Tese de doutorado
Qualidade, satisfação de vida e frequência de doenças crônicas e seus fatores de risco em japoneses e nipo-brasileiros idosos
KAJITA, Graziela Tiemy. Qualidade, satisfação de vida e frequência de doenças crônicas e seus fatores de risco em japoneses e nipo-brasileiros idosos. 2009. Tese (Doutorado) - Universidade Federal de São Paulo (UNIFESP), São Paulo, 2009.
Kajita, Graziela Tiemy
Goals. Analyze the frequency of risk factors for chronic disease on quality of life and life satisfaction of Native Japanese and Japanese-Brazilian older adults. Method. 111 Japanese and 134 non-mixed Japanese Brazilian were invited to participate in identical protocol in both countries. They were asked to answer to auto-applied questionnaire (with a bilingual version in Japanese and Portuguese) and were submitted to three physical ability tests (Timed Up-&-Go test, Six Minute Walk Test and hand grip strength test). They were asked about self-referred diseases, clinical history and personal habits, other than answering to validated questionnaires by the World Health Organization Quality of Life, abbreviated version; Life Satisfaction Index – A; International Physical Activity Questionnaire, Environmental Module; and Physical Activity Scale for the Elderly. Berry’s Acculturation Model was used as the theoretical tool to identify the Japanese-Brazilians’ predominant acculturation strategy. The linear regressions models analyzed the influence of physical activity, age, sex and the presence of chronic disease and chronic disease risk factors against the dependent variables (quality of life and life satisfaction). There was also analysis by linear regression of environmental factors determined by questionnaire included in the model. Multivariate analysis of covariance was used to determine the association between the country of origin and the generation to which the subject was with quality of life and its domains (physical, psychological, social and environmental), life satisfaction and physical activity performance. Results. The Japanese-Brazilians referred to having significantly more Diabetes Mellitus (19% vs. 8%, p<.05) and vascular disease (34% vs. 18%, p<.05) than the Native Japanese which in turn referred higher cholesterol (44% vs. 28%, p<.05), and higher consumption of alcohol (63% vs. 10%, p<.001) and smoking habits (29% vs. 20%, p<.05). The Japanese-Brazilians that perceived being marginalized by the Japanese culture referred to having less heart disease (r=-.20, p<.05). Those integrated to their culture of origin had higher prevalence of alcohol consumption habits (r=.18, 0<.05) and less prevalence of smoking (r=-.18; p<.05). Physical activity did not differ significantly amongst the two groups (128±68 of the Native Japanese vs. 108±69 of the Japanese-Brazilians). Higher body mass index (BMI) predicted higher prevalence of chronic diseases in Japanese-Brazilians (β=0.22; p<.05) whereas gender predicted higher prevalence of chronic disease in the Native Japanese (β=-0.25; p<.05). Age and PASE predicted higher quality of life (β=-0.23; p<.05 e β=0.32; p<.001, respectively) in the Native Japanese and acculturation strategies practically predicted quality of life in the Japanese-Brazilians (β=0.19; p<.06). Gender, age and PASE predicted higher life satisfaction in the Native Japanese (β=-0.27; β=-0.27; p<.01; and β=0.21; p<.05, respectively) whilst the Japanese-Brazilians predicted higher life satisfaction through PASE and acculturation strategies (β=0.21; β=0.21, p<.05, respectively). Risk factors for chronic disease predicted higher life satisfaction in both groups (β=-0.19 in the Native Japanese and β=-0.18 in the Japanese-Brazilians), though at p<.07. The perception of one’s neighborhood (IPS-E) in Native Japanese men were higher than women (p<.05) which was also observed in the Japanese-Brazilians. There was a positive correlation with PASE and IPS-E amongst the Native Japanese (r=.19, p<.05), which was not seen in the Japanese-Brazilians. The Native Japanese as a whole and divided in gender had higher performance in the physical ability tests of Timed Up-&-Go and Six-Minute Walk Test (p<.001). The Six-Minute Walk Test correlated with PASE in both groups (r=.23 for the Native Japanese and r=.31, p<.05 for the Japanese-Brazilians). Conclusions. Subjective well-being and quality of life were predicted by higher physical activity performance in the Japanese and Japanese-Brazilian samples. Built environment predicted higher physical activity performance in the Japanese sample and not observed in the Japanese-Brazilian sample. There were, nonetheless, significant differences in the built environment perception and the physical activity performance observed through physical ability tests in which the elderly Japanese had higher perception of the built environment, less time to perform the Timed Up-&-Go Test and longer distance covered in the Six-Minute Walk Test. Chronic disease risk factors such as diabetes mellitus and vascular disease were more present in the Japanese-Brazilian sample and smoking and drinking habits and high cholesterol were more present in the Japanese sample. It is possible to infer that both groups were submitted to ecological influence since both groups are from the same ethnic background in different physical environments. Self-reference to chronic disease, physical activity performance demonstrated through questionnaire, physical ability tests, and quality of life and life satisfaction allows a broad discussion of the Japanese-Brazilians in comparison with the Native Japanese to implement preventive health programs for the elderly especially when acculturation strategies are taken into consideration. This study demonstrated that there are clinical differences in both samples, suggesting that environmental factors played a key role on prevalence of chronic disease risk factors. Community-based programs may be one way of encouraging physical activity and decrease chronic disease risk factors in the Japanese-Brazilian minority group.