Heraclito Barbosa De Carvalho - Academia.edu (original) (raw)

Papers by Heraclito Barbosa De Carvalho

Scientific Reports, Apr 23, 2019

Adolescence is a critical stage of development and has an important influence on energy balancere... more Adolescence is a critical stage of development and has an important influence on energy balancerelated behaviours (eBRBs). When adolescents are associated with obesity it can lead to increased cardiometabolic risk. Here we assess if eBRBs adopted by adolescents included in a subsample are associated with markers of total and abdominal adiposity in a multicentre european study, Healthy Lifestyle in Europe by Nutrition in Adolescence (HeLeNA-Css) and a Brazilian study, Brazilian Cardiovascular Adolescent Health (BRACAH study), and whether sleep duration influence the association between skipping breakfast, physical activity and sedentary behaviours, with total and abdominal obesity (AO). Multilevel linear regression models using fixed and random intercepts were used to analyse the association between markers of obesity and eBRBs. skipping breakfast was the prevalent behaviour in association with obesity among european and Brazilian boys besides european girls, even after stratification by sleep time. Moreover, European boys who slept properly and skipped breakfast had an increased waist circumference (WC), while body mass index (BMI) increased in Brazilian boys. Among Brazilian boys less sleep was protective for total obesity (β = −0.93 kg/m 2 ; 95% CI: −1.80; −0.07). European girls when they were more sedentary, showed an increase in WC, especially for those who reported they slept adequately. skipping breakfast was associated with total and Ao in adolescents independent of sleep duration. Overweight/obesity represents a growing problem because they seriously affect health, leading to impaired quality of life for both, children and adults 1. The worldwide prevalence of childhood overweight and obesity rose from 4.2% to 6.7% between 1990 to 2010. In this way, the expected trend is to reach 60 million (9.1%) by 2020 2. Regarding abdominal obesity (AO) it has been identified as atherosclerosis' determinant in young adults,

Background: Agreement (and disagreement) assessments are essential steps in the evaluation of new... more Background: Agreement (and disagreement) assessments are essential steps in the evaluation of new and existing methods. We aimed to provide a statistical approach to assess systematic disagreement between two measures/methods when both are attended by random error and high variability. Methods: We applied ordinary least products (OLP) regression and the Bland-Altman method in six simulated pairs of samples. In OLP regression, fixed bias defined if 95% confidence intervals (CIs) of the intercept did not include 0. Proportional bias was defined if 95% CIs of the slope did not include 1. As a comparator, we assessed fixed and proportional bias by the Bland-Altman method. Results: We found divergence between studied statistical method outcomes only for measures with low variability (coefficient of variation, CV < 25,0%). Conclusion: OLP regression is a simple and powerful tool for detecting systematic disagreement when the measures are attended by high variability, as well as behavio...

Contemporary Drug Problems, 2017

Recent evidence has indicated that cannabis use before driving is associated with a modest but in... more Recent evidence has indicated that cannabis use before driving is associated with a modest but increased risk for traffic-related injuries. However, the question of whether recent cannabis use is associated with a greater risk for other types of injuries remains unanswered. Aiming to understand better how acute cannabis use might affect the risk for all causes of injury, we have summarized the limited data available in the literature on the risk of non-traffic injuries associated with recent cannabis use. Very few studies were able to provide estimate risks for all injuries or injuries other than those related to road traffic injuries, with the limited evidence available showing mixed findings. The only significant risk found (in only one study) suggests an inverse association between all injuries and cannabis use. Study designs are limited, and the majority of studies have neither data on acute cannabis use among injured individuals nor a valid control group for estimating injury risk attributable to cannabis. In conclusion, studies of the association between cannabis and non-traffic injuries present several limitations, particularly regarding sampling strategies, injury risk assessment for different causes of injury, and a dose-response risk relationship with injury. Further studies, incorporating better design for different causes of injury and drug testing, are required to reach firmer conclusions on the association between cannabis use and non-traffic injury risk.

Blood Pressure, Oct 6, 2014

Preventive Medicine, 2016

Backgroud. Several lifestyle-related behaviors are associated with cardiovascular health outcomes... more Backgroud. Several lifestyle-related behaviors are associated with cardiovascular health outcomes in adolescents. To examine the associations between clustered lifestyle-related behaviors and blood pressure (BP) levels in adolescents. Methods. Participants were recruited by multistage random cluster in two cross-sectional studies; one conducted in 2006 and 2007 in ten cities from nine European countries: Athens and

$Research paper thumbnail of Attributable fractions of the association between family socioeconomic factors and blood pressure in adolescents: results from two observational studies$

Blood Pressure

Purpose: We aimed to estimate the attributable fraction of systolic (SBP) and diastolic blood pre... more Purpose: We aimed to estimate the attributable fraction of systolic (SBP) and diastolic blood pressure (DBP) that can be explained by the family socioeconomic status (FSFs) in adolescents from two observational studies. Methods: Participants were recruited by multi-stage random cluster in two cross-sectional studies performed in Europe (n= 3,308; HELENA study) and Brazil (n=991; BRACAH study). SBP and DBP were measured and FSFs were self-reported in both studies: socioeconomic status and parental education. Associations of SBP and DBP with FSFs were examined by multilevel linear regression through two different models (hierarchical and fully adjusted). The generalized attributable fractions of the FSFs were estimated by comparison between models. Results: The higher generalized attributable fraction was observed in boys on the SBP; 13.2% to 22.4%. In girls, we found lower generalized attributable fractions, in Brazilians girls between 10.8% to 12.1%; and European girls between 3.1% ...

PLOS ONE, 2015

Background Resting heart rate (RHR) reflects sympathetic nerve activity a significant association... more Background Resting heart rate (RHR) reflects sympathetic nerve activity a significant association between RHR and all-cause and cardiovascular mortality has been reported in some epidemiologic studies. Methods To analyze the predictive power and accuracy of RHR as a screening measure for individual and clustered cardiovascular risk in adolescents. The study comprised 769 European adolescents (376 boys) participating in the HELENA cross-sectional study (2006-2008) were included in this study. Measurements on systolic blood pressure, HOMA index, triglycerides, TC/HDL-c, VO 2 máx and the sum of four skinfolds were obtained, and a clustered cardiovascular disease (CVD) risk index was computed. The receiver operating characteristics curve was applied to calculate the power and accuracy of RHR to predict individual and clustered CVD risk factors. Results RHR showed low accuracy for screening CVD risk factors in both sexes (range 38.5%-54.4% in boys and 45.5%-54.3% in girls). Low specificity's (15.6%-19.7% in boys;

Blood pressure, Jan 16, 2015

We aimed to estimate the attributable fraction of systolic (SBP) and diastolic blood pressure (DB... more We aimed to estimate the attributable fraction of systolic (SBP) and diastolic blood pressure (DBP) that can be explained by family socioeconomic factors (FSFs) in adolescents using two observational studies. Participants were recruited by multistage random cluster in two cross-sectional studies performed in Europe [Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, n = 3308] and Brazil [Brazilian Cardiovascular Adolescent Health (BRACAH) study, n = 991]. SBP and DBP were measured, and FSFs (socioeconomic status and parental education) were self-reported in both studies. The correlations of SBP and DBP with FSFs were examined by multilevel linear regression through two different models (hierarchical and fully adjusted). The generalized attributable fractions of the FSFs were estimated by comparing the models. Our results showed a significant inverse relationship between parental education (father and mother) and SBP in European boys. The higher generalized attri...

Revista Andaluza de Medicina del Deporte, 2015

Nutricion hospitalaria, 2014

Objectives: To estimate the prevalence of obesity, overweight, abdominal obesity and high blood p... more Objectives: To estimate the prevalence of obesity, overweight, abdominal obesity and high blood pressure in a sample of adolescents from a low-income city in Brazil and to estimate the relationship with the socioeconomic status of the family, the education level of the family provider and the type of school. Methods: This cross-sectional study randomly sampled 1,014 adolescents (54.8% girls), between 14-19 years of age, attending high school from Imperatriz (MA). The outcomes of this study were: obesity and overweight, abdominal obesity and high blood pressure (systolic and/ or diastolic). The independent variables were: socioeconomic status (SES) of the family, education level of the family provider (ELFP) and type of school. The confounding variables were: gender, age and physical activity level. Prevalence was estimated, and the association between the endpoints and the independent variables was analyzed using a prevalence ratio (PR), with a 95% confidence interval, estimated by ...

European Journal of Public Health, 2015

To analyze the association between dietary protein and amino acids intake and systolic (SBP) and ... more To analyze the association between dietary protein and amino acids intake and systolic (SBP) and diastolic (DBP) blood pressure in European adolescents. Methods: Participants were from the cross-sectional study performed in Europe, Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA study; n = 1605; 12.5-17.5 years; 833 girls) selected by complex sampling. The associations between dietary protein and amino acids intake and SBP/DBP were examined by multilevel linear regression models (context variable by school); the analysis being stratified by sex. Cities, seasonality, age, socioeconomic level, parental education level, body mass index, waist circumference, Tanner stage and physical activity were used as covariates. Results: In boys, we found an inverse association between protein (animal and vegetable) intake and DBP; and a positive association between histidine and SBP. In girls, we observed a positive association among tryptophan, histidine with SBP and methionine with DBP. On the other hand, we observed an inverse association between tyrosine and both SBP and DBP levels in girls. Conclusions: The association between amino acids and BP levels is controversial and depends on the type of amino acids, and protein intake can help control the DBP in boys.

Objective It is an accepted fact that confinement conditions increase the risk of some infections... more Objective It is an accepted fact that confinement conditions increase the risk of some infections related to sexual and/or injecting drugs practices. Mathematical techniques were applied to estimate time-dependent incidence densities of HIV infection among inmates. Methods A total of 631 prisoners from a Brazilian prison with 4,900 inmates at that time were interviewed and their blood drawn. Risky behavior for HIV infection was analyzed, and serological tests for HIV, hepatitis C and syphilis were performed, intended as surrogates for parenteral and sexual HIV transmission, respectively. Mathematical techniques were used to estimate the incidence density ratio, as related to the time of imprisonment. Results Prevalence were: HIV-16%; HCV-34%; and syphilis-18%. The main risk behaviors related to HIV infection were HCV prevalence (OR=10.49) and the acknowledged use of injecting drugs (OR=3.36). Incidence density ratio derivation showed that the risk of acquiring HIV infection increases with the time of imprisonment, peaking around three years after incarceration. Conclusions The correlation between HIV and HCV seroprevalence and the results of the mathematical analysis suggest that HIV transmission in this population is predominantly due to parenteral exposure by injecting drug, and that it increases with time of imprisonment. Resumo Objetivo É um fato correntemente aceito que as condições de confinamento aumentam o risco de algumas infecções relacionadas às práticas sexuais e/ou ao uso de drogas injetáveis. Realizou-se estudo para estimar a densidade de incidência da infecção pelo HIV na população prisional com aplicação de técnicas matemáticas.

BMC Pediatrics, 2014

Background: Resting heart rate reflects sympathetic nerve activity. A significant association bet... more Background: Resting heart rate reflects sympathetic nerve activity. A significant association between resting heart rate (HR) and all causes of cardiovascular mortality has been reported by some epidemiologic studies. Despite suggestive evidence, resting heart rate (RHR) has not been formally explored as a prognostic factor and potential therapeutic outcome and, therefore, is not generally accepted in adolescents. Discussion: The core of the debate is the methodological aspects used in "Resting heart rate: its correlations and potential for screening metabolic dysfunctions in adolescents"; the points are: cutoff used for cluster RHR, two different statistical models used to analyze the same set of variables, one for continuous data, and another for categorical data; interpretation of p-value < 0.05, sampling process involving two random stages, analysis of design effect and the parameters of screening tests. Summary: Aspects that must be taken into account for evaluation of a screening test to measure the potential for discrimination for a common variable (population with outcome vs. no outcome population), the main indicators are: sensitivity, specificity, accuracy, positive predictive value and negative predictive value. The measures of argumentation equality (CI) or difference (p-valor) are important to validate these indicators but do not indicate quality of screening.

Revista da Sociedade Brasileira de Medicina Tropical, 2007

Surveys of risky behavior relating to HIV/AIDS are generally made for groups at risk of infection... more Surveys of risky behavior relating to HIV/AIDS are generally made for groups at risk of infection, for which HIV/AIDS prevalence is usually expected to be higher than in the general population. Therefore, an educational homepage in Portuguese was created on the Internet to inform/ask internauts regarding knowledge and behavior. The internauts were classified as adolescents (13 to 25 years) and adults (>25 years). The number of STDs was reported as 1. 8 ± 2. 6 infections (range: 1 to 20 infections); 43% used condoms during sexual intercourse. Alcohol consumption was reported by 63% and illicit drug use by 32% (marijuana 24% and inhalants 15%). Among the adolescents, 31% did not classified alcohol as a drug. The adults more frequently reported homosexuality, anal intercourse and STDs, although the adolescents also presented high rates of risky behavior. These results show the need to reach out to internauts through better control strategies. Different types of strategies must be en...

Clinics, 2009

OBJECTIVES: To evaluate crack cocaine use practices, risk behaviors associated with HIV infection... more OBJECTIVES: To evaluate crack cocaine use practices, risk behaviors associated with HIV infection among drug users, and their involvement with violence. INTRODUCTION: HIV infections are frequent among drug users due to risky sexual behavior. It is generally accepted that crack cocaine use is related to increased levels of violence. Several reports point to an increase in violence from those involved in drug trafficking. Although HIV infections and risky sexual behavior among drug users have been quite well studied, there are few studies that evaluate violence as it relates to drugs, particularly crack. METHODS: A total of 350 drug users attending drug abuse treatment clinics in São Paulo, Brazil were interviewed about their risky behaviors. Each patient had a serological HIV test done. RESULTS: HIV prevalence was 6.6% (4.0 to 10.2). Violence was reported by 97% (94.7 to 99.1) of the subjects (including cases without personal involvement). Acts of violence such as verbal arguments, physical fights, threats, death threats, theft, and drug trafficking were significantly higher among crack users. A decrease in frequency of sexual intercourse was observed among users of injected drugs, though prostitution was observed as a means of obtaining drugs. A high number of crack cocaine users had a history of previous imprisonment, many for drug-related infractions. DISCUSSION: The data presented are in accordance with other reports in the literature, and they show a correlation between drug use, imprisonment, violence, and drug trafficking. CONCLUSION: A high HIV prevalence and associated risky sexual behaviors were observed among crack cocaine users. The society and the authorities that deal with violence related to crack users and drug trafficking should be aware of these problems.

Cadernos de Saúde Pública, 2009

O estudo objetivou avaliar associação entre via de parto e complicações maternas. Realizou-se coo... more O estudo objetivou avaliar associação entre via de parto e complicações maternas. Realizou-se coorte retrospectiva com partos ocorridos durante o ano de 2003, em um hospital público. As complicações avaliadas foram: infecção, hemorragia, histerectomia, rotura uterina, lesão de órgão contíguo, trombose venosa profunda e embolia pulmonar. Utilizou-se a odds ratio (OR) e os testes de qui-quadrado de Pearson e de Fisher, além da regressão logística. Estabeleceu-se o nível de 0,05 como significante. Foram encontradas 15 complicações. Tomando-se o parto vaginal como referência, encontrou-se associação entre cesárea e as complicações tomadas em conjunto. Analisando-se variáveis confundidoras, encontrou-se associação das complicações com hipertensão, soropositividade para HIV, placenta prévia e descolamento prematuro de placenta. Após controle para estas quatro variáveis, manteve-se a associação entre cesárea e complicações (OR = 9,7; p = 0,04). Encontrou-se também associação entre complica...

Medicine, 2014

Several studies have reported high prevalence of risk factors for cardiovascular disease in adole... more Several studies have reported high prevalence of risk factors for cardiovascular disease in adolescents. To perform: i) systematically review the literature on the prevalence of high blood pressure (HBP) in adolescents; ii) analyze the possible methodological factors associated with HBP; and iii) compare the prevalence between developed and developing countries. We revised 10 electronic databases up to August 11, 2013. Only original articles using international diagnosis of HBP were considered. The pooled prevalence's of HBP were estimated by random effects. Meta-regression analysis was used to identify the sources of heterogeneity across studies. Fifty-five studies met the inclusion criteria and total of 122,053 adolescents included. The pooled-prevalence of HBP was 11.2%, 13% for boys, and 9.6% for girls (P < 0.01). Method of measurement of BP and year in which the survey was conducted were associated with heterogeneity in the estimates of HBP among boys. The data indicate that HBP is higher among boys than girls, and that the method of measurement plays an important role in the overall heterogeneity of HBP value distributions, particularly in boys. (Medicine 93(27):e232) Abbreviations: 95% CI = confidence interval, BPb = lood pressure, CVD = cardiovascular diseases, HBPh = igh blood pressure, PRISMAp = referred reporting items for systematic reviews and meta-analyses.

Sao Paulo Medical Journal, 2008

CONTEXT AND PURPOSE: Uterine cervical ectopy (cervical erosion) is today considered to be a physi... more CONTEXT AND PURPOSE: Uterine cervical ectopy (cervical erosion) is today considered to be a physiological condition, but there still seems to be a strong tendency towards treating it. The purpose of this study was to review the medical literature for evidence regarding benefits from treating cervical ectopy. METHODS: The following databases were reviewed: Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Cochrane Library databases. In addition, six medical textbooks were consulted. RESULTS: The review showed that: 1) there is probably an association between ectopy and higher risk of Chlamydia trachomatis, human papillomavirus and human immunodeficiency virus infection; 4) there is probably an association between ectopy and cervical intraepithelial neoplasia; 5) there is an association between ectopy and mucous discharge and nocturia; and 6) there is no eviden...

Hypertension Research, 2011