Henrique L. Guerra

Parkinsonism and Parkinson's disease in the elderly: A community-based survey in Brazil (the Bambuí study)

Several community‐based surveys on the prevalence of Parkinsonism and Parkinsons disease have been conducted worldwide, with variations on their methodology and results. The objective of this study is to assess the prevalence of Parkinsonism and its causes in a cohort of individuals age 64 years or older in Bambuí, a Brazilian town. In phase I, 1,186 people older than 64 years responded to a 9‐question screening questionnaire for Parkinsonism. In phase II, all subjects who scored ≥ 2 points on the test were examined independently by at least 2 movement disorder‐trained physicians. A movement disorder senior specialist excluded or confirmed the diagnosis in all suspected cases. The response rate was high for both phases (96% for phase I and 94% for phase II). The prevalence rate per 100 population over 64 years of age in this group was 7.2% for Parkinsonism of all types (n = 86). The most frequent causes were idiopathic Parkinsons disease and drug‐induced Parkinsonism, with prevalence rates of 3.3% (n = 39) and 2.7% (n = 32), respectively. The prevalence of vascular Parkinsonism was 1.1% (n = 13). We found 1 case of posttraumatic Parkinsonism and another with multiple system atrophy. In this first population‐based study of Parkinsonism conducted in Brazil, the prevalence in a cohort of elderly subjects was higher than the observed in other populations worldwide, especially because of the high rates of drug‐induced and vascular Parkinsonism. The prevalence of Parkinsons disease was similar to that observed in elderly people in door‐to‐door surveys in other American, European, and Eastern countries.

[Maps of epidemiological rates: a Bayesian approach].

This article presents statistical methods recently developed for the analysis of maps of disease rates when the geographic units have small populations at risk. They adopt the Bayesian approach and use intensive computational methods for estimating risk in each area. The objective of the methods is to separate the variability of rates due to differences between regions from the background risk due to pure random fluctuation. Risk estimates have a total mean quadratic error smaller than usual estimates. We apply these new methods to estimate infant mortality risk in the municipalities of the State of Minas Gerais in 1994.

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.

Projeto Bambuí: avaliação de serviços odontológicos privados, públicos e de sindicato

OBJETIVO: Partindo do principio de que um dos objetivos dos servicos odontologicos publicos e reduzir os efeitos das desigualdades sociais sobre a saude bucal, investigou-se se essas desigualdades estao presentes entre usuarios dos servicos odontologicos publicos, privados e de sindicato. METODOS: A populacao estudada foi constituida por uma amostra representativa de adultos residentes na cidade de Bambui, MG. Os participantes foram entrevistados por meio de um questionario estruturado. RESULTADOS: Entre os 1.664 moradores amostrados, 1.382 (83,1%) participaram do inquerito de saude bucal. Destes, 656 preenchiam os criterios de inclusao (idade >18 anos, presenca de pelo menos um dente natural e visita ao dentista pelo menos uma vez na vida) e participaram do trabalho. Os usuarios dos servicos privados estavam mais satisfeitos com a aparencia dos dentes (ORaj=3,03; IC95%=1,70-5,39) e com a mastigacao (ORaj=2,27; IC95%=1,17-4,40) do que os usuarios de servicos publicos. Aqueles tambem percebiam menos necessidade atual de tratamento odontologico (ORaj=0,39; IC95%=0,18-0,86) e receberam com mais frequencia tratamento restaurador (ORaj=9,57; IC95%=4,72-19,43) ou preventivo (ORaj=5,57; IC95%=2,31-13,40) na ultima visita ao dentista. Aqueles que usaram os servicos do sindicato tambem receberam mais tratamentos restauradores (ORaj=8,51; IC95%=2,80-25,92) e preventivos (ORaj=11,42; IC95%=3,49-37,43) na ultima visita ao dentista do que os usuarios de servicos publicos. Nenhuma diferenca foi encontrada em relacao a satisfacao com a aparencia dos dentes, a capacidade de mastigacao e a percepcao de necessidade de tratamento odontologico. CONCLUSAO: Os servicos publicos odontologicos, com base no estudo da comunidade local, aparentemente nao tem conseguido reduzir as desigualdades sociais com referencia a saude bucal.

Prevalence of insomnia and associated socio-demographic factors in a Brazilian community: the Bambuı́ study

BACKGROUND Population-based studies of insomnia among adults residing in communities in developing countries are rare. The objectives of this population-based study were to determine the prevalence and factors associated with insomnia among adults (18 years and over) living in a Brazilian town with 15,000 inhabitants (Bambuí MG) and to determine how the use of different definitions of insomnia affect its prevalence. METHODS A total of 87.3% of 1221 randomly selected individuals aged 18+ participated. Prevalences were estimated based on different definitions. To determine the associated characteristics, insomnia was defined as a complaint in the last month, occurring at least three times a week, causing distress. RESULTS (1) Prevalence ranged from 12.0 to 76.3%; (2) prevalence of insomnia, as defined above, was 35.4%; (3) prevalence among women increased with age and was higher than that of men; (4) insomnia was independently associated with less education in both sexes, and among females it was associated with older age (60+ years). CONCLUSIONS The prevalence of insomnia in Bambuí was high, similar to that of urban centers of developed countries; this investigation substantiated the importance of operational criteria in studies of insomnia.

The Bambuí Health and Aging Study (BHAS): private health plan and medical care utilization by older adults

The aim of this cross sectional study was to investigate whether holding a private health plan affects the consumption of medical services (hospitalization and visits to a doctor) and use of medications by older adults. All residents in Bambuí town (Minas Gerais, Brazil) aged >/= 60 years (n = 1,742) were selected. From these, 92.2% were interviewed and 85.9% were examined (blood tests and physical measurements). After adjustments for worse health status, reported less visits to a doctor, and used a small number of prescribed medications. The main explanation for the aged holding a private health plan was economic, not health. Even though those who had only public health coverage complained more in relation to medical care (70.9%), an important proportion of the aged with a private health care plan presented some kind of complaint (45.2%). Another worrying factor was the difficulty to acquire medication because of financial problems (47.2 and 25.2% reported, respectively). Further investigations are needed to verify whether our results can be generalized to other communities of the country.

The Bambuí Health and Aging study (BHAS): prevalence of risk factors and use of preventive health care services

OBJECTIVE To describe, for the first time in Brazil, the prevalence of risk factors and the use of preventive health care services among adults 60 years and older. METHODS This population-based study was conducted during 1996-1997 in the state of Minas Gerais, in the town of Bambuí, which is located in the municipality of the same name. In 1996 the town had 14,950 inhabitants. For the study, all the towns residents aged > or = 60 years were selected, along with a comparison sample of persons aged 18-59 years. Data were gathered using interviews and physical examinations. RESULTS Of the 1,742 inhabitants of the town of Bambuí aged > or = 60 years, 1,606 (92.2%) participated in the interview and 1,495 (85.8%) were examined (blood pressure, anthropometric measurements, and blood tests). Among the 1,020 younger adults selected for the survey, 909 of them (89.1%) participated in the interview, and 820 of them (80.4%) underwent the physical examination. The prevalence of the following risk factors was higher among older adults than among younger adults: physical inactivity (47.7% vs. 28.0%); blood pressure 140-159 mmHg (systolic) or 90-99 mmHg (diastolic) (25.8% vs. 8.7%); blood pressure > or = 160 mmHg (systolic) or > or = 100 mmHg (diastolic) (19.1% vs. 4.1%); total cholesterol > or = 240 mg/dL (40.6% vs. 9.8%); and blood glucose > or = 126 mg/dL (12.4% vs. 2.2%). The daily consumption of fruits and vegetables was similar among the older adults and the younger ones (51.9% and 51.7%), as was also body mass index > or = 25 kg/m2 (51.6% and 56.2%). Smoking was lower among the older adults (18.7%) than among the younger ones (31.1%). The proportion of participants whose blood pressure had been checked in the preceding year was high (86.8% among the older adults and 61.2% among the younger ones), suggesting that the high prevalence of uncontrolled hypertension was not due to limited access to health care. CONCLUSIONS For a long time it was believed that the kinds of risk factors that we found in the urban section of the municipality of Bambuí were public health problems only in large Brazilian cities. Around 72% of the municipalities in Brazil have < or = 20,000 inhabitants, and these smaller municipalities contain some 19% of the countrys entire population. The high prevalence of various risk factors among the older and younger adults in Bambuí indicates a great need for health promotion and disease prevention actions. More research is needed to find out whether our results in Bambuí reflect the reality of other small towns in Brazil.

Prevalence of sleep complaints and associated factors in community-dwelling older people in Brazil: the Bambuı́ Health and Ageing Study (BHAS)

BACKGROUND Population-based studies of insomnia among older people residing in communities in developing countries are rare. The objectives of this population-based study were to determine the prevalence and factors associated with insomnia among older adults (60 years and over) living in a Brazilian town with 15,000 inhabitants (Bambuí MG). METHODS All 1742 residents in this age group were selected for a structured interview and blood tests. From these, 1516 (87.0%) participated in the study. RESULTS The prevalence of insomnia was 38.9%, being higher among women (45.3%) than among men (28.8%). The use of sleeping pills was reported by 380/1513 (25.1%) of the participants; 186 (49.0%) of these complained of insomnia, suggesting that their treatment should be reassessed. Factors independently associated with insomnia were: female sex (OR=1.78, 95% CI=1.41-2.24), dissatisfaction with free time arrangements (OR=1.88, 95% CI=1.28-2.77), self-rated health as reasonable or bad/very bad (OR=2.02, 95% CI=1.50-2.72 and OR=3.12, 95% CI=2.21-4.39, respectively), history of previous medical diagnosis of some chronic conditions (OR=1.38, 95% CI=1.10-1.73), inability to perform routine activities due to a health problem in the previous 2 weeks (OR=1.54, 95% CI=1.10-2.15), and staying in bed in the previous 2 weeks (OR=1.61, 95% CI=1.04-2.48). CONCLUSIONS The prevalence of insomnia was high, indicating that this was a public health problem for older adults living in the study community. Our results emphasize the necessity for further investigations about insomnia among older people living in small communities in Brazil and other developing countries.

Prevalência de helmintos intestinais em três mesorregiões do Estado de Minas Gerais

A parasitological assay of feces, through the Kato-Katz method, was undertaken in 18,973 schoolchildren (7 to 14 years old), at primary school level, from a public school of the State of Minas Gerais. Three mesoregions were studied: Tri ngulo Mineiro/ Alto Para ba ( 60 municipalities); northwest Minas Gerais (13) and south/south-west regions of Minas Gerais (144). Among the examined children, 15,545 (82%) were negative; 2,863 (15%) were infected with a single species of helminthes and 565 (3%) were infected by more than one species. The prevalence rates were: A. lumbricoides 10.3%; T. trichiura 4.7%; hookworm 2.9%; E. vermicularis 1.2%; H. nana 0.4% and Taenia sp 0.2%. The largest helminthes prevalence/mesoregion were for T. trichiura (24.2%) and A. lumbricoides (18.7%) in the south/south-west region; hookworm (12.1%) and Taenia sp (0.7%) in the northwest region of Minas Gerais. Intestinal helminthiasis is still regarded as a serious public health problem, including regions where the socio-economic conditions are more favorable.

Atividade de detergentes e desinfetantes sobre a evolução dos ovos de Ascaris lumbricoides

Ascaris lumbricoides infection is acquired via ingestion of embryonated eggs of the parasite, thus justifying the search for ovicidal compounds. We studied the effect of 16 household and laboratory detergents and disinfectants on the embryogenesis of this helminth. Children carrying this infection were treated with levamisole. Eliminated female worms were collected and dissected to obtain eggs from the uteri. The eggs were placed in contact with various products at different dilutions and for various periods of time. After washing, eggs were incubated at 28 grades C for 20 days, for viability tests and to determine the embryonation rate. Only one product completely inhibited the embryonation of eggs at every dilution and for every time period tested. Five products inhibited more than 50% of embryonation, while six inhibited less than 50%. Three products showed no effect on embryonation, while for one the percentage of embryonated eggs was higher than in the control tubes.