38 research outputs found

    History and prospects of Geriatrics

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    Short Assessment of Health Literacy for Portuguese-speaking Adults

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    OBJETIVO: Desarrollar y validar un instrumento breve para evaluaci√≥n de alfabetismo en salud en el idioma portugu√©s. M√ČTODOS: El instrumento desarrollado consiste de 50 itens que eval√ļan la capacidad del individuo de pronunciar y comprender t√©rminos m√©dicos comunes. Las propiedades psicom√©tricas se evaluaron en una muestra de 226 ancianos brasile√Īos. La validez del constructo se estableci√≥ por la correlaci√≥n con el n√ļmero de a√Īos de escolaridad, relato de alfabetismo funcional y desempe√Īo cognitivo global. La validez discriminatoria fue establecida por la exactitud del instrumento en la detecci√≥n de alfabetismo en salud inadecuado, definido como la incapacidad de comprender correctamente prescripciones m√©dicas estandarizadas. RESULTADOS: Las correlaciones con los criterios de constructo presentaron magnitud moderada a alta (coeficientes de Spearman = 0,63 a 0,76). El instrumento present√≥ tambi√©n consistencia interna satisfactoria (Cronbach = 0,93) y buena confiabilidad examen-reexamen (coeficiente de correlaci√≥n intra-clase = 0,95). El √°rea bajo la curva caracter√≠stica de operaci√≥n del receptor para detecci√≥n de alfabetismo inadecuado fue 0,82. Una versi√≥n con 18 itens fue derivada y present√≥ propiedades psicom√©tricas similares. CONCLUSIONES: El instrumento desarrollado present√≥ buena validez y consistencia en una muestra de ancianos brasile√Īos y puede ser utilizado en ambientes cl√≠nicos o de investigaci√≥n con la finalidad de detectar alfabetismo en salud inadecuado.OBJECTIVE: To develop and validate a short health literacy assessment tool for Portuguese-speaking adults. METHODS: The Short Assessment of Health Literacy for Portuguese-speaking Adults is an assessment tool which consists of 50 items that assess an individual's ability to correctly pronounce and understand common medical terms. We evaluated the instrument's psychometric properties in a convenience sample of 226 Brazilian older adults. Construct validity was assessed by correlating the tool scores with years of schooling, self-reported literacy, and global cognitive functioning. Discrimination validity was assessed by testing the tool's accuracy in detecting inadequate health literacy, defined as failure to fully understand standard medical prescriptions. RESULTS: Moderate to high correlations were found in the assessment of construct validity (Spearman's coefficients ranging from 0.63 to 0.76). The instrument showed adequate internal consistency (Cronbach's alpha=0.93) and adequate test-retest reliability (intraclass correlation coefficient=0.95). The area under the receiver operating characteristic curve for detection of inadequate health literacy was 0.82. A version consisting of 18 items was tested and showed similar psychometric properties. CONCLUSIONS: The instrument developed showed good validity and reliability in a sample of Brazilian older adults. It can be used in research and clinical settings for screening inadequate health literacy.OBJETIVO: Desenvolver e validar um instrumento breve para avalia√ß√£o de alfabetismo em sa√ļde na l√≠ngua portuguesa. M√ČTODOS: O instrumento desenvolvido consiste de 50 itens que avaliam a capacidade do indiv√≠duo de pronunciar e compreender termos m√©dicos comuns. As propriedades psicom√©tricas foram avaliadas em uma amostra de 226 idosos brasileiros. A validade de construto foi estabelecida pela correla√ß√£o com o n√ļmero de anos de escolaridade, relato de alfabetismo funcional e desempenho cognitivo global. A validade discriminativa foi estabelecida pela acur√°cia do instrumento na detec√ß√£o de alfabetismo em sa√ļde inadequado, definido como a incapacidade de compreender corretamente prescri√ß√Ķes m√©dicas padronizadas. RESULTADOS: As correla√ß√Ķes com os crit√©rios de construto apresentaram magnitude moderada a alta (coeficientes de Spearman = 0,63 a 0,76). O instrumento apresentou ainda consist√™ncia interna satisfat√≥ria (Cronbach = 0,93) e boa confiabilidade teste-reteste (coeficiente de correla√ß√£o intraclasse = 0,95). A √°rea sob a curva caracter√≠stica de opera√ß√£o do receptor para detec√ß√£o de alfabetismo inadequado foi 0,82. Uma vers√£o com 18 itens foi derivada e apresentou propriedades psicom√©tricas similares. CONCLUS√ēES: O instrumento desenvolvido apresentou boa validade e consist√™ncia em uma amostra de idosos brasileiros e pode ser utilizado em ambientes cl√≠nicos ou de pesquisa com a finalidade de detectar alfabetismo em sa√ļde inadequado

    Adaptation to the driving simulator and prediction of the braking time performance, with and without distraction, in older adults and middle-aged adults

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    Context: Many studies show the importance of evaluating the adaptation time of subjects in a virtual driving environment, looking forwards to a response as closest as a possible real vehicle. Objectives This study aimed to identify and analyze the adaptation to the driving simulator in older adults and middle-aged adults with and without a distraction, and a secondary aim was to identify predictors of safe performance for older adults' drives. Design: Male and female middle-aged adults (n = 62, age = 30.3 ¬Ī 7.1 years) and older adults (n = 102, age = 70.4 ¬Ī 5.8 years) were evaluated for braking time performance in a driving simulator; cognition performance assessment included the Mini-Mental State Examination; motor evaluation included ankle flexor muscle strength with the isokinetic dynamometer and handgrip strength; the postural balance was evaluated with Timed Up and Go test, with and without a cognitive distraction task. Results: Older adults (men and women) and middle-aged adult women require more time to adapt to the driving simulator. The distractor increases the adaptation time for all groups. The main predictors of braking time for older women are age, muscle strength, and postural balance associated with distraction, and for older men, muscle strength. Conclusions: Age, sex, and distractor interfere in the adaptation of the virtual task of driving in a simulator. The evaluation model developed with multi-domains demonstrated the ability to predict which skills are related to braking time with and without the presence of the distractor

    Muscle strength and muscle mass as predictors of hospital length of stay in patients with moderate to severe COVID‚Äź19: a prospective observational study.

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    Background: Strength and muscle mass are predictors of relevant clinical outcomes in critically ill patients, but in hospitalized patients with COVID-19, it remains to be determined. In this prospective observational study, we investigated whether muscle strength or muscle mass are predictive of hospital length of stay (LOS) in patients with moderate to severe COVID-19 patients. Methods: We evaluated prospectively 196 patients at hospital admission for muscle mass and strength. Ten patients did not test positive for SARS-CoV-2 during hospitalization and were excluded from the analyses. Results: The sample comprised patients of both sexes (50% male) with a mean age (SD) of 59 (¬Ī15) years, body mass index of 29.5 (¬Ī6.9) kg/m2. The prevalence of current smoking patients was 24.7%, and more prevalent coexisting conditions were hypertension (67.7%), obesity (40.9%), and type 2 diabetes (36.0%). Mean (SD) LOS was 8.6 days (7.7); 17.0% of the patients required intensive care; 3.8% used invasive mechanical ventilation; and 6.6% died during the hospitalization period. The crude hazard ratio (HR) for LOS was greatest for handgrip strength comparing the strongest versus other patients (1.47 [95% CI: 1.07‚Äď2.03; P = 0.019]). Evidence of an association between increased handgrip strength and shorter hospital stay was also identified when handgrip strength was standardized according to the sex-specific mean and standard deviation (1.23 [95% CI: 1.06‚Äď1.43; P = 0.007]). Mean LOS was shorter for the strongest patients (7.5 ¬Ī 6.1 days) versus others (9.2 ¬Ī 8.4 days). Evidence of associations were also present for vastus lateralis cross-sectional area. The crude HR identified shorter hospital stay for patients with greater sex-specific standardized values (1.20 [95% CI: 1.03‚Äď1.39; P = 0.016]). Evidence was also obtained associating longer hospital stays for patients with the lowest values for vastus lateralis cross-sectional area (0.63 [95% CI: 0.46‚Äď0.88; P = 0.006). Mean LOS for the patients with the lowest muscle cross-sectional area was longer (10.8 ¬Ī 8.8 days) versus others (7.7 ¬Ī 7.2 days). The magnitude of associations for handgrip strength and vastus lateralis cross-sectional area remained consistent and statistically significant after adjusting for other covariates. Conclusions: Muscle strength and mass assessed upon hospital admission are predictors of LOS in patients with moderate to severe COVID-19, which stresses the value of muscle health in prognosis of this disease

    Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.

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    How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2)

    Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

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    How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years.; We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Globally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1-7·8), from 65·6 years (65·3-65·8) in 1990 to 73·0 years (72·7-73·3) in 2017. The increase in years of life varied from 5·1 years (5·0-5·3) in high SDI countries to 12·0 years (11·3-12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1-33·1) were expected to be spent in poor health in high SDI countries compared with 11·7% (8·8-15·1) in low-middle SDI countries. HALE at birth increased by 6·3 years (5·9-6·7), from 57·0 years (54·6-59·1) in 1990 to 63·3 years (60·5-65·7) in 2017. The increase varied from 3·8 years (3·4-4·1) in high SDI countries to 10·5 years (9·8-11·2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1·0 year (0·4-1·7) in Saint Vincent and the Grenadines (62·4 years [59·9-64·7] in 1990 to 63·5 years [60·9-65·8] in 2017) to 23·7 years (21·9-25·6) in Eritrea (30·7 years [28·9-32·2] in 1990 to 54·4 years [51·5-57·1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1·4 years (0·6-2·3) in Algeria to 11·9 years (10·9-12·9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75·8 years [72·4-78·7]) and males (72·6 years [69·8-75·0]) and the lowest estimates were in Central African Republic (47·0 years [43·7-50·2] for females and 42·8 years [40·1-45·6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41·3% (38·8-43·5) for communicable diseases and by 49·8% (47·9-51·6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40·1% (36·8-43·0), although age-standardised DALY rates decreased by 18·1% (16·0-20·2). With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low SDI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health

    Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017.

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    BACKGROUND: Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. METHODS: The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries-Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised

    Effects of resistance training program in elderly with memory impairment

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    O envelhecimento populacional ocorrido nas √ļltimas d√©cadas provocou um aumento da preval√™ncia das doen√ßas cr√īnicas. Neste contexto, o estudo do comprometimento cognitivo entre idosos assume grande import√Ęncia, sobretudo as condi√ß√Ķes que podem preceder as manifesta√ß√Ķes cl√≠nicas da Doen√ßa de Alzheimer. O objetivo deste estudo foi detectar os efeitos de um programa de exerc√≠cios resistidos no desempenho cognitivo e na for√ßa muscular de idosos sedent√°rios com comprometimento da mem√≥ria. Trinta e um idosos sedent√°rios sem dem√™ncia ou depress√£o foram distribu√≠dos aleatoriamente em dois grupos: Grupo Atividade F√≠sica e Grupo Controle. O programa de exerc√≠cios resistidos durou nove meses e consistiu de tr√™s s√©ries de seis exerc√≠cios por sess√£o, realizados em aparelhos com sistema de alavancas, por aproximadamente uma hora, duas vezes por semana. Ambos os grupos foram submetidos aos seguintes testes cognitivos a cada tr√™s meses: Teste Comportamental de Mem√≥ria de Rivermead (RBMT), Amplitude de D√≠gitos Diretos e Indiretos do WAIS, Escala de Queixas de Mem√≥ria e Teste Cognitivo de Cambridge (CAMCOG). Ap√≥s nove meses, o grupo que realizou os exerc√≠cios resistidos teve um aumento significativo do escore padronizado do RBMT (p=0,021) e da for√ßa muscular (p<0,001), sem diferen√ßa significativa dos demais par√Ęmetros avaliados. Estes resultados indicam que os exerc√≠cios resistidos supervisionados podem melhorar o desempenho da mem√≥ria em idosos sedent√°rios com pr√©vio comprometimento, al√©m de determinar o aumento da for√ßa muscular.The aging population in last decades increased the prevalence of chronic diseases. In this context, the study of cognitive impairment among elderly people assumes great importance, principally of conditions than can precede the clinics manifestations of Alzheimer disease. The objective was to detect the effects of resistance training program on cognitive performance and muscle strength of sedentary elderly with memory impairment. Thirty-one sedentary patients aged 60 and older, without dementia or depression, were randomly assigned to two groups: Physical Activity Group and Control Group. The resistance training program occurred on nine months, consisted of three series of six exercises by workout, performed with lever-kind weight training machines, nearly one hour, two times for week. Both groups were submitted by cognitive tests each three months: Rivermead Behavioral Memory Test (RBMT), WAIS forward digit span and backward digit span, and subjective Memory Complains Scale, and CAMCOG. Before nine months, the resistance training group had a significant increase in RBMT profile score (p=0.021) and muscle strength (p<0.001). There weren\'t significant differences in others parameters assessed. These findings showed that supervised resistance training can enhance a memory performance in sedentary elderly with previous impairment and improve muscle strength

    Physical activity and cognition in the elderly: A review

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    Abstract Physical activity has been indicated as a strategy to promote health in the elderly, as well as to encourage the maintenance of functional capacity, and acts in the prevention and control of various diseases. In recent years, there has been great interest in studying the benefits of physical activity in the preservation or even improvement of cognitive performance in both the elderly without cognitive impairment and in elderly patients with some degree of cognitive impairment or dementia. The majority of epidemiological studies and clinical trials have evaluated aerobic exercises while few have assessed resistance exercise programs. The objective of this review was to examine the effects of different types of physical activity on cognitive function of elderly individuals with or without prior impairment
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