SUMIKA MORI LIN
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/66, Hospital das Clínicas, Faculdade de Medicina
LIM/66, Hospital das Clínicas, Faculdade de Medicina
19 resultados
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Agora exibindo 1 - 10 de 19
- Sensorial differences according to sex and ages(2014) SILVA, L. A. da; LIN, S. M.; TEIXEIRA, M. J.; SIQUEIRA, J. T. T. de; JACOB FILHO, W.; SIQUEIRA, S. R. D. T. deObjective To investigate age and sex differences in orofacial sensory detection. Methods One hundred and twenty-six (126) healthy subjects were divided into five groups according to their ages. They were assessed with a quantitative sensory testing protocol for gustative, olfactory, thermal (cold/warm), mechanical (tactile/vibration/electric), and pain (deep/superficial) detection thresholds. The corneal reflex was also evaluated. Data were analyzed with the one-way ANOVA, chi-squared, Fisher's exact, Mann-Whitney, and Kruskal-Wallis tests. Results The groups of subjects over 61years old had higher olfactory (P<0.001), gustative (sweet P=0.004, salty P=0.007, sour P=0.006), thermal (warm P<0.001, cold P<0.001), and tactile (P<0.001) detection thresholds than the others. The vibration detection threshold was high only for subjects over 75years old (P<0.001). The electric and deep pain detection thresholds were different for the 61-75years old group (P <= 0.001). Women in all age groups had lower gustative (sweet P=0.020, salty P=0.002, sour P<0.001, and bitter P=0.002), olfactory (P=0.010), warm (P<0.001) and deep (P<0.001), and superficial pain (P=0.008) detection thresholds than men, and men from all age groups had lower vibratory detection thresholds (P=0.006) than women. Conclusion High sensory detection thresholds were observed in subjects over the 6th decade of life, and women had a more accurate sensory perception than men.
- Comparison of 3 Frailty Instruments in a Geriatric Acute Care Setting in a Low-Middle Income Country(2018) LIN, Sumika Mori; ALIBERTI, Marlon Juliano Romero; FORTES-FILHO, Sileno de Queiroz; MELO, Juliana de Araujo; APRAHAMIAN, Ivan; SUEMOTO, Claudia Kimie; JACOB FILHO, WilsonObjective: Comparison of frailty instruments in low-middle income countries, where the prevalence of frailty may be higher, is scarce. In addition, less complex diagnostic tools for frailty are important in these settings, especially in acutely ill patients, because of limited time and economic resources. We aimed to compare the performance of 3 frailty instruments for predicting adverse outcomes after 1 year of followup in older adults with an acute event or a chronic decompensated disease. Design: Prospective cohort study. Setting: Geriatric day hospital (GDH) specializing in acute care. Participants: A total of 534 patients (mean age 79.6 +/- 8.4 years, 63% female, 64% white) admitted to the GDH. Measurements: Frailty was assessed using the Cardiovascular Health Study (CHS) criteria, the Study of Osteoporotic Fracture (SOF) criteria, and the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) questionnaire. Monthly phone contacts were performed over the course of the first year to detect the following outcomes: incident disability, hospitalization, fall, and death. Multivariable Cox proportional hazard regression models were performed to evaluate the association of the outcomes with frailty as defined by the 3 instruments. In addition, we compared the accuracy of these instruments for predicting the outcomes. Results: Prevalence of frailty ranged from 37% (using FRAIL) to 51% (using CHS). After 1 year of follow-up, disability occurred in 33% of the sample, hospitalization in 40%, fall in 44%, and death in 16%. Frailty, as defined by the 3 instruments was associated with all outcomes, whereas prefrailty was associated with disability, using the SOF and FRAIL instruments, and with hospitalization using the CHS and SOF instruments. The accuracy of frailty to predict different outcomes was poor to moderate with area under the curve varying from 0.57 (for fall, with frailty defined by SOF and FRAIL) to 0.69 (for disability, with frailty defined by CHS). Conclusions: In acutely ill patients from a low-middle income country GDH acute care unit, the CHS, SOF, and FRAIL instruments showed similar performance in predicting adverse outcomes. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
- Implementing the Objective Structured Clinical Examination (OSCE) in a Geriatrics Fellowship Program - a three-year experience(2012) AVELINO-SILVA, T. J.; GIL, L. A.; LIN, S. M.; FARIAS, L. L.; KIKUCHI, E. L.; SUEMOTO, C. K.; JACOB-FILHO, W.Background: The Objective Structured Clinical Examination (OSCE) appears to be an effective alternative for assessing not only medical knowledge, but also clinical skills, including effective communication and physical examination skills. Our purpose was to implement an OSCE model in a Geriatrics fellowship program and to compare the instrument with traditional essay examination. Methods: Seventy first- and second-year geriatric fellows were initially submitted to a traditional essay examination and scored from 0 to 10 by a faculty member. Subsequently, the same fellows underwent an OSCE with eight ten-minute stations, covering a wide range of essential aspects of geriatric knowledge. Each OSCE station had an examiner responsible for its evaluation according to a predefined checklist. Checklist items were classified for analysis purposes as clinical knowledge items (CKI) and communication skills items (CSI); student responses were scored 0-10. Results: While essay exams took from 30 to 45 minutes to complete, 180 to 200 minutes were required to evaluate students using the proposed OSCE method. Students scored an average of 6.2 ± 1.2 on the traditional essay examination versus 6.6±1.0 on the OSCE(p<0.001). Sub-analyses of OSCE scores indicated that average performance on CKI was lower than the average on CSI (6.4±1.1 vs.8.4±1.1; p<0.001). Students’ performance on the essay exam was similar to their performance on CKI (p=0.13). Second-year fellows performed better than first-year fellows on both the essay exam (p<0.001) and CKI (p=0.05), but not on CSI (p=0.25). Conclusion: The OSCE was successfully implemented as an educational strategy during our Geriatrics fellowship program. Combining different testing modalities may provide the best assessment of competence for various domains of knowledge, skills, and behavior comparison of first and second-year fellows’ performance on traditional essay examination and OSCE.
- Feasibility, safety, acceptability, and functional outcomes of playing Nintendo Wii Fit Plus (TM) for frail older adults: A randomized feasibility clinical trial(2018) GOMES, Gisele Cristine Vieira; SIMOES, Maria do Socorro; LIN, Sumika Mori; BACHA, Jessica Maria Ribeiro; VIVEIRO, Larissa Alamino Pereira; VARISE, Eliana Maria; CARVAS JUNIOR, Nelson; LANGE, Belinda; JACOB FILHO, Wilson; POMPEU, Jose EduardoBackground: Recently, interactive video games (IVGs) have been used as a health-care intervention that provides both exercise and cognitive stimulation. Several studies have shown that IVGs can improve postural control, gait, cognition, and functional independence in elderly people and patients with neurological disease. However, there is a lack of evidence about the effects of IVGs on frail and pre-frail elderly people. The aim of this study was to evaluate the feasibility, safety, and acceptability of playing Nintendo Wii Fit Plus (TM) (NWFP) interactive video games, and the functional outcomes (postural control, gait, cognition, mood, and fear of falling) in frail and pre-frail older adults. Methods: This study is a randomized controlled, parallel-group, feasibility trial. Participants were frail and pre-frail older adults randomly assigned to the experimental group (EG, n = 15) or control group (CG, n = 15). Participants in the EG performed 14 training sessions, lasting 50 min each, twice a week. In each training session, participants played five of 10 selected games, with two attempts at each game. Participants in the CG received general advice regarding the importance of physical activity. All participants were assessed on three occasions by a blinded physical therapist: before and after intervention, and 30 days after the end of the intervention (follow-up). We assessed the feasibility (score of participants in the games), acceptability (game satisfaction questionnaire), safety (adverse events during training sessions), and functional outcomes: (1) postural control (Mini-BESTest); (2) gait (Functional Gait Assessment); (3) cognition (Montreal Cognitive Assessment); (4) mood (GDS-15); and (5) fear of falling (FES-I). Results: Participants in the EG improved their scores in all 10 games, reported that they understood and enjoyed the tasks of the games, and presented few adverse events during the practice. There was a significant improvement in the Mini-BESTest and Functional Gait Assessment in the EG when compared with the CG (p < 0.05). Conclusion: The use of NWFP was feasible, acceptable, and safe for frail older adults and improved their postural control and gait. There were no effects on cognition, mood, or fear of falling. This trial was registered in the Brazilian Registry of Clinical Trials (RBR-823rst) on 11 June 2016.
bookPart Escalas(2019) SARAIVA, Marcos Daniel; ALIBERTI, Márlon Juliano Romero; SERRANO, Priscila Gonçalves; ONODERA, Eduardo Sho; APOLINARIO, Daniel; MAGALDI, Regina Miksian; FORTES FILHO, Sileno de Queiroz; MELO, Juliana de Araújo; ROTTA, Thereza Cristina Ariza; LIN, Sumika Mori; RANGEL, Luis Fernando; SILVA, Marina Maria Biella; APRAHAMIAN, Ivan; MAUER, Sivan; SIQUEIRA, Alaise Silva Santos de; MORILLO, Lilian Schafirovits; ARAúJO, Juliano Silveira de; STORNIOLO, Luana Vergian- Depression is associated with self-rated frailty in older adults from an outpatient clinic: a prospective study(2019) APRAHAMIAN, Ivan; SUEMOTO, Claudia Kimie; LIN, Sumika Mori; SIQUEIRA, Alaise Silva Santos de; BIELLA, Marina Maria; MELO, Brian Alvarez Ribeiro de; JACOB-FILHO, WilsonObjectives:The aim of the present study was to evaluate the association between depression and SSRI monotherapy and frailty both baseline and prospectively in older adults.Design:Prospective cohort study, 12-month follow-up.Setting:Geriatric outpatient clinic in SAo Paulo, Brazil.Participants:A total of 811 elderly adults aged 60 or older.Measurements:Depression was diagnosed as follows: (1) a diagnosis of major depression disorder (MDD) according to DSM-5; or (2) an incomplete diagnosis of MDD, referred to as minor or subsyndromic depression, plus Geriatric Depression Scale 15-itens 6 points, and social or functional impairment secondary to depressive symptoms and observed by relatives. Frailty evaluation was performed through the FRAIL questionnaire, which is a self-rated scale. Trained investigators blinded to the baseline assessment conducted telephone calls to evaluate frailty after 12-month follow-up. The association between depression and the use of SSRI with frailty was estimated through a generalized estimating equation adjusted for age, gender, total drugs, and number of comorbidities.Results:Depression with SSRI use was associated with frailty at baseline (OR 2.82, 95% CI = 1.69-4.69) and after 12 months (OR 2.75, 95% CI = 1.84-4.11). Additionally, depression with SSRI monotherapy was also associated with FRAIL subdomains Physical Performance (OR 1.99, 95% CI = 1.29-3.07) and Health Status (OR 4.64, 95% CI = 2.11-10.21). SSRI use, without significant depressive symptoms, was associated with subdomain Health Status (OR 1.52, 95% CI = 1.04-2.23).Conclusion:It appears that depression with SSRI is associated to frailty, and this association cannot be explained only by antidepressant use.
- Persistent pain is a risk factor for frailty: a systematic review and meta-analysis from prospective longitudinal studies(2018) SARAIVA, Marcos Daniel; SUZUKI, Gisele Sayuri; LIN, Sumika Mori; ANDRADE, Daniel Ciampi de; JACOB-FILHO, Wilson; SUEMOTO, Claudia KimieBackground: pain is prevalent in frail older adults; however, the association of pain and frailty has not been evaluated yet by a systematic assessment of prospective longitudinal studies. Objective: we aimed to assess the association of persistent pain as a risk factor for frailty incidence, using data from longitudinal studies in a systematic review and meta-analysis. Methods: publications were identified using a systematic search on PubMed, Embase, Cochrane Library and clinicaltrials. gov databases from inception to October 2017. Since heterogeneity across studies was high, we used random-effects metaanalysis to calculate the pooled relative risk for the association between persistent pain and the incidence of frailty. We investigated sources of heterogeneity among studies using meta-regression and stratified analyses. Results: we included five prospective longitudinal studies with 13,120 participants (46% women, mean age from 59 to 85 years old). Participants with persistent pain at baseline had twice the risk of developing frailty during the follow-up (pooled RR = 2.22, 95% CI = 1.14-4.29). No variables were related to study heterogeneity in sensitivity analyses. Conclusion: persistent pain was a risk factor for the development of frailty in a meta-analysis of longitudinal studies. Better understanding of the association between pain and frailty with proper evaluation of potential confounders could allow the development of targeted interventions.
bookPart Síndrome de fragilidade(2019) GOMES, Gisele Cristine Vieira; TOSI, Fabiana Cassales; SUEMOTO, Cláudia Kimie; LIN, Sumika Mori- Frailty and cognitive status evaluation can better predict mortality in older adults?(2018) APRAHAMIAN, Ivan; SUEMOTO, Claudia Kimie; ALIBERTI, Marlon Juliano Romero; FORTES FILHO, Sileno de Queiroz; MELO, Juliana de Araujo; LIN, Sumika Mori; JACOB FILHO, WilsonObjectives: to evaluate the improvement in one-year mortality prediction after adding a 2-min cognitive screening to a simple 1-min frailty detection instrument. Secondary outcomes were new activities of daily living (ADL) disability and falls. Design: Prospective cohort study. Setting: A geriatric day-hospital for intermediate care. Participants: A total of 701 older adults with an acute or decompensated disease (79.5 (8.3) years, 64% female). Measurements: A rapid and simple frailty evaluation was performed using the FRAIL questionnaire. The presence of cognitive impairment was defined by previous diagnosis of dementia or a score of five or less on an education-corrected 10-point cognitive screening tool. Results: Frail participants with normal (hazard risk [HR] 4.0, 95% confidence interval [CI], 1.73-9.25) and impaired cognition had a higher risk of death (HR 4.38, 95% CI, 1.95-9.87) than robust participants. The presence of cognitive impairment increased the risk of death in prefrail (HR 3.60, 95% CI, 1.55-8.34) and robust participants (HR 3.49, 95% CI, 1.22-9.96). Cognitive impairment was associated with an increased risk of incident ADL disability in all frailty categories. The presence of cognitive impairment was associated with a significantly higher risk of fall in robust seniors. The predictive accuracy of the FRAIL scale was lower than expected (between 0.58 and 0.69), and a small improvement was observed after adding the cognitive screening (between 0.61 and 0.72). Conclusion: Despite of significant results in predicting relevant clinical events, the present combination of the FRAIL and 10-CS scales may not be ideal in clinical practice.
- Serotonin receptor inhibitor is associated with falls independent of frailty in older adults(2021) LIN, Sumika M.; BORGES, Marcus K.; SIQUEIRA, Alaise S. S. de; BIELLA, Marina M.; JACOB-FILHO, Wilson; CESARI, Matteo; VOSHAAR, Richard C. Oude; APRAHAMIAN, IvanObjectives: To evaluate whether fall risk in older adults is associated with the use of selective serotonin receptor inhibitor (SSRI) monotherapy among geriatric outpatients, and whether this association is moderated by the presence of depressive disorder and/or frailty. Methods: Prospective cohort study with a 12-month follow-up and including 811 community-dwelling adults aged 60 or older from a university-based Geriatric Outpatient Unit. Major depressive disorder (MDD) was diagnosed according to DSM-5 criteria; subsyndromal depression as not meeting MDD criteria, but a Geriatric Depression Scale 15-item score ? 6 points. Frailty was evaluated with the FRAIL questionnaire. The association between SSRI use, depression, or both as well as the association between SSRI use, frailty, or both with falls were estimated through a generalized estimating equation (GEE) adjusted for relevant confounders. Results: At baseline, 297 patients (36.6%) used a SSRI (82 without remitted depression) and 306 (37.7%) were classified as physically frail. Frailty was more prevalent among SSRI users (44.8% versus 33.7%, p =.004). After 12 months, 179 participants had at least one fall (22.1%). SSRI use, depression as well as frailty were all independently associated with falls during follow-up. Nonetheless, patients with concurrent of SSRI usage and non-remitted depression had no higher risk compared to either remitted SSRI users or depressed patients without SSRIs. In contrast, concurrence of SSRI use and frailty increases the risk of falling substantially above those by SSRI usage or frailty alone. Conclusion: SSRI usage was independently associated with falls. Especially in frail-depressed patients, treatment strategies for depression other than SSRIs should be considered.