Can internet use reduce the incidence of cognitive impairment? Analysis of the EpiFloripa Aging Cohort Study (2009-2019).

This study aims to estimate the effect of internet use on the incidence of cognitive impairment in older adults. Data are from the EpiFloripa Aging Cohort Study which has been following a population-based sample of older adults (60+) residing in Florianópolis, southern Brazil, for ten years. The outcome was the incidence of cognitive decline in follow-up waves measured by the Mini-Mental State Examination using cutoff points according to education. The exposure was internet use according to wave (yes/no). We excluded individuals with cognitive impairment from Wave 1 (n = 453). We used a longitudinal analysis model (Generalized Estimating Equations) to estimate incidence rate ratios (IRR) with 95% confidence intervals. We estimated the risk of cognitive impairment in Wave 2 or Wave 3 according to internet use in the previous wave. The incidence of cognitive impairment was 13.4% in Wave 2 and 13.3% in Wave 3. Despite the aging of this cohort, the prevalence of internet users increased from 26.4% in Wave 1 to 32.8% in Wave 2 and 46.8% in Wave 3. The risk of cognitive impairment in Wave 2 or Wave 3 was 70% lower for older adults who used the internet in the previous wave, adjusted for sex, age, years of education, household income, and self-reported comorbidities (IRR = 0.30; 95% CI: 0.15-0.61; p = 0.001). Internet use was associated with a decline in the incidence of cognitive impairment among older adults living in the urban areas of southern Brazil after a period of ten years.

A comprehensive program of cognitive stimulation with digital inclusion, physical activity and social interaction can modify BDNF levels and improve cognition in adults over 50: a randomized controlled pilot study.

OBJECTIVES: To analyze the effect of a comprehensive program of cognitive stimulation with digital inclusion, physical activity and social interaction, called "Oficina da Lembrança" (OL), on the cognitive status and concentration of biomarkers of neuroplasticity, neurodegeneration in adults aged 50 years and over attending a Memory Clinic. METHODS: In this pilot randomized controlled study, 64 patients without dementia aged 45 to 79 years, seen at a University Memory Clinic in Southern Brazil, were randomly allocated to the intervention and control groups. The intervention consisted of participation in OL for 12 weeks. Serum biomarkers (brain-derived neurotrophic factor [BDNF], S100ß, and neuron-specific enolase [NSE]) and cognitive status were analyzed as primary and secondary outcomes. The Wilcoxon test and Generalized Estimating Equations (GEE) were applied. RESULTS: Of the 64 patients invited to participate in the study, 33 (intervention: 17, control: 16) completed the study with all data. Improvement of cognitive status was significant in the intervention group (22.6 to 24.5) but not in the control group (20.1 to 21.1). There was a significant reduction of BDNF in OL participants, but no significant change was observed in the neurodegenerative biomarkers S100ß or NSE. The concentration of BDNF decreased significantly post-OL in the intervention group (-288.1, 95%CI -362.1 to -94.1), even after adjusting for sex, age, and educational level. Cognitive status was significantly improved in OL participants. CONCLUSION: The OL program improved cognitive status, reduced serum BDNF levels, and empowered digitally excluded older adults. There was no effect of this intervention on S100ß or NSE. CLINICAL TRIAL REGISTRATION: This study has a Universal Trial Number (UTN) U1111-1195-2642 and was registered in the Brazilian Clinical Trials Registry (ReBEC), number RBR-38X665.

Impact of iodine supplementation during preconception, pregnancy and lactation on maternal thyroid homeostasis and offspring psychomotor development: protocol of the IodineMinho prospective study.

BACKGROUND: Iodine deficiency is the most common cause of preventable brain harm and cognitive impairment in children. Portuguese women of childbearing age, pregnant women and their progeny were shown to have inadequate iodine intake. Consequently, the Portuguese Health Authorities have recommended a daily supplementation with 150-200 µg iodine in preconception, pregnancy, and lactation. The IodineMinho study intends to evaluate whether (i) this recommendation impacted on the prevalence of iodine deficiency in pregnant women from the Minho region of Portugal, (ii) the time of initiation of iodine supplementation (if any) influences the serum levels of thyroid hormones at several intervals during pregnancy and (iii) there are serum thyroid-hormone parameters in the 1st trimester of pregnancy that predict psychomotor development of the child at 18 months of age. METHODS: Most Portuguese women are followed throughout pregnancy in community Family Health Units, where family physicians may choose to follow the National recommendation or other, concerning iodine sufficiency. This study will recruit women (N = 304) who intend to become pregnant or are already pregnant from 10 representative Units. Physician's approach and prescriptions, sociodemographic, nutrition and clinical information will be obtained at baseline and throughout pregnancy. To evaluate endocrine function, blood and urine samples will be collected at recruitment, once in each trimester of pregnancy, at delivery and 3 months after delivery. Breastmilk samples will be collected for iodine and energy content analysis. Children will be evaluated for psychomotor development at 18 months. Maternal thyroid volume will be evaluated by ultrasound scan at baseline, in the 3rd trimester and at 3 months after delivery. DISCUSSION: Iodine deficiency early during development precludes children from achieving full intellectual capabilities. This protocol describes a study that is innovative and unique in its detailed and comprehensive evaluation of maternal and child endocrine and psychomotor parameters. By evaluating the effectiveness of the iodine supplementation recommendation, it will contribute to the public health systems' efforts to provide excellence in maternal and infant care. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04288531 . Registered 28 February 2020-Retrospectively registered.

Hearing and Language Skills in Children Using Hearing Aids: Experimental Intervention Study.

INTRODUCTION: Hearing loss in childhood compromises a child's auditory, linguistic, and social skill development. Stimulation and early intervention through therapy and the use of personal sound amplification devices (PSAPs) are important for improving communication. PURPOSE: To verify the effectiveness of speech therapy intervention on the auditory and linguistic skills of Brazilian children aged between 6 and 8 years using PSAPs. METHODS: Experimental study analyzing the intervention process in children aged between 6 and 8 years with mild to severe bilateral hearing loss and prelingual deafness who are PSAP users. Diagnostic information was analyzed, and assessments and interventions were carried out using the Glendonald Auditory Screening Procedure (GASP), a phoneme discrimination test with figures (TFDF), an expressive language category classification test, and an Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) questionnaire. RESULTS: Sixteen children participated in the study; they were divided into a control group (CG) of six children and an intervention group (IG) of ten children. All research subjects underwent two protocol application sessions, and the IG underwent six speech therapy intervention sessions. In the IT-MAIS, the CG had a 9% increase in score, and the IG had an increase of 3% after intervention. The TFDF obtained a 5% increase in the IG in terms of phonemic discrimination ability. The expressive language category classification tests and GASP were considered not sensitive enough to modify the parameters of auditory and linguistic skills. CONCLUSIONS: The study found a significant improvement amongst the IG in the TFDF protocol and an increase in IT-MAIS scores in both groups.

Vitamin D serum concentration is prospectively associated with depressive symptoms in the EpiFloripa Aging Cohort Study: a structural equation modeling approach.

OBJECTIVE: To evaluate the direct, indirect, and total prospective effects of serum concentrations of 25-hydroxycholecalciferol (25[OH]D) on depressive symptoms in older adults. METHODS: Data from the second (2013-2015) and third (2017-2019) waves of the EpiFloripa Aging Cohort Study (= 60 years) were analyzed. Depressive symptoms were assessed with the 15-item Geriatric Depression Scale. 25(OH)D levels were measured using the microparticle chemiluminescence method. A directed acyclic graph was constructed to identify the minimum set of adjustments. Structural equation modeling analysis was used to determine the effects of 25(OH)D on depressive symptoms. RESULTS: Data from 574 older adults (63.1% female) were analyzed. In the follow-up (n=390), 16.2% of them presented severe depressive symptoms (= 6 points). Structural equation modeling analysis revealed that 25(OH)D had a small direct negative effect (ß = -0.11, p < 0.05) and an overall negative effect (ß = -0.13; p < 0.05) on depressive symptoms in wave 3 (increased 25[OH]D led to decreased depressive symptoms). No direct or indirect effect on depressive symptoms was found in wave 2. CONCLUSION: Our findings indicate a prospective association between 25(OH)D and depressive symptoms, suggesting a long-term effect in older adults from southern Brazil.

Cognition, physical function, and life purpose in the rural elderly population: A systematic review protocol.

INTRODUCTION: Aging in rural settings worldwide, from the perspective of cognition, physical function, and life purpose essential constructs for a prosperous old age, still needs comprehensive discussion. This systematic review protocol aims to highlight the prevalence of cognitive decline, physical functioning, and life purpose in older adults aging in rural community settings. METHODS AND ANALYSIS: We will include cross-sectional studies published until April 2023 found in 8 databases: Embase, MEDLINE, LILACS, PsycINFO, Scopus, SciELO, and Web of Science. Ryyan software will be used for the first selection, and the Observational Study Quality Evaluation (OSQE) will assess methodological quality and risk of bias. Primary analysis will involve titles and abstracts using MeSH descriptors such as "Physical functioning," "Cognition," "Cognitive function," "Life purpose," "Elderly," "Older," "Rural aging," "Rural population," "Communities, rural," "Distribution, rural spatial," "Medium communities," "Rural settlement," "Small community." If necessary, secondary analysis will include a complete reading of selected articles by two blinded reviewers, confirmed by a third person. Publication bias will be assessed using cross-sectional analytical study quality. Sensitivity analyses will identify manuscripts significantly influencing combined prevalence of endpoints.

Correction: Cognition, physical function, and life purpose in the rural elderly population: A systematic review protocol.

[This corrects the article DOI: 10.1371/journal.pone.0291699.].

Iodineminho Study: Iodine Supplementation and Prevalence of Iodine Deficiency In Pregnant Women.

CONTEXT: Iodine is necessary for proper brain development. The prevalence of iodine deficiency in Portuguese pregnant women led the health authorities, in 2013, to recommend iodine supplementation for women in preconception, throughout pregnancy, and during lactation. OBJECTIVE: This work aimed to assess the effect of iodine supplementation initiated in the preconception or the first trimester of pregnancy on the prevalence of iodine deficiency and maternal thyroid status. METHODS: An observational prospective cohort study was conducted that followed the thyroid function and iodine status of women recruited during preconception or in the first trimester of pregnancy. RESULTS: Median urinary iodine concentration (UIC) was significantly higher among women taking iodine supplements (no-supplement group UIC = 63 µg/L; supplement group UIC = 100 µg/L; P = .002) but still below the levels recommended by the World Health Organization. Only 15% of pregnant women had adequate iodine status and 17% showed a UIC of less than 50 µg/L. There was no influence whether iodine supplementation was started during preconception or during the first trimester of gestation (UIC preconception group: 112 µg/L vs UIC pregnancy group: 91 µg/L; P = .569). In the first trimester of pregnancy, total thyroxine levels were lower and free triiodothyronine levels were higher in nonsupplemented women. Thyroglobulin levels were lower in women who started iodine supplementation during preconception compared to nonsupplemented women and women who started iodine supplementation during gestation. CONCLUSION: In the Minho region of Portugal, fertile women have insufficient iodine intake. Additional public health measures are needed since the current recommendations for iodine supplementation for pregnancy are unsatisfactory to achieve adequate iodine status.

Transcranial photobiomodulation increases cognition and serum BDNF levels in adults over 50 years: A randomized, double-blind, placebo-controlled trial.

BACKGROUND: There is a significant lack of therapeutic options for mild cognitive impairment (MCI), which is rapidly becoming a global epidemic due to aging. Transcranial photobiomodulation (t-PBM) involves delivering near-infrared light (NIR) to the scalp, targeting cortical areas of the brain. NIR t-PBM has recently emerged as a potential therapy for various neurodegenerative conditions, including memory issues. AIMS: This study aimed to evaluate cognition scores (primary outcome), depression, anxiety, resilience scores, neuroplasticity, and neurodegeneration biomarkers (secondary outcomes) in individuals with MCI undergoing t-PBM therapy or receiving a placebo. MATERIALS AND METHODS: A total of 93 older adult individuals with MCI were randomly assigned to either a t-PBM (n = 47) or Placebo (n = 46) group. Clinical assessments were conducted at baseline, 60 days post-treatment, and a 150-day follow-up. We also measured serum levels of brain-derived neurotrophic factor (BDNF), a neuroplasticity biomarker, as well as neuron-specific enolase (NSE) and calcium-binding protein B (S100B), which are neurodegeneration biomarkers. Intervention effects were analyzed using repeated measures (RM) two-way ANOVA followed by Tukey post hoc test. Fischer's exact test and Generalized Estimating Equations (GEE) were also applied. RESULTS: Of the 93 older adults individuals invited to participate, 76 (t-PBM: 40, placebo: 36) completed the study. The t-PBM significantly improved cognition as measured by the Montreal Cognitive Assessment (MoCA) compared to placebo (p = 0.0301). The delta values for MoCA scores were 3.20 in the t-PBM group and 1.97 in the placebo group. This effect persisted until the three-month follow-up, accompanied by increased BDNF levels in the t-PBM group but not in the placebo group (p = 0.0046). The delta values for BDNF were 821.94 in the t-PBM group and 359.41 in the placebo group. t-PBM did not alter depression, anxiety, resilience scores, nor the levels of NSE and S100B in individuals with MCI. CONCLUSION: The t-PBM increases cognitive function and BDNF levels in adults with MCI. Its application as an adjunctive treatment may play a crucial role in preventing neurodegenerative diseases.

Associations between fruit and vegetable intakes and incident depression in middle-aged and older adults from 10 diverse international longitudinal cohorts.

BACKGROUND: Emerging observational evidence supports a role for higher fruit and vegetable intake in protecting against the development of depression. However, there is a scarcity of research in older adults or in low- to middle-income countries (LMICs). METHODS: Participants were 7801 community-based adults (mean age 68.6 ± 8.0 years, 55.8 % female) without depression, from 10 diverse cohorts, including four cohorts from LMICs. Fruit and vegetable intake was self-reported via comprehensive food frequency questionnaire, short food questionnaire or diet history. Depressive symptoms were assessed using validated measures, and depression defined applying validated cut-offs. The associations between baseline fruit and vegetable intakes and incident depression over a follow-up period of three to nine years were examined using Cox regression. Analyses were performed by cohort with results meta-analysed. RESULTS: There were 1630 cases of incident depression (21 % of participants) over 40,258 person-years of follow-up. Higher intake of fruit was associated with a lower risk of incident depression (HR 0.87, 95%CI [0.77, 0.99], I2 = 4 %). No association was found between vegetable intake and incident depression (HR 0.93, 95%CI [0.84, 1.04], I2 = 0 %). LIMITATIONS: Diverse measures used across the different cohorts and the modest sample size of our study compared with prior studies may have prevented an association being detected for vegetable intake. CONCLUSIONS: Our study supports a role for fruit, but not vegetable intake in protecting against depression. Research investigating different types of fruits and vegetables using standardised measures in larger cohorts of older adults from low- and middle-income countries is warranted.

Trajectory of Cognitive Decline Before and After Stroke in 14 Population Cohorts.

Importance: Poststroke cognitive impairment is common, but the cognitive trajectory following a first stroke, relative to prestroke cognitive function, remains unclear. Objective: To map the trajectory of cognitive function before any stroke and after stroke in global cognition and in 4 cognitive domains, as well as to compare the cognitive trajectory prestroke in stroke survivors with the trajectory of individuals without incident stroke over follow-up. Design, Setting, and Participants: The study used harmonized and pooled data from 14 population-based cohort studies included in the Cohort Studies of Memory in an International Consortium collaboration. These studies were conducted from 1993 to 2019 across 11 countries among community-dwelling older adults without a history of stroke or dementia. For this study, linear mixed-effects models were used to estimate trajectories of cognitive function poststroke relative to a stroke-free cognitive trajectory. The full model adjusted for demographic and vascular risk factors. Data were analyzed from July 2022 to March 2024. Exposure: Incident stroke. Main outcomes and measures: The primary outcome was global cognition, defined as the standardized average of 4 cognitive domains (language, memory, processing speed, and executive function). Cognitive domain scores were formed by selecting the most commonly administered test within each domain and standardizing the scores. Results: The study included 20 860 participants (12 261 [58.8%] female) with a mean (SD) age of 72.9 (8.0) years and follow-up of 7.51 (4.2) years. Incident stroke was associated with a substantial acute decline in global cognition (-0.25 SD; 95% CI, -0.33 to -0.17 SD), the Mini-Mental State Examination, and all cognitive domains (ranging from -0.17 SD to -0.22 SD), as well as accelerated decline in global cognition (-0.038 SD per year; 95% CI, -0.057 to -0.019 SD per year) and all domains except memory (ranging from -0.020 to -0.055 SD per year), relative to a stroke-free cognitive trajectory. There was no significant difference in prestroke slope in stroke survivors compared with the rate of decline in individuals without stroke in all cognitive measures. The mean rate of decline without a previous stroke was -0.049 SD per year (95% CI, -0.051 to -0.047 SD) in global cognition. Conclusions and relevance: In this cohort study using pooled data from 14 cohorts, incident stroke was associated with acute and accelerated long-term cognitive decline in older stroke survivors.

The association between vitamin D and BDNF on cognition in older adults in Southern Brazil.

OBJECTIVE: To estimate the association between vitamin D and the cognitive decline of older adults and evaluate whether this association is mediated by brain-derived neurotrophic factor (BDNF) serum concentration. METHODS: Cross-sectional study nested in a population-based cohort. Of the 604 participants in the complementary examination of the EpiFloripa Study, 576 older adults (60 years or older) were eligible for the study. The outcome is cognitive decline evaluated by the Mini-Mental State Examination, the exposure is vitamin D, and BDNF is the mediator. The control variables are age, sex, per capita family income, and educational level. The direct effect of vitamin D and BDNF on cognitive decline and the indirect effect mediated by BDNF was evaluated using path analysis, with the estimation of standardized coefficients. RESULTS: Among the participants, we observed a direct and positive effect of vitamin D on cognitive function (Coef: 0.06; 95%CI: 0.02 to 0.11; p < 0.001) and serum BDNF concentration (Coef: 21.55; 95%CI: 9.92 to 33.17; p = 0.002), i.e., the higher the vitamin D, the higher the cognitive function and serum level of BDNF. CONCLUSION: There was an association between vitamin D on serum BDNF and on cognitive decline in older adults. Moreover, BDNF did not have an effect on cognitive decline, so BDNF was not a mediator of the vitamin D effect on cognitive decline.

Promoting Digital Proficiency and Health Literacy in Middle-aged and Older Adults Through Mobile Devices With the Workshops for Online Technological Inclusion (OITO) Project: Experimental Study.

BACKGROUND: Digital inclusion and literacy facilitate access to health information and can contribute to self-care behaviors and informed decision-making. However, digital literacy is not an innate skill, but rather requires knowledge acquisition. OBJECTIVE: The present study aimed to develop, conduct, and measure the impact, on digital and health literacy, of a digital inclusion program aimed at community dwellers. METHODS: The program targeted the recruitment of people aged 55 and older that owned mobile devices with an internet connection in 3 cities in northern Portugal (Paredes de Coura, Guimarães, and Barcelos). The program was titled the Workshops for Online Technological Inclusion (OITO) project and, in each city, was promoted by the coordinator of municipal projects and organized as an in-person 8-workshop program, using mobile devices, smartphones, or tablets. A quasi-experimental design was used with a nonrandomized allocation of participants in each set of 8 workshops. Sociodemographic, health status, and mobile use information were collected at baseline. Digital and health literacy were measured via the Mobile Device Proficiency Questionnaire and the Health Literacy Scale questionnaires, respectively, at baseline (T1), program completion (T2), and a 1-month follow-up (T3). A self-reported measure of autonomy was evaluated at T1 and T2 using a visual scale. RESULTS: Most participants were women with primary schooling (up to 4 years) aged between 65 and 74 years and retired. The intervention had an 81% (97/120) recruitment rate, 53% (43/81) adherence, and 94% (67/71) satisfaction rate, with 81 participants completing the entire 8-workshop program. Most participants had owned their mobile device for more than one year (64/81, 79%), were frequent daily users (70/81, 86%), and had received their mobile device from someone else (33/64, 52%). Over 80% (71/81) of the participants who completed the intervention used Android smartphones. At baseline, participants had low baseline scores in digital literacy, but medium-high baseline scores in health literacy. They showed significant improvement in digital literacy at T2 and T3 compared to T1, but without a significant difference between T2 and T3, regardless of sex, age, or schooling. A significant improvement in self-reported autonomy was observed at T3 compared with baseline. Regarding health literacy, no significant differences were found at T2 or T3 compared to the baseline. CONCLUSIONS: The feasibility indicators showed that the OITO project methodology had a substantial rate of recruitment and satisfaction. Program participants had significant improvement in digital literacy after 8 workshops and maintained their score 1 month after completing the intervention. There was no significant change in health literacy during the project period.

Association between healthy food environment and metabolic syndrome, waist circumference, and systolic blood pressure in older adults in Southern Brazil.

The aim of this study was to investigate the association between healthy food outlet proximity, metabolic syndrome (MS), and two of its components, waist circumference (WC) and systolic blood pressure (SBP), in older adults (63-107 years old, median age 73 years) living in Florianópolis, South Brazil in 2013-2014. This is a cross-sectional analysis of the second wave of the EpiFloripa Aging Cohort Study. Individual-level data on MS, WC, SBP, and socio-demographic and health-related characteristics were collected from face to face interviews. The healthy food environment was assessed via the number and types of establishments present. The residences of older adult participants were georeferenced using Geographical Information System (GIS) software. The number of each type of food establishment in a 500 m buffer around the each residence was determined. Multivariate linear regression was used to test association between food outlet proximity and continuous outcomes (SBP and WC), and multiple logistic regression was used to examine the relations between the predictor variables and the dichotomous outcome of MS (yes/no). The study revealed that greater frequency of supermarkets and restaurants in the neighborhood was associated with a lower likelihood of having MS. WC was lower in individuals living in places with greater availability of greengrocers' shops and restaurants. The results demonstrated that the number of establishments in a neighborhood is associated with cardiometabolic outcomes, and the likelihood of MS and increased WC is lower for older adults who live in neighborhoods with more access to establishments that sell foundational components of a healthy diet.

Iodine supplementation: compliance and association with adverse obstetric and neonatal outcomes.

Objectives: Over 1.9 billion people worldwide are living in areas estimated to be iodine insufficient. Strategies for iodine supplementation include campaigns targeting vulnerable groups, such as women in pre-conception, pregnancy and lactation. Portuguese women of childbearing age and pregnant women were shown to be mildly-to-moderately iodine deficient. As a response, in 2013, the National Health Authority (NHA) issued a recommendation that all women considering pregnancy, pregnant or breastfeeding, take a daily supplement of 150-200 µg iodine. This study explored how the iodine supplementation recommendation has been fulfilled among pregnant and lactating women in Portugal, and whether the reported iodine supplements intake impacted on adverse obstetric and neonatal outcomes. Design and methods: Observational retrospective study on pregnant women who delivered or had a fetal loss in the Braga Hospital and had their pregnancies followed in Family Health Units. Results: The use of iodine supplements increased from 25% before the recommendation to 81% after the recommendation. This was mostly due to an increase in the use of supplements containing iodine only. Iodine supplementation was protective for the number of adverse obstetric outcomes (odds ratio (OR) = 0.791, P = 0.018) and for neonatal morbidities (OR = 0.528, P = 0.024) after controlling for relevant confounding variables. Conclusion: The recommendation seems to have succeeded in implementing iodine supplementation during pregnancy. National prospective studies are now needed to evaluate the impact of iodine supplementation on maternal thyroid homeostasis and offspring psychomotor development and on whether the time of the beginning of iodine supplementation (how early during preconception or pregnancy) is relevant to consider.

Self-Reported Hearing Loss and Associated Factors in Older Adults at a Memory Clinic.

Purpose The prevalence of dementia has increased in recent years and, along with hearing loss, can negatively impact the health of older adults. The purpose of this retrospective cross-sectional study was to establish self-reported hearing loss and associated factors in older adults at a memory clinic. Method Researchers conducted a retrospective cross-sectional study on factors associated with self-reported hearing loss (i.e., lifestyle, general health, cognition, functional capacity). Data were taken from medical records of older adults (≥ 60 years old) who received care between 2017 and 2018 at a memory clinic located at the Southern Santa Catarina University in Brazil. Analysis included the Pearson chi-squared test and logistic regression, estimation of the crude and adjusted odds ratios (OR), with respective confidence intervals of 95%. Results Researchers analyzed the medical records of 257 older adults and verified a prevalence of 13.2% of these adults with self-reported hearing loss. There was a higher prevalence of the outcome (i.e., self-reported hearing loss) in older adults who reported tinnitus (35.2%), those with mild cognitive impairment (14.7%), and those who were sedentary (19.2%). After adjustment for confusion factors, tinnitus (OR = 4.63; p = .019) and sedentarism (OR = 2.89; p = .029) were still associated with the outcome. Conclusions Tinnitus and sedentarism were associated with hearing loss in older adults receiving care at a memory clinic. As a public health issue, presbycusis needs to be included in the health planning and health promotion agendas, with effective control, prevention, and treatment measures.

Stabilometric analysis as a cognitive function predictor in adults over the age of 50: A cross-sectional study conducted in a Memory Clinic.

BACKGROUND: The aging process reduces adaptive balance responses. Two-thirds of older adults with cognitive problems suffer at least one fall every year, a rate three times higher than that observed in older adults without dementia. This cross-sectional study aims to analyze the relationship between balance and cognitive status in adults older than 50 years. METHODS: Individuals over the age of 50, who attended a Memory Clinic, were evaluated for balance changes using stabilometry, with analysis of the center of pressure (CoP). The following CoP parameters were assessed using an S-Plate pressure platform: 1) sway length, 2) sway area, and 3) anteroposterior and laterolateral sway (width, mean deviation, and speed). The individuals were evaluated with eyes open and closed for 30 s in each test. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive status. RESULTS: Eighty-seven subjects participated in the study. The average age was 67.8 years, 81.4% were female, and the average MoCA score was 19.8 points. Greater CoP oscillation was observed in the eyes closed condition, demonstrating greater postural imbalance. We found a significant and direct effect of MoCA score on the CoP area in the eyes open condition. CONCLUSION: The results suggest that stabilometric analysis may be a predictor of cognitive function.

Acesso a serviço de saúde e reabilitação auditiva de adultos e idosos durante o período inicial da pandemia COVID-19 no Brasil / Access to health service and hearing rehabilitation for adult and older adults during the initial period of the COVID-19 pandemic in Brazil / Acceso a servicios de salud yrehabilitación auditiva para adultos y ancianos durante el período inicial de la pandemia COVID-19 en Brasil

Introdução: A perda auditiva é uma deficiência comum na população mundial e contribui para dificuldade na comunicação verbal e redução da qualidade de vida, evidenciando a importância da identificação precoce, reabilitação e acompanhamento audiológico dessa deficiência para mitigar suas consequências. Durante a pandemia da COVID-19, as medidas restritivas diminuíram a capacidade de atendimento dos serviços de saúde auditiva e dificultaram a busca de auxílio para resolver problemas relacionados à adaptação aos dispositivos eletrônicos de amplificação sonora (DAES), sendo uma barreira no processo de reabilitação da perda auditiva. Objetivo: Caracterizar os usuários de DEAS e o processo inicial de reabilitação auditiva de adultos e idosos e verificar fatores associados ao retorno para a consulta de monitoramento auditivo durante o período inicial da pandemia da COVID-19.Métodos: Estudo observacional transversal com usuários adultos e idosos de um serviço ambulatorial de saúde auditiva com retorno para consulta de monitoramento auditivo agendada no período inicial da implementação das medidas restritivas da pandemia da COVID-19 no Brasil. Resultados: A maioria dos participantes conseguiu retornou para a consulta de monitoramento auditivo, sendo eles em sua maioria idosos, do sexo feminino e vacinados contra a COVID-19. Houve maior prevalência de adaptação adequada aos DAES. Não houve associação estatística entre as variáveis relacionadas à adaptação aos DAES, COVID-19 e saúde mental e o retorno à consulta de monitoramento auditivo. Conclusão: Os fatores relacionados à adaptação aos DAES, à COVID-19 ou à saúde mental não influenciaram o retorno à consulta de monitoramento auditivo na presente pesquisa. (AU)

Introduction: Hearing loss is a common disability in the world population and contributes to difficulty in verbal communication and reduced quality of life, highlighting the importance of early identification, rehabilitation and audiological monitoring of this disability to mitigate its consequences. During the COVID-19 pandemic, restrictive measures reduced the service capacity of hearing health services and made it difficult to seek help to solve problems related to adaptation to personal sound amplification products (PSAPs), being a barrier in the rehabilitation process of hearing loss. Aim: To characterize PSAPs users and the initial hearing rehabilitation process for adults and elderly people and verify the factors associated with the return to hearing monitoring consultations in the initial period of the COVID-19 pandemic. Methods: Cross-sectional observational study with adults and elderly people: elderly users of an outpatient hearing health service who return for a scheduled hearing monitoring consultation in the initial period of the implementation of restrictive measures of the COVID-19 pandemic in Brazil. Results: Most participants were able to return to the hearing monitoring clinic, the majority of whom were elderly, female and vaccinated against COVID-19. There was a higher prevalence of adequate adaptation to the PSAPs. There was no statistical association between variables related to adaptation to PSAPs, COVID-19 and mental health and return to hearing monitoring consultation. Conclusion: Factors related to adaptation to PSAPs, COVID-19 or mental health did not influence the return to hearing monitoring consultation in the present investigation. (AU)

Introducción: La pérdida auditiva es una discapacidad común en la población mundial y contribuye a la dificultad en la comunicación verbal y a la reducción de la calidad de vida, destacando la importancia de la identificación temprana, rehabilitación y seguimiento audiológico de esta discapacidad para mitigar sus consecuencias. Durante la pandemia de COVID-19, las medidas restrictivas redujeron la capacidad de atención de los servicios de salud auditiva y dificultaron la búsqueda de ayuda para resolver problemas relacionados con la adaptación a dispositivos electrónicos de amplificación del sonido (DEAS), siendo una barrera en el proceso de rehabilitación de la pérdida auditiva. Objetivo: Caracterizar a los usuarios de DEAS y el proceso inicial de rehabilitación auditiva de adultos y ancianos y verificar los factores asociados al retorno a las consultas de monitorización auditiva en el período inicial de la pandemia COVID-19. Métodos: Estudio observacional transversal con adultos y ancianos: ancianos usuarios de un servicio ambulatorio de salud auditiva que regresan para consulta de monitorización auditiva programada en el período inicial de la implementación de medidas restrictivas de la pandemia de COVID-19 en Brasil. Resultados: La mayoría de los participantes pudieron regresar a la clínica de monitorización auditiva, la mayoría de los cuales eran ancianos, mujeres y estaban vacunados contra COVID-19. Hubo mayor prevalencia de adaptación adecuada a la DEAS. No hubo asociación estadística entre variables relacionadas con adaptación a DEAS, COVID-19 y salud mental y retorno a consulta de monitorización auditiva. Conclusión: Los factores relacionados con la adaptación a DEAS, el COVID-19 o la salud mental no influyeron en el retorno a la consulta de monitorización auditiva en la presente investigación. (AU)

Vitamin D serum concentration is prospectively associated with depressive symptoms in the EpiFloripa Aging Cohort Study: a structural equation modeling approach

Objective: To evaluate the direct, indirect, and total prospective effects of serum concentrations of 25-hydroxycholecalciferol (25[OH]D) on depressive symptoms in older adults. Methods: Data from the second (2013-2015) and third (2017-2019) waves of the EpiFloripa Aging Cohort Study (≥ 60 years) were analyzed. Depressive symptoms were assessed with the 15-item Geriatric Depression Scale. 25(OH)D levels were measured using the microparticle chemiluminescence method. A directed acyclic graph was constructed to identify the minimum set of adjustments. Structural equation modeling analysis was used to determine the effects of 25(OH)D on depressive symptoms. Results: Data from 574 older adults (63.1% female) were analyzed. In the follow-up (n=390), 16.2% of them presented severe depressive symptoms (≥ 6 points). Structural equation modeling analysis revealed that 25(OH)D had a small direct negative effect (β = -0.11, p < 0.05) and an overall negative effect (β = -0.13; p < 0.05) on depressive symptoms in wave 3 (increased 25[OH]D led to decreased depressive symptoms). No direct or indirect effect on depressive symptoms was found in wave 2. Conclusion: Our findings indicate a prospective association between 25(OH)D and depressive symptoms, suggesting a long-term effect in older adults from southern Brazil.