Ana Paula Fabrino Bretas Cupertino

Validity of the Center for Epidemiological Studies Depression Scale among Brazilian elderly

OBJECTIVE: To obtain internal construct and criteria validity for the Center of Epidemiological Studies - Depression scale in elderly people. METHODS: The instrument was applied to 903 elderly living in a city in southeastern Brazil, between 2002 and 2003. Results were compared with the Brazilian version of the CES-D applied to a sub-sample of 446 participants. Internal consistency of the two scales was assessed using Cronbachs alpha measured for the items in their total and for the items of each factor obtained for the assessed instrument. To assess the construct validity, the 20 items underwent exploratory factorial analysis to discover their variation pattern and the variance explained according to each factor. RESULTS: The scale presented satisfactory index for internal validity (a=0.860), sensibility (74.6%), specificity (73.6%), and for cutoff point >11. However, it presented a relatively high frequency of false positives compared to the GDS 33.8% vs. 15%. Exploratory factorial analysis of the instrument created factorial structure with three factors: negative affects, problems initiating behaviors, and positive affects. CONCLUSIONS: The instrument seemed to be psychometrically suitable when applied to older people. However, further cross-sectional and longitudinal studies, carried out in different contexts, may explain the effects of somatic and situational variables on the results of the instrument in older people.

Eventos estressantes, estratégias de enfrentamento, auto-eficácia e sintomas depressivos entre idosos residentes na comunidade

The relationship among stressful life events, coping strategies, self-efficacy in coping and depression in 544 participants of a study on successful aging involving elderly who reside in the community was assessed (74,6% women; age = 72.11; + 8.29; 42,1% age 60-69; 39% 70-79 and 18,9% 80-99). Stressful life events were classified into categories related to: finitude, problems concerning offspring, care, crisis and psychological well-being. Coping strategies generated five factors: negative emotions, environment control, religiosity, avoidance behaviors, and emotional inhibition. Self-efficacy of coping was evaluated between appropriate versus inappropriate. Mean score of depression assessed through CES-D was 10.24, + 8,66); prevalence was 32% to a cut-off score >11. Major risk for depression was associated with negative emotions, uncontrollable events, age 60-69 and inappropiate self-efficacy of coping. The stressful life events seemed less predictive of depression than the cognitive assessment and the coping did.The relationship among stressful life events, coping strategies, self-efficacy in coping and depression in 544 participants of a study on successful aging involving elderly who reside in the community was assessed (74,6% women; age = 72.11; + 8.29; 42,1% age 60-69; 39% 70-79 and 18,9% 80-99). Stressful life events were classified into categories related to: finitude, problems concerning offspring, care, crisis and psychological well-being. Coping strategies generated five factors: negative emotions, environment control, religiosity, avoidance behaviors, and emotional inhibition. Self-efficacy of coping was evaluated between appropriate versus inappropriate. Mean score of depression assessed through CES-D was 10.24, + 8,66); prevalence was 32% to a cut-off score >11. Major risk for depression was associated with negative emotions, uncontrollable events, age 60-69 and inappropiate self-efficacy of coping. The stressful life events seemed less predictive of depression than the cognitive assessment and the coping did.

Relações entre padrão do sono, saúde percebida e variáveis socioeconômicas em uma amostra de idosos residentes na comunidade: Estudo PENSA

Changes in sleep pattern constitute a common complaint among elders. Age-related changes can be observed in different levels of the architecture and quality of sleep. The objective of the present study was to observe the relation between age-related sleep changes, insomnia symptoms, apnea symptoms, parasomnia symptoms with socio-economic variables and perceived health status. Sleep pattern was evaluated using the Mini-Sleep Questionnaire. Results indicated that women and individuals with lower education reported higher frequency of insomnia symptoms, the elder-elder group. On the other hand, individuals with higher perceived health status presented lower frequency of apnea symptoms, and higher perceived health status was associated to better sleep pattern overall. It can be concluded that sleep pattern is associated to socio-economic variables such as age, gender, education and perceived health.

Design and baseline characteristics from the KAN-QUIT disease management intervention for rural smokers in primary care

OBJECTIVE To describe the design, implementation, baseline data, and feasibility of establishing a disease management program for smoking cessation in rural primary care. METHOD The study is a randomized clinical trial evaluating a disease management program for smoking cessation. The intervention combined pharmacotherapy, telephone counseling, and physician feedback, and repeated intervention over two years. The program began in 2004 and was implemented in 50 primary care clinics across the State of Kansas. RESULTS Of eligible patients, 73% were interested in study participation. 750 enrolled participants were predominantly Caucasian, female, employed, and averaged 47.2 years of age (SD=13.1). In addition to smoking, 427 (57%) had at least one additional major risk factor for cardiovascular disease (diabetes, hypertension, high cholesterol, heart disease or stroke). Participants smoked on average 23.7 (SD=10.4) cigarettes per day, were contemplating (61%) or preparing to quit (30%), were highly motivated and confident of their ability to quit smoking, and reported seeing their physicians multiple times in the past twelve months (Median=3.50; Mean=5.48; SD=6.58). CONCLUSION Initial findings demonstrate the willingness of patients to enroll in a two-year disease management program to address nicotine dependence, even among patients not ready to make a quit attempt. These findings support the feasibility of identifying and enrolling rural smokers within the primary care setting.

Variabilidade no envelhecimento ativo segundo gênero, idade e saúde

The present study investigated the relation among socio-demographic and health variables and participation in physical and occupational activities. The sample was formed by 155 aged individuals (60 and older) interviewed by the PENSA study in Juiz de Fora, MG. 72% of the sample was female with average age of 70.3 years (SD=8.2). Questionnaires based on self-report were used for data collection. Results indicated that men participated more frequently in physical activities than women, and women were more active in occupational activities, such as housework and work as volunteers. Higher frequency of participation in occupational activities was associated with higher education, higher income, and higher functional status. However, age was not a significant determinant of active lifestyle. This present study demonstrated a variability of active aging due to gender, socio-demographic and health variables, highlighting the implications of the lifestyle of elderly Brazilians in the process of healthy aging.

Eventos de vida estressantes entre idosos brasileiros residentes na comunidade

Stressful life events in Brazilian community-dwelling elderly. We examined stressful life events in 544 elderly participants of PENSA, in Minas Gerais (74.6% women and 25.4% men; age = 72.11; + 8.29; 42.1% aged 60-69; 39% 70-79 and 18.9%, 80-99). Stressful life events were classified into categories related to: death and illness, problems affecting children, caregiving, turning points (transitions), and psychological wellbeing. Men reported turning points (60-69), problems affecting their children (70-79), death and illness and psychological well-being (≥ 80); women reported turning points (transitions) (60-69), problems affecting their children (60-79), and own death and illness (≥ 80). Women evaluated events as more stressful than men did. There are similar results in the literature.

Medidas prospectivas de sintomas depressivos entre idosos residentes na comunidade

OBJETIVO: Identificar fatores sociodemograficos associados a padroes de incidencia, remissao e estabilidade de sintomas depressivos entre idosos residentes na comunidade. METODOS: Estudo prospectivo em que foram entrevistados 310 idosos residentes na comunidade, em Juiz de Fora, MG, entre 2002 e 2004. O seguimento (T2) foi realizado 15,7 meses apos a primeira entrevista (T1). Os sintomas de depressao foram avaliados pela escala do Center for Epidemiological Studies - Depression. Os idosos foram classificados segundo a evolucao dos sintomas de depressao e comparados quanto as variaveis sociodemograficas com o teste de qui-quadrado e Exato de Fisher. RESULTADOS: Nao houve diferencas na prevalencia de sintomas depressivos entre T1 e T2 (33,8%). Foram identificados quatro grupos segundo a evolucao dos sintomas da primeira para a segunda medida: livres de depressao (50,9%); recorrencia (19,7%); incidencia (15,2%); remissao (14,2%). Ter pontuado para depressao em T1, ser do sexo feminino e possuir baixa escolaridade representaram riscos para a manifestacao de sintomas depressivos em T2. CONCLUSOES: Piores trajetorias de evolucao em sintomatologia depressiva (incidencia e recorrencia) associaram-se ao genero feminino.OBJECTIVE To identify sociodemographic factors associated with patterns of incidence, remission and stability of depressive symptoms in community-dwelling elderly individuals. METHODS prospective study was conducted, where 310 community-dwelling elderly individuals of the city of Juiz de Fora, Southeastern Brazil, were interviewed between 2002 and 2004. Follow-up (T2) was performed 15.7 months after the first interview (T1). Depressive symptoms were evaluated with the Center for Epidemiological Studies Depression Scale. Elderly individuals were classified according to the progression of depressive symptoms and compared in terms of sociodemographic variables with Pearsons chi-square test and Fishers exact test. RESULTS There were no differences in the prevalence of depressive symptoms between T1 and T2 (33.8%). A total of four groups were identified, according to the progression of symptoms from the first to the second measure: without depressive symptoms (50.9%); recurrence (19.7%); incidence (15.2%); and remission (14.2%). Scoring for depression in T1, being female and having a low level of education represented risks of manifesting depressive symptoms in T2. CONCLUSIONS The worst progressions of depressive symptoms (incidence and recurrence) were associated with the female gender.

Triagem cognitiva: comparações entre o mini-mental e o teste de trilhas

This study investigated the performance of elderly people in the Mini-Mental State Examination cognitive screening test. By comparing the performance of ninety-two elderly subjects in the Mini-Mental test and the Trail Making test, the authors demonstrated that the Mini-Mental test is not appropriate for identifying precocious cognitive decline. The results of the analyses showed that those who passed the Trail Test had better performance than those who failed. At first, these results may suggest that both the Trail test and the Mini-Mental test are screening for cognitive decline. However, the analysis of the average number of correct answers in the test showed that around 90% of those who correctly completed the Trail Test B would pass the Mini-Mental test in clinical evaluations. These results held true even when a conservative cut-off point was adopted (those for literate subjects). Almost 90% of the subjects, who would be described as having a cognitive deficiency per Trail Test B did not show a decline when Mini-Mental cognitive screening was used. These results point to the importance of reviewing the screening procedures when prevention of cognitive decline is the aim. These results suggest that the Mini-Mental cognitive screening test detects decline when it has already begun but that it has little value when evaluating a sample of healthy subjects.

Empowering Promotores de Salud as Partners in Cancer Education and Research in Rural Southwest Kansas

PURPOSE/OBJECTIVES To describe community-based participatory processes used to develop promotore training on cancer research, and to assess the feasibility of training promotores from rural communities to disseminate cancer research information. DESIGN Prospective, cohort design. SETTING Rural communities in the state of Kansas. SAMPLE 34 Spanish-speaking promotores attended an information session; 27 enrolled and 22 completed training. METHODS With input from a community advisory board, the authors developed a leadership and cancer curriculum and trained Spanish-speaking promotores to disseminate information on cancer research. Promotores completed pretraining and post-training surveys in Spanish to assess demographic characteristics and changes in knowledge of cancer, cancer treatment and cancer research studies, and intent to participate in cancer research. MAIN RESEARCH VARIABLES Cancer knowledge, awareness of cancer clinical trials, interest in participating in cancer clinical research studies. FINDINGS Compared to pretraining, after training, promotores were more likely to correctly define cancer, identify biopsies, describe cancer stages, and report ever having heard of cancer research studies. CONCLUSIONS Completion rates of the training and willingness to participate in cancer research were high, supporting the feasibility of training promotores to deliver community-based education to promote cancer research participation. IMPLICATIONS FOR NURSING Nursing professionals and researchers can collaborate with promotores to disseminate cancer education and research among underserved rural Latino communities in Kansas and elsewhere. Members of these communities appear willing and interested in improving their knowledge of cancer and cancer clinical trials.

Depression Symptoms among Patients with Multiple Chronic Conditions

Aim: To identify depressive symptoms and biological psychosocial risk factors associated among patients with multiple chronic conditions (MCC). Methods: The study was conducted in a center for the treatment of hypertension, diabetes, and chronic kidney disease in Brazil. During three months a structured interview was conducted among patients waiting for routine visits. In the univariate analysis, descriptive statistics were performed to characterize the sample and in the bivariate analysis were used the chi-square. The risk of depression was calculated in a Prevalence Ratio with 95% confidence interval, as association measure. Variables with p<0.10 were selected for inclusion in the multivariate model, except in the case of self reported chronic disease and the elderly (60 years old or more). Results: The study population included 1.558 patients with MCC. The mean age of participants was 61.4 years (SD = 12.4), most were women (57.5%) and had low levels of education (87.3%). The most prevalent disease was hypertension (88.6%), over half of the sample (55.9%) had 2 chronic diseases, 12% were smokers, and 3.5% were heavy alcohol users. The prevalence of depressive symptoms was 33.3% and was associated with female gender, diabetes and tobacco use. Conclusion: There is a high prevalence of depressive symptoms in this population and it is associated with a number of health conditions and health behaviors, confirming the complex relationship between depressive symptoms and MCC. These data reinforce the need for screening, early diagnosis and management of depression among patients with MCC.