João Macêdo Coelho Filho

Epidemiologia do envelhecimento no Nordeste do Brasil: resultados de inquérito domiciliar

OBJETIVO: Identificar o perfil multidimensional de idosos residentes em um centro urbano do Nordeste do Brasil. METODOS: Uma amostra de 667 idosos (60 anos ou mais) da cidade de Fortaleza, Ceara, foi selecionada por amostragem estratificada por nivel socioeconomico, aleatoria, em multiplos estagios e sistematica, sendo entrevistada no domicilio atraves de questionario de avaliacao multidimensional. RESULTADOS: A maioria dos idosos foi do sexo feminino (66%) e residia em domicilio multigeracional (75,3%). Mais da metade (51,9%) vivia sem conjuge; 92,4% referiram pelo menos uma doenca; 26,4% foram classificados como casos psiquiatricos e perda da autonomia foi observada em 47,7%; 6,6% foram internados e 61,4% procuraram servicos de saude nos ultimos seis meses. Nas areas mais pobres houve maior prevalencia de domicilio multigeracional, perda de autonomia e morbidade psiquiatrica. CONCLUSOES: Os idosos da cidade de Fortaleza, em sua maioria, residem em domicilios multigeracionais, e apresentam morbidade fisica e mental particularmente alta em areas mais pobres, uma realidade preocupante em termos de seu progressivo impacto sobre os servicos de saude nas proximas decadas.

Perfil de utilização de medicamentos por idosos em área urbana do Nordeste do Brasil

OBJECTIVE To identify medication use patterns among elderly people residing in areas with different socioeconomic status in the city of Fortaleza, Brazil. METHODS A total of 668 elderly (aged 60 years or older) residing in the city of Fortaleza, Ceará, Brazil, selected from a multistage random sampling stratified by socioeconomic status (higher, intermediate, and lower areas), were interviewed in a household survey. Descriptive statistics for dichotomous variables were presented as percent of the respective totals, and those for continuous variables as mean +/- SD. Multivariate analyses were performed to identify factors associated with the use of prescription, non-prescription and inappropriate) drugs. RESULTS Most (80.3% in the higher area) were on at least one non-prescription drug. More than one third (37.4%) were on at least one non- prescription drug and nearly 20% used at least one inappropriate in the lower area. PD use was associated with advanced age (OR=1.7, 95% CI=1.1-2.8); male sex (OR=0.5, 95% CI=0.3-0.7); health service visits (OR=2.5, 95% CI=1.9-3.1); chronic diseases (OR=4.0, 95% CI=2.5-6.2); and higher socioeconomic status (OR=2.0, 95% CI=1.5-2.6).Non- prescription drug use was associated with disability (OR=1.5, 95% CI=1.1-2.2), and higher socioeconomic status (OR=0.6; 95% CI=0.5-0.8). Inappropriate drugs use was mainly associated with male sex (OR=0.4, 95% CI=0.2-0.8); chronic diseases (OR=2.0, 95% CI=1.2-3.3); and higher socioeconomic status (OR=0.7, 95% CI=0.5-0.9). CONCLUSIONS The proportions of elderly using prescription, non-prescription and inappropriate drugs were remarkable and inequalities were seen particularly among those from different socioeconomic status. These results emphasize the need for strategies to optimize the access and rationalize the use of drugs for elderly people in Brazil.

Prevalence and associated factors to hepatitis C in hemodialysis patients in Brazil

OBJECTIVE The prevalence of hepatitis C virus (HCV) is higher in patients on hemodialysis than in the general population, probably due to greater exposure to risk situations. The purposes of the study were to determine anti-HCV antibodies prevalence among hemodialysis patients and dialysis clinics and patients factors associated with HCV transmission. METHODS A cross-sectional study was conducted in 752 hemodialysis patients in all 12 dialysis clinics of Fortaleza, Brazil, and were screened using third generation ELISA. Sociodemographic, clinical, and epidemiological data of 663 patients were collected through interviews. Nosocomial factors were assessed using a specific questionnaire tool. Statistical analysis was conducted using Students t test, odds ratio and multivariate analysis. RESULTS The prevalence of anti-HCV was 52% (390/746; ranged from 6% to 72%). The anti-HCV positivity was higher in patients who had previous peritoneal dialysis (OR=1.76; 95% CI 1.12-2.76) and blood transfusion (OR=2.75; 95% CI 1.25-6.03). Dialysis age has been associated with anti-HCV positivity (OR=1.47; 95% CI 1.35-1.61). Clinics practices associated with anti-HCV positivity were: previous preparing of heparin (OR=2.92; 95% CI 1.23-6.92), failure in gloves use or change (OR=5.73; 95% CI 1.75-18.72), unsatisfactory dialysis machine disinfection (OR=2.79; 95% CI 1.57-4.96), and patient isolation in dialysis room (OR=0.18; 95% CI 0.05-0.61). CONCLUSIONS The results show high anti-HCV prevalence among hemodialysis patients and the association of nosocomial factors with new HCV infection cases.

Valor da ultra-sonografia abdominal com transdutor multifreqüencial de 5 a 10 mhz no diagnóstico de apendicite

The aim of the present study was to establish the diagnostic value of abdominal ultrasonography in the diagnosis of appendicitis using 5¾10 MHz multifrequency transducers. A transversal study of 240 consecutive patients examined from April 1996 to September 1998 due to suspected acute appendicitis was conducted. The ultrasonography criteria for acute appendicitis were noncompressible appendix with thickness above 6.0 mm, with or without apendicolith and/or collection. The adopted gold standard were surgical findings and clinical follow-up during one year. The prevalence of appendicitis was 59%. Abdominal ultrasound showed: sensitivity = 90%, specificity = 97%, accuracy = 93%, predictive positive value = 98%, predictive negative value = 87%, false positive = 2% and false negative = 13%. Ultrasonography using 5¾10 MHz multifrequency transducers showed to be a very effective imaging diagnosis method for acute appendicitis.

Prevalência e fatores associados ao comprometimento cognitivo funcional em idosos residentes na comunidade brasileira

The identification of the prevalence of cognitive impairment and associated factors among older adults is important in countries facing rapid demographic transition, given the significant implications for public policy and health planning. Objective To determine the prevalence of functional cognitive impairment (FCI) and associated factors in Brazilian community-dwelling older adults. Methods A cross-sectional study involving 461 elderly subjects residing in Fortaleza city, Ceará was conducted. Cognitive assessment was performed using three tests: the MMSE (Mini-Mental State Examination), VF (Verbal Fluency) and CT (Clock Test). The functional capacity evaluation was based on a survey of 21 basic and instrumental activities of daily living (ADLs). Cognitive impairment was defined by MMSE cut-off points adjusted for literacy. Functional impairment was defined as dependency to carry out more than four ADLs. Results The prevalence of FCI was 13.64% (95% CI: 10.33 to 16.64%). FCI was proportionally associated with age with OR=2.24 (95% CI: 1.04 to 4.79) for individuals aged 70 to 79 years and OR=8.27 (95 % CI: 4.27 to 16.4) for those aged 80 to 100 years. FCI was associated with self-reported diseases including hypertension OR=2.06 (95% CI: 1.17 to 3.65), stroke OR=2.88 (95% CI: 1.66 to 5.00) and acute myocardial infarction OR=2.94 (95% CI: 1.59 to 5.42). The occurrence of FCI was proportionally correlated with the number of drugs used. Conclusion Functional cognitive impairment is a prevalent condition in Brazilian community-dwelling older adults and its occurrence is associated with age, number of drugs used, and vascular morbidities.