Influência da renda na associação entre disfunção cognitiva e polifarmácia: Projeto Bambuí / Influence of income on the association between cognitive impairment and polypharmacy: Bambuí Project

OBJETIVO: Avaliar a prevalência da polifarmácia e a influência da renda na associação entre uso de medicamentos e disfunção cognitiva, entre idosos. MÉTODOS: Dos 1.606 integrantes da linha base da coorte de idosos de Bambuí (Minas Gerais), iniciada em 1997, 1.554 participaram do estudo. Todos os participantes foram submetidos ao questionário mini-exame do estado mental. A associação entre disfunção cognitiva e polifarmácia foi testada por meio de regressões ordinais multivariadas, realizadas para a população total e para cada um dos estratos de renda. RESULTADOS: A prevalência de polifarmácia (consumo de dois ou mais medicamentos) foi de 70,4 por cento, e o número de medicamentos consumidos mostrou-se negativa e independentemente associado à disfunção cognitiva (OR=0,72; IC 95 por cento: 0,55;0,95). Quando estratificada pela renda pessoal (<2 salários mínimos versus > 2), observou-se associação negativa entre uso de medicamentos e disfunção cognitiva entre idosos com renda mais baixa (OR=0,64; IC95 por cento: 0,48;0,86), mas não entre aqueles de renda mais elevada (OR=1,74; IC 95 por cento: 0,81;3,74). CONCLUSÕES: Com referência à associação entre disfunção cognitiva e número de medicamentos consumidos, os resultados indicam desigualdade social no uso de medicamentos. É possível que esses idosos não estejam consumindo os medicamentos necessários ao adequado tratamento de seus problemas de saúde.

OBJECTIVE: To evaluate the prevalence of polypharmacy and the influence of income on the association between medication use and cognitive impairment among elderly people. METHODS: Out of the 1,606 baseline members of the Bambuí cohort of elderly people, which started in 1997, 1,554 took part in the study. The Mini-Mental State Examination was applied to all the participants. The association between cognitive impairment and polypharmacy was tested by means of multivariate ordinal regression, performed for the whole population and for each of the income strata. RESULTS: The prevalence of polypharmacy (two or more medications consumed) was 70.4 percent and the number of medications used presented an independent negative association with cognitive impairment (OR=0.72; 95 percent CI: 0.55;0.95). When this was stratified according to personal income (<2 minimum monthly salaries versus > 2 minimum monthly salaries), a negative association was observed between medication use and cognitive impairment among elderly people with lower income (OR=0.64; 95 percent CI: 0.48;0.86), but not among those with higher income (OR=1.74; 95 percent CI: 0.81;3.74). CONCLUSIONS: With regard to the association between cognitive impairment and number of medications consumed, the results indicate social inequality in the use of medications. It is possible that these elderly people are not consuming the medicines needed for appropriate treatment of their health problems.

[Influence of income on the association between cognitive impairment and polypharmacy: Bambuí Project]. / Influência da renda na associação entre disfunção cognitiva e polifarmácia: Projeto Bambuí

OBJECTIVE: To evaluate the prevalence of polypharmacy and the influence of income on the association between medication use and cognitive impairment among elderly people. METHODS: Out of the 1,606 baseline members of the Bambuí cohort of elderly people, which started in 1997, 1,554 took part in the study. The Mini-Mental State Examination was applied to all the participants. The association between cognitive impairment and polypharmacy was tested by means of multivariate ordinal regression, performed for the whole population and for each of the income strata. RESULTS: The prevalence of polypharmacy (two or more medications consumed) was 70.4% and the number of medications used presented an independent negative association with cognitive impairment (OR=0.72; 95% CI: 0.55;0.95). When this was stratified according to personal income (<2 minimum monthly salaries versus >or= 2 minimum monthly salaries), a negative association was observed between medication use and cognitive impairment among elderly people with lower income (OR=0.64; 95% CI: 0.48;0.86), but not among those with higher income (OR=1.74; 95% CI: 0.81;3.74). CONCLUSIONS: With regard to the association between cognitive impairment and number of medications consumed, the results indicate social inequality in the use of medications. It is possible that these elderly people are not consuming the medicines needed for appropriate treatment of their health problems.

Tendências nas condições de saúde e uso de serviços de saúde entre idosos brasileiros: um estudo baseado na Pesquisa Nacional por Amostra de Domicílios (1998, 2003) / Trends in health conditions and use of health services by the Brazilian elderly: a study based on the National Household Sample Survey (1998, 2003)

Este trabalho teve por objetivo verificar as tendências das condições de saúde e do uso de serviços de saúde entre idosos brasileiros, utilizando dados da Pesquisa Nacional por Amostras de Domicílios (PNAD). Foram incluídos no estudo 28.943 e 35.042 participantes das PNAD 1998 e 2003 com idade > 60 anos, respectivamente. Os resultados mostraram que houve melhora nas condições de saúde dos idosos nesse período, considerando-se indicadores como percepção da saúde, ter estado recentemente acamado, capacidade para realizar atividades da vida diária e número de doenças crônicas. Os resultados também monstraram que houve aumento do número de consultas médicas e odontológicas entre 1998 e 2003. Tais tendências foram consistentemente observadas em ambos os sexos. Os autores chamam a atenção para a importância do suplemento de saúde da PNAD como fonte de informação para o monitoramento e/ou vigilância das condições de saúde da população idosa brasileira.

This study examined trends in health conditions and use of health services by the Brazilian elderly, based on health data from the National Household Sample Surveys (PNAD) conducted in 1998 and 2003. 28,943 and 35,042 individuals aged > 60 years were included in the study, respectively. The results showed an improvement in health conditions in the study population during this period, as measured by self-rated health, having remained bedridden in the previous two weeks, ability to perform selected activities of daily living, number of chronic conditions, and self-reported arthritis. There was also an increase in the number of doctor and dentist visits from 1998 to 2003. The trends were consistent for both men and women. The results emphasize the importance of the PNAD health supplement as a source of information for the surveillance or monitoring of health and health-related conditions in the Brazilian elderly population.

[Trends in health conditions and use of health services by the Brazilian elderly: a study based on the National Household Sample Survey (1998, 2003)]. / Tendências nas condições de saúde e uso de serviços de saúde entre idosos brasileiros: um estudo baseado na Pesquisa Nacional por Amostra de Domicílios (1998, 2003).

This study examined trends in health conditions and use of health services by the Brazilian elderly, based on health data from the National Household Sample Surveys (PNAD) conducted in 1998 and 2003. 28,943 and 35,042 individuals aged > 60 years were included in the study, respectively. The results showed an improvement in health conditions in the study population during this period, as measured by self-rated health, having remained bedridden in the previous two weeks, ability to perform selected activities of daily living, number of chronic conditions, and self-reported arthritis. There was also an increase in the number of doctor and dentist visits from 1998 to 2003. The trends were consistent for both men and women. The results emphasize the importance of the PNAD health supplement as a source of information for the surveillance or monitoring of health and health-related conditions in the Brazilian elderly population.

Estudo epidemiológico de base populacional sobre uso de medicamentos entre idosos na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil / A population-based study on use of medication by the elderly in Greater Metropolitan Belo Horizonte, Minas Gerais, Brazil

Este estudo teve por objetivo investigar o consumo de medicamentos e fatores associados (sócio-demográficos, condições de saúde e uso de serviços de saúde) em uma amostra representativa de 1.598 pessoas com 60+ anos de idade, residentes na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil. A variável dependente foi o número de medicamentos consumido nas duas semanas precedentes. A prevalência do uso de medicamentos foi de 72,1 por cento e a média de medicamentos consumidos igual a 2,18, predominando aqueles com ação sobre o sistema cardiovascular. O consumo de qualquer número de medicamentos apresentou associação independente com sexo feminino, idade (80+ anos), ter visitado um médico e apresentar alguma condição crônica. O consumo de maior número de medicamentos (5+) apresentou associações significativas com escolaridade (8+ anos, OR = 2,28) e pior auto-avaliação da saúde (razoável, OR = 5,45; ruim/muito ruim, OR = 5,35). Os resultados deste trabalho mostram que o tipo de medicamento consumido e os fatores associados a esse consumo foram muito semelhantes ao observado em outras populações, sugerindo que existe uma certa uniformidade no consumo e nos seus determinantes, entre populações diferentes.

The aim of this study was to investigate the use of medication and associated factors (sociodemographics, health conditions, and health services use) in a representative sample of 1,598 elderly individuals (60+ years) in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. The dependent variable was the number of drugs used in the preceding two weeks. Prevalence of medication was 72.1 percent, and mean consumption was 2.18 drugs, most of which acting on the cardiovascular system. Use of medication (any amount) was independently associated with gender (female), age (80+ years), having consulted a physician, and presence of any chronic health condition. Use of five or more drugs was significantly associated with schooling (8+ years, OR=2.28), worse self-rated health (fair, OR = 5.45; bad/very bad, OR = 5.35). The results show that the types of medications used and factors associated with consumption were similar to those observed in other populations, suggesting some uniformity among various populations in the use of medication and its determinants.

[A population-based study on use of medication by the elderly in Greater Metropolitan Belo Horizonte, Minas Gerais, Brazil]. / Estudo epidemiológico de base populacional sobre uso de medicamentos entre idosos na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil.

The aim of this study was to investigate the use of medication and associated factors (sociodemographics, health conditions, and health services use) in a representative sample of 1,598 elderly individuals (60+ years) in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. The dependent variable was the number of drugs used in the preceding two weeks. Prevalence of medication was 72.1%, and mean consumption was 2.18 drugs, most of which acting on the cardiovascular system. Use of medication (any amount) was independently associated with gender (female), age (80+ years), having consulted a physician, and presence of any chronic health condition. Use of five or more drugs was significantly associated with schooling (8+ years, OR=2.28), worse self-rated health (fair, OR = 5.45; bad/very bad, OR = 5.35). The results show that the types of medications used and factors associated with consumption were similar to those observed in other populations, suggesting some uniformity among various populations in the use of medication and its determinants.

[A population-based study on use of medications by elderly Brazilians: the Bambuí Health and Aging Study (BHAS)]. / Estudo de base populacional sobre o consumo de medicamentos entre idosos: Projeto Bambuí

This study aimed to assess the prevalence and factors associated with use of prescribed and non-prescribed medications among older adults living in Bambuí, Minas Gerais, Brazil. A total of 1,606 (92.2%) out of 1,742 inhabitants aged 60+ years were interviewed. Among the participants, 1,281 (79.7%) and 274 (17.1%) had used prescribed and non-prescribed drugs in the previous 90 days, respectively. Use of prescribed medications was independently associated with gender (female), age (70-79 and > or = 80), higher family income, worse health conditions, and physician visits. Non-prescribed medications were negatively associated with physician visits and positively associated with female gender and consultation with a pharmacist. In general, factors associated with the use of prescribed and non-prescribed drugs in this study were similar to those observed in studies conducted in other countries. Meanwhile, our results differ from those of other studies by showing less frequent use of prescribed medications among the poorer elderly. Moreover, our results suggest that self-medication has been used in place of formal health care in the study community.

Estudo de base populacional sobre o consumo de medicamentos entre idosos: Projeto Bambuí / A population-based study on use of medications by elderly Brazilians: the Bambuí Health and Aging Study (BHAS)

Investigou-se a prevalência e fatores associados ao consumo de medicamentos prescritos e não prescritos entre idosos (60 anos ou mais). Participaram deste trabalho 1.606 (92,2 por cento) dos 1.742 idosos residentes na cidade de Bambuí, Minas Gerais, Brasil. Entre os participantes, 1.281 (79,7 por cento) e 274 (17,1 por cento) haviam consumido medicamentos prescritos e não prescritos nos últimos noventa dias, respectivamente. O consumo de medicamentos prescritos esteve associado ao sexo feminino, idade (70-79 e > 80 anos), renda familiar (maior), estado de saúde (pior) e número de consultas médicas (maior). O uso de medicamentos não prescritos apresentou associacão negativa com consulta médica e associacão positiva com sexo (feminino) e consulta a um farmacêutico. Os fatores associados ao consumo de medicamentos prescritos e não prescritos verificados neste trabalho foram semelhantes aos observados em estudos conduzidos em outros países. Diferentemente deles, nosso estudo mostrou um menor consumo de medicamentos prescritos entre idosos com pior situacão sócio-econômica. Nossos resultados sugerem, ainda, que a automedicacão entre idosos esteja sendo utilizada em substituicão à atencão formal à saúde.

Bambuí Project: a qualitative approach to self-medication.

Representations related to self-medication were investigated, seeking to identify contextual elements that can reinforce or inhibit such practice. An anthropological approach based on the model of signs, meanings, and actions was used. Twenty-nine inhabitants from the town of Bambuí, Minas Gerais State, Brazil, were interviewed (17 women and 12 men), selected among participants in a health survey that had been on medication in the previous 90 days. The research focused on the identification of different types of self-medication practiced by the interviewee or by a relative, and then "ways of thinking and behaving" associated with this practice were investigated. The influence of pharmacists/drugstore sales attendants as well as family and friends, perception of the health problem as transitory and a minor issue, familiarity with and easy access to certain pharmaceuticals, as well as difficulties in access to (and negative assessment of) health care were determinant factors for self-medication.

Bambuí Project: a qualitative approach to self-medication

Foram investigadas representações subjacentes à prática da automedicação, procurando-se identificar elementos contextuais que de alguma maneira reforçam ou inibem essa prática. Para tal, utilizou-se uma abordagem antropológica baseada no modelo de "Signos, Significados e Ações". Foram entrevistados 29 moradores da cidade de Bambuí, Minas Gerais, Brasil (17 mulheres e 12 homens), selecionados aleatoriamente entre participantes de um inquérito de saúde, que haviam consumido algum medicamento nos últimos noventa dias. Buscou-se identificar distintas modalidades de automedicação praticadas pelo entrevistado ou por algum familiar e, a partir daí, investigou-se as "maneiras de pensar e de agir" associadas a esta prática. Verificou-se que, a influência do balconista da farmácia, familiares e amigos, a percepção do problema de saúde como transitório e sem gravidade, a familiaridade e facilidade de acesso a certos medicamentos, bem como a disponibilidade e a percepção do atendimento médico recebido como de pior qualidade, foram fatores determinantes da automedicação.

Tratamiento del síndrome de Lesch-Nyhan / Treatment of Lesch-Nyhan syndrome

Objetivo. En este trabajo se revisan los tratamientos empleados hasta la fecha, dirigidos a paliar las diversas manifestaciones características del síndrome de Lesch-Nyhan (SLN), los efectos adversos registrados y las líneas actuales de investigación que abren futuras esperanzas terapéuticas. Desarrollo. El SLN es un defecto congénito del metabolismo de las purinas ocasionado por el déficit de la enzima hipoxantina-guanina fosforribosiltransferasa (HPRT). Desde el punto de vista clínico se caracteriza por hiperuricemia y trastornos neurológicos graves, que parecen relacionarse con la magnitud del defecto enzimático. Conclusiones. La escasa frecuencia del SLN, junto con el desconocimiento de la fisiopatología de los trastornos neurológicos, explica que la terapéutica se fundamente en recomendaciones sintomáticas. Los fármacos inhibidores de la enzima xantina oxidasa ayudan a controlar la excreción elevada de ácido úrico, pero hasta la fecha no se ha encontrado ningún tratamiento eficaz para los síntomas neurológicos (AU)