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Background: Physical activity (PA) has been associated with decreased symptoms of depression and anxiety in the general population, but more consistent evidence is needed in the university population. Purpose: Investigate the association between physical activity and depressive and anxiety symptoms in undergraduates. Methods: 100 university students (23 ± 4 years, 47% female) were included in this cross-sectional study. We performed multiple linear regression analyses to investigate the association between the main variables. Results: The physical activity (MET/min/week) had a significant association with depressive (F(2, 97) = 15.104, p <.001; adjusted R2 =.222) and anxiety symptoms (F(2, 97) = 11.853 p <.001; adjusted R2 =.180), explaining these outcomes in approximately 22% and 18%, respectively. Moderate or vigorous physical activity did not have an association with depressive (B = −0.10, t = −0.700, p =.486) or anxiety symptoms (B = −0.11, t = 0.725, p =.470). Discussion: Individuals with high levels of physical activity have lower depressive and anxiety symptoms than individuals with lower levels of PA. Translation to Health Education Practice: Increasing the level of physical activity may be a viable strategy to reduce symptoms of anxiety and depression in university students. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) [ABSTRACT FROM AUTHOR]

To investigate the validity of six age-predicted maximum heart rate (HRmax) equations after stroke. Sixty individuals (54 (12) years; 64 (69) months after stroke) were included. A Cardiopulmonary Exercise Test (CPET) performed on a treadmill obtained the HRmax. The most used age-predicted equations were investigated: (1) 220-age, proposed by Fox; (2) 206.9– (0.67 × age), proposed by Gellish; (3) 208– (0.7 × age), proposed by Tanaka; (4) 216.6– (0.84 × age), proposed by Astrand; (5) 164– (0.72 × age) and (6) 200– (0.92 × age) proposed by Brawner. No statistically significant agreement was found between the HRmax obtained by the CPET and the one predicted by the equations 1–5 (–0.18 ≤ 95% confidence interval ≤0.79). A significant and moderate agreement was found between the HRmax obtained by the CPET and the one predicted by equation (6) (95% CI= 0.05–0.75; Intraclass Correlation Coefficient= 0.51). Bland-Altman plots showed that equations (1–4) and (6) overestimated the HRmax. Equation (6) presented the lower mean difference. The equations developed for non-disabled individuals (1–4) are not adequate to be used in individuals after a stroke. Equation (6) (Brawner) showed the best results to be used in individuals after stroke; however, it should be used cautiously. Prediction equations for maximum heart rate (HRmax) are commonly used to prescribe aerobic exercise for individuals following a stroke. The equations developed for non-disabled individuals are not valid for use with individuals after stroke, leading to an overestimation of the HRmax. An age-predicted HRmax equation developed for individuals with coronary heart disease may provide outcomes that are more accurate for stroke survivors, but care should still be taken when using it. [ABSTRACT FROM AUTHOR]

Blood cell biomarkers, such as the neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR), have been recently used as prognostic markers in tumors. In this study, we investigated the association between NLR and PLR with sociodemographic, clinical, anthropometric, and quality of life factors of hospitalized women with non-metastatic breast cancer. A cross-sectional observational study was conducted at a reference center for oncological treatment in Southeast Brazil. Female participants aged over 18 years, with a histopathological diagnosis of stage I, II or III breast cancer, in any phase of antineoplastic treatment, were included. Our study revealed a high risk for participants, with high mean values of NLR and PLR, indicating low antitumor activity and worse prognosis. The binary logistic regression model showed that there was a significant association of the NLR marker and marital status (OR = 3.1; 95%CI = 1.06-8.57; p = 0.03) and, in relation to PLR, a trend was shown for a higher chance in women of black ethnicity to have increased PLR compared to white women (OR = 4.13; 95%CI = 0.96-17.70; p = 0.05). However, the inflammatory markers (NLR and PLR) did not show any significant association with nutritional factors. NLR and PLR are inflammatory biomarkers that can be easily obtained and measured in clinical practice. [ABSTRACT FROM AUTHOR]

The unique characteristics of rural areas and agricultural work can contribute to the genesis of diseases, including mental disorders such as depression. To estimate the prevalence of and factors associated with depression symptoms in Brazilian farmers. A cross-sectional epidemiological study involving 784 farmers of the state of Espírito Santo/Brazil was carried out. Depression was identified using the Mini-International Neuropsychiatric Interview. Hierarchical logistic regression was used to assess the associated factors. The prevalence of depression symptoms among farmers was 16.8% (n = 132). Of those experiencing symptoms, 6.1% (n = 48) we're currently experiencing a depressive episode, and 10.7% (n = 84) a recurrent depressive episodes. The associated factors were: female gender (OR 1.63; 95% CI 1.04–2.54), not owning the land (OR 1.79; 95% CI 1.11–2.89), professional dissatisfaction (OR 1.99; 95% CI 1.18–3.35), previous pesticide poisoning (OR 2.87; 95% CI 1.45–5.67), complex multimorbidity (OR 1.95; 95% CI 1.15–3.31) and occurrence of previous depressive episodes (OR 9.83; 95% CI 4.39–21.99). A high prevalence of depression symptoms was identified among rural workers. Sociodemographic, occupational, clinical, and professional dissatisfaction factors were associated with a higher risk of depression symptoms in this population. [ABSTRACT FROM AUTHOR]

This cross-sectional study aimed to examine the relationship between postpartum depression symptoms, anxiety, and stress during the postpartum period. A total of 101 women were assessed using the Depression, Anxiety and Stress Scale (DASS-21) and the Edinburgh Postnatal Depression Scale (EPDS) within 14 days after delivery. Multivariate regression analysis revealed that paid work, tobacco use, and stress symptoms were significantly associated with a higher incidence of postpartum depression symptoms. These results underscore the importance of comprehensive prenatal care and effective postpartum follow-up to address maternal mental health and prevent adverse outcomes for both mothers and children. [ABSTRACT FROM AUTHOR]

The study aims to evaluate the association between substance use and social isolation with food consumption in adolescents. A crosssectional study was conducted with 2,040 adolescents from a medium-sized city in Brazil. The exposures assessed were the use of alcohol, tobacco, and other substances, and social isolation. The outcomes were the regular consumption (=5 times/week) of beans, fruit/fruit salad, candies, and soft drinks, and an unhealthy eating score. The association between health risk behaviors and food consumption was assessed through logistic and linear regressions. Regular users of alcohol were more likely to have regular consumption of candies and soft drinks, and those who used tobacco regularly were less likely to have regular bean consumption and more likely to have regular candies consumption. The use of at least one substance was negatively associated with regular bean consumption and positively associated with regular consumption of sweets and soft drinks. Socially isolated adolescents were less likely to have regular bean consumption. Substance use was positively associated with the unhealthy eating score. In conclusion, substance use and social isolation were associated with less regular consumption of healthy food markers and greater regular consumption of unhealthy food markers. [ABSTRACT FROM AUTHOR]

This study aimed to identify the prevalence of women in prisons who have already had an HIV test inside prison and the factors associated with this test. A cross-sectional study was carried out with 1327 women in 15 prisons in 9 states in Brazil. Almost 60% (95% CI: 57.8–63.7) of women have already been tested for HIV in prison. The factors associated with this HIV test were age ≥41 years (OR = 1.9; 95% CI = 1.2–2.9), highest level of education (OR = 1.9; 95% CI = 1.3–2.8), having been arrested 3 or more times (OR = 1.9; 95% CI = 1.3–2.8), having received information about HIV/STI in the lifetime (OR = 1.4; 95% CI = 1.1–1.9) and perceived themselves to be at no risk for HIV infection (OR = 1.7; 95% CI = 1.2–2.5), black or mixed race (OR = 0.7; 95% CI = 0.5–0.9) and having a male sexual partner (OR = 0.6; 95% CI = 0.5–0.9). The routine HIV testing in prisons needs to be expanded to promote HIV prevention for a population with limited access to these services outside of prison. [ABSTRACT FROM AUTHOR]

Substantial research has shown that the population distribution of major depressive disorder (MDD) is strongly influenced by race, gender, and socioeconomic position. However, a deeper understanding of inequities in access to care for MDD according to these social markers is yet to be reached. We use data from the 2019 Brazilian National Health Survey, which includes 87,187 respondents aged 18 years and over, to test two hypotheses derived from the inverse care law: women, Black, and low-education respondents have higher frequencies of MDD, but lower access to each step of the depression care cascade, including diagnosis by a health professional, regular healthcare visits, and access to specialised treatment (H1); low-education Black women show the highest MDD frequency and the lowest access to care across the entire cascade (H2). Partially supporting H1 and H2, our results reveal a bottleneck in the first step of the depression care cascade. While no racial inequities were observed in the MDD prevalence, Black individuals were less likely than whites to be diagnosed by a health professional (OR 0.74). Women (OR 2.64) and low-education (OR 1.18) were more likely to have probable MDD in relation to men and high-education respondents, respectively, but only women (OR 1.58) were more likely to be diagnosed. Low-education Black women were equally more likely to have probable MDD (OR 3.11) than high-education white men. Conversely, high-education white women emerged as the most likely to be diagnosed with MDD (OR 1.63). Our findings suggest the inverse care law applies to the depression care cascade in Brazil through indication that its healthcare system perpetuates a multilayered system of oppression that overlooks multiply marginalised individuals. We also show that adequate screening by health care professionals should mitigate the complex patterns of inequity revealed by our study. [ABSTRACT FROM AUTHOR]

Establish the validity of a triaxial accelerometer (Dynaport®) for evaluating the energy expenditure of patients with stroke sequelae at a rehabilitation hospital This is a cross-sectional study with 24 stroke inpatients of a rehabilitation hospital. The participants were assessed on energy expenditure by an ergospirometer system and the triaxial accelerometer simultaneously during a walk test. The data collected by both devices were compared by intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement An almost perfect agreement (ICC = 0,94) in the energy expenditure measured by the accelerometer compared to the results of the ergospirometer system was found during the exercise test. The Bland-Altman analysis has shown suitable limits of agreement. Post hoc analyses with the maximum volume of oxygen and the total energy expenditure measured by the ergospirometer system evidenced significant correlation with the energy expenditure measurements by the accelerometer Our results evidence that the triaxial accelerometer Dynaport® and its built-in software are valid for estimating the energy expenditure of stroke sequelae during a walk exercise. [ABSTRACT FROM AUTHOR]

Oxygen uptake efficiency slope during submaximal tests has been proposed as a more appropriate measure of aerobic capacity after suffering a stroke, since some individuals cannot tolerate maximal exercise testing. However, it has not yet been investigated whether the oxygen uptake efficiency slope is able to differentiate between healthy individuals and those who have suffered a stroke. To compare the oxygen uptake efficiency slope during walking and stair climbing between stroke survivors and age- and sex-matched healthy controls. This is a cross-sectional study in which 18 individuals who had suffered a stroke (stroke survivors) and 18 healthy controls matched for sex and age were included. Oxygen consumption and minute ventilation were collected breath-by-breath during walking (6-min Walk Test) and stair climbing. The oxygen uptake efficiency slope was estimated by the slope of the line obtained through linear regression. The stroke survivors had a lower oxygen uptake efficiency slope during the 6-min Walk Test than the healthy controls (MD 498, 95% CI 122 to 873, p =.01). The between-group difference for the Stair Test was smaller and not statistically significant (MD 349, 95%CI −73 to 772, p =.10). Stroke survivors had lower oxygen uptake efficiency slope during the performance of the 6-min Walk Test when compared to sex- and age-matched healthy controls. This suggests that stroke survivors have worse cardiopulmonary capacity. [ABSTRACT FROM AUTHOR]

To estimate the prevalence of at-risk drinking and smoking and associated factors among older adults in primary care in Brazil. A cross-sectional study carried out in seven primary care units with 503 older adults (60+), in a city in the state of Sao Paulo, Brazil. At-risk drinking was defined by AUDIT-C and by consumption of units per week. Poisson regression was used to assess the association between the sociodemographic and health characteristics and smoking and at-risk drinking. The median age of the 503 participants was 69.6 (SD ± 6.7; range:60-93). One third of participants (33.6%) were current drinkers, 16% were at-risk drinkers (AUDIT-C), 4% at-risk drinkers (units per week), and 13% of the sample were regular smokers. The prevalence of at-risk drinking (AUDIT-C) was higher for males (RP: 4.89; 95% CI: 2.52–9.49) and for those with higher levels of education (RP: 1,861.85 95% CI: 1.08–3.14), and lower for those over the age of 70 (RP: 0.50; 95% CI: 0.30-0.84). The prevalence of smoking was higher for those with depressive symptoms (RP: 1.95; 95% CI: 1.03-3.66), and lower for those over age 70 (RP: 0.52; 95% CI: 0.29-0.94). The results point to a set of factors associated with at-risk drinking (being male, younger and having a higher education), and with smoking (being younger and having depressive symptoms). Our findings could help health professionals to identify at-risk drinkers and smokers, as well as support strategies for future interventions by the identification of the groups most vulnerable to these behaviors. [ABSTRACT FROM AUTHOR]

Investigate the association between pelvic floor muscle function and stress urinary incontinence (SUI) in women in the third trimester of pregnancy. Cross-sectional observational study. Urinary symptoms were collected through a questionnaire. The physical examination of the pelvic floor muscle was performed by vaginal palpation and manometry. Multivariate logistic regression analyses were performed to investigate the factors associated with SUI. Analysis of the data collected from nulliparous and multiparous women identified an association between decreased pelvic floor muscle function (i.e. Power, Repetition, and Maximal Voluntary Contraction (MVC)) and the presence of SUI. There were also associations noted between power and SUI [AOR (95% CI) = 1.41 (1.01–1.97)], repetition and SUI [AOR (95% CI) = 1.31 (1.06–1.63)], and MVC and SUI [AOR (95% CI) = 1.02 (1.00–1.03)]. In the analysis of nulliparous women, there was also an association between low resting vaginal pressure (manometry) and SUI [AOR (95% CI) = 1.03 (1.01–1.06)]. Low pelvic floor muscle strength, low MVC, and decreased ability to repeat sustained pelvic floor muscle contractions were associated with SUI in the third gestational trimester. In nulliparous women, there was an association between low resting vaginal pressure and SUI; however, none these associations were identified in multiparous women. [ABSTRACT FROM AUTHOR]

The suspension of social activities combined with health insecurity, uncertainty and fear of COVID-19 may influence physical activity practice. We aimed to investigate the relationship between the fear of COVID-19 and anxiety on physical activity patterns during the pandemic period. This cross-sectional study was performed in a sample of 520 Brazilian participants recruited by online sampling and snowball method. We assessed demographic variables, health perceptions, anxiety, fear of COVID-19 and physical activity characteristics. Both fear scores and anxiety were higher in woman (p < 0.0001). We observed a remarkable reduction in the frequency and intensity of physical activity and a modification in the exercise practice environment (from gym or sports centers to home-based physical activity) (p < 0.05). Sedentary (sitting) behavior increased during pandemic both in the weekdays and in the weekend (p < 0.0001). Participants who have never been infected were more prone of being classified in higher levels for physical activity (OR: 1.916, CI = 1.043–3.521) versus those who were previously infected (p = 0.05). Participants with a low or moderate level of physical activity before the pandemic presented lower chances of being classified as high physical activity level during the pandemic in comparison to those with high level before pandemic (p < 0.001). The Fear of Covid-19 score was negatively associated with the physical activity level (the higher the fear, the lower the level of physical activity); that is, for every increase in scale score, the odds of vigorous physical activity decreased 3%. In conclusion, fear of COVID-19 and previous contact with the virus negatively influenced physical activity practice. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of sleep problems and associated factors among Brazilian physiotherapists during the Coronavirus Disease 2019 (COVID-19) pandemic. Methods: Cross-sectional online survey of physiotherapists in Brazil. Sociodemographic data, sleep quality (Pittsburgh Sleep Quality Index – PSQI) and symptoms of anxiety, depression and stress (21-item Depression, Anxiety and Stress Scale – DASS-21) were assessed. Results: 342 physiotherapists responded the survey (18% male, median age 31 [27–38] years, 78% frontline workers). The three biggest fears reported by frontline physiotherapists were fear of being infected (48%), shortage of personal protective equipment (24%) and the severity of the disease (16%). The overall prevalence of poor sleep quality was 86%. Frontline physiotherapists showed worse scores on all PSQI components but sleep latency, disturbances and daytime dysfunction (p ≤ 0.037). Symptoms of anxiety and stress were highest in frontline workers (p ≤ 0.032). Being a frontline worker was independently associated with a poor sleep quality (odds ratio [95% CI] 1.99 [1.01 to 3.93]). Conclusion: Poor sleep quality was highly prevalent among Brazilian physiotherapists during the COVID-19 outbreak. Frontline physiotherapists showed worse sleep quality and more symptoms of anxiety and stress than non-frontline physiotherapists. Being at the frontline was associated with a higher chance of poor sleep quality. [ABSTRACT FROM AUTHOR]

To compare the prevalence and characteristics of hypertension in women experiencing incarceration (WEI) to the general population in Brazil: (1) a prison survey conducted from January 2014 to December 2015 in 15 states, with 1,327 WEI; and (2) a household survey in the 26 states and the Federal District of Brazil administered to women in the general population (WGP). Data analysis used SPSS® version 20.0. The point estimates and the prevalence ratio with their respective confidence intervals were calculated using Poisson regression. Ages in the two populations differed, 27.9% of WGP were over 50, while 7.3% of WEI were. The overall prevalence of arterial hypertension was 31.3% (95% CI: 28.6–34.0) in the WEI and 38.9% (95% CI: 37.8–39.9) for WGP. For individuals under 30, hypertension was found in 22.4% of WEI and 13.4% of WGP. WEI have a higher prevalence of hypertension at an earlier age than the GP. Less education, obesity, using illegal drugs, previous pregnancy, and not using contraceptives were more frequent in this group, revealing the need to implement policies aimed at treating both their hypertension and other health issues in prison. [ABSTRACT FROM AUTHOR]

Objectives: Older adults are one of the most vulnerable age groups to the social distance measures imposed by the COVID-19 pandemic. This study aimed to assess factors associated with depressive and anxiety symptoms in Brazilian older adults during the pandemic. Method: This cross-sectional online study assessed 380 older adults (over 60 years of age) living in Brazil, from 26th May 2020 to 29th June 2020. A self-reported questionnaire included sociodemographic data, lifestyle, health characteristics, and the COVID-19 related variables. The Geriatric Depression Scale (GDS) and the Geriatric Anxiety Inventory (GAI) were also applied. Data were analyzed via logistic regression models, using a hierarchical approach. Results: The prevalence of depressive symptoms according to GDS was 28.7% (95% CI = 24.4%, 33.4%) and the prevalence of anxiety symptoms according to GAI was 26.1% (95% CI = 21.9%, 30.7%). Physically inactive older adults, the ones who were in social isolation for more days, feel much vulnerable to contracting COVID-19, and never or almost never receive support from family/friends were more likely to have depressive symptoms. Being female, physically inactive or physically active 1–3 times/week, feel very vulnerable to contracting COVID-19 and never or almost never receive support from family/friends were associated with the anxiety symptoms. Conclusion: A high prevalence of depressive and anxious symptoms was identified in Brazilian older adults. The data can help in planning interventions aimed at older adults, also including their families, health professionals, and the whole society. [ABSTRACT FROM AUTHOR]

The Human Immunodeficiency Virus (HIV) is considered one of the greatest public health challenges given its impact on morbidity and mortality, and there is currently no vaccine available. The costs for any vaccine have to be weighed against current preventative measures as well as its impact in reducing future infections. This was the rationale behind conducting a willingness to pay (WTP) study to guide future funding decisions. A cross-sectional study was conducted involving residents of Northern Brazil regarding their WTP for a hypothetical vaccine against HIV with 70% effectiveness. 634 individuals were interviewed and 94% accepted to use this hypothetical vaccine. The WTP was US$47.54 (200.00BRL). We believe these findings can contribute to decision-making about pricing once a HIV vaccine becomes available in Brazil and in discussions with its acceptability. [ABSTRACT FROM AUTHOR]

Introduction: Psychological processes can play an important role in the expression and clinical impact of fibromyalgia. Objective: To investigate the association between the severity of pain and disability and psychological factors in patients with fibromyalgia. Methods: The following outcomes were assessed in 104 patients with fibromyalgia: pain intensity, using the Pain Numerical Rating Scale; disability, using the Patient-Specific Functional Scale; depression, using the Beck Depression Scale; anxiety, using the State-Trait Anxiety Inventory; kinesiophobia, using the Tampa Scale for Kinesiophobia; pain catastrophizing, using the Pain Catastrophizing Scale; beliefs and attitudes toward pain, using the Survey of Pain Attitudes; and the occurrence of abuse during some stage of life. Statistical analysis was performed using SPSS version 15. Initially, a simple regression analysis was performed between the dependent variables (pain and disability) and the other variables with a significance level of p ≤ 0.20, and then a multiple regression analysis was performed with a significance level of p ≤ 0.05. Results: Depression was found to be associated with pain severity (β = 0.07 [95% CI: 0.02 to 0.11], p =.00), and kinesiophobia was found to be associated with disability severity (β = −0.06 [95% CI: −0.09 to −0.02], p =.00). Depression can explain 10% of the variability of pain intensity, while kinesiophobia can explain 9% of the variability of disability. Conclusion: There are weak associations that are not clinically relevant between depression and pain severity, and between kinesiophobia and disability severity. However, other psychological factors are not associated with the severity of pain or disability. [ABSTRACT FROM AUTHOR]

Brazil is among the top ten countries in preterm delivery worldwide. This study assesses the factors associated with preterm birth in the Western Brazilian Amazon. A population-based cross-sectional study was held between July 2015 to June 2016 in Cruzeiro do Sul, Brazilian Amazon. A total of 1525 births were included in this analysis. Preterm birth was defined as births at gestational age < 37 weeks. A stepwise multiple logistic regression was used to identify factors associated with preterm delivery. The prevalence rate of preterm birth was 7.9% (n = 120; 95% CI: 6.5–9.3). After adjusting for confounding factors, a positive association with preterm birth was observed for pregnant women who completed less than six antenatal care visits (OR: 2.93; 95% CI: 1.89–4.56), who had a birth interval of < 18 months (OR: 2.65; 95% CI: 1.04–6.75), and who experienced bleeding (OR: 2.17; 95% CI: 1.39–3.38) and hypertension during pregnancy (OR: 1.74; 95% CI: 1.07–2.82). Factors associated with preterm birth in the Western Brazilian Amazon were mostly related to the aspects of health care provided to women, and thus could be prevented. Proper, timely, and regular antenatal care visits can help reduce adverse outcomes, such as hypertension and bleeding. [ABSTRACT FROM AUTHOR]

the aim of this study is two-fold: 1) to explore the pain characteristics among breast cancer survivors that return to work and do not return to work; 2) to identify the factors associated with pain on the upper quadrant of the affected side. Sixty-two breast cancer survivors were included. Quality of life was assessed using EORTC QLQ-C30 and QLQ-BR23. Pain characteristics were assessed with a body diagram and a numeric rating scale. Thirty-five breast cancer survivors did not return to work. Ninety-one percent of women that did not return to work reported pain. The most frequent pain sites were the cervical spine and the axilla of the affected side. There were no significant differences in pain intensity between groups. The factors associated with pain on the upper quadrant of the affected side were perception of shoulder stiffness OR = 5.93 (1.38–44.87, 95%CI) and time since surgery of more than four years OR = 5.54 (1.36–20.97, 95% CI). Pain was highly prevalent among breast cancer survivors. Breast cancer survivors that returned to work presented better quality of life. Longer time since surgery and perception of shoulder stiffness were associated with pain on the upper quadrant of the affected side. Pain is a major factor following breast cancer surgery preventing returning to work. This group reported more pain on the cervical spine and axilla of the affected side. Rehabilitation needs to focus specifically on pain management in order to improve quality of life. A multidisciplinary approach involving pain specialists and vocational support is recommended. [ABSTRACT FROM AUTHOR]

To examine the psychological well-being of primary caregivers of infants and toddlers with Congenital Zika Syndrome (CZS), and the roles of family resources, parenting stress, and coping strategies in caregivers' adaptation. Family caregivers (N = 50) of children with CZS who were receiving treatment at a rehabilitation hospital in Recife, Brazil participated a cross-sectional survey study. Caregivers completed measures of anxiety and depression, coping strategies, family resources, and parenting stress. Mild to severe symptoms of depression were identified in 40% of caregivers and were a more prominent concern than symptoms of anxiety. Fewer family resources and high levels of parenting stress were significantly associated with both anxiety and depression. The association between parenting stress and depression was moderated by coping, such that parenting stress was associated with higher caregiver depression at low but not high levels of coping strategy use. Practitioners in Brazil should consider the role of family coping and resources as important resilience promoting factors in the development of new programs designed to promote psychological adaptation in caregivers to children with CZS. It is recommended that caregiver mental health support services be integrated into existing early intervention programs targeting children with CZS. Parents and other primary caregivers are encouraged to take an active role in the care and developmental monitoring of children born with CZS, but their ability to provide care may be compromised by difficulties in psychological adaptation. Moderate and severe symptoms of depression were more prominent in caregivers than moderate and severe symptoms of anxiety (20% versus 6%, respectively). Practitioners should include assessment of coping strategies, parenting stress and family resources conjointly with evaluation of symptoms of depression and anxiety as part of routine CZS family evaluations. A useful approach for caregivers in Brazil may be to more fully integrate caregiver mental health support services into existing early intervention programs for children with CZS. [ABSTRACT FROM AUTHOR]

This article evaluated the predictors of EE and its components, EOI and CC, in relatives of first episode psychosis patients (FEP) in Brazil. Cross-sectional observational study conducted with 82 dyads of FEP patients and their relatives. Data collection instruments: sociodemographic and clinical data questionnaire, Family Questionnaire, Zarit Burden Interview and Morisky Medication Adherence Scale. Logistic and linear regression models were used. Our results indicate that patient's age, relative's sex, daily time spent together, and family burden were predictors of EE and its components. Our findings may be helpful in planning nursing interventions to reduce EE and prevent psychotic relapses. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the prevalence of use of psychoactive agents among medical students attending Federal Higher Education Institutes in Brazil and to identify the licit and illicit drugs most often employed. Methods: The cross-sectional study involved ten medical schools located in a Brazilian state. Students were asked to complete a online questionnaire. Differences between the proportions of users and non-users of licit and illicit agents were compared using χ2 test and multivariate logistic regression analysis. Results: 647 students completed the survey satisfactorily. 70% (n = 452) of respondents consumed at least one psychoactive substance. Alcohol was the substance most frequently consumed followed by tobacco and cannabis. Most respondents who had used antidepressants and benzodiazepines reported that the drugs were informally indicated by health professionals. The use of licit substances was associated with no practising religion, high income and living with friends. The use of illicit substances was related to age (23–27 years), gender (male) and no practising religion. Conclusion: Our study draws attention to the importance of promoting responsibility and self-criticism during medical education in order to avoid students developing a feeling of dominance regarding alcohol or drug consumption that may deteriorate into addiction or even recklessness regarding their future prescribing practice. [ABSTRACT FROM AUTHOR]

Purpose: To validate the Comprehensive and Brief International Classification of Functioning, Disability and Health Core Sets for obstructive pulmonary diseases from the perspective of adults with asthma. Methods: This was a qualitative, cross-sectional study. Individual interviews with questions related to the disease and its impact on the patient's life were performed. The meaning condensation procedure was used for analysis. Results: Thirty-five participants (26 females, 41 ± 13 years old) were interviewed. A total of 405 concepts were identified, and 348 were associated to the components Body Functions (n = 168), Body Structures (n = 22), Activities and Participation (n = 33), Environmental Factors (n = 125). These concepts were linked to 61 categories: second level (n = 25), third level (n = 33), fourth level (n = 3), which confirmed 41% and 77% of those included in the Comprehensive and Brief Core Sets, respectively. Twenty-four additional categories were identified, and 57 concepts could not be linked to the classification. Conclusions: The International Classification of Functioning, Disability and Health Core Sets for obstructive pulmonary diseases were supported by the perspective of adults with asthma. The Brief version seemed the best reference for rehabilitation, reflecting the typical disabilities and impairments of these patients. Unconfirmed and added categories have been reported, and their analysis may assist future document updates. The use of the International Classification of Functioning, Disability and Health Core Sets for Obstructive Pulmonary Diseases is relevant to guide patient assessment, treatment and monitoring. The concepts related to the Body functions and Environmental factors were the most relevant according to the perspective of adults with asthma. The Comprehensive and Brief International Classification of Functioning, Disability and Health Core Sets for Obstructive Pulmonary Diseases were supported by adults with asthma. [ABSTRACT FROM AUTHOR]

Objective: The aims of the present research were to determine the prevalence of the use of dietary supplements and anabolic-androgenic steroids (AAS) without professional guidance in the countryside of Northeastern Brazil, and to compare blood pressure (BP) between nonusers of dietary supplements, thermogenic supplement users and AAS users. Methods: The sample consisted of 346 resistance training (RT) practitioners and bodybuilders. The participants answered a questionnaire on the use of dietary supplements and/or AAS. In addition, the participants underwent BP assessment. Results: 76.9% of the sample consumed dietary supplements and AAS at some point in their lives. 66.8% (95%CI: 61.5–71.7) of our sample used only food supplements without any guidance from a qualified professional. AAS and cosmetic doping was reported by 8.1% (95%CI: 5.6–11.2%) and 2.0% (95%CI: 1.0–4.2%) of the sample, respectively. Regarding BP, a significant difference was observed for systolic BP when nonusers of dietary supplements were compared to users of thermogenic supplements (126.5 ± 15.1 mmHg s. 134.7 ± 14.5 mmHg; p=.034) and when compared to AAS users (126.5 ± 15.1 mmHg vs. 136.6 ± 12.2 mmHg; p=.010). Conclusions: Our findings point to excessive consumption of dietary supplements and AAS (without professional guidance) by RT practitioners and bodybuilders. In addition, we observed high systolic blood pressure in users of thermogenic supplements and AAS users. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the relationship between pharyngeal response time (PRT) and lateralization of brain lesions. Methods: A Cross-sectional study. 73 videofluoroscopic swallow studies (VFSS)were conducted on patients after stroke The study subjects were divided into : group 1 (G1) consisting of 39 individuals with left cortical lesion and group 2 (G2) consisting of 34 individuals with right cortical lesions. The VFSS of G1 and G2 subjects were analyzed using puree (A) and liquid (B) consistencies, and were also subdivided into young adults and older persons.. The mean PRT was divided into times shorter and longer than 250 ms. Results: No statistically significant difference was observed between G1 and G2 for the A and B consistencies, being obtained : G1 (A mean: 56.6 ms; B mean: 99.5 ms; A mean: 3627 ms; B mean: 1712 ms) and G2 (A mean: 79.6 ms; B mean: 110.7 ms; A mean: 2040 ms, B mean: 1529 ms), for PRT shorter (A:p =.673; B: p = 1.000) and longer (A: p =.435; B: p =.847) than 250 ms, respectively. No statistically significant difference was found regarding the variable age in the comparison between young and old adults for mean PRT according to the A and B consistencies in G1 (A: p =.260; B: p =.732) and G2 (A: p =.586; B: p =.104). Conclusion: No relationship between PRT and lateralization of brain lesion was observed with respect to subject age and to the swallowing of different food consistencies. [ABSTRACT FROM AUTHOR]

Objective: Evaluate, code and qualify the participation of Brazilian stroke survivors based on the international classification of functioning, disability and health (ICF) and identify predictors of post-stroke participation. Methods: An exploratory, observational, cross-sectional study was conducted involving 78 individuals with hemiparesis stemming from a stroke. The stroke specific quality of life (SS-QOL) was used to evaluate the participation component of the ICF. The geriatric depression scale was used to screen depressive symptoms; the functional independence measure (FIM) was used to measure the degree of dependence; grip strength was determined using a dynamometer; and cognitive status was evaluated using the mini mental state examination. The one-way analysis of variance followed by the Bonferroni test was used for the comparison the participation scores of different groups (age and marital status). The independent t-test was used for the comparisons of the other groups (sex, time since the occurrence of stroke (<12 months or >12 months) and degree of functional independence). Multiple linear regression was employed to identify measures capable of predicting participation. Results: Based on the classification and qualifiers of the ICF, the individuals analyzed exhibited a moderate level of participation. Participation was significantly associated with time since the occurrence of stroke (F = 2.46; 95% confidence interval (CI) = −23.67–0.34; p = 0.05), degree of functional independence (F = 2.40; 95% CI = −33.0 to −18.93; p < 0.001) and marital status (married or widowed) (F = 2.6; p = 0.05). No statistically significant associations were found with regard to age, sex or affected side of the body. Functional independence was the main predictor of participation (F = 99.2; r2 = 0.57; p <0.001) and the occurrence of depressive symptoms was a moderate predictor (F =12.78; r2 = 0.40; p = 0.001). Conclusions: Twenty-four ICF categories were coded and qualified with the use of the SS-QOL, enabling the participation component of the ICF biopsychosocial model to be easily evaluated in clinical practice. Overall, the sample in the present study demonstrated a moderate decline in participation following a stroke and only the "social roles" domain was severely affected. The FIM was the main predictor of participation and the depression was a moderate predictor. Therefore, health professionals involved in the rehabilitation of these patients should focus on the promotion of functional independence and improvements in emotional health to optimize social participation following a stroke. The Brazilian stroke individuals analyzed exhibited a moderate level of participation. Functional independence was the main predictor of participation and the occurrence of depressive symptoms was a moderate predictor. Age, sex and affected side of the body were not predictors of participation. Our findings support that twenty-four International classification of functioning, disability and health categories were coded and qualified with the use of the stroke specific quality of life. Rehabilitation of social functioning post stroke patients should be focused on the promotion of functional independence and improvement in emotional health. This study offers a participation assessment model that can facilitate the incorporation of the ICF in the clinical practice. [ABSTRACT FROM AUTHOR]

We sought to examine the frailty association with depression and functional disability in hospitalized older adults. In particular, we compared non-frail, pre-frail, and frail elderly hospitalized individuals. We performed a cross-sectional study with 255 hospitalized Brazilian elderly patients. We used a structured instrument to assess socio-economic data, the Fried frailty phenotype and used morbidity scales (Geriatric Depression; Katz; Lawton and Brody). The adjusted analysis revealed that frail elderly exhibit increased odds ratios (OR) for depressive symptoms (OR = 2.72, 95% CI: 1.12-6.62), disability related to basic activities (OR = 3.50, 95% CI: 1.26-9.60), and instrumental daily living (OR = 2.70, 95% CI: 1.12-6.44). Frailty in hospitalized older adults is associated with depressive symptomatology and functional disability. [ABSTRACT FROM AUTHOR]

The study examined the validity of the Line Drill test (LD) in male adolescent basketball players (10–15 years). Sensitiveness of the LD to changes in performance across a training and competition season (4 months) was also considered. Age, maturation, body size and LD were measured (n = 57). Sensitiveness of the LD was examined pre- and post-competitive season in a sub-sample (n = 44). The time at each of the four shuttle sprints of the LD (i.e. four stages) was modelled with Bayesian multilevel models. We observed very large correlation of performance at stage 4 (full LD protocol) with stage 3, but lower correlations with the early LD stages. Players’ performance by somatic maturity differed substantially only when considering full LD protocol performance. Substantial improvements in all stages of the protocol were observed across the 4-month competitive season. The LD protocol should be shortened by the last full court shuttle sprint, remaining sensitive to training exposure, and independent of maturity status and body size. [ABSTRACT FROM PUBLISHER]

The aim of this study was to analyze the association of combined physical activity (PA)/sedentary behaviour (SB) with depressive symptoms (DS) in older adults. A cross-sectional study was conducted with 622 individuals ≥ 60 years old. After adjusting for gender, years of study, and monthly household income, prevalence ratios for presence of DS were statistically significant for older adults with <150 min/week in PA and ≥75th percentile of SB on weekdays (PR = 2.11,95%CI: 1.54–2.90) and on weekends (PR = 2.20,95%CI:1.57–3.09). Older adults who do not meet the PA guidelines and spend more time in SB on weekdays or weekend days are more likely to present with DS compared to those who meet the recommendations of PA and spend less time in SB during the day. [ABSTRACT FROM PUBLISHER]

Purpose:To evaluate the reproducibility of the Stroke Specific Quality of Life (SS-QOL) items that address the participation component of the International Classification of Functioning, Disability and Health (ICF) and analyse the correlation between the subscore of these 26 items and the total SS-QOL score. Methods:Seventy-five stroke survivors participated in this study. Reproducibility was evaluated using the intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM), minimum detectable change (MDC) and the Bland–Altman plot. The correlation between the subscore of the 26 items and the total SS-QOL score was analysed using Spearman’s correlation coefficients (rho) and simple linear regression. An alpha risk ≤ 0.05 was considered for all analyses. Results:The SS-QOL items that address the participation component of the ICF demonstrated excellent reliability (intra-rater ICC2,1 = 0.96; inter-rater ICC2,1 = 0.95). The SEM and MDC were adequate. The Bland–Altman plot demonstrated satisfactory agreement. A significant and strong correlation (rho = 0.83) was found between the 26 SS-QOL items that address participation and the total SS-QOL score. Moreover, the evaluation of participation was found to explain 73% of the evaluation of health-related quality of life. Conclusion:The 26 SS-QOL items that address the participation component of the ICF demonstrated adequate reproducibility. Thus, participation, which represents the social aspects of functionality, can be adequately evaluated with these items.Implications for RehabilitationThe 26 Stroke Specific Quality of Life items that address participation proved to be reproducible for the analysis of social participation following a stroke.The findings can lead to a better understanding of the social participation of individuals with chronic hemiparesis and assist in the establishment of adequate treatment for such individuals.The rehabilitation process can be directed towards more specific goals focused on the patient expectations, thereby contributing to greater humanization and effectiveness of treatment to improve social participation following a stroke. [ABSTRACT FROM PUBLISHER]

This study aimed to verify the prevalence and characteristics of sports injuries (SI) and determine the association between the physical activity level (PA) and SI with perception of health-related quality of life (HRQoL) in Brazilian basketball master athletes. A cross-sectional study was conducted with 410 male master athletes, between 35 and 85 years of age (mean 52.26, SD ±11.83). The HRQoL was assessed using the Medical Outcomes Study – Short Form-36. The PA was evaluated using the International Physical Activity Questionnaire. Information regarding SI was collected using the Reported Morbidity Survey. Poisson regression, as estimated by the prevalence ratio (PR), was used as a measure of the association of PA and SI with HRQoL. The majority of athletes showed a high SI prevalence (58.3%) and reported one injury (67.8%) that occurred during training (61.1%) and primarily affected a lower limb (74.6%). The adjusted regression models showed a positive association of PA with theFunctional Capacity(PR = 1.46, 95% confidence interval [CI] = 1.12–1.90) andPhysical Component(PR = 1.32, 95% CI = 1.03–1.70) of HRQoL. Furthermore, the SI were negatively associated with HRQoL inFunctional Capacity(PR = 1.85, 95% CI = 1.51–2.27),Physical Aspects(PR = 3.99, 95% CI = 3.08–5.18),Pain(PR = 1.65, 95% CI = 1.26–2.16),Social Functioning(PR = 1.79, 95% CI = 1.41–2.27),Emotional Aspects(PR = 4.40, 95% CI = 3.35–5.78),Mental Healthdomains (PR = 1.37, 95% CI = 1.06–1.68),Physical Component(PR = 2.35, 95% CI = 1.90–2.90) andMental Component(PR = 2.65, 95% CI = 2.14–3.29). These results highlighted that master athletes showed a high SI prevalence, primarily in the lower limbs. PA positively correlates with the physical HRQoL domain, whereas SI may decrease the HRQoL levels of both physical and mental domains. [ABSTRACT FROM PUBLISHER]

Transwomen are a high-risk population for HIV/AIDS worldwide. However, many transwomen do not test for HIV. This study aimed to identify factors associated with resistance to HIV testing among transwomen in Fortaleza/CE. A cross-sectional study was conducted between August and December 2008 with a sample of 304 transwomen recruited through respondent-driven sampling. Data analysis utilized Respondent-Driven Sampling Analysis Tool and SPSS 11.0. Univariate, bivariate, and multivariate analyses examined risk factors associated with resistance to HIV testing. Less than 18 years of age (OR = 4.221; CI = 2.419–7.364), sexual debut before 10 years of age (OR = 6.760; CI = 2.996–15.256), using illegal drugs during sex (OR = 2.384; CI = 1.310–4.339), experience of discrimination (OR = 3.962; CI = 1.540–10.195) and a belief that the test results were not confidential (OR = 3.763; CI = 2.118–6.688) are independently associated with resistance to testing. Intersectoral and targeted strategies aimed at encouraging the adoption of safer sexual behaviors and testing for HIV among transwomen are required. [ABSTRACT FROM AUTHOR]

Malnutrition is a risk factor for noncommunicable diseases related to ageing, and it can also contribute to musculoskeletal health. This study investigated whether nutritional risk is associated with chronic musculoskeletal pain in community-dwelling older persons. Nutritional risk was assessed by the DETERMINE Checklist. Chronic musculoskeletal pain was defined as the presence of pain in the past six months that did not disappear for at least 30 consecutive days. Multivariate logistic regression including confounding variables was used for the analysis. The sample was comprised of 383 participants (age 75.6 ± SD 6.1); the majority were at moderate-to-high nutritional risk (69%) and approximately one third presented chronic musculoskeletal pain (30%). The nutritional risk score was independently associated with chronic musculoskeletal pain: adding one unit in the risk score produces an 11% increment in the odds of presenting pain (OR 1.109, 95% CI 1.022–1.204). Individuals classified into moderate- or high-risk categories also had substantially higher odds (∼90%) of presenting chronic musculoskeletal pain when compared to those in the low-risk category, although our findings were only marginally significant. This is the first study to demonstrate the association between nutritional risk and chronic musculoskeletal pain above and beyond the contributed effects from relevant confounders. [ABSTRACT FROM PUBLISHER]

We examined whether women who had regular jobs throughout life performed better cognitively than older adult housewives. Linear regression was used to compare global cognitive performance scores of housewives (G1) and women exposed to work of low (G2) and high (G3) complexity. The sample comprised 477 older adult Brazilian women, 430 (90.4%) of whom had performed lifelong jobs. In work with data, the G2 group's cognitive performance scores were 1.73 points higher (p =.03), and the G3 group scored 1.76 points (p =.02) higher, than the G1. In work with things and with people, the G3 scored, respectively, 2.04 (p <.01) and 2.21 (p <.01) cognitive test points higher than the G1. Based on our findings we suggest occupation of greater complexity is associated with better cognitive performance in women later in life. [ABSTRACT FROM AUTHOR]

Little is known about the influence of different types and sources of social support on physical activity in adolescents. The aim of this study was to analyse the association between physical activity and different types and sources of social support in adolescents. The sample consisted of 2,859 adolescents between 14–19 years of age in the city of João Pessoa, in Northeastern Brazil. Physical activity was measured with a questionnaire and social support from parents and friends using a 10-item scale five for each group (type of support: encouragement, joint participation, watching, inviting, positive comments and transportation). Multivariable analysis showed that the types of support provided by parents associated with physical activity in adolescents were encouragement for females (P < 0.001) and adolescents between 14–16 years of age (P = 0.003), and transportation (P = 0.014) and comments (P = 0.037) for males. The types of social support provided by friends were: joint participation in male adolescents (P < 0.001) and in these 17–19-year-olds (P < 0.001), and comments in both genders (males:P = 0.009; females:P < 0.001) and 14–16-year-olds (P < 0.001). We conclude that the type of social support associated with physical activity varies according to its source, as well as the gender and age of the adolescents. [ABSTRACT FROM AUTHOR]

Alcohol and other drugs use seem to be common among people infected with HIV on antiretroviral treatment (ART). Their effects on HIV progression is still in debate. This study aimed to assess the association between alcohol and drug use and an HIV disease progression biomarker (CD4 cell count) among patients on ART. A cross-sectional study was carried out at an HIV treatment center affiliated with Medical School of the University of São Paulo, Brazil. Four hundred and thirty-eight HIV-positive patients on ART were interviewed by trained psychiatrists and psychologists using the following instruments: Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Alcohol Use Disorders Identification Test (AUDIT), 17-item Hamilton Rating Scale for Depression, and the Simplified Medication Adherence Questionnaire (SMAQ). In the previous month, 219 (50%) and 41 (9.3%) patients reported use of alcohol and illicit drugs, respectively. Fifty patients (12.6%) were classified as having harmful alcohol use by AUDIT. According to SCID-I, 80 patients (18.3%) were alcohol abusers, 24 (5.5%) alcohol dependents, and 21 (4.2%) had a current depressive disorder. Almost 73% (n= 319–72.8%) of the patients were adherent to ART. Alcohol dependents were nine times (p< 0.01) more likely to have CD4 cell count ≤200/mm3, and this association was independent of ART adherence. In conclusion, alcohol dependence seems to be associated with low CD4 cell count in HIV-positive patients. Based on these data, HIV health care workers should always assess alcohol consumption in the treatment setting, and patients should be advised that alcohol dependence may be linked to low CD4. [ABSTRACT FROM AUTHOR]

People living with mental illness are at increased risk for HIV. There are scarce data on correlates and prevalence of HIV infection, and none with a nationally representative sample. We report on correlates of HIV infection from a cross-sectional national sample of adults receiving care in 26 publicly funded mental health treatment settings throughout Brazil. Weighted prevalence rate ratios were obtained using multiple log-binomial regression modeling. History of homelessness, ever having an STD, early age of first sexual intercourse before 18 years old, having suffered sexual violence, previous HIV testing, self-perception of high risk of HIV infection and not knowing one's risk were statistically associated with HIV infection. Our study found an elevated HIV seroprevalence and correlates of infection were not found to include psychiatric diagnoses or hospitalizations but instead reflected marginalized living circumstances and HIV testing history. These adverse life circumstances (history of homelessness, having suffered sexual violence, reporting a sexually transmitted disease, and early sexual debut) may not be unique to people living with mental illness but nonetheless the mental health care system can serve as an important point of entry for HIV prevention in this population. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the characteristics of pregnant women whether they are HIV infected or not and their prenatal care. It is a cross-sectional study. HIV-infected women were derived from a cohort study of all HIV-infected pregnant women followed from 1995 to 2005, at the Instituto de Puericultura e Pediatria Martagão Gesteira - Rio de Janeiro. HIV-non-infected women were derived from a random sample of all pregnant women who gave birth at Rio de Janeiro municipality between 1999 and 2001. All relevant sociodemographic, clinical, and pregnancy outcomes data were retrieved from both studies. To evaluate the prenatal care, we calculated the Kotelchuck Modified Index (KMI). The index is based on the months of initiation of prenatal care and the proportion of visits observed in each trimester, according to gestational age at birth. Comparisons were performed using Student t- and chi-square tests. Variables with p-value < 0.25 were included in an unconditional logistic regression model. There were 713 HIV-infected women and 2145 HIV-non-infected women. Variables independently associated with HIV status were: inadequate KMI (OR=4.08, 95% CI=3.17-5.24); lower educational level (OR=1.32, 95% CI = 1.04-1.68); does not live with a partner (OR =3.54, 95% CI =2.66-4.64); lower family income (OR = 4.71, 95% CI = 3.62-6.14); tobacco use (OR = 2.17, 95% CI = 1.63-2.88); and hypertension (OR = 1.47, 95% CI = 1.01 2.17). Prematurity was not independently associated with HIV status. Although in Brazil, the HIV care is free of charge, pregnant women are still having difficulty to reach the specialized care. Better access to care must be offered to this population and studies of prematurity in the HIV-infected women must evaluate their prenatal care. [ABSTRACT FROM AUTHOR]

Travestisare highly vulnerable to HIV infection in Brazil. We conducted a survey among 304 travestis using Respondent-Driven Sampling from August to December 2008. Travestis are young (49% <24 years), poorly educated (55% just elementary school), low social class (62% Class C-E), reside with families (49%) or friends/madam (22%), are victims of homophobia (91%) and violence (61%). They report early sexual debut (75% <14), many sexual partners, drug use during sex (43%), and unprotected sex (male partner, 47%, both male and female partners, 50%). Sex work is common (82%, 59% >10 partners last six months) and relatively low cost (median=US$24). A majority report testing for HIV (69%), and report high prevalence (12% disclosed a positive result). Almost all the respondents refused to test in the study. Interventions, targeted to both travestis and to the general community about sexual discrimination, are necessary. [ABSTRACT FROM AUTHOR]

Objective: to investigate factors associated with repeat pregnancies among adolescents in a tertiary hospital in the city of São Paulo, Brazil. Background: Teenage mothers present a high risk of repeat pregnancies during adolescence. Most of these pregnancies are unplanned. Methods: A cross-sectional study conducted in a tertiary hospital in São Paulo, Brazil. The study population included 745 first-time pregnancies and 170 two or more times pregnant teenagers hospitalised for childbirth. Logistic regression models were used to identify independent factors associated with repeat pregnancy in this population. Results: Older age at first pregnancy was associated with a decreased risk of repeat pregnancies (odds ratio and 95% confidence interval 0.78 (0.68–0.89)). Prenatal examinations (0.13 (0.05–0.32)), higher education (0.83 (0.76–0.91)) and higher monthly income (0.79 (0.67–0.95)) were also protective against repeat pregnancies. Those who used contraceptives (2.76 (1.80–4.21)) and lived with their partners (2.44 (1.53–3.88)) had an increased risk of becoming pregnant more than once. Conclusion: Preventive programmes aiming to avoid repeat pregnancies in adolescents should not be restricted to the transmission of information. Behavioural changes in family planning must include access not only to adequate information but also to adequate healthcare, contraceptive methods, education and training. [ABSTRACT FROM PUBLISHER]