ABSTRACT
A asma é uma doença heterogênea caracterizada pela história de sintomas respiratórios que variam de intensidade e ao longo do tempo. Devido à sua alta prevalência, constitui um problema mundial de saúde pública, atingindo todas as faixas etárias, em especial crianças e adolescentes. O objetivo deste artigo foi analisar as produções científicas sobre asma baseadas no Estudo de Riscos Cardiovasculares em Adolescentes (ERICA). Trata-se de uma revisão narrativa incluindo os artigos originais sobre asma baseados nos dados do ERICA, publicados em periódicos indexados em inglês e português. O ERICA foi um estudo multicêntrico nacional realizado em 2013 e 2014, que investigou a prevalência de asma e fatores de risco cardiovascular, incluindo obesidade, diabetes mellitus, hipertensão arterial sistêmica, dislipidemia, tabagismo, sedentarismo, hábitos alimentares inadequados, e a associação entre esses fatores, em adolescentes de 12 a 17 anos, estudantes de escolas públicas e privadas de municípios brasileiros com mais de 100.000 habitantes. Nos cinco estudos selecionados, foi possível demonstrar que a prevalência de asma foi significativamente maior entre adolescentes do sexo feminino em todas as capitais e macrorregiões do Brasil, com predomínio da doença na região Sudeste do nosso país. Além disso, a asma esteve fortemente associada ao tabagismo (passivo e ativo) e foi associada à duração curta do sono. Por outro lado, não esteve associada com os níveis séricos de vitamina D. Em relação aos parâmetros metabólicos, foi observado que a síndrome metabólica e alguns de seus componentes, como a circunferência abdominal, estiveram significativamente associados à asma grave em adolescentes brasileiros.
Asthma is a heterogeneous disease characterized by a history of respiratory symptoms that vary in intensity and over time. Due to its high prevalence, asthma is considered a global public health problem affecting all age groups, especially children and adolescents. This study aimed to analyze scientific papers on asthma based on the Study of Cardiovascular Risks in Adolescents (ERICA). We provide a narrative review of original articles on asthma based on ERICA data published in indexed journals in English and Portuguese. ERICA was a national multicenter study conducted in 2013 and 2014 that investigated the prevalence of asthma and cardiovascular risk factors, including obesity, diabetes mellitus, systemic arterial hypertension, dyslipidemia, smoking, sedentary lifestyle, and inadequate eating habits, and the association between these factors in adolescents aged 12 to 17 years, students from public and private schools in Brazilian cities of more than 100,000 population. In the 5 selected studies, the prevalence of asthma was significantly higher in female adolescents in all capitals and macro-regions of Brazil, occurring predominantly in the southeast region of the country. In addition, asthma was strongly associated with smoking (passive and active) as well as with short sleep duration, but not with serum vitamin D levels. Regarding metabolic parameters, metabolic syndrome and some of its components, such as waist circumference, were significantly associated with severe asthma in Brazilian adolescents.
Subject(s)
Humans , Male , Female , Child , Adolescent , Multicenter Studies as TopicABSTRACT
Abstract Objective: To describe the prevalence of fish consumption and its association with cardiovascular risk factors and healthy behavior in Brazilian adolescents. Method: The authors investigated data from 71,533 participants of the Study of Cardiovascular Risk in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes - ERICA), a nationwide, cross-sectional, school-based study. Of these, 37,815 adolescents were included for blood analyses. All prevalence estimates were presented proportionally with their 95% confidence intervals. Bivariate relationships were evaluated with Pearson's Chi-square test, and a multinomial logistic regression model was applied, considering p < 0.05. Results: Prevalence of fish consumption in the 7 days prior to the interview was 28.6% (95%CI 26.9-30.3), significantly higher among male adolescents (p = 0.0049), Asian descendants (p = 0.0270), private and rural school students (p < 0.001), and who resided in the Northern region (p < 0.001). A positive association between fish consumption and healthy behavior (breakfast consumption: OR=1.16; 95%CI 1.10-1.22; meals with family members: lunch: OR=1.07; 95%CI 1.01-1.13; dinner: OR=1.13; 95%CI 1.04-1.23; physical activity: OR=1.14; 95%CI 1.02-1.28) and an inverse association with hypertriglyceridemia (OR = 0.84; 95%CI 0.73-0.98) remained significant even after adjustment for possible confounding factors. Conclusion: This study demonstrated that fish consumption was associated with lower cardiovascular risk and may represent a marker of a healthy lifestyle in Brazilian adolescents.
ABSTRACT
Abstract Objective: To investigate the association between oral contraceptive use and cardiovascular risks, including metabolic syndrome and their components in Brazilian adolescents. Method: This study used data from the Study of Cardiovascular Risks in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes - ERICA), a nationwide, cross-sectional, school-based study with individuals aged 12-17 years. Sociodemographic variables and OC use were assessed by a self-administered questionnaire. International Diabetes Federation criteria were used to define metabolic syndrome. Descriptive statistics were reported as prevalence and their respective confidence interval of 95% of oral contraceptives according to variables. Logistic regression was performed. Crude and adjusted odds ratios were calculated. Results: This subsample was composed of 22,682 female adolescents, of which 12.65% reported using oral contraceptives and their use was associated with hypertension and hypertriglyceridemia. These associations remained statistically significant after adjusting for age, school region, race, and tobacco use with an increase of 2.68 (1.66 - 4.32) and 3.45 (2.56 - 4.65) times, respectively. Conclusion: The present study was the first to examine the association between the use of oral contraceptives and cardiovascular risk factors among the largest number of female Brazilian adolescents. This method was significantly associated with hypertension, hypertriglyceridemia. Teenagers using oral contraceptives should be monitored for side effects, including blood pressure measurements and advised to avoid smoking.
Subject(s)
Humans , Female , Child , Adolescent , Cardiovascular Diseases/chemically induced , Cardiovascular Diseases/epidemiology , Brazil/epidemiology , Cross-Sectional Studies , Risk Factors , Contraceptives, Oral/adverse effects , Heart Disease Risk FactorsABSTRACT
Abstract Objective: To investigate the association between birth weight and excess weight among students aged 6-14 years, adjusted for life course confounding factors. Methods: Cross-sectional study with 6-14-year-old schoolchildren in 2010; 795 school children from two public schools. In addition, a sub-sample was selected using a case-cohort study approach. Sociodemographic, breastfeeding, food introduction, previous weight gain, family history, current clinical and behavioral variables as well as maternal variables related to pregnancy, were collected. Multivariable weighted logistic regression was used to evaluate the association between birth weight and overweight. All prevalent cases of overweight (n = 160) were selected to compose the case group and a random sub-sample of all students participating in the study (n = 276 students, of whom 88 were cases) were the control group. Results: An unadjusted 6% increase in the excess weight prevalence ratio (p-value = 0.004) was found for each 100 g increase in birth weight. With adjustment for age, sex and behavioral variables (models 1 and 2), the association of birth weight with excess weight was positive and statistically significant, but it was no longer significant in the final model (model 3) when clinical variables were considered. Conclusions: Although some of the secondary associations were statistically significant, we could not identify a significant association between birthweight and excess weight in adolescents.
Subject(s)
Humans , Female , Pregnancy , Adolescent , Weight Gain , Overweight/epidemiology , Birth Weight , Brazil/epidemiology , Body Mass Index , Prevalence , Cross-Sectional Studies , Cohort StudiesABSTRACT
Abstract Objective To investigate the association between asthma and sleep duration in participants of the Study of Cardiovascular Risks in Adolescents. Materials and methods Cross-sectional, national, school-based study, involving adolescents aged 12-17 years. In the period between 2013−14, data from 59,442 participants were analyzed. Bivariate analysis between current asthma and short sleep duration, defined as < 7 h/night, was performed separately with the other variables analyzed: sex, age group, type of school, weight categories, and common mental disorders. Then, different generalized linear models with Poisson family and logarithmic link functions were used to assess the independence of potential confounding covariates associated with both asthma and short sleep duration in the previous analysis. Crude and adjusted prevalence ratios and respective 95% confidence intervals were calculated, and a value of p < 0.05 was considered significant for all analyses performed. Results Prevalence of current asthma was 13.4%, being significantly higher among students with short sleep duration (PR: 1.17; 95% CI: 1.01-1.35; p = 0.034). This remained significant even after adjusting for the other study covariates. Conclusion There was a positive association between the prevalence of current asthma and short sleep duration among Brazilian adolescents. Considering the high prevalence and morbidity of the disease in this age group, the promotion of sleep hygiene should be considered as a possible health strategy aimed at contributing to better control of asthma in this population.
Subject(s)
Humans , Adolescent , Asthma/epidemiology , Sleep , Brazil/epidemiology , Prevalence , Cross-Sectional StudiesABSTRACT
OBJECTIVES: Adolescence is characterized by continuing profound mental, physical, and social changes and entering into the labor market during this phase may have negative consequences on physical and mental health. Common mental disorders (CMD) are characterized as disorders of mental functions, including symptoms of depression and anxiety as well as various nonspecific and somatic complaints such as reduced ability to concentrate, tiredness, irritation, and forgetfulness. Despite its increasing prevalence, few studies have addressed CMD and its association with work, in adolescents. In the present study, we aimed to identify the main factors associated with CMD and evaluated its association with work, in school adolescents. METHODS: A cross-sectional study was conducted with 12 to 17-year-old adolescent students using a self-administered questionnaire with questions related to work. CMD was verified using the General Health Questionnaire of 12 items. In total, 3424 adolescents were studied. RESULTS: The prevalence of CMD and work in the last year was 28.72% and 19.63%, respectively. After adjustment for potential confounding variables, multivariate analysis showed associations of CMD with female gender (OR=2.72) and work (OR=1.70). CONCLUSION: In the present study, a high number of cases of CMD were observed among the studied adolescents. Female gender and work history in the last year were negatively and independently associated with the presence of CMD.
Subject(s)
Humans , Female , Child , Adolescent , Mental Disorders/epidemiology , Anxiety Disorders , Schools , Mental Health , Prevalence , Cross-Sectional Studies , Surveys and QuestionnairesABSTRACT
Abstract Objective: Blood pressure (BP) references for Brazilian adolescents are lacking in the literature. This study aims to investigate the normal range of office BP in a healthy, non-overweight Brazilian population of adolescents. Method: The Brazilian Study of Cardiovascular Risks in Adolescents (Portuguese acronym "ERICA") is a national school-based study that included adolescents (aged 12 through 17 years), enrolled in public and private schools, in cities with over 100,000 inhabitants, from all five Brazilian macro-regions. Adolescents' height and body mass index (BMI) were classified in percentiles according to age and gender, and reference curves from the World Health Organization were adopted. Three consecutive office BP measurements were taken with a validated oscillometric device using the appropriate cuff size. The mean values of the last two readings were used for analysis. Polynomial regression models relating BP, age, and height were applied. Results: Among 73,999 adolescents, non-overweight individuals represented 74.5% (95% CI: 73.3-75.6) of the total, with similar distribution across ages. The majority of the non-overweight sample was from public schools 84.2% (95% CI: 79.9-87.7) and sedentary 54.8% (95% CI: 53.7-55.8). Adolescents reporting their skin color as brown (48.8% [95% CI: 47.4-50.1]) or white (37.8% [95% CI: 36.1-39.5]) were most frequently represented. BP increased by both age and height percentile. Systolic BP growth patterns were more marked in males when compared to females, along all height percentiles. The same pattern was not observed for diastolic BP. Conclusions: Blood pressure references by sex, age, and height percentiles for Brazilian adolescents are provided.
Resumo Objetivo Referências de pressão arterial (PA) para adolescentes brasileiros estão ausentes na literatura. Este estudo tem como objetivo investigar a variação normal da pressão arterial no consultório em uma população brasileira saudável de adolescentes sem sobrepeso. Método O Estudo dos Riscos Cardiovasculares em Adolescentes (ERICA) é um estudo brasileiro, de âmbito nacional e de base escolar, que incluiu adolescentes (12 a 17 anos) matriculados em escolas públicas e privadas, em cidades com mais de 100.000 habitantes, de todas as cinco macrorregiões brasileiras. A altura e o índice de massa corporal (IMC) dos adolescentes foram classificados em percentis de acordo com a idade e o sexo, sendo adotadas as curvas de referência da Organização Mundial de Saúde. Foram realizadas três medidas consecutivas de PA no consultório com um dispositivo oscilométrico validado, utilizando o manguito de tamanho apropriado. Os valores médios das duas últimas leituras foram utilizados nas análises. Modelos de regressão polinomial relacionando PA, idade e estatura foram aplicados. Resultados Entre os 73.999 adolescentes, os indivíduos sem sobrepeso representaram 74,5% (IC95%: 73,3-75,6) do total, com distribuição similar entre as idades. A maior parte da amostra sem sobrepeso originava-se das escolas públicas, com 84,2% (IC95%: 79,9-87,7), e os sedentários 54,8% (IC95%: 53,7-55,8). Os adolescentes que relataram sua cor de pele como parda (48,8% [IC95%: 47,4-50,1]) e branca (37,8%: [IC 95% 36,1-39,5]) foram os mais representados. A PA aumentou tanto com a idade, quanto com o percentil de altura. Os padrões de aumento sistólico da PA foram mais acentuados no sexo masculino quando comparados ao sexo feminino, em todos os percentis de altura. O mesmo padrão não foi observado para a PA diastólica. Conclusões São fornecidas referências de pressão arterial por sexo, idade e percentil de altura para adolescentes brasileiros.
Subject(s)
Humans , Male , Female , Child , Adolescent , Cardiovascular Diseases , Reference Values , Blood Pressure , Brazil , Body Mass Index , Cross-Sectional Studies , Risk FactorsABSTRACT
Abstract Objective: To investigate the association between smoking and asthma, and possible associated factors in Brazilian adolescents. Methods: A cross-sectional, national, school-based study with adolescents aged 12-17 years, participants in the Study of Cardiovascular Risks in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes - ERICA). A total of 66,394 participants answered a self-administered questionnaire with questions about asthma, smoking, lifestyle and sociodemographic variables. Bivariate analysis between Current Asthma (CA) and Severe Asthma (SA) and the other study variables were performed using Chi-squared. Then, the crude and adjusted Prevalence Ratios (PR), and respective 95% Confidence Intervals (95% CI) of current asthma/severe asthma and smoking variables, corrected for sociodemographic and lifestyle variables, were estimated using generalized linear models with Poisson regression, logit link, and robust variance. Results: The prevalence of current asthma and severe asthma were significantly higher in adolescents who were exposed to: experimentation (current asthma: PR = 1.78, 95% CI: 1.51-2.09; severe asthma: PR = 2.01; 95% CI: 1.35-2.98); current smoking (current asthma: PR = 2.08, 95% CI: 1.65-2.64; severe asthma: PR = 2.29; 95% CI: 1.38-3.82); regular smoking (current asthma: PR = 2.25, 95% CI: 1.64-3.07; severe asthma: PR: 2.41; 95% CI: 1.23-4.73); and passive smoking (current asthma: PR = 1.47, 95% CI: 1.27-1.67; severe asthma: PR = 1.66; 95% CI: 1.19-2.32); these associations remained significant after adjustment. Conclusions: Asthma and smoking were significantly associated in Brazilian adolescents, regardless of the sociodemographic and lifestyle factors, notably in those with more severe disease.
Resumo: Objetivo: Investigar a associação entre asma, tabagismo e possíveis fatores associados em adolescentes brasileiros. Métodos: Estudo transversal, nacional, de base escolar, envolveu adolescentes com 12 a 17 anos, participantes do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA). Os 66.394 participantes responderam questionários autopreenchíveis com questões sobre asma, tabagismo, estilo de vida e dados sociodemográficos. Foram realizadas análises bivariadas entre asma ativa e asma grave e demais variáveis do estudo, com o uso de χ2. Em seguida, foram estimadas as razões de prevalência (RP) brutas e ajustadas e seus respectivos intervalos de confiança de 95% (IC 95%), entre asma ativa/asma grave e variáveis de tabagismo, corrigidas pelas variáveis sociodemográficas e de estilo de vida, através de modelos lineares generalizados com regressão de Poisson, função de ligação logarítmica e variância robusta. Resultados: A prevalência de asma ativa e asma grave foi significativamente mais elevada naqueles expostos a experimentação (asma ativa: RP = 1,78; IC 95%: 1,51-2,09; asma grave: RP = 2,01; IC 95%: 1,35-2,98); tabagismo atual (asma ativa: RP = 2,08; IC 95%: 1,65-2,64; asma grave: RP = 2,29; IC 95%: 1,38-3,82); tabagismo frequente (asma ativa: RP = 2,25; IC 95%: 1,64-3,07; AG = 2,41; IC 95%: 1,23-4,73) e tabagismo passivo (asma ativa: RP = 1,47; IC 95%: 1,27-1,67; asma grave: RP = 1,66; IC 95%: 1,19-2,32). As associações permaneceram significativas após ajuste. Conclusão: A asma e o tabagismo se associaram de modo significativo em adolescentes brasileiros independente de fatores sociodemográficos e estilo de vida, especialmente naqueles com doença mais grave.
Subject(s)
Humans , Male , Female , Child , Adolescent , Asthma/etiology , Asthma/epidemiology , Smoking/adverse effects , Smoking/epidemiology , Socioeconomic Factors , Severity of Illness Index , Brazil/epidemiology , Poisson Distribution , Family Characteristics , Prevalence , Cross-Sectional Studies , Surveys and Questionnaires , Risk Factors , Life StyleABSTRACT
ABSTRACT OBJECTIVE To describe the prevalence of asthma and physician-diagnosed asthma in Brazilian adolescents. METHODS Cross-sectional, national, school-based study with adolescents from 12 to 17 years old, participants in the Study of Cardiovascular Risks in Adolescents (ERICA). The study stratified the sample by region and grouped according to schools and classes with representativeness to the set of cities with more than 100,000 inhabitants of the Country, macro-regions, capitals, and Federal District. A questionnaire collected data through a self-filled in method. We calculated the prevalences and their confidence intervals of 95% (95%CI) according to sex, age group, type of school and skin color. RESULTS Between 2013 and 2014, 74,589 adolescents were evaluated, 55.3% of the female sex. The total prevalence of active asthma was of 13.1% (95%CI 12.1-13.9), being higher in girls (14.8%; 95%CI 13.7-16.0) when compared to boys (11.2%; 95%CI 10.3-12.2) in all geographical strata examined. It was also higher between students of private schools (15.9%; 95%CI 14.2-17.7) when compared to public ones (12.4%; 95%CI 11.4-13.4). It was higher in the Southeast region (14.5%; 95%CI 12.9-16.1), and in the city of Sao Paulo (16.7%; 95%CI 14.7-18.7). The lowest prevalence was observed in North region (9.7%; 95%CI 9.7-10.5), and in Teresina (6.3%; 95%CI 4.9-7.7). The prevalence of physician-diagnosed asthma was of 8.7% (95%CI 8.2-9.1); higher in the North region (13.5%; 95%CI 12.7-14.2), and in Porto Alegre (19.8%; 95%CI 17.5-22.3). It was lower in the Midwest (6.9%; 95%CI 6.0-7.8), and in Cuiaba (4.8%; 95%CI 3.8-5.9). We found no significant difference in the expression of this rate between the sexes, as well as in other variables evaluated by the study. CONCLUSIONS The prevalence of asthma in Brazilian adolescents is high. Rates of active asthma and physician-diagnosed asthma vary widely in different regions and capitals evaluated by the ERICA. These results may assist in the preparation of preventive programs and policies on health and a better understanding of the factors associated with asthma in this age group.
RESUMO OBJETIVO Descrever a prevalência de asma ativa e de diagnóstico médico de asma em adolescentes brasileiros. MÉTODOS Estudo transversal, nacional, de base escolar com adolescentes de 12 a 17 anos, participantes do Estudo de Riscos Cardiovasculares em adolescentes (ERICA). A amostra foi estratificada por região e conglomerada por escolas e turmas com representatividade para o conjunto de municípios com mais de 100 mil habitantes do País, macrorregiões, capitais e Distrito Federal. Os dados foram coletados em questionário autopreenchível. Foram calculadas as prevalências e respectivos intervalos de confiança de 95% (IC95%) segundo sexo, faixa etária, tipo de escola e cor da pele. RESULTADOS Entre 2013 e 2014 foram avaliados 74.589 adolescentes, 55,3% do sexo feminino. A prevalência total de asma ativa foi 13,1% (IC95% 12,1-13,9), sendo superior nas meninas (14,8%; IC95% 13,7-16,0) em relação aos meninos (11,2%; IC95% 10,3-12,2) em todos estratos geográficos analisados, e também entre os alunos da rede privada (15,9%; IC95% 14,2-17,7) em relação aos de escolas públicas (12,4%; IC95% 11,4-13,4). Foi mais elevada na região Sudeste (14,5%; IC95% 12,9-16,1) e na cidade de São Paulo (16,7%; IC95% 14,7-18,7). A menor prevalência foi observada na região Norte (9,7%; IC95% 9,7-10,5) e em Teresina (6,3%; IC95% 4,9-7,7). A prevalência de diagnóstico médico de asma foi 8,7% (IC95% 8,2-9,1); mais elevada na região Norte (13,5%; IC95% 12,7-14,2) e em Porto Alegre (19,8%; IC95% 17,5-22,3) e mais baixa no Centro-Oeste (6,9%; IC95% 6,0-7,8) e em Cuiabá (4,8%; IC95% 3,8-5,9). Não ocorreu diferença significativa na expressão desta taxa entre os sexos, assim como nas outras variáveis avaliadas pelo estudo. CONCLUSÕES A prevalência de asma em adolescentes brasileiros é alta. As taxas de asma ativa e de diagnóstico médico variam amplamente nas diferentes regiões e capitais avaliadas pelo ERICA. Estes resultados poderão auxiliar na elaboração de programas preventivos e de políticas de saúde e no melhor entendimento sobre os fatores associados à asma nessa faixa etária.
Subject(s)
Humans , Male , Female , Adolescent , Asthma/epidemiology , Asthma/diagnosis , Socioeconomic Factors , Students/statistics & numerical data , Brazil/epidemiology , Residence Characteristics , Sex Factors , Epidemiologic MethodsABSTRACT
RESUMO: Objetivo: Descrever a metodologia de um estudo sobre associações entre crescimento intrauterino restrito (CIUR) e prevalência de sobrepeso, obesidade e hipertensão arterial em escolares. Métodos: O estudo, conduzido em dois estágios, foi desenvolvido em 2 escolas municipais de Niterói (RJ) de junho a dezembro de 2010, sendo elegíveis todos os escolares de 6 a 14 anos. O primeiro estágio consistiu em um inquérito nutricional e de potenciais fatores de risco. Foram aplicados questionários aos responsáveis e adolescentes. Concomitantemente, foram selecionados os participantes de um estudo caso-controle, com casos prevalentes definidos como todos os escolares que apresentaram excesso de peso (Z-score de índice de massa corporal -IMC/idade/sexo > +1,00). O grupo controle consistiu em uma amostra aleatória da população de estudo do inquérito, o que permitiu o cálculo de razões de prevalências. Foram realizados bioimpedância elétrica, exames de sangue, ultrassonografia da carótida e entrevistas. As variáveis proxy de CIUR foram definidas a partir de informações sobre peso ao nascer (PN) e idade gestacional (IG). Adicionalmente, foram coletadas informações sobre os dois primeiros anos de vida dos escolares a partir de seus prontuários médicos. Resultado s: Entre os 1.040 escolares elegíveis, participaram do estudo 795 escolares (76,4%). A taxa de retorno do questionário enviado para os responsáveis foi de 85,1%. Para o estudo caso-controle, 62,5% (n = 363) dos selecionados participaram, resultando em uma razão caso:controle de 1:1,8. Foram localizados 55,8% (n = 444) dos prontuários, dos quais em 65,7% (n = 292) foram coletadas informações dos primeiros anos de vida. Conclusão: O presente estudo permitirá a análise de múltiplos desfechos e exposições relacionados ao CIUR e alterações metabólicas.
ABSTRACT: Objective: To describe the methodological features of a study on the association between restricted intrauterine growth and prevalence of overweight, obesity and hypertension in school aged children. Methods: The study was conducted in two stages in two public schools in Niterói (RJ), from June through December 2010. All students aged 6 to 14 years were eligible to participate. The first stage consisted of an interview to collect information on demographic variables, diet and other variables. A sample was selected for the second stage, in order to conduct an equivalent of a case-cohort study. There was an interval of about 15 days between the two stages. Cases were overweight students, defined as a Z-score for BMI/age/sex > +1.00 in the first stage. Controls were selected by using a random schedule in which the sample frame was the whole cohort. Bioelectrical impedance analysis, carotid ultrasound to measure intimal-medial thickness, blood measurements and interviews were obtained. Gestational age and weight at birth were used to define proxy variables of restricted intrauterine growth. Early health information was obtained from medical registers. Results: The study participation was 76.4% (n = 795) out of 1,040 eligible to participate). 85.1% of parent's questionnaires were returned. 62.5% of the eligible children participated in the case-control study (case: control ratio = 1:1.8). Early life health information was obtained from 292 children. Conclusion: The present study has the potential to provide important information about multiple outcomes and exposures related to restricted intrauterine growth and metabolic abnormalities.
Subject(s)
Humans , Male , Female , Child , Adolescent , Fetal Development/physiology , Fetal Growth Retardation/epidemiology , Hypertension/epidemiology , Metabolic Diseases/epidemiology , Overweight/epidemiology , Pediatric Obesity/epidemiology , Case-Control Studies , Cohort Studies , Prevalence , Research DesignABSTRACT
ABSTRACT OBJECTIVE To determine the distribution of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides in Brazilian adolescents, as well as the prevalence of altered levels of such parameters. METHODS Data from the Study of Cardiovascular Risks in Adolescents (ERICA) were used. This is a country-wide, school-based cross-sectional study that evaluated 12 to 17-year old adolescents living in cities with over 100,000 inhabitants. The average and distribution of plasma levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides were evaluated. Dyslipidemia was determined by levels of total cholesterol ≥ 170 mg/dl, LDL cholesterol ≥ 130 mg/dl, HDL cholesterol < 45 mg/dL, or triglycerides ≥ 130 mg/dl. The data were analyzed by gender, age, and regions in Brazil. RESULTS We evaluated 38,069 adolescents – 59.9% of females, and 54.2% between 15 and 17 years. The average values found were: total cholesterol = 148.1 mg/dl (95%CI 147.1-149.1), HDL cholesterol = 47.3 mg/dl (95%CI 46.7-47.9), LDL cholesterol = 85.3 mg/dl (95%CI 84.5-86.1), and triglycerides = 77.8 mg/dl (95%CI 76.5-79.2). The female adolescents had higher average levels of total cholesterol, LDL cholesterol, and HDL cholesterol, without differences in the levels of triglycerides. We did not observe any significant differences between the average values among 12 to 14 and 15- to 17-year old adolescents. The most prevalent lipid alterations were low HDL cholesterol (46.8% [95%CI 44.8-48.9]), hypercholesterolemia (20.1% [95%CI 19.0-21.3]), and hypertriglyceridemia (7.8% [95%CI 7.1-8.6]). High LDL cholesterol was found in 3.5% (95%CI 3.2-4.0) of the adolescents. Prevalence of low HDL cholesterol was higher in Brazil’s North and Northeast regions. CONCLUSIONS A significant proportion of Brazilian adolescents has alterations in their plasma lipids. The high prevalence of low HDL cholesterol and hypertriglyceridemia, especially in Brazil’s North and Northeast regions, must be analyzed in future studies, to support the creation of strategies for efficient interventions.
RESUMO OBJETIVO Determinar a distribuição de colesterol total, LDL-colesterol, HDL-colesterol e triglicerídeos em adolescentes brasileiros, bem como a prevalência de níveis alterados de tais parâmetros. MÉTODOS Foram utilizados dados do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA), estudo transversal, de âmbito nacional e base escolar que avaliou adolescentes de 12 a 17 anos, residentes em municípios com mais de 100 mil habitantes. Foi avaliada a média e distribuição dos níveis plasmáticos de colesterol total, LDL-colesterol, HDL-colesterol e triglicerídeos. Dislipidemia foi determinada por níveis de colesterol total ≥ 170 mg/dl, LDL-colesterol ≥ 130 mg/dl, HDL-colesterol < 45 mg/dL ou triglicerídeos ≥ 130 mg/dl. Os dados foram analisados por sexo, idade e regiões do Brasil. RESULTADOS Foram avaliados 38.069 adolescentes, 59,9% do sexo feminino; 54,2% com idade entre 15 a 17 anos. Os valores médios encontrados foram: colesterol total 148,1 mg/dl (IC95% 147,1-149,1), HDL-colesterol 47,3 mg/dl (IC95% 46,7-47,9), LDL-colesterol 85,3 mg/dl (IC95% 84,5-86,1), e triglicerídeos 77,8 mg/dl (IC95% 76,5-79,2). Adolescentes do sexo feminino apresentaram níveis médios de colesterol total, LDL-colesterol e HDL-colesterol mais elevados, mas sem diferença nos níveis de triglicerídeos. Não houve diferença significativa de valores médios entre adolescentes de 12 a 14 e de 15 a 17 anos. As alterações com maior prevalência foram HDL-colesterol baixo (46,8% [IC95% 44,8-48,9]), hipercolesterolemia (20,1% [IC95% 19,0-21,3]) e hipertrigliceridemia (7,8% [IC95% 7,1-8,6]). O LDL-colesterol elevado foi observado em 3,5% (IC95% 3,2-4,0) dos adolescentes. As prevalências de HDL-colesterol baixo foram mais elevadas nas regiões Norte e Nordeste do País. CONCLUSÕES Uma parcela significativa dos adolescentes brasileiros apresenta alterações dos lípides plasmáticos. A alta prevalência de HDL-colesterol baixo e a hipertrigliceridemia, sobretudo nas regiões Norte e Nordeste do Brasil, devem ser analisadas em futuros estudos para subsidiar formulações de estratégias de intervenções eficazes.
Subject(s)
Humans , Male , Female , Adolescent , Dyslipidemias/epidemiology , Triglycerides/blood , Brazil/epidemiology , Epidemiologic Methods , Dyslipidemias/blood , Cholesterol, HDL/blood , Cholesterol, LDL/bloodABSTRACT
ABSTRACT OBJECTIVE To estimate the prevalence of sexual initiation and contraceptive use at the last sexual intercourse of Brazilian adolescents, according to sociodemographic features. METHODS The data were obtained from the Study of Cardiovascular Risks in Adolescents (ERICA), a national school-based cross-sectional study. We included 74,589 adolescents from 32 geographic strata (27 capitals and five sets of municipalities with more than 100,000 inhabitants of each of the five macro-regions of the Country). Information on sexual initiation and contraceptive use at the last sexual intercourse (male condom and oral contraceptive pill) has been used. We have estimated prevalence and confidence intervals (95%CI) considering sample weights according to sex, age, type of school, residence status, macro-region and capitals. RESULTS We observed that 28.1% (95%CI 27.0-29.2) of the adolescents had already initiated sexual life, with higher prevalence among those aged 17 years (56.4%, 95%CI 53.9-58.9), males (33.5%, 95%CI 31.8-35.2), studying at public schools (29.9%, 95%CI 28.5-31.4), and from the Northern region (33.9%, 95%CI 32.3-35.4), mainly from Macapa, Manaus, and Rio Branco. Among those who had started their sexual life, 82.3% (95%CI 81.1-83.4) reported the use of contraceptive methods at the last intercourse, and the prevalence of use was higher among adolescents aged 17 years (85.3%, 95%CI 82.7-87.6), females (85.2%, 95%CI 83.8-86.5) and those living in the Southern region (85.9%, 95%CI 82.9-88.5). Male condom was used by 68.8% (95%CI 66.9-70.7), with no difference by type of school or macro-regions; the contraceptive pill was used by 13.4% (CI95% 12.2-14.6), and more frequently used among women (24.7%, 95%CI 22.5-27,0) and 17-year-old adolescents (20.8%, 95%CI 18.2-23.6) from urban settings(13.7%, 95%CI 12.5-14.9) and from the Southern region (22.6%, 95%CI 19.0-26.8), and less often in the Northern region. CONCLUSIONS ERICA’s data analysis on sexuality and contraception shows heterogeneities in the prevalence of sexual initiation and use of contraceptive methods among Brazilian adolescents, depending on their age, where they live, and the type of school they study at. Younger adolescents and those living in the Northern region seem to be more vulnerable to the consequences of unprotected sexual intercourses.
RESUMO OBJETIVO Estimar prevalências de iniciação sexual e uso de métodos contraceptivos na última relação sexual de adolescentes brasileiros, segundo características sociodemográficas. MÉTODOS Os dados foram obtidos do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA), estudo transversal nacional de base escolar. Foram incluídos 74.589 adolescentes provenientes de 32 estratos geográficos (27 capitais e cinco conjuntos de municípios com mais de 100 mil habitantes de cada uma das cinco macrorregiões do País). Utilizaram-se informações sobre iniciação sexual e uso de métodos contraceptivos na última relação sexual (preservativo masculino e pílula anticonceptiva oral). Estimaram-se prevalências e intervalos de confiança (IC95%) das variáveis de interesse considerando pesos amostrais e segundo sexo, idade, tipo de escola, situação de residência, macrorregião e capitais. RESULTADOS Observou-se que 28,1% (IC95% 27,0-29,2) dos adolescentes tinham iniciado a vida sexual, com maior prevalência naqueles com 17 anos (56,4%, IC95% 53,9-58,9), no sexo masculino (33,5%, IC95% 31,8-35,2), em escolas públicas (29,9%, IC95% 28,5-31,4) e na região Norte (33,9%, IC95% 32,3-35,4), destacando-se em Macapá, Manaus e Rio Branco. Entre adolescentes que tinham iniciado a vida sexual, 82,3% (IC95% 81,1-83,4) referiram uso de métodos contraceptivos na última relação sexual, sendo a prevalência de uso maior entre adolescentes com 17 anos de idade (85,3%, IC95% 82,7-87,6), mulheres (85,2%, IC95%:83,8-86,5) e residentes na região Sul (85,9%, IC95% 82,9-88,5). O preservativo masculino foi usado por 68,8% (IC95% 66,9-70,7), sem diferença por tipo de escola ou macrorregiões. Pílula anticoncepcional foi utilizada por 13,4% (IC95% 12,2-14,6), sendo mais frequente entre mulheres (24,7%, IC95% 22,5-27,0), adolescentes de 17 anos (20,8%, IC95% 18,2-23,6), da área urbana (13,7%, IC95% 12,5-14,9) e da região Sul (22,6%, IC95% 19,0-26,8), e menos frequente na região Norte. CONCLUSÕES A análise dos dados sobre sexualidade e contracepção do ERICA mostra que há heterogeneidades nas prevalências de iniciação sexual e uso de métodos contraceptivos entre os adolescentes brasileiros, a depender de sua idade, de onde vivem e do tipo de escola que frequentam. Adolescentes mais novos e residentes na região Norte parecem ser os mais vulneráveis às consequências das práticas sexuais não protegidas.
Subject(s)
Humans , Male , Female , Adolescent , Sexual Behavior/statistics & numerical data , Brazil , Residence Characteristics , Cross-Sectional Studies , Surveys and Questionnaires , Adolescent Behavior/physiology , Condoms , Contraception , Contraception BehaviorABSTRACT
ABSTRACT OBJECTIVE To describe the response rate and characteristics of people who either took part or not in from the Study of Cardiovascular Risks in Adolescents (ERICA) , according to information subsets. METHODS ERICA is a school-based, nation-wide investigation with a representative sample of 12 to 17-year-old adolescents attending public or private schools in municipalities with over 100,000 inhabitants in Brazil. Response rate of eligible subjects were calculated according to macro-regions, sex, age, and type of school (public or private). We also calculated the percentages of replacement schools in comparison with the ones originally selected as per the sample design, according to the types of schools in the macro-regions. The subjects and non-subjects were compared according to sex, age, and average body mass indices (kg/m2). RESULTS We had 102,327 eligible adolescents enrolled in the groups drawn. The highest percentage of complete information was obtained for the subset of the questionnaire (72.9%). Complete information regarding anthropometric measurements and the ones from the questionnaire were obtained for 72.0% of the adolescents, and the combination of these data with the 24-hour dietary recall were obtained for 70.3% of the adolescents. Complete information from the questionnaire plus biochemical blood evaluation data were obtained for 52.5% of the morning session adolescents (selected for blood tests). The response percentage in private schools was higher than the one in public schools for most of the combination of information. The ratio of older and male adolescents non-participants was higher than the ratio among participants. CONCLUSIONS The response rate for non-invasive procedures was high. The response rate for blood collection – an invasive procedure that requires a 12-hour fasting period and the informed consent form from legal guardians – was lower. The response rate observed in public schools was lower than in the private ones, and that may reflect lower school frequency of registered students.
RESUMO OBJETIVO Descrever o percentual de resposta e características de participantes e não-participantes no Estudo de Riscos Cardiovasculares em Adolescentes (ERICA) segundo subconjuntos de informações. MÉTODOS O ERICA é um inquérito de base escolar de abrangência nacional com amostra representativa de adolescentes, de 12 a 17 anos de idade, que estudam em escolas públicas ou privadas de municípios com mais de 100 mil habitantes de todo o Brasil. Foram calculadas frequências de participação (de elegíveis) por macrorregiões, sexo, idade, e tipo de escola (pública ou privada). Foram calculados também os percentuais de escolas substitutas das selecionadas na origem do desenho amostral, de acordo com o tipo de escola nas macrorregiões. Os participantes e não-participantes foram comparados segundo sexo, idade e média de índice de massa corporal (kg/m2). RESULTADOS Estavam cadastrados nas turmas sorteadas 102.327 adolescentes elegíveis. O maior percentual de informações completas foi obtido para o subconjunto do questionário (72,9%). Informações completas das medidas antropométricas e do questionário foram obtidas em 72,0% dos adolescentes, e a combinação dessas informações com recordatório alimentar de 24h, em 70,3%. Informações completas do questionário mais avaliação bioquímica do sangue foram obtidas em 52,5% dos adolescentes do turno da manhã (elegíveis para exame de sangue). O percentual de resposta nas escolas privadas foi maior do que a das escolas públicas para a maioria das combinações de informações. A proporção de adolescentes não participantes do sexo masculino e mais velhos foi maior do que entre os participantes. CONCLUSÕES O percentual de resposta para procedimentos não invasivos foi elevado. Para a coleta de sangue, procedimento invasivo, com necessidade de jejum de 12 horas e de consentimento escrito dos responsáveis, a participação foi menor. O percentual de participação observado nas escolas públicas foi menor do que nas particulares, podendo refletir menor frequência escolar dos alunos cadastrados.
Subject(s)
Humans , Male , Female , Adolescent , Cardiovascular Diseases/epidemiology , Surveys and Questionnaires , Health Surveys , Schools/statistics & numerical data , Socioeconomic Factors , Students/statistics & numerical data , Brazil/epidemiology , Anthropometry , Risk FactorsABSTRACT
The Study of Cardiovascular Risk in Adolescents (ERICA) aims to estimate the prevalence of cardiovascular risk factors and metabolic syndrome in adolescents (12-17 years) enrolled in public and private schools of the 273 municipalities with over 100,000 inhabitants in Brazil. The study population was stratified into 32 geographical strata (27 capitals and five sets with other municipalities in each macro-region of the country) and a sample of 1,251 schools was selected with probability proportional to size. In each school three combinations of shift (morning and afternoon) and grade were selected, and within each of these combinations, one class was selected. All eligible students in the selected classes were included in the study. The design sampling weights were calculated by the product of the reciprocals of the inclusion probabilities in each sampling stage, and were later calibrated considering the projections of the numbers of adolescents enrolled in schools located in the geographical strata by sex and age.
El Estudio de Riesgo Cardiovascular en Adolescentes (ERICA) tiene como objetivo estimar la prevalencia de factores de riesgo cardiovascular y síndrome metabólico en adolescentes (12-17 años) matriculados en las escuelas públicas y privadas de 273 municipios con más de 100 mil habitantes en Brasil. La población de estudio fue estratificada en 32 estratos geográficos (27 capitales y cinco conjuntos con otros municipios de cada macrorregión del país); además se seleccionó una muestra de 1.251 escuelas con probabilidad proporcional a su tamaño. En cada escuela se seleccionaran tres combinaciones de horario (matutino y vespertino) con año de la clase, y en cada combinación se seleccionó una clase. Todos los estudiantes elegibles en las clases seleccionadas fueron objeto de la investigación. Los pesos de diseño de la muestra se calcularon por el producto de los inversos de las probabilidades de selección en cada etapa de la muestra y después se calibraron teniendo en cuenta las proyecciones del número de adolescentes inscritos en las escuelas ubicadas en los estratos geográficos por sexo y edad.
O Estudo de Riscos Cardiovasculares em Adoles-centes (ERICA) objetiva estimar prevalência de fatores de risco cardiovascular e da síndrome metabólica em adolescentes (12 a 17 anos) matriculados em escolas públicas e privadas dos 273 municípios com mais de 100 mil habitantes no Brasil. A população de pesquisa foi estratificada em 32 estratos geográficos (27 capitais e cinco conjuntos com os demais municípios de cada macrorregião do país) e uma amostra de 1.251 escolas foi selecionada com probabilidade proporcional ao tamanho. Em cada escola foram selecionadas três combinações de turno (manhã e da tarde) e ano (série), e em cada uma destas combinações foi selecionada uma turma. Todos os alunos elegíveis das turmas selecionadas foram objeto de pesquisa. Os pesos amostrais do desenho foram calculados pelo produto dos inversos das probabilidades de inclusão em cada estágio da amostra e foram depois calibrados considerando as projeções do número de adolescentes matriculados em escolas localizadas nos estratos geográficos considerados por sexo e idade.
Subject(s)
Adolescent , Female , Humans , Male , Cardiovascular Diseases/epidemiology , Metabolic Syndrome/epidemiology , Brazil/epidemiology , Prevalence , Research Design , Residence Characteristics , Risk Factors , Sample Size , Students/statistics & numerical dataABSTRACT
OBJETIVO: Avaliar a viabilidade de estratégia de relacionamento probabilístico de bases de dados na identificação de óbitos de pacientes submetidos a procedimentos de alta complexidade em cardiologia. MÉTODOS: O custo de processamento foi estimado com base em 1.672 registros de pacientes submetidos à cirurgia de revascularização do miocárdio, relacionados com todos os registros de óbito no Brasil em 2005. A acurácia do relacionamento baseou-se em linkage probabilístico entre 99 registros de autorização de internação hospitalar de pacientes submetidos a cirurgias cardíacas em instituto de referência em cardiologia, com status vital conhecido, e todos os registros de óbito do estado do Rio de Janeiro em 2005. O linkage foi realizado em quatro etapas: padronização das bases, blocagem, pareamento e classificação dos pares. Utilizou-se a blocagem em cinco passos, com chaves de blocagem com combinação de variáveis como soundex do primeiro e último nome, sexo e ano de nascimento. As variáveis utilizadas no pareamento foram "nome completo", com a utilização da distância de Levenshtein, e "data de nascimento". RESULTADOS: O segundo e o quinto passos de blocagem tiveram os maiores números de pares formados e os maiores tempos de processamento para o pareamento. O quarto passo demandou menor custo de processamento. No estudo de acurácia, após os cinco passos de blocagem, a sensibilidade do linkage foi de 90,6 por cento e a especificidade foi de 100 por cento. CONCLUSÕES: A estratégia de relacionamento probabilístico utilizada apresenta boa acurácia e poderá ser utilizada em estudos sobre a efetividade dos procedimentos de alta complexidade e alto custo em cardiologia.
OBJECTIVE: To evaluate the viability of a probabilistic record linkage strategy to identify patients who underwent complex cardiology procedures among the total deceased population. METHODS: The processing cost was estimated based on 1,672 records of patients undergoing coronary artery bypass grafting that were compared with all death records in Brazil in 2005. The accuracy of the linkage strategy was based on the probabilistic linkage of 99 hospital admissions records of patients, with known vital status, who underwent cardiac surgery at a single cardiology institute, with the death records of the state of Rio de Janeiro, Southeastern Brazil, in 2005. Linkage was conducted in four stages: standardizing the databases, blocking, matching, and rating peers. Blocking in five steps was used, with blocking keys formed by a combination of variables such as soundex codes for the first and last names, sex, and year of birth. The variables used for matching were "full name" with the use of Levenshtein distance and "birth date". RESULTS: The second and fifth blocking steps resulted in the largest number of formed pairs and the largest processing times for the matching. The fourth step required a lower processing cost. In the accuracy study, after five blocking steps, the sensitivity of the linkage was 90.6 percent, and the specificity was 100 percent. CONCLUSIONS: The probabilistic strategy used has high accuracy and can be used in studies of the effectiveness of high-complexity, high-cost cardiology procedures.
OBJETIVO: Evaluar la viabilidad de estrategia de relación probabilística en la identificación de pacientes sometidos a procedimientos de alta complejidad en cardiología. MÉTODOS: El costo de procesamiento fue calculado con base en 1.672 registros de pacientes sometidos a cirugía de revascularización del miocardio, relacionados con todos los registros de óbito en Brasil en 2005. La precisión de la relación se basó en linkage probabilística de 99 registros de autorización de internación hospitalaria de pacientes sometidos a cirugías cardíacas en instituto de referencia en cardiología, con status vital conocido, con todos los registros de óbito del estado de Rio de Janeiro en 2005. El linkage fue realizado en cuatro etapas: estandarización de las bases, blocaje, pareamiento y clasificación de los pares. Se utilizó blocaje en cinco pasos, con claves de blocaje con combinación de variables como soundex del primero y último nombre, sexo y año de nacimiento. Las variables utilizadas en el pareamiento fueron "nombre completo", con la utilización de la distancia de Levenshtein y "fecha de nacimiento". RESULTADOS: El segundo y el quinto pasos de blocaje tuvieron los mayores números de pares formados y los mayores tiempos de procesamiento para el pareamiento. El cuarto paso demandó menor costo de procesamiento. En el estudio de precisión, posterior a cinco pasos de blocaje, la sensibilidad del linkage fue de 90,6 por ciento y la especificidad fue de 100 por ciento. CONCLUSIONES: La estrategia de relación probabilística utilizada presenta buena precisión y podrá ser utilizada en estudios sobre la efectividad de los procedimientos de alta complejidad y alto costo en cardiología.
Subject(s)
Female , Humans , Male , Cardiovascular Diseases/mortality , Cardiovascular Diseases , Coronary Artery Bypass/mortality , Databases, Factual/statistics & numerical data , Medical Record Linkage , Brazil , Death Certificates , Feasibility Studies , Medical Records Systems, Computerized , Predictive Value of Tests , Probability , Sensitivity and Specificity , Treatment OutcomeABSTRACT
Fundamentos: A doença arterial coronariana é a principal causa de óbito no mundo e os pacientes submetidos àcirurgia de revascularização miocárdica (CRVM) constituem o grupo de maior risco. Objetivo: Analisar aspectos epidemiológicos na CRVM em hospital especializado em cirurgia cardíaca no Rio de Janeiro, entre agosto 2004 e junho 2009. Método: Estudo retrospectivo, realizado entre agosto2004 e junho 2009, em que se analisou a primeira CRVM em 1.029 pacientes consecutivos maiores de 18 anos.Foram analisados dados do pré-operatório e considerado o tipo de evolução hospitalar (alta versus óbito).Resultados: Média de idade 61,2±10,3 anos e 67,3% do sexo masculino, peso 72,0±13,6kg, altura 1,63±0,09m, índice de massa corporal 26,9±4,3kg/m2 e superfície corporal1,77±0,19m2. Cor da pele por autoclassificação observada: 75,8% brancos, 16,5% pardos e 7,7% pretos, versus a esperada segundo o IBGE 2008): branca=54,3%,parda=33,8%, preta=11,5% e amarela ou indígena=0,3% (p<0,0001). Fatores de risco cardiovascular: hipertensãoarterial sistêmica 88,3%, dislipidemia 66,4%, colesterol sérico 173±50,2mg/dl, história familiar 50,4%, diabetes mellitus 32,9% e tabagismo prévio 56,6%. EuroSCORE4,91±6,81% (quartis 1,40% e 5,26%). A mortalidade observada (8,89%) foi superior à esperada (4,91%)(p<0,0001). Conclusão: Conhecer os fatores de risco permite a prevenção, auxilia a decisão do médico e facilita a alocação de recursos. Houve predomínio inesperado e desproporcionados pacientes de cor da pele branca e elevada prevalência dos fatores de risco cardiovascular, além de mortalidadeacima do esperado neste grupo de pacientes.