Impact of socioeconomic status on Brazilian elderly health

OBJECTIVE: To investigate the impact of socioeconomic status on elderly health. METHODS: The study was based on cross-sectional data from Survey on Health, Well-Being, and Aging in Latin America and the Caribbean. The sample comprised 2,143 non-institutionalized elderly aged 60 years and older living in the urban area of São Paulo, southeastern Brazil. Linear regression models estimated the effect of socioeconomic status indicators (years of schooling completed, occupation and purchasing power) on each one of the following health indicators: depression, self-rated health, morbidity and memory capacity. A 5% significance level was set. RESULTS: There was a significant effect of years of education and purchasing power on self-rated health and memory capacity when controlled for the variables number of diseases during childhood, bed rest for at least a month due to health problems during childhood, self-rated health during childhood, living arrangements, sex, age, marital status, category of health insurance, intake of medicines. Only purchasing power had an effect on depression. Despite the bivariate association between socioeconomic status indicators and number of diseases (morbidity), this effect was no longer seen after including the controls in the model. CONCLUSIONS: The study results confirm the association between socioeconomic status indicators and health among Brazilian elderly, but only for some dimensions of socioeconomic status and certain health outcomes.

Risk-factors for antepartum fetal deaths in the city of São Paulo, Brazil

OBJECTIVE: To assess risk factors for antepartum fetal deaths. METHODS: A population-based case-control study was carried out in the city of São Paulo from August 2000 to January 2001. Subjects were selected from a birth cohort from a linked birth and death certificate database. Cases were 164 antepartum fetal deaths and controls were drawn from a random sample of 313 births surviving at least 28 days. Information was collected from birth and death certificates, hospital records and home interviews. A hierarchical conceptual framework guided the logistic regression analysis. RESULTS: Statistically significant factors associated with antepartum fetal death were: mother without or recent marital union; mother's education under four years; mothers with previous low birth weight infant; mothers with hypertension, diabetes, bleeding during pregnancy; no or inadequate prenatal care; congenital malformation and intrauterine growth restriction. The highest population attributable fractions were for inadequacy of prenatal care (40%), hypertension (27%), intrauterine growth restriction (30%) and absence of a long-standing union (26%). CONCLUSIONS: Proximal biological risk factors are most important in antepartum fetal deaths. However, distal factors - mother's low education and marital status - are also significant. Improving access to and quality of prenatal care could have a large impact on fetal mortality.

Fatores associados à evolução ponderal de gestantes: uma análise multinível

OBJETIVO: Avaliar a influência de fatores socioeconômicos, reprodutivos e comportamentais sobre a evolução do peso durante a gestação. MÉTODOS: O peso corporal foi mensurado prospectivamente em uma coorte de 215 gestantes saudáveis atendidas por um serviço público de pré-natal do Município de São Paulo, no período de 1997 a 1998. Os critérios de inclusão foram: idade > 18 anos e início do pré-natal com idade gestacional < 16 semanas. A relação entre as variáveis independentes com a evolução do peso durante a gestação foi avaliada mediante análise multinível linear hierarquizada, analisada pelo teste de máxima verossimilhança. RESULTADOS: Na análise multinível, os fatores significantemente associados ao ganho de peso gestacional foram IMC inicial, escolaridade, situação marital e paridade. As equações obtidas permitiram identificar o efeito individualizado de cada uma das características: IMC inicial eutrófico, escolaridade >4 anos, ausência de companheiro e primiparidade proporcionam acréscimos de 3,0 kg, 1,9 kg, 2,3 kg e 2,4 kg, respectivamente, no ganho de peso total durante a gestação. CONCLUSÕES: O IMC inicial, escolaridade e paridade são características maternas que, com o estado marital, devem ser consideradas no desenvolvimento de estratégias para a promoção de um ganho de peso adequado durante a gestação.

Hepatites B e C em usuários de drogas injetáveis vivendo com HIV em São Paulo, Brasil

OBJETIVO: Descrever o perfil de usuários de drogas injetáveis vivendo com HIV/Aids e estimar a prevalência de hepatites B e C nesse grupo. MÉTODOS: Estudo transversal realizado com 205 pessoas vivendo com HIV/Aids, usuários de drogas injetáveis em acompanhamento em três unidades de atendimento da rede pública do Município de São Paulo, em 2003. Foi selecionada amostra não-probabilística, obtida de forma consecutiva e voluntária, nos dias em que compareciam para consulta nas unidades de atendimento. Por meio de entrevistas, foram levantados dados pessoais e informações sobre comportamento sexual, uso de drogas e conhecimento de hepatites. Foram realizados testes para detecção da infecção pelos vírus das hepatites B e C. RESULTADOS: Dos entrevistados, 81% eram homens e 19% mulheres, com idade média de 39 anos (dp=6,1) e seis anos de educação formal (dp=2,0). Não havia diferença em relação ao estado marital entre os sexos, 48% eram solteiros, 42% casados e 8% divorciados. A idade média do primeiro uso de tabaco, álcool e drogas ilícitas foi 13, 15 e 18 anos, respectivamente. Prevalências de hepatites B e C foram, respectivamente, de 55% (IC 95%: 49;63) e 83% (IC 95%: 78;88). Antes de usar droga injetável pela primeira vez, 80% dos respondentes não tinham ouvido falar de hepatites B e C. CONCLUSÕES: A alta prevalência de hepatites B e C e o baixo nível de conhecimento sobre a doença justificam a inclusão de esclarecimentos sobre as infecções hepáticas e de vacinação contra hepatite B nas estratégias de redução de danos pelo HIV.

Missed opportunities for congenital syphilis and HIV perinatal transmission prevention

OBJECTIVE: To estimate the prevalence of missed opportunities for congenital syphilis and HIV prevention in pregnant women who had access to prenatal care and to assess factors associated to non-testing of these infections. METHODS: Cross-sectional study comprising a randomly selected sample of 2,145 puerperal women who were admitted in maternity hospitals for delivery or curettage and had attended at least one prenatal care visit, in Brazil between 1999 and 2000. No syphilis and/or anti-HIV testing during pregnancy was a marker for missed prevention opportunity. Women who were not tested for either or both were compared to those who had at least one syphilis and one anti-HIV testing performed during pregnancy (reference category). The prevalence of missed prevention opportunity was estimated for each category with 95% confidence intervals. Factors independently associated with missed prevention opportunity were assessed through multinomial logistic regression. RESULTS: The prevalence of missed prevention opportunity for syphilis or anti-HIV was 41.2% and 56.0%, respectively. The multivariate analysis showed that race/skin color (non-white), schooling (<8 years), marital status (single), income (<3 monthly minimum wages), having sex during pregnancy, history of syphilis prior to the current pregnancy, number of prenatal care visits (<6), and last prenatal visit before the third trimester of gestation were associated with an increased risk of missed prevention opportunity. A negative association with missed prevention opportunity was found between marital status (single), prenatal care site (hospital) and first prenatal visit in the third trimester of gestation. CONCLUSIONS: High rates of non-tested women indicate failures in preventive and control actions for HIV infection and congenital syphilis. Pregnant women have been discontinuing prenatal care at an early stage and are failing to undergo prenatal screening for HIV and syphilis.

Acesso à esterilização cirúrgica pelo Sistema Único de Saúde, Ribeirão Preto, SP

OBJETIVO: Caracterizar o perfil de indivíduos que não obtiveram o procedimento de contracepção cirúrgica e fatores associados. MÉTODOS: Estudo transversal realizado em Ribeirão Preto (SP), em 2004, com 230 indivíduos que não obtiveram cirurgia de esterilização no período de 1999 a 2004 pelo Sistema Único de Saúde. Foi aplicado um questionário com informações sociodemográficas, uso de métodos anticoncepcionais e aspectos da esterilização e desejo de esterilizar-se no futuro. Foram comparadas as variáveis sexo, idade, religião, renda per capita, estado marital e escolaridade do total dos que não obtiveram o procedimento com 297 indivíduos esterilizados. RESULTADOS: Dos 230 entrevistados 21,3% eram homens e 78,7% mulheres. A maioria era casada, branca, católica e tinha pelo menos quatro anos de estudo. A renda per capita mediana mensal foi R$ 140,00. Dos entrevistados, 23 (10%) tinham expectativa de fazer a cirurgia. Os restantes 207 foram classificados em dois grupos: 71% decidiram adiar cirurgia e 29% encontraram obstáculos no acesso à esterilização. O segundo grupo foi associado a ser mulher, jovem e negra. Após regressão logística, ser negro foi o único fator que se manteve associado à não-obtenção da esterilização. Ao comparar com o grupo dos que obtiveram o procedimento, pertencer ao sexo feminino, ser de maior idade, ter como religião a evangélica e ser solteiro estiveram associados à não obtenção da esterilização, enquanto maior renda e maior escolaridade favoreceram o acesso. CONCLUSÕES: Poucos indivíduos estudados não tiveram acesso à esterilização, sobretudo por terem adiado esse procedimento e uma menor parcela teve obstáculos institucionais. Os negros encontraram mais barreiras que os brancos.

Factors associated to quality of life in active elderly

OBJECTIVE: To analyze whether quality of life in active, healthy elderly individuals is influenced by functional status and sociodemographic characteristics, as well as psychological parameters. METHODS: Study conducted in a sample of 120 active elderly subjects recruited from two open universities of the third age in the cities of São Paulo and São José dos Campos (Southeastern Brazil) between May 2005 and April 2006. Quality of life was measured using the abbreviated Brazilian version of the World Health Organization Quality of Live (WHOQOL-bref) questionnaire. Sociodemographic, clinical and functional variables were measured through crossculturally validated assessments by the Mini Mental State Examination, Geriatric Depression Scale, Functional Reach, One-Leg Balance Test, Timed Up and Go Test, Six-Minute Walk Test, Human Activity Profile and a complementary questionnaire. Simple descriptive analyses, Pearson's correlation coefficient, Student's t-test for non-related samples, analyses of variance, linear regression analyses and variance inflation factor were performed. The significance level for all statistical tests was set at 0.05. RESULTS: Linear regression analysis showed an independent correlation without colinearity between depressive symptoms measured by the Geriatric Depression Scale and four domains of the WHOQOL-bref. Not having a conjugal life implied greater perception in the social domain; developing leisure activities and having an income over five minimum wages implied greater perception in the environment domain. CONCLUSIONS: Functional status had no influence on the Quality of Life variable in the analysis models in active elderly. In contrast, psychological factors, as assessed by the Geriatric Depression Scale, and sociodemographic characteristics, such as marital status, income and leisure activities, had an impact on quality of life.

Consumo de frutas e hortaliças por adultos em Ribeirão Preto, SP

OBJETIVO: Avaliar o consumo de frutas e hortaliças por adultos e identificar variáveis sociodemográficas e de estilo de vida associadas ao consumo desses alimentos. MÉTODOS: Estudo transversal, de base populacional, realizado na área urbana de Ribeirão Preto, SP, em 2006, com amostra selecionada por conglomerados, em três estágios, tendo como unidade primária o setor censitário. A amostra foi composta por 930 participantes com 30 anos e mais; na análise de dados levou-se em consideração o efeito de desenho. O consumo de frutas e hortaliças baseou-se em questionário de freqüência semiquantitativo, utilizando-se como indicadores os escores médios de freqüência de consumo de frutas e hortaliças, consumo diário e consumo mínimo desses alimentos. As variáveis independentes analisadas foram: faixa etária, estado marital, escolaridade, renda familiar per capita, estado nutricional, tabagismo e atividade física. Médias dos escores de freqüência de consumo foram estimadas por pontos e por intervalos com 95% de confiança. Para o estudo de associação, razões de prevalências foram estimadas por pontos e por intervalos com 95% de confiança, utilizando-se regressão de Poisson. Testes de tendência linear foram aplicados, adotando-se nível de significância de 5%. RESULTADOS: Apenas 24% dos homens e 38% das mulheres atenderam à recomendação mínima do consumo de frutas e hortaliças; observou-se associação positiva com a idade e renda per capita. Mulheres com maior escolaridade e homens que viviam com a companheira consumiam mais frutas e hortaliças que os demais. Atividade física, tabagismo e estado nutricional não apresentaram associação com o consumo mínimo recomendado de frutas e hortaliças. CONCLUSÕES: Fatores socioeconômicos têm importante influência sobre o consumo de frutas e hortaliças e, por serem passíveis de intervenção, podem contribuir para a adoção de hábitos alimentares saudáveis.

Atividade física e fatores associados em adultos de área rural em Minas Gerais, Brasil

OBJETIVO: Estimar os níveis de atividade física e sua associação com fatores sociodemográficos em moradores de áreas rurais. MÉTODOS: Estudo transversal, de base populacional, incluindo 567 adultos de duas comunidades rurais do Vale do Jequitinhonha, MG, entre os anos de 2008 e 2009. Os níveis de atividade física foram coletados por meio do Questionário Internacional de Atividade Física, versão longa adaptada. Utilizou-se o ponto de corte de 150 minutos de atividade física semanal entre os domínios: trabalho, domicílio, lazer e deslocamento. Os fatores sociodemográficos pesquisados foram sexo, cor da pele, idade, estado marital, escolaridade e autopercepção de saúde. Foram realizadas análise bivariada (qui-quadrado, p< 0,05) e análise múltipla de regressão logística. RESULTADOS: A prevalência de indivíduos que praticaram 150 minutos ou mais de atividade física no trabalho foi de 82,9% (IC 95%: 77,8;88,0) entre os que trabalham atualmente. Essa proporção para os outros domínios foram: domicílio 63,5% (IC 95%: 59,6;67,4); lazer 10,1% (IC 95%: 7,6;12,6); e no deslocamento 32,0% (IC 95%: 28,2;35,8). Os homens foram mais ativos que as mulheres no lazer, deslocamentos e trabalho, enquanto as mulheres foram mais ativas no ambiente doméstico. A atividade física de lazer foi mais prevalente em indivíduos de maior escolaridade, mais jovens e entre os de cor preta e parda. No deslocamento, mulheres mais jovens e homens e mulheres com estado de saúde excelente/bom foram mais ativos. Os homens com maior escolaridade foram os menos ativos neste domínio. CONCLUSÕES: A prevalência de adultos fisicamente ativos em área rural é alta, mas os níveis de atividade física no lazer são baixos e seguem padrões similares aos de áreas urbanas segundo idade, sexo e escolaridade.

Is adolescent pregnancy a risk factor for low birth weight?

OBJECTIVE: The objective of this study was to evaluate whether adolescent pregnancy is a risk factor for low birth weight (LBW) babies. METHODS: This was a cross-sectional study of mothers and their newborns from a birth cohort in Aracaju, Northeastern Brazil. Data were collected consecutively from March to July 2005. Information collected included socioeconomic, biological and reproductive aspects of the mothers, using a standardized questionnaire. The impact of early pregnancy on birth weight was evaluated by multiple logistic regression. RESULTS: We studied 4,746 pairs of mothers and their babies. Of these, 20.6% were adolescents (< 20 years of age). Adolescent mothers had worse socioeconomic and reproductive conditions and perinatal outcomes when compared to other age groups. Having no prenatal care and smoking during pregnancy were the risk factors associated with low birth weight. Adolescent pregnancy, when linked to marital status "without partner", was associated with an increased proportion of low birth weight babies. CONCLUSIONS: Adolescence was a risk factor for LBW only for mothers without partners. Smoking during pregnancy and lack of prenatal care were considered to be independent risk factors for LBW.

Metabolic syndrome in fixed-shift workers

OBJECTIVE To analyze if metabolic syndrome and its altered components are associated with demographic, socioeconomic and behavioral factors in fixed-shift workers.METHODS A cross-sectional study was conducted on a sample of 902 shift workers of both sexes in a poultry processing plant in Southern Brazil in 2010. The diagnosis of metabolic syndrome was determined according to the recommendations from Harmonizing the Metabolic Syndrome. Its frequency was evaluated according to the demographic (sex, skin color, age and marital status), socioeconomic (educational level, income and work shift), and behavioral characteristics (smoking, alcohol intake, leisure time physical activity, number of meals and sleep duration) of the sample. The multivariate analysis followed a theoretical framework for identifying metabolic syndrome in fixed-shift workers.RESULTS The prevalence of metabolic syndrome in the sample was 9.3% (95%CI 7.4;11.2). The most frequently altered component was waist circumference (PR 48.4%; 95%CI 45.5;51.2), followed by high-density lipoprotein. Work shift was not associated with metabolic syndrome and its altered components. After adjustment, the prevalence of metabolic syndrome was positively associated with women (PR 2.16; 95%CI 1.28;3.64), workers aged over 40 years (PR 3.90; 95%CI 1.78;8.93) and those who reported sleeping five hours or less per day (PR 1.70; 95%CI 1.09;2.24). On the other hand, metabolic syndrome was inversely associated with educational level and having more than three meals per day (PR 0.43; 95%CI 0.26;0.73).CONCLUSIONS Being female, older and deprived of sleep are probable risk factors for metabolic syndrome, whereas higher educational level and higher number of meals per day are protective factors for metabolic syndrome in fixed-shift workers.

Health self-assessment by hemodialysis patients in the Brazilian Unified Health System

ABSTRACT OBJECTIVE To examine whether the level of complexity of the services structure and sociodemographic and clinical characteristics of patients in hemodialysis are associated with the prevalence of poor health self-assessment. METHODS In this cross-sectional study, we evaluated 1,621 patients with chronic terminal kidney disease on hemodialysis accompanied in 81 dialysis services in the Brazilian Unified Health System in 2007. Sampling was performed by conglomerate in two stages and a structured questionnaire was applied to participants. Multilevel multiple logistic regression was used for data analysis. RESULTS The prevalence of poor health self-assessment was of 54.5%, and in multivariable analysis it was associated with the following variables: increasing age (OR = 1.02; 95%CI 1.01–1.02), separated or divorced marital status (OR = 0.62; 95%CI 0.34–0.88), having 12 years or more of study (OR = 0.51; 95%CI 0.37–0.71), spending more than 60 minutes in commuting between home and the dialysis service (OR = 1.80; 95%CI 1.29–2.51), having three or more self-referred diseases (OR = 2.20; 95%CI 1.33–3.62), and reporting some (OR = 2.17; 95%CI 1.66–2.84) or a lot of (OR = 2.74; 95%CI 2.04–3.68) trouble falling asleep. Individuals in treatment in dialysis services with the highest level of complexity in the structure presented less chance of performing a self-assessment of their health as bad (OR = 0.59; 95%CI 0.42–0.84). CONCLUSIONS We showed poor health self-assessment is associated with age, years of formal education, marital status, home commuting time to the dialysis service, number of self-referred diseases, report of trouble sleeping, and also with the level of complexity of the structure of health services. Acknowledging these factors can contribute to the development of strategies to improve the health of patients in hemodialysis in the Brazilian Unified Health System.

Use of the Brazilian People’s Pharmacy Program by older adults

ABSTRACT OBJECTIVE To assess the prevalence and factors associated with the use of the expanded Brazilian People’s Pharmacy Program among older adults and the reasons for not using it. METHODS In this population-based cross-sectional study conducted in the urban area of Pelotas, RS, Southern Brazil, we evaluated 1,305 older adults (aged 60 years or over) who had used medication in the last 15 days. Independent variables were socioeconomic factors, economic status, household income in minimum wages, educational attainment in years of schooling and occupational status. Demographic variables were sex, age, marital status, and self-reported skin color/race. Poisson regression was employed to analyze the factors associated with the use of the program. RESULTS The prevalence of use was 57.0% whilst the prevalence of knowledge of the program was 87.0%. In individuals aged 80 years or over, use of the program was 41.0%. As to the origin of the prescriptions used by older adults, 46.0% were from the Brazilian Unified Health System. The main reasons for not using the program were: difficulty in getting prescriptions, medication shortage, and ignorance about the medications offered and about the program. Higher age, lower income, presence of chronic diseases, and use of four or more medications were associated with use of the program. CONCLUSIONS It is necessary to expand the knowledge and use of the Brazilian People’s Pharmacy Program, especially among older adults, and to improve the dissemination of its list of medications to users and physicians. Thus it will be possible to reduce spending on long-term medications, which are especially important for this population.

Access to childbirth care by adolescents and young people in the Northeastern region of Brazil

ABSTRACT OBJECTIVE To identify the factors that interfere with the access of adolescents and young people to childbirth care for in the Northeast region of Brazil. METHODS Cross-sectional study with 3,014 adolescents and young people admitted to the selected maternity wards to give birth in the Northeast region of Brazil. The sample design was probabilistic, in two stages: the first corresponded to the health establishments and the second to women who had recently given birth and their babies. The data was collected by means of interviews and consulting the hospital records, from pre-tested electronic form. Descriptive statistics were used for the univariate analysis, Pearson’s Chi-square test for the bivariate analysis and multiple logistic regressions for the multivariate analysis. Sociodemographic variables, obstetrical history, and birth care were analyzed. RESULTS Half of the adolescents and young people interviewed had not been given guidance on the location that they should go to when in labor, and among those who had, 23.5% did not give birth in the indicated health service. Furthermore, one third (33.3%) had to travel in search of assisted birth, and the majority (66.7%) of the postpartum women came to maternity by their own means. In the bivariate analysis, the variables marital status, paid work, health insurance, number of previous pregnancies, parity, city location, and type of health establishment showed a significant association (p < 0.20) with inadequate access to childbirth care. The multivariate analysis showed that married adolescents and young people (p < 0.015), with no health insurance (p < 0.002) and from the countryside (p < 0.001) were more likely to have inadequate access to childbirth care. CONCLUSIONS Adolescents and young women, married, without health insurance, and from the countryside are more likely to have inadequate access to birth care. The articulation between outpatient care and birth care can improve this access and, consequently, minimize the maternal and fetal risks that arise from a lack of systematic hospitalization planning.

Risk-factors for non-adherence to antiretroviral therapy

Cross-sectional study analyzed as case-control to identify risk factors for non-adherence to antiretroviral therapy. We studied 412 out-clinics HIV infected subjects of three public hospitals of Recife, Pernambuco. The objective was to examine the association between non-adherence to the antiretroviral therapy and biological, social-behavior and demographics and economic factors, factors related to the disease and/or treatment, factors related to life habits and depression symptoms. Variables significantly associated with non-adherence to antiretroviral therapy were: time elapsed since HIV diagnosis (p = 0.002), daily dose (p = 0.046), use of alcohol (p = 0.030) and past drug use (p = 0.048), and borderline p-values were found for educational level (p = 0.093) and family monthly income (p = 0.08). In the multivariable analysis, the factors that remained in the final model were family monthly income, time period with HIV infection and use of alcohol. No association was observed between non-adherence to antiretroviral therapy and gender, age, sexual orientation, marital status, educational level and place of residence. Based on our results and the local situation we suggest: assessment of social needs; training of partners and/or families on supporting adherence, creation of "adherence groups" to motivate and to reassure patients on the benefits of treatment; counseling and/or psychotherapy for alcohol drinkers.