Vitor Passos Camargos

Tendências em dez anos das condições de saúde de idosos brasileiros: evidências da Pesquisa Nacional por Amostra de Domicílios (1998, 2003, 2008)

Data from a representative national household survey were used to examine 10-year trends (1998-2008) in health conditions of Brazilian elderly. A random sample of 105,254 individuals aged > 60 years participated. The mean age was 69 years and 56% were women. There was a gradual increase in the prevalence of good or excellent self-rated health (39.3%, 43.5% and 45.0%, in 1998, 2003 and 2008, respectively) and a decrease in self-reported arthritis, heart disease, and depression. The prevalence of self-reported hypertension (43.9%, 48.8%, and 53.3%, respectively) and diabetes (10.3%, 13.0% and 16.1% respectively) increased sharply. The prevalence of inability to perform activities of daily living (eating, bathing or using the toilet) remained stable (6.5%, 6.4% and 6.9%, respectively). The achievement of three or more physician visits over the previous 12 months increased by 21% from 1998 to 2008. Hospitalization decreased by 10% in the corresponding period. The above mentioned trends persisted after adjustments for age and sex. The results showed improvements in some health dimensions of the elderly, but not all. Changes in the use of health services occurred as expected with the expansion of primary healthcare activities in Brazil.

Saúde urbana: "a cidade é uma estranha senhora, que hoje sorri e amanhã te devora"

More than half of the worlds population is living in cities and the world is turning more and more urbanized. This literature review explores the ramifications of urban transformation, showing how cities take shape and impact human health in our times. While cities can offer positive opportunities, their negative impacts related to the lack of social organization, precarious urban living and working conditions, lack of governance and opportunities as well as the lack of strategies for promoting social equity tend to increase the adverse effects on the health of the urban communities. The article also advocates the study of urban health as a branch of knowledge related to public health, proposing a common conceptual model and taxonomy for urban health. Future directions for research and practice are discussed in the light of some examples from the Brazilian scientific literature.

Imputação múltipla e análise de casos completos em modelos de regressão logística: uma avaliação prática do impacto das perdas em covariáveis

Researchers in the health field often deal with the problem of incomplete databases. Complete Case Analysis (CCA), which restricts the analysis to subjects with complete data, reduces the sample size and may result in biased estimates. Based on statistical grounds, Multiple Imputation (MI) uses all collected data and is recommended as an alternative to CCA. Data from the study Saúde em Beagá, attended by 4,048 adults from two of nine health districts in the city of Belo Horizonte, Minas Gerais State, Brazil, in 2008-2009, were used to evaluate CCA and different MI approaches in the context of logistic models with incomplete covariate data. Peculiarities in some variables in this study allowed analyzing a situation in which the missing covariate data are recovered and thus the results before and after recovery are compared. Based on the analysis, even the more simplistic MI approach performed better than CCA, since it was closer to the post-recovery results.

Predictors of 10-year hospital use in a community-dwelling population of Brazilian elderly: the Bambuí cohort study of aging

We use data from a population-based cohort of elderly Brazilians to assess predictors of hospitalizations during ten years of follow-up. Participants were 1,448 persons aged 60 years and over at baseline (1997). The outcome was self-reported number of hospitalizations per year. Slightly more than a fifth (23%) experienced no hospitalizations during the 10 year follow-up. About 30% had 1-2 events, 31% had between 3 and 7 events, and about 18% had 8 or more events during this time. Results of multivariable hurdle and Cox proportional hazards models showed that the risk of hospitalization was positively associated with male sex, increased age, chronic conditions, and visits to the doctors in the previous 12 months. Underweight was a predictor of any hospitalization, while obesity was an inconsistent predictor of hospitalization.

Instrumento para condução de observação social sistemática: métodos e resultados da concordância interobservadores

A observacao social sistematica tem sido utilizada para a coleta de informacoes do entorno fisico e social da vizinhanca. Os objetivos deste artigo foram descrever a operacionalizacao da observacao social sistematica do entorno fisico e social de vizinhancas urbanas e avaliar a concordância do instrumento utilizado. O instrumento foi elaborado para coleta de informacoes em diferentes dominios. No total, 1.306 segmentos de rua, pertencentes a 149 diferentes vizinhancas de Belo Horizonte, Minas Gerais, Brasil, foram observados. Para o estudo de concordância, 149 segmentos foram reauditados. Para se estabelecer a concordância, foi utilizado o kappa Fleiss interobservador. A concordância media dos itens foi 0,57 (DP = 0,24); 53% tiveram concordância substancial ou quase perfeita; 20,4%, moderada. O instrumento se mostrou adequado para observacao de caracteristicas com maior estabilidade temporal, principalmente quanto a servicos, caracterizacao dos imoveis, ambiente para pedestres e seguranca.Systematic social observation has been used as a health research methodology for collecting information from the neighborhood physical and social environment. The objectives of this article were to describe the operationalization of direct observation of the physical and social environment in urban areas and to evaluate the instruments reliability. The systematic social observation instrument was designed to collect information in several domains. A total of 1,306 street segments belonging to 149 different neighborhoods in Belo Horizonte, Minas Gerais, Brazil, were observed. For the reliability study, 149 segments (1 per neighborhood) were re-audited, and Fleiss kappa was used to access inter-rater agreement. Mean agreement was 0.57 (SD = 0.24); 53% had substantial or almost perfect agreement, and 20.4%, moderate agreement. The instrument appears to be appropriate for observing neighborhood characteristics that are not time-dependent, especially urban services, property characterization, pedestrian environment, and security.

Características individuais associadas à autopercepção da extensão territorial da vizinhança

There is a growing interest in evaluating the impact of neighborhood characteristics on health. The definition of neighborhood involves two main strategies, one using artificial boundaries, usually created for administrative purposes, and the other based on the individual’s definition, namely the perceived neighborhood. The aim of this study was to identify factors associated with heterogeneity in the perceived neighborhood among participants in a health survey in Belo Horizonte, Minas Gerais State, Brazil. Ordinal logistic regression was used to determine and quantify this association. Larger size of the perceived neighborhood was associated with better socioeconomic status, positive employment status, positive assessment of aesthetic aspects and mobility within the neighborhood, active identification of problems in the neighborhood, less involvement in sports/leisure activities, and knowing more neighbors. The study’s results can help produce more significant neighborhood definitions that are more consistent with residents’ own perceptions, thereby favoring more accurate estimates of neighborhood impact on health.

Individual characteristics associated with perception of the local neighborhood’s territory

There is a growing interest in evaluating the impact of neighborhood characteristics on health. The definition of neighborhood involves two main strategies, one using artificial boundaries, usually created for administrative purposes, and the other based on the individual’s definition, namely the perceived neighborhood. The aim of this study was to identify factors associated with heterogeneity in the perceived neighborhood among participants in a health survey in Belo Horizonte, Minas Gerais State, Brazil. Ordinal logistic regression was used to determine and quantify this association. Larger size of the perceived neighborhood was associated with better socioeconomic status, positive employment status, positive assessment of aesthetic aspects and mobility within the neighborhood, active identification of problems in the neighborhood, less involvement in sports/leisure activities, and knowing more neighbors. The study’s results can help produce more significant neighborhood definitions that are more consistent with residents’ own perceptions, thereby favoring more accurate estimates of neighborhood impact on health.

Las características individuales asociadas con la percepción de la extensión territorial del vecindario

There is a growing interest in evaluating the impact of neighborhood characteristics on health. The definition of neighborhood involves two main strategies, one using artificial boundaries, usually created for administrative purposes, and the other based on the individual’s definition, namely the perceived neighborhood. The aim of this study was to identify factors associated with heterogeneity in the perceived neighborhood among participants in a health survey in Belo Horizonte, Minas Gerais State, Brazil. Ordinal logistic regression was used to determine and quantify this association. Larger size of the perceived neighborhood was associated with better socioeconomic status, positive employment status, positive assessment of aesthetic aspects and mobility within the neighborhood, active identification of problems in the neighborhood, less involvement in sports/leisure activities, and knowing more neighbors. The study’s results can help produce more significant neighborhood definitions that are more consistent with residents’ own perceptions, thereby favoring more accurate estimates of neighborhood impact on health.

Instrumento para la realización de observaciones sociales sistemáticas: métodos y resultados de la adecuación entre observadores

A observacao social sistematica tem sido utilizada para a coleta de informacoes do entorno fisico e social da vizinhanca. Os objetivos deste artigo foram descrever a operacionalizacao da observacao social sistematica do entorno fisico e social de vizinhancas urbanas e avaliar a concordância do instrumento utilizado. O instrumento foi elaborado para coleta de informacoes em diferentes dominios. No total, 1.306 segmentos de rua, pertencentes a 149 diferentes vizinhancas de Belo Horizonte, Minas Gerais, Brasil, foram observados. Para o estudo de concordância, 149 segmentos foram reauditados. Para se estabelecer a concordância, foi utilizado o kappa Fleiss interobservador. A concordância media dos itens foi 0,57 (DP = 0,24); 53% tiveram concordância substancial ou quase perfeita; 20,4%, moderada. O instrumento se mostrou adequado para observacao de caracteristicas com maior estabilidade temporal, principalmente quanto a servicos, caracterizacao dos imoveis, ambiente para pedestres e seguranca.Systematic social observation has been used as a health research methodology for collecting information from the neighborhood physical and social environment. The objectives of this article were to describe the operationalization of direct observation of the physical and social environment in urban areas and to evaluate the instruments reliability. The systematic social observation instrument was designed to collect information in several domains. A total of 1,306 street segments belonging to 149 different neighborhoods in Belo Horizonte, Minas Gerais, Brazil, were observed. For the reliability study, 149 segments (1 per neighborhood) were re-audited, and Fleiss kappa was used to access inter-rater agreement. Mean agreement was 0.57 (SD = 0.24); 53% had substantial or almost perfect agreement, and 20.4%, moderate agreement. The instrument appears to be appropriate for observing neighborhood characteristics that are not time-dependent, especially urban services, property characterization, pedestrian environment, and security.

A systematic social observation tool: methods and results of inter-rater reliability

A observacao social sistematica tem sido utilizada para a coleta de informacoes do entorno fisico e social da vizinhanca. Os objetivos deste artigo foram descrever a operacionalizacao da observacao social sistematica do entorno fisico e social de vizinhancas urbanas e avaliar a concordância do instrumento utilizado. O instrumento foi elaborado para coleta de informacoes em diferentes dominios. No total, 1.306 segmentos de rua, pertencentes a 149 diferentes vizinhancas de Belo Horizonte, Minas Gerais, Brasil, foram observados. Para o estudo de concordância, 149 segmentos foram reauditados. Para se estabelecer a concordância, foi utilizado o kappa Fleiss interobservador. A concordância media dos itens foi 0,57 (DP = 0,24); 53% tiveram concordância substancial ou quase perfeita; 20,4%, moderada. O instrumento se mostrou adequado para observacao de caracteristicas com maior estabilidade temporal, principalmente quanto a servicos, caracterizacao dos imoveis, ambiente para pedestres e seguranca.Systematic social observation has been used as a health research methodology for collecting information from the neighborhood physical and social environment. The objectives of this article were to describe the operationalization of direct observation of the physical and social environment in urban areas and to evaluate the instruments reliability. The systematic social observation instrument was designed to collect information in several domains. A total of 1,306 street segments belonging to 149 different neighborhoods in Belo Horizonte, Minas Gerais, Brazil, were observed. For the reliability study, 149 segments (1 per neighborhood) were re-audited, and Fleiss kappa was used to access inter-rater agreement. Mean agreement was 0.57 (SD = 0.24); 53% had substantial or almost perfect agreement, and 20.4%, moderate agreement. The instrument appears to be appropriate for observing neighborhood characteristics that are not time-dependent, especially urban services, property characterization, pedestrian environment, and security.