dementia sample showed that physical factors as global motor function and gait speed were found to be positively associated with PA, but not lower global cognition . Nevertheless, even after adjustment for age, global cognitive function (MMSE) and walking aid use, institu- tionalized vs. community-dwelling dementia patients had significantly lower total daily PA lev- els. So, other factors will also play a role here such as differences in physical environment and (absence of) PA policies in care institutions. Future research will have to characterize more comprehensively the influence ofthe physical environment and PA policies since these factors are understudied . Active PA policies and the support of caregivers within care institutions may facilitate the PA behavior of institutionalized patients. However, the (absence of) PA poli- cies in institutions are not inventoried in this study. ‘Activating care’ is a recent development and not fully implemented yet. Our results suggest that a lot of work needs to be done here. The main PA peak in the early morning of institutionalized dementia patients seems to be related to their basic activities of daily living instead of organized activities. Future research on the effectiveness of PA policies in care institutions is warranted.
Participants’ mean age was 71.08 ± 7.77 years, ranging from 60 to 96 years, 65.1% women. Participants were predominantly married or lived with a partner (52.7%) or were residents of senior homes (54.8%). In relation to socioeconomic and employment statuses, 81.5% ofthe participants were retired or pensioners, and 51.4% and 33.2% belonged to the lowest socioeconomic strata C and D, respectively. The prevalence of functional di- sability in the study sample was 29.4%. The mean total time spent sitting was 576.51 ± 5.14 min/day. Distri- bution of age, years of education and variables related to physical activity and SB are shown in Table 1. When examining differences in the mean and frequency ofthe study variables between men and women, the only significant differences were found for variables related to physical activity level. Women presented lower time spent (min/day) in physical activity at work, transpor- tation and leisure activities. On the other hand, women spent significantly more time in physical activity per- taining to the domestic domain (Table 1).
Global cognition must also be evaluated in order to successfully select individuals with excellent memory performance. A low score on this type of test may indi- cate a subclinical pathologic process that does not affect the memory system. On the other hand, above average scores suggest that these individuals have an optimal performance when associated with unusually high memory scores. It is important to note that the cogni- tive evaluation typically performed in a neurological or psychiatric routine is essentially not a measure of global cognition. Some tools for dementia screening are excel- lent for the diagnosis of mild cognitive impairment or dementia staging but should be avoided as classi- fiers for “cognitively normal”, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA). 62 A comprehensive and validated
Depression was assessed by the Portuguese version ofthe Depression Anxiety Stress Scale (DASS-21). This scale is comprised by 21 items, divided into three scales (depres- sion, anxiety, and stress) with seven items each, and graded from 0 (It did not apply anything to me) to 3 (Applied to me mostofthe time). Participants evaluate the degree to which they experienced each symptom during the previous week. The results ofthe depression scale are determined by the sum of results ofthe seven items, where the mini- mum is 0 and the maximum 21. The highest scores on the depression scale correspond to negative emotional states (Pais-Ribeiro, Honrado, & Leal, 2004). The internal consis- tency for the present study, estimated by Cronbach’s alpha, was .89.
(Lindau et al., 2007). A number of reasons have been discussed for this decline in activity. According to Lindau et al. (2007), older individuals who identify as showing fair or poor health were more likely to report sexual problems and were less likely to be sexually active than individuals showing good health. Furthermore, physical problems that come with age may contribute to low self-esteem, poor self-image, and diminished sexual responsiveness and sexual desire (Bachmann & Lieblum, 2004). Additionally, there are differences between sexes. Themost noticeable changes in women are related to declining functioning ofthe ovaries. Women may experience vaginal dryness and atrophy, due to the gradual decline in levels of oestrogen in the body (DeLamater, 2012). Men commonly experience a slow decline in testosterone production. The refractory period is especially affected, that is, they need a longer time to regroup after orgasm before they can achieve another orgasm. Additionally, themost prominent change in male sexual function with age is erectile dysfunction (Kenny, 2013). The link between SWB and aging has been a neglected area of research, for a long time (Trudel et al., 2010). SWB from birth to the end ofthe fertile period is a well-researched subject in the social sciences. SWB and sexual development in old age, however, has received much less attention (DeLamater, 2012; Schwartz, Diefendorf & McGlynn-Wright, 2014); this is due to the widely held belief that olderadultsare asexual (Kenny, 2013). Moreover, late life sexuality has been often regarded as a medical and specialist research topic (Gott & Hinchliff, 2003). Indeed, treatment for common sexual medical conditions that occur in late life, prevention of sexually transmitted diseases, and risky sexual behaviour among olderadults, arethemost broached areas when considering olderadults’ SWB (Kenny, 2013; Lindau & Gavrilova, 2010).
Along with cancer, advanced dementia is a major trigger of referral to exclusive palliative care; delirium, pressure ulcers and hypoalbuminemia are important predictors of death. Although few patients were under palliative care upon admission, many had been referred to palliative care by the end of hospital stay. Given hospitalized olderadults may not have been screened for palliative care eligibility prior to admission, clinicians must be aware of factors indicative of poor prognosis, and take quick action to provide the best possible care for patients and respective caregivers and/or family members.
Favorable neighborhood environmental characteristics were associated to less time spent in sedentary behavior in olderadults. The findings highlighted gender diffe- rences, with men reporting more neighborhood cha- racteristics associated to time spent in SB compared to women. Overall, our findings showed that access to shops, bus stop, leisure spaces, clubs and open air and indoor gyms was associated to spending less time in SB (i.e. a reduction between 25 and 49 minutes per day). For men, having access to various types of businesses and bus stops in the neighborhood was associated with reductions in time spent in SB greater than an hour (i.e. -66 and -78 minutes per day, respectively). Among women, a reduction between 25 and 32 minutes per day spent in SB was associated to the presence of gyms and leisure clubs both indoor or outdoor. To the best of our knowledge, this is the first study in Brazil to investigate the role of neighborhood environmental characteristi- cs as risk factors to reduce sedentary behavior in later life using an objective measure i.e. accelerometry. Olderadultsare more likely to be sedentary and this behavior has been measured by TV watching time 9,22,23 . Howe-
Evenson et al., 2012; Healy et al., 2011) and the least amount of time in MVPA. They are also the age group that has the highest prevalence of abdominal obesity, which is positively associated with multiple comorbidities (Sardinha et al., 2012). In olderadults, positive associations have been found for overall sedentary time with increased BMI (Bell, Kivimaki, Batty, & Hamer, 2014; Nicklas et al., 2014; Stamatakis, Hirani, & Rennie, 2009), body fat mass (Chastin, Ferriolli, Stephens, Fearon, & Greig, 2012; Larsen et al., 2013; Swartz, Tarima, et al., 2011), and waist circumference (Stamatakis et al., 2009; Swartz, Tarima, et al., 2011), but only one study has examined how the pattern in which total sedentary time is accumulated may partially attenuate the negative effects ofsedentary time (Chastin et al., 2012). This study using an objective method for assessing sedentary time (ActivPAL) found sedentary time fragmentation (calculated as the ratio ofthe number ofsedentary bouts divided by the total sedentary time), to be inversely associated withthe percentage of body fat. The different durations of uninterrupted bouts ofsedentary time could be related with adiposity but was not investigated. Therefore, little is known about the thresholds for prolonged time spent in sedentary behavior or how long sedentary time must be interrupted before it exacerbates abdominal obesity odds. This knowledge may provide an insight into the patterns through which sedentary time influences this cardiovascular disease risk phenotype. In addition, this information may also have potential implications for novel strategies designed to decrease this behavior. Therefore, we sought to characterize the associations between physical activity dimensions and if different durations of continuous sedentary bouts were associated withthe odds for abdominal obesity, in olderadults.
Firstly, for ‘beliefs about the interest in sexuality’, ‘health limitations despite the desire’ was themost reported category (83.3%). Previous studies have already shown that physical health, cardiovascular illnesses, diabetes and arthritis may influence the expression of sexuality (Helmes & Chapman, 2012; Lindau et al., 2007). Moreover, the functional level of residents in a nursing home may predict the attitudes towards sexuality in olderadults, as showed by Bouman, Arcelus, and Benbow (2007) in a study using ASKAS (Aging Sexual Knowledge and Attitude Scale). It appears that half ofthe participants consider olderadults to be ‘interested in sexuality’ (50.0%), to have the ‘need of expressing sexually’ (33.3%) and believe that ‘olderadults have more sexual experience’ (16.6%), which indicates some positive beliefs regarding sexuality in older people. This may be due to the fact that 66.7% ofthe participants had geriatric qualifications and worked for more than 5 years in the institution (50.0%). However, 33.3% reported that olderadultsare ‘no interested in sexuality’ and that olderadults do ‘not the same ability of expressing sexually’ (33.3%), thus demonstrating some negative beliefs towards olderadults’ sexuality. Despite the shift in societal attitudes and the distancing from stereotypical perceptions of asexual old age, the social taboo associated with sexuality in older age prevails (Holmes, Reingold, & Teresi, 1997; Roach, 2004), and seems deeply rooted even in health care services. These results could be explained due to FCs likely considering most patients to be too sick to be interested in their sexuality as showed by Saunamäki, Andersson, and Engström (2010) in a study using the Sexual and Beliefs Survey in Sweden. The fact that this study’s sample came from a nursing home, in which most residents were bedridden or had a severe cognitive impairment may explain these negative beliefs.
Risk aversion and temporal discounting are preferences that are strongly linked to sub- optimal financial and health decision making ability. Prior studies have shown they differ by age and cognitive ability, but it remains unclear whether differences are due to age-related cognitive decline or lower cognitive abilities over the life span. We tested the hypothesis that cognitive decline is associated with higher risk aversion and temporal discounting in 455 older persons without dementia from the Memory and Aging Project, a longitudinal co- hort study of aging in Chicago. All underwent repeated annual cognitive evaluations using a detailed battery including 19 tests. Risk aversion was measured using standard behavioral economics questions: participants were asked to choose between a certain monetary pay- ment versus a gamble in which they could gain more or nothing; potential gamble gains var- ied across questions. Temporal discounting: participants were asked to choose between an immediate, smaller payment and a delayed, larger one; two sets of questions addressed small and large stakes based on payment amount. Regression analyses were used to ex- amine whether prior rate of cognitive decline predicted level of risk aversion and temporal discounting, controlling for age, sex, and education. Over an average of 5.5 (SD=2.9) years, cognition declined at an average of 0.016 units per year (SD=0.03). More rapid cognitive de- cline predicted higher levels of risk aversion (p=0.002) and temporal discounting (small stakes: p=0.01, high stakes: p=0.006). Further, associations between cognitive decline and risk aversion (p=0.015) and large stakes temporal discounting (p=0.026) persisted in analy- ses restricted to persons without any cognitive impairment (i.e., no dementia or mild cogni- tive impairment); the association of cognitive decline and small stakes temporal discounting was no longer statistically significant (p=0.078). These findings are consistent withthe hy- pothesis that subtle age-related changes in cognition can detrimentally affect individual preferences that are critical for maintaining health and well being.
A total of 390 individuals were evaluated. Mean age was 77.78 ± 7.96 years and 71% were women. Regarding education, 57.4% had 2-4 years, 18.5% 5-8 years, and 24.1% had >8 years (Table 1). The AD group corre- sponded to 68.2% ofthe sample. This group was older, had a higher proportion of women, and was less educated than the control group (Table 1). The NC group consisted of 124 individuals. Only gender did not show a statistical difference (p = 0.146) (Table 1). The neuropsychological assessment using PDT scores for the MMSE and the Bourke et al. scale are summarized in Table 1. There was no difference between the groups according to scores on the PDT from the MMSE (p = 0.839). However, a significant difference was observed between the groups for the PDT scored by the Bourke et al. scale (p <0.001), and the NC group had a higher correct drawing percentage (85.5%) when compared withthe AD group (66.9% incorrect drawing). Addi- tionally, PDT scores differed significantly between AD and NC groups across all educational levels (p <0.001) (Table 2).
The present study shows some points that might be considered worthy of attention. Firstly, we highlight the inclusion of a high number ofolderadults, which con- sisted of a representative sample ofthe population ex- amined. In addition, all participants were first screened withthe Mini-Mental State Examination according to schooling, minimizing the interference of education lev- el on the quality of self-reported information obtained withthe questionnaire. As limitations, it is important to cite the use of a self-report instrument to assess sed- entary behavior. Self-report measures are dependent on participants memory and recall ability, which are more frequently compromised in olderadults. In addition, self-report measures ofsedentary behavior usually lead to underestimation of results. However, these types of in- struments are still commonly used in large-scale studies. In a systematic review of longitudinal studies conducted from 1996 and 2011, 46 ofthe 48 articles that met inclu- sion criteria used self-reported measures, which include total time watching television as well as other screen behaviors 30 . Thus, we believe that more studies using
Tobacco, alcohol, and betel quid arethe main causes of squamous cell cancers ofthe upper aerodigestive tract. These substances can cause multifocal carcinogenesis leading to multiple synchronous or metachronous cancers ofthe oesophagus, head and neck region, and lungs (‘ield cancerisation’). Globally there are several million people who have survived either head and neck squamous cell cancer (HNSCC) or lung cancer (LC). HNSCC and LC survivors are at increased risk of developing second primary malignancies, including second primary cancers ofthe oesophagus. The risk of second primary oesophageal squamous cell cancer (OSCC) ranges from 8-30% in HNSCC patients. LC and HNSCC survivors should be ofered endoscopic surveillance ofthe oesophagus. Lugol chromoendoscopy is the traditional and best evaluated screening method to detect early squamous cell neoplasias ofthe oesophagus. More recently, narrow band imaging combined with magnifying endoscopy has been established as an alternative screening method in Asia. Low-dose chest computed tomography (CT) is the best evidence- based screening technique to detect (second primary) LC and to reduce LC-related mortality. Low-dose chest CT screening is therefore recommended in OSCC, HNSCC, and LC survivors. In addition, OSCC survivors should undergo periodic pharyngolaryngoscopy for early detection of second primary HNSCC. Secondary prevention aims at quitting smoking, betel quid chewing, and alcohol consumption. As ield cancerisation involves the oesophagus, the bronchi, and the head and neck region, the patients at risk are best surveilled and managed by an interdisciplinary team.
of fluid balance, both by modulating the activity ofthe sympathetic nervous system on the cardiovascular system, and by acting on the kidney (48-50). Intravenous infusion of chemical substances like serotonin or stim- ulation of cardiopulmonary receptors pro- moting bradycardia and hypotension are methods used to evaluate the cardiopulmo- nary receptors (Bezold-Jarisch reflex). The renal response is a reduction of vascular resistance and efferent sympathetic activity (50). The reflex response obtained in our laboratory after the stimulation of cardiopul- monary receptors by injecting serotonin was similar for diabetic and control rats (48), suggesting that the cardiovascular response to stimulation of chemosensitive cardiac re- ceptors is preserved in the STZ-diabetic model. However, the reflex response induced by a similar plasma volume expansion and associated changes in left ventricle end dia- stolic pressure produced lower bradycardia and hypotension in diabetic than in control rats. Furthermore, the modulation of renal sympathetic activity was abolished in STZ animals. The physiological role of this al- tered response in diabetes could be associ- ated with renal dysfunction in the balance between sodium and water intake and up- take, changing the natriuretic and diuretic responses in this condition. The reduction in renal sodium excretion associated with a decrease in renal sympathetic activation was also described by Patel and Zhang (49). Indeed, the examination ofthe various com- ponents ofthe volume reflex in different models of diabetic rats indicated an altered neural component associated with a humoral component ofthe effector limb probably related to atrial natriuretic factor (50).
General characteristics ofthe sample. Sociodemographic characteristics are summarized in Table 1. Mean age at baseline was 75.1 (SD 7.0) years; 25.4% ofthe sample was aged 80 years or older, 64.9% were female and 8.9% were living alone. Levels of education were relatively high, with only 2.5% illiteracy and 16.9% having at- tained tertiary education. here was a high prevalence of cardiovascular risk factors and of chronic non-com- municable disease; more than 40% of participants were current smokers, 73.9% of participants had been told that they were hypertensive, 18.5% had received a diag- nosis of diabetes, and 7.8% reported a stroke diagnosed by a clinician.
ABSTRACT: Laryngeal foreign bodies in adultsare rare. The foreign bodies accidentally entering the larynx are symptomatic in the form of choking, stridor or even death. We are presenting a rare case of foreign body in the larynx in a 42 year old male who was symptom free except for dysphonia. The foreign body was removed successfully under local anesthesia.
Among olderadults who reported at least one ofthe eight chronic diseases, 583 speciic medicines were reported to treat those diseases, which, in diferent dosage forms (including ixed-dose combinations), totaled 17,634 reports. he 40 most frequently cited medicines accounted for 73% of reports. In 63% of cases these were medicines for high blood pressure or heart diseases and cholesterol control; 13% for diabetes; and 13% were psychoactive. Table 4 features the 10 most reported medicines by olderadults, accounting for 49% of reports. he single most reported drug, considering only the number of reports within each disease separately, and not including ixed-dose combinations, was hydrochlorothiazide (9%), followed by losartan (8%), both reported for high blood pressure, heart diseases or stroke. Simvastatin, indicated for blood cholesterol control, was the third most reported drug (6%), followed by metformin for diabetes control (5%). he list was completed with enalapril (4%), captopril (9%), atenolol (6%), glibenclamide (4%), propranolol (2%), and furosemide (2, 0%), all reported for treating high blood pressure, withthe exception of glibenclamide, used to treat diabetes.
Therefore, in order to learn the degree of (in)dependence ofthe elderly, it is necessary to assess their functional ability, which is expressed through the performance of activities of daily living. The assessment ofthe functional ability is relevant and directly associated with indicators of quality of life ofthe elderly. The execution of activities of daily living is considered an accepted and legitimate parameter to establish this evaluation, which is used by professionals in health care to evaluate degrees of dependence in their patients. In this setting, it is possible to understand functional assessment, within a specific function, as the assessment ofthe ability to perform self-care and fulfill basic daily needs; that is, the execution of activities of daily living (4) .
but by comparing different degrees of religious involvement (from a non-religious to a deeply religious person). Church attendance, i.e. how often someone attends religious meetings, is one ofthemost widely used questions to investigate the level of religious involvement. Other questions are non-organizational religiosity (time spent in private religious activities such as prayer, meditation, and reading religious texts) and subjective religiosity (the importance ofthe religion in someone’s life). However, caution is necessary in interpreting the relationship between private religious practices and health in cross-sectional studies. People may pray more while they are sick or under stressful situations. Turning to religion when sick may result in a spurious positive a s s o c i a t i o n b e t w e e n r e l i g i o u s n e s s a n d p o o r h e a l t h . Conversely, a poor health status could decrease the capacity to attend a religious meeting, in that way creating another bias on the association between religiousness and health. Finally, a very important dimension of religiosity is religious commitment, which reflects the influence that religious beliefs have on a person’s decisions and lifestyle. According to the Harvard psychologist Gordon Allport 30 a persons’
In order to try to alleviate its traffic congestion problem, Sao Paulo adopted in 1997 a circulation restriction known as “rodízio” (or “rotation”). The restriction consisted of cars with license plates terminated by 0 and 1 being prohibited to circulate around downtown on Mondays, cars with license plates terminated by 2 and 3 cannot circulate on Tuesdays, and so on. Even though this policy is in place for more than a decade, congestion is much higher now than in 1997. Mexico City adopts a similar policy, called “Hoy no Circula”. Bogota has its version ofthe same policy called “Pico & Placa”, among many other examples. Besides such command and control measures, cities also invest massive amounts of resources in infrastructure to try to reduce congestion.