Adriano Marçal Pimenta

Relationship between body image disturbance and incidence of depression: the SUN prospective cohort

BackgroundBody image disturbance is an increasing problem in Western societies and is associated with a number of mental health outcomes including anorexia, bulimia, body dysmorphia, and depression. The aim of this study was to assess the association between body image disturbance and the incidence of depression.MethodsThis study included 10,286 participants from a dynamic prospective cohort of Spanish university graduates, who were followed-up for a median period of 4.2 years (Seguimiento Universidad de Navarra – the SUN study). The key characteristic of the study is the permanently open recruitment that started in 1999. The baseline questionnaire included information about body mass index (BMI) and the nine figure schemes that were used to assess body size perception. These variables were grouped according to recommended classifications and the difference between BMI and body size perception was considered as a proxy of body image disturbance. A subject was classified as an incident case of depression if he/she was initially free of depression and reported a physician-made diagnosis of depression and/or the use of antidepressant medication in at least one of the follow-up questionnaires. The association between body image disturbance and the incidence of depression was estimated by calculating the multivariable adjusted Odds Ratio (OR) and its 95% Confidence Interval (95% CI), using logistic regression models.ResultsThe cumulative incidence of depression during follow-up in the cohort was 4.8%. Men who underestimated their body size had a high percentage of overweight and obesity (50.1% and 12.6%, respectively), whereas women who overestimated their body size had a high percentage of underweight (87.6%). The underestimation exhibited a negative association with the incidence of depression among women (OR: 0.72, 95% CI: 0.54 – 0.95), but this effect disappeared after adjusting for possible confounding variables. The proportion of participants who correctly perceived their body size was high (53.3%) and gross misperception was seldom found, with most cases selecting only one silhouette below (42.7%) or above (2.6%) their actual BMI.ConclusionWe found no association between body image disturbance and subsequent depression in a cohort of university graduates in Spain.

Prevalence of metabolic syndrome in a rural area of Brazil

CONTEXT AND OBJECTIVE Metabolic syndrome (MS) is recognized worldwide as an important public health concern. However, little information is available for rural populations in Brazil. The aim was to determine the prevalence and risk factors associated with MS in a rural village in Brazil in 2004. DESIGN AND SETTING Cross-sectional population-based study, in Virgem das Graças, a rural community in the Jequitinhonha Valley, State of Minas Gerais. METHODS MS was the dependent variable, defined as any three of these risk factors: arterial hypertension, high glucose or triglyceride concentrations, low high-density lipoprotein cholesterol and abdominal obesity. MS prevalence, according to selected socioeconomic and demographic variables (age, skin color, marital status, schooling and smoking habits), was determined in 251 subjects aged 20-88 years. Multivariate logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals. RESULTS MS prevalence was 21.6% (7.7% for men and 33.6% for women); the age-adjusted prevalence was 19.0%. The highest prevalences were observed for women > 60 years of age (52.9%) and women with body mass index (BMI) >or= 25 kg/m(2) (64%). Age, sex and BMI were associated risk factors for MS, while skin color was only significantly associated with MS for women. The models were adjusted for age, smoking habits, marital status, skin color and schooling. CONCLUSIONS BMI and age were independently associated factors for MS in this rural community. These findings provide important evidence on the prevalence of MS as a public health problem, particularly for women and overweight individuals.

Associação entre obesidade central, triglicerídeos e hipertensão arterial em uma área rural do Brasil

BACKGROUND: Hypertension represents a serious public health problem and is one of the most frequent causes of morbidity around the world. OBJECTIVE: To estimate the prevalence of hypertension and its risk factors in a rural community located in the north-eastern state of Minas Gerais, Brazil. METHODS: A cross-sectional study was carried out in 2004 in the Virgem das Gracas Village, a rural community located the Jequitinhonha Valley. The sample consisted of 287 males and females aged between 18 to 88 years. Hypertension was defined according to Joint National Committee criteria (systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mmHg): subjects already receiving anti-hypertensive treatment were considered to be hypertensive. Bivariate analysis was performed to test the relationship between the independent variables and hypertension. Logistic regression was used to adjust for confounding and to identify interactions. The strength of association was measured using Odds Ratio (OR) and its 95% confidence intervals [CI (95%)]. RESULTS: The crude prevalence of hypertension was 47.0% [CI (95%): 41.1 - 53.0], the age-standardized prevalence was 43.2% [CI (95%): 35.7 - 50.7], while the schooling-standardized prevalence was 44.1% [CI (95%): 43.9 - 44.3]. Age, triglycerides, waist circumference and sex were found to be independent risk factors for hypertension according to multivariate analysis. CONCLUSION: The findings provide important evidence concerning the hypertension as a public health problem and its association with dyslipidemia and abdominal obesity in the rural area of Minas Gerais.BACKGROUND Hypertension represents a serious public health problem and is one of the most frequent causes of morbidity around the world. OBJECTIVE To estimate the prevalence of hypertension and its risk factors in a rural community located in the north-eastern state of Minas Gerais, Brazil. METHODS A cross-sectional study was carried out in 2004 in the Virgem das Graças Village, a rural community located the Jequitinhonha Valley. The sample consisted of 287 males and females aged between 18 to 88 years. Hypertension was defined according to Joint National Committee criteria (systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mmHg): subjects already receiving anti-hypertensive treatment were considered to be hypertensive. Bivariate analysis was performed to test the relationship between the independent variables and hypertension. Logistic regression was used to adjust for confounding and to identify interactions. The strength of association was measured using Odds Ratio (OR) and its 95% confidence intervals [CI (95%)]. RESULTS The crude prevalence of hypertension was 47.0% [CI (95%): 41.1 - 53.0], the age-standardized prevalence was 43.2% [CI (95%): 35.7 - 50.7], while the schooling-standardized prevalence was 44.1% [CI (95%): 43.9 - 44.3]. Age, triglycerides, waist circumference and sex were found to be independent risk factors for hypertension according to multivariate analysis. CONCLUSION The findings provide important evidence concerning the hypertension as a public health problem and its association with dyslipidemia and abdominal obesity in the rural area of Minas Gerais.

Prevalência da síndrome metabólica e seus fatores associados em área rural de Minas Gerais (MG, Brasil)

OBJETIVO: Estimar a prevalencia da sindrome metabolica (SM) e seus fatores associados em area rural de Minas Gerais. METODOLOGIA: Trata-se de um estudo transversal, de base populacional, conduzido nas comunidades rurais de Virgem das Gracas e Caju, Vale do Jequitinhonha, Minas Gerais. Foram coletas informacoes sobre caracteristicas demograficas, do estilo de vida, antropometricas, bioquimicas e hemodinâmicas de 534 participantes adultos. A SM foi definida segundo criterios estabelecidos pela National Cholesterol Education Program - Adult Treatment Panel III. Associacoes independentes entre as covariaveis e a SM foram avaliadas usando-se a regressao multivariada de Poisson com variâncias robustas. O nivel de significância estatistica foi estabelecido em 5,0%. RESULTADOS: A SM estava presente em 14,9% dos participantes. O sexo feminino, a obesidade, a inflamacao cronica subclinica, a resistencia a insulina, a idade e o consumo moderado de bebida alcoolica permaneceram independentemente associados a SM. CONCLUSOES: Na populacao rural estudada, a SM era problema de Saude Publica, associada a fatores modificaveis. Portanto, medidas preventivas primarias poderiam ser usadas para diminuir a prevalencia deste agravo e o seu impacto na saude das pessoas.

Prevalência e fatores associados a sintomas de ansiedade em uma coorte de gestantes atendidas em um centro de saúde do município do Rio de Janeiro

OBJECTIVES: to determine the prevalence and the association between socio-demographic, obstetric and nutritional variables and anxiety symptoms in pregnant women. METHODS: the study involved cohorts with five follow-up stages. A cross-sectional analysis was carried out of 151 pregnant women. The presence or absence of anxiety was treated as the dependent variable, which was measured between 19 and 21 weeks of gestation. The State-Trait Anxiety Inventory (STAIT) scale was used to evaluate the anxiety trait. The socio-demographic, obstetric and nutritional data obtained using a questionnaire were treated as independent variables. The statistical analysis was performed using a multivariate Poisson regression with robust variance. RESULTS: the mean age was 25 years and mean level of schooling nine years. The prevalence of anxiety was 64.9% (95%CI: 56.7-72.5). The anxiety trait was associated with age between 18 and 24.9 years (PR=1.35; 95%CI: 1.06-1.71) and 1-8 years of schooling (PR=1.39; 95%CI: 1.11-1.73). CONCLUSIONS: it was observed that the anxiety trait was highly prevalent in this sample of pregnant women whose progress was followed at a health care center. Knowledge of the factors associated with the anxiety is of fundamental importance in allowing the health team to intervene in a timely and appropriate fashion in a pregnant womans treatment.

Association between central obesity, triglycerides and hypertension in a rural area in Brazil

BACKGROUND: Hypertension represents a serious public health problem and is one of the most frequent causes of morbidity around the world. OBJECTIVE: To estimate the prevalence of hypertension and its risk factors in a rural community located in the north-eastern state of Minas Gerais, Brazil. METHODS: A cross-sectional study was carried out in 2004 in the Virgem das Gracas Village, a rural community located the Jequitinhonha Valley. The sample consisted of 287 males and females aged between 18 to 88 years. Hypertension was defined according to Joint National Committee criteria (systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mmHg): subjects already receiving anti-hypertensive treatment were considered to be hypertensive. Bivariate analysis was performed to test the relationship between the independent variables and hypertension. Logistic regression was used to adjust for confounding and to identify interactions. The strength of association was measured using Odds Ratio (OR) and its 95% confidence intervals [CI (95%)]. RESULTS: The crude prevalence of hypertension was 47.0% [CI (95%): 41.1 - 53.0], the age-standardized prevalence was 43.2% [CI (95%): 35.7 - 50.7], while the schooling-standardized prevalence was 44.1% [CI (95%): 43.9 - 44.3]. Age, triglycerides, waist circumference and sex were found to be independent risk factors for hypertension according to multivariate analysis. CONCLUSION: The findings provide important evidence concerning the hypertension as a public health problem and its association with dyslipidemia and abdominal obesity in the rural area of Minas Gerais.BACKGROUND Hypertension represents a serious public health problem and is one of the most frequent causes of morbidity around the world. OBJECTIVE To estimate the prevalence of hypertension and its risk factors in a rural community located in the north-eastern state of Minas Gerais, Brazil. METHODS A cross-sectional study was carried out in 2004 in the Virgem das Graças Village, a rural community located the Jequitinhonha Valley. The sample consisted of 287 males and females aged between 18 to 88 years. Hypertension was defined according to Joint National Committee criteria (systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mmHg): subjects already receiving anti-hypertensive treatment were considered to be hypertensive. Bivariate analysis was performed to test the relationship between the independent variables and hypertension. Logistic regression was used to adjust for confounding and to identify interactions. The strength of association was measured using Odds Ratio (OR) and its 95% confidence intervals [CI (95%)]. RESULTS The crude prevalence of hypertension was 47.0% [CI (95%): 41.1 - 53.0], the age-standardized prevalence was 43.2% [CI (95%): 35.7 - 50.7], while the schooling-standardized prevalence was 44.1% [CI (95%): 43.9 - 44.3]. Age, triglycerides, waist circumference and sex were found to be independent risk factors for hypertension according to multivariate analysis. CONCLUSION The findings provide important evidence concerning the hypertension as a public health problem and its association with dyslipidemia and abdominal obesity in the rural area of Minas Gerais.

Intervention study for smoking cessation in Spanish college students: pragmatic randomized controlled trial

AIM To evaluate the effectiveness of a nurse intervention aimed at helping college student smokers quit smoking. DESIGN Single-blind, pragmatic randomized controlled trial which compares a multi-component intervention, tailored specifically to college students, with a brief advice session with a 6-month follow-up. SETTINGS This study was conducted at the University of Navarra, Spain. PARTICIPANTS A total of 255 college student smokers (age range = 18-24 years) were randomized to an intervention group (n = 133) or to a control group (n = 122). INTERVENTION A multi-component intervention based on the Theory of Triadic Influence of Flay was developed. The intervention consisted of a 50-minute motivational interview conducted by a nurse and online self-help material. The follow-up included a reinforcing e-mail and group therapy. MEASUREMENTS The primary outcome was self-reported abstinence, with biochemical verification at 6 months. The secondary outcomes consisted of the mean number of cigarettes smoked per day, self-reported attempts to quit smoking and stage of change at 6 months. FINDINGS At the 6-month follow-up, the smoking cessation incidence was 21.1% in the intervention group compared with 6.6% in the control group (difference = 14.5 confidence interval = 6.1-22.8; relative risk = 3.41, 95% confidence interval = 1.62-7.20). The difference in the mean number of cigarettes at 6 months was significantly different (difference = -2.2, confidence interval = -3.6 to -0.9). CONCLUSIONS A multi-component intervention tailored to college students and managed by a nurse is effective in increasing smoking cessation among college students.

Utilization of public and private health services by the population of Belo Horizonte

OBJECTIVE To analyze the differences in health services utilization by users of Brazilian Unified Health System (SUS) and beneficiaries of Supplemental Health (SH). METHODS A total of 288 adult subjects, residing in Belo Horizonte, who participated in the VIGITEL telephone survey in 2009, composed the sample, whose variables were analyzed according to the classification as users of SUS or beneficiaries of SH. Prevalence Ratios (PR), adjusted for sex, age and schooling, were calculated to evaluate differences between groups. RESULTS Need and demand for health services were similar between groups, and users of SUS were less successful in obtaining service (PR = 0.78; p = 0.027). Most participants in both groups evaluated the health care received as very good/good without significant differences (72.1% for SUS, 84.0% for SH; p > 0.05). CONCLUSION Although there are differences in the utilization of health services in Belo Horizonte, the service obtained is well rated by both users of SUS and health plans.

Clustering and combining pattern of metabolic syndrome components in a rural Brazilian adult population

CONTEXT AND OBJECTIVE Metabolic syndrome is characterized by clustering of cardiovascular risk factors such as obesity, dyslipidemia, insulin resistance, hyperinsulinemia, glucose intolerance and arterial hypertension. The aim of this study was to estimate the probability of clustering and the combination pattern of three or more metabolic syndrome components in a rural Brazilian adult population. DESIGN AND SETTING This was a cross-sectional study conducted in two rural communities located in the Jequitinhonha Valley, Minas Gerais, Brazil. METHODS The sample was composed of 534 adults (both sexes). Waist circumference, blood pressure and demographic, lifestyle and biochemical characteristics were assessed. The prevalences of metabolic syndrome and its components were estimated using the definitions of the National Cholesterol Education Program - Adult Treatment Panel III. A binomial distribution equation was used to evaluate the probability of clustering of metabolic syndrome components. The statistical significance level was set at 5% (P < 0.05). RESULTS Metabolic syndrome was more frequent among women (23.3%) than among men (6.5%). Clustering of three or more metabolic syndrome components was greater than expected by chance. The commonest combinations of three metabolic syndrome components were: hypertriglyceridemia + low levels of HDL-c + arterial hypertension and abdominal obesity + low levels of HDL-c + arterial hypertension; and of four metabolic syndrome components: abdominal obesity + hypertriglyceridemia + low levels of HDL-c + arterial hypertension. CONCLUSION The population studied presented high prevalence of metabolic syndrome among women and clustering of its components greater than expected by chance, suggesting that the combination pattern was non-random.

Factors associated with infection from the use of peripherally inserted central catheters in a neonatal intensive care unit

This was an epidemiological, longitudinal and analytical study carried out in a hospital in the Brazilian state of Minas Gerais, with the aim of analyzing the factors associated with infection due to the use of peripherally inserted central catheters in newborn infants hospitalized in the intensive care unit. Data were collected via a structured form, filled out by the professionals and checked by the researchers. We studied a total of 291 catheters inserted into 233 neonates. The factors associated with catheter removal due to suspected infection were: prematurity; birthweight < or =1500 g; polyurethane catheter; non-centralized placing of the catheter; and duration of use >30 days. After multivariate adjustment, the following factors remained independently associated: weight < 2500 g at the time of insertion, catheter repair, and duration of catheter use. We concluded that factors related to staff practices contributed to removal of the catheters, indicating a need for interventions that improve the safety and efficacy of catheter use.