Desenpenho funcional, carga alostática e biomarcadores do estresse em idosos residentes na comunidade

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Avaliação multidimensional de pessoas idosas atendidas por equipes de saúde da família em Natal-RN: uma análise demográfica e epidemiológica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Quedas em idosos assistidos na estratégia saúde da família: frequência e fatores associados

The growth of the elderly population is a global phenomenon and, in Brazil, this transformation is happening in a very rapid rhythm. With the current population aging, this emerging age group will need more health care and attention. One of the characteristics of the population aging is the progressive accumulation of disabilities, which makes it more vulnerable to falls. This study was developed with the purpose of knowing the episode falls in the scope of an elderly population treated at a Family Health Unit. It is a research with cross-sectional nature, and its sample was composed by 121 elderly. The research was approved by the Ethics Committee of HUOL, with Opinion nº 816.022. We applied a questionnaire to the participants, and the results were statistically analyzed by using Chi-square test and Fisher’s exact test to verify the association between variables. In order to perform a multivariate analysis, we used the method of the Binomial Logistic Regression. For both tests, we accepted significance p<0,05 and CI of 95%. The results prove that the majority belongs to the female gender (76,9%); the age group of elderly reaches 88,4% and 11,6% is over-aged; regarding the marital status, 35,3% are married and 29,4% widowed; 92,1% with family income between one and two minimum wages; and 91,8% live with their partners and/or children. Regarding the frequency of falls, we found that 61,2% of the surveyed elderly suffered one or more falls in 2014. As associated factors, it became clear that 73,8% were due to extrinsic factors, 6,4% to intrinsic factors and 21,4% to both factors. As a consequence of the fall, we found that 89,2% have fear of falling again, 37,3% showed anxiety and 13,3% had their ambulation affected. Concerning the exposure to the risk factors, the most prevalent places were: street/avenue (31,0%), pavement (19,0%), living room (14,3%) and courtyard/backyard (10,7%). The study has proven a statistically significant association among female gender (p=0,001), rubble/objects in the backyard (p=0,015) and furniture that may cause accidents (p=0,005). It was evident among the elderly people surveyed, 72.7% receive little information about falls, being a risk factor for falls. We conclude that there is a high frequency of falls in the surveyed elderly, thereby constituting a worrisome data because this event in the elderly population is a serious matter, which raises the need to ensure them a safe environment in their homes and, above all, outside them. The information provided by the Family Health Strategy team are important to avoid these occurrences, which reinforces the need for developing health education activities together with the population as a way to prevent and reduce the occurrence of falls, thereby improving the quality of life of elderly.

Prática do acolhimento à pessoa idosa na atenção básica: uma estratégia de humanização

The aging of the population already is a fact, before considered a phenomenon, today, is part of the reality of the majority of the societies in the world. The present study it has as objective to analyze the practical one of the shelter developed for the team to multidiscipline for the elderly in the Strategy of Health of the Family. One is about a descriptive and exploratória inquiry, developed by means of quantitative boarding. The population of this study consisted of nineteen teams that work in the inserted ESF in the urban zone of the city of Sousa-PB, understanding a complete of 133 professionals. The collection of date was carried through through a questionnaire contends closed questions, referring to the partner-demographic date e, specific open questions. The main results indicate that the professionals of Health of the city of Sousa, PB, that had participated of this study had consisted in a complete of 76. Amongst these, 20% are nurses, followed of the odontólogos in 6%; 35% are ACS and technician of nursing with 19%. The age of the interviewed ones meets in the age band enters, 21 and 30 years, in 43%. The majority is of the feminine sex with a 84% total. Already in accordance with civil state 34% is married. If treating to the wage, the doctor has of greater of 12 wages. The participants present the percentile greater of formed time of with referring 33% of 1 the 3 years of formation. E finally, the changeable time of performance, if had detached 39% of the participants with 08 the 11 years. With regard to as if it processes the reception and attendance to the person in the ESF, we can observe that, with priority attendance was prominence with 27% of the participants, followed of a considerate attendance with 26%. Already in relation to the actions that are developed daily in the ESF, these they are come back toward the HIPERDIA with 40%, followed of actions ruled in orientation with 27%. Some actions they are carried through in accordance with the aged necessity of each (13%) and through visits domiciliary (9%). It was asked to them as the shelter was facilitated in the UBS, these had told that it is through the attention that is excused the aged one (35%), and finally, as this made it difficult age, in its majority with 37% they had not wanted to answer, followed of the lack of understanding with 26%. With this study it was possible to conclude that the practical one developed for the professionals of the ESF of the city of Sousa, PB with the elderly, is characterized by an assistance ruled in the clinical aspect, little focused in the actions that to permeate the PNH

Efeito da estrutura etária nas taxas de homicídios em regiões metropolitanas brasileiras (Natal - Recife - São Paulo)

Este estudio examina el fenómeno de asesinato, desde la perspectiva de cambiar la estructura de edad de la zona metropolitana de Natal, Recife y Sao Paulo, utilizando los datos del Sistema de Información de Mortalidad-SIM/DATASUS, del Ministerio de Salud. Se llevaron a cabo ejercicios teóricos estandarización directa con las estructuras de diferentes edades para evaluar el efecto de los cambios en la estructura de la población en las tasas de mortalidad por homicidio. Los resultados presentados en las pirámides de edad y las cartas apuntan a la población de edad avanzada en las tres áreas metropolitanas de la serie analizada, así como las que muestran un mayor riesgo de victimización en las personas, hombres, de edades comprendidas entre 15 y 39 años. Hemos utilizado diversos ejercicios de las tasas de homicidios con patrones estandarizados de distintas edades, incluyendo una población proyectada para el año 2020 de la Región Metropolitana de São Paulo, cada vez más evidente que cuando la población se vuelve más edad con menos gente en los grupos de mayor riesgo tienden a tener menores tasas de muertes por homicidio, también puede presentar otros resultados siempre la misma línea de razonamiento

Gasto com a internação de idosos em unidades de terapia intensiva

Introduction: Population aging in Brazil underscores the need to discuss the proper management of the budget allocated in health field, especially in the sectors of high complexity, where coexist costly procedures, limited resources and the need for cost containment. In the other hand, demand is growing in a way directly proportional to the increase in the number of elderly in country. Objective: In this way, this research had as main objective to analyze the costs resulting from the admission of elderly in intensive care units (ICU) and its associated factors. Methods: This is a cross-sectional study with a quantitative approach and featured as a descriptive and exploratory research. Data were collected from medical records of elderly hospitalized in ICU from a brazilian city called Natal-RN, between november first, 2013 and january, 31 of 2014. The variables collected relate to the socio demographic profile, morbidity framework and characterization of hospitalization. The dependent variable was categorized by quartile 75 in high and low expense of hospitalization and submitted to chi-square test with the independent variables of the survey. Associations with p value <0.20 in the bivariate analysis were submitted to the technique of multiple logistic regression. We opted for the construction of three regression models from the above algorithm: general regression model, composed by all 493 hospitalizations in the study, other made with 181 individuals admitted in health public system (SUS) and a third one related to 312 cases from private service in health area. Results: In the general regression model, the variables respiratory diseases, hospitalizations in the private system, disoriented patient and previous stroke were associated with greater probability of high spending in the ICU. In the other hand, in SUS kind of hospitalizations, this probability was associated with disoriented patient, 80 years old or more, sepsis and admission for clinical reason. In the cases from the private network health, the high expenditure was associated with respiratory disease, mechanical ventilation, hospitalization for clinical reason and disoriented patients. Conclusion: The increased expenditure on hospitalization of elderly in intensive care depends on the clinical conditions of individuals. This highlights the importance of avoiding hospitalizations due to diseases sensitive to primary care by health preventive actions and providing comprehensive care to the elderly. In addition, obtaining different explanatory models, according to kind hospital funding, demonstrates the importance of the organization in health services related to composition of costs of hospitalization among the elderly. Another question founded was the need that to improve the funding, we must use rationally the available resources by avoiding unnecessary hospitalizations of elderly people in the extremes of severity. On this kind of precarious funding, ICU hospitalization of elderly non-critical or in a terminal state can compromise the quality of services provided to those who really need intensive care.

Fatores associados à mortalidade dos idosos com as condições de vida da população do Nordeste do Brasil

As condições de vida são usualmente entendidas como importantes fatores intervenientes das causas básicas de mortalidade e da qualidade de vida da população. Ao considerar esta questão em uma população idosa e sua influência nas causas mais relevantes que as levam à morte, teve-se como objetivo principal, estudar a associação da mortalidade dos idosos por doenças cardiovasculares para ambos os sexos, com indicadores que expressam as condições de vida da população do Nordeste, nos anos 2000 e 2010. Para atingir tal propósito foi traçado um desenho de estudo ecológico com cortes transversais nos anos 2000 e 2010 tendo como unidades de análises as microrregiões e a mesorregiões do Nordeste. Utilizou-se a Modelagem de Equações Estruturais (MEE) para explicar essas associações, tomando como base as estatísticas de óbitos por doenças cardiovasculares (construto endógeno) e variáveis socioeconômicas e demográficas (construto exógeno) das microrregiões do Nordeste, para o ano 2000. Utilizou-se o Método dos Componentes Principais como recurso metodológico na construção de um índice sintético que permitiu classificar as condições de vida nas mesorregiões do Nordeste, tomadas como unidades de análises, nos anos 2000 e 2010, de acordo com as condições de vida e as principais causas de mortalidade por doenças cardiovasculares. A aplicação da MEE sugeriu uma forte associação do construto exógeno condições de vida, composto pelos indicadores: anos de estudo dos homens idosos, percentual de idosos em domicílios com banheiro/água encanada e probabilidade de sobrevivência aos 60 anos, com a variável desfecho taxa de mortalidade por doenças cardiovasculares dos homens e mulheres idosos. O índice sintético construído permitiu identificar os diferentes ritmos de envelhecimento populacional entre as regiões e distintos processos de evolução dos níveis de mortalidade pelas doenças cardiovasculares, muitas delas compatíveis com as condições de vida no Nordeste. Os resultados sugerem que o construto condições de vida está fortemente associado por esta causa de morte entre os idosos para ambos os sexos no Nordeste do Brasil. Neste sentido, sugere-se que estes resultados sejam considerados como relevantes para formulação de políticas de saúde regionais voltadas para este contingente populacional do Nordeste do Brasil

Estrutura da população de Coleodactylus natalensis Freire, 1999 (Squamata: Sphaerodactylidae) no Parque Estadual Dunas de Natal, Rio Grande do Norte, Brasil

Coleodactylus natalensis Freire, 1999, an endemic species of Atlantic Forest fragments around the Natal municipality, Rio Grande do Norte State, Brazil, has as type locality the Parque Estadual Dunas de Natal (05º48 S to 05º53 S and 35º09 W to 35º12 W), one of the largest restinga (herb and shrub association on sand dunes along the Brazilian coastline) associate fragment, surrounded by urban zone, placed on setentrional Atlantic Forest limits. We made estimates on populational density, spatial distribution, habitat and microhabitat preferences and feeding ecological aspects like sazonal and sexual variations on diet, prey electivities and niche breadth. We randomly sampled ninety-six 50m2 quadrants in each of the four habitats identified in the study area. Were collected 49 specimens and their stomach contents were analyzed; prey items found were correlated with leaf-litter invertebrates from habitat samples. We found a 98,5 ± 75,5 individuals/ha density, in grouped distribution pattern on densest habitats and random distribution on others habitats. This species lives mostly on leaf-litter in forest habitats, in higher humidity points, with lower temperatures, deeper leaf litter and lower sea level elevations than the randomly chosen points in the study area. Isopoda and Aranae were the most important prey categories in numeric, frequency and volumetric terms. Niche breadth has an intermediate value and was variable in sexual and in habitat terms. There was no correlation between morfometric measures and prey size on diet. The C. natalensis population studied seems to be diet opportunist, although selects larger prey items. The Parque Estadual das Dunas do Natal has several indications of anthropic pressure from the surrounding urban area that may affects the local C. natalensis population. Thus, the fragility of this species calls for urgent conservation efforts

Estrutura da população de Microcerotermes exiguus ( Isoptera: Termitidae) e sua partuicipação no consumo de madeira em uma área de caatinga, Nordeste, Brasil

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Estudo epidemiológico das parasitoses oculares na população de escolares da cidade de Natal-RN, Brasil

The objective of this study is to estimate the prevalence of Ocular Toxocariasis, Diffuse Unilateral Subacute Neuroretinitis (DUSN), Toxoplasma gondii infection and Ocular Toxoplasmosis in a student population in Natal-RN/Brazil and relate it to demographic, epidemiologic and socio-economic risk factors. The incidence of DUSN was observed in patients at the Federal University of Rio Grande do Norte Ophthalmology Service and the Prontoclinica de Olhos Ophthalmology clinic in Natal. In cases where a worm was found in the subretinal space, the result of treatment with photocoagulation using Green Laser (Eye Light ALCON) was evaluated in relation to final visual result. The sample was randomly selected among the schools of the four districts of Natal, according to the type of institution (public or private), its level (elementary or secondary), and study period (morning, afternoon or evening). The school population was studied from March to May, 2001. Initially, the students answered a questionnaire to evaluate demographic, epidemiologic and socio-economic risk factors. Afterwards, the following procedures were carried out: blood samples were taken for Toxoplasmosis (IgG, IgM) serology, hemogram, ophthalmological examination, consisting of clinical history, measurement of visual acuity, refraction under cycloplegia, biomicroscopy of the anterior segment and annexa, funduscopy and examination of extrinsic motility. The prevalence of Toxocariasis was 0.2% or 2 per one thousand students. The sample was insufficient to estimate the prevalence of DUSN. Seventy patients with DUSN diagnosis were examined from January, 2001 to January, 2003. A live worm was found in the subretinal space of all four patients in the acute phase, and these were treated with laser photocoagulation. After follow-up (average = 11.5 months), visual acuity improved in three eyes and remained unaltered in one eye. Worms were found in 22 of the 66 patients in the chronic phase, and these also were treated with laser photocoagulation. After a follow-up period of 13.1 months, on average, visual acuity improved in two of the patients, remained unchanged in 19 and worsened in one. The comparison of visual result before and after treatment was not statistically significant (p = 0.302). The diagnosis of DUSN in the acute phase, followed by prompt localization and destruction of the worm by photocoagulation, can improve the patient s vision. However, destruction of the worm by laser photocoagulation in eyes with DUSN in the chronic phase does not improve visual acuity. Seroprevalence for IgG was 46% (Confidence Interval CI 95%-42.9-49.2%) and for IgM it was 1.4% (CI 95% = 0.8-2.4%). The prevalence of ocular lesion was 1.15% (CI 95% = 0.6 - 2.0%). Socio-economic conditions were determinants in the prevalence of Systemic and Ocular Toxoplasmosis in the bivaried analysis and confirmed in the multivaried analysis (mother s scholarity illiterate/ OR = 2.9 and p < 0.001). The T. gondii infection prevalence, although high, was less than that found in studies performed in the South and Southeast of Brazil and that of Ocular Toxoplasmosis was completely discrepant, varying from 5 to 17 times less. Although important epidemiological variables such as owning a cat, drinking unfiltered water, and coming into contact with rivers or lakes showed an association in the preliminary analysis, they lost their influence when included in the logistic model. Future studies are scheduled to begin in March, 2004, in collaboration with other Brazilian and American universities in an attempt to discover the reason for these findings, as well as identifying the different strains of Toxoplasma gondii, and studying the sources of water utilized by the population of Natal Brazil

Envelhecimento populacional: um diagnóstico dos idosos institucionalizados, em Natal/RN

The aging process lived by the Brazilian population concurred to the transformation in the family models, causing difficulties related to the elderly care on the Family environment, a fact that is one of the main reasons for their institutionalization. Facing this scenario, the need of investigating how the elderly lives on the long-term facilities (ILPI) has aroused. In this study, it has been conducted an analysis of the populational aging process, contrasting the Rio Grande do Norte to Brazil and the Northeast Region, between 1980 to 2010. Faced with the realization of this process, and the rising number of long-term facilities for the elderly (ILPI), it was needed to make a rescue of the abiding laws regarding elderly institutionalization, on the scope of Natal, which surged after the 1988 Federal Constitution, checking what were the impacts on the assistance of the institutionalized elderly. Lastly, it were investigated the possible determinants associated with the institutionalization, in Natal-RN, considering the aspects of the family structure, family relationship, economic, health and well being of the elderly. The results showed that Rio Grande do Norte, particularly Natal, follows the national scene, since between 1980 and 2000 its population passed the intermediate level in the process of population aging for, in 2010, to be considered elderly. Throughout this process, it was observed that Natal has been adapting to the federal legislation, through the creation of the municipal policy, City Council and other relevant standards for the elderly, promoting significant changes in ILPI.However, philanthropic institutions needs better resources for their maintenance. In research with the elderly, it was found that although the majority of the elderly have declared themselves satisfied with life, they had indicators of impairment of functional capacity and cognitive, isolated social behavior and depression, affecting the life quality of these elderly. These results reflect the need for greater investment of public power in the drafting, implementation and monitoring of public policies aimed at promoting changes that raise the level of life quality of this segment of the population

Representações Sociais do ser idoso e suas implicações na assistência e nas práticas educativas voltadas à população idosa residente em Natal/RN

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Ecologia e história natural de população Hemidactylus agrius (Squamata: Gekkonidae) em área de Caatinga, com avaliação da distribuição das espécies nativas do gênero no nordeste do Brasil

The genus Hemidactylus Oken, 1817 has cosmopolite distribution, with three species occurring in Brazil, two of them native, H. brasilianus and H. agrius, and one exotic, H. mabouia. Considering the studies about ecology of lizards conducted in the Ecological Station of the Seridó, from 2001 to 2011, this study aimed (1) to re-evaluate the occurrence of the species of Hemidactylus in this ESEC; (2) to analyze ecological and biological aspects of the H. agrius population; and (3) to investigate the current and potential distribution of the native species of the genus in northeastern Brazil, analyzing the suitability of ESEC to this taxon. For the first two objectives, a sampling area consisting of five transects of 200 x 20 m, was inspected in alternating daily shifts for three consecutive days, from August 2012 to August 2013. For the latter objective, occurrence points of H. agrius and H. brasilianus from literature and from the database of Herpetological Collections of the UFRN and the UNICAMP were consulted to build predictive maps via the Maximum Entropy algorithm (MaxEnt). In ESEC Seridó, 62 H. agrius individuals were collected (25 females, 18 males and 19 juveniles), and two neonates were obtained from a communal nest incubated in the laboratory. No record was made for the other two species of the genus. Hemidactylus agrius demonstrated to be a nocturnal species specialized in habitats with rocky outcrops; but this species is generalist regarding microhabitat use. In the population studied, females had an average body length greater than males, and showed higher frequencies of caudal autotomy. Regarding diet, H. agrius is a moderately generalist species that consumes arthropods, especially insect larvae, Isoptera and Araneae; and vertebrates, with a case of cannibalism registered in the population. With respect to seasonal differences, only the number of food items ingested differed between seasons. The diet was similar between sexes, but ontogenetic differences were recorded for the total volume and maximum length of the food items. Significant relationships were found between lizard body/head size measurements and the maximum length of prey consumed. Cases of polydactyly and tail bifurcation were recorded in the population, with frequencies of 1.6% and 3.1%, respectively. In relation xv to the occurrence points of the native species, 27 were identified, 14 for H. agrius and 13 for H. brasilianus. The first species presented restricted distribution, while the second showed a wide distribution. In both models generated, the ESEC Seridó area showed medium to high suitability. The results of this study confirm the absence of H. brasilianus and H. mabouia this ESEC, and reveal H. agrius as a dietary opportunist and cannibal species. Further, the results confirm the distribution patterns shown by native species of Hemidactylus, and point ESEC Seridó as an area of probable occurrence for the species of the genus, the establishing of H. brasilianus and H. mabouia are probably limited by biotic factors, a fact yet little understood

A plasticidade acústica de uma população de Boto - Cinza, Sotalia Guianensis (Van Banédén, 1864) (Cetacea, Delphinidae), na região Nordeste do Brasil

The environmental characteristics can modify the acoustics of a species due to habitat, time of day and year. Therefore, this study investigated the relationships between seasons, tide, daily cycle of tides, times of day and different habitat and noise emission of S. guianensis. Sound recordings occurred in the Curral’s Cove and Lagoon Complex of Guaraíras (CLG) in the municipality of Tibau do Sul/RN. Whistles are emitted with lower frequency during rainy season and spring tide while clicks are higher; whistles, clicks and calls have higher frequency during ebb tide. These modifications can be related with turbidity and prey availability. The whistles and clicks occurrence are higher at night probably because luminosity is lower. Furthermore, the whistles and clicks frequency reduction overnight allows the sound to travel longer distance and helps the view which is limited; but the minimum frequency increase was needed to catch the prey. The low occurrence of calls could be related to the small group size. The acoustic changes at night may be partly influenced by light levels as prey availability that is larger in this period. Whistle frequencies and click initial frequency are higher in CLG than Curral’s cove that permitted good precision. However, click central frequency is lower and may be connected to tracking the area. Several factors may be associated with such modifications as background noise, bottom and others. This study supports the hypothesis that S. guianensis presents an acoustic plasticity according to the local conditions where the species is embedded and adapts to the environmental changes.

Consanguinidade e efeito fundador da mutação G377S da doença de Gaucher em população de Tabuleiro do Norte – Ceará – Brasil

Gaucher’s disease (GD) is caused by a β-glucocerebrosidase deficiency, leading to the accumulation of glucocerebroside in the reticuloendothelial system. The prevalence of GD in Tabuleiro do Norte (TN) (1:4000) is the highest in Brazil. The purpose of this study was to present evidence of consanguinity and founder effect for the G377S mutation (c.1246G>A) among GD patients in TN based on enzyme, molecular and genealogical studies. Between March 2009 and December 2010, 131 subjects at risk for GD (GC in dried blood ≤2.19 nmol/h/ml) and 5 confirmed GD patients from the same community were submitted for molecular analysis to characterize the genetic profile of the population. Based on the enzymatic and molecular analysis, the subjects were classified into three categories: affected (n=5), carrier (n=20) and non-carrier (n=111). All carriers were (G377S/wt). Affected subjects were homozygous (G377S/G377S). The identification of a single mutation in carriers and homozygotes from different generations, the history of the community and the genealogy study suggest that the high prevalence of GD in this population may be due to a combination of consanguinity and founder effect for the G377S mutation