Hypertension control and related factors at primary care located in the west side of the city of São Paulo, Brazil

Realizou-se estudo para caracterizar o controle de hipertensos atendidos na atenção primária com amostra de 440 hipertensos. Os hipertensos foram entrevistados e a medida da pressão foi realizada com aparelho automático validado. A relação entre as variáveis classificatórias foi avaliada com o teste qui-quadrado e posterior análise multivariada. Os resultados mostraram que o controle da hipertensão arterial foi de 45,5% e se associou (p<0,05) a mulheres, idade menos elevada, menos tempo de doença, já ter feito tratamento para hipertensão, menos interrupção do tratamento, conhecimento sobre a importância dos exercícios físicos, raramente deixar de tomar remédio na hora certa, menor número de drogas anti-hipertensivas prescritas, antecedentes para doenças cardíacas, prática de exercícios físicos e menos tristeza. A análise de regressão logística mostrou que a falta de controle da hipertensão foi dependente de tratamento anterior para hipertensão (OR = 2,26; IC 95%, 1,4 - 3,6), falta de conhecimento sobre prática de atividade física (OR = 3,5; IC 95%, 1,1 - 10,8) e ausência de antecedente familiar para problemas cardíacos (OR = 2,2; IC 95%, 1,3 - 3,5). Menos da metade dos hipertensos estava controlada e o controle se associou a variáveis biológicas, tratamento, atitudes e conhecimento sobre a hipertensão e seu tratamento.The objective of this study was to characterize blood pressure control of 440 hypertensive patients. The subjects were interviewed and had their blood pressure measurement by means of an automatic device. The results showed that 45.5% had an adequate blood pressure control. People under control were different (p<0.05) from those without control: the ones under blood pressure control were mainly women, younger, with a shorter time of disease, with previous treatment for hypertension, less interruptions in treatment and more conscious about the importance of physical activities. They also rarely forgot to take the medicines in the right time, generally using less than, 3 or more antihypertensive drugs, with family history of cardiovascular diseases, reporting physical activity more frequently and less sadness. The multivariate analysis revealed a statistically significant association of uncontrolled hypertension with previous treatment (OR = 2.26; IC 95%, 1.4 - 3.6), no family history of cardiovascular diseases (OR = 2.2; IC 95%, 1.3 3.5) and unaware of the importance of physical activities for blood pressure control (OR = 3.5; IC 95%, 1.1 10.8). Blood pressure control was associated with biological variables, behavior and information about hypertension as a risk factor and its treatment

Suicide rates and trends in Sao Paulo, Brazil, according to gender, age and demographic aspects: a joinpoint regression analysis

Objective: To evaluate suicide rates and trends in Sao Paulo by sex, age-strata, and methods. Methods: Data was collected from State registry from 1996 to 2009. Population was estimated using the National Census. We utilized joinpoint regression analysis to explore temporal trends. We also evaluated marital status, ethnicity, birthplace and methods for suicide. Results: In the period analyzed, 6,002 suicides were accrued with a rate of 4.6 per 100,000 (7.5 in men and 2.0 in women); the male-to-female ratio was around 3.7. Trends for men presented a significant decline of 5.3% per year from 1996 to 2002, and a significant increase of 2.5% from 2002 onwards. Women did not present significant changes. For men, the elderly (&gt; 65 years) had a significant reduction of 2.3% per year, while younger men (25-44 years) presented a significant increase of 8.6% from 2004 onwards. Women did not present significant trend changes according to age. Leading suicide methods were hanging and poisoning for men and women, respectively. Other analyses showed an increased suicide risk ratio for singles and foreigners. Conclusions: Specific epidemiological trends for suicide in the city of Sao Paulo that warrant further investigation were identified. High-risk groups - such as immigrants - could benefit from targeted strategies of suicide prevention

C-reactive protein as an inflammatory marker of acute infections outside intensive care settings: case report and evidence-based literature review

We present the clinical case of a 76-year-old woman with delirium causedby multiple factors, including pneumonia. Although this type of case is quitecommon in clinical practice, it provides us with an opportunity to discusslaboratory testing in this context, with a special focus on the role of C-reactiveprotein (CRP). We present data regarding the requests for determination ofserum CRP levels at the University of S&atilde;o Paulo University Hospital overthe past few years. We also present a review of the medical literature on thetopic, as well as clinical epidemiology concepts related to the impact that CRPtesting has on the medical decision-making process

Neck circumference is associated with carotid intimal-media thickness but not with coronary artery calcium : results from the ELSA-Brasil

Abstract Background and aims: It is uncertain whether neck circumference can be a risk indicator for subclinical atherosclerosis. We aimed to investigate their relationships measured by coronary artery calcium (CAC) and common carotid intima-media thickness (cc-IMT) with neck circumference in ELSA-Brasil. Methods and results: In cross-sectional and sex-specific analyses of 2266 women (50.6 8.4 yrs) and 1886 men (50.7 9.0 yrs) with both cc-IMT and CAC, free from previous cardiovascular disease at baseline, we built logistic models using diverse cut-off points for CAC score (0 vs >0, 0.05 for all). Conclusion: Neck circumference was significantly and independently associated with cc-IMT but not with CAC in women and men, indicating a possible effect of perivascular fat tissue on atherosclerosis

Associations of cigarette smoking with subclinical inflammation and atherosclerosis : ELSA-Brasil (The Brazilian Longitudinal Study of Adult Health)

Background-—There is a need to identify sensitive biomarkers of early tobacco-related cardiovascular disease. We examined the association of smoking status, burden, time since quitting, and intensity, with markers of inflammation and subclinical atherosclerosis. Methods and Results-—We studied 14 103 participants without clinical cardiovascular disease in ELSA-Brasil (Brazilian Longitudinal Study of Adult Health). We evaluated baseline cross-sectional associations between smoking parameters and inflammation (highsensitivity C-reactive protein [hsCRP]) and measures of subclinical atherosclerosis (carotid intima–media thickness, ankle-brachial index, and coronary artery calcium [CAC]). The cohort included 1844 current smokers, 4121 former smokers, and 8138 never smokers. Mean age was 51.7 8.9 years; 44.8% were male. After multivariable adjustment, compared with never smokers, current smokers had significantly higher levels of hsCRP (b=0.24, 0.19–0.29 mg/L; P0 (odds ratio: 1.83; 95% confidence interval, 1.46–2.30; P0 were lower with increasing time since quitting (P0 (P=0.03) after adjusting for duration of smoking. Conclusions-—Strong associations were observed between smoking status, burden, and intensity with inflammation (hsCRP) and subclinical atherosclerosis (carotid intima–media thickness, ankle-brachial index, CAC). These markers of early cardiovascular disease injury may be used for the further study and regulation of traditional and novel tobacco products

Lack of association between subclinical hypothyroidism and carotid–femoral pulse wave velocity in a cross-sectional analysis of the ELSA–Brasil

BACKGROUND There is little available data on carotid–femoral pulse wave velocity (cf-PWV) in subjects with subclinical hypothyroidism (SCH). We aimed to analyze the association between SCH and cf-PWV using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA–Brasil). METHODS We included subjects with normal thyroid function (thyrotropin (TSH): 0.4–4.0 mIU/l, and normal free thyroxine (FT4: 0.8–1.9 ng/dl) and SCH (TSH > 4.0 mIU/l and normal FT4) evaluated for cf-PWV in a crosssectional analysis. We excluded individuals using medications that interfere in thyroid function, antihypertensives, or diuretics, and subjects with chronic kidney disease or previous cardiovascular disease. Generalized linear and logistic regression models evaluated cf-PWV as a dependent variable and SCH as an independent variable, adjusted for cardiovascular risk factors.RESULTS Of 8,341 subjects (52.3% women), 7,878 (94.4%) were euthyroid and 463 (5.6%) showed SCH. The median age was 50 years (interquartile range: 44–56). The groups differed by age, sex, body mass index, glomerular filtration rate, and C-reactive protein. SCH was not associated with cf-PWV in the full-adjusted linear model (β = −0.039; P = 0.562) and with cf-PWV >75th percentile in the full-adjusted logistic model (odds ratio = 0.94; 95% confidence interval = 0.72–1.22). CONCLUSION In a large sample, SCH was not associated with increased cf-PWV

Association between cognitive performance and self-reported glaucoma in middle-aged and older adults : a cross-sectional analysis of ELSA-Brasil

Recent evidence suggests that glaucoma and Alzheimer's disease are neurodegenerative diseases sharing common pathophysiological and etiological features, although findings are inconclusive. We sought to investigate whether self-reported glaucoma patients without dementia present poorer cognitive performance, an issue that has been less investigated. We employed cross-sectional data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) and included participants ≥50 years of age without a known diagnosis of dementia and a self-reported glaucoma diagnosis. We excluded those with previous stroke, other eye conditions, and using drugs that could impair cognition. We evaluated cognition using delayed word recall, phonemic verbal fluency, and trail making (version B) tests. We used multinomial linear regression models to investigate associations between self-reported glaucoma with cognition, adjusted by several sociodemographic and clinical variables. Out of 4,331 participants, 139 reported glaucoma. Fully-adjusted models showed that self-reported glaucoma patients presented poorer performance in the verbal fluency test (β=-0.39, 95%CI=-0.64 to -0.14, P=0.002), but not in the other cognitive assessments. Thus, our results support the hypothesis that self-reported glaucoma is associated with poor cognitive performance; however, longitudinal data are necessary to corroborate our findings

Consumo de comida ultraprocesada y nivel socioeconómico : un análisis transversal del Estudio Longitudinal Brasileño sobre Salud en la Edad Adulta (ELSA-Brasil)

The objective of the study was to estimate the contribution of ultra-processed foods to total caloric intake and investigate whether it differs according to socioeconomic position. We analyzed baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil 2008-2010; N = 14.378) and data on dietary intake using a food frequency questionnaire, assigning it into three categories: unprocessed or minimally processed foods and processed culinary ingredients, processed foods, and ultra-processed foods. We measured the associations between socioeconomic position (education, per capita household income, and occupational social class) and the percentage of caloric contribution of ultra-processed foods, using generalized linear regression models adjusted for age and sex. Unprocessed or minimally processed foods and processed culinary ingredients contributed to 65.7% of the total caloric intake, followed by ultra-processed foods (22.7%). After adjustments, the percentage of caloric contribution of ultra-processed foods was 20% lower among participants with incomplete elementary school when compared to postgraduates. Compared to individuals from upper income classes, the caloric contribution of ultra-processed foods was 10%, 15% and 20% lower among the ones from the three lowest income, respectively. The caloric contribution of ultra-processed foods was also 7%, 12%, 12%, and 17% lower among participants in the lowest occupational social class compared to those from high social classes. Results suggest that the caloric contribution of ultra-processed foods is higher among individuals from high socioeconomic positions with a dose-response relationship for the associations.O estudo teve como objetivo estimar a contribuição dos alimentos ultraprocessados à ingestão calórica total e investigar se essa contribuição difere de acordo com nível socioeconômico. Analisamos os dados da linha de base do Estudo Longitudinal de Saúde do Adulto-Brasil (ELSA-Brasil 2008-2010; N = 14.378) e os de ingestão alimentar, usando um questionário sobre frequência de consumo alimentar, em três categorias: alimentos não processados ou minimamente processados e ingredientes culinários processados, alimentos processados e alimentos ultraprocessados. Estimamos as associações entre nível socioeconômico (escolaridade, renda domiciliar per capita e classe social ocupacional) e o percentual da contribuição calórica dos ultraprocessados, usando modelos lineares generalizados, ajustados por idade e sexo. Os alimentos não processados ou minimamente processados e ingredientes culinários processados representaram 65,7% da ingestão calórica total, seguidos pelos ultraprocessados (22,7%). Depois dos ajustes, a contribuição dos ultraprocessados foi 20% mais baixa entre participantes com ensino fundamental incompleto, quando comparados aos indivíduos com pós-graduação. Quando comparados aos indivíduos das classes de renda mais alta, a contribuição calórica dos ultraprocessados foi 10%, 15% e 20% mais baixa entre aqueles pertencentes aos três quintis de renda mais baixos, respectivamente. Além disso, a contribuição calórica dos ultraprocessados foi 7%, 12%, 12% e 17% mais baixa entre os participantes da classe social ocupacional mais baixa, comparados aos das classes sociais mais altas. Os resultados sugerem que a contribuição calórica dos alimentos ultraprocessados é mais alta entre os indivíduos de nível socioeconômico mais alto, com gradiente de dose e resposta nas associações.El objetivo del estudio fue estimar la contribución de las comidas ultraprocesadas en la ingesta total calórica e investigar si difiere según el nivel socioeconómico. Analizamos datos de referencia, procedentes del Estudio Longitudinal Brasileño sobre Salud en la Edad Adulta (ELSA-Brasil 2008-2010; N = 14.378) y datos de la ingesta nutricional, usando un cuestionario de frecuencia sobre comidas, asignándole tres categorías: comida sin procesar o mínimamente procesada e ingredientes culinarios procesados, comidas procesadas, y comidas ultraprocesadas. Medimos las asociaciones entre el nivel socioeconómico (educación, ingreso por hogar per cápita, y clase ocupacional social) y el porcentaje de la contribución calórica de la comida ultraprocesada, usando modelos de regresión lineal generalizada, ajustados por edad y sexo. Las comidas sin procesar o mínimamente procesadas con ingredientes culinarios procesados contribuyeron al 65,7% del total de la ingesta calórica, seguidos de la comida ultraprocesada (22,7%). Tras los ajustes, el porcentaje de la contribución calórica de la comida ultraprocesada fue un 20% menor entre los participantes con la escuela elemental incompleta, cuando se compararon con los postgraduados. Comparados con los individuos de las clases con ingresos superiores, la contribución calórica de las comidas ultraprocesadas fue un 10%, 15% y 20% menor entre quienes pertenecían a las tres categorías de ingresos más bajas, respectivamente. La contribución calórica de la comida ultraprocesada fue también un 7%, 12%, 12%, y 17% más baja entre los participantes en el nivel ocupacional social más bajo, comparados con aquellos de las clases sociales altas. Los resultados sugieren que la contribución calórica de la comida ultraprocesada es más alta entre quienes proceden de niveles socioeconómicos más altos con una relación dosis-respuesta para las asociaciones establecidas

Common mental disorders and sociodemographic characteristics: baseline findings of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Objective: To assess the prevalence of common mental disorders (CMD) and the association of CMD with sociodemographic characteristics in the Brazilian Longitudinal Study of Adult Health (ELSABrasil) cohort. Methods: We analyzed data from the cross-sectional baseline assessment of the ELSA-Brasil, a cohort study of 15,105 civil servants from six Brazilian cities. The Clinical Interview Schedule-Revised (CIS-R) was used to investigate the presence of CMD, with a score X 12 indicating a current CMD (last week). Specific diagnostic algorithms for each disorder were based on the ICD-10 diagnostic criteria. Prevalence ratios (PR) of the association between CMD and sociodemographic characteristics were estimated by Poisson regression. Results: CMD (CIS-R score X 12) was found in 26.8% (95% confidence intervals [95%CI] 26.1-27.5). The highest burden occurred among women (PR 1.9; 95%CI 1.8-2.0), the youngest (PR 1.7; 95%CI 1.5-1.9), non-white individuals, and those without a university degree. The most frequent diagnostic category was anxiety disorders (16.2%), followed by depressive episodes (4.2%). Conclusion: The burden of CMD was high, particularly among the more socially vulnerable groups. These findings highlight the need to strengthen public policies aimed to address health inequities related to mental disorders

Leisure time physical activity and cardio-metabolic health: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Background-—Although increasing effort has been devoted to the promotion of a healthy lifestyle such as leisure time physical activity for cardio-metabolic health, specific evidence supporting health policy remains sparse, particularly in those ethnically diverse populations where cardio-metabolic diseases are reaching epidemic proportion and yet are grossly understudied. Methods and Results-—We conducted a cross-sectional analysis of the baseline data from 10 585 participants aged 35 to 74 free of cardiovascular diseases in the Brazilian Longitudinal Study of Adult Health. Leisure time physical activity status was defined by the American Heart Association and the World Health Organization recommendations (≥150 min/week moderate activities or 75 min/week vigorous activities). In total, 1183 (21%) women and 1387 (29%) men were active. After accounting for covariates, the favorable effects of leisure time physical activity on cardio-metabolic parameters were evident. Specifically, the average blood pressure, heart rate, and Framingham Risk Score for cardiovascular diseases of the active were significantly lower within each sex. The ORs comparing the active versus the inactive women were 0.78 (95% CI: 0.66–0.92) for hypertension and 0.78 (95% CI: 0.65– 0.93) for cardiovascular diseases in 10 years. Among men, the ORs were 0.75 (95% CI: 0.65–0.87) for hypertension and 0.73 (95% CI: 0.61–0.87) for diabetes. The 10-year risk of cardiovascular diseases was significantly lower among the active men with a 33% reduction (OR=0.67, 95% CI: 0.57–0.78). Conclusions-—We observed beneficial effects of leisure time physical activity on cardio-metabolic health in this large Brazilian population that are consistent with studies in North America and Europe