Vaccination is the most effective measure to prevent the complications of influenza. This population-based study aimed to estimate influenza vaccine coverage in non-institutionalized elderly, analyze the factors involved in lack of influenza vaccine uptake, and identify post-vaccination adverse effects. The study population lived in an urban neighborhood in Southern Brazil, and the sample consisted of 425 elderly. A total of 396 elderly individuals (age 60-95 years) were interviewed. Although 100% of the sample reported knowing about the vaccine, only 5.3% referred to their personal doctor as the source of information. Among elders that had not received the vaccine, 83.2% were explicit about not wanting to take it. The main reasons were fear of adverse effects and disbelief in the vaccine's effectiveness. However, the actual prevalence of adverse effects was low. Age, smoking, and lack of a doctor's appointment in the previous year were independently associated with vaccine non-compliance. The results show that improvements are needed in the immunization campaign, especially targeting elders less than 70 years of age and smokers.

Cabrera MAS, Dip RM, Furlan MO, Rodrigues SL. Use of drugs that act on the cytochrome p450 system in the elderly. Clinics. 2009;64(4):273-8. OBJECTIVES:The objective of this study was to analyze medications that act on the cytochrome P450 (CYP450) enzymatic system and are used daily by non-institutionalized elderly individuals. METHODS: A cross-sectional population-based study of elderly individuals (≥ 60 years old) was conducted. All continuously used medications with hepatic metabolism via CYP450 that are classified as substrates, inducers or inhibitors were considered. For the analysis, elderly individuals were stratified according to age groups, and hepatic metabolism activity due to daily alcohol consumption and smoking were considered. RESULTS: Elderly individuals (396 in total: 222 women and 174 men) between 60 and 95 years of age (mean: 72.1) were assessed. Use of drugs that act on CYP450 was identified in 61.6% of the subjects. Drug use was observed among 16.2% of the subjects: three drugs among 9.8% and four or more among 6.3% of the subjects. The metabolic activities of the drugs used were classified as substrates (58.8%), inhibitors (14.9%), and inducers (4.3%). The main drugs used were beta-blockers and statins (as substrates), proton pump inhibitors and fluoxetine (as inhibitors), and prednisone and carbamazepine (as inducers). CONCLUSIONS:The results demonstrate that the elderly use high levels of medications that act on CYP450, thereby increasing the risk of drug interactions in a group that is already vulnerable to adverse drug effects.

This is a 12-year follow-up cohort study with 800 people (60–85 years old). The association between lipid disorders and mortality was analysed by Cox proportional hazard adjusted model. All-cause mortality was considered the dependent variable, and lipid disorders as independent variables: total cholesterol (TC) >200 and <170 mg/dl, HDL-c <35 and 40, LDL-c >100 and 130, and triglycerides (TG) >50. An initial analysis of all subjects was performed and a second was carried out after having excluded individuals with a body mass index (BMI) <20 kg/m2 or mortality in ≤2 years. The mortality showed a positive association with low TC and a negative association with high TC and high LDL-c. After the exclusion of underweight and premature mortality, there was a positive association only with TC <170 mg/dl (HR = 1.36, CI95%: 1.02–1.82). The data did not show a higher risk with high levels of TC, LDL-c, and TG. However, they showed higher mortality among older adults with low TC.

OBJECTIVE The objective of this study is to analyze the frequency and factors associated with falls in adults aged 55 years or more.METHODS This is a study inserted into another population-based study with representative sample of persons aged 40 years or more of the urban area in a medium-sized municipality of the State of Paraná, Brazil, in 2011. That study obtained demographic and socioeconomic data and characteristics related to life habits, health conditions, and functional capacity (n = 1,180). In 2012, we selected all persons aged 55 years or more (n = 501). We have estimated grip strength and the occurrence of a fall since the last interview in 80.6% of the adults. The crude and adjusted odds ratios (OR) have been calculated by logistic regression according to a hierarchical model.RESULTS The rate of fall was 24.3%. After adjustments, we could observe higher chances of falls among women (OR = 3.10; 95%CI 1.79–5.38), among persons aged 65 years or more (OR = 2.39; 95%CI 1.45–3.95), with poor sleep quality (OR = 1.78; 95%CI 1.08–2.93), and with low grip strength (OR = 2.31; 95%CI 1.34–3.97).CONCLUSIONS Poor sleep quality and low muscle strength can be indicators of increased risk of falls and need assessments and interventions aimed at preventing them.

I PALAVRAS-CHAVE:-Ensino; -Habilidades; -Atitudes; -Aprendizagem Baseada em Problemas;-Avaliação. RESUMO Este artigo relata a experiência do ensino de Habilidades e Atitudes, na graduação em Medicina da ABSTRACT This article describes an experience of teaching Attitudes and Skills in a medical course at the Londrina State University using the methodology of Problem-Based Learning grounded in a biopsychosocial model. The teaching of Attitudes and Skills requires from teachers a multi-axial diagnostic formulation in a contextual and standardized description of the clinical condition through a number of highly informati

BackgroundLoss of muscle strength exerts a considerable impact on the quality of life and mortality of older adults. The present household survey study measured body composition and muscle strength with the aim of analyzing the roles of low lean mass, low muscle strength and obesity in stair negotiation ability and the effect of comorbidities on the relationship between body composition and functional capacity.MethodsBody composition was assessed using bioelectrical impedance analysis and muscle strength was assessed with a hand grip dynamometer. The study population comprised individuals >55 years of age from a medium-sized Brazilian municipality. The sample included 451 participants.ResultsA total of 368 subjects were interviewed; their ages varied from 56 to 91 years. Among males, low muscle strength was associated with stair negotiation difficulty independent of muscle mass, age and obesity but muscle mass was not. However, when we analyzed comorbidities and body composition jointly, chronic lower limb pain and obesity were independently associated with stair negotiation difficulty but body composition and age were not. Among women, after comorbidities were included into the model, low muscle strength and obesity remained associated with stair negotiation difficulty as chronic lower limb pain and depression. The relationship between muscle function and comorbidities is discussed in this article.

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-Anthropometric indicators enable professionals for predicting risk of falls in the elderly; however, there is a gap in literature on reference values. This study analyzes anthropometric indicators such as screening tests for falls in the elderly. Cross-sectional population-based systematic sampling was conducted through a household survey and body composition assessment. Anthropometric measurements were performed using portable electronic scale and stadiometer. Bioimpedance device was used to measure body mass index, body fat and lean body mass. Falls were evaluated in the 12 months preceding the interview as a dependent variable. Discriminatory analysis was performed for falls through the ROC curve, sensitivity, specificity, positive and negative predictive values. Overall, 275 older adults participated in this study, whose prevalence of falls was 23.6%. The average body mass index was 27.8kg/cm 2 and 52.1% of individuals were overweight. Among older men, height (ROC=0.68; 95%CI 0.54-0.78) and lean body mass (ROC=0.63, 95%CI 0.58-0.76) were associated to the occurrence of falls. When considering cutoff of 52.2kg and 166cm, sensitivity was obtained in 75% and high negative predictive values (88.1% and 89.1% respectively). For women, lean body mass (ROC=0.61, 95%CI 0.30-0.49) and body mass (ROC=0.60, 95%CI 0.53-0.72) were relevant from the optimal cutoff point of 28.9% and 57.2kg/m 2 . Lean body mass was more sensitive (63.2%) and body mass little more specific (64.3%), both with high negative predictive values (82.0% and 83.0%). The indicators used were able to discriminate older adults who have suffered from falls.Key words: Anthropometry; Obesity; Older adults; ROC Curve; Sarcopenia. ROC=0,68; IC95%=0,78) e massa corporal magra (ROC=0,63; IC95%=0,76) (88,1% e 89,1% respectivamente). Para as mulheres, a massa corporal magra (ROC=0,61; IC95%=0,49) e a massa corporal (ROC=0,60; IC95%=0,72) Resumo -Indicadores antropométricos instrumentalizam profissionais para predizer risco de quedas em idosos, entretanto, há lacunas de evidências na literatura sobre valores de referência. O objetivo foi analisar os indicadores antropométricos como testes de rastreio para quedas em idosos. Estudo com delineamento transversal de base populacional