High Prevalence of Dementia in a Community-Based Survey of Older People from Brazil: Association with Intellectual Activity Rather than Education

Although several surveys have been conducted around the world, few surveys have investigated the prevalence of dementia in Latin America. The aim of this study was to estimate dementia prevalence in a community sample in Ribeirao Preto, Brazil, and to evaluate its distribution across several socio-demographic and clinical characteristics and habits. The population was aged 60 years and older and a representative sample from three different social regions. The screening instruments used in the first phase were the Mini-Mental State Examination, the Fuld Object-Memory Evaluation, the Informant Questionnaire on Cognitive Decline in the Elderly, and the Bayer Activities of Daily Living Scale. In the second phase, the Cambridge Examination was employed to diagnose dementia according to the DSM-IV criteria. The estimate of dementia prevalence was adjusted for screening instrument performance, using the positive and negative predictive values. The data were weighted to compare frequencies, considering the sampling and the non-response effect, and subjected to multivariate analysis. In all, 1.145 elderly subjects were evaluated (mean age: 70.9 years), of whom 63.4% were female and 52.8% had up to 4 years of schooling (participation rates at the first and the second phases were 62.6 and 60%, respectively). The observed and estimated prevalences of dementia were 5.9% and 12.5%, respectively (n = 68). Alzheimer's disease was the main cause (60.3%). Dementia was associated with old age, low education, stroke, absence of arthritis, and not reading books. The estimated prevalence of dementia was higher than the prevalence previously found. Associated factors confirmed the importance of intellectual activities in prevention.

Prevalence and correlates of dizziness in community-dwelling older people: a cross sectional population based study

Abstract Background Dizziness is a common complaint among older adults and has been linked to a wide range of health conditions, psychological and social characteristics in this population. However a profile of dizziness is still uncertain which hampers clinical decision-making. We therefore sought to explore the relationship between dizziness and a comprehensive range of demographic data, diseases, health and geriatric conditions, and geriatric syndromes in a representative sample of community-dwelling older people. Methods This is a cross-sectional, population-based study derived from FIBRA (Network for the Study of Frailty in Brazilian Elderly Adults), with 391 elderly adults, both men and women, aged 65 years and older. Elderly participants living at home in an urban area were enrolled through a process of random cluster sampling of census regions. The outcome variable was the self-report of dizziness in the last year. Several feelings of dizziness were investigated including vertigo, spinning, light or heavy headedness, floating, fuzziness, giddiness and instability. A multivariate logistic regression analysis was conducted to estimate the adjusted odds ratios and build the probability model for dizziness. Results The complaint of dizziness was reported by 45% of elderly adults, from which 71.6% were women (p=0.004). The multivariate regression analysis revealed that dizziness is associated with depressive symptoms (OR = 2.08; 95% CI 1.29–3.35), perceived fatigue (OR = 1.93; 95% CI 1.21-3.10), recurring falls (OR = 2.01; 95% CI 1.11-3.62) and excessive drowsiness (OR = 1.91; 95% CI 1.11–3.29). The discrimination of the final model was AUC = 0.673 (95% CI 0.619-0.727) (p< 0.001). Conclusions The prevalence of dizziness in community-dwelling elderly adults is substantial. It is associated with other common geriatric conditions usually neglected in elderly adults, such as fatigue and drowsiness, supporting its possible multifactorial manifestation. Our findings demonstrate the need to expand the design in future studies, aiming to estimate risk and identify possible causal relations.

Disentangling social networks from spatiotemporal dynamics: the temporal structure of a dolphin society

Social networks are static illustrations of dynamic societies, within which social interactions are constantly changing. Fundamental sources of variation include ranging behaviour and temporal demographic changes. Spatiotemporal dynamics can favour or limit opportunities for individuals to interact, and then a network may not essentially represent social processes. We examined whether a social network can embed such nonsocial effects in its topology, whereby emerging modules depict spatially or temporally segregated individuals. To this end, we applied a combination of spatial, temporal and demographic analyses to a long-term study of the association patterns of Guiana dolphins, Sotalia guianensis. We found that association patterns are organized into a modular social network. Space use was unlikely to reflect these modules, since dolphins' ranging behaviour clearly overlapped. However, a temporal demographic turnover, caused by the exit/entrance of individuals (most likely emigration/immigration), defined three modules of associations occurring at different times. Although this factor could mask real social processes, we identified the temporal scale that allowed us to account for these demographic effects. By looking within this turnover period (32 months), we assessed fission-fusion dynamics of the poorly known social organization of Guiana dolphins. We highlight that spatiotemporal dynamics can strongly influence the structure of social networks. Our findings show that hypothetical social units can emerge due to the temporal opportunities for individuals to interact. Therefore, a thorough search for a satisfactory spatiotemporal scale that removes such nonsocial noise is critical when analysing a social system. (C) 2012 The Association for the Study of Animal Behaviour. Published by Elsevier Ltd. All rights reserved.

STATE INSTITUTIONS, POWER, AND SOCIAL NETWORKS IN BRAZILIAN URBAN POLICIES

A large historiographic tradition has studied the Brazilian state, yet we know relatively little about its internal dynamics and particularities. The role of informal, personal, and unintentional ties has remained underexplored in most policy network studies, mainly because of the pluralist origin of that tradition. It is possible to use network analysis to expand this knowledge by developing mesolevel analysis of those processes. This article proposes an analytical framework for studying networks inside policy communities. This framework considers the stable and resilient patterns that characterize state institutions, especially in contexts of low institutionalization, particularly those found in Latin America and Brazil. The article builds on research on urban policies in Brazil to suggest that networks made of institutional and personal ties structure state organizations internally and insert them,into broader political scenarios. These networks, which I call state fabric, frame politics, influence public policies, and introduce more stability and predictability than the majority of the literature usually considers. They also form a specific power resource-positional power, associated with the positions that political actors occupy-that influences politics inside and around the state.

Social Networks, Segregation and Poverty in Sao Paulo

The associations between segregation and urban poverty have been intensely scrutinized by the sociology and urban studies literatures. More recently, several studies have emphasized the importance of social networks for living conditions. Yet relatively few studies have tested the precise effects of social networks, and fewer still have focused on the joint effects of residential segregation and social networks on living conditions. This article explores the associations between networks, segregation and some of the most important dimensions of access to goods and services obtained in markets: escaping from social precariousness and obtaining monetary income. It is based on a study of the personal networks of 209 individuals living in situations of poverty in seven locales in the metropolitan area of Sao Paulo. Using network analysis and multivariate techniques, I show that relational settings strongly influence the access individuals have to markets, leading some individuals into worse living conditions and poverty. At the same time, although segregation plays an important role in poverty, its effects tend to be mediated by the networks in which individuals are embedded. Networks in this sense may enhance or mitigate the effects of isolation produced by space.

Multidimensional Projections for Visual Analysis of Social Networks

Visual analysis of social networks is usually based on graph drawing algorithms and tools. However, social networks are a special kind of graph in the sense that interpretation of displayed relationships is heavily dependent on context. Context, in its turn, is given by attributes associated with graph elements, such as individual nodes, edges, and groups of edges, as well as by the nature of the connections between individuals. In most systems, attributes of individuals and communities are not taken into consideration during graph layout, except to derive weights for force-based placement strategies. This paper proposes a set of novel tools for displaying and exploring social networks based on attribute and connectivity mappings. These properties are employed to layout nodes on the plane via multidimensional projection techniques. For the attribute mapping, we show that node proximity in the layout corresponds to similarity in attribute, leading to easiness in locating similar groups of nodes. The projection based on connectivity yields an initial placement that forgoes force-based or graph analysis algorithm, reaching a meaningful layout in one pass. When a force algorithm is then applied to this initial mapping, the final layout presents better properties than conventional force-based approaches. Numerical evaluations show a number of advantages of pre-mapping points via projections. User evaluation demonstrates that these tools promote ease of manipulation as well as fast identification of concepts and associations which cannot be easily expressed by conventional graph visualization alone. In order to allow better space usage for complex networks, a graph mapping on the surface of a sphere is also implemented.

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care: study protocol for a randomised controlled trial (Prevquedas Brazil)

Background Falling in older age is a major public health concern due to its costly and disabling consequences. However very few randomised controlled trials (RCTs) have been conducted in developing countries, in which population ageing is expected to be particularly substantial in coming years. This article describes the design of an RCT to evaluate the effectiveness of a multifactorial falls prevention program in reducing the rate of falls in community-dwelling older people. Methods/design Multicentre parallel-group RCT involving 612 community-dwelling men and women aged 60 years and over, who have fallen at least once in the previous year. Participants will be recruited in multiple settings in Sao Paulo, Brazil and will be randomly allocated to a control group or an intervention group. The usual care control group will undergo a fall risk factor assessment and be referred to their clinicians with the risk assessment report so that individual modifiable risk factors can be managed without any specific guidance. The intervention group will receive a 12-week Multifactorial Falls Prevention Program consisting of: an individualised medical management of modifiable risk factors, a group-based, supervised balance training exercise program plus an unsupervised home-based exercise program, an educational/behavioral intervention. Both groups will receive a leaflet containing general information about fall prevention strategies. Primary outcome measures will be the rate of falls and the proportion of fallers recorded by monthly falls diaries and telephone calls over a 12 month period. Secondary outcomes measures will include risk of falling, fall-related self-efficacy score, measures of balance, mobility and strength, fall-related health services use and independence with daily tasks. Data will be analysed using the intention-to-treat principle.The incidence of falls in the intervention and control groups will be calculated and compared using negative binomial regression analysis. Discussion This study is the first trial to be conducted in Brazil to evaluate the effectiveness of an intervention to prevent falls. If proven to reduce falls this study has the potential to benefit older adults and assist health care practitioners and policy makers to implement and promote effective falls prevention interventions. Trial registration ClinicalTrials.gov (NCT01698580)

Septic shock in older people: a prospective cohort study

Abstract Background Septic shock is the first cause of death in Intensive Care Units. Despite experimental data showing increased inflammatory response of aged animals following infection, the current accepted hypothesis claims that aged patients are immunocompromised, when compared to young individuals. Results Here, we describe a prospective cohort study designed to analyze the immune profile of this population. Conclusion Older people are as immunocompetent as the young individual, regarding the cytokines, chemokines and growth factors response to devastating infection.