Solange Andreoni

Reference values for lung function tests: I. Static volumes

Static lung volume (LV) measurements have a number of clinical and research applications; however, no previous studies have provided reference values for such tests using a healthy sample of the adult Brazilian population. With this as our main purpose, we prospectively evaluated 100 non-smoking subjects (50 males and 50 females), 20 to 80 years old, randomly selected from more than 8,000 individuals. Gender-specific linear prediction equations were developed by multiple regression analysis with total lung capacity (TLC), functional residual capacity (FRC), residual volume (RV), RV/TLC ratio and inspiratory capacity (IC) as dependent variables, and with age, height, weight, lean body mass and indexes of physical fitness as independent ones. Simpler demographic and anthropometric variables were as useful as more complex measurements in predicting LV values, independent of gender and age (R2 values ranging from 0.49 to 0.78, P < 0.001). Interestingly, prediction equations from North American and European studies overestimated the LV at low volumes and underestimated them at high volumes (P < 0.05). Our results, therefore, provide a more appropriate frame of reference to evaluate the normalcy of static lung volume values in Brazilian males and females aged 20 to 80 years.

Mental Disorders in Megacities: Findings from the São Paulo Megacity Mental Health Survey, Brazil

Background World population growth is projected to be concentrated in megacities, with increases in social inequality and urbanization-associated stress. São Paulo Metropolitan Area (SPMA) provides a forewarning of the burden of mental disorders in urban settings in developing world. The aim of this study is to estimate prevalence, severity, and treatment of recently active DSM-IV mental disorders. We examined socio-demographic correlates, aspects of urban living such as internal migration, exposure to violence, and neighborhood-level social deprivation with 12-month mental disorders. Methods and Results A representative cross-sectional household sample of 5,037 adults was interviewed face-to-face using the WHO Composite International Diagnostic Interview (CIDI), to generate diagnoses of DSM-IV mental disorders within 12 months of interview, disorder severity, and treatment. Administrative data on neighborhood social deprivation were gathered. Multiple logistic regression was used to evaluate individual and contextual correlates of disorders, severity, and treatment. Around thirty percent of respondents reported a 12-month disorder, with an even distribution across severity levels. Anxiety disorders were the most common disorders (affecting 19.9%), followed by mood (11%), impulse-control (4.3%), and substance use (3.6%) disorders. Exposure to crime was associated with all four types of disorder. Migrants had low prevalence of all four types compared to stable residents. High urbanicity was associated with impulse-control disorders and high social deprivation with substance use disorders. Vulnerable subgroups were observed: women and migrant men living in most deprived areas. Only one-third of serious cases had received treatment in the previous year. Discussion Adults living in São Paulo megacity had prevalence of mental disorders at greater levels than similar surveys conducted in other areas of the world. Integration of mental health promotion and care into the rapidly expanding Brazilian primary health system should be strengthened. This strategy might become a model for poorly resourced and highly populated developing countries.

Reference values for lung function tests: III. Carbon monoxide diffusing capacity (transfer factor)

Carbon monoxide diffusing capacity (DLCO) or transfer factor (TLCO) is a particularly useful test of the appropriateness of gas exchange across the lung alveolocapillary membrane. With the purpose of establishing predictive equations for DLCO using a non-smoking sample of the adult Brazilian population, we prospectively evaluated 100 subjects (50 males and 50 females aged 20 to 80 years), randomly selected from more than 8,000 individuals. Gender-specific linear prediction equations were developed by multiple regression analysis with single breath (SB) absolute and volume-corrected (VA) DLCO values as dependent variables. In the prediction equations, age (years) and height (cm) had opposite effects on DLCOSB (ml min-1 mmHg-1), independent of gender (-0.13 (age) + 0.32 (height) - 13.07 in males and -0.075 (age) + 0.18 (height) + 0.20 in females). On the other hand, height had a positive effect on DLCOSB but a negative one on DLCOSB/ VA (P < 0.01). We found that the predictive values from the most cited studies using predominantly Caucasian samples were significantly different from the actually measured values (P < 0.05). Furthermore, oxygen uptake at maximal exercise (VO2max) correlated highly to DLCOSB (R = 0.71, P < 0.001); this variable, however, did not maintain an independent role to explain the VO2max variability in the multiple regression analysis (P > 0.05). Our results therefore provide an original frame of reference for either DLCOSB or DLCOSB/VA in Brazilian males and females aged 20 to 80 years, obtained from the standardized single-breath technique.

Maximal aerobic power and leg muscle mass and strength related to age in non-athletic males and females

Abstract To investigate the relationships between the age-associated decline in peak oxygen uptake (peak V˙O2), leg muscle mass (LMM) and leg strength (LS) under the modulating effect of gender and level of physical activity (LPA, as assessed by questionnaire), we evaluated 71 sedentary subjects [males(M):females(F), 34:37], aged 20–80 years. Peak V˙O2 at maximum cycle ergometry was related to LMM (dual energy X-ray absorptiometry) and LS (isokinetic dynamometry) using both standard (y · x−1) and power function ratios (allometry). Absolute values of all variables were higher in males and declined with age (P < 0.01). Differences between the genders disappeared after peak V˙O2·LS−1.46 (M) or −1.62 (F) adjustment but remained significant between peak V˙O2·LMM-−0.51 (M) or −0.45 (F) and LS·LMM-−0.91 (M) or −1.10 (F) corrected values. Allometric correction of peak V˙O2 and LS by LMM slowed their age-related declines; the flattening effect however, was more evident in the females. Interestingly, while no age-related decrement in peak V˙O2·LS−1 was found, power function ratio values also declined with age, and at a slower rate in females. These findings are consistent with those obtained following a multiple regression analysis using LPA as an independent covariate (P < 0.01). We conclude that using adequate scaling methods and controlling by LPA: (1) no gender differences are observed in peak V˙O2 adjusted for LS, (2) loss of LS and LMM are important determinants of the age-associated reduction in physical fitness in both genders but (3) age per se has an LS- and LMM-independent influence on the functional decline, although this intrinsic effect of senescence is less pronounced in females.

Effects of tiotropium and formoterol on dynamic hyperinflation and exercise endurance in COPD

BACKGROUND It is currently unclear whether the additive effects of a long-acting beta(2)-agonist (LABA) and the antimuscarinic tiotropium bromide (TIO) on resting lung function are translated into lower operating lung volumes and improved exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). METHODS On a double-blind and cross-over study, 33 patients (FEV(1) = 47.4 +/- 12.9% predicted) were randomly allocated to 2-wk formoterol fumarate 12 microg twice-daily (FOR) plus TIO 18 microg once-daily or FOR plus placebo (PLA). Inspiratory capacity (IC) was obtained on constant-speed treadmill tests to the limit of tolerance (Tlim). RESULTS FOR-TIO was superior to FOR-PLA in increasing post-treatment FEV(1) and Tlim (1.34 +/- 0.42 L vs. 1.25 +/- 0.39 L and 124 +/- 27% vs. 68 +/- 14%, respectively; p < 0.05). FOR-TIO slowed the rate of decrement in exercise IC compared to FOR-PLA (Deltaisotime-rest = -0.27 +/- 0.40 L vs. -0.45 +/- 0.36 L, p < 0.05). In addition, end-expiratory lung volume (% total lung capacity) was further reduced with FOR-TIO (p < 0.05). Of note, patients showing greater increases in Tlim with FOR-TIO (16/26, 61.6%) had more severe airways obstruction and lower exercise capacity at baseline. Improvement in Tlim with FOR-TIO was also related to larger increases in FEV(1) (p < 0.05). CONCLUSIONS Compared to FOR monotherapy, FOR-TIO further improved effort-induced dynamic hyperinflation and exercise endurance in patients with moderate-to-severe COPD. These beneficial consequences were more likely to be found in severely-disabled patients with larger resting functional responses to the combination therapy. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT00680056 [ClinicalTrials.gov].

Epidemiologia do aborto inseguro em uma população em situação de pobreza Favela Inajar de Souza, São Paulo

Procurou-se, neste trabalho, comparar os Resultados de Pesquisa recente, realizada em Sao Paulo, Brasil, pais em que o aborto e ilegal em quase todas as circunstâncias, com dados referentes a Cuba, pais onde o aborto e legal e seguro, dispondo de registros confiaveis. Essa pesquisa foi sediada em uma comunidade da Zona Norte da cidade de Sao Paulo, Favela Inajar de Souza: um estudo transversal que teve por objetivo estimar a frequencia de Abortos Inseguros, bem como determinar as caracteristicas sociodemograficas e a morbidade associadas a tal ocorrencia, em uma populacao em situacao de pobreza. Foram entrevistadas todas as mulheres entre 15 e 54 anos residentes na comunidade (Censo). Na analise dos dados foram empregados o teste exato de Fisher e o teste qui-quadrado para as variaveis categoricas, e a analise de variância (ANOVA) para as variaveis numericas. Em toda a analise adotou-se um nivel de significância de 5%, com p < 0,05. Encontrou-se, na populacao estudada, Favela Inajar, um alto numero de abortos inseguros e alta porcentagem de complicacoes pos-aborto. Em comum com Cuba, quanto ao Aborto Induzido foi observada semelhanca de perfil somente em relacao a Idade e ao Estado Civil. Nos Resultados foram constatadas tambem - contrariamente ao que ocorre em Cuba - associacoes estatisticamente significativas entre Aborto Inseguro e Renda/Escolaridade (baixas), Aborto Inseguro e Etnia/Cor, Aborto Inseguro e Nao Apoio do Parceiro, e Aborto Inseguro e Migracao Interna - o que torna essa populacao especialmente vulneravel ao aborto inseguro frente as violencias estruturais, geradoras de iniquidade, vigentes no Brasil. O aborto legal e seguro, tal como em Cuba, transformaria essa realidade. A legalizacao do aborto beneficiaria, sobretudo, as mulheres pobres.

Acoustic and Long-Term Average Spectrum Measures to Detect Vocal Aging in Women

Along the normal aging process, voice tends to become weak, breathy, and loses projection, which may interfere in the communication process. One reliable way to evaluate voice quality is through acoustical analysis using, for instance, the long-term average spectrum (LTAS). The aim of this study was to identify acoustic measures, particularly LTASs, which characterize vocal aging in women without vocal complaints. For this purpose, 30 elderly and 30 young women were included in this study. All spoke standard Portuguese and none had a history of vocal and laryngeal alterations or respiratory diseases. On the basis of the reading task, in habitual and loud levels, the following parameters were assessed: the equivalent sound level (L(eq)), the speaking fundamental frequency (SFF) and, at the LTAS window, the difference between the levels of the regions of the first formant and fundamental frequency F(0) (L(1) - L(0)), alpha ratio, and the amplitude levels obtained at equal intervals of 160 Hz, ranging from 0 to 8 kHz. There were significant differences between young and old voices for SFF and L(eq) in both levels. In the LTAS window, amplitude levels were higher for young voices, comprising all frequencies except those in the regions between 4.6-6.7 and 4.8-6.5 kHz, in habitual and loud levels, respectively. There were also significant differences regarding L(1) - L(0) and alpha ratio between groups, in both levels.The observed differences in LTASs slopes, L(1) - L(0) measures, and even L(eq) and SFF measures, may be attributed, to some extent, to lower subglottal pressure or a glottal setting providing a slower glottal closing speed for the elderly group.

Brief motivational interview and educational brochure in emergency room settings for adolescents and young adults with alcohol related problems: a randomized single blind clinical trial

OBJECTIVE To evaluate the effectiveness of brief motivational interviewing and an educational brochure when delivered in emergency room to reduce alcohol abuse and related problems among adolescents and young adults. METHOD A randomized single-blind clinical trial with a three-month follow-up was carried out at three emergency rooms from October 2004 to November 2005; subjects assessed were 16-25 years old treated for alcohol related events up to 6 hours after consumption. Socio-demographic data, quantity, frequency and negative consequences of alcohol consumption, motivation to change habits and future risk perception were evaluated. Statistical analysis was performed on subjects who completed follow-up (completers). ANCOVA model was used to analyze the difference between the intervention groups with statistical significance level α = 5% and confidence interval (CI) of 95%. RESULTS 186 subjects formed the initial sample, being 175 included and randomized to the educational brochure group (n = 88) or motivational interviewing group (n = 87). Follow-up assessment was performed in 85.2% of the sample. No significant difference between groups was observed. However, significant reductions (p < 0.01) in related problems and alcohol abuse were found in both groups. CONCLUSION In this sample a reduction of alcohol use and related problems was observed. Preliminary data indicate that controlled clinical trials with motivational interviewing, educational brochure and nonintervention should be of future interest among Brazilian adolescent populations.

Clustering of psychiatric and somatic illnesses in the general population: multimorbidity and socioeconomic correlates.

The distribution of psychiatric disorders and of chronic medical illnesses was studied in a population-based sample to determine whether these conditions co-occur in the same individual. A representative sample (N = 1464) of adults living in households was assessed by the Composite International Diagnostic Interview, version 1.1, as part of the São Paulo Epidemiological Catchment Area Study. The association of sociodemographic variables and psychological symptoms regarding medical illness multimorbidity (8 lifetime somatic conditions) and psychiatric multimorbidity (15 lifetime psychiatric disorders) was determined by negative binomial regression. A total of 1785 chronic medical conditions and 1163 psychiatric conditions were detected in the population concentrated in 34.1 and 20% of respondents, respectively. Subjects reporting more psychiatric disorders had more medical illnesses. Characteristics such as age range (35-59 years, risk ratio (RR) = 1.3, and more than 60 years, RR = 1.7), being separated (RR = 1.2), being a student (protective effect, RR = 0.7), being of low educational level (RR = 1.2) and being psychologically distressed (RR = 1.1) were determinants of medical conditions. Age (35-59 years, RR = 1.2, and more than 60 years, RR = 0.5), being retired (RR = 2.5), and being psychologically distressed (females, RR = 1.5, and males, RR = 1.4) were determinants of psychiatric disorders. In conclusion, psychological distress and some sociodemographic features such as age, marital status, occupational status, educational level, and gender are associated with psychiatric and medical multimorbidity. The distribution of both types of morbidity suggests the need of integrating mental health into general clinical settings.

Unsafe abortion: social determinants and health inequities in a vulnerable population in São Paulo, Brazil

This cross-sectional population-based study in a peripheral low-income community in São Paulo, Brazil, aimed to estimate the prevalence of unsafe abortion and identify the socio-demographic characteristics associated with it and its morbidity. The article discusses the studys results, based on univariate and multiple multinomial logistic regression analyses. The final regression models included: age at first intercourse < 16 years (OR = 4.80); > 2 sex partners in the previous year (OR = 3.63); more live born children than the womans self-reported ideal number (OR = 3.09); acceptance of the abortion due to insufficient economic conditions (OR = 4.07); black ethnicity/color (OR = 2.67); and low schooling (OR = 2.46), all with p < 0.05. The discussion used an approach to social determinants of health based on the concept and model adopted by the WHO and the health inequities caused by such determinants in the occurrence of unsafe abortion. According to the findings, unsafe abortion and socio-demographic characteristics are influenced by the social determinants of health described in the study, generating various levels of health inequities in this low-income population.