Maria Fernanda Lima-Costa

Condições de saúde, capacidade funcional, uso de serviços de saúde e gastos com medicamentos da população idosa brasileira: um estudo descritivo baseado na Pesquisa Nacional por Amostra de Domicílios

The objective of this research was to describe health conditions and health services utilization among Brazilian seniors. The study was based on 28,943 adults > 60 years (99.9%) from an overall National Household Survey (PNAD 1998). The results show that prevalence rates for at least one chronic disease (69.0%), hypertension (43.9%), arthritis (37.5%), and inability to feed oneself/bathe/use the toilet (2.0%) are very similar to those observed in other populations. Physician visits and hospitalization patterns are within the variation reported by different countries. The low prevalence rates of older adults who had interrupted activities because of a health problem (13.9%) or had been bedridden (9.5%) in the previous 2 weeks or hospitalized in the previous year (13.6%) show that the vast majority are not subject to these events. Considering that 50% of this population live on less than or equal to one Brazilian monthly minimum wage, expenditures on medications consume approximately one-fourth (23%) of total income for half of the elderly population.

Internações por condições sensíveis à atenção primária: a construção da lista brasileira como ferramenta para medir o desempenho do sistema de saúde (Projeto ICSAP - Brasil)

Ambulatory care sensitive hospitalizations are a set of conditions for which access to effective primary care can reduce the likelihood of hospitalization. These hospitalizations have been used as an indicator of primary care performance in several countries and in three Brazilian states, but there is little consensus on which conditions should be included in this indicator. This paper presents a description of the steps undertaken to construct and validate a list for Brazil. The final list includes 20 groups of diagnostic conditions that represented 28.3% of a total of 2.8 million hospitalizations in the National Unified Health System in 2006. Gastroenteritis and complications, congestive heart failure, and asthma represented 44.1% of all ambulatory care sensitive hospitalizations. From 2000 to 2006, ambulatory care sensitive hospitalizations decreased by 15.8%, and this reduction was more significant than that observed in all other hospitalizations. The article concludes with potential applications and limitations of the proposed Brazilian list.

Parkinsonism and Parkinson's disease in the elderly: A community-based survey in Brazil (the Bambuí study)

Several community‐based surveys on the prevalence of Parkinsonism and Parkinsons disease have been conducted worldwide, with variations on their methodology and results. The objective of this study is to assess the prevalence of Parkinsonism and its causes in a cohort of individuals age 64 years or older in Bambuí, a Brazilian town. In phase I, 1,186 people older than 64 years responded to a 9‐question screening questionnaire for Parkinsonism. In phase II, all subjects who scored ≥ 2 points on the test were examined independently by at least 2 movement disorder‐trained physicians. A movement disorder senior specialist excluded or confirmed the diagnosis in all suspected cases. The response rate was high for both phases (96% for phase I and 94% for phase II). The prevalence rate per 100 population over 64 years of age in this group was 7.2% for Parkinsonism of all types (n = 86). The most frequent causes were idiopathic Parkinsons disease and drug‐induced Parkinsonism, with prevalence rates of 3.3% (n = 39) and 2.7% (n = 32), respectively. The prevalence of vascular Parkinsonism was 1.1% (n = 13). We found 1 case of posttraumatic Parkinsonism and another with multiple system atrophy. In this first population‐based study of Parkinsonism conducted in Brazil, the prevalence in a cohort of elderly subjects was higher than the observed in other populations worldwide, especially because of the high rates of drug‐induced and vascular Parkinsonism. The prevalence of Parkinsons disease was similar to that observed in elderly people in door‐to‐door surveys in other American, European, and Eastern countries.

Estudo de base populacional sobre o consumo de medicamentos entre idosos: Projeto Bambuí

Investigou-se a prevalencia e fatores associados ao consumo de medicamentos prescritos e nao prescritos entre idosos (60 anos ou mais). Participaram deste trabalho 1.606 (92,2%) dos 1.742 idosos residentes na cidade de Bambui, Minas Gerais, Brasil. Entre os participantes, 1.281 (79,7%) e 274 (17,1%) haviam consumido medicamentos prescritos e nao prescritos nos ultimos noventa dias, respectivamente. O consumo de medicamentos prescritos esteve associado ao sexo feminino, idade (70-79 e > 80 anos), renda familiar (maior), estado de saude (pior) e numero de consultas medicas (maior). O uso de medicamentos nao prescritos apresentou associacao negativa com consulta medica e associacao positiva com sexo (feminino) e consulta a um farmaceutico. Os fatores associados ao consumo de medicamentos prescritos e nao prescritos verificados neste trabalho foram semelhantes aos observados em estudos conduzidos em outros paises. Diferentemente deles, nosso estudo mostrou um menor consumo de medicamentos prescritos entre idosos com pior situacao socio-economica. Nossos resultados sugerem, ainda, que a automedicacao entre idosos esteja sendo utilizada em substituicao a atencao formal a saude.

Estudo de base populacional dos fatores associados à incapacidade funcional entre idosos na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil

This study assessed factors associated with functional disability in old age in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. The theoretical model was based on predisposing (socio-demographic), extra-individual (social support, use of health services), and intra-individual factors (health conditions). The study was conducted in a probabilistic sample of 1,786 subjects aged > 60 years. The dependent variable was disability defined as mild (some difficulty) or severe (total dependence) in performing at least one basic activity of daily living. Prevalence of disability was 16% (8% mild; 8% severe). Age and worse self-rated health were independently and positively associated with mild and severe disability. Self-reported hypertension and arthritis were associated with mild disability, while diabetes and stroke were associated with severe disability. Severe disability was independently and negatively associated with number of visits by friends in the previous 30 days. According to the results, chronic conditions associated with disability in the study population are preventable, and severely disabled elderly had less extra-family social support.

Validity of self-reported hypertension and its determinants (the Bambuí study)

OBJECTIVE Assessing the validity of self-reported hypertension and its determinants among adults living in the community was the objective of this study. METHODS A simple random sample of residents in the city of Bambuí, State of Minas Gerais, Brazil aged >18 years was selected. Three blood pressure measurements were performed in 970 inhabitants. Sensitivity, specificity as well as positive and negative predictive values of self-reported hypertension were assessed in relation to hypertension (mean blood pressure >90 or >140 mm Hg and/or present use of anti-hypertensive drugs). RESULTS Sensibility and specificity of self-reported hypertension were 72.1% (95% CI: 69.3-75.0) and 86.4% (95% CI: 84.3-88.6), respectively. Its prevalence was 27.2% (95% CI: 24.4-30.1), being reasonably similar to the prevalence of hypertension (23.3%; 95% CI: 20.7-26.1%). The validity of self-reported hypertension was higher among women, among individuals aged 40-59 and > or =60 years, among those who visited a doctor more recently (< two years) and among those with higher body mass index (>25 kg/m2). CONCLUSIONS The results of this study show that self-reported hypertension is an appropriate indicator of hypertension prevalence, even in a population not living in a large urban center.

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.

Estudo epidemiológico de base populacional sobre uso de medicamentos entre idosos na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil

The aim of this study was to investigate the use of medication and associated factors (sociodemographics, health conditions, and health services use) in a representative sample of 1,598 elderly individuals (60+ years) in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. The dependent variable was the number of drugs used in the preceding two weeks. Prevalence of medication was 72.1%, and mean consumption was 2.18 drugs, most of which acting on the cardiovascular system. Use of medication (any amount) was independently associated with gender (female), age (80+ years), having consulted a physician, and presence of any chronic health condition. Use of five or more drugs was significantly associated with schooling (8+ years, OR=2.28), worse self-rated health (fair, OR = 5.45; bad/very bad, OR = 5.35). The results show that the types of medications used and factors associated with consumption were similar to those observed in other populations, suggesting some uniformity among various populations in the use of medication and its determinants.

Major Expansion Of Primary Care In Brazil Linked To Decline In Unnecessary Hospitalization

In 1994 Brazil launched what has since become the worlds largest community-based primary health care program. Under the Family Health Program, teams consisting of at least one physician, one nurse, a medical assistant, and four to six trained community health agents deliver most of their services at community-based clinics. They also make regular home visits and conduct neighborhood health promotion activities. This study finds that during 1999-2007, hospitalizations in Brazil for ambulatory care-sensitive chronic diseases, including cardiovascular disease, stroke, and asthma, fell at a rate that was statistically significant and almost twice the rate of decline in hospitalizations for all other causes. In municipalities with high Family Health Program enrollment, chronic disease hospitalization rates were 13 percent lower than in municipalities with low enrollment, when other factors were held constant. These results suggest that the Family Health Program has improved health system performance in Brazil by reducing the number of potentially avoidable hospitalizations.

Evolução das desigualdades sociais em saúde entre idosos e adultos brasileiros: um estudo baseado na Pesquisa Nacional por Amostra de Domicílios (PNAD 1998, 2003)

O objetivo deste trabalho foi verificar se as desigualdades sociais em saude de adultos (20-64 anos) e idosos (> 65 anos) brasileiros se alteraram entre 1998 e 2003. O estudo foi realizado em uma amostra de 203.455 e 239.700 participantes da PNAD 1998 e 2003, respectivamente. As condicoes de saude e funcao fisica, uso de servicos de saude e filiacao a plano de saude daqueles pertencentes ao quintil inferior da distribuicao da renda domiciliar per capita foram comparadas as daqueles com renda mais alta, utilizando-se metodos multivariados de analise. Os resultados mostraram que nos dois anos considerados, os individuos no estrato mais baixo de renda apresentavam piores condicoes de saude, pior funcao fisica e menor uso de servicos de saude, tanto na faixa etaria de 20-64 quanto na de > 65 anos de idade. As forcas das associacoes entre renda domiciliar per capita, condicoes de saude e uso de servicos de saude nao se modificaram entre 1998 e 2003, indicando que nao houve alteracoes nas desigualdades sociais em saude no periodo estudado. A persistencia dessas desigualdades aponta para a ineficiencia de politicas, nos ultimos cinco anos, que as reduzissem.