Andréa Cintra Lopes

Frailty criteria and cognitive performance are related: Data from the Fibra study in Ermelino Matarazzo, Sao Paulo, Brazil

ObjectivesTo assess the relationship between the CHS frailty criteria (Fried et al., 2001) and cognitive performance.DesignCross sectional and population-based. Setting: Ermelino Matarazzo, a poor sub district of the city of São Paulo, Brazil.Participants384 community dwelling older adults, 65 and older.MeasurementsAssessment of the CHS frailty criteria, the Brief Cognitive Screening Battery (memorization of 10 black and white pictures, verbal fluency animal category, and the Clock Drawing Test) and the Mini-Mental State Examination (MMSE).ResultsFrail older adults performed significantly lower than non-frail and pre frail elderly in most cognitive variables. Grip strength and age were associated to MMSE performance, age was associated to delayed memory recall, gait speed was associated to verbal fluency and CDT performance, and education was associated to CDT performance.ConclusionBeing frail may be associated with cognitive decline, thus, gerontological assessments and interventions should consider that these forms of vulnerability may occur simultaneously.

Mini-Mental State Examination performance in frail, pre-frail, and non-frail community dwelling older adults in Ermelino Matarazzo, São Paulo, Brazil.

BACKGROUND Frailty in older adults is a multifactorial syndrome defined by low metabolic reserve, less resistance to stressors, and difficulty in maintaining organic homeostasis due to cumulative decline of multiple physiological systems. The relationship between frailty and cognition remains unclear and studies about Mini-Mental State Examination (MMSE) performance and frailty are scarce. The objective was to examine the association between frailty and cognitive functioning as assessed by the MMSE and its subdomains. METHODS A cross-sectional population-based study (FIBRA) was carried out in Ermelino Matarazzo, a poor subdistrict of the city of São Paulo, Brazil. Participants were 384 community dwelling older adults, 65 years and older who completed the MMSE and a protocol to assess frailty criteria as described in the Cardiovascular Health Study (CHS). RESULTS Frail older adults had significantly worse performance on the MMSE (p < 0.001 for total score). Linear regression analyses showed that the MMSE total score was influenced by age (p < 0.001), education (p < 0.001), family income (p < 0.001), and frailty status (p < 0.036). Being frail was associated more significantly with worse scores in Time Orientation (p < 0.004) and Immediate Memory (p < 0.001). CONCLUSIONS Our data suggest that being frail is associated with worse cognitive performance, as assessed by the MMSE. It is recommended that the assessment of frail older adults should include the investigation of their cognitive status.

A avaliação de serviços em Audiologia: concepções e perspectivas

ABSTRACT The evaluation of services has played an important role in health planning and management, since an effective system may reorganize the accomplishment of actions and services to meet the needs of the target population and to optimize financial resources. Although there have been some international experiences in the assessment of hearing health services, their contribution is limited, due to the particularities of each country’s Hearing Health Attention Policies. In Brazil, integral assistance to the hearing impaired has been guaranteed by Portaria GM/MS number 2.073/04, with the purpose to organize a hierarchical and regionalized network, integrated in Primary-, Medium- and High-complexity Health Care Attention. The improvement of this Policy is a natural consequence, follo-wing its implantation, in order to constitute quality hearing health public services, not only upon its creation, but also and mainly in the constant maintenance and improvement of the process of assisting people with hearing impairment, assuring its effectiveness. Therefore, professional qualification and incentive of discussions regarding the evaluation of the quality of hearing health services provided by Brazil’s Unified Health System are indispensable.

Avaliação de serviços de saúde auditiva sob a perspectiva do usuário: proposta de instrumento

PURPOSE: To verify the applicability of a questionnaire for the assessment of hearing health services, under the perspective of the users. METHODS: The questionnaire was inspired on the study conducted by the Hearing and Communication Group, and presents 18 questions focused on the following dimensions: access to the service, hearing evaluation, personal attendance, family benefits, communication and information, and professional competence. Each question of this instrument was presented in a graduation scale of five points. The casuistic comprised 53 patients (or caregiver), that were invited, by the reception professionals, to answer to the questionnaire. Data were calculated in percentage, and the score for each domain and the total score were established. Inferential statistic tests were applied, adopting a significant level of 5%, in order to verify the influences of demographic characteristics on the total score. RESULTS: The score for the access domain was 62.25%, for hearing evaluation was 85.96%, for personal attendance was 82.05%, for family benefits was 68.57%, for the domain communication and information was 79.13%, for professional competence was 97.39%, and the total score was 70.65%. It was verified that patients with lower schooling levels, lesser time attending the service, and those that had already received the hearing aid obtained higher total scores on the questionnaire. CONCLUSION: The questionnaire used in the present study proved to be easily applicable in hearing health services; however, its application on national level is necessary, so that standardization and reliability and validity can be established.

Depressive symptoms in old age: relations among sociodemographic and self-reported health variables

BACKGROUND Depression in old age is a complex multifactorial phenomenon that is influenced by several biopsychosocial variables. Depressive symptoms are associated with the presence of chronic diseases, with being female, with low education and low income levels, and with poor perceived health assessment. In impoverished areas, older adults may have more physical disability, as they may have less access to health services. Therefore, they may be more likely to report depressive symptoms. METHODS Population-based cross-sectional research was undertaken using data from the FIBRA study conducted in Ermelino Matarazzo, a poor subdistrict of the city of São Paulo, Brazil. The participants comprised 303 elderly people, aged 65 years and over, who attended a single-session data collection effort carried out at community centers. The protocol comprised sociodemographic and self-reported health variables, and the Geriatric Depression Scale. RESULTS The majority of the subjects reported five or fewer symptoms of depression (79.21%), reported one or two self-reported chronic diseases (56.86%), declared themselves to have one or two self-reported health problems (46.15%), and had good perceived health assessment (40.27%). The presence of depressive symptoms was associated with a higher number of self-reported health problems, poor perceived health assessment, and lower schooling levels, in the total sample and in analyses including men only. For women, depressive symptoms were associated with the number of self-reported health problems and family income. CONCLUSION The presence of health problems, such as falls and memory problems, lower perceived health, and low education (and low family income for women) were associated with a higher presence of depressive symptoms among elderly people in this poor area of São Paulo.

The influence of speech stimuli contrast in cortical auditory evoked potentials

UNLABELLED Studies about cortical auditory evoked potentials using the speech stimuli in normal hearing individuals are important for understanding how the complexity of the stimulus influences the characteristics of the cortical potential generated. OBJECTIVE To characterize the cortical auditory evoked potential and the P3 auditory cognitive potential with the vocalic and consonantal contrast stimuli in normally hearing individuals. METHOD 31 individuals with no risk for hearing, neurologic and language alterations, in the age range between 7 and 30 years, participated in this study. The cortical auditory evoked potentials and the P3 auditory cognitive one were recorded in the Fz and Cz active channels using consonantal (/ba/-/da/) and vocalic (/i/-/a/) speech contrasts. DESIGN A crosssectional prospective cohort study. RESULTS We found a statistically significant difference between the speech contrast used and the latencies of the N2 (p = 0.00) and P3 (p = 0.00) components, as well as between the active channel considered (Fz/Cz) and the P3 latency and amplitude values. These correlations did not occur for the exogenous components N1 and P2. CONCLUSION The speech stimulus contrast, vocalic or consonantal, must be taken into account in the analysis of the cortical auditory evoked potential, N2 component, and auditory cognitive P3 potential.

Alterações auditivas em trabalhadores de indústrias madeireiras do interior de Rondônia

Occupational noise is considered a physical risk that is frequent in almost all industrial segments. That is why occupational safety and health professionals give it special attention. The present study investigated the presence of audiometric alterations in wood industry workers from the countryside of Rondonia, Brazil. Sixteen workers of three industries took part in the study. They were interviewed on their hearing capacities and went through audiologic examination by means of preliminary tonal audiometry and acustic impedance tests. All the participants were male, most of them under 25 years old. They reported not having finished elementary school. Half of the sample presented auditory complaints and mentioned use of hearing protectors. Audiometric tracings disclosed alterations in half of the sample.

Relations between memory complaints, depressive symptoms and cognitive performance among community dwelling elderly

Contexto A queixa de memoria e comum entre pessoas idosas, entretanto sua relevância clinica para o diagnostico de alteracoes cognitivas e questionavel, visto que diversos fatores podem se associar as queixas. Objetivo: O presente estudo avaliou a relacao entre queixas de memoria, sintomas depressivos e desempenho cognitivo em 301 idosos residentes em Ermelino Matarazzo que participaram da pesquisa de base populacional Perfis de Fragilidade em Idosos Brasileiros da Rede FIBRA. Objetivo O presente estudo avaliou a relacao entre queixas de memoria, sintomas depressivos e desempenho cognitivo em 301 idosos residentes em Ermelino Matarazzo que participaram da pesquisa de base populacional Perfis de Fragilidade em Idosos Brasileiros da Rede FIBRA. Metodos O desempenho cognitivo foi avaliado por meio dos testes de memorizacao de 10 figuras comuns, Miniexame do Estado Mental (MEEM), Fluencia Verbal (FV) e Teste do Desenho do Relogio, que compoem a Bateria Breve de Rastreio Cognitivo (BBRC). As queixas de memoria foram avaliadas pelo Questionario de Queixas de Memoria (MAC-Q) e os sintomas depressivos, pela Escala de Depressao Geriatrica (EDG). Resultados Participantes do sexo feminino apresentaram maior indice de queixas de memoria, comparado ao dos homens (p = 0,013). Idosos menos escolarizados apresentaram queixas de memoria mais intensas e pior desempenho cognitivo, comparados aos de maior escolaridade (p < 0,003). A presenca de sintomas depressivos associou-se a pior avaliacao da memoria (r = 0,39, p < 0,001). Conclusao: As queixas de memoria se associaram a sexo, escolaridade e sintomas depressivos, entre idosos residentes na comunidade. Nao houve associacao entre queixas e desempenho cognitivo. Conclusao As queixas de memoria se associaram a sexo, escolaridade e sintomas depressivos, entre idosos residentes na comunidade. Nao houve associacao entre queixas e desempenho cognitivo.

EMISSÕES OTOACÚSTICAS EVOCADAS TRANSIENTES EM RECÉM-NASCIDOS A TERMO E PRÉ-TERMO

PURPOSE: to analyze the absolute amplitude and response level of transient evoked otoacoustic emissions in preterm and full-term newborns. METHODS: 50 full-term and 50 preterm newborns took part in the study. They underwent newborn hearing screening, through research of transient evoked otoacoustic emissions, performed between 24 hours and 11 weeks of life. All newborns showed transient evoked otoacoustic emissions in the newborn hearing screening test. RESULTS: no statistically significant difference of amplitude and response level was found between the full-term and preterm newborns. There was no significant correlation among factors such as prematurity, age of newborn at test and time of hearing stimulation with the results obtained. CONCLUSION: transient evoked otoacoustic emissions recorded in full-term and preterm newborns showed similar absolute amplitude and Response level.

Prevalence of noise-induced hearing loss in drivers

Summary Introduction: Work-related hearing loss is one of the most common occupational illness progresses over the years of noise exposure associated with the work environment, may cause damage to undertake physical activity, the individuals physiological and mental besides causing hearing damage irreversible interfering with communication and quality of life. With high prevalence of male evaluates which is the second leading cause of hearing loss. Since there is no medical treatment for this type of hearing loss, it is evident the importance of preventive and conferences aimed at preserving hearing and health as a whole. Objective: To assess the prevalence of hearing loss in audiometry admission of drivers. Methods: Retrospective study. By 76 charts of professional drivers in leased transport companies. We analyzed data from specific interview and pure tone audiometry. Results: The prevalence of abnormal tests was 22.36% with the lowest thresholds for tritonal average of 3,000, 4,000 and 6,000 Hz. The higher the age, the higher thresholds. Conclusion: This study has highlighted the occurrence of hearing in the absence of complaints. Considering that PAIR is preventable, justifies the importance of coordinated and multidisciplinary involving not only health teams and safety, but also the institutions involved in preserving the health of workers, as the team SESMET, unions or prosecutors.