OCORRÊNCIA DE INFECÇÃO E MORTALIDADE POR COVID-19 EM RESIDENCIAIS PARA IDOSOS NO BRASIL

Introduction: Mortality rates due to COVID-19 in older people living in long-term care homes reach 80% in some countries. In Brazil, little is known about the incidence and mortality in this population. Objective: To describe the occurrence of COVID-19 infection and mortality in care homes for the older people in Brazil. Methods: Cross-sectional and descriptive study using primary and secondary sources and non-probabilistic sampling. Between April and June 2020, through an electronic questionnaire, care homes administrators from all over Brazil were invited to report the occurrence of infection and mortality of residents by COVID-19. In addition, an active search for data was carried out with the services of the State Public Prosecutor Offices, State Health Departments and the Unified Social Assistance System. The data were analyzed using descriptive statistics. Results: Information from 1,802 care homes from 11 states was analyzed, where 42,216 older people lived. The incidence rate of COVID-19 was 6.14%, and 458 deaths were recorded in the period, with a case-fatality rate of 17.65%. Conclusion: The incidence and fatality observed in this study were lower than the rates observed in other countries. However, given the limitations regarding the collection of information and other barriers to the study, new structured data sources are essential for understanding the spread of the virus in care homes in the country.Introdução: As taxas de mortalidade pela COVID-19 em idosos que vivem em Residenciais de Cuidado de Longa Duração (RCLD) chegam a 80% em alguns países. No Brasil, pouco se conhece sobre a incidência e mortalidade nesta população. Objetivo: Descrever a ocorrência da infecção e mortalidade por COVID-19 em RCLD para idosos no Brasil. Metodologia: Estudo transversal e descritivo com uso de fontes primárias e secundárias e amostragem não probabilística. Entre abril e junho de 2020, por meio de um questionário eletrônico, administradores de RCLD de todo o Brasil foram convidados a informar a ocorrência de infecção e mortalidade de residentes por COVID-19. Além disso, foi realizada busca ativa de dados junto aos serviços do Ministério Público Estadual, Secretarias de Saúde e Sistema Único de Assistência Social. Os dados foram analisados através de estatística descritiva Resultados: Foram analisadas as informações de 1,802 RCLD de 11 estados, onde residiam 42,216 idosos. A taxa de incidência de COVID-19 foi de 6,14%. Foram registrados no período 458 óbitos, com uma taxa de letalidade de 17,65%. Conclusão: A incidência e letalidade observados neste estudo foram menores do que as taxas observadas em outros países. Entretanto, dadas as limitações quanto a coleta de informações e outras barreiras para o estudo, novas fontes estruturadas de dados são fundamentais para o conhecimento da propagação do vírus nos RCLD no país

ENFRENTAMENTO A PANDEMIA DE COVID-19 POR PARTE DOS GESTORES DE INSTITUIÇÕES DE LONGA PERMANÊNCIA PARA IDOSOS NA AMÉRICA LATINA

Introduction: Few information is available on coping and mitigating COVID-19 in long-term care services for older people (ILPIs) in Latin America (LA). Objectives: To describe how ILPI managers in LA planned and adapted their coping routines to the COVID-19 pandemic, and whether they were able to comply with the recommendations of the World Health Organization (WHO). Methodology: Cross-sectional study, based on the application of an online survey aimed at LTCF managers in LA. A 46-question questionnaire (adopting WHO principles) was sent to participants. Descriptive statistics was used to summarize the data. Results: 23 managers answered the survey (excluding Brazilian respondents), totaling 874 older person (5 -270); a questionnaire was excluded due to lack of answers. Fourteen ILPIs (63.60%) were private for profit. The rate of adherence to WHO recommendations was over 70% for most issues. A little more than half of the institutions developed a strategic coping plan, or identified strategies to deal with deaths from suspected cases. Difficulty in acquiring personal protective equipment was reported by 59.10% of the investigated LTCIs. The testing capacity for SARS-Cov-2 has been reduced (36.36% had no test). Conclusions: The rate of adherence to the recommendations proposed by WHO for coping with COVID-19 was over 70% for most investigated LTCIs. Strategic coping plans were developed in just over half of the institutions. The availability of PPE and the testing capacity for SARS-Cov-2 proved to be quite unsatisfactory.Introdução: Pouco se sabe sobre o enfrentamento e mitigação à COVID-19 em serviços de longa permanência para idosos (ILPIs) na América Latina (AL). Objetivos: Descrever como os gestores de ILPIs na AL planejaram e adequaram suas rotinas de enfrentamento à pandemia de COVID-19, e se foram capazes de cumprir com as recomendações da Organização Mundial da Saúde(OMS). Metodologia: Estudo transversal, baseado na aplicação de uma pesquisa online dirigida aos gestores de ILPIs na AL. Um questionário de 46 questões (adotando os princípios da OMS) foi enviado aos participantes. Estatística descritiva foi usada para resumir os dados. Resultados: 23 gestores responderam a pesquisa (excluídos os respondentes brasileiros), totalizando 874 idosos (5 –270); um questionário foi excluído por falta de respostas. Quatorze ILPIs (63,60%) eram privadas com fins lucrativos. A taxa de adesão às recomendações da OMS foi superior a 70% para a maioria das questões. Pouco mais da metade das instituições elaborou um plano estratégico de enfrentamento, ou identificou estratégias para lidar com óbitos de casos suspeitos. Dificuldade para a aquisição de equipamentos de proteção individual foram relatados por 59,10% das ILPIs investigadas. A capacidade de testagem para o SARS-Cov-2 foi reduzida (36,36% não dispunham de nenhum teste). Conclusões: A taxa de adesão às recomendações propostas pela OMS para o enfrentamento da COVID-19 foi superior a 70% para a maioria das ILPIs investigadas. Planos estratégicos de enfrentamento foram elaborados em pouco mais da metade das instituições. A disponibilidade de EPIs e a capacidade de testagem para o SARS-Cov-2 mostrou-se bastante insatisfatória

Mapping research conducted on long-term care facilities for older people in Brazil: a scoping review

This scoping review aimed to explore the characteristics, strengths, and gaps in research conducted in Brazilian long-term care facilities (LTCFs) for older adults. Electronic searches investigating the residents (≥60 years old), their families, and the LTCF workforce in Brazil were conducted in Medline, EMBASE, LILACS, and Google Scholar, within the timescale of 1999 to 2018, limited to English, Portuguese, or Spanish. The reference lists were hand searched for additional papers. The Mixed Methods Appraisal Tool (MMAT) was used for critical appraisal of evidence. Data were reported descriptively considering the study design, using content analysis: 327 studies were included (n = 159 quantitative non-randomized, n = 82 quantitative descriptive, n = 67 qualitative, n = 11 mixed methods, n = 6 randomized controlled trials, and n = 2 translation of assessment tools). Regardless of the study design, most were conducted in a single LTCF (45.8%), in urban locations (84.3%), and in non-profit settings (38.7%). The randomized trials and descriptive studies presented the lowest methodological quality based on the MMAT. This is the first review to provide an overview of research on LTCFs for older people in Brazil. It illustrates an excess of small-scale, predominantly qualitative papers, many of which are reported in ways that do not allow the quality of the work to be assured

The use of ChatGPT in scientific publishing

The use of Generative Pretrained Transformer (ChatGPT), an artificial intelligence tool, for writing scientific articles has been reason for discussion by the academic community ever since its launch in late 2022. This artificial intelligence technology is becoming capable of generating fluent language, and distinguishing between text produced by ChatGPT and that written by people is becoming increasingly difficult. Here, we will present some topics to be discussed: (1) ensuring human verification; (2) establishing accountability rules; (3) avoiding the automatization of scientific production; (4) favoring truly open-source large language models (LLMs); (5) embracing the benefits of artificial intelligence; and (6) broadening the debate. With the emergence of these technologies, it is crucial to regulate, with continuous updates, the development and responsible use of LLMs with integrity, transparency, and honesty in research, along with scientists from various areas of knowledge, technology companies, large research funding bodies, science academies and universities, editors, non-governmental organizations, and law experts.</p

Nutritional status and functional capacity of institutionalized elderly in Botucatu/SP

INTRODUCTION: Functional capacity is an important component of quality of life and health marker that reflects the overall condition of the elderly. Together with functional capacity assessment, nutritional and anthropometric evaluations are also used to estimate health in this population. Observed association between these parameters. OBJECTIVE: To study the relationship among anthropometric and nutritional data and functional capacity in the senior population of a long permanence institution (LPI) located in Botucatu - SP, Brazil, analyzed the relationship between anthropometric data and the functional capacity in elderly. MATERIALS AND METHODS: Design: Cross-sectional. We evaluated 54 individuals, and measured anthropometric data with calculation of body mass index (BMI). We evaluated the functional capacity by the Basic Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). We analyzed the association between dependence and anthropometric variables obtained. RESULTS: Of the institutionalized individuals assessed (19 males and 35 females with mean age of 76.1 ± 9.9 years), 46.3% showed BMI &lt; 22 kg/m2. Dependence for ADL was directly associated with low weight (BMI &lt; 22 kg/m2) in 33.3% of the cases (p &lt; 0.05). CONCLUSION: Most LPI elderly residents showed low weight associated with reduced functional capacity for ADL.</p

Public health and centenarians: necessary adjustments and an uncertain future

In a global population aging scenario, achieving 100 years and older is no longer an isolated incident: in Brazil there are already more than 24 thousand centenarians, and in some countries this segment will increase about 700% till 2050, when approximately 3 million centenarians are estimated in the world. Despite being a social, economic and technological triumph, the growth of centenarians is associated with significant challenges to traditional models of security and social support, as well as a potential problem for public health policies. In this paper we propose to present our opinions about this theme, to revise the implications to public health of the exponential increase in the number of centenarians, highlighting the importance of developing a national research agenda in Brazil involving this issue. We also discussed propositions on the reorientation of public health policies models, focusing on this age group..</p

Avaliação nutricional e capacidade funcional de idosos institucionalizados em Botucatu/SP

Introduction: Functional capacity is an important component of quality of life and health marker that reflects the overall condition of the elderly. Together with functional capacity assessment, nutritional and anthropometric evaluations are also used to estimate health in this population. Observed association between these parameters. Objective: To study the relationship among anthropometric and nutritional data and functional capacity in the senior population of a long permanence institution (LPI) located in Botucatu – SP, Brazil, analyzed the relationship between anthropometric data and the functional capacity in elderly. Materials and methods: Design: Cross- -sectional. We evaluated 54 individuals, and measured anthropometric data with calculation of body mass index (BMI). We evaluated the functional capacity by the Basic Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). We analyzed the association between dependence and anthropometric variables obtained. Results: Of the institutionalized individuals assessed (19 males and 35 females with mean age of 76.1 ± 9.9 years), 46.3% showed BMI < 22 kg/m2 . Dependence for ADL was directly associated with low weight (BMI ≤ 22 kg/m2 ) in 33.3% of the cases (p < 0.05). Conclusion: Most LPI elderly residents showed low weight associated with reduced functional capacity for ADL.Introdução: A capacidade funcional é um importante componente da qualidade de vida e marcador de saúde, refletindo a condição geral do idoso. Juntamente com a avaliação da capacidade funcional, as avaliações nutricional e antropométrica também estimam a saúde dessa população. Observa-se associação entre esses parâmetros. Objetivo: Estudar a associação do estado nutricional com a capacidade funcional em idosos de instituição de longa permanência (ILP) da cidade de Botucatu/SP, analisando a relação entre os dados antropométricos e a capacidade funcional no indivíduo idoso. Materiais e métodos: Tipo de estudo: transversal. Foram avaliados 54 indivíduos, sendo mensurados dados antropométricos com cálculo do índice de massa corporal (IMC). Avaliou-se a capacidade funcional pelas Atividades Básicas de Vida Diária (ABVD) e Atividades Instrumentais de Vida Diária (AIVD). Foi analisada a associação entre dependência e as variáveis antropométricas obtidas. Resultados: Dos institucionalizados (19 do gênero masculino e 35 do feminino, com idade média de 76,1 ± 9,9 anos), 46,3% apresentaram IMC abaixo de 22 kg/m2 . A dependência para as ABVD, em 33,3% dos casos, esteve diretamente relacionada ao baixo peso (IMC ≤ 22 kg/m2 ; p < 0,05). Conclusão: A maioria dos idosos da ILP apresentou baixo peso associado à capacidade funcional diminuída para as ABVD.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Recommendations for clinic prevention: relevant aspects in elderly people

The American Academy of Family Physicians (AAFP) released a summary of the "Recommendations for Clinical Preventive Services". It is a publication based on "Recommendations for Clinical Preventive Services" published by the United States Preventive Services Task Force (USPSTF). These recommendations are provided only as an aid to physicians in making clinical decisions about the care of their patients. They reflect the clinic references existing at the time of publication. But its only should be used with the clear understanding that continued research may result in new knowledge and consequently there is a need for updates. Some recommendations of the USPSTF are important in clinical practice with the elderly.</p

Infecção do trato urinário adquirida em ambiente hospitalar em idosos

Introduction: Hospital-acquired urinary tract infection (HAUTI) is an important cause of morbidity in the elderly population. Objective: Evaluate the occurrence of HAUTI and risk factors associated with it. Method: This is a prospective study of a sample of 332 elderly people, interned in a university hospital. Criteria for defining infection were established by the Center for Diseases and Prevention Control. Statistical analysis of data used calculation of frequencies, odds ratio and logistic regression. The rate of hospital infection was 23.6%. The prevalent topographies of infection were respiratory infections (27.6%), urinary tract infections (26.4%) and surgical wound infections (23.6%, with 21, 20 and 19 episodes, respectively. The HAUTI incidence density associated with urinary catheterization was 24.2 infections by 1,000 catheter-days. The length of hospital stay of patients without nosocomial infection was 6.9 days and with HAUTI was increased in 10.4 (p<0.05).The rate of mortality of patients with HAUTI was 20%. Pathogens were isolated in 75% of episodes of HAUTI and the prevalent were: Escherichia coli (33%) and Pseudomonas aeruginosa (20%). Risk factors found for HAUTI were urinary catheterization implementation (odds ratio (OR) = 43.1; 95% confidence interval (95 CI%) = 3.9 – 311.1), hospitalization with community infection (OR= 21.9; 95% CI = 4.9 – 97.9); vascular diseases (OR=14; 95% CI = 2 – 98); diabetes mellitus (OR= 5.5; 95% CI = 1.4 – 21) and urinary catheterization by more than three days (OR=3.7; 95% CI = 1 – 13.8). Conclusions: HAUTI presented elevated incidence and it increased the length of hospital stay.Introdução: A infecção do trato urinário adquirida no hospital (ITUH) é uma importante causa de morbidade em idosos. Objetivo: Avaliar a ocorrência e os fatores de risco de ITUH. Métodos: Estudo prospectivo em amostra de 322 idosos, internados em hospital universitário. Os critérios para definição de infecção foram do Centers for Disease Control and Prevention. Na análise estatística dos dados foram utilizados cálculo de frequências, odds ratio e regressão logística. Resultados: A taxa de infecção hospitalar foi de 23,6%. As topografias prevalentes foram: pneumonia (27,6%), trato urinário (26,4%) e sítio cirúrgico (23,6%), com 21, 20 e 19 episódios, respectivamente. A densidade de incidência de ITUH associada ao cateterismo urinário foi de 24,2 infecções por 1.000 cateteres-dia. O tempo de internação dos pacientes sem infecção hospitalar foi de 6,9 dias e com ITUH foi acrescido em 10,4 (p < 0,05). A letalidade dos pacientes com ITUH foi de 20%. Foram isolados patógenos em 75% dos episódios de ITUH, sendo os prevalentes: Escherichia coli (33%) e Pseudomonas aeruginosa (20%). Os fatores de risco encontrados para ITUH foram: realização de cateterismo urinário (odds ratio (OR) = 43,1; intervalo de confiança de 95% (IC 95%) = 3,9 – 311,1), internação com infecção comunitária (OR = 21,9; IC 95% = 4,9 – 97,9), doença vascular (OR = 14; IC 95% = 2 – 98), diabetes mellitus (OR = 5,5; IC 95% =1,4 – 21) e cateterismo urinário por mais que três dias (OR = 3,7; IC 95% = 1 – 13,8). Conclusões: A ITUH apresentou incidência elevada e aumentou o tempo de internação