Uso de tabaco entre idosos: revisão sistemática e meta-análise

The aim of this study was to combine the results of identified surveys on the prevalence of tobacco use in old age to estimate world prevalence of tobacco use and possible factors related to such behavior among the elderly. The literature search included electronic databases such as MEDLINE, LILACS, and Biological Abstracts, hand-searching of specialist journals and cited reference searches. The combined global prevalence was estimated using the random effects model. The total number of elderly subjects included in all surveys was 140,058, with data available from all the continents. Overall prevalence of tobacco use was 13% in both genders (22% male and 8% female). The prevalence rates were heterogeneous among surveys and were associated with smoking definition, questionnaire application, and country economic status. Few epidemiological studies assessed tobacco use among the elderly. A higher prevalence rate of tobacco use in males who live in higher income countries could be found, although additional evidence regarding elderly samples is still required.O objetivo deste estudo foi combinar os resultados de pesquisas identificadas sobre a prevalência do tabagismo em idosos, para estimar sua prevalência mundial e possíveis fatores relacionados a este tipo de comportamento entre eles. A revisão da literatura incluiu busca nas bases de dados eletrônicas como MEDLINE, LILACS e Biological Abstracts, busca manual em jornais especializados e nas referências citadas. A prevalência global combinada foi estimada usando-se o modelo de efeitos randômicos. O número total de idosos incluídos em todos os levantamentos foi 140.058, com dados disponíveis em todos os continentes. A prevalência de tabagismo foi de 13% em ambos os sexos (22% homens e 8% mulheres). As taxas de prevalência foram heterogêneas e estiveram associadas com a definição de tabagismo, aplicação do questionário e com a economia de cada país. A maior taxa de prevalência foi encontrada entre idosos do sexo masculino que vivem em países de renda mais alta.Universidade Federal do Rio de Janeiro Instituto de PsiquiatriaGlaxoSmithKline do BrasilUniversidade do Estado do Rio de Janeiro Faculdade de Ciências MédicasFundação Oswaldo Cruz Escola Nacional de Saúde Pública Sergio AroucaUniversidade Federal de São Paulo (UNIFESP) Departamento de PsiquiatriaUNIFESP, Depto. de PsiquiatriaSciEL

Prevalence of dynapenia and overlap with disability, depression, and executive dysfunction

OBJECTIVE: This study aims to investigate handgrip strength and dynapenia prevalence among older adults stratified by Brazilian macroregions. Additionally, we aim to evaluate the overlap between dynapenia and Instrumental Activities of Daily Living (IADL) disability, depression, and executive dysfunction on a national basis and by each Brazilian macroregion. METHODS: This cross-sectional analysis was based on data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). A multistage cluster sample design was used, with a representative population-based study of non-institutionalized community-dwelling Brazilians aged ≥ 50 years from 70 municipalities across all five macroregions of the country. The outcome variable was dynapenia. Covariables were IADL disability, depression, and executive dysfunction. The Brazilian macroregions were used for stratification. In addition, the following additional variables were included: age group, gender, education level, macroregions (North, Northeast, Southeast, South, and Midwest), self-reported health, multimorbidity, and falls. RESULTS: A total of 8,849 (94%) of the sample provided complete information for the handgrip strength assessment and were included in this analysis. Dynapenia prevalence was higher in North and Northeast regions (28.5% and 35.1%, respectively). We identified statistically significant differences between different macroregions for dynapenia, IADL disability, and verbal fluency, with worse values in the North and Northeast regions. In the North and Northeast macroregions, nearly half of the subjects that presented executive dysfunction and IADL disability also had dynapenia. There was a more significant overlap in the prevalence of all four conditions in the North and Northeast regions (4.8% and 5.5%, respectively), whereas the overlap was smaller in the South (2.3%). There was also a smaller overlap in the prevalence of dynapenia and depression in the South (5.8%) compared with other macroregions. CONCLUSIONS: Macroregions in Brazil exhibit marked differences in the prevalence of dynapenia and in its overlap with IADL disability, depression, and executive dysfunction

Metacognitive Improvements Following Cognitive Stimulation Therapy for People with Dementia: Evidence from a Pilot Randomized Controlled Trial

OBJECTIVES: Impaired self-awareness is a common feature of dementia, with considerable clinical impact. Some therapeutic strategies such as cognitive stimulation and psychotherapy have been suggested to mitigate loss of awareness. Nevertheless, evidence of intervention improving awareness of deficits is scarce. The present study aims to explore the impact of a Brazilian adapted version of Cognitive Stimulation Therapy (CST-Brasil), an evidence-based psychosocial intervention for people with dementia (PwD), on the level of awareness, reporting here a secondary outcome of a pilot randomized controlled trial. METHODS: 47 people with mild to moderate dementia attending an out-patient unit were randomly allocated to CST (n = 23) or treatment as usual (TAU) (n = 24) across 7 weeks, in a pilot randomized controlled trial. Awareness was measured before and after the intervention. RESULTS: Results indicated that people in both groups increased in overall awareness of the disease, but only those receiving CST exhibited improvements of awareness of cognitive ability. CONCLUSIONS: These findings suggest that CST may also improve metacognitive abilities in PwD, which could potentially be applied to other settings with beneficial effects. CLINICAL IMPLICATIONS: Considering the negative impacts of anosognosia, CST-led improvements in awareness have the potential to benefit PwD and their caregivers

Association among race/color, gender, and intrinsic capacity: results from the ELSI-Brazil study

OBJECTIVE: To investigate associations among race/color, gender, and intrinsic capacity (IC) (total and by domains) in middle-aged and older adults from a Brazilian cohort. As a secondary objective, we investigate these associations across Brazilian regions. METHODS: This is a cross-sectional study conducted with baseline data from the 2015–2016 Brazilian Longitudinal Study of Aging (ELSI-Brazil). IC was investigated via cognitive (verbal fluency), physical (gait velocity/handgrip), and psychosocial (Center for Epidemiological Studies Depression) domains. Moreover, IC sensory domain was evaluated via self-reported sensory disease diagnoses (vision and/or hearing impairment) and race/color was identified via self-reported criteria. RESULTS: We evaluated a total of 9,070 participants (aged ≥ 50 years). Black and Brown participants were 80% and 41% more likely to show a worse IC cognitive domain than white controls, respectively (OR = 1.80, 95%CI: 1.42–2.28, p < 0.001 and OR = 1.41, 95%CI: 1.21–1.65, p < 0.001). Moreover, Black and Brown women had almost a threefold greater chance of showing a worse IC than white men (OR = 2.91, 95%CI: 1.89–4.47, p < 0.001 and OR = 2.51, 95%CI: 2.09 - 3.02, p < 0.001) and a 62% (OR = 1.62, 95%CI: 1.02–2.57) and 32% (OR = 1.32, 95%CI: 1.10–1.57) greater risk of falling below our IC score cutoff point than white women. We found the greatest differences in the Brazilian South, whereas its North showed the lowest associations among race/color, gender, and IC. CONCLUSION: IC racial and gender disparities reinforce the need for public health policies to guarantee equality during aging. Promoting greater access to good health care requires understanding how racism and sexism can contribute to health inequities and their consequences in different Brazilian regions

Experiences of cognitive stimulation therapy (CST) in Brazil: a qualitative study of people with dementia and their caregivers

Objectives: There is a lack of investment in psychosocial treatments for people with dementia in Brazil. Cognitive Stimulation Therapy (CST) is a group-based intervention that has shown to have benefits on activities of daily living and mood for people with dementia in Brazil. This study aims to explore the experiences and perceived changes following CST groups. Methods: Individual interviews were conducted with the participants of the group (n = 12) and their caregivers (n = 11). Framework analysis was used to inspect the data. Results: Two main themes have emerged: ‘Personal benefits of being part of the group’, containing two subthemes: ‘Benefits for caregivers’ and ‘Benefits for person with dementia’ and ‘Day-to-day changes’, containing seven subthemes; ‘Memory’, Sociability’, ‘Language’, ‘Mood’, ‘Orientation’, ‘Everyday activities’ and ‘Behavioural and psychological symptoms’. Conclusion: Results suggest that CST groups led to perceived personal benefits for the people with dementia and caregivers and that there are perceived changes for the participants of the groups

Use of transcranial magnetic stimulation in the treatment of nonfluent primary progressive aphasia: a case report

ABSTRACT Primary progressive aphasia comprises a group of neurodegenerative diseases characterized by progressive speech and language dysfunction. Neuroimaging (structural and functional), biomarkers, and neuropsychological assessments allow for early diagnosis. However, there is no pharmacological treatment for the disease. Speech and language therapy is the main rehabilitation strategy. In this case report, we describe a female patient diagnosed with nonfluent primary progressive aphasia who underwent sessions of high-frequency transcranial magnetic stimulation in the left dorsolateral prefrontal cortex and showed improvement in depression scores, naming tasks in oral and written speech, and comprehension tasks in oral and written discourse

VISÃO DOS GRADUANDOS DE ENFERMAGEM SOBRE DIFERENTES FERRAMENTAS TECNOLÓGICAS QUE AUXILIAM NO ENFRETAMENTO DA COVID-19 E FORMAÇÃO NA ÁREA DA SAÚDE

Desde o início da pandemia causada pelo SARS-CoV-2, uma das principais medidas prevenção e precaução é o distanciamento social, com isso aumentase a importância de utilizar os recursos de monitoramento telefônico e de telemedicina para atender a população que apresenta sinais e sintomas característicos de síndrome gripal ou até mesmo sinais e sintomas de crises de ansiedade. Além da plataforma de telemedicina há outro recurso utilizado para o acompanhamento da população que apresenta sinais e sintomas de Síndrome Gripal, que é o monitoramento telefônico realizado pelos alunos bolsistas em parceria com a Secretaria Municipal de Saúde de Bandeirantes e Vigilância Epidemiológica. O objetivo deste trabalho é relatar a experiência dos discentes da Universidade Estadual do Norte do Paraná e que atuam no monitoramento dos casos suspeitos e notificados de COVID-19. A interação da Telemedicina e do monitoramento telefônico são fundamentais para o momento que o mundo está vivendo, pois ambos prestam auxílio ao cuidado com a saúde, através de consultas e orientações de saúde para os usuários, dando um suporte adequado ao paciente em domicílio, acompanhando sua saúde, sanando suas dúvidas e funcionando também para evitar a propagação do vírus, uma vez que os usuários recebem informações adequadas em domicilio e deixam de ir em busca de um atendimento presencial sem que seja necessário

CENTRAL DE TELEATENDIMENTO EM COMBATE À PANDEMIA DE COVID-19: EXPERIÊNCIA DO NORTE DO PARANÁ

O SARS-CoV-2 é um vírus identificado como a causa de um surto de doença respiratória que possui uma alta transmissibilidade entre as pessoas. Essa pandemia está influenciando em todos os aspectos da vida cotidiana, com implicações de longo alcance, especialmente na área da saúde. Diante disso os serviços de saúde modificaram seu fluxo de trabalho visando a redução da taxa de transmissão do vírus. Tais mudanças envolveram a suspensão de procedimentos eletivos, redução de pessoal em todos os serviços e diminuição da jornada de atendimento na assistência básica. O objetivo deste trabalho é relatar a experiência de acadêmicos do último ano do curso de enfermagem e participantes do Núcleo de Estudos e Enfrentamento da Covid-19 da Universidade Estadual do Norte do Paraná (NEECOVID) durante os atendimentos remotos no aplicativo Telemedicina Paraná da Plataforma TELEATEND, descrevendo sua eficácia e evolução. Esta plataforma é extremamente inovadora e passa por constantes atualizações, ela permite que os acadêmicos revejam e compreendam a importância do raciocínio clínico no cotidiano de trabalho, para repensar e rediscutir a melhor conduta frente aos sinais e sintomas apresentados pelo paciente