Josélia Oliveira Araújo Firmo

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.

Socioeconomic position and health in a population of Brazilian elderly: the Bambuí Health and Aging Study (BHAS)

OBJECTIVEnDespite the vast scientific literature on the social determinants of health, there is still a debate on the extent to which this relationship remains in old age. The objective of this study was to examine the association between socioeconomic circumstances and health among older adults in a small town in Brazil.nnnMETHODSnThe study was carried out in Bambuí, a town of around 15 000 inhabitants that is located in the state of Minas Gerais, which is in southeastern Brazil. From 1 177 residents aged 65 years or older, 1 074 of them (91.2%) were interviewed and 997 (84.7%) were examined (physical measurements and blood tests). Those in the lowest third of the distribution of total household monthly income, with an income of less than US

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

240 per month, were compared with those who had an income above that level.nnnRESULTSnLower family income was independently associated with: (1) some lifestyle risk factors (less consumption of fresh fruits or vegetables and less frequent exercise during leisure time in the preceding 30 days), (2) several indicators of worse health status (General Health Questionnaire score, self-rated health, self-rated visual acuity, level of difficulty in walking 300 meters, inability to perform routine activities because of a health problem in the preceding 2 weeks, and seropositivity for Trypanosoma cruzi), (3) a higher number of nonprescribed medications used in the preceding 3 months, and (4) a higher number of hospitalizations in the preceding 12 months. Obesity was more frequent in the higher-income group.nnnCONCLUSIONSnThe results of this study do not confirm observations in some developed countries of a lack of association between socioeconomic status and health among the aged. Our results showed that a small difference in monthly family income was sufficiently sensitive to identify elderly persons in worse health, even within a community that appears to be uniformly poor.

The control of schistosomiasis in Brazil: an ethno-epidemiological study of the effectiveness of a community mobilization program for health education

OBJECTIVEnTo 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.nnnMETHODSnThis 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.nnnRESULTSnOf 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.nnnCONCLUSIONSnFor 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)

This study combined anthropological and epidemiological approaches to assess the effectiveness of community mobilization for health education, developed as part of the Brazilian program for the control of schistosomiasis. The study was carried out in two villages in the state of Minas Gerais, SE Brazil, exposed to the same established schistosomiaisis control strategies. Residents of one village were also exposed to the community mobilization for health education (study area) while those from the other community were not exposed to this program (control area). Schistosoma mansoni prevalence rates for the study and control villages were compared over time. A population-based survey was carried out in the two villages to obtain information on socio-demographic factors, water contact patterns and knowledge of S. mansoni transmission. Intensive ethnographic interviews with key informants in each locality were employed to determine the knowledge, attitudes and practices of the communities regarding schistosomiasis. Ethnographic data were analysed using the model of systems of signs, meanings and actions. Differences were observed in prevalence trends between the study and control areas but they could not be explained by the existence of the community mobilization program in the former. It was also found that educational actions carried out by the Brazilian Ministry of Health transmitted information on schistosomiasis but were ineffective in transforming the information received into preventive behaviour related to water contact. With regard to disease, the population studied tended to distinguish minor symptoms, which they associated with water contact, from major symptoms, which they attributed to lack of medical treatment. This distinction mediated perceptions of the severity of xistose and reduced the importance of avoiding contact with potentially infested waters. The perception of protection conferred by treatment observed in the present study might also apply to other communities where access to treatment is readily available and free. The extent to which this perception exists in endemic areas needs to be determined so that apparent contradictions of this type can be addressed in future educational programs.

Signos, significados e ações associados à doença de Chagas

BACKGROUNDnPopulation-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).nnnMETHODSnAll 1742 residents in this age group were selected for a structured interview and blood tests. From these, 1516 (87.0%) participated in the study.nnnRESULTSnThe 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).nnnCONCLUSIONSnThe 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.

Association between sleep duration and all-cause mortality in old age: 9-year follow-up of the Bambui Cohort Study, Brazil

An anthropological approach was employed to investigate the universe of representations (ways of thinking) and behaviors (ways of acting) associated with Chagas disease in a group of public service workers in Belo Horizonte (both infected and not infected with Trypanosoma cruzi). An attempt was also made to evaluate the repercussions of this universe of representations and behaviors on the lives of the infected individuals. The collection and analysis of the data followed the systems of signs, meanings, and actions model developed by Corin et al. (1989, 1992). Sixteen seropositive and 12 seronegative workers were interviewed to compare their ways of thinking and acting towards the disease. Data analysis allowed identification of diverse elements within a context that maximized the limitations imposed by Chagas disease. These should be taken into account in the planning of educational campaigns and elaboration of health care models for Chagas patients.

Bipolar disorder prevalence: a systematic review and meta-analysis of the literature

This study investigates the association of sleep duration with risk of all‐cause mortality among elderly Brazilians using data from a 9‐year population‐based cohort study and applying a multivariable longitudinal categorical and continuous analysis using Cox’s proportional hazards models. This analysis used data from the Bambui Health and Ageing Study (BHAS), conducted in Bambuí city (approximately 15u2003000 inhabitants) in southeastern Brazil. The study population comprised 1512 (86.8%) of all eligible 1742 elderly residents. In multivariable analysis, using sleep duration as categorical variable and controlling for multiple measures of sociodemographic and health status, those who slept 9u2003h or more per night were found to be at higher risk of mortality than those who slept 7u2003h [hazard ratio (HR): 1.53; 95% confidence interval (CI): 1.12–2.09]. Excluding those whose deaths occurred within 2u2003years after entry, this association remained significant (HR: 1.56; 95% CI: 1.12–2.18). In analyses using sleep duration as a continuous variable, a linear correlation was found between sleep duration and mortality in all adjusted models in the whole sample (HR: 1.08; 95% CI: 1.02–1.15) and following exclusion of those whose deaths occurred within 2u2003years after entry (HR: 1.13; 95% CI: 1.06–1.21). Both linear and quadratic terms were significant, reflecting a predicted relationship, with mortality predominantly increasing in association with long sleep duration but with the addition of a slight decrease in association with shorter sleep duration. In conclusion, long rather than short sleep duration was associated principally with all‐cause mortality in this sample. It is therefore reasonable to suggest that clinicians should be aware of the potential adverse prognosis associated with prolonged sleep.

Dimensions Underlying the Mini-Mental State Examination in a Sample With Low-Education Levels: The Bambuí Health and Aging Study

OBJECTIVEnBipolar disorder (BD) is common in clinical psychiatric practice, and several studies have estimated its prevalence to range from 0.5 to 5% in community-based samples. However, no systematic review and meta-analysis of the prevalence of BD type 1 and type 2 has been published in the literature. We carried out a systematic review and meta-analysis of the lifetime and 1-year prevalence of BD type 1 and type 2 and assessed whether the prevalence of BD changed according to the diagnostic criteria adopted (DSM-III, DSM-III-R vs. DSM-IV).nnnMETHODSnWe searched MEDLINE, Scopus, Web of Science, PsycINFO, and the reference lists of identified studies. The analyses included 25 population- or community-based studies and 276,221 participants.nnnRESULTSnThe pooled lifetime prevalence of BD type 1 was 1.06% (95% confidence interval [95%CI] 0.81-1.31) and that of BD type 2 was 1.57% (95%CI 1.15-1.99). The pooled 1-year prevalence was 0.71% (95%CI 0.56-0.86) for BD type 1 and 0.50% (95%CI 0.35-0.64) for BD type 2. Subgroup analysis showed a significantly higher lifetime prevalence of BD type 1 according to the DSM-IV criteria compared to the DSM-III and DSM-IIIR criteria (p < 0.001).nnnCONCLUSIONnThis meta-analysis confirms that estimates of BD type 1 and type 2 prevalence are low in the general population. The increase in prevalence from DSM-III and DSM-III-R to DSM-IV may reflect different factors, such as minor changes in diagnostic operationalization, use of different assessment instruments, or even a genuine increase in the prevalence of BD.

The Bambuí Health and Aging Study (BHAS): factors associated with hospitalization of the elderly

OBJECTIVESnTo investigate the validity of previously suggested dimensions underlying the Mini-Mental State Examination (MMSE) and differences in associations of these dimensions with sociodemographic and health characteristics in an older Latin-American community sample with low levels of education.nnnDESIGNnSecondary analysis of baseline data from a population-based cohort study.nnnSETTINGnBambuí, Brazil.nnnPARTICIPANTSnOf 1,742 total residents aged 60 years or older, 1,558 (89.4%) participated at this study.nnnMEASUREMENTSnA standard Brazilian version of the MMSE.nnnRESULTSnA five-factor solution (Concentration, Language/Praxis, Orientation, Attention, and Memory) for the MMSE was generated from Principal Components Analysis, and the five-factor solutions proposed in previous studies of developed nation samples were tested in this sample by Confirmatory Factor Analysis. In the adjusted linear regression models, MMSE factors varied in their correlates: for example, female gender was associated with higher concentration, orientation, and attention but lower Language/Praxis; increased age was inversely associated only with language and attention; and activity of daily living impairment was principally associated with lower Language/Praxis.nnnCONCLUSIONnThis study provides support for the cross-sectional equivalence of the MMSE, suggesting that most of the items and underlying constructs remain meaningful after alteration and translation in a low-education sample with lower overall distribution of scores.