Use of Medicines Among a Brazilian Elderly Sample: A Cross-sectional Study

Background: The use of multiple medicines is very frequent among the elderly, allowing them to perceive more often adverse side effects from drugs and present undesirable drug interactions.Methods: This article presents a cross-sectional survey about the use of medicines among 300 elderly Brazilians, equally divided into institutionalized and community-dwelling groups.Results: The average daily intake of medicines is 3.2 among institutionalized elderly, a higher (p < 0.001) number when compared with community-dwelling elderly, who takes an average of 1.8 medicines daily. The most commonly used medications are antihypertensives (58.0%), diuretics (23.0%), nonsteroidal anti-inflammatory drugs (22.7%), supplements (21.7%), antidiabetics (16.3%), and antiulcerants (14.0%). Antiulcerants, diuretics, supplements, and central nervous system drugs are more frequently used by institutionalized than by community-dwelling elderly.Conclusion: In this Brazilian elderly sample, the most widely used medicines were antihypertensives, diuretics, and nonsteroidal anti-inflammatory drugs, and institutionalized used more medications than community-dwelling elderly. Copyright (C) 2011, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC. All rights reserved.

Telejornalismo e interatividade na TV digital: uma construção colaborativa e participativa no espaço digital

Pós-graduação em Televisão Digital: Informação e Conhecimento - FAAC

Diet and trophic groups of an aquatic insect community in a tropical stream

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

Antibiotic treatment schemes for very severe community-acquired pneumonia in children: a randomized clinical study

Objective. To compare clinical response to initial empiric treatment with oxacillin plus ceftriaxone and amoxicillin plus clavulanic acid in hospitalized children diagnosed with very severe community-acquired pneumonia (CAP).Methods. A prospective randomized clinical study was conducted among children 2 months to 5 years old with a diagnosis of very severe CAP in the pediatric ward of São Paulo State University Hospital in Botucatu, São Paulo, Brazil, from April 2007 to May 2008. Patients were randomly divided into two groups by type of treatment: an oxacillin/ceftriaxone group (OCG, n = 48) and an amoxicillin/clavulanic acid group (ACG, n = 56). Analyzed outcomes were: time to clinical improvement (fever and tachypnea), time on oxygen therapy, length of stay in hospital, need to widen antimicrobial spectrum, and complications (including pleural effusion).Results. The two groups did not differ statistically for age, sex, symptom duration before admission, or previous antibiotic treatment. Time to improve tachypnea was less among ACG patients than OCG patients (4.8 +/- 2.2 versus 5.8 +/- 2.4 days respectively; P = 0.028), as was length of hospital stay (11.0 +/- 6.2 versus 14.4 +/- 4.5 days respectively; P = 0.002). There were no statistically significant differences between the two groups for fever improvement time, time on oxygen therapy, need to widen antimicrobial spectrum, or frequency of pleural effusion.Conclusions. Both treatment plans are effective in treating very severe CAP in 2-monthto 5-year-old hospitalized children. The only analyzed outcome that favored amoxicillin/clavulanic acid treatment was time required to improve tachypnea.

Fish community alterations due to pollution and damming in Tiete and Paranapanema rivers (Brazil)

The Tiete River crosses the metropolitan region of São Paulo (Brazil) and receives a large amount of pollution, in contrast to Paranapanema River which runs in a less populated area. In the inferior portions of the basins of these rivers, a series of reservoirs has been built for hydroelectric energy generation which improve the water quality due to the decantation of suspended soils and aeration in the water spills.Twenty-nine sampling sites were established along the two rivers and in each sampling site, two groups of eight gillnets were used with standardized sizes in two seasons: winter (dry season: June-September 1994) and summer (rainy season: December-March 1995). The fishes were measured and weighed.Twenty-five parameters related. to the water were recorded. PCA and cluster analysis helped to identify two groups of sampling sites. The first one corresponds to the rainy season samples, while the second corresponds to the dry season samples, so evidencing strong seasonal environmental variation. However, the dry season group is still divided into polluted and non-polluted sites, showing that during drought there are larger effects of pollutant concentration due to the decreased flow.A total of 415 kg of fish were caught, corresponding to 8324 individuals belonging to 64 different species, in 22 families and four orders of Teleostei. The largest catches occurred in the middle Tiete River. The catches in the reservoirs of the Tiete River, during the rainy season are superior to those of the dry season. on the other hand, sampling sites located in running water presented an inverse pattern with the largest catches in the dry-season. In river Paranapanema, catches are lower than in the Tiete River, except in Rosana Reservoir during the rainy season. Fish diversity was shown to be a good-indicator of environmental stress. In Tiete River an expressive fall in species richness was detected in the polluted stretches, with dominance of one or two species. In the intermediary stretches, the presence of rapids increases the amount of dissolved oxygen, allowing the development of the most abundant and diverse fish community of the river. Fish communities in the reservoirs of the inferior stretch of Tiete River are more diverse. on the other hand, the damming of the superior reaches of Paranapanema River provoked a decrease in diversity. 0 the whole, types of local fish communities detected, showing different compositions and specific abundances, revealed different ecological situations. A discriminant analysis revealed that the parameters of the water influencing the fish community were: dissolved oxygen, conductivity, nitrogen (nitrate, ammoniacal and albuminoid), phosphate, alkalinity, hardness and iron. Copyright (C) 2003 John Wiley Sons, Ltd.

Spatial and temporal patterns and their influence on fish community at Itupararanga Reservoir, Brazil

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

Fish community structure along a conservation gradient in Bodoquena Plateau streams, central West of Brazil.

Aim: To investigate whether composition and structure of stream ichthyofauna vary along the conservation gradient in the Bodoquena Plateau; Methods: Standardized sampling was performed in nine stream stretches (three references, three in the pasture, and three in urban areas), each 80 m long, in April, May and June/08; Results: A quantity of 8,102 individuals representing 36 species was collected. There were no significant differences with respect to absolute species richness among stretches. Urban stretches were more similar to each other than the other two groups, both regarding species composition and abundance. A set of six species was considered an indicator of reference stretches, whereas two were of pasture stretches and four of urban stretches. Poecilia reticulata and Corydoras aeneus, occurring only in urban stretches, were unique in showing the maximum values in the indicator species analysis; Conclusions: Results indicate changes in the ichthyofauna with urbanized surrounding water courses. The presence and abundance of Poecilia reticulata and Corydoras aeneus may indicate the quality loss of these environments.

Spatial and temporal distribution of the zoobenthos community during the filling up period of Porto Primavera Reservoir (Paraná River, Brazil)

Este estudo é parte do monitoramento limnológico empreendido pela Companhia Energética do Estado de São Paulo (CESP) durante o processo de enchimento do reservatório de Porto Primavera (Usina Hidrelétrica Engenheiro Sérgio Motta). Este reservatório, localizado no alto rio Paraná, entre os Estados de São Paulo e Mato Grosso, é o quarto maior do país. A primeira etapa de enchimento do lago começou em dezembro de 1998 e a segunda em março de 2001. Amostras para a análise da comunidade bentônica e das características sedimentológicas foram coletadas trimestralmente entre agosto de 1999 e novembro de 2001 e também em agosto de 2002 (11 campanhas). As coletas foram feitas em 13 estações de amostragem distribuídas no reservatório e em uma localizada a jusante da barragem. 128 táxons de invertebrados foram encontrados, sendo Mollusca, Annelida, Insecta e Nematoda os grupos dominantes durante praticamente todos os meses analisados. A classe Insecta foi a melhor representada, com 9 diferentes ordens, dentro das quais os Diptera contribuíram com a ocorrência de 63 táxons. A espécie exótica de bivalve Corbicula fluminea foi registrada em todas as estações de amostragem mostrando sua grande capacidade para colonizar novos habitats em regiões neotropicais. Variações consideráveis na densidade da fauna foram observadas para os diferentes períodos e locais analisados. A densidade máxima (média de 7812 ind.m-2) foi registrada no centro do reservatório enquanto que as densidades mínimas foram registradas na zona lacustre próxima à barragem (média de 9 ind.m-2). A maior riqueza de espécies por local/período (24 táxons) foi encontrada no trecho superior do reservatório (trecho fluvial). A diversidade máxima foi observada nas zonas superior e central do reservatório, com valores de 3.82 e 3.86 (bits.ind-1) no início (agosto/1999) e final (agosto/2002) do processo de enchimento, respectivamente. Não foi encontrado um padrão de distribuição dos grupos faunísticos que pudesse estar associado com a textura granulométrica dos diferentes locais amostrados. Por outro lado, constatou-se a diminuição, ou mesmo a não ocorrência de organismos, nas estações com elevada concentração de matéria orgânica (>40%) em baixo estado de degradação (grandes detritos vegetais). Tal fato pode estar relacionado com a falta de depósitos de sedimentos, dificultando a fixação de organismos da fauna bentônica, bem como com condições químicas mais redutoras em função da intensidade dos processos de decomposição da fitomassa inundada.

A SOCIAL JUSTICE STUDY: BRAZIL

This paper discusses the question of social justice in a global world, focussing on Brazil. Though largely debated, this question has not yet been properly answered (Kelsen, 2001, p. 1). Trying to contribute to this debate, this paper raises a general thesis: social justice involves a chaotic-solidaristic integration (da Silveira, 2002) between the discourse towards the egalitarian rights and duties and its practical sustainability by ethics and democracy.

WATER BALANCE and SPATIAL DISTRIBUTION of AN ANURAN COMMUNITY FROM BRAZIL

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

TMD and GOHAI indices of Brazilian institutionalised and community-dwelling elderly

Considering the controversy in the literature regarding several aspects of temporomandibular dysfunction (TMD) in elderly populations and the absence of reliable data on elderly Brazilians in this field, this study consisted of an evaluation of TMD prevalence and the self-perception of oral health among institutionalised and community-dwelling elderly in Sao JosE dos Campos, Brazil.Two hundred and fifteen community-dwelling and 185 institutionalised elderly people were evaluated by the Helkimo anamnestic (Ai) and clinical dysfunction (Di) indices and answered a questionnaire using the Geriatric Oral Health Assessment Index (GOHAI).The major prevalence of TMD symptoms was for the Ai0 (symptom-free) group (69.5%), while the major prevalence of clinical signs was for the DiI (mild) group (56%). Women presented a higher AiII classification than men (chi(2) test, p = 0.049). Community-dwelling elderly presented a significantly lower Ai0 classification than the institutionalised ones (Two ratios equality test, p < 0.001). There was no relationship between the institutionalised status and the clinical dysfunction index for Di0 and DiIII classification (Two ratios equality test, p = 0.194 and 0.535 respectively). The institutionalised elderly presented greater (One-way anova = 0.005) self-perception of oral health (33.45) than did the community-dwelling group (32.66). There were only weak Pearson's correlations among the anamnestic (-33.0%) or clinical (-14.7%) findings by the TMD and GOHAI indices. Symptom-free (Ai0) institutionalised elderly presented better scores in all GOHAI dimensions and elderly representing an absence of clinical TMD signs (Di0) presented higher GOHAI physical dimension scores in both groups.The prevalence of TMD symptoms among this sample of elderly individuals was relatively low, self-perception of oral health was reasonable and a weak, inverse correlation was found between TMD signs and symptoms and elderly self-perception of oral health measured by the GOHAI index.

Teaching in the community: Changing and implementing a new curriculum

The Faculdade de Medicina de Botucatu is changing to, and implementing a new curriculum aimed at integrating teaching and learning in the community. Emphasis is on preparing the community settings for teaching, learning and providing health care. A particular task is staff development with emphasis on problem-based learning (PBL) and training medical and nursing students in the leadership to participate in this process. The new curriculum includes the gradual introduction of clinical practice during First Year, integration of the basic sciences with clinical sciences, through integrated modules studied in small groups, and maintenance of the two year clerkship. The undergraduates are introduced gradually to the community: 8% of the total curriculum during First Year, 10% during Second Year, 10% during Third Year, 20% during Fourth Year, 30% during Fifth and Sixth Years. The basic health units at primary care level, and the regional specialty outpatients and hospitals at the second level, are the main teaching sites. An Education Development Committee was established to discuss the strategies for supporting the changes and to structure the planning for promoting the gradual transformation of staff development. After 18 months of implementation of the curriculum, there followed discussions and monitoring of the objectives of changes in medical education at our school. Successful implementation of the new curriculum would fail, if the objectives were not absorbed by every member of the implementation Committee.

Caries experience associated to social and preventive factors in children of a pastoral community from Limeira-SP

Aim: To evaluate caries experience and prevalence associated to social and preventive factors in 3-6-year-old children of a Pastoral Community from Limeira, Brazil. Methods: A cross-sectional study was carried out through an epidemiologic research about the oral conditions of 110 children registered at the Children's Pastoral Community from the city of Limeira, SP, Brazil. Intraoral examination was performed by a trained dentist and the parents/caregivers filled out a questionnaire in order to outline the children's profile with respect to gender, parental education and oral health. Results: Differences related to gender were not detected (p= 0.3404). The most frequent periods of breastfeeding were 0 to 2 months (36.36%) and 2 to 6 months (35.45%), corresponding to 71.81% of the cases. The time bottle feeding pointed to two most frequent categories: 1) more than 12 months (35.45%) and 2) between 2 and 6 months (22.63%). Regarding parental education, the majority of the sample has not completed primary school (38.32%). It was observed a larger number of decayed teeth in male children (63.39%). Caries experience was significantly higher in children who were breastfed for only 2 months of life (41.96%). Children that did not use baby bottle or did not use a baby bottle for more than 1 year presented a smaller dmft, corresponding to 29.17% and 28.33%, respectively. Time of use of bottle and pacifier presented a significant association (p<0.05). Conclusions: The implementation of adequate strategies and actions is needed to reinforce oral health conditions in risk groups.

Physical inactivity and related barriers: A study in a community dwelling of older brazilians

This study sought to investigate the prevalence of physical inactivity and related barriers in older Brazilian adults. A cross-sectional, population-based study was conducted, and a stratified random sampling procedure was used. A total of 359 older adults were interviewed. The long version of the International Physical Activity Questionnaire (IPAQ) and the Questionnaire of Barriers to Physical Activity Practice were used to assess physical activity level and barriers, respectively. No statistically significant difference was observed on the prevalence of physical inactivity in either gender or age groups. Regarding barriers, the proportion of 9 out of 22 barriers was statistically significant between men and women. Self-reported physical inactivity/activity in older Brazilian adults continues to be a concern. Uncommonly, older males reported a higher prevalence of physical inactivity compared to their counterparts. Additionally, physical inactivity prevalence continued to increase with the aging process. Yet, personal barriers such as lack of time and poor health were strongly associated with physical inactivity. The results of this study may help health professionals and public policy makers to better address the issues related to a healthy lifestyle among older adults and promote physical activity among Brazilian older adults and in other countries with similar characteristics. © 2012 Sebastião Gobbi et al.

Pathological and behavioral risk factors for higher serum c-reactive protein concentrations in free-living adults - A Brazilian community-based study

Low-grade chronic systemic inflammation is often associated with chronic non-communicable diseases, and its most frequently used marker, the C-reactive protein (CRP), has become an identifier of such diseases as well as an independent predictor for cardiovascular disorders and mortality. CRP is produced in response to pro-inflammatory signaling and to individual and behavioral factors, leading to pathological states. The aim of this study was to rank the predicting factors of high CRP concentrations in free-living adults from a community-based sample. We evaluated 522 adults (40-84 years old; 381 women) for anthropometric characteristics, dietary intake, clinical and physical tests, and blood analysis. Subjects were assigned to groups, according to CRP concentrations, as normal CRP (G1;<3.0 mg/L; n = 269), high CRP (G2; 3.0-6.0 mg/L; n = 139), and very high CRP (G3; >6.0 mg/dL; n = 116). Statistical comparison between groups used one-way ANOVA or Kruskal-Wallis tests, and prediction of altered values in increasing CRP was evaluated by proportional hazard models (odds ratio). CRP distribution was influenced by gender, body mass index, body and abdominal fatness, blood leukocytes, and neutrophil counts. The higher CRP group was discriminated by the above variables in addition to lower VO2max, serum metabolic syndrome components (triglycerides, glucose, and HDL cholesterol), higher insulin, homeostasis assessment of insulin resistance, uric acid, gamma-GT, and homocysteine. After adjustments, only fatness, blood leukocytes, and hyperglycemia remained as independent predictors for increased serum CRP concentrations. Intervention procedures to treat low-grade chronic inflammation in overweight women would mainly focus on restoring muscle mass and functions in addition to an antioxidant-rich diet. © 2012 Springer Science+Business Media, LLC.