Identification and characteristics of patients with palliative care needs in Brazilian primary care.

BACKGROUND: The Brazilian healthcare system offers universal coverage but lacks information about how patients with PC needs are serviced by its primary care program, Estratégia Saúde da Família (ESF). METHODS: Cross-sectional study in community settings. Patients in ESF program were screened using a Palliative Care Screening Tool (PCST). Included patients were assessed with Karnofsky Performance Scale (KPS), Edmonton Symptom Assessment System (ESAS) and Palliative Care Outcome Scale (POS). RESULTS: Patients with PC needs are accessing the ESF program regardless of there being no specific PC support provided. From 238 patients identified, 73 (43 women, 30 men) were identified as having a need for PC, and the mean age was 77.18 (95 % Confidence Interval = ±2,78) years, with non-malignant neurologic conditions, such as dementia and cerebrovascular diseases, being the most common (53 % of all patients). Chronic conditions (2 or more years) were found in 70 % of these patients, with 71 % scoring 50 or less points in the KPS. Overall symptom intensity was low, with the exception of some cases with moderate and high score, and POS average score was 14.16 points (minimum = 4; maximum = 28). Most patients received medication and professional support through the primary care units, but limitations of services were identified, including lack of home visits and limited multi-professional approaches. CONCLUSION: Patients with PC needs were identified in ESF program. Basic health care support is provided but there is a lack of attention to some specific needs. PC policies and professional training should be implemented to improve this area.

Bidirectional associations between chronic low back pain and sleep quality: A cohort study with schoolteachers.

AIMS: Although both chronic low back pain (cLBP) and sleep problems are prevalent among active workers, the relation between these variables is not well established. This study aimed to examine the bidirectional association between cLBP and sleep in schoolteachers. METHODS: The Pittsburgh Sleep Quality Index (PSQI) and cLBP were self-reported by 530 schoolteachers in Londrina, Brazil, at baseline and after 2 years of follow-up. Generalized estimating equations were adjusted for sociodemographic, lifestyle and mental health variables. RESULTS: Poor sleep quality at baseline was associated with cLBP at follow-up after adjusting for sociodemographic and lifestyle variables (OR=1.61; 95% confidence interval [95% CI]=1.06, 2.47). Changes in the PSQI score over time were also associated with a higher likelihood of cLBP at follow-up (OR=1.13; 95% CI=1.07, 1.20 for each 1-point increase in the PSQI score), regardless of mental health condition. cLBP at baseline was associated with worse sleep quality at follow-up after adjusting for sociodemographic and lifestyle variables (OR=1.56; 95% CI=1.02, 2.37). The presence of cLBP also changed the PSQI score over time (ß coefficient=1.153; 95% CI=0.493, 1.814). CONCLUSIONS: Worse sleep quality was prospectively and bidirectionally associated with cLBP. Concretely, changes in PSQI values after 2 years of follow-up increased the likelihood of reporting cLBP, and baseline cLBP was associated with sleep quality worsening (i.e., higher score in the PSQI). Mental health conditions such as self-rated health, depression and anxiety play a relevant confounding role in the bidirectional associations between sleep and chronic low back pain.

[Relationship between body mass index, waist circumference, and waist-to-hip ratio and mortality in elderly women: a 5-year follow-up study]. / Relação do índice de massa corporal, da relação cintura-quadril e da circunferência abdominal com a mortalidade em mulheres idosas: seguimento de 5 anos.

This study examines the association between body mass index (BMI), waist-to-hip ratio (WHR), and waist circumference (WC) and all-cause and cardiovascular mortality in elderly women in a 5-year longitudinal study of 575 female outpatients 60 years and over. The highest BMI, WHR, and WC quartiles and predefined BMI categories were analyzed as predictive variables. Death occurred in 88 (15.4%). Underweight (BMI < 18.5 kg/m2) was associated with all-cause mortality in uni- and multivariate analyses, regardless of age bracket. The survival curves and univariate analysis showed that the highest WHR quartile (> or = 0.97) was associated with all-cause mortality. However, after adjustment for age, smoking, and previous cardiovascular diseases, the increase in WHR was positively associated only in women from 60 to 80 years of age. None of the anthropometric measurements was associated with cardiovascular mortality. The results indicate that underweight and increased waist-to-hip ratio were predictors of all-cause mortality in elderly women, mainly among those under 80 years.

Influenza vaccination in non-institutionalized elderly: a population-based study in a medium-sized city in Southern Brazil.

Vaccination is the most effective measure to prevent the complications of influenza. This population-based study aimed to estimate influenza vaccine coverage in non-institutionalized elderly, analyze the factors involved in lack of influenza vaccine uptake, and identify post-vaccination adverse effects. The study population lived in an urban neighborhood in Southern Brazil, and the sample consisted of 425 elderly. A total of 396 elderly individuals (age 60-95 years) were interviewed. Although 100% of the sample reported knowing about the vaccine, only 5.3% referred to their personal doctor as the source of information. Among elders that had not received the vaccine, 83.2% were explicit about not wanting to take it. The main reasons were fear of adverse effects and disbelief in the vaccine's effectiveness. However, the actual prevalence of adverse effects was low. Age, smoking, and lack of a doctor's appointment in the previous year were independently associated with vaccine non-compliance. The results show that improvements are needed in the immunization campaign, especially targeting elders less than 70 years of age and smokers.

Body weight dissatisfaction and its correlates among Brazilian adolescents / Insatisfação com peso corporal e correlatos entre adolescentes brasileiros

OBJECTIVE: This study examined the prevalence of body weight dissatisfaction and its relationship to physical activity and nutritional status in adolescents. METHOD: The study enrolled 2,288 adolescents. The dependent variable was body weight dissatisfaction. The independent variables were physical activity and nutritional status. The confounders were gender, and economic condition. Associations between dependent and independent variables were analyzed through the chi-square test and the magnitude of the associations was estimated by Poisson regression. RESULTS: A total of 56.6% of adolescents were not satisfied with their weight, with 17.9% wanting to increase it, while 37.7% wanted to decrease their weight. In boys and girls, body weight dissatisfaction was associated with nutritional status, abdominal obesity and physical activity in crude analyses. After adjustments, nutritional status and abdominal obesity remained significantly associated to body weight dissatisfaction in both sexes. CONCLUSION: A high prevalence of body weight dissatisfaction was identified, which was associated with the nutritional status and abdominal obesity in adolescents.

RESUMO OBJETIVOS: Esse estudo teve como objetivo analisar a prevalência de insatisfação com o peso corporal e sua relação com atividade física e estado nutricional em adolescentes. MÉTODO: O estudo envolveu 2.288 adolescentes. A variável dependente foi a insatisfação com o peso corporal. As variáveis independentes foram a atividade física e estado nutricional. Os fatores de confusão foram: sexo e condição econômica. As associações entre as variáveis dependentes e independentes foram analisadas por meio do teste do qui-quadrado e a magnitude das associações foi estimada pela regressão de Poisson. RESULTADOS: Um total de 56,6% dos adolescentes não se declararam satisfeitos com seu peso, 17,9% queriam aumentar, enquanto que 37,7% queriam diminuir o seu peso. Entre meninos e meninas, a insatisfação como peso corporal associou-se com o estado nutricional, obesidade abdominal e atividade física em análises primárias. Após os ajustes, o estado nutricional e a obesidade abdominal permaneceram significativamente associados à insatisfação com o peso corporal em ambos os sexos. CONCLUSÕES: Uma elevada prevalência de insatisfação com o peso corporal foi identificada e associada com o estado nutricional e com obesidade abdominal em adolescentes.

Use of drugs that act on the cytochrome P450 system in the elderly.

OBJECTIVES: The objective of this study was to analyze medications that act on the cytochrome P450 (CYP450) enzymatic system and are used daily by non-institutionalized elderly individuals. METHODS: A cross-sectional population-based study of elderly individuals (> or = 60 years old) was conducted. All continuously used medications with hepatic metabolism via CYP450 that are classified as substrates, inducers or inhibitors were considered. For the analysis, elderly individuals were stratified according to age groups, and hepatic metabolism activity due to daily alcohol consumption and smoking were considered. RESULTS: Elderly individuals (396 in total: 222 women and 174 men) between 60 and 95 years of age (mean: 72.1) were assessed. Use of drugs that act on CYP450 was identified in 61.6% of the subjects. Drug use was observed among 16.2% of the subjects: three drugs among 9.8% and four or more among 6.3% of the subjects. The metabolic activities of the drugs used were classified as substrates (58.8%), inhibitors (14.9%), and inducers (4.3%). The main drugs used were beta-blockers and statins (as substrates), proton pump inhibitors and fluoxetine (as inhibitors), and prednisone and carbamazepine (as inducers). CONCLUSIONS: The results demonstrate that the elderly use high levels of medications that act on CYP450, thereby increasing the risk of drug interactions in a group that is already vulnerable to adverse drug effects.

Metabolic syndrome, abdominal obesity, and cardiovascular risk in elderly women.

BACKGROUND: Metabolic syndrome and abdominal obesity are risk factors for cardiovascular diseases in middle age women but, not completely understood in older people. In this study we analyzed the association between metabolic syndrome and abdominal obesity and the occurrence of cardiovascular events in these elderly women. METHODS: A prospective follow-up study included 516 consecutive women aged 60-84 years who sought medical care at a geriatric outpatient facility. The presence of metabolic syndrome and higher quartiles of waist circumference and waist-to-hip ratio were analyzed as predictive variables, and were adjusted for age, smoking, and previous cardiovascular diseases. The outcomes were the occurrence of stroke, myocardial infarction, evidence of coronary artery disease, or cardiovascular death. RESULTS: During a mean follow-up of 6.6 years, 94 (18.2%) cardiovascular events were observed (48 fatal and 46 non-fatal). Metabolic syndrome was diagnosed in 206 women (39.9%). After adjustments for confounding variables, metabolic syndrome and waist-to-hip ratio above the 75th percentile (>0.98) were predictors of the outcomes, but greater waist circumference (>96 cm) was not. Adjusted hazard ratios for these variables were: metabolic syndrome, 1.66, 95% CI -1.11 to 2.47, p=0.01; waist-to-hip ratio, 1.72, 95% CI -1.05 to 2.82; p=0.03 and waist circumference, 1.37, 95% CI -0.91 to 2.07, p=0.12. CONCLUSION: Metabolic syndrome and high waist-to-hip ratio were associated with increased risk of cardiovascular events in the studied sample.

Influenza vaccination in non-institutionalized elderly: a population-based study in a medium-sized city in Southern Brazil / Vacinação contra a gripe em idosos não-institucionalizados: estudo de base populacional em município de médio porte do Sul do Brasil

Vaccination is the most effective measure to prevent the complications of influenza. This population-based study aimed to estimate influenza vaccine coverage in non-institutionalized elderly, analyze the factors involved in lack of influenza vaccine uptake, and identify post-vaccination adverse effects. The study population lived in an urban neighborhood in Southern Brazil, and the sample consisted of 425 elderly. A total of 396 elderly individuals (age 60-95 years) were interviewed. Although 100 percent of the sample reported knowing about the vaccine, only 5.3 percent referred to their personal doctor as the source of information. Among elders that had not received the vaccine, 83.2 percent were explicit about not wanting to take it. The main reasons were fear of adverse effects and disbelief in the vaccine's effectiveness. However, the actual prevalence of adverse effects was low. Age, smoking, and lack of a doctor's appointment in the previous year were independently associated with vaccine non-compliance. The results show that improvements are needed in the immunization campaign, especially targeting elders less than 70 years of age and smokers.

A medida mais efetiva para evitar complicações da gripe é a vacinação. Os objetivos deste estudo de base populacional foram: estimar a cobertura vacinal contra a gripe em idosos não institucionalizados, analisar os fatores associados à não-adesão e identificar os eventos adversos pós-vacinais. A população de estudo foi constituída por idosos residentes em um município do Sul do Brasil. A amostra foi calculada em 425 idosos. Foram entrevistados 396 idosos, com idade entre 60 e 95 anos. Embora 100 por cento dos idosos referissem conhecer a vacina, apenas 5,3 por cento referiram o médico como fonte da informação. Dentre os que não se vacinaram 83,2 por cento alegaram como motivo da não-adesão o desejo explícito de não ser vacinado. As principais justificativas para isso foram o medo de eventos adversos e a falta de credibilidade na eficácia da vacina. A prevalência de eventos adversos foi baixa. Idade, tabagismo e ter referido ausência de consulta médica no último ano associaram-se a menor adesão. Evidenciou-se a necessidade de melhorias nas campanhas vacinais para idosos abaixo de 70 anos e idosos tabagistas.

Use of drugs that act on the cytochrome P450 system in the elderly

OBJECTIVES: The objective of this study was to analyze medications that act on the cytochrome P450 (CYP450) enzymatic system and are used daily by non-institutionalized elderly individuals. METHODS: A cross-sectional population-based study of elderly individuals (> 60 years old) was conducted. All continuously used medications with hepatic metabolism via CYP450 that are classified as substrates, inducers or inhibitors were considered. For the analysis, elderly individuals were stratified according to age groups, and hepatic metabolism activity due to daily alcohol consumption and smoking were considered. RESULTS: Elderly individuals (396 in total: 222 women and 174 men) between 60 and 95 years of age (mean: 72.1) were assessed. Use of drugs that act on CYP450 was identified in 61.6 percent of the subjects. Drug use was observed among 16.2 percent of the subjects: three drugs among 9.8 percent and four or more among 6.3 percent of the subjects. The metabolic activities of the drugs used were classified as substrates (58.8 percent), inhibitors (14.9 percent), and inducers (4.3 percent). The main drugs used were beta-blockers and statins (as substrates), proton pump inhibitors and fluoxetine (as inhibitors), and prednisone and carbamazepine (as inducers). CONCLUSIONS: The results demonstrate that the elderly use high levels of medications that act on CYP450, thereby increasing the risk of drug interactions in a group that is already vulnerable to adverse drug effects.

Relação do índice de massa corporal, da relação cintura-quadril e da circunferência abdominal com a mortalidade em mulheres idosas: seguimento de 5 anos / Relationship between body mass index, waist circumference, and waist-to-hip ratio and mortality in elderly women: a 5-year follow-up study

Este estudo analisa a associação entre a relação cintura-quadril (RCQ), a circunferência abdominal (CA) e o índice de massa corporal (IMC) com a mortalidade total e cardiovascular em 575 mulheres idosas ambulatoriais por um seguimento de cinco anos. Os maiores quartis de RCQ, CA e IMC, bem como as categorias pré-determinadas de IMC, foram analisados como variáveis preditivas e analisada a interferência de algumas variáveis confundidoras. Oitenta e oito mulheres morreram durante o seguimento (15,4 por cento). As mulheres com baixo peso (IMC < 18,5kg/m²) apresentavam uma associação positiva com a mortalidade total nas análises uni e multivariadas, independentemente da estratificação etária. Nas curvas de sobrevida e na análise univariada, o maior quartil de RCQ (> 0,97) estava associado com a maior mortalidade total, entretanto, na análise multivariada o aumento de RCQ apresentou uma associação independente com a mortalidade total, apenas entre as mulheres de 60 a 80 anos. Nenhuma medida antropométrica apresentou uma associação significativa com a mortalidade cardiovascular. Os resultados identificaram o baixo peso e a RCQ como preditores de mortalidade total em idosas, principalmente entre as mulheres com até 80 anos.

Obesidade em idosos: prevalência, distribuiçäo e associaçäo com hábitos e co-morbidades / Elderly obesity: prevalence, distribution and association between hahits and co-morbidity

Objetivos: Identificar a prevalência de obesidade global e central através do índice de massa corpórea (IMC) e razäo cintura-quadril (RCQ), e suas associaçöes como o diabetes melito (DM), a hipertensäo arterial (HA), a hipercolesterolemia, os baixos níveis de lipoproteína colesterol de alta densidade (HDL-c), a hipertrigliceridemia, nível social, a atividade física e o tabagismo em populaçäo de idosos atendida em ambulatórios. Metodologia: Foram avaliados 847 idosos ambulatoriais com 60 anos ou mais, através de um estudo transversal. Resultados: A obesidade definida pelo IMCz 30kg/m2 foi identificada em 9,3 por cento dos homens e 23,8 por cento das mulheres (p< 0,001), sendo menor entre os idosos com 80 anos ou mais, em ambos os sexos (p< 0,05). Em homens obesos, identificou-se uma maior freqüência de DM, HDL-c baixo e hipertrigliceridemia, quando comparados aos homens com IMC< 30kg/m2. As mulheres obesas apresentavam uma freqüência maior apenas de HA. Os pacientes com RCQz percentil 75 (RCQ> 1,01 para homens e RCQ> 0,96 para mulheres) apresentavam maiores freqüências de HA, DM, HDL-c baixo e hipertrigliceridemia no sexo masculino e HA e DM no sexo feminino. Conclusöes: Os resultados revelam diferenças em relaçäo ao sexo, com os homens apresentando menor prevalência de obesidade e maiores associaçöes entre IMC ou RCQ com os fatores de riscos relacionados à gordura corpórea. Os dados obtidos por este estudo contribuem para ampliaçäo do referencial antropométrico dos idosos, além de identificarem as correlaçöes entre os indicadores antropométricos e as alteraçöes metabólicas associadas à obesidade.

Uniäo da Vitória: crescendo sem drogas e álcool / Uniäo da Vitória: growing without drugs and alcohol

Uniäo da Vitória é considerado um dos bairros mais pobres de Londrina tendo como principais fatores o desemprego e a marginalizaçäo. Nascido de um conflito entre trabalhadores rurais e a mecanizaçäo da lavoura, este bairro tem uma força e uma uniäo característica de luta pelos direitos humanos. Pesquisou-se o que os moradores da Uniäo da Vitória na faixa etária entre 13 e 25 anos possuíam de informaçöes sobre álcool e drogas. Foi um desafio enfrentado pelo grupo com o objetivo de conseguir transmitir algo produtivo e construtivo para uma populaçäo com a mente pré-formada nas bases do seu cotidiano