Prevalência de doenças da tireóide em idosos: resultados do São Paulo Ageing & Health Study

This study aimed to estimate prevalence of thyroid disorders in the São Paulo Ageing & Health Study, an epidemiological study addressing several health-adverse outcomes among elderly people living in a poor area of São Paulo, Brazil. All participants answered a questionnaire and had a blood sample collected to assess levels of tireotropic hormone and free-thyroxine. Among 1,373 people (60.8% women), prevalence rates (95% confidence interval) for thyroid dysfunction (%) were: overt hyperthyroidism, 0.7% (0.2-1.1)[women: 0.8% (0.2-1.5); men: 0.4% (0.01-0.9)]; overt hypothyroidism, 5.7% (4.5-6.9) [women: 5.9% (4.3-7.5); men: 5.4% (3.5-7.3)]; subclinical hyperthyroidism, 2.4% (1.6-3.2) [women: 2.8% (1.6-3.9); men: 1.9% (0.7-3.0)]; and subclinical hypothyroidism, 6.5% (5.2-7.8) [women: 6.7% (5.0-8.4); men: 6.1% (4.1-8.2)]. There was no difference in prevalence rates according to gender, but almost 40% of women were diagnosed and under treatment compared to 9% of men. The burden of thyroid disorders in this sample is high and most participants were not aware of them.O objetivo da pesquisa foi avaliar a prevalência de doenças da tireóide no São Paulo Ageing & Health Study, estudo epidemiológico focado em desfechos de saúde adversos em amostra de idosos moradores de São Paulo, Brasil. Todos os participantes responderam a questionário e colheram sangue para dosagem de hormônio tireotrópico e tiroxina-livre. Entre os 1.373 participantes (60,8% mulheres), a prevalência (intervalo de 95% de confiança) de hipertireoidismo clínico foi de 0,7% (0.2-1,1) [mulheres: 0,8% (0,2-1,5); homens: 0,4% (0,01-0,9)]; hipotireoidismo clínico, 5,7% (4,5-6,9) [mulheres: 5,9% (4,3-7,5); homens: 5,4% (3,5-7,3)]; hipertireoidismo subclínico, 2,4% (1,6-3,2) [mulheres: 2,8% (1,6-3,9); homens: 1,9% (0,7-3,0)]; e hipotireoidismo subclínico, 6,5% (5,2-7,8) [mulheres: 6,7% (5,0-8,4); homens: 6,1% (4,1-8,2)]. Não houve diferença na prevalência de doenças da tireóide por sexo. Quarenta por cento das mulheres tinham diagnóstico e estavam tratando, comparadas a 9% dos homens. A prevalência de disfunção tireoidiana foi elevada e a maioria dos participantes desconhecia o diagnóstico.(FAPESP) São Paulo Research Foundatio

Insulin resistance and carotid intima-media thickness mediate the association between resting-state heart rate variability and executive function: A path modelling study

Background: Research has linked high-frequency heart rate variability (HF-HRV) to cognitive function. The present study adopts a modern path modelling approach to understand potential causal pathways that may underpin this relationship. Methods: Here we examine the association between resting-state HF-HRV and executive function in a large sample of civil servants from Brazil (N = 8114) recruited for the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). HF-HRV was calculated from 10-min resting-state electrocardiograms. Executive function was assessed using the trail-making test (version B). Results and conclusions: Insulin resistance (a marker of type 2 diabetes mellitus) and carotid intima-media thickness (subclinical atherosclerosis) mediated the relationship between HRV and executive function in seriatim. A limitation of the present study is its cross-sectional design; therefore, conclusions must be confirmed in longitudinal study. Nevertheless, findings support that possibility that HRV provides a 'spark' that initiates a cascade of adverse downstream effects that subsequently leads to cognitive impairment.Fil: Kemp, Andrew H.. University of Sydney; Australia. Universidade de Sao Paulo; BrasilFil: Rodríguez López, Santiago. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad. Universidad Nacional de Córdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad; Argentina. University of Sydney; Australia. Universidad Autónoma de Madrid; EspañaFil: Passos, Valeria M. A.. Universidade Federal de Minas Gerais; BrasilFil: Bittencourt, Marcio S.. Universidade de Sao Paulo; BrasilFil: Dantas, Eduardo M.. University of Vale do São Francisco; BrasilFil: Mill, José G.. Universidade Federal do Espírito Santo; BrasilFil: Ribeiro, Antonio L. P.. Universidade Federal de Minas Gerais; BrasilFil: Thayer, Julian F.. Ohio State University; Estados UnidosFil: Bensenor, Isabela M.. Universidade de Sao Paulo; BrasilFil: Lotufo, Paulo A.. Universidade de Sao Paulo; Brasi

Luz solar e suicídio no trópico de Capricórnio, São Paulo, Brasil, 1996-2004

Estudos epidemiológicos têm confirmado que as taxas de suicídio apresentam variação sazonal relacionada às horas de insolação. O padrão de suicídios foi analisado na cidade de São Paulo, Brasil, no trópico de Capricórnio, de 1996 a 2004. A regressão de Poisson foi utilizada para estimar padrões de sazonalidade, bem como verificar a associação dia-a-dia entre duração da insolação e suicídio. Durante os nove anos houve 3.984 suicídios (76,9% homens; mediana de idade=38,7 anos). As médias de suicídio por estação do ano e por mês de suicídio foram similares. Segundo a regressão de Poisson, não houve associação entre insolação e suicídio (p=0,45) para ambos os sexos. Conclui-se que não houve padrão sazonal de suicídios na cidade de São Paulo.Several studies have confirmed seasonal variation in suicide rates according to hours of sunshine. The suicide pattern was assessed in São Paulo, southeastern Brazil, at the tropic of Capricorn from 1996 to 2004. Poisson regression was employed to estimate parameters of seasonality, as well as to verify associations for each day between daylight duration and suicide. During the nine-year study period, there were 3,984 suicides (76.9% in men; median age=38.7 years old). Seasonal averages of suicides were similar, as were monthly averages. Poisson regression did not reveal any association between suicide rates and hours of sunshine (p=0.45) for both sexes. In conclusion, no seasonal pattern was observed for suicides

Resultados de oito aplicações do Teste do Progresso na Faculdade de Medicina da Universidade de São Paulo

BACKGROUND: Progress testing is a longitudinal tool for evaluating knowledge gains during the medical school years. OBJECTIVES: (1) To implement progress testing as a form of routine evaluation; (2) to verify whether cognitive gain is a continuous variable or not; and (3) to evaluate whether there is loss of knowledge relating to basic sciences in the final years of medical school. METHODS: A progress test was applied twice a year to all students from 2001 to 2004. The mean percentage score was calculated for each school year, employing ANOVA with post hoc Bonferroni test evaluation for each test. RESULTS: Progress testing was implemented as a routine procedure over these 4 years. The results suggest a cognitive gain from first to sixth year in all eight tests, as a continuum (P for trend < .0001). Gain was found to be continuous for basic sciences (taught during the first 2 years), clinical sciences (P < .0001), and clerkship rotation (P < .0001). There was no difference between the performance of men and women. CONCLUSION: Progress testing was implemented as a routine, applied twice a year. Data suggest that cognitive gain during medical training appears to be a continuum, even for basic science issues.O Teste do Progresso foi introduzido na Faculdade de Medicina da Universidade de São Paulo em 2001. OBJETIVO: (1) Testar a viabilidade da aplicação rotineira do teste; (2) verificar se o ganho de conhecimentos era progressivo e contínuo durante a graduação; (3) determinar se esse ganho de conhecimento inclui também as disciplinas do curso básico. MÉTODOS: O teste foi aplicado duas vezes por ano entre 2001-2004. Em cada teste, calculou-se o escore médio de acertos por ano letivo usando-se ANOVA com correção de Bonferroni para múltiplas comparações. RESULTADOS: O Teste do Progresso foi implementado como rotina entre 2001-2004. Os resultados sugerem um ganho cognitivo contínuo e progressivo ao longo da graduação (P < 0,0001) nos oito testes aplicados até o momento. Esse ganho seria significativo mesmo para as disciplinas do curso básico (P < 0,05), curso clínico (P < 0.0001) e internato (P < 0.0001). Não houve diferença de performance em função do gênero. CONCLUSÃO: O Teste do Progresso foi implementado como rotina, sendo aplicado semestralmente. Os resultados sugerem que o ganho cognitivo parece ser contínuo e progressivo mesmo para as disciplinas do básico ao longo dos seis anos

Life Course Socioeconomic Position and C-Reactive Protein: Mediating Role of Health-Risk Behaviors and Metabolic Alterations. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Background: Chronic inflammation has been postulated to be one mediating mechanism explaining the association between low socioeconomic position (SEP) and cardiovascular disease (CVD). We sought to examine the association between life course SEP and C-reactive protein (CRP) levels in adulthood, and to evaluate the extent to which health-risk behaviors and metabolic alterations mediate this association. Additionally, we explored the possible modifying influence of gender. Methods and Findings: Our analytical sample comprised 13,371 participants from ELSA-Brasil baseline, a multicenter prospective cohort study of civil servants. SEP during childhood, young adulthood, and adulthood were considered. The potential mediators between life course SEP and CRP included clusters of health-risk behaviors (smoking, low leisure time physical activity, excessive alcohol consumption), and metabolic alterations (obesity, hypertension, low HDL, hypertriglyceridemia, and diabetes). Linear regression models were performed and structural equation modeling was used to evaluate mediation. Although lower childhood SEP was associated with higher levels of CRP in adult life, this association was not independent of adulthood SEP. However, CRP increased linearly with increasing number of unfavorable social circumstances during the life course (p trend <0.001). The metabolic alterations were the most important mediator between cumulative SEP and CRP. This mediation path accounted for 49.5% of the total effect of cumulative SEP on CRP among women, but only 20.2% among men. In consequence, the portion of the total effect of cumulative SEP on CRP that was mediated by risk behaviors and metabolic alterations was higher among women (55.4%) than among men (36.8%). Conclusions: Cumulative SEP across life span was associated with elevated systemic inflammation in adulthood. Although health-risk behaviors and metabolic alterations were important mediators of this association, a sizable fraction of this association was not mediated by these factors, suggesting that other pathways might play a role, especially among men

The influence of the day of the week of hospital admission on the prognosis of stroke patients

This study aimed to evaluate the weekday and weekend distribution of stroke case hospital admissions and their respective prognosis based on a sample from the Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral (EMMA), a cohort of stroke patients admitted to a community hospital in the city of São Paulo, Brazil. We ascertained all consecutive cases of first-time strokes between April 2006 and December 2008 and performed a subsequent one-year follow-up. No association was found between frequency of hospital admissions due to ischemic and hemorrhagic strokes and the specific day of the week on which the admission occurred. However, ten-day and twelve-month case-fatality was higher in hemorrhagic stroke patients admitted at the weekend. We also found that intracerebral hemorrhage patients admitted on weekends had a worse survival rate (50%) compared with those admitted during weekdays (25.6%, P log-rank = 0.03). We found a multivariate hazard ratio of 2.49 (95%CI: 1.10-5.81, P trend = 0.03) for risk of death at the weekend compared to weekdays for intracerebral hemorrhage cases. No difference in survival was observed with respect to the overall sample of stroke or ischemic stroke patients

Applying the Maternal Near Miss Approach for the Evaluation of Quality of Obstetric Care: A Worked Example from a Multicenter Surveillance Study

Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. the expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P < 0.001), delays related to quality of medical care (P = 0.012), absence of blood derivatives (P = 0.013), difficulties of communication between health services (P = 0.004), and any delay during the whole process (P = 0.039). Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. in this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Campinas UNICAMP, Sch Med Sci, Dept Obstet & Gynaecol, BR-13083881 Campinas, SP, BrazilCtr Res Reprod Hlth Campinas Cemicamp, BR-13083888 Campinas, SP, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilSch Med Sci, CISAM, Recife, PE, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilUniv Fed Bahia, Salvador, BA, BrazilHosp Geral Cesar Cals, Fortaleza, Ceara, BrazilHosp Geral Fortaleza, Fortaleza, Ceara, BrazilMaternidade Odete Valadares, Belo Horizonte, MG, BrazilHosp Materno Infantil, Goiania, Go, BrazilInst Materno Infantil Pernambuco, Recife, PE, BrazilUniv Fed Pernambuco, Recife, PE, BrazilUniv Fed Campina Grande, Campina Grande, PB, BrazilUniv Fed Maranhao, Sao Luis, MA, BrazilUniv Fed Parana, BR-80060000 Curitiba, Parana, BrazilUniv Fed Paraiba, BR-58059900 Joao Pessoa, Paraiba, BrazilHosp Maternidade Fernando Magalhaes, Rio de Janeiro, RJ, BrazilUniv Fed Rio Grande do Sul, Porto Alegre, RS, BrazilHosp Maternidade Celso Pierro, Campinas, SP, BrazilInst Fernandes Figueira Fiocruz, Rio de Janeiro, RJ, BrazilHosp Israelita Albert Einstein, São Paulo, BrazilUniv State São Paulo, Botucatu, SP, BrazilJundiai Sch Med, Jundiai, SP, BrazilUniv São Paulo, BR-14049 Ribeirao Preto, SP, BrazilSanta Casa Limeira, Limeira, SP, BrazilSanta Casa Sao Carlos, Sao Carlos, SP, BrazilMaternidade Leonor Mendes de Barros, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilCNPq: 402702/2008-5Web of Scienc

The Acute-Phase Proteins Serum Amyloid A and C Reactive Protein in Transudates and Exudates

The distinction between exudates and transudates is very important in the patient management. Here we evaluate whether the acute-phase protein serum amyloid A (SAA), in comparison with C reactive protein (CRP) and total protein (TP), can be useful in this discrimination. CRP, SAA, and TP were determined in 36 exudate samples (27 pleural and 9 ascitic) and in 12 transudates (9 pleural and 3 ascitic). CRP, SAA, and TP were measured. SAA present in the exudate corresponded to 10% of the amount found in serum, that is, the exudate/serum ratio (E/S) was 0.10 ± 0.13. For comparison, the exudate/serum ratio for CRP and TP was 0.39 ± 0.37 and 0.68 ± 0.15, respectively. There was a strong positive correlation between serum and exudate SAA concentration (r = 0.764;p < 0.0001). The concentration of SAA in transudates was low and did not overlap with that found in exudates (0.02-0.21 versus 0.8–360.5 g/mL). SAA in pleural and ascitic exudates results mainly from leakage of the serum protein via the inflamed membrane. A comparison of the E/S ratio of SAA and CRP points SAA as a very good marker in discriminating between exudates and transudates