Ubirani Barros Otero

Malnutrition mortality in the elderly, southeast Brazil, 1980-1997

OBJECTIVE To assess the frequency of nutritional disturbances as cause of death in elderly. METHODS Female and male subjects aged 60 years and more were selected from municipalities of the southeastern region between 1980 and 1997. Data was collected from death certificates provided by the Death Data System (1980-1998) and the population size was estimated using data provided by the Center for Regional Development and Planning (Cedeplar). Death categorization was performed using the ICD-9 (260 to 263.9) for the period 1980 to 1995 and ICD-10 (E40 to E46) for recent years. RESULTS In Brazil, between 1980 and 1997, there were 36,955 deaths associated to malnutrition among elderly. The southeast region concentrates the largest number of deaths, 23,968 (64.9%). In the state of São Paulo, there were 11,067 deaths caused by malnutrition in elderly and in the state of Rio de Janeiro, 7,763. These two regions are responsible for the highest values observed for the region. There are higher death proportions and mortality rates among subjects aged 70 years and more than in subjects of any sex of the age group 60 to 69 years. CONCLUSION The preliminary results of the study raise some issues as follows: the role of malnutrition as an associated cause of death; the trend of increased number of deaths for malnutrition among elderly people; distinctive death characteristics among states in the same geographic region. Statistical analysis such as time series analysis might explain better these issues. There is a need to further study the role of malnutrition among elderly aged 60 years and more to establish adequate intervention programs.

Lack of association between age at menarche and age at menopause: Pró-Saúde Study, Rio de Janeiro, Brazil

OBJECTIVE To investigate the association between age at menarche and age at menopause among Brazilian women. METHODS This study is based on cross-sectional data obtained in 1999 from technical and administrative employees who were recruited for participation at the Pró-Saúde cohort study in Rio de Janeiro, Brazil. The final study population consisted of 1462 women. Participants completed a self-administered multidimensional questionnaire. In addition to the study exposure (age at menarche) and outcome (age at menopause) variables, the following independent variables were selected: parity; schooling; self-classified race; use of oral contraceptives; smoking; and body mass index (BMI). Median ages at natural menopause and the survival curves were estimated by the Kaplan-Meier method. To estimate the association between age at menarche and age at natural menopause, a Cox semi-parametric model was fitted. Women who were still menstruating, who had undergone surgery for the removal of the uterus or ovaries, or who were in perimenopause were censored. RESULTS Natural menopause occurred in 205 women. The median and mode for natural menopause were 51.7 and 50 years of age, respectively. In the multivariate analysis, no statistically significant association was observed between age at menarche and age at menopause (HR: 1.01; 95% CI: 0.93-1.11). CONCLUSION In the current study, the hypothesis of an association between age at menarche and age at natural menopause was not confirmed. Specific studies on the determinants of age at menopause should be conducted, due to the importance of menopause in the causality of diseases with high case mortality rate.

Óbitos por desnutrição em idosos, São Paulo e Rio de Janeiro: análise de séries temporais. 1980-1996

OBJETIVOS: Descrever a evolucao da mortalidade por desnutricao em idosos nas Regioes Metropolitanas dos Estados do Rio de Janeiro (RMRJ) e Sao Paulo (RMSP), verificar as suas tendencias, entre 1980 e 1996, e propor um modelo que permita prever a ocorrencia de casos. METODOLOGIA: Trata-se de um estudo ecologico, de series temporais, baseado em dados secundarios. Foram incluidos no estudo individuos com 60 anos de idade ou mais, de ambos os sexos, das RMRJ e RMSP. A fonte de dados utilizada foi o Sistema de Informacoes sobre Mortalidade (SIM). Analisou-se a serie de casos mensais, no periodo de janeiro de 1980 a dezembro de 1996. Para modelagem da serie e predicao de casos por desnutricao em idosos, utilizou-se o metodo Box and Jenkins, SARIMA (Sazonal Autoregressive Integrated Moving Average). RESULTADOS: Os resultados apontam a existencia de sazonalidade, com maior numero de obitos nos meses de junho e julho na RMSP, no mes de janeiro na RMRJ, provavelmente, decorrente do clima frio, nestes meses, em Sao Paulo e do calor intenso no Rio de Janeiro. Este resultado pode ser explicado pela possibilidade de idosos, com estado nutricional comprometido, terem dificuldades em manter a temperatura corporal normal durante os meses de inverno, representando um estresse adicional a um organismo sem reservas. CONCLUSOES: As series apresentaram tendencia de aumento e revelaram um padrao sazonal no inverno na RMSP e no verao na RMRJ. Ao estimar os modelos SARIMA para as Regioes para o ano de 1996, os resultados reforcaram a hipotese de que este metodo pode ser eficiente para fazer previsoes futuras. Provavelmente um estudo que leve em consideracao causas multiplas de morte permitira verificar a real contribuicao da desnutricao como causa basica ou contributiva para a morte. Infelizmente, ate este momento, esses dados nao estao disponiveis para analise.

Auto-avaliação de saúde e limitações físicas decorrentes de problemas de saúde

OBJECTIVE: To evaluate self-rated health and physical disabilities due to health problems. METHODS: Population-based cross-sectional study carried out in 18 Brazilian cities between 2002 and 2005. There were interviewed 26,424 residents (aged 15 years or more) of households selected by a two-stage probabilistic sampling. Percentages and confidence intervals were calculated considering the study design effects. RESULTS: Poorer self-rated health status and physical disabilities were found among women, those aged 50 years old or more and those with lower education. In addition, higher percentages of fair or poor self-rated health were found in cities in Northern and Northeastern Brazil compared to those in Southern and Southeastern Brazil. CONCLUSIONS: Poorer health conditions in the North/Northeast compared to the South/Southeast regions reflect factors related to social inequalities, mainly lower education.OBJETIVO: Avaliar a autopercepcao de saude e a presenca de limitacoes fisicas devido a problemas de saude. METODOS: Estudo transversal de base populacional realizado entre 2002 e 2005, em 18 capitais de estados do Brasil. Entrevistaram-se 26.424 moradores de 15 anos ou mais de idade em domicilios selecionados por amostra probabilistica em dois estagios. Calcularam-se percentuais e intervalos de confianca considerando-se os efeitos do desenho do estudo. RESULTADOS: Os resultados mostraram que as piores condicoes de saude sao referidas por mulheres, individuos com 50 anos ou mais e com menor grau de escolaridade. Os percentuais relacionados a percepcao de saude regular ou ruim foram maiores nas cidades das regioes Norte e Nordeste quando comparados aos das cidades das regioes Sul e Sudeste. CONCLUSOES: As piores condicoes de saude das regioes Norte/Nordeste comparadas as das regioes Sul/Sudeste revelam um conjunto de fatores relacionados as desigualdades sociais, entre os quais o menor grau de escolaridade.

Avaliação ambiental de BTEX (benzeno, tolueno, etilbenzeno, xilenos) e biomarcadores de genotoxicidade em trabalhadores de postos de combustíveis

Introduction: gas station workers are exposed to several chemicals in their workplace, highlighting benzene, due to its carcinogenic properties. Objective: to assess the genotoxic damage related to occupational exposure to BTEX (benzene, toluene, ethylbenzene, xylenes) in workers of five gas stations in Rio de Janeiro, RJ. Methods: analysis of BTEX concentrations in the air were carried out; as well as activities of catalase and glutathione S-transferase; and comet assay in whole blood samples of 97 workers. Results: BTEX levels were within the Brazilian threshold levels recommended by the NR 15, including Annex 13-A. However, an oscillation of the comet assay results was observed among workers of different gas stations, mainly in workers from gas stations with lower concentrations of benzene. Discussion: this result is in accordance with the current international scientific literature that indicates a supralinear exposure-response curve for benzene. In lower concentrations we could observe a high non-linear risk of leukemia, probably due to a greater benzene metabolism and a higher production of its toxic metabolites. Conclusion: the results of this study suggest that exposure to BTEX, even in low concentrations, contributes to genotoxic risk to human health.