Kidney function decline associated with proton pump inhibitors: results from the ELSA-Brasil cohort.

OBJECTIVE: Investigate the longitudinal association of use and time of use of proton pump inhibitors (PPI) with incidence of chronic kidney disease (CKD) and kidney function change. METHODS: Prospective study with 13,909 participants from baseline (2008-2010) and second wave (2012-2014) of the ELSA-Brasil (mean interval between visits = 3.9 years (1.7-6.0)). Participants answered about use and time use of the PPI in the two weeks prior the interview. Renal function was assessed by glomerular filtration rate estimated by the Collaboration Equation for the Epidemiology of Chronic Kidney Disease. Values below 60ml/min/1.73 m² in wave 2 were considered incident CKD. Associations between PPI use and time of use at baseline and incident CKD and decline in renal function were estimated, respectively, by logistic regression and linear models with mixed effects, after adjusting for confounders. RESULTS: After adjustments, PPI users for more than six months had an increased risk of CKD compared to non-users. Compared to non-users, users PPIs for up to six months and above six months had greater decline in kidney function over time. CONCLUSION: This cohort of adults and elderly, after a mean interval of 3.9 years, PPI use and initial duration were associated with kidney function change between visits.

Indicadores de acesso nos serviços de reabilitação física das desordens musculoesqueléticas em Belo Horizonte (MG) / Indicadores de acceso en servicios de rehabilitación física para trastornos musculoesqueléticas en Belo Horizonte (MG) / Access indicators in physical rehabilitation services for musculoskeletal disorders in Belo Horizonte (MG)

RESUMO A crescente demanda por atendimento nos serviços de reabilitação física do Sistema Único de Saúde (SUS) excede a oferta, o que resulta em longas filas de espera. Neste estudo, realizou-se uma pesquisa quantitativa de cunho exploratório que teve por objetivo a apresentação de indicadores para facilitar o acesso aos serviços de reabilitação física no que tange às desordens musculoesqueléticas. Os dados foram colhidos dos prontuários de usuários residentes nas regiões noroeste e oeste de Belo Horizonte (MG), com mais de 18 anos de idade, submetidos a acolhimento no Centro Especializado em Reabilitação IV no ano de 2019. Obtiveram-se os seguintes indicadores: absenteísmo no momento da avaliação; tempo médio para início do tratamento de acordo com a prioridade; tempo médio de tratamento; e média de usuários atendidos ao mês. A análise deste estudo foi pautada em 362 prontuários. O tempo médio para início de tratamento foi de aproximadamente 69 dias e o período médio de tratamento, de 94 dias. O serviço absorveu cerca de 30 novos usuários ao mês e apresentou índice de absenteísmo de 16,8%. Acredita-se que os indicadores apresentados possivelmente favorecerão a gestão e o controle das filas de espera dos serviços de reabilitação do SUS.

RESUMEN La creciente demanda de atención en los servicios de rehabilitación física del Sistema Único de Salud (SUS) supera la oferta, lo que se traduce en largas colas de espera. Este estudio es una investigación cuantitativa exploratoria, que tuvo como objetivo presentar indicadores para facilitar el acceso a los servicios de rehabilitación física con respecto a los trastornos musculoesqueléticos. Se recolectaron datos de las historias clínicas de los usuarios residentes en las regiones noroeste y oeste de Belo Horizonte (en Mina Gerais, Brasil), mayores de 18 años de edad y que ingresaron al Centro Especializado en Rehabilitación IV en 2019. Se obtuvieron los siguientes indicadores: Absentismo al momento de la evaluación; tiempo medio para iniciar el tratamiento según la prioridad; tiempo medio de tratamiento y número medio de usuarios atendidos por mes. El análisis de este estudio se basó en 362 historias clínicas. El tiempo medio para iniciar el tratamiento fue de aproximadamente 69 días y el período medio de tratamiento, 94 días. El servicio recibió cas 30 nuevos usuarios al mes y presentó una tasa de absentismo del 16,8%. Los indicadores presentados pueden favorecer la gestión y control de las listas de espera de los servicios de rehabilitación del SUS.

ABSTRACT The growing demand for care in the physical rehabilitation services of the Unified Health System (SUS) exceeds the supply, resulting in long waiting lines. This study is an exploratory quantitative research, which aims to present indicators to ease the access to physical rehabilitation services related to musculoskeletal disorders. Data were collected from the medical records of users residing in the northwest and west regions of Belo Horizonte (MG), who were over 18 years old and underwent treatment at the Specialized Rehabilitation Center IV (CER-IV) in 2019. The following indicators were obtained: absenteeism at the time of assessment; average time to start treatment according to priority; mean treatment time; and average number of users served per month. The analysis was based on 362 medical records. The mean time to start treatment was approximately 69 days and the mean treatment period was 94 days. The service absorbed around 30 new users per month and presented an absenteeism rate of 16.8%. It is believed that the indicators presented will possibly favor the management and control of the SUS rehabilitation services waiting lines.

Lack of association between proton pump inhibitor use and decline in cognitive performance in the ELSA-Brasil cohort.

OBJECTIVE: The study aims to investigate the longitudinal association of use and time of use of proton pump inhibitors (PPIs) with decreased performance in three cognitive tests. METHODS: Prospective cohort study included 7115 participants with mean age of 58.9 years at baseline (2008-2010) who participated in the second wave (2012-2014) of ELSA-Brasil (average interval between visits = 3.9 years (range: 1.7 to 6.0 years)). Cognitive performance was assessed by tests of memory, phonemic and semantic verbal fluency, and the trail making test, applied to both waves. Associations with the use and time of use of PPIs at baseline were investigated using linear models with mixed effects after adjusting for confounding factors. RESULTS: At baseline, 7.4% (529) of the participants used PPIs on a regular basis. After all adjustments, the interaction term use of PPI × age was not statistically significant for the cognitive tests evaluated, indicating that the use of PPI at baseline was not associated with a more accelerated decline in cognitive performance between waves. The interaction term PPI use × age was not statistically significant, in any of the categories of medication use time, any of the cognitive function tests evaluated, indicating that PPI use time is not associated with decrease in cognitive scores as the time interval between visits increases. CONCLUSION: In this cohort middle-aged and elderly adults, after average interval of 3.9 years (relatively short time to detect cognitive decline in a young cohort), the use and time of use of PPIs at the beginning of the study were not associated with a decline in cognitive performance in these tests between visits.

Desempenho motor e índice de massa corporal em crianças de cinco anos / Motor performance and body mass index in children of five years

As crianças estão cada vez mais utilizando brincadeiras e jogos eletrônicos, passando muitas horas diante da televisão e isso pode atrapalhar o processo de desenvolvimento motor bem como o desenvolvimento do processo de sobrepeso e obesidade. A educação física escolar é um importante aliado na promoção de hábitos de vida mais ativos, sendo a educação infantil a primeira etapa de escolarização e prática de atividades motoras desta fase é fundamental. O objetivo desse estudo foi avaliar o índice de massa corporal (IMC) e o desempenho motor de escolares com idade de cinco anos dos Centros Municipais de Educação Infantil em Divinópolis/MG. O desempenho motor foi avaliado com o Teste de Coordenação Corporal para Crianças (Körperkoodinations test Für Kinder ­ KTK) composto por quatro testes: equilibrar-se andando de costas, saltos monopedais, saltos laterais e transposição lateral sobre plataforma. O IMC foi calculado a partir de medidas de peso e altura. Os resultados do presente estudo demonstram que 80,65% da amostra apresenta deficiência na coordenação motora, e quando comparado entre os sexos, os meninos apresentaram melhor coordenação motora que as meninas. Ao analisar o IMC e a coordenação motora não foi encontrada qualquer relação significativa entre eles. Pode-se concluir com o presente estudo que o IMC não influenciou no desempenho motor dos alunos, e que a maioria dos alunos está com a coordenação motora abaixo do esperado. A falta de aulas de educação física com o professor especialista e estímulos específicos para o desenvolvimento motor podem ter contribuído para os resultados encontrados neste estudo, reforçando a necessidade do professor de educação física n o ensino infantil.(AU)

: Children are increasingly using games and electronic games, spending many hours in front of the television and this can hinder the process of motor development as well as the development of overweight and obesity. School physical education is an important ally in the promotion of more active life habits, with early childhood education being the first stage of schooling and the practice of motor activities in this phase is fundamental. The objective of this study was to evaluate the body mass index (BMI) and the motor performance of schoolchildren aged five years old from the Municipal Centers of Early Childhood Education in Divinópolis / MG. Motor performance was assessed with the Body Coordination Test for Children (Körperkoordinations test Für Kinder - KTK) composed of four tests: balance on your back, single-legged jumps, lateral jumps and lateral transposition on a platform. BMI was calculated from weight and height measurements. The results of the present study showed that 80.65% of the sample has impaired motor coordination, and when compared between genders, boys showed better motor coordination than girls. When analyzing BMI and motor coordination, no significant relationship was found between them. It can be concluded with the present study that the BMI did not influence the motor performance of the students, and that the majority of the students have motor coordination below the expected. The lack of physical education classes with the specialist teacher and specific stimuli for motor development may have contributed to the results found in this study, reinforcing the need for physical education teachers in early childhood education.(AU)

Home intervention model to promote physical activity in female older adults / Modelo de intervenção domiciliar para promoção de exercício físico em idosas

The aim of the study was to describe the logical model of a home intervention using a motivational strategy to improve physical fitness components in female older adults. A quasi-experimental study was conducted with 91 elderly women between 61 and 80 years old, divided into intervention (IG) and control (CG) groups. The participants also answered a questionnaire with sociodemographic information, stage of behaviour change, physical activity and physical performance tests, before and after 12 weeks of intervention. The intervention was performed using a guide with home-based physical exercise associated with motivational strategies (telephone calls and home visits). The intervention with reduced interaction was planned to have a low financial cost, both in relation to the physical space and the materials necessary to practice the home-based physical activities, making feasible the applicability in different places. The logical model provides insight into the intervention and its phases of planning, implementation, and evaluation

O objetivo do estudo foi descrever o modelo lógico de uma intervenção domiciliar utilizando estratégia motivacional para melhora dos componentes de aptidão física em mulheres. Foi realizado um estudo quase-experimental, com 91 idosas, entre 61 e 80 anos, divididas em grupo intervenção (GI) e controle (GC). As idosas responderam um questionário com informações sociodemográficas, estágio de mudança de comportamento, atividade física e realizaram testes de desempenho físico, antes e após 12 semanas de intervenção. A intervenção foi realizada com o uso do guia domiciliar de exercícios físicos associado a estratégias motivacionais (ligações telefônicas e visitas domiciliares). A intervenção com interação reduzida foi planejada para ter um baixo custo financeiro, tanto em relação ao espaço físico quanto aos materiais necessários à prática do exercício físico domiciliar, viabilizando a aplicabilidade em diferentes locais. O modelo lógico fornece uma visão da intervenção e das fases de planejamento, implementação e avaliação.

Barriers to the involvement of the elderly in public services to promote physical activity.

The aim of this study was to examine the sociodemographic, health and behavioural characteristics related to non-participation of elderly people in activities offered by the program PROETI Health of Uberaba, Minas Gerais state. Observational study, case-control design with pairing 1:1 and sample composed of 220 elderly 60-80 years. Binary Logistic Regression was used to identify the sociodemographic, health and behavioral factors associated with non-engagement of non-users to the program. After hierarchical analysis, the non-engagement of the elderly in the program activities was associated with depressive symptoms, insufficient physical activity in the domain of leisure and reduced self-efficacy for performing moderate or vigorous physical activity. The characteristics identified in this study should receive priority attention in the formulation of community programs targeted at promoting physical activity for elderly people.

Barriers to the involvement of the elderly in public services to promote physical activity / Barreiras no engajamento de idosos em serviços públicos de promoção de atividade física

The aim of this study was to examine the sociodemographic, health and behavioural characteristics related to non-participation of elderly people in activities offered by the program PROETI Health of Uberaba, Minas Gerais state. Observational study, case-control design with pairing 1:1 and sample composed of 220 elderly 60-80 years. Binary Logistic Regression was used to identify the sociodemographic, health and behavioral factors associated with non-engagement of non-users to the program. After hierarchical analysis, the non-engagement of the elderly in the program activities was associated with depressive symptoms, insufficient physical activity in the domain of leisure and reduced self-efficacy for performing moderate or vigorous physical activity. The characteristics identified in this study should receive priority attention in the formulation of community programs targeted at promoting physical activity for elderly people.

O objetivo deste estudo foi analisar as características sociodemográficas, de saúde e comportamentais relacionadas a não participação das idosas nas atividades oferecidas pelo programa Proeti Saúde de Uberaba, Minas Gerais. Estudo observacional, do tipo caso controle, com pareamento 1:1, tendo amostra sido composta por 220 idosas de 60 a 80 anos. A Regressão Logística Binária foi utilizada para a identificação dos fatores sociodemográficos, de saúde e comportamentais associados ao não engajamento das não usuárias ao programa. Após análise hierarquizada o não engajamento das idosas às atividades do programa mostrou-se associada à sintomatologia depressiva, prática insuficiente de atividade física no domínio do lazer e autoeficácia reduzida para a realização de atividade física moderada ou vigorosa. As características identificadas neste estudo devem receber atenção prioritária na formulação de programas comunitários direcionados à promoção de atividade física às pessoas idosas.

Treinamento aeróbio em natação melhora a resposta de parâmetros metabólicos de ratos durante teste de esforço / Aerobic swimming training improves metabolic parameters response during exertion test in rats

Foram investigados os efeitos do treinamento aeróbio em natação com baixa intensidade sobre as respostas do lactato e da glicose sanguíneos de ratos durante teste de esforço. Ratos Wistar adultos foram distribuídos aleatoriamente em dois grupos: sedentário (n = 6) e treinado (n = 6). Todos receberam água e ração ad libitum e foram mantidos em ambiente com temperatura de 22 ± 2ºC e ciclo claro/escuro de 12 horas. O grupo treinado foi submetido a um programa de natação contínua sem sobrecarga, 30 min/dia, cinco dias/semana, por seis semanas. Três dias após a última sessão de treino, as concentrações sanguíneas de lactato e glicose foram medidas em três momentos durante dois testes de esforço de 20 minutos (repouso, 10 min e 20 min), sendo um sem carga e outro com carga (5 por cento do peso corporal), separados por dois dias. Observou-se correlação inversa entre lactato e glicose durante o exercício (ρ = - 0,74; P < 0,001). A concentração de lactato elevou-se do repouso para 10 min (P < 0,05) e estabilizou-se entre 10 e 20 min, em ambos os grupos nos dois testes. No teste com carga, o lactato estabilizou-se em níveis mais elevados frente aos níveis sem carga (P < 0,05), nos dois grupos. Os animais treinados exibiram níveis de lactato mais baixos do que os sedentários (P < 0,05) nos dois testes. A glicose sanguínea decaiu do repouso até 20 min nos sedentários, no teste com carga (P < 0,05). Nos treinados, a glicose sanguínea estabilizou-se em ambos os testes (P > 0,05). Conclui-se que o treinamento aeróbio em natação aplicado foi capaz de alterar as respostas do lactato e glicose sanguíneos de ratos durante os testes de esforço.

The effects of low intensity aerobic swimming training on blood lactate and glucose responses in rats were investigated during exertion test. Twelve adult male Wistar rats were randomly divided into two groups: sedentary (n= 6) and trained (n= 6). All animals received water and food ad libitum and were kept in a room with temperature of 22 ± 2ºC and dark/light cycle of 12 hours. Animals from trained group were submitted to a swimming training protocol of 30 min/day, 5 days/week, for 6 weeks. Sedentary animals did not exercise. Three days after the last training session all animals were submitted to two 20-minute swimming tests with 48 hour-interval, being one unloaded and the other with a load of 5 percent of body weight. Blood lactate and glucose were measured at rest, 10 min and 20 min of exercise. Negative correlation between blood lactate and glucose levels was observed during the exertion tests (ρ = - 0.74, P<0.001). Blood lactate concentration increased from rest to 10 min of exercise and stabilized from 10 to 20 min of exercise in both exercised and sedentary animals (P<0.05) during the unloaded exertion test. Blood lactate stabilized at higher levels when compared to those in the unloaded test in both groups (P<0.05) during the loaded exertion test. Trained rats presented lower levels of blood lactate than sedentary animals in both exercise tests (P<0.05). Blood glucose declined from rest to 10 min of exercise in sedentary rats during the loaded test (P<0.05). However, in trained animals blood glucose stabilized in both exercise tests (P>0.05). It was concluded that aerobic swimming training changed blood lactate and glucose response in rats during exertion test.