Maria Pastor-Valero

High prevalence of dementia among older adults from poor socioeconomic backgrounds in Sao Paulo, Brazil

BACKGROUND The aim of this study was to determine the prevalence of dementia in a socioeconomically disadvantaged population of older adults living in the city of São Paulo, Brazil. METHODS A cross-sectional one-phase population-based study was carried out among all residents aged > or = 65 in defined census sectors of an economically disadvantaged area of São Paulo. Identification of cases of dementia followed the protocol developed by the 10/66 Dementia Research Group. RESULTS Of 2072 individuals in the study, 105 met the criteria for a diagnosis of dementia, yielding a prevalence of 5.1%. Prevalence increased with age for both men and women after age 75 years, but was stable from 65 to 74 years. Low education and income were associated with increased risk of dementia. CONCLUSIONS The prevalence of dementia among older adults from low socioeconomic backgrounds is high. This may be partly due to adverse socioeconomic conditions and consequent failure to compress morbidity into the latter stages of life. The increasing survival of poorer older adults with dementia living in developing countries may lead to a rapid increase in the prevalence of dementia worldwide.

Consumo de frutas e hortaliças por idosos de baixa renda na cidade de São Paulo

OBJETIVO: Estimar os fatores socioeconomicos e sociodemograficos associados ao consumo diario de cinco porcoes de frutas e hortalicas por idosos residentes em areas de baixa renda, identificando as principais frutas e hortalicas que compoem a dieta desta populacao. METODOS: Estudo transversal de base populacional com 2.066 idosos (>60 anos) de baixa renda residentes na cidade de Sao Paulo, SP, em 2003-2005. Para a avaliacao do consumo de frutas e hortalicas foi aplicado questionario de frequencia alimentar. As respostas foram transformadas em consumo diario e comparadas as recomendacoes da Organizacao Mundial da Saude (consumo de cinco ou mais porcoes diarias). A relacao entre consumo recomendado de frutas e hortalicas e variaveis socioeconomicas foi avaliada mediante modelos de regressao logistica. RESULTADOS: Dos participantes, 60,5% eram mulheres e 39,5% homens. Cerca de um terco dos idosos (n=723; 35,0%) nao consumia diariamente nenhum tipo de fruta ou hortalica e 19,8% relataram consumo diario de cinco ou mais porcoes de frutas e hortalicas. Este consumo esteve positivamente associado a renda e a escolaridade. CONCLUSOES: O consumo de frutas e hortalicas de idosos de baixa renda do municipio de Sao Paulo mostrou-se insuficiente em relacao as recomendacoes da Organizacao Mundial da Saude e esta associado a condicoes socioeconomicas desfavoraveis.OBJECTIVE To estimate the socioeconomic and sociodemographic factors associated with the daily intake of five servings of fruit and vegetables by elderly individuals living in low income areas, identifying the main fruits and vegetables which compose the diet of this population. METHODS This is a cross-sectional population-based study with 2,066 low income elderly individuals (> or =60 years) living in the city of São Paulo, Southeastern Brazil, in 2003-2005. To assess the fruit and vegetable intake a Food Frequency Questionnaire was administered. The answers were transformed into daily intake and compared with the recommendations of the World Health Organization (five or more servings per day). The relationship between recommended fruit and vegetable intake and socioeconomic variables was analyzed using logistic regression models. RESULTS Of the participants, 60.5% were women and 39.5% were men. Approximately one third of the elders (n=723; 35.0%) did not consume any kind of fruit or vegetable on a daily basis and 19.8% reported a daily intake of five or more servings of fruits and vegetables. This intake was positively associated with income and years of schooling. CONCLUSIONS The fruit and vegetable intake of low income elderly individuals in the city of São Paulo was insufficient according to the recommendations of the World Health Organization and is associated with unfavorable socioeconomic conditions.

Education and WHO Recommendations for Fruit and Vegetable Intake Are Associated with Better Cognitive Function in a Disadvantaged Brazilian Elderly Population: A Population-Based Cross-Sectional Study

Brazil has one of the fastest aging populations in the world and the incidence of cognitive impairment in the elderly is expected to increase exponentially. We examined the association between cognitive impairment and fruit and vegetable intake and associated factors in a low-income elderly population. A cross-sectional population-based study was carried out with 1849 individuals aged 65 or over living in São Paulo, Brazil. Cognitive function was assessed using the Community Screening Instrument for Dementia (CSI-D). Fruit and vegetable intake was assessed with a Food Frequency Questionnaire (FFQ) and categorized into quartiles of intake and into total daily fruit and vegetable intake using the cut-off points for the WHO recommendations (<400grams/day or ≥400 grams/day). The association between cognitive impairment and each quartile of intake, and WHO recommendation levels, was evaluated in two separate multivariate logistic models. The WHO recommendations for daily intakes ≥400 grams/day were significantly associated with 47% decreased prevalence of cognitive impairment. An effect modification was found in both models between cognitive impairment and “years of education and physical activity” and “years of education and blood levels of HDL” So that, having 1 or more years of education and being physically active or having 1 or more years of education and levels higher than 50 mg/dl of HDL-cholesterol strongly decreased the prevalence of cognitive impairment. In this socially deprived population with very low levels of education and physical activity and fruit and vegetable intake, those who attained WHO recommendations, had 1 year or more of education and were physically active had a significantly lower prevalence of cognitive impairment. A more comprehensive understanding of the social determinants of mental health is needed to develop effective public policies in developing countries.

Fruit and vegetable intake among low income elderly in the city of São Paulo, Southeastern Brazil.

OBJETIVO: Estimar os fatores socioeconomicos e sociodemograficos associados ao consumo diario de cinco porcoes de frutas e hortalicas por idosos residentes em areas de baixa renda, identificando as principais frutas e hortalicas que compoem a dieta desta populacao. METODOS: Estudo transversal de base populacional com 2.066 idosos (>60 anos) de baixa renda residentes na cidade de Sao Paulo, SP, em 2003-2005. Para a avaliacao do consumo de frutas e hortalicas foi aplicado questionario de frequencia alimentar. As respostas foram transformadas em consumo diario e comparadas as recomendacoes da Organizacao Mundial da Saude (consumo de cinco ou mais porcoes diarias). A relacao entre consumo recomendado de frutas e hortalicas e variaveis socioeconomicas foi avaliada mediante modelos de regressao logistica. RESULTADOS: Dos participantes, 60,5% eram mulheres e 39,5% homens. Cerca de um terco dos idosos (n=723; 35,0%) nao consumia diariamente nenhum tipo de fruta ou hortalica e 19,8% relataram consumo diario de cinco ou mais porcoes de frutas e hortalicas. Este consumo esteve positivamente associado a renda e a escolaridade. CONCLUSOES: O consumo de frutas e hortalicas de idosos de baixa renda do municipio de Sao Paulo mostrou-se insuficiente em relacao as recomendacoes da Organizacao Mundial da Saude e esta associado a condicoes socioeconomicas desfavoraveis.OBJECTIVE To estimate the socioeconomic and sociodemographic factors associated with the daily intake of five servings of fruit and vegetables by elderly individuals living in low income areas, identifying the main fruits and vegetables which compose the diet of this population. METHODS This is a cross-sectional population-based study with 2,066 low income elderly individuals (> or =60 years) living in the city of São Paulo, Southeastern Brazil, in 2003-2005. To assess the fruit and vegetable intake a Food Frequency Questionnaire was administered. The answers were transformed into daily intake and compared with the recommendations of the World Health Organization (five or more servings per day). The relationship between recommended fruit and vegetable intake and socioeconomic variables was analyzed using logistic regression models. RESULTS Of the participants, 60.5% were women and 39.5% were men. Approximately one third of the elders (n=723; 35.0%) did not consume any kind of fruit or vegetable on a daily basis and 19.8% reported a daily intake of five or more servings of fruits and vegetables. This intake was positively associated with income and years of schooling. CONCLUSIONS The fruit and vegetable intake of low income elderly individuals in the city of São Paulo was insufficient according to the recommendations of the World Health Organization and is associated with unfavorable socioeconomic conditions.

Depressive symptoms and psychosocial aspects of work in bank employees.

BACKGROUND The financial sector has seen an increase in the number of cases of violence and stress, which can result in adverse health outcomes, including depressive symptoms, but studies related to stress at work and depression for these workers are scarce. AIMS To investigate the association between exposure to psychosocial work stressors and depressive symptoms in bank employees. METHODS A self-administered questionnaire was completed by a sample of bank employees in Pará and Amapá, Brazil. The survey assessed sociodemographic characteristics, mental health (Patient Health Questionnaire-9), Demand-Control-Support and Effort-Reward Imbalance (ERI). Outcomes included two levels of depressive symptoms: major depressive symptoms (MDS) and other forms of depressive symptoms (ODS). Logistic regression models were used to estimate associations between depressive symptoms, the two job stress models and relevant covariates. RESULTS Of 2806 eligible subjects, there were 1445 respondents (52% response rate) and the final analyses included 1046 participants. The overall prevalence of depressive symptoms was 32% (MDS = 18%; ODS = 14%), with no statistically significant difference between men and women. High demands, low levels of control and low social support were associated with MDS and/or ODS, adjusted for gender, age and other work-related conditions. High effort/low reward, over-commitment and ERI were also associated with MDS and ODS. CONCLUSIONS Psychosocial conditions in banking activity involving high strain, low social support at work, high effort with low reward and over-commitment may represent possible risk factors for depressive symptoms in bank employees.

Psychosocial Work Conditions and Burnout Among Brazilian Bank Employees: A Cross-Sectional Study

OBJECTIVES Changes in the modern economy have affected the financial sector. Time pressures, excessive work demands, and job stress are frequent concerns among bank employees, which might predispose them to burnout symptoms. The objective of the present study was to investigate the association between burnout symptoms and exposure to psychosocial work conditions in bank employees. METHODS A cross-sectional study of 1046 bank employees was carried out in Pará and Amapá, northern Brazil. We applied a self-administered questionnaire evaluating socio-demographic characteristics, burnout (Maslach Burnout Inventory), and two job stress models (Demand-Control-Support and Effort-Reward Imbalance). Two levels of burnout symptoms were analysed: moderate level of burnout (MLB) and high level of burnout (HLB). Logistic regression models were used to estimate associations between the two levels of burnout and the two stress models, controlling for relevant covariates. RESULTS The overall prevalence of burnout was 71.8% (31.1% for HLB; 40.7% for MLB), regardless of gender. Exposure to adverse psychosocial conditions in the workplace, such as high strain, low social support at work, high effort/low reward, and over commitment showed strong association with HLB and MLB, and these associations were independent of age, gender, and other occupational characteristics. CONCLUSIONS We found that psychosocial conditions in the financial sector involving high strain, low social support at work, high effort/low reward, and over commitment represent possible risk factors for moderate and HLB symptoms in bank employees.

Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis

Objectives To determine the appropriateness of medical imaging examinations involving radiation and to estimate the effective radiation dose and costs associated. Design Cross-sectional retrospective study. Setting Two Spanish public tertiary hospitals. Participants 2022 medical imaging tests were extracted from the radiology information system in February and March of 2014. MRI and ultrasound examinations were excluded. Primary and secondary outcome measures Five outcomes were set independently by at least two researchers according to four guidelines: (1) appropriate; (2) inappropriate; (3) inappropriate due to repetition, if the timing to carry out next diagnostic tests was incorrect according to guidelines; (4) not adequately justified, if the referral form did not include enough clinical information to allow us to understand the patient’s clinical condition; and (5) not included in the guidelines, if the referral could not be matched to a clinical scenario described in the guidelines. We estimated the prevalence of the five categories according to relevant clinical and sociodemographic variables and the effective radiation dose and costs for each category. Results Approximately half of the imaging tests were deemed as appropriate (967, 47.8%) while one-third (634, 31.4%) were considered inappropriate. 19.6% of the effective dose and 25.2% of the cost were associated with inappropriate tests. Women were less likely than men to have an imaging test classified as appropriate (adjusted OR 0.70,95% CI 0.57 to 0.86). Imaging tests requested by general practitioners were less likely to be considered appropriate than those requested by central services (adjusted OR 0.60, 95% CI 0.38 to 0.93). Mammography and CT were more likely to be appropriate than conventional X-rays. Conclusion There was a significant frequency of inappropriateness, which resulted in a high percentage of associated effective radiation dose. Percentage of inappropriateness depends on sociodemographic and clinical characteristics such as sex, age, referral physician and medical imaging test.

Avoiding fears and promoting shared decision-making: How should physicians inform patients about radiation exposure from imaging tests?

Objective We aimed to evaluate the population’s awareness about the radiation exposure associated with five specific imaging tests, and their preference regarding three different formats for receiving the information before undergoing an imaging test. Methods A quantitative and qualitative evaluation through a survey and focal groups including general population from two health departments in Spain. The sampling was carried out in stages (according to health department size) and stratified by age and sex, to get a representative sample. We randomly selected the participants from these stages to be contacted by telephone by a trained nurse. Oral informed consent was obtained. Results Of 602 participants in the quantitative survey, 418 (70.3%) stated that they were aware of the risk associated with radiation. While the majority of these 418 participants knew that x-rays involve radiation (85.4%), fewer were aware that CT (42%) and mammography (38%) also involve radiation, and a substantial proportion believed, incorrectly, that MRI (38%) and ultrasound (18.4%) expose patients to radiation. The population preference was to receive the information using both oral and written formats, accompanied by a table showing the equivalence of the radiation associated with the imaging test to either a number of chest X-rays and exposure number of days of background radiation. Discussion The general population does not receive enough information regarding radiation exposure and the associated risks related to imaging tests. Initiatives should be designed to reinforce the patient’s awareness when ordering a diagnostic imaging test.

The Fate of Patients with Solitary Pulmonary Nodules: Clinical Management and Radiation Exposure Associated.

Background The appropriate management of the large number of lung nodules detected during the course of routine medical care presents a challenge. We aimed to evaluate the usual clinical practice in solitary pulmonary nodule (SPN) management and associated radiation exposure. Methods We examined 893 radiology reports of consecutive patients undergoing chest computed tomography (CT) and radiography at two public hospitals in Spain. Information on diagnostic procedures from SPN detection and lung cancer diagnosis was collected prospectively for 18 months. Results More than 20% of patients with SPN detected on either chest radiograph (19.8%) or CT (26.1%) underwent no additional interventions and none developed lung cancer (100% negative predictive value). 346 (72.0%) patients with SPN detected on chest radiograph and 254 (61.5%) patients with SPN detected on CT had additional diagnostic tests and were not diagnosed with lung cancer. In patients undergoing follow-up imaging for SPNs detected on CT median number of additional imaging tests was 3.5 and the mean cumulative effective dose was 24.4 mSv; for those detected on chest radiograph the median number of additional imaging tests was 2.8 and the mean cumulative effective dose was 10.3 mSv. Conclusions Patients who did not have additional interventions were not diagnosed of lung cancer. There was an excessive amount of interventions in a high percentage of patients presenting SPN, which was associated with an excess of radiation exposure.

Grade 2 disabilities in leprosy patients from Brazil: Need for follow-up after completion of multidrug therapy

Background Leprosy continues to be a public health problem in many countries. Difficulties faced by health services include late diagnosis, under-reporting of new cases, adequate monitoring of disabilities and treatment. Furthermore, systematic follow-up after completion of treatment is important, when new disabilities may occur, or existing disabilities may get worse. The objective of the present study was to determine the prevalence of leprosy-associated grade 2 disabilities (G2D) after completion of multidrug therapy (MDT) and to identify factors associated with G2D. Methods We performed a cross-sectional study of 222 leprosy cases registered in Vitória da Conquista, Bahia state, Brazil from 2001–2014. We performed a clinical examination of the study participants and collected socio-economic and clinical information by interview. We identified factors associated with grade 2 disability (G2D) using logis tic regression. Results In total, 38 (17.1%) participants were diagnosed with G2D, and 106 (47.7%) with grade 1 disabilities (G1D). The following independent factors were significantly associated with G2D: occurrence of leprosy reaction (adjusted OR = 2.5; 95%CI = 1.09–5.77), thickening and/or tenderness of one or more nerve trunks (adjusted OR = 3.0; CI = 1.13–8.01) and unemployment (adjusted OR = 7.17; CI = 2.44–21.07). Conclusions This study shows that physical disabilities remain after completion of MDT and frequently occur in an endemic area in Brazil. Finding new ways to reduce the burden of disability are urgently needed, and may include systematic follow-up of patients after treatment completion combined with evidence-based preventative measures.