PREVALÊNCIA E CAUSAS DE NÃO ADESÃO AO TRATAMENTO ANTI-HIPERTENSIVO DE IDOSOS NA ATENÇÃO BÁSICA / PREVALENCE AND CAUSES OF NONADHERENCE TO ANTIHYPERTENSIVE TREATMENT OF THE ELDERLY IN PRIMARY CARE

Introdução: A hipertensão arterial é o fator de risco modificável melhor relacionado com a morbimortalidade cardiovascular. Com o envelhecimento da população, a prevalência da hipertensão arterial aumentou, elevando também a taxa de mortalidade por doenças cardiovasculares. Objetivo: Determinar a prevalência e causas da não adesão ao tratamento medicamento e não medicamentoso dos pacientes idosos hipertensos de uma Unidade Básica de Saúde. Métodos: Estudo descritivo, quantitativo, desenvolvido com idosos hipertensos cadastrados no programa HIPERDIA de uma Unidade Básica de Saúde de São Luís (MA), no período de outubro a dezembro de 2011, com aplicação de 3 questionários: instrumento sobre perfil sociodemográfico e clínico, Questionário de Frequência de Consumo de Alimentos (QFCA) e Medida de Adesão aos Tratamentos (MAT). Resultados: De acordo com os dados, 47% dos entrevistados tinham idade entre 60 a 69 anos. As mulheres correspondiam a 69,7%. A prática de atividade física com regularidade foi de 16,7% dos idosos. Dos idosos, 60,6% tinham aderência à terapêutica medicamentosa, 31,8% foram considerados fracamente aderentes, e 7,6% não aderentes ao tratamento medicamentoso. A maioria dos idosos obtinha suas medicações de farmácias da rede pública, correspondendo a 56,1%. Em relação à obtenção da medicação, 84,8% apresentam alguma dificuldade (falta de recursos financeiros, falta de medicação na unidade básica). Conclusão: Percebeu-se que a taxa de não adesão ao tratamento anti-hipertensivo de idosos é influenciada por diversos fatores. Os resultados apontam a necessidade de implementação de abordagens interdisciplinares de promoção da saúde para aumento da adesão terapêutica.Palavras-chaves: Hipertensão. Idosos. Terapêutica.AbstractIntroduction: Hypertension is a modifiable risk factor, which is better related to cardiovascular morbidity and mortality. Because of population ageing, the prevalence of hypertension increased as well as the rate of cardiovascular mortality. Objective: To determine the prevalence and causes of nonadherence to drug treatment and non-drug treatment of hypertensive elderly patients of a Primary Care Unit. Methods: Quantitative descriptive study developed with elderly hypertensive patients enrolled in the HIPERDIA program of a Primary Care Unit of São Luís, Maranhão State, Brazil. The study was performed from October to December 2011 by applying three questionnaires: a instrument about socio-demographic and clinical profile, a Food Frequency Questionnaire (FFQ) and the Measurement of Treatment Adherence (MTA). Results: According to the data, 47% of the participants were between 60 to 69 years of age with 69.7% being women. 16.7% of elderly people said to practice regular physical activity. Of all elderly people, 60.6% had adherence to drug therapy, 31.8% were considered poorly adherent, and 7.6% nonadherent to medication. Most of them (56.1%) obtained their medications from public drugstores. Regarding the acquisition of medication, 84.8% have some difficulties (lack of financial resources, lack of medication in the Primary care unit). Conclusion: We noticed that the rate of nonadherence to antihypertensive treatment of elderly people is influenced by several factors. The results indicate the need for implementation of interdisciplinary approaches of health promotion in order to increase therapeutic adherence.Keywords: Hypertension. Elderly. Therapeutics

DEPRESSÃO EM IDOSOS HIPERTENSOS E DIABÉTICOS NO CONTEXTO DA ATENÇÃO PRIMÁRIA EM SAÚDE

Objetivo: Determinar a prevalência de depressão em idosos com diagnóstico de hipertensão arterial e/ou diabetes assistidos por equipes da Estratégia de Saúde da Família. Métodos: Trata-se de um estudo transversal, descritivo, com abordagem quantitativa, realizado no período de outubro de 2010 à março de 2011, com 66 pacientes idosos com hipertensão arterial e/ou diabetes atendidos em uma Unidade de Saúde, mediante aplicação da Escala Geriátrica de Depressão. Resultados: Verificou-se que 31,8% dos idosos tinham depressão, destes, 27,3% foram caracterizados tendo depressão leve (escore de 6 a 10 pontos) e 4,5% com depressão severa (escore de 11 pontos ou maior). Conclusão: Com base na alta prevalência de depressão nos idosos atendidos na atenção primária, fazem-se necessárias iniciativas para o diagnóstico e tratamento adequados da depressão nesta população, visando à melhoria da expectativa e qualidade de vida dos idosos

Inadequate prenatal care utilization and associated factors in São Luís, Brazil

BACKGROUND: Over the last decades there has been a reduction of social inequalities in Brazil, as well as a strong expansion of health services, including prenatal care. The objective of the present study was to estimate the rate of inadequate prenatal care utilization and its associated factors in São Luís, Brazil, in 2010 and to determine whether there was a reduction of inequity in prenatal care use by comparing the present data to those obtained from a previous cohort started in 1997/98. METHODS: Data from the BRISA (Brazilian birth cohort studies of Ribeirão Preto and São Luís) population-based cohort, which started in 2010 (5067 women), were used. The outcome variable was the inadequate utilization of prenatal care, classified according to the recommendations of the Brazilian Ministry of Health. The explanatory variables were organized into three hierarchical levels based on the Andersen’s behavioral model of the use of health services: predisposing, enabling and need factors. RESULTS: Only 2.0% of the women did not attend at least one prenatal care visit. The rate of inadequate prenatal care utilization was 36.7%. Despite an improved adequacy of prenatal care use from 47.3% in 1997/98 to 58.2% in 2010, social inequality persisted: both low maternal schooling (prevalence ratio (PR) = 2.78; 95% confidence interval (95% CI) 2.23-3.47 for 0 to 4 years of study) and low family income, less than 0.5 monthly minimum wage per capita (PR = 1.37; 95% CI 1.22-1. 54), continued to be associated with higher rates of inadequate prenatal care utilization. Racial disparity regarding adequate utilization of prenatal services was detected, with black (PR = 1.19; 95% CI 1.04-1.36) and mulatto (PR = 1.14; 95% CI 1.02-1.26) women showing higher rates of inadequate use. On the other hand, women covered by the FHP - Family Health Program (PR = 0.92; 95% CI 0.85-0.98) showed a lower rate of inadequate prenatal care utilization. CONCLUSIONS: Despite strong expansion of health services and expressive improvements in adequate prenatal care use and social indicators, inequalities in prenatal care use still persist. The FHP seems to be effective in reducing inadequate prenatal care utilization

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data