Socioeconomic position and health in a population of Brazilian elderly: the Bambuí Health and Aging Study (BHAS)

OBJECTIVE: Despite the vast scientific literature on the social determinants of health, there is still a debate on the extent to which this relationship remains in old age. The objective of this study was to examine the association between socioeconomic circumstances and health among older adults in a small town in Brazil. METHODS: The study was carried out in Bambuí, a town of around 15 000 inhabitants that is located in the state of Minas Gerais, which is in southeastern Brazil. From 1 177 residents aged 65 years or older, 1 074 of them (91.2%) were interviewed and 997 (84.7%) were examined (physical measurements and blood tests). Those in the lowest third of the distribution of total household monthly income, with an income of less than US$ 240 per month, were compared with those who had an income above that level. RESULTS: Lower family income was independently associated with: (1) some lifestyle risk factors (less consumption of fresh fruits or vegetables and less frequent exercise during leisure time in the preceding 30 days), (2) several indicators of worse health status (General Health Questionnaire score, self-rated health, self-rated visual acuity, level of difficulty in walking 300 meters, inability to perform routine activities because of a health problem in the preceding 2 weeks, and seropositivity for Trypanosoma cruzi), (3) a higher number of nonprescribed medications used in the preceding 3 months, and (4) a higher number of hospitalizations in the preceding 12 months. Obesity was more frequent in the higher-income group. CONCLUSIONS: The results of this study do not confirm observations in some developed countries of a lack of association between socioeconomic status and health among the aged. Our results showed that a small difference in monthly family income was sufficiently sensitive to identify elderly persons in worse health, even within a community that appears to be uniformly poor

Avaliação do Programa de Controle da Esquistossomose (PCE/PCDEN) em municípios situados na Bacia do Rio São Francisco, Minas Gerais, Brasil

Foi feita uma avaliação do programa de controle da esquistossomose (PCE/PCDEN) na região da Bacia do Rio São Francisco em Minas Gerais. A área em estudo compreende seis municípios, com 130.000 habitantes e 916 localidades em uma área de 10.722km². As atividades tiveram início em quatro municípios entre 1983 e 1985 e em dois outros em 1987. As principais medidas de controle adotadas foram tratamentos sucessivos com oxamniquine e aplicações de niclosamida em coleções hídricas. A prevalência da infecção pelo Schistosoma mansoni nos primeiros quatro municípios, que inicialmente estava entre 18 e 32%, diminuiu abruplamente após a primeira intervenção (1984/85) e permaneceu em níveis inferiores aos iniciais até a última avaliação realizada (1990/94); tendência semelhante foi observada para a proporção de caramujos infectados. Nestes municípios, a proporção de localidades sem a infecção ou com prevalências inferiores a 5% aumentou em detrimento daquelas com níveis mais altos de prevalência. Nos dois outros municípios, com prevalências iniciais inferiores a 5 %, nãoforam observadas mudanças substanciais nos indicadores endêmicos; a relação custo benefício do programa nos últimos municípios deve ser avaliada e as prioridades redirecionadas para erradicar as áreas focais e prevenir a expansão para áreas indenes. Os autores chamam a atenção para as dificuldades a longo prazo de um programa de controle fundamentado em tratamentos sucessivos. Informações sobre os fatores determinantes da infecção pelo S. mansoni em cada localidade, ou em conjunto de localidades semelhantes, permitiriam a elaboração de medidas complementares ao tratamento mais duradouras e menos dependentes da contínua utilização deste

The association between nutritional status and cognitive impairment in Brazilian community-dwelling older adults assessed using a range of anthropometric measures - the Bambui Study

ABSTRACT In most studies, body mass index (BMI) has been used as the main measurement of nutritional status. However, BMI does not differentiate between body fat and muscle mass. Objective: To investigate the association between nutritional status and cognitive impairment in a population of Brazilian elderly. Methods: Participants (n=1,496) from the Bambuí Cohort Study of Aging were selected based on the results for the two variables nutritional status and cognitive impairment (MMSE score). Gender, age, education, lifestyle, ApoE, chronic diseases, depressive symptoms, current use of hypnotic or sedative medication and functional disability were used as confounding factors for adjusting the logistic regression. Results: Cognitive impairment was associated with lower BMI (OR: 0.91; CI: 0.86-0.95), waist circumference (OR: 0.97; CI: 0.95-0.99), triceps skinfold thickness (OR: 0.92; CI: 0.89-0.96) among the younger participants (60-69 years), while lower arm muscle circumference (OR: 0.88; CI: 0.80-0.98) and corrected arm muscle area (OR: 0.96; CI: 0.93-0.99) were associated with cognitive impairment among the older participants (70 years and over). Conclusion: There was a difference of association between anthropometric measures and cognitive impairment after stratifying by age group. In the group aged between 60 and 69, cognitive impairment was associated with measures related to fat mass, while in the group aged over 70, cognitive impairment was associated with measures related to muscle mass. This finding suggests that investigation of nutritional status in the elderly using anthropometric measures should not be restricted only to the use of BMI, and should also, differ according to age