Chester Luiz Galvão Cesar

Desigualdades sociais na prevalência de doenças crônicas no Brasil, PNAD-2003

Os inqueritos de saude de base populacional constituem o principal instrumento utilizado para conhecer a prevalencia de doencas cronicas, de restricoes de atividades e de uso de servicos de saude. Com base nos dados da PNAD-2003, foram estimadas as prevalencias das 12 doencas cronicas pesquisadas, segundo sexo, idade, cor, escolaridade, macrorregiao de residencia e situacao urbana ou rural do domicilio. Foram analisados a presenca de limitacoes e o uso de servicos de saude segundo a presenca de doenca cronica. Utilizando regressao de Poisson, foram estimadas as razoes de prevalencias ajustadas por idade, sexo, macrorregiao de residencia e tipo de respondente. A prevalencia de pelo menos uma doenca cronica aumentou com a idade, foi maior entre mulheres, indigenas, pessoas com menor escolaridade, cidadaos detentores de plano de saude, migrantes de outros estados, residentes em areas urbanas e moradores da regiao Sul. A presenca de doenca cronica provocou aumento de limitacao de atividades e da demanda por servicos de saude. As condicoes mais prevalentes foram: doenca de coluna, hipertensao, artrite e depressao. Foi detectada significativa desigualdade social no padrao das doencas cronicas, segundo genero, cor/raca, nivel de escolaridade, regiao de residencia e situacao do domicilio.

Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003- 2008

The aims of this study are: to evaluate the prevalence of chronic diseases in the Brazilian population comparing data of 2008 with those of 2003; to estimate the impact of chronic conditions on the use of health services and on the restriction of daily activities and to measure the differentials in the prevalence of specific diseases according to educational strata and the affiliation to a private health plan. Data were obtained from PNAD 2008 and 2003. The analysis included estimations of crude and adjusted prevalence ratios, using svy commands from Stata 11 software. The prevalence of at least one disease was higher in: the elderly, women, low schooling level, black or indigenous people, urban residents, migrants and people living in the south region of Brazil. The most frequent diseases were: hypertension, back and spinal cord disorders, arthritis and depression. Between 2003 and 2008, an increase in the prevalence of diabetes, hypertension, cancer and cirrhosis was observed, and there was a reduction in chronic kidney failure and tuberculosis. All the diseases analyzed, with the exception of cancer and tendinitis/tenossinovitis, revealed a higher prevalence in low educational level strata. The greatest social inequalities were in chronic kidney failure, cirrhosis, tuberculosis and arthritis/rheumatism.

Prevalência de transtornos mentais comuns em populações atendidas pelo Programa Saúde da Família (QUALIS) no Município de São Paulo, Brasil

The prevalence of common mental disorders has increased in many countries. Cases are often not identified and adequately treated because traditional health care services are rarely prepared to deal with this problem. The Family Health Program (FHP) has been implemented in Brazil since 1995-1996 and provides a new primary health care model with the potential for better care for these patients. This study investigates common mental disorders prevalence according to FHP coverage and associated socio-demographic factors. A large health and health care survey was conducted from January to March 2001 in areas partly covered by the FHP in a peripheral area of the city of Sao Paulo and included common mental disorders screening in 2,337 individuals > 15 years of age. There was no significant difference in common mental disorders prevalence according to FHP. Common mental disorders prevalence was significantly higher among females (PR = 1.34), elderly (PR = 1.56), and individuals with lower income (PR = 2.64) or less schooling (PR = 2.83). Common mental disorders was associated with indicators of social disadvantage, implying the need to focus on specific health problems and risk groups to improve the impact of care.

Utilização de serviços de saúde em áreas cobertas pelo programa saúde da família (Qualis) no Município de São Paulo

OBJETIVO: O Programa de Saude da Familia se constitui em estrategia de reorganizacao do sistema de atencao a saude para o Sistema Unico de Saude. O objetivo do estudo foi verificar mudancas no perfil de utilizacao de servicos de saude apos implantacao do Programa, identificando fatores associados as mudancas observadas. METODOS: Foram analisados dados de utilizacao de servicos e procura por assistencia em duas amostras definidas por conglomerados e representativas da populacao coberta (n=1.865) e nao coberta pelo Programa de Saude da Familia (n=2.036) de dois distritos do Municipio de Sao Paulo. Os dados fazem parte de inquerito populacional realizado em 2001. Foi empregada a analise estatistica propria para conglomerados. RESULTADOS: Na utilizacao de servicos, nas areas cobertas pelo Programa de Saude da Familia, nao foram observadas razoes de prevalencia significantemente diferentes segundo escolaridade e renda, e nas areas nao cobertas as razoes de prevalencia foram mais elevadas para maior escolaridade e renda. Na procura por assistencia em pessoas com episodios de morbidade, nas areas cobertas pelo Programa a razao de prevalencia foi maior em pessoas com grau de limitacao intenso, e nas areas nao cobertas a razao de prevalencia foi mais elevada para maior escolaridade e menor para os inativos. CONCLUSOES: Nas areas estudadas, na populacao coberta pelo Programa de Saude da Familia a renda e escolaridade nao se constituem em fatores que diferenciam de forma significativa o perfil de utilizacao de servicos de saude e de procura por assistencia, indicando que o programa pode estar contribuindo para maior equidade nessas condicoes.

Impact of chronic disease on quality of life among the elderly in the state of São Paulo, Brazil: a population-based study

OBJECTIVES To assess the impact of chronic disease and the number of diseases on the various aspects of health-related quality of life (HRQOL) among the elderly in São Paulo, Brazil. METHODS The SF-36 Health Survey was used to assess the impact of the most prevalent chronic diseases on HRQOL. A cross-sectional and population-based study was carried out with two-stage stratified cluster sampling. Data were obtained from a multicenter health survey administered through household interviews in several municipalities in the state of São Paulo. The study evaluated seven diseases--arthritis, back-pain, depression/anxiety, diabetes, hypertension, osteoporosis, and stroke--and their effects on quality of life. RESULTS Among the 1 958 elderly individuals (60 years of age or older), 13.6% reported not having any of the illnesses, whereas 45.7% presented three or more chronic conditions. The presence of any of the seven chronic illnesses studied had a significant effect on the scores of nearly all the SF-36 scales. HRQOL achieved lower scores when related to depression/anxiety, osteoporosis, and stroke. The higher the number of diseases, the greater the negative effect on the SF-36 dimensions. The presence of three or more diseases significantly affected HRQOL in all areas. The bodily pain, general health, and vitality scales were the most affected by diseases. CONCLUSIONS The study detected a high prevalence of chronic diseases among the elderly population and found that the degree of impact on HRQOL depends on the type of disease. The results highlight the importance of preventing and controlling chronic diseases in order to reduce the number of comorbidities and lessen their impact on HRQOL among the elderly.

Health related quality of life among the elderly: a population-based study using SF-36 survey

As life expectancy continues to rise, one of the greatest challenges of public health is to improve the quality of later years of life. The aim of this present study was to analyze the quality of life profile of the elderly across different demographic and socioeconomic factors. A cross-sectional study was carried out in two stages, involving 1,958 individuals aged 60 years or more. Health related quality of life (HRQOL) was assessed using the SF-36 questionnaire. The lowest scores were found among measures for vitality, mental health and general health and the highest among factors including social functioning and role limitations due to emotional and physical factors. HRQOL was found to be worse among women, in individuals at advanced ages, those who practiced evangelical religions and those with lower levels of income and schooling. The greatest differences in SF-36 scores between the categories were observed in functional capacity and physical factors. The results suggest that healthcare programs for the elderly should take into account the multi-dimensionality of health and social inequalities so that interventions can target the most affected elements of HRQOL as well as the most vulnerable subgroups of the population.

Fatores associados à não realização do exame de Papanicolaou: um estudo de base populacional no Município de Campinas, São Paulo, Brasil

This study analyzes the prevalence of non-submittal to Pap smears according to socioeconomic, demographic, and health-related behavioral variables in women 40 years or older in Campinas, Sao Paulo State. This was a cross-sectional population-based study with a sample of 290 women. Based on multivariate analysis, factors associated with not having Pap smears were: age (40-59 years), race/ethnicity (black or mixedrace), and schooling (≤ 4 years). The following reasons were cited for not having Pap smears: considered unnecessary (43.5%), embarrassment (28.1%), and barriers related to health services (13.7%). The Unified National Health System performed 43.2% of the reported Pap smears. Health services should promote more equitable access to the health care system and improve the quality of care for women, since Pap smears are an effective tool against cervical cancer. The study confirmed that women’s failure to obtain Pap smears is associated with social and racial inequality, placing these women at increased risk of cervical cancer.This study analyzes the prevalence of non-submittal to Pap smears according to socioeconomic, demographic, and health-related behavioral variables in women 40 years or older in Campinas, São Paulo State. This was a cross-sectional population-based study with a sample of 290 women. Based on multivariate analysis, factors associated with not having Pap smears were: age (40-59 years), race/ethnicity (black or mixed-race), and schooling (< 4 years). The following reasons were cited for not having Pap smears: considered unnecessary (43.5%), embarrassment (28.1%), and barriers related to health services (13.7%). The Unified National Health System performed 43.2% of the reported Pap smears. Health services should promote more equitable access to the health care system and improve the quality of care for women, since Pap smears are an effective tool against cervical cancer. The study confirmed that womens failure to obtain Pap smears is associated with social and racial inequality, placing these women at increased risk of cervical cancer.

Dietary quality index and associated factors among adolescents of the state of Sao Paulo, Brazil.

OBJECTIVE To assess dietary quality and associated factors in adolescents. STUDY DESIGN We conducted a population-based cross-sectional study in a sample of 1584 adolescents living in areas of the state of São Paulo, Brazil. Dietary intake was measured with the 24-hour recall method, and dietary quality was assessed by means of the Health Eating Index (HEI), adapted to fit to the local requirements. Linear regression analyses were performed to assess the association between the HEI and demographic, socioeconomic, and lifestyle variables. RESULTS A total of 97.1% of the adolescents studied had an inadequate diet or a diet that needed improvement. The mean overall HEI score was 59.7. Lower mean HEI scores were found for fruits, dairy products, and vegetables. Male adolescents who were physically active and lived in a house or apartment had higher HEI scores. The multiple regression analyses showed that the quality of the diet improved as age decreased. Adolescents who lived in houses or apartments had higher HEI scores than adolescents living in shacks or slums, regardless of age and energy intake. CONCLUSIONS Dietary quality is associated with income and age. A better understanding of the factors associated can provide input to the formulation of policies and development of nutritional actions.

Hipertensão arterial em idosos: prevalência, fatores associados e práticas de controle no Município de Campinas, São Paulo, Brasil

The objective of this study was to assess the prevalence of reported hypertension among the elderly in Campinas, Sao Paulo, Brazil, identifying related factors, the use of healthcare services, and knowledge and practices related to treatment options. This was a cross-sectional population-based study, with stratified clustered multiple-stage sampling. Data analysis for the 426 individuals (60 years of age and older) considered the sampling design and outlining effect. Hypertension prevalence was 51.8% (46.4% in men and 55.9% in women) and was higher among the elderly with less education (55.9%), immigrants from other States (60.2%), and the overweight or obese (57.2%). The results indicate that healthcare services are ensuring access to medical care (71.6% have regular physician appointments) and medication (86.7% take their routine medication), without distinction as to socioeconomic status. However, social inequalities persist in knowledge and use of other measures to control blood pressure, like appropriate diet and exercise, which are also underused by more privileged socioeconomic strata.

Transtornos mentais comuns e uso de psicofármacos: impacto das condições socioeconômicas

OBJECTIVE To evaluate the influence of socioeconomic conditions on the association between common mental disorders and the use of health services and psychoactive drugs. METHODS This was a population-based cross-sectional study conducted in the city of Botucatu, Southeastern Brazil. The sample was probabilistic, stratified and cluster-based. Interviews with 1,023 subjects aged 15 years or over were held in their homes between 2001 and 2002. Common mental disorders were evaluated using the Self-Reporting Questionnaire (SRQ-20). The use of services was investigated in relation to the fortnight preceding the interview and the use of psychotropic drugs, over the preceding three days. Logistic regression was used for multivariable analysis, and the design effect was taken into consideration. RESULTS Out of the whole sample, 13.4% (95% CI: 10.7;16.0) had sought health services over the fortnight preceding the interview. Seeking health services was associated with female gender (OR=2.0) and the presence of common mental disorders (OR=2.2). 13.3% of the sample (95% CI: 9.2;17.5) said they had used at least one psychotropic drug, especially antidepressives (5.0%) and benzodiazepines (3.1%). In the multivariable analysis, female gender and the presence of common mental disorders remained associated with the use of benzodiazepines. Per capita income presented a direct and independent association with the use of psychoactive drugs: the greater the income, the greater the use of these drugs was. CONCLUSIONS Lower income was associated with the presence of common mental disorders, but not with the use of psychotropic drugs. The association of common mental disorders and the use of psychotropic drugs in relation to higher income strengthens the hypothesis that inequality of access to medical services exists among this population.OBJETIVO: Evaluar la influencia de las condiciones socioeconomicas en la asociacion entre trastornos mentales comunes, uso de servicios de salud y de psicofarmacos. METODOS: Estudio transversal poblacional realizado en la ciudad de Botucatu, (Sudeste de Brasil), con muestreo probabilistico, estratificado y por conglomerados. Fueron realizadas entrevistas domiciliares con 1.023 sujetos de 15 anos o mas de edad, entre 2001 y 2002. Trastorno mental comun fue evaluado utilizando el Self Reporting Questionnaire (SRQ-20). El uso de servicios fue investigado con relacion a la quincena anterior a la entrevista y uso de psicotropicos, en los tres dias anteriores. Se utilizo regresion logistica para analisis multivariable, considerando el efecto del diseno. RESULTADOS: En el total de la muestra, 13.4% (IC 95%: 10.7;16.0) buscaron servicios de salud en la quincena anterior a la entrevista. La busqueda de servicios de salud se asocio al sexo femenino (OR=2.0) y la presencia de trastorno mental comun (OR=2.2). En la muestra 13.3% (IC 95%: 9.2; 17.5) se refirieron a haber usado al menos un psicotropico, destacandose los antidepresivos (5.0%) y los benzodiazepinicos (3.1%). En el analisis multivariable, sexo femenino y presencia de trastorno mental comun se mantuvieron asociados al uso de benzodiazepinicos. Renta per capita se mostro directa e independientemente asociada al uso de psicofarmacos, de acuerdo al aumento de la renta. CONCLUSIONES: Menor renta se asocio a la presencia de trastorno mental comun, pero no al uso de psicotropicos. La asociacion entre trastorno mental comun y uso de psicotropicos y mayor renta refuerza la hipotesis de la existencia de injusticias en el acceso a la asistencia medica en la poblacion estudiada.