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Objectives: This study aimed to determine the median age at natural menopause and analyze lifestyle, anthropometric, and dietary characteristics associated with the age at natural menopause among Brazilian women., Methods: This cross-sectional study involved 2,731 women 50 years and over, drawn from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2015/16). Nonparametric Kaplan-Meier cumulative survivorship estimates were used to assess the median timing of natural menopause. Cox proportional hazards regression models were employed to estimate the associations between age at natural menopause and exposure variables., Results: The overall median age at natural menopause was 50 years. In the adjusted Cox model, current smoking (hazard ratio [HR], 1.11; 95% CI, 1.01-1.23) and underweight (HR, 1.34; 95% CI, 1.12-1.61) were associated with earlier natural menopause. Conversely, performing recommended levels of physical activity in the last week (HR, 0.88; 95% CI, 0.80-0.97), being overweight (HR 0.86; 95% CI, 0.74-0.99), and adhering to two or three healthy eating markers (HR, 0.80; 95% CI, 0.66-0.97; HR, 0.76; 95% CI, 0.61-0.94, respectively) were associated with later age at natural menopause. Binge drinking and waist circumference were not associated with age at natural menopause., Conclusions: Lifestyle, anthropometric, and dietary characteristics are significant factors that affect the age at natural menopause. Our findings can contribute to public policies targeted at Brazilian women's health., Competing Interests: Financial disclosure/conflicts of interest: None reported., (Copyright © 2024 by The Menopause Society.)

Immunosenescence is a phenomenon caused by changes in the immune system, and part of these changes involves an increase in circulating immunological biomarkers, a process known as "Inflammaging." Inflammaging can be associated with many diseases related to older people. As the older population continues to grow, understanding changes in the immune system becomes essential. While prior studies assessing these alterations have been conducted in countries with Caucasian populations, this investigation marks a pioneering effort. The object of the study is to describe for the first time that the distribution of cytokines, chemokines, and growth factors serum levels, assessed by Luminex platform, has been examined in a Brazilian population-based study of older adult females and males by age. Blood samples from 2111 participants (≥50 years old) were analyzed at the baseline (2015/2016) of the ELSI-Brazil study. The exploratory variables considered in the study were age, sex, educational level, residence area, geographic region, alcohol and smoking consumption, physical activity, and self-reported medical diagnoses of hypertension, diabetes, asthma, arthritis, and cancer. The association between serum biomarker levels and age was assessed by a quantile regression model adjusted in the total population and stratified by sex. The significance level considered in the analysis was 0.05. The mean age of the participants was 62.9 years, with a slight majority of female (52.7 %). Differences were found between the sexes in the median circulating levels of the CCL11, CXCL10, and FGF biomarkers. Eight biomarkers showed significant associations with age, including the pro-inflammatory CXCL10, TNF-α, IL-6, IL-17, and IL-2; and type 2/regulatory CCL11 and IL-4, showing positive associations, and anti-inflammatory IL-1Ra showing a negative association. The results suggest similar associations between the sexes, revealing an inflammatory profile characterized by types 1 and 2. Remarkably, these findings reinforce the concept of the Inflammaging process in Brazilian population. These findings add novel insights to about the immunosenescence aspects in middle-income countries and help define biomarkers capable of monitoring inflammation in older adults., Competing Interests: Declaration of competing interest The authors declare no conflict of interest and none of financial or personal interests appeared to influence the work reported in this article., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Based on a national representative sample of the population aged 50 years or older, this study aimed to estimate the prevalence of frailty among men and women, identify associated sociodemographic and health factors, and estimate the population attributable fraction. Data from the second wave (2019-2021) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) were used. Frailty was classified based on the number of positive items among unintentional weight loss, exhaustion, low level of physical activity, slow gait, and weakness. The main analyses were based on multinomial logistic regression stratified by sex. The prevalence of frailty was lower in men (8.6%; 95%CI: 6.9; 10.7) than in women (11.9%; 95%CI: 9.6; 14.8), with the most frequent item being the low level of physical activity in both. Age and schooling level were the sociodemographic factors associated with pre-frailty and fragility among men and women. The population attributable fraction was different for frailty between genders. In men, the highest population attributable fraction was due to not having a partner (23.5%; 95%CI: 7.7; 39.2) and low schooling level (18.2%; 95%CI: 6.6; 29,7). In women, higher population attributable fraction values were due to memory deficit (17.1%; 95%CI: 7.6; 26.6), vision deficit (13.4%; 95%CI: 5.1; 21.7), and diabetes mellitus (11.4%; 95%CI: 4.6; 18,1). Similar population attributable fraction levels were observed for heart disease (8.9%; 95%CI: 3.8; 14.1 in women and 8.8%; 95%CI: 2.0; 15.6 in men). Strategies aimed at physical activity have the potential to prevent frailty in both men and women, and the prevention of chronic conditions is more important in women.

Objectives: There is little nationally representative information about factors associated with longevity among older Brazilians., Methods: Baseline survey data from the Brazilian longitudinal Study of Aging (ELSI-Brazil) were linked to vital statistics systems. Mortality rates and life expectancy estimates were calculated and compared to official sources. Cox Proportional Hazards models and Population Attributable Fractions (PAFs) identified significant predictors of mortality. Results: Calculated mortality rates and life expectancy estimates were similar to official statistics for most ages with higher risk of death among older ages, as expected. High School completion, being partnered, and female sex were negatively associated with mortality, while being underweight, previous diagnosis of a chronic condition, having any functional limitations, poor self-rated health, low grip strength, and smoking were all associated with higher mortality risk. Discussion: The ELSI-Brazil study has potential to identify factors associated with longevity and to inform programs and policies designed to enhance healthy aging among older adults in Brazil., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Immunobiography describes the life-long effects of exogenous or endogenous stimuli on remodeling of immune cell biology, including the development of memory T and B-cells. The present study aimed at investigating the rhythms of changes in phenotypic features of memory T and B-cells along childhood and adolescence. A descriptive-observational investigation was conducted including 812 healthy volunteers, clustered into six consecutive age groups (9 Mths -1 Yr ; 2 Yrs ; 3-4 Yrs ; 5-7 Yrs ; 8-10 Yrs ; 11-18 Yrs ). Immunophenotypic analysis of memory T-cell (CD4 + and CD8 + ) and B-cell subsets were performed by flow cytometry. The results pointed out that memory-related biomarkers of T and B-cells displayed a bimodal profile along healthy childhood and adolescence, regardless of sex. The first stage of changes occurs around 2 Yrs , with predominance of naive cells, while the second and more prominent wave occurs around the age 8-10 Yrs , with the prevalence of memory phenotypes. The neighborhood connectivity profile analysis demonstrated that the number of correlations reaches a peak at 11-18 Yrs and lower values along the childhood. Males presented higher and conserved number of correlations when compared to females. Altogether, our results provide new insights into immunobiography and a better understanding of interactions among the cellular subsets studied here during childhood and adolescence., (© 2023. The Author(s).)

Objectives: To investigate home-based gait speed performance for men and women stratified by age group and its associations with sociodemographic and anthropometric variables., Methods: Data from the 2 nd wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2019-2021) were used. Gait speed was tested twice at home over 3.0 meters at usual pace. Associations of sociodemographic and anthropometric variables with gait speed were evaluated using gamma regression., Results: Median gait speed value reduced with increasing age in both sexes [men: 0.70 m/s (50-59 years) to 0.53 m/s (≥80 years); women: 0.68 m/s (50-59 years) to 0.48 m/s (≥80 years)] and was significantly lower in women than men in the age groups of 60-69 and 70-79 years. Age group and education among men and age group, education, and waist circumference among women were significantly associated with gait speed., Conclusions: Our findings may be helpful as reference values to identify mobility limitation among older Brazilians., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

This study aimed to estimate prevalence of loneliness among older Brazilian adults over the first seven months of the COVID-19 pandemic and to identify the predictors of loneliness trajectories. Pre-pandemic data derived from face-to-face interviews of participants of the 2019-2020 Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is a nationally representative study of community-dwelling individuals aged 50 years and over. Pandemic data were based on three rounds of telephone interviews among those participants, conducted from May to October 2020. Loneliness was measured by a single-item question, considering those who had at least two repeated measures. Explanatory variables included depression, living alone, leaving home in the last week, and virtual connectedness in the last month. Mixed-effects logistic regression was used to estimate odds ratios with their 95% confidence intervals (95%CI) and to investigate loneliness trajectories and their predictors. In total, 5,108 participants were included. The overall prevalence of loneliness in the pre-pandemic period was 33.1% (95%CI: 29.4-36.8), higher than the pandemic period (round 1: 23.6%, 95%CI: 20.6-26.9; round 2: 20.5%, 95%CI: 17.8-23.5; round 3: 20.6%, 95%CI: 17.1-24.6). A significant interaction (p ≤ 0.05) was evidenced only between depression and time; participants with depression showed a greater reduction in loneliness levels. Although loneliness levels in Brazil have decreased during the pandemic, this pattern is not present for all older adults. Individuals with depression had a more significant reduction, probably due to feeling closer to their social network members during the stay-at-home recommendations.

Objective: To analyze the factors associated with paid work, after the dam failure, based on geographic strata, among men and women residing in Brumadinho, Minas Gerais., Methods: Baseline data from participants of the Brumadinho Health Project, aged 18 years or older, obtained through a questionnaire, between July and November 2021 (n=2,783) were used. The dependent variable was paid work after the dam failure and the explanatory variables were geographic stratum, age, education, race/skin color, self-perception of health and employment relationship before the event. The adjusted analysis was estimated by logistic regression. All analyses were performed separately for men and women., Results: Paid work after the dam failure was reported by 58.3% (95%CI 55.0-61.6) of the participants, with the highest prevalence among men (71.4%; 95%CI 67.1-75.3) compared to women (48.6%; 95%CI 44.3-52.8) (p<0.001). After adjustments, the results showed that the population who was directly exposed to the disaster was less likely to have a paid work after it, both for women (OR=0.68; 95%CI 0.48-0.95) and for men (OR=0.48; 95%CI 0.30-0.78). In addition, women directly exposed to the disaster and who reported being self-employed before it were less likely to have a paid work, compared to women who reported being employed with or without a formal contract., Conclusion: Participation in the labor market is determined by several factors. Thus, intersectoral policies are necessary the population's demands of life and work are met in disaster situations.

Objective: In January 2019 a dam at the Córrego do Feijão mine suffered a catastrophic failure that killed 270 people and caused extensive damage. It is unknown how exposure to such a disaster might affect healthcare utilization., Methods: We assessed survey data from the Brumadinho Health Project, a cohort study that includes people who were exposed to the dam failure and two comparison groups: people unexposed to mining or the disaster and people from a mining community, but not exposed to the disaster. Main outcomes include any doctor visit or hospitalization in the past year, having a usual source of healthcare, having blood pressure and blood sugar checked, and being up to date with vaccinations, for adults 18 years and over. We used survey-weighted robust Poisson regression to assess differences between those exposed and the two comparison groups while controlling for confounders., Results: In multivariable models, the exposed group had a 15% higher chance of having a doctor visit than the unexposed group. For hospitalization and reports of blood pressure and blood sugar assessments, there was no significant difference among any of the groups. The exposed group had a 24% higher chance and the unexposed mining community had a 143% higher chance of being up to date with immunizations, as compared to the unexposed group., Conclusion: There were some differences in healthcare utilization among individuals exposed to the dam failure. Continued monitoring of the situation is warranted, as the full consequences of such a traumatic event may take considerable time to unfold.

Objective: To describe the consumption of psychotropic drugs in the adult population residing in Brumadinho, Minas Gerais, after the Vale dam collapse, which occurred in 2019., Methods: This is a cross-sectional study, part of the Brumadinho Health Project, developed in 2021, with a representative population-based sample of adults (18 years and over) residing in Brumadinho. A total of 2,805 adults with information on self-reported use of psychotropic drugs (antidepressants and anxiolytics-hypnotics/sedatives) in the last 15 days were included in the analysis. The prevalence of psychotropic drug use was estimated, and the most used psychotropic drugs were identified. Pearson's chi-square test (with Rao-Scott correction) was used to test associations between exposures and use of psychotropic drugs, considering a significance level of p<0.05., Results: The use of antidepressants (14.2%) was more common than the use of anxiolytics or hypnotics/sedatives (5.2%), with sertraline and fluoxetine being the most used antidepressants. The use of anxiolytics and hypnotics/sedatives was higher among residents who lived in the area directly affected by the dam's mud, and the use of any psychotropic drug was higher among those who lost a relative/friend in the disaster and assessed that their health worsened after the disaster, and among women., Conclusion: The results of the study corroborate what was observed in other populations exposed to similar tragedies, regarding the pattern of associations and the of use of psychotropic drugs.

Objective: To present the methodological aspects of the Brumadinho Health Project and to describe the epidemiological profile of participants in the baseline cohort., Methods: Prospective, population-based cohort study in a representative sample of residents (aged 12 and over) of Brumadinho, Minas Gerais, after a mining tailings dam failure. Information for the baseline was collected in 2021, two years after the mining tailings dam collapsed, including sociodemographic, health and service use aspects, among others. Prevalence estimates of health outcomes were described in Brumadinho, as well as in the Metropolitan Region of Belo Horizonte and Minas Gerais, using data from the 2019 National Health Survey. All analyses were performed in the software Stata 17.0, considering the sampling weights and design effect., Results: 3,080 (86.4%) residents participated in the study, most of them being females (56.7%) and with a mean age of 46.1 years. The diseases more frequently reported were arterial hypertension (30.1%), high cholesterol (23.1%) and depression (22.5%), similarly to what was observed in the Metropolitan Region of Belo Horizonte and Minas Gerais, although the prevalence in Brumadinho was higher. At least one medical appointment and one hospitalization occurred in 75.2% and 9.4% of residents in the past year, respectively., Conclusion: It is important to monitor health, physical and mental conditions of residents after the occurrence of a disaster of this magnitude. This information can contribute with risk management of these processes, not only in the affected municipality, but also in other areas where populations are at risk of major disasters.

This study aimed to investigate the association between social capital and functional disability, based on a longitudinal perspective, using data from the cohort of older adults from Bambuí, Minas Gerais State, Brazil. The baseline of this study was composed of all surviving and disability-free - up until the seventh year of follow-up (2004) - older adults who were followed up until 2011. The outcome variable was functional disability for basic activities of daily living (ADL) and instrumental activities of daily living (IADL), separately analyzed. Social capital was the exposure of interest, measured through its cognitive (cohesion and social support) and structural (social participation and satisfaction with the neighborhood) components. Sociodemographic variables, health conditions, and lifestyle habits were used for adjustment purposes, and the occurrence of death was considered a competitive event. The hypothesis of association between social capital and functional disability was tested using the competing risk model, which provides hazard ratios (HR) and a 95% confidence interval (95%CI). After multivariate analysis, social capital - in its structural component - was associated with functional disability. Older adults who were dissatisfied with the neighborhood had a higher risk of developing functional disability for IADL (HR = 2.36; 95%CI: 1.31-4.24), in relation to their counterparts. This study results suggest that functional disability is associated with aspects other than health, evidencing the need for the development of policies and interventions that support aspects related to the physical and social environment in which older adults live.

The Centers for Disease Control and Prevention (CDC) Clear Communication Index (CCI) was cross-culturally adapted to Brazilian Portuguese (BR). It was necessary to analyze the reliability and validity of the BR-CDC-CCI for its use in Brazil. This study aimed to evaluate the psychometric properties of the instrument in its Brazilian version. Four specialists in health education used the BR-CDC-CCI to evaluate a population-level health education material. Primary health care professionals ( n = 105) evaluated the same health material using the BRCDC-CCI, and 30 professionals performed the retest 15 to 20 days after the first assessment. Cohen Kappa and area under the receiver operating characteristic (ROC) curve analyses were developed. Inter-rater agreement ranged from moderate to almost perfect , with 90% of the items almost perfect . The percentage of agreement ranged from 8.6% to 98.1%. For the analyzed questions, the area on the ROC curve was 0.9412 (confidence interval [CI] 95%; [0.8259, 1.000]). The BR-CDC-CCI had sufficient validity and reliability for its use in the evaluation of educational/informational materials in health in the Brazilian context. In view of the good results from this psychometric assessment, we anticipated the BR-CDC-CCI could contribute to improvements in Brazilian professionals' skills in developing health communication materials, thereby improving the quality of education and, possibly health outcomes. [ HLRP: Health Literacy Research and Practice . 2022;6(2):e84-e87. ].

Objective: To determine prevalence and factors associated with intention to get vaccinated against COVID-19 among older Brazilians., Methods: This was a cross-sectional study based on telephone interviews with participants of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) aged 60 years and over, conducted in 70 municipalities in March 2021., Results: Among the 4,364 participants (mean age = 70.1 years), 91.8% intended to get vaccinated or had already been vaccinated, 2.5% did not intend to get vaccinated and 5.7% were undecided. Participants living in the North and Southeast regions were more likely to want to get vaccinated, as were those with two or more chronic diseases. Those who learned about COVID-19 from friends/family/social media were more likely to be undecided about vaccination (odds ratio = 3.15; 95%CI 1.28;7.77)., Conclusion: The study identified one of the highest prevalence of intention to get vaccinated against COVID-19 described in the literature to date.

Chronic bacterial infections are associated with changes in the immunosenescence process and immunological biomarkers can assist in monitoring these changes. The identification of this immunological profile is important because Chlamydia pneumoniae (C. pneumoniae) and Helicobacter pylori (H. pylori) infections are important factors of morbidity and mortality among the older adults. This study aimed to identify changes in the immunological profile in the presence of C. pneumoniae and H. pylori infections among community-dwelling older adults. This is a cross-sectional study that used data from 1432 participants from the Bambuí Cohort Study of Aging, Minas Gerais, Brazil. The presence of immunoglobulin G (IgG) for C. pneumoniae and H. pylori was considered a dependent variable and assessed in the participants' serum using the enzyme-linked immunosorbent assay (ELISA). In assessing the immunological profile, the following inflammatory markers were considered: CXCL8, CXCL9, CXCL10, CCL2, CCL5, IL-1β, IL-6, IL-10, IL-12, TNF, and CRP. Associations were assessed by logistic regression, estimating odds ratios and confidence intervals (95%) using the Stata® V.13.1 software. The seroprevalence of anti-C. pneumoniae and anti-H. pylori antibodies was 55.9% and 70.3%, respectively. While high levels of anti-C. pneumoniae antibodies were associated with higher concentrations of CXCL10 and IL-10, higher levels of IL-1β and IL-6 were inversely associated with the titration of anti-H. pylori antibodies. The results characterize immunological profiles associated with these chronic infections and reinforce the potential effects of biomarkers on infections by these bacteria and on the immunosenescence process., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: Vaccine hesitancy may represent a barrier to effective COVID-19 immunisation campaigns. This study assesses individual, disease-specific and contextual factors associated with COVID-19 vaccine acceptance among a nationally representative sample of older Brazilian adults., Design: Cross-sectional analysis of data from household interviews and a supplementary telephone survey., Setting: Brazil and its five geographic regions., Participants: Data are derived from 6584 individuals aged 50 years and over who participated in the second wave of the Brazilian Longitudinal Study of Aging., Primary and Secondary Outcome Measures: Survey-weighted multinomial logistic regression assesses factors associated with intending, not intending or being uncertain about one's intention to vaccinate against COVID-19., Findings: Seventy-one per cent of study participants intend to receive a COVID-19 vaccine once available, while 17% (representative of nearly 9 million people) have no intention to vaccinate, and 12% are still undecided. Besides age, demographic and health-related factors related to COVID-19 severity and complications were not associated with intention to vaccinate. Those who most trusted social media or friends and family for COVID-19 information and those who did not trust any information source were 68% and 78% more likely to refuse vaccination, respectively, as compared with those who trusted official information sources. People who inconsistently used face masks when outside were 3.4 times more likely than consistent face mask users to intend to refuse vaccination. Higher municipal COVID-19 fatality rates were negatively associated with vaccine refusal., Conclusions: Most national COVID-19 immunisation strategies identify older individuals as among those prioritised for early vaccination, given their increased risk of more severe symptoms and complications of the disease. Because individual, disease-specific, and contextual factors were associated with vaccine acceptance, there is a clear need for multilevel and multichannel information and outreach campaigns to increase COVID-19 vaccine acceptance among vulnerable older populations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This study aimed to examine the association between frailty syndrome and the perception of problems in indicators of attributes in primary healthcare (PHC) among elderly Brazilians. This was a cross-sectional study with 5,432 participants 60 years or older in the first wave of the Brazilian Longitudinal Study of Aging (ELSI-Brasil), conducted in 2015 and 2016. Frailty, the independent variable, was defined according to the theoretical framework of the frailty phenotype, and the indicators of problems in PHC attributes, the dependent variables, were obtained from questions related to health services use. Access, longitudinal care, coordination, comprehensiveness, family orientation, and cultural adequacy were the target attributes. For the data analysis, logistic regression models were used, adjusted for predisposing, enabling, and need factors for use of health services. Among the participants, 55.1% were females, 57.9% were 60 to 69 years of age, and 51.8% reported multimorbidity. Frail and pre-frail elders accounted for 13.4% and 54.5% of the sample, respectively. Multivariate analyses showed that frail elders (compared to robust elders) showed higher odds of reporting problems with access (OR = 1.45; 95%CI: 1.08-1.93), longitudinal care (OR = 1.54; 95%CI: 1.19-2.00), and comprehensive care (OR = 1.45; 95%CI: 1.14-1.85), in addition to more problems with attributes of PHC (OR = 1.38; 95%CI: 1.05-1.82, for 5 or more). The study suggests the occurrence of inequities in the care provided by Brazilian PHC for frail elders, particularly in the attributes of access, longitudinal care, and comprehensiveness.

Chronic infections, such as cytomegalovirus (CMV) and herpes simplex virus type 1 (HSV-1), contribute to the inflammation process among older adults and are associated with the immunosenescence process. The aim was to identify the immunological profile associated with CMV and HSV-1 infections among older adults. This is a cross-sectional study, carried out with 1492 participants from the Bambuí Cohort Study of Aging - Minas Gerais, Brazil. For analysis purposes, we considered the presence of immunoglobulin G (IgG) for CMV and HSV-1 in the participants' serum, assessed by the enzyme-linked immunosorbent assay (ELISA); outcomes were defined by titration above the median (>160 UR/mL for HSV-1 and >399.5 U/mL for CMV). In order to assess the immunological profile, the following biomarkers were considered: IL-1beta, IL-10, IL-12, TNF, CXCL8, CXCL9, CXCL10, CCL2, CCL5, IL-6 and CRP; the first four being categorized as detectable levels or not, and the others using the Classification and Regression Tree (CART) method. The analysis was adjusted for sociodemographic variables, health behaviors and health conditions. The seroprevalence of anti CMV and anti HSV-1 antibodies was 99.4% and 97.0%, respectively. Higher concentrations of CXCL8 and CCL5 chemokines were associated with lower antibody titers for CMV, and higher concentrations of CXCL9, IL-6 and CRP were associated with higher levels of antibodies to CMV. Moreover, intermediate levels of CXCL10 were also associated with higher levels of antibodies to CMV. In HSV-1 infection, intermediate levels of CXCL9, CCL5 and IL-6 were less likely to have higher antibody titers for this infection. On the other hand, higher levels of CXCL10 and CRP were positively associated with higher antibody titers for HSV-1. The results describe important immunological changes and reinforce the potential effect of CMV and HSV-1 on the immunosenescence process., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Previous validity studies of the Alberta Infant Motor Scale (AIMS), using raw scores and percentile curves for group comparisons, showed that infants in Brazil achieved gross motor milestones at later ages. Validity of the AIMS norms were later reassessed using a logistic regression model that placed the AIMS items on an age scale., Objectives: Our study examined the validity of the AIMS norms for Brazilian infants using the recommended method for calculating and comparing item locations., Methods: Data from 732 Brazilian infants (2009-11), 3 days to 18 months old, were compared to the AIMS normative sample (n=2202). Logistic regression placed the AIMS items of both samples on age scales representing the age at which 50% of infants passed an item and compared the two datasets. Pearson correlation coefficient tested the association across samples., Results: 47 of the 58 AIMS items met the criterion for stable regression to calculate item locations of the Brazilian dataset. Based on the age when 50% of the infants passed a criterion, most of the items from the Brazilian sample (n=28) differed by two weeks or less compared to the Canadian normative sample., Conclusion: The sequence and age for the emergence of AIMS items were similar between the Brazilian and Canadian samples. Canadian norms are appropriate for clinical decisions and research with Brazilian infants., (Copyright © 2021 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To evaluate the clinical impact of a comprehensive medication management (CMM) service in a Brazilian primary health-care setting., Methods: A quasi-experimental study has been carried out between July 2014 and November 2016 with patients who received the service in the primary care setting of a Brazilian city (n = 1057). Factors associated with drug therapy problems (DTP) detection in the initial assessment were evaluated by performing univariate and multivariate analyzes. To evaluate the impact of the CMM service, a linear regression model was constructed from the difference between the initial and final values of the clinical and laboratory parameters adjusted by multiple variables., Results: A total of 1642 DTPs was identified, the most prevalent one being "nonadherence" (31.9%) and the "need for additional drug therapy" (22.9%). The use of 5 or more medications and the presence of 3 or more diseases were positively associated with the identification of 3 or more DTPs during the initial assessment. Even after multiple adjustments, a statistically significant reduction has been observed in the values of glycated hemoglobin, systolic blood pressure, low-density cholesterol, and total cholesterol., Conclusion: The CMM service contributed to the resolution of DTP and showed positive clinical impact in primary health care in the studied setting.

This article aims to evaluate the joint and separate association between abdominal and general adiposity indicators and mortality. Data was collected from 1,366 older adults in the Bambuí Cohort Study of Aging with complete information for all variables of interest. The outcome variable was all-cause time until death; exposure variables were a body shape index (ABSI), waist circumference (WC), waist-to-height ratio (WHtR) and body mass index (BMI), assessed at the beginning of the study, and at the 3rd, 5th and 11th year of follow-up. Association between the quartiles of anthropometric indicators and mortality was calculated using an extended Cox proportional hazards model and adjusted for socioeconomic and behavioral confounding factors. Older adults in the 4th ABSI quartile had a higher risk of mortality regardless of BMI (1.27; 95%CI: 1.01-1.58), but this association was not observed in sensitivity analyses. Older adults in the 2nd, 3rd and 4th BMI quartiles had a lower risk of mortality, even when adjusted for WC or ABSI. WC and WHtR showed no association consistent with all-cause mortality after adjustment for confounding factors. Considering the loss of significance in the sensitivity analyses, ABSI's predictive capacity for mortality is still weak. Thus, adopting ABSI in clinical practice or in epidemiological surveys, in conjunction or replacing BMI and WC, requires more in-depth studies.

The scope of this study was to estimate the prevalence and factors associated with severe falls among elderly Brazilians. It included a transversal study of 10,537 elderly individuals who participated in the National Health Survey (2013). The dependent variable was a report of severe falls in the past year. The independent variables comprised, hierarchically, socio-demographic factors, behavior, health status and functional capacity. Logistic regression was used to obtain the odds ratio (OR) and the confidence interval (95%CI), using the 13.1 Stata program. The prevalence of severe falls was 7.5% (95%CI: 6.7-8.3) and the highest odds were among women (OR: 1.35; 95%CI: 1.03-1.77), 70 to 79 years of age (OR: 1.47; 95%CI: 1.12-1.95) and 80 years and above (OR: 2.00; 95%CI: 1.46-2.74), living without a spouse/partner (OR: 1.37; 95%CI: 1.08-1.74), sedentary in leisure time (OR: 1.55; 95%CI: 1.06-2.26), having multimorbities (OR: 1.54; 95%CI: 1.19-2.00), sleeping difficulties (OR: 2.18; 95%CI: 1.65-2.88), limitations in daily activities (OR: 2.25; 95%CI 1.63 -3.10) and use of a walking aid (OR: 1.89; 95%CI: 1.30-2.73). The prevalence of severe falls was high and multifactorial, enabling the identification of profiles of greater vulnerability, which should be considered in public policies for specific interventions.

The objective of this study was to examine the prevalence of going out to work during the COVID-19 epidemic, and the factors associated with this, among adults aged 50 years and over who were in paid employment before its onset. We used data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted through face-to-face interviews between August 2019 and March 2020 (before the onset of the epidemic), in a representative national sample of adults aged 50 and over, and data obtained through telephone interviews carried out among the same participants (ELSI-COVID-19 initiative), conducted between May 26 and June 8, 2020 (during the epidemic). The analyses were based on odds ratios (OR) estimated by logistic regression. The participants' mean age was 59.9 years (SD = 6.5). The prevalence of going out to work in the previous seven days was 38.4% (95%CI: 31.3-46.1), 50.2% among men and 25.1% among women (formal work, self-employment, and informal work). The results showed that among men, the likelihood of going out to work was lower among those aged 60 to 69 years compared to those aged 50 to 59 years (OR = 0.27; 95%CI: 0.15-0.48). Among women, the likelihood was lower among those who were self-employed (OR = 0.28; 95%CI: 0.12-0.64) or in informal employment before the epidemic (OR = 0.25; 95%CI: 0.09-0.69), compared to those in formal employment. One of the hypotheses to explain this association is that women in informal employment were more likely to be dismissed, and that self-employed women have stopped working during the epidemic.

The objective of this study was to evaluate whether healthy behaviours determine the adoption of individual protective measures to fight COVID-19. The data were obtained from the ELSI-COVID-19 initiative, a telephone survey conducted among participants in the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which includes a national sample representative of the population aged 50 years or older. The outcomes evaluated were three protective measures (not having left home in the past week, wearing a mask when leaving home, and sanitizing hands when returning home), and the explanatory variables were health behaviours (smoking, alcohol consumption, consumption of fruits and vegetables, and physical activity). The associations were evaluated by logistic models, considering adjustments for potential confounding factors. A total of 5,827 individuals participated in the analysis; 32.2% did not leave home in the last week, and among those who left home, 97.5% used a face mask, and 97.3% sanitized their hands when they returned home. The practice of physical activity at the recommended levels was associated with a lower chance of not leaving home in the previous week. Ex-smokers were more likely to use a mask, and those who practised physical activity were less likely to adopt this protective measure. Individuals with low-risk alcohol consumption had a higher chance of sanitizing their hands. Actions aimed at increasing the adoption of protective measures to fight the new coronavirus should consider the existence of vulnerable groups, which can be identified by the distribution of other health behaviours in the population.

The aim of the study was to examine the prevalence of social distancing, the use of face masks and hand washing when leaving home among Brazilian adults aged 50 or over. Data from 6,149 telephone interviews were used, conducted between May 26 and June 8, 2020 among participants in the Brazilian Longitudinal Study of Aging (ELSI-Brazil). Social distancing was defined by not having left home in the last seven days. Only 32.8% of study participants did not leave home during the period considered, 36.3% left between one and two times, 15.2% between three and five times and 15.7% left every day. The main reasons for leaving home were to buy medicine or food (74.2%), to work (25.1%), to pay bills (24.5%), for health care (10.5%), to exercise (6.2%), and to meet family or friends (8.8%). Among those who left home, 97.3% always wore face masks and 97.3% always performed hand washing. Women left home less often than men. Men left home more often to work and exercise while women left home more often to seek healthcare. Men (odds ratio - OR = 1.84), those with higher education (OR = 1.48 and 1.95 for 5-8 and 9 years, respectively) and urban residents (OR = 1.54) left home more frequently to perform essential activities, regardless of age or other characteristics. Results show low adherence to social distancing, but high prevalence in the reported use of face masks and hand washing.

Little is known about vitamin D status in older adults in South America, where exposures to ultra-violet radiation are high. We examined the distribution of serum 25-hydroxyvitamin D (25OHD) concentration and its determinants in a nationally representative sample of Brazilians aged 50 years and older. Explanatory variables included environment and individuals' characteristics from the ELSI baseline survey (2015-16). Among the 2,264 participants (mean age = 62.6 years), the geometric mean of 25OHD concentration was 66.8 nmol/L. The prevalence of vitamin D deficiency (< 30 nmol/L) and insufficiency (< 50 nmol/L) were 1.7% (95% CI 1.0, 2.8) and 16% (95% CI 12, 20), respectively. Mean concentrations were lower in those geographical regions situated at lower latitudes. Those at the oldest age, women, self-classified as Black and Brown, living in urban areas and current smokers were more likely to have vitamin D insufficiency, independent of each other and other relevant factors. In contrast, individuals who eat fish regularly were considerably less likely to present lower concentration. Based on these findings it is possible to estimate that about 875,000 older Brazilians have vitamin D deficiency and 7.5 million its insufficiency.

What Is Known and Objective: There are no instruments to assess the patient's knowledge of oral anticoagulation with warfarin, in which the performance of the items has been evaluated through the item response theory. To evaluate psychometric properties of the Brazilian version of the Oral Anticoagulation Knowledge Test, using the item response theory., Methods: This methodological study was developed in an anticoagulation clinic of a university hospital with a sample of 201 patients treated with warfarin. The item response theory was used to evaluate questions regarding psychometric properties and the performance of the Brazilian version of the Oral Anticoagulation Knowledge Test items. The unidimensionality hypothesis was analysed by decomposing the polychoric correlation and the Cronbach's alpha coefficient. An item characteristic curve of the 20 items of the instrument was made to identify the discrimination power of each item of the performance scale., Results and Discussion: Correlations were positive and statistically significant among the 20 items, with a Cronbach's alpha coefficient of 0.82. The difficulty parameter ranged from -4.14 to 0.42. The discrimination parameter ranged from 0.41 to 1.89. The items regarding drug-drug/drug-food interactions were able to differentiate knowledge about oral anticoagulation with greater accuracy., What Is New and Conclusion: This study is the first that uses this methodology to evaluate the knowledge on oral anticoagulation therapy with warfarin. The evaluation using item response theory showed that the Brazilian version of the Oral Anticoagulation Knowledge Test is suitable for assessing the patient's knowledge of oral anticoagulation with warfarin. Thus, our findings confirmed the utility of this instrument and provided an essential point of reference for the structuring of health education activities that ensure the individualization of educational interventions in patients on warfarin., (© 2020 John Wiley & Sons Ltd.)

Background: Many bimanual activities are challenging for children with unilateral spastic cerebral palsy (USCP). Aims : To investigate hand use by children with USCP in daily activities of their interest. Material e methods: Sample included twenty children with USCP, aged 8 to 14 years old. Participants identified bimanual activities of their interest and no interest. Children's performance on these activities were videotaped. Videos were coded according to the affected extremity's forms and effectiveness of use, caregiver provision and types of assistance, and child's satisfaction. The relative proportions of each parameter were compared using the signed-rank test, considering the time spent in activities of interest and no interest. Results : We analyzed 116 activities. We found effects of interest in children's satisfaction ( p =  0.003) and on the type of assistance ( p =  0.03). Specifically, children demonstrated longer periods of satisfaction performing activities of their interest and caregiver physical assistance was provided for longer periods of time in activities of no interest. There were no effects on the other parameters. Conclusions : A model that illustrates the impact of a child's interest on the performance of daily bimanual activities is presented, grounded in our results and in the literature.

Background: Children with congenital Zika syndrome (CZS) maintain severe motor impairments at the end of the first year of life. Presence of certain symptoms and comorbidities increase these children's vulnerability., Aims: To evaluate gross motor function of a group of Brazilian children with CZS at 24 months of age and to investigate the association between the presence of CZS symptoms and comorbidities with gross motor development., Methods and Procedures: Fifty children with CZS participated in the study. Information was collected from medical charts, and gross motor development was evaluated by the Gross Motor Function Measure (GMFM)-88. GMFM-88 scores were compared among comorbid groups. Three subgroups of children were identified by cluster analysis, based on information from head circumference at birth, symptoms, comorbidities and gross motor function., Outcomes and Results: Significant associations (p < 0.001) were observed between number of comorbidities/symptoms and dimensions A (r = -0.57) and B (r = -0.58) of the GMFM-88. Children were grouped into 3 clusters, with different gross motor skills. Children with epilepsy and dysphagia composed the cluster with smaller median scores for dimensions A and B of the GMFM-88., Conclusions and Implications: The presence of CZS symptoms and comorbidities compromise the gross motor repertoire of children with CZS at 24 months., (© 2020 The Authors.)

This study evaluated the factors associated with the performance of Brazilian Oral Health Teams (OHTs).This is multilevel research that used data from 12,386 Brazilian OHTs in 2012. The OHTs performance was estimated in previous research by using Item Response Theory model, which employed 20 questions about dental procedures in Primary Care. The first level covariates were based on OHTs procedures such as: the record of pregnant woman dental appointment, provision of dentistry home care, dental appointments scheduled choices, and OHTs in charge for more than 5000 individuals. Moreover, the use of guidelines was accessed concerning delivering prostheses in primary care, referring to secondary care, referring to suspected oral cancer, and providing care towards patients with special needs. Variables included in level 2 were GINI and Human Development Index. Multilevel linear regression models were constructed, estimating linear regression coefficients, 95% confidence intervals, and P values.OHTs performance was different among the 3,613 municipalities analyzed (P < .001), with 36.7% of the variation in the performance of the OHTs being attributed to the variability between municipalities. The adjusted model showed that higher performance OHTs reported attention to pregnant women, dentistry home care and use of dental care guidelines (P < .001). There were lower performance scores for those OHTs with more restricted scheduling (P < .05), compared to those that reported scheduling appointments at any day and time. The best OHTs and population ratio led to a better performance score (P = .010). At the municipal level, better socioeconomic status was associated with better performance of the OHTs (P < .001).OHTs with higher performance are associated with oral health services organizations and municipalities' socioeconomic status.

Objective: To investigate the association of contextual and individual variables with systemic arterial hypertension (SAH) among elderly Brazilians., Methods: Cross-sectional study with data from the National Health Survey (2013) and the Atlas of Human Development in Brazil. SAH was defined by direct measurement of blood pressure and/or the use of medications for this condition. The contextual independent variables were the Municipal Human Development Index (MHDI) and the Gini Index, by Federation Unit. The individual independent variables included sociodemographic factors, health behaviors, health conditions, and the use of health service. Multilevel logistic models were used to study the associated factors., Results: Among the 10,211 participants aged 60 years and older, the prevalence of hypertension was 66.7% (95%CI 65.1 - 68.3). After adjusting for all variables, the chance of hypertension was higher in the Federation Units with the highest MHDI, in women, aged 70 years or older, in non-whites, with one or more chronic diseases, overweight and obesity, high waist circumference, and among those who had four or more medical appointments in the previous year. On the other hand, a negative association was observed between hypertension and education., Conclusion: The individual profile associated with hypertension was similar to what had already been reported in the scientific literature, but it is noteworthy that the elderly residing in the higher MHDI Federation Units were more likely to have this condition, suggesting a higher survival of hypertensive patients in these regions.

The Yellow Fever (YF) vaccination is recommended for people living in endemic areas and represents the most effective strategy to reduce the risk of infection. Previous studies have warned that booster regimens should be considered to guarantee the long-term persistence of 17DD-YF-specific memory components in adults living in areas with YF-virus circulation. Considering the lower seroconversion rates observed in children (9-12 months of age) as compared to adults, this study was designed in order to access the duration of immunity in single-dose vaccinated children in a 10-years cross-sectional time-span. The levels of neutralizing antibodies (PRNT) and the phenotypic/functional memory status of T and B-cells were measured at a baseline, 30-45 days, 1, 2, 4, 7, and 10 years following primary vaccination. The results revealed that a single dose induced 85% of seropositivity at 30-45 days and a progressive time-dependent decrease was observed as early as 2 years and declines toward critical values (below 60%) at time-spans of ≥4-years. Moreover, short-lived YF-specific cellular immunity, mediated by memory T and B-cells was also observed after 4-years. Predicted probability and resultant memory analysis emphasize that correlates of protection (PRNT; effector memory CD8 + T-cells; non-classical memory B-cells) wane to critical values within ≥4-years after primary vaccination. Together, these results clearly demonstrate the decline of 17DD-YF-specific memory response along time in children primarily vaccinated at 9-12 months of age and support the need of booster regimen to guarantee the long-term persistence of memory components for children living in areas with high risk of YF transmission., (Copyright © 2019 Campi-Azevedo, Reis, Peruhype-Magalhães, Coelho-dos-Reis, Antonelli, Fonseca, Costa-Pereira, Souza-Fagundes, Costa-Rocha, Mambrini, Lemos, Ribeiro, Caldas, Camacho, Maia, de Noronha, de Lima, Simões, Freire, Martins, Homma, Tauil, Vasconcelos, Romano, Domingues, Teixeira-Carvalho and Martins-Filho.)

This study aimed to measure the contribution of selected health behaviors to the prevalence of hypertension control in Brazilian adults 50 years or older, based on data from the ELSI-Brasil study. The study included 4,318 individuals 50 years or older who reported having received a medical diagnosis of hypertension and were taking antihypertensive medication. The selected health behaviors were: physical activity, healthy diet, not consuming excessive alcohol, and never having smoked. The contribution of each health behavior to prevalence of hypertension control was estimated by the attribution method, via adjustment of the binomial additive hazards model, stratified by sex. Prevalence of hypertension control was 50.7% (95%CI: 48.2; 53.1). Overall, health behaviors made a larger contribution to hypertension control in women (66.3%) than in men (36.2%). Moderate alcohol consumption made the largest contribution in both sexes, but particularly in women (52.7% in women versus 19% in men). Physical activity contributed 12.6% in women and 10.7% in men. The other behaviors were more relevant in men: never having smoked (3.4%) and regular consumption of vegetables, legumes, and fruits (3.1%). These results underline the need for measures to promote the adoption of healthy behaviors by hypertensive individuals to reduce blood pressure levels, improve the effectiveness of antihypertensive medication, and decrease their cardiovascular risk.

The present study aims to determine whether 17DD-YF-specific humoral and cellular immunological memory is maintained 8-years after primary vaccination with subdoses (10,447IU;3,013IU;587IU;158IU;31IU). For this purpose, this follow-up study was carried out in a subset of volunteers ( n = 98) originally enrolled in the dose-response study in 2009 and 46 non-vaccinated controls. Our results demonstrated that vaccinees, who had seroconverted following primary vaccination and had not been revaccinated, present similar neutralizing antibodies levels and YF-specific cellular memory, particularly CMCD4 and EMCD8 as compared to the reference full dose (27,476IU). Although, PRNT seropositivity rates were similar across subgroups (94, 82, 83, 94, 80, and 91%, correspondingly), only doses above 587IU elicited similar iterative proportion of seropositivity rates, calculated as a progressive decrease on seropositivity rates along time (89, 80, 80, and 91%, respectively) as compared to 158IU and 31IU (68 and 46%, respectively). Noteworthy were the strong positive correlations ("EMCD4,EMCD8" and "TNFCD8,IFNCD8") observed in most subdoses, except for 31IU. Major similarities underscored the preserved antibody titers and the outstanding levels of EMCD8, relevant correlates of protection for YF-specific immunity. These findings provide evidences to support the regular use of dose sparing strategy for YF vaccine in adults.

Objectives: First, to assess the psychometric properties of key questions included in a public sector evaluation of primary dental care in Brazil; and second, to evaluate the performance of dental teams in relation to these items., Methods: Secondary analysis of a national primary care dataset monitoring quality and access to dental care. Data were collected through face-to-face interviews with representatives of dental teams participating in the 'National Programme for Improving Access and Quality of Primary Care'. Twenty-three mandatory questions about the dentists' reported delivery of dental procedures were included in the analysis. Item Response Theory (IRT) modelling was applied to measure the psychometric properties of the instrument-level of difficulty and discrimination parameter of each item-and then to estimate dental team performance scores based on these parameters. Based on IRT, possible scores ranged from -4 to +4., Results: Three of the 23 mandatory items were removed due to poor internal consistency, resulting in a scale of 20 items for assessing dental team performance. The results showed variation in procedures delivered by the dental teams; whilst more than a half of the procedures were executed by at least 80% of the dental teams, those relating to dentures (partial/total) and frenectomy (lingual/labial) were performed by less than 30%. Amongst the 20 items included in the model, those related to partial/total dentures and oral cancer follow-up presented higher levels of difficulty and were less frequently provided. The items relating to the treatment of deciduous teeth and access to the dental pulp of permanent teeth had the highest discrimination parameters and, consequently, greater weight in the performance's score estimation; therefore, dental teams that did not perform these items had the lowest performance scores. In the present study, dental team performance scores ranged from -3.66 to +1.87 with a mean/median of -0.06/+0.01., Conclusion: The findings suggest that whilst the items within the instrument demonstrated some potential to discriminate between poor and very poor teams, they were ineffective in discriminating between poor and good teams. Whilst Brazilian dental teams perform many mandatory procedures, variation in the nature of their delivery of care requires further investigation to enhance service provision to the population., Competing Interests: The authors have declared that no competing interests exist.

The scope of this paper was to investigate the associations of disability in three domains (BADL, IADL and mobility) with cardiovascular diseases, diabetes and multimorbidity profile, among the elderly living in the Metropolitan Region of Belo Horizonte (MRBH). A cross-sectional study was conducted with a representative sample of 2,172 elderly persons (60 years and over). Disability, for each domain (BADL, IADL and mobility), was assessed as reporting great difficulty or need for help to perform at least one activity among those investigated, and self-reported diseases included arterial hypertension, myocardial infarction or angina, stroke, diabetes, and combinations of these diseases. Adjusted Poisson regression was used, and the attributable population fraction was also estimated. A major contribution of Cerebral Vascular Accidents (strokes) to disability in all domains was observed, especially BADLs, as well as the presence of infarction or angina in disability in IADLs and mobility, especially when combined with diabetes and hypertension. The multimorbidity profile can be used to identify vulnerable groups, which should be the target of prevention and rehabilitation, reducing the financial and social cost of this event among the elderly.

Objective: This study aims to describe the primary care services carried out by Oral Health Teams (OHTs) in Brazil, and to understand the nuances that lead to different levels of OHT performance., Material & Methods: A mixed-methods study with a sequential explanatory design was developed. In the quantitative phase, secondary data from a national survey (PMAQ-AB) was used to describe the work of 12,403 OHTs. Item response theory (IRT) was applied, to evaluate the psychometric qualities of 20 oral health questions from PMAQ-AB and to identify the performance of OHT. The quantitative results guided the selection of the qualitative sample. An extreme case sampling strategy was used (opposite results). OHTs were selected from Belo Horizonte metropolitan region in Brazil using scores measured by IRT. Data were collected through semi-structured interviews. Data analysis was conducted using deductive and inductive thematic analysis., Results: Quantitative results showed that there are OHT with high and low performance in Brazil. The IRT analysis showed that items related to prostheses and oral cancer tend to discriminate high-performance OHTs from other OHTs. Qualitative results deepened the understanding of accessing oral health services and found several access barriers, such as the insufficient number of OHTs for the population, and a very long waiting time for dental consultations other than urgency. The qualitative results confirmed that high-performance OHTs tend to emphasize oral cancer surveillance and deliver prostheses in PHC services., Conclusion: Despite the expansion of oral health in PHC in Brazil in recent years, OHTs still face many challenges such as: access barriers; failures in prevention, early diagnosis and follow-up of oral cancer cases; and insufficient rehabilitation with prostheses., Competing Interests: The authors have declared that no competing interests exist.

The study aimed to identify the cutoff points for inflammatory markers that best discriminate the occurrence of metabolic syndrome in community-dwelling older adults. Baseline data were used from the elderly cohort in the city of Bambuí, Minas Gerais State, Brazil. The target exposure was presence of metabolic syndrome, defined according to the Adult Treatment Panel III criterion, and the outcomes included the following inflammatory markers: cytokines (IL-1β, IL-6, IL-10, IL-12 e TNF), chemokines (CXCL8, CXCL9, CCL2, CXCL10, and CCL5), and C-reactive protein (CRP). Definition of the cutoff points for the inflammatory markers was based on the Classification and Regression Tree (CART) method. The associations between these markers and metabolic syndrome were estimated by logistic regression models, obtaining odds ratios and 95% confidence intervals, considering adjustment for confounding factors. Prevalence of metabolic syndrome was 49.1%, and IL-1β, IL-12, and TNF levels were not associated statistically with this exposure. After adjustment, presence of metabolic syndrome was associated with higher IL-6 and CRP levels and lower CXCL8 and CCL5. Significant associations were also observed with intermediate serum CXCL9 and CXCL10 levels. The combination of markers also showed a significant and consistent association with metabolic syndrome. In addition to demonstrating an association between metabolic syndrome and a wide range of biomarkers (some not previously described in the literature), the results highlight that this association occurs at much lower levels than previously demonstrated, suggesting that metabolic syndrome plays an important role in the inflammatory profile of the older adults.

Objective: Investigate whether the use of psychoactive drugs would be a predictor of incidence of functional disability among seniors living in community., Methods: It is a population-based longitudinal study, developed between January 1, 1997 and December 31, 2011, with older adults living in community. The association between the use of psychoactive drugs and the development of functional disability for instrumental (IADLs) and basic (BADLs) activities of daily living was tested using the extended Cox proportional hazards model, which considers the measure of exposure of interest throughout the follow-up period. The analyses were stratified by sex and adjusted by sociodemographic characteristics, health behavior and health conditions., Results: After multivariate adjustment, the use of two or more psychoactive drugs in the female stratum was associated with disability for both IADLs (HR = 1.58; 95%CI 1.17-2.13) and BADLs (HR = 1.43; 95%CI 1.05-1.94), the use of benzodiazepines was associated with disability for IADLs (HR = 1.32; 95%CI 1.07-1.62), and the use of antidepressants was associated with disability for both IADLs (HR = 1.51; 95%CI 1.16-1.98) and BADLs (HR = 1.44; 95%CI 1.10-1.90). In the male stratum, the use of antipsychotics was associated with disability for IADLs (HR = 3.14; 95%CI 1.49-6.59)., Conclusions: The study showed a prospective association between the use of psychoactive drugs and functional disability. These results indicate the need to carefully assess the prescription of psychoactive drugs for older adults and monitor their usage in order to detect damages to the health of users.

Introduction: Inflammation plays an important role in the aging process., Objective: This cross-sectional study aims to examine the association between inflammatory markers and hospitalizations among older adults, considering as potential confounding factors the predisposing and enabling factors for the use of health services and health conditions., Methods: We used data from 1,393 participants (≥ 60 years) in the baseline cohort from Bambuí. The markers assessed were ten cytokines and chemokines [interleukin (IL)-1, IL-6, IL-10, IL-12, tumor necrosis factor (TNF), CCL2, CCL5, CXCL8, CXCL9, and CXCL10]. The outcome variable was one or more hospitalizations in the preceding 12 months., Results: Elevated serum levels of IL-6 were significantly associated with hospitalizations [prevalence ratio (PR) = 1.38; confidence interval of 95% (95%CI) 1.02 - 1.87 and PR = 1.38; 95%CI 1.01 - 1.88 for the intermediate and highest tertiles, respectively]. High levels of CXCL9 were also independently associated with the outcome (PR = 1.38; 95%CI 1.01 - 1.89 and PR = 1.46; 95%CI 1.07 - 2.00, respectively). Other markers showed no statistically significant association with hospitalizations., Conclusion: Among the ten markers analyzed, only IL-6 and CXCL9 were associated with hospitalizations.

Objective: To describe the prevalence of receipt of pensions and associated factors in a nationally representative sample of the Brazilian population aged 50 years and over., Methods: We used data from 9,130 participants from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) baseline survey. The outcome variable was receipt of pensions from any source. The exploratory variables were age, gender, residence by region and by urban/rural area, household arrangements, schooling, household assets, perception of income sufficiency, age when started working, number of chronic diseases, and functional limitation. The analyses were based on the Poisson and binary logistic regressions., Results: The prevalence of the receipt of pension was 54.3%. In the multivariate analysis, the following factors showed statistically significant (p < 0.05) associations with the outcome: age [Prevalence Ratio (PR) = 2.59 and 3.24 for 60-69 and 70 years], rural residence (PR = 1.23 ), residence in the Northeast, South and Southeast compared to the North (PR ranging from 1.18 to 1.23), living arrangements (PR = 1.07 and 1.15 for living with one person and living alone), perception of income sufficiency (PR = 1.08 and 1.15 for sometimes and always), functional limitation (PR = 1.13) and having 1 and ≥ 2 chronic diseases (PR = 1,09 and 1,17). Negative association was observed for 5-8 years of education. No association between age when the individual started working and the outcome was observed. Younger participants (50-59 years old) with ≥ 2 diseases or functional limitation were 31% and 63% more likely to receive pensions, respectively; the strength of these associations declined with age., Conclusions: The results suggest that health conditions are important determinants of early retirement. Discussions to increase age to the retirement cannot be separated from those on improvements in the health conditions of the Brazilian population.

Objective: To examine the factors associated with hospital use and their frequency in a nationally representative sample of the Brazilian population aged 50 years or older., Methods: Data from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2015-2016, were used. Predisposing, enabling and need factors for the use of health services were considered. The analyzes were based on the Hurdle regression model and on estimates of population attributable risks., Results: Among 9,389 participants, 10.2% had been hospitalized in the previous 12 months. After adjusting for potential confounding variables, statistically significant associations (p < 0.05) were observed for need factors (previous medical diagnosis for chronic diseases and limitation to perform basic activities of daily living) and for enabling factors (living in a rural area and in the North and Midwest regions of the country). The analysis of population attributable risks (PAR) showed a hierarchy of the need factors for the occurrence of hospitalizations, with higher contributions by stroke (PAR = 10.7%) and cardiovascular disease (PAR = 10.0%), followed by cancer (PAR = 8.9%), difficulty to perform basic activities of daily living (PAR = 6.8%), depression (PAR = 5.5%), diabetes (PAR = 4.4% ) and hypertension (PAR = 2.2%)., Conclusions: Four of the major diseases associated with hospitalizations (stroke, cardiovascular disease, diabetes and hypertension) are part of the Brazilian list of primary care-sensitive hospitalizations. These results show that there is a window of opportunity to reduce unnecessary hospitalizations among older Brazilian adults through effective primary care actions.

Objective: To estimate the prevalence of adequate control of hypertension among older adults and to examine its association with predisposing and enabling factors and the need to use health services., Methods: The analysis was carried out with 4,148 participants (≥ 50 years) from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), who reported being hypertensive and using antihypertensive medication. Adequate control of hypertension was defined as systolic and diastolic blood pressure below 140 mmHg and 90 mmHg, respectively. The following exploratory variables were included: age, sex, health behaviors, and body mass index (predisposing factors); region of residence, rural or urban residence, education level, socioeconomic status of the household, and coverage by private health plan (enabling factors); and medical diagnosis of diabetes (need). The multivariate analysis was performed using Poisson regression and binary logistic regression., Results: The prevalence of adequate control of hypertension was equal to 51.1% (95%CI 48.5-53.6). After adjusting for potential confounders, we observed statistically significant associations (p < 0.05) for education level > 4 years [prevalence ratio (PR) = 1.12 in relation to the lowest level], highest quintile of the socioeconomic status (PR = 1.22 in relation to the lowest quintile), coverage by private health plan (PR = 1.13), residence in the South (PR = 1.19) and Midwest regions (PR = 1.20) in relation to the Southeast region, and obesity (PR = 1.10)., Conclusions: Half of the population studied had adequate control of hypertension. The improvement of this control is an important challenge, which should consider overcoming social and regional inequalities associated with it.

Objective: To assess the prevalence and factors associated with cost-related underuse of medications in a nationally representative sample of Brazilians aged 50 years and over., Methods: Among the 9,412 participants of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), 6,014 reported using at least one medication on regular basis and were included in the analysis. Underuse of medications was by stopping taking or reducing the number of tablets or the dose of any prescribed medication for financial reasons. The theoretical framework used for the selection of the exploratory variables included predisposing factors, enabling factors, and factors of need. Associations were tested by Poisson regression., Results: The prevalence of underuse of medications was 10.6%. After adjustments for relevant covariables, positive and statistically significant associations (p < 0.05) with the outcome were found for females [prevalence ratio (PR) = 1.39], sufficiency of the family income for expenses (PR = 1.74 for sometimes and PR 2.42 for never), frequency with which the physician explains about the disease and treatment (PR = 1.31 for rarely or never), number of medications used (PR = 1.39 for 2-4 and 1.53 for 5 or more), fair (PR = 2.02) and poor or very poor self-rated health (PR = 2.92), and a previous medical diagnosis of depression (PR = 1.69). Negative associations were observed for the age groups of 60-79 years (PR = 0.75) and 80 years and over (PR = 0.43), socioeconomic status of the household (PR = 0.70, 0.79, and 0.60 for the second, third, and fourth quartile, respectively), and private health plan coverage (PR = 0.79). There were no associations between hypertension and self-reported diabetes and underuse of medications., Conclusions: Cost-related underuse of medications is multidimensional and complex, and it covers socio-demographic characteristics, health conditions, and the use of health services. The explanation about the disease and its treatment to the patient and the expansion of the universal access to pharmaceutical care can minimize the risks of underuse.

Objective: To describe the prevalence of the practice of physical activity (PA) among older Brazilian adults and associated factors. In addition, potential effect modifiers of the association between PA and age were investigated., Methods: We have analyzed data from 8,736 participants (92.8%) aged 50 and older from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). Physical activity was measured using the short version of the International Physical Activity Questionnaire. The outcome variable was defined as at least 150 minutes of weekly activities in all domains. The exploratory variables were age, sex, education, ethnicity, marital status, number of chronic diseases and medical appointments, and knowledge about or participation in public programs that encourage physical activity. Logistic regression and estimates of predicted probabilities were performed., Results: The prevalence of recommended levels of physical activity was 67.0% (95%CI 64.3-69.5). Physical activity was associated with age [odds ratio (OR) = 0.97; 95%CI 0.96-0.98], higher educational level (OR = 1.27; 95%CI 1.11-1.45 for 4-7 years and OR = 1.52; 95%CI 1.28-1.81 for eight years or more), participants who were married/ in a long term relationship (OR = 1.22; 95%CI 1.08-1.38), and those who reported knowledge about (OR = 1.34; 95%CI 1.16-1.54) or participation in (OR = 1.78; 95%CI 1.34-2.36) a program aimed at the practice of physical activity. Women and those with lower educational level (p value for interaction < 0.05) reported lower physical activity levels., Conclusions: In addition to the association with marital status and health promotion programs, there were significant sex and educational level inequalities in physical activity decline later in life. These findings help the identification of groups more vulnerable to decreased physical activity levels with aging, as well as the planning of health promotion strategies, especially in older groups.

Background: Acute kidney injury (AKI) is associated with a significant increase in morbidity, mortality, and health care costs. In intensive care units (ICU), AKI is commonly multifactorial and frequently involves diverse factors, such as hypovolemia, sepsis, and the use of nephrotoxic drugs. We aimed to investigate drug therapy and other factors associated with the development of AKI in a Brazilian public hospital., Methods: This is a cross-sectional study involving critically ill patients at an ICU of a tertiary hospital. All data on sequential serum creatinine (S Cr ) level, glomerular filtration rate (GFR), and urine output were collected during ICU stay. The primary outcome was the occurrence of AKI assessed by the Acute Kidney Injury Network (AKIN) criterion. Sociodemographics, clinical data and drug therapy were considered as covariates. Factors associated with AKI were assessed using logistic regression., Results: Overall, 122 participants were included in the study. Median age was 46.0 (interquartile range, IQ = 29.0-69.0) years, with a predominance of men (58.2%). Mean number of prescribed drugs throughout ICU stay was 22.0 ± 9.4. The number of potentially nephrotoxic drugs ranged from two to 24 per patient. A total of 29 (23.8%) ICU patients developed AKI. In the AKI-group, patients were older and showed higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores at admission, higher rates of sedation, mechanical ventilation, and infection. More drugs in general and specifically more vasoactive drugs were prescribed for AKI group. Patients who developed AKI tended to have extended stays in the ICU and a lower probability of being discharged alive than patients with no AKI development. Model adjustments of logistic regression showed that the number of medications (OR 1.15; 95% CI [1.05-1.27]) was the only factor associated with AKI in this study. This association was independent of drug nephrotoxicity., Discussion: Intensive care is characterized by its complexity that combines unstable patients, severe diseases, high density of medical interventions, and drug use. We found that typical risk factors for AKI showed statistical association on bivariate analysis. The contribution of drug therapy in the occurrence of AKI in medical ICUs reinforces the need for prevention strategies focused on early recognition of renal dysfunction and interventions in drug therapy. These actions would help improve the quality of patient care and ensure progress towards medication safety., Competing Interests: The authors declare there are no competing interests.

Psychosocial factors appear to be associated with increased risk of disability in later life. However, there is a lack of evidence based on long-term longitudinal data from Western low-middle income countries. We investigated whether psychosocial factors at baseline predict new-onset disability in long term in a population-based cohort of older Brazilians adults. We used 15-year follow-up data from 1,014 participants aged 60 years and older of the Bambuí (Brazil) Cohort Study of Aging. Limitations on activities of daily living (ADL) were measured annually, comprising 9,252 measures. Psychosocial factors included depressive symptoms, social support and social network. Potential covariates included sociodemographic characteristics, lifestyle, cognitive function and a physical health score based on 10 self-reported and objectively measured medical conditions. Statistical analysis was based on competitive-risk framework, having death as the competing risk event. Baseline depressive symptoms and emotional support from the closest person were both associated with future ADL disability, independently of potential covariates wide range. The findings showed a clear graded association, in that the risk gradually increased from low emotional support alone (sub-hazard ratio - SHR = 1.11; 95%CI: 1.01; 1.45) to depressive symptoms alone (SHR = 1.52; 95%CI: 1.13; 2.01) and then to both factors combined (SHR = 1.61; 95%CI: 1.18; 2.18). Marital status and social network size were not associated with incident disability. In a population of older Brazilian adults, lower emotional support and depressive symptoms have independent predictive value for subsequent disability in very long term.

During immunosenescence many proinflammatory markers such as cytokines and chemokines are increased. This process called by Franceschi and colleagues as inflammaging is associated with chronic inflammation and the ethiology and pathophysiolgy of many ageing diseases as Alzheimer's and atherosclerosis. The knowledge of immune profile during ageing may provide some interventions that would improve the immune function in elderly and quality of life for old people. However, the identification of a group of potential biomarkers to monitor the ageing process is very difficult. In addition, most of the evidence evaluating immune biomarkers profile is based on data from older Caucasian adults. To our knowledge, no previous Latin American old population-based cohort has evaluated immunological parameters along the ageing process. The present work evaluated CXCL8, CXCL9, CXCL10, CCL2, CCL5, IL-1, IL-6, IL-12, TNF and IL-10 serum levels in 1494 older adults aged 60 to 95 from a population based ageing cohort in Brazil. Our data suggest that there is an increased positive predicted probability of participants to be a high producer of IL-6, CXCL8 and CXCL9. Moreover, results did not differ between men and women, except for CXCL10 that increased only in men. Results were not different in the adjusted model by many potential confounders, including African genomic ancestry. Together, these findings add novel insights about the immunologic aspects of ageing supported by a large population-based cohort study that provides evidences that corroborate with the inflammaging proposal and subsidize the establishment of biomarkers for monitoring the health status of aged population., (Copyright © 2017 Elsevier Inc. All rights reserved.)