Luiz Cláudio Ribeiro

Prevalência de quedas e fatores associados em idosos

OBJECTIVE To estimate the prevalence of falls in elderly individuals and to analyze associated factors. METHODS Cross-sectional study with 420 elderly subjects (aged 60 years or older) living in the city of Juiz de Fora (Southeastern Brazil) in 2010. A household survey was conducted and the occurrence of falls in the 12 previous months was described. For the analysis of factors associated with the outcome, a theoretical determination model with three hierarchical blocks was built. The variables were adjusted among each other within each block; those with level of significance < 0.20 were included in the Poisson regression model and adjusted to the immediately higher level, with 5% significance level. RESULTS The prevalence of falls among the elderly was 32.1% (95%CI: 27.7; 36.9). Among those who experienced falls, 53% had a single fall and 19% had fractures as a consequence. Most of the falls (59%) occurred at the elderly persons home. The occurrence of falls was associated with old age, female sex, need of help for locomotion and self-reported diagnosis of osteoporosis. CONCLUSIONS Falls are frequent among the elderly. Knowledge of the factors associated with the occurrence of this event can aid the development of prevention strategies and adequate health services.OBJETIVO: Estimar la prevalencia de caidas en ancianos y analizar factores asociados. METODOS: Estudio transversal con 420 ancianos (60 anos o mas) residentes en Juiz de Fora, Sureste de Brasil, en 2010. Se realizo pesquisa domiciliaria y se describio la ocurrencia de caida en los ultimos 12 meses. Para analisis de los factores asociados al resultado, se construyo un modelo teorico de determinacion con tres bloques jerarquizados. Las variables fueron ajustadas entre si dentro de cada bloque; las que presentaron nivel de significancia < 0,20 fueron incluidas en el modelo de regresion de Poisson y ajustadas al nivel superior al de cada una, con el nivel de 5% de significancia. RESULTADOS: La prevalencia de caidas entre los ancianos fue de 32,1% (IC95% 27,7;36,9). Entre aquellos que sufrieron caida, 53% tuvieron una unica caida y 19% tuvieron fractura como consecuencia. La mayor parte de las caidas (59%) ocurrio en el domicilio del anciano. La ocurrencia de caidas se asocio con edad avanzada, sexo femenino, necesidad de auxilio para locomocion y diagnostico auto-referido de osteoporosis. CONCLUSIONES: Las caidas son frecuentes entre ancianos. El conocimiento de los factores asociados a la ocurrencia de este evento puede auxiliar en la elaboracion de estrategias de prevencion y servicios de salud adecuados.

Avaliação da atenção básica pela ótica político-institucional e da organização da atenção com ênfase na integralidade

This article presents part of the data from an evaluation of primary care, implemented as part of research funded by the Brazilian Ministry of Health in 2005. Thirty-one municipalities from the States of Minas Gerais and Espírito Santo comprised the study sample. Data collected with qualitative methods (interviews and documents) were summarized, with the production of a set of categorical variables. The article presents the distribution of values for the variables by municipality. The variables were submitted to correspondence analysis, which showed their internal validity. The article also provides observations on relevant aspects of the field. In conclusion, the evaluation demonstrates advances in the Family Health Strategy in Brazil, with important contributions to the Project for Expansion and Consolidation of the Family Health Strategy, despite persistent obstacles, particularly related to human resources in the family health strategies and local use of the data produced.

Prevalence of falls and associated factors in elderly individuals

OBJECTIVE To estimate the prevalence of falls in elderly individuals and to analyze associated factors. METHODS Cross-sectional study with 420 elderly subjects (aged 60 years or older) living in the city of Juiz de Fora (Southeastern Brazil) in 2010. A household survey was conducted and the occurrence of falls in the 12 previous months was described. For the analysis of factors associated with the outcome, a theoretical determination model with three hierarchical blocks was built. The variables were adjusted among each other within each block; those with level of significance < 0.20 were included in the Poisson regression model and adjusted to the immediately higher level, with 5% significance level. RESULTS The prevalence of falls among the elderly was 32.1% (95%CI: 27.7; 36.9). Among those who experienced falls, 53% had a single fall and 19% had fractures as a consequence. Most of the falls (59%) occurred at the elderly persons home. The occurrence of falls was associated with old age, female sex, need of help for locomotion and self-reported diagnosis of osteoporosis. CONCLUSIONS Falls are frequent among the elderly. Knowledge of the factors associated with the occurrence of this event can aid the development of prevention strategies and adequate health services.OBJETIVO: Estimar la prevalencia de caidas en ancianos y analizar factores asociados. METODOS: Estudio transversal con 420 ancianos (60 anos o mas) residentes en Juiz de Fora, Sureste de Brasil, en 2010. Se realizo pesquisa domiciliaria y se describio la ocurrencia de caida en los ultimos 12 meses. Para analisis de los factores asociados al resultado, se construyo un modelo teorico de determinacion con tres bloques jerarquizados. Las variables fueron ajustadas entre si dentro de cada bloque; las que presentaron nivel de significancia < 0,20 fueron incluidas en el modelo de regresion de Poisson y ajustadas al nivel superior al de cada una, con el nivel de 5% de significancia. RESULTADOS: La prevalencia de caidas entre los ancianos fue de 32,1% (IC95% 27,7;36,9). Entre aquellos que sufrieron caida, 53% tuvieron una unica caida y 19% tuvieron fractura como consecuencia. La mayor parte de las caidas (59%) ocurrio en el domicilio del anciano. La ocurrencia de caidas se asocio con edad avanzada, sexo femenino, necesidad de auxilio para locomocion y diagnostico auto-referido de osteoporosis. CONCLUSIONES: Las caidas son frecuentes entre ancianos. El conocimiento de los factores asociados a la ocurrencia de este evento puede auxiliar en la elaboracion de estrategias de prevencion y servicios de salud adecuados.

Desigualdades sociais na mortalidade cardiovascular precoce em um município de médio porte no Brasil

Cardiovascular diseases are the main cause of death in many countries. In Brazil, premature cardiovascular death is more frequent than in wealthy countries. The aim of this study was to analyze the relationship between premature cardiovascular death and socioeconomic conditions in urban areas. The study design was ecological, with the urban areas of a medium-size municipality in Minas Gerais State, Brazil, as the units of analysis. The relationship between standardized mortality ratio and social development index (SDI) was studied with a binomial negative generalized linear model. The urban regions with the best socioeconomic conditions had significantly lower cardiovascular mortality. The reduction of socioeconomic inequalities in medium-size cities could help decrease health inequities.

Hospitalizations for primary care-sensitive conditions in a Southern Brazilian municipality

OBJECTIVE To study the most frequent causes of hospitalizations for primary care-sensitive conditions (HPCSC) in the city of Juiz de Fora, MG, Brazil, by age group and gender, over the periods of 2002 to 2005 and of 2006 to 2009. METHODS This was a descriptive study, with data collected from the Hospital Information System of the Unified Health System (Sistema de Informação Hospitalar do Sistema Único de Saúde - SIH-SUS) and from population projections by the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE). HPCSC rates were calculated for 1,000 inhabitants, and the most frequent causes were studied by gender and age group, comparing both periods. RESULTS HPCSP showed rates of 7.74/1,000 between 2002 and 2005 and 8.81/1,000 between 2006 and 2009. The main causes were heart failure, cerebrovascular diseases, angina pectoris, pulmonary diseases, and kidney and urinary tract infections, which together represented 4.9/1,000 in the first period and 5.6/1,000 in the second period. The evolution of the rates between both periods occurred differently by age group and gender. CONCLUSION The study did not exhibit any remarkable differences in HPCSC rates between the periods. Regarding the most frequent causes, reduced hospitalization rates for gastroenteritis, asthma, high blood pressure, and cerebrovascular diseases were observed, as well as increased hospitalizations for heart failure, pulmonary diseases, epilepsies, and kidney and urinary tract infections; these hospitalizations occurred differently by gender and age group. The results showed that a deep reflection regarding the determinants of hospitalizations for avoidable causes is needed.

Prevalence and risk factors for giardiasis and soil-transmitted helminthiasis in three municipalities of Southeastern Minas Gerais State, Brazil: risk factors for giardiasis and soil-transmitted helminthiasis.

Giardiasis and soil-transmitted helminthiasis (STH) are parasitic diseases that are among the major health concerns observed in economically disadvantaged populations of developing countries, and have clear social and environmental bases. In Brazil, there is a lack of epidemiologic data concerning these infections in the study area, whose inhabitants have plenty of access to health care services, including good dwelling and adequate sanitary conditions. In this survey we investigated the risk factors for giardiasis and STH in three municipalities with good sanitation, situated in Minas Gerais state, Brazil. A cross-sectional survey was conducted in the municipalities of Piau, Coronel Pacheco and Goianá, in both urban and rural areas. The fieldwork consisted of a questionnaire and the examination of 2,367 stool samples using the Hoffmann, Pons and Janer method. Of all individuals from the population sample, 6.1% were found infected with the parasitic diseases included in this work. Hookworm infection was the most prevalent disease, followed by giardiasis, trichuriasis and ascariasis. Infection was more prevalent in males (8.1%, p < 0.001; odds ratio [OR] = 1.975) and in individuals living in rural areas (8.6%, p = 0.003; OR = 1.693). Multivariate analysis showed that variables such as inadequate sewage discharge (p < 0.001), drinking of unsafe water (p < 0.001), lack of sanitary infrastructure (p = 0.015), and host sex (p < 0.001) were the risk factors more strongly associated with infection status (95% confidence interval [CI]). In this study we demonstrate that giardiasis and STH still persist, infecting people who have good housing conditions and free access to public health care and education.

Oportunidades do ambiente domiciliar para o desenvolvimento motor

OBJETIVO: Avaliar as oportunidades presentes no ambiente domiciliar para o desenvolvimento motor de lactentes. METODOS: Estudo epidemiologico de base populacional, transversal, realizado com 239 lactentes com idade entre tres e 18 meses, residentes no municipio de Juiz de Fora, MG, em 2010. Os participantes foram selecionados por amostragem aleatoria estratificada, conglomerada, em multiplos estagios. Para avaliar a qualidade e quantidade de estimulo motor no ambiente domiciliar foi utilizado o instrumento Affordance in the Home Environment for Motor Development - Infant Scale. Procedeu-se a analise bivariada com aplicacao do teste qui-quadrado, seguida de regressao logistica multinomial para verificar a associacao entre as oportunidades presentes no domicilio e fatores biologicos, comportamentais, demograficos e socioeconomicos. RESULTADOS: As oportunidades de estimulacao ambiental foram relativamente baixas. Na analise bivariada, para a faixa etaria de tres a nove meses, foi encontrada associacao com os fatores: ordem de nascimento (p = 0,06), classificacao socioeconomica (p = 0,08), renda mensal (p = 0,06) e renda per capita (p = 0,03). No modelo de regressao, prevaleceu a classificacao socioeconomica (RC = 7,46; p = 0,03). Para a faixa etaria de dez a 18 meses, os fatores associados, na analise bivariada, foram: estado civil materno (p < 0,01), convivio da crianca com o pai (p = 0,08), chefe da familia (p = 0,04), numero de pessoas no domicilio (p = 0,05), escolaridade materna (p < 0,01) e paterna (p < 0,01), classificacao socioeconomica (p < 0,01) e renda per capita (p = 0,03). No modelo de regressao, o estado civil materno (RC = 4,83; p = 0,02), escolaridade materna (RC = 0,29; p = 0,03) e paterna (RC = 0,33; p = 0,04) permaneceram associados as oportunidades de estimulacao ambiental. CONCLUSOES: A uniao estavel dos pais, maior escolaridade materna e paterna e maior nivel economico foram os fatores associados as melhores oportunidades de estimulacao motora no lar.

Polymerase chain reaction for the evaluation of Schistosoma mansoni infection in two low endemicity areas of Minas Gerais, Brazil

This study aimed to evaluate the occurrence of schistosomiasis in areas with low endemicity using polymerase chain reaction (PCR) as a diagnostic method. We analysed faecal samples from 219 individuals residing in Piau and Coronel Pacheco, state of Minas Gerais, Brazil, using a single faecal sample from each individual and two slides of the Kato-Katz technique as a gold standard. Fifteen out of the 219 samples were positive with both methods of diagnosis. One sample was diagnosed as positive by the Kato-Katz technique only and 61 were diagnosed only by PCR. The positivity rates were 7.3% with the Kato-Katz method and 34.7% with PCR. When both techniques were assumed to have 100% specificity and positive individuals were identified by both methods, the sensitivity of the Kato-Katz method was 20.8% and the PCR sensitivity was 98.7%. The Kappa index between the two techniques was 0.234, suggesting weak agreement. The assessment of a single faecal sample by PCR detected more cases of infection than the analysis of one sample with two slides using the Kato-Katz technique, suggesting that PCR can be a useful diagnostic tool, particularly in areas with low endemicity.

Infection profile of patients undergoing autologous bone marrow transplantation in a Brazilian institution

CONTEXT AND OBJECTIVE Hematopoietic stem cell transplantation (HSCT) has been widely used for treating oncological and hematological diseases. Although HSCT has helped to improve patient survival, the risk of developing infection during hospitalization is an important cause of morbidity and mortality. This study aimed to analyze the infection profile during hospitalization and the associated risk factors among patients undergoing autologous HSCT at the University Hospital, Universidade Federal de Juiz de Fora. DESIGN AND SETTING This was a cross-sectional study on patients undergoing autologous HSCT at a public university hospital. METHODS Patients with febrile neutropenia between 2004 and 2009 were retrospectively evaluated regarding their infection profile and associated risk factors. RESULTS Infection occurred in 57.2% of 112 patients with febrile neutropenia. The main source of infection was the central venous catheter (25.9%). Infection was chiefly due to Gram-positive bacteria, although Gram-negative-related infections were more severe and caused a higher death rate. Sex, age, skin color, nutritional status and underlying disease were not associated with the development of infection. Patients with severe mucositis (Grades III and IV) had a higher infection rate (P < 0.001). Patients who developed pulmonary complications during hospitalization had higher infection rates (P = 0.002). Infection was the main cause of death (57.1%) in the study sample. CONCLUSION Strategies aimed at reducing infection-related mortality rates among patients undergoing autologous HSCT are necessary.

Avaliação dos Tipos 1 e 2 de alcoolismo de Cloninger em homens participantes de um programa de tratamento ambulatorial

CONTEXTO: A classificacao Tipo 1/Tipo 2 de Cloninger e uma das mais estudadas tipologias de alcoolismo. OBJETIVOS: Testar a aplicabilidade dessa tipologia, caracterizar os subtipos identificados e avaliar seu comportamento ante um programa terapeutico. METODOS: Partindo das variaveis descritas por Cloninger et al., 16 caracteristicas de 308 homens alcoolistas tratados ambulatorialmente foram submetidas a analise de cluster para identificacao de dois subgrupos (clusters). Posteriormente, efetivaram-se cruzamentos de dados para testar possivel associacao dos clusters identificados com variaveis demograficas e clinicas. RESULTADOS: Pacientes do cluster 1 foram caracterizados por inicio mais tardio dos problemas relacionados ao alcool, menos problemas sociais e maior sentimento de culpa em relacao a seu consumo. O cluster 2 incluiu pacientes com historia familiar de alcoolismo mais evidente, caracteristicas anti-sociais mais presentes, mais uso disfuncional de outras substâncias psicoativas e piores niveis de adesao ao tratamento. CONCLUSOES: Os resultados evidenciaram a diferenciada associacao dos clusters a variaveis de tratamento e prognostico; em sua maior parte foram coerentes com a classificacao Tipo 1/Tipo 2 e reforcam a tese de que o simples diagnostico de dependencia ao alcool nao e suficiente para atender as necessidades terapeuticas de subgrupos especificos de pacientes.