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This study aimed to quantify the health and economic impacts of alcohol consumption in Brazil for 2019. Ecological study using secondary data sources. We calculated the disease burden using estimates from the Global Burden of Disease study, which incorporated data from health surveys and hospital records. Costs were estimated based on direct expenses recorded in the Hospital and Outpatient Information System of the Unified Health System, with data by sex, age group, cause, and Federative Units. Alcohol consumption was a necessary cause for 30,355 deaths and approximately 1.69 million disability-adjusted life years in Brazil, representing 2.2% and 2.6% of the national totals, respectively. The impact was more pronounced among men, in the Northeast region and within the 40- to 64-year-old age group. The total costs attributed to these outcomes reached approximately Int$43.1 million, with hospital admissions accounting for 94.16% of these expenses. In 2019, alcohol consumption had a significant impact on both the health of Brazilians and the expenses of the health system. As a preventable risk factor, alcohol consumption necessitates effective intersectoral strategies to mitigate its burden. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyse the attributable risk of mortality and DALYs (Disability Adjusted Life Years) due to occupational carcinogens for lung cancer between 1990 and 2019 in Brazil and federation units, as well as its relationship with the Socio-demographic Index (SDI). Epidemiological study. This is an epidemiological study that used GBD 2019 (Global Burden of Disease Study) estimates of lung cancer mortality rates and DALYs attributable to occupational carcinogens. The relationship between these rates and SDI was assessed using panel data analysis. In Brazil, occupational exposure to asbestos, silica and diesel vapours accounted for more than 85.00% of lung cancer deaths and DALYs attributable to occupational carcinogens in both sexes between 1990 and 2019. An increase in both rates was observed in women for almost all the occupational carcinogens assessed, especially in the North and Northeast regions of the country, with diesel vapours standing out the most. The present study highlighted the urge to characterise exposure to occupational risks for lung cancer, especially for the female population in the North and Northeast regions of Brazil. [ABSTRACT FROM AUTHOR]

Background: Based on participatory research tools and analysis with a gender focus, we aim to identify the knowledge associated with native plants of the Atlantic Forest in one Quilombola community whose territory is juxtaposed with a protected area, in South Brazil. Methods: Through the perception of the residents of the Quilombola community of São Roque, we classified the availability, harvesting intensity, abundance, and importance of fourteen plants native to the Atlantic Forest found in their territory. These fourteen plants were selected after initial interviews with a free listing of plants done with all adults (44 people), followed by plant collection and identification. A participatory workshop was built with the community to collect data through three activities: four-cell tool, environment matrix, and importance matrix. To identify the gender nuances in the knowledge within this community, all activities were separated into two groups based on the gender of the 22 participants (9 women and 13 men) and the researchers. Results: The species Pau-pra-tudo (Picrasma crenata), Quina (Coutarea hexandra), and Cipó-milome (Aristolochia triangularis) were similarly classified as important by both groups, which indicates the cultural and environmental relevance associated with them regardless of gender. The perceptions of other species were expressed differently between the groups, showing the variance of the ecological knowledge and the relationship between the sociocultural contexts of gender and the knowledge manifested. The final part of the workshop was a lecture given by two community experts about herbal medicines based on forest species found in the territory. Conclusions: Based on the multiple forms of results recorded in the workshop, we discuss the demand for inclusion of the traditional community in land management plans of environmental agencies, highlighting how individual characteristics, such as gender, can fill gaps in data about local biodiversity. [ABSTRACT FROM AUTHOR]

To evaluate the association of ultra-processed food (UPF) consumption with depression among Brazilian adults (≥18 years). Cross-sectional study. Data were obtained from a population-based survey conducted in 2023 (n = 21,690). UPF consumption was investigated using a questionnaire regarding the consumption on the previous day of 13 subgroups of UPF selected from those most consumed in Brazil according to a previous national survey (cutoff score ≥5 subgroups). The medical diagnosis of depression was self-reported. Logistic regression models were used to estimate the adjusted (by sex, age, education, presence of partner/spouse, and overweight) Odds Ratio (aOR) of UPF consumption according to the presence of depression. Analyses were conducted for the total population and stratified by sex. Medical diagnosis of depression was reported by 12.3%. The prevalence of high UPF consumption (≥5 subgroups) was 17.7%, being higher in men (22.0%) and those with depression (19.3%). Depression increased the chance of presenting a high UPF consumption among the total population (aOR 1.35; CI 95% 1.08–1.68) and women (aOR 1.35; CI 95% 1.03–1.77), with no association among men. The presence of depression was associated with greater consumption of UPF among Brazilian adults, especially among the female population. Public health actions to reduce UPF consumption could benefit from targeting this population group. [ABSTRACT FROM AUTHOR]

determinants of access to rehabilitation professionals after stroke in middle-income countries, where the burden of this disease is higher, are little known. To identify the determinants of access to rehabilitation professionals by individuals with stroke at one, three, and six months after hospital discharge in Brazil and compare referral and access rates after discharge. Longitudinal and prospective study, with individuals with primary stroke, without previous disabilities. At hospital discharge, the number of rehabilitation professionals referred by the multidisciplinary team was recorded. The possible determinants of access, according to Andersen's model, were: a) predisposing factors: age, sex, education levels, and belief that they could improve with treatment; b) need factors: stroke severity, levels of disability; c) enabling factors: socioeconomic status, disposable income for health care, and quality of care provided by rehabilitation professionals. One, three, and six months after hospital discharge, individuals were contacted to identify which rehabilitation professionals were accessed. Multiple linear regression model and Wilcoxon tests were used (α=5%). 201 individuals were included. Disability levels and stroke severity explained 31%, 34%, and 39% (p<0.01) of access at one, three, and six months after hospital discharge, respectively. In all periods, there was less access than that recommended at the time of hospital discharge (p<0.01). Need factors (disability levels and stroke severity) were determinants of access in all assessed periods. In addition, in all periods, the comprehensiveness of care for individuals with stroke was compromised. [ABSTRACT FROM AUTHOR]

Background: Globally, dietary patterns are shifting toward an increased consumption of ultra-processed foods, raising the risk of some metabolic and nutritional diseases from a young age. This trend is now also affecting low- and middle-income countries. Considering this, we aimed to assess the contribution of ultra-processed foods to total energy intake and their association with the nutritional intake of children and adolescents in Cantagalo, São Tomé and Príncipe. Methods: We conducted a cross-sectional study with a sample of 546 households. Data were collected on anthropometrics, sociodemographic characteristics, and lifestyle, including 24 h food recall questionnaires for children and adolescents. The reported foods were nutritionally assessed and categorized according to the NOVA classification to estimate the contribution of ultra-processed foods. Logistic regression models were used to estimate the magnitude of the associations between higher consumption of ultra-processed foods and nutritional intake, adjusting for confounders. Results: The contribution of ultra-processed foods to daily energy intake was 9.5% for girls and 8.5% for boys. Higher consumption of ultra-processed foods was significantly associated with a lower intake of fiber (OR = 0.932; 95%CI, 0.872–0.996), vitamin B12 (OR = 0.812; 95%CI, 0.668–0.985), and zinc (OR = 0.443; 95%CI, 0.308–0.639) and a higher intake of iron (OR = 1.479; 95%CI, 1.065–2.055) and sodium (OR = 1.001; 95%CI, 1.000–1.001), after adjusting for confounders. Conclusion: Higher consumption of ultra-processed foods was especially associated with a lower intake of fiber, vitamin B12, and zinc, and with a higher intake of iron. [ABSTRACT FROM AUTHOR]

Background: This study aimed to develop prognostic models for predicting the need for invasive mechanical ventilation (IMV) in intensive care unit (ICU) patients with COVID-19 and compare their performance with the Respiratory rate-OXygenation (ROX) index. Methods: A retrospective cohort study was conducted using data collected between March 2020 and August 2021 at three hospitals in Rio de Janeiro, Brazil. ICU patients aged 18 years and older with a diagnosis of COVID-19 were screened. The exclusion criteria were patients who received IMV within the first 24 h of ICU admission, pregnancy, clinical decision for minimal end-of-life care and missing primary outcome data. Clinical and laboratory variables were collected. Multiple logistic regression analysis was performed to select predictor variables. Models were based on the lowest Akaike Information Criteria (AIC) and lowest AIC with significant p values. Assessment of predictive performance was done for discrimination and calibration. Areas under the curves (AUC)s were compared using DeLong's algorithm. Models were validated externally using an international database. Results: Of 656 patients screened, 346 patients were included; 155 required IMV (44.8%), 191 did not (55.2%), and 207 patients were male (59.8%). According to the lowest AIC, arterial hypertension, diabetes mellitus, obesity, Sequential Organ Failure Assessment (SOFA) score, heart rate, respiratory rate, peripheral oxygen saturation (SpO2), temperature, respiratory effort signals, and leukocytes were identified as predictors of IMV at hospital admission. According to AIC with significant p values, SOFA score, SpO2, and respiratory effort signals were the best predictors of IMV; odds ratios (95% confidence interval): 1.46 (1.07–2.05), 0.81 (0.72–0.90), 9.13 (3.29–28.67), respectively. The ROX index at admission was lower in the IMV group than in the non-IMV group (7.3 [5.2–9.8] versus 9.6 [6.8–12.9], p < 0.001, respectively). In the external validation population, the area under the curve (AUC) of the ROX index was 0.683 (accuracy 63%), the AIC model showed an AUC of 0.703 (accuracy 69%), and the lowest AIC model with significant p values had an AUC of 0.725 (accuracy 79%). Conclusions: In the development population of ICU patients with COVID-19, SOFA score, SpO2, and respiratory effort signals predicted the need for IMV better than the ROX index. In the external validation population, although the AUCs did not differ significantly, the accuracy was higher when using SOFA score, SpO2, and respiratory effort signals compared to the ROX index. This suggests that these variables may be more useful in predicting the need for IMV in ICU patients with COVID-19. ClinicalTrials.gov identifier: NCT05663528. [ABSTRACT FROM AUTHOR]

Background: Hybridization between the local medical systems (LMSs) and biomedicine has been the focus of different studies in ethnobiology, primarily due to the increasing access to biomedicine by indigenous peoples and local communities. Studies on hybridization allow for an understanding of the process of developing and evolving local knowledge systems. In this study, we propose a hybridization score to determine how individuals' socioeconomic characteristics and preference between LMS and biomedicine determine the complementarity of therapeutic options. Methods: We conducted semistructured interviews and applied free listing technique in a rural community in Northeast Brazil to assess the treatments the local population sought and which were preferred. Results: Our analyses showed that the level of schooling was the socioeconomic factor that negatively affected the hybridization process. Individuals with higher levels of schooling tended to prefer LMS strategies less and, consequently, showed a lower probability of hybridizing the two systems. Additionally, older people who preferred LMS strategies showed a greater tendency to adopt hybridization in human health-seeking behavior. Conclusions: Our findings provide further evidence of the complementarity between different medical systems and demonstrate that socioeconomic factors can affect local knowledge and are responsible for differences in individual propensity to hybridize distinct medical systems. [ABSTRACT FROM AUTHOR]

Background: Longevity increases pose public health challenges, especially in managing falls and their psychological impacts on older adults. Limited evidence exists on the relationship between a fear of falling (FOF), previous falls, and depressive symptoms among community-dwelling older adults. Objective: To evaluate the association between falls, FOF, and depressive symptoms in community-dwelling older adults. Methods: This cross-sectional study, conducted in 2018, included 400 older adults from a Basic Health Unit in São Paulo, Brazil. The Geriatric Depression Scale (GDS-15) and the International Falls Efficacy Scale (FES-I) were used, along with self-report questionnaires on fall history. Linear and logistic regression were used to analyze the relationships between variables. Results: The mean age was 75.2 (SD = 8.53) years, with 63.2% being female. Depressive symptoms were observed in 18.3% of the participants, while 90.5% reported a fear of falling (FOF). More than half (63.0%) experienced falls, with 49.5% occurring in the last year. Factors such as the female gender, negative health perceptions, and functional dependence were associated with depressive symptoms. Adjusted analyses indicated that both a fear of falling (FOF) (B = 0.043; p = 0.012) and a history of falls (B = 0.725; p = 0.015) were associated with depressive symptoms. Conclusions: Falls, FOF, and depressive symptoms are interlinked among older adults, underscoring the need for targeted interventions to improve their mental and physical health. [ABSTRACT FROM AUTHOR]

• Cross-sectional study on eating behavior and dietary practices. • Males had a lower prevalence of Emotional Eating (EE) and Uncontrolled Eating (UE). • Older individuals had a lower prevalence of high EE and UE scores. • Older individuals also had a higher adherence to Dietary Practices. • High EE and UE scores were associated with Body Mass Index (BMI) and Body Fat (BF). • Dietary practices were inversely associated with BMI and BF. Type 2 diabetes (T2DM), hypertension, and obesity are major contributors to global mortality. This study aimed to evaluate eating behavior and dietary practices among individuals with T2DM and/or hypertension, examining their associations with sociodemographic and anthropometric characteristics. We hypothesized that these factors may contribute to body mass index (BMI) and body fat (BF) levels in these individuals. In a cross-sectional study, adults/older individuals diagnosed with T2DM and/or hypertension were included. Eating behavior was evaluated via Three-factor Eating Questionnaire-R21. Dietary practices were assessed using the Dietary Guidelines for the Brazilian Population (DGBP) questionnaire. Poisson regression examined associations between eating behaviors, dietary practices, and sociodemographic factors. Linear regressions were employed to analyze relationships between eating behavior, dietary practices, BMI, and BF. The study included 275 primarily female (70.5%) participants under 60 years old (54.2%). Male and older participants had a lower prevalence of high scores in the 'emotional eating' (EE; PR: 0.40 [0.25;0.63]) and 'uncontrolled eating' (UE; PR: 0.68 [0.50;0.92]) domains. In contrast, older patients had a higher prevalence of adherence to the DGBP recommendations (PR:1.53 [1.20;1.94]). A positive association was observed between high EE (β:3.71 [1.98;5.44]) and UE (β:2.85 [1.15;4.55]) scores and BMI, whereas higher dietary practice scores (β:-2.19 [-3.88;-0.50]) were negatively associated with BMI. High EE (β:2.20 [0.38;4.02]) and UE (β:1.92 [0.17;3.67]) scores were positively associated with BF regardless of the confounding factors included. Higher scores on the dietary practices were inversely associated with BF (β:-1.94 [-3.67;-0.21]). Understanding dietary behaviors and practices can facilitate a more comprehensive and effective treatment approach. In a cross-sectional study of adults with type 2 diabetes and/or hypertension, males and older participants had a lower prevalence of high scores in EE and UE domains. Conversely, older patients had a higher prevalence of adherence to the DGBP. High EE and UE scores correlated positively with BMI, while higher dietary practices were negatively associated with BMI. High EE and UE scores were also associated with BF, whereas higher dietary practices were inversely associated with BF. Abbreviations: BF, Body Fat percentage; BMI, Body Mass Index; DGBP, Dietary Guideline for the Brazilian Population; EE, Emotional Eating; UE, Uncontrolled Eating. [Display omitted] [ABSTRACT FROM AUTHOR]

To estimate the health and economic burden of non-communicable diseases (NCDs) attributed to alcohol consumption in 2019 for the Brazilian Unified Health System (SUS) stratified by states. Observational, descriptive, and ecological study. We used population attributable fractions (PAFs) of NCDs due to alcohol consumption from the Global Burden of Disease study. We applied the PAFs to the costs of hospitalizations and outpatient procedures of medium to high complexity paid by SUS for each outcome, obtained from official databases. We also calculated the disability-adjusted life years (DALYs) and mortality caused by alcohol-related NCDs. We converted the costs into international dollars (Int$) using the purchasing parity power in 2019. Alcohol-related NCDs accounted for 8.48% of deaths and 7.0% of DALYs among men, and 1.33% of deaths and 1.6% of DALYs among women. The main diseases were substance use, digestive, and neoplastic diseases. The SUS spent Int$202.0 million on alcohol-related NCDs, mostly on hospitalizations. The highest health burden was observed in the states of the Northeast region, and the highest expenses in the states from the South. The burden and cost values varied by sex, age group, and state. The study showed that alcohol consumption has a significant impact on Brazilian population morbidity and mortality and SUS expenditures, especially among men. These results can support policies for the prevention and control of alcohol consumption and health promotion at the subnational level, prioritizing strategies that are more appropriate to local realities. [ABSTRACT FROM AUTHOR]

Racial disparity in physical activity in people with diabetes in Brazil remains scarcely investigated. We examined the association between physical activity and diabetes-related complications according to race in the Brazilian population. Cross-sectional. We analyzed data from the 2019 National Health Survey, a population-based survey of Brazilian adults. We used a self-reported questionnaire to assess physical activity during commuting, leisure-time, domestic, and occupational activities. Diabetes-related complications included vision, kidney, and circulatory impairment, foot ulcers, diabetic coma, and all-cause complications. We used robust Poisson regression models with restricted cubic splines to examine the association between physical activity and diabetes-related complications. We included 2529 adults with diabetes (48.9% women; mean age: 53.5 ± 11.9 years). One-third experienced diabetes-related complications. Black adults performed less leisure-time and more occupational and commuting physical activity than White participants. Black participants showed a higher probability of all-cause (1.61; 95%CI: 1.29, 2.02) and vision complications (1.58; 95%CI: 1.23, 2.04) compared to White participants independent of physical activity status. Only leisure-time physical activity was associated with a reduced probability of all-cause complications (PR: 0.78; 0.71, 0.86) whereas commuting and occupational physical activity were not associated with any diabetes-related complications. Physically inactive, Brown adults showed a higher probability of kidney, circulatory, vision, and all-cause complications than active, White adults. However, physical activity attenuated the probability of these complications in Brown participants. The association between physical activity and diabetes-related complications is domain-specific. We revealed a racial disparity in physical activity in people with diabetes in Brazil. [ABSTRACT FROM AUTHOR]

Increased arterial stiffness is independently associated with cardiovascular risk. Obstructive sleep apnea (OSA) and sleep duration (SDUR) may contribute to increased arterial stiffness, but it is unclear whether this association is modulated by gender. We aimed to evaluate the potential impact of gender in modulating the association of OSA and SDUR with arterial stiffness. Participants from the ELSA-Brasil study performed sleep assessments with portable polygraph to define OSA severity and SDUR by 1-week wrist actigraphy. Pulse wave velocity (PWV) was measured using a standard technique without access to the sleep data. We studied 1863 participants (42.2% male, age: 49±8 years, respiratory disturbance index (RDI): 9.9 (4.5–19.4) events/h, SDUR: 6.5 (5.9–7.1) hours, mean PWV: 7.3 ± 1.2 m/s). We found that men had higher PWV, higher frequency of diabetes, and higher blood pressure when compared to women. The regression analysis showed an independent association between increased RDI and PWV in men (ß: 0.007; 95% CI: 0.001–0.012), but not in women. In contrast, an independent association between SDUR and increased arterial stiffness was observed only in women (ß: 0.068; 95% CI: 0.002–0.134). In conclusion, the association of sleep disorders with arterial stiffness showed a distinct gender pattern depending on the sleep variable studied. [ABSTRACT FROM AUTHOR]

This cross-sectional study employs structural equation modelling (sEM) to explore both direct and indirect effects of parental level of education and child individual factors on the length-for-age outcomes in children aged 6–24 months assisted by the Bolsa Família Program in the State of Alagoas. A total of 1448 children were analysed by the sEM technique. A negative standardised direct effect (sDE) of the children's younger age (sDE: −0·06; P = 0·017), the use of bottle feeding (sDE: −0·11; P < 0·001) and lack of a minimum acceptable diet (sDE: −0·09; P < 0·001) on the length-for-age indicator was found. Being female (SDE: 0·08; P = 0·001), a higher birth weight (SDE: 0·33; P < 0·001), being ever breastfed (sdE: 0·07; P = 0·004) and a higher level of parental education (SDE: 0·09; P < 0·001) showed a positive SDE effect on the child's length-for-age. The model also demonstrated a negative standardised indirect effect (SIE) of the sweet beverage consumption (SIE: −0·08; P = 0·003) and a positive effect of being ever breastfed (SIE: 0·06; P = 0·017) on the child's length-for-age through parental level of education as a mediator. This research underscores the crucial role of proper feeding practices and provides valuable insights for the development of targeted interventions, policies and programmes to improve nutritional well-being and promote adequate linear growth and development among young children facing similar challenges. [ABSTRACT FROM AUTHOR]

Evidence has suggested that a history of falls and fear of falling (FOF) are associated with reduced mobility among older adults. Although many studies have explored the association between the history of falls and FOF in the context of decreased mobility, most have had small sample sizes, limiting the generalizability of the results. Therefore, this study sought to contribute to the body of knowledge around these constructs to further support the previous findings. To investigate the association between a history of falls and FOF with low mobility in community-dwelling older adults. This cross-sectional study included 308 older adults (69.9 ± 7.1 years, 57.8% female). The Timed Up and Go (TUG) test was used to classify mobility limitations in participants and the Falls Efficacy Scale–International - Brazil was used to quantify FOF. Participants were also asked if they had fallen in the previous 12 months. Multivariable logistic regression was used. The prevalence rates of a history of falls and FOF were 32.7 and 48.4%, respectively. Older adults with a history of falls and FOF had 2.20 (95%CI: 1.20; 4.02) and 3.80 (95%CI: 1.90; 7.58) greater odds of presenting low mobility than older adults without these health problems, respectively. History of falls and FOF are associated with higher odds of low mobility in community-dwelling older adults. Therefore, it is of the utmost importance to introduce public health programs aimed at preventing falls in older adults to reduce possible adverse health outcomes, including low mobility. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of oral squamous cell carcinoma (OSCC) associated or not with oral potentially malignant disorders (OPMD), and the epidemiological profile and traditional risk factors in Latin America. Methods: A retrospective observational study was conducted in 17 Latin American centres. There were included cases of OSCC, analysing age, gender, OSCC and their association with previous OPMD. Clinicopathological variables were retrieved. The condition of sequential‐OSCC versus OSCC‐de novo (OSCC‐dn) was analysed concerning the aforementioned variables. Quantitative variables were analysed using Student's t‐test, and qualitative variables with chi‐square. Results: In total, 2705 OSCC were included with a mean age of 62.8 years old. 55.8% were men. 53.75% of the patients were smokers and 38% were common drinkers. The lateral tongue border was the most affected site (24.65%). There were regional variations in OPMD, being leukoplakia the most frequent. Of the overall 2705 OSCC cases, 81.4% corresponded to OSCC‐dn, while s‐OSCC were 18.6%. Regarding lip vermillion SCC, 35.7% corresponded to de novo lip SCC and 64.3% were associated with previous OPMD. Conclusions: In Latin America, OSCC‐dn seems to be more frequent with regional variations of some clinical and histopathological features. Further prospective studies are needed to analyse this phenomenon. [ABSTRACT FROM AUTHOR]

Latent Class Analysis (LCA) is a statistical method that can help researchers interested in better understanding the movement behaviors (MB) of children, based on the analysis of the level of physical activity (PA) and sedentary time (ST). This study aimed to evaluate and compare two models LCA (one for the accelerometer and one for the 24-hour recall) that represent the MB of children. A cross-sectional study involving 101 10-year-old Brazilian children. The classes were based on vigorous PA (VPA), moderate PA (MPA), light PA (LPA), and sedentary time (ST). To assess these behaviors, a 24-hour recall and an accelerometer were used. The accelerometer was used during four days. The time spent on each of the MB was categorized dichotomously, based on the 25th and 75th percentiles. Thus, "adequate" times were considered when the ST was below 25thP, the LPA and MPA were above 25thP and the VPA was above 75thP. LCA was used to model the variable "MB." For each latent class model (accelerometer and recall), two classes were found: "Adequate MB" and "Inadequate MB." Regardless of the method (accelerometer or self-report), the values of the "Inadequate MB" class had higher prevalence. Self-report predicted higher PA and lower ST compared to the accelerometer. The model based on accelerometry revealed that girls were 2.11 times more likely to belong to the "Inadequate MB" class when compared to boys. LCA was a multivariate statistical method that allowed the integrated evaluation of parameters that represent the MB analyzed by device-based and self-report methods. [ABSTRACT FROM AUTHOR]

Background: Temporomandibular disorders (TMD) do not only occur in adults but also in adolescents, with negative impacts on their development. Aim: To propose a predictive model for TMD in adolescents using a decision tree (DT) analysis and to identify groups at high and low risk of developing TMD in the city of Recife, PE, Brazil. Design: This cross‐sectional study was conducted in Recife on 1342 schoolchildren of both sexes aged 10–17 years. The analyses were performed using Pearson's chi‐squared test and Fisher's exact test, as well as the CHAID algorithm for the construction of the DT. The SPSS statistical program was used. Results: The prevalence of TMD was 33.2%. Statistically significant associations were observed between TMD and sex, depression, self‐reported orofacial pain, and orofacial pain on clinical examination. The DT consisted of self‐reported orofacial pain, orofacial pain on physical examination, and depression, with an overall predictive power of 73.0%. Conclusion: The proposed tree has a good predictive capacity and permits to identify groups at high risk of developing TMD among adolescents, such as those with self‐reported orofacial pain or orofacial pain on examination associated with depression. [ABSTRACT FROM AUTHOR]

To verify the psychometric properties of the Brazilian-Portuguese version of the Falls Behavioral (FaB-Brazil) Scale in Parkinson's disease (PD). Participants (n = 96) were assessed by disease-specific, self-report and functional mobility measures. Internal consistency of the FaB-Brazil scale was evaluated using Cronbach's alpha and inter-rater and test–retest reliability using intraclass correlation coefficients (ICC). The standard error of measurement (SEM), minimal detectable change (MDC), ceiling and floor effects, and convergent and discriminative validity were evaluated. Internal consistency was moderate (α = 0.77). Excellent inter-rater (ICC = 0.90; p < 0.001) and test–retest (ICC = 0.91; p < 0.001) reliability were found. The SEM was 0.20 and MDC was 0.38. Ceiling and floor effects were not found. Convergent validity was established by the positive correlations between the FaB-Brazil scale and age, modified Hoehn and Yahr, PD duration, Movement Disorders Society-Unified Parkinson's Disease Rating Scale, Motor Aspects of Experiences of Daily Living, Timed Up & Go and 8-item Parkinson's Disease Questionnaire, and negative correlations between the FaB-Brazil scale and community mobility, Schwab & England, and Activities-specific Balance Confidence scale. Females showed greater protective behaviors than males; recurrent fallers showed greater protective behaviors than non-recurrent fallers (p < 0.05). The FaB-Brazil scale is reliable and valid for assessing people with PD. Fall-related behaviors should be part of the fall risk assessment of community-dwelling people with Parkinson's disease. The Brazilian-Portuguese version of the Fall Behavioral (FaB-Brazil) Scale is reliable and valid for assessing everyday behaviors and actions related to falling in community-dwelling people with Parkinson's disease. The FaB-Brazil scale may be used to tailor individualized fall prevention programs. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the quality of life (QoL) of patients with cervicofacial nonmelanoma skin cancer (NMSC) using the Brazilian Portuguese‐adapted and validated version of the skin cancer index (SCI). After collecting demographic and clinical data from 182 patients with cervicofacial NMSC, the Brazilian versions of the SCI and the Dermatological Life Quality Index (DLQI) were applied preoperatively (T0) and 4 months postoperatively (T1). Assessments were carried out using the Shapiro–Wilk test, Student's t‐test, Mann–Whitney test, Kruskal–Wallis test, and Spearman's correlation. The QoL was evaluated using the Student's t‐test in paired samples at T0 and T1. Significant results were observed, with an increase in scores on the SCI scale in all its dimensions and a decrease in scores on the DLQI scale, demonstrating better postoperative QoL. The variables that presented significant results on the total scale, which indicated better QoL, were men, without children, income above four minimum wages, from the private sector, did not report pruritus, and scalp lesions. The QoL measurement indicated a change from the baseline and improvement after 4 months postoperatively in all subscales, indicating that surgical treatment increased the QoL of these patients from an emotional, social, and physical appearance point of view. The multivariate analysis produced several statistically significant findings in relation to emotional, social, appearance, and total scores. [ABSTRACT FROM AUTHOR]

Objectives: The populational impact of poor sleep quality and the risk of dementia is unclear. We analyzed the Population Attributable Fraction (PAF) of poor sleep quality for dementia, and its association with other two sleep parameters through self‐reported and single questions collected in a large‐scale Brazilian cohort (ELSI‐Brazil). Methods: A subset of the ELSI‐Brazil with complete responses to sleep quality was retrieved for this study. This is a large representative sample of the Brazilian elderly population with an extensive assessment of sociodemographic and health risk variables. Prevalence of poor sleep quality was estimated according to the complex sample design, and its PAF was measured using a meta‐analytic relative risk. A total of 6024 (56.3% women, mean 62.8 ± 9.5 years of age) individuals had complete responses. Results: The prevalence of poor sleep quality was 24.9% (95%CI 23%–26%), and the PAF of poor sleep quality including other 10 modifiable risk factors of dementia was 52.5% in Brazil. Secondary analyses identified that sleep quality, restorative sleep and sleep drug usage varied considerably according to age ranges, race, and gender. Conclusions: Poor sleep quality is an important populational modifiable risk factor for dementia in Brazil. Targeted interventions may provide an important impact in preventing dementia in low‐ and middle‐income countries. Key points: Poor sleep quality is a modifiable risk factor of dementiaPoor sleep quality was frequently reported by adults and older adultsPrevalence of sleep quality varies widely across races [ABSTRACT FROM AUTHOR]

Background: Incidence of first-episode psychosis (FEP) varies substantially across geographic regions. Phenotypes of subclinical psychosis (SP), such as psychotic-like experiences (PLEs) and schizotypy, present several similarities with psychosis. We aimed to examine whether SP measures varied across different sites and whether this variation was comparable with FEP incidence within the same areas. We further examined contribution of environmental and genetic factors to SP. Methods: We used data from 1497 controls recruited in 16 different sites across 6 countries. Factor scores for several psychopathological dimensions of schizotypy and PLEs were obtained using multidimensional item response theory models. Variation of these scores was assessed using multi-level regression analysis to estimate individual and between-sites variance adjusting for age, sex, education, migrant, employment and relational status, childhood adversity, and cannabis use. In the final model we added local FEP incidence as a second-level variable. Association with genetic liability was examined separately. Results: Schizotypy showed a large between-sites variation with up to 15% of variance attributable to site-level characteristics. Adding local FEP incidence to the model considerably reduced the between-sites unexplained schizotypy variance. PLEs did not show as much variation. Overall, SP was associated with younger age, migrant, unmarried, unemployed and less educated individuals, cannabis use, and childhood adversity. Both phenotypes were associated with genetic liability to schizophrenia. Conclusions: Schizotypy showed substantial between-sites variation, being more represented in areas where FEP incidence is higher. This supports the hypothesis that shared contextual factors shape the between-sites variation of psychosis across the spectrum. [ABSTRACT FROM AUTHOR]

Obesity has a multifactorial origin. Among the behavioural risk factors, excessive consumption of unhealthy foods, skipping breakfast and reduced physical activity stand out. The main objective of this article was to identify trends in dietary habits and their association with overweight/obesity over a 12‐year period in schoolchildren aged 7 to 10 years in Florianópolis, southern Brazil. A cross‐sectional panel analysis study, using anthropometric, sociodemographic, physical activity and food consumption data of schoolchildren aged 7 to 10 years, collected in three waves of the Study of Prevalence of Obesity in Children and Adolescents (EPOCA), carried out during the years 2007, 2012/2013 and 2018/2019, was performed. To analyse the trend in dietary variables over the years, the 95% CIs were compared with the non‐overlap of intervals indicating statistical significance. Multiple logistic regression analysis was performed to test the association of weight status with dietary markers. The prevalence of overweight/obesity was 34.4%, 37.2% and 34.2% in 2007, 2012/2013 and 2018/2019, respectively, and there were no statistically significant differences among waves. There was a progressive and significant reduction in the consumption of soft drinks and sweets and in eating breakfast by schoolchildren, from 2007 to 2019. Breakfast consumption was inversely associated with the chance of overweight/obesity (OR 0.74, 95% CI 0.59–0.93), and female students were less likely to have overweight/obesity when compared to boys (OR 0.70, 95% CI 0.61–0.81). The reduction in the consumption of soft drinks and sweets over the years might be caused by efforts in public policies that intended to reduce the consumption of unhealthy foods among schoolchildren. The progressive and significant reduction in having breakfast should be better elucidated in future studies, to minimise the potential impact of this practice on schoolchildren's bodyweight. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to examine the hypothesis that periodontal disease is associated with chronic non-communicable diseases. Methods: In this cross-sectional study, we evaluated the periodontal health condition of the population, based on the community periodontal index, as well as the number of missing teeth and the presence of systemic health conditions. We quantified the association between oral health and the presence of chronic diseases using simple logistic regression, adjusting for confounding factors including age, smoking, and overweight. Results: The study population consisted of 334 volunteers, aged between 19 and 81 years. In patients over 45 years old, periodontal disease was found to be significantly associated with hypertension and diabetes. Furthermore, in female patients, periodontal disease was significantly associated with hypertension, diabetes, and cancer. Conclusion: Our findings indicate that periodontal disease is positively and significantly associated with both arterial hypertension and diabetes, independent of potential confounding factors. [ABSTRACT FROM AUTHOR]

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Objectives: To assess characteristics of hospitalized adolescents facing chronic diseases, correlating the perceptions of their illness, quality of life and the prevalence of risk behaviors, considering gender and the diseases' durations. Methods: The sample consisted of 61 adolescents, aged between 10 and 19 years, with chronic diseases, hospitalized at the University Hospital of the State University of Londrina. They answered a questionnaire and the scales World Health Organization Quality of Life (WHOQOL-BREF) and Illness Perception Questionnaire (IPQ). They were divided in groups, according to the durations of the disease: group 1 (up to 4 years) and group 2 (5 years or more). Results: Group 2 demonstrated higher leisure activity (p = 0.02) and more painful symptoms (p = 0.02). In WHOQOL-BREF, group 2 had a higher quality of life in the domain on environment (p = 0.02) and a higher total score (p = 0.04). Lower scores on the IPQ were associated with higher scores on the WHOQOL-BREF. Positive correlation was found between WHOQOL-BREF total score and years of disease, in which male presented higher scores. Conclusions: These findings may alert to the need for more knowledge about the diseases and the importance of encouraging ways to improve quality of life and care to reduce risky behaviors. [ABSTRACT FROM AUTHOR]

This study verified the diagnostic accuracy of the nutritional status classified by the international height and BMI references of the World Health Organization (WHO) (WHO/2007), International Obesity Task Force (IOTF/2012) and MULT (2023). The data pool was composed by 22 737 subjects aged five to 16 years from the Santos and Porto Alegre surveys. A correlation matrix between the z-scores of the BMI references and the skinfold measurements was calculated through the Pearson correlation coefficient (r), and the subject's nutritional status was classified according to the international growth references. The accuracy for diagnosing obesity was performed separately by sex and using the 95th percentile of the triceps and subscapular skinfold sum, while Lin's concordance coefficient, Bland–Altman method and the Cohen's Kappa coefficient (Kappa) were used to verify the concordance and reliability among the BMI references. The correlation matrix showed a high positive correlation among the BMI z-scores (r ≥ 0·99) and among the skinfold measurements (r ≥ 0·86). The prevalence of stunting was higher when applying the MULT reference (3·4 %) compared with the WHO reference (2·3 %). The Bland–Altman plots showed the lowest critical difference (CD) between the height references of WHO and MULT (CD = 0·22). Among the BMI references, the WHO obesity percentile presented lower performance than MULT for boys, presenting a lower +LR value (WHO = 6·99/MULT 18 years = 10·99; 19 years = 8·99; 20 years = 8·09) for the same −LR values (0·04). Therefore, MULT reference holds promise as a valuable tool for diagnosing childhood obesity, particularly when considering sex differences. This enhances its suitability for assessing the nutritional status of Brazilian schoolchildren. [ABSTRACT FROM AUTHOR]

Background: Mortality rate estimation in small areas can be difficult due the low number of events/exposure (i.e. stochastic error). If the death records are not completed, it adds a systematic uncertainty on the mortality estimates. Previous studies in Brazil have combined demographic and statistical methods to partially overcome these issues. We estimated age- and sex-specific mortality rates for all 5,565 Brazilian municipalities in 2010 and forecasted probabilistic mortality rates and life expectancy between 2010 and 2030. Methods: We used a combination of the Tool for Projecting Age-Specific Rates Using Linear Splines (TOPALS), Bayesian Model, Spatial Smoothing Model and an ad-hoc procedure to estimate age- and sex-specific mortality rates for all Brazilian municipalities for 2010. Then we adapted the Lee-Carter model to forecast mortality rates by age and sex in all municipalities between 2010 and 2030. Results: The adjusted sex- and age-specific mortality rates for all Brazilian municipalities in 2010 reveal a distinct regional pattern, showcasing a decrease in life expectancy in less socioeconomically developed municipalities when compared to estimates without adjustments. The forecasted mortality rates indicate varying regional improvements, leading to a convergence in life expectancy at birth among small areas in Brazil. Consequently, a reduction in the variability of age at death across Brazil's municipalities was observed, with a persistent sex differential. Conclusion: Mortality rates at a small-area level were successfully estimated and forecasted, with associated uncertainty estimates also generated for future life tables. Our approach could be applied across countries with data quality issues to improve public policy planning. [ABSTRACT FROM AUTHOR]

This study evaluated changes in the use of sweeteners over one decade and the relationship between socio-demographics, diet and weight status with the type of sweetener. Data came from the Brazilian National Dietary Surveys of 2008–2009 and 2017–2018, including ≥ 10-year-old individuals (n 32 749; n 44 744, respectively, after excluding pregnant and lactating women). The use of table sugar, non-caloric sweeteners (NCS), both or none was reported through a specific question. Food consumption was assessed using two non-consecutive food records (2008–2009) and 24-h recalls (2017–2018). For the last survey, means of energy, macro and micronutrient intake, food groups' contribution (%) to daily energy intake and age- and energy-adjusted nutrient intake were estimated according to the type of sweetener used. Differences in means and proportions across the categories of sweeteners used were evaluated based on the 95 % CI. All analyses were stratified by sex and considered sample design and weights. Over 10 years, the use of table sugar decreased by 8 %, while the habit of not using any sweetener increased almost three times, and the use of NCS remained stable. Larger reductions in the use of table sugar were observed in the highest income level and among men. Regardless of sex, compared with NCS users, table sugar users had greater mean intake of energy, carbohydrates and added sugar and lower micronutrient intake means. Although table sugar is still the most used sweetener, the increased choice of 'no sweetener' is noteworthy in Brazil. [ABSTRACT FROM AUTHOR]

The Inventory of Depression and Anxiety Symptoms–Expanded version (IDAS-II) is one of the few tools designed to assess internalizing symptoms based on dimensional models. We conducted two studies, the first testing internal validity aspects of the IDAS-II and the second testing the external validity of the scales. In the first study we adapted the IDAS-II to Brazilian Portuguese and tested its internal structure, including a higher order factorial solution coherent with the internalizing spectrum, the stability of the factor structure, and its measurement invariance for sex and racial groups. Participants were 2,379 Brazilian adults. In the second study, we investigated the IDAS-II scales' associations with broad pathological personality traits in Brazilian (N = 245) and North American (N = 402) samples. The results of the first study indicated that the IDAS-II scales are grouped into three first-order factors (Distress, Obsessions/Fear, and Positive Mood), replicating Wester et al. (2022) and Petre et al. (2023). Our results also suggested the plausibility of an internalizing second-order factor for the IDAS-II Brazilian version. The multigroup confirmatory factor analysis shows that this scale is invariant for males and females and for White and Black/Brown people. In the second study, the IDAS-II scales demonstrated mostly coherent associations with broad domains of pathological personality traits. Besides the internal validity of the Brazilian IDAS-II, our results also provide information about its external validity and expand its nomological network, as it is the first study reporting its associations with broad domains of pathological personality traits. Public Significance Statement: Our results attest to the validity of the Brazilian version of Inventory of Depression and Anxiety Symptoms–Expanded version and indicate that the measure is invariant for sex and race, is coherent with the hierarchical taxonomy of psychopathology model, and presents plausible associations with pathological personality traits. [ABSTRACT FROM AUTHOR]

The purpose of this study was to analyse secular trend in handgrip strength (HGS) in adolescents using an allometric approach and identify the factors associated. The sample comprised 657 and 1004 adolescents (14 to 19 years) in 2007 and 2017/2018, respectively, of public schools in Florianópolis, Brazil. The dependent variable was HGS normalised to body mass and height. Covariance analysis was used to examine secular trends in HGS, and multiple linear regression was used to identify associated factors. The independent variables were sociodemographic, biological, and behavioural factors. Comparison of HGS between surveys indicated a negative secular trend in both sexes (p < 0.001). In boys, there was a positive association of HGS with age and FFM in both surveys. In 2017/18, there was a positive association with sexual maturation and a negative association with sitting time and fat percentage. In girls, FFM was positively associated with HGS in both surveys. In 2007, there were positive associations of HGS with age and vigorous physical activity, whereas, in 2017/18, negative associations were observed with economic level and sitting time. The findings of the present study show a decline in adolescent HGS. And behavioural changes appear to be contributing to declines in HGS. [ABSTRACT FROM AUTHOR]

Context: The participation of judo athletes with disabilities in competitions has increased over the years as well as the burden of sports-related injuries and illnesses in this population. However, there is limited knowledge about sports-related injuries in judo athletes with different disabilities. Objective: To investigate the prevalence of injuries in judo athletes with disabilities, considering the different impairment groups, magnitude of injury (ie, mechanism, nature, and severity of injury), and specific body parts. Design: Cross-sectional study (level of evidence, 3). Setting: Brazilian Judo athletes with disabilities. Patients: Fifty-one judo athletes with disabilities (15 men and 36 women) participated in this study. Main Outcome Measures: Data were obtained from an adapted injury report form. The prevalence of injuries was assessed, considering type of impairment, body parts, mechanisms, and severity as well as differences between male and female athletes, with the significance level set at P < .05. Results: The results demonstrated a high prevalence of injuries in female athletes with visual impairment (n = 11, 73.3%) and male athletes with amputations (n = 14, 38.8%). A high prevalence was found in the national group, especially for male athletes (n = 29, 80.5%). Among athletes who had injuries, 69.4% (n = 12) of male and 80.0% (n = 25) of female athletes' injuries occurred due to direct contact with other athletes, and 72.2% (n = 26) of male and 86.6% (n = 13) of female athletes' injuries were in the training environment. The magnitude of injuries ranged from moderate to severe for male and female athletes. The knee (n = 25, 49.0%) and shoulder (n = 12, 23.5%) were the body parts most affected by injuries in both male and female athletes. Conclusion: A large percentage of judo athletes with disabilities reported experiencing an injury during the previous 2 years; percentages were greater in athletes with visual and physical impairment. Moreover, most injuries occurred in the knee or shoulder, during training, and in direct contact with other athletes and were of severe magnitude. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate the communication/training strategies and technological tools used by fitness coaches from Brazilian football teams during home-based training according to age categories (professional and youth), competitive level (1st, 2nd and 3rd/4th divisions) and sex (male and female). An online questionnaire was applied to collect data. Eighty-two fitness coaches from sixty-seven male and female football teams (professional and youth teams) answered the questionnaire. Message apps were the main communication route between fitness coaches and players during home-based training. Online spreadsheets were frequently used to control the training. Regarding equipment provided to players for training, 70.7% of male professional players used some equipment. In contrast, most female professional and youth players (both sexes) did not receive any equipment, respectively (p<0.01). Male players who compete in the 1st and 2nd divisions received more equipment for training than those who compete in the 3rd and 4th divisions (p<0.01). The main physical fitness variables trained by all players during home-based training were muscle strength, strength-endurance, and aerobic capacity. Training load and training response were applied through series/repetitions/time and effort perception scales, respectively. In conclusion, the financial differences between professional and youth teams and between males and females and competitive levels can induce different home-based training conditions in Brazilian football teams during lockdown-like situations, especially related to equipment available for training targeted physical qualities. Thus, players should be monitored closely during lockdown-like situations and provided appropriate support to facilitate their training. [ABSTRACT FROM AUTHOR]

Purpose: Excess weight in adolescents with cancer during treatment does affect cancer outcomes. Neck circumference (NC), an easygoing anthropometric measure, may present greater metabolic risk, and is associated with excess adiposity. The aim of this study was to identify the prevalence of elevated NC in adolescents with cancer and associated factors. Methods: Cross-sectional study with adolescents aged 10–19 years, under antineoplastic treatment, evaluated from 2015 to 2017, at a Pediatric Oncology Institute's outpatient clinic. Anthropometric parameters were collected, besides diagnosis, sex, and age. The classification of elevated NC was carried out considering cutoff values for adolescents, according to sex and age group. A binary logistic regression was used to determine relationships between NC and associated factors. Results: Among 496 eligible cases, most were male (n = 299, 60.3%). A total of 31.9% of cases had high NC. There is significant and moderate correlation between skinfold thickness (TS) and NC (ρ = 0.6; p = 0.000), and a significant but weak correlation between TS and body mass index (ρ = 0.267; p = 0.000). The adjusted analysis for sex, age group, and type of tumor showed that females are more likely to belong to the high NC category, to have excess adiposity. The age group between 10 and 12 years was the most associated with this outcome (2.795 [0.979–7.977]; p < 0.05). TS is also associated with high NC (1.114 [1.050–1.182]; p < 0.05). Conclusion: It was concluded that there is high prevalence of elevated NC and higher risks for this outcome considering type of tumor, sex, age group, besides being an easy and simple measure for use in clinical practice. [ABSTRACT FROM AUTHOR]

The aim of this study was to estimate smoking-attributable mortality (SAM) in the population aged 35 years and over in Brazil's 27 federal units by sex, in 2019. This is an attributable mortality analysis. We applied a method dependent on the prevalence of smoking, based on the population attributable fractions. Data on mortality due to causes causally related to smoking were derived from Brazil's Death Registry, data on prevalence of smoking from a survey conducted in Brazil in 2019, and data on relative risks from five US cohorts. Crude and age-adjusted SAM rates were calculated by sex. Estimates of SAM were calculated by specific causes of death and major mortality groups for each federal unit by sex. In 2019, smoking caused 480 deaths per day in Brazil. Although the SAM varied among the federal units, the pattern is not clear, with the greatest difference being between Rio Grande do Sul (crude rate: 248.8/100,000 inhabitants) and Amazonas (106.0/100,000). When the rates were adjusted by age, the greatest differences were observed between Acre (271.1/100,000) and Distrito Federal (131.1/100,000). SAM was higher in males; however, while the main specific cause of SAM in men was ischemic heart disease, in women it was chronic obstructive pulmonary disease. The major mortality group having the greatest impact on SAM across all federal units was the cardiometabolic diseases. The variability in the burden of SAM in the different regions of Brazil reaffirms the need for SAM data disaggregated at the geographic level. [ABSTRACT FROM AUTHOR]

Background: The use of potentially inappropriate medications (PIM) by the elderly is commonly studied, but studies evaluating the use of PIM by frail elderly covered by prepaid health plans are still lacking. Objective: To identify the prevalence of use and the factors associated with the use of PIM by the elderly patients with high and moderate risk of clinical-functional vulnerability, according to the Beers criteria 2019. Methods: A cross-sectional study was developed with elderly people from a private health plan in Vitória-ES, Brazil. Socioeconomic, demographic and clinical data were collected through a digital platform and a structured questionnaire through an interview, from October 2018 to June 2019. The association between the use of PIM and independent variables was verified by univariate logistic regression with their respective confidence intervals (CI) 95%. The Multiple Model included the variables with P ≤.20. Results: 332 elderly patients were interviewed (mean age 81.5 years, gender 237 female, 95 male). A 65% prevalence of PIM use was identified. In the multiple logistic regression model, the variables associated with the use of PIM were self-medication (P =.004), high risk of clinical-functional vulnerability (P =.022), use of psychotropic medications (P =.000001), musculoskeletal medications (P =.04) and alimentary tract medications (P =.03). Physical exercises were considered a protection factor (P =.02). Conclusion: The high prevalence of PIM use indicates the need for improvement in elderly private health care, to increase pharmacotherapy safety for this population. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of potential drug–drug interactions involving psychotropics prescribed by dentists, and dispensed by the public healthcare system, as well as to describe the severity and level of evidence of those interactions in the state of Minas Gerais, Brazil. Materials and Methods: We conducted data analysis from pharmaceutical claims in which dental patients received systemic psychotropics in 2017. Data from the Pharmaceutical Management System provided the drug dispensing history of the patients, allowing the identification of those on concomitant medication use. The outcome was the occurrence of potential drug–drug interactions, which were detected according to IBM Micromedex®. Independent variables were the patient's sex, age, and the number of drugs used. Descriptive statistics was performed using SPSS v. 26. Results: Overall, 1480 individuals were prescribed psychotropic drugs. The prevalence of potential drug–drug interactions was 24.8% (n = 366). The total of 648 interactions was observed and, most of which were of major severity (n = 438, 67.6%). Most interactions occurred in female individuals (n = 235; 64.2%), with 46.0 (±17.3) years‐old, concurrently taking 3.7 (±1.9) drugs. Conclusion: A substantial proportion of dental patients presented potential drug–drug interactions, mostly of major severity, which might be life‐threatening. [ABSTRACT FROM AUTHOR]

Objective: To characterize the clinical-epidemiological profile of patients admitted to the adult intensive care unit of a teaching hospital. Method: Descriptive epidemiological study, with a quantitative approach, cross-sectional and retrospective nature. The research was carried out at the teaching hospital, in an adult intensive care unit between January and December 2021. Results: 153 people were hospitalized. There was a predominance of males (68.6%). The average age was 53 years (standard deviation=20). Regarding the municipality of residence, Maringá predominated (39.9%). The average length of stay was 17 days (median=11; standard deviation=18). Regarding the primary cause of admission, it was noted that the most frequent causes were trauma (14.4%). Regarding the outcome of hospitalization, although the majority of participants were discharged from the sector (58.8%), there was an important proportion who died (37.3%). Conclusion: Predominance of males, with an average age of 53 years, from the city of Maringá, hospitalized for around 17 days due to trauma and/or fractures, which required intubation and without vasoactive drugs and hemodialysis, with a more rise in the sector is frequent, although the mortality rate was 37%, raising a warning for managers. [ABSTRACT FROM AUTHOR]

This study aims to investigate the fear or failure (FoF) in Brazilian runners of both sex, performance levels and age categories, as well as to verify the relationship between FoF and socioeconomic status (SES). Sample size as composed by 916. Age, sex, body height, body weight, SES, and running pace were self-reported. The Multidimensional Questionnaire of FoF was applied in an online platform. Running pace, and SES were categorized and processed through multivariate analysis and Spearman correlations, with the p-value set at 0.05. Female runners with better performance (2.13 ± 0.74) and younger (2.16 ± 0.80), as a well as male runners with worse performance (2.04 ± 0.69) and older (2.04 ± 0.89) presented the highest values of FoF. Among women, SES was negatively associated with FoF (r = −0.144; p = 0.006), while a positive association between running pace and SES was observed among men (r = 0.290; p < 0.001). Non-professional Brazilian runners presented low values of FoF. [ABSTRACT FROM AUTHOR]

This study aimed to compare the prevalence and socio-economic determinants of frailty in older adults in Brazil and Chile using nationally representative survey data. Analytical research using data from the Brazilian Longitudinal Study of Aging (ELSI) and the Chilean National Health Survey (ENS) conducted in Brazil and Chile between 2015 and 2017. The study included 5484 older adults aged 60 years or older in Brazil and 2031 in Chile. Frailty was measured using the FRAIL index, and logistic regression models were used to identify the determinants of frailty. The prevalence of frailty is 15.6% and 12.6% in Brazil and Chile, respectively. Frailty is associated with several factors, including age, sex, living alone, residing in urban areas, and decreased life satisfaction. However, the analysis revealed notable differences between countries. A greater number of significant variables were associated with frailty in Brazil, whereas Chile displayed fewer categories with significant odds. Health insurance had no significant effect in either of the two countries. The limitations in data sources and methodologies make it challenging to compare frailty determinants in Latin America. This study overcomes these barriers and shows that, even within the same region, significant differences exist. Levels and characteristics that are important in one country may not be so in another. The results emphasize the need to consider contextual factors in the implementation of emerging social and healthcare policies, such as home-based long-term care. [ABSTRACT FROM AUTHOR]

Violence is a global public health problem that affects especially the most vulnerable people. The aim was to analyze the prevalence of psychological violence in the Brazilian population and inequalities according to sex and skin color. This was a cross-sectional study in which the database of the National Health Survey 2019 was used. Psychological violence was considered present when an individual answered yes to at least one of the five variables investigated: In the last 12 months, has anyone (a) offended you, humiliated you, or ridiculed you in front of other people?; (b) yelled at you or called you names?; (c) used social media or cell phones to threaten, offend, curse, or expose your images without your consent?; (d) threatened to hurt you or hurt someone important to you?; and (e) destroyed something of yours on purpose? The independent variable was skin color. The crude prevalence ratio (PR) was determined by Poisson regression. All analyses were stratified by sex. Of the 88,531 respondents, 41,662 were males and 46,869 were females. The prevalence of the presence of psychological violence was 19% in women and 15.6% in men. Men and women with black/brown/yellow/indigenous skin color were 20% and 15% more likely to suffer one or more items of psychological violence, respectively, than men and women with white skin color (PR = 1.20; 95% CI [1.11, 1.30] and PR = 1.15; 95% CI [1.08, 1.23]). Psychological violence occurred predominantly against females and individuals with black/brown/yellow/indigenous skin color. There were notable inequalities in the exposure to this type of violence that need to be considered when making plans to address this problem. The findings emphasize the relevance of constantly reviewing political and social constructions to promote a reduction of inequalities. [ABSTRACT FROM AUTHOR]

Objectives To examine the rate of self-reported coronavirus disease-2019 (COVID-19) and its association with mental and cognitive health during the post-infection phase among middle-aged and older indigenous adults. Methods A cross-sectional study was conducted, including 141 individuals ≥50 and over from an urban indigenous community in Amazonas, Brazil. COVID-19 was deduced from self-reported infections. Cognitive function was evaluated using the Mini-Mental State Exam, Brief Cognitive Screening Battery (BCSB), and language fluency tests. Meanwhile, mental health was assessed through validated scales examining happiness, stress, and depression symptoms. The association between the rate of COVID-19 and cognitive and mental well-being was analyzed using logistic and linear regressions, adjusted for covariates. Results From March 2020 to February 2022, 65.2% of the urban indigenous group tested positive for COVID-19. Lower functional capacity decreased the odds of contracting COVID-19 (p  = .03). Adjusted linear regression models showed that COVID-19 was associated with higher BCSB learning (p  = .017) and delayed recall (p  = .028). Women, higher age, lower functional capacity, and hospitalization were associated with worse cognitive performance (p  < .05). No impact of mental health indicators on past COVID-19 infection was noted. Discussion COVID-19 was prevalent among urban Indigenous Brazilians. Unexpectedly, it was linked to enhanced learning and memory, not mental health issues. Cognitive performance was lower for men, older individuals, those with less functional ability, and hospitalized patients, indicating that participant characteristics and disease severity affect the COVID-19 and cognition relationship. Longitudinal studies across diverse Indigenous communities are necessary to understand COVID-19's impact on their cognitive and mental health. [ABSTRACT FROM AUTHOR]

Context: Joint hypermobility (JH) represents the extreme of the normal range of motion or a condition for a group of genetically determined connective tissue disorders. Generalized joint hypermobility (GJH) is suspected when present in all four limbs and the axial skeleton, scored in prepubescent children and adolescents by a Beighton Score (BS) ≥ 6. Parameters are also used to identify GJH in hypermobile Ehlers–Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSDs). The purpose of this study is to characterize children with JH based on the location of variables in the BS ≥ 6 and identify children with JH in the axial skeleton, upper limbs (ULs), and lower limbs (LLs) simultaneously. Methods: We analyzed 124 medical records of one- to nine-year-old children with JH by BS. Results: The characterization of GJH by combinations of the axial skeleton, ULs, and LLs simultaneously totaled 25.7%. BS = 6 and BS = 8 consisted of variables located in ULs and LLs. BS = 7 included the axial skeleton, ULs, and LLs. BS ≥ 6 represents the majority of the sample and predominantly girls. Conclusions: BS ≥ 6 represents the majority of the sample and predominantly girls. Most characterized children with GJH present BS = 6 and BS = 8 with variables located only in ULs and LLs, a condition that does not imply the feature is generalized. In children, BS = 7 and BS = 9 characterize GJH by including the axial skeleton, ULs, and LLs. These results draw attention to the implications for defining the diagnosis of hEDS and HSDs. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to investigate whether peripheral and inspiratory muscle strength and architecture, functional capacity, functional mobility, fatigue, and health-related quality of life are predictors of the Post–COVID-19 Functional Status Scale score in patients with post–COVID-19 syndrome who were hospitalized. Design: A cross-sectional study included 69 patients (53.3 ± 13.2 yrs, 36 men) with post–COVID-19 syndrome. The following outcomes were assessed: peripheral (dynamometry) and inspiratory (manovacuometry) muscle strength, muscle architecture (ultrasound), functional capacity (six-minute walk test), functional mobility (Timed Up and Go), fatigue (Functional Assessment of Chronic Illness Therapy), health-related quality of life (36-item Short-Form Health Survey), and functional status (Post–COVID-19 Functional Status scale). Results: Functional mobility (β = 0.573, P < 0.001), vastus intermedius echogenicity (β = −0.491, P = 0.001), length of stay (β = 0.349, P = 0.007), and female sex (β = 0.415, P = 0.003) influenced the Post– COVID-19 Functional Status Scale. Conclusions: Functional mobility, muscle quality of the vastus intermedius, length of stay, and female sex influence the Post–COVID-19 Functional Status Scale score in this population. It is noteworthy that functional mobility is an independent predictor of Post–COVID-19 Functional Status Scale. [ABSTRACT FROM AUTHOR]

Background: While the COVID-19 pandemic's total impact on global mortality is uncertain, an estimated 15 million excess deaths occurred during the first two pandemic years, suggesting that a broad impact, since several causes of death showed a substantial rise. Aims: To estimate excess suicides in Brazil and evaluate differences within and between subgroups during the first 2 years of the COVID-19 pandemic. Method: Based on suicide data from the mortality information system of the Brazilian Ministry of Health, the expected number of suicides was estimated by age group, gender, 4-month periods and regions through quasi-Poisson generalized additive models. Analyses were performed in R software and RStudio. Results: Between March 2020 and February 2022, 29,295 suicides were reported in Brazil, close to what would be expected (30,116; 95% Confidence Interval (95% CI): [28,009, 32,224]), albeit in males and females aged 30 to 59 years and 60 years and over, there were excess suicides in at least one of the six 4-month periods evaluated, especially in the second pandemic year. In the Southeast region, a 28% increase was observed in women 60 years and older during the second year. In the North region, suicide increased 23% and 32% among women aged 30 to 59 years during the first and second pandemic years, respectively. The Northeast region had a 16% excess in suicides among men aged 30 to 59 years and 61% among women 60 years old and older during the second pandemic year, reaching 83% in July to October 2021. Conclusions: During the first 2 pandemic years, the pattern of suicides was not homogeneous in Brazil. There were substantial excess suicides in women aged 30 to 59 years from the North and Northeast, while among the elderly and men there was a consistent pattern in several four-month periods throughout Brazil. [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]

Smartphone addiction and its excessive use could cause musculoskeletal symptoms such neck and upper limb pain. The purpose of this study was to investigate the association between smartphone use and musculoskeletal pain in the upper limbs and neck, as well as to observe the relationship in between smartphone addiction and musculoskeletal pain and upper limb function in university students. It is a cross-sectional, analytical study. A total of 165 university students participated in the research. Each student had their own smartphone. The students answered a structured questionnaire about pain in the upper limbs and neck; the Smartphone Addiction Inventory (SPAI) and the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH). Prevalence of neck and upper limb pain was 34.0%. Smartphone addiction and its use to play games and listen to music were risk factors to upper limb pain. Moreover, the smartphone addiction and age proved to be risk factors to neck pain. There was correlation between DASH and SPAI scores, and there was association between DASH score and neck and upper limb pain. Being of the female sex and smartphone addiction predicted the risk of incapacity development. We found association between neck and upper limb pain with smartphone addiction. Functional incapacity was associated to neck and upper limb pain. It was predicted by smartphone addiction and being of the female sex. [ABSTRACT FROM AUTHOR]

Introduction: The impact of specific policies on HIV care has been scarcely investigated. In this study we aimed to analyze the impact of the Treatment For All policy (TFA‐2013) and the adoption of integrase strand transfer inhibitors (INSTIs‐2017) as first‐line therapy on clinical indicators of people living with HIV (PLHIV) in Brazil. Methods: We assessed the public database of Brazil's Ministry of Health and extracted data from 2009 to 2019. We investigated the impact of TFA and INSTIs with a time‐series analysis of four health indicators in PLHIV: antiretroviral treatment (ART) initiation with a CD4+ count >500/mm3; ART initiation <1 month after the first CD4+ measurement; viral load suppression (VLS); and treatment adherence. We explored trends over time by gender, age, macroregion of residency and municipal‐level social vulnerability index. Results: We included 753 316 PLHIV in 2019. Most were males (64.81%) in the 30–49 years age category (50.86%). We observed an overall improvement in all HIV clinical indicators, with notable impact of TFA on timely ART initiation and VLS, and mild impact of INSTIs on treatment adherence. Such improvements were heterogeneous, with remarkable gaps in gender, age and socioeconomic groups that have persisted over time. Indicators point to inferior outcomes among children, older adults, women and people living in socially vulnerable locations. Conclusions: Recent Brazilian public policies have had positive impacts on key HIV clinical indicators. However, our results highlight the need for specific policies to improve HIV care for children, older adults, women and socially vulnerable groups. [ABSTRACT FROM AUTHOR]

BACKGROUND: The COVID-19 pandemic had direct and indirect impacts on public health, also affecting the mental health of the population. OBJECTIVE: To analyze symptoms of generalized anxiety disorder (GAD) and associated factors, in primary health care (PHC) professionals. METHODS: Cross-sectional and analytical study conducted with professionals who work in the Primary Health Care (PHC) of the Northern health macro-region of the state of Minas Gerais, Brazil. Data collection was carried out through an online, self-administered questionnaire, made available from August 27, 2021, to October 30, 2021 using the Google Forms tool. The questionnaire included sociodemographic questions as well as questions related to the history of anxiety and work during the pandemic. To assess anxiety symptoms, the General Anxiety Disorder-7 (GAD-7) instrument was used. Data treatment consisted of descriptive analysis of the variables, bivariate analysis followed by multivariate Poisson Regression with robust variance. RESULTS: 702 health professionals participated in the study and the general prevalence of GAD was 32.2%. Current anxiety symptoms were self-reported by 37.6% of the participants. In the final model, the associated factors identified were: female sex (PR = 1.82; 95% CI = 1.17–2.84; p = 0.007), previous symptoms (PR = 1.58; 95% CI = 1.19–2.10; p = 0.002) and (PR = 2.68; 95% CI = 2.00–3.62; p < 0.001) current self-reported anxiety. CONCLUSION: The results show the need to implement actions in mental health promotion and anxiety prevention, through the dissemination of information about mental health care, health education activities, encouraging the adoption of healthy habits and professional monitoring when necessary. [ABSTRACT FROM AUTHOR]

Background: Merkel cell carcinoma (MCC) comprises a rare malignant primary skin tumor presenting neuroendocrine differentiation. Recently, agents blocking the programmed cell death protein 1 and programmed cell death protein ligand 1 pathway (PD-1/PD-L1) have demonstrated objective and durable tumor regressions in patients presenting advanced MCC. This study aimed to describe the sociodemographic, clinical, and histopathological characteristics of MCC patients, also assessing the prevalence of PD-L1 expression and Merkel cell Polyomavirus (MCPyV), as well as their prognostic roles. Methods: Data from patients diagnosed with MCC between 1996 and 2019 at a reference cancer center in Rio de Janeiro, southeastern Brazil, were evaluated in a retrospective study. Tumor samples were tested for MCPyV and PD-L1 employing immunohistochemistry. Survival analyses were carried out employing the Kaplan–Meier method and curves were compared using the log-rank test. A multiple semiparametric Cox model was used. Values p < 0.05 were considered significant. Results: A total of 65 patients were included in the study, with a mean age at diagnosis of 72 (standard deviation 13.9). A total of 56.9% (37/65) of the patients were male, 86.2% (56/65) were white, and 56.9% (37/64) were illiterate or with incomplete elementary school. MCPyV immunohistochemistry was positive in 29 cases (44.6%) and PD-L1 positivity was ≥ 1% in 42 cases (64.6%). Significant associations between MCPyV and PD-L1 expression ≥ 1% (p = 0.003) and PD-L1 expression ≥ 5% (p = 0.005) were noted. Concerning the multivariate analysis, only education level and advanced MCC stage indicated statistically significant worse progression-free survival. Regarding overall survival (OS), being male, education level and advanced stage comprised risk factors. The estimated OS at 60 months for stages I to III was of 48.9% and for stage IV, 8.9%. Conclusions: This is the first large Brazilian cohort to assess the prevalence of MCPyV in MCC tumors, as well as PD-L1 expression and their associations. No correlations were noted between MCPyV infection or PD-L1 expression and survival rates. [ABSTRACT FROM AUTHOR]