Amanda Cristina de Souza Andrade

Comunidades quilombolas de Vitória da Conquista, Bahia, Brasil: hipertensão arterial e fatores associados

Este estudo objetivou estimar a prevalencia de hipertensao arterial em residentes das comunidades quilombolas e avaliar possiveis fatores associados. Foi realizado um inquerito de base populacional em uma amostra de 797 individuos com 18 anos ou mais. A hipertensao arterial foi definida por pressao arterial sistolica > 140mmHg e/ou pressao arterial diastolica > 90mmHg e/ou uso de medicamentos anti-hipertensivos. Empregou-se a regressao de Poisson com variância robusta, adotando a entrada hierarquica de variaveis. A prevalencia de hipertensao foi de 45,4% (IC95%: 41,89-48,85), o fator distal: seguranca na vizinhanca; os fatores intermediarios: idade, classe economica, escolaridade e inatividade fisica; e o fator proximal: indice de massa corporal mostraram-se associados com a hipertensao. Observa-se a necessidade da promocao da saude por meio de atencao inclusiva aos quilombolas, valendo-se de acoes em niveis individual e populacional. A alta prevalencia de hipertensao arterial reforca a necessidade de um amplo acesso aos servicos de saude para prevencao, diagnostico precoce e orientacoes para o manejo adequado.The study aimed to estimate the prevalence of hypertension in members of quilombos (slavedescendant African-Brazilian communities) and to evaluate possible associated factors. A population-based survey included 797 individuals 18 years or older. Hypertension was defined as systolic blood pressure ≥ 140mmHg or diastolic blood pressure ≥ 90mmHg or reported use of antihypertensive medication. We used Poisson regression with robust variance and hierarchical entry of variables. Prevalence of hypertension was 45.4% (95%CI: 41.89-48.85). Factors associated with hypertension were: neighborhood security (distal), age, economic class, education, and physical inactivity (intermediate), and body mass index (proximal). Health promotion is needed in the quilombo communities through action at the individual and population levels. The high prevalence of hypertension highlights the need for broad access to health services for prevention, early diagnosis, and guidelines for adequate management.

Myocardial Fibrosis Progression in Duchenne and Becker Muscular Dystrophy: A Randomized Clinical Trial

Importance In Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD), interventions reducing the progression of myocardial disease could affect survival. Objective To assess the effect of early angiotensin-converting enzyme (ACE) inhibitor therapy in patients with normal left ventricular function on the progression of myocardial fibrosis (MF) identified on cardiovascular magnetic resonance (CMR). Design, Setting, and Participants A randomized clinical trial conducted in 2 centers included 76 male patients with DMD or BMD undergoing 2 CMR studies with a 2-year interval for ventricular function and MF assessment. In a non–intent-to-treat trial, 42 patients with MF and normal left ventricular ejection fraction (LVEF) were randomized (1:1) to receive or not receive ACE inhibitor therapy. The study was conducted from June 26, 2009, to June 30, 2012. Data analysis was performed from June 30, 2013, to October 3, 2016. Interventions Randomization (1:1) to receive or not receive ACE inhibitor therapy. Main Outcomes and Measures Primary outcome was MF progression from baseline to the 2-year CMR study. Results Of the 76 male patients included in the study, 70 had DMD (92%) and 6 had BMD (8%); mean (SD) age at baseline was 13.1 (4.4) years. Myocardial fibrosis was present in 55 patients (72%) and LV systolic dysfunction was identified in 13 patients (24%). Myocardial fibrosis at baseline was an independent indicator of lower LVEF at follow-up (coefficient [SE], −0.16 [0.07]; P = .03). Among patients with MF and preserved LVEF (42 [55%]), those randomized (21 patients in each arm) to receive ACE inhibitors demonstrated slower MF progression compared with the untreated group (mean [SD] increase of 3.1% [7.4%] vs 10.0% [6.2%] as a percentage of LV mass; P = .001). In multivariate analysis, ACE inhibitor therapy was an independent indicator of decreased MF progression (coefficient [SE], −4.51 [2.11]; P = .04). Patients with MF noted on CMR had a higher probability of cardiovascular events (event rate, 10 of 55 [18.2%] vs 0 of 21 [0%]; log-rank P = .04). Conclusions and Relevance In this 2-year, follow-up, randomized clinical trial of patients with Duchenne or Becker muscular dystrophy whose LVEF was preserved and MF was present as determined on CMR, ACE inhibitor therapy was associated with significantly slower progression of MF. The presence of MF was associated with worse patient prognosis. Trial Registration clinicaltrials.org Identifier: NCT02432885

Self-Rated Health among Urban Adolescents: The Roles of Age, Gender, and Their Associated Factors

Health status is often analyzed in population surveys. Self-rated health (SRH) is a single-item summary measure of the perception of one’s health. In Brazil, studies on the SRH of adolescents remain scarce, especially those aiming to understand the domains that compose this construct. Therefore, the aim of this study is to determine the prevalence of poor SRH and its associated factors among 11- to 13-year-olds and 14- to 17-year-olds living in a large urban center in Brazil. This cross-sectional study was conducted using a household survey across Belo Horizonte that included 1,042 adolescents. Stratified logistic regression models were used for each age group to assess the associations between worse SRH and the following variables: socio-demographic, social and family support, lifestyles, psychological health, and anthropometry. Approximately 11% (95% CIs = 8.7–13.6) of the studied adolescents rated their health as poor, and SHR decreased with age among males and females. This trend was more pronounced among girls (from 6.9% among 11- to 13-year-old girls to 16.9% among 14- to 17-year-old girls) than boys (from 8.3% among 11- to 13-year-old boys to 11% among 14- to 17-year-old boys). Worse SRH was associated with family support (as assessed by the absence of parent-adolescent conversations; odds ratio [OR] = 3.5 among 11- to 13-year-olds), family structure (OR = 2.8 among 14- to 17-year-olds), and argument reporting (OR = 8.2 among 14- to 17-year-olds). Among older adolescents, the consumption of fruit fewer than five times per week (OR = 2.4), life dissatisfaction (OR = 2.8), underweight status (OR = 6.7), and overweight status (OR = 2.7) were associated with poor SRH. As adolescents age, their universe expands from their relationship with their parents to include more complex issues, such as their lifestyles and life satisfaction. Therefore, these results suggest the importance of evaluating SRH across adolescent age groups and demonstrate the influence of the family environment (in addition to other factors) on negative health assessments, particularly among 14- to 17-year-olds.

Overweight in men and women among urban area residents: individual factors and socioeconomic context

Abstract The present study aimed to evaluate factors associated with overweight among adults living in urban areas, with the income of the census tract as a context variable. The survey assessed individuals from two health districts of Belo Horizonte, Minas Gerais State, Brazil. Excess weight was determined by body mass index > 25kg/m2. Multilevel logistic regression was used. The sample comprised 2,935 individuals aged 20 to 60 years. The prevalence of overweight was 52.3% (95%CI: 49.9-54.8), similar between men and women. Higher schooling proved to be protective against overweight in women and a risk for men. Living in census tracts with higher income was associated with excess weight only in males. Report of the consumption of diet soft drinks was positively associated with overweight in both sexes. The occurrence of this event seems to be influenced by different factors or to interrelate differently in men and women.The present study aimed to evaluate factors associated with overweight among adults living in urban areas, with the income of the census tract as a context variable. The survey assessed individuals from two health districts of Belo Horizonte, Minas Gerais State, Brazil. Excess weight was determined by body mass index > 25kg/m2. Multilevel logistic regression was used. The sample comprised 2,935 individuals aged 20 to 60 years. The prevalence of overweight was 52.3% (95%CI: 49.9-54.8), similar between men and women. Higher schooling proved to be protective against overweight in women and a risk for men. Living in census tracts with higher income was associated with excess weight only in males. Report of the consumption of diet soft drinks was positively associated with overweight in both sexes. The occurrence of this event seems to be influenced by different factors or to interrelate differently in men and women.

Características individuais associadas à autopercepção da extensão territorial da vizinhança

There is a growing interest in evaluating the impact of neighborhood characteristics on health. The definition of neighborhood involves two main strategies, one using artificial boundaries, usually created for administrative purposes, and the other based on the individual’s definition, namely the perceived neighborhood. The aim of this study was to identify factors associated with heterogeneity in the perceived neighborhood among participants in a health survey in Belo Horizonte, Minas Gerais State, Brazil. Ordinal logistic regression was used to determine and quantify this association. Larger size of the perceived neighborhood was associated with better socioeconomic status, positive employment status, positive assessment of aesthetic aspects and mobility within the neighborhood, active identification of problems in the neighborhood, less involvement in sports/leisure activities, and knowing more neighbors. The study’s results can help produce more significant neighborhood definitions that are more consistent with residents’ own perceptions, thereby favoring more accurate estimates of neighborhood impact on health.

Quilombo communities in Vitória da Conquista, Bahia State, Brazil: hypertension and associated factors

Este estudo objetivou estimar a prevalencia de hipertensao arterial em residentes das comunidades quilombolas e avaliar possiveis fatores associados. Foi realizado um inquerito de base populacional em uma amostra de 797 individuos com 18 anos ou mais. A hipertensao arterial foi definida por pressao arterial sistolica > 140mmHg e/ou pressao arterial diastolica > 90mmHg e/ou uso de medicamentos anti-hipertensivos. Empregou-se a regressao de Poisson com variância robusta, adotando a entrada hierarquica de variaveis. A prevalencia de hipertensao foi de 45,4% (IC95%: 41,89-48,85), o fator distal: seguranca na vizinhanca; os fatores intermediarios: idade, classe economica, escolaridade e inatividade fisica; e o fator proximal: indice de massa corporal mostraram-se associados com a hipertensao. Observa-se a necessidade da promocao da saude por meio de atencao inclusiva aos quilombolas, valendo-se de acoes em niveis individual e populacional. A alta prevalencia de hipertensao arterial reforca a necessidade de um amplo acesso aos servicos de saude para prevencao, diagnostico precoce e orientacoes para o manejo adequado.The study aimed to estimate the prevalence of hypertension in members of quilombos (slavedescendant African-Brazilian communities) and to evaluate possible associated factors. A population-based survey included 797 individuals 18 years or older. Hypertension was defined as systolic blood pressure ≥ 140mmHg or diastolic blood pressure ≥ 90mmHg or reported use of antihypertensive medication. We used Poisson regression with robust variance and hierarchical entry of variables. Prevalence of hypertension was 45.4% (95%CI: 41.89-48.85). Factors associated with hypertension were: neighborhood security (distal), age, economic class, education, and physical inactivity (intermediate), and body mass index (proximal). Health promotion is needed in the quilombo communities through action at the individual and population levels. The high prevalence of hypertension highlights the need for broad access to health services for prevention, early diagnosis, and guidelines for adequate management.

Bullying among adolescents in a Brazilian urban center – “Health in Beagá” Study

OBJECTIVE To analyze the prevalence of bullying and its associated factors in Brazilian adolescents. METHODS Data were used from a population-based household survey conducted by the Urban Health Observatory (OSUBH) utilizing probability sampling in three stages: census tracts, residences, and individuals. The survey included 598 adolescents (14-17 years old) who responded questions on bullying, sociodemographic characteristics, health-risk behaviors, educational well-being, family structure, physical activity, markers of nutritional habits, and subjective well-being (body image, personal satisfaction, and satisfaction with their present and future life). Univariate and multivariate analysis was done using robust Poisson regression. RESULTS The prevalence of bullying was 26.2% (28.0% among males, 24.0% among females). The location of most bullying cases was at or on route to school (70.5%), followed by on the streets (28.5%), at home (9.8%), while practicing sports (7.3%), at parties (4.6%), at work (1.7%), and at other locations (1.6%). Reports of bullying were associated with life dissatisfaction, difficulty relating to parents, involvement in fights with peers and insecurity in the neighborhood. CONCLUSIONS A high prevalence of bullying among participating adolescents was found, and the school serves as the main bullying location, although other sites such as home, parties and workplace were also reported. Characteristics regarding self-perception and adolescent perceptions of their environment were also associated with bullying, thus advancing the knowledge of this type of violence, especially in urban centers of developing countries.

Unawareness of hypertension and its determinants among 'quilombolas' (inhabitants of 'quilombos' - hinterland settlements founded by people of African origin) living in Southwest Bahia, Brazil

This study sought to evaluate the prevalence of unawareness of arterial hypertension (AH) and associated factors among the quilombola population and to describe aspects of the non-pharmacological management of AH. It involved a cross-sectional study with a sample of 358 people with AH aged 18 years or more. AH was considered systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or reported use of antihypertensive drugs. Unawareness of AH was classified as persons answering negatively when asked if they suffered from AH. Poisson regression was then used. The prevalence of unawareness of AH was 44.1% (95% CI: 38.9-49.3). Among those who already knew the diagnosis and had drug treatment only 24.8% had controlled BP. The unawareness of AH was positively associated with the male sex and Stage 1 of AH and negatively with increasing age, overweight, negative self-perception of health and medical visits. For non-pharmacological management, low percentages of quilombola reported appropriate standard recommendations of care. Arterial hypertension is a serious public health issue among the quilombola population, revealing great vulnerability in health due to poor levels of awareness, treatment and control.

Neighborhood-based physical activity differences: Evaluation of the effect of health promotion program

Introduction The practice of physical activity is an important factor in the prevention of health problems. However, a small portion of the population is physically active. Recent reviews show that physical activity classes in community settings have the potential to increase population levels of physical activity and reduce health inequalities. Objective To evaluate the effect of the Academias da Cidade Program in Belo Horizonte on the practice of physical activity in leisure time (PALT) by non-users living near the program centers. Methods We conducted a home-based health survey in Belo Horizonte (2008–2009) with 1,581 adults who were non-users of the program and who lived within a 1,500-meter radius of one active program center (exposed group) and two nonoperational centers with sites reserved for their construction (unexposed group). We collected data on PALT levels (≥150 minutes/week), which was measured with the Physical Activity International Questionnaire and analyzed with binary logistic regression using the Generalized Estimating Equations method. The propensity score was used as an adjustment variable to control the potential confusion in the measures of effect of exposure studied. Results The overall prevalence of the PALT was 26.5% in the exposed group and 22.7% in the unexposed group. The exposed group was more likely to be active in leisure time (OR = 1.05; CI 95%: 1.01–1.10). When considering the interaction between exposed group and distance, individuals in the exposed group who lived less than 500 meters from the program center were more likely to be active in leisure time (OR = 1.18, CI 95%: 1.03–1.35) compared to their counterparts. Conclusion Promoting physical activity in the community can favorably affect PALT levels among residents, especially those living closest to intervention centers. We believe the Academias da Cidade Program is a promising strategy to facilitate the access to appropriate spaces for the practice of physical activity and contribute to increase the levels physical activity within populations.

Contextual characteristics associated with the perceived neighbourhood scale in a cross-sectional study in a large urban centre in Brazil

Introduction Health outcomes have been associated with physical and social characteristics of neighbourhoods, but little is known about the relationship between contextual factors and perceived neighbourhood scale. Objective To identify the contextual factors associated with self-perceived neighbourhood scale. Methods We analysed data from a cross-sectional population-based study in Belo Horizonte, Brazil, that took place in 2008–2009. The dependent variable was perceived neighbourhood, encoded as an ordinal scale based on a brief description of the concept of the neighbourhood, and two independent scales relating distance, expressed in terms of geography and time. Street connectivity, demographic density and residents’ perceptions of the neighbourhoods’ physical and social environment were used as contextual predictors. Individual characteristics were used as covariates. Multilevel ordinal logistic regression models estimated the association between perceived neighbourhood scale and contextual characteristics. Results Residents that perceive better walkability (OR 2.96; 95% CI 1.29 to 3.82) and high amounts of violence (OR 1.35; 95% CI 1.12 to 1.62) perceived their neighbourhoods to be larger, even after adjusting for individual characteristics. Conclusion There are contextual factors that are associated with self-perceived neighbourhood scale. Careful definition of neighbourhood scale is a key factor in improving the results of eco-epidemiological studies. Although these findings must be further explored in other studies, these results can contribute to a better understanding of an appropriate choice of neighbourhood scale, especially for cities in Latin America.