Johnnatas Mikael Lopes

Excessive daytime sleepiness in the elderly: association with cardiovascular risk, obesity and depression

OBJECTIVE To observe the relationship between Excessive Daytime Sleepiness (EDS) and the presence of risk factors for cardiovascular dysfunction, depression and obesity in the elderly. METHODS We interviewed 168 elderly from the community of Campina Grande, Paraíba. They were selected according to health districts in the period of 2010. We used the Epworth Sleepiness Scale to diagnose excessive daytime sleepiness (> 10 points); waist circumference for the risk of cardiovascular dysfunction (> 94 or > 80 cm); Geriatric Depression Scale for depression (>10 points) and body mass index for obesity (> 25 kg/m2). Association analysis was performed by the Chi-square test adjusted for sex and age group, adopting α < 0.05. RESULTS One hundred and sixty eight elderly individuals with mean age of 72.34 ± 7.8 years old participated in this study, being 122 (72.6%) women. EDS was identified in 53 (31.5%) of them; depression, in 72 (42.9%); overweight/obesity, in 95 (64.46%); and risk of cardiovascular dysfunction, in 129 (79.6%). Depressed men (78.6%, p = 0.0005) and risk of cardiovascular dysfunction (57.1%, p = 0.02) were more prone to EDS. In women, only obesity was related to sleepiness (42.1%, p = 0.01). Only those aged between 70 - 79 years old showed association between sleepiness and obesity. CONCLUSION It was found that obesity for women, and depression and cardiovascular dysfunction risking for men were associated with EDS in the elderly. The variable sex is a confusion condition for the association with sleepiness.

Seguranca alimentar, renda e Programa Bolsa Familia: estudo de coorte em municipios do interior da Paraiba, Brasil, 2005-2011

This study aims to evaluate the impact of the conditional cash transfer program known as Bolsa Família in overcoming food insecurity. A cohort study was conducted in 2005 and 2011 in a sample of families in São José dos Ramos and Nova Floresta, Paraíba State, Brazil. In 2005, 609 households were interviewed, and in 2011 we located and re-interviewed 406 families. There had been an increase in food security and mild food insecurity and an improvement in socioeconomic indicators. A significant association was observed between higher income and improved food security. The program showed a positive impact by increasing income and providing improved levels of food security and mild food insecurity. Other socioeconomic variables may be contributing to this improvement. The fight against food insecurity and malnutrition thus requires additional policies and programs that act on other determinants.Este trabalho tem por objetivo avaliar o impacto do Programa Bolsa Familia na superacao da Inseguranca Alimentar. Realizou-se um estudo de coorte em 2005 e 2011, em amostra de familias residentes em Sao Jose dos Ramos e Nova Floresta, Paraiba, Brasil. Em 2005 foram avaliados 609 domicilios e em 2011 foram encontradas e entrevistadas 406 familias. Houve aumento da seguranca alimentar/inseguranca alimentar leve e melhoria nos indicadores socioeconomicos. Percebeu-se uma relacao significativa entre a elevacao da renda e a melhoria dos niveis de Inseguranca Alimentar. O programa impacta positivamente no aumento da renda, propiciando melhorias dos niveis de seguranca alimentar/inseguranca alimentar leve. Percebeu-se que outras variaveis socioeconomicas podem estar contribuindo na melhoria deste perfil. Diante disso, no combate a inseguranca alimentar e nutricional, sao necessarias outras politicas e programas que ajam nos demais determinantes.

The role of EEG in patients with syncope.

Abstract EEG is a popular, low-cost examination used in neurologic and nonneurologic evaluations. Nevertheless, the diagnostic usefulness of EEG has some limitations, and it may increase medical costs. The manifestations of syncope may lead to misdiagnoses, and frequently, it is mislabeled as epilepsy. An EEG is usually obtained, yet some studies have suggested that EEGs have little value in diagnosing this condition. We aimed to determine the diagnostic usefulness of EEG in patients with syncope. We retrospectively examined EEG recordings of 10,408 patients. EEG findings were evaluated for all patients with a diagnosis of syncope (syncope, convulsive syncope, loss of consciousness, or sudden unexplained falls), including requests from neurologists and nonneurologists. EEGs were classified into (1) normal, (2) epileptiform discharges (spike/sharp waves), and (3) slow waves. The EEGs were separated according to gender and age. From 1,003 patients with the diagnosis of syncope, 899 (89.53%) were normal, 62 (6.18%) showed bilateral slow waves, 19 (1.89%) right slow waves, 18 (1.79%) epileptiform discharges, and 6 (0.6%) left slow waves. Epileptiform discharges only occurred among females. Left focal sharp waves were disclosed in 18 (50%), generalized discharges in 8 (44.4%), and right focal discharges in 1 (5.6%). Bilateral slow waves were more prevalent among adults. We conclude that EEG is not useful for evaluating the diagnosis of syncope because of its very low diagnostic yield. Patients with syncope must have a correct history and physical examination plus cardiovascular tests.

[Food security, income, and the Bolsa Família program: a cohort study of municipalities in Paraíba State, Brazil, 2005-2011].

This study aims to evaluate the impact of the conditional cash transfer program known as Bolsa Família in overcoming food insecurity. A cohort study was conducted in 2005 and 2011 in a sample of families in São José dos Ramos and Nova Floresta, Paraíba State, Brazil. In 2005, 609 households were interviewed, and in 2011 we located and re-interviewed 406 families. There had been an increase in food security and mild food insecurity and an improvement in socioeconomic indicators. A significant association was observed between higher income and improved food security. The program showed a positive impact by increasing income and providing improved levels of food security and mild food insecurity. Other socioeconomic variables may be contributing to this improvement. The fight against food insecurity and malnutrition thus requires additional policies and programs that act on other determinants.Este trabalho tem por objetivo avaliar o impacto do Programa Bolsa Familia na superacao da Inseguranca Alimentar. Realizou-se um estudo de coorte em 2005 e 2011, em amostra de familias residentes em Sao Jose dos Ramos e Nova Floresta, Paraiba, Brasil. Em 2005 foram avaliados 609 domicilios e em 2011 foram encontradas e entrevistadas 406 familias. Houve aumento da seguranca alimentar/inseguranca alimentar leve e melhoria nos indicadores socioeconomicos. Percebeu-se uma relacao significativa entre a elevacao da renda e a melhoria dos niveis de Inseguranca Alimentar. O programa impacta positivamente no aumento da renda, propiciando melhorias dos niveis de seguranca alimentar/inseguranca alimentar leve. Percebeu-se que outras variaveis socioeconomicas podem estar contribuindo na melhoria deste perfil. Diante disso, no combate a inseguranca alimentar e nutricional, sao necessarias outras politicas e programas que ajam nos demais determinantes.

Associação da depressão com as características sociodemográficas, qualidade do sono e hábitos de vida em idosos do Nordeste brasileiro: estudo seccional de base populacional

Introduction: Depressive disorders can be defined as episodes of depressed mood or loss of interest and pleasure in nearly all activities. Depression is considered a major mental disorder in the elderly, and may be related to quality of sleep and living habits as well as being influenced by sociodemographic factors. Objective: To determine the prevalence of depression among the elderly in the north-east of Brazil, and the relationship between the condition and socio-demographic profile, quality of sleep and living habits. Method: An epidemiological cross-sectional study was performed of the elderly population of the urban area of Campina Grande, Paraiba. The dependent variable presence of depression and the independent variables sociodemographic aspects, sleep quality, and living habits were investigated. Estimates of the prevalence of the variables were obtained and association measured using Poisson Regression. A 5% significance level was adopted for the estimates. Results: The study included 168 elderly patients with a mean age of 72.3 (±7.8) years, most of whom, 122 (72.6%), were women. Depression was identified in 72 elderly persons (42.9%). Elderly women were twice as associated with depression (PR=2.26) as men. A subjective quality of sleep of very good (PR=0.34), medium/high risk of sleep disturbance (PR = 4.08), taking sleeping medications once or twice (PR=5.21) and three times or more (PR=8.69) a week, daytime dysfunction once or twice (PR=14.40) and three times or more (PR=27) a week and poor quality of sleep on the Pittsburgh index were associated with depression in bivariate analysis, although there was no relationship following multivariable adjustment. Conclusion: The prevalence of depression was high in the studied population, being noticeably more frequent among elderly woman. However, it was not possible to detect an association between depression and living habits and sleep quality.

Validation of the two minute step test for diagnosis of the functional capacity of hypertensive elderly persons

1 Universidade Federal do Rio Grande do Norte, Departamento de Saúde Coletiva, Programa de Pósgraduação em Saúde Coletiva. Natal, RN, Brasil. 2 Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Santa Cruz, RN, Brasil. 3 Faculdade Maurício de Nassau, Curso de Fisioterapia. Natal, RN, Brasil. 4 Faculdade de Ciências Médicas de Minas Gerais, Curso de Medicina. Belo Horizonte, MG, Brasil. 5 Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Curso de Fisioterapia. Santa Cruz, RN, Brasil.Objectives : To analyze the accuracy of the 2 minute step test in the diagnosis of the normal functional capacity (FC) of hypertensive elderly individuals or hypertensive elderly individuals with other associated chronic conditions (ACC). Methods : An observational diagnosis type study of 101 subjects, 41 of whom were hypertensive and 60 of whom were normotensive, was carried out. Receiver Operating Characteristic curves (ROC) were constructed based on the normal FC variable. Results : For hypertensive patients, the 2MST, with an under the ROC curve area of 0.7 (95% CI: 0.50 to 0.87, p = 0.04), proved to be accurate at diagnosing FC. Among hypertensive individuals with an elevation of 69, sensitivity of 80% and specificity of 54% were observed. The 2MST was accurate at predicting normal FC among hypertensive patients with ACC, with an under the ROC curve area of 0.88 (95% CI: 0.69 to 1.00, p= 0.02). With an elevation of 65 the sensitivity was 83% and the specificity was 67%. Conclusions : The 2MST revealed good sensitivity and specificity when assessing the FC of elderly hypertensive individuals and elderly hypertensive patients with ACC, which was not the case among normotensive elderly persons.

Factors Associated With Scoliosis in Schoolchildren: a Cross-Sectional Population-Based Study

Background The present study aimed to investigate the prevalence of scoliosis and to analyze the factors associated with scoliosis in schoolchildren aged between 7 and 17 years. Methods This is a cross-sectional and quantitative study with stratified random selection of public school students in the city of Santa Cruz, Brazil. The presence of scoliosis was examined, as well as the flexibility of the posterior muscle chain, socioeconomic characteristics, anthropometry, lifestyle habits, sexual maturation, and ergonomics of school furniture. In order to identify factors associated with scoliosis, the variables were divided in biological, socioeconomic, lifestyle, and ergonomic factors, and crude and adjusted prevalence ratios (PRs) were estimated by means of Poisson regression analysis. Results Two hundred and twelve pupils participated in this study (mean age 11.61 years, 58% female). The prevalence of scoliosis was 58.1% (n = 123) and associated with female sex (PR 2.54; 95% CI, 1.33–4.86) and age between 13 and 15 years (PR 5.35; 95% CI, 2.17–13.21). Sleeping in a hammock was inversely associated with scoliosis (PR 0.44; 95% CI, 0.23–0.81). Conclusions Scoliosis seems to be positively associated with female sex and age between 13 and 15 years, whereas the habit of sleeping in a hammock is negatively associated with the onset of scoliosis.

Cultura de segurança do paciente em três hospitais brasileiros com diferentes tipos de gestão

Resumo O objetivo do estudo foi avaliar a cultura de seguranca do paciente e fatores associados em hospitais brasileiros com diferentes tipos de gestao: federal, estadual e privado. O desenho foi observacional transversal. Enviaram-se 1576 questionarios aos profissionais de tres hospitais do estado do Rio Grande do Norte, utilizando o Hospital Survey on Patient Safety Culture, adaptado para o Brasil, que mede 12 dimensoes da cultura de seguranca. As percepcoes sao descritas atraves de uma nota geral (0 a 10) e dos percentuais de respostas positivas para estimar fortalezas e fragilidades em cada dimensao. A taxa de resposta foi de13,6% (n = 215). A seguranca do paciente teve nota entre 7 e 10, para 78,1% dos respondentes, sendo a maior media das notas apresentada pelo hospital privado (8,32). O tipo de gestao hospitalar, unidade de servico, cargo e quantidade de notificacao de eventos adversos estiveram associados a nota geral da seguranca do paciente (p < 0,001). Apenas o hospital privado apresentou fortalezas nas dimensoes analisadas, enquanto que as fragilidades apareceram em todos os hospitais.

Klapp method effect on idiopathic scoliosis in adolescents: blind randomized controlled clinical trial

[Purpose] To estimate the effect of Klapp method on idiopathic scoliosis in school students. [Subjects and Methods] A single-blind randomized clinical trial with 22 students randomly divided into intervention group (n=12) and inactive control group (n=10). Exercise protocol consisted of Klapp method, 20 sessions, three times a week for intervention group, and inactivity for control group. Dorsal muscle strength was measured by dynamometer; body asymmetries and gibbosity angles were measured by biophotogrammetry. Data were obtained by Generalized Estimated Equation, with 5% significance level. Clinical impact for dependent variables was estimated by “d” Cohen. [Results] There was no change in intragroup analysis and intergroup for all postural symmetry variables. However, it was detected intergroup difference in extensor muscle strength and intergroup difference with marginal significance of gibbosity angles. Regarding extensor muscle strength, intervention group produced average improvement of 7.0 kgf compared to control group. Gibbosity angles progressed less in intervention group, with 5.71° average delay compared to control group. [Conclusion] Klapp method was effective for gibbosity stabilization and it improves spine extensor muscle strength.

Hospitalização por acidente vascular encefálico isquêmico no Brasil: estudo ecológico sobre possível impacto do Hiperdia

OBJECTIVE The study evaluated the trend of hospitalization for ischemic stroke (HIS) and its hospital mortality in Brazil over the last 15 years as well as the impact of the Hiperdia program in this scenario. METHODS An ecological study was designed with analytical approach and data collected in the Hospital Admission System on episodes of stroke, over the years 1998 to 2012. All data were stratified by sex and age, creating an indicator for HIS and proportion of hospital mortality. To estimate the trend of the data a polynomial curve fitting was created; and the Generalized Linear Model was applied to investigate the impact of Hiperdia on the endpoint HIS and hospital mortality. We adopted a 5% significance level to minimize an error type I. RESULTS We observed a reduction of HIS from 37.57/105 inhabitants in 1998 to 2001 to 10.33/105 inhabitants in 2002 to 2005, declining 73.64%. The reduction occurred in both sexes and for all age groups. The mortality rate of ischemic stroke also declined in Brazil since 2002, in both men and women, therefore in less than 3%; and only in the groups aged between 0 and 14 and above 80 years, we did not detect trend. CONCLUSION Therefore, the decline of HIS temporally coincided with the implementation of Hiperdia in 2002 and this trend continues today.