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Background HPV-related external genital lesions are the most common outcome of HPV infection, a sexual transmitted disease responsible by low-grade squamous intraepithelial lesion (LSIL) and 99% of cervical cancer. The aim of this study was to assess the prevalence of HPV-related lesions and associated factors in the Brazilian young adult population. Methods We included 7,694 unvaccinated people from 16 to 25 years recruited from primary care units and submitted to interview, genital examination and cervical/penile sampling. Linear Array® Test (Roche) was used for HPV detection and genotyping. Results The prevalence of HPV-related lesions was 4% (234), being more frequent in men (5.8%) than women (2.3%). From those, 63% (p Conclusion We found a high prevalence of genital lesion in this young adult population. As expected, most participants were HPV positive. Although HPV 16 was not usually related to external lesions, it was the most frequent HPV type found followed by HPV 6 and 11. Sexual behavior, smoking and hormonal contraception were the main factors associated with genital lesions. Increase awareness about healthy sexual behaviors and immunization coverage should be used as a target to prevent HPV infection and related lesions in the young Brazilian population. Disclosure No significant relationships.

Background The number of cases of acquired syphilis are increasing in many countries. In Brazil, a previous official report based on compulsory notifications showed a sustained increase from 2.0 to 58.1 cases per 100,000 inhabitants over the last six years (2010–2017). We aimed to evaluate the prevalence of self-reported syphilis among women and men aged 16 to 25 years who use the public health system in Brazil. Methods This is a cross-sectional, nationwide, multicenter study with 8,581 sexually active young adults recruited from 119 primary care units in all 26 Brazilian capitals and the Federal District. Data on sociodemographic and sexual behavior characteristics were obtained by face-to-face interviews. To evaluate syphilis, we asked the participants if they had ever had syphilis during their lives (current or in the past). We weighted the measures by population size in each capital and by sex. Results Of all participants (49.17% women), 8,076 provided information about syphilis, and 224 (2.86%, 95%CI2.29%–3.43%) reported having the disease. The prevalence was similar between genders (p=0.240), with frequencies of 3.20% for men and 2.54% for women. The participants who self-reported syphilis were older [22.35 years (22.01–22.70)] than those without the disease [21.38 years (21.32–21.44); p Conclusion Our results showed a high prevalence of self-reported syphilis in young adults of Brazil with significant difference between education level. Income and skin color/race were not associated with syphilis showing a disseminate outbreak. These data reinforce the importance of implementing strategies to combat this disease in young adults, especially among those with low educational level. Disclosure No significant relationships.

Background Brazil has a strong HIV prevention public health program since 1980s that includes continuous and free nationwide distribution of male and female condoms, rapid test triage, and educommunication strategies. Even so, the detection rate of HIV has increased, achieving 14.3/1000,000 individuals aged 15–24 years (2017). Regarding this alarming situation, we aimed to access the HIV prevalence and associate characteristics in young Brazilian adults (aged 16 to 25 years). Methods Data from POP-Brazil Study, a cross-sectional, nationwide, multicenter study with sexually active men and women who use the public health system in Brazil were obtained. Trained primary health care professionals asked participants about sociodemographic characteristics and presence of HIV. Additionally, they invited to undergo a rapid HIV test. Those individuals that not answered the question or did not take the laboratorial test were considered missing values. The measures were weighted by population size in each capital and by sex. Results Of 8,581 participants, 3,009 do not provided information about HIV, and 49 (1.54%, CI95% 0.83%-2.25%) reported positivity or were reagent in the rapid HIV test, without significant differences between Brazilian regions. The positivity was significantly higher in men than women (2.7% vs. 0.6%, p Conclusion The high prevalence of HIV is even more concerning taking into account the high proportion of missing individuals. Association of HIV with homosexual intercourse and non-vaginal sexual behavior were more frequently in male. Despite the sustained Brazilian public health program, this particular age range need to be on the focus of prevention strategies. Disclosure No significant relationships.

Background Available data suggest mixed evidence of hormonal contraceptives (HC) on the association with high-risk human papillomavirus (HPV) types, the main cause of cervical cancer. Therefore, we aimed to analyze the use of HC and the prevalence of HPV in unvaccinated Brazilians women aged 16–25 years. Methods We analyzed cross-sectional data collected from 5,268 sexually active women who participated in the National Survey of Human Papillomavirus Prevalence (POP-Brazil). This survey enrolled participants from all 26 Brazilian capitals and the Federal District. Professionals from primary care units were trained for specimen and data collection. All participants answered a face-to-face questionnaire and provided biological samples for genital HPV analysis. HPV genotyping for HPV types was done using the Roche PCR-based Linear Array Genotyping Test. Sampling weights by sex and age were applied to the data. Results The majority of the participants use any type of contraception [76.58% (95% CI 74.82 - 78.35)], being 2,577 [47.59% (45.54% – 49.63%)] on hormonal contraceptives. The use of HC was more frequent in older women (≥ 22 years), with higher education, married or living with a partner, and those with less than two sexual partners in the last year. No significant difference was found between the prevalence of high-risk HPV types and the use of HC: 38.57% among users of HC vs. 38.56% among don´t users of HC (p = 0.994). Multivariate analysis showed that HC was not associated with high-risk HPV even after adjusting for age, educational level, presence of partner, smoke, and number of partners. Conclusion Use of HC was not associated with HPV DNA detection. Even so, more studies are necessary evaluating the type of hormonal contraceptive, as well as length and dose of use. Disclosure No significant relationships.

The aim of this study was to evaluate self-reported syphilis and associated factors in sexually active young adults (16–25 years old) in the Public Health System in Brazil. This was a cross-sectional study with 8071 participants recruited from 119 primary care units. Of these, 224 (2.86%, 95% CI 2.29–3.43%) reported having the disease. Age, lower socio-economic class, being a smoker, not using a condom at first sexual intercourse, and ever had a same-sex sexual experience were associated with syphilis. The results reinforce the importance of implementing strategies focused on socio-economic class and early sexual education that encourage condom use from the beginning of sexual activity. Keywords: Syphilis, Epidemiology, Primary care, Public health

The sexual behaviors of 15- to 24-year-olds increase the risk of this population to acquire sexually transmitted infections (STIs). The present study aimed to describe the sexual behavior in the transition to adulthood Brazilian population and its association with STI history. We analyzed cross-sectional data collected from 8562 sexually active women and men who participated in the National Survey of Human Papillomavirus Prevalence (POP-Brazil). This large-scale survey enrolled participants from 26 Brazilian capitals and the Federal District. Professionals from primary care facilities were trained to collect data utilizing a standardized questionnaire with questions on sociodemographic, sexual behavior, and drug use. We constructed a Poisson model with robust variance for both crude and adjusted analysis to investigate the associations between the variables. To adjust the distribution of the sample to the study population, we weighted the measures by the population size in each city and by gender. There were differences in several aspects from sexual behavior between genders. The majority of men reported an early sexual initiation, more sexual partners, and a different practice in sexual positions when compared with women. Women reported use of contraception more frequently than men (P

to describe the perception of data collection performed by primary health care professionals as collaborators of the national POP-Brasil survey - Epidemiological Study of National Prevalence of HPV Infection.in all, 217 professionals from 119 primary care units participated in the POP-Brasil Study conducted in the 26 Brazilian capitals and the Federal District.the professionals were trained and certified locally for collecting data and biological material from 8,580 participants; participation in the study allowed professionals to recognize the importance of their work.the successful experience confirms how important it is to do research as part of work practice, as long as professionals are trained and have adequate support, given that their work routine is compatible with the execution of the research protocol.descrever a percepção da coleta de dados realizada por profissionais da Atenção Primária à Saúde como colaboradores da pesquisa nacional POP-Brasil - Estudo Epidemiológico sobre a Prevalência Nacional de Infecção pelo HPV.ao todo, 217 profissionais de 119 unidades de saúde participaram do Estudo POP-Brasil, desenvolvido nas 26 capitais brasileiras e no Distrito Federal.os profissionais foram treinados e certificados in loco para a coleta de dados e material biológico de 8.580 participantes; a participação no estudo possibilitou ao profissional reconhecer a importância de seu trabalho.a experiência exitosa confirma o quão importante é fazer pesquisa na prática de trabalho, desde que os profissionais sejam treinados e contem com o apoio adequado, pois a rotina de trabalho é compatível com a execução do protocolo de pesquisa.describir la percepción de la inserción de profesionales de la Atención Primaria a la Salud como colaboradores de una investigación nacional POP-Brasil - Estudo Epidemiológico sobre la Prevalencia Nacional de Infección por VPH.en total, 217 profesionales de 119 unidades de salud participaron del Estudio POP-Brasil, desarrollado en las 26 capitales brasileñas y el Distrito Federal.los profesionales fueron capacitados y certificados en el lugar para la recolección de datos y de material biológico de 8.580 participantes; la participación posibilitó al profesional reconocer la importancia de su trabajo en una investigación a nivel nacional.la experiencia exitosa confirma lo importante que es hacer investigación en la práctica de trabajo, siempre que los profesionales sean capacitados y tengan un soporte adecuado, pues la rutina de trabajo es compatible con la ejecución del protocolo de investigación.

Introduction Human papillomavirus (HPV) is associated with the development of genital warts and different types of cancer, including virtually all cervical cancers and a considerable number of penile, anal and oropharyngeal cancers. Data regarding the prevalence of HPV infection in Brazil are limited and fragmented. We aim to determine HPV prevalence in sexually active women and men aged 16–25 years and to investigate regional differences in virus prevalence and types. Methods and analysis This is a nationwide, multicentric, cross-sectional, prospective study that will include participants aged 16–25 years from all Brazilian capital cities. Recruitment will occur in primary health units by trained health professionals who will be responsible for collecting biological samples and interviewing the volunteers. After signing informed consent, all participants will answer a questionnaire that will collect sociodemographic and behavioural data. All samples will be processed in a certified central laboratory, and strict quality control will be performed by many different procedures, including double data entry, training and certification of primary care health professionals responsible for data collection, simulation of interviews, and auditing and monitoring of visits. The sample size will be standardised based on the population distribution of each capital using SAS and R statistical software. Ethics and dissemination The project was approved by the research ethics committee of the main institution and the corresponding ethics committees of the recruitment sites. This will be the first Brazilian nationwide study to determine overall HPV prevalence and to examine regional differences and social, demographic and behavioural factors related to HPV infection. Critical analysis of the study results will contribute to epidemiological knowledge and will set a baseline for future evaluation of the impact of the National HPV Vaccination Program.

A better understanding of the factors that affect self-perception of body characteristics may play an important role in weight control practices. The objective of this study was to analyze body weight perception and body image satisfaction in low-income adult women in Southern Brazil.This was a cross-sectional survey study in a cohort of women recruited from areas of social vulnerability in the city of Porto Alegre, RS. A random sample (n = 218) of women was interviewed, and socioeconomic and lifestyle factors, body image perception using the Stunkard Scale, body weight estimation, weight concern and duplicate anthropometric measurements were obtained.The average age of the low-income women was 56.3 ± 9.5 years. The prevalences of overweight and obese individuals were 34.1% and 52.5%, respectively. Among all women, 83.0% were dissatisfied with their body image, and 68.9% of the women estimated their body weight correctly. In addition to BMI (body mass index), the proportions of women with a higher income (p = 0.05), smoking history (p 0.01) and history of hypertension (p = 0.04) were significantly different between groups according to body image satisfaction. Multivariate analyses using Poisson regression showed that black/mixed race, higher income, and underweight and obese women were more likely to be dissatisfied with their body image.The majority of women know their body weight and have body image dissatisfaction. Skin color, higher income and BMI were significantly associated with dissatisfaction. In addition, these women consider the "healthiest" body image to be thinner than the "ideal" body image, and the "ideal" image is one of normal weight and not too thin.

RESUMO Objetivo: Comparar a capacidade funcional de indivíduos idosos (60 a 79 anos) com a dos idosos mais velhos (≥ 80 anos) nos primeiros 6 meses após a alta da unidade de terapia intensiva. Métodos: Coorte prospectiva multicêntrica, na qual foram coletados dados referentes à internação na unidade de terapia intensiva e aos desfechos após a alta hospitalar (no pós-alta imediato, após 3 meses e após 6 meses). A força muscular foi avaliada por meio do protocolo do Medical Research Council e da dinamometria (preensão palmar); a capacidade de execução das Atividades de Vida Diária e independência funcional pelo índice de Barthel e pelo nível habitual de atividade física (International Physical Activity Questionnaire); e a qualidade de vida pelo 12-Item Short-Form Health Survey Versão 2. Resultados: Dentre os 253 pacientes incluídos, 167 eram idosos entre 61 a 79 anos, e 86 eram idosos mais velhos. Os idosos mais velhos, no sexto mês de avaliação, apresentaram maior necessidade de cuidador (69,0% versus 49,5%; p = 0,002). A funcionalidade prévia à unidade de terapia intensiva e no terceiro mês após alta foi menor nos idosos mais velhos em comparação aos mais jovens (Barthel anterior à unidade de terapia intensiva: 73,0 ± 30,0 versus 86,5 ± 22,6; p < 0,001; Barthel no terceiro mês: 63,5 ± 34,0 versus 71,5 ± 35,5; p = 0,03), assim como o nível habitual de atividade física (International Physical Activity Questionnaire no terceiro mês: ativo/muito ativo 3,4% versus 18,3%; nenhuma atividade física 64,4% versus 39,7%; p < 0,001; e International Physical Activity Questionnaire no sexto mês: ativo/muito ativo 5,8% versus 20,8%; nenhuma atividade física 69,2% versus 43,4%; p = 0,005). Os idosos mais velhos apresentaram menor força muscular ao serem avaliados pela preensão palmar no membro dominante (14,5 ± 7,7 versus 19,9 ± 9,6; p = 0,008) e do não dominante (13,1 ± 6,7 versus 17,5 ± 9,1; p = 0,02). Não houve diferença na perda da funcionalidade e na qualidade de vida referida, entre os grupos etários. Conclusão: Mesmo com grande perda funcional após a alta da unidade de terapia intensiva em ambos os grupos etários, não houve diferença na magnitude da perda da funcionalidade de indivíduos idosos (60 a 79 anos) quando comparados aos idosos mais velhos (≥ 80 anos) nos primeiros 6 meses após a alta da unidade de terapia intensiva. ABSTRACT Objective: To compare the functional capacity of younger elderly individuals (60 to 79 years old) with that of older elderly individuals (≥ 80 years old) during the first 6 months after discharge from the intensive care unit. Methods: A multicenter prospective cohort study was conducted, in which data on intensive care unit admission and outcomes after hospital discharge (immediate post-discharge, after 3 months and after 6 months) were collected. Muscle strength was evaluated through the protocol of the Medical Research Council and dynamometry (handgrip); the ability to perform activities of daily life and functional independence were assessed by the Barthel index and the usual level of physical activity (International Physical Activity Questionnaire); and quality of life was assessed by the 12-Item Short-Form Health Survey Version 2. Results: Among the 253 patients included, 167 were younger elderly (between 61 and 79 years old), and 86 were older elderly (≥ 80 years old). During the sixth month of evaluation, the older elderlies presented a higher need for a caregiver (69.0% versus 49, 5%, p = 0.002). Functional capacity prior to intensive care unit admission and in the third month after discharge was lower in older elderlies than in younger ones (Barthel prior to the intensive care unit: 73.0 ± 30.0 versus 86.5 ± 22.6; p

To evaluate the effect of an extended visitation model compared with a restricted visitation model on the occurrence of delirium among ICU patients.Prospective single-center before and after study.Thirty-one-bed medical-surgical ICU.All patients greater than or equal to 18 years old with expected length of stay greater than or equal to 24 hours consecutively admitted to the ICU from May 2015 to November 2015.Change of visitation policy from a restricted visitation model (4.5 hr/d) to an extended visitation model (12 hr/d).Two hundred eighty-six patients were enrolled (141 restricted visitation model, 145 extended visitation model). The primary outcome was the cumulative incidence of delirium, assessed bid using the confusion assessment method for the ICU. Predefined secondary outcomes included duration of delirium/coma; any ICU-acquired infection; ICU-acquired bloodstream infection, pneumonia, and urinary tract infection; all-cause ICU mortality; and length of ICU stay. The median duration of visits increased from 133 minutes (interquartile range, 97.7-162.0) in restricted visitation model to 245 minutes (interquartile range, 175.0-272.0) in extended visitation model (p0.001). Fourteen patients (9.6%) developed delirium in extended visitation model compared with 29 (20.5%) in restricted visitation model (adjusted relative risk, 0.50; 95% CI, 0.26-0.95). In comparison with restricted visitation model patients, extended visitation model patients had shorter length of delirium/coma (1.5 d [interquartile range, 1.0-3.0] vs 3.0 d [interquartile range, 2.5-5.0]; p = 0.03) and ICU stay (3.0 d [interquartile range, 2.0-4.0] vs 4.0 d [interquartile range, 2.0-6.0]; p = 0.04). The rate of ICU-acquired infections and all-cause ICU mortality did not differ significantly between the two study groups.In this medical-surgical ICU, an extended visitation model was associated with reduced occurrence of delirium and shorter length of delirium/coma and ICU stay.

Introduction and objectives Subclinical systolic dysfunction is one of the proposed mechanisms for increased cardiovascular risk associated with metabolic syndrome (MS). This study investigated the association between MS and impaired left ventricular global longitudinal strain (GLS) and the role of each MS criteria in this association. Methods We analyzed a random sample of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) after excluding participants with prevalent heart disease. Results Among the 1055 participants fulfilling the inclusion criteria (53% women; 52 ± 9 years), 444 (42%) had MS. Those with MS had worse GLS (–18.0% ± 2.5%) than those without (–19.0% ± 2.4%; P .0001). In multiple linear regression models, MS was associated with worse GLS after adjustment for various risk factors (GLS difference = 0.86%; P .0001), even after inclusion of body mass index . Adjusted PR for impaired GLS as assessed by 3 cutoffs (1, 1.5, and 2 standard deviations) were higher among participants with than without MS: GLS –16.1% (PR, 1.76; 95%CI, 1.30-2.39); GLS –14.8% (PR, 2.35; 95%CI, 1.45-3.81); and GLS –13.5% (PR, 2.07; 95%CI, 0.97-4.41). After inclusion of body mass index in the models, these associations were attenuated, suggesting that they may, at least in part, be mediated by obesity. In quantile regression analyses, elevated waist circumference was the only MS component found to be independently associated with GLS across the whole range of values. Conclusions Metabolic syndrome is independently associated with impaired GLS. Among the MS criteria, central obesity best depicted the link between metabolic derangement and cardiac function.

To compare the functional capacity of younger elderly individuals (60 to 79 years old) with that of older elderly individuals (≥ 80 years old) during the first 6 months after discharge from the intensive care unit.A multicenter prospective cohort study was conducted, in which data on intensive care unit admission and outcomes after hospital discharge (immediate post-discharge, after 3 months and after 6 months) were collected. Muscle strength was evaluated through the protocol of the Medical Research Council and dynamometry (handgrip); the ability to perform activities of daily life and functional independence were assessed by the Barthel index and the usual level of physical activity (International Physical Activity Questionnaire); and quality of life was assessed by the 12-Item Short-Form Health Survey Version 2.Among the 253 patients included, 167 were younger elderly (between 61 and 79 years old), and 86 were older elderly (≥ 80 years old). During the sixth month of evaluation, the older elderlies presented a higher need for a caregiver (69.0% versus 49, 5%, p = 0.002). Functional capacity prior to intensive care unit admission and in the third month after discharge was lower in older elderlies than in younger ones (Barthel prior to the intensive care unit: 73.0 ± 30.0 versus 86.5 ± 22.6; p0.001, Barthel in the third month: 63.5 ± 34.0 versus 71.5 ± 35.5, p = 0.03), as was the usual level of physical activity (International Physical Activity Questionnaire in the third month: active/very active 3.4% versus 18.3%, no physical activity 64.4% versus 39.7%, p0.001, and International Physical Activity Questionnaire in the sixth month: active/very active 5.8% versus 20.8%, no physical activity 69.2% versus 43.4%, p = 0.005). Older elderlies had lower muscle strength when assessed according to handgrip in both the dominant (14.5 ± 7.7 versus 19.9 ± 9.6, p = 0.008) and non-dominant limb (13.1 ± 6.7 versus 17.5 ± 9.1, p = 0.02). There were no differences in functional capacity loss or reported quality of life between the age groups.Although there were great functional capacity losses after discharge from the intensive care unit in both age groups, there was no difference in the magnitude of functional capacity loss between younger (60 to 79 years) and older elderly individuals (≥ 80 years old) during the first 6 months after discharge from the intensive care unit.Comparar a capacidade funcional de indivíduos idosos (60 a 79 anos) com a dos idosos mais velhos (≥ 80 anos) nos primeiros 6 meses após a alta da unidade de terapia intensiva.Coorte prospectiva multicêntrica, na qual foram coletados dados referentes à internação na unidade de terapia intensiva e aos desfechos após a alta hospitalar (no pós-alta imediato, após 3 meses e após 6 meses). A força muscular foi avaliada por meio do protocolo do Medical Research Council e da dinamometria (preensão palmar); a capacidade de execução das Atividades de Vida Diária e independência funcional pelo índice de Barthel e pelo nível habitual de atividade física (International Physical Activity Questionnaire); e a qualidade de vida pelo 12-Item Short-Form Health Survey Versão 2.Dentre os 253 pacientes incluídos, 167 eram idosos entre 61 a 79 anos, e 86 eram idosos mais velhos. Os idosos mais velhos, no sexto mês de avaliação, apresentaram maior necessidade de cuidador (69,0% versus 49,5%; p = 0,002). A funcionalidade prévia à unidade de terapia intensiva e no terceiro mês após alta foi menor nos idosos mais velhos em comparação aos mais jovens (Barthel anterior à unidade de terapia intensiva: 73,0 ± 30,0 versus 86,5 ± 22,6; p0,001; Barthel no terceiro mês: 63,5 ± 34,0 versus 71,5 ± 35,5; p = 0,03), assim como o nível habitual de atividade física (International Physical Activity Questionnaire no terceiro mês: ativo/muito ativo 3,4% versus 18,3%; nenhuma atividade física 64,4% versus 39,7%; p0,001; e International Physical Activity Questionnaire no sexto mês: ativo/muito ativo 5,8% versus 20,8%; nenhuma atividade física 69,2% versus 43,4%; p = 0,005). Os idosos mais velhos apresentaram menor força muscular ao serem avaliados pela preensão palmar no membro dominante (14,5 ± 7,7 versus 19,9 ± 9,6; p = 0,008) e do não dominante (13,1 ± 6,7 versus 17,5 ± 9,1; p = 0,02). Não houve diferença na perda da funcionalidade e na qualidade de vida referida, entre os grupos etários.Mesmo com grande perda funcional após a alta da unidade de terapia intensiva em ambos os grupos etários, não houve diferença na magnitude da perda da funcionalidade de indivíduos idosos (60 a 79 anos) quando comparados aos idosos mais velhos (≥ 80 anos) nos primeiros 6 meses após a alta da unidade de terapia intensiva.

CONTEXTO E OBJETIVO: Diabetes mellitus e transtornos depressivos frequentemente coexistem. No entanto, essa relação tem sido pouco avaliada nos estágios hiperglicêmicos e em uma amplitude maior de transtornos mentais comuns (TMCs). O objetivo foi investigar a associação entre TMCs e estágios de glicemia. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado com funcionários públicos com idade entre 35- 74 anos participantes da coorte ELSA-Brasil. MÉTODOS: TMCs foram classificados usando o instrumento Clinical Interview Schedule – Revised (CIS-R). Para a classificação dos estágios de glicemia, foi utilizado o teste de tolerância a glicose, hemoglobina glicada (HbA1c), relato pessoal de diabetes e uso de medicamentos. A glicemia foi categorizada como: normal, hiperglicemia intermediária, classificação nova de diabetes, e diabetes prévio. Controle glicêmico foi avaliado pela HbA1c. RESULTADOS: TMCs foram mais prevalentes nos pacientes com diabetes prévio. Após ajustes, as associações foram consideravelmente enfraquecidas, permanecendo significativas somente para aqueles com escore do CIS-R ≥ 12 (razão de prevalência, RP: 1,15; intervalo de confiança de 95%, IC: 1,03-1,29). Hiperglicemia intermediária não teve associação com CMDs. Para aqueles com diabetes prévio e classificação nova de diabetes, para cada aumento de 1% na HbA1c, a prevalência de transtorno depressivo foi, respectivamente, 12% e 23% maior (RP: 1,12; IC: 1,00-1,26 e RP: 1,23; IC: 1,04-1,44). CONCLUSÃO: Aqueles com diabetes prévio tiveram escore do CIS-R mais elevado. Entre todos com diabetes, o controle glicêmico pior foi relacionado ao transtorno depressivo. Não foi observada relação entre hiperglicemia intermediária e TMCs, sugerindo que a relação causal relacionada aos TMCs, se presente, deve agir de forma mais próxima ao início de diabetes. CONTEXT AND OBJECTIVE: Diabetes mellitus and depressive disorders frequently coexist. However, this relationship has been little evaluated across stages of hyperglycemia and for a broad range of common mental disorders (CMDs). The objective here was to investigate the association between CMDs and stages of glycemia. DESIGN AND SETTING: Cross-sectional study conducted among civil servants aged 35-74 years participating in the ELSA-Brasil cohort. METHODS: CMDs were classified using the Clinical Interview Schedule – Revised (CIS-R). Glycemia was classified in stages as normal, intermediate hyperglycemia, newly classified diabetes or previously known diabetes, based on oral glucose tolerance testing, glycated hemoglobin (HbA1c), self-reported diabetes and medication use. Blood glucose control was assessed according to HbA1c. RESULTS: CMDs were most prevalent in individuals with previously known diabetes. After adjustments, associations weakened considerably and remained significant only for those with a CIS-R score ≥ 12 (prevalence ratio, PR: 1.15; 95% confidence interval, CI: 1.03-1.29). Intermediate hyperglycemia did not show any association with CMDs. For individuals with previously known diabetes and newly classified diabetes, for every 1% increase in HbA1c, the prevalence of depressive disorders became, respectively, 12% and 23% greater (PR: 1.12; 95% CI: 1.00-1.26; and PR: 1.23; 95% CI: 1.04-1.44). CONCLUSION: Individuals with previously known diabetes had higher CIS-R scores. Among all individuals with diabetes, worse blood glucose control was correlated with depressive disorder. No relationship between intermediate hyperglycemia and CMDs was observed, thus suggesting that causal processes relating to CMDs, if present, must act more proximally to diabetes onset.

Objective: To assess the prevalence of common mental disorders (CMD) and the association of CMD with sociodemographic characteristics in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. Methods: We analyzed data from the cross-sectional baseline assessment of the ELSA-Brasil, a cohort study of 15,105 civil servants from six Brazilian cities. The Clinical Interview Schedule-Revised (CIS-R) was used to investigate the presence of CMD, with a score ≥ 12 indicating a current CMD (last week). Specific diagnostic algorithms for each disorder were based on the ICD-10 diagnostic criteria. Prevalence ratios (PR) of the association between CMD and sociodemographic characteristics were estimated by Poisson regression. Results: CMD (CIS-R score ≥ 12) was found in 26.8% (95% confidence intervals [95%CI] 26.1-27.5). The highest burden occurred among women (PR 1.9; 95%CI 1.8-2.0), the youngest (PR 1.7; 95%CI 1.5-1.9), non-white individuals, and those without a university degree. The most frequent diagnostic category was anxiety disorders (16.2%), followed by depressive episodes (4.2%). Conclusion: The burden of CMD was high, particularly among the more socially vulnerable groups. These findings highlight the need to strengthen public policies aimed to address health inequities related to mental disorders.

Background: Current normal reference values for echocardiography are derived from North American or European populations, and it is not known if these are applicable to the multiethnic constitution of Brazilian and South American populations. Objective: We aimed to describe reference values for echocardiographic measurements in a contemporary cohort of middle-aged and elderly free-living Brazilians. Methods: Echocardiographic studies from 3234 participants (33% of those for whom echocardiography was available) were read in the ELSA Echocardiography Reading Center. Their demographic characteristics did not differ substantially from remaining participants of similar age in the ELSA-Brasil cohort - a study of Brazilian public servants aged 35 to 74 years. Among these, we identified a reference normal sample of 950 (29%) participants (56±10 years; 40% men) after excluding those with prevalent hypertension (51%), diabetes (27%), metabolic syndrome (45%), self-reported cardiovascular disease (13%), or echocardiographically determined myocardiopathy or significant valvular disease (13%). Results: The Table describes sex-specific mean±SD values from the reference normal sample. Mean values for structural measurements were larger for men, but systolic function and mitral annular tissue Doppler measurements were similar. The majority of measurements were within the normal range of other populations. Conclusion: Although results in this sample, which we believe to be the largest drawn to date from an apparently normal Latin American population, are mostly similar to those of other international reference samples, particularities exist that may relate to its multi-ethnic nature or to other regional characteristics. We believe that these results are suitable for use as regional normative values and for international comparisons.

Objectives Early menarche has been linked to higher risk of type 2 diabetes in Western and Asian societies, yet whether age at menarche is associated with diabetes in Latin America, where puberty and diabetes may have different life courses, is unknown. We tested the hypothesis that earlier menarche is associated with higher diabetes risk in Brazilian adults. Methods We used data from 8,075 women aged 35-74 years in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) who had complete information on age at menarche, diabetes status, and covariates. Diabetes was defined based on self-reported physician diagnosis, medication use, and laboratory variables (fasting glucose, 2-hour glucose, and glycated hemoglobin). Poisson regression was used to generate risk ratios (RR) and 95% confidence intervals (CI). Results Menarche onset < 11 years [vs. 13-14 years (referent)] was associated with higher risk of diabetes (RR = 1.34; 95% CI: 1.14-1.57) after adjusting for sociodemographic factors, maternal education, maternal and paternal diabetes, and birth weight. This persisted after further control for BMI at age 20 years and relative leg length. Additionally, among those not taking diabetes medications, earlier menarche [