Chronic Diseases In Brazil Research Articles

Development of the Brazilian Version of a Pan-Canadian Behavior Change Program and Its Health and Fitness Outcomes.

Chronic diseases are a major health problem worldwide, especially in lower-income jurisdictions. Considering this scenario, the World Health Organization has recently established, as a research priority, preventive interventions for populations from lower-income countries, such as the middle-income country of Brazil. The purpose of this article is to describe the components of a pan-Canadian lifestyle program adapted to Brazilians and to report its health and fitness outcomes. A 12-week program called ACCELERATION was translated and culturally adapted to Brazilians. A quasi-randomized controlled trial was designed, consisting of weekly emails and educational videos addressing risk factors for chronic disease. Health and fitness measures included body composition, cardiovascular variables, aerobic fitness, and muscular strength. The Brazilian experimental group showed maintenance in heart rate, blood pressure, and VO2max values while presenting an improvement of 3.3% in body fat percentage (p = 0.040, d = −0.325) and 5.1% in muscular strength (p = 0.039, d = 0.328). Overall, these results were similar to the Canadian intervention. Based on these findings, the Brazilian version of the program has the potential to contribute to the fight against chronic diseases in Brazil.

Inequalities in the geographic distribution of chronic diseases in Brazil: an index methodology

The purpose of the present article is to compare the geographic distribution of nine chronic diseases in Brazil: arterial hypertension, arthritis/rheumatism, back/spine, bronchitis/asthma, cancer, chronic renal failure, depression, diabetes and heart disease. The data used is from the Brazilian National Health Survey (PNS) composed of 60,202 participants (≥ 18 years old). The morbidity rate of diseases was calculated for 27 units of Brazil. A geographic chronic disease index (gCDI) was formulated as a summary measure to group and compare the distribution of these illnesses based on factor analysis (FA). The observation of trends in health-related indexes and maps can be an advantage to analyse large databases. The final index indicated regional differences showing that the South of Brazil had more individuals with chronic diseases compared to the North of the country mainly for arterial hypertension, depression, diabetes, and heart disease.

Inequalities in the geographic distribution of chronic diseases in Brazil: an index methodology

Inequalities in the geographic distribution of chronic diseases in Brazil: an index methodology

Prevalence of Multimorbidity of Chronic Noncommunicable Diseases in Brazil: Population-Based Study.

BackgroundMultimorbidity is the co-occurrence of two or more chronic diseases.ObjectiveThis study, based on self-reported medical diagnosis, aims to investigate the dynamic distribution of multimorbidity across sociodemographic levels and its impacts on health-related issues over 15 years in Brazil using national data.MethodsData were analyzed using descriptive statistics, hypothesis tests, and logistic regression. The study sample comprised 679,572 adults (18-59 years of age) and 115,699 elderly people (≥60 years of age) from the two latest cross-sectional, multiple-cohort, national-based studies: the National Sample Household Survey (PNAD) of 1998, 2003, and 2008, and the Brazilian National Health Survey (PNS) of 2013.ResultsOverall, the risk of multimorbidity in adults was 1.7 times higher in women (odds ratio [OR] 1.73, 95% CI 1.67-1.79) and 1.3 times higher among people without education (OR 1.34, 95% CI 1.28-1.41). Multiple chronic diseases considerably increased with age in Brazil, and people between 50 and 59 years old were about 12 times more likely to have multimorbidity than adults between 18 and 29 years of age (OR 11.89, 95% CI 11.27-12.55). Seniors with multimorbidity had more than twice the likelihood of receiving health assistance in community services or clinics (OR 2.16, 95% CI 2.02-2.31) and of being hospitalized (OR 2.37, 95% CI 2.21-2.56). The subjective well-being of adults with multimorbidity was often worse than people without multiple chronic diseases (OR=12.85, 95% CI: 12.07-13.68). These patterns were similar across all 4 cohorts analyzed and were relatively stable over 15 years.ConclusionsOur study shows little variation in the prevalence of the multimorbidity of chronic diseases in Brazil over time, but there are differences in the prevalence of multimorbidity across different social groups. It is hoped that the analysis of multimorbidity from the two latest Brazil national surveys will support policy making on epidemic prevention and management.

O direito à escolarização de crianças e adolescentes com doenças crônicas no Brasil: uma análise a partir do pensamento complexo e da teoria crítica

O empreendimento deste artigo tem como objetivo dar ênfase sobre o processo de escolarização de crianças e adolescentes com doenças crônicas no Brasil. Consideramos que o impacto do adoecimento crônico e os prejuízos associados à doença, podem (in)visibilizar sua participação e protagonismo no espaço escolar e por conseguinte na sociedade. Muitos estudos sobre a experiência do adoecimento crônico, na perspectiva socioantropológica nas últimas décadas, se intensificou no Brasil valendo-se de referenciais de experiência que privilegiam o ponto de vista das pessoas em suas narrativas, contrapondo-se à concepção biomédica. Nesse sentido, metodologicamente, para este empreendimento, nos valeremos das concepções da teoria crítica e da complexidade. Ao recorremos tais concepções, foi possível considerar que, tanto as marcas que (in)visibilizam crianças adolescentes com doenças crônicas na escola, são também as que colocam seus familiares/cuidadores, assim como professores em condições desiguais de exclusão e humilhação social, sob a ordem do preconceito e discriminação. Na mesma medida que nos aponta para a necessidade de maior aprofundamento no que se refere às possibilidades e aos desafios sofridos cotidianamente, mas principalmente e efetivamente sobre seus direitos e amparo à vida escolar, do mesmo modo que indica maior responsabilidade do Estado para ampliação das políticas públicas de amparo e proteção social à esse público.

An evaluation of non-adherence to pharmacotherapy for chronic diseases and socioeconomic inequalities in Brazil.

To evaluate non-adherence to pharmacotherapy for chronic diseases and to investigate the existence of socioeconomic inequalities related to this outcome in Brazil. This was a cross-sectional study based on data from the National Survey on Access, Use and Promotion of the Rational Use of Medicines (PNAUM). The study population corresponded to individuals aged 18 years or older with a medical diagnosis of at least one chronic disease and an indication for pharmacological treatment. The dependent variable was non-adherence to chronic disease pharmacotherapy measured by less than 80% adherence to drug therapy. Socioeconomic inequality related to non-adherence was assessed by absolute (SII) and relative (RII) inequality indices, calculated by logistic regression analyses. The prevalence of non-adherence to pharmacotherapy in Brazil was 20.2%, ranging from 17.0 to 27.8% between regions. Furthermore, this study revealed absolute and relative socioeconomic inequalities in non-adherence to pharmacotherapy of chronic diseases in Brazil (SII = -7.4; RII = 0.69) and the Northeast (SII = -14.0; RII = 0.59) and Center West (SII = -20.8; RII = 0.38) regions. The probability of non-adherence to pharmacotherapy in Brazil was higher among individuals with worse socioeconomic status. The findings of the present study indicate the need for the restructuring and strengthening of public policies aimed at reducing socioeconomic inequalities, in order to promote equity in adherence to the pharmacotherapy associated with chronic diseases.

Evaluation of Arterial Hypertension Care in Four Brazilian Metropoles

Hypertension (AH) is one of the most prevalent chronic diseases in Brazil, which, in 2018, affected about 24.5% of the adult population, reaching 59.3% of people aged 65 and over. (Ministry of Health 2020)1 These levels of prevalence and with an increasing trend have a major impact on morbidity and mortality, with high social cost.

Adapting the Scale to Measure Care Ability of Family Caregivers of People with Chronic Diseases in Brazil

Objective: To translate and culturally adapt the Scale to Measure the Care Ability of Family Caregivers of People with Chronic Diseases to the Brazilian context. Materials and Methods: This is a methodological study that followed the steps recommended by Dorcas Beaton for translating and culturally adapting this scale in Brazil. All ethical precepts have been respected. Results: The first translation of the instrument into Brazilian Portuguese was done by two translators; the consensual version was then established, which was back-translated into Spanish by another independent translator. The committee of specialists comprised seven health professionals, obtaining a content validity index (CVI) = 1.00 in 41 items, CVI = 0.86 in three items and CVI = 0.71 in four items. After adjusting the seven items, a pretest was applied to 14 family caregivers of people with chronic kidney disease. Based on this, the participants’ difficulties were observed, and then the items were reviewed. Conclusions: After the translation and adaptation process was completed, the Brazilian version of the instrument entitled “Scale to Measure the Care Ability of Family Caregivers of People with Chronic Diseases” was obtained.

Measuring Spiritual Well-Being in Brazilian Adolescents with Chronic Illness Using the FACIT-Sp-12: Age Adaptation of the Self-Report Version, Development of the Parental-Report Version, and Validation.

Spiritual well-being is a major issue in health care, but instruments for measuring this construct in adolescents are lacking. This study adapted the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-Sp-12) for use with Brazilian adolescents with chronic diseases and developed a parental observer-rated version, using an expert panel, back-translation, and cognitive interviews with 72 participants. The psychometric properties of both versions were verified with two- and three-factor models by testing with 212 participants. The self- and parental-reported versions showed face validity, content validity, and acceptable levels of internal consistency for the overall scale and the two-factor model. The convergent validity was satisfactory for most items in both two- and three-factor models, but there was a lack of discrimination in the three-factor model using multitrait-multimethod analysis. This study presents the first instrument to assess the spiritual well-being of adolescents from their point of view and to allow their parents to serve as evaluators. However, we recommend further psychometric testing of the self- and parental-report scales to assess spiritual well-being in adolescentswith chronic diseases in Brazil.

Reference values for laboratory tests of cholesterol, glycosylated hemoglobin and creatinine of the Brazilian adult population.

This article aims to estimate reference values for laboratory tests of cholesterol, glycosylated hemoglobin and creatinine for the Brazilian adult population. A descriptive study carried out with laboratory data from the National Health Survey (Pesquisa Nacional de Saúde - PNS). Samples of blood and urine were collected in a PNS subsample of 8,952 individuals aged 18 years old or older. To determine the reference values, exclusion criteria were applied: presence of previous diseases and outliers, defined by values outside the range estimated by the mean ± 1.96 × standard deviation. Subsequently, reference values were calculated according to gender, age group and race/skin color. Differences in reference values according to gender were observed. Women had higher values of total cholesterol, LDL-c and HDL-c. Glycosylated hemoglobin showed similar values in relation to gender, and creatinine was higher among men. The mean reference values were higher in the elderly population, aged 60 years old or older. The mean, lower and upper limits of total cholesterol and fractions of non-white people were slightly lower. There was no difference according to race/skin color for glycosylated hemoglobin and creatinine. The establishment of national reference parameters for laboratory tests, adapted to the sociodemographic and geographic characteristics, provides relevant information for evaluation of diagnosis and treatment of chronic diseases in Brazil.

Factors associated with low adherence to medicine treatment for chronic diseases in Brazil.

ABSTRACTOBJECTIVE To analyze factors associated with low adherence to drug treatment for chronic diseases in Brazil.METHODS Analysis of data from Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - Brazilian Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based cross-sectional household survey, based on a probabilistic sample of the Brazilian population. We analyzed the association between low adherence to drug treatment measured by the Brief Medication Questionnaire and demographic, socioeconomic, health, care and prescription factors. We used Poisson regression model to estimate crude and adjusted prevalence ratios, their respective 95% confidence interval (95%CI) and p-value (Wald test).RESULTS The prevalence of low adherence to drug treatment for chronic diseases was 30.8% (95%CI 28.8-33.0). The highest prevalence of low adherence was associated with individuals: young adults; no education; resident in the Northeast and Midwest Regions of Brazil; paying part of the treatment; poor self-perceived health; three or more diseases; reported limitations caused by a chronic disease; using five drugs or more.CONCLUSIONS Low adherence to drug treatment for chronic diseases in Brazil is relevant, and regional and demographic differences and those related to patients’ health care and therapy regime require coordinated action between health professionals, researchers, managers and policy makers.

Free access to medicines for the treatment of chronic diseases in Brazil.

ABSTRACTOBJECTIVE To analyze the free access to medicines for the treatment of chronic diseases in the Brazilian population, according to demographic and socioeconomic factors. We also analyzed the most used pharmacological groups, according to funding source: free-of-charge or out-of-pocket paid.METHODS Analysis of data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based household survey, of cross-sectional design, based on probabilistic sample of the Brazilian population. We analyzed as outcome the prevalence of free access (free-of-charge) to all medicines for treatment of the reported chronic diseases, in the last 30 days. We studied the following independent variables: sex, age group, education in complete years of school, economic class, health plan, and geographical region of residence. We estimated the prevalences and 95% confidence intervals (95%CI) and applied the Pearson’s Chi-squared test to assess the differences between the groups, considering a 5% significance level.RESULTS About half of adults and older adults who have had full access to the treatment of chronic diseases in Brazil obtained all needed medicines for free (47.5%; 95%CI 45.1–50.0). The prevalences of free access were higher among men (51.4%; 95%CI 48.1–54.8), age group of 40-59 years (51.1%; 95%CI 48.1–54.2), and in the poorest social classes (53.9%; 95%CI 50.2–57.7). The majority of medicines that act on the cardiovascular system, such as diuretics (C03) (78.0%; 95%CI 75.2–80.5), beta-blockers (C07) (62.7%; 95%CI 59.4–65.8), and the agents that work in the renin-angiotensin system (C09) (73.4%; 95%CI 70.8–75.8), were obtained for free. Medicines that act on the respiratory system, such as agents against obstructive airway diseases (R03) (60.0%; 95%CI 52.7–66.9) were mostly paid with own resources.CONCLUSIONS Free access to medicines for treatment of chronic diseases occurs to a considerable portion of the Brazilian population, especially for the poorest ones, indicating decreased socioeconomic inequalities, but with differences between regions and between some classes of medicines.

Access to medicines for chronic diseases in Brazil: a multidimensional approach.

ABSTRACTOBJECTIVE To analyze the access to medicines to treat non-communicable diseases in Brazil according to socioeconomic, demographic, and health-related factors, from a multidimensional perspective.METHODS Analysis of data from the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM), household survey, sampling plan by conglomerates with representativeness of the Brazilian population and large areas of the country, according to sex and age domains. Data collected in 2013–2014 with sample of adults (≥ 20 years) who reported having non-communicable diseases and medical indication for use of medicines (n = 12,725). We assessed the prevalence of access to medicines for self-reported non-communicable diseases, considering four dimensions: availability, geographic accessibility, acceptability, and affordability. We applied Pearson’s Chi-square test to assess the statistical significance of the differences between strata, considering the level of significance of 5%. We found prevalence of 94.3%, 5.2%, and 0.5% for full, partial, and null access, respectively. Higher prevalence was observed among seniors in the South compared to the Northeast; for those who reported having one non-communicable disease compared to those who reported having two or more; for those who needed one medicine compared to those who needed three or more; and for those who self-assessed their health as good or very good. Geographic accessibility was similar in the Unified Health System and in the private pharmacies (72.0%). Total availability of medicines was 45.2% in the Unified Health System, 67.4% in the Popular Pharmacy Program, and 88.5% in private pharmacies. Acceptability was 92.5% in the Unified Health System, 97.8% in the Popular Pharmacy Program, and 98.7% in private pharmacies. As to affordability, 2.6% of the individuals failed to take the medicines they should in the 30-day period prior to the interview due to financial difficulty. Prevalence of full access to medicines for non-communicable diseases in Brazil is high and presents significant differences for age group, region of the country, number of non-communicable diseases, and for medicines prescribed and self-assessment of health. The major barriers to access to medicines were identified in the dimensions analyzed.

NOPA, Usability Testing of an Application to Help Patients During the Treatment of Infectious, and Chronic Diseases in Brazil

The amount of applications for mobile technology developed to help nurses, doctors, and patients during the treatment of chronic illnesses can be considered an advance provided by the widespread usage of devices such as mobile phones, smartphones, and tablets. Mobile healthcare, or MHealth, refers to the use of mobile devices in healthcare. Designed for different operational systems and virtual stores, more than 5000 applications options are offered nowadays. A wide range of solutions such as booklets of vaccination and medication control are assisting people in their daily activities and consequently increasing the efficacy of treatment performance. This paper aims to present the usability testing of a mobile application designed to help patients during the treatment of chronicle illnesses in Brazil. Advantages and disadvantages related to this service also will be presented.

Pré-hipertensão, hipertensão arterial e fatores associados em pacientes odontológicos: estudo transversal na cidade de Santa Maria-RS, Brasil

INTRODUÇÃO: A hipertensão arterial sistêmica é um dos mais importantes fatores de risco de doenças cardiovasculares e uma das doenças crônicas mais prevalentes no Brasil e na população mundial.OBJETIVO: Avaliar a prevalência de hipertensão e pré-hipertensão, fatores associados e adesão ao tratamento anti-hipertensivo em uma amostra de pacientes odontológicos de uma faculdade particular do Rio Grande do Sul, Brasil.MATERIAL E MÉTODO: Participaram deste estudo 250 pacientes de ambos os gêneros, com idade igual ou superior a 18 anos. Foram obtidos dados demográficos, história de hipertensão arterial e outras doenças sistêmicas, informações sobre o uso de medicação anti-hipertensiva e tabagismo, e realizadas medidas antropométricas. A adesão ao tratamento foi avaliada pelo teste de Morisky e Green. Três aferições de pressão arterial foram realizadas por um Cirurgião-Dentista e a medição média das últimas duas tomadas foi utilizada na presente análise.RESULTADO: A idade média dos pacientes foi de 46,6 (±13,8) anos. Trinta por cento apresentavam pré-hipertensão e 36%, hipertensão arterial sistêmica. Destes, 28,9% não conheciam sua condição de hipertensão. A hipertensão mostrou associação estatisticamente significante com aumento da idade (p<0,001) e diabetes (p=0,009). Dentre os pacientes em tratamento anti-hipertensivo, 58,1% não eram aderentes, enquanto 41,9% não estavam com a pressão arterial controlada.CONCLUSÃO: Na presente amostra, observou-se uma alta prevalência de pré-hipertensão e hipertensão não diagnosticadas, bem como alta taxa da doença não controlada. Estes resultados apontam para a importância da aferição da pressão arterial rotineiramente durante as visitas odontológicas.

Fatores associados ao risco para doenças não transmissíveis em adultos brasileiros: estudo transversal de base populacional

No Brasil, devido às mudanças nos perfis demográfico, epidemiológico e nutricional da população, as doenças infecciosas vêm cedendo lugar às crônicodegenerativas. Em face da grande heterogeneidade demográfica, social e econômica do país, são exigidas ações de saúde pública que sejam direcionadas às realidades locais. Com o objetivo de identificar os fatores associados ao risco para doenças não transmissíveis em adultos brasileiros, foi realizado um inquérito domiciliar, entre junho de 2002 e outubro de 2005, em amostra representativa de 18 capitais brasileiras. As prevalências dos fatores de risco para doenças crônicas não transmissíveis foram: excesso de peso; atividade física irregular ou sedentarismo;consumo de cigarros; consumo de álcool de risco; hipertensão arterial referida; diabetes referida; e hipercolesterolemia referida. A ausência de fatores de risco foi observada em apenas 8,5% da população entrevistada. Conclui-se que a alta prevalência de exposição a pelo menos um dos fatores de risco estudados evidencia que as ações em saúde devem ser multifatoriais e não dirigidas somente a um fator isolado.

Tendency of mortality in acute myocardial infarction in Curitiba (PR) in the period of 1998 to 2009.

Acute Myocardial Infarction (AMI) is the single leading cause of death among non-transmitted chronic diseases in Brazil. The knowledge of mortality trends is necessary for planning prevention strategies. To evaluate trends in mortality from myocardial infarction in the period from 1998 to 2009 in Curitiba (PR), their distribution by gender, age and their impact in reducing the absolute number of deaths from this disease in this period. Demographic data were obtained from the Brazilian Institute of Geography and Statistics (IBGE) and death data were obtained from the Mortality Information System of the Ministry of Health, considering gender, age and residence. From the fit of a Poisson regression model we estimated mortality rates and expected number of deaths that were not observed. We found significant downward trend (p < 0.001) in the period. The estimated average reduction in death rate from AMI each year was 3.8% (95% CI: 3.2% - 4.5%). There was no significant difference between genders (p = 0.238), although the evolution of age-specific standard mortality rates differed significantly between the groups (p = 0.018). It is estimated that the annual reduction of 3.8% in the mortality rate has resulted in 2,168 deaths below the number expected given the mortality rate observed in 1998 and projecting that number on the population growth occurred during the study period. Although it remains an important cause of death, mortality from AMI decreased significantly during the evaluation period.

P2-93 Mortality from chronic diseases in Brazil, 1980–2008

IntroductionThe profile of causes of death in Brazil has changed in recent decades. The objective is to describe the evolution of mortality from chronic diseases in Brazil, 1980–2008.MethodsCrude and age-...

A feasibility study of cell phone and landline phone interviews for monitoring of risk and protection factors for chronic diseases in Brazil

The study objective was to evaluate the feasibility of interviews by cell phone as a complement to interviews by landline to estimate risk and protection factors for chronic non-communicable diseases. Adult cell phone users were evaluated by random digit dialing. Questions asked were: age, sex, education, race, marital status, ownership of landline and cell phones, health condition, weight and height, medical diagnosis of hypertension and diabetes, physical activity, diet, binge drinking and smoking. The estimates were calculated using post-stratification weights. The cell phone interview system showed a reduced capacity to reach elderly and low educated populations. The estimates of the risk and protection factors for chronic non-communicable diseases in cell phone interviews were equal to the estimates obtained by landline phone. Eligibility, success and refusal rates using the cell phone system were lower than those of the landline system, but loss and cost were much higher, suggesting it is unsatisfactory as a complementary method in such a context.

Fatigue of the patient with Cancer: a systematic review

Cancer is one of the most prevailing chronic diseases in Brazil and in the world. However, the utilized treatments may develop numberless collateral effects. Since the last decade, the symptom of fatigue has been associated directly with cancer and its treatments and has become the object of study in this field. This systematic review was elaborated with the objective of analyzing scientific articles about the fatigue of patients with cancer in the years between 2002 and 2006, in connection with nursing and through the descriptors fatigue, cancer and nursing from the data base of MEDLINE, LILACS and BDENF. This study sampled 27 articles whose authors counted on one nurse at least. The analysis comprised types of cancer and of treatment, the use of scales for measuring fatigue, the methodology, outline of the study, the place and the publication periodical. The results of this study point out to the need of improving the knowledge about fatigue considering that it is a subject still little known by health professionals; it also evidences the need of availing such knowledge and of giving continuity to further investigations in order to clear up better the results of the interventions and to lead to softening such debilitating symptom.