Incapacidade em atividades instrumentais de vida diária em idosos: diferenças de gênero

OBJECTIVE To analyze gender differences in the incidence and determinants of disability regarding instrumental activities of daily living among older adults. METHODS The data were extracted from the Saúde, Bem-Estar e Envelhecimento (SABE – Health, Wellbeing and Ageing) study. In 2000, 1,034 older adults without difficulty in regarding instrumental activities of daily living were selected. The following characteristics were evaluated at the baseline: sociodemographic and behavioral variables, health status, falls, fractures, hospitalizations, depressive symptoms, cognition, strength, mobility, balance and perception of vision and hearing. Instrumental activities of daily living such as shopping and managing own money and medication, using transportation and using the telephone were reassessed in 2006, with incident cases of disability considered as the outcome. RESULTS The incidence density of disability in instrumental activities of daily living was 44.7/1,000 person/years for women and 25.2/1,000 person/years for men. The incidence rate ratio between women and men was 1.77 (95%CI 1.75;1.80). After controlling for socioeconomic status and clinical conditions, the incidence rate ratio was 1.81 (95%CI 1.77;1.84), demonstrating that women with chronic disease and greater social vulnerability have a greater incidence density of disability in instrumental activities of daily living. The following were determinants of the incidence of disability: age ≥ 80 and worse perception of hearing in both genders; stroke in men; and being aged 70 to 79 in women. Better cognitive performance was a protective factor in both genders and better balance was a protective factor in women. CONCLUSIONS The higher incidence density of disability in older women remained even after controlling for adverse social and clinical conditions. In addition to age, poorer cognitive performance and conditions that adversely affect communication disable both genders. Acute events, such as a stroke, disables elderly men more, whereas early deficits regarding balance disable women more.OBJETIVO Analisar diferenças de gênero na incidência e determinantes de incapacidade em atividades instrumentais de vida diária em idosos. MÉTODOS Os dados são provenientes do Estudo Saúde, Bem-Estar e Envelhecimento. Em 2000, 1.034 idosos sem dificuldades nas atividades instrumentais de vida diária foram selecionados. As características verificadas na linha de base foram: sociodemográficas, comportamentais, estado de saúde, quedas e fraturas, internações, sintomas depressivos, cognição, força, mobilidade, equilíbrio e percepção de visão e audição. Atividades instrumentais, como fazer compras, cuidar do próprio dinheiro e da própria medicação, utilizar meios de transporte e telefone, foram reavaliadas em 2006 e os casos incidentes de incapacidade foram considerados como desfecho. RESULTADOS A densidade de incidência de incapacidade em atividades instrumentais de vida diária foi de 44,7/1.000 pessoas/ano para mulheres e 25,2/1.000 pessoas/ano para homens. A razão da densidade de incidência entre mulheres e homens foi 1,77 (IC95% 1,75;1,80). Após ajuste por condições socioeconômicas e clínicas, a razão da densidade de incidência foi 1,81 (IC95% 1,77;1,80), mostrando que mulheres com doenças crônicas e maior vulnerabilidade social apresentaram maior densidade de incidência de incapacidade em atividades instrumentais de vida diária. Foram determinantes da incidência de incapacidade: idade ≥ 80 anos e pior percepção de audição em ambos os sexos; acidente vascular encefálico entre homens e idade entre 70-79 anos entre mulheres. Melhor desempenho cognitivo foi fator protetor em ambos os sexos e melhor equilíbrio para mulheres. CONCLUSÕES A maior densidade de incidência de incapacidade em mulheres foi mantida mesmo após ajuste por condições clínicas e sociais adversas. Além da idade, o pior desempenho cognitivo e condições que adversamente afetam a comunicação incapacitam ambos os gêneros. Eventos agudos, como o acidente vascular cerebral, incapacitam mais os homens, enquanto déficit precoce no equilíbrio incapacita mais as mulheres

Pericoronarite: fatores de risco associados e indicações de tratamentos conservadores comparados à tratamentos farmacológicos

A pericoronarite tem sido um grande desafio na Odontologia, visto que é negligenciada muitas vezes quanto ao diagnóstico e tratamento, o que pode levar à uma condição potencialmente fatal. Para reverter tal situação, os cirurgiões-dentistas devem ter amplo conhecimento da microbiota das infecções odontogênicas para obtenção do sucesso no diagnóstico e a devida terapêutica medicamentosa. Diversos fatores podem desencadear a pericoronarite, como cárie dentária, pulpite, gangrena pulpar e abscesso periapical. É diagnosticada clinicamente com base na presença de inflamação dos tecidos moles associada ao dente parcialmente erupcionado. O tratamento limita-se a um procedimento cirúrgico local ou que envolva tratamento antibiótico empírico. Baseado nisto, este trabalho teve como objetivo realizar uma revisão da literatura sobre etiologia, epidemiologia, microbiota, assim como também, a importância do diagnóstico precoce e prevenção, as opções de tratamento disponíveis, incluindo a eficácia e indicações de tratamentos conservadores comparados com tratamentos farmacológicos

A relevância do tipo de material para a percepção de sustentabilidade em embalagens

The main objective of this article was to investigate, through the visual perception of consumers, the perceived environmental value of packaging, considering the ability of the type of material used to improve communication. For this, it used methods inherent to the area of Design and Machine Learning, in which Phase 1 consisted of the development of experimental packages designed to support perceptual evaluations on communication about sustainable orientation; Phase 2 adopted methods inherent to the area of Machine Learning and Empirical Aesthetics to collect data with the public; and Phase 3 was equipped with the data collected for the training of predictive and interpretation models that corroborate the understanding of the perception of sustainability through the materials. It was possible to verify, based on the responses provided by the public, the existence of types of materials that contribute to the perception of environmental value, such as paperboard and glass, and materials that undermine this perception, such as metais and polymer, demonstrating the need to disseminate more in-depth information about the subject to the consuming public

A System Core Ontology for Capability Emergence Modeling

To properly understand organizational adaptation and innovation, it is critical to understand the emergence phenomenon, i.e., how the capabilities of a system emerge after changes. However, for this, we should be able to explain systems, their structure, behavior, and capabilities. In pursuit of an understanding of the emergence phenomenon and the nature of those new kinds of systems in organizations, we propose a well-founded system core ontology based on the Unified Foundational Ontology. The ontology is also grounded in system science definitions and disposition theories. For a more integrated explanation of emergence, the proposed ontology considers distinct perspectives of a system, such as its composition, structure, properties, and functions. In the end, we discuss the applications and implications of the proposed ontology on the enterprise architecture area and emergence modeling

Calidad de vida de los enfermeros del servicio de atención móvil de emergências

Objetivo: avaliar a qualidade de vida de enfermeiros do Serviço de Atendimento Móvel de Urgência do Distrito Federal (Brasil) e identificar os domínios que influenciaram nessa avaliação. Método: estudo observacional, descritivo, transversal e quantitativo, com dados obtidos de 123 enfermeiros que responderam a um questionário desenvolvido e estruturado para conhecer variáveis sociodemográficas e clínicas e com aplicação do World Health Organization Quality of Life Instrument Bref, para avaliar a qualidade de vida. Os dados foram submetidos à estatística descritiva e inferencial. Resultados: os enfermeiros eram em sua maioria mulheres, entre 20 a 40 anos, casadas, com nível acadêmico de especialização e sem vínculo empregatício com outra instituição. A maior parte (72,36%) considerou sua qualidade de vida boa ou muito boa e estava satisfeita ou muito satisfeita com a saúde (65,03%). O domínio meio ambiente foi o pior avaliado. Observou-se correlação significativa entre os domínios relações sociais (p=0,049) e meio ambiente (p=0,035) quando correlacionados à variável sexo. As mulheres avaliaram melhor suas relações sociais e o meio ambiente em relação aos homens. Conclusão: o conhecimento produzido por essa investigação poderá subsidiar o delineamento de estratégias que permitam diminuir as dificuldades relacionadas à vida e ao trabalho de enfermeiros do Serviço de Atendimento Móvel de Urgência. Ações nesse sentido poderão contribuir para a melhoria da saúde, do bem estar e da qualidade de vida dos profissionais e terão efeitos positivos sobre a qualidade da assistência à saúde prestada à população.Objective: to evaluate the quality of life of nurses from the Mobile Emergency Care Service of the Federal District (Brazil) and to identify the domains that influenced this assessment. Method: an observational, descriptive, cross-sectional and quantitative study, with data obtained from 123 nurses who answered a questionnaire developed and structured in order to know sociodemographic and clinical variables and with the application of the World Health Organization Quality of Life Instrument Bref, to assess the quality of life. The data were submitted to descriptive statistics and inferential statists. Results: most of the nurses were women, aged between 20 and 40 years old, married, with a specialization degree and without any employment relation with another institution. Most (72.36%) considered their quality of life good or very good and were satisfied or very satisfied with their health (65.03%). The environment domain was the worst evaluated. A significant correlation was observed between the social relations (p=0.049) and environment (p=0.035) domains when correlated with the gender variable. The women rated their social relations and environment better than the men. Conclusion: the knowledge produced by this investigation may support the design of strategies that enable reducing the difficulties related to the life and work of nurses of the Mobile Emergency Care Service. Actions in this direction may contribute to the improvement of health, well-being and quality of life of the professionals and will have positive effects on the quality of health care provided to the population.Objetivo: evaluar la calidad de vida de los enfermeros del Servicio de Atención Móvil de Emergencias del Distrito Federal (Brasil) e identificar los dominios que influenciaron en esa evaluación. Método: estudio de observación, descriptivo, transversal y cuantitativo, en el que se obtuvieron datos de 123 enfermeros que respondieron a un cuestionario desarrollado y estructurado para descubrir variables sociodemográficas y clínicas y en el que se aplicó el instrumento World Health Organization Quality of Life Instrument Bref para evaluar la calidad de vida. Los datos se sometieron a estadística descriptiva y inferencial. Resultados: en su mayoría, los enfermeros eran mujeres de 20 a 40 años de edad, casadas, con un nivel académico de especialización y sin ningún vínculo de empleo con otras instituciones. La mayor parte (72,36%) consideraron que su calidad de vida era buena o muy buena y se mostraron satisfechas o muy satisfechas con su salud (65,03%). El dominio del medio ambiente fue el peor evaluado. Se observó una correlación significativa entre los dominios de las relaciones sociales (p=0,049) y del medio ambiente (p=0,035) al correlacionarlos con la variable del sexo. Las mujeres evaluaron mejor que los hombres sus relaciones sociales y el medio ambiente. Conclusión: los conocimientos obtenidos gracias a esta investigación podrán ayudar a delinear estrategias que permitan reducir las dificultades relacionadas con la vida y el trabajo de los enfermeros del Servicio de Atención Móvil de Emergencias. Implementar acciones en este sentido podrá contribuir a mejorar la salud, el bienestar y la calidad de vida de los profesionales y tendrá efectos positivos sobre la calidad de la atención a la salud que se presta a la población

Association of health vulnerability with adverse outcomes in older people with COVID-19: a prospective cohort study

OBJECTIVES: Health vulnerability is associated with a higher risk of mortality and functional decline in older people in the community. However, few studies have evaluated the role of the Vulnerable Elders Survey (VES-13) in predicting clinical outcomes of hospitalized patients. In the present study, we tested the ability of the VES-13 to predict mortality and the need for invasive mechanical ventilation in older people hospitalized with coronavirus disease 2019 (COVID-19). METHODS: This prospective cohort included 91 participants aged X60 years who were confirmed to have COVID-19. VES-13 was applied, and the demographic, clinical, and laboratory variables were collected within 72h of hospitalization. A Poisson generalized linear regression model with robust variance was used to estimate the relative risk of death and invasive mechanical ventilation. RESULTS: Of the total number of patients, 19 (21%) died and 15 (16%) required invasive mechanical ventilation. Regarding health vulnerability, 54 (59.4%) participants were classified as non-vulnerable, 30 (33%) as vulnerable, and 7 (7.6%) as extremely vulnerable. Patients classified as extremely vulnerable and male sex were strongly and independently associated with a higher relative risk of in-hospital mortality (po0.05) and need for invasive mechanical ventilation (po0.05). CONCLUSION: Elderly patients classified as extremely vulnerable had more unfavorable outcomes after hospitalization for COVID-19. These data highlight the importance of identifying health vulnerabilities in this population

Insulin-loaded polymeric mucoadhesive nanoparticles: development, characterization and cytotoxicity evaluation

Mucoadhesive nanoparticles are particularly interesting for delivery through nasal or pulmonary routes, as an approach to overcome the mucociliary clearance. Moreover, these nanoparticles are attractive for peptide and protein delivery, particularly for insulin to treat diabetes, as an alternative to conventional parenteral administration. Thus, chitosan, a cationic mucoadhesive polysaccharide found in shells of crustaceans, and the negatively-charged dextran sulfate are able to form nanoparticles through ionic condensation, representing a potential insulin carrier. Herein, chitosan/dextran sulfate nanoparticles at various ratios were prepared for insulin loading. Formulations were characterized for particle size, zeta potential, encapsulation efficiency, scanning electron microscopy, differential scanning calorimetry, and in vitro drug release. Moreover, the interaction with mucin and the cytotoxicity against a lung cell line were studied, which altogether have not been addressed before. Results evidenced that a proper selection of polyelectrolytes is necessary for smaller particle size formation and also the composition and zeta potential impact encapsulation efficiency, which is benefited by the positive charge of chitosan. Insulin remained stable after encapsulation as evidenced by calorimetric assays, and was released in a sustained manner in the first 10 h. Positively-charged nanoparticles based on chitosan/dextran-sulfate at the ratio of 6:4 successfully interacted with mucin, which is a prerequisite for delivery to mucus-containing tissues. Finally, insulin-loaded nanoparticles displayed no cytotoxicity effect against lung cells at tested concentrations, suggesting the potential for further in vivo studies

GROWTH, YIELD AND POST-HARVEST EVALUATION OF LETTUCE PLANTS SUBJECTED TO DIFFERENT LEAF SILICON CONCENTRATIONS

Lettuce is considered the most produced and consumed leafy vegetable; however, it has short post-harvest life, which generates significant losses for both producers and consumers. Studies have proven the beneficial effect of silicon on fruits and vegetables. Therefore, the aim of the current study is to evaluate the influence of leaf calcium silicate application on the growth, biomass production and postharvest conservation of curly lettuce. The experiment was carried out in greenhouse at Federal Rural University of Amazonia, Parauapebas Campus / PA. It followed a completely randomized design (CRD) with five Si concentrations (0.0, 2.0, 4.0, 6.0 and 8.0 mg L-1) and eight repetitions, which totaled 40 plants. Plants were grown in plastic pots (capacity = 3 dm3) filled with soil classified as Red-Yellow Argisol. Different Si concentrations were applied to plant leaves, at the 20th and 27th days after transplantation (DAT). Silicon has favored the growth and development of lettuce plants, as well as reduced their post-harvest weight loss. It was possible concluding that the herein tested Si concentrations, which were applied to leaves - in the form of calcium silicate - had beneficial effect on lettuce plants

O uso de antimicrobianos na Atenção Primária à Saúde / The use of antimicrobials in primary health care

A resistência aos antimicrobianos é um problema mundial de saúde pública, aumentando consideravelmente a mortalidade e morbidade por doenças e complicações infecciosas que, anteriormente, eram tratáveis com antibióticos ou antimicrobianos quimioterápicos. Esse fenômeno é, em parte, induzido pelo uso indiscriminado dos medicamentos disponíveis, o qual, no contexto brasileiro, se estende aos diferentes níveis de atenção do Sistema Único de Saúde (SUS). Nesse sentido, a Atenção Primária à Saúde (APS) tem uma contribuição importante para o fortalecimento desse fenômeno, já que é responsável por atender um alto número de infecções frequentes, sendo a porta de entrada preferencial do sistema de saúde brasileiro. Com base nessas considerações, o presente artigo tem por objetivo discutir o uso de antimicrobianos na APS