Antibodies to hepatitis C virus (HCV) in chronic renal failure (CRF) patients on conservative therapy: prevalence, risk factors and relationship to liver disease

Self-reported diabetes, hypertension and hypercholesterolemia among older persons in Malaysia

AIM

The objective of this study is to determine the prevalence of self-reported diabetes, hypertension and hypercholesterolemia among older persons in Malaysia and their associated factors.

METHODS

The study used data from the National Health and Morbidity Survey in 2018. It was a cross-sectional study with two-staged stratified cluster sampling design. In total, 3977 adults aged ≥60 years were selected for this study. Respondents were interviewed face to face using a structured questionnaire. Self-reported diabetes, hypertension or hypercholesterolemia was defined as having ever been told they have these diseases by a medical doctor or paramedic. Data were analyzed using SPSS version 25. The multiple logistic regression model was used to examine the factors associated with the prevalence of self-reporting.

RESULTS

The prevalence of self-reported diabetes, hypertension and hypercholesterolemia among older persons in Malaysia were 27.7%, 51.1% and 41.8% respectively. Presence of other comorbidities and being obese showed higher odds for all three diseases. Indians, unemployed, inactive had higher odds for diabetes. Other Bumiputras, unemployed, non-smoker, obese and inactive had higher odds for hypertension. Non-smoker had higher odds for hypercholesterolemia.

CONCLUSIONS

Health promotion, vigilance, attention and services targeting on the associated factors should be strengthened for older persons in Malaysia to ensure healthy aging. Geriatr Gerontol Int 2020; 20: 79-84.

Anemia among Adult Diabetic Patients Attending a General Hospital in Eastern Ethiopia: a Cross-sectional Study

BACKGROUND

Although anemia is a common condition among patients with diabetes mellitus, there is little evidence on anemia among this segment of population in Ethiopia at large and in the study setting in particular. Thus, this study aimed at assessing the magnitude of anemia and its associated factors among adult diabetic patients attending a general hospital in Eastern Ethiopia.

METHODS

A health facility-based cross-sectional study was conducted among 325 randomly selected adult diabetes mellitus patients attending a follow-up clinic at Gelemso General Hospital, Eastern Ethiopia. Data were collected through an interview using a pre-tested and structured questionnaire followed by physical and laboratory measurements. Data were then entered into EpiData Version.3.1 and analyzed by using STATA version 16.0. Binary logistic regression models were fitted to identify factors associated with anemia. All statistical tests were declared significant at p-value < 0.05.

RESULTS

The magnitude of anemia among adult diabetic patients was 30.2% (95% confidence interval (CI): 25.4%-35.4%). Anemia was higher in males (36%) than females (20.5%). Male gender (Adjusted Odds Ratio (AOR) = 2.1, 95% CI: 1.2, 3.8), DM duration of ≥5 years (AOR= 1.9, 95% CI: 1.0, 3.7), presence of comorbidity (AOR= 1.9, 95% CI: 1.0, 3.7), and having diabetic complications (AOR= 2.3, 95% CI: 1.3, 4.2) were significantly associated with anemia.

CONCLUSION

Anemia was a moderate public health problem among adult DM patients in the study setting. Being male in gender, duration of DM, presence of DM complications, and DM co-morbidities were factors associated with anemia. Therefore, routine screening and appropriate management of anemia targeting males, DM patients with longer duration of DM, and those with complications and co-morbidities should be devised to improve patients' quality of life. Early diagnosis and regular monitoring of DM could also help to minimize further complications.

Dietary intake, anthropometric measurements, biochemistry profile and their associations with chronic kidney disease and diabetes mellitus

The chronic kidney disease (CKD) and diabetes mellitus (DM) are considered a serious public health problem. The objective was investigating the association of DM with the anthropometric measures, biochemical profile and dietary intake in patients with CKD. Is a cross-sectional study done in 2017, with 51 patients previously diagnosed with CKD. We collect socio-demographic, lifestyle variables, anthropometric measurements, biochemical profile and dietary intake. We using the Kolmogorov–Smirnov test, followed by Pearson's χ² test and Student's t test. Data were analysed using several multivariable logistic regression models, including the socio-demographic, anthropometric, dietary intake and biochemical variable. Variables with P ≤ 0⋅20 in the univariate analyses were selected and kept in the block in the simple and multiple logistic regression analysis, to determine the differences between the categories and the factors associated with the presence of DM or not, remaining in the model final, only the significant variables (P ≤ 0⋅05). Each variable was adjusted for all other variables included in the univariate analysis. The strength of the association was assessed by the odds ratio and 95% confidence intervals (CI). The multivariate logistic regression analysis evidenced that the increase of 1 cm in waist circumference and 1 mg/dl in VLDL-c values increases the chance of DM, respectively, by 8⋅4% (OR 1⋅076; P 0⋅05) and 8⋅8% (OR 1⋅102; P 0⋅01). In contrast, an increase of 1 mg/dl in total cholesterol decreases the chance of developing DM by 3⋅1% (OR 0⋅965; P 0⋅01), that is, it becomes a protective factor. The present study identified the associations between overweight, dietary intake and biochemical tests.

Incidence and prevalence of diabetes self-reported on elderly in south of Brazil: results of EpiFloripa Ageing Study

Abstract This study investigated the prevalence and incidence of diabetes self-referred in the elderly. Longitudinal population-based study (EpiFloripa Ageing Study), with 1.702 elderly in 2009/10 and 1.197 in 2013/14 of Florianópolis, SC. Self-reported and anthropometric data were collected at home. The prevalence of diabetes self-referred in 2009/10 was 22.1% (95%CI 20.1-24.1). The characteristics were: no formal schooling (2.30; CI95% 1.32-4.00); 5 to 8 years of schooling (OR = 1.70, CI95% 1.07-2.69); increased waist circumference (OR = 3.31, CI95% 2.05-5.34) and hypertension (OR = 2.38, CI95%: 1.68-3.36). The incidence of diabetes self-reported after four years of follow-up was 8.3% (95% CI, 6.7-10.3). After adjustment: increased waist circumference (OR= 2.23, CI95% 1.09-4.57) at baseline was associated with the incidence of diabetes. The prevalence and incidence of diabetes were high among the elderly. Interventions must be performed especially with elderly with low and without formal schooling, with increased waist circumference and hypertension, thus they were the subgroups with higher odds ratio of reporting and developing diabetes.

The Association Between Diabetes and Cognitive Function in Later Life

Introduction:

Although diabetes through several possible mechanisms such as increased microvascular pathology and inefficiency of glucose utilization during cognitive tasks can be associated with cognitive impairment, there is inconclusive evidence that shows elderly diabetic patients under therapy have higher cognitive function compared to their non-diabetics counterparts. The present study was conducted to elucidate the association between diabetes and cognitive function in later life.

Methods:

Data for this study, consisting of 2202 older adults aged 60 years and above, were taken from a population-based survey entitled “Identifying Psychosocial and Identifying Economic Risk Factor of Cognitive Impairment among Elderly. Data analysis was conducted using the IBM SPSS Version 23.0.

Results:

The mean of MMSE was found to be 22.67 (SD = 4.93). The overall prevalence of self-reported diabetes was found to be 23.6% (CI95%: 21.8% - 25.4%). The result of independent t-test showed diabetic subjects had a higher mean score of MMSE (M = 23.05, SD =4 .55) than their counterparts without diabetes (M = 22.55, SD = 5.04) (t = -2.13 p<.05). The results of multiple linear regression analysis showed that diabetes was not significantly associated with cognitive function, after controlling the possible confounding factors.

Conclusions:

The findings from the current study revealed that diabetes is not associated with cognitive decline. This study supports the findings that long-term treatment of diabetes may reduce the risk of cognitive decline. This finding may provide new opportunities for the prevention and management of cognitive decline.

Anti-hepatitis C virus therapy in chronic kidney disease patients improves long-term renal and patient survivals

BACKGROUND

Hepatitis C virus (HCV) infection is a documented risk factor for chronic kidney disease (CKD) and progression to end-stage renal disease (ESRD). However, to date there are no reports on the long-term hard endpoints (ESRD and death) of anti-HCV therapy [interferon-based therapy (IBT) or new direct-acting antivirals] in CKD patients. Direct-acting antivirals are not available in Taiwan's single-payer national health insurance database currently released for research. Therefore, we hypothesized that a retrospective analysis of the long-term outcomes of IBT in CKD patients will serve as a proxy for direct-acting antivirals to increase our understanding of progression to ESRD following HCV infection.

AIM

To evaluate the long-term outcomes (ESRD and death) of anti-HCV therapy, especially IBT, in HCV-infected patients with stage 1-5 CKD.

METHODS

We analyzed 93894 Taiwanese adults diagnosed with CKD and without HBV infection. Of these, 4.9% were infected with HCV. Of the 4582 HCV-infected CKD patients, 482 (10.5%) received IBT (treated cohort). They were matched 1:4 with 1928 untreated HCV-infected CKD patients (untreated cohort) by propensity scores and year, which further matched 1:2 by propensity scores with 3856 CKD patients without HCV infection (uninfected cohort). All participants were followed until the occurrence of ESRD, death, or the end of 2012. The association between HCV infection, IBT use, and risks of ESRD and death was analyzed using competing risk analysis.

RESULTS

Taking the uninfected cohort as a reference, the adjusted hazard ratios for ESRD, after adjusting for competing mortality, were 0.34 (0.14-0.84, P = 0.019) and 1.28 (1.03-1.60, P = 0.029) in the treated and untreated cohorts, respectively. The treated cohort had a 29% (0.54-0.92, P = 0.011) decrease in mortality compared to the untreated cohort, in which the mortality was 31% (1.18-1.45, P < 0.001) higher than in the uninfected cohort. The reduced risks of ESRD (0.14, 0.03-0.58, P = 0.007) and death (0.57, 0.41-0.79, P = 0.001) were greatest in HCV-infected CKD patients who received at least 4 mo of IBT, which accounted for 74% of the treated cohort.

CONCLUSION

Adequate anti-HCV therapy in CKD patients improves long-term renal and patient survival.

Reported diabetes mellitus: incidence and determinants in cohort of community dwelling elderly people in São Paulo City, Brazil: SABE study, health, wellness and aging

To verify the association between the incidence of DM and predictors, in a cohort of elderly people. Elderly people (≥ 60 y) were analyzed, of both genders, participants of the SABE Survey, carried out in the city of São Paulo, Brazil, in 2000 (n = 2,143) and 2006 (n = 1,115). The study variables were: DM; demographic (gender, age group, education level, companionship in the residence), nutritional status (risk for obesity, body obesity, and high abdominal fat), clinical (number of reported diseases), and lifestyle (alcohol consumption, smoking, intake of meat and fruit and vegetables). Multiple logistic regression (p < 0.05) was used to verify the association between variables of this study, with the statistical software Stata/SE 10.1. In 2006, 914 subjects, survivors of 2000, were analyzed and 72 were identified as new cases of DM (7.7/1.000 person-years). It was found that body obesity (OR = 1.67, CI = 1.00 to 2.81) and high abdominal fat (OR = 2.32, CI = 1.47 to 3.67) were predictors of the incidence of DM in the elderly (p < 0.000). It was concluded that body obesity and abdominal fat are the variables which contribute to the development of DM in the elderly.

Palmar strength and sociodemographic, clinical-functional, and psycho-cognitive factors in elderly with Diabetes Mellitus

Abstract Introduction: An important consequence of the aging of people with DM2 is physical disability, particularly the loss of mobility. Objective: To determine sociodemographic, clinical-functional, and psycho-cognitive factors related to the reduction in hand grip strength (HGS) in elderly patients with type 2 diabetes mellitus (DM2) and to verify the relationship between HGS and fragility. Method: This is an observational cross-sectional study with 156 elderly individuals aged 60 years and over, both male and female, diagnosed with DM2. The participants were assessed according to sociodemographic, clinical-functional, psycho-cognitive, and functional mobility data. HGS was evaluated using a manual dynamometer. The tests performed were: Mann-Whitney or Kruskal-Wallis, and Chi-square. The level of significance was set at 5% (p < 0.05). Results: A significant relationship was observed between HGS and each of the following: sex (p < 0.001), age range (p = 0.04), marital status (p = 0.004), physical activity (p = 0.06), number of conditions diagnosed (p = 0.002), use of insulin therapy (p = 0.03), complaint of pain in lower limb power (p < 0.001), falls in the last year (p = 0.004), fear of falling (p = 0.003), Mini-Mental State Examination (p = 0.01), Geriatric Depression Scale (p = 0.008), fragility phenotype (p < 0.001). Conclusion: HGS was reduced in elderly women with DM2, those who did not have a marital life had five or more diseases diagnosed with insulin therapy, did not engage in regular physical activity, complained of lower limb pain, had a history of two or more falls in the last year, had a fear of falling, had a cognitive deficit, had depressive symptoms, and were fragile.

[Factors associated with the self-rated health of elderly frequenters of low-budget community restaurants in Belo Horizonte]

The scope of this paper was to evaluate the self-rated health among elderly frequenters of low-budget community restaurants (RP) in Belo Horizonte (BH) and the factors associated with this outcome. It involved a cross-sectional study in all RP and BH cafeteria. The self-rated health was classified as bad and very bad; average; good and very good. Sociodemographic and economic variables were considered to be possible associated factors, as well as those related to physical health and social resources. In the univariate analysis, the Chi-square test and Mann-Whitney tests were used. In the multivariate analysis a model of ordinal logistic regression was created. The sample consisted of 279 elderly people, the majority (68.5%) being male. Most of the elderly (57.5%) considered their health as being good or very good. Factors associated with better health perception in the multivariate analysis (p-value < 0.05) were satisfaction with relationships with friends, not having diabetes or any other cardiovascular disease and finally, the low frequency and lack of problems that hinder the elderly from doing the things they need or want to do. Such studies contribute to the understanding of the health perception of elderly people associated with several factors that can influence healthy aging.

Prevalência simultânea de hipertensão e diabetes em idosos brasileiros: desigualdades individuais e contextuais

Resumo A prevalência da simultaneidade de doenças específicas nos idosos ainda é pouco descrita na literatura. O objetivo do estudo foi estimar a prevalência simultânea de hipertensão arterial e diabetes mellitus em idosos brasileiros, e os fatores contextuais e individuais a ela associados. Estudo transversal de base populacional com idosos (≥ 60 anos) entrevistados pelo Vigitel em 2012 (n = 10.991). As análises foram realizadas por meio de regressão de Poisson multinível no Stata 12. A média de idade dos idosos foi de 69,4 anos e a prevalência simultânea das doenças foi de 16,2% com variação nas capitais brasileiras. Em São Paulo e Curitiba as prevalências foram mais elevadas do que em Boa Vista e Manaus. Maiores prevalências foram observadas nas capitais das regiões Sul/Sudeste/Centro-Oeste, nos idosos de cor preta e parda, naqueles com escolaridade ≤ 8 anos de estudo, nos não fumantes e ex-fumantes, e com excesso de peso. Verificou-se o efeito da região geográfica na prevalência simultânea pela elevação de 23,5% na magnitude da razão de prevalencia, após ajuste para todas as variáveis individuais. Por meio do estudo, foi possível dimensionar o efeito do contexto onde estão inseridos os idosos (região de residência) sobre a prevalência das principais doenças que acometem e relacionam-se à mortalidade na população idosa na atualidade.

Access and adherence to medication among people with diabetes in Brazil: evidences from PNAUM

OBJECTIVE

To describe people with diabetes in Brazil and to compare their sociodemographic characteristics, access and self-reported adherence to diabetes prescribed drugs.

METHODS

Data analysis from the National Survey on Access, Use and Promotion of the Rational Use of Medicines, a household survey, with sampling by clusters, according to sex and age domains and national and macro-regional representativeness. Adults (≥ 20 years old) who reported having diabetes constituted the sample. The weighted frequencies of the variables in the sample were analyzed and the Pearson χ2 test was applied to evaluate the statistical significance of the differences between the strata for the data of access, form of financing and adherence to the drugs, considering the level of significance of 5%.

RESULTS

We found a higher proportion of women, people over 60 years and economy class C. Most participants reported having two or more comorbidities, in addition to diabetes, and taking five or more drugs. Regarding access, 97.8% say they have access to prescription drugs for diabetes and 70.7% say they get them totally free of charge. There was low adherence to anti-diabetic treatment, with significant macro-regional differences (p = 0,001), and greater vulnerability in the South and Northeast regions.

CONCLUSION

Better access to diabetes medicines in the country has been demonstrated. However, to improve the efficiency of health public spending, it is necessary to achieve higher rates of adherence to treatment.

Social inequalities in care for the elderly with diabetes in Brazil

Objective.

To measure the prevalence of various care services offered to the elderly with diabetes mellitus in Brazil, and to assess the social inequalities in these services.

Methods.

This cross-sectional, population-based study was carried out in 2013. The care services offered were evaluated in terms of the following eight indicators: recommendations to lower carbohydrates, to measure blood glucose, and to examine the feet; requests made for blood tests, for glycated hemoglobin tests, and for glycemic curve tests; and whether service users had had their eyes or feet examined in the previous year. We used the slope index of inequality and the concentration index to assess the inequalities among wealth quintiles.

Results.

A total of 1 685 elderly persons with diabetes were evaluated. Overall, 41.7% of them had had their eyes examined in the preceding year, 35.4% had had their feet examined in the preceding year, and 10.9% had been offered all eight of the care services. The largest absolute differences (in percentage points) between the first (poorest) and fifth (richest) wealth quintiles in terms of the care services that were offered to the users were for: a recommendation to measure blood glucose (25.8), a glycated hemoglobin test request (27.4), a glycemic curve test request (31.9), having the eyes examined in the preceding year (29.3), and having the feet examined in the preceding year (27.0).

Conclusion.

There were notable inequalities in the prevalences of the care services. In the future, measurement of blood glucose and examination of the feet should be emphasized, especially for elderly persons in a lower socioeconomic level.

The prevalence of diabetes mellitus and its associated factors in the Brazilian adult population: evidence from a population-based survey

Objective:

To estimate the prevalence of self-reported diabetes mellitus (DM) and its associated factors among the Brazilian adult population.

Methods:

The prevalence of DM was assessed in the Survey on Social Dimensions of Inequalities, a national survey with macro-regions representativeness carried out in 2008. Data were collected by a personal face-to-face interview with 12,423 individuals of both sexes, aged over 20 years. The χ2 test at 5.0% was performed in order to identify associated factors, and logistic regression was used to estimate adjusted odds ratios.

Results:

The prevalence of DM in Brazil was 7.5%. After adjusting for potential confounders, diabetes remained associated with age (≥ 40 years), education (< 8 years of study), marital status (non-married), obesity, sedentary lifestyle, comorbidity with hypertension and hypercholesterolemia, as well as the demand for health services.

Conclusion:

Results indicate a high prevalence of DM and its associated preventable factors in Brazil. Thus, they highlight the need for a behavioral change as a strategy for prevention and control of diabetes and its complications.

Potential use of telephone-based survey for non-communicable disease surveillance in Sri Lanka

BACKGROUND

Telephone survey (TS) has been a popular tool for conducting health surveys, particularly in developed countries. However, the feasibility, and reliability of TS are not adequately explored in Sri Lanka. The main aim of this study is to assess the effectiveness of telephone-based survey in estimating the prevalence of common non-communicable diseases (NCDs) in Sri Lanka.

METHODS

We carried out an observational cross-sectional study using telephone interview method in Galle district, Sri Lanka. The study participants were selected randomly from the residents living in the households with fixed land telephone lines. The prevalence of the main NCDs was estimated using descriptive statistics.

RESULTS

Overall, 975 telephone numbers belonging to six main areas of Galle district were called, and 48% agreed to participate in the study. Of the non-respondents, 22% actively declined to participate. Data on NCDs were gathered from 1470 individuals. The most common self-reported NCD was hypertension (17.%), followed by diabetes (16.3%) and dyslipidaemia (15.6%). Smoking was exclusively seen in males (7.4%), and regular alcohol use was significantly more common in males (19.2%) than females (0.4%, P < .001).

CONCLUSIONS

Our study revealed average response rate for telephone based interview in Sri Lankan setting. Overall prevalence of main NCDs in this study showed a comparable prevalence to studies used face to face interview method. This study supports the potential use of telephone-based survey to assess heath related information in Sri Lanka.

Prevalence and associated factors of diabetes in the elderly population in Viçosa, Minas Gerais, Brazil

OBJECTIVES

To assess the prevalence and factors associated with diabetes in the elderly population and verify the correlation between the use of medications for diabetes and information about the disease.

METHODS

This epidemiological cross-sectional study was conducted in Viçosa, Minas Gerais, Brazil, with 621 elderly people aged 60 years or older selected by simple random sampling. A semi-structured questionnaire was used as a research tool and included questions about socioeconomic conditions, lifestyle, health conditions, and nutritional status. The weight, height, and waist circumference were measured. The dependent variable was the self-reported diabetes. In the association analysis between explanatory variables and self-reported diabetes, the Poisson regression analysis with robust variance was used. In the bivariate analysis, a p value < 0.25 was used to include the variables for the multivariate modeling, and in the final model, the variables with p value < 0.10 association were included.

RESULTS

The prevalence of diabetes was 22.4%. The multivariate hierarchical analysis showed the following factors independently and positively associated with diabetes: gender, self-reported health, history of hypertension/dyslipidemia, polypharmacy, and waist circumference. The elderly schooling was negatively associated with diabetes.

CONCLUSION

The results showed the need for implementation of educational public policies to promote behavior changes of the population to prevent and control diabetes and its complications.

Risk and protection factors for self-reported hypertension and diabetes in João Pessoa, Brazil. The VIGITEL survey, 2014. A cross-sectional study

CONTEXT AND OBJECTIVE

Chronic diseases are the main cause of death among adults and are responsible for most outpatient and hospital care expenses in Brazil. The objective here was to determine the prevalence of hypertension and diabetes and to analyze the associations with risk and protection factors among adults.

DESIGN AND LOCAL

Cross-sectional study in a state capital in northeastern Brazil.

METHODS

Data on adults of both sexes aged ≥ 45 years who were interviewed in the Vigitel telephone survey in 2014 were analyzed. Prevalence ratios were estimated using Poisson regression, to identify associated factors.

RESULTS

Among women, the prevalence of hypertension was 48.4% and of diabetes, 12.7%; among men, the prevalences were 41.9% and 13.8%, respectively. Multivariate analysis showed that for women, age group ≥ 65 years, overweight, self-assessed poor health and dyslipidemia remained associated with higher prevalence of hypertension. For men, overweight and self-assessed poor health remained associated with higher prevalence of hypertension. Regarding diabetes, in the multivariate model for women, age group 55-64 years, schooling level between zero and four years and no regular consumption of beans remained associated with higher prevalence. For men, age groups 55-64 years and ≥ 65 years and being married or in a stable partnership were associated with higher prevalence of diabetes.

CONCLUSIONS

The results indicated that the prevalences of hypertension and diabetes were high and that preventable factors were associated with this situation, thus providing support for public policies aimed towards coping with this.

Contribution of family social support to the metabolic control of people with diabetes mellitus: A randomized controlled clinical trial

AIM

This randomized controlled clinical trial aimed to evaluate the contribution of family social support to the clinical/metabolic control of people with type 2 diabetes mellitus.

BACKGROUND

Diabetes mellitus is a chronic disease that requires continuous care in order for individuals to reach glycemic control, the primordial goal of treatment. Family social support is essential to the development of care skills and their maintenance. However, there are few studies that investigate the contribution of family social support to diabetes control.

METHODS

The study was developed between June 2011 and May 2013, and included 164 people who were randomized using simple randomization. The intervention group differed from the control group in that it included a family caregiver, who was recognized by the patient as a source of social support. The educational interventions received by people with diabetes mellitus were used as the basis of the education provided through telephone calls to patients' family members and caregivers, and their purpose was to encourage dialogue between the patients and their relatives about the topics related to diabetes.

RESULTS

Regarding the clinical impact, the results showed that there was a greater reduction in blood pressure and glycated hemoglobin in the intervention group than in the control group, showing a positive effect on the control of the disease.

CONCLUSIONS

Families should be incorporated into the care of people with diabetes mellitus and especially in health care programs, in particular those that can promote different forms of social support to strengthen the bond between family members.

Factors associated with diabetes among the elderly receiving care at a specialized gerontology-geriatric outpatient clinic

Abstract Objective: To identify the prevalence of diabetes and its relation to associated factors in elderly persons receiving care at a specialist gerontology-geriatric outpatient service. A descriptive cross-sectional study of 301 elderly persons of both genders was performed. Method: The bivariate analysis was performed using the Pearson’s Chi-square test for Independence and Fisher's exact test, considering 5% of significance and 95% confidence. A multivariate logistic regression model was adjusted to identify factors that may influence the occurrence of diabetes. Result: There was no statistically significant association between the prevalence of diabetes and socioeconomic and demographic variables, behavioral factors and health conditions. Only the Body Mass Index variable was close to being statistically significant (p=0.059). Conclusion: The result confirms the need to develop new studies on the subject to consider the particularities and specificities of the elderly population to enable the creation of educational intervention strategies aimed at this group.

Expenditures of medicine use in hypertensive/diabetic elderly and physical activity and engagement in walking: cross secctional analysis of SABE Survey

BACKGROUND

The literature shows the inverse association between physical activity level (PAL) and chronic diseases that have a significant burden over health care costs. However, in upper-middle income countries and in elderly population this information are scarce.

OBJECTIVE

To describe the annual drug expenditures for the hypertensive and diabetic elderly population in Brazil and to analyze the association with PAL and engagement in walking.

METHODS

This cross sectional study is part of SABE Survey and comprised 806 hypertensive and/or diabetic elderly (≥60 years old). The annual expenditures of medicine use was estimated for all medications for hypertension and/or diabetes they were taking. The PAL was considered insufficient when moderate physical activity was <150 min/week or vigorous physical activity was < 75 min/week. Engagement in walking was considered by at least 1 day a week. All expenditures were presented through the descriptive values (in American Dollars US$) according PAL and engagement in walking. The association analysis between annual expenditures, PAL and engagement in walking were performed by multiple logistic regression models adjusted for gender, age and body mass index.

RESULTS

The average annual cost was higher in diabetic and insufficient physically activity elderly. The 1-year estimated.cost was US$ 73386,09 and 295% higher in insufficiently physically active. Older people who reported not walking had a higher risk to higher annual expenditures of medicine use (OR = 1.57, 95% CI 1.03-2.40).

CONCLUSIONS

The annual expenditures of medicine use for controlling hypertension and diabetes of Brazilian elderly were higher and inversely associated with physical activity level and engagement in walking.

Quality of life and characteristics of diabetic patients

This study aimed to assess the association between quality of life and clinical and sociodemographic variables in type 2 diabetes patients, after they had started treatment in Primary and Specialized Health Care. This is an analytical cross-sectional study with a sampling of diabetic patients from Primary (n = 385) and Specialized (n = 385) Health Care. The dependent variable, quality of life, was evaluated by the Diabetes Quality of Life Measure - Brazil. Clinical and sociodemographic data were collected. Bivariate analysis by chi square test tested the association between the dependent variable with the independent ones. Next, we performed an analysis of multiple logistic regression. In Specialized Health Care, individuals who practice physical activity had less chance of having worse quality of life and those with less time of diagnosis presented higher chance of worse quality of life. In Primary Health Care, those who performed diets and presented glycated hemoglobin ≤ 7% had less chance of having worse quality of life. Women presented higher chances of worse quality of life than men. We concluded that with exception to the time of diagnosis and sex, other variables that influenced quality of life of diabetics were modifiable factors (glycated hemoglobin, alimentary diet and physical activity).

Uso contínuo de medicamentos e condições de trabalho entre motoristas de caminhão

Resumo Os motoristas de caminhão têm sido pouco explorados quanto aos problemas de saúde que os acometem e, principalmente, quanto ao seu perfil de consumo de medicamentos. Este estudo teve o objetivo de determinar o uso contínuo de medicamentos, por motoristas de caminhão, e identificar as características profissionais associadas. Para a sua realização, conduziu-se um estudo transversal com motoristas de caminhão estacionados no Pátio de Triagem do Porto de Paranaguá, Paraná, Brasil. Realizou-se uma entrevista com obtenção de dados socioeconômicos, problemas de saúde, condições de trabalho e uso contínuo de medicamentos. Dos motoristas avaliados (n = 665), 21,1% referiram utilizar algum medicamento continuamente, com destaque para o captopril (10,7%), metformina (10,3%), omeprazol (6,2%) e sinvastatina (6,2%). Motoristas com dezesseis anos ou mais de experiência profissional (RP 1,67; IC 95% 1,11-2,51), proprietários do próprio caminhão (RP 1,38; IC 95% 1,03-1,86) e que não possuíam vínculo empregatício formal (RP 1,49; IC 95% 1,11-2,00) apresentaram maior prevalência de uso contínuo de medicamentos. Observa-se que algumas condições de trabalho têm importante papel do uso contínuo de medicamentos pelos motoristas de caminhão.

Profile of Hiperdia patients in the municipality of Barra Bonita, Sao Paulo state

Abstract Introduction: The "Hiperdia System" sets goals and guidelines to expand prevention, diagnosis, treatment and control of Diabetes Mellitus and Hypertension. Knowing the epidemiological characteristics of the population is important to strengthen public health programs. Objective: The objective of the study was to describe the sociodemographic profile, risk factors and complications of hypertensive, diabetic and hypertensive diabetic people registered in the HiperDia system of the Ministry of Health of the Basic Health Units (Unidades Básicas de Saúde - UBS) in Barra Bonita, São Paulo State. Methods: This is a descriptive cross-sectional study, which used 113 medical records of diabetic and hypertensive patients as a data source for information about gender, age, race, education, marital status, body mass index (BMI), family history, smoking, sedentarism, acute myocardial infarction, stroke, kidney disease, amputation and diabetic foot. Descriptive statistics were used. Results: As a result, the epidemiological profile of patients registered in the HiperDia system was characterized by: a mean age of 57.3 years; 61.9% women, 82.1% Caucasians, 66.4% with education level up to incomplete primary education, 48.5% lived with partners and children, 19.5% were smokers, 51.4% were sedentary, 44.3% were overweight and obese and 69% had a diagnosis of hypertension and diabetes. Conclusion: The results were relevant allowing professionals and health managers to institute preventive programs to intervene in the risk factors involved in the genesis and complications of hypertension and diabetes.

Prevalência e fatores associados à presença de anemia em idosos do município de Viçosa (MG), Brasil

Resumo A anemia é o problema hematológico mais comum encontrado na população idosa. Com objetivo de avaliar a prevalência e os fatores associados à anemia em idosos no município de Viçosa (MG), foi realizado um estudo transversal, de base populacional. Os dados foram coletados de junho a dezembro de 2009, mediante inquérito domiciliar e realização de exames bioquímicos em 349 idosos. A prevalência de anemia foi de 11,7% (IC95% 8,3%-15,1%) e mostrou-se mais elevada entre os homens (15,4%), entre idosos com 80 anos e mais (30,0%) e naqueles que praticavam polifarmácia (16,8%). Os resultados evidenciaram determinantes de anemia semelhantes ao observado em países desenvolvidos. A real necessidade da polifarmácia deve ser avaliada na atenção à saúde dos idosos, com vistas a prevenir iatrogenias, dentre as quais a anemia está incluída.

Anemia in Patients with Type 2 Diabetes Mellitus

The objective of this study was to evaluate the prevalence of anemia in DM2 patients and its correlation with demographic and lifestyle and laboratory variables. This is a descriptive and analytical study of the type of case studies in the urban area of the Ijuí city, registered in programs of the Family Health Strategy, with a total sample of 146 patients with DM2. A semistructured questionnaire with sociodemographic and clinical variables and performed biochemical test was applied. Of the DM2 patients studied, 50 patients had anemia, and it was found that the body mass items and hypertension and hematological variables are significantly associated with anemia of chronic disease. So, the prevalence of anemia is high in patients with DM2. The set of observed changes characterizes the anemia of chronic disease, which affects quality of life of diabetic patients and is associated with disease progression, development, and comorbidities that contribute significantly to increasing the risk of cardiovascular diseases.

Microvascular complications in type 2 diabetes and associated factors: a telephone survey of self-reported morbidity

The scope of this article is to estimate the prevalence of microvascular complications of self-reported type 2 diabetes and the association with sociodemographic characteristics, nutritional status, treatment given and time since diagnosis. It involved a cross-sectional study with 318 people with type 2 diabetes living in Maringá in the State of Paraná. A telephone survey of self-reported morbidity was conducted in the months from January to June 2012. For the analysis descriptive statistics, univariate and multiple logistic regression were used. The prevalence of self-reported complications of diabetes was 53.8%, the most frequent being retinopathy (42.8%), followed by peripheral neuropathy (14.5%) and nephropathy (12.9%). The variables associated with the presence of complications were age (p = 0.008), overweight/obesity (p = 0.002), insulin (p < 0.001), insulin use linked to oral antidiabetic drug (p = 0.003) and time since diagnosis (p = 0.013). The prevalence of self-reported microvascular complications for people with diabetes was high, being more frequent among those of more advanced age, with inadequate nutritional status, a delay in diagnosis of the disease and those who were using insulin alone or in combination with oral antidiabetic agents.

Diabetes mellitus referido e fatores associados em idosos residentes em Campina Grande, Paraíba

OBJETIVO: Verificar a prevalência de diabetes mellitus referido e fatores associados em idosos residentes em Campina Grande-PB. METODOLOGIA: Trata-se de estudo transversal, de base populacional e domiciliar, com indivíduos de 60 anos de idade ou mais, de ambos os sexos. O diabetes mellitus referido foi considerado variável dependente para fins de análise e de estudo das possíveis associações. As variáveis independentes avaliadas foram: grupo etário, situação conjugal, nível socioeconômico, estado nutricional, prática de atividade física regular, tabagismo e ingestão de bebida alcoólica. Para identificar os fatores associados ao diabetes mellitus referido, foram realizadas análises de regressão univariada e multivariada, por meio do SPSS 17.0. RESULTADOS: Foram avaliados 806 idosos (69,1% mulheres), com média etária de 72,4 anos (DP=8,76). A prevalência de diabetes mellitus referido foi de 14,7%. Tanto entre homens como entre mulheres, constatou-se maior prevalência do diabetes mellitus referido no grupo etário de 60 a 69 anos (50% e 48,2%, respectivamente). O diabetes mellitus referido esteve associado às variáveis sobrepeso/obesidade (IC95%: 1,028-4,248; p=0,042) e ingestão de bebidas alcoólicas (IC95%: 1,107-3,092; p=0,019) entre as idosas. Entre os homens, houve associação com a doença referida apenas com a ingestão de bebidas alcoólicas no passado (IC95%: 1,082-13,085; p=0,037). CONCLUSÃO: Os resultados deste estudo sugerem influência do estado nutricional e da ingestão de bebidas alcoólicas (atual ou passada) sobre o diabetes mellitus referido em idosos. Conhecer os fatores modificáveis que influenciam essa doença é fundamental para subsidiar o planejamento de ações voltadas para promoção, prevenção e diagnóstico precoce desse agravo.

Prevalence, correlates, and description of self-reported diabetes in brazilian capitals - results from a telephone survey

INTRODUCTION

The prevalence of diabetes is increasing worldwide. The objective of this study is to estimate the prevalence of self-reported diabetes in Brazilian adults and to describe its population correlates as well as the clinical characteristics of the reported cases.

METHODS

We analyzed basic and supplementary data of 54.144 subjects participating in VIGITEL 2011 (Surveillance System for Risk and Protective Factors for Chronic Diseases), a telephone survey based on a probabilistic sample of subjects ≥ 18 years old residing in Brazilian state capitals and the Federal District. Estimates reported are weighted so as to represent the surveyed population.

RESULTS

The prevalence of self-reported diabetes was 6.3% (95% CI 5.9-6.7), increasing markedly with age and nutritional status, and decreasing with level of education. Prevalence was higher among those self-declaring their race/color as black. Most cases (90%) reported the diagnosis being made at 35 years or older. The vast majority (99.8%) of self-reported cases informed having previously performed at least one glucose test, and 76% of those not reporting diabetes also informed having previously performed glucose testing. Most cases (92.6%) reported following some form of diabetes treatment, 79% taking medication.

CONCLUSION

The estimated prevalence of known diabetes found, 6.3%, is consistent with estimates given by international summaries. The additional data collected in VIGITEL 2011 regarding previous glucose testing and current treatment support the use of telephone-based information to monitor the prevalence of known diabetes in Brazilian capitals.

Factors associated with the prevalence of hypertension and control practices among elderly residents of São Paulo city, Brazil

The aim of this study was to analyze the prevalence of hypertension and control practices among the elderly. The survey analyzed data from 872 elderly people in São Paulo, Brazil, through a cluster sampling, stratified according to education and income. A Poisson multiple regression model checked for the existence of factors associated with hypertension. The prevalence of self-reported hypertension among the elderly was 46.9%. Variables associated with hypertension were self-rated health, alcohol consumption, gender, and hospitalization in the last year, regardless of age. The three most common measures taken to control hypertension, but only rarely, are oral medication, routine salt-free diet and physical activity. Lifestyle and socioeconomic status did not affect the practice of control, but knowledge about the importance of physical activity was higher among those older people with higher education and greater income. The research suggests that health policies that focus on primary care to encourage lifestyle changes among the elderly are necessary.

Nível de atividade física, comorbidades e idade de pacientes hipertensos

No envelhecimento, hábito inativo está associado a doenças crônicas. Existem diferentes domínios da atividade física, tais como: tempo livre e locomoção. O objetivo foi analisar associações entre diferentes domínios de atividade física, comorbidades e idade em hipertensos. Foram entrevistados 192 hipertensos. Classificados em menos ativos e mais ativos para atividades no lazer, locomoção, ocupação e total e estratificados em grupos etários. A circunferência de cintura foi avaliada e comorbidades auto referidas. O teste Qui-quadrado analisou as associações e o teste ANOVA one way comparou os grupos etários, adotando significância estatística quando p<0,05. As médias de atividade física ocupacional e total foram menores para idade igual ou acima dos 60 e 70 anos, respectivamente. A atividade ocupacional esteve associada à idade em mulheres e, ao colesterol e diabetes em homens, que também tiveram atividade física de locomoção associada à circunferência de cintura. Em síntese a atividade física de hipertensos associa-se a comorbidades para diferentes grupos etários e sexos.

Avaliação da competência de idosos diabéticos para o autocuidado

Estudo descritivo, de corte transversal e correlacional, que objetivou avaliar as competências de idosos com diabetes para o autocuidado, por meio da utilização da Escala para Identificação da Competência do Diabético para o Autocuidado, e os fatores pessoais associados ao resultado. A população do estudo foi composta por idosos cadastrados nas unidades básicas de saúde de Fortaleza, CE, Brasil. Da amostra, apenas 6% dos idosos foram considerados competentes para o autocuidado em diabetes e os fatores que se destacaram como influenciadores de baixa pontuação foram a baixa escolaridade e a diminuição da acuidade visual. Conforme os resultados, devido ao reduzido número de idosos considerados competentes para a prática do autocuidado, verifica-se a importância do desenvolvimento de ações de promoção da saúde direcionados para essa parcela da população, devendo-se estimular a prática do autocuidado, bem como avaliar as competências para execução da mesma, de modo a facilitar o direcionamento de ações de saúde.

[Adherence to drug treatment among registered users in the "HIPERDIA" Program in Teresina in the State of Piauí]

Arterial hypertension and diabetes mellitus are among the most chronic diseases prevalent in Brazil. The study sought to evaluate the socioeconomic profile and the therapeutic adherence of users registered in the HIPERDIA Program in Teresina in the State of Piauí. This research was conducted in the Primary Healthcare Units, where a questionnaire was given to four hundred people evaluating their adherence based on the Batalla and Morisky-Green tests. The socioeconomic profile of interviewees was as follows: senior citizens, women, married with 1 to 4 years of study, pensioners and salaried employees. Only 22.5% of hypertensive and 30.7% of diabetic interviewees were considered adherents according to Batalla, and among all of them only 26.75% were adherents according to Morisky-Green. There was no association between sociodemographic and clinical variables and adherence according to Morisky-Green, however there was an association with the type of morbidity presented. In light of these results, health education is the main strategy to improve adherence of users as well as the participation of professionals in the Family Healthcare Team, including the pharmacist, the nutritionist and the physical trainer.

Uso de anti-hipertensivos e antidiabéticos por idosos: inquérito em Belo Horizonte, Minas Gerais, Brasil

A preocupação com efeitos prejudiciais do uso de medicamentos por idosos tem motivado estudos com o objetivo de identificar problemas nessa utilização. Realizou-se um inquérito domiciliar entre aposentados, com idade > 60 anos, residentes em Belo Horizonte, Minas Gerais, Brasil (2003), que declararam ter diabetes ou hipertensão arterial. A qualidade do uso de medicamentos anti-hipertensivos e antidiabéticos foi avaliada com base em redundância, associações medicamentosas e fármacos inapropriados. Entre os 283 (89%) idosos autodeclarados hipertensos, em uso de farmacoterapia, 68,2% utilizavam diuréticos, e 37,8% utilizavam IECA. Entre os 22 (64,7%) autodeclarados diabéticos sob farmacoterapia, 45,5% utilizavam insulina, e 77,3%, antidiabéticos orais. Entre os 89 autodeclarados diabéticos hipertensos, 80 (90%) utilizavam anti-hipertensivos, e 51 (57,3%), antidiabéticos. Observou-se o uso de associações medicamentosas, medicamentos redundantes ou inadequados, o que indica a necessidade de seguimento de protocolos terapêuticos e maior atenção à saúde dos pacientes idosos.

[Diabetes mellitus: factors associated with prevalence in the elderly, control measures and practices, and health services utilization in São Paulo, Brazil]

This study analyzes factors associated with diabetes prevalence according to demographic and socioeconomic variables, health status, and lifestyle among 872 elderly living in the city of São Paulo, Brazil, in addition to health services utilization and control measures and practices. Reported diabetes prevalence among the elderly was 17.9%, a higher rate than in the adult population. The highest diabetes rates in elderly individuals were associated with: bad or very bad self-rated health, never having consumed alcohol or having stopped drinking, widowhood, and at least one hospitalization in the previous 12 months, independently of age. Among the elderly, 69.9% routinely sought out health services due to their diabetes, and 96.1% received treatment at the services they turned to. There is a lack of information, knowledge, and use of control measures for diabetes among the elderly. Health policies focusing on professional training and family orientation are needed to promote lifestyle changes among the elderly.

[Health survey in Campinas, São Paulo State, Brazil (ISACamp): comparison of estimates according to ownership of a residential telephone line]

The study assesses differences in socio-demographic, lifestyle, and health-related characteristics among adults with and without residential telephone lines using data from a health survey in Campinas, São Paulo State, Brazil, (2008-2009), through a population-based cross-sectional survey that included 2,637 adults (18 years and older). Descriptive statistics, chi-square tests, prevalence, and 95% confidence intervals were used in the analysis. Estimates were also made of the bias associated with non-coverage of the population without telephones before and after adjusting for post-stratification. The impact of bias on the confidence intervals was assessed by the bias ratio. Some 76% of respondents owned residential telephone lines. Except for marital status, differences were observed in socio-demographic data according to ownership of residential telephones. After post-stratification adjustment, there was a decrease in bias estimates for variables associated with ownership of telephone lines. However, except for osteoporosis, post-stratification adjustment was insufficient to correct the non-coverage bias.

Compreendendo o significado de qualidade de vida segundo idosos portadores de diabetes mellitus tipo II

Trata-se de uma pesquisa qualitativa com abordagem fenomenológica, objetivando descrever o significado de qualidade de vida, segundo relatos de idosos portadores de diabetes mellitus tipo II, e avaliar as repercussões da doença sobre sua vida. Entrevistamos 12 idosos diabéticos, no período de setembro a outubro de 2008, entre um e quarenta anos de evolução da doença. Foi feita a seguinte questão norteadora: "Para o Sr. (a), o que significa qualidade de vida?" A análise dos discursos mostrou facetas relevantes ligadas ao cotidiano do idoso com diabetes mellitus. Para eles, a qualidade de vida está intimamente relacionada à saúde física, independência na vida diária e econômica, integração social, suporte familiar e saúde mental-espiritual. A restrição alimentar foi o ponto de maior repercussão do diabetes sobre seu modo de viver. Verificou-se que cabe aos profissionais de saúde ampliar o diálogo profissional-paciente, promovendo autonomia e independência no cuidado e corresponsabilização.