Frailty and audiovisual senses in older patients with diabetes: a cross-sectional observational study.

Objective: This study aimed to analyze the relationship between frailty in older patients with diabetes and audiovisual senses. Methods: The survey included (1) basic attributes, (2) diabetes-related items, (3) frailty, evaluated according to the Obu Study of Health Promotion for the Elderly (OSHPE) standard, and (4) audiovisual function. Participants included 157 diabetes patients aged ≥65 years, divided into three groups: robust health (n=50), pre-frail (n=76), and frail (n=31). A simple regression analysis, in which the total OSHPE score was used as the dependent variable and the most relevant audiovisual items were used as independent variables, was performed to analyze the frailty factor. Next, a multiple regression analysis adjusted for age and sex was performed with total OSHPE score as the dependent variable and the items most relevant for audiovisual senses as independent variables. Results: For the robust health, pre-frail, and frail groups, frequencies of hearing loss were 18.4%, 42.1%, and 35.5%, respectively, and were associated with frailty; visual impairment frequencies were 38%, 63.2%, and 58.1%, respectively. In multiple regression analysis, economic difficulties (B=0.349, ß=0.172, p<0.05), absence of dyslipidemia (B=-0.494, ß=-0.171, p<0.05), lower MNA score (B=-0.169, ß=-0.214, p<0.05), and worsening hearing in the poor hearing ear (B=0.015, ß=0.176, p<0.05) were significantly associated with frailty. Conclusions: Hearing but not vision was associated with frailty in older patients with diabetes.

Evaluación de la precisión y exactitud de una encuesta alimentaria de registro con apoyo de imagen digital en tiempo real / Evaluation of the precision and accuracy of a food registry survey with digital image support in real time

Introducción: las encuestas alimentarias son utilizadas para la determinación del consumo de alimentos y nutrientes a nivel poblacional y/o individual, aunque subestiman la ingesta en un 37% o más. La introducción de nuevas tecnologías como la imagen digital de la porción de consumo, podría contribuir a disminuir el error de estimación para calorías y determinados macronutrientes. Objetivo: evaluar la precisión y exactitud del método de registro apoyado con imagen digital en tiempo real en la estimación de ingesta de calorías y macronutrientes en adultos jóvenes, considerándose como método de referencia el registro por pesada (RPP). Método: se evaluó la ingesta del almuerzo sometido previamente a un RPP de 58 sujetos. Antes y después de la ingesta, cada participante capturó una imagen de sus porciones de consumo y completaron un registro de ingesta. Se determinó el estado nutricional de los sujetos. El análisis estadístico se realizó con medianas, Kruskal-Wallis y concordancia con Bland-Altman (p < 0,05). Resultados: la mayor proporción de los sujetos presentó estado nutricional normal (72%) y el 80% presentó riesgo cardiovascular promedio. Se encontraron diferencias significativas entre los tres métodos al estimar la ingesta en calorías, proteínas y lípidos. La subestimación de calorías y lípidos disminuye del 32% al 25,8% al utilizar una imagen digital como apoyo a la estimación de ingesta y lípidos de 47% al 24,4%. Conclusiones: el registro complementado con imagen digital de las porciones consumidas presenta mejor concordancia con el método de referencia (RPP) en estimación de calorías, proteínas y lípidos, mejorando la precisión y exactitud del método

Introduction: food surveys are used to determine the consumption of food and nutrients at the population and/or individual level, although they underestimate the intake by 37% or more. The introduction of new technologies such as the digital image of the portion of consumption could help to reduce the estimation error for calories and certain macronutrients. Objective: to evaluate the precision and accuracy of the food record method supported with real-time digital imaging in the estimation of caloric intake and macronutrients in young adults, considering the weighed food record (WFR) as a reference method. Methods: lunch intake was evaluated previously submitted to a WFR of 58 subjects. Before and after the intake, each participant captured an image of their consumption portions and completed a food record. The nutritional status of the subjects was determined. The statistical analysis was performed with medians, Kruskal-Wallis, and concordance with Bland-Altman (p < 0.05). Results: the highest proportion of subjects presented normal nutritional status (72%) and 80% presented average cardiovascular risk. Significant differences were found between the three methods when estimating the intake for calories, proteins, lipids. The underestimation of calories and lipids decreases from 32% to 25.8% and lipids from 47% to 24.4% when using a digital image to support the estimation of intake. Conclusions: the food record complemented with digital image of the consumed portions presents better agreement with the reference method (WFR) in estimation of calories, proteins and lipids, improving the precision and accuracy of the method

[Evaluation of the precision and accuracy of a food registry survey with digital image support in real time]. / Evaluación de la precisión y exactitud de una encuesta alimentaria de registro con apoyo de imagen digital en tiempo real.

INTRODUCTION: Introduction: food surveys are used to determine the consumption of food and nutrients at the population and/or individual level, although they underestimate the intake by 37% or more. The introduction of new technologies such as the digital image of the portion of consumption could help to reduce the estimation error for calories and certain macronutrients. Objective: to evaluate the precision and accuracy of the food record method supported with real-time digital imaging in the estimation of caloric intake and macronutrients in young adults, considering the weighed food record (WFR) as a reference method. Methods: lunch intake was evaluated previously submitted to a WFR of 58 subjects. Before and after the intake, each participant captured an image of their consumption portions and completed a food record. The nutritional status of the subjects was determined. The statistical analysis was performed with medians, Kruskal-Wallis, and concordance with Bland-Altman (p < 0.05). Results: the highest proportion of subjects presented normal nutritional status (72%) and 80% presented average cardiovascular risk. Significant differences were found between the three methods when estimating the intake for calories, proteins, lipids. The underestimation of calories and lipids decreases from 32% to 25.8% and lipids from 47% to 24.4% when using a digital image to support the estimation of intake. Conclusions: the food record complemented with digital image of the consumed portions presents better agreement with the reference method (WFR) in estimation of calories, proteins and lipids, improving the precision and accuracy of the method.

INTRODUCCIÓN: Introducción: las encuestas alimentarias son utilizadas para la determinación del consumo de alimentos y nutrientes a nivel poblacional y/o individual, aunque subestiman la ingesta en un 37% o más. La introducción de nuevas tecnologías como la imagen digital de la porción de consumo, podría contribuir a disminuir el error de estimación para calorías y determinados macronutrientes. Objetivo: evaluar la precisión y exactitud del método de registro apoyado con imagen digital en tiempo real en la estimación de ingesta de calorías y macronutrientes en adultos jóvenes, considerándose como método de referencia el registro por pesada (RPP). Método: se evaluó la ingesta del almuerzo sometido previamente a un RPP de 58 sujetos. Antes y después de la ingesta, cada participante capturó una imagen de sus porciones de consumo y completaron un registro de ingesta. Se determinó el estado nutricional de los sujetos. El análisis estadístico se realizó con medianas, Kruskal-Wallis y concordancia con Bland-Altman (p < 0,05). Resultados: la mayor proporción de los sujetos presentó estado nutricional normal (72%) y el 80% presentó riesgo cardiovascular promedio. Se encontraron diferencias significativas entre los tres métodos al estimar la ingesta en calorías, proteínas y lípidos. La subestimación de calorías y lípidos disminuye del 32% al 25,8% al utilizar una imagen digital como apoyo a la estimación de ingesta y lípidos de 47% al 24,4%. Conclusiones: el registro complementado con imagen digital de las porciones consumidas presenta mejor concordancia con el método de referencia (RPP) en estimación de calorías, proteínas y lípidos, mejorando la precisión y exactitud del método.

Factors related to mental health and hearing in community-dwelling elderly.

The purpose of this study was to clarify the factors related to mental health and hearing in community-dwelling elderly. Elderly participants in a project to prevent long-term care need were given a self-administered questionnaire and tested by pure-tone audiometry. One hundred fifty were taken as subjects. Forty-one of these subjects (27.3%) were found to have poor mental health. The results of multiple logistic regression analysis with mental health level as the dependent variable indicated that subjects 65-74 years old who did not think their own hearing was bad had better mental health than those who did think their hearing was bad (odds ratio 10.800). Among subjects 75 years and older, those who had not been certified as needing long-term care had better mental health than those who had been certified (odds ratio 3.937). When planning mental health support for community-dwelling elderly in the future, it will be necessary to consider differences in background due to age group. The present results suggest that appropriate support for awareness of hearing and acceptance of decreased hearing ability in people in early old age (65-74 years old) may help to prevent declining mental health in later old age.

[Factors determining frequency of social interaction in frail elderly individuals. A study of the elderly in urban environments].

OBJECTIVES: We examined the relationship between the frequency of social interaction and physical, psychological, and social functioning among frail, non-housebound elderly to determine the best way to support social exchange and help prevent frail elderly from becoming housebound. METHODS: We recruited elderly individuals characterized as frail who lived in urban environments. A multidimensional examination was conducted that included interviews and physical performance tests. We defined an exchange as meeting and talking in person or talking by phone with friends, neighbors, relatives, or children living separately from the participants, and determined how many days a week frail elderly participants made contact with others. Independent variables were basic personality attributes; physical functioning, including eyesight, hearing, grip strength, masticatory force, ability to perform activities of daily living, walking ability, history of falls, and cognitive function; psychological functioning, including subjective health assessment, depression, and fear of falling; and social functioning, including ability to perform instrumental activities of daily living, social networks, and social activity. Multiple regression analysis was performed with SPSS 15.0 J to identify factors that could predict the frequency of contact with others. Data are expressed as mean +/- standard deviation. RESULTS: Of 61 elderly individuals recruited, 58 non-housebound individuals were selected for our study (men, n = 12; women, n = 46; mean age, 81.2 +/- 6.0 years). We found that participants interacted with others 4.5 +/- 2.0 days per week. For both male and female participants, the following independent variables were analyzed for the ability to predict frequency of contact with others: hearing (low-pitched sound), hearing (high-pitched sound), and scores on the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence. Multiple regression analysis revealed that hearing (low-pitched sound) and results of the TMIG index of competence significantly predicted frequency of contact with others for female participants. Specifically, participants without hearing loss and with a higher total score on the TMIG index of competence contacted others more frequently. CONCLUSION: Hearing and the ability to perform instrumental activities of daily living influence the frequency of contact with others. In particular, importance should be placed on hearing functions, which form the basis of communication. In addition to hearing evaluation and care (e.g., auditory test and hearing aid), maintaining the ability to perform instrumental activities of daily living is necessary to support social exchange.

[Characterization of chronic pain and analgesic approaches among community-dwelling elderly]. / Caracterização da dor crônica e métodos analgésicos utilizados por idosos da comunidade.

OBJECTIVE: To characterize chronic pain and analgesic approaches in community- dwelling elderly of the northern district of Londrina - Brazil. METHODS: Cross-sectional study with individuals 60 years old and more, resident in the local area of a Basic Health Unit (UBS) of Londrina, by home inquiry. Chronic pain was defined as pain lasting for six months or more. The elderly with pain, were questioned about characteristics of the pain as regards location, duration, frequency, intensity, improvement and worsening situations, as well as the impact of pain in the quality of life and also about analgesic approaches. RESULTS: One hundred and seventy two elderly were interviewed (101 women and 71 men). Presence of chronic pain was observed in 107 (62.%) of these 69.3% were female and 52.1% male (p = 0.004). The very old people, 80-year-old or more (p=0.01) and the depressive elderly (p=0.0008) presented higher frequency of chronic pain. Most prevalent pains were in the legs and back, with 31.2% each, and the majority of elderly referred to continuous, daily high intensity pain. Regarding analgesic approaches, the pharmacologic method was mentioned by 86 elderly (80.4%) and simple analgesic (32.6%) was the most used. CONCLUSION: Facts show that there is a high predominance of chronic pain in the population of elderly, mainly in women, in very old people and in depressive individuals.

Estresse ocupacional em trabalhadores de uma unidade de internação de um hospital-escola / Occupational stress in employees of a unit of internment of a trainee-hospital

O estresse ocupacional é resultante de uma relação desarmônica entre o trabalhador e o trabalho, podendodesencadear transtornos pessoais, familiares e ocupacionais. O presente estudo tem como objetivo identificar osníveis de estresse dos profissionais de uma unidade de internação de adultos de um hospital-escola. Foi utilizadoo Job Scale Stress adaptado para o português como Escala de Estresse no Trabalho, que possui 17 questõespara avaliar as dimensões - demanda psicológica, controle (discernimento intelectual e autoridade) e apoiosocial. Trata-se de um estudo de caráter descritivo, com análise quantitativa dos dados. Participaram da pesquisa 59 trabalhadores. Os resultados demonstraram escore alto para as dimensões demanda e controle eescore baixo para a dimensão apoio social, indicativo de sofrimento psíquico e estresse. Conclui-se que énecessária a inclusão de novas estratégias e o aprimoramento das já existentes no sentido de reduzir os níveisde estresse dos trabalhadores.

Occupational stress is a result of an anti-symmetrical relation between the employees and their jobs, and it cancause some personal distress, in a family and at work as well. This present study has the purpose to identify thelevels of stress in employees from a unit of internment of a trainee-hospital. “Job Scale Stress” was used in aversion adapted to portuguese as Escala de Estresse no Trabalho that contains seventeen questions to evaluatethe dimensions - psychological demand, control (intellectual discernment and authority) and social support. It is adescriptive study, with quantitative analysis of the data. Participated of the research 59 employees. The resultshave demonstrated high score on demand and control and low score on social support dimensions, whatindicates a psychological suffering and stress. It was concluded that, it is necessary the inclusion of newstrategies, and improvement on the ones already existent, to reduce the employees level of stress.

El estrés ocupacional es el resultado de una relación de desarmonía entre el trabajador y el trabajo, en el que sepuede desencadenar trastornos personales, familiares y ocupacionales. El estudio tiene por objetivo identificarlos niveles de estrés de los profesionales de un sector de internación de adultos de un hospital escuela. Fueutilizado el Job Scale Stress adaptado para la lengua portuguesa como Escala de Estresse no Trabalho, queposee diecisiete cuestiones para evaluar las dimensiones – demanda psicológica, control (discernimientointelectual y autoridad) y apoyo social. Se trata de un estudio de carácter descriptivo, con análisis cuantitativo delos datos. Cincuenta y nueve trabajadores participaron de la pesquisa. Los resultados mostraron un alto gradopara las dimensiones demanda y control, y bajo para la dimensión apoyo social, indicando sufrimiento psíquico y estrés. Se puede concluir que es necesaria la inclusión de nuevas estrategias y perfeccionamiento de las ya existentes en el sentido de reducir los niveles de estrés de los trabajadores.

Caracterização da dor crônica e métodos analgésicos utilizados por idosos da comunidade / Characterization of chronic pain and analgesic approaches among community-dwelling elderly

OBJETIVO: Caracterizar a dor crônica e os métodos analgésicos utilizados por idosos residentes na área de abrangência de uma Unidade Básica de Saúde (UBS), localizada na região norte da cidade de Londrina (PR). MÉTODOS: Estudo transversal descritivo com todos os indivíduos com 60 anos ou mais residentes na área de abrangência da UBS, através de inquérito domiciliar. Utilizou-se como critério de dor crônica a dor de duração mínima de seis meses. Os idosos foram questionados sobre as características da dor quanto à localização, duração, freqüência, intensidade, fatores de melhora e de piora, assim como o impacto da dor na vida do indivíduo e descrição dos métodos analgésicos utilizados. RESULTADOS: Foram entrevistados 172 idosos (101 mulheres e 71 homens). A presença de dor crônica foi observada em 107 (62,21 por cento); no sexo feminino esta prevalência foi de 69,3 por cento e no masculino 52,1 por cento (p = 0,004). Os idosos mais velhos - 80 anos ou mais - apresentaram maior referência de dor crônica (p = 0,01), assim como os idosos com depressão (p<0,001). Os locais de maior prevalência de dor foram membros inferiores e região dorsal, com 31,25 por cento cada, sendo que grande número de idosos referiam dor diária, contínua e de alta intensidade. Em relação aos métodos analgésicos, houve predomínio dos métodos farmacológicos, referidos por 86 idosos (80,37 por cento), e com maior utilização de analgésicos simples (32,6 por cento). CONCLUSÃO: Os dados mostram que há uma grande prevalência de dor crônica nessa população de idosos, principalmente nas mulheres com 80 anos ou mais e nos indivíduos depressivos.

OBJECTIVE: To characterize chronic pain and analgesic approaches in community- dwelling elderly of the northern district of Londrina - Brazil. METHODS: Cross-sectional study with individuals 60 years old and more, resident in the local area of a Basic Health Unit (UBS) of Londrina, by home inquiry. Chronic pain was defined as pain lasting for six months or more. The elderly with pain, were questioned about characteristics of the pain as regards location, duration, frequency, intensity, improvement and worsening situations, as well as the impact of pain in the quality of life and also about analgesic approaches. RESULTS: One hundred and seventy two elderly were interviewed (101 women and 71 men). Presence of chronic pain was observed in 107 (62. percent) of these 69.3 percent were female and 52.1 percent male (p = 0.004). The very old people, 80-year-old or more (p=0.01) and the depressive elderly (p=0.0008) presented higher frequency of chronic pain. Most prevalent pains were in the legs and back, with 31.2 percent each, and the majority of elderly referred to continuous, daily high intensity pain. Regarding analgesic approaches, the pharmacologic method was mentioned by 86 elderly (80.4 percent) and simple analgesic (32.6 percent) was the most used. CONCLUSION: Facts show that there is a high predominance of chronic pain in the population of elderly, mainly in women, in very old people and in depressive individuals.

Aspectos éticos envolvidos na assistência a idosos dependentes e seus cuidadotes / Ethic Aspects Involved in Rendering Assistance to Dependent Elderly and their Care Givers

O envelhecimento transforma pessoas ativas e produtivas em vulneráveis e dependentes. Os idosos são responsáveis pela maiorfreqüência de internações e maior tempo de ocupação de leitos hospitalares no Brasil em relação a outras faixas etárias. Indicadoresdo IBGE com dados da Pesquisa Nacional de Amostra de Domicílios de 2004 mostram que 73,1 dos brasileiros com mais de 60 anosvivem em domicílios com renda “per capita” de até dois salários mínimos. O Projeto de Extensão Assistência Interdisciplinar ao Idosoem Nível Primário (PAINP) envolve docentes e alunos de diferentes áreas da Universidade Estadual de Londrina(UEL), em ações junto aidosos cadastrados no Programa Saúde da Família (PSF) de uma Unidade Básica de Saúde do município de Londrina. O presente artigotem como objetivo propor uma reflexão bioética para profissionais e familiares envolvidos no cuidado a idosos dependentes, tendo comocenário algumas ações desenvolvidas no Projeto PAINP tais como visitas domiciliares, reuniões com cuidadores familiares e equipes doPSF. Os dados encontrados são preocupantes e as questões levantadas indicam a necessidade de se ampliar a discussão em seus aspectoséticos com relação ao processo de envelhecimento para que se possa garantir vida mais digna ao idoso dependente em uma sociedadeque envelhece rapidamente.

Ética em enfermagem: de um ensaio com enfoque deontológico para uma aprendizagem baseada na pedagogia da problematização / Ethics in Nursing - From a Deontological Focus to Learning Based on the Pedagogy of Problematization

O primeiro Código de Ética em Enfermagem foi elaborado pela Associação Brasileira de Enfermagem em 1958; posteriormente, em 1975, foi aprovado o Código de Deontologia em Enfermagem, que foi reformulado com a denominação de Código de Ética dos Profissionais de Enfermagem em 1993 e em 2000. O ensino de ética profissional sempre esteve presente nas escolas de enfermagem no Brasil. O Curso de Enfermagem da Universidade Estadual de Londrina (UEL), fundada em 1972 passou ao longo dos trinta e três anos de funcionamento por cinco reformas curriculares. Este trabalho tem como objetivo relatar a passagem do ensino da ética, com enfoque em legislação e deontologia, presente nas reformas iniciais para a inserção de discussões com abordagens mais reflexivas nas reformas realizadas no currículo de transição, implantado em 1996, e no currículo integrado em 2000. No currículo integrado em 2000, a bioética passou a integrar um dos temas transversais, as "seivas" que permeiam os conteúdos e práticas de enfermagem ao longo dos quatro anos de curso. Pretende-se com essa articulação formar enfermeiros com competência técnica, humana e comprometidos na solução das necessidades e problemas de saúde da população.

Distinct pathways regulate expression of cardiac electrical and mechanical junction proteins in response to stretch.

To define mechanisms regulating expression of cell-cell junction proteins, we have developed an in vitro system in which neonatal rat ventricular myocytes were subjected to pulsatile stretch. Previously, we showed that expression of the gap junction protein, connexin (Cx) 43, is increased by approximately 2-fold after 1 hour of stretch, and this response is mediated by stretch-induced secretion of vascular endothelial growth factor (VEGF). Here, we report that the mechanical junction proteins plakoglobin, desmoplakin, and N-cadherin are also upregulated by pulsatile stretch but by a mechanism independent of VEGF or other secreted chemical signals. Stretch-induced upregulation of mechanical junction proteins was blocked by anti-beta1 and anti-beta3 integrin antibodies. Transfection of cells with adenovirus expressing GFP-FRNK, a dominant-negative inhibitor of focal adhesion kinase (FAK)-dependent signaling, blocked stretch-induced upregulation of Cx43 and mechanical junction proteins but did not block the ability of exogenous VEGF to upregulate Cx43 expression. Conditioned medium removed from uninfected cells after stretch increased Cx43 expression when added to nonstretched cells, and this effect was blocked by anti-VEGF antibodies, but stretch-conditioned medium from GFP-FRNK cells had no effect on Cx43 expression. The src kinase inhibitor 4-amino-5-(4-chloro-phenyl)-7-(t-butyl)pyrazolol[3,4-d]pyrimidine blocked stretch-induced upregulation of mechanical junction proteins but not Cx43. Thus, stretch upregulates expression of both electrical and mechanical junction proteins via integrin-dependent activation of FAK. Stretch-induced upregulation of Cx43 expression is mediated by FAK-dependent secretion of VEGF. In contrast, stretch-induced upregulation of adhesion junction proteins involves intracellular mechanotransduction pathways initiated via integrin signaling and acting downstream of src kinase.

Inflammation of atrium after cardiac surgery is associated with inhomogeneity of atrial conduction and atrial fibrillation.

BACKGROUND: Atrial fibrillation (AF) is common after cardiac surgery. Abnormal conduction is an important substrate for AF. We hypothesized that atrial inflammation alters atrial conduction properties. METHODS AND RESULTS: Normal mongrel canines (n=24) were divided into 4 groups consisting of anesthesia alone (control group); pericardiotomy (pericardiotomy group); lateral right atriotomy (atriotomy group); and lateral right atriotomy with antiinflammatory therapy (methylprednisolone 2 mg/kg per day) (antiinflammatory group). Right atrial activation was examined 3 days after surgery. Inhomogeneity of conduction was quantified by the variation of maximum local activation phase difference. To initiate AF, burst pacing was performed. Myeloperoxidase activity and neutrophil cell infiltration in the atrial myocardium were measured to quantify the degree of inflammation. The inhomogeneity of atrial conduction of the atriotomy and pericardiotomy groups was higher than that of the control group (2.02+/-0.10, 1.51+/-0.03 versus 0.96+/-0.08, respectively; P<0.005). Antiinflammatory therapy decreased the inhomogeneity of atrial conduction after atriotomy (1.16+/-0.10; P<0.001). AF duration was longer in the atriotomy and pericardiotomy groups than in the control and antiinflammatory groups (P=0.012). There also were significant differences in myeloperoxidase activity between the atriotomy and pericardiotomy groups and the control group (0.72+/-0.09, 0.41+/-0.08 versus 0.18+/-0.03 DeltaOD/min per milligram protein, respectively; P<0.001). Myeloperoxidase activity of the antiinflammatory group was lower than that of the atriotomy group (0.17+/-0.02; P<0.001). Inhomogeneity of conduction correlated with myeloperoxidase activity (r=0.851, P<0.001). CONCLUSIONS: The degree of atrial inflammation was associated with a proportional increase in the inhomogeneity of atrial conduction and AF duration. This may be a factor in the pathogenesis of early postoperative AF. Antiinflammatory therapy has the potential to decrease the incidence of AF after cardiac surgery.

Capacidade funcional de idosos restritos ao domicílio, do conjunto Ruy Virmond Carnascialli, Londrina/PR / Functional capacity of elderly who are forced to stay at home due to their physical limitations, from the housing development Ruy Virmond Carnascialli, Londrina/PR

A incapacidade funcional é definida pela presença de dificuldade no desempenho de atividades da vida cotidiana ou mesmo pela impossibilidade de desempenhá-las. O objetivo do estudo foi avaliar a incapacidade funcional de idosos restritos ao domicílio. Participaram deste estudo 104 idosos acima de 60 anos, da área de abrangência da Unidade Básica da Saúde (UBS) do Conjunto Habitacional Ruy Virmond Carnascialli, Região Norte da cidade de Londrina/PR. Para a coleta de dados, foi utilizado um questionário sócio-demográfico e o Funcional Autonomy Measurement System instrumento composto por 29 aspectos divididos em cinco domínios: Atividade de Vida Diária, Mobilidade, Comunicação, Função Mental e Atividade Instrumental de Vida Diária. Para o tratamento estatístico dos dados, foi utilizado o programa Epi Info 6.04b e software Excel da Microsoft. A amostra constituiu-se predominantemente por idosos do gênero feminino e com média de idade de 75,8 +- 8,1 anos. Em relação às atividades de vida diária, os idosos mostraram-se dependentes principalmente no banho 29 (27,9 por cento), no cuidado pessoal 22 (21,1 por cento) e higiene 22 (21,1 por cento). No domínio mobilidade a maior incapacidade foi em relação a locomoção externa 28 (26,9 por cento). A visåo foi o item mais comprometido entre os idosos, sendo que 60 (57,7 por cento) referiram ter dificuldade ou precisarem de auxílio/supervisão. Já em relação à atividade instrumental de vida diária, fazer compras e utilizar telefone foram as atividades que obtiveram a maior porcentagem de dependência, 53,8 por cento, e 42,3 por cento respectivamente. Os resultados mostraram a necessidade de estratégias efetivas para a prevençåo e reabilitação do declínio funcional.

Remodeling of gap junctions and slow conduction in a mouse model of desmin-related cardiomyopathy.

OBJECTIVE: We studied a transgenic mouse model of human desmin-related cardiomyopathy with cardiac-specific expression of a 7-amino acid deletion mutation in desmin (D7-des) to test the hypothesis that impaired linkage between desmin and desmosomes alters expression and function of the electrical coupling protein, connexin43 (Cx43). METHODS: Expression of Cx43 and selected mechanical junctions proteins was characterized in left ventrices of D7-des and control mice by quantitative confocal microscopy and immunoblotting. Remodeling of gap junctions was also analyzed by electron microscopic morphometry. The electrophysiological phentoype of D7-des mice was characterized by electrocardiography and optical mapping of transmembrane voltage. RESULTS: Cx43 signal at intercalated disks was decreased by approximately 3-fold in D7-des ventricular tissue due to reductions in both gap junction number and size. Immunoreactive signal at cell-cell junctions was also reduced significantly for adhesion molecules and linker proteins of desmosomes and fascia adherens junctions. Electron microscopy showed decreased gap junction remodeling. However, immunoblotting showed that the total tissue content of Cx43 and mechanical junction proteins was not reduced, suggesting that diminished signal at cell-cell junctions was not due to insufficient protein expression, but to failure of these proteins to assemble properly within electrical and mechanical junctions. Remodeling of gap junctions in D7-des mice led to slowing of ventricular conduction as demonstrated by optical electrophysiological mapping. CONCLUSIONS: These results illustrate how a defect in a protein conventionally thought to fulfill a mechanical function in the heart can also lead to electrophysiological alterations that may contribute to arrhythmogenesis.

Matrix-protein-specific regulation of Cx43 expression in cardiac myocytes subjected to mechanical load.

To elucidate mechanisms responsible for mechanotransduction in the heart and define the effects of remodeling of the extracellular matrix, we cultured neonatal rat ventricular myocytes on native type I collagen, fibronectin, or denatured collagen and subjected them to uniaxial, pulsatile stretch. Changes in expression of the cardiac gap junction protein, Cx43, were measured by confocal microscopy and immunoblotting. Cells grown on fibronectin or denatured collagen exhibited significantly greater Cx43 expression than cells grown on native collagen. Stretch induced a approximately 2-fold increase in Cx43 expression in cells grown on native collagen but no increase in cells grown on fibronectin or denatured collagen. Incubation of cells on native collagen with a peptide containing the arginine-glycine-aspartate (RGD) motif upregulated Cx43 expression equivalent to that induced by stretch. Nonselective activation of integrin signaling with MnCl2 also upregulated Cx43 expression in cells grown on native collagen. This effect was blocked completely by pretreatment with anti-beta1 integrin antibody but not by anti-beta3 integrin antibody. Stretch led to a marked increase in beta1 integrin immunofluorescent signal in cells grown on native collagen but not in cells grown on fibronectin or denatured collagen. Stretch-induced upregulation of Cx43 was also blocked by anti-beta1 integrin antibody. Thus, matrix protein-myocyte interactions regulate Cx43 expression via beta1 integrin signaling initiated by mechanical stimulation in cells grown on native type I collagen, or by RGD-integrin signaling independent of mechanical stress in cells grown on fibronectin or denatured collagen. Changes in the composition of the extracellular matrix may affect electrical coupling in cardiac myocytes.

The relationship between fear of falling, activities of daily living and quality of life among elderly individuals.

The purpose of the present study was to examine the relationship between functional disability and fear of falling during daily activities. Also examined was the relationship between fear of falling and health-related Quality of Life (QOL). Health-related QOL concepts were measured using the Short Form 36 Health Survey (SF-36) within an elderly day services sample. Eligible subjects were elderly persons using Day Service (type B) who were capable of independently answering a questionnaire and had no memory problems. Forty-three males and 92 females were eligible for this study. Forty-nine (36.3%) subjects expressed no fear of falling, whereas 22 (16.3%) reported that they were very fearful of falling. Among females, walking and bathing had a highly significant relationship with the fear of falling. The fear of falling can contribute to psychological conditions such as depression, and also impacts on the health-related QOL of frail elderly people. Thus, it is critical to provide integrated health care activities for these individuals that address both psychological well-being and physical functioning.