Valéria Maria de Azeredo Passos

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.

Cohort Profile: Longitudinal Study of Adult Health (ELSA-Brasil)

Chronic diseases are a global problem, yet information on their determinants is generally scant in low- and middle-income countries. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) aims to contribute relevant information regarding the development and progression of clinical and subclinical chronic diseases, particularly cardiovascular diseases and diabetes, in one such setting. At Visit 1, we enrolled 15 105 civil servants from predefined universities or research institutes. Baseline assessment (2008–10) included detailed interviews and measurements to assess social and biological determinants of health, as well as various clinical and subclinical conditions related to diabetes, cardiovascular diseases and mental health. A second visit of interviews and examinations is under way (2012–14) to enrich the assessment of cohort exposures and to detect initial incident events. Annual surveillance has been conducted since 2009 for the ascertainment of incident events. Biological samples (sera, plasma, urine and DNA) obtained at both visits have been placed in long-term storage. Baseline data are available for analyses, and collaboration via specific research proposals directed to study investigators is welcome.

Hipertensão arterial no Brasil: estimativa de prevalência a partir de estudos de base populacional

Endereço para correspondência: Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190, sala 4082, Belo Horizonte-MG. CEP: 30190-100 E-mail: vpassos@medicina.ufmg.br Resumo Estudos epidemiológicos sobre a hipertensão arterial são fundamentais para conhecer a distribuição da exposição e do adoecimento e as condições que influenciam a dinâmica de risco e controle na comunidade. Este artigo analisa estudos de prevalência de hipertensão no Brasil, de base populacional, em adultos, a partir de 1990. Foram incluídos todos os estudos publicados nas bases Medline e LILACS. A análise considerou a população-alvo, o desenho do estudo, o plano amostral, as características sociodemográficas da população-alvo, os critério de definição de hipertensão e a análise estatística. Nos 13 estudos selecionados, as taxas de prevalência mostram que cerca de 20% dos adultos apresentam hipertensão, sem distinção por sexo, mas também com evidente tendência de aumento com a idade. Os estudos ainda estão restritos às Regiões Sul e Sudeste. É marcante a preocupação com a metodologia e precisão da estimativa da prevalência. Ainda são escassos, entretanto, estudos sobre conhecimento, tratamento e controle da hipertensão. Palavras-chave: hipertensão; prevalência; estudos de base populacional.

Type 2 diabetes: prevalence and associated factors in a Brazilian community - the Bambuí health and aging study

CONTEXT AND OBJECTIVE Diabetes is an increasing cause of death in developing countries. Our objective was to describe the prevalence and clinical factors associated with diabetes and impaired fasting glycemia among adults (18-59 years) and elderly adults (60+ years). DESIGN AND SETTING Population based, cross-sectional study in Bambuí, Brazil. METHODS 816 adult and 1,494 elderly participants were interviewed; weight, height and blood pressure measured; and blood samples collected. Diabetes was defined as plasma fasting glucose > 126 mg/dl and/or use of hypoglycemic agents; impaired fasting glycemia as glycemia of 110-125 mg/dl. Associations were investigated using multinomial logistical regression (reference: fasting glycemia < 109 mg/dl). RESULTS Among the elderly, 218 (14.59%) presented diabetes and 199 (13.32%) impaired fasting glycemia, whereas adult prevalences were 2.33% and 5.64%. After multinomial analysis, diabetes remained associated, for adults, with increased waist-to-hip ratio and total cholesterol > 240 mg/dl; for elderly adults, with family history of diabetes, body-mass index of 25-29 kg/m(2), body-mass index > 30 kg/m(2), increased waist-to-hip ratio, low HDL-cholesterol triglyceridemia of 200-499 mg/dl and triglyceridemia > 500 mg/dl. Among adults, impaired fasting glycemia remained associated negatively with male sex and positively with ages of 40-59 years, physical inactivity and increased waist-to-hip ratio; among the elderly, with alcohol consumption, overweight, obesity and triglycerides > 200 mg/dl. CONCLUSIONS The results reinforce the importance of interventions to reduce physical inactivity, alcohol consumption, obesity and dyslipidemia, so as to prevent increasing incidence of diabetes.

Leishmania (Viannia) braziliensis is the predominant species infecting patients with American cutaneous leishmaniasis in the State of Minas Gerais, Southeast Brazil

Skin biopsies from 53 patients with American cutaneous leishmaniasis (ACL) from the State of Minas Gerais, Brazil, were used for a characterization of the Leishmania parasites. A pair of primers flanking the conserved region of the Leishmania minicircle kDNA was used to obtain amplified DNA via the polymerase chain reaction. The amplified products were subsequently hybridized with Leishmania subgenus-specific radiolabeled probes. Parasites from 49 out of 53 samples (92.5%) were characterized as belonging to the subgenus Viannia and four (7.5%) as belonging to the subgenus Leishmania. Clinical, epidemiological and molecular evidence allow us to conclude that Leishmania (V.) braziliensis and Leishmania (L.) amazonensis are the species present in the patients studied and that L. (V.) braziliensis is the predominant species in the State of Minas Gerais, Brazil.

Perfil de risco cardiovascular e autoavaliação da saúde no Brasil: estudo de base populacional

OBJETIVOS: Estimar a prevalencia e a aglomeracao de fatores de risco cardiovascular (hipertensao, tabagismo, inatividade fisica, uso excessivo de alcool, dieta inadequada e obesidade central) e investigar a sua associacao com autoavaliacao da saude apos ajuste por caracteristicas sociodemograficas e diagnostico medico de diabetes e doenca isquemica do coracao. METODOS: Participaram 9 211 brasileiros de 30 a 69 anos, residentes em 16 capitais, incluidos no Inquerito Domiciliar sobre Comportamentos de Risco e Morbidade Referida de Doencas e Agravos Nao Transmissiveis, 2002-2003, um estudo transversal de base populacional realizado pelo Ministerio da Saude. A variavel resposta foi o escore de aglomeracao de fatores de risco cardiovascular, variando de zero a 3: nenhuma exposicao ou exposicao a 1, 2 e 3 ou mais fatores de risco. Os dados foram analisados por regressao logistica multinomial, tendo como referencia a categoria zero de fatores de risco cardiovascular, com e sem hipertensao. RESULTADOS: A prevalencia dos fatores de risco, exceto uso de alcool, foi superior a 25%. A frequencia de 2 ou mais fatores de risco foi de 47,49%; 17,91% dos participantes nao apresentavam nenhum fator. A aglomeracao de fatores de risco foi inversamente associada com renda e escolaridade e foi maior nas idades entre 50 e 59 anos, sem diferencas significativas entre os sexos. Uma pior autoavaliacao de saude foi mais frequente em participantes com mais fatores de risco. A inclusao da hipertensao no escore representou piora no perfil de risco com o aumento da idade e associacao significativa com doenca isquemica do coracao e diabetes referidos. CONCLUSOES: A elevada prevalencia de fatores de risco cardiovascular em adultos brasileiros reforca a importância de politicas voltadas para a reducao desses fatores. A associacao entre pior percepcao da saude e maior numero de fatores de risco cardiovascular chama a atencao para a importância, a abrangencia e a complexidade desse marcador subjetivo de saude em inqueritos populacionais e sugere que a autopercepcao de uma saude ruim nao e suficiente para uma atitude saudavel.

Electrocardiographic changes during low-dose, short-term therapy of cutaneous leishmaniasis with the pentavalent antimonial meglumine

The pentavalent antimonial (Sb5+) meglumine is the drug of choice for the treatment of cutaneous leishmaniasis (CL) in Brazil. Although the cardiotoxicity of high-dose, long-term Sb5+ therapy is well known, the use of low-dose, short-term meglumine has been considered to be safe and relatively free from significant cardiac effects. In order to investigate the cardiotoxicity of low-dose, short-term therapy with meglumine in cutaneous leishmaniasis, 62 CL patients treated with meglumine were studied. A standard ECG was obtained before and immediately after the first cycle of treatment (15 mg Sb5+ kg-1 day-1). The electrocardiographic interpretation was carried out blindly by two investigators using the Minnesota Code. There were no significant differences in qualitative ECG variables before and after meglumine treatment. However, the corrected QT interval was clearly prolonged after antimonial therapy (420.0 vs 429.3 ms, P < 10(-6)). QTc augmentation exceeded 40 ms in 12 patients, 7 of whom developed marked QTc interval enlargement (500 ms) after meglumine therapy. This previously unrecognized cardiac toxicity induced by short-term, low-dose antimonial therapy has potentially important clinical implications. Since sudden death has been related to QTc prolongation over 500 ms induced by high-dose antimonial therapy, routine electrocardiographic monitoring is probably indicated even in CL patients treated with short-term, low-dose meglumine schedules. Until further studies are conducted to establish the interactions between pentavalent antimonials and other drugs, special care is recommended when using meglumine in combination with other medications, in particular with drugs that also increase the QTc interval.

Projeto Bambuí: prevalência de sintomas articulares crônicos em idosos

BACKGROUND Arthritis is one of the more prevalent chronic conditions and a leading cause of disability in the elderly. The objective of this study is to assess the prevalence and to identify the factors associated with arthritis in the elderly population of Bambuí, Brazil. METHODS A population based cross-sectional study was carried out among 1606 senior citizens ( > or = 60 years of age). Arthritis was defined by: a) report of medical diagnosis of arthritis and b) report of chronic hand and knee symptoms (CHKS). Multiple logistic regression was used to investigate the independent association between arthritis and selected factors. RESULTS Prevalence of medical diagnosis of arthritis was of 25.3% (15.3% in men and 31.9% in women). Prevalence of CHKS was of 44.2%. CHKS was negatively associated with gender (masculine) and years of education ( > or = 8) and positively associated with Body Mass Index (25-29, 30-34, > or = 35 kg/m2), report of myocardial infarct, stroke symptoms and Chagas disease. CONCLUSIONS Our results are consistent with other studies concerning higher prevalence of arthritis among obese and less educated women. Association of CHKS with the report of some chronic conditions may be related to greater utilization of health services motivated by these conditions. This finding requires further investigation in future studies. Identification of these characteristics of the senior citizens living in the community, with a higher prevalence of arthritis may subsidize the organization of healthcare programs for this age group.

Estratégias e desenvolvimento de garantia e controle de qualidade no ELSA-Brasil

The ELSA-Brasil (Estudo Longitudinal de Saude do Adulto - Brazilian Longitudinal Study for Adult Health) is a cohort study composed of 15,105 adults followed up in order to assess the development of chronic diseases, especially diabetes and cardiovascular disease. Its size, multicenter nature and the diversity of measurements required effective and efficient mechanisms of quality assurance and control. The main quality assurance activities (those developed before data collection) were: careful selection of research instruments, centralized training and certification, pretesting and pilot studies, and preparation of operation manuals for the procedures. Quality control activities (developed during data collection and processing) were performed more intensively at the beginning, when routines had not been established yet. The main quality control activities were: periodic observation of technicians, test-retest studies, data monitoring, network of supervisors, and cross visits. Data that estimate the reliability of the obtained information attest that the quality goals have been achieved.

Prevalence, awareness, treatment and influence of socioeconomic variables on control of high blood pressure : results of the ELSA-Brasil study

High blood pressure (HBP) is the leading risk factor for years of life lost in Brazil. Factors associated with HBP awareness, treatment and control need to be understood better. Our aim is to estimate prevalence, awareness, and types of anti-hypertensive treatment and to investigate the association of HBP control with social position. Data of 15,103 (54% female) civil servants in six Brazilian state capitals collected at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline (2008-2010) were used to estimate prevalence and cross-sectional association of HBP control with education, per capita family income and self-reported race, using multiple logistic regression. Blood pressure was measured by the oscillometric method. 35.8% were classified as presenting HBP; 76.8% of these used anti-hypertensive medication. Women were more aware than men (84.8% v. 75.8%) and more often using medication (83.1% v. 70.7%). Adjusted HBP prevalence was, in ascending order, Whites (30.3%), Browns (38.2%) and Blacks (49.3%). The therapeutic schemes most used were angiotensin-converting enzyme inhibitors, in isolation (12.4%) or combined with diuretics (13.3%). Among those in drug treatment, controlled blood pressure was more likely in the (postgraduate) higher education group than among participants with less than secondary school education (PR = 1.21; 95% CI: 1.14–1.28), and among Asian (PR = 1.21; 95% CI: 1.12–1.32) and ‘Whites (PR = 1.19; 95% CI: 1.12–1.26) compared to Blacks. Socioeconomic and racial inequality—as measured by different indicators—are strongly associated with HBP control, beyond the expected influence of health services access.