Influence of obesity and handgrip strength in the static postural balance of active older women

The objective of this study was to investigate the influence of the obesity and handgrip strength on the static balance of active older women in the opened and closed eyes conditions. Thirty one women aged from 65 to 75 years (16 eutrophic and 15 obese) were evaluated. Mean age and BMI of the eutrophic women were, respectively, 68.3 +/- 2.7 years and 23.4 +/- 1.6kg/m(2), and of the obese women were 69.1 +/- 2.7 years and 33.5 +/- 3kg/m(2). Handgrip strength was evaluated using a dynamometer (JAMAR). A tridimensional sensors system was used to evaluate the static postural balance. The tests were performed for 90 seconds, with eyes opened and closed. The mean handgrip strength of the eutrophic women was 25.1 +/- 4.6kgf and of the obese women was 24.8 +/- 5.2kgf, (p>0,05). Significant differences between groups were only observed in the maximum displacement with opened eyes (p=0,04) and closed eyes(p<0,01). There was no correlation between the maximum displacement neither with the BMI or the handgrip strength. The present study showed smaller a-p displacement in obese than in eutrophic women, with major statistic difference in the eyes closed condition. In the present study, the handgrip strength did not influence the static balance, however the obesity was a determinant factor for the smaller a-p displacement of the active older women.

Improvement of Older Women's Sexuality Through Emancipatory Education

The purpose of this action research (AR) was to explore the ways in which sexuality is experienced daily and to improve the expression of older women's sexuality. The pedagogy of autonomy as proposed by the Brazilian educator Paulo Freire theoretically supported this AR, with the participation of six older adult women living in a rural setting in southwest Brazil. The older women's experiences regarding sexuality, their concerns, and their educational demands could be summarized through five phrases: the improvement of self-esteem as a way to promote sexuality; sexuality impaired by loneliness and lack of affection; men's sexual satisfaction seen as a woman's obligation; women's sexuality controlled by the society; and relinquishment of the companion to attend to the expectations of family members. Dialogical and participative educational approaches and continuous observation-participation strategies were performed to support the women's care and educational requirements.

Construction and validation of an instrument that breaks the silence: the impact of domestic and/or sexual violence on women's health, as shown during climacterium

Objective: The aim of this study was to construct and to validate a measure of the consequences of domestic violence on women's health during climacterium. Methods: A questionnaire was administered at the Outpatient Climacterium Clinic to 124 women aged 40 to 65 years who were the victims of domestic and/or sexual violence (experimental group). They were divided into three groups: (1) those who were victims of violence exclusively during childhood/adolescence, (2) those who were victims of violence exclusively during adulthood, and (3) those who were victims of violence throughout their lives. The instrument included 34 items evaluating the beginning, frequency, and type of violence; the search for health assistance and reporting of the violence; the violence and the number of comorbidities; and violence and the Kupperman Menopausal Index. We also included a control group composed of perimenopausal and postmenopausal women who did not experience any violence (n = 120). Results: The instrument presented a Cronbach alpha = 0.82, good reliability among the examiners (+0.80), and a good possibility of reproducibility. The mean age of menopause was 45.4 years, and the mean age in the control group was 48.1 years. Group 1 showed a mean of 5.1 comorbidities, Group 2 had 4.6, and Group 3 had 4.4. Sexual violence (43.5%) and other types of violence both presented average comorbidities (4.60) but represented a significant impairment in the victim's sexual life. There were significant associations in group 3 and a high Kupperman Menopausal Index score. In the experimental group, 80.6% did not seek health services for the violence they experienced. Conclusions: The questionnaire presented good internal consistency and a validated construction. It can be easily reproduced and is indicated to evaluate the consequences of domestic and/or sexual violence on women's health during climacterium.

Gender-based violence and socioeconomic inequalities: Does living in more deprived neighbourhoods increase women's risk of intimate partner violence?

This study investigates the influence of neighbourhood socioeconomic conditions on women's likelihood of experiencing intimate partner violence (IPV) in Sao Paulo, Brazil. Data from 940 women who were interviewed as part of the WHO multi-country study on women's health and domestic violence against women, and census data for Sao Paulo City, were analyzed using multilevel regression techniques. A neighbourhood socioeconomic-level scale was created, and proxies for the socioeconomic positions of the couple were included. Other individual level variables included factors related to partner's behaviour and women's experiences and attitudes. Women's risk of IPV did not vary across neighbourhoods in Sao Paulo nor was it influenced by her individual socioeconomic characteristics. However, women in the middle range of the socioeconomic scale were significantly more likely to report having experienced violence by a partner. Partner behaviours such as excessive alcohol use, controlling behaviour and multiple sexual partnerships were important predictors of IPV. A women's likelihood of IPV also increased if either her mother had experienced IPV or if she used alcohol excessively. These findings suggest that although the characteristics of people living in deprived neighbourhoods may influence the probability that a woman will experience IPV, higher-order contextual dynamics do not seem to affect this risk. While poverty reduction will improve the lives of individuals in many ways, strategies to reduce IPV should prioritize shifting norms that reinforce certain negative male behaviours. (C) 2012 Elsevier Ltd. All rights reserved.

Family Health Strategy Professionals Facing Medical Social Needs: difficulties and coping strategies

Professionals of Family Health Strategy (FHS) work in communities where there are complex medical social problems. These contexts may lead them to psychological suffering, jeopardizing their care for the users, and creating yet another obstacle to the consolidation of FHS as the primary health care model in Brazil. The study investigated the difficulties and coping strategies reported by health professionals of the FHS teams when they face medical social needs of the communities where they work. Focus groups and semi-structured interviews were carried out with 68 professionals of three primary care units in the city of Sao Paulo (Southeastern Brazil). Drug dealing and abuse, alcoholism, depression and domestic violence are the most relevant problems mentioned by the study group. Professionals reported lack of adequate training, work overload, poor working conditions with feelings of professional impotence and frustration. To overcome these difficulties, professionals reported collective strategies, particularly experience sharing during team meetings and matrix support groups. The results indicate that the difficulties may put the professionals in a vulnerable state, similar to the patients they care for. The promotion of specialized and long term support should be reinforced, as well as the interaction with the local network of services and communities leaders. That may help professionals to deal with occupational stress related to medical and social needs present in their routine work; in the end, it may as well contribute to the strengthening of FHS.

The impact of asymptomatic vertebral fractures on quality of life in older community-dwelling women: the Sao Paulo Ageing & Health Study

OBJECTIVES: The aim of this study was to investigate the impact of asymptomatic vertebral fractures on the quality of life in older women as part of the Sao Paulo Ageing & Health Study. METHODS: This study was a cross-sectional study with a random sample of 180 women 65 years of age or older with or without vertebral fractures. The Quality of Life Questionnaire of the European Foundation for Osteoporosis was administered to all subjects. Anthropometric data were obtained by physical examination, and the body mass index was calculated. Lateral thoracic and lumbar spine X-ray scans were obtained to identify asymptomatic vertebral fractures using a semi-quantitative method. RESULTS: Women with asymptomatic vertebral fractures had lower total scores [61.4(15.3) vs. 67.1(14.2), p = 0.03] and worse physical function domain scores [69.5(20.1) vs. 77.3(17.1), p = 0.02] for the Quality of Life Questionnaire of the European Foundation for Osteoporosis compared with women without fractures. The total score of this questionnaire was also worse in women classified as obese than in women classified as overweight or normal. High physical activity was related to a better total score for this questionnaire (p = 0.01). Likewise, lower physical function scores were observed in women with higher body mass index values (p < 0.05) and lower physical activity levels (p < 0.05). Generalized linear models with gamma distributions and logarithmic link functions, adjusted for age, showed that lower total scores and physical function domain scores for the Quality of Life Questionnaire of the European Foundation for Osteoporosis were related to a high body mass index, lower physical activity, and the presence of vertebral fractures (p < 0.05). CONCLUSION: Vertebral fractures are associated with decreased quality of life mainly physical functioning in older community-dwelling women regardless of age, body mass index, and physical activity. Therefore, the results highlight the importance of preventing and controlling asymptomatic vertebral fractures to reduce their impact on quality of life among older women.

The impact of asymptomatic vertebral fractures on quality of life in older community-dwelling women: the São Paulo Ageing & Health Study

OBJECTIVES: The aim of this study was to investigate the impact of asymptomatic vertebral fractures on the quality of life in older women as part of the Sao Paulo Ageing & Health Study. METHODS: This study was a cross-sectional study with a random sample of 180 women 65 years of age or older with or without vertebral fractures. The Quality of Life Questionnaire of the European Foundation for Osteoporosis was administered to all subjects. Anthropometric data were obtained by physical examination, and the body mass index was calculated. Lateral thoracic and lumbar spine X-ray scans were obtained to identify asymptomatic vertebral fractures using a semi-quantitative method. RESULTS: Women with asymptomatic vertebral fractures had lower total scores [61.4(15.3) vs. 67.1(14.2), p = 0.03] and worse physical function domain scores [69.5(20.1) vs. 77.3(17.1), p = 0.02] for the Quality of Life Questionnaire of the European Foundation for Osteoporosis compared with women without fractures. The total score of this questionnaire was also worse in women classified as obese than in women classified as overweight or normal. High physical activity was related to a better total score for this questionnaire (p = 0.01). Likewise, lower physical function scores were observed in women with higher body mass index values (p<0.05) and lower physical activity levels (p,0.05). Generalized linear models with gamma distributions and logarithmic link functions, adjusted for age, showed that lower total scores and physical function domain scores for the Quality of Life Questionnaire of the European Foundation for Osteoporosis were related to a high body mass index, lower physical activity, and the presence of vertebral fractures (p<0.05). CONCLUSION: Vertebral fractures are associated with decreased quality of life mainly physical functioning in older community-dwelling women regardless of age, body mass index, and physical activity. Therefore, the results highlight the importance of preventing and controlling asymptomatic vertebral fractures to reduce their impact on quality of life among older women.

Non-accidental injuries found in necropsies of domestic cats: a review of 191 cases

Animal cruelty is defined as a deliberate action that causes pain and suffering to an animal. In Brazil, legislation known as the Environmental Crimes Law states that cruelty toward all animal species is criminal in nature. From 644 domestic cats necropsied between January 1998 and December 2009, 191 (29.66%) presented lesions highly suggestive of animal cruelty. The main necroscopic finding was exogenous carbamate poisoning (75.39%) followed by blunt-force trauma (21.99%). Cats from 7 months to 2 years of age were the most affected (50.79%). In Brazil, violence is a public health problem and there is a high prevalence of domestic violence. Therefore, even if laws provide for animal welfare and protection, animals are common targets for violent acts. Within a context of social violence, cruelty toward animals is an important parameter to be considered, and the non-accidental lesions that were found are evidence of malicious actions.

Effects of circuit-based exercise programs on the body composition of elderly obese women

Aim: The aim of this study was to investigate the impact of circuit-based exercise on the body composition in obese older women by focusing on physical exercise and body weight (BW) gain control in older people. Methods: Seventy older women (>60 years old) voluntarily took part in the study. Participants were randomized into six different groups according to body mass index (BMI): appropriate weight (AW) control (AWC) and trained (AWT) groups, overweight (OW) control (OWC) and trained (OWT) groups, and obesity (O) control (OC) and trained (OT) groups. The exercise program consisted of 50 minutes of exercise three times per week for 12 weeks. The exercises were alternated between upper and lower body using rest between sets for 40 seconds with intensity controlled by heart rate (70% of work). The contraction time established was 5 seconds to eccentric and concentric muscular action phase. The following anthropometric parameters were evaluated: height (m), body weight (BW, kg), body fat (BF, %), fat mass (FM, kg), lean mass (LM, kg), and BMI (kg/m(2)). Results: The values (mean +/- standard deviation [SD]) of relative changes to BW (-8.0% +/- 0.8%), BF (-21.4% +/- 2.1%), LM (3.0% +/- 0.3%), and FM (-31.2% +/- 3.0%) to the OT group were higher (P < .05) than in the AWT (BW: -2.0% +/- 1.1%; BF: -4.6% +/- 1.8%; FM: -7.0% +/- 2.8%; LM: 0.2% +/- 1.1%) and OWT (BW: -4.5% +/- 1.0%; BF: -11.0% +/- 2.2%; FM: -16.1% +/- 3.2%; LM: -0.2% +/- 1.0%) groups; additionally, no differences were found for C groups. While reduction (P < .03) in BMI according to absolute values was observed for all trained groups (AWT: 22 +/- 1 versus 21 +/- 1; OWT: 27 +/- 1 versus 25 +/- 1, OT: 34 +/- 1 versus 30 +/- 1) after training, no differences were found for C groups. Conclusion: In summary, circuit-based exercise is an effective method for promoting reduction in anthropometrics parameters in obese older women.

Burden of maternal bipolar disorder on at-risk offspring: A controlled study on family planning and maternal care

Introduction: Bipolar disorder (BD) is a highly incapacitating disease typically associated with high rates of familial dysfunction. Despite recent literature suggesting that maternal care is an important environmental factor in the development of behavioral disorders, it is unclear how much maternal care is dysfunctional in BD subjects. Objective: The objective of this study was to characterize maternal care in DSM-IV/SCID diagnosed BD type I subjects compared to healthy controls with (PD) and without (NPD) other psychiatric diagnoses. Materials and methods: Thirty-four BD mothers and 106 controls underwent an interview about family planning and maternal care, obstetrical complications, and mother-child interactions. K-SADS-PL questions about violence exposure were used to ascertain domestic violence and physical/sexual abuse. Results: BD mothers were less likely to have stable unions (45.5%; p < 0.01) or to live with the biological father of their children (33.3%; p < 0.01), but had higher educational level and higher rates of social security use/retirement. They also had fewer children and used less contraceptive methods than controls. Children of BD women had higher rates of neonatal anoxia, and reported more physical abuse (16.1%; p = 0.02) than offspring of NPD mothers. Due to BD mothers' symptoms, 33.3% of offspring suffered physical and/or psychological abuse. Limitations: Post hoc analysis, and the use of questions as a surrogate of symptoms as opposed to validated instruments. Conclusion: This is one of few reports confirming that maternal care given by BD women is dysfunctional. BD psychopathology can lead to poor maternal care and both should be considered important environmental risk factors in BD, suggesting that BD psychoeducation should include maternal care orientation. (C) 2012 Elsevier B.V. All rights reserved.

Effects of an adapted physical activity program on the physical condition of elderly women: an analysis of efficiency

Background: Specific research tools and designs can assist in identifying the efficiency of physical activity in elderly women. Objectives: To identify the effects of physical activity on the physical condition of older women. Method: A one-year-long physical activity program (123 sessions) was implemented for women aged 60 years or older. Four physical assessments were conducted, in which weight, height, BMI, blood pressure, heart rate, absences, grip strength, flexibility, VO2max, and static and dynamic balance were assessed. The statistical analyses included a repeated measures analysis, both inferential (analysis of variance - ANOVA) and effect size (Cohen's d coefficient), as well as identification of the participants' efficiency (Data Envelopment Analysis - DEA). Results: Despite the observation of differences that depended on the analysis used, the results were successful in the sense that they showed that physical activity adapted to older women can effectively change the decline in physical ability associated with aging, depending on the purpose of the study. The 60-65 yrs group was the most capable of converting physical activity into health benefits in both the short and long term. The >65 yrs group took less advantage of physical activity. Conclusions: Adherence to the program and actual time spent on each type of exercise are the factors that determine which population can benefit from physical activity programs. The DEA allows the assessment of the results related to time spent on physical activity in terms of health concerns. Article registered in Clinicaltrials.gov under number NCT01558401.

Aging reduces complexity of heart rate variability assessed by conditional entropy and symbolic analysis

Increasing age is associated with a reduction in overall heart rate variability as well as changes in complexity of physiologic dynamics. The aim of this study was to verify if the alterations in autonomic modulation of heart rate caused by the aging process could be detected by Shannon entropy (SE), conditional entropy (CE) and symbolic analysis (SA). Complexity analysis was carried out in 44 healthy subjects divided into two groups: old (n = 23, 63 +/- A 3 years) and young group (n = 21, 23 +/- A 2). It was analyzed SE, CE [complexity index (CI) and normalized CI (NCI)] and SA (0V, 1V, 2LV and 2ULV patterns) during short heart period series (200 cardiac beats) derived from ECG recordings during 15 min of rest in a supine position. The sequences characterized by three heart periods with no significant variations (0V), and that with two significant unlike variations (2ULV) reflect changes in sympathetic and vagal modulation, respectively. The unpaired t test (or Mann-Whitney rank sum test when appropriate) was used in the statistical analysis. In the aging process, the distributions of patterns (SE) remain similar to young subjects. However, the regularity is significantly different; the patterns are more repetitive in the old group (a decrease of CI and NCI). The amounts of pattern types are different: 0V is increased and 2LV and 2ULV are reduced in the old group. These differences indicate marked change of autonomic regulation. The CE and SA are feasible techniques to detect alteration in autonomic control of heart rate in the old group.

Reincidência da violência contra crianças no Município de Curitiba: um olhar de gênero

OBJETIVOS: Analisar a reincidência de violência infantil no Município de Curitiba - Paraná e compreender o fenômeno com base na perspectiva de gênero. MÉTODOS: Estudo de abordagem quantitativa do tipo descritivo exploratório. Dentre as 338 notificações de violência contra crianças de zero a 9 anos de idade junto à Rede de Proteção à Criança e ao Adolescente dessa cidade com última notificação em 2009 foram analisados 300 casos por serem reincidentes. RESULTADOS: A totalidade dos casos foi de violência intrafamiliar e a reincidência mais frequente foi a negligência, tendo com principal agressora a mãe. A violência sexual apareceu mais entre as meninas, com casos reincidentes no mesmo tipo ou com a negligência antecedendo. A manifestação da violência reincidente contra crianças apresentou-se sobreposta, recorrente, com tendência a agravar-se com a evolução dos casos. CONCLUSÃO: A violência contra as crianças é determinada por relações de poder determinadas pelas categorias gênero e geração, que produzem iniquidades potencializadoras da vulnerabilidade familiar em relação à violência. O olhar crítico sobre essa questão pode indicar medidas de superação no tocante à assistência e à prevenção de sua ocorrência e reincidência tanto do setor saúde como de outros setores.

Maus-tratos contra a criança e o adolescente no Estado de São Paulo, 2009

OBJETIVO: Descrever o perfil das notificações em crianças e adolescentes no Estado de São Paulo em 2009 e analisar possíveis fatores associados. MÉTODOS: Foram analisadas 4.085 notificações em menores de 15 anos, registradas no Sistema de Vigilância de Violências e Acidentes (VIVA); um teste de regressão logística foi utilizado. RESULTADOS: O sexo feminino foi 61,4% do total. A faixa etária mais frequente entre as meninas foi a de 10 a 14 anos (38,8%) e entre os meninos foi < 5 anos (35,8%). A violência física representou 43,3% dos casos em meninos e a sexual 41,7% em meninas. Os principais autores das agressões foram os pais (43,8% do total) e conhecidos (29,4%). Agressores homens representaram 72,0%. A residência foi o local de ocorrência de 72,9% dos casos; violência de repetição foi referida em 51,4% das notificações. Diferenças encontradas entre os casos de violência física e sexual: a) violência física - maioria meninos (50,9%), pais como autores (48,4%) e mulheres como autoras (42,8%); b) violência sexual - maioria meninas (77,2%), conhecidos como autores (48,4%) e homens como autores (96,1%). Variáveis associadas à violência física: sexo masculino (OR: 2,22), idade 10-14 anos (OR: 1,68) e pais como autores (OR: 2,50). A violência sexual foi associada ao sexo feminino (OR: 2,84), idade 5-9 anos (OR: 1,66) e desconhecidos como autores (OR: 1,53). CONCLUSÃO: As políticas públicas deveriam garantir o direito de toda criança ter uma vida saudável e livre de violência. A análise das notificações é importante instrumento para estabelecer estratégias de prevenção.

Influência da obesidade e da força de preensão palmar no equilíbrio postural estático de idosas ativas

O objetivo deste estudo foi investigar a influência da obesidade e da força de preensão palmar (FPP) no equilíbrio postural estático de idosas ativas nas condições de olhos abertos e fechados. Participaram 31 idosas (16 eutróficas e 15 obesas). A idade média e o Índice de Massa Corpórea (IMC) das eutróficas foram, respectivamente, 68,3±2,7 anos e 23,4±1,6kg/m², e das obesas 69,1±2,7 anos e 33,5±3kg/m². A FPP foi avaliada usando um dinamômetro (JAMAR). O equilíbrio postural estático foi avaliado usando um sistema tridimensional nas condições de olhos abertos (OA) e fechados (OF), durante 90 segundos cada condição. A FPP das idosas eutróficas foi 25,1±4,6kgf e das obesas foi 24,8±5,2kgf, não havendo diferenças significativas. No equilíbrio postural, foram observadas diferenças significativas entre os grupos apenas no deslocamento máximo a-p com AO (p=0,04) e OF (p<0,01), com as idosas obesas apresentando menor deslocamento a-p em relação às eutróficas. Não houve correlação entre o deslocamento máximo a-p com IMC e a FPP. No presente estudo FPP não influenciou o equilíbrio postural estático, enquanto a obesidade foi fator determinante de menor deslocamento ântero-posterior de idosas ativas.