Erika Aparecida Silveira

Prevalence of cardiovascular risk factors in elderly individuals treated in the Brazilian Public Health System in Goiânia

BACKGROUND Cardiovascular risk factors (CVRF) present a high prevalence and have an impact on the morbimortality of the elderly; however, this question is still unknown by the elderly treated in the Brazilian Public Health System (SUS). OBJECTIVE To investigate the prevalence of CVRF among the elderly treated by SUS in the city of Goiânia, state of Goiás, Brazil. METHODS Cross-sectional study using a multiple-stage sampling method, carried out through a home-based interview with 418 elderly individuals aged > 60 years treated by SUS in the city of Goiânia, state of Goiás, Brazil. Socioeconomic and demographic data, as well as data on lifestyle, weight, height, waist circumference, blood pressure and medications used were collected. The studied CVRF were: arterial hypertension, diabetes mellitus, total obesity, central obesity, dyslipidemias, smoking, sedentary lifestyle and alcohol consumption. The Chi-square test was used for the analyses of the associations, with significance being set at 5%. RESULTS The prevalences of the CVRF were: 80.4% of arterial hypertension; 83.3% of central obesity; 59.8% of sedentary lifestyle; 32.2% of total obesity; 23.4% of dyslipidemias; 19.1% of diabetes mellitus; 10.0% of smoking and 5.9% of alcohol consumption. As for the simultaneity, 2.4% of the elderly did not present CVRF. The simultaneity of two or more CVRF occurred in 87.3% of the elderly and was more frequent among women. CONCLUSION The CVRF occur simultaneously in more than half of the elderly individuals, and the most prevalent ones were: arterial hypertension, central obesity and sedentary lifestyle. It is necessary to foster the strategies of health promotion and prevention of cardiovascular injury in elderly individuals treated by SUS in the city of Goiânia, especially among those with simultaneous CVRF.

[Obesity prevalence and associated factors in the elderly in Pelotas, Rio Grande do Sul State, Brazil: obesity classification according to two cutoff points for body mass index].

The aim of this study was to estimate obesity prevalence and associated factors in the elderly, according to two cutoff points for body mass index (BMI). This was a cross-sectional, population-based study of a sample of 596 elderly residents in Pelotas, southern Brazil. Nutritional status was evaluated through BMI based on self-reported weight and stature. Poisson multiple regression with hierarchical analysis was applied, with two dependent variables for definition of obesity: BMI > 27 kg/m(2) and BMI > or =30 kg/m(2), the cutoff points proposed by Lipschitz and the World Health Organization, respectively. Prevalence of obesity was 48.7% (95%CI: 44.6-52.7) for BMI > 27 kg/m2 and 25.3% (95%CI: 21.9-29.0) for BMI > or =30 kg/m(2). Two multiple regression models showed an association between obesity and female gender and age. BMI > 27 kg/m(2) showed an association with age and smoking and BMI > or =30 kg/m(2) with sedentary lifestyle. Obesity prevalence was high in this group of elderly. For the Brazilian elderly population and from a public health perspective, the study suggests the use of a more sensitive cutoff point, namely BMI > 27 kg/m(2).

Capacidade funcional, condições socioeconômicas e de saúde de idosos atendidos por equipes de Saúde da Família de Goiânia (GO, Brasil)

O envelhecimento populacional e um desafio para os profissionais de saude. Este estudo objetivou avaliar a capacidade funcional e identificar os fatores associados a dependencia para as atividades de vida diaria (AVD) e instrumentais de vida diaria (AIVD) e descrever o perfil socioeconomico, demografico e de saude de idosos. Trata-se de pesquisa transversal realizada com idosos atendidos pelas equipes de Saude da Familia do Distrito Sanitario Leste de Goiânia (GO). Aplicou-se questionario para obtencao de dados socioeconomicos e demograficos, fatores relacionados a saude e escalas de avaliacao funcional. Para analise, utilizou-se o teste Qui-Quadrado, considerando o nivel de significância de 5%. A amostra foi composta por 388 idosos, sendo 57,5% entre 60 e 69 anos, 58,5% do sexo feminino, 39,7% analfabetos, 77,3% com renda 80 anos. Esses resultados denotam que os idosos estao vivenciando envelhecimento caracterizado por comorbidades e dependencia para realizar as atividades diarias.

Fatores associados à autoavaliação de saúde ruim em idosos usuários do Sistema Único de Saúde

This article reports on prevalence of poor self-rated health and associated factors among elderly users of the Brazilian Unified National Health System (SUS) in Goiânia, Goiás State, Brazil. The article is based on a cross-sectional study with a proportional sample of elderly in the nine health districts of Goiânia. Data were collected after a pilot study and training of field staff. The measure of association was the prevalence ratio (PR) and respective confidence interval (95%CI). Multivariate analysis was performed using hierarchical Poisson regression. In 403 elderly, prevalence of poor self-rated health was 27.5% (95%CI: 23.2-32.2). The rate was 29.7% in women and 29.1% among seniors aged 60-64 years. Variables associated with poor self-rated health according to multivariate analysis were: less than one year of schooling, lack of physical exercise, use of five or more medications, and recent weight loss. The results showed high prevalence of poor self-rated health and associated factors, including both adverse social conditions and individual health and lifestyle factors.

Methods, diagnostic criteria, cutoff points, and prevalence of sarcopenia among older people.

Aim. To identify methods, index, diagnostic criteria, and corresponding cutoff points used to estimate the prevalence of sarcopenia in older people in different countries. Methods. A systematic review was carried out in accordance with PRISMA Statement. The search encompassed the MEDLINE and LILACS databases and was executed during March 2012 using the keyword sarcopenia. Results. A total of 671 studies were identified by the search strategy, and 30 meet all inclusion criteria. Specifically for dual-X-ray absorptiometry, prevalence ranged from 2.2% to 95% in men and from 0.1% to 33.9% in women. For bioelectrical impedance analysis, the range was from 6.2% to 85.4% in men and 2.8% to 23.6% in women. Regarding anthropometric and computed tomography, prevalence rates were, respectively, 14.1% and 55.9%. Conclusions. Heterogeneity in prevalence of sarcopenia was identified, due to diagnostic method choice, cutoff points, and, characteristics of the population as well as reference population. These factors should be considered in research designs to enable comparison and validation of results. Despite the limitations of most studies that indicated high prevalence rates, the results indicate the need for early detection of this syndrome.

Autoavaliação da saúde por idosos brasileiros: revisão sistemática da literatura

OBJETIVO: Realizar uma revisao sistematica da literatura sobre autoavaliacao do estado de saude na populacao idosa brasileira. METODOS: Foram pesquisadas as bases de dados Medline e LILACS, conforme a metodologia PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Foram incluidos artigos originais sobre a autoavaliacao do estado de saude realizados com idosos brasileiros. Foram consideradas as caracteristicas gerais dos estudos, a prevalencia de autoavaliacao negativa da saude, os fatores associados a essa autoavaliacao negativa, a pergunta utilizada para a consulta e as categorias de resposta. RESULTADOS: Dos 97 estudos encontrados, 11 atenderam os criterios de inclusao. Foram identificadas variacoes entre os estudos quanto a formulacao da pergunta e as opcoes de resposta. A prevalencia de autoavaliacao negativa de saude variou de 12,6 a 51,9% entre os estudos. As variaveis dependentes predominantemente associadas a autoavaliacao negativa de saude foram: presenca de doencas, numero de medicamentos em uso, renda familiar/domiciliar mensal, internacoes, consultas medicas, dificuldade/incapacidade para atividades de vida diaria, presenca de sintomas depressivos e ansiosos e queixa de insonia. CONCLUSOES: A heterogeneidade de fatores associados a autoavaliacao negativa indica que a saude dos idosos e definida por determinantes que se aproximam do conceito ampliado de saude. E recomendavel a padronizacao das perguntas e respostas de pesquisa sobre autoavaliacao de saude em idosos, ja que essas informacoes possibilitarao conhecer, acompanhar e comparar resultados para orientar a tomada de decisao no tocante a formulacao de politicas de saude para a Brasil e a America Latina.

Applicability and agreement of different diagnostic criteria for sarcopenia estimation in the elderly.

The purpose of this study cross-sectional study comprising 132 community dwelling elderly (≥ 60 years) was to identify sarcopenia prevalence in the Brazilian elderly, utilizing different diagnostic criteria and analyze agreement between criteria. Sarcopenia was assessed by nine muscle mass diagnostic criteria, by two muscle strength criteria and also by the combination of criteria. Prevalence was analyzed for each method, along with differences by gender and age group through calculation of the prevalence ratio (PR) and confidence interval (CI) 95%. The Kappa coefficient was used to analyze the level of agreement between all criteria. Sarcopenia prevalence varied between 60.6% and 8.3% with the application of muscle mass criteria, and between 54.2% and 48.8% with the application of strength criteria. The combination muscle mass+strength resulted in a decrease of prevalence in all criteria, varying between 36.6% and 6.1%. There was an increase in prevalence according to age groups for all methods. Prevalence was higher for men according to three muscle mass criteria, and higher in women for strength criteria and by two combined mass+strength criteria. The best level of agreement was obtained for two methods that utilized dual energy X-ray absorptiometry (DXA). The prevalence of sarcopenia differs by gender and age and definition criteria. The low agreement levels obtained between methods and the different prevalence values encountered indicate the necessities of an operational definition for the estimation of sarcopenia in different population.

Fatores associados à ocorrência de cesárea e aborto em mulheres selecionadas em um centro de saúde no município do Rio de Janeiro, Brasil

OBJETIVOS: investigar fatores potencialmente associados a ocorrencia de cesarea e aborto. METODOS: foram analisados dados de uma coorte no pos-parto com 352 mulheres entre 15-45 anos. Os seguintes desfechos foram estudados: ocorrencia de cesarea no ultimo parto e ocorrencia de aborto anterior a ultima gravidez. A analise estatistica foi feita por meio de modelos de regressao logistica multivariados e hierarquizados. RESULTADOS: as prevalencias de cesarea e aborto foram de 36,3% e 34,0%, respectivamente. O modelo final revelou que as seguintes variaveis permaneceram estatisticamente associadas a ocorrencia de cesarea: nivel 1: cor de pele branca (OR=2,02; IC95%: 1,29-3,16); nivel 2: ligadura (OR=19,68; IC95%: 5,77-67,15). As seguintes variaveis permane-ceram associadas a ocorrencia de aborto: nivel 1: idade >29 anos (OR=6,11; IC95%: 2,94-12,72), estado marital: vive em uniao (OR=4,22; IC95%: 2,03-8,78); solteira: (OR=3,70; IC95%: 1,59-8,61). CONCLUSOES: a cor de pele branca e a pratica de ligadura foram co-variaveis potencialmente associadas a ocorrencia de cesarea, enquanto o estado marital em uniao ou solteira e a idade materna estiveram associadas a ocorrencia de aborto, sendo maior a probabilidade para mulheres acima de 29 anos.

Estimativas da cobertura mamográfica no Estado de Goiás, Brasil

This cross-sectional study aimed to estimate mammogram coverage in the State of Goiás, Brazil, describing the supply, demand, and variations in different age groups, evaluating 98 mammography services as observational units. We estimated the mammogram rates by age group and type of health service, as well as the number of tests required to cover 70% and 100% of the target population. We assessed the association between mammograms, geographical distribution of mammography machines, type of service, and age group. Full coverage estimates, considering 100% of women in the 40-69 and 50-69-year age brackets, were 61% and 66%, of which the Brazilian Unified National Health System provided 13% and 14%, respectively. To achieve 70% coverage, 43,424 additional mammograms would be needed. All the associations showed statistically significant differences (p < 0.001). We conclude that mammogram coverage is unevenly distributed in the State of Goiás and that fewer tests are performed than required.

Fatores de risco e de proteção para câncer de mama: uma revisão sistemática

This review aimed to investigate risk and protective factors for breast cancer and to analyze whether scientific evidence from the World Cancer Research Fund and American Institute for Cancer Research, published in 2007, was confirmed by new research. In May 2010 we reviewed cohort and case-control analytical studies from 2007 to 2010 in the PubMed, LILACS, and SciELO databases. We selected 27 articles (14 case-control and 13 cohort studies). Breastfeeding and physical activity were protective factors against breast cancer, and alcohol consumption was a risk factor. A direct proportional relationship was observed between larger waist circumference, weight throughout adulthood, and height and risk of breast cancer in postmenopausal women. The association between body fat and breast cancer is contradictory in both premenopausal and postmenopausal women. According to the accumulated evidence, breastfeeding and healthy lifestyle are the factors most strongly associated with breast cancer prevention.