Roberta Carvalho de Figueiredo

Effects of Depression, Anxiety, Comorbidity, and Antidepressants on Resting-State Heart Rate and Its Variability: An ELSA-Brasil Cohort Baseline Study

OBJECTIVE Increases in resting-state heart rate and decreases in its variability are associated with substantial morbidity and mortality, yet contradictory findings have been reported for the effects of the mood and anxiety disorders and of antidepressants. The authors investigated heart rate and heart rate variability in a large cohort from Brazil, using propensity score weighting, a relatively novel method, to control for numerous potential confounders. METHOD A total of 15,105 participants were recruited in the Brazilian Longitudinal Study of Adult Health. Mood and anxiety disorders were ascertained using the Portuguese version of the Clinical Interview Schedule-Revised. Heart rate and its variability were extracted from 10-minute resting-state electrocardiograms. Regressions weighted by propensity scores were carried out to compare participants with and without depressive or anxiety disorders, as well as users and non-users of antidepressants, on heart rate and heart rate variability. RESULTS Use of antidepressants was associated with increases in heart rate and decreases in its variability. Effects were most pronounced for the tricyclic antidepressants (Cohens d, 0.72-0.81), followed by serotonin and norepinephrine reuptake inhibitors (Cohens d, 0.42-0.95) and other antidepressants (Cohens d, 0.37-0.40), relative to participants not on antidepressants. Only participants with generalized anxiety disorder showed robust, though small, increases in heart rate and decreases in its variability after propensity score weighting. CONCLUSIONS The findings may, in part, underpin epidemiological findings of increased risk for cardiovascular morbidity and mortality. Many factors that have an adverse impact on cardiac activity were controlled for in this study, highlighting the importance of cardiovascular risk reduction strategies. Further study is needed to examine whether, how, and when such effects contribute to morbidity and mortality.

Doença crônica, auto-avaliação de saúde e comportamento de risco: diferença de gênero

OBJETIVO: Analisar a associacao entre relato de doencas cronicas com comportamentos de risco e auto-avaliacao da saude, segundo o genero. METODOS: Foram incluidos 39.821 participantes com idade >30 anos do sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico (VIGITEL) realizado em 27 capitais brasileiras em 2006. A variavel dependente foi construida pelo relato de diagnostico medico de diabetes, hipertensao e infarto e/ou acidente vascular cerebral. Os individuos foram agrupados segundo ausencia de doenca, uma doenca cronica, e mais de uma. A associacao dessa variavel com comportamento de risco (composto por: fumar, consumir carnes com gordura e leite integral, nao realizar atividade fisica regular no lazer, nao consumir frutas e hortalicas regularmente e adicionar sal a refeicao pronta), auto-avaliacao da saude, indicadores de saude e sociodemograficos foi investigada por regressao logistica multinomial segundo o sexo, tendo como referencia a ausencia de doenca. RESULTADOS: O relato de uma e mais de uma doenca cronica foi maior entre homens e mulheres mais velhos e com menor escolaridade, com IMC>30kg/m2, e que faziam dieta. Observou-se relacao inversa entre numero de comportamentos de risco e relato de duas ou mais doencas (OR=0,64; IC 95%: 0,54;0,76 entre homens) e (OR=0,86; IC 95%: 0,77;0,97 entre mulheres). Homens (OR=33,61; IC 95%: 15,70;71,93) e mulheres (OR=13,02; IC 95%: 6,86;24,73) que auto-avaliaram a saude como ruim relataram mais doencas cronicas. Nao houve interacao estatistica entre auto-avaliacao da saude e sexo. CONCLUSOES: Associacao inversa entre numero de comportamentos de risco e relato de duas ou mais doencas cronicas sugere causalidade reversa e/ou maior sobrevivencia dos que se cuidam melhor. Homens parecem perceber sua saude pior que as mulheres na presenca de doenca cronica, apos ajustamento por fatores de confusao.OBJECTIVE To analyze the association between chronic diseases and health risk behaviors and self-perceived health status by gender. METHODS A total of 39.821 adults (30+ years old) who participated in the system Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--Telephone-Based Surveillance of Risk and Protective Factors for Chronic Diseases) carried out in 27 Brazilian capitals in 2006 were included in the study. The dependent variable was medical diagnosis reporting of diabetes, hypertension and myocardial infarct or stroke. Respondents were grouped into three categories: no disease; one chronic disease; and two or more. The associations between the dependent variable and sociodemographic characteristics, behavioral risk factors (smoking, consumption of fatty meat and whole milk, leisure-time physical inactivity, low fruit and vegetable intake and intake of added salt) and self-perceived health status were assessed in men and women using multinomial logistic regression. RESULTS Chronic disease reporting was higher among older men and women with lower schooling, BMI > or = 30 kg/m2 and who were on a diet. There was an inverse association between number of risk behaviors and two or more chronic diseases (OR: 0.64; 95% CI: 0.54;0.76 among men and OR: 0.86; 95% CI: 0.77;0.97 among women). Those men (OR: 33.61; 95% CI: 15.70;71.93) and women (OR: 13.02; 95% CI: 6.86; 24.73) who self-perceived their health as poor reported more chronic diseases. There was no statistical interaction between self-perceived health status and gender. CONCLUSIONS An inverse association between number of risk behaviors and reporting of two or more chronic diseases suggests a reverse causality and/or higher survival rates among those who take better care of themselves. Men seem to have poorer perception of their health status compared to women, after adjustment for confounders.

Patterns of benzodiazepine and antidepressant use among middle-aged adults. The Brazilian longitudinal study of adult health (ELSA-Brasil)

BACKGROUND Antidepressant and benzodiazepine medicines are widely prescribed in high-income countries. Our aim was to investigate and describe clinical and demographic characteristics of their use in a large cohort from a middle-income country. METHODS Participants (n=15,105) from the Brazilian Health Longitudinal Study (ELSA-Brasil), a civil servant cohort from six different sites in Brazil were asked about antidepressant and benzodiazepine use. The Clinical Interview Schedule-Revised was used for psychiatric assessment. Sociodemographic and clinical data were also collected. RESULTS Current use of antidepressant and benzodiazepine medicines was respectively reported by 6.87% and 3.88% of participants. These numbers were higher in major depression-MDD (16.5% and 13.9%), generalized anxiety disorder-GAD (14% and 9.5%) and any mental disorder (11.7% and 7.8%). The use of antidepressant and benzodiazepine was directly associated with clinical comorbidities and psychiatry diagnosis. In addition, older age was associated with benzodiazepine use and more years of schooling, with antidepressant use. Finally, the use of these medicines was strongly associated (odds ratio=8.48, p<0.001). LIMITATIONS Our cohort does not include younger adults (18-34 years), although it includes older (65-75 years) participants. DISCUSSION Antidepressant and benzodiazepine use in Brazil is lower than in high-income countries. We found that factors such as age and education level were associated with the use of these medicines, whereas MDD and GAD were poor predictors of psychopharmacotherapy use, suggesting misuse/overuse of psychopharmacotherapy among individuals without psychiatric illness and underuse among those with psychiatric conditions in Brazil.

Chronic diseases, self-perceived health status and health risk behaviors: gender differences

OBJETIVO: Analisar a associacao entre relato de doencas cronicas com comportamentos de risco e auto-avaliacao da saude, segundo o genero. METODOS: Foram incluidos 39.821 participantes com idade >30 anos do sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico (VIGITEL) realizado em 27 capitais brasileiras em 2006. A variavel dependente foi construida pelo relato de diagnostico medico de diabetes, hipertensao e infarto e/ou acidente vascular cerebral. Os individuos foram agrupados segundo ausencia de doenca, uma doenca cronica, e mais de uma. A associacao dessa variavel com comportamento de risco (composto por: fumar, consumir carnes com gordura e leite integral, nao realizar atividade fisica regular no lazer, nao consumir frutas e hortalicas regularmente e adicionar sal a refeicao pronta), auto-avaliacao da saude, indicadores de saude e sociodemograficos foi investigada por regressao logistica multinomial segundo o sexo, tendo como referencia a ausencia de doenca. RESULTADOS: O relato de uma e mais de uma doenca cronica foi maior entre homens e mulheres mais velhos e com menor escolaridade, com IMC>30kg/m2, e que faziam dieta. Observou-se relacao inversa entre numero de comportamentos de risco e relato de duas ou mais doencas (OR=0,64; IC 95%: 0,54;0,76 entre homens) e (OR=0,86; IC 95%: 0,77;0,97 entre mulheres). Homens (OR=33,61; IC 95%: 15,70;71,93) e mulheres (OR=13,02; IC 95%: 6,86;24,73) que auto-avaliaram a saude como ruim relataram mais doencas cronicas. Nao houve interacao estatistica entre auto-avaliacao da saude e sexo. CONCLUSOES: Associacao inversa entre numero de comportamentos de risco e relato de duas ou mais doencas cronicas sugere causalidade reversa e/ou maior sobrevivencia dos que se cuidam melhor. Homens parecem perceber sua saude pior que as mulheres na presenca de doenca cronica, apos ajustamento por fatores de confusao.OBJECTIVE To analyze the association between chronic diseases and health risk behaviors and self-perceived health status by gender. METHODS A total of 39.821 adults (30+ years old) who participated in the system Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--Telephone-Based Surveillance of Risk and Protective Factors for Chronic Diseases) carried out in 27 Brazilian capitals in 2006 were included in the study. The dependent variable was medical diagnosis reporting of diabetes, hypertension and myocardial infarct or stroke. Respondents were grouped into three categories: no disease; one chronic disease; and two or more. The associations between the dependent variable and sociodemographic characteristics, behavioral risk factors (smoking, consumption of fatty meat and whole milk, leisure-time physical inactivity, low fruit and vegetable intake and intake of added salt) and self-perceived health status were assessed in men and women using multinomial logistic regression. RESULTS Chronic disease reporting was higher among older men and women with lower schooling, BMI > or = 30 kg/m2 and who were on a diet. There was an inverse association between number of risk behaviors and two or more chronic diseases (OR: 0.64; 95% CI: 0.54;0.76 among men and OR: 0.86; 95% CI: 0.77;0.97 among women). Those men (OR: 33.61; 95% CI: 15.70;71.93) and women (OR: 13.02; 95% CI: 6.86; 24.73) who self-perceived their health as poor reported more chronic diseases. There was no statistical interaction between self-perceived health status and gender. CONCLUSIONS An inverse association between number of risk behaviors and reporting of two or more chronic diseases suggests a reverse causality and/or higher survival rates among those who take better care of themselves. Men seem to have poorer perception of their health status compared to women, after adjustment for confounders.

Socioeconomic inequalities in youth smoking in Brazil

Objective The contribution of smoking to socioeconomic inequalities in health is increasing worldwide, including in Brazil. Youth smoking may play an important role in the increasing social inequalities related to smoking. This study investigates social determinants of smoking among 15-year-old to 19-year-old individuals. Design Cross-sectional study. Setting The study uses data of 3536 participants aged 15–19 years of age of the Global Adult Tobacco Survey (GATS) and the National Household Sample Survey (Pesquisa Nacional por Amostragem de Domicilio, PNAD) obtained from household interviews. Smoking was defined as currently smoking tobacco products, regardless of frequency. Household socioeconomic indicators included per capita income, the educational level and sex of the head of the household, the presence of smoking restrictions and the number of smokers (excluding adolescents). Adolescent social factors included years of delaying school and social status (full-time student, working, and neither working nor studying). The hierarchical logistic regression analysis considered the effect of the complex sampling design. Results From 3536 participants, 6.2% were smokers (95% CI 5.4 to 7.1). More men than women had the habit of smoking (7.2%; 5.9 to 8.6 vs 3.6%; 2.7 to 4.6). The likelihood of smoking was significantly greater for men and older teens. There was an upward trend in the OR of smoking according to the number of smokers in the house. Adolescents living in households with no smoking restrictions had a greater likelihood of being smokers. OR of smoking rose as the number of years of delaying school increased, being about three times greater among adolescents who were working and five times greater among those who were neither studying nor working. Conclusions Results demonstrate that socioeconomic inequality in smoking is established at younger ages and that school delay as well as school abandonment may contribute to increased smoking-related inequalities. Smoking restrictions at home were protective against adolescents becoming smokers. Living with other smokers was a strong predictor of adolescents becoming smokers.

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.

Hemodialysis vascular access thrombosis: The role of factor V Leiden, prothrombin gene mutation and ABO blood groups.

BACKGROUND Vascular access thrombosis increases morbidity in hemodialysis (HD) patients. The aim of this study was to investigate the association between HD vascular access thrombosis and mutations in the prothrombin and factor V Leiden (FV) genes and ABO blood system. METHODS This cross-sectional study included 195 patients with end stage renal disease (ESRD) on HD for more than six months. HD patients were allocated into two groups according to the occurrence (cases, N=46) or not (controls, N=149) of previous vascular access thrombosis. FV and prothrombin gene mutations were investigated by polymerase chain reaction and ABO blood group phenotyping was performed by the indirect technique. Univariate analysis detected the variables with a trend to be associated with thrombosis and was followed by multivariate analysis to define independent predictors of vascular access thrombosis. RESULTS FV Leiden mutation and ABO blood group were not associated with vascular access thrombosis, whereas G20210A mutation in the prothrombin gene was significantly higher in patients with vascular access thrombosis and independently associated with this complication (OR=12.0; CI 95%=1.8-83.5; p=0.012). CONCLUSIONS G20210A mutation emerges as an important genetic factor predisposing to vascular access thrombosis. The definition of risk factors for thrombosis will certainly enable a rational approach for HD patients.

Aspectos éticos em estudos longitudinais: o caso do ELSA-Brasil

The debate about ethics in research with human beings has historically emphasized experimental studies because of their greater potential to harm the subjects involved. However, observational studies also include risks and relevant questions to be discussed. This article aims to present and discuss the ethical aspects involved in the implementation of ELSA-Brasil, a longitudinal multicenter study, with public funding, in which the research subjects and investigators are employees of the same institutions. The procedures adopted to meet the ethical requirements and commitments are described, as well as the casuistics that guided the actions according to their guiding principles (beneficence, autonomy and social justice). We present some moral problems that required consideration of risks and benefits at the confluence with the studys objectives, and we conclude with comments on the peculiarities and the potential benefits of a longitudinal study.

Comparison of venous plasma glycemia and capillary glycemia for the screening of type 2 diabetes mellitus in the Japanese-Brazilian community of Mombuca (Guatapará-SP)

BackgroundTo identify the most appropriate cut-off points of fasting glycemia for the screening of diabetes mellitus type 2 (DM2) with the comparison of the properties of capillary glycemia (CG) and venous blood plasma glycemia (PG) in a population of Japanese origin from the community of Mombuca, Guatapará - SP, Brazil.MethodsThis was a population-based descriptive cross-sectional study conducted on a sample of 131 individuals of both genders aged 20 years or more (66.8% of the target population). CG was measured with a glucometer in a blood sample obtained from the fingertip and PG was determined by an enzymatic method (hexokinase) in venous blood plasma, after a 10-14 hour fast in both cases. Data were analyzed by the receiver operating characteristic (ROC) curve in order to identify the best cut-off point for fasting glycemia (CG and PG) for the diagnosis of DM, using the 2-hour plasma glycemia > 200 mg/dl as gold - standard.ResultsThe ROC curve revealed that the best cut-off point for the screening of DM was 110 mg/dl for CG and 105 mg/dl for PG, values that would optimize the relation between individuals with positive and false-positive results. The area under the ROC curve was 0.814 for CG (p < 0.01) and 0.836 for PG (p < 0.01).ConclusionsThe cut-off points of 105 mg/dl(5.8 mmol/l) for PG and of 110 mg/dl(6.1 mmol/l) for CG appear to be the most appropriate for the screening of DM2 in the population under study, with emphasis on the fact that the value recommended for CG is 5 mg/dl higher than that for PG, in contrast to WHO recommendations.

Obesidade e sua relação com fatores de risco para doenças cardiovasculares em uma população nipo-brasileira

OBJECTIVE: To describe associations of weight excess and abdominal obesity with cardiovascular risk factors in a Japanese-Brazilian population from Mombuca, Guatapara, SP. METHODS: Cross-sectional study with 131 individuals of Japanese ancestry (69.2% first and 30.8% second generation), aged 20 years or more, corresponding to 66.8% of the resident population from this age group. Data were collected through standardized questionnaires and laboratory and physical examinations were performed. RESULTS: Prevalence of overweight and obesity was 29.6% and 46.3% in men and 25.6% and 39.0% in women, respectively. The prevalence of abdominal obesity was 55.6% in men and 20.8% in women. Body mass index was independently associated with triglycerides, waist circumference and age; systolic blood pressure with waist circumference. CONCLUSIONS: Data from the present survey highlight the necessity of interventions to prevent obesity in the Japanese-Brazilian population from Mombuca.