The Bambuí health and ageing study (BHAS): methodological approach and preliminary results of a population-based cohort study of the elderly in Brazil

OBJECTIVE: A cohort study has been designed to identify predictors of adverse health events in the elderly. The methodology of the study and preliminary descriptive results are presented. METHODS: The study population comprises all residents of Bambuí (Minas Gerais, Brazil), aged 60 or more years (n=1.742). From these, 92.2% were interviewed and 85.9% underwent clinical examination, consisting of haematological and biochemical tests, serology for Trypanosoma cruzi, anthropometric and blood pressure measures and electrocardiogram. Aliquots of serum, plasma and DNA were stored for future investigations. The baseline interview included sociodemographic characteristics, self-referred health condition and history of selected diseases, medication use, health service use, source of medical care, physical activities, smoking, drinking and eating habits, reproductive history, physical functioning, life events, social support and mental health. Individuals are being followed up annually. RESULTS: The following characteristics predominated among participants: women (60,0%), married (48.9%) or widowed (35.4%), people living in households with up to 2 residents (73.8%), heads of family (76.7%), people with monthly income between 1.00 and 2.99 Brazilian minimum wages (62.0%) and people with up to 4 years of schooling (89.1%). The median age was 68 years. Among the cohort members, only 1.7% were lost in the first follow-up. CONCLUSIONS: In general, the characteristics of the study population were very similar to those from other epidemiological studies of the elderly based on large Brazilian cities. The small number of losses to follow-up indicates that the choice of Bambuí was adequate, assuring the feasibility of a long term cohort study.

Core group approach to identify college students at risk for sexually transmitted infections

OBJECTIVE: To analyze the core group for sexually transmitted infections (STI) among college students. METHODS: Cross-sectional study carried out in a convenience sample comprising 711 college students of the public university of Morelos, Mexico, between 2001 and 2003. Sociodemographic and sexual behavior information were collected using self-applied questionnaires. Herpes simplex 2 (HSV-2) infection was tested in the blood. The number of sexual partners in the last year and cocaine consumption were used as indicators to construct the dependent variable "level of STI risk" in three categories: low, medium and high risk (core group). A multinomial analysis was conducted to evaluate whether different sex behaviors were associated with the variable "level of STI risk". RESULTS: There was significant association between HSV-2 seroprevalence and the variable "level of STI risk": 13%, 5.6% and 3.8% were found in high (core group), medium and low categories, respectively. There were gender differences regarding the core group. Men started having sexual intercourse earlier, had more sex partners, higher alcohol and drug consumption, higher frequency of sex intercourse with sex workers, exchanging sex for money, occasional and concurrent partners compared to women. CONCLUSIONS: The study findings suggest existing contextual characteristics in the study population that affect their sex behavior. In Mexico, the cultural conception of sexuality is determined mainly by gender differences where men engage in higher risky sexual behavior than women.

Oral health in the family health strategy: a change of practices or semantics diversionism

OBJECTIVE:To evaluate public health dentistry practices of two different family health models. METHODS: Qualitative study conducted with data obtained from focus groups consisting of 58 dentists working in the Family Health Strategy for at least three years between August-October, 2006. The Paideia Family Health Approach was used in the city of Campinas and the Oral Health Initiative as part of the Family Health Strategy was implemented in the city of Curitiba, Southeastern and Southern Brazil, respectively. Data was analyzed using the hermeneutic-dialectic method. Analysis indicators were employed to indicate backwardness, stagnation or progress in oral health practices effective from the implementation of the strategies referred. The indicators used were: work process; interdisciplinary approach; territorialization; capacity building of human resources; health promotion practices; and responsiveness to users' demands. RESULTS: There was progress in user access to services, humanization of health care, patient welcoming and patient-provider relationship. The results related to health promotion practices, territorialization, interdisciplinary approach and resource capacity building indicated a need for technical and operational enhancements in both cities. CONCLUSIONS: Both models have brought about important advances in terms of increased access to services and humanization of health care. Universal access to oral health at all levels of complexity was not achieved in both cities studied. Local health managers and oral health program coordinators must bring more weight to bear in the arena that defines public policy priorities.

Perspectives on access to in vitro fertilization in Portugal

OBJECTIVE: To analyze users' reasons for choosing in vitro fertilization treatment in public or private services and to identify their suggestions for improving fertility treatment. METHODS: A qualitative study using an interpretative approach was conducted. Fifteen semi-structured interviews were conducted with patients undergoing in vitro fertilization treatment (nine women, one man and five couples) at home or at their workplace in the districts of Viana do Castelo, Braga, Porto and Lisbon, Portugal, between July 2005 and February 2006. RESULTS: Users evaluated access to in vitro fertilization treatment in public and private services based mainly on their individual experiences and called for more access to less costly, faster and friendlier care with suitable facilities, appropriate time management and caring medical providers. These perceptions were also associated with views on the need for fighting stigmatization of infertility, protecting children's rights and guaranteeing sustainability of health care system. Interviewees sought to balance reduced waiting time and more attentive care with costs involved. The choice of services depended on the users' purchase power and place of residence and availability of attentive care. CONCLUSIONS: Current national policies on in vitro fertilization treatment meet user's demands of promoting access to, and quality, availability and affordability of in vitro fertilization treatment. However, their focus on legal regulation and technical-scientific aspects contrasts with the users' emphasis on reimbursement, insurance coverage and focus on emotional aspects of the treatment. The study showed these policies should ensure insurance coverage, participation of user representatives in the National Council for Assisted Reproductive Technology, promotion of infertility research and certification of fertility laboratories.

Population health diagnosis with an ecohealth approach

OBJECTIVE To analyze the characteristics of health diagnosis according to the ecohealth approach in rural and urban communities in Mexico.METHODS Health diagnosis were conducted in La Nopalera, from December 2007 to October 2008, and in Atlihuayan, from December 2010 to October 2011. The research was based on three principles of the ecohealth approach: transdisciplinarity, community participation, gender and equity. To collect information, a joint methodology and several techniques were used to stimulate the participation of inhabitants. The diagnostic exercise was carried out in five phases that went from collecting information to prioritization of problems.RESULTS The constitution of the transdisciplinary team, as well as the participation of the population and the principle of gender/equity were differentials between the communities. In the rural community, the active participation of inhabitants and authorities was achieved and the principles of transdisciplinarity and gender/equity were incorporated.CONCLUSIONS With all the difficulties that entails the boost in participation, the incorporation of gender/equity and transdisciplinarity in health diagnosis allowed a holistic public health approach closer to the needs of the population.

The metagenomic approach and causality in virology

Nowadays, the metagenomic approach has been a very important tool in the discovery of new viruses in environmental and biological samples. Here we discuss how these discoveries may help to elucidate the etiology of diseases and the criteria necessary to establish a causal association between a virus and a disease.

Readmission of older patients after hospital discharge for hip fracture: a multilevel approach

ABSTRACT OBJECTIVE To identify individual and hospital characteristics associated with the risk of readmission in older inpatients for proximal femoral fracture in the period of 90 days after discharge. METHODS Deaths and readmissions were obtained by a linkage of databases of the Hospital Information System of the Unified Health System and the System of Information on Mortality of the city of Rio de Janeiro from 2008 to 2011. The population of 3,405 individuals aged 60 or older, with non-elective hospitalization for proximal femoral fracture was followed for 90 days after discharge. Cox multilevel model was used for discharge time until readmission, and the characteristics of the patients were used on the first level and the characteristics of the hospitals on the second level. RESULTS The risk of readmission was higher for men (hazard ratio [HR] = 1.37; 95%CI 1.08–1.73), individuals more than 79 years old (HR = 1.45; 95%CI 1.06–1.98), patients who were hospitalized for more than two weeks (HR = 1.33; 95%CI 1.06-1.67), and for those who underwent arthroplasty when compared with the ones who underwent osteosynthesis (HR = 0.57; 95%CI 0.41–0.79). Besides, patients admitted to state hospitals had lower risk for readmission when compared with inpatients in municipal (HR = 1.71; 95%CI 1.09–2.68) and federal hospitals (HR = 1.81; 95%CI 1.00–3.27). The random effect of the hospitals in the adjusted model remained statistically significant (p < 0.05). CONCLUSIONS Hospitals have complex structures that reflect in the quality of care. Thus, we propose that future studies may include these complexities and the severity of the patients in the analysis of the data, also considering the correlation between readmission and mortality to reduce biases.