RESUMO
The aim of this study is to assess the factors associated with hypertension prevalence, awareness, treatment, and control, in the elderly populations of the International Mobility in Aging Study (IMIAS). Approximately 200 men and 200 women aged 65-74 years were recruited at each site (n=1995) during IMIAS' 2012 baseline survey at five cities: Kingston (Canada), Saint-Hyacinthe (Canada), Tirana (Albania), Manizales (Colombia) and Natal (Brazil). Blood pressure and anthropometric measurements were taken at participants' homes. Hypertension prevalence ranged from 53.4% in Saint-Hyacinthe to 83.5% in Tirana. Diabetes and obesity were identified as risk factors in all cities. More than two-thirds of hypertensive participants were aware of their condition (from 67.3% in Saint-Hyacinthe to 85.4% in Tirana); women were more aware than men. Awareness was positively associated with diabetes in Kingston, Manizales and Natal. Though most of those aware of their hypertensive condition were being treated pharmacologically, associations between awareness and physical activity and refraining from smoking were weak. Control among treated hypertensive participants was low, especially in Tirana and Natal. Diabetes and physical inactivity were associated with poor hypertension control. Hypertension is common in the older populations of IMIAS. Diabetes is strongly associated with hypertension prevalence, awareness and lack of control of hypertension. The fact that awareness is not strongly associated with healthy behaviours suggests that antihypertensive medication is not accompanied by non-pharmacological therapies. Improved health behaviours could strengthen hypertension control. Efforts should be made to increase men's awareness of hypertension. Hypertension control in diabetic patients is a challenge.
Assuntos
Envelhecimento , Anti-Hipertensivos/uso terapêutico , Conscientização , Pressão Sanguínea/fisiologia , Hipertensão/epidemiologia , Atividade Motora/fisiologia , Idoso , Brasil/epidemiologia , Canadá/epidemiologia , Feminino , Seguimentos , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Masculino , Prevalência , Estudos Prospectivos , Fatores de RiscoRESUMO
OBJECTIVES: To present the study design and baseline results of the longitudinal International Mobility in Aging Study (IMIAS) on gender differences in physical performance and mobility disability prevalence in five diverse societies. METHODS: Data are from surveys on random samples of people aged 65-74 years at Canadian (Kingston, Ontario; Saint-Hyacinthe, Quebec), Mediterranean (Tirana, Albania) and Latin American sites (Natal, Brazil; Manizales, Colombia) (N=1995). Mobility disability was defined as reporting difficulty in walking 400m or climbing stairs. Activities of daily living (ADL) disability was based on any self-reported difficulty in five mobility-related ADLs. The short physical performance battery (SPPB) was used to assess physical performance. Poisson regression models were fitted to estimate prevalence ratios. RESULTS: Age-adjusted prevalence of low SPPB, mobility disability and ADL disability were higher in women than in men in all sites except for Kingston. After adjustment for education and income, gender differences in SPPB and ADL disability attenuated or disappeared in Saint-Hyacinthe and Manizales but remained large in Tirana and Natal and mobility disability remained more frequent in women than in men at all sites except Kingston. After further adjustment by chronic conditions and depressive symptoms, gender differences in mobility remained large at all sites except Kingston but only in Tirana did women have significantly poorer physical performance than men. DISCUSSION: Results provide evidence for gender as a risk factor to explain poorer physical function in women and suggest that moving toward gender equality could attenuate the gender gap in physical function in old age.
Assuntos
Atividades Cotidianas , Envelhecimento , Pessoas com Deficiência/estatística & dados numéricos , Avaliação Geriátrica/estatística & dados numéricos , Limitação da Mobilidade , Idoso , Idoso de 80 Anos ou mais , Brasil , Canadá , Avaliação da Deficiência , Feminino , Identidade de Gênero , Avaliação Geriátrica/métodos , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Prevalência , Quebeque , Fatores de Risco , Autorrelato , Fatores Sexuais , Caminhada/fisiologiaRESUMO
OBJECTIVE: To assess the prevalence and the types of drug to drug interactions in a population 65 years and over and to identify the factors associated to the occurrence of interactions. DESIGN: Cross sectional study ("Aging in Leganés"), a community survey. SETTING: Community level. Leganés (Madrid). PATIENTS AND OTHER PARTICIPANTS: People 65 years and over (n = 1284, response rate 83%). MEASUREMENTS AND MAIN RESULTS: Information on use of health services and medication use was collected through home interviews. Drugs were classified by its active components and into therapeutic categories. Drug to drug interactions were identified using Hansten's classification. Bivariate and multivariate analysis were carried out to identify factors associated to the frequency of interactions. RESULTS: The prevalence of drug to drug interactions was estimated as 13.6%. Interactions of clinical significance occurred in 9.9% of the population 65 and over. Hypertension, diabetes, Parkinson and cardiovascular diseases are significatively associated to interactions. The number of visits to the specialists was a risk factor (OR = 2.1 for those with five or more visits), after controlling for specific chronic conditions. Contacts with primary care, age and sex of the elderly were not associated to the frequency of interactions. DISCUSSION: The frequency of interactions is associated to preventable factors. Improvements in the communication between specialists and primary care and cooperation with pharmacists could result in better monitoring of medication use in the elderly.
Assuntos
Interações Medicamentosas , Polimedicação , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , MasculinoRESUMO
OBJECTIVES: To identify attitudes, knowledge and self-perceived risks among doctors in the Este-Oriente District of Sevilla concerning HIV/AIDS infection; to detect attitude problems and structural barriers affecting doctors' predisposition towards patients with HIV/AIDS infection. DESIGN: A cross sectional study using a self-administered questionnaire. SETTING: Este-Oriente Primary Care district, Sevilla. PARTICIPANTS: Permanent and provisional doctors and paediatricians working in the district during the survey. MEASUREMENTS AND RESULTS: Reply rate was 86% (n = 111). Most doctors (85%) had treated one or more patients with HIV. 91% thought they had to treat these persons. However, 21% would not work with them, if they had the choice. CONCLUSIONS: Attitudes of doctors and paediatricians in the Este-Oriente district of Sevilla towards HIV/AIDS patients can be qualified as positive. Most doctors need to extend their knowledge of this disease. The perception of risk of contagion is high and higher than the real risk. Important attitude and structural barriers to care provision were detected: intervention strategies were proposed by the doctors and paediatricians of this district.
Assuntos
Síndrome da Imunodeficiência Adquirida/terapia , Atitude do Pessoal de Saúde , Infecções por HIV/terapia , Médicos , Estudos Transversais , Feminino , Humanos , Masculino , Pediatria , Atenção Primária à Saúde , Espanha , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To evaluate the efficacy of a self-care hypertension programme within primary care. DESIGN: Two models of intervention by means of self-care were compared, both using individual education and family support, with one of them using group education. SETTING AND PATIENTS: All those attending 10 health centres in Andalucía and who had a recent diagnosis of light or moderate Hypertension or with their hypertension not monitored over the preceding 6 months, were included. MEASUREMENTS AND MAIN RESULTS: These 160 people were assigned at random to the intervention group (group education) or the control group (individual education). Data analysis provided the results for the 95 people who completed the study. Both systolic and diastolic arterial pressure (SAP and DAP) diminished significantly during the study period, both in the sample as a whole and in the intervention group. However, the lessening of systolic pressure only reached statistically significant differences in the control group. Over the study period, the lessening of SAP was 6.2 in the intervention group and 8.0 in the control group; whereas the lessening of DAP was 7.0 in the intervention group and 2.3 in the control group. CONCLUSIONS: Arterial hypertension can be controlled in primary care by health education for self-care. On the basis of this study's findings, it is not valid to conclude that group is more efficacious than individual education.
Assuntos
Hipertensão/terapia , Atenção Primária à Saúde , Avaliação de Programas e Projetos de Saúde , Autocuidado , Adulto , Distribuição de Qui-Quadrado , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/estatística & dados numéricos , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Fatores de Risco , Autocuidado/métodos , Autocuidado/estatística & dados numéricos , Fatores Socioeconômicos , Espanha/epidemiologiaRESUMO
Risk factors for squamous cell carcinoma of the uterine cervix were studied among low income, married Hispanic women and their husbands, using a case-control design. A total of 45 eligible cases were identified at public hospitals and community clinics in the San Francisco Bay Area. For each case, a control was selected within two years of age from among Hispanic women seen at the same institution. Thirty-nine matched pairs of couples were interviewed to assess histories of sexual behavior and other possible risk factors. Cases and controls differed markedly in the number of past sexual partners of their husbands. Cases were 5.3 times more likely to be married to husbands who had had 20 or more sexual partners than were controls. Cases and controls themselves did not differ in their number of sexual partners, but cases were younger at first intercourse than were controls. The association with husband's sexual history persisted after adjusting for the woman's number of sexual partners or age at first intercourse. These results support the infectious and venereal transmission of cervical cancer and indicate the important role of husbands in its occurrence in a population with high incidence rates.