Hospitalizations in older adults from the Zona da Mata of Minas Gerais, Brazil: data from the Unified Health System, 2016­2018

Introduction: The growing older population increases proportionately the demand for hospital care due to the increase in health problems. Objective: To estimate the prevalence and incidence of hospitalizations, and to investigate associated factors in older adults from the Zona da Mata of Minas Gerais, Brazil, between 2016-2018. Secondly, to provide a more comprehensive epidemiological overview of hospitalizations, the following were estimated: monthly hospitalization rate; hospital mortality rate; frequency of hospitalizations according to diagnosis, hospitalizations for conditions sensitive to primary care and in-hospital death; and hospital costs. Methods: This is an ecological and descriptive-analytic study. Data were obtained from the Brazilian Hospital Information System (SIH/SUS). Results: The prevalence of hospitalizations was 35.1% (31.2% in women and 39.7% in men). The monthly rate of hospitalizations was higher in older men when compared with older women (Rate-Ratio=1.35 [95% CI=1.27-1.43]) and adult men between 40­59 years (Rate Ratio=2.42 [95% CI=2.26-2.58]). The cumulative incidence of hospitalization was 144/1,000 older persons (125/1,000 women and 169/1,000 men). Factors significantly associated with hospitalizations were: male sex (PR=1.52 [95% CI=1.11-2.08]); hospitalization in surgical bed (PR=1.93 [95% CI=1.05-3.56]); absence of death (PR=1.94 [95% CI=1.03-3.65]); and hospital stay ≥15 days (PR=0.71 [95% CI=0.54 0.95]). The cost of hospitalizations was R$ 220,8 million (mean of R$ 201,700/day). Conclusion: The findings strengthen the need for preventive healthcare for the older population living in the Zona da Mata of Minas Gerais and alert managers to the substantial socioeconomic impact of hospitalizations.

The usefulness of patient-reported outcome measures in decision making in Chagas cardiomyopathy: a scoping review.

Chagas cardiomyopathy (ChC) presents many biopsychosocial complexities, highlighting the need to have patient self-report questions. This study demonstrates the scope of the use of patient-reported outcome measures (PROMs) in patients with ChC and highlights the main research gaps. This is a scoping review and the search strategy was performed in the Online Medical Literature Analysis and Retrieval System (MEDLINE), Excerpta Medica database (EMBASE), Accumulated Index of Nursing and Allied Health Literature (CINAHL), Cochrane Central, Latin American Literature and Caribbean in Health Sciences (LILACS) and Diagnostic Test Accuracy (DITA). The search identified 4484 studies and 20 studies met the inclusion criteria. The Short-Form of 36 items (SF-36) had potential prognostic value and the ability to identify systolic dysfunction. The Human Activity Profile was able to screen for functional impairment, and the New York Heart Association showed potential prognostic value. The SF-36 and Minnesota Living with Heart Failure Questionnaire were responsive to interventions. The pharmaceutical care affected adherence to treatment as assessed by the Morisky score and also for SF-36. Despite the increased use of PROMs, there are still a large number of gaps in the literature, and further studies using PROMs are needed.

Association between sleep problems and functional disability in community-dwelling older adults.

BACKGROUND: Sleep problems are frequently observed in older adults. They can lead to changes in the individual's physical, occupational, cognitive, and social functioning, compromising the performance of activities of daily living and contributing to the occurrence of functional disability. This study evaluated the association between sleep problems and functional disability in community-dwelling older adults. METHODS: This was a cross-sectional study with data from 10,507 Brazilian community-dwelling older adults participating in the 2013 National Health Survey. The exposure variable was self-reported sleep problems in the last two weeks. The outcome measure was functional disability assessed from self-reported questionnaires, categorized into basic activities of daily living (BADL) and instrumental activities of daily living (IADL), and defined as not being able to perform or having little or a lot of difficulty in at least one of the activities investigated in the domain of interest. RESULTS: Older adults who reported sleep problems had 1.53 (95%CI: 1.34; 1.75) and 1.42 (95%CI: 1.26; 1.59) greater odds of having a disability in BADL and IADL when compared to individuals who reported having no sleep problems. CONCLUSIONS: Older adults with sleep problems were more likely to have a functional disability, both in BADL and IADL. Thus, it is important to implement strategies to screen for sleep problems in older adults in primary health care as a preventive strategy for functional disability.

Urinary incontinence in middle-aged and older women with hip and knee osteoarthritis: An outpatient study of frequency and risk factors.

AIMS: To investigate the frequency and the factors associated with urinary incontinence (UI) in a sample of middle-aged and older women with lower limb osteoarthritis (OA). METHODS: Women aged 50 years or older with clinical hip/knee OA diagnoses were recruited for this cross-sectional study. Self-reported UI and type, sociodemographic characteristics, medical conditions, physical activity level, anthropometric and body composition measurements, muscle strength, and physical function were assessed. Uni and multivariable logistic regression were used to investigate the factors associated with UI. RESULTS: Among 100 middle-aged and older women (mean 67.27 ± 8.77 SD years), 67% reported UI. In the UI group, 33% reported stress UI, 36% reported urgency UI, and 31% reported mixed UI. In the univariate analysis, age, level of physical activity, pulmonary disease, number of medications, body mass index (BMI), number of deliveries, and activity limitation were significantly associated with UI. In the multivariable analysis, older age (60-69 years OR: 4.91, 95% CI: 1.25-19.36; ≥70 years OR: 8.06, 95% CI: 1.96-33.22), compared to 50-59 years, morbid obesity (OR: 14.10, 95% CI: 1.36-146.48), compared to BMI < 30 kg/m2 , and activity limitation (OR: 5.31, 95% CI: 1.61-17.54), assessed as short physical performance battery ≤8, remained significantly associated with UI. CONCLUSIONS: UI was highly frequent among middle-aged and older women with hip/knee OA. Older age, activity limitation, and morbid obesity were independently associated with UI. Interventions targeting physical function and weight management must be considered to prevent and treat UI in this population.

Construction and validation of the community health workers perception questionnaire on conditions amenable to physiotherapy in primary health care / Construção e validação do questionário de percepção dos Agentes Comunitários de Saúde sobre condições sensíveis à fisioterapia na Atenção Primária

Abstract Introduction Community health workers, like the physiotherapist, perform essential functions in primary health care, being an important element in the transformation of public policies. There are no reported studies investigating the knowledge of community health workers about health conditions amenable to physiotherapy intervention in primary health care. Objective To construct a questionnaire to investigate the perception of community health workers about health conditions that could be remedied by physiotherapy intervention in primary health care. Methods This was a methodological study in which it was initially an analysis matrix with the aim of encompassing the ideas contemplated in the questionnaire. To construct the instrument, a literature review was carried out, and health conditions treatable with physiotherapy in primary health care were chosen. To validate the content and appearance of the items, twelve physiotherapists specialized in primary health care judged the suitability of the items contained. The content validity index was used to determine the degree of agreement during the response analysis process. Subsequently, a semantic analysis was carried out through the understanding of the items by 15 community health workers. In the validation stage, two rounds of evaluation were carried out. Adjustments were made to 17 questions. Results The study investigated a questionnaire with 20 questions containing hypothetical situations of home visits, in which the resident's situation could or could not constitute a health risk amenable to physiotherapeutic intervention. Conclusion The community health workers perception instrument on health conditions amenable to physiotherapy intervention in primary health care proved to be valid for use in this context. The use of the instrument may contribute to the development of community health worker training programs, with the aim of facilitating team communication.

Resumo Introdução O Agente Comunitário de Saúde (ACS), assim como o fisioterapeuta, desencadeia funções fundamentais na Atenção Primária à Saúde (APS), sendo ele-mento importante na transformação de políticas públicas. Inexistem estudos que investiguem o conhecimento dos ACS sobre as condições de saúde sensíveis à inter-venção da fisioterapia na APS. Objetivo Construir um questionário de investigação da percepção dos ACS sobre as condições de saúde sensíveis à intervenção da fisioterapia na APS. Métodos Trata-se de um estudo metodológico no qual, inicialmente, construiu-se uma matriz de análise com o intuito de englobar as ideias contempladas no questionário. Para a construção do instrumento, realizou-se uma revisão da literatura, sendo eleitas condições de saúde sensíveis à intervenção da fisioterapia na APS. Para a validação de conteúdo e aparente dos itens, 12 fisioterapeutas especialistas em APS julgaram a adequação dos itens contidos. Utilizou-se o índice de validade de conteúdo para verificar o grau de concordância durante o processo de análise das respos-tas. Posteriormente, realizou-se análise semântica por meio da compreensão dos itens por 15 ACS. Na etapa de validação, foram realizadas duas rodadas de avaliação. Foram feitos ajustes em 17 questões. Resultados O estudo resultou em um questionário com 20 questões contendo situações hipotéticas de visitas domiciliares, cuja situação do morador poderia ou não configurar um risco à saúde sensível à intervenção fisioterapêutica. Conclusão O instrumento de percepção dos ACS sobre as condições de saúde sensíveis à intervenção da fisioterapia na APS mostrou-se válido para ser utilizado no contexto da APS. A utilização do instrumento poderá contribuir na elaboração de programas de capacitação dos ACS, com o intuito de facilitar a comunicação da equipe.

Factors associated with fear of falling in older women with knee osteoarthritis: A cross-sectional study.

Knee instability in patients with knee osteoarthritis (KOA) is associated with fear of falling (FoF). This study aimed to investigate the prevalence and the factors associated with FoF in older women with KOA. A cross-sectional study was conducted with 93 older women with KOA. Sociodemographic variables, medical conditions, handgrip strength, and anthropometric and body composition measurements were assessed. The Short Physical Performance Battery was used to measure functional performance. The Western Ontario and McMaster Universities Osteoarthritis Index was applied to assess pain, stiffness, and disability. FoF was assessed by the Falls Efficacy Scale-International. The prevalence of FoF was high (88.2 %). Disability, history of falls, handgrip strength, obesity, number of medications, and pain were independently associated with FoF. Our findings suggest that health professionals should investigate FoF when evaluating older women with KOA and address these risk factors when developing strategies to prevent or minimize FoF in this population.

Inflammatory biomarkers at different stages of Sarcopenia in older women.

In recent years, studies have found that Sarcopenia alters inflammatory biomarkers. However, the behavior of inflammatory biomarkers at different stages of Sarcopenia is not well understood. This study aimed to compare a broad panel of inflammatory biomarkers in older women at different stages of Sarcopenia. The study included 71 Brazilian community-dwelling older women. Muscle Strength was assessed by using handgrip strength (Jamar dynamometer). The Short Physical Performance Battery (SPPB) was performed to assess the physical performance, and body composition was assessed by DEXA. Sarcopenia was diagnosed and classified according to the EWGSOP2 criteria. Blood was drawn, and inflammatory biomarkers associated with Sarcopenia (IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, TNF, adiponectin, leptin, resistin, BDNF, sTNFr-1 and sTNFr-2) was analysed. After diagnosis and classification of sarcopenia, 45% of women did not present Sarcopenia (NS, N = 32), 23.9% were diagnosed with Sarcopenia Probable (SP, N = 17), 19,7% with Sarcopenia Confirmed (SC, N = 14), and 11.3% with Severe Sarcopenia (SS, N = 8). The analysis of inflammatory biomarkers revealed that the more advanced the stage of Sarcopenia, the higher the levels of BDNF, IL-8, sTNFr-1, and sTNFr-2. The assessment of BDNF, IL-8, sTNFr-1, and sTNFr-2 levels may be an adjuvant tool in diagnosis and severity classification of Sarcopenia in older Brazilian women.

Home-based gait speed and the association with sociodemographic and anthropometric variables: A national study (ELSI-Brazil).

OBJECTIVES: To investigate home-based gait speed performance for men and women stratified by age group and its associations with sociodemographic and anthropometric variables. METHODS: Data from the 2nd wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2019-2021) were used. Gait speed was tested twice at home over 3.0 meters at usual pace. Associations of sociodemographic and anthropometric variables with gait speed were evaluated using gamma regression. RESULTS: Median gait speed value reduced with increasing age in both sexes [men: 0.70 m/s (50-59 years) to 0.53 m/s (≥80 years); women: 0.68 m/s (50-59 years) to 0.48 m/s (≥80 years)] and was significantly lower in women than men in the age groups of 60-69 and 70-79 years. Age group and education among men and age group, education, and waist circumference among women were significantly associated with gait speed. CONCLUSIONS: Our findings may be helpful as reference values to identify mobility limitation among older Brazilians.

Suitability of the animated activity questionnaire for use as computer adaptive test: establishing the AAQ-CAT.

PURPOSE: The animated activity questionnaire (AAQ) is a computer-based measure of activity limitations. To answer a question, patients choose the animation of a person performing an activity that matches their own level of limitation. The AAQ has not yet been tested for suitability to be applied as computer-adaptive test (CAT). Thus, the objective of this study was to develop and evaluate an AAQ-based CAT to facilitate the application of the AAQ in daily clinical care. METHODS: Patients (n = 1408) with hip/knee osteoarthritis from Brazil, Denmark, France, The Netherlands, Norway, Spain, and the UK responded to all 17 AAQ items. Assumptions of item-response theory (IRT) modelling were investigated. To establish item parameters for the CAT, a graded response model was estimated. To evaluate the performance of post-hoc simulated AAQ-based CATs, precision, test length, and construct validity (correlations with well-established measures of activity limitations) were evaluated. RESULTS: Unidimensionality (CFI = 0.95), measurement invariance (R2-change < 2%), and IRT item fit (S-X2 p > .003) of the AAQ were supported. Performing simulated CATs, the mean test length was more than halved (≤ 8 items), while the range of precise measurement (standard error ≤ 0.3) was comparable to the full AAQ. The correlations between original AAQ scores and three AAQ-CAT versions were ≥ 0.95. Correlations of AAQ-CAT scores with patient-reported and performance measures of activity limitations were ≥ 0.60. CONCLUSION: The almost non-verbal AAQ-CAT is an innovative and efficient tool in patients with hip/knee osteoarthritis from various countries, measuring activity limitations with lower respondent burden, but similar precision and construct validity compared to the full AAQ.

Construct validity and reliability of the participation scale (P-scale) in individuals with spinal cord injury.

OBJECTIVES: To investigate the reliability and the construct validity of the Participation Scale (P-scale) in adults with Spinal Cord Injury (SCI). DESIGN: A cross-sectional study. SETTING: : SARAH Network of Rehabilitation Hospitals, Brazil. PARTICIPANTS: : One hundred individuals with SCI. INTERVENTIONS: : Not applicable. OUTCOME MEASURES: : Sociodemographic and clinical characteristics were investigated. To assess reliability the P-scale was applied twice with a one-week interval. To assess construct validity the Functional Independence Measure, the Beck Depression Inventory, and the Accessibility Perception Questionnaire were administered. RESULTS: The mean age of the participants was 38.9 ± 12.80 years. The majority were male (70%) and had traumatic injuries (74%). The P-scale showed significant correlations with the Functional Independence Measure motor domain (rs = -0.280) and cognitive domain (rs = -0.520); with the Beck Depression Inventory score (rs = 0.610); with the Accessibility Perception Questionnaire displacement domain (rs = -0.620) and psycho-affective domain (rs = 0.530). Mean scores obtained on the P-scale differed significantly between the groups with and without depressive symptoms (P = 0.001), neuropathic pain (P = 0.033), and functional dependence (P = 0.001). There was no difference between the paraplegic and quadriplegic groups. The P-scale had adequate internal consistency (Cronbach's alpha = 0.873), excellent test-retest reliability (ICC2,1 = 0.992; 95% CI = 0.987-0.994), and in the Bland-Altman plot analysis, only six values fell outside the limits of agreement. CONCLUSION: Our results support the use of the P-scale to assess the participation of individuals with SCI in research and clinical practice.

Examining the factors associated with functional capacity of community-dwelling older adults using the ICF framework: a cross-sectional study from the Frailty in Brazilian Older Adults Study (FIBRA).

BACKGROUND: There are many factors associated with functioning and disability in older adults and these relationships are not clear. OBJECTIVE: To explore the factors associated with functional capacity of older adults using the framework of the International Classification of Functioning, Disability, and Health (ICF). METHODS: This is a cross-sectional study with a dataset from a survey of 1 377 community-dwelling older adults (≥ 65 years) in a middle-income country. Three functional outcomes were selected to represent the functioning domains: 1) muscle strength for body function; 2) walking speed for activity; and 3) advanced activities of daily living (ADL) for participation. Demographic, clinical, and social information was selected to represent the domains of health conditions and contextual factors (i.e. personal and environmental factors). Multivariate models tested the impact of these factors on each outcome. RESULTS: Depressive symptoms, age, and physical activity were associated with the three outcomes. Muscle strength was also associated with urinary incontinence, visual deficits, female sex, and employment. Walking speed was also associated with urinary incontinence, obesity, fractures due to falls, female sex, health professionals' visits, and walking aid devices. Advanced ADL were also associated with stroke, visual deficits, education, employment, health perception, social support, and walking aid devices. CONCLUSION: Functional capacity of older adults is associated with some non-modifiable factors, such as age and sex. The modifiable factors must be addressed by health professionals and policymakers in the geriatric area, especially depression, obesity, physical inactivity, and social support.

Adiponectin Is a Contributing Factor of Low Appendicular Lean Mass in Older Community-Dwelling Women: A Cross-Sectional Study.

Inflammation is a chronic, sterile, low-grade inflammation that develops with advanced age in the absence of overt infection and may contribute to the pathophysiology of sarcopenia, a progressive and generalized skeletal muscle disorder. Furthermore, a series of biomarkers linked to sarcopenia occurrence have emerged. To aid diagnostic and treatment strategies for low muscle mass in sarcopenia and other related conditions, the objective of this work was to investigate potential biomarkers associated with appendicular lean mass in community-dwelling older women. This is a cross-sectional study with 71 older women (75 ± 7 years). Dual-energy X-ray absorptiometry was used to assess body composition. Plasmatic blood levels of adipokines (i.e., adiponectin, leptin, and resistin), tumor necrosis factor (TNF) and soluble receptors (sTNFr1 and sTNFr2), interferon (INF), brain-derived neurotrophic factor (BDNF), and interleukins (IL-2, IL-4, IL-5, IL-6, IL-8, and IL-10) were determined by enzyme-linked immunosorbent assay. Older women with low muscle mass showed higher plasma levels of adiponectin, sTNFr1, and IL-8 compared to the regular muscle mass group. In addition, higher adiponectin plasma levels explained 14% of the lower appendicular lean mass. High adiponectin plasmatic blood levels can contribute to lower appendicular lean mass in older, community-dwelling women.

Nationwide handgrip strength values and factors associated with muscle weakness in older adults: findings from the Brazilian Longitudinal Study of Aging (ELSI-Brazil).

BACKGROUND: Handgrip strength (HGS) is a simple, quick, inexpensive, and highly reliable method for the assessment of muscle strength in clinical practice and epidemiological studies. This study aimed at describing the HGS values by age group and sex in Brazilians aged 50 years and over, determining age group- and sex-specific cutoff points for muscle weakness, and investigating sociodemographic and anthropometric variables associated with muscle weakness for each sex. METHODS: Data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) were analyzed. HGS was measured in the dominant hand using a hydraulic hand dynamometer. Fractional polynomial regression models were fitted to estimate the percentiles (P5, P10, P20, P25, P50, P75, P90, and P95) of HGS by age group and sex. The P20 of the maximum HGS by age group and sex was used to define muscle weakness. Associations between sociodemographic (racial self-classification, place of residence, schooling, and monthly household income per capita in tertiles) and anthropometric variables (body mass index and waist circumference) and muscle weakness, by sex, were evaluated using logistic regression. RESULTS: The analytical sample included 7905 participants (63.1 ± 9.1 years; 60% women). HGS reduced with increasing age in both sexes. Men presented higher HGS than women in all age groups. The cutoff points for muscle weakness ranged from 28 to 15 kg for men and from 17 to 9 kg for women. In the adjusted analyses, low schooling (0-4 years) was positively associated with muscle weakness in both sexes (in men, odds ratio (OR) 2.45, 95% confidence interval (CI) 1.46-4.12; in women, OR 1.90, 95%CI 1.18-3.06). Low and middle monthly household income per capita also had a positive association with muscle weakness among women (OR 1.78, 95%CI 1.37-2.32; OR 1.32, 95%CI 1.01-1.73, respectively). Overweight had a negative association with muscle weakness among men (OR 0.66, 95%CI 0.52-0.83), and obesity was inversely associated with muscle weakness in both sexes (in men, OR 0.49, 95%CI 0.31-0.78; in women, OR 0.69, 95%CI 0.52-0.92). CONCLUSIONS: This study provides HGS values and cutoff points for muscle weakness by age group and sex from a nationally representative sample of older Brazilian adults. The variables associated with muscle weakness slightly differed between men and women. HGS values and cutoff points generated can be used as benchmarks in clinical settings and foster future epidemiological research.

Reliability and validity of specific quality of life assessment questionnaires related to chronic venous insufficiency: a systematic review.

This systematic review aimed to discuss the main findings regarding the reliability and validity of health-related quality of life questionnaires for chronic venous insufficiency. Searches were performed on the MEDLINE, CINAHL, Web of Science, LILACS, and Scopus databases. The search terms used were related to "venous insufficiency", and "quality of life". The CIVIQ-20 and CIVIQ-14 instruments had adequate internal consistency and both were able to discriminate disease severity. The VEINES-QoL showed adequate internal consistency but was not able to discriminate disease severity. Most studies did not demonstrate a correlation between VEINES-QoL and the mental component of the SF-36. The AVVQ had inadequate reliability but its validity was also doubtful when compared to the SF-36. The VARIShort demonstrated good internal consistency, reproducibility, and validity, but only the original study was included. For venous leg ulcers, the CCVUQ showed adequate reliability and validity when compared to VLU-QoL.

Esta revisão sistemática objetivou discutir os principais achados sobre a confiabilidade e validade dos questionários de qualidade de vida relacionada à saúde na insuficiência venosa crônica. A busca foi realizada nas bases de dados MEDLINE, CINAHL, Web of Science, LILACS e Scopus. Os termos de busca foram relacionados a "insuficiência venosa" e "qualidade de vida". O Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ)-20 e o CIVIQ-14 apresentaram consistência interna adequada e foram capazes de discriminar a gravidade da doença. O Venous Insufficiency Epidemiological and Economic Study ­ Quality of Life (VEINES-QoL) apresentou consistência interna adequada, mas não foi capaz de discriminar a gravidade da doença. A maioria dos estudos não demonstrou associação do VEINES-QoL com o componente mental do Short Form Health Survey (SF-36). O Aberdeen Varicose Vein Questionnaire (AVVQ) apresentou confiabilidade inadequada e validade duvidosa quando comparado ao SF-36. O VARIShort demonstrou consistência interna, reprodutibilidade e validade boas, mas apenas o estudo original foi incluído. Na úlcera venosa, o Charing Cross Venous Ulcer Questionnaire (CCVUQ) apresentou confiabilidade e validade adequadas quando comparado ao Venous Leg Ulcer Quality of Life (VLU-QoL).

Time trends of physical activity for leisure and transportation in the Brazilian adult population: results from Vigitel, 2010-2019.

This time-series study examined a 10-year historical series of the physical activity prevalence for leisure and transportation in the Brazilian adult population. Information from 512,969 adults interviewed from the Vigitel between 2010 and 2019 was analyzed. Individuals who reported practicing at least 150 minutes/week of moderate-intensity physical activity or at least 75 minutes/week of vigorous-intensity physical activity were considered active during leisure time. Individuals who reported walking or cycling to/from work, course, or school at least 30 minutes/day, equivalent to at least 150 minutes/week of moderate-intensity physical activity, were considered active during transportation. The prevalence of physical activity for leisure and transportation was calculated annually and stratified by sex, age group, schooling, and race/skin color. The segmented regression model was applied to analyze the time series. Annual percent change and average annual percent change were calculated. Over time, the prevalence of physical activity for leisure increased, and the prevalence of physical activity for transportation decreased. The highest prevalence of physical activity for leisure was observed among males, young individuals, and those with high education. Older adults, those with high education, and white people presented the lowest prevalence of active transport. Policymakers should propose strategies that encourage and facilitate physical activity for leisure in women, individuals aged ≥ 35 years, and those with less education (< 12 years), and physical activity for transportation among older adults (≥ 60 years), those with high education (≥ 12 years), and white people.

Fratura por fragilidade: fatores de risco em uma coorte retrospectiva / Fragility fracture: risk factors in a retrospective cohort

Objetivo: Avaliar os fatores de risco para fratura por fragilidade (FF) em pacientes internados em um hospital terciário de ensino, no município de Diamantina, Minas Gerais. Métodos: Dados sociodemográficos, de saúde, estilo de vida (tabagismo, consumo de álcool, exposição ao sol, nível de atividade física, hábitos alimentares), mobilidade e nível de dependência foram coletados dos prontuários de pacientes com 50 anos ou mais, internados com FF, no período de abril a setembro de 2020. Resultados: Um total de 52 pacientes foram internados com diagnóstico de FF, sendo 60% com diagnóstico de fratura proximal de fêmur. Somente 17,3% dos pacientes possuíam diagnóstico prévio de osteoporose. Os fatores de risco mais frequentes para FF foram sexo feminino, déficit cognitivo, sarcopenia, dinapenia, histórico familiar de osteoporose ou fratura por queda, baixa exposição ao sol, consumo insuficiente de leite e derivados, inatividade física e dependência nas atividades básicas e instrumentais de vida diária. Quando comparados os grupos com fratura proximal de fêmur e outras fraturas, o grupo com fratura proximal de fêmur apresentou maior frequência de indivíduos com idade avançada (≥ 80 anos), déficit cognitivo, baixo peso, sarcopenia, tabagismo, inatividade física e limitação na mobilidade, ao passo que o grupo com outras fraturas apresentou maior frequência de histórico familiar de osteoporose ou fratura por queda. Conclusão: Os resultados demonstraram um subdiagnóstico da osteoporose na população estudada. Muitos fatores de risco modificáveis para osteoporose e quedas foram identificados. Intervenções direcionadas para estes fatores de risco devem ser consideradas de forma a prevenir as FF.

Objective: To evaluate the risk factors for fragility fractures (FF) in patients admitted to a tertiary teaching hospital in the municipality of Diamantina, Minas Gerais. Methods: Sociodemographic, health, lifestyle (smoking, alcohol consumption, sun exposure, physical activity level, eating habits), mobility, and dependence level data were collected from the medical records of patients aged 50 years or older, hospitalized with FF, from April to September 2020. Results: A total of 52 patients were hospitalized with FF, 60% had a diagnosis of proximal femur fracture. Only 17.3% of the patients had a previous diagnosis of osteoporosis. The most prevalent risk factors for FF were female gender, cognitive deficit, sarcopenia, dynapenia, family history of osteoporosis or fracture due to fall, low sun exposure, insufficient consumption of milk and dairy products, physical inactivity, and dependence on basic and instrumental activities of daily living. When comparing the groups with proximal femoral fractures and other fractures, the group with proximal femoral fractures showed a higher frequency of individuals with advanced age (≥ 80 years), cognitive deficit, low weight, sarcopenia, smoking, physical inactivity, and mobility limitation, whereas the group with other fractures presented a higher frequency of family history of osteoporosis or fracture due to fall. Conclusion: The results demonstrated an underdiagnosis of osteoporosis in the studied population. Many modifiable risk factors for osteoporosis and falls have been identified. Interventions toward these risk factors should be considered in order to prevent FF.

Individual characteristics, perceived neighborhood, and walking for transportation among older Brazilian people residing in a large urban area.

This study aimed to investigate the association of individual and environmental characteristics with walking for transportation among older Brazilian people living in a large urban area. Data from 825 participants (≥ 60 years) from a multistage household survey in Belo Horizonte, Brazil, were used. Walking for transportation was evaluated using the International Physical Activity Questionnaire. The environmental variables included six perceived neighborhood scales (walkability, quality of services, physical disorder, safety, social disorder, and social cohesion). A Poisson regression analysis with robust variance was performed. The walking for transportation was significantly associated with walkability scale, lower family income (up to four minimum wages), very good/good self-rated health, and high social participation. Our results suggest that promoting adequate conditions for walkability in urban areas, expanding the opportunities for social participation, and improving general health is essential to increase walking levels for transportation among this older Brazilian population.

Do Older Brazilian Women Who Participate in a Regular Physical Exercise Program Have Higher Habitual Physical Activity Levels? A Cross-Sectional Study Based on Accelerometer Data.

A cross-sectional study was conducted to compare the habitual physical activity level, measured by accelerometry, gait performance, assessed by the GAITRite® system, handgrip strength, and static balance between older Brazilian women who participate (n = 50; 70.7 ± 5.5 years) and do not participate (n = 50; 70.1 ± 5.6 years) in a regular physical exercise program, and to investigate whether participation in a regular exercise program ensures compliance with physical activity recommendations. Older women who participated in a regular physical exercise program had significantly shorter sedentary activity time (effect size [ES] = 0.54), longer moderate activity time (ES = 0.85), and higher energy expenditure (ES = 0.64), number of steps (ES = 0.82), gait speed (ES = 0.49), and step length (ES = 0.45). However, regular participation in an exercise program did not guarantee compliance with physical activity recommendations. Behavioral changes to increase physical activity levels among older women who do and do not participate in a regular exercise program are necessary.

The prognostic value of the Incremental Shuttle Walk Test in Chagas cardiomyopathy.

PURPOSE: To verify the value of the Incremental Shuttle Walk Test (ISWT) distance to identify patients with Chagas cardiomyopathy (ChC) at risk of adverse cardiovascular events. METHODS: Fifty-two patients with ChC (51 ± 6 years) were evaluated by ISWT, echocardiography, Cardiopulmonary Exercise Testing, and Human Activity Profile (HAP) Questionnaire. Patients were prospectively followed for 44 ± 10 months. The combined endpoint was cardiac death/heart transplant/stroke. The prognostic value of ISWT was verified by the Cox regression, and the ISWT was adjusted for age, sex, left ventricular ejection fraction (LVEF), and minute ventilation/carbon dioxide production relationship (VE/VCO2 slope). RESULTS: At the final follow-up, 11 patients (21%) had experienced the endpoint event. When adjusted for age, sex, LVEF, and VE/VCO2 slope, only ISWT distance (HR 0.99, 95% confidence interval (CI): 0.98-0.99; p = 0.026) and VE/VCO2 slope (HR 0.93, 95% CI: 0.87-0.99; p = 0.044) remained as independent predictors of adverse cardiovascular events in patients with ChC. The optimal cutoff point for identifying poor prognosis was the ISWT distance less than 440 m (AUC = 0.72). There was a significant difference (p = 0.032) in the number of events between the groups with low ISWT distance (≤440 m) and high (>440 m) ISWT distance. CONCLUSIONS: The ISWT is a valuable tool with potential value in the prognostic evaluation of patients with ChC.Implications for rehabilitationPatients with Chagas cardiomyopathy showed functional impairment since the early stages of heart disease.The Incremental Shuttle Walk Test (ISWT) can be a valuable and inexpensive tool in the risk stratification of the patients.The ISWT distance is an independent predictor of adverse cardiovascular event.The ISWT distance of 440m is the optimal cut-off point in the identification of patients at risk for adverse cardiovascular events.