Validity and reproducibility of retinal arteriole and venule diameter measurements: ELSA-Brasil study. A cross-sectional study

ABSTRACT BACKGROUND: Investigation of alterations to retinal microvasculature may contribute towards understanding the role of such changes in the pathophysiology of several chronic non-communicable diseases. The objective here was to evaluate the validity and reproducibility of retinal arteriole and venule diameter measurements made by Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) graders. DESIGN AND SETTING: Cross-sectional study at six teaching and research institutions. METHODS: To evaluate validity, each of 25 retinal images from the University of Wisconsin (gold standard) was measured by five ELSA-Brasil graders. To evaluate reproducibility, 105 images across the spectrum of vessel diameters were selected from 12,257 retinal images that had been obtained between 2010 and 2012, and each image was reexamined by the same grader and by an independent grader. All measurements were made using the Interactive Vessel Analysis (IVAN) software. Bland-Altman plots, paired t tests and intraclass correlation coefficients (ICCs) were analyzed. RESULTS: Mean differences between ELSA-Brasil and gold-standard readings were 0.16 µm (95% CI -0.17-0.50; P = 0.31) for central retinal artery equivalent (CRAE), -0.21 µm (95% CI -0.56-0.14; P = 0.22) for central retinal vein equivalent (CRVE) and 0.0005 (95% CI -0.008-0.009; P = 0.55) for arteriole/venule ratio (AVR). Intragrader ICCs were 0.77 (95% CI 0.67-0.86) for CRAE, 0.90 (95% CI 0.780.96) for CRVE and 0.70 (0.55-0.83) for AVR. Intergrader ICCs were 0.75 (95% CI 0.64-0.85) for CRAE, 0.90 (95% CI 0.79-0.96) for CRVE and 0.68 (95% CI 0.55-0.82) for AVR. CONCLUSIONS: Retinal microvascular diameter measurements are valid and present moderate to high intra and intergrader reproducibility in ELSA-Brasil.

Prevalência do HIV no Brasil 2005-2015: dados do Sistema Único de Saúde / HIV prevalence in Brazil 2005-2015: data from the Unified Health System / Prevalencia del VIH en Brasil 2005-2015: datos del Sistema Único de Salud

INTRODUÇÃO: O HIV, tornou-se um dos maiores problemas da saúde pública no mundo. O Brasil tem apresentado avanços em relação ao tratamento, porém teve alguns retrocessos. O objetivo do estudo foi descrever a prevalência do HIV no Brasil no período de 2005-2015. MATERIAIS E MÉTODOS: Estudo transversal com dados secundários do Sistema Único de Saúde (DATASUS) sobre notificações de HIV. A análise estatística se deu por meio do teste de qui-quadrado para comparar a frequência do número de casos de acordo com as variáveis de notificação de casos e obtenção das taxas de HIV. RESULTADOS: O Brasil apresentou entre os anos de 2005-2015 aumento nas taxas de notificações de HIV, passando de 11 casos em para 18 casos/100 mil habitantes. A região sul apresentou aumento de 16,6 para 28,9 casos/100 mil habitantes. Homens possuem as taxas mais altas de notificações, sendo a faixa etária mais prevalente a dos 30-49 anos. A Cor/Raça branca teve o maior percentual médio (46,9%) de pessoas com notificação entre os anos de 2005-2012. Pessoas com menores níveis educacionais tiveram queda nas taxas de notificações entre 2005-2015, passando de 45,4%-27,9%. DISCUSSÃO: No Brasil, observa-se no período avaliado o aumento nas taxas de prevalência de HIV, com predomínio de novos casos na faixa etária dos 30 aos 49 anos e do sexo masculino. CONCLUSÕES: São necessárias medidas de prevenção e educação em saúde desta população mais exposta ao risco sejam realizadas no país com maior frequência, principalmente nas regiões que se tem maior número de registros do país.

INTRODUCTION: HIV has become one of the biggest public health problems in the world. Brazil has progressed in relation to treatment; however, it has had some setbacks. The aim of this study was to describe the prevalence of HIV in Brazil for the period from 2005-2015. MATERIALS AND METHODS: Cross-sectional study with secondary data from the Unified Health System (DATASUS) on HIV notifications. Statistical analysis was performed by using the chi-square test to compare the frequency of the number of cases, according to the variables of case reporting and obtaining HIV rates. RESULTS: Between 2005 and 2015, Brazil had an increase in the rates of HIV notifications, going from 11 cases to 18 cases per 100-thousand inhabitants. The southern region had an increase from 16.6 to 28.9 cases per 100-thousand inhabitants. Men had the highest rates of notifications, with the age range from 30 to 49 years of age being the most prevalent. The white color/race had the highest average percentage (46.9%) of people with notification between 2005 and 2012. People with lower educational levels had a drop in reporting rates between 2005 and 2015, from 45.4% to 27.9%. DISCUSSION: In Brazil, increased HIV prevalence rates were observed during the period evaluated, with a prevalence of new cases in males 30 to 49 age group. CONCLUSIONS: Health prevention and education measures in this population most exposed to the risk are needed in the country with higher frequency, especially in regions with the highest number of records in the country.

INTRODUCCIÓN: El VIH, se ha convertido en uno de los mayores problemas de salud pública en el mundo. Brasil ha presentado avances en relación al tratamiento, sin embargo tuvo algunos retrocesos. El objetivo del estudio fue describir la prevalencia del VIH en Brasil en el período 2005-2015. MATERIALES Y MÉTODOS: Estudio transversal con datos secundarios del Sistema Único de Salud (DATASUS) sobre notificaciones de VIH. El análisis estadístico se dio por medio de la prueba de chi-cuadrado para comparar la frecuencia del número de casos de acuerdo con las variables de notificación de casos y obtención de las tasas de VIH. RESULTADOS: Brasil presentó entre los años 2005-2015 un aumento en las tasas de notificaciones de VIH, pasando de 11 casos a 18 casos/100 mil habitantes. La región sur presentó un aumento de 16.6 a 28.9 casos/100 mil habitantes. Los hombres poseen las tasas más altas de notificaciones, siendo el grupo de edad más prevalente de los 30-49 años. El color/raza blanca tuvo el mayor porcentaje medio (46.9%) de personas con notificación entre los años 2005-2012. Las personas con menores niveles educativos cayeron en las tasas de notificaciones entre 2005-2015, pasando del 45.4%-27.9%. DISCUSIÓN: En Brasil, se observa en el período evaluado el aumento en las tasas de prevalencia del VIH, con predominio de nuevos casos en la franja etaria de los 30 a los 49 años y del sexo masculino. CONCLUSIONES: Son necesarias medidas de prevención y educación en salud de esta población más expuesta al riesgo se realicen en el país con mayor frecuencia, principalmente en las regiones que se tienen mayor número de registros del país.