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PURPOSE: Understanding the relationship between antithyroperoxidase antibodies (TPOAb) and carotid intima-media thickness (cIMT) could provide insights into the mechanisms linking thyroid autoimmunity and cardiovascular disease. We aimed to explore the association of multiple categories of TPOAb with the increased cIMT at baseline and at follow-up in participants from the ELSA-Brasil Study. METHODS: This prospective cohort study analyzed data from 9,264 participants (51.5 ± 8.9 years old, 55.9% women) without a history of cardiovascular disease. Fasting serum TPOAb levels were determined. Values of cIMT equal to or above one deviation standard of the sample's mean were classified as increased cIMT at baseline. The increased cIMT after the 8-year follow-up was calculated after excluding participants with increased cIMT at baseline. Multivariate analyses were done using binary logistic and Poisson regression models. RESULTS: The increased cIMT was prevalent in 14.3% of the participants at baseline and its development occurred in 16.8% participants during the cohort. After adjustment for all confounder variables, TPOAb detectability (OR = 1.84, 95%CI = 1.21-2.79), and low detectable (OR = 1.81, 95%CI = 1.18-2.75), high detectable (OR = 2.01, 95%CI = 1.29-3.11) and positive (OR = 1.70, 95%CI = 1.07-2.70) TPOAb were positively associated with increased cIMT at baseline. The associations of low and high detectable TPOAb and increased cIMT at baseline were consistent when excluding those with thyroid dysfunction. There was no statistically significant association between TPOAb levels and increased cIMT at follow-up (p > 0.05), neither for all sample nor for euthyroid individuals. CONCLUSION: Different levels of TPOAb, including its detectability, were associated with increased cIMT at baseline in the studied sample. We highlight that may be relevant to consider the levels of TPOAb detectability as possible marker of increased cardiovascular risk.
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The association of thyroid function with essential and non-essential amino acids is understudied, despite their common metabolic roles. Thus, our aim was to evaluate the association of thyroid function with the levels of branched-chain amino acids (BCAAs-leucine, isoleucine, and valine) and of alanine in the general population. We utilized data from the São Paulo research center of ELSA-Brasil, a longitudinal population-based cohort study. Thyroid parameters included thyroid stimulating hormone (TSH), free T4 and free T3 levels, and the FT4:FT3 ratio. BCAAs and alanine were analyzed on a fully automated NMR platform. The current analysis included euthyroid participants and participants with subclinical hyperthyroidism and hypothyroidism. We used Pearson's coefficient to quantify the correlation between thyroid-related parameters and amino acids. Linear regression models were performed to analyze whether thyroid parameters were associated with BCAAs and alanine levels. We included 4098 participants (51.3 ± 9.0 years old, 51.5% women) in this study. In the most adjusted model, higher levels of TSH were associated with higher levels of alanine, FT4 levels were inversely associated with isoleucine levels, FT3 levels were statistically significant and positively associated with valine and leucine, and the T3:T4 ratio was positively associated with all amino acids. We observed that subclinical hypothyroidism was positively associated with isoleucine and alanine levels in all models, even after full adjustment. Our findings highlight the association of subclinical hypothyroidism and thyroid-related parameters (including TSH, free T4, free T3, and FT4:FT3 ratio) with BCAAs and alanine. Further studies are needed to explore the mechanisms underlying this association. These insights contribute to our understanding of the influence of thyroid-related parameters on BCAA and alanine metabolism.
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Objective: To evaluate the association of TSH, free T3 (FT3), free T4 (FT4), and conversion (FT3:FT4) ratio values with incident hypertension. Materials and methods: The study included data from participants of the ELSA-Brasil study without baseline hypertension. Serum TSH, FT4 and FT3 levels, and FT3:FT4 ratio values were assessed at baseline, and incident hypertension (defined by blood pressure levels ≥ 140/90 mmHg) was estimated over a median of 8.2 years of follow-up. The risk of incident hypertension was evaluated considering a 1-unit increase in TSH, FT4, FT3, and conversion ratio values and after dividing these variables into quintiles for further analysis using Poisson regression with robust variance. The results are presented as relative risks (RR) and 95% confidence intervals (CIs) before and after adjustment for multiple variables. Results: The primary analysis incorporated data from 5,915 euthyroid individuals, and the secondary analysis combined data from all euthyroid individuals, 587 individuals with subclinical hypothyroidism, and 31 individuals with subclinical hyperthyroidism. The rate of incident hypertension was 28% (95% CI: 27%-29.3%). The FT4 levels in the first quintile (0.18-1.06 ng/dL) were significantly associated with incident hypertension (RR: 1.03, 95% CI: 1.01-1.06) at follow-up. The association between FT4 levels in the first quintile and incident hypertension was also observed in the analysis of combined data from euthyroid individuals and participants with subclinical thyroid dysfunction (RR: 1.04, 95% CI: 1.01-1.07). The associations were predominantly observed with systolic blood pressure levels in euthyroid individuals. However, in the combined analysis incorporating euthyroid participants and individuals with subclinical thyroid dysfunction, the associations were more pronounced with diastolic blood pressure levels. Conclusion: Low FT4 levels may be a mild risk factor for incident hypertension in euthyroid individuals and persons with subclinical thyroid dysfunction.
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Hipertensión , Tirotropina , Tiroxina , Triyodotironina , Humanos , Hipertensión/epidemiología , Hipertensión/sangre , Masculino , Femenino , Brasil/epidemiología , Persona de Mediana Edad , Estudios Prospectivos , Estudios Longitudinales , Adulto , Tirotropina/sangre , Incidencia , Tiroxina/sangre , Triyodotironina/sangre , Hipertiroidismo/sangre , Hipertiroidismo/epidemiología , Hipotiroidismo/sangre , Hipotiroidismo/epidemiología , Factores de Riesgo , Pruebas de Función de la Tiroides , AncianoRESUMEN
CONTEXT: The presence of thyroid peroxidase antibodies (TPOAbs) may be considered as an indicator of adverse health outcomes. OBJECTIVE: We aimed to investigate the potential determinants of TPOAb levels and to analyze the association between TPOAb titers and the risk of all- and specific-cause mortality. METHODS: Baseline and longitudinal data of 13 187 participants from the ELSA-Brasil Study were analyzed. We investigated the association of TPOAb, detectability, positivity, and persistent positivity with sociodemographic and lifestyle factors using logistic regressions. Cox proportional hazards and Fine-Gray subdistribution hazard regression analyses were used to verify the association of TPOAbs with mortality. RESULTS: The determinants of TPOAb detectability and positivity were younger age, higher body mass index, female sex, and former and current smoking status. Black, mixed, and other self-reported races, intermediate and higher education, and heavy drinking were determinants of detectable and positive TPOAb levels. Female sex, White race, and former smoking were determinants of persistent TPOAb positivity at 2 visits, although only the female sex maintained its association at 3 visits. Moreover, after multivariate adjustment, there were associations between higher levels of TPOAbs and higher risk of cancer-related mortality among men, and TPOAb detectability and mortality by other causes among women. CONCLUSION: Sociodemographic and lifestyle-related factors were determinants of multiple TPOAb categories. TPOAb levels were associated with mortality risk; however, the low mortality rate in this sample might have compromised this finding. We suggest further studies to explore the clinical importance of detectable TPOAb levels, not only its positivity, as a potential marker of inflammation.
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Autoanticuerpos , Yoduro Peroxidasa , Masculino , Humanos , Femenino , Brasil/epidemiologíaRESUMEN
ABSTRACT Objective: To evaluate the association of TSH, free T3 (FT3), free T4 (FT4), and conversion (FT3:FT4) ratio values with incident hypertension. Materials and methods: The study included data from participants of the ELSA-Brasil study without baseline hypertension. Serum TSH, FT4 and FT3 levels, and FT3:FT4 ratio values were assessed at baseline, and incident hypertension (defined by blood pressure levels ≥ 140/90 mmHg) was estimated over a median of 8.2 years of follow-up. The risk of incident hypertension was evaluated considering a 1-unit increase in TSH, FT4, FT3, and conversion ratio values and after dividing these variables into quintiles for further analysis using Poisson regression with robust variance. The results are presented as relative risks (RR) and 95% confidence intervals (CIs) before and after adjustment for multiple variables. Results: The primary analysis incorporated data from 5,915 euthyroid individuals, and the secondary analysis combined data from all euthyroid individuals, 587 individuals with subclinical hypothyroidism, and 31 individuals with subclinical hyperthyroidism. The rate of incident hypertension was 28% (95% CI: 27%-29.3%). The FT4 levels in the first quintile (0.18-1.06 ng/dL) were significantly associated with incident hypertension (RR: 1.03, 95% CI: 1.01-1.06) at follow-up. The association between FT4 levels in the first quintile and incident hypertension was also observed in the analysis of combined data from euthyroid individuals and participants with subclinical thyroid dysfunction (RR: 1.04, 95% CI: 1.01-1.07). The associations were predominantly observed with systolic blood pressure levels in euthyroid individuals. However, in the combined analysis incorporating euthyroid participants and individuals with subclinical thyroid dysfunction, the associations were more pronounced with diastolic blood pressure levels. Conclusion: Low FT4 levels may be a mild risk factor for incident hypertension in euthyroid individuals and persons with subclinical thyroid dysfunction.
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Elevated levels of glycoprotein acetylation (GlycA) and C-reactive protein (CRP) have been associated with carotid artery plaque (CAP). However, it is not yet established if elevations in both inflammatory biomarkers provide incremental association with CAP. This study aimed evaluate the cross-sectional association of high CRP and GlycA with CAP at baseline participants from the ELSA-Brasil adult cohort. Participants with information on CRP, GlycA, and CAP with neither previous cardiovascular disease nor CRP >10 mg/L were included. High GlycA and CRP were defined as values within upper quintile and >3 mg/L, respectively. Participants were classified into 4 groups: 1. nonelevated CRP/GlycA (reference group); 2. elevated CRP alone; 3. elevated GlycA alone; and 4. both elevated. The analysis included 4,126 participants with median age of 50 years-old, being 54.2% of women. Prevalence of CAP was 36.1%. Participants with high CRP had the highest frequency of obesity, whereas participants with high GlycA presented higher cardiovascular risk factor burden and were more likely to have CAP than the reference group (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.11 to 1.73), persisting after multivariable adjustment (OR 1.37, 95% CI 1.02 to 1.83). Participants with both elevated CRP and GlycA were more likely to have CAP in crude (OR 1.35, 95% CI 1.10 to 1.65) but not in adjusted models. The findings suggest potential different biologic pathways between inflammation and carotid atherosclerosis: high GlycA was associated with CAP whereas high CRP was more associated with obesity.
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Proteína C-Reactiva , Estenosis Carotídea , Adulto , Femenino , Humanos , Persona de Mediana Edad , Acetilación , Biomarcadores , Proteína C-Reactiva/análisis , Estudios Transversales , Glicoproteínas , Inflamación , Obesidad , Factores de Riesgo , MasculinoRESUMEN
Objective: To determine the relationship between psoriasis, thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triodothyronine (FT3), thyroid peroxidase antibodies (TPOAb), and subclinical thyroid dysfunctions in middle-aged and older adults. Materials and methods: Cross-sectional analyses included a self-reported medical diagnosis of psoriasis and thyroid function from the 3rd visit (2017-2019) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). TSH, FT4, and FT3 levels were analyzed as continuous variables and quintiles, and TPOAb positivity and subclinical hypothyroidism as a yes/no variable. Logistic regression models were built as crude and adjusted by main confounders (age, sex, education level, race/ethnicity, and smoking). Results: From 9,649 participants (52.3% women; 59.2 ± 8.7 years old), the prevalence of psoriasis was 2.8% (n = 270). TSH, FT4, TPOAb positivity, and subclinical hypothyroidism were not associated with psoriasis in the main analyses. In the stratified analysis, our findings showed positive associations of the lowest (OR = 2.01; 95% CI 1.05-3.84; p = 0.036) and the highest (OR = 2.13; 95% CI 1.12-4.05; p = 0.022) quintiles of FT4 and a protective association of TPOAb positivity (OR = 0.43; 95% CI 0.19-0.98; p = 0.046) with prevalent psoriasis in women. In the logistic regression for FT3, participants in the 1st quintile showed a statistically significant association with psoriasis for the whole sample (OR = 1.66; 95% CI 1.11-2.46; p = 0.013) and for men (OR = 2.25; 95% CI 1.25-4.04; p = 0.007) in the sex-stratified analysis. Conclusions: The present study showed that the association of FT4 levels with psoriasis are different according to sex, with a possible U-shaped curve in women but not in men. Although there were some associations of FT3 with psoriasis, they may be a consequence of non-thyroidal illness syndrome. Further prospective data may clarify the association of thyroid function and psoriasis.
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Hipotiroidismo , Psoriasis , Masculino , Persona de Mediana Edad , Humanos , Femenino , Anciano , Estudios Longitudinales , Brasil/epidemiología , Estudios Transversales , Hipotiroidismo/epidemiología , Tirotropina , Psoriasis/epidemiología , Tiroxina , Pruebas de Función de la Tiroides , TriyodotironinaRESUMEN
OBJECTIVE: This study investigated the association of psoriasis with cardiovascular risk factors and psychological aspects among participants of the Brazilian Longitudinal Study of Adult Health. METHODS: This is a cross-sectional study from the baseline data of the Brazilian Longitudinal Study of Adult Health cohort, collected between 2008 and 2010 in six state capitals of Brazil (i.e., Belo Horizonte, Porto Alegre, Rio de Janeiro, Salvador, São Paulo, and Vitória). Participants were active and retired civil servants from college and research institutions, aged between 35 and 74 years. Exclusion criteria included the intention to quit working at the institution, pregnancy, severe cognitive impairment, and, if retired, residence outside of a study center's corresponding area. Psoriasis case identification was based on a previous medical diagnosis of psoriasis. Cardiovascular risk profile, psychological aspects, and sociodemographic variables were investigated. RESULTS: Data from 15,105 participants were analyzed (mean age of 52.3 years, 51.3% women). The prevalence of psoriasis was 1.6% (n=236). Psoriasis was associated with higher education (OR 1.94 [CI 1.07-3.52]), health insurance plan (OR 1.56 [CI 1.08-2.25]), central obesity (OR 1.63 [CI 1.10-2.40]), smoking status (former OR 1.40 [CI 1.03-1.88]; current OR 1.61 [CI 1.08-2.40]), and very bad self-perception of health (OR 7.22 [CI 2.41-21.64]), remaining significant even after multivariate adjustment. Self-reported Black participants were less likely to have psoriasis (OR 0.45 [CI 0.26-0.75]). CONCLUSION: In a sample of healthy workers, psoriasis was associated with central obesity, smoking, and a very bad self-perception of health, which may contribute to future cardiovascular disease.
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Obesidad Abdominal , Fumar , Embarazo , Adulto , Humanos , Femenino , Persona de Mediana Edad , Anciano , Masculino , Estudios Transversales , Brasil/epidemiología , Estudios Longitudinales , Fumar/efectos adversos , Obesidad/complicaciones , Obesidad/epidemiología , Factores de RiesgoRESUMEN
There is a lack of consensus about the association between psoriasis (PSO) and carotid intima-media thickness (cIMT) in literature, since previous studies considered dermatologic clinic patients or general population. This study aimed to compare cIMT levels according to PSO in a sample of 10,530 civil servants form the ELSA-Brasil cohort study and analyze its association with the disease. The PSO cases and disease duration were identified by medical diagnosis self-reported at study enrollment. A paired group was identified by propensity score matching among all the participants without PSO. Mean cIMT values were considered for continuous analysis while cIMT above 75th percentile was considered for categorical analysis. Multivariate conditional regression models were used to analyze association between cIMT and PSO diagnosis, by comparing PSO cases against paired controls and overall sample without disease. A total of n = 162 PSO cases were identified (1.54%) and no difference in cIMT values was observed between participants with PSO and overall sample or control group. PSO was not associated with linear increment of cIMT (vs. overall sample: ß = 0.003, p = 0.690; vs. matched controls: ß = 0.004, p = 0.633) neither with increased chance of having cIMT above 75th percentile (vs. overall sample: OR = 1.06, p = 0.777; vs. matched controls: OR = 1.19, p = 0.432; conditional regression: OR = 1.31, p = 0.254). There was no relationship between disease duration and cIMT (ß = 0.000, p = 0.627). Although no significant relationship between mild cases of psoriasis and cIMT was observed among a wide cohort of civil servants, longitudinal investigation about cIMT progression and severity of disease are still needed.
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Grosor Intima-Media Carotídeo , Humanos , Adulto , Estudios de Cohortes , Factores de Riesgo , Estudios Longitudinales , Estudios de Casos y Controles , Valor Predictivo de las PruebasRESUMEN
ABSTRACT Objective: To determine the relationship between psoriasis, thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triodothyronine (FT3), thyroid peroxidase antibodies (TPOAb), and subclinical thyroid dysfunctions in middle-aged and older adults. Materials and methods: Cross-sectional analyses included a self-reported medical diagnosis of psoriasis and thyroid function from the 3rd visit (2017-2019) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). TSH, FT4, and FT3 levels were analyzed as continuous variables and quintiles, and TPOAb positivity and subclinical hypothyroidism as a yes/no variable. Logistic regression models were built as crude and adjusted by main confounders (age, sex, education level, race/ethnicity, and smoking). Results: From 9,649 participants (52.3% women; 59.2 ± 8.7 years old), the prevalence of psoriasis was 2.8% (n = 270). TSH, FT4, TPOAb positivity, and subclinical hypothyroidism were not associated with psoriasis in the main analyses. In the stratified analysis, our findings showed positive associations of the lowest (OR = 2.01; 95% CI 1.05-3.84; p = 0.036) and the highest (OR = 2.13; 95% CI 1.12-4.05; p = 0.022) quintiles of FT4 and a protective association of TPOAb positivity (OR = 0.43; 95% CI 0.19-0.98; p = 0.046) with prevalent psoriasis in women. In the logistic regression for FT3, participants in the 1st quintile showed a statistically significant association with psoriasis for the whole sample (OR = 1.66; 95% CI 1.11-2.46; p = 0.013) and for men (OR = 2.25; 95% CI 1.25-4.04; p = 0.007) in the sex-stratified analysis. Conclusions: The present study showed that the association of FT4 levels with psoriasis are different according to sex, with a possible U-shaped curve in women but not in men. Although there were some associations of FT3 with psoriasis, they may be a consequence of non-thyroidal illness syndrome. Further prospective data may clarify the association of thyroid function and psoriasis.
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SUMMARY OBJECTIVE: This study investigated the association of psoriasis with cardiovascular risk factors and psychological aspects among participants of the Brazilian Longitudinal Study of Adult Health. METHODS: This is a cross-sectional study from the baseline data of the Brazilian Longitudinal Study of Adult Health cohort, collected between 2008 and 2010 in six state capitals of Brazil (i.e., Belo Horizonte, Porto Alegre, Rio de Janeiro, Salvador, São Paulo, and Vitória). Participants were active and retired civil servants from college and research institutions, aged between 35 and 74 years. Exclusion criteria included the intention to quit working at the institution, pregnancy, severe cognitive impairment, and, if retired, residence outside of a study center's corresponding area. Psoriasis case identification was based on a previous medical diagnosis of psoriasis. Cardiovascular risk profile, psychological aspects, and sociodemographic variables were investigated. RESULTS: Data from 15,105 participants were analyzed (mean age of 52.3 years, 51.3% women). The prevalence of psoriasis was 1.6% (n=236). Psoriasis was associated with higher education (OR 1.94 [CI 1.07-3.52]), health insurance plan (OR 1.56 [CI 1.08-2.25]), central obesity (OR 1.63 [CI 1.10-2.40]), smoking status (former OR 1.40 [CI 1.03-1.88]; current OR 1.61 [CI 1.08-2.40]), and very bad self-perception of health (OR 7.22 [CI 2.41-21.64]), remaining significant even after multivariate adjustment. Self-reported Black participants were less likely to have psoriasis (OR 0.45 [CI 0.26-0.75]). CONCLUSION: In a sample of healthy workers, psoriasis was associated with central obesity, smoking, and a very bad self-perception of health, which may contribute to future cardiovascular disease.
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This study analyzed the factors associated with driving status among older adults in Brazil. The sample consisted of 15,221 older adults (≥65 years) residing in Brazilian capitals in 2018. The following question established the participants' driving status: "Do you drive a car, motorcycle, and/or another vehicle?" Sociodemographic, health conditions, and health-related behaviors were derived through standard procedures. Poisson regression analysis was performed to estimate prevalence ratios and 95% confidence interval. The prevalence of drivers was 28.83%. We found that being physically active during leisure time and higher daily recreational screen time (>3 h/day) were associated with driving status. Self-perceived negative health and being physically active by commuting showed an inverse association with driving status. The high prevalence of older drivers and the characteristics associated with driving reinforces the importance of public policy strategies for these individuals.
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Conducción de Automóvil , Anciano , Brasil/epidemiología , Humanos , Actividades Recreativas , Factores Socioeconómicos , TransportesRESUMEN
OBJECTIVES: This analysis describes the protocol of a study with a case-cohort to design to prospectively evaluate the incidence of subclinical atherosclerosis and Cardiovascular Disease (CVD) in Chronic Inflammatory Disease (CID) participants compared to non-diseased ones. METHODS: A high-risk group for CID was defined based on data collected in all visits on self-reported medical diagnosis, use of medicines, and levels of high-sensitivity C-Reactive Protein >10 mg/L. The comparison group is the Aleatory Cohort Sample (ACS): a group with 10% of participants selected at baseline who represent the entire cohort. In both groups, specific biomarkers for DIC, markers of subclinical atherosclerosis, and CVD morbimortality will be tested using weighted Cox. RESULTS: The high-risk group (n = 2,949; aged 53.6 ± 9.2; 65.5% women) and the ACS (n=1543; 52.2±8.8; 54.1% women) were identified. Beyond being older and mostly women, participants in the high-risk group present low average income (29.1% vs. 24.8%, p < 0.0001), higher BMI (Kg/m2) (28.1 vs. 26.9, p < 0.0001), higher waist circumference (cm) (93.3 vs. 91, p < 0.0001), higher frequencies of hypertension (40.2% vs. 34.5%, p < 0.0001), diabetes (20.7% vs. 17%, p = 0.003) depression (5.8% vs. 3.9%, p = 0.007) and higher levels of GlycA a new inflammatory marker (p < 0.0001) compared to the ACS. CONCLUSIONS: The high-risk group selected mostly women, older, lower-income/education, higher BMI, waist circumference, and of hypertension, diabetes, depression, and higher levels of GlycA when compared to the ACS. The strategy chosen to define the high-risk group seems adequate given that multiple sociodemographic and clinical characteristics are compatible with CID.
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Aterosclerosis , Enfermedades Cardiovasculares , Hipertensión , Aterosclerosis/epidemiología , Biomarcadores , Enfermedades Cardiovasculares/epidemiología , Grosor Intima-Media Carotídeo , Estudios de Cohortes , Femenino , Humanos , Masculino , Factores de RiesgoRESUMEN
Exergame, a type of enjoyable active video game that combines physical exertion and game is a technological innovation that has generated important information for the health field. In the car-diovascular area, exergames have been used to manage blood pressure in adults with some positive results. Despite this, in primary studies, it is possible to identify that participants dropout of the exergames interventions, but no synthesis of evidence has been produced so far to explore that. The aims of this review are i) to estimate the pooled rate of dropouts in controlled trials assessing the effects of exergame-based interventions on resting blood pressure in adults and older people; ii) to compare dropout rates between exergame and controls groups, and iii) to investigate the intervention characteristics associate with dropout rates. Inclusion criteria: Randomized controlled trials (RCTs) or quasi-RCTs (≥ 4 weeks) assessing the effects of exergame-based interventions on resting blood pressure in adults aged ≥ 18 years old. Without restriction to language, date of the publication, and intervention setting. Literature searches will be conducted using PubMed, Scopus, SPORTDiscus, Cumulative Index of Nursing and Allied Health Literature, Web of Science, Cochrane Central Register of Controlled Trials, and Scientific Electronic Library Online. The quality of the RCTs will be assessed using Cochrane's risk of bias tool. A descriptive narrative synthesis and a random-effects model meta-analysis of the pooled event rate (prevalence) will be provided (p < 0.05). This protocol is registered with PROSPERO: CRD42020199547.
Exergame, um tipo de videogame ativo divertido que combina esforço físico e jogo virtual, é uma inovação tecnológica que tem gerado informações importantes para a área da saúde. Na área cardiovascular, os exer-games têm sido usados para gerenciar a pressão arterial em adultos, com alguns resultados positivos. Apesar disso, em estudos primários, é possível identificar que os participantes abandonaram (dropout) as interven-ções dos exergames, mas nenhuma síntese de evidências foi produzida até o momento para explorar isso. Os objetivos desta revisão são i) estimar a taxa combinada de dropouts em estudos controlados que avaliam os efeitos de intervenções baseadas em exergame na pressão arterial de repouso em adultos e idosos; ii) comparar as taxas de dropouts entre os grupos exergame e controles e iii) investigar as características de intervenção associadas às taxas de dropouts. Serão incluídos ensaios clínicos randomizados (ECRs) ou quase-ECRs (≥ 4 semanas) avaliando efeitos de intervenções com exergames sobre a pressão arterial em repouso em adultos (≥ 18 anos). Não haverá restrição de idioma, data de publicação e ambiente de intervenção. As buscas na lite-ratura serão conduzidas usando PubMed, Scopus, SPORTDiscus, Cumulative Index of Nursing and Allied Health Literature, Web of Science, Cochrane Central Register of Controlled Trials e Scientific Electronic Library Online. O risco de viés dos ECRs será avaliado por meio da ferramenta da Cochrane. Uma síntese narrativa descritiva e uma metanálise de modelo de efeitos aleatórios da taxa de eventos combinados (pre-valência) serão fornecidas (p < 0,05). Este protocolo está registrado com PROSPERO: CRD42020199547.
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Pacientes Desistentes del Tratamiento , Ejercicio Físico , Guías como Asunto , Presión Arterial , Actividad MotoraRESUMEN
Abstract Objectives This analysis describes the protocol of a study with a case-cohort to design to prospectively evaluate the incidence of subclinical atherosclerosis and Cardiovascular Disease (CVD) in Chronic Inflammatory Disease (CID) participants compared to non-diseased ones. Methods A high-risk group for CID was defined based on data collected in all visits on self-reported medical diagnosis, use of medicines, and levels of high-sensitivity C-Reactive Protein >10 mg/L. The comparison group is the Aleatory Cohort Sample (ACS): a group with 10% of participants selected at baseline who represent the entire cohort. In both groups, specific biomarkers for DIC, markers of subclinical atherosclerosis, and CVD morbimortality will be tested using weighted Cox. Results The high-risk group (n = 2,949; aged 53.6 ± 9.2; 65.5% women) and the ACS (n=1543; 52.2±8.8; 54.1% women) were identified. Beyond being older and mostly women, participants in the high-risk group present low average income (29.1% vs. 24.8%, p < 0.0001), higher BMI (Kg/m2) (28.1 vs. 26.9, p < 0.0001), higher waist circumference (cm) (93.3 vs. 91, p < 0.0001), higher frequencies of hypertension (40.2% vs. 34.5%, p < 0.0001), diabetes (20.7% vs. 17%, p = 0.003) depression (5.8% vs. 3.9%, p = 0.007) and higher levels of GlycA a new inflammatory marker (p < 0.0001) compared to the ACS. Conclusions The high-risk group selected mostly women, older, lower-income/education, higher BMI, waist circumference, and of hypertension, diabetes, depression, and higher levels of GlycA when compared to the ACS. The strategy chosen to define the high-risk group seems adequate given that multiple sociodemographic and clinical characteristics are compatible with CID.
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Objetivo: Verificar a tendência da taxa de mortalidade por suicídio em adolescentes, adultos e idosos, nas Regiões do Brasil, entre 1996 e 2016. Métodos: Estudo de séries temporais, incluindo óbitos por suicídio de adolescentes, adultos e idosos. Foram utilizados dados secundários, disponibilizados pelo Sistema de Informação de Mortalidade e pelo Instituto Brasileiro de Geografia e Estatística. A análise de regressão linear segmentada foi adotada para calcular a variação anual percentual e alterações significativas na tendência. Resultados: Entre 1996 e 2016 ocorreram 195.440 óbitos por suicídio no Brasil. Houve aumento significativo na taxa de mortalidade por suicídio na região Nordeste em adolescentes e adultos do sexo feminino. As taxas aumentaram no Nordeste e reduziram significativamente no Sudeste e Sul para as idosas. O sexo masculino apresentou aumento da taxa de mortalidade por suicídio nas regiões Norte, Nordeste e CentroOeste para os adolescentes; aumento nas regiões Norte e Nordeste e, redução significativa da taxa na região Sul para os adultos. Para os idosos, houve aumento na região Norte e redução significativa da taxa na região Sul. Conclusão: Observou-se diferentes taxas de mortalidade por suicídio entre regiões, sexos e grupos etários.
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BACKGROUND: Being active has been shown to have beneficial effects for the health of individuals with chronic diseases. However, data on the association between multimorbidity and physical activity are limited. OBJECTIVE: To investigate the association between chronic diseases, multimorbidity and insufficient physical activity among older adults in southern Brazil, according to sex. DESIGN AND SETTING: Cross-sectional population-based and household-based study derived from the second wave (2013-2014) of the EpiFloripa Aging Cohort Study. METHODS: Insufficiency of physical activity (outcome) was ascertained using the long version of the International Physical Activity Questionnaire (≤ 150 minutes/week). Eleven self-reported chronic diseases were identified. Multimorbidity was defined from the number of chronic diseases (none; 2 or 3; or 4 or more). The adjustment variables were age, schooling, marital status, income, smoking, alcohol consumption and cognition. Additionally, each chronic disease was adjusted for the others. Associations were tested using logistic regression (crude and adjusted). RESULTS: Among the 1197 participants (≥ 63 years), women (54.0%) were more likely than men (39.6%) to be insufficiently active. In the adjusted analysis, women and men with depressive symptoms, and men with diabetes, were more likely to be insufficiently active than those without symptoms. Multimorbid women were more likely to be insufficiently active, and the magnitude of the effect was strongest for 4 or more diseases. CONCLUSION: This study indicates that the associations were sex-specific. Depressive symptoms and multimorbidity were associated with insufficient physical activity among women, while diabetes was associated with insufficient physical activity among men.
Asunto(s)
Enfermedad Crónica , Multimorbilidad , Conducta Sedentaria , Anciano , Brasil/epidemiología , Enfermedad Crónica/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
ABSTRACT BACKGROUND: Being active has been shown to have beneficial effects for the health of individuals with chronic diseases. However, data on the association between multimorbidity and physical activity are limited. OBJECTIVE: To investigate the association between chronic diseases, multimorbidity and insufficient physical activity among older adults in southern Brazil, according to sex. DESIGN AND SETTING: Cross-sectional population-based and household-based study derived from the second wave (2013-2014) of the EpiFloripa Aging Cohort Study. METHODS: Insufficiency of physical activity (outcome) was ascertained using the long version of the International Physical Activity Questionnaire (≤ 150 minutes/week). Eleven self-reported chronic diseases were identified. Multimorbidity was defined from the number of chronic diseases (none; 2 or 3; or 4 or more). The adjustment variables were age, schooling, marital status, income, smoking, alcohol consumption and cognition. Additionally, each chronic disease was adjusted for the others. Associations were tested using logistic regression (crude and adjusted). RESULTS: Among the 1197 participants (≥ 63 years), women (54.0%) were more likely than men (39.6%) to be insufficiently active. In the adjusted analysis, women and men with depressive symptoms, and men with diabetes, were more likely to be insufficiently active than those without symptoms. Multimorbid women were more likely to be insufficiently active, and the magnitude of the effect was strongest for 4 or more diseases. CONCLUSION: This study indicates that the associations were sex-specific. Depressive symptoms and multimorbidity were associated with insufficient physical activity among women, while diabetes was associated with insufficient physical activity among men.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Enfermedad Crónica/epidemiología , Conducta Sedentaria , Multimorbilidad , Brasil/epidemiología , Estudios TransversalesRESUMEN
OBJECTIVE: To analyze the effects of an exergame-based training compared to resistance training on the quality of life and symptoms of depression in older adults. METHODS: This was a two-arm, non-blinded, randomized clinical trial. Thirty-five participants (62.09 ± 7.11 years) were randomized either on the Exergame-based Training Group (n = 17) or the Resistance Training Group (n = 18). Sessions lasted 50 to 60 minutes, three times per week, for 13 weeks. For the Exergame-based Training Group, we used games that simulate sports and adventure activities through Xbox360 Kinect™. The Resistance Training Group performed ten exercises per session for upper and lower limbs using free weights and machines, following linear periodization and individualized loads. Quality of life and symptoms of depression were assessed using the World Health Organization Quality of Life assessment - an abbreviated version (WHOQOL-BREF) and the Geriatric Depression Scale, respectively. We performed a two-way analysis of variance (p < 0.05). RESULTS: Only time effects were identified for overall quality of life, general health, and symptoms of depression. After the intervention, overall quality of life score increased (3.82 ± 0.95 versus 4.18 ± 0.53, p = 0.05), whereas symptoms of depression decreased (3.35 ± 1.73 versus 2.59 ± 1.54, p = 0.02) in the Exergame-based Training Group, and the general health improved in the Resistance Training Group (3.78 ± 0.81 versus 4.11 ± 0.68, p = 0.05) compared with the baseline scores. CONCLUSION: Both training groups improved different aspects of quality of life. The Exergaming-based Training Group improved the overall perception, whereas the Resistance Training Group improved the general health-related perception. Participants in the Exergame-based Training Group also decreased the number of symptoms of depression.
OBJETIVO: Analisar os efeitos de um treinamento baseado em exergames comparado ao treinamento contra resistência na qualidade de vida e nos sintomas depressivos em adultos mais velhos. METODOLOGIA: Trata-se de um estudo clínico randomizado, com dois braços e não cego. Trinta e cinco participantes (62,09 ± 7,11 anos) foram randomizados para o Grupo de Treinamento com Exergames (n = 17) ou Treinamento de Resistência (n = 18). As sessões tiveram duração de 50 a 60 minutos, três vezes por semana, durante 13 semanas. Para o Grupo de Treinamento com Exergames, foram utilizados jogos que simulavam atividades esportivas e de aventura por meio do Xbox360 Kinect™. O Grupo de Treinamento contra Resistência realizou dez exercícios por sessão, para membros superiores e inferiores, utilizando pesos livres e máquinas, seguindo periodização linear e ajuste de carga individualizado. A qualidade de vida e os sintomas depressivos foram avaliados usando o instrumento de Qualidade de Vida da Organização Mundial da Saúde versão abreviada (WHOQOL-BREF) e a Escala de Depressão Geriátrica, respectivamente. Foram realizadas análises de variância two-way (p ≤ 0,05). RESULTADOS: Apenas efeitos no tempo foram identificados para qualidade de vida geral, saúde geral e sintomas depressivos. Após a intervenção, o escore de qualidade de vida geral aumentou (3,82 ± 0,95 versus 4,18 ± 0,53, p = 0,05) e os sintomas depressivos diminuíram (3,35 ± 1,73 versus 2,59 ± 1,54, p = 0,02) no Grupo de Treinamento com Exergames, e a saúde geral melhorou no Grupo de Treinamento contra Resistência (3,78 ± 0,81 versus 4,11 ± 0,68, p = 0,05) quando comparados com os escores da linha de base. CONCLUSÃO: Ambos os grupos de treinamento melhoraram diferentes aspectos da qualidade de vida. O Grupo de Treinamento com Exergames melhorou a percepção geral, enquanto o Grupo de Treinamento contra Resistência apresentou melhorias na percepção geral relacionada à saúde. Os participantes do Grupo de Treinamento com Exergames também diminuíram o número de sintomas depressivos.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Depresión/terapia , Terapia por Ejercicio , Terapia de Exposición Mediante Realidad Virtual , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Salud del AncianoRESUMEN
This study aimed to investigate the association between simultaneity of leisure-time physical inactivity and high television time with the presence of chronic diseases in adults and older adults in Brazil. We analyzed secondary data from Vigitel 2013 database, a cross-sectional national survey. It was included 37 947 adults (18-59 years) and 14 982 older adults (≥60 years) living in Brazilian state capitals. The association was between simultaneity of risk behaviors considering leisure-time physical inactivity (<10 min/day) and high television time (≥2 h/day), with the presence of chronic diseases (diabetes, dyslipidemia, hypertension and obesity), measured according to the age group. We performed a binary logistic regression, crude and adjusted analysis, using weighted to reflect population estimates. In adults, there was an association between leisure-time physical inactivity and television time with the presence of diseases. In practice, the simultaneity of risk behaviors when compared with those without risk behavior had higher odds for diabetes (OR = 1.83), dyslipidemia (OR = 1.17), hypertension (OR = 1.54) and obesity (OR = 1.60). In older adults, the simultaneity was associated with diabetes (OR = 1.61), hypertension (OR = 1.33) and obesity (OR = 1.81). We concluded that for adults and older adults the simultaneity of leisure-time physical inactivity and high television time increased the odds for the presence of chronic disease, especially for diabetes and obesity.