Lidocaine Needling in Myofascial Pain Syndrome for Palliative Oncologic Care: A Randomized Clinical Study.

Background: Physical pain is highly prevalent and impacts the well-being of patients with advanced oncologic disease. Although myofascial pain syndrome (MPS) can be one of the components of pain in cancer patients on palliative care (PC), so far there is no evidence about the benefit of treatment with 1% lidocaine needling. Objectives: To evaluate the efficacy of MPS treatment with injection of 1% lidocaine on the reduction of pain in cancer patients on PC. Design: Single-blind randomized clinical trial. Subjects: Patients aged 50 years or older with end-stage cancer, admitted to a cancer ward or monitored during radiotherapy in three Brazilian hospitals, with a diagnosis of MPS with a pain intensity of five or more according to the Visual Analog Scale (VAS). The patients were divided into two groups: trigger point (TP) injection with 1% lidocaine and control. Measurements: Pain intensity was assessed with the VAS, pain threshold with an algometer, and the medications being used were determined before and 72 hours after the intervention. Results: Thirty patients (15 per group) were assessed. After 72 hours, there was a reduction in referred pain intensity (p < 0.001) and an increase in pressure threshold (p = 0.007) in the intervention group (IG), with no difference in the control. The frequency of individuals who reduced the doses and/or classes of pain medications was higher in the IG (p = 0.011). Conclusion: One percent lidocaine needling in TPs was an effective therapy for pain reduction in MPS.

Influence of cerebral blood flow on volumetric loss related to Alzheimer's disease.

CBF measured with Arterial Spin Labeling (ASL) obtained by Magnetic Resonance Imaging (MRI) may become an important biomarker by showing changes in early stages of AD, such as in the prodromal stage of Mild Cognitive Impairment (MCI). Objective: Verify the correlation between atrophy and CBF in patients with MCI and mild phase ADD, to demonstrate whether changes in CBF can be considered as vascular biomarkers in the diagnosis of the DA continuum. Methods: 11 healthy volunteers, 16 MCI and 15 mild ADD were evaluated. Images of the brain were acquired, including CBF measured with Arterial Spin Labeling (ASL). Results: When comparing MCI with control, a reduction in normalized CBF was observed in left posterior cingulate (estimated difference -0.38; p=0.02), right posterior cingulate (estimated difference -0.45; p=0.02) and right precuneus (estimated difference -0.28; p <0.01); also increase in normalized CBF in right upper temporal pole (estimated difference 0.22; p=0.03). It was also observed that in MCI, the smaller the gray matter volume, the smaller the CBF in the left posterior cingulate; as well as the greater the cerebrospinal fluid volume, consequent to the encephalic volumetric reduction associated with atrophy, the greater the CBF in the right superior temporal pole. When comparing controls, MCI and mild AD, in relation to the other variables, no other correlations were observed between CBF and atrophy. Conclusion: In patients with MCI, the reduction of CBF in the left posterior cingulate correlated with gray matter atrophy, as well as the increase of CBF in the right upper temporal pole correlated with an increase in cerebrospinal fluid consequent to the encephalic volumetric reduction associated with atrophy, demonstrating the influence of CBF in AD related brain atrophy. These findings position CBF as a possible vascular biomarker for early-stage AD diagnoses.

A imagem por ressonância magnética (IRM) pode se tornar um importante biomarcador ao mostrar alterações nos estágios iniciais da doença de Alzheimer (DA). Objetivo: Sendo a atrofia cerebral um importante biomarcador de neurodegeneração na DA, o presente estudo foi realizado com o objetivo de verificar se há correlação entre atrofia e fluxo sanguíneo cerebral (FSC) em pacientes com diagnóstico de CCL e demência da doença de Alzheimer (DDA) leve, com o objetivo de revelar se as alterações no FSC podem ser consideradas possíveis biomarcadores vasculares no diagnóstico do continuum da DA. Métodos: Foram avaliados 11 voluntários saudáveis, 16 CCL e 15 DDA leve. Imagens do cérebro foram adquiridas em um equipamento de 3 T, incluindo imagens ponderadas em T1 de alta resolução para avaliação anatômica e Arterial Spin Labeling (ASL) para a quantificação de FSC. Resultados: Quando comparado CCL com controle, observou-se redução no FSC normalizado em cingulado posterior esquerdo (diferença estimada de -0,38; p=0,02), cingulado posterior direito (diferença estimada de -0,45; p=0,02) e precúneo direito (diferença estimada de -0,28; p <0,01); e aumento de FSC normalizado no polo temporal superior direito (diferença estimada de 0,22; p=0,03). No CCL, quanto menor o volume da substância cinzenta, menor o FSC no cingulado posterior esquerdo; quanto maior o volume de fluido cerebroespinhal, consequente à redução volumétrica encefálica, maior o FSC no polo temporal superior direito. Conclusão: Nos pacientes com diagnóstico de CCL, a redução de FSC no cingulado posterior esquerdo apresentou correlação com atrofia da substância cinzenta, assim como o aumento de FSC no polo temporal superior direito apresentou correlação com o aumento de fluido cerebroespinhal, demonstrando a provável influência do FSC na atrofia encefálica relacionada à DA.

Contribution of Pharmaceutical Care to Person-centered Health Care and the Safety of Pharmacotherapy for Hospitalized Older Individuals in Brazil: An Investigative Single-arm Intervention Trial.

BACKGROUND: Adverse drug events (ADE) and medication errors (ME) provide large numbers of victims. Older people are more susceptible to these events, due to the continuing search for several chronic degenerative disease treatments. The Third Global Patient Safety Challenge announced the objective of reducing unnecessary polypharmacy, encouraging deprescription, and aiming to ensure the prescription of medications in an appropriate manner, based on the best evidence and taking into account the individual factors of people. OBJECTIVE: To evaluate whether Pharmaceutical Care (PC), when inserted in a geriatric ward and the context of person-centered health care, cooperates with the safety of pharmacotherapy in older individuals in Brazil. METHODS: This is an investigative, single-arm, preliminary study. INCLUSION CRITERIA: individuals aged ≥60 years and admitted to the geriatric ward between August 2019 to January 2020. The PC (with the practice of pharmacotherapeutic follow-up, medication reconciliation, and pharmacotherapy review) was made available to identify ADE and ME, as well as the associated factors and clinical outcomes, were analyzed. RESULTS: 60 participants were included. It was found that, on hospital admission, 93.3% of them were polymedicated and 86.7% had a history of using potentially inappropriate medications (PIM). ADE and ME were detected in 43 individuals (71.7%) and, in total, 115 incidents were identified, with drugs that act on the nervous system associated with them (31.9%). Acceptance of the PC's recommendations reached the rate of 85.2%. Polypharmacy (p=0.03) and the presence of multiple diseases (p=0.03) had an effect on the presentation of ADE and ME. The number of medications in use decreased in the comparison between admission and hospital discharge (p<0.0001). CONCLUSION: This investigative study indicated that ADE and ME are linked to the polypharmacy in use at the beginning of hospitalization. On the other hand, we showed that the PC (inserted in the multidisciplinary team) contributed to the deprescribing of medications at hospital discharge. Therefore, the PC can provide improvements in this scenario.

Palliative Care in Advanced Alzheimer's Disease Dementia: Evaluation of the Answers Given by Caregivers and Physicians to the Accuracy of Surprise Question, as a Prognostic Tool.

Introduction: Alzheimer's disease (AD) dementia is the sixth leading cause of death in the United States. The surprise question (SQ) "Would you be surprised if this patient were to die within the next 12 months?" was used to identify death-risk patients, who could benefit from palliative care. Objective: To examine the prognostic accuracy of the SQ by physicians and caregivers in outpatients with AD dementia. Methods: This is a longitudinal and prospective study involving 101 patients along 1 year, applying the SAS 9.2 software and adopting a .05 P-value to assess the variables that influenced answers to the accuracy of SQ using the chi-square test. Results: 27 patients (26.7%) died during the follow-up. When caregivers answered the SQ, it presented a 51.8% sensitivity (CI 31.9 - 71.3), a 66.7% negative predictive value (20.7 - 63.6), a 56.2% specificity (CI 29.8 - 80.2), and a 40.9% positive predictive value of (CI 43.0 - 85.4) with a 53.4% accuracy (CI 38.5 - 68.4). When physicians answered, the SQ had an 88.8% sensitivity (CI 70.8 - 97.6), a 40% negative predictive value (CI 5.2 - 85.3), a 12.5% specificity (CI 1.5 - 38.3), a 63.1% positive predictive value (CI 45.9 - 78.1) with a 60.4% accuracy (CI 45.8 - 75). Conclusion: SQ remains a good tool with high sensitivity for the identification of patients with advanced AD dementia when presented to the attending physician for planning palliative advanced care with accuracy of 60.4% and caregivers' accuracy of 53.4%.

Influence of cerebral blood flow on volumetric loss related to Alzheimer's disease / Influência do fluxo sanguíneo cerebral na perda volumétrica relacionada à doença de Alzheimer

ABSTRACT: CBF measured with Arterial Spin Labeling (ASL) obtained by Magnetic Resonance Imaging (MRI) may become an important biomarker by showing changes in early stages of AD, such as in the prodromal stage of Mild Cognitive Impairment (MCI). Objective: Verify the correlation between atrophy and CBF in patients with MCI and mild phase ADD, to demonstrate whether changes in CBF can be considered as vascular biomarkers in the diagnosis of the DA continuum. Methods: 11 healthy volunteers, 16 MCI and 15 mild ADD were evaluated. Images of the brain were acquired, including CBF measured with Arterial Spin Labeling (ASL). Results: When comparing MCI with control, a reduction in normalized CBF was observed in left posterior cingulate (estimated difference -0.38; p=0.02), right posterior cingulate (estimated difference -0.45; p=0.02) and right precuneus (estimated difference -0.28; p <0.01); also increase in normalized CBF in right upper temporal pole (estimated difference 0.22; p=0.03). It was also observed that in MCI, the smaller the gray matter volume, the smaller the CBF in the left posterior cingulate; as well as the greater the cerebrospinal fluid volume, consequent to the encephalic volumetric reduction associated with atrophy, the greater the CBF in the right superior temporal pole. When comparing controls, MCI and mild AD, in relation to the other variables, no other correlations were observed between CBF and atrophy. Conclusion: In patients with MCI, the reduction of CBF in the left posterior cingulate correlated with gray matter atrophy, as well as the increase of CBF in the right upper temporal pole correlated with an increase in cerebrospinal fluid consequent to the encephalic volumetric reduction associated with atrophy, demonstrating the influence of CBF in AD related brain atrophy. These findings position CBF as a possible vascular biomarker for early-stage AD diagnoses.

RESUMO: A imagem por ressonância magnética (IRM) pode se tornar um importante biomarcador ao mostrar alterações nos estágios iniciais da doença de Alzheimer (DA). Objetivo: Sendo a atrofia cerebral um importante biomarcador de neurodegeneração na DA, o presente estudo foi realizado com o objetivo de verificar se há correlação entre atrofia e fluxo sanguíneo cerebral (FSC) em pacientes com diagnóstico de CCL e demência da doença de Alzheimer (DDA) leve, com o objetivo de revelar se as alterações no FSC podem ser consideradas possíveis biomarcadores vasculares no diagnóstico do continuum da DA. Métodos: Foram avaliados 11 voluntários saudáveis, 16 CCL e 15 DDA leve. Imagens do cérebro foram adquiridas em um equipamento de 3 T, incluindo imagens ponderadas em T1 de alta resolução para avaliação anatômica e Arterial Spin Labeling (ASL) para a quantificação de FSC. Resultados: Quando comparado CCL com controle, observou-se redução no FSC normalizado em cingulado posterior esquerdo (diferença estimada de -0,38; p=0,02), cingulado posterior direito (diferença estimada de -0,45; p=0,02) e precúneo direito (diferença estimada de -0,28; p <0,01); e aumento de FSC normalizado no polo temporal superior direito (diferença estimada de 0,22; p=0,03). No CCL, quanto menor o volume da substância cinzenta, menor o FSC no cingulado posterior esquerdo; quanto maior o volume de fluido cerebroespinhal, consequente à redução volumétrica encefálica, maior o FSC no polo temporal superior direito. Conclusão: Nos pacientes com diagnóstico de CCL, a redução de FSC no cingulado posterior esquerdo apresentou correlação com atrofia da substância cinzenta, assim como o aumento de FSC no polo temporal superior direito apresentou correlação com o aumento de fluido cerebroespinhal, demonstrando a provável influência do FSC na atrofia encefálica relacionada à DA.

The effect of frailty on the 24-hour blood pressure pattern in the very elderly.

Frailty plays a crucial role in the management of hypertension in the very elderly and has a strong association with cardiovascular diseases. Nevertheless, its influence on the 24-hour blood pressure pattern, including elevated asleep systolic blood pressure (BP) and the lack of BP fall during sleep (non-dipping) has not been explored in a population above 80 years. Patients older than 80 years were classified into frail or robust subtypes by the five item frailty phenotype criteria. All participants were submitted to office blood pressure measurements and ambulatory BP monitoring over a 24-hour period. Nocturnal dipping was defined as nighttime BP fall ≥10%. Thirty-eight frail and 36 non-frail individuals (mean age 85.3 ± 3.7 years; 67% females) were analyzed. Awake systolic and diastolic BP were similar for frail and robust individuals. Frail patients had higher systolic BP during sleep (128 ± 15 mm Hg vs. 122 ±13 mm Hg p = .04) and reduced systolic BP fall [1 (-4.5 - 5)% vs. 6.8 (2.1 - 12.8)% p < .01]. Frailty was independently associated with higher risk of non-dipping (OR 12.4; CI 1.79 - 85.9) and reduced nighttime systolic BP fall (-6.1%; CI -9.6 - -2.6%). In conclusions, frailty has a substantial influence on nighttime BP values and pattern in patients older than 80 years.

Seroprevalence of SARS-CoV-2 infection among residents and workers of long-term care facilities in Ribeirão Preto, Brazil: an epidemiological survey / Soroprevalência de infecção por SARS-CoV-2 em residentes e trabalhadores de instituições de longa permanência em Ribeirão Preto, Brasil: um inquérito epidemiológico

OBJECTIVE: Residents and workers in long-term care facilities (LTCF) for older adults share the same space, and residents are more susceptible to COVID-19 complications. The aim of this study was to determine the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies as an indication of previous infection of both residents and workers in LTCFs, as well as associated factors. METHODS: This epidemiological survey was conducted in Ribeirão Preto, Brazil, a medium-sized city. Stratified sampling was performed, with data collected on demographics, health, LTCF protective measures, activities of daily living, and cognition. A serological test was carried out on all selected individuals. RESULTS: The mean resident and worker ages were 80.62 (SD, 9.66) and 37.41 (SD, 12.42) years, respectively. The serological test was positive in 13.33% of the residents, who had 2.91 (SD, 1.28) chronic diseases and used 5.65 (SD, 2.79) medications. Dementia screening was negative in only 11.1%, and only 20% were independent in activities of daily living. The serological test results were positive in 25.93% of the workers, although SARS-CoV-2 had been previously detected in only 6.9%. The LTCF did not perform systematic screening of worker respiratory symptoms. CONCLUSIONS: There was a higher seroprevalence of SARS-CoV-2 among LTCF workers than residents. Systematic screening of worker symptoms before each shift was not regularly performed. The high prevalence of cognitive changes among LTCF residents can impede adherence to personal protection measures.

Residentes e trabalhadores compartilham o mesmo espaço em instituições de longa permanência para idosos (ILPI), sendo os residentes mais suscetíveis às complicações por COVID-19. O objetivo deste estudo foi determinar a soroprevalência de anticorpos para a síndrome respiratória aguda grave por coronavírus 2 (SARS-CoV-2) como uma indicação de infecção anterior de residentes e trabalhadores nas ILPI, bem como fatores associados. METODOLOGIA: Inquérito epidemiológico realizado em Ribeirão Preto, Brasil, uma cidade de médio porte. Amostragem estratificada foi realizada, com informações obtidas sobre dados demográficos, de saúde e condutas protetivas da ILPI. Dados básicos em relação às atividades de vida diária e cognição foram coletados. Um teste sorológico foi realizado em todos os indivíduos selecionados. RESULTADOS: Os residentes idosos da amostra tinham 80,62 ± 9,66 anos e os trabalhadores 37,41 ± 12,42 anos. Teste sorológico positivo foi de 13,33% entre os residentes que apresentavam 2,91 ± 1,28 doenças crônicas e usavam 5,65 ± 2,79 medicamentos, com apenas 11,1% com rastreamento de demência negativo e 20% sendo independentes. Entre os trabalhadores, 25,93% tiveram resultado positivo, sendo o SARS-CoV2 detectado previamente em apenas 6,9% deles. Triagem sistemática de sintomas respiratórios do trabalhador não foi realizado pela ILPI. CONCLUSÕES: Houve uma maior soroprevalência do SARS-CoV-2 entre os trabalhadores das ILPIs do que entre os residentes. A triagem sistemática dos sintomas do trabalhador antes de cada turno de trabalho não era regularmente realizada. Houve uma alta prevalência de alterações cognitivas que podem dificultar cumprir as medidas de proteção individual das ILPIs.

Health aspects of active bodybuilders: monitoring by multidisciplinary team / Aspectos de salud de los culturistas activos: seguimiento por un equipo multidisciplinario / Aspectos de saúde de fisiculturistas ativos: acompanhamento por equipe multidisciplinar

ABSTRACT Preparation in bodybuilding involves high-intensity workouts and drastic feeding strategies. Little is known about health risks. Athletes (n=510, 59.8% male) were evaluated about health aspects, anthropometry, and blood pressure (BP). Chronic diseases were reported by 6,6%, but 88.9% of them did not treat; 1.9% reported hypertension, with 15.7% having high BP; and 52.5% reported the use of prohibited drugs in the last 6 months. Body mass index was 26.2±2.5 for man and 22.3±2.2 Kg/m2 for woman. Men had lower monitoring than women by physical education professionals, nutritionists, and physicians (p<0.01). Athletes are exposed to health risks factors such as lack of knowledge about diseases, high use of prohibited substances and less monitoring by professionals among men.

Resumo A preparação para o fisiculturismo inclui exercícios de alta intensidade e estratégias alimentares drásticas. Pouco se sabe sobre os riscos à saúde. Atletas (n=510, 59,8% homens) foram avaliados quanto à saúde, antropometria e pressão arterial (PA). Doenças crônicas foram relatadas por 6,6% (88,9% não tratadas); 1,9% relataram hipertensão, mas 15,7% tinham PA elevada; e 52,5% relataram uso de drogas proibidas nos últimos 6 meses. O índice de massa corporal foi 26,2±2,5 para homens e 22,3±2,2 kg/m2 para mulheres. Os homens tiveram menor acompanhamento por profissionais de educação física, nutricionistas e médicos (p <0,01). Os atletas estão expostos a riscos à saúde, como desconhecimento de doenças, alto uso de substâncias proibidas e menor monitorização profissional dos homens.

RESUMEN La preparación en el culturismo incluye ejercicios de alta intensidad y estrategias de alimentación drásticas. Se sabe poco sobre los riesgos para la salud. Los deportistas (n=510, 59,8% hombres) fueron evaluados cuanto a la salud, antropometría y presión arterial (PA). Las enfermedades crónicas fueron reportadas por 6,6% (88,9% no tratavam); 1,9% informó hipertensión, pero 15,7% tenía PA alta; y 52,5% informó el uso de drogas prohibidas en 6 meses. El índice de masa fue 26,2±2,5 para el hombre y 22,3±2,2 kg/m2 para la mujer. Los hombres tuvieron menor seguimiento por profesionales de educación física, nutricionistas y médicos (p<0,01). Los deportistas están expuestos a riesgos para la salud como el desconocimiento de las enfermidades y el alto uso de sustancias prohibidas.

Use of statins for the secondary prevention of stroke: are we respecting the scientific evidences?

BACKGROUND: Stroke accounts for approximately as 5.0% of disability-adjusted years of life and 10.0% of all deaths worldwide. Secondary stroke prevention in surviving individuals, which includes the use of statins, reduces atherothrombotic stroke recurrence, complications and mortality. The present study aimed to characterize the Brazilian population with stroke history and estimate the prevalence of statin use as secondary prevention. METHODS: This is a population-based cross-sectional study conducted in Brazilian urban areas. A total of 41.433 individuals were interviewed, representing 171 million of Brazilians, based on post-stratification weights. We included only participants aged 20 years or older who answered "yes" to the following question: "Did any doctor ever tell you that you had a stroke?" The main outcome was the prevalence of statin use among individuals who answered affirmatively. To identify the factors associated with stroke occurrence, the participants were categorized according to clinical and sociodemographic characteristics. RESULTS: Only 24.2% (95% CI 19.9 - 29.1) of those who reported history of stroke regardless of other conditions also reported statin use. However, the results indicated that 52.9% (95% CI 43.6 - 62.0) of individuals who reported a previous diagnosis of dyslipidemia stated the use of statins. Regarding patients who reported stroke and did not report dyslipidemia history, only 9.1% (95% CI 5.9 - 13.8) referred to use statins. CONCLUSION: This study showed a low prevalence of statin use by individuals with a history of stroke in Brazil. Actions involving the organization of services and training of professionals may positively impact the rates of stroke recurrence.

Impact of the severity of dementia due to Alzheimer's disease on the gustatory sensitivity of older persons.

OBJECTIVE: To evaluate the association between the severity of dementia and taste recognition abilities in older persons with Alzheimer's disease (AD). METHODS: Anthropometric measurements were performed and body mass index was used to determine the nutritional status. The taste strips were used to test gustatory functions of the five basic tastes (sweet, salty, sour, bitter and umami). RESULTS: A total of 30 healthy younger subjects, 30 healthy older subjects, 37 with mild stage AD and 23 with moderate stage AD were recruited. The older subjects with moderate AD showed a significant reduction of taste, less recognition of bitter and salty taste (score: 10.6 ± 2.6; 2.6 ± 0.9; 1.7 ± 1.5) when compared to older people without cognitive impairment (score: 13.3 ± 1.8; 3.4 ± 0.9; 3.2 ± 0.9), and less recognition of sweet taste (score: 2.9 ± 1.2) when compared to subjects with mild stage AD (score: 3.6 ± 0.8). Impaired recognition of salty taste was detected since the early stages of AD. Among the factors that possibly influence gustatory function, a significant correlation was detected between taste ability and age, medication intake, mini-mental state examination and the nutritional status. CONCLUSION: The severity of dementia is directly associated with greater impairment of taste sensitivity, especially among older subjects with moderate stage disease.

Medicamentos passíveis de infusão por hipodermóclise / Medicines subject to hypodermoclysis infusion

Modelo do estudo: Revisão Sistemática da Literatura e discussão com profissionais especialistas. Objetivo: Propor a lista de medicações, diluente e volume de diluição, para o uso por hipodermóclise, a pacientes acima de 18 anos Método: Com base em diretrizes Prisma, foi realizado um levantamento bibliográfico na base de dados MEDLINE através do portal Pubmed e pela biblioteca virtual SCIELO, utilizando os descritores: infusions; subcutaneous; palliative care; hospice; palliative care nursing e as palavra-chave hypodermoclysis e off-label use, seus correspondentes em português e seus cruzamentos. Os artigos encontrados foram analisados a partir do instrumento AMSTAR, seguido de discussão com profissionais de formação avançada em CP. Resultados: Dos artigos foram extraídas as seguintes variáveis: medicamentos administrados por hipodermóclise, veículo e volume de diluição, tempo de infusão, forma de administração (continua e em bolus), além de observações referentes à administração em sítio único e concentração máxima. A partir destas variáveis elaborou-se síntese em relação às medicações a serem utilizadas. Conclusões: Chegou-se a uma lista de medicações, dosagem, volume de diluição e diluente. Os resultados encontrados na literatura foram discutidos em processo dialógico e convergente, pelos profissionais de enfermagem, medicina e farmácia. Sendo assim, esta lista possui perfil replicável para outros serviços com cuidados paliativos ou que utilizam a via hipodermóclise. (AU)

Study Design: Systematic Literature Review and discussion with professional experts. Objective: To propose a list of medications, diluents and dilution volumes for use with hypodermoclysis, to patients over 18 years of age. Methods: Based on Prism guidelines, bibliographic survey in the MEDLINE database through the PubMed portal and the SCIELO virtual library, through the descriptors: infusions; subcutaneous; palliative care; hospice; palliative care nursing the keywords hypodermoclysis and off-label use. Their correspondents in Portuguese and their crosses were considered. The items found were analyzed from the AMSTAR instrument, followed by discussion with professionals in advanced training in CP. Results: The following variables were extracted from the articles: medications given through hypodermoclysis, vehicle and dilution volume, time of infusion, form of administration (continuous and bolus), as well as observations referring to single site administration and maximum concentration. From these variables, synthesis was elaborated in relation to the medications to be used. Conclusions: There was a list of medications, dosage, dilution volume and diluents. The results found in the literature were discussed in a dialogical and convergent process, by a nurse, physicians and a pharmacist. Thus, this list has a replicable profile for other services with palliative care or using the hypodermoclysis approach. (AU)

Neuro-degeneration profile of Alzheimer's patients: A brain morphometry study.

INTRODUCTION: Alzheimer's disease (AD) is a primary and progressive neurodegenerative disorder, which is marked by cognitive deterioration and memory impairment. Atrophy of hippocampus and other basal brain regions is one of the most predominant structural imaging findings related to AD. Most studies have evaluated the pre-clinical and initial stages of AD through clinical trials using Magnetic Resonance Imaging. Structural biomarkers for advanced AD stages have not been evaluated yet, being considered only hypothetically. OBJECTIVE: To evaluate the brain morphometry of AD patients at all disease stages, identifying the structural neuro-degeneration profile associated with AD severity. MATERIAL AND METHODS: AD patients aged 60 years or over at different AD stages were recruited and grouped into three groups following the Clinical Dementia Rating (CDR) score: CDR1 (n = 16), CDR2 (n = 15), CDR3 (n = 13). Age paired healthy volunteers (n = 16) were also recruited (control group). Brain images were acquired on a 3T magnetic resonance scanner using a conventional Gradient eco 3D T1-w sequence without contrast injection. Volumetric quantitative data and cortical thickness were obtained by automatic segmentation using the Freesurfer software. Volume of each brain region was normalized by the whole brain volume in order to minimize age and body size effects. Volume and cortical thickness variations among groups were compared. RESULTS: Atrophy was observed in the hippocampus, amygdala, entorhinal cortex, parahippocampal region, temporal pole and temporal lobe of patients suffering from AD at any stage. Cortical thickness was reduced only in the parahippocampal gyrus at all disease stages. Volume and cortical thickness were correlated with the Mini Mental State Examination (MMSE) score in all studied regions, as well as with CDR and disease duration. DISCUSSION AND CONCLUSION: As previously reported, brain regions affected by AD during its initial stages, such as hippocampus, amygdala, entorhinal cortex, and parahippocampal region, were found to be altered even in individuals with severe AD. In addition, individuals, specifically, with CDR 3, have multiple regions with lower volumes than individuals with a CDR 2. These results indicate that rates of atrophy have not plateaued out at CDR 2-3, and in severe patients there are yet neuronal loss and gliosis. These findings can add important information to the more accepted model in the literature that focuses mainly on early stages. Our findings allow a better understanding on the AD pathophysiologic process and follow-up process of drug treatment even at advanced disease stages.

A abordagem da intersetorialidade para o ensino médico em atenção primária / The approach intersectoral for medical education in primary health care

Introdução: O processo de criação do Sistema Único de Saúde (SUS) como um modelo de atenção à saúde, mais humanizado, abrangente, eficaz e resolutivo tem a intersetorialidade como um de seus instrumentos para a transformação. No entanto, há escassez de artigos que abordem a intersetorialidade no contexto da educação médica e da organização das práticas, principalmente na atenção primária. Objetivo: Trazer à luz o conceito de intersetorialidade e o princípio da orientação comunitária na organização das práticas na realidade das equipes de saúde da família, no âmbito do SUS. Método: Análise documental realizada para discutir o conceito de intersetorialidade na obra de autores da Atenção Primária à Saúde (APS), na documentação oficial do Ministério da Saúde e em publicações selecionadas sobre a intersetorialidade. Discutiu-se também a orientação comunitária nas ações prestadas de APS segundo a percepção do médico e da equipe de saúde da família, no Brasil. Foi descrita a evolução do antigo Programa de Saúde da Família para a Estratégia de Saúde da Família como modelo de reorganização da atenção primária à saúde no SUS e no cenário de ensino das Unidades de Saúde da Família (USF) ligadas à Faculdade de Medicina de Ribeirão Preto- Universidade de São Paulo, no período de 1999 a 2014. Resultados: A documentação oficial e científica consultada mostrou avanço das transformações nos serviços de Saúde da Família, como modelo de organização da APS no país. O cenário das USF orientado para a APS vem contribuindo para a adequação da formação médica e dos profissionais de saúde nessa área. Considerações finais: Não obstante, percebendo-se as potencialidades das práticas intersetoriais e orientadas para a comunidade na mudança do paradigma da saúde, há muito o que fazer no sentido amplo da intersetorialidade, que compreende a abordagem dos determinantes sociais da saúde no planejamento integrado local. (AU)

Introduction: The process of creating the Unified Health System (SUS) as one health care model more humanized, comprehensive, effective and decisive has intersectorality as one of its tools for transformation. However, there are few articles that address the intersectoral approach in the context of medical education and organization of practices, especially in primary care. Objective: Bring forth the concept of intersectionality and the principle of community orientation in the organization of practices in the reality of family health staffs, under the SUS. Method: Analysis of documents held to discuss the concept of intersectionality in the work of authors of Primary Health Care (PHC), the official documentation of the Ministry of Health and selected publications on intersectionality. It also discussed the community orientation in the given actions of Primary Health Care in the perception of the physician and the family health staffs in Brazil. It described the evolution of the former Family Health Program to the Family Health Strategy as reorganization model of PHC in the SUS and in the education scenario of the Family Health Units (FHU) involved in the Ribeirão Preto Medical School - University of São Paulo in the period from 1999 to 2014. Results: Official and scientific documentation consulted showed advance of changes in family health services, such as the PHC model of organization in the country. The setting of FHU oriented to PHC has contributed to the adaptation of medical training and health professionals in this area. Final Considerations: Nevertheless, perceiving the potential of intersectoral and practices geared towards the community in the health paradigm change, there is plenty to do in the broad sense of intersectionality comprising addressing the social determinants of health in local integrated plan.(AU)

Frailty syndrome in an independent urban population in Brazil (FIBRA study): a cross-sectional populational study / Síndrome da fragilidade em uma população urbana independente no Brasil (estudo FIBRA): um estudo transversal populacional

ABSTRACT: CONTEXT AND OBJECTIVE: Frailty is a multifactorial syndrome. The aim of this study was to determine the prevalence and characteristics of frailty syndrome in an elderly urban population. DESIGN AND SETTING: Cross-sectional study carried out at the homes of a randomized sample representing the independent elderly individuals of Ribeirão Preto, Brazil. METHODS: Sociodemographic characteristics, clinical data and criteria of the frailty phenotype were obtained at the subjects' homes; 385 individuals were evaluated. Frailty was defined based on detection of weight loss, exhaustion, weakness, slowness and low physical activity level. Individuals with three or more of these characteristics were classified as frail and those with one or two as pre-frail. Specific cutoff points for weakness, slowness and low physical activity level were calculated. RESULTS: The participants' mean age was 73.9 ± 6.5 years, and 64.7% were women. 12.5% had lost weight over the last year; 20.5% showed exhaustion, 17.1% slowness, 24.4% low physical activity level and 20.5% weakness. 9.1% were considered frail and 49.6% pre-frail. Frail subjects were older, attended more medical visits, had a higher chance of hospitalization within the last 12 months and had more cerebrovascular events, diabetes, neoplasms, osteoporosis and urinary and fecal incontinence. CONCLUSION: In this independent elderly population, there were numerous frail and pre-frail individuals. Frailty syndrome was associated with high morbidity. Cutoff points for weakness, slowness and low physical activity level should be adjusted for the population under study. It is essential to identify frail and pre-frail older individuals for appropriate interventions.

RESUMO: CONTEXTO E OBJETIVO: Fragilidade é uma síndrome multifatorial. O objetivo deste estudo foi determinar a prevalência e características da síndrome da fragilidade em uma população urbana de idosos. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado nas casas em amostra randomizada para representar os idosos independentes de Ribeirão Preto, Brasil. MÉTODO: Características sociodemográficas, dados clínicos e critérios do fenótipo da fragilidade foram obtidos nas casas. Foram avaliados 385 idosos. A definição da fragilidade foi baseada na detecção de perda de peso, exaustão, fraqueza, lentidão e baixo nível de atividade física. Idosos com três ou mais destas características foram classificados com frágeis; com uma ou duas características como pré-frágeis. Foram calculados pontos de corte específicos para fraqueza, lentidão e baixo nível de atividade física. RESULTADOS: A média de idade dos participantes foi de 73,9 ± 6,5 anos, com 64,7% de mulheres. 12,5 % perderam peso no último ano, 20,5% tiveram exaustão, 17,1% lentidão, 24,5% baixo nível de atividade física e 20,5% fraqueza. Foram considerados frágeis 9,1% e pré-frágeis 49,6%. Os frágeis eram mais velhos, foram em mais consultas médicas, tiveram maior chance de internação nos últimos 12 meses e tiveram mais eventos cerebrovasculares, diabetes, neoplasias, osteoporose, incontinência fecal e urinária. CONCLUSÃO: Em uma população idosa independente, existem vários indivíduos frágeis e pré-frágeis. A síndrome da fragilidade foi associada com alta morbidade. Pontos de corte para fraqueza, lentidão e baixo nível de atividade física devem ser ajustados para a população em estudo. É essencial identificar idosos frágeis e pré-frágeis para intervenções apropriadas.

Frailty syndrome in an independent urban population in Brazil (FIBRA study): a cross-sectional populational study.

CONTEXT AND OBJECTIVE:: Frailty is a multifactorial syndrome. The aim of this study was to determine the prevalence and characteristics of frailty syndrome in an elderly urban population. DESIGN AND SETTING:: Cross-sectional study carried out at the homes of a randomized sample representing the independent elderly individuals of Ribeirão Preto, Brazil. METHODS:: Sociodemographic characteristics, clinical data and criteria of the frailty phenotype were obtained at the subjects' homes; 385 individuals were evaluated. Frailty was defined based on detection of weight loss, exhaustion, weakness, slowness and low physical activity level. Individuals with three or more of these characteristics were classified as frail and those with one or two as pre-frail. Specific cutoff points for weakness, slowness and low physical activity level were calculated. RESULTS:: The participants' mean age was 73.9 ± 6.5 years, and 64.7% were women. 12.5% had lost weight over the last year; 20.5% showed exhaustion, 17.1% slowness, 24.4% low physical activity level and 20.5% weakness. 9.1% were considered frail and 49.6% pre-frail. Frail subjects were older, attended more medical visits, had a higher chance of hospitalization within the last 12 months and had more cerebrovascular events, diabetes, neoplasms, osteoporosis and urinary and fecal incontinence. CONCLUSION:: In this independent elderly population, there were numerous frail and pre-frail individuals. Frailty syndrome was associated with high morbidity. Cutoff points for weakness, slowness and low physical activity level should be adjusted for the population under study. It is essential to identify frail and pre-frail older individuals for appropriate interventions.

Hepatitis B vaccination coverage in patients with diabetes mellitus.

OBJECTIVE: Analyze the factors associated with full hepatitis B vaccination (three doses) in patients with diabetes mellitus. METHOD: Cross-sectional study, conducted in a health unit in a city in the state of São Paulo, with 255 patients on outpatient follow-up, in 2014. Data were obtained from the computerized system of the Municipal Health Department and via a structured questionnaire. A logistic regression model was used for analysis. RESULTS: Full hepatitis B vaccination was noted in 13.7% of the patients and shown to be directly associated with their educational level (OR=1.30; CI: 1.07-1.57) and current or previous work as a health professional (OR=3.21; CI: 1.16-8.89). CONCLUSION: Hepatitis B vaccination coverage was found to be low in patients with diabetes mellitus, indicating their vulnerability to this serious and potentially fatal disease. Higher educational level and working in the field of health were associated with better vaccination coverage. OBJETIVO: Analisar os fatores associados à vacinação completa contra hepatite B (3 doses) em pacientes com diabetes mellitus. MÉTODO: Estudo transversal, realizado em uma Unidade de Saúde, de uma cidade do interior paulista, com 255 pacientes em seguimento ambulatorial, em 2014. Os dados foram obtidos no sistema informatizado da Secretaria Municipal de Saúde e por meio de um questionário estruturado e, para análise, modelo de regressão logística. RESULTADOS: Vacinação completa contra hepatite B foi observada em 13,7% dos pacientes e mostrou-se diretamente associada ao nível de escolaridade (OR=1,30; IC: 1,07-1,57) e ao trabalho atual ou pregresso como profissional da saúde (OR=3,21; IC: 1,16-8,89). CONCLUSÃO: A cobertura vacinal contra hepatite B mostrou-se baixa em pacientes com diabetes mellitus, evidenciando a vulnerabilidade a essa doença grave e potencialmente fatal. Maior escolaridade e o trabalho na área da saúde foram associados a melhor cobertura vacinal.

Hepatitis B vaccination coverage in patients with diabetes mellitus / Cobertura vacunal contra hepatitis B en pacientes con diabetes mellitus / Cobertura vacinal contra hepatite B em pacientes com diabetes mellitus

Abstract OBJECTIVE Analyze the factors associated with full hepatitis B vaccination (three doses) in patients with diabetes mellitus. METHOD Cross-sectional study, conducted in a health unit in a city in the state of São Paulo, with 255 patients on outpatient follow-up, in 2014. Data were obtained from the computerized system of the Municipal Health Department and via a structured questionnaire. A logistic regression model was used for analysis. RESULTS Full hepatitis B vaccination was noted in 13.7% of the patients and shown to be directly associated with their educational level (OR=1.30; CI: 1.07-1.57) and current or previous work as a health professional (OR=3.21; CI: 1.16-8.89). CONCLUSION Hepatitis B vaccination coverage was found to be low in patients with diabetes mellitus, indicating their vulnerability to this serious and potentially fatal disease. Higher educational level and working in the field of health were associated with better vaccination coverage.

Resumen OBJETIVO Analizar los factores asociados con la vacunación completa contra hepatitis B (3 dosis) en pacientes con diabetes mellitus. MÉTODO Estudios transversal, llevado a cabo en una Unidad de Salud de una ciudad del interior paulista, con 255 pacientes en seguimiento ambulatorio, en 2014. Los datos fueron obtenidos en el sistema informatizado de la Secretaría Municipal de Salud y mediante un cuestionario estructurado y, para el análisis, un modelo de regresión logística. RESULTADOS Vacunación completa contra hepatitis B fue observada en el 13,7% de los pacientes y se mostró directamente asociada con el nivel de escolaridad (OR=1,30; IC: 1,07-1,57) y con el trabajo actual o anterior como profesional sanitario (OR=3,21; IC: 1,16-8,89). CONCLUSIÓN La cobertura vacunal contra hepatitis B se mostró baja en pacientes con diabetes mellitus, evidenciándose la vulnerabilidad a esa enfermedad severa y potencialmente fatal. Mayor escolaridad y el trabajo en el área sanitaria estuvieron asociados con la mejor cobertura vacunal.

Resumo OBJETIVO Analisar os fatores associados à vacinação completa contra hepatite B (3 doses) em pacientes com diabetes mellitus. MÉTODO Estudo transversal, realizado em uma Unidade de Saúde, de uma cidade do interior paulista, com 255 pacientes em seguimento ambulatorial, em 2014. Os dados foram obtidos no sistema informatizado da Secretaria Municipal de Saúde e por meio de um questionário estruturado e, para análise, modelo de regressão logística. RESULTADOS Vacinação completa contra hepatite B foi observada em 13,7% dos pacientes e mostrou-se diretamente associada ao nível de escolaridade (OR=1,30; IC: 1,07-1,57) e ao trabalho atual ou pregresso como profissional da saúde (OR=3,21; IC: 1,16-8,89). CONCLUSÃO A cobertura vacinal contra hepatite B mostrou-se baixa em pacientes com diabetes mellitus, evidenciando a vulnerabilidade a essa doença grave e potencialmente fatal. Maior escolaridade e o trabalho na área da saúde foram associados a melhor cobertura vacinal.

Salt preferences of normotensive and hypertensive older individuals.

The aim of this study was to evaluate the preference for salt in hypertensive and normotensive older individuals. Hypertensive (group 1: n=32, aged 73.7±6.3 years) or normotensive patients (group 2: n=26, aged 71.5±8.0 years) were submitted to a test to determine their preference for bread samples with different salt concentrations: 1.5%, 2.0% (usual concentration), and 2.7%, and were reevaluated 2 weeks later using the same salt concentrations, but with the addition of oregano. Twenty-four-hour urinary sodium excretion (UNaV), blood pressure (BP), and body mass index (BMI) were obtained. Systolic BP, BMI, and UNaV were higher in group 1. In the first analysis, group 1 showed greater preference for the saltiest sample (P=.001). Comparing the first evaluation and the second, a greater preference for less salty samples was observed in both groups (P<.01). Hypertensive older patients consumed more salt and showed a greater salt preference than the normotensive patients. The use of the spice reduced the preference for salt in both groups.