Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Association Between Bone Mass Index (bmi) And Hand Osteoarthritis (oa) [estudo Da Associação Entre O índice De Massa Corpórea (imc) E Osteoartrite (oa) De Mãos]

Objective: To evaluate the incidence of hand osteoarthritis (OA) among patients that were referred to the Rheumatology Unit at State University of Campinas and to verify the association between hand OA and bone mass index (BMI). Methods: We evaluated 515 outpatients, calculating the BMI and registering the age at diagnosis, sex, ethnicity and diagnosis. Logistic regression was also performed. Results: Hands OA was present in 15.8%. There was no relation between BMI and hands OA in the univariated analysis. However, when multivariated logistic regression was performed, we observed 5.4% increase in the risk to develop hands OA per each 1 kg/m2 of enhance in the BMI. We also observed that overweight patients showed 2,16 fold more risk than normal subjects to present hands OA. The obese patients showed 2.04 fold more risk than the normal ones. Conclusions: We concluded that despite the lack of direct association between BMI and the hands OA prevalence, patients with BMI > 25 kg/m2 are at higher risk to develop hands OA.443206211Lawrence, R.C., Hochberg, M.C., Kelsey, J.L., Estimates of the prevalence of selected arthritic and musculoskeletal diseases in the United States (1989) J Rheumatol, 16, pp. 427-441Maurek, K., Basic data on arthritis knee, hip and sacroiliac joints in adults ages 25-74, United States,1971-1975 (1979) Vital Health Stat, 213, pp. S11Felson, D.T., Naimark, A., Anderson, J., Kazis, L., Castelli, W., Meenam, R.F., The prevalence of knee osteoarthritis in the elderly (1987) Arthritis Rheum, 30, pp. 914-918Lethbridge-Cejku, M., Tobin, J.D., Scott Jr., W.W., Reichle, R., Plato, C.C., Hochberg, M.C., The relationship of age and gender to prevalence and pattern of radiographic changes of osteoarthritis of the knee: Data from Baltimore Longitudinal Study of Aging (1994) Aging Clin Exp Res, 6, pp. 353-357Anderson, J.J., Felson, D.T., Factors associated with osteoarthritis of the knee in the First National Health and Nutrition Examination Survey (NHANES-I): Evidence for an association with overweight, race and physical demands of work (1988) Am J Epidemiol, 128, pp. 179-180Davis, M.A., Ettinger, W.H., Neuhaus, J.M., Cho, S.A., Houck, W.W., The association of knee injury and obesity with unilateral and bilateral osteoarthritis of the Knee (1989) Am J Epidemiol, 130, pp. 278-288Davis, M.A., Neuhaus, J.M., Ettinger, W.H., Mueller, W.H., Body fat distribution and osteoarthritis (1990) Am J Epidemiol, 132, pp. 701-707Hochberg, M.C., Lethbridge-Cejku, M., Scott Jr., W.W., Reichle, R., Plato, C.C., Tobin, J.D., The association of body weight, body fatness and body fat distribution with osteoarthritis of the knee: Data from the Baltimore Longitudinal Study of Aging (1995) J Rheumatol, 22, pp. 488-493Tepper, S., Hochberg, M.C., Factors associated with hip osteoarthritis: Data from the First National Health and Nutrition Examination Survey (NHANES-I) (1993) Am J Epidemiol, 137, pp. 1081-1088Caspi, D., Flusser, G., Farber, I., Clinical, Radiologic, Demographic, and Occupational Aspects of Hand Osteoarthritis in the Elderly (2001) Semin Arthritis Rheum, 30, pp. 321-331Felson, D., Weight and osteoarthritis (1996) Am J Clin Nutr, 63, pp. 430S-432SCarman, W., Sowers, M., Hawthorne, V., Weissfeld, L., Obesity as a risk factor for osteoarthritis of the hand and wrist: A prospective study (1994) Am J Epidemiol, 139, pp. 119-129Goldin, R., McAdam, L., Louie, J., Clinical and radiological survey of the incidence of osteoarthrosis among obese patients (1976) Ann Rheum Dis, 35, pp. 349-353Cicuttini, F., Baker, J., Spector, T., The association of obesity with osteoarthritis of the hand and knee in women: A twin study (1996) J Rheumatol, 23, pp. 1221-1226Lawrence, J.S., Bremner, J.M., Bier, F., Osteoarthrosis. Prevalence in the population and relationship between symptoms and x-rays changes (1996) Ann Rheum Dis, 25, pp. 1-24Anderson, J.J., Felson, D.T., Factors associated with osteoarthritis of the knee in the first National Health and Nutrition Examination Survey(NHANES I). Evidence for an association with overweight, race and physical demands of work (1988) Am J Epidemiol, 128, pp. 179-189Solomon, L., International Symposium on joint failure. Geographical and anatomical patterns of OA (1984) Br J Rheumatol, 23, pp. 177-180Sowers, M., Lachance, L., Hochberg, M., Radiographically defined osteoarthritis of the hand and knee in young and middle aged African American and Caucasian women (2000) Osteoathritis Cartilage, 8, pp. 69-77Hsieh, F.Y., Sample Size Tables for Logistic Regression (1989) Statistics in Medicine, 8, pp. 795-802Stecher, R.M., Heberden oration. Heberden's nodes. A clinical description of osteoarthritis of the finger joints (1955) Ann Rheum Dis, 14, pp. 1-10Silberg, M., Frank, E.L., Jarrer, S.R., Aging and osteoarthritis of the human sternoclavicular joint (1959) Osteoarthritis, 35, pp. 851-863Sahyoun, N.R., Hochberg, M.C., Helmick, C.G., Harris, T., Pamuk, E.R., Incidence of Self-Reported Physician Diagnosed Arthritis Among Women (1999) Am J Public Health, 89, pp. 391-394Sowers, D., Zobel, D., Weissfeld, L., Progression of osteoarthritis of the hand and metacarpal bone loss (1991) Arthritis Rheum, 34, pp. 36-42Tsai, C.L., Liu, T.K., Osteoarthritis in women: Its relationship to estrogen and current trends (1992) Life Sci, 50, pp. 1737-1744Guerne, P.A., Carson, D., Lotz, M., IL-6 production by human articular chondrocytes. Modulation of its synthesis, growth factors, and hormones in vitro (1990) J Immunol, 144, pp. 499-505Pacifici, R., Avioli, L.V., The effect of natural and surgical menopause on the secretion of cytokenis from human blood monocytes (1993) Osteoporosis Int, pp. S106-S107Spector, T.D., Hart, D.J., Brown, P., Frequency of osteoarthritis in hysterectomized women (1991) J Rheumatol, 18, pp. 1877-1883Samantha, A., Jones, A., Regan, M., Wilson, S., Doherty: In osteoarthritis in women affected by hormonal changes or smoking? (1993) Br J Rheumatol, 32, pp. 366-370van Saase, J.L.C.M., van Romunde, L.K.J., Cats, A., Vandenbroucke, J.P., Valkenburg, H.A., Epidemiology of osteoarthritis: Zoetermeer survey (1989) Ann Rheum Dis, 48, pp. 271-280Yazici, H., Saville, P.D., Salvati, E.A., Primary osteoarthrosis of the knee or hip: Prevalence of Heberden's nodes in relation to age and sex (1975) JAMA, 231, pp. 1256-126

Exercise Therapy As A Treatment In Osteoarthritis Of The Hip: A Review Of Randomized Clinical Trials [exercício Físico Como Tratamento Na Osteoartrite De Quadril: Uma Revisão De Ensaios Clínicos Aleatórios Controlados]

Functions of the hip are crucial for the functional independence of an individual, being the reason of great repercussion of Osteoarthritis (OA) on the alterations in this joint. Hip OA is a chronic degenerative disease and the available treatment aims to alleviate its symptoms. Exercises, one of the conservative treatment possibilities, have been indicated for the reduction of pain and function improvement. The purpose of this systematic review is to clarify the function and effectiveness of physical exercises in the conservative treatment of hip OA. The review of the literature was based on PUBMED, LILACS and MEDLINE database consultation, searching for article publications of randomized clinical trials for the last ten years (July/2005 - July/1995), using the combination of the following keywords: osteoarthritis, hip, exercise. The search resulted in eighteen articles; ten of each followed given criteria and underwent complete revision. After analysis of the ten selected studies, three categories were identified: a) specific exercises for OA of hip (n=3); b) exercises for OA of hip and knee (n=4) and c) exercises for pre and post-surgery of total hip (n=3). Three studies have encountered limitations with the practice of exercises. Although, the majority of the articles have demonstrated good results of exercises in the hip OA treatment, it is still not possible to determine their actual extension in the clinical picture of the illness and on its progression, mainly due to the scarcity of researches and to the lack of specificity of the proposed interventions.464273280Brooks, P.M., Impact of osteoarthritis on individuals and society: How much disability? Social consequences and health economic implications (2002) Curr Opin Rheumatol, 14, pp. 573-577Buckwalter, J.A., Stanish, W.D., Rosier, R.N., Schenck, R.C., Dennid, D.A., Coutts, R.D., The increasing need for nonoperative treatment of patients with osteoarthritis (2001) Clin Orthop Relat Res, 385, pp. 36-45Lohmander, L.S., What can we do about osteoarthritis? (2000) Arthritis Res, 2, pp. 95-100Breedveld, F.C., Osteoarthritis: The impact of a serious disease (2004) Rheumatology, 43, pp. i4-i8Arokoski, M.H., Haara, M., Heikki, J.H., Arokoski, J.P., Physical function in men with and without hip osteoarthritis (2004) Arch Phys Med Rehabil, 85, pp. 574-581Sims, K., The development of hip osteoarthritis: Implications for conservative management (1999) Man Ther, 4, pp. 127-135Felson, D.T., Epidemiology of hip and knee osteoarthritis (1998) Epidemiol Rev, 10, pp. 1-24Reijman, M., Hazes, J.M.W., Pols, H.A.P., Bernsen, R.M.D., Koes, B.W., Zeinstra, S.M.A., Validity and reliability of three definitions of hip osteoarthritis: Cross sectional an longitudinal approach (2004) Ann Rheum Dis, 63, pp. 1427-1433Bennell, K., Hinman, R., Exercise as a treatment for osteoarthritis (2005) Curr Opin Rheumatol, 17, pp. 634-640Tak, E., Staats, P., Hespen, A.V., Hopman-Rock, M., The effects of an exercise program for older adults with osteoarthritis of the hip (2005) J Rheumatol, 32, pp. 1106-1113Buckwalter, J.A., Saltzman, C., Brown, T., The impact of osteoarthritis (2004) Clin Orthop Relat Res, 427 S, pp. S6-S15Minor, M.A., Impact of exercise on osteoarthritis outcomes (2004) J Rheumatol, 31, pp. 81-86Fransen, M., McConnell, S., Bell, M., Therapeutic exercise for people with osteoarthritis of the hip or knee-asystematic review (2002) J Rheumatol, 29, pp. 1737-1745Van Barr, M.E., Assendelft, W.J.J., Decker, J., Oostenforp, R.A.B., Bijlsma, J.W.J., Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: A systematic review of randomized clinical trials (1999) Arthritis Rheum, 42, pp. 1361-1369Roddy, E., Zhang, W., Doherty, M., Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee- the MOVE consensus (2004) Rheumatology, 44, pp. 67-73Coimbra, I.B., Pastor, E.H., Greve, J.M.D., Puccinelli, M.L.C., Fuller, R., Cavalcanti, F.S., Consenso brasileiro para o tratamento da osteoartrite (artrose) (2002) Rev Bras Reumatol, 42, pp. 371-374Recommendations for the medical management of osteoarthritis of the hip and knee (2000) Arthritis Rheum, 43, pp. 190-191b. , ACR Subcommittee on osteoarthritisAltman, R.D., Hochberg, M.D., Moskowitz, R.W., Schnitzer, T.J., Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update (2000) Arthritis Rheum, 43, pp. 1905-1915Hoeksma, H.L., Van Den Ende, C., Ronday, H.K., Heering, A., Breedveld, F.C., Comparison of the responsiveness of the harris Hip Score with generic measures for hip function in osteoarthritis of the hip (2003) Ann Rheum Dis, 62, pp. 935-938Steultjens, M.P., Dekker, J., Bijlsma, J.W., Coping, pain and disability in osteoarthritis: A longitudinal study (2001) J Rheumatol, 28, pp. 1068-1072Ravaud, P., Giraudeau, B., Logeart, I., Management of osteoarthritis (OA) with an unsupervised home based exercise programme and/ or patient administeres assessment tools. A cluster randomized controlled trial with a 2X2 factorial design (2004) Ann Rheum Dis, 63, pp. 703-708Mairl, J., Faillenet, M.A.F., Grange, C., A specific arm-interval exercise program could improve the health status and walking ability of elderly patients after total hip arthroplasty: A pilot study (2004) J Rehabil Med, 36, pp. 92-94McNally, M.A., Cooke, E.A., Mollan, R.A., The effect of active movement of the foot on venous blood flow after total hip replacement (1997) J Bone Joint Surg Am, 79, pp. 1198-1201Jong, O.R.W., Hopman-Rock, M., Tak, E.C.M.P., Klazinga, N.S., An implementation study of two evidence-based exercise and health education programmes for older adults with osteoarthrtis of the knee and hip (2004) Health Educ Res, 19, pp. 316-325Veenhof, C., Dekker, J., Bijlsma, J.W.J., Ende, C.H.M.V.D., Influence of various recruitment strategies on the study population and outcome of a randomized controlled trial involving patients with osteoarthritis of the hip or knee (2005) Arthritis Rheum, 53, pp. 375-382Heuts, P.H., Bie, R., Drietelaar, M., Self-management in osteoarthritis of hip or knee: A randomized clinical trial in a primary healthcare setting (2005) J Rheumatol, 32, pp. 543-549Hoeksma, H.L., Dekker, J., Ronday, H.K., Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: A randomized clinical trial (2004) Arthritis Rheum, 51, pp. 722-729Haslam, R., A comparison of acupuncture with advice and exercises on the symptomatic treatment of osteoarthritis of the hip: A randomized controlled trial (2001) Acupunct Med, 19, pp. 19-26Foley, A., Halbert, J., Hewitt, T., Croft, M., Does hydrotherapy improve strenght and physical function in patients with osteoarthritis-a randomized controlled trial comparing a gym based and a hydrotherapy based strengthening programme (2003) Ann Rheum Dis, 62, pp. 1162-1167Van Barr, M.E., Dekker, J., Oostendoro, R.A.B., The Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: A randomized clinical trial (1998) J Rheumatol, 25, pp. 2432-2439Van Barr, M.E., Deker, J., Oostendorp, R.A.B., Bijl, D., Voorn, T.B., Bijlsma, J.W.J., Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: Nine months' follow up (2001) Arthritis Rheum, 60, pp. 1123-1130Hopman-Rock, M., Westhoff, M.H., The effects of a health educational and exercise program for older adults with osteoarthritis for the hip or knee (2000) J Rheumatol, 27, pp. 1947-1954Gocen, Z., Sen, A., Unver, B., Karatosun, V., Gunal, I., The effect of preoperative physiotherapy and education on the outcome of total hip replacement: A prospective randomized controlled trial (2004) Clin Rehabil, 18, pp. 353-358Gilbey, H.J., Ackland, T., Wang, A.W., Morton, A.R., Trouchet, T., Tapper, J., Exercise improves early functional recovery after total hip arthroplasty (2003) Clin Orthop Relat Res, 408, pp. 193-200Wang, A.W., Gibey, H.J., Ackland, T.R., Perioperative exercise programs improve early return of ambulatory function after total hip arthroplasty (2002) Am J Phys Med Rehabil, 81, pp. 801-806Marques, A.P., Kondo, A., A fisioterapia na osteoartrose: Uma revisão da literatura (1998) Rev Bras Reumatol, 38, pp. 83-9

Bone Mineral Density In Patients With Systemic Lupus Erythematosus And Its Relation To Estrogen Levels [densidade Mineral Ossea Em Pacientes Com Lupus Eritematoso Sistemico E Sua Relacao Com Niveis Estrogenicos]

Objectives: 1) To evaluate bone mineral density (BMD) in patients with systemic lupus erythematosus (SLE); 2) to determine the role of corticosteroids and cytotoxic drugs; 3) to assess the effect of estrogen on BMD in SLE. Patients and methods: BMD (DEXA) at lumbar vertebrae (L2-L4) and at femoral neck in 60 pre-menopausal SLE patients and in 64 controls, and concentrations of estradiol were measured. Age, age at disease onset, body mass index (BMI), time of disease, disease activity (SLEDAI), prednisone dose at the evaluation, total cumulative and cumulative prednisone dose in the last year and cytotoxic drugs were also assessed. Results: Mean plasmatic estradiol was 175.98 pg/ml in patients and 149.9 in controls. BMD was lower in patients than in controls (p < 0.0001). The mean current, cumulative, and last year prednisone doses were respectively 19.17 mg/d, 28. 78 g, and 5.33 g. There was no association between corticosteroids or the cytotoxic drug used and bone loss (BL). The serum concentration of estradiol did not influence the bone mass loss. The body mass index and age at the disease onset showed influence on BMD at L2. Conclusion: BMD was significantly lower in SLE patients but not related to CE or to other drugs; the estradiol had no effect on BMD. Low bone mass index interacting with early onset of disease might influence the probability of loss of bone mass.404175182Bresnihan, B., Outcome and survival in systemic lupus erythematosus (1989) Ann Rheum Dis, 48, pp. 443-445Mills, J.A., Systemic lupus erythematosus (1994) N Engl J Med, 330, pp. 1871-1879Dykman, T.R., Gluck, O.S., Murphy, W.A., Hahn, B.H., Evaluation of factors associated with glucocorticoid-induced osteopenia in patients with rheumatic diseases (1985) Arthritis Rheum, 28, pp. 361-368Ramsey-Goldman, R., Schilling, E., Daugherty, C., Conte, C., Rairie, J., Manzi, S., Fractures in patients with lupus (1996) Arthritis Rheum, 39 (SUPPL. 9), pp. S89Dhillon, V.B., Davies, M.C., Hall, M.L., Assessment of the effect of oral corticosteroids on bone mineral density in systemic lupus erythematosus: A preliminary study with dual energy x-ray absorptiometry (1990) Ann Rheum Dis, 49, pp. 624-626Kalla, A.A., Van Wyk Kotze, T.J., Meyers, O.L., Metacarpal bone mass in systemic lupus erythematosus (1992) Clin Rheumatol, 11, pp. 475-482Kalla, A.A., Fataar, A.A., Jessop, S.J., Bewerunge, L., Loss of trabecular bone mineral density in systemic lupus erythematosus (1993) Arthritis Rheum, 36, pp. 1726-1734Formiga, F., Moga, I., Nolla, J.M., Pac, M., Mitjavila, F., Roig-Escofet, D., Loss of bone mineral density in premenopausal women with systemic lupus erythematosus (1995) Ann Rheum Dis, 54, pp. 274-276Houssiau, F.A., Lefebvre, C., Depresseaux, G., Lambert, M., Devogelaer, J.P., Nagant-De Deuxchans, C., Trabecular and cortical bone loss in systemic lupus erythematosus (SLE) (1996) Br J Rheumatol, 35, pp. 244-247Horslev-Petersen, K., Influence of disease activity and drug treatment on bone mineral density (BMD) in patients with systemic lupus erythematosus (1995) Rheumatology in Europe, 24 (SUPPL. 3), p. 11Sels, F., Bone density in systemic lupus erythematosus (1995) Rheumatology in Europe, 24 (SUPPL. 3), p. 353Sels, F., Dequeker, J., Verwilghen, J., Mbuyi-Muamba, J.M., SLE and osteoporosis: Dependence and/or independence on glucocorticoids (1996) Lupus, 5, pp. 89-92Sels, F., Dequeker, J., Verwilghen, J., Mbuyi-Muamba, J.M., SLE and osteoporosis: Dependence and/or independence on glucocorticoids (1996) Lupus, 5, pp. 89-92Rosin, M., Yarboro, C., Nuzzo, V., Klippel, J., Gourley, M., Corticosteroid (CS) effects on mineral density (BMD) in patients with systemic lupus erythematosus (SLE) (1996) Arthritis Rheum, 39 (SUPPL. 9), pp. S293Hearth-Holmes, M., Nandy, I., Elder, C., Wolf, R., Bone mineral density (BMD) in two groups of patients with systemic lupus erythematosus (1996) Arthritis Rheum, 39 (SUPPL. 9), pp. S292Petri, M., Osteoporosis in SLE: Prednisone affects lumbar spine more than other areas (1996) Arthritis Rheum, 39 (SUPPL. 9), pp. S138Tan, E.M., Systemic lupus erythematosus: Immunologic aspects (1985), pp. 1049-1054. , McCarty DJ (ed): Arthritis and Allied Conditions, Philadelphia, Lea and FebigerBombardier, C., Gladman, D.D., Urowitz, M.B., Caron, D., Chang, C.H., The committee on prognosis studies in SLE. Derivation of the SLEDAI: A disease activity index for lupus patients (1992) Arthritis Rheum, 35, pp. 630-640Cullun, I.D., Ell, P.J., Ryder, J.P., X-ray dual-photon absorptiometry: A new method for the measurement of bone density (1989) Br J Radiol, 62, pp. 587-592(1994), World Health Organization (WHO). Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis, Geneva, WHO (Reports series, 843), 130pMagaro, M., Tricerri, A., Piane, D., Generalized osteoporosis in non-steroid treated rheumatoid arthritis (1991) Rheumatol Int, 11, pp. 73-76Kroger, H., Honkanen, R., Saarikoski, A., Alhava, E., Decreased axial bone mineral density in perimenopausal women with rheumatoid arthritis: A population based study (1994) Ann Rheum Dis, 53, pp. 18-23Gough, A.K.S., Lilley, J., Eyre, S., Holder, R.L., Emery, P., Generalized bone loss in patients with early rheumatoid arthritis (1994) Lancet, 344, pp. 23-27Laan, R.F.J.M., Van Riel, P.L.C.M., Van Erning, L.J.T.H.O., Lemmens, J.A.M., Ruijs, S.H.J., Van de Putte, L.B.A., Vertebral osteoporosis in rheumatoid arthritis patients: Effect of low dose prednisone therapy (1992) Br J Rheumatol, 31, pp. 91-96Joffe, I., Epstein, S., Osteoporosis associated with rheumatoid arthritis: Pathogenesis and management (1991) Semin Arthritis Rheum, 20, pp. 256-272Kipen, Y., Buchbinder, R., Forbes, A., Strauss, B., Littlejohn, G., Morand, E., Prevalence of reduced bone mineral density in systemic lupus erythematosus and the role of steroids (1997) J Rheumatol, 24, pp. 1922-1929Liel, Y., Edward, J., Shary, J., Spicer, K.M., Gordon, L., Bell, N.H., The effects of race and body habitus on bone mineral density of the radius, hip and spine in premenopausal women (1988) J Clin Endocrinol Metab, 66, pp. 1247-1250Katzman, D.K., Bachrachl, K., Carter, D.R., Marcus, R., Clinical anthropometric correlates of bone mineral acquisition in healthy adolescent girls (1991) J Clin Endocrinol Metab, 73, pp. 1332-1339Heiss, C.J., Sanborn, C.F., Nichols, D.L., Bonnick, S.L., Alford, B.B., Association of body fat distribution, circulating sex hormones and bone density in postmenopausal women (1995) J Clin Endocrinol Metab, 80, pp. 1591-1596Formiga, F., Nolla, J.M., Mitjavila, F., Bonnin, R., Navarro, M.A., Moga, I., Bone mineral density and hormonal status in men with systemic lupus erythematosus (1996) Lupus, 5, pp. 623-626LoCascio, V., Bone loss in response to long-term glucocorticoid therapy (1990) Bone Miner, 8, pp. 39-51Adachi, J.D., Bensen, W.G., Hodsman, A.B., Corticosteroid-induced osteoporosis (1993) Semin Arthritis Rheum, 22, pp. 375-384Laan, R.F.J.M., Van Riel, P.L.C.M., Van Erning, L.J.T.H.O., Lemmens, J.A.M., Ruijs, S.H.J., Van de Putte, L.B.A., Low-dose prednisone induces rapid reversible axial bone loss in rheumatoid arthritis patients (1993) Ann Intern Med, 119, pp. 963-968Pacifici, R., Brown, C., Puscheck, E., Effect of surgical menopause and estrogen replacement on cytokine release from human blood mononuclear cells (1991) Proc Natl Acad Sci U S A, 88, pp. 5134-5138Lahita, R.G., Sex steroids and SLE: Metabolism of androgens and estrogens [Editorial] (1992) Lupus, 1, pp. 125-12

Factors Associated With The History Of Falls Of Elderly Assisted By The Family Health Program [fatores Associados Ao Histórico De Quedas De Idosos Assistidos Pelo Programa De Saúde Da Família]

This study aims at identifying the sociodemographic, clinical-functional and psycho-cognitive factors associated with the history of falls of community- dwelling elderly individuals assisted by Programa Saúde da Família (PSF - Family Health Program). The sample comprised 96 elderly subjects equally divided into three groups according to the report of falls that occurred during the past year, as follows: without falls, one fall or recurrent falls. There were no significant differences between groups in relation to sociodemographic data. The non-faller group presented less complaints about pain (p=0.012) and dizziness (p=0.003), and less near-falls reports (p=0.003) when compared to the faller groups. Besides, it presented better mobility (p<0.001) and functional capacity (p<0.001) in comparison with the same groups. In the psychocognitive assessment, recurrent fallers showed higher depressed mood score (p=0.009) and higher cognitive impairment score (p=0.040) compared to non-fallers. The occurrence of falls must be considered a significant agent that negatively affects elders' life. This is why its causative as well as impeditive factors must be accurately identified, so that professionals can effectively prevent falls or their debilitating consequences.194898909Boulgarides, L.K., Use of clinical and impairment- based tests to predict falls by community-dwelling older adults (2003) Physical Therapy, 83 (4), pp. 328-339. , Alexandria, VA, aprilMinistério da Saúde Atenção Básica E a Saúde Da Família, , http://http://200.214.130.35/dab/cgab/, BRASIL, Acesso em: 14 abril 2008Brochet, B., Population-based study of pain in the elderly people: A descriptive survey (1998) Age and Ageing, 27 (3), pp. 279-289. , Bristol, UK, mayChandler, J.M., (2002) Equilíbrio E Quedas No Idoso: Questões Sobre a Avaliação E O Tratamento, pp. 265-277. , In: GUCCIONE, A. A. Fisioterapia Geriátrica. Rio de Janeiro: Guanabara KooganChiu, A.Y.Y., Au-Yeung, S.S.Y., Lo, S.K., A comparison of four functional tests in discriminating fallers from non-fallers in older people (2003) Disability and Rehabilitation, 25 (1), pp. 45-50. , Washington, DC, janCoimbra, A.M., Falls in the elderly of the Family Health Program (2010) Archives of Gerontology and Geriatrics, 51 (3), pp. 317-322. , Maryland Heigts, nov.-decFabrício, S.C.C., Rodrigues, R.A.P., Costa Júnior., M.L., Causas e conseqüências de quedas de idosos atendidos em hospital público (2004) Revista De Saúde Pública, 38 (1), pp. 17-24. , São Paulo, fevGawryszewski, V.P., Jorge, M.H.P.M., Koizumi, M.S., Mortes e internações por causas externas entre os idosos no Brasil: O desafio de integrar a saúde coletiva e a atenção individual (2004) Revista Associação Médica Brasileira, 50 (1), pp. 97-103. , São PauloHerdon, J.G., Chronic medical conditions and risk of fall injury events at home in older adults (1997) Journal of the American Geriatric Society, 45 (6), pp. 739-743. , New York, junLebrão, M.L., Duarte, Y.A.O., (2003) O Projeto SABE No Município De São Paulo: Uma Abordagem Inicial, p. 255. , Brasília: Organização Pan-Americana daSaúdeLipschitz, D.A., Screening for nutritional status in the elderly (1994) Primary Care, 21 (1), pp. 55-67. , Philadelphia, Saunders, marLourenço, R.A., Veras, R.P., Mini-Exame do Estado Mental: Características psicométricas em idosos ambulatoriais (2006) Revista De Saúde Pública, 40 (4), pp. 712-719. , São Paulo, agoMatsudo, S.M., Matsudo, V.K.R., Barros, N.T.L., Impacto do envelhecimento nas variáveis antropométricas, neuromotoras e metabólicas da aptidão física (2000) Revista Brasileira De Ciência E Movimento, 8 (4), pp. 21-32. , São Paulo, setMorris, M., Predisposing factors for occasional and multiple falls in older Australians who live at home (2004) The Australian Journal of Physiotherapy, 50 (3), pp. 153-159. , St. KildaNevitt, M.C., Falls in the elderly: Risk factors and prevention (1997) Gait Disorders of Aging, pp. 13-36. , In: MASDEU, J. C.SUDARSKY, L.WOLFSON, L.(edit.), Falls and Therapeutic strategies. Philadelphia: Lippincott-Raven PublishersParadela, E.M.P., Lourenço, R.A., Veras, R.P., Validação da Escala de Depressão Geriátrica em um ambulatório geral (2005) Revista De Saúde Pública, 39 (6), pp. 918-923. , São Paulo, dezPerracini, M.R., Ramos, L.R., Fatores associados a quedas em uma coorte de idosos residentes no comunidade (2002) Revista De Saúde Pública, 36 (6), pp. 709-716. , São Paulo, dezPodsiadlo, D., Richardson, S., The timed "Up & Go": A test of basic functional mobility for frail elderly persons (1991) Journal of the American Geriatric Society, 39 (2), pp. 142-148. , New York, febRamos, L.R., Two-year follow-up study of elderly residents in S. Paulo, Brazil: Methodology and preliminary results (1998) Revista De Saúde Pública, 32 (5), pp. 397-407. , São Paulo, outRamos, L.R., Significance and management of disability among urban elderly residents in Brazil (1993) Journal Os Cross Cultural Gerontology, 8 (4), pp. 313-323. , DordrechtRekeneire, N., Is a fall just a fall: Correlates of falling in healthy older persons. The health, aging and body composition study (2003) Journal of the American Geriatric Society, 51 (6), pp. 841-846. , New York, juneRomani, F.A., Prevalência de transtornos oculars na população de idosos residentes na cidade de Veranópolis, RS, Brasil (2005) Arquivo Brasileiros De Oftalmologia, 68 (5), pp. 649-655. , São Paulo, outShumway-Cook, A., Brauer, S., Woollacott, M., Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go test (2000) Physical Therapy, 80 (9), pp. 896-903. , Alexandria, VA, septSiqueira, F.V., Prevalência de quedas em idosos e fatores associados (2007) Revista De Saúde Pública, 41 (5), pp. 49-56. , São Paulo, outStalenhoef, P.A., A risk model for the prediction of recurrent falls in communityd welling elderly: A prospective cohort study (2002) Journal of Clinical Epidemiology, 55 (11), pp. 1088-1094. , novTinetti, M.E., Williams, C.S., Gill, T.M., Health, functional and psychological outcomes among older persons with chronic dizziness (2000) Journal of the American Geriatric Society, 48 (4), pp. 417-421. , New York, april(1977) International Classification of Diseases, , WORLD HEALTH ORGANIZATION, 9th Revision (ICD-9). Geneva: WHOYusuf, H.R., Leisure-time physical activity among older adults: United States, 1990 (1996) Archives of Internal Medicine, 156 (12), pp. 1321-1326. , Chicago, jun

Influence Of Muscle Mass And Bone Mass On The Mobility Of Elderly Women: An Observational Study

Background: The purpose of this study was to investigate the influence of muscle mass and bone mineral density on markers of mobility in dwelling elderly women. Methods. This cross-sectional study included 99 elderly women, who were 65 years old or above, in Campinas-SP, Brazil. To collect data, we used sociodemographic data, the body mass index (BMI), health status, comorbidities, use of medications, mobility tests (TUG and gait speed) and examinations of the body composition (densitometry with dual-emission X-ray absorptiometry "DXA"). In order to examine the relationship between muscle and bone mass with mobility (gait speed and TUG), we applied the Spearman correlation coefficient.Also was applied the analysis of covariance (ANCOVA) adjusted for age and comorbidities. To identify the factors associated with mobility, we used the univariate and multivariate logistic regression analysis. The level of significance for statistical tests was P &lt; 0.05. Results: The correlation between sarcopenia and bone mineral density with mobility tests showed a significant relationship only between sarcopenia and TUG (r = 0.277, P = 0.006) in Spearman correlation coefficient. The result of the correlation analysis (ANCOVA) showed that sarcopenia was associated with gait speed (r2 = 0.0636, P = 0.0018) and TUG (r2 = 0.0898, P = 0.0027). The results of the multivariate analysis showed that age (P = 0.034, OR = 1.081) was associated with worse performance on gait speed. By highlighting the TUG test, the results of the multivariate analysis showed that the age (P = 0.004, OR = 1.111) and BMI in overweight (P = 0.011, OR = 7.83) and obese (P &lt; 0.001, OR = 7.84) women were associated with lower performance of the functionality of the lower limbs. Conclusion: The findings with regard to mobility tests which were analyzed in this study indicate the association of variables related to the aging process that contribute to the decline in physical performance, for example, age, BMI and sarcopenia. © 2014 Falsarella et al.; licensee BioMed Central Ltd.141Shin, H., Panton, L.B., Button, G.R., Ilich, J.Z., Relationship of physical performance with body composition and bone mineral density in individuals over 60 years of age: A systematic review (2011) J Aging Res, 23, pp. 1-14Thomas, E., Croft, P.R., Dziedzic, K.S., Hand problems in community-dwelling older adults: Onset and effect on global physical function over a 3-year period (2009) Rheumatology (Oxford), 48, pp. 183-187. , 19141575Hootman, J.M., Helmick, C.G., Projections of US prevalence of arthritis and associated activity limitations (2006) Arthritis Rheum, 54, pp. 226-229. , 10.1002/art.21562 16385518Brooks, P.M., Impact of osteoarthritis on individuals and society: How much disability? Social consequences and health economic implications (2002) Curr Opin Rheumatol, 14, pp. 573-577. , 10.1097/00002281-200209000-00017 12192258Dunlop, D.D., Semanik, P., Song, J., Manheim, L.M., Shih, V., Chang, R.W., Risk factors for functional decline in older adults with arthritis (2005) Arthritis Rheum, 52, pp. 1274-1282. , 10.1002/art.20968 15818691Song, J., Chang, R.W., Dunlop, D.D., Population impact of arthritis on disability in older adults (2006) Arthritis Rheum, 55, pp. 248-255. , 10.1002/art.21842 16583415Estrada, M., Kleppinger, A., Judge, J.O., Walsh, S.J., Kuchel, G.A., Functional impact of relative versus absolute sarcopenia in healthy older women (2007) J Am Geriatr Soc, 55, pp. 1712-1719. , 10.1111/j.1532-5415.2007.01436.x 17979895Frisoli, A.J., Chaves, P.H., Ingham, S.J., Fried, L.P., Severe osteopenia and osteoporosis, sarcopenia, and frailty status in community-dwelling older women: Results from the Women's Health and Aging Study (WHAS) II (2010) Bone, 48, pp. 952-957. , 21195216Lang, T., Streeper, T., Cawthon, P., Baldwin, K., Taaffe, D.R., Harris, T.B., Sarcopenia: Etiology, clinical consequences, intervention, and assessment (2010) Osteoporos Int, 21, pp. 543-559. , 10.1007/s00198-009-1059-y 19779761Baumgartner, R.N., Koehler, K.M., Gallagher, D., Romero, L., Heymsfield, S.B., Ross, R.R., Garry, P.J., Lindeman, R.D., Epidemiology of sarcopenia among the elderly in New Mexico (1998) Am J Epidemiol, 147, pp. 755-763. , 10.1093/oxfordjournals.aje.a009520 9554417Gomez-Ambrosi, J., Rodriguez, A., Catalan, V., Fruhbeck, G., The bone-adipose axis in obesity and weight loss (2008) Obes Surg, 18, pp. 1134-1143. , 10.1007/s11695-008-9548-1 18563500Karinkanta, S., Heinonen, A., Sievanen, H., Uusi-Rasi, K., Fogelholm, M., Kannus, P., Maintenance of exercise-induced benefits in physical functioning and bone among elderly women (2009) Osteoporos Int, 20, pp. 665-674. , 10.1007/s00198-008-0703-2 18696173Reid, K.F., Naumova, E.M., Carabello, R.J., Phillips, E.M., Fielding, R.A., Lower extremity muscle mass predicts functional performance in mobility-limited elders (2008) J Nutr Health Aging, 12, pp. 493-498. , 10.1007/BF02982711 18615232Cruz-Jentoft, A.J., Baeyens, J.P., Bauer, J.M., Boirie, Y., Cederholm, T., Landi, F., Martin, F.C., Zamboni, M., Sarcopenia: European consensus on definition and diagnosis: Report of the European working group on sarcopenia in older people (2010) Age Ageing, 39, pp. 412-423. , 10.1093/ageing/afq034 20392703Global database on body mass index BMI Classification, , http://www.apps.who.int/bmi/index.jsp?introPage=intro-3.htmlFried, L.P., Tangen, C.M., Walston, J., Newman, A.B., Hirsch, C., Gottdiener, J., Seeman, T., McBurnie, M.A., Frailty in older adults: Evidence for a phenotype (2001) J Gerontol A Biol Sci Med Sci, 56, pp. 146-156. , 10.1093/gerona/56.3.M146Ries, J.D., Echternach, J.L., Nof, L., Gagnon, B.M., Test-retest reliability and minimal detectable change scores for the timed up & go test, the six-minute walk test, and gait speed in people with Alzheimer disease (2009) Phys Ther, 89, pp. 569-579. , 10.2522/ptj.20080258 19389792Lucki, K., Bach, M., Banzer, W., Vogt, L., Walker use affects timed up and go and gait speed measures (2009) J Am Geriatr Soc, 57, pp. 1963-1965. , 10.1111/j.1532-5415.2009.02475.x 19807815Hayes, K., Johnson, M., Measures of adult general performance tests. The berg balance scale, dynamic gait index (DGI), gait speed, physical performance test (PPT), timed chair stand test, timed up and go, and tinetti performance-oriented mobility assessment (POMA) (2003) Arthritis & Rheuma, 49, pp. 28-42. , 10.1002/art.11411Kanis, J.A., Diagnosis of osteoporosis and assessment of fracture risk (2002) Lancet, 359, pp. 1929-1936. , 10.1016/S0140-6736(02)08761-5 12057569Broadwin, J., Goodman-Gruen, D., Slymen, D., Ability of fat and fat-free mass percentages to predict functional disability in older men and women (2001) J Am Geriatr Soc, 49, pp. 1641-1645. , 10.1111/j.1532-5415.2001.49273.x 11843997Woo, J., Leung, J., Kwok, T., BMI, body composition, and physical functioning in older adults (2007) Obesity, 15, pp. 1886-1894. , 10.1038/oby.2007.223 17636108Aleman, M.H., Lee, S.Y., Javed, F., Thornton, J., Heymsfield, S.B., Pierson, R.N., Pi Sunyer, F.X., Gallagher, D., Elderly Mexicans have less muscle and greater total and truncal fat compared to African-Americans and Caucasians with the same BMI (2009) J Nutr Health Aging, 13, pp. 919-923. , 10.1007/s12603-009-0252-1 19924354Kim, M.J., Yabushita, N., Kim, M.K., Matsuo, T., Okuno, J., Tanaka, K., Alternative items for identifying hierarchical levels of physical disability by using physical performance tests in women aged 75 years and older (2010) Geriatr Gerontol Int, 10, pp. 302-310. , 10.1111/j.1447-0594.2010.00614.x 20345433Öztürk, A., Yümin, E.T., Sertel, M., Yümin, M., The relationship between physical, functional capacity and quality of life (QoL) among elderly people with a chronic disease (2011) Arch Gerontol Geriatr, 53, pp. 278-283. , 10.1016/j.archger.2010.12.011 21215469Escalante, A., Lichtenstein, M.J., Hazuda, H.P., Walking velocity in aged persons: Its association with lower extremity joint range of motion (2001) Arthritis Rheum, 45, pp. 287-294. , 10.1002/1529-0131(200106)45:33.0.CO;2-1 11409671Bohannon, R.W., Brennan, P.J., Pescatello, L.S., Marschke, L., Hasson, S., Murphy, M., Adiposity of elderly women and its relationship with self-reported and observed physical performance (2005) J Geriatr Phys Ther, 28, pp. 10-13. , 16236222Sharkey, J.R., Branch, L.G., Gender difference in physical performance, body composition and dietary intake in homebound elders (2004) J Women Aging, 16 (3-4), pp. 71-9

Análise espaço-temporal do uso da terra em parte do semi-árido cearense Spatial and temporal-time analysis of land use in part of the semi-arid region of Ceará State, Brazil

A cobertura vegetal exerce papel imprescindível à proteção e conservação dos recursos naturais, principalmente no que diz respeito aos solos. Este estudo teve como objetivo avaliar e analisar a dimensão espacial e temporal da ação antrópica na cobertura vegetal de parte do semi-árido cearense, utilizando imagens LANDSAT TM-5, de 1985 e 1994, e técnicas de geoprocessamento, para verificar a hipótese de que a degradação ambiental vem sendo intensificada. Foram confeccionadas cartas de vegetação, uso da terra, solos e hidrografia, obtendo-se cartas de sobreposição, por meio das quais se constatou o aumento de áreas degradadas nas diferentes unidades fitoecológicas. No período de uma década, comprovou-se o processo progressivo da degradação nas áreas dos municípios de Independência, Pedra Branca, Mombaça e Tauá, tendo as áreas do município de Pedra Branca apresentado menor degradação. A unidade fitoecológica mais degradada, dentre as estudadas, foi a Caatinga Arbórea Aberta, desencadeando processos de degradação e transformação das unidades circunvizinhas. Grande parte da área foi atingida por processos de degradação ambiental, com forte pauperização da biodiversidade, acompanhados por um rebaixamento geral das formações vegetais.<br>The vegetation cover plays a key role in protection and conservation of natural resources, particularly concerning soils. This study had as objective to analyze space and time dimensions of anthropic influence on the vegetation cover in part of the semi-arid region of the Ceará State, Brazil. LANDSAT TM-5 satellite images of 1985 and 1994 combined with geoprocessing techniques were used to verify the hypothesis of intensification of environmental degradation. Maps of the vegetation cover, land use, soils, and hydrography were elaborated. They pointed out to an increase in degraded areas of the different phytoecological units. During this decade, a progressive degradation process was verified in study areas of the Independência, Pedra Branca, Mombaça and Tauá counties The Pedra Branca areas suffered the least from degradation. Among all areas, the sparse arborous Caatinga was the most degraded ecological unit, triggering degradation and transformation processes in the neighboring units. A large part of the area under investigation was environmentally degraded, with a substantial reduction of biodiversity, besides an overall downsizing of vegetal formations