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Identifying environmental factors and their relationship with epigenetic alterations is essential for understanding cancer, a leading cause of death. Currently, cancer screening and early detection development efforts are ongoing and epigenetics-based tests are one of the top choices as strategies. The understanding of how these alterations behave in cancer-free (CF) populations with well annotated data is essential. We randomly selected 601 saliva specimens from two Brazilian countrywide epidemiological studies POP-Brazil and SMESH. Extracted DNAs were sodium bisulfite converted and analyzed by Quantitative Methylation-Specific PCR (QMSP). Five genes previously reported as DNA methylation prone in cancer were selected (ITGA4, EDRNB, PAX5, p16, CCNA1). All participants were interviewed and provided sociodemographic and sexual behavior information as well as genital (gn) and oral biological samples. Variables were categorized and Fisher’s exact test was performed using SAS 9.4. Surprisingly, methylation in 3 cancer associated genes showed considerable frequencies in this CF group. DNA methylation was observed for EDNRB in 75/601 samples (12.5%), PAX5 in 55/601 (9.2%), and ITGA4 in 20/601 (3.3%). 12 samples displayed concomitant methylation on 2 of these 3 genes. p16 and CCNA1 methylation were only present in 1 sample each. Preliminary analyses suggest that specific genes methylation are observed with the presence of low (LR) and high-risk (HR) HPV types. EDNRB methylation groups with the presence of HR HPV type 16, 31, 39, 51, 58 and 59 from gn samples and LR types 6 and 42. ITGA4 methylation and HR HPV types 16 and 59 were detected in oral samples, and types 52, 56 and 68 in gn samples, as well as LR HPV types 40 and 42. In people with early onset of smoking, EDNRB and PAX5 seem to be more frequently methylated. The positivity of PAX5 was higher in participants who smoke, use alcohol and presented a positive diagnosis of syphilis and/or HIV. PAX5 methylation was more frequent in HR HPV 33, 58, 68 and 62 and LR type 6. Further analyses are ongoing. Our study shows methylation in cancer related genes in a CF population. The variables collected include some proven cancer risk factors and others still unknown, thus lead us to uncover directions to identify main cancer related players in a Brazilian population. The presence of cancer related alterations may indicate premalignant stages, exposure and lifestyle consequences, both at the same time or separately. In our pilot analysis, different types of HPV seem to correlate with epigenetic changes, this could bring attention to less studied HPV types and their role in carcinogenesis. Additional analyses of the current data and larger prospective, population-based studies, assessing the use of salivary DNA methylation in cancer-free and cancer groups of subjects are needed to explore the current findings and dissect the potential of saliva as a means of tracking cancer related changes. Citation Format: Ana Paula Muterle Varela, Dieila Giomo De Lima, Laura Palmieri, Juliana Comerlato, Fernando Hayashi Sant’Anna, Isabel C Bandeira, Marina Bessel, Pedro Isaacsson Velho, Eliana M. Wendland, Mariana Brait. HPV status and epigenetic profiling of saliva from a cancer-free population [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6528.

Background: To describe success and failure (S&F) after lumbar spine surgery in terms that are preciseand that are equally understandable across the entire health ecosystem. Methods: Back and leg pain (NPRS scale) and disability (Oswestry Disability Index –ODI) of patients operated were prospectively recorded before and 6 to 12 months after the procedure. Satisfaction was recorded in the postoperative period. Initially, patients were classified as Satisfied or Unsatisfied.Optimal cutoff values for disability and pain were estimated with ROC curves. Satisfied and Unsatisfied groups were subdivided into four categories based on a combination of satisfaction, disability and pain: Success, Incomplete success, Incomplete failure and Failure. These categories were translated into operational definitions with simple verbal terms, according to previously described norms of numeric-to-verbal equivalence. Results: 486 consecutive patients were recruited from May 2019 to February 2021, with a drop-out rate of 16.4%; Preoperative PROMs mean values were ODI 42.2 (+ 16.4), NPRS back 6.6 (+ 2.6) and NPRS leg 6.2 (+ 2.9) points; 19.3% were classified as Unsatisfied and cutoff values for disability (ODI=28; AUC 0.79) and pain (NPRS=6; AUC 0.79) were defined. Satisfied and Unsatisfied groups were further subdivided based on concordance or non-concordance with the discrimination cutoff values: Success (59.6%) - satisfied with pain and disability levels concordant (NPRS ≤5, AND ODI ≤27); Incomplete success (20.4%) - satisfied with pain and disability levels non-concordant (NPRS ≥6 AND/OR ODI ≥28); Incomplete failure (7.1%) – unsatisfied with pain and disability levels non-concordant (NPRS ≤5 AND/OR ODI ≤27); and Failure (12.4%) - unsatisfied with pain and disability levels concordant (NPRS ≥6 AND ODI ≥28). After that, groups were translated to: Success - patients are satisfied and present no or only mild to tolerable pain, and no or borderline disability; Incomplete Success – patients are satisfied despite levels of pain and/or disability worse than the ideal for success; Incomplete Failure – patients are not satisfied despite levels of pain and/or disability better than expected for failure; Failure – patients are unsatisfied and present moderate to severe pain and disability.Conclusion: It is possible to report S&F after surgery for degenerative disc disease of the lumbar spine with precise and meaningful operational definitions focused on the experience of the patient.

Background External genital lesions (EGL) are the most common sexually transmitted infections (STIs). We aimed to evaluate the prevalence, determinants and sex differences in EGL among young adults from Brazil. Methods Overall, 7694 participants (aged 16 to 25 years) underwent an interview, genital examination and sampling for HPV genotyping. Results The prevalence of EGL was 4.08% (234) and is more frequent in men (5.72%) than women (2.31%) (p p = 0.032) were positive for HPV infection and the types HPV6 and HPV11 were the most prevalent ones. Conclusion The prevalence of EGL in young adults was consistently high, and most cases were associated with genital HPV infection and STIs. Although men have a higher prevalence, both sexes share most genital lesion determinants. The promotion of sexual education and vaccination especially focus in young men, who are usually outside the targets of primary health care programmes, can prevent EGL in Brazilian young adults.

Objectives To investigate whether the presence of persistent self-reported oral lesions (PSOLs) is associated with sexual behaviors and with the presence of sexually transmitted infections (STIs) in individuals aged 16–25 years in the state capitals of Brazil. Materials and Methods Data from the POP-Brazil study were analyzed. An association analysis was performed by Poisson regression with the presence of PSOLs as the outcome. The exposure variables were the age at first sexual intercourse, the number of partners, oral sex practice, and aspects of condom use for model 1, and the presence of a self-reported STI or a positive rapid test for HIV/syphilis and the presence of genital human papillomavirus (HPV) for model 2. The results were adjusted for socioeconomic variables. Results The prevalence of PSOLs was 76% higher among individuals who had two or more sexual partners in the past year (p = 0.046) and 68% higher in those who reported not using condoms for contraception (p = 0.032). The group with HIV/syphilis or self-reported STI had a 140% higher PSOL prevalence (p = 0.003). Conclusions The self-report of oral lesions in adolescents and young adults may suggest risky sexual behavior and the presence of STI. Clinical relevance It is necessary to contextualize the reality of the young person to optimize oral health care.

RESUMO Objetivo: Descrever as características clínicas e os preditores de ventilação mecânica em pacientes adultos internados com COVID-19. Métodos: Conduziu-se um estudo de coorte retrospectiva com inclusão de pacientes hospitalizados entre 17 de março e 3 de maio de 2020, que tiveram o diagnóstico de infecção pelo SARS-CoV-2. As características clínicas e demográficas foram extraídas de registros em prontuário eletrônico. Resultados: Incluíram-se no estudo 88 pacientes consecutivos. A mediana da idade dos pacientes foi de 63 anos (IQR: 49 - 71); 59 (67%) pacientes eram do sexo masculino, 65 (86%) tinham educação universitária e 67 (76%) tinham, no mínimo, uma comorbidade. Dentre eles, 29 (33%) pacientes foram admitidos à unidade de terapia intensiva, 18 (20%) necessitaram de ventilação mecânica e nove (10,2%) morreram durante a hospitalização. O tempo mediano de permanência na unidade de terapia intensiva e o tempo mediano de ventilação mecânica foram, respectivamente, de 23 e 29,5 dias. Idade acima ou igual a 65 anos foi fator de risco independente para ventilação mecânica (RC: 8,4; IC95% de 1,3 - 55,6; valor de p = 0,02). Conclusão: Nossos achados descrevem a primeira onda de pacientes brasileiros hospitalizados por COVID-19. Em nossa população, idade foi o maior preditor de insuficiência respiratória e necessidade de ventilação mecânica. Abstract Objective: This study aims to describe the clinical characteristics and predictors of mechanical ventilation of adult inpatients with COVID-19 in a single center. Methods: A retrospective cohort study was performed and included adult inpatients hospitalized from March 17th to May 3rd, 2020, who were diagnosed with SARS-CoV-2 infection. Clinical and demographic characteristics were extracted from electronic medical records. Results: Overall, 88 consecutive patients were included in this study. The median age of the patients was 63 years (IQR 49 - 71); 59 (67%) were male, 65 (86%) had a college degree and 67 (76%) had at least one comorbidity. Twenty-nine (33%) patients were admitted to the intensive care unit, 18 (20%) patients needed mechanical ventilation, and 9 (10.2%) died during hospitalization. The median length of stay in the intensive care unit and the median duration of mechanical ventilation was 23 and 29.5 days, respectively. An age ≥ 65 years was an independent risk factor for mechanical ventilation (OR 8.4 95%CI 1.3 - 55.6 p = 0.02). Conclusion: Our findings describe the first wave of Brazilian patients hospitalized for COVID-19. Age was the strongest predictor of respiratory insufficiency and the need for mechanical ventilation in our population.

Made available in DSpace on 2022-04-29T08:46:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-07-01 Monocytes play a major role in the initial innate immune response to SARS-CoV-2. Although viral load may correlate with several clinical outcomes in COVID-19, much less is known regarding their impact on innate immune phenotype. We evaluated the monocyte phenotype and mitochondrial function in severe COVID-19 patients (n = 22) with different viral burden (determined by the median of viral load of the patients) at hospital admission. Severe COVID-19 patients presented lower frequency of CD14 + CD16- classical monocytes and CD39 expression on CD14 + monocytes, and higher frequency of CD14 + CD16 + intermediate and CD14-CD16 + nonclassical monocytes as compared to healthy controls independently of viral load. COVID-19 patients with high viral load exhibited increased GM-CSF, PGE-2 and lower IFN-α as compared to severe COVID-19 patients with low viral load (p < 0.05). CD14 + monocytes of COVID-19 patients with high viral load presented higher expression of PD-1 but lower HLA-DR on the cell surface than severe COVID-19 patients with low viral load. All COVID-19 patients presented decreased monocyte mitochondria membrane polarization, but high SARS-CoV-2 viral load was associated with increased mitochondrial reactive oxygen species. In this sense, higher viral load induces mitochondrial reactive oxygen species generation associated with exhaustion profile in CD14 + monocytes of severe COVID-19 patients. Altogether, these data shed light on new pathological mechanisms involving SARS-CoV-2 viral load on monocyte activation and mitochondrial function, which were associated with COVID-19 severity. Laboratory of Cellular and Molecular Immunology Universidade Federal de Ciências da Saúde de Porto Alegre Graduate Program in Health Sciences Universidade Federal de Ciências da Saúde de Porto Alegre Graduate Program in Biosciences Universidade Federal de Ciências da Saúde de Porto Alegre Institute of Tropical Pathology and Public Health Universidade Federal de Goiás Graduate Program in Pharmaceutical Science Health Science Institute Federal University of Pará/UFPA Exercise and Immunometabolism Research Group Postgraduation Program in Movement Sciences Department of Physical Education Universidade Estadual Paulista (UNESP), SP Dermatology Division Department of Medical Clinics Ribeirão Preto Medical School University of São Paulo, São Paulo Hospital Moinhos de Vento Department of Molecular and Comparative Pathobiology Johns Hopkins School of Medicine Graduate Program in Pediatrics Universidade Federal de Ciências da Saúde de Porto Alegre Exercise and Immunometabolism Research Group Postgraduation Program in Movement Sciences Department of Physical Education Universidade Estadual Paulista (UNESP), SP

Objectives To investigate the pattern of multiple human papillomavirus (HPV) infections and associated factors in young women who access the Brazilian public health care system to better understand the characteristics of multiple HPV infections, a critical issue in this era of multivalent vaccines. Methods This was a cross-sectional, multicenter study with sexually active unvaccinated women (16–25 years old) from 119 primary Brazilian healthcare centers between September 2016 and November 2017. Cervical samples were collected by trained health professionals, and HPV detection was performed in a central laboratory by Linear Array. Results Of the 5268 women, 33.00% (95% CI 31.07–34.92) had multiple infections. At least one type of high-risk HPV was present in 85.50% of all multiple infections. All HPV types were detected more frequently in association with other types than alone. Young individuals who were single or in a casual relationship and those who had more than one sexual partner in the past year were more likely to have multiple infections. Conclusions In this work, a high rate of multiple HPV infections among unvaccinated young adults tended to increase due to certain risk factors. Such data can provide insight for decision makers in the development of public policies regarding HPV prevention., Plain Language Summary Understanding the characteristics of multiple infections is critical in the era of HPV multivalent vaccines for the prevention of cervical carcinomas. Therefore, in this cross-sectional study, we aimed to investigate the pattern of multiple HPV infections and associated factors in 5,268 sexually active unvaccinated women (16–25 years old) who access the Brazilian public health care system. Cervical samples were collected by trained health professionals, and HPV detection was performed in a central laboratory by Linear Array. A total of 33.00% (95% CI 31.07–34.92) had multiple infections (60.43% of the HPV-positive sample). The number of HPV types in a multiple infection ranged from 2 to 14 different types. The viral types more frequently identified were HPV 16 and 52. All HPV types were detected more frequently in association with other types than alone. The incidence of multiple infections was 1.29 times higher in single than in married or cohabitating participants. Women who had two or more partners in the last year also had higher rates of multiple infections than those who had fewer than two sexual partners. In conclusion, a high prevalence of multiple infections prior to the national HPV immunization program was observed, especially with the increase in less safe behavior factors.

Background Prophylactic HPV vaccination has been recommended for the prevention of cancers caused by HPV infection. Nevertheless, may be reduce the oral HPV prevalence, the putative precursor to oral squamous cell carcinoma. This study aimed to report the prevalence of oral HPV among vaccinated and unvaccinated women and men aged 16 to 25 years who use the public health system. Methods POP-Brazil study is a cross-sectional, multicentric survey. Participants were recruited from 119 public primary care units distributed throughout all 27 capitals of Brazil. Trained health professionals applied a face-to-face interview. Oral sample was collected through mouthwash and gargle cycles. HPV genotyping was performed in a central lab using the Roche PCR-based Linear Array genotyping test. Sampling weights by sex and age were applied to the data. Results Oral HPV samples were collected from 5,684 participants; 613 (8.93%) vaccinated against HPV, in which 86.57% were women. Among women, the overall HPV prevalence was significantly lower in those vaccinated [0.43% (95% CI, 0.03-0.83)] than unvaccinated [1.65% (95% CI, 0.97– 2.33] (p Conclusion Vaccinated individuals had a lower prevalence of overall oral HPV besides the null infection by 6, 11, 16, and 18 HPV types showing another benefit of this cancer prevention measure. Due to the low prevalence of oral HPV, type specific analysis demand higher number of positive participants.

Background Psychoactive substances are increasing within the young population enhancing exposure to sexual risks, violence and mortality by preventable causes. Moreover, the use of these substances at this stage of life can be a predictor of abuse in adult live. Thus, this study aims to examine the patterns of drugs use in Brazilian young adults. Methods A cross sectional study was performed in all Brazilian capitals between September-2016 to December-2017. 8581 participants aged 16 to 25 years answered a structured interview with socio and behavioral questions. The sample was weighted in each capital by age range and sex. Results Alcohol (71.6%), cannabis (27.4%), and cocaine (9.9%) were the most common addictive substances experienced once in life in the sample. The regular use in the past 12 months was reported in 40.5%, 12.5% and 2.5%, respectively. Significant differences were observed between men and women in regular use of alcohol (48.7% and 32.5%, p Conclusions Brazilian youth showed high rates of psychoactive substances use mainly alcohol and cannabis. Thus, knowledge about the patterns of alcohol and drugs use in this population is important to direct actions and prevent associated risks. Key message High rates of alcohol and cannabis use are reported in Brazilian youth population.

Background The transition of adolescence to adulthood involves a variety of physical, behavioral and social transformations including try tobacco product. Understand smoking at this stage is important to tobacco control. Therefore, we aimed to analyze the use of cigarette smoking in Brazilian youth. Methods Nationwide study including participants aged 16 to 25 years from all Brazilian capitals between September/2016-December/2017. A standardized questionnaire with behavioral questions was applied by trained health care professionals. The sample was weighted in each capital by age range and sex. Results Of 8,581 participants (50.8% women), 15.1% were smokers and 20% former smokers. The average age of first use was 15.5 years. Smoking in men was higher than women (20.1% vs. 10.3%, p Conclusions In this study be a man, have low education, a homosexual and alcohol use is associated to smoking among young. These findings are important for creation of policies to combat and prevent smoking in this population. Key message Smoking data among young people is important to direct new heath policies.

BACKGROUND The credibility of a study and its internal and external validity depend crucially on the quality of the data produced. An in-depth knowledge of quality control processes is essential as large and integrative epidemiological studies are increasingly prioritized. OBJECTIVE This study aimed to describe the stages of quality control in the POP-Brazil study and to present an analysis of the quality indicators. METHODS Quality assurance and control were initiated with the planning of this nationwide, multicentric study and continued through the development of the project. All quality control protocol strategies, such as training, protocol implementation, audits, and inspection, were discussed one by one. We highlight the importance of conducting a pilot study that provides the researcher the opportunity to refine or modify the research methodology and validating the results through double data entry, test-retest, and analysis of nonresponse rates. RESULTS This cross-sectional, nationwide, multicentric study recruited 8628 sexually active young adults (16-25 years old) in 119 public health units between September 2016 and November 2017. The Human Research Ethics Committee of the Moinhos de Vento Hospital approved this project. CONCLUSIONS Quality control processes are a continuum, not restricted to a single event, and are fundamental to the success of data integrity and the minimization of bias in epidemiological studies. The quality control steps described can be used as a guide to implement evidence-based, valid, reliable, and useful procedures in most observational studies to ensure data integrity. INTERNATIONAL REGISTERED REPORT RR1-10.2196/31365

Background In addition to screening by Pap smears, vaccination against human papillomavirus (HPV) can dramatically reduce cervical cancers caused by the virus. The acceptance of HPV vaccination is directly related to HPV knowledge. This research aimed to evaluate knowledge about HPV and vaccination among men and women aged 16–25 years who use the public health system in Brazil. Methods This was a cross-sectional, multicenter study of sexually active young adults recruited from 119 primary care units between 2016 and 2017. All participants answered a face-to-face standardized questionnaire. Results Of 8581 participants, the mean percentage of correct answers about HPV and vaccination was 51.79% (95% CI 50.90-52.67), but 75.91% (95% CI 74.13-77.69) had awareness of the HPV vaccination. Women answered a higher proportion of questions correctly than men did (p = 0.0003). Lower education level was the variable that most interfered with knowledge. The best information sources for knowledge were both health professionals and the media (1.33%, 95% CI 1.03-1.70). Conclusions The results emphasize the importance of educational programs about HPV and vaccination among young adults, especially in socially disadvantaged populations. These findings can help to increase the vaccination rate in the country and to stimulate public health policies., Highlights • This is the first nationwide study of young adults who use the public health system. • Lower education level was the variable that most interfered with knowledge. • The best information source was the combination of health professionals and the media. • These results can complement surveillance data on increasing the vaccination rate.

Aims of the study: To investigate the effect of clinical predictors on admission and the set of therapeutic interventions on length of stay, ICU admission, need for MV and mortality. Methods used to conduct the study: Retrospective cohort of inpatients with RT-PCR positive for COVID-19 from March to July 2020. Multivariate models were used to assess risk for ICU admission, need for MV and hospital mortality. Logistic regression analysis was conducted to examine factors associated with the results. Results of the study: 459 patients were enrolled (median age 60.0 years old). For patients treated with AZM-Corticosteroid (46.8%) the risk for ICU admission was 0.17 (OR; 95%CI 0.05-0.57), for MV 0.16 (OR; 95%CI 0.04-0.74) and for mortality 0.16 (OR; 95%CI 0.03-0.91). AZM-Corticosteroid also decreased the length of stay in 1.5 day. AZM-Corticosteroid and anticoagulation when indicated (17.2%), also reduced the ICU stay in 1.5 and MV in 4 days. When included HCQ, the benefits were lost and the times increased. Age >65 years, presence of up one comorbidity, pulmonary involvement more than or equal to 50%, saturation 1,250 ng/mL and CRP >8.0 mg/dL at admission were clinical predictors for death. HFNC was able to prevent intubation by 38.1%. Conclusion drawn from the study and clinical implications: AZM-Corticosteroids and anticoagulation represented a favorable combination for inpatients with COVID-19, reducing length of hospitalization, risk of MV and mortality. HCQ did not yield benefits to combination therapy and we do not support its use for inpatients. HFNC was able to prevent intubation in one third of patients. Already on admission some clinical predictors may help to estimate a higher risk of poor evolution.

Highlights • This study included a nationwide sample of Brazilian young adults of both sexes with a diversity of social classes and skin colors. • HPV (overall and high-risk) affects individuals of all socioeconomic classes in Brazil. • The results highlight the importance of public health actions related to HPV reaching all socioeconomic classes., The aim of this study is to evaluate genital human papillomavirus (HPV) infection according to socioeconomic categories in Brazil. This cross-sectional, nationwide study included 7,694 sexually active women and men aged 16–25 years. Individuals of all socioeconomic groups in all 26 Brazilian capitals and the Federal District were enrolled through public primary care units between September 2016 and November 2017. All participants answered a standardized interview administered by trained primary care health professionals. Socioeconomic class was analyzed using a pricing classification system for the Brazilian public that divides the market exclusively in terms of economic class based on the ownership of assets and the education level. Cervical samples were obtained using a Digene® HC2 DNA Collection, and penile/scrotum samples were obtained using a wet Dacron swab. HPV typing (overall and high-risk) was performed in a central lab. Of the 7,694 participants (47.85% women), 17.92% belonged to class A-B, 56.08% to class C, and 26.00% to class D-E. The prevalence of overall HPV was similar among the social classes: 51.16% for classes A-B, 53.39% for class C, and 55.47% for classes D-E (P = 0.479). Similar results were found for high-risk HPV. After adjustments, the presence of HPV in individuals with a brown skin color belonging to classes A-B was 57.00% higher [prevalence ratio 1.57 (95%: 1.23, 2.01)] than that in whites and had no impact on the other social classes. In conclusion, HPV infection affects all socioeconomic classes in Brazil, evidencing the importance of offering the HPV vaccine to the entire population.

RESUMO Objetivo: Descrever as características clínicas e os preditores de ventilação mecânica em pacientes adultos internados com COVID-19. Métodos: Conduziu-se um estudo de coorte retrospectiva com inclusão de pacientes hospitalizados entre 17 de março e 3 de maio de 2020, que tiveram o diagnóstico de infecção pelo SARS-CoV-2. As características clínicas e demográficas foram extraídas de registros em prontuário eletrônico. Resultados: Incluíram-se no estudo 88 pacientes consecutivos. A mediana da idade dos pacientes foi de 63 anos (IQR: 49 - 71); 59 (67%) pacientes eram do sexo masculino, 65 (86%) tinham educação universitária e 67 (76%) tinham, no mínimo, uma comorbidade. Dentre eles, 29 (33%) pacientes foram admitidos à unidade de terapia intensiva, 18 (20%) necessitaram de ventilação mecânica e nove (10,2%) morreram durante a hospitalização. O tempo mediano de permanência na unidade de terapia intensiva e o tempo mediano de ventilação mecânica foram, respectivamente, de 23 e 29,5 dias. Idade acima ou igual a 65 anos foi fator de risco independente para ventilação mecânica (RC: 8,4; IC95% de 1,3 - 55,6; valor de p = 0,02). Conclusão: Nossos achados descrevem a primeira onda de pacientes brasileiros hospitalizados por COVID-19. Em nossa população, idade foi o maior preditor de insuficiência respiratória e necessidade de ventilação mecânica.

Introduction: The transition from adolescence to adulthood involves a variety of physical, behavioral, and social transformations, often including tobacco use. Because understanding smoking at this stage is important for tobacco control, we aimed to analyze the prevalence of cigarette smoking in the Brazilian youth population. Methods: This study included participants aged 16–25 years from all Brazilian capitals. A standardized questionnaire was administered by trained healthcare professionals to collect information about sociodemographic status, sexual behavior, and tobacco use. The samples from each capital were weighted by age range and sex. Results: Of the 8,581 participants, 15.1% were current smokers, and 20.0% were former smokers; the average age at first tobacco use was 15.5 years. The prevalence of smoking in men was higher than that in women (20.1 vs. 10.3%, p < 0.01). Education level was associated with current smoking and former smoking. Participants with an elementary education level had a higher smoking prevalence (PR: 5.84, 95%, CI: 4.29–7.95) than those with a secondary education (PR: 2.19, 95% CI: 1.63–2.93) and those with higher education. Those without current partners (PR: 1.27, 95% CI: 1.03–1.56) also had a higher prevalence of smoking than those with partners, and participants who had a previous same-sex sexual experience smoked more (PR: 2.29, 95% CI: 1.78–2.96) than those who did not. In addition, regular use of alcohol was associated with higher prevalence of cigarette smoking (PR: 5.65, 95% CI: 4.03–7.90) than a lack of alcohol consumption. Skin color and socioeconomic class did not exhibit significant relationships with tobacco use patterns. Conclusions: Smoking was associated with education level regardless of social class, and some specific behaviors associated with a same-sex sexual experience were associated with a higher prevalence of smoking. These findings are important for formulating policies and directing actions to combat and prevent smoking among young populations.

We examined human papillomavirus (HPV) vaccine effectiveness in a nationwide sample of women aged 16 to 25 years who utilized the public health system in Brazil. This was a cross-sectional, multicentric survey conducted between September 2016 and November 2017 (POP-Brazil Study). A total of 5,945 young adult women were recruited from 119 public primary care units from all 27 federative units of Brazil by trained health professionals. The participants participated in a face-to-face interview and provided biological samples for genital HPV analysis. HPV genotyping was performed using a Linear Array HPV genotyping test in a central laboratory. Sampling weights were applied to the data. Overall, 11.92% (95% CI 10.65, 13.20) of the participants reported having been vaccinated. The frequency of vaccination was highest in 16- to 17-year-old women, with a decreasing vaccination rate with increasing age, and vaccinated women were more likely to belong to the high socioeconomic status group. The use of a quadrivalent vaccine decreased the HPV types 6, 11, 16, and 18 by 56.78%, from 15.64% in unvaccinated women to 6.76% in vaccinated women (P < 0.01), even after adjustment for age. Those who received the vaccine had lower HPV 16 (2.34% in vaccinated vs 8.91% in unvaccinated, P < 0.01) and 6 rates (2.06% vs 5.77%, P < 0.01). Additionally, a higher rate of high-risk HPV types other than HPV 16 and 18 (40.47% in vaccinated vs 32.63% in unvaccinated, P < 0.01) was observed. In conclusion, the results of this study support the effectiveness of HPV vaccination in Brazil. Continuous surveillance must be assured to monitor the HPV infection rate in the vaccination era.

INTRODUCTION AND OBJECTIVE:Despite comparable outcomes of the different treatment options of localized prostate cancer (LPC), the side effects, the impact on quality of life (QoL) and the cost are ...

IntroductionHuman papillomavirus (HPV) is the most common sexually transmitted infection and is associated with several types of cancer. The number of cases of HPV-associated head and neck squamous cell carcinomas (HNSCCs), especially oropharyngeal carcinomas, has increased significantly in recent years despite decreased tobacco smoking rates. Currently, no data concerning the risk factors and prevalence of HPV in HNSCC patients in all regions of Brazil are available, making it difficult to promote advances in this field of public health. Therefore, our goal is to determine the impact of infection by HPV, including HPVs with different genotypes, on head and neck cancer and the risk factors associated with the development of head and neck cancer in all regions of Brazil.Methods and analysisThis is a case–control study that will include 622 patients and 622 controls from all regions of Brazil. A questionnaire will be applied to gather information on sociodemographic, behavioural and health factors. Oral, cervical or penile/scrotal, and anal specimens and serum samples will be collected from all participants. Formalin-fixed paraffin-embedded tissue from tumour biopsies will be analysed only in the case group. Molecular and serological analyses will be performed to evaluate the presence and role of HPV in the development of head and neck cancer.Ethics and disseminationThis project was approved by the research ethical committee of the proposing institution (Hospital Moinhos de Vento, number 2.852.060). Ethical approval from the collaborators is currently under evaluation and is not yet complete. The results of this study will be presented at meetings with the Brazilian Ministry of Health through technical reports and to the scientific community at national and international events, with subsequent publication of scientific articles.

Current studies have shown that fast weight gain may be more important than body mass index on the incidence of breast cancer. The aim of this study was to evaluate the association between body weight and breast cancer.This was a case-control study nested in a cohort of a breast cancer mammography screening program in Southern Brazil. A trained investigator administered a standardized interview to collect sociodemographic and clinical data, and body weight history (weight at menarche, at marriage, at first and last pregnancy, and at menopause). Current anthropometric measurements were also made.Fifty-seven women with cancer (66.7% postmenopausal) and 159 controls were included. Current age (60.3 ± 10.4 vs. 55.8 ± 8.4 years, P .01), marital status (49.1% vs. 64.8% with a partner, P = .03), and physical activity (48.2% vs. 32.3% sedentary, P = .01) were significantly different between cases and controls, respectively. Odds ratio showed that age and current waist circumference were associated with postmenopausal cancer. No difference was found in relation to body weight at different stages of life.Women with social vulnerability recruited at a mammography screening program in Southern Brazil showed a large weight gain during life, but no significant differences were found in body weight between women with or without breast cancer.

IntroductionHuman papillomavirus (HPV) infection is transmitted through skin-to-skin contact, and vaginal and anal sex are the most common transmission routes. Sex workers and men who have sex with men (MSM) are more exposed to the virus, and therefore, a higher frequency of this infection would be expected. The prevalence of HPV infection types and the forms and factors of transmission must be investigated to control infection-related outcomes. This protocol study will be the first nationwide study with a uniform methodology to evaluate HPV prevalence of and infection types among sex workers and MSM in Brazil.Methods and analysisThis multicentre cross-sectional study will be conducted with a respondent-driven sampling method to recruit 1174 sex workers and 1198 MSM from all regions of Brazil. The study will consist of preliminary interviews to verify the eligibility criteria and characterise the network size as well as a second questionnaire to obtain sociodemographic, behavioural and sexual information. Specimens from the oral cavity and anal and cervical or penile/scrotal sites will be collected. All HPV samples will be processed in a certified central laboratory. Other sexually transmitted infections will be evaluated by interview and by rapid testing for HIV and syphilis. Strict quality control will be conducted using different procedures, including the training and certification of the health professionals responsible for acquiring data and monitoring visits.Ethics and disseminationThe project was approved by the research ethics committee of the main institution and the corresponding ethics committees of the recruitment sites. Due to the literature gap on the sexual health of sex workers and MSM and the intense stigma surrounding these populations, a critical analysis of the study results will contribute to epidemiological knowledge and will be useful for the development of strategies against virus morbidities.

7 p., 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 MSand impaired leftventricularglobal longitudinalstrain(GLS)andtheroleofeachMScriteria inthisassociation. Methods: We analyzed a random sample of the Brazilian Longitudinal Study of Adult Health (ELSABrasil) 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., Introducción y objetivos: La disfunción sistólica subclínica es uno de los mecanismos propuestos para el aumento del riesgo cardiovascular asociado con el síndrome metabólico (SM). Este estudio investigó la asociación entre SM y deterioro del strain longitudinal global (SLG) del ventrículo izquierdo y el papel de cada criterio de SM en esta asociación. Métodos: Se analizó una muestra aleatoria del Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil) después de excluir a aquellos con cardiopatía prevalente. Resultados: De los 1.055 participantes que cumplían los criterios de inclusión (el 53% mujeres; edad, 52 - 9 años), 444 (42%) reunían criterios de SM. Aquellos con SM presentaron un SLG más reducido (–18,0 - 2,5%) que aquellos sin SM (–19,0 - 2,4%; p < 0,0001). En los modelos de regresión lineal múltiple, el SM se asoció con SLG ma´ s reducido despue´ s de ajustar por varios factores de riesgo (diferencia de SLG, 0,86%; p < 0,0001), incluso después de incluir el índice de masa corporal. Las TP ajustadas para los participantes con SLG reducido evaluados con 3 puntos de corte (1, 1,5 y 2 desviaciones estándar) fueron más altas entre aquellos con SM que sin este: SLG –16,1% (TP = 1,76; IC95%, 1,30-2,39); SLG –14,8% (TP = 2,35; IC95%, 1,45-3,81), y SLG – 13,5% (TP = 2,07; IC95%, 0,97-4,41). Después de incluir el índice de masa corporal en los modelos, estas asociaciones se atenuaron; lo que indica que la obesidad puede mediar, al menos en parte, estas asociaciones. En los análisis de regresión cuantílica, la circunferencia de cintura aumentada fue el único componente del SM que se halló independientemente asociado con el SLG a lo largo de todo el rango de valores. Conclusiones: El SM se asocia de manera independiente con alteración del SLG. Entre los criterios de SM, la obesidad central describe mejor la relación entre el trastorno metabólico y la función cardiaca.

Objectives This study aimed to report the national prevalence of oral HPV infection among unvaccinated women and men aged 16–25 years who utilized the public primary care services. Methods POP-Brazil is a cross-sectional, multicentric, nationwide survey conducted between September 2016 and November 2017. Recruitment was based in 119 public primary care practices in 26 state capitals and the Federal District of Brazil. Trained health professionals conducted face-to-face interviews. Oral samples were collected with mouthwash and gargle cycles. Genotyping was performed using the Roche PCR-based linear array genotyping test. Sampling weights by sex and age were applied. Results Valid oral HPV samples were collected from 5071 (96.88%) participants; 4005 women and 1066 men. Mean participant age was 21.63 years. Overall HPV prevalence was 1.69% (n = 73, 95% CI 1.05–2.32). Thirty individuals presented at least one high-risk HPV type [0.57% (95% CI, 0.29–0.85)]. There were no associations between age, sex, sociodemographic characteristics, drug use or sexual behavior and oral HPV prevalence. Conclusion The prevalence of oral HPV infection in Brazilian teenagers and young adults is low, with no sociodemographic or behavioral correlates.

Serological assays emerged as complementary tools to RT-PCR in the diagnosis of SARS-CoV-2 as well as being needed for epidemiological studies. This study aimed to assess the performance of a rapid test (RT) compared to that of serological tests using finger prick blood samples. A total of 183 samples were evaluated, 88 of which were collected from individuals with negative RT-PCR and 95 from positive RT-PCR individuals. The diagnostic performance of RT (WONDFO®) and LUMIT (PROMEGA®) were compared to that of ELISA (EUROIMMUN®) for detecting antibodies against SARS-CoV-2 according to time from symptoms onset. The IgG antibody tests were detected in 77.4% (LUMIT), 77.9% (RT), and 80.0% (ELISA) of individuals. The detection of antibodies against SARS-CoV-2 increases in accordance with increasing time from symptoms onset. Considering only time from symptoms onset &gt, 21 days, the positivity rate ranged from 81.8 to 97.0% between the three tests. The RT and LUMIT showed high agreement with ELISA (agreement = 91.5%, k = 0.83, and agreement = 96.3%, k = 0.9, respectively) in individuals who had symptoms 15 to 21 days before sample collection. Compared to that of the ELISA assay, our results show sensitivity ranged from 95% to 100% for IgG antibody detection in individuals with symptoms onset between 15 and 21 days before sample collection. The specificity was 100% in individuals with symptoms onset &gt, 15 days before serological tests. This study shows good performance and high level of agreement of three immunoassays for the detection of SARS-CoV-2 antibodies.