Carla Jorge Machado

Fatores associados à incapacidade funcional dos idosos no Brasil: análise multinível

OBJECTIVE To analyze the influence of demographic, socioeconomic, health, and contextual factors of the Brazilian federation units on the functional disability of the elderly. METHODS Cross-sectional study based on data from the 2003 PNAD (Brazilian National Household Survey), of IBGE (Brazilian Institute of Geography and Statistics) and Ipea (Institute of Applied Economic Research). The sample was composed of 33,515 individuals aged 60 years and older. The dependent variable was functional disability, measured by difficulty in climbing slopes or stairs. The independent variables were divided into two levels: individual (demographic, socioeconomic and health-related characteristics) and contextual (Gini Index and Gross Domestic Product per capita by Brazilian state in 2000). A multinomial and multilevel logistic regression model was utilized in order to estimate the effect of the independent variables on the functional disability of the elderly. RESULTS Functional disability was associated with demographic, socioeconomic and health factors. At the individual level, sex, level of schooling, income, occupation, self-perception of health and chronic diseases were the factors that were most strongly related to functional disability. At the contextual level, income inequality proved to exert an important influence. CONCLUSIONS Self-perception of health is the factor that is most strongly related to the functional disability of the elderly in Brazil, followed by chronic diseases. Sex, occupation, level of schooling and income are also highly associated with it. Actions that approach the main factors associated with functional disability can contribute significantly to the well-being and quality of life of the elderly.OBJETIVO: Analisar a influencia dos fatores demograficos, socioeconomicos, de condicoes de saude e do contexto das unidades da federacao na incapacidade funcional dos idosos. METODOS: Estudo transversal que utilizou dados da Pesquisa Nacional por Amostra de Domicilio (PNAD) de 2003, do Instituto Brasileiro de Geografia e Estatistica (IBGE) e do Instituto de Pesquisa Economica Aplicada (Ipea). A amostra foi constituida de 33.515 individuos com 60 anos ou mais de idade. A variavel dependente foi a incapacidade funcional, mensurada pela dificuldade por subir ladeira ou escada. As variaveis independentes foram divididas em dois niveis: individual (caracteristicas demograficas, socioeconomicas e relativas a saude) e de contexto (Indice de Gini e Produto Interno Bruto per capita por unidade da federacao em 2000). Um modelo de regressao logistica multinomial multinivel foi utilizado para estimar o efeito das variaveis independentes na incapacidade funcional dos idosos. RESULTADOS: A incapacidade funcional foi associada com fatores demograficos, socioeconomicos e de saude. Em nivel individual, o sexo, a educacao, a renda, a ocupacao, a autopercepcao de saude e as doencas cronicas foram os fatores mais fortemente relacionados. Em nivel de contexto, a desigualdade de renda exibiu uma importante influencia. CONCLUSOES: A autopercepcao de saude e o fator mais fortemente relacionado com a incapacidade funcional dos idosos no Brasil, seguida das doencas cronicas. Sexo, ocupacao, escolaridade e renda tambem sao altamente associados. Acoes que abordam os principais fatores associados a incapacidade funcional podem contribuir significativamente para o bem-estar e qualidade de vida dos idosos.

Conceituando e mensurando a incapacidade funcional da população idosa: uma revisão de literatura

This article aims to review the main concepts and measures of functional disability currently used in studies focusing on this subject. According to this review, functional disability can be defined as a difficulty or the need for help for performing basic or more complex daily activities necessary for keeping an independent life in the community. As refers to measurement criteria, the studies do not follow a clear-cut standard, varying substantially in relation to scales, dimensions and classifications besides depending directly or indirectly on the kind of available information. A correct method for rating functional disability does not exist at yet. For this reason it is essential that the researchers clearly indicate the concept of functional disability used in the studies and detail, which measures or tools were applied.

Prevalence of HIV, syphilis, hepatitis B and C among adults with mental illness: a multicenter study in Brazil

OBJECTIVE There is evidence that patients with mental illness have increased prevalence of sexually transmitted infections, but data in Brazil are scarce. The objective of this study was to determine the prevalence of HIV, hepatitis C and B, and syphilis among patients with mental illness in Brazil. METHOD A multicenter representative sample of adults with mental illness was randomly selected from 26 mental health institutions throughout Brazil. Sociodemographic, sexual behavior and clinical data were obtained from person-to-person interviews and blood was collected for serology testing. Seroprevalence with 95% confidence limits were obtained correcting for sampling scheme. RESULTS Of the 2,475 patients interviewed, 2,238 had blood collected. Most participants were sexually active ever (88.8%) or in the last 6 months (61.6%), female (51.9%), and single (66.6%). Half of the sample had less than 5 years of schooling and the mean monthly individual income was low (US

A construção da base de dados nacional em Terapia Renal Substitutiva (TRS) centrada no indivíduo: aplicação do método de linkage determinístico-probabilístico

210.00). Condom use was very low either during lifetime (8%) or in the last 6 months (16%). Overall seroprevalence were 1.12%, 0.80%, 1.64%, 14.7% and 2.63% for, respectively, syphilis, HIV, HBsAg, anti-HBc and anti-HCV. CONCLUSIONS Seroprevalences found were higher than other populations with representative studies in Brazil, with high rates of sexual risk behavior. This is of public health concern, and prevention and care strategies for sexually transmitted infections among psychiatric patients should urgently be implemented by health authorities.

A literature review of record linkage procedures focusing on infant health outcomes

Os sistemas de informação em saúde são ferramentas fundamentais para subsidiar a tomada de decisões e auxiliar a organização dos serviços, por meio do planejamento das ações e do acompanhamento e avaliação dos objetivos propostos. O sistema de saúde brasileiro tem larga experiência com a captura e o uso de informações. No entanto, Morais e Gómez (2007) fazem uma reflexão de que os atuais pressupostos, práticas e saberes de informação e informática em saúde não mais dão conta da complexidade do processo saúde/doença/cuidado, apontando algumas questões: a fragmentação dos indivíduos entre diversas bases de dados em saúde, o que acar-

IMPACT OF MATERNAL AGE ON BIRTH OUTCOMES: A POPULATION-BASED STUDY OF PRIMIPAROUS BRAZILIAN WOMEN IN THE CITY OF SÃO PAULO

Record linkage is a powerful tool in assembling information from different data sources and has been used by a number of public health researchers. In this review, we provide an overview of the record linkage methodologies, focusing particularly on probabilistic record linkage. We then stress the purposes and research applications of linking records by focusing on studies of infant health outcomes based on large data sets, and provide a critical review of the studies in Brazil.

Subnotificação de nascidos vivos: procedimentos de mensuração a partir do Sistema de Informação Hospitalar

The aim of this study is to analyse the impact of maternal age at first birth on low birth weight, preterm birth and low Apgar scores at one minute and at five minutes among live births delivered to primiparous Brazilian women in the city of São Paulo. Analyses were based on 73,820 birth records from the 1998 birth cohort. Logistic regression was used to assess the association between maternal age and each outcome variable, controlling for the following risk factors: delivery mode, plurality, sex, maternal education, number of prior losses, prenatal care, race, parity and community development. Maternal ages below 20 and above 30 years were significantly associated with the risks of low birth weight and preterm birth, but no association was found between maternal ages and Apgar score, with the exception that ages 15-19 reduced the odds of a low one-minute score. Even though this result seems to be inconsistent, low birth weight, preterm birth and low Apgar scores measure different dimensions of newborn well-being, and the association of each measure with maternal age is expected to diverge.

Life expectancy among elderly Brazilians in 2003 according to different levels of functional disability

OBJETIVO: Avaliar a subnotificacao de registros de nascidos vivos em sistemas de informacao em saude. METODOS: Foram utilizados dados secundarios do Sistema de Informacao Hospitalar (SIH) e Sistema de Informacao sobre Nascidos Vivos (Sinasc) em municipios de Minas Gerais, 2001. A analise foi feita por meio de dois procedimentos: a comparacao do numero de nascidos vivos por municipio de residencia e a tecnica de relacionamento probabilistico de dados individuais. Em ambos os casos, consideraram-se como indicadores de subnotificacao as proporcoes de nascidos vivos informadas ao SIH e nao obtidas no Sinasc. Os municipios foram posteriormente agregados em quatro faixas de tamanho populacional. RESULTADOS: O relacionamento probabilistico identificou maior proporcao de nascidos vivos subnotificados no Sinasc, relativamente a comparacao do numero de nascidos vivos nos municipios. As variacoes das diferencas entre os percentuais de subnotificacao por procedimentos foram: 9,4% nos municipios com populacao menor que 5.000 habitantes; 9,1% nos municipios com populacao entre 5.000 e 9.999 e 8,0% nos municipios com populacao entre 10.000 e 49.999 e com mais de 50.000 habitantes. CONCLUSOES: A magnitude de acrescimos revelou-se sensivel ao procedimento adotado. O relacionamento probabilistico incrementou certeza no pareamento e possibilitou identificacao de maior proporcao de casos nao registrados no Sinasc, inclusive em grandes municipios. O SIH apresentou-se como importante indicador de subnotificacao de nascidos vivos.

Maternal neonatal and community factors influencing neonatal mortality in Brazil.

The aim of the present study was to estimate disability-free life expectancy for the Brazilian elderly in 2003, by gender and age, based on different concepts of functional disability. The Sullivan method is used to combine the period life tables from the Brazilian Institute of Geography and Statistics (IBGE, 2003) and the prevalence of functional disability according to the 2003 National Sample Household Survey (PNAD 2003). The main results of the study indicate that at age 60, Brazilian men can expect to live 19 years, 39% with mild, 21% with moderate, and 14% with severe functional disability, respectively. At the same age, Brazilian women can expect to live 22 years: 56% with mild, 32% with moderate, and 18% with severe functional disability.

Factors associated with functional disability of elderly in Brazil: a multilevel analysis

Child mortality (the mortality of children less than five years old) declined considerably in the developing world in the 1990s, but infant mortality declined less. The reductions in neonatal mortality were not impressive and, as a consequence, there is an increasing percentage of infant deaths in the neonatal period. Any further reduction in child mortality, therefore, requires an understanding of the determinants of neonatal mortality. 209,628 birth and 2581 neonatal death records for the 1998 birth cohort from the city of São Paulo, Brazil, were probabilistically matched. Data were from SINASC and SIM, Information Systems on Live Births and Deaths of Brazil. Logistic regression was used to find the association between neonatal mortality and the following risk factors: birth weight, gestational age, Apgar scores at 1 and 5 minutes, delivery mode, plurality, sex, maternal education, maternal age, number of prior losses, prenatal care, race, parity and community development. Infants of older mothers were less likely to die in the neonatal period. Caesarean delivery was not found to be associated with neonatal mortality. Low birth weight, pre-term birth and low Apgar scores were associated with neonatal death. Having a mother who lives in the highest developed community decreased the odds of neonatal death, suggesting that factors not measured in this study are behind such association. This result may also indicate that other factors over and above biological and more proximate factors could affect neonatal death.