Estela Maria Motta Lima Leão de Aquino

Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): Objectives and Design

Although low- and middle-income countries still bear the burden of major infectious diseases, chronic noncommunicable diseases are becoming increasingly common due to rapid demographic, epidemiologic, and nutritional transitions. However, information is generally scant in these countries regarding chronic disease incidence, social determinants, and risk factors. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) aims to contribute relevant information with respect to the development and progression of clinical and subclinical chronic diseases, particularly cardiovascular diseases and diabetes. In this report, the authors delineate the studys objectives, principal methodological features, and timeline. At baseline, ELSA-Brasil enrolled 15,105 civil servants from 5 universities and 1 research institute. The baseline examination (2008-2010) included detailed interviews, clinical and anthropometric examinations, an oral glucose tolerance test, overnight urine collection, a 12-lead resting electrocardiogram, measurement of carotid intima-media thickness, echocardiography, measurement of pulse wave velocity, hepatic ultrasonography, retinal fundus photography, and an analysis of heart rate variability. Long-term biologic sample storage will allow investigation of biomarkers that may predict cardiovascular diseases and diabetes. Annual telephone surveillance, initiated in 2009, will continue for the duration of the study. A follow-up examination is scheduled for 2012-2013.

Adolescência e reprodução no Brasil: a heterogeneidade dos perfis sociais

This study aims to estimate the prevalence of adolescent pregnancy (AP) in three Brazilian cities Salvador, Rio de Janeiro, and Porto Alegre and to examine the profiles of pregnant girls and their partners in relation to pregnancy outcomes. Data for a retrospective assessment of AP were collected using an interview-based household survey applied to a stratified sample of males and females aged 18-24. A total of 4,634 individuals were interviewed (85.2 % of the eligible individuals). 21.4% of males and 29.5% of females aged 20-24 reported AP, but few such pregnancies had taken place before age 15 (0.6% and 1.6%). Pregnancy between adolescent partners was reported by 55.1% of males and 27.9% of females. 79.8% of the latter became pregnant while involved in a stable relationship with an older partner. AP levels varied inversely to schooling and income levels. 72.2% of females and 34.5% of males carried their first AP to completion, and more cases of induced abortion were reported by male partners in pregnancies (41.3%) than by females (15.3%). With the birth of the first child, 25.0% of women interrupted their studies temporarily and 17.3% definitively. However, 42.1% of primiparous mothers were already outside school before pregnancy.

Aspectos psicossociais do trabalho e distúrbios psíquicos entre trabalhadoras de enfermagem

OBJECTIVE To evaluate the association between psychological demand and job control and demand with psychological distress among nurses. METHODS A cross-sectional study included 502 female nurses working in a public hospital at the city of Salvador, state of Bahia, Brazil. The Demand-Control Model proposed by Karasek to evaluate the association between job control-demand and psychological distress was adopted. The SRQ-20 was used to measure psychological distress. RESULTS The prevalence of psychological distress was 33.3%, ranging from 20.0% among lady nurses to 36.4%, among nurse assistants. Strong dose-response gradients were observed between demand and psychological distress and the negative association between job control and psychological distress. Prevalence of psychological distress was higher (PR=2.6; 95% CI: 1.81-3.75) among professionals in high-strain jobs (high demand, low control) when compared to professionals in low-strain jobs (low demand, high control), after adjustment by potential confounders in a logistic multiple regression model. CONCLUSIONS Study findings reinforce the relevance of intervening in the organizational structure in order to increase control upon job and adjust the levels of psychological demands.

Alcohol drinking patterns by gender, ethnicity, and social class in Bahia, Brazil

OBJETIVOS: Investigar padroes de consumo de alcool e prevalencia de consumo de alto risco. METODOS: Inquerito domiciliar realizado no municipio de Salvador, Bahia, com amostra de 2.302 adultos. Casos de consumo de alto risco foram definidos como sujeitos que referiram uso diario ou semanal mais episodios de embriaguez, alem daqueles que informaram qualquer uso de bebidas alcoolicas com embriaguez frequente (pelo menos uma vez por semana). RESULTADOS: Cinquenta e seis por cento da amostra referiram consumo atual de bebidas alcoolicas. Consumo global estava significantemente associado a genero (homens), estado civil (solteiros), migracao (nao-migrantes), educacao (nivel superior) e classe social (alta). Nenhuma diferenca significante foi encontrada com relacao a etnicidade, com excecao de cachaca e outras bebidas destiladas. A prevalencia anual de consumo de alto risco foi 7%, seis vezes mais prevalente entre homens que entre mulheres (quase 13% comparado a 2,4%). Foi encontrada uma associacao positiva de prevalencia de consumo de alto risco com educacao e classe social. Nenhuma relacao global foi encontrada entre etnicidade e consumo de alto risco. Genero masculino e niveis socioeconomicos mais altos foram associados ao aumento de consumo de alto risco. Analises estratificadas revelaram um efeito consistente de genero, atraves de todos os estratos de variaveis independentes. CONCLUSOES: Os resultados sugerem que elementos sociais e culturais determinam padroes locais de consumo de bebidas alcoolicas. Pesquisas adicionais sobre efeitos de longo prazo de etnicidade, classe social e genero sobre consumo de alcool sao necessarias, visando a explicar o seu papel como fontes de desigualdades sociais em saude.OBJECTIVE To study patterns of alcohol consumption and prevalence of high-risk drinking. METHODS A household survey was carried out in a sample of 2,302 adults in Salvador, Brazil. Cases of High-Risk Drinking (HRD) were defined as those subjects who referred daily or weekly binge drinking plus episodes of drunkenness and those who reported any use of alcoholic beverages but with frequent drunkenness (at least once a week). RESULTS Fifty-six per cent of the sample acknowledged drinking alcoholic beverages. Overall consumption was significantly related with gender (male), marital status (single), migration (non-migrant), better educated (college level), and social class (upper). No significant differences were found regarding ethnicity, except for cachaça (Brazilian sugarcane liquor) and other distilled beverages. Overall 12-month prevalence of high-risk drinking was 7%, six times more prevalent among males than females (almost 13% compared to 2.4%). A positive association of HRD prevalence with education and social class was found. No overall relationship was found between ethnicity and HRD. Male gender and higher socioeconomic status were associated with increased odds of HRD. Two-way stratified analyses yielded consistent gender effects throughout all strata of independent variables. CONCLUSIONS The findings suggest that social and cultural elements determine local patterns of alcohol-drinking behavior. Additional research on long-term and differential effects of gender, ethnicity, and social class on alcohol use and misuse is needed in order to explain their role as sources of social health inequities.

Aproximacoes socioantropologicas sobre a gravidez na adolescencia

This paper aims to discuss the construction of teenage pregnancy as a social problem. It also seeks to present and analyze the data of the qualitative phase of the research study Teenage Pregnancy: A Multicentric Study of Young People, Sexuality and Reproduction in Brazil (GRAVAD study) undertaken in four Brazilian capitals: Porto Alegre, Rio de Janeiro and Salvador. The data indicate the indissoluble character of the articulation between social class and gender in the understanding of the phenomenon of teenage pregnancy. Among girls from the middle class we observe alterations in their management of their school projects and course, which, until that point, were processed in a linear manner. The same does not occur among girls from lower income groups whose irregularity in school life is independent of motherhood. Among the young men there are no significant changes, since middle class boys not interrupt their school projects or courses, and boys from lower income groups enter the work force precociously, and this is not a direct consequence of teenage fatherhood.

Arterial hypertension in the adult population of Salvador (BA) - Brazil

OBJECTIVE To estimate the prevalence of hypertension (H) and its association with other cardiovascular risk factors in a highly multiracial population. METHODS A cross-sectional study carried out in Salvador, Brazil, in a population sample of 1439 adults > or = 20 years of age. All participants completed a questionnaire at home and had the following measurements taken: blood pressure, body weight, height, waist circumference (WC), and serum glucose and lipids. Hypertension was defined as mean SBP > or = 140 and/or DBP > or = 90 mmHg. Hypertension prevalence was estimated with a 95% confidence interval (CI). The associations were measured by the adjusted odds ratio (AOR), using regression analysis. RESULTS Overall prevalence of HA was 29.9%: 27.4% CI (23.9-31.2) in men and 31.7%, CI (28.5-34.9) in women. Among black men, this prevalence was 31.6%, and among black women, 41.1%. Among white men it was 25.8%, and among white women, 21.1%. Arterial hypertension was significantly associated with age > or = 40, overweight/obesity (aOR = 2.37[1.57-3.60]) for men and 1.62 (1.02-2.58) for women. Among men, HA was associated with a high level of education and among women, with dark brown and black skin, abdominal obesity, aOR = 2.05 CI (1.31-3.21), diabetes aOR = 2.16 CI (1.19-3.93), and menopause. CONCLUSION Arterial hypertension predominated among black people of both genders, and in women. Those variables that remained independently associated with AH differed in both genders, except overweight/obesity. Our results suggest the need for an in-depth study of AH among black people and early, continuing educational interventions.

Research on abortion in Brazil: gaps and challenges for the public health field

This paper provides a review of abortion studies produced in the field of public health in Brazil, highlighting current research gaps and challenges. Most studies focus on women admitted to public hospitals for treatment of incomplete abortion, so their scope is limited to abortions presenting complications. Womens profiles, abortion methods, motives, and immediate consequences for womens physical health are also included. However, there remains a need for studies on the following aspects: measuring abortion incidence; investigating cases of post-abortion complications and death; analyzing the relationship between abortion and contraception; investigating the impact of abortion on womens mental health; and incorporating mens perspectives. There is an urgent need for evaluative research on abortion care in public services. Research results should be disseminated widely, so as to help overcome any ideological bias in the current debate on abortion rights in the country.

Maternidade e paternidade na adolescência: algumas constatações em três cidades do Brasil

Abstract This study describes young people from 18 to 24years of age who experienced motherhood andfatherhood. The data are from a multi-centerstudy (the GRAVAD Research Project) conductedin the Brazilian cities of Porto Alegre, Rio deJaneiro, and Salvador through a household sur-vey with a three-stage stratified probabilisticsample. Among a total of 4,634 interviewees,17.9% of women and 6.3% of men became par-ents before the age of 20. Young fathers andmothers show low schooling and early partici-pation in the work market. Most report a percapita monthly family income of some U

Doenças crônicas não transmissíveis no Brasil: prioridade para enfrentamento e investigação

150.The existence of children motivates the maritalunion at a young age, during which the roles ofmale provider and female caregiver are reaf-firmed. Even for young parents who have formeda new family nucleus themselves, their ownoriginal families provide a basis of material andaffective support.Pregnancy in Adolescence; Gender Identity; Ado-lescent; Paternity Introducao Maternidade na adolescencia e um tema quevem suscitando nao so o interesse entre estu-diosos da demografia, da saude publica e dasciencias sociais, como tambem o debate publi-co. Os estudos demograficos tem demonstradoque no Brasil, nos ultimos vinte anos, houveum aumento da taxa especifica de fecundidadee uma elevacao relativa de nascimentos emmulheres de 15 a 19 anos, em contraste com atendencia revelada em outros grupos etarios,fato este tambem observado em alguns paisesda America Latina

Simultaneidade de fatores de risco cardiovascular modificáveis na população adulta de Salvador (BA), Brasil

As Doencas Cronicas Nao Transmissiveis representam a maior carga de morbimortalidade no Brasil. Em 2011, o Ministerio da Saude lancou seu Plano de Acoes Estrategicas para o Enfrentamento das Doencas Cronicas Nao Transmissiveis, enfatizando acoes populacionais para controlar as doencas cardiovasculares, diabetes, câncer e doenca respiratoria cronica, predominantemente pelo controle do fumo, inatividade fisica, alimentacao inadequada e uso prejudicial de alcool. Apesar da producao cientifica significativa sobre essas doencas e seus fatores de risco no Brasil, poucos sao os estudos de coorte nessa tematica. Nesse contexto, o Estudo Longitudinal da Saude do Adulto (ELSA-Brasil) acompanha 15.105 servidores publicos do Pais. Seus dados espelham a realidade brasileira de altas prevalencias de diabetes e hipertensao e dos fatores de risco. A diversidade das informacoes produzidas permitira aprofundar o entendimento causal dessas doencas e subsidiar politicas publicas para seu enfrentamento.Chronic Non-Communicable Diseases are the main source of disease burden in Brazil. In 2011, the Brazilian Ministry of Health launched the Strategic Plan of Action for Management of Chronic Non-Communicable Diseases focusing on population-based interventions to manage cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases mainly through fighting tobacco use, unhealthy diets, physical inactivity and the harmful use of alcohol. Although a significant number of scientific studies on chronic diseases and their risk factors have been undertaken in Brazil, few are of cohort design. In this context, the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort study of 15,105 Brazilian public servants reflects the reality of high prevalences of diabetes, hypertension and the main chronic diseases risk factors. The diversity of information that the Study will produce can provide important input to better understand the causes of chronic diseases and to support public policies for fighting them.