Characteristics of the clinical treatment of Brazilian and French older adults with diabetes.

OBJECTIVE: The study aimed to compare the drug therapy profile between French older adults with diabetes of the GERODIAB cohort and Brazilian older adults with diabetes assessed in a cross-sectional study conducted in Brazil. METHOD: This quantitative cross-sectional study was conducted with a sample of 246 Brazilian people aged 65 and over receiving care through the Unified Health System in the city of Fortaleza, Northeastern Brazil, who were compared to a sample of 987 French people aged 70 and over receiving care the Rouen University Center in France. RESULTS: The French participants treated for type 2 diabetes (T2D) with insulin alone, insulin + oral hypoglycemic agent (OHA) or OHA/GLP-1 analogue were older and presented higher mean values for body mass index, waist circumference and duration of diabetes in years. The French reported more episodes of hypoglycemia in all treatment modalities. These episodes occurred more frequently in the older adults treated with insulin alone and less frequently in those treated with OHA or GLP-1 analogues. The percentage of Brazilian and French older adults who monitored capillary blood glucose differed significantly in all treatment modalities. CONCLUSION: The significant differences relating to the drug therapy modalities used by Brazilian and French older adults with diabetes point to the importance of understanding the therapeutic objective of drug therapy with older adults with diabetes. Adapting the therapy to the patient's clinical conditions can prevent the worsening of comorbidities that influence the loss of autonomy and frailty.

Medical hiring formats in the Family Health Strategy and the performance of their core attributes. / Formatos de contratação médica na Estratégia Saúde da Família e o desempenho de seus atributos essenciais.

The study aimed to investigate the perception of doctors about the different hiring methods and their influence on the performance of the PHC essential attributes to analyze the formats that best contribute to its implementation and strengthening. This is a quantitative, cross-sectional research using a semi-structured form with 268 doctors from the ESF in Fortaleza, Ceará, Brazil. A unique sociodemographic profile was identified for each group evaluated, influencing the work process and opinions about hiring formats. The development of the essential PHC attributes was positively evaluated, but different perceptions were observed by professional hiring method assessed. The work performed by doctors in the ESF is influenced by how they are hired (p<0.001). Better performance of the statutory (4.4) was noted, followed by scholarship holders of the Mais Médicos Program/Primary Care Valorization Program (3.7), Consolidated Labor Laws (3.5), and, finally, those working with Self-Employed Payment Receipt (RPA) (2.4). We analyzed that hiring through the Brazilian Statutory Regime and RPA are, respectively, the best (85%) and the worst (96.6%) hiring formats.

O estudo tem o objetivo de investigar a percepção dos médicos sobre as diversas formas de contratação e sua influência sobre o desempenho dos atributos essenciais da APS, afim de analisar as formas de vínculo que melhor contribuem à sua implantação e fortalecimento. Pesquisa quantitativa e transversal, utilizando-se da aplicação de formulário semiestruturado junto a 268 médicos da ESF de Fortaleza, Ceará. Verificou-se perfil sociodemográfico singular para cada grupo avaliado, que podem influenciar o processo de trabalho e opiniões sobre as formas de contratação. O desenvolvimento dos atributos essenciais da APS foi avaliado positivamente, mas houve diferença nesta percepção de acordo com o vínculo avaliado. O trabalho realizado pelos médicos na ESF é influenciado pela forma de contratação destes (p<0,001). Percebeu-se melhor desempenho dos estatutários (4,4), seguidos dos bolsistas do Programa Mais Médicos/Programa de Valorização da Atenção Básica (3,7), Consolidação das Leis do Trabalho (3,5) e, por último, os atuantes por Recibo de Pagamento Autônomo-RPA (2,4). Analisou-se que a contratação via Regime Estatutário e RPA, são, respectivamente, a melhor (85%) e a pior (96,6%) forma de contratação.

Satisfação e acesso à saúde bucal das pessoas que vivem com HIV/Aids no nordeste brasileiro / Access to and satisfaction with oral health care among persons with HIV/Aids in Northeastern Brazil

RESUMO Este estudo objetivou avaliar, na perspectiva das Pessoas Vivendo com HIV/Aids (PVHA), uso e satisfação com os serviços públicos de saúde bucal no Sistema Único de Saúde em Fortaleza (CE). Aplicaram-se questionários estruturados sobre perfil socioeconômico, uso e satisfação dos serviços públicos de saúde bucal para 241 PVHA que frequentam 8 Serviços de Assistência Especializada em HIV/Aids. A idade média dos usuários foi de 37,8 ± 9,6 anos; 161 (68,3%) do sexo masculino; com ensino médio completo (n=79; 32,8%); 59 (24,5%) ganham até 1 salário mínimo (US$ 255). Apenas 155 (64,3%) foram ao dentista nos dois anos anteriores. Destes, 68 (28,2%) frequentavam serviços públicos, 31 (45,6%) dos quais não completaram o tratamento por falta de materiais/equipamentos defeituosos/reformas nas unidades de saúde. A nota média atribuída pelo paciente ao atendimento dos profissionais foi 7,6 (±2,5), 50 (73,6%) declararam-se muito satisfeitos/satisfeitos. Quanto ao atendimento humanizado, 59 (86,7%) estavam muito satisfeitos/satisfeitos. Pacientes encaminhados pelo Serviços de Assistência Especializada em HIV/Aids e os que residem perto das unidades de saúde tiveram probabilidade significativamente maior de usar os serviços públicos. Apesar do uso limitado dos serviços públicos de saúde bucal, principalmente devido ao acesso insuficiente e aos procedimentos ineficazes de agendamento, os serviços usados pelos entrevistados foram avaliados satisfatoriamente.

ABSTRACT This study aimed to investigate, from the perspective of People Living with HIV/Aids (PLWHA), the use of and satisfaction with public oral health services within the Unified Health System (SUS) in Fortaleza (Northeastern Brazil). Structured questionnaires on socioeconomic profile and public oral health service use and satisfaction were administered to 241 PLWHA attending eight Specialized Healthcare Services (SAE) in HIV/Aids. The mean age was 37.8 ± 9.6 years, 161 (68.3%) were male, 79 (32.8%) had completed high school, and 59 (24.5%) reported earning ≤1 minimum wage (USD 225). Only 155 (64.3%) had been to the dentist in the preceding 2 years. Of these, 68 (28.2%) attended public services, but nearly half (45.6%) did not complete treatment due to lack of supplies, malfunctioning equipment or ongoing repair of facilities. On average, the service was graded 7.6 ± 2.5, and 50 PLWHA (73.6%) reported being satisfied/very satisfied. As for humanized care, 86.7% were satisfied/very satisfied. Patients referred by SAE or residing near the facility were significantly more likely to use public services. Despite the limited use of public oral health services, mainly due to insufficient access and ineffective appointment scheduling and referral procedures, the services were mostly graded as satisfactory.

Formatos de contratação médica na estratégia saúde da família e o desempenho de seus atributos essenciais / Medical hiring formats in the family health strategy and the performance of their core attributes

Resumo O estudo tem o objetivo de investigar a percepção dos médicos sobre as diversas formas de contratação e sua influência sobre o desempenho dos atributos essenciais da APS, afim de analisar as formas de vínculo que melhor contribuem à sua implantação e fortalecimento. Pesquisa quantitativa e transversal, utilizando-se da aplicação de formulário semiestruturado junto a 268 médicos da ESF de Fortaleza, Ceará. Verificou-se perfil sociodemográfico singular para cada grupo avaliado, que podem influenciar o processo de trabalho e opiniões sobre as formas de contratação. O desenvolvimento dos atributos essenciais da APS foi avaliado positivamente, mas houve diferença nesta percepção de acordo com o vínculo avaliado. O trabalho realizado pelos médicos na ESF é influenciado pela forma de contratação destes (p<0,001). Percebeu-se melhor desempenho dos estatutários (4,4), seguidos dos bolsistas do Programa Mais Médicos/Programa de Valorização da Atenção Básica (3,7), Consolidação das Leis do Trabalho (3,5) e, por último, os atuantes por Recibo de Pagamento Autônomo-RPA (2,4). Analisou-se que a contratação via Regime Estatutário e RPA, são, respectivamente, a melhor (85%) e a pior (96,6%) forma de contratação.

Abstract The study aimed to investigate the perception of doctors about the different hiring methods and their influence on the performance of the PHC essential attributes to analyze the formats that best contribute to its implementation and strengthening. This is a quantitative, cross-sectional research using a semi-structured form with 268 doctors from the ESF in Fortaleza, Ceará, Brazil. A unique sociodemographic profile was identified for each group evaluated, influencing the work process and opinions about hiring formats. The development of the essential PHC attributes was positively evaluated, but different perceptions were observed by professional hiring method assessed. The work performed by doctors in the ESF is influenced by how they are hired (p<0.001). Better performance of the statutory (4.4) was noted, followed by scholarship holders of the Mais Médicos Program/Primary Care Valorization Program (3.7), Consolidated Labor Laws (3.5), and, finally, those working with Self-Employed Payment Receipt (RPA) (2.4). We analyzed that hiring through the Brazilian Statutory Regime and RPA are, respectively, the best (85%) and the worst (96.6%) hiring formats.

Dependence in instrumental activities of daily living and its implications for older adults' oral health.

We aimed to assess the association between dependence in instrumental activities of daily living (IADL) and oral health in older adults. We conducted a cross-sectional study of 280 people aged ≥60 years served at public primary health care centers in Northeastern Brazil. Sociodemographic, oral discomfort and general health data were collected. The Lawton and Brody scale were used to assess IADL. This research adheres to the STROBE checklist. Most participants were married (n = 139; 49.6%), women (n = 182; 65.0%) and retired (n = 212; 75.7%). A total of 37 (13.2%) older adults had some degree of dependence in IADL. Dependence in IADL was associated with: retirement (p<0.040), poor general health (p = 0.002), speech problems (p = 0.014), use of medications (p = 0.021), difficulty chewing and swallowing food (p = 0.011), voice changes (p = 0.044), edentulism (p = 0.011), use of toothbrush (p<0.001), use of toothpaste (p<0.001), and visit to the dentist in the previous year (p = 0.020). Functional disability was associated with older age, cardiovascular diseases, speech problems, chewing and swallowing difficulties, use of medication and brushing deficiency. The functional dependence in IADL can be considered an indicator of oral health status in older adults.

Condições de saúde bucal em pessoas acometidas por Covid-19 / Oral health conditions in people affected by Covid-19

Objetivo: Descrever alterações bucais relatadas por pessoas acometidas pela COVID-19 e identificar a relação dessas manifestações com a forma de apresentação da doença (leve ou grave). Métodos: Estudo transversal, descritivo e analítico. O instrumento versou sobre dados sociodemográficos, hábitos deletérios, forma de acometimento da COVID-19 e alterações bucais em adultos residentes no estado do Ceará. A coleta dos dados foi realizada por questionário on-line com utilização dos Formulários Google® disponibilizado de forma pública. Os dados foram analisados utilizando o software SPSS® versão 24.0 IBM®, sendo calculadas frequências absoluta e relativa das variáveis do estudo e razão de prevalência. A associação entre variáveis foi verificada pelo teste Qui-quadrado, com nível de significância de 5%. Resultados: Do total de 1958 respondentes, 586 relataram acometimento pela COVID-19. Dos afetados pela doença, 566 (96,6%) são da faixa etária entre 18 e 59 anos, 436 (74,4%) mulheres, 304 (51,9%) pós-graduados e 358 (51,1%) casados; 391 (66,7%) habitam com três a cinco pessoas e têm rendimento superior a cinco salários-mínimos [290 (49,5%)]. Predominou a forma leve da COVID-19 [312 (53,2%)], embora tenha havido grande percentual da forma grave [274 (46,8%)]. Do total, 123 que tiveram alterações bucais, como dificuldade para mastigar e engolir os alimentos (62;50,4%), queimação na boca (30;24,4%) e ferida na boca (14;11,4%). Os acometidos pela forma grave da COVID-19 mostraram probabilidade 1,55 vezes maior de apresentar alteração bucal quando comparado ao caso leve da doença (p=0,006). Conclusão: Pessoas acometidas com a forma grave da COVID-19 estão mais propensas a apresentar alterações bucais.

Objective: To describe oral changes reported by people affected by COVID-19 and to identify the relationship of these manifestations with the form of presentation of the disease (mild or severe). Methods: Cross-sectional, descriptive and analytical study. The instrument was about social-demographic data, deleterious habits, form of involvement of COVID-19 and oral changes in adults living in the state of Ceará. Data collection was performed by online questionnaire using Google® Forms publicly available. Data were analyzed using SPSS® software version 24.0 IBM®, being calculated absolute and relative frequencies of the study variables and prevalence ratios. The association between variables was verified by the Chi-square test, with a significance level of 5%. Results: Of the total 1958 respondents, 586 reported affected by COVID-19. Of those affected by the disease, 566 (96.6%) were between 18 and 59 years of age, 436 (74.4%) were female, 304 (51.9%) had a graduate degree, and 358 (51.1%) were married; 391 (66.7%) lived with three to five people and had an income greater than five minimum wages [290 (49.5%)]. The mild form of COVID-19 [312 (53.2%)] predominated, although there was a large percentage of the severe form [274 (46.8%)]. Of the total, 123 (xx%) who had oral changes, such as difficulty chewing and swallowing food (62;50.4%), burning in the mouth (30;24.4%), and mouth sore (14;11.4%). Those affected by the severe form of COVID-19 were 1.55 times more likely to have mouth changes when compared to the mild case of the disease (p=0.006). Conclusion: People affected with the severe form of COVID-19 were more likely to present oral alterations.

Major depression and associated factors in institutionalized older adults.

This quantitative epidemiological study aimed to analyze the prevalence of major depression in 237 older adults aged 60 to 104 years living in long-term care facilities in a large city in the state of Ceará, Northeastern Brazil. A sociodemographic questionnaire (age, gender, education, duration of institutionalization) was administered and the DSM-IV-TR was used as a reference for the clinical assessment of major depression. The Katz scale was used to classify dependence in activities of daily living and the Pfeffer scale was used to classify dependence in instrumental activities of daily living. The Mini Mental State Examination and the Category Fluency Test were used to assess cognitive function. Data underwent descriptive and analytical statistics with a significance level of 5%. The participants' mean age was 75.3 ± 8.6 years. Of these, 82 older adults (34.6%) presented a diagnosis of major depression. Major depression was significantly associated family visits (p = 0.036). The prevalence of major depression in institutionalized older adults is high. The assessment of the prevalence of major depression should be carried out based on internationally accepted clinical criteria rather than on depressive symptoms screening tests since the diagnosis itself is what will determine the non-drug or drug therapy.

Impacto psicossocial do isolamento durante pandemia de covid-19 na população brasileira: análise transversal preliminar / Psychosocial impact of COVID-19 self-isolation on the Brazilian population: a preliminary cross-sectional analysis

Resumo Este artigo trata de uma pesquisa quantitativa, descritiva e analítica da população brasileira em isolamento social (IS) durante pandemia do novo coronavírus, com o objetivo de identificar preditores de estresse psicossocial com dados recolhidos por questionário on-line nas redes sociais em abril de 2020. Do total de 3.836 pessoas participantes, prevaleceram: mulheres (2.821; 73,5%); faixa etária de 30 a 39 anos (1.101; 28,7%); com pós-graduação (2075;54,1%); estando em IS (3.447; 89,9%). Houve diferença significativa pelo fato de as pessoas estarem em IS: sentir medo de serem infectadas pelo coronavírus (p<0,001); preocupação se alguém precisava sair de casa (p<0,001); rotina modificada após o IS, destacando "entretanto conseguiram se adaptar à nova realidade", comparado aos que "tiveram a rotina alterada sem conseguir se adaptar" (p<0,001); tristeza ou preocupação, fazendo outras atividades como exercício físico, práticas religiosas, atividades lúdicas (p<0,001); e não pensaram numa solução para esse problema (p<0,001); além de mudança no padrão de sono (p=0,006). Os achados revelam a necessidade de discussão ampliada dos determinantes sociais da saúde, que devem envolver não só a doença, mas levar em consideração as relações sociais, as manifestações culturais e a economia, que podem impactar a saúde mental das pessoas.

Abstract This is a quantitative, descriptive, and analytical study of the Brazilian population in social isolation (SI) during the novel coronavirus pandemic whose aim was to identify predictive factors for psychosocial stress using data collected by a social media-based online questionnaire administered in April 2020. Among the 3,836 participants, most were women (2,821; 73.5%), aged from 30 to 39 years (1,101; 28.7%), with post-graduate education (2,075;54.1%), and in SI (3,447; 89.9%). We found significant differences between individuals who were in SI and those who were not regarding: feeling afraid of being infected by the coronavirus (p<0.001) and worried if someone had to leave the house (p<0.001); changes in routine after self-isolating in those who managed to adapt to the new reality compared to those who could not adapt (p<0.001); feeling sad and worried while doing other activities, such as physical exercise, religious practices, or recreational activities (p<0.001); inability to imagine a solution to this problem (p<0.001), and changes in sleep pattern (p=0.006). Our findings indicate the need for further discussions about the social determinants of health, addressing not only the disease per se, but also social relations, cultural manifestations, and the economy, which may impact people's mental health.

Nutritional assessment of older adults with diabetes mellitus.

AIMS: We aimed to screen the nutritional status of older adults with diabetes mellitus, seeking to outline the needs of this population group considering their socioeconomic status. METHODS: Cross-sectional study of 246 diabetic people aged 65-94 years in Northeastern Brazil. Semi-structured questionnaires were used to collect sociodemographic, general health and lifestyle data. The Mini Nutritional Assessment was used to screen nutritional status. RESULTS: Participants' mean age was 73 ±â€¯6.4 years, and there was a predominance of women (56.5%). The mean duration of diabetes was 14.1 years (±9.6 years). Patients aged 80 years or older presented a 3.7-fold higher risk of malnutrition (p < 0.001), and those who were uneducated exhibited a 5.8-fold higher risk of malnutrition (p = 0.040). Patients with BMI of 18.6-24.9 km/m2 presented a 2.2-fold higher risk of malnutrition than overweight or obese patients (p < 0.001). Nutritional status was significantly associated with coronary artery disease (p = 0.010) and stroke (p < 0.001). Malnourished patients exhibited a 2.2-fold higher occurrence of infection in the past 6 months (p = 0.017) and 2-fold higher occurrence of foot injuries (p = 0.028) than their well-nourished peers. CONCLUSION: Malnutrition in older diabetic patients exacerbates underlying diseases and contributes to unfavorable prognosis, particularly in the oldest old and in individuals with low levels of education.

Diagnóstico e tratamento de lesões não cariosas: a visão do cirurgião-dentista do sistema público de saúde / Diagnosis and treatment of non-carious lesions: the vision of the dentist of the public health system

Introdução: as lesões dentárias não cariosas apresentam etiologia multifatorial e, caracterizam-se por ocasionar desgastes irreversíveis na estrutura dentária, sem envolvimento de microrganismos, podendo ser diagnosticadas como erosão (de origem intrínseca ou extrínseca), abfração, atrição ou abrasão. Objetivo: analisar o conhecimento de cirurgiões-dentistas a respeito do diagnóstico e do tratamento dos diferentes tipos de lesões dentárias não cariosas. Métodos: realizou-se estudo observacional, descritivo, de natureza quantitativa, utilizando-se, como instrumento de coleta de informações, um questionário semiestruturado aplicado em cirurgiões-dentistas do município de Fortaleza-CE. Os resultados foram analisados de forma descritiva e foi utilizado o teste de Qui-Quadrado com nível de significância de 5%. Resultados: verificaram-se, entre os cirurgiões-dentistas, os seguintes percentuais de acerto referentes às lesões de abfração, abrasão, atrição, erosão de origem extrínseca, erosão de origem intrínseca e erosão de origem extrínseca associada à abrasão, respectivamente: 51,97%, 20,60%, 78,43%, 81,37%, 71,57% e 7,84%. Observou-se, também, associação estatisticamente significante positiva entre o conhecimento dos profissionais a respeito de lesões de abfração e atrição e o tempo de formado. Conclusão: embora grande parte dos profissionais tenham sido capazes de identificar um plano de tratamento adequado para os casos propostos em questão, o diagnóstico das lesões não cariosas não foi preciso, exceto quando se tratou de erosão de origem intrínseca ou extrínseca e atrição que obtiveram percentual de acertos acima de 70%.

Introduction: non-carious dental lesions present multifatorial etiology, and are characterized by irreversible wear on the tooth structure, without the involvement of microorganisms, and can be diagnosed as erosion (intrinsic or extrinsic), abfraction, attrition or abrasion. Objective: to analyze the knowledge of dental surgeons regarding the diagnosis and treatment of different types of non-carious dental lesions. Methods: a quantitative, observational, descriptive study was carried out using a semistructured questionnaire as a tool for collecting information applied to dentists in the city of Fortaleza-CE. The results were analyzed in a descriptive way and the chi-square test with significance level of 5% was used. Results: the following percentages were found for abfraction, abrasion, attrition, extrinsic erosion, intrinsic erosion, and extrinsic erosion associated with abrasion, respectively: 51.97%, 20.60%, 78.43%, 81.37%, 71.57% and 7.84%. It was also observed a statistically significant positive association between the professionals' knowledge regarding abfraction and attrition lesions and the time of formation. Conclusion: although many professionals were able to choose an adequate treatment plan for the proposed cases, the diagnosis of non-carious lesions was not precise, except for intrinsic or extrinsic erosion, and attrition that obtained a percentage of right answers above 70%.

Idosos com depressão: uma análise dos fatores de institucionalização e apoio familiar / Depressed older adults: an analysis of factors related to institutionalization and family support / Mayores con depresión: un análisis de los factores de la institucionalización y del apoyo familiar

OBJETIVO: Identificar a prevalência de depressão de idosos residentes em instituições de longa permanência (ILPI) e sua relação com os motivos de institucionalização. MÉTODOS: Estudo quantitativo e transversal realizado em Fortaleza, Ceará, que utilizou um instrumento de coleta de dados elaborado para realizar avaliação clínica concernente à depressão maior, utilizando os critérios diagnósticos do Diagnostical and statistical manual of mental disorders (DSM-IV-TR). Serviu também para registrar os dados secundários obtidos dos prontuários dos pacientes idosos no intuito de complementar as informações relativas ao contexto da institucionalização. RESULTADOS: Do total de idosos pesquisados, 82 (34,6%) apresentaram diagnóstico de Depressão Maior segundo os critérios do DSM-IV-TR. No diagnóstico de depressão por ILPI, verifica-se significância estatística entre as duas ILPI (p=0,042). Na associação verificada entre depressão e tempo de institucionalização (p=0,001), é importante destacar o maior percentual entre os idosos com até três anos de institucionalização (37,8% dos casos de depressão), levando se a considerar que o pouco tempo de afastamento familiar e o processo de adaptação ao novo tipo de moradia possam constituir fatores de risco para a doença. CONCLUSÃO: Os achados acima descritos aludem à ideia de que o tempo de institucionalização, a carência das relações interpessoais, a solidão e o fato de o idoso receber visitas de familiares neste período constituem fatores de risco para a depressão.

OBJECTIVE: To identify the prevalence of depression in older adults living in long-term care (LTC) facilities and its association with the reasons for institutionalization. METHODS: Quantitative, cross-sectional study carried out in Fortaleza, Ceará, using a data collection instrument designed to perform clinical assessment of major depression, based on the Diagnostical and statistical manual of mental disorders (DSM-IV-TR) diagnostic criteria. It was also used to record secondary data obtained from the medical records of the older adult patients in order to complement information on the institutionalization context. RESULTS: Of all older adults analyzed, 82 (34.6%) presented a diagnosis of major depression according to DSM-IV-TR criteria. As for the diagnosis of depression related to the LTC facility, there was a statistically significant difference between the two LTC facilities (p=0.042). With regard to the association between depression and institutionalization duration (p=0.001), it is important to highlight a higher percentage among older adults with up to three years of institutionalization (37.8% of the cases of depression), which suggests that a short period of separation from family and the process of adaptation to the new type of housing may constitute risk factors for the disease. CONCLUSION: The findings described above allude to the idea that institutionalization duration, lack of interpersonal relationships, loneliness and the fact that the older adults receive visits from family members in this period are risk factors for depression.

OBJETIVO: Identificar la prevalencia de depresión de mayores que viven en instituciones de larga permanencia (ILP) y su relación con los motivos de la institucionalización. MÉTODOS: Estudio cuantitativo y transversal realizado en Fortaleza, Ceará, que utilizó un instrumento para la recogida de datos que ha sido elaborado para realizar la evaluación clínica de la depresión mayor utilizando los criterios diagnósticos del Diagnostical and statistical manual of mental disorders (DSM-IV-TR). Ha servido también para registrar los datos secundarios de los historiales clínicos de los pacientes mayores para complementar las informaciones relativas al contexto de la institucionalización. RESULTADOS: Del total de mayores investigados, 82 (34,6%) presentaron el diagnóstico de Depresión Mayor según los criterios del DSM-IV-TR. En el diagnóstico de depresión por ILP se verifica la significación estadística entre las dos ILP (p=0,042). En la asociación verificada entre la depresión y el tiempo de institucionalización (p=0,001) se puede destacar el mayor porcentual entre los mayores de hasta tres años de institucionalización (37,8% de los casos de depresión) considerándose que el poco tiempo de alejamiento familiar y el proceso de adaptación al nuevo tipo de vivienda pueden ser factores de riesgo para la enfermedad. CONCLUSIÓN: Los hallazgos descritos indican la idea de que el tiempo de institucionalización, la carencia de las relaciones interpersonales, la soledad y el hecho del mayor recibir visitas de los familiares en ese periodo son factores de riesgo para la depresión.

Oral health of older people: tracking soft tissue injuries for the prevention of oral cancer.

OBJECTIVE: To detect oral soft tissue injuries in older people. METHOD: A quantitative analytical cross-sectional study conducted in Fortaleza, Ceará. Individual interviews addressed age, gender, marital status, income, and education. The community oral health indicator was used to detect oral soft tissue injuries and their location. RESULTS: Most of the 821 participants aged 60-100 years were women (580; 70.6%), attended school for up to 5 years (401; 48.8%), were illiterate (201; 24.5%), were retired (608; 74.1%), and received up to 2 wages (701; 85.4%). A total of 604 participants (73.6%) wore dentures. Injuries included red patches (152; 55.9%), blisters (58; 21.3%), lesions and/or wounds (39; 14.3%), and white patches (30; 11%). Locations of injuries were the roof of the mouth (167; 61.4%), gums (62; 22.8%), cheeks (39; 14.3%), tongue (15; 5.5%), lips (15; 5.5%), and the floor of the mouth (12; 4.4%). Injuries were associated with age (p<0.001), retirement (p=0.005), education (p=0.010), dentures (p<0.001) and red patches (p<0.001). CONCLUSION: Tracking soft tissue injuries and referring older adults with suspected malignant lesions to the health team should be included as oral cancer identification and prevention measures. Furthermore, health care providers should raise older adults' awareness of the importance of regular preventive examinations.

Older adults' dependence in activities of daily living: Implications for oral health.

OBJECTIVE: To assess the relationship between ADL and oral health status in older adults. DESIGN AND SAMPLE: Quantitative, analytical, cross-sectional research with 280 people aged ≥60 in public primary health care centers in the city of Fortaleza, Northeastern Brazil. MEASURES: Collection of sociodemographic data, oral discomfort data, and general health data and application of the Community Oral Health Indicator-COHI and the activities of daily living scale. RESULTS: Significant differences in functional dependence were found between age groups (p < .001), incomes (p = .034), and levels of education (p = .003). Tooth loss (OR = 2.13; p = 0.025), having no teeth (OR = 2.97), difficulties in chewing and swallowing food (OR = 2.56; p = 0.003), problems with taste of food (OR = 2.06; p = .044), poor self-rated general health (OR = 3.7; p = .001), hearing problems (OR = 2.23; p = .009) and speech problems (OR = 3.15; p = .002) increased chances for functional dependence. Dependent individuals were less likely to use toothpaste, thereby increasing the potential for caries (p = .013). Age 80 or older (p < .001), ages 70-79 (p < .001), three or more visible dental cavities (p = .030) and difficulty chewing and swallowing food (p = .027) remained associated with dependence in ADL in the logistic regression model. CONCLUSION: Functional dependence in activities of daily living has implications for the oral health status of older people.

Subjective well-being and oral discomfort in older people.

ABSTRACTBackground:The study aims to assess the relationship between oral discomfort and subjective well-being (SWB) in older people. METHODS: A quantitative cross-sectional study was conducted in four Reference Centers for Social Welfare in Fortaleza, Northeastern Brazil. A census was held and individual interviews were carried out with all the older people (n = 246) enrolled in the centers. A questionnaire addressing sociodemographic data (age, gender, marital status, income, and education) and oral discomfort (dry mouth, difficulty in chewing and swallowing food, problems with the taste of food, burning mouth sensation, pain for no apparent reason, and mouth swelling) and the 62-item SWB scale were used. RESULTS: Participants were 246 people aged 60-89 years (mean of 69 ± 6.9 years). The majority were women (n = 199; 80.9%), had incomplete primary education (n = 161; 65.4%), had an income of up to one minimum wage (n = 182; 74%), were retired (n = 169; 68.7%), were white (n = 100; 40.7%), and had no partner (n = 177; 72%). The mean SWB score (subscale 1) was associated with age (p = 0.010), gender (p = 0.019), health in the previous year (p = 0.027), systemic diseases (p = 0.007), speech problems (p = 0.016), vision problems (p = 0.006), number of teeth (p = 0.010), and dry mouth (p = 0.044). SWB (subscale 2) was associated with gender (p = 0.029), skin color (p = 0.023), general health (p < 0.001), health in the previous year (p < 0.001), systemic diseases (p = 0.001), drinking (p = 0.022), soft tissue problems (p = 0.001), and pain for no apparent reason (p = 0.025). CONCLUSION: The relationship between oral discomfort and SWB reveals that older people's poor oral health leads to physical, psychological, and/or social problems that directly interfere with their well-being.

Oral health of older people: tracking soft tissue injuries for the prevention of oral cancer / Saúde bucal de idosos: rastreio de lesões dos tecidos moles na prevenção do câncer bucal / Salud bucal de personas mayores: rastreo de lesiones de tejidos blandos en la prevención del cáncer bucal

ABSTRACT Objective: To detect oral soft tissue injuries in older people. Method: A quantitative analytical cross-sectional study conducted in Fortaleza, Ceará. Individual interviews addressed age, gender, marital status, income, and education. The community oral health indicator was used to detect oral soft tissue injuries and their location. Results: Most of the 821 participants aged 60-100 years were women (580; 70.6%), attended school for up to 5 years (401; 48.8%), were illiterate (201; 24.5%), were retired (608; 74.1%), and received up to 2 wages (701; 85.4%). A total of 604 participants (73.6%) wore dentures. Injuries included red patches (152; 55.9%), blisters (58; 21.3%), lesions and/or wounds (39; 14.3%), and white patches (30; 11%). Locations of injuries were the roof of the mouth (167; 61.4%), gums (62; 22.8%), cheeks (39; 14.3%), tongue (15; 5.5%), lips (15; 5.5%), and the floor of the mouth (12; 4.4%). Injuries were associated with age (p<0.001), retirement (p=0.005), education (p=0.010), dentures (p<0.001) and red patches (p<0.001). Conclusion: Tracking soft tissue injuries and referring older adults with suspected malignant lesions to the health team should be included as oral cancer identification and prevention measures. Furthermore, health care providers should raise older adults' awareness of the importance of regular preventive examinations.

RESUMO Objetivo: Detectar agravos aos tecidos moles orais em pessoas idosas. Método: Estudo quantitativo, analítico, transversal, realizado. As entrevistas individuais abordaram idade, sexo, estado civil, renda e educação. O Indicador Comunitário de Saúde Bucal foi utilizado para detectar agravos aos tecidos moles orais e sua localização. Resultados: A maioria dos 821 participantes tinha entre 60 e 100 anos, era mulheres (580; 70,6%), com até 5 anos de escolaridade (401; 48,8%), analfabeta (201; 24,5%), aposentada (608; 74,1%), recebia até dois salários (701; 85,4%) e 604 (73,6%) usava prótese dentária. Os agravos incluíram manchas vermelhas (152; 55,9%), bolhas (58; 21,3%), lesões e/ou feridas (39; 14,3%) e manchas brancas (30; 11%). As localizações foram palato (167; 61,4%), gengivas (62; 22,8%), bochechas (39; 14,3%), língua (15; 5,5%); lábios (15; 5,5%) e assoalho da boca (12; 4,4%). As localizações estiveram associadas à idade (p <0,001), aposentadoria (p = 0,005), escolaridade (p = 0,010), próteses (p <0,001) e manchas vermelhas (p <0,001). Conclusão: Rastrear agravos aos tecidos moles e encaminhar idosos com suspeita de lesões malignas à equipe de saúde devem ser medidas de identificação e prevenção do câncer bucal. Além disso, os profissionais de saúde devem conscientizar os idosos da importância de exames preventivos regulares.

RESUMEN Objetivo: Detectar agravamientos en los tejidos blandos orales en personas mayores. Método: Estudio cuantitativo, analítico, trasversal, llevado a cabo en Fortaleza, Ceará. Entrevistas individuales abordaron edad, sexo, estado civil, ingresos y educación. El Indicador Comunitario de Salud Bucal fue utilizado para detectar agravamientos a los tejidos blandos orales y su ubicación. Resultados: La mayoría de los 821 participantes tenían entre 60 y 100 años, estaba compuesto de mujeres (580; 70,6%), con hasta 5 años de escolaridad (401; 48,8%), analfabetas (201; 24,5%), jubiladas (608; 74,1%), cobraban hasta dos sueldos mínimos (701; 85,4%) y 604 (73,6%) llevaban prótesis dental. Los agravamientos incluyeron manchas rojas (152; 55,9%), burbujas (58; 21,3%), lesiones y/o heridas (39; 14,3%) y manchas blancas (30; 11%). Las ubicaciones fueron paladar (167; 61,4%), encías (62; 22,8%), mejillas (39; 14,3%), lengua (15; 5,5%), labios (15; 5,5%) y suelo de la boca (12; 4,4%). Las ubicaciones estuvieron asociadas con la edad (p<0,001), jubilación (p = 0,005), escolaridad (p = 0,010), prótesis (p <0,001) y manchas rojas (p <0,001). Conclusión: Rastrear agravamientos a los tejidos blandos y derivar a las personas mayores con sospecha de lesiones malignas al equipo de salud deben ser medidas de identificación y prevención del cáncer bucal. Además, los profesionales sanitarios deben concienciar a los ancianos acerca de la importancia de hacer exámenes preventivos regulares.

Acute kidney injury in critically ill obstetric patients: a cross-sectional study in an intensive care unit in Northeast Brazil / Lesão renal aguda em pacientes obstétricas gravemente doentes: um estudo transversal em uma unidade de terapia intensiva do nordeste do Brasil

Abstract Introduction: Acute kidney injury (AKI) is a complication still poorly studied in the setting of obstetric patients, which is associated with increased mortality. Objective: The aim of this study was to investigate the frequency and risk factors of AKI among critically ill obstetric patients. Methods: A cross-sectional study was conducted with all patients admitted to an intensive care unit (ICU) due to obstetric complications, in Fortaleza, Brazil, in the period between January 2012 and December 2014. AKI was defined according to AKIN criteria. Results: A total of 389 patients were included, aged between 13 and 45 years. The main causes of ICU admission were pregnancy-related hypertensive syndromes (54.5%), hemorrhage and hemorrhagic shock (12.3%), heart diseases (9.0%), respiratory insufficiency (8.2%) and sepsis (5.4%). AKI was found in 92 cases (24%), and this was the most frequent complication. General mortality was 7.5%, and mortality due to AKI was 21% (p = 0.0007). In the multivariate analysis, risk factors for AKI were cesarian delivery (95% CI = 0.23-0.85, p = 0.01) and thrombocythopenia (95% CI = 1.50-4.36, p = 0.001). AKI was an independent risk factor for death (OR = 6.64, 95% CI = 3.11-14.15, p < 0.001). Conclusion: AKI was the main complication among critically ill obstetric patients and it was associated with increased mortality. Most cases were associated with pregnancy-related hypertensive disorders, which are complications that can be easily identified and treated during prenatal care.

Resumo Introdução: A lesão renal aguda (LRA) é uma complicação ainda pouco estudada no contexto das pacientes obstétricas, que está associada com aumento da mortalidade. Objetivo: Investigar a frequência e os fatores de risco da LRA entre pacientes obstétricas. Métodos: Foi realizado estudo transversal com todas as pacientes admitidas em uma unidade de terapia intensiva (UTI) devido a complicações obstétricas em Fortaleza, Brasil, no período de janeiro de 2012 a dezembro de 2014. LRA foi definida de acordo com o critério AKIN. Resultados: Foram incluídas 389 pacientes, com idade entre 13 e 45 anos. As principais causas de admissão na UTI foram síndromes hipertensivas da gestação (54,5%), hemorragia e choque hemorrágico (12,3%), cardiopatias (9,0%), insuficiência respiratória (8,2%) e sepse (5,4%). LRA foi encontrada em 92 casos (24%), e esta foi a complicação mais frequente. A mortalidade geral foi de 7,5%, e a mortalidade por LRA foi de 21% (p = 0,0007). Na análise multivariada, os fatores de risco para LRA foram parto cesariano (IC 95% = 0,23-0,85, p = 0,01) e plaquetopenia (IC 95% = 1,50-4,36, p = 0,001). LRA foi um fator de risco independente para óbito (OR = 6,64, IC 95% = 3,11-14,15, p < 0,001). Conclusão: LRA foi a complicação mais frequente em pacientes obstétricas gravemente doentes e esteve associada com aumento da mortalidade. A maioria dos casos esteve associada às síndromes hipertensivas da gravidez, que são complicações passíveis de tratamento durante o pré-natal.

Cytology-Based Screening During Antenatal Care as a Method for Preventing Cervical Cancer

Background: Cervical cancer is one of the most serious threats to women's lives. Therefore, the present study aimed to know the dynamics in the collection of cytologic samples during antenatal care as a method of cervical cancer screening and to identify the factors associated with its performance. Material and Methods: Analytical cross-sectional study carried out with pregnant and postpartum women in Fortaleza, Ceará, Northeastern Brazil. Data were collected using a questionnaire addressing sociodemographic variables, antenatal care, pregnancy and cytology-based screening for cervical cancer during antenatal care. Measures of central tendency were calculated and the Chi-squared test and Fisher's exact test were used with a significance level of 5%. Results: Participants were 229 pregnant women and 89 postpartum women. Age ranged 18 to 43 years, with a mean of 27.9 years (SD=6.1). Only 35 (11%) participants had Pap smears during antenatal care. A total of 283 women did not have Pap smears during pregnancy; of these, 229 (80.9%) did not have the test because of lack of clear information from the health professional, 25 (8.8%) for fear of bleeding or abortion, and 29 (10.3%) because they had had the test before pregnancy. Undergoing cytology-based screening for cervical cancer was associated with high-risk pregnancy (p=0.002), antenatal care provided by a physician (p=0.003), knowledge about the possibility of having the test during pregnancy (p<0.001) and paid job (p=0.043). Conclusion: The percentage of cytology-based screening for cervical cancer during antenatal care was low. Therefore, health education is suggested to improve this figure. However, receiving antenatal care at MEAC, having consultations with a physician, and knowing that it is possible to have a Pap smear during pregnancy were significant protective factors for undergoing cytology screening during pregnancy.

Salivary flow and xerostomia in older patients with type 2 diabetes mellitus.

OBJECTIVES: To assess salivary flow in older patients with type 2 diabetes mellitus (DM2) and its association with xerostomia. METHODS: Cross-sectional clinical study conducted with older patients diagnosed with type 2 diabetes for at least one year receiving treatment at the Integrated Center for Diabetes and Hypertension of Ceará (CIHD) in the city of Fortaleza, Ceará, Northeastern Brazil. Oral clinical examination was carried out to assess the decayed, missing and filled teeth index (DMFT). Perception of the presence of xerostomia/dry mouth was assessed using the Visual Analogue Scale. Stimulated salivary flow was measured and samples were obtained using an extra-soft silicone device. RESULTS: 120 older patients with diabetes (60 insulin-dependent and 60 non-insulin-dependent) aged 65-91 years, with a mean age of 72.26 ± 6.53 years, were assessed. Of these, 111 (92.5%) presented a decrease in salivary flow while 59 (49.2%) reported moderate to severe xerostomia/dry mouth. The DMFT Index presented a mean of 27.53 ± 4.86 teeth. CONCLUSIONS: Reduced salivary flow was found in the group assessed in the present research; however, this finding is not in accordance with the perception of xerostomia/dry mouth reported by the patients.