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1.
Rev Bras Epidemiol ; 23: e200029, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32401915

RESUMO

BACKGROUND: Benzodiazepines are the most widely used psychoactive drugs, despite the risks associated with their prolonged use, especially among older adults. OBJECTIVE: To investigate the use of benzodiazepines among community-dwelling people aged ≥ 75 years. METHODS: The study was conducted among members of the baseline (in 1997) and survivors (in 2012) of the Bambuí Project cohort. The prevalence of benzodiazepine use was estimated separately for each year, and the comparison between them was performed using the Poisson regression model with robust variance. RESULTS: The prevalence of benzodiazepine use was higher in 2012 (33.9%) compared to 1997 (24.9%). After multiple adjustments, the difference in prevalence did not remain significant in study population (PR = 1.25; 95%CI 0.99 - 1.60), unlike that observed in the female stratum (PR = 1.38; 95%CI 1.04 - 1.84). Clonazepam was the strongest-growing drug between the two years (PR = 4.94; 95%CI 2.54 - 9.62). CONCLUSION: This study showed an important increase in benzodiazepine use in an older adult population. These results are concerning as these drugs are contraindicated for use in older adults, mainly if used chronically, and are available in the national list of essential medicines. Health professionals should be aware of the risks involved in its use regarding this population.

2.
Artigo em Inglês | MEDLINE | ID: mdl-32396611

RESUMO

We aimed to examine the relationship between APOE*4 carriage on cognitive decline, and whether these associations were moderated by sex, baseline age, ethnicity, and vascular risk factors. Participants were 19,225 individuals aged 54-103 years from 15 longitudinal cohort studies with a mean follow up duration ranging between 1.2 and 10.7 years. Two-step individual participant data (IPD) meta-analysis was used to pool results of study-wise analyses predicting memory and general cognitive decline from carriage of one or two APOE*4 alleles, and moderation of these associations by age, sex, vascular risk factors and ethnicity. Separate pooled estimates were calculated in both men and women who were younger (i.e., 62 years) and older (i.e., 80 years) at baseline. Results showed that APOE*4 carriage was related to faster general cognitive decline in women, and faster memory decline in men. A stronger dose-dependent effect was observed in older men, with faster general cognitive and memory decline in those carrying two versus one APOE*4 allele. Vascular risk factors were related to an increased effect of APOE*4 on memory decline in younger women, but a weaker effect of APOE*4 on general cognitive decline in older men. The relationship between APOE*4 carriage and memory decline was larger in older-aged Asians than Whites. In sum, APOE*4 is related to cognitive decline in men and women, although these effects are enhanced by age and carriage of two APOE*4 alleles in men, a higher numbers of vascular risk factors during the early stages of late adulthood in women, and Asian ethnicity.

3.
Nat Commun ; 11(1): 2542, 2020 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-32439900

RESUMO

The electrocardiographic PR interval reflects atrioventricular conduction, and is associated with conduction abnormalities, pacemaker implantation, atrial fibrillation (AF), and cardiovascular mortality. Here we report a multi-ancestry (N = 293,051) genome-wide association meta-analysis for the PR interval, discovering 202 loci of which 141 have not previously been reported. Variants at identified loci increase the percentage of heritability explained, from 33.5% to 62.6%. We observe enrichment for cardiac muscle developmental/contractile and cytoskeletal genes, highlighting key regulation processes for atrioventricular conduction. Additionally, 8 loci not previously reported harbor genes underlying inherited arrhythmic syndromes and/or cardiomyopathies suggesting a role for these genes in cardiovascular pathology in the general population. We show that polygenic predisposition to PR interval duration is an endophenotype for cardiovascular disease, including distal conduction disease, AF, and atrioventricular pre-excitation. These findings advance our understanding of the polygenic basis of cardiac conduction, and the genetic relationship between PR interval duration and cardiovascular disease.

4.
Infect Dis Poverty ; 9(1): 51, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393333

RESUMO

BACKGROUND: Chagas disease is endemic in Latin America and still represents an important public health problem in the region. Chronic cardiomyopathy is the most significant chronic form due to its association with morbidity and mortality. The last decade has seen increasing evidence that inflammatory cytokines and chemokines are responsible for the generation of inflammatory infiltrate and tissue damage, with chronic chagasic cardiomyopathy patients presenting a pro-inflammatory immune response. Although studies have evaluated the role of chemokines in experimental T. cruzi infection, few have addressed their systemic profile, especially for human infection and in aging populations. The present work aimed to use the data from a large population based study of older adults, conducted in an endemic area for Chagas disease, to examine the association between serum levels of cytokines and chemokines, T. cruzi infection and electrocardiogram (ECG) abnormality. METHODS: The present work evaluated serum levels of CCL2, CXCL9, CXCL10, CCL5, CXCL8, IL-1ß, IL-6, TNF, IL-12 and IL-10 by Flow Cytometric Bead Array assay (CBA) and the results expressed in pg/ml. The baseline survey started in January 1st 1997, with 1284 participants of an aged population-based cohort. Participants signed an informed consent at baseline and at each subsequent visit and authorized death certificate and medical records verification. RESULTS: Our results demonstrated that Chagas disease patients had higher serum levels of CXCL9, CXCL10 and IL-1ß and lower serum levels of CCL5 than non-infected subjects. Moreover, our data demonstrated that CXCL9 and CXCL10 increased in an age-dependent profile in Chagas disease patients. CONCLUSION: Together, this study provided evidences that serum biomarkers increase along the age continuum and may have potential implications for establishing clinical management protocols and therapeutic intervention in Chagas disease patients.

5.
Cad Saude Publica ; 36(4): e00107319, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32374810

RESUMO

This study aimed to assess the prevalence and factors associated with dynapenia in a nationally representative sample of Brazilians aged 50 years and older. A cross-sectional study was performed with baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). Dynapenia was defined as low muscle strength (< 27kg for men and < 16kg for women). Explanatory variables were sociodemographic characteristics, health conditions, health behaviors and physical performance. Analyses were based on multivariate logistic regression and population attributable fractions. Among the 8,396 participants, the prevalence of dynapenia was 17.2% (16.6% among men and 17.7% among women); for those aged 65 years and older, the prevalence was 28.2% (29.1% and 27.5% among men and women, respectively). Dynapenia was positively associated with age, low gait speed, limitations in performing two or more basic daily activities, falls and self-reported chronic diseases; and negatively associated with education level, physical activity and body mass index (overweight/obese, OR = 0.26). Prevalence of dynapenia is high in Brazilian older adults. Educational skills and physical activity improvement present greater potential to reduce dynapenia in this population.

6.
J Am Heart Assoc ; 9(6): e014176, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32157953

RESUMO

Background Risk stratification of Chagas disease patients in the limited-resource setting would be helpful in crafting management strategies. We developed a score to predict 2-year mortality in patients with Chagas cardiomyopathy from remote endemic areas. Methods and Results This study enrolled 1551 patients with Chagas cardiomyopathy from Minas Gerais State, Brazil, from the SaMi-Trop cohort (The São Paulo-Minas Gerais Tropical Medicine Research Center). Clinical evaluation, ECG, and NT-proBNP (N-terminal pro-B-type natriuretic peptide) were performed. A Cox proportional hazards model was used to develop a prediction model based on the key predictors. The end point was all-cause mortality. The patients were classified into 3 risk categories at baseline (low, <2%; intermediate, ≥2% to 10%; high, ≥10%). External validation was performed by applying the score to an independent population with Chagas disease. After 2 years of follow-up, 110 patients died, with an overall mortality rate of 3.505 deaths per 100 person-years. Based on the nomogram, the independent predictors of mortality were assigned points: age (10 points per decade), New York Heart Association functional class higher than I (15 points), heart rate ≥80 beats/min (20 points), QRS duration ≥150 ms (15 points), and abnormal NT-proBNP adjusted by age (55 points). The observed mortality rates in the low-, intermediate-, and high-risk groups were 0%, 3.6%, and 32.7%, respectively, in the derivation cohort and 3.2%, 8.7%, and 19.1%, respectively, in the validation cohort. The discrimination of the score was good in the development cohort (C statistic: 0.82), and validation cohort (C statistic: 0.71). Conclusions In a large population of patients with Chagas cardiomyopathy, a combination of risk factors accurately predicted early mortality. This helpful simple score could be used in remote areas with limited technological resources.

7.
Exp Gerontol ; 132: 110837, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31935439

RESUMO

BACKGROUND: The aim of this study was to analyze the association between inflammatory markers and recurrent and severe falls in 1304 community-dwelling older adults from the Bambuí Cohort Study of Aging. METHODS: Information about falls in the previous 12 months was collected, and classified based on recurrence (two or more falls) and severity (requirement of medical attention). The screened biomarkers included interleukins (IL-1ß, IL-6, IL-10, and IL-12, TNF), chemokines (CXCL8, CXCL9, CXCL10, CCL2, and CCL5), and high-sensitive C-reactive protein (hs-PCR). Potential confounders included sociodemographic, behavioral, and health indicators. Associations were evaluated through logistic regression, using odds ratios (OR) and 95% confidence intervals (95% CI), with Stata 13.1. RESULTS: The prevalence of recurrent and severe falls was 10.7% and 9.0%, respectively. After adjustments, elevated levels of IL-12 (OR: 1.92; 95% CI: 1.09-3.37) and CXCL9 (OR: 1.67; 95% CI: 1.05-2.66) were found to be associated with recurrent falls, while elevated levels of TNF (OR: 1.58; 95% CI: 1.01-2.50), IL-12 (OR: 2.04; 95% CI: 1.13-3.70), CXCL10 (OR: 1.75; 95% CI: 1.04-2.92), and CCL5 (OR: 1.90; 95% CI: 1.18-3.07) were associated with severe falls. CONCLUSIONS: The results highlight a wide range of biomarkers not yet explored in the literature and suggest that inflammation may be an important component of recurrent and severe falls.

8.
J Infect Public Health ; 13(2): 211-215, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31431425

RESUMO

BACKGROUND: Influenza is a significant cause of morbidity and mortality worldwide. Since 1999, influenza vaccine is provided free-of-charge to adults aged 60 years or more in Brazil. Although vaccination coverage is high, previous studies have shown that socioeconomic and lifestyle factors play an essential role in predicting vaccine uptake. This study aimed to investigate whether previous knowledge of factors that constrain influenza vaccine uptake among older adults contributed to increasing the access to vaccination in 2015-16. METHODS: This cross-sectional study assessed data from the baseline of the Brazilian Longitudinal Study of Aging. This national representative sample encompassed individuals aged 60 and older (n=5221). Vaccination status was the outcome variable; covariates included socio-demographic and behavioral characteristics, health status, and access to healthcare. Logistic regression fitted the association between vaccine uptake and covariates. RESULTS: The coverage of influenza vaccination was 73.0% (95% confidence interval: 70.6-75.2); ranking lower than the goal of 80% set up by the national health authority. The most frequent reasons to justify the option of skipping vaccination were cultural beliefs about the lack of efficacy and possible side effects of the vaccine. The coverage of vaccination did not differ by socioeconomic characteristics. Older individuals, never smokers, having two or more chronic diseases, and being registered in the Family Health Program were positively associated with influenza vaccine uptake. CONCLUSIONS: Absent socioeconomic inequalities point out changes in the barriers to vaccination. These findings provide insights into tailoring public health strategies, targeting professional recommendations and public perceptions of the vaccine.

9.
Sci Rep ; 9(1): 18085, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31792241

RESUMO

Age-related cognitive decline (ACD) is the gradual process of decreasing of cognitive function over age. Most genetic risk factors for ACD have been identified in European populations and there are no reports in admixed Latin American individuals. We performed admixture mapping, genome-wide association analysis (GWAS), and fine-mapping to examine genetic factors associated with 15-year cognitive trajectory in 1,407 Brazilian older adults, comprising 14,956 Mini-Mental State Examination measures. Participants were enrolled as part of the Bambuí-Epigen Cohort Study of Aging. Our admixture mapping analysis identified a genomic region (3p24.2) in which increased Native American ancestry was significantly associated with faster ACD. Fine-mapping of this region identified a single nucleotide polymorphism (SNP) rs142380904 (ß = -0.044, SE = 0.01, p = 7.5 × 10-5) associated with ACD. In addition, our GWAS identified 24 associated SNPs, most in genes previously reported to influence cognitive function. The top six associated SNPs accounted for 18.5% of the ACD variance in our data. Furthermore, our longitudinal study replicated previous GWAS hits for cognitive decline and Alzheimer's disease. Our 15-year longitudinal study identified both ancestry-specific and cosmopolitan genetic variants associated with ACD in Brazilians, highlighting the need for more trans-ancestry genomic studies, especially in underrepresented ethnic groups.

10.
Ciênc. Saúde Colet ; 24(11): 4171-4180, nov. 2019. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-1039525

RESUMO

Resumo O objetivo foi analisar o padrão de consumo de álcool entre idosos (60 anos ou mais) brasileiros e sua associação com fatores sociodemográficos, hábitos de vida e condições de saúde. Trata-se de um estudo transversal, realizado com 10.537 idosos (90,1%) participantes da Pesquisa Nacional de Saúde de 2013. O consumo de bebidas alcoólicas foi classificado em não uso, uso leve/ moderado e uso de risco. Utilizou-se o modelo de regressão multinomial para o estudo dos fatores associados. A prevalência para uso leve/moderado e de risco foi de 9,4% (IC95%: 8,4-10,6%) e 4,6% (IC95%:4,0-5,3%), respectivamente. Os dois padrões de consumo foram inversamente associados à idade, mais frequentes entre homens, mais escolarizados, fumantes e que praticavam atividade física. O consumo leve/moderado foi menos frequente entre não brancos e entre aqueles com relato de AVC e diabetes, enquanto o consumo de risco foi menos frequente entre idosos com diagnóstico para doenças do coração e mais frequentes entre os que reportaram depressão. Esse resultado identifica perfis de maior vulnerabilidade, com pequenas diferenças entre os padrões de consumo. Essas informações devem ser consideradas na elaboração de propostas para promoção de hábitos saudáveis e controle do abuso de álcool em idosos.


Abstract The scope of this study was to analyze the pattern of alcohol consumption among elderly Brazilians (60 years and over) and their association with sociodemographic factors, lifestyle habits and health conditions. This is a cross-sectional study of 10,537 elderly (90.1%) participants from the National Health Survey of 2013. The consumption of alcoholic beverages was classified as non-use, mild / moderate use and risk use. The multinomial regression model was used to study the associated factors. The prevalence for mild / moderate and risk use was 9.4% (95% CI: 8.4- 10.6%) and 4.6% (95%CI: 4.0-5.3%), respectively. The two consumption patterns were inversely associated with age and more frequent among men, better schooling, smokers and physical activity practitioners. Mild / moderate consumption was less frequent among non-whites and those with a history of stroke and diabetes, whereas risk use was less frequent among the elderly diagnosed for heart disease and more frequent among those suffering from depression. This result identifies profiles of greater vulnerability, with small differences between two patterns of consumption. This information should be considered in the preparation of proposals to promote healthy habits and control of alcohol use among the elderly.

11.
Cien Saude Colet ; 24(11): 4171-4180, 2019.
Artigo em Português | MEDLINE | ID: mdl-31664390

RESUMO

The scope of this study was to analyze the pattern of alcohol consumption among elderly Brazilians (60 years and over) and their association with sociodemographic factors, lifestyle habits and health conditions. This is a cross-sectional study of 10,537 elderly (90.1%) participants from the National Health Survey of 2013. The consumption of alcoholic beverages was classified as non-use, mild / moderate use and risk use. The multinomial regression model was used to study the associated factors. The prevalence for mild / moderate and risk use was 9.4% (95% CI: 8.4- 10.6%) and 4.6% (95%CI: 4.0-5.3%), respectively. The two consumption patterns were inversely associated with age and more frequent among men, better schooling, smokers and physical activity practitioners. Mild / moderate consumption was less frequent among non-whites and those with a history of stroke and diabetes, whereas risk use was less frequent among the elderly diagnosed for heart disease and more frequent among those suffering from depression. This result identifies profiles of greater vulnerability, with small differences between two patterns of consumption. This information should be considered in the preparation of proposals to promote healthy habits and control of alcohol use among the elderly.

12.
Cad Saude Publica ; 35(9): e00156018, 2019 Sep 09.
Artigo em Português | MEDLINE | ID: mdl-31508696

RESUMO

Time trends in the prevalence rates of incapacity in the elderly can occur due to the effects of age, period, or cohort. Age is related to biological factors, the period to the subject's environmental context, and the cohort to the subject's exposures from birth to the present. The study aimed to verify which time dimensions most influence the evolution in the prevalence of incapacity in the elderly over the course of 15 years. Data were used from the Bambuí Elderly Cohort, and incapacity was assessed by report of "great difficulty" or "inability" to perform at least one of the activities related to mobility and basic and instrumental activities of daily living. The analysis was done with the age-period-cohort model for aggregate data, with calculation of the effects of time dimensions by analysis of deviance. A Poisson regression model determined the associations between age, period, and cohort and prevalence of incapacity, considering the total population and stratification by sex and schooling. Period effect was the most important for the three dimensions of incapacity, with an increase in prevalence at the start of the period, followed by a reduction over time, with minor differences in relation to sex and schooling. Cohort effect was significant, although less important than period effect. The results highlight the importance of analyzing the elder's environment for reducing prevalence of incapacity, with an emphasis on policies and programs that can positively impact the time trend in this outcome, given the consistent effect of period observed in this study.

13.
Cad Saude Publica ; 35(8): e00175318, 2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31411274

RESUMO

The aim was to evaluate the separate and joint association of abdominal adiposity indicators (a body shape index - ABSI, waist circumference - WC, waist-to-height ratio - WHtR) and body mass index (BMI) with arterial hypertension and diabetes mellitus, in Brazilian older adults. Data from the 2013 Brazilian National Health Survey (PNS 2013) were used for the population aged 60 years or older (10,537 older adults). Arterial hypertension and diabetes mellitus outcomes were self-reported and the following anthropometric indices were evaluated by direct measurement: a ABSI, BMI, WC and WHtR. Associations were assessed by logistic regression, with adjustments for confounding factors. The results of this study evidenced a higher strength of association between the report of arterial hypertension and diabetes mellitus with BMI, WC and WHtR in the Brazilian population of older adults in separate analyses, when compared to ABSI. When adjusted for BMI, ABSI showed a greater strength of association with the outcomes, but it was not superior to the performance of WC and WHtR. Considering the lower strength of association, in separate and joint analyses, between the new index (ABSI) and the chronic conditions assessed, BMI, WC and WHtR probably remain as useful indices in public health, at least in relation to arterial hypertension and diabetes mellitus in Brazilian older adults.

14.
PLoS Med ; 16(7): e1002853, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31335910

RESUMO

BACKGROUND: With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups. METHODS AND FINDINGS: We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54-105 (mean = 72.7) years and without dementia at baseline. Studies had 2-15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = -0.1, SE = 0.01), APOE*4 carriage (B = -0.31, SE = 0.11), depression (B = -0.11, SE = 0.06), diabetes (B = -0.23, SE = 0.10), current smoking (B = -0.20, SE = 0.08), and history of stroke (B = -0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both). Age (B = -0.07, SE = 0.01), APOE*4 carriage (B = -0.41, SE = 0.18), and diabetes (B = -0.18, SE = 0.10) were independently associated with faster cognitive decline (p < 0.05 for all). Different effects between Asian people and white people included stronger associations for Asian people between ever smoking and poorer cognition (group by risk factor interaction: B = -0.24, SE = 0.12), and between diabetes and cognitive decline (B = -0.66, SE = 0.27; p < 0.05 for both). Limitations of our study include a loss or distortion of risk factor data with harmonization, and not investigating factors at midlife. CONCLUSIONS: These results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences.


Assuntos
Cognição , Disfunção Cognitiva/etnologia , Grupos Étnicos/psicologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Comorbidade , Diabetes Mellitus/etnologia , Exercício Físico , Feminino , Educação em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Fumar/etnologia , Acidente Vascular Cerebral/etnologia
15.
Genome Biol Evol ; 11(9): 2593-2604, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31328768

RESUMO

After the colonization of the Americas by Europeans and the consequent Trans-Atlantic Slave Trade, most Native American populations in eastern Brazil disappeared or went through an admixture process that configured a population composed of three main genetic components: the European, the sub-Saharan African, and the Native American. The study of the Native American genetic history is challenged by the lack of availability of genome-wide samples from Native American populations, the technical difficulties to develop ancient DNA studies, and the low proportions of the Native American component in the admixed Brazilian populations (on average 7%). We analyzed genome-wide data of 5,825 individuals from three locations of eastern Brazil: Salvador (North-East), Bambui (South-East), and Pelotas (South) and we reconstructed populations that emulate the Native American groups that were living in the 16th century around the sampling locations. This genetic reconstruction was performed after local ancestry analysis of the admixed Brazilian populations, through the rearrangement of the Native American haplotypes into reconstructed individuals with full Native American ancestry (51 reconstructed individuals in Salvador, 45 in Bambui, and 197 in Pelotas). We compared the reconstructed populations with nonadmixed Native American populations from other regions of Brazil through haplotype-based methods. Our results reveal a population structure shaped by the dichotomy of Tupi-/Jê-speaking ancestry related groups. We also show evidence of a decrease of the diversity of nonadmixed Native American groups after the European contact, in contrast with the reconstructed populations, suggesting a reservoir of the Native American genetic diversity within the admixed Brazilian population.

16.
Cad Saude Publica ; 35(7): e00091018, 2019 Jul 22.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31340334

RESUMO

This study aimed to measure the contribution of selected health behaviors to the prevalence of hypertension control in Brazilian adults 50 years or older, based on data from the ELSI-Brasil study. The study included 4,318 individuals 50 years or older who reported having received a medical diagnosis of hypertension and were taking antihypertensive medication. The selected health behaviors were: physical activity, healthy diet, not consuming excessive alcohol, and never having smoked. The contribution of each health behavior to prevalence of hypertension control was estimated by the attribution method, via adjustment of the binomial additive hazards model, stratified by sex. Prevalence of hypertension control was 50.7% (95%CI: 48.2; 53.1). Overall, health behaviors made a larger contribution to hypertension control in women (66.3%) than in men (36.2%). Moderate alcohol consumption made the largest contribution in both sexes, but particularly in women (52.7% in women versus 19% in men). Physical activity contributed 12.6% in women and 10.7% in men. The other behaviors were more relevant in men: never having smoked (3.4%) and regular consumption of vegetables, legumes, and fruits (3.1%). These results underline the need for measures to promote the adoption of healthy behaviors by hypertensive individuals to reduce blood pressure levels, improve the effectiveness of antihypertensive medication, and decrease their cardiovascular risk.

17.
Cien Saude Colet ; 24(5): 1853-1864, 2019 May 30.
Artigo em Português | MEDLINE | ID: mdl-31166518

RESUMO

The scope of this paper was to investigate the associations of disability in three domains (BADL, IADL and mobility) with cardiovascular diseases, diabetes and multimorbidity profile, among the elderly living in the Metropolitan Region of Belo Horizonte (MRBH). A cross-sectional study was conducted with a representative sample of 2,172 elderly persons (60 years and over). Disability, for each domain (BADL, IADL and mobility), was assessed as reporting great difficulty or need for help to perform at least one activity among those investigated, and self-reported diseases included arterial hypertension, myocardial infarction or angina, stroke, diabetes, and combinations of these diseases. Adjusted Poisson regression was used, and the attributable population fraction was also estimated. A major contribution of Cerebral Vascular Accidents (strokes) to disability in all domains was observed, especially BADLs, as well as the presence of infarction or angina in disability in IADLs and mobility, especially when combined with diabetes and hypertension. The multimorbidity profile can be used to identify vulnerable groups, which should be the target of prevention and rehabilitation, reducing the financial and social cost of this event among the elderly.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Pessoas com Deficiência/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Multimorbidade
18.
Depress Anxiety ; 36(10): 941-949, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31066979

RESUMO

BACKGROUND: Both diabetes and depression increase the mortality risk in the elderly. In this study, we evaluated mortality risk associated with the comorbidity between depression and diabetes. We also assessed the moderating role of inflammation in the mortality risk in this population. METHODS: We included a total of 1,183 community-dwelling older adults, divided into four groups: "neither diabetes nor depression"; "diabetes only"; "depression only," and "both diabetes and depression," and followed-up for a median of 13.5 years. We evaluated the inflammatory status by the high-sensitivity C-reactive protein (hs-CRP) levels. Date of death was computed by reviewing death certificates. We used Cox's proportional hazards models and additive interactions to evaluate the risk of mortality in the subject groups and the moderating effect of hs-CRP. RESULTS: Participants with both diabetes and depression had higher death risk (hazard ratio [HR]: 2.33; 95% confidence interval [CI]: 1.59-3.42) than those with each condition alone (HR diabetes: 2.08 95% CI: 1.56-2.76 HR depression: 1.26; 95% CI: 1.03-1.54). High level of hs-CRP, indicative of high inflammatory status, significantly moderated the risk of mortality in subjects with both diabetes and depression (Bonferroni-adjusted p = 0.0116). CONCLUSIONS: The coexistence of diabetes and depression symptoms is associated with the highest death risk in this population. This risk is moderated by inflammatory status.

19.
Rev Bras Epidemiol ; 22: e190039, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31038572

RESUMO

INTRODUCTION: Inflammation plays an important role in the aging process. OBJECTIVE: This cross-sectional study aims to examine the association between inflammatory markers and hospitalizations among older adults, considering as potential confounding factors the predisposing and enabling factors for the use of health services and health conditions. METHODS: We used data from 1,393 participants (≥ 60 years) in the baseline cohort from Bambuí. The markers assessed were ten cytokines and chemokines [interleukin (IL)-1, IL-6, IL-10, IL-12, tumor necrosis factor (TNF), CCL2, CCL5, CXCL8, CXCL9, and CXCL10]. The outcome variable was one or more hospitalizations in the preceding 12 months. RESULTS: Elevated serum levels of IL-6 were significantly associated with hospitalizations [prevalence ratio (PR) = 1.38; confidence interval of 95% (95%CI) 1.02 - 1.87 and PR = 1.38; 95%CI 1.01 - 1.88 for the intermediate and highest tertiles, respectively]. High levels of CXCL9 were also independently associated with the outcome (PR = 1.38; 95%CI 1.01 - 1.89 and PR = 1.46; 95%CI 1.07 - 2.00, respectively). Other markers showed no statistically significant association with hospitalizations. CONCLUSION: Among the ten markers analyzed, only IL-6 and CXCL9 were associated with hospitalizations.


Assuntos
Citocinas/sangue , Hospitalização/estatística & dados numéricos , Fatores Etários , Idoso , Biomarcadores/sangue , Brasil , Estudos Transversais , Feminino , Humanos , Inflamação/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Fatores de Risco , Fatores Sexuais , Estatísticas não Paramétricas , Fatores de Tempo
20.
Ciênc. Saúde Colet ; 24(5): 1853-1864, Mai. 2019. tab
Artigo em Português | LILACS-Express | ID: biblio-1001794

RESUMO

Resumo O objetivo foi investigar as associações da incapacidade em três níveis (ABVD, AIVD e mobilidade) com doenças cardiovasculares, diabetes e multimorbidade, entre idosos residentes na Região Metropolitana de Belo Horizonte (RMBH). Estudo transversal em amostra representativa de adultos da RMBH, tendo sido selecionados 2.172 idosos (60 anos ou mais). A incapacidade, para cada domínio (ABVD, AIVD e mobilidade), foi avaliada como o relato de muita dificuldade ou necessidade de ajuda para realizar pelo menos uma atividade entre as investigadas, e as doenças autorreferidas incluíram hipertensão arterial, infarto do miocárdio e angina, acidente vascular encefálico (AVE), diabetes, e as combinações dessas doenças. Utilizou-se regressão de Poisson ajustada, estimando-se também a fração atribuível populacional. Houve importante contribuição do AVE para a incapacidade em todos os domínios, com destaque para as ABVD, bem como do infarto/angina na incapacidade em AIVD e mobilidade, sobretudo quando combinadas com diabetes e hipertensão. O perfil de multimorbidade pode ser usado para identificação de grupos vulneráveis, que deveriam ser alvo de ações de prevenção e reabilitação, reduzindo o custo financeiro e social desse evento entre idosos.


Abstract The scope of this paper was to investigate the associations of disability in three domains (BADL, IADL and mobility) with cardiovascular diseases, diabetes and multimorbidity profile, among the elderly living in the Metropolitan Region of Belo Horizonte (MRBH). A cross-sectional study was conducted with a representative sample of 2,172 elderly persons (60 years and over). Disability, for each domain (BADL, IADL and mobility), was assessed as reporting great difficulty or need for help to perform at least one activity among those investigated, and self-reported diseases included arterial hypertension, myocardial infarction or angina, stroke, diabetes, and combinations of these diseases. Adjusted Poisson regression was used, and the attributable population fraction was also estimated. A major contribution of Cerebral Vascular Accidents (strokes) to disability in all domains was observed, especially BADLs, as well as the presence of infarction or angina in disability in IADLs and mobility, especially when combined with diabetes and hypertension. The multimorbidity profile can be used to identify vulnerable groups, which should be the target of prevention and rehabilitation, reducing the financial and social cost of this event among the elderly.

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