Bariatric surgery is associated with increased risk of new-onset inflammatory bowel disease: case series and national database study

BACKGROUND

Case series suggest a possible association between bariatric surgery and incident IBD.

AIM

The aim of this study was to evaluate the association between bariatric surgery and new-onset IBD.

METHODS

We first conducted a multi-institutional case series of patients with a history of IBD and bariatric surgery. We next conducted a matched case-control study using medical and pharmacy claims from 2008 to 2012 in a US national database from Source Healthcare Analytics LLC. Bariatric surgery was defined by ICD-9 or CPT code. Bariatric surgery was evaluated as recent (code in database timeframe), past (past history V code) or no history. Conditional logistic regression was used to estimate odds ratios (OR) and 95% CI for new-onset IBD, CD and UC.

RESULTS

A total of 15 cases of IBD (10 CD, 4 UC, 1 IBD, type unclassified) with a prior history of bariatric surgery were identified. Most cases were women, had Roux-en-Y surgery years prior to diagnosis and few IBD-related complications. A total of 8980 cases and 43 059 controls were included in our database analysis. Adjusting for confounders, a past history of bariatric surgery was associated with an increased risk of new-onset IBD (OR 1.93, 95% CI 1.34-2.79). However, patients who had recent bariatric surgery did not appear to be at shorter term risk of IBD (OR 0.94, 95% CI 0.58-1.52).

CONCLUSION

New-onset IBD was significantly associated with a past history of bariatric surgery. This potential association needs to be confirmed in future prospective studies.

Significance and management of disability among urban elderly residents in Brazil

Brazil's population is aging very rapidly, and the care for the elderly is an emerging priority. The results of a multidimensional functional assessment of elderly residents in Sao Paulo showed extreme poverty and massive cohabitation in multigenerational households. The health profile showed a high prevalence of chronic illnesses, mental disorders, and disability. Using a Guttman scale, a set of activities of daily living was validated as an indicator of dependency. Attention was given to the dependency associated factors, and in particular to the association between chronic illness and loss of independence among the aged. Fortunately, for the existing health care system in Brazil, cultural values are still keeping the family in the front line of caregiving, but this situation is not likely to withstand the increasing burden of a growing elderly population with an ever higher rate of disability.

TP53 codon 72 polymorphism as a risk factor for cardiovascular disease in a Brazilian population

TP53, a tumor suppressor gene, has a critical role in cell cycle, apoptosis and cell senescence and participates in many crucial physiological and pathological processes. Identification of TP53 polymorphism in older people and age-related diseases may provide an understanding of its physiology and pathophysiological role as well as risk factors for complex diseases. TP53 codon 72 (TP53:72) polymorphism was investigated in 383 individuals aged 66 to 97 years in a cohort from a Brazilian Elderly Longitudinal Study. We investigated allele frequency, genotype distribution and allele association with morbidities such as cardiovascular disease, type II diabetes, obesity, neoplasia, low cognitive level (dementia), and depression. We also determined the association of this polymorphism with serum lipid fractions and urea, creatinine, albumin, fasting glucose, and glycated hemoglobin levels. DNA was isolated from blood cells, amplified by PCR using sense 5'-TTGCCGTCCCAAGCAATGGATGA-3' and antisense 5'-TCTGGGAAGGGACAGAAGATGAC-3' primers and digested with the BstUI enzyme. This polymorphism is within exon 4 at nucleotide residue 347. Descriptive statistics, logistic regression analysis and Student t-test using the multiple comparison test were used. Allele frequencies, R (Arg) = 0.69 and P (Pro) = 0.31, were similar to other populations. Genotype distributions were within Hardy-Weinberg equilibrium. This polymorphism did not show significant association with any age-related disease or serum variables. However, R allele carriers showed lower HDL levels and a higher frequency of cardiovascular disease than P allele subjects. These findings may help to elucidate the physiopathological role of TP53:72 polymorphism in Brazilian elderly people.

Aerobic exercise training programmes for improving physical and psychosocial health in adults with Down syndrome

BACKGROUND

Although physical fitness has been suggested to improve physical and psychosocial health for a variety of population profiles, there is a lack of information about the safety and effectiveness of aerobic exercise for adults with Down syndrome.

OBJECTIVES

To evaluate the effectiveness and safety of aerobic exercise training programmes for physiological and psychosocial outcomes in adults with Down syndrome.

SEARCH STRATEGY

Search terms and synonyms for "aerobic exercise" and "Down syndrome" were used within the following databases:CENTRAL (2005, Issue 2); MEDLINE (1966 to March 2005); EMBASE (2005 to April 2005); CINAHL (1982 to March 2005); LILACS (1982 to March 2005); PsycINFO (1887 to March 2005); ERIC (1966 to March 2005); CCT (March 2005); Academic Search Elite (to March 2005), C2- SPECTR (to March 2005 ), NRR (2005 Issue 1), ClinicalTrials.gov (accessed March 2005)and within supplements of Medicine and Science in Sports and Exercise.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials using supervised aerobic exercise training programmes with behavioral components accepted as co-interventions.

DATA COLLECTION AND ANALYSIS

Two reviewers selected relevant trials, assessed methodological quality and extracted data. Where appropriate, data was pooled using meta-analysis with a random effects model

MAIN RESULTS

The two studies included in this trial used different kinds of aerobic activity: walking/jogging and rowing training. One included study was conducted in the USA, the other in Portugal. In the meta-analyses, only maximal treadmill grade, a work performance variable, was improved in the intervention group after aerobic exercise training programmes (-4.26 [95% CI -6.45, -2.06]) grade. The other outcomes in the meta-analysis showed no significant differences between intervention and control groups, as expressed by weighted mean difference: VO(2) peak -0.30 (95% CI -377, 3.17) mL.Kg.min(-1); peak heart rate, -2.84 (95% CI -10.73, 5.05) bpm; respiratory exchange ratio, 0.01 (95% CI -0.04, 0.06); pulmonary ventilation, -5.86 (95% CI -16.06, 4.34) L.min(-1). 30 other measures including work performance, oxidative stress and body composition variables could not be combined in the meta-analysis. Trials reported no significant improvements in these measures.

AUTHORS' CONCLUSIONS

There is insufficient evidence to support improvement in physical or psychosocial outcomes of aerobic exercise in adults with Down syndrome. Although evidence exists which supports improvements in physiological and psychological aspects from strategies using mixed physical activity programmes, well-conducted research which examines long-term physical outcomes, adverse effects, psychosocial outcomes and costs are required before informed practice decisions can be made.

Frequency of Werner helicase 1367 polymorphism and age-related morbidity in an elderly Brazilian population

Werner syndrome (WS) is a premature aging disease caused by a mutation in the WRN gene. The gene was identified in 1996 and its product acts as a DNA helicase and exonuclease. Some specific WRN polymorphic variants were associated with increased risk for cardiovascular diseases. The identification of genetic polymorphisms as risk factors for complex diseases affecting older people can improve their prevention, diagnosis and prognosis. We investigated WRN codon 1367 polymorphism in 383 residents in a district of the city of São Paulo, who were enrolled in an Elderly Brazilian Longitudinal Study. Their mean age was 79.70 +/- 5.32 years, ranging from 67 to 97. This population was composed of 262 females (68.4%) and 121 males (31.6%) of European (89.2%), Japanese (3.3%), Middle Eastern (1.81%), and mixed and/or other origins (5.7%). There are no studies concerning this polymorphism in Brazilian population. These subjects were evaluated clinically every two years. The major health problems and morbidities affecting this cohort were cardiovascular diseases (21.7%), hypertension (83.7%), diabetes (63.3%), obesity (41.23%), dementia (8.0%), depression (20.0%), and neoplasia (10.8%). Their prevalence is similar to some urban elderly Brazilian samples. DNA was isolated from blood cells, amplified by PCR and digested with PmaCI. Allele frequencies were 0.788 for the cysteine and 0.211 for the arginine. Genotype distributions were within that expected for the Hardy-Weinberg equilibrium. Female gender was associated with hypertension and obesity. Logistic regression analysis did not detect significant association between the polymorphism and morbidity. These findings confirm those from Europeans and differ from Japanese population.

Association of the apolipoprotein A-IV: 360 Gln/His polymorphism with cerebrovascular disease, obesity, and depression in a Brazilian elderly population

The identification of genetic polymorphisms as risk factors for complex diseases can be relevant for their prevention, diagnosis, and prognosis. The apolipoprotein A-IV: 360 Gln/His polymorphism was investigated in 383 elderly individuals, who were participants of a longitudinal study commenced in 1991. The major morbidities that affect elderly people, such as cardiovascular diseases, diabetes, low cognitive function, depression, and obesity, were extensively investigated. DNA was isolated from blood cells, amplified by PCR, and digested with Fnu4HI. In this population the frequency of the His allele was 0.056 and the genotypes were distributed according to Hardy-Weinberg equilibrium. Logistic regression analysis showed a significant association between the presence of His allele and cerebrovascular disease and/or transitory ischemic attack (odds ratio) (OR = 3.070, P = 0.027), obesity (OR = 2.241, P = 0.047), and depression (OR = 2.879, P = 0.005). This study indicates that the presence of the rare allele in elderly people can play a significant role in the occurrence of multifactorial diseases. This is the first study analyzing this polymorphism in elderly people in Brazil. More studies should be encouraged to elucidate the mechanisms involved in these diseases.

Brazilian version of the Berg balance scale

The purpose of the present study was to translate and adapt the Berg balance scale, an instrument for functional balance assessment, to Brazilian-Portuguese and to determine the reliability of scores obtained with the Brazilian adaptation. Two persons proficient in English independently translated the original scale into Brazilian-Portuguese and a consensus version was generated. Two translators performed a back translation. Discrepancies were discussed and solved by a panel. Forty patients older than 65 years and 40 therapists were included in the cultural adaptation phase. If more than 15% of therapists or patients reported difficulty in understanding an item, that item was reformulated and reapplied. The final Brazilian version was then tested on 36 elderly patients (over age 65). The average age was 72 years. Reliability of the measure was assessed twice by one physical therapist (1-week interval between assessments) and once by one independent physical therapist. Descriptive analysis was used to characterize the patients. The intraclass correlation coefficient (ICC) and Pearson's correlation coefficient were computed to assess intra- and interobserver reliability. Six questions were modified during the translation stage and cultural adaptation phase. The ICC for intra- and interobserver reliability was 0.99 (P < 0.001) and 0.98 (P < 0.001), respectively. The Pearson correlation coefficient for intra- and interobserver reliability was 0.98 (P < 0.001) and 0.97 (P < 0.001), respectively. We conclude that the Brazilian version of the Berg balance scale is a reliable instrument to be used in balance assessment of elderly Brazilian patients.

Incidence of proximal femur fractures in Marilia, Brazil

BACKGROUND

SETTING

Three general hospitals in the town of Marília that have an orthopaedic and traumatologic unit. Marília is a Municipality with 161.000 inhabitants in the middle-east of São Paulo State, Brazil.

PATIENTS/PARTICIPANTS

All inpatients, living in Marília-SP, aged 20 years or more, with a diagnosis of proximal femur fracture (WHO, International Classification of Diseases, 9th.ed., code 820), in the period of January 01, 1994 and December 31, 1995.

MAIN OUTCOME MEASURES

The incidence rates of the proximal femur fractures in Marília-SP. Secondary Measurements: mean-age of the occurrence (male and female), in-hospital mortality, hospitalar costs to S.U.S. (Government Health System), the average length of hospital stay, seasonality, mean-interval between admission and surgical procedure, type of fracture: transcervical and pertrochanteric, content validity of S.I.H.-S.U.S data base report on proximal femur fractures, when compared with hospital registrations.

OBJECTIVE

To determine the incidence (crude, age-specific and age-adjusted) of fractures of the proximal femur in Marília-SP, Brazil, in 1994 and 1995.

DESIGN

Retrospective cohort study.

RESULTS

The crude incidence rate was 4.96/10,000 inhabitants/year in 1994 and 5.51/10,000 inhabitants/year in 1995; the age-specific incidence rate increased from 0.25/10,000 inhabitants 20-49 years/year to 100.27/10,000 inhabitants 70 years or more/year in 1995 among women; the age-adjusted incidence rate was 29.48/10,000 inhabitants 60 years or more/year in 1994, and 35.83/10,000 inhabitants 60 years or more/year in 1995.

CONCLUSION

The crude incidence rate of the proximal femur fractures in Marília-SP, Brazil was 4.96 / 10,000 inhabitants in 1994 and 5.51/10,000 inhabitants in 1995. It was significantly greater among women (7.2/10,000 inhabitants in 1994 and 8.6/10,000 inhabitants in 1995) and among the elderly, 70 year-old or more (female: 90.21/10,000 inhabitants in 1994 and 100.27/10,000 inhabitants in 1995; male: 25.46/10,000 inhabitants in 1994 and 45.66/10,000 inhabitants in 1995).

Cortisol, DHEAS and aging: resistance to cortisol suppression in frail institutionalized elderly

Convincing evidences has linked the hypothalamus-pituitary-adrenal (HPA) axis to aging patterns. F excess is implicated in the development of frailty characteristics whereas DHEAS is positively correlated to successful aging. We compared serum F and DHEAS levels of independent community-living (successful group, 19 M and 28 F, 69 to 87 yr) with those of institutionalized elderly (frail group, 20 M and 30 F, 65 to 95 yr). Serum F was determined at 1) baseline (08:00 h, 16:00 h and 23:00 h), 2) after 2 overnight dexamethasone (DEX) suppression tests (DST, using 0.25 and 1.0 mg doses), and 3) 60 min after ACTH stimulation (250 microg i.v. bolus); serum DHEAS was determined at 08:00 h. Basal serum F at 08:00 h, 16:00 h and 23:00 h and serum DHEAS levels were similar in both groups; however F: DHEAS ratio at 08:00 h was higher in the frail, compared to the successful group (mean +/- SD: 0.55 +/- 0.53 and 0.35 +/- 0.41, respectively; p = 0.04). In response to DST, F suppression was less effective in frail elderly after either 0.25 or 1.0 mg doses (9.0 +/- 6.0 and 2.0 +/- 0.9 microg/dl), as compared to the successful group (5.8 +/- 4.4 and 1.5 +/- 0.5 microg/dl) (p = 0.01). In addition, a significant correlation was observed between post-DEX F levels (both doses) and parameters of cognitive and physical frailty. Normal and similar F levels were observed after ACTH stimulation in both groups. Our data suggest a deficient feedback regulation of the HPA axis in frail institutionalized elderly, as demonstrated by a higher set point for F suppression. This augmented HPA tonus enforces the hypothesis that even milder F excess may be related to characteristics of frailty in the elderly.

Dependence in activities of daily living and cognitive impairment strongly predicted mortality in older urban residents in Brazil: a 2-year follow-up

OBJECTIVES

To identify a set of predictors of mortality among residents in the community, before any physical, biochemical, or image examination is performed, that could be collected on a routine standardized basis, to help the clinician define a patient follow-up strategy and the health planner make decisions regarding the care of older people.

DESIGN

A household follow-up study, with an evaluation at baseline and 2 years later.

SETTING

Residential area, with a low rate of in- and outmigration, in Sao Paulo, a large industrialized urban center in southeastern Brazil.

PARTICIPANTS

One thousand six hundred sixty-seven older urban residents in the community (65+), from different socioeconomic backgrounds, enrolled after a study area census.

INTERVENTION

Structured home interview with Brazilian Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire, previously validated in Portuguese.

MEASUREMENTS

A logistic regression model for the risk of dying in the period was developed, having as independent variables, sociodemographic characteristics plus six other dimensions: subjective self-evaluation of health, past medical history, use of health services, dependence in activities of daily living (ADLs), mental health, and cognitive status.

RESULTS

There were 146 deaths (9%) in the cohort during the follow-up interval. The variables that appeared as independent predictors of death in the final logistic regression model were: gender (relative risk (RR) = 2.8 (males)), age (RR = 2.0 (80+ vs. 65-69)), hospitalization in the previous 6 months (RR = 2.4 (at least one)), dependence in ADLs (RR = 3.0 (assistance required for 7 vs. 0 ADLs)); and cognitive impairment (RR = 1.9 (Mini-Mental State Examination 18 vs. 30)).

CONCLUSION

These findings suggest that in developing countries such as Brazil, an assessment of dependence in daily living and cognitive status should be an essential part of any health evaluation of an older person, not only because these variables represent potentially high independent mortality risks, but also because they can be easily and reliably assessed, using well-validated instruments, and may be susceptible to intervention.

Applicability of the CERAD neuropsychological battery to Brazilian elderly

There is a limited choice of psychometric tests for Portuguese speaking people which have been evaluated in well defined groups. A Portuguese version of CERAD neuropsychological battery was applied to a control group of healthy elderly (CG) (mean age 75.1 years/ education 7.9 years), 31 Alzheimer disease (AD) patients classified by clinical dementia rating (CDR) as CDR1 (71.4/ 9.0) and 12 AD patients CDR 2 (74.1/ 9.3). Cut-off points were: verbal fluency-11; modified Boston naming-12; Mini-mental State Examination (MMSE) -26; word list memory-13; constructional praxis-9; word recall-3, word recognition-7; praxis recall-4. There was a significant difference between CG and AD-CDR1 (p<0.0001) for all tests. There was a less significant difference for constructional praxis and no difference for Boston naming. Comparison between AD-CDR1 and AD-CDR2 showed difference only for MMSE, verbal fluency, and Boston naming. The performance of CG was similar to that of a US control sample with comparable education level. These results indicate that this adaptation may be useful for the diagnosis of mild dementia but further studies are needed to define cut-offs for illiterates/low education people.

Abnormalities of renal function in the elderly

OBJECTIVE

To investigate the glomerular and proximal tubular renal function and the prevalence of urinary abnormalities in the elderly.

DESIGN

Cross-sectional study.

SETTING

General community in the city of São Paulo.

PARTICIPANTS

A population-based sample of 200 elderly subjects was randomly selected. Of these, 81 subjects (45 females and 36 males; mean +/- SD age: 73.7 +/- 6 years) accepted to undergo laboratory examination and were included in the study.

MAIN OUTCOME MEASURES

24-h creatinine clearance (CCr), microalbuminuria, urinary retinol-binding protein (urRBP), leukocyturia, hematuria and total proteinuria.

RESULTS

CCr was lower than 80 ml/min/1.73 m2 in 68% of the subjects. The median (range) CCr was 65 ml/min/1.73 m2 (21-112) in males and 77 ml/min/1.73 m2 (27-107) in females (p = 0.14). No individual had serum creatinine greater than 1.5 mg/dl. urRBP determination was normal in 79 of 81 subjects. The prevalence of microalbuminuria (> 20 micrograms/ml) was 31% (n = 25, 19 men and 6 women). These individuals presented higher mean systolic blood pressure (147 +/- 20 vs. 135 +/- 22 mmHg, p = 0.02) and mean serum creatinine (1.13 +/- 0.20 vs. 0.96 +/- 0.20 mg/dl, p < 0.01) than those without microalbuminuria. The prevalence of leukocyturia (> 10,000/mm3), hematuria (> 10,000/mm3) and total proteinuria (> or = 0.3 mg/dl) was 19%, 28% and 5% in males and 33%, 27% and 4% in females.

CONCLUSIONS

Glomerular dysfunction and urinary abnormalities are frequent features in the elderly, however, proximal tubular dysfunction is uncommon in this population.

[Epidemiology of ageing in Northeastern Brazil: results of a household survey]

INTRODUCTION

The population of Brazil is ageing very rapidly, and the care of the elderly is an emerging priority. Up to this date, there is no comprehensive study addressing the profile of the elderly in Northeastern Brazil. The objective is to compile the multidimensional profile of the elderly residents in a metropolitan area of Northeastern Brazil.

METHODS

Six hundred sixty-seven elderly (60 years and over), residents in the city of Fortaleza, Ceará, Brazil, constituting a multistage random sample stratified by socioeconomic status. The data was gathered by household survey using a multidimensional functional assessment questionnaire.

RESULTS

The majority of the elderly were living in multigenerational households (75,3%). More than half (51,9%) lived without the spouse; 92,4% mentioned at least one disease; 26,4% were considered psychiatric cases; 47,7% showed loss of autonomy; 6,6% were hospitalized, and 61,4% used health services within the twelve and six months preceding the interview, respectively. The prevalence of multigenerational households, loss of autonomy and psychiatric morbidity were higher in the poorest areas.

CONCLUSIONS

The elderly population in the city of Fortaleza lives mainly in multigenerational households, with physical and mental morbidity rates particularly high in poor areas, they represent special concern in terms of burden for the social and health services in the next decades

[Trypanosoma cruzi infection in blood donor candidates]

INTRODUCTION

Transmission of American trypanossomiasis by transfusion has been reduced by expansion of control measures of blood quality in Brazil. A research project was, therefore, undertaken to evaluate soropositivity for Trypanosoma cruzi infection on blood donors and to compare this rate with those found in 1958 and 1975 in blood banks.

METHOD

A transversal study was carried out on blood donors in Londrina, Paraná, Brazil. ELISA and Immunofluorescence were the serological test techniques used in the diagnosis of Trypanosoma cruzi infection.

RESULTS AND CONCLUSION

A serumprevalence rate of 1.3% was found with a tendency for positive serum findings for Trypanosoma cruzi infection on blood donors to decrease over Aime (1958, 1975, and 1995).

Seroprevalence of Trypanosoma cruzi infection in students at the seven-fourteen age range, Londrina, PR, Brazil, in 1995

Seropositivity for Chagas disease was evaluated in 834 children aged between 7 and 14 from the Municipal Teaching System in the district of Londrina, State of Paraná. A seroprevalence rate of 0.1% was found through the use of an indirect immunofluorescent test and an enzyme-linked immunosorbent assay. This low rate of seroprevalence provides evidence that the vectorial transmission of Chagas disease has been eliminated in Londrina. The main reason for the elimination of vectorial transmission of Trypanosoma cruzi infection, as evaluated by serological tests, may be a remarkable change in the economic structure of the northern region of Paraná in the 1960's. At that time coffee production was almost completely replaced by soy beans, wheat and grazing in the rural areas. This change deeply affected the rural ecology and caused an exodus of the population from rural to urban areas as well as a decrease in the total number of the population of that region. The measures introduced for controlling the disease through the Program of Chagas Disease Control established by the Fundação Nacional de Saúde of the Brazilian Ministry of Health, certainly, had a positive impact on the reduction of American trypanosomiasis prevalence in the area under study. However, it does not seem that this was the most relevant factor responsible for the elimination of vectorial transmission of Chagas disease in Londrina.

Two-year follow-up study of elderly residents in S. Paulo, Brazil: methodology and preliminary results

INTRODUCTION

Previous cross-sectional studies have shown a high prevalence of chronic disease and disability among the elderly. Given Brazil's rapid aging process and the obvious consequences of the growing number of old people with chronic diseases and associated disabilities for the provision of health services, a need was felt for a study that would overcome the limitations of cross-sectional data and shed some light on the main factors determining whether a person will live longer and free of disabling diseases, the so-called successful aging. The methodology of the first follow-up study of elderly residents in Brazil is presented.

METHOD

The profile of the initial cohort is compared with previous cross-sectional data and an in-depth analysis of nonresponse is carried out in order to assess the validity of future longitudinal analysis. The EPIDOSO ('Epidemiologia do Idoso') Study conducted a two-year follow-up of 1,667 elderly people (65+), living in S. Paulo. The study consisted of two waves, each consisting of household, clinical, and biochemical surveys.

RESULTS AND CONCLUSIONS

In general, the initial cohort showed a similar profile to previous cross-sectional samples in S. Paulo. There was a majority of women, mostly widows, living in multigenerational households, and a high prevalence of chronic illnesses, psychiatric disturbances, and physical disabilities. Despite all the difficulties inherent in follow-up studies, there was a fairly low rate of nonresponse to the household survey after two years, which did not actually affect the representation of the cohort at the final household assessment, making unbiased longitudinal analysis possible. Concerning the clinical and blood sampling surveys, the respondents tended to be younger and less disabled than the nonrespondents, limiting the use of the clinical and laboratory data to longitudinal analysis aimed at a healthier cohort. It is worth mentioning that gender, education, family support, and socioeconomic status were not important determinants of nonresponse, as is often the case.

[Multicenter study of elderly patients assisted at outpatient cardiology and geriatrics clinics in Brazilian institutions]

PURPOSE

To evaluate epidemiological, clinical and therapeutic aspects of elderly patients with cardiovascular disease in Brazil.

METHODS

Elderly patients with cardiovascular disease treated in 36 centers of cardiology and geriatrics were investigated through a questionnaire applied to those who had an appointment during the analyzed period.

RESULTS

2196 elderly patients ranging from 65 to 96 years of age were analyzed, 60% of which were females. The main risk factors were: sedentarism (74%); high blood pressure (53%), high LDL-cholesterol (33%), high total cholesterol (30%), obesity (30%), low HDL-cholesterol (15%), diabetes (13%) and smoking (6%). A higher prevalence of females existed among those with > or = 3 risk factors. The main reason for the medical appointment was high blood pressure (48%). Stress test and coronariography were requested more often in males. The most common diagnoses were hypertension (67%), and coronary disease (29%). The most often used medications were diuretics (42%).

CONCLUSION

There was high prevalence of risk factors (93%), mainly in females; sedentarism was the most common risk factor and prevalence increased with age; hypertension was the most common reason for a medical appointment. Diuretics were the most used drugs; congestive heart failure was the main disease associated to hospitalization (31%) and emergencies (10%).

[Risk factors for cardiovascular diseases in physicians. Preliminary data from the VIDAM Project of the Paulista Medical Association]

PURPOSE

To evaluate the frequency and other characteristics of some cardiovascular risk factors among physicians of São Paulo State, Brazil.

METHODS

From a questionnaire, 1395 voluntary physicians answered questions about personal and familial cardiovascular disease and risk factors, and blood pressure, serum total cholesterol, glucose, height and weight were recorded.

RESULTS

The frequency of familial history of ischemic heart disease was 24.4%; positive personal antecedent of hypercholesterolemia, 12.4%; serum total cholesterol > or = 240 mg/dl, 14.3%; positive personal antecedent of hypertension, 8.4%; systolic blood pressure > or = 140 mmHg or diastolic > or = 90 mmHg, 23.8%; current cigarette smokers, 17.4%; prior cigarette smokers, 19.1%; positive personal antecedent of diabetes, 0.8%; serum glucose > 120 mg%, 7.7%; sedentarism, 37%, and obesity, 17.2%.

CONCLUSION

Cigarette smoking was the only risk factor that was taken in account with emphasis by the physicians of São Paulo State in order to prevent themselves from cardiovascular disease.

[Eating patterns among the elderly of different socioeconomic groups living in a urban area of southeastern Brazil]

Two hundred and eight three male and female elderly subjects were studied. They participated in the Multicentric project: "Health assessment of elderly people living in the urban area of S. Paulo", Brazil, and were stratified by socio-economic level in three areas of S. Paulo city. The food frequency questionnaire was applied in order to discover their food pattern. The results show that for the energy-producing foods more than 90% of the total sample eat tubers, rice, bread and pasta; however, only the rice and bread are consumed daily. As for protein, 70% or more of the elderly people eat beans, beef, poultry, milk and eggs but for the daily consumption there are differences between the 3 regions. More than 85% of the subjects eat fruits, leafy and other vegetables; nevertheless, the frequency of their daily consumption is bigger in the wealthier area. The dietetic information shows that the group analysed has the same food pattern as other population groups as far the energy-producing foods are concerned; there are, however, some difference as regards the protein foods and fruit and vegetables.

[Oral health status in people 60 years old or older in the municipality of São Paulo (Brazil)]

The oral health status of people aged 60 years or over in S. Paulo in 1989 is discussed. According to data relating to dental caries, periodontal diseases, need and use of prosthesis and prevalence of hard and soft oral tissue pathologies, this study concludes that elder people present a very bad oral health status. The definition of a policy and dental care programs addressed to the aged are recommended.

The use of the Clinical Interview Schedule for the evaluation of mental health in the aged community

As a part of a survey to study the health and living conditions of the elderly population, a random sample of residents aged 65 and over are examined using the Clinical Interview Schedule (CIS) in order to evaluate their psychiatric status. The aim of this study is to evaluate this standard method of assessment as a case-identification instrument in our country. The schedule was completed by 91 subjects. It is easily administered, easily scored, and economical on time. Its completion rate is high. The weighted total scores (WTS) range from 0 to 48. Using the case criteria defined by Cooper & Schwarz (1982), 27 subjects (30%) are considered cases and 64 (70%) are regarded as non-cases. The sensitivity coefficients for the WTS are examined against the overall severity rating at different cut-off points. The optimum cut-off can be anywhere between 16 and 20 points. The WTS has higher validity coefficients to detect the following diagnostic categories (sensitivity, specificity): normals (100%,-); personality (100%, 92%) and affective disorders (100%, 75%). In general the CIS items are given low ratings. Psychotic symptoms are rarely found in this sample. One main problem arose: the item depersonalization is misunderstood by some patients probably because of interpreting it as an upsetting memory disturbance.

[Risk factors for chronic non-communicable diseases: a domiciliary survey in the municipality of São Paulo, SP (Brazil). Methodology and preliminary results]

The non-communicable chronic diseases are important causes of death in Brazil, mainly in the great urban centres. There are various risk factors related to these diseases, whose remotion or attenuation would contribute to a fall in mortality. The methodology of the first comprehensive multicenter study into risk factors of non-communicable chronic diseases carried out in Latin America is explained. In Brazil, this study was carried out in the cities of S. Paulo, SP and Porto Alegre, RS. Preliminary results from the city of S. Paulo as to the prevalence of arterial hypertension (22.3%), tabagism (37.9%), obesity (18.0%), alcoholism (7.7%) and sedentarism (69.3%) are presented. These results are compared with existing data from Brazil and other countries, and the relationship between various risk factors and the mortality from cardiovascular diseases in S. Paulo and some developed countries is discussed.

Geographical stratification by socio-economic status: methodology from a household survey with elderly people in S. Paulo, Brazil

Considering that in most developing countries there are still no comprehensive lists of addresses for a given geographical area, there has always been a problem in drawing samples from the community, ensuring randomisation in the selection of the subjects. This article discusses the geographical stratification by socio-economic status used to draw a multistage random sample from a community-based elderly population living in a city like S. Paulo-Brazil. Particular attention is given to the fact that the proportion of elderly people in the total population of a certain area appeared to be a good discriminatory variable for such stratification. The validity of the stratification method is analysed in the light of the socio-economic results obtained in the survey.

The use of the face-hand test to screen for organic brain syndromes. A pilot study

A reduced version of the Face-Hand Test (FHT), the FHT-R, was applied to a random sample of 91 elderly subjects living in the community (S. Paulo-Brazil), to study the instrument's ability to detect Organic Brain Syndrome (OBS). The scores of the FHT-R test were then compared with a psychiatric assessment using the Clinical Interview Schedule. Five persons were regarded as OBS "cases" and 86 as OBS "non cases". At the cut-off point 0/1 the validity coefficients were as follows: Sensitivity 60%, Specificity 94%, Positive Predictive Value 38%, Negative Predictive Value 98% and Overall Misclassification Rate 8%. The usefulness of this clinical test to screen for OBS in epidemiological surveys is discussed.

Validity of a Brazilian version of the Older Americans Resources and Services (OARS) mental health screening questionnaire

A validity study of the Brazilian version of the 15-item Short Psychiatric Evaluation Schedule (SPES), included in the mental health assessment of Older Americans Resources and Services (OARS), designed to detect psychiatric disorders in the elderly, against the "caseness" criterion suggested by Cooper and Schwarz was carried out with a community sample, as part of a survey to study health and living conditions of the elderly in a large urban center of a developing country, São Paulo, Brazil. The screening questionnaire was completed by 292 subjects, and 91 were selected for the psychiatric interview. The validity coefficients were as follows: sensitivity 61%, specificity 89%, positive predictive value 66%, negative predictive value 87% and misclassification rate 18%. A discriminant analysis using a stepwise procedure was then applied to select the best item discriminators of the screening questionnaire. The best set of discrimination comprised six items leading to the following validity coefficients: sensitivity 82%, specificity 77%, positive predictive value 58%, negative predictive value 92% and misclassification rate 21%. The possible factors related to false positive and false negative responses on the screening are discussed.

[The aging of the world population. A new challenge]

O envelhecimento populacional é hoje um fenômeno universal, característico tanto dos países desenvolvidos como, de modo crescente, do Terceiro Mundo. São apresentados dados que ilustram a verdadeira revolução demográfica desde o início do século e estimativas até o ano 2025. Os fatores responsáveis pelo envelhecimento são discutidos, com especial referência ao declínio tanto das taxas de fecundidade como das de mortalidade. Em conjunto, tais declínios levam a um menor ingresso de jovens em populações que passam a viver períodos mais longos. Esse processo gradativo é conhecido como "transição epidemiológica" e seus vários estágios são abordados. As repercussões para a sociedade, de populações progressivamente mais idosas são consideráveis, particularmente no que diz respeito à saúde. Os padrões de mortalidade e morbidade são discutidos e o conceito de autonomia, como uma forma de quantificar qualidade de vida, é introduzido. É proposta redefinição do próprio conceito de envelhecimento, refletindo a realidade médico-social do Terceiro Mundo. São formuladas questões sobre a interação envelhecimento-mudanças sociais em curso nos países subdesenvolvidos, cujas respostas podem ser grandemente facilitadas pelo uso do método epidemiológico.

[Population aging: a Brazilian reality]

São apresentados dados mostrando que tanto as taxas de mortalidade quanto as de fecundidade estão decaindo significativamente para a população brasileira, como um todo, desde 1940 e 1960, respectivamente. Pirâmides etárias por sexo são analisadas à luz das mudanças demográficas. Enfatiza-se o fato de que, desde 1940, é o grupo etário com 60 anos ou mais o que proporcionalmente mais cresce na população brasileira. De 1980 ao ano 2000 eles crescerão 107%, enquanto os menores de 15 anos crescerão apenas 14%. Comparando-se as taxas de crescimento dos idosos no Brasil e na Inglaterra, a tendência é haver um crescimento cada vez menor na Inglaterra (230% entre 1900-1960 e 80% entre 1960-2025) e um crescimento cada vez maior no Brasil (497% e 917% respectivamente). Os dados mostram que a expectativa de vida ao nascimento no Estado de São Paulo passou de 57 anos, em 1950, para 70 anos, em 1982. Já em 1982, uma mulher no Município de São Paulo podia aos 45 anos esperar viver mais do que uma mulher da mesma idade na Inglaterra. Em termos de sobrevida, 77% da coorte de mulheres nascidas no Município de São Paulo, em 1982 deverão estar vivas aos 65 anos, comparado com 85% na Inglaterra. Para os homens os dados são de 62% e 75%, respectivamente. Conclui-se que o Brasil, embora ainda longe de resolver os problemas relacionados à infância, já está tendo que enfrentar as implicações sociais e de saúde decorrentes de um processo de envelhecimento comparável àquele experimentado pelos países mais desenvolvidos.

[Growth of the elderly population in Brazil: transformations and consequences in society]

São discutidas as transformações sociais e econômicas que incidem sobre a vida dos idosos decorrentes do aumento da população de 60 anos ou mais, no Brasil. O processo migratório e a intensa urbanização (em 1940 a população rural era de 68,8% e em 1980 de 32,4%) afetaram particularmente a população idosa dos grandes centros, ou daqueles que envelheceram nestas cidades. Esta nova organização social acentuou os problemas de solidão e pobreza dos idosos. Além desta perda de status social que exclui sua participação na sociedade moderna, o idoso teve também reduzido o suporte emocional no interior de sua família. Entre os fatores que concorrem para tal, destacam-se a mudança do padrão do modelo familiar, de extensa para nuclear, a maior mobilidade e o aumento do número de separações e divórcios. O maior período de vida da mulher e suas conseqüências (redução de renda, aumento do número de viúvas e maior freqüência de longos períodos de doenças crônicas), como também a mudança do papel social da mulher no mundo contemporâneo, fazem parte de uma discussão específica relativa à mulher e à velhice. A questão do trabalho, da aposentadoria e do custo social (coeficiente de dependência) é outro aspecto abordado.

Management of loculated abscesses that are difficult to drain: a new approach

Fourteen critically ill patients underwent percutaneous drainage of abdominal abscesses. All 14 had one or more relative contraindications to external drainage procedure: (a) multiloculated abscesses; (b) multiple abscesses; (c) abscesses that form fistulae to surrounding organs; (d) abscesses containing viscous fluid, debris, or necrotic material. A total of 32 cavities was drained, usually using a multiple trocar/catheter system. Biplane computed tomography demonstrated a safe drainage route in all patients. In those patients in whom the contents of the abscess were too viscous to permit drainage, the contents were liquefied with acetylcysteine. Nine of the 14 patients (64%) recovered completely following the drainage procedure.