Water and sediment toxicity and hazard assessment of DCOIT towards neotropical marine organisms

DCOIT is an effective antifouling biocide, which presence in the environment and toxicity towards non-target species has been generating great concern. This study evaluated the waterborne toxicity of DCOIT on marine invertebrates (i.e., survival of brine shrimp Artemia sp., larval development of the sea urchin Echinometra lucunter and the mussel Perna perna), as well as DCOIT-spiked-sediment toxicity on the fecundity rate of the copepod Nitrocra sp. And the mortality of the amphipod Tiburonella viscana. The data outcomes were used to calculate environmental hazards and risks, which were compared to their corresponding values obtained from temperate regions. Waterborne toxicity can be summarized as follows: Artemia sp. (LC_50-48h = 163 (135-169) μg/L), E. lucunter (EC_50-36h = 33.9 (17-65) μg/L), and P. perna (EC_50-48h = 8.3 (7-9) μg/L). For whole-sediment toxicity, metrics were calculated for T. viscana (LC_50-10d = 0.5 (0.1-2.6) μg/g) and Nitrocra sp, (EC_50-10d = 200 (10-480) μg/kg). The DCOIT hazard was assessed for both tropical and non-tropical pelagic organisms. The predicted no-effect concentration (PNEC) for tropical species (0.19 μg/L) was 1.7-fold lower than that for non-tropical organisms (0.34 μg/L). In whole-sediment exposures, DCOIT presented a PNEC of 0.97 μg/kg, and the risk quotients (RQs) were >1 for areas with constant input of DCOIT such as ports ship/boatyards, marinas, and maritime traffic zones of Korea, Japan, Spain, Malaysia, Indonesia, Vietnam, and Brazil. The presented data are important for supporting the establishment of policies and regulations for booster biocides worldwide.

Long-term immune and virological response in HIV-infected patients receiving antiretroviral therapy

WHAT IS KNOWN AND OBJECTIVE

The trajectory of HIV viral load and CD4 count and the occurrence of clinical events are primary considerations in the evaluation of antiretroviral therapy (ART) success or failure, yet a large number of studies do not describe these events from the point of therapy initiation. This study aims to describe the virological and immune response to ART and factors associated with immune and virological success in outpatients from a HIV/AIDS clinic in southern Brazil from therapy initiation.

METHODS

Longitudinal observational with ambidirectional data collection study with adult patients followed for at least 12 months after enrolment. Outcomes include (i) favourable immune response, defined as CD4 count ≥200 cells/mm³; and (ii) virological success, defined as viral load below the limit of detection (50 copies/mL).

RESULTS

The study included 332 patients, mostly men (63%), whose mean age was 40 (±10) years and with median family income of BR$ 490·00 per month (IQR: 350-875). Before starting ART, 43% of patients had indications of stable immune status (CD4 count ≥200 cells/mm³); the median CD4 count was 179 cells/mm³ (IQR: 93·5, 267) and increased to 379·5 cells/mm³ (IQR: 236·5, 591·3). The proportion of patients with CD4 count ≥200 cells/mm³ increased from 76% to 83%, and with undetectable viral load (UVL) increased from 51·7% to 73%. Factors associated with immune success at the end of study follow-up were as follows: female gender, pretreatment CD4 count ≥200 cells/mm³, previous UVL (measured when started prospective follow-up) and treatment with three drugs compared with ≥4. Factors associated with virological success were as follows: UVL (measured when started prospective follow-up) and use of three drugs compared with ≥4.

WHAT IS NEW AND CONCLUSIONS

Results of this study show that a large proportion (73%) of patients have rapid and successful immune and virological responses to ART and that factors which predict this response include starting ART early, whereas viral load is low and CD4 count is high, with fewer drugs. These results further support the ongoing need for ongoing programmes to increase early HIV testing, early linkage to and treatment with ART, and increased viral suppression.

Blood pressure variability in controlled and uncontrolled blood pressure and its association with left ventricular hypertrophy and diastolic function

High systolic blood pressure (SBP) variability has been associated with higher risk for target-organ damage. In a cross-sectional study done in a tertiary outpatient hypertension clinic, we compared short-term SBP variability among controlled and uncontrolled hypertensive patients and evaluated the association between higher levels of SBP variability and diastolic function and left ventricular hypertrophy (LVH). Patients were evaluated by 24-h ambulatory blood pressure monitoring and transthoracic Doppler echocardiogram. Blood pressure (BP) variability was evaluated by the time-rate index and high variability corresponded to index values in the top quartile of distribution. Echocardiographic parameters were compared in patients with and without higher BP variability within controlled and uncontrolled office BP (⩽140/90 mm Hg). The analyses included 447 patients with 58±12 years of age, 67% were women, 68% white, 43% current or previous smokers and 32% with diabetes mellitus. Among the whole sample, 137 patients had controlled and 310 uncontrolled BP. The 75th percentile cutoff points for the time-rate index were 0.502 mm Hg min(-1) and 0.576 mm Hg min(-1) for participants with controlled and uncontrolled BP, respectively. After adjustment for confounders, the time-rate index did not differ between controlled and uncontrolled patients. BP variability was not associated with LVH or diastolic function in controlled and uncontrolled BP after adjustment for 24-h SBP and age. Patients with controlled and uncontrolled BP had similar SBP variability assessed by time-rate index, which was not associated with LVH or diastolic function. These findings should be confirmed in studies with larger sample size.

Seasonal variation in food intake and the interaction effects of sex and age among adults in southern Brazil

BACKGROUND/OBJECTIVES

Because studies have evidenced variations in nutrient intake, further investigation of the interaction between demographic characteristics and the seasons is necessary. We aimed to test the differences in food intake throughout the seasons and the interaction between the seasons and sex and age.

SUBJECTS/METHODS

This study included 273 individuals. Food intake was evaluated with 24-hour dietary recalls, and the reported food items were sorted into food groups. We performed the test on the differences in intake of food groups throughout the seasons with repeated measures and on the interaction effect by using the Generalized Estimate Equation.

RESULTS

Intake of fruits and natural fruit juices and sweetened beverages was lower, whereas that of grains and derivatives was higher in the winter. The intake of leafy vegetables and fish and seafood was lower in the autumn. The consumption of coffee and eggs was higher in the spring. Intake of chocolate powder and sugar, salt and lean poultry was higher in the winter. The variation in consumption of grains and derivatives, eggs, fatty poultry and processed meat over the seasons was more likely to be modified by sex. Age interacted with the seasons for leafy vegetables, beans and lentils, lean beef, lean poultry, low fat milk and light yogurt, vegetable oil and unsalted margarine, chocolate powder and sugar and processed meat.

CONCLUSIONS

This study shows that food intake may change seasonally and that seasonal variation depends on sex and age, which might aggregate a specific co-variation component.

A candidate short-term toxicity test using Ampelisca brevicornis to assess sublethal responses to pharmaceuticals bound to marine sediments

Lethal and sublethal responses related to different phases of metabolism (phases I and II enzymatic activities), neurotoxicity (acetylcholinesterase activity), oxidative stress (lipid peroxidation and antioxidant enzyme activities), and genetic damage (DNA strand breaks) were analysed to assess the possible adverse effects of pharmaceuticals bound to marine sediments. The crustacean amphipod Ampelisca brevicornis was chosen as the bioindicator species. Organisms were exposed for 10 days to sediment spiked with pharmaceutical compounds frequently used and previously detected in the environment: carbamazepine (CBZ), ibuprofen (IBP), fluoxetine (FX), 17α-ethynylestradiol (EE2), propranolol (PRO), and caffeine (CAF). Short-term bioassay to evaluate amphipod mortality was recommended to assess pollution by CBZ, FX, and PRO. IBP and PRO were metabolized by phases I and II detoxification enzymatic activities. Oxidative stress was caused by PRO and CAF. Contrary to expected results, DNA damage (strand breaks) decreased after the exposure of amphipods to sediment spiked with IBP, FX, EE2, PRO, and CAF (including environmental concentrations). FX was neurotoxic to amphipods. The battery of biomarkers tested allowed the assessment of bioavailability, oxidative stress, genotoxicity, and neurotoxicity of the pharmaceuticals analysed. The results of this study suggested that pharmaceutical products at concentrations currently found in the environment might cause a wide variety of adverse effects (based on laboratory studies). The results obtained here are useful for environmental risk assessment of marine sediments contaminated by pharmaceuticals. Nevertheless, more research is needed using field-based marine sediments.

Factors associated with therapeutic success in HIV-positive individuals in southern Brazil

WHAT IS KNOWN AND OBJECTIVE

Therapeutic success is characterized by undetectable viral load, immune reconstitution confirmed by CD4+ T-cell count and no clinical manifestations of disease. High treatment adherence is a major determinant of therapeutic success that needs prevention of viral replication, allowing immune reconstitution. Adherence to treatment <95% has been associated with both immune and viral failure. The objective of this study was to evaluate factors associated with therapeutic success in adult patients on highly active antiretroviral therapy (HAART) in a specialized centre for HIV-AIDS in southern Brazil, being defined therapeutic success as achieving and maintaining undetectable viral load, stable immune status (CD4+ T lymphocyte count ≥200 cells/mm(3) ) and adherence to HAART ≥ 95%.

METHODS

We conducted a historical cohort study nested in the PC-HIV randomized clinical trial of PC-HIV. We included adults who were on HAART at Pelotas HIV/AIDS Assistance Service between June 2006 and July 2007 and for whom information on treatment adherence, viral load and CD4+ cell count was available. Pregnant women were excluded. We obtained clinical data from medical records and socio-demographic information in an interview. Therapeutic success was defined as achieving and maintaining undetectable viral load, stable immune status (CD4+ T lymphocyte count ≥200 cells/mm(3) ) and adherence to HAART ≥95%.

RESULTS AND DISCUSSION

We included 136 patients (60% male) in the cohort study. Mean age was 40 ± 10 years, and median treatment duration was 59 months (IQR 25-93). Family income varied from 0 to 8 times the minimum wage (IQR 1·0-2·3). Therapeutic success was achieved by 90% (122 patients), and it was associated with previously undetectable viral load (PR = 1·30; 95% CI = 1·13-1·49) and treatment adherence prior to study entry (PR = 1·34; 95% CI = 1·07-1·69), independently of sex, age and previous immune status.

WHAT IS NOW AND CONCLUSION

When undetectable viral load, CD4+ cell count ≥200 cells/mm(3) and treatment adherence above 95% are included in the definition of therapeutic success, the rate was elevated (90%) and the factors associated were previous history of adherence to HAART and previous undetectable viral load.

Ecotoxicological assessment of sediments from an urban marine protected area (Xixová-Japuí State Park, SP, Brazil)

This study aimed to evaluate the environmental quality of the marine portion of Xixová-Japuí State Park (XJSP), an urban marine protected area, which is influenced by multiple contamination sources, by using ecotoxicological and geochemical analyses. Sediments were predominantly sandy, with low CaCO3 and organic matter contents, and presented contamination by metals (Cd,Cu,Zn). Acute toxicity was detected in three tested samples, and copepod exposed to sediments from four stations exhibited lower fecundities, despite the absence of significant effects. Contamination and toxicity seemed to be associated, suggesting that the environment is degraded and presents risks to the biota. Whole sediment TIE indicated ammonia as a main responsible for toxicity, suggesting sewage is a main contributor to sediment degradation. As external contamination sources seem to be negatively influencing the sediment quality, the park conservation objectives are not being fully reached, demanding actions to mitigate impacts.

Accuracy of anthropometric indexes of obesity to predict diabetes mellitus type 2 among men and women with hypertension

BACKGROUND

Anthropometric measurements and indexes that assess excess of adiposity are associated with cardiovascular risk factors, and predict diabetes mellitus.

METHODS

This cross-sectional study reported the performance of adiposity indexes to detect or turn diabetes unlikely in patients with hypertension. Patients with hypertension (blood pressure (BP) ≥140/90 mm Hg or antihypertensive drug use) aged 18-80 years, being 150 men and 332 women, had weight, height, waist circumference (WC), hip circumference, body mass index (BMI), waist-hip ratio (WHR), waist-to-height ratio (WHtR), and waist-to-square height ratio (WHt(2)R) calculated. Diabetes was diagnosed by fasting blood glucose ≥126 mg/dl or antidiabetic drug use (23% of the sample).

RESULTS

All anthropometric indexes were associated with diabetes in a modified Poisson regression, adjusting for age, smoking, and physical activity, in women, but not in men. In men, only the area under the receiver-operating characteristic curve (AUC) for WHR was statistically associated with diabetes (0.67, 95% confidence interval (CI) 0.57-0.77). A cutoff of ≥0.95 had sensitivity of 84.6% (73.3-95.9) and negative post-test probability of 12.8% (3.2-22.4). Among women, WC >88 cm, WHR ≥0.85, and WHtR > 0.54 had sensitivity >93% and negative post-test probability <7.5%.

CONCLUSIONS

WHR ≥0.85, WC >88.0 cm, and WHtR >0.54 for women and WHR ≥0.95 for men are highly suggestive of diabetes among this population of hypertensive patients. Indexes below these cutoffs turn diabetes unlikely in this context. The investigation of reproducibility of this performance in other outpatient clinics is warranted.

Association between pregnancy-related hypertension and severity of hypertension

Hypertension in pregnancy is an emerging sex-specific risk factor for cardiovascular disease and may lead to more severe hypertension after pregnancy. The objectives of this study were to investigate the frequency of pregnancy-related hypertension among patients referred to a hypertension clinic and its association with the severity of hypertension and evidence of end-organ damage. In this cross-sectional study, women with hypertension were submitted to a systematic clinical evaluation. The occurrence of pregnancy-related hypertension was investigated by questionnaire. The association between pregnancy-related hypertension and severity of hypertension (stage 2 according to Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII)) and end-organ damage was assessed in a logistic regression model. The mean age, systolic and diastolic blood pressure and body mass index (BMI) of the 768 women examined were 51.6+/-12.7 years, 158.2+/-26.6 mm Hg, 93.8+/-14.3 mm Hg and 29.4+/-5.6 kg/m(2), respectively. The proportion of women with pregnancy-related hypertension was 32.9%. It was significantly associated with hypertension at stage 2 (OR: 1.60, 95% CI: 1.14-2.24; P=0.01) after controlling for confounders. The occurrence of a pregnancy-related hypertension was not associated with evidence of optic fundi abnormalities, left ventricular hypertrophy or abnormalities in kidney function. In conclusion, pregnancy-related hypertension is frequent in women referred to a hypertension clinic, and is associated with severe hypertension but not with evidence of end-organ damage.

Does psychosocial stress cause hypertension? A systematic review of observational studies

Acute stress promotes transient elevation of blood pressure, but there is no consistent evidence that this effect results in hypertension. In this systematic review of cohort and case-control studies that investigated the association between psychosocial stress and hypertension, we conducted a complete search up to February 2007 in MEDLINE, EMBASE, PSYCINFO and LILACS, through a search strategy that included eight terms to describe the exposure, six related to the design of the studies and one term for outcome. The quality was assessed by the Newcastle-Ottawa Quality Assessment Scale. The selection was done in duplicate by two teams of independent reviewers. Among 82 studies selected in the second phase, only 14 (10 cohort studies and 4 case-control studies), totalling 52,049 individuals, fulfilled the selection criteria. The average quality of the studies was 6.6+/-1.3 in a 9-point scale. Acute life events were associated with hypertension in one and were not associated in two studies. Five out of seven studies found a significant and positive association between measures of chronic stress and hypertension, with risk ratios ranging from 0.8 to 11.1. Three out of five studies reported high and significant risks of affective response to stress for hypertension, one a significant risk close to a unit and one reported absence of risk. Acute stress is probably not a risk factor for hypertension. Chronic stress and particularly the non-adaptive response to stress are more likely causes of sustained elevation of blood pressure. Studies with better quality are warranted.

Compliance with a critical pathway for the management of febrile neutropenia and impact on clinical outcomes

Febrile neutropenia is associated with significant morbidity and mortality. Managing infectious in neutropenic patients remains a dynamic process, making necessary timely and efficient empirical antibiotic therapy. The implementation of critical pathways has been suggested as a strategy to improve clinical effectiveness. This study evaluated the compliance with an institutional critical pathway for the management of febrile neutropenia and the impact on clinical outcomes at Hospital de Clínicas de Porto Alegre, Brazil (HCPA). We performed a cohort study that prospectively included patients hospitalized from January 2004 to December 2005 and presented febrile neutropenia (190 episodes). Historical controls were selected from March 2001 to April 2003 (193 episodes) before the critical pathway was introduced. This study showed a low rate of full compliance (21.6%; 95% CI 15.7-27.5) with the critical pathway. In most cases, there was partial compliance (67.9%; 95% CI 61.3-74.5). Despite the moderate adherence observed, we recorded a decrease in in-hospital all-cause mortality in the sample studied after protocol implementation (from 24.4 to 14.4%; P = 0.017) and reduction in the length of use of cephalosporin and quinolones. In conclusion, implementation of a critical pathway seems to be an effective strategy to improve clinical outcomes in patients hospitalized with febrile neutropenia.

Absence of association between depression and hypertension: results of a prospectively designed population-based study

The objective of this study was to examine the relation between hypertension and depression. In a cross-sectional study of the urban region of a State capital with more than 1.5 million inhabitants, 1174 men and women aged 18-80 years, selected at random from the population, were studied. Blood pressure, hypertension (blood pressure readings >or=140/90 mm Hg or use of blood pressure-lowering agents), risk factors for hypertension and depression according to the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) were investigated in home interviews. The prevalence of major depression and hypertension were 12.4% (95% confidence interval (CI): 10.5-14.3) and 34.7% (95% CI: 32.2-37.4), respectively. Systolic and diastolic blood pressures of individuals with and without a lifetime episode of depression were not different after adjustment for age and gender. Lifetime episodic major depression was not associated with hypertension in bivariate analysis (risk ratios (RR): 0.96, 95% CI: 0.76-1.23) and after adjustment for confounding (RR: 1.15; 95% CI:0.75-1.76). Hypertension and depression were not associated in this free-living population of adults, suggesting that their concomitant occurrence in clinical practice may be ascribed to chance.

Stopping oral contraceptives: an effective blood pressure-lowering intervention in women with hypertension

The association of combined oral contraceptives (OC) with higher blood pressure (BP) may be attenuated with pills with smaller doses of oestrogen. The effect of stopping OC on BP of patients with hypertension was not described to date. In a cohort study of patients with hypertension, we identified 72 women using OC among 2112 patients seen from 1989 to 2002. Stopping hormonal contraception was recommended to all. The main outcome measurement was BP change in women who stopped (n=44) and who did not stop (n=28) OC, adjusting for baseline BP and age. Odds ratio for having a reduction of at least 20 mmHg in systolic blood pressure (SBP) or 10 mmHg in diastolic blood pressure (DBP), adjusting for age, change in weight and prescription of BP-lowering drugs, were calculated. The mean follow-up time was 6.6+/-7.5 months. Participants who stopped and did not stop OC had similar baseline characteristics. The deltas of SBP (adjusted) were 15.1+/-2.6 mmHg in patients who stopped and 2.8+/-3.2 mmHg in patients who did not stop OC (P=0.004). The corresponding values for DBP were 10.4+/-1.8 and 2.7+/-2.2 mmHg (P=0.008), respectively. The odds ratio (adjusted) for having a decrease of at least 20 mmHg in SBP or 10 mmHg in DBP was 0.28 (95% CI 0.08-0.90) in patients who stopped OC. Stopping OC is an effective antihypertensive intervention in a clinical setting.

Headache is not more frequent among patients with moderate to severe hypertension

The association between hypertension and headache has been a contentious issue. Most studies have showed that mild hypertension and headache are not associated, but this may not be the case in patients with hypertension classified at more severe stages. We investigated the association between hypertension classified at moderate to severe stages and headache in a cross-sectional study conducted in the hypertension clinic of a tertiary care University hospital. In total, 1763 referred patients with a medical diagnosis of hypertension in most cases (95.7%) were evaluated by an extensive protocol questionnaire, detailed physical examination, laboratory examination, and had their blood pressure classified according to the VI Joint National Committee (JNC-VI) recommendation. Logistic regression models were used to explore the association between severity of hypertension and pulse pressure with the presence of headache, controlling for several potential confounders. The complaint of headache was referred by 903 (51.3% of whole sample), and a total of 378 patients (21.4%) were classified at the moderate to severe stage (stage III of the JNC-VI report). The diagnosis of moderate to severe hypertension was not associated with the complaint of headache (OR 1.02, 95% CI from 0.79 to 1.30). Pulse pressure and headache were inversely associated (OR 0.91, 95% CI from 0.86 to 0.97, for 10 mmHg). We concluded that headache and hypertension classified at moderate to severe stages were not associated in patients attending to a hypertension clinic. The novel finding of an inverse association between pulse pressure and headache should be addressed in further investigations.

Efficacy of ropivacaine compared with ropivacaine plus sufentanil for postoperative analgesia after major knee surgery

This study compared the analgesic efficacy of an epidural infusion of ropivacaine and ropivacaine with sufentanil following major knee surgery. In a double-blind clinical trial, 115 adult patients received either epidural ropivacaine (R group, 2 mg.ml(-1)), or ropivacaine (2 mg.ml(-1)) with sufentanil (RS group, 1 microg.ml(-1)), using a patient-controlled epidural analgesia technique. Pain scores (visual analogue scale, VAS, and the simple descriptive scale, SDS), side-effects, motor block and treatment quality were recorded at 6, 12 and 24 h after the insertion of the epidural catheter. In the RS group, analgesic efficacy was significantly greater than in the R group between 12 and 24 h following insertion of the epidural catheter (VAS: 92.9% vs. 72.9%, p = 0.009). There was no significant difference during the other periods. Pruritus, nausea and vomiting were significantly more frequent in the RS group. Good postoperative analgesia was obtained with an epidural infusion of ropivacaine (2 mg.ml(-1)). When this local anaesthetic was administered with sufentanil, there was an improvement in the analgesic effect but a significant increase in the number of patients who reported adverse effects. The differences were more pronounced 12 h after the beginning of the analgesic schedule. This study failed to demonstrate any worthwhile clinical benefit from the addition of sufentanil.

Carriage of gram-negative bacilli in young Brazilian children with community-acquired pneumonia

BACKGROUND

Gram-negative bacilli are not infrequently encountered as etiologic organisms of pneumonia in children in warm-climate countries.

OBJECTIVES

To investigate the nasopharyngeal carriage rate and antimicrobial susceptibility patterns of gram-negative bacilli colonizing children with community-acquired pneumonia in Fortaleza, Brazil.

METHODS

A single nasopharyngeal specimen was collected from children 2 months to 5 years of age presenting at one of the three children's hospitals in Fortaleza and fulfilling the World Health Organization criteria for pneumonia. Randomly recruited healthy children from public daycare centers and immunization clinics served as controls.

RESULTS

The study included 912 children, 482 (53%) with pneumonia and 430 (47%) controls. Aerobic gram-negative bacilli were seen in 79 (16%) of the 482 children with pneumonia and 51 (12%) of the 430 healthy controls. Nonfermentative gram-negative bacilli were seen in 85 (18%) of children with pneumonia and 54 (13%) of healthy controls. Neither gender, nutritional status, season, previous hospital admission nor antibiotic use was associated with carriage with gram-negative bacilli. However, pneumonia was associated with increased carriage, whereas concomitant colonization with Streptococcus pneumoniae or Haemophilus influenzae was associated with decreased carriage with gram-negative bacilli. Only 36% of all Escherichia species and 76% of all Klebsiella isolates were susceptible to cotrimoxazole; 90% of all Acinetobacter species were susceptible to gentamicin.

CONCLUSION

Nasopharyngeal carriage with gram-negative bacilli, in particular with Acinetobacter species, is common and associated with a clinical diagnosis of community-acquired pneumonia in children in Fortaleza, Brazil.

Establishing the prevalence of hypertension. Influence of sampling criteria

OBJECTIVE

To compare the prevalence of systemic hypertension in two different populations: a representative sample of the adult urban population of Porto Alegre, and individuals who sought blood pressure measurement in a hypertension prevention and control campaign.

METHODS

A cross-sectional study was carried out involving a representative sample of the adult urban population of Porto Alegre and a population sample obtained from a hypertension prevention and control campaign, which included all the individuals who sought the blood pressure assessment unit at the Hospital das Clínicas in Porto Alegre. The following parameters were investigated: history of hypertension, use of antihypertensive drugs, age, and sex. Adjustments for age and sex in the prevalence rates were performed to make them comparable.

RESULTS

Hypertension prevalence, defined as values > or =160/95 mmHg or treatment with antihypertensive drugs, was higher in the campaign sample (42%) as compared with the population sample (24%). Among those who were aware of their hypertensive condition and were under medication, 54% of the campaign sample and 62% of the representative population sample maintained their pressure levels <160/90 mmHg.

CONCLUSION

Prevalence rates of hypertension differed a lot in the campaign sample and in the representative population sample, showing that the sampling criterion may influence assessment of risk factors and bias the association between risk factors and health aggravations.

Characteristics associated with the dropout of hypertensive patients followed up in an outpatient referral clinic

OBJECTIVE

To determine the characteristics associated with the dropout of patients followed up in a Brazilian out patient clinic specializing in hypertension.

METHODS

Planned prospective cohort study of patients who were prescribed an antihypertensive treatment after an extensive initial evaluation. The following parameters were analyzed: sex, age, educational level, duration of disease, pressure level used for classifying the patient, previous treatment, physical activity, smoking, alcohol consumption, familial history of hypertension, and lesion in a target organ.

RESULTS

We studied 945 hypertensive patients, 533 (56%) of whom dropped out of the follow-up. The mean age was 52.3+/-12.9 years. The highest probabilities of dropout of the follow-up were associated with current smoking, relative risk of 1.46 (1.04-2.06); educational level equal to or below 5 years of schooling, relative risk of 1.52 (1.11-2.08); and hypertension duration below 5 years, relative risk of 1.78 (1.28-2.48). Age increase was associated with a higher probability of follow-up with a relative risk of 0.98 (0.97-0.99).

CONCLUSION

We identified a group at risk for dropping out the follow-up, which comprised patients with a lower educational level, a recent diagnosis of hypertension, and who were smokers. We think that measures assuring adherence to treatment should be directed to this group of patients.

Behavior of ambulatory blood pressure surrounding episodes of headache in mildly hypertensive patients

BACKGROUND

Headache is usually associated with high blood pressure (BP) despite the lack of evidence of such an association in most observational studies. Ambulatory BP monitoring provides an opportunity to analyze this relation because it permits measurement of BP before, during, and after episodes of headache.

METHODS

We evaluated 76 patients with mild hypertension who underwent clinical evaluation, ambulatory BP monitoring, and questioning about the occurrence of headache and its characteristics during monitoring. The 24-hour BP curves of patients with and without headache during monitoring were compared using analysis of variance for multiple factors and repeated measurements. Hourly averages of BP surrounding the episode and 24-hour mean BP of patients with headache were compared using paired sample t tests.

RESULTS

Twenty-five participants (33%) experienced headache during monitoring. Their 24-hour BP curves did not differ from those of participants without headache. Mean 24-hour BP was not different from BP registered during the episode of headache (mean +/- SD systolic BP: 137.0 +/- 17.3 vs 139.4 +/- 21.1; P =.13; diastolic BP: 83.3 +/- 12.8 vs 85.0 +/- 18.2; P =.30). Blood pressure values registered during the episode of headache and in the hours before and after the episode were not different from each other. Analysis restricted to 8 patients with migrainelike headache showed a similar pattern.

CONCLUSIONS

In patients with mild hypertension, there is no association between the occurrence of headache and variation of BP. Health professionals must discourage patients with hypertension from believing that they can rely on the presence of such a symptom to know about their BP levels.

In vitro effects of antiviral agents on human keratocytes

PURPOSE

To study the effects of antiviral agents on human keratocytes in vitro.

METHODS

Cultured human keratocytes were incubated with either ganciclovir, idoxuridine, trifluridine, or cidofovir at concentrations from 0.0001 to 10 mg/mL. Phase-contrast microscopy and XTT (sodium [2,3-bis [2-methoxy-4-nitro-5-sulphophenyl]-2h-tetrazolium-5-carboxanilide, inner salt) colorimetric assay were performed after 24, 48, and 72 hours of incubation.

RESULTS

When adjustments were made for time of incubation and concentration, trifluridine reduced cell viability significantly more than ganciclovir, idoxuridine, and cidofovir (p<0.001, three-way analysis of variance). There was significant time-and dose-dependent reduction of cell viability (p<0.001) with trifluridine and cidofovir. After a 72-hour incubation with ganciclovir or idoxuridine, cell viability was reduced as compared with 24- and 48-hour incubation (p<0.001); only the effects of the highest concentration tested (1.0 mg/mL) were significantly different from those of the lower concentrations (p<0.002). At a concentration of 1.0 mg/mL, trifluridine and cidofovir produced moderate to severe signs of cytotoxicity, whereas ganciclovir and idoxuridine displayed much less severe morphologic signs.

CONCLUSIONS

Our results indicate that antiviral agents may have both time- and concentration-related toxic effects on stromal keratocytes. These findings may impact the selection of the most appropriate antiviral drug when it is needed to treat infections involving the corneal stroma.

Molecular epidemiology of penicillin-resistant Streptococcus pneumoniae colonizing children with community-acquired pneumonia and children attending day-care centres in Fortaleza, Brazil

To study clonal diversity of penicillin-resistant Streptococcus pneumoniae, 161 randomly selected isolates with reduced susceptibility to penicillin, collected from the nasopharynx of children under 5 years of age with community-acquired pneumonia and healthy controls from public day-care and immunization centres in Fortaleza, Brazil, were characterized by microbiological and serological techniques and automated ribotyping. Also included were 44 randomly selected penicillin-susceptible strains and three international reference strains. With automated ribotyping 75 ribopatterns were observed: 50 ribogroups were unique and 25 ribogroups were represented by two or more isolates. Genetic diversity was extensive but some degree of genetic homogeneity was found in strains from children with pneumonia, strains from children in day-care centres, isolates with reduced susceptibility to penicillin and isolates expressing 'paediatric' serogroups. Fourteen (56%) clusters contained both isolates with reduced penicillin susceptibility and penicillin-susceptible isolates, suggesting emergence of penicillin resistance. In general, there was a good correlation between ribogroups and serogroups, but 12 (48%) clusters contained isolates with alternative serogroups. Isolates with such alternative serogroups were more often encountered in penicillin-susceptible strains (41%) than in strains with reduced susceptibility to penicillin (7%). Thirty-eight (19%) isolates (including seven penicillin-susceptible strains) showed ribotypes indistinguishable from those of two international epidemic clones of S. pneumoniae: ribogroup 54-S-1 (15 isolates) with a ribopattern characteristic of the 23F multiresistant 'Spanish/USA' clone and ribogroup 74-S-3 (23 isolates) with a pattern similar to that of the 6B multiresistant 'Spanish' clone.

Normal values of echocardiographic measurements. A population-based study

OBJECTIVE

To describe echocardiographic measurements and left ventricular mass in a population sample of healthy adults inhabitants of the urban region of Porto Alegre.

METHODS

An analytical, observational, population-based, cross-sectional study was done. Through a multi-stage probability sample, 114 individuals were selected to be submitted to a M-mode and two-dimensional echocardiogram with color Doppler. The analyses were restricted to healthy participants. Echocardiographic measurements were described by mean, standard deviation, 95 percentile and 95% confidence limits.

RESULTS

A total of 100 healthy participants, with several characteristics similar to those from the original population, had a complete and reliable echocardiographic examination. The measurements of aorta, left atrium, interventricular septum, left ventricle in systole and diastole, left posterior wall and left ventricular mass, adjusted or not for body surface area or height, were significantly higher in males. The right ventricle size was similar among the genders. Several echocardiographic measurements were within standard normal limits. Interventricular septum, left posterior wall and left ventricular mass, adjusted or not for anthropometric measurements, and aortic dimensions had lower mean and range than the reference limits.

CONCLUSION

The means and estimates of distribution for the measurements of interventricular septum, left posterior wall and left ventricular mass found in this survey were lower than those indicated by the international literature and accepted as normal limits.

Familial predisposition to hypertension and the association between urinary sodium excretion and blood pressure in a population-based sample of young adults

The reasons for the inconsistent association between salt consumption and blood pressure levels observed in within-society surveys are not known. A total of 157 normotensive subjects aged 18 to 35 years, selected at random in a cross-sectional population-based survey, answered a structured questionnaire. They were classified as strongly predisposed to hypertension when two or more first-degree relatives had a diagnosis of hypertension. Anthropometric parameters were obtained and sitting blood pressure was determined with aneroid sphygmomanometers. Sodium and potassium excretion was measured by flame spectrophotometry in an overnight urine sample. A positive correlation between blood pressure and urinary sodium excretion was detected only in the group of individuals strongly predisposed to hypertension, both for systolic blood pressure (r = 0.51, P<0.01) and diastolic blood pressure (r = 0.50, P<0.01). In a covariance analysis, after controlling for age, skin color and body mass index, individuals strongly predisposed to hypertension who excreted amounts of sodium above the median of the entire sample had higher systolic and diastolic blood pressure than subjects classified into the remaining conditions. The influence of familial predisposition to hypertension on the association between salt intake and blood pressure may be an additional explanation for the weak association between urinary sodium excretion and blood pressure observed in within-population studies, since it can influence the association between salt consumption and blood pressure in some but not all inhabitants.

Toxicity of topical anesthetic agents to human keratocytes in vivo

PURPOSE

To test the potential toxicity on human keratocytes of topical anesthetic agents used after photorefractive keratectomy (PRK) to reduce or eliminate pain.

SETTING

Department of Ophthalmology, Doheny Eye Institute, University of Southern California, Los Angeles, California, USA.

METHODS

Cultured human keratocytes were incubated with commercially available tetracaine and proparacaine at reduced concentrations of 0.001%, 0.01%, 0.1%, and 0.25%. Evaluations were performed by phase-contrast microscopy and tetrazolium salt colorimetric assay every 2 hours for 12 hours after adding 1 of the anesthetic agents to the media.

RESULTS

After time of incubation and concentration were adjusted, both drugs reduced overall cell viability; however, tetracaine produced a larger decrease in cell viability than proparacaine (P = .008). For both drugs, significant differences were found among concentrations for and across time (P < .001 and P = .004, respectively).

CONCLUSION

Both tetracaine and proparacaine had toxic effects on stromal keratocytes related not only to drug concentrations but also to time exposure. These findings underscore the widespread concern that anesthetic drugs may affect corneal stromal wound healing after PRK.

[Association of various measurements of obesity and the prevalence of hypertension]

PURPOSE

To evaluate the association between body mass index (BMI), waist-hip ratio and waist circumference with the prevalence of hypertension in a representative sample of 1088 adults of Porto Alegre (RS), Brazil.

METHODS

In this cross-sectional survey, subjects were considered as having hypertension if they had systolic blood pressure > or = 160 mmHg or diastolic > or = 90 mmHg, and were considered obese if they had BMI > or = 27 kg/m2, or had a waist-hip-ratio > or = 0.95 cm (men) or 0.80 (women) or had a waist circumference > or = 96 (men) or 92 (women).

RESULTS

Obesity defined by the BMI was associated with hypertension in both genders (RR 1.9, CI 1.0-3.2 in men; RR 2.2, CI 1.3-3.8 in women). The other indices were significantly associated with hypertension just in women.

CONCLUSION

BMI > or = 27.0 kg/m2 was strongly associated with increased odds to have hypertension. Similar magnitude of the association with the other indices indicate their utility to estimate the risk of hypertension.

Alcohol intake and blood pressure: the importance of time elapsed since last drink

BACKGROUND

A positive association of chronic exposure to alcoholic beverages with blood pressure and the prevalence of hypertension has been described in epidemiological surveys, but the influence of time elapsed since last ingestion in this setting was not demonstrated.

DESIGN

A cross-sectional, population-based survey.

METHODS

In total 1089 adults from Porto Alegre, randomly selected from a population-based, multi-stage probability sample, were interviewed at home. The average daily alcohol intake of each subject was calculated taking into account the concentration of ethanol in the beverages (distilled or fermented beverages), and the time elapsed between the last ingestion of ethanol and the moment of blood pressure determination. Standardized sitting blood pressure and anthropometric parameters were collected. The magnitude and shape of the associations were analyzed considering blood pressure as a continuous variable and the prevalence of arbitrarily defined hypertension. Simple and multiple linear regression models, including models to identify nonlinear associations, with quadratic and cubic terms of the amount of alcohol consumed, were employed. Blood pressure means were compared by analysis of variance and analysis of covariance. The association between hypertension and exposure to ethanol was analyzed through logistic regression models, controlling for various potential confounders.

RESULTS

Positive nonlinear associations of the amount of alcohol consumed with blood pressure and the prevalence of hypertension (> or = 160/95 mmHg) were found, independent of age, years of education, smoking, and use of oral contraceptive and antihypertensive drugs. The consumption of 30 g/day ethanol was associated with increases of 1.5 and 2.3 mmHg in diastolic and systolic blood pressures, respectively, for men, and 2.1 and 3.2 mmHg, respectively, for women. The prevalence of hypertension was higher among those ingesting more than 30 g/day (odds ratio = 2.9, P < 0.01). The time elapsed between the last ingestion and blood pressure measurement was independently associated with the prevalence of hypertension. Men with last consumption of alcohol 13-23 h prior to measurement had odds of being hypertensive 2.6 (confidence interval 1.3-5.0) greater than did subjects who had consumed alcoholic beverages 24 h and more before the blood pressure determination. For men, systolic and diastolic blood pressures were lower during the first 3 h after ingestion and increased afterward. Frequency of consumption and type of beverage consumed were not independently associated with level of blood pressure.

CONCLUSION

A time-dependent association between alcohol consumption and effects on blood pressure, demonstrated in experimental studies, was found for free-living individuals selected at random.

Blood pressure effects of antihypertensive drugs and changes in lifestyle in a Brazilian hypertensive cohort

BACKGROUND

The antihypertensive efficacy of drug therapy and of some nonpharmacologic recommendations has been demonstrated in controlled clinical trials, but not in a clinical setting.

OBJECTIVE

To assess the antihypertensive effectiveness of drug therapy and of three nonpharmacologic recommendations (loss of weight, salt-intake restriction, and physical exercise).

DESIGN

A prospectively planned cohort study.

SETTING

A hospital-based hypertensive outpatient clinic.

PATIENTS

We studied 637 patients (65.5% women) with systolic blood pressures above 140 mmHg or diastolic blood pressures above 90 mmHg, corresponding to 76% of 839 patients who were administered a prescription for hypertension and who returned for the first follow-up visit 3.5 months later on average.

METHODS

The nonpharmacologic prescription consisted of salt-intake restriction for all, weight reduction for overweight patients, and practice of aerobic physical exercise for those for whom it was not contraindicated; 60% of the patients were treated with drugs according to standard recommendations. Patients treated with drugs were compared with untreated subjects; for the nonpharmacologic interventions, the groups were compared according to their reported compliances with the recommendations (at least some compliance versus none). The main outcome measures were variations in systolic and diastolic blood pressures between the baseline evaluation and the first follow-up visit and an improvement in prognosis, represented by a favorable change in the classification of the blood pressure (according to Joint National Committee V criteria).

RESULTS

The cohort constituted predominantly low-income, middle-aged, overweight white women, with low-to-moderate hypertension of long duration. The group treated with drugs exhibited the greatest reduction in blood pressure, with clinical significance even discounting the losses in follow-up; the group of patients who reported compliance with the low-energy-intake diet also showed a consistent antihypertensive effect, which was still detectable on the occasion of the third follow-up visit 9 months after the first prescription; reported compliance with a low-sodium diet and practice of physical exercise were not associated with a reduction in blood pressure; among a subset of the patients, reported compliance with the salt-intake-restricted diet did not reduce the amount of sodium to the theoretical antihypertensive threshold. It was not possible to determine whether the lack of an antihypertensive effect of physical exercise for this cohort was secondary to a misreport of the extent of compliance or to an absence of effect of the intensity of training prescribed. The effects of drug therapy and compliance with a low-energy-intake diet were shown to be independent of other interventions or confounders.

CONCLUSION

The antihypertensive effect of drugs demonstrated in well-controlled clinical trials is achievable in clinical practice. The recommendation to lose weight was the only nonpharmacologic intervention with a detectable antihypertensive effect in this cohort. The absence of effect of a low-sodium diet is probably secondary to the insufficient reduction in the amount of salt consumed. The lack of an antihypertensive effect of physical exercise could reflect either a misreported compliance or an absence of effect of the intensity of training recommended in this study.

Effect of topical fluoroquinolones on corneal re-epithelialization after excimer laser keratectomy

PURPOSE

To measure the effects of commercially prepared topical fluoroquinolones on the healing rate of epithelial defects in the rabbit cornea after excimer laser keratectomy.

SETTING

The Doheny Eye Institute and the Department of Ophthalmology, University of Southern California School of Medicine, Los Angeles, California, USA.

METHODS

Twenty-four New Zealand white rabbits had unilateral excimer laser superficial keratectomy to create a circular, central corneal epithelial defect. Following keratectomy, each rabbit was randomly assigned to one of three treatment groups, each consisting of eight rabbits. Each rabbit was treated with one drop of the assigned medication, each hour until epithelialization was complete; Group 1 received ciprofloxacin, Group 2, ofloxacin, and Group 3, preservative-free artificial tears as a control. The epithelial defect was stained with fluorescein and photographed every 12 hours with a cobalt blue filtered light. Planimetric measurements of the wound area were made with an image analysis system.

RESULTS

The control group eyes were re-epithelialized within 84 hours. The fluoroquinolone-treated eyes required 144 hours for complete healing. Both ciprofLoxacin and ofloxacin significantly delayed corneal epithelial healing (P = .0055) compared with the control. Two animals treated with topical ciprofloxacin developed a white precipitate in the area of the epithelial defect; however, the precipitate did not prevent closure of the epithelial defect. No such precipitate was seen with ofloxacin.

CONCLUSION

These data suggest that both ofloxacin and ciprofloxacin influence corneal wound healing in rabbits after laser keratectomy and that their healing rates did not differ. A white precipitate that appeared in the epithelial defect area in some rabbits treated with ciprofloxacin did not prevent closure of the defect.

[Diagnosis of systemic hypertension: evidences that current criteria should be revised]

It has been recommended to take the average of several blood pressure (BP) determinations with a sphygmomanometer to diagnose hypertension, but there is no agreement on the reading numbers.

PURPOSE

Describing the behavior of BP readings taken in three different days to establish the classificatory BP in an outpatient hypertension clinic.

METHOD

In the outpatient hypertension clinic of the Clinical Pharmacology Division of the Hospital de Clínicas de Porto Alegre, we use the mean of six readings taken in three different days to establish the classificatory blood pressure, except for those with very high or low values in the first day. In this report we describe the behavior of BP in 58 patients submitted to this routine.

RESULTS

The mean of systolic (SBP) and diastolic (DBP) blood pressures decreased from the first to the 6th reading (ANOVA for repeated measurements: F = 4.45, P = 0.001 for SBP and F = 5.54, P < 0.001 for DBP). Afterward, the patients were classified into two groups according their first SBP and DBP reading. The decreasing in both SBP and DBP was confined to those with the first measurement in the upper half of the entire group (ANOVA: F = 8.03; P < 0.0001 for SBP and F = 6.33, P < 0.0001 for DBP). Regression to the mean and some reactiveness in the first day are possible explanations for this.

CONCLUSION

These data corroborate that the hypertension diagnosis should not be based in an single blood pressure determination and suggest that the recommendation to diagnose severe hypertension based on high values in the first two readings could misclassify some patients.

Aerosolization of infectious virus by excimer laser

PURPOSE

To determine the potential for aerosolization of infectious virus present within the tear film during excimer laser photoablation of the cornea.

METHODS

Cell monolayers infected with herpes simplex virus or adenovirus, simulating virus-infected corneas, were ablated with the 193-nm excimer laser. Adjacent dishes containing noninfected cell monolayers were subsequently assayed for viral infection.

RESULTS

Viral spread to sentinel dishes occurred with both herpes simplex and adenovirus. The titer of virus present in the infected cell monolayers influenced the likelihood of spread to adjacent dishes. The presence of a vacuum aspiration system appeared to influence the direction of virus spread, with dishes located in the direction of the vacuum most likely to contain virus.

CONCLUSIONS

The potential for aerosolization of infectious virus exists with photoablation using a large-diameter excimer laser beam. Our experimental design, however, does not prove that spread of infectious virus is likely to occur in the clinical setting. Appropriate measures should be taken to reduce the possibility of the spread of virus from the patient to the surgeon, other medical staff, or other patients.

Alcoholic beverage consumption and associated factors in Porto Alegre, a southern Brazilian city: a population-based survey

OBJECTIVE

To describe the pattern of alcoholic beverage consumption and the prevalence of at risk drinking behaviors, as well as their association with demographic and socioeconomic factors in the adult population of Porto Alegre, a southern Brazilian city.

METHOD

In a cross-sectional, population-based, multistage random sampling study, 1,091 (600 female) individuals (92% of those eligible) were selected and interviewed at home. Exposure to alcohol was measured by the CAGE questionnaire and by inquiring about the type, quantity and frequency of alcoholic beverage consumption. An average consumption of 30 g per day or more, a level of exposure associated with health risks, was considered as heavy drinking. Two positive answers to the GAGE questionnaire represented the cutoff for indicating dependence.

RESULTS

The prevalences were: 9.3% (95% CI: 7.6 to 11.0) for dependence, 15.5% (13.4 to 17.7) for heavy drinking and 12.3% (10.4 to 14.2) for daily drinking; 24.1% (21.7 to 26.6) were abstinent. Women consumed alcoholic beverages in lower frequency and amounts than men. The most widely consumed beverages were beer, wine and "cachaça," a Brazilian sugarcane spirit. In a logistic regression model, increasing age, lower education and income, and nonwhite race were associated with heavy drinking and dependence. Households with 3-4 persons were associated with the lowest risk of heavy drinking, but the prevalence of dependence was higher in crowded households. The presence of another heavy drinker or dependent in the household was associated with heavy drinking but not with dependence.

CONCLUSIONS

The study characterized a detailed pattern of alcoholic beverage use and indicated that at risk drinking is an important public health problem in a developing country. The risk factors for heavy drinking and dependence were the same, with the exception of age at starting to drink, heavy drinking or dependence-positive household members.

Study of the usefulness of optic fundi examination of patients with hypertension in a clinical setting

The purpose of this study was to evaluate the usefulness of direct opthalmoscopy by non-opthalmologists in patients with hypertension. In a cross-sectional survey, we analysed the association between optic fundi abnormalities, individually and according to the criteria of Keith and Wagener (KW), with blood pressure and duration of known hypertension in 400 non-diabetic hypertensive patients. The optic fundi abnormalities were more frequent in patients with diastolic blood pressure (DBP) > 105 mm Hg (P = 0.002), SBP > 180 mm Hg (P < 0.0001) and with a duration of known hypertension > 3 years (P = 0.002). The severity of hypertension did not vary in parallel with the KW classes I and II: 34.5% of patients classified as KW I had a diastolic pressure of > 105 mm Hg compared with only 25.3% of those classified as KW II. Class III abnormalities were infrequent (2.5% of the whole cohort). In a logistic regression model, diffuse arteriolar narrowing was associated with DBP (P = 0.002) and age (P < 0.001). Abnormalities of the arteriovenous crossings were associated with SBP (P = 0.001) and duration of disease (P = 0.008). The positive predictive value of any fundoscopic abnormality to estimate the severity of hypertension was 59% and the negative value was 60%. The results of this study demonstrate that optic fundi examination by internists and cardiologists does not give an accurate assessment of the severity of hypertension in most patients, and that the Keith-Wagener classification of retinopathy has a limited applicability.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prevalence of smoking and associated factors in a metropolitan area in the southern region of Brazil]

A cross-sectional study was carried out for the purpose of evaluating, the prevalence of smoking and the factors associated with it in Porto Alegre, a city in southern Brazilian. Through proportional, multiple stage, random sampling, 1.091 individuals (92% of those eligible) of 18 or more years of age, were interviewed at home. Exposure to smoking was measured by a questionnaire that inquired about the type, quantity and frequency of tobacco use. The prevalence of smoking was 34.9% (CI 31.9-37.8). It was higher -among men--41.5% (CI 38.5-44.4) then women--29.5% (CI 26.8-32.2). The former started smoking at mean age of 16 (+/- 5.6), with mode of 15 and smoked an average of 19.0 (+/- 14.0) cigarettes per day. Females started at a mean age of 17.8 (+/- 6.7), with mode of 14 years old and smoked 14.5 (+/- 10.3). The association of the drinking habit and demographic and socioeconomic variables with smoking was evaluated through logistic regression. The variables included in the model were sex, age, education, income, professional qualification and alcohol consumption. The prevalence of smoking was greater for men, individuals of lower socioeconomic level, between 30 and 39 years of age, and among those accustomed to consuming alcoholic beverages. In conclusion, this study demonstrated that smoking is a public health problem in Brazil as in another countries. It is associated with sex, age, education and professional qualification, as has been observed elsewhere. The association of alcohol consumption with smoking may be understood as risk behavior, both having similar determinants.

[Prevalence of systemic arterial hypertension and associated risk factors in the Porto Alegre metropolitan area. Populational-based study]

PURPOSE

To evaluate the contemporaneous prevalence of hypertension in Porto Alegre, RS, and its association with biological, socioeconomic and environmental factors.

METHODS

It was done an observational and analytical study with a cross-sectional design, of a representative sample of the adults of the urban region. The study was planned with a power to describe the main estimates with 0.5% confidence limits of +/- 2%. One thousand and ninety one individuals, selected at random in conglomerates and in a multiple stage process, were interviewed. The data were obtained in the domiciles through standardized questionnaires and physical examination.

RESULTS

The prevalence of hypertension, defined by blood pressure (BP) > or = 160/95 mmHg, was 12.6% (CI = 10.6 to 14.6). Considering as hypertensives the individuals with BP < 160/95 mmHg under drug treatment, the prevalence increased to 19.2% (CI = 16.9 to 21.5). The corresponding figures for the 140/90 mmHg criteria were 25.8% (CI = 23.2 to 28.4) and 29.8% (CI = 27.1 to 32.5). Among those using anti-hypertensive drugs (11%), 58.9 had BP < 160/95 mmHg and 35.5% < 140/90 mmHg; 57.7% of the hypertensives (160/95 criteria) were aware of diagnosis; 28% had body mass index above 27kg/m2, 15.5% consumed more than 30g per day of ethanol, 35.1% were smokers, and 17.8% ex-smokers. The prevalence increased with age and was higher in individuals with obesity, strong family history of hypertension, low education and in those which abused from alcoholic beverages. In a logistic regression model, these putative risk factors showed to be independent of others.

CONCLUSION

The contemporaneous prevalence of hypertension in Porto Alegre demonstrates that the prevalence rates have not decreased in the last 15 years. It was also shown an inadequate BP control in almost 50% of those under drug treatment, and finally, the association of hypertension with well-known risk factors.

Infant feeding and deaths due to diarrhea. A case-control study

The association between infant feeding habits and infant mortality from diarrhea was investigated in a population-based case-control study in two urban areas in southern Brazil during 1985. Each of 170 infants who died due to diarrhea was compared with two neighborhood controls. After allowance was made for confounding variables, infants who received powdered milk or cow's milk, in addition to breast milk, were at 4.2 times (95% confidence interval (CI) 1.7-10.1) the risk of death from diarrhea compared with infants who did not receive artificial milk, while the risk for infants who did not receive any breast milk was 14.2 times higher (95% CI 5.9-34.1). Similar results were obtained when infants who died from diarrhea were compared with infants who died from diseases that were presumed to be due to noninfectious causes. Each additional daily breast feed reduced the risk of diarrhea death by 20% (95% CI 2-34%), but the increase in risk associated with each bottle feed was not significant after allowance was made for the number of breast feeds. The only other consumption variable associated with diarrhea mortality was the frequency with which tea, water, or juice were drunk with each feed (increase in risk, 42% (95% CI 4-93%]. The odds ratios associated with nonbreast milk were highest in the first two months of life. Possible biases were investigated, including the interruption of breast-feeding as an early consequence of the terminal illness, but the strong protective effect of breast-feeding persisted after these adjustments.

Water supply, sanitation and housing in relation to the risk of infant mortality from diarrhoea

In a population-based case-control study in the metropolitan areas of Porto Alegre and Pelotas in southern Brazil children dying in infancy from diarrhoea were compared to neighbourhood controls in terms of several social and environmental variables. Factors found to be significantly associated with an increased risk of death from diarrhoea included the non-availability of piped water, the absence of a flush toilet, residence in a poorly built house and household overcrowding. When adjustment was made for confounding variables and the mutual confounding effect of the environmental variables on each other, the only association that remained statistically significant was that with the availability of piped water. The association with poor housing was almost significant (p = 0.052). Compared to those with water piped to their house, those without easy access to piped water were found to be 4.8 times more likely to suffer infant death from diarrhoea (95% confidence interval 1.7 to 13.8) and those with water piped to their plot but not to their house had a 1.5 times greater risk (95% confidence interval 0.8 to 3.0).

Influence of birth weight on mortality from infectious diseases: a case-control study

The association between birth weight and infant mortality from infectious diseases was investigated in a population-based case-control study in two urban areas in southern Brazil. All deaths of children, seven to 364 days of age, occurring in a year were studied and the parents of the 357 infants dying of an infectious cause were interviewed, as were the parents of two neighborhood control infants for each case. Low birth weight infants (less than 2,500 g) were found, after allowing for confounding factors, to be 2.3 (90% confidence interval = 1.6 to 3.4) times more likely to die of an infection than those of higher birth weight. The odds ratios were 2.0 (1.1 to 3.6) for deaths due to diarrhea, 1.9 (1.0 to 3.6) for respiratory infections, and 5.0 (1.3 to 18.6) for other infections. These estimates of the risks associated with low birth weight are considerably lower than those from studies in developed countries.

[Epidemiology of sudden infant deaths in cities of Rio Grande do Sul (Brazil)]

Foram investigados os óbitos infantis pós-perinatais ocorridos no período de um ano, em 10 cidades gaúchas, incluindo a região metropolitana de Porto Alegre, por meio de estudo de casos e controles. Setenta e duas mortes súbitas na infância (MSI) foram identificadas através de amplo sistema de monitorização de óbitos e investigadas em pormenores através de entrevistas médicas com os pais da criança e revisão de prontuários ambulatoriais e hospitalares. Os óbitos foram mais comuns em meninos, no primeiro trimestre de vida e durante o inverno. A comparação de cada caso de MSI com duas crianças-controle da mesma vizinhança, através de regressão logística condicional múltipla, identificou os seguintes fatores de risco: baixo nível socioeconômico (medido através da renda familiar e da escolaridade materna), baixo peso ao nascer, presença de outras crianças no domicílio, mães jovens e fumantes e aleitamento misto ou artificial. Nenhuma das 72 MSI foi reconhecida como tal pelos médicos que preencheram os atestados de óbito, sendo as mesmas atribuídas predominantemente a "broncopneumonias".

Evidence for protection by breast-feeding against infant deaths from infectious diseases in Brazil

In a population-based case-control study of infant mortality in two urban areas of southern Brazil, the type of milk in an infant's diet was found to be an important risk factor for deaths from diarrhoeal and respiratory infections. Compared with infants who were breast-fed with no milk supplements, and after adjusting for confounding variables, those completely weaned had 14.2 and 3.6 times the risk of death from diarrhoea and respiratory infections, respectively. Part-weaning was associated with corresponding relative risks (RR) of 4.2 and 1.6. The risk of death from infections other than diarrhoea or respiratory infection was less clearly associated with breast-feeding (completely weaned, RR = 2.5; partly weaned, RR = 0.4). Cow's and formula milk seemed to be equally hazardous. For deaths due to diarrhoea the increased risk associated with not breast-feeding was greatest in the first two months of life (RR for completely weaned vs breast-fed without supplementary milk = 23.3).