Celita Salmaso Trelha

Caracterização da dor crônica e métodos analgésicos utilizados por idosos da comunidade

OBJECTIVE: To characterize chronic pain and analgesic approaches in community- dwelling elderly of the northern district of Londrina - Brazil. METHODS: Cross-sectional study with individuals 60 years old and more, resident in the local area of a Basic Health Unit (UBS) of Londrina, by home inquiry. Chronic pain was defined as pain lasting for six months or more. The elderly with pain, were questioned about characteristics of the pain as regards location, duration, frequency, intensity, improvement and worsening situations, as well as the impact of pain in the quality of life and also about analgesic approaches. RESULTS: One hundred and seventy two elderly were interviewed (101 women and 71 men). Presence of chronic pain was observed in 107 (62.%) of these 69.3% were female and 52.1% male (p = 0.004). The very old people, 80-year-old or more (p=0.01) and the depressive elderly (p=0.0008) presented higher frequency of chronic pain. Most prevalent pains were in the legs and back, with 31.2% each, and the majority of elderly referred to continuous, daily high intensity pain. Regarding analgesic approaches, the pharmacologic method was mentioned by 86 elderly (80.4%) and simple analgesic (32.6%) was the most used. CONCLUSION: Facts show that there is a high predominance of chronic pain in the population of elderly, mainly in women, in very old people and in depressive individuals.

Psychoactive Drugs as Risk Factors for Functional Decline Among Noninstitutionalized Dependent Elderly People

OBJECTIVE To analyze the association between use of psychoactive drugs and functional decline among noninstitutionalized dependent elderly people. DESIGN Cross-sectional study. PARTICIPANTS A total of 161 community-dwelling elderly people with functional dependence. MEASUREMENTS The data were analyzed using logistic regression with adjustment for age models. The independent variables were the following: use of psychoactive drugs (antidepressants, anticonvulsants, anxiolytics, antipsychotics, or sedatives), cognitive decline (Mini-Mental State Examination score<20), and daytime sleepiness. The dependent variables were the following: dependence relating to activities of daily living (ADLs) and dependence relating to instrumental activities of daily living (IADLs). RESULTS Data on 131 individuals of mean age 77.5 years were analyzed. Psychoactive drugs were used by 33.6%. Age-adjusted univariate analysis showed associations between psychoactive drug use and both ADLs and IADLs. However, in multivariate analysis, only ADLs showed a significant association with psychoactive drug use, independent of cognitive decline and daytime sleepiness (OR=2.67; 95% CI: 1.04-6.85; P=.04). CONCLUSIONS There is a greater risk of impairment of ADLs among noninstitutionalized elderly people using psychoactive drugs. These results indicate the need for rational use of medication groups among this population with greater risk of functional impairment.

Saúde bucal de idosos restritos ao domicílio: estudo descritivo de uma demanda interdisciplinar

No municipio de Londrina, a proporcao de pessoas acima de 60 anos em 2002 era de 9,35%, enquanto que a media nacional, neste mesmo ano, foi de 8,52%. Do total dessa populacao, estima-se que 15% apresentam problemas de saude que dificultam seu deslocamento para atendimento medico-odontologico. Somadas a essa dificuldade, a baixa renda familiar para a utilizacao dos servicos odontologicos privados e a falta de prioridade nos servicos publicos os coloca em uma condicao de abandono. Foram selecionados 43 idosos, moradores do Conjunto Habitacional Ruy Viermond Carnascialli, e entao submetidos a uma entrevista e exame clinico odontologico em seus domicilios. Foi observado que 79,1% referiram a ultima visita a um dentista ha mais de cinco anos, e apenas 55,8% reconhecem a necessidade de um atendimento odontologico. No exame clinico, observou-se que 79,1% dos idosos ja haviam perdido todos os seus dentes no arco superior e 65,1% no arco inferior, necessitando usar proteses. Quanto ao tempo de uso de uma mesma protese, foi encontrada a media de 15 anos, sendo que ao considerar o estado geral de conservacao, 67,8% das proteses superiores e 82,4% das inferiores tiveram indicacao de substituicao. O indice de dentes cariados, perdidos ou obturados encontrado foi de 29,7, com a media de 2,3 dentes higidos presentes por idoso. Devido as precarias condicoes encontradas, serao necessarios estudos considerando a restricao ao domicilio e suas implicacoes, como fatores de risco para a ma condicao e manutencao da saude bucal em idosos.

Association between complaints of dizziness and hypertension in non-institutionalized elders

Summary Introduction: Advancing age increases the risk for a number of chronic diseases. Hypertension and dizziness are highly prevalent in the elderly population and represent major health problems. Objective: To verify the association between complaints of dizziness and the presence of hypertension in non-institutionalized elders. Method: This was a prospective cross-sectional cohort study of the elderly population of Londrina, Paraná in terms of aging and longevity. The required sample size was calculated, and subjects e” 60 years of age of both genders were selected at random. Data were collected using a questionnaire covering socio-demographic information and self-reported cases of hypertension and dizziness. Statistical analysis was performed using the chi-square test with p d” 0.05 as the level of significance. Results: The study included 493 elderly subjects, of whom 257 (52.1%) complained of dizziness and 308 (62.5%) reported a diagnosis of arterial systemic hypertension. Dizziness was significantly associated with hypertension (χ2 = 6.26, p = 0.01) and female sex. Conclusions: Hypertension and dizziness were both highly prevalent and were significantly associated, showing the great need for investments in preventive measures.

Fear of falling and activity restriction{ in older adults from the urban community of Londrina: a cross-sectional study

Objective The objective of this study was to assess the fear of falling and restriction of activities in the elderly of the city of Londrina (PR). Materials and method A cross-sectional study was conducted with individuals over 60 years old of both sexes. They were interviewed at their home with the Falls Efficacy Scale International - Brazil the Survey of Activities and Fear of Falling in the Elderly a socio-demographic and health perception questionnaire. Results The participants were 38 elderly people (mean age 71.6 ± 6.1 years) with a prevalence of women (68.4%). The occurrence of a fall in the last year was reported by 44.7% of the elderly, and the prevalence of the fear of falling again by 56.3%. In the evaluation of the Falls Efficacy Scale, 97.4% of participants reported fear of falling in at least one of the activities while 55.3% had score ≥ 23 points showing high risk for falls. Fifty two percent of the elders restricted their activity due the fear of falling. Conclusion These results show a high frequency of fear of falling associated with restriction of activities and individuals with a high risk potential for falls. The evaluation of this data contributes to establishing indicators and development of preventive strategies and specific interventions for the elderly with fear of falling.

One-Year Follow-up of Non-institutionalized Dependent Older Adults: Mortality, Hospitalization, and Mobility

Les aînés dépendants qui ne sont pas institutionnalisées présentent une forte morbidité et mortalité, exigent des soins de leurs familles et consomment de ressources primaires de soins de santé. Pour élargir les connaissances en ce qui concerne ce groupe, nous avons effectué une étude prospective d’un an, basée sur la population de cohorte de 130 personnes âgées dépendantes et non-institutionnalisées (60 ans et plus). Cette étude a été stratifiée en fonction du degré de la mobilité: la marche indépendante (groupe A), l’utilisation des aides pour la marche (groupe B), et alité ou confiné au fauteuil roulant (groupe C). Les résultats analysés étaient les suivants: la mort, l’hospitalisation, et l’incapacité de se déplacer. La mortalité totale était au pourcentage de 8.5 (p = 0,05). Le taux global d’hospitalisation était au pourcentage de 34,6, les principales causes étant l’AVC et la pneumonie. La mortalité totale était de 8,5 pour cent (p = 0,05). Le taux global d’hospitalisation était de 34,6 pour cent, les principales causes étant l’AVC et la pneumonie. À la fin d’un an, la proportion de sujets classés comme capables de marcher d’une façon indépendante a baissé (57% contre 43 %, p = 0,03). Nous pourrions déduire qu’il y avait un taux élevé de mortalité et d’hospitalisation dans ce groupe de personnes âgées dépendantes, et une proportion croissante de gens handicapés après un an. Non-institutionalized dependent older adults present high morbidity and mortality, demand care from their families, and consume primary health care resources. To expand knowledge about this group, we conducted a population-based one-year prospective cohort study of 130 non-institutionalized dependent older persons (age 60 and older), stratified according to baseline mobility: independent walking (group A), use of walking aids (group B), and bedridden or confined to a wheelchair (group C). The outcomes analysed were death, hospitalization, and mobility disability. Total mortality was 8.5 per cent (p = .05). Overall hospitalization rate was 34.6 per cent; the main causes were stroke and pneumonia. After one year, there was a decline in the proportion of subjects classified as independent walking (57% vs. 43%; p = .03). We conclude that there was a high rate of mortality and hospitalization in this group of dependent older people, and an increase in disability after a one-year follow-up.

O ensino da Saúde Coletiva na Universidade Estadual de Londrina: da análise documental à percepção dos estudantes

The National Curricular Directives for undergraduates in the health area were approved in 2002, in an attempt to break the biomedical paradigm with regards to the production of knowledge and professions. With the purpose of adapting to those directives, the Physiotherapy course at the State University of Londrina reformulated its curriculum and, included among the alterations, it expanded the class hours and restructured the Collective Health discipline. The purpose of this study was to analyze whether the Collective Health content of the new curriculum covers the formation of abilities under the curricular directives, as well as evaluating student perceptions with regards to their formation for working with basic health care. Accordingly, a documentary analysis of the content of interviews given by graduating students in the last semester of their courses was carried out. It was ascertained that the content analyzed covers essential aspects of social sciences and humanities in health, and that the apprenticeship in basic health care was what most provided experience in team work. Despite assessing the Collective Health classes positively, the students suggested that the theoretical discussions be more articulated to the apprenticeship, because, accordingly, there would be greater opportunities for learning the work of physiotherapy in the basic health care arena more effectively.

Fear of falling and self-perception of health in older participants and non-participants of physical activity programs

Fear of falling, self-perception of health, and participation in physical activity programs have been associated with several variables related to health and performance in older adults. The purpose of this study was to evaluate self-perception of health and fear of falling in older adult participants and non-participants of physical activity programs, and to verify the relationship between these variables. A total of 40 healthy but sedentary older adults, and 45 physically active older adults were assessed through the Falls Efficacy Scale International-Brazil (FES-I) and a questionnaire that measured their self-perception of health. The older adults that did not participate in regular physical activity programs presented higher scores of fear of falling, which, in turn, is associated with an increase of risk for falls. Moreover, older adults, participants in regular physical activity programs exhibited a more positive health perception than did the non-participants. Also, non-participants of physical activity programs perceived their health status as being poor or very poor as well as expressing great concern about falling compared to those who considered their health as excellent, good or regular. The results of this study have important implications for making clinical decisions in prevention or rehabilitation of older people, and they justify recommendations to the public health system.

Effectiveness of aquatic exercises compared to patient-education on health status in individuals with knee osteoarthritis: a randomized controlled trial:

Objective: To compare the effectiveness of aquatic exercises with patient-education in individuals with knee osteoarthritis. Design: Randomized controlled trial with blinded assessor and intention-to-treat analysis. Setting: Aquatic Physiotherapy Centre and Primary Health Care Unit. Subjects: A total of 60 patients, aged 68.3 (SD = 4.8) with clinical symptoms and radiographic grading (Kellgren–Lawrence 1–4) of knee osteoarthritis were included. Interventions: An eight-week treatment protocol of aquatic exercise (n = 31) (16 individual sessions, twice a week) and an educational program (group sessions, once a week) (n = 29). Main measures: Before, after eight-week intervention, and a three-month follow-up with results for the following outcome measures: pain, function, quality of life, functional mobility, and depression. Results: At the end of treatment, the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) functional capacity values reduced in favour of the aquatic exercise group for both the total score MD (mean difference) = –14.2; 95% CI (confidence interval) (−18; −10.5), P = 0.04 and the pain domain MD = −3.8 points; 95% CI (−8.71; −1), P = 0.021. The total score also reduced in the follow-up: MD = −12.3 points; 95% CI (−24.7; −6.1), P = 0.017. No differences were found for the outcomes functional mobility or depression. Conclusion: Aquatic exercise improved pain and function after eight weeks, and function at the three-month follow-up compared to the patient-education program.

Características antropométricas, capacidade funcional de exercício e atividade física de crianças vítimas de queimaduras

1Physical therapist, master in Rehabilitation Sciences. Research fellow of Demanda Social/Capes/Fundação Araucária – Londrina (PR), Brazil. 2Physical therapist at the Hospital Universitário de Londrina, master in Rehabilitation Sciences – Londrina (PR), Brazil. 3Physical therapist, professor of the Department of Physical Therapy of Universidade Estadual de Londrina (UEL), PhD in Health Sciences – Londrina (PR), Brazil. 4Physical therapist, professor of the Department of Physical Therapy of Universidade Estadual de Londrina (UEL), PhD in Education, Productivity research fellow of Fundação Araucária – Londrina (PR), Brazil. ABSTRACT | This study aimed to analyze the anthropometric characteristics, functional capacity of exercise, and physical activity of children who suffered burns. It also aimed to verify whether there is association between the anthropometric and physical activity variables and the severity of the burns, after hospital discharge. Nutritional status, regular physical activity, and functional capacity of exercise were evaluated by z-score, “Physical Activity Questionnaire for Older Children,” and six-minute walk test (6MWT), respectively. Shapiro-Wilk test was used to verify the normality of the data. Fisher’s exact test was used to study the association among the qualitative variables. A statistical significance of 5% was adopted. The mean age was 10.0±2.7 years old, and most participants were classified as greatly burned. After 12.7±5.5 months of hospital discharge, 13 (61.9%) participants were eutrophic and 7 (33.3%) were shorter than expected. Regarding physical activity, 11 (52.3%) were classified as active, and the mean distance traveled in the 6MWT was 564.7±70.6 m. There was no significant difference in the association between the variables eutrophic or overweight and active or sedentary (p=0.65) nor between moderately or greatly burned and active or sedentary (p=0.31). The findings showed no association of children classified as greatly burned or overweight/obese with sedentary lifestyle. There was also no reduction of functional capacity of 371O objetivo do estudo foi analisar as caracteristicas antropometricas, capacidade funcional do exercicio e atividade fisica, bem como verificar se ha associacao entre as variaveis antropometricas e de atividade fisica com a gravidade da queimadura em criancas apos a alta hospitalar. O estado nutricional foi estabelecido pelo escore z, a atividade fisica regular foi avaliada por meio do questionario Physical Activity Questionnaire for Older Children (PAQ-C), e a capacidade funcional de exercicio pelo teste de caminhada de seis minutos (TC6). O teste Shapiro-Wilk foi utilizado para verificar a normalidade dos dados. Para analise de associacao entre as variaveis qualitativas foi utilizado o teste exato de Fisher. A significância foi estabelecida em 5%. A idade foi de 10,0±2,7 anos, e a maioria dos participantes foi classificada como grande queimado. Apos 12,7±5,5 meses da alta hospitalar, 13 (61,9%) participantes encontravam-se eutroficos e 7 (33,3%) com a estatura abaixo do esperado. Em relacao a atividade fisica, 11 (52,3%) foram classificados como ativos, e a distância percorrida no TC6 foi de 564,7±70,6. Na analise de associacao, nao houve diferenca significante entre as variaveis eutroficos ou sobrepeso com ativos ou sedentarios (p=0,65); e entre medio ou grande queimados com ativos ou sedentarios (p=0,31). Os achados mostraram que nao houve associacao entre as criancas consideradas grande queimado ou sobrepeso/obesas com o sedentarismo, tambem nao houve reducao da capacidade funcional do exercicio, mesmo com parte dos participantes apresentando alteracao nos dados antropometricos e sendo sedentarios.