Associação entre linguagem e o reconhecimento de expressões faciais de emoções em idosos / The association between language and recognition of facial emotional expressions in elderly individuals

RESUMO Objetivo Verificar a associação entre o bom desempenho de linguagem e o reconhecimento de expressões faciais de emoções em idosos. Método Estudo transversal realizado com 118 idosos dos serviços de atenção primária à saúde de um município paulista. Foram coletados dados sociodemográficos, de desempenho da linguagem pelo domínio do Exame Cognitivo de Addenbrooke - Revisado e de Reconhecimento de Expressões Faciais de Emoções. A amostra foi dividida em tercis de acordo com o desempenho na linguagem: T1 = melhor, T2 = mediano e T3 = pior. Os grupos T1xT3 foram comparados em relação ao desempenho no reconhecimento de expressões faciais de raiva, nojo, medo, alegria, tristeza e surpresa e para as intensidades 40%, 60%, 80% e 100%. A associação das variáveis independentes sobre o desempenho de linguagem foi analisada por meio de regressão logística. O modelo multivariado foi construído a partir dos resultados das análises univariadas e incluiu as variáveis contínuas por emoção e por intensidade. Idade e escolaridade, associadas ao desempenho de linguagem no modelo univariado, foram incluídas no modelo multivariado para ajustar as análises de associação. Resultados A amostra era predominantemente feminina (84,7%), com idade média de 70,5 anos e 3,5 anos de escolaridade. As variáveis ​​associadas ao melhor desempenho de linguagem na análise comparativa de T1 e T3 foram: surpresa (OR= 1,485, IC 95% 1,194 - 1,846) e nojo (OR= 1,143, IC 95% 1,005 - 1,300). Conclusão O reconhecimento de expressões faciais das emoções surpresa e nojo mostraram-se importantes fatores associados ao bom desempenho da linguagem.

ABSTRACT Purpose To check the association between a good performance of language and the recognition of facial emotional expressions in elderly individuals. Methods Transversal study performed with 118 elderly individuals from the primary care services of health of a city in the state of São Paulo. Sociodemographic data were collected, regarding the performance of language through the domain of Addenbrooke Cognitive Examination - Revised and Recognition of Facial Emotional Expressions. The sample was divided in thirds according to the performance of language: T1 = the best, T2 = average, and T3 = the worst. The groups T1xT3 were compared regarding the performance of recognition of facial expressions of anger, disgust, fear, happiness, sadness, and surprise, and for the intensities of 40%, 60%, 80%, and 100%. The association of independent variables over the performance of language was analyzed through logistic regression. The multivariate model was built from the results of the univariate analyses and has included the continuous variables by emotion and by intensity. Age and schooling associated to the performance of language in the univariate model were included in the multivariate model in order to adjust association analyses. Results The sample was mainly female (84.7%), with an average age of 70.5 years old, and 3.5 schooling years. The variables associated to the best performance of language in comparative analysis of T1 and T3 were: surprise (OR = 1.485, IC 95% 1.194 - 1.846), and disgust (OR = 1.143, IC 95% 1.005 - 1.300). Conclusion The recognition of facial emotional expressions of surprise and disgust were shown as important factors associated to the good performance of language.

Prevalência e fatores associados à síndrome da fragilidade no idoso do Distrito Federal / Prevalence and factors associated with the frailty syndrome in older adults in the Brazilian Federal District

INTRODUÇÃO: A síndrome da fragilidade no idoso (SFI) tem sido reconhecida como uma condição de vulnerabilidade fisiológica associada ao envelhecimento, resultante de uma reserva homeostática reduzida e da dificuldade do organismo em responder adequadamente ao estresse, característica altamente preditiva de uma variedade de desfechos clínicos adversos associados, que incluem declínio funcional, institucionalização e mortalidade. OBJETIVO: Identificar a prevalência e os fatores associados à SFI em população assistida por uma unidade ambulatorial de atenção secundária em centro especializado de atendimento em geriatria e gerontologia do Distrito Federal. MÉTODOS: Trata-se de um estudo observacional, descritivo, transversal e analítico realizado com idosos atendidos no centro especializado em geriatria e gerontologia da Secretaria de Saúde do Distrito Federal (SES/DF). Na avaliação dos idosos, foram coletados dados para identificação do perfil, capacidade funcional, informações referentes às multimorbidades e desfechos clínicos, como quedas. Os idosos também foram classificados na SFI pelos critérios de Fried. Para a análise estatística, utilizaram-se o teste de χ2 e a regressão de Poisson. RESULTADOS: No presente estudo, 24% da amostra total foi considerada frágil, 32,9% pré-frágil e 42,1% não frágil. Com relação aos aspectos sociodemográficos, houve associação de fragilidade com maior faixa etária e menor nível educacional. Diabetes, hipertensão arterial sistêmica, incontinência urinária, polifarmácia, depressão, quedas e alteração cognitiva tiveram associação com maior risco de fragilidade. CONCLUSÃO: Mediante os resultados obtidos, será possível definir medidas e estratégias para prevenção de morbimortalidade e proporcionar melhor qualidade de vida para os idosos.

INTRODUCTION: Frailty syndrome (FS) in older adults has been recognized as a physiological vulnerability condition associated with aging, resulting from reduced homeostatic reserve and a difficulty of the body to respond adequately to stress, a highly predictive feature of a variety of adverse clinical outcomes including functional decline, institutionalization, and mortality. OBJECTIVE: To identify the prevalence and factors associated with FS in a population assisted by an outpatient geriatric unit at a specialized geriatric and gerontological care center in the Brazilian Federal District. METHODS: This is an observational, descriptive, cross-sectional and analytical study conducted with older people who were assisted at the specialized center for geriatrics and gerontology of the Brazilian Federal District Health Department. In the baseline evaluation of the participants, data were collected to identify the profile, functional capacity, multimorbidities and clinical outcomes such as falls, as well as the level of frailty, which was classified according to Fried's criteria. Statistical analysis was performed using the chi-square test and Poisson's regression. RESULTS: In the present study, 24% of the total sample was considered frail, 32.9% pre-frail and 42.1%, non-frail. Regarding sociodemographic aspects, there was an association of frailty with the higher age group and with lower educational level. Diabetes, systemic arterial hypertension, incontinence, polypharmacy, depression, falls, and cognitive impairment were directly related to higher risk of frailty. CONCLUSION: The results obtained were useful to help define measures and strategies to prevent morbidity and mortality as well as to provide better quality of life for older adults.

Prevalence and influencing factors of mild cognitive impairment among the elderly in Zhoushan City / 预防医学

Objective To learn the prevalence, distribution and risk factors of mild cognitive impairment (MCI) among elderly in Zhoushan City, and to provide the reference for MCI control. Methods A total of 1801 elderly people aged 60 to 79 years old from six districts of Zhoushan City were sampled by method of stratified random sampling. After self-evaluated with Ascertain Dementia 8 (AD8) and screened with Screening Scale for Mild Cognitive Impairment (sMCI), the diagnosis by specialists was conducted for that positive to AD8 and sMCI. Results of 1801 respondents, 873 (48.47％) people were male, and the other 928 (51.53％) people were female; 38.65％ of the people selected aged 60-<65; 90.28％ had a primary school education or were illiterate; 78.51％ had legitimate and healthy wives. A total of 122 elderly people were diagnosed with MCI, and the prevalence of MCI was 6.77％. Multivariate logistic regression analysis showed that male elderly people (OR=0.53, 95％CI:0.28-1.00) were less likely to develop MCI compared to the female, and the illiterate (OR=2.09, 95％CI: 1.16-3.77) were more likely to develop MCI compared to the educated . Conclusion The prevalence of MCI among the elderly in Zhoushan was 6.77％; the female and the illiterate were more likely to develop MCI.

Política nacional do idoso: percepção dos gestores e perfil dos idosos de um município de pequeno porte / National Policy on the Elderly: managers' perception and profile of the elderly of a small municipality / Política Nacional del Mayor: percepción de gestores y el perfil de mayores de un pequeño município

Objetivo: Identificar a percepção dos gestores municipais sobre a PNI, relacionando-a ao perfil sociodemográfico dos idosos e as estratégias de atenção à saúde em um município de pequeno porte do Rio Grande do Sul. Métodos: Trata-se de um estudo transversal, descritivo-exploratório, de abordagem quanti-qualitativa. As entrevistas foram realizadas com seis gestores de um único município e 134 idosos, identificados por questionário sociodemográfico. As entrevistas foram transcritas e analisadas a partir da análise de conteúdo. A análise estatística foi realizada no programa SPSS versão 21, com aplicação do teste Qui-Quadrado e adotado p<0,05. Resultados: Ao longo das entrevistas com os gestores emerge o desconhecimento acerca da PNI, impactando no planejamento das ações. A saúde é representada a partir da ausência da doença, relacionando-a como freqüente no envelhecimento. A análise estatística aponta resultados significativos na relação entre escolaridade e acesso ao serviço (p<0,01) e avaliação dos idosos sobre os serviços (p=0,00). Conclusão: A falta de conhecimento dos gestores no que se refere à PNI impacta diretamente nas ações de saúde para esse ciclo de vida no município. Os idosos eram, na sua maioria, do sexo feminino, com ensino fundamental incompleto, aposentados que usavam unidade básica de saúde e que não identificavam seu papel de controle social para o planejamento de ações que sejam de seu interesse.

Objective: The aim of this study was to identify the municipal managers' perception of the PNI, relating this policy to the sociodemographic profile of the elderly, and health care strategies in a small municipality of Rio Grande do Sul. Methods: This is s a descriptive and exploratory cross-sectional study of quantitative and qualitative approach. The interviews were carried out with six health managers of a single municipality and 134 elderly, identified by means of a sociodemographic questionnaire. The interviews were transcribed and analyzed using the content analysis method. Statistical analysis was performed using the software SPSS version 21. The Chi-square test was performed, adopting p<0.05. Results: Through the interviews with health managers, the ignorance of the NPI has emerged, impacting on health planning. Health is represented based on the absence of disease, being related as frequent in aging. The statistical analysis points out significant results in the association between educational level and access to the service (p<0.01) and the elderly's evaluation about the service (p=0.00). Conclusion: The managers' lack of knowledge regarding the PNI poses a direct impact on health actions for this life cycle in the municipality. The majority of the elderly were female, with incomplete elementary education, retirees who used a basic health unit and who did not identify their role as social control in the planning of actions that are of interest to them.

Objetivo: El objetivo de ese estudio fue identificar la percepción de los gestores municipales sobre la Política Nacional del Mayor (PNM) relacionándola con el perfil sociodemográfico de los mayores y las estrategias de atención en salud de un pequeño municipio de Rio Grande do Sul. Métodos: Se trata de um estudio transversal, descriptivo-exploratorio, de abordaje cuanticualitativo. Las entrevistas se realizaron con seis gestores de um solo municipio y 134 mayores identificados por un cuestionario sociodemográfico. Las entrevistas fueron trascritas y analizadas a partir del análisis de contenido. El análisis estadístico fue realizado en el programa SPSS versión 21. Fue realizada la prueba de Chi-cuadrado y adoptado el p<0,05. Resultados: A lo largo de las entrevistas con los gestores emerge el desconocimiento sobre la PNM lo que impacta en el planeamiento de las acciones. La salud está representada a partir de la ausencia de la enfermedad relacionándola como frecuente en el envejecimiento. El análisis estadístico señala resultados significativos en la relación entre la escolaridad y el acceso al servicio (p<0,01) y la evaluación de los mayores sobre los servicios (p=0,00). Conclusión: La ausência de conocimiento de parte de los gestores sobre la PNM tiene impacto directo en las acciones de salud para ese ciclo de vida del municipio. Los mayores eran, en su mayoría, del sexo femenino con educación primaria incompleta, jubilados que frecuentaban la unidad básica de salud y no identificaban su papel de control social para el planeamiento de acciones que sean de su interés.

A comparative effectiveness research on operative methods of femoral neck fractures in the elderly / 中国综合临床

Objective To compare the effect of compression hollow screw fixation,artificial femoral head replacement and total hip replacement in the elderly.Methods From August 2007 to April 2009,152 cases of femoral neck fracture in the elderly were divided into three groups: compression hollow screw fixation group(54 patients,24 males,with an average age of 59.8±5.3 years);artificial femoral head replacement group(48 patients,16 males,with an average age of 65.3±6.7 years);and total hip replacement group(50 patients,18 males,with an average age of 77.3±6.5 years).The evaluation indicators,including the average sugical time,the average amount of bleeding,the average length of stay and the average postopererative bed time,were compared respectively among the three groups.The postoperative evaluation was made according to Harris Score.Results Harris score in the three groups were 21 excellent and 23 good in the compression hollow screw fixation group,with an average score of 80.52±2.70;26 excellent and 14 good in the artificial femoral head replacement group,with an average score of 86.57±1.90;and 42 excellent and 3 good in the total hip replacement group,with an average score of 96.04±2.10.The total hip replacement group was significantly better than the other two groups(H=0.589,F=12.151,Ps＜0.05).The rate of postoperative complications were 25.93%(14/54) in the compression hollow screw fixation group,18.75%(9/48) in the artificial femoral head replacement group and 4.00%(2/50) in the total hip replacement group(H=1.291,P＜0.05).Conclusion Compared among the three surgery,total hip replacement could resume function and improve the quality of life better,with lower rate of complications.However,the surgical injury and the amount of bleeding were largest.Therefore,we suggest selecting appropriate surgery with considering the patient′s age,physical condition,displacement degree of the fracture,et al.in old femoral neck fractures patients.