[Show abstract][Hide abstract] ABSTRACT: The scope of this study was to evaluate the knowledge of pharmacotherapy among users of arterial hypertension medication. A quantitative cross-sectional study was conducted with adults aged 20 years or older, who were users of antihypertensive drugs dispensed by the Public Pharmacy of São Francisco de Paula in the State of Rio Grande do Sul. The study evaluated the knowledge of patients about the drug name, therapeutic indication, dose, administration routine, and duration of treatment, attributing a score (0-5). Multiple linear regression was used to investigate the relationship between the patients' knowledge and characteristics and 678 medication users were interviewed. The mean knowledge score was 3.27 (SD = 1.16). Lower age, higher schooling, Caucasian, better self-reported health and lower number of prescribed drugs were associated with higher knowledge scores. It was observed that the patients' knowledge of all the aspects evaluated is limited, a result that could compromise the correct and safe use of the drugs, and suggesting the need for better counseling and follow-up of users, to control this morbidity.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Physical inactivity is one of the most important modifiable risk factors that is raising the global burden of chronic diseases. METHODS: This is a cross-sectional, population-based study of 790 women aged 20 years or older living in the urban area of a municipality in Southern Brazil. The level of physical activity was measured using the International Physical Activity Questionnaire, short form. Inactivity was defined as fewer than 150 min.wk-1 spent in moderate or vigorous physical activities. Prevalence ratios were calculated by robust Poisson regression. RESULTS: The prevalence of physical inactivity was 48.7% (95%CI 43.3%-54.1%). After adjusting for confounders, we found a linear trend for increasing prevalence of physical inactivity with increasing Body Mass Index (p=0.008). Women who were married or in a domestic partnership were 29% less physically active than single women (p=0.044). A borderline association was detected between the presence of minor psychiatric disorders (MPD) and physical inactivity (p=0.058). CONCLUSIONS: There was a high prevalence of inactivity. Obese women, those married or in domestic partnerships and those with MPD were more likely to lead an inactive lifestyle. These results suggest that strategies are required for breaking down barriers to physical activity in this demographic group.
Journal of Physical Activity and Health 04/2013; · 1.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A cross-sectional study was conducted with the elderly population in rural and urban areas characterized by the prevalence of morbidity and symptoms, and 229 elderly people were interviewed. The average age was 72.3, of which 57.2% lived in the rural zone and 56.3% were female. The morbidities most reported were insomnia (37.7%), anxiety (32.1%), depression (26.7%), and in the rural zone it was diabetes (13.3%). In this zone, Alzheimer´s disease was more prevalent among the elderly who handled pesticides (21.7%). The most prevalent symptoms among urban zone residents were: cough/runny nose and sight alterations (41.2%), allergy/itching (11.4%). In the rural zone, dry mouth (25.4%), sight alterations (35.6%) and leg pain (66.1%) were also more prevalent among those who used pesticides. The inadequate use of Individual Protection Equipment was 85.4%, and 45.1% also disposed of pesticide packaging inappropriately. The setting up of public health programs is necessary to promote health among the elderly and the potential exposure to pesticides for this population should be seen as a health risk determinant.
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to investigate the association between reproductive events and abdominal obesity (waist circumference, ≥ 88 cm) and general obesity (body mass index, ≥ 30.0 kg/m) in a sample of women between the ages of 40 and 65 years treated at an outpatient clinic in southern Brazil.
This was a cross-sectional study of a sample of 617 women from southern Brazil. Menopause status was classified as premenopausal, women who had regular menstrual cycles; perimenopausal, women who had irregular menstrual cycles whether in periodicity or flow; or postmenopausal, women whose last menstrual period occurred more than 12 months before the time of interview. Poisson regression was used to calculate crude and adjusted prevalence ratios and their respective 95% CIs.
The prevalence rates of abdominal and general obesity were 66.6% (95% CI, 62.8%-70.3%) and 45.5% (95% CI, 41.5%-9.4%), respectively. After adjustment for demographic, socioeconomic, and behavioral variables, early menarche (≤ 11 y) and parity were strong predictors of abdominal and general obesity, presenting a dose-response relationship. Women with a history of three or more pregnancies and menarche at age 11 years or earlier had a 25% higher prevalence of abdominal obesity (95% CI, 1.07-1.46) and a 75% increase in obesity (95% CI, 1.37-2.24) compared with nulliparous or primiparous women with menarche at 14 years or older. Women with a postmenopause status showed an increase of 52% in general obesity, compared with those with a premenopause status.
Characteristics of reproductive life may have a strong influence on body fat buildup in women during the menopausal transition.
Menopause (New York, N.Y.) 04/2012; 19(9):1022-8. · 3.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aim To investigate the association between socioeconomic, demographic, behavioral, and reproductive factors and the metabolic syndrome (MS) in climacteric women. Method This cross-sectional study was carried out in a sample of 527 women aged 40-65 years seen at an outpatient menopause and gynecologic surgery clinic in Southern Brazil. MS was defined according to NCEP-ATP III diagnostic criteria. Poisson regression was used to calculate crude and adjusted prevalence ratios and their respective 95% confidence intervals (CI). Results The prevalence of MS was 54.8% (95% CI 50.6-59.1%), varying with menopausal status (45.7% before menopause, 56.3% in perimenopause, and 57.5% in postmenopausal women). Among the components of MS, hypertension and abdominal obesity were the most prevalent (84.8% and 66.8%, respectively). The prevalence of MS rose with advancing age and increasing parity. Women with low education (years of schooling) showed a higher prevalence of MS compared to those with a high education level (64% vs. 36.8%). Women with early menarche (≤11 years of age) showed an increase of 32% in MS prevalence (95% CI 1.08-1.62) compared to those with a late menarche (≥14 years of age). Conclusion These findings are relevant to public health, particularly as they show the significance of exposure to long-term, hard-to-reverse effects, such as early menarche and low educational achievement, in the development of metabolic syndrome.
[Show abstract][Hide abstract] ABSTRACT: Physical activity instruments can be subjective or objective. There is a need to assess the reliability of these instruments, especially for researches in children. The aim of this study was to determine the validity of the Netherlands Physical Activity Questionnaire (NPAQ).
Population under study were Brazilian children aged 4 to 11 years old, enrolled in a population-based study. Data collection took place in two distinct moments: 1) application of the NPAQ by face-to-face interviews with mothers' children and 2) utilization of accelerometers by children as the reference method. GT1M Actigraph accelerometer was worn for five consecutive days. Validity analyses were performed by sensitivity and specificity and ROC (Receiver Operator Characteristic) curve.
Two hundred and thirty nine children participated in both phases of the study. A total of 73.2% children achieved the recommendation of 60 min/day of moderate to vigorous physical activity. The mean and median of the NPAQ score were 25.5 and 26, respectively. The score ranged from 7 to 35 points. The correlation coefficient between the NPAQ and the time spent in moderate to vigorous physical activities was 0.27. Based on the area under the ROC curve, the median value presented the best indicators of sensitivity (59.4%) and specificity (60.9%), and the area under curve was 0.63. The predictive capacity of the NPAQ to identify active children was high regardless the cut-off point chosen. This capacity was even higher if the score was higher than 30.
Based on sensitivity and specificity values, the NPAQ did not show satisfactory validity. The comparison of the reliability of the NPAQ with other instruments is limited, but correlation coefficients found in this study are similar to others. Physical activity level of children estimated from the NPAQ must be interpreted cautiously, and objective measures such as accelerometers should be encouraged.
International Journal of Behavioral Nutrition and Physical Activity 01/2011; 8:45. · 3.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study evaluated the demand of emergency health service. It was performed a descriptive analyses of 1647 adults that consulted at emergency public service of Pelotas, Brazil. Older subjects, non white skin color, lower schooling, without partner, and smokers presented higher prevalence of consultations at this service when compared with the general population. Individuals waited, on average, 15 minutes to have their consultations, exams were requested in more than 40% of the visits, and intravenous medication were administered in one third of the visits. Elderly waited longer before searching the service, but they had lowest awaiting time after arriving at emergency service and had higher percentage of regular doctor and social support. Elderly had more diagnosis related to circulatory system, while among the youngest, external causes were the most frequent. The low waiting average for consultation suggest this service provide an immediate care while the great number of ill-defined signs or symptoms indicate that the provided care is provisional. It is necessary to train emergency professionals to reduce the number of tests requested and to assure that either professional as the population is conscious about the importance of a continuity of care.
[Show abstract][Hide abstract] ABSTRACT: The study evaluated free access to hypertension and diabetes medicines and the reasons reported for lack of access. The sample included 4,003 elderly people living in Primary Care Unit coverage areas from 41 Southern and Northeastern Brazilian cities. Free access was higher in the Northeast (62.4%). The strategy of the Family Health Program (Programa Saúde da Família - PSF) was more effective in providing access than the traditional model, with higher results in the Northeast (61.2%) than in the South (39.6%). Around 20% of medicines included in the Hypertension and Diabetes Program and 26% of those included in the National Essential Medicines List (RENAME) were paid out of pocket. In the Northeast, 25% of insulin and 32% of oral antidiabetics were paid out of pocket. Unavailability in the public sector and a lack of money determined the lack of access. Although the PSF, Hypertension and Diabetes Program and RENAME expanded free access, supplies were insufficient. A greater connection between programs and a clear definition of responsibilities can improve medicine acquisition process, increasing the effectiveness of pharmaceutical assistance.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 06/2010; 26(6):1163-74. · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Medicine access is an important goal of medicine policy; however the evaluation of medicine access is a subject under conceptual and methodological development. The aim of this study was to describe quantitative methodologies to measure medicine access on household level, access expressed as paid or unpaid medicine acquisition.
Searches were carried out in electronic databases and health institutional sites; within references from retrieved papers and by contacting authors.
Nine papers were located. The methodologies of the studies presented differences in the recall period, recruitment of subjects and medicine access characterization.
The standardization of medicine access indicators and the definition of appropriate recall periods are required to evaluate different medicines and access dimensions, improving studies comparison. Besides, specific keywords must be established to allow future literature reviews about this topic.
BMC Health Services Research 01/2010; 10:146. · 1.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the use of healthcare services by elderly individuals suffering from chronic diseases.
Cross-sectional study carried out with 2,889 individuals aged 65 years or more with chronic conditions - arterial hypertension, diabetes mellitus and mental illness -, living in catchment areas of primary care units in 41 cities of the South and Northeast regions of Brazil in 2005. The analyzed data were obtained in the baseline study of Programa de Expansão e Consolidação da Saúde da Família (Program for the Expansion and Consolidation of Family Health). The studied variables were sex, age, skin color, marital status, level of schooling, family income, smoking, functional disability, and care model of the primary care unit. The adjusted analysis of outcomes was performed by means of Poisson regression.
The prevalence of medical visit in the last six months was 45% in the South region and 46% in the Northeast region. The prevalence of participation in groups of educational activities in the last year was 16% in the South and 22% in the Northeast. In both regions, use of services was higher for elderly people under the age of 80 years, with low level of schooling and living in catchment areas of primary care units with Programa Saúde da Família (Family Health Program). Only in the South region did the elderly with functional disability have higher prevalence of medical visits.
The prevalence of medical visit and participation in groups of educational activities was low when compared to previous studies conducted with elderly individuals in Brazil. The results indicate that, although the Family Health Program promotes greater use of services at primary care units by elderly people with chronic conditions, it is necessary to expand the access of those aged over 80 and of individuals with functional disability.
Revista de saude publica 07/2009; 43(4):604-12. · 1.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study evaluated the use of outpatient services by senior citizens (N = 4,003) drawing on data from the baseline study that evaluated the Project for Expansion and Consolidation of the Family Health Strategy (PROESF) in 41 cities in South and Northeast Brazil. Use of outpatient services was greater and more appropriate to the needs of the elderly in the South than in the Northeast. Primary care facilities in both regions met the demand by lower-income elderly, but those requiring more care were treated at other levels. The results highlight the need to increase the supply of outpatient services and ensure access by the elderly, particularly for individuals with functional impairments in the Northeast. In addition to promoting equity, primary care in both regions should adopt targeted approaches for the health needs of senior citizens.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 11/2008; 24(10):2267-78. · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study focused on the prevalence of interpersonal continuity of care and its determinants. A cross-sectional population-based study was conducted with 3,133 individuals 20 years or older in Pelotas, Rio Grande do Sul State, Brazil. Multivariate analysis used Poisson regression, with the first level representing socioeconomic and demographic variables and the proximal level including health care and health needs variables. Prevalence of interpersonal continuity of care was 43.7% (95%CI: 42.0-45.5). Female gender, higher age, higher income, consultation during the previous year, report of chronic disease, and consultation outside the public health system showed higher interpersonal continuity of care. Among individuals that consulted in public primary health care services, female gender, age, and the Family Health Program were associated with interpersonal continuity of care. Some vulnerable groups (low-income and users of the public health system) showed low prevalence of the outcome.
Cadernos de Saúde Pública 05/2008; 24(4):915-25. · 0.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aimed to evaluate the prevalence of access to continuous-use medicines for treatment of systemic arterial hypertension, diabetes mellitus, and/or mental health problems, and the associated factors. A cross-sectional study was developed under the Project for the Expansion and Consolidation of the Family Health Program in 41 cities in South and Northeast Brazil. The sample included 4,060 adults and 4,003 elderly living in the coverage areas for primary health care clinics. Prevalence of access to continuous-use medicines was 81% in non-elderly adults and 87% in the elderly. Greater access was associated with the following factors: adults in South Brazil - older age, higher socioeconomic status, type of chronic disease, and participation in support groups in the primary health clinic area; adults in the Northeast - systemic arterial hypertension with or without diabetes mellitus; elderly in the South - more schooling; and elderly in the Northeast - older age, more schooling, non-smoking, enrollment in the primary health care clinic coverage area, and the family health care model. The results show important inequity in health, reinforcing the need for policies to expand access, mainly for lower-income population groups.
Cadernos de Saúde Pública 03/2008; 24(2):267-80. · 0.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The article presents the methodology used in the Baseline Study that evaluated the effectiveness of the Family Health Strategy as compared to traditional primary health care units. The study included 41 municipalities with more than 100 thousand inhabitants each, 21 from the South and 20 from the Northeast of Brazil. As the principal dependent variable and underlying premise for sampling in the Baseline Study, the effectiveness of program activities in the primary care units was analyzed in the population within the respective coverage areas, using an epidemiological survey. The health care model in the primary care units was the principal independent variable. Its effect on program activities was controlled according to geopolitical region, metropolitan area, and population size in the municipalities. Coverage of the activities was characterized according to socioeconomic, demographic, and health-related factors. The use of comparison groups, multiple-stage samples, standardized measures, adjustment for geographic and socio-demographic characteristics, and well-defined criteria for judging the findings are contributions by the methodology employed here for designing future studies to evaluate primary health care.
[Show abstract][Hide abstract] ABSTRACT: In order to describe the profile of primary health care teams in 41 municipalities with more than 100 thousand inhabitants each, a total of 4,749 health workers in two States from the South (1,730) and five from the Northeast (3,019) of Brazil were included from a sample of traditional primary care units and the Family Health Program (FHP). After providing informed consent, the health workers answered a self-applied questionnaire with demographic, work-related, and their own health-related data. The principal differences between the two models involved the structuring of the teams, with the FHP including more community health agents, more women, more young workers, fewer hired on the basis of formal admissions exams, more with a single job, more precarious employment arrangements, less employment satisfaction, less time on the job, larger workloads, greater specialization in the area, and better pay. The FHP also showed worse self-perceived health and more medical appointments. Management efforts are needed to support these workers, who form the basis of the health system and are key protagonists in the development and consolidation of primary care.
[Show abstract][Hide abstract] ABSTRACT: This study evaluated the use of outpatient ser- vices by senior citizens (N = 4,003) drawing on data from the baseline study that evaluated the Project for Expansion and Consolidation of the Family Health Strategy (PROESF) in 41 cities in South and Northeast Brazil. Use of outpatient services was greater and more appropriate to the needs of the elderly in the South than in the Northeast. Primary care facilities in both regions met the demand by lower-income elderly, but those requiring more care were treated at other levels. The results highlight the need to increase the supply of outpatient services and ensure ac- cess by the elderly, particularly for individuals with functional impairments in the Northeast. In addition to promoting equity, primary care in both regions should adopt targeted approaches for the health needs of senior citizens.
Cadernos de Saúde Pública 01/2008; 24(10). · 0.89 Impact Factor