Chester Luis Galvão Cesar

Prevalência de deficiência auditiva referida e causas atribuídas: um estudo de base populacional

The objective was to determine the prevalence of self-reported hearing loss in four urban areas in Sao Paulo State, Brazil, and to describe the causes and socio-demographic variables. This was a population-based cross-sectional study with data on individuals 12 years or older living in the areas in 2001 and 2002. Participation included 5,250 subjects selected by two-stage probability sampling, stratified in clusters. Data analysis was exploratory, including bivariate and multiple logistic regression analysis. Prevalence of hearing loss was 5.21%, and higher levels were associated with: age > 59 years (18.7%), illness in the 15 days prior to the interview (8.4%), common mental disorders (8.8%), and use of medication in the previous 3 days (8.4%). The study of factors associated with hearing loss can lead to health interventions for addressing that the populations real needs, mostly in primary care. More population-based studies on hearing are needed in Brazil, since there are few publications on the subject.

Medidas de associação em estudo transversal com delineamento complexo: razão de chances e razão de prevalência

O objetivo deste estudo foi apresentar e discutir a utilizacao das medidas de associacao: razao de chances e razao de prevalencias, em dados obtidos de estudo transversal realizado em 2001-2002, utilizando-se amostra estratificada por conglomerados em dois estagios (n=1.958). As razoes de chances e razoes de prevalencias foram estimadas por meio de regressao logistica nao condicional e regressao de Poisson, respectivamente, utilizando-se o pacote estatistico Stata 7.0. Intervalos de confianca e efeitos do desenho foram considerados na avaliacao da precisao das estimativas. Dois desfechos do estudo transversal com diferentes niveis de prevalencia foram avaliados: vacinacao contra influenza (66,1%) e doenca pulmonar referida (6,9%). Na situacao em que a prevalencia foi alta, as estimativas das razoes de prevalencia foram mais conservadoras com intervalos de confianca menores. Na avaliacao do desfecho de baixa prevalencia, nao se observaram grandes diferencas numericas entre as estimacoes das razoes de chances e razoes de prevalencia e erros-padrao obtidos por uma ou outra tecnica. O efeito do desenho maior que a unidade indicou que a amostragem complexa, em ambos os casos, aumentou da variância das estimativas. Cabe ao pesquisador a escolha da tecnica e do estimador mais adequado ao seu objeto de estudo, permanecendo a escolha no âmbito epidemiologico.

Utilização de medicamentos e fatores associados: um estudo de base populacional no Município de Campinas, São Paulo, Brasil

This article analyzes prevalence rates in the use of medication according to demographic, socioeconomic, and health-related behavioral variables through a population-based cross-sectional study of individuals 18 years and older (n=941) in Campinas, Sao Paulo State, Brazil. The study used multistage sampling, both stratified and cluster. Chi-square test was performed, and adjusted prevalence ratios were estimated by gender and age, both with 95% confidence intervals. A Poisson multiple regression model was developed, and the following factors were associated with use of medication: female gender, age 40 and over, reported illness in the previous two weeks, and number of chronic diseases. The most widely consumed drugs were for the cardiovascular and nervous systems, besides herbal remedies. Prevalence of medication in Campinas was lower than in most studies. Local health surveys could help identify drug use patterns and guarantee more appropriate interventions for pharmaceutical care policy.

Fatores associados à doença pulmonar em idosos

OBJECTIVE To investigate the prevalence of reported pulmonary disease among elderly subjects, according to sociodemographic and economic characteristics, lifestyle, physical mobility, and health status. METHODS This was a cross-sectional population-based study that included 1,957 elderly subjects (aged 60 and over). Information was collected by means of interviews. Subjects were selected using a two-stage probabilistic, stratified, cluster sampling strategy in six municipalities in the State of São Paulo between 2001 and 2002. Descriptive statistics, chi-squared association tests, prevalence ratios, and 95% confidence intervals were utilized. Adjusted analysis was carried out by Poisson regression. RESULTS Among the interviewees, around 7% reported pulmonary disease. There was no association between pulmonary disease and influenza vaccination. Adjusted analysis identified the following factors that were independently associated with reported disease: smoking (PR: 2.03; 95% CI: 1.39-2.97); medication use (PR: 2.05; 95% CI: 1.11-3.79); health status self-assessed as poor or very poor (PR: 1.89; 95% CI: 1.20-2.96); and depression, anxiety, or emotional problems (PR: 1.86; 95% CI: 1.11-3.10). CONCLUSIONS The findings from the present study reinforce the importance of respiratory diseases among the elderly, particularly in more vulnerable groups. Preventive measures and specific care for such groups are therefore justified.

Envelhecimento e deficiência auditiva referida: um estudo de base populacional

O objetivo do estudo foi estimar a prevalencia da deficiencia auditiva referida por idosos do Municipio de Sao Paulo, Brasil, segundo caracteristicas sociodemograficas e descrever caracteristicas atribuidas a esta deficiencia. Os dados sao provenientes do Inquerito de Saude do Municipio de Sao Paulo (ISA-Capital/2003), com analise do subgrupo dos idosos (n = 872). Realizaram-se o teste do χ2 e a analise de regressao de Poisson. A prevalencia da deficiencia auditiva referida pelos idosos foi 11,2% e foi maior entre os homens (RP = 1,86; IC95%: 1,19-2,92). Observou-se grande desconhecimento dos idosos quanto as causas da deficiencia auditiva referida (42,5%), 25,5% relataram ter dificuldades em atividades de lazer, 11,4% necessitavam de ajuda para atividades cotidianas e 63,3% relataram nao necessitar de assistencia em decorrencia deste deficit. A alta prevalencia de deficiencia auditiva referida pelos idosos, principalmente do sexo masculino, remete a relevância deste problema para a saude publica, ja que o envelhecimento populacional e uma realidade nova e vem acompanhada de exigencias ainda desconhecidas por profissionais e pelo poder publico.

Socio-economic variables influence the prevalence of inadequate nutrient intake in Brazilian adolescents: results from a population-based survey

OBJECTIVE To estimate the prevalence of inadequate nutrient intake among adolescents and the association between socio-economic variables and nutritional status. DESIGN Cross-sectional study with a population-based sample. SETTINGS The usual nutrient intake distribution was estimated using the Iowa State University method. The Estimated Average Requirement cut-off point method was used to determine the proportion of adolescents with inadequate intake for each nutrient, according to sex, income, parental educational level and nutritional status. SUBJECTS Twenty-four-hour dietary recalls were applied in 525 male and female Brazilian adolescents aged 14-18 years. RESULTS The highest prevalence of inadequate nutrient intake was observed for vitamin E (99 % in both sexes). For male and female adolescents, the prevalence of inadequate intake was: Mg, 89 % and 84 %; vitamin A, 78 % and 71 %; vitamin C, 79 % and 53 %; and vitamin B6, 21 % and 33 %, respectively. The prevalence of inadequate intake for niacin, thiamin, riboflavin, Se, Cu and vitamin B12 was <15 %. Individuals in the lower income and lower parental educational level strata had the highest risk of having inadequate intake for P, riboflavin and vitamins A, B6 and B12. Compared with non-overweight individuals, overweight individuals had a higher risk of inadequate intake for Mg, vitamin A, P, thiamin and riboflavin. CONCLUSIONS The present study found a high prevalence of inadequate intake of nutrients that are recognised as being protective against chronic diseases. Adolescents in the lower income and lower parental educational level strata were less likely to have their nutrient intake requirements met.

Dietary calcium intake and overweight: An epidemiologic view

OBJECTIVE We evaluated the relation between overweight and calcium intake in adults living in the municipality of São Paulo, Brazil. METHODS This was a cross-sectional population-based study on a sample of 1459 adults that was obtained by multistage cluster sampling. Dietary intake was measured by the 24-h recall method. Poissons and linear regression analyses were performed to evaluate the relation between overweight and quartiles of calcium intake adjusted for energy. RESULTS The prevalence of overweight was 43.1% and the average adjusted calcium intake was 448.6 mg. In the linear regression analyses, the regression coefficient for adjusted calcium was significant and negative (P = 0.019, beta(1) = -0.0001). Although evaluated by quartiles, the prevalence ratio for overweight in the first quartile of calcium intake was 1.24 (95% confidence interval 1.00-1.54) and that in the second quartile was 1.24 (95% confidence interval 1.03-1.49). CONCLUSION In the present study, calcium intake showed a significant negative association with body mass index.

Vacinação contra influenza em idosos por área de residência: prevalência e fatores associados

A vacinacao contra influenza e a principal forma de prevenir e reduzir a morbidade e mortalidade associadas a doenca entre os idosos e grupos de risco. O objetivo deste estudo e determinar fatores demograficos, socioeconomicos, comportamentais e de saude associados a vacinacao, entre idosos residentes em diferentes areas do Estado de Sao Paulo, no periodo de 2001 a 2002. Trata-se de um delineamento transversal de base populacional que considerou os idosos residentes em duas areas do Estado: uma composta pelo municipio de Campinas e distrito do Butanta, na cidade de Sao Paulo, e outra pelos municipios de Taboao da Serra, Embu e Itapecerica da Serra (regiao metropolitana do municipio de Sao Paulo). A amostra foi composta por 849 e 641 individuos com 60 anos ou mais, residentes em tais localidades, respectivamente. Na analise bruta foram utilizadas razoes de prevalencia e intervalos de confianca de 95% e a analise multivariada foi realizada pela regressao de Poisson. A prevalencia de vacinacao auto-referida foi de 66,9% entre os residentes em Campinas e no distrito do Butanta e 67,6% naqueles das demais localidades. Apos analise ajustada, para os idosos de Campinas e Butanta, apenas menor escolaridade (RP = 1,25; IC 95%: 1,02-1,54) esteve associada a vacinacao. Ja na area composta pelos municipios menos populosos, idade mais avancada (RP = 1,15; IC 95%: 1,02-1,31), hipertensao arterial (RP = 1,21; IC 95%: 1,02-1,45), diabetes (RP = 1,16; IC 95%: 1,01-1,33) e doenca cronica de pulmao (RP = 1,30; IC 95%: 1,03-1,64) referidas, estiveram tambem associadas. Apesar de a prevalencia de vacinacao contra influenza entre os idosos das diversas localidades ser praticamente a mesma, pode-se observar diferencas no perfil do idoso quanto a referencia desse procedimento preventivo.

Trans fatty acid intake among the population of the city of São Paulo, Southeasthern Brazil

OBJECTIVE To analyze the monounsaturated and polyunsaturated trans fatty acid intake among the general population. METHODS A cross-sectional study was conducted in São Paulo, Southeastern Brazil, in 2003, on a representative sample of 2,298 male and female subjects, including 803 adolescents (12 to 19 years), 713 adults (20 to 59 years) and 782 elderly people (60 years or over). Food intake was measured using 24-hour recall. Mean trans fatty acid intake was described according to gender and age group. RESULTS The mean trans fatty acid intake was 5.0 g/day (SE = 0.1), accounting for 2.4% (SE = 0.1) of total energy and 6.8% (SE = 0.1) of total lipids. The adolescents had the highest mean intake levels (7.4 g/day; 2.9% of energy) while the adults and the elderly had similar intake (2.2% of energy for both; 6.4% of lipids and 6.5% of lipids, respectively). The mean trans fatty acid intake among adult and elderly women (approximately 2.5% of energy and 7.0% of lipids) was higher than among men in the same age group. The food item with the highest contribution towards trans fatty acids was margarine, accounting for more than 30% of total intake, followed by filled cookies among adolescents and meat among adults and the elderly. CONCLUSIONS The trans fatty acid intake is above the level recommended by the World Health Organization. Replacement of the trans fatty acids in manufactured food items may be an effective measure for reducing trans fatty acid intake in Brazil.OBJETIVO: Analisar o consumo de acidos graxos monoinsaturados e poliinsaturados de configuracao trans na populacao geral. METODOS: Estudo transversal realizado em Sao Paulo, SP, 2003, com amostra representativa de 2.298 individuos, sendo 803 adolescentes (12 a 19 anos), 713 adultos (20 a 59 anos) e 782 idosos (60 anos ou mais), de ambos os sexos. O consumo alimentar foi medido por meio do recordatorio alimentar de 24 horas. Os valores medios de ingestao de acidos graxos trans foram descritos segundo sexo e faixa etaria. RESULTADOS: O consumo medio de acidos graxos trans foi de 5,0g/dia (EP=0,1), correspondendo a 2,4% (EP=0,1) do total calorico e 6,8% (EP=0,1) do total de lipidios. Os adolescentes apresentaram as maiores medias de ingestao (7,4g/dia e 2,9% energia), enquanto os adultos e idosos registraram ingestao semelhante (2,2% energia; 6,4% lipidios e 6,5% lipidios, respectivamente). As medias de consumo de acidos graxos trans entre mulheres adultas e idosas (aproximadamente 2,5% energia e 7,0% lipidios) foram maiores que as medias dos homens de mesma faixa etaria. O alimento de maior contribuicao para o consumo de acidos graxos trans foi a margarina, representando mais de 30% do total ingerido, seguido do biscoito recheado para os adolescentes e da carne bovina para os adultos e idosos. CONCLUSOES: O consumo de acidos graxos trans encontra-se acima do preconizado pela Organizacao Mundial da Saude. A substituicao dos acidos graxos trans dos alimentos industrializados pode ser uma medida eficaz para a reducao do consumo desse tipo de gordura no Brasil.

Sources of variation of energy and nutrient intake among adolescents in São Paulo, Brazil

The aim of the current study was to describe the sources of variation of energy and nutrient intake and to calculate the number of repetitions of diet measurements to estimate usual intake in adolescents from São Paulo, Brazil. Data was collected using 24-hour dietary recalls (24hR) in 273 adolescents between 2007 and 2008. Individuals completed a repeat 24hR around two months later. The sources of variation were estimated using the random effect model. Variance ratios (within-person to between-person variance ratio) and the number of repetitions of 24hR to estimate usual intake were calculated. The principal source of variation was due to within-person variance. The contribution of day of week and month of year was less than 8%. Variations ranged from 1.15 for calcium to 7.31 for vitamin E. The number of 24hR repeats required to estimate usual intake varied according to nutrient and gender, numbering 15 for males and 8 for females.