Longitudinal study of patients with chronic Chagas cardiomyopathy in Brazil (SaMi-Trop project): a cohort profile.

PurposeWe have established a prospective cohort of 1959 patients with chronic Chagas cardiomyopathy to evaluate if a clinical prediction rule based on ECG, brain natriuretic peptide (BNP) levels, and other biomarkers can be useful in clinical practice. This paper outlines the study and baseline characteristics of the participants.ParticipantsThe study is being conducted in 21 municipalities of the northern part of Minas Gerais State in Brazil, and includes a follow-up of 2 years. The baseline evaluation included collection of sociodemographic information, social determinants of health, health-related behaviours, comorbidities, medicines in use, history of previous treatment for Chagas disease, functional class, quality of life, blood sample collection, and ECG. Patients were mostly female, aged 50-74 years, with low family income and educational level, with known Chagas disease for >10 years; 46% presented with functional class >II. Previous use of benznidazole was reported by 25.2% and permanent use of pacemaker by 6.2%. Almost half of the patients presented with high blood cholesterol and hypertension, and one-third of them had diabetes mellitus. N-terminal of the prohormone BNP (NT-ProBNP) level was >300 pg/mL in 30% of the sample.Findings to dateClinical and laboratory markers predictive of severe and progressive Chagas disease were identified as high NT-ProBNP levels, as well as symptoms of advanced heart failure. These results confirm the important residual morbidity of Chagas disease in the remote areas, thus supporting political decisions that should prioritise in addition to epidemiological surveillance the medical treatment of chronic Chagas cardiomyopathy in the coming years. The São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) represents a major challenge for focused research in neglected diseases, with knowledge that can be applied in primary healthcare.Future plansWe will continue following this patients' cohort to provide relevant information about the development and progression of Chagas disease in remotes areas, with social and economic inequalities.Trial registration numberNCT02646943; Pre-results

Uso de serviços odontológicos por rotina entre idosos brasileiros: Projeto SB Brasil Routine use of dental services by the elderly in Brazil: the SB Brazil Project

Investigou-se o uso de serviços odontológicos por rotina entre idosos brasileiros participantes do Projeto SB Brasil. Desses, 2.305 eram dentados, 2.704, edentados, a prevalência do uso foi de 20% e 17%, respectivamente. A regressão logística mostrou que, entre dentados, o uso foi maior entre aqueles com maior escolaridade e menor entre residentes no Norte e Nordeste; na zona rural; que não usaram no último ano; que não foram informados sobre como evitar problemas bucais; que relataram dor; que necessitavam de próteses e de tratamento periodontal; que autoperceberam sua mastigação regular; cuja condição bucal afetava o relacionamento; que autoperceberam sua fala ruim/péssima. Entre edentados, o uso por rotina foi maior entre aqueles com maior escolaridade e entre usuários de serviços pagos. Foi menor entre não brancos; residentes no nordeste; na zona rural; que não usaram no último ano; que não foram informados sobre como evitar problemas bucais; os com menor renda; que necessitavam de prótese; cuja condição bucal afetava o relacionamento. Iniqüidades, barreiras financeiras e falta de informações parecem prejudicar o uso rotineiro, indicando necessidade de políticas públicas.The routine use of dental services by elderly participants in a representative survey of Brazilians (the SB Brazil Project) was investigated. 2,305 were dentate and 2,704 edentulous. Prevalence of use was 20% and 17%, respectively. Poisson regression showed that for dentate individuals, use was lower among residents who: lived in rural areas; had not received preventive oral health information; had lower incomes; needed a dental prosthesis; had periodontal problems; perceived their chewing as fair, bad, or terrible; felt that oral health affected their social interaction; and reported tooth pain. Among edentulous individuals, use was higher among those who paid out-of-pocket for dental services and was lower among those who: lived in rural areas; had used dental services more than a year previously; self-identified as non-white; had not received preventive oral health information; had less schooling; needed a dental prosthesis; and felt that oral health affected their social interaction. Inequalities, economic barriers, and lack of information jeopardized the routine use of dental services. Targeted public policies are required to correct these problems

Benznidazole Use among Patients with Chronic Chagas' Cardiomyopathy in an Endemic Region of Brazil.

Chagas disease (CD) is a neglected tropical disease that affects individuals in almost every country in Latin America. There are two available drugs with antiparasitic profiles; however, only benznidazole (BZN) has been approved for commercialization in Brazil. The usefulness of prescribing BZN for patients with chronic Chagas cardiomyopathy (CCC) is controversial. There are no studies in the literature describing the extent of BZN use at this stage or the profile of patients using this drug. The present study aimed to determine the prevalence and factors associated with previous BZN use among individuals with CCC. This cross-sectional study was conducted with 1,812 individuals with CCC from 21 Brazilian cities endemic for CD. The dependent variable was "prior use of BZN" (no vs. yes). The independent variables were grouped into socioeconomic, lifestyle and medical history aspects. Binary logistic regression (α ≥ 0.05) was used. Among the evaluated individuals, 27.2% reported previous use of BZN. The likelihood of prior use of BZN was higher among younger individuals (OR = 2.7), individuals with a higher education (OR = 2.7), individuals with a lower monthly per capita income (OR = 1.3), individuals who practiced physical exercise (OR = 1.5), individuals who had prior knowledge of the CD diagnosis (OR = 2.5), individuals without hypertension (OR = 1.3) and individuals with a longer time to the CD diagnosis (OR = 6.1). The present study revealed a small proportion of therapeutic BZN use among Brazilian CCC patients. This finding suggests a late diagnosis and undertreatment of the disease. BZN use was higher among individuals with better clinical and demographic conditions but with a lower income and a longer time to the CD diagnosis. Knowledge of the BZN usage profile may help reduce the current state of neglect of this disease and pave the way for future studies

QUALIDADE DE VIDA, SATISFAÇÃO E ESFORÇO/RECOMPENSA NO TRABALHO, TRANSTORNOS PSIQUICOS E NÍVEIS DE ATIVIDADE FÍSICA ENTRE TRABALHADORES DA ATENÇÃO PRIMÁRIA À SAÚDE

Estudo transversal que investigou qualidade de vida, satisfação com o trabalho, presença de transtornos psíquicos e hábitos de atividade física entre trabalhadores da atenção primária à saúde de Montes Claros – MG. Foram utilizados instrumentos validados (WHOQOL-Bref, Escala de Equilíbrio Esforço/Recompensa no trabalho, Questionário de Saúde Geral e o Questionário Internacional de Atividades Físicas). Foram conduzidas análises descritivas e bivariadas. Na análise bivariada, as categorias profissionais foram reunidas em três grupos (ACS; técnicos/auxiliares; enfermeiros/dentistas/médicos). Foram avaliados 752 trabalhadores (95% do total), sendo 470 ACS, 69 Técnicos/Auxiliares de Enfermagem e 51 de Saúde Bucal, 52 Cirurgiões-dentistas, 71 Enfermeiros e 39 Médicos. A idade média foi 32 anos (±8,3), sendo 80% mulheres. Cerca de 20% apresentaram insatisfação com o trabalho. Relações sociais e Meio ambiente foram respectivamente as dimensões de menor e maior impacto na qualidade de vida. No trabalho, 67% apresentaram desequilíbrio entre esforço/recompensa. Cerca de 16% apresentou saúde psíquica debilitada e 22% eram sedentários/insuficientemente ativos. A satisfação com o trabalho, o esforço/recompensa no trabalho, a saúde psíquica e o nível de atividade física mostraram diferença estatisticamente significativa (

Autopercepção da saúde bucal e impacto na qualidade de vida do idoso: uma abordagem quanti-qualitativa Self-perception of oral health and impact on quality of life among the elderly: a quantitative-qualitative approach

Este estudo, de abordagem quanti-qualitativa, objetivou aprofundar o entendimento das relações entre autopercepção, impacto na qualidade de vida e condições bucais de idosos. Exame clínico e entrevista gravada contendo questões objetivas e discursivas foram realizados com 45 idosos. Conduziu-se análise descritiva quantitativa das questões objetivas e referentes ao exame clínico e à análise de conteúdo das questões discursivas de abordagem qualitativa. Imagens fotográficas do estado bucal foram relacionadas a trechos das entrevistas. A análise quantitativa evidenciou: 4,8 dentes em média; CPOD (número de dentes cariados, perdidos e obturados) médio de 29,9; 57,7% eram desdentados, 60% acreditavam não necessitar tratamento, 75% sofriam impacto na qualidade de vida devido às condições bucais, apesar de 67% perceberem positivamente sua saúde bucal. Na análise qualitativa constatou-se subestimação de sintomas, falta de esperança e resignação frente às limitações impostas pelo precário estado clínico. Muitos encararam as limitações como conseqüência do envelhecimento e não como problema que mereça ser corrigido. O que mais incomodou foram as relações de dependência e a proximidade com a morte, minimizando outros problemas. A população idosa foi informada de que poderia modificar sua autopercepção, conscientizando-a que esta realidade pode ser modificada.<br>A qualitative-quantitative approach was used in this study to obtain a clearer understanding of the relationship between self-perception, impact on quality of life and oral health among the elderly. Clinical examination and recorded interviews with objective and discursive questions were conducted with 45 institutionalized elderly people. Descriptive analyses of quantitative data were made. The interviews were transcribed and a systematic reading of the interviews was carried out selecting the components related to the categories under analysis. Photographic images of the oral clinical status were correlated with participants' speech. Quantitative analysis revealed: an average of 4.8 teeth; DMFT were 29.9; 57.7 % were toothless; 60% believed they did not need dental care; 75% suffered a great impact on quality of life due to oral health conditions, despite the fact that 67% evaluated their oral health positively. Underestimation of symptoms, lack of hope and resignation due to limitations regarding poor clinical status were detected. Most elderly people viewed such limitations as a consequence of aging and not as a problem that may be solved. This reality can be changed through information and guidance for elderly people