The 894G>T endothelial nitric oxide synthase genetic polymorphism affects hemodynamic responses to mental stress performed before and after exercise.

Nitric oxide is the primary mediator of vasodilation during mental stress. Since genetic polymorphisms in the nitric oxide synthase (eNOS) gene seem to impair the production of NO, this study aimed to evaluate the effect of an exercise bout on hemodynamic responses to mental stress in subjects with the 894G>T polymorphism of eNOS. Subjects without (wild-type group; n = 16) or with (polymorphic-type group; n = 19) the 894G>T polymorphism underwent a mental stress challenge before and after a maximal cardiopulmonary exercise test. Blood pressure was measured by auscultation and forearm blood flow by venous occlusion plethysmography. The groups were similar regarding anthropometric, metabolic, resting blood pressure and exercise variables. Before exercise, systolic blood pressure response during mental stress was higher in the polymorphic-type group (∆wild-type: 8.0 ± 2.0% vs. ∆polymorphic-type: 12.5 ± 1.8%, P = 0.01), while the increase in forearm vascular conductance was similar between the groups (∆wild-type 90.8 ± 26.4% vs. ∆polymorphic-type: 86.3 ± 24.1%, P = 0.44). After exercise, the systolic blood pressure at baseline and during mental stress was lower than before exercise in the whole group (P < 0.05), but the pressure response during mental stress was still higher in the polymorphic-type group (∆wild-type: 5.8 ± 1.5% vs. ∆polymorphic-type: 10.2 ± 1.4%, P = 0.01). The increase in forearm vascular conductance was inhibited only in the polymorphic-type group (∆before exercise 86.3 ± 24.1% vs. ∆after exercise: 41.5 ± 12.6%, P = 0.04). In conclusion, these results suggest the 894G>T eNOS polymorphism is associated with altered hemodynamic responses to mental stress both before and after a single bout of dynamic exercise with potential clinical implications.

[Colon and rectal cancer mortality in Brazilian capitals, 1980-1997]. / Mortalidade por câncer de cólon e reto nas capitais brasileiras no período 1980-1997.

BACKGROUND: In Brazil, colorectal tumors are among the five more important sites of neoplasms, for both sexes, in terms of mortality. The etiology of colon and rectal cancer is complex and some of the factors involved in its genesis are related to diet. Brazilian geographic regions present heterogeneous alimentary profiles, that could be influencing the distribution of the mortality rates for these tumors. OBJECTIVE: To describe the patterns of mortality from cancers of the colon and the rectum in Brazilian State capitals in the period 1980-1997. MATERIAL AND METHODS: Mortality data for individuals of both sexes, residents in Brazilian State capitals (except Palmas, Tocantins) was obtained from the Ministry of Health Mortality System (SIM/MS). We considered as death from colon and rectum cancers those whose underlying cause of death was coded as 153.0 to 153.9, 154.0 and 154.1, according to ICD 9, in the period 1980-95; C18.0 to C18.9, C19 and C20,according to ICD 10, in the period 1996-97. The trends of the standardized mortality rates from colon and rectum cancer were analyzed through linear regression models. RESULTS: The highest standardized mortality rates for colorectal cancer were observed in the South and Southeastern regions and varied between 8,0 and 10,7/100000 inhabitants. Porto Alegre (11,9), São Paulo (10,8) and Rio de Janeiro (9,6) presented the greatest rates among the State capitals in the study period. In the South region, rates of mortality for Porto Alegre and Florianópolis presented an increasing trend in the study period and the same behavior was observed for São Paulo and Vitória in the Southeastern region. Brasilia and the other capitals of the Midwest, with the exception of Goiânia, showed a tendency of increment of the mortality rates. Among the capitals of the North and Northeast regions, an increasing trend of mortality was observed in Rio Branco and Fortaleza. The separate analysis of the mortality rates for tumors of the colon and for tumors of the rectum showed a similar pattern, with higher values being observed for colon neoplasia. DISCUSSION: Regional differences in the mortality rates for colon and rectum neoplasias have been discussed for different authors, who point to the contribution of cultural and alimentary habits, and differences of life style and socioeconomic status to this heterogeneity, besides other aspects related to access to health services and quality of hospital care and preventive services. These factors must be considered in the evaluation of the differences observed in Brazilian capitals. Although the State capitals situated in South and Southeastern regions presented higher rates than the others, mortality rates of Porto Alegre (9,8/100.000) and Rio de Janeiro (9,0/100.000), in period 1983- 85, were about three times lower than those observed in the United States, Canada and France, in 1985. The sex distribution pattern of the mortality rates in Brazilian capitals was not uniform, with higher rates in men. We observed a trend of increment of the mortality rates of colorectal cancer in all Brazilian regions, similar to that was observed in some countries of the world, although with different gradients. CONCLUSIONS: The standardized mortality rates for colon and rectum neoplasias presented important regional differences among Brazilian State capitals. The highest rates were observed in the South and Southeastern regions. A trend of increment of the standardized mortality rates for cancers of the colon and the rectum was observed in all Brazilian regions in the period 1980-1997.

[Translation and cultural adaptation of the questionnaire on the reason for food choices (Food Choice Questionnaire - FCQ) into Portuguese]. / Tradução e adaptação cultural do questionário sobre motivo das escolhas alimentares (Food Choice Questionnaire - FCQ) para a língua portuguesa.

The Food Choice Questionnaire (FCQ) assesses the importance that subjects attribute to nine factors related to food choices: health, mood, convenience, sensory appeal, natural content, price, weight control, familiarity and ethical concern. This study sought to assess the applicability of the FCQ in Brazil; it describes the translation and cultural adaptation from English into Portuguese of the FCQ via the following steps: independent translations, consensus, back-translation, evaluation by a committee of experts, semantic validation and pre-test. The pre-test was run with a randomly sampled group of 86 male and female college students from different courses with a median age of 19. Slight differences between the versions were observed and adjustments were made. After minor changes in the translation process, the committee of experts considered that the Brazilian Portuguese version was semantically and conceptually equivalent to the English original. Semantic validation showed that the questionnaire is easily understood. The instrument presented a high degree of internal consistency. The study is the first stage in the process of validating an instrument, which consists of face and content validity. Further stages, already underway, are needed before other researchers can use it.

Impaired hemodynamic response to mental stress in subjects with prehypertension is improved after a single bout of maximal dynamic exercise.

INTRODUCTION: High blood pressure during mental stress in subjects with prehypertension is associated with blunted vasodilation in skeletal muscles, which might be improved by an acute bout of exercise. OBJECTIVE: To investigate the hemodynamic responses to mental stress before and after a bout of exercise in subjects with prehypertension. METHOD: Eighteen subjects with prehypertension and 16 with normotension underwent a mental stress test before and after a maximal cardiopulmonary exercise test on a treadmill. Blood pressure was measured by auscultation, and forearm blood flow was measured by venous occlusion plethysmography; from these measurements, the vascular conductance was calculated. RESULTS: Subjects with prehypertension had a higher mean blood pressure during mental stress (prehypertension 112 ± 2 vs. normotension 101 ± 3 mm Hg, p<0.05), and their vascular conductance did not increase (baseline 0.025 ± 0.004 vs. mental stress 0.022 ± 0.003 a.u., p.0.05). After the exercise bout, the mean blood pressure during mental stress was lower in subjects with prehypertension (before exercise 112 ± 2 vs. after exercise 107 ± 2 mm Hg, p<0.05), and vascular conductance increased (baseline 0.011 ± 0.001 vs. mental stress 0.024 ± 0.004 a.u., p<0.05). CONCLUSION: Subjects with prehypertension had elevated blood pressure and a blunted vasodilator response during mental stress, but their blood pressure was attenuated and their vasodilator response was normalized after a single bout of maximal dynamic exercise.

Tradução e adaptação cultural do questionário sobre motivo das escolhas alimentares (Food Choice Questionnaire - FCQ) para a língua portuguesa / Translation and cultural adaptation of the questionnaire on the reason for food choices (Food Choice Questionnaire - FCQ) into Portuguese

Resumo O Food Choice Questionnaire (FCQ) avalia a importância atribuída pelos indivíduos a nove fatores relacionados às escolhas alimentares: saúde, humor, conveniência, apelo sensorial, conteúdo natural, preço, controle de peso, familiaridade e preocupação ética. O estudo objetivou descrever o processo de tradução e adaptação cultural do FCQ para a língua portuguesa e avaliar sua aplicabilidade com as seguintes etapas: traduções independentes, obtenção do consenso em português, retrotradução, avaliação por um comitê de especialistas, validação semântica e pré-teste. Este foi aplicado em uma amostra aleatória de 86 estudantes universitários, de ambos os sexos, mediana de 19 anos de idade. Pequenas diferenças entre as versões foram observadas e poucas adaptações realizadas. Após discretas modificações nos processos de tradução, o comitê de especialistas considerou que a versão para o português apresentou equivalências semântica e conceitual. A validação semântica demonstrou fácil compreensão. O instrumento apresentou alto grau de consistência interna. O estudo foi a primeira etapa do processo de validação de um instrumento, que é a validade de face e de conteúdo. Novas etapas, que já se encontram em andamento, são necessárias antes de sua utilização por outros pesquisadores.

Abstract The Food Choice Questionnaire (FCQ) assesses the importance that subjects attribute to nine factors related to food choices: health, mood, convenience, sensory appeal, natural content, price, weight control, familiarity and ethical concern. This study sought to assess the applicability of the FCQ in Brazil; it describes the translation and cultural adaptation from English into Portuguese of the FCQ via the following steps: independent translations, consensus, back-translation, evaluation by a committee of experts, semantic validation and pre-test. The pre-test was run with a randomly sampled group of 86 male and female college students from different courses with a median age of 19. Slight differences between the versions were observed and adjustments were made. After minor changes in the translation process, the committee of experts considered that the Brazilian Portuguese version was semantically and conceptually equivalent to the English original. Semantic validation showed that the questionnaire is easily understood. The instrument presented a high degree of internal consistency. The study is the first stage in the process of validating an instrument, which consists of face and content validity. Further stages, already underway, are needed before other researchers can use it.

Intra- and inter-tester reproducibility of venous occlusion plethysmography: comparison between a manual and a semi-automatic method of blood flow analysis.

Venous occlusion plethysmography (VOP) is a valid non-invasive method to assess peripheral blood flow (BF) in humans. Our aim was to determine intra- and inter-tester reproducibility of BF analysis using a traditional manual method and a novel system, based on a semi-automatic approach. Ten healthy subjects and ten subjects with chronic heart failure (CHF) were evaluated. Blood flow was measured on the forearm at baseline and after 5 min of circulatory occlusion (reactive hyperemia (RH)). Two testers independently and blindly analyzed each VOP recording. Both methods were highly reproducible intra- and inter-testers. In addition, there was a high association between the methods, since the intraclass correlation coefficients (ICCs) for healthy subjects were 0.99, 0.99 and 0.99, and the coefficients of variation (CVs) were 1.8, 2.4 and 1.6% for baseline, RH peak and RH area under the curve, respectively. For CHF subjects, the ICCs were 0.99, 0.98 and 0.99, and the CVs were 2.9, 3.6 and 2.0%. In addition, the time spent on the semi-automatic analyses was shorter (p < 0.05). In conclusion, both methods demonstrated high intra- and inter-tester reproducibility for baseline and RH BF analysis. However, since the semi-automatic method was faster to generate the results, the present study supports its usage for the analysis of BF measured by VOP.

Impaired hemodynamic response to mental stress in subjects with prehypertension is improved after a single bout of maximal dynamic exercise

INTRODUCTION: High blood pressure during mental stress in subjects with prehypertension is associated with blunted vasodilation in skeletal muscles, which might be improved by an acute bout of exercise. OBJECTIVE: To investigate the hemodynamic responses to mental stress before and after a bout of exercise in subjects with prehypertension. METHOD: Eighteen subjects with prehypertension and 16 with normotension underwent a mental stress test before and after a maximal cardiopulmonary exercise test on a treadmill. Blood pressure was measured by auscultation, and forearm blood flow was measured by venous occlusion plethysmography; from these measurements, the vascular conductance was calculated. RESULTS: Subjects with prehypertension had a higher mean blood pressure during mental stress (prehypertension 112±2 vs. normotension 101±3 mm Hg, p<0.05), and their vascular conductance did not increase (baseline 0.025±0.004 vs. mental stress 0.022±0.003 a.u., p.0.05). After the exercise bout, the mean blood pressure during mental stress was lower in subjects with prehypertension (before exercise 112±2 vs. after exercise 107±2 mm Hg, p<0.05), and vascular conductance increased (baseline 0.011±0.001 vs. mental stress 0.024±0.004 a.u., p<0.05). CONCLUSION: Subjects with prehypertension had elevated blood pressure and a blunted vasodilator response during mental stress, but their blood pressure was attenuated and their vasodilator response was normalized after a single bout of maximal dynamic exercise.

Mortalidade por câncer de cólon e reto e consumo alimentar em capitais brasileiras selecionadas / Colorectal cancer mortality and diet patterns in selected Brazilian State capitals

As taxas de mortalidade por câncer de cólon e reto mostram uma variação regional no Brasil e a heterogeneidade do padrão alimentar nas suas regiões geográficas poderia possivelmente explicar, pelo menos em parte, essas diferenças. Um estudo ecológico foi realizado com o objetivo de identificar possíveis associações entre padrões de consumo alimentar e taxas de mortalidade padronizadas por idade em capitais brasileiras selecionadas. O padrão de consumo alimentar em cada capital foi caracterizado com base no consumo de grupos de alimentos associados a essa neoplasia na literatura. Os dados de consumo de alimentos foram obtidos no ENDEF (Estudo Nacional de Despesas Familiares). A regressão linear múltipla foi utilizada para analisar as correlações entre as taxas de mortalidade e as variáveis alimentares. Essas taxas mostraram uma correlação positiva com o consumo de calorias, cereais, carnes, ovos/leite e legumes/frutas. Quando ajustado por consumo calórico total, carne e legumes/frutas foram as únicas variáveis que mantiveram uma correlação positiva. O modelo multivariado final com essas variáveis foi capaz de explicar 92 por cento da variação das taxas de mortalidade nas capitais selecionadas. Esses resultados sugerem que diferenças no consumo calórico total e no consumo de carne e legumes/frutas poderiam explicar, parcialmente, os diferentes padrões de distribuição da mortalidade por câncer de cólon e reto no Brasil.

Mortalidade por câncer de cólon e reto nas capitais brasileiras no período 1980-1997 / Colon and rectal cancer mortality in Brazilian capitals, 1980-1997

RACIONAL: No Brasil, os tumores de cólon e reto estão entre as cinco localizações anatômicas mais importantes em termos de mortalidade, para ambos os sexos. A etiologia dessa neoplasia é complexa e vários fatores estão envolvidos na sua gênese, entre estes os relacionados à dieta. Este país apresenta perfis alimentares heterogêneos nas suas regiões geográficas, que poderiam estar influenciando a distribuição das taxas de mortalidade por esses tumores. OBJETIVO: Descrever o padrão de mortalidade por câncer de cólon e reto nas capitais brasileiras, no período de 1980-1997. MATERIAL E MÉTODOS: Foram utilizados os dados de mortalidade do Subsistema de Informações sobre Mortalidade do Ministério da Saúde para os anos de 1980 a 1997, para indivíduos de ambos os sexos, residentes nas capitais dos Estados brasileiros, com exceção de Palmas, Tocantins. Foram considerados como óbitos por câncer de cólon e de reto aqueles cuja causa básica havia sido codificada como 153.0 a 153.9, 154.0 e 154.1, segundo a Classificação Internacional de Doenças (CID) 9, no período 1980-95; C18.0 a C18.9, C19 e C20, segundo a CID 10, no período 1996-97. A tendência das taxas padronizadas de mortalidade por câncer de cólon e reto foi analisada com base em modelos de regressão linear. RESULTADOS: As maiores taxas padronizadas de mortalidade para câncer de cólon/reto foram observadas nas regiões sul e sudeste, variando entre 8,0 e 10,7/100.000 habitantes. Porto Alegre (11,9), São Paulo (10,8) e Rio de Janeiro (9,6) apresentaram as taxas de maior magnitude no período estudado.Na região Sul, Porto Alegre e Florianópolis apresentaram tendência crescente da mortalidade por essa neoplasia, sendo o mesmo comportamento observado para São Paulo e Vitória, na região Sudeste. Brasília e as capitais da região centro-oeste, com exceção de Goiânia, mostraram tendência de crescimento das taxas de mortalidade. Entre as capitais das regiões norte e nordeste, verificou-se tendência crescente da mortalidade em Rio Branco e Fortaleza. A análise isolada das taxas de mortalidade por tumores de cólon e de reto mostrou comportamento semelhante, com valores mais altos para câncer de cólon. CONCLUSÕES: As taxas de mortalidade padronizadas por câncer de cólon/reto apresentaram importantes diferenças regionais e entre as capitais brasileiras, observando-se taxas mais elevadas nas regiões sul e sudeste. Todas as regiões apresentaram tendência de incremento...

História familiar de Diabetes Mellitus tipo 2 e modulação autonômica cardíaca / Family history of type 2 Diabetes Mellitus and cardiac autonomic modulation

Fundamentos: Faltam evidências para identificar se a redução na função autonômica observada em indivíduos com história familiar de primeiro grau de diabetes mellitus tipo 2 (HFDM2) é uma característica primária ou uma consequência de desordens metabólicas comumente observadas nesses indivíduos. Objetivo: Investigar a influência da HFDM2 na modulação autonômica cardíaca em ausência de desordens metabólicas concomitantes. Métodos: Foram recrutados indivíduos saudáveis com HFDM2 (grupo HFDM2; n=61) e sem HFDM2 (grupo-controle; n=53). O protocolo incluiu: dosagem de glicose, insulina, colesterol total e subfrações, triglicerídeos, leptina e proteína C-reativa; e avaliação da variabilidade da frequência cardíaca (VFC) através da análise espectral de um registro de intervalos RR durante 10 minutos na posição supina. Resultados: Os indivíduos com HFDM2 apresentaram maiores valores para variáveis antropométricas e metabólicas e uma menor VFC quando comparados com o grupo-controle (p menor que 0,05)...

Função autonômica e reatividade vascular em indivíduos com parentesco de diabetes tipo 2 e em portadores do polimorfismo 894G>T da óxido nítrico sintase endotelial / Autonomic function and vascular reactivity in individuals with relatives of type 2 diabetes and in patients with the polymorphism 894>T of endothelial nitric oxide synthase

As doenças crdiovasculares estão entre as principais causas de mortalidade em muitos países. O sistema nervoso autônomo e a função endotelial constituem mecanismos centrais no desenvolvimento e progressão de doenças cardiovasculares. A função autonômica e a reatividade vascular podem estar alteradas em indivíduos com maior risco para doença cardiovascular, como indivíduos com história familiar de primeiro grau de diabetes tipo 2 (HFDM2) e indivíduos com polimorfismo 894G>T da enzima óxido nítrico sintase endotelial (eNOS). Os objetivos dos três artigos apresentados na tese foram: artigo I. Investigar a influência da HFDM2 na modulação autonômica cardíaca em ausência de desordens metabólicas concomitantes; artigo II. Investigar a influência da HFDM2 na reatividade vascular em ausência de desordens metabólicas concomitantes e, artigo III. Investigar a influência do polimorfismo 894>T no efeito de uma sessão de exercício dinâmico máximo na reatividade vascular. Foram recrutados indivíduos saudáveis com e sem HFDM2 para os artigos I e II. A variabilidade da frequência cardíaca (VFC) foi determinada através da análise espectral de um registro de intervalos RR durante 10 minutos na posição supina (artigo I) e a reatividade vascular durante a hiperemia reativa através da pletismografia de oclusão venosa (artigo II). Para a realização do artigo III, foram recrutados indivíduos saudáveis com e sem o polimorfismo 894>T da eNOS. O protocolo consistiu na determinação da reatividade vascular basal e durante a hiperemia reativa, o qual eram realizados pré, 10, 60 e 120 minutos após um teste de esforço cardiopulmonar máximo. Os indivíduos com HFDM2 apresentaram maiores valores para variáveis antropométricas e metabólicas e uma menor VFC (artigo I) e reatividade vascular (artigo II) quando comparados com o grupo-controle (p<0,05). Em seguida, os grupos foram emparelhados para essas variáveis consideradas capazes de alterar a VFC e a reatividade vascular...

Cardiovascular diseases are among the leading causes of mortality in many countries. The autonomic nervous system and the endothelial function are central mechanisms in the development and progression of cardiovascular diseases. The autonomic function and vascular reactivity may be altered in subjects with higher risk for cardiovascular disease, as subjects with family history of first-degree relatives of type 2 diabetes (FDRs), and subjects with the 894G>T polymorphism of the endothelial nitric oxide synthase (eNOS). The aims of these three papers presented at this thesis were: paper I. To investigate the influence of FDR on cardiac autonomic modulation in the absence of concomitant metabolic disorders; paper II. To investigate the influence of FDR on vascular reactivity in the absence of concomitant metabolic disorders; paper III. To investigate the influence of the 894G>T polymorphism on the effect of a single bout of maximal dynamic exercise on vascular reactivity. Healthy subjects with and without FDRs were recruited for the paper I and II. The heart rate variability (HRV) was determined by spectral analysis of inter-beat intervals recorded during 10 min in the supine position (paper I) and vascular reactivity during the reactive hiperemia by venous occlusion plethysmography (paper II). For the paper III, healthy subjects with and without the 894G>T polymorphism of the eNOS were recruited. The protocol consisted of vascular reactivity assessment at baseline and during reactive hyperemia, which were performed pre, 10, 60 and 120 min after a maximal cardiopulmonary exercise test. The FDR's exhibited higher values for anthropometric and metabolic variables and lower values for HRV (paper I), and vascular reactivity (paper II) when compared to the control subjects (p<0.05). After matching the groups for variables, that are known to alter HRV and vascular reactivity, no significant difference was observed between groups in the paper I and II (p>0.05)...

Mortalidade por câncer de colon e reto e perfil de consumo alimentar em capitais brasileiras / Mortality for colon and rectal neoplasms profile consumption food in cities brasileiras

No Brasil, os tumores de cólon e reto estão entre as cinco localizações anatômicas mais importantes em termos de mortalidade, para ambos os sexos. A etiologia do câncer de cólon e reto é complexa e vários fatores estão envolvidos na sua gênese, entre eles, os fatores da dieta. O Brasil apresenta perfil alimentar heterogêneo nas suas regiões geográficas. Com o objetivo de descrever o padrão de mortalidade por câncer de cólon e reto nas capitais brasileiras, no período de 1980-1997, foram utilizados os óbitos por câncer de cólon (153.0 - 153.9, na CID 9 e C18.9, na CID 10) e reto (154.1, na CID 9 e C19 e C20, na CID 10), de indivíduos de ambos os sexos, residentes nas capitais dos estados brasileiros. Estes dados foram correlacionados com perfis de consumo alimentar e renda média do chefe de família, obtidos no ENDEF e no Censo Demográfico do IBGE. A tendência das taxas de mortalidade por câncer de cólon e reto foi analisada com base no percentual médio anual de variação, e as correlações entre consumo alimentar e renda média do chefe de família e mortalidade por essa neoplasia foram analisadas por regressão linear simples e múltipla. As maiores taxas de mortalidade padronizadas por câncer de cólon/reto foram observadas nas regiões Sul e Sudeste, variando entre 8,03 e 10,71 no período 1980-1997, sendo que Porto Alegre (11,86, triênio 1995/97), Curitiba (9,41), São Paulo (10,83) e Rio de Janeiro (9,58) apresentaram as maiores magnitudes de taxas. Todas as regiões apresentaram uma tendência de incremento da mortalidade por câncer de cólon/reto, no período 1980-1997. O sexo masculino apresentou taxas mais elevadas, nas capitais das regiões sul e sudeste, com razão homem/mulher variando entre 1,01 e 1,28, no triênio 1995/97. A análise isolada do câncer de cólon e reto mostrou um comportamento semelhante, sendo que as taxas de mortalidade padronizadas foram maiores para o câncer de cólon e apresentaram maior percentual médio anual de incremento, ano período analisado. As diferenças das taxas de mortalidade por câncer de cólon e reto nas capitais, poderiam ser explicadas pela variação do total calórico e do consumo de carnes e legumes/frutas. O modelo multivariado final foi capaz de explicar 92 por cento da variação das taxas de mortalidade padronizadas por câncer de cólon e reto, nas capitais estudadas.