Luiz Roberto Ramos

Brazilian version of the Berg balance scale

The purpose of the present study was to translate and adapt the Berg balance scale, an instrument for functional balance assessment, to Brazilian-Portuguese and to determine the reliability of scores obtained with the Brazilian adaptation. Two persons proficient in English independently translated the original scale into Brazilian-Portuguese and a consensus version was generated. Two translators performed a back translation. Discrepancies were discussed and solved by a panel. Forty patients older than 65 years and 40 therapists were included in the cultural adaptation phase. If more than 15% of therapists or patients reported difficulty in understanding an item, that item was reformulated and reapplied. The final Brazilian version was then tested on 36 elderly patients (over age 65). The average age was 72 years. Reliability of the measure was assessed twice by one physical therapist (1-week interval between assessments) and once by one independent physical therapist. Descriptive analysis was used to characterize the patients. The intraclass correlation coefficient (ICC) and Pearsons correlation coefficient were computed to assess intra- and interobserver reliability. Six questions were modified during the translation stage and cultural adaptation phase. The ICC for intra- and interobserver reliability was 0.99 (P < 0.001) and 0.98 (P < 0.001), respectively. The Pearson correlation coefficient for intra- and interobserver reliability was 0.98 (P < 0.001) and 0.97 (P < 0.001), respectively. We conclude that the Brazilian version of the Berg balance scale is a reliable instrument to be used in balance assessment of elderly Brazilian patients.

O envelhecimento da população mundial: um desafio novo

Demographic aging as a worldwide phenomenon is described with emphasis on the situation in Brazil up to the year 2025. The causes of demographic aging in developing countries are reviewed and attention is given to the consequences particularly for the provision of health services. The authors also examine concepts such as the quality of life in the context of demographic aging. (SUMMARY IN ENG) (ANNOTATION)

Perfil do idoso em área metropolitana na regiäo sudeste do Brasil: resultados de inquérito domiciliar

A multicentre study concerned with the health needs of the elderly population living in urban areas and coordinated by the Panamerican Health Organization was undertaken in 6 Latin-American countries. In Brazil, 1,602 elderly residents (of 60 years of age and over) in the District of S. Paulo, constituting a multistage random sample stratified by socioeconomic status, participated in a household survey using a multidemensional functional assessment questionnaire. The results showed a highly deprived population (70% had a per capita income of less than US

Applicability of the CERAD neuropsychological battery to Brazilian elderly

100 per month), living mostly in multigenerational households (59% were living with children and/or grandchildren), with a high prevalence of chronic physical illnesses (only 14% referred no illness) and psychiatric disorders (27% were considered psychiatric cases), a high proportion of them showing a loss of autonomy (47% needed help in performing at least one of the activities of daily living). The results are put into perspective concerning future needs in terms of specialized health services and social support for the growing population of elderly people in Brazil.Trata-se de estudo multicentrico visando levantar as necessidades de saude da populacao de idosos residentes em zona urbana, conduzido em 6 paises na America Latina e coordenado pela Organizacao Panamericana da Saude. No Brasil, 1.602 idosos (60 anos e +) residentes no Distrito de Sao Paulo, participaram de inquerito domiciliar com questionario de avaliacao funcional multidimensional - amostra populacional aleatoria, em multiplos estagios, estratificada por nivel socioeconomico. Os resultados mostraram uma populacao bastante carente (70% tinha uma renda per capita de menos de 100 dolares por mes), vivendo predominantemente em domicilios multigeracionais (59% viviam com os filhos e/ou com netos), com alta prevalencia de doencas cronicas (somente 14% referiu nao ter nenhuma doenca) e disturbios psiquiatricos (27% foram considerados casos psiquiatricos), e com uma elevada proporcao de pessoas com perda de autonomia (47% precisavam de ajuda para realizar pelo menos uma das atividades da vida diaria). Os resultados sao analisados tendo em vista as demandas futuras por servicos de saude especializados e suporte social por parte da crescente populacao de idosos no Brasil.

Physical Activity Interventions in Latin America A Systematic Review

There is a limited choice of psychometric tests for Portuguese speaking people which have been evaluated in well defined groups. A Portuguese version of CERAD neuropsychological battery was applied to a control group of healthy elderly (CG) (mean age 75.1 years/ education 7.9 years), 31 Alzheimer disease (AD) patients classified by clinical dementia rating (CDR) as CDR1 (71.4/ 9.0) and 12 AD patients CDR 2 (74.1/ 9.3). Cut-off points were: verbal fluency-11; modified Boston naming-12; Mini-mental State Examination (MMSE) -26; word list memory-13; constructional praxis-9; word recall-3, word recognition-7; praxis recall-4. There was a significant difference between CG and AD-CDR1 (p<0.0001) for all tests. There was a less significant difference for constructional praxis and no difference for Boston naming. Comparison between AD-CDR1 and AD-CDR2 showed difference only for MMSE, verbal fluency, and Boston naming. The performance of CG was similar to that of a US control sample with comparable education level. These results indicate that this adaptation may be useful for the diagnosis of mild dementia but further studies are needed to define cut-offs for illiterates/low education people.

Epidemiologia do envelhecimento no Nordeste do Brasil: resultados de inquérito domiciliar

BACKGROUND Recommendations for physical activity in the Guide to Community Preventive Services (the Community Guide) have not been systematically examined or applied in developing countries such as those in Latin America. The aim of this systematic review was to assess the current evidence base concerning interventions to increase physical activity in Latin America using a modified Community Guide process and to develop evidence-based recommendations for physical activity interventions. METHODS In 2006, a literature review of both peer-reviewed and non-peer-reviewed literature in Portuguese, Spanish, and English was carried out to identify physical activity interventions conducted in community settings in Latin America. Intervention studies were identified by searching ten databases using 16 search terms related to physical activity, fitness, health promotion, and community interventions. All intervention studies related to physical activity were summarized into tables. Six reviewers independently classified the intervention studies by the categories used in the Community Guide and screened the studies for inclusion in a systematic abstraction process to assess the strength of the evidence. Five trained researchers conducted the abstractions. RESULTS The literature search identified 903 peer-reviewed articles and 142 Brazilian theses related to physical activity, of which 19 were selected for full abstraction. Only for school-based physical education classes was the strength of the evidence from Latin America sufficient to support a practice recommendation. CONCLUSIONS This systematic review highlights the need for rigorous evaluation of promising interventions to increase physical activity in Latin America. Implementation and maintenance of school physical education programs and policies should be strongly encouraged to promote the health of Latin American children.

Crescimento da população idosa no Brasil: transformações e conseqüências na sociedade

OBJETIVO: Identificar o perfil multidimensional de idosos residentes em um centro urbano do Nordeste do Brasil. METODOS: Uma amostra de 667 idosos (60 anos ou mais) da cidade de Fortaleza, Ceara, foi selecionada por amostragem estratificada por nivel socioeconomico, aleatoria, em multiplos estagios e sistematica, sendo entrevistada no domicilio atraves de questionario de avaliacao multidimensional. RESULTADOS: A maioria dos idosos foi do sexo feminino (66%) e residia em domicilio multigeracional (75,3%). Mais da metade (51,9%) vivia sem conjuge; 92,4% referiram pelo menos uma doenca; 26,4% foram classificados como casos psiquiatricos e perda da autonomia foi observada em 47,7%; 6,6% foram internados e 61,4% procuraram servicos de saude nos ultimos seis meses. Nas areas mais pobres houve maior prevalencia de domicilio multigeracional, perda de autonomia e morbidade psiquiatrica. CONCLUSOES: Os idosos da cidade de Fortaleza, em sua maioria, residem em domicilios multigeracionais, e apresentam morbidade fisica e mental particularmente alta em areas mais pobres, uma realidade preocupante em termos de seu progressivo impacto sobre os servicos de saude nas proximas decadas.

Effects of a community-based, professionally supervised intervention on physical activity levels among residents of Recife, Brazil.

Sao discutidas as transformacoes sociais e economicas que incidem sobre a vida dos idosos decorrentes do aumento da populacao de 60 anos ou mais, no Brasil. O processo migratorio e a intensa urbanizacao (em 1940 a populacao rural era de 68,8% e em 1980 de 32,4%) afetaram particularmente a populacao idosa dos grandes centros, ou daqueles que envelheceram nestas cidades. Esta nova organizacao social acentuou os problemas de solidao e pobreza dos idosos. Alem desta perda de status social que exclui sua participacao na sociedade moderna, o idoso teve tambem reduzido o suporte emocional no interior de sua familia. Entre os fatores que concorrem para tal, destacam-se a mudanca do padrao do modelo familiar, de extensa para nuclear, a maior mobilidade e o aumento do numero de separacoes e divorcios. O maior periodo de vida da mulher e suas consequencias (reducao de renda, aumento do numero de viuvas e maior frequencia de longos periodos de doencas cronicas), como tambem a mudanca do papel social da mulher no mundo contemporâneo, fazem parte de uma discussao especifica relativa a mulher e a velhice. A questao do trabalho, da aposentadoria e do custo social (coeficiente de dependencia) e outro aspecto abordado.The social and economic transformation which has been occurring in the life of the elderly, and the increase of the Brazilian population aged 60 years or over is discussed. The migration process (in 1940 the rural population was 68.8% and in 1980, 32.4%) and the intense urbanisation in major Brazilian cities has been particularly evident for the elderly population, or for those growing older in these cities. This new social organization had increased the problems of loneliness and poverty among the elderly. Furthermore, as a consequence of the loss of social status which has reduced their participation in contemporary society, the elderly have been loosing the emotional suport within their own families. Traditionally, older people are viewed as an integral part of the family and enjoy high esteem and prestige. There are factors which play an important role in the family changes - these factors are the decrease in the number of children, their dispersion owing to migration and urbanisation, and the increase in the number of divorces between couples. The relatively longer life span of women has brought unique consequences such as a decrease of income, an increase in the number of widows and a longer period of chronic disease, as well as the changing role of women and their participation in the labour force which further diminish the chances of family support. This paper also discusses certain aspects related to the issues of work, retirement and social expenditure (dependency ratio).

Fatores de risco para doenças crônicas não-transmissíveis: inquérito domiciliar no Município de São Paulo, SP (Brasil). Metodologia e resultados preliminares

OBJECTIVES We evaluated the effects of a community-based intervention, the Academia da Cidade program (ACP), on increasing leisure-time physical activity among residents of Recife, Brazil. METHODS We used the International Physical Activity Questionnaire to assess leisure-time physical activity and transport physical activity (i.e., activities involved in traveling from place to place) levels in a random sample of 2047 Recife residents surveyed in 2007. We also examined factors related to exposure to ACP (participation in the intervention, residing near an intervention site, hearing about or seeing intervention activities). We estimated prevalence odds ratios (ORs) of moderate to high leisure-time and transport physical activity levels via intervention exposures adjusted for sociodemographic, health, and environmental variables. RESULTS Prevalence ORs for moderate to high levels of leisure-time physical activity were higher among former (prevalence OR=2.0; 95% confidence interval [CI]=1.0, 3.9) and current (prevalence OR=11.3; 95% CI=3.5, 35.9) intervention participants and those who had heard about or seen an intervention activity (prevalence OR=1.8; 95% CI=1.3, 2.5). Transport physical activity levels were inversely associated with residing near an ACP site. CONCLUSIONS The ACP program appears to be an effective public health strategy to increase population-level physical activity in urban developing settings.

Validity and reliability of the sagittal abdominal diameter as a predictor of visceral abdominal fat

The non-communicable chronic diseases are important causes of death in Brazil, mainly in the great urban centres. There are various risk factors related to these diseases, whose remotion or attenuation would contribute to a fall in mortality. The methodology of the first comprehensive multicenter study into risk factors of non-communicable chronic diseases carried out in Latin America is explained. In Brazil, this study was carried out in the cities of S. Paulo, SP and Porto Alegre, RS. Preliminary results from the city of S. Paulo as to the prevalence of arterial hypertension (22.3%), tabagism (37.9%), obesity (18.0%), alcoholism (7.7%) and sedentarism (69.3%) are presented. These results are compared with existing data from Brazil and other countries, and the relationship between various risk factors and the mortality from cardiovascular diseases in S. Paulo and some developed countries is discussed.As doencas crionicas nao-transmissiveis sao causa importante de morte no Brasil, principalmente nos grandes centros urbanos. Existem inumeros fatores de risco relacionados a este tipo de doencas, cuja remocao, ou atenuacao, pode contribuir para o declinio da mortalidade. Descreve-se a metodologia do primeiro estudo muiticentrico abrangente realizado na America Latina sobre a questao dos fatores de risco de doencas cronicas nao-transmissiveis. No Brasil o estudo foi realizado nos municipios de Sao Paulo, SP e Porto Alegre, RS. Sao apresentados resultados preliminares para o Municipio de Sao Paulo quanto a prevalencia de hipertencao arterial (22,3%), tabagismo (37,9%), obesidade (18,0%), alcoolismo (7,7%) e sedentarismo (69,3%). Os resultados obtidos sao comparados com dados existentes para o Brasil e outros paises, e discute-se a relacao entre a magnitude dos diversos fatores de risco e a mortalidade por doencas cardiovasculares em Sao Paulo e alguns paises desenvolvidos.