Potentially inappropriate medications used by the elderly: Prevalence and risk factors in Brazilian care homes

Abstract. Background: The use of potentially inappropriate medications (PIM) among the elderly is a serious public health problem because it is intrinsically linked to increased morbidity and mortality, causing high costs to public health systems. This study's objective was to verify the prevalence of and the factors associated with the use of PIMs by elderly Brazilians in institutional settings. Methods. We performed a transversal study, by consulting the case files of elderly people living in Long Term Care for the Elderly (LTC) in towns in the State of São Paulo, Brazil, as well as structured interviews with the nurses responsible for them.We identified PIMs using the list of recently updated Beers criteria developed by a group of specialists from the American Geriatrics Society (AGS), who reviewed the criteria based on studies with high scientific evidence levels. We defined the factors studied to evaluate the association with PIM use prior to the statistical analyses, which were the chi-square test and multiple logistic regression. Results: Among the elderly who used drugs daily, 82.6% were taking at least one PIM, with antipsychotics (26.5%) and analgesics (15.1%) being the most commonly used. Out of all the medications used, 32.4% were PIMs, with 29.7% of these being PIMs that the elderly should avoid independent of their condition, 1.1% being inappropriate medication for older adults with certain illnesses or syndromes, and 1.6% being medications that older adults should use with caution. In the multivariate analysis, the factors associated with PIM use were: polypharmacy (p = 0.0187), cerebrovascular disease (p = 0.0036), psychiatric disorders (p < 0.0001) and dependency (p = 0.0404). Conclusions: The results of this study showed a high prevalence of PIM use in institutionalized elderly Brazilian patients. and the associated factors were polypharmacy, psychiatric disorders, cerebrovascular diseases and dependency. © 2013 Lima et al.; licensee BioMed Central Ltd.

Transfer function-noise modeling and spatial interpolation to evaluate the risk of extreme (shallow) water-table levels in the Brazilian Cerrados

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Volatile Oil of Psidium cattleianum Sabine from the Brazilian Atlantic Forest

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Brachyuran soft-bottom assemblage from marine shallow waters in the southeastern Brazilian littoral.

The present investigation examined the assemblages of brachyuran crabs in three bays of southeastern So Paulo State, analyzing the numbers of species and individuals, biomass, and diversity. The crabs were collected monthly in Ubatumirim, Ubatuba, and Mar Virado bays in the Ubatuba region over 2 years (1998 and 1999). In each bay, six tows were made from a fishing boat. A total of 39,820 specimens, representing 11 super families, 39 genera, and 65 species of brachyurans, were obtained. The mean number of specimens and biomass varied seasonally, which can be mainly related with the population tendencies of two dominant species in the area (Callinectes ornatus and Hepatus pudibundus). The highest numbers of individuals and species were found in Ubatuba Bay, followed by Ubatumirim and Mar Virado. The highest diversity index was estimated for Ubatumirim (H' = 2.44), followed by Ubatuba (H' = 2.37) and Mar Virado (H' = 1.86). In general, the coastal region supported high abundance and species richness concerning brachyurans, with high diversity indices, probably because of its more-heterogeneous substrate, which may afford more refuges for certain species. These results suggested that environmental conditions in this area, although they showed certain differences, are favorable for the establishment and development of a diverse brachyuran guild.

In situ differentiation of labile/inert metal species in Brazilian tropical rivers by means of a time-controlled batch-procedure based on TEPHA resin

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Benthic response to upwelling events off the SE Brazilian coast

The main aim of the present study was to evaluate and compare temporal responses of the benthos in 2 continental shelf areas (Cabo Frio and Ubatuba) off the SE Brazilian coast. In Cabo Frio (23 degrees S, 42 degrees W), the western boundary coastal upwelling of the South Atlantic Central Water (SACW) enhances primary productivity, potentially increasing food supply to the benthic communities via sinking of particulate organic carbon (POC). In contrast, POC fluxes in Ubatuba (23 degrees S, 45 degrees W) are expected to be comparatively lower because SACW remains subsurface. We analyzed the temporal and spatial input of phytodetritus (concentration of chlorophyll a in sediments) and the benthic microbial biomass (estimated by ATP-based carbon content in sediments). Median surface chlorophyll concentration was computed for all daily available SeaWiFS images (from 2001 and 2002) to follow chlorophyll a inputs. All parameters used to investigate benthic responses in the study areas showed consistently higher values in Cabo Frio than in Ubatuba. The results showed that benthic response to upwelling may last months, fueling the microbial communities in the Cabo Frio region.

Tide-topography interaction along the eastern Brazilian shelf

In the Tropics, continental shelves governed by western boundary currents are considered to be among the least productive ocean margins in the world, unless eddy-induced shelf-edge upwelling becomes significant. The eastern Brazilian shelf in the Southwest Atlantic is one of these, and since the slight nutrient input from continental sources is extremely oligotrophic. It is characterized by complex bathymetry with the presence of shallow banks and seamounts. In this work, a full three-dimensional nonlinear primitive equation ocean model is used to demonstrate that the interaction of tidal currents and the bottom topography of the east Brazil continental shelf is capable of producing local upwelling of South Atlantic Central Water, bringing nutrients up from deep waters to the surface layer. Such upper layer enrichment is found to be of significance in increasing local primary productivity. (c) 2005 Elsevier Ltd. All rights reserved.

Influence of a Brazilian sewage outfall on the toxicity and contamination of adjacent sediments

The submarine sewage outfall of Santos (SSOS) is situated in the Santos Bay (São Paulo, Brazil) and is potentially a significant source of contaminants to the adjacent marine ecosystem. The present study aimed to assess the influence of SSOS on the sediment toxicity and contamination at Santos Bay. At the disposal site, sediments tended to be finer, organically richer and exhibited higher levels of surfactants and metals, sometimes exceeding the Threshold Effect Level values. The SSOS influence was more evident toward the East, where the sediments exhibited higher levels of TOC, total S and metals during the summer 2000 sampling campaign. Sediment toxicity to amphipods was consistently detected in four of the five stations studied. Amphipod survival tended to correlate negatively to Hg, total N and % mud. This work provides evidence that the SSOS discharge affects the quality of sediments from Santos Bay, and that control procedures are warranted. (c) 2005 Elsevier Ltd. All rights reserved.

Benthic foraminiferal distribution on the southeastern Brazilian shelf and upper slope

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Vertical distribution of benthic invertebrate larvae during an upwelling event along a transect off the tropical Brazilian continental margin

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Pleistocene mammals from the southern Brazilian continental shelf

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Induced spawning of hatchery-raised Brazilian catfish, cachara Pseudoplatystoma fasciatum (Linnaeus, 1766)

In the months of January 2001 and 2002, female cachara Pseudoplatystoma fasciatum were selected during their first and second gonadal maturation (2 years and 7 months old and 3 years and 7 months old, respectively) with an of oocyte diameter of 937.5 mum (82.5% with central nuclei and 17.5% with peripheral nuclei). Nine females in first maturation received two doses of carp pituitary extract (CPE), 0.5 mg/kg and 5.0 mg/kg; seven received two doses of human chorionic gonadotropin (hCG), 5 and 10 IU/g; five received doses of 0.5 CPE mg/kg and 5 hCG IU/g (CPE+hCG); and four received 0.9% saline (saline). Nine females from CPE and seven from hCG presented oocytes with the same diameter at the moment of oocyte release (100% with germinal vesicle breakdown and fertilization rate of 53.44 +/- 18.3 and 54.81 +/- 11.8%; larvae number of 165,330 +/- 94.1 and 158,570 +/- 20.6, respectively). The five females from CPE+hCG did not respond to the hormonal treatment. The four females from the saline group did not ovulate. In January 2002, 6 of 15 selected females that were going through the second reproductive cycle received CPE (five received hCG and four received saline), showing oocyte diameters similar to the ones in the first maturation. At stripping, CPE females had an oocyte diameter of 1062.5 mum (the hCG females had oocyte diameters ranging from 937.5 to 1125.0 mum; fertilization rates of 56.08 +/- 30.9 and 81.90 +/- 17.3%; 364,547 +/- 244 and 633,129 +/- 190, larvae, respectively). The fertilization rates and larvae number were higher in the second gonad maturation, both for CPE and hCG. (C) 2004 Elsevier B.V. All rights reserved.

Microcystin-LR in Brazilian Aquaculture Production Systems

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Seasonal variations in chemical composition and stable isotopes of farmed and wild Brazilian freshwater fish

This study examined variations in the Fulton condition factor, chemical composition, and stable isotopes of carbon and nitrogen in the Brazilian freshwater fish cachara (Pseudoplatystoma fasciatum), comparing farmed and wild fish in different seasons. Values for energy, protein, moisture, and Fulton's condition factor were higher for farmed than for wild fish in the rainy season, indicating better nutritional quality; however, these differences were not observed in the dry season. Likewise, we found significant enhancement of delta(15)N in farmed fish in the rainy season but not in the dry season, whereas enhancement of delta(13)C was observed in both seasons. The combined measurement of delta(13)C and delta(15)N provided traceability under all conditions. Our findings show that stable isotope analysis of C and N can be used to trace cachara origin, and that seasonal variations need to be considered when applying chemical and isotopic authentication of fish and fish products. (C) 2010 Elsevier Ltd. All rights reserved.

HEMATOLOGICAL ASSESSMENT IN FOUR BRAZILIAN TELEOST FISH WITH PARASITIC INFECTIONS, COLLECTED IN FEEFISHING FROM FRANCA, São Paulo, BRAZIL

The effects of parasitic infections in condition factor, hematocrit, hemoglobin, mean corpuscular hemoglobin concentration (MCHC), and leucocytes and thrombocytes distribution in Piaractus mesopotamicus, Leporinus macrocephalus, hybrid tambacu (P. mesopotamicus x Colossoma macropomum and Brycon amazonicus collected in feefishing from Franca, São Paulo, Brazil were evaluated. Parasitized tambacu and L. macrocephalus had higher (p<0.05) condition factor than unparasitized fish. However, the contrary occurred in P. mesopotamicus and B. amazonicus. Changes in the hematocrit, hemoglobin and MCHC were not related to parasitism. Parasitic infections did not cause effect on leucocytes and thrombocytes percentage (p>0.05) of tambacu. In P. mesopotamicus parasitized by Monogenea Anacanthorus penilabiatus and dinoflagellate Piscinoodinium pillulare, increase in monocytes and decrease in thrombocytes percentage (p<0.05) were found. However, the same parasitic association in L. macrocephalus caused a decrease in lymphocytes percentage accompanied by increase in neutrophils percentage (p<0.05). In B. amazonicus, infection by Ichthyophthirius multifiliis, P. pillulare and monogeneans caused increase in neutrophils percentage.