Cerebrovascular and hypertensive diseases as multiple causes of death in Brazil from 2004 to 2013.

OBJECTIVES: The proportion of deaths attributed to hypertensive diseases (HYPDs) was only 50% of that registered for cerebrovascular diseases (CBVDs) in 2013 in Brazil. This article aims to evaluate mortality related to HYPDs and CBVDs as multiple causes of death, in Brazil from 2004 to 2013. STUDY DESIGN: Analysis of historical series of secondary data obtained from Brazilian official registries. METHODS: Data about the deaths were obtained from the Mortality Information System of the Brazilian Ministry of Health, available on the DATASUS website. CBVDs and HYPDs were evaluated according to their mentions as the underlying cause of death or entry in any line of the death certificates (DCs), according to their International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes. RESULTS: When CBVDs were the underlying causes of death, HYPDs were mentioned in 40.9% of the DCs. When HYPDs were the underlying causes of death, CBVDs were mentioned in only 5.0%. When CBVDs were mentioned without HYPDs, they were selected as the underlying cause of death 74.4% of the time. When HYPDs were mentioned in DCs without CBVDs, HYPDs were selected 30.0% of the time. In 2004, the frequency of any mention of HYPDs relative to the frequency of HYPDs cited as underlying causes increased fourfold and was followed by a plateau until 2013. In contrast, the frequency of any mention of CBVDs relative to the frequency of CBVDs as underlying causes decreased in the same period. Because this study was based on DC records, it was limited by the way these documents were completed, which may have included lack of record of the causes related to the sequence that culminated in death. CONCLUSION: When deaths related to HYPDs were evaluated as multiple causes of death, they were mentioned up to four times more often than when they were selected as underlying causes of death. This reinforces the need for better control of hypertension to prevent deaths.

Development of pro- and antisaccades in children with attention-deficit hyperactivity disorder (ADHD) and healthy controls.

To date, the investigation of the antisaccade task, a simple test of "executive functions," in children with ADHD has yielded inconsistent results. The present study aimed at contributing to this issue by (a) the investigation of a large sample of carefully diagnosed ADHD patients aged 7-15 years, and (b) the analyses of differential age effects in patients and controls. Healthy control children were pairwise matched with patients (N = 46; age = 136 +/- 24 months) for age and gender, and did not significantly differ in IQ. Horizontal pro- and antisaccades were elicited under the 200-ms gap and overlap conditions (blocks of 100 trials each). Overall, patients exhibited (a) augmented pro- and antisaccadic reaction times, (b) augmented error rates (antitasks), (c) augmented proportions of early responses (all conditions), and (d) reduced proportions of express saccades under the prosaccadic gap condition. The greater decline in anti- as compared to pro-SRT with increasing age that characterized controls was missing in patients. Confirming Barkley's (1997) neuropsychological theory of ADHD, these results altogether point to alterations in "executive functions" in ADHD patients that are presumably supported by frontal lobe structures, in particular the lateral prefrontal cortex and the frontal eye fields.

The gap effect in pro-saccades and anti-saccades in psychometric schizotypes.

Schizophrenic patients and their first-degree relatives exhibit deficits in the anti-saccade task. In the present study, anti-saccade task performance was examined in subjects with 'high' and 'low' expressions of the schizotypal personality trait. For that purpose, the SPQ-G, the German adaptation of the Schizotypal Personality Questionnaire (SPQ; Raine, 1991), was filled in by 489 university students. Twenty and 21 participants with 'high' and 'low' SPQ-G scores, respectively, were compared with respect to saccadic eye movements elicited under the overlap and 200 ms gap conditions of the pro- and anti-saccade tasks. Each task block comprised 150 trials, 75 to either side in random order. The order of presentation of the task blocks was counterbalanced across the participants of each group. Saccadic reaction times were slower during the anti- as compared to the pro-saccade task and under the overlap as compared to the gap condition. Direction errors occurred almost exclusively during the anti-saccade task, express saccades mainly under the pro-saccadic gap condition. High-schizotypal participants did not differ significantly from low-schizotypal participants in any of these measures. While these results might suggest normal anti-saccade task performance in schizotypal personality as defined by the SPQ-G, the sampling strategy adopted in the present study is the more plausible explanation for the lack of group differences.

Structural barriers and facilitators in HIV prevention: a review of international research.

OBJECTIVES: This article provides an overview of a growing body of international research focusing on the structural and environmental factors that shape the spread of the HIV/AIDS epidemic, and create barriers and facilitators in relation to HIV-prevention programs. OVERVIEW OF STRUCTURAL-FACTORS LITERATURE: Most of the research on structural and environmental factors can be grouped into a small number of analytically distinct but interconnected categories: economic (under)development and poverty; mobility, including migration, seasonal work, and social disruption due to war and political instability; and gender inequalities. An additional focus in research on structural and environmental factors has been on the effects of particular governmental and intergovernmental policies in increasing or diminishing HIV vulnerability and transmission. INTERVENTIONS: A smaller subset of the research on structural factors describes and/or evaluates specific interventions in detail. Approaches that have received significant attention include targeted interventions developed for heterosexual women, female commercial sex workers, male truck drivers, and men who have sex with men. CONCLUSIONS: The structural and environmental factors literature offers important insights and reveals a number of productive intervention strategies that might be explored in both resource-rich and -poor settings. However, new methodologies are required to document and evaluate the effects of the structural interventions, which by their very nature involve large-scale elements that cannot be easily controlled by experimental or quasi-experimental research designs. Innovative, interdisciplinary approaches are needed that can move beyond the limited successes of traditional behavioral interventions and explicitly attempt to achieve broader social and structural change.

[Evaluation of the protection received by a BC antimeningococcal vaccine in the State of Santa Catarina, Brazil, 1990/92]. / Avaliação da proteção conferida pela vacina antimeningocócica BC no estado de Santa Catarina, Brazil, 1990/92.

Results of the evaluation of the anti-meningococcal BC Cuban vaccine based on routine epidemiological surveillance information of meningitis for the years 1990 to 1992, following mass-vaccination of 232,022 children aged between 3 months and 7 years in 1989/90 during an epidemic of serogroup B meningococcal disease in the State of Santa Catarina, Brazil, are presented. The protective efficacy of the vaccine was calculated from the incidence rates for the cohort of vaccinated and non-vaccinated children in 20 municipalities. Main results for cases confirmed by bacteriological tests were 59% (CI 95%: 23 to 78%) for children aged under 4 years and 78% (CI 95%: 54 to 90%) for children aged 4 to 7 years. Eighty-six percent of cases serogrouped (n = 29) were B, and in these cases efficacy increased to 66% (< 4 years) and 88% (4-7 years), but at 95% CI were wider. The protective efficacy based on death rates from the disease in children < 4 years was 76% (CI 95%: 41 to 91%). There was no evidence of decreasing protective efficacy in the three year follow-up, as shown by the yearly estimates. An interesting hypothesis arising from the findings is that the lower protective efficacy for children aged < 4 years, observed in studies in which only cases confirmed by laboratory tests are analysed, could be due to a selective effect of this procedure. More severe cases die shortly after the onset of the disease, often before medical care is provided. On the other hand, the attenuation of the disease by vaccination gives a better chance for medical intervention and collection of samples for laboratory analysis. Finally, the authors support the use of the vaccine in epidemics of serogroup B meningococcal disease. They also suggest that three, rather than two doses of vaccine should be tested in children under 2 years of age to further increase its efficacy.

[Arterial hypertension in Ilha do Governador, Rio de Janeiro, Brazil: II. Prevalence]. / Hipertensão arterial na Ilha do Governador, Brasil: II. Prevalência.

The aim of this paper (the second of two) is to present the basic results of a cross-sectional study on arterial hypertension in adults in Ilha do Governador (a district of the city of Rio de Janeiro, Brazil), with a representative sample of the population, stratified by the census tracts' mean household income (low, median, and high). Overall, prevalence of uncontrolled hypertension in Ilha do Governador was 16.1% (C.I. of 95%: 13.4 to 18.9%), and with the inclusion of controlled hypertensive individuals this figure rose to 24.9% (C I. of 95%: 21.7 to 28.7%). Under both criteria (whether including controlled hypertensive individuals or not), higher prevalences were from low-income strata, while lower ones were from the high-income strata. However, it was only possible to reject the hypothesis of strata homogeneity of prevalences (including controlled hypertensives), and even then at a 10% level of significance, when the confounding effect of age was adjusted. Proportionally, women with hypertension appear to control their blood pressure levels better than men in all age brackets.

[Arterial hypertension in Ilha do Governador, Rio de Janeiro, Brazil: I. Methodology]. / Hipertensão arterial na Ilha do Governador, Rio de Janeiro, Brasil: I. Metodologia.

The aim of this paper (first of a series of two) is to present the main methodological aspects used in a cross-sectional study whose proposals were to establish the prevalence of arterial hypertension in adults in Ilha do Governador (a district of the city of Rio de Janeiro, Brazil), and to examine its relationship to other risk factors, including those for cardiovascular diseases, so as to establish its control status. Sampling design (of clusters in strata, according to mean household income) is described in detail, in addition to measurement methods, and training of observers. Indicators of performance in field work and quality control are also presented as results of the application of the metodology of study.

Diastolic pressure as an index of salt sensitivity.

This paper analyses the association between blood pressure and sodium excretion in 3975 individuals aged 20-74 years, selected in a probability sample survey of private households carried out in Rio Grande do Sul, Brazil. Sodium and creatinine titrations were performed in casual urine samples collected at the time of BP measurements. A subsample of 611 subjects provided 24 h urine collections. The regression slopes of systolic pressure on sodium excretion increased when diastolic level was higher. At the lowest levels of diastolic pressure the slope did not differ significantly from zero. The adjusted correlation coefficient then rose progressively to a maximum of +0.41 at diastolic pressures of 95-99 mmHg. Strikingly, at diastolic pressures of > or = 100 mmHg, there was no longer any significant association between systolic pressure and sodium excretion. These results could explain some earlier contradictory findings concerning the role of salt intake in hypertension and provide estimates of expected reduction on the prevalence of hypertension in each diastolic pressure group following a reduction on salt intake of a population.

[Arterial hypertension and obesity in Ilha do Governador-Rio de Janeiro]. / Hipertensão arterial e obesidade na Ilha do Governador-Rio de Janeiro.

PURPOSE: To investigate the association between hypertension and obesity and also their prevalence in the adult population from Ilha do Governador-Rio de Janeiro. METHODS: It is a domiciliar inquiry, with a probalistic cluster sample in two stages. We interviewed 1272 adult residents in the selected households. Social-demographic information, anthropometric measures, habits related to smoking, physical activities and blood pressure were registered. RESULTS: The prevalence of hypertension-systolic pressure > or = 160mmHg or diastolic pressure > or = 95mmHg or anti-hypertensive treatment at the moment of the interview, was 24.9% whereas the prevalence of obesity-body mass index (BMI) > or = 27kg/m2 was 28.4%. The prevalence of hypertension increased 2.4 fold from the lowest (< 25kg/m2) to the highest (> or = 30kg/m2) band of BMI. It was observed an association between hypertension and obesity that persisted after adjusting for sex, age, skin color, smoking, physical activity and level of education. Interaction of obesity with sex, age and skin color was found. The association between hypertension and obesity was stronger for men, for the youngest and also for the white people. CONCLUSION: The results point out the necessary of actions to prevent and control the occurrence of both hypertension and obesity, mainly at younger ages, to decrease the rates of cardiovascular diseases.

Genetic and nongenetic determinants of blood pressure in a southern Brazilian sample.

A probabilistic sample representative of the adult population of Rio Grande do Sul, Brazil, was studied to estimate the genetic and nongenetic determinants of blood pressure. Four thousand five hundred and sixty-five individuals, 20 to 74 years old, from 2050 households, were examined. The genetic determination of the SBP (systolic blood pressure) and DBP (diastolic blood pressure) was evaluated in 557 families extracted from this sample. The analysis was performed first with no adjustments for other influencing factors, and then adjusting for the effects of the two significant covariates, age and Quetelet's index, identified through a multiple stepwise regression analysis with nine independent variables. Higher heritability estimates were obtained for DBP (raw data: 0.40; residuals: 0.45) than for SBP (raw data: 0.22; residuals: 0.26). The significant correlation coefficients varied from 0.13 (for father-offspring raw data, total sample), to 0.36 (for siblings, adjusted data, untreated sample). Slight differences were observed between the total and pharmacologically untreated samples in relation to correlation and heritability estimates.

[Risk of tubercular infection among schoolchildren with high BCG coverage]. / Risco de infecção tuberculosa entre escolares com alta cobertura pelo BCG.

Mycobacterium tuberculosis infections may be difficult to detect by the tuberculin test in populations where nonspecific tuberculin sensitivity (induced by BCG and "atypical" mycobacteria) is frequent. In those populations, the rate of M. tuberculosis infection can be determined by comparing the levels of sensitivity before and after BCG vaccination, and classifying as infected those who do not show increased sensitivity in the post-vaccination test. To test this method on a BCG-vaccinated population, a survey was carried out in a sample of 1,721 schoolchildren 6 to 10 years of age, from a suburban area of the city of Rio de Janeiro, where BCG vaccination had been carried out on a large scale. The results suggest that the method is valid for BCG-vaccinated populations, although its accuracy may be affected by the intrinsic variability of tuberculin tests and BCG vaccination, by the action of infections with non-tuberculous mycobacteria, and by low infection rates. The tuberculous infection rate found in the sample group (4.13%) was compared with the results of a tuberculin survey carried out in the same area in 1970, and the incidence of infection was found to be decreasing by 7.68% annually. The annual risk of tuberculous infection for 1986 was 0.36 or 0.51%, depending on the mathematical model used for the calculation. These figures are smaller than the official estimates derived from the incidence rates of notified cases or from surveys made before intradermal vaccination was adopted. This may be due to methodological error, inaccuracies of notification data, association between age and risk of infection and/or peculiarities of the surveyed area.

Salt and blood pressure in Rio Grande do Sul, Brazil.

A 1978 survey of 4,565 people in Rio Grande do Sul obtained interview and blood pressure data as well as casual urine specimens for subsequent sodium and creatinine titrations. Data derived from this survey have demonstrated a variety of complex relationships between blood pressure and sodium, a number of which are examined here. The main conclusion is that observed blood pressure differentials could reflect the kidney's ability to handle sodium, an ability subject to the influences of age, heredity, and the environment. As a consequence, it is suggested that the adoption of salt restriction by populations could bring them large health benefits.

[Sources of discrepancy in psychiatric diagnosis at hospitals in Rio de Janeiro, Brazil]. / Fontes de discordância em diagnósticos psiquiátricos em hospitais do Rio de Janeiro, Brasil.

The hospitalization records for two consecutive admissions of the same patients were examined at three psychiatric hospitals in Rio de Janeiro, Brazil. The authors investigated sources of discrepancy between diagnosis, examining such data as sex and age of patients, type of hospital (public, private or academic), type of diagnosis, interval between admissions, average duration of stay, and whether or not the evaluating physicians and the institutions were the same in both admissions. The diagnosis categories "Schizophrenia" and "Alcohol and drugs" showed fewer discrepancies than the other groups of diagnoses as a whole, regardless of the hospital in which the admissions had been (P less than 0.01). In the case of patients with the two admissions at different hospitals, the type of diagnosis and the interval between the last two admissions were found to be associated with diagnosis discrepancy (P less than 0.05). When the last two admissions were to the same institution, discrepancies were associated with the type of hospital and whether or not the attending physician was the same in both events (P less than 0.01).