Sandhi Maria Barreto

Chronic non-communicable diseases in Brazil: burden and current challenges

Non-communicable diseases (NCDs) have become a major health priority in Brazil--72% of all deaths were attributable to NCDs in 2007. They are also the main source of disease burden, with neuropsychiatric disorders being the single largest contributor. Morbidity and mortality due to NCDs are greatest in the poor population. Although the crude NCD mortality increased 5% between 1996 and 2007, age-standardised mortality declined by 20%. Declines were primarily for cardiovascular and chronic respiratory diseases, in association with the successful implementation of health policies that lead to decreases in smoking and the expansion of access to primary health care. Of note, however, the prevalence of diabetes and hypertension is rising in parallel with that of excess weight; these increases are associated with unfavourable changes of diet and physical activity. Brazil has implemented major policies for the prevention of NCDs, and its age-adjusted NCD mortality is falling by 1·8% per year. However, the unfavourable trends for most major risk factors pose an enormous challenge and call for additional and timely action and policies, especially those of a legislative and regulatory nature and those providing cost-effective chronic care for individuals affected by NCDs.

Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): Objectives and Design

Although low- and middle-income countries still bear the burden of major infectious diseases, chronic noncommunicable diseases are becoming increasingly common due to rapid demographic, epidemiologic, and nutritional transitions. However, information is generally scant in these countries regarding chronic disease incidence, social determinants, and risk factors. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) aims to contribute relevant information with respect to the development and progression of clinical and subclinical chronic diseases, particularly cardiovascular diseases and diabetes. In this report, the authors delineate the studys objectives, principal methodological features, and timeline. At baseline, ELSA-Brasil enrolled 15,105 civil servants from 5 universities and 1 research institute. The baseline examination (2008-2010) included detailed interviews, clinical and anthropometric examinations, an oral glucose tolerance test, overnight urine collection, a 12-lead resting electrocardiogram, measurement of carotid intima-media thickness, echocardiography, measurement of pulse wave velocity, hepatic ultrasonography, retinal fundus photography, and an analysis of heart rate variability. Long-term biologic sample storage will allow investigation of biomarkers that may predict cardiovascular diseases and diabetes. Annual telephone surveillance, initiated in 2009, will continue for the duration of the study. A follow-up examination is scheduled for 2012-2013.

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.

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.

Hipertensão arterial no Brasil: estimativa de prevalência a partir de estudos de base populacional

Endereço para correspondência: Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190, sala 4082, Belo Horizonte-MG. CEP: 30190-100 E-mail: vpassos@medicina.ufmg.br Resumo Estudos epidemiológicos sobre a hipertensão arterial são fundamentais para conhecer a distribuição da exposição e do adoecimento e as condições que influenciam a dinâmica de risco e controle na comunidade. Este artigo analisa estudos de prevalência de hipertensão no Brasil, de base populacional, em adultos, a partir de 1990. Foram incluídos todos os estudos publicados nas bases Medline e LILACS. A análise considerou a população-alvo, o desenho do estudo, o plano amostral, as características sociodemográficas da população-alvo, os critério de definição de hipertensão e a análise estatística. Nos 13 estudos selecionados, as taxas de prevalência mostram que cerca de 20% dos adultos apresentam hipertensão, sem distinção por sexo, mas também com evidente tendência de aumento com a idade. Os estudos ainda estão restritos às Regiões Sul e Sudeste. É marcante a preocupação com a metodologia e precisão da estimativa da prevalência. Ainda são escassos, entretanto, estudos sobre conhecimento, tratamento e controle da hipertensão. Palavras-chave: hipertensão; prevalência; estudos de base populacional.

O professor, as condições de trabalho e os efeitos sobre sua saúde

O estudo das relacoes entre o processo de trabalho docente, as reais condicoes sob as quais ele se desenvolve e o possivel adoecimento fisico e mental dos professores constituem um desafio e uma necessidade para se entender o processo saude-doenca do trabalhador docente e se buscar as possiveis associacoes com o afastamento do trabalho por motivo de saude. Este artigo apresenta o perfil dos afastamentos do trabalho por motivos de saude de uma populacao de profissionais da educacao. Buscando elementos na literatura disponivel, aventa a hipotese de que as condicoes de trabalho nas escolas podem gerar sobreesforco dos docentes na realizacao de suas tarefas. Foram analisados os dados apresentados no Relatorio preparado pela Gerencia de Saude do Servidor e Pericia Medica (GSPM) da Prefeitura Municipal de Belo Horizonte, Minas Gerais, relativos aos afastamentos do trabalho de funcionarios da Secretaria Municipal de Educacao, de abril de 2001 a maio de 2003. Os afastamentos foram indicados pelos atestados medicos fornecidos pela propria instituicao. Os dados obtidos, embora nao permitissem discriminar o numero de professores envolvidos, possibilitaram o conhecimento do numero de afastamentos entre os professores, sendo que os transtornos psiquicos ficaram em primeiro lugar entre os diagnosticos que provocaram os afastamentos.

Condições de trabalho, qualidade de vida e disfonia entre docentes

Voice disorders are common among teachers, with adverse consequences for their work and quality of life. This study focuses on factors associated with voice-related quality of life among female teachers in the municipal school system in Belo Horizonte, Southeast Brazil. A cross-sectional study with 2,133 female teachers was conducted, using the Voice-Related Quality of Life (VRQL) questionnaire, which has two domains: socio-emotional and physical. Teachers were grouped into quartiles based on the distribution of the final score in each domain. Those in the lowest quartile were then compared with all the others for a number of factors, using multiple logistic regression analysis. Less creativity at work and poor relationship with pupils were associated with worse voice-related quality of life in both domains. Mental disorders (GHQ12 > 4) were associated with worse voice-related quality of life in the socio-emotional domain, and intra-class noise with worse voice-related quality of life in the physical domain. Improvements in working conditions are key factors for achieving better voice-related quality of life among teachers.

Prevalência de fatores de risco e proteção de doenças crônicas não transmissíveis em adolescentes: resultados da Pesquisa Nacional de Saúde do Escolar (PeNSE), Brasil, 2009

A adolescencia e marcada por transformacoes e exposicao a diversas situacoes e riscos para a saude. O estudo atual estima a prevalencia dos principais fatores de risco e protecao a saude dos adolescentes entrevistados em 2009 na Pesquisa Nacional de Saude do Escolar (PeNSE). A PeNSE, parceria do Instituto Brasileiro de Geografia e Estatistica (IBGE) com o Ministerio da Saude, usou questionario autoaplicavel em palmtop coletando informacao de 60.973 estudantes em 1.453 escolas publicas privadas nas 27 capitais. RESULTADOS: consumo de alimentos em cinco dias ou mais na semana: 62,6% comem feijao, apenas 31,5% consomem frutas, 58,3% comem guloseimas e 37% tomam refrigerantes; 43,1% dos alunos sao suficientemente ativos fisicamente e 79,5% gastam mais de duas horas diarias em frente a TV. Em relacao a tabaco e drogas: 6,3% sao fumantes atuais, 71,4% dos alunos disseram ja ter experimentado alguma bebida alcoolica. O consumo atual de bebida alcoolica foi de 27% e as drogas ilicitas foram usadas alguma vez na vida em 8,7%. Esses dados geram evidencias para orientar a implementacao de politicas publicas e realizar acoes para minimizar a exposicao de fatores de risco dos adolescentes brasileiros.

Saúde, trabalho e envelhecimento no Brasil

O envelhecimento da populacao tem importante reflexo na composicao etaria da populacao economicamente ativa. O objetivo do presente estudo e determinar os diferenciais de saude dos idosos, segundo sua insercao no mercado de trabalho, apos considerar a influencia dos fatores socio-demograficos. Este trabalho incluiu 2.886 idosos do sexo masculino, com 65 anos ou mais de idade, residentes em dez regioes metropolitanas brasileiras e participantes da Pesquisa Nacional por Amostra de Domicilios, Fundacao Instituto Nacional de Geografia e Estatistica realizada em 1998. A analise incluiu o qui-quadrado e a odds ratio estimado atraves de regressao logistica multipla. Mais de um quarto dos idosos trabalhava. Em relacao aos aposentados, os que trabalhavam eram mais jovens, tinham maior escolaridade e maior renda domiciliar per capita; eles relataram menor frequencia de doencas cronicas, apresentaram menor dificuldade para realizacao das atividades da vida diaria, mas nao apresentaram diferencas com relacao ao uso de servicos de saude. Nossos resultados indicam que a saude e em especial os indicadores de autonomia e mobilidade fisica sao fatores preditivos independentes da permanencia na vida ativa em idades mais elevadas.

Auto-avaliação de saúde bucal em idosos: análise com base em modelo multidimensional

The aim of this study was to investigate factors associated with negative self-rated oral health. Elderly subjects from the Brazilian Ministry of Healths oral health survey (2002-2003) who rated their own oral health as bad or very bad were compared to those who rated their oral health as excellent, good, or fair, using prevalence ratios based on Poisson regression. The minority (870; 17%) gave their own oral health a negative rating. Negative self-rated oral health was less prevalent among those with 1-9 teeth and the edentulous, and more prevalent among blacks, mixed-race, and indigenous, those who had never used dental service, with soft tissue alterations, who reported little pain or medium to intense pain, rated their own appearance and chewing as fair or bad or very bad, reported that their oral health limited their social interaction a little or considerably, and reported needing dental treatment (PR = 1,47; 95%CI: 1.20-1.79). Despite their precarious oral conditions, the majority gave their oral health a positive rating. Subjective conditions were more heavily associated with self-rated oral health than were objective conditions. The findings suggest unequal oral health conditions and allow orienting public policies aimed at oral health and quality of life.