Race and stroke mortality in Brazil

Sendo desconhecidas as taxas de mortalidade cerebrovascular segundo raça no Brasil, foram coletadas informações de óbitos de 2010 do Sistema de Informação de Mortalidade do Ministério da Saúde. Foram calculadas as taxas de mortalidade cerebrovascular, ajustadas por idade (por 100 mil), com intervalo de confiança de 95%, por sexo e raça/cor de pele. A diferença entre brancos, pardos e negros foi significativa para homens, com taxas, respectivamente, de 44,4 (43,5;45,3), 48,2 (47,1;49,3) e 63,3 (60.6;66,6); e para mulheres, com taxa, respectivamente, de 29,0 (28,3;29,7), 33,7 (32,8;34,6) e 51,0 (48,6;53,4). Em conclusão, a mortalidade cerebrovascular no Brasil é maior entre negros.Considerando que en Brasil se desconocen las tasas de mortalidad cerebrovascular, según la raza, se colectaron informaciones de óbitos de 2010 del Sistema de Información de Mortalidad del Ministerio de la Salud. Se calcularon las tasas de mortalidad cerebrovascular, ajustadas por edad (por 100 mil), con intervalo de confianza de 95%, por sexo y raza/color de piel. La diferencia entre blancos, pardos y negros fue significativa para hombres, con tasas de 44,4 (43,5; 45,3), 48,2 (47,1;49,3) y 63,3 (60.6;66,6), respectivamente; y para mujeres, tasas de 29,0 (28,3;29,7), 33,7 (32,8;34,6) y 51,0 (48,6;53,4), respectivamente. En conclusión, la mortalidad cerebrovascular en Brasil es mayor entre negros.As stroke mortality rates according to race were not known in Brazil, data on mortality for the year 2010 was collected from the Mortality Information System of the Brazilian Ministry of Health. Cerebrovascular mortality rates adjusted for age (per 100,000) were calculated with a confidence interval of 95% (95%CI) by sex and race/skin color. The differences between races were significant for men with rates of 44.4 (43.5;45.3), 48.2 (47.1;49.3) and 63.3 (60.6;66.6) for white, brown and black, respectively; and for women, with rates of 29.0 (28.3;29.7), 33.7 (32.8;34.6) and 51.0 (48.6;53.4) for white, brown and black, respectively. The burden of stroke mortality is higher among blacks compared to brown and white

Raca e mortalidade cerebrovascular no Brasil

Sendo desconhecidas as taxas de mortalidade cerebrovascular segundo raça no Brasil, foram coletadas informações de óbitos de 2010 do Sistema de Informação de Mortalidade do Ministério da Saúde. Foram calculadas as taxas de mortalidade cerebrovascular, ajustadas por idade (por 100 mil), com intervalo de confiança de 95%, por sexo e raça/cor de pele. A diferença entre brancos, pardos e negros foi significativa para homens, com taxas, respectivamente, de 44,4 (43,5;45,3), 48,2 (47,1;49,3) e 63,3 (60.6;66,6); e para mulheres, com taxa, respectivamente, de 29,0 (28,3;29,7), 33,7 (32,8;34,6) e 51,0 (48,6;53,4). Em conclusão, a mortalidade cerebrovascular no Brasil é maior entre negros

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

Perfil lipídico e consumo de bebida alcoólica: estudo longitudinal de saúde do adulto (ELSA-BRASIL)

Objetivo: investigar o efeito do consumo de álcool em geral e do tipo de bebida alcoólica consumida, em diferentes medidas lipídicas. Método: o efeito do consumo de álcool foi investigado, bem como do tipo de bebida alcoólica, em diferentes medidas lipídicas, em ambos os sexos de população do Estudo Longitudinal de Saúde do Adulto. Resultados: foram realizadas análises em relação ao tipo e quantidade de consumo de bebida alcoólica por sexo. O consumo baixo-amoderado de álcool, independentemente do tipo de bebida alcoólica consumida, resultou em níveis mais elevados de HDLcolesterol, HDL2-colesterol e HDL3-colesterol em homens e mulheres. Não houve participantes da pesquisa que consumiam quantidade baixa a moderada de bebidas alcoólicas destiladas. Os triglicerídeos tiveram efeitos inversos para homens e mulheres no perfil lipídico. Para homens, bebidas destiladas contribuíram para melhor perfil dos triglicerídeos, enquanto para mulheres foi o contrário. Homens que consumiam bebidas alcoólicas destiladas tiveram níveis menores de triglicerídeos e mulheres que consumiam bebidas alcóolicas destiladastiveram níveis maiores. Nossos resultados estão de acordo com os de estudos anteriores. Conclusão: o consumo de álcool resultou em níveis diferentes de medidas lipídicas séricas em homens e mulheres. Dessa forma, conclui-se que a resposta ao álcool tem diferenças biológicas.Objetivo: investigar el efecto del consumo de alcohol general, así como el tipo de bebida alcohólica consumida, en diferentes medidas lipídicas. Método: el efecto del consumo de alcohol fue investigado, así como el tipo de bebida alcohólica, en diferentes medidas lipídicas en ambos sexos de población del Estudio Longitudinal de Salud del Adulto. Resultados: se realizaron análisis en relación al tipo y cantidad de consumo de bebida alcohólica por sexo. El consumo bajo a moderado de alcohol, independientemente del tipo de bebida alcohólica consumida, resultó en niveles más altos de HDL-colesterol, HDL2-colesterol y HDL3-coleseterol en hombres y mujeres. No hubo participantes de investigación que consumían en cantidad baja a moderada de bebidas alcohólicas destiladas. Los triglicéridos tuvieron efectos inversos para hombres y mujeres en el perfil lipídico. Para los hombres, las bebidas destiladas contribuyeron a un mejor perfil de lostriglicéridos, mientras que para las mujeres fue lo contrario. Los hombres que consumían bebidas alcohólicas destiladas tenían niveles más pequeños de triglicéridos y las mujeres que consumían bebidas alcohólicas destiladas tuvieron niveles más altos. Nuestros resultados están de acuerdo con estudios anteriores. Conclusión: el consumo de alcohol resultó en niveles significativamente mayores de HDL-colesterol, HDL2-colesterol y HDL3-colesterol, tanto en mujeres como en hombres. De esta forma, se concluye que la respuesta al alcohol tiene diferencias biológicas.Objective: to investigate the effect of general alcohol consumption and of the type of alcoholic beverage consumed, in different lipid measurements. Method: the effect of alcohol consumption as well as that of the type of alcoholic beverage consumed were investigated, in different lipid measurements, for the participants in the Longitudinal Study on Adults’ Health for both sexes. Results: nalyses were conducted on the type and amount of alcoholic beverage consumed by sex. Low-to-moderate alcohol consumption, regardless of the type of alcoholic beverage, resulted in higher levels of HDL-cholesterol, HDL2- cholesterol and HDL3-cholesterol in males and females. No participants in the study consumed low-to-moderate amounts of spirits. Triglycerides showed inverse effects for men and women according to the lipid profile. For men, spirits contributed to a better triglyceride profile while for women it was the opposite. Men who consumed spirits showed lower triglyceride levels, and women who consumed that beverage type had higher levels. Our results are in agreement with those of previous studies. Conclusion: alcohol consumption resulted in different levels of serum lipid measurements in men and women. Thus, it is concluded that response to alcohol has biological differences

Nível de escolaridade e dependência funcional em sobreviventes de acidente vascular cerebral isquêmico

We evaluated the functional dependence of stroke survivors from the Study of Stroke Mortality and Morbidity, using the Rankin Scale. Out of 355 ischemic stroke survivors (with a mean age of 67.9 years), 40% had some functional dependence at 28 days and 34.4% had some functional dependence at 6 months. Most predictors of physical dependence were identified at 28 days. These predictors were: low levels of education [illiterate vs. >= 8 years of education, multivariate odds ratio (OR) = 3.7; 95% confidence interval (95%CI): 1.60-8.54] and anatomical stroke location (total anterior circulation infarct, OR = 16.9; 95%CI: 2.93-97.49). Low levels of education and ischemic brain injury influenced functional dependence in these stroke survivors. Our findings reinforce the necessity of developing strategies for the rehabilitation of stroke patients, more especially in formulating specific strategies for care and treatment of stroke survivors with low socioeconomic status.Foi avaliada a dependência funcional em sobreviventes de acidente vascular cerebral (AVC) do Estudo da Mortalidade e Morbidade do Acidente Vascular Cerebral, utilizando a Escala de Rankin. De 355 sobreviventes com AVC isquêmico (idade média de 67,9 anos), 40% tinham dependência funcional em 28 dias e 34,4% em 6 meses. Os principais indicadores de dependência física foram identificados em 28 dias, e eram: baixa escolaridade (analfabetos vs. > 8 anos de educação, RC = 3,7; IC95%: 1,60-8,54) e localização do AVC (infarto circulação total anterior, RC = 16,9; IC95%: 2,93-97,49). Baixo nível educacional e insulto cerebral isquêmico influenciaram o grau de dependência funcional nesses sobreviventes de AVC. Nossos achados reforçam a necessidade de desenvolvimento de estratégias para reabilitação de pacientes com AVC e formulação de estratégias específicas de atenção e tratamento para essas pessoas, especialmente na população com baixo nível socioeconômico.CNPqFAPES

A Reappraisal in Sao Paulo, Brazil (2008) of "The Ecology of Medical Care:" The "One Per Thousand's Rule"

BACKGROUND AND OBJECTIVES: Medical ecology is a conceptual framework introduced in 1961 to describe the relationship and utilization of health care services by a given population. We applied this conception to individuals enrolled in a private health maintenance organization (HMO) in Sao Paulo, Brazil, with the aim of describing the utilization of primary health care, verifying the frequency of various symptoms, and identifying the roles of different health care sources. METHODS: This was a cross-sectional telephone survey among a random sample of people enrolled in a private HMO. We interviewed a random sample of non-pregnant adults over age 18 using 10 questions about symptoms and health care use during the month prior to interview. RESULTS: The final sample consisted of 1,065 participants (mean age 68 years, 68% female). From this sample, 424 (39.8%) reported the presence of symptoms, 311 (29.2%) had a medical office consult, 104 (9.8%) went directly to an emergency medical department, 63 (5.9%) were hospitalized, 22 (2.1%) used complementary medicine resources, seven (0.7%) were referred to home care, and one (0.1%) was admitted to an academic hospital. CONCLUSIONS: The proportion of study participants referred to an academic care center was similar to that observed in previous "medical ecology" studies in different populations

Terminology of primary health care

INTRODUÇÃO: Muitos termos da área de Atenção Primária à Saúde não são utilizados adequadamente. É importante resgatar a origem desses termos, a fim de entender porque são usados de maneiras diferentes por trabalhadores da saúde e pela população leiga. OBJETIVO: Pesquisar e discutir os significados e usos de termos ligados àAtenção Primária à Saúde. MÉTODO: Revisão, em diferentes fontes, de significados de termos como Atenção Primária à Saúde, medicina de família, clínica geral, medicina interna, Programa Saúde da Família. RESULTADOS: Referências diferentes geralmente têm o mesmo significado para termos similares. Alguns termos, como, por exemplo, "clínica médica", que na prática significa "medicina interna", não têmorigem clara. DISCUSSÃO: Muitos termos são usados indevidamente por causa de diferentes interesses e motivos históricos. Este trabalho não pretende esgotar a discussão sobre a importância da terminologia na Atenção Primária. É um campo relevante de investigação, porque pode ajudar a comunicação entre pacientes, profissionais da saúde e políticos e, em especial, colaborar para o adequado entendimento pelos estudantes deste cenário de prática

Suicide rates and income in Sao Paulo and Brazil: a temporal and spatial epidemiologic analysis from 1996 to 2008

Background: In a classical study, Durkheim noted a direct relation between suicide rates and wealth in the XIX century France. Since that time, several studies have verified this relationship. It is known that suicide rates are associated with income, although the direction of this association varies worldwide. Brazil presents a heterogeneous distribution of income and suicide across its territory; however, evaluation for an association between these variables has shown mixed results. We aimed to evaluate the relationship between suicide rates and income in Brazil, State of Sao Paulo (SP), and City of SP, considering geographical area and temporal trends. Methods: Data were extracted from the National and State official statistics departments. Three socioeconomic areas were considered according to income, from the wealthiest (area 1) to the poorest (area 3). We also considered three regions: country-wide (27 Brazilian States and 558 Brazilian micro-regions), state-wide (645 counties of SP State), and city-wide (96 districts of SP city). Relative risks (RR) were calculated among areas 1, 2, and 3 for all regions, in a cross-sectional approach. Then, we used Joinpoint analysis to explore the temporal trends of suicide rates and SaTScan to investigate geographical clusters of high/low suicide rates across the territory. Results: Suicide rates in Brazil, the State of SP, and the city of SP were 6.2, 6.6, and 5.4 per 100,000, respectively. Taking suicide rates of the poorest area (3) as reference, the RR for the wealthiest area was 1.64, 0.88, and 1.65 for Brazil, State of SP, and city of SP, respectively (p for trend <0.05 for all analyses). Spatial cluster of high suicide rates were identified at Brazilian southern (RR = 2.37), state of SP western (RR = 1.32), and city of SP central (RR = 1.65) regions. A direct association between income and suicide were found for Brazil (OR = 2.59) and the city of SP (OR = 1.07), and an inverse association for the state of SP (OR = 0.49). Conclusions: Temporospatial analyses revealed higher suicide rates in wealthier areas in Brazil and the city of SP and in poorer areas in the State of SP. We further discuss the role of socioeconomic characteristics for explaining these discrepancies and the importance of our findings in public health policies. Similar studies in other Brazilian States and developing countries are warranted

Potent Antiretroviral Therapy for Human Immunodeficiency Virus Infection Increases Aortic Stiffness

Background: Highly active antiretroviral therapy for AIDS is known to increase cardiovascular risk, but the effects of potent antiretroviral agents according to gender are unknown. Objective: The present study evaluated the impact of HIV infection treatment on aortic stiffness according to gender. Methods: From university-affiliated hospitals, we recruited 28 AIDS patients undergoing highly active antiretroviral treatment (HAART), 28 treatment-naive HIV-infected patients, 44 patients with type 2 diabetes, and 30 controls. Aortic stiffness was determined by measuring pulse wave velocity (PWV) using a validated and non-invasive automatic device. Results: The crude mean PWV values and 95% confidence intervals (95% CI) for HAART, diabetics, and controls were 9.77 m/s (95% CI 9.17-10.36),, 9.00 m/s (95% CI 8.37-9.63), 9.90 m/s (95% CI 9.32-10.49), and 9.28 m/s (95% CI 8.61-9.95), respectively, for men (P-value for trend = 0.14), and 9.61 m/s (95% CI 8.56-10.66), 8.45 m/s (95% CI 7.51-9.39), 9.83 (95% CI 9.21-10.44), and 7.79 m/s (95% CI 6.99-8.58), respectively, for women (P-value for trend &lt;0.001). Post-hoc analysis revealed a significant difference between the mean PWV values in the HAART group and controls in women (P-value &lt;0.01). After adjusting for other potential covariates, including systolic blood pressure and diabetes, these results did not change. The findings indicate that the impact of HAART treatment on aortic stiffness was amplified in women with hypertension, dyslipidemia, and metabolic syndrome. Conclusion: Potent anti-retroviral agents used in the treatment of HIV infection increases aortic stiffness, mainly among women with higher cardiovascular risk. (Arq Bras Cardiol 2012;99(6):1100-1107)Fundamento: Sabe-se que a terapia antirretroviral altamente potente para Aids reconhecida aumenta o risco cardiovascular, mas os efeitos dos agentes antirretrovirais de acordo com o gênero ainda são desconhecidos. Objetivo: O presente estudo avaliou o impacto do tratamento para o vírus da imunodeficiência humana (HIV) na rigidez\ud aórtica de acordo com o gênero. Métodos: Foram recrutados 28 pacientes com Aids submetidos à terapia antirretroviral altamente potente (HAART), 28 pacientes\ud infectados pelo HIV virgens de tratamento, 44 pacientes com diabetes tipo 2, e 30 controles. A rigidez aórtica foi determinada pela medição da Velocidade da Onda de Pulso (VOP), utilizando um equipamento automático validado e não invasivo. Resultados: Os resultados médios brutos da VOP (e intervalo de confiança de 95%) para participantes nos grupos terapia antirretroviral potente, HIV virgem de tratamento, diabéticos, e controles foram 9,77 m/s (9,17-10,36), 9,00 m/s (8,37-9,63), 9,90 m/s (9,32-10,49) e 9,28 m/s (8,61-9,95), respectivamente, para os homens (p de tendência = 0,14) e 9,61 m/s\ud (8,56-10,66), 8,45 m/s (7,51-9,39), 9,83 (9,21-10,44) e 7,79 m/s (6,99-8,58), respectivamente, para as mulheres (p valor de tendência < 0,001). Análises post-hoc revelaram uma diferença significativa entre os valores médios de VOP no grupo com HAART e controles em mulheres (p < 0,01). Ajustes para as demais covariáveis potenciais, incluindo pressão arterial sistólica e diabetes, não alteraram esses resultados. Os achados indicam que o impacto do tratamento com HAART na rigidez aórtica foi amplificado nas mulheres com hipertensão, dislipidemia e síndrome metabólica. Conclusão: Agentes antirretrovirais potentes utilizados no tratamento da infecção pelo HIV aumentam a rigidez da aorta, especialmente em mulheres com maior risco cardiovascular. (Arq Bras Cardiol 2012;99(6):1100-1107)FAPESPFAPES

ELSA-Brasil: a 4-year incidence of hearing loss in adults with and without hypertension

OBJECTIVE To compare the incidence of hearing loss among adults stratified by the occurrence of hypertension, and to investigate the association between hypertension and hearing loss. METHODS Longitudinal observational study, part of the Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil, Longitudinal Study on Adult’s Health). Data from the first and second waves were analyzed, including information from audiological assessment and general health of the subjects. As outcome, we considered the presence of hearing loss (hearing thresholds above 25 dBHL at frequencies from 500 Hz to 8 kHz) and, as exposure variable, hypertension (report of medical diagnosis of hypertension; and/or use of drugs to treat hypertension; and/or pressure systolic blood pressure ≥ 140 mmHg; or diastolic blood pressure ≥ 90 mmHg). As covariables for adjustment were considered: sex, age, education, race / ethnicity, income, smoking, diabetes, and occupational exposure to noise. Poisson regression analysis was conducted, estimating the crude and adjusted relative risks, with 95% confidence intervals, in order to assess the factors associated with hearing loss. RESULTS In crude analyses, the incidence of hearing loss was higher for subjects with hypertension (9.7% versus 5.4%). The crude relative risks for hearing loss was almost double (1.93; 95%CI: 1.10–3.39) for subjects with hypertension in the right ear. In the adjusted analyses, the relative risks was not significant for the hypertension variable (1.42; 95%CI: 0.75–2.67). Being 60 years or older (RR: 5.41; 95%CI: 2.79–10.50) showed a statistically significant association with hearing loss, indicating that older adults have higher relative risks for hearing loss. CONCLUSION In the adjusted analyses controlled for multiple risk factors there was no association between hypertension and hearing loss. The dichotomous variable age (being 60 years or older), on the other hand, has shown a significant association with hearing loss