Correlates and impact of DSM-5 binge eating disorder, bulimia nervosa and recurrent binge eating: a representative population survey in a middle-income country.

PURPOSE: Binge eating disorder (BED), bulimia nervosa (BN) and recurrent binge eating (RBE) are binge eating spectrum conditions causing a significant impact in individual's health and functioning. Information regarding those conditions came mostly from high-income countries. The objective of this study was to assess the prevalence of DSM-5 BED, BN and RBE and correlates in a representative sample from a metropolitan area of a middle-income country. METHODS: The data were obtained from a cross-sectional population-based household survey in two stages in Rio de Janeiro, Brazil. Noninstitutionalized residents aged 18-60 years were assessed by lay interviewers using the Questionnaire of Eating and Weight Patterns-5 (QEWP-5). Positive cases and a paired sample screen-negative cases were reassessed by phone with the Eating Disorders Section of SCID-I-P (adapted for DSM-5). The data were collected from September 2019 to February 2020. RESULTS: Overall, 2297 individuals were interviewed. Prevalence of BED was 1.4%, BN 0.7%, RBE 6.2%. Psychiatric comorbidities, such as depression, anxiety and ADHD were significantly more prevalent in people with BED, BN and RBE than in people without these eating problems. Several medical conditions, when controlling for body mass index, were significantly more prevalent in people with BED, BN and RBE. People with BED and BN had marked impairments in work/school, social and family life, reduced mental and physical HRQoL and under half had sought treatment. CONCLUSION: As in high income countries, in Rio de Janeiro, Brazil, BED, BN and RBE are prevalent conditions and are associated with elevated BMI, functional impairment, psychiatric and medical comorbidity and poorer HRQoL.

Psychosocial Work Conditions and Burnout Among Brazilian Bank Employees: A Cross-Sectional Study.

OBJECTIVES: Changes in the modern economy have affected the financial sector. Time pressures, excessive work demands, and job stress are frequent concerns among bank employees, which might predispose them to burnout symptoms. The objective of the present study was to investigate the association between burnout symptoms and exposure to psychosocial work conditions in bank employees. METHODS: A cross-sectional study of 1046 bank employees was carried out in Pará and Amapá, northern Brazil. We applied a self-administered questionnaire evaluating socio-demographic characteristics, burnout (Maslach Burnout Inventory), and two job stress models (Demand-Control-Support and Effort-Reward Imbalance). Two levels of burnout symptoms were analysed: moderate level of burnout (MLB) and high level of burnout (HLB). Logistic regression models were used to estimate associations between the two levels of burnout and the two stress models, controlling for relevant covariates. RESULTS: The overall prevalence of burnout was 71.8% (31.1% for HLB; 40.7% for MLB), regardless of gender. Exposure to adverse psychosocial conditions in the workplace, such as high strain, low social support at work, high effort/low reward, and over commitment showed strong association with HLB and MLB, and these associations were independent of age, gender, and other occupational characteristics. CONCLUSIONS: We found that psychosocial conditions in the financial sector involving high strain, low social support at work, high effort/low reward, and over commitment represent possible risk factors for moderate and HLB symptoms in bank employees.

Changes in physical activity and screen time related to psychological well-being in early adolescence: findings from longitudinal study ELANA.

BACKGROUND: Psychological well-being influences health behaviours differently in adolescent boys and girls. We evaluated the role of psychological well-being in early adolescence in the onset and persistence of insufficient physical activity and exceeding recommended screen time, depending on gender. METHODS: This work derives from a cohort study called Longitudinal Study of Adolescent Nutritional Assessment conducted among elementary school students from two public and four private schools in Rio de Janeiro, Brazil from 2010-2013. We analysed data from 2010 and 2012 from 526 adolescents. Physical activity was evaluated using the International Physical Activity Questionnaire. Those who performed less than 60 min per day of moderate to vigorous physical activity (MVPA) were classified as insufficiently active. Screen time was evaluated based on daily time spent in front of television, video games, and computers. Those who had 4 h or more screen time per day were classified as exceeding the recommended time. Psychological well-being was assessed using the psychological domain of the KIDSCREEN 27 questionnaire. Linear regression was used to estimate coefficient (ß) and r (2) values for continuous variables. Relative risks (RR) and confidence intervals (95 % CI) for onset and persistence of insufficient activity and exceeding recommended screen time were estimated with Poisson regression models. RESULTS: Among girls, linear regression analyses showed a significant inverse association between psychological well-being and screen minutes per day at T2 (r (2) = 0.049/ß = -3.81 (95 % CI -7.0, -0.9)), as well as an association between poor psychological well-being and onset of exceeding recommended screen time in categorical analyses (RR crude: 1.3; CI 95 % 1.1, 1.7; RR adjusted: 1.3; CI 95 % 1.0, 1.6). For boys, an association was found between psychological well-being and onset of insufficient activity 2 years later (RR crude: 1.3; CI 95 % 1.2, 1.4; RR adjusted: 1.2; CI 95 % 1.1, 1.4). CONCLUSION: Adolescence is crucial for the development of unhealthy behaviours related to psychological well-being status in the context of a middle-income country. Gender differences are important because poor psychological well-being seems to affect sedentary behaviour in girls more than in boys, and predicts insufficient activity among boys.

Direct and indirect exposure to violence and psychological distress among civil servants in Rio de Janeiro, Brazil: a prospective cohort study.

BACKGROUND: Important social and economic changes accompanying the recent fast rate of urbanization have been considered a major factor in triggering and sustaining urban violence in Brazil. The purpose of this paper is to investigate the effects of exposure to direct, indirect, and contextual violence on the risk of psychological distress. METHODS: Prospective longitudinal study carried out among 3,058 civil servants working at university campuses in Rio de Janeiro. Psychological distress was measured using the General Health Questionnaire, and exposure to individual violence was assessed as direct (DV), indirect (IV), and both direct and indirect (DIV). Contextual violence was assessed through the geocoding of residential addresses of study participants and the rates of homicides in 2005 at the corresponding weighting area. Multiple logistic regression was used to evaluate individual and contextual correlates of psychological distress. RESULTS: Exposure to DIV increased more than six times (95% CI 2.7-16.0) the odds of psychological distress occurrence at the six-year follow-up. Regarding persistence of psychological distress, the association with violence exposure was 1.6 (95% CI 1.0-2.4) for DV and 2.7 (95% CI 1.3-5.3) for IV. Contextual violence was not associated with psychological distress, and no interaction effect was found between exposure to individual and contextual violence in the occurrence/persistence of psychological distress. CONCLUSIONS: Results of this study highlight the importance of assessing multiple forms of violence in research on the social determinants of mental disorders and support the view that individual exposure to different forms of violence increases the risk of psychological distress.

Social inequalities in BMI trajectories: 8-year follow-up of the Pró-Saúde study in Rio de Janeiro, Brazil.

OBJECTIVE: In a cohort of government employees in Rio de Janeiro, Brazil, we investigated prospectively, sex-specific associations between education and BMI trajectories and their potential effect modification by race. DESIGN: Of the 4030 participants in Phase 1 (1999), 3253 (81 %) participated in Phase 2 (2003) and 3058 (76 %) participated in Phase 3 (2006). Education was categorized as elementary, high school or college graduate. Study participants self-identified as White, Black or Pardo. BMI was calculated from measured weight and height. BMI trajectories were modelled using a generalized additive regression model with mixed effects (GAMM). SETTING: The Pro-Saúde Study, a longitudinal investigation of social determinants of health. SUBJECTS: Women (n 1441) and men (n 1127) who participated in the three phases of data collection and had complete information for all study variables. RESULTS: Women and men with less than high school, or only a high school education, gained approximately 1 kg/m(2) more than college graduates (women: 1·06 kg/m(2) (P<0·001) and 1·06 kg/m(2) (P<0·001), respectively; men: 1·04 kg/m(2) (P=0·013) and 1·01 kg/m(2) (P=0·277), respectively). For women only, race was independently associated with weight gain. Women identifying as Pardo or Black gained 1·03 kg/m(2) (P=0·01) and 1·02 kg/m(2) (P=0·10), respectively, more than Whites. No effect modification by race was observed for either men or women. CONCLUSIONS: While both lower education and darker race were associated with greater weight gain, gender similarities and differences were observed in these associations. The relationship between weight gain and different indicators of social status are therefore complex and require careful consideration when addressing the obesity epidemic.

Rank, job stress, psychological distress and physical activity among military personnel.

BACKGROUND: Physical fitness is one of the most important qualities in armed forces personnel. However, little is known about the association between the military environment and the occupational and leisure-time dimensions of the physical activity practiced there. This study assessed the association of rank, job stress and psychological distress with physical activity levels (overall and by dimensions). METHODS: This a cross-sectional study among 506 military service personnel of the Brazilian Army examined the association of rank, job stress and psychological distress with physical activity through multiple linear regression using a generalized linear model. RESULTS: The adjusted models showed that the rank of lieutenant was associated with most occupational physical activity (ß = 0.324; CI 95% 0.167; 0.481); "high effort and low reward" was associated with more occupational physical activity (ß = 0.224; CI 95% 0.098; 0.351) and with less physical activity in sports/physical exercise in leisure (ß = -0.198; CI 95% -0.384; -0.011); and psychological distress was associated with less physical activity in sports/exercise in leisure (ß = -0.184; CI 95% -0.321; -0.046). CONCLUSIONS: The results of this study show that job stress and rank were associated with higher levels of occupational physical activity. Moreover job stress and psychological distress were associated with lower levels of physical activity in sports/exercises. In the military context, given the importance of physical activity and the psychosocial environment, both of which are related to health, these findings may offer input to institutional policies directed to identifying psychological distress early and improving work relationships, and to creating an environment more favorable to increasing the practice of leisure-time physical activity.

Temporal relationship between intimate partner violence and postpartum depression in a sample of low income women.

To estimate whether there is a temporal association between Postpartum Depression (PPD) and intimate partner violence (IPV), and to assess the potential role of social support on this relationship. A cross-sectional study was conducted between January 2006 and March 2007 with 701 low income women who received prenatal and postpartum care in primary health care units of the public sector in São Paulo, Brazil. The Self-Report Questionnaire (SRQ-20) was used to assess the presence of PPD. Structured standardized questionnaires were used to assess IPV and social support. The prevalence of PPD was estimated with a 95 % confidence interval. Crude and adjusted prevalence ratios were calculated using Poisson regression to examine the association between PPD and exposure variables. Values of p < 0.05 were considered statistically significant. The prevalence of PPD was 27.9 % (95 %CI 24.6:31.2). The prevalence of psychological IPV was 38.6 %, physical IPV 23.4 %, and sexual IPV 7.1 %. The multivariate analysis showed that PPD was strongly associated with current psychological and physical/sexual violence, after controlling for confounding factors, and less so with past (prenatal or lifetime) IPV. Presence of social support was an independent protective factor for PPD. Identifying and addressing intimate partner violence, including psychological violence, in the postpartum period should be considered as part of a comprehensive approach to caring for new mothers.

Sexual Orientation Disparities in Depression and Substance Use Among Adults: Results from the Brazilian National Health Survey 2019.

Purpose: We compared the prevalence of depression, hazardous alcohol use, daily tobacco use, and hazardous alcohol and tobacco use (HATU) by sexual orientation and sex among Brazilian adults. Methods: Data were obtained from a national health survey conducted in 2019. This study included participants aged 18 years and older (N = 85,859). Adjusted prevalence ratios (APRs) and confidence intervals were estimated using Poisson regression models stratified by sex to examine the association between sexual orientation, depression, daily tobacco use, hazardous alcohol use, and HATU. Results: After controlling for the covariates, gay men showed a higher prevalence of depression, daily tobacco use, and HATU compared with heterosexual men (APR ranged from 1.71 to 1.92). Furthermore, bisexual men showed a higher prevalence (almost three times) of depression compared with heterosexual men. Lesbian women showed a higher prevalence of binge and heavy drinking, daily tobacco use, and HATU compared with heterosexual women (APR ranged from 2.55 to 4.44). Among bisexual women, the results were significant for all analyzed outcomes (APR ranged from 1.83 to 3.26). Conclusions: This study was the first to use a nationally representative survey to assess sexual orientation disparities related to depression and substance use by sex in Brazil. Our findings highlight the need for specific public policies aimed at the sexual minority population and for greater recognition and better management of these disorders by health professionals.

Association between self-rated health and mortality: 10 years follow-up to the Pró-Saúde cohort study.

BACKGROUND: The association between self-rated health (SRH) and mortality is well documented in the literature, but studies on the subject among young adults in Latin America are rare, as are those evaluating this association using repeated SRH measures, beyond the baseline measurement. This study aims to evaluate the association between SRH evaluated at three data collection stages and mortality. METHODS: Cox regression models were used to examine the association between SRH (Very good, Good, Fair/Poor) varying over time and mortality, over a 10 year period, in a cohort of non-faculty civil servants at a public university in Rio de Janeiro, Brazil (Pró-Saúde Study, n = 4009, men = 44.4%). RESULTS: About 40% of the population changed their self-rating over the course of follow-up. After adjustment for self-reported physician-diagnosed chronic diseases and other covariates, men who reported "Fair/Poor" SRH showed relative hazard of death of 2.13 (CI95% 1.03-4.40) and women, 3.43 (CI95% 1.23-9.59), as compared with those who reported "Very good" SRH. CONCLUSIONS: In a population of young adults, our findings reinforce the role of SRH as a predictor of mortality, even controlling for objective measures of health.

Association between fear of falling and spatial and temporal parameters of gait in older adults: the FIBRA-RJ study.

PURPOSE: To evaluate the association between fear of falling (FoF) and spatial and temporal parameters of gait in older adults. METHODS: This cross-sectional study evaluated 291 clients of a private health care insurance who were over 65 years of age and living in the North Zone of Rio de Janeiro City in 2013. FoF was assessed by the Falls Efficacy Scale-International (FES-I-BR), and gait parameters, such as gait speed, cadence, step time, step length, stride length, and variability (standard deviation of stride length), were assessed using GAITRite®. The covariates were age, sex, history of falls, number of medications, cognitive decline, body mass index, and sight impairment. The association between FoF and gait parameters was assessed by linear regression, and the respective 95% confidence intervals (95% CIs) were calculated. RESULTS: The prevalence of FoF was 51.9%. The adjusted analyses showed an association between FoF and the following gait parameters: decreased gait speed, decreased cadence, increased step time, and decreased step and stride length. No association was found between FoF and stride lenght variability. CONCLUSION: This study suggests that FoF is associated with changes in gait parameters, with the exception of stride length variability. These findings show a need for interventions to reduce FoF in older adults, which is a modifiable factor that is related to gait changes. More studies are needed to elucidate the relationship between FoF and motor control of gait in older adults.

Correction: Psychosocial and environmental determinants of physical activity in a Brazilian public university employees-ELDAF: A prospective cohort study protocol.

[This corrects the article DOI: 10.1371/journal.pone.0263385.].

Psychosocial and environmental determinants of physical activity in a Brazilian public university employees - ELDAF: A prospective cohort study protocol.

BACKGROUND: Increased physical activity levels and their determinations are essential issues worldwide. The Longitudinal Study of Physical Activity Determinants (ELDAF) aims to understand the roles of psychosocial and environmental factors in workers' physical activity levels. METHODS: A prospective cohort study of non-faculty civil servants from a public university (approximately 1,200 individuals) will start in 2022 (baseline). The primary measurements will be accelerometer- and questionnaire-based physical activity, social support, social network, socioeconomic status, bereavement, job stress, body image, common mental disorders, depression, and neighborhood satisfaction. Additional measurements will include necessary sociodemographic, physical morbidity, lifestyle and anthropometric information. Participants' places of residence will be geocoded using complete addresses. All participants will furnish written, informed consent before the beginning of the study. Pilot studies were performed to identify and correct potential problems in the data collection instruments and procedures. ELDAF will be the first cohort study conducted in Latin America to investigate physical activity and its determinants.

Social support and leisure-time physical activity: longitudinal evidence from the Brazilian Pró-Saúde cohort study.

BACKGROUND: Although social support has been observed to exert a beneficial influence on leisure-time physical activity (LTPA), multidimensional approaches examining social support and prospective evidence of its importance are scarce. The purpose of this study was to investigate how four dimensions of social support affect LTPA engagement, maintenance, type, and time spent by adults during a two-year follow-up. METHODS: This paper reports on a longitudinal study of 3,253 non-faculty public employees at a university in Rio de Janeiro (the Pró-Saúde study). LTPA was evaluated using a dichotomous question with a two-week reference period, and further questions concerning LTPA type (individual or group) and time spent on the activity. Social support was measured by the Medical Outcomes Study Social Support Scale (MOS-SSS). To assess the association between social support and LTPA, two different statistical models were used: binary and multinomial logistic regression models for dichotomous and polytomous outcomes, respectively. Models were adjusted separately for those who began LTPA in the middle of the follow up (engagement group) and for those who had maintained LTPA since the beginning of the follow up (maintenance group). RESULTS: After adjusting for confounders, statistically significant associations (p < 0.05) between dimensions of social support and group LTPA were found in the engagement group. Also, the emotional/information dimension was associated with time spent on LTPA (OR = 2.01; 95% CI 1.2-3.9). In the maintenance group, material support was associated with group LTPA (OR = 1.80; 95% CI; 1.1-3.1) and the positive social interaction dimension was associated with time spent on LTPA (OR = 1.65; 95% CI; 1.1-2.7). CONCLUSIONS: All dimensions of social support influenced LTPA type or the time spent on the activity. However, our findings suggest that social support is more important in engagement than in maintenance. This finding is important, because it suggests that maintenance of LTPA must be associated with other factors beyond the individual's level of social support, such as a suitable environment and social/health policies directed towards the practice of LTPA.

Psychosocial determinants of physical activity among workers: an integrative review.

Knowledge of the psychosocial determinants of physical activity is critical to informing preventive and therapeutic interventions in the workplace. This study reviewed available evidence on psychosocial factors that have been associated with physical activity among workers. Studies were selected in December 2019 from the Scopus, Web of Science, and PubMed databases, with no date limits, using the following search terms: "physical activity", "physical exercise", "psychosocial", "workers", and "working-age". Thirty-nine studies published between 1991 and 2019 were evaluated. The determinants of physical activity investigated among workers were smoking status, stress, psychosocial working conditions, depression, anxiety, social relationships, work ability, job satisfaction, burnout, and self-efficacy. Some consistencies and controversies were observed in the associations among these determinants and physical activity and are discussed, as are suggestions for future studies. The findings of this review may be of interest to physical activity interventions designed to reduce psychosocial risks factors in work environments.

Job strain and other work conditions: relationships with psychological distress among civil servants in Rio de Janeiro, Brazil.

BACKGROUND: In developing countries, traditional sources of employment and work practices have changed rapidly and work environment has appeared as an important factor associated with an increased prevalence of mental disorders in these countries. AIMS: To investigate the association between job strain and other work characteristics with psychological distress, and to estimate the contextual effects of different working environments on psychological distress, using cross-sectional data from an occupational cohort. METHODS: The subjects were 3,574 non-faculty civil servants working at university campuses in Rio de Janeiro, Brazil (Pró-Saúde Study). Psychological distress was measured by the 12-item General Health Questionnaire. Work characteristics were measured by the modified version of the Karasek model and through questions about night shift work and occupational status. RESULTS: After adjusting for age, education, income and other work characteristics, low social support at work and high job strain were associated with psychological distress. For low social support, the association was stronger in men (Prevalence Ratio = 2.02; 95% Confidence Interval 1.6-2.6) than in women (PR = 1.46; 95% CI 1.2-1.4). High job strain was similarly significant in both women (PR = 1.43; 95% CI 1.2-1.7) and men (PR = 1.30; 95% CI 1.0-1.7). Men having a routine non-manual work presented 29% more psychological distress than those undertaking professional roles. Night shift work did not show significant association with psychological distress. In the multilevel analysis, the prevalence of psychological distress did not vary significantly across work units. CONCLUSION: Job strain and poor support at work seem important psychological stressors in the workplace in Brazil. Our findings are comparable to those found in more developed countries, providing additional evidence of an association between an adverse psychosocial work environment and psychological distress, being thus useful for policymakers in planning and promoting healthier and happier working force necessary for economic development.

Prevalence of Sarcopenic Obesity and its Association with Functionality, Lifestyle, Biomarkers and Morbidities in Older Adults: the FIBRA-RJ Study of Frailty in Older Brazilian Adults.

OBJECTIVES: To assess the prevalence of sarcopenic obesity and its association with functionality, lifestyle, biomarkers, and morbidities in older adults. METHODS: The study analyzed cross-sectional data from 270 older adults who participated in phase III of the Frailty in Brazilian Older People Study (Fragilidade em Idosos Brasileiros-Rio de Janeiro, FIBRA-RJ study-2013). They took part in a home interview surveying socioeconomic, demographic, lifestyle, morbidities, and functional data. Blood was collected for biochemical marker analysis and participants' body composition was determined by dual-energy X-ray absorptiometry. For women, the diagnosis of sarcopenic obesity was defined at a body fat percentage ≥38% and appendicular skeletal muscle mass index (ASMMI) <5.45 kg/m2. For men, a fat percentage ≥27% and ASMMI <7.26 kg/m2 was defined as sarcopenic obesity. Multivariate analysis was performed using a multinomial regression model (95% confidence intervals), with sarcopenic obesity as the outcome. RESULTS: The prevalence of sarcopenic obesity was 29.3%. In the final fitted model, the variables that displayed statistically significant association with sarcopenic obesity were lower gait speed, self-reported medical diagnosis of arthrosis or arthritis, and high levels of glycemia. CONCLUSION: The study showed a high prevalence of sarcopenic obesity in non-institutionalized older adults in Brazil. The finding that this condition was associated with modifiable risk factors may provide insights into measures directed at prevention and reduction of the risk of sarcopenic obesity in this population subgroup.

Stability and bidirectional relationship between physical activity and sedentary behaviours in Brazilian adolescents: Longitudinal findings from a school cohort study.

PURPOSE: We investigated the stability, correlations and bidirectional relationship of light physical activities (PA), moderate and vigorous PA (MVPA), television viewing (TV) and video game/computer use (VG) in Brazilian adolescents. METHODS: Adolescent Nutritional Assessment Longitudinal Study-ELANA is a middle school cohort study conducted in Rio de Janeiro-Brazil in 2010-2012. Self-reported data on PA (International Physical Activity Questionnaire- IPAQ) and screen activities were obtained from 810 adolescents (mean ages of 10.9 years old (SD 0.78) for girls; 11 years old (SD 0.85) for boys) to perform autoregressive cross-lagged structural equation models in two time points for PA and three time points for screen activities. RESULTS: There was no significant stability of light PA and MVPA for boys and girls. Moderate stability of screen activities were found for both genders, with a significant coefficient of TV for boys (T1-T2:0.29; T2-T3:0.27 p<0.001); and VG for boys (T1-T2:0.33; T2-T3:0.35 p<0.001) and girls (T1-T2: 0.26; T2-T3:0.37 p<0.01). Significant lagged effects were obtained only among girls: light PA had effect on VG (-0.10 p<0.01), as well as in the opposite direction of TV on light PA (-0.03 p<0.01) and TV on MVPA (-0.11 p<0.01). CONCLUSION: The light PA, MVPA and screen activities (among girls) did not demonstrate stability over time. A warning scenario was suggested by the stability of high amounts of screen activities among boys over time. Screen activities had bidirectional association with light PA and MVPA among girls over time.

Higher risk of common mental disorders after experiencing physical violence in Rio de Janeiro, Brazil: the Pró-Saúde Study.

BACKGROUND: In Brazil, violence is a major public health problem. However, up until now, the extent to which violence acts as a risk factor for mental disorders has not been investigated prospectively. AIMS: We determined the risk of common mental disorders (CMD) associated with personal experience with physical violence (PV). METHODS: A cohort of 3253 public employees in Rio de Janeiro completed questionnaires that measured CMD (GHQ-12), experience with PV and stressful life events (SLE). RESULTS: After adjusting for age, income and SLE, those who experienced PV in either 1999 or 2001 and those who experienced PV in both years had, respectively, 1.2-fold (95% CI; 1.0-1.4) and 2.1-fold (1.6-2.6) increased risks of CMD. CONCLUSION: Direct exposure to violence may act cumulatively on the risk of developing CMD. The absence of association for reporting CMD both in 1999 and 2001 suggests that other determinants may be more relevant for chronic mental disorders.

[Association between abdominal circumference and hypertension among women: the Pró-Saúde Study]. / Associação entre circunferência abdominal e hipertensão arterial em mulheres: Estudo Pró-Saúde.

This study aimed to estimate the prevalence of hypertension according to levels of abdominal circumference (AC) and body mass index (BMI, expressed as kg/m(2)) among public employees at a university in Rio de Janeiro, Brazil. Cross-sectional data were obtained for 1,743 non-pregnant women aged 24-69 years participating in the Pró-Saúde Study. Underweight women and those with BMI > 35 kg/m(2) were excluded. Hypertension was defined as systolic blood pressure >140 mmHg or diastolic > 90 mmHg or the use of anti-hypertensive drugs. Age-adjusted prevalence rates for hypertension were calculated considering two strata of AC (normal: < 88 cm; high: > 88 cm) and three levels of BMI (normal: 18.5-24.9 kg/m(2); overweight: 25.0-29.9 kg/m(2); and obesity I: 30.0-34.9 kg/m(2)). Among normal-weight women, participants with high AC showed a two-fold higher prevalence of hypertension as compared to those with AC < 88 cm (18% vs. 8%, p < 0.05). Routine measurement of AC, in addition to BMI, could contribute to early identification of hypertension in women.

[Interobserver reliability of the International Classification of Primary Care]. / Confiabilidade interobservador da Classificação Internacional de Cuidados Primários.

OBJECTIVE: The International Classification of Primary Care was developed as an attempt to overcome the limitations of the International Statistical Classification of Diseases and Related Health Problems, 10th revision, when used for primary health care. The aim of the study was to evaluate the interobserver reliability of the International Classification for Primary Care when coding reasons for health-related interruption of daily activities. METHODS: Data analyzed pertained to 801 subjects from Phase 2 of the Pró-Saúde Study, involving the employees of a Rio de Janeiro university who reported having been prevented from carrying out any of their usual activities (work, study, or leisure) for health-related reasons in the two weeks prior to data collection. Health problems reported in response to an open question were separately coded by two classifiers. Interobserver reliability with respect to number of health problems was calculated by weighted kappa; for the remaining analyses (chapters and full codes), crude kappa coefficients were used. RESULTS: A total of 1,641 health problems were coded by the first classifier, and 1,629 by the second. Interobserver reliability with respect to the number of health problems coded was substantial (weighted kappa=0.94; 95% CI: 0.93;0.94). Chapter and full codes showed substantial (kappa=0.89; 95% CI: 0.88;0.90) and moderate (0.76; 95% CI: 0.76;0.78) reliability, respectively. CONCLUSIONS: The results suggest that the International Classification of Primary Care is adequate for the coding of health-related reasons for interruption of daily activities.