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1.
Ciênc. Saúde Colet ; 24(11): 4211-4226, nov. 2019. tab
Artigo em Português | LILACS-Express | ID: biblio-1039510

RESUMO

Resumo O Problema Crônico de Coluna (PCC) é uma das doenças mais prevalentes no mundo e representa uma das principais causas de anos de vida perdidos por incapacidade. Embora de grande relevância para a saúde pública, estudos sobre o acesso e a utilização dos tipos de tratamento são escassos. O objetivo deste artigo é descrever os principais tratamentos para PCC no Brasil, analisar os fatores associados à sua utilização e discutir possíveis desigualdades na utilização de fisioterapia /exercícios e a utilização de medicamentos. A partir da PNS 2013 foram realizadas análises descritivas sobre prevalência de PCC e regressão logística múltipla para analisar a associação segundo as características demográficas, socioeconômicas, a situação da saúde, a limitação causada pelo PCC, acesso a serviços de saúde e regionais. Ter ensino superior aumenta 2,39 vezes as chances de realizar fisioterapia, no entanto, a escolaridade não se mostrou associada à utilização de medicamentos. Indivíduos de estratos superiores apresentam quase 2 vezes mais chances de realizar fisioterapia, o que não foi observado para medicamentos. Sobre as condições de saúde, o aumento do grau da limitação por PCC eleva a chance de uso de medicamentos em até 3,5 vezes, mas não varia quando associado à realização de fisioterapia.


Abstract Chronic low back pain (LBP) is one of the most common diseases in the world and one of the leading causes of years of life lost due to disability. Despite being a major public health concern, studies on access to and use of different types of treatment are scarce. The aim of this article is to describe the most common treatments for chronic LBP in Brazil, examine the factors associated with the use of these treatments, and discuss possible inequalities in the use of physical therapy/exercise and medications. A descriptive analysis was performed using data from the 2013 National Health Survey. Multiple logistic regression was conducted to determine the association between treatment use and demographic, socioeconomic, health status, access to health services, and geographical characteristics. People with higher education were 2.39 times more likely to do physiotherapy. However, no association was found between education level and medication use. People in social class A/B were almost twice as likely to do physical therapy. However, there was no association between social status and medication use. People with a very high or high degree of functional limitation were 3.5 times more likely to use medication. However, no association was observed between functional limitation and physical therapy use.

2.
Cien Saude Colet ; 24(11): 4211-4226, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31664394

RESUMO

Chronic low back pain (LBP) is one of the most common diseases in the world and one of the leading causes of years of life lost due to disability. Despite being a major public health concern, studies on access to and use of different types of treatment are scarce. The aim of this article is to describe the most common treatments for chronic LBP in Brazil, examine the factors associated with the use of these treatments, and discuss possible inequalities in the use of physical therapy/exercise and medications. A descriptive analysis was performed using data from the 2013 National Health Survey. Multiple logistic regression was conducted to determine the association between treatment use and demographic, socioeconomic, health status, access to health services, and geographical characteristics. People with higher education were 2.39 times more likely to do physiotherapy. However, no association was found between education level and medication use. People in social class A/B were almost twice as likely to do physical therapy. However, there was no association between social status and medication use. People with a very high or high degree of functional limitation were 3.5 times more likely to use medication. However, no association was observed between functional limitation and physical therapy use.

3.
Rev Bras Epidemiol ; 22Suppl 02(Suppl 02): E190004.SUPL.2, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31596375

RESUMO

INTRODUCTION: This article aims at describing the National Health Survey (Pesquisa Nacional de Saúde- PNS) methodology of collecting laboratory exams data. METHODOLOGY: A subsample of 25% of the census tracts was selected, according to the stratification of the PNS sample, with a probability inversely proportional to the difficulty of collection. The collection of blood and urine was done in the households by a laboratory agent, among residents selected for individual interview. Due to the difficulties found in the field work, the sample did not reach the minimum expected number in some strata, and a post-stratification procedure was proposed for the data analysis. RESULTS: The collection of biospecimens was performed in 8,952 individuals. Laboratory tests were: glycated hemoglobin; total cholesterol; LDL cholesterol; HDL cholesterol; serology for dengue; red blood cell count (erythrogram) and white series count (leukogram); high performance liquid chromatography (HPLC) for diagnosis of hemoglobinopathies; creatinine. Theexcretion of potassium, salt and sodium and creatinine was estimated in the urine. The database of laboratory exams was weighed and made publicly available on the Oswaldo Cruz Foundation's PNS website and can be accessed without prior authorization. CONCLUSION: The total subsample of laboratory exams is of great value, since it allowed us to establish national reference parameters adequate to sociodemographic and geographic characteristics of the Brazilian population, providing relevant and complementary information for the analysis of the health situation of Brazil.


Assuntos
Técnicas de Laboratório Clínico/métodos , Coleta de Dados/métodos , Bases de Dados Factuais , Inquéritos Epidemiológicos/métodos , Adolescente , Adulto , Coleta de Amostras Sanguíneas/métodos , Brasil , Colesterol/sangue , Cromatografia Líquida de Alta Pressão , Dengue/sangue , Contagem de Eritrócitos , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Coleta de Urina/métodos , Adulto Jovem
4.
Cad Saude Publica ; 35(10): e00214918, 2019.
Artigo em Português | MEDLINE | ID: mdl-31596402

RESUMO

This study is a quantitative and qualitative assessment of data from the Brazilian Information System on Live Births (SINASC) in Brazil. Coverage of the data by municipality was estimated as the ratio between reported and estimated live births. Data quality in the SINASC was assessed via probabilistic linkage with the database from the Birth in Brazil study, 2011-2012, and kappa coefficients of agreement were calculated. In 2013, data coverage was high and homogeneous in all states of Brazil. However, the analysis according to municipalities (counties) showed greater spatial heterogeneity. As for completeness of information in SINASC, kappa coefficients were statistically different from zero for all the tested variables (p < 0.001), and marginal distributions of all the variables were similar in the two databases. Gestational age was the variable with the worst agreement, with a kappa value of 0.461. The indicator that describes the inconsistencies, measured by the sum of the square of the differences between the reported and expected prematurity rates by birthweight bracket, showed the highest value in the North of Brazil and the lowest in the South, pointing to geographic inequalities in measurement of gestational age.

5.
Rev Bras Epidemiol ; 22Suppl 1(Suppl 1): e190002, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576978

RESUMO

INTRODUCTION: Respondent-Driven Sampling (RDS) has been used in surveys with key populations at risk of HIV infection, such as female sex workers (FSW). This article describes the application of the RDS method among FSW in 12 Brazilian cities, during a survey carried out in 2016. METHODOLOGY: A biological and behavioral surveillance study carried out in 12 Brazilian cities, with a minimum sample of 350 FSW in each city. Tests were performed for HIV, syphilis, and hepatitis B and C infections. A social-behavioral questionnaire was also applied. RESULTS: The sample was comprised of 4,328 FSW. For data analysis, the sample was weighted according to each participant's network size (due consideration to the implications of RDS complex design and to the effects of homophilia are recommended). DISCUSSION: Although RDS methods for obtaining a statistical sample are based on strong statistical assumptions, allowing for an estimation of statistical parameters, with each new application the method has been rethought. In the analysis of whole-sample data, estimators were robust and compatible with those found in 2009. However, there were significant variations according to each city. CONCLUSION: The achieved sample size was of great relevance for assessing progress and identifying problems regarding the prevention and treatment of Sexually Transmitted Infections. New RDS studies with more time and operational resources should be envisaged. This could further network development.


Assuntos
Infecções por HIV/epidemiologia , Inquéritos Epidemiológicos/métodos , Hepatite C/epidemiologia , Vigilância da População/métodos , Profissionais do Sexo/estatística & dados numéricos , Sífilis/epidemiologia , Brasil/epidemiologia , Cidades , Feminino , Humanos , Fatores de Risco , Tamanho da Amostra , Amostragem , Inquéritos e Questionários
6.
Cad Saude Publica ; 35(7): e00091018, 2019 Jul 22.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31340334

RESUMO

This study aimed to measure the contribution of selected health behaviors to the prevalence of hypertension control in Brazilian adults 50 years or older, based on data from the ELSI-Brasil study. The study included 4,318 individuals 50 years or older who reported having received a medical diagnosis of hypertension and were taking antihypertensive medication. The selected health behaviors were: physical activity, healthy diet, not consuming excessive alcohol, and never having smoked. The contribution of each health behavior to prevalence of hypertension control was estimated by the attribution method, via adjustment of the binomial additive hazards model, stratified by sex. Prevalence of hypertension control was 50.7% (95%CI: 48.2; 53.1). Overall, health behaviors made a larger contribution to hypertension control in women (66.3%) than in men (36.2%). Moderate alcohol consumption made the largest contribution in both sexes, but particularly in women (52.7% in women versus 19% in men). Physical activity contributed 12.6% in women and 10.7% in men. The other behaviors were more relevant in men: never having smoked (3.4%) and regular consumption of vegetables, legumes, and fruits (3.1%). These results underline the need for measures to promote the adoption of healthy behaviors by hypertensive individuals to reduce blood pressure levels, improve the effectiveness of antihypertensive medication, and decrease their cardiovascular risk.

7.
Cad. Saúde Pública (Online) ; 35(10): e00214918, 2019. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-1039396

RESUMO

Resumo: Neste trabalho, avaliam-se quantitativa e qualitativamente as informações do Sistema de Informações sobre Nascidos Vivos (SINASC). A cobertura das informações por município foi estimada pela razão entre nascidos vivos informados e estimados. Para avaliação da qualidade das informações do SINASC, relacionou-se o sistema à base de dados do estudo Nascer no Brasil, 2011-2012, e foram estimados coeficientes kappa de concordância. Em 2013, a cobertura das informações foi alta e homogênea em todas as Unidades da Federação. Entretanto, a análise por município brasileiro apresentou maior heterogeneidade espacial. Quanto à qualidade de preenchimento das informações do SINASC, os coeficientes kappa de concordância foram estatisticamente diferentes de zero para todas as variáveis testadas (p < 0,001), e as distribuições marginais para todas as variáveis consideradas foram semelhantes nas duas bases de dados. A idade gestacional foi a variável que mostrou pior concordância, com valor de kappa de 0,461. O indicador que descreve as inconsistências, medido pela soma do quadrado das diferenças entre os percentuais de prematuridade informados e esperados por faixa de peso ao nascer, teve o valor mais alto na Região Norte e o menor na Região Sul, apontando para desigualdades geográficas na mensuração da idade gestacional.


Abstract: This study is a quantitative and qualitative assessment of data from the Brazilian Information System on Live Births (SINASC) in Brazil. Coverage of the data by municipality was estimated as the ratio between reported and estimated live births. Data quality in the SINASC was assessed via probabilistic linkage with the database from the Birth in Brazil study, 2011-2012, and kappa coefficients of agreement were calculated. In 2013, data coverage was high and homogeneous in all states of Brazil. However, the analysis according to municipalities (counties) showed greater spatial heterogeneity. As for completeness of information in SINASC, kappa coefficients were statistically different from zero for all the tested variables (p < 0.001), and marginal distributions of all the variables were similar in the two databases. Gestational age was the variable with the worst agreement, with a kappa value of 0.461. The indicator that describes the inconsistencies, measured by the sum of the square of the differences between the reported and expected prematurity rates by birthweight bracket, showed the highest value in the North of Brazil and the lowest in the South, pointing to geographic inequalities in measurement of gestational age.


Resumen: En este trabajo, se evalúa cuantitativa y cualitativamente la información del Sistema de Información sobre Nacidos Vivos (SINASC) de Brasil. La cobertura de la información por municipio se estimó por la razón entre nacidos vivos informados y estimados. Para la evaluación de la calidad de la información del SINASC, se efectuó la relación del sistema con la base de datos del estudio Nacer no Brasil, 2011-2012 y se estimaron los coeficientes kappa de concordancia. En 2013, la cobertura de la información fue alta y homogénea en todas las unidades de la Federación. No obstante, el análisis por municipio brasileño presentó mayor heterogeneidad espacial. En cuanto a la calidad de cumplimentación de la información del SINASC, los coeficientes kappa de concordancia fueron estadísticamente diferentes de cero para todas las variables probadas (p < 0,001) y las distribuciones marginales para todas las variables consideradas fueron semejantes en las dos bases de datos. La edad gestacional fue la variable que mostró peor concordancia, con valor de kappa de 0,461. El indicador que describe las inconsistencias, medido por la suma del cuadrado de las diferencias entre los porcentajes de prematuridad informados y esperados por franja de peso al nacer, tuvo el valor más alto en la región Norte y el menor en la Sur, apuntando desigualdades geográficas en la medición de la edad gestacional.

8.
Rev. bras. epidemiol ; 22(supl.1): e190002, 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1042210

RESUMO

ABSTRACT Introduction: Respondent-Driven Sampling (RDS) has been used in surveys with key populations at risk of HIV infection, such as female sex workers (FSW). This article describes the application of the RDS method among FSW in 12 Brazilian cities, during a survey carried out in 2016. Methodology: A biological and behavioral surveillance study carried out in 12 Brazilian cities, with a minimum sample of 350 FSW in each city. Tests were performed for HIV, syphilis, and hepatitis B and C infections. A social-behavioral questionnaire was also applied. Results: The sample was comprised of 4,328 FSW. For data analysis, the sample was weighted according to each participant's network size (due consideration to the implications of RDS complex design and to the effects of homophilia are recommended). Discussion: Although RDS methods for obtaining a statistical sample are based on strong statistical assumptions, allowing for an estimation of statistical parameters, with each new application the method has been rethought. In the analysis of whole-sample data, estimators were robust and compatible with those found in 2009. However, there were significant variations according to each city. Conclusion: The achieved sample size was of great relevance for assessing progress and identifying problems regarding the prevention and treatment of Sexually Transmitted Infections. New RDS studies with more time and operational resources should be envisaged. This could further network development.


RESUMO Introdução: O método de amostragem Respondent-Driven Sampling (RDS) tem sido utilizado em inquéritos com populações-chave sob maior risco de infecção pelo HIV, como as mulheres trabalhadoras do sexo (MTS). Este artigo tem o objetivo de descrever a implementação do RDS entre MTS em 12 cidades brasileiras em 2016. Metodologia: Trata-se de um estudo de vigilância biológica e comportamental realizado em 12 cidades brasileiras, com amostra mínima de 350 MTS em cada cidade. Foram realizados testes para infecções por HIV, sífilis, hepatites B e C, e aplicou-se questionário sociocomportamental. Resultados: Participaram 4.328 MTS. Para a análise dos dados, foi elaborada uma ponderação amostral considerando o tamanho da rede de cada participante; recomenda-se que o desenho complexo de amostragem por RDS e o efeito de homofilia sejam considerados. Discussão: Apesar de o RDS ser fundamentado em pressupostos estatísticos para obtenção de uma amostra probabilística e possibilitar estimação de parâmetros estatísticos, ele vem sendo repensado a cada nova aplicação. Na análise dos dados na totalidade da amostra, os estimadores mostraram-se robustos e coerentes aos encontrados em 2009. Entretanto, constataram-se grandes variações por cidade. Conclusão: O tamanho amostral alcançado foi de grande relevância para avaliar avanços e identificar problemas a respeito da prevenção e assistência às infecções sexualmente transmissíveis. Ressalta-se a necessidade de pensar estudos RDS com maior tempo e recursos para implementação, o que poderia permitir um melhor desenvolvimento das redes.

9.
Rev. bras. epidemiol ; 22(supl.2): E190004.SUPL.2, 2019.
Artigo em Português | LILACS-Express | ID: biblio-1042227

RESUMO

RESUMO: Introdução: O artigo teve o objetivo de descrever a metodologia de coleta dos dados dos exames laboratoriais da Pesquisa Nacional de Saúde (PNS). Metodologia: Foi selecionada uma subamostra de 25% dos setores censitários, obedecendo à estratificação da amostra da PNS, com probabilidade inversamente proporcional à dificuldade de coleta. A coleta de sangue e urina dos moradores selecionados para entrevista individual foi realizada nos domicílios por um agente de laboratório. Por conta das dificuldades encontradas no trabalho de campo,a amostra não atingiu número suficiente em alguns estratos da pesquisa, então para a análise dos dados foi proposto procedimento de pós-estratificação. Resultados: A coleta de material biológico foi realizada em 8.952 indivíduos. Os exames realizados foram: hemoglobina glicada; colesterol total; colesterol LDL; colesterol HDL; sorologia para dengue; hemograma série vermelha (eritograma) e série branca (leucograma); cromatografia líquida de alta eficiência (HPLC) para diagnóstico de hemoglobinopatias; e creatinina. Na urina, estimativa de excreção de potássio, sal, sódio e creatinina. A base de dados dos exames laboratoriais foi ponderada e disponibilizada para os usuários no site da PNS da Fundação Oswaldo Cruz, sem necessidade de autorização prévia para uso. Conclusão: A subamostra total coletada é de grande valia, pois permitiu estabelecer parâmetros de referência nacionais adequados às características sociodemográficas e geográficas da população brasileira, fornecendo informações relevantes e complementares para a análise da situação de saúde do Brasil.


ABSTRACT: Introduction: This article aims at describing the National Health Survey (Pesquisa Nacional de Saúde- PNS) methodology of collecting laboratory exams data. Methodology: A subsample of 25% of the census tracts was selected, according to the stratification of the PNS sample, with a probability inversely proportional to the difficulty of collection. The collection of blood and urine was done in the households by a laboratory agent, among residents selected for individual interview. Due to the difficulties found in the field work, the sample did not reach the minimum expected number in some strata, and a post-stratification procedure was proposed for the data analysis. Results: The collection of biospecimens was performed in 8,952 individuals. Laboratory tests were: glycated hemoglobin; total cholesterol; LDL cholesterol; HDL cholesterol; serology for dengue; red blood cell count (erythrogram) and white series count (leukogram); high performance liquid chromatography (HPLC) for diagnosis of hemoglobinopathies; creatinine. Theexcretion of potassium, salt and sodium and creatinine was estimated in the urine. The database of laboratory exams was weighed and made publicly available on the Oswaldo Cruz Foundation's PNS website and can be accessed without prior authorization. Conclusion: The total subsample of laboratory exams is of great value, since it allowed us to establish national reference parameters adequate to sociodemographic and geographic characteristics of the Brazilian population, providing relevant and complementary information for the analysis of the health situation of Brazil.

10.
Cad. Saúde Pública (Online) ; 35(7): e00091018, 2019. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-1011714

RESUMO

Resumo: O objetivo foi quantificar a contribuição de comportamentos em saúde selecionados para a prevalência do controle da hipertensão junto a adultos brasileiros com 50 ou mais anos de idade. Foram analisados os dados do ELSI-Brasil. Foram incluídos, no estudo, 4.318 indivíduos com 50 anos ou mais, que relataram ter recebido diagnóstico médico de hipertensão arterial e faziam tratamento medicamentoso para ela. Os comportamentos em saúde selecionados foram: prática de atividade física, adoção de dieta saudável, não consumir de forma excessiva bebida alcoólica e nunca ter fumado. A contribuição de cada comportamento em saúde estudado para a prevalência do controle da hipertensão arterial foi estimada pelo método da atribuição, por meio do ajuste do Modelo Binomial de Riscos Aditivos, estratificado por sexo. A prevalência do controle da hipertensão foi de 50,7% (IC95%: 48,2; 53,1). De maneira geral, os comportamentos em saúde tiveram uma maior contribuição para o controle da hipertensão nas mulheres (66,3%) do que nos homens (36,2%). O consumo moderado de álcool foi o que mais contribuiu em ambos os sexos (52,7% em mulheres; 19% em homens), sendo destacada a sua contribuição para as mulheres. A prática de atividade contribuiu com 12,6% em mulheres e 10,7% em homens. Os demais comportamentos apresentaram maior relevância entre os homens: nunca ter fumado (3,4%) e consumo regular de verduras, legumes e frutas (3,1%). Esses resultados reforçam a necessidade de medidas que promovam a adoção de comportamentos saudáveis entre hipertensos para reduzir os níveis pressóricos, melhorar o efeito dos anti-hipertensivos e diminuir o risco cardiovascular.


Resumen: El objetivo fue cuantificar la contribución de comportamientos de salud, seleccionados para la prevalencia del control de la hipertensión, entre adultos brasileños con 50 o más años de edad. Se analizaron los datos de ELSI-Brasil. Se incluyeron en el estudio a 4.318 individuos, con 50 años o más, que informaron haber recibido un diagnóstico médico de hipertensión arterial y contaban con un tratamiento médico para la misma. Los comportamientos de salud seleccionados fueron: práctica de actividad física, adopción de una dieta saludable, no consumir de forma excesiva bebidas alcohólicas y no haber fumado nunca. La contribución de cada comportamiento de salud estudiado para la prevalencia del control de la hipertensión arterial se estimó mediante el método de la atribución, a través del ajuste del modelo binomial de riesgos añadidos, estratificado por sexo. La prevalencia del control de la hipertensión fue de un 50,7% (IC95%: 48,2; 53,1). De manera general, los comportamientos de salud tuvieron una mayor contribución para el control de la hipertensión en las mujeres (66,3%) que en los hombres (36,2%). El consumo moderado de alcohol fue lo que más contribuyó en ambos sexos (52,7% en mujeres; 19% en hombres), siendo destacada su contribución en el caso de las mujeres. La práctica de actividad contribuyó con un 12,6% en mujeres y un 10,7% en hombres. Los demás comportamientos presentaron mayor relevancia entre los hombres: no haber fumado nunca (3,4%) y consumo regular de verduras, legumbres y frutas (3,1%). Esos resultados refuerzan la necesidad de medidas que promuevan la adopción de comportamientos saludables entre hipertensos para reducir los niveles presóricos, mejorar el efecto de los antihipertensivos y disminuir el riesgo cardiovascular.


Abstract: This study aimed to measure the contribution of selected health behaviors to the prevalence of hypertension control in Brazilian adults 50 years or older, based on data from the ELSI-Brasil study. The study included 4,318 individuals 50 years or older who reported having received a medical diagnosis of hypertension and were taking antihypertensive medication. The selected health behaviors were: physical activity, healthy diet, not consuming excessive alcohol, and never having smoked. The contribution of each health behavior to prevalence of hypertension control was estimated by the attribution method, via adjustment of the binomial additive hazards model, stratified by sex. Prevalence of hypertension control was 50.7% (95%CI: 48.2; 53.1). Overall, health behaviors made a larger contribution to hypertension control in women (66.3%) than in men (36.2%). Moderate alcohol consumption made the largest contribution in both sexes, but particularly in women (52.7% in women versus 19% in men). Physical activity contributed 12.6% in women and 10.7% in men. The other behaviors were more relevant in men: never having smoked (3.4%) and regular consumption of vegetables, legumes, and fruits (3.1%). These results underline the need for measures to promote the adoption of healthy behaviors by hypertensive individuals to reduce blood pressure levels, improve the effectiveness of antihypertensive medication, and decrease their cardiovascular risk.

11.
Rev Saude Publica ; 52Suppl 2(Suppl 2): 6s, 2018 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-30379279

RESUMO

OBJECTIVE: To characterize healthcare access and utilization among older Brazilians. METHODS: Data are from the baseline wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is a nationally representative, population-based cohort study of persons aged 50 years and older conducted in 2015/2016 (n = 9,412). The prevalence of barriers to primary care and number and type of doctor visits in the past 12 months are compared by three main sources of healthcare (private, Family Health Strategy, traditional public clinics). Two-part multivariable hurdle analyses assess the relation between healthcare utilization, primary care problems, and source of healthcare, while controlling for healthcare determinants. RESULTS: Females comprised 54% of the sample, with a mean age of 63 years. There were no demographic differences by source of healthcare. Nearly 83% had at least one doctor visit in the past 12 months, with higher use among private health plan holders. Private health plan holders most frequently visited specialists, while those using the public system were more likely to visit a general practitioner. Primary care barriers averaged 3.5 out of 12 and were the highest among those using traditional health posts. A greater number of primary care problems was negatively associated with all types of healthcare utilization. CONCLUSIONS: By international standards, access to basic healthcare among older Brazilians is relatively high. Nevertheless, different levels of primary care problems between the public and private sectors and resulting utilization patterns suggest the need to continue working to close remaining gaps.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência
12.
Rev Saude Publica ; 52Suppl 2(Suppl 2): 5s, 2018 Oct 25.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30379280

RESUMO

OBJECTIVE: To describe the prevalence of the practice of physical activity (PA) among older Brazilian adults and associated factors. In addition, potential effect modifiers of the association between PA and age were investigated. METHODS: We have analyzed data from 8,736 participants (92.8%) aged 50 and older from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). Physical activity was measured using the short version of the International Physical Activity Questionnaire. The outcome variable was defined as at least 150 minutes of weekly activities in all domains. The exploratory variables were age, sex, education, ethnicity, marital status, number of chronic diseases and medical appointments, and knowledge about or participation in public programs that encourage physical activity. Logistic regression and estimates of predicted probabilities were performed. RESULTS: The prevalence of recommended levels of physical activity was 67.0% (95%CI 64.3-69.5). Physical activity was associated with age [odds ratio (OR) = 0.97; 95%CI 0.96-0.98], higher educational level (OR = 1.27; 95%CI 1.11-1.45 for 4-7 years and OR = 1.52; 95%CI 1.28-1.81 for eight years or more), participants who were married/ in a long term relationship (OR = 1.22; 95%CI 1.08-1.38), and those who reported knowledge about (OR = 1.34; 95%CI 1.16-1.54) or participation in (OR = 1.78; 95%CI 1.34-2.36) a program aimed at the practice of physical activity. Women and those with lower educational level (p value for interaction < 0.05) reported lower physical activity levels. CONCLUSIONS: In addition to the association with marital status and health promotion programs, there were significant sex and educational level inequalities in physical activity decline later in life. These findings help the identification of groups more vulnerable to decreased physical activity levels with aging, as well as the planning of health promotion strategies, especially in older groups.


Assuntos
Exercício , Fatores Etários , Idoso , Brasil , Feminino , Promoção da Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos
13.
Rev Saude Publica ; 52Suppl 2(Suppl 2): 16s, 2018 Oct 25.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30379281

RESUMO

OBJECTIVE: To identify factors associated with perceived quality of life in a representative national sample of the population aged 50 or over. METHODS: Data from 7,651 participants of the baseline ELSI-Brazil (Brazilian Longitudinal Study of Aging), conducted between 2015 and 2016, were used. The perceived quality of life was measured by the CASP-19 scale - (CASP - control, autonomy, self-fulfillment and pleasure), considering the highest tertile as good quality of life. The independent variables included socio-demographic characteristics, mobility, loneliness, and indicators of sociability (social network, social support and social participation). The associations were tested using multivariate Poisson regression. RESULTS: The best perceived quality of life showed a positive and independent association with the frequency of contacts with friends (PR = 1.25 for at least once every 2-3 months and PR = 1.36 for at least once a week), instrumental support from spouse or partner in the household (PR = 1.69), and emotional support from other relatives (PR = 1.45), children or children in law (PR = 1.41) and spouse or partner (PR = 1.33). Negative associations were observed for participants aged 80 and over (RP = 0.77), with 4 to 7 or 8 or more years of schooling (PR = 0.78 and 0.75, respectively) and with difficulty in mobility (PR = 0.83). CONCLUSIONS: In addition to age and schooling, mobility, sociability and instrumental and emotional support are associated with perceived quality of life among older Brazilian adults. These characteristics must be considered when actions are taken, aiming to promote quality of life in this population.


Assuntos
Nível de Saúde , Percepção , Qualidade de Vida/psicologia , Participação Social/psicologia , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Prevalência , Fatores Socioeconômicos
14.
Rev Saude Publica ; 52Suppl 2(Suppl 2): 17s, 2018 Oct 25.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30379282

RESUMO

OBJECTIVE: To estimate the prevalence of frailty and to evaluate the associated factors in the non-institutionalized Brazilian population aged 50 years or older. METHODS: The analyses were conducted in 8,556 participants of the baseline survey of the Longitudinal Study of Health of the Brazilian Elderly (ELSI-Brazil) conducted in 2015 and 2016. Frailty was defined based on five characteristics: weight loss, weakness, slowness, exhaustion and low level of physical activity. Participants with three or more characteristics were classified as frail. A Poisson regression model was used to examine the association between frailty and sociodemographic and health factors. RESULTS: The prevalence of frailty was 9.0% (95%CI 8.0-10.1) among participants aged 50 years or over. Among the older adults aged 60 or over, the prevalence was 13.5% (95%CI 11.9-15.3) and 16.2% (95%CI 14.3-18.3) among those 65 aged years or over. Factors associated with higher prevalence of frailty were low schooling, residence without a partner, health conditions (poor self-rated health and two or more chronic diseases) and limitation to perform basic activities of daily living. CONCLUSIONS: The prevalence of frailty among Brazilians aged 65 years or older is similar to their European counterparts. Poor health conditions, functional limitation and low schooling emerge as the factors most strongly associated with the frailty in this population.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Avaliação Geriátrica/métodos , Idoso , Brasil/epidemiologia , Doença Crônica , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos
15.
Rev Saude Publica ; 52Suppl 2(Suppl 2): 14s, 2018 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-30379283

RESUMO

OBJECTIVE: To evaluate the magnitude of wealth-related inequalities in basic activities of daily living among community-dwelling Brazilian older adults and to determine the contribution of demographic, socioeconomic, and health conditions to the inequality. METHODS: We used data from the 2015 Brazilian Longitudinal Study of Aging (ELSI-Brazil) with a nationally representative sample of adults aged 50 years or older. We assessed wealth-related inequalities in basic activities of daily living by the concentration index. Concentration index was decomposed to determine the contribution of demographic, health, and socioeconomic factors to wealth-related inequalities in basic activities of daily living. RESULTS: The prevalence of disability in the sample was 15.7% (95%CI 14.9-17.6). The concentration index was -0.145 (95%CI -0.194- -0.097), which indicates that disability is concentrated in the poorest individuals in Brazil. Inequalities in basic activities of daily living disability are primarily explained by socioeconomic status (wealth and own education) not by demographic or health factors. CONCLUSIONS: There are avoidable wealth-related inequities for those with a disability in Brazil. The strong contribution of the socioeconomic status highlights the need for new public health policies that promote equity, universality, and integrality, in addition to the expansion of home nursing public services.


Assuntos
Atividades Cotidianas , Pessoas com Deficiência/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Idoso , Brasil/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Classe Social
16.
Rev Saude Publica ; 52Suppl 2(Suppl 2): 8s, 2018 Oct 25.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30379284

RESUMO

OBJECTIVE: To assess the prevalence and factors associated with cost-related underuse of medications in a nationally representative sample of Brazilians aged 50 years and over. METHODS: Among the 9,412 participants of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), 6,014 reported using at least one medication on regular basis and were included in the analysis. Underuse of medications was by stopping taking or reducing the number of tablets or the dose of any prescribed medication for financial reasons. The theoretical framework used for the selection of the exploratory variables included predisposing factors, enabling factors, and factors of need. Associations were tested by Poisson regression. RESULTS: The prevalence of underuse of medications was 10.6%. After adjustments for relevant covariables, positive and statistically significant associations (p < 0.05) with the outcome were found for females [prevalence ratio (PR) = 1.39], sufficiency of the family income for expenses (PR = 1.74 for sometimes and PR 2.42 for never), frequency with which the physician explains about the disease and treatment (PR = 1.31 for rarely or never), number of medications used (PR = 1.39 for 2-4 and 1.53 for 5 or more), fair (PR = 2.02) and poor or very poor self-rated health (PR = 2.92), and a previous medical diagnosis of depression (PR = 1.69). Negative associations were observed for the age groups of 60-79 years (PR = 0.75) and 80 years and over (PR = 0.43), socioeconomic status of the household (PR = 0.70, 0.79, and 0.60 for the second, third, and fourth quartile, respectively), and private health plan coverage (PR = 0.79). There were no associations between hypertension and self-reported diabetes and underuse of medications. CONCLUSIONS: Cost-related underuse of medications is multidimensional and complex, and it covers socio-demographic characteristics, health conditions, and the use of health services. The explanation about the disease and its treatment to the patient and the expansion of the universal access to pharmaceutical care can minimize the risks of underuse.


Assuntos
Uso de Medicamentos/economia , Adesão à Medicação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Socioeconômicos
17.
Rev Saude Publica ; 52Suppl 2(Suppl 2): 7s, 2018 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-30379285

RESUMO

OBJECTIVE: To investigate the association between life course socioeconomic conditions and two oral health outcomes (edentulism and use of dental prostheses among individuals with severe tooth loss) among older Brazilian adults. METHODS: This was a cross-sectional study with data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) which includes information on persons aged 50 years or older residing in 70 municipalities across the five great Brazilian regions. Regression models using life history information were used to investigate the relation between childhood (parental education) and adulthood (own education and wealth) socioeconomic circumstances and edentulism and use of dental prostheses. Slope index of inequality and relative index of inequality for edentulism and use of dental prostheses assessed socioeconomic inequalities in both outcomes. RESULTS: Approximately 28.8% of the individuals were edentulous and among those with severe tooth loss 80% used dental prostheses. Significant absolute and relative inequalities were found for edentulism and use of dental prostheses. The magnitude of edentulism was higher among individuals with lower levels of socioeconomic position during childhood, irrespective of their current socioeconomic position. Absolute and relative inequalities related to the use of dental prostheses were not related to childhood socioeconomic position. CONCLUSIONS: These findings substantiate the association between life course socioeconomic circumstances and oral health in older adulthood, although use of dental prostheses was not related to childhood socioeconomic position. The study also highlights the long-lasting relation between childhood socioeconomic inequalities and oral health through the life course.


Assuntos
Prótese Dentária/estatística & dados numéricos , Boca Edêntula/epidemiologia , Saúde Bucal/estatística & dados numéricos , Fatores Socioeconômicos , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
18.
Rev Saude Publica ; 52Suppl 2(Suppl 2): 4s, 2018 Oct 25.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30379286

RESUMO

OBJECTIVE: To investigate macroregional variations in cognitive function in a national sample representative of the Brazilian population aged 50 years and older. METHODS: Data from the baseline of the Longitudinal Study of Brazilian Elderly (ELSI-Brazil), collected between 2015 and 2016, were used. Memory was measured by means of a 10-word list and executive function, by semantic verbal fluency, based on the naming of animals. Gender, age, education, and rural or urban residence were potentially confounding. RESULTS: Among the 9,412 ELSI-Brazil participants, 9,085 were included in the analysis; 53.9% were women and the average age was 63.0 (0.42) years. After adjusting for potential confounding variables, average scores for memory and verbal fluency were lower in the Northeast region and higher in the Midwest and Southeast, respectively. In the South region, higher scores were found for immediate and combined memory. In all regions, older participants and those with lower schooling had worse scores for memory and verbal fluency. CONCLUSIONS: There are differences in cognitive function among older adults in the different macroregions, independent of age, gender, schooling, and rural or urban residence.


Assuntos
Cognição/fisiologia , Transtornos da Memória/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Escolaridade , Feminino , Humanos , Estudos Longitudinais , Masculino , Transtornos da Memória/epidemiologia , Transtornos da Memória/fisiopatologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , População Rural , População Urbana
19.
Rev Saude Publica ; 52Suppl 2(Suppl 2): 12s, 2018 Oct 25.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30379287

RESUMO

OBJECTIVE: To assess the prevalence and factors associated with falls in a nationally representative sample of older Brazilians residing in urban areas. METHODS: Data from 4,174 participants (60 years or older) from the baseline of ELSI-Brazil, conducted between 2015 and 2016, were used. The outcome variable was the reporting of one or more falls in the last 12 months. The exploratory variables were sociodemographic characteristics, factors related to the urban environment, and health conditions. Statistical analysis was performed using Poisson regression. RESULTS: The prevalence of falls was 25.1%. Of these, 1.8% resulted in a hip or femur fracture and, among them, 31.8% required surgery for prosthesis placement. Statistically significant associations (p < 0.05) with falls were observed for females [prevalence ratio (PR) = 1.26], age group of 75 years or older (PR = 1.21), fear of falling due to defective sidewalks (PR = 1.47), fear of crossing streets (PR = 1.22), diabetes (PR = 1.17), arthritis or rheumatism (PR = 1.29), and depression (PR = 1.53). No significant associations were found for educational level, marital status, hypertension, and perception of violence in the neighborhood. CONCLUSIONS: The factors associated with falls among older adults are multidimensional, comprising individual characteristics and the urban environment, which indicates the need for intra and intersectoral actions to prevent falls in this population.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Idoso , Brasil/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Prevalência , Fatores Socioeconômicos , População Urbana
20.
Rev Saude Publica ; 52Suppl 2(Suppl 2): 10s, 2018 Oct 25.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30379288

RESUMO

OBJECTIVE: To evaluate the occurrence and factors associated with multimorbidity among Brazilians aged 50 years and over. METHODS: This is a cross-sectional study in a nation-based cohort of the non-institutionalized population in Brazil. Data were collected between 2015 and 2016. Multimorbidity was assessed from a list of 19 morbidities, which were categorized into ≥ 2 and ≥ 3 diseases. The analysis included the calculation of frequencies and the most frequent 10 pairs and triplets of combinations of diseases. The crude and adjusted analyses evaluated the demographic, socioeconomic, behavioral, and contextual variables (area of residence, geopolitical region, and coverage of the Family Health Strategy) using Poisson regression. RESULTS: From the total of 9,412 individuals, 67.8% (95%CI 65.6-69.9) and 47.1% (95%CI 44.8-49.4) showed ≥ 2 and ≥ 3 diseases, respectively. In the adjusted analysis, women, older persons, and those who did not consume alcohol had increased multimorbidity. There were no associations with race, area of residence, geopolitical region, and coverage of the Family Health Strategy. The 10 pairs (frequencies observed between 11.6% and 23.2%) and the 10 triplets (frequencies observed between 4.9% and 9.5%) of the most frequent diseases mostly included back problems (15 times) and systemic arterial hypertension (11 times). All combinations were statistically higher than expected by chance. CONCLUSIONS: The occurrence of multimorbidity was high even among younger individuals (50 to 59 years). Approximately two in three (≥ 2 diseases) and one in two (≥ 3 diseases) individuals aged 50 years and over presented multimorbidity, which represents 26 and 18 million persons in Brazil, respectively. We observed high frequencies of combinations of morbidities.


Assuntos
Multimorbidade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Socioeconômicos
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