Prevalence of chronic obstructive pulmonary disease and associated factors: the PLATINO Study in São Paulo, Brazil

Chronic obstructive pulmonary disease (COPD) is now a major public health concern; deaths attributable to COPD in Latin America have increased by 65.0% in the last decade. This study was aimed at evaluating COPD prevalence and associated factors in adults (> 40 years) living in Greater Metropolitan São Paulo, Brazil. The study is part of the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (The PLATINO Project), a multi-center survey on COPD burden in Latin America, with São Paulo as the first center where the project has been carried out. A population-based sample was selected in multiple stages. Spirometry tests were performed in each subject pre- and post-bronchodilator and COPD was mainly defined as the ratio of forced expiratory volume to forced vital capacity below 70.0% (fixed ratio definition). Other spirometric criteria were also used for the diagnosis of COPD. COPD prevalence was 15.8% (95%CI: 13.5-18.1) using the fixed ratio definition. COPD was positively associated with age and smoking and inversely with body mass index. Utilization of different COPD spirometry criteria resulted in different percentages of COPD, but similar associated factors.

[Breast cancer's secondary prevention and associated factors]

OBJECTIVE

To evaluate the prevalence of secondary prevention of breast cancer and associated factors.

METHODS

A population-based cross-sectional study was conducted in the city of Pelotas, southeastern Brazil, in 2002. The study sample comprised 879 women aged 40 to 69 years. Information was collected on demographic, social, economic, behavioral, biological and care management variables. Statistical analysis based on Poisson regression model was carried out.

RESULTS

The prevalence of breast self-examination (BSE) was 83.5% (95% CI: 80.9-85.9). Of them, 80.4% (95% CI: 77.3-83.2) carried out BSE at least once a month. The prevalence of clinical breast examination was 83.3% (95% CI: 80.6-85.7). Mammography was occasionally performed in 70% (95% CI: 66.8-73.0) of the sample. Of these women, 83.7% (95% CI: 80.5-86.6) underwent mammography at least once in the last two years. Sixty-two percent (95% CI: 58.7-65.2) of the women interviewed attended a gynecological visit at least once in the last year. The factors mainly associated to the high prevalence of secondary prevention of breast cancer were: higher social status; greater association of risk factors for breast cancer; family history of breast cancer; hormone replacement therapy and previous breast biopsy or surgery.

CONCLUSIONS

Preventive measures for breast cancer have been widely taken in the study sample; however, data points out to some limitations related to efficacy. Social and economic status seems to be a major determinant to gynecological care access and, consequently, access to secondary prevention of breast cancer.

Epidemiology of leisure-time physical activity: a population-based study in southern Brazil

We aimed to measure the prevalence of physical inactivity (PI) during leisure time and to identify variables associated with it in a southern Brazilian adult population. A population-based cross-sectional study was carried out, covering a multiple-stage sample of 1,968 subjects aged 20-69 years. Weekly participation in leisure-time physical activity was addressed. For each activity, energy expenditure was calculated using data on duration, metabolic equivalent, and body weight. Energy expenditures of individual activities were summed to give a weekly total. PI was defined as fewer than 1,000 kilocalories per week. The prevalence of PI was 80.7% (95%CI: 78.9-82.4). After adjusted analyses, the following variables were positively associated with the outcome: female gender, age, living with a partner, and smoking. Schooling and economic status were inversely associated with PI. Chronically undernourished individuals were significantly more likely to be inactive. We found no differences according to skin color or alcohol consumption. In conclusion, the prevalence of PI in this adult population was higher than in populations from developed countries, but the associated variables were similar.

Tabagismo em estudantes de Medicina: tendências temporais e fatores associados

INTRODUÇÃO: Após o declínio observado na prevalência de tabagismo entre estudantes de Medicina entre as décadas de 1960 e 1980, parece estar ocorrendo, atualmente, uma estabilização nessa prevalência. OBJETIVO: Avaliar as tendências temporais de tabagismo entre estudantes de Medicina da Universidade Federal de Pelotas (RS) nos últimos dezessete anos, e alguns dos fatores associados ao hábito de fumar desses estudantes. MÉTODO: Estudos transversais com metodologias comparáveis foram conduzidos em 1986, 1991, 1996 e 2002. Questionários auto-aplicáveis foram utilizados. Definiu-se como fumante o indivíduo que fumava mais de um cigarro por dia há mais de um mês. Foram realizadas análises descritivas iniciais, análises brutas com utilização dos testes de qui-quadrado para heterogeneidade e tendência linear, e regressão de Poisson para avaliar o efeito do ano cursado sobre a freqüência de tabagismo, com controle para a idade do estudante. RESULTADOS: A prevalência atual de tabagismo entre os estudantes foi de 10,1%, valor estatisticamente similar ao dos levantamentos de 1991 e 1996. Não foram encontradas diferenças na prevalência de tabagismo por sexo, idade, tabagismo materno ou paterno. A freqüência de tabagismo aumentou durante a faculdade. CONCLUSÕES: A tendência de declínio na prevalência de tabagismo em estudantes de Medicina da Universidade Federal de Pelotas parece estar sendo substituída por uma estabilização em torno de 10% a 15%. O combate ao fumo ainda parece indispensável em ambientes universitários, especialmente nas escolas de Medicina.

Cobertura do exame físico de mama: estudo de base populacional em Pelotas, RS

OBJETIVOS: Verificou-se a cobertura do exame físico de mama realizado por médicos, no último ano, nas mulheres com idade entre 20 e 69 anos, residentes na zona urbana da cidade de Pelotas. Identificaram-se características associadas à realização do procedimento. Os resultados foram comparados com outro estudo transversal de base populacional realizado em 1992. MATERIAIS E MÉTODOS: Realizou-se um estudo transversal de base populacional, utilizando-se amostragem por conglomerados. A regressão logística foi realizada seguindo modelo hierarquizado. RESULTADOS: Entre as 1122 mulheres de 20 a 69 anos incluídas no estudo, verificou-se que 549 (48,9%) tiveram exame de mama realizado por médicos. Encontrou-se associação para classe social, cor da pele, freqüência de consultas médicas e realização de exame citopatológico. DISCUSSÃO: Abordou-se a falta de integralidade no sistema local de saúde. Discutiu-se as evidências da iniqüidade da atenção.

[Pap test coverage in the city of Pelotas, Rio Grande do Sul, Brazil]

In Brazil, the effectiveness of preventive public heath programs and actions is rarely evaluated. A cross-sectional study was thus performed in a population-based sample focused on several health characteristics of adults living in Pelotas, Rio Grande do Sul, Brazil. The study aimed to measure temporal trends in coverage of Pap smear testing in the city. The authors studied the factors associated with failure of women to submit to a Pap smear. An updated Pap smear was defined as one performed in the previous 3 years. The sample consisted of 1,122 women ages 20 to 69 years, 72.2% of whom had an updated Pap smear, 16.6% of whom were behind schedule for testing, and 11.2% of whom had never had a Pap smear. Risk factors for never having a test were low socioeconomic status and old age. Logistic regression showed an independent effect of social class, low family income, age, skin color, marital status, and no medical appointment in the previous year. However, the effect of chronic diseases disappeared in logistic regression. The authors compare the results of the study conducted in 1992 with the present. Pap smear coverage increased from 65.0% to 72.2% (1992 to 1999/2000) in the city, yet such figures had still not ensured the effectiveness of the program for uterine cervical cancer prevention.

Prevalência de distúrbios psiquiátricos menores na cidade de Pelotas, RS

Foi realizado um estudo transversal, de base populacional, com o objetivo de determinar a prevalência de distúrbios psiquiátricos menores (DPM) e verificar sua associação com fatores de risco. A amostragem por conglomerados foi definida em estágios múltiplos, incluindo 1967 pessoas com idade entre 20 e 69 anos, identificadas em 40 setores censitários da zona urbana da cidade de Pelotas. As entrevistas foram realizadas nos domicílios, utilizando-se um questionário pré-codificado, contendo SRQ-20, informações socioeconômicas e demográficas, presença de doenças crônicas, utilização de serviços de saúde, consumo de álcool, hábito de tabagismo e coleta de medidas antropométricas. A presença de DPM foi definida a partir de 6 e 7 respostas positivas no SRQ-20, para homens e mulheres, respectivamente. A prevalência de DPM foi de 28,5%, com intervalo de confiança de 95% entre 26,5% e 30,5%. A prevalência foi maior nas pessoas inseridas nas classes sociais mais baixas, de menor renda, acima de 40 anos e do sexo feminino. Na análise ajustada, os distúrbios psiquiátricos menores mantiveram-se associados com hábito de tabagismo, presença de doença crônica não transmissível e freqüência de consultas médicas. Os resultados indicam que as prevalências de DPM foram semelhantes a outros estudos realizados no município e atingem principalmente as camadas sociais mais baixas. Embora não tenham sido diferentes em relação ao tipo de serviço de saúde utilizado, mostraram associação com a freqüência de utilização de assistência médica, sugerindo que esses resultados possam orientar a formação de profissionais de saúde e o planejamento das ações de saúde.

Cost-effectiveness of hypertension treatment: a population-based study

CONTEXT

The cost-effectiveness of the treatment of hypertension has scarcely been investigated in population-based studies. Most data come from secondary analysis of clinical trials and administrative sources.

OBJECTIVE

To describe the health care costs for outpatient hypertension treatment in comparison with diabetes mellitus and chronic bronchitis, and to examine the cost-effectiveness of different classes of antihypertensive drugs.

DESIGN

Cross-sectional population-based study.

SETTING

Urban area of Pelotas, southern Brazil.

PARTICIPANTS

Individuals aged 20-69 years, identified through multi-stage probability sampling.

METHODS

Participants were interviewed at home. Demographic data, education, income, smoking, previous morbidity, use of medicine and other characteristics were assessed via a pre-tested questionnaire, and blood pressure while seated was measured in a standardized way.

RESULTS

Approximately 24% of the participants had high blood pressure or were taking antihypertensive drugs, and among these, 33% had had a physician consultation during the month preceding the interview. The monthly mean costs of care for hypertension (R$ 89.90), diabetes (R$ 80.64) and bronchitis (R$ 92.63) were similar. Treatment of hypertension consumed 22.9% of the per-capita income, corresponding to R$ 392.76 spent per year exclusively on antihypertensive drugs. Most of the direct costs associated with hypertension and diabetes were spent on drugs, while patients with bronchitis had greater expenditure on appointments. The cost-effectiveness relationship was more favorable for diuretics (116.3) and beta blockers (228.5) than for ACE inhibitors (608.5) or calcium channel blockers (762.0).

CONCLUSION

The costs of hypertension care are mainly dependent on the expenditure on blood pressure-lowering drugs. Treatment of hypertension with diuretics or beta blockers was more cost-effective than treatment with ACE inhibitors and calcium channel blockers.

[Contraceptive methods and adequacy of hormonal oral contraceptive use in the city of Pelotas, Rio Grande do Sul, Brazil: 1992-1999]

A cross-sectional study was conducted to assess contraceptive methods and the adequacy of oral contraceptive use by women aged 20 to 49 years in the city of Pelotas. The results were compared with another cross-sectional study performed in 1992. A sample was randomly selected, including 766 women aged 20 to 49 years. Some 495 of the sample (64.6%) used a contraceptive method, in the following order: oral contraceptives (55.4%), surgical sterilization (22.2%), condoms (10,5%), and IUD (7.7%). Among users of oral contraceptives, 62 (22.2%) had some contraindication. Incorrect use of contraceptive methods was associated with age but not with socioeconomic status. As compared to the previous study, there was a reduction in the use of oral contraceptives. Meanwhile, other methods such as surgical sterilization, condoms, and IUD were used more frequently than in 1992.

Uma amostra de pacientes com diabetes tipo 1 no sul do Brasil

Objetivos: Descrever uma população de pacientes com diabetes tipo 1 (DM1) em relação a fatores demográficos, ambientais, sócio-econômicos e manejo da doença. Delineamento: Série de casos. Participantes: Indivíduos com DM1, com até 10 anos de doença, até 30 anos de idade, residentes em onze municípios do sul do Brasil. Resultados: Foram estudados 126 indivíduos com DM1 (57 homens e 69 mulheres), sendo que a idade mais freqüente de início da doença foi dos 11 aos 15 anos (31%). Houve variação sazonal na época de apresentação. O diagnóstico foi feito por sintomas que motivaram uma dosagem de glicemia em 61%, por hospitalização, não em UTI, em 22% e por cetoacidose em 18%. Na amostra, 47% aplicava insulina uma vez ao dia. Sessenta por cento dos pacientes realizava algum tipo de automonitorização, um terço reutilizava seis ou mais vezes a seringa e 50% da insulina era fornecida pelo poder público. Quanto ao reconhecimento da hipoglicemia, 18% dos pacientes não sabiam citar nenhum dos sinais de alerta. Grande parte da amostra (73%) consultava médico especialista em DM. Dos pacientes com mais de 5 anos de doença, 16% nunca haviam feito fundoscopia e 17% haviam realizado o exame há 2 anos ou mais. As formas de apresentação da doença e da aquisição de insulina e a consulta com especialista estiveram associadas à renda familiar. As mulheres seguiam a dieta de modo mais adequado (p= 0,05) e auto-aplicavam insulina com mais freqüência, quando comparadas aos homens. Conclusões: Os fatores sócio-econômicos influenciaram neste estudo a forma de diagnóstico da doença, a obtenção de insulina e o acesso à especialistas. Os pacientes ainda carecem de conhecimentos básicos a respeito do manejo da doença.