Impaired physical mobility in elderly: related factors and defining characteristics

The present exploratory study aims at estimating the occurrence of the Nursing Diagnosis "Impaired Physical Mobility' in elderly who live in a home institution in the city of Goiania, Goiás. The study was carried out from December 1999 to February 2000. The collection of data was done through interviews, observations, physical exam and information obtained from the professionals who assisted the elderly. Sixty patients ranging from 60 to 105 years were the subjects of this study. Results showed 100% of the elderly were impaired regarding physical mobility. This impairment was generally related to muscular-skeletal-weakness (76.7%), reduced muscle resistance and strength (61.7%), neuro-muscular weakness (55%), besides perceptional or cognitive damage (53.3%). The most frequent defining characteristics were: decreased flexibility (96.7%), jeopardized articulations (96.7%), and inability to move in a physical environment (83.3%).     

Poverty,social exclusion and health in Portugal

People in Portugal have never been so healthy. Nevertheless, there are great differences in health status between social groups and regions. In 1994, Portugal was the country with the second worst level of inequality in terms of income distribution and with the highest level of poverty in the European Union (EU). Poverty in Portugal affects mainly the elderly and women (especially in single parent families). Beyond these groups, there are the children, the ethnic minorities and the homeless. Substance abusers, the unemployed, and ex-prisoners are also strongly affected by situations of social exclusion and poverty. Although poverty has been an important issue on the political agenda in Portugal, it shows a worrying tendency to resist traditional Social Security interventions. In the late 1990s, however, welfare coverage rates appear to have risen. To what extent can poverty cause a worsening of health status? Is there any sustainable positive association between welfare and improved health status? How, to whom and when should actions to improve the health status of the disadvantaged be addressed, without subverting the health status of the rest of the population. It is also necessary to reveal the consequences of poor health to individuals, families and communities in terms of income, social empowerment and the ability to fulfil other needs. Finally, reflection on the role and effectiveness of traditional social security models is necessary, in order to improve the impact and adequacy of its interventions. The goal of this paper is to contribute to the knowledge about disadvantage, the current health situation of the most vulnerable groups in Portuguese society-those affected by poverty, deprivation and social exclusion-and to detect the constraints on access to health and health care.     

Minimally invasive video thoracoscopic correction of pectus excavatum

Pectus excavatum, the most common congenital deformity of the chest wall, has esthetic, psychological and social repercussions as well as a slight impact on pulmonary function. Treatment is surgical and is carried out for esthetic purposes in most cases. The most commonly applied surgical technique is based on the one originally described by Ravitch: sub-perichondrial, bilateral chondrectomy and sternal osteotomy. In 1997, however. Nuss described a minimally invasive approach to correction by means of a support bar. Our objective was to perform minimally invasive correction of pectus excavatum using a substernal extrapleural approach guided by video-assisted thoracoscopy. We treated three patients over 15 years of age without surgical complications. In all three cases, the minimally invasive technique corrected the pectus excavatum with excellent esthetic results. Both the path of insertion and duration were shorter with the described approach than with traditional surgery. Video images facilitated extrapleural insertion of the bar and minimized complications.     

Diagnostic usefulness of brief versions of Alcohol Use Disorders Identification Test (AUDIT) for detecting hazardous drinkers in primary care settings

OBJECTIVE: The aim of this study was to evaluate the diagnostic usefulness of the brief versions of the Alcohol Use Disorders Identification Test (AUDIT) for detecting hazardous drinkers and to compare it with that of the full-AUDIT in primary care settings. METHOD: Five hundred patients were randomly selected in a primary care center. An interview on quantity-frequency was administered for assessment of weekly alcohol intake. The standard used for classification of hazardous drinkers was a weekly alcohol consumption of 280 g for men and 168 g for women. Cut-off points were 8 for the full-AUDIT, 1 for the AUDIT-3 (third item), 3 for the AUDIT-C (items 1, 2 and 3), 5 for the AUDIT-PC (items 1, 2, 4, 5 and 10) and 3 for the modified Fast Alcohol Screening Test (m-FAST; items 3, 5, 8 and 10). Sensitivity, specificity, positive and negative predictive values, and areas under the receiver operating characteristic (AUROC) curves were measured. RESULTS: Diagnostic usefulness of the questionnaires for detecting hazardous drinkers was for the full-AUDIT: 81.4% sensitivity, 94.6% specificity and 0.97 AUROC curve; for the AUDIT-3: 83.1% sensitivity, 90.9% specificity and 0.89 AUROC curve; for the AUDIT-C: 100% sensitivity, 79.4% specificity and 0.97 AUROC curve; for the AUDIT-PC: 98.3% sensitivity 90.9% specificity and 0.97 AUROC curve; and for the m-FAST: 79.7% sensitivity, 93.7% specificity and 0.93 AUROC curve. CONCLUSIONS: The AUDIT-C and AUDIT-PC show a higher sensitivity, lower specificity and a similar AUROC curve than the full-AUDIT, thus allowing their use as screening instruments that are as reliable as the original test for detecting hazardous drinkers. The AUDIT-3 and m-FAST, when compared with the full-AUDIT, performed less well, therefore limiting their use for this purpose.     

Nontraditional work factors in farmworker adolescent populations: implications for health research and interventions

Agriculture has been documented to be one of the most hazardous work environments for both adults and children. Adolescents may be especially vulnerable to adverse health effects from agricultural exposures due to the rapid growth and development experienced during those years. Separating the occupational, economic, and social issues in this population is difficult. Weak regulatory protection, lack of compliance with existing regulations, and gaps in service provision characterize the working conditions of adolescent farmworkers. Although there is increasing research on the impact of work organization on mental and physical health in adult working populations, there is a scarcity of research focused on this concept in young workers--and it remains virtually unaddressed in young farmworkers. Work characteristics of the informal work sector, better delineated in international literature, should be considered when planning research or interventions in this at-risk population. Further, the population of adolescent farmworkers is diverse, and research strategies and interventions need to be targeted and tailored to the heterogeneous groups. This article addresses some of the nontraditional work factors associated with the less-than-formal work organization and environments in the farmworker adolescent population and how these factors may inform the planning of research and interventions. Specifically, mobility, cultural patterns and social networks, alternative sampling strategies, alternative delivery of health care and education, and involvement of a wide range of players in the work environment of adolescent farmworkers should all be considered when conducting research or planning programs for this population.     

Joint effects of smoking, noise exposure and age on hearing loss

BACKGROUND: Smoking has been shown to have adverse effects on hearing, but it's unclear whether smoking interacts with known causes of hearing loss such as noise exposure and ageing. AIMS: To examine the hypothesis that smoking, noise and age jointly affect hearing acuity. METHODS: This cross-sectional study was carried out in 535 male adult workers of a metal processing factory. Pure-tone audiometric tests were utilized to assess hearing loss. Noise exposure assessment was based on a job exposure matrix constructed with industrial hygienist scoring and job titles. Each participant answered questionnaires about socio-demographic, life-style, occupational and health-related data. Analysis of the possible underlying biological model was undertaken assessing departures from additivity using measures of the size of the interaction present. RESULTS: Age and occupational noise exposures were, separately, positively associated with hearing loss. For all the factors combined the estimated effect on hearing loss was higher than the sum of the effects from each isolated variable, especially for smoking and noise among those 20-40 years of age, and for smoking and age among those non-exposed to occupational noise. CONCLUSIONS: The synergistic effect of smoking, noise exposure and age on hearing loss, found in this study, is consistent with the biological interaction. Furthermore, it is possible that distinct ototoxic substances in the chemical composition of mainstream smoke may synergistically affect hearing when in combination with noise exposure, which needs to be examined in future studies.     

Incidence, clinical features and subtypes of delirium in elderly patients treated for hip fractures

OBJECTIVE: To describe the incidence, risk factors and clinical features (subtypes) of delirium during the postoperative period after hip fracture surgery in elderly patients. DESIGN: Prospective study. METHODS: Thirty-four consecutive patients (9 men and 25 women) were included in this study between June 16 to July 14, 2003. All patients underwent surgery for a fractured neck of femur and were pre- and postoperatively cared for at a combined geriatric/orthopedic ward. ASSESSMENT: The diagnosis of delirium was based on the criteria of the DSM-IV and the Confusion Assessment Method Scale. Subtypes of delirium were classified according to the criteria proposed by Lipowski: hyperactive-hyperalert (or agitated), hypoactive-hypoalert (somnolent) and mixed delirium. Results: Fifty-five percent (n = 19) of the 34 patients developed delirium after surgery. The development of delirium was associated with the medication midazolam taken perioperatively. Nine (47%) of the delirious patients had a hyperactive type of delirium; 5 (26%) developed a hypoactive delirium, and 5 (26%) had a mixed type. We did not find any association among subtypes of delirium and clinical features. CONCLUSIONS: Delirium is a common complication in the postoperative period of elderly patients treated for hip fractures. The use of midazolam in the perioperative period increased the risk of developing postoperative delirium. The hyperactive type of delirium was the most common subtype of delirium.     

Radiographic assessment of resectability of locoregional disease in children with high-risk neuroblastoma during neoadjuvant chemotherapy

BACKGROUND: The optimal timing for attempting removal of the primary tumor and regional disease in patients with high-risk neuroblastoma is uncertain. The purpose of this study was to evaluate resectability of the primary tumor and regional disease, as determined radiographically, in children with high-risk neuroblastoma during neoadjuvant chemotherapy. PROCEDURE: Patients enrolled in our institutional high-risk neuroblastoma protocol were evaluated prospectively by CT scan and/or MRI to determine the resectability of their primary tumor and regional disease at diagnosis, after two cycles of experimental therapy and after standard induction therapy. Tumors were considered to be unresectable if there was significant involvement with major vascular structures or contiguous organs, or would likely require nephrectomy to remove the entire tumor. RESULTS: Twenty-four patients were referred prior to surgery for treatment of high-risk neuroblastoma. Seven of 24 (29%) patients were felt to be resectable at diagnosis, with an additional 9 patients becoming resectable after the initial experimental therapy. Thus, overall, 16 of 24 (67%) patients were felt to be resectable by the completion of the initial therapy. Only four additional patients of the remaining eight were considered resectable after the completion of standard induction therapy. CONCLUSIONS: Based on these data, we conclude that complete resection of the primary tumor and regional disease in children with high-risk neuroblastoma can be performed after an initial phase therapy in the majority of patients. Since earlier tumor removal may decrease the chance for the subsequent development of chemotherapy-resistant disease, we are recommending surgical resection as soon as the locoregional disease appears to be resectable.