Association between common mental disorders, sleep quality, and menopausal symptoms: a population-based study in Southern Brazil.

OBJECTIVE: To investigate the association between common mental disorders (CMD), sleep quality, and moderate and severe menopausal symptoms in adult women in southern Brazil. METHODS: This cross-sectional, population-based study investigated a representative sample of 393 women (age 40-69 years) living in an urban area. A standardized and pretested questionnaire that included the Self-Reporting Questionnaire-20 for CMD (Self-Reporting Questionnaire-20 ≥7), the Pittsburgh Sleep Quality Index-BR for sleep disorders (Pittsburgh Sleep Quality Index >5), and the Menopause Rating Scale for moderate/severe menopausal symptoms (Menopause Rating Scale >8) was used for data collection. Unadjusted and adjusted prevalence ratios and 95% confidence intervals (95% CIs) were estimated using robust Poisson regression. RESULTS: The prevalence of moderate/severe menopausal symptoms in the sample was 58.0% (95% CI 53.0-63.0), the prevalence of CMD was 40.2% (95% CI 35.3-45.2), and the prevalence of poor sleep quality was 49.4% (95% CI 44.3-54.5). CMD and poor sleep quality occurred simultaneously in 34.4% of participants (95% CI 29.6-39.3). Moderate/severe menopausal complaints were significantly more prevalent in women with CMD (P < 0.001) and poor sleep quality (P < 0.001); the presence of both CMD and poor sleep quality increased the likelihood of moderate/severe menopausal complaints threefold. After adjustment, CMD and poor sleep quality remained strongly and significantly associated with moderate/severe menopausal complaints (P < 0.001). CONCLUSIONS: Considering the complex time-course relationship between CMD, sleep quality, and menopausal symptoms, longitudinal studies should follow women with these issues throughout the menopausal period to identify a possible temporal link between exposures and outcome. : Video Summary:http://links.lww.com/MENO/A554.

Hypertension Management in Brazil: Usual Practice in Primary Care-A Meta-Analysis.

Knowing the usual clinical practice is relevant for evaluations in health care and economic policies of management of hypertension. This study aimed to describe the usual management of hypertension in the Brazilian primary healthcare system through a systematic review and meta-analysis. The search of population-based studies conducted in Brazil was undertaken using PubMed, EMBASE, and Brazilian databases. Eligible studies were those conducted in adults with hypertension (blood pressure (BP) ≥ 140/90 mmHg or using BP lowering drugs). Three datasets' data were analyzed: SESI study (in Brazilian workers); HIPERDIA (Brazilian Registration and Monitoring of Hypertensive and Diabetic Patients Program); and a population-based study. Meta-analysis has been performed using the fixed and random effect models. A total of 11 studies or data sets were included in the systematic review. Hypertensive individuals had, on average, 2.6 medical visits annually and 18.2% were on diuretics (n = 811 hypertensive patients) and 16.2% on ACE inhibitors (n = 1768 hypertensive patients). BP control rate ranged from 43.7 to 67.5%; 35.5% had measured total cholesterol and 36.5% determined fasting plasma glucose in the previous 12 months. Thiazide diuretics and ACE inhibitors were the most used BP lowering medications as single drugs, but the control rate of hypertension is insufficient.

Impact of nightshift work on overweight and abdominal obesity among workers of a poultry processing plant in southern Brazil.

The authors examined the associations of shiftwork with overweight and abdominal obesity through a cross-sectional study of 1206 employees 18 to 50 yrs of age who were working on a production line in a poultry processing plant. Night-shift workers (n = 800) were considered exposed, whereas day shiftworkers (n = 406) were considered nonexposed. Overweight was defined as a body mass index ≥ 25 kg/m(2) and abdominal obesity as a waist circumference ≥ 88 cm in women and ≥ 102 cm in men. The mean age of the workers was 30.5 yrs (standard deviation = 8.7 yrs), and 65.2% were women. Nightshift workers compared to dayshift workers showed higher prevalences of overweight (42.2% vs. 34.3%; p= .020) and abdominal obesity (24.9% vs. 19.5%; p = .037). After adjusting for sociodemographics, parental overweight status, behavioral characteristics, and sleep characteristics, including hours of sleep, the prevalence ratios for overweight and abdominal obesity were 1.27 (95% confidence interval [ CI]: 1.00-1.61) and 1.45 (95% CI: 1.10-1.92), respectively, for the nightshift workers compared to the dayshift workers. A consistent finding in our study was the independent contribution of night shiftwork to overweight and abdominal obesity among Brazilian workers. Further studies are needed to understand the biological mechanisms involved and the complex behavioral and social adaptations experienced by night-shift workers.

Major dietary patterns and cardiovascular risk factors among young Brazilian adults.

PURPOSE: Diet is one of the most important modifiable risk factors for cardiovascular diseases. The scientific literature has consistently shown the effects of certain diets on health; however, given the variety of cultures and dietary habits across the world, it is likely that much remains to be learned about dietary patterns and health outcomes. We assessed the associations between main dietary patterns and cardiovascular risk factors among 4,202 young Brazilian adults in a cross-sectional analysis. METHODS: In a principle components analysis, two main dietary patterns were identified: common Brazilian and processed food. As outcomes, we examined body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, HDL cholesterol (HDL-c), and LDL cholesterol (LDL-c). Means, crude, and adjusted ß coefficients and 95% CIs were estimated according to quintiles of dietary patterns. RESULTS: Common Brazilian scores were inversely associated with BMI, WC, LDL-c, HDL-c, and total cholesterol values among men. Among women, inverse association trends were observed with SBP, DBP, LDL-c, HDL-c, and total cholesterol. The processed food pattern was positively associated with LDL-c, HDL-c, total cholesterol, BMI, and WC values among the men. Among the women, the processed food pattern was not significantly associated with cardiovascular risk factors. CONCLUSIONS: In conclusion, our findings confirm that diet has an important role on health during early adulthood. The common Brazilian pattern showed generally healthier trends regarding CVD risk factors, but the ultimate effects on risk of risk of disease are unclear because of the inverse relation with HDL-c levels.

Sociodemographic and lifestyle characteristics in relation to dietary patterns among young Brazilian adults.

OBJECTIVE: To identify dietary patterns among young adults and the relationships with socio-economic, demographic and lifestyle characteristics. DESIGN: Population-based, cross-sectional analysis of a cohort study. Food intake was assessed by a frequency questionnaire, and dietary patterns were identified using principal components analysis. SETTING: Southern Brazil. SUBJECTS: A total of 4202 men and women aged 23 years, who participated in the 1982 Pelotas Birth Cohort Study. RESULTS: Five dietary patterns were identified: common Brazilian, processed food, vegetable/fruit, dairy/dessert and tubers/pasta. Subjects who had low own or maternal educational levels, low social position or who were always poor throughout life had high adherence to the common Brazilian dietary pattern. In contrast, the processed food pattern was more likely to be followed by those belonging to middle and high social position and who were never poor. Men and smokers showed high adherence to the processed food and common Brazilian dietary patterns. Vegetable/fruit pattern was more likely to be followed by women and subjects engaged in physical activity. Women also showed high adherence to the dairy/dessert pattern. CONCLUSIONS: Our study among young Brazilian adults has identified distinct dietary patterns that are clearly influenced by socio-economic and lifestyle characteristics, which have important policy implications in a country with marked social and economic inequalities.

Inadequate use of prenatal services among Brazilian women: the role of maternal characteristics.

CONTEXT: To improve the uptake of prenatal care, it is important to know how the use of prenatal care varies by maternal attitudes and social and demographic factors. METHODS: Information about social and demographic variables, prenatal care, parity, pregnancy planning, abortion attempts, satisfaction with pregnancy and satisfaction with the relationship with the child's father was collected from 611 postpartum women in Porto Alegre in southern Brazil. Multinomial logistic regression was used to evaluate associations between these variables and whether the women's use of prenatal care was adequate, partially inadequate or inadequate. RESULTS: About 40% of women had inadequate or partially inadequate prenatal care. After adjustment for other covariates, including satisfaction with the pregnancy, women having an unplanned pregnancy were significantly more likely to have had inadequate care than women who had planned their pregnancy (odds ratio, 2.0). Not living with the child's father (2.8) and dissatisfaction with pregnancy (2.1) were also associated with inadequate use of prenatal care. Women having their second or higher order birth were significantly more likely to report inadequate use of prenatal care than women having their first birth (3.9-9.0). Household income was inversely associated with inadequate use of care. CONCLUSIONS: The study suggests that maternal attitudes may be important for adequate prenatal care. Interventions should be created to encourage women with negative maternal attitudes to use prenatal care and to ensure that they have access to the care they need.

Abnormal eating behaviors in adolescent and young adult women from southern Brazil: reassessment after four years.

OBJECTIVE: To investigate whether abnormal eating behaviors in young women could predict eating disorders after 4 years. METHOD: 56 women were identified as presenting abnormal eating behaviors in a cross-sectional study (Eating Attitudes Test-26 and Edinburgh Bulimic Investigation Test). They were matched for age and neighborhood to two controls (n = 112). Four years later, they were re-assessed with the two screening questionnaires plus the Composite International Diagnostic Interview (CIDI 2.1). RESULTS: Women with abnormal eating behaviors at baseline showed a high probability of presenting abnormal eating behaviors but it was not associated with eating disorders 4 years later. They were also at higher risk for obsessive-compulsive disorder, post-traumatic stress disorder, and specific phobia. DISCUSSION: Abnormal eating behaviors were related to the maintenance of the disturbed behavior over the years, and were associated with increased probability for psychiatric diagnoses.

Prevalence and associations of symptoms of upper extremities, repetitive strain injuries (RSI) and 'RSI-like condition'. A cross sectional study of bank workers in Northeast Brazil.

BACKGROUND: The repetitive strain injury syndrome (RSI) is a worldwide occupational health problem affecting all types of economic activities. We investigated the prevalence and some risk factors for RSI and related conditions, namely 'symptoms of upper limbs' and 'RSI-like condition'. METHODS: We conducted a cross-sectional study with 395 bank workers in Recife, Northeast Brazil. Symptoms of upper limbs and 'RSI-like condition' were assessed by a simple questionnaire, which was used to screen probable cases of RSI. The diagnosis of RSI was confirmed by clinical examination. The associations of potential risk factors and the outcomes were assessed by multiple logistic regression analysis. RESULTS: We found prevalence rates of 56% for symptoms of the upper limbs and 30% for 'RSI-like condition'. The estimated prevalence of clinically confirmed cases of RSI was 22%. Female sex and occupation (as cashier or clerk) increased the risk of all conditions, but the associations were stronger for cases of RSI than for less specific diagnoses of 'RSI-like condition' and symptoms of upper limbs. Age was inversely related to the risk of symptoms of upper limbs but not to 'RSI-like' or RSI. CONCLUSION: The variation in the magnitude of risk according to the outcome assessed suggests that previous studies using different definitions may not be immediately comparable. We propose the use of a simple instrument to screen cases of RSI in population based studies, which still needs to be validated in other populations. The high prevalence of RSI and related conditions in this population suggests the need for urgent interventions to tackle the problem, which could be directed to individuals at higher risk and to changes in the work organization and environment of the general population.

Influência da percepção do peso e do índice de massa corporal nos comportamentos alimentares anormais / Influence of body mass index and body weight perception on eating disorders symptoms

Objetivo: Estudar a associação entre a percepção do peso corporal, o índice de massa corporal e os comportamentos alimentares anormais. Métodos: Delineamento transversal, de base populacional, com mulheres de 12 a 29 anos, da zona urbana de Porto Alegre, RS (n=513). Para medir a prevalência de comportamentos alimentares anormais utilizou-se o Teste de Atitudes Alimentares 26 (EAT-26) e o Teste de Investigação Bulímica de Edimburgo (BITE), considerados separadamente e em conjunto, e a percepção do peso corporal por meio de 2 perguntas estruturadas: qual era o peso que a mulher julgava ideal e a auto-avaliação sobre seu peso. O índice de massa corporal (IMC) foi calculado por medida de peso e altura aferidos. Resultados: Considerando os instrumentos conjuntamente, 30,2 por cento das mulheres tinham comportamento alimentar de risco, e 11,3 por cento apresentaram comportamento alimentar anormal. Além disso, 82 por cento das mulheres apresentaram IMC normal, sendo que 2 por cento eram magras, e 16 por cento apresentaram IMC de sobrepeso/obesidade. Das mulheres estudadas, 46 por cento tinham o ideal de pesar menos, e 37,8 por cento consideravam-se gordas. Entre as mulheres com IMC normal, 25,2 por cento das que se achavam normais apresentavam comportamento alimentar de risco, e 5,7 por cento comportamento alimentar anormal. Das mulheres que se consideravam gordas, 47,2 por cento apresentaram comportamento alimentar de risco, e 19,2 por cento tinham comportamento alimentar anormal. Mulheres que se sentiam gordas apresentaram um risco quatro vezes maior de apresentar comportamentos alimentares anormais (razão de odds 4,50; IC 95 por cento 2,88-7,01; p<0,001). Conclusão: A percepção do peso corporal-sentir se gorda - mostrou um papel mais importante na determinação dos comportamentos alimentares anormais do que o índice de massa corporal (IMC sobrepeso/obesidade)

Características reprodutivas de mulheres de 15 a 49 anos: estudos comparativos e planejamento de açöes / Reproductive charactistics of women from 15 to 49 years of age: comparative studies and planning for actions

A disponibilidade de dados sobre o perfil socioeconomico, demográfico e reprodutivo das mulheres tanto em nível nacional, regional e municipal permite comparaçöes entre regiöes além de oferecer subsídios para o planejamento de açöes do Programa de Assistência Integral à Saúde da Mulher. Foi realizado um estudo transversal de base-populacional com uma amostra de 3.002 mulheres de 15 a 49 anos residindo na zona urbana da cidade de Pelotas, RS. As informaçöes socioeconômicas, demográficas e reprodutivas foram obtidas através de um questionário estruturado. A análise foi realizada através da comparaçäo estatística de médias e proporçöes. Na análise da esterilizaçäo os dados foram controlados para a idade. Cerca de 56 por cento das mulheres eram casadas/em uniäo e 35 por cento solteiras. Um terço das mulheres eram donas-de-casa e 50 por cento tinham trabalho remunerado. Cerca da metade das adolescentes tinham vida sexual ativa, e dessas, 33 por cento já tinham estado grávidas. Observou-se elevado percentual de gravidez indesejada principalmente entre as jovens. O número médio de filhos entre as mulheres de 45 a 49 anos - final da vida reprodutiva - foi de 2,4. Os métodos contraceptivos mais prevalentes foram a pílula e a esterilizaçäo. Entre as mulheres casadas/em uniäo, 15 por cento estavam esterilizadas. Cerca de 25 por cento das mulheres acima de 35 anos haviam feito ligadura tubária. Entre as mulheres esterilizadas, 29,6 por cento tinham tido perda fetal e 18,3 por cento haviam tido peo menos um filho prematuro. Entre o total de maridos/companheiros, 20 por cento näo aceitavam o uso de pelos menos um método contraceptivo. Os resultados confirmam a necessidade de uma maior atençäo e desenvolvimento de programas especiais para adolescentes, de melhorias no acesso aos serviços de expansäo do uso das opçöes anticoncepcionais disponíveis e de açöes programáticas e pesquisas sobre o tema "homem/saúde reprodutiva"

Amamentaçäo e padroes alimentares em crianças de duas coortes de base populacional no sul do Brasil: tendências e diferenciais / Breastfeeding and feeding patterns in two cohorts of children in souther brazil: trends and differences

Avalia as mudanças na duraçäo da amamentaçäo na cidade de Pelotas, Rio Grande do Sul, entre os anos de 1982 e 1993. Foram avaliados todos os nascimentos hospitalares ocorridos em ambos os anos, e amostras sistemáticas dessas crianças foram visitadas com cerca de 12 meses de idade. Observou-se um aumento na duraçäo mediana da amamentaçäo de 3,1 meses em 1982 para 4,0 meses em 1993. Este aumento suporta um possível impacto das campanhas nacionais ocorridas durante a década. Em ambas as coortes, houve interaçäo entre a renda familiar e os percentuais de crianças amamentadas em diferentes idades. Nos primeiros meses, estes percentuais foram superiores nas famílias de maior renda, mas, a partir de nove meses, a amamentaçäo foi mais frequente no grupo de baixa renda. Crianças com baixo peso ao nascer apresentaram duraçoes mais curtas de amamentaçäo. Apesar ds progressos observados, a duraçäo do aleitamento permanece bastante inferior ao recomendado internacionalmente, salientando a necessidade de campanhas futuras que priorizem crianças com baixo peso ao nascer e pertencentes às famílias de baixa renda.

Determinantes da desnutriçao infantil em uma populaçao de baixa renda: um modelo de análise hierarquizado / Determinants of malnutrition in a low-income population: hierarchical analytical model

Para investigar os determinantes da desnutriçao infantil em populaçoes de baixa renda, estudou-se os efeitos da variáveis sócioeconômicas, ambientais, reprodutivas, de morbidade, de cuidados maternos, de peso ao nascer e de amamentaçao sobre dois indicadores nutricionais: altura/idade e peso/altura. Todas as 354 crianças menores de 2 anos vivendo em duas áreas pobres da periferia urbana de Pelotas, no sul do Brasil, foram incluídas no estudo. Realizou-se uma análise multivariada, levando-se em consideraçao um modelo hierárquico dos fatores de risco na determinaçao destes déficits nutricionais. As variáveis selecionadas em um determinado nível do modelo permaneciam e eram consideradas fatores de risco para a desnutriçao, mesmo que, com a inclusao de variáveis hierarquicamente inferiores, estas houvessem perdido sua significância estatística. O modelo final para o déficit de altura/idade foi composto pelas variáveis educaçao e presença do pai, educaçao da mae, trabalho materno, peso ao nascer e idade da criança. O modelo final para peso/altura constituiu-se das variáveis número de utilidades domésticas, intervalo interpartal, condiçoes de moradia, bairro, peso ao nascer, idade e sexo da criança, e hospitalizaçoes prévias