Rural work and COVID-19: challenges and proposals for the prevention of damages.

The COVID-19 pandemic has highlighted the inequalities in health care access in Brazil, exarcerbating vulnerabilities and social determinants of health. Inequality is part of the context of rural populations, especially rural workers and family and subsistence farmers due to both the direct consequences of work activity and the unfavorable socioeconomic context, especially regarding service provision, the guaranteeing of rights, and the coordination of care networks. This article reviews challenges to the health of these workers and outlines proposals for disease prevention in the context of the COVID-19 pandemic.

Apandemia de covid-19 no mundo trouxe à tona as desigualdades vivenciadas no acesso à saúde no Brasil, escancarando as vulnerabilidades e os determinantes sociais de saúde. É nesse ínterim de iniquidades que as populações rurais se inserem, em especial trabalhadores e trabalhadoras rurais e membros da agricultura familiar e de subsistência, tanto pelas consequências diretas da atividade laboral quanto pelo contexto socioeconômico desfavorável, especialmente no que diz respeito a oferta de serviços, garantia de direitos e articulação das redes de assistência. Frente a isso, o presente trabalho discute os desafios relacionados à saúde desses trabalhadores e traça propostas para a prevenção de agravos da referida população no contexto da pandemia de covid-19.

Prevalence and Factors Associated with Metabolic Syndrome in Patients at a Psychosocial Care Center: A Cross-Sectional Study.

BACKGROUND: Metabolic syndrome (MS) is associated with greater risk of morbimortality and it has high prevalence in people with mental illness. OBJECTIVE: Estimate the prevalence of Metabolic Syndrome (MS) and its associated factors in the patients of a Psychosocial Care Center (CAPS in Brazilian Portuguese) in the city of Salvador, state of Bahia, Brazil. METHOD: Cross-sectional study set at CAPS in the city of Salvador-Bahia between August 2019 and February 2020. MS was evaluated according to the National Cholesterol Education Program's Adult Treatment Panel III. In addition to descriptive statistics, gross and adjusted prevalence ratios were described. RESULTS: MS was found in 100 (35.2%) individuals, 116 (40.9%) were obese and 165 (58.1%) had increased waist circumference. Polypharmacy was identified in 63 (22.3%) patients and 243 (85.9%) used antipsychotics. Under gross evaluation, women (PR = 1.88; 95%CI: 1.35-2.63) and those who used antidepressants (PR = 1.41; 95%CI: 1.05-1.88) showed an association with MS. After logistic regression, depression (PR = 1.86; 95%CI: 1.38-2.51), acanthosis (PR = 1.50; 95%CI: 1.18-1.90), use of antipsychotics (PR = 1.88; 95%CI: 1.13-2.75), and hypertriglyceridemic waist (PR = 3.33; 95%CI: 2.48-4.46) were associated with MS. CONCLUSION: The prevalence of MS signals multimorbidity among individuals with mental disorders and suggests a need for clinical screening.

Interaction between Work and Metabolic Syndrome: A Population-Based Cross-Sectional Study.

Metabolic syndrome (MS) is a clinical condition and a relevant risk factor in the development of cardiovascular diseases; it occurs as a result of lifestyle factors, e.g., work. The aim of this research was to estimate the interaction between work and MS among primary health care (PHC) nursing professionals in the state of Bahia, Brazil. A sectional multicentered study carried out in 43 municipalities in Bahia, whose study population consisted of nursing professionals. The exposure variables were occupation, professional exhaustion, and working time, and the outcome variable was MS. Interaction measures based on the additivity criteria were verified by calculating the excess risks due to the interactions and according to the proportion of cases attributed to the interactions and the synergy index. The global MS prevalence is 24.4%. There was a greater magnitude in the exposure group regarding the three investigated factors (average level occupation, professional exhaustion, and working time in PHC for more than 5 years), reaching an occurrence of 44.9% when compared to the prevalence of 13.1% in the non-exposure group (academic education, without professional burnout, and working time in PHC for up to 5 years). The study's findings showed a synergistic interaction of work aspects for MS occurrence among PHC nursing professionals.

Effect of Hospital Accreditation Process in Outcomes of Patients with Acute Coronary Syndrome

Abstract Background: Hospital accreditation has as goal the standardization of patient care, aiming quality improvement. On 2015, a cardiology reference hospital was evaluated and got level 3 from ONA in care given to Acute Coronary Syndrome (ACS) patients. Objetive: To compare length of stay (LOS) at Coronary Care Unit (CCU) and the total LOS at the hospital of ACS patients before and after ONA 3 accreditation. Other clinical outcomes were also analyzed. Methods: Systematic and prospective registry of admitted ACS patients at CCU, whose population was divided into pre-accreditation (period 1) and post-accreditation (period 2). Descriptive analysis was performed. For statistical analysis the Mann-Whitney test, chi-squared, Fisher's exact test and Multiple Linear Regression were performed. P value was considered statistically significant when < 0,05. Results: 372 patients were admitted with ACS, 186 in period 1, of which 47 (25,3%) with ST segment Elevation Myocardial Infarction (STEMI), and 186 in period 2, of which 70 (37,6%) with STEMI. The mean age was 65,9 years (± 12,2). About the CCU LOS, there was a reduction from 3 (IQR: 2-4) to 2,5 days (IQR: 2-4; p value = 0,088). Regarding the hospital LOS, there was also a reduction from 8 (IQR: 5-12,25) to 6 days (IQR:4-11; p value = 0,004). Analyzing the type of ACS, there was a significant reduction only at the hospital LOS in non-STEMI patients: 8 to 6 days (p value = 0,001). Other hospitalization length of stay and clinical outcomes did not present a significant reduction in the comparison. Conclusion: After the ONA 3 accreditation, there was a reduction of hospital LOS. There were no significant differences in the other outcomes analyzed.

Aterectomia rotacional multiarterial em lesão de tronco de coronária esquerda seguida de implante de stents / Multivessel rotational atherectomy in left main coronary artery lesion followed by stent implantation

Paciente com 82 anos, portadora de múltiplas comorbidades, com angina do peito apesar de terapia medicamentosa otimizada. Submetida à coronariografia, que evidenciou doença triarterial com envolvimento do tronco da coronária esquerda e intensa calcificação das artérias coronárias. A cirurgia de revascularização miocárdica foi contraindicada, sendo encaminhada para intervenção coronária percutânea, realizada em dois tempos, com intervalo de 15 meses. Primeiramente, a coronária esquerda foi abordada, realizando-se aterectomia rotacional no tronco da coronária esquerda, artérias descendente anterior e circunflexa, com implante de cinco stents farmacológicos com sucesso. Posteriormente, a coronária direita foi tratada com aterectomia rotacional e implante de quatro stents farmacológicos, também com sucesso

A 82-year-old patient with multiple comorbidities and angina, in spite of optimal drug therapy, was submitted to coronary angiography, which showed three-vessel disease with left main coronary artery involvement and severe coronary artery calcification. Coronary artery bypass grafting surgery was contraindicated and the patient was referred for percutaneous coronary intervention, which was carried out in two stages, with a 15-month interval between them. Firstly, the left coronary artery was treated and rotational atherectomy was performed in the left main coronary artery, left anterior descending and left circumflex arteries, with successful implantation of five drug-eluting stents. Subsequently, the right coronary artery was treated with rotational atherectomy, and four drug-eluting stents were also successfully implanted

[Adiponectin and low cardiometabolic risk in obese women]. / Adiponectina e baixo risco cardiometabólico em obesas.

OBJECTIVE: To investigate the association between elevated levels of plasmatic adiponectin (AdipoQ) and low cardiometabolic risk (CMR) in obese women (O(b)W). SUBJECTS AND METHODS: Case-control study, matched by age, of 306 O(b)W, BMI > 30 kg/m², with 66 cases (21.6%) - all non-hypertensive, normolipidemic, and non-diabetic - conducted in SUS (Brazil's Public Health System) outpatient referral services for obesity in the City of Salvador, Brazil. Secondary data were collected from medical records; primary and complementary data were obtained from a clinical pathology laboratory. Values of AdipoQ > 10.00 µg/ml (> 3(rd) quartile) were considered elevated. Descriptive, bivariate, and conditional logistic regression analyses were performed. RESULTS: A statistically significant positive association between low CMR and AdipoQ > 10.00 µg/ml in physically active (AOR = 5.1; CI95%: 1.8-14.3), non-smoking (AOR = 3.6;CI95%: 1.6-8.4) O(b)W was found. CONCLUSION: This study suggests that physically active, non-smoking O(b)W, with higher AdipoQ levels, present greater chances of a low CMR. It becomes important to reinforce encouragement of the adoption of healthy behaviors, by means of public policies.

Adiponectina e baixo risco cardiometabólico em obesas / Adiponectin and low cardiometabolic risk in obese women

OBJETIVO: Investigar a associação entre níveis elevados de adiponectina plasmática (AdipoQ) e baixo risco cardiometabólico (RCM) em obesas (MOb). SUJEITOS E MÉTODOS: Estudo caso-controle, pareado pela idade com 306 MOb, IMC > 30 kg/m², sendo 66 (21,6 por cento) casos - todos não hipertensos, normolipídicos e não diabéticos - realizados em ambulatórios referência do Sistema Único de Saúde (SUS) para obesidade em Salvador. Dados secundários foram coleta-dos dos prontuários médicos, primários e complementares em laboratório de patologia clínica. Valores de AdipoQ > 10,00 µg/mL (> 3º quartil) foram considerados elevados. Foram realizadas análises: descritiva, bivariada e regressão logística condicional. RESULTADOS: Associação positiva, estatisticamente significante (ES), entre baixo RCM e AdipoQ > 10,00 µg/mL em MOb ativas fisicamente (OR= 5,1; IC95 por cento: 1,8-14,3), não fumantes (OR= 3,6; IC95 por cento: 1,6-8,4). CONCLUSÃO: Este estudo sugere que MOb ativas fisicamente, não fumantes e com níveis mais elevados de AdipoQ apresentam mais chances de baixo RCM. Torna-se importante reforçar, por meio de políticas públicas, o estímulo à adoção de comportamentos saudáveis.

OBJECTIVE: To investigate the association between elevated levels of plasmatic adiponectin (AdipoQ) and low cardiometabolic risk (CMR) in obese women (ObW). SUBJECTS AND METHODS: Case-control study, matched by age, of 306 ObW, BMI > 30 kg/m², with 66 cases (21.6 percent) - all non-hypertensive, normolipidemic, and non-diabetic - conducted in SUS (Brazil's Public Health System) outpatient referral services for obesity in the City of Salvador, Brazil. Secondary data were collected from medical records; primary and complementary data were obtained from a clinical pathology laboratory. Values of AdipoQ > 10.00 µg/ml (> 3rd quartile) were considered elevated. Descriptive, bivariate, and conditional logistic regression analyses were performed. RESULTS: A statistically significant positive association between low CMR and AdipoQ > 10.00 µg/ml in physically active (AOR = 5.1; CI95 percent: 1.8-14.3), non-smoking (AOR = 3.6;CI95 percent: 1.6-8.4) ObW was found. CONCLUSION: This study suggests that physically active, non-smoking ObW, with higher AdipoQ levels, present greater chances of a low CMR. It becomes important to reinforce encouragement of the adoption of healthy behaviors, by means of public policies.

[Influence of the self-reported skin color on the prevalence of metabolic syndrome in an urban Brazilian population]. / Influência da cor de pele auto-referida na prevalência da síndrome metabólica numa população urbana do Brasil.

BACKGROUND: The metabolic syndrome (MS) has a high prevalence in different parts of the world, with variations between different ethnic groups. OBJECTIVE: This study aims at exploring the influence of the self-reported skin color on the prevalence of MS Methods: Cross-sectional study, carried out in a population subgroup (n=1,439 adults) in Salvador, Brazil. The self-reported skin color (white, mulatto or black) was used as well as the MS criterion of ATP-III. The Chi-square test for tendency was used to analyze the prevalence gradient between the groups and logistic regression, for association analysis. RESULTS: The general prevalence of MS, adjusted for potentially confounder variables, did not differ among whites (23.3%), mulattos (23.3%) and blacks (23.4%). The analysis by sex showed, among men, a reduction in the MS prevalence of whites (26.2%, 95%CI: 20.7-31.7), in comparison to blacks (17.5%, 95%CI: 12.3-22.8) and an intermediate prevalence among mulattos, 21.9%, 95%CI: 18.6-25.1, p tend. = 0.002. Among the women, the tendency was the opposite, being higher among the blacks, 27.0%, 95%CI: 22.2-31.8, and lower among the whites, 20.5%, 95%CI: 15.6-25.4, p tend. = 0.02. The multivariate analysis of the association between skin color and MS (white = group of reference) showed that the black color of the skin was a protective factor among black men, with a prevalence ratio (PR) = 0.60 (0.36-0.97), whereas it tended to be a risk factor among black women, with a PR = 1.33 (0.94-1.78). CONCLUSION: The prevalence of MA presented an inverse variation according to the color of skin between men and women. To be black was a protective factor among men and a risk factor among women.

Influência da cor de pele auto-referida na prevalência da síndrome metabólica numa população urbana do Brasil / Influence of the self-reported skin color on the prevalence of metabolic syndrome in an urban Brazilian population / Influencia del color de la piel autodeclarado en la prevalencia del síndrome metabólico en una población urbana de Brasil

Fundamento: A síndrome metabólica tem uma elevada prevalência em diferentes partes do mundo, com variações entre diferentes grupos étnicos. Objetivo: Este estudo pretende explorar a influência da cor de pele auto-referida sobre a prevalência da SM. Métodos: Estudo transversal, realizado em subgrupo populacional em Salvador, Brasil. Utilizou-se auto-definição de cor de pele (branca, parda e negra) e o critério de SM do ATP-III. Foi usado o quiquadrado para tendência a fim de analisar gradiente das prevalências entre os grupos e a regressão logística para análises de associações. Resultados: A prevalência geral da SM, ajustada por variáveis potencialmente confundidoras, não diferiu entre brancos (23,3 por cento), pardos (23,3 por cento) e negros (23,4 por cento,). A análise por sexo mostrou entre os homens redução da prevalência da SM dos brancos, 26,2 por cento IC95 por cento(20,7-31,7), em comparação aos negros, 17,5 por cento IC95 por cento (12,3-22,8), e uma prevalência intermediária entre os pardos, 21,9 por cento IC95 por cento (18,6 - 25,1), p tend= 0,002. Entre as mulheres, a tendência foi inversa, maior nas negras, 27,0 por cento IC95 por cento (22,2-31,8), e menor nas brancas, 20,5 por cento IC95 por cento(15,6-25,4), p tend= 0,02. Na análise multivariada da associação entre cor de pele e SM (branco=grupo de referência), a cor negra entre os homens foi fator de proteção, razão de prevalência (RP)= 0,60 (0,36 - 0,97), enquanto que nas mulheres tendeu a ser fator de risco, RP= 1,33 (0,94 - 1,78). Conclusão: A prevalência da SM variou em função da cor de pele de modo inverso entre homens e mulheres. Ser negro foi fator de proteção entre homens e de risco nas mulheres.

Background: The metabolic syndrome (MS) has a high prevalence in different parts of the world, with variations between different ethnic groups. Objective: This study aims at exploring the influence of the self-reported skin color on the prevalence of MS. Methods: Cross-sectional study, carried out in a population subgroup (n=1,439 adults) in Salvador, Brazil. The self-reported skin color (white, mulatto or black) was used as well as the MS criterion of ATP-III. The Chi-square test for tendency was used to analyze the prevalence gradient between the groups and logistic regression, for association analysis. Results: The general prevalence of MS, adjusted for potentially confounder variables, did not differ among whites (23.3 percent), mulattos (23.3 percent) and blacks (23.4 percent). The analysis by sex showed, among men, a reduction in the MS prevalence of whites (26.2 percent, 95 percentCI: 20.7-31.7), in comparison to blacks (17.5 percent, 95 percentCI: 12.3-22.8) and an intermediate prevalence among mulattos, 21.9 percent, 95 percentCI: 18.6-25.1, p tend. = 0.002. Among the women, the tendency was the opposite, being higher among the blacks, 27.0 percent, 95 percentCI: 22.2-31.8, and lower among the whites, 20.5 percent, 95 percentCI: 15.6-25.4, p tend. = 0.02. The multivariate analysis of the association between skin color and MS (white = group of reference) showed that the black color of the skin was a protective factor among black men, with a prevalence ratio (PR) = 0.60 (0.36-0.97), whereas it tended to be a risk factor among black women, with a PR = 1.33 (0.94-1.78). Conclusion: The prevalence of MA presented an inverse variation according to the color of skin between men and women. To be black was a protective factor among men and a risk factor among women.

Fundamento: El síndrome metabólico tiene una elevada prevalencia en diferentes partes del mundo, con variaciones entre diferentes grupos étnicos. Objetivo: Este estudio pretende explorar la influencia del color de la piel autodeclarado sobre la prevalencia del SM. Métodos: ESTUDio transversal, realizado en subgrupo poblacional en Salvador, Brasil. Se utilizó la autodefinición de color de la piel (blanca, parda y negra) y el criterio de SM del ATP-III. Se usó el test chi-cuadrado para tendencia a fin de analizar gradiente de las prevalencias entre los grupos y la regresión logística para análisis de asociaciones. Resultados: La prevalencia general del SM, ajustado por variables potencialmente confusas, no difirió entre blancos (23,3 por ciento), pardos (23,3 por ciento) y negros (23,4 por ciento,). El análisis por sexo mostró entre los hombres reducción de la prevalencia del SM de los blancos, el 26,2 por ciento IC95 por ciento(20,7-31,7), en comparación con los negros, 17,5 por ciento IC95 por ciento (12,3-22,8), y una prevalencia intermedia entre los pardos, 21,9 por ciento IC95 por ciento (18,6 - 25,1), p tend= 0,002. Entre las mujeres, la tendencia fue inversa, mayor en las negras, 27,0 por ciento IC95 por ciento (22,2-31,8), y menor en las blancas, 20,5 por ciento IC95 por ciento(15,6-25,4), p tend= 0,02. En el análisis multivariado de la asociación entre color de la piel y SM (blanco=grupo de referencia), el color negro entre los hombres fue factor de protección, razón de prevalencia (RP)= 0,60 (0,36-0,97), mientras que en las mujeres tendió a ser factor de riesgo, RP= 1,33 (0,94-1,78). Conclusión: LA Prevalencia del SM varió en función del color de la piel de modo inverso entre hombres y mujeres. Ser negro fue factor de protección entre hombres y de riesgo en las mujeres.

[Physical activity in the prevention of diabetes in black ethnicity: how much is required?]. / Atividade física na prevenção de diabetes em etnia negra: quanto é necessário?

OBJECTIVE: Analyze how much total physical activity (intensity and duration) is required and its different domains (work, commuting, household, and leisure time) as predictors of absence of diabetes in the black ethnicity population. METHODS: The design was cross-sectional with a sample of 2305 adults from 20 to 96 years of age, 902 (39.1%) male, living in the city of Salvador, Brazil. Receiver Operating Characteristic curves (ROC) were constructed to compare the areas of amount of physical activity in their different domains with absence of diabetes. Sensitivity and specificity were also established to identify the best cutoffs for the amount of physical activity related to absence of diabetes. Based on these cutoff points, a multivariate model was constructed to identify the association between physical activity and diabetes. RESULTS: Among the different amounts of physical activity greater significance was found in areas under the ROC curve for total physical activity, moderate activities performed during leisure time and work among men and commuting among women. Walking by itself was not a good predictor of absence of diabetes among men. It was also observed that 185 minutes/week of physical activity accumulated in different domains for men and 215 minutes/week for women were the best cutoffs for predicting absence of diabetes. CONCLUSION: Physical activity accumulated in different domains should be suggested in amounts suitable for a black ethnicity population in order to contribute to diabetes prevention.

Atividade física na prevenção de diabetes em etnia negra: quanto é necessário? / Physical activity in the prevention of diabetes in black ethnicity: how much is required?

OBJETIVO: Analisar a quantidade (intensidade e duração) de atividade física total e em seus diferentes domínios (trabalho, deslocamento, atividade doméstica e tempo livre) como preditores da ausência de diabetes em população de etnia negra. MÉTODOS: Estudo transversal com amostra de 2305 adultos negros de 20 anos a 96 anos de idade, sendo 902 (39,1 por cento) homens, residentes na cidade de Salvador, Bahia, Brasil. Foram construídas curvas Receiver Operating Characteristic (ROC) e comparadas às áreas entre a quantidade de atividade física em seus diferentes domínios e a ausência de diabetes. Verificou-se também a sensibilidade e especificidade para identificar os melhores pontos de corte da quantidade de atividade física para a ausência de diabetes. Com base nestes pontos de corte, construiu-se modelo multivariado para identificar associação entre atividade física e diabetes. RESULTADOS: Entre as diferentes quantidades de atividade física encontrou-se maior significância estatística nas áreas sob a curva ROC na atividade física total, nas atividades moderadas realizados no tempo livre e no trabalho entre os homens, e no deslocamento entre as mulheres. A caminhada isoladamente não foi bom preditor da ausência de diabetes entre homens. Observou-se também que 185 minutos/semana de atividade física acumulada nos diferentes domínios para homens e 215 minutos/semana para mulheres foram os melhores pontos de corte para predizer a ausência de diabetes, porém após análise multivariada encontrou-se associação entre atividade física e diabetes apenas entre os homens. CONCLUSÃO: A atividade física acumulada nos diferentes domínios deve ser sugerida em quantidades adequadas para a população de etnia negra visando contribuir para a prevenção do diabetes.

OBJECTIVE: Analyze how much total physical activity (intensity and duration) is required and its different domains (work, commuting, household, and leisure time) as predictors of absence of diabetes in the black ethnicity population. METHODS: The design was cross-sectional with a sample of 2305 adults from 20 to 96 years of age, 902 (39.1 percent) male, living in the city of Salvador, Brazil. Receiver Operating Characteristic curves (ROC) were constructed to compare the areas of amount of physical activity in their different domains with absence of diabetes. Sensitivity and specificity were also established to identify the best cutoffs for the amount of physical activity related to absence of diabetes. Based on these cutoff points, a multivariate model was constructed to identify the association between physical activity and diabetes. RESULTS: Among the different amounts of physical activity greater significance was found in areas under the ROC curve for total physical activity, moderate activities performed during leisure time and work among men and commuting among women. Walking by itself was not a good predictor of absence of diabetes among men. It was also observed that 185 minutes/week of physical activity accumulated in different domains for men and 215 minutes/week for women were the best cutoffs for predicting absence of diabetes. CONCLUSION: Physical activity accumulated in different domains should be suggested in amounts suitable for a black ethnicity population in order to contribute to diabetes prevention.

Criteria for central obesity in a Brazilian population: impact on metabolic syndrome.

OBJECTIVE: To identify and propose the optimal waist circumference cut-off points (WCp) for the diagnosis of central obesity (CO) in a Brazilian population, so as to compare these cut-off points with those recommended by the ATPIII (WC-ATPIII), and to estimate the difference in prevalence rates of metabolic syndrome (MS) using the two criteria. METHODS: Cross-sectional study conducted in a population subgroup of 1439 adults in the city of Salvador, Brazil. ROC curves of waist circumference (WC) were plotted to identify diabetes mellitus (DM) and obesity. ROC curve sensitivity and specificity values >60% and the closest to each other were used to define WCp. The prevalence of MS was estimated using WCp and WC-ATPIII. RESULTS: Eight hundred and twenty nine women comprised 57.7% of the sample. The WCp selected were 84 cm for women and 88 cm for men. These cut-off points detected DM with a 68.7% and 70% sensitivity, and a 66.2% and 68.3% specificity, respectively. For obesity, sensitivity and specificity were 79.8% and 77.6% in women and 64.3% and 71.6% in men, respectively. Using WC-ATPIII, 88 cm (for women) and 102 cm (for men), the sensitivity was 53.3% and 26.5%, respectively, to diagnose DM. For obesity, sensitivity was 66.5% (for women) and 28.6% (for men). The prevalence of MS using WCp was 23.7%, 95%CI (21.6-25.9), whereas using WC-ATPIII it was 19.0%, 95%CI (17.1-20.9), 1.2 times higher using WCp. CONCLUSION: WC-ATPIII were inappropriate and underestimated the prevalence of MS in the population studied, particularly among men. We suggest that the WC cut-off points > 84 cm for women and > 88 cm for men should be tested in other Brazilian populations.

Critério de obesidade central em população brasileira: impacto sobre a síndrome metabólica / Criteria for central obesity in a Brazilian population: impact on metabolic syndrome / Criteria for central obesity in a Brazilian population: impact on metabolic syndrome

OBJETIVO: Identificar e propor os melhores pontos de corte da circunferência da cintura (CCp) para diagnosticar obesidade central numa população brasileira; compará-los àqueles recomendados pelo ATPIII (CC-ATPIII) e estimar diferenças nas prevalências da síndrome metabólica (SM) usando os dois critérios. MÉTODOS: Estudo transversal, realizado em subgrupo populacional de 1.439 adultos, Salvador, Brasil. Foram construídas curvas ROC da circunferência da cintura (CC) para identificar diabete melito (DM) e obesidade. Valores >60 por cento da sensibilidade e da especificidade da curva ROC e mais próximos entre si foram usados para definir o CCp. A prevalência da SM foi estimada pelos CCp e pelos CC-ATPIII. RESULTADOS: As 829 mulheres compuseram 57,7 por cento da amostra. Os CCp selecionados foram 84 cm para mulheres e 88 cm para homens. Esses pontos detectaram DM com sensibilidade de 68,7 por cento e 70 por cento, respectivamente, e especificidade de 66,2 por cento e 68,3 por cento. Para obesidade, a sensibilidade e a especificidade foram 79,8 por cento e 77,6 por cento nas mulheres, e 64,3 por cento e 71,6 por cento nos homens. Pelos CC-ATPIII, 88 cm (mulheres) e 102 para (homens), as sensibilidades foram de 53,3 por cento e 26,5 por cento, para diagnosticar DM. Para obesidade, a sensibilidade foi 66,5 por cento (mulheres) e 28,6 por cento (homens). A prevalência da SM, pelos CCp foi 23,7 por cento, IC 95 por cento (21,6 - 25,9) e pelos CC-ATPIII de 19,0 por cento, IC 95 por cento (17,1- 20,9), 1,2 vezes maior pelo CCP. CONCLUSÃO: As CC-ATPIII foram inapropriados e subestimam a prevalência da SM nessa população, particularmente entre os homens. Sugerimos que os pontos de corte da CC de >84 cm nas mulheres e > 88 cm nos homens sejam testados em outras populações brasileiras.

OBJECTIVE: To identify and propose the optimal waist circumference cut-off points (WCp) for the diagnosis of central obesity (CO) in a Brazilian population, so as to compare these cut-off points with those recommended by the ATPIII (WC-ATPIII), and to estimate the difference in prevalence rates of metabolic syndrome (MS) using the two criteria. METHODS: Cross-sectional study conducted in a population subgroup of 1439 adults in the city of Salvador, Brazil. ROC curves of waist circumference (WC) were plotted to identify diabetes mellitus (DM) and obesity. ROC curve sensitivity and specificity values >60 percent and the closest to each other were used to define WCp. The prevalence of MS was estimated using WCp and WC-ATPIII. RESULTS: Eight hundred and twenty nine women comprised 57.7 percent of the sample. The WCp selected were 84cm for women and 88cm for men. These cut-off points detected DM with a 68.7 percent and 70 percent sensitivity, and a 66.2 percent and 68.3 percent specificity, respectively. For obesity, sensitivity and specificity were 79.8 percent and 77.6 percent in women and 64.3 percent and 71.6 percent in men, respectively. Using WC-ATPIII, 88cm (for women) and 102cm (for men), the sensitivity was 53.3 percent and 26.5 percent, respectively, to diagnose DM. For obesity, sensitivity was 66.5 percent (for women) and 28.6 percent (for men). The prevalence of MS using WCp was 23.7 percent, 95 percentCI (21.6 - 25.9), whereas using WC-ATPIII it was 19.0 percent, 95 percentCI (17.1- 20.9), 1.2 times higher using WCp. CONCLUSION: WC-ATPIII were inappropriate and underestimated the prevalence of MS in the population studied, particularly among men. We suggest that the WC cut-off points > 84cm for women and > 88cm for men should be tested in other Brazilian populations.

Fatores prognósticos da estenose mitral reumática durante o período da gravidez e puerpério / Prognostic factors of rheumatic mitral stenosis during pregnancy and puerperium

OBJECTIVE: To identifity characteristics associated with complications during pregnancy and puerperium in patients with rheumatic mitral stenosis. METHODS: Forty-one pregnant women (forty-five pregnancies) with mitral stenosis, followed-up from 1991 to 1999 were retrospectively evaluated. Predictor variables: the mitral valve area (MVA), measured by echocardiogram, and functional class (FC) before pregnancy (NYHA criteria).Maternal events: progression of heart failure, need for cardiac surgery or balloon mitral valvulotomy, death, and thromboembolism. Fetal/neonatal events: abortion, fetal or neonatal death, prematurity or low birth weight (<2,500g), and extended stay in the nursery or hospitalization in newborn ICU. RESULTS: The mean + or - SD of age of the patients was 28.8 + or - 4.6 years. The eventful and uneventful patients were similar in age and percentage of first pregnancies. As compared with the level 1 MVA, the relative risk (RR) of maternal events was 5.5 (95 per cent confidence interval (CI) =0.8-39.7) for level 2 MVA and 11.4 (95 per cent CI=1.7-74.5) for level 3 MVA. The prepregnancy FC (FC > or = II and III versus I) was also associated with a risk for maternal events (RR=2.7; 95 per cent CI=1.4-5.3).MVA and FC were not importantly associated with these events, although a smaller frequency of fetal/neonatal events was observed in patients who had undergone balloon valvulotomy. CONCLUSION: In pregnant women with mitral stenosis, the MVA and the FC are strongly associated with maternal complications but are not associated with fetal/neonatal events. Balloon mitral valvulotomy could have contributed to reducing the risks of fetal/neonatal events in the more symptomatic patients who had to undergo this procedure during pregnancy.