Priscila Maria Stolses Bergamo Francisco

Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003- 2008

The aims of this study are: to evaluate the prevalence of chronic diseases in the Brazilian population comparing data of 2008 with those of 2003; to estimate the impact of chronic conditions on the use of health services and on the restriction of daily activities and to measure the differentials in the prevalence of specific diseases according to educational strata and the affiliation to a private health plan. Data were obtained from PNAD 2008 and 2003. The analysis included estimations of crude and adjusted prevalence ratios, using svy commands from Stata 11 software. The prevalence of at least one disease was higher in: the elderly, women, low schooling level, black or indigenous people, urban residents, migrants and people living in the south region of Brazil. The most frequent diseases were: hypertension, back and spinal cord disorders, arthritis and depression. Between 2003 and 2008, an increase in the prevalence of diabetes, hypertension, cancer and cirrhosis was observed, and there was a reduction in chronic kidney failure and tuberculosis. All the diseases analyzed, with the exception of cancer and tendinitis/tenossinovitis, revealed a higher prevalence in low educational level strata. The greatest social inequalities were in chronic kidney failure, cirrhosis, tuberculosis and arthritis/rheumatism.

Medidas de associação em estudo transversal com delineamento complexo: razão de chances e razão de prevalência

O objetivo deste estudo foi apresentar e discutir a utilizacao das medidas de associacao: razao de chances e razao de prevalencias, em dados obtidos de estudo transversal realizado em 2001-2002, utilizando-se amostra estratificada por conglomerados em dois estagios (n=1.958). As razoes de chances e razoes de prevalencias foram estimadas por meio de regressao logistica nao condicional e regressao de Poisson, respectivamente, utilizando-se o pacote estatistico Stata 7.0. Intervalos de confianca e efeitos do desenho foram considerados na avaliacao da precisao das estimativas. Dois desfechos do estudo transversal com diferentes niveis de prevalencia foram avaliados: vacinacao contra influenza (66,1%) e doenca pulmonar referida (6,9%). Na situacao em que a prevalencia foi alta, as estimativas das razoes de prevalencia foram mais conservadoras com intervalos de confianca menores. Na avaliacao do desfecho de baixa prevalencia, nao se observaram grandes diferencas numericas entre as estimacoes das razoes de chances e razoes de prevalencia e erros-padrao obtidos por uma ou outra tecnica. O efeito do desenho maior que a unidade indicou que a amostragem complexa, em ambos os casos, aumentou da variância das estimativas. Cabe ao pesquisador a escolha da tecnica e do estimador mais adequado ao seu objeto de estudo, permanecendo a escolha no âmbito epidemiologico.

Impacto da vacinação contra influenza na mortalidade por doenças respiratórias em idosos

OBJECTIVE Respiratory diseases, especially infectious ones, are becoming increasingly representative in the morbidity and mortality patterns of elderly persons. The aim of the present study was to analyze trends in the mortality by respiratory diseases and to observe the impact of influenza vaccination on mortality rates. METHODS The study was carried out between 1980 and 2000. Subjects were elderly persons living in the State of Sao Paulo, and mortality data were obtained from the Mortality Information System of the Brazilian Ministry of Health. This is an ecological time-series study. We analyzed the time trends of standardized mortality rates by infectious diseases, according to age group (60-64, 65-69, 70-74, 75-79, and 80+ years) and sex, using polynomial regression. We estimated confidence intervals for the mean expected response in the years following the intervention. RESULTS Rates increased for both sexes among the elderly population. After the intervention, we observed a declining trend with respect to mortality indicators. For older males, the mean rate in the 1980-1998 period was 5.08 deaths per thousand men, with a nonlinear, non-constant increase of 0.13 per year; in 2000, the rate observed was 4.72 deaths per thousand men. The mean annual rate among women over 60 years was 3.18 deaths per thousand women, with a nonlinear, non-constant increase of 0.08 per year; in 2000, the rate observed was 2.99 deaths per thousand women. There was also a significant reduction in mortality rates in all age groups. CONCLUSIONS Data indicate the importance of respiratory diseases among the elderly population and suggest that specific protection against influenza has a positive effect on the prevention of mortality due to these diseases.

Utilização de medicamentos e fatores associados: um estudo de base populacional no Município de Campinas, São Paulo, Brasil

This article analyzes prevalence rates in the use of medication according to demographic, socioeconomic, and health-related behavioral variables through a population-based cross-sectional study of individuals 18 years and older (n=941) in Campinas, Sao Paulo State, Brazil. The study used multistage sampling, both stratified and cluster. Chi-square test was performed, and adjusted prevalence ratios were estimated by gender and age, both with 95% confidence intervals. A Poisson multiple regression model was developed, and the following factors were associated with use of medication: female gender, age 40 and over, reported illness in the previous two weeks, and number of chronic diseases. The most widely consumed drugs were for the cardiovascular and nervous systems, besides herbal remedies. Prevalence of medication in Campinas was lower than in most studies. Local health surveys could help identify drug use patterns and guarantee more appropriate interventions for pharmaceutical care policy.

Fatores associados à doença pulmonar em idosos

OBJECTIVE To investigate the prevalence of reported pulmonary disease among elderly subjects, according to sociodemographic and economic characteristics, lifestyle, physical mobility, and health status. METHODS This was a cross-sectional population-based study that included 1,957 elderly subjects (aged 60 and over). Information was collected by means of interviews. Subjects were selected using a two-stage probabilistic, stratified, cluster sampling strategy in six municipalities in the State of São Paulo between 2001 and 2002. Descriptive statistics, chi-squared association tests, prevalence ratios, and 95% confidence intervals were utilized. Adjusted analysis was carried out by Poisson regression. RESULTS Among the interviewees, around 7% reported pulmonary disease. There was no association between pulmonary disease and influenza vaccination. Adjusted analysis identified the following factors that were independently associated with reported disease: smoking (PR: 2.03; 95% CI: 1.39-2.97); medication use (PR: 2.05; 95% CI: 1.11-3.79); health status self-assessed as poor or very poor (PR: 1.89; 95% CI: 1.20-2.96); and depression, anxiety, or emotional problems (PR: 1.86; 95% CI: 1.11-3.10). CONCLUSIONS The findings from the present study reinforce the importance of respiratory diseases among the elderly, particularly in more vulnerable groups. Preventive measures and specific care for such groups are therefore justified.

Diabetes auto-referido em idosos: prevalência, fatores associados e práticas de controle

The aim of the study was to assess the prevalence of self-reported diabetes in the elderly, identifying associated factors, knowledge, and practices related to treatment options. This was a cross-sectional population-based study with stratified clustered two-stage sampling in six municipalities in the State of Sao Paulo, Brazil. Among the 1,949 elderly, 15.4% presented self-reported diabetes. Body mass index and exercising were statistically associated with diabetes. There was a significant difference between diabetics and non-diabetics in terms of self-rated health, hospitalization, self-reported illness in the previous two weeks, and report of the following diseases: hypertension, anemia, chronic kidney disease, and heart disease. In terms of per capita family income, there was no difference in regular medical visits, participation in discussion groups, and control practices. The findings show the need for behavior changes to prevent and control diabetes and its complications. Educational interventions are needed to expand the coverage of diabetes care.

Comparação de estimativas para o auto-relato de condições crônicas entre inquérito domiciliar e telefônico - Campinas (SP), Brasil

OBJETIVO: O objetivo do presente estudo foi comparar as estimativas obtidas por diferentes modalidades de inquerito para condicoes cronicas auto-referidas em adultos residentes em Campinas (SP) no ano de 2008. METODOS: Foram utilizados os dados do ISACamp, inquerito domiciliar realizado pela Faculdade de Ciencias Medicas da Universidade Estadual de Campinas com apoio da Secretaria Municipal de Saude, e do VIGITEL - Campinas (SP), inquerito telefonico realizado pelo Ministerio da Saude para Vigilância de Fatores de Risco e Protecao para Doencas Cronicas na populacao adulta (18 anos ou mais). Estimativas do auto-relato de hipertensao arterial, diabetes, osteoporose, asma/bronquite/enfisema, foram avaliadas e comparadas por meio do teste t de Student para duas amostras independentes. RESULTADOS: Para as estimativas globais, maior prevalencia de hipertensao arterial e osteoporose foram verificadas pelo inquerito telefonico. Diabetes e asma/bronquite/enfisema nao apresentaram diferencas estatisticas significantes. Na analise segundo variaveis socio-demograficas, maior prevalencia de hipertensao foi obtida pelo VIGITEL para os homens, entre as pessoas de 18 a 59 anos e nos que referiram 9 ou mais anos de estudo. Maior prevalencia de osteoporose entre adultos (18 a 59 anos) foi verificada pelo VIGITEL. Em relacao a asma/bronquite/enfisema nos idosos, maior prevalencia foi observada pelo ISACamp. CONCLUSAO: Exceto para hipertensao arterial, os dados obtidos do inquerito telefonico constituiram uma alternativa rapida para disponibilizar estimativas globais da prevalencia das condicoes estudadas na populacao adulta residente em Campinas (SP).

Vacinação contra influenza em idosos: prevalência, fatores associados e motivos da não-adesão em Campinas, São Paulo, Brasil

The objective of this study was to assess the prevalence of self-reported influenza vaccination in the elderly, identifying associated factors and reasons for noncompliance, using a cross-sectional population-based design with stratified two-stage cluster sampling in Campinas, São Paulo State, Brazil, in 2008-2009. Among the 1,517 elderly, 62.6% reported vaccination during the previous year. Occupational activity, leisure-time physical activity, self-reported diabetes, hospitalization, and recommendation by a healthcare worker were statistically associated with vaccination. Except for diabetics, vaccination failed to reach adequate levels in elderly with chronic illnesses. Reasons for noncompliance were: not believing it was necessary and fear of reactions. Socioeconomic conditions, lifestyle, and physical mobility did not restrict access, but coverage was below the target established by the Brazilian Ministry of Health. Campaigns targeting younger elders (60-69 years) and patients with chronic illnesses, as well as orientation by health professionals, could expand vaccination coverage in groups that have shown low adherence to previous campaigns.

Práticas preventivas de detecção de câncer em mulheres: comparação das estimativas dos inquéritos de saúde (ISA - Capital) e vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico (VIGITEL - São Paulo)

OBJETIVO: O objetivo deste estudo foi comparar estimativas obtidas em inqueritos domiciliar e telefonico, da realizacao dos exames de Papanicolaou e mamografia em mulheres residentes no municipio de Sao Paulo em 2008, segundo caracteristicas sociodemograficas, bem como dimensionar as diferencas observadas. METODOS: Foram utilizados os dados do ISA - Capital 2008, inquerito domiciliar realizado no municipio de Sao Paulo pela Universidade de Sao Paulo (USP), Universidade Estadual de Campinas (UNICAMP) e Secretaria de Estado da Saude com apoio da Secretaria Municipal de Saude de Sao Paulo, e do VIGITEL - Sao Paulo, inquerito telefonico realizado pelo Ministerio da Saude para Vigilância de Fatores de Risco e Protecao para Doencas Cronicas. Estimativas da realizacao do exame de Papanicolaou e mamografia na vida, bem como a realizacao no ultimo ano foram comparadas segundo o tipo de inquerito (domiciliar/telefone) por meio de regressao de Poisson ajustada por idade e escolaridade. RESULTADOS: Nao foram encontradas diferencas estatisticamente significantes entre as estimativas obtidas pelo VIGITEL e ISA - Capital para as prevalencias de realizacao de mamografia no ultimo ano. No entanto, para as estimativas globais de realizacao do exame de Papanicolaou alguma vez na vida e no ultimo ano e da mamografia na vida, foi possivel verificar diferencas estatisticamente significantes, com prevalencias de cobertura superiores entre as entrevistadas pelo inquerito telefonico. CONCLUSAO: Os resultados sinalizam a tendencia de superestimacao de alguns indicadores de cobertura de mamografia e de exame de Papanicolaou nos dados de pesquisa via telefone, apontando a necessidade de novos estudos que tambem contribuam para o melhor entendimento das diferencas observadas com o uso de diferentes modalidades de inqueritos.

Sleep duration pattern and chronic diseases in Brazilian adults (ISACAMP, 2008/09)

OBJECTIVE The aim of the present study was to assess sleep patterns in the adult population of the city of Campinas (Brazil) according to socioeconomic/demographic variables, chronic diseases, and symptoms. METHODS A population-based cross-sectional study was conducted using data from the Campinas Health Survey (ISACAMP) carried out in 2008 and 2009. A total of 2637 individuals aged 18 years or older (obtained from a probabilistic sample) were analyzed. Associations between sleep pattern and the independent variables were determined using the chi-square test. Multinomial logistic regression models were used to adjust for confounders. RESULTS The prevalence of six or fewer hours of sleep was greater among individuals aged 40 years or older and among divorced or single individuals. The sleep pattern of nine or more hours was more prevalent among those with less than 40 years of age, among those who were divorced, or single, among those with a lower level of schooling, those who did not work and housewives. Both short and long sleep patterns were more prevalent among individuals with heart disease, vascular problems, rheumatism/arthritis/arthrosis, osteoporosis, or emotional problems. The prevalence of the short sleep duration was greater among individuals with back problems and those with three or more health conditions. A strong association was found between sleep duration and sleep quality. CONCLUSIONS Socio-demographic factors and health diseases were associated to sleep duration. This issue should be considered in health promotion strategies.