Two-year follow-up study of elderly residents in S. Paulo, Brazil: methodology and preliminary results

INTRODUCTION: Previous cross-sectional studies have shown a high prevalence of chronic disease and disability among the elderly. Given Brazil’s rapid aging process and the obvious consequences of the growing number of old people with chronic diseases and associated disabilities for the provision of health services, a need was felt for a study that would overcome the limitations of cross-sectional data and shed some light on the main factors determining whether a person will live longer and free of disabling diseases, the so-called successful aging. The methodology of the first follow-up study of elderly residents in Brazil is presented. METHOD: The profile of the initial cohort is compared with previous cross-sectional data and an in-depth analysis of nonresponse is carried out in order to assess the validity of future longitudinal analysis. The EPIDOSO (‘Epidemiologia do Idoso’) Study conducted a two-year follow-up of 1,667 elderly people (65+), living in S. Paulo. The study consisted of two waves, each consisting of household, clinical, and biochemical surveys. RESULTS AND CONCLUSIONS: In general, the initial cohort showed a similar profile to previous cross-sectional samples in S. Paulo. There was a majority of women, mostly widows, living in multigenerational households, and a high prevalence of chronic illnesses, psychiatric disturbances, and physical disabilities. Despite all the difficulties inherent in follow-up studies, there was a fairly low rate of nonresponse to the household survey after two years, which did not actually affect the representation of the cohort at the final household assessment, making unbiased longitudinal analysis possible. Concerning the clinical and blood sampling surveys, the respondents tended to be younger and less disabled than the nonrespondents, limiting the use of the clinical and laboratory data to longitudinal analysis aimed at a healthier cohort. It is worth mentioning that gender, education, family support, and socioeconomic status were not important determinants of nonresponse, as is often the case.

The impact of family control on firm's return

Family firm is a field of growing interest. The aim of this article is to understand whether CEOs identity impacts family firm’s stock returns. From a sample of Portuguese and Spanish family firms findings show that who manages the firms result in significantly different risk exposure. Moreover, we find that the abnormal return found by Fahlenbrach (2009) to founder-controlled firms disappear when we use valueweighted portfolios and include two new factors: market aggregate illiquidity and debt intensity to the four-factor Carhart model. Finally, our results explain why the majority of family firm is controlled by its founder.

The Bambuí health and ageing study (BHAS): methodological approach and preliminary results of a population-based cohort study of the elderly in Brazil

OBJECTIVE: A cohort study has been designed to identify predictors of adverse health events in the elderly. The methodology of the study and preliminary descriptive results are presented. METHODS: The study population comprises all residents of Bambuí (Minas Gerais, Brazil), aged 60 or more years (n=1.742). From these, 92.2% were interviewed and 85.9% underwent clinical examination, consisting of haematological and biochemical tests, serology for Trypanosoma cruzi, anthropometric and blood pressure measures and electrocardiogram. Aliquots of serum, plasma and DNA were stored for future investigations. The baseline interview included sociodemographic characteristics, self-referred health condition and history of selected diseases, medication use, health service use, source of medical care, physical activities, smoking, drinking and eating habits, reproductive history, physical functioning, life events, social support and mental health. Individuals are being followed up annually. RESULTS: The following characteristics predominated among participants: women (60,0%), married (48.9%) or widowed (35.4%), people living in households with up to 2 residents (73.8%), heads of family (76.7%), people with monthly income between 1.00 and 2.99 Brazilian minimum wages (62.0%) and people with up to 4 years of schooling (89.1%). The median age was 68 years. Among the cohort members, only 1.7% were lost in the first follow-up. CONCLUSIONS: In general, the characteristics of the study population were very similar to those from other epidemiological studies of the elderly based on large Brazilian cities. The small number of losses to follow-up indicates that the choice of Bambuí was adequate, assuring the feasibility of a long term cohort study.

Food frequency consumption and lipoproteins serum levels in the population of an urban area, Brazil

OBJECTIVE: To identify the association between food group consumption frequency and serum lipoprotein levels among adults. METHODS: The observations were made during a cross-sectional survey of a representative sample of men and women over 20 years old living in Cotia county, S. Paulo, Brazil. Data on food frequency consumption, serum lipids, and other covariates were available for 1,045 adults. Multivariate analyses adjusted by age, gender, body mass index, waist-to-hip ratio, educational level, family income, physical activity, smoking, and alcohol consumption were performed. RESULTS: Consumption of processed meat, chicken, red meat, eggs and dairy foods were each positively and significantly correlated with LDL-C, whereas the intake of vegetables and fruits showed an inverse correlation. Daily consumption of processed meat, chicken, red meat, eggs, and dairy foods were associated with 16.6 mg/dl, 14.5 mg/dl, 11.1 mg/dl, 5.8 mg/dl, and 4.6 mg/dl increase in blood LDL-C, respectively. Increases of daily consumption of fruit and vegetables were associated with 5.2 mg/dl and 5.5 mg/dl decreases in LDL-C, respectively. Alcohol beverage consumption showed a significant positive correlation with HDL-C. CONCLUSIONS: Dietary habits in the study population seem to contribute substantially to the variation in blood LDL and HDL concentrations. Substantially CHD risk reduction could be achieved with dietary changes.

Portugal making a difference with children and families: the GADIF model

Portugal is a culture grounded in strong traditions and family. Yet, social changes like women returning to the workforce and a decreas ed national birth rate are impacting the traditional family structure and care giving environments of children. Female employment has been increasing steadily in P ortugal over the last three decades (Galego & Pereira, 2006) and the total fert ility rate decreasing from 4.1 to 2.8 (INE, 2006). Furthermore, extended family me mbers, like grandparents, no longer reside close by to their children and grandc hildren as in the past, because of a changing labor market. Many of the younger gen eration are leaving their rural communities to flock to urban areas because o f job opportunities, leaving behind older relatives who would have otherwise par ticipated in the daily care of children. Given these social and economic changes, children are spending more time in out-of-home care with non-familial caregive rs. Yet, government regulations and guidelines in early care and educat ion (ECCE) and early intervention (EI) are only just emerging; it contin ues to be a work in progress.

Housework, paid work and psychiatric symptoms

OBJECTIVE: To evaluate the hypothesis that work burden, the simultaneous engagement in paid work and unpaid family housework, is a potential risk factor for psychiatric symptoms among women. METHODS: A cross-sectional study was carried out with 460 women randomly selected from a poor area of the city of Salvador, Brazil. Women between 18 to 70 years old, who reported having a paid occupation or were involved in unpaid domestic activities for their families, were eligible. Work burden-related variables were defined as: a) double work shift, i.e., simultaneous engagement in a paid job plus unpaid housework; and b) daily working time. Psychiatric symptoms were collected through a validated questionnaire, the QMPA. RESULTS: Positive, statistically significant associations between high (>7 symptoms) QMPA scores and either double work shift (prevalence ratio -- PR=2.04, 95% confidence interval -- CI: 1.16, 2.29) or more than 10 hours of daily work time (PR=2.29, 95% CI: 1.96, 3.43) were found after adjustment for age, marital status and number of pre-school children. CONCLUSIONS: Major correlates of high QMPA scores are work burden variables. Being married or having pre-school children are also associated with high QMPA scores only when associated with work burden.

Hospital visitors as controls in case-control studies

OBJECTIVE: Selecting controls is one of the most difficult tasks in the design of case-control studies. Hospital controls may be inadequate and random controls drawn from the base population may be unavailable. The aim was to assess the use of hospital visitors as controls in a case-control study on the association of organochlorinated compounds and other risk factors for breast cancer conducted in the main hospital of the "Instituto Nacional de Câncer" -- INCA (National Cancer Institute) in Rio de Janeiro (Brazil). METHODS: The study included 177 incident cases and 377 controls recruited among female visitors. Three different models of control group composition were compared: Model 1, with all selected visitors; Model 2, excluding women visiting relatives with breast cancer; and Model 3, excluding all women visiting relatives with any type of cancer. Odds ratios (OR) and 95% confidence intervals were calculated to test the associations. RESULTS: Age-adjusted OR for breast cancer associated with risk factors other than family history of cancer, except smoking and breast size, were similar in the three models. Regarding family history of all cancers, except for breast cancer, there was a decreased risk in Models 1 and 2, while in Model 3 there was an increased risk, but not statistically significant. Family history of breast cancer was a risk factor in Models 2 and 3, but no association was found in Model 1. In multivariate analysis a significant risk of breast cancer was found when there was a family history of breast cancer in Models 2 and 3 but not in Model 1. CONCLUSIONS: These results indicate that while investigating risk factors unrelated to family history of cancer, the use of hospital visitors as controls may be a valid and feasible alternative.

Nutritional status of pregnant women: prevalence and associated pregnancy outcomes

INTRODUCTION: Although obesity is well recognized as a current public health problem, its prevalence and impact among pregnant women have been less investigated in Brazil. The objective of the study was to evaluate the impact of pre-obesity and obesity among pregnant women, describing its prevalence and risk factors, and their association with adverse pregnancy outcomes. METHODS: A cohort of 5,564 pregnant women, aged 20 years or more, enrolled at aproximately 20 to 28 weeks of pregnancy, seen in prenatal public clinics of six state capitals in Brazil were followed up, between 1991 and 1995. Prepregnancy weight, age, educational level and parity were obtained from a standard questionnaire. Height was measured in duplicate and the interviewer assigned the skin color. Nutritional status was defined using body mass index (BMI), according to World Health Organization (WHO) criteria. Odds ratios and 95% confidence interval were calculated using logistic regression. RESULTS: Age-adjusted prevalences (and 95% CI) based on prepregnancy weight were: underweight 5.7% (5.1%-6.3%), overweight 19.2% (18.1%-20.3%), and obesity 5.5% (4.9%-6.2%). Obesity was more frequently observed in older black women, with a lower educational level and multiparous. Obese women had higher frequencies of gestational diabetes, macrosomia, hypertensive disorders, and lower risk of microsomia. CONCLUSIONS: Overweight nutritional status (obesity and pre-obesity) was seen in 25% of adult pregnant women and it was associated with increased risk for several adverse pregnancy outcomes, such as gestational diabetes and pre-eclampsia.

Representações coloniais no feminino: o oriente de Isabel Tamagnini

O Diário de uma Viagem a Timor (1882-1883) descreve o itinerário de Isabel Pinto da França Tamagnini entre Singapura e Díli. O Diário oferece uma representação peculiar da cultura asiática e das suas mulheres, através do olhar de uma europeia cuja formação e mundividência em pouco ultrapassavam a esfera doméstica e religiosa. A escrita de Tamagnini reflecte a sensibilidade de um estrato privilegiado da sociedade, que considerava a escrita feminina como um passatempo tolerável de senhoras prendadas. Logo nas primeiras linhas do Diário, Tamagnini afirma claramente que a sua produção e recepção devem restringir-se ao círculo da família e amigos, pois ela mesma o considera um texto recreativo e impressionista. Mas é precisamente esta característica que faz do Diário de Tamagnini um documento da sociedade colonial portuguesa de finais do século xix. Tamagnini compõe uma representação subjectiva de uma realidade ‘exótica’ e dos seus actores, recordando a noção de ‘orientalismo’ de Edward Said. O olhar de Tamagnini é dominado pela pertença a uma elite etnocêntrica e produz um texto crítico, simultaneamente confessional e moralizador. Tamagnini parece viajar através de espaços de socialização aristocrática, mais do que através de geografias e culturas. Mas o espaço urbano é progressivamente substituído pelo território ‘selvagem’, à medida que a viagem se aproxima do destino. E aqui o Diário funciona como texto paradigmático, se bem que por vezes irreverente, de uma representação etnocêntrica da colónia, dos agentes coloniais e ‘seus’ colonizados, com especial atenção à descrição dos ‘tipos’ femininos observados ao longo desta Viagem a Timor.

A Correspondência luso-brasileira: narrativa de um trânsito intercultural

O artigo explora a experiência intercultural entre Portugal e o Brasil, entre 1807 e 1823, de duas famílias oriundas da pequena nobreza rural do Norte de Portugal, com especial atenção ao percurso intercultural feminino. A Correspondência é uma representação polifónica de um movimento de transculturação pessoal, familiar, social e grupal, ao longo de quase duas décadas, e funciona como uma tradução por vezes consecutiva, outras vezes simultânea, dos eventos históricos testemunhados. O conceito de tradução intercultural aqui utilizado baseia-se no pensamento de Boaventura de Sousa Santos (2006; 2008). Esta análise da Correspondência articula os contextos concretos e situados do seu objecto de estudo, com o propósito de construir o conhecimento de diferentes momentos históricos, racionalidades e mundividências.

Comfort and functionality of pregnant women's feet study of kinetic parameters with silicon insoles

As gestantes, fruto das suas alterações fisiológicas e biomecânicas, constituem uma população de risco relativamente a dores ou lesões do sistema músculo-esquelético, nomeadamente, nos membros inferiores e coluna. Os objectivos deste estudo consistiram em avaliar: (i) a dor e o conforto dos pés durante a marcha: sem o uso de qualquer palmilha nas gestantes e no grupo de controlo; com a aplicação de uma palmilha de retropé e com a aplicação de uma palmilha completa (nas gestantes); (ii) a distribuição das pressões plantares e, (iii) as forças de reacção do solo nas mesmas condições experimentais. Avaliámos ainda a duração das diferentes fases do ciclo de marcha nas gestantes, com e sem palmilhas, e no grupo de controlo, sem o uso de palmilha. Os nossos resultados mostraram que: (i) as gestantes demoram mais tempo a completar a fase de apoio da marcha, (ii) têm um aumento significativo de dores nos pés, face ao grupo de controlo, (iii) as gestantes sentem menos dor e mais conforto quando realizam marcha, com palmilhas, especialmente com a palmilha completa, (iv) a palmilha completa redistribui as forças, diminui os valores de pressão e aumenta a área de contacto do pé com o solo. Os nossos resultados sugerem que, o uso da palmilha completa de silicone, durante a marcha, pode ser eficaz na melhoria da sintomatologia dolorosa e no aumento do conforto da grávida.

Comparative analysis of the ground reaction forces, during the support phase, in a group of pregnant women on their 3rd trimester of pregnancy and in a group of not pregnant women

PURPOSE: To analyze and compare the Ground Reaction Forces (GRF), during the stance phase of walking in pregnant women in the 3rd trimester of pregnancy, and non pregnant women. METHODS: 20 women, 10 pregnant and 10 non pregnant, voluntarily took part in this study. GRF were measured (1000 Hz) using a force platform (BERTEC 4060-15), an amplifier (BERTEC AM 6300) and an analogical-digital converter of 16 Bits (Biopac). RESULTS: The study showed that there were significant differences among the two groups concerning absolute values of time of the stance phase. In what concerns to the normalized values the most significant differences were verified in the maximums values of vertical force (Fz3, Fz1) and in the impulse of the antero-posterior force (Fy2), taxes of growth of the vertical force, and in the period of time for the antero-posterior force (Fy) be null. CONCLUSIONS: It is easier for the pregnant to continue forward movement (push-off phase). O smaller growth rates in what concerns to the maximum of the vertical force (Fz1) for the pregnant, can be associated with a slower speed of gait, as an adaptation strategy to maintain the balance, to compensate the alterations in the position of her center of gravity due to the load increase. The data related to the antero-posterior component of the force (Fy), shows that there is a significant difference between the pregnant woman’s left foot and right foot, which accuses a different functional behavior in each one of the feet, during the propulsion phase (TS).