Lumbar safety triangle: comparative study of coronal and coronal oblique planes in 3.0-T magnetic resonance imaging / Triângulo de segurança lombar: estudo comparativo dos planos coronal e coronal oblíquo em ressonância magnética 3.0-T

Abstract Objective: To compare the measurements of the lumbar safety triangle (Kambin's triangle) and the invasion of the dorsal root ganglion in the triangle in coronal and coronal oblique planes. Materials and Methods: A cross-sectional study, in which 210 3.0-T magnetic resonance images of L2-L5 were analyzed in coronal and coronal oblique planes. Exams with lumbar spine anomalies were excluded. Demographic (sex and age) and radiological variables were recorded by a single evaluator. Results: Most sample was female (57.1%), mean age 45.5 ± 13.3 (18-98 years). The measurements average, as well as the areas, gradually increased from L2 to L5. The dorsal root ganglion invaded the triangle in all images. The safety triangle average area was smaller in the coronal oblique plane than in the coronal plane. Of the seven dimensions of safety triangle obtained for each level of the lumbar spine, six were significantly smaller in the coronal oblique plane than in the coronal plane. The only dimension that showed no difference was the smallest ganglion dimension. Conclusion: The dimensions and areas investigated were smaller in coronal oblique plane, especially the area (difference > 1 mm). The analysis of the triangular zone in this plane becomes important in the preoperative assessment of minimally invasive procedures.

Resumo Objetivo: Comparar as medidas do triângulo de segurança lombar (triângulo de Kambin) e invasão do gânglio da raiz dorsal no triângulo nas incidências coronal e coronal oblíqua. Materiais e Métodos: Estudo transversal, em que foram analisadas 210 imagens de ressonância magnética 3.0-T de L2-L5 nos planos coronal e coronal oblíquo. Foram excluídos exames com anomalias da coluna lombar. Variáveis demográficas (sexo e idade) e radiológicas foram registradas por um único avaliador. Resultados: A maioria da amostra era do sexo feminino (57,1%), com idade média de 45,5 ± 13,3 (18-98 anos). A média das medidas, assim como as áreas, aumentaram gradativamente de L2 a L5. O gânglio da raiz dorsal invadiu o triângulo em todas as imagens. A área média do triângulo de segurança foi menor na incidência coronal oblíqua do que na incidência coronal. Das sete dimensões do triângulo de segurança obtidas para cada nível da coluna lombar, seis foram significativamente menores no plano coronal oblíquo do que no plano coronal. Única dimensão que não apresentou diferença foi a menor dimensão do gânglio. Conclusão: As dimensões e áreas investigadas foram menores na incidência coronal oblíqua, especialmente a área (diferença > 1 mm). A análise da zona triangular nesta incidência torna-se importante na avaliação pré-operatória de procedimentos minimamente invasivos.

Accuracy of the triglyceride-glucose index as a surrogate marker for identifying metabolic syndrome in non-diabetic individuals.

OBJECTIVES: This study aimed to verify the performance of the triglyceride-glucose (TyG) index in predicting metabolic syndrome (MetS) using three different criteria in healthy individuals living in rural areas. In addition, it aimed to estimate the TyG index cutoff point in the prediction of MetS. METHODS: The study was a cross-sectional study of healthy individuals (aged ≥18 y) living in rural areas of southern Brazil. Individuals with diabetes mellitus were excluded. The variables investigated were waist circumference, blood pressure, triglycerides, high-density lipoprotein cholesterol, fasting glucose, and TyG index. MetS was defined using three criteria: harmonized, International Diabetes Foundation, and National Cholesterol Education Program Adult Treatment Panel III. The Poisson regression model was used for the multivariate analysis. The performance of the TyG index in identifying MetS was determined by receiver operating characteristic curves. RESULTS: A total of 133 individuals were included in this study, with a mean age of 49.0 ± 13.5 y; 54.1% were female. The TyG index performed better in predicting MetS through the harmonized criteria, with area under the curve (AUC) = 0.889 (95% confidence interval [CI], 0.829-0.949), followed by the International Diabetes Foundation criteria, with AUC = 0.877 (95% CI, 0.814-0.940), and the National Cholesterol Education Program criteria, with AUC = 0.867 (95% CI, 0.797-0.937). The TyG index cutoff points defined for the harmonized and International Diabetes Foundation criteria were ≥ 8.61, and ≥ 8.79 for the National Cholesterol Education Program Adult Treatment Panel III. CONCLUSIONS: The TyG index proved to be valid for diagnosing MetS. The largest AUC of the TyG index was identified for the harmonized criteria. Thus, the TyG index can be used to diagnose MetS in individuals living in rural areas.

Lumbar safety triangle: comparative study of coronal and coronal oblique planes in 3.0-T magnetic resonance imaging.

Objective: To compare the measurements of the lumbar safety triangle (Kambin's triangle) and the invasion of the dorsal root ganglion in the triangle in coronal and coronal oblique planes. Materials and Methods: A cross-sectional study, in which 210 3.0-T magnetic resonance images of L2-L5 were analyzed in coronal and coronal oblique planes. Exams with lumbar spine anomalies were excluded. Demographic (sex and age) and radiological variables were recorded by a single evaluator. Results: Most sample was female (57.1%), mean age 45.5 ± 13.3 (18-98 years). The measurements average, as well as the areas, gradually increased from L2 to L5. The dorsal root ganglion invaded the triangle in all images. The safety triangle average area was smaller in the coronal oblique plane than in the coronal plane. Of the seven dimensions of safety triangle obtained for each level of the lumbar spine, six were significantly smaller in the coronal oblique plane than in the coronal plane. The only dimension that showed no difference was the smallest ganglion dimension. Conclusion: The dimensions and areas investigated were smaller in coronal oblique plane, especially the area (difference > 1 mm). The analysis of the triangular zone in this plane becomes important in the preoperative assessment of minimally invasive procedures.

Objetivo: Comparar as medidas do triângulo de segurança lombar (triângulo de Kambin) e invasão do gânglio da raiz dorsal no triângulo nas incidências coronal e coronal oblíqua. Materiais e Métodos: Estudo transversal, em que foram analisadas 210 imagens de ressonância magnética 3.0-T de L2-L5 nos planos coronal e coronal oblíquo. Foram excluídos exames com anomalias da coluna lombar. Variáveis demográficas (sexo e idade) e radiológicas foram registradas por um único avaliador. Resultados: A maioria da amostra era do sexo feminino (57,1%), com idade média de 45,5 ± 13,3 (18­98 anos). A média das medidas, assim como as áreas, aumentaram gradativamente de L2 a L5. O gânglio da raiz dorsal invadiu o triângulo em todas as imagens. A área média do triângulo de segurança foi menor na incidência coronal oblíqua do que na incidência coronal. Das sete dimensões do triângulo de segurança obtidas para cada nível da coluna lombar, seis foram significativamente menores no plano coronal oblíquo do que no plano coronal. Única dimensão que não apresentou diferença foi a menor dimensão do gânglio. Conclusão: As dimensões e áreas investigadas foram menores na incidência coronal oblíqua, especialmente a área (diferença > 1 mm). A análise da zona triangular nesta incidência torna-se importante na avaliação pré-operatória de procedimentos minimamente invasivos.

Transtheoretical model for lifestyle changes in older persons: a systematic review protocol.

Adherence to lifestyle changes is a major challenge for healthcare professionals. The transtheoretical model (TTM) was proposed to promote behavioral changes, used in different health conditions (smoking, alcoholism, drug addiction, and obesity) and age groups. However, the effectiveness of the model in older persons is not yet known. This systematic review protocol follows the PRISMA-P guidance. The question the review will address is, Are interventions based on the TTM, compared with conventional interventions, associated with lifestyle changes in older adults? Databases MEDLINE/PubMed, EMBASE, LILACS, CENTRAL, WoS, and PsycINFO will be searched. Randomized clinical controlled trials and quasi-experimental studies describing the effectiveness of TTM-based interventions in changing the lifestyle of individuals aged 65 and over, compared with conventional interventions for lifestyle changes, will be included. Studies that do not address the stages of change characteristic of TTM or that use pharmacological interventions as a comparator will be excluded. Reviewers independently will screen papers for eligibility criteria, and, extracting data, assess the risk of bias for included studies and will evaluate the overall quality of evidence (GRADE system). If possible, a meta-analysis will be conducted. Otherwise, a narrative synthesis will be prepared according to the SWiM guideline.

Metabolic syndrome components relationship with lipid indices and anthropometric parameters in rural workers: exploratory factor analysis / Relação dos componentes da síndrome metabólica com índices lipídicos e parâmetros antropométricos em trabalhadores rurais: análise fatorial exploratória / Relación de los componentes del síndrome metabólico con índices lipídicos y parámetros antropométricos en trabajadores rurales: análisis factorial exploratório

Background and Objectives: The search for simple and rapid screening indicators for metabolic syndrome (MS) is important due to its high frequency in the adult population. And this aspect is little explored in the rural Brazilian population. The objective of this study was to verify the relationship of MS components with lipid indices and anthropometric parameters in rural workers. Methods: Cross-sectional study with rural workers aged 18 years or older. The MS was determined through harmonized criteria. The fasting glucose (GLI), systolic (SBP) and diastolic (DBP) blood pressure, HDL-c and waist circumference (WC); anthropometric parameters: body mass index (BMI), waist/height ratio (WHtR) and body fat percentage (%F); and lipid indices: glycemic triglyceride index (TyG), lipid accumulation product (LAP) and visceral adiposity index (VAI). Exploratory factor analysis was performed that included, in model I, the anthropometric parameters and, in model II, the lipid indices. Results: out of the 167 workers, 21.0% were older adults (≥60 years), 39.5% were male and 61.1% had MS, with a higher prevalence in females. Model II responded to the highest explained variance (78.43%) including metabolic (VAI, LAP, TyG and TG and -HDL-c), cardiometabolic (SBP, DBP and CC) and glycemic factors. Model I explained 70.4% of the variance, which included excess weight, blood pressure and lipid/glycemic factors. Conclusion: the model that included the lipid indices explained the greatest variance observed and the VAI presented the most significant load of this factor.(AU)

Justificativa e Objetivos: A busca por indicadores simples e rápidos de rastreio de síndrome metabólica (SM) é importante, devido a sua alta frequência na população adulta. Contudo, este aspecto é pouco explorado na população rural brasileira. O objetivo deste estudo foi verificar a relação dos componentes da SM com índices lipídicos e parâmetros antropométricos em trabalhadores rurais. Métodos: Estudo transversal com trabalhadores rurais com 18 anos ou mais. A SM foi determinada pelo critério harmonizado. Foram investigados os seguintes componentes da SM: triglicerídeos (TG), glicose em jejum (GLI), pressão arterial sistólica (PAS) e diastólica (PAD), HDL-c e circunferência da cintura (CC); os parâmetros antropométricos: índice de massa corporal (IMC), relação cintura/estatura (RCE) e percentual de gordura corporal (%G); e os índices lipídicos: índice triglicerídeos glicemia (TyG), produto de acumulação de lipídios (LAP) e índice de adiposidade visceral (VAI). Foi realizada análise fatorial exploratória que incluiu, no modelo I, os parâmetros antropométricos e, no modelo II, os índices lipídicos. Resultados: Dos 167 indivíduos investigados, 21,0% eram idosos (≥60 anos), 39,5% do sexo masculino e 61,1% apresentaram SM, com maior frequência no sexo feminino. O modelo II respondeu a maior variância explicada (78,43%) incluindo os fatores metabólico (VAI, LAP, TyG, TG e o -HDL-c), cardiometabólico (PAS, PAD e CC) e glicêmico. O modelo I explicou 70,4% da variância, que incluiu os fatores excesso de peso, pressão arterial e lipídico/glicêmico. Conclusão: o modelo que incluiu os índices lipídicos explicou a maior variância observada e o VAI apresentou a carga mais significativa desse fator.(AU)

Antecedentes y objetivos: La búsqueda de indicadores de detección simples y rápidos para el síndrome metabólico (SM) es importante debido a su alta frecuencia en la población adulta. Y este aspecto es poco explorado en la población rural brasileña. El objetivo de este estudio fue verificar la relación de los componentes del SM com índices lipídicos e parámetros antropométricos en trabajadores rurales. Métodos: estudio transversal con trabajadores rurales de 18 años o más. El SM fue determinado por criterio armonizado. Se investigaron los seguientes componentes de la SM: triglicéridos (TG), glucosa en ayunas (GLI), presión arterial sistólica (PAS) y diastólica (PAD), HDL-c y circunferencia de cintura (CC); parámetros antropométricos: índice de masa corporal (IMC), relación cintura /talla (WHtR) y porcentaje de grasa corporal (% F); y índices de lípidos: índice glucémico de triglicéridos (TyG), el producto de acumulación de lípidos (LAP) y el índice de adiposidad visceral (VAI). Se realizo um análisis factorial exploratorio que incluyó, em modelo I, los parâmetros antropométricos y, en el modelo II, los índices lipídicos. Resultados: De los 167 trabajadores, 21,0% eran ancianos (≥60 años), 39,5% hombres y 61,1% tenían SM, con mayor frecuencia en mujeres. El modelo II respondió a la mayor varianza explicada (78,43%) incluyendo factores metabólico (VAI, LAP, TyG y TG y -HDL-c), cardiometabólico (SBP, DBP y CC) y glucémico. El modelo I explicó el 70,4% de la varianza, que incluía exceso de peso, presión arterial y factores lipídicos / glucémicos. Conclusión: el modelo que incluyó los índices lipídicos explicó la mayor varianza observada y el VAI presentó la carga más significativa de este factor.(AU)

Teleconsultation in the prevention and control of older persons' health with regard to the COVID-19 pandemic: study protoco / Teleconsulta para prevenção e controle da saúde do idoso frente à pandemia de COVID-19: protocolo do estudo

OBJECTIVE: To report the following study protocol: "Prevention program for older persons' health care focusing on the COVID-19 pandemic in the city of Recife ­ PE." METHODS: An action research study will be conducted with 151 older people of both sexes residing in the 8 health districts of Recife, Brazil. A teleconsultation service will be used to converse with participants. Activities will be organized into 2 moments: diagnosis and intervention. A guided conversation strategy will be used, dealing with issues related to coronavirus disease 2019 (COVID-19) prevention; social isolation; thoughts, emotions, and spirituality; family and community support; and personal development and ground rules for everyday life. The intervention with each older person will happen weekly for 12 weeks and will be characterized by listening to them and exchanging knowledge with the aim of bonding and optimizing adherence and compliance to COVID-19 prevention and control measures. Our data analysis will follow 3 approaches: cross-sectional (multivariate regression model), quasi-experimental (analysis of standardized residuals), and qualitative (interview and content analysis). EXPECTED RESULTS AND RELEVANCE: The construction of scientific knowledge is a key strategy when faced with the great challenge to global collective health presented by the COVID-19 pandemic. Data generated in this study may contribute to the improvement of knowledge, attitudes, and preventive practices, as well as to a good acceptance of the prevention program by older participants.'

OBJETIVO: Apresentar o protocolo "Programa de prevenção para a saúde do idoso com foco na pandemia de COVID-19 no município do Recife ­ PE". METODOLOGIA: Um estudo de pesquisa-ação será conduzido com 151 idosos de ambos os sexos que residem nos 8 distritos sanitários de Recife, Brasil. Um serviço de teleconsulta será usado para comunicação com os participantes. As atividades serão organizadas em 2 momentos: diagnóstico e intervenção. Uma estratégia de conversa guiada será adotada para com os idosos, tratando de temas relacionados à prevenção de COVID-19; isolamento social; pensamentos, emoções e espiritualidade; família e suporte comunitário; desenvolvimento pessoal; e regras básicas para o cotidiano. A intervenção com cada idoso ocorrerá uma vez por semana por 12 semanas, sendo caracterizada pela escuta e troca de conhecimentos com o objetivo de gerar um vínculo e otimizar a aderência e observância de medidas de prevenção e controle de COVID-19. A análise de dados seguirá 3 abordagens: transversal (modelo de regressão multivariada), quase-experimental (análise de resíduos padronizados), e qualitativa (entrevista e análise de conteúdo). RESULTADOS ESPERADOS E RELEVÂNCIA: A construção do conhecimento científico é uma estratégia chave frente ao grande desafio para a saúde coletiva global representado pela pandemia de COVID-19. Dados gerados por este estudo podem contribuir para a melhoria do conhecimento, atitudes, e medidas de prevenção, além de uma boa aceitação do programa de prevenção por parte dos participantes idosos.

Accuracy of SARC-F and SARC-CalF for sarcopenia screening in older women from southern Brazil.

OBJECTIVES: The aim of this study was to verify the accuracy of the SARC-F and the SARC-CalF as screening tools for sarcopenia in community-dwelling older women ≥60 y of age. METHODS: This was a cross-sectional study evaluating a convenience sample of women ≥60 y of age, living in Southern Brazil. Sarcopenia was defined according to the criteria proposed in the latest European Working Group on Sarcopenia in Older People consensus (EWGSOP2). Appendicular muscle mass was assessed by dual-energy x-ray absorptiometry. Muscle strength was measured by handheld dynamometry, and physical performance through the 4-m gait speed test. The SARC-F questionnaire and SARC-CalF score for sarcopenia screening were also applied. RESULTS: We evaluated 288 participants, with a mean age of 67.6 ± 5.8 y. The frequency of probable and confirmed sarcopenia in the sample was 7.3% and 2.1%, respectively. The frequency of risk for sarcopenia assessed by the SARC-F was 4.5% and SARC-CalF 22.2%. Despite the excellent specificity (95.4%) demonstrated by the SARC-F, its sensitivity in identifying confirmed cases was null, whereas the SARC-CalF showed high sensitivity (83.3%) and good specificity (79%). CONCLUSION: The present study findings suggested that SARC-CalF may be able to outperform SARC-F as a sarcopenia screening tool in women ≥60 y of age even under the new EWGSOP2 criteria, the main determinant of which is strength as observed in studies based on the previous definition.

Is Sensory Loss an Understudied Risk Factor for Frailty? A Systematic Review and Meta-analysis.

BACKGROUND: Age-related sensory loss and frailty are common conditions among older adults, but epidemiologic research on their possible links has been inconclusive. Clarifying this relationship is important because sensory loss may be a clinically relevant risk factor for frailty. METHODS: In this systematic review and meta-analysis, we searched 3 databases for observational studies investigating 4 sensory impairments-vision (VI), hearing (HI), smell (SI), and taste (TI)-and their relationships with frailty. We meta-analyzed the cross-sectional associations of VI/HI each with pre-frailty and frailty, investigated sources of heterogeneity using meta-regression and subgroup analyses, and assessed publication bias using Egger's test. RESULTS: We included 17 cross-sectional and 7 longitudinal studies in our review (N = 34,085) from 766 records. Our cross-sectional meta-analyses found that HI and VI were, respectively, associated with 1.5- to 2-fold greater odds of pre-frailty and 2.5- to 3-fold greater odds of frailty. Our results remained largely unchanged after subgroup analyses and meta-regression, though the association between HI and pre-frailty was no longer significant in 2 subgroups which lacked sufficient studies. We did not detect publication bias. Longitudinal studies largely found positive associations between VI/HI and frailty progression from baseline robustness, though they were inconclusive about frailty progression from baseline pre-frailty. Sparse literature and heterogenous methods precluded meta-analyses and conclusions on the SI/TI-frailty relationships. CONCLUSIONS: Our meta-analyses demonstrate significant cross-sectional associations between VI/HI with pre-frailty and frailty. Our review also highlights knowledge gaps on the directionality and modifiability of these relationships and the impact of SI/TI and multiple sensory impairments on frailty.

Evaluation of the lumbar safety triangle through magnetic resonance imaging / Avaliação do triângulo de segurança lombar por meio da ressonância magnética / Evaluación del triángulo de seguridad lumbar por medio de la resonancia magnética

ABSTRACT Objective: To evaluate the lumbar triangular safety zone, its boundaries and its relationship with the dorsal root ganglion through Magnetic Resonance Imaging (MRI). Methods: The boundaries, shape and dimensions of 303 triangular safety zones were analyzed in Tesla 3.0 Magnetic Resonance Imaging (MRI) coronal sections from L2 to L5, including the dorsal root ganglion. Results: The sample consisted of 101 patients with a mean age of 32 years. The height of the triangular safety zone was formed by the lateral edge of the dura mater, the width by the upper plateau of the lower vertebra and the hypotenuse by the corresponding nerve root. The mean dimensions and the area varied according to the level studied. The dorsal root ganglion invaded the dimensions of the triangle in all the images studied. Conclusion: Based on the data and the analyses performed, we concluded that knowledge of the boundaries of the triangular safety zone through MRI increases the safety of minimally invasive procedures in the lumbar spine. Level of evidence I; Diagnostic studies - Investigation of a diagnostic test.

RESUMO Objetivo: Avaliar a zona triangular de segurança lombar, seus limites e sua relação com o gânglio da raiz dorsal por meio da ressonância magnética (RM). Métodos: Foram estudados os limites, o formato e as dimensões de 303 zonas triangulares de segurança no corte coronal de RM 3.0 Tesla de L2 a L5, incluindo o gânglio da raiz dorsal. Resultados: A amostra foi composta por 101 pacientes com média de idade de 32 anos. A altura da zona triangular de segurança era formada pela borda lateral da dura-máter; a largura, pelo platô superior da vértebra inferior; e a hipotenusa, pela raiz nervosa correspondente. A média das dimensões, assim como a área, variaram conforme o nível estudado. O gânglio da raiz dorsal invadiu as dimensões do triângulo em todas as imagens estudadas. Conclusão: Baseados nos dados e nas análises realizadas, concluímos que o conhecimento dos limites da zona triangular de segurança, por meio da imagem da RM, aumenta a segurança dos procedimentos minimamente invasivos na coluna lombar. Nível de evidência I; Estudos diagnósticos-Investigação de um exame para diagnóstico.

RESUMEN Objetivo: Evaluar la zona triangular de seguridad lumbar, sus límites y su relación con el ganglio de la raíz dorsal a través de la Resonancia Magnética (RM). Métodos: Se estudiaron los límites, el formato y las dimensiones de 303 zonas triangulares de seguridad en el corte coronal de RM 3.0 Tesla de L2 a L5, incluyendo el ganglio de la raíz dorsal. Resultados: La muestra fue compuesta por 101 pacientes, con promedio de edad de 32 años. La altura de la zona triangular de seguridad estaba formada por el borde lateral de la duramadre, el ancho por la meseta superior de la vértebra inferior y la hipotenusa por la raíz nerviosa correspondiente. El promedio de las dimensiones, así como el área, variaron según el nivel estudiado. El ganglio de la raíz dorsal invadió las dimensiones del triángulo en todas las imágenes estudiadas. Conclusión: Basándose en los datos y análisis realizados, concluimos que el conocimiento de los límites de la zona triangular de seguridad a través de la imagen de RM aumenta la seguridad de los procedimientos mínimamente invasivos en la columna lumbar. Nivel de evidencia I; Estudios diagnósticos - Investigación de un examen para diagnóstico.

The Swallowing Clinical Assessment Score in Parkinson's Disease (SCAS-PD) Is a Valid and Low-Cost Tool for Evaluation of Dysphagia: A Gold-Standard Comparison Study.

BACKGROUND: Dysphagia is a predictor of mortality in Parkinson's disease (PD). Developing alternative methods to videofluoroscopy swallowing study (VFSS) for the evaluation of dysphagia is a public health necessity. The Swallowing Clinical Assessment Score in Parkinson's Disease (SCAS-PD) is an alternative and low-cost tool for diagnosis of dysphagia, but had not been properly validated in comparison to the gold-standard method. The objective of this study was to assess the validity and reliability of the SCAS-PD. METHODS: SCAS-PD was applied to 31 patients with PD, and VFSS was conducted concurrently. This clinical assessment uses different volumes and viscosities to identify signs of swallowing impairments. For validation purposes, the interclass correlation coefficient and the weighted kappa were calculated. The AUC of the ROC curve, sensitivity, and specificity values for detection of penetration/aspiration (PA) were assessed. Internal consistency was calculated by Cronbach's alpha. RESULTS: Fifty-one percent of patients were classified with dysphagia. SCAS-PD was differentiated between normal/functional deglutition and dysphagia with AUC 0.97, 95% CI 0.92-1.00, and an optimal cutoff at 19 (sensitivity 100% and specificity 87.5%). The internal consistency was α = 0.91 for the total score. The internal consistency of the SCAS-PD domains was oral phase (α = 0.73), pharyngeal phase (α = 0.86), and signs of PA (α = 0.95). The weighted kappa analysis demonstrated a high rate of concordance at 0.71 (p < 0.001) between SCAS-PD and VFSS. CONCLUSIONS: SCAS-PD has been shown to have a good concordance with the VFSS. Considering this, SCAS-PD is highly applicable in clinical settings, since it is a simple and low-cost diagnostic tool for detecting dysphagia in PD patients.

Associação do tabagismo com biomarcadores REDOX e fatores de risco cardiometabólicos em idosos / Association of smoking with redox biomarkers and cardiometabolic risk factors in elder individuals

Resumo Introdução O tabagismo constitui a principal causa de morte evitável no mundo e é considerado um importante fator de risco para as doenças cardiovasculares (DCV). Objetivo Verificar a associação do tabagismo com sexo, metabolismo redox e fatores de risco cardiometabólicos de 381 idosos da Estratégia Saúde da Família de Porto Alegre/RS. Método Para categorizar o tabagismo, seguiram-se as recomendações do Center of Diseases Control (CDC). Os marcadores de estresse oxidativo investigados foram: produtos avançados da oxidação proteica (AOPP), metabólitos do óxido nítrico (NOx), capacidade antioxidante medida por meio do ensaio ferric reducing ability of plasma (FRAP). Fatores de risco cardiometabólicos também foram avaliados. Resultados Em relação ao sexo/fumo, foram mais frequentes as mulheres não fumantes (P = 0,001). Os homens ex-tabagistas apresentaram maiores concentrações de FRAP (P = 0,001), e os tabagistas, maior concentração de NOx, (0,012), menores médias de circunferência de cintura-CC (P = 0,017) e de índice de massa corporal-IMC (P = 0,003) e maior HDL-c (P = 0,003). Não foram verificados resultados significativos entre as mulheres. Conclusão Os idosos do sexo masculino tabagistas apresentaram menores valores de CC, IMC e HDL-c, porém os tabagistas apresentaram aumento da concentração do NO x, o qual é um biomarcador de estresse oxidativo associado a doenças cardiovasculares. Portanto, é preciso destacar a importância na prevenção e adesão à cessação de tabagismo para evitar comorbidades cardiovasculares.

Abstract Background Smoking is the leading cause of preventable death worldwide, and is considered an important risk factor for cardiovascular disease (CVD). Objective To investigate the association of smoking with sex, redox metabolism and cardiometaboic risk factors of 381 elderly from the Family Health Strategy of Porto Alegre. Method To categorize smoking, followed by the recommendations of the Center for Disease Control (CDC). We studied the following oxidative stress markers investigated: advanced products of protein oxidation (AOPP), nitric oxide metabolites (NOx), the antioxidant capacity was measured by Ferric Reducing Ability of Plasma (FRAP). Cardiometabolic risk factors were also evaluated. Results Regarding sex/smoking, women are more often non-smokers (P = 0.001). Former male smokers had higher concentrations of FRAP (P = 0.001), and smokers had higher concentration of NOx (0.012), lower average waist circumference-WC (P = 0.017), body mass index-BMI (P = 0.003) and increased HDL-c levels (P = 0.003). There were found significant results among women. Conclusion The elderly male smokers presented lower values of WC, BMI and HDL-c, but smokers presented increased NOx concentration, which is a oxidative stress biomarker associated with cardiovascular diseases. Therefore, it is important to emphasize the importance in preventing and adhering to smoking cessation to avoid cardiovascular comorbidities..

Performance of Anthropometric Indicators in the Prediction of Metabolic Syndrome in the Elderly.

Introduction: Studies have demonstrated the relevance of anthropometric indicators in the prediction of metabolic syndrome (MetS). However, researches involving older people are still scarce. Therefore, the objective was to describe the frequency of MetS and to determine the performance of anthropometric indicators as predictors of MetS in the total sample, in men and women. Methods: Cross-sectional study involving 479 elderly individuals attended in primary health care. The revised National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) guidelines were used for the MetS diagnosis. The anthropometric indicators evaluated were neck circumference, sagittal abdominal diameter (SAD), SAD/height, sagittal index, and conicity index (C-Index). The predictive performance of the MetS anthropometric indicators was determined using a receiver operating characteristic (ROC) curve. A cutoff point >0.700 was used to evaluate diagnostic performance. Results: The frequency of MetS was 60.5%. The anthropometric indicators demonstrating adequate performance were in total sample: SAD/height (auROC = 0.810), SAD (auROC = 0.777), and C-Index (auROC = 0.706); in women: SAD (auROC = 0.820), SAD/height (auROC = 0.810), neck circumference (auROC = 0.782), and C-Index (auROC = 0.727); in men: SAD/height (auROC = 0.768), SAD (auROC = 0.760), and C-Index (auROC = 0.724). Conclusions: A high frequency of MetS was observed. Of the five anthropometric indicators investigated, three presented good performance in the total sample (SAD, SAD/height, and C-Index), four in women (SAD, SAD/height, neck circumference, and C-Index), and three in men (SAD, SAD/height, and C-Index). The anthropometric indicators, SAD, SAD/height, and C-Index, proved to perform adequately in all the three segments investigated.

Effect of Exercise on Cognition, Conditioning, Muscle Endurance, and Balance in Older Adults With Mild Cognitive Impairment: A Randomized Controlled Trial.

BACKGROUND AND PURPOSE: Mild cognitive impairment (MCI) may be a precursor to dementia; however, its progression may be prevented or slowed with exercise. This study aimed at determining the effects of group aerobic and strength training on cognition, conditioning, muscle endurance, and balance in underprivileged community-dwelling older adults with MCI. METHODS: This was a single-blind, randomized, and matched-pair controlled (gender, age, body mass index, and Addenbrooke's Cognitive Examination-Revised for MCI diagnosis) clinical trial. It was developed in 4 community centers. Fifty-two sedentary, functionally independent individuals, aged 60 years or more, with MCI were randomized into intervention group (n = 26) and control group (n = 26). Participants were tested before and after a 24-week exercise program. Sociodemographic characteristics, cognition (Mini-Mental State Examination), conditioning (2-minute stationary walk test), lower-limb endurance (30-second sit/stand test), and balance data (Functional Reach test) were collected. The intervention group walked and exercised twice weekly (60 minutes each) using ankle weights, latex resistance bands, and dumbbells. The exercise load and intensity were regularly increased on the basis of a preestablished incremental number of sets and repetitions and on the basis of the participants' correct movement execution with a given load. Data were analyzed with Pearson χ test, Fisher exact test, Student t test, Mann-Whitney U test, 2-way repeated measures analysis of variance, and the Cohen d. RESULTS AND DISCUSSION: Before the intervention, no significant differences were found between groups for any of the variables. Postintervention, significant differences were observed in cognition, conditioning, muscle endurance, and balance. Significant time-by-group interactions were detected in all the intergroup analyses. The improvements observed in the intervention group had medium to large effect sizes (0.35-1.15). The control group's decrease in cognition (13.9%) had a large effect size, while its Functional Reach test decrease (11.4%) had a medium effect size, with no significant change in conditioning or muscle endurance. CONCLUSION: The training program improved cognitive function, muscle endurance, aerobic conditioning, and balance in older adults with MCI.

The effect of group exercises on balance, mobility, and depressive symptoms in older adults with mild cognitive impairment: a randomized controlled trial.

OBJECTIVE:: To determine the effects of group exercises on balance, mobility, and depressive symptoms in community-dwelling older adults with mild cognitive impairment. DESIGN:: Single blinded, randomized, matched pairs clinical trial. SETTING:: Four primary healthcare units. SUBJECTS:: Fifty-two sedentary subjects with mild cognitive impairment were paired (age, sex, body mass index, and Addenbrooke's Cognitive Examination Revised score), tested, and then randomized into an intervention group ( n = 26) and a control group ( n = 26). INTERVENTION:: The intervention group performed strength (ankle weights, elastic bands, and dumbbells) and aerobic exercises (walking) in their communities' public spaces, twice a week (60 minutes each), during 24 weeks. The control group maintained its usual routine. MAIN MEASURES:: Balance (Berg Balance Scale (BBS)), mobility (Timed Up and Go Test (TUG)), and depressive symptoms (Geriatric Depression Scale-15) were assessed before and after the intervention. RESULTS:: Before the intervention, the two groups did not differ statistically. After, the intervention group showed significant improvement ( P < 0.05) in balance (before: 53 ± 3; after: 55.1 ± 1.1 points), mobility (before: 10.7 ± 2.9 seconds; after: 8.3 ± 2 seconds), and depressive symptoms (median punctuation (interquartile range) before: 4 (1.8-6); after: 2.5 (1-4)). The control group presented a significant increase in their depressive symptoms (median before: 3.5 (2-7.3); after: 4 (2-5.3)), while their balance and mobility showed no significant modification. Small effect sizes were observed in the intervention group and control group depressive symptoms, as well as in the control group's mobility and balance. Large effect sizes were observed the intervention group's mobility and balance. CONCLUSION:: Group exercises improved balance, mobility, and depressive symptoms in community-dwelling older adults with mild cognitive impairment.

Body image satisfaction, nutritional status, anthropometric indicators and quality of life among the elderly / Satisfação com a imagem corporal, estado nutricional, indicadores antropométricos e qualidade de vida em idosos

Objective: to determine the prevalence of body image satisfaction in elderly subjects, as well as its relationship with nutritional status, anthropometric indicators and quality of life. Method: a cross-sectional, descriptive and analytical study was carried out with elderly individuals from Primary Care units (Family Health Strategy) from all the health districts of Porto Alegre, in the state of Rio Grande do Sul. The variables studied were: sociodemographic (gender; age; marital status and schooling), anthropometric (weight; height; body mass index; arm, calf, waist and hip circumference; waist-hip ratio and triceps skinfold), nutritional (Mini Nutritional Assessment), and clinical (quality of life; body image satisfaction). The Stunkard Silhouettes Scale, the Mini Nutritional Assessment and the Flanagan quality of life scale were applied. For data analysis, logistic regression (five steps) was performed with the Conditional Backward method. Results: a total of 532 elderly users (68.96 (7.14) years) were evaluated, mostly women (64.8%) who were dissatisfied with their body image (71.7%). The predictors of body image satisfaction were: eutrophic/underweight body mass index, eutrophy/insufficient arm circumference, and higher mean quality of life scores. Conclusion: in general, a low prevalence of body image satisfaction was identified among the elderly. Subjects with lower body mass index, smaller arm circumference measures and better quality of life had a greater chance of being satisfied with their body image.

Objetivo: determinar a prevalência da satisfação com a imagem corporal em idosos, bem como a sua relação com o estado nutricional, indicadores antropométricos e qualidade de vida. Método: estudo transversal, descritivo e analítico desenvolvido com idosos provenientes de unidades da Estratégia Saúde da Família de todos os distritos sanitários de Porto Alegre/Rio Grande do Sul. As variáveis pesquisadas foram: sociodemográficas (sexo; idade; estado civil e escolaridade), antropométricas (peso; altura; índice da massa corporal; circunferências do braço, panturrilha, cintura e quadril; razão cintura-quadril e dobra cutânea triciptal), nutricional (Mini Avaliação Nutricional), e clínicas (qualidade de vida; satisfação com a imagem corporal). Foram aplicadas a Escala de Silhuetas de Stunkard (imagem corporal), a Mini Avaliação Nutricional e a escala de qualidade de vida de Flanagan. Para análise dos dados foi realizada regressão logística (cinco etapas) com o método Backward condicional. Resultados: foram avaliados 532 usuários idosos [68,96 (7,14) anos], em sua maioria mulheres (64,8%) e insatisfeitas com sua imagem corporal (71,7%). Foram consideradas variáveis preditoras da satisfação com a imagem corporal: índice de massa corporal eutrófico/baixo peso, circunferência do braço eutrofia/insuficiente e média mais alta na qualidade de vida. Conclusão: identificou-se baixa prevalência da satisfação com a imagem corporal entre os idosos em geral. Aqueles com menor índice de massa corporal, menores medidas de circunferência do braço e melhor qualidade de vida apresentaram maiores chances de serem satisfeitos com a sua imagem corporal.

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.

Association between adductor pollicis muscle thickness and nutritional parameters in hospitalized elderly patients.

INTRODUCTION: the measurement of the adductor pollicis muscle thickness (APMT) has been investigated as an anthropometric parameter; however, there are few studies related to hospitalized elderly patients. OBJECTIVE: to analyze the association between APMT and nutritional parameters in hospitalized elderly patients. METHOD: cross-sectional study made in 331 hospitalized elderly patients. The following variables have been assessed: APMT, Mini Nutritional Assessment® (MNA®), body mass index (BMI), arm circumference (AC), calf circumference (CC) and handgrip strength (HGS). RESULTS: the mean age was 78.4 ± 9.7 years and 56.8% were women. The women had showed APMT mean values significantly lower than the men (12.67 ± 4.13 mm vs 15.26 ± 4.01 mm), as well as the elderly patients ≥ 80 years old showed APMT values lower than the younger patients (12.62 ± 4.38 mm vs 14.83 ± 3.90 mm). In relation to the APMT classification, the women were more frequently below P5 than the men (89.9% vs 37.1%). In the univariate analysis, the mean values of APMT were significantly lower in the malnourished elderly patients (MNA®), thinness (BMI), AC < 21 cm, CC < 31 and HGS < P5, regardless of gender. In the multivariate analysis, APMT remained as a factor independently associated with all nutritional indicators, even when adjusted to age and gender. CONCLUSION: APMT has associated with all the nutritional parameters investigated, regardless of gender and age, reinforcing its applicability in the nutritional assessment of elderly people.

Association between adductor pollicis muscle thickness and nutritional parameters in hospitalized elderly patients / Asociación entre el espesor del músculo aductor del pulgar y parámetros nutricionales en pacientes ancianos hospitalizados

Introduction: the measurement of the adductor pollicis muscle thickness (APMT) has been investigated as an anthropometric parameter; however, there are few studies related to hospitalized elderly patients. Objective: to analyze the association between APMT and nutritional parameters in hospitalized elderly patients. Method: cross-sectional study made in 331 hospitalized elderly patients. The following variables have been assessed: APMT, Mini Nutritional Assessment® (MNA®), body mass index (BMI), arm circumference (AC), calf circumference (CC) and handgrip strength (HGS).Results: the mean age was 78.4 ± 9.7 years and 56.8% were women. The women had showed APMT mean values significantly lower than the men (12.67 ± 4.13 mm vs 15.26 ± 4.01 mm), as well as the elderly patients ≥ 80 years old showed APMT values lower than the younger patients (12.62 ± 4.38 mm vs 14.83 ± 3.90 mm). In relation to the APMT classification, the women were more frequently below P5 than the men (89.9% vs 37.1%). In the univariate analysis, the mean values of APMT were significantly lower in the malnourished elderly patients (MNA®), thinness (BMI), AC < 21 cm, CC < 31 and HGS < P5, regardless of gender. In the multivariate analysis, APMT remained as a factor independently associated with all nutritional indicators, even when adjusted to age and gender. Conclusion: APMT has associated with all the nutritional parameters investigated, regardless of gender and age, reinforcing its applicability in the nutritional assessment of elderly people

Introducción: la medida del espesor del musculo aductor del pulgar (EMAP) ha sido investigada como parámetro antropométrico, pero son escasos los estudios en ancianos hospitalizados. Objetivo: analizar la asociación entre EMAP y parámetros nutricionales en ancianos hospitalizados. Método: estudio transversal con 331 ancianos hospitalizados. Se evaluaron las siguientes variables: EMAP, Mini Nutricional AssessmentR (MNAR), índice de masa corporal (IMC), circunferencia del brazo (CB), circunferencia de la pantorrilla (CP) y fuerza de prensión palmar (FPP). Resultados: el promedio de edad fue de 78,4 ± 9,7 anos y el 56,8% eran mujeres. Las mujeres tenían valores medios de EMAP significativamente menores que los hombres (12,67 ± 4,13 mm frente a 15,26 ± 4,01 mm), asi como los ancianos ≥ 80 anos tenían valores de EMAP inferiores a los mas jóvenes (12,62 ± 4,38 mm frente a 14,83 ± 3,90 mm). En cuanto a la clasificación de la EMAP, las mujeres se encontraban con mas frecuencia por debajo del P5 que los hombres (89,9% frente al 37,1%). En el análisis univariado, los niveles medios de la EMAP se mostraron mucho mas pequeños en los ancianos con desnutrición (MNAR), delgadez (IMC), CB < 21 cm, CP < 31 cm y FPP < P5, independientemente del sexo. En el análisis multivariado, la EMAP permaneció como factor independiente asociado a todos los parámetros nutricionales, incluso cuando se ajusto para edad y sexo. Conclusiones: la EMAP se asocio con todos los para metros nutricionales investigados, independientemente del sexo y de la edad, reforzando su aplicabilidad en la evaluación nutricional de ancianos