Autoavaliação de saúde por pacientes em hemodiálise no Sistema Único de Saúde

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.OBJETIVO Analisar se nível de complexidade de estrutura dos serviços e características sociodemográficas e clínicas de pacientes em hemodiálise estão associados à prevalência de autoavaliação de saúde ruim. MÉTODOS Neste estudo transversal, foram avaliados 1.621 pacientes com doença renal crônica terminal em hemodiálise acompanhados em 81 serviços de diálise no Sistema Único de Saúde, no ano de 2007. A amostragem foi realizada por conglomerado em dois estágios e um questionário estruturado foi aplicado aos participantes. Para análise dos dados, foi usada regressão logística múltipla multinível. RESULTADOS A prevalência de autoavaliação de saúde ruim foi de 54,5%, e na análise multivariada apresentou associação com as seguintes variáveis: aumento da idade (OR = 1,02; IC95% 1,01–1,02), estado civil separado ou divorciado (OR = 0,62; IC95% 0,34–0,88), ter doze anos ou mais de estudo (OR = 0,51; IC95% 0,37–0,71), gastar mais de 60 min no deslocamento entre a casa e o serviço de diálise (OR = 1.80; IC95% 1,29–2,51), apresentar três ou mais doenças autorreferidas (OR = 2,20; IC95% 1,33–3,62) e relatar alguma (OR = 2,17; IC95% 1,66–2,84) ou muita (OR = 2,74; IC95% 2,04–3,68) dificuldade para dormir. Indivíduos em tratamento nos serviços de diálise com maior nível de complexidade na estrutura apresentaram menor chance de autoavaliar sua saúde como ruim (OR = 0,59; IC95% 0,42–0,84). CONCLUSÕES Autoavaliação de saúde ruim mostrou-se associada à idade, anos de estudo, estado civil, tempo de deslocamento de casa até o serviço de diálise, número de doenças autorreferidas, relato de dificuldade para dormir e também ao nível de complexidade da estrutura dos serviços de saúde. O reconhecimento desses fatores pode contribuir para o desenvolvimento de estratégias para melhorar a saúde dos pacientes em hemodiálise no Sistema Único de Saúde

A case-control study of microenvironmental risk factors for urban visceral leishmaniasis in a large city in Brazil, 1999-2000.

OBJECTIVES: We investigated potential microenvironmental risk factors for visceral leishmaniasis in urban and suburban areas, and developed risk scores to characterize the household and the neighborhood. These scores may be useful to identify microenvironments within cities that place residents at greater risk of visceral leishmaniasis. METHODS: In this case-control study, cases were all persons with visceral leishmaniasis reported from July 1999 through December 2000 in the Belo Horizonte metropolitan area, Brazil. Two kinds of controls-neighborhood and hospital-were used. Cases and controls were matched by age (+/-2 years). We developed four scores to characterize the microenvironment (indoor, outdoor, animal indoor, and animal outdoor), and also considered the level of urbanization of the area. RESULTS: A total of 106 neighborhood controls and 60 hospital controls were identified for 109 cases. Among the cases, 69 (63.3%) were men and 40 (36.7%) were women. Most cases were under 15 years old (64.2%), and 39 (35.8%) were 15 years old or more. The outdoor score [odds ratio (OR) = 1.49; 95% confidence interval (CI) = 1.03-2.14] and animal outdoor scores (OR = 1.79[95% CI 1.21-2.65]) were significantly associated with the odds of visceral leishmaniasis in our sample. We also found a significant interaction between sex and age. Compared to females 15 years old or more, males 15 years old or more were more likely to have visceral leishmaniasis (OR = 7.02[95% CI 2.20-22.20]). CONCLUSIONS: Animals in the neighborhood were associated with a greater odds of visceral leishmaniasis. Cases were more likely than controls to live in transitional or rural areas, although this difference was not statistically significant, possibly because of the small sample size.http://deepblue.lib.umich.edu/bitstream/2027.42/78577/1/OliveiraDiezRoux2007_RevistaPana.pd

The influence of neighborhood social capital on leisure-time physical activity : a population-based study in Brazil.

Environmentally targeted approaches to promote physical activity are emerging in recent years as a complementary strategy to the traditional individual approaches. This study explored the relation between community social capital and leisure-time physical activity in an adult population-based sample in Brazil. We applied a generalized estimating equation approach to analyze a cross-sectional survey of 3667 adults living in 149 neighborhoods. Social capital was assessed by scales that measured collective efficacy and social cohesion in the neighborhood. We find that individuals living in areas with higher level of social cohesion were more likely to be physically active even after controlling for potentially confounding individual and area-level covariates (PR?=?1.56; 95% CI?=?1.13, 2.16). Collective efficacy was not significantly associated with leisure-time physical activity. Interventions to strengthen social cohesion in the community may be an avenue for promoting physical activity

Time trends and predictors of mortality from ill-defined causes in old age: 9 year folllow-up of the Bambuí cohort study (Brazil) Tendências e fatores associados aos óbitos por causas mal definidas em idosos: nove anos de seguimento da coorte de Bambuí (Brasil)

The study objective was to examine differentials in time trends and predictors of deaths assigned to symptoms, signs and ill-defined conditions in comparison with other ill-defined conditions (ill-defined cardiovascular diseases, cancer and injury) in a population-based cohort study. Of 1,606 baseline participants aged 60 years and over, 524 died during 9-year follow-up and were included in this study. Deaths coded to "symptoms" declined by 77% in the period from 1997-1999 to 2003-2005. Deaths coded to other ill-defined conditions remained unchanged. The calendar period 2003-2005 (RR = 0.25; 95%CI: 0.09-0.70) and in-hospital deaths (RR = 0.16; 95%CI: 0.08-0.34) were independently associated with "symptoms", but not with other ill-defined conditions. Baseline socio-demographic characteristics and chronic diseases were not predictors of these outcomes. International and national agencies have focused on the reduction of deaths assigned to "symptoms" to improve the registration of vital statistics, while other ill-defined conditions have received little attention. Our data provide evidence supporting the need to redress this situation.<br>As tendências e os determinantes dos óbitos codificados como sinais, sintomas e afecções mal definidas ("sintomas") foram comparados a outras causas mal definidas (algumas doenças cardiovasculares, neoplasias e causas externas). De 1.606 participantes da coorte de base populacional de idosos de Bambuí, Minas Gerais, Brasil, 524 faleceram em nove anos de seguimento e foram incluídos no estudo. As mortes por "sintomas" diminuíram 77% entre 1997-1999 e 2003-2005. Os óbitos por outras causas mal definidas permaneceram inalterados. O período de 2003-2005 (RR = 0,25; IC95%: 0,09-0,70) e os óbitos hospitalares (RR = 0,16; IC95%: 0,08-0,34) associaram-se independentemente com "sintomas", e não com as outras causas mal definidas. Características sócio-demográficas e doenças crônicas na linha de base não apresentaram associações com esses eventos. Estratégias para a redução dos óbitos por "sintomas" têm sido priorizadas por agências internacionais e nacionais, enquanto os óbitos por outras causas mal definidas têm recebido pouca atenção. Os resultados reforçam a necessidade de estratégias para mudar essa situação

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