Pro-Saude Study Research Articles

The Risk of Diabetes Associated with DDE Exposure and its Interaction with a Common FTO Gene Variant: The Pro-Saude Study, Brazil

The Risk of Diabetes Associated with DDE Exposure and its Interaction with a Common FTO Gene Variant: The Pro-Saude Study, Brazil

Dietary patterns, obesity markers and leukocyte telomere length among Brazilian civil servants: cross-sectional results from the Pro-Saude study - CORRIGENDUM.

Dietary patterns, obesity markers and leukocyte telomere length among Brazilian civil servants: cross-sectional results from the Pro-Saude study - CORRIGENDUM.

Dietary patterns, obesity markers and leukocyte telomere length among Brazilian civil servants: cross-sectional results from the Pro-Saude study.

Dietary patterns express the combination and variety of foods in the diet. The partial least squares method allows extracting dietary patterns related to a specific health outcome. Few studies have evaluated obesity-related dietary patterns associated with telomeres length. This study aims to identify dietary patterns explaining obesity markers and to assess their association with leukocyte telomere length (LTL), a biological marker of the ageing process. Cross-sectional study. University campuses in the state of Rio de Janeiro, Brazil. 478 participants of a civil servants' cohort study with data on food consumption, obesity measurements (total body fat, visceral fat, BMI, leptin and adiponectin) and blood samples. Three dietary patterns were extracted: (1) fast food and meat; (2) healthy and (3) traditional pattern, which included rice and beans, the staple foods most consumed in Brazil. All three dietary patterns explained 23·2 % of food consumption variation and 10·7 % of the obesity-related variables. The fast food and meat pattern were the first factor extracted, explaining 11-13 % variation of the obesity-related response variables (BMI, total body fat and visceral fat), leptin and adiponectin showed the lowest percentage (4·5-0·1 %). The healthy pattern mostly explained leptin and adiponectin variations (10·7 and 3·3 %, respectively). The traditional pattern was associated with LTL (β = 0·0117; 95 % CI 0·0001, 0·0233) after adjustment for the other patterns, age, sex, exercise practice, income and energy intake. Leukocyte telomere length was longer among participants eating a traditional dietary pattern that combines fruit, vegetables and beans.

Do changes in income and social networks influence self-rated oral health trajectories among civil servants in Brazil? Evidence from the longitudinal Pr\xf3-Sa\xfade study

BackgroundSocial factors are important determinants of health. However, evidence from longitudinal studies on the possible role of changes in socioeconomic circumstances on adult’s oral health is scarce. This study aimed to test whether changes in income and changes in social networks of family members and friends were associated with trajectories of self-rated oral health (SROH) among adults over a 13-year period.MethodsA prospective cohort study (Pro-Saude Study) was conducted involving non-faculty civil servants at university campi in Rio de Janeiro, Brazil. Individual data was collected through self-completed questionnaires in four waves (1999, 2001, 2007 and 2012). SROH trajectories between 2001 and 2012 were “Good-stable SROH”, “Changed SROH”, “Poor-stable SROH”. Per capita family income and social networks of family members and friends data obtained in 1999 and 2012 were grouped into “High stable”, “Increase”, “Decrease”, “Low stable”. Ordinal logistic regression using complete data of 2118 participants was used to estimate odds ratio (OR) and 95% CIs of changes in income and changes in social networks with SROH trajectories, adjusted for age, sex, skin colour and marital status.ResultsParticipants in the low income-stable and small social networks-stable groups showed 2.44 (95% CI 1.68–3.55) and 1.98 (95% CI 1.38–2.85) higher odds for worst trajectory of SRHO than those in the respective high-stable groups. Those in the decrease income group and decrease social networks group were 78% (95% CI 1.25–2.54) and 58% (95% CI 1.07–2.34) more likely to worst trajectory of SRHO than those in the high income-stable and high social networks-stable groups.ConclusionsAdults reporting low income and low social networks of family members and friends over 13 years and those with income and social networks decrease during the study period were at higher risk of having worsened their self-rated oral health.

Tooth loss over 13 years of follow-up: Can regular dental visits reduce racial and socioeconomic inequalities?

To assess if regular dental visits modify the effects of social and racial indicators on the incidence of tooth loss. This is a longitudinal analysis using data from the Pro-Saude Study. In 1999-2001, 3253 civil servants responded to self-administered questionnaires, and then in 2012-2013, with 19% attrition. The outcome was any increase in self-reported tooth loss, measured in four ordered categories (none, one or few, many, all or almost all). Main variables included income, education, race/ethnicity and an adapted version of Everyday Discrimination Scale. The dental visit was dichotomized into regular and problem-oriented attenders. Potentially confounding factors were age and sex; effect modification was estimated using the relative excess of risk due to interaction (RERI). An increase in the tooth loss category was reported by 23.1% of the individuals over 13 years of follow-up. Among problem-oriented attenders, 27.3% reported an increase against 20.4% in regular users (p<0.01). Interaction results are inconclusive. Even though not significant, either antagonism or synergism were observed: between lower income and problem-oriented (RERI=-0.22; 95%CI: -0.75: 0.31), being Black+Brown and problem-oriented (RERI=-0.25; 95%CI: -0.64: 0.14), discrimination and problem-oriented (RERI=-0.15; 95%CI: -0.55: 0.25), and between having less than university degree and being problem-oriented (RERI=0.21; 95%CI: -0.19: 0.62). Regular attenders from advantaged groups seem to benefit more from dental care than disadvantaged groups, increasing unfair inequalities. Inconsistencies in current findings warrant further investigations. Regular attenders from advantaged groups seem to benefit more from dental care than disadvantaged groups, increasing inequities, but the effect size of the Relative Excess of Risk due to Interaction was not large and was inconclusive.

Neighborhood food environment and consumption of fruit and leafy vegetables: Pro-Saude Study, Brazil

ObjectiveTo explore the relationship between availability of different types of retail food stores and consumption of fruit and leafy vegetables. Study designThis study is a cross-sectional study. MethodsData were derived from 2032 adults living in the city of Rio de Janeiro, Brazil, participating in the longitudinal Pro-Saude Study. Exposure to street markets, fruit and vegetable stores, groceries and markets, unhealthy food outlets, restaurants, and supermarkets within 1600 m buffers was obtained by georeferencing residential addresses. Consumption of fruit and leafy vegetables was assessed via two single questions, categorized as ‘yes’ (≥4 days/week) and ‘no’ (<3 days/week). Multiple logistic regression models were used to assess relationships of interest adjusted for surrounding average monthly income, sex, age, education, and family income per capita. ResultsExcept for supermarkets, the presence of a greater number of retail food stores – irrespective of the type – was associated with higher odds of consumption of fruit and leafy vegetables than with areas with a lower number (e.g. odds ratio = 1.47; 95% confidence interval = 1.13–1.91). ConclusionsThe greater availability of several types of retail food stores close to participants’ residences was associated with higher consumption of fruit and leafy vegetables in Rio de Janeiro.

DIMENSÕES DO APOIO SOCIAL E PRÁTICA DE ALEITAMENTO MATERNO: ESTUDO PRÓ-SAÚDE

Objetivo: Estimar associação entre o apoio social e suas dimensões e a prevalência do aleitamento materno (AM) nos dois primeiros anos de vida. Métodos: Estudo seccional com mulheres (n=1.634) participantes da fase 1 (1999) do Estudo Pró-Saúde, com informações coletadas por meio de questionário autopreenchível. A duração do AM foi autorrelatada em meses e, posteriormente, as prevalências foram avaliadas aos 6, 9, 12 e 24 meses. O apoio social foi avaliado em três dimensões: interação social positiva/afetiva, apoio de informação/emocional e apoio material. Foram estimadas razões de chances com intervalo de 95% de confiança via regressão logística, ajustadas por características maternas, e tendo por desfecho a prevalência de aleitamento materno em meses. Resultados: A prevalência de aleitamento materno aos 6, 9, 12 e 24 meses foi respectivamente, de 58,0%, 31,9%, 23,5% e 9,7%. A dimensão interação social positiva/afetiva foi a mais importante para o aleitamento materno aos seis meses (OR=1,52 IC95%=1,03-2,25) e também para o aleitamento materno aos 24 meses (OR=2,38 IC95%=1,03-5,49). Conclusão: O apoio social é um importante aspecto a ser considerado para dar suporte à mãe que amamenta, principalmente nos primeiros meses de vida da criança.DOI: 10.12957/demetra.2019.43037

Associations of neighborhood socioeconomic, natural and built environmental characteristics with a 13-year trajectory of non-work physical activity among civil servants in Rio de Janeiro, Brazil: The Pro-Saude Study

Positive influences of natural and built environment characteristics on human physical activity have been observed mainly in high-income countries, but mixed results exist. We explored these relationships in Rio de Janeiro, Brazil, where exuberant nature coexists with high levels of social inequality and urban violence. Data originated from questionnaires self-administered by 1731 civil servants at university campuses who participated in 4 waves (1999, 2001, 2007, 2012) of a longitudinal study, and had their residential addresses geocoded. In multinomial regression models, adjusted for individual sociodemographic characteristics, mutually adjusted associations were estimated between 13-year trajectories of non-work physical activity and 8 contextual variables: distances from waterfronts, cycle paths, outdoor gym equipment, and squares; 2 indicators of exposure to greenness (a vegetation index - NDVI - derived from satellite images, and trees close to home); an indicator of walkability (street density), and neighborhood average income. Compared to participants living in the upper quartile of distance to waterfronts, those living in its lowest quartile had 2.6-fold higher odds (aOR: 2.62, 95% CI: 1.37–5.01) of reporting non-work PA in all 4 study waves. Similar results were observed in relation to distance to cycle paths; no independent associations were observed with other natural and built environment variables.

Does life-course socioeconomic position influence racial inequalities in the occurrence of uterine leiomyoma? Evidence from the Pro-Saude Study

We aimed to investigate whether life-course socioeconomic position mediates the association between skin color/race and occurrence of uterine leiomyomas. We analyzed 1,475 female civil servants with baseline data (1999-2001) of the Pró-Saúde Study in Rio de Janeiro State, Brazil. Life-course socioeconomic position was determined by parental education (early life socioeconomic position), participant education (socioeconomic position in early adulthood) and their combination (cumulative socioeconomic position). Gynecological/breast exams and health insurance status were considered markers of access to health care. Hazard ratios (HR) and 95% confidence intervals (95%CI) were estimated using Cox proportional hazards models. Compared with white women, black and parda (“brown”) women had higher risk of reporting uterine leiomyomas, respectively HR: 1.6, 95%CI: 1.2-2.1; HR: 1.4, 95%CI: 0.8-2.5. Estimates were virtually identical in models including different variables related to life-course socioeconomic position. This study corroborated previous evidence of higher uterine leiomyomas risk in women with darker skin color, and further suggest that life-course socioeconomic position adversity does not influence this association.

Does menopause start earlier in smokers? Evidence from the Pro-Saude Study

OBJECTIVES: cigarette smoking has been the modifiable risk factor most consistently associated with earlier menopause. This preliminary study based on cross-sectional data aimed to analyze the association between smoking status and age of onset of menopause in a Brazilian population. METHODS: a cross-sectional study was carried out with 1,222 female employees of Rio de Janeiro university campuses aged over 35 years who were at risk of natural menopause. A Cox proportional hazards model was used to investigate the association between smoking status and age at the onset of menopause, adjusting for education, parity and alcohol consumption. RESULTS: current smokers showed a 56% increase in the risk of menopause, being 1.8 years younger at menopause onset compared with women who had never smoked. However, no differences were observed between former smokers and women who had never smoked. The adjusted median age at menopause was 49.5 years for current smokers and 51.3 years for women who had never smoked (p&lt;0.05). CONCLUSIONS: the results suggest a deleterious but potentially reversible effect of smoking on the age of onset of menopause, which should receive greater attention in tobacco control efforts. Longitudinal analyses of this association will be carried out in the future in a follow-up study of this population.

Occupational stress and self-perceived oral health in Brazilian adults: a Pro-Saude study

The scope of this study is to investigate the association between occupational stress and self-perception of oral health. Data were obtained through a self-administered questionnaire filled out in a Pró-Saúde Study by 3253 administrative technical staff from Rio de Janeiro's State University. Occupational stress was measured by means of a questionnaire elaborated in 1970 by Karasek, duly shortened by Thorell in 1988. Ordinal logistic regression was used for data analysis, subsequently adjusted for three blocks of variables. Workers exposed to high occupational demands and little occupational control and to passive work had higher chances of self-perception of worse oral health, when compared with those exposed to low occupational demands, there being no association observed in those exposed to active work. However, in the multiple regression model the following estimates were reduced in magnitude and lost statistical significance, namely high occupational demands and passive work. Workers exposed to high occupational demands revealed worse self-reported oral health, which seems to be partly explained by health behavior patterns, the presence of oral health problems and seeking dental services at longer intervals than once per year.

Prevalência de diagnóstico médico auto-relatado de miomas uterinos em população brasileira: Padrões demográficos e socioeconômicos no Estudo Pró-Saúde *

Uterine leiomyomas (UL) are considered the most common tumors of the female reproductive system. However, there are few epidemiological studies about this condition in Brazil. To estimate the prevalence of self-reported history of UL according to demographic and socioeconomic characteristics, and to markers of access to health care. We analyzed data from 1,733 university employees who participated at the baseline waves of the Pro-Saude Study (1999-2001), in relation to three outcomes: (1) self-reported medical diagnosis of UL, (2) UL with symptoms prior to diagnosis, and (3) cases with hysterectomy due to UL. Prevalence and 95% confidence intervals (95% CI) were estimated in relation to strata of variables related to demographic (age, color/race) and socioeconomic characteristics (education, income) and of markers of access to health care (Pap smear, breast clinical exam and private health insurance status). The prevalence of medically-diagnosed UL was 23.3% (95% CI - 21.3, 25.2), the UL with symptoms prior to diagnosis of 13.3% (95% CI - 11.7, 15.0) and hysterectomy due to UL, 8.4% (95% CI - 7.5, 10.3). Among participants younger than 45 years old, higher prevalence was observed among women with worse socioeconomic conditions and of black color/race. Among those with 45 years or more, there was higher prevalence among women with better access to health care. In this study population of Brazilian women, UL is a relevant health problem, and its prevalence and associated socio-demographic gradients are similar to those observed in other countries.

P1-405 Job stress, workplace social support and occupational accidents in the pro-saude study, Brazil

IntroductionThe objective of this study was to investigate the association between job stress and the occurrence of occupational accidents using multilevel modelling in order to take into account clustering of...

Does leisure-time physical activity in early adulthood predict later physical activity? Pro-Saude Study

INTRODUCTION: Leisure-Time Physical Activity (LTPA) is a health behavior that is considered relatively stable over the course of life; this life-long habit seems to be shaped during youth and early adulthood. LTPA is one of the few healthy behaviors more prevalent among men than among women. METHODS:Data from 3,199 participants of the Pro-Saude Study were analyzed - a cohort of employees of a university in Rio de Janeiro, collected with a self-reported multidimensional questionnaire. The association between LTPA in early adulthood and later was investigated using multinomial logistic regression, with estimated odds ratios (OR), considering three outcome categories: inactive, insufficiently active, and active. Past LTPA was grouped into three categories: never/rarely (reference category), sometimes and frequently/always. Estimates were adjusted for: age; participants' schooling, their father's and mother's schooling, and color/race. RESULTS:Analysis shows men who engaged in LTPA sometimes and almost always/always in early adulthood had an OR= 1.42 (95% CI: 0.70-2.89) and OR= 3.33 (95% CI: 1.82-6.10), respectively, of being physically active in later adulthood than those who did not engage in LTPA. Among women, the corresponding odds ratios were lower: OR = 1.19 (95% CI: 0.79-1.79) and OR =1.42 (95% CI: 1.00-2.04). CONCLUSION:LTPA during early adulthood is associated with physical activity later in adulthood, and this association is stronger in men than in women. Public policies that encourage LTPA among youth, with specific efforts directed at women, could increase the proportion of physically active adults.

Aferição da pressão arterial: experiência de treinamento de pessoal e controle de qualidade no Estudo Pró-Saúde

The adequacy of medical management and the validity of epidemiological inference on arterial hypertension depend crucially on the accuracy of measurement procedures. This article reports on our experience with the procedures used for personnel training and quality control of blood pressure measurements in the Pro-Saude Study phase 2, which was conducted among 3,574 civil servants at a university in Rio de Janeiro, Brazil, in 2001. We utilized mercury sphygmomanometers and standard techniques according to international protocols. We monitored the technicians' adherence to adopted guidelines, final digit preference, differences between subsequent measurements, and proportion of missing data. Overall, these procedures helped minimize the potential for systematic errors related to the auscultatory method of blood pressure measurement, thus allowing valid analyses of factors associated with hypertension.

Correspondence analysis for the evaluation of women's profile during post-menopause and hormone replacement therapy

This study illustrates the use of correspondence analysis to identify distinct profiles characterizing hormone replacement therapy (HRT) users and non-users, allowing the visualization of concurrent characteristics associated with this self-selection process. We analyzed cross-sectional information provided by 195 women reporting natural menopause, among 2,240 participants in the Pro-Saude Study (Rio de Janeiro, Brazil). Non-users had an unfavorable profile, including greater weight gain during adult life, older age, later menopause, and less schooling. This analytic tool should be used more extensively in public health research, in exploratory analyses of the relations among a large number of variables in key populations.

Stressful life events and common mental disorders: results of the Pro-Saude Study

This study investigates the association between stressful life events (SLE) and common mental disorders (CMD) among university employees in Rio de Janeiro, Brazil. Phase 1 sectional data from a cohort study (the Pro-Saude Study) were collected among 4,030 participants. A standardized self-administered questionnaire (General Health Questionnaire) assessed the presence of CMD during the previous two weeks, the occurrence of SLE in the previous 12 months, and socio-demographic characteristics. After adjustment for gender, age, income, and marital status, severe financial problems were associated with the greatest risk of CMD (OR = 2.6; 95%CI: 2.2-3.0), followed by physical aggression (OR = 2.1; 95%CI: 1.5-2.8), disruption of a love relationship (OR = 1.9; 95%CI: 1.6-2.3), forced change of residence (OR = 1.9; 95%CI: 1.5-2.4), serious disease (OR = 1.8; 95%CI: 1.5-2.1), hold-up or theft (OR = 1.5; 95%CI: 1.2-1.8), and hospitalization (OR = 1.4; 95%CI: 1.1-1.8). Results suggest that long-term effects of SLE should be investigated, as well as other potential modifying factors in the development and maintenance of CMD in order to support more effective mental health interventions.