Prevalence of sarcopenia and its associated factors: the impact of muscle mass, gait speed, and handgrip strength reference values on reported frequencies

OBJECTIVES: Sarcopenia is a common treatable geriatric condition. The aim of this study was to estimate the prevalence of sarcopenia and its associated factors in community-dwelling elderly living in Rio de Janeiro, Brazil, and to discuss the impact of different muscle mass, handgrip strength and gait speed cut-off values on the reported frequency of sarcopenia. METHODS: The health habits, functional capacity, and anthropometric measurements of 745 individuals aged X65 years from the Frailty in Brazilian Older People study were analyzed. The participants were classified into the following four groups: no sarcopenia, pre-sarcopenia, sarcopenia and severe sarcopenia. Univariate and multivariate regression analyses were performed. Muscle mass, handgrip strength and gait speed cut-off thresholds tailored to the sample and those proposed by the European Working Group on Sarcopenia in Older People were used to compare the prevalence rates of sarcopenia. RESULTS: Seventy-three percent of the participants were female, 61.9% were Caucasian, and the mean age was 76.6 years. The prevalence rates of sarcopenia were 10.8% and 18% using the sample-tailored and European consensus cut-off values, respectively. Sarcopenia was associated with advanced age (OR: 37.2; CI95%12.35- 112.48), Caucasian race (OR: 1.89; CI 95% 1.02-3.52), single marital status (OR:6; CI95% 2.2-16.39), low income (OR:3.64; CI 95% 1.58-8.39), and the presence of comorbidities (OR:3.26; CI 95%1.28-8.3). CONCLUSION: In this study, the estimated prevalence of sarcopenia was similar to that reported in most studies after the tailored handgrip strength and gait speed cut-off values were adopted. A higher prevalence was observed when the cut-off values suggested by the European consensus were used. This indicates that the prevalence of sarcopenia must be estimated using population-specific reference values

Incidence, persistence and risk factors of fear of falling in older adults: cohort study (2008–2013) in Rio de Janeiro, Brazil

OBJECTIVE: To evaluate the incidence and persistence of fear of falling in older adults and the clinical/functional, psychosocial and lifestyle-related risk factors. METHODS: A longitudinal study with 393 community-dwelling older adults aged 65 years and over (110 men/ 283 women) resident in the North Zone of the city of Rio de Janeiro, Brazil. The fear of falling was assessed by the Falls Efficacy Scale-I-BR. The explanatory variables assessed were: number of comorbidities and medicines, history of falls, fracture from falling, use of walking aids, functional dependence in basic and instrumental activities of daily living, hearing and visual impairment, hand grip strength, walking speed, self-rated health, body mass index, depressive symptoms, cognitive impairment, living alone and activity level. Incidence, persistence and risk factors were estimated. Multivariate analysis was performed using Poisson Regression, obtaining relative risks (RR) and corresponding to 95% confidence intervals. RESULTS: Among the 393 participants, fear of falling occurred in 33.5% and was persistent in 71.3%. Incidence was found to associate with using seven or more medicines and reporting worse activity level than the prior year. Risk factors for persistent fear were: using seven or more medicines, a history of one or two falls, reduced walking speed, hearing impairment, cognitive impairment, depressive symptoms and poor or very poor self-rated health. CONCLUSION: Fear of falling is a frequent and persistent condition. Many factors related to persistent fear showed no association with the incidence of fear, emphasizing the need for focused strategies to reduce risk factors that may be associated with the chronification of fear of falling

Tradução, adaptação e validação de construto do Teste do Relógio aplicado entre idosos no Brasil

OBJECTIVE: In Brazil, not many studies have investigated the validation of cognitive tests in the ageing population and none of them has analyzed the psychometric properties of Tuokko's Clock Test. The objective of the study was to translate and adapt the test to the Brazilian context, and to assess its construct validation. METHODS: This is a cross-sectional population-based study, involving 353 elderly patients from Juiz de Fora (Southeastern Brazil), from 2004-2005. To assess convergent and divergent validities Pearson's correlation statistics was used. The Clock Test substests were correlated with theses reference instruments: mini-mental state examination, digits, block design to evaluate the convergent validity. the divergent validity was assessed by comparing the substests to the Center for Epidemiologic Studies Depression Scale. RESULTS: In the sample, 74.1% were women, aged between 63 and 107 years (73.8±8.5), average schooling was 7.4 years (SD=4.7). In regard to convergent validity, significant correlations were found between all CT subtests and MMSE, Digits, and Block Design (pOBJETIVO: Pocos estudios en Brasil investigaron la validez de las pruebas cognitivas en muestras poblacionales de ancianos y ninguno analizó las propiedades psicométricas de la Prueba del Reloj de Tuokko. El objetivo del estudio fue traducir y adaptar el modelo de dicha prueba al contexto brasilero y evaluar su validez de construcción. MÉTODOS: Se realizó un estudio transversal con una muestra poblacional constituida por 353 individuos de la ciudad de Juiz de Fora (Sureste de Brasil), 2004-2005. Para evaluar la validez convergente y discriminante, se utilizó la correlación de Pearson. Las subpruebas de la Prueba del Reloj se correlacionaron con los instrumentos de referencia: cubos y dígitos, y mini-prueba del estado mental para evaluar la validez convergente. La validez discriminante fue investigada por medio de la correlación de las subpruebas con Center for Epidemiologic Studies Depresión Scale. RESULTADOS: De la muestra, 74,1% eran del sexo femenino, con edad entre 63 y 107 años (73,8+8,5) y promedio de escolaridad de 7,4 años (DP= 4,7). Se obtuvo validez convergente, con correlaciones estadísticamente significativas entre todas las subpruebas (pOBJETIVO: Poucos estudos no Brasil investigaram a validação de testes cognitivos em amostras populacionais de idosos e nenhum deles analisou as propriedades psicométricas do Teste do Relógio de Tuokko. O objetivo do estudo foi traduzir e adaptar o modelo desse teste ao contexto brasileiro e avaliar sua validade de construto. MÉTODOS: Estudo transversal com uma amostra populacional constituída por 353 sujeitos de Juiz de Fora (MG), 2004-2005. Para avaliar as validades convergente e discriminante, utilizou-se a correlação de Pearson. Os subtestes do Teste do Relógio foram correlacionados com os instrumentos de referência: cubos e dígitos, e mini-exame do estado mental para avaliar a validade convergente. A validade discriminante foi investigada por meio da correlação dos subtestes com a Center for Epidemiologic Studies Depression Scale. RESULTADOS: Da amostra, 74,1% eram do sexo feminino, com idade entre 63 e 107 anos (73,8+8,5) e média de escolaridade foi 7,4 anos (DP=4,7). Obteve-se validade convergente, com correlações estatisticamente significativas entre todos os subtestes (

Fear of falling and advanced activities of daily living in elderly

Considerando que o medo de quedas é vivenciado inclusive por idosos que nunca caíram, podendo levar a limitações nas atividades de vida diária, o presente estudo investigou a associação entre medo de cair e Atividades Avançadas de Vida Diária (AAVD) em idosos comunitários. A amostra foi composta por 645 idosos (65 anos ou mais), clientes de uma operadora de saúde, de ambos os sexos, entrevistados pelo Estudo FIBRA-RJ. Para avaliar o medo de cair foi utilizado a Escala Internacional de Eficácia de Quedas - Brasil (FES-I-BR). As AAVD foram avaliadas com inventário baseado na literatura, sendo a manutenção de 7 ou mais AAVD, do total de 12, considerada como melhor funcionalidade. A prevalência de medo de queda foi 5% menor para idosos com pior funcionalidade para AAVD comparado àqueles com melhor funcionalidade. Esta associação entre o medo de cair e AAVD foi independente da fragilidade, idade, sexo, histórico de quedas, autopercepção de saúde, depressão, número de doenças crônicas e de medicação. Discute-se neste estudo se o desengajamento nas AAVD seria um mecanismo adaptativo na velhice e possíveis estratégias para redução do medo de quedas em idosos.The elderly population that never fell also experienced the fear of falls, which may lead to limitations in activities of daily living, this study investigated the association between fear of falling and Advanced Activities of Daily Living (AADL) in the elderly community. The sample consisted of 645 elderly (65 years or older), clients of a health care provider, of both sexes, interviewed by the FIBRA-RJ Study. The fear of falling was evaluated by the International Falls Efficiency Scale - Brazil (FES-I-BR). The AADLs were evaluated with literature-based inventory, with the maintenance of 7 or more AADLs, out of a total of 12, considered as better functionality. The prevalence of fear of falling was 5% lower for the elderly with worse functionality for AADL compared to those with better functionality. This association between fear of falling and AADL was independent of fragility, age, sex, history of falls, self-perception of health, depression, number of chronic diseases and medication. This study discusses whether disengagement in AADL would be an adaptive mechanism in old age and possible strategies for reducing the fear of falls in the elderly

Validação da escala de depressão geriátrica em um ambulatório geral

OBJECTIVE: The Geriatric Depression Scale for screening depressive symptoms in the elderly has not been assessed in elderly outpatients who seek primary health care in Brazil. The objective was to determine the validity of the Short Scale for Major Depressive Episode or Dysthymia (GDS-15) in elderly outpatients. METHODS: The scale was applied in 302 subjects with 65 years and older and then examined by an independent geriatrician, blinded to the results. Major depression and dysthymia were diagnosed using the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Sensitivity and specificity were calculated at several cutoff values and a Receiver Operating Characteristic curve was plotted. RESULTS: The best equilibrium was at the cutoff value of 5/6 showing 81% sensitivity and 71% specificity; the area under the Receiver Operating Characteristic curve was 0.85 (95% CI: 0.79-0.91). CONCLUSIONS: The GDS-15 can be used for screening depressive symptoms in Brazilian elderly outpatients. The previously suggested cutoff value of 5/6 is adequate.OBJETIVO: A Escala de Depressão Geriátrica, utilizada para o rastreamento de sintomas depressivos em idosos, ainda não teve suas características de medida avaliadas em ambulatórios gerais no Brasil. O objetivo foi estudar a validade da Escala, com 15 itens (EDG-15), na identificação de episódio de Depressão Maior ou Distimia em idosos atendidos em ambulatório geral. MÉTODOS: A Escala foi aplicada em 302 indivíduos com 65 anos ou mais, que em seguida foram examinados, de maneira independente, por um geriatra que não tinha conhecimento dos resultados da Escala. Os diagnósticos de Depressão Maior ou Distimia foram feitos utilizando-se os critérios do Diagnostic and Statistical Manual of Mental Disorders-IV. A sensibilidade e a especificidade nos vários pontos de corte foram expressas pela curva Receiver Operating Characteristic. RESULTADOS: O ponto de corte de melhor equilíbrio foi 5/6, obteve sensibilidade de 81% e especificidade de 71%; e o valor da área sob a curva Receiver Operating Characteristic foi de 0,85 (IC 95%: 0,79-0,91). CONCLUSÕES: A Escala de Depressão Geriátrica pode ser utilizada para o rastreamento de sintomas depressivos na população geriátrica ambulatorial brasileira. O ponto de corte 5/6, sugerido inicialmente por outros autores, mostrou-se adequado

Predictors of functional impairment and awareness in people with dementia, mild cognitive impairment and healthy older adults from a middle-income country

ObjectiveTo investigate the demographic, clinical and cognitive correlates of functional capacity and its awareness in people with dementia (PwD; n = 104), mild cognitive impairment (PwMCI; n = 45) and controls (healthy older adults; n = 94) in a sample from a middle-income country.MethodsDementia and MCI were diagnosed, respectively, with DSM-IV and Petersen criteria. Performance in activities of daily living (ADL) at three different levels [basic (The Katz Index of Independence), instrumental (Lawton instrumental ADL scale) and advanced (Reuben’s advanced ADL scale)], measured through self- and informant-report, as well as awareness (discrepancy between self- and informant-report), were compared between groups. Stepwise regression models explored predictors of ADL and their awareness.ResultsPwD showed impairment in all ADL levels, particularly when measured through informant-report. No differences were seen between controls and PwMCI regardless of measurement type. PwD differed in awareness of instrumental and basic, but not of advanced ADL, compared to controls. Age, gender, education and fluency were the most consistent predictors for ADL. Diagnosis was a significant predictor only for instrumental ADL. Awareness of basic ADL was predicted by memory, and awareness of instrumental ADL was predicted by general cognitive status, educational level, and diagnosis.ConclusionResults reinforce the presence of lack of awareness of ADL in PwD. Use of informant-reports and cognitive testing for fluency are suggested for the clinical assessment of ADL performance. Finally, assessment of instrumental ADL may be crucial for diagnostic purposes

Impact of Bacillus Calmette–Guérin Moreau vaccine on lung remodeling in experimental asthma

AbstractWe analyzed the effects of different administration routes and application times of the BCG-Moreau strain on airway and lung inflammation and remodeling in a murine model of allergic asthma. BALB/c mice (n=168) were divided into two groups. The first group received BCG-Moreau strain while the second group received saline using the same protocol. BCG or saline were intradermally or intranasally injected one or two months before the induction of asthma. Mice were further sensitized and challenged with ovalbumin or received saline. Twenty-four hours after the last challenge, BCG prevented the triggering of pro-inflammatory cytokines, probably by increasing Foxp3 and interleukin (IL)-10, modulating eosinophil infiltration and collagen fiber deposition, thus reducing airway hyperresponsiveness. In conclusion, BCG-Moreau prevented lung remodeling in the present model of allergic asthma, regardless of administration route and time of vaccination. These beneficial effects may be related to the increase in regulatory T cells and to IL-10 production in tandem with decreased Th2 cytokines (IL-4, IL-5, and IL-13)

Análise multivariada e geoestatística de variáveis físico-hídricas de diferentes solos

The research aimed the use of multivariate analysis, in order to reduce the dimensionality of the hydro-physical variables set of different soils in the Northwestern Paraná, to facilitate the interpretation of the interdependence between them and also to identify the similarity between the soils. The experiment was conducted in a regular grid of 36 sampling points, in three soils: an Alfisol and two distrophic Oxisols; under different managements. The data were subjected to the principal component analysis, to transformation in new variables, and after to the geostatistics, to quantify the spatial dependence degree of the major components and of the soil water infiltration rate. The principal component analysis supported in understanding of the differences and similarities among the hydro-physical variables of the soil. With the principal components analysis, there was a reduction from thirteen soil hydro-physical variables to two new variables, that were soil porosity and infiltration rate, which explained 78.4% of the variation in data.O trabalho teve como objetivo o uso da análise multivariada, visando à redução da dimensionalidade do conjunto de variáveis físico-hídricas, de diferentes solos do Nordeste do Estado do Paraná, de modo a facilitar a interpretação da interdependência entre elas. O experimento foi desenvolvido mediante utilização de uma malha regular de 36 pontos amostrais, em três solos: um Nitossolo Vermelho distroférrico e dois Latossolos Vermelhos distróficos; sob diferentes manejos. Os dados foram submetidos à análise de componentes principais, para transformação em novas variáveis, e em seguida à geoestatística, para quantificar o grau de dependência espacial dos componentes principais e da taxa de infiltração básica de água no solo. Com a análise de componentes principais, houve uma redução de treze variáveis físico-hídricas do solo para apenas duas novas variáveis, que foram porosidade do solo e taxa de infiltração, as quais explicaram 78,40% da variação dos dados

The Barretos Cancer Hospital Animal Facility: implementation and results of a dedicated platform for preclinical oncology models

The Barretos Cancer Hospital Animal Facility (BCHAF) is a unique facility in Brazil exclusively dedicated to working with animal models for cancer research. In this article, we briefly present our modern facility and the main experiments performed, focusing on mutant strains of mice (PTCH-knockout and ApcMin mice), xenograft models, and patient-derived xenografts (PDXs). Our results show the progress and challenges in establishing these models and the need for having an appropriate representation of our cancer population to better understand tumor biology and to identify cancer biomarkers, which could be putatively targeted, allowing for personalized therapy.This study was funded by the Public Ministry of Labor Campinas (Research, Prevention and Education of Occupational Cancer) and by Pio XII Foundation, Barretos Cancer Hospital internal funds, Grant Number: 13/2021