title: Health self-assessment by hemodialysis patients in the Brazilian Unified Health System.
abstract: OBJECTIVE
  To examine whether the level of complexity of the services structure and sociodemographic and clinical characteristics of patients in hemodialysis are associated with the prevalence of poor health self-assessment.
  
  
  METHODS
  In this cross-sectional study, we evaluated 1,621 patients with chronic terminal kidney disease on hemodialysis accompanied in 81 dialysis services in the Brazilian Unified Health System in 2007. Sampling was performed by conglomerate in two stages and a structured questionnaire was applied to participants. Multilevel multiple logistic regression was used for data analysis.
  
  
  RESULTS
  The prevalence of poor health self-assessment was of 54.5%, and in multivariable analysis it was associated with the following variables: increasing age (OR = 1.02; 95%CI 1.01-1.02), separated or divorced marital status (OR = 0.62; 95%CI 0.34-0.88), having 12 years or more of study (OR = 0.51; 95%CI 0.37-0.71), spending more than 60 minutes in commuting between home and the dialysis service (OR = 1.80; 95%CI 1.29-2.51), having three or more self-referred diseases (OR = 2.20; 95%CI 1.33-3.62), and reporting some (OR = 2.17; 95%CI 1.66-2.84) or a lot of (OR = 2.74; 95%CI 2.04-3.68) trouble falling asleep. Individuals in treatment in dialysis services with the highest level of complexity in the structure presented less chance of performing a self-assessment of their health as bad (OR = 0.59; 95%CI 0.42-0.84).
  
  
  CONCLUSIONS
  We showed poor health self-assessment is associated with age, years of formal education, marital status, home commuting time to the dialysis service, number of self-referred diseases, report of trouble sleeping, and also with the level of complexity of the structure of health services. Acknowledging these factors can contribute to the development of strategies to improve the health of patients in hemodialysis in the Brazilian Unified Health System.
authors.affiliation: Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa, Viçosa, MG, Brasil.
authors.forename: Tiago Ricardo
authors.initials: TR
authors.lastname: Moreira
authors.affiliation: Departamento de Nutrição Clínica e Social, Escola de Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brasil.
authors.forename: Luana
authors.initials: L
authors.lastname: Giatti
authors.affiliation: Departamento de Estatística, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
authors.forename: Cibele Comini
authors.initials: CC
authors.lastname: Cesar
authors.affiliation: Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
authors.forename: Eli Iola Gurgel
authors.initials: EI
authors.lastname: Andrade
authors.affiliation: Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
authors.forename: Francisco de Assis
authors.initials: Fde A
authors.lastname: Acurcio
authors.affiliation: Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
authors.forename: Mariângela Leal
authors.initials: ML
authors.lastname: Cherchiglia
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D003430:Cross-Sectional Studies; D059026:Diagnostic Self Evaluation; D005260:Female; D006306:Health Surveys; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009313:National Health Programs; D010043:Outcome and Process Assessment, Health Care; D015995:Prevalence; D006435:Renal Dialysis / Q000523:psychology*; D018434:Sickness Impact Profile; D012959:Socioeconomic Factors; D055815:Young Adult