Marcos Aparecido Sarria Cabrera

Obesidade em idosos: prevalência, distribuiçäo e associaçäo com hábitos e co-morbidades

Objective: The goal was to define the prevalence of global and central obesity through the body mass index (BMI) and the waist-to-hip ratio (WHR). Besides, the associations between BMI and WHR were evaluated as the risk factors related to the excess of body fat and to the central pattern of distribution of fat, such as diabetes mellitus (DM), hypertension, hypercholesterolaemia, low levels of high density lipoprotein cholesterol (HDL-c), hypertriglyceridaemia, smoking, practice of physical activities, and social level. Methodology: Through a cross-sectional study, 847 outpatients 60 years old or more were evaluated. Results: Obesity was detected in 9.3% of the men and 23.8% of the women (p = percentile 75 (WHR> 1.01 for men and WHR> 0.96 for women) presented higher frequencies of hypertension, DM, low HDL-c, and hypertriglyceridaemia in the male and hypertension and DM in the female. Conclusions: The results reveal differences in relation to sex, with men presenting lower prevalence of obesity and higher associations between BMI or WHR, with risk factors related to the body fat. The data obtained contribute to the amplification of the anthropometric reference of the elderly, besides identifying the characteristics of the correlations between the anthropometric indicators and the metabolic alterations associated with obesity.

Prevalência de obesidade abdominal em hipertensos cadastrados em uma Unidade de Saúde da Família

FUNDAMENTO: A obesidade abdominal e importante fator de risco cardiovascular e, juntamente com as dislipidemias, a intolerância a glicose e a hipertensao arterial, compoe a sindrome metabolica. OBJETIVO: Verificar a prevalencia de obesidade abdominal e fatores associados em hipertensos. METODOS: Estudo transversal com hipertensos de 20 a 79 anos cadastrados em uma Unidade Saude da Familia do municipio de Londrina, Parana. A obesidade abdominal foi identificada por meio da relacao cintura-quadril (RCQ) e da circunferencia abdominal (CA), conforme pontos de corte recomendados pela Organizacao Mundial de Saude (RCQ > 1,0 e CA > 102 cm para homens, e RCQ > 0,85 e CA > 88 cm para mulheres). RESULTADOS: Entre os 378 entrevistados, a prevalencia de obesidade abdominal identificada pela RCQ foi de 65,3% nos adultos e 68,1% nos idosos, sendo de 87,9% no sexo feminino e de 30,2% no masculino (p < 0,001). Nas mulheres, a RCQ elevada esteve associada ao relato de colesterol aumentado, nao realizacao de atividade fisica regular, ausencia de trabalho remunerado e baixa escolaridade. Nao houve associacao de RCQ elevada com quaisquer variaveis no sexo masculino. A circunferencia abdominal elevada esteve presente em 66,8% dos adultos e 64,3% dos idosos, tambem com diferencas entre os sexos (p < 0,001). A CA elevada mostrou-se associada, no sexo feminino, ao diabete e ao nao tabagismo, e, entre homens, ao diabete e a nao realizacao de atividade fisica regular. CONCLUSAO: Esses resultados mostram uma alta prevalencia de obesidade abdominal, especialmente no sexo feminino, reforcando a necessidade de estrategias que promovam a diminuicao da obesidade abdominal entre hipertensos.

Caracterização da dor crônica e métodos analgésicos utilizados por idosos da comunidade

OBJECTIVE: To characterize chronic pain and analgesic approaches in community- dwelling elderly of the northern district of Londrina - Brazil. METHODS: Cross-sectional study with individuals 60 years old and more, resident in the local area of a Basic Health Unit (UBS) of Londrina, by home inquiry. Chronic pain was defined as pain lasting for six months or more. The elderly with pain, were questioned about characteristics of the pain as regards location, duration, frequency, intensity, improvement and worsening situations, as well as the impact of pain in the quality of life and also about analgesic approaches. RESULTS: One hundred and seventy two elderly were interviewed (101 women and 71 men). Presence of chronic pain was observed in 107 (62.%) of these 69.3% were female and 52.1% male (p = 0.004). The very old people, 80-year-old or more (p=0.01) and the depressive elderly (p=0.0008) presented higher frequency of chronic pain. Most prevalent pains were in the legs and back, with 31.2% each, and the majority of elderly referred to continuous, daily high intensity pain. Regarding analgesic approaches, the pharmacologic method was mentioned by 86 elderly (80.4%) and simple analgesic (32.6%) was the most used. CONCLUSION: Facts show that there is a high predominance of chronic pain in the population of elderly, mainly in women, in very old people and in depressive individuals.

Condições de saúde bucal de idosos de comunidade urbana de Londrina, Paraná

OBJETIVO: Verificar a condicao dentaria e periodontal, o uso e necessidade de protese, e a presenca de lesoes associadas ao uso de protese em idosos residentes em uma area urbana do municipio de Londrina, Parana. METODO: Estudo transversal, com coleta dos dados por meio de visitas domiciliares que incluiram entrevista e exame odontologico em idosos de 60 a 74 anos e funcionalmente independentes. RESULTADOS: A media de idade dos 267 idosos examinados foi de 66,5 anos, 59,2% nunca estudaram ou tinham escolaridade inferior a 4 anos de estudo e 59,9% eram mulheres. O indice de dentes cariados, perdidos e obturados encontrado foi de 27,9, com maior participacao dos dentes perdidos (85,9%). A media de dentes presentes entre as mulheres (5,7 dentes) foi menor do que entre os homens (11,6 dentes) (p<0,01). O edentulismo foi detectado em 43,1% dos idosos, e a presenca de 20 dentes naturais ou mais em 8,8% das mulheres e 28% dos homens (p<0,01). Dos 408 sextantes que possibilitaram avaliacao periodontal, 49,2% apresentavam bolsa periodontal. A necessidade de protese foi de 45,7% na arcada inferior e 19,1% na superior, com maior frequencia no sexo masculino. Dos 204 individuos que usavam protese, 40,7% apresentavam lesoes de mucosa. CONCLUSAO: Os resultados obtidos indicam que os idosos da comunidade avaliada apresentam elevadas prevalencias de problemas bucais, com necessidade de tratamento odontologico, com diferencas entre homens e mulheres, e que ha necessidade de programas de saude bucal que atendam as necessidades especificas da populacao idosa.

Factors associated with negative self‐perception of oral health among elderly people in a Brazilian community

OBJECTIVE Self-perception of oral health is an important measurement for assessing the health and quality of life of elderly people. The aim of this study was to analyse associations between negative self-perception of oral health and poor oral state, socio-demographic variables, depression and use of medications. METHOD In this cross-sectional study, elderly people aged 60 to 74 years living in the urban zone of a city in southern Brazil were interviewed and examined. Functionally dependent individuals were excluded. Self-perception was measured using the General Oral Health Assessment Index, and scores of 30 points or less were considered to represent negative perception. The physical, social and worry dimensions of this indicator were also analysed. RESULTS Two hundred and sixty-seven elderly people (mean age 66.5 years, 59.9% female) were included in the study. Most of them had had little schooling. Negative self-perception was identified in 18.7%, although none of the poor oral state was associated with this variable. In multivariate analysis, negative self-perception was associated with female gender and depression. The women presented significantly lower means in the three dimensions analysed and individuals with depression, in the physical and social dimensions. Poor oral health (edentulism and absence of posterior occlusion) were associated with the physical dimension. CONCLUSION Negative self-perception of oral health was associated with gender and depression, but not with poor oral health. Therefore, gender and the presence of depression are factors to be taken into account in assessments involving this age group.

Adesão ao tratamento farmacológico e não farmacológico e fatores associados na atenção primária da hipertensão arterial

A cross-sectional study was conducted with 385 hypertensive patients between 20 and 79 years of age in a family health unit in Londrina, State of Parana, Brazil, to determine the adherence to pharmacological and non pharmacological treatment for arterial hypertension in primary healthcare and identify associated factors. The adherence to pharmacological treatment was 59%. Regular physical activity was reported by 68 (17.7%) hypertensive patients and 266 (69.1%) mentioned dietary changes. In the multiple regression analysis, adherence to drug treatment was associated with: increased age (50 to 79), consulting with a physician at least once a year, no regular alcohol consumption and previous myocardial infarction. Hypertensive males, with education up to 4th grade and above, who had at least one consultation per year, with diabetes or no history of high cholesterol, were more adherent to physical activity. Dietary changes were associated with education below the 4th grade and consulting with a physician at least once a year. These results show variable levels of adherence to treatment and demonstrate the importance of comprehensive actions in the care for hypertensive patients.

A prospective study of risk factors for cardiovascular events among the elderly.

Objective To analyze the impact of cardiovascular (CV) risk factors on the occurrence of fatal and non-fatal CV events in elderly individuals. Methods The present research was a prospective cohort study of 800 elderly Brazilian outpatients (60 to 85 years old) with a 12-year follow-up period (baseline: 1997–1998). The outcome variable was CV mortality or non-fatal CV events (stroke, infarction, angina, heart failure). Hypertension, diabetes, global and abdominal obesity, dyslipidemias, and metabolic syndrome were analyzed as independent variables. The analyses were based on Cox proportional hazard models and adjusted for gender, age range, smoking, regular physical activity, and previous cardiovascular disease. Results A total of 233 fatal and non-fatal CV events were observed (29.1%). In the adjusted analysis, the following variables were associated with CV risk: hypertension hazard ratio (HR): 1.69; confidence interval (CI) 95%: 1.28–2.24, diabetes (HR: 2.67; CI 95%: 1.98–3.61), metabolic syndrome (HR: 1.61; CI 95%: 1.24–2.09), abdominal obesity (HR: 1.36; CI 95%: 1.03–1.79), hypertriglyceridemia (HR: 1.67; CI 95%: 1.22–2.30) and high triglyceride/HDL-c ratio (HR: 1.73; CI 95%: 1.31–2.84). Hypertension, diabetes, and dyslipidemia remained associated with CV risk regardless of abdominal obesity. Conclusion In this prospective study, hypertension, diabetes, metabolic syndrome, abdominal obesity, and hypertriglyceridemia were predictors of CV risk in elderly individuals. These results confirm the relevance of controlling these CV risk factors in this age group.

Influenza vaccination in non-institutionalized elderly: a population-based study in a medium-sized city in Southern Brazil

Vaccination is the most effective measure to prevent the complications of influenza. This population-based study aimed to estimate influenza vaccine coverage in non-institutionalized elderly, analyze the factors involved in lack of influenza vaccine uptake, and identify post-vaccination adverse effects. The study population lived in an urban neighborhood in Southern Brazil, and the sample consisted of 425 elderly. A total of 396 elderly individuals (age 60-95 years) were interviewed. Although 100% of the sample reported knowing about the vaccine, only 5.3% referred to their personal doctor as the source of information. Among elders that had not received the vaccine, 83.2% were explicit about not wanting to take it. The main reasons were fear of adverse effects and disbelief in the vaccines effectiveness. However, the actual prevalence of adverse effects was low. Age, smoking, and lack of a doctors appointment in the previous year were independently associated with vaccine non-compliance. The results show that improvements are needed in the immunization campaign, especially targeting elders less than 70 years of age and smokers.

Interação ensino, serviços e comunidade: desafios e perspectivas de uma experiência de ensino-aprendizagem na atenção básica

Teaching, Care and Community Interaction Practical Activities are curricular modules of the medical course of the State University of Londrina aimed at early introduction of students to the Family Health Program in order to give them the opportunity to understand the determinants of the health-disease process, the importance of health promotion and preventive actions and of the local health services. The activities are developed in the first four years of the medical course in modules of about 140 hours, with sequential contents structured in concept maps ranging from knowledge about the covered neighborhood to medical activities making part of primary care. The most evident results include diversification of the teaching-learning scenario, early contact of the students with the primary care system and development of skills involving the doctor-patient relationship and patient-centered care. Among the challenges is the need to make the work in the local health services more attractive to students, teachers and local health teams.

Prevalência de fatores de risco cardiovascular em pessoas com 40 anos ou mais de idade, em Cambé, Paraná (2011): estudo de base populacional

Objective: to estimate the prevalence of cardiovascular disease risk factors by sex and socioeconomic status. Methods: cross-sectional population-based representative sample of people aged 40 or older, living in Cambe-PR. Household interviews were conducted, collecting anthropometric measurements and laboratory tests in the first half of 2011. Prevalence, prevalence ratios (PR) and 95% confidence intervals (95% CI) were calculated. Results: 1,180 people were interviewed. Most prevalent risk factors were physical inactivity during leisure (71.4%), overweight/obesity (68.3%), hypertension (55.9%) and low consumption of fruit (54.3%) and vegetables (35.5%). Overweight/obesity prevalence was lower among men compared to women (PR 0.82, 95% CI 0.73-0.92). Physical inactivity during leisure, as well as low fruit and vegetable consumption were more prevalent among men and women of lower socioeconomic classes. Conclusion: high cardiovascular disease risk factor prevalence was found, especially among individuals from lower socioeconomic classes.