Patricia Pereira de Oliveira

Comparative analysis of risk for falls in patients with and without type 2 diabetes mellitus

OBJECTIVE: To compare frequency and risk of falls based on a functional mobility test in diabetic and non-diabetic individuals. METHODS: Cross-sectional study involving patients with and without type 2 diabetes mellitus (DM2) selected by convenience sampling. Men and women between the ages of 50 and 65 were included and divided as group 1 (G1) - with DM2 diagnosis for 200 mg/dL; and group 2 (G2) - no diabetes, same age group, and fasting blood glucose < 100 mg/dL. Both groups responded to a structured questionnaire about their health, fall risk, and underwent a physical exam and a mobility assessment test (Timed Up and Go - TUG). The results were analyzed by the software SPSS, with TUG being categorized in ranges of risk for fall. We considered that the risk was positive for all those who fit into medium- and high-risk range. RESULTS: Fifty patients with DM2 and 68 patients without DM2 were assessed. There were no statistical differences in the number of falls between the groups, however non-diabetic subjects obtained a higher performance in TUG test (p = 0.003) as the risk categories were observed. Reduced visual acuity and difficulty in getting up were more frequently reported in G1 (p < 0.05). CONCLUSION: There appears to be an association between hyperglycemic status and poorer mobility, with an increased fall risk even in younger patients and in those with shorter disease duration.

First reported outbreak of green tobacco sickness in Brazil

Dermal absorption of nicotine by people harvesting tobacco may cause an acute intoxication called green tobacco sickness. Although Brazil is the second largest producer of tobacco in the world, green tobacco sickness had not been reported in the country to date. We conducted a 1:1 matched case-control study among persons involved in tobacco farming to determine the occurrence of green tobacco sickness in the northeast region of Brazil and to identify the risk factors involved. A case-patient was a person who received a diagnosis by health professional of acute intoxication during the study period and had a cotinine level over 10 ng/mL detected by High Performance Liquid Chromatography. We identified 107 case-patients. The main signs and symptoms observed were dizziness, weakness, vomit, nausea and headache. Independent risk factors identified were being male, a non smoker and having worked in the harvest of tobacco leaves. Case-patients had higher median urinary cotinine levels than controls (p < 0.05). Epidemiological and laboratory data indicate for the first time the occurrence of green tobacco sickness in Brazil.

Prevalência de fraturas vertebrais e fatores de risco em mulheres com mais de 60 anos de idade na cidade de Chapecó, Santa Catarina, Brasil

Fractures are the main problems related to bone fragility in postmenopausal women and account for the increase in the risk of new fractures, mortality, and costs. This studys objective was to verify the occurrence of vertebral fragility fracture and correlate it with demographic, behavioral, and clinical factors in a Brazilian population. The cross-sectional study was based on a random sample of elderly women living in Chapecó, Santa Catarina State, Brazil. The sample consisted of 186 white women over 60 years of age. Of these, 48.9% had asymptomatic vertebral fractures, with higher prevalence in T11-12 and L4-5. Adjusted analysis showed a gradient between age and vertebral fracture, while fracture prevalence was 2.3 times higher in women over 80 years. Fracture prevalence was 1.44 times higher in sedentary as compared to non-sedentary women. Due to the high prevalence of asymptomatic vertebral fractures, the authors suggest the use of spinal x-rays in elderly women for fracture screening and prevention.

Monitoring of risk and protective factors for chronic non communicable diseases by telephone survey in Brazilian State Capitals, 2008.

OBJECTIVE To estimate the prevalence of protective and risk factors for the most important chronic non communicable diseases in all Brazilian capitals, including the Federal District. METHODS Data used were collected in 2008 through VIGITEL, an ongoing population-based telephone survey surveillance system implemented in all Brazilian State capitals since 2006. In 2008, over 54,000 interviews were completed over the phone with a random sample of individuals living in all 27 capitals. RESULTS The analyses showed differences in the prevalence of determinants of chronic diseases by demographic characteristics such as gender, age and schooling. Men were more likely to be current smokers, overweight, and consumers of soft drinks, fatty meat and alcohol. They were also more likely to be more active in leisure. Women reported being more likely to eat healthy, but also were more likely to have a physician diagnosis of high blood pressure, dyslipidemia, osteoporosis and overall poor health status. In general, the prevalence of risk factors studied increased with decreasing levels of schooling. DISCUSSION The VIGITEL system was implemented to monitor changes in the prevalence of determinants of chronic diseases over time to inform public health workers and decision makers to adjust existing programs and policies according to the changing profile of consumers. The ultimate goal is to improve the health of the Brazilian population.

Prevalência do risco para fraturas estimado pela ultra-sonometria óssea de calcâneo em uma população de mulheres brasileiras na pós-menopausa

A strong aging tendency is currently being observed in the world population, leading to an increase n the prevalence of such diseases as osteoporosis and fractures. This study aimed to determine the prevalence of fracture risk, estimated by quantitative ultrasound of the calcaneus in a population of postmenopausal women residing in the Ilha de Paqueta neighborhood of Rio de Janeiro, Brazil. We conducted anthropometric measurements and quantitative ultrasound of the calcaneus using Sonost 2000 in 385 postmenopausal women. Some 59.22% of the sample showed a T-score < -1, while 16.88% had T-score < -2.5. The test parameters varied with increasing age, with a statistically significant difference (p < 0.05) between fracture risk groups according to age, time since menopause, weight, BMI, and body fat. There was a correlation between sound velocity and BMI (r = 0.155; p = 0.002). We concluded that some 60% of the female study population showed some degree of fracture risk. The women at highest risk (T-score < -2.5) were older, with more time since menopause, and had higher weight and BMI as compared to the other groups.

Redução da mobilidade funcional e da capacidade cognitiva no diabetes melito tipo 2

OBJECTIVES The aim of the present study was to evaluate the functional mobility and its relationship to cognitive ability in patients with type 2 diabetes (T2DM), age between 50 and 65 years and under 10 years of diagnosis. MATERIALS AND METHODS An observational, analytical and cross-sectional study, involving no diabetic and type 2 diabetic individuals with inadequate glycemic control, selected by convenience sampling. In both groups, were administered structured questionnaire and cognitive assessment with Mini-Mental State Examination (MMSE) and the clock drawing test (CDT), besides assessment of functional mobility by the Timed Up & Go (TUG). RESULTS In TUG, DM2 patients presented a mean time of 11.27 seconds versus 9.52 seconds (p = 0.013). The association between cognitive decline and decrease of mobility was positive in individuals with T2DM (p = 0.037). In the subgroup that showed decrease of mobility and associated cognitive decline, 18% were patients with DM2 and 1.6% were individuals without T2DM (p < 0.01). CONCLUSIONS Patients with T2DM presented worse functional mobility and cognitive performance, supporting the hypothesis that DM2 influence functional mobility and cognitive ability, regardless of neuropathic or vascular complications. These data suggest that hyperglycemia is an aggravating factor in the performance of activities requiring mental functions such as attention, working memory and orientation.Objectives: The aim of the present study was to evaluate the functional mobility and its relationship to cognitive ability in patients with type 2 diabetes (T2DM), age between 50 and 65 years and under 10 years of diagnosis. Materials and methods: An observational, analytical and cross-sectional study, involving no diabetic and type 2 diabetic individuals with inadequate glycemic control, selected by convenience sampling. In both groups, were administered structured questionnaire and cognitive assessment with Mini-Mental State Examination (MMSE) and the clock drawing test (CDT), besides assessment of functional mobility by the Timed Up & Go (TUG). Results: In TUG, DM2 patients presented a mean time of 11.27 seconds versus 9.52 seconds (p = 0.013). The association between cognitive decline and decrease of mobility was positive in individuals with T2DM (p = 0.037). In the subgroup that showed decrease of mobility and associated cognitive decline, 18% were patients with DM2 and 1.6% were individuals without T2DM (p < 0.01). Conclusions: Patients with T2DM presented worse functional mobility and cognitive performance, supporting the hypothesis that DM2 influence functional mobility and cognitive ability, regardless of neuropathic or vascular complications. These data suggest that hyperglycemia is an aggravating factor in the performance of activities requiring mental functions such as attention, working memory and orientation.

A ultrassonometria óssea e o risco de fraturas em idosas

Objective: To verify the prevalence of women with risk of fractures estimated by ultrasonometry of the calcaneus (UOC) in a population of elderly women and its association with clinical risk factors. Methods: Cross-sectional study of which sample was randomly selected and submitted to a structured questionnaire about risk factors for fractures. All women underwent UOC. Results: We studied 168 Caucasian postmenopausal women, with a mean age of 69.56 ± 6.27 years; 81% of these women had abnormal test results and 41% of the abnormal results were considered higher risk. Women with abnormal test results had lower weight, height and BMI, and had lower values of SOS, BUA, BQI and T-score. After adjustment, BMI remained significant for abnormal UOC (OR = 3.37, 95% CI: 1.19 9.56, p = 0.02), and history of previous fractures for UOC of the higher risk range (OR = 4.44, 95% CI: 1.16-16.96, p = 0.03). Conclusion: We observed a high prevalence of risk of fractures determined by the UOC. Our prevalence was higher than those in other Brazilian studies. There was an association between UOC and BMI and previous history of fractures.

Relação entre qualidade de vida e fratura vertebral em mulheres idosas residentes no Sul do Brasil

PURPOSE: To investigate the relationship between quality of life and spinal fracture in women aged over 60 living in Southern Brazil. METHODS: A case-control study was conducted with the application of the WHOQOL-bref questionnaire to 100 women living in the city of Chapeco (SC), aged over 60, postmenopausal, white or Caucasian, with no important cognitive impairment or a history of diseases known to affect bone metabolism, or malignant neoplasias. The population was divided into two groups depending on the presence or absence of fractures in the spine radiography. We analyzed variables related to the current and previous medical history, life habits and family history of fractures, and the domains and facets that compose the WHOQOL-bref. All participants were informed about the objectives and methodologies adopted and gave written informed consent to participate in the study. RESULTS: The mean age of the women in the fracture group was older than that of women with fractures (p<0.05). Also women with fractures tended to belong to a higher social class, to have more years of study, a higher family income, and a greater use of alcoholic drinks (p<0.05). In the evaluation of the WHOQOL-bref domains, the fracture group had the highest average in the psychological field (x=63.6± 3.0) and the lowest in the environment field (x=9.3±58.8). In the group without fracture, the highest average also occurred in the psychological domain (x=67.2± 9.3) and the lowest in the field of social relations (x=57.5±7.7). Statistical analysis showed no significant correlation between the averages of the facets that make up the areas between the groups with and without fractures. CONCLUSIONS: This study suggests that there is no impairment of quality of life among older women with vertebral fractures, but the relation between QL and time of occurrence and severity of the fractures should be better evaluated. Both groups had higher scores in the psychological domain, showing that the respondents rely on personal beliefs, spirituality and religion, accept their physical appearance while maintaining self-esteem and the ability to think, to learn and to concentrate despite the presence of this disease. There was no statistically significant difference between groups or between domains in the same group.

Effect of conjugated estrogen versus conjugated estrogen associated with medroxyprogesterone acetate in postmenopausal women on internal carotid artery pulsatility index: A randomized pilot study

Aim:  To compare the effect of conjugated estrogen (CEE) versus conjugated estrogen and medroxyprogesterone acetate (MPA) therapy on internal carotid artery pulsatility index (PI) in postmenopausal women.

Confiabilidade da causa basica de obito por cancer entre Sistema de Informacoes sobre Mortalidade do Brasil e Registro de Cancer de Base Populacional de Goiania, Goias, Brasil

El presente estudio evalua la fiabilidad de las causas basicas de muerte por cancer mediante la relacion probabilistica entre el Sistema de Informaciones sobre Mortalidad (SIM) y el Registro de Cancer de Base Poblacional (RCBP) de Goiânia, Goias, Brasil, entre 2000 y 2005. La fiabilidad fue evaluada utilizando el indice kappa de Cohen ajustado para evitar errores debido al sesgo y a la prevalencia (prevalence-adjusted and bias-adjusted kappa – PABAK). Se identificaron 2.874 individuos en la relacion. El kappa bruto vario 0,336-0,846 y 0,810-0,990 PABAK en los 14 grupos de neoplasias definidos en el estudio. De los 35 canceres principales 12 (34,3%) tuvieron valores brutos de kappa por debajo de 0.600 y PABAK por encima de 0.981. Entre los principales tipos de cancer comunes por sexo, la concordancia oscilo en 0.672 y 0.790 y ajustado entre 0.894 y 0.961. Fueron reclasificados un 67% casos de cancer con una localizacion mal definida en el SIM con informacion proveniente del RCBP. Este estudio se mostro util para la calificacion de las estimativas de mortalidad por cancer en areas cubiertas por el RCBP.