Artigos de revisão INTRODUÇÃOOs termos envelhecimento ou senescência têm sido indistintamente empregados para definir o processo pós-maturacional responsável pela diminuição da homeostasia e aumento da vulnerabilidade do organismo. O envelhecimento tem sido classificado como normal ou usual. Normal, quando envolve mudanças fisiológicas universais e inexoráveis; usual, quando inclui doenças relacionadas à idade 1 . O processo de envelhecimento -normal ou usual -ocasiona modificações na quantidade e qualidade do sono, as quais afetam mais da metade dos adultos acima de 65 anos de idade, que vivem em casa e 70% dos institucionalizados 2 , com impacto negativo na sua qualidade de vida. Sono e envelhecimentoLorena Teresinha Consalter Geib* Alfredo Cataldo Neto** Ricardo Wainberg*** Magda Lahorgue Nunes**** Essas modificações no padrão de sono e repouso alteram o balanço homeostático, com repercussões sobre a função psicológica, sistema imunológico, performance, resposta comportamental, humor e habilidade de adaptação 3 . Os fatores que contribuem para os problemas de sono na velhice podem ser agrupados nas seguintes categorias: 1) dor ou desconforto físi-co; 2) fatores ambientais; 3) desconfortos emocionais e 4) alterações no padrão do sono. Nessa última categoria, incluem-se as queixas referentes ao tempo dispendido na cama sem dormir, dificuldade para reiniciar o sono, menor duração do sono noturno, maior latência de sono e despertar pela manhã mais cedo do que o desejado. Além dessas queixas, são também prevalentes a sonolência e a fadiga diurna, com aumento de cochilos 4 , o comprometimento cognitivo 5,6 e do desempenho diurno 7,8 , e vários outros problemas, que, embora não sejam específicos do envelhecimento, têm um grande impacto sobre os idosos em decorrência de seus efeitos sobre o sono: falta de adaptação às perturbações emocionais, hábitos inadequados de sono, transtornos orgânicos e afetivos, uso de drogas (psicotrópicas ou outras), agita-* Professora Titular do curso

OBJECTIVETo analyze the prevalence of depression in older adults and associated factors.METHODSCross-sectional study using a stratified random sample of 621 individuals aged ≥ 60 from 27 family health teams in Porto Alegre, RS, Southern Brazil, between 2010 and 2012. Community health agents measured depression using the 15-item Geriatric Depression Scale. Scores of ≥ 6 were considered as depression and between 11 and 15 as severe depression. Poisson regression was used to search for independent associations of sociodemographic and self-perceived health with both depression and its severity.RESULTSThe prevalence of depression was 30.6% and was significantly higher in women (35.9% women versus 20.9% men, p < 0.001). The variables independently associated with depression were: female gender (PR = 1.4, 95%CI 1.1;1.8); low education, especially illiteracy (PR = 1.8, 95%CI 1.2;2 6); regular self-rated health (OR = 2.2, 95%CI 1.6;3.0); and poor/very poor self-rated health (PR = 4.0, 95%CI 2.9;5.5). Except for education, the strength of association of these factors increases significantly in severe depression.CONCLUSIONSA high prevalence of depression was observed in the evaluations conducted by community health agents, professionals who are not highly specialized. The findings identified using the 15-item Geriatric Depression Scale in this way are similar to those in the literature, with depression more associated with low education, female gender and worse self-rated health. From a primary health care strategic point of view, the findings become still more relevant, indicating that community health agents could play an important role in identifying depression in older adults.

No abstract

The association of childhood maltreatment and suicide has been extensively examined within the population. Depression figures as a main cause for the elevated suicide rate in advanced ages and is often related to childhood maltreatment. The purpose of the present study was to examine the relationship between childhood maltreatment subtypes and suicide risk, testing geriatric depression as a moderator. This is a cross-sectional study looking at a sample of 449 individuals 60 year s old or older from the Multidimensional Study of the Elderly of Porto Alegre Family Health Strategy, Brazil (EMI-SUS/POA). Childhood maltreatment (Childhood Trauma Questionnaire), geriatric depressive symptoms (Geriatric Depression Scale), and suicide risk (Mini International Neuropsychiatric Interview) were assessed. The subtypes of childhood abuse and neglect were significantly associated with suicide risk. In the multivariate analysis, controlling for age, gender, income, marital status, ethnicity, smoking, and geriatric depression symptoms, all trauma subtypes remained associated with suicide risk with the exception of physical neglect (EA = 3.65; PA = 3.16; SA = 5.1; EN = 2.43; PN = 1.76). The present study showed that childhood maltreatment subtypes predicted suicide risk, and geriatric depression does not directly mediate this relation.

No abstract

Background:Childhood maltreatment is an important factor associated with adverse mental health outcomes including geriatric depression and the “big five” personality characteristics. The objective of this study was to evaluate a model where personality characteristics mediate the relationship between childhood maltreatment and geriatric depression.Method:In this cross-sectional study, elderly subjects from socioeconomically disadvantaged neighborhoods of Porto Alegre, Brazil (n = 260) completed the Childhood Trauma Questionnaire (CTQ), NEO-Five Factor Inventory (NEO-FFI), and Mini International Neuropsychiatric Interview 5.0 (MINI plus). We used structural equation modeling (SEM) to evaluate the mediation hypothesis.Results:The five personality factors (neuroticism, extraversion, agreeableness, openness, and conscientiousness) were related to childhood maltreatment and depression. Mediation analysis revealed that neuroticism and extraversion are complete mediators, agreeableness and conscientiousness are partial mediators, and openness is not a mediator.Conclusions:These findings support the hypothesis in which childhood maltreatment is associated with geriatric depression and mediated by personality factors. These results suggest that reducing the maladaptive personality trait in elderly people who suffered childhood maltreatment could prevent geriatric depression.

BACKGROUNDS -Tattooing is an atavist and diffuse phenomenon of interest to various areas of knowledge. Its practice by specific groups such as prisoners and psychiatric patients has turned it into a stigma. OBJECTIVES: To investigate the discourse of tattooed individuals about the discrimination and the construction of stigmas resulting from marks in the body. METHODS: 42 individuals were interviewed and the data were analyzed. RESULTS: The profile of the participants was as follows: most were women; with 2 to 4 tattoos; who were about 23 years old when they got their first tattoo; with an undergraduate degree; who viewed tattooing as a trend; who did not report any important fact that made them get a tattoo; who classified the pain of getting a tattoo as tolerable, who stated that never felt discriminated and never felt the need to hide the tattoos; who find that tattoos make them more sexually attractive; who do not view tattooing as a form of cultural resistance; who said they would not have done it if they believed it caused them professional problems; who stated that they were not drunk when they got the tattoos; who said they were not habitual drugs users, who believed that tattooing is a form of expression and aesthetic sense. CONCLUSION A difference between the discourse of tattooed individuals and their acts was observed in relation to the social context. In addition, there has been an important shift in the meaning of the practice to tattooed individuals. Keywords: Prejudice; Skin; Tattooing Resumo: FUNDAMENTOS -A tatuagem é um fenômeno atávico e difuso que suscita abordagem por diversos saberes. Sua utilização por grupos específicos como prisioneiros e pacientes psiquiátricos sempre a manteve associada a um caráter de estigma. OBJETIVOS -Buscar o discurso do tatuado acerca da discriminação e da construção de estigmas a partir da inscrição de marcas no corpo. MÉTODOS -Foram analisadas entrevistas de 42 indivíduos. RESULTADOS -O perfil obtido foi de maioria de mulheres; com duas a quatro tatuagens; com 23 anos ao fazê-las; com formação superior completa; que acham que era moda fazer tatuagens; que não referem nenhum fato marcante que os tenha levado a fazer o desenho; que classificam a dor como suportável; que afirmam que nunca se sentiram discriminados; que nunca esconderam sua tatuagem; que acham que a tatuagem é um atrativo sexual; que não veem a tatuagem como uma forma de resistência cultural; que deixariam de fazê-la se lhes trouxesse prejuízo profissional; que dizem não ter usado álcool quando fizeram o desenho; que afirmam não serem usuários habituais de drogas; que acham que a tatuagem é uma forma de se expressar e de se embelezar. CONCLUSÕES -Percebeu-se que existe uma diferença entre o discurso do tatuado e os seus atos, quanto ao contexto social, e verificou-se uma importante mudança no significado da prática para o tatuado. Palavras-chave: Pele; Preconceito; Tatuagem

Background: In several countries, prevalence studies demonstrate that chronic use of BZD in the elderly population is very high. This scenario has reached pandemic proportions for decades and is an important public health problem. Objectives: To examine the independent association between chronic benzodiazepine use in depression, anxiety and bipolar disorder, as well as other clinical and sociodemographic factors. Methods: This cross-sectional study was developed from a population-based survey and conducted from March, 2011 to December, 2012 using a random sample of 550 elderly people who were enrolled in the Family Health Strategy in Porto Alegre, Brazil. Data was collected from identifying epidemiological and health data (sociodemographic, self-perception health, self-reported diseases, smoking, alcohol and pharmacotherapeutic evaluation) and from the diagnoses of mood and anxiety disorders. Results: Elderly patients diagnosed with depression, anxiety, concomitant depression/anxiety and bipolar disorders, and those who were using antidepressants have a higher risk of benzodiazepine use. Individuals who self-reported drinking alcohol had a lower risk of benzodiazepine use. Discussion: Benzodiazepines are often used by the elderly for long periods, which has a direct impact on the treatment of mood and anxiety disorders and on vulnerable groups such as the elderly, who may be unnecessarily taking these drugs.