Maria Fernanda Furtado de Lima e Costa

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.

Inquéritos Nacionais de Saúde: experiência acumulada e proposta para o inquérito de saúde brasileiro

As informacoes oriundas das fontes de dados secundarios dos sistemas de informacao em saude existentes sao fundamentais, mas insuficientes para responder as necessidades atuais da gestao do Sistema Unico de Saude na identificacao dos problemas e necessidades de saude da populacao brasileira. Os inqueritos populacionais sao instrumentos utilizados como subsidios a formulacao e avaliacao das politicas publicas, tornando-se crescente a sua utilizacao nos diversos paises como ferramenta de apoio ao planejamento em saude. O artigo realiza uma breve revisao das iniciativas de realizacao de inqueritos no âmbito internacional e no Brasil, e propoe um roteiro para a realizacao do Inquerito Nacional de Saude.

A multivariate analysis of socio-demographic factors, water contact patterns and Schistosoma mansoni infection in an endemic area in Brazil

Associations between socio-demographic factors, water contact patterns and Schistosoma mansoni infection were investigated in 506 individuals (87% of inhabitants over 1 year of age) in an endemic area in Brazil (Divino), aiming at determining priorities for public health measures to prevent the infection. Those who eliminated S. mansoni eggs (n = 198) were compared to those without eggs in the stools (n = 308). The following explanatory variables were considered: age, sex, color, previous treatment with schistosomicide, place of birth, quality of the houses, water supply for the household, distance from houses to stream, and frequency and reasons for water contact. Factors found to be independently associated with the infection were age (10-19 and > or = 20 yrs old), and water contact for agricultural activities, fishing, and swimming or bathing (Adjusted relative odds = 5.0, 2.4, 3.2, 2.1 and 2.0, respectively). This suggests the need for public health measures to prevent the infection, emphasizing water contact for leisure and agricultural activities in this endemic area.

Death of elderly patients in the Santa Genoveva Clinic in Rio de Janeiro: excess mortality that the public health system could have prevented

From January to May 1996, 156 inpatients died in a clinic for elderly people in Rio de Janeiro, Brazil. The highest mortality rate was observed in May: 143/1,000 inpatients. As a result, the clinic was closed by the Ministry of Health. This study investigated whether the excessive number of deaths observed in the clinic in early 1996 was unexpected or reflected prevailing conditions. The investigation used the Public Health System database (SIH-SUS). The study period was 01/1993 to 05/1996. The investigation was based on: 1) a time-series analysis of the number of deaths and crude mortality rates and 2) comparison of the mortality rates observed in that clinic with those calculated for 15 area hospitals, defined as the reference rates. Risk of death in the clinic was higher than expected in 28 of the 41 months considered in the study. Highest risks were observed in January 1993 (RRcrude = 2.23; 95% CI 1.56-3. 14) and May 1996 (RRadjusted = 2.73; 95% CI 1.88-3.95). The high mortality rates observed in the clinic in 1996 were already present in 1993. Thus, adequate use of the SIH-SUS could have anticipated and avoided the excess mortality identified in early 1996.

QUESTIONNAIRES IN THE SCREENING FOR Schistosoma mansoni INFECTION: A STUDY OF SOCIO DEMOGRAPHIC AND WATER CONTACT VARIABLES IN FOUR COMMUNITIES IN BRAZIL

The use of questionnaires has been recommended for identifying, at a lower cost, individuals at risk for schistosomiasis. In this study, validity of information obtained by questionnaire in the screening for Schistosoma mansoni infection was assessed in four communities in the State of Minas Gerais, Brazil. Explanatory variables were water contact activities, sociodemographic characteristics and previous treatment for schistosomiasis. From 677, 1474, 766 and 3290 individuals eligible for stool examination in the communities, 89 to 97% participated in the study. The estimated probability of individuals to be infected, if they have all characteristics identified as independently associated with S.mansoni infection, varied from 15% in Canabrava, to 42% in Belo Horizonte, 48% in Comercinho and 80% in São José do Acácio. Our results do not support the hypothesis that a same questionnaire on risk factors could be used in screening for S.mansoni infection in different communities.

Comportamentos em saúde entre idosos hipertensos, Brasil, 2006

OBJETIVO: Estimar as prevalencias de comportamentos prejudiciais a saude e de outros fatores de risco cardiovascular entre idosos com hipertensao auto-referida e comparando-as com de nao-hipertensos. METODOS: Foram utilizados dados do sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico (VIGITEL), referentes aos 9.038 idosos residentes em domicilios com pelo menos uma linha telefonica fixa nas 26 capitais brasileiras e no Distrito Federal em 2006. RESULTADOS: A prevalencia de hipertensao auto-referida foi de 55% (IC 95%: 53;57). A maioria dos hipertensos apresentava concomitância de tres ou mais fatores de risco (69%; IC 95%: 67;71). Foram observadas altas prevalencias de atividades fisicas insuficientes no lazer (88%; IC 95%: 86;89) e do consumo de frutas e hortalicas inferior a cinco porcoes diarias (90%; IC 95%: 88;90) entre hipertensos, seguidas pela adicao de sal aos alimentos (60%; IC 95%: 57;63), consumo habitual de carnes gordurosas (23%; IC 95%: 21;25), tabagismo (9%; IC 95%: 7;10) e consumo abusivo de alcool (3%; IC 95%: 2;4). Essas prevalencias foram semelhantes as observadas entre nao hipertensos (p >0,05), exceto tabagismo. A prevalencia do tabagismo foi menor entre hipertensos (razao de prevalencia ajustada [RPA] = 0,75; IC 95%: 0,64;0,89) e as prevalencias de sobrepeso (RPA= 1,37; IC 95%: 1,25;1,49), dislipidemia (RPA 1,36; IC 95%: 1,26;1,36) e diabetes (RPA= 1,37; IC 95%: 1,27;1,37) foram mais altas. CONCLUSOES: Os resultados sugerem que, exceto tabagismo, os comportamentos prejudiciais a saude entre idosos persistem apos o diagnostico da hipertensao arterial.OBJECTIVE To estimate the prevalence of unhealthy behaviors and other cardiovascular risk factors among older adults with self-reported arterial hypertension, and to compare these prevalences with those of non-hypertensives. METHODS Data used was obtained from the system Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases) referring to the 9,038 older adults living in households with at least one fixed telephone line in the 26 Brazilian state capitals and Federal District in 2006. RESULTS Prevalence of self-reported hypertension was 55% (95% CI: 53;57). The majority of hypertensives showed three or more concomitant risk factors (69%; 95% CI: 67;71). It was found a high prevalence of insufficient physical activity during leisure (88%; 95% CI: 86;89) and of fruit and vegetable intake below five daily portions (90%; 95% CI: 88;90) among hypertensive subjects, followed by adding salt to meals (60%; 95% CI: 57;63), regular intake of fatty meats (23%; 95% CI: 21;25), smoking (9%; 95% CI: 7;10), and binge drinking (3%; 95% CI: 2;4). With the exception of smoking, these prevalences were similar to those reported by non-hypertensive subjects (p >0.05). Prevalence of smoking was lower among hypertensives (adjusted prevalence ratio [APR] = 0.75; 95% CI: 0.64;0.89), whereas prevalence of overweight (APR = 1.37; 95% CI: 1.25;1.49), dyslipidemia (APR = 1.36; 95% CI: 1.26;1.36), and diabetes (APR = 1.37; 95% CI: 1.27;1.37) was higher. CONCLUSIONS Results suggest that, with the exception of smoking, unhealthy behaviors persist among older adults after hypertension is diagnosed.

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.

Estado nutricional e variáveis sócio-econômicas na repetência escolar: um estudo prospectivo em crianças da primeira série em Belo Horizonte, Brasil

This study aimed to establish a correlation between anthropometric and socioeconomic variables and repetition in school for first grade pupils, as well to determine the predictive value of such variables vis-à-vis repetition. A study with a prospective and concurrent approach was developed in four elementary schools in Belo Horizonte, Minas Gerais State, with 699 children (95% of those eligible). After adjustment for confounders, children whose mothers had less than eight years of schooling, of mothers with unskilled jobs, from single-parent households (mother, father, or guardian), whose per capita family income was less than or equal to half the minimum wage, and who had a height/age/sex index under the 10.1 percentile were at greater risk of repeating the first grade. The data are potentially useful for selecting children to be monitored and to prevent repetition in the schools investigated.

Efetividade da vacina antiamarílica 17D: uma avaliação epidemiológica em serviços de saúde

O objetivo do presente estudo foi avaliar a efetividade da vacina antiamarilica 17D nas condicoes de sua utilizacao pelos servicos de saude publica. Em 1989, um estudo prospectivo nao-concorrente foi desenvolvido em Bocaiuva, Estado de Minas Gerais, Brasil, 6 meses apos vacinacao em massa da populacao. A populacao-alvo do estudo foi constituida por estudantes matriculados no primeiro grau em todas as escolas situadas em Bocaiuva. O grupo exposto foi constituido por uma amostra probabilistica simples de estudantes vacinados (n = 173) e o grupo nao-exposto foi constituido por todos aqueles nao submetidos a vacinacao (n = 55). Os soros foram examinados pelo teste da neutralizacao em camundongos; estes exames foram realizados as cegas, ou seja, o examinador desconhecia a situacao vacinal do paciente. Os resultados da sorologia foram os seguintes: entre os vacinados, 75% eram soropositivos, 17% soronegativos e 7% apresentaram exame inconclusivo; entre os nao-vacinados estes resultados foram de 9, 87 e 4%, respectivamente. A razao de soropositividades entre vacinados e nao-vacinados, ajustada pela idade, foi 7,6 (IC95%: 3,4 a 16,7). A fracao da soropositividade atribuivel a vacinacao, ajustada pela idade, foi 86,8% (IC95%: 70,6 a 94,0). Os resultados mostram que a efetividade da vacinacao, definida atraves da soropositividade para o virus, ficou abaixo dos niveis esperados para a vacina 17D. Isto pode ter sido consequencia de falhas operacionais na conservacao ou aplicacao da vacina. Nossos resultados apontam para a necessidade de avaliacoes sistematicas na rotina dos servicos de saude apos a utilizacao em massa da vacina.