Angela Andréia França Gravena

Depressão em idosos inscritos no Programa de Controle de hipertensão arterial e diabetes mellitus

Objective: To identify the presence of depressive symptoms in elderly enrolled in a control program for hypertension and diabetes mellitus in a mu- nicipality of northwestern Parana. Methods: A descriptive, transversal study conducted in basic health units in Sarandi - PR (Brazil), with 100 elderly registered in the Programa Hiperdia (Hyperday program). A mental health section of the questionnaire, Brazil Old Age Schedule (BOAS), was used. The Mann-Whitney and Chi-Square tests were used to analyze the association between depressive symptoms and sociodemographic characteristics and nutritional status. Results: The majority of the elderly were female (82.0%). The prevalence of depressive symptoms was 30.0%, of which 20.0% were classified as major depression. The depressive symptoms were more frequent in those who were: women (31.7%); 80 years of age or older (33.3%); without education (39.1%); living alone (43.7%); underweight (33.3%) or obese (32.5%). Conclusion: The family health strategy teams need to be attentive to the presence of depressive symptoms in the elderly , especially in those who are already attending established support groups. Keywords: Aged; Depression; Hypertension; Diabetes mellitus; Mental health; Public health RESUMO Objetivo: Identificar a presenca de sintomas depressivos em idosos inscritos no Programa de controle de hipertensao arterial e diabetes mellitus em um municipio do Noroeste do Parana. Metodos: Estudo descritivo transversal, realizado nas unidades basicas de saude de Sarandi - PR, com 100 idosos cadastrados no Programa Hiperdia. A secao de saude mental do questionario Brazil Old Age Schedule (BOAS) foi usada. Os testes Mann-Whitney e Qui-quadrado foram empregados para analisar a associacao entre sintomas de depressao e caracteristicas sociodemograficas e estado nutricional. Resultados: A maioria dos idosos era do sexo feminino (82,0%). A prevalencia de sintomas depressivos foi de 30,0%, dos quais 20,0% classificados como depressao maior. Os sintomas depressivos foram mais frequentes nas mulheres (31,7%); em idosos com 80 anos e mais (33,3%); sem nenhuma escolaridade (39,1%), que moravam so (43,7%) e que apresentavam baixo peso (33,3%) ou obesidade (32,5%). Conclusao: As equipes da estrategia saude da familia devem estar atentas para a presenca de sintomas depressivos em idosos, sobretudo aqueles que pertencem aos grupos de convivencia ja instalados. Descritores: Idoso; Depressao; Hipertensao; Diabetes mellitus; Saude mental; Saude Publica RESUMEN Objetivo: Identificar la presencia de sintomas depresivos en ancianos inscritos en el Programa de control de hipertension arterial y diabetes mellitus en un municipio del Nor oeste de Parana. Metodos: Estudio descriptivo transversal, realizado en las unidades basicas de salud de Sarandi - PR, con 100 ancianos registrados en el Programa Hiperdia. Fue usada la seccion de salud mental del cuestionario Brazil Old Age Schedule (BOAS). Los tests Mann-Whitney y chi- cuadrado fueron empleados para analizar la asociacion entre sintomas de depresion y caracteristicas sociodemograficas y estado nutricional. Resultados: La mayoria de los ancianos era del sexo femenino (82,0%). La prevalencia de sintomas depresivos fue del 30,0%, de los cuales el 20,0% clasificados como depresion mayor. Los sintomas depresivos fueron mas frecuentes en las mujeres (31,7%); en ancianos con 80 anos y mas (33,3%); sin ninguna escolaridad (39,1%), que vivian solos (43,7%) y que presentaban bajo peso (33,3%) u obesidad (32,5%). Conclusion: Los equipos de la estrategia salud de la familia deben estar atentos a la presencia de sintomas depresivos en ancianos, sobre todo aquellos que pertenecen a los grupos de convivencia ya instalados. Descriptores: Ancianos; Depresion; Hipertension; Diabetes mellitus; Salud mental; Salud publicaOBJETIVO: Identificar a presenca de sintomas depressivos em idosos inscritos no Programa de controle de hipertensao arterial e diabetes mellitus em um municipio do Noroeste do Parana. METODOS: Estudo descritivo transversal, realizado nas unidades basicas de saude de Sarandi - PR, com 100 idosos cadastrados no Programa Hiperdia. A secao de saude mental do questionario Brazil Old Age Schedule (BOAS) foi usada. Os testes Mann-Whitney e Qui-quadrado foram empregados para analisar a associacao entre sintomas de depressao e caracteristicas sociodemograficas e estado nutricional. RESULTADOS: A maioria dos idosos era do sexo feminino (82,0%). A prevalencia de sintomas depressivos foi de 30,0%, dos quais 20,0% classificados como depressao maior. Os sintomas depressivos foram mais frequentes nas mulheres (31,7%); em idosos com 80 anos e mais (33,3%); sem nenhuma escolaridade (39,1%), que moravam so (43,7%) e que apresentavam baixo peso (33,3%) ou obesidade (32,5%). CONCLUSAO: As equipes da estrategia saude da familia devem estar atentas para a presenca de sintomas depressivos em idosos, sobretudo aqueles que pertencem aos grupos de convivencia ja instalados.

Risk factors for cervical HPV infection and genotypes distribution in HIV-infected South Brazilian women

BackgroundHuman Papillomavirus (HPV) infection is particularly burdensome for women infected with human immunodeficiency virus (HIV), which increases their risk of developing cervical lesions and cancer (CC). We conducted a molecular study of the distribution of cervical HPV genotypes and the risk factors for this infection in HIV-infected Brazilian women.FindingsCervical and endocervical samples for Papanicolaou screening and HPV detection were collected from 178 HIV-infected women using highly active antiretroviral therapy (HAART) of Maringá city/Brazil. Risk factors were assessed using a standardized questionnaire, and the data regarding to HIV infection from medical records. HPV was detected by polymerase chain reaction (PCR), and genotyping using PCR-restriction fragment length polymorphism analysis. HIV infection was well controlled, but women with a current CD4+ T lymphocyte count between 200–350 cells/mm3 (37.6%) had a two-fold greater risk of HPV infection than those with > 350 cells/mm3 (26.4%). HPV was associated with parity ≥3, hormonal contraceptive use and current smoker. HPV infection occurred with high frequency (46.6%) but a low frequency of cervical abnormalities was detected (7.30%), mainly low-grade squamous intraephitelial cervical lesions (LSIL) (84.6%). A high frequency of multiple HPV infections was detected (23.0%), and the most frequent HPV genotype was HPV-72 (6.7%), followed by −16, -31 and -51 (6.14% each).ConclusionsWe showed that HAART use does not protect HIV-infected women from HPV, but appear to exert some protection against cervical lesions development. This study provides other important information about risk factors and cervical HPV in HIV-infected women, which can contribute to planning protocols.

Idade materna e fatores associados a resultados perinatais

OBJECTIVE: To analyze and compare perinatal outcomes of pregnant adolescent women and pregnant women in later age (between 20 and 34 years old) from data of a Live Born Information System. METHODS: A cross-sectional study was carried out with data collected retrospectively of 18,009 live born infants from consults of data of a Live Born Information System. Registers of live born infants were distributed in three groups: group I (adolescents) - 10 to 19 years old; group II - 20 to 34 years old; and group III (later age) - 35 years or older. RESULTS: Findings showed that perinatal risks were related to prematurity (OR 1,35) and five-minute (OR 1,44) among infants born to adolescent mothers. CONCLUSION: Results pointed out high indexes of preterm birth in low-birth-weight infants and five-minute Apgar scores of less than seven in pregnancies that occurred in adolescents and in women 35 years and older.

Resultados perinatais em gestações tardias

The objective of the present study was to compare perinatal outcomes in women aged 35 or older with women aged 20 to 34 years. This retrospective study was performed by reviewing the obstetric records of 1255 mothers who gave birth at the only hospital in Sarandi-PR, from January 2007 to December 2008. The analyzed variables were: marital status, education, gestational age at birth, type of delivery, newborn birth weight, Apgar score at one and five minutes and stillbirths. Logistic regression showed that advanced maternal age was significantly associated with adverse outcomes such as cesareans (OR 1.23, 95% CI 0.19-0.44) and 5-minute Apgar scores below 7 (OR 5.78 95% CI 0.74-0.76). These results are important to show the risk of complications in pregnant women aged 35 years or older, and the need to provide guidance to women who wish to postpone pregnancy.The objective of the present study was to compare perinatal outcomes in women aged 35 or older with women aged 20 to 34 years. This retrospective study was performed by reviewing the obstetric records of 1255 mothers who gave birth at the only hospital in Sarandi-PR, from January 2007 to December 2008. The analyzed variables were: marital status, education, gestational age at birth, type of delivery, newborn birth weight, Apgar score at one and five minutes and stillbirths. Logistic regression showed that advanced maternal age was significantly associated with adverse outcomes such as cesareans (OR 1.23, 95% CI 0.19-0.44) and 5-minute Apgar scores below 7 (OR 5.78 95% CI 0.74-0.76). These results are important to show the risk of complications in pregnant women aged 35 years or older, and the need to provide guidance to women who wish to postpone pregnancy.

Outcomes in late-age pregnancies

The objective of the present study was to compare perinatal outcomes in women aged 35 or older with women aged 20 to 34 years. This retrospective study was performed by reviewing the obstetric records of 1255 mothers who gave birth at the only hospital in Sarandi-PR, from January 2007 to December 2008. The analyzed variables were: marital status, education, gestational age at birth, type of delivery, newborn birth weight, Apgar score at one and five minutes and stillbirths. Logistic regression showed that advanced maternal age was significantly associated with adverse outcomes such as cesareans (OR 1.23, 95% CI 0.19-0.44) and 5-minute Apgar scores below 7 (OR 5.78 95% CI 0.74-0.76). These results are important to show the risk of complications in pregnant women aged 35 years or older, and the need to provide guidance to women who wish to postpone pregnancy.The objective of the present study was to compare perinatal outcomes in women aged 35 or older with women aged 20 to 34 years. This retrospective study was performed by reviewing the obstetric records of 1255 mothers who gave birth at the only hospital in Sarandi-PR, from January 2007 to December 2008. The analyzed variables were: marital status, education, gestational age at birth, type of delivery, newborn birth weight, Apgar score at one and five minutes and stillbirths. Logistic regression showed that advanced maternal age was significantly associated with adverse outcomes such as cesareans (OR 1.23, 95% CI 0.19-0.44) and 5-minute Apgar scores below 7 (OR 5.78 95% CI 0.74-0.76). These results are important to show the risk of complications in pregnant women aged 35 years or older, and the need to provide guidance to women who wish to postpone pregnancy.

Depression in elderly enrolled in a control program for hypertension and diabetes mellitus

Objective: To identify the presence of depressive symptoms in elderly enrolled in a control program for hypertension and diabetes mellitus in a mu- nicipality of northwestern Parana. Methods: A descriptive, transversal study conducted in basic health units in Sarandi - PR (Brazil), with 100 elderly registered in the Programa Hiperdia (Hyperday program). A mental health section of the questionnaire, Brazil Old Age Schedule (BOAS), was used. The Mann-Whitney and Chi-Square tests were used to analyze the association between depressive symptoms and sociodemographic characteristics and nutritional status. Results: The majority of the elderly were female (82.0%). The prevalence of depressive symptoms was 30.0%, of which 20.0% were classified as major depression. The depressive symptoms were more frequent in those who were: women (31.7%); 80 years of age or older (33.3%); without education (39.1%); living alone (43.7%); underweight (33.3%) or obese (32.5%). Conclusion: The family health strategy teams need to be attentive to the presence of depressive symptoms in the elderly , especially in those who are already attending established support groups. Keywords: Aged; Depression; Hypertension; Diabetes mellitus; Mental health; Public health RESUMO Objetivo: Identificar a presenca de sintomas depressivos em idosos inscritos no Programa de controle de hipertensao arterial e diabetes mellitus em um municipio do Noroeste do Parana. Metodos: Estudo descritivo transversal, realizado nas unidades basicas de saude de Sarandi - PR, com 100 idosos cadastrados no Programa Hiperdia. A secao de saude mental do questionario Brazil Old Age Schedule (BOAS) foi usada. Os testes Mann-Whitney e Qui-quadrado foram empregados para analisar a associacao entre sintomas de depressao e caracteristicas sociodemograficas e estado nutricional. Resultados: A maioria dos idosos era do sexo feminino (82,0%). A prevalencia de sintomas depressivos foi de 30,0%, dos quais 20,0% classificados como depressao maior. Os sintomas depressivos foram mais frequentes nas mulheres (31,7%); em idosos com 80 anos e mais (33,3%); sem nenhuma escolaridade (39,1%), que moravam so (43,7%) e que apresentavam baixo peso (33,3%) ou obesidade (32,5%). Conclusao: As equipes da estrategia saude da familia devem estar atentas para a presenca de sintomas depressivos em idosos, sobretudo aqueles que pertencem aos grupos de convivencia ja instalados. Descritores: Idoso; Depressao; Hipertensao; Diabetes mellitus; Saude mental; Saude Publica RESUMEN Objetivo: Identificar la presencia de sintomas depresivos en ancianos inscritos en el Programa de control de hipertension arterial y diabetes mellitus en un municipio del Nor oeste de Parana. Metodos: Estudio descriptivo transversal, realizado en las unidades basicas de salud de Sarandi - PR, con 100 ancianos registrados en el Programa Hiperdia. Fue usada la seccion de salud mental del cuestionario Brazil Old Age Schedule (BOAS). Los tests Mann-Whitney y chi- cuadrado fueron empleados para analizar la asociacion entre sintomas de depresion y caracteristicas sociodemograficas y estado nutricional. Resultados: La mayoria de los ancianos era del sexo femenino (82,0%). La prevalencia de sintomas depresivos fue del 30,0%, de los cuales el 20,0% clasificados como depresion mayor. Los sintomas depresivos fueron mas frecuentes en las mujeres (31,7%); en ancianos con 80 anos y mas (33,3%); sin ninguna escolaridad (39,1%), que vivian solos (43,7%) y que presentaban bajo peso (33,3%) u obesidad (32,5%). Conclusion: Los equipos de la estrategia salud de la familia deben estar atentos a la presencia de sintomas depresivos en ancianos, sobre todo aquellos que pertenecen a los grupos de convivencia ya instalados. Descriptores: Ancianos; Depresion; Hipertension; Diabetes mellitus; Salud mental; Salud publicaOBJETIVO: Identificar a presenca de sintomas depressivos em idosos inscritos no Programa de controle de hipertensao arterial e diabetes mellitus em um municipio do Noroeste do Parana. METODOS: Estudo descritivo transversal, realizado nas unidades basicas de saude de Sarandi - PR, com 100 idosos cadastrados no Programa Hiperdia. A secao de saude mental do questionario Brazil Old Age Schedule (BOAS) foi usada. Os testes Mann-Whitney e Qui-quadrado foram empregados para analisar a associacao entre sintomas de depressao e caracteristicas sociodemograficas e estado nutricional. RESULTADOS: A maioria dos idosos era do sexo feminino (82,0%). A prevalencia de sintomas depressivos foi de 30,0%, dos quais 20,0% classificados como depressao maior. Os sintomas depressivos foram mais frequentes nas mulheres (31,7%); em idosos com 80 anos e mais (33,3%); sem nenhuma escolaridade (39,1%), que moravam so (43,7%) e que apresentavam baixo peso (33,3%) ou obesidade (32,5%). CONCLUSAO: As equipes da estrategia saude da familia devem estar atentas para a presenca de sintomas depressivos em idosos, sobretudo aqueles que pertencem aos grupos de convivencia ja instalados.

Prevalence of metabolic syndrome in pre- and postmenopausal women

Objective The objective of this study was to determine the prevalence of metabolic syndrome (MS) and its components among pre- and postmenopausal women, as well as the association between menopausal status and MS. Materials and methods A retrospective study was conducted at a reference cardiology outpatient clinic in a city located in Northwestern Paraná State, Brazil. A total of 958 medical records of symptomatic climacteric women evaluated between 2010 and 2014 were analyzed. The study consisted of two groups: pre- and post-menopausal women. MS was characterized according to the criteria of the National Cholesterol Education Programs Adult Treatment Panel III - NCEP-ATP III-2005. Results MS was observed in 18.5% of the total study population; 9.4% of the premenopausal women and 22.2% of the postmenopausal women displayed MS, corresponding to a relative risk of 2.75. In addition, the frequency of MS increased with age. Regarding the components of MS, postmenopausal women were more likely to have high density lipoprotein (HDL-C) levels < 50 mg/dL; systolic blood pressure (SBP) values ≥ 130 mmHg or diastolic blood pressure (DBP) values ≥ 85 mmHg; and fasting glucose levels ≥ 100 mg/dL. Conclusion MS was more prevalent among postmenopausal women than among premenopausal women.

The Rise in Mortality from Breast Cancer in Young Women: Trend Analysis in Brazil.

Introduction Breast cancer is the most common cause of cancer death among women. Objective The objective of this study was to analyze time trends in overall mortality from breast cancer in Brazil, Brazilian regions and States. Methods This is an exploratory study, of the time series of deaths from breast cancer contained in the Mortality Information System (SIM), of women living in Brazil, Brazilian regions and States, from 1996 to 2013. For the trend analysis, the polynomial regression model was used, and a significant trend was considered when the estimated model obtained a p value <0.05. Results There was a tendency of increased mortality from breast cancer in Brazilian women (average increase of 0.18 per year; p <0.001), with regional differences, particularly in the age group 20–49 years (0.07 per year; p <0.001). The age group 50–69 years remained constant but had high average rates (37.14). Conclusion More effective planning is needed to focus on the different scenarios of the Brazilian regions. Screening strategies for the incidence and mortality from breast cancer must also be rethought according to age group in the country.

Resultados perinatais nos extremos da vida reprodutiva e fatores associados ao baixo peso ao nascer

The aim of this study is to investigate perinatal outcomes in the extremes of reproductive age and verify the risk factors for low birth weight. This is a retrospective study of deliveries in the city of Sarandi, state of Paraná, Brazil in 2008, and it was performed by accessing data from the Information System on Live Births. The 331 expectant mothers were subdivided into two groups: adolescents (10-19 years of age) and late-age (35 years or older). Rates of cesarean deliveries were significantly higher (66.1%) in mothers 35 or older than in adolescents (26.8%). Regarding risk factors for low weight at birth, it was observed that this condition was strongly associated with prematurity and marital status. The perinatal outcomes of mothers 35 or older were not significantly different from the results of the adolescents, thus confirming the occurrence of adverse results in both extremes of reproductive age, with the exception of the incidence of cesarean delivery.Objetivou-se investigar os resultados perinatais nos extremos da vida reprodutiva e verificar os fatores de risco para o baixo peso ao nascer. Trata-se de um estudo retrospectivo dos partos ocorridos no municipio de Sarandi, Parana, no ano de 2008, a partir de consultas aos dados do Sistema de Informacao de Nascidos Vivos. As 331 gestantes foram subdivididas em dois grupos: adolescentes (10-19 anos) e tardias (35 anos ou mais). As taxas de parto cesareo foram significativamente maiores (66,1%) nas gestantes com 35 anos ou mais do que nas adolescentes (26,8%). Quanto aos fatores de risco para o baixo peso ao nascer, observou-se que este esteve fortemente associado com prematuridade e o estado civil. Os resultados perinatais das gestantes com 35 anos ou mais nao apresentaram diferenca significativa quando comparados aos resultados das adolescentes, confirmando a ocorrencia de resultados adversos nos dois extremos da vida reprodutiva, exceto pela ocorrencia de parto cesareo.

Sintomas climatéricos e estado nutricional de mulheres na pós-menopausa usuárias e não usuárias de terapia hormonal

PURPOSE To analyze the climacteric symptoms, nutritional status and distribution of abdominal fat in postmenopausal women using or not hormone therapy. METHODS exploratory analytical study of the population survey type in the urban area of Maringa, Parana, conducted on 456 postmenopausal women aged 45 to 69 years. Data collection was based on the urbanized census sector (368) of the municipality, according to the Brazilian Demographic Census. A simple random sample proportional to women residing in each census sector was used, and a questionnaire was applied during a home visit, when anthropometric measurements were performed and blood pressure was determined. The Blatt and Kupperman Menopausal Index was used for the evaluation of climacteric symptoms. The outcome variable was the use of hormone therapy. RESULTS Mean subject age was 58.7 years. Overweight was present in 72.6% of the women and abdominal obesity in 81.4% of them. Mild climacteric symptoms were observed in 69.5% of the women. Only 18.4% of the women studied were using hormone therapy and they were white, non-smokers, had no comorbidities, and had a partner. Users of hormone therapy had a lower frequency of overweight and obesity and had a lower prevalence of severe climacteric symptoms. CONCLUSION Overweight and obesity were prevalent in this sample. Although fewer in number, the hormone therapy users had a lower frequency of overweight and mild and severe menopausal symptoms during the postmenopausal period.