74 results on '"Pedro Guatimosim Vidigal"'
Search Results
2. Validation of equations to estimate kidney function with and without adjustment by race/color in Brazilian adults (ELSA-Brazil)
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Wagner Luis da Cruz Almeida, Sandhi Maria Barreto, Pedro Guatimosim Vidigal, and José Geraldo Mill
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Glomerular filtration rate ,Chronic kidney diseases ,Kidney function tests ,Creatinine ,Public aspects of medicine ,RA1-1270 - Abstract
ABSTRACT Objective: To evaluate accuracy and agreement between creatinine clearance (CrCl) measured in 12-h urine and glomerular filtration rate (GFR) calculated by the Modification of Diet in Renal Disease (MDRD-4) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas, with and without adjustment for race/color. Methods: Baseline data from the Longitudinal Study of Adult Health (ELSA-Brazil) in adults (35-74 years of age) of both genders were used. Serum creatinine was measured in fasting blood and urinary creatinine was measured in an overnight 12-h urine collect. The agreement between CrCl and the calculated GFR was analyzed by the Bland-Altman method. One-way analysis of variance (ANOVA) with race/color factor was used to verify differences between means of CrCl and GFR with and without correction for race/color. Statistical significance was accepted for p
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- 2023
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3. Optimizing strategies to identify high risk of developing type 2 diabetes
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Paula Andreghetto Bracco, Maria Inês Schmidt, Alvaro Vigo, José Geraldo Mill, Pedro Guatimosim Vidigal, Sandhi Maria Barreto, Mária de Fátima Sander, Maria de Jesus Mendes da Fonseca, and Bruce Bartholow Duncan
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type 2 diabetes ,screening strategies ,screening tool ,mass screening ,prediction score ,sensitivity ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
IntroductionThe success of diabetes prevention based on early treatment depends on high-quality screening. This study compared the diagnostic properties of currently recommended screening strategies against alternative score-based rules to identify those at high risk of developing diabetes.MethodsThe study used data from ELSA-Brasil, a contemporary cohort followed up for a mean (standard deviation) of 7.4 (0.54) years, to develop risk functions with logistic regression to predict incident diabetes based on socioeconomic, lifestyle, clinical, and laboratory variables. We compared the predictive capacity of these functions against traditional pre-diabetes cutoffs of fasting plasma glucose (FPG), 2-h plasma glucose (2hPG), and glycated hemoglobin (HbA1c) alone or combined with recommended screening questionnaires.ResultsPresenting FPG > 100 mg/dl predicted 76.6% of future cases of diabetes in the cohort at the cost of labeling 40.6% of the sample as high risk. If FPG testing was performed only in those with a positive American Diabetes Association (ADA) questionnaire, labeling was reduced to 12.2%, but only 33% of future cases were identified. Scores using continuously expressed clinical and laboratory variables produced a better balance between detecting more cases and labeling fewer false positives. They consistently outperformed strategies based on categorical cutoffs. For example, a score composed of both clinical and laboratory data, calibrated to detect a risk of future diabetes ≥20%, predicted 54% of future diabetes cases, labeled only 15.3% as high risk, and, compared to the FPG ≥ 100 mg/dl strategy, nearly doubled the probability of future diabetes among screen positives.DiscussionCurrently recommended screening strategies are inferior to alternatives based on continuous clinical and laboratory variables.
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- 2023
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4. Laboratory profile after mining dam breach: Brumadinho Health Project results
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Chams Bicalho Maluf, Fabiano de Almeida Brito, Taynãna César Simões, Sérgio Viana Peixoto, and Pedro Guatimosim Vidigal
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Man-made disasters ,Mining ,Laboratory tests ,Brazil ,Public aspects of medicine ,RA1-1270 - Abstract
ABSTRACT Objective: To evaluate changes in selected laboratory tests in the population included in the Brumadinho Health Project, according to the exposure to the dam failure. Methods: Cross-sectional study carried out on representative sample of residents (≥12 years) in Brumadinho, Minas Gerais, including: 1) non-exposed; 2) directly affected by tailings sludge; 3) residents in mining area. The prevalence of abnormal results of blood count, total, HDL and LDL cholesterol, triglycerides, aspartate aminotransferase, alanine aminotransferase, creatinine, urea, estimate of glomerular filtration rate (eGFR) and high-sensitivity C-reactive protein (hs-CRP) were estimated. The Prevalence Ratios (PR) and 95% Confidence Intervals (95%CI) of having an abnormal laboratory finding were estimated using Generalized Linear Models with Poisson probability distribution. Crude and adjusted models were estimated for age range, gender, diabetes, body mass index, smoking, hypertension. Results: After adjusting, there was no difference in PR between the three populations for most tests, with the exception of the population residing in an area with mining activity and not directly affected by the mud, with a lower chance of having altered total cholesterol (PR: 0.84; 95%CI 0.74–0.95) and a higher chance of having altered HDL cholesterol (PR: 1.26; 95%CI 1.07–1.50), hs-CRP (PR: 1.19; 95%CI 1.04–1.37), and eGFR
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- 2022
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5. The positive association between serum uric acid, impaired fasting glucose, impaired glucose tolerance, and diabetes mellitus in the ELSA-Brasil study
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Aline Isabel Rodrigues Galvão, Alline Maria R. Beleigoli, Pedro Guatimosim Vidigal, Bruce Bartholow Duncan, Maria Inês Schmidt, Sarah L. Appleton, Sandhi Maria Barreto, and Maria de Fátima Haueisen Sander Diniz
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Diabetes Mellitus ,Uric Acid ,Impaired Glucose Tolerance ,Insulin Resistance ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract: There is a conflict in the literature regarding the association between serum uric acid (SUA) levels and glycemic status. Therefore, we evaluated the association between SUA level and glycemic status - impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes mellitus - and insulin resistance, in a large Brazilian study. This is a cross-sectional, observational study with 13,207 participants aged 35-74 years, at baseline (2008-2010) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). A multinomial regression analysis was performed to test the association between SUA and glycemic status (IFG, IGT, and newly diagnosed type 2 diabetes at the cohort baseline) after adjustments by age, sex, skin color, body mass index, physical activity, smoking, alcohol consumption, comorbidities, and medicines use. Logistic regression model was used to evaluate the association between SUA and insulin resistance by HOMA-IR. Stratified analyses by sex were performed. The mean age (standard deviation) was 51.4 (8.9) years, 55.2% of participants were women. There were 1,439 newly diagnosed diabetes. After all adjustments, higher SUA was associated with IFG, IGT, and diabetes, with odds ratio (OR) = 1.15 (95%CI: 1.06; 1.25), 1.23 (95%CI: 1.14; 1.33), and 1.37 (95%CI: 1.24; 1.51), respectively. There was association between SUA levels and insulin resistance with OR = 1.24 (95%CI: 1.13; 1.36). In analysis stratified by sex, higher SUA persisted independently associated with impaired glycemic status. Our results suggest that a higher SUA levels were significantly associated with glycemic status in a large Latin American population, mainly among women.
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- 2021
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6. Subclinical Thyroid Dysfunction was not Associated with Cardiac Arrhythmias in a Cross-Sectional Analysis of the ELSA-Brasil Study
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Kamilla Maria Araújo Brandão Rajão, Antônio Luiz Pinho Ribeiro, Valéria Maria Azeredo Passos, Isabela Judith Martins Benseñor, Pedro Guatimosim Vidigal, Cleber Pinto Camacho, and Maria de Fátima Haueisen Sander Diniz
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Thyroid Diseases/complications ,Pathologic Processes ,Thyroropin (TSH) ,Arrhythmias, Cardiac ,Adults ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background: The association of subclinical thyroid dysfunction (STD) with cardiac arrhythmias remains controversial, particularly in the non-elderly population. Objective: To investigate whether STD was associated with cardiac arrhythmias in a cohort of middle-aged and older adults. Methods: Baseline data of the Longitudinal Study of Adult Health, ELSA-Brasil (35-74 years) were collected from 2008 to 2010. After exclusion of clinical hypothyroidism and hyperthyroidism, participants were categorized as euthyroidism (TSH = 0.4-4.0 µU/mL), subclinical hypothyroidism (TSH > 4.0 µU/mL; FT4 = 0.8-1.9 ng/dL), and subclinical hyperthyroidism (TSH < 0.4 µU/mL; FT4 = 0.8-1.9 ng/dL). The prevalence rates of tachycardia (HR > 100) and bradycardia (HR < 60), atrial fibrillation/flutter, conduction disorders, extrasystoles, low QRS voltage, prolonged QT intervals, and persistent supraventricular rhythms were compared between groups after adjusting for age, sex, comorbidities, lifestyle, body mass index and medications. Results: The HR data of 13,341 participants (52% female; median age, 51 years) and the electrocardiogram readings of 11,795 were analyzed; 698 participants (5.23%) were classified as subclinical hypothyroidism, 193 (1.45%) as subclinical hyperthyroidism, and 12,450 (93.32%) as euthyroidism. The prevalence of rhythm and conduction disorders was similar, as were HR medians, even in the subgroups with TSH < 0.01 UI/mL or > 10.0 UI/mL or in older adults. Conduction disorders were less prevalent in older adults with subclinical hypothyroidism (adjusted OR = 0.44; 95% CI 0.24 to 0.80). Conclusion: In this large, multicenter and cross-sectional study, STD was not associated with cardiac arrhythmias, but a longitudinal assessment is necessary.
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- 2019
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7. Establishing a blood fructosamine reference range for the Brazilian population based on data from ELSA – Brasil
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William Pedrosa, Maria de Fátima Haueisen Sander Diniz, Sandhi Maria Barreto, and Pedro Guatimosim Vidigal
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Medicine (General) ,R5-920 ,Chemistry ,QD1-999 - Abstract
Objectives: The fructosamine test is used in the monitoring of diabetes mellitus, particularly in cases with restrictions on the use of glycated hemoglobin (mainly in the setting of altered red blood cell lifespan and interference by hemoglobin variants). It could also provide additional information on shorter-term glycemic control. The objective of the study is to establish the reference range of the fructosamine in the Brazilian population. Design and methods: The reference interval was defined as suggested by the Clinical and Laboratory Standards Institute (CLSI). The study participants were from a Brazilian cohort (The Longitudinal Study of Adult Health – ELSA-Brasil) with baseline data collected between 2008 and 2010. A total of 466 subjects were selected after exclusion of diabetic individuals, and those with altered glycemic markers and renal function tests. Results: The reference interval was 186–248 μmol/L for women and 196–269 μmol/L for men. Fructosamine levels were higher in men than in women (p = 0.006) and in the non-white population (p = 0.034) and had a negative correlation with the body mass index (r = −0.117; p = 0.011). Conclusions: The reference intervals for fructosamine were affected by sex. Reference intervals stratified by sex would be more adequate in the interpretation of the fructosamine test. Keywords: Fructosamine, Reference interval, Diabetes mellitus
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- 2019
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8. Challenges of the Unified Health System: present status of public laboratory services in 31 cities of Minas Gerais, Brazil
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Pedro Guatimosim Vidigal, Letícia Maria Henriques Resende, Joanna Paula Guimarães Cardoso, Liz Custódio Souza Seabra, Mariana Rabelo Maia, Tasso Amós de Araújo Mendes, and Luciana de Gouvêa Viana
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Sistema Único de Saúde ,exames laboratoriais ,serviços de saúde ,planejamento em saúde ,gestão em saúde ,Pathology ,RB1-214 - Abstract
Introduction: Modifications in the Brazilian Unified Health System (SUS) have led to a significant improvement in the national health indexes. However, some challenges still need to be faced, especially concerning SUS patients' access to high-quality laboratory support services.Objective: To evaluate the present status of laboratory services in SUS in 31 cities of Minas Gerais, Brazil, between 2008 and 2011.Material and method: This analysis was performed through data from the Information Technology Department of SUS (DATASUS) and through interviews with local public health managers with structured questionnaires.Results: Among all the studied cities, 21 had their own laboratory, 90.2% of which were in precarious conditions, not meeting the requirements established by the legislation in force, and employing inappropriate procedures and techniques, in addition to using obsolete equipment. The range of available laboratory tests was limited, what demanded the services of supporting laboratories. None of the evaluated laboratories developed any systematic activity on quality management, including control of analytical quality, maintenance of laboratory equipment, calibration and performance evaluation of critical equipment, continuing education programs, and safety and biosecurity.Conclusion: The effective role of laboratory test results in medical decision is unquestionably impaired, risking the safety of SUS patients. The present work reveals the deficiencies of public laboratory services in Minas Gerais, and proposes a new management model, which is able to associate operational quality, technological development and optimization of human and material resources with higher productivity.
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- 2014
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9. Physical Activity and Lipid Profile in the ELSA- Brasil Study
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Raquel Caroline da Silva, Maria de Fátima Haueisen Sander Diniz, Sheila Alvim, Pedro Guatimosim Vidigal, Ligia Maria Giongo Fedeli, and Sandhi Maria Barreto
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Atividade Motora ,Doenças Cardiovasculares ,Perfil de Saúde ,Hipercolesterolemia ,Colesterol ,Triglicérides ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background: Regular physical activity (PA) induces desirable changes in plasma levels of high- and low-density lipoproteins (HDL and LDL, respectively) and triglycerides (TG), important risk factors for cardiometabolic diseases. However, doubts whether intensity and duration have equivalent benefits remain. Objective: To assess the association of PA intensity and duration with HDL, LDL and TG levels. Methods: Cross-sectional study with 12,688 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline, who were not on lipid-lowering medication. After adjustment for important covariates, multiple linear regression was used to assess the association of PA intensity and duration with HDL, LDL and TG (natural logarithm) levels. Results: Both moderate and vigorous PA and PA practice ≥ 150 min/week were significantly associated with higher HDL and lower TG levels. Vigorous PA was associated with lower LDL only on univariate analysis. After adjustments, moderate and vigorous PA increased mean HDL level by 0.89 mg/dL and 1.71 mg/dL, respectively, and reduced TG geometric mean by 0.98 mg/dL and 0.93 mg/dL, respectively. PA practice ≥ 150 min/week increased mean HDL level by 1.05 mg/dL, and decreased TG geometric mean by 0.98 mg/dL. Conclusion: Our findings reinforce the benefits of both PA parameters studied on HDL and TG levels, with a slight advantage for vigorous PA as compared to the recommendation based only on PA duration.
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- 2016
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10. Avaliando a comutatividade: importante requisito da qualidade para laboratórios clínicos Understanding commutability: important quality requirement for clinical laboratories
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Chams Bicalho Maluf, Indiayara Oliveira Silva, and Pedro Guatimosim Vidigal
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Contagem de células sanguíneas ,Técnicas e procedimentos de laboratório ,Controle da qualidade ,Acreditação ,Gestão em saúde ,Comutatividade ,Blood cell count ,Laboratory techniques and procedures ,Quality control ,Accreditation ,Health management ,Commutability ,Pathology ,RB1-214 - Abstract
INTRODUÇÃO: Poucos laboratórios no Brasil realizam a avaliação da comutatividade dos resultados de exames, provavelmente por desconhecimento dos procedimentos para sua realização e também pela pouca importância dada a essa avaliação. OBJETIVO: Avaliar a comutatividade dos resultados de exames hematológicos realizados em três analisadores automatizados em um laboratório de um hospital público universitário, em Belo Horizonte, MG, Brasil, propondo procedimento prático, de baixa complexidade, factível de ser utilizado em laboratórios clínicos. MATERIAL E MÉTODOS: As amostras foram selecionadas visando obter valores nos níveis de decisão terapêutica. Foram processadas seis amostras por dia, durante quatro dias, em duplicata em três analisadores, totalizando 48 replicatas em cada instrumento. Foi avaliada a correlação entre os resultados de 10 dos principais parâmetros hematológicos obtidos nos instrumentos-teste e aqueles obtidos com o instrumento-referência. Foram estimados os erros sistemáticos e totais, considerando as especificações da variação biológica como limite máximo aceitável. RESULTADOS: O coeficiente de correlação (r) entre os equipamentos para os parâmetros investigados foi > 0,975. Os erros sistemático (médio) e total, obtidos para os parâmetros analisados, quando se comparam os equipamentos de teste com o de referência, atenderam às especificações da qualidade definidos. Discussão: A comutatividade é um importante processo da gestão da qualidade do laboratório clínico e visa garantir a comparabilidade de resultados de exames realizados por diferentes sistemas. CONCLUSÃO: Utilizando procedimento padronizado internacionalmente, prático e de baixa complexidade, demonstrou-se que os exames realizados nos equipamentos avaliados são equivalentes, podendo ser usados indistintamente no acompanhamento de pacientes.INTRODUCTION: Few Brazilian laboratories evaluate the commutability of test results, probably due to the lack of procedure expertise as well as the neglected importance of its assessment. OBJECTIVE: The aim of this study was to evaluate the commutability of hematological test results performed with three automated analyzers at the laboratory of a public university hospital in Belo Horizonte, MG, Brazil, proposing a practical, simple, and feasible procedure to be applied in clinical laboratories. MATERIAL AND METHODS: Samples were selected in order to obtain hematologic values for therapeutic decision levels. Six samples were processed in duplicate in three analyzers daily during a four-day period amounting to a total of 48 replicates in each instrument. The correlation between the results of 10 hematologic parameters obtained with test instruments and the reference instrument was assessed. Systematic and total errors were estimated and criteria for acceptable performance were based on the biological variation specifications. RESULTS: The correlation coefficient (r) between test instruments and reference instrument results was > 0.975. Systematic (mean) and total errors met the required quality specifications when compared with reference instruments. Discussion: Commutability is an important process of quality management in clinical laboratories and it ensures the comparability of test results carried out with different procedures. CONCLUSION: Through a practical, simple, and internationally standardized procedure, this study showed that test results from the evaluated instruments were equivalent, which allows their use in patient monitoring.
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- 2011
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11. Importância do dismorfismo eritrocitário na investigação da origem da hematúria: revisão da literatura The importance of the dysmorphic erythrocyte for investigation of the source of hematuria: literature review
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Leonardo de Souza Vasconcellos, Maria Goretti Moreira Guimarães Penido, and Pedro Guatimosim Vidigal
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Dismorfismo eritrocitário ,Morfologia das hemácias ,Hematúria glomerular ,Sangramento glomerular ,Urinálise ,Artigo de revisão ,Dysmorphic erythrocyte ,Red cells morphology ,Glomerular hematuria ,Glomerular bleeding ,Urinalysis ,Review article ,Pathology ,RB1-214 - Abstract
As hematúrias são achados comuns nos exames de urina de rotina e nem sempre são sinais de doenças. A presença de hematúria associada a outras alterações urinárias, especialmente a proteinúria, sugere comprometimento do trato urinário e merece investigação. Na literatura são inúmeros os trabalhos que valorizam a sedimentoscopia urinária, principalmente a morfologia das hemácias, como indicativo do local do sangramento: se glomerular ou não-glomerular. Neste artigo, os autores revisam o estudo do dismorfismo eritrocitário, enfatizando a definição, a fisiopatologia, os métodos, os valores de referência e as limitações apontadas na literatura. As comparações com demais marcadores de hemorragia glomerular também foram discutidas. No final, os autores relatam como a literatura interpreta e utiliza os resultados da pesquisa do dismorfismo eritrocitário para guiar a propedêutica complementar na investigação da origem da hematúria.The hematurias are a frequent finding in urinary routine exams and do not necessarily indicate illness. The presence of hematuria associated with other urinary disturbances, especially proteinuria, indicates urinary tract pathology and should be investigated. In the literature, several studies point out the importance of urinary sedimentoscopy, specially the red cells morphology, to determine the source of bleeding: glomerular or non-glomerular. In this article, the authors review the dysmorphic erythrocyte, emphasizing on the meaning, the physiopathology, the methods, the cut-of values, and the limitations according to the literature. The comparisons with other markers of glomerular bleeding were also discussed. At the end, the authors exposed how the literature analyses and applies the dysmorphic erythrocyte results to guide the complementary research for investigation the source of urinary bleeding.
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- 2005
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12. Life course socioeconomic position and C-reactive protein: mediating role of health-risk behaviors and metabolic alterations. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
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Lidyane V Camelo, Luana Giatti, Jorge Alexandre Barbosa Neves, Paulo A Lotufo, Isabela M Benseñor, Dóra Chor, Rosane Härter Griep, Maria de Jesus Mendes da Fonseca, Pedro Guatimosim Vidigal, Ichiro Kawachi, Maria Inês Schmidt, and Sandhi Maria Barreto
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Medicine ,Science - Abstract
BACKGROUND: Chronic inflammation has been postulated to be one mediating mechanism explaining the association between low socioeconomic position (SEP) and cardiovascular disease (CVD). We sought to examine the association between life course SEP and C-reactive protein (CRP) levels in adulthood, and to evaluate the extent to which health-risk behaviors and metabolic alterations mediate this association. Additionally, we explored the possible modifying influence of gender. METHODS AND FINDINGS: Our analytical sample comprised 13,371 participants from ELSA-Brasil baseline, a multicenter prospective cohort study of civil servants. SEP during childhood, young adulthood, and adulthood were considered. The potential mediators between life course SEP and CRP included clusters of health-risk behaviors (smoking, low leisure time physical activity, excessive alcohol consumption), and metabolic alterations (obesity, hypertension, low HDL, hypertriglyceridemia, and diabetes). Linear regression models were performed and structural equation modeling was used to evaluate mediation. Although lower childhood SEP was associated with higher levels of CRP in adult life, this association was not independent of adulthood SEP. However, CRP increased linearly with increasing number of unfavorable social circumstances during the life course (p trend
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- 2014
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13. The Bambuí health and aging study (BHAS). Prevalence of intermittent claudication in the aged population of the community of Bambuí and its associated factors
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Valéria Maria de Azeredo Passos, Sandhi Maria Barreto, Henrique Leonardo Guerra, Josélia Oliveira Araújo Firmo, Pedro Guatimosim Vidigal, and Maria Fernanda Furtado Lima-Costa
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peripheral obstructive arterial disease ,intermittent claudication ,elderly ,prevalence ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
OBJECTIVE: To assess the prevalence of intermittent claudication in the aged population of Bambuí, Brazil, and to identify the factors associated with this disease. METHODS: Population-based cross-sectional study of the aged population ( > or = 60 years of age) of Bambuí. Participants were interviewed and examined, after written consent. Intermittent claudication was defined based on a standardized questionnaire. Analysis was performed using multiple logistic regression. RESULTS: Of the 1,742 elderly living in Bambuí, 1,485 (85.2%) were enrolled in the study. Thirty-seven individuals (2.5%) with intermittent claudication were identified: 28 (1.9%) males and 9 (0.6%) females. Their age brackets were: 16 (1.08%) individuals between 60 and 69 years of age, 17 (1.15%) between 70 and 79 years, and 4 (0.27%) > or = 80 years. A significant association between intermittent claudication and the following characteristics was found: male sex (OR=5.1; CI 2.4-11.0), smokers (OR=3.1; CI 1.2-8.5), ex-smokers (OR=3.4; CI 1.3-8.7), and more than 2 hospital admissions in the last 12 months (OR=2.8; CI 1.1-7.2). CONCLUSION: Disease prevalence was similar to that of other countries. The association between intermittent claudication and smoking strengthens the significance of tobacco in peripheral artery disease pathogenesis. The association of intermittent claudication and a higher number of hospital admissions suggests greater morbidity in the elderly affected.
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- 2001
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14. Nationwide vitamin D status in older Brazilian adults and its determinants: The Brazilian Longitudinal Study of Aging (ELSI)
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Paulo Roberto Borges de Souza-Júnior, Pedro Guatimosim Vidigal, Cesar de Oliveira, Sérgio Viana Peixoto, Fabíola Bof de Andrade, Maria Fernanda Lima-Costa, Clarissa M. Vidigal, and Juliana Vaz de Melo Mambrini
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0301 basic medicine ,Male ,Longitudinal study ,Aging ,Science ,vitamin D deficiency ,Article ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,medicine ,Vitamin D and neurology ,Humans ,Longitudinal Studies ,Vitamin D ,Aged ,Multidisciplinary ,business.industry ,Health care ,Baseline survey ,medicine.disease ,030104 developmental biology ,%22">Fish ,Medicine ,Female ,Geometric mean ,business ,030217 neurology & neurosurgery ,Brazil ,Demography - Abstract
Little is known about vitamin D status in older adults in South America, where exposures to ultra-violet radiation are high. We examined the distribution of serum 25-hydroxyvitamin D (25OHD) concentration and its determinants in a nationally representative sample of Brazilians aged 50 years and older. Explanatory variables included environment and individuals’ characteristics from the ELSI baseline survey (2015–16). Among the 2,264 participants (mean age = 62.6 years), the geometric mean of 25OHD concentration was 66.8 nmol/L. The prevalence of vitamin D deficiency (
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- 2020
15. Association between diabetes and cognitive function at baseline in the Brazilian Longitudinal Study of Adult Health (ELSA- Brasil)
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Pedro Guatimosim Vidigal, Valéria Maria de Azeredo Passos, Bruce Bartholow Duncan, Maria de Jesus Mendes da Fonseca, Sandhi Maria Barreto, Alline Beleigoli, Maria de Fátima Haueisen Sander Diniz, Mônica Maria Teixeira, Maria Inês Schmidt, and Larissa Fortunato Araújo
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Adult ,Male ,Longitudinal study ,Population ,Trail Making Test ,lcsh:Medicine ,030209 endocrinology & metabolism ,Neuropsychological Tests ,Article ,03 medical and health sciences ,Cognition ,0302 clinical medicine ,Diabetes complications ,Risk Factors ,medicine ,Humans ,Verbal fluency test ,Cognitive Dysfunction ,Longitudinal Studies ,Vascular dementia ,education ,lcsh:Science ,Aged ,Psychomotor learning ,education.field_of_study ,Multidisciplinary ,Cognitive ageing ,business.industry ,lcsh:R ,Age Factors ,Middle Aged ,medicine.disease ,Executive functions ,Diabetes Mellitus, Type 2 ,Educational Status ,Female ,lcsh:Q ,business ,Brazil ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
Diabetes has been associated with cognitive changes and an increased risk of vascular dementia and Alzheimer’s disease, but it is unclear whether there are associations between diabetes and early alterations in cognitive performance. The present study consisted of a cross-section analysis of 14,444 participants aged 35–74 years and from a developing country at baseline in the Brazilian Longitudinal Study of Adult Health (ELSA–Brasil); these participants were recruited between 2008 and 2010. We investigated whether there was an association between diabetes and early changes in the cognitive performance of this Brazilian population. To assess cognitive domains, we used the word-list learning, word-list delayed recall and word recognition tests along. Phonemic verbal fluency tests included semantic phonemic test (animals) and a phonemic test (words beginning with the letter F). Executive functions associated with attention, concentration and psychomotor speed were evaluated using the Trail Making Test B. The exposure variable in the study was defined as diabetes. Multiple linear regression was used to estimate the association between diabetes and cognitive performance. The results were adjusted for age, sex, education, hypertension, coronary disease, depression, physical activity, smoking, alcohol consumption, and the cholesterol/HDL-C ratio. We found a significant association between diabetes and decreased memory, language and executive function (attention, concentration and psychomotor speed) performance in this population from a country with a distinct epidemiological profile, even after adjusting for the main intervening variables.
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- 2020
16. Perfil laboratorial após rompimento de barragem de mineração: resultados do Projeto Saúde Brumadinho
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Chams Bicalho Maluf, Fabiano de Almeida Brito, Taynãna César Simões, Sérgio Viana Peixoto, and Pedro Guatimosim Vidigal
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Epidemiology ,Brasil ,Cholesterol, HDL ,Public Health, Environmental and Occupational Health ,Laboratory tests ,Mineração ,Cholesterol, LDL ,General Medicine ,Desastres provocados pelo homem ,Man-made disasters ,Mining ,Testes laboratoriais ,C-Reactive Protein ,Cross-Sectional Studies ,Risk Factors ,Humans ,Brazil - Abstract
Objective: To evaluate changes in selected laboratory tests in the population included in the Brumadinho Health Project, according to the exposure to the dam failure. Methods: Cross-sectional study carried out on representative sample of residents (≥12 years) in Brumadinho, Minas Gerais, including: 1) non-exposed; 2) directly affected by tailings sludge; 3) residents in mining area. The prevalence of abnormal results of blood count, total, HDL and LDL cholesterol, triglycerides, aspartate aminotransferase, alanine aminotransferase, creatinine, urea, estimate of glomerular filtration rate (eGFR) and high-sensitivity C-reactive protein (hs-CRP) were estimated. The Prevalence Ratios (PR) and 95% Confidence Intervals (95%CI) of having an abnormal laboratory finding were estimated using Generalized Linear Models with Poisson probability distribution. Crude and adjusted models were estimated for age range, gender, diabetes, body mass index, smoking, hypertension. Results: After adjusting, there was no difference in PR between the three populations for most tests, with the exception of the population residing in an area with mining activity and not directly affected by the mud, with a lower chance of having altered total cholesterol (PR: 0.84; 95%CI 0.74–0.95) and a higher chance of having altered HDL cholesterol (PR: 1.26; 95%CI 1.07–1.50), hs-CRP (PR: 1.19; 95%CI 1.04–1.37), and eGFR
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- 2022
17. Red cell distribution width is associated with cardiovascular risk in adults
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Natane Moreira de Carvalho, Chams Bicalho Maluf, Douglas Roberto Mesquita Azevedo, Rodrigo Citton Padilha dos Reis, Cristina Dickie de Castilhos, Sandhi Maria Barreto, and Pedro Guatimosim Vidigal
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Adult ,Erythrocyte Indices ,Doenças cardiovasculares ,Risk ,Health Policy ,Índices eritrocitários ,Public Health, Environmental and Occupational Health ,Erythrocyte indices ,Eritrócitos ,Cohort Studies ,Cardiovascular diseases ,Cardiovascular Diseases ,Heart Disease Risk Factors ,Risk Factors ,Humans ,Risco - Abstract
Red cell distribution width (RDW) is a measure of erythrocyte size variability. Recent studies have shown that RDW is a predictive, and prognostic marker of mortality and cardiovascular (CVD) events in the general population and in CVD patients. This study aimed to investigate the association between RDW and CVD risk in a large sample of adults. A subsample of CVD free participants of the ELSA-Brasil cohort were included (n=4,481). In the cross-sectional approach, multiple regression analysis was used to investigate the association between RDW and the Framingham Risk Score (FRS). Linear mixed effect model evaluated whether baseline RDW predicted changes in CVD risk after about four-year follow up. Cross-sectional analysis showed that RDW was independently associated with FRS, participants in the fourth-quartile of RDW distribution had a 29% higher FRS than those in the first-quartile RDW (p
- Published
- 2022
18. Associação positiva entre ácido úrico sérico, glicemia em jejum alterada, tolerância glicêmica alterada e diabetes mellitus no estudo ELSA-Brasil
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Aline Isabel Rodrigues Galvão, Alline Maria R. Beleigoli, Pedro Guatimosim Vidigal, Bruce Bartholow Duncan, Maria Inês Schmidt, Sarah L. Appleton, Sandhi Maria Barreto, and Maria de Fátima Haueisen Sander Diniz
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Adult ,Blood Glucose ,medicine.medical_specialty ,Population ,Resistência à Insulina ,Type 2 diabetes ,Resistencia a la Insulina ,Impaired glucose tolerance ,Insulin resistance ,Diabetes mellitus ,Internal medicine ,Ácido Úrico ,Glucose Intolerance ,medicine ,Diabetes Mellitus ,Humans ,Intolerancia a la Glucosa ,Longitudinal Studies ,education ,Impaired Glucose Tolerance ,Glycemic ,education.field_of_study ,business.industry ,Public Health, Environmental and Occupational Health ,Fasting ,Middle Aged ,medicine.disease ,Impaired fasting glucose ,Uric Acid ,Cross-Sectional Studies ,Diabetes Mellitus, Type 2 ,Medicine ,Female ,Public aspects of medicine ,RA1-1270 ,Intolerância à Glucose ,Insulin Resistance ,business ,Body mass index ,Brazil - Abstract
There is a conflict in the literature regarding the association between serum uric acid (SUA) levels and glycemic status. Therefore, we evaluated the association between SUA level and glycemic status - impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes mellitus - and insulin resistance, in a large Brazilian study. This is a cross-sectional, observational study with 13,207 participants aged 35-74 years, at baseline (2008-2010) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). A multinomial regression analysis was performed to test the association between SUA and glycemic status (IFG, IGT, and newly diagnosed type 2 diabetes at the cohort baseline) after adjustments by age, sex, skin color, body mass index, physical activity, smoking, alcohol consumption, comorbidities, and medicines use. Logistic regression model was used to evaluate the association between SUA and insulin resistance by HOMA-IR. Stratified analyses by sex were performed. The mean age (standard deviation) was 51.4 (8.9) years, 55.2% of participants were women. There were 1,439 newly diagnosed diabetes. After all adjustments, higher SUA was associated with IFG, IGT, and diabetes, with odds ratio (OR) = 1.15 (95%CI: 1.06; 1.25), 1.23 (95%CI: 1.14; 1.33), and 1.37 (95%CI: 1.24; 1.51), respectively. There was association between SUA levels and insulin resistance with OR = 1.24 (95%CI: 1.13; 1.36). In analysis stratified by sex, higher SUA persisted independently associated with impaired glycemic status. Our results suggest that a higher SUA levels were significantly associated with glycemic status in a large Latin American population, mainly among women. Resumo: Há uma controvérsia na literatura a respeito da associação entre níveis de ácido úrico sérico (AUS) e glicemia. Portanto, avaliamos a associação entre AUS e glicemia (glicemia em jejum alterada, intolerância glicêmica e diabetes mellitus), além da resistência insulínica, em uma amostra grande no Brasil. O estudo transversal observacional incluiu 13.207 participantes com idade entre 35 e 74 anos na linha de base (2008-2010) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Foi realizada análise de regressão multivariada para testar a associação entre AUS e glicemia (glicemia em jejum alterada, intolerância glicêmica e diagnóstico novo de diabetes tipo 2 na linha de base da coorte) depois de ajustar para idade, sexo, cor, índice de massa corporal, atividade física, tabagismo, consumo de álcool, comorbidades e uso de medicação. O modelo de regressão logística foi usado para avaliar a associação entre AUS e resistência insulínica por HOMA-IR. Foram realizadas análises estratificadas por sexo. A média de idade (DP) foi 51,4 (8,9) anos, e 55,2% dos participantes eram mulheres. Houve 1.439 novos diagnósticos de diabetes. Depois de todos os ajustes, o AUS esteve associado à glicemia em jejum alterada, intolerância glicêmica e diabetes, com odds ratio (OR) = 1,15 (IC95%: 1,06; 1,25), 1,23 (IC95%: 1,14; 1,33) e 1,37 (IC95%: 1,24; 1,51), respectivamente. Houve uma associação entre níveis de AUS e resistência insulínica, com OR = 1,24 (IC95%: 1,13; 1,36). Na análise estratificada por sexo, persistiu a associação independente entre AUS elevado e glicemia. Os resultados sugerem que níveis elevados de AUS estão associados de maneira significativa com a glicemia em uma população latino-americana grande, sobretudo entre mulheres. Resumen: Hay un conflicto en la literatura respecto a la asociación entre los niveles de ácido úrico sérico (AUS) y el estado glucémico. Por eso, evaluamos la asociación entre el nivel AUS y el estatus glucémico: glucosa alterada en ayunas (GAA), tolerancia a la glucosa alterada (TGA) y diabetes mellitus (diabetes), comparados con la resistencia a la insulina en un amplio estudio en Brasil. Se realizó un estudio transversal, observacional con 13.207 participantes, con edades comprendidas entre los 35-74 años, en la base de referencia del Estudio Longitudinal de Salud entre Adultos brasileños (2008-2010) (ELSA-Brasil). Se realizó un análisis de regresión multinomial para probar la asociación entre AUS y el estado glucémico (GAA, TGA y de nuevo la diabetes tipo 2, diagnosticada en la cohorte como base de referencia) tras los ajustes por edad, sexo, color de piel, índice de masa corporal, actividad física, fumar, consumo de alcohol, comorbilidades, uso de medicinas. Se usó el modelo de regresión logística para evaluar la asociación entre AUS y la resistencia a la insulina por el HOMA-IR. Se realizó también un análisis estratificado por sexo. La media de edad (desviación estándar) fue 51,4 (8,9) años, un 55,2% de los participantes eran mujeres. Hubo 1.439 nuevos casos de diabetes diagnosticados. Tras todos los ajustes, una AUS más alta estuvo asociada con GAA, TGA y diabetes, con odds ratio (OR) = 1,15 (IC95%: 1,06; 1,25), 1,23 (IC95%: 1,14; 1,33), y 1,37 (IC95%: 1,24; 1,51), respectivamente. Hubo asociación entre los niveles AUS y la resistencia a la insulina con OR = 1,24 (IC95%: 1,13; 1,36). En el análisis estratificado por sexo, una AUS más alta persistía independientemente asociada con un estado glucémico alterado. Nuestros resultados sugieren que unos niveles más altos de AUS estuvieron significativamente asociados con el estado glucémico en una amplia población latinoamericana, principalmente entre mujeres.
- Published
- 2021
19. Association between C-reactive protein with all-cause mortality in ELSA-Brasil cohort
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Douglas R. M. Azevedo, Chams B. Maluf, Francesco P. Cappuccio, Pedro Guatimosim Vidigal, Sheila Maria Alvim Matos, Rosane Harter Griep, Chen Ji, Luana Giatti, Sandhi Maria Barreto, Michelle A. Miller, and Antonio Luiz Pinho Ribeiro
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Adult ,Male ,medicine.medical_specialty ,Longitudinal study ,Epidemiology ,Population ,030204 cardiovascular system & hematology ,Risk Assessment ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,RA0421 ,Cause of Death ,Neoplasms ,Internal medicine ,medicine ,Humans ,Longitudinal Studies ,030212 general & internal medicine ,education ,Original Research ,Aged ,education.field_of_study ,biology ,Proportional hazards model ,business.industry ,C-reactive protein ,Public Health, Environmental and Occupational Health ,Middle Aged ,mortality ,C-Reactive Protein ,Quartile ,Cardiovascular Diseases ,Cohort ,biology.protein ,Female ,business ,Biomarkers ,Brazil ,Follow-Up Studies ,Cohort study - Abstract
BackgroundHigh-sensitivity C reactive protein (hsCRP) has been proposed as a marker of incident cardiovascular disease and vascular mortality, and may also be a marker of non-vascular mortality. However, most evidence comes from either North American or European cohorts. The present proposal aims to investigate the association of hsCRP with the risk of all-cause mortality in a multiethnic Brazilian population.MethodsBaseline data (2008–2010) of a cohort of 14 238 subjects participating in the Brazilian Longitudinal Study of Adult Health were used. hsCRP was assayed with immunochemistry. The association of baseline covariates with all-cause mortality was calculated by Cox regression for univariate model and adjusted for different confounders after a mean follow-up of 8.0±1.1 years. The final model was adjusted for age, sex, self-rated race/ethnicity, schooling, health behaviours and prevalent chronic disease.ResultsThe risk of death increased steadily by quartiles of hsCRP, from 1.45 (95% CI 1.05 to 2.01) in quartile 2 to 1.95 (95% CI 1.42 to 2.69) in quartile 4, compared with quartile 1. Furthermore, the persistence of a significant graded association after the exclusion of deaths in the first year of follow-up suggests that these results are unlikely to be due to reverse causality. Finally, the HR was unaffected by the exclusion of participants who had self-reported medical history of diabetes, cancer and chronic obstructive pulmonary disease.ConclusionsOur study shows that hsCRP level is associated with mortality in a highly admixed population, independent of a large set of lifestyle and clinical variables.
- Published
- 2020
20. Markers of adiposity, insulin resistance, prediabetes and cognitive function at baseline of the Brazilian Longitudinal Study of Adult Health (ELSA - Brasil)
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Maria Inês Schmidt, Maria de Fátima Haueisen Sander Diniz, Valéria Maria de Azeredo Passos, Larissa Fortunato Araújo, Pedro Guatimosim Vidigal, Sandhi Maria Barreto, Roberta Carvalho de Figueiredo, Mônica Maria Teixeira, Maria de Jesus Mendes da Fonseca, Alline Beleigoli, Enrico A. Colosimo, and Bruce Bartholow Duncan
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Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Trail Making Test ,030209 endocrinology & metabolism ,Impaired glucose tolerance ,Prediabetic State ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Insulin resistance ,Cognition ,Internal medicine ,Internal Medicine ,medicine ,Verbal fluency test ,Humans ,030212 general & internal medicine ,Effects of sleep deprivation on cognitive performance ,Prediabetes ,Longitudinal Studies ,Adiposity ,business.industry ,General Medicine ,medicine.disease ,Cognitive test ,Cross-Sectional Studies ,Female ,Insulin Resistance ,business ,Body mass index ,Brazil - Abstract
Aim The aim of the study is to investigate whether adiposity markers, insulin resistance and prediabetes are associated with cognitive performance in middle-aged men and women without diabetes. Methods Cross-sectional study with 11,115 adults without diabetes (34–64 years old). Cognitive performance was tested by word-list learning, word-list delayed recall, word recognition tests, semantic and phonemic verbal fluency tests and trail making test B. Linear regression models and generalized linear regression with logarithmic links between the cognitive tests and anthropometric indicators (body mass index [BMI]), insulin resistance (Homeostasis Model Assessment for Insulin Resistance [HOMA-IR]), and prediabetes (impaired glucose tolerance) were stratified by sex. The results were adjusted for age, education, comorbidities, health-related behaviors, waist circumference, and lipids. Results Among women, higher BMI was associated with poorer performance on phonemic verbal fluency test (β-0.02 [−0.04; −0.01]) and memory tests (β-0.05 [−0.07; −0.02]). Higher HOMA-IR was associated with poorer cognitive performance in memory (β-0.11 [−0.19; −0.01]) and phonemic verbal fluency tests (β-0.12 [−0.20; −0.04]). In men, HOMA-IR (β-0.15 [−0.25; −0.04]) and prediabetes (β-0.35 [−0.69; -0.03]) were associated with poorer performance on memory tests. Conclusions We found a significant association of BMI and HOMA-IR with cognitive performance in young and middle-aged adult women without diabetes. In men, we found an association between HOMA-IR and prediabetes and poorer performance on memory tests.
- Published
- 2020
21. Non-HDL-C goals based on the distribution of population percentiles in ELSA-Brasil: Is it time to change?
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Ligia Maria Giongo Fedeli, Sandhi Maria Barreto, William Pedrosa, Pedro Guatimosim Vidigal, Cristina D. Castilhos, Fabiano de Almeida Brito, Rodrigo Citton Padilha dos Reis, and Chams B. Maluf
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Percentile ,Longitudinal study ,education.field_of_study ,business.industry ,Non hdl c ,Population ,Treatment goals ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Non hdl cholesterol ,Medicine ,lipids (amino acids, peptides, and proteins) ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,education ,Adult health ,Lipoprotein cholesterol ,Demography - Abstract
Background and aims Non–high-density lipoprotein cholesterol (non-HDL-C) goals are defined as 30 mg/dL (0.78 mmol/L) higher than the respective low-density lipoprotein cholesterol (LDL-C) goals. This definition, however, do not consider the population distribution of non-HDL-C, which could represent a more appropriate individual goal when both markers are discordant. The aim of this study is to establish non-HDL-C goals at the same population percentiles of LDL-C. Methods Non-HDL-C values were assigned at the same percentiles correspondent to the LDL-C treatment goals for 14,837 participants from the Longitudinal Study of Adult Health (ELSA-Brasil) with triglycerides levels ≤ 400 mg/dL (4.52 mmol/L). We also assessed the frequency of reclassification, defined as the number of subjects with LDL-C levels in the recommended therapeutic category, but with non-HDL-C levels above or below the category. Results The non-HDL-C values, based on correspondent LDL-C population percentiles, were 92 (2.38), 122 (3.16), 156 (4.04), 191 (4.95), and 223 mg/dL (5.78 mmol/L). Among participants with LDL-C Conclusions Our results demonstrated that non-HDL-C percentiles-based goals were up to 8 mg/dL (0.21 mmol/L) lower than the guidelines recommended goal and had a profound impact on the reclassification of participants, notably when LDL-C was
- Published
- 2018
22. Time From Smoking Cessation and Inflammatory Markers: New Evidence From a Cross-Sectional Analysis of ELSA-Brasil
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Antonio Luiz Pinho Ribeiro, Sandhi Maria Barreto, Bruce Bartholow Duncan, Luana Giatti, Lidyane do Valle Camelo, Flávia Soares Peres, and Pedro Guatimosim Vidigal
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Adult ,Male ,medicine.medical_specialty ,Longitudinal study ,Time Factors ,Cross-sectional study ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Leukocyte Count ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Internal medicine ,medicine ,Humans ,Longitudinal Studies ,030212 general & internal medicine ,Aged ,COPD ,biology ,business.industry ,Smoking ,C-reactive protein ,Confounding ,Public Health, Environmental and Occupational Health ,Middle Aged ,medicine.disease ,Former Smoker ,C-Reactive Protein ,Cross-Sectional Studies ,Linear Models ,biology.protein ,Smoking cessation ,Female ,Smoking Cessation ,business ,Biomarkers ,Brazil - Abstract
Introduction The time for inflammatory markers of former smokers to revert to never smoker levels is still controversial, ranging from 5 to 20 years. We aimed to determine the time from smoking cessation for white blood cell (WBC) count and serum C-reactive protein (CRP) levels to return to those of never-smokers, after adjusting for confounding factors and for secondhand smoke (SHS) exposure among participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods Cross-sectional analysis of baseline participants of ELSA-Brasil. We used linear regression analysis and generalized linear models with gamma distribution and logarithmic link function to estimate the association of WBC count and CRP levels with time from smoking cessation. The following confounding factors were considered: sex, age, education, SHS, alcohol consumption, leisure-time physical activity, BMI, total cholesterol/HDL ratio, hypertension, diabetes, cardiovascular disease, and chronic obstructive pulmonary disease (COPD). Results: After all adjustments, time from smoking cessation
- Published
- 2017
23. Intake of selected foods and beverages and serum uric acid levels in adults: ELSA-Brasil (2008–2010)
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Carolina Gomes Coelho, Maria de Fátima Haueisen Sander Diniz, Pedro Guatimosim Vidigal, Rosa Weiss Telles, Michelle Timóteo da Silva, and Sandhi Maria Barreto
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0301 basic medicine ,Adult ,Male ,Longitudinal study ,Meat ,Alcohol Drinking ,Medicine (miscellaneous) ,Logistic regression ,Food group ,Beverages ,03 medical and health sciences ,chemistry.chemical_compound ,Food Preferences ,0302 clinical medicine ,Environmental health ,Vegetables ,Medicine ,Humans ,030212 general & internal medicine ,Hyperuricemia ,Longitudinal Studies ,Aged ,030109 nutrition & dietetics ,Nutrition and Dietetics ,business.industry ,Alcoholic Beverages ,Serum uric acid ,Confounding ,Public Health, Environmental and Occupational Health ,Feeding Behavior ,Middle Aged ,medicine.disease ,Nutrition Surveys ,Diet ,Uric Acid ,Cross-Sectional Studies ,chemistry ,Fruit ,Uric acid ,Alcohol intake ,Female ,Dairy Products ,business ,Energy Intake ,Brazil ,Research Paper - Abstract
Objective:To investigate the association between the intake of selected food groups and beverages and serum uric acid (UA).Design:Cross-sectional study using the baseline data (2008–2010) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Food intake was assessed by food frequency questionnaire with 114 items. Linear and logistic regressions investigated the associations between the daily intake of each food group (servings/d) and UA (mg/dl) and hyperuricemia (UA ≥ 6·8 mg/dl), respectively. All the analyses were adjusted for potential confounders, energy intake and all food groups.Setting:Teaching and research institutions from six Brazilians states.Subjects:The participants were 14 320 active and retired civil servants, aged 35–74 years.Results:Higher intake of dairy products was associated with lower serum UA levels in both sexes, with a statistical dose-response gradient. High meat intake was associated with high UA only in women, and high intake of organ meats, in men. Intake of fish and fruits, vegetables and legumes were not associated with serum UA. In men, moderate and high intake of alcoholic beverages, specifically beer and spirits, but not wine, increased UA. In women, only high intake of alcoholic beverages, specifically beer, was associated with increased serum UA. Similar associations were seen for hyperuricemia.Conclusions:Results suggest a potential beneficial role of dairy products consumption on UA levels. The association between alcohol intake and UA differed according to type of beverage and between sexes. Results reinforce the need to consider the whole diet in the analysis and to conduct sex stratified analysis.
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- 2019
24. INTAKE OF SELECTED FOODS AND BEVERAGES AND HYPERURICEMIA IN ADULTS - ELSA-BRASIL (2008-2010)
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Sandhi Maria Barreto, Michelle Timóteo da Silva, Rosa Weiss Telles, Carolina Gomes Coelho, Pedro Guatimosim Vidigal, and Maria Fátima Haueisen Sander Diniz
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business.industry ,Environmental health ,medicine ,Hyperuricemia ,medicine.disease ,business - Published
- 2019
25. Effects of Calcium, Magnesium, and Potassium concentrations on ventricular repolarization in unselected individuals
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Pedro Guatimosim Vidigal, Yongmei Liu, Alice Stanton, Kent D. Taylor, Thomas Meitinger, Vilmundur Gudnason, Massimo Mangino, Mario Pirastu, Nilesh J. Samani, Christopher Newton-Cheh, Xiuqing Guo, Bruno H. Stricker, Mortiz F. Sinner, Steven R. Cummings, Jennifer A. Brody, Antonio Luiz Pinho Ribeiro, Mark J. Caulfield, Bryan Kestenbaum, Dennis O. Mook-Kanamori, Jørgen K. Kanters, Kirill V. Tarasov, Martina Müller-Nurasyid, Luana Giatti, Elsayed Z. Soliman, Christian R. Juhl, Nuno R. Zilhão, Harold Snieder, Eric Campana, Mika Kähönen, Ginevra Biino, Raymond Noordam, Jun Ding, Chris H. L. Thio, Jerome I. Rotter, Torben Hansen, M. Abdullah Said, Francesco Cucca, Allan Linneberg, Nona Sotoodehnia, Niels Grarup, Peter S. Sever, James F. Wilson, André G. Uitterlinden, Xia Shen, Luisa Foco, Yong Qian, Christina Ellervik, Diana van Heemst, Antonietta Robino, Henry J. Lin, Konstantin Strauch, Patricia B. Munroe, Nabi Shah, Claus Graff, Daniel S. Evans, Peter J. van der Most, Stefan Weiss, Maria Pina Concas, Reem Salman, Hao Mei, Linda Repetto, Helen R. Warren, Peter K. Joshi, Susan R. Heckbert, Tim D. Spector, Sandhi Maria Barreto, Jie Yao, Marcus Dörr, Eulalia Catamo, Anna F. Dominiczak, Leo-Pekka Lyytikäinen, Giorgia Girotto, Peter P. Pramstaller, Gudny Eiriksdottir, J. Wouter Jukema, Paulo A. Lotufo, Colin N. A. Palmer, Andrew Tinker, James G. Wilson, Mary L. Biggs, Astrid Petersmann, Arie C. Maan, Peter S. Braund, Maria Fernanda Lima-Costa, Paraskevi Christofidou, Sandosh Padmanabhan, Adolfo Correa, Melanie Waldenberger, Alessandro De Grandi, Stefan Kääb, Cristian Pattaro, Annette Peters, William J Young, Alex S. F. Doney, Katharina Schramm, Terho Lehtimäki, Christopher P. Nelson, Martin Gögele, Marten E. van den Berg, Marco Brumat, Pim van der Harst, Niek Verweij, Simona Vaccargiu, Noordam, R, Young, Wj, Salman, R, Kanters, Jk, van den Berg, Me, van Heemst, D, Lin, Hj, Barreto, Sm, Biggs, Ml, Biino, G, Catamo, E, Concas, Mp, Ding, J, Evans, D, Foco, L, Grarup, N, Lyytikäinen, Lp, Mangino, M, Mei, H, van der Most, Pj, Müller-Nurasyid, M, Nelson, Cp, Qian, Y, Repetto, L, Said, Ma, Shah, N, Schramm, K, Vidigal, Pg, Weiss, S, Yao, J, Zilhao, Nr, Brody, Ja, Braund, P, Brumat, M, Campana, E, Christofidou, P, Caulfield, Mj, De Grandi, A, Dominiczak, Af, Doney, Asf, Eiriksdottir, G, Ellervik, C, Giatti, L, Gögele, M, Graff, C, Guo, X, van der Harst, P, Joshi, Pk, Kähönen, M, Kestenbaum, B, Lima-Costa, Mf, Linneberg, A, Maan, Ac, Meitinger, T, Padmanabhan, S, Pattaro, C, Peters, A, Petersmann, A, Sever, P, Sinner, Mf, Shen, X, Stanton, A, Strauch, K, Soliman, Ez, Tarasov, Kv, Taylor, Kd, Thio, Chl, Uitterlinden, Ag, Vaccargiu, S, Waldenberger, M, Robino, A, Correa, A, Cucca, F, Cummings, Sr, Dörr, M, Girotto, G, Gudnason, V, Hansen, T, Heckbert, Sr, Juhl, Cr, Kääb, S, Lehtimäki, T, Liu, Y, Lotufo, Pa, Palmer, Cna, Pirastu, M, Pramstaller, Pp, Ribeiro, Alp, Rotter, Ji, Samani, Nj, Snieder, H, Spector, Td, Stricker, Bh, Verweij, N, Wilson, Jf, Wilson, Jg, Jukema, Jw, Tinker, A, Newton-Cheh, Ch, Sotoodehnia, N, Mook-Kanamori, Do, Munroe, Pb, Warren, Hr., Cardiovascular Centre (CVC), Life Course Epidemiology (LCE), and Epidemiology
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Male ,Cardiac & Cardiovascular Systems ,030204 cardiovascular system & hematology ,ELECTROCARDIOGRAM ,Electrocardiography ,0302 clinical medicine ,cohort studies ,Risk Factors ,Medicine ,Magnesium ,030212 general & internal medicine ,Correlation of Data ,1102 Cardiorespiratory Medicine and Haematology ,RISK ,education.field_of_study ,medicine.diagnostic_test ,ACTION-POTENTIAL DURATION ,ASSOCIATION ,Middle Aged ,COUNCIL ,electrocardiographic intervals ,Cardiovascular Diseases ,Cardiology ,Female ,epidemiology ,Electrical conduction system of the heart ,Cardiology and Cardiovascular Medicine ,Electrophysiologic Techniques, Cardiac ,Life Sciences & Biomedicine ,medicine.medical_specialty ,Population ,electrolytes epidemiology ,meta-analysis ,chemistry.chemical_element ,electrolytes ,Calcium ,QT interval ,1117 Public Health and Health Services ,03 medical and health sciences ,QRS complex ,DISPERSION ,Heart Conduction System ,Internal medicine ,Humans ,PR interval ,education ,Science & Technology ,Cohort Studies ,Electrocardiographic Intervals ,Electrolytes ,Epidemiology ,Meta-analysis ,business.industry ,QT INTERVAL ,RESTING HEART-RATE ,Confidence interval ,REDUCTION ,chemistry ,Cardiovascular System & Hematology ,CONDUCTION ,Asymptomatic Diseases ,Potassium ,Cardiovascular System & Cardiology ,electrocardiographic interval ,business ,cohort studie - Abstract
BACKGROUND Subclinical changes on the electrocardiogram are risk factors for cardiovascular mortality. Recognition and knowledge of electrolyte associations in cardiac electrophysiology are based on only in vitro models and observations in patients with severe medical conditions.OBJECTIVES This study sought to investigate associations between serum electrolyte concentrations and changes in cardiac electrophysiology in the general population.METHODS Summary results collected from 153,014 individuals (54.4% women; mean age 55.1 +/- 12.1 years) from 33 studies (of 5 ancestries) were meta-analyzed. Linear regression analyses examining associations between electrolyte concentrations (mmol/l of calcium, potassium, sodium, and magnesium), and electrocardiographic intervals (RR, QT, QRS, JT, and PR intervals) were performed. The study adjusted for potential confounders and also stratified by ancestry, sex, and use of antihypertensive drugs.RESULTS Lower calcium was associated with longer QT intervals (-11.5 ms; 99.75% confidence interval [CI]: -13.7 to -9.3) and JT duration, with sex-specific effects. In contrast, higher magnesium was associated with longer QT intervals (7.2 ms; 99.75% CI: 1.3 to 13.1) and JT. Lower potassium was associated with longer QT intervals (-2.8 ms; 99.75% CI: -3.5 to -2.0), JT, QRS, and PR durations, but all potassium associations were driven by use of antihypertensive drugs. No physiologically relevant associations were observed for sodium or RR intervals.CONCLUSIONS The study identified physiologically relevant associations between electrolytes and electrocardiographic intervals in a large-scale analysis combining cohorts from different settings. The results provide insights for further cardiac electrophysiology research and could potentially influence clinical practice, especially the association between calcium and QT duration, by which calcium levels at the bottom 2% of the population distribution led to clinically relevant QT prolongation by >5 ms. (C) 2019 by the American College of Cardiology Foundation.
- Published
- 2019
26. Método de apuração de custos: estudo de caso em uma fundação de apoio de Minas Gerais
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Leandro Pinheiro Cintra, Renato da Costa Braga, and Pedro Guatimosim Vidigal
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0301 basic medicine ,030505 public health ,030109 nutrition & dietetics ,Data collection ,Knowledge management ,business.industry ,Total absorption costing ,Process (engineering) ,Computer science ,Cost centre ,Purchasing ,03 medical and health sciences ,Triangulation (geometry) ,Accountability ,0305 other medical science ,Activity-based costing ,business - Abstract
This article presents a costing method for a Support Foundation, based on the study of its case. A survey was carried out to map their areas, whose data collection techniques used were: consultation of archives and internal documents, semi-structured interviews and non-participant observations. As results were identified the procedures, resources activities developed. The analysis, by triangulation, allowed defining the apportionment metrics for each cost center, which allowed the comparisons with the theoretical constructs available and the description on how the absorption costing method fits the pricing needs and decision-making. It was possible to identify that the foundation presents as final product the activities carried out by the Personnel, Purchasing, Import and Accountability Areas. From the results obtained in this process, we propose future studies and reflections on the potential of applying the mapping procedures and the costing method adopted to organizations of the same nature.
- Published
- 2018
27. Chronic kidney disease among adult participants of the ELSA-Brasil cohort: association with race and socioeconomic position
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Roberto Marini Ladeira, Antonio Alberto Lopes, Sandhi Maria Barreto, Rosane Harter Griep, Pedro Guatimosim Vidigal, Maria Inês Schmidt, Isabela M. Benseñor, José Geraldo Mill, Paulo A. Lotufo, Dóra Chor, Antonio Luis Pinho Ribeiro, and Bruce Bartholow Duncan
- Subjects
Adult ,Male ,Gerontology ,medicine.medical_specialty ,Longitudinal study ,Epidemiology ,030232 urology & nephrology ,Black People ,Renal function ,Logistic regression ,White People ,Odds ,03 medical and health sciences ,0302 clinical medicine ,Outcome Assessment, Health Care ,Prevalence ,medicine ,Albuminuria ,Humans ,Longitudinal Studies ,030212 general & internal medicine ,Renal Insufficiency, Chronic ,Socioeconomic status ,Aged ,business.industry ,Public Health, Environmental and Occupational Health ,Middle Aged ,medicine.disease ,Socioeconomic Factors ,Cohort ,Female ,business ,Brazil ,Glomerular Filtration Rate ,Demography ,Kidney disease - Abstract
BACKGROUND: There is increased interest in understanding why chronic kidney disease (CKD) rates vary across races and socioeconomic groups. We investigated the distribution of estimated glomerular filtration rate (eGFR), urinary albumin-creatinine ratio (ACR) and CKD according to these factors in Brazilian adults. METHODS: Using baseline data (2008-2010) of 14 636 public sector employees (35-74 years) enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA)-Brasil multicentre cohort, we estimated the prevalence of CKD by sex, age, race and socioeconomic factors. CKD was defined as ACR≥30 mg/g and/or eGFR
- Published
- 2015
28. Standardization and reference intervals of platelet volume indices: Insight from the Brazilian longitudinal study of adult health (ELSA-BRASIL)
- Author
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Pedro Guatimosim Vidigal, Chams B. Maluf, and Sandhi Maria Barreto
- Subjects
Adult ,Blood Platelets ,Male ,Longitudinal study ,medicine.medical_specialty ,Pathology ,Adolescent ,Reference range ,Young Adult ,Reference Values ,Internal medicine ,medicine ,Humans ,Longitudinal Studies ,Young adult ,Mean platelet volume ,Child ,Aged ,Platelet Count ,business.industry ,Platelet Distribution Width ,Hematology ,General Medicine ,Middle Aged ,medicine.disease ,Obesity ,Population Surveillance ,Female ,Metabolic syndrome ,business ,Mean Platelet Volume ,Body mass index ,Brazil - Abstract
Platelet volume indices (PVI) are associated with hematological and non-hematological diseases, notably cardiovascular and cerebrovascular diseases. The establishment of PVI reference intervals (RIs) are essential to evaluate whether these indices are useful in clinical practice. Healthy-associated RIs have not yet been established for the Brazilian population. Here, we determined RIs of PVI for a health adult population, participants of the Brazilian Longitudinal Study of Adult Health ELSA-Brasil. A total of 580 individuals out of an initial sample of 3115 subjects constituted the healthy reference sample. To be part of the study, individuals had to fulfill the following criteria: blood count within 2 hours of collection, no use of continuous medication, self-rated health as good or very good, no reported diagnosis of diabetes and/or arterial hypertension, not smoking, lack of metabolic syndrome, body mass index (BMI)
- Published
- 2014
29. Establishing a blood fructosamine reference range for the Brazilian population based on data from ELSA – Brasil
- Author
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Maria de Fátima Haueisen Sander Diniz, Pedro Guatimosim Vidigal, William Pedrosa, and Sandhi Maria Barreto
- Subjects
1, 5 AG, 1,5-anhydroglucitol ,medicine.medical_specialty ,Longitudinal study ,Clinical Biochemistry ,Population ,Reference range ,BMI, Body mass index ,Article ,NBT, Nitroblue tetrazolium method ,Reference interval ,lcsh:Chemistry ,IDF, International diabetes federation ,chemistry.chemical_compound ,Diabetes mellitus ,Internal medicine ,medicine ,OGTT, Oral glucose tolerance test ,education ,Glycemic ,lcsh:R5-920 ,education.field_of_study ,FPG, Fasting plasma glucose ,CLSI, Clinical and laboratory standard institute ,Radiological and Ultrasound Technology ,business.industry ,2-h PG, 2 h post glucose load ,Fructosamine ,lcsh:QD1-999 ,chemistry ,Cohort ,Glycated hemoglobin ,A1c, Glycate hemoglobin ,lcsh:Medicine (General) ,business ,Body mass index - Abstract
Objectives The fructosamine test is used in the monitoring of diabetes mellitus, particularly in cases with restrictions on the use of glycated hemoglobin (mainly in the setting of altered red blood cell lifespan and interference by hemoglobin variants). It could also provide additional information on shorter-term glycemic control. The objective of the study is to establish the reference range of the fructosamine in the Brazilian population. Design and methods The reference interval was defined as suggested by the Clinical and Laboratory Standards Institute (CLSI). The study participants were from a Brazilian cohort (The Longitudinal Study of Adult Health – ELSA-Brasil) with baseline data collected between 2008 and 2010. A total of 466 subjects were selected after exclusion of diabetic individuals, and those with altered glycemic markers and renal function tests. Results The reference interval was 186–248 μmol/L for women and 196–269 μmol/L for men. Fructosamine levels were higher in men than in women (p = 0.006) and in the non-white population (p = 0.034) and had a negative correlation with the body mass index (r = −0.117; p = 0.011). Conclusions The reference intervals for fructosamine were affected by sex. Reference intervals stratified by sex would be more adequate in the interpretation of the fructosamine test., Highlights • Reference intervals for fructosamine in serum. • The reference intervals for fructosamine were affected by sex. • The reference intervals for fructosamine are different for different population.
- Published
- 2019
30. Factors associated with metabolically healthy status in obesity, overweight, and normal weight at baseline of ELSA-Brasil
- Author
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Antonio Luiz Pinho Ribeiro, Paulo A. Lotufo, Sandhi Maria Barreto, Maria de Fátima Haueisen Sander Diniz, Pedro Guatimosim Vidigal, Isabela M. Benseñor, Alline Beleigoli, Maria Inês Schmidt, and Bruce Bartholow Duncan
- Subjects
Gerontology ,Male ,obesity ,Cross-sectional study ,Health Status ,Metabolicaly healthy obesity ,Comorbidity ,Metabolically healthy status ,030204 cardiovascular system & hematology ,Overweight ,Body Mass Index ,0302 clinical medicine ,Mass index ,030212 general & internal medicine ,Longitudinal Studies ,Índice de massa corporal ,Anthropometry ,General Medicine ,Middle Aged ,Nutrition Surveys ,Phenotype ,Obesidade ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,metabolically healthy obesity ,Female ,medicine.symptom ,Brazil ,Research Article ,Adult ,National Health and Nutrition Examination Survey ,Observational Study ,metabolically healthy status ,03 medical and health sciences ,medicine ,overweight ,Humans ,Obesity ,National Cholesterol Education Program ,Life Style ,Aged ,Demography ,business.industry ,Weight change ,Body Weight ,medicine.disease ,Cross-Sectional Studies ,Sobrepeso ,business ,Body mass index ,Biomarkers - Abstract
Supplemental Digital Content is available in the text, The primary aim of this study was to evaluate metabolically healthy status (MHS) among participants in obesity, overweight, and normal weight groups and characteristics associated with this phenotype using baseline data of Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The secondary aim was to investigate agreement among 4 different MHS criteria. This cross-sectional study included 14,545 participants aged 35 to 74 years with a small majority (54.1%) being women. Of all participants, 22.7% (n = 3298) were obese, 40.8% (n = 5934) were overweight, and 37.5% (n = 5313) were of normal weight. Socio-demographic, behavioral, and anthropometric factors related to MHS were ascertained. Logistic regression models estimated the odds of associations. We used 4 different criteria separately and in combination to define MHS: the National Health and Nutrition Examination Survey (NHANES), the National Cholesterol Education Program (NCEP-ATPIII), the International Diabetes Federation (IDF) and comorbidities, and the agreement between them were evaluated by Cohen-kappa coefficient. MHS was present among 12.0% (n = 396) of obese, 25.5% (n = 1514) of overweight, and 48.6% (n = 2582) of normal weight participants according to the combination of the 4 criteria. The agreement between all the 4 MHS criteria was strong (kappa 0.73 P
- Published
- 2016
31. More on: The association between mean platelet volume and cardiovascular risk factors
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Rodrigo Citton Padilha Reis, Sandhi Maria Barreto, Chams B. Maluf, and Pedro Guatimosim Vidigal
- Subjects
Blood Platelets ,Metabolic Syndrome ,medicine.medical_specialty ,business.industry ,Pre analytical ,Platelet Count ,Cardiovascular risk factors ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Cardiovascular Diseases ,Risk Factors ,Internal medicine ,Internal Medicine ,medicine ,Cardiology ,Humans ,Platelet ,030212 general & internal medicine ,Mean platelet volume ,business ,Mean Platelet Volume - Published
- 2016
32. Variability in baseline laboratory measurements of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
- Author
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Lloyd E. Chambless, Pedro Guatimosim Vidigal, Bruce Bartholow Duncan, Álvaro Vigo, Maria Inês Schmidt, Ruben Ladwig, Cristina D. Castilhos, Ligia Maria Giongo Fedeli, and Isabela M. Benseñor
- Subjects
Adult ,Quality Control ,Longitudinal study ,Pathology ,medicine.medical_specialty ,Physiology ,Intraclass correlation ,Immunology ,Biophysics ,030209 endocrinology & metabolism ,Ocean Engineering ,Multi-center studies ,Biochemistry ,Laboratory measurements ,Central laboratory ,03 medical and health sciences ,Estatística médica ,0302 clinical medicine ,Statistics ,medicine ,Humans ,Longitudinal Studies ,Clinical Investigation ,General Pharmacology, Toxicology and Pharmaceutics ,lcsh:QH301-705.5 ,Reliability (statistics) ,Adult health ,Observer Variation ,lcsh:R5-920 ,Reproducibility ,030505 public health ,business.industry ,General Neuroscience ,Reproducibility of Results ,Quality control ,Cell Biology ,General Medicine ,Reference Standards ,Random effects model ,lcsh:Biology (General) ,Serum potassium ,lcsh:Medicine (General) ,Laboratories ,0305 other medical science ,business ,Brazil - Abstract
Multi-center epidemiological studies must ascertain that their measurements are accurate and reliable. For laboratory measurements, reliability can be assessed through investigation of reproducibility of measurements in the same individual. In this paper, we present results from the quality control analysis of the baseline laboratory measurements from the ELSA-Brasil study. The study enrolled 15,105 civil servants at 6 research centers in 3 regions of Brazil between 2008–2010, with multiple biochemical analytes being measured at a central laboratory. Quality control was ascertained through standard laboratory evaluation of intra- and inter-assay variability and test-retest analysis in a subset of randomly chosen participants. An additional sample of urine or blood was collected from these participants, and these samples were handled in the same manner as the original ones, locally and at the central laboratory. Reliability was assessed with the intraclass correlation coefficient (ICC), estimated through a random effects model. Coefficients of variation (CV) and Bland-Altman plots were additionally used to assess measurement variability. Laboratory intra and inter-assay CVs varied from 0.86% to 7.77%. From test-retest analyses, the ICCs were high for the majority of the analytes. Notably lower ICCs were observed for serum sodium (ICC=0.50; 95%CI=0.31–0.65) and serum potassium (ICC=0.73; 95%CI=0.60–0.83), due to the small biological range of these analytes. The CVs ranged from 1 to 14%. The Bland-Altman plots confirmed these results. The quality control analyses showed that the collection, processing and measurement protocols utilized in the ELSA-Brasil produced reliable biochemical measurements.
- Published
- 2016
33. Physical Activity and Lipid Profile in the ELSA- Brasil Study
- Author
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Sandhi Maria Barreto, Pedro Guatimosim Vidigal, Ligia Maria Giongo Fedeli, Sheila Alvim, Maria de Fátima Haueisen Sander Diniz, and Raquel Caroline da Silva
- Subjects
Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Time Factors ,Epidemiology ,Doenças Cardiovasculares ,030204 cardiovascular system & hematology ,chemistry.chemical_compound ,0302 clinical medicine ,Reference Values ,Risk Factors ,Triglicérides ,Perfil de Saúde ,030212 general & internal medicine ,Longitudinal Studies ,Hipercolesterolemia ,Univariate analysis ,medicine.diagnostic_test ,Middle Aged ,Lipoproteins, LDL ,Cholesterol ,Cardiovascular Diseases ,Female ,lipids (amino acids, peptides, and proteins) ,Cardiology and Cardiovascular Medicine ,Lipoproteins, HDL ,Colesterol ,Brazil ,Adult ,medicine.medical_specialty ,Hypercholesterolemia ,Physical activity ,Motor Activity ,Statistics, Nonparametric ,Atividade Motora ,03 medical and health sciences ,Age Distribution ,Internal medicine ,medicine ,Humans ,Exercise physiology ,Sex Distribution ,Exercise ,Adult health ,Health Profile ,Triglycerides ,Aged ,Dyslipidemias ,business.industry ,Plasma levels ,Original Articles ,Endocrinology ,Cross-Sectional Studies ,chemistry ,Socioeconomic Factors ,lcsh:RC666-701 ,Geometric mean ,business ,Lipid profile - Abstract
Background: Regular physical activity (PA) induces desirable changes in plasma levels of high- and low-density lipoproteins (HDL and LDL, respectively) and triglycerides (TG), important risk factors for cardiometabolic diseases. However, doubts whether intensity and duration have equivalent benefits remain. Objective: To assess the association of PA intensity and duration with HDL, LDL and TG levels. Methods: Cross-sectional study with 12,688 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline, who were not on lipid-lowering medication. After adjustment for important covariates, multiple linear regression was used to assess the association of PA intensity and duration with HDL, LDL and TG (natural logarithm) levels. Results: Both moderate and vigorous PA and PA practice ≥ 150 min/week were significantly associated with higher HDL and lower TG levels. Vigorous PA was associated with lower LDL only on univariate analysis. After adjustments, moderate and vigorous PA increased mean HDL level by 0.89 mg/dL and 1.71 mg/dL, respectively, and reduced TG geometric mean by 0.98 mg/dL and 0.93 mg/dL, respectively. PA practice ≥ 150 min/week increased mean HDL level by 1.05 mg/dL, and decreased TG geometric mean by 0.98 mg/dL. Conclusion: Our findings reinforce the benefits of both PA parameters studied on HDL and TG levels, with a slight advantage for vigorous PA as compared to the recommendation based only on PA duration.
- Published
- 2016
34. Platelet volume is associated with the Framingham risk score for cardiovascular disease in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
- Author
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Rodrigo Citton Padilha Reis, Pedro Guatimosim Vidigal, Chams B. Maluf, and Sandhi Maria Barreto
- Subjects
0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Longitudinal study ,Multivariate analysis ,Systolic hypertension ,Clinical Biochemistry ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Longitudinal Studies ,Mean platelet volume ,Aged ,Framingham Risk Score ,business.industry ,Biochemistry (medical) ,Confounding ,Platelet Distribution Width ,General Medicine ,Middle Aged ,medicine.disease ,Health Surveys ,030104 developmental biology ,Cardiovascular Diseases ,Cohort ,Multivariate Analysis ,Cardiology ,Female ,business ,Mean Platelet Volume ,Brazil - Abstract
Background:Platelet volume indices (PVI), an easy and inexpensive surrogate measure of platelet function, have been associated with cardiovascular diseases (CVD) and their risk factors. However, results are conflicting because of the lack of standardized procedures. The purpose of this study is to investigate the relationship of PVI with the Framingham risk score (FRS).Methods:Baseline data (2008–2010) of 3115 participants enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were used. PVI measurements were strictly controlled. The cohort was distributed according to risk factors and the general FRS was estimated. Multiple linear regression analysis was used to estimate the association between PVI and FRS.Results:Mean platelet volume (MPV), platelet distribution width (PDW) and platelet large cell ratio (P-LCR) independently correlated (p≤0.01) with FRS after adjustment for confounding variables. One unit increase in MPV, PDW, or P-LCR increased the FRS by 0.59%, 0.40%, and 0.08%, respectively. Diabetics had higher (p≤0.004) MPV, PDW, and P-LCR, and hypertensive individuals had higher (p≤0.045) PDW and P-LCR.Conclusions:Increased PVI was independently correlated with higher CVD risk based on the FRS, diabetes, and systolic hypertension. Prospective follow up of this cohort is warranted to confirm that PVI is associated with the development of CVD.
- Published
- 2015
35. Life course socioeconomic position and C-reactive protein: mediating role of health-risk behaviors and metabolic alterations. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
- Author
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Jorge Alexandre Barbosa Neves, Maria de Jesus Mendes da Fonseca, Sandhi Maria Barreto, Pedro Guatimosim Vidigal, Lidyane do Valle Camelo, Paulo A. Lotufo, Luana Giatti, Ichiro Kawachi, Isabela M. Benseñor, Rosane Harter Griep, Maria Inês Schmidt, and Dóra Chor
- Subjects
Gerontology ,Male ,Longitudinal study ,Epidemiology ,Health Status ,Health Behavior ,Physiology ,lcsh:Medicine ,Social Sciences ,Disease ,Sociology ,Risk Factors ,Medicine and Health Sciences ,Longitudinal Studies ,Young adult ,Prospective cohort study ,lcsh:Science ,Immune Response ,Multidisciplinary ,Middle Aged ,Socioeconomic Aspects of Health ,C-Reactive Protein ,Cardiovascular Diseases ,Life course approach ,Educational Status ,Female ,Brazil ,Cohort study ,Research Article ,Adult ,Mediation (statistics) ,Immunology ,Risk-Taking ,medicine ,Humans ,Social Stratification ,Proteina C-reativa ,Cardiovascular Disease Epidemiology ,Aged ,Lifecourse Epidemiology ,Doenças cardiovasculares ,Inflammation ,lcsh:R ,Biology and Life Sciences ,medicine.disease ,Obesity ,Social Epidemiology ,Health Care ,Inflamação ,Social Class ,Socioeconomic Factors ,lcsh:Q - Abstract
Background: Chronic inflammation has been postulated to be one mediating mechanism explaining the association between low socioeconomic position (SEP) and cardiovascular disease (CVD). We sought to examine the association between life course SEP and C-reactive protein (CRP) levels in adulthood, and to evaluate the extent to which health-risk behaviors and metabolic alterations mediate this association. Additionally, we explored the possible modifying influence of gender. Methods and Findings: Our analytical sample comprised 13,371 participants from ELSA-Brasil baseline, a multicenter prospective cohort study of civil servants. SEP during childhood, young adulthood, and adulthood were considered. The potential mediators between life course SEP and CRP included clusters of health-risk behaviors (smoking, low leisure time physical activity, excessive alcohol consumption), and metabolic alterations (obesity, hypertension, low HDL, hypertriglyceridemia, and diabetes). Linear regression models were performed and structural equation modeling was used to evaluate mediation. Although lower childhood SEP was associated with higher levels of CRP in adult life, this association was not independent of adulthood SEP. However, CRP increased linearly with increasing number of unfavorable social circumstances during the life course (p trend ,0.001). The metabolic alterations were the most important mediator between cumulative SEP and CRP. This mediation path accounted for 49.5% of the total effect of cumulative SEP on CRP among women, but only 20.2% among men. In consequence, the portion of the total effect of cumulative SEP on CRP that was mediated by risk behaviors and metabolic alterations was higher among women (55.4%) than among men (36.8%). Conclusions: Cumulative SEP across life span was associated with elevated systemic inflammation in adulthood. Although health-risk behaviors and metabolic alterations were important mediators of this association, a sizable fraction of this association was not mediated by these factors, suggesting that other pathways might play a role, especially among men.
- Published
- 2014
36. Challenges of the Unified Health System: present status of public laboratory services in 31 cities of Minas Gerais, Brazil
- Author
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Liz Custódio Souza Seabra, Luciana de Gouvêa Viana, Joanna Paula Guimarães Cardoso, Pedro Guatimosim Vidigal, Tasso Amós de Araújo Mendes, Letícia Maria Henriques Resende, and Mariana Rabelo Maia
- Subjects
exames laboratoriais ,medicine.medical_specialty ,Quality management ,media_common.quotation_subject ,Clinical Biochemistry ,Legislation ,serviços de saúde ,laboratory tests ,Pathology and Forensic Medicine ,planejamento em saúde ,medicine ,lcsh:Pathology ,health management ,Quality (business) ,health services ,Productivity ,media_common ,gestão em saúde ,Health management system ,business.industry ,health planning ,Public health ,Unified Health System ,Information technology ,Medical Laboratory Technology ,Engineering management ,Work (electrical) ,Sistema Único de Saúde ,business ,Brazil ,lcsh:RB1-214 - Abstract
Introduction: Modifications in the Brazilian Unified Health System (SUS) have led to a significant improvement in the national health indexes. However, some challenges still need to be faced, especially concerning SUS patients' access to high-quality laboratory support services.Objective: To evaluate the present status of laboratory services in SUS in 31 cities of Minas Gerais, Brazil, between 2008 and 2011.Material and method: This analysis was performed through data from the Information Technology Department of SUS (DATASUS) and through interviews with local public health managers with structured questionnaires.Results: Among all the studied cities, 21 had their own laboratory, 90.2% of which were in precarious conditions, not meeting the requirements established by the legislation in force, and employing inappropriate procedures and techniques, in addition to using obsolete equipment. The range of available laboratory tests was limited, what demanded the services of supporting laboratories. None of the evaluated laboratories developed any systematic activity on quality management, including control of analytical quality, maintenance of laboratory equipment, calibration and performance evaluation of critical equipment, continuing education programs, and safety and biosecurity.Conclusion: The effective role of laboratory test results in medical decision is unquestionably impaired, risking the safety of SUS patients. The present work reveals the deficiencies of public laboratory services in Minas Gerais, and proposes a new management model, which is able to associate operational quality, technological development and optimization of human and material resources with higher productivity. Introdução: Desde a sua criação, modificações no Sistema Único de Saúde (SUS) levaram a uma melhoria significativa nos índices nacionais de saúde. No entanto, alguns desafios ainda precisam ser enfrentados, especialmente o acesso de pacientes do SUS aos serviços de apoio de laboratório de qualidade.Objetivo:Avaliar a situação atual da assistência laboratorial no SUS em 31 municípios de Minas Gerais, Brasil, entre 2008 e 2011.Material e método: Foi realizado levantamento de dados do Departamento de Informática do SUS (DATASUS) e de entrevistas com gestores utilizando questionário estruturado.Resultados: Dos municípios estudados, 21 possuíam laboratório próprio, sendo que 90,2% deles apresentavam instalações físicas precárias, fora das especificações previstas na legislação vigente, e empregavam procedimentos e técnicas inadequadas, com utilização de equipamentos obsoletos. O perfil de exames era restrito, necessitando da utilização de laboratórios de apoio. Nenhum dos laboratórios avaliados apresentava programas de educação permanente, de controle da qualidade dos exames laboratoriais, de manutenção dos equipamentos analíticos, de aferição de instrumentos críticos e de segurança e biossegurança.Conclusão: O papel efetivo dos resultados dos testes de laboratório na decisão médica mostrou-se, sem dúvida, prejudicado, acarretando risco à segurança dos pacientes usuários do SUS. O presente trabalho revelou a precariedade da assistência laboratorial pública em MG e propõe a mudança para um modelo de gestão capaz de aliar qualidade operacional, desenvolvimento tecnológico, otimização de recursos humanos e materiais e maior produtividade.
- Published
- 2014
37. The Bambuí Health and Aging study (BHAS): prevalence of risk factors and use of preventive health care services
- Author
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Elizabeth Uchoa, Pedro Guatimosim Vidigal, Henrique L. Guerra, Josélia Oliveira Araújo Firmo, Maria Fernanda Lima-Costa, and Sandhi Maria Barreto
- Subjects
Adult ,Male ,medicine.medical_specialty ,lcsh:Arctic medicine. Tropical medicine ,Adolescent ,Urban Population ,Health surveys ,lcsh:RC955-962 ,Population ,lcsh:Medicine ,Physical examination ,Preventive Health Services ,Health care ,Prevalence ,medicine ,Health Status Indicators ,Humans ,risk factors ,education ,health services ,health of the elderly ,disease control and prevention ,Aged ,Aged, 80 and over ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Public health ,lcsh:Public aspects of medicine ,lcsh:R ,Age Factors ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Middle Aged ,Anthropometry ,Blood pressure ,Health promotion ,Female ,business ,Body mass index ,Brazil ,Demography - Abstract
Objective. To describe, for the first time in Brazil, the prevalence of risk factors and the use of preventive health care services among adults 60 years and older. Methods. This population-based study was conducted during 1996-1997 in the state of Minas Gerais, in the town of Bambuí, which is located in the municipality of the same name. In 1996 the town had 14 950 inhabitants. For the study, all the town's residents aged > or = 60 years were selected, along with a comparison sample of persons aged 18-59 years. Data were gathered using interviews and physical examinations. Results. Of the 1 742 inhabitants of the town of Bambuí aged > or = 60 years, 1 606 (92.2%) participated in the interview and 1 495 (85.8%) were examined (blood pressure, anthropometric measurements, and blood tests). Among the 1 020 younger adults selected for the survey, 909 of them (89.1%) participated in the interview, and 820 of them (80.4%) underwent the physical examination. The prevalence of the following risk factors was higher among older adults than among younger adults: physical inactivity (47.7% vs. 28.0%); blood pressure 140-159 mmHg (systolic) or 90-99 mmHg (diastolic) (25.8% vs. 8.7%); blood pressure > or = 160 mmHg (systolic) or > or = 100 mmHg (diastolic) (19.1% vs. 4.1%); total cholesterol > or = 240 mg/dL (40.6% vs. 9.8%); and blood glucose > or = 126 mg/dL (12.4% vs. 2.2%). The daily consumption of fruits and vegetables was similar among the older adults and the younger ones (51.9% and 51.7%), as was also body mass index > or = 25 kg/m² (51.6% and 56.2%). Smoking was lower among the older adults (18.7%) than among the younger ones (31.1%). The proportion of participants whose blood pressure had been checked in the preceding year was high (86.8% among the older adults and 61.2% among the younger ones), suggesting that the high prevalence of uncontrolled hypertension was not due to limited access to health care. Conclusions. For a long time it was believed that the kinds of risk factors that we found in the urban section of the municipality of Bambuí were public health problems only in large Brazilian cities. Around 72% of the municipalities in Brazil have
- Published
- 2001
38. A reliable and specific enzyme-linked immunosorbent assay for the capture of IgM from human chagasic sera using fixed epimastigotes of Trypanosoma cruzi
- Author
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Alvaro J. Romanha, Paulo R. Z. Antas, Andréa Carla Leite Chaves, Maurício Roberto Motta Pinto da Luz, Pedro Guatimosim Vidigal, Emily N. Azevedo, Norah Medrano-Mercado, Ângela C. Volpini, and T. C. Araujo-Jorge
- Subjects
Chagas disease ,Bolivia ,Adolescent ,Endemic Diseases ,Antibodies, Protozoan ,Enzyme-Linked Immunosorbent Assay ,Cross Reactions ,Immunofluorescence ,Polymerase Chain Reaction ,Sensitivity and Specificity ,law.invention ,Fixatives ,Neutralization Tests ,Rheumatoid Factor ,law ,Formaldehyde ,parasitic diseases ,medicine ,Humans ,Rheumatoid factor ,Chagas Disease ,Child ,Fluorescent Antibody Technique, Indirect ,Trypanosoma cruzi ,Polymerase chain reaction ,General Veterinary ,biology ,medicine.diagnostic_test ,IIf ,General Medicine ,biology.organism_classification ,medicine.disease ,Leishmania ,Virology ,Infectious Diseases ,Immunoglobulin M ,Child, Preschool ,Insect Science ,Acute Disease ,biology.protein ,Parasitology ,Antibody - Abstract
A rapid, sensitive, specific, and reliable enzyme-linked immunosorbent assay (ELISA) is proposed for determination of the levels of anti-Trypanosoma cruzi IgM in acute chagasic sera (ACD). The efficiency of this ELISA as a diagnostic method was compared with that of parasite DNA detection by polymerase chain reaction (PCR) and that of indirect immunofluorescence (iIF) anti-T. cruzi IgM detection. We tested whether this ELISA using fixed epimastigotes (epi) could detect anti-T. cruzi IgM in serum samples from two groups of children with acute Chagas' disease from a hyperendemic area in Bolivia. In a comparison of the ELISA method with other techniques, 95% and 71% of the results correlated with PCR and iIF findings, respectively. At the serum dilution applied (1:250), rheumatoid factor (RF) did not influence the results, and samples from patients carrying leishmaniasis or mixed Leishmania and T. cruzi infection could also be excluded from ACD. Highly specific and reliable results were obtained, a great number of the sera could be tested in only one assay, and a quantitative index of reactivity (IR) could be calculated without serial titration. Using test samples in triplicate, the method provides a useful tool for the detection of early acute-phase T. cruzi infection in humans.
- Published
- 2000
39. Social Inequalities in C-Reactive Protein Levels in Adults from the Brazilian Longitudinal Study of Adult Health (Elsa-Brasil): A Life Course Analysis
- Author
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Pedro Guatimosim Vidigal, Luana Giatti, I. M. Bensenor, Maria de Jesus Fonseca, Sandhi Maria Barreto, Lidyane do Valle Camelo, R. H. Griep, Paulo A. Lotufo, Maria Inês Schmidt, and Dóra Chor
- Subjects
Gerontology ,Longitudinal study ,biology ,Epidemiology ,business.industry ,C-reactive protein ,General Medicine ,biology.protein ,Life course approach ,Medicine ,Social inequality ,C-reactive protein measurement ,business ,Adult health - Published
- 2015
40. Logistics of collection and transportation of biological samples and the organization of the central laboratory in the ELSA-Brasil
- Author
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Ligia G Fedeli, José Geraldo Mill, Leite Cm, Isabela M. Benseñor, Viviane Câmara Maniero, Paulo A. Lotufo, Alexandre C. Pereira, Cristina D. Castilhos, Pedro Guatimosim Vidigal, Robercia dos Anjos Pimentel, Universidade de São Paulo (USP), Universidade Federal de Minas Gerais, Universidade Federal do Espírito Santo, Universidade Federal do Rio Grande do Sul, Universidade Federal da Bahia, Fundação Oswaldo Cruz, and Universidade do Estado de São Paulo
- Subjects
Estudos de Coortes ,medicine.medical_specialty ,Longitudinal study ,Urine ,Type 2 diabetes ,Logistics ,Urinalysis ,Urinálise ,Cohort Studies ,chemistry.chemical_compound ,Insulin resistance ,Diabetes mellitus ,medicine ,Multicenter Studies as Topic, methods ,Técnicas e Procedimentos Diagnósticos ,Sistemas de Informação em Laboratório Clínico ,Diagnostic Techniques and Procedures ,Gynecology ,Hematologic Tests ,business.industry ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,Testes Hematologicos ,lcsh:RA1-1270 ,Tecnicas e Procedimentos Diagnosticos ,Estudos Multicêntricos como Assunto, métodos ,medicine.disease ,Testes Hematológicos ,Sistemas de Informacao em Laboratorio Clinico ,chemistry ,Logística ,BRASIL ,Uric acid ,Logistica ,Urinalise ,business ,Clinical Laboratory Information Systems ,Dyslipidemia ,Estudos Multicentricos como Assunto, metodos ,Cohort study - Abstract
O Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) é um estudo de coorte multicêntrico com o objetivo de identificar os fatores de risco associados ao diabetes tipo 2 e à doença cardiovascular na população brasileira. O artigo descreve as estratégias de coleta, processamento, transporte e de controle de qualidade dos exames de sangue e urina no ELSA. O estudo optou pela centralização dos exames em um único laboratório. O processamento das amostras foi realizado nos laboratórios locais, reduzindo o peso do material a ser transportado e diminuindo os custos do transporte para o laboratório central no Hospital da Universidade de São Paulo. O estudo incluiu exames para avaliação de diabetes, resistência à insulina, dislipidemias, alterações eletrolíticas, hormônios tireoidianos, ácido úrico, alterações de enzimas hepáticas, inflamação e hemograma completo. Além desses exames, foram estocados DNA de leucócitos, amostras de urina, plasma e soro. O laboratório central realizou aproximadamente 375.000 exames. The ELSA (Estudo Longitudinal de Saúde do Adulto - Brazilian Longitudinal Study for Adult Health) is a multicenter cohort study which aims at the identification of risk factors associated with type 2 diabetes and cardiovascular diseases in the Brazilian population. The paper describes the strategies for the collection, processing, transportation, and quality control of blood and urine tests in the ELSA. The study decided to centralize the tests at one single laboratory. The processing of the samples was performed at the local laboratories, reducing the weight of the material to be transported, and diminishing the costs of transportation to the central laboratory at the Universidade de São Paulo Hospital. The study included tests for the evaluation of diabetes, insulin resistance, dyslipidemia, electrolyte abnormalities, thyroid hormones, uric acid, hepatic enzyme abnormalities, inflammation, and total blood cell count. In addition, leukocyte DNA, urine, plasma and serum samples were stored. The central laboratory performed approximately 375,000 tests.
- Published
- 2013
41. C-reactive protein and B-type natriuretic peptide yield either a non-significant or a modest incremental value to traditional risk factors in predicting long-term overall mortality in older adults
- Author
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Pedro Guatimosim Vidigal, Alline Beleigoli, Antonio Luiz Pinho Ribeiro, Eric Boersma, Maria Fernanda Lima-Costa, Maria de Fátima Haueisen Sander Diniz, and Cardiology
- Subjects
Male ,medicine.medical_specialty ,medicine.drug_class ,lcsh:Medicine ,Risk Factors ,Cause of Death ,Internal medicine ,Diabetes mellitus ,Natriuretic Peptide, Brain ,medicine ,Natriuretic peptide ,Humans ,lcsh:Science ,Survival analysis ,Aged ,Cause of death ,Geriatrics ,Models, Statistical ,Multidisciplinary ,biology ,business.industry ,Hazard ratio ,C-reactive protein ,lcsh:R ,Age Factors ,Middle Aged ,Prognosis ,medicine.disease ,Survival Analysis ,Surgery ,Patient Outcome Assessment ,C-Reactive Protein ,Blood pressure ,biology.protein ,Female ,lcsh:Q ,business ,Biomarkers ,Research Article - Abstract
Background: New biomarkers may aid in preventive and end-of-life decisions in older adults if they enhance the prognostic ability of traditional risk factors. We investigated whether C-reactive protein (CRP) and/or B-type natriuretic peptide (BNP) improve the ability to predict overall mortality among the elderly of the Bambu, Brazil Study of Aging when added to traditional risk factors. Methods: From 1997 to 2007, 1,470 community-dwelling individuals (>= 60 years) were followed-up. Death was ascertained by continuous verification of death certificates. We calculated hazard ratios per 1 standard deviation change (HR) of death for traditional risk factors only (old model), and traditional risk factors plus CRP and/or BNP (new models) and assessed calibration of the models. Subsequently, we compared c-statistic of each of the new models to the old one, and calculated integrated discriminative improvement (IDI) and net reclassification improvement (NRI). Results: 544 (37.0%) participants died in a mean follow-up time of 9.0 years. CRP (HR 1.28, 95% CI 1.17-1.40), BNP (HR 1.31 95% CI 1.19-1.45), and CRP plus BNP (HR 1.26, 95% CI 1.15-1.38, and HR 1.29, 95% CI 1.16-1.42, respectively) were independent determinants of mortality. All models were well-calibrated. Discrimination was similar among the old (c-statistic 0.78 [0.78-0.81]) and new models (p=0.43 for CRP; p=0.57 for BNP; and p=0.31 for CRP plus BNP). Compared to the old model, CRP, BNP, and CRP plus BNP models led to an IDI of 0.009 (p
- Published
- 2013
42. The importance of the dysmorphic erythrocyte for investigation of the source of hematuria: literature review
- Author
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Leonardo de Souza Vasconcellos, Pedro Guatimosim Vidigal, and Maria Goretti Moreira Guimarães Penido
- Subjects
Gynecology ,Dysmorphic erythrocyte ,Artigo de revisão ,medicine.medical_specialty ,biology ,Glomerular hematuria ,business.industry ,Dismorfismo eritrocitário ,Clinical Biochemistry ,Glomerular bleeding ,Hematúria glomerular ,Urinalysis ,biology.organism_classification ,Morfologia das hemácias ,Urinálise ,Pathology and Forensic Medicine ,Medical Laboratory Technology ,Review article ,Red cells morphology ,Sangramento glomerular ,Glomerula ,medicine ,business - Abstract
As hematúrias são achados comuns nos exames de urina de rotina e nem sempre são sinais de doenças. A presença de hematúria associada a outras alterações urinárias, especialmente a proteinúria, sugere comprometimento do trato urinário e merece investigação. Na literatura são inúmeros os trabalhos que valorizam a sedimentoscopia urinária, principalmente a morfologia das hemácias, como indicativo do local do sangramento: se glomerular ou não-glomerular. Neste artigo, os autores revisam o estudo do dismorfismo eritrocitário, enfatizando a definição, a fisiopatologia, os métodos, os valores de referência e as limitações apontadas na literatura. As comparações com demais marcadores de hemorragia glomerular também foram discutidas. No final, os autores relatam como a literatura interpreta e utiliza os resultados da pesquisa do dismorfismo eritrocitário para guiar a propedêutica complementar na investigação da origem da hematúria. The hematurias are a frequent finding in urinary routine exams and do not necessarily indicate illness. The presence of hematuria associated with other urinary disturbances, especially proteinuria, indicates urinary tract pathology and should be investigated. In the literature, several studies point out the importance of urinary sedimentoscopy, specially the red cells morphology, to determine the source of bleeding: glomerular or non-glomerular. In this article, the authors review the dysmorphic erythrocyte, emphasizing on the meaning, the physiopathology, the methods, the cut-of values, and the limitations according to the literature. The comparisons with other markers of glomerular bleeding were also discussed. At the end, the authors exposed how the literature analyses and applies the dysmorphic erythrocyte results to guide the complementary research for investigation the source of urinary bleeding.
- Published
- 2005
43. The Bambuí Health and Aging Study (BHAS): private health plan and medical care utilization by older adults
- Author
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Sandhi Maria Barreto, Josélia Oliveira Araújo Firmo, Maria Fernanda Lima-Costa, Pedro Guatimosim Vidigal, Henrique L. Guerra, and Elizabeth Uchoa
- Subjects
Male ,Health plan ,Gerontology ,medicine.medical_specialty ,Health Services for the Aged ,Cross-sectional study ,Serviços de Saúde ,lcsh:Medicine ,Medical care ,Interviews as Topic ,Health care ,medicine ,Complaint ,Health Status Indicators ,Humans ,Aged ,Consumption (economics) ,Medicamento ,business.industry ,Public health ,Idoso ,lcsh:Public aspects of medicine ,lcsh:R ,Public Health, Environmental and Occupational Health ,Drugs ,lcsh:RA1-1270 ,Middle Aged ,Health Services ,Drug Utilization ,Medical services ,Socioeconomic Factors ,Family medicine ,Multivariate Analysis ,Female ,business ,Prepaid Health Plans - Abstract
The aim of this cross sectional study was to investigate whether holding a private health plan affects the consumption of medical services (hospitalization and visits to a doctor) and use of medications by older adults. All residents in Bambuí town (Minas Gerais, Brazil) aged > or = 60 years (n = 1,742) were selected. From these, 92.2% were interviewed and 85.9% were examined (blood tests and physical measurements). After adjustments for counfounders, those under exclusive public coverage (n = 1,296), compared with those holding a private health plan (n = 310), presented some evidence of having worse health status, reported less visits to a doctor, and used a small number of prescribed medications. The main explanation for the aged holding a private health plan was economic, not health. Even though those who had only public health coverage complained more in relation to medical care (70.9%), an important proportion of the aged with a private health care plan presented some kind of complaint (45.2%). Another worrying factor was the difficulty to acquire medication because of financial problems (47.2 and 25.2% reported, respectively). Further investigations are needed to verify whether our results can be generalized to other communities of the country.
- Published
- 2002
44. The Bambuí health and aging study (BHAS). Prevalence of intermittent claudication in the aged population of the community of Bambuí and its associated factors
- Author
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Henrique L. Guerra, Valéria Maria de Azeredo Passos, Josélia Oliveira Araújo Firmo, Maria Fernanda Lima-Costa, Sandhi Maria Barreto, and Pedro Guatimosim Vidigal
- Subjects
Male ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Multivariate analysis ,Cross-sectional study ,prevalence ,Population ,Prevalence ,Disease ,Logistic regression ,elderly ,Risk Factors ,Internal medicine ,Surveys and Questionnaires ,medicine ,Humans ,Prospective Studies ,education ,Prospective cohort study ,Aged ,Aged, 80 and over ,education.field_of_study ,business.industry ,intermittent claudication ,Intermittent Claudication ,Middle Aged ,Intermittent claudication ,Cross-Sectional Studies ,Logistic Models ,lcsh:RC666-701 ,Multivariate Analysis ,Physical therapy ,peripheral obstructive arterial disease ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Brazil - Abstract
OBJECTIVE: To assess the prevalence of intermittent claudication in the aged population of Bambuí, Brazil, and to identify the factors associated with this disease. METHODS: Population-based cross-sectional study of the aged population ( > or = 60 years of age) of Bambuí. Participants were interviewed and examined, after written consent. Intermittent claudication was defined based on a standardized questionnaire. Analysis was performed using multiple logistic regression. RESULTS: Of the 1,742 elderly living in Bambuí, 1,485 (85.2%) were enrolled in the study. Thirty-seven individuals (2.5%) with intermittent claudication were identified: 28 (1.9%) males and 9 (0.6%) females. Their age brackets were: 16 (1.08%) individuals between 60 and 69 years of age, 17 (1.15%) between 70 and 79 years, and 4 (0.27%) > or = 80 years. A significant association between intermittent claudication and the following characteristics was found: male sex (OR=5.1; CI 2.4-11.0), smokers (OR=3.1; CI 1.2-8.5), ex-smokers (OR=3.4; CI 1.3-8.7), and more than 2 hospital admissions in the last 12 months (OR=2.8; CI 1.1-7.2). CONCLUSION: Disease prevalence was similar to that of other countries. The association between intermittent claudication and smoking strengthens the significance of tobacco in peripheral artery disease pathogenesis. The association of intermittent claudication and a higher number of hospital admissions suggests greater morbidity in the elderly affected.
- Published
- 2001
45. Hypertension and clustering of cardiovascular risk factors in a community in Southeast Brazil: the Bambuí Health and Ageing Study
- Author
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Henrique L. Guerra, Maria Fernanda Lima-Costa, Sandhi Maria Barreto, Josélia Oliveira Araújo Firmo, Valéria Maria de Azeredo Passos, and Pedro Guatimosim Vidigal
- Subjects
Gerontology ,Adult ,Male ,cardiovascular risk factors ,lcsh:Diseases of the circulatory (Cardiovascular) system ,hypertension ,Adolescent ,Population ,prevalence ,Overweight ,Logistic regression ,Risk Factors ,medicine ,Confidence Intervals ,Cluster Analysis ,Humans ,Prospective Studies ,Risk factor ,Sex Distribution ,Cluster analysis ,Prospective cohort study ,education ,Life Style ,Aged ,Aged, 80 and over ,education.field_of_study ,business.industry ,Hypertriglyceridemia ,Smoking ,Age Factors ,Middle Aged ,medicine.disease ,Cross-Sectional Studies ,Ageing ,lcsh:RC666-701 ,Multivariate Analysis ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Brazil ,Demography - Abstract
OBJECTIVE - A population-based prospective study was analysed to: a) determine the prevalence of hypertension; b) investigate the clustering of other cardiovascular risk factors and c) verify whether older differed from younger adults in the pattern of clustering. METHODS - The data comprised a representative sample of the population of Bambui, Brazil. Multiple logistic regression was used to investigate the independent association between hypertension and selected factors. RESULTS - A total of 820 younger adults (82.5%) and 1494 older adults (85.9%) participated in this study. The overall prevalence of hypertension was 24.8% (SE=1.4 %), being higher in women (26.9±1.5%) than in men (22.0± 1.7%) (p=0.033). Hypertension was positively and significantly associated with physical inactivity, overweight, hypercholesterolemia hyperglycemia and hypertriglyceridemia. The coexistence of hypertension with 4 or more of these risk factors occurred 6 times more than expected by chance, after adjusting for age and sex (OR=6.3; 95%CI: 3.4-11.9). The pattern of risk factor clustering in hypertensive individuals differed with age. CONCLUSION - Our results reinforce the need to increase detection and treatment of hypertension and to approach patients' global risk profiles.
- Published
- 2001
46. Ageing with Trypanosoma cruzi infection in a community where the transmission has been interrupted: the Bambuí Health and Ageing Study (BHAS)
- Author
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Joa Firmo, Henrique L. Guerra, Pedro Guatimosim Vidigal, Elizabeth Uchoa, Sandhi Maria Barreto, and Mff Lima e Costa
- Subjects
Gerontology ,Adult ,medicine.medical_specialty ,Adolescent ,Urban Population ,Epidemiology ,Enzyme-Linked Immunosorbent Assay ,Disease ,Cohort Studies ,Interviews as Topic ,medicine ,Prevalence ,Health Status Indicators ,Humans ,Chagas Disease ,Trypanosoma cruzi ,Child ,Aged ,biology ,business.industry ,Public health ,Confounding ,Age Factors ,Confounding Factors, Epidemiologic ,General Medicine ,Hemagglutination Tests ,Middle Aged ,medicine.disease ,biology.organism_classification ,Survival Analysis ,Cross-Sectional Studies ,Cohort effect ,Infectious disease (medical specialty) ,Child, Preschool ,Data Interpretation, Statistical ,business ,Trypanosomiasis ,Brazil ,Demography - Abstract
BACKGROUND The prevalence of Chagas' disease is decreasing in Brazil. Due to cohort effect, the disease might remain a public health problem for some time among older individuals. The present burden of Trypanosoma cruzi infection for the elderly living in areas where the transmission has been interrupted has not been studied. METHODS The prevalence of T. cruzi infection and its association with indicators of health status and health services use were assessed among the elderly living in one of the oldest endemic areas in Brazil (Bambui, MG). Seropositivity was determined by blood tests (IHA and ELISA) performed in 85.6% of all residents aged 60+ (1496/1742) and in 83.1% of sampled residents aged 5-59 years (1212/1458). RESULTS Seropositivity showed a cohort effect, with no cases below 20 years and high prevalence among those aged 60+ years (37.7%). After adjustment for confounders, seropositivity was associated with self-rated health reasonable (OR = 1.43; 95% CI : 1.03-1.98) and bad/very bad (OR = 1.89; 95% CI : 1.30-2.75), staying in bed in past 2 weeks (OR = 1.88; 95% CI : 1.21-2.92), hospitalization in past 12 months (OR = 1.41; 95% CI : 1.05-1.89) and use of 5+ prescribed medications in past 3 months (OR = 1.75; 95% CI : 1.15-2.59). IMPLICATIONS Our results are an example of how survival of individuals with past exposure to infectious disease may lead to a different picture of ageing in the developing world. Policy makers need to consider the extra burden imposed by increasing rates of non-infectious disease among the elderly (as observed in Brazil) including the consequences of T. cruzi infection in areas where the infection was widespread in the past.
- Published
- 2001
47. Characterization of Trypanosoma cruzi Strains Isolated from Chronic Chagasic Patients, Triatomines and Opossums Naturally Infected from the State of Rio Grande do Sul, Brazil
- Author
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Luciano Percival Krug, Pedro Guatimosim Vidigal, Mário Steindel, Cloé Duarte Fernandes, Isabela P. Ceravolo, Silvane M. F. Murta, Alvaro J. Romanha, and Nanci Nardi
- Subjects
Microbiology (medical) ,Chagas disease ,lcsh:Arctic medicine. Tropical medicine ,lcsh:RC955-962 ,Trypanosoma cruzi ,lcsh:QR1-502 ,Virulence ,Animals, Wild ,Disease Vectors ,lcsh:Microbiology ,Microbiology ,Didelphis albiventris ,Mice ,Triatoma infestans ,parasitic diseases ,medicine ,Animals ,Humans ,Chagas Disease ,Triatoma ,Infectivity ,biology ,Opossums ,Panstrongylus ,medicine.disease ,biology.organism_classification ,Virology ,RAPD ,Chagas' disease ,isoenzyme characterization ,Vector (epidemiology) ,epidemiology ,Brazil ,randomly amplified polymorphic DNA - Abstract
Thirty-five Trypanosoma cruzi strains were isolated from chronic chagasic patients, triatomines and opossums from different municipalities of the State of Rio Grande do Sul. Parasites were characterized by means of mice infectivity, enzyme electrophoresis and randomly amplified polymorphic DNA (RAPD) analysis. Twenty-nine strains were isolated from chagasic patients, 4 from triatomines (2 from Triatoma infestans and 2 from Panstrongylus megistus) and 2 from opossums Didelphis albiventris. Thirty-three T. cruzi strains were of low and 2 strains of high virulence in mice. Both virulent strains were isolated from P. megistus. Isoenzyme analysis of the strains showed 3 different zymodemes. Eleven strains isolated from chagasic patients and 2 from D. albiventris were Z2. Eighteen strains from patients and 2 from T. infestans were ZB and 2 T. cruzi strains isolated from P. megistus were Z1. RAPD profiles obtained with 4 random primers showed a high genetic heterogeneity of the T. cruzi strains. Zymodeme 2 and ZB strains were the more polymorphic. A band sharing analysis of the RAPD profiles of Z2 and ZB strains using 3 primers, showed a very low percentage of shared bands, 20% among 13 ZB strains and 14% among 13 Z2 strains. According to the isoenzyme results, 3 T. cruzi populations were present in State of Rio Grande do Sul. Zymodeme 2 and ZB strains were found infecting man (domiciliar transmission cycle) whereas Z1 strains were found infecting the sylvatic vector P. megistus.
- Published
- 1997
48. Editor's Correspondence
- Author
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Silvana Maria Eloi-Santos, Pedro Guatimosim Vidigal, and Débora Maria Tavares Andrade
- Subjects
medicine.medical_specialty ,Natriuretic Agents ,medicine.drug_class ,business.industry ,Treatment outcome ,Disease progression ,medicine.disease ,NPR2 ,Heart failure ,Internal medicine ,Internal Medicine ,Natriuretic peptide ,medicine ,Cardiology ,business - Published
- 2010
49. Modelos alternativos de financiamento ao desenvolvimento de produtos no setor farmacêutico
- Author
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Luiza Pinheiro Alves da Silva, Márcia Siqueira Rapini, Gabriela Costa Chaves, Jorge Antonio Zepeda Bermudez, Marco Antônio Vargas, Pedro Guatimosim Vidigal, and Allan Claudius Queiroz Barbosa
- Subjects
Difusão de inovações ,Financiamento ,Inovações tecnológicas ,Tecnologia farmacêutica ,Access to medicines ,Acesso a medicamentos ,Infecções por coronavírus ,Pesquisa ,Vacina ,Pharmaceutical innovation system ,Pharmaceutical innovation ,Indústria farmacêutica ,Inovação farmacêutica ,Financiamento a inovação ,Biofarmacêutica ,Medicamentos ,Sistema de inovação farmacêutico ,Patentes - Abstract
CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior O problema foco desta tese é a incompatibilidade entre os determinantes para inovação no sistema setorial de inovação farmacêutico e o acesso a medicamentos, elemento fundamental do direito humano à saúde. Do lado econômico, o estímulo à inovação se dá por meio de garantia de apropriabilidade, principalmente por meio de monopólios; pelo financiamento público as atividades inovativas, de modo a estimular o investimento privado; e pela demanda e estimativa de retorno financeiro, que está vinculada a renda do público consumidor. Do lado social, o reconhecimento de direitos humanos universais determina que a saúde é indissociável do direito à vida, todavia, ele é dependente de um mercado caracterizado por diversas falhas, que fazem com que o acesso a tecnologias de saúde seja extremamente desigual entre os países e dentro dos mesmos. A inovação farmacêutica está na interface entre estas dimensões, já que os medicamentos são ao mesmo tempo um produto de alto valor agregado, proveniente de uma das indústrias mais lucrativas do mundo e uma tecnologia indispensável para o cuidado. O financiamento é um dos determinantes para a inovação no setor e também um dos principais gargalos. Esse problema vem sendo discutido a quase duas décadas nos foros internacionais multilaterais, em especial a OMS. Foi feita uma análise do sistema de inovação farmacêutico atual, das discussões na OMS sobre o assunto e das iniciativas implementadas por este órgão para Covid-19. Observou-se o surgimento de novos atores no setor, tais como parcerias para o desenvolvimento produtivo e financiadores sem fins lucrativos. Todavia, mesmo com a disrupção significativa causada pela pandemia, a dinâmica de funcionamento do sistema setorial de inovação farmacêutico permaneceu inalterada, privilegiando critérios econômicos e não de saúde pública, e os países de alta renda, de onde se originam as grandes empresas multinacionais globais. Com isso, manteve-se o acesso desigual a medicamentos e outras tecnologias de saúde. Apesar de haver propostas e diretrizes para o enfrentamento deste problema conciliadas nos foros internacionais que tratam da saúde, a implementação prática dos mecanismos não é suficiente. É preciso reorientar o sistema de inovação farmacêutico e seus determinantes neste sentido, para que se estabeleça um novo paradigma. The focus problem of this thesis is the incompatibility between the determinants for innovation in the pharmaceutical innovation sector system and access to medicines, a fundamental element of the human right to health. On the economic side, the stimulus to innovation takes place through the guarantee of appropriation, mainly through monopolies; by public financing as innovative activities, in order to stimulate private investment; and by demand and estimated financial return, which is linked to consumer income. On the social side, the recognition of universal human rights determines that health is inseparable from the right to life, however, it is dependent on a market characterized by several flaws, which make access to health technologies extremely unequal between countries and within them. Pharmaceutical innovation is at the interface between these dimensions, as medicines are at the same time a product with high added value, coming from one of the most profitable industries in the world and an indispensable technology for healthcare. Financing is one of the determinants for innovation in the sector and one of the main bottlenecks. This problem has been discussed for nearly two decades in international multilateral forums, especially the WHO. An analysis was made of the current pharmaceutical innovation system, the WHO discussions on the subject and the initiatives implemented by this body for Covid-19. The emergence of new actors in the sector was observed, such as partnerships for product development and non-profit financiers. However, even with the disruption caused by the pandemic, the working dynamics of the pharmaceutical sectoral innovation system remained unchanged, privileging economic rather than health criteria, and high-income countries, from which originate the large global multinational companies. As a result, unequal access to medicines and other health technologies was maintained. Although there are proposals and guidelines reconciled in the international health forums for dealing with this problem, the implementation of mechanisms is not sufficient. It is necessary to reorient the pharmaceutical innovation system and its determinants in this sense, so that a new paradigm can be established.
- Published
- 2021
50. RDW e o risco de doença cardiovascular em participantes do Estudo Longitudinal de Saúde do Adulto (ELSA – Brasil)
- Author
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Natane Moreira de Carvalho, Pedro Guatimosim Vidigal, Chams Bicalho Maluf, and Sandhi Maria Barreto
- Subjects
Doenças cardiovasculares ,Fatores de Risco ,Diabetes mellitus ,Índices de Eritrócitos ,Hipertensão - Abstract
Introdução: O RDW (do inglês Red Cell Distribution Width) é uma medida da variabilidade do tamanho dos eritrócitos. Estudos recentes mostraram que o RDW é um marcador preditivo e prognóstico de mortalidade e de doenças cardiovasculares (DCV). Este estudo teve como objetivos investigar a associação entre RDW e (i) o risco de DCV em 10 anos, (ii) a incidência de Hipertensão Arterial Sistêmica e (iii) a incidência de Diabetes Mellitus em participantes do Estudo Longitudinal de Saúde ELSA - Brasil. Métodos: Uma subamostra de participantes da linha de base (2008 a 2010) e que compareceram à segunda visita (2012 a 2014) da coorte ELSA - Brasil foram incluídos (n = 4481). Na abordagem transversal, a análise de regressão múltipla foi utilizada para investigar a associação entre o RDW e o Escore de Risco de Framingham (ERF). Na análise longitudinal, foi utilizado o modelo de regressão linear misto para avaliar se o RDW na linha de base foi capaz de predizer mudança no risco de DCV na segunda visita. A associação entre RDW e a incidência de hipertensão e diabetes foi investigada usando a regressão de riscos proporcionais de Cox. Nesses modelos, a variável resposta (incidência de hipertensão e diabetes) foi avaliada na segunda visita, enquanto o RDW foi medido na linha de base do estudo. Resultados: Participantes no quarto quartil (Q4) da distribuição do RDW apresentaram um ERF 30% maior do que aqueles no primeiro quartil (Q1: p < 0,001), mostrando que o RDW foi associado com ERF avaliado na linha de base do estudo, mesmo após os ajustes das variáveis potenciais de confusão. Os modelos de regressão linear misto confirmaram os achados da análise transversal e mostraram associações significativas entre RDW e ERF avaliado na segunda visita. O termo de interação entre o RDW e a covariável tempo não foi estatisticamente significativo (Q4: p = 0,577), indicando que a inclinação da associação não mudou ao longo do tempo. O RDW não foi associado com a incidência de hipertensão (eβ = 1,077; valor de p = 0,192; IC95% = 0,963 - 1,205) e diabetes mellitus na segunda visita (eβ = 0,999; valor de p = 0,991; C95% = 0,841 - 1,186). Conclusões: Nesta coorte de brasileiros adultos, o RDW foi independentemente associado com o aumento do risco de DCV, porém não foi capaz de prever uma piora do risco cardiovascular na trajetória longitudinal desses indivíduos ao longo de quatro anos. O RDW não se relacionou com a incidência de hipertensão e diabetes mellitus no período estudado. O acompanhamento prospectivo dessa população poderá auxiliar a esclarecer a relação entre RDW e risco de DCV em 10 anos, hipertensão e diabetes mellitus
- Published
- 2019
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