Perfil de gestantes institucionalizadas da região noroeste do Paraná / Perfil de gestantes institucionalizadas de la región noroeste de Paraná / Profile of institutionalized pregnant women in the northwest region of Paraná

RESUMO Objetivo: Analisar o perfil sociodemográfico de gestantes em situação de risco. Métodos: Trata-se de um estudo retrospectivo, do tipo documental, com caráter quantitativo, realizado em uma instituição não governamental na região noroeste do Paraná. Foram analisados prontuários correspondentes aos anos de 2016 a 2019, totalizando 180 prontuários. Os dados foram compilados e processados por meio de estatística descritiva simples. Resultados: Foram analisados 180 prontuários, desses, constatou-se que a idade mínima das gestantes institucionalizadas estava entre 12 anos e 40 anos de idade, com a faixa etária predominante entre 21 e 30 anos. Dentre essas, 91 gestantes (50,54%) se autodeclaravam pardas ou pretas. Quanto ao grau de escolaridade, 107 (59,44%) possuíam ensino médio incompleto, e 95 (52,78%) já haviam tido uma gestação anterior. Dentre os principais motivos pelos quais as gestantes se encontravam em situação de vulnerabilidade, estavam os transtornos mentais, a violência doméstica e os conflitos familiares. Conclusão: Estudos que avaliem o perfil sociodemográfico das gestantes em situação de vulnerabilidade social são importantes para que profissionais de enfermagem possam reconhecer e elaborar estratégias para minimizar riscos para a saúde materno-infantil, estabelecer maior vínculo e assisti-las de forma integral por meio do pré-natal.

RESUMEN Objetivo: analizar el perfil sociodemográfico de gestantes en situación de riesgo. Métodos: se trata de un estudio retrospectivo, del tipo documental, con carácter cuantitativo, realizado en una institución no gubernamental en la región noroeste de Paraná-Brasil. Se analizaron registros médicos correspondientes a los años 2016 a 2019, totalizando 180 registros. Los datos fueron compilados y procesados por medio de estadística descriptiva simple. Resultados: se analizaron 180 registros médicos, de esos, se constató que la edad mínima de las gestantes institucionalizadas estaba entre 12 años y 40 años de edad, con la franja etaria predominante entre 21 y 30 años. De estas, 91 mujeres embarazadas (50,54%) se autodeclaraban pardas o negras. En cuanto al grado de escolaridad, 107 (59,44%) poseían enseñanza secundaria incompleta; y 95 (52,78%) ya habían tenido una gestación anterior. Entre los principales motivos por los cuales las embarazadas se encontraban en situación de vulnerabilidad, estaban los trastornos mentales, la violencia doméstica y los conflictos familiares. Conclusión: estudios que evalúen el perfil sociodemográfico de las gestantes en situación de vulnerabilidad social son importantes para que profesionales de enfermería puedan reconocer y elaborar estrategias para minimizar riesgos para la salud materno infantil, establecer mayor vínculo y asistirlas de forma integral por medio del prenatal.

ABSTRACT Objective: To analyze the sociodemographic profile of women at risk pregnancy. Methods: This is a quantitative retrospective study, of the documentary type, conducted in a non-governmental institution in the northwest region of Paraná. Records from the years 2016 to 2019 were analyzed, totaling 180 records. Data were compiled and processed using simple descriptive statistics. Results: A total of 180 medical records were analyzed, finding that the minimum age of institutionalized pregnant women was between 12 and 40 years, with the predominant age group between 21 and 30 years. Among these, 91 pregnant women (50.54%) declared themselves to be brown or black. As for the level of education, 107 (59.44%) had not completed high school, and 95 (52.78%) had already had a previous pregnancy. Among the main reasons why pregnant women were in a vulnerable condition were mental disorders, domestic violence, and family conflicts. Conclusion: Studies that evaluate the sociodemographic profile of pregnant women in conditions of social vulnerability are important so that nursing professionals can recognize and develop strategies to minimize risks to maternal and child health, establish a greater bond and assist them comprehensively through the prenatal.

Functional Outcomes of Patients with Schizophrenia After Hip Fracture Surgery: A 1-Year Follow-up from an Institutional Hip Fracture Registry.

BACKGROUND: Schizophrenia impairs a patient's self-care abilities, which are crucial after a hip fracture. Studies on the outcomes of patients with schizophrenia after a hip fracture are dated. This study aims to investigate the complication rates, 1-year mortality, and functional outcomes of surgically managed hip fractures in elderly patients with schizophrenia. METHODS: This is a retrospective, single-institution cohort study based on a prospectively maintained registry of patients with hip fracture. In this study, 3,056 patients who were ≥60 years of age were treated under a geriatric-orthopaedic hip fracture pathway from January 2014 to December 2018. Baseline demographic characteristics and the Modified Barthel Index (MBI) scores were obtained at admission and at 6 months and 1 year after the fracture. Complications from the fracture and the surgical procedure were recorded during a minimum follow-up period of 2 years. A matching process (based on age, sex, and the MBI at admission) of up to 6 patients without schizophrenia per 1 patient with schizophrenia was utilized to increase power. Differences in perioperative, 6-month, and 1-year outcomes were compared for significance among surgically managed patients with schizophrenia and patients without schizophrenia. RESULTS: Thirty-eight patients with schizophrenia were compared with 170 geriatric patients without schizophrenia who underwent a surgical procedure for a hip fracture. Patients with schizophrenia were more likely to be institutionalized postoperatively (26.3% compared with 4.7%; p < 0.001). Patients with schizophrenia had poorer MBI scores at 12 months (76 compared with 90 points; p = 0.006). The 1-year mortality rate was comparable (p = 0.29) between patients with schizophrenia (5.7%) and those without schizophrenia (2.4%). Similar trends in MBI were observed in the conservatively managed group of patients. CONCLUSIONS: There was no increase in postoperative complications after a surgical procedure for a hip fracture in elderly patients with schizophrenia. The 1-year mortality after a surgical procedure for hip fracture is similar in both patients with schizophrenia and those without schizophrenia. Patients with schizophrenia and hip fracture who were surgically managed had poorer 1-year functional outcomes compared with patients without schizophrenia matched for age, sex, and MBI at admission. This information will be useful in shared decision-making discussions with patients and families. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Alive and at home: Five-year outcomes in older adults following emergency general surgery.

BACKGROUND: While the short-term risks of emergency general surgery (EGS) admission among older adults have been studied, little is known about long-term functional outcomes in this population. Our objective was to evaluate the relationship between EGS admission and the probability of an older adult being alive and residing in their own home 5 years later. We also examined the extent to which specific EGS diagnoses, need for surgery, and frailty modified this relationship. METHODS: We performed a population-based, retrospective cohort study of community-dwelling older adults (age, ≥65 years) admitted to hospital for one of eight EGS diagnoses (appendicitis, cholecystitis, diverticulitis, strangulated hernia, bowel obstruction, peptic ulcer disease, intestinal ischemia, or perforated viscus) between 2006 and 2018 in Ontario, Canada. Cases were matched to controls from the general population. Time spent alive and at home (measured as time to nursing home admission or death) was compared between cases and controls using Kaplan-Meier analysis and Cox models. RESULTS: A total of 90,245 older adults admitted with an EGS diagnosis were matched with controls. In the 5 years following an EGS admission, cases experienced significantly fewer months alive and at home compared with controls (mean time, 43 vs. 50 months; p < 0.001). Except for patients operated on for appendicitis and cholecystitis, all remaining patient subgroups experienced reduced time alive and at home compared with controls (p < 0.001). Cases remained at elevated risk of nursing home admission or death compared with controls for the entirety of the 5-year follow-up (hazard ratio, 1.17-5.11). CONCLUSION: Older adults who required hospitalization for an EGS diagnosis were at higher risk for death or admission to a nursing home for at least 5 years following admission compared with controls. However, most patients (57%) remained alive and living in their own home at the end of this 5-year period. LEVEL OF EVIDENCE: Epidemiological, level III.

Long-Term Survival and Risk of Institutionalization in Onco-Geriatric Surgical Patients: Long-Term Results of the PREOP Study.

OBJECTIVES: To evaluate long-term survival and institutionalization in onco-geriatric surgical patients, and to analyze the association between these outcomes and a preoperative risk score. DESIGN: Prospective cohort study with long-term follow-up. SETTING: International and multicenter locations. PARTICIPANTS: Patients aged 70 years or older undergoing elective surgery for a malignant solid tumor at five centers (n = 229). MEASUREMENTS: We assessed long-term survival and institutionalization using the Preoperative Risk Estimation for Onco-geriatric Patients (PREOP) score, developed to predict the 30-day risk of major complications. The PREOP score collected data about sex, type of surgery, and the American Society for Anesthesiologists classification, as well as the Timed Up & Go test and the Nutritional Risk Screening results. An overall score higher than 8 was considered abnormal. RESULTS: We included 149 women and 80 men (median age = 76 y; interquartile range = 8). Survival at 1, 2, and 5 years postoperatively was 84%, 77%, and 56%, respectively. Moreover, survival at 1 year was worse for patients with a PREOP risk score higher than 8 (70%) compared with 8 or lower (91%). Of those alive at 1 year, 43 (26%) were institutionalized, and by 2 years, almost half of the entire cohort (46%) were institutionalized or had died. A PREOP risk score higher than 8 was associated with increased mortality (hazard ratio = 2.6; 95% confidence interval [CI] = 1.7-4.0), irrespective of stage and age, but not with being institutionalized (odds ratios = 1 y, 1.6 [95% CI = .7-3.8]; 2 y, 2.2 [95% CI = .9-5.5]). CONCLUSION: A high PREOP score is associated with mortality but not with remaining independent. Despite acceptable survival rates, physical function may deteriorate after surgery. It is imperative to discuss treatment goals and expectations preoperatively to determine if they are feasible. Using the PREOP risk score can provide an objective measure on which to base decisions. J Am Geriatr Soc 68:1235-1241, 2020.

Early experience with medical assistance in dying in Ontario, Canada: a cohort study.

BACKGROUND: Medical assistance in dying (MAiD) was legalized across Canada in June 2016. Some have expressed concern that patient requests for MAiD might be driven by poor access to palliative care and that social and economic vulnerability of patients may influence access to or receipt of MAiD. To examine these concerns, we describe Ontario's early experience with MAiD and compare MAiD decedents with the general population of decedents in Ontario. METHODS: We conducted a retrospective cohort study comparing all MAiD-related deaths with all deaths in Ontario, Canada, between June 7, 2016, and Oct. 31, 2018. Clinical and demographic characteristics were collected for all MAiD decedents and compared with those of all Ontario decedents when possible. We used logistic regression analyses to describe the association of demographic and clinical factors with receipt of MAiD. RESULTS: A total of 2241 patients (50.2% women) were included in the MAiD cohort, and 186 814 in the general Ontario decedent cohort. Recipients of MAiD reported both physical (99.5%) and psychologic suffering (96.4%) before the procedure. In 74.4% of cases, palliative care providers were involved in the patient's care at the time of the MAiD request. The statutory 10-day reflection period was shortened for 26.6% of people. Compared with all Ontario decedents, MAiD recipients were younger (mean 74.4 v. 77.0 yr, standardized difference 0.18);, more likely to be from a higher income quintile (24.9% v. 15.6%, standardized difference across quintiles 0.31); less likely to reside in an institution (6.3% v. 28.0%, standardized difference 0.6); more likely to be married (48.5% v. 40.6%) and less likely to be widowed (25.7% v. 35.8%, standardized difference 0.34); and more likely to have a cancer diagnosis (64.4% v. 27.6%, standardized difference 0.88 for diagnoses comparisons). INTERPRETATION: Recipients of MAiD were younger, had higher income, were substantially less likely to reside in an institution and were more likely to be married than decedents from the general population, suggesting that MAiD is unlikely to be driven by social or economic vulnerability. Given the high prevalence of physical and psychologic suffering, despite involvement of palliative care providers in caring for patients who request MAiD, future studies should aim to improve our understanding and treatment of the specific types of suffering that lead to a MAiD request.

Estimativas de impacto da COVID-19 na mortalidade de idosos institucionalizados no Brasil / Estimates of the impact of COVID-19 on mortality of institutionalized elderly in Brazil

Resumo O presente estudo tem como objetivo estimar o impacto da COVID-19 na mortalidade de idosos institucionalizados no Brasil. Foram estimados números de óbitos pela doença para o País, Unidades da Federação e Regiões, com base nas estimativas calculadas e efetuadas neste trabalho do percentual de óbitos de idosos que ocorreriam em instituições de longa permanência de acordo com os totais. Essa estimativa foi baseada em informações disponíveis para uma série de países. O percentual ponderado foi de 44,7%. Estimaram-se 107.538 óbitos de idosos nestas instituições no Brasil em 2020, por COVID-19. São previstos maiores números de óbitos na Região Sudeste (48.779 óbitos), seguida da Região Nordeste (28.451 óbitos); São Paulo é a Unidade da Federação que na estimativa será mais afetada (24.500 óbitos). Fica claro o forte impacto da COVID-19 na população idosa residente em instituições de longa permanência para idosos. As estimativas ultrapassam para o país 100 mil idosos, potencialmente os mais frágeis e vulneráveis, e são baseadas em número de óbitos totais conservador, tendo em vista outras estimativas e a situação alarmante de crescimento dos números de óbitos no Brasil.

Abstract The COVID-19 pandemic poses difficulties for long-term care institutions for the elderly, with increased mortality rates for the residents. This study aims to estimate the impact of COVID-19 on mortality of institutionalized elderly in Brazil. Estimates of the percentage of elderly deaths occurring in care homes were calculated for Brazil, States and Regions using estimates for the total number of deaths. The estimation was based upon information available for other countries. The weighted percentage was 44.7% and 107,538 COVID-19 deaths were estimated for the elderly in these institutions in Brazil in 2020. Higher numbers of deaths were expected in the Southeast Region (48,779 deaths), followed by the Northeast Region (28,451 deaths); São Paulo was the most affected State (24,500 deaths). The strong impact of COVID-19 on the elderly population living in long-term care facilities is clear. Estimates for the country exceeded 100,000 elderly people, potentially the most fragile and vulnerable, and are based upon a conservative number of total deaths, in view of other estimates and the alarming situation of death growth in Brazil from COVID-19.

Characterization of the self-perception of oral health in the Brazilian adult population / Caracterização da condição percebida de saúde bucal na população adulta brasileira

Abstract This article aims to perform an analysis of the factors that determine the self-perception of oral health of Brazilians, based on a multidimensional methodology basis. This is a cross-sectional study with data from a national survey. A household interview was conducted with a sample of 60,202 adults. Self-perception of oral health was considered the outcome variable and sociodemographic characteristics, self-care and oral health condition, use of dental services, general health and work condition as independent variables. The dimensionality reduction test was used and the variables that showed a relationship were submitted to logistic regression. The negative oral health condition was related to difficulty feeding, negative evaluation of the last dental appointment, negative self-perception of general health condition, not flossing, upper dental loss, and reason for the last dental appointment. The use of a multidimensional methodological basis was able to design explanatory models for the self-perception of oral health of Brazilian adults, and these results should be considered in the implementation, evaluation, and qualification of the oral health network.

Resumo O objetivo deste artigo é realizar uma análise dos fatores que determinam a autopercepção de saúde bucal dos brasileiros sob base metodológica multidimensional. Estudo transversal, com dados provenientes de inquérito em âmbito nacional. Foi realizada entrevista domiciliar com uma amostra de 60.202 adultos. Considerou-se a autopercepção de saúde bucal como variável desfecho e características sociodemográficas, de autocuidado e condição de saúde bucal, de utilização de serviços odontológicos, de condição de saúde geral e de trabalho como variáveis independentes. Empregou-se o teste de redução de dimensionalidade e as variáveis que apresentaram relação passaram pelo teste de regressão logística. A autopercepção negativa de saúde bucal apresentou-se relacionada à dificuldade para se alimentar, avaliação negativa do atendimento recebido durante a última consulta odontológica, autopercepção ruim da condição de saúde geral, não utilização de fio dental, perda dental superior e motivo da última consulta com o cirurgião dentista. A utilização de base metodológica multidimensional foi capaz de (re)desenhar modelos explicativos para a condição percebida de saúde bucal de adultos brasileiros, devendo, os seus resultados serem considerados na implementação, avaliação e qualificação da rede de saúde bucal.

Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions: a mixed-methods study protocol.

INTRODUCTION: Optimal medication management is one of the basic conditions necessary for home-dwelling older adults living with multiple chronic conditions (OAMCC) to be able to remain at home and preserve their quality of life. Currently, the reasons for such high numbers of emergency department visits and the very significant rate of hospitalisations for OAMCC, due to medication-related problems (MRPs), is poorly explored. This study aims to reveal the current state of the medication management practices of polymedicated, home-dwelling OAMCC and to make proposals for improving clinical and medication pathways through an innovative and integrated model for supporting medication management and preventing adverse health outcomes. METHODS AND ANALYSIS: A mixed-methods study will address the medication management of polymedicated, home-dwelling OAMCC. Its explanatory sequential design will involve two major phases conducted sequentially over time. The quantitative phase will consist of retrospectively exploiting the last 5 years of electronic patient records from a local hospital (N ≈ 50 000) in order to identify the different profiles-made up of patient-related, medication-related and environment-related factors-of the polymedicated, home-dwelling OAMCC at risk of hospitalisation, emergency department visits, hospital readmission (notably for MRPs), institutionalisation or early death. The qualitative study will involve: (a) obtaining and understanding the medication management practices and experiences of the identified profiles extracted from the hospital data of OAMCC who will be interviewed at home (N ≈ 30); (b) collecting and analysing the perspectives of the formal and informal caregivers involved in medication management at home in order to cross-reference perspectives about this important dimension of care at home. Finally, the mixed-methods findings will enable the development of an innovative, integrated model of medication management based on the Agency for Clinical Innovation framework and Bodenheimer and Sinsky's quadruple aim. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Human Research Ethics Committee of the Canton Vaud (2018-02196). Findings will be disseminated in peer-reviewed journals, professional conferences and other knowledge transfer activities with primary healthcare providers, hospital care units, informal caregivers' and patients' associations.

Sintomas depressivos e fatores associados em idosos residentes em instituição de longa permanência / Depressive symptoms and associated factors in elderly long-term care residents

Resumo O objetivo deste artigo é verificar a prevalência e fatores associados a sintomas depressivos em idosos institucionalizados. Trata-se de um estudo epidemiológico com delineamento transversal, composto por 42 idosos de uma Instituição de Longa Permanência para Idosos (ILPI). A coleta de dados foi realizada no período de abril a dezembro de 2014 por meio de um questionário com informações sobre aspectos demográficos e socioeconômicos, a Escala de Depressão Geriátrica em versão reduzida (EDG-15) e o Mini Exame do Estado Mental (MEEM). Dos idosos estudados, 54,8% apresentaram sintomas depressivos, predominando o sexo feminino com 64,7%. Houve associação significativa entre sintomas depressivos e as variáveis: aposentado (p = 0,043); incontinência urinária (p = 0,028); autopercepção de saúde (p-valor = 0,042) e qualidade do sono (p-valor = 0,000). O estudo verificou alta prevalência de sintomas depressivos em idosos institucionalizados, associado às variáveis presença de incontinência urinária, autopercepção de saúde (negativa), qualidade de sono (ruim) e aposentadoria (sim). Através do estudo e diante das necessidades enfrentadas por essa população, faz-se necessário a busca por medidas que atuem diretamente nas variáveis modificáveis, prevenindo e tratando-as.

Abstract Objective: To determine the prevalence and factors associated with depressive symptoms in institutionalized elderly. Methods: This is an epidemiological cross-sectional study with 42 elderly in a Long-Term Care Institution for the Elderly (LTCIE). Data was collected from April to December 2014 through a questionnaire with information on demographic and socioeconomic aspects, the Geriatric Depression Scale short version (GDS-15) and the Mini Mental State Examination (MMSE). Results: Of the elderly studied, 54.8% had depressive symptoms and were predominantly females (64.7%). There was a significant association between depressive symptoms and variables retired (p = 0.043); urinary incontinence (p = 0.028); self-perceived health (p-value = 0.042) and sleep quality (p-value = 0.000). Conclusion: The study found a high prevalence of depressive symptoms in institutionalized elderly, associated with the presence of urinary incontinence, (negative) self-perceived health, (poor) quality of sleep and retirement (yes). Following the study and in the face of the needs of this population, it is necessary to seek measures that act directly on the modifiable variables, preventing and treating them.

[Mortality and functional independence one year after hip fracture surgery: extracapsular fracture versus intracapsular fracture]. / Mortalité et indépendance fonctionnelle un an après chirurgie pour fracture de l'extrémité supérieure du fémur : comparaison fracture extracapsulaire versus fracture intracapsulaire.

OBJECTIVES: Outcome in hip fracture patients tends to be poor, with an associated death rate of 20 to 33%. The primary aim of our monocentric retrospective study was to compare mortality rates one year after surgery in patients with extracapsular fracture versus patients with intracapsular fracture of the proximal femur. Our secondary aims were the evaluation of functional independence and the rate of institutionalization one year after surgery. METHODS: We compared two groups of 100 patients. The first group had an average age of 83.2 years, and the patients underwent total hip replacement for intracapsular fracture. Patients in the second group, who underwent osteosynthesis for extracapsular fracture, were aged 83.6 years on average. RESULTS: One year post-surgery, there was not a significant difference in mortality between the two groups (23% for extracapsular fracture vs 22% for intracapsular fracture). The rate of independent walking was significantly better in the intracapsular fracture group (42.3% vs 27.3%, p=0.047), and the rate of institutionalization was significantly higher in the extracapsular fracture group (35.8% vs 17.3%, p=0.043). CONCLUSION: Elderly patients with hip fracture are prone to poor outcomes. When compared with osteosynthesis, total hip replacement does not lead to higher mortality rates though it is a more complex surgery. Our findings raise questions regarding of treatment for extracapsular fracture and the choice between osteosynthesis or total hip replacement with a reconstruction of the proximal femur.

How Chronic Is Polypharmacy in Old Age? A Longitudinal Nationwide Cohort Study.

OBJECTIVE: To evaluate the chronicity of polypharmacy among older adults and to identify factors associated with chronic polypharmacy. DESIGN: Longitudinal cohort study using register data. SETTING: Nationwide, Sweden. PARTICIPANTS: All 711,432 older adults (aged 65 years and older) living in Sweden with five or more prescription drugs in October 2010 were included and followed up until December 2013. Mean age at baseline was 77 (SD = 7.8) years, 59% were women, and 7% lived in nursing homes. MEASUREMENT: Monthly changes in the exposure to polypharmacy. Data regarding prescription drug use were extracted from the Swedish Prescribed Drugs Register. RESULTS: Overall, 82% were continuously exposed to polypharmacy for 6 months or longer, and 74% for 12 months or longer. The proportion of individuals who remained exposed until the end of the study was 55%. Among the 21,361 individuals who had not been exposed to polypharmacy during the 6-month period before baseline (ie, with a new episode of polypharmacy), only 30% remained exposed for 6 months or longer. The proportion of older adults who spent at least 80% of their follow-up time with polypharmacy was substantially higher among prevalent polypharmacy users at baseline than among those with a new polypharmacy episode (80% vs 24%; P < .01). Factors associated with chronic polypharmacy included higher age, female sex, living in an institution, chronic multimorbidity, and multidose dispensing. CONCLUSION: Polypharmacy is most often chronic, although a substantial share of older adults experience short, recurring episodes of polypharmacy and are thus exposed to its potential harms in a transient rather than persistent manner. J Am Geriatr Soc 67:455-462, 2019.

Quality of life of institutionalized aged with and without symptoms of depression / Calidad de vida de los ancianos institucionalizados con y sin síntomas de depresión / Qualidade de vida de idosos institucionalizados com e sem sinais de depressão

ABSTRACT Objective: compare the quality of life (QOL) of aged residents in homes for aged people with or without symptoms of depression, and identify social, physical activity; leisure; health and basic activities of daily living (ADL) variables that correlate with QOL scores. Method: cross-sectional study conducted with 101 institutionalized aged. Multiple linear regression was used for data analysis. Results: symptoms of depression changed negatively the QOL in the domains: autonomy; present, past and future activities; social participation; intimacy and total score. Dependent aged presented lower QOL for the performance of ADL in the domains: autonomy; social participation and total score; dancing without limitation of movement; liking the residential and not presenting symptoms of depression were the variables that positively influenced the QOL of the aged. Conclusion: social and psychological support, good living conditions and stimulating assistance can improve the QOL of institutionalized elderlies.

RESUMEN Objetivo: comparar la calidad de vida (CV) de los ancianos residentes en instituciones de larga permanencia con o sin síntomas de depresión, e identificar variables sociales, de actividad física, de ocio, de salud y de actividades básicas de la vida diaria (ABVD) que se correlacionan con las puntuaciones de CV. Método: estudio transversal realizado con 101 ancianos institucionalizados. Para el análisis de los datos se utilizó la regresión lineal múltiple. Resultados: los síntomas de depresión cambiaron negativamente la CV en los dominios: autonomía; actividades presentes, pasadas y futuras; participación social; intimidad y puntuación total. Los ancianos dependientes para la realización de la ABVD tuvieron menor CV en los dominios: autonomía, participación social y puntuación total; bailar sin limitación de movimiento, gustar de lo hogar, y no mostrar síntomas de depresión, fueron las variables que influenciaron de forma positiva en la CV de los ancianos. Conclusión: el apoyo social y psicológico, unas buenas condiciones de vida y una asistencia estimulante pueden mejorar la calidad de vida de los ancianos institucionalizados.

RESUMO Objetivo: comparar a qualidade de vida (QV) de idosos residentes em instituições de longa permanência com ou sem sinais de depressão, e identificar variáveis sociais, de atividade física, lazer, saúde e atividades básicas da vida diária (ABVD) que se correlacionam aos escores de QV. Método: estudo transversal realizado com 101 idosos institucionalizados. A regressão linear múltipla foi usada para a análise dos dados. Resultados: sinais de depressão alteraram negativamente a QV nos domínios: autonomia, atividades presentes, passadas e futuras, participação social, intimidade e escore total; idosos dependentes para a realização das ABVD apresentaram QV inferior nos domínios: autonomia, participação social e escore total; dançar sem limitação de movimento, gostar do residencial e não apresentar sinais de depressão foram as variáveis que influenciaram positivamente a QV dos idosos. Conclusão: suporte social e psicológico, boas condições de moradia e assistência estimuladora podem melhorar a QV de idosos institucionalizados.

Concept formation of ambience for labor and normal institutionalized delivery / Elaboración del concepto de ambiencia para el trabajo de parto y el parto normal institucionalizado / Formação do conceito ambiência para trabalho de parto e parto normal institucionalizado

ABSTRACT Objective: to develop the concept ambience for labor and normal institutionalized delivery, identifying in the literature its antecedent, defining attributes and the consequent. Method: the method used was the analysis of literature, corresponding to the first stage of the qualitative method of concept analysis. The theoretical operation was performed in the databases CINAHL COCHRANE, LILACS, PsycINFO, and PubMed. Results: aspects of the parturient woman and the qualification of the physical and social space are presented as the antecedent. The defining attributes outline the assistance interaction process with Non-Invasive Technologies. As the consequent, we highlight the outcome for normal delivery, pain relief and comfort, woman satisfaction and well-being. Final considerations: the analysis of the antecedent, defining attributes and the consequent allowed the elaboration of an unprecedent theoretical proposition of this concept.

RESUMEN Objetivo: elaborar el concepto ambiencia para el trabajo de parto y el parto normal institucionalizado, identificando en la literatura sus antecedentes, sus atributos definidores y consecuentes. Método: se utilizó el método de análisis crítico de la literatura, que corresponde al primer paso de la metodología cualitativa del análisis de concepto. Se hizo una búsqueda teórica en las bases de datos CINAHL, COCHRANE, LILACS, PsycINFO y PubMed. Resultados: los elementos relativos a la parturienta y a la calificación del espacio físico y social se presentan como antecedentes. Los atributos definidores delimitan el proceso de interacción de la atención con el uso de las tecnologías no invasivas. Ya de los consecuentes, se destacan el resultado del parto normal, el alivio del dolor y comodidad, la satisfacción y el bienestar de la parturienta. Consideraciones finales: el análisis de los antecedentes, atributos definidores y consecuentes permitieron elaborar una propuesta teórica inédita de este concepto.

RESUMO Objetivo: elaborar o conceito ambiência para trabalho de parto e parto normal institucionalizado, identificando na literatura seus antecedentes, atributos definidores e consequentes. Método: empregou-se o método da análise crítica da literatura, correspondendo à primeira etapa da metodologia qualitativa de análise de conceito. A exploração teórica foi realizada nas bases de dados CINAHL, COCHRANE, LILACS, PsycINFO e PubMed. Resultados: elementos referentes à parturiente e à qualificação do espaço físico e social são apresentados como antecedentes. Os atributos definidores delineiam o processo de interação assistencial com o uso das Tecnologias Não Invasivas. Como consequentes, destacam-se desfecho para o parto normal, alívio e conforto da dor, satisfação e bem-estar da parturiente. Considerações finais: a análise dos antecedentes, atributos definidores e consequentes permitiu elaborar uma proposição teórica inédita desse conceito.

Prevalence and factors associated with alterations of the temporomandibular joint in institutionalized elderly / Prevalência e fatores associados a alterações na articulação temporomandibular em idosos institucionalizados

Abstract This article aims to analyze the prevalence and associated factors of TMJ alterations in elderly institutionalized. An cross-sectional study of 1192 elderly institutionalized in Brazil was undertaken. Intra and extra-oral exams were performed and the TMJ was evaluated based on the Oral Health Assessment Form of the WHO (1997). Demographic data and elderly dependence were also collected. The self-perception of the elderly regarding oral health was measured using the Geriatric Oral Health Assessment Index - GOHAI. Data analysis was performed using the Chi-squared test and robust Poisson regression (level of significance of 5%). The prevalence of TMJ alteration was low compared to adults and was only associated with the state of dependence of the elderly individual (independent had 45.4% more alterations than dependent individuals), gender (women had 47.4% more alterations), self-perception of oral health (who evaluated negatively had 65.6% more alterations) and the need of upper dentures (who needed some kind of upper dentures had 45.8% more alterations than those who did not). Despite being low, the presence of alterations in the TMJ was more frequent in elderly independent, women, who evaluated negatively oral health and need some kind of upper dentures.

Resumo O objetivo deste artigo é avaliar a prevalência e os fatores associados a alterações na ATM em idosos institucionalizados. Estudo observacional e transversal, conduzido em 1.192 idosos brasileiros. Foram realizados exames intra e extraoral, baseados na Ficha de Avaliação da OMS (1997). Dados demográficos e nível de dependência também foram coletados. A autopercepção do idoso quanto à saúde bucal foi obtida através do GOHAI (Geriatric Oral Health Assessment Index). Na análise dos dados foram usados o teste do Qui-quadrado e a Regressão robusta de Poisson (nível de significância de 5%). A presença de alguma alteração na ATM foi pouco prevalente quando comparada a dos adultos, e esteve associada à condição de dependência do idoso (os independentes tiveram 45,4% mais alterações do que os dependentes), ao sexo (mulheres tiveram 47,4% mais alterações), à autopercepção de saúde bucal (quem avaliou negativamente teve 65,6% mais alterações) e à necessidade de prótese (PT) superior (quem necessita de algum tipo de PT superior teve 45,8%). Apesar de ter sido baixa, a presença de alterações na ATM esteve mais frequente em idosos independentes, do sexo feminino, que avaliaram negativamente a saúde bucal e que necessitam de algum tipo de PT superior.

Frequency of metabolic syndrome and associated factors in institutionalized elderly individuals.

INTRODUCTION: Population aging generally accompanies an increase in chronic noncommunicable diseases, such as metabolic syndrome (MS). Nursing homes have provided a solution for the decreased ability of elderly individuals for self-care and familial difficulties in meeting the health care needs of elderly individuals. PURPOSE: The aim of the present study was to determine the frequency of MS and its associated factors in elderly individuals living in nursing homes. PATIENTS AND METHODS: This cross-sectional study was conducted with 202 institutionalized elderly individuals. MS was diagnosed according to the National Cholesterol Education Program - Adult Treatment Panel III criteria. Sociodemographic, clinical, and lifestyle factors were assessed to verify their association with MS by logistic regression. RESULTS: The MS frequency was 29.2%. The most frequent MS components were low high-density lipoprotein cholesterol level (63.9%) and abdominal obesity (42.7%). Factors associated with MS were female sex (prevalence ratio [PR]=2.16; 95% CI, 1.04-4.49), age-adjusted institutionalization time >50% (PR=2.38, 95% CI, 1.46-3.88), and high concentrations of interleukin-6 (PR=2.01; 95% CI, 1.21-3.32) and tumor necrosis factor-α (PR=1.70; 95% CI, 1.05-2.77). Moreover, it was verified that the likelihood of having MS was 1.85-fold higher (95% CI, 1.11-3.10) in the group with a diet characterized by very high energy, very low fat, and high dietary fiber. CONCLUSION: The occurrence of MS in institutionalized elderly individuals was higher in females, and individuals with longer age-adjusted institutionalization time, higher concentrations of immunologic biomarkers, and a dietary intake consisting of higher energy and fiber and lower total fat. The results of the study are useful for guiding health care programs aimed at institutionalized elderly individuals.

Prevalence of oral lesions and chronic non-communicable diseases in a sample of chilean institutionalized versus non-institutionalized elderly

Chile is experiencing a process of demographic aging with an increase in the number of elderly people, a percentage of which resides in long-term establishments for the elderly (LEE). however, there is little information on the reality of the elderly in these long-term care facilities, so this study was conducted to compare the epidemiological profile of the prevalent oral pathologies as well as chronic non-communicable diseases (NCDs), of institutionalized versus non-institutionalized elderly subjects. seventy-six institutionalized and forty-three non-institutionalized subjects were examined intraorally, and their clinical health record, gender and age were obtained, according to inclusion/exclusion criteria. the results indicate that female gender is the most common, with an average age of 78.5 year, with those 80 years old and above comprising the predominant group. the most prevalent oral lesions within the institutionalized group were denture stomatitis and irritative hyperplasia, while in the non-institutionalized these two lesions were found less frequently. as for the presence of xerostomia, there was no difference between the groups. the most common condition in both groups was total maxillary and mandibular edentulous, with the latter variable present more frequently in the institutionalized group (p<0.05). the predominant NCD for both groups were arterial hypertension, arthritis-osteoarthritis and diabetes mellitus (p>0.05), and depression was the most prevalent NCD in the non-institutionalized group (p<0.05). this study provides valuable information on the epidemiology of elderly´s oral lesions and NCDs to inform the decision-making process of public health policies.

Health profiles in people with intellectual developmental disorders / Perfiles de salud en personas con trastornos del desarrollo intelectual

Abstract: Objective: To better understand the health profiles of people with intellectual disability (ID), focusing on the variables that are associated with a poorer health status. Materials and methods: Data were collected from the Survey on Disability, Personal Autonomy and Dependency (EDAD 2008) of the Spanish National Statistics Institute (INE). The health data of 2840 subjects with IDD were analyzed in order to verify the impact of different variables on their health profiles. Results: People with severe and profound levels of IDD presented a higher number of medical diagnoses. At residence centers there was a larger proportion of individuals with a higher prevalence of chronic diseases and more severe conditions; age also was an important factor. Conclusion: The health profiles of individuals with IDD differ depending on the severity level of their IDD and their degree of institutionalization. Further research is needed to provide better health care for people with IDD.

Resumen: Objetivo: Conocer los perfiles de salud de las personas con discapacidad intelectual (DI), incidiendo en las variables que se relacionan con un peor estado de salud. Material y métodos: Se han empleado datos procedentes de la Encuesta sobre Discapacidades, Autonomía personal y situaciones de Dependencia (EDAD 2008) del Instituto Nacional de Estadística (INE). Se han comparado los datos de salud de 2840 sujetos con discapacidad intelectual para analizar las diferencias en sus perfiles de salud. Resultados: En los centros residenciales hay una mayor proporción de personas con DI profunda y severa, de edad más avanzada y con mayor prevalencia de enfermedades crónicas. Las personas con niveles más graves de DI presentan un mayor número de diagnósticos de enfermedades. Conclusión: Los perfiles de salud de las personas con DI difieren en función de su grado de institucionalización y su nivel de DI. Es necesario seguir investigando para ofrecer una mejor atención sanitaria a las personas con DI.

Falls in institutionalized older adults: risks, consequences and antecedents / Caídas de personas mayores institucionalizadas: riesgos, consecuencias y antecedentes antecedents / Quedas em idosos institucionalizados: riscos, consequências e antecedentes

ABSTRACT Objective: To analyze the occurrence of falls in institutionalized elderly addressing the risks, consequences and antecedents. Method: Cross-sectional study carried out with 45 older adults in Long-Term Care Facilities for the Older adult in João Pessoa, Brazil, in June and July 2016. A socio-demographic questionnaire and the Berg Balance Scale were applied, classifying as risk of fall scores lower than 45. Descriptive statistics and tests were conducted: independent t-test, Anova (Tukey), Chi-square, Mann Whitney. Statistically significance was p <0.05. Data were processed in SPSS version 19.0. Results: A total of 66.7% (30) falls occurred, 20% (9) of them in the external area, with 66.7% (30) of the participants having hypertension as a previous disease and, as consequence, the fracture was highlighted with 11.2% (5). The Berg Scale had different scores when compared to the falls suffered by the elderly and previous diseases influenced the occurrence of falls (p <0.05). Conclusion: It is necessary to implement public financing policies or partnerships that allow environments adaptations aiming at reducing the risks of falls.

RESUMEN Objetivo: Analizar los riesgos, consecuencias y antecedentes de caídas en personas mayores institucionalizadas. Método: Se trata de un estudio transversal, realizado entre 45 personas mayores e internadas en Instituciones de Cuidado a Largo Plazo en João Pessoa, Paraíba, Brasil, entre junio y julio de 2016. Se aplicó el cuestionario sociodemográfico y la Escala de Equilibrio de Berg clasificando el riesgo de caídas cuando la puntuación era inferior a 45. Se utilizó la estadística descriptiva y las pruebas: t de Student independiente, Anova (Tukey), distribución de Pearson (Ji-Cuadrado), Mann Whitney y se consideró significativamente estadístico p < 0,05. Se procesó en el SPSS versión 19.0. Resultados: Las caídas ocurrieron en el 66,7% de las personas mayores (30), el 20% (9) en el área externa y el 66,7% (30) con enfermedad previa de hipertensión; cabe resaltar fracturas en el 11,2% (5). La Escala de Berg evaluó puntuaciones diferentes (p < 0,05) al comparar las caídas sufridas por las personas mayores resaltando que las enfermedades previas influenciaron el suceso de caídas (p < 0,05). Conclusión: Es necesario implantar políticas públicas de financiación o crear asociaciones que posibiliten la adaptación de los diversos ambientes con el objetivo de reducir los riesgos de caídas.

RESUMO Objetivo: Analisar a ocorrência de quedas em idosos institucionalizados quanto aos riscos, consequências e antecedentes. Método: Estudo transversal, realizado com 45 idosos em Instituições de Longa Permanência para Idosos em João Pessoa/PB, Brasil, em junho e julho de 2016. Aplicou-se questionário sociodemográfico e Escala de Equilíbrio de Berg classificando risco de quedas quando escore inferior a 45. Realizou-se estatística descritiva e testes: t independente, Anova (Tukey), Qui-quadrado, Mann Whitney. Considerado significativamente estatístico p < 0,05 e processados no SPSS versão 19.0. Resultados: As quedas ocorreram em 66,7% (30), sendo 20% (9) na área externa, 66,7% (30) com doença prévia hipertensão e como consequência destacou-se fratura com 11,2% (5). A Escala de Berg avaliou pontuações diferentes (p < 0,05) quando comparadas às quedas sofridas pelos idosos, e as doenças prévias influenciaram ocorrência de quedas (p < 0,05). Conclusão: Necessita-se implementar políticas públicas de financiamento ou parcerias que possibilitem adaptação dos ambientes visando a redução dos riscos de quedas.