Divane Leite Matos

Evolução das desigualdades sociais em saúde entre idosos e adultos brasileiros: um estudo baseado na Pesquisa Nacional por Amostra de Domicílios (PNAD 1998, 2003)

O objetivo deste trabalho foi verificar se as desigualdades sociais em saude de adultos (20-64 anos) e idosos (> 65 anos) brasileiros se alteraram entre 1998 e 2003. O estudo foi realizado em uma amostra de 203.455 e 239.700 participantes da PNAD 1998 e 2003, respectivamente. As condicoes de saude e funcao fisica, uso de servicos de saude e filiacao a plano de saude daqueles pertencentes ao quintil inferior da distribuicao da renda domiciliar per capita foram comparadas as daqueles com renda mais alta, utilizando-se metodos multivariados de analise. Os resultados mostraram que nos dois anos considerados, os individuos no estrato mais baixo de renda apresentavam piores condicoes de saude, pior funcao fisica e menor uso de servicos de saude, tanto na faixa etaria de 20-64 quanto na de > 65 anos de idade. As forcas das associacoes entre renda domiciliar per capita, condicoes de saude e uso de servicos de saude nao se modificaram entre 1998 e 2003, indicando que nao houve alteracoes nas desigualdades sociais em saude no periodo estudado. A persistencia dessas desigualdades aponta para a ineficiencia de politicas, nos ultimos cinco anos, que as reduzissem.

Tendências nas condições de saúde e uso de serviços de saúde entre idosos brasileiros: um estudo baseado na Pesquisa Nacional por Amostra de Domicílios (1998, 2003)

This study examined trends in health conditions and use of health services by the Brazilian elderly, based on health data from the National Household Sample Surveys (PNAD) conducted in 1998 and 2003. 28,943 and 35,042 individuals aged > 60 years were included in the study, respectively. The results showed an improvement in health conditions in the study population during this period, as measured by self-rated health, having remained bedridden in the previous two weeks, ability to perform selected activities of daily living, number of chronic conditions, and self-reported arthritis. There was also an increase in the number of doctor and dentist visits from 1998 to 2003. The trends were consistent for both men and women. The results emphasize the importance of the PNAD health supplement as a source of information for the surveillance or monitoring of health and health-related conditions in the Brazilian elderly population.

Projeto Bambuí: estudo de base populacional dos fatores associados com o uso regular de serviços odontológicos em adultos

A cross-sectional study was conducted in Bambuí, Minas Gerais, to identify factors associated with regular use of dental services. Participants were interviewed with a structured questionnaire and previously validated questions. 999/1,221 (81.8%) randomly selected individuals aged > 18 years participated in the Bambuí dental survey. Of these, 654 out of 656 individuals who had at least one natural tooth and had visited a dentist during their lifetime participated in the study. Results adjusted by multiple logistic regression showed that regular use of dental services was significantly related to having > 8 and 4-7 years of schooling (OR = 9.90; 95% CI = 2.90-33.77 and OR = 3.87; 95% CI = 1.11-13.51, respectively), having a preference for restorative treatment rather than extraction (OR = 4.91; 95% CI = 2.23-10.79), having no present need of dental treatment (OR = 4.87; 95% CI = 3.17-7.49), and belief that visiting the dentist prevents tooth decay and gum disease (OR = 1.73; 95% CI = 1.13-2.65). The results show that regular use of dental services was related to factors distributed in the Andersen and Newman model (1973) explaining use of dentistry services.A cross-sectional study was conducted in Bambui, Minas Gerais, to identify factors associated with regular use of dental services. Participants were interviewed with a structured questionnaire and previously validated questions. 999/1,221 (81.8%) randomly selected individuals aged > 18 years participated in the Bambui dental survey. Of these, 654 out of 656 individuals who had at least one natural tooth and had visited a dentist during their lifetime participated in the study. Results adjusted by multiple logistic regression showed that regular use of dental services was significantly related to having > 8 and 4-7 years of schooling (OR = 9.90; 95% CI = 2.90-33.77 and OR = 3.87; 95% CI = 1.11-13.51, respectively), having a preference for restorative treatment rather than extraction (OR = 4.91; 95% CI = 2.23-10.79), having no present need of dental treatment (OR = 4.87; 95% CI = 3.17-7.49), and belief that visiting the dentist prevents tooth decay and gum disease (OR = 1.73; 95% CI = 1.13-2.65). The results show that regular use of dental services was related to factors distributed in the Andersen and Newman model (1973) explaining use of dentistry services.

Auto-avaliação da saúde bucal entre adultos e idosos residentes na Região Sudeste: resultados do Projeto SB-Brasil, 2003

O objetivo deste estudo foi verificar quais fatores de predisposicao e facilitacao, da condicao de saude bucal, de necessidade de tratamento e de comportamento estao associados a auto-avaliacao da saude bucal entre adultos (35-44 anos) e idosos (65-74 anos) residentes na Regiao Sudeste do Brasil. Fizeram parte deste trabalho 3.240 pessoas participantes do Projeto SB-Brasil/Regiao Sudeste. As caracteristicas daqueles que avaliaram a sua saude bucal como otima ou boa foram comparadas as daqueles que avaliaram como regular, ruim ou pessima. No modelo final, as caracteristicas independentemente associadas a melhor auto-avaliacao da saude bucal entre os adultos foram renda domiciliar per capita > R

Prevalência e fatores associados à realização da mamografia na faixa etária de 50-69 anos: um estudo baseado na Pesquisa Nacional por Amostra de Domicílios (2003)

181,00, nao necessidade atual de tratamento odontologico, municipio de residencia com mais de 50 mil habitantes e visita ao dentista ha > 3 anos. Entre os idosos foram: renda domiciliar per capita > R

Chagas Disease Predicts 10-Year Stroke Mortality in Community-Dwelling Elderly The Bambuí Cohort Study of Aging

181,00, nao necessidade atual de tratamento odontologico e possuir entre 1 a 19 dentes. Nossos resultados confirmam estudos de outros paises, mostrando a existencia de associacoes entre auto-avaliacao e fatores de predisposicao e facilitacao, condicao de saude bucal, necessidade de tratamento e comportamento.

A influência de respondente substituto na percepção da saúde de idosos: um estudo baseado na Pesquisa Nacional por Amostra de Domicílios (1998, 2003) e na coorte de Bambuí, Minas Gerais, Brasil

This study was developed to estimate the prevalence and factors associated with mammograms among Brazilian women, based on data from the National Household Sample Survey (PNAD) in 2003. 16,570 and 10,722 women aged 50-59 and 60-69 years participated in the study. 43% of participants aged 50-69 years had received a mammogram in the previous two years. The rate was lower among older women (37%) as compared to the younger group (46%). In both age groups, having received a mammogram in the previous two years was positively and independently associated with urban residence, region of residence, years of schooling, family income, Papanicolaou exam, number of physician visits, and health plan coverage. The results showed that the prevalence of mammograms in the previous two years is low among older Brazilian women, mainly in the 60-69-year group. The study identified striking inequalities in mammogram coverage. Further research is needed to better understand the reasons for such inequalities and thus help overcome them.

Tendência na utilização de serviços odontológicos entre idosos brasileiros e fatores associados: um estudo baseado na Pesquisa Nacional por Amostra de Domicílios (1998 e 2003)

Background and Purpose— Previous case–control studies have suggested a causal link between Chagas disease, which is caused by the protozoan Trypanosoma cruzi, and stroke. We investigated the relationship between Chagas disease and long-term stroke mortality in a large community-based cohort of older adults. Methods— Participants were 1398 (80.3% from total) residents aged ≥60 years in Bambuí City, Brazil. The end point was death from stroke. Potential confounding variables included age, sex, conventional stroke risk factors, and high sensitive C-reactive protein. Results— Participants of this study were followed from 1997 to 2007 leading to 9740 person-years of observation. The baseline prevalence of T. cruzi infection was 37.5% and the overall mortality rate from stroke was 4.62 per 1000 person-years. The risk of death from stroke among T. cruzi-infected participants was twice that of those noninfected (adjusted hazard ratio, 2.36; 95% CI, 1.25 to 4.44). A B-type natriuretic peptide level in the top quartile was a strong and independent predictor of stroke mortality among those infected (adjusted hazard ratio, 2.72; 95% CI, 1.25 to 5.91). The presence of both a high B-type natriuretic peptide level and electrocardiographic atrial fibrillation increased the risk of stroke mortality by 11.49 (95% CI, 3.19 to 41.38) in these individuals. Conclusions— This study provides new evidence supporting a causal link between Chagas disease and stroke. The results also showed that B-type natriuretic peptide alone or in association with atrial fibrillation has prognostic value for stroke mortality in T. cruzi chronically infected older adults.

Predictors of 10-year mortality in a population of community-dwelling Brazilian elderly: the Bambuí cohort study of aging

This study was developed to examine whether the use of a proxy respondent influences the distribution and factors associated with health perception among older adults, as well as the mortality relative risk. The study included 28,943 and 35,040 participants from the Brazilian National Household Survey (PNAD) in 1998 and 2003, respectively, and 1,606 members of the cohort from Bambui, Minas Gerais, Brazil. The results showed that use of proxy in the PNAD 1998 and 2003 did not modify the distribution of health perception or associated factors. The 5-year mortality rate ratio among cohort participants was higher in direct interviews with seniors (RR = 2.40) as compared to those answered by proxies (RR = 1.28), but the direction of the association was the same. These results indicate that health perception data from the PNAD can be used regardless of who answers the interview and that the association between worse health perception and mortality persisted even when perception was inferred from a proxy.

Características associadas ao uso de serviços odontológicos públicos pela população adulta brasileira

The objective of this study was to determine the prevalence and associated factors in the use of dental services by elderly Brazilians in 1998 and 2003. The Andersen & Newman model was used as the conceptual basis for the research. 28,943 and 35,040 elderly participants from the 1998 and 2003 National Household Surveys were included in the study. Elders who had visited the dentist during the previous year were compared to those who had never been to the dentist, using multinomial logistic regression. Prevalence of dental visits in the previous year increased from 13.2 to 17.4%. Predisposing factors (gender, age, and schooling), need factors (general health perception), and enabling factors (per capita household income, health insurance coverage, rural/urban residence, and geographic macro-region) were independently and significantly associated with use of dental services. Important social disparities were also observed, highlighting the need for policies to reduce such inequalities.