Development and construction of an open-platform, open-source low-cost portable uroflowmeter: The OpenFlow device.

BACKGROUND: Uroflowmetry is useful to screen for and manage many voiding disorders. Home-based uroflowmetry might better represent the patient's true voiding pattern and be more widely adopted if an accurate low-cost portable device was available. OBJECTIVE: Development and initial evaluation of an open-platform, open-source low-cost portable uroflowmeter. MATERIALS AND METHODS: We designed and built an uroflowmeter comprising of a load cell and digital memory card unit connected to a programmable microcontroller board mounted upon a 3D printed frame. It generated date-stamped tables which were processed and plotted. Twenty urologists were recruited to assess the device. Each participant received the equipment that was returned, along with a bladder diary, after at least 24 consecutive hours of homemade uroflowmetry recording. Additionally, were assessed with the International Prostatic Symptom Score (I-PSS) and Peeling diagram, whereas the device's ease of use, robustness, and portability were evaluated with a Likert-type questionnaire. Two experienced urodynamicists independently evaluated the tracings' quality rated with a 3° ordinal scale: (1) Interpretable without artifacts; (2) Interpretable with artifacts; (3) Uninterpretable. RESULTS: Participants' median age was 36.6 years old, none having an I-PSS > 5 or Peeling > 2. Overall 138 voidings were recorded (77 daytime, 61 nightly episodes). The device's ease of use, robustness, and portability obtained maximum score in 80% of evaluations. Most (98%) of the tracings were considered interpretable. Limitations included its small study population and short monitoring times. CONCLUSION: The construction of a cheap (<50 USD), accurate user-friendly portable uroflowmeter proved feasible, which could facilitate access to portable uroflowmetry.

Factors associated with above-average cognitive performance in long-lived older adults / Fatores associados ao desempenho cognitivo acima da média em idosos longevos

Abstract Objective To investigate the factors associated with performance equal to or higher than the 95th percentile in the Mini Mental State Examination of elderly people aged 80 years and over. Method This is a cross-sectional, descriptive, and quantitative research conducted with a convenience sample composed of 101 cognitively healthy older adults residing in Brazil's Federal District, assessed by scales that measure mood, social support, functional performance, and health. Results Bivariate statistical analyses indicated that older individuals with better cognitive performance in the Mini Mental State Examination, when compared to participants with performance below the 95th percentile, showed better self-perceived health, greater satisfaction with the ability to perform daily tasks, and a more positive evaluation of general social support and in the domain of having someone to talk to when feeling lonely. Conclusion High global cognitive performance in old age is associated with perceived health, satisfaction with functional performance, and social support.

Resumo Objetivo Investigar os fatores associados ao desempenho igual ou superior ao percentil 95 no Miniexame de Estado Mental de pessoas idosas com 80 anos e mais. Método Trata-se de uma pesquisa transversal, descritiva e quantitativa, conduzida com uma amostra de conveniência composta por 101 idosos cognitivamente saudáveis, residentes no Distrito Federal e avaliados por escalas de humor, suporte social, desempenho funcional e saúde. Resultados Análises estatísticas bivariadas indicaram que os longevos com melhor desempenho cognitivo no Miniexame de Estado Mental, quando comparados aos participantes com desempenho abaixo ao percentil 95, apresentaram melhor autopercepção de saúde, maior satisfação com a capacidade de resolução de tarefas cotidianas, avaliação mais positiva do suporte social geral e relacionado ao domínio de ter com quem conversar quando se sente sozinho. Conclusão O elevado desempenho cognitivo global na velhice se associa à saúde percebida, à satisfação em relação ao desempenho funcional e ao suporte social.

Subclinical Hypothyroidism is Not Associated with Femoral Osteoporosis in Individuals Aged 50 Years or Older.

BACKGROUND: Thyroid dysfunction and osteoporosis are conditions strongly associated with aging, and the prevalence of both conditions is expected to increase in the coming decades. Thyroid hormones regulate bone metabolism, and the role of subclinical hypothyroidism on bone mineral density (BMD) is still controversial. Hence, this study aims to assess the association of subclinical hypothyroidism with femoral osteopenia and osteoporosis in individuals aged 50 years or older. METHODOLOGY: This retrospective cohort study was carried out with 864 outpatients having at least one result for TSH levels before the first record of dual-energy X-ray absorptiometry (DXA). The primary endpoints were osteopenia (-2.5 standard deviation (SD)

Impact of different automated peritoneal dialysis modalities on the inflammatory profile of elderly patients with chronic kidney disease / Impacto das diferentes modalidades de diálise peritoneal automatizada sobre o perfil inflamatório de idosos portadores de doença renal crônica

Abstract Introduction: Chronic kidney disease, more prevalent in the elderly, is considered a public health issue worldwide. Objective: To evaluate the impact of automated, peritoneal dialysis modalities, intermittent and continuous, on the inflammatory profile of elderly people with chronic kidney disease. Methods: Prospective, cross-sectional and analytical study carried out in a dialysis clinic in Brasília - Brazil, with 74 elderly people aged 60 years or older. The patients underwent rapid Peritoneal Equilibration Test, clinical assessment, blood collection for biochemical and cytokine assessments, interleukin 6 and transforming growth factor beta 1, and answered a quality-of-life questionnaire (KDQOL-SF36). We used a 5% significance level for data analysis, associations and correlations. Results: Patients in the continuous modality had higher serum values of transforming growth factor beta 1 than those in the intermittent modality, which had higher peritoneal transforming growth factor beta 1, age and residual renal function than those in continuous mode. Interleukin 6 dosage in the peritoneum was associated with age, while serum IL-6 was associated with IL-6 in the peritoneum, time on dialysis and age. There was no association between the modality and the presence of diabetes, blood volume or nutritional status. Both modalities enable good adaptation to the dialysis treatment. Conclusion: Inflammation in automated peritoneal dialysis is mainly associated with low residual renal function, advanced age and longer time on therapy, and not to the type of dialysis performed.

Resumo Introdução: A doença renal crônica, mais prevalente em idosos, é considerada um problema de saúde pública em todo o mundo. Objetivo: Avaliar o impacto das modalidades de diálise peritoneal automatizada, intermitente e contínua, no perfil inflamatório de idosos renais crônicos. Métodos: Estudo prospectivo, transversal e analítico realizado em uma clínica de diálise em Brasília, com 74 idosos com idade igual ou maior que 60 anos. Os pacientes foram submetidos ao Teste de Equilíbrio Peritoneal rápido, avaliação clínica, coleta de sangue para avaliações bioquímicas e de citocinas, interleucina 6 e fator de crescimento transformador beta 1, e questionário de qualidade de vida (KDQOL-SF36). Foram utilizadas para análise dos dados, associações e correlações com nível de significância de 5%. Resultados: Pacientes na modalidade contínua apresentaram valores séricos do fator de crescimento transformador beta 1 maiores do que os em modalidade intermitente. Estes apresentaram fator de crescimento transformador beta 1 no peritônio, idade e função renal residual maiores do que os em modalidade contínua. A dosagem da interleucina 6 no peritônio foi associada à idade, enquanto a IL-6 sérica foi associada à IL-6 no peritônio, ao tempo em diálise e à idade. Não houve associação entre a modalidade e a presença de diabetes, volemia ou estado nutricional. Ambas as modalidades permitem boa adequação à terapia dialítica. Conclusão: A inflamação na diálise peritoneal automatizada está associada principalmente à baixa função renal residual, à idade avançada e ao maior tempo em terapia, e não à modalidade de diálise realizada.

Impact of different automated peritoneal dialysis modalities on the inflammatory profile of elderly patients with chronic kidney disease.

INTRODUCTION: Chronic kidney disease, more prevalent in the elderly, is considered a public health issue worldwide. OBJECTIVE: To evaluate the impact of automated, peritoneal dialysis modalities, intermittent and continuous, on the inflammatory profile of elderly people with chronic kidney disease. METHODS: Prospective, cross-sectional and analytical study carried out in a dialysis clinic in Brasília - Brazil, with 74 elderly people aged 60 years or older. The patients underwent rapid Peritoneal Equilibration Test, clinical assessment, blood collection for biochemical and cytokine assessments, interleukin 6 and transforming growth factor beta 1, and answered a quality-of-life questionnaire (KDQOL-SF36). We used a 5% significance level for data analysis, associations and correlations. RESULTS: Patients in the continuous modality had higher serum values of transforming growth factor beta 1 than those in the intermittent modality, which had higher peritoneal transforming growth factor beta 1, age and residual renal function than those in continuous mode. Interleukin 6 dosage in the peritoneum was associated with age, while serum IL-6 was associated with IL-6 in the peritoneum, time on dialysis and age. There was no association between the modality and the presence of diabetes, blood volume or nutritional status. Both modalities enable good adaptation to the dialysis treatment. CONCLUSION: Inflammation in automated peritoneal dialysis is mainly associated with low residual renal function, advanced age and longer time on therapy, and not to the type of dialysis performed.

Fatores associados a hospitalização de idosos longevos residentes no Distrito Federal ­ Brasil / Factors associated with hospitalization for long elderly residents in the Federal District ­ Brazil / Factores asociados a la hospitalización de ancianos largo residentes en el Distrito Federal - Brasil

O objetivo do presente estudo foi analisar os fatores associados a hospitalização de idosos com 80 anos e mais residentes no Distrito Federal -Brasil. Foram investigados 208 idosos longevos (80 anos e mais) atendidos em ambulatório do Distrito Federal entre os anos de 2016 a 2018. Utilizaram-se testes de rastreio cognitivo, desempenho funcional, fragilidade e questionários padronizados.Ahospitalização no último ano foi associada a idade mais avançada, menor escolaridade, maior prevalência de declínio cognitivo, e possuir fragilidade nos domínios perda de peso e força de preensão manual. Após ajustes segundo modelo logístico múltiplo permaneceram associadas à hospitalização as variáveis escolaridade, fragilidade perda de peso e número de consultas médicas no último ano. Nesse contexto, para prevenção da hospitalização na velhice avançada faz-se necessário investimentos em medidas de gerenciamento de caso, qualificação da atenção em saúde, rastreio e manejo da fragilidade.

The objective of this study was to analyze the factors associated with hospitalization of elderly people aged 80 years and over residing in the Federal District -Brazil. A total of 208 long-lived elderly (80 years and older) treated at an outpatient clinic of the Federal District between 2016 and 2018 were investigated. Cognitive screening, functional performance, frailty and standardized questionnaires tests were used. Hospitalization in the last year was associated with older age, lower education, higher prevalence of cognitive decline, and frailty criteria in the weight loss and handgrip strength. After adjustments according to the multiple logistic model, the variables schooling, frailty weight loss and number ofmedical appointments in the last year remained associated with hospitalization.In this way, to prevent hospitalization in advanced old age, investments in case management measures, health care qualification, screening and management of frailty are required.

El objetivo del presente estudio fue analizar los factores asociados a la hospitalización de ancianos de 80 años y más residentes en el Distrito Federal -Brasil. Se investigaron 208 ancianos longevos (80 años y más) atendidos en un ambulatorio del Distrito Federal entre 2016 y 2018. Se utilizaron pruebas de tamizaje cognitivo, desempeño funcional, fragilidad y cuestionarios estandarizados. La hospitalización en el último año se asoció con mayor edad, menor escolaridad, mayor prevalencia de deterioro cognitivo y fragilidad en los dominios de pérdida de peso y fuerza de prensión manual. Después de los ajustes según el modelo logístico múltiple, las variables escolaridad, fragilidad, pérdida de peso y número de consultas médicas en el último año permanecieron asociadas a la hospitalización. En ese contexto, para prevenir la hospitalización en la vejez avanzada, es necesario invertir en medidas de manejo de casos, calificación de la atención a la salud, tamizaje y manejo de la fragilidad.

Serum levels of interleukin-2 differ between prostate cancer and benign prostatic hyperplasia / Níveis séricos de interleucina-2 diferem entre câncer de próstata e hiperplasia benigna da próstata

ABSTRACT Objective Investigation onthe systemic inflammatory profile ofpatients affected by prostate cancer (PCa) or prostatic hyperplasia (BPH) may contribute to characterize the pathological profile as well as enable identification of markers and promote alternatives for appropriate, less invasive treatments. Methods This research compared serum levels of 10 classic inflammatory mediators among patients aged 50 years or older affected by PCa or BPH. For this, clinical, biochemical, metabolic, anthropometric and inflammatory aspects of each patient was considered. Results From the statistical analysis, a weakpositive correlation (r = 0.16) between IL-2 with serum total PSA values was found. In addition, median serum IL-2 values were three times higher in patients with PCa compared to BPH patients. Conclusion By interpretation of current literature, we hypothesize that the activity of infiltratedtype M1 macrophages and activated cytotoxic cells in the neoplasm milieu might explain this increase of IL-2 as part of anendogenous anti-neoplastic response.

RESUMO Objetivo A investigação do perfil inflamatório sistêmico de pacientes acometidos por câncer de próstata (CaP) ou hiperplasia prostática (HPB) pode contribuir para caracterizar o perfil patológico, bem como possibilitar a identificação de marcadores e promover alternativas de tratamentos adequados e menos invasivos. Métodos Esta pesquisa comparou os níveis séricos de 10 mediadores inflamatórios clássicos em pacientes com 50 anos ou mais afetados por CaP ou HPB. Para tanto, foram considerados os aspectos clínicos, bioquímicos, metabólicos, antropométricos e inflamatórios de cada paciente. Resultados A partir da análise estatística, foi encontrada umacorrelação positiva fraca (r = 0,16) entre IL-2 com os valores de PSA total sé o. Além disso, os valores medianos de IL-2 no soro foram três vezes maiores em pacientes com CaP em comparação com pacientes com HPB. Conclusão Pela interpretação da literatura atual, hipotetizamos que a atividade de macrófagos do tipo M1 infiltrados e células citotóxicas ativadas no meio da neoplasia pode explicar esse aumento de IL-2 como parte de uma resposta antineoplásica endógena.

Serum Levels of Matrix Metalloproteinase-1 in Brazilian Patients with Benign Prostatic Hyperplasia or Prostate Cancer.

Metalloproteinases (MMPs) are involved in metastatic tumor processes, with changes in circulating levels detected in several cancer types. Here, we compare serum concentrations of metalloproteinase-1 (MMP-1) across individuals clinically diagnosed with prostate cancer (PCa) or benign prostatic hyperplasia (BPH), correcting results for the rs495366 single nucleotide polymorphism (SNP) that predisposes to differential MMP-1 levels. 196 men aged ≥50 years were followed at a university hospital urology outpatient clinic, with clinical, anthropometric, and rectal examinations performed by one urologist. Blood samples obtained prior to any clinical intervention provided baseline MMP-1 and total/free PSA levels as well as metabolic, hormonal, and inflammatory markers. The SNP was genotyped by real-time PCR. Participants with medical and/or laboratory profile compatible with malignancy composed the PCa group when confirmed by the Gleason scale. As expected, A-allele homozygotes showed reduced levels of MMP-1. Genotype-adjusted analyses revealed the mean MMP-1 level as 2-fold higher in PCa carriers compared to BPH patients. No other differences were found according to the prostatic condition or genotypic distribution, except for the expected raise in total and free PSA levels in PCa. In conclusion, increased serum levels of MMP-1 were observed in this context of prostatic malignancy compared to a benign phenotype, regardless of a genetic influence.

Whole-Blood Levels of MicroRNA-9 Are Decreased in Patients With Late-Onset Alzheimer Disease.

Recent evidence suggests changes in circulating microRNA levels may be promising biomarkers for the clinical diagnosis of Alzheimer disease (AD). We hypothesized that whole-blood microRNAs may be useful to identify individuals with established AD. For this purpose, a sample of community-dwelling women (≥55 years old) carrying the ApoE ∊4 allele were clinically evaluated using the American Psychiatric Association/Diagnostic and Statistical Manual of Mental Disorders, Fourth edition and the Alzheimer Disease Assessment Scale-Cognitive Subscale criteria to diagnose probable AD, and the Clinical Dementia Rating scale to stage the dementia. A set of 25 mature microRNAs was rationally selected for evaluation based on experimental evidence of interaction with genes linked to the late-onset AD neuropathology. Whole-blood concentrations were determined by quantitative real-time polymerase chain reaction. Compared to patients without dementia, a median 3-fold decrease in miR-9 levels was found among patients with AD (P = .001). Our findings support blood-borne miR-9 as a candidate biomarker for probable AD, embodied by evidence from the literature of its implication in amyloidogenesis.

Circulating Interleukin-6 (but Not Other Immune Mediators) Associates with Criteria for Fried's Frailty among Very Old Adults.

METHODS: One hundred and sixty-one very old patients (aged ≥80 years) devoid of cognitive decline were eligible for analyses. Clinical and biochemical data along with physical and cognitive assessments encompassing dual-energy X-ray scans and hand dynamometry were adopted to investigate frailty criteria, while circulating immune mediators (IFNγ, IL-2, IL-4, IL-6, IL-10, and TNFα) were assessed using high-throughput flow cytometry. RESULTS: Preliminarily, IL-6 correlated positively with waist-to-hip ratio and C-reactive protein and negatively with glycemia. In analyses controlled for these factors, serum levels of IL-6 were comparatively augmented among the very old participants with reduced grip strength (OR = 3.299; 95% CI 1.08-6.09; p=0.032) and among those with slow walk speed (OR = 2.460; 95% CI 1.16-7.05; p=0.022). CONCLUSIONS: Our study shows a strong negative correlation of IL-6 levels with Fried's frailty components of grip strength and walk speed in very old adults, regardless of confounding factors.

Elderly individuals in multigenerational households: Family composition, satisfaction with life and social involvement / Longevos em domicílios multigeracionais: condições sociodemográficas, humor, funcionalidade, envolvimento social e satisfação com a vida

The purpose of this study was to investigate the link between multi-generational household arrangements (uni-, bi- or tri-generational) and sociodemographic variables, functional performance, mood, social support and life satisfaction in cognitively healthy elderly individuals. This is a cross-sectional, descriptive and quantitative study. A total of 107 elderly individuals from the Federal District were evaluated using the Geriatric Depression Scale, the Mini Exame do Estado Mental (Mini-Mental State Examination), the Scales of Basic, Instrumental and Advanced Activities of Daily Living, the Perceived Social Support, and the Life Satisfaction Scale. Bivariate statistical analysis indicated that tri-generational arrangements were associated with being female, being a widowed individual and having more children; and uni- or bi-generational arrangements were associated with a greater life satisfaction in comparison to people of the same age, a bigger participation in cultural activities and driving an automobile. These findings indicate that, for elderly individuals, living arrangements are associated with family composition, life satisfaction and social engagement.

O objetivo deste estudo foi investigar a associação entre os arranjos domiciliares multigeracionais (uni, bi ou trigeracionais) e variáveis sociodemográficas, desempenho funcional, humor, suporte social e satisfação com a vida em idosos longevos cognitivamente saudáveis. Trata-se de estudo transversal, descritivo e quantitativo. Foram avaliados 107 idosos do Distrito Federal, por meio dos seguintes instrumentos: Geriatric Deepression Scale, Mini Exame do Estado Mental, Escala de Atividades Básicas, Instrumentais e Avançadas de Vida Diária, Escala de Suporte Social Percebido e de Satisfação com a Vida. Análises estatísticas bivariadas indicaram que arranjos trigeracionais associaram-se ao sexo feminino, ao estado de viuvez e à existência de mais filhos; já os arranjos uni ou bigeracionais associaram-se à maior satisfação com a vida em comparação com pessoas da mesma idade, bem como à maior participação em atividades culturais e à prática de dirigir automóvel. Esses achados indicam que, para longevos, os arranjos domiciliares associam-se a variáveis de composição familiar, satisfação com a vida e envolvimento social.

Perfil cognitivo e associações entre idosos longevos em contexto ambulatorial no Distrito Federal / Cognitive profile and associations among very old adults in an outpatient setting in the Federal Distric

Objetivou investigar associações entre o declínio cognitivo de idosos longevos em contexto ambulatorial e variáveis sociodemográficas, desempenho funcional, doenças crônicas, número de hospitalizações e acesso aos serviços de saúde. Foram entrevistados idosos longevos (80 anos e mais) residentes no Distrito Federal, avaliados em contexto ambulatorial por questionários padronizados e pelo Miniexame do Estado Mental (MEEM). Nas análises bivariadas, o declínio cognitivo esteve associado à faixa etária (85 anos e mais), possuir uma ou mais limitações nas atividades básicas de vida diária (ABVD), residir em arranjos domiciliares bi e trigeracionais e ter maior número de hospitalizações no último ano. No modelo logístico múltiplo, permaneceram associados ao declínio cognitivo em longevos as ABVD e as hospitalizações no último ano. Por tratar-se de uma população com maior demanda assistencial de saúde, torna-se necessário delinear medidas de prevenção e a promoção de cuidados de longa duração.

The aim was to investigate associations between the cognitive decline of very old adults in outpatient settings and sociodemographic variables, functional performance, chronic diseases, number of hospitalizations and access to health services. Very old adults (80 years and over) residing in the Federal District were interviewed, evaluated in an outpatient setting by means of standardized questionnaires and the Mini-Mental State Examination (MMSE). In bivariate analyzes, cognitive decline was associated with the age group (85 years and over), having one or more limitations in basic activities of daily living (BADL), living in bi and tri-generational household arrangements and having a higher number of hospitalizations in the prior year. In the multiple logistic model, BADL and hospitalizations in the prior year remained associated with cognitive decline in very old adults. As it is a population with a greater demand for health care, it is necessary to outline measures of preventive and promotion of long-term care.

Elderly individuals in multigenerational households: Family composition, satisfaction with life and social involvement / Longevos em domicílios multigeracionais: condições sociodemográficas, humor, funcionalidade, envolvimento social e satisfação com a vida

The purpose of this study was to investigate the link between multi-generational household arrangements (uni-, bi- or tri-generational) and sociodemographic variables, functional performance, mood, social support and life satisfaction in cognitively healthy elderly individuals. This is a cross-sectional, descriptive and quantitative study. A total of 107 elderly individuals from the Federal District were evaluated using the Geriatric Depression Scale, the Mini Exame do Estado Mental (Mini-Mental State Examination), the Scales of Basic, Instrumental and Advanced Activities of Daily Living, the Perceived Social Support, and the Life Satisfaction Scale. Bivariate statistical analysis indicated that tri-generational arrangements were associated with being female, being a widowed individual and having more children; and uni- or bi-generational arrangements were associated with a greater life satisfaction in comparison to people of the same age, a bigger participation in cultural activities and driving an automobile. These findings indicate that, for elderly individuals, living arrangements are associated with family composition, life satisfaction and social engagement.

O objetivo deste estudo foi investigar a associação entre os arranjos domiciliares multigeracionais (uni, bi ou trigeracionais) e variáveis sociodemográficas, desempenho funcional, humor, suporte social e satisfação com a vida em idosos longevos cognitivamente saudáveis. Trata-se de estudo transversal, descritivo e quantitativo. Foram avaliados 107 idosos do Distrito Federal, por meio dos seguintes instrumentos: Geriatric Deepression Scale, Mini Exame do Estado Mental, Escala de Atividades Básicas, Instrumentais e Avançadas de Vida Diária, Escala de Suporte Social Percebido e de Satisfação com a Vida. Análises estatísticas bivariadas indicaram que arranjos trigeracionais associaram-se ao sexo feminino, ao estado de viuvez e à existência de mais filhos; já os arranjos uni ou bigeracionais associaram-se à maior satisfação com a vida em comparação com pessoas da mesma idade, bem como à maior participação em atividades culturais e à prática de dirigir automóvel. Esses achados indicam que, para longevos, os arranjos domiciliares associam-se a variáveis de composição familiar, satisfação com a vida e envolvimento social.

Prevalência do uso de medicamentos potencialmente inapropriados ao idoso no Brasil: uma revisão sistemática / Prevalencia del uso de medicamentos potencialmente inapropiados para los ancianos en Brasil: una revisión sistemática / Prevalence use of potentially inappropriate drugs for elderly in Brazil: a sistematic review

O envelhecimento está relacionado, via de regra, ao uso de medicamentos. Esta é uma revisão sistemática sobre as prevalências de uso de medicamento potencialmente perigosos em idosos, em estudos brasileiros, utilizando-se o Critério de Beers. A prevalência variou entre 17 e 98,2% em amostras domiciliares, ambulatoriais, hospitalares e em instituições de longa permanência. Dados que demonstram a necessidade de políticas de enfrentamento aos riscos inerentes ao uso de medicamento pelo paciente idoso no Brasil.

The aging is related with use of drugs. This research is a systematic review about use of potentially inappropriate drugs for elderly evaluated by Beers Criteria. The prevalence's range was 17 to 98,2% on home, ambulatory, hospital or nursing home samples. These data demonstrate that governmental politics are necessary to face the risks of drugs using by elderly in Brazil.

El envejecimiento generalmente está relacionado con el uso de medicamentos. Esta es una revisión sistemática de la prevalencia del uso de drogas potencialmente peligrosas en los ancianos, en estudios brasileños, utilizando el Criterio de Beers. La prevalencia varió entre 17 y 98.2% en muestras de atención domiciliaria, ambulatoria, hospitalaria y de atención a largo plazo. Datos que demuestran la necesidad de políticas para enfrentar los riesgos inherentes al uso de medicamentos por parte de pacientes de edad avanzada en Brasil.

Doadores de sangue envelhescentes e idosos: prevalência e reações adversas / Aging and elderly blood donors: prevalence and adverse reactions / Envejecimiento y donantes de sangre elderly: prevalencia y reacciones adversas

Verificou-se a prevalência e reações adversas às doações de sangue em doadores envelhescentes e idosos. Estudo retrospectivo, com dados do sistema informatizado de Hemocentro em Brasília. Do total de 55636 doadores, 6,3% eram envelhescentes; e 0,8%, idosos. Houve menor prevalência de reações adversas nos idosos, sem diferença significativa. Quanto à intensidade das reações, foram leves nos idosos, leves e moderados nos envelhescentes, também sem diferença significativa.

Prevalence and adverse reactions to blood donations were found in aging and elderly donors. Retrospective study with data from the computerized system of Hemocenter in Brasília. Of the 55636 donors, 6.3% were aging and 0.8% elderly. There was a lower prevalence of adverse reactions in the elderly, with no significant difference. Regarding the intensity of the reactions, they were mild in the elderly, mild and moderate in the aging, also without significant difference.

La prevalencia y las reacciones adversas a las donaciones de sangre se encontraron en donantes envejecimiento y ancianos. Estudio retrospectivo con datos del sistema computarizado de Hemocentro en Brasilia. De los 55636 donantes, 6.3% estaban envejeciendo y 0.8% ancianos. Hubo una menor prevalencia de reacciones adversas en los ancianos, sin diferencias significativas. En cuanto a la intensidad de las reacciones, fueron leves en los ancianos, leves y moderados en el envejecimiento, también sin diferencias significativas.

Capacitação, conhecimentos e crenças de médicos da Atenção Primária à Saúde relacionados ao envelhecimento / Professional education, knowledge and beliefs of Primary Health Care physicians related to aging / Capacitación, conocimiento y creencias de los médicos de Atención Primaria relacionados con el envejecimiento

O aumento da população idosa, com os complexos problemas de saúde que a envolvem, evidencia a necessidade do uso da Atenção Primária à Saúde (APS), que deve ser a porta de entrada para a atenção à saúde dos idosos. Espera-se que a APS exerça ações curativas e, principalmente, de prevenção e promoção à saúde para este grupo etário. O objetivo deste estudo foi avaliar, em 49 médicos que atuam na APS de Anápolis, estado de Goiás, a formação profissional na área do envelhecimento, os conhecimentos básicos sobre a velhice e as crenças relacionadas aos idosos. Foram aplicados os seguintes questionários: formação acadêmica na área do envelhecimento; Questionário Palmore-Neri-Cachioni, a fim de avaliar os conhecimentos básicos sobre a velhice; e Escala de Neri, para verificar as crenças relacionadas aos idosos. Os médicos mostraram carecer de formação acadêmica e conhecimentos básicos na área gerontológica. Entre eles, 22,4% deles não cursaram a disciplina Geriatria e Gerontologia na graduação, 71,4% não tinham qualquer tipo de especialização, 91,8% não fizeram residência médica. Nos últimos cinco anos, somente 38,8% participaram de cursos de Geriatria e Gerontologia, 10,2% fizeram pesquisa na área, e 59,2% leram algum artigo sobre envelhecimento. Na avaliação dos conhecimentos básicos sobre a velhice, os maiores números de acertos, 91,8% e 83,7%, surgiram nas duas questões que tratam de aspectos físicos do envelhecimento. A questão que recebeu menor número de acertos (6,1%) aborda o aspecto social do envelhecimento; e as duas questões que tratam de aspectos psicológicos tiveram menos de 20% de acertos. Quanto às crenças relacionadas à velhice, a tendência geral das respostas foi negativa. O domínio com avaliação mais positiva foi Agência e o com avaliação mais negativa foi Relacionamento Social. O item com crença mais positiva foi o relacionado à sabedoria. Concluiu-se que é necessária educação continuada para os médicos que atuam na APS, focada nos diferentes aspectos do envelhecimento, incluindo os psicossociais, assim como a adoção de crenças positivas relacionadas aos idosos.

The increase in the elderly population, with the complex health problems that involve it, evidences the need to use Primary Health Care (APS), which should be the gateway to health care for the elderly. It is expected that the APS will carry out curative actions and, mainly, of prevention and health promotion in this age group. The objective of this study was to evaluate the professional training, basic knowledge and beliefs related to the area of aging, in 49 physicians who worked in APS of Anápolis, Goiás, Brazil. The following questionnaires were used: one to verify the professional training in the area of aging; the Palmore-Neri-Cachioni Questionnaire, in the evaluation of basic knowledge about old age; and the Neri Scale, to know the beliefs related to the elderly. The physicians showed lack of professional training and basic knowledge in the gerontological area. Among them, 22.4% did not attend Geriatrics / Gerontology discipline at graduation, 71.4% did not have any type of specialization and 91.8% did not obtain medical residency. In the last five years, only 38.8% participated in Geriatrics courses, 10.2% did research in the area and 59.2% read some article about aging. In the evaluation of basic knowledge about old age, the highest numbers of correct answers, 91.8% and 83,7%, have arisen in the two questions that deal with the physical aspects of aging. The issue that received fewer correct answers (6.1%) addresses the social aspect of aging and two issues dealing with psychological aspects had less than 20% of correct answers. As to the beliefs related to old age, the general tendency of the answers was negative. The domain with the most positive evaluation was Agency and the one with the most negative evaluation was Social Relationship. The item with the most positive belief was that of wisdom. It was concluded that continuous education of these professionals is necessary, focused on the different aspects of aging including the psychosocial, as well as the adoption of positive beliefs related to the elderly.

El aumento de la población de ancianos, con los complejos problemas de salud que lo rodean, resalta la necesidad del uso de Atención Primaria de Salud (APS), que debería ser la puerta de entrada a la atención de la salud de los ancianos. Se espera que PHC realice acciones curativas y, principalmente, prevención y promoción de la salud para este grupo de edad. El objetivo de este estudio fue evaluar, en 49 médicos que trabajan en APS de Anápolis, estado de Goiás, Brasil, la formación profesional en el área del envejecimiento, los conocimientos básicos sobre la vejez y las creencias relacionadas con los ancianos. Se aplicaron los siguientes cuestionarios: educación académica en el área del envejecimiento; Cuestionario Palmore-NeriCachioni para evaluar los conocimientos básicos sobre la vejez; y Escala Neri para verificar las creencias relacionadas con los ancianos. Los médicos mostraron falta de antecedentes académicos y conocimientos básicos en gerontología. Entre ellos, el 22.4% de ellos no asistió al curso de pregrado de Geriatría y Gerontología, el 71.4% no tenía especialización, el 91.8% no tenía residencia. En los últimos cinco años, solo el 38.8% asistió a cursos de Geriatría y Gerontología, el 10.2% investigó en el área y el 59.2% leyó algún artículo sobre el envejecimiento. En la evaluación de los conocimientos básicos sobre la vejez, el mayor número de respuestas correctas, 91.8% y 83.7%, surgió en las dos preguntas que tratan con los aspectos físicos del envejecimiento. La pregunta que recibió el menor número de visitas (6,1%) aborda el aspecto social del envejecimiento; y las dos preguntas que tratan aspectos psicológicos tenían menos del 20% de respuestas correctas. En cuanto a las creencias relacionadas con la vejez, la tendencia general de las respuestas fue negativa. El dominio con la calificación más positiva fue Agencia y el dominio con la calificación más negativa fue Relación Social. El artículo con la creencia más positiva estaba relacionado con la sabiduría. Se concluyó que se requiere educación continua para los médicos que trabajan en APS, centrados en diferentes aspectos del envejecimiento, incluido el psicosocial, así como la adopción de creencias positivas relacionadas con los ancianos.

The rs4430796 SNP of the HNF1ß gene associates with type 2 diabetes in older adults.

INTRODUCTION: The impact of type 2 diabetes mellitus raises interest in understanding its evolutionary-genetic basis, to unveil yet unknown pathways that may have immediate medical relevance. The HNF1ß gene (hepatocyte nuclear factor-1 beta) is a transcription factor expressed in tissues such as liver, kidney, genital tract and pancreas that is known to be essential for insulin secretion and glucose balance. We tested the association of allelic variants produced by the HNF1ß gene (rs4430796) variation with the clinical and biochemical profile of elderly Brazilian outpatients with metabolic disorders. MATERIAL AND METHODS: Anthropometry, blood pressure, glycaemia, lipemia and other parameters were assessed in 184 Brazilians aged 60 or older in clinical care settings. Alleles were determined by amplification of the polymorphic site by real time polymerase chain reaction. RESULTS: Analysing variables across the genotypes, a statistically significant difference was noticed in the allele frequencies among diabetic patients, with 30.8% of the A homozygous bearing the condition compared to a prevalence of 12.2% between G homozygotes. CONCLUSION: Our results corroborate the possible protective property of the GG genotype from the rs4430796 variation (already presented in the literature) against occurrence of diabetes mellitus, which appears applicable to elderly individuals as well, even in the context of multiple metabolic disorders so typical in older Brazilians.

Diagnosis and Prognosis of Prostate Cancer from Circulating Matrix Metalloproteinases and Inhibitors.

Although prostate cancer (PCa) is the sixth most common type of neoplasm in the world and the second in prevalence among men (10% of all cases), there is shortage of studies focused on primary prevention of the disorder as well as little understanding on its pathophysiology. Currently, the PCa screening tools are the prostate specific antigen (PSA) dosage conjugated to rectal examination and confirmed by prostate biopsy. Despite the name, the PSA presents reduced specificity, being necessary the identification of new biomarkers that allow an earlier and more precise diagnosis and even better prognosis. Several studies have associated matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) to PCa tumorigenesis and metastasis. Most of the studies so far have been carried out by investigating in situ expression of the metalloproteinases, either by transcriptional measures or by immunohistochemistry with biopsy or postoperative tissue. Investigations in human plasma and serum are scarce, and a bibliographical search resulted in 17 studies which are presented and interpreted herein. This narrative review discusses their settings and findings along with aspects related to circulating metalloproteinases as potential biomarkers for diagnosis or prognosis of the prostatic malignancy, expressing the authors' reticent view on their applicability due to the poor quality of evidence available.

Interplay between circulating nitric oxide and interleukin-17 in elderly outpatients with non-inflammatory conditions.

Nitric oxide (NOx) availability in biological systems is associated with either favorable or unfavorable outcomes. In this sense, several studies bring about evidence that unbalanced NOx production may be underlying to the pathophysiology of vascular disorders. Our study investigated the possible association of clinical, biochemical and inflammatory variables with total circulating levels of NOx in elderly patients devoid of major inflammatory conditions. Clinical (demographics, lifestyle, anthropometry, pressoric traits) and biochemical characteristics (lipemic, glycemic and hormonal profiles) were assessed from 168 geriatrics outpatients eligible for primary care for age-related disorders. Furthermore, circulating levels of 10 inflammatory mediators and of NOx were measured. Correlation tests analyzed categorical or continuous traits according to serum NOx and found no association between NOx and any of the clinical or laboratory data but a negative correlation between plasma NOx concentrations and levels of the immune mediator IL17a (r = -0.236; P = 0.004). Evidence for a correlation between circulating NOx and IL17 is already present in the literature, mostly from studies conducted under inflammatory conditions. Our hypothesis is that such negative correlation can be attributed to an endogenous homeostatic system that IL17 production by the constitutively produced NOx from the vascular endothelium.

Matrix Metalloproteinase-1 Gene Polymorphism Associated with Ultrasound-Assessed Carotid Thickness among Older Adults.

BACKGROUND AND AIM: Due to the high incidence of vascular diseases, it is necessary to identify new circulating or structural markers for predicting risk for chronic diseases. Some studies suggest that MMP1 gene polymorphisms are associated with the enzyme expression levels in situ (e.g., in atherosclerotic plaques). OBJECTIVES: Thus, the study of this polymorphism may help understanding the pathophysiology of coronary disease. METHODS: We performed cross-sectional clinical and laboratory evaluations (including measurement of intima-media thickness of carotid arteries) and genotyping of the MMP1 SNP rs495366 (A/G) in 366 elderly people. RESULTS: No significant differences between genotypes were noted for biochemical, metabolic, inflammatory, or clinical variables except for a significant difference in intima-media thickness for the left carotid artery and a trend toward significance for the right counterpart. CONCLUSION: Carriers of the allele associated with lower MMP1 expression (allele A) presented greater carotid thickness. We suggest that the phenomenon can be explained by impaired remodeling of the arterial wall (poor degradation of collagen fibers in this scenario), yielding carotid wall thickening and a greater intrinsic risk for cerebrovascular events.