Factors associated with non-adoption of healthy behavior among individuals with diabetes: a population-based study in Brazil

BACKGROUND

The non-adoption of behavioral changes to control diabetes mellitus contributes to a low adherence to self-care. This study aimed to investigate the factors associated with non-adoption of healthy behaviors among diabetic individuals.

METHODS

Cross-sectional study using data from the National Health Survey (Pesquisa Nacional de Saúde) carried out in 2013 in Brazil, with adults (≥18 years) (n = 3098). The outcome variable was the non-adoption-two or fewer-of healthy behaviors. Logistic regression model was used to identify the factors associated with non-adoption of healthy behaviors.

RESULTS

Approximately, 50% of the participants adopted two or fewer healthy habits and the most frequently mentioned were not drinking excessively (94.1%) and not smoking (89.1%). Not using diabetic medication (odds ratio (OR) = 1.37, 95% confidence interval (CI) = 1.02-1.85), not making regular doctor visits (OR = 1.42, 95% CI = 1.08-1.87), no limitation of usual activities (OR = 1.39, 95% CI = 1.01-1.94) and good self-rated health (OR = 1.47, 95% CI = 1.09-1.98) increased the chance of individuals non-adoption of healthy behaviors independently of gender, age, schooling and economic status.

CONCLUSIONS

Health professionals need to be aware of issues, such as diabetic medication use, frequency of doctor visits, limitation of usual activities and good self-rated health, which are factors that can interfere with the adoption of healthy behaviors of diabetic patients.

Excess mortality associated with COVID-19 in Brazil: 2020-2021

OBJECTIVE

To evaluate excess mortality in Brazil from January 2020 to April 2021, according to the primary causes of death registered in the Brazilian Mortality Information System (MIS).

METHODS

Cross-sectional study with data extracted from the MIS. Excess deaths were examined by the primary cause of death according to 11 grouped causes. Autoregressive models used mortality data from 2015 to 2019 to predict expected deaths from January 2020 to April 2021. Excess deaths were calculated as the difference between the observed and the expected number of deaths.

RESULTS

Total excess deaths of 370 055 were observed in the studied period, corresponding to a ratio of observed to expected of 1.14 in 2020 and 1.40 in 2021. Excess deaths were seen in three groups: symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified; other diseases of the respiratory system and coronavirus infection, unspecified site.

CONCLUSIONS

The excess mortality in Brazil in these 16 months was 1.20 times greater than the previous year. The increase in not elsewhere classified causes and causes of death associated to COVID-19 indicate caution about the negative balance for some causes. Furthermore, the inequalities of mortality reporting systems in low- and middle-income countries in relation to underestimation of mortality still need to be addressed.

The association between alcohol consumption and self-reported current depression among adults residing in Brazil

BACKGROUND

The purpose of the current study was to investigate the association between binge and heavy drinking and self-reported current depression (SRCD) in a representative population-based sample of adults residing in Brazil.

METHODS

The sample for this study was based on the 2013 Brazilian National Health Survey. SRCD was accessed using the Patient Health Questionnaire (PHQ-8), a valid eight-item depression measure for population-based studies instrument. The association between binge/heavy drinking and SRCD was investigated using weighted and adjusted multivariable logistic regression models.

RESULTS

Out of the final study sample of 59 399 Brazilians, 47.2% were young adults, 34.6% were middle age adults and 52.4% were females. The prevalence of binge drinking was 13.8%, of heavy drinking was 3.2% and SRCD was 7.6%. There was a significant weighted and adjusted association between binge drinking and SRCD among young and middle age females (OR = 1.5, 95% CI:1.1-2.0 and OR = 0.6, 95% CI:0.4-0.8, respectively) and between heavy drinking and SRCD among young and middle age males (OR = 1.8, 95% CI:1.2-2.8 and OR = 2.5, 95% CI:1.5-4.1, respectively).

CONCLUSIONS

The possible protective factor of binge drinking for SRCD among middle-aged Brazilian females needs to be further investigated and understood. Longitudinal research is needed to provide further evidence of associations found in this study.

Hypertensive disorders in pregnancy: frequency and associated factors in a cohort of Brazilian women

OBJECTIVE

To evaluate the frequency of and risk factors associated with hypertensive disorders in general antenatal care in five distinct areas of Brazil.

METHODS

We performed a cohort study of 4892 women enrolled in midpregnancy from 1991 to 1995. Patients were queried at enrollment about hypertension prior to pregnancy. Medical diagnoses of hypertensive disorders in pregnancy were abstracted from patient records. Hypertensive disorders in pregnancy were classified according to recommendations of the American College of Obstetrics and Gynecology (ACOG).

RESULTS

Of 4892 women studied, 367 (7.5%) presented hypertensive disorders, 113 (2.3%) being preeclampsia/eclampsia and 198 (4.0%) chronic hypertension. Frequencies of superimposed preeclampsia/eclampsia and transitory hypertension were 0.5% and 0.7%, respectively. Greater brachial arm circumference was strongly associated both with preeclampsia/eclampsia and with chronic hypertension (threefold difference across extreme quartiles, p < or =0.001). In adjusted analyses, being older, black, and obese were important and statistically significant risk factors for chronic hypertension. Similarly, nulliparity was a statistically significant risk factor for preeclampsia/eclampsia, and tendencies toward increased risk were seen for older, black, and obese women in adjusted analyses. Preeclampsia/eclampsia and chronic hypertension were notably less frequent in Manaus, although regional differences were statistically significant only for chronic hypertension.

CONCLUSIONS

Hypertensive disorders commonly complicate pregnancy in Brazilian women. Risk factors for these disorders appear similar to those reported in other countries. Use of an inappropriately sized cuff to measure blood pressure may result in many false-positive diagnoses in more obese women. The considerably lower frequency of hypertensive disorders found in Manaus, in the Amazon region, warrants further study.

Nutritional status of pregnant women: prevalence and associated pregnancy outcomes

INTRODUCTION

Although obesity is well recognized as a current public health problem, its prevalence and impact among pregnant women have been less investigated in Brazil. The objective of the study was to evaluate the impact of pre-obesity and obesity among pregnant women, describing its prevalence and risk factors, and their association with adverse pregnancy outcomes.

METHODS

A cohort of 5,564 pregnant women, aged 20 years or more, enrolled at approximately 20 to 28 weeks of pregnancy, seen in prenatal public clinics of six state capitals in Brazil were followed up, between 1991 and 1995. Prepregnancy weight, age, educational level and parity were obtained from a standard questionnaire. Height was measured in duplicate and the interviewer assigned the skin color. Nutritional status was defined using body mass index (BMI), according to World Health Organization (WHO) criteria. Odds ratios and 95% confidence interval were calculated using logistic regression.

RESULTS

Age-adjusted prevalences (and 95% CI) based on prepregnancy weight were: underweight 5.7% (5.1%-6.3%), overweight 19.2% (18.1%-20.3%), and obesity 5.5% (4.9%-6.2%). Obesity was more frequently observed in older black women, with a lower educational level and multiparous. Obese women had higher frequencies of gestational diabetes, macrosomia, hypertensive disorders, and lower risk of microsomia.

CONCLUSIONS

Overweight nutritional status (obesity and pre-obesity) was seen in 25% of adult pregnant women and it was associated with increased risk for several adverse pregnancy outcomes, such as gestational diabetes and pre-eclampsia.

Fasting plasma glucose is a useful test for the detection of gestational diabetes. Brazilian Study of Gestational Diabetes (EBDG) Working Group

OBJECTIVE

To evaluate fasting plasma glucose as a screening test for states of gestational diabetes.

RESEARCH DESIGN AND METHODS

Baseline data of a cohort conducted in general prenatal care units in Brazil, enrolling 5,579 women aged > or = 20 years with gestational ages of 24-28 weeks at the time of testing and no previous diagnosis of diabetes. A standardized 2-h 75-g oral glucose tolerance test was performed in 5,010 women. Gestational diabetes and its subcategories--diabetes and impaired glucose tolerance--were defined according to the 1994 World Health Organization panel recommendations. We evaluated screening properties of calculated sensitivity and specificity for fasting plasma glucose with receiver operator characteristic curves.

RESULTS

For detection of the subcategory diabetes, a fasting plasma glucose of 89 mg/dl jointly maximizes sensitivity (88%) and specificity (78%), identifying 22% of the women as test-positive. For detection of impaired glucose tolerance, a value of 85 mg/dl jointly maximizes sensitivity and specificity (68%), identifying as test-positive 35% of the women. Lowering the cut point to 81 mg/dl increases sensitivity to 81%, but decreases specificity to 54%, labeling as test-positive 49% of the women.

CONCLUSIONS

Fasting plasma glucose is a useful test for the screening of both subcategories of gestational diabetes, a threshold of 85 mg/dl being an acceptable option. Effective screening for the subcategory diabetes can be achieved using a cut point of 89 mg/dl. If greater emphasis is placed on the detection of impaired glucose tolerance, a lower value, 81 mg/dl, may be needed.