Elizabeth Uchoa

The Bambuí health and ageing study (BHAS): methodological approach and preliminary results of a population-based cohort study of the elderly in Brazil

OBJECTIVE A cohort study has been designed to identify predictors of adverse health events in the elderly. The methodology of the study and preliminary descriptive results are presented. METHODS The study population comprises all residents of Bambuí (Minas Gerais, Brazil), aged 60 or more years (n=1.742). From these, 92.2% were interviewed and 85.9% underwent clinical examination, consisting of haematological and biochemical tests, serology for Trypanosoma cruzi, anthropometric and blood pressure measures and electrocardiogram. Aliquots of serum, plasma and DNA were stored for future investigations. The baseline interview included sociodemographic characteristics, self-referred health condition and history of selected diseases, medication use, health service use, source of medical care, physical activities, smoking, drinking and eating habits, reproductive history, physical functioning, life events, social support and mental health. Individuals are being followed up annually. RESULTS The following characteristics predominated among participants: women (60,0%), married (48.9%) or widowed (35.4%), people living in households with up to 2 residents (73.8%), heads of family (76.7%), people with monthly income between 1.00 and 2.99 Brazilian minimum wages (62.0%) and people with up to 4 years of schooling (89.1%). The median age was 68 years. Among the cohort members, only 1.7% were lost in the first follow-up. CONCLUSIONS In general, the characteristics of the study population were very similar to those from other epidemiological studies of the elderly based on large Brazilian cities. The small number of losses to follow-up indicates that the choice of Bambuí was adequate, assuring the feasibility of a long term cohort study.

Estudo de base populacional sobre o consumo de medicamentos entre idosos: Projeto Bambuí

Investigou-se a prevalencia e fatores associados ao consumo de medicamentos prescritos e nao prescritos entre idosos (60 anos ou mais). Participaram deste trabalho 1.606 (92,2%) dos 1.742 idosos residentes na cidade de Bambui, Minas Gerais, Brasil. Entre os participantes, 1.281 (79,7%) e 274 (17,1%) haviam consumido medicamentos prescritos e nao prescritos nos ultimos noventa dias, respectivamente. O consumo de medicamentos prescritos esteve associado ao sexo feminino, idade (70-79 e > 80 anos), renda familiar (maior), estado de saude (pior) e numero de consultas medicas (maior). O uso de medicamentos nao prescritos apresentou associacao negativa com consulta medica e associacao positiva com sexo (feminino) e consulta a um farmaceutico. Os fatores associados ao consumo de medicamentos prescritos e nao prescritos verificados neste trabalho foram semelhantes aos observados em estudos conduzidos em outros paises. Diferentemente deles, nosso estudo mostrou um menor consumo de medicamentos prescritos entre idosos com pior situacao socio-economica. Nossos resultados sugerem, ainda, que a automedicacao entre idosos esteja sendo utilizada em substituicao a atencao formal a saude.

Antropologia médica: elementos conceituais e metodológicos para uma abordagem da saúde e da doença

This paper discusses the relevance, specificity, and potential of the anthropological approach to health and illness. Medical anthropology is shown as complementary to other approaches that currently deal with public health problems. The impact of social and cultural factors on health-related perceptions and behaviors is illustrated and commented. A conceptual and methodological framework is also proposed to systematize the study of representations and practices of communities in the area of public health. The specific contribution of the anthropological approach is discussed in terms of the effectiveness of public health programs.

Estudo de base populacional dos fatores associados à incapacidade funcional entre idosos na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil

This study assessed factors associated with functional disability in old age in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. The theoretical model was based on predisposing (socio-demographic), extra-individual (social support, use of health services), and intra-individual factors (health conditions). The study was conducted in a probabilistic sample of 1,786 subjects aged > 60 years. The dependent variable was disability defined as mild (some difficulty) or severe (total dependence) in performing at least one basic activity of daily living. Prevalence of disability was 16% (8% mild; 8% severe). Age and worse self-rated health were independently and positively associated with mild and severe disability. Self-reported hypertension and arthritis were associated with mild disability, while diabetes and stroke were associated with severe disability. Severe disability was independently and negatively associated with number of visits by friends in the previous 30 days. According to the results, chronic conditions associated with disability in the study population are preventable, and severely disabled elderly had less extra-family social support.

Prevalência e fatores associados à automedicação: resultados do projeto Bambuí

OBJECTIVE A population-based study was carried out in the municipality of Bambuí, Brazil (population: approx. 15,000 inhabitants), to determine the prevalence of self-medication and its associated factors. METHODS A random sample of 1,221 residents aged >18 years was selected. Of these, 796 reported use of medications in the last 90 days and were selected for this study (775 participated). Data was collected through home interviews. Study variables were divided in 3 groups: social and economic, health status and health service use indicators. Statistical analysis was performed using Pearsons Qui-square test, and odds ratios adjusted by multinomial logistic regression. RESULTS Of the total, 419 (54.0%) reported use of only prescribed medications, 133 (17.2%) took prescribed and over-the-counter medications, and 223 (28.8%) took only over-the-counter medications in the last 90 days. After adjusting for confounders, the following variables presented significant associations with exclusive use of self-medication: female sex (OR=0.6; IC95%=0.4 - 0.9); age (OR=0.4; IC95%=0.3 - 0.6 for 40-59 years old and OR=0.2; IC95%=0.1 - 0.5 for >60 years); >5 residents in the household (OR=2.1; 1.1 - 4.0); number of visits to a doctor in the previous 12 months (OR=0.2; IC95%=0.1 - 0.4 and OR=0.1; IC95%=0.0-0.1 for 1 visit and >2 visits, respectively); report of consulting a pharmacist in the previous 12 months (OR=1.9; IC95%=1.1 - 3.3); and reports of financial expenses with medications during this period (OR=0.5; IC95%=0.3 - 0.8). CONCLUSIONS The study results show that the prevalence of self-medication in the studied community was similar to that observed in developed countries. These results also suggest that self-medication works in place of the formal health attention in this community.

Estudo epidemiológico de base populacional sobre uso de medicamentos entre idosos na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil

The aim of this study was to investigate the use of medication and associated factors (sociodemographics, health conditions, and health services use) in a representative sample of 1,598 elderly individuals (60+ years) in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. The dependent variable was the number of drugs used in the preceding two weeks. Prevalence of medication was 72.1%, and mean consumption was 2.18 drugs, most of which acting on the cardiovascular system. Use of medication (any amount) was independently associated with gender (female), age (80+ years), having consulted a physician, and presence of any chronic health condition. Use of five or more drugs was significantly associated with schooling (8+ years, OR=2.28), worse self-rated health (fair, OR = 5.45; bad/very bad, OR = 5.35). The results show that the types of medications used and factors associated with consumption were similar to those observed in other populations, suggesting some uniformity among various populations in the use of medication and its determinants.

Unexpected high prevalence of 1‐month depression in a small Brazilian community: the Bambuí Study

Objective:  To determine the prevalence of depression in a community with 15 000 inhabitants in Brazil (Bambuí).

Cohort Profile: The Bambuí (Brazil) Cohort Study of Ageing

Ageing of the population is the most important demographic change facing many countries around the world. The speed of demographic ageing in Latin American and the Caribbean, however, will be unprecedented in comparison with Western European and North American countries. This demographic change will generate populations with large numbers of elderly who at some time in their lives have been exposed to infectious diseases. Infections may affect ageing in different ways. Most important postulated mechanisms include enhanced inflammation, pathogen-dependent tissue destruction or accelerated cellular ageing through increased turnover. Most epidemiological studies of ageing have, understandably, focused on non-communicable diseases and related conditions. To our knowledge, no previous population-based cohort study had examined the consequences of the double burden of non-communicable diseases and a parasitic chronic infection in old age. Chagas disease, which is caused by the protozoan Trypanosoma cruzi, is endemic in Latin American countries, with about 8 million people infected. As a consequence of immigration from endemic countries, Chagas disease is an emerging issue in North America and Europe, and an example in the era of globalization of how infectious diseases extend beyond endemic areas. Chagas disease is related to poor socio-economic circumstances in early life. In endemic areas, the main source of infection is a bloodsucking triatomine insect that colonizes poor households. Most individuals in these areas acquire the infection at <20 years of age, and 30% develop chronic chagasic cardiomyopathy. The ageing of the population, together with a cohort effect observed in endemic areas where the household insect transmission has been interrupted, will lead to increases in the number of older adults who are already infected by T. cruzi. The main objective of the Bambui Cohort Study of Ageing is to examine the separate and joint effects of chronic T. cruzi infection and non-communicable diseases on health outcomes in old age.

Is the GDS-30 better than the GHQ-12 for screening depression in elderly people in the community? The Bambui Health Aging Study (BHAS)

BACKGROUND Two-phase diagnostic surveys are popular in psychiatric epidemiology. The Geriatric Depression Scale (GDS) and the General Health Questionnaire (GHQ) are commonly used to screen in older and younger populations, respectively. METHOD In Phase I, in this Brazilian population-based study, we screened 392 participants aged >or= 75 years. In Phase II, half of those scoring >or= 11 in the GDS and >or= 4 in the GHQ and 20% of others were selected for detailed evaluation with ICD-10 diagnoses assessed by the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) (n = 126). RESULTS Internal consistencies were good for all scales. At the optimal cut-off points GDS-30 (14/15) yielded 73% sensitivity and 65% specificity, while classical GHQ (4/5), Likert (15/16) and c-GHQ (5/6) yielded 66-75% sensitivity and 57-62% specificity. Receiver operating characteristic (ROC) curve analysis against SCAN indicated only moderate screening potential [area under the ROC curve (AUROC): GDS = 0.76; classical GHQ = 0.74; Likert = 0.76; c-GHQ = 0.73], with no statistically significant differences. All measures were biased by disability and self-reported health. CONCLUSIONS In this study, neither screen was sufficiently predictive of SCAN ICD-10 diagnosis to recommend their use in two-phase surveys. Despite its theoretical advantages, the GDS-30 performed no better than the GHQ-12, and was biased in similar ways.

Norms for the mini-mental state examination: adjustment of the cut-off point in population-based studies (evidences from the Bambuí health aging study)

OBJECTIVE To estimate the prevalence of cognitive impairment in an elderly population-based cohort, using several Mini-Mental State Examination (MMSE) cut-off points recommended by Brazilian authors and to examine the percentile distribution of MMSE scores in the study population. METHOD A total of 1558 subjects aged>60 years (89.4% of the total), living in the city of Bambuí, MG, completed the MMSE and were included in the present study. RESULTS The estimated prevalences of cognitive impairment varied from 13.2% to 27.0% depending on the cut-off point and agreement varied widely between them (kappa range: 0.38 to 0.88). Cut-off point 13/14 corresponded to the 5th percentile and 21/22 corresponded to the lower quartile of the MMSE score distribution. CONCLUSION In the absence of comparable cut-off points, percentile distributions are more adequate for population-based studies of elderly with low schooling level.