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Liz Vaccariello, Cynthia Sass, Keith L. Moore, Arthur F. Dalley, Anne M. Agur, Oblicuo externo del abdomen , cuadrado lumbar, iliocostal ipsolaterales. Oblicuo externo del abdomen , transverso del abdomen , recto del abdomen , piriforme, cuadrado lumbar y Cinco ejercicios infalibles para lograr un abdomen plano.
Cirujanos pioneros han salvado la mano de un hombre y han evitado amputarla creando un 'bolsillo' dentro de su abdomen. Un hombre fue asesinado de un disparo en el abdomen. Motorizados matan a hombre de un balazo en el abdomen. Abdomen [online]. Spanish words that begin with a. Spanish words that begin with ab. Spanish words that begin with abd. Load a random word. Discover all that is hidden in the words on. While there is no evidence to show UI as a risk factor for cognitive deficit, this result makes clear the importance of assessing the condition in elderly individuals who report or have a diagnosis of UI.
It is known that mental deficiency is an important risk factor for the development of incontinence16, despite the scarcity of studies. This association is expected considering the impact of UI on the psychosocial life of the elderly. It is also worth noting that most of the studies conducted with the elderly focus on the female population, and there is a need to broaden this theme among elderly men. Among the limitations of the present study, we highlight the fact that the association between the types of UI and the health conditions studied was not investigated.
There is also the possibility that the individuals of the study were in drug treatment for UI and at the time of data collection did not mention urine leakage. It is suggested that longitudinal surveys are carried out to verify the causal relationship between the variables. It is also worth mentioning that while there is no biological plausibility that UI causes functional disability and cognitive deficit, the relationship of these conditions with incontinence is evident, highlighting the need to evaluate physical and mental health conditions in the practice of care of the elderly with a diagnosis of UI.
These are common conditions in primary care and negatively affect the quality of life of the elderly. These findings may support public policies for the elderly population, strategies to prevent UI and its effects on the health of this population and the organization of treatment in primary health care. In addition, its prevalence is higher among the elderly, women, older elderly people, those with yellow or brown skin or indigenous, and those without schooling. Urinary incontinence should not be understood as a normal alteration of the physiology of aging, and thus health education actions and guidelines for individuals at all ages are required.
In this sense, the training of health professionals regarding the approach to incontinence, methods of evaluation and. It is suggested that longitudinal studies are carried out to verify the relationship between incontinence and physical and mental health indicators, as well as the impact on the quality of life of the elderly. Rev Bras Enferm [Internet]. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society.
Urology [Internet]. J Am Geriatr Soc [Internet]. Rev Bras Epidemiol [Internet]. Self-reported urinary incontinence in elderly and its associated factors. Factors associated with urinary incontinence in elderly individuals who meet frailty criteria. Prevalence of Self-reported urinary incontinence in community-dwelling older adults of Westmoreland, Jamaica. Prevalence of urinary incontinence in a random sample of the urban population of Pouso Alegre, Minas Gerais, Brazil.
Rev Latinoam Enferm [Internet]. Neurourol Urodyn. Factors associated with self-reported and medically diagnosed urinary incontinence among communitydwelling older women In Korea. Int Neurourol J [Internet]. Neurourol Urodyn [Internet]. Urinary incontinence and its association with functional physical and cognitive health among female nursing home residents in Switzerland. BMC Geriatrics [Internet]. Association of functional ability and benign prostatic hyperplasia with urinary incontinence in older Korean men.
Occult urinary incontinence in elderly women and its association with geriatric condition. Associated factors to urinary incontinence in women undergoing urodynamic testing. Rev Bras Geriatr Gerontol [Internet]. Urinary incontinence and risk of functional decline in older women: data from the Norwegian HUNTstudy. BMC Geriatr. Functional disability and compromised mobility among older women with urinary incontinence.
Female Pelvic Med Reconstr Surg. Urinary incontinence and depression in middle-aged United States women. Obstet Gynecol. Anxiety and depression associated with incontinence in middleaged women: a large Norwegian cross-sectional study. Int Urogynecol J. Urinary incontinence and prevalence of high depressive symptoms in black and white older women. Int Urogynecol J [Internet]. Poor self-rated health and associated factors among elderly urban residents.
Negative selfrated health in the elderly in cities with different levels of economic well-being: data from FIBRA. Am J Public Health [Internet]. Home health care for the elderly: associated factors and characteristics of access and health care. Urinary incontinence in women and racial aspects: a literature review. Abstract Objective: to develop an app for the investigation and prevention of osteoporosis for use by health professionals.
Method: the development of the app was performed in six steps: definition of the target audience; survey of validated osteoporosis risk assessment tools in Brazil; programming of the app through the progressive web; selection of data for the preparation of sections of the evaluation form and clinical recommendations; automated auditing and evaluation of the app by health professionals. Results: three screens were prepared for the app. These were based on the data extracted using the Osteorisk, Sapori and Frax tools for sociodemographic data age, gender, weight, height and ethnicity , health use of glucocorticoids, hormone replacement therapy, arthritis rheumatoid arthritis, secondary osteoporosis, previous low impact fractures, parents with a history of hip fractures and health related behaviors physical activity, alcohol intake and smoking.
The appl followed the design pattern and functionalities of the osteoporosis adviser tool OPAD. Regarding guidelines relating to clinical recommendations, the guidelines on osteoporosis and fall prevention in the elderly of the Ministry of Health and the Brazilian Society of Geriatrics and Gerontology, respectively, were taken as a basis. Conclusion: the app allows the early identification of patients presenting risk factors for osteoporosis and, based on these results, provides guidance on the preventive measures to be adopted, aiming at reducing complications resulting from fractures, hospitalizations, disabilities and deaths.
Rio de Janeiro, Rio de Janeiro, Brasil. This situation encourages greater use of telecare and apps and decision support tools in this area, and in turn to more publications in the application of mobile technology in health line of research2. The spread of information and communication technologies, with the global use of mobile devices and broadband expansion, has had major repercussions in the area of medicine. This technological configuration has enabled the development of web systems and specific applications for health professionals and patients.
Examples include the Alzhe alert, which estimates the risk of a person developing Alzheimer's disease over the years, depending on their daily habits and activities3; and ADep Ayuda para depression in Spanish , a free access program on psychoeducation and cognitive-behavioral intervention for depression, produced in Mexico4. One of the great challenges facing Brazil is the aging of its population.
Osteoporosis and fractures due to frailty are highlighted by high costs to public health, negatively impacting the quality of life of the elderly. In Brazilian studies, the reported prevalence of osteoporosis among postmenopausal women ranges from In general, these studies also show a high prevalence of all types of fractures due to bone fragility, varying from Paulo showed that low-energy trauma was the cause of It is estimated that Aiming to avoid these complications, several European, North American and Asian studies have demonstrated the clinical relevance of assessment tools that can be used to identify individuals at a higher risk of developing osteoporosis.
The objective of this study was to develop a progressive web app to assist health professionals in the assessment and prevention of osteoporosis with content based on risk assessment tools available in literature. METHOD A study was performed to develop a low-cost app that can be used by any health service and is easy to install on mobile devices. The steps for building the app involved the definition of the target audience; a survey of validated osteoporosis risk assessment tools in Brazil; programming of the app through the progressive web; selection of data for the sections of the assessment form and clinical recommendations; automated auditing and evaluation of the app by health professionals.
Survey of validated osteoporosis risk assessment tools in Brazil A survey of scientific publications was carried out in the Medline and Lilacs databases of the Virtual Health Library VHL and in the Capes journal portal, aiming to identify the validated risk assessment tools for osteoporosis in Brazil. The criteria for inclusion of articles were: publications available online, in Portuguese or English and published between and We excluded studies describing tools not evaluated for the Brazilian population. The descriptors used were: osteoporosis, risk factors, risk assessment and hip fractures.
After the evaluation of the articles, three tools Osteorisk, Sapori and Frax were identified that served as basis for the creation of the app. The Osteorisk tool is based on age and weight, and the evaluation of the Brazilian population sample showed an overall sensitivity to identify women with a high risk of osteoporosis of The simplicity of the app, its low cost and the savings generated make this tool an excellent screening method to identify women who are at higher risk of osteoporosis Postmenopausal hormone therapy and regular physical activity played a protective role The Frax tool has an algorithm that calculates the risk of the patient suffering a fracture due to bone fragility in the next ten years, correlating the risk factors with the result of the bone mineral density of the femoral neck, measured by bone densitometry.
The clinical risk factors assessed are: age; gender; body mass index BMI ; previous fractures; family history of femoral fracture; prolonged corticotherapy;. We chose to develop a progressive web app PWA , a term used to denote a new software development methodology. Unlike traditional apps, a PWA can be seen as a hybrid evolution between regular web pages or websites and a mobile app. This new app model combines features offered by the most modern browsers with the advantages of using a mobile phone Throughout the development of this application we tried to meet the precepts established in software engineering.
Selection of data for preparation of the Assessment Form section and for clinical recommendations The use of risk assessment tools should consider the profile of their population, as genetic, racial and anthropometric differences contribute to explain divergences in the incidence and prevalence of low bone density and fractures in several countries around the world The selection of data for the preparation of the assessment form was based on the three validated osteoporosis risk assessment tools in Brazil Osteorisk, Sapori and Frax.
The weight and age data common to the three tools were used in the patient risk classification for low bone density which was based on the algorithm calculation of the Osteorisk tool: 0. Individuals are considered low risk when the result of the calculation is greater than 1, medium risk when the value is between -2 and 1 and high risk when the value is less than This tool performs well, as shown in the work of Sen et al.
Family history, specifically parents with a history of femoral fracture, current smoking, chronic use of glucocorticoids and previous low impact fractures. The use of glucocorticoids followed the Frax recommendation to indicate a positive result if current oral glucocorticoid use was identified for more than 3 months with a prednisolone dose of 5 mg or more or equivalent dose of other corticosteroids.
Regarding alcohol consumption, the use of 3 units of alcohol or more per day was considered affirmative, in accordance with the Frax guidelines. A unit of alcohol varies little between different countries and is between g of alcohol. This is equivalent to a standard glass of beer ml , a measure of spirits 30 ml , an average glass of wine ml or a measure of aperitif 60 ml For the definition of secondary osteoporosis, Frax considers whether the patient has a disease strongly associated with osteoporosis.
According to the sample of the Sapori study, postmenopausal hormone therapy and regular physical activity in the previous year had a protective role. The app was configured to only signal these affirmations as positive for identified continuous cases during the previous year However the design pattern, with fields for the inclusion of numerical values of anthropometric data and yes or no option buttons for risk factor items, were adopted. The functionality of offering recommendations on lifestyle, treatment and the timing of bone densitometry exams immediately after submission of the form were also followed With respect to the clinical recommendations for the adoption of preventive measures for osteoporosis, the application was based on the Clinical Protocol and Therapeutic Guidelines of Osteoporosis of the Ministry of Health MS , Ordinance No.
Automated Audit To evaluate the performance of the app, Google's automated open source Lighthouse tool was used This provides a comprehensive audit of all aspects of the quality of a web app by performing a series of tests on the page, and generates a performance report based on those tests, displaying flaws and recommendations for improving the application.
Lighthouse was run as an extension of Chrome, auditing the items listed in Table 1. Evaluation of app by health professionals An evaluation of the prototype was carried out to discover the opinions of health professional users regarding the functionality, usability and reliability of the application. After the evaluation period, an online questionnaire was created using the Likert Scale with a score of 1 to 5, varying from totally disagree to fully agree.
Scores over 4 were considered adequate. These issues were based on studies that assess features such as the functionality, reliability, usability and efficiency of mobile apps The questionnaire included a question about the professional profile of the evaluators, who could be doctors, nurses, other health professionals.
After the evaluation phase of the prototype and corrections of the initial version, the application was sent for registration with the Institute of Technological Innovation of Uerj. Upon completion of this process, the app will be made available for free access on a secure hosting server on the Google Play Store. The volunteers were previously informed about the evaluation of the application, with only those who agreed to and signed the Free and Informed Consent Form allowed to participate.
The assessment form screen was based on the design used by the OPAD tool with fields for the numerical completion of the age, weight, height and T-score values and yes or no option buttons for the risk factors to be evaluated. The guidelines on osteoporosis and prevention of falls among the elderly of the Ministry of Health and the Brazilian Society of Geriatrics and Gerontology, respectively, were used as a basis for the guidelines relating to clinical recommendations.
Three screens were created for the OSTEOGUIA app, based on the data extracted using the Osteorisk, Sapori and Frax tools for sociodemographic data age, gender, weight, height and ethnicity , health use of glucocorticoids, therapy hormone replacement therapy, rheumatoid arthritis, secondary osteoporosis, previous low-impact fracture, parents with a history of hip fracture and health-related behaviors physical activity, alcohol intake, and smoking.
The home screen features a fixed menu at the top that leads to five sections: three with interactive information on osteoporosis, risk factors, and densitometry; one that leads to the assessment form and one to the contact form Figure 1. Rio de Janeiro, The Osteoporosis section provides interactive buttons that lead to screens with information on definition, etiology, epidemiology, mortality, falls, and a button with a tutorial on using the app in which a link to the bibliographic references is located. The Risk Factors section details each important risk factor in the assessment of the patient, separated into two columns: modifiable and non-modifiable factors.
Each risk factor is represented by a button that provides detailed information, including important data to be considered when completing the assessment form. As the diagnosis of osteoporosis can also be made based on the measurement of bone mineral density by the dual X-ray densitometry technique, the Densitometry section provides recommendations for the examination, according to the guidelines of the Ministry of Health. In the Assessment Form the health professional inserts the general details of the patient and the items related to the risk factors.
Figure 2. The patient's general data is entered in the text fields and risk factors are selected using the yes or no options, following the design pattern of the OPAD tool, and then automatically transferred to the app algorithms. If the patient has undergone a bone densitometry exam of the lumbar spine, a field asks them to provide the numeric value of the T-Score obtained in the lumbar segment of L1-L4.
After submitting the assessment form the user is directed to the final screen, Results and Clinical Recommendations. Here a report provides the BMI of the patient, with an alert for underweight patients, the risk classification of the patient for low bone density and the densitometry result as classified by the World Health Organization WHO , categorized as osteoporosis, low bone density osteopenia or normal Figure 3.
In the Contact section the user is provided with a form so that they can send a message to the app developers with questions, comments and suggestions. Suggested indicators for improving accessibility relate to technical features that make content accessible to a user of assistive technology, such as a screen reader for the visually impaired.
Improvements to the PWA features include improvements in server access such. All seven evaluated items were approved, with an emphasis on the ease of use and reliability of the application, and Eight professionals participated in this evaluation, and all identified themselves as doctors.
The online questionnaire was available in the same trial period as the prototype. Danachi et al. Despite the many treatments available for the prevention and management of osteoporosis, with the effective reduction of vertebral and non-vertebral injuries, the majority of the Brazilian population still do not have access to early diagnosis and appropriate therapy for the disease8. The Brazilian government provides medication for osteoporosis through the SUS but, without adequate epidemiological. The OSTEOGUIA application was developed to try to fill this gap, seeking to identify the needs of health professionals and providing scientifically based information, aiming to provide a better service to the population which presents risk factors associated with osteoporosis.
The systematic review found that there are few clinical decision support applications in osteoporosis available and that most studies evaluating these tools do not incorporate the three main components in the assessment: risk factors, diagnosis and treatment There is a tendency to develop such apps based on patient experience.
Some tools, such as Osteorisk, Sapori and Frax, identify individuals at greater risk for fracture, optimizing the start of and adherence to treatment, resulting in a more effective selection of patients to undergo bone densitometry, as the doctor can request the examination for those who are most at risk by quantitatively weighing the clinical risk factors. This progressive web app follows the new trend for the mobile web in its relative ease of development and user experience advantages, having the potential to meet the demand of health professionals working with osteoporosis.
The OSTEOGUIA app incorporates the risk factors used by these tools with the advantages of portability and easy installation on mobile devices, adapting to any screen size by adopting a responsive design pattern. During the literature review, no online application for the use of the Osteorisk tool was identified. The Sapori tool was developed as an Excel tool and although an internet version of the Frax tool is available, the mobile app is not free.
The use of free coding tools allowed the development of a low cost app. In addition, the use of established web languages facilitates the maintenance and improvement of the app, which can be expanded by linking the assessment form to the registry in a structured database, allowing a more accurate statistical analysis with the possibility of developing new risk assessment tools that consider regional ethnic differences.
The impact generated by the use of these tools in the long term and the analysis of the profile of patients in question is a possibility for extending this study. Another feature that could be improved in the app is the provision of a statistical analysis correlating the risk factors and results of lumbar bone densitometry values with a representative population sample.
As limitations of the present study, it should be noted that the online questionnaire applied to health professionals for the evaluation of the OSTEOGUIA app lacks a protocol for internal validation by the information technology sector of the institution. In addition, the low number of evaluators and the fact that only health professionals responded further limits the extrapolation of the results of this research.
Based on these results, the professional can provide guidance about the preventive measures to be adopted, aimed at a better quality of life, reducing complications such as fractures, hospitalizations, disabilities and deaths. It should be emphasized that the clinical recommendations provided by the app are based on the Clinical Protocol and Therapeutic Guidelines for Osteoporosis of the Ministry of Health and the guidelines on the prevention of falls among the elderly of the Brazilian Society of Geriatrics and Gerontology.
Therefore, although this app is easy to use and can be accessed by mobile devices, its guidelines are scientifically based. The burden of osteoporosis in Brazil. Arq Bras Endocrinol Metab. Rev Min Enferm. J Med Syst. A four-year experience with a Web-based selfhelp intervention for depressive symptoms in Mexico. Acta Paul Enferm. The epidemiology and management of postmenopausal osteoporosis: a viewpoint from Brazil. Clin Interv Aging. Epidemiology of osteoporotic fractures in Brazil: what we have and what we need.
Arq Brasil Endocrinol Metabol. Rev Bras Ortop. A risk assessment tool OsteoRisk for identifying Latin American women with osteoporosis. J Gen Int Med. Application of Osteorisk to postmenopausal patients with osteoporosis. Sao Paulo Med J. Osteoporosis Int. Correlation between osteoporotic fracture risk in Brazilian postmenopausal women calculated using the FRAX with and without the inclusion of bone densitometry data. Arch Osteoporosis.
Daniel Nations. What is a web application? A clinical decision support system for the diagnosis, fracture risks and treatment of osteoporosis. Comp Math Meth Med. Projeto Diretrizes. Tools for Web Developers.follow link
Meaning of "abdomen" in the Spanish dictionary
Auditar apps da Web com o Lighthouse [Internet]. Tibes CM. Rev Bras Reumatol. Development of a prototype clinical decision support tool for osteoporosis disease management: a qualitative study of focus groups. Abstract Objective: to identify the prevalence of self-medication, the therapeutic classes used without medical prescription, the symptoms treated with such medication and associated factors among participants of an Open University of the Third Age OU3A.
Method: a cross-sectional, descriptive and analytical study was carried out, the sample of which was composed of OU3A attendees. Results: the majority were aged years The most frequently mentioned therapeutic classes were analgesics The most commonly reported self-medication symptoms were muscle and joint pain Conclusion: the most frequently mentioned reasons for self-medicating were previous experience using the drug and the certainty that it is safe.
Most of the above medications are potentially inappropriate for the elderly. However, the elderly consider them safe and are unaware of the risks to which they expose them. They may also be unaware that pain treated by self-medication may be related to pre-existing diseases, which require the appropriate professional and treatment. Keywords: Self Medication.
Health of the Elderly. Drug Utilization. The practice known as responsible self-medication is recommended by the World Health Organization WHO as a way of relieving the public health system. The WHO considers self-medication a responsible practice when individuals, in treating their own symptoms and minor ailments, use approved and prescription medications without a medical prescription.
Such drugs are supposedly safe as long as they are taken as directed in the packaging inserts and labels1. In the European Union and in countries such as the USA, Canada and Japan, self-medication is a wellestablished practice, and responsible self-medication is used primarily for the treatment of non-serious symptoms and illnesses, such as colds, flu, common headaches, some types of mycosis, muscle pain and other clinical conditions1. In Brazil, self-medication is a very common practice, according to a review published in This review was based on Brazilian cross-sectional studies of high methodological quality that used population samples to analyze the use of drugs in the 15 days prior to the period of data collection.
According to the survey, self-medication is exercised by about one-third of the adult population under the age of For the authors of the study, the fact that Brazilians are living longer causes them to seek ways of avoiding the risks inherent in greater longevity, and medication use is seen as one of these means. The practice of self-medication becomes an important tool in this context.
In these workshops, it was observed that the OU3A was predominantly made up of autonomous and socially active citizens with access to health services and who were medication users3. OU3A students, in general, have characteristics of successful and active aging4. In the OU3A context, participant health surveys enable the identification of the profile, demands and risk factors for negative outcomes among an elderly population that remains active and participatory.
This knowledge favors the planning of actions aimed at maintaining functional capacity, autonomy and active aging. An approach to self-medication, a practice which exposes the user, especially the elderly, to the risk of adverse events, requires delineable educational interventions that are applicable in the context of an OU3A. Based on the assumption that identifying the target audience is a key strategy for the successful planning of efficient health promotion actions, the objective of this study was to estimate the prevalence of self-medication, the classes of drug used without a prescription, the symptoms treated with the same and associated factors among individuals enrolled at the OU3A.
We also sought to identify the reasons for adopting the practice, according to the participants. The survey began in the second half of , when there were students enrolled in the activities of OU3A of the SAH. Data were collected between August and October During recruitment, OU3A students were approached at the SAH and invited to participate in the survey, constituting a convenience sample. After the selection of those that fit the inclusion criteria, a total of individuals were obtained.
A previously structured questionnaire was applied for data collection, in which the participants reported their age, gender, frequency of self-medication, reasons for self-medication, health problems, medicines used without a prescription and if they had a health plan. For the question about the frequency of selfmedication, four response options were provided: "always", "almost always", "sometimes", "almost never" or "rarely" and "never".
This categorization allowed us to estimate the frequency of self-medication. The questionnaire provided categories of motives for self-medication which could be selected by the participants and space to include other reasons. The descriptive analysis of the data was performed by determining the measures of central tendency mean and dispersion standard deviation for the quantitative variables and the distribution of frequency and percentages absolute and relative frequencies for the categorical variables.
In addition to the prevalence, the association between variables was estimated by bivariate analysis. In inferential analysis, this association was also evaluated through the following hypothesis tests: Pearson's chi-squared test and Fisher's exact test. The latter was used in cases in which the expected frequency was less than five. Only three participants were aged between 56 and 59 years old. Table 1 shows the prevalence of self-medication according to frequency, the prevalence of the classes of drug used and the symptoms treated with selfmedication.
Individuals were considered practitioners of self-medication irrespective of whether they said they self-medicated "sometimes", "almost always" or "always" and also included those who reported that "rarely" or "almost never" used non-prescription medicines. One of the participants who selfmedicated did not describe the frequency.
Of the medications consumed without medical prescription, the most frequently mentioned class was analgesics. Dipyrone was reported by 40 participants The symptoms most frequently used to justify self-medication were muscle and joint pain, headache and colds and flu, reported by 55 participants The least frequent causes were heartburn, abdominal cramps, diarrhea, and an obstructed bowel.
Table 2 shows the association between selfmedication, regardless of frequency, and the variables age, gender, reported diseases and presence or not of a health plan. Prevalence of self-medication, classes of drugs used and symptoms attributed to the practice among participants of an OU3A.
Excluded in cases in which the question related to the variable was not answered; bConfidence interval; cNon-steroidal anti-inflammatory drugs. Association between self-medication, irrespective of frequency, and variables studied among OU3A participants. Prevalence Ratio; Confidence Interval; Pearson's chi-squared test or Fisher's exact test; Excluding three participants who were under 60 years of age between 56 and 59 years ; eSystemic Arterial Hypertension.
Association between drug classes used without medical prescription, attributed symptoms and frequency of self-medication among participants of the OU3A. Practices self-medication Sometimes. Prevalence Ratio; Confidence Interval; Pearson's chi-squared test or Fisher's exact test; Excluded in cases in which the question related to the variable was not answered; eNon-steroidal anti-inflammatory drugs.
The presence of hypothyroidism. Table 5 presents the reasons for self-medication, according to the participants. The most frequent reasons were the fact that the medication had been prescribed before, previous experience with the medicine, being sure that the medicine is safe, advice of relatives or friends, and the non-serious nature of the health or illness problem. Muscle and joint pain Variablea.
Excluded in cases in which the question related to the variable was not answered Prevalence of Ratio; Confidence Interval; Pearson's Chisquared test or Fisher's exact test; eSystemic arterial hypertension. Reasons for self-medication, according to the participants of the OU3A. However, in some studies, the practice is even more common. Individuals who do not practice physical activity used more medications on their own, which, for the authors, suggested that people who maintain healthier lifestyles resort less to medicines6.
In the present study, most participants were practitioners of self-medication. The most prevalent therapeutic classes were analgesics, muscle relaxants, NSAIDs and first-generation antihistamines. The prevalence of analgesic and non-prescription. NSAID use was similar to that found in other studies5,7. It was also found that one of the main reasons for self-medication, according to the participants, was being sure of the safety of using these drugs.
This was the main reason for self-medication in a recent study conducted with elderly people in Iran8. However, muscle relaxants, NSAIDs and first-generation antihistamines are for the most part potentially inappropriate for the elderly. Muscle relaxants and first-generation antihistamines have anticholinergic effects and consequently increase the risk of falls and fractures. NSAIDs increase the risk of ulcer and gastrointestinal bleeding9. In a cross-sectional population-based study of 1, elderly in Pelotas, Rio Grande do Sul, in , the association of the practice of self-medication with.
For the authors, this indicates the need to raise awareness among the elderly to avoid the consumption of over-the-counter medications Potentially inappropriate drugs for the elderly are those that should be avoided or used with caution in this age group.
Therefore, the prescription of these drugs requires consideration of the risk-benefit relationship, the availability of alternative agents and non-pharmacological resources, the choice of the lowest required dose, the potential drug interactions and the monitoring of the effects on the patient However, in Brazil, self-medication is stimulated by the misconception that the drug in question is a simple, risk-free commodity. In part, this is due to exposure to abusive advertising of drugs, which are made available to the consumer through self-service and also because the user often does not ask the pharmacist for advice when going to the pharmacy or drugstore1.
This situation is particularly worrying when the user is elderly and the "merchandise" is inappropriate for the age group, especially when the individuals in question are not aware of the risks. It is also noted that the practice of self-medication is not restricted to prescription-only, over-the-counter OTC medicines. In every case, the dispensation of medicines, exempt or not from prescription, should be understood as a process of health care. Even the dispensing of non-prescription drugs is not free of instruction1.
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When accompanied by appropriate guidance, the risks related to the use of medicines are reduced. This care is especially important when the dispensed medications are anticholinergic. Free access to these drugs, especially when unprotected, raises the risk of adverse reactions. This happens for several reasons. First, unrestricted selling and advertising create the illusion that these products are innocuous and harmless, which no medication can be. This image, however, can increase consumption and excessive and irresponsible use.
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Secondly, these drugs are better known by their trade names than by their active principles. There are several trade names for the same drug, raising the possibility of overdosage. In addition, the associated use of these drugs by the same individual increases the anticholinergic load - a cumulative effect of the. Such reactions may also be mistaken for symptoms of disease or clinical conditions and result in the prescription of another drug without the "symptom" being recognized as an adverse reaction. This situation characterizes what we know as the iatrogenic cascade.
Cognitive decline, confusion, delirium, urinary retention, constipation, and visual disturbances are common adverse effects that may be - and are - confounded with symptoms of illness. In the older age group, self-medication is mainly carried out to mitigate suffering such as pain4. In fact, in the present study, muscle and joint pain was prevalent among the symptoms treated with selfmedication.
On the other hand, this symptom has been associated with the presence of arthrosis and hypothyroidism, conditions that require appropriate professional treatment. The pain possibly associated with preexisting diseases may indicate that they are not being treated properly. Appropriate medical treatment can promote control of symptoms and thus reduce self-medication.
In short, the practice of self-medication exposes the individual, especially the elderly, to the risk of adverse events and iatrogenesis, subjecting them to functional impairments that may impair their autonomy and their capacity to participate. Tackling this practice through educational actions can reduce the associated risks.
In addition, it is important to explain to the individual the basis for the guidelines and instructions they receive. In USP OU3A pharmaceutical care workshops, participants begin to adhere to and follow the instructions when they know the reasons on which they are based. The patient is autonomous in decision making and may disregard the guidelines if they consider them irrelevant This type of educational approach is fully delineated and applicable in the context of the OU3A. Actions of this kind are consistent with collective health, which is a social practice that is transformative in nature, involving the studies of health conditions that seek to protect and promote health, quality of life and the social well-being of individuals and.
This approach can be practiced in different organizations and institutions and by different agents, within and outside the spaces conventionally recognized as the health sector In fact, it is fundamental that such guidelines and educational actions on self-medication are carried out, developed and expanded in the most varied contexts of attention and care for the elderly. Likewise, further studies on the characterization and factors associated with self-medication by the elderly, especially follow-up, case-control and qualitative studies, are needed to provide more detailed, precise and accurate information about these relationships.
In the present study, the findings were limited by several aspects, such as sample size, which made a more profound analysis of the potential associations between variables difficult. Also, due to the crosssectional design of the study, it was not possible to determine the direction of the associations identified, which can be achieved in follow-up studies. In addition, the information obtained is subject to memory bias, as it is self-reported, that is, based only on the reports of the participants. Muscle and joint pain, which stood out among the symptoms treated with self-medication, was associated with the presence of arthrosis and hypothyroidism, which require professional and appropriate treatment.
Pain potentially associated with preexisting diseases may indicate that they are not being treated properly. The practice of self-medication exposes the individual, especially the elderly, to the risk of adverse events, iatrogenesis, and the masking and aggravation of diseases, subjecting them to functional impairments that may compromise their autonomy and capacity for participation.
Tackling this practice requires delineable and applicable educational actions in the context of Open Universities of the Third Age. Borja-Oliveira CR. Prevalence of selfmedication among the elderly in Kermanshah-Iran.
Glob J Health Sci. Brazilian consensus of potentially inappropriate medication for elderly people. Geriatr Gerontol Aging. Borja CRO. Rev Salusvita. Abstract Objective: to investigate the relationships between the perceived quality of life of elderly people who care for other elderly people with neurological diseases dementia and strokes and the gender, age and caregiver burden, diagnosis, functional dependence, and cognitive status of the care recipient. The levels of physical vulnerability of the elderly were identified through the Lawton and Brody questionnaires and the Katz scale and the cognitive assessment of elderly care recipients was assessed with the Clinical Dementia Rating.
The data were analyzed by chi-squared test for comparison of categorical variables , Mann-Whitney and KruskalWallis U tests for comparison of continuous variables. To study the associations between variables, univariate logistic regression analysis was performed, followed by multivariate logistic regression analysis. Results: the age, gender of the caregiver, type of neurological condition, and physical and cognitive functioning of the care recipient did not statistically influence the quality of life of the caregiver.
Conclusion: the quality of life of the elderly caregiver is negatively influenced by the burden involved in caring for another elderly person. Identifying the negative emotional aspects of caregivers that negatively affect their quality of life should be considered a target for intervention by health teams. Among these diseases are strokes and dementias of various etiologies1. Diseases that generate significant physical and psychological impairments are also associated with a progressive loss of independence and autonomy, behavioral changes and the need for care of an instrumental, material, social and emotional nature2.
The levels of physical and cognitive dependence associated with strokes and dementias range from difficulties in mobility to more complex levels of physical disability, which involve dependence in the performance of activities related to personal care3. These situations have a direct impact on the well-being of family caregivers, who generally perform their role without help or appropriate guidance. Caregivers often become involved in conflicts, anxiety, depression, stress, fears and experience a sense of burden that can have an impact on quality of life4.
There are several factors that are related to the perceptions of quality of life of elderly caregivers, including the quality of personal relationships, sociodemographic characteristics such as age and gender, the degree of burden and the abilities to deal with dependent elderly recipients of care6. Population aging has repercussions on two important phenomena.
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The growing number of elderly people can lead to these individuals being burdened by a condition of dual vulnerability due to the burden of care and the aging process. Such situations may influence the psychological, physical and social health of caregivers, affecting their perception of quality of life. The variability of factors that influence quality of life and its subjectivity impose reflections on aging and make it essential understand the factors.
Those involved in care are constantly exposed to depressive feelings and burden, which increases with the greater dependence of the care recipient and negatively influence the health of caregivers Positive and negative feelings, psychological conflicts, grief, fear and insecurity are common throughout the caring experience6.
Caldeira et al. The psychological resources of caregivers to deal with difficult situations may be inadequate to meet their life needs and the needs of the elderly care recipient, resulting in negative personal perceptions about their quality of life. Engaging in the care of an elderly person often results in the caregiver setting aside their life in favor of assuming responsibility for the life of another, restricting their ability to care for their own health and resulting in negative effects on their quality of life13, The present study aimed to investigate the relationships between the perceptions of quality of life of elderly caregivers of elderly people with neurological diseases dementia and strokes and gender, age and caregiver burden, as well as the diagnosis, functional dependence and cognitive status of the care recipient.
METHODS The present study integrated the database of the study entitled "The psychological well-being of elderly people who take care of other elderly people in a family context", which had a convenience sample of participants indicated by professionals linked to public and private services aimed at the elderly, such as elderly care clinics, home care and medical services. These caregivers met the following inclusion criteria: age 60 or older, had been a caregiver for at least six months, and agree to participate in the survey.
Caregivers who scored below the cutoff point of the Cognitive Abilities Screening Instrument -. These cutoff points were 23 for elderly persons aged 60 to 69 years, and 20 for those aged 70 or older. For a null correlation greater than 0. This information was obtained through an open question that aimed to identify the main medical diagnosis of each elderly care recipient. For the present study, 45 elderly people who cared for other elderly people with dementia and 30 elderly people who cared for elderly people with strokes were chosen from the above-mentioned base sample.
Trained interviewers collected data from the elderly who were recruited from households The subjects confirmed their agreement to participate by signing a Free and Informed Consent Form. The variables of interest selected for the present study were: the gender, age, burden and perceived quality of life of elderly caregivers, and the type of illness dementia or stroke and levels of physical and cognitive dependence of the elderly care recipients.
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The Zarit et al. The instrument generates a total score ranging from 0 to The cutoff point for separating the caregivers with the lowest and highest burden is 8. The higher the score the greater the total perceived burden. The three factors described by Bianchi7 were also considered: factor 1 role-related stress composed of 10 items, factor 2 intrapsychic stress with 7 items and 3 factors presence or absence of competencies and expectations related to care with 5 items. This acronym designates control, autonomy, self-realization and pleasure, and is based on Maslow's basic human needs theory The scale has undergone semantic-cultural validation and validation of its construct, which is based on a structure composed of two factors, the first of which brings together items from the self-realization and pleasure domains and the second which includes items from the control and autonomy domains generated by confirmatory factorial analyzes20, The level of physical impairment of the elderly care recipients was assessed from the Lawton and Brody questionnaire , in a version by Brito, Nunes and Yuaso and by the Katz scale validated for Brazil by Lino et al.
Both have three response options: no help, partial help, or total help. The partial and total help options were included in one possibility — with help. The items of the two scales to which the answer was with help were counted and added together. The distribution was divided into terciles 1 to 8, 9 to 12 and 13 activities of daily living impaired. The level of cognitive impairment of the elderly care recipients was assessed by the Clinical Dementia Rating — CDR This instrument assesses the degree of impairment of cognitive functions in people with suspected dementia.
Scores can range from 0 no dementia to 3 severe dementia , with intermediate points 0. The memory domain carries the most weight in the scoring The distributions of the caregiver scores on the quality of life and burden scales were submitted to the Kolmogorov-Smirnov test for the evaluation of normality. As the distributions were not normal,. Fisher's Chi-square and Exact Tests were used to make comparisons between the nominal variables and the Mann-Whitney U-Test was used to compare the ordinal variables.
To study the associations between the total score and the two factors of the perceived quality of life scale and the independent variables, univariate logistic regression analysis was performed, followed by multivariate logistic regression analysis. There were no statistically significant differences between the caregivers of elderly people with dementia and caregivers of the elderly with strokes Group A and Group B, respectively in relation to the variables studied Table 1.
Presence or absence of competencies and expectations related to care. Factor 3 of the burden scale. Sense of self-realization and pleasure Factor 1 of perceived quality of life scale Sense of control and autonomy Factor 2 of perceived quality of life scale. The independent variable with the most robust association with low quality of life score was the burden perceived by the caregivers. Caregivers with high scores for items that represent role-related stress Factor 1 of the burden scale had a higher chance of low quality of life scores.
Caregivers who scored on the 2nd tercile of factor 3 of the perceived burden scale presence or. Higher scores in total burden, role-related stress, intrapsychic stress and the presence or absence of skills and expectations connected to care resulted in greater chances of an outcome of self-realization and pleasure of the elderly caregivers Factor 1 of CASP Table 3.
Caregiver score in role-related stress factor 1 of burden scale Caregiver score in intrapsychic stress factor 2 of burden scale Caregiver score in presence or absence of competences and expectations related to care factor 3 of burden scale. Univariate logistic regression analysis for low sense of self-realization and pleasure scores in the quality of life of elderly caregivers of other elderly people with neurological diseases.
Caregivers with higher total perceived burden scores and those with the highest levels of burden assessed by factor 1 role-related stress were 6. Univariate logistic regression analysis for low sense of control and autonomy scores in the quality of life of elderly caregivers of other elderly persons with neurological diseases. Campinas, Brazil, Four blocks of variables were considered in hierarchical multivariate logistic regression analysis, the dependent variable of which was total quality of life perceived by the caregivers.
In block 1 gender and age of caregivers were included; in block 2, the neurological diseases of the elderly; in block 3, the levels of physical and cognitive impairment of the elderly care recipients and; in block 4, the. Based on the results of the hierarchical multivariate analysis, with the Stepwise criterion of variable selection, only the total score of the perceived burden scale was associated with a low total score on the perceived quality of life scale. CI: 3. In addition, it describes the characteristics of the care recipients in terms of levels of physical and cognitive dependence and what influences these variables in the perception of quality of life of the elderly caregiver.
The predominance of elderly women in the study sample was similar to the findings of other studies6, This corroborates the importance of the role of women in the task of caring, as within the family context women most frequently become caregivers However, being female did not influence the chance of perceiving a worse quality of life7.