Search

Background: Handgrip strength (HGS) is an indicator of muscle strength, suited for evaluating the aging process. Its use depends on the availability of reliable normative reference values (NRV). The main objective of this study is to provide NRV of HGS for Brazilians aged 65 to 90 years., Methods: Participants were from the Frailty in Brazilian Older People research. 2,999 successful aging (SA) participants comprised the development sample. HGS was measured using a hydraulic dynamometer. Obtaining NRV involved regressing HGS on age per sex-height strata, fitting separate fractional polynomial (FP) models for the mean and coefficient of variation. Model fit was assessed via standardized residuals, probability/quantile plots, and comparing observed to normal expected percentages of participants falling within specified centile intervals. For validation, the latter procedure was applied to 2,369 unsuccessfully aging (UA) participants., Results: Across strata, the best-fitting models for the means were FP of power 1. FP models for the CV indicated age invariance, entailing steady heteroscedastic age decline in SD since coefficients for the means were negative and SD = CV×mean. All models adjusted well. Centiles distributions for the SA and UA populations showed anticipated patterns, respectively falling on and below the normative expected centile references. Results (NRV) are presented in tables and centile charts. Equations are also provided., Conclusion: NRV/charts may be endorsed for routine use, while still tested further. They would aid professionals caring for older people, not only to identify those at risk and eligible for immediate provisions, but also in planning prevention and rehabilitation measures., Competing Interests: We explicitly declare that there are no conflicts of interest.

Aim: To evaluate the Probability of Repeated Admission (Pra) scale performance in predicting healthcare utilization and death in a community sample of Rio de Janeiro city, Brazil., Methods: This was a prospective longitudinal study. The sample was composed of community-dwelling older people who participated in the research network Frailty in Brazilian Older People Study, Rio de Janeiro section. It analyzed data from the baseline and the follow up. At the baseline, 764 older adults were stratified by the Pra, and, 3 years later, data on health services utilization and survival status were collected. The Pra accuracy, obtained by the area under the curve, the sensitivity and the specificity to predict hospitalization in 3 years; visits to the emergency department; and death were determined. Cox regression estimated the survival curves, according to the risk strata., Results: The accuracy, the sensitivity and the specificity of Pra were 62% (95% CI 57-68%), 8.8% and 95.4% for hospitalization in 3 years; 59% (95% CI 53-64%), 8.3% and 94.8% for emergency room visits; 66% (95% CI 59-74%) and 68% (95% CI 63-73%), 15.0% and 96.0% for death. Survival curves showed that high-risk individuals were more likely to die compared with the low-risk individuals, adjusted to covariables (P < 0.001)., Conclusions: The Pra presented low accuracy, low sensitivity and high specificity for all outcomes observed, indicating a poor performance to screen vulnerable older adults in Brazil. Therefore, this tool should not be used alone, as a case-finding instrument. Geriatr Gerontol Int 2020; 20: 360-365., (© 2020 Japan Geriatrics Society.)

Objectives: Sarcopenia is a common treatable geriatric condition. The aim of this study was to estimate the prevalence of sarcopenia and its associated factors in community-dwelling elderly living in Rio de Janeiro, Brazil, and to discuss the impact of different muscle mass, handgrip strength and gait speed cut-off values on the reported frequency of sarcopenia., Methods: The health habits, functional capacity, and anthropometric measurements of 745 individuals aged ≥65 years from the Frailty in Brazilian Older People study were analyzed. The participants were classified into the following four groups: no sarcopenia, pre-sarcopenia, sarcopenia and severe sarcopenia. Univariate and multivariate regression analyses were performed. Muscle mass, handgrip strength and gait speed cut-off thresholds tailored to the sample and those proposed by the European Working Group on Sarcopenia in Older People were used to compare the prevalence rates of sarcopenia., Results: Seventy-three percent of the participants were female, 61.9% were Caucasian, and the mean age was 76.6 years. The prevalence rates of sarcopenia were 10.8% and 18% using the sample-tailored and European consensus cut-off values, respectively. Sarcopenia was associated with advanced age (OR: 37.2; CI95%12.35-112.48), Caucasian race (OR: 1.89; CI 95% 1.02-3.52), single marital status (OR:6; CI95% 2.2-16.39), low income (OR:3.64; CI 95% 1.58-8.39), and the presence of comorbidities (OR:3.26; CI 95%1.28-8.3)., Conclusion: In this study, the estimated prevalence of sarcopenia was similar to that reported in most studies after the tailored handgrip strength and gait speed cut-off values were adopted. A higher prevalence was observed when the cut-off values suggested by the European consensus were used. This indicates that the prevalence of sarcopenia must be estimated using population-specific reference values.

Frailty is a state of multisystem physiological vulnerability related to aging and an increased risk of adverse outcomes. This study aimed to evaluate the prevalence and associated factors of frailty in the Fibra-JF Study, Minas Gerais, Brazil. We selected a random sample of 461 individuals aged 65 years or more stratified by territorial unit, gender and age. The frailty syndrome was established by the presence of three or more of five items: a feeling of exhaustion, low handgrip strength, slow gait speed, weight loss, and low caloric expenditure. The mean age was 74.4 (SD ± 6.8) years, 69.6% were women and 71.9% white. The prevalence of frailty was 5.2%; 49.9% was from pre-frail subjects. Advanced age (OR: 6.4; CI 1.76-23.8), impairment of the basic activities of daily living (OR: 5.2, CI 1.1-23.1) and self-perception of poor health (OR: 0.13, CI 0.03-0.4) were associated with frailty. In this study, a substantial number of individuals was classified as frail, while half of the sample was at risk of progression towards this condition, suggesting that it is urgent to adopt public health measures focused on frailty prevention and reduction of associated adverse health outcomes.

Objective: To evaluate retention of intraoral fluoride in biofilm and saliva, an experimental dentifrice containing hydrocolloid (tara gum) was used as a controlled-release system for fluoride (F)., Materials and Methods: In a triple-blind randomized crossover trial with washout, 18 individuals used the following different dentifrices for a week: 100-TGF (sodium fluoride NaF associated with tara gum, 1100 mg/L), 50-TGF (50% NaF associated with tara gum + 50% free NaF, 1100 mg/L), PC (free NaF, 1100 mg/L), TG (with tara gum and without F), and placebo (without F or tara gum). On the seventh day of dentifrice use, biofilm was collected at 1 and 12 h, and saliva was collected up to 60 min and 12 h after the last toothbrushing. F concentrations were determined by physico-chemical analysis of fluoride using the hexamethyldisiloxane-facilitated diffusion technique. Data were subjected to two-way analysis of variance (repeated measures) and Spearman's correlation coefficient (p < 0.05) testing., Results: No significant difference was observed with the same dentifrice regarding F retention in biofilm at 1 and 12 h after toothbrushing for the 100-TGF, placebo, and TG groups (p > 0.05). The highest area under the curve values in saliva were found for the 50-TGF, 100-TGF, and PC groups., Conclusion: The dentifrice containing hydrocolloid as a controlled-release system for F promoted F retention in the oral cavity, even at 12 h after brushing., Clinical Relevance: Hydrocolloid added to dentifrices as a controlled-release system for F might contribute to a higher anti-caries effect., Trial Registration: NCT02809014.

The aim of this study was to evaluate the prevalence of temporomandibular disorders (TMD) signs and symptoms, its correlation with gender, parafunctional habits, emotional stress, anxiety, and depression and its impact on oral health-related quality of life (OHRQL) in college preparatory students at public and private institutions in João Pessoa, Paraíba (PB). The sample consisted of 303 students. Presence of TMD symptoms was determined by an anamnesis questionnaire containing questions related to the presence of parafunctional habits and emotional stress. A simplified clinical evaluation protocol was used. Anxiety and depression were determined with the Hospital Anxiety and Depression (HAD) scale and the OHRQL using the short version contained in the Oral Health Impact Profile (OHIP-14). The Chi-square, Fisher Exact, Mann Whitney, and Kruskal-Wallis tests were performed. Presence of signs and symptoms of TMD was statistically associated (p ≤ 0,05) with female gender, parafunctional habits, emotional stress, and anxiety, and represented greater impairment of the OHRQL. The physical pain domain was the most affected. The increased prevalence of signs and symptoms of TMD among college preparatory students indicates that there is a need for education and clarification among teachers and students to improve early diagnosis and to prevent the problem.

Objective: To determine the association between body composition and frailty in older Brazilian subjects., Material and Methods: This is a Cross-sectional study called FIBRA-BR and developed in community Brazilian aged ≥65 (n=5638). Frailty was assessed according to Fried et al. definition and body composition was determined by BMI, waist circumference and waist-hip ratio., Results: The lowest prevalence of frailty was observed in subjects with BMI between 25.0 and 29.9kg/m 2 . Subjects with a BMI <18.5 and those with elevated WC presented a higher risk of frailty compared to eutrophic subjects (odds ratio (OR)=3.10; 95% CI: 2.06-4.67) and (OR=1.15; 95% CI: 1.03-1.27), respectively. Being overweight was protective for pre-frailty (OR=0.48; 95% CI: 0.4-0.58) and frailty (OR=0.77; 95% CI: 0.67-0.9). Obese older people presented a higher risk of pre-frailty only (OR=1.29; 95% CI: 1.09-1.51). Older people with high WC showed a greater proportion of frailty regardless of the BMI range., Conclusion: Undernutrition is associated with pre-frailty and frailty in Brazilian elderly subjects, whereas obesity is associated only with pre-frailty. Overweight seems to have a protective effect against the syndrome. The excess of abdominal fat is associated with both profiles independent of the BMI., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Frailty is common and associated with poorer outcomes in the elderly, but its role as potential cardiovascular disease (CVD) risk factor requires clarification. We thus aimed to meta-analytically evaluate the evidence of frailty and pre-frailty as risk factors for CVD. Two reviewers selected all studies comparing data about CVD prevalence or incidence rates between frail/pre-frail vs. robust. The association between frailty status and CVD in cross-sectional studies was explored by calculating and pooling crude and adjusted odds ratios (ORs) ±95% confidence intervals (CIs); the data from longitudinal studies were pooled using the adjusted hazard ratios (HRs). Eighteen cohorts with a total of 31,343 participants were meta-analyzed. Using estimates from 10 cross-sectional cohorts, both frailty and pre-frailty were associated with higher odds of CVD than robust participants. Longitudinal data were obtained from 6 prospective cohort studies. After a median follow-up of 4.4 years, we identified an increased risk for faster onset of any-type CVD in the frail (HR=1.70 [95%CI, 1.18-2.45]; I 2 =66%) and pre-frail (HR=1.23 [95%CI, 1.07-1.36]; I 2 =67%) vs. robust groups. Similar results were apparent for time to CVD mortality in the frail and pre-frail groups. In conclusion, frailty and pre-frailty constitute addressable and independent risk factors for CVD in older adults., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: Frailty syndrome can be defined as a state of vulnerability to stressors resulting from a decrease in functional reserve across multiple systems and compromising an individual's capacity to maintain homeostasis. The purpose of this study was to determine the prevalence of frailty and its association with social and demographic factors, functional capacity, cognitive status and self-reported comorbidities in a sample of community-dwelling older individuals who are clients of a healthcare plan., Methods: We evaluated 847 individuals aged 65 years or older who lived in the northern area of the city of Rio de Janeiro, Brazil. The subjects were selected by inverse random sampling and stratified by gender and age. To diagnose frailty, we used the scale proposed by the Cardiovascular Health Study, which consisted of the following items: low gait speed, grip strength reduction, feeling of exhaustion, low physical activity and weight loss. The data were collected between 2009 and 2010, and the frailty prevalence was calculated as the proportion of individuals who scored positive for three or more of the five items listed above. To verify the association between frailty and risk factors, we applied a logistic regression analysis., Results: The prevalence of frailty syndrome was 9.1% (95% confidence interval [CI], 7.3-11.3); 43.6% (95% CI, 40.3-47) of the individuals were considered robust, and 47.3% (95% CI 43.8-50.8) were considered pre-frail (p<0.001). The frail individuals tended to be older (odds ratio [OR] 13.2, 95% CI, 8.7-20) and have lower education levels (OR 2.1, 95% CI, 1-4.6), lower cognitive performance (OR 0.76, 95% CI, 0.73-0.79) and reduced health perception (OR 65.8, 95% CI, 39.1-110.8). Frail individuals also had a greater number of comorbidities (OR 6.6, 95% CI, 4.4-9.9) and worse functional capacity (OR 3.8, 95% CI, 2.9-5)., Conclusion: The prevalence of frailty was similar to that seen in other international studies and was significantly associated with educational level, cognition, comorbidities, functional capacity, perception of health and old age.

Background: Circulating nucleic acids were discovered more than 60 y ago. With the recent developments in the study of circulating nucleic acids, its application in the diagnostic field has increased. The objective of this study was to assess the usefulness of the quantification of cell-free plasma DNA (CF-DNA) concentration in the diagnosis of infections in febrile patients and as a prognostic marker in septic patients., Methods: Concentrations of CF-DNA, procalcitonin (PCT) and C-reactive protein (CRP) were measured in 110 febrile patients who were clinically diagnosed with fever of unknown origin, localized infection, sepsis or septic shock., Results: Concentrations of CF-DNA increase according to the severity of the infection. The best cut-off point for predicting infection was 2800 GE (genome equivalents)/mL (sensitivity: 95.0%; specificity: 96.7%) and 14,000 GE/mL for sepsis prediction (sensitivity: 77.8%; specificity: 94.6%). Higher concentrations of CF-DNA were found in exitus septic patients than in survivors. The diagnostic efficiency of CF-DNA was similar to PCT and higher than CRP in infectious processes., Conclusions: Normal concentrations of CF-DNA can exclude the presence of an infection in febrile patients, and very high concentrations (>10-fold over the normal reference range) stratify the severity of infections, showing a high prognostic value to predict mortality in the absence of other causes for elevated CF-DNA.

Mutations in the PARKIN gene are associated with early-onset (juvenile) Parkinson's disease. We analyzed the coding sequence of this gene (exons 1-12) in patients from a family with three affected siblings, born to first-degree consanguineous parents, with an onset before 23 years and foot dystonia as the initial clinical symptom. The three patients were alive without cognitive impairment at ages of 70, 69, and 65 years, showing a marked response to levodopa treatment. A 2 bp-deletion at exon 11 (1276-1277 del GA) was found. The three patients were homozygous for this frameshift mutation, which would introduce a Stop at codon 394. This is a new PARKIN-mutation that would produce a truncated protein, lacking exon 12 and most the 11th. This region includes the C-terminal ring-finger domain of parkin, essential for its function as a ubiquitin-protein ligase. Compared to patients from other families with truncating mutations, our patients had an earlier onset. In addition, the three patients had dystonia at onset. In conclusion, we described a new PARKIN truncating mutation associated with an early onset parkinsonism, and the presence of foot dystonia as the initial symptom.