Common Mental Disorders And The Use Of Psychoactive Drugs: The Impact Of Socioeconomic Conditions

Objective: To evaluate the infl uence of socioeconomic conditions on the association between common mental disorders and the use of health services and psychoactive drugs. Methods: This was a population-based cross-sectional study conducted in the city of Botucatu, Southeastern Brazil. The sample was probabilistic, stratifi ed and cluster-based. Interviews with 1,023 subjects aged 15 years or over were held in their homes between 2001 and 2002. Common mental disorders were evaluated using the Self-Reporting Questionnaire (SRQ-20). The use of services was investigated in relation to the fortnight preceding the interview and the use of psychotropic drugs, over the preceding three days. Logistic regression was used for multivariable analysis, and the design effect was taken into consideration. Results: Out of the whole sample, 13.4% (95% CI: 10.7;16.0) had sought health services over the fortnight preceding the interview. Seeking health services was associated with female gender (OR=2.0) and the presence of common mental disorders (OR=2.2). 13.3% of the sample (95% CI: 9.2;17.5) said they had used at least one psychotropic drug, especially antidepressives (5.0%) and benzodiazepines (3.1%). In the multivariable analysis, female gender and the presence of common mental disorders remained associated with the use of benzodiazepines. Per capita income presented a direct and independent association with the use of psychoactive drugs: the greater the income, the greater the use of these drugs was. Conclusions: Lower income was associated with the presence of common mental disorders, but not with the use of psychotropic drugs. The association of common mental disorders and the use of psychotropic drugs in relation to higher income strengthens the hypothesis that inequality of access to medical services exists among this population.424717723Ballester, D.A., Filipon, A.P., Braga, C., Andreoli, S.B., The general practitioner and mental health problems: Challenges and strategies for medical education (2005) Sao Paulo Med J, 123 (2), pp. 72-76. , doi:10.1590/ S1516-31802005000200008Beck, C.A., Williams, J.V., Wang, J.L., Kassam, A., El-Guebaly, N., Currie, S.R., Psychotropic medication use in Canada (2005) Can J Psychiatry, 50 (10), pp. 605-613Galduroz, J.C., Noto, A.R., Nappo, S.A., Carlini, E.L., First household survey on drug abuse in São Paulo, Brazil, 1999: Principal findings (2003) Sao Paulo Med J, 121 (6), pp. 231-237. , doi:10.1590/S1516-31802003000600003Harding, T.W., Arango, M.V., Baltazar, J., Climent, C.E., Ibrahim, H.H., Ladrido-Ignacio, L., Mental disorders in primary health care: A study of their frequency and diagnosis in four developing countries (1980) Psychol Med, 10 (2), pp. 231-241Hart, J.T., The inverse care law (1971) Lancet, 1 (7696), pp. 405-412Hennekens, C.H., Buring, J.E., (1987) Epidemiology in Medicine, , Boston: Little, Brown and Company;Hosmer, D.W., Lemeshow, S., (1989) Applied Logistic Regression, , New York: John Wiley & Sons;Iacoponi, E., Detecção de distúrbios emocionais pelo médico: Impacto do tipo de trabalho médico e do conceito sobre doenças mentais. (1997) Rev Cienc Med PUCCAMP, 6, pp. 41-45Lima, M.S., Hotopf, M., Mari, J.J., Béria, J.U., De Bastos, A.B., Mann, A., Psychiatric disorder and the use of Benzodiazepines: An example of the inverse care law from Brazil (1999) Soc Psychiatry Psychiatr Epidemiol, 34 (6), pp. 316-322Maragno, L., Goldbaum, M., Gianini, R.J., Novaes, H.M.D., Cesar, C.L., Prevalência de Transtorno mental comum em populacões atendidas pelo Programa Saúda da família (QUALIS) no município de Sao Paulo, Brasil. (2006) Cad Saude Publica, 22 (8), pp. 1639-1648. , doi: 10.1590/S0102-311X2006000800012Mari, J.J., Williams, P., A validity study of a Psychiatric Screening Questionnaire (SRQ-20) in Primary care in the city of São Paulo (1986) Br J Psychiatry, 148, pp. 23-26Mari, J.J., Almeida-Filho, N., Coutinho, E., Andreoli, S.B., Miranda, C.T., Streiner, D., The epidemiology of psychotropic use in the city of São Paulo (1993) Psychol Med, 23 (2), pp. 467-474Marín-Lŕon, L., Oliveira, H.B., Barros, M.B., Dalgalarrondo, P., Botega, N.J., Social inequality and common mental disorders (2007) Rev Bras Psiquiatr, 29 (3), pp. 250-253Mendoza-Sassi, R., Béria, J.U., Barros, A.J., Outpatient health service utilization and associated factors: A population-based study (2003) Rev Saude Publica, 37 (3), pp. 372-378Moncrieff, J., Psychiatric drug promotion and the politics of neo-liberalism (2006) Br J Psychiatry, 188, pp. 301-302Patel, V., Araya, R., Lima, M., Ludermir, A., Todd, C., Women, poverty and common mental disorders in four restructuring societies (1999) Soc Sci Med, 49 (11), pp. 1461-1471Rodrigues, M.A., Facchini, L.A., Lima, M.S., Modificações nos padrões de consumo de psicofármacos em localidade do Sul do Brasil. (2006) Rev Saude Publica, 40 (1), pp. 107-114. , doi:10.1590/ S0034-89102006000100017(2000) Collaborating Centre for Drug Statistics Methodoly Guidelines for ATC classification and DDD assignment, , World Health Organization, 3. ed. Oslo;Zandstra, S.M., Furer, J.W., van de Lisdonk, E.H., van't Hof, M., Bor, J.H.J., van Well, C., Different study criteria affect the prevalence of benzodiapine use (2002) Soc Psychiatry Psychiatr Epidemiol, 37 (3), pp. 139-14

Social Inequalities In Health Among The Elderly [desigualdades Sociais Em Saúde Entre Idosos]

The aim of the present study was to assess social inequalities in health status, health behavior and the use of health services based on education level. A population-based cross-sectional study was carried out involving 1,518 elderly residents of Campinas, São Paulo State, Brazil. Significant demographic and social differences were found between schooling strata. Elderly individuals with a higher degree of schooling are in greater proportion alcohol drinkers, physically active, have healthier diets and a lower prevalence of hypertension, diabetes, dizziness, headaches, back pain, visual impairment and denture use, and better self-rated health. But, there were no differences in the use of health services in the previous two weeks, in hospitalizations or surgeries in the previous year, nor in medicine intake over the previous three days. Among elderly people with hypertension and diabetes, there were no differences in the regular use of health services and medication. The results demonstrate social inequalities in different health indicators, along with equity in access to some health service components.27SUPPL.2198208Braveman, P.A., Cubbin, C., Egerter, S., Williams, D.R., Pamuk, E., Socioeconomic disparities in health in the United States: What the patterns tell us (2010) Am J Public Health, 100 (SUPPL. 1), pp. S186-S196Silva, J.B., Barros, M.B.A., Epidemiologia e desigualda-de: Notas sobre a teoria e a história (2002) Rev Panam Salud Pública, 12, pp. 375-383Equitity in health and health care: A WHO/SIDA initiative (1996) Geneva: World Health Organization, , World Health Organization(2008) As Causas Sociais Das Iniqüidades Em Saúde No Brasil/CNDSS, , Comissão Nacional dos Determinantes Sociais em Saúde, Rio de Janeiro: Editora FiocruzMarmot, M., WHO Commission on Social Determinants of Health. Closing the health gap in a generation: The work of the Commission on Social Determinants of Health and its recommendations (2009) Glob Health Promot, (SUPPL. 1), pp. 23-27Gwatkin, D.R., Health inequalities and the health of the poor: What can we do? (2000) Bull World Health Organ, 78, pp. 3-18Liberatos, P., Link, B.G., Kelsey, J.L., The measurement of social class in epidemiology (1988) Epidemiol Rev, 10, pp. 87-120Muntaner, C., Borrel, C., Benach, J., Pasarín, M.I., Fe-Randes, E., The association of social class and social stratification with patterns of general and mental health in a Spanish population (2003) Int J Epidemiol, 32, pp. 950-958Wilkinson, R.G., Income distribution and life expectancy (1992) BMJ, 304, pp. 165-168Espelt, A., Borrell, C., Rodríguez-Sanz, M., Muntaner, C., Pasarín, M.I., Benach, J., Inequalities in health by social class dimensions in European countries of different political traditions (2008) Int J Epidemiol, 37, pp. 1095-1105Robert, S., House, J., SES differentials in health by age and alternative indicators of SES (1996) J Aging Health, 8, pp. 359-388Crimmins, E.M., Kim, J.K., Seeman, T.E., Poverty and biological risk: The earlier "aging" of the poor (2009) J Gerontol a Biol Sci Med Sci, 64, pp. 286-292Adams, J.M., White, M., Biological ageing: A fundamental, biological link between socioeconomic status and health? (2004) Eur J Public Health, 14, pp. 331-334Huisman, M., Kunst, A.E., Mackenbach, J.P., Socioeco-nomic inequalities in morbidity among the elderly: A European overview (2003) Soc Sci Med, 57, pp. 861-873Kaplan, M.S., Huguet, N., Feeny, D.H., McFarland, B.H., Self-reported hypertension prevalence and income among older adults in Canada and the United States (2010) Soc Sci Med, 70, pp. 844-849Fang, R., Kmetic, A., Millar, J., Drasic, L., Disparities in chronic disease among Canada's low-income populations (2009) Prev Chronic Dis, 6, pp. A115Barros, M.B.A., César, C.L.G., Carandina, L., Goldbaum, M., (2008) As Dimensões Da Saúde: Inquérito Populacio-nal Em Campinas, S P, , São Paulo: Editora HucitecBarbor, T.E., la Fuente, J.R., Saunders, J., Grant, M., (1992) AUDIT-The Alcohol Use Disorders Identification Test: Guidelines For Use In Primary Health Care, , Geneva: World Health OrganizationCervi, A., Franceschni, S.C.C., Priore, S.E., Análise crítica do uso do índice de massa corporal para idosos (2005) Rev Nutr, 18, pp. 765-775Mari, J.J., Williams, P., A validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of Sao Paulo (1986) Br J Psychiatry, 148, pp. 23-26Mackenbach, J.P., Stirbu, I., Roskam, A.J., Schaap, M.M., Menvielle, G., Leinsalu, M., Socioeconomic inequalities in health in 22 European countries (2008) N Engl J Med, 358, pp. 2468-2481(2004) Bra-sil, 15 Capitais E Distrito Federal, 2002-2003, , Instituto Nacional de Câncer. Inquérito domiciliar sobre comportamentos de risco e morbidade refe-rida de doenças e agravos não transmissíveis, Rio de Janeiro: Instituto Nacional de Câncer(2008) Vigilância De Fatores De Risco E Proteção Para Doenças Crônicas Por Inquérito Telefônico. Brasí-lia, , Secretaria de Vigilância em Saúde/Secretaria de Gestão Estratégica e Participativa. VIGITEL Brasil 2007, Ministério da Saúde, Série G. Estatísticas e Informação em Saúde)Mendoza-Sassi, R.A., Beria, J.U., Prevalence of alcohol use disorders and associated factors: A population-based study using AUDIT in southern Brazil (2003) Addiction, 98, pp. 799-804Barros, M.B.A., Botega, N., Dalgalarrondo, P., Marin-Le-on, L., Oliveira, H.B., Prevalence of alcohol abuse and associated factors in a population-based study (2007) Rev Saúde Pública, 41, pp. 502-509Shankar, A., McMunn, A., Steptoe, A., Health-related behaviors in older adults relationships with socio-economic status (2010) Am J Prev Med, 38, pp. 39-46Florindo, A.A., Hallal, P.C., Moura, E.C., Malta, D.C., Practice of physical activities and associated factors in adults, Brazil (2006) Rev Saúde Pública 200943 Suppl, 2, pp. S65-S73Azevedo-e-Silva, G., Valente, J.G., Almeida, L.M., Moura, E.C., Malta, D.C., Tobacco smoking and level of education in Brazil (2006) Rev Saúde Pública, 43 (2 SUPPL.), pp. S48-S56Peixoto, S.V., Firmo, J.O., Lima-Costa, M.F., Factors associated to smoking habit among older adults (The Bambuí Health and Aging Study) (2005) Rev Saúde Públi-ca, 39, pp. 746-753Jaime, P.C., Figueiredo, I.C., Moura, E.C., Malta, D.C., Factors associated with fruit and vegetable consumption in Brazil (2006) Rev Saúde Pública 200943 Suppl, 2, pp. S57-S64Salehi, L., Eftekhar, H., Mohammad, K., Tavafian, S.S., Jazayery, A., Montazeri, A., Consumption of fruit and vegetables among elderly people: A cross sectional study from Iran (2010) Nutr J, 13, p. 2Stringhini, S., Sabia, S., Shipley, M., Brunner, E., Nabi, H., Kivimaki, M., Association of socioeconom-ic position with health behaviors and mortality (2010) JAMA, 303, pp. 1159-1166Barros, M.B.A., Cesar, C.L.G., Carandina, L., Torre, G.D., Desigualdades sociais na prevalência de doenças crônicas no Brasil, PNAD-2003 (2006) Ciênc Saúde Cole-tiva, 11, pp. 911-926Machado, G.P.M., Barreto, S.M., Passos, V.M.A., Lima-Costa, M.F., Projeto Bambuí: Prevalência de sin-tomas articulares crônicos em idosos (2004) Rev Assoc Med Bras, 50, pp. 367-372Barreto, S.M., Figueiredo, R.C., Doença crônica, au-to-avaliação de saúde e comportamento de risco: Diferença de gênero (2009) Rev Saúde Pública, 43 (SUPPL. 2), pp. 38-47Lethbridge-Cejku, M., Schiller, J.S., Bernadel, L., Summary health statistics for U.S. adults: National Health Interview Survey, 2002 (2004) Vital Health Stat, 10 (222), pp. 1-151Frazão, P., Costa, C.M., Almeida, M.F., Risks associated with tendinitis: Effects from demographic, socio-economic, and psychological status among Brazilian workers (2010) Am J Ind Med, 53, pp. 72-79Ryskulova, A., Turczyn, K., Makuc, D.M., Cotch, M.F., Klein, R.J., Janiszewski, R., Self reported age-related eye diseases and visual impairment in the United States: Results of the 2002 National Health Interview Survey (2008) Am J Public Health, 98, pp. 454-461Castro, S.S., César, C.L., Carandina, L., Barros, M.B.A., Al-Ves, M.C.G.P., Goldbaum, M., Deficiência visual, audi-tiva e física: Prevalência e fatores associados em estudo de base populacional (2008) Cad Saúde Pública, 24, pp. 1773-1782Barros, M.B.A., Zanchetta, L.M., Moura, E.C., Malta, D.C., Auto-avaliação da saúde e fatores associados, Bra-sil (2006) Rev Saúde Pública, 43 (2 SUPPL.), pp. S27-S37Alves, L.C., Leite, I.D., Machado, C.J., Factors associated with functional disability of elderly in Brazil: A multilevel analysis (2010) Rev Saúde Pública, 44, pp. 468-478Barros, A.J.D., Bertoldi, A.D., Desigualdades na utili-zação e no acesso a serviços odontológicos: Uma avaliação em nível nacional (2002) Ciênc Saúde Coletiva, 7, pp. 709-717Patel, R., Lawlor, D.A., Ebrahim, S., British Women's Heart and Health Study cohort. Socio-economic position and the use of preventive health care in older British women: A cross-sectional study using data from the British Women's Heart and Health Study cohort (2007) Fam Pract, 24, pp. 7-10Zaitune, M.P.A., Barros, M.B.A., Cesar, C.L.G., Carandina, L., Goldbaum, M., Hipertensão em idosos: Prevalên-cia, fatores associados e práticas de controle no Município de Campinas, São Paulo, Brasil (2006) Cad Saúde Pública, 22, pp. 285-294Silveira, E.A., Araújo, C.L., Gigante, D.P., Barros, A.J.D., Lima, M.S., Validação do peso e altura referidos para o diagnóstico do estado nutricional em uma popula-ção de adultos no Sul do Brasil (2005) Cad Saúde Pública, 21, pp. 235-245Skinner, K.M., Miller, D.R., Lincoln, E., Lee, A., Kazis, L.E., Concordance between respondent self-reports and medical records for chronic conditions: Experience from the Veterans Health Study (2005) J Ambul Care Manage, 28, pp. 102-110Knight, M., Stewart-Brown, S., Fletcher, L., Estimating health needs: The impact of a checklist of conditions and quality of life measurement on health information derived from community surveys (2001) J Public Health Med, 23, pp. 179-186Mackenbach, J.P., Looman, C.W., van der Meer, J.B., Differences in the misreporting of chronic conditions, by level of education: The effect on inequalities in prevalence rates (1996) Am J Public Health, 86, pp. 706-71

Comparison Of Estimates For The Self-reported Chronic Conditions Among Household Survey And Telephone Survey - Campinas (sp), Brazil [comparação De Estimativas Para O Autorrelato De Condições Crônicas Entre Inquérito Domiciliar E Telefônico - Campinas (sp), Brasil]

Objective: To compare the estimates obtained by different methods of population-based surveys for self-reported chronic conditions among adults living in Campinas in the year 2008. Methods: Data from ISACamp Survey, conducted by the Faculty of Medical Sciences from Universidade Estadual de Campinas (UNICAMP) with support from the County Health Department and VIGITEL (Campinas), a telephone survey conducted by the Brazilian Ministry of Health toward Surveillance of Risk and Protective Factors for Chronic non-communicable Diseases in the adult population (18 years and over) were analyzed. Estimates of self-reported hypertension, diabetes, osteoporosis, and asthma/bronchitis/emphysema were evaluated and compared by the independent (two-sample) Student's t-test. Results: For global estimates, a higher prevalence of hypertension and osteoporosis was ascertained by the telephone survey. Diabetes and asthma/bronchitis/ emphysema results showed no statistically significant differences. According to sociodemographic variables, a higher prevalence of hypertension was obtained by VIGITEL for men, among people aged 18 to 59 years, and those who reported nine or more years of schooling. A higher prevalence of osteoporosis among adults (18 to 59 years) was verified by VIGITEL. Concerning asthma/ bronchitis/emphysema in the elderly, ISACamp survey showed a higher prevalence. Conclusion: Except for the hypertension prevalence, the telephone survey has proven to be a rapid alternative to provide global prevalence estimates of health conditions in the adult population of Campinas.14SUPPL. 1515Viacava, F., Informações em saúde: A importância dos inquéritos populacionais (2002) Ciênc Saúde Coletiva, 7 (4), pp. 607-621Cesar, C.L.G., Barata, R.B., (2008) Editorial Rev Bras Epidemiol, 11 (SUPPL. 1), pp. 3-5Lavrakas, P.J., (1990) Telephone Survey Methods: Sampling, Selection and Supervision, , London: Sage PublicationsMonteiro, C.A., Moura, E.C., Jaime, P.C., Lucca, A., Florindo, A.A., Figueiredo, I.C.R., Monitoramento de fatores de risco para as doenças crônicas por entrevistas telefônicas (2005) Rev Saúde Pública, 39 (1), pp. 47-57Nelson, D.E., Powell-Griner, E., Town, M., Kovar, M.G., A comparison of national estimates from the National Health Interview Survey and the Behavioral Risk Factor Surveillance System (2003) Am J Public Health, 93 (8), pp. 1335-1341Bernal, R., Silva, N.N., Cobertura de linhas telefônicas residenciais e vícios potenciais em estudos epidemiológicos (2009) Rev Saude Publica, 43 (3), pp. 421-426(2002) Reducing Risks, Promoting Healthy Life, p. 2002. , The World Health Report, Geneva: World Health Organization(2007) Guia Metodológico De Avaliação E Definição De Indicadores: Doenças Não Transmissíveis E Rede Carmem, , Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde, Brasília: Ministério da SaúdeChrestani, M.A., Santos, I.S., Matijasevich, A.M., Hipertensão arterial sistêmica auto-referida: Validação diagnóstica em estudo de base populacional (2009) Cad Saúde Pública, 25 (11), pp. 2395-2406Barros, M.B.A., Inquéritos domiciliares de saúde: Potencialidades e desafios (2008) Rev Bras Epidemiol, 11 (SUPPL. 1), pp. 6-19Cesar, C.L.G., Carandina, L., Alves, M.C.G.P., Barros, M.B.A., Goldbaum, M., (2005) Saúde E Condição De Vida Em São Paulo: Inquérito Multicêntrico De Saúde No Estado De São Paulo -ISA-SP, p. 212. , São Paulo: USP/FSP(2006) Vigilância De Fatores De Risco E Proteção Para Doenças Crônicas Por Inquérito Telefônico: Estimativas Sobre Freqüência E Distribuição Sócio-demográfica De Fatores De Risco E Proteção Para Doenças Crônicas Nas Capitais Dos 26 Estados Brasileiros E No Distrito Federal Em 2006, p. 2007. , Ministério da Saúde. VIGITEL Brasil, Brasília: Ministério da SaúdeLwanga, S.K., Lemeshow, S., (1991) Sample Size Determination In Health Studies: A Practical Manual, , Geneva: World Health Organization(2008) Vigilância De Fatores De Risco E Proteção Para Doenças Crônicas Por Inquérito Telefônico, p. 2009. , Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Secretaria de Gestão Estratégia e Participativa. VIGITEL Brasil, Brasília: Ministério da SaúdeLee, S., Davis, W.W., Nguyen, H.A., McNeel, T.S., Brick, J.M., Flores-Cervantes, I., Examining Trends and Averages Using Combined Cross-sectional Survey Data From Multiple Years, , http://www.chis.ucla.edu/pdf/paper_trends_averages.pdf, CHIS Methodology Paper, 2007. [cited 2011 Jun 02]. Available fromKish, L., (1965) Survey Sampling, , New York: John Wiley and SonsFahimi, M., Link, M., Schwartz, D.A., Levy, P., Mokdad, A., Tracking chronic disease and risk behavior prevalence as survey participation declines: Statistics from the Behavioral Risk Factor Surveillance System and other national surveys (2008) Prev Chronic Dis, 5 (3), pp. A80Cricelli, C., Mazzaglia, G., Samani, F., Marchi, M., Sabatini, A., Nardi, R., Prevalence estimates for chronic diseases in Italy: Exploring the differences between self-report and primary care databases (2003) J Public Health Med, 25 (3), pp. 254-257Okura, Y., Urban, L.H., Mahoney, D.W., Jacobsen, S.J., Rodeheffer, R.J., Agreement between self-reported questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure (2004) J Clin Epidemiol, 57 (10), pp. 1096-1103Barros, M.B.A., Cesar, C.L.G., Carandina, L., Torre, G.D., Desigualdades sociais na prevalência de doenças crônicas no Brasil, PNAD-2003 (2006) Ciênc Saúde Coletiva, 11 (4), pp. 911-926Molenaar, E.A., van Ameijden, E.J., Grobbee, D.E., Numans, M.E., Comparison of routine care self-reported and biomedical data on hipertension and diabetes: Results of the Utrecht Health Project (2007) Eur J Public Health, 17 (2), pp. 199-205Lima-Costa, M.F., Peixoto, S.V., Firmo, J.O.A., Uchoa, E., Validade do diabetes auto-referido e seus determinantes: Evidências do projeto Bambuí (2007) Rev Saúde Pública, 41 (6), pp. 947-953Vargas, C.M., Burt, V.L., Gllum, R.F., Pamuk, E.R., Validity of self-reported hypertension in the National Health and Nutrition Examination Survey III, 1988-1991 (1997) Prev Med, 26 (5), pp. 678-685Lima-Costa, M.F., Peixoto, S.V., Firmo, J.O.A., Validade da hipertensão arterial auto-referida e seus determinantes (projeto Bambuí) (2004) Rev Saúde Pública, 38 (5), pp. 637-642Frazão, P., Naveira, M., Prevalência de osteoporose: Uma revisão crítica (2006) Rev Bras Epidemiol, 9 (2), pp. 206-214Martini, L.A., Moura, E.C., Santos, L.C., Malta, D.C., Pinheiro, M.M., Prevalência de diagnóstico auto-referido de osteoporose, Brasil, 2006 (2009) Rev Saúde Pública, 43 (SUPPL. 2), pp. 107-116Hasselgren, M., Arne, M., Lindahl, A., Janson, S., Lundbäck, B., Estimated prevalences of respiratory symptoms, asthma and chronic obstructive pulmonary disease related to detection rate in primary health care (2001) Scand J Prim Health Care, 19 (1), pp. 54-57Mullerova, H., Wedzicha, J., Soriano, J.B., Vestbo, J., Validation of a chronic obstructive pulmonary disease screening questionnaire for population surveys (2004) Respir Med, 98 (1), pp. 78-83Lima-Costa, M.F., Barreto, S.M., Giatti, L., Condições de saúde, capacidade funcional, uso de serviços de saúde e gastos com medicamentos da população idosa brasileira: Um estudo descritivo baseado na Pesquisa Nacional por Amostra de Domicílios (2003) Cad Saúde Pública, 19 (3), pp. 735-743Goldman, N., Lin, I.F., Weinstein, M., Lin, Y.H., Evaluating the quality of self-reports of hypertension and diabetes (2003) J Clin Epidemiol, 56 (2), pp. 148-15

Socioeconomic inequalities in dental health services in Sao Paulo, Brazil, 2003-2008

__Background:__ Access to, and use of, dental health services in Brazil have improved since 2003. The increase of private health care plans and the implementation of the "Smiling Brazil" Program, the largest public oral health care program in the world, could have influenced this increase in access. However, we do not yet know if inequalities in the use of dental health services persist after the improvement in access. The aims of this study are to analyze socioeconomic differences for dental health service use between 2003 and 2008 in São Paulo and to examine changes in these associations since the implementation of the Smiling Brazil program in 2003. __Method:__ Data was obtained via two household health surveys (ISA-Capital 2003 and ISA-Capital 2008) which investigated living conditions, lifestyle, health status and use of health care services. Logistic regression was used to analyze associations between socioeconomic factors and dental services use. Additionally, trends from 2003 to

Profile of patients with rheumatic diseases undergoing treatment with anti-TNF agents in the Brazilian Public Health System (SUS), Belo Horizonte - MG

The aim of this study was to describe the baseline demographic and clinical characteristics as well as the functional status of a prospective cohort of patients with rheumatic diseases assisted by the Brazilian Public Health System (SUS). Data for 302 patients receiving tumor necrosis factor α inhibitors (anti-TNF agents) was collected through a standard form. Among patients, 229 (75.8%) were female and 155 (51.3%) were Caucasian; the mean age was 50.3 ± 12.8 years, and the mean disease duration was 9.9 ± 8.7 years. Among them 214 patients (70.9%) received adalimumab, 72 (23.8%) etanercept, and 16 (5.3%) infliximab. Mean Health Assessment Questionnaire-Disability Index (HAQ-DI) was 1.37 ± 0.67 for all participants. Poor functional response was associated with female gender, married patients and with a score of < 0.6 on the EuroQoL-5 dimensions (EQ-5D). Significant correlation was found between the HAQ-DI values, disease activity and quality of life (QOL). The results obtained in this study contribute to a better understanding of the clinical and demographic characteristics of patients with rheumatic diseases at the beginning of anti-TNF-agent treatment by SUS. Furthermore, our findings are consistent with another Brazilian and foreign cross-sectional investigations. This knowledge can be of great importance for further studies evaluating the effectiveness of biological agents, as well as, to contribute to improve the well-being of the patients with rheumatic diseases

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 24 domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, ten anteaters, and six sloths. Our dataset 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 south of the USA, Mexico, and Caribbean countries at the northern portion of the Neotropics, to its austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n=5,941), and Cyclopes sp. has the fewest (n=240). The armadillo species with the most data is Dasypus novemcinctus (n=11,588), and the least recorded for Calyptophractus retusus (n=33). With regards 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 datasets of Neotropical Series which 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 dataset

Ação inseticida do extrato de Derris amazonica Killip para Cerotoma arcuatus Olivier (Coleoptera: Chrysomelidae

A abundância e o potencial inseticida de Derris amazonica e a necessidade de controle de Cerotoma arcuatus Olivier (Coleoptera: Chrysomelidae) na cultura do feijão-caupi (Vigna unguiculata L. Walp) estimularam a realização desta pesquisa, que objetivou avaliar a ação inseticida do extrato de D. amazonica a adultos de C. arcuatus em condições de laboratório. Os bioensaios testaram as vias de intoxicação por ingestão de folhas contaminadas, contato com superfície contaminada e aplicação tópica, com delineamento experimental inteiramente casualizado, com quatro repetições. Os valores de mortalidade e consumo foliar dos insetos foram submetidos à análise de regressão, sendo utilizada a análise de Probit para determinação das CL50, da DL50 e dos TL50. O extrato de D. amazonica, contendo 3,7% de rotenona, foi tóxico para adultos de C. arcuatus via ingestão de folhas contaminadas (CL50=15,14 µL do extrato.mL-1 de água), superfície contaminada (CL50=0,45 µL do extrato.cm-2) e aplicação tópica (DL50=1,44 µL do extrato.g-1 do inseto). Mortalidades de adultos de C. arcuatus superiores a 80% e os menores tempos letais médios foram obtidos na concentração de 5% (v v-1) do extrato em todos os bioensaios. O consumo foliar de adultos de C. arcuatus foi inversamente proporcional a concentração do extrato quando expostos por via de ingestão foliar ou aplicação tópica, sendo inclusive observada inibição da alimentação dos indivíduos. O extrato de D. amazonica é tóxico para C. arcuatus e inibe a alimentação dos insetos a partir da concentração de 1% (v v-1).The abundance and insecticidal potential of Derris amazonica in addition to need of controlling Cerotoma arcuatus for bean crop stimulated this research. The objective of this work was to evaluate insecticide action of the extract of D. amazonica to adults of C. arcuatus in laboratory conditions. The bioassays were carried out using three distend methodologies: leaf intake, contact in treated surface (filter paper) and topical application. A completed randomized experimental design was used with four replications. Mortality values and leaf consumption of the insects were subjected to regression analyses, being the Probit analyses used to determine of the i.e., LC50, LT50 and LD50. The extract of D. amazonica containing 3.7% of rotenone was toxic to adults C. arcuatus when exposed to treated leaves (LC50 = 15.14 µl.mL-1), treated surface (LC50 = 0.45 µl.cm-2) and subjected to topical exposure (LD50 = 1.44 µl.g-1). In all bioassays the adults mortality was higher than 80% with lower median lethal times obtained with 5% (v.v-1) concentrations of the extract. Leaf consumption by adults C. arcuatus was inversely proportional to the concentration of the extract when exposed by leaf intake or topical application, also being observed inhibition of feeding individuals. The extract of D. amazonica is toxic to C. arcuatus and inhibits the feeding of insects from the concentration of 1% (v v-1)

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities 1,2 . This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity 3�6 . Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55 of the global rise in mean BMI from 1985 to 2017�and more than 80 in some low- and middle-income regions�was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing�and in some countries reversal�of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories. © 2019, The Author(s)