Behavior of neuropathy symptom score and neuropathy disability score in patients with and without peripheral diabetic neuropathy: A retrospective cohort study.

BACKGROUND: This study aimed to stablish cut-off of early diagnosis of diabetic polyneuropathy (PDN) based on neuropathy symptom score (NSS) and neuropathy disability score (NDS); to determine the behavior of NDD and NDS in patients with and without PDN; and to verify the association between clinical and demographic variables with both tests. METHODS: This retrospective cohort included 86 patients with diabetes. The NSS and NDS evaluations were collected in medical records in two moments: initial (entry into service) and final (after three years). Individuals were categorized in three groups: G1- PDN in both evaluations (N = 27); G2- PDN only in the final evaluation (N = 16); G3-individuals without PDN (N = 43). A ROC curve was performed to evaluate the sensitivity and specificity of NSS and NDS for PDN diagnosis. ANOVA was used to compare NSS and NDS between groups and evaluations, and multiple regression was performed to find predictors of PDN. RESULTS: The NSS and NDS showed excellent sensitivity and specificity (NDS ≥1.5 and NSS ≥6.5) for PDN diagnosis. There was a significant difference between groups in initial (p = 0.000) and final (p = 0.000) NDS and NSS evaluations. There was an association between peripheral arterial disease (PAD) and increase in NSS (p = 0.024) in G2; and association between loss of protective sensation (LOPS) and increase in NSS in G3 (p < 0.001). CONCLUSION: NSS and NDS tests showed excellent sensitivity and specificity for early PDN diagnosis. Behavior of both tests can differ patients with and without PDN. Furthermore, PAD and LOPS can be a predictor of PDN evolution.

Factors Related to Recurrent Falls Among Older Adults Attending Primary Health Care: A Biopsychosocial Perspective.

The objective of this study was to investigate factors related to recurrent falls among older adults attending primary health care, considering the biopsychosocial perspective. A representative sample of 201 older adults were interviewed in three Primary Health Care units randomly selected in a city in southeastern Brazil. Outcome included self-report of two or more falls in the past 12 months. Exposures included personal and environmental aspects, according to domains of International Classification of Functioning of the World Health Organization (ICF-WHO). Recurrent falls were reported by 24.4% of the participants. Associations with depressive symptoms (p = .003), having osteoporosis (p = .031), chronic musculoskeletal pain (p = .020), frailty (p = .013), sleep satisfaction (p < .001), and functional status (p < .001) were found. In logistic regression models, cognitive status, musculoskeletal pain, and functional status were predictors of recurrent falls; however, only sleep satisfaction remained significant in the final model. Strategies aimed at preventing recurrent falls in primary health care should consider assessments and interventions targeting sleep aspects among older adults.

Relações entre sedentarismo e mobilidade com e sem dupla tarefa em idosos usuários da atenção básica em saúde / Relationships between sedentarism and mobility with and without double task among older adult users of primary health care

Os efeitos do sedentarismo nos sistemas musculoesquelético e neuromuscular podem influenciar negativamente o desempenho dos idosos em atividades com dupla-tarefa, o que aumenta o risco de quedas, declínio funcional e morte. O objetivo foi investigar as relações entre sedentarismo e mobilidade com e sem dupla tarefa em idosos usuários da atenção básica em saúde. Trata-se de estudo transversal, com 139 idosos que frequentam três unidades matriciais de saúde aleatoriamente selecionadas, em Uberaba, Minas Gerais. O sedentarismo foi avaliado pelo International Physical Activity Questionnaire (IPAQ), sendo classificados como sedentários os idosos inativos ou insuficientemente ativos. O estado cognitivo foi avaliado pela Prova Cognitiva de Leganés. A mobilidade com e sem dupla tarefa, bem como, a força muscular foram avaliadas por testes de desempenho físico. As características sociodemográficas e o número de medica- mentos foram avaliados por autorrelato. Os modelos multivariados foram testados por regressão linear múltipla em blocos, com intervalo de confiança de 95%. A maioria era mulheres (81,3%); idade média 66,96 (8,24) anos; 17,3% eram sedentários. Pior desempenho na mobilidade com dupla tarefa motora (p=0,040) e com dupla tarefa cognitiva (p=0,040) foi observado entre os idosos sedentários. O sedentarismo foi preditor de baixa mobilidade com dupla-tarefa motora e cognitiva controlado por variáveis sociodemográficas, entretanto, tais efeitos não se mantiveram após inclusão de variáveis de saúde. Não foram observadas relações entre sedentarismo e mobilidade sem dupla tarefa. Conclui-se que o sedentarismo influencia a mobilidade com dupla tarefa motora e cognitiva em idosos, porém outras condições de saúde podem interferir nessas relações.(AU)

The effects of sedentarism on the musculoskeletal and neuromuscular systems may negatively influence performance of older adults in dual-task activities, which increases risk of falls, functional decline, and death. The objective was to investigate the relationships between sedentarism and mobility with and without double tasks among older adult usersof primary health care. This is a cross-sectional study with 139 older adults from three health care units randomly selected in the city of Uberaba, Minas Gerais. Sedentarism was identified by the International Physical Activity Questionnaire (IPAQ). Inactive or insuf- ficiently active elderly individuals were classified as sedentary. Cognitive status was assessed by the Leganés Cognitive Test. Mobility with and without double tasks, as well as, muscle strength were assessed by physical performance tests. Sociodemographic characteristics and number of medications were assessed by self-report. Multiple linear regressions were performed in blocks, with 95% confidence interval. Most participants were women (81.3%); whose average age was 66.96 (8.24) years; 17.3% were sedentary. Poorer performance in mobility with double motor task (p = 0.040) and double cognitive task (p = 0.040) was observed among sedentary participants. In multivariate models, physical inactivity influenced the motor and cognitive double-tasks performance controlled by sociodemographic variables; however, such effects were not remained after inclusion of health variables. No relationships were observed between sedentarism and mobility without double tasks. In conclusion, sedentarism influences mobility with dual motor and cognitive tasks among older adults, but other health conditions may play a role in these relationships.(AU)