Evandro Silva Freire Coutinho

Uso de medicamentos como fator de risco para fratura grave decorrente de queda em idosos

Falls leading to fractures among the elderly are a major public problem. A case-control study was conducted on the use of certain drugs as a risk factor for hospitalization due to fractures after falls among individuals aged 60 years or over in the city of Rio de Janeiro, Brazil. One hundred sixty-nine cases and 315 in-patient controls were matched by age, sex, and hospital. Odds ratios (OR) adjusted for potential confounders were calculated using conditional logistic regression. Increased risk of such accidents was found for calcium channel antagonists (OR = 1.96, 1.16-3.30) and benzodiazepines (OR = 2.09, 1.08-4.05), and decreased risk was associated with diuretics (OR = 0.40, 0.20-0.80). Antacids, digitalis, and laxatives were associated with reduced risk of fractures after falls that reached borderline statistical significance (0.05 < p < 0.10). The findings highlight the need to weigh risks and benefits of medication in the elderly. It is also important to advise such individuals and their families on how to avoid falls when such medication proves necessary.

Prevalência de consumo de bebidas alcoólicas e de alcoolismo em uma região metropolitana do Brasil

Foi realizado Inquerito epidemiologico com o objetivo de estimar o uso de substâncias psicoativas e a prevalencia de alcoolismo. Tomou-se como referencia a populacao de maiores de 13 anos de idade de regiao administrativa da cidade do Rio de Janeiro, RJ (Brasil), da qual se extraiu uma amostra aleatoria de 1.459 individuos. Os resultados referentes ao uso de bebidas alcoolicas e alcoolismo, identificados atraves do teste CAGE, mostraram: prevalencia de 51% para o consumo de alcool e de 3% para alcoolismo, sendo 4,9% em homens e 1,7% em mulheres; maior proporcao de consumidores de alcool e de alcoolistas entre homens de 30 e 49 anos; abstinencia mais frequente entre os viuvos, protestantes e individuos com niveis de renda inferiores.An epidemiological survey was carried out for the purpose of estimating the use of psychoactive substances and the prevalence of alcoholism. The target population consisted of people over 13 years old living in a district of Rio de Janeiro city - Brazil. A random sample of 1,459 people was researched. Data on the use of alcohol and on alcoholism are presented. The diagnosis of this latter, based upon the CAGE Test, showed that 51% used alcohol and 3% were suspected of alcoholism: 4.9% and 1.7% among men and women, respectively. The greatest prevalence of the use of alcohol and of alcoholism was found among men between 30 and 49 years of age. Abstinence from alcohol was more frequent among widowed, Evangelical and low-income groups.

Acurácia da metodologia de relacionamento probabilístico de registros para identificação de óbitos em estudos de sobrevida

Probabilistic record linkage methodology has been increasingly used to ascertain outcomes in cohort studies. However, only a few studies have evaluated its accuracy. The aim of this study was to evaluate the accuracy of probabilistic record linkage methodology to ascertain deaths in a cohort of 250 elderly people hospitalized for fractures caused by falls. The vital status of cohort members was determined through household visits conducted at one and six months after hospital admission. Record linkage was used to link records from the cohort to the Rio de Janeiro State mortality database. Deaths identified by the latter process were compared to the results obtained by active follow-up (gold standard). The vital status of 20 cohort members could not be determined by active follow-up. Among the remaining 230, 60 died within 180 days after hospital admission. Record linkage had a sensitivity of 85.5%, specificity of 99.4%, positive predictive value of 98.1%, and negative predictive value of 94.9%. In conclusion, probabilistic record linkage appears to be a useful tool for identifying deaths in cohort studies conducted in Brazil.

Perfil demográfico e sócio-econômico da população de internos dos hospitais psiquiátricos da cidade do Rio de Janeiro

Knowledge on the characteristics of patients admitted to psychiatric hospitals is essential to adequate care, yet such information is not always available. A survey was conducted on patients in the 20 psychiatric hospitals in the city of Rio de Janeiro, Brazil. This paper presents demographic and socioeconomic data on the study population: 3223 persons (66.0% male; 52.6% under 40) on October 24, 1995. 73.8% had not finished elementary school; 25.5% were illiterate. 71.6% of the males and 61.1% of the females were single. Both groups had the same divorce percentage (13%). 43.1% of patients had jobs at the time of first admission, but only half had kept them by the time of this survey. Some 50% of the patients only received visits at extended intervals or not at all. This finding, plus the fact that 37.4% had been hospitalized for more than one year and 65. 1% did not leave the hospital during holidays or weekends, provides a picture of their social isolation. The findings are discussed based on epidemiological data, and hypotheses are suggested to explain some of the results.

Cross-cultural adaptation to Brazil of the instrument Caregiver Abuse Screen (CASE) for detection of abuse of the elderly by caregivers

This first of two papers focuses on the first part in the cross-cultural adaptation of the Portuguese-language version of Caregiver Abuse Screen (CASE), a brief instrument for detecting domestic violence against the elderly. CASE was originally developed in Canada and used to screen violence against the elderly by interviewing their caregivers. Besides a broad literature review, the evaluation of conceptual and item equivalences involved expert discussion groups. Semantic equivalence included the following steps: two translations and respective back-translations; an evaluation of referential and general (connotative) equivalence between the original instrument and each version; further discussions with experts in order to define the final version; and pre-testing the latter in 40 caregivers of elderly subjects in an outpatient geriatric clinic. It was possible to establish high-quality conceptual, item, and semantic equivalence for the Portuguese-language version. Although the results shown here were encouraging, they should be reevaluated in light of a forthcoming psychometric analysis (measurement equivalence) to be performed by the research group.

Estudo de prevalência de depressão e síndrome cerebral orgânica na população de idosos, Brasil

Data from a prevalence study of Organic Cerebral Syndrome and Depression in an elderly population living in three boroughs of Rio de Janeiro city are presented. The methodological issues related to interrater and test-retest reliability are discussed and the cut-off point for the instrument adapted (BOAS) established. The prevalence rates in the three boroughs were found, respectively, to be: 5.9%, 9.8% and 29.8% for Organic Cerebral Syndrome and 20.9%, 23.0% and 36.8% for Depression. The prevalence rats have been adjusted using information on sensitivity and specificity for both diagnosis. Aspects of these differences are discussed in the light of national and international literature.

Ensaios clínicos pragmáticos: uma opção na construção de evidências em saúde

The authors present and discuss the potential of pragmatic clinical trials as an alternative to both explanatory trials and observational studies to support the use of therapeutic interventions with good evidence. They argue that this strategy, when properly applied, can be a powerful tool to obtain unbiased measures of effectiveness, with simpler logistics and lower costs than in current clinical trials.

Escala de apoio social aplicada a uma população de gestantes: confiabilidade teste-reteste e estrutura de concordância dos itens

There is a growing interest in research on the association between social support and health outcomes. The objective of this study was to evaluate the reliability and structure of agreement of a social support scale. Test-retest reliability was measured in a group of pregnant women (n = 65) in a public maternity ward. Intraclass correlation coefficient (ICC) and quadractically weighted kappa (kw2) were used as agreement measures. Log-linear statistical models were fitted to describe patterns of agreement. ICC for social support score was 0.90. The kw2 ranged from 0.23 to 0.70. Log-linear models that provided the best fit to the data were diagonal agreement plus linear-by-linear association and quasi-independence models. The scale was considered a reliable instrument to measure social support scale in low-income pregnant women.

Association between home posture habits and neck pain in High School adolescents.

BACKGROUND Neck pain (NP) in adolescence is as frequent as in adulthood. However, the relationship between home posture habits and neck pain is still unknown. OBJECTIVE To investigate the prevalence of NP and the association with home posture habits (HPH) in adolescents. METHODS Cross-sectional study with High School adolescents. Students answered questions regarding sociodemographic variables, lifestyle, HPH (illustration in the questionnaire), time (TV, computer, video-game) and the presence of NP. Multivariate logistic regression was used to investigate the association between HPH and NP. RESULTS The prevalence of NP was 48.9%. The ones who watched TV lying supine in bed for 2 hours or more a day yielded an odds ratio (OR) of 6.21 (1.45-26.52) for acute neck pain (ANP). Who watched TV and used the desktop in the slump posture yielded, respectively, an OR of 4.0 (1.63-9.85), and 2.03 (1.23-3.34) for chronic neck pain (CNP). The ones who frequently changed their positions while using the desktop and used it for 2 hours or more a day yielded an OR of 0.34 (0.14-0.85) for ANP. CONCLUSION Our findings support the high prevalence of NP in adolescence and raise the association between some HPH and neck pain.

Transtorno do estresse pós-traumático no puerpério em uma maternidade de alto risco fetal no Município do Rio de Janeiro, Brasil

The objectives of this study were to estimate the prevalence of postpartum posttraumatic stress disorder (PTSD) in a maternity hospital for fetal high-risk pregnancies and to identify vulnerable subgroups. This was a cross-sectional study at a fetal high-risk maternity hospital in Rio de Janeiro, Brazil, with a sample of 456 women who had given birth at this hospital. The Trauma History Questionnaire and Post-Traumatic Stress Disorder Checklist were used to screen for lifetime traumatic events and PTSD symptoms, respectively. Overall prevalence of PTSD was 9.4%. Higher PTSD prevalence was associated with three or more births, a newborn with a 1-minute Apgar score of seven or less, history of mental disorder prior to or during the index pregnancy, postpartum depression, physical or psychological intimate partner violence during the pregnancy, a history of unwanted sexual experience, and lifetime exposure to five or more traumas. Rapid diagnosis and treatment of PTSD are essential to improve the mothers quality of life and the infants health.O objetivo deste artigo e estimar a magnitude de transtorno do estresse pos-traumatico (TEPT) no puerperio em uma maternidade de referencia para agravos perinatais e identificar subgrupos vulneraveis. Trata-se de um estudo transversal realizado uma maternidade de alto risco fetal no Rio de Janeiro, Brasil, com 456 mulheres que realizaram o parto na instituicao. O Trauma History Questionnaire e o Post-Traumatic Stress Disorder Checklist foram utilizados para captar experiencias traumaticas e sintomas de TEPT, respectivamente. A prevalencia geral de TEPT foi de 9,4%. O TEPT mostrou-se mais prevalente entre mulheres com tres ou mais partos, que tiveram recem-nascido com Apgar no 1o minuto menor ou igual a sete, com historico de agravo mental antes ou durante a gravidez, com depressao pos-parto, que sofreram violencia fisica ou psicologica perpetrada por parceiro intimo na gravidez, que tiveram experiencia sexual nao desejada e que foram expostas a cinco ou mais traumas. Rapido diagnostico e tratamento sao fundamentais para melhorar a qualidade de vida da mulher e a saude do recem-nascido.