Gender,race and socioeconomic influence on diagnosis and treatment of thyroid disorders in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Thyroid diseases are common, and use of levothyroxine is increasing worldwide. We investigated the influence of gender, race and socioeconomic status on the diagnosis and treatment of thyroid disorders using data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort study of civil servants (35-74 years of age) from six Brazilian cities. Diagnosis of thyroid dysfunction was by thyrotropin (TSH), and free thyroxine (FT4) if TSH was altered, and the use of specific medications. Multivariate logistic regression models were constructed using overt hyperthyroidism/hypothyroidism and levothyroxine use as dependent variables and sociodemographic characteristics as independent variables. The frequencies of overt hyper- and hypothyroidism were 0.7 and 7.4%, respectively. Using whites as the reference ethnicity, brown, and black race were protective for overt hypothyroidism (OR=0.76, 95%CI=0.64-0.89, and OR=0.53, 95%CI=0.43-0.67, respectively, and black race was associated with overt hyperthyroidism (OR=1.82, 95%CI=1.06-3.11). Frequency of hypothyroidism treatment was higher in women, browns, highly educated participants and those with high net family incomes. After multivariate adjustment, levothyroxine use was associated with female gender (OR=6.06, 95%CI=3.19-11.49) and high net family income (OR=3.23, 95%CI=1.02-10.23). Frequency of hyperthyroidism treatment was higher in older than in younger individuals. Sociodemographic factors strongly influenced the diagnosis and treatment of thyroid disorders, including the use of levothyroxine.     

Pituitary fossa: chemical shift effect in MR imaging

The effect of chemical shift on magnetic resonance (MR) imaging of the pituitary fossa was studied. Healthy volunteers underwent conventional MR imaging of the pituitary fossa and then imaging with the frequency-encoding gradient reversed or with the phase- and frequency-encoding gradients interchanged. Comparison of the image pairs in each subject showed that the thin, black stripe evident at the water-fat interface within the pituitary fossa was altered when the gradients were changed. Therefore, the low-intensity signal within the pituitary fossa is a chemical shift misregistration effect.     

Anulus fibrosus in bulging intervertebral disks

In this investigation the association of radial tears of the anulus fibrosus and bulging of the intervertebral disk was studied. An index of disk bulging was measured in sagittal anatomic sections in 149 lumbar disks from 31 cadavers. The indexes of disk bulging were correlated with stages of disk development and the presence of an annular tear. The largest disk-bulging indexes were always associated with radial tears of the anulus. Eighty-four percent of the disks with radial tears had disk-bulging indexes greater than 2.5 mm. Most normal adult disks had an index of less than 2.5 mm. The results challenge the concept that the anulus fibrosus is intact in bulging disks, although ruptured in herniated disks.     

Gender and health in Brazil: considerations based on the National Household Sampling Survey]

As in the principal industrial countries, Brazilian women have lived longer than men. However, paradoxically, women present higher morbidity indicators than men. Knowledge of the Brazilian pattern regarding this matter could be a useful contribution to an understanding of their determinants in our specific reality, as well as enabling us to foresee future trends that would make it possible to plan adjustment in the health system. A morbidity study based on data from the National Household Sample Survey (PNAD/IBGE), was undertaken in ten Brazilian states in 1986 with this in view. Coefficients of the prevalence of perceived morbidity, demand for and utilization of health services according to sex, standardized by age and using the direct method, were built up. As a measurement of the differentials, sex ratios were calculated. The excess of perceived morbidity in women was constant in all the regions. The sex differential in the utilization of health services showed regional variations, suggesting a relationship with the health services supply. Sex differentials were not observed in childhood; the highest values were found during the woman's reproductive period, decreasing sharply after 60 years of age. The pattern is very similar in all regions. In the present study, the findings could be partially explained by the methodology adopted, but they are similar to the findings reported in other countries. The intense transformations in the reproductive pattern and in the social status of Brazilian women probably have a considerable impact on the health status and on the recourse to health services, not as yet evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)