Carlos Henrique Klein

Serological screening and toxoplasmosis exposure factors among pregnant women in South of Brazil

Serological screening and evaluation of exposure factors for Toxoplasma gondii transmission were conducted in 2126 pregnant women from southern Brazil. Specific antibodies against Toxoplasma gondii were presented by 74.5% (n=1583) of the pregnant women evaluated. Contact with soil was found to be the major factor for infection.

Inquérito sobre uso de medicamentos por idosos aposentados, Belo Horizonte,MG

OBJETIVO: Caracterizar o uso de medicamentos por aposentados e pensionistas idosos, com enfase nas diferencas entre generos. METODOS: Inquerito domiciliar conduzido com amostra aleatoria simples de 667 individuos com 60 anos ou mais, residentes em Belo Horizonte, MG, em 2003. Os idosos foram entrevistados por farmaceuticos, utilizando questionario padronizado. Foram estimadas a prevalencia de uso e a media de medicamentos usados nos ultimos 15 dias anteriores a entrevista, as quais foram estratificadas de acordo com o genero segundo variaveis sociodemograficas e de saude. RESULTADOS: A prevalencia de uso de medicamentos foi de 90,1%, significativamente maior entre as mulheres (93,4%) do que entre os homens (84,3%). Mulheres utilizaram em media 4,6±3,2 produtos e homens 3,3±2,6 (p<0,001). Os principios ativos mais usados pelos idosos pertenciam aos sistemas cardiovascular, nervoso, e do trato alimentar e metabolismo. O consumo foi superior entre as mulheres nesses tres grupos, assim como as medias de uso de medicamentos segundo variaveis sociodemograficas e de saude selecionadas. CONCLUSOES: O estudo identificou uso mais intenso de medicamentos pelas mulheres, fato que as torna mais vulneraveis aos prejuizos de polifarmacia, como risco de interacoes e uso inadequado.

Complexidade do regime terapêutico prescrito para idosos

OBJECTIVE: To examine factors associated with therapeutic regimen complexity of drug prescriptions for elderly people in Belo Horizonte, Minas Gerais, Brazil. METHODS: A household survey of elderly people selected by simple random sampling from Brazils social security register. The medication complexity index (MCI), a direct measurement of actions required to administer medication, was derived from information in the latest prescription. Univariate and bivariate analyses were performed to identify factors associated with the MCI. RESULTS: Of the 667 interviewees, 56.5% had prescriptions meeting the inclusion criteria; most (69.2%) were females aged 72.4 years (mean); 35.5% self-rated their health good or very good; and 37.4% reported five or more diseases. In the 15 days prior to interview, 1873 drugs were used (mean=5.1), of which 942 appeared on the prescriptions examined (mean=2.5). Over the same period, 22.3% of interviewees failed to use some prescribed drug. The MCI ranged from 1 to 24 (mean=6.1). Number of drugs prescribed (>2), less schooling, worse perception of health and a lower benefit payment associated positively with greater complexity (p<0.05). An association was observed between regimen complexity and failure to use some drug in the preceding 15 days (p=0.034). CONCLUSION: Elderly people in worse socio-economic and health conditions seem more likely to receive more complex therapeutic regimens, which are associated with non-compliance to the proposed treatment. This is an important consideration in the healthcare of elderly. Simplification of therapy could aid self-care among the elderly.

Utilização de fitoterápicos por idosos: resultados de um inquérito domiciliar em Belo Horizonte (MG), Brasil

The herbal drugs constitute an alternative or complementary therapy for the health needs and its use has been growing in the aged population of many countries. However, herbal drugs present important adverse effects and drug interactions and should not be indiscriminately used. The aim of this study was to investigate the profile of herbal drug use by elderly and pensioner residents of Belo Horizonte, Brazil. Eight hundred and eighty-one retirees were randomly selected from the Instituto Nacional do Seguro Social (INSS) database for in-home interview. The prevalence of herbal drugs use, and possible drug interactions were investigated. Results showed that 667 (80.3%) of selected individuals were interviewed. Seventy-one subjects (10.6%) used herbal drugs in the past 15 days, mainly those prepared from ginkgo (41.8%), horse chestnut (12.3%), and soya extract (8.2%). More than 60% of the herbal drugs were acquired in compounding pharmacies. Almost 45% of the herbal drug users were exposed to at least one potential herb-drug interaction, such as between ginkgo and thiazide diuretics (14) and antithrombotic/anticoagulants (8). Strategies to provide orientation for the rational use of these products in elderly people are necessary, since they are the population most exposed to polypharmacy and in consequence, most vulnerable to inappropriate uses of medications.

Intestinal parasite analysis in organic sediments collected from a 16th-century Belgian archeological site

Parasite eggs found in organic remains collected from medieval structures in Raversijde (medieval name: Walraversijde), a village on the northern coast of Belgium, are discussed. The eggs were identified as Ascaris lumbricoides and Trichuris trichiura, both human parasites. Species identification allowed elucidating the origin of the organic sediments and the structures, in this case latrines used by humans. Capillaria sp. and free-living nematode larvae were also found in the latrine. Although neither parasite burden nor prevalence rates could be measured, the abundance of human intestinal parasite eggs indicated a high infection rate in the village residents, reflecting very poor sanitation.

Mortalidade por doenças cardiovasculares em três estados do Brasil de 1980 a 2002

OBJETIVO: Avaliar e comparar a mortalidade de adultos por doencas do aparelho circulatorio (DAC), especialmente doencas isquemicas do coracao (DIC) e doencas cerebrovasculares (DCBV), no periodo de 1980 a 2002 nos Estados do Rio de Janeiro, Rio Grande do Sul e Sao Paulo e em suas capitais, levando em consideracao o impacto dos obitos por causas mal definidas nas taxas de mortalidade. METODOS: Foram estimadas as taxas de mortalidade (brutas e ajustadas por sexo e idade) por DAC, DIC e DCBV em individuos com 20 ou mais anos. Essas taxas foram compensadas com parte dos obitos por causas mal definidas, na mesma proporcao dos obitos por DAC, DIC ou DCBV em relacao a todos os obitos, excluidos os mal definidos. Tambem foram estimadas as medias e diferencas anuais das taxas de mortalidade compensadas e ajustadas com modelos de regressao linear. A populacao padrao foi a do Estado do Rio de Janeiro em 2000. RESULTADOS: O declinio anual das taxas compensadas e ajustadas de mortalidade por DAC em 100 000 habitantes variou de -13,1 a -8,7 no Estado do Rio de Janeiro e no Municipio de Sao Paulo, respectivamente. Nas DIC, o declinio anual foi maior no Municipio e no Estado do Rio de Janeiro (-5,0 e -4,5, respectivamente), e menor no Estado do Rio Grande do Sul e no Municipio de Sao Paulo (-2,8 e -2,7, respectivamente). Nas DCBV, a variacao observada foi de -6,5 a -2,9 no Estado do Rio de Janeiro e em Porto Alegre, respectivamente. CONCLUSAO: Tendo em vista que o declinio nas taxas de mortalidade compensadas e ajustadas por DAC, DIC e DCBV ocorreu depois de 1980, e pouco provavel que tenha resultado do controle dos fatores de risco e implementacao da revascularizacao do miocardio. Essa queda poderia estar relacionada ao desenvolvimento economico acentuado que a precedeu, com consequente melhoria das condicoes de vida e reducao da exposicao a infeccoes no periodo perinatal e na infância.

Sampling design for the Study of Cardiovascular Risks in Adolescents (ERICA)

O Estudo de Riscos Cardiovasculares em Adoles-centes (ERICA) objetiva estimar prevalencia de fatores de risco cardiovascular e da sindrome metabolica em adolescentes (12 a 17 anos) matriculados em escolas publicas e privadas dos 273 municipios com mais de 100 mil habitantes no Brasil. A populacao de pesquisa foi estratificada em 32 estratos geograficos (27 capitais e cinco conjuntos com os demais municipios de cada macrorregiao do pais) e uma amostra de 1.251 escolas foi selecionada com probabilidade proporcional ao tamanho. Em cada escola foram selecionadas tres combinacoes de turno (manha e da tarde) e ano (serie), e em cada uma destas combinacoes foi selecionada uma turma. Todos os alunos elegiveis das turmas selecionadas foram objeto de pesquisa. Os pesos amostrais do desenho foram calculados pelo produto dos inversos das probabilidades de inclusao em cada estagio da amostra e foram depois calibrados considerando as projecoes do numero de adolescentes matriculados em escolas localizadas nos estratos geograficos considerados por sexo e idade.The Study of Cardiovascular Risk in Adolescents (ERICA) aims to estimate the prevalence of cardiovascular risk factors and metabolic syndrome in adolescents (12-17 years) enrolled in public and private schools of the 273 municipalities with over 100,000 inhabitants in Brazil. The study population was stratified into 32 geographical strata (27 capitals and five sets with other municipalities in each macro-region of the country) and a sample of 1,251 schools was selected with probability proportional to size. In each school three combinations of shift (morning and afternoon) and grade were selected, and within each of these combinations, one class was selected. All eligible students in the selected classes were included in the study. The design sampling weights were calculated by the product of the reciprocals of the inclusion probabilities in each sampling stage, and were later calibrated considering the projections of the numbers of adolescents enrolled in schools located in the geographical strata by sex and age.

Utilização de medicamentos por idosos brasileiros, de acordo com a faixa etária: um inquérito postal

The objective of this study was to evaluate factors associated with use of medicines by the elderly. A national postal survey was conducted with a random sample of 3,000 elderly individuals selected from the registry of the Brazilian National Social Security Institute. The study estimated the prevalence and average number of medicines used in the 15 days prior to the survey, according to age bracket. Prevalence of use of medication was 83.0%: 78.8% in the 60-69 year bracket and 87.3% in individuals 70 years or older (p < 0.05). Older elders had taken an average of 4.4 drugs, as compared to 3.3 among younger elders. Drugs for the cardiovascular system were the most widely used. Age 70 years and older, female gender, poor self-rated health, interruption of routine daily activities, six or more medical visits in the previous year, private health insurance, and reporting of four or more illnesses were independently associated with use of medications (p < 0.05). The results expand the knowledge on use of medications among elderly Brazilians, emphasizing the need to improve pharmaceutical care focused on this subgroup of the population.

Uso de anti-hipertensivos e antidiabéticos por idosos: inquérito em Belo Horizonte, Minas Gerais, Brasil

Concern over the harmful effects of drug use by the elderly has motivated studies aimed at identifying problems in such utilization. This was a household survey with retirees aged > 60 years living in Belo Horizonte, Minas Gerais State, Brazil, in 2003, who reported having a diagnosis of diabetes and/or hypertension. Quality of anti-hypertensive and anti-diabetic medication was measured by redundancy, combinations of drugs, and inappropriate drugs. Among 283 elderly patients (89%) with self-reported hypertension and use of anti-hypertensive pharmacotherapy, 68.2% were using diuretics and 37.8% ACE inhibitors. Among the 22 (64.7%) self-reported diabetic patients under pharmacotherapy, 45.5% were using insulin and 77.3% oral anti-diabetic agents. Among the 89 self-reported diabetic and hypertensive patients, 80 (90%) were using anti-hypertensive drugs and 51 (57.3%) anti-diabetic agents. The study revealed the use of dose combinations, redundant use, and inappropriate medicines, thus indicating the need to monitor treatment protocols and improve healthcare for elderly patients.

Utilização de medicamentos por aposentados brasileiros: 1 - metodologia e resultados de cobertura de inquérito multicêntrico

This paper reports methodological aspects and response rates of a survey with the main objective of describing the drug utilization profile of retirees of the Institute of National Social Security of Brazil, 60 years of age or older, in three simple random samples: Brazil (countrywide), Belo Horizonte municipality, and Rio de Janeiro municipality. This cross-sectional study employed two approaches: mail (self-report questionnaires) and home interviews (questionnaires completed by interviewers). This strategy allowed evaluation of response agreement between the mail and home interview approaches. In the national sample of 3,000 individuals, 1,025 only responded to the self-report questionnaire. Despite this the low response rate, there was reasonable resemblance between respondents and non-respondents, suggesting that this sample is representative of the target population. In Belo Horizonte and Rio de Janeiro the initial samples of 800 individuals were replicated for both approaches, mail and home interview. The response rates to the mail surveys were 46.8% and 34.4% in Belo Horizonte and Rio de Janeiro, respectively. The response rates to the home interviews were 80.3% and 70.7% in Belo Horizonte and Rio de Janeiro, respectively, after unavoidable attrition.