O envelhecimento populacional e a mudança no perfil epidemiológico ocorridos nas últimas décadas trazem novos desafios sociais, políticos e culturais tanto no Brasil como no restante do mundo. A nova Promoção da Saúde tem influenciado o setor saúde propondo uma concepção ampla do processo saúde-doença e de seus determinantes, na articulação de saberes técnicos e populares, e na mobilização de todos os setores da sociedade para seu enfrentamento e resolução. Objetivos: Traçar um panorama da produção bibliográfica sobre Promoção da Saúde do Idoso, no Brasil. Identificar o enfoque conceitual de Promoção da Saúde e o tipo de delineamento de pesquisa dos artigos avaliados.Método: Realizou-se um estudo exploratório descritivo, por meio de levantamento bibliográfico no banco de dados LILACS, mediante descritores do vocabulário DECS. O período pesquisado foi de 1994 a 2009, no Brasil; tendo como marco histórico a promulgação da Política Nacional do Idoso. A análise dos dados foi dividida em duas seções: quanto aos periódicos e quanto aos artigos selecionados. Resultados: Foram obtidos 112 registros de publicações; sendo: 26 teses, 21 livros, 63 artigos, 1 (hum) editorial de saúde e 1 (hum) documento Pelos critérios de inclusão foram analisados 31 artigos em 23 revistas da área da saúde. As áreas dos periódicos que mais publicaram artigos sobre a temática da promoção da saúde do idoso, foram a Saúde Pública (8) e Enfermagem (8). O estudo mostrou que as publicações se concentraram nas regiões Sudeste e Sul do país. Quanto aos artigos, verificou- que a maior parte (22), foi publicada nos três anos mais recentes ao período analisado. Abordam em sua maioria a Promoção da Saúde sob o enfoque sócio-ambiental com ênfase no campo do desenvolvimento de habilidades. Conclusões: O panorama atual da literatura brasileira indica uma tendência de crescimento das publicações voltadas para a temática do envelhecimento a respeito da promoção da saúde do idoso desde 2006, nas diferentes áreas da saúde. O enfoque da Promoção da Saúde sob a perspectiva socioambiental demonstra uma preocupação dos pesquisadores quanto aos determinantes da saúde sob um olhar ampliado, para além do enfoque biomédico. A ênfase no campo do desenvolvimento de habilidades representa um aspecto preponderante na maioria dos artigos analisados o que aponta para a necessidade de uma análise critica sobre o desenvolvimento de pesquisas na área de envelhecimento e promoção da saúde no Brasil / Introduction- Population aging and epidemiological changes that have taken place in the last twenty years brought new social, political and cultural challenges in Brazil as well as in the rest of the world. The new concept of Health Promotion has influenced health field proposing a wider conception of the health-sickness process and its determinants, as well as the articulation of technical and traditional knowledge, and in the mobilization of all sectors of society in facing the issue and working out solutions. In this research we had the following objectives: to elaborate a scenery of the bibliographical production on Health Promotion for the Elderly in Brazil; to identify the conceptual focus on Health Promotion and the process by which such researches were carried out in the articles under consideration. Methodology: We carried out an exploratory descriptive study by means of the bibliographical inventory LILACS database, through DECS vocabulary descriptors. The period under consideration comprehends the years between 1994 and 2009, considering the promulgation of The National Policy for the Elderly as its historical benchmark. Data analysis was divided into two sections: first, with reference to periodicals; and second, with reference to selected articles. Results: 112 registered publications were obtained; 26 of them were theses, 21 were books, 63 were articles and 1 (one) was an editorial on health. According to the inclusion criteria, 31 articles published in 23 magazines were analyzed. Public Health and Nursing journals published the majority number of articles on the theme of health promotion for the elderly, 8 (eight) each one of them. This study showed that these publications were concentrated in the Southeast and South regions of the country. As for the articles, it was found that most of them (22) were published in the three most recent years of the period under consideration. The articles focus was mainly on the socio-environmental scope of Health Promotion with special emphasis on development of personal skills. Conclusions: The current scenery in the Brazilian literature shows a growing tendency in the number of articles engaged with the theme of aging focusing on health promotion for the elderly since 2006 in different areas of health field. The emphasis on Health Promotion under socio-environmental perspective demonstrates both, special concern from the researchers on health determinants, further than the biomedical focus. The emphasis on the field of development of personal skills represents a major aspect in most of the articles under evaluation, suggesting the need of critical analysis about the development of researches concerning Health Promotion and Aging in Brazil

À medida que a população envelhece, a prevalência das doenças crônicas não transmissíveis aumenta. Dentre as doenças que acometem a população idosa, destaca-se o diabetes mellitus (DM). Por ser uma doença crônica e envolver riscos de complicações e sequelas, a realização de atividades de autocuidado pode contribuir para o controle da doença. Dessa forma, o objetivo dessa pesquisa foi estudar o perfil clínico, epidemiológico e sociodemográfico, bem como o nível de adesão ao autocuidado de idosos com DM Tipo 2 (DM2). Trata-se de um estudo observacional do tipo transversal, sendo selecionados 115 indivíduos com idade igual ou superior a 60 anos, com DM2 e cadastrados no Ambulatório do Estágio Integrado do Centro de Saúde Escola Joel Domingos Machado no município de Ribeirão Preto/SP há pelo menos um ano. Os instrumentos de coleta de dados foram o Instrumento de Caracterização dos Participantes, Critério de Classificação Econômica Brasil e o Questionário de Atividades de Autocuidado com o Diabetes. Todos os preceitos éticos foram respeitados. Quanto aos resultados obtidos, observou-se um predomínio de mulheres e de participantes com ensino fundamental incompleto (68,7%). O tempo médio de diagnóstico da doença foi de 13,6 anos para os homens e 14,4 anos para as mulheres. Em relação ao tipo de tratamento farmacológico utilizado, 50,4% dos participantes relataram utilizar apenas antidiabético oral, 37,4% antidiabético oral associado à insulina, 9,6% apenas insulina e 2,6% não faziam uso de nenhum medicamento. Cerca de 88% mencionaram a hipertensão arterial como doença associada e 11,3% apresentavam nefropatia como complicação decorrente do DM. Quanto às atividades de autocuidado, verificou-se níveis baixos de adesão tanto para adesão geral quanto para as recomendações alimentares, especialmente entre as mulheres. Por outro lado, o domínio medicação foi o que apresentou maior adesão por parte dos participantes. A avaliação dos itens \"avaliar o açúcar no sangue o número de vezes recomendado\" e \"examinar os pés\" mostrou diferença significativa quando mulheres e homens foram comparados. Em elação ao tabagismo, a maioria relatou não fumar. A análise multivariada mostrou que no domínio adesão geral, não utilizar nenhum e/ou apenas um antidiabético oral foram considerados fatores preditores para baixa adesão. Já os preditores de alta adesão foram não utilizar metformina e apresentar hemoglobina glicada alterada. No que se refere ao domínio adesão à alimentação, não utilizar nenhum antidiabético oral foi fator preditor de baixa adesão, enquanto ser negro e apresentar glicemia de jejum não controlada representaram fatores preditores de alta adesão. Aderir às recomendações gerais e alimentares se correlacionaram positivamente com o tempo de diagnóstico [(r=0,34964; p<0,001); (r=0,25947; p=0,005), respectivamente]. Conclui-se que fatores sociodemográficos, clínicos e epidemiológicos influenciam a adesão ao autocuidado. Obter informações para orientar e planejar ações que possam aumentar a adesão ao tratamento do DM é fundamental para melhorar o controle da doença, diminuir riscos de complicações e proporcionar melhor qualidade de vida aos pacientes. / As the population ages the prevalence of chronic non-communicable diseases increases. Amongst the diseases that affect the elderly population, diabetes mellitus (DM) stands out. As a chronic disease and involve risks of complications and sequelae, the performance of self-care activities may contribute to disease control. The objective of this research was to study the clinical, epidemiological and sociodemographic profile, as well as the level of adherence to self-care of the elderly with type 2 DM (DM2). This is a cross-sectional observational study, in which were selected 115 individuals aged 60 years and over with type 2 DM and registered at the School Health Center Joel Domingos Machado Ambulatory of Integrated Internship for at least one year. The data collection instruments were: Instrument of Participants Characterization, Brazilian Criterion of Economic Classification and the Summary of Diabetes Self-Care Activities Questionnaire. All ethical guidelines were respected. Regarding the results, it was observed that the women and individuals with incomplete elementary school (68.7%) were predominated. The average time of diagnosis was 13.6 years for men and 14.4 years for women. Regarding the type of pharmacological treatment, 50.4% of the participants reported only oral antidiabetic use, 37.4% oral antidiabetic associated with insulin, 9.6% only insulin and 2.6% did not use any medication. About 88% reported hypertension as an associated disease and 11.3% had nephropathy as a complication of diabetes. As for self-care activities, it was verified low adherence levels for both general adherence and dietary recommendations, especially among women. However, the medication domain has presented the highest adherence by the participants. The evaluation of the items \"assessing blood sugar the recommended number of times\" and \"examining the feet\" showed a significant difference when women and men were compared. Regarding smoking, the majority reported do not smoke. The multivariate analysis showed that in the general adhesion domain, not using any and / or only an oral antidiabetic were considered predictive factors for low adhesion. On the other hand, the predictors of high compliance were not to use metformin and to have altered glycated hemoglobin. Regarding the adherence to food domain, no oral antidiabetic agent was used as a predictor of low adherence, while being black and presenting uncontrolled fasting glucose represented predictors of high adherence. Adhering to general and dietary recommendations had a positive correlation with the time of diagnosis [(r = 0.34964; p <0.001); (R = 0.25947; p = 0.005)]. We conclude that the factors sociodemographic, clinical and epidemiological factors to influence adherence to self-care. Obtaining information to guide and plan actions that can increase adherence to DM treatment is fundamental to improve disease control, reduce risks of complications, and provide better quality of life for patients.

Esse estudo tem por objetivo validar o Michigan Alcoholism Screening Test - Geriatric Version (MAST-G) e identificar os problemas relacionados ao uso de bebida alcoólica entre os idosos usuários da Unidade Saúde da Família (USF) do município de São Carlos (SP). O desenho metodológico do estudo é do tipo descritivo de abordagem quantitativa. Os dados foram coletados por meio de um questionário contendo as informações sociodemográficas e o MAST-G, seguindo as etapas de tradução e adaptação transcultural. A amostra foi constituída por 111 pessoas com idade igual ou superior a 60 anos cadastrados na USF do município de São Carlos. Do resultado, a idade média foi de 70 anos, sendo 45% do sexo masculino e 55% do sexo feminino, escolaridade média de 3 anos e 92% residem com a família. O MAST-G apresentou um bom índice de confiabilidade, com Alfa de Cronbach ? = 0,7873 e por meio da curva de ROC mostrou uma boa especificidade e sensibilidade no valor de corte de 5 respostas positivas, corroborando a literatura internacional. Pode-se concluir que o instrumento é de fácil aplicação e pouco intimidativo, além de ser possível averiguar diversas questões acerca do comportamento do beber do idoso e assim, possibilitando um atendimento especializado, pontual para que o idoso tenha uma assistência de qualidade. / This study aims to validate the Michigan Alcoholism Screening Test - Geriatric Version (MAST-G) and to identify the pattern of consumption and alcohol use among elderly users of Family Health Units (USF) in the municipality of São Carlos (SP), Brazil. The methodological design of the study is a descriptive quantitative approach. Data were collected using an instrument that contains sociodemographic information and the MAST-G, following the steps of translation and cultural adaptation. The sample consisted of 111 people aged over 60 years who were enrolled in the USF of São Carlos. The result, the average age was 70 years, 45% male and 55% female, average schooling for 3 years and 92% living with family. The MAST-G had a good level of reliability, with Cronbach\'s alpha ? = 0.7873 and shows a good specificity and sensitivity in cut-off of 5 positive answers, as observed by the ROC curve, in good agreement with the literature. It could be concluded that the instrument is easy to be applied and less intimidating, besides being able to ascertain other questions about the behavior of the life of the elderly so it can allow a specialized service, timely so that the elderly have a better quality of assistance.

O adoecimento de um membro familiar costuma acarretar inúmeras alterações em toda a estrutura e dinâmica familiar. Com a progressão e o agravamento da doença, quando a pessoa se encontra sem possibilidade de tratamento modificador da doença, aumenta o sofrimento tanto da pessoa adoecida quanto de sua família. O cuidador familiar de pessoas idosas em cuidados paliativos sofre junto ao enfermo, podendo enfrentar sobrecarga física, emocional e social decorrente da tarefa de cuidar e da possibilidade da morte. Entretanto, são escassos os estudos que avaliam a sobrecarga desta população. O objetivo deste estudo é identificar e analisar a percepção de sobrecarga por parte do cuidador familiar de idosos em cuidados paliativos. Trata-se de uma pesquisa do tipo transversal, exploratório, de metodologia quantitativa, não probabilística, com uma casuística total composta por 100 pessoas. Essa casuística foi estratificada de acordo com escore obtido por meio da aplicação do protocolo Karnofsky Performance Scale (KPS) com os idosos (com 60 anos ou acima) em cuidados paliativos oncológicos: um grupo com 25 cuidadores familiares de idosos com KPS abaixo de 40%; um grupo com 25 cuidadores de idosos em cuidados paliativos oncológicos com KPS de 70%, 60% ou 50%; um grupo controle com 50 cuidadores familiares de idosos em cuidados paliativos oncológicos, com KPS maior ou igual a 80%. Durante a coleta de dados, além do KPS, foram aplicados o questionário de caracterização clínica e sociodemográfica e os protocolos: Questionário de Classificação Socioeconômica Brasil e o Caregiver Burden Scale (CBScale), validado no Brasil. Para análise dos dados, foi realizada estatística descritiva e as comparações com os grupos foram feitas por meio do Teste Exato de Fisher e de um modelo de regressão quantílica. As análises foram feitas pelo software SAS 9.0 e Stata versão 13. Os resultados indicaram que os cuidadores familiares são, em sua maioria, mulheres, filhas ou esposas, de meia idade a idade mais avançada, predominantemente, na faixa etária de 56 a 71 anos, com baixa escolaridade, pertencentes a classes sociais C e que não realizam nenhuma atividade remunerada. Os maiores índices de sobrecarga foram percebidos em cuidadores do sexo feminino e em cuidadores de idosos os quais apresentam menores escores relativos à capacidade funcional (avaliados pelo KPS). Conclui-se que o agravamento da doença, o declínio funcional do idoso e a possibilidade da sua morte mais próxima fazem aumentar a sobrecarga dos cuidadores, com impactos na sua saúde e qualidade de vida, o que indica a necessidade de oferecimento de serviços de apoio a essa população o mais precocemente possível / The illness of a family member often brings on numerous changes throughout the structure and family dynamics. With the progression and worsening of the disease, when the person has no possibility of modifying the disease treatment, the suffering of the ill person and the family increases. The family caregivers of the elderly in palliative care suffer with the ill person and may face physical, emotional and social burden from the task of caring for and the possibility of death. However, there are only few studies assessing the burden of this population. The aim of this study is to identify and analyze the perception of burden on the part of caregivers of seniors in palliative care. It is a cross-sectional survey, exploratory, quantitative methodology, non-probabilistic, with the full sample composed of 100 people. This sample was stratified according to the score obtained by applying the Karnofsky Performance Scale (KPS) to the elderly (aged 60 and above) in oncology palliative care: a group of 25 family caregivers of elderly patients with KPS below 40%; a group of 25 caregivers of elderly in oncology palliative care with KPS of 70%, 60% or 50%; a control group of 50 family caregivers of elderly in oncology palliative care, with KPS greater than or equal to 80%. During data collection, in addition to KPS, it was applied a questionnaire clinical and sociodemographic and protocols: Brazil Economic Classification Criteria and the Caregiver Burden Scale (CBScale), validated in Brazil. For data analysis, it was performed descriptive statistics and comparisons with groups; they were made by Fisher\'s exact test and a Regression Quantiles Model. The analyses were performed using the software SAS 9.0 and Stata version 13. The results indicated that family caregivers are mostly women, daughters or wives, from middle- aged to older ages predominantly in the age group of 56-71, poorly educated, and belonging to social classes C and they do not perform any remunerated activity. The largest burden rates were seen in female caregivers and caregivers of seniors who have lower scores related to functional capacity (assessed by KPS). In conclusion, the aggravation of the disease, the functional decline of the elderly and the possibility of death increase the burden on caregivers, with impacts on their health and quality of life, which indicates the need of offering support services to this population as soon as possible

Background: Together with bone mass, muscularity and adiposity constitute the three major components of body composition. The latter two, independent of bone mass, influence largely the morbidity and mortality in old age. / The adverse effect of adiposity on morbidity and mortality in mid-life is well established but it remains intriguing in late-life. Whether adiposity is deleterious or is paradoxically protective for survival in older adults remains elusive. Body mass index (BMI) in mid-life has been used as a conventional measurement of adiposity and has been categorized to predict cardiovascular risk and mortality. Therefore the majority of the data was collected from early and mid-life adults. However, the predictive validity of these reference values in older adults is uncertain. / The second component in body composition is muscularity. Both muscle strength and muscle mass can affect morbidity and perhaps mortality as well. Age-associated muscle loss or sarcopenia adversely affects physical function and therefore the daily activities and the quality of life in old age. Very few studies of muscle loss have been undertaken in Asian and Chinese population. In addition, data about the longitudinal change in muscle mass, muscle strength and muscle function is lacking in older Chinese. / Physical function depends not only on muscle mass and strength but also on cognitive function which executes the motor task. Impaired cognitive function can give rise to derailed motor task execution despite good muscle strength. Physical limitations in cognitive decline may be secondary to sarcopenia, dys-execution of motor task, or both. On the other side, motor impairment can occur early in the process of neuro-degeneration. Whether it is the early manifestation of dementia rather than its sequel remains uncertain. / Muscle mass and strength is positively associated with BMI. In the lower end of BMI, underweight together with muscle loss will certainly result in physical limitations. In the upper end of BMI, however, the interaction between muscularity and adiposity is more complicated. Sarcopenic obesity is prevalent in the western populations but much less is known in Asian and Chinese population, not to mention in old age. BMI, though is protective against sarcopenia, will affect physical function adversely at its upper end. This paradox needs reconciliation. Perhaps an optimal ratio between adiposity and muscularity, representing the amount of adiposity supported by one unit of muscle mass can non-paradoxically be related to physical limitations. / Contraction in vertical dimension or height loss is a common occurrence in late life. Age-associated stature decline has been attributed to both clinical and subclinical vertebral fractures secondary to established osteoporosis. However its significance may extend beyond bone loss. Senile kyphosis can affect postural stability in locomotion and may result in falls and fractures independently of bone mass. The health impact of contraction in vertical dimension has less often been examined. / While the contraction in vertical body dimension may have health impact and significance, the risk of excess in horizontal dimension, waist circumference and waist-hip ratio have been well accepted and widely applied in the conventional cardiovascular mortality risk assessment. Whether central adiposity exerts similar adverse effect in old age or older adults are more resistive to the hazard of central adiposity remains unanswered. / Against this background, I together with my colleagues have conducted a series of studies to examine how body composition, adiposity and muscularity, and how body dimension, contraction in vertical dimension (height loss) and excess in horizontal dimension (central adiposity), affect the mortality, physical limitation and cognitive decline in old age. / Hypothesis: I hypothesize that (1) Adiposity in older adults is protective for survival (2) Muscularity alone and in combination of adiposity is related to physical limitation and cognitive decline (3) Excess in horizontal dimension (central adiposity) is adaptive and can be beneficial for survival while contraction in vertical dimension (height loss) is degenerative and deleterious to health / Methods: In collaboration with my colleagues, I have conducted a territory-wide prospective health survey in older adults. Four thousand community-dwelling men and women aged 65 years or over were recruited between August 2001 and December 2003. The sample was stratified so that approximately 33% were in each of the age groups: 65-69, 70-74 and 75 and over. / Muscle and fat mass, and their distribution, together with bone mineral density were examined using dual-energy X-ray absorptiometry (DXA) by a Hologic QDR 2000 densitometer (Hologic, Waltham, WA). Body weight and body dimensions: stature, waist and hip circumferences were recorded. Their grip strength was measured by hand grip dynamometer (Jamar Hand dynamometer 5030 J1, Sammons Preston, INC, Bolingbrook, IL, USA). Participants were asked to stand up with folded arms from a chair 5 times and the time required was recorded. The time to walk 6 meters at normal pace and the step lengths were measured. / A questionnaire containing information regarding demographics, physical activity level (PASE score), physical limitation and medical diagnosis was administered by trained interviewers. / Cognitive function was assessed by trained interviewers using the cognitive score of the Chinese version of the Community Screening Instrument of Dementia (CSI-D) and the Mini-mental Status Examination (MMSE) score. / The body composition measurements, body dimension (stature and waist hip circumferences) measurements, physical performance tests and cognitive function were repeated prospectively in the second year and 4th year visits. Mortality status was ascertained annually through the Hong Kong Special Administrative Region Death Registry. / Results: Adiposity -- We have observed a beneficial effect of adiposity for survival in older men. The crude mortality hazard ratio decreased consistently by 0.85 (p<0.005) and 0.86 (p<0.005) per every quintile increase in body mass index (BMI), and body fat index (BFI) respectively. The best survived men fell into a BMI range of 25, which is defined as overweight in the Asia-Pacific classification of BMI. Furthermore, the highest two quintiles of whole body fat percentage were associated with significantly lower all-cause mortality. Therefore older men were resistive to the hazard of being overweight and may benefit from being overweight and slightly obese. / Muscularity -- The mean relative appendicular skeletal mass (ASM/height square) was 7.19 and 6.05 kg/m2 in men and women respectively. / The relationship between muscle mass, muscle function and cognitive function is more complex and perhaps is bidirectional. In both older men and women, the cognitively impaired (CSI-D cognitive score ≦28.40) group had weaker grip strength (-5.10 kg, p =0.000 in men; -1.08 kg in women, p =0.000) and performed worse in the two physical function tests (in men, 6-meter walk speed, -0.13 m/s, p =0.000, chair stand test, 1.42 seconds, p =0.000; in women, 6-meter walk speed, -0.08 m/s, p = 0.000, chair stand test, 1.48 seconds, p =0.000) After adjustment for age, ASM, PASE and other co-morbidities, significant differences in grip strength (-2.60 kg, p =0.000 in men; -0.49 kg, p = 0.011 in women) and the two physical function tests persisted between the cognitively impaired and non-impaired group (in men, 6-meter walk speed, -0.072m/s, p = 0.001, chair stand test, 0.80 seconds, p = 0.045; in women, 6-meter walk speed, -0.049 m/s, p =0.000, chair stand test, 0.98 seconds, p =0.000). Therefore muscle loss though coexisting with cognitive decline, cannot fully account for the poorer physical function and weaker muscle strength observed in the cognitively impaired older adults. / In a reverse direction, I have also examined if loss in muscle mass and strength can precede cognitive decline. In men, being underweight, having a lower ASM, a weaker grip strength, a slower chair-stand test, a shorter step length and a slower timed walk were significantly associated with a lower MMSE score 4 years afterwards. In women, all except underweight and a lower ASM were significantly associated with MMSE score 4 years later. Therefore being underweight, having weaker grip strength, a slower chair-stand test, a shorter step-length in men and weaker grip strength in women, was associated with faster cognitive decline over a four year period. Weak grip strength is a predictor of faster cognitive decline in both genders. / Adiposity and Muscularity in combination -- Having analyzed adiposity and muscularity individually, I have combined the two and examined whether the adiposity to muscle ratio, as conceptualized as the weight of fat supported by one unit of muscle, can predict incident or worsening physical limitation. In men having BMI >23, all 3 adiposity to muscle ratios were predictive of physical limitation. (all p values <0.001) In women, throughout the entire BMI range, all 3 adiposity to muscle ratios were associated with physical limitation 4 years later both before and after adjustment. (all p values <0.05) Therefore sarcopenia and sarcopenic obesity as measured by either the body weight or fat mass bearing on a unit of muscle mass (the adiposity to muscle ratio), is a valid predictor of incident or worsening physical limitation in older women throughout the entire BMI range and in older men having BMI > 23. / Loss in vertical dimension (Height loss) -- I have conducted a prospective analysis about height loss in older adults across a period of four years. Twenty five (1.6%) men and 64 (4.0%) women lost >2 cm after 4 years. Rapid height loss (>2 cm after 4 years) was associated with excess all fractures and hip fractures (adjusted HR for all fractures = 2.86, p<0.001; adjusted HR for hip fractures = 4.74, p<0.01) in women but only hip fractures (adjusted HR = 4.93, p<0.05) in men. The all-cause (adjusted HR = 3.43, p<0.01) and respiratory disease mortality (adjusted HR = 5.64, p<0.05) were higher in men with rapid height loss while those in women were insignificant. Therefore modest height loss occurring in old age, >2 cm in 4 years, was associated with excess hip fracture, total and respiratory disease mortality in older men. In women, it was associated with excess BMD decline, all fractures and hip fractures but not mortality. Contraction in vertical dimension in late-life is hazardous to health. / Excess in horizontal dimension (Central adiposity) -- In answering whether central adiposity is hazardous or protective, we have examined the effect of the excess in horizontal dimension (central adiposity) by three measurements, namely waist-hip ratio (WHR), relative truncal fat (RTF), and relative abdominal fat (RAF). In men, the lowest mortality belonged to the quintile having WHR (0.92 – 0.94) and the second highest RTF quintile (mean WHR 0.94). In addition, the upper four quintiles of RAF (abdominal fat according to anatomical landmark in DXA / whole body fat) were associated with significantly lower all-cause mortality, and the adjusted hazard ratio (95% CI) in ascending quintiles of RAF compared with the lowest quintile was 0.62 (0.43–0.89), 0.58 (0.4– 0.85), 0.52 (0.36–0.77), and 0.67 (0.47–0.96). Therefore, in older men, excess in horizontal dimension or accumulation of central adiposity in late life may be beneficial for survival. / Conclusion: Body composition, as represented by adiposity and muscularity, is a major determinant of health in old age. In contrast to conventional belief, adiposity and being overweight may be beneficial for survival in late life. This may bear significant implication on the recommended cutoff values for BMI in the older population. Muscle loss can result in physical limitation and is related to cognitive impairment. In a reverse manner, loss in muscle mass and muscle strength can precede cognitive decline. When taking muscularity and adiposity together, the right balance between the two, or the adiposity to muscle ratio, is a predictor of physical limitation. When considering the two body dimensions, the vertical and the horizontal, loss in vertical dimension (height loss) in late life is hazardous for health while the excess in horizontal dimension (central adiposity) may be protective. Therefore the loss in vertical dimension is degenerative, and the excess in adiposity, both in general and in horizontal dimension, on the contrary, may be an ageing adaption to retain energy reserve for survival benefit rather than a degenerative process. / Au Yeung, Tung Wai. / Thesis M.D. Chinese University of Hong Kong 2015. / Includes bibliographical references (leaves 145-163). / Title from PDF title page (viewed on 14, September, 2016).

The purpose of this study was to contribute to the paucity of literature present on educational psychology involvement in supporting primary school-aged children’s sleep. The research was formed using a pragmatic, mixed-methods approach with a two-phase design. Phase one explored the views of 59 participants (teachers, n= 16; parents/carers, n= 21; children, n= 22) about children’s sleep, their academic outcomes and psychosocial functioning. There were some associations between parent, child, and teacher reports of children’s sleep-related difficulties, academic outcomes and aspects of children’s psychosocial functioning. Phase two adopted a time-series pre- and post-intervention design with the aim of evaluating a school-based, six-week Sleep Club intervention for children. Twenty-nine participants (teaching assistants, n= 2; parents/carers, n= 13; and children, n= 14) took part in phase two, with the findings drawing on evaluations, quizzes, field notes, surveys, and parent interviews. Six children were selected to provide greater insight into parent and child views through case study analysis. At the end of the intervention, there was an increase in children’s sleep-related knowledge, and there were improvements in many aspects of children’s sleep-related behaviours. Thematic analysis identified that the Sleep Club facilitated communication about sleep between children and their parents and raised children’s awareness and understanding of their sleep. Children enjoyed being part of a club with other children, from whom they felt they were able to learn. Learning about emotions, sleep and the body was noted by several children, though some children did not enjoy completing the given questionnaires. Overall, participants felt that the individual sessions and the intervention could have lasted longer than the time offered. Twenty-two participants (76%, including parents, children, and school staff) reported that they would recommend the Sleep Club intervention to others. The role of the educational psychologist in supporting children with sleep difficulties is discussed.

O objetivo geral desse trabalho foi o de analisar os fatores intrínsecos associados ao risco de quedas entre os idosos residentes no Município de São Paulo no ano de 2000. Para alcançar tal objetivo foram utilizados os dados referentes à população idosa do Estudo SABE (Saúde, Bem-Estar e Envelhecimento) Brasil, obtidos junto aos idosos residentes na zona urbana do Município de São Paulo, no ano de 2000. Utilizou-se a análise multivariada, o que permitiu uma abordagem analítica dos dados, considerando-se o comportamento per si e na presença das demais variáveis estudadas. Os cruzamentos dessas variáveis com a queda foram realizados separadamente, por sexo e idade, utilizando-se a ponderação amostral e o teste de associação de Rao Scott. Para identificar o risco de morte para as variáveis idade, sexo e queda, foram utilizadas a análise de sobrevida e as curvas de sobrevida de Kaplan Meier. Com essa pesquisa, concluiu-se que quanto mais longeva for a pessoa, maior o número de fatores intrínsecos relacionados à ocorrência de quedas. Por isso, a importância de novos estudos envolvendo os fatores intrínsecos para futuras prevenções de quedas nos idosos. Além disso, foi possível verificar, com as curvas de sobrevida de Kaplan Méier, o risco elevado de morte nos idosos que sofreram queda ou com idade avançada, principalmente para o sexo feminino. / The objective of this study was to analyze the intrinsic factors associated with risk of falls among the elderly living in São Paulo in 2000. For this purpose we used the data on the elderly population in the study SABE ( Health, Welfare and Ageing)- Brazil obtained the elderly living in the urban area of São Paulo in 2000. We used multivariate analysis, which allowed for an analytical data, considering the behavior itself and in the presence of others. The intersections of these variables with the fall were performed separately by sex and age using the weighted sample and the test of association Rao-Scott. To identify the risk of death for the variables age, sex and fall-was used survival analysis and survival curves of Kaplan Meier. With this research it was found that the more a person is long-lived, the greater the number of intrinsic factors related to falls. Hence the importance of new studies involving the intrinsic factors for future preventions of falls in the elderly. Moreover, it was possible to verify, with the survival curves of Kaplan Meier, the increased risk of death in elderly people suffered falls or with advanced age, especially for females.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2017-07-12T19:12:26Z No. of bitstreams: 1 Willian de Andrade Pereira de Brito.pdf: 1808753 bytes, checksum: 40a3ab8c6a799a0fc265bcbfff482d36 (MD5) / Made available in DSpace on 2017-07-12T19:12:26Z (GMT). No. of bitstreams: 1 Willian de Andrade Pereira de Brito.pdf: 1808753 bytes, checksum: 40a3ab8c6a799a0fc265bcbfff482d36 (MD5) Previous issue date: 2016 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Trata-se de um estudo de caso único que aborda a hipodermóclise no cuidado e autonomia do idoso cujo objetivo geral foi elaborar um protocolo de hipodermóclise para a pessoa idosa e como objetivos específicos: caracterizar a produção científica sobre a hipodermóclise, identificar as vantagens e desvantagens da hipodermóclise e avaliar o conteúdo do protocolo de hipodermóclise por um painel de experts em enfermagem gerontológica. O estudo foi realizado, no período de junho de 2015 a novembro de 2016, nas seguintes etapas: na primeira etapa foi realizada Revisão integrativa da literatura para identificação das evidências científicas acerca da hipodermóclise na base de dados PUBMED e BVS, com os descritores hipodermóclise; enfermagem; saúde, obtendo-se 30 artigos. A segunda etapa caracterizou-se pela elaboração do protocolo, com base nas evidências identificadas da revisão integrativa. A terceira etapa configurou-se pela avaliação do protocolo por um painel de experts em enfermagem gerontológica, composta por seis profissionais selecionados segundo critérios de formação e atuação profissional desses enfermeiros. A partir da análise temática dos estudos da revisão integrativa foram elaboradas quatro categorias: Terapia subcutânea, uma via alternativa para o cuidado em saúde; Hipodermóclise: técnica, utilização e aplicabilidade; Hipodermóclise: tecnologias em saúde e a equipe de enfermagem; Hipodermóclise e o idoso. Dentre as evidências identificadas destacam-se as características da via subcutânea na infusão de medicamentos, sendo a hipodermóclise uma alternativa terapêutica, principalmente quando comparada à administração de medicamentos por via intravenosa; as etapas de realização da técnica e as especificidades relacionadas à hipodermóclise, assim como os cuidados desenvolvidos antes, durante e após o procedimento. Quanto à correlação da terapia subcutânea com os profissionais, constatou-se a necessidade de conhecimento e manejo de tecnologias na saúde. Os fatores que contribuem para o desconhecimento da técnica estão relacionados a não abordagem da temática nas universidades e a falta de aproximação dessas discussões com os profissionais e instituições de saúde. Quanto ao uso da hipodermóclise no idoso, esta ocorre, principalmente, no processo de gerenciamento da desidratação leve/ moderada. Tais evidências subsidiaram a elaboração de um protocolo de enfermagem voltado para o manejo desse quadro em idosos, justamente por demonstrar que apesar da possibilidade de utilização da via subcutânea para administração de medicamentos, essa técnica tem grande utilidade para a reposição hidroeletrolítica em idosos. Após a construção do protocolo, o mesmo foi avaliado por um painel de experts quanto a sua estrutura e composição das recomendações sendo indicado: inclusão de figuras para ilustrar as regiões de aplicação da hipodermóclise e da angulação para inserção do dispositivo. Após essas modificações, originou-se a versão final do protocolo. Assim, o estudo favoreceu uma discussão ampla sobre a relação da hipodermóclise com a prática clínica e sua aplicabilidade na atenção à saúde do idoso considerando as vantagens do seu uso para o idoso e para os profissionais nos serviços de saúde. Portanto, conclui-se que a hipodermóclise representa uma técnica importante para a enfermagem no cuidado ao idoso, não somente pela sua efetividade clínica no manejo da desidratação, mas porque pode possibilitar maior conforto e preservação da autonomia desses indivíduos na manutenção das suas atividades diárias favorecendo a reabilitação desses indivíduos e melhoria da qualidade de vida / This is a unique case study that addresses the hypodermoclysis in the care and autonomy of the elderly whose general objective was to elaborate a hypodermoclysis protocol for the elderly and as specific objectives: to characterize the scientific production on hypodermoclysis, to identify the advantages and disadvantages Of the hypodermoclysis and to evaluate the content of the hypodermoclysis protocol by a panel of experts in gerontological nursing. The study was carried out, from June 2015 to November 2016, in the following stages: in the first stage was carried out an integrative review of the literature to identify the scientific evidence about the hypodermoclysis in the database PUBMED and VHL, with the descriptors hypodermoclysis; nursing; Health, obtaining 30 articles. The second stage was characterized by the elaboration of the protocol, based on the evidences identified from the integrative review. The third stage consisted of the evaluation of the protocol by a panel of experts in gerontological nursing, composed of six professionals selected according to the training and professional performance criteria of these nurses. From the thematic analysis of the integrative review studies, four categories were elaborated: Subcutaneous therapy, an alternative pathway for health care; Hypodermoclysis: technique, use and applicability; Hypodermoclysis: health technologies and the nursing team; Hypodermoclysis and the elderly. Among the identified evidences the characteristics of the subcutaneous route in the infusion of medicaments stand out, being hypodermoclysis a therapeutic alternative, mainly when compared to the intravenous drug administration; The stages of the technique and the specificities related to hypodermoclysis, as well as the care developed before, during and after the procedure. As for the correlation of subcutaneous therapy with professionals, it was verified the need for knowledge and management of health technologies. The factors that contribute to the lack of knowledge of the technique are related to the lack of approach to the theme in universities and the lack of approximation of these discussions with professionals and health institutions. Regarding the use of hypodermoclysis in the elderly, this occurs mainly in the process of management of mild / moderate dehydration. These evidences supported the elaboration of a nursing protocol aimed at the management of this condition in the elderly, precisely for demonstrating that despite the possibility of using the subcutaneous route for administration of medications, this technique has great utility for the hydroelectrolytic replacement in the elderly. After the construction of the protocol, it was evaluated by a panel of experts regarding its structure and composition of the recommendations being indicated: inclusion of figures to illustrate the regions of application of hypodermoclysis and angulation for insertion of the device. After these modifications, the final version of the protocol originated. Thus, the study favored a broad discussion about the relationship between hypodermoclysis and clinical practice and its applicability in the health care of the elderly considering the advantages of its use for the elderly and for professionals in health services. Therefore, it is concluded that hypodermoclysis represents an important technique for nursing care in the elderly, not only for its clinical effectiveness in the management of dehydration, but also because it can provide greater comfort and preservation of the autonomy of these individuals in the maintenance of their daily activities favoring Rehabilitation of these individuals and improvement of quality of life

Os objetivos deste estudo foram: caracterizar os idosos internados na Clínica Médica de um Hospital Geral Terciário, do interior paulista, segundo: variáveis sociodemográficas, estilo de vida, condições de saúde, acesso aos serviços de saúde e rede de apoio familiar e social; identificar a capacidade cognitiva, a capacidade funcional e a presença de sintomas de depressão desses idosos; verificar a existência de associação entre a variável queda com as variáveis faixa etária, sexo, déficit cognitivo, uso de óculos, hábito de beber e presença de sintomas de depressão; e verificar a existência de associação entre a variável déficit cognitivo com as variáveis faixa etária, sexo e estado conjugal. Trata-se de um estudo não experimental, descritivo e transversal. Realizado com idosos, internados na Clínica Médica, do referido hospital, no período de abril a julho de 2011. Para a coleta de dados, utilizaram-se o Miniexame do Estado Mental (MEEM), uma readaptação do Older Americans Resources and Services (OARS) e a Escala de Depressão Geriátrica (EDG). Foram estudados 105 idosos, média de idade de 73,8 anos (s=8,9); 59,0% eram homens; 62,9% moravam com esposo(a) ou companheiro(a); 47,6% estudaram de um a quatro anos; 90,5% eram aposentados. Quanto ao estilo de vida, 80,0% não fumavam atualmente; 71,4% consumiam bebida alcoólica; 66,7% não praticavam atividade física. Com relação à saúde, 72,4% a autoavaliaram como \"Boa\"; 56,2% tinham diagnóstico de hipertensão arterial e 22,9 de fibrilação atrial; para 78,1% todos os medicamentos eram receitados pelo médico; 91,4% avaliaram sua visão como \"Boa\"; 23,9% faziam uso dos óculos; 39,0% caíram nos últimos 12 meses; 23,8% caíram de três a quatro vezes. Quanto ao acesso aos serviços de saúde e à rede de apoio familiar e social, 96,2% utilizavam Hospital Público e estavam satisfeitos; para 45,7%, o esposo(a) ou companheiro(a) foi a primeira menção para cuidador na presença de incapacidades. Na avaliação cognitiva pelo MEEM, 34,3% apresentaram cognição comprometida. Quanto ao desempenho para as AVDs, no momento da admissão, 81,9% apresentavam algum grau de dificuldade nas ABVDs e 86,7% nas AIVDs; durante a hospitalização, 89,5% e, no momento da alta, 84,8% realizavam as atividades básicas com dificuldades. Os sintomas de depressão estiveram presentes em 54,3% dos idosos, média de 5,4 (s=2,5). Observou-se associação entre a presença de quedas e o uso de óculos (p<0,01) e entre a presença de déficit cognitivo e a faixa etária (p=0,04). A identificação do perfil e das necessidades dos idosos hospitalizados pode subsidiar o planejamento da assistência, com enfoque multiprofissional. / The objectives of this study were to characterize elderly individuals hospitalized in the medical clinic of a tertiary general hospital in the interior of São Paulo, Brazil according to the following socio-demographic variables: lifestyle, health conditions, access to health services and family and social support network; to identify cognitive and functional capacity and depression symptoms among these patients; to verify potential association between the variable \'fall\' with age, gender, cognitive deficit, use of glasses, alcohol consumption, and depression symptoms; and also to verify potential association between the variable \'cognitive deficit\' with age, gender and marital status. This non-experimental, descriptive and cross-sectional study addressed elderly individuals hospitalized in the medical clinic of the mentioned hospital from April to July 2011. The Mini-Mental State Examination (MMSE), a readaptation of Older Americans Resources and Services (OARS), and the Geriatric Depression Scale (GDS) were used to collect data. A total of 105 elderly individuals aged 73.8 years old in average (s=8.9) participated in the study; 59.0% were men; 62.9% lived with spouses or partners; 47.6% studied from one to four years; 90.5% were retired. In relation to lifestyle, 80.0% did not smoke at the time; 71.4% consumed alcohol; 66.7% did not exercise. In relation to their health condition, 72.4% reported it was \"good\"; 56.2% had hypertension, and 22.9 had atrial fibrillation; 78.1% had all medications prescribed by a physician; 91.4% reported their eyesight was \"good\"; 23.9% wore glasses; 39,0% fell in the last 12 months; 23.8% fell from three to four times. In regard to access to health services and family and social support network, 96.2% used public hospitals and were satisfied; 45.7% reported the spouse or partner would be the primary caregiver in case of disability. A total of 34.3% presented compromised cognition in the MMSE cognitive evaluation. In relation to the performance of ADLs at the time of admission, 81.9% presented some level of difficulty in BADLs and 86.7% in IADLs; 89.5% and 84.8% performed basic activities with difficulty during hospitalization and at time of discharge, respectively. Depression symptoms were observed in 54.3% of the elderly individuals, average of 5.4 (s=2.5). Association between falls and the use of glasses (p<0.01) and between cognitive deficit and age (p=0.04) was observed. The identification of the profile and needs of hospitalized elderly individuals can support planning of care with a multidisciplinary focus.

O trauma desponta como mais uma doença a que os idosos podem estar vulneráveis. Além disso, tendo em vista o aumento desta faixa etária, é possível que, em breve, a realidade do trauma nesta população também cresça. Dessa forma, é fundamental que os profissionais dos serviços de saúde conheçam as alterações que ocorrem com o processo de envelhecimento e as características específicas do trauma, com a finalidade de melhor assistir esta população. Assim, os objetivos deste estudo foram: identificar o perfil sociodemográfico de idosos, vítimas de trauma; caracterizar as doenças preexistentes e os medicamentos em uso; descrever as características do trauma e sua evolução; verificar a existência de associação entre variáveis sociodemográficas, doenças preexistentes, características e evolução do trauma; verificar a existência de correlação entre dias internados em CTI e ISS. Trata-se de um estudo não experimental, retrospectivo e exploratório. Realizado a partir da análise de dados de natureza secundária contidos em um banco de dados do Núcleo Hospitalar de Epidemiologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, referentes às notificações dos pacientes, vítimas de trauma, atendidos na Unidade de Emergência, deste hospital, no período de 2008 a 2010. Dessa forma, a coleta dos dados seguiu as informações contidas no referido banco, além da busca nos prontuários médicos para identificação de doenças preexistentes, do uso de medicamentos em domicílio e das complicações clínicas após o trauma. Foram estudados 131 idosos, vítimas de trauma, média de idade 69,9 anos (s=7,7); 73,3% eram homens; 55,1%, casados; 54,7%, aposentados; 65,6% possuíam doenças preexistentes, sendo 38,9% hipertensão arterial sistêmica e 19,8% etilismo, média de doenças 2,3 (s=1,4); 48,9% tomavam medicação em domicílio, média 3,2 medicamentos (s=2,3). Quanto às características do trauma, para 31,3%, o mecanismo de trauma foi queda e para 28,2%, pedestre; 83,2% por trauma contuso; 59,5% possuíam lesão em cabeça/pescoço, 45,8% em extremidades e ossos da pelve, média 1,8 (s=1,0); 44,3% obtiveram ISS entre 9 e 15 (trauma moderado) e 30,5% ISS de 25 ou mais (trauma muito grave); 80,2% apresentaram TRISS entre 51% ou mais (francas condições de se evitar o óbito). Com relação à evolução do trauma, 30,5% internaram em CTI, média de 4,2 dias; 62,6% desenvolveram complicações clínicas, sendo 43,5% infecciosas e 30,5% cardiovasculares; 46,1% foram submetidos à cirurgia ortopédica; 66,4% sobreviveram ao trauma, 47,3% receberam alta hospitalar com limitações moderadas e 33,6% faleceram, sendo 36,4% por traumatismo cranioencefálico e 22,7% por sepse. Houve associação entre mecanismo do trauma e doença preexistente (p=0,01) e associação entre mecanismo do trauma e sexo (p=0,03); a presença de doenças aumentou em 3,10 a chance para desenvolver complicações em relação aos que não apresentavam doenças (p=0,02); para os internados em CTI, a chance de ter complicações aumenta em 28,2 (p<0,01); conforme aumenta o índice de gravidade do trauma, maiores são as chances de complicações, odds = 3,07 entre ISS 16 e 24 (grave) e odds = 6,50 com ISS 25+ (muito grave) em relação ao ISS 9 a 15 (moderado); para idosos com complicações, a chance de morte aumenta em 5,56, quando comparados com aqueles que não apresentaram (p<0,01); para idosos com TRISS <50% (sobrevida inesperada), a chance de óbito foi de 10,13 em relação àqueles com TRISS >=50% (morte evitável) (p<0,01); a correlação entre os dias de internação no CTI e os escores do ISS foi fraca e positiva (r=0,18), indicando que quanto maior o número de dias de internação no CTI maiores são os índices de gravidade do trauma (p=0,03). O conhecimento das características e da evolução do trauma pode possibilitar aos profissionais de saúde o planejamento de medidas preventivas, além de viabilizar melhor atendimento aos idosos na atenção intra-hospitalar e após a alta, com vistas a melhorar a qualidade de vida. / Trauma emerges as another condition to which elderly individuals are vulnerable. Considering the increase in this population, trauma events are also likely to increase among older individuals. Hence, it is essential that health care providers are aware of changes that may occur with the aging process and the specific characteristics of trauma aiming to better care for this population. This study identifies the sociodemographic profile of elderly trauma victims; characterizes pre-existent diseases and used medications; describes the characteristics of trauma and its progression; verifies potential correlation between days hospitalized in ICU and Injury Severity Score (ISS). This non-experimental, retrospective and exploratory study was based on secondary data collected from a database of the Hospital Epidemiology Center at the Hospital das Clinicas, Medical School, University of São Paulo at Ribeirão Preto concerning reports of elderly trauma victims cared for in the hospital\'s emergency department from 2008 to 2010. Data collection was based on information contained in the database and search on medical charts to identify pre-existent diseases, medication used at home, and clinical complications after the trauma. A total of 131 elderly trauma victims participated in the study: 69.9 years old in average (sd=7.7); 73.3% men; 55.1% married; 54.7% retired; 65.6% with pre-existent diseases: 38.9% systemic arterial hypertension, and 19.8% alcoholism; average of diseases 2.3 (sd=1.4); 48.9% took medication at home, average of 3.2 medications (sd=2.3). In relation to the characteristics of trauma: 31.3% was caused by falls and 28.2% pedestrian; 83.2% was contusion trauma; 59.5% had head and neck injury; 45.8% had limbs and pelvic bones affected, average 1.8 (sd=1.0); 44.3% obtained ISS between 9 and 15 (moderate trauma) and 30.5% ISS was 25 or above (very severe trauma); 80.2% presented Trauma and Injury Severity Score (TRISS) between 51% or above (real conditions to avoid death). In relation to trauma progression, 30.5% was hospitalized in ICU, 4.2 days in average; 62.6% developed clinical complications: 43.5% infections and 30.5% cardiovascular; 46.1% was submitted to orthopedic surgery; 66.4% survived, 47.3% was discharged with moderate impairment and 33.6% died: 36.4% due to brain injury and 22.7% due to sepsis. An association between the mechanism of trauma and pre-existent diseases was found (p=0.01) as well as association between mechanism of trauma and gender (p=0.03). Pre-existent diseases increased 3.10 times the chance of complications comparing to those with no pre-existent diseases (p=0.02). The chances of complications increased 28.2 times for those hospitalized in ICU (p<0.01); the higher the index of trauma severity, the greater the chances of complications, odds = 3.07 between ISS 16 to 24 (severe) and odds = 6.50 with ISS 25+ (very severe) in relation to ISS 9 to 15 (moderate). The chances of dying increased 5.56 times for those with complications compared to those with no complications (p<0.01); chances of death was 10.13 times higher for individuals with TRISS <50% (unexpected survival) in relation to those with TRISS >=50% (evitable death) (p<0.01). Correlation between duration of hospitalization in ICU and ISS scores was weak and positive (r=0.18) indicating that the longer the hospitalization in ICU, the higher the trauma severity index (p=0.03). Knowledge concerning the trauma characteristics and progression can enable health care providers to plan preventive measures and provide better care to elderly individuals both at the hospital and after discharge aiming to improve their quality of life.