Eduardo Ferrioli

Efeito da reabilitação vestibular sobre a qualidade de vida de idosos labirintopatas

Dizziness is a symptom that affects the population world over, being more prevalent in the elderly due to the process of functional deterioration of the hearing and vestibular systems with aging. AIM: The objective of this study was to evaluate prospectively the effect of Vestibular Rehabilitation (VR) as treatment for labyrinth disease of vascular and metabolic origin in the quality of life of geriatric patients. METHODS: The study was outlined as clinical-prospective, longitudinal, and observed, with the participation of 40 elder citizens of both genders, divided in 2 groups, dizziness of vascular or metabolic origin. The patients were evaluated and underwent VR - based on Cawthorne and Cookseys protocol. The statistical analysis from the data was done through the t-Student test, the coefficients of Pearson and Spearman. RESULTS: based on quality of life scales showed that the individuals treated and assessed improved after Vestibular Rehabilitation. CONCLUSION: we concluded that VR, based on the protocols of Cawthorne and Cooksey, could be beneficial to this population

High Prevalence of Dementia in a Community-Based Survey of Older People from Brazil: Association with Intellectual Activity Rather than Education

Although several surveys have been conducted around the world, few surveys have investigated the prevalence of dementia in Latin America. The aim of this study was to estimate dementia prevalence in a community sample in Ribeirão Preto, Brazil, and to evaluate its distribution across several socio-demographic and clinical characteristics and habits. The population was aged 60 years and older and a representative sample from three different social regions. The screening instruments used in the first phase were the Mini-Mental State Examination, the Fuld Object-Memory Evaluation, the Informant Questionnaire on Cognitive Decline in the Elderly, and the Bayer Activities of Daily Living Scale. In the second phase, the Cambridge Examination was employed to diagnose dementia according to the DSM-IV criteria. The estimate of dementia prevalence was adjusted for screening instrument performance, using the positive and negative predictive values. The data were weighted to compare frequencies, considering the sampling and the non-response effect, and subjected to multivariate analysis. In all, 1.145 elderly subjects were evaluated (mean age: 70.9 years), of whom 63.4% were female and 52.8% had up to 4 years of schooling (participation rates at the first and the second phases were 62.6 and 60%, respectively). The observed and estimated prevalences of dementia were 5.9% and 12.5%, respectively (n = 68). Alzheimers disease was the main cause (60.3%). Dementia was associated with old age, low education, stroke, absence of arthritis, and not reading books. The estimated prevalence of dementia was higher than the prevalence previously found. Associated factors confirmed the importance of intellectual activities in prevention.

Vestibular rehabilitation's effect over the quality of life of geriatric patients with labyrinth disease

UNLABELLED Dizziness is a symptom that affects the population world over, being more prevalent in the elderly due to the process of functional deterioration of the hearing and vestibular systems with aging. AIM The objective of this study was to evaluate prospectively the effect of Vestibular Rehabilitation (VR) as treatment for labyrinth disease of vascular and metabolic origin in the quality of life of geriatric patients. METHODS The study was outlined as clinical-prospective, longitudinal, and observed, with the participation of 40 elder citizens of both genders, divided in 2 groups, dizziness of vascular or metabolic origin. The patients were evaluated and underwent VR - based on Cawthorne and Cookseys protocol. The statistical analysis from the data was done through the t-Student test, the coefficients of Pearson and Spearman. RESULTS based on quality of life scales showed that the individuals treated and assessed improved after Vestibular Rehabilitation. CONCLUSION we concluded that VR, based on the protocols of Cawthorne and Cooksey, could be beneficial to this population.

Diagnosing Sarcopenia in Male Patients With Cirrhosis by Dual-Energy X-Ray Absorptiometry Estimates of Appendicular Skeletal Muscle Mass

BACKGROUND Ascites in cirrhotic patients interfere with accurate assessment of skeletal muscle when diagnosing sarcopenia. We hypothesized measurement of appendicular skeletal muscle index (ASMI) with dual-energy x-ray absorptiometry (DXA) improves the diagnosis of sarcopenia in cirrhotic patients as ASMI does not include the fluid-filled abdominal compartment. OBJECTIVE To evaluate if ASMI is influenced by ascites, lower limb edema (LLE) and predicts mortality alone or combined with handgrip strength (HGS) in cirrhotic patients. DESIGN ASMI, HGS, and 36-month mortality were obtained in 144 men with cirrhosis. ASMI was compared before and after paracentesis in 20 men with ascites and to results from 20 matched controls. The prognostic value of ASMI alone and with HGS was tested in a survival. Survival probabilities were obtained for sarcopenia diagnosed by standard ASMI and HGS European Working Group on Sarcopenia in Older People (EWGSOP) cutoffs and a new cutoff calculated from our ASMI + HGS tertiles. RESULTS ASMI did not change after paracentesis, was lower in patients than in controls (P < .001), and was not influenced by LLE (D = 0.30 kg/m2, P = .068; R2 = 2.40%). Mortality was influenced by ASMI and HGS (Pinteraction = 0.028). Sarcopenia diagnosed by EWGSOP was also diagnosed by our new cutoff; both predicted mortality with the latter more sensitive for mortality risk prediction (P = .011). CONCLUSIONS DXA-measured ASMI is not influenced by ascites or LLE in cirrhotic patients; can diagnose low skeletal muscle/sarcopenia; and predicts mortality, particularly when combined with HGS.

Association among measures of mobility-related disability and self-perceived fatigue among older people: a population-based study

Objective: To investigate the relationship between self-perceived fatigue with different physical functioning tests and functional performance scales used for evaluating mobility-related disability among community-dwelling older persons. Method: This is a cross-sectional, population-based study. The sample was composed of older persons with 65 years of age or more living in Cuiabá, MT, and Barueri, SP, Brazil. The data for this study is from the FIBRA Network Study. The presence of self-perceived fatigue was assessed using self-reports based on the Center for Epidemiologic Studies-Depression Scale. The Lawton instrumental activities of daily living scale (IADL) and the advanced activities of daily living scale (AADL) were used to assess performance and participation restriction. The following physical functioning tests were used: five-step test (FST), the Short Physical Performance Battery (SPPB), and usual gait speed (UGS). Three models of logistic regression analysis were conducted, and a significance level of α<0.05 was adopted. Results: The sample was composed of 776 older adults with a mean age (SD) of 71.9 (5.9) years, of whom the majority were women (74%). The prevalence of self-perceived fatigue within the participants was 20%. After adjusting for covariates, SPPB, UGS, IADL, and AADL remained associated with self-perceived fatigue in the final multivariate regression model. Conclusion: Our results suggest that there is an association between self-perceived fatigue and lower extremity function, usual gait speed and activity limitation and participation restriction in older adults. Further cohort studies are needed to investigate which physical performance measure may be able to predict the negative impact of fatigue in older adults.

Performance of the 13C-urea breath test for the diagnosis of H. pylori infection using a substrate synthesized in Brazil: A preliminary study

OBJECTIVE: The 13C-urea breath test is the main non-invasive test for the diagnosis of Helicobacter pylori infection. The availability of this test throughout the country is limited, mainly due to the difficulty in obtaining the labeled isotope from abroad. Recently, researchers from the Nuclear Energy Center in Agriculture at the University of São Paulo (CENA/USP) succeeded in synthesizing 13C-enriched urea for Helicobacter pylori diagnosis. The aim of the study was to compare the performance of the 13C-urea breath test using 13C-urea acquired abroad with that of a test using 13C-urea synthesized in Brazil. METHOD: Sixty-four dyspeptic patients participated in the study (24 men and 40 women). Initially, the patients performed the 13C-urea breath test using the imported substrate (Euriso-Top, France). Seven to fourteen days later, all the patients repeated the test using the Brazilian substrate. The samples from both examinations were processed in an infrared isotope analyzer (IRIS, Wagner Analisen Technik, Germany), and all delta over baseline (DOB) [%] values above four were considered positive results. RESULTS: Twenty-seven patients (42%) exhibited negative results for Helicobacter pylori infection, and thirty-seven patients (58%) exhibited positive results when tested using the foreign substrate (gold standard). There was a 100% concordance regarding the presence or absence of infection when the gold standard results were compared with those obtained using the Brazilian substrate. CONCLUSIONS: Similar performance in the diagnosis of Helicobacter pylori infection was demonstrated when using the 13C-urea breath test with the Brazilian 13C-urea substrate and the test with the substrate produced abroad. This validation represents an important step toward increasing the availability of the 13C-urea breath test throughout the country, which will have a positive influence on the management of Helicobacter pylori infection.

Evaluating Communication Skills of Geriatrics Fellows: interrater Agreement of an Objective Structured Clinical Examination

To the Editor: Evaluating communication skills of geriatric fellows is a matter of paramount importance, but there has been limited work on this topic. The Division of Geriatrics of the University of S~ao Paulo Medical School conducts an annual Objective Structured Clinical Examination (OSCE), but a concern related to interrater agreement on communication skills has been raised. The purpose of this study was to evaluate the interrater reliability of a communication assessment scale.

Fenótipo de fragilidade: influência de cada item na determinação da fragilidade em idosos comunitários – Rede Fibra

The phenotype of frailty is used to assess frailty among the elderly by examining the following items: weight loss; exhaustion; low level of physical activity; weakness; and slow gait speed. The aim of the study was to evaluate the contribution of each item to determine the frailty syndrome among elderly Brazilians. The analysis was done using Multinomial Logistic Regression. The total sample of 5532 randomly selected elderly people in many cities in Brazil between December 2008 and September 2009 was assessed using the phenotype of frailty. The most frequent items were level of physical activity, followed by muscular weakness and slow gait speed. Items that were more likely to develop frailty, when positive, were slow gait speed (OR = 10.50, 95%CI 8.55 - 12.90, p <0.001) and muscular weakness (OR = 7.31, 95%CI 6,02 - 8,86, p <0.001). The final model with five items explained 99.6% of frailty in the sample. These results suggested that the level of physical activity, weakness and slow gait speed were the items that most influence the determination of frailty, however the application of all items of the phenotype of frailty is the best way to assess frailty.The phenotype of frailty is used to assess frailty among the elderly by examining the following items: weight loss; exhaustion; low level of physical activity; weakness; and slow gait speed. The aim of the study was to evaluate the contribution of each item to determine the frailty syndrome among elderly Brazilians. The analysis was done using Multinomial Logistic Regression. The total sample of 5532 randomly selected elderly people in many cities in Brazil between December 2008 and September 2009 was assessed using the phenotype of frailty. The most frequent items were level of physical activity, followed by muscular weakness and slow gait speed. Items that were more likely to develop frailty, when positive, were slow gait speed (OR = 10.50, 95%CI 8.55 - 12.90, p <0.001) and muscular weakness (OR = 7.31, 95%CI 6,02 - 8,86, p <0.001). The final model with five items explained 99.6% of frailty in the sample. These results suggested that the level of physical activity, weakness and slow gait speed were the items that most influence the determination of frailty, however the application of all items of the phenotype of frailty is the best way to assess frailty.

Composição corporal de idosas diabéticas tipo 2: antropometria vs absorcimetria de raios-X de dupla energia

foi avaliada pelas medidas antropometricas das dobras cutâneas do triceps, suprailiaca e coxa e associadas aoexame de Raios-x de dupla varredura, considerado o padrao ouro. Os intervalos de concordância de Bland eAltman foram os valores do desvio-padrao do coeficiente de variacao do exame de Raios-x de dupla varredurae os valores da antropometria deviam estar nessa faixa. Foram comparadas as medias (teste