RESUMO
OBJECTIVE: The study aimed to compare the drug therapy profile between French older adults with diabetes of the GERODIAB cohort and Brazilian older adults with diabetes assessed in a cross-sectional study conducted in Brazil. METHOD: This quantitative cross-sectional study was conducted with a sample of 246 Brazilian people aged 65 and over receiving care through the Unified Health System in the city of Fortaleza, Northeastern Brazil, who were compared to a sample of 987 French people aged 70 and over receiving care the Rouen University Center in France. RESULTS: The French participants treated for type 2 diabetes (T2D) with insulin alone, insulin + oral hypoglycemic agent (OHA) or OHA/GLP-1 analogue were older and presented higher mean values for body mass index, waist circumference and duration of diabetes in years. The French reported more episodes of hypoglycemia in all treatment modalities. These episodes occurred more frequently in the older adults treated with insulin alone and less frequently in those treated with OHA or GLP-1 analogues. The percentage of Brazilian and French older adults who monitored capillary blood glucose differed significantly in all treatment modalities. CONCLUSION: The significant differences relating to the drug therapy modalities used by Brazilian and French older adults with diabetes point to the importance of understanding the therapeutic objective of drug therapy with older adults with diabetes. Adapting the therapy to the patient's clinical conditions can prevent the worsening of comorbidities that influence the loss of autonomy and frailty.
Assuntos
Diabetes Mellitus Tipo 2 , Idoso , Idoso de 80 Anos ou mais , Glicemia , Brasil/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Hipoglicemiantes/uso terapêutico , InsulinaRESUMO
Structurally intact tropical forests sequestered about half of the global terrestrial carbon uptake over the 1990s and early 2000s, removing about 15 per cent of anthropogenic carbon dioxide emissions1-3. Climate-driven vegetation models typically predict that this tropical forest 'carbon sink' will continue for decades4,5. Here we assess trends in the carbon sink using 244 structurally intact African tropical forests spanning 11 countries, compare them with 321 published plots from Amazonia and investigate the underlying drivers of the trends. The carbon sink in live aboveground biomass in intact African tropical forests has been stable for the three decades to 2015, at 0.66 tonnes of carbon per hectare per year (95 per cent confidence interval 0.53-0.79), in contrast to the long-term decline in Amazonian forests6. Therefore the carbon sink responses of Earth's two largest expanses of tropical forest have diverged. The difference is largely driven by carbon losses from tree mortality, with no detectable multi-decadal trend in Africa and a long-term increase in Amazonia. Both continents show increasing tree growth, consistent with the expected net effect of rising atmospheric carbon dioxide and air temperature7-9. Despite the past stability of the African carbon sink, our most intensively monitored plots suggest a post-2010 increase in carbon losses, delayed compared to Amazonia, indicating asynchronous carbon sink saturation on the two continents. A statistical model including carbon dioxide, temperature, drought and forest dynamics accounts for the observed trends and indicates a long-term future decline in the African sink, whereas the Amazonian sink continues to weaken rapidly. Overall, the uptake of carbon into Earth's intact tropical forests peaked in the 1990s. Given that the global terrestrial carbon sink is increasing in size, independent observations indicating greater recent carbon uptake into the Northern Hemisphere landmass10 reinforce our conclusion that the intact tropical forest carbon sink has already peaked. This saturation and ongoing decline of the tropical forest carbon sink has consequences for policies intended to stabilize Earth's climate.
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Dióxido de Carbono/metabolismo , Sequestro de Carbono , Florestas , Árvores/metabolismo , Clima Tropical , África , Atmosfera/química , Biomassa , Brasil , Secas , História do Século XX , História do Século XXI , Modelos Teóricos , TemperaturaRESUMO
AIMS: This study aimed to compare the sociodemographic and epidemiological profiles between Brazilian and French older people with type 2 diabetes mellitus. METHODS: Quantitative analytical study of 248 type 2 diabetes patients aged 65+ years receiving care in a center for integrated diabetes and hypertension care. The data were compared with the GERODIAB study conducted in France. RESULTS: The participants' mean age was 73.16 ± 6.4 years, with 162 (65.4%) participants aged less than 75 years and 38 (15.3%) over 80 years old. Almost all the participants (99.2%) lived at home, 35 (14.1%) were uneducated, and 17 (6.9%) had completed higher education. The majority (232 older people) were retired. Most of the median values of the variables differed statistically (p < 0.001) between the two populations. Peripheral vascular disease, diabetic neuropathy, foot wound, amputation, hypoglycemia, hyperosmolarity and other intercurrent infections differed statistically (p < 0.001) between the two populations. Most of the medication use variables differed significantly (p < 0.05) between Brazilians and the French. CONCLUSIONS: The statistically significant differences between the two populations reveal better conditions among the French participants, which highlights the importance of the scientific evidence found in the French study for developing public health actions targeted at Brazilian diabetic older people.
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Diabetes Mellitus Tipo 2/epidemiologia , Idoso , Brasil , Estudos de Coortes , Estudos Transversais , Feminino , França/epidemiologia , Humanos , Masculino , Estudos ProspectivosRESUMO
INTRODUCTION: Diabetes mellitus (DM) is a risk factor for periodontitis for over 40 years and novel evidence suggests that periodontitis has an impact on glycemic control in patients with diabetes. This study aimed to compare oral health complications in diabetic older patients from Brazil and France. METHODS: This cross-sectional study included 120 patients aged 65 and over diagnosed with type 2 diabetes. Sixty patients were admitted to a center for diabetes and hypertension care in Brazil and 60 patients were admitted to the Rouen University hospital. Dental conditions were assessed through the decayed, missing and filled teeth index and periodontal condition was assessed using the Community Periodontal Index. The significance threshold was pâ¯<â¯0.05. RESULTS: Decayed teeth differed statistically between the groups (pâ¯=â¯0.001). The French group presented more tooth mobility, gingival recession and furcation involvement (pâ¯<â¯0.001). Tooth brushing frequency differed significantly between the groups (pâ¯<â¯0.030). The main cause of missing teeth was periodontitis in the French group and caries and periodontitis in the Brazilian group (pâ¯<â¯0.001). Statistical significance was found for use of fixed upper (pâ¯=â¯0.013) and lower (pâ¯=â¯0.013) dentures in the French group. The French group needed upper denture rehabilitation (pâ¯=â¯0.010) while the Brazilian group needed lower denture rehabilitation (pâ¯=â¯0.003). CONCLUSION: Edentulism was prevalent in diabetic older people in both countries. However, the French participants presented with better oral health.
Assuntos
Cárie Dentária/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Saúde Bucal , Periodontite/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Dentaduras , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Perda de Dente/epidemiologia , Mobilidade Dentária/epidemiologiaRESUMO
OBJECTIVES: To assess salivary flow in older patients with type 2 diabetes mellitus (DM2) and its association with xerostomia. METHODS: Cross-sectional clinical study conducted with older patients diagnosed with type 2 diabetes for at least one year receiving treatment at the Integrated Center for Diabetes and Hypertension of Ceará (CIHD) in the city of Fortaleza, Ceará, Northeastern Brazil. Oral clinical examination was carried out to assess the decayed, missing and filled teeth index (DMFT). Perception of the presence of xerostomia/dry mouth was assessed using the Visual Analogue Scale. Stimulated salivary flow was measured and samples were obtained using an extra-soft silicone device. RESULTS: 120 older patients with diabetes (60 insulin-dependent and 60 non-insulin-dependent) aged 65-91 years, with a mean age of 72.26 ± 6.53 years, were assessed. Of these, 111 (92.5%) presented a decrease in salivary flow while 59 (49.2%) reported moderate to severe xerostomia/dry mouth. The DMFT Index presented a mean of 27.53 ± 4.86 teeth. CONCLUSIONS: Reduced salivary flow was found in the group assessed in the present research; however, this finding is not in accordance with the perception of xerostomia/dry mouth reported by the patients.