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Objectives: To evaluate the psychometric properties of different factorial models of the Medical Outcomes Study Social Support Survey (MOS-SSS) and screen the frequency of social support in older Brazilians., Method: Methodological study. Five factorial models of the MOS-SSS were tested for their validity and reliability using three Brazilian samples from different locations in the country. The factorial invariance was assessed across locations using multigroup analysis. The global average score was calculated., Results: A total of 1574 older people participated in the study. For all models, there was adequate factorial and convergent validity and good reliability; the discriminant validity was not achieved. Therefore, a second-order hierarchical model was proposed and showed validity, reliability and invariance across samples. In the three Brazilian samples, participants presented high frequency of social support., Conclusion: A second-order hierarchical model was fitted the Brazilian samples, allowing the calculation of the global score of social support, which was high among the participants., Implications for Practice: The MOS-SSS assesses social support levels among older individuals in community or clinical settings. Nurses can tailor interventions based on scale outcomes for personalised care for older people., (© 2024 John Wiley & Sons Ltd.)

Background: Telomere length has been investigated as a biomarker of biological aging and is associated with several diseases, lifestyle, and socioeconomic factors., Objective: This study aimed to verify whether food insecurity is associated with shorter telomere length in older people., Methods: This is a cross-sectional study carried out in a municipality in the interior of Brazil, with a sample of 440 older people from the community. For telomere length analysis, a blood sample was obtained from each participant, followed by real-time qPCR, and sociodemographic and health information was collected through interviews. Food security/insecurity was measured using the reduced version of the Brazilian Food Insecurity Scale. Descriptive analysis and multiple logistic regression were performed to analyze the factors associated with shorter telomere length, adopting a significance level of 5%., Results: We found that food insecurity was significantly associated with shorter telomere length, regardless of age group, skin color, tabagism, physical activity, milk and dairy consumption, living arrangement, and basic activities of daily life., Conclusion: The findings show the importance of ensuring full access to adequate nutrition for the older population, who are physiologically and socially vulnerable., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: To verify whether shorter telomere length is associated with anorexia of ageing in community-dwelling older people., Methods: Conducted as a cross-sectional investigation, the study enrolled 448 participants residing in an urban area of a municipality in Brazil. Relative telomere length in blood samples was measured using quantitative polymerase chain reaction (qPCR), whereas the presence of anorexia of ageing was determined using the Simplified Appetite Nutritional Questionnaire. Data analysis employed multiple logistic regression., Results: Among the 448 older individuals surveyed, 70.69% were female, and the predominant age bracket ranged from 60 to 69 years (45.08%). Approximately 25% exhibited the shortest telomeric length, with a corresponding anorexia of ageing prevalence of 41.16%. Older individuals with diminished telomere lengths displayed an increased likelihood of experiencing anorexia of ageing (odds ratio [OR] = 1.92; 95% confidence interval [CI] = 1.12-3.29), independent of factors such as gender, age group, depressive symptoms, pain and performance in basic daily life activities., Conclusions: The observed association between anorexia of ageing and a telomeric biomarker underscores the imperative to meticulously evaluate the nutritional dimensions of older people, with a view to implementing interventions that may enhance their overall health status., (© 2024 British Dietetic Association.)

Competing Interests: Competing interests: None declared.

Background: Patients with long-term ventricular assist devices (VAD) are predisposed to infection, bleeding, and pressure injuries at the insertion of the driveline. There is no consensus on a driveline dressing protocol. Chlorhexidine is often used to clean the driveline exit site and has been associated with lower rates of infection. For driveline coverage, bacteriostatic agents and transparent film have shown good results, but are costly. The same issue was associated with anchorage devices., Objectives: The purpose of this study was to evaluate the types of dressings used in the driveline of patients using HeartMate (HM) and to describe the incidence density of local complications (infection, bleeding, and pressure injury) within 30 days postoperatively., Methods: A retrospective cohort study was conducted and included 22 patients admitted to the Intensive Care Unit after implantation of HM II and III in a Brazilian private hospital., Results: Several types of dressings were used in the drivelines. There were 22 different types of dressings. Dressing type 6 (Chlorhexidine, Excilon, Gauze and IV3000) were the most used (45.4%). Subjects using the Flexi-Trak anchoring device had a higher rate of local bleeding (50.0%) and those who used the Hollister device had more infection (61.1%) and pressure injury associated with a medical device (11.1%), compared to others. Infection was the primary complication (45.4%), followed by local bleeding (27.7%)., Conclusion: Despite the high variability of products used in the driveline of patients using HeartMate, the dressing made with chlorhexidine, silver-impregnated absorbent foam and transparent film, and the use of anchoring devices was the most frequently used. Infection was the most common complication., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: With the increase in the older adult population, it is essential to identify the living and health conditions that can impact the quality of life of these individuals., Objectives: To identify the domains and factors associated with the quality of life of older adults under the Family Health Strategy program., Design and Setting: This was a cross-sectional analytical study was conducted in the municipality of Palmas, Tocantins, Brazil., Methods: We assessed 449 older adults enrolled in the Family Health Strategy program. Data were collected between April and July, 2018. World Health Organization Quality of Life Assessment (WHOQOL-OLD) was used to assess the quality of life (QoL) and multiple linear regression was used to estimate the factors associated with QoL., Results: The QoL domain with the highest score was death and dying (mean = 70.4), and the lowest score was for sensory functions (mean = 61.0 points). The factors associated with QoL were single marital status (β = -4.55; P = 0.014), level of independence for daily living activities (β = 4.92; P < 0.001), self-assessment of regular health (β = 5.35; P < 0.001), and poor health (β = -8.67; P < 0.001)., Conclusion: The death and dying domain of QoL presented the highest score. Marital status, impairment in daily activities, and health self-assessment were associated with QoL.

Population longevity has been growing globally. In developing countries such as Brazil, the impact of this reality is enormous. The aging process is challenging for the healthcare system, making individuals more susceptible to chronic health conditions and mental health-related diseases. Primary healthcare (PHC) providers must be able to accompany older adults with their singularities in their work processes. This study aims to understand PHC nurses' perspectives on the mental health care of hypertensive older adults. This is a study with a qualitative approach, using in-depth interviews and a focus group with 16 nurses from the five Brazilian municipalities with the highest number of older adults. The themes that emerged from the data collection were possibilities of PHC, characterization of PHC, and mental health care in PHC. The study findings contribute to the knowledge base on how PHC nurses provide care to hypertensive older adults and which weaknesses they should overcome in their work environment. The different ways providers have been developing strategies to improve their care should be encouraged, improved, and systematized.

Objective: To evaluate the relationship between depressive symptoms and sleep quality in aged caregivers of elderly people, in a context of high social vulnerability., Methods: A Cross-sectional study conducted between July 2019 and March 2020 with 65 aged caregivers of elderly people that were treated in five Family Heath Units from São Carlos, São Paulo. Instruments to characterize the caregivers and to evaluate the depressive symptoms and sleep quality were used in data collection. The Kruskal Wallis and Spearman Correlation tests were adopted., Results: 73.9% of the caregivers presented poor sleep quality and 69.2% did not have depressive symptoms. In the caregivers with severe depressive symptoms, the mean sleep quality score was 11.4; in those with mild depressive symptoms, it was 9.0; and in those without depressive symptoms, it was 6.4. There was a direct and moderate correlation between sleep quality and depressive symptoms., Conclusion: There is a relationship between depressive symptoms and sleep quality in aged caregivers.

Introduction: Family caregivers of older persons devote much of their time and energy to caring for another person. This exposure may burden caregivers and compromise their health and quality of life., Objective: To investigate the relationship between burden, sociodemographic, caregiving, and health characteristics of informal caregivers of dependent older adults., Methods: Cross-sectional and analytical study carried out in Palmas, Tocantins, Brazil, with 52 informal caregivers of older persons who need full-time help for basic living activities. Caregivers' burden was assessed by Zarit Burden Interview (ZBI). Data were analyzed using a T -test, Pearson's correlation, and Multiple Linear Regression., Results: The ZBI mean score of caregivers was 26.3 points (SD = 14.6; min = 0; max = 68). Burden scores were higher among caregivers who did not receive help from other people in care ( p = 0.016), reported family dysfunction ( p = 0.001), and had depression symptoms ( p = 0.007). A correlation was found between the scores of burdens and satisfaction with care ( r = 0.76; p < 0.001) and perceived material support ( r = -0.30; p = 0.40). Satisfaction with care (β: 0.61; p < 0.001) and family dysfunction (β: 8.07; p = 0.033) were significantly associated with the burden score., Conclusion: Caregivers with dysfunctional families and satisfaction with the care presented the highest-burden scores. The findings reveal the need for strategies to facilitate mediation and reduce caregiver burden by strengthening the family network support or providing professional assistance., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Marinho, Batista, Nobre, Guimarães, Santos-Orlandi, Brito, Pagotto, Saidel, Fusco, Maia, Corona and Nunes.)

Considering that telomere length can be determined not only by issues related to cell biology but also by aspects related to social factors and environmental exposures, studies on the relationship between social aspects and telomere length can help to better understand the still scarcely known aspects of the human aging process. Thus, this research seeks to verify whether social support networks are associated with telomere length in older adults. This is a cross-sectional study conducted with 448 individuals aged at least 60 years living in the urban area of an inland Brazilian municipality. Relative quantification of telomere length was obtained through real-time qPCR. Social support was assessed through the Medical Outcomes Study Social Support Scale. Descriptive statistics and multiple logistic regression were used in data analysis. The evaluated social support networks for older adults consist in a mean of 16.4 people, and the percentage of older adults who reported up to five members in their network was 27.75%. Shorter telomere length was identified in 25% of the participants, and the older adults who reported having up to five members in their support network were more likely to have a shorter telomere length than those who reported more numerous networks (odds ratio: 1.89, p  = 0.011) regardless of gender, age, household arrangement, cognitive decline, and dependence for basic and instrumental activities of daily living, which suggests that measures that stimulate the creation and maintenance of social support networks should be implemented to improve older adults' health.

Background: COVID-19 pneumonia has been responsible for many ICU patients' admissions with hypoxemic respiratory failure, and oxygen therapy is one of the pillars of its treatment. The current pandemic scenario has limited the availability of ICU beds and access to invasive ventilation equipment. High-flow nasal cannula (HFNC) can reduce the need for orotracheal intubation compared with conventional oxygen therapy, providing better results than noninvasive respiratory support. However, HFNC use has been controversial due to concerns about the benefits and risks of aerosol dispersion. In this context, we evaluated the performance of the HFNC therapy in patients with COVID-19 and investigated factors that can predict favorable responses., Methods: A prospective observational study was conducted, which included hospitalized adult subjects with COVID-19 in the respiratory wards who needed oxygen therapy. Clinical and laboratory parameters were collected to compare HFNC therapy use and the outcomes., Results: In 6 months, 128 subjects were included and the success rate of HFNC therapy was 53%. Logistic regression analysis showed that the Charlson comorbidity score, need for oxygen flow, [Formula: see text] , and breathing frequency predicted therapy failure. The mortality rate increased among the non-responders versus the responders (47% vs 3%), 48% of failure occurred in the first 24 h of the HFNC therapy. A ROX (respiratory frequency - oxygenation) index > 4.98 in 6 h and > 4.53 in 24 h predicted success of the HFNC therapy with an area under the curve of 0.7, and a ROX index < 3.47 predicted failure with 88% of specificity. CONCLUSIONS: HFNC in the subjects with COVID-19 was associated with reduced mortality and improved oxygenation in the subjects with respiratory distress. Close monitoring of specific parameters defines eligible patients and rapidly identifies those in need of invasive ventilatory support., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2022 by Daedalus Enterprises.)

Muscle weakness is associated with negative outcomes, in addition to being related to the pathogenesis of frailty and functional disability in the older individuals. Muscle strength and functionality are considered biomarkers of aging. Progressive resistance training (PRT) is a type of training that has been the subject of studies as it presents itself as a therapeutic option to fight the reduction of muscle strength and functionality in older individuals. However, few studies have assessed the clinically relevant gains in the levels of muscle strength and functionality of older individuals after PRT, in addition to the need of testing new PRT approaches, including individualization and periodization in training programs. Therefore, this article aims to assess the effect of an individual and periodized PRT protocol on handgrip strength (HS) and functionality in older individuals. Thus, the study sample included 69 older individuals, divided into 2 groups: case ( n  = 41) and control ( n  = 28). The case group participated in a PRT protocol for 12 weeks, with two weekly sessions. When compared to the control group, which received only health education, the individuals in the case group had a greater magnitude of improvement in all variables related to the assessed functionality (Timed up and go test, gait speed, and HS), proving the applicability of the assessed protocol to improve strength and functionality in the older individuals of a community.

Aim: to analyze the relationship between family functionality and burden of informal caregivers of hospitalized older people., Methods: this is a cross-sectional study conducted with 98 informal caregivers of hospitalized older people in an inpatient unit of a large hospital in São Carlos, São Paulo. For data collection were used questionnaires to sociodemographic and care context characterization, to evaluate burden and family functionality. Descriptive analyzes and Spearman's correlation coefficient were used., Results: female caregivers predominated, who took care of their parents and had no training. Approximately 59.8% of caregivers had good family functionality and 49.5% scored for mild to moderate burden. There was a negative correlation, moderate magnitude, between family functionality and burden (p<0,001). The higher the burden score, the lower the family functionality score and vice versa., Conclusion: caregivers with high burden had worse family functionality. Therefore, nurses need to identify such conditions early and implement assertive interventions so that the family functions as a therapeutic resource.

Background: Covid-19 toll is disproportionate in Blacks although the mechanisms remain incompletely understood. From a biological perspective, several host proteins have received most attention as logical susceptibility targets. Specifically, angiotensin-converting enzyme 2 (ACE2) serves as the epithelial cell receptor and acts in concert with transmembrane protease serine 2 (TMPRSS2). Intriguingly, ACE2 can also suppress the inflammatory response and therefore may impact the severity of Covid-19 infections (from the exuberant immune response a.k.a. "cytokine storm"). We, therefore, assessed expression of ACE2 and TMPRSS2 in Blacks versus Whites., Methods: Archived mucosal biopsies from colonoscopic biopsies of visually normal rectal mucosa without concurrent neoplasia or inflammation were used for this study. Total mRNA was isolated and subjected to real-time polymerase chain reaction for ACE2, and TMPRSS2 was assessed from non-Hispanic Blacks (n = 45) and non-Hispanic Whites (n = 38). GAPDH and beta-actin were used for normalization. Multivariable analysis was performed using Analyse-IT software., Results: ACE2 and TMPRSS2 levels were not altered by gender, BMI, or age. ACE2 levels were lower in Blacks than Whites achieving statistical significance in multivariable (0.51-fold, p = 0.03) but not quite in univariable (p = 0.07) analysis. This downregulation was mirrored in TMRPSS2 in both univariable (p = 0.03) and multivariable analyses (0.41-fold, p = 0.02). Moreover, there was a strong correlation between ACE2 and TMPRSS2 levels (r-squared = 0.78)., Conclusions: To our knowledge, this is the first report on racial differences inACE2 and TMPRSS2 mucosal expression. This may provide potential biological underpinnings for the disproportionately higher mortality of Covid-19 in Blacks and should spur future studies., (© 2021. W. Montague Cobb-NMA Health Institute.)

Background: Anemia is the most common hematological abnormality among older adults, and it is associated with decreased physical performance. But the role of hemoglobin in the absence of anemia remains unclear. Thus, this study aimed to assess the impact of hemoglobin levels on physical performance in Brazilian older adults without anemia., Methods: The study is longitudinal in that it relies on two waves of the Saúde, Bem-Estar e Envelhecimento (SABE; Health, Well-being, and Aging) study: 2010 and 2015-2016. Mixed-effects linear regression was used to determine the effects of the hemoglobin concentrations on the Short Physical Performance Battery-SPPB over time among the 1,023 who had complete data and did not have anemia in 2010. In the follow-up, there were 567 without anemia., Results: In analyses adjusted for age, education, comorbidities, body mass index, and physical inactivity, we found a differential association between hemoglobin concentration and SBBP by sex, with a positive interaction (β Hb*female= 0.20, 95% CI 0.04,0.37). At lower levels of hemoglobin, women have lower levels of SPPB than men, but at higher levels of hemoglobin concentration, there are no sex differences in physical performance. In addition, higher age was negatively associated with SPPB levels and cardiometabolic diseases, other diseases, and physical inactivity. Education was positively associated with physical performance., Conclusion: Our study demonstrates that higher hemoglobin levels were associated with better physical performance among older adults without anemia in Brazil. However, there were sex differences in this association. This finding is important because, in clinical practice, most health professionals focus on the World Health Organization definition of anemia. Our study suggests the importance of hemoglobin levels among older adults, even those without anemia, and highlights sex differences., (© 2022. The Author(s).)

Objective: To evaluate the efficacy of a mindfulness-based treatment (MBT) for smoking cessation or reduction and compare it with that of cognitive behavioral therapy (CBT)., Methods: This was a single-center randomized controlled clinical trial including 113 patients divided into two groups: MBT (n = 54) and CBT (n = 59). The interventions comprised eight 90-min sessions. The primary outcome was smoking cessation at 16 weeks after program initiation. Secondary outcomes included reduction in the mean number of cigarettes smoked/day at 16 weeks after treatment initiation, as well as smoking cessation and reduction in the number of cigarettes smoked/day at the last program session. Participants had to attend ≥ 50% of the sessions to be included in the primary outcome analysis. An intention-to-treat analysis was also performed., Results: There was no difference between the groups regarding the primary outcome (30.4% in the MBT group vs. 31.6% in the CBT group, p = 0.68) or immediate abstinence rates (47.8% in the MBT group vs. 36.8% in the CBT group, p = 0.47). Both treatments were equally effective in reducing the number of cigarettes smoked/day at the last program session (a reduction of 93.33% [0-100%] in the MBT group and of 70% [33.3-100%] in the CBT group, p = 0.92) and at 16 weeks after program initiation (a reduction of 57.1% [0-100%] in the MBT group and of 70% [25-100%] in the CBT group, p = 0.49)., Conclusions: MBT appears to be as effective as CBT for smoking cessation or reduction and can be an option for the treatment of tobacco use disorders in Brazil (Brazilian Registry of Clinical Trials identifier: RBR-3w2scz [http://www.ensaiosclinicos.gov.br]).

Background and Aims: Portal pressure can be used to identify patients with chronic liver disease who have progressed to cirrhosis. Portal pressure can also provide accurate prognostication for patients with cirrhosis. However, there are no practical means for assessment of portal pressure. Although it is well established that the gastric mucosal blood supply increases in patients with cirrhosis, this has been difficult to quantify reproducibly. Our group has developed a novel spectroscopic technology called spatially resolved subdiffuse reflectance spectroscopy (SRSRS), which enables quantification of mucosal microcirculation. We aim to ascertain if quantification of the gastric mucosal microcirculation with SRSRS correlates with clinical evidence of portal hypertension., Methods: Patients undergoing EGD for clinical indications had 10 measurements taken in the endoscopically normal gastric fundus via SRSRS probe to assess the microcirculation. Cases were defined as patients with cirrhosis (n = 18), and controls were those without evidence of liver disease (n = 18); this was corroborated with transient elastography., Results: The blood volume fraction (P = .06) and subdiffuse reflectance (P = .02) from a shallow depth in the gastric fundus were higher in patients with cirrhosis than those without. These markers were combined to yield an overall optical marker that can differentiate patients with cirrhosis from controls with a sensitivity of 72% and specificity of 94% (area under receiver operating curve, 0.82)., Conclusions: Spectroscopic quantification of gastric fundal mucosal microcirculation is a promising surrogate of clinical correlates of portal hypertension. This approach may represent a less-intrusive surrogate biomarker for liver disease prognostication and potentially response to therapy., (Copyright © 2021 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Background: Metabolic syndrome and chronic diseases have impact on the job performance of police officers., Objective: To investigate the association of overweight/obesity and cardiovascular risk factors with work shift and duration of employment among police officers., Methods: Cross-sectional study with 102 police officers in Cajazeiras, Paraíba, Brazil, in which we analyzed sociodemographic data, occupational characteristics, body mass index (BMI), lipid profile, personal history of disease and lifestyle. Statistical analysis included the chi-square and Fisher's exact test., Results: Overweight/obesity was found among most participants (83.3%). Hypertriglyceridemia (49.1%), low HDL-C (56.9%) and high LDL-C (46.1%) levels were associated with abnormal BMI (p<0.05). Hypertension was the main disease reported by overweight/obese participants (28.2%) (p=0.01). Job position, lifestyle and work shift were not associated with any of the analyzed variables, however, abnormal BMI, dyslipidemia, and hypertension were frequent among the participants with 6-10 or more than 10 years in the job (p<0.05)., Conclusion: Part of the participants with at least 6 years in the job exhibited overweight/obesity in association with dyslipidemia and hypertension. We recommend prevention and therapeutic strategies to protect officers from chronic diseases or attenuate their long-term complications. Additional prospective studies are needed to confirm the associations we found, mainly between duration of employment and occupational diseases.

Goals: To determine whether diabetic patients with hepatitis C virus (HCV) treated with direct-acting antiviral agents have improved diabetes, accounting for change in both hemoglobin A1c (HbA1c) and diabetes medications, and whether any improvement was sustained., Background: HCV infection is associated with an increased risk of diabetes, with improvement in glycemic control after eradication. There remains uncertainty about the durability and magnitude of this effect., Study: HbA1c and diabetes medications were recorded at 6-month intervals for 1.5 years pretreatment and posttreatment for 122 patients. Subjects were classified as having improved diabetes if there was a decrease in HbA1c≥0.5% with no increase in diabetes medications or a decrease in diabetes medications with a stable HbA1c., Results: HbA1c at the nearest time point before treatment was 8.4%±1.9%, compared with 7.8%±1.7% after treatment, a mean difference of 0.6% [95% CI (0.2, 0.9), P<0.01]. A linear mixed effects model incorporating each subject's repeated measurements over time also demonstrated a reduction after treatment of 0.5% [95% CI, (0.3, 0.8), P<0.001]. Accounting for both HbA1c and diabetes medications, 42 of 122 (34%) had an improvement in diabetes after HCV treatment, and 20 of 28 (71%) of these subjects sustained improvement at 1.5 years follow-up. Prescription of insulin was associated with improved diabetes., Conclusions: Treatment of HCV with direct-acting antiviral agents was associated with improved diabetes in a significant portion of patients with an average reduction in HbA1c of clinically significant magnitude. Among responders, this effect was sustained over 1.5 years of follow-up.

Introduction: Multiple illness and injury classes can cause a functional disability of the elderly, or the right to seek help from another person. Caregiving can be generated without the caregiver functions, leading to burden., Objective: to describe the sociodemographic and care profile of caregivers of the elderly and to analyze the factors associated with excessive stress regarding care., Method: This is a cross-sectional study, part of the SABE (Health, well-being and aging) Study, carried out in the city of São Paulo in 2010, with 362 caregivers. The excessive stress associated with care was evaluated by the Zarit Scale, and the load was found to be less than 24 points and the presence of burden was considered, with scores ≥ 24 points. Hierarchical Logistic Regression was used to analyze the factors associated with the stress of family caregivers., Results: Most of the caregivers were family members (91.5%), being female (75.4%), mean age 53.9 years (SD ± 15.5), married (65.3%), lived in the same household with the elderly (68.2%). One-third of them presented burden, which was associated with age (OR = 1.04, p = 0.001), family dysfunction (OR = 5.60, p = 0.000), continuous care (OR = 78, p = 0.030)., Conclusions: The data reveal the need to maintain their needs and support to caregivers, especially their relatives and their sources of life and their debts.

Introduction: Possessing active social networks seems to positively influence the functional performance of elderly people., Objective: To verify the association between the characteristics of social networks of the elderly people and the emergence of functional impairment., Methods: This is a longitudinal population-based study, which used the 2006 (n = 1,413) and 2010 (n = 990) cohorts of the Health, Well-Being, and Aging (SABE) Study. To characterize the social networks, the following variables were used: number of members in the network; living arrangements; sex and age of the members; coresidence with children or only elderly individuals; satisfaction with the relationships; and receiving and offering social support (financial, material, emotional, performing tasks inside and outside the home, providing companionship, and personal care). Logistic regression was used to analyze the data. All ethical guidelines were followed., Results: The social networks of the elderly people had an average of 8.15 members and consisted predominantly of family members aged between 15 and 59 years. Dependent elderly people received more material support, help in performing household tasks and those outside the home, and personal care, while the independent elderly people received more emotional support and companionship. Provision of social support (OR = 0.32, 95%CI 0.14 - 0.71) decreased the chances of developing dependency, independent of sociodemographic and health conditions., Conclusion: The strengthening of social networks in old age should be encouraged since confidence in informal care offered, mainly by families, may not be the best option for dealing with the growing demand for care that accompanies the aging of the population.

Introduction: Frailty is a preventable and reversible syndrome characterized by a cumulative decline of physiological systems, causing greater vulnerability to adverse conditions., Objective: To describe the prevalence of frailty among older adults and analyze its associated factors and progression., Method: This is a longitudinal study that used the Health, Well-being, and Aging Study (Saúde, Bem-Estar e Envelhecimento - SABE) database of 2006 and 2010. Five components identified the frailty syndrome: weight loss; fatigue; decreased strength, low physical activity, and reduced walking speed. Older adults were classified as "pre-frail" (1-2 components) and "frail" (3 or more). We used a hierarchical multiple multinomial regression to analyze associated factors., Results: Out of the total number of older adults (n = 1,399), 8.5% were frail, and the associated factors were age, functional impairment, cognitive decline, hospitalization, and multimorbidity. In four years, 3.3% of non-frail and 14.7% of pre-frail older adults became frail., Conclusion: Identifying the prevalence of frailty and its associated factors can help to implement adequate interventions early to improve the quality of life of older adults.

Introduction: The city of São Paulo has the largest community of Japanese descendants outside of Japan., Objectives: To compare the demographic, economic, functional, and health conditions of non-Japanese, Japanese, and their descendants; and to analyze comparatively the functional and health conditions of older adults born in Japan and their descendants born in Brazil., Methods: A cross-sectional study was carried out in the city of São Paulo, in 2010, with 1,345 older adults (≥ 60 years) participants in the SABE Study (Health, Welfare and Aging). The participants were classified as non-Japanese (not born in Japan), Japanese (born in Japan) or have reported being a direct descendant of Japanese. For the data analysis, χ2 test with Rao-Scott correction was used., Results: Of the 1,345 older adults, 3.3% were Japanese or descendants. These differed from non-Japanese in terms of higher education and reported income sufficiency. Among older adults born in Japan, there was a higher proportion of oldest old (38.8%), cardiovascular diseases (48.9%) and cognitive decline (26.7%)., Conclusion: It is noted that Japanese and descendants older adults presented better functionality when compared to non-Japanese. Among Japanese and descendants, differences in the profile of diseases were observed. It is believed that such results may be due to cultural influences.

Introduction: Functionality in aging is associated with the autonomy and independence of older people., Objective: To identify and hierarchize the difficulties reported by older adults in performing activities of daily living., Method: This is a cross-sectional, descriptive, household-based study that used the Health, Well-being, and Aging Study (Saúde, Bem-Estar e Envelhecimento - SABE) database of 2000, 2006, and 2010. We evaluated the functionality using reports on the difficulty in performing basic and instrumental activities of daily living (ADL and IADL, respectively). The Guttman scaling assessed the hierarchy of functional impairment., Results: The prevalence of reported difficulty in performing one or more IADLs was 35.4, 45.8, and 41.0%; while for ADLs, it was 16.3, 13.3, and 17.5%, in 2000, 2006, and 2010, respectively. In ten years of follow-up, the variability in prevalence among women ranged from 42.3 to 54.6% for IADL impairment, and 17.0 to 20.4% for ADL. For men, it varied from 25.6 to 33.1% for IADL impairment, and 8.0 to 13.7% for ADL. In the three waves, the activities with the highest reported difficulty were using transportation, performing heavy tasks, and managing finances, while feeding was the least prevalent., Conclusion: The prevalence of functional impairment increased in ten years, with higher variability among women and with advancing age. These results contribute to the planning of services and adequate distribution of existing resources as they reveal the needs and care required.

Background: Treatment of hepatitis C virus (HCV) with direct-acting antiviral (DAA) regimens has resulted in high rates of sustained virologic response (SVR). Treatment of vulnerable populations may be improved by incorporating an on-site intensive specialty pharmacy (ON-ISP)., Aims: To describe outcomes of HCV treatment at a safety-net hospital and proportion of subjects achieving SVR for those using the ON-ISP compared to an off-site pharmacy (OFF-SP)., Methods: A retrospective cohort study of 219 subjects treated for HCV with DAA at Boston Medical Center was conducted. Subject characteristics, virologic response, and pharmacy services used were recorded. We used multivariable logistic regression to test the association between ON-ISP and SVR after adjusting for covariates., Results: SVR occurred in 71% of subjects by intention-to-treat (73% among ON-ISP users vs 57% among OFF-SP users) and 95% completing treatment per-protocol (96% among ON-ISP users vs 87% among OFF-SP users). Adjustment for age, sex, ethnicity, insurance, fibrosis, prior treatment, and MELD revealed an increased likelihood of SVR among users of ON-ISP: OR 6.0 (95% CI 1.18-31.0). No significant difference in treatment delay or adverse events was seen among users of either pharmacy type., Conclusions: HCV treatment with DAA was well tolerated, but the rate of SVR was low (71%) compared to trials. This was due to loss to follow-up, as the per-protocol rate of SVR was much higher (95%). Use of ON-ISP was associated with an increase in SVR and may be valuable for improving care for vulnerable populations.

Objective: To investigate the prevalence of demand and provision of care for the Brazilian population with functional disabilities in activities of daily living., Methods: This is a quantitative and descriptive study using baseline data from ELSI-Brazil (Brazilian Longitudinal Study of Aging), a cohort study with a representative sample of the Brazilian population aged 50 years or older (n = 9,412). We considered the demand for care from the self-report of having some difficulty to perform at least one activity of daily life (eating, bathing, going to the toilet, dressing, moving in a room [ambulation], and transferring from chair [transfer]). Care supply was measured by having some help to perform the activity of daily living., Results: Approximately a quarter of the individuals evaluated (23.2%) reported difficulty in at least one activity of daily living, especially regarding transfer and dressing. Age, schooling, and number of chronic diseases were significantly associated with the difficulty in activities of daily living. Among those who reported difficulty, 35.1% received help of others and 11.8% did not receive (lack of care). The activities with greater lack of care were bathing (13.3%) and transfer (11.7%), which reveals an undignified survival condition. Care remains a family (94.1%) and female (72.1%) issue; despite the important changes that have taken place in society, there is still a lack of care policies. Of the total caregivers, 25.8% reported stopping working or studying to perform this role and only 9.2% were paid (hired ones or family members)., Conclusions: The ELSI-Brazil results reveal the expressive care demand of the Brazilian population aged 50 years or older with functional disabilities on activities of daily living and the lack of care policies aimed at this public.

Background & Aims: There is little evidence showing that dynapenic obesity is associated with lipid and glucose metabolism disorders, high blood pressure, chronic disease and metabolic syndrome. Our aim was to analyze whether dynapenic abdominal obesity can be associated with lipid and glucose metabolism disorders, high blood pressure, metabolic syndrome and cardiovascular diseases in older adults living in São Paulo., Methods: This cross-sectional study included 833 older adults who took part of the third wave of the Health, Well-being and Aging Study in 2010. Based on waist circumference (>88 cm women and >102 cm men) and handgrip strength (<16 kg women and <26 kg men), four groups were identified: non-dynapenic/non-abdominal obese (ND/NAO), abdominal obese alone (AOA), dynapenic alone (DA) and dynapenic/abdominal obese (D/AO). Dependent variables were blood pressure, lipid profile, fasting glucose and glycated-haemoglobin, metabolic syndrome and cardiovascular diseases. Logistic regression was used to analyze the associations between dynapenia and abdominal obesity status and lipid and glucose metabolic profiles, blood pressure, cardiovascular diseases and metabolic syndrome., Results: The fully adjusted models showed that D/AO individuals had higher prevalence of low HDL plasma concentrations (OR = 2.51, 95%CI: 1.40-4.48), hypertriglyceridemia (OR = 2.53, 95%CI: 1.43-4.47), hyperglycemia (OR = 2.05, 95%CI: 1.14-3.69), high glycated-haemoglobin concentrations (OR = 1.84, 95%CI: 1.03-3.30) and metabolic syndrome (OR = 12.39, 95%CI: 7.38-20.79) than ND/NAO. Dynapenic and D/AO individuals had higher prevalence of heart disease (OR = 2.05, 95%CI: 1.17-3.59 and OR = 1.92, 95%CI: 1.06-3.48, respectively) than ND/NAO., Conclusion: D/AO was associated with high prevalence of lipid and glucose metabolism disorders and metabolic syndrome while dynapenia and D/AO were associated with high prevalence of heart disease., (Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objective: To propose a care need classification for elderly people by identifying their functional demands., Method: Cross-sectional study carried out in São Paulo, in 2006, with 1,413 elderly (≥ 60 years old), participants in the Health, Well-being and Aging study (SABE - Saúde, Bem Estar e Envelhecimento). For the care need classification, we used the Guttman Scaling method e the frequency of assistance required by the elderly., Results: The hierarchy of activities of daily living had good internal consistency (α = 0.92) and satisfactory coefficients of reproducibility (98%), scalability (84%) and minimum marginal reproducibility (87%). Care need was categorized into: no need (requires no caregiver), minimum need (requires caregiver sporadically), moderate need (requires caregiver intermittently) and maximum need (requires full-time caregiver)., Conclusion: This classification will allow identifying elderly that need assistance in everyday activities and will orientante health professionals in the development of a line of care.

Objectives: To determine the relationship between social support and mortality in older adults, independent of other health conditions., Method: This was a longitudinal study using the database of the 2006 SABE Study (Heath, Well-being and Aging), composed of 1413 individuals aged 60 years and over, living in São Paulo/Brazil. The present study used a questionnaire constructed for the SABE Study, which was reviewed by experts of Latin America and the Caribbean. The social network was evaluated using the variables: social support received; social support offered; number of members in the social network. The covariates included were age, gender, living arrangements, marital status, income, education, comorbidity, depressive symptoms, cognition and functional difficulties. Death as an outcome was evaluated after four years of follow-up., Results: From a total of 1413 older adults at baseline, 268 died in a mean follow-up period of 3,9 years (SE=0,03). In the model adjusted offering social support and having networks composed of 9 or more members reduced the risk of death in the older adults., Conclusions: This study suggest that older adult who are offered support can benefit from mutual exchanges since reciprocity in relationships improves psychological well-being and is indicative of the quality of relationships. Thus, the older adults are part of a group of people whose role is not only to receive, but also to provide help to others, and the support offered seems to be as important as that received., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Some myeloproliferative neoplasm (MPN) patients harbor JAK2(V617F) mutation, and CALR mutations were recently discovered in wild type (WT) JAK2(V617F). We evaluated the frequency and type of CALR mutations, and clinical and hematological characteristics in WT JAK2(V617F) and MPL(W515K/L) MPN patients. Sixty-five patients were included: 21 with primary myelofibrosis (PMF), 21 with myelofibrosis post-essential thrombocythemia (MPET) and 23 with essential thrombocythemia (ET). Screening for JAK2(V617F) and MPL(W515K/L) were performed using real-time PCR, while CALR mutations were analyzed by fragment analysis and Sanger sequencing. JAK2(V617F) was the most frequent mutation (54.5%) and one patient (1.5%) harbored MPL(W515L). CALR mutations were present in 38.1% of PMF, 12.5% of ET and 33.3% of MPET patients. Five types of CALR mutations were detected, among which type 1 (32.1%) and type 2 (21.4%) were found to be the most common. A novel CALR mutation in a PMF patient was found. Patients carrying CALR mutations had higher platelet count and less presence of splenomegaly than JAK2(V617F), while triple negatives had higher C-reactive protein levels than CALR mutant carriers. Screening for CALR mutations and its correlation with clinical features could be useful for the characterization of MPN patients and result in its incorporation into a new prognostic score., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Status epilepticus (SE) is a severe condition that may lead to hippocampal cell loss and epileptogenesis. Some of the mechanisms associated with SE-induced cell death are excitotoxicity, neuroinflammation, and apoptosis., Objective: The objective of the present study is to test the hypothesis that DBS has anti-inflammatory and antiapoptotic effects when applied during SE., Methods: Rats undergoing pilocarpine-induced SE were treated with anterior thalamic nucleus (AN) deep brain stimulation (DBS). Inflammatory changes and caspase 3 activity were measured within 1 week of treatment., Results: In pilocarpine-treated rats, DBS countered the significant increase in hippocampal caspase 3 activity and interleukin-6 (IL-6) levels that follows SE but had no effect on tumor necrosis factor α (TNFα)., Conclusions: DBS has anti-inflammatory and antiapoptotic effects when given to animals undergoing status.

The objective of this study was to determine the effect of orbital decompression procedures on the intraocular pressure (IOP). The orbital compartment syndrome represents an emergency situation. Due to the elevated IOP vision loss may ensue. Several maneuvers including lateral canthotomy are discussed to reduce the IOP. Eight orbits were studied in a fresh frozen cadaveric model (4 specimens). Intraorbital volume was determined by CT volumetry. An orbital compartment syndrome was simulated by injecting viscous material into the orbit. Injected volumes were documented and lateral canthotomy, cantholysis, inferior and superior septolysis were performed. IOP and exophthalmometric measurements were obtained after each intervention. Controlled elevation of IOP was achieved in all specimens. IOP was partially reduced after performing a lateral canthotomy in eight orbits. IOP was significantly and sufficiently decreased under 20 mmHg by inferior cantholysis in seven orbits. An additional superior cantholysis was necessary in two orbits to achieve a complete decompression. Inferior or superior septolysis were not needed to further reduce the IOP. Lateral canthotomy must be followed by an inferior cantholysis to successfully decompress an orbital compartment syndrome in the majority of cases. Occasionally, superior cantholysis may generate additional benefit. Additional inferior and superior septolysis were not shown to provide a beneficial effect when performed after canthotomy and cantholysis.

OBJECTIVE To validate a screening instrument using self-reported assessment of frailty syndrome in older adults. METHODS This cross-sectional study used data from the Saúde, Bem-estar e Envelhecimento study conducted in Sao Paulo, SP, Southeastern Brazil. The sample consisted of 433 older adult individuals (≥ 75 years) assessed in 2009. The self-reported instrument can be applied to older adults or their proxy respondents and consists of dichotomous questions directly related to each component of the frailty phenotype, which is considered the gold standard model: unintentional weight loss, fatigue, low physical activity, decreased physical strength, and decreased walking speed. The same classification proposed in the phenotype was utilized: not frail (no component identified); pre-frail (presence of one or two components), and frail (presence of three or more components). Because this is a screening instrument, "process of frailty" was included as a category (pre-frail and frail). Cronbach's α was used in psychometric analysis to evaluate the reliability and validity of the criterion, the sensitivity, the specificity, as well as positive and negative predictive values. Factor analysis was used to assess the suitability of the proposed number of components. RESULTS Decreased walking speed and decreased physical strength showed good internal consistency (α = 0.77 and 0.72, respectively); however, low physical activity was less satisfactory (α = 0.63). The sensitivity and specificity for identifying pre-frail individuals were 89.7% and 24.3%, respectively, while those for identifying frail individuals were 63.2% and 71.6%, respectively. In addition, 89.7% of the individuals from both the evaluations were identified in the "process of frailty" category. CONCLUSIONS The self-reported assessment of frailty can identify the syndrome among older adults and can be used as a screening tool. Its advantages include simplicity, rapidity, low cost, and ability to be used by different professionals.

OBJECTIVE To analyze gender differences in the incidence and determinants of disability regarding instrumental activities of daily living among older adults. METHODS The data were extracted from the Saúde, Bem-Estar e Envelhecimento (SABE - Health, Wellbeing and Ageing) study. In 2000, 1,034 older adults without difficulty in regarding instrumental activities of daily living were selected. The following characteristics were evaluated at the baseline: sociodemographic and behavioral variables, health status, falls, fractures, hospitalizations, depressive symptoms, cognition, strength, mobility, balance and perception of vision and hearing. Instrumental activities of daily living such as shopping and managing own money and medication, using transportation and using the telephone were reassessed in 2006, with incident cases of disability considered as the outcome. RESULTS The incidence density of disability in instrumental activities of daily living was 44.7/1,000 person/years for women and 25.2/1,000 person/years for men. The incidence rate ratio between women and men was 1.77 (95%CI 1.75;1.80). After controlling for socioeconomic status and clinical conditions, the incidence rate ratio was 1.81 (95%CI 1.77;1.84), demonstrating that women with chronic disease and greater social vulnerability have a greater incidence density of disability in instrumental activities of daily living. The following were determinants of the incidence of disability: age ≥ 80 and worse perception of hearing in both genders; stroke in men; and being aged 70 to 79 in women. Better cognitive performance was a protective factor in both genders and better balance was a protective factor in women. CONCLUSIONS The higher incidence density of disability in older women remained even after controlling for adverse social and clinical conditions. In addition to age, poorer cognitive performance and conditions that adversely affect communication disable both genders. Acute events, such as a stroke, disables elderly men more, whereas early deficits regarding balance disable women more.

Objective: To analyze similarities among factors associated with the components of frailty in elderly., Method: We studied 1,413 elderly from the second wave of the SABE Study in 2006. Each of the five components of the frailty phenotype was considered a dependent variable in the hierarchical logistic regression models., Results: In both genders, age, schooling, sedentary lifestyle, and screening positive for depression were associated similarly with more than one component of frailty. Other similarities were also observed with stroke and screening positive for cognitive decline in men, and number of diseases and gait speed in women. The most similar associations happened between weakness and slowness; weakness, slowness, and LPAL; or weakness, slowness, and exhaustion., Discussion: Encouraging physical activity, screening for and treating depression and treating both diseases of the central nervous system and chronic diseases must be the focus of strategies to avoid, delay, or even remedy frailty.

Objective: The aim of the present study was to examine the association between nutritional status and the incidence of disability regarding instrumental activities of daily living (IADL) among older adults., Design: The study is part of the longitudinal SABE (Saúde, Bem-Estar e Envelhecimento; Health, Wellbeing and Ageing) Study that began in 2000 (first wave) with a multistage, clustered, probabilistic sample (n 2143) of older adults (≥60 years). The second wave was carried out in 2006, when 1115 elders were re-interviewed. The dependent variable was the occurrence of disability in 2006 (report of difficulty on ≥1 IADL). Nutritional status (measured at baseline) was classified on the basis of BMI: ≤23·0 kg/m2 (underweight); >23·0 and <28·0 kg/m2 (ideal range - reference); ≥28·0 and <30·0 kg/m2 (overweight); and ≥30·0 kg/m2 (obesity)., Setting: São Paulo, Brazil., Subjects: One thousand and thirty-four individuals without difficulties regarding IADL in 2000 were selected, 611 of whom were re-interviewed in 2006., Results: In the multiple logistic regression analysis adjusted for baseline variables (gender, age, number of chronic diseases, stroke, osteoarthritis and cognitive status), underweight (OR = 2·03; P = 0·034) and obesity (OR = 1·79; P = 0·022) remained associated with disability., Conclusions: Both underweight and obesity are associated with an increased risk of developing disability regarding IADL among older adults, in an independent fashion of other risk factors. Thus, adequate nutritional status is a key point to consider in the establishment of preventive measures.

Background: The incidence of inflammatory bowel disease (IBD) has increased over the past several decades with a corresponding increase in the number of patients on combination immunosuppressive therapy including corticosteroids, anti-metabolites and biologic agents. The exact incidence of pneumocystis jiroveci pneumonia (PJP) in IBD patients is unknown but there has been an increase in the number of reports of PJP in IBD patients on combination immunosuppressive therapy., Methods: We evaluated the published literature describing PJP infections in IBD patients, as well as other non-HIV cohorts and identified risk factors for PJP infection in this group of patients. Prophylaxis and treatment regimens were reviewed., Results: Corticosteroid therapy, lymphopenia (total lymphocyte count < 600 cells/mm), and age greater than 55 years appear to be risk factors for developing pneumocystis jiroveci pneumonia. In addition, PJP mortality is greater in the non-HIV cohort in contrast to the HIV population. No evidence-based guidelines for primary PJP prophylaxis exist to direct practice for gastroenterology providers., Conclusions: Better surveillance and reporting of opportunistic infections including PJP are needed to elucidate risk factors for acquisition of infection. Gastroenterology providers should continue to evaluate the need for PJP prophylaxis on a case-by-case basis to recognize patients who may benefit from primary PJP prophylaxis. In particular, older patients on corticosteroids, multiple immunosuppressive agents, and patients with lymphopenia should be considered for prophylaxis.

Objective: To examine the association between weight change and the incidence of disability in activities of daily living (ADL) among elderly women., Method: In 2006, 227 women aged ≥75 years and independent in ADL were selected from SABE Study (Health, Well-being, and Aging) in Sao Paulo, Brazil. The dependent variable was the report of difficulty on ≥1 ADL in 2009. Differences in weight were calculated between baseline and second interview, and converted to percentage change in relation to initial weight. A change (gain or loss) ≥5% was considered significant. A logistic regression analysis was performed including sociodemographic and health-related variables., Results: After adjusting, weight gain remained associated to disability (OR = 2.42; p = .027), whereas weigh loss lost significance (OR = 1.66; p = .384)., Discussion: Weight loss is generally considered more worrisome than weight gain in elderly. However, weight loss alone was not a risk factor for disability in our study.

Determining the groups that are most susceptible to developing disability is essential to establishing effective prevention and rehabilitation strategies. The aim of the present study was to determine gender differences in the incidence of disability regarding activities of daily living (ADL) and determinants among elderly residents of Sao Paulo, Brazil. In 2000, 1634 elderly with no difficulties regarding ADL (modified Katz Index) were selected. These activities were reassessed in 2006 and disability was the outcome for the analysis of determinants. The following characteristics were analyzed at baseline: socio-demographic, behavioral, health status, medications, falls, hospitalizations, depressive symptoms, cognition, handgrip, mobility and balance. The incidence density was 42.4/1000 women/year and 17.5/1000 men/year. After adjusting for socioeconomic status and health conditions, women with chronic diseases and social vulnerability continued to have a greater incidence of disability. The following were determinants of the incidence of disability: age and depressive symptoms in both genders; stroke and slowness on the sit-and-stand test among men; and osteoarthritis and sedentary lifestyle among women. Better cognitive performance and handgrip strength were protective factors among men and women, respectively. Adverse clinical and social conditions determine differences between genders regarding the incidence of disability. Decreased mobility and balance and health conditions that affect the central nervous system or lead to impaired cognition disable men more, whereas a sedentary lifestyle, reduction in muscle strength and conditions that affect the osteoarticular system disable women more., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

The objective of this cross-sectional, descriptive study was to identify the activities of the Nursing Intervention Classification considered as priorities for an Ineffective Breathing Pattern and not performed for elderly inpatients of a teaching hospital in the state of Goiás. The study participants were 43 nursing professionals, and data collection was performed in the period spanning October to December 2008, after receiving approval from the Ethics Committee. It was observed that among the 67 activities considered to be priorities for the referred diagnosis, only seven were performed by all of the participants; the other activities, with a varied frequency, were not performed, with the main reason cited being that a professional from a different area completed the activity. It is understood that the fact that the nursing staff does not perform these activities can cause lack of complete coverage in nursing care; therefore there is a need for a legal apparatus to describe the activities that comprise professional practice exclusive to nursing personnel and those activities that have an interdisciplinary nature.

Genes located outside the HLA region (6p21) have been considered as candidates for susceptibility to ankylosing spondylitis. We tested the hypothesis that the G22A polymorphism of the adenosine deaminase gene (ADA; 20q13.11) is associated with ankylosing spondylitis in 166 Brazilian subjects genotyped for the HLA*27 gene (47 patients and 119 controls matched for gender, age and geographic origin). The HLA-B*27 gene and the G22A ADA polymorphism were identified by PCR with sequence-specific oligonucleotide probes and PCR-RFLP, respectively. There were no significant differences in frequencies of ADA genotypes [odds ratio (OR) = 1.200, 95% confidence interval (CI) = 0.3102-4.643, P > 0.8] and ADA*01 and ADA*02 alleles (OR = 1.192, 95%CI = 0.3155-4.505, P > 0.8) in patients versus controls. We conclude that the G22A polymorphism is not associated with ankylosing spondylitis.

Objective: Adenosine deaminase acts on adenosine and deoxyadenosine metabolism and modulates the immune response. The adenosine deaminase G22A polymorphism (20q.11.33) influences the level of adenosine deaminase enzyme expression, which seems to play a key role in maintaining pregnancy. The adenosine deaminase 2 phenotype has been associated with a protective effect against recurrent spontaneous abortions in European Caucasian women. The aim of this study was to investigate whether the G22A polymorphism of the adenosine deaminase gene is associated with recurrent spontaneous abortions in Brazilian women., Methods: A total of 311 women were recruited to form two groups: G1, with a history of recurrent spontaneous abortions (N = 129), and G2, without a history of abortions (N = 182). Genomic DNA was extracted from peripheral blood with a commercial kit and PCR-RFLP analysis was used to identify the G22A genetic polymorphism. Fisher's exact test and odds ratio values were used to compare the proportions of adenosine deaminase genotypes and alleles between women with and without a history of recurrent spontaneous abortion (p<0.05). The differences between mean values for categorical data were calculated using unpaired t tests. The Hardy-Weinberg equilibrium was assessed with a chi-square test., Results: Statistically significant differences were identified for the frequencies of adenosine deaminase genotypes and alleles between the G1 and G2 groups when adjusted for maternal age., Conclusions: The results suggest that the adenosine deaminase *2 allele is associated with a low risk for recurrent spontaneous abortions, but this association is dependent on older age.

The population ageing is a challenge for health professionals. This study seek to evaluate the functional capacity and to identify the factors associated to the dependence for the activities of daily life (ADL) and activities instrumental of daily life (AIDL), and also to describe the socioeconomic, demographic and health profile of the elderly. A transverse study was carried out with seniors assisted by Family Health teams of the District East Sanitary of Goiania (GO). A questionnaire was applied to obtain socioeconomic and demographic date, factors related to the health and scales of the functional evaluation. For analyses it was used Square-Qui Test considering the level of significance of 5%. The sample was composed by 388 elderly, 57.5% with age varying from 60 to 69 years, 58.5% female, 39.7% illiterate, 77.3% with income ≤ 2 minimum wages and 70.9% bearers of chronic diseases. It was verified that 34.8% needed help in one or more ADL and 60.6% in AIDL. The factors more frequently associated at dependence in both activities were: balance and mobility debilitated, depression, cognitive deficit and age ≥ 80 years. These results denote that the elderly are living aging characterized by comorbidities and dependence to accomplish daily activities.

Although recurrent hepatitis C virus (HCV) after liver transplantation (LT) is universal, a minority of patients will develop cirrhosis within 5 years of surgery, which places them at risk for allograft failure. This retrospective study investigated whether 2 serum fibrosis markers, serum hyaluronic acid (HA) and YKL-40, could be used to predict rapid fibrosis progression (RFP) post-LT. These markers were compared with conventional laboratory tests, histological assessment, and hepatic stellate cell activity (HSCA), a key step in fibrogenesis, as assessed by immunohistochemical staining for alpha-smooth muscle actin. Serum and protocol liver biopsy samples were obtained from 46 LT recipients at means of 5 +/- 2 (biopsy 1) and 39 +/- 6 (biopsy 2) months post-LT, respectively. RFP was defined as an increase in the fibrosis score >or= 2 from biopsy 1 to biopsy 2 (a mean interval of 33 +/- 6 months). The ability of parameters at biopsy 1 to predict RFP was compared with the areas under receiver operating characteristic curves (AUROCs). Of the 46 subjects, 15 developed RFP. Serum HA and YKL-40 performed significantly better than conventional parameters and HSCA in predicting RFP post-LT for HCV at biopsy 1, with AUROCs of 0.89 and 0.92, respectively. The accuracy of serum HA >or= 90 microg/L and YKL-40 >or= 200 microg/L in predicting RFP at biopsy 1 was 80% and 96%, respectively. In conclusion, we found that elevated levels of serum HA and YKL-40 within the first 6 months after LT accurately predicted RFP. Larger studies evaluating the role of serum HA and YKL-40 in post-LT management are warranted.