Irenio Gomes da Silva Filho

Suicide risk in the elderly: Data from Brazilian public health care program

OBJECTIVE Examine prevalence and level of suicide risk, and its associations with sociodemographic factors and mood disorders. METHODS A cross-sectional study with a random sample of 530 individuals aged 60 years or more from Family Health Strategy of Porto Alegre, Brazil. Diagnosis was made by psychiatrists using the Mini International Neuropsychiatric Interview plus (MINIplus). RESULTS Suicide risk was found in 15.7% of the sample. Female gender, elderly with no income or with no paid activity and those who have lost one or more of his sons presented association with suicide risk. Bipolar disorder shows association with suicide risk for those with or without current episode. For unipolar depression only elderly with a current episode shows association with suicide risk. LIMITATIONS The cross-sectional design limits the examination of causative relationships. The MINIplus questions are not broad enough to assess other important self-destructive behaviors. CONCLUSIONS A high rate of suicide risk was found. As expected an increased rate of mood disorders were related to the risk of suicide. The loss of sons may partly explain a subtype of late-life risk of suicide or mood disorders especially in the oldest-old. These findings can be a useful to generate other research hypothesis and for health professionals who care older persons. Detecting characteristics linked to suicide, therefore opening up the possibility of preventing tragic outcomes providing a proper treatment.

Electrical Stimulation for Urinary Incontinence in Women: A Systematic Review

BACKGROUND Electrical stimulation is commonly recommended to treat urinary incontinence in women. It includes several techniques that can be used to improve stress, urge, and mixed symptoms. However, the magnitude of the alleged benefits is not completely established. OBJECTIVES To determine the effects of electrical stimulation in women with symptoms or urodynamic diagnoses of stress, urge, and mixed incontinence. SEARCH STRATEGY Our review included articles published between January 1980 and January 2012. We used the search terms ″urinary incontinence″, ″electrical stimulation ″, ″ intravaginal ″, ″ tibial nerve ″ and ″ neuromodulation ″ for studies including female patients. SELECTION CRITERIA We evaluated randomized trials that included electrical stimulation in at least one arm of the trial, to treat women with urinary incontinence. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed the data from the trials, for inclusion or exclusion, and methodological analysis. MAIN RESULTS A total of 30 randomized clinical trials were included. Most of the trials involved intravaginal electrical stimulation. Intravaginal electrical stimulation showed effectiveness in treating urge urinary incontinence, but reported contradictory data regarding stress and mixed incontinence. Tibial-nerve stimulation showed promising results in randomized trials with a short follow-up period. Sacral-nerve stimulation yielded interesting results in refractory patients. CONCLUSIONS Tibial-nerve and intravaginal stimulation have shown effectiveness in treating urge urinary incontinence. Sacral-nerve stimulation provided benefits in refractory cases. Presently available data provide no support for the use of intravaginal electrical stimulation to treat stress urinary incontinence in women. Further randomized trials are necessary to determine the magnitude of benefits, with long-term follow-up, and the effectiveness of other electrical-stimulation therapies.

Efeitos de um treino de atenção, memória e funções executivas na cognição de idosos saudáveis

INTRODUCTION: Studies show there is a significant decrease in cognitive functions such as attention, memory and executive functions throughout the normal aging process. OBJECTIVE: To verify the effects of an attention, memory and executive functions training on the cognition of healthy elderly people. METHODS: 76 healthy elderly subjects were divided into experimental (EG) and control groups (CG), both were composed by 38 participants each. The EG received 12 training sessions in attention, memory and executive functions. RESULTS: In the post-test, the EG presented better performance in tasks of attention, working memory, language (inferences and spontaneous writing), constructional praxia, problems solving, and executive functions. CONCLUSION: The training revealed significant results for a 12-session intervention, indicating that healthy elderly individuals may improve their cognitive functions.

Maturational changes of neonatal electroencephalogram: A comparison between intra uterine and extra uterine development

OBJECTIVES To evaluate electroencephalogram (EEG) patterns in very low birth weight premature newborns when reaching term-to-term neonates, thereby comparing extra uterine to intra uterine development. METHODS EEG recordings were obtained between 2 and 14 days of life in 47 preterm (<37 weeks) very low birth weight (⩽1500 g) newborns and repeated when reaching term age (38-42 weeks) in a subsample (n=22). EEG recordings were also obtained in term newborns. Clinical evaluation was performed at birth and at 6 and 12 months. RESULTS Relative to the first EEG, preterm newborns showed a reduction in delta brushes and interburst intervals and increased interhemispheric synchrony, suggesting an improvement in EEG maturation. Further organization in sleep patterns, like a reduction in total sleep time and phase shifts, were also observed. However, when reaching term, preterm newborns still had less mature EEG patterns, phase shifts and transitional sleep than matched controls. Background abnormalities and dysmaturity in preterm newborns during the first EEG predicted adverse neurological outcome later on. CONCLUSIONS EEG patterns in preterm very low birth weight newborns might be influenced by extra uterine development. Specific EEG abnormalities are related to increased risk of neurological disorders. SIGNIFICANCE Extra uterine development of very low birth weight delays the acquisition of maturational EEG patterns.

The inverted CD4:CD8 ratio is associated with gender-related changes in oxidative stress during aging

Aging has been associated with increased generation of free radicals as well as immunosenescence. Previous studies have identified older individuals with inverted T CD4:CD8 cell ratio and increased immunity to cytomegalovirus (CMV). Here, we investigated markers of oxidative stress and antioxidant defences in older individuals with inverted CD4:CD8 T-cell ratio. Sixty-one subjects were identified with inverted CD4:CD8 ratio. Older individuals with a CD4:CD8 ratio <1 had increased levels of plasma advanced oxidation protein products (AOPP) and ferric reducing ability of plasma (FRAP), but reduced levels of thiobarbituric acid reactive substances (TBARS) as compared to subjects with normal CD4:CD8 ratio. The CMV IgG serology was negatively correlated with CD4:CD8 ratio. These markers were more evident among elderly men than women. Our data suggest a close relationship between chronic CMV infection and oxidative profile in older individuals in the midst of its influence on the peripheral T-cell subsets.

The brain-derived neurotrophic factor (BDNF) gene Val66Met polymorphism affects memory performance in older adults.

Objective: Memory impairment is an important contributor to the reduction in quality of life experienced by older adults, and genetic risk factors seem to contribute to variance in age-related cognitive decline. Brain-derived neurotrophic factor (BDNF) is an important nerve growth factor linked with development and neural plasticity. The Val66Met polymorphism in the BDNF gene has been associated with impaired episodic memory in adults, but whether this functional variant plays a role in cognitive aging remains unclear. The purpose of this study was to investigate the effects of the BDNF Val66Met polymorphism on memory performance in a sample of elderly adults. Methods: Eighty-seven subjects aged > 55 years were recruited using a community-based convenience sampling strategy in Porto Alegre, Brazil. The logical memory subset of the Wechsler Memory Scale-Revised was used to assess immediate verbal recall (IVR), delayed verbal recall (DVR), and memory retention rate. Results: BDNF Met allele carriers had lower DVR scores (p = 0.004) and a decline in memory retention (p = 0.017) when compared to Val/Val homozygotes. However, we found no significant differences in IVR between the two groups (p = 0.088). Conclusion: These results support the hypothesis of the BDNF Val66Met polymorphism as a risk factor associated with cognitive impairment, corroborating previous findings in young and older adults.

Consumo de nutrientes em idosos residentes em Porto Alegre (RS), Brasil: um estudo de base populacional

A cross-sectional, population-based study was conducted on a random sample of 427 elderly individuals living in Porto Alegre, Brazil, to establish the nutrient consumption profile and verify its association with sociodemographic and health variables. Dietary intake was assessed using the 24-hour Food Recall Survey and the Dietetic Research Investigation technique. Seventy percent of the elderly respondents were women: 48.5% were between 60 and 69 years old; 68.8% had less than 8 years of schooling; 39% had a family income of between 2 and 5 minimum wages and 58.4% took no physical exercise. Hypertension was the most prevalent disease among the elderly and 54.9% were underweight. Men consumed more calories, protein, fiber, minerals and vitamins than women. Carbohydrate and calcium intake increases with advancing age, while zinc intake decreases. Physical exercise increased the intake of calories, magnesium, potassium and phosphorus. The higher the schooling the greater the intake of vitamins B6 and B12; the higher the family income, the greater the consumption of vitamin B6 and folic acid. The results show that there are nutritional deficiencies in the daily diet of the Brazilian elderly population, especially among women and individuals over 80 years of age.A cross-sectional, population-based study was conducted on a random sample of 427 elderly individuals living in Porto Alegre, Brazil, to establish the nutrient consumption profile and verify its association with sociodemographic and health variables. Dietary intake was assessed using the 24-hour Food Recall Survey and the Dietetic Research Investigation technique. Seventy percent of the elderly respondents were women: 48.5% were between 60 and 69 years old; 68.8% had less than 8 years of schooling; 39% had a family income of between 2 and 5 minimum wages and 58.4% took no physical exercise. Hypertension was the most prevalent disease among the elderly and 54.9% were underweight. Men consumed more calories, protein, fiber, minerals and vitamins than women. Carbohydrate and calcium intake increases with advancing age, while zinc intake decreases. Physical exercise increased the intake of calories, magnesium, potassium and phosphorus. The higher the schooling the greater the intake of vitamins B6 and B12; the higher the family income, the greater the consumption of vitamin B6 and folic acid. The results show that there are nutritional deficiencies in the daily diet of the Brazilian elderly population, especially among women and individuals over 80 years of age.

Pattern of P50 suppression deficit in patients with epilepsy and individuals with schizophrenia

OBJECTIVE To identify P50 suppression in patients with epilepsy, to investigate the effect of seizure control on P50 suppression, and to compare epilepsy patients with individuals with schizophrenia and healthy volunteers. METHOD P50 evoked potential parameters and P50 suppression were studied crossectionally in patients with uncontrolled or controlled epilepsy, in individuals with schizophrenia and in healthy volunteers. RESULTS Individuals with schizophrenia had significantly smaller conditioning stimulus (S1) amplitude, and patients with epilepsy had larger test stimulus (S2) amplitude. Mean S2/S1 ratio was 0.71 ± 0.33 for patients with uncontrolled epilepsy; 0.68 ± 0.36 for patients with controlled epilepsy; 0.96 ± 0.47 for individuals with schizophrenia, and 0.42 ± 0.24 for healthy volunteers. CONCLUSION The sensory filter of patients with epilepsy is altered, and this alteration is not associated with seizure control. Also, it works differently from the sensory filter of individuals with schizophrenia.

Patterns of alcohol use in an elderly sample enrolled in the Family Health Strategy program in the city of Porto Alegre, Brazil

This article aims to determine the pattern of alcohol use in the elderly and its associations with sociodemographic characteristics in an elderly sample of patients from the city of Porto Alegre, Rio Grande do Sul, Brazil. A cross-sectional study was conducted involving 557 seniors, aged 60 years or more, through application of the Mini International Neuropsychiatric Interview and a global assessment questionnaire for the elderly. The majority of the 557 senior citizens did not complete elementary school (58.3%), were white (65.1%), married (37.6%), had no caregiver (62.2%), were catholic (65.5%) and practicing their religion (68.6%), were retired (67.7%), and had a personal income of up to one minimum salary (56.1%). The study revealed 67 (12%) elderly people with a history of alcoholism, of which 17 (3.1%) had a diagnosis of current alcoholism, 50 (9%) had a history of alcohol dependence in the past and 16 (2.9%) had a current alcohol abuse problem. Men had a prevalence ratio of 11.6 times for a history of alcoholism in comparison to women. The results confirm that alcoholism is frequent in the population of Brazilian elderly, drawing attention to some socio-demographic characteristics that can make a difference in the early diagnosis of alcoholism.

Body image satisfaction, sociodemographic, functional and clinical aspects of community-dwelling older adults

Abstract Body image, according to the definition by Ledoux et al.(1) is “the systematic, cognitive, affective, conscious, and unconscious representation that people have concerning their bodies during their biological development and throughout their social relationships”. Objective: To determine the prevalence of body image satisfaction (BIS) and its relationship with sociodemographic, functional and clinical aspects in older adults. Methods: A cross-sectional, analytical and prospective study of a random sample of older adults from all health districts of Porto Alegre (30 health units) was conducted. The following aspects were studied: sociodemographic data (sex, age, marital status and education), BIS (Stunkard’s scale), functional tests (30 seconds Sit/Stand Test, time to walk 10m, Handgrip Strength - HGS), physical activity (Minnesota Questionnaire) and cognition (Mini-Mental State Examination). Results: Most of the 532 participants were dissatisfied with their body image (92.5%), particularly the women (71.7%). After Binary Logistic Regression (6 steps), BIS predictors were: high scores for the Sit/Stand (OR: 1.13; p=0.013), higher HGS (OR: 1.06; p=0.049), shorter time engaged in physical activity (OR: 0.77; p<0.001). Conclusion: The prevalence of BIS was low and most of the variables analyzed bore no relation to BIS. Notwithstanding, a relationship was found with greater HGS, higher Sit/Stand score and less time engaged in physical activity. Given the scarcity of studies on this subject, our study furthers the knowledge on how body image affects this population group.