The extent of arteriolar narrowing has been recognized as a major sign of end-organ damage in pat... more The extent of arteriolar narrowing has been recognized as a major sign of end-organ damage in patients with hypertension, but most methods used for its evaluation are highly dependent on the observer. We describe a new semi-automated method to measuring arteriolar-to-venous (A/V) ratio in retinal photography and present its application in the evaluation of patients with hypertension. In a cross-sectional study, 58 patients with hypertension had retinographies taken and digitized to determine the vessel diameter by direct measurement (micrometric method) or by the new microdensitometric method. Sub-pixel resolution was obtained via cubic spline fitting of the edge of vessel walls. For each pair of adjacent pixels, 10 intermediate points were generated in the perpendicular direction of the wall. Vessel widths were automatically extracted from this synthetic curve, with cut-points defined where the exterior wall position equals the double of mean noise along the slice. The intra- and i...
Retinal abnormalities, particularly arteriolar narrowing, are powerful predictors of cardiovascul... more Retinal abnormalities, particularly arteriolar narrowing, are powerful predictors of cardiovascular events. The precision of internists and ophthalmologists in the assessment of retinal vessels widths has been disputed but not evaluated against a technology of edge detection. Fifty-two patients with hypertension had optic fundi examination done by an internist and an ophthalmologist, and had retinographies taken and digitized to determine vessel diameters by a new technology of edge detection (microdensitometric method). Physicians asserted the presence of arteriolar narrowing (<or=0.67) through direct ophthalmoscopy and projected retinography. The microdensitometric method measures automatically the vessel widths based on the subpixel resolution of the edge of vessel walls. Sensitivity (SE), specificity (SP), positive (PPV) and negative predictive values (NPV), and kappa statistics were calculated, taken the microdensitometric method as reference. The performance of the direct e...
Anthropometric measurements and indexes that assess excess of adiposity are associated with cardi... more Anthropometric measurements and indexes that assess excess of adiposity are associated with cardiovascular risk factors, and predict diabetes mellitus. This cross-sectional study reported the performance of adiposity indexes to detect or turn diabetes unlikely in patients with hypertension. Patients with hypertension (blood pressure (BP) ≥140/90 mm Hg or antihypertensive drug use) aged 18-80 years, being 150 men and 332 women, had weight, height, waist circumference (WC), hip circumference, body mass index (BMI), waist-hip ratio (WHR), waist-to-height ratio (WHtR), and waist-to-square height ratio (WHt(2)R) calculated. Diabetes was diagnosed by fasting blood glucose ≥126 mg/dl or antidiabetic drug use (23% of the sample). All anthropometric indexes were associated with diabetes in a modified Poisson regression, adjusting for age, smoking, and physical activity, in women, but not in men. In men, only the area under the receiver-operating characteristic curve (AUC) for WHR was statist...
We aimed to evaluate the prevalence, frequency and type of leisure-time physical activity (LTPA) ... more We aimed to evaluate the prevalence, frequency and type of leisure-time physical activity (LTPA) among adults in Greece, as well as its relationship with socio-demographic, lifestyle and clinical characteristics of these people. From May 2001 to December 2002 we randomly enrolled 1514 men and 1528 women, without any evidence of cardiovascular or any other chronic disease. The sampling was stratified by the age-gender distribution of (census 2001) of the greater area of Athens. Weekly energy expenditure assessed by considering frequency, duration (in minutes) and intensity of sports related physical activity during a usual week. 53% of men and 48% of women were classified as physically active. Men were more likely to be active as compared to women (p < 0.05), while the lowest activity rates were observed in 40 to 49 years old participants (p < 0.01). Physically active people had higher occupation skills, were more likely to live in rural areas, to be unmarried, non smokers and ...
The article describes assessments and measurements performed in the Brazilian Longitudinal Study ... more The article describes assessments and measurements performed in the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil). Some assessments including anthropometric assessment, casual blood pressure measurement, and ankle-brachial index have an established clinical application while others including pulse wave velocity, heart rate variability, and carotid intima-media thickness have no established application and do not have reference values for healthy Brazilian population but may be important predictors of cardiovascular outcomes. Blood pressure measurement following postural change maneuver was included in the ELSA-Brasil because it has not been much tested in epidemiological studies. Innovative approaches were developed for assessing the ankle-brachial index using an automatic device instead of the mercury column to measure blood pressure and for assessing the anterior-posterior diameter of the right lobe of the liver by ultrasound for quantitative assessment of nonalcohol...
A substantial number of preschool children exhibit psychological symptoms that have an impact on ... more A substantial number of preschool children exhibit psychological symptoms that have an impact on their own and their families&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; lives. The aim of the current study was to investigate the prevalence, stability and increase/decrease in emotional and behavioral symptoms and the resultant impairment at two assessment points at preschool age. The sample consisted of 1,034 children drawn from the general population with a mean age of 51 months at t1 and 72 months at t2. Parents completed the Strengths and Difficulties Questionnaire extended version (Goodman, J Child Psychol Psychiatry 38(5):581-586, 1997; Goodman, J Child Psychol Psychiatry 40(5):791-799, 1999). At t1, 6.9 % of the preschoolers had a total difficulties and 6.8 % a total impact score within the abnormal range. At t2, these scores were 5.7 and 6.2 %, respectively. We found moderate stability of symptoms. From t1 to t2, emotional symptoms and prosocial behavior significantly increased, while hyperactivity, conduct problems, peer problems and total difficulties decreased. The mean total impact score did not change. Boys showed higher levels of symptoms (except emotional symptoms) and impact, and lower prosocial behavior, than girls. Moreover, there was a significant time × gender interaction, with girls showing a larger decrease in hyperactivity/inattention and in total difficulties than boys. The stepwise multiple regression analysis revealed that the total impact score at baseline, male gender, conduct problems, hyperactivity and peer problems significantly contributed to the explained variance of the total impact score at follow-up. This is one of very few studies to examine the stability and change of psychological symptoms in a large community sample of preschoolers, assessed twice during preschool age.
The status of the homolateral axillary lymph nodes is still the most important prognostic factor ... more The status of the homolateral axillary lymph nodes is still the most important prognostic factor in early stage breast cancer. The information obtained from the pathological examination of the lymph nodes guides is of critical importance in the decision process regarding the use of postoperative adjuvant therapy. However, lymph node axillary dissection can be followed by significant locoregional morbidity. The sentinel lymph node (SLN) technique was developed as a means of avoiding the full exploration of the axilla and consists in the identification of the first lymph node in the lymphatic drainage system of the breast tumour in the homolateral axilla. It has been demonstrated that the status of the SLN is highly predictive for the presence or absence of tumour involvement in the remaining lymph nodes in the axilla. In this study we evaluated the SLN technique using both 99mTc labelled dextran 500 and patent blue V dye in relation to the classical lymph node resection a series of 56 women with early breast cancer who attended the Breast Unit of the Academic Hospital of the Federal University of Rio Grande do Sul, Brazil. To our knowledge this is the first report in the literature of the utilization of 99mTc dextran 500 for the SLN technique. As there are no similar commercially available dedicated radiopharmaceuticals labelled for use in lymphoscintigraphy studies, we report on an effective method to label dextran 500 with 99mTc which proved to be simple, inexpensive and yielded similar results for SLN identification compared with those given in the literature. The median age of the patients was 57 years (range 32-82 years). Seventeen patients were age 50 years or less, and 39 patients were older than 50 years. The median tumour size was 2.0 cm (range 0.8-7.0 cm). The mapping of the SLN was possible in all cases during the transoperative period by using a hand-guided gamma probe and a blue dye. A median of 2.0 (range 1-5) SLN were excised per patient. The median of axillary lymph nodes excised per patient was 21 (range 10-36). The calculated sensitivity and specificity of the method were 95.6% and 100%, respectively. The negative predictive value and overall accuracy were 97% and 98.2%, respectively. In conclusion, the SLN technique was feasible and produced similar positive results as previously reported in the literature.
Race is commonly described in epidemiological surveys based on phenotypic characteristics. Traini... more Race is commonly described in epidemiological surveys based on phenotypic characteristics. Training of interviewers to identify race is time-consuming and self identification of race might be difficult to interpret. The aim of this study was to determine the agreement between race definition based on the number of ascendants with black skin colour, with the self-assessment and observer's assessment of the skin colour. In a cross-sectional study of 50 women aged 14 years or older, from an outpatient clinic of an University affiliated hospital, race was assessed through observation and the self-assignment of the colour of skin and by the number of black ascendants including parents and grandparents. Reliability was measured through Kappa coefficient. Agreement beyond chance between self-assigned and observed skin colour was excellent for white (0.75 95% CI 0.72-0.78) and black women (0.89 95% CI 0.71-0.79), but only good for participants with mixed colour (0.61 95% CI 0.58-0.64), ...
The extent of arteriolar narrowing has been recognized as a major sign of end-organ damage in pat... more The extent of arteriolar narrowing has been recognized as a major sign of end-organ damage in patients with hypertension, but most methods used for its evaluation are highly dependent on the observer. We describe a new semi-automated method to measuring arteriolar-to-venous (A/V) ratio in retinal photography and present its application in the evaluation of patients with hypertension. In a cross-sectional study, 58 patients with hypertension had retinographies taken and digitized to determine the vessel diameter by direct measurement (micrometric method) or by the new microdensitometric method. Sub-pixel resolution was obtained via cubic spline fitting of the edge of vessel walls. For each pair of adjacent pixels, 10 intermediate points were generated in the perpendicular direction of the wall. Vessel widths were automatically extracted from this synthetic curve, with cut-points defined where the exterior wall position equals the double of mean noise along the slice. The intra- and i...
Retinal abnormalities, particularly arteriolar narrowing, are powerful predictors of cardiovascul... more Retinal abnormalities, particularly arteriolar narrowing, are powerful predictors of cardiovascular events. The precision of internists and ophthalmologists in the assessment of retinal vessels widths has been disputed but not evaluated against a technology of edge detection. Fifty-two patients with hypertension had optic fundi examination done by an internist and an ophthalmologist, and had retinographies taken and digitized to determine vessel diameters by a new technology of edge detection (microdensitometric method). Physicians asserted the presence of arteriolar narrowing (<or=0.67) through direct ophthalmoscopy and projected retinography. The microdensitometric method measures automatically the vessel widths based on the subpixel resolution of the edge of vessel walls. Sensitivity (SE), specificity (SP), positive (PPV) and negative predictive values (NPV), and kappa statistics were calculated, taken the microdensitometric method as reference. The performance of the direct e...
Anthropometric measurements and indexes that assess excess of adiposity are associated with cardi... more Anthropometric measurements and indexes that assess excess of adiposity are associated with cardiovascular risk factors, and predict diabetes mellitus. This cross-sectional study reported the performance of adiposity indexes to detect or turn diabetes unlikely in patients with hypertension. Patients with hypertension (blood pressure (BP) ≥140/90 mm Hg or antihypertensive drug use) aged 18-80 years, being 150 men and 332 women, had weight, height, waist circumference (WC), hip circumference, body mass index (BMI), waist-hip ratio (WHR), waist-to-height ratio (WHtR), and waist-to-square height ratio (WHt(2)R) calculated. Diabetes was diagnosed by fasting blood glucose ≥126 mg/dl or antidiabetic drug use (23% of the sample). All anthropometric indexes were associated with diabetes in a modified Poisson regression, adjusting for age, smoking, and physical activity, in women, but not in men. In men, only the area under the receiver-operating characteristic curve (AUC) for WHR was statist...
We aimed to evaluate the prevalence, frequency and type of leisure-time physical activity (LTPA) ... more We aimed to evaluate the prevalence, frequency and type of leisure-time physical activity (LTPA) among adults in Greece, as well as its relationship with socio-demographic, lifestyle and clinical characteristics of these people. From May 2001 to December 2002 we randomly enrolled 1514 men and 1528 women, without any evidence of cardiovascular or any other chronic disease. The sampling was stratified by the age-gender distribution of (census 2001) of the greater area of Athens. Weekly energy expenditure assessed by considering frequency, duration (in minutes) and intensity of sports related physical activity during a usual week. 53% of men and 48% of women were classified as physically active. Men were more likely to be active as compared to women (p < 0.05), while the lowest activity rates were observed in 40 to 49 years old participants (p < 0.01). Physically active people had higher occupation skills, were more likely to live in rural areas, to be unmarried, non smokers and ...
The article describes assessments and measurements performed in the Brazilian Longitudinal Study ... more The article describes assessments and measurements performed in the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil). Some assessments including anthropometric assessment, casual blood pressure measurement, and ankle-brachial index have an established clinical application while others including pulse wave velocity, heart rate variability, and carotid intima-media thickness have no established application and do not have reference values for healthy Brazilian population but may be important predictors of cardiovascular outcomes. Blood pressure measurement following postural change maneuver was included in the ELSA-Brasil because it has not been much tested in epidemiological studies. Innovative approaches were developed for assessing the ankle-brachial index using an automatic device instead of the mercury column to measure blood pressure and for assessing the anterior-posterior diameter of the right lobe of the liver by ultrasound for quantitative assessment of nonalcohol...
A substantial number of preschool children exhibit psychological symptoms that have an impact on ... more A substantial number of preschool children exhibit psychological symptoms that have an impact on their own and their families&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; lives. The aim of the current study was to investigate the prevalence, stability and increase/decrease in emotional and behavioral symptoms and the resultant impairment at two assessment points at preschool age. The sample consisted of 1,034 children drawn from the general population with a mean age of 51 months at t1 and 72 months at t2. Parents completed the Strengths and Difficulties Questionnaire extended version (Goodman, J Child Psychol Psychiatry 38(5):581-586, 1997; Goodman, J Child Psychol Psychiatry 40(5):791-799, 1999). At t1, 6.9 % of the preschoolers had a total difficulties and 6.8 % a total impact score within the abnormal range. At t2, these scores were 5.7 and 6.2 %, respectively. We found moderate stability of symptoms. From t1 to t2, emotional symptoms and prosocial behavior significantly increased, while hyperactivity, conduct problems, peer problems and total difficulties decreased. The mean total impact score did not change. Boys showed higher levels of symptoms (except emotional symptoms) and impact, and lower prosocial behavior, than girls. Moreover, there was a significant time × gender interaction, with girls showing a larger decrease in hyperactivity/inattention and in total difficulties than boys. The stepwise multiple regression analysis revealed that the total impact score at baseline, male gender, conduct problems, hyperactivity and peer problems significantly contributed to the explained variance of the total impact score at follow-up. This is one of very few studies to examine the stability and change of psychological symptoms in a large community sample of preschoolers, assessed twice during preschool age.
The status of the homolateral axillary lymph nodes is still the most important prognostic factor ... more The status of the homolateral axillary lymph nodes is still the most important prognostic factor in early stage breast cancer. The information obtained from the pathological examination of the lymph nodes guides is of critical importance in the decision process regarding the use of postoperative adjuvant therapy. However, lymph node axillary dissection can be followed by significant locoregional morbidity. The sentinel lymph node (SLN) technique was developed as a means of avoiding the full exploration of the axilla and consists in the identification of the first lymph node in the lymphatic drainage system of the breast tumour in the homolateral axilla. It has been demonstrated that the status of the SLN is highly predictive for the presence or absence of tumour involvement in the remaining lymph nodes in the axilla. In this study we evaluated the SLN technique using both 99mTc labelled dextran 500 and patent blue V dye in relation to the classical lymph node resection a series of 56 women with early breast cancer who attended the Breast Unit of the Academic Hospital of the Federal University of Rio Grande do Sul, Brazil. To our knowledge this is the first report in the literature of the utilization of 99mTc dextran 500 for the SLN technique. As there are no similar commercially available dedicated radiopharmaceuticals labelled for use in lymphoscintigraphy studies, we report on an effective method to label dextran 500 with 99mTc which proved to be simple, inexpensive and yielded similar results for SLN identification compared with those given in the literature. The median age of the patients was 57 years (range 32-82 years). Seventeen patients were age 50 years or less, and 39 patients were older than 50 years. The median tumour size was 2.0 cm (range 0.8-7.0 cm). The mapping of the SLN was possible in all cases during the transoperative period by using a hand-guided gamma probe and a blue dye. A median of 2.0 (range 1-5) SLN were excised per patient. The median of axillary lymph nodes excised per patient was 21 (range 10-36). The calculated sensitivity and specificity of the method were 95.6% and 100%, respectively. The negative predictive value and overall accuracy were 97% and 98.2%, respectively. In conclusion, the SLN technique was feasible and produced similar positive results as previously reported in the literature.
Race is commonly described in epidemiological surveys based on phenotypic characteristics. Traini... more Race is commonly described in epidemiological surveys based on phenotypic characteristics. Training of interviewers to identify race is time-consuming and self identification of race might be difficult to interpret. The aim of this study was to determine the agreement between race definition based on the number of ascendants with black skin colour, with the self-assessment and observer's assessment of the skin colour. In a cross-sectional study of 50 women aged 14 years or older, from an outpatient clinic of an University affiliated hospital, race was assessed through observation and the self-assignment of the colour of skin and by the number of black ascendants including parents and grandparents. Reliability was measured through Kappa coefficient. Agreement beyond chance between self-assigned and observed skin colour was excellent for white (0.75 95% CI 0.72-0.78) and black women (0.89 95% CI 0.71-0.79), but only good for participants with mixed colour (0.61 95% CI 0.58-0.64), ...
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