No abstract

We conducted a study of the association between gender, race/ethnicity, and social class and prevalence of depressive disorders in an urban sample (N = 2302) in Bahia, Brazil. Individual mental health status was assessed by the PSAD/QMPA scale. Family SES and head of household's schooling and occupation were taken as components for a 4-level social class scale. Race/ethnicity (white, moreno, mulatto, black) was assessed with a combination of self-designation and a system of racial classification. The overall 12-month prevalence of depressive symptoms was 12%, with a female:male ratio of 2:1. Divorced/widowed persons showed the highest prevalence and single the lowest. There was a negative correlation with education: the ratio college educated:illiterate was 4:1. This gradient was stronger for women than men. There was no F:M difference in depression among Whites, upper-middle classes, college-educated, or illiterate. Prevalence ratios for single, widowed and Blacks were well above the overall pattern. Regarding race/ethnicity, higher prevalences of depression were concentrated in the Moreno and Mulatto subgroups. There was a consistent social class and gender interaction, along all race/ethnicity strata. Three-way interaction analyses found strong gender effect for poor and working-class groups, for all race/ethnicity strata but Whites. Black poor yielded the strongest gender effect of all (up to nine-fold). We conclude that even in a highly unequal context such as Bahia, Blacks, Mulattos and women were protected from depression by placement into the local dominant classes; and that the social meaning of ethnic-gender-generation diversity varies with being unemployed or underemployed, poor or miserable, urban or rural, migrant or non-migrant.

Objective To compare some anthropometric indexes of obesity and identify among them which one best discriminates the high coronary risk (HCR). Methods ResultsThe largest area under ROC curve was found between the C index and the HCR, in individuals of male sex, 0.80 (0.74-0.85 Conclusion Those results show that C and WHCR indexes are the best indexes of obesity to discriminate HCR. WC has intermediate discriminatory power and the BMI was the least suitable anthropometric index of obesity to discriminate HCR. Those data suggest that the indexes of abdominal obesity are better to discriminate HCR than the indexes of general obesity. Key words anthropometric indexes of obesity, coronary risk, abdominal obesityThe role of obesity was coronary risk factor is controversial. However, the best explanation for the association between obesity and ischemic heart disease is that it would occur in a subgroup of obese individuals, which means in people who showed adiposity located in the abdominal or central region, even in the absence of general obesity 1 . The accumulation of fat in the abdomen region has been described as the type of obesity that offers the greatest risk for the health of the individuals. The incidence of diabetes, atherosclerosis, gout, urinary calculus and sudden cardiac death is high in some obese individuals. However, an adiposity aspect that draws attention to is the regional distribution of fat in the body. Considering that perspective, the thickness of neck/sacral region skin folds and the fat-muscle proportion of brachio/femoral region were related, which created the masculine differentiation index. Through that index, fat was classified as (a) android; that located in the central region and more specific for men, and (b) gynoid; fat located more in the hips and thighs, and more specific for women 2 . Some years later 3 , abdominal obesity was related to the increase of risk of myocardial infarction, cerebrovascular accident and early death, with a strong association among those variables. Such findings were particularly important to the extent that, by then, there was an association only between general obesity levels and the mentioned diseases. In opposition to the concepts at that time, the highest risk of myocardial infarction or early death was found in men with high quantity of abdominal fat, which suggested that men, even lean, but with body fat concentrated in the abdomen are those with the highest risk to develop cardiovascular diseases.More recent researches still identify the abdominal fat as a powerful coronary risk factor, with the comparison among the many obesity indexes as cardiovascular risk factor, being the result of many studies 4,5,6 . In this study, the main objective was to analyze the anthropometric indexes of general and abdominal obesity as instruments of screening to discriminate high coronary risk (HCR). MethodsA cross-section study performed in Salvador, Bahia, Brazil, in 2000, in a subgroup of participants in "Monit" project, develop by the team of chronic non-transmi...

Objective. this study compares the performance of the waist-height ratio with other anthropometric indicators of obesity: waist circumference (WC), waist-to-hip ratio (WHR), conicity index (C Index), and body mass index (BMI) for discriminating the level of coronary risk (HCR). MethOds. a cross-sectional study of a subset of the participants enrolled on the "Monitoring Cardiovascular Diseases and Diabetes in Brazil" project (MONIT) was carried out in Salvador, Brazil (2000). The total sample comprised 968 people (391 men and 577 women) aged 30 to 74. First, the total area was calculated under the ROC curves between the C Index, WHR, waist/height ratio, WC, BMI and HCR at a 95% confidence interval. Sensitivity and specificity were then calculated. Analyses were carried out using STATA 7.0. Results. Areas under the ROC curves used as indicators of obesity were C Index 0.80, WHR 0.76, waist/height ratio 0.76, WC 0.73, and BMI 0.64 for men and Index C 0.75, WHR 0.75, waist/height ratio 0.69, WC 0.66 and BMI 0.59 for women. cOnclusiOn. Indicators of abdominal obesity are better at discriminating HCR than the usual obesity indicator (BMI). The waist/height ratios are closer to the results of other studies. Furthermore, the waist/height ratio whose statistical significance justifies its use.

OBJECTIVE:To estimate the prevalence of chronic pain, identifying the associated factors. METHODS:A cross-sectional study was conducted in a population sample of 2,297 individuals aged 20 years or more, in Salvador, Northeastern Brazil, in 1999 and 2000. A standardized questionnaire was administered at the individuals' home to collect data about pain, sociodemographic characteristics, and abdominal circumference measurement. The criterion for chronic pain classifi cation was duration above six months. Prevalence of pain was estimated by adjusted prevalence ratio with confi dence interval of 95% and p<0.05 for the univariate analyses and logistic regression. RESULTS:The presence of chronic pain was found in 41.4% of the population. In the gross analysis, the most frequent associated factors were: sex, age, marital status, smoking and alcohol consumption (p<0.05). In the multivariate analysis, female sex, age, smoking and presence of central obesity were independent predictors, while moderate consumption of alcohol and being single were protectors. CONCLUSIONS:The presence of chronic pain was predominant in women, elderly individuals, obese individuals, smokers and ex-smokers. Preventive public health strategies are suggested, aiming to disseminate the risks of smoking and obesity for the development of chronic pain. In addition, the periodic monitoring of health is encouraged.

Objective: To estimate the prevalence of hypertension (H) and its association with other cardiovascular risk factors in a highly multiracial population. Methods:A cross-sectional study carried out in Salvador, Brazil, in a population sample of 1439 adults ≥ 20 years of age. All participants completed a questionnaire at home and had the following measurements taken: blood pressure, body weight, height, waist circumference (WC), and serum glucose and lipids. Hypertension was defined as mean SBP ≥140 and/or DBP ≥ 90 mmHg. Hypertension prevalence was estimated with a 95% confidence interval (CI). The associations were measured by the adjusted odds ratio (AOR), using regression analysis. Results:Overall prevalence of H was 29.9%: 27.4% CI (23.9-31.2) in men and 31.7%, CI (28.5-34.9) in women. Among black men, this prevalence was 31.6%, and among black women, 41.1%. Among white men it was 25.8%, and among white women, 21.1%. Arterial hypertension was significantly associated with age ≥ 40, overweight/obesity (AOR = 2.37[1.57-3.60]) for men and 1,62 (1.02 -2.58) for women. Among men, H was associated with a high level of education and among women, with dark brown and black skin, abdominal obesity, AOR = 2.05 CI (1.31-3.21), diabetes AOR = 2.16 CI (1.19-3.93), and menopause. Conclusion:Arterial hypertension predominated among black people of both genders, and in women. Those variables that remained independently associated with H differed in both genders, except overweight/obesity. Our results suggest the need for an in-depth study of H among black people and early, continuing educational interventions.

ObjectiveTo study patterns of alcohol consumption and prevalence of high-risk drinking. Methods A household survey was carried out in a sample of 2,302 adults in Salvador, Brazil. Cases of High-Risk Drinking (HRD) were defined as those subjects who referred daily or weekly binge drinking plus episodes of drunkenness and those who reported any use of alcoholic beverages but with frequent drunkenness (at least once a week). Results Fifty-six per cent of the sample acknowledged drinking alcoholic beverages. Overall consumption was significantly related with gender (male), marital status (single), migration (non-migrant), better educated (college level), and social class (upper). No significant differences were found regarding ethnicity, except for cachaça (Brazilian sugarcane liquor) and other distilled beverages. Overall 12-month prevalence of highrisk drinking was 7%, six times more prevalent among males than females (almost 13% compared to 2.4%). A positive association of HRD prevalence with education and social class was found. No overall relationship was found between ethnicity and HRD. Male gender and higher socioeconomic status were associated with increased odds of HRD. Two-way stratified analyses yielded consistent gender effects throughout all strata of independent variables. Conclusions The findings suggest that social and cultural elements determine local patterns of alcohol-drinking behavior. Additional research on long-term and differential effects of gender, ethnicity, and social class on alcohol use and misuse is needed in order to explain their role as sources of social health inequities. Resumo Objetivos

IntroduçãoCom o processo da industrialização, existe um crescente número de pessoas que se tornam sedentárias com poucas oportunidades de praticar atividades físicas. Diversos autores têm demonstrado associação entre sedentarismo e agravos cardiovasculares 1 , câncer 2,3 , diabetes 4 e saúde mental 5 . Outros estudos demonstram que o sedentarismo no lazer está associado à hipertensão arterial e diabetes 6,7,8 , além de ser mais prevalente em mulheres, idosos e pessoas de baixa escolaridade 9,10 .Sedentarismo no lazer pode ser identificado como a não participação em atividades físi-cas nos momentos de lazer, considerando atividade física como qualquer movimento corporal produzido pela musculatura esquelética que resulte em gasto energético 11 , tendo componentes e determinantes de ordem bio-psicosocial, cultural e comportamental, podendo ser exemplificada por jogos, lutas, danças, esportes, exercícios físicos e deslocamentos.Para identificar o sedentarismo, o instrumento que vem sendo utilizado de forma mais freqüente é a versão curta do Questionário Internacional de Atividade Física (QIAF), que contempla as diversas facetas desse problema de saúde pú-blica: atividades domésticas, atividades no trabalho, atividades no lazer e deslocamentos 12 . Assim, o sedentarismo no lazer é um recorte do sedentarismo quando analisado globalmente.