Anthropometric measures in relation to Basal Cell Carcinoma: a longitudinal study

Background: The relationship between anthropometric indices and risk of basal cell carcinoma ( BCC) is largely unknown. We aimed to examine the association between anthropometric measures and development of BCC and to demonstrate whether adherence to World Health Organisation guidelines for body mass index, waist circumference, and waist/ hip ratio was associated with risk of BCC, independent of sun exposure. Methods: Study participants were participants in a community- based skin cancer prevention trial in Nambour, a town in southeast Queensland ( latitude 26 degrees S). In 1992, height, weight, and waist and hip circumferences were measured for all 1621 participants and weight was remeasured at the end of the trial in 1996. Prevalence proportion ratios were calculated using a log- binomial model to estimate the risk of BCC prior to or prevalent in 1992, while Poisson regression with robust error variances was used to estimate the relative risk of BCC during the follow- up period. Results: At baseline, 94 participants had a current BCC, and 202 had a history of BCC. During the 5- year follow- up period, 179 participants developed one or more new BCCs. We found no significant association between any of the anthropometric measures or indices and risk of BCC after controlling for potential confounding factors including sun exposure. There was a suggestion that short- term weight gain may increase the risk of developing BCC for women only. Conclusion: Adherence to World Health Organisation guidelines for body mass index, waist circumference and waist/ hip ratio is not significantly associated with occurrence of basal cell carcinomas of the skin.

Nutrition-related habits and associated factors of Brazilian adolescents

To investigate the nutrition-related habits (NRH) of Brazilian adolescents and evaluate the associations with risk factors. Cross-sectional school-based was carried out among high school adolescents aged 14-18 years (n = 1,759) from public and private schools from two cities. The NRH were investigated by the weekly consumption of vegetables, fruit, sweet food and fried food. Risk factors investigated were: city, sex, age, socioeconomic status and nutritional status. In statistics, Poisson regression was used with robust variance adjustment. Data indicated low consumption of fruits and vegetables, 70.0 and 71.0%, respectively, and high consumption of sweets and fried food, 66.7 and 63%, respectively. Boys showed risk of inadequate intake of vegetables [prevalence ratios (PR) 1.10, 95% CI 1.01-1.16] and fruit (PR 1.09, 95% CI 1.01-1.16). Furthermore, adolescents who live in Maringa had greater likelihood of consuming vegetables and fruit (20 and 25%, respectively). However, they presented risk of inadequate consumption of sweets (PR 1.19, 95% CI 1.11-1.28) for adolescents who live in Presidente Prudente. We concluded that inadequate NRH show high prevalence among adolescents and indicate the need to employ educational strategies that promote the adoption of more healthy habits and behaviors.

Chronic obstructive pulmonary disease in Brazil: mortality and hospitalization trends and rates, 1996-2008

SETTING: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death among adults in Brazil. OBJECTIVE: To evaluate the mortality and hospitalisation trends in Brazil caused by COPD during the period 1996-2008. DESIGN: We used the health official statistics system to obtain data about mortality (1996-2008) and morbidity (1998-2008) due to COPD and all respiratory diseases (tuberculosis: codes A15-16; lung cancer: code C34, and all diseases coded from J40 to 47 in the 10th Revision of the International Classification of Diseases) as the underlying cause, in persons aged 45-74 years. We used the Joinpoint Regression Program log-linear model using Poisson regression that creates a Monte Carlo permutation test to identify points where trend lines change significantly in magnitude/direction to verify peaks and trends. RESULTS: The annual per cent change in age-adjusted death rates due to COPD declined by 2.7% in men (95%CI -3.6 to -1.8) and -2.0% (95%CI -2.9 to -1.0) in women; and due to all respiratory causes it declined by -1.7% (95%CI 2.4 to -1.0) in men and -1.1% (95%CI -1.8 to -0.3) in women. Although hospitalisation rates for COPD are declining, the hospital admission fatality rate increased in both sexes. CONCLUSION: COPD is still a leading cause of mortality in Brazil despite the observed decline in the mortality/hospitalisation rates for both sexes.

Asthma mortality in Australia 1920-94: Age, period, and cohort effects

Study objective-To investigate asthma mortality during 1920-94 in Australia in order to assess the relative role of period and birth cohort effects. Design-Asthma mortality (both sexes) was age standardised and examined for changes over time. The data were also examined for age, period, and cohort (APC) effects using Poisson regression modelling. Setting-National Australian mortality data. Participants-Population (both sexes) aged 15-34 years, 1920-94. Main results-Age adjusted period rates indicate an increase in asthma mortality during the 1950s, and increases and subsequent falls (epidemics) during the mid 1960s and late 1980s. APC modelling suggested an increasing cohort effect (adjusted for both age and period) from the birth cohort 1950-54 onwards. Period effects (adjusted for age and cohort) are characterised by an increase in the 1950s (possibly due to changes in diagnostic labelling), minimal or no increases in the mid 1960s and late 1980s (where period peaks had been noted when data were adjusted for age only), and declines in mortality risk subsequent to the periods where age-period analysis had noted increases. Thus, in Australia, some of the mid 1960s epidemic in asthma deaths, and all of the late 1980s mortality increase, seem to be attributable to cohort effects. Conclusions-The increase in asthma mortality cohort effect is consistent with empirical evidence of recent increases in prevalence (and presumably incidence) of asthma in Australia, and suggests the need for more research into the underlying environmental aetiology of this condition.

Exclusive Breastfeeding in Southern Brazil: Prevalence and Associated Factors

Background: Worldwide strategies have been conducted in order to guarantee longer periods of exclusive breastfeeding for most children, especially those from developing countries. The evaluation of infant feeding practices and the identification of weaning risk factors are essential for public health policy planning. Methods: This cross-sectional study was carried out in Joinville, the biggest city of Santa Catarina State in the southern Brazilian region. The caregivers of children under 1 year of age were systematically selected for interview in previously drawn immunization units during the 2005 National Vaccination Campaign. A structured questionnaire was applied for collection of infant, maternal, and healthcare variables. A 24-hour food recall survey was included in order to evaluate infant feeding practices. Descriptive statistic analysis on breastfeeding prevalence and Poisson regression analysis of risk factors for discontinuing exclusive breastfeeding for infants up to 6 months of age were performed. Results: Caregivers of 1,470 infants were interviewed. The feeding inquiry showed an overall rate of breastfeeding of 72.5% and a frequency of exclusive breastfeeding of 43.7% and 53.9% among infants younger than 6 and 4 months of age, respectively. The findings associated with the interruption of exclusive breastfeeding for infants up to 6 months were: higher infant age (P < 0.001), pacifier use (P < 0.001), and lower maternal educational level (P = 0.013). Conclusions: In developing countries, specific strategies must be created for the delivery of information about breastfeeding and the effect of pacifier use, especially for less educated women.

High prevalence of polycystic ovary syndrome in women born small for gestational age

There is evidence that intrauterine growth restriction, resulting in newborn girls that are small for gestational age (SGA), may be related to the onset of polycystic ovary syndrome (PCOS). Thus, we studied whether women born SGA have a higher prevalence of PCOS than women born appropriate for gestational age (AGA). This was a prospective birth cohort study of 384 women born at term between June 1, 1978, and May 31, 1979, in Ribeirao Preto, Brazil. After exclusion, 165 women effectively participated in this study, of whom 43 were SGA and 122 were AGA. The prevalence of PCOS was analysed. At a mean age of 29 years, the women agreed to follow the study protocol, which included: anamnesis, physical examination, serum tests [follicle stimulating hormone, luteinizing hormone, total and free testosterone, dehydroepiandrostenedione sulphate, 17-OH-progesterone, fasting insulin, sex steroid-binding globulin (SHBG) and fasting glucose] and pelvic ultrasound. Data regarding gestational age, birthweight, age at menarche and maternal data were obtained from the files of the cohort. The adjusted relative risk (RR) values of the SGA, insulin resistance, body mass index, maternal smoking and parity variables were analysed using Poisson regression with robust adjustment of variance for the prediction of PCOS. The prevalence of PCOS was higher in the SGA group than in the AGA group [adjusted RR = 2.44, 95% CI (1.39-4.28)]. Hyperandrogenism was more prevalent in the SGA women than in the AGA women (P = 0.011). Circulating SHBG was lower in the SGA women than in the AGA women (P = 0.041), but fasting insulinemia was similar in both groups. The prevalence of PCOS in SGA women was twice as high as in AGA women in our study population.

The rise of multiple births in Brazil

Aim: The aim of this study was to assess the rise in multiple births and its influence on trends of low birth weight (LBW) rates in Porto Alegre, Brazil. Methods: This is a registry-based study of live births from 1994 to 2005 obtained from the national live birth information system. Chi-square tests for trends were assessed for LBW and multiple birth rates. The impact of multiple births on LBW trends was assessed by sequential modelling, including year and further adjustment for multiple births. Risk factors for multiple births were assessed using the Poisson regression. Results: A total of 263 252 live births were studied. The LBW rate increased from 9.70% to 9.88% (p < 0.001) and the multiple birth rate rose from 1.95% to 2.53% (p < 0.001). LBW rate increased among twins, from 57.14% to 63.46% (p = 0.001). The twin birth rate rose by 24.7%, while the rate of triplets or higher-order increased by 150%. Multiple births may be responsible for 23.9% of the increase in the LBW rate over the period. Mothers with higher levels of schooling, older mothers and mothers delivering in private hospitals were more likely to deliver multiple births. Conclusions: It seems that both the increase in multiple births and in the LBW among multiple births contributed to this rise in overall LBW rate.

A Nationwide Population-Based Study of Tension-Type Headache in Brazil

To estimate the 1-year prevalence of tension-type headache (TTH) and the degree of the association of TTH with some sociodemographic characteristics of a representative sample of the adult population of Brazil. This was an observational, cross-sectional, population-based study. We conducted telephone interviews on 3848 people, aged 18-79 years, randomly selected from the 27 states of Brazil. Trained lay interviewers administered the structured questionnaire. It included questions about the sociodemographic characteristics of the population, as well as questions about headache. The degree of the association was calculated through prevalence ratios, adjusted with Poisson regression by gender, age, years of education, marital status, household income, job status, body mass index (BMI), and physical exercise. The estimated 1-year gender- and-age-adjusted prevalence of TTH was 13.0% (95% CI: 11.8-14.2%); 15.4% in males and 9.5% in females. The prevalence of probable TTH was 22.6% (95% CI: 21.1-24.1%). Most (86.2%) subjects reported episodic TTH; 6.4% had chronic TTH. The prevalence was higher at 18-29 years of age (16.2%). TTH was 1.6 times more prevalent in men, and 1.54 times more in subjects with more than 11 years of education. There was no significant association of TTH with marital or job status, household income, BMI, and physical activity. This is the first nationwide epidemiological study of TTH in Brazil. The overall prevalence of TTH in Brazil is low, at 13%. TTH is significantly more prevalent in males and subjects with higher education level.

Chronic daily headache in Brazil: a nationwide population-based study

The objectives of this study were to estimate the 1-year prevalence of chronic daily headache (CDH) and the degree of the association of CDH with some sociodemographic characteristics of the adult population of Brazil. This was a cross-sectional, population-based study. We conducted telephone interviews with 3848 people, aged 18-79 years, randomly selected from the 27 States of Brazil. The degree of the association was calculated through prevalence ratios, adjusted with Poisson regression by gender, age and some sociodemographic factors. The estimated 1-year gender- and age-adjusted prevalence of CDH was 6.9%. CDH was 2.4 times more prevalent in women, 1.72 times more in unemployed, 1.63 times more in subjects with high household income and two times greater in those who did not exercise. The overall prevalence of CDH in Brazil is high. CDH is significantly more prevalent in women, the unemployed, subjects with higher income, and in those who do not exercise.

Untreated Dental Caries in a Brazilian Paediatric AIDS Patient Population

Purpose: The objective of the present study was to assess the prevalence of untreated caries in a Brazilian paediatric acquired immunodeficiency syndrome (AIDS) patient population and its association with sociodemographic, behavioural and clinical characteristics. Materials and Methods: The study group was comprised of 125 HIV-infected patients (aged 3 to 15 years) who had already manifested AIDS and were assisted in a specialised health care unit. Dental examinations followed the World Health Organization`s guidelines for oral health surveys. Family caregivers provided information about the socioeconomic standing and the behaviour of their children. Patients` medical records in the hospital provided information on the clinical status of patients. A Poisson regression analysis was used for assessing the covariates for the prevalence of untreated dental caries, as adjusted by age. Results: The prevalence of untreated caries was 58%; a higher prevalence was found in younger children with primary and mixed dentition. The prevalence of untreated caries associated significantly with lower socioeconomic status (household crowding and schooling of the caregiver), dietary habits (higher frequency of sugar consumption) and poorer clinical status (HIV viral load and symptom severity). Conclusions: The high burden of untreated caries on paediatric AIDS patients reinforced the importance of integrating the clinician with the interdisciplinary health care team that assisted these children. The identification of socioeconomic and behavioural factors associated with caries experience reinforced the importance of the attention that children with AIDS received within their own households for the prevention of dental disease, particularly a proper nutritional advisement and monitoring of dental hygiene.

Análise espacial do padrão de introdução e disseminação da dengue nos municípios do Espírito Santo

O número de municípios infestados pelo Aedes aegypti no Estado do Espírito Santo vem aumentando gradativamente, levando a altas taxas de incidência de dengue ao longo dos anos. Apesar das tentativas de combate à doença, esta se tornou uma das maiores preocupações na saúde pública do Estado. Este estudo se propõe a descrever a dinâmica da expansão da doença no Estado a partir da associação entre variáveis ambientais e populacionais, utilizando dados operacionalizados por meio de técnicas de geoprocessamento. O estudo utilizou como fonte de dados a infestação pelo mosquito vetor e o coeficiente de incidência da doença, as distâncias rodoviárias intermunicipais do Estado, a altitude dos municípios e as variáveis geoclimáticas (temperatura e suficiência de água), incorporadas a uma ferramenta operacional, as Unidades Naturais do Espírito Santo (UNES), representadas em um único mapa operacionalizado em Sistema de Informação Geográfica (SIG), obtido a partir do Sistema Integrado de Bases Georreferenciadas do Estado do Espírito Santo. Para análise dos dados, foi realizada a Regressão de Poisson para os dados de incidência de dengue e Regressão Logística para os de infestação pelo vetor. Em seguida, os dados de infestação pelo mosquito e incidência de dengue foram georreferenciados, utilizando como ferramenta operacional o SIG ArcGIS versão 9.2. Observou-se que a pluviosidade é um fator que contribui para o surgimento de mosquito em áreas não infestadas. Altas temperaturas contribuem para um alto coeficiente de incidência de dengue nos municípios capixabas. A variável distância em relação a municípios populosos é um fator de proteção para a incidência da doença. A grande variabilidade encontrada nos dados, que não é explicada pelas variáveis utilizadas no modelo para incidência da doença, reforça a premissa de que a dengue é condicionada pela interação dinâmica entre muitas variáveis que o estudo não abordou. A espacialização dos dados de infestação pelo mosquito e incidência de dengue e as Zonas Naturais do ES permitiu a visualização da influência das variáveis estatisticamente significantes nos modelos utilizados no padrão da introdução e disseminação da doença no Estado.

Consumo de álcool e adiposidade abdominal : resultados do estudo longitudinal de saúde do adulto – ELSA Brasil

A acumulação de tecido adiposo abdominal apresenta associação positiva com eventos cardiovasculares, pressão arterial e alterações metabólicas. Dentre os fatores de risco para o aumento da obesidade abdominal está o alto consumo de bebidas alcoólicas, particularmente a cerveja. O objetivo deste estudo foi identificar associação entre consumo de bebidas alcoólicas (CBA) e adiposidade abdominal. Trata-se de uma investigação de corte transversal conduzida a partir da linha de base do Estudo Longitudinal de Saúde do Adulto – ELSA-Brasil, composta por 15.105 indivíduos (35 a 74 anos). Foram analisadas variáveis antropométricas, socioeconômicas e consumo de bebidas alcoólicas e utilizados, para diagnóstico de obesidade abdominal, os pontos de corte da circunferência da cintura (CC) e relação cintura/quadril (RCQ) preconizados pela Organização Mundial de Saúde. O CBA foi categorizado em quintis. Teste de Kolmogorov-Smirnov foi utilizado para avaliar a normalidade das variáveis. A associação entre variáveis antropométricas e o CBA foi avaliada utilizando-se teste Mann-Whitney, Kruskal-Wallis e teste qui-quadrado. Foram testados modelos de regressão linear e Poisson, ajustados por idade, sexo, IMC, tabagismo, atividade física, renda e escolaridade. A CC inadequada foi associada a maior CBA em toda amostra (1,03, IC95% 1,01-1,05) e em homens (1,05, IC95% 1,03-1,08). A RCQ inadequada foi associada a maior CBA tanto para o total da amostra (1,04, IC95% 1,01-1,06) como para mulheres (1,07, IC95% 1,03-1,12). Homens no quinto quintil de consumo de cerveja apresentaram chance 1,05 maior (IC95% 1,02-1,08) de ter a CC inadequada quando comparados aos que se encontravam no primeiro quintil. Já entre as mulheres a chance foi 1,16 (IC95% 1,13-1,20). Homens e mulheres no quinto quintil de consumo de cerveja tinham, respectivamente, 1,03 (IC95% 1,00-1,07) e 1,10 (IC95%1,04-1,15) vezes mais chance de apresentar RCQ inadequada. O consumo de vinho só foi associado a maior chance de ter CC aumentada entre mulheres (β=0,026, p<0,027). Neste estudo, o consumo de álcool foi associado positivamente com obesidade abdominal, sendo mais importante a contribuição da cerveja para aumento da CC e da RCQ.

Narrowing inequalities in infant mortality in Southern Brazil

OBJECTIVE: To determine the trends of infant mortality from 1995 to 1999 according to a geographic area-based measure of maternal education in Porto Alegre, Brazil. METHODS: A registry-based study was carried out and a municipal database created in 1994 was used. All live births (n=119,170) and infant deaths (n=1,934) were considered. Five different geographic areas were defined according to quintiles of the percentage of low maternal educational level (<6 years of schooling): high, medium high, medium, medium low, and low. The chi-square test for trend was used to compare rates between years. Incidence rate ratio was calculated using Poisson regression to identify excess infant mortality in poorer areas compared to higher schooling areas. RESULTS: The infant mortality rate (IMR) decreased steadily from 18.38 deaths per 1,000 live births in 1995 to 12.21 in 1999 (chi-square for trend p<0.001). Both neonatal and post-neonatal mortality rates decreased although the drop seemed to be steeper for the post-neonatal component. The higher decline was seen in poorer areas. CONCLUSION: Inequalities in IMR seem to have decreased due to a steeper reduction in both neonatal and post-neonatal components of infant mortality in lower maternal schooling area.

Outpatient health service utilization and associated factors: a population-based study

OBJECTIVE: To identify factors that lead people to visit a doctor in Brazil and assess differences between socioeconomic groups. METHODS: A cross-sectional study comprising 1,260 subjects aged 15 or more was carried out in southern Brazil. Demographic, socioeconomic, health needs and regular source of care data were analyzed concerning visits to a doctor within two months from the interview. Adjusted prevalence ratios and 95% confidence intervals were calculated using Poisson regression. RESULTS: Adjusted PR showed that women having stressful life events, health insurance, and a regular doctor increased the outcome. A dose-related response was found with self-reported health, and the probability of visiting a doctor increased with health needs. Analysis in the chronic disease group revealed that uneducated lower income subjects had a 62% reduction in the chance of visiting a doctor compared to uneducated higher income ones. However, as it was seen a significant interaction between income and education, years of schooling increased utilization in this group. CONCLUSIONS: Results suggest the existence of health inequity in the poorest group that could be overcome with education. Specific measures reinforcing the importance of having a regular doctor may also improve access in the underserved group.

Infant mortality: comparison between two birth cohorts from Southeast and Northeast, Brazil

OBJECTIVE: To obtain population estimates and profile risk factors for infant mortality in two birth cohorts and compare them among cities of different regions in Brazil. METHODS: In Ribeirão Preto, southeast Brazil, infant mortality was determined in a third of hospital live births (2,846 singleton deliveries) in 1994. In São Luís, northeast Brazil, data were obtained using systematic sampling of births stratified by maternity unit (2,443 singleton deliveries) in 1997-1998. Mothers answered standardized questionnaires shortly after delivery and information on infant deaths was retrieved from hospitals, registries and the States Health Secretarys' Office. The relative risk (RR) was estimated by Poisson regression. RESULTS: In São Luís, the infant mortality rate was 26.6/1,000 live births, the neonatal mortality rate was 18.4/1,000 and the post-neonatal mortality rate was 8.2/1,000, all higher than those observed in Ribeirão Preto (16.9, 10.9 and 6.0 per 1,000, respectively). Adjusted analysis revealed that previous stillbirths (RR=3.67 vs 4.13) and maternal age <18 years (RR=2.62 vs 2.59) were risk factors for infant mortality in the two cities. Inadequate prenatal care (RR=2.00) and male sex (RR=1.79) were risk factors in São Luís only, and a dwelling with 5 or more residents was a protective factor (RR=0.53). In Ribeirão Preto, maternal smoking was associated with infant mortality (RR=2.64). CONCLUSIONS: In addition to socioeconomic inequalities, differences in access to and quality of medical care between cities had an impact on infant mortality rates.