Luana Giatti

Questionario do ELSA-Brasil: desafios na elaboracao de instrumento multidimensional

This article describes the development of the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil) questionnaire. We first address the selection of topics whose contents have to cover the knowledge available on the complex causal network of outcomes and allow comparability with similar studies. Then we deal with the translation and adaptation of measurement instruments including neighborhood environment rating scales, depression and anxiety disorder rating scale and a food frequency questionnaire and discuss criteria that guided theme block sequencing. And finally we focus on the practical importance of pretesting and pilot studies. The ELSA may provide an original contribution regarding factors that cause or aggravate the outcomes of interest in the Brazilian population, as well as protective factors.

Experimentation and use of cigarette and other tobacco products among adolescents in the Brazilian state capitals (PeNSE 2012)

INTRODUCTIONnNicotine dependence establishes itself more rapidly among adolescents than among adults. Tobacco occupies the fourth place in the rank of main risk factors for non-communicable diseases in the continent. Studies reveal that other forms of tobacco use have increased among adolescents.nnnMETHODSnWere included the 9th grade students from the 26 State Capitals and the Federal District. who were participants of the National Adolescent School-based Health Survey (PeNSE), in 2012. Factors independently associated with experimentation and regular use of cigarettes were investigated by means of multinomial logistic regression, using as reference never tried a cigarette. The use of other tobacco products included cigar, pipe, narghile and others.nnnRESULTSnOf the in the 61,037 participants in the 26 Brazilian capitals and the Federal District, 22.7% (95%CI 21.7 - 23.5) had experimented cigarettes, 6.1% (95%CI 5.6 - 6.6) are regular smokers and 7.1% (95%CI 6.5 - 7.7) had used other tobacco products, with half of them also being regular smokers. The chances of experimenting and being a regular smoker increased with age and according to the frequency of weekly exposure to other smokers. These chances were also higher among students who worked, who lived in monoparental families or without their parents, and those who felt that their parents would not mind if they smoked.nnnCONCLUSIONnResults reinforce the association between social disadvantages and experimenting and regular smoking. In addition, the use of other tobacco products is worthy of attention and may lead to regular smoking.

Hipertensão arterial referida e utilização de medicamentos de uso contínuo no Brasil: um estudo de base populacional

The aim of this study was to estimate the prevalence of non-adherence to several continuous-use drugs by patients 30 to 79 years of age with self-reported hypertension, and associated factors, drawing on data from the Brazilian National Sample Household Survey (PNAD-2008). Prevalence ratios (PR) and respective 95% confidence intervals (95%CI) were obtained by Poisson regression. The proportion of individuals that failed to adhere to continuous-use medication was 17%. Characteristics directly associated with non-adherence were: male gender, residence in the North, Northeast, or Central-West of Brazil, and smoking. Non-adherence decreased with age, per capita family income, number of chronic diseases, and medical consultation in the previous 12 months, and was inversely associated with 11 or more years of schooling (PR = 0.92; 95%CI: 0.86-0.98), not working and not being unemployed, and physical activity. Adherence to antihypertensive medication is necessary and requires investment in primary care, improved access to health services, and measures to offset regional, social, and gender inequalities.O objetivo do presente estudo foi estimar a prevalencia e fatores associados a nao utilizacao de algum medicamento de uso continuo nos individuos de 30-79 anos que referiram hipertensao arterial na Pesquisa Nacional por Amostra de Domicilios (PNAD-2008), Brasil. Razoes de prevalencia (RP) e respectivos intervalos de 95% de confianca (IC95%) foram obtidos por meio de regressao de Poisson. A proporcao de individuos que nao utilizava medicamentos de uso continuo foi de 17%. Caracteristicas positivamente associadas a nao utilizacao foram: sexo masculino, residencia nas regioes Norte, Nordeste, Centro-oeste e habito de fumar. O nao uso desses medicamentos diminuiu com a idade, renda domiciliar per capita, numero de doencas cronicas e de consulta medica nos ultimos 12 meses; foi menor entre os que tinham 11 anos e mais de estudo (RP = 0,92; IC95%: 0,86-0,98), nos que nao trabalhavam nem estavam desempregados e nos que nao realizavam atividade fisica. A adesao a terapia medicamentosa no controle de hipertensao arterial e necessaria e requer investimento na atencao primaria, na melhoria no acesso aos servicos de saude e no enfretamento das desigualdades regionais, sociais e de genero.

Education plays a greater role than age in cognitive test performance among participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BackgroundBrazil has gone through fast demographic, epidemiologic and nutritional transitions and, despite recent improvements in wealth distribution, continues to present a high level of social and economic inequality. The ELSA–Brasil, a cohort study, aimed at investigating cardiovascular diseases and diabetes, offers a great opportunity to assess cognitive decline in this aging population through time-sequential analyses drawn from the same battery of tests over time. The purpose of this study is to analyze the influence of sex, age and education on cognitive tests performance of the participants at baseline.MethodsAnalyses pertain to 14,594 participants with aged 35 to 74xa0years, who were functionally independent and had no history of stroke or use of neuroleptics, anticonvulsants, cholinesterase inhibitors or antiparkinsonian agents. Mean age was 52.0u2009±u20099.0xa0years and 54.2xa0% of participants were women. Cognitive tests included the word memory tests (retention, recall and recognition), verbal fluency tests (VFT, animals and letter F) and Trail Making Test B. Multivariable linear regression analysis was used to determine the influence of sociodemographic characteristics on the distribution of the final score of each test.ResultsWomen had significant and slightly higher scores than men in all memory tests and VFT, but took more time to perform Trail B. Reduced performance in all tests was seen with an increase age and, more importantly, with decrease level of education. The word list and VFT scores decreased at about one word for every 10xa0years of age; whereas higher-educated participants scored four words more on the word list test, and six or seven more correct words on VFT, when compared to lower-educated participants. Additionally, the oldest and less educated participants showed significant lower response rates in all tests.ConclusionsThe higher influence of education than age in this Brazilian population reinforce the need for caution in analyzing and diagnosing cognitive impairments based on traditional cognitive tests and the importance of searching for education-free cognitive tests, especially in low and middle-income countries.

Methods of cognitive function investigation in the Longitudinal Study on Adult Health (ELSA-Brasil)

CONTEXT AND OBJECTIVEnMany uncertainties concerning risk factors and evolution of cognitive disorders remain. We describe the methods and preliminary results from the investigation of the cognitive function in the Longitudinal Study on Adult Health (ELSA-Brasil).nnnDESIGN AND SETTINGnMulticenter cohort study on public employees at six public teaching and research institutions.nnnMETHODSnThe participants were interviewed and examined to obtain a broad range of social, clinical and environmental characteristics. The following standardized tools were used to assess memory, language and visuospatial and executive functions: words or figure memory test; semantic (animals) and phonemic (letter F) verbal fluency tests; and trail test B.nnnRESULTSn15,101 out of 15,105 participants took the cognitive tests: 54% were women; the mean age was 51 years; and 52% had a university degree. 14,965 participants (99%) did the word test and 136 (1%) did the figure test due to low schooling level. The scores from the semantic verbal fluency tests (mean = 18.42 ± 5.29; median = 18 words) were greater than the scores from the phonemic verbal fluency tests (mean = 12.46 ± 4.5; median = 12 words). The median time taken to perform the trail test was 1.6 minutes.nnnCONCLUSIONnThe large cohort size, of young age, and the extensive amount of clinical and epidemiological data available will make it possible to investigate the prognostic value of biological, behavioral, environmental, occupational and psychosocial variables over the short and medium terms in relation to cognitive decline, among adults and elderly people.

Adaptacao transcultural e confiabilidade de medidas de caracteristicas autorreferidas de vizinhanca no ELSA-Brasil

OBJETIVO: Descrever o processo de adaptacao de escalas de medida de caracteristicas de vizinhanca para o portugues brasileiro. METODOS: As dimensoes abordadas foram coesao social, ambiente propicio para atividade fisica, disponibilidade de alimentos saudaveis, seguranca em relacao a crimes, violencia percebida e vitimizacao. No processo de adaptacao foram avaliados aspectos de equivalencia entre as escalas originais e respectivas versoes para o portugues. A confiabilidade teste-reteste foi avaliada em submostra de 261 participantes do Estudo Longitudinal de Saude do Adulto (ELSA-Brasil) que responderam ao mesmo questionario em dois momentos distintos em um intervalo de tempo de sete a 14 dias entre as duas aplicacoes. RESULTADOS: Os aspectos de equivalencia avaliados mostraram-se adequados. O coeficiente de correlacao intraclasse variou entre 0,83 (IC95% 0,78;0,87) para Coesao Social e 0,90 (IC95% 0,87;0,92) para Ambiente para Atividade Fisica. As escalas apresentaram consistencia interna (alfa de Cronbach) que variaram entre 0,60 e 0,84. CONCLUSOES: As medidas autorreferidas de caracteristicas de vizinhanca tiveram reprodutibilidade muito boa e boa consistencia interna. Os resultados sugerem que essas escalas podem ser utilizadas em estudos com populacao brasileira que apresente caracteristicas similares aquelas do ELSA-Brasil.

Job strain and unhealthy lifestyle: results from the baseline cohort study, Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BackgroundUnhealthy lifestyle choices, such as smoking and sedentary behavior, are among the main modifiable risk factors for chronic non-communicable diseases. The workplace is regarded as an important site of potential health risks where preventive strategies can be effective. We investigated independent associations among psychosocial job strain, leisure-time physical inactivity, and smoking in public servants in the largest Brazilian adult cohort.MethodsWe conducted a cross-sectional analysis of baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)—a multicenter prospective cohort study of civil servants. Our analytical samples comprised 11,779 and 11,963 current workers for, respectively, analyses of job strain and leisure-time physical activity and analyses of job strain and smoking. Job strain was assessed using the Brazilian version of the Swedish Demand-Control-Support Questionnaire; physical activity was evaluated using a short form of the International Physical Activity Questionnaire. We also examined smoking status and number of cigarettes smoked per day. The association reported in this paper was assessed by means of multinomial and logistic regression, stratified by sex.ResultsAmong men, compared with low-strain activities (low demand and high control), job strain showed an association with physical inactivity (odds ratio [OR]u2009=u20091.34; 95% confidence interval [CI]u2009=u20091.09–1.64) or with the practice of physical activities of less than recommended duration (ORu2009=u20091.44; 95% CIu2009=u20091.15–1.82). Among women, greater likelihood of physical inactivity was identified among job-strain and passive-job groups (ORu2009=u20091.47; 95% CIu2009=u20091.22–1.77 and ORu2009=u20091.42; 95% CIu2009=u20091.20–1.67, respectively). Greater control at work was a protective factor for physical inactivity among both men and women. Social support at work was a protective factor for physical inactivity among women, as was smoking for both genders. We observed no association between demand or control dimensions and smoking.ConclusionsJob strain, job control, and social support were associated with physical activity. Social support at work was protective of smoking. Our results are comparable to those found in more developed countries; they provide additional evidence of an association between an adverse psychosocial work environment and health-related behaviors.

Recrutamento de participantes no Estudo Longitudinal de Saude do Adulto

OBJETIVO: Apresentar as estrategias de comunicacao e recrutamento no Estudo Longitudinal de Saude do Adulto (ELSA-Brasil) e discutir os resultados alcancados na constituicao da coorte. METODOS: As estrategias foram voltadas a divulgacao, a institucionalizacao e ao recrutamento propriamente dito. As acoes de comunicacao pretenderam promover o fortalecimento de imagem institucional positiva para o estudo, a gestao de conhecimentos e o dialogo eficaz com seu publico-alvo. Foi criado web site oficial visando dialogar com diferentes publicos, funcionar como difusor cientifico e contribuir para a consolidacao da imagem do estudo perante a sociedade. RESULTADOS: Foram recrutados 16.435 mulheres e homens, servidores ativos e aposentados de seis instituicoes publicas de ensino e pesquisa para constituir a coorte de 15.105 participantes. As metas de recrutamento foram plenamente alcancadas nos seis centros, com leve predominio de mulheres e daqueles mais jovens, e um pouco menos de servidores com menor escolarizacao. CONCLUSOES: As estrategias utilizadas se mostraram adequadas e essenciais para o sucesso da captacao e participacao dos servidores.

Association between perceived neighbourhood characteristics, physical activity and diet quality: results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BackgroundThe study explores associations between perceived neighbourhood characteristics, physical activity and diet quality, which in Latin America and Brazil have been scarcely studied and with inconsistent results.MethodsWe conducted a cross-sectional analysis of 14,749 individuals who participated in the Brazilian Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto, ELSA-Brasil) baseline. The study included current and retired civil servants, aged between 35 and 74xa0years, from universities and research institutes in six Brazilian states. The International Physical Activity Questionnaire (IPAQ) long form was used to characterize physical activity during leisure time and commuting; additional questions assessed how often fruit and vegetables were consumed, as a proxy for diet quality. Neighbourhood characteristics were evaluated by the “Walking Environment” and “Availability of Healthy Foods” scales originally used in the Multi-Ethnic Study of Atherosclerosis (MESA). Associations were examined using multinomial logistic regression.ResultsPerceiving a more walkable neighbourhood was positively associated with engaging in leisure time physical activity and doing so for longer weekly. Compared with those who saw their neighbourhood as less walkable, those who perceived it as more walkable had 1.69 (95xa0% CI 1.57–1.83) and 1.39 (1.28–1.52) greater odds of engaging in leisure time physical activity for more than 150xa0min/week or up to 150xa0min/week (vs. none), respectively. Perceiving a more walkable neighbourhood was also positively associated with transport-related physical activity. The same pattern was observed for diet: compared with participants who perceived healthy foods as less available in their neighbourhood, those who saw them as more available had odds 1.48 greater (1.31–1.66) of eating fruits, and 1.47 greater (1.30–1.66) of eating vegetables, more than once per day.ConclusionsPerceived walkability and neighbourhood availability of healthy food were independently associated with the practice of physical activity and diet quality, respectively, underlining the importance of neighbourhood-level public policies to changing and maintaining health-related habits.

Self-reported hypertension and non-adherence to continuous-use medication in Brazil: a population-based study

The aim of this study was to estimate the prevalence of non-adherence to several continuous-use drugs by patients 30 to 79 years of age with self-reported hypertension, and associated factors, drawing on data from the Brazilian National Sample Household Survey (PNAD-2008). Prevalence ratios (PR) and respective 95% confidence intervals (95%CI) were obtained by Poisson regression. The proportion of individuals that failed to adhere to continuous-use medication was 17%. Characteristics directly associated with non-adherence were: male gender, residence in the North, Northeast, or Central-West of Brazil, and smoking. Non-adherence decreased with age, per capita family income, number of chronic diseases, and medical consultation in the previous 12 months, and was inversely associated with 11 or more years of schooling (PR = 0.92; 95%CI: 0.86-0.98), not working and not being unemployed, and physical activity. Adherence to antihypertensive medication is necessary and requires investment in primary care, improved access to health services, and measures to offset regional, social, and gender inequalities.O objetivo do presente estudo foi estimar a prevalencia e fatores associados a nao utilizacao de algum medicamento de uso continuo nos individuos de 30-79 anos que referiram hipertensao arterial na Pesquisa Nacional por Amostra de Domicilios (PNAD-2008), Brasil. Razoes de prevalencia (RP) e respectivos intervalos de 95% de confianca (IC95%) foram obtidos por meio de regressao de Poisson. A proporcao de individuos que nao utilizava medicamentos de uso continuo foi de 17%. Caracteristicas positivamente associadas a nao utilizacao foram: sexo masculino, residencia nas regioes Norte, Nordeste, Centro-oeste e habito de fumar. O nao uso desses medicamentos diminuiu com a idade, renda domiciliar per capita, numero de doencas cronicas e de consulta medica nos ultimos 12 meses; foi menor entre os que tinham 11 anos e mais de estudo (RP = 0,92; IC95%: 0,86-0,98), nos que nao trabalhavam nem estavam desempregados e nos que nao realizavam atividade fisica. A adesao a terapia medicamentosa no controle de hipertensao arterial e necessaria e requer investimento na atencao primaria, na melhoria no acesso aos servicos de saude e no enfretamento das desigualdades regionais, sociais e de genero.