Multimorbidity prevalence and patterns at the baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Background: To identify multimorbidity patterns, by sex, according to sociodemographic and lifestyle in ELSA-Brasil. Methods: Cross-sectional study with 14,516 participants from ELSA-Brasil (2008-2010). Fuzzy c-means was used to identify multimorbidity patterns of 2+ chronic morbidities, where the consequent morbidity had to occur in at least 5% of all cases. Association rule (O/E≥1.5) was used to identify co-occurrence of morbidities, in each cluster, by sociodemographic and lifestyle factors. Results: The prevalence of multimorbidity was higher in women (73.7%) compared to men (65.3%). Among women, cluster 1 was characterized by hypertension/diabetes (13.2%); cluster 2 had no overrepresented morbidity; and cluster 3 all participants had kidney disease. Among men, cluster 1 was characterized by cirrhosis/hepatitis/obesity; cluster 2, most combinations included kidney disease/migraine (6.6%); cluster 3, no pattern reached association ratio; cluster 4 predominated co-occurrence of hypertension/rheumatic fever, and hypertension/dyslipidemia; cluster 5 predominated diabetes and obesity, and combinations with hypertension (8.8%); and cluster 6 presented combinations of diabetes/hypertension/heart attack/angina/heart failure. Clusters were characterized by higher prevalence of adults, married and participants with university degrees. Conclusion: Hypertension/diabetes/obesity were highly co-occurred, in both sexes. Yet, for men, morbidities like cirrhosis/hepatitis were commonly clustered with obesity and diabetes; and kidney disease was commonly clustered with migraine and common mental disorders. The study advances in understanding multimorbidity patterns, benefiting simultaneously or gradually prevention of diseases and multidisciplinary care responses.

Exploring cross-country heterogeneity in the relation between female labor force participation and fertility in Latin America / Explorando a heterogeneidade entre países na relação entre participação feminina na força de trabalho e fecundidade na América Latina / Explorando la heterogeneidad entre países en la relación entre participación laboral de las mujeres y fecundidad en América Latina

Abstract In Latin America, despite an apparent convergence on the relation between female labor force participation (FLFP) and total fertility rates (TFR), there are differences between and within countries that must be considered. This paper aimed to understand the heterogeneity in the relation between the FLFP rate and the TFR in Latin American from 1990 to 2018 in order to identify cross-country patterns. Using World Bank data for the 20 countries in Latin America, clustering longitudinal data was performed, and mixed-effect models were fitted to quantify the heterogeneity. Three patterns of relationship were observed in Latin American countries: low TFR and intermediate FLFP, high TFR and high FLFP, and high TFR and low FLFP. The heterogeneity identified suggests the diversity of socio-economic and cultural factors influences the dynamics of the relation between FLFP and TFR in Latin America.

Resumo Na América Latina, apesar de uma aparente convergência na relação entre taxas de fecundidade total (TFT) e participação feminina na força de trabalho (PFFT), existem diferenças entre e dentro dos países que devem ser consideradas. Este artigo objetiva entender a heterogeneidade na relação entre a PFFT e a TFR na América Latina de 1990 a 2018, a fim de identificar padrões entre países. Usando dados do Banco Mundial para os 20 países da América Latina, dados de agrupamento longitudinal foram realizados e modelos de efeito misto foram ajustados para quantificar a heterogeneidade. Três padrões de relacionamento foram observados nos países latino-americanos: TFT baixa e PFFT intermediária; TFT alta e PFFT alta; e TFR alta e PFFT baixa. A heterogeneidade identificada sugere que a diversidade de fatores socioeconômicos e culturais influencia a dinâmica da relação entre PFFT e TFT na América Latina.

Resumen En América Latina, a pesar de una aparente convergencia en la relación entre las tasas globales de fecundidad (TGF) y la participación de femenina en la fuerza de trabajo (PFFT), hay diferencias entre y dentro de los países de la región, que deben ser consideradas. El objetivo de este trabajo es entender la heterogeneidad en la relación entre la tasa de PFFT y la TGF en América Latina desde 1990 hasta 2018, con el fin de identificar patrones entre países. Utilizando datos del Banco Mundial para los veinte países de América Latina, se agruparon datos longitudinales y se ajustaron modelos de efectos mixtos para cuantificar la heterogeneidad. Se observaron tres patrones de relación en los países de América Latina: baja TGF y PFFT intermedia; alta TGF y alta PFFT, y alta TGF y baja PFFT. La heterogeneidad identificada sugiere que la diversidad de factores socioeconómicos y culturales influye en la dinámica de la relación entre la PFFT y la TGF en América Latina.

Advanced glycation end product: A potential biomarker for risk stratification of non-alcoholic fatty liver disease in ELSA-Brasil study.

BACKGROUND: Liver diseases are associated with the excess formation of advanced glycation end products (AGEs), which induce tissue inflammation and oxidative damage. However, the trend of oxidative marker levels according to the steatosis grade in non-alcoholic fatty liver disease (NAFLD) is unclear. AIM: To compare serum AGE levels between participants with NAFLD accordingly to steatosis severity in the baseline ELSA-Brasil population. METHODS: In 305 individuals at baseline ELSA-Brasil, NAFLD-associated steatosis was classified by ultrasound hepatic attenuation. The participants were grouped according to the severity of steatosis: mild and moderate/severe pooled. The measurement of serum fluorescent AGE concentrations was based on spectrofluorimetric detection. Serum AGE content and clinical and laboratory characteristics of the participants were compared between groups. The correlation between serum AGE levels and the grade of steatosis was analyzed. Logistic regression analysis was used to investigate the relationship between serum AGE levels and steatosis severity. A P value < 0.05 was considered statistically significant. RESULTS: According to the steatosis severity spectrum in NAFLD, from mild to moderate/severe, individuals with the most severe steatosis grade had a higher incidence of metabolic syndrome (63% vs 34%, P ≤ 0.001), diabetes mellitus (37% vs 14%, P ≤ 0.001), and high cholesterol levels (51% vs 33%, P < 0.001). Moreover, individuals with increasing severity of steatosis presented increasing waist circumference, body mass index, systolic and diastolic blood pressure, fasting blood glucose, glycated hemoglobin, insulin, triglycerides, alanine aminotransferase, gamma-glutamyl transferase, C-reactive protein, and uric acid levels and lower high-density lipoprotein. Higher serum AGE content was present in the moderate/severe group of individuals than in the mild group (P = 0.008). In addition, the serum AGE levels were correlated with the steatosis grade in the overall sample (rho = 0.146, P = 0.010). Logistic regression analysis, after adjusting for confounding variables, showed that subjects with higher serum AGE content had a 4.6-fold increased chance of having moderate or severe steatosis when compared to low levels of serum AGEs. According to the results of the receiver operator characteristic curves analyses (areas under the curve, AUC = 0.83), AGEs could be a good marker of steatosis severity in patients with NAFLD and might be a potential biomarker in predicting NAFLD progression, strengthening the involvement of AGE in NAFLD pathogenesis. CONCLUSION: NAFLD-associated steatosis was associated with serum AGE levels; therefore, plasmatic fluorescent AGE quantification by spectroscopy could be a promising alternative method to monitor progression from mild to severe NAFLD accordingly to steatosis grade.

Impact of protocol change on individual factors related to course of adverse reactions to chemotherapy for breast cancer.

PURPOSE: Asthenia, myalgia, arthralgia, mucositis, abdominal pain, diarrhea, and neutropenia are adverse reactions commonly reported by women undergoing chemotherapy. Traditional approaches do not take into account the effect that chemotherapeutic changes and variable interactions can cause in adverse reactions. We aimed to identify the impact of the change of a chemotherapy protocol within the same treatment in profiles associated with adverse reactions. METHODS: A total of 166 women admitted to the Brazilian National Institute of Cancer (INCA) were followed. Polymorphisms, clinical variables, and FAC-D protocols (3 cycles of cyclophosphamide, 5-fluorouracil, and doxorubicin followed by 3 cycles of docetaxel) composed the set of independent variables analyzed. Reaction levels were recorded at the end of each chemotherapy cycle via interviews. Marginal models were fitted. RESULTS: The results of marginal models for non-hematological reactions revealed that the docetaxel phase was associated with increased reaction levels compared with the FAC phase. In addition, the set of factors associated with the reactions changed in each protocol. The post-menopausal status was related to high levels of asthenia in docetaxel protocol whereas CYP2B6 polymorphism (rs3745274) was related to high levels in FAC protocol. Regarding the docetaxel phase, high levels of abdominal pain and mucositis were related to CBR3 gene (rs8133052) polymorphism and diabetes respectively. CONCLUSION: The results suggest the need for monitoring non-hematological reactions during the docetaxel phase of FAC-D treatment. The factors related to more severe reactions depend on the chemotherapy protocol used.

Pharmacogenomic implications of population admixture: Brazil as a model case.

The heterogeneous Brazilian population, with European, African and Amerindian ancestral roots is a model case for exploring the impact of population admixture on the frequency distribution of polymorphisms in pharmacogenes, and the design and interpretation of pharmacogenomics trials. Examples drawn from studies carried out by researchers of the Brazilian pharmacogenomics network, support the following conclusions: the distribution of polymorphisms varies across geographical regions and self-reported 'race/color' categories, and is best modeled as continuous functions of individual proportions of European and African ancestry; the differential frequency of polymorphisms impacts the calculations of sample sizes required for adequate statistical power in clinical trials performed in different segments of the Brazilian population; and extrapolation of pharmacogenomics data from well-defined ethnic groups to Brazilians is plagued with uncertainty. Data for warfarin and tacrolimus are reviewed to highlight the advantages and challenges of performing pharmacogenomic trials in Brazilians.