Saúde urbana: "a cidade é uma estranha senhora, que hoje sorri e amanhã te devora" * Urban health: "the city is a strange lady, smiling today, devouring you tomorrow"

Currently, half of the world population resides in cities. The percentage of world population that is elderly is expected to double from 11% to 22% by 2050 and will be concentrated in urban areas of developing countries. The purpose of this study was to evaluate the functional status of elderly who live in the Belo Horizonte Metropolitan Area, Minas Gerais State, Brazil. The International Classification of Functioning, Disability and Health (ICF) was employed as the theoretical model. Probabilistic sampling was used to select 1,611 elderly persons (defined as ≥60 years) for the study. The response variable "functional performance" was developed by counting the number of basic and instrumental activities of daily living (ADL) that subjects found difficult to carry out. A zero-inflated negative binomial (ZINB) regression model was fitted to the data. The prevalence of disability was 47.1%. Neighborhood self-perception revealed that 84.0% of the elderly were satisfied with their neighborhood, although only 18.4% trusted people around them. Concerns about walking around the neighborhood were: fear of being robbed (78.0%) and fear of falling due to sidewalk defects (48.2%), which caused a 62% increase in the number of ADL carried out with difficulty. It is well known that there is a continuous tendency for functional results to improve as the frequency of walking increases. Thus, urban infrastructure interventions, such as improving public sidewalks, might influence the frequency of elderlies walking in their neighborhoods. Making walking possible-or even pleasant-could increase their social participation and use of services.

Oxidative stress disturbances have been reported in depressed patients and in animals submitted to stress. Recent evidence suggests that antidepressants may have antioxidant properties. However, the therapeutic potential of antioxidants as antidepressant drugs has not been systematically investigated. Therefore, this study tested the hypothesis that N-acetyl-L-cysteine (NAC), a cysteine prodrug with powerful antioxidant activity, would possess antidepressant-like properties in the forced swimming test. Male Wistar rats were subjected to 15 min of forced swimming and immediately afterward, 5, and 23 h later received intraperitoneal injections of NAC (5, 15, 50, 150, and 250 mg/kg), imipramine, (15 mg/kg) or vehicle. One hour later they were submitted to the 5 min test swimming session, where immobility time was recorded. Independent groups of animals received the same treatments and their exploratory activity was measured in an open arena for 5 min. NAC (at the doses of 15, 50, and 150 mg/kg) and imipramine induced a significant decrease in immobility time without changing exploratory behavior measured in an open arena. These results suggest that antioxidants such as NAC may have antidepressant effects.

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Abstract

O objetivo deste estudo foi avaliar as questões sobre capacidade funcional utilizadas no Inquérito de Saúde da Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil, realizado em 2010, utilizando a Teoria de Resposta ao Item. Foram analisados: dimensionalidade da escala, posição dos itens na escala, poder de discriminação dos itens e precisão da estimativa da capacidade funcional. O estudo teve como base uma amostra de 2.174 idosos, com idades entre 60 e 99 anos, 61% mulheres e escolaridade mediana de 4 anos de estudos. O instrumento de 21 itens com 4 opções de respostas forneceu coeficiente alfa de Cronbach de 0,98; a análise fatorial mostrou existir um fator explicando 92% da variabilidade entre as questões. Os resultados indicaram: (i) redundância nas questões; (ii) precisão na estimação da capacidade funcional apenas para os idosos que estão abaixo da mediana na escala; e (iii) dificuldade dos idosos em discernir entre as opções de resposta. A análise sugere a necessidade de se discutir as questões a serem incluídas no instrumento, com vistas a uma maior cobertura da escala e melhor adequação das opções de respostas.

Background Excessive stress and anxiety can impair learning. The objective structured clinical examination (OSCE) is a valuable tool to assess and promote the acquisition of clinical skills. However, significant OSCE-related stress and anxiety are frequently reported. The aim of this study was to investigate the relationships between physiological stress, self-reported levels of anxiety due to an OSCE, self-efficacy, and the meanings that physical therapy students attribute to their experience with the exam. Design Concurrent mixed methods study. Methods A total of 32 students took part in this study. All were enrolled in the third semester of a 10-semester Physical Therapy Bachelor Program. Salivary cortisol levels, self-reported anxiety (State-Trait Anxiety Inventory, STAI) were measured before the OSCE. Exam scores and self-efficacy ratings were also recorded. Correlations between variables were tested with the Pearson correlation, with ɑ at 0.05. Semi-structured interviews were used to explore the personal perspectives of students. Thematic analysis was used to investigate emergent themes. Results Trait anxiety scores were significantly higher than normative values (p < 0.001). A high proportion of students showed high (STAI> 49) state anxiety (37.5%) and trait anxiety (65.6%). Salivary cortisol was not associated anxiety (p > 0.05). Neither stress nor anxiety correlated with OSCE scores. A moderate and significant direct correlation was found for self-efficacy scores and OSCE scores (r = 0.475, p = 0.007). Students reported that confidence had a calming effect and led to better self-perceived performance. They also reported that the OSCE can provide meaningful learning experiences despite being stressful. Conclusions A high proportion of our students reported a stable/lingering negative affect. However, neither stress nor anxiety related to OSCE scores. Students’ confidence in their capabilities was correlated with their performance. Their subjective reports suggest that self-confidence may have protected them from the negative effects of stress and anxiety on academic performance.

OBJECTIVE To determine the impact of the physical and social surroundings of the neighborhood, which are presented as facilitators or barriers for the social participation of Brazilian older adults.METHODS The study was conducted in a probabilistic representative sample of the Brazilian population aged 50 years and older and who lived in urban areas (n = 7,935). The response variable was social participation, which was defined from two questions about activities performed with other persons: visited friends or relatives in their homes in the last 12 months (yes, no); went out with other persons to public places, such as restaurant, movies, club, park, in the last 12 months (yes, no). The explanatory variables included fear of falling because of defects in sidewalks, concern about the difficulty to get on a bus, subway, or train, difficulty to cross streets, and perception of violence in the neighborhood. Potential confounding variables included age, marital status, education level, self-rated health, living in an asphalted or paved street, time living in the municipality, and socioeconomic position score. Prevalence ratios and respective confidence intervals were estimated using Poisson regression.RESULT Difficulty to cross streets presented an independent association with restricted social participation (PR = 0.95; 95%CI 0.93–0.98) among both women (PR = 0.96; 95%CI 0.92–0.99) and men (PR = 0.94; 95%CI 0.90–0.99). Concern about the difficulty to get on a bus, subway, or train was associated with the outcome only among men (PR = 0.95; 95%CI 0.91–0.99). The fear of falling because of defects in sidewalks and the perception of violence in the neighborhood were not associated with social participation.CONCLUSIONS Urban characteristics that hinder the crossing of streets and accessibility to public transport can be inferred as important barriers for the social participation of Brazilian older adults.