Luísa Scheer Ely

Alcoolismo e tabagismo em idosos: relação com ingestão alimentar e aspectos socioeconômicos

Abstract Objectives : To determine the prevalence of alcoholism and smoking among theelderly living in Porto Alegre city and to establish an association between dailyfood intake and socioeconomic status according to sex, age group, income,location and family composition. Methods : This research was conducted asMultidimensional Study of the Elderly in Porto Alegre city (EMIPOA), whichwas developed by the IGG/PUCRS. The interviews were conducted in theambulatory of the Institute of Geriatrics and Gerontology, Hospital Sao Lucas ofPUCRS. We administered a questionnaire with socioeconomic data and healthdata by trained professionals. Results : Of the 832 respondents, 71.2% were womenand 28.8% men. The most prevalent age range was 60 to 69 years (44.8%).Prevalence in the age group above-mentioned 7.5% for alcoholics and 23.9% forsmokers. Alcoholism and smoking prevailed among men, 11.7% and 20.8%respectively. Regarding education, the highest prevalence was among alcoholicsand smokers who had only 1 degree, 4.7% and 16.1%, respectively. It was observedthat among the elderly alcoholics or smokers, most do not have familyrelationship (

Hematological parameters and prevalence of anemia among free-living elderly in south Brazil

Objective The aims of this study were to analyze the hematological parameters, the prevalence of anemia and the association between anemia and socioeconomic conditions in an elderly community-based population. Methods A population-based study was performed as part of the Multidimensional Study of the Elderly in Porto Alegre, Brazil (EMIPOA). An initial total of 1058 community residents aged 60 years and older were interviewed. Of these, 392 agreed to have a physical evaluation and a blood sample was taken from each. The hematological parameters analyzed in the blood samples included the hemoglobin concentration, mean cell volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and red cell distribution width (RDW). The association between the variables and the diagnosis of anemia was assessed using the chi-squared test and a multiple logistic regression model. Results The overall prevalence of anemia was 12.8%. Anemia was present in 13.7% of women and in 10.4% of men. Normocytic normochromic anemia without anisocytosis was the most common type of anemia (46%). The assessment of erythrocyte morphology showed significant differences between anemic and non-anemic individuals (microcytosis = 12% vs. 1.5%, hypochromia = 40% vs. 8.8%, and anisocytosis = 26% vs. 7%). In the analysis of socioeconomic conditions, significant differences were found in respect to age and race. Conclusion The prevalence of anemia increases with age and is associated with race, microcytosis, hypochromia and anisocytosis. Anemia is not a condition that should be associated only with the aging process, as it may be due to pathological conditions that occur most frequently in this age group. As a result, a diagnosis of anemia warrants adequate clinical attention.

Tabagismo em idosos

Smoking cigarettes is an important accelerator of the aging process which compromises the life expectancy, and the quality of life. Smokers over 50 years old have a higher dependence on nicotine, smoke more cigarettes, smoke longer, have more health problems related to smoking and have more difficulty in quitting smoking. The main causes of death from smoking are cardiovascular diseases, chronic obstructive pulmonary disease and lung cancer. Nowadays, there are a number of strategies to stop smoking cigarettes, non-pharmacological and pharmacological, which are also advantageous for the elderly. This study aims to report data on smoking in Brazil and in the world, the pathology involved and the toxic effects of cigarette components as well as suggest treatment strategies, especially in the elderly. We examined published articles from the databases: Pubmed, Scielo, Portal Capes, Ministerio da Saude, Instituto Nacional do Cancer, IBGE and the World Health Organization. We concluded that smoking is a source of risk and major cause of numerous diseases. But the desire to quit is higher among those who recognize that this habit affects their health. While the benefits of stopping smoking are higher among younger, smoking cessation at any age reduces the risk of death and improves the general health condition.

Prevalência de enteroparasitos em idosos

OBJECTIVES: To evaluate the prevalence of intestinal parasites in elderly patients from a geriatric ambulatory in Porto Alegre, Rio Grande do Sul state, Brazil, and in elderly residents of two long-stay institutions in the same city, as well as to evaluate the presence of enteroparasites in the elderlys pets. METHODS: Stool samples from the elderly and the pets were analyzed through fecal parasitological examination. To evaluate the enteroparasites, macroscopic exam, concentration methods of Hoffman, Pons and Janer and the Baermann-Moraes method were used. Socioeconomic conditions and hygiene habits were evaluated, and for the elderly that had pets a questionnaire about their way of life was applied. RESULTS: 310 elderly were studied with mean age of 78.6±8.4 years old, 77.1% were women and 22.9% were man. The prevalence of intestinal parasites was 12.9% for the elderly from the geriatric ambulatory and 12.9% for the institutionalized elderly. The results showed no association between enteroparasites from pets and their owner, because no elder who had a pet with parasitic disease presented positive result in fecal examination. CONCLUSIONS: The prevalence of enteroparasites in the elderly from Porto Alegre was lower than in other studies. These results showed that each geographic area has its socioeconomic, environmental, and educational peculiarities. The studies should be continued in the elderly from different areas of Rio Grande do Sul and Brazil to identify particular situations. Sanitary measures and education can be proposed based on such studies to improve population health.

The Association Between the Chronic Use of Non-Steroidal Anti- Inflammatory Drugs and Oxidative and Inflammatory Markers in the Elderly

OBJECTIVES Investigate the association between the chronic or occasional use of nonsteroidal anti-inflammatory drugs (NSAIDs) and plasma levels of oxidative and inflammatory markers in elderly at the Family Health Strategy in Brazil. METHODS It was a cross-sectional study of data collected from random elderly volunteers. A questionnaire including sociodemographic, health and medicine use data was administered. The blood levels of FRAP (ferric reducing ability of plasma), AOPP (plasma advanced oxidation protein products), MDA (malondialdehyde) and insulin were measured. RESULTS The study sample comprised 758 elderly patients, of which 121 (15.96%) used NSAIDs. The mean age was 68.53 years and 68.41 for individuals who used NSAIDs occasionally and chronically, respectively. Gastric problems may be associated with the chronic or occasional use of NSAIDs (P = 0.042). Which indicates mean plasma levels of Insulin and HOMA-IR (Homeostasis Model Assessment Insulin Resistance) are increased in chronic use of NSAIDs and describes a statistical trend (P = 0.065) for the association of chronic NSAIDs use with the BMI (body mass index) of the subjects studied. CONCLUSION This study suggests that there is no association between the chronic or occasional use of NSAIDs and oxidative and inflammatory markers. It is known that NSAIDs have innumerable adverse effects, but they can have some benefits. So, additional studies are needed to clarify whether NSAIDs are associated with these markers and whether they are related with their real consequences.

Uso de anti-inflamatórios e analgésicos por uma população de idosos atendida na Estratégia Saúde da Família

The aim of this study was to analyze the prevalence of the use of anti-inflammatory and analgesic drugs among elderly persons from the Family Health Program in Porto Alegre, Rio Grande do Sul, and investigate associated factors such as sociodemographic and health data; continuous or as needed use of drug, drug used subject to medical prescription or self-medicated. Data collection occurred between March 2011 and December 2012. Community health workers applied a questionnaire relating to sociodemographic and health data and medication use. Non-steroidal antiinflammatory drugs, glucocorticoids, non-opioid analgesics and opioids were evaluated. A total of 758 elderly persons were included and anti-inflammatory and analgesic drugs were used by 28.8% of the population. Acetaminophen and ibuprofen were the most frequently used drugs. Regarding self-perception of health, the worse the perception of health, the greater was the use of therapy ( p<0.001). Liver disease and osteoarthritis/ arthritis/rheumatism were found to be associated with anti-inflammatory and analgesic use ( p<0.001). The prevalence of anti-inflammatory and analgesic use was considered moderate when compared to previous studies (28.8%). In addition, most of the elderly persons used the drugs when only needed, most probably due to feeling minor to moderate pain or because they had suffered the adverse effects of these medications in the past and so chose to use them sporadically.

Soroepidemiologia de Toxoplasma gondii em idosos atendidos pela Estratégia Saúde da Família, Porto Alegre, Rio Grande do Sul, Brasil

The aim of this study was to evaluate the seroprevalence of Toxoplasma gondii and relate it to the socioeconomic, hygienic, sanitary and health conditions of the elderly of the Family Health Strategy (FHS) in the city of Porto Alegre, Rio Grande do Sul, Brazil. The research involved a cross-sectional study in which a questionnaire with epidemiologic questions was applied and blood samples were taken. The assessment of IgG and IgM anti-T. gondii was performed using the ELISA technique. Seroprevalence was evaluated among 599 elderly individuals with 88% for IgG anti-T. gondii and with 0.8% for IgM. In the multivariate analysis, the variables that associated themselves independently with positive IgG were age range, personal income and wearing spectacles. Those associated with positive IgM were age, self-rated health and wearing spectacles. The results call attention to the high prevalence of IgG anti-T. gondii in elderly individuals in the FHS in Porto Alegre, generating concern in the event that the reactivation of toxoplasmosis and the development of more severe symptoms of this infection occur.

Evaluation of prescription understanding by elderly attended by Unified Health System, Porto Alegre, RS, Brazil

Aims: This article aimed to evaluate the use of drugs and to correlate the understanding of the prescription with the elderly lipid profile and blood pressure. Methods: It was an observational, cross-sectional, quantitative study, which evaluated 97 records of the elderly outpatient from Single Health System of the Institute of Geriatrics and Gerontology (IGG) and the University Extension Center (UEC) Villa Fatima, Porto Alegre/RS from 2008 to 2009. Results: The results revealed that the lack of understanding might be related to the progression of age of the population. The prescription understanding of the patients attending the IGG was higher when compared to the elderly who attended the UEC (p<0.05). The parameters of blood pressure and dyslipidemia are not directly correlated to the understanding of the prescription. Conclusions: Thus, it is necessary to work towardsfollowing of pharmacotherapy from elderly patients to improve therapy adhesion in this population.

Prevalência de enteroparasitoses em idosos da Estratégia Saúde da Família de Porto Alegre, Brasil

132 Geriatr Gerontol Aging, Vol. 10, Num. 3, p.132-9 Engroff P, Ely LS, Silva AB, Viegas K, Loureiro F, Gomes I, DeCarli GA 133 Geriatr Gerontol Aging, Vol. 10, Num. 3, p.132-9 INTRODUCTION Intestinal parasites in the human intestinal tract are responsible for symptoms such as diarrhea, malnutrition, anemia, and psychosocial changes, among others.1 Intestinal parasitic infections are common in children, and therefore, this population is the primary focus of prevention and treatment campaigns. In the elderly population, little is known about the influence of parasites on aging. It is believed that intestinal parasite infections can be more severe in the elderly due to the aging of the immune system.2-4 Three epidemiological factors are required for the occurrence of parasitic disease: • suitable host conditions, including nutritional status; • cultural and behavioral factors; • the resistance of the parasite to the host immune system and the environment.5,6 Few epidemiological studies examine only elderly populations. Previous studies have reported cases in certain areas where the prevalence of intestinal parasitic infections in elderly population ranges from 9.5% to 72.8%.3,7-11 To understand the reality and needs of each region, the Family Health Strategy (FHS) team, which is part of the Unified Health System in Brazil, implements health surveillance, promotion, prevention, and disease control activities.12 The use of epidemiological tools and the collection of survey data by Community Health Workers (CHW) regarding the social and environmental factors that may affect human health enable closer proximity of health services to the population.13 Certain environmental factors may interfere with the disease process and increase the risk of contamination by intestinal parasites. Despite the development of new sanitation technologies, the health system in Brazil is not suitable, and deficiencies have been noted in the health education provided to the population, especially low-income individuals.14 Therefore, this study aimed to determine the prevalence of intestinal parasites and identify the association between this prevalence and the sociodemographic, environmental, and health factors of the FHS elderly residing in the city of Porto Alegre, RS, Brazil. METHOD This study is part of the “The multidimensional study of the elderly in the Family Health Strategy in Porto Alegre, Brazil (EMI-SUS)”, which occurred between March 2011 and December 2012. This prospective, randomized cross-sectional study was conducted on a sample of elderly individuals who were registered in the FHS in the municipality of Porto Alegre. To select the study participants, FHS teams were stratified by Health Districts (HD), and approximately 30% of the teams from each HD were selected; for the 30 FHS teams selected, 36 respondents were randomly selected from each FHS.15 The inclusion criteria for the study were as follows: older than 60 years of age and registered in the FHS. This project was approved by the Ethics Committees of PUCRS (protocol 10/04967) and of the Municipal Health Secretary of Porto Alegre (protocol 001.021434.10.7). Data collection was performed in two steps. First, during home visits, the CHW invited the elderly to participate in the study, obtained their consent and prepared a general questionnaire to collect the epidemiological variables. At this time, the CHW also informed each participant about the required fecal sample collection. Second, the project team collected blood and stool samples at the healthcare unit where each elderly individual was registered. Blood samples were collected into a tube containing EDTA, and fecal samples were collected into a plastic pot with screw top and stored in a refrigerator for no more than three days. Parasitological stool examinations (PSE) were conducted by the Biochemistry, Molecular Genetics and Parasitology Laboratory of the Institute of Geriatrics and Gerontology using the spontaneous sedimentation technique16 and the Baermann-Moraes method17 for all the samples. Hemograms were performed by the Clinical Pathology Laboratory of Hospital São Lucas by fluorescence flow cytometry (Sysmex XT 2000 – Kobe, Japan). Anemia was defined using the WHO hemoglobin values (< 13 g/dL for men and < 12 g/dL for women).18 Eosinophilia was considered present when the blood eosinophil value was above 400/uL. The following variables were used to test the correlation between the socioeconomic status of the 13 regions of Porto Alegre (Center, South, Center/South, Axis Baltazar, North, Humaitá/Navegantes, Restinga, East, Partenon, Lomba do Pinheiro, Glória, Cruzeiro and Northeast) with the prevalence of intestinal parasites: indicators of inadequate housing, water supply, sewage, and pavement. The georeferenced socioeconomic indicators, based on the 2010 Population Census of the Brazilian Institute of Geography and Statistics, were obtained from the Observatory of the City of Porto Alegre.19 The indicators for water supply and pavement, given originally as the number of houses with an adequate supply, were recalculated to show the number with an inadequate supply. The 30 FHS teams selected for the study were distributed across 13 of the 17 regions. Statistical analysis was performed in SPSS version 17. The variables were described as frequencies, means, and standard deviations. The χ2 Pearson test was used to compare the frequencies of the different variables. The χ2 test for linear Prevalence of intestinal parasites in the elderly 134 Geriatr Gerontol Aging, Vol. 10, Num. 3, p.132-9 trend was used to compare ordinal variables. If variables in the Pearson test had one or more cells with an expected value of less than five, they were analyzed using Fisher’s exact test. The significance level was p < 0.05. The multivariate analysis used binary logistic regression; the entry criterion for all variables was p < 0.300. In the final model, the variables were maintained if the independent p values were less than 5%. RESULTS Of the 1.080 randomly selected elderly individuals, 764 answered the epidemiological questionnaire, 608 provided fecal samples, and 581 provided blood samples. Therefore, after applying the exclusion criteria, a total of 581 elderly individuals participated in this study. The mean age was 68.2 ± 7.0 years, and 376 of the participants were female (64.7%). The overall prevalence of intestinal protozoans and helminthes was 10.8% (95%CI 8.6 – 13.6), and the prevalence of pathogenic parasites was 2.8% (Giardia lamblia, n = 6; Ascaris lumbricoides, n = 4; Strongyloides stercoralis, n = 3; Trichuris trichiura, n = 2; Iodamoeba bütschlii, n = 1) (95%CI 1.7 – 4.4). Co-infection was observed in only five individuals (Endolimax nana + Entamoeba coli, n = 3; Entamoeba coli + Giardia lamblia, n = 1; Entamoeba coli + Iodamoeba bütschlii, n = 1). The prevalence of intestinal parasites is described in Table 1. In the bivariate analysis, there were no statistically significant relationships between the prevalence of intestinal parasites and the socioeconomic and demographic variables (Table 2). Table 3 presents the hygienic and sanitary variables. The elderly who reported having other pets had a higher prevalence of intestinal parasites (27.8%) than those who had dogs and cats or who did not have pets (p = 0.041). The elderly who had animals that were bathed weekly showed a higher prevalence of intestinal parasites (16.0%) than those who were bathed less frequently (p = 0.024). Intestinal parasites N % Endolimax nana 29 42.7 Entamoeba coli 23 33.8 Giardia lamblia 6 8.8 Ascaris lumbricoides 4 5.9 Strongyloides stercoralis 3 4.4 Trichuris trichiura 2 2.9 Iodamoeba bütschlii 1 1.5 Total 68 100 Table 1. Description of intestinal parasites species Variable Population n (%) Prevalence of intestinal parasites % p Gender Female 376 (64.7) 10.1 0.439 Male 205 (35.3) 12.2 Race* White 374 (65.2) 9.9 0.479# Black 108 (18.8) 14.8 Mulatto 77 (13.4) 9.1 Others 15 (2.6) 6.7 Marital status* Married 226 (39.2) 13.7 0.230 Single 99 (17.2) 6.1 Separated 94 (16.3) 10.6 Widowed 157 (27.3) 10.2 Education* Illiterate 73 (12.6) 9.6 0.695Ɨ Incomplete primary school/school dropout 415 (71.6) 10.8 Primary school 56 (9.7) 12.5 High school or above 36 (6.2) 11.1 Age group (years) 60–69 376 (64.7) 11.4 0.404Ɨ 70–79 159 (27.4) 10.7 80 or above 46 (7.9) 6.5 Income* No income 45 (8.2) 6.7 0.572Ɨ Up to 1 BS 309 (56.3) 11.3 More than 2 BS 195 (35.5) 11.3 Cohabitants* Spouse and family 159 (27.6) 13.8 0.264 No spouse; others 194 (33.7) 9.8 Only spouse 118 (20.5) 12.7 Lives alone 105 (18.2) 6.7 Own professional activity?* Yes 118 (20.6) 13.6 0.286 No 454 (79.4) 10.1 Total 581 (100.0) 10.8 95CI% 8.6 – 13.6 BS: basic salary (~

Atenção farmacêutica e bioética: o pressuposto da beneficência

310.00) #p value calculated by Fisher’s exact test. Ɨp value calculated by Fisher’s exact test for linear trend. *Some individuals did not answer this question so were considered missing. Table 2. Description of socioeconomic and demographic variables according to the prevalence of intestinal parasites Engroff P, Ely LS, Silva AB, Viegas K, Loureiro F, Gomes I, DeCarli GA 135 Geriatr Gerontol Aging, Vol. 10, Num. 3, p.132-9 In the final multivariate analysis, the variables that were independently associated with seropositivity to intestinal parasites were the presence of animals other than dogs or cats (birds, chicken, sheep, and goats; OR = 0.208; p = 0.046) and having pets that were bathed weekly (OR = 11.31; p = 0.027). Evaluating the association with other health variables (Table 4), we observed that the elderly who did not have hypertension (15.4%) or did not have mental diseases (depression, mood disorders, cognitive impairment, and dementia; 12.8%) had a higher prevalence of intestinal parasites than #p value calculated by Fisher’s exact χ2 test. *Some individuals did not answer this question so were considered missing. Variable Population n (%) Prevalence of intestinal parasites