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      Socio-demographic characteristics, treatment coverage, and self-rated health of individuals who reported six chronic diseases in Brazil, 2003 Translated title: Características sócio-demográficas, cobertura de tratamento e auto-avaliação da saúde dos indivíduos que referiram seis doenças crônicas no Brasil, 2003

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          Abstract

          The Brazilian World Health Survey, carried out in 2003, included questions about diagnosis of six chronic diseases: arthritis, angina, asthma, depression, schizophrenia and diabetes mellitus. The probabilistic sample of 5,000 adults was selected in 250 census tracts. We analyzed the socio-demographic profile, the coverage of treatment, and self-rated health of the individuals that reported diagnosis of one of these diseases. To control for age and sex, logistic regression models were used. Among the 5,000 participants, 39.1% reported medical diagnosis of at least one of the six diseases. Depression was the most prevalent (19.2%), followed by asthma (12.0%), arthritis (10.5%), angina (6.7%), diabetes (6.2%) and schizophrenia (1.7%). Significant differences by age were found for all diseases, except for asthma. All diseases were more prevalent among women, except angina. Analysis by educational level showed that the diabetes prevalence rate was significantly larger among those with incomplete schooling. Although the six diseases presented different treatment coverage rates, for individuals with diagnosis of any one of the six diseases, the self-rated health was always worst, even after controlling for age and sex.

          Translated abstract

          A Pesquisa Mundial de Saúde (PMS), realizada no Brasil em 2003, incluiu questionamento sobre diagnóstico de seis doenças: artrite, angina, asma, depressão, esquizofrenia e diabetes mellitus. Foram selecionados 5 mil indivíduos em 250 setores censitários, por amostragem probabilística. Analisou-se o perfil sócio-demográfico, a cobertura de tratamento e a auto-avaliação de saúde dos indivíduos com diagnóstico de uma dessas doenças, ajustando-se os efeitos de sexo e idade por modelos de regressão logística. A depressão foi a mais prevalente (19,2%), seguida pela asma (12,0%), artrite (10,5%), angina de peito (6,7%), diabetes (6,2%) e esquizofrenia (1,7%), sendo que 39,1% referiram diagnóstico médico de pelo menos uma. Foram encontradas diferenças significativas por idade, exceto para asma. Todas as doenças foram mais prevalentes entre as mulheres, exceto angina. A taxa de diabetes foi significativamente maior entre os de menor grau de instrução. Conclui-se que as seis doenças apresentam comportamento diferenciado em relação à cobertura de tratamento. Porém, no que se refere à percepção da própria saúde, comparando-se os portadores de qualquer uma das seis doenças em relação aos demais, a avaliação foi bem pior, mesmo após ajuste por idade e sexo.

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          Health-related quality of life associated with chronic conditions in eight countries: results from the International Quality of Life Assessment (IQOLA) Project.

          Few studies and no international comparisons have examined the impact of multiple chronic conditions on populations using a comprehensive health-related quality of life (HRQL) questionnaire. The impact of common chronic conditions on HRQL among the general populations of eight countries was assessed. Cross-sectional mail and interview surveys were conducted. Sample representatives of the adult general population of eight countries (Denmark, France, Germany, Italy, Japan, The Netherlands, Norway and the United States) were evaluated. Sample sizes ranged from 2031 to 4084. Self-reported prevalence of chronic conditions (including allergies, arthritis, congestive heart failure, chronic lung disease, hypertension, diabetes, and ischemic heart disease), sociodemographic data and the SF-36 Health Survey were obtained. The SF-36 scale and summary scores were estimated for individuals with and without selected chronic conditions and compared across countries using multivariate linear regression analyses. Adjustments were made for age, gender, marital status, education and the mode of SF-36 administration. More than half (55.1%) of the pooled sample reported at least one chronic condition, and 30.2% had more than one. Hypertension, allergies and arthritis were the most frequently reported conditions. The effect of ischemic heart disease on many of the physical health scales was noteworthy, as was the impact of diabetes on general health, or arthritis on bodily pain scale scores. Arthritis, chronic lung disease and congestive heart failure were the conditions with a higher impact on SF-36 physical summary score, whereas for hypertension and allergies, HRQL impact was low (comparing with a typical person without chronic conditions, deviation scores were around -4 points for the first group and -1 for the second). Differences between chronic conditions in terms of their impact on SF-36 mental summary score were low (deviation scores ranged between -1 and -2). Arthritis has the highest HRQL impact in the general population of the countries studied due to the combination of a high deviation score on physical scales and a high frequency. Impact of chronic conditions on HRQL was similar roughly across countries, despite important variation in prevalence. The use of HRQL measures such as the SF-36 should be useful to better characterize the global burden of disease.
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            The treatment gap in mental health care

            Mental disorders are highly prevalent and cause considerable suffering and disease burden. To compound this public health problem, many individuals with psychiatric disorders remain untreated although effective treatments exist. We examine the extent of this treatment gap. We reviewed community-based psychiatric epidemiology studies that used standardized diagnostic instruments and included data on the percentage of individuals receiving care for schizophrenia and other non-affective psychotic disorders, major depression, dysthymia, bipolar disorder, generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), and alcohol abuse or dependence. The median rates of untreated cases of these disorders were calculated across the studies. Examples of the estimation of the treatment gap for WHO regions are also presented. Thirty-seven studies had information on service utilization. The median treatment gap for schizophrenia, including other non-affective psychosis, was 32.2%. For other disorders the gap was: depression, 56.3%; dysthymia, 56.0%; bipolar disorder, 50.2%; panic disorder, 55.9%; GAD, 57.5%; and OCD, 57.3%. Alcohol abuse and dependence had the widest treatment gap at 78.1%. The treatment gap for mental disorders is universally large, though it varies across regions. It is likely that the gap reported here is an underestimate due to the unavailability of community-based data from developing countries where services are scarcer. To address this major public health challenge, WHO has adopted in 2002 a global action programme that has been endorsed by the Member States.
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              Transição epidemiológica e o estudo de carga de doença no Brasil

              No Brasil, a transição epidemiológica não tem ocorrido de acordo com o modelo experimentado pela maioria dos países desenvolvidos. Velhos e novos problemas em saúde coexistem, com predominância das doenças crônico-degenerativas, embora as doenças transmissíveis ainda desempenhem um papel importante. Neste estudo, os diferenciais, em relação ao padrão epidemiológico, são descritos para o Brasil e grandes regiões, para o indicador de saúde dos estudos da carga de doença, o DALY. Entre os principais resultados encontrados, para o Brasil, destaca-se que o grupo das doenças não-transmissíveis, infecciosas/parasitárias/maternas/perinatais/nutricionais, e das causas externas representaram, respectivamente, 66,3%, 23,5% e 10,2% da carga total de doença estimada. A utilização do indicador DALY propicia a identificação de prioridades em função do perfil epidemiológico, facilitando a tomada de decisões e destinação adequada de recursos por parte dos gestores.
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                Author and article information

                Journal
                csp
                Cadernos de Saúde Pública
                Cad. Saúde Pública
                Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz (Rio de Janeiro, RJ, Brazil )
                0102-311X
                1678-4464
                2005
                : 21
                : suppl 1
                : S43-S53
                Affiliations
                [02] Rio de Janeiro orgnameFundação Oswaldo Cruz orgdiv1Centro de Informação Científica e Tecnológica Brasil
                [01] Rio de Janeiro orgnameFundação Oswaldo Cruz orgdiv1Escola Nacional de Saúde Pública Sergio Arouca Brasil
                Article
                S0102-311X2005000700006 S0102-311X(05)02100006
                10.1590/S0102-311X2005000700006
                7fdd8817-5616-4e02-bd23-708a50643be6

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 03 October 2005
                : 10 October 2005
                : 04 May 2005
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 41, Pages: 0
                Product

                SciELO Brazil

                Self URI: Full text available only in PDF format (EN)
                Categories
                Articles

                Chronic Disease,Health Services Coverage,Nível de Saúde,Doença Crônica,Cobertura de Serviços de Saúde,Health Status

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