Socioeconomic aspects of spousal concordance for hypertension, obesity, and smoking in a community of Rio de Janeiro, Brazil

OBJECTIVE: The present study aims to evaluate the environmental role in the distribution of hypertension, obesity, and smoking and spousal concordance for the presence/absence of these 3 cardiovascular risk factors. METHODS: A cross-sectional study was conducted in a community in Rio de Janeiro, Brazil. The households were randomly selected. Odds ratios were estimated to measure spousal concordance, across socioeconomic levels.. RESULTS: Overall a significant aggregation of all 3 risk factors was present. The crude odds ratio for hypertension was 1.78 (95%CI=1.02-3.08); for obesity, it was 1.80 (95%CI=1.09-2.96); and for smoking, it was 3.40 (95% CI=2.07-5.61). The spousal concordance for hypertension decreased significantly (p<0.001) from the lower to the higher educational level. In the case of obesity and smoking, the opposite was observed, although p-values for the linear trend were 0.10 and 0.08, respectively. CONCLUSION: In lower socioeconomic levels, couples are more concordant for hypertension and discordant for smoking. For hypertension and smoking, education seems to be a discriminant stronger than income, but for obesity the 2 socioeconomic indicators seem to represent different aspects of the environmental determinants of risk factor distribution

Survival in coronary artery bypass grafts and coronary angioplasties paid privately or by health insurance in Rio de Janeiro state: 2000 - 2007

Submitted by Gilvan Almeida ([email protected]) on 2017-01-18T16:35:22Z No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Sobrevida_Carlos Klein_2010.pdf: 377994 bytes, checksum: 1e6d9cc868c66744bb4004f46d38c938 (MD5)Approved for entry into archive by Fátima Lopes ([email protected]) on 2018-06-05T19:20:42Z (GMT) No. of bitstreams: 2 Sobrevida_Carlos Klein_2010.pdf: 377994 bytes, checksum: 1e6d9cc868c66744bb4004f46d38c938 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Made available in DSpace on 2018-06-05T19:20:42Z (GMT). No. of bitstreams: 2 Sobrevida_Carlos Klein_2010.pdf: 377994 bytes, checksum: 1e6d9cc868c66744bb4004f46d38c938 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2010Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Instituto do Coração. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, BrasilUniversidade Federal do Rio de Janeiro. Faculdade de Medicina. Instituto do Coração. Rio de Janeiro, RJ, BrasilUniversidade Federal do Rio de Janeiro. Faculdade de Medicina. Instituto do Coração. Rio de Janeiro, RJ, BrasilUniversidade Federal do Rio de Janeiro. Faculdade de Medicina. Instituto do Coração. Rio de Janeiro, RJ, BrasilFundamentos: A cirurgia de revascularização miocárdica (RVM) e a angioplastia coronariana (AC) são procedimentos comuns na prática clínica, que precisam ser continuamente avaliados. Objetivo: Estudar a sobrevida nos indivíduos submetidos à RVM ou AC no Estado do Rio de Janeiro (ERJ), pagas por seguros de saúde e privados, no período de 2000 a 2007. Métodos: Estudo utilizando bancos de dados para identificar os indivíduos submetidos aos procedimentos e aqueles que correram, para estimar a sobrevida. As informações sobre RVM e AC provieram das Comunicações de Internação Hospitalar (CIH) e sobre óbitos das Declarações de Óbitos. Foi realizado relacionamento probabilístico entre os bancos com o programa RecLink® para identificar os indivíduos que morreram após os procedimentos. Resultados: Apenas 980 procedimentos foram notificados em oito anos em 937 indivíduos residentes no ERJ. No interior do ERJ foram realizadas 32,4% das RVM dos 509 indivíduos submetidos ao procedimento, enquanto as demais foram feitas em outros estados, 66,6% em São Paulo (SP). Foram dentificados 428 indivíduos com AC, 71,7% realizadas no interior do ERJ e as demais em outros estados, 22,8% em SP. Não foi encontrada qualquer notificação sobre RVM ou AC pelos hospitais privados do Município do RJ. A sobrevida nas RVM em sete anos foi 88,0% e nas AC 86,9%. Conclusão: O desempenho, avaliado pela sobrevida pósprocedimento das AC ou RVM realizadas no âmbito do sistema privado ou suplementar do ERJ, de 2000 a 2007, foi insatisfatório e se assemelhou ao verificado no sistema público, conforme os registros disponíveis das CIH.Background : Coronary artery bypass grafts (CABG) and coronary angioplasties (CA) are common medical procedures that must be continually evaluated. Objective : To study survival rates among patients undergoing CABG or CA in Rio de Janeiro State, Brazil, paid privately or by health insurance from 2000 to 2007. Methods : Study using databases to identify individuals undergoing these procedures and deaths among them, in order to estimate survival rates. Information on CABG and CA came from Hospital Admission Notifications (CIH) and deaths from death certificates. A probabilistic link was constructed between the databases using the RecLink ® program to identify individuals who died after the procedures. Results : Only 980 procedures were reported in eight years for 937 individuals living in Rio de Janeiro State, with 32.4% of the 509 CABG patients undergoing the procedure in upstate areas and the remainder in other States, 66.6% in São Paulo. We identified 428 individuals with CA, 71.7% in upstate Rio de Janeiro and the others elsewhere, with 22.8% in São Paulo State. No notifications were found of any CABG or CA procedures at private hospitals in the Rio de Janeiro. Municipality. The survival rates for CABG at 7 years were 88.0% and 86.9% for CA. Conclusion : Assessed by survival rates after CA or CABG procedures conducted under the aegis of the supplementary or private health system in Rio de Janeiro State between 2000 and 2007, this performance was not satisfactory, resembling that of the government health system, according to records available from the Hospital Admission Notifications

Pergunte de mais de uma maneira: alternativas para aumentar a eficácia da anamnese

Este trabalho focaliza a comunicação na relação médico-paciente, identificando pontos potencialmente geradores de dificuldades linguísticas para o médico. Os aspectos focalizados dizem respeito, primeiramente, ao emprego, pelas partes envolvidas numa situação de comunicação, de variedades linguísticas diferentes; e em segundo lugar, às estratégias discursivas empregadas. Defendemos que, para o médico, é fundamental ter certeza de que compreendeu o problema que lhe foi trazido, mas, para isso, terá de procurar confirmar com o paciente, em diferentes momentos da consulta, sua compreensão das informações que está recebendo e saber passar-lhe, de modo compreensível, seu julgamento da situação clínica e as ações necessárias. As situações que ilustram os problemas aqui referidos fazem parte da experiência profissional dos autore

Socioeconomic aspects of spousal concordance for hypertension, obesity, and smoking in a community of Rio de Janeiro, Brazil

OBJECTIVE: The present study aims to evaluate the environmental role in the distribution of hypertension, obesity, and smoking and spousal concordance for the presence/absence of these 3 cardiovascular risk factors. METHODS: A cross-sectional study was conducted in a community in Rio de Janeiro, Brazil. The households were randomly selected. Odds ratios were estimated to measure spousal concordance, across socioeconomic levels.. RESULTS: Overall a significant aggregation of all 3 risk factors was present. The crude odds ratio for hypertension was 1.78 (95%CI=1.02-3.08); for obesity, it was 1.80 (95%CI=1.09-2.96); and for smoking, it was 3.40 (95% CI=2.07-5.61). The spousal concordance for hypertension decreased significantly (p<0.001) from the lower to the higher educational level. In the case of obesity and smoking, the opposite was observed, although p-values for the linear trend were 0.10 and 0.08, respectively. CONCLUSION: In lower socioeconomic levels, couples are more concordant for hypertension and discordant for smoking. For hypertension and smoking, education seems to be a discriminant stronger than income, but for obesity the 2 socioeconomic indicators seem to represent different aspects of the environmental determinants of risk factor distribution

Up to 15-Year Survival of Men and Women after Percutaneous Coronary Intervention Paid by the Brazilian Public Healthcare System in the State of Rio de Janeiro, 1999-2010

Abstract Background: Percutaneous coronary intervention (PCI) is the most frequently used invasive therapy for ischemic heart disease (IHD). Studies able to provide information about PCI's effectiveness should be conducted in a population of real-world patients. Objectives: To assess the survival rate of IHD patients treated with PCI in the state of Rio de Janeiro (RJ). Methods: Administrative (1999-2010) and death (1999-2014) databases of dwellers aged ≥ 20 years old in the state of RJ submitted to one single PCI paid by the Brazilian public healthcare system (SUS) between 1999 and 2010 were linked. Patients were grouped as follows: 20-49 years old, 50-69 years old and ≥ 70 years old, and PCI in primary PCI, with stent and without stent placement (bare metal stent). Survival probabilities in 30 days, one year and 15 years were estimated by using the Kaplan-Meier method. Cox hazards regression models were used to compare risks among sex, age groups and types of PCI. Test results with a p-value < 0.05 were deemed statistically significant. Results: Data of 19,263 patients (61 ± 11 years old, 63.6% men) were analyzed. Survival rates of men vs. women in 30 days, one year and 15 years were: 97.3% (97.0-97.6%) vs. 97.1% (96.6-97.4%), 93.6% (93.2-94.1%) vs. 93.4% (92.8-94.0%), and 55.7% (54.0-57.4%) vs. 58.1% (55.8-60.3%), respectively. The oldest age group was associated with lower survival rates in all periods. PCI with stent placement had higher survival rates than those without stent placement during a two-year follow-up. After that, both procedures had similar survival rates (HR 0.91, 95% CI 0.82-1.00). Conclusions: In a population of real-world patients, women had a higher survival rate than men within 15 years after PCI. Moreover, using a bare-metal stent failed to improve survival rates after a two-year follow-up compared to simple balloon angioplasty

Cardiovascular mortality among a cohort of hypertensive and normotensives in Rio de Janeiro, Brazil, 1991-2009

Submitted by Gilvan Almeida ([email protected]) on 2016-10-10T13:38:04Z No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) CardiovascularMortality.pdf: 1086840 bytes, checksum: 3af4282ca5fa261e9d128bca0f802499 (MD5)Rejected by Éder Freyre ([email protected]), reason: Refazer on 2017-02-14T13:21:45Z (GMT)Submitted by Gilvan Almeida ([email protected]) on 2019-02-05T18:00:05Z No. of bitstreams: 2 CardiovascularMortality.pdf: 1086840 bytes, checksum: 3af4282ca5fa261e9d128bca0f802499 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Approved for entry into archive by Regiane Silva ([email protected]) on 2019-05-31T12:48:01Z (GMT) No. of bitstreams: 2 CardiovascularMortality.pdf: 1086840 bytes, checksum: 3af4282ca5fa261e9d128bca0f802499 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Made available in DSpace on 2019-05-31T12:48:01Z (GMT). No. of bitstreams: 2 CardiovascularMortality.pdf: 1086840 bytes, checksum: 3af4282ca5fa261e9d128bca0f802499 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2015Federal University of Rio de Janeiro. Institute of Studies in Public Health. Rio de Janeiro, Brazil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Departamento de Epidemiologia e Métodos Quantitativos em Saúde. Rio de Janeiro, RJ, Brasil.Federal University of Rio de Janeiro. Clementino Fraga Filho University Hospital. Rio de Janeiro, Brazil.Federal University of Rio de Janeiro. Medical School. Graduate Program in Medicine – Cardiology. Rio de Janeiro, Brazil.Federal University of Rio de Janeiro. Medical School. Department of Clinical Medicine. Rio de Janeiro, Brazil.Federal University of Rio de Janeiro. Institute of Studies in Public Health. Rio de Janeiro, Brazil.Background: Although there is strong evidence of the benefits of antihypertensive treatment, the high prevalence of this important cardiovascular risk factor and its complications, as well as the low control rates of hypertension observed in many studies justify the investigation of these relationships in population studies. The objective was to investigate the ratio of cardiovascular disease mortality between hypertensives (non-treated, controlled and uncontrolled) and non-hypertensives in a cohort of a population sample of adults living in Ilha do Governador, Rio de Janeiro state, Brazil, who were classified in a survey conducted in 1991 and 1992 and whose death certificates were sought 19 years later. Methods: A cohort study was performed on probabilistic linkage between data from an epidemiological study of hypertension performed in Ilha do Governador, in Rio de Janeiro, Brazil (1991 to 1992) and data from the Mortality Information System of Rio de Janeiro (1991 to 2009). The survey aimed to estimate the prevalence of hypertension and other cardiovascular risk factors in 1,270 adults aged 20 years or older selected through a probabilistic sampling of households at three economic levels (low, middle and high income). We performed a probabilistic record linkage of these databases and estimated the risk of cardiovascular death using Kaplan-Meier method to plot survival curves and Cox proportional hazards models comparing hypertensive subjects all together, and by hypertension subgroups: untreated, controlled, and uncontrolled hypertensives with non-hypertensive ones. Results: A total of 170 deaths occurred, of which 31.2 % attributed to cardiovascular causes. The hazard ratio for cardiovascular death was 6.1 times higher (95 % CI 2.7 13.7) in uncontrolled hypertensive patients relative to non-hypertensive patients. The hazard ratios for untreated hypertensive and controlled hypertensive patients were 2.7 times (95 % CI 1.1 6.3) and 2.1 times (95 % CI 0.38 11.5) higher than for normotensive patients, respectively. Conclusion: The present study demonstrated a higher cardiovascular death risk among hypertensive than among non-hypertensive ones that is not associated uniquely to treatment, because uncontrolled hypertensives demonstrated a greater risk than untreated ones. Although the subgroups of hypertensive individuals were susceptible to changes in their classification over the 19 years of the study, the baseline classification was consistent with a worse prognosis in these individuals

Survival and Predictive Factors of Lethality in Hemodyalisis: D/I Polymorphism of The Angiotensin I-Converting Enzyme and of the Angiotensinogen M235T Genes

Background: End-stage kidney disease patients continue to have markedly increased cardiovascular disease morbidity and mortality. Analysis of genetic factors connected with the renin-angiotensin system that influences the survival of the patients with end-stage kidney disease supports the ongoing search for improved outcomes. Objective: To assess survival and its association with the polymorphism of renin-angiotensin system genes: angiotensin I-converting enzyme insertion/deletion and angiotensinogen M235T in patients undergoing hemodialysis. Methods: Our study was designed to examine the role of renin-angiotensin system genes. It was an observational study. We analyzed 473 chronic hemodialysis patients in four dialysis units in the state of Rio de Janeiro. Survival rates were calculated by the Kaplan-Meier method and the differences between the curves were evaluated by Tarone-Ware, Peto-Prentice, and log rank tests. We also used logistic regression analysis and the multinomial model. A p value &#8804; 0.05 was considered to be statistically significant. The local medical ethics committee gave their approval to this study. Results: The mean age of patients was 45.8 years old. The overall survival rate was 48% at 11 years. The major causes of death were cardiovascular diseases (34%) and infections (15%). Logistic regression analysis found statistical significance for the following variables: age (p = 0.000038), TT angiotensinogen (p = 0.08261), and family income greater than five times the minimum wage (p = 0.03089), the latter being a protective factor. Conclusions: The survival of hemodialysis patients is likely to be influenced by the TT of the angiotensinogen M235T gene