Alessandra Paiva de Castro

The relationship between foot pain, anthropometric variables and footwear among older people.

OBJECTIVE To verify the prevalence of pain among older people when wearing shoes, and the relationships between foot pain, high-heeled shoes and anthropometric variables. METHOD Both feet of 227 older women and 172 older men were evaluated with respect to anthropometric variables, arch index and foot posture index. The participants were also asked about the presence of foot pain while wearing high-heeled shoes. The data were analyzed using the Chi-square test, Pearsons correlation, MANOVA, multiple regression analysis, t test, and analysis of probability. FINDINGS The prevalence of foot pain when wearing shoes was high and was associated with the female gender, however wearing high-heeled shoes was not associated with pain. The women with foot pain presented larger values for the circumferences of the metatarsal heads and the instep (after normalization with the foot length) than those without pain. The men with pain did not present different measurements from those without pain.

Quedas em idosos institucionalizados: características gerais, fatores determinantes e relações com a força de preensão manual

OBJETIVO: Identificar a ocorrencia de quedas em idosos institucionalizados no Municipio de Sao Carlos (SP), descrever os fatores determinantes e verificar sua associacao com a forca de preensao manual. METODOS: Participaram do estudo 61 idosos institucionalizados (31 homens e 30 mulheres) que foram avaliados quanto a forca de preensao manual e entrevistados quanto a eventos de queda e possiveis fatores determinantes. RESULTADOS: Verificou-se que 54,1% haviam sofrido pelo menos uma queda no ano que antecedeu a entrevista e que a incapacidade de assistir televisao possui correlacao significativa com o indice de quedas (p=0,05), ao contrario das demais atividades funcionais estudadas (deambular, tomar banho e sentar sem auxilio), dor e doencas. Foram encontradas diferencas estatisticamente significantes entre as medias de idade dos idosos que ja haviam caido (76,76 anos, ±9,17) e dos que nao haviam caido (71,05 anos, ±8,67); e entre as medias de forca de preensao manual de idosos que ja haviam caido (19,37 kgf, ±8,92) e dos que nao haviam caido (25,45 kgf, ±12,14). A analise de variância nao mostrou diferenca no numero de quedas sofridas entre homens e mulheres. CONCLUSOES: Houve alta incidencia de quedas em idosos institucionalizados no municipio estudado, sendo que os idosos com menor forca de preensao manual, os mais velhos e os incapazes de assistir televisao se mostraram mais propensos a sofrer quedas.

The relationship between the body mass index (BMI) and foot posture in elderly people

We wanted to evaluate the postural characteristics of the feet of older people and their relationship with the BMI. We evaluated 227 older women and 172 older men with respect to the BMI, the arch index (AI) and the foot posture index (FPI). The obese women presented mean values for the AI significantly greater than those of the normal and overweight women. The means for some of the criteria of the FPI were significantly higher in the obese men. There was a positive correlation between the BMI and the AI and some of the FPI criteria. The conclusion was that obese women presented flatter feet while obese men presented more pronated feet, indicating a relationship between high BMI values and postural characteristics of the feet of subjects studied.

Efeito do programa de revitalização de adultos sobre a ocorrência de quedas dos participantes

Effect of the Adult Revitalization program on the occurrence of falls among its participants Objective: To assess the effect of the first year of an Adult Revitalization program on the number of occurrences of falls, and its relationship with the evolution of muscle strength, flexibility and dynamic balance. Method: 94 individuals (79 women and 15 men) who participated in an Adult Revitalization program in Sao Carlos, State of Sao Paulo, Brazil, for one year were evaluated regarding their hand grip strength, flexibility, dynamic balance and occurrences of falls on five occasions: an initial evaluation followed by four others at three-month intervals. Results: The women and the men experienced gains in flexibility and balance over the course of the program, but there was no significant reduction in the number of falls. Only women improved their muscle strength. The individuals who reported having fallen at least once during that year (28.72% of the participants) gained strength and flexibility, but their dynamic balance did not increase. In this group, the mean number of falls decreased between the first and the third evaluation, but increased between the third and the fourth evaluation, which coincided with the period of resting from physical activities. The individuals who did not fall presented gains in balance and flexibility but not in their hand grip strength. Conclusion: After one year, the number of falls among the participants in the Adult Revitalization program did not decrease significantly. Among the participants who fell at least once during the study period, the improvement in the number of falls occurred inversely to the improvement in handgrip strength and dynamic balance, but did not present any relationship with the improvement in flexibility.

The influence of arthritis on the anthropometric parameters of the feet of older women

Age-related and arthritis-related foot modifications have been described in literature, but there is a lack of references that allow shoes to be designed on the basis of specific anthropometric measurements of older women. The aim of this study was to identify the anthropometric characteristics of the feet of elderly women with and without arthritis. This is an observational transversal study. The right and left feet of 227 older women aged between 60 and 90 years (69.6 + or - 6.8 years) were evaluated, of whom 45 reported a diagnosis of arthritis (non-osteoarthritis). The anthropometric evaluation of the feet comprised the variables of width, perimeter, height, foot length, first and fifth metatarsophalangeal angles, the arch-index and the foot posture index (FPI). The data were analyzed using the analysis of probability to compare the groups (arthritic and non-arthritic women). The differences between the means were significant in the case of the FPI and some of its criteria, such as the calcaneal frontal plane position, the bulge in the region of the talo-navicular joint and the forefoot alignment. The width of the right foot was also significantly greater in the women with arthritis. These results are preliminary findings that may help direct larger studies of foot characteristics among older adults with arthritis.

A relação do ângulo da articulação metatarsofalangeana e de medidas antropométricas com a postura dos pés de idosos

OBJECTIVES: To investigate the relationship between the first metatarsophalangeal joint angle (Ang-I), the age, anthropometric measures and foot posture of older adults. METHODS: The sample was composed of 227 older women with a mean age of 69.6 (±6.8) years and 172 older men with a mean age of 69.4 (±6.7) years. The studied variables were: the width and circumference of the metatarsal heads, the height of the first metatarsal head and the dorsum of the foot, the length of the foot, the Ang-I and fifth metatarsophalangeal joint angles, the arch index and the foot posture index. The measurements were taken with analog instruments. The data were analyzed using Pearsons correlation. RESULTS: There was no association between Ang-I and age or arch index, but there were positive associations between Ang-I and the width and circumference of the metatarsal heads, the foot posture index and the fifth metatarsophalangeal angle. There was a negative association between Ang-I and the height of the dorsum of the foot. CONCLUSIONS: Relationships were found between greater Ang-I values and greater widths and circumferences of the forefeet, greater fifth metatarsophalangeal angles and greater pronation of the feet and smaller values for the height of the dorsum of the foot.

Força muscular de idosos com e sem depressão participantes de um programa de ginástica

OBJECTIVE: To assess the effect of an activity program on the hand grip strength of depressed and non-depressed elderly people. METHODS: We evaluated 85 older people (30 depressed women and 39 non-depressed women, and four depressed men and 12 non-depressed men) with a mean age of 65.59 (±8.26) years, who participated in an activity program developed for older people and lasting one year. In this period, four hand grip strength assessments were held: one at the beginning of the program, two during the program and one at the end. Data analysis was performed using Analysis of Variances, Tukeys test and t test. RESULTS: We did not find any significant differences among the four evaluations in terms of strength in the total group and in the subgroups. Moreover, there were no significant differences between the depressed women and the non-depressed women, or between the depressed men and the non-depressed men, in any one of the four evaluations. CONCLUSIONS: The activity program evaluated was incapable of increasing the hand grip strength of the depressed and non-depressed older people and it appears there is no association between such condition and strength.

Relação entre alterações climáticas e fatores determinantes da mortalidade de idosos no município de São Carlos (SP) em um período de dez anos

The aim of this study was to identify the correlation between the number of deaths of elderly people and climate change in the district of Sao Carlos (SP) over a period of 10 years (1997-2006). Records of deaths were obtained from DATASUS for people aged over 60 who died between 1997 and 2006 in Sao Carlos. The average monthly maximum and minimum temperature data and relative air humidity in Sao Carlos were provided by the National Institute of Meteorology. The mortality coefficient of the district was calculated by gender and age and the resulting data were analyzed using t test, one-way ANOVA, the Bonferroni test and the Pearson correlation coefficient test. There were 8,304 deaths which predominantly occurred among males aged over 80, and diseases of the circulatory system were the main cause of death. There was a positive correlation between mortality by infectious disease and minimum humidity, and a negative correlation between mortality by infectious diseases and minimum temperatures, between mortality caused by respiratory disease and minimum humidity, between mortality caused by endocrine disease and minimum and maximum temperature. Thereby, it was possible to conclude that there was a correlation between climate change and mortality among elderly individuals in Sao Carlos.

Diferenças regionais e custos dos procedimentos de fisioterapia no Sistema Único de Saúde do Brasil, 1995 a 2008

OBJETIVO: Descrever os atendimentos ambulatoriais fisioterapicos prestados pelo Sistema Unico de Saude (SUS) no Brasil quanto a sua distribuicao geografica, custos, tipos de procedimento e tipos de prestador. METODOS: Foram utilizados dados do Departamento de Informatica do SUS (DATASUS), referentes ao periodo de 1995 a 2008, que incluiam a quantidade e o valor dos procedimentos aprovados para pagamento pelas Secretarias de Saude e a quantidade e o valor dos procedimentos apresentados para pagamento. Os coeficientes de atendimento (CoA) foram calculados dividindo-se o numero de atendimentos no ano em uma regiao pela populacao estimada no mesmo ano e regiao. RESULTADOS: O CoA no Brasil em 2008 foi de 0,19 e as regioes Norte e Centro-Oeste apresentaram os menores coeficientes (0,13 e 0,10, respectivamente). Entre 1995 e 2007 houve um crescimento no coeficiente nacional de atendimentos de 33,7%, sendo que a regiao Norte apresentou o maior aumento, de 143,8%, a Centro-Oeste, de 62,1%, e a Nordeste, de 56,1%. O atendimento nas alteracoes motoras foi o procedimento mais realizado (61,8%) e os valores de pagamento aprovados foram menores que os apresentados pelos gestores dos servicos em 2008 (10,4%). Estabelecimentos privados com fins lucrativos prestaram 44,5% dos atendimentos fisioterapicos pagos pelo SUS em 2008. Os estabelecimentos municipais responderam por 26,6% dos atendimentos e os federais por apenas 0,9%. Entre 1995 e 2007, a quantidade de atendimentos oferecidos pelos estabelecimentos municipais cresceu 278,7%. CONCLUSOES: Observou-se que a oferta de atendimento fisioterapico ambulatorial pelo SUS ainda e pequena e geograficamente desigual, embora regioes menos desenvolvidas apresentem um maior crescimento no CoA. O SUS remunera inadequadamente os servicos prestados em fisioterapia e ainda o faz, em grande parte, por meio de convenios com estabelecimentos privados.