Repositório RCAAP

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.

Few population-based studies have examined long term cognitive trajectory, and these studies were conducted in high income countries. We investigated the association of age, gender and education with 10-year cognitive trajectory in a well-defined population of elderly using data from the Bambuí Cohort Study of Aging, in Brazil. Cognition was measured using the Mini- Mental State Examination (MMSE). Cohort members underwent annual follow-ups. This analysis was based on 12,206 MMSE measurements from 1,461 (91%) baseline participants. We used mixed effects models to study MMSE as outcome. The key findings from this analysis are that women and people with a higher schooling level at baseline had high scores of MMSE, while older participants started off lower. Regarding cognitive decline, women, older people and those with a higher schooling level declined faster.

This study aimed to examine the prognostic value of lipid parameters for incident hypertension in elderly living in a community. The study included 306 (81% from total) persons aged > 60 years who were free of hypertension and of cardiovascular diseases at the baseline survey of the Bambuí Cohort Study of Aging. The cumulative incidence of hypertension over three years was 37.3%. The relative risk (RR) of incident hypertension decreased 0.92 for each unit of HDL-cholesterol (95%CI: 0.86-0.99) independent of several potential confounding factors. Individuals with HDL-cholesterol in the top tercile (> 55mg/dL) had a risk of hypertension halve that those in the bottom tercile (RR = 0.54; 95%CI: 0.33-0.90). Other lipid parameters had no significant effect on the outcome. High HDL-cholesterol showed an independent protective effect on subsequent development of hypertension in the elderly.

We used data on 1,399 participants aged 60 and over from the Bambuí Cohort Study of Aging to examine predictors of mortality in a socioeconomically disadvantaged population. From 1997 to 2007, 599 participants died and 6.2% were lost to follow-up, leading to 12,415 person-years (pyrs) of observation. The death rate was 48.3 per 1,000 pyrs. Age (adjusted hazard ratio [HR] = 1.40), male gender (HR = 1.80), never married (HR = 1.78) or a widow (HR = 1.26), poor self-rated health (HR = 1.31), inability to perform four or more activities of daily living (HR = 3.29), number of cardiovascular risk factors (HR = 1.51 for two and HR = 1.91 for three or more), Trypanosoma cruzi infection (HR = 1.27), and number of medications (HR = 1.06) were each significantly (p < 0.05) and independently associated with mortality. The Mini-Mental State Examination score showed a protective effect (HR = 0.96). Except T. cruzi infection, other predictors of mortality were highly consistent with those found in more affluent elderly populations.

This paper explores the contribution of anthropological perspectives for clarifying the mechanisms through which socioeconomic circumstances influence the strategies developed by elderly for addressing their health problems in a small Brazilian city. Interviews with 20 key-informants explored the community's broad perception of the health situation of the elderly. Life histories collected from 30 elderly women examined their own perception of their health status and their health strategies. Narratives converge in emphasising the important role played by financial factors in accessing health services and medication. Life histories also describe some damaging strategies resorted to by the elderly to deal with their lack of resources. Elderly women emphasize the crucial support they receive from their family and/or neighbours to overcome health problems. Thus, the issue of poverty is not only a matter of socioeconomic circumstances, but also the poverty of broader social networks.

This ethno-epidemiological inquiry aims to comprehend hypertension-related experiences in the elderly population of Bambuí, in the State of Minas Gerais, Brazil. It combines ethnographic descriptions with statistical data. The subjective significance of factors associated with adequate arterial pressure control is explored. A baseline cohort of 26 people with hypertension, randomly selected from a total number of 1,494 residents over the age of 60, was interviewed utilizing signs, meanings and actions methodology. Multivariate analysis shows an association (p < 0.001) between female gender and monthly household income and treatment of hypertension and adequate blood pressure control. The number of doctor visits is associated with treatment but not with adequate blood pressure control. Conflicting cultural construction of "blood pressure problems" contributes to "non-adherence" to treatment. There is a fine line between blood pressure "control" and what is perceived as health professionals "controlling" patients' lives. Doctor-prescribed regimes are perceived as "prohibiting life's pleasures" and "controlling" personal liberty and free choice. Giving elderly people a voice regarding their social context can promote autonomy, well-being and happiness in later life.

In order to investigate the association between satisfaction with the neighborhood environment and self-rated health among older elderly, data from 814 participants of the eleventh wave of the Bambuí Cohort Study of Aging were analyzed using robust Poisson regression analyses. Those elderly with higher satisfaction with their neighborhoods (PR = 0.75; 95%CI: 0.63-0.87) were less likely to report worse self-rated health. The number of chronic diseases (two, PR = 1.69; 95%CI: 1.05-2.70, three or more, PR = 1.99, 95%CI: 1.27-3.13), difficulty in performing daily activities (PR = 1.51; 95%CI: 1.28-1.78), presence of depressive symptoms (PR = 1.68; 95%CI: 1.44-1.95) and frequency of leisure-time exercise in previous 90 days (less than once a week, PR =1.24; 95%CI: 1.03-1.50) were all positively and significantly associated with poor self-rated health. This study provided empirical evidence that satisfaction with the neighborhood environment was associated with the health of the older elderly. The findings further suggest the potential importance of including this indicator in analyses of place and health among the elderly.

The aim of this study was to estimate physical activity energy expenditure among older adults. The study comprised 1,585 residents in Bambuí, Minas Gerais State, Brazil, aged &gt; 60 years (91% of the town's total elderly), and examined the frequency and duration of 23 types of physical activity among them. Median energy expenditure was 975 MET.min/week (1,195.8 among men and 803.1 among women), declining significantly with age in both sexes. The prevalence of sedentary lifestyles (< 450 MET.min/week) was 31.2%. Unhurried walking accounted for about 1/3 of total energy expenditure. Multivariate analysis based on ordinal logistic regression showed inverse associations between energy expenditure and age and hospitalizations in both sexes. Among men, inverse associations were observed with smoking, number of chronic diseases and number of medical appointments. These results emphasize the need for effective strategies to increase physical activity in older elderly, and underscore the high prevalence of walking in this group.

The aim of this study was to investigate whether cohort differences exist in the prevalence of cardiovascular risk factors among older elderly from the Bambuí Cohort Study of Aging. Participants were those aged 71-81 years at two points in time a decade apart: 457 in 1997 (earlier cohort) and 553 in 2008 (recent cohort). The prevalence of hypertension (PR = 1.27; 95%CI: 1.19-1.36) and of diabetes mellitus (PR = 1.39; 95%CI: 1.06-1.83) was higher in the recent cohort compared to the earlier one, regardless of sex. The recent cohort had a lower prevalence of smoking (PR = 0.58; 95%CI: 0.42-0.80), and lower total cholesterol/HDL cholesterol ratio level (PR = 0.85; 95%CI: 0.80-0.89). There was a 136% increase in the pharmacologic treatment of diabetes and a 56% increase in pharmacologic management of hypertension in 2008 in comparison with 1997. Overall, the number of cardiovascular risk factors in the recent cohort remained similar to that of the early cohort.

The aim of this study was to evaluate the effect of birth cohort on nutritional status among older elderly (71-81 years old) from the Bambuí Cohort Study of Aging, conducted in Brazil in 1997 and 2008. We compared the two birth cohorts - 1916-1926 (older cohort) and 1927-1937 (recent cohort) - considering body mass index (BMI = weight/height²), waist circumference (WC) and prevalence of overweight (BMI ³ 27kg/m²). BMI (β = 0.09, 95%CI: 0.04, 0.15) and prevalence of overweight (PR = 1.02; 95%CI: 1.01; 1.03) were higher in the recent cohort than the earlier cohort, regardless of sex and schooling. No difference was observed in WC. Stratified by sex, similar overall trends were observed for men, and WC was higher in the recent cohort. Among women there was no difference in BMI and overweight, but WC was lower in the recent cohort. The cohort effect was greater among older men and, in the near future, may result in greater prevalence of overweight in this group.

We examined for cohort differences in hypertension control between participants in the Bambuí Cohort Study of Aging of aging born 1916-1926 and 1927-1937. Participants included hypertensive elderly aged 71-81 at baseline (n = 313) and at 11th wave follow up (n = 484). Prevalence of hypertension awareness (70.9% and 81.2%, respectively), median medical appointments in previous 12 months (2 and 3, respectively) and antihypertensive drug use (74.4% and 90.7% respectively) increased significantly from older to younger cohort. However, prevalence of appropriately controlled hypertension among those treated (< 140/< 90mmHg) was similar in both cohorts (44.6% and 40.1%, p = 0.255). Multivariate analysis returned schooling as the only factor independently associated with appropriately controlled hypertension. Despite increased medical appointments and drug use in the recent cohort, the prevalence of appropriately controlled hypertension remained as low as in the older cohort.

This study examined differences in the use of medications in two birth cohorts (born from 1916 to 1926 and from 1927 to 1937) among older elderly in the population-based cohort study in Bambuí, Minas Gerais State, Brazil. The study used data on participants who were 71-81 years of age in the baseline survey in 1997 (n = 492) and in the 11th wave, in 2008 (n = 620). The number of medications currently consumed (mean = 4.6 and 3.4, respectively) and prevalence of polypharmacy (46.6% and 29.1%, respectively) were higher in the more recent cohort as compared to the earlier one. These differences were independent of gender, age, schooling, number of medical visits in the previous 12 months, and number of chronic conditions. The more recent cohort showed significant differences in the use of psychoactive drugs, lipid modifying agents, drugs for diabetes, and antithrombotic agents, as well as changes in drugs used for arterial hypertension. In general, these changes are consistent with those observed in elderly populations in high-income countries.

The aim of this study was to investigate the cohort differences in physical functioning levels among the older (cohort members born in 1916-1926 and in 1927-1937) participants of the Bambuí Cohort Study of Aging. The data came from participants aged 71-81 who took part at baseline in 1997 (n = 491) and in the 11th wave in 2008 (n = 620). The physical functioning variables included the following self-reported measures: activities of daily living, the instrumental activities of daily living and mobility. Poisson regression analyses were used to investigate the cohort year differences in physical functioning levels. Overall, the young cohort (2008) showed better levels of physical functioning compared to the older cohort (1997) across all three measures of physical functioning used.

A autoavaliação da imagem corporal é uma construção multidimensional por meio da qual os indivíduos descrevem as representações internas da estrutura corporal e da aparência física, em relação a si próprio e aos outros. As Escalas de Silhuetas são testes que viabilizam a autoavaliação, especialmente em pesquisas de campo, devido ao baixo custo e facilidade na administração do método. O objetivo deste trabalho foi resgatar as Escalas de Silhuetas construídas ou adaptadas desde 1983 e realizar uma revisão sistemática sobre a validação destas frente a medidas objetivas do estado nutricional. Foram identificados 33 estudos com grande variação na correlação com o estado nutricional de adultos, tanto para as Escalas de Silhuetas adaptadas (coeficientes de correlação de 0,66 a 0,87) quanto para as construídas (0,59 a 0,94). Já em crianças e adolescentes, as correlações entre as Escalas de Silhuetas e o estado nutricional não resultaram em valores satisfatórios em vários dos estudos. Muitos trabalhos utilizaram estatística inapropriada. Os dados da presente revisão indicam que deve-se ter cuidado no uso de Escalas de Silhuetas para estimar o estado nutricional com ou sem a medição antropométrica.

The aim of this study was to describe the pattern of trends in lung cancer mortality in Brazil and identify the effects of the factors age, period and cohort (APC) on mortality rates. A time series study was conducted using secondary population-based data. Lung cancer mortality rates by sex were calculated for the period 1980 to 2007. APC models were adjusted to identify the influence of age, period and cohort effects on rates. Lung cancer mortality rates are significantly higher among men. Specific rates for men over the age of 64 and for women of all ages are increasing. There was a greater increase of adjusted rates among women. With respect to the age effect, mortality risk increases with age starting with the earliest age groups. With regard to the cohort effect, there is a lesser risk of mortality among men born after 1950 and an increasing risk across all cohorts among women. The results regarding younger generations indicate that present trends are likely to continue. The cohort effect among women suggests an increasing trend in mortality rates, whereas a decrease in rates among men under the age of 65 suggests that this trend will continue. These trends reflect tobacco control measures adopted since 1986.

Leprosy may present acute/subacute inflammatory processes (leprosy reactions). The study characterized the reactional states of patients at health clinics in Vitória, Espírito Santo State, Brazil, and associated them with sociodemographic factors and clinical/nutritional variables. between January and December 2009, longitudinal follow-up of patients with leprosy continued until leprosy reactions occurred or patients completed 6 months of multidrug therapy. Of the 151 patients participating, 78 (51.7%) were females, 48 (31.8%) had 5 to 8 years schooling, 93 (61.6%) worked and earned from 1 to 3 minimum wages, and 55 (36.4 %) had leprosy reactions, but with no statistical association to socioeconomic characteristics or nutritional status. However, absence of reaction was more common in the low-weight group, suggesting a trend in this group to protection from the reaction (p = 0.0906). The study found no association between nutritional status and leprosy reaction.

Com o objetivo de descrever a tendência de ocorrência de acidentes de trânsito, sua mortalidade, tipo de veículo envolvido, tamanho da frota e perfil das vítimas em Campinas, São Paulo, Brasil, entre 1995 e 2008, foram estimadas taxas de motorização e ocorrência de acidentes, letalidade, mortalidade proporcional, taxas de mortalidade e razões entre taxas. A frota de motocicletas cresceu 241%. Apesar da queda da letalidade dos acidentes de ocupantes de motos entre 2000 e 2008, esta categoria representou 49,3% do total de acidentes fatais em vias públicas em 2008. As motos foram responsáveis pelas maiores taxas de atropelamento (66,7 atropelados/mil acidentes) e de atropelamentos seguidos de morte (4 óbitos/mil acidentes). Os homens mantiveram risco de morrer no trânsito muito superior ao das mulheres. Nos atropelamentos, predominaram elevadas taxas de mortalidade em idosos; entre os ocupantes de veículos, os mais atingidos foram os de 15 a 29 anos. Na faixa de 15 a 39 anos, entre 2006 e 2008, quase 80% eram ocupantes de moto. Ações pluri-institucionais devem priorizar a prevenção de acidentes entre motociclistas.

O objetivo deste trabalho foi descrever os medicamentos prescritos aos idosos residentes na zona urbana do Município de Florianópolis, Santa Catarina, Brasil, nos 30 dias anteriores à entrevista e, a partir disto, comparar com a Relação Municipal de Medicamentos (REMUME). Foi realizado um estudo transversal populacional de base domiciliar, no qual os 1.705 idosos entrevistados relataram ter utilizado o total de 5.458 medicamentos prescritos e dentro dos critérios da pesquisa, que corresponderam a 374 princípios ativos diferentes. Os medicamentos mais utilizados foram os indicados para o sistema cardiovascular, sendo a classe farmacológica dos redutores de colesterol e triglicerídeos os mais prevalentes, apesar de não haver nenhum exemplar desta classe de medicamentos selecionado na REMUME. Embora haja algumas faltas, a REMUME coincide com a maior proporção dos medicamentos prescritos no Município de Florianópolis. A principal diferença entre as prescrições é que as oriundas do SUS estão em maior conformidade com a REMUME.

Os cortadores de cana-de-açúcar exercem atividade muito pesada e em condições precárias de trabalho. Além disso, fatores ambientais podem ser um importante agravante à sobrecarga térmica desses trabalhadores. Neste artigo, analisa-se a condição atmosférica no dia da morte de 14 trabalhadores do corte de cana-de-açúcar no Estado de São Paulo, Brasil. Compara-se valores estatísticos históricos da temperatura, umidade, vento e radiação com os valores destas variáveis meteorológicas observadas no dia de cada óbito. Os dados atmosféricos foram obtidos da reanálise do National Center for Environmental Prediction/National Center for Atmospheric Research (NCEP/NCAR). Em 10 dos 14 casos analisados, as temperaturas observadas nos dias dos óbitos foram maiores ou iguais à média somada ao desvio-padrão. Em seis desses casos o valor da temperatura atingiu ou ficou muito próxima do recorde histórico. Constatou-se que a condição atmosférica pode ser um fator importante a ser considerado na análise das condições gerais de trabalho dos cortadores de cana-de-açúcar.

Analisou-se a validade do peso e altura autorreferidos para determinação do estado nutricional, e as implicações do seu uso em análises de associação com desfechos em saúde. Baseando-se em um estudo transversal de base populacional realizado em Pelotas, Rio Grande do Sul, Brasil, em 2007 (n = 2.986), sorteou-se uma subamostra de 276 indivíduos com idade > 20 anos. Em média, o peso autorreferido foi similar ao medido; a altura medida foi superestimada nos homens (1,4cm) e nas mulheres (2,5cm); o índice de massa corporal (IMC) real foi subestimado em quase 1kg/m². Mesmo com diferenças médias pequenas, a variabilidade dos dados foi grande. Sexo, idade e escolaridade influenciaram nos resultados. O uso de medidas autorreferidas gerou subestimativas de sobrepeso e obesidade, assim como erros imprevisíveis em análises de associação com desfechos em saúde (subestimativa, superestimativa e inversão nas medidas reais de efeito). Equações de correção reduziram a média das diferenças com os valores medidos, mas não reduziram a variabilidade das diferenças e nem solucionaram erros de classificação ou vieses nas associações.