlation with the count; therefore, HIV patients should have periodic ophthalmological examinations, independently of CD4+ count.

INTRODUCCIÓN: desde los primeros casos de virus de inmunodeficiencia humana (VIH), se conocen manifestaciones oculares secundarias a la infección y estas se han relacionado con el conteo de linfocitos CD4+. OBJETIVO: describir la correlación entre las manifestaciones oculares en pacientes con VIH y el conteo de linfocitos CD4+. MATERIAL Y MÉTODOS: estudio transversal analítico de pacientes con VIH, en quienes se analizó la correlación entre conteo de CD4+ y manifestaciones oftalmológicas. RESULTADOS: se incluyeron 21 pacientes entre 26 y 67 años de edad. Solo tres no se encontraban en terapia antirretroviral. El 67% presentó algún tipo de manifestación ocular, 42% presentó manifestaciones no relacionadas con la infección, 47% manifestaciones relacionadas y 24% ambas. La microangiopatía de la conjuntiva fue la manifestación ocular más frecuente (35.7%). Hubo una correlación estadísticamente significativa (r = 0.76, p = 0.0001) entre las manifestaciones oculares relacionadas con la infección y el conteo de linfocitos CD4+. CONCLUSIONES: los pacientes con VIH presentan con frecuencia manifestaciones oculares, la mayoría asociadas a la infección. Existe correlación entre la presencia de estas con el conteo de CD4+; sin embargo, un número similar de manifestaciones no asociadas a la infección se presentaron sin correlación con el conteo, por lo que los pacientes con VIH deberían tener revisiones oftalmológicas periódicas, independientemente del conteo de CD4+.

[Aging, facing strategies of the aged and the consequences for family]. / Envelhecimento, estratégias de enfrentamento do idoso e repercussões na família.

This qualitative study seeks the understanding of the perception of the elderly, users of Basic Health Unit of São Paulo, on aging, coping strategies and impact on family. Interviews with three elderly people, from 71 to 90 years-old, were held from September 2007 to July'2008. Participants responded to questions under the Geriatric Depression Scale, Ecomapa, Genogram and Calgary model. From the Bardin analysis, we could determine three categories - the moment of realizing the life cycle; suffering the consequences of this time; facing the aging and old age. We believe in the continuity of studies that search for strategies with older people and their families in an attempt to improve life quality and family dynamics by the inclusion of entertainment, according to the possibilities offered to their communities.