Consumption of alcohol and blood pressure: Results of the ELSA-Brasil study

<div><p>Background</p><p>Prevention and reduction of excessive use of alcohol represents damages to society in general. In turn, arterial hypertension is the main attributable risk factor premature life lost years and disability.</p><p>Objective</p><p>To investigate the relationship between alcohol consumption and high blood pressure in participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).</p><p>Methodology</p><p>A baseline data of total of 7,655 participants volunteers between 35 and 74 years of age, of both genders, in six educational and research institutions of three different regions of the country were interviewed between 2008–2010. Socioeconomic, haemodynamic, anthropometric and health data were collected in the research centers of ELSA-Brasil. The presence of high blood pressure was identified when the systolic blood pressure was ≥140 mm Hg and/or the diastolic was ≥90 mm Hg. Alcohol consumption was estimated and categorized regarding consumption and pattern of ingestion. The Student’s t-test, chi-squared and logistic regression tests were used for analysis, including potential co-variables of the model, and a 5% significance level was adopted.</p><p>Results</p><p>A dose-response relation was observed for the consumption of alcohol (g/week) in systolic blood pressure and diastolic blood pressure. Alcohol consumption was associated with high blood pressure in men who reported moderate (<i>OR</i> = 1.69; _95%CI 1.35–2.11) and excessive (<i>OR</i> = 2.70; _95%CI 2.04–3.59) consumption. Women have nearly three times more chance of presenting elevated blood pressure when presenting excessive consumption (<i>OR</i> = 2.86, _95%CI 1.77–4.63), and binge drinkers who drink more than 2 to 3 times a month have approximately 70% more chance of presenting with elevated blood pressure, after adjusting for consumption of drinks with meals.</p><p>Conclusion</p><p>The consumption of alcohol beverages increases the odds of elevated blood pressure, especially among excessive drinkers. Therefore alcohol consumption needs a more robust regulation in view of its impact on population health.</p></div

The Influence of Parental Psychopathology on Offspring Suicidal Behavior across the Lifespan

<div><p>Suicide tends to occur in families, and parental psychopathology has been linked to offspring suicidal behaviors. This study explores the influence of parental mental disorders across the lifespan. Data are from the Sao Paulo Megacity Mental Health Survey, a cross-sectional household study with a representative sample of the adult population living in the Sao Paulo Metropolitan Area, Brazil (N=2,942). Survival models examined bivariate and multivariate associations between a range of parental disorders and offspring suicidality. After controlling for comorbidity, number of mental disorders and offspring psychopathology, we found that parental psychopathology influences suicidal behaviors throughout most part of the life cycle, from childhood until young adult years. Generalized anxiety disorder (GAD) and antisocial personality were associated with offspring suicidal ideation (OR 1.8 and 1.9, respectively), panic and GAD predicted suicidal attempts (OR 2.3 and 2.7, respectively), and panic was related to the transition from ideation to attempts (OR 2.7). Although noticed in many different stages of the lifespan, this influence is most evident during adolescence. In this period, depression and antisocial personality increased the odds of suicidal ideation (OR 5.1 and 3.2, respectively), and depression, panic disorder, GAD and substance abuse predicted suicidal attempts (OR varying from 1.7 to 3.8). In short, parental disorders characterized by impulsive-aggression and anxiety-agitation were the main predictors of offspring suicidality across the lifespan. This clinically relevant intergenerational transmission of suicide risk was independent of offspring mental disorders, and this underscores the need for a family approach to psychopathology.</p></div

Association between the categories of alcohol consumption (g/week) and elevated systolic and diastolic blood pressure.

<p>ELSA-Brasil, 2008–2010 (n = 7,655). Model 1: Adjusted for sex, race/skin colour, income per capita, physical activity, smoking, abdominal obesity. Model 2: model 1 + adjusted for age, family history of hypertension.</p

Odds ratio (OR) for elevated systemic blood pressure according to alcohol consumption.

<p>ELSA-Brasil, 2008–2010 (n = 7,655).</p

Determinants of the use of health care services: multilevel analysis in the Metropolitan Region of Sao Paulo

<div><p>OBJECTIVE To evaluate the individual and contextual determinants of the use of health care services in the metropolitan region of Sao Paulo.METHODS Data from the Sao Paulo Megacity study – the Brazilian version of the World Mental Health Survey multicenter study – were used. A total of 3,588 adults living in 69 neighborhoods in the metropolitan region of Sao Paulo, SP, Southeastern Brazil, including 38 municipalities and 31 neighboring districts, were selected using multistratified sampling of the non-institutionalized population. Multilevel Bayesian logistic models were adjusted to identify the individual and contextual determinants of the use of health care services in the past 12 months and presence of a regular physician for routine care.RESULTS The contextual characteristics of the place of residence (income inequality, violence, and median income) showed no significant correlation (p > 0.05) with the use of health care services or with the presence of a regular physician for routine care. The only exception was the negative correlation between living in areas with high income inequality and presence of a regular physician (OR: 0.77; 95%CI 0.60;0.99) after controlling for individual characteristics. The study revealed a strong and consistent correlation between individual characteristics (mainly education and possession of health insurance), use of health care services, and presence of a regular physician. Presence of chronic and mental illnesses was strongly correlated with the use of health care services in the past year (regardless of the individual characteristics) but not with the presence of a regular physician.CONCLUSIONS Individual characteristics including higher education and possession of health insurance were important determinants of the use of health care services in the metropolitan area of Sao Paulo. A better understanding of these determinants is essential for the development of public policies that promote equitable use of health care services.</p></div

Characteristics of participants, by blood pressure classification.

<p>ELSA-Brasil, 2008–2010 (n = 7,655).</p

Associations between the number of child adversities and lifetime suicidality¹,^†.

<p>Associations between the number of child adversities and lifetime suicidality<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0155639#t004fn003" target="_blank">¹</a>,<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0155639#t004fn002" target="_blank">^†</a>.</p

Odds ratio (OR) for high systemic blood pressure according to the pattern of alcohol consumption.

<p>ELSA-Brasil, 2008–2010 (n = 4,857).</p

Final multivariate model for associations between child adversity and lifetime (LT) suicidality¹.

<p>Final multivariate model for associations between child adversity and lifetime (LT) suicidality<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0155639#t005fn002" target="_blank">¹</a>.</p

Descriptive characteristics of the participants of São Paulo Megacity Mental Health Survey (N = 5,037).

<p>Descriptive characteristics of the participants of São Paulo Megacity Mental Health Survey (N = 5,037).</p