Cognitive and Functional Decline among Individuals 50 Years of Age or Older in Cambé, Paraná, Brazil: A Population-Based Study.

AIMS: To identify the frequency of cognitive and functional decline (CFD) among adults 50 years of age and older by a population-based study. METHODS: Cognitive function was analyzed by the Mini-Mental State Examination, and the functional conditions were based on instrumental activities of daily living (IADL). Cases of CFD included individuals with cognitive decline and 2 or more compromised IADL. RESULTS: A total of 693 individuals were studied. The frequency of CFD was 16.3%. A low socioeconomic profile was associated with greater CFD independent of gender, age, education, and presence of depression (OR = 2.46; 95% CI: 1.53-3.97). CONCLUSIONS: These data show a high frequency of CFD among adults 50 years and older. Individuals with less education and a lower socioeconomic level exhibited poorer cognitive and functional conditions.

Association between social capital and self-perception of health in Brazilian adults.

OBJECTIVE To investigate the association between social capital and social capital and self-perception of health based on examining the influence of health-related behaviors as possible mediators of this relationship. METHODS A cross-sectional study was used with 1,081 subjects, which is representative of the population of individuals aged 40 years or more in a medium-sized city in Southern Brazil. The subjects who perceived their health as fine, bad or very bad were considered to have a negative self-perception of their health. The social capital indicators were: number of friends, people from whom they could borrow money from when needed; the extent of trust in community members; whether or not members of the community helped each other; community safety; and extent of participation in community activities. The behaviors were: physical activity during leisure time, fruits and vegetable consumption, tobacco use and alcohol abuse. The odds ratios (OR) and confidence intervals (CI) 95% were calculated by binary logistic regression. The significance of mediation was verified using the Sobel test. RESULTS Following adjustment for demographic and clinical variables, subjects with fewer friends (OR = 1.39, 95%CI 1.08;1.80), those who perceived less frequently help from people in the neighborhood (OR = 1.30, 95%CI 1.01;1.68), who saw the violent neighborhood (OR = 1.33, 95%CI 1.01;1.74) and who had not participated in any community activity (OR = 1.39, 95%CI 1.07;1.80) had more negative self-perception of their health. Physical activity during leisure time was a significant mediator in the relationship between all social capital indicators (except for the borrowed money variable) and self-perceived health. Fruit and vegetable consumption was a significant mediator of the relationship between the extent of participation in community activities and self-perceived health. Tobacco use and alcohol abuse did not seem to have a mediating role in any relationship. CONCLUSIONS Lifestyle seems to only partially explain the relationship between social capital and self-perceived health. Among the investigated behaviors, physical activity during leisure time is what seems to have the most important role as a mediator of this relationship.

[Reliability of the diagnoses of hospital admissions for external causes financed by the Brazilian Unified Health System-SUS in two cities in the State of Paraná, Brazil]. / Confiabilidade dos diagnósticos de internações por causas externas financiadas pelo Sistema Único de Saúde em dois municípios do Estado do Paraná, Brasil.

The scope of this article is to analyze the reliability of the diagnoses of hospital admissions for external causes financed by the Brazilian Unified Health System (SUS). The diagnoses for hospital admissions from the Hospital Information System (SIH-SUS) data were compared with those from the research panel created from information culled from authorizations for hospital admission (AIH) complemented with information from other sources. The reliability was analyzed in groups using crude agreement and Kappa statistics. The crude agreement was 41.1% in Londrina and 15.8% in Maringá and the highest reliability was found for groupings for self-inflicted lesions and traffic accidents in Londrina (Kappa 0.57 and 0.56) while in Maringá reliability was acceptable for self-inflicted lesions (Kappa 0.28). The low agreement with differentiated standards according to groupings of causes and according to the municipalities highlight the fact that efforts must be made to improve the quality and use of the SIH-SUS in order to understand and intervene in accidents and violence in Brazil.

Factors associated with road accidents among Brazilian motorcycle couriers.

The objective of the study was to identify factors associated with reports of road accidents, among motorcycle couriers in two medium-sized municipalities in southern Brazil. A self-administered questionnaire was answered by motorcycle couriers that had worked for at least 12 months in this profession. The outcomes analyzed were reports on accidents and serious accidents over the 12 months prior to the survey. Bivariate and multivariate analyses by means of logistic regression were carried out to investigate factors that were independently associated with the outcomes. Seven hundred and fifty motorcycle couriers, of mean age 29.5 years (standard deviation = 8.1 ), were included in the study. Young age (18 to 24 years compared to ≥ 25 years, odds ratio [OR] = 1.77) speeding (OR = 1.48), and use of cell phones while driving (OR = 1.43) were factors independently associated with reports of accidents. For serious accidents, there was an association with alternation of work shifts (OR = 1.91) and speeding (OR = 1.67). The characteristics associated with accidents-personal (young age), behavioral (use of cell phones while driving and speeding), and professional (speeding and alternation of work shifts)-reveal the need to adopt wide-ranging strategies to reduce these accidents, including better work conditions for these motorcyclists.

[Utilization of generics in an area covered by a family health unit in a southern Brazilian city]. / Utilização de genéricos em área de atuação da equipe de Saúde da Família em município do sul do Brasil.

The objective of the study was to estimate the prevalence of generics and their associated factors in a population of adults aged 20 to 59 years. The sample consisted of 374 individuals from the catchment area of a Family Health Unit in Ponta Grossa, PR, Brazil. Data were collected in home interviews. Study variables were divided into 3 groups: sociodemographic, health status and the use of health services. The chi-square test was used for statistical analysis. The prevalence of generics was 9.9%. Of those interviewed, 96.5% claimed to know about generic drugs, 64.3% believed they had the same quality as brand-name drugs and 88.9% reported they were cheaper. The most commonly-used groups of drugs were those for the nervous system and those for the cardiovascular system. After univariate analysis, the following factors were found to be statistically significant: economic status, employment status, health insurance, presence of chronic disease, medical consultation in the previous three months and hospitalization within the previous 12 months. The low prevalence of the use of generic drugs emphasizes the fact that stronger policies are needed to make generics available to the public, especially through the Family Health Strategy, since it is the studied population's principal form of access to these medications.

[Homicides between men aged 15 to 29 years and related factors in the State of Paraná, Brazil, 2002/2004]. / Homicídios de homens de quinze a 29 anos e fatores relacionados no estado do Paraná, de 2002 a 2004.

Homicides are the main cause of non-natural death in Brazil and studies about them may contribute to their control. The objective of this study was to verify mortality rates due to homicides and legal interventions among young men in the State of Paraná, Brazil, and to identify correlated municipal characteristics. An ecological study was conducted, having the municipalities of the State as units of analysis. Mortality rates of homicides and legal interventions among men from 15 to 29 years of age were calculated for the years 2002-2004 and demographic and social municipal indicators were obtained. Mortality rate in the State was 94.8 per one hundred thousand. The size of the population, the proportion of young people aged 15 to 24 years, the proportion of enrollments in universities and the Gini index were the main indicators correlated to homicide mortality (p<0.0001). Mortality rates were highest in municipalities of metropolitan regions, in those located at the border with Paraguay and in those located in the way between them and the Southeast Region of Brazil. Mortality rates and the proportion of deaths due to firearms increased with the size of the municipality. The greater number of youth and easier access to firearms and illicit drugs in such places may be influencing on these rates.

[Consumption of medicines by adults within an area covered by a family health unit]. / Consumo de medicamentos entre adultos na área de abrangência de uma Unidade de Saúde da Família.

There are few studies about the consumption of medication by adults in Brazil. Therefore, the purpose of this research was to identify the profile of medication consumption and associated factors among adults aged 29 to 59 years old. This is a cross-sectional study. The sample included 374 individuals from the area of a family health unit in the city of Ponta Grossa, State of Paraná. The interviews were conducted from December 2006 to January 2007, with a 7-day recall. The medications were classified according to the Anatomical Therapeutic Chemical Classification. Qui-square test and logistic regression were used for statistical analysis. The prevalence of medication consumption was 67.1%. The use varied from 1 to 17 drugs. Analgesics were the therapeutic class most consumed. After multivariate analysis, the variables which remained significantly associated to use were: gender, self-perception of health, presence of chronic diseases, and access to a health plan. Commercial pharmacy was the main place for obtaining medicines (63.6%). The prevalence of medication consumption was similar to that found in national and international studies. The findings in this research may be a guide for the actions of family health teams.

[Breastfeeding prevalence before and after the implementation of a children's morbid mortality reduction program in the municipality of Campo Mourão, Paraná State]. / Prevalência de aleitamento materno antes e após a implantação de um programa de redução de morbimortalidade infantil, no município de Campo Mourão (PR).

Health services evaluation contributes to the reformulation and establishment of new health practices and improvement of health indicators. The purpose of this study was to describe breastfeeding prevalence in the sixth month in children who were born before and after the implementation of a children's morbid mortality reduction program, in the municipality of Campo Mourão, Paraná State, and to verify the scope of actions to support breastfeeding. One hundred ninety-seven mothers, who had a child born before and after the implementation of the program, were interviewed. In their sixth month of life exclusive breastfeeding prevalence was 34.0% and 36.5%, respectively, for those born before and after the implementation. As for coverage, 16.2% of women took part in at least one educational lecture, 87.8% were interviewed by the group during admission to puerperium, 79.7% received educational material and 77.2% received material for the newly-born care. This study provided evidence of low impact of the program on breastfeeding prevalence. Other evaluative studies are suggested, so that the planning of actions and procedures of the program achieve their goal which is to provide a better care for the woman and child.

Arterial hypertension and family care: care provided to hypertensive individuals in a small municipality in Southern Brazil.

OBJECTIVE: Based on the analysis of indicators which express the rationale of the actions of the program, we developed a cross-sectional study to assess the performance of a Family Healthcare Team as regards the care provided to individuals with arterial hypertension living in a small municipality. METHODS: The study carried out was based on the analysis of the records (Record A) of SIAB (Primary Care Information System) of 418 individuals suffering from arterial hypertension, of 351 records stored in the primary healthcare center, and of 376 interviews with individuals living in the area under the team's care, in the year 2003. The following variables were studied: gender, age, family income, housing conditions, health services used, presence of diabetes mellitus, coverage and concentration of care. RESULTS: Women above 60 years of age prevailed. They were 65.7% of the cases. The arterial hypertension prevalence rate was 18%, and was different for both genders: for women it was 22.3%. The coverage was 64.1% for appointments with doctors, 32.4% for appointments with nurses, and 36.4% for home visits. The information on files revealed that 25.8% of hypertensive individuals did not receive care in 2003 and 52.7% did not receive care in the last semester. The concentration of care was below the recommendation. CONCLUSION: The information showed that the organization of health care does not reflect the rationale of health surveillance in that services focus mostly on meeting spontaneous demand, which in turn reflects unpreparedness as to the use of information systems for the planning and evaluation of actions.