Lucélia Magalhães

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.

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.

Critério de obesidade Central em População Brasileira: impacto sobre a Síndrome metabólica

OBJECTIVE: To identify and propose the optimal waist circumference cut-off points (WCp) for the diagnosis of central obesity (CO) in a Brazilian population, so as to compare these cut-off points with those recommended by the ATPIII (WC-ATPIII), and to estimate the difference in prevalence rates of metabolic syndrome (MS) using the two criteria. METHODS: Cross-sectional study conducted in a population subgroup of 1439 adults in the city of Salvador, Brazil. ROC curves of waist circumference (WC) were plotted to identify diabetes mellitus (DM) and obesity. ROC curve sensitivity and specificity values >60% and the closest to each other were used to define WCp. The prevalence of MS was estimated using WCp and WC-ATPIII. RESULTS: Eight hundred and twenty nine women comprised 57.7% of the sample. The WCp selected were 84cm for women and 88cm for men. These cut-off points detected DM with a 68.7% and 70% sensitivity, and a 66.2% and 68.3% specificity, respectively. For obesity, sensitivity and specificity were 79.8% and 77.6% in women and 64.3% and 71.6% in men, respectively. Using WC-ATPIII, 88cm (for women) and 102cm (for men), the sensitivity was 53.3% and 26.5%, respectively, to diagnose DM. For obesity, sensitivity was 66.5% (for women) and 28.6% (for men). The prevalence of MS using WCp was 23.7%, 95%CI (21.6 - 25.9), whereas using WC-ATPIII it was 19.0%, 95%CI (17.1- 20.9), 1.2 times higher using WCp. CONCLUSION: WC-ATPIII were inappropriate and underestimated the prevalence of MS in the population studied, particularly among men. We suggest that the WC cut-off points > 84cm for women and > 88cm for men should be tested in other Brazilian populations.

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

OBJETIVO: Estimar a frequencia da simultaneidade de fatores de risco cardiovascular modificaveis, com e sem inclusao da hipertensao arterial, em uma populacao miscigenada. METODO: Estudo transversal realizado em 1 298 adultos com idade > 20 anos na Cidade de Salvador, Brasil, em 2000. Foram incluidos oito fatores de risco cardiovascular modificaveis, considerados em qualquer combinacao: colesterol total > 240 mg/dL; colesterol das lipoproteinas de alta densidade (HDL-c) 200 mg/dL; glicemia > 126 mg/dL + diabetes controlado; indice de massa corporal > 25 kg/m², cintura > 102 cm (homens) e > 88 cm (mulheres), tabagismo e alcoolismo. Os resultados foram estratificados de acordo com o numero de fatores de risco simultâneos (de zero a cinco ou mais; e dois ou mais). Os dados foram analisados em termos de proporcoes estimadas e intervalo de confianca de 95% (IC95%), com e sem inclusao da hipertensao arterial (criterio JNC-VI), razoes entre proporcoes e qui-quadrado para proporcoes como medida de associacao. RESULTADOS: Entre os homens (41,4% dos participantes), 7,5% (IC95%: 2,5 a 9,7) nao apresentaram fatores de risco; 68,8% (IC95%: 65,0 a 72,8) apresentaram dois ou mais fatores de risco, excluida a hipertensao. Quando a hipertensao foi incluida, 73,4% (IC95%: 69,7 a 77,1) apresentaram dois ou mais fatores de risco. Entre as mulheres, 11,6% nao apresentaram fatores de risco. A presenca de dois ou mais fatores de risco, excluida a hipertensao, foi observada em 67,7% (IC95%: 64,8 a 71,4). Apos inclusao da hipertensao, 71,7% (IC95%: 68,5 a 74,9) das mulheres apresentaram dois ou mais fatores de risco. Foram observadas diferencas significativas entre presenca de dois ou mais fatores de risco para homens com ate 4 anos de estudo versus homens com 5 a menos de 11 anos de estudo (P <0,05); mulheres com ate 4 anos de estudo versus 5 a menos de 11 anos de estudo; mulheres com ate 4 anos de estudo versus 11 ou mais anos de estudo (P <0,01); e para mulheres negras versus brancas (P <0,01). CONCLUSAO: A elevada proporcao de multiplos fatores de risco cardiovascular em Salvador, incluindo-se ou nao a hipertensao, especialmente na populacao de baixa escolaridade e em pessoas negras, sugere a necessidade de estrategias sociais abrangentes para reduzir as desigualdades sociais, promover a saude, e facilitar o tratamento de fatores de risco cardiovascular.

Social inequality and alcohol consumption-abuse in Bahia, Brazil-- interactions of gender, ethnicity and social class.

BackgroundThis paper reports findings on Alcohol Consumption-Abuse (ACAb) in Bahia, Brazil, a research setting characterized by racial/ethnic and socioeconomic diversity.MethodsA household survey was conducted with a sample of 2,302 adults. ACAb was defined as daily intake of more than two units of beverage, with drunkenness, or weekly binge drinking plus episodes of drunkenness, or any use of alcoholic beverages with frequent drunkenness, with failed attempts to stop drinking.ResultsThe rate of 12-month prevalence was 7%, with an overall male: female ratio of 6:1. A positive association of ACAb prevalence with education and social class was found. Male gender and higher socio-economic status were associated with increased odds of ACAb. No relationship was found between ethnicity and ACAb. Stratified analysis yielded consistent gender effects, throughout all strata of independent variables. A strong interaction of gender (male) and social class (upper class) was found for Mulattos and Morenos (maximum Prevalence rate = 9.04).ConclusionInteraction patterns found defy simple generalizations based on class, ethnicity, and gender considered alone.

Hypertension in a female nursing staff-pattern of occurrence, diagnosis, and treatment

OBJECTIVE To report the pattern of occurrence, diagnosis, and treatment of hypertension in a female nursing staff of an emergency hospital. METHODS We carried out a cross-sectional study that included interviews and blood pressure measurements of 494 nursing professionals at an emergency hospital in the city of Salvador, in the state of Bahia, Brazil. We considered hypertensive all individual with blood pressure > or = 140/90 mmHg or normal pressure if on regular treatment. RESULTS We found a prevalence of hypertension of 36.4%. Only 18.3% of the individuals ignored their hypertensive condition, and 64.2% admitted not being having regular treatment. Of those individuals who were having treatment, 69.4% had elevated blood pressure on examination. The major reasons for not being on treatment was the occasional elevation of blood pressure (22.2%) and medical counseling (20.0%). CONCLUSION The results point to the need to introduce hypertension control measures in this occupational group, because of the magnitude of the disease and the potential impact on diffusion of knowledge and measures to control hypertension.

Acute myocarditis secondary to pheochromocytoma

1. Muitos vezes o diagnostico so e firmado na anatomia patologica e, frequentemente, confundido com infarto agudo do miocardio, ou cardite viral. Relatamos um caso de mulher de 40 anos portadora de feocromocitoma, com hipertensao previa do tipo leve e labil e que desenvolveu, subitamente, debito cardiaco baixo com arritmias graves e potencialmente letais, cujo acompanhamento permitiu a suspeita e a investigacao da condicao subjacente. Teve recuperacao completa sem sequelas e sem a realizacao de exames invasivos, permanecendo a mesma condicao de hipertensa da situacao anterior. Feocromocitoma e um tumor funcionante, composto de celulas cromoafins, que produzem catecolaminas, sendo que a grande maioria delas (85%) encontra-se na medula da suprarenal. O restante ocorre no sistema paraganglionico, que se estende da pelves ate a cabeca. O feocromocitoma pode ter origem familiar, em associacao com neoplasias endocrinas multiplas. E uma condicao que produz um largo espectro de manifestacoes clinicas e bioquimicas, a maioria relacionada ao excesso de catecolaminas circulantes de modo paroxistico. Embora a hipertensao seja uma apresentacao cardinal, existem relatos da ausencia de hipertensao 2 . A grande maioria dos pacientes (75%) apresenta a triade subita classica, caracterizada, por cefaleia, palpitacoes e hipertensao grave. A condicao e ameacadora de vida pelas complicacoes cardiovasculares, principalmente o acidente vascular cerebral do tipo hemorragico, as arritmias e o comprometimento hemodinamico do coracao. Cardite aguda, como manifestacao primaria, nao e comum e foi inicialmente descrita por Mc-Guinley e cols. em 1987 3 como miocardite norepinefrinica e, posteriormente, por Sardesai e cols., em 1990 como cardiomiopatia induzida por catecolaminas 4

Influência da cor de pele auto-referida na prevalência da síndrome metabólica numa população urbana do Brasil

BACKGROUND The metabolic syndrome (MS) has a high prevalence in different parts of the world, with variations between different ethnic groups. OBJECTIVE This study aims at exploring the influence of the self-reported skin color on the prevalence of MS Methods: Cross-sectional study, carried out in a population subgroup (n=1,439 adults) in Salvador, Brazil. The self-reported skin color (white, mulatto or black) was used as well as the MS criterion of ATP-III. The Chi-square test for tendency was used to analyze the prevalence gradient between the groups and logistic regression, for association analysis. RESULTS The general prevalence of MS, adjusted for potentially confounder variables, did not differ among whites (23.3%), mulattos (23.3%) and blacks (23.4%). The analysis by sex showed, among men, a reduction in the MS prevalence of whites (26.2%, 95%CI: 20.7-31.7), in comparison to blacks (17.5%, 95%CI: 12.3-22.8) and an intermediate prevalence among mulattos, 21.9%, 95%CI: 18.6-25.1, p tend. = 0.002. Among the women, the tendency was the opposite, being higher among the blacks, 27.0%, 95%CI: 22.2-31.8, and lower among the whites, 20.5%, 95%CI: 15.6-25.4, p tend. = 0.02. The multivariate analysis of the association between skin color and MS (white = group of reference) showed that the black color of the skin was a protective factor among black men, with a prevalence ratio (PR) = 0.60 (0.36-0.97), whereas it tended to be a risk factor among black women, with a PR = 1.33 (0.94-1.78). CONCLUSION The prevalence of MA presented an inverse variation according to the color of skin between men and women. To be black was a protective factor among men and a risk factor among women.BACKGROUND: The metabolic syndrome (MS) has a high prevalence in different parts of the world, with variations between different ethnic groups. OBJECTIVE: This study aims at exploring the influence of the self-reported skin color on the prevalence of MS Methods: Cross-sectional study, carried out in a population subgroup (n=1,439 adults) in Salvador, Brazil. The self-reported skin color (white, mulatto or black) was used as well as the MS criterion of ATP-III. The Chi-square test for tendency was used to analyze the prevalence gradient between the groups and logistic regression, for association analysis. RESULTS: The general prevalence of MS, adjusted for potentially confounder variables, did not differ among whites (23.3%), mulattos (23.3%) and blacks (23.4%). The analysis by sex showed, among men, a reduction in the MS prevalence of whites (26.2%, 95%CI: 20.7-31.7), in comparison to blacks (17.5%, 95%CI: 12.3-22.8) and an intermediate prevalence among mulattos, 21.9%, 95%CI: 18.6-25.1, p tend. = 0.002. Among the women, the tendency was the opposite, being higher among the blacks, 27.0%, 95%CI: 22.2-31.8, and lower among the whites, 20.5%, 95%CI: 15.6-25.4, p tend. = 0.02. The multivariate analysis of the association between skin color and MS (white = group of reference) showed that the black color of the skin was a protective factor among black men, with a prevalence ratio (PR) = 0.60 (0.36-0.97), whereas it tended to be a risk factor among black women, with a PR = 1.33 (0.94-1.78). CONCLUSION: The prevalence of MA presented an inverse variation according to the color of skin between men and women. To be black was a protective factor among men and a risk factor among women.

Influence of the self-reported skin color on the prevalence of metabolic syndrome in an urban Brazilian population

BACKGROUND The metabolic syndrome (MS) has a high prevalence in different parts of the world, with variations between different ethnic groups. OBJECTIVE This study aims at exploring the influence of the self-reported skin color on the prevalence of MS Methods: Cross-sectional study, carried out in a population subgroup (n=1,439 adults) in Salvador, Brazil. The self-reported skin color (white, mulatto or black) was used as well as the MS criterion of ATP-III. The Chi-square test for tendency was used to analyze the prevalence gradient between the groups and logistic regression, for association analysis. RESULTS The general prevalence of MS, adjusted for potentially confounder variables, did not differ among whites (23.3%), mulattos (23.3%) and blacks (23.4%). The analysis by sex showed, among men, a reduction in the MS prevalence of whites (26.2%, 95%CI: 20.7-31.7), in comparison to blacks (17.5%, 95%CI: 12.3-22.8) and an intermediate prevalence among mulattos, 21.9%, 95%CI: 18.6-25.1, p tend. = 0.002. Among the women, the tendency was the opposite, being higher among the blacks, 27.0%, 95%CI: 22.2-31.8, and lower among the whites, 20.5%, 95%CI: 15.6-25.4, p tend. = 0.02. The multivariate analysis of the association between skin color and MS (white = group of reference) showed that the black color of the skin was a protective factor among black men, with a prevalence ratio (PR) = 0.60 (0.36-0.97), whereas it tended to be a risk factor among black women, with a PR = 1.33 (0.94-1.78). CONCLUSION The prevalence of MA presented an inverse variation according to the color of skin between men and women. To be black was a protective factor among men and a risk factor among women.BACKGROUND: The metabolic syndrome (MS) has a high prevalence in different parts of the world, with variations between different ethnic groups. OBJECTIVE: This study aims at exploring the influence of the self-reported skin color on the prevalence of MS Methods: Cross-sectional study, carried out in a population subgroup (n=1,439 adults) in Salvador, Brazil. The self-reported skin color (white, mulatto or black) was used as well as the MS criterion of ATP-III. The Chi-square test for tendency was used to analyze the prevalence gradient between the groups and logistic regression, for association analysis. RESULTS: The general prevalence of MS, adjusted for potentially confounder variables, did not differ among whites (23.3%), mulattos (23.3%) and blacks (23.4%). The analysis by sex showed, among men, a reduction in the MS prevalence of whites (26.2%, 95%CI: 20.7-31.7), in comparison to blacks (17.5%, 95%CI: 12.3-22.8) and an intermediate prevalence among mulattos, 21.9%, 95%CI: 18.6-25.1, p tend. = 0.002. Among the women, the tendency was the opposite, being higher among the blacks, 27.0%, 95%CI: 22.2-31.8, and lower among the whites, 20.5%, 95%CI: 15.6-25.4, p tend. = 0.02. The multivariate analysis of the association between skin color and MS (white = group of reference) showed that the black color of the skin was a protective factor among black men, with a prevalence ratio (PR) = 0.60 (0.36-0.97), whereas it tended to be a risk factor among black women, with a PR = 1.33 (0.94-1.78). CONCLUSION: The prevalence of MA presented an inverse variation according to the color of skin between men and women. To be black was a protective factor among men and a risk factor among women.

Positions, Guidelines and Standardizations. Vehicles of Assistance to Medical Practice

Positions, Guidelines and Standardizations. Vehicles of Assistance to Medical Practice Antônio Carlos Sobral Sousa,1,2 Claudio Pereira da Cunha,3 Lucélia Batista Neves Cunha Magalhães,4 Sergio Emanuel Kaiser,5 José Francisco Kerr Saraiva6 Departamento de Medicina e Núcleo de Pós graduação em medicina da Universidade Federal de Sergipe;1 Centro de Ensino e Pesquisa da Fundação São Lucas,2 Aracaju, SE; Universidade Federal do Paraná,3 Curitiba, PR; Universidade Federal da Bahia,4 Slavador, BA; Universidade do Estado do Rio de Janeiro,5 Rio de Janeiro, RJ; Pontifícia Universidade Católica de Campinas (PUC-Camp),6 São Paulo, SP – Brazil