Concepções e vivências da sexualidade e seus efeitos nas vidas de mulheres idosas / Conceptions and experiences of sexuality and the efects on the lives of elderly women / Concepciones y vivencias de la sexualidade y sus efectos em la vida de las mujeres mayores

Objetivo: desvelar os conceitos e percepções da sexualidade de mulheres idosas e os impactos em suas vidas. Método: trata-se de um estudo qualitativo exploratório-descritivo, com onze entrevistadas, mulheres entre 60 e 80 anos de idade, usuárias de uma Unidade Básica de Saúde, localizada no noroeste do Paraná. Resultados: observou-se que as mulheres idosas, em sua maioria, relacionam a sexualidade ao ato sexual e, consequentemente, depende de seu parceiro e percebem o ato como algo exclusivo do casamento e que depende do marido para acontecer. Conclusão: conclui-se que a sexualidade, apesar do conceito ter relação direta com o ato sexual, podem produzir influência em sua autoestima, na dinâmica familiar e busca pela assistência de saúde.

Objective: to reveal the concepts and perceptions of elderly women's sexuality and the impacts on their lives. Method: this is an exploratory-descriptive qualitative study, with eleven interviewees, women between 60 and 80 years of age, users of a Basic Health Unit, located in the northwest of Paraná. Results: it was observed that the majority of elderly women relate sexuality to the sexual act and, consequently, depend on their partner and perceive the act as something exclusive to marriage and that it depends on the husband to happen. Conclusion: It is concluded that sexuality, despite the concept having a direct relationship with the sexual act, can influence self-esteem, family dynamics and the search for health care.

Objetivos: revelar los conceptos y percepciones sobre la sexualidad de las mujeres mayores y los impactos en sus vidas. Método: Se trata de un estudio cualitativo exploratorio-descriptivo, con once entrevistadas, mujeres entre 60 y 80 años, usuarias de una Unidad Básica de Salud, ubicada en el noroeste de Paraná. Resultados: se observó que la mayoría de las mujeres mayores relacionan la sexualidad con el acto sexual y, en consecuencia, dependen de su pareja y perciben el acto como algo exclusivo del matrimonio y que depende del marido para realizarse. Conclusión: se concluye que la sexualidad, apesar de que el concepto tiene relación directa con el acto sexual, puede influir en la autoestima, la dinámica familiar y la búsqueda de atención de salud.

Research progress on dental materials for preventing root caries / 口腔疾病防治

@#The high incidence and untreated rate of root caries, a common and frequently occurring oral disease with challenging treatment in elderly individuals, is the main cause of tooth loss among elderly people, as rapid development results in pulpitis and periapical periodontitis or residual crown and root, which has been regarded as one of the common chronic oral diseases seriously affecting the quality of life of elderly people. Thus, early intervention and prevention are important. Traditional dental materials for preventing root caries have been widely used in clinical practice; however, they have the disadvantages of tooth coloring, remineralization and low sterilization efficiency. A series of new dental materials for preventing root caries have gradually become a research hotspot recently, which have the advantages of promoting the mineralization of deep dental tissue, prolonging the action time and enhancing adhesion. Future caries prevention materials should be designed according to the characteristics of root surface caries and the application population and should be developed toward simplicity, high efficiency and low toxicity. This review describes current research regarding anti-caries prevention material application, serving as a theoretical underpinning for the research of root caries prevention materials, which is important for both promotion in the effective prevention of root caries and improvement in the status of oral health and the quality of life among old people.

Projetos de extensão universitária e experiências de lazer para pessoas idosas nas universidades públicas brasileiras: um panorama atual / Leisure practices for the elderly in brazilian public universities: a current panorama

O objetivo foi investigar as experiências de lazer ofertadas às pessoas idosas nos projetos e programas existentes nas universidades públicas brasileiras. Realizou-se uma pesquisa exploratória e descritiva. O universo do estudo foi composto por 113 universidades públicas brasileiras, os dados foram coletados por meio de instrumento online com uma amostra de 54 coordenadores. Os programas e projetos ofertam atividades de lazer de acordo com as condições de espaço, material e pessoal. Nem todas as regiões possuem programas bem estruturados. Há carência de recursos, materiais em boa parte deles; faltam estruturas construídas e locais para a realização das atividades. A oferta de atividades de lazer para pessoas idosas nas universidades públicas brasileiras ainda é um campo em expansão. A maior parte dos programas surge por meio da extensão universitária e tem sido ela, uma das mantenedoras da continuidade dos mesmos.

The objective was to investigate the experienses of leisure practices offered to the elderly in existing projects and programs in Brazilian public universities. An exploratory and descriptive research was carried out. The study universe consisted of 113 Brazilian public universities, data were collected through an online instrument with a sample of 54 coordinators. The programs and projects offer leisure activities according to the conditions of space, material and personnel. Not all regions have wellstructured programs. There is a lack of resources, materials in most of them; there is a lack of built structures and places to carry out activities. The provision of leisure activities for the elderly in Brazilian public universities is still an expanding field. Most of the programs arise through university extension and it has been one of the maintainers of their continuity.

Development and testing of the Prev'Quedas game for older adults in the community: a descriptive study / Desarrollo y prueba del juego Prev'Quedas para personas mayores de la comunidad: un estudio descriptivo / Desenvolvimento e testagem do jogo Prev'Quedas para pessoas idosas da comunidade: estudo descritivo

ABSTRACT Objectives: to develop and test a board game for fall prevention in older adults in the community. Methods: a descriptive study, carried out through the use of game design elements (narrative, mechanics, aesthetics and technology), the Health Promotion Model, assessment by experts and testing with older adults. For assessment, the Concordance Index was used, considering it greater than 80%. Results: three prototypes and the final version were developed. The game's narrative was based on promotion model, comprising individual aspects, benefits and barriers in behavior to prevent falls. The mechanics outlined goals and rules. Aesthetics encompassed layout and illustrations. The technology involved board, cards, pin, roulette and instruction manual. The game was assessed by 36 experts and 31 older women from the community, with a Concordance Index of 93.22% and 99%, respectively. Conclusions: the game developed and tested was considered an adequate educational strategy for fall prevention.

RESUMEN Objetivos: desarrollar y probar un juego de mesa para la prevención de caídas en ancianos de la comunidad. Métodos: estudio descriptivo, realizado mediante el uso de elementos de diseño de juegos (narrativa, mecánica, estética y tecnología), el Modelo de Promoción de la Salud, evaluación por expertos y testeo con ancianos. Para la evaluación se utilizó el Índice de Concordancia, considerándose mayor al 80%. Resultados: se desarrollaron tres prototipos y la versión final. La narrativa del juego se basó en el modelo de promoción, que comprende aspectos individuales, beneficios y barreras en el comportamiento para prevenir caídas. La mecánica delineó objetivos y reglas. La estética abarcó el diseño y las ilustraciones. La tecnología involucró tablero, cartas, pin, ruleta y manual de instrucciones. El juego fue evaluado por 36 expertos y 31 ancianas de la comunidad, con un Índice de Concordancia de 93,22% y 99%, respectivamente. Conclusiones: el juego desarrollado y probado fue considerado una estrategia educativa adecuada para la prevención de caídas.

RESUMO Objetivos: desenvolver e testar um jogo de tabuleiro para prevenção de quedas em idosos da comunidade. Métodos: estudo descritivo, realizado através da utilização dos elementos do design de jogos (narrativa, mecânica, estética e tecnologia), do Modelo de Promoção da Saúde, da avaliação por especialistas e testagem com pessoas idosas. Para avaliação, utilizou-se o Índice de Concordância, considerando-o maior que 80%. Resultados: desenvolveram-se três protótipos e a versão final. A narrativa do jogo foi embasada no modelo de promoção, compreendendo aspectos individuais, benefícios e barreiras no comportamento para prevenção de quedas. A mecânica delineou objetivos e regras. A estética abrangeu layout e ilustrações. A tecnologia envolveu tabuleiro, cartas, pino, roleta e manual de instrução. O jogo foi avaliado por 36 especialistas e 31 idosas da comunidade, com índice de concordância de 93,22% e 99%, respectivamente. Conclusões: o jogo desenvolvido e testado foi considerado uma estratégia educacional adequada para prevenção de quedas.

Discapacidad en personas mayores / Disability in Older People

Introducción: El envejecimiento en Cuba constituye un problema demográfico y, desde una perspectiva individual, generalmente se acompaña de enfermedades que deterioran la funcionalidad; esto condiciona la discapacidad en las personas mayores. Objetivo: Identificar la prevalencia de discapacidad y las enfermedades que padecen los adultos mayores. Métodos: Se realizó un estudio piloto en 40 personas mayores del área de salud José Trujillo; del municipio Mariel. Se aplicó el instrumento WHODAS 2.0 para medir la discapacidad y se identificaron las enfermedades en las historias clínicas. Se resumió la información en porcentajes. Resultados: De las personas mayores estudiadas, 75 por ciento estaban discapacitadas con niveles entre ligero y moderado (27 y 25 por ciento respectivamente), con mayor frecuencia en mujeres y en edades avanzadas. Las dimensiones más afectadas fueron la comprensión y comunicación y la participación en sociedad. Las enfermedades principales fueron las cardiovasculares y las mentales (40 por ciento y 23,3 por ciento respectivamente). Conclusiones: La magnitud de la discapacidad fue importante en las personas estudiadas, las dimensiones más afectadas fueron la comprensión y comunicación, las actividades de la vida diaria y la participación en sociedad. Las enfermedades cardiovasculares fueron las más frecuentes, pero las enfermedades mentales fueron las que se relacionaron con niveles graves de discapacidad(AU)

Introduction: Aging in Cuba is a demographic problem and, from an individual perspective, it is generally accompanied by diseases that affect functionality. This brings about disability in older people. Objective: To identify the prevalence of disability and diseases suffered by older adults. Methods: A pilot study was carried out with forty elderly people from José Trujillo health area of ​​ Mariel Municipality. The WHODAS 2.0 instrument was applied to measure disability. Their diseases were identified in the medical records. Information was summarized in percentages. Results: Of the older people studied, 75 percent were disabled with levels between light and moderate (27 percent and 25 percent, respectively), with more frequency in women and in advanced ages. The most affected dimensions were understanding and communication, as well as participation in society. The main diseases were cardiovascular and mental (40 percent and 23.3 percent, respectively). Conclusions: The disability magnitude was important in the people studied. The most affected dimensions were understanding and communication, activities of daily living and participation in society. Cardiovascular diseases were the most frequent, but mental illnesses were those associated with severe levels of disability(AU)

Intergenerational financial transfers and physical health of old people in rural China: evidence from CHARLS data / Transferências financeiras intergeracionais e saúde física de idosos na China rural: evidências de dados CHARLS

ABSTRACT: With the reduction of intergenerational temporal transfers, financial transfers from adult offspring to their elderly parents are prevailing in rural China. Although much has been done, little is known about the association between the expansion of intergenerational transfers and rural old people's physical health in China. The purpose of this paper was to examine the effect of intergenerational financial transfers on the elders' physical health in rural China. Using data collected from China Health and Retirement Longitudinal Study (CHARLS), panel data fixed effect model and threshold model are employed to estimate the impact of intergenerational financial transfers on the old people's physical health in rural areas. Results showed that; although, the intergenerational financial transfers have a positive effect on the old people's physical health, no linear relationship exists between them. Intergenerational financial transfers are clearly less effective for low-income old people's physical health than those of middle-income, while the effect on high-income old people's health is the most insignificant. Studies concerning the effect of intergenerational financial transfers on the elders' health in developing countries remain limited. Findings of this paper provided great insights into how intergenerational transfers, such as intergenerational financial transfers, may affect the well-beings of old residents in rural areas. Additionally, this study can offer inspiration to policy makers regarding what measures they should take to enhance rural old residents' well-beings.

RESUMO: Com a redução de transferências temporais intergeracionais, as transferências financeiras da prole adulta a seus pais idosos estão prevalecendo em China rural. Embora muito tenha sido feito, pouco se sabe sobre a associação entre a expansão das transferências intergeracionais e a saúde física dos idosos rurais na China. O objetivo deste artigo é examinar o efeito das transferências financeiras intergeracionais sobre a saúde física dos anciãos na China rural. Usando dados coletados do estudo longitudinal de saúde e aposentadoria da China (CHARLS), o modelo de efeito fixo de dados do painel e o modelo de limiar são empregados para estimar o impacto das transferências financeiras intergeracionais na saúde física dos idosos em áreas rurais. Os resultados mostram que, embora as transferências financeiras intergeracionais tenham um efeito positivo na saúde física dos idosos, não existe relação linear entre eles. As transferências financeiras intergeracionais são claramente menos eficazes para a saúde física de idosos de baixa renda do que as de renda média, enquanto o efeito sobre a saúde de idosos de alta renda é o mais insignificante. Os estudos sobre o efeito das transferências financeiras intergeracionais sobre a saúde dos anciãos nos países em desenvolvimento permanecem limitados. Os achados deste artigo fornecem grandes insights sobre como as transferências intergeracionais, e as transferências financeiras intergeracionais podem afetar o bem-estar de idosos residentes em áreas rurais. Além disso, este estudo pode oferecer inspiração para os decisores políticos sobre as medidas que devem tomar para melhorar o bem-estar dos residentes rurais.

Usos y competencias digitales en personas mayores beneficiarias de un plan de inclusión digital en Uruguay / Uses and digital competences in elderly people who are beneficiaries of a digital inclusion plan in Uruguay / Usos e competências digitais em idosos beneficiários de um plano de inclusão digital no Uruguay

Resumen: El artículo analiza los usos de tecnologías de la información y la comunicación (TIC) y el desarrollo de competencias digitales en adultos mayores en el contexto de la implementación de una política pública de acceso. Se analiza una encuesta para conocer los usos y los factores que lo determinan, aplicando técnicas de análisis multivariado. El análisis cualitativo de las entrevistas semiestructuradas permite conocer el proceso y factores de adquisición de los distintos niveles de competencia digital. Se concluye que el acceso a Internet en el hogar, el uso previo de TIC y la capacitación son tres factores que contribuyen al uso por parte de las personas mayores y que están en condiciones de desarrollar competencias digitales complejas. Quienes tienen una visión más crítica sobre las tecnologías son las que logran mejor nivel de competencia digital. Finalmente, las competencias digitales se desarrollan en forma distinta que en otros sectores de la población y de no ser por la política pública implementada, seguirían en situación de exclusión.

Abstract: We analyse in this article the uses of information and communication technologies (ICT) and the development of digital skills in older persons in the context of the implementation of a public policy of ICT access. A survey is analysed to know the uses and the factors that determine it by applying multivariate analysis techniques. The qualitative analysis of the semi-structured interviews allows knowing the process and acquisition factors of the different levels of digital competence. We conclude that Internet access in the household and previous use of ICT and training, are three factors that contribute to the use and the development of complex digital skills by older persons. Digital skills are developed differently than in other sectors of the population. In addition, those who have a more critical vision about technologies are those who achieve a better level of digital competence. We also conclude that the implementation of this policy, initiates a process of digital inclusion of persons that would be excluded if not.

Resumo: O artigo analisa os usos das tecnologias da informação e comunicação (TIC) e o desenvolvimento de habilidades digitais em idosos no contexto da implementação de uma política de acesso público. Um questionário é analisado para conhecer os usos e os fatores que o determinam aplicando técnicas de análise multivariada. A análise qualitativa das entrevistas semiestruturadas permite conhecer os fatores do processo e aquisição dos diferentes níveis de competência digital. Conclui-se que o acesso à Internet em casa, o uso prévio de TIC e treinamento são três fatores que contribuem para o uso e que os idosos são capazes de desenvolver habilidades digitais complexas. As habilidades digitais são desenvolvidas diferentemente de outros setores da população. Conclui-se que aqueles que têm uma visão mais crítica sobre as tecnologias são aqueles que alcançam um melhor nível de competência digital. Finalmente, e um processo de inclusão digital de setores que, se não fosse por esta política, permaneceriam em situação de exclusão.

Research on equity and influencing factors of disability among Chinese middle-aged and old people / 北京大学学报(医学版)

OBJECTIVE@#To evaluate disability status and equity of the middle-aged and old population in China, and to explore the influencing factors contributing to the inequity of disability.@*METHODS@#This study was based on data collected from the first wave survey (2007-2010) of World Health Organization Study on Global Ageing and Adult Health (SAGE). Concentration index (CI) and concentration curve were calculated to measure the economic-related inequity of disability among the Chinese middle-aged and old people. The CI was further decomposed in which the attributions of social and individual determinants were calculated.@*RESULTS@#The mean score of the World Health Organization Disability Assessment Sche-dule (WHODAS) was 7.32 among the Chinese middle-aged and old people, 6.37 for males and 8.21 for females. The CI for the whole participants was -0.190 9, compared with -0.184 4 for the middle-aged and old men and -0.196 1 for the women. After decomposition of the CI, socioeconomic status contributed most to disability inequity among the Chinese middle-aged and old population. Financial status, educational level and work type contributed 66.41%, 16.45% and 13.10% respectively to inequity of disability. Individual lifestyle factors, including tobacco use, alcohol consumption and physical activities, contributed less to inequity of disability compared with social structural determinants.@*CONCLUSION@#There was inequity of disability among Chinese middle-aged and old population, and those with better financial status were less likely to suffer from functional disability. Middle-aged and old males were less disabled than females, and had less inequity of disability. Financial status, educational level and work type took the highest contribution to inequity of disability among Chinese middle-aged and old population, suggesting that promoting healthy lifestyles alone cannot effectively reduce the inequity of disability. The government needs to continually strengthen and improve appropriate social and medical protection measures on the basis of the importance it attaches to the health of the middle-aged and old population, and makes reducing health inequities a policy priority. The government should pay attention to the provision of healthcare and other resources in areas where development is relatively lagging and where there is a relative concentration of middle-aged and old population. Meanwhile, there should be more significant support for research on health status and equity among the middle-aged and old population to obtain more evidence for proactive responses to rapid population aging in China and policy development.

Caracterización clínico-epidemiológica de mordeduras en personas mayores en la provincia de los Andes, región de Valparaíso, Chile / Clinical-epidemiological characterization of bites in the elderly in the Andes province, Valparaíso region, Chile

Introducción: las mordeduras constituyen un relevante problema de salud, con amplio espectro clínico, pudiendo causar la muerte. Existe escasa información del tema en personas mayores (PM). Método: análisis de base de datos realizada a partir de formularios de notificación de mordeduras de centros de salud y de Protocolos de Denuncia de Animal Mordedor en la provincia de Los Andes, Chile. Objetivo: caracterizar epidemiológicamente las mordeduras en personas mayores ocurridas en la provincia de Los Andes, V región,(2005-2007). Resultados: de los 2358 casos de mordeduras notificados, 234 casos ocurrieron en PM (9,92 por ciento del total de casos), con un promedio de edad de 70,09 ± 7,896 años (rango = 60-95 años). La tasa de mordeduras para PM fue de 657,1 por 100000 hbtes (2005), 745,8 por 100000 hbtes (2006) y 627,6 por 100000 hbtes (2007). De éstos, la mayoría se produjo en el sexo femenino (56,8 por ciento) (p 0,016). El animal mordedor más frecuente fue el perro (75,6 por ciento) en ambos sexos. La complicación más frecuente fue la herida (74,4 por ciento), seguida por enfermedad por arañazo de gato (2,1 por ciento) y fractura (1,3 por ciento). Hubo 1 caso de artritis y 1 de celulitis por mordedura de araña. Conclusiones: las mordeduras en personas mayores son causa de morbilidad importante. Es relevante mejorar los sistemas de registro y vigilancia, y las medidas de educación en la tenencia responsable de animales para lograr una disminución de casos. Se requieren más estudios para determinar otras complicaciones y consecuencias de mordeduras en PM no visualizadas en este estudio.(AU)

Introduction: bites are a relevant health problem, with a varied clinical spectrum, which can cause death. There is limited information about bites in old people (OP). Methods: database analysis made with bites notification forms by health centers and Animal Bites Reporting Protocols in the province of Los Andes, Chile. Objective: typify bites epidemiologically in old people in the province of Los Andes, V region (2005 to 2007). Objective: typify bites epidemiologically in elderly people in the province of Los Andes, V region (2005 to 2007). Results: 234 out of 2358 cases of reported bites occurred in OP (9.92 percent of all cases), with an average age of 70.09 ± 7.896 years (range = 60-95 years). The bite rate for OP was 657.1 per 100000 inhabitants (2005), 745.8 per 100000 inhabitants (2006) and 627.6 per 100000 inhabitants (2007). Of these, most of them occurred in females (56.8 percent) (p 0.016). The most frequent biting animal was the dog in both genders (75.6 percent). The most frequent complication was injury (74.4 percent), followed by cat scratch disease (2.1 percent) and fracture (1.3 percent). There was 1 case of arthritis and 1 case of cellulitis due to spider bite. The most frequent complication was the wound (74.4 percent), followed by cat's scratch disease (2.1 percent) and fracture (1.3 ). There was 1 case of arthritis and 1 case of cellulitis due to spider bite. Conclusions: bites in old people are a cause of relevant morbidity. It is relevant to improve the registration and surveillance systems, and the education measures in responsible animal tenure to achieve a reduction of of cases. More studies are required to determine other complications and consequences of bites in OP not visualized in this study.(AU)

Effectiveness and securities of ticagrelor and clopidogrel in antiplatelet therapy for coronary heart disease in old people: A meta-analysis / 吉林大学学报(医学版)

Objective: To explore the curative effects and securities of ticagrelor and clopidogrel in the antiplatelet therapy for coronary heart disease in the aged patients, and to provide a more rational strategy for antiplatelet therapy. Methods: Computer search was performed in Cochrane Central Register of Controlled Trial. Ovid Medline. EMBase. PubMed. CNKI. Wanfang. VIP and CBM. and the randomized controlled trial (RCT) of ticagrelor and clopidogrel in the treatment of coronary heart disease in the old people were collected. The patients in ticagrelor group were given ticagrelor and other drugs, and the patients in clopidogrel group were given clopidogrel and other drugs. RevMan 5. 3 software was used to perform Meta-analysis, and the adverse events related to the effectiveness such as the major adverse cardiovascular events (MACE), myocardial infarction (MI), stent thrombosis, death, stroke and the adverse events related to safety (bleeding event) were observed. Results: According to inclusion and exclusion criteria,a total of 15 RCT were included. The results of Meta-analysis showed that the incidences of MACE (RR=0. 59, 95%CI: 0.46-0.76. Z=4. 08. P<0.01). MI (RR = 0. 48. 95%Ch 0.28-0.81. Z= 2.74, P= 0. 006), stent thrombosis (RR=0.16, 95%CI: 0.06 0.48, Z = 3.30, P=0.0010), and death (RR = 0.52, 95%CI: 0.30 0.89, Z=2.41, P = 0.02) in ticagrelor group were decreased compared with clopidogrel group; there was no significant difference in stroke rate (RR = 0. 76, 95%CI: 0. 39 1. 47, Z=0. 81, P=0. 42) between two groups, and the incidence of bleeding event in ticagrelor group was increased compared with clopidogrel group (RR = 1. 57, 95CI: 1.20 2.05, Z=3. 28, P=0. 001). Conclusion: For the aged patients with coronary heart disease, ticagrelor is superior to clopidogrel; but the incidence of bleeding is increased.

Treatment of elderly patients with aneurysmal subarachnoid hemorrhage: comparison between surgical clipping and endovascular coil embolization / 国际脑血管病杂志

Objective To compare the treatment effect of surgical clipping and endovascular coil embolization for aneurysmal subarachnoid hemorrhage (aSAH) in the elderly.Methods Elderly patients with aSAH (aged ＞65 years) treated in Shanghai Pudong Hospital from January 2009 to December 2017 were enrolled retrospectively.They were divided into craniotomy clipping group and endovascular intervention group according to the treatment strategy.The Glasgow Outcome Scale w as used for short-term outcome assessment at discharge,4-5 were defined as good outcome,and 1-3 were defined as poor outcome.Longterm follow-up w as performed to assess clinical outcomes using the modified Rankin Scale,0-2 w as defined as good outcome and 3-6 w ere defined as poor outcome.The clinical and imaging information,perioperative complications,short-term and long-term clinical outcomes,and long-term imaging outcomes w ere compared between the two groups.Multivariate logistic regression analysis was used to assess the independent influencing factors of clinical outcomes.Results A total of 68 elderly patients with aSAH were enrolled.Of these,47 (69.1％) received endovascular coil embolization and 21 (30.9％) underwent microsurgical clipping.There were no significant differences between the two groups in the incidence of perioperative complications,short-term and long-term adverse outcomes,and imaging recurrence rate.Multivariate logistic analysis showed that smoking (odds ratio [OR] 36.319,95％ confidence interval [CI] 3.530-373.640;P =0.003),modified Fisher grade (OR 20.406,95％ CI 2.022-205.964;P =0.011) and World Federation of Neurological Societies (WFNS) grade (OR 4.686,95％ CI 1.012-21.692;P=0.048) were the independent risk factors for short-term poor outcomes in elderly patients with aSAH.Conclusion Both endovascular intervention and microsurgical clipping are safe and effective treatments for elderly patients with aSAH.

Treatment of elderly patients with aneurysmal subarachnoid hemorrhage: comparison between surgical clipping and endovascular coil embolization / 国际脑血管病杂志

Objective@#To compare the treatment effect of surgical clipping and endovascular coil embolization for aneurysmal subarachnoid hemorrhage (aSAH) in the elderly.@*Methods@#Elderly patients with aSAH (aged >65 years) treated in Shanghai Pudong Hospital from January 2009 to December 2017 were enrolled retrospectively. They were divided into craniotomy clipping group and endovascular intervention group according to the treatment strategy. The Glasgow Outcome Scale was used for short-term outcome assessment at discharge, 4-5 were defined as good outcome, and 1-3 were defined as poor outcome. Long-term follow-up was performed to assess clinical outcomes using the modified Rankin Scale, 0-2 was defined as good outcome and 3-6 were defined as poor outcome. The clinical and imaging information, perioperative complications, short-term and long-term clinical outcomes, and long-term imaging outcomes were compared between the two groups. Multivariate logistic regression analysis was used to assess the independent influencing factors of clinical outcomes.@*Results@#A total of 68 elderly patients with aSAH were enrolled. Of these, 47 (69.1%) received endovascular coil embolization and 21 (30.9%) underwent microsurgical clipping. There were no significant differences between the two groups in the incidence of perioperative complications, short-term and long-term adverse outcomes, and imaging recurrence rate. Multivariate logistic analysis showed that smoking (odds ratio [OR] 36.319, 95% confidence interval [CI] 3.530-373.640; P=0.003), modified Fisher grade (OR 20.406, 95% CI 2.022-205.964; P=0.011) and World Federation of Neurological Societies (WFNS) grade (OR 4.686, 95% CI 1.012-21.692; P=0.048) were the independent risk factors for short-term poor outcomes in elderly patients with aSAH.@*Conclusion@#Both endovascular intervention and microsurgical clipping are safe and effective treatments for elderly patients with aSAH.

Serum lipoprotein (a) predicts the outcomes in elderly patients with acute ischemic stroke and type 2 diabetes mellitus / 国际脑血管病杂志

Objective To investigate the predictive value of serum lipoprotein (a) (Lp [a]) levels for short-term functional outcomes in elderly patients with acute ischemic stroke and type 2 diabetes mellitus.Methods Elderly patients with acute ischemic stroke and type 2 diabetes mellitus admitted to Nanjing First Hospital from June 2016 to December 2016 were enrolled retrospectively.The modified Rankin scale was used to assess the outcomes at 90 d after onset;0-2 was defined as good outcome and ＞2 were defined as poor outcome.Multivariate logistic regression analysis was used to determine independent risk factors for poor outcomes,and the receiver operator characteristic (ROC) curve analysis was used to evaluate the predictive value of serum Lp(a) levels for poor outcomes.Results A total of 231 patients were enrolled,with an average age of 69.7 years and males accounting for 65.4％.The median serum Lp(a) was 166 mg/L (interquartile range 78-331 mg/L).At 90 d after onset,140 patients (60.6％) had good outcomes and 91 (39.4％) had poor outcomes.After adjustment for other confounding variables,multivariate logistic regression analysis showed that elevated serum Lp(a) (referenced to the lowest quartile,the 3rd quartile:odds ratio[OR]2.899,95％ confidence interval[CI] 1.154-7.285,P =0.024;the 4th quartile:OR 3.334,95％ CI 1.329-8.361,P =0.010),the baseline National Institute of Health Stroke Scale score (OR 1.224,95％ CI 1.143-1.310;P＜ 0.001),and complicated with coronary heart disease (OR 2.504,95％ CI 1.196-5.243;P =0.015) were the independent risk factors for poor outcomes.ROC curve analysis showed that the area under the curve of serum Lp(a) level in predicting the poor outcome was 0.775 (95％ CI 0.696-0.854;P=0.04).The optimal cut-off value was 119 mg/L,the sensitivity was 71.15％,the specificity was 75.90％,the positive predictive value was 38.52％,and the negative predictive value was 61.48％.Conclusion Serum Lp(a) level has certain predictive value for the short-term poor outcomes in elderly patients with acute ischemic stroke and type 2 diabetes mellitus.

Effectiveness and securities of ticagrelor and clopidogrel in antiplatelet therapy for coronary heart disease in old people:A Meta-analysis / 吉林大学学报(医学版)

Objective:To explore the curative effects and securities of ticagrelor and clopidogrel in the antiplatelet therapy for coronary heart disease in the aged patients, and to provide a more rational strategy for antiplatelet therapy.Methods:Computer search was performed in Cochrane Central Register of Controlled Trial, Ovid-Medline, EMBase, PubMed, CNKI, Wanfang, VIP and CBM, and the randomized controlled trial (RCT) of ticagrelor and clopidogrel in the treatment of coronary heart disease in the old people were collected.The patients in ticagrelor group were given ticagrelor and other drugs, and the patients in clopidogrel group were given clopidogrel and other drugs.RevMan 5.3software was used to perform Meta-analysis, and the adverse events related to the effectiveness such as the major adverse cardiovascular events (MACE) , myocardial infarction (MI) , stent thrombosis, death, stroke and the adverse events related to safety (bleeding event) were observed.Results:According to inclusion and exclusion criteria, a total of 15RCT were included.The results of Meta-analysis showed that the incidences of MACE (RR=0.59, 95％CI:0.46-0.76, Z=4.08, P＜0.01) , MI (RR=0.48, 95％CI:0.28-0.81, Z=2.74, P=0.006) , stent thrombosis (RR=0.16, 95％CI:0.06-0.48, Z=3.30, P=0.0010) , and death (RR=0.52, 95％CI:0.30-0.89, Z=2.41, P=0.02) in ticagrelor group were decreased compared with clopidogrel group;there was no significant difference in stroke rate (RR=0.76, 95％CI:0.39-1.47, Z=0.81, P=0.42) between two groups, and the incidence of bleeding event in ticagrelor group was increased compared with clopidogrel group (RR=1.57, 95％CI:1.20-2.05, Z=3.28, P=0.001) .Conclusion:For the aged patients with coronary heart disease, ticagrelor is superior to clopidogrel;but the incidence of bleeding is increased.

Violência estrutural no modo e nas condições de vida de pessoas idosas em situação de rua / Structural violence in the living ways and conditions of the elderly in street situations / Violencia estructural en las formas y condiciones de vida de los ancianos en situaciones de calle

Analisar as situações de violência estrutural vivenciadas pelas pessoas idosas em situação de rua foi o objetivo deste estudo observacional, transversal, descritivo e qualitativo, que utiliza a análise textual discursiva de Roque Moraes. A amostra foi constituída por 4 mulheres e 15 homens idosos em situação de rua, de Porto Alegre, RS. As situações de violência estrutural descritas foram a fome, o frio, a falta de acesso ao estudo e ao trabalho, dentre outros. Promover acesso aos direitos fundamentais é imprescindível a esta população.

The aim of this observational, transversal, descriptive and qualitative study, which uses Roque Moraes' discursive textual analysis, is to analyze the situations of structural violence experienced by the elderly in a street situation. The sample consisted of 4 women and 15 elderly men in a street situation, in Porto Alegre, RS. The situations of structural violence described were hunger, cold, lack of access to study and work, among others. Promoting access to fundamental rights is essential for this population.

El objetivo de este estudio observacional, transversal, descriptivo y cualitativo, que utiliza el análisis textual discursivo de Roque Moraes, fue analizar las situaciones de violencia estructural experimentadas por los ancianos sin hogar. La muestra consistió en 4 mujeres y 15 hombres sin hogar de edad avanzada, de Porto Alegre, RS. Las situaciones de violencia estructural descritas fueron hambre, frío, falta de acceso al estudio y al trabajo, entre otras. Promover el acceso a los derechos fundamentales es esencial para esta población. Palabras clave: Ancianos callejeros; Violencia estructural; Condiciones de vida.

Effects of a 20-week concurrent training program on bone metabolism in elderly women / Efecto de 20 semanas de entrenamiento concurrente sobre el metabolismo óseo de adultas mayores

The present study evaluated the effect of a 20-week concurrent training program on bone metabolism in elderly women. The sample consisted of 51 elderly women living in the municipality of Muriaé (MG), distributed into two groups: a concurrent training group (CTG = 25), with an average age of 69.44 ± 6.82 years, and a control group (CG = 26), with mean age of 68.30 ± 6.34 years. Biophysical parameters were determined based on weight, height and body mass index. Bone metabolism was assessed by collecting second-morning urine samples before and after intervention to analyze levels of the biochemical marker deoxypyridinoline (DPD), which quantifies bone resorption. Results: The results showed a post-intervention decline in DPD content in the GTC when compared to controls (p = 0.007) and an improvement in the variables weight, BMI and DPD between the GTC and GC (p = 0.000). Conclusion: Concurrent training was efficient in improving bone metabolism in the elderly population studied.

El presente estudio evaluó los efectos de 20 semanas de entrenamiento concurrente sobre el metabolismo óseo de adultas mayores. La muestra fue compuesta por 51 mujeres adultas mayores, residentes en el municipio de Muriaé (MG), voluntarias, distribuidas en dos grupos, un grupo participó en entrenamiento concurrente (GTC=25), con una edad media de 69,44±6,82 años y un grupo control (GC=26) con una media de 68,30±6,34 años. Los parámetros biofísicos se determinaron por medio del peso corporal, la estatura e índice de masa corporal. Para la evaluación del metabolismo óseo, se realizó la recolección de la orina matinal en el pre y post-test, utilizando como reactivo el marcador bioquímico de deoxipiridinolina (DPD) que cuantifica la reabsorción ósea. Los resultados mostraron una reducción en la concentración de DPD en el GTC cuando se compararon los grupos (p = 0,007) y la mejora de las variables, peso corporal, IMC y DPD entre el GTC y el GC en el post-test (p = 0,000). Se percibe que el entrenamiento concurrente, para las mujeres adultas mayores fue eficiente en la mejoría de las condiciones de salud del metabolismo óseo.

Síndrome de apnea hipopnea obstructiva del sueño y consumo de benzodiacepinas en adultos mayores. Reporte de un caso / Obstructive sleep apnea hypopnea syndrome and benzodiazepine consumption in older adults. A case report

Resumen Introducción: El síndrome de apnea hipopnea obstructiva del sueño (SAHOS) es un trastorno del dormir que se caracteriza por obstrucción de la vía aérea durante el sueño. Los factores de riesgo más importantes para este trastorno son la obesidad y la edad. La obstrucción de la vía aérea ocasiona síntomas como ronquido de gran intensidad, pausas en la respiración o sensación de ahogamiento durante el sueño. Por otra parte, se ha descrito en la literatura que el uso de benzodiacepinas empeora el ronquido y las pausas en la respiración, por lo que podría incrementar la duración y severidad del SAHOS. Reporte del caso: Mujer de 74 años de edad que acude a consulta a la Clínica de Sueño de la UNAM por sintomatología anímica, y al interrogarla sobre otros trastornos del dormir refiere ronquido intenso, interrumpido por períodos de silencio y pausas en la respiración, por lo que se le realizó polisomnografía nocturna dividida que arrojó el resultado de SAHOS grave. Discusión: El consumo de benzodiacepinas es muy frecuente en los adultos mayores. En este caso, la paciente llevaba ingiriendo 1.5 mg/día de clonazepam durante 8 años, por lo que podría haber empeorado el SAHOS. Conclusiones: La paciente tenía factores de riesgo para desarrollar el SAHOS. Es necesario estudiar más la asociación entre las benzodiacepinas y el empeoramiento del SAHOS.

Abstract Introduction: Obstructive sleep apnea hypopnea syndrome (OSAHS) is caused by an obstruction in the upper airway during sleep. Obesity and advanced age are main risk factors for OSAHS. The classic symptoms of OSAHS include snoring, apneas and choking during sleep. On the other hand, some scientific literature describes that the consumption of benzodiazepines may worsen the snoring and the severity and duration of OSAHS. Case report: A 74-year-old female reported on her appointment to have mood alterations. When asked about other sleep disorders, she said that she snored loudly, with pauses on her breathing. Therefore, a split night polysomnography was performed which revealed a diagnosis of severe OSAHS. Discussion: Old people are frequent consumers of benzodiazepines. The woman of this study had been taking 1.5 mg of clonazepam per day for the last eight years. This may have worsened the OSAHS. Conclusion: The patient presented risk factors that could lead to OSAHS. It is important to study the relationship between benzodiazepines and the severity of OSAHS.

Clinical features, treatment, and outcomes of moyamoya disease in the elderly / 国际脑血管病杂志

Objective To preliminarily explore the clinical features,treatment,and outcomes of moyamoya disease in the elderly.Methods The clinical data of the elderly patients with moyamoya disease (aged ＞ 60 years) admitted to the Department of Neurosurgery,the 307th Hospital of PLA from May 2007 to July 2016 were collected retrospectively.Their clinical features,imaging features,and surgical outcomes were analyzed.Results A total of 68 patients were enrolled,including 35 females (51.47％) and 33 males (48.53％).The ratio of male to female was 1:1.06.The age at the time of diagnosis of moyamoya disease was 62.82 ±3.08 years.Fifty-two patients (76.5％) had vascular risk factors.The most common clinical manifestation was cerebral ischemia (n =61,89.7％).Thirty of them (44.1％) presented as transient ischemic attack.The Suzuki staging of most patients was 4-6 (71.6％),12 patients (17.6％) complicated with posterior cerebral artery stenosis or occlusion.Thirty-one patients were treated with encephalo-duroarterio-synangiosis (EDAS).Among them,17 patients underwent bilateral surgery and 14 underwent unilateral surgery.The incidence of perioperative infarction or hemorrhage was 5.6％ (2 patients developed cerebral infarction and 1 patient developed cerebral hemorrhage);37 patients received conservative treatment.During the follow-up period,5 patients developed cerebral infarction (1 in the surgical treatment group and 4 in the conservative treatment group);there was no significant difference between the 2 groups.There were no significant differences in age,sex,vascular risk factor,clinical symptoms,and preoperative modified Rankin Scale (mRS) scores between the 2 groups.Cerebral angiography was performed 6-9 months after operation in the surgical treatment group.A total of 24 cerebral hemispheres were evaluated by Matsushima typing,of which 17 (70.8％) were excellent.During the follow-up period,the proportion of patients with clinical outcome excellent (the mRS score was 0) (Z =-5.268,P ＜ 0.00l) and clinical improvement (the mRS score was improved ≥ 1 compared to the baseline) (Z =-3.780,P ＜ 0.001) were significantly higher than the conservative treatment group.Conclusions The clinical symptoms of old patients with moyamoya disease were mainly cerebral ischemia.Most of them had vascular risk factors,and the imaging manifestations showed higher Suzuki staging.The perioperative risk of EDAS in the old patients with moyamoya disease was lower.It might be an effective method to prevent clinical symptoms progress and improve the outcomes.

Descrições sobre a velhice: a identidade terceira idade em depoimentos de idosos / Descriptions of old age: senior citizens' identity as they appear in elderly people's reports

Na contemporaneidade, os mais diferentes discursos sobre uma vida saudável, que prometem felicidade e bem-estar, mas também prescrevem condutas, modos de ser e de viver, são produzidos por especialistas em saúde e veiculados pela mídia. Nesses discursos a velhice é sinônima de doença, e a juventude, de saúde. Cada vez mais, são produzidos discursos que prometem uma velhice sem as marcas que lhe são próprias. Neste artigo, fruto de uma pesquisa mais ampla, apresentamos algumas definições sobre a velhice construídas em discursos de idosos, praticantes e não praticantes de atividades físicas, da cidade de Campina Grande ­ PB. Foram entrevistados cinco homens e nove mulheres, com idades que variaram entre 62 a 88 anos. As entrevistas foram submetidas à Análise de Discurso. Os relatos constroem uma imagem da velhice que contraria a tradicional, segundo a qual os idosos são fracos, impotentes e não têm projetos para o futuro. A velhice, neles, assemelha-se muito à "identidade terceira idade", cada vez mais presente na sociedade e na mídia, uma imagem na qual essa fase da vida aparece como a "melhor idade", um período do ciclo vital pleno de possibilidades. (AU)

There is a great variety of discourses about a healthy way of life today, and they all promise happiness and well-being, besides prescribing behaviors, ways of being and living. They are produced by health specialists and are conveyed by the media. In these discourses old age is synonymous with illness whereas youth is synonymous with health. As a result, new discourses are increasingly produced, promising an old age devoid of its characteristic signs. In this article, the result of a broader research, we will use definitions of old age constructed by discourses of aged people themselves, who either practice or practice physical exercises or not, in the city of Campina Grande, in the state of Paraíba. We interviewed five men and nine women and their ages varied between 62 and 88 years old. These interviews were analyzed according to the principles of Discourse Analysis. These reports construct an image of old age that contradicts the traditional view of it, according to which aged people are weak, impotent and lack projects for the future. For them, old age closely resembles "the identity of the elderly" increasingly present in society and in the media, an image in which this life stage appears as "the best years" a period in the vital cycle full of possibilities. (AU)

Fundamentos teóricos- metodológicos sobre la educación del adulto mayor en el contexto de la educación permanente / Theoretical - methodological basis on old people's education in the context of permanent education

El trabajo tiene como objetivo fundamentar teórica y metodológicamentela educación del adulto mayor en el contexto de la educación permanente. Para ello, se describe conceptualmente el carácter de la educación a lo largo de la vida, su integración a la existencia humana. Los métodos del nivel teórico empleados fueron el análisis y síntesis para la construcción del marco teórico-metodológico. Quedan argumentados tres modelos pedagógicos necesarios por su importancia en el estudio desarrollado. La educación del adulto mayor se inscribe en el proceso íntegro de educación permanente, al proveer conocimientos, habilidades y actitudes valiosas para el crecimiento personal como respuesta a la dinámica de los cambios científicos, tecnológicos y sociales.

The objective of the paper is to provide a theoretical and methodological basis on old people's education in the context of permanent education. To that end, the character of education throughout life and its integration to human existence is described. Theoretical level methods such as analysis and synthesis were used in order to construct the theoretical-methodological framework. Three pedagogical models, which are necessary because of their importance for the study, are argued. Old people's education forms part of the whole permanent education process, as it provides knowledge, skills and valuable attitudes towards personal growth as an answer to scientific, technological and social changes dynamics.