Henrique Leonardo Guerra

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.

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.

Projeto Bambuí: um estudo epidemiológico de características sociodemográficas, suporte social e indicadores de condição de saúde dos idosos em comparação aos adultos jovens

Summary The objectives of the present study are: a) to describe the distribution of socio demographic characteristics, indicators of social support, and indicators of health status among the elderly, and b) to compare these characteristics with those of young adults living in the municipality of Bambui, Minas Gerais. All inhabitants aged 60 or more years (1,742 individuals) and a random sample of 1,020 inhabitants aged 18-59 years were selected. From these, 1,606 (92.2%) and 909 (99.1%) participated in the study, respectively. The characteristics of the elderly, in comparison with young adults, were similar to the Brazilian population regarding age distribution, higher proportion of women in older ages, increasing fecundity, less education, less household income and increased proportion of widows and heads of family among the elderly. The ratio between sexes was close to those of urban areas in Brazil. The socioeconomic data pointed out the higher vulnerability of the elderly in the study population, in relation to young adults, especially among females. The social indicators revealed that the elderly are an important source of support to the family showing solidarity between generations. All indicators used showed decrease in health status with age, with a great proportion of hospitalization among elderly, especially among those oldest. Our results reinforce the need for further population based epidemiologic studies of the elderly to better understand their characteristics and social demands around the country.

Avaliação do Programa de Controle da Esquistossomose (PCE/PCDEN) em municípios situados na Bacia do Rio São Francisco, Minas Gerais, Brasil

An evaluation of the control program on schistosomiasis (PCE/PCDEN) was performed in the region of Sao Francisco river in Minas Gerais. The study area comprises six municipalities, with 130,000 inhabitants and 916 localities situated in an area with 10,722 km² . The activities initiated in 1983-85 in four municipalities and in 1987 in the other two. The main measures of control were repeated treatment with oxamniquine and use of niclosamide. The prevalence of infection by Schistosoma mansoni in the first four municipalities, that was initially around 18 and 32%, dropped abruptly after the first intervention (1983/85) and remained in levels below the initial ones until the last assessment (1990-94); similar trends were observed for the proportion of infected snails. In these municipalities, the proportion of localities without infection or with prevalence below 5 % increased in relation to those with higher prevalence. In the other two municipalities, with initial prevalence below 5%, there were no substantial changes in S. mansoni prevalence or proportion of infected snails; the cost benefit of the program in these municipalities need to be assessed and the priorities redirected to eradicate focal areas and prevent spread to non infected localities. The authors call attention to the difficulties in the long term of a control program based on repeated treatments. Information on factors associated with S. mansoni infection in each locality, or in groups of similar localities, would allow to develop additional measures to treatment that could last longer and be less dependent on the continuous use of chemotherapy.

The Bambuí health and aging study (BHAS). Prevalence of intermittent claudication in the aged population of the community of Bambuí and its associated factors

OBJECTIVE To assess the prevalence of intermittent claudication in the aged population of Bambuí, Brazil, and to identify the factors associated with this disease. METHODS Population-based cross-sectional study of the aged population (>/= 60 years of age) of Bambuí. Participants were interviewed and examined, after written consent. Intermittent claudication was defined based on a standardized questionnaire. Analysis was performed using multiple logistic regression. RESULTS Of the 1,742 elderly living in Bambuí, 1,485 (85.2%) were enrolled in the study. Thirty-seven individuals (2.5%) with intermittent claudication were identified: 28 (1.9%) males and 9 (0.6%) females. Their age brackets were: 16 (1.08%) individuals between 60 and 69 years of age, 17 (1.15%) between 70 and 79 years, and 4 (0.27%) >/= 80 years. A significant association between intermittent claudication and the following characteristics was found: male sex (OR=5.1; CI 2.4-11.0), smokers (OR=3.1; CI 1.2-8.5), ex-smokers (OR=3.4; CI 1.3-8.7), and more than 2 hospital admissions in the last 12 months (OR=2.8; CI 1.1-7.2). CONCLUSION Disease prevalence was similar to that of other countries. The association between intermittent claudication and smoking strengthens the significance of tobacco in peripheral artery disease pathogenesis. The association of intermittent claudication and a higher number of hospital admissions suggests greater morbidity in the elderly affected.

Central de regulação de leitos do SUS em Belo Horizonte, Minas Gerais, Brasil: avaliação de seu papel pelo estudo das internações por doenças isquêmicas do coração

The hospital admissions center in Belo Horizonte, Minas Gerais State, Brazil, aims to assure fast, timely, and equitable access to hospitalization services through the Unified National Health System. However, many patients are admitted directly to the hospitals, without going through the admissions center. This study compared the characteristics of hospitalizations in Belo Horizonte in 2002 according to type of access. All admissions for acute myocardial infarction and acute coronary disease were included. Of 3,705 admissions, 24.9% were processed through the hospital admissions center and 75.1% through direct access. Direct hospitalizations were more common as compared to processing by the hospital admissions center for patients>70 years), those with presumptive diagnosis of acute coronary disease, to the surgical department, and on weekends. Admissions via the hospital admissions center were more common than direct access for patients residing outside Belo Horizonte, at non-public hospitals, and for the intensive care unit. Length-of-stay also varied according to type of access. The results confirm differences in the characteristics of admissions according to the two types of access.A Central de Internacoes de Belo Horizonte, Minas Gerais, Brasil, visa tornar agil o acesso as internacoes pelo Sistema Unico de Saude (SUS). Entretanto, muitas internacoes ocorrem diretamente nos hospitais, sem intermediacao da Central de Internacao. O estudo comparou as caracteristicas das internacoes realizadas em 2002, com relacao a via de acesso. Foram selecionadas internacoes com hipotese diagnostica de infarto agudo do miocardio e insuficiencia coronariana aguda. De 3.705 internacoes, 24,9% foram realizadas pela Central de Internacao e 75,1% por via direta. As proporcoes de internacoes via direta foram maiores que pela Central de Internacao para pacientes > 70 anos, internados por insuficiencia coronariana aguda, na clinica cirurgica e no fim de semana. Os percentuais das internacoes via Central de Internacao foram maiores que os feitos por via direta para residentes em outros municipios, em hospitais nao publicos e com utilizacao de UTI. O numero de dias de internacao tambem foi diferente entre as vias. O estudo mostrou diferencas nas caracteristicas das internacoes realizadas pelas duas vias de acesso.

Acesso à internação e fatores associados ao óbito hospitalar por doenças isquêmicas do coração no SUS

BACKGROUND Analyses on mortality rate due to diseases when outcome depends on proper, timely medical intervention may point out the vulnerabilities and inequity associated to health care access. Ischemic heart diseases will act as models for such assessment. OBJECTIVE The present study investigates factors associated to the hospital death rate of patients admitted to hospital due to acute myocardial infarction (AMI) and heart failure (HF), and whether admittance through Belo Horizonte Municipal Health Office (SMSA-BH) Admission Center (AC) was in any way associated to hospital death after adjustment of relevant factors. METHODS Data obtained from the Hospital Admission Authorizations (AIH) and requests for hospital beds at SMSA data base on latest hospital admissions based on AMI or HF diagnostic hypotheses. Multivariate analysis was conducted to investigate risk factors for hospital death. RESULTS No association was found between hospital admittance access and hospital death risk from those causes. Multivariate analysis showed higher death risk for 60 and 60+ year-old patients (OR=2.9), AMI diagnostic hypothesis (OR=3.0), the need for ICU care (OR=1.6), females (OR=1.4), surgery type (OR=1.9), and public health service hospital (OR=3.5). Hospital admissions due to AMI on weekends also showed higher death risk for death (OR=1.7). CONCLUSION Further investigation is necessary in order to evaluate the kind of medical assistance provided on weekends at public hospitals. Other hospital factors are to be taken into account, as well as patients and assistance procedures, as subsidies for proposals to ensure higher equity and quality standard for public health services.

Schistosomiasis mansoni in the region of the Triângulo Mineiro, State of Minas Gerais, Brazil

In order to reevaluate the possible presence of schistosomiasis mansoni in the Triângulo Mineiro, one of the areas of the State of Minas Gerais where this parasite is not commonly found, malacological survey and fecal examinations were undertaken in the region between October 1990 and June 1992. A sample of 7,032 1st grade school children from 29 counties had their feces examined using the Kato-Katz method. Amongst the children examined, two from Planura and one from each countie of Capinópolis, Conceição das Alagoas, Uberaba, Uberlândia, Prata and Gurinhatã were positive for Schistosoma mansoni. None of the children were identified as being autoctonous cases. In the malacological survey, 5,406 planorbid snails were examined. The specimens were identified morphologically and examined for S. mansoni by squashing between glass plates. The species were identified as Biomphalaria tenagophila in three counties, as B. straminea in ten and B. intermedia in 16. No snails were found in eight other counties studies. The snails were found to be negative for S. mansoni. The presence of intermediate hosts for S. mansoni, associated with parasitized individuals emphasizes the necessity of epidemiological surveillance for schistosomiasis in the region of Triângulo in the State of Minas Gerais.

Biomedical factors associated with hospitalization of older adults: The Bambuí Health and Aging Study (BHAS)

The objective of this study was to identify biomedical factors (body mass index, blood pressure, blood glucose, total cholesterol and fractions, triglycerides, and albumin) associated with hospitalization of older adults. All residents of the town of Bambuí, Minas Gerais State, ages > or = 60 years (n = 1,742) were selected for the study, of whom 1,494 (85.2%) participated. None of the biomedical factors studied was independently associated with occurrence of 1 hospitalization during the previous 12 months. Body mass index < 20 Kg/m and total cholesterol = 200-263 mg/dl and > or 264 mg/dl were independently associated with > or = 2 hospitalizations. The introduction of biomedical factors did not modify the previously identified associations between hospitalization and indicators constructed from information obtained in a questionnaire survey. The results show that data easily obtained through interviews can be useful both for identifying older adults at risk of hospitalization and thus for assisting in prevention.

Mortalidade em internações de longa duração como indicador da qualidade da assistência hospitalar ao idoso

Este estudo propõe um modelo de monitoramento da mortalidade hospitalar em internações de idosos como forma de avaliar a qualidade da assistência. Utilizando o banco de dados do Sistema de Informações de Internações Hospitalares do Sistema Único de Saúde (SIH-SUS), foram estudados 17 hospitais, onde foram consideradas as autorizações de internações hospitalares (AIH) de pacientes idosos classificadas como “Atendimento a pacientes sob cuidados prolongados”, entre 1999 e 2002. As taxas de mortalidade de cada hospital foram comparadas às do hospital com menor taxa de mortalidade. As razões das taxas mensais de mortalidade [risco relativo(RR)] foram ajustadas por sexo, idade e diagnóstico à internação. As taxas variaram de 18 a 194 óbitos por 1.000 AIH-mês, sendo identificados hospitais com taxas de mortalidade altas e persistentes, no período estudado. Essas taxas são o ponto de partida para a avaliação da qualidade da assistência, usando dados facilmente acessíveis por todos os gestores.