Evaluation of social inclusion in Brazilian adult women with epilepsy: Perception of stigma and quality of life.

Epilepsy is a chronic disease characterized by recurrent epileptic seizures that can affect the perception of stigma and compromise the quality of life of those living with it. In addition, sociodemographic factors such as employment and maintaining a job, education, and the autonomy to drive vehicles are often impaired. OBJECTIVE: To assess the social inclusion of adult women with epilepsy in relation to the perception of stigma and quality of life, and the clinical aspects of the disease. METHODOLOGY: Data from 70 adult Brazilian women with epilepsy regarding aspects related to their social inclusion were verified. Such data were linked to clinical aspects and scores from the questionnaires: Quality of Life in Epilepsy Inventory 31 (QOLIE-31) and the Epilepsy Stigma Scale (ESS), with a significance level of p < 0.05. RESULTS: Average age of 45.5 years, 40 (57.1 %) women were divorced/single/widowed, 31 (44.3 %) women had less than 10 years of formal education, 32 (45.7 %) women had no income, and 57 (81.4 %) did not have a driver's license. The age at the time of the first seizure was 18 years, the seizures were focal in 46 (65.7 %) cases, and 26 (37.1 %) cases were seizure-free in the last year. A high number of women reported that the diagnosis of epilepsy negatively influenced aspects of autonomy such as the possession of a driver's license and going out alone. Longer duration of epilepsy was associated with lower education, not having children, and lower scores on the QOLIE-31. Higher scores on the QOLIE-31 were correlated with lower frequency of seizures and with the age at the time of the first seizure. Values in the dimension - energy and fatigue of the QOLIE-31 were significantly lower in the group with less independence compared to the other two groups with more independence, in latent class analyses (ANOVA, adjusted for age 42.1 ± 35.6 vs 57.2 ± 28.4 vs 73.9 ± 23.8, p = 0.0295). DISCUSSION: Clinical aspects of epilepsy and having a partner, autonomy, and independence such as driving vehicles are factors that contribute to social inclusion and to the perception of a better quality of life for adult women with epilepsy. CONCLUSION: It was observed that having a partner, autonomy, and independence such as driving vehicles are factors that contribute to social inclusion and to the perception of a better quality of life for adult women with epilepsy.

Modeling the potential impact of a sugar-sweetened beverage tax on ischemic heart disease and stroke in Brazil.

BACKGROUND: A high intake of sugar-sweetened beverages (SSBs) is associated with the risk of several chronic diseases, including ischemic heart disease (IHD) and stroke. This study aimed to model the impact of a 20% tax on all SSBs for IHD and stroke among Brazilian adults. METHODS: This was an ex-ante risk comparative study. The model applied a 20% tax on SSBs and projected the incidence, prevalence and mortality of IHD and stroke over a 20-year period (2019-39). Using data on consumption, previously published cross- and own-price elasticities of SSBs, and relative risk, we estimated changes in IHD and stroke burden. RESULTS: Our model predicts that a 20% SSB tax may reduce new cases of IHD by ~13%, especially among women, and avert ~8% of the deaths attributable to IHD over 20 years. These results represent a decrease of 19 543 new cases and 8466 and 7274 fewer deaths in the period for men and women, respectively. Estimates of reduction in incidence, prevalence and deaths from stroke were not significant over 20 years. CONCLUSIONS: Even under conservative assumptions, our study found that a small reduction in SSB consumption led to a substantial decrease in IHD incidence and mortality in Brazil.

Cesarean section rates according to the Robson Classification and its association with adequacy levels of prenatal care: a cross-sectional hospital-based study in Brazil.

BACKGROUND: The rate of Cesarean section (CS) deliveries has been increasing worldwide for decades. Brazil exhibits high rates of patient-requested CS deliveries. Prenatal care is essential for reducing and preventing maternal and child morbidity and mortality, ensuring women's health and well-being. The aim of this study was to verify the association between the level of prenatal care, as measured by the Kotelchuck (APNCU - Adequacy of the prenatal care utilization) index and CS rates. METHODS: We conducted a cross-sectional study based on data from routine hospital digital records and federal public health system databases (2014-2017). We performed descriptive analyses, prepared Robson Classification Report tables, and estimated the CS rate for the relevant Robson groups across distinct levels of prenatal care. Our analysis also considered the payment source for each childbirth - either public healthcare or private health insurers - and maternal sociodemographic data. RESULTS: CS rate by level of access to prenatal care was 80.0% for no care, 45.2% for inadequate, 44.2% for intermediate, 43.0% for adequate, and 50.5% for the adequate plus category. No statistically significant associations were found between the adequacy of prenatal care and the rate of cesarean sections in any of the most relevant Robson groups, across both public (n = 7,359) and private healthcare (n = 1,551) deliveries. CONCLUSION: Access to prenatal care, according to the trimester in which prenatal care was initiated and the number of prenatal visits, was not associated with the cesarean section rate, suggesting that factors that assess the quality of prenatal care, not simply adequacy of access, should be investigated.

Acupuncture, seizure frequency, and quality of life in temporal lobe epilepsy.

OBJECTIVE: To assess seizure frequency and quality of life (QOL) in a group of adults with temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) before and after 10 weeks of systemic acupuncture sessions and compare the results with a group of patients with TLE-HS not undergoing acupuncture. METHODS: The Quality of Life in Epilepsy Inventory (QOLIE-31) and the initial and final seizure frequency of 26 adult patients with TLE-HS who underwent acupuncture sessions for 10 consecutive weeks were assessed. The data were compared to those of 26 patients with TLE-HS not submitted to acupuncture, with p < 0.05. RESULTS: There was a clinically significant effect in reducing the mean number of seizures per month in the follow-up period of patients submitted or not to acupuncture (no intervention group and intervention group, effect size: -0.94 and -1.01, respectively). In the last four weeks of follow-up, there was a significant difference between the no intervention and intervention groups (0.5 [0-2] and 0 [0-4]; p = 0.018). When using minimally important change (MIC) threshold data for the QOLIE-31 between the final and initial scores, with the Cantril Ladder Scale as anchoring, it was observed that, in the intervention group, large clinically significant effects were seen for all dimensions, except for cognitive function, medication effect, and social function, which presented medium effects. In the follow-up, the variation of the QOLIE-31 scores was positive for both groups; however, it was higher in all dimensions in the intervention group, indicating a better QOL. CONCLUSION: There was a reduction in the mean number of seizures per month in all patients during the follow-up period. Acupuncture significantly reduced the number of seizures in the intervention group in the final phase of the study. QOL improvements occurred in all patients, however, more significantly in the intervention group.

Taxing sugar-sweetened beverages as a policy to reduce overweight and obesity in countries of different income classifications: a systematic review.

OBJECTIVE: To evaluate the potential impact of sugar-sweetened beverage (SSB) taxes on overweight and obesity prevalence in countries of different income classifications. DESIGN: Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO number CRD42020161612). Five databases (Cochrane Library, Embase, LILACS (via Virtual Health Library) and MEDLINE (via PubMed), and Web of Science were searched, from January 2009 to December 2019. Articles that reported changes in purchases, sales, intake, body weight, BMI, overweight and/or obesity prevalence due to a tax on or price change in SSB were included. SETTING: Studies conducted in countries of different income classifications. PARTICIPANTS: The search yielded 8349 articles of which 21 met inclusion criteria. RESULTS: Among the sixteen studies selected, only two did not show that consumption, sales and purchase decreased as the price of SSB increased. In eight of the thirteen studies selected, a positive effect of an SSB tax on decreasing overweight and obesity prevalence was expected. It is estimated that a 20 % taxation on SSB would result in a greater decrease in the prevalence of overweight and obesity compared to a 10 % rate. Studies with no significant effect of taxing on sales, purchases, consumption and prevalence of obesity were from high-income countries, while significant effects of taxing on reducing purchase, consumption and/or obesity prevalence were found in studies from upper-middle- and middle-income countries. CONCLUSION: A high SSB tax might be an effective fiscal policy to decrease purchase and consumption of SSB and reduce overweight/obesity prevalence, especially if the tax were specific for beverage volume.

Identifying Overweight and Obesity in Brazilian Schoolchildren, 2014.

CONTEXT: For any intervention in a population, we need to understand population characteristics and needs. The School Health Program (PSE) is a Brazilian national proposal for the improvement of schoolchildren's quality of life by integrating health and education areas to address vulnerabilities that affect the development of students from public schools. OBJECTIVE: To describe the prevalence of overweight and obesity in school-aged children and adolescents and to expound methods to evaluate the nutritional status deviation. DESIGN: Cross-sectional study. SETTING: Schools in Itatiba, Sao Paulo, Brazil, participating in PSE. PARTICIPANTS: A total of 6829 schoolchildren aged 6 month to 15 years. MAIN OUTCOME MEASURES: Nutritional status and standard percentile curves for body mass index (BMI) for gender. RESULTS: In children younger than 5 years, the prevalence of being overweight was 13.9%; for those between 5 years or older and younger than 10 years, it was 33.9%; and for those 10 years or older, it was 34.0%. In males, obesity and severe obesity were more present (10.7% and 3.7%, respectively) than in girls (9.5% and 1.9%, respectively). Regarding location, it was found that the region with the highest income showed a higher prevalence of overweight children. Compared with the World Health Organization reference BMI curves, our reference percentile curve showed a higher standard for the cutoff points between normal range and overweight. CONCLUSION: From our results, we found that age and measures of weight and height in schoolchildren could contribute, in a cheap and simple way, to the assessment of nutritional status in a region. This is helpful in providing health monitoring and assisting in making public health decisions, as well as serving in comparison with other scientific studies. Partnership between education and health systems can facilitate and improve the quality of health management among schoolchildren.

Pulmonary function and physical performance outcomes with preoperative physical therapy in upper abdominal surgery: a randomized controlled trial.

OBJECTIVE: Investigation of the effects of preoperative physical therapy on pulmonary function and physical performance before and after upper abdominal surgery. DESIGN: Non-blind randomized controlled trial. SETTING: Tertiary public hospital and private university, São Paulo state, Brazil. SUBJECTS: Thirty-two patients undergoing abdominal surgery. INTERVENTIONS: Patients were randomly assigned to receive physical therapy, with respiratory and global exercises, 2-3 weeks before surgery (treatment group; n = 16) or await operation without engaging in practicing (control group; n = 16). After surgery, a physical therapy protocol was administered to all subjects until the seventh postoperative day. MAIN MEASURES: Pulmonary function outcome variables were inspiratory and expiratory strength, respiratory muscle endurance and spirometry, and physical performance outcome variables were the functional independence measure and 6-minute walk test distance. Any postoperative pulmonary complications were recorded. RESULTS: There were no between-group differences at randomization. In the preoperative period, patients in the intervention group had higher inspiratory strength and respiratory muscle endurance than controls (88 cmH(2)O versus 64 cmH(2)O and 28 cmH(2)O versus 23 cmH(2)O, respectively; P <0 0.05). On the seventh postoperative day, in addition to inspiratory force and respiratory muscle endurance, the intervention group showed better results than controls in the functional independence measure score (118 versus 95) and 6-minute walk test distance (368.5 m versus 223 m), all P <0 0.05. Postoperative pulmonary complications occurred in 11 patients in the control group and five in the intervention group (P = 0.03). CONCLUSION: Preoperative physical therapy improved pulmonary function and physical performance in the pre- and postoperative periods among patients undergoing upper abdominal surgery.

Lifestyle behaviors and associated factors among individuals with diabetes in Brazil: a latent class analysis approach.

The purpose of the cross-sectional study was to identify patterns of modifiable lifestyle behaviors and examine the relationship between sociodemographic characteristics and distinct lifestyle behaviors. The data were gathered from the National Health Survey 2019, a study that included adults with diabetes. Four domains of lifestyle behaviors were used to define these behaviors: smoking, alcohol consumption, physical activity, and diet. The association between patterns of lifestyle behaviors and variables of interest was assessed using multinomial regression analysis. The three lifestyle patterns identified were: Class 1, referred to as "unhealthy diet," comprised 17.0% of the sample and was characterized by unhealthy eating habits; Class 2 (less active and insufficient fruit and vegetable intake) represented 71.2% of the sample; Class 3 referred to as "low risk" (11.8%) is characterized by a lower probability of engaging in most risky behaviors. A person over 45 years of age with little or no education and no health care coverage was less likely to be a member of Class 1. Male individuals who do not attend a doctor regularly exhibited more chances of belonging to Class 2. Mixed-race individuals aged 45 years or more with a low level of education have a lower chance of belonging to this class.

The Potential Impact of Different Taxation Scenarios towards Sugar-Sweetened Beverages on Overweight and Obesity in Brazil: A Modeling Study.

The adoption of fiscal policies based on the specific taxation of sugar-sweetened beverages (SSBs) has been recommended by international health agencies, as they are measures that potentially reduce consumption. This study is an ex ante risk comparison that estimates the impact of three tax scenarios (20, 25, and 30%) with a 100% pass-on rate to SSBs on the prevalence of high weight and obesity in the Brazilian population. Data on the consumption habits, weight, and height of 46,164 adults aged 20 years or over from Brazilian recent national surveys were used. The shift in consumption after taxation was estimated based on the price elasticity of the demand. The percentage changes in overweight for 20, 25, and 30% taxation were 1.84% (95%CI: 1.82; 1.86), 1.89% (95%CI: 1.87; 1.90), and 2.25% (95%CI: 2.24; 2.27), respectively. The change in the prevalence of obesity was 1.93% (95%CI: 1.87; 2.00), 2.90% (95%CI: 2.80; 3.02), and 4.16% (95%CI: 4.01; 4.32), respectively. Taxes on SSBs may have a more favorable result among the heaviest consumers, who are young adults (20-29 years), especially men, thereby promoting a greater reduction in the prevalence of high weight and obesity.

Impact of a reduction in sugar-sweetened beverage consumption on the burden of type 2 diabetes in Brazil: A modeling study.

AIM: To model the impact of a 20 % tax on sugar-sweetened beverages (SSBs) on the disease burden of T2DM among Brazilian adults. METHODS: This is an ex-ante risk comparative study. The model applied a 20 % tax on SSB and projected the incidence, prevalence, and mortality of T2DM over a 20-year period (2019 to 2039). Using recent national data on consumption, previously published cross- and own-price elasticities of SSBs and diabetes relative risk we estimated changes on T2DM burden. RESULTS: With a 20 % tax on SSBs, after 10 years, we estimated a reduction of 37,303 new cases of T2DM for men and 56,757 for women; 184,129 prevalent cases for men and 219,236 for women; and 5,386 and 6,075 deaths for men and women, respectively. After 20 years, 8.6 % and 12.4 % new cases of T2DM will have been prevented, 4.0 % and 5.5 % prevalent cases, and 13.7 % and 12.7 % deaths among men and women, respectively. CONCLUSIONS: SSB taxes have the potential to reduce the burden of and deaths attributable to T2DM. Our results show that a fiscal policy may significantly impact strategic plans to tackle noncommunicable diseases.

Association between early pulmonary complications after abdominal surgery and preoperative physical capacity.

Objective: To investigate whether early postoperative pulmonary complications after abdominal surgery are associated with a lower performance in preoperative six-minute walk test.Methods: A cross-sectional cohort study of 50 participants who underwent elective abdominal surgery and performed the six-minute walk test within 48 hours prior to surgery were conducted. Postoperative pulmonary complications up to the seventh postoperative day were obtained from medical records.Results: Overall, 25 participants developed postoperative pulmonary complications. The mean (standard deviation) preoperative walked distances of the participants with and without postoperative pulmonary complications were, respectively, 444.8 (81.3) meters and 498.3 (63.7) meters (p = .013). The incidence of postoperative pulmonary complications was greater in the participants with walked distance < 400 meters. The multivariable logistic regression model revealed a significant association between postoperative pulmonary complications and preoperative walked distance (Odds ratio = 0.978, p = .010) in participants who underwent intestinal, stomach, or bile tract resection. Conclusions: This study found a high incidence of postoperative pulmonary complications in abdominal surgery participants and an association between lower preoperative physical capacity and the risk of postoperative pulmonary complications in participants who underwent intestinal, stomach, and biliary tract resection.

Analysis of cardiovascular risk and carotid intima-media thickness in patients with psoriasis.

BACKGROUND: Psoriasis is associated with atherosclerosis and increased cardiovascular risk. Currently, an automated ultrasound, called quantitative intima media thickness, has proven to be a useful method to evaluate subclinical atherosclerosis. OBJECTIVES: To compare increased cardiovascular risk in psoriasis patients receiving two types of treatments: Methotrexate and tumor necrosis factor inhibitor and to evaluate the correlation between the Framingham score and quantitative intima media thickness. METHODS: Fifty patients with plaque psoriasis were selected from June 2017 to July 2018, divided into two groups, receiving methotrexate and tumor necrosis factor inhibitor. Measurement of abdominal circumference, blood pressure, body mass index and presence of metabolic syndrome were performed. Afterwards, the patients were evaluated for increased cardiovascular risk with the Framingham score and for the quantitative intima media thickness of the carotid arteries. RESULTS: The mean age was 54.8 (±12.5) with a slight male predominance (58%). Overall, 84% of the patients had elevated waist circumference, 82% had a body mass index above ideal, and 50% had a metabolic syndrome. For the correlation between quantitative intima media thickness and Framingham Score, Pearson's linear correlation coefficient was 0.617 (p<0.001), indicating a moderate to strong positive association. STUDY LIMITATIONS: The protective effect of the therapies cited in relation to the increased cardiovascular risk was not evaluated. CONCLUSIONS: A moderate to strong positive association was found correlating the Framingham Score values with the quantitative intima media thickness measurement and it is not possible to state which drug has the highest increased cardiovascular risk.

Lifestyle behaviors and associated factors among individuals with diabetes in Brazil: a latent class analysis approach / Comportamentos de estilo de vida e fatores associados entre indivíduos portadores de diabetes no Brasil: uma abordagem com análise de classes latentes

Abstract The purpose of the cross-sectional study was to identify patterns of modifiable lifestyle behaviors and examine the relationship between sociodemographic characteristics and distinct lifestyle behaviors. The data were gathered from the National Health Survey 2019, a study that included adults with diabetes. Four domains of lifestyle behaviors were used to define these behaviors: smoking, alcohol consumption, physical activity, and diet. The association between patterns of lifestyle behaviors and variables of interest was assessed using multinomial regression analysis. The three lifestyle patterns identified were: Class 1, referred to as "unhealthy diet," comprised 17.0% of the sample and was characterized by unhealthy eating habits; Class 2 (less active and insufficient fruit and vegetable intake) represented 71.2% of the sample; Class 3 referred to as "low risk" (11.8%) is characterized by a lower probability of engaging in most risky behaviors. A person over 45 years of age with little or no education and no health care coverage was less likely to be a member of Class 1. Male individuals who do not attend a doctor regularly exhibited more chances of belonging to Class 2. Mixed-race individuals aged 45 years or more with a low level of education have a lower chance of belonging to this class.

Resumo Neste estudo de caráter transversal objetivou-se identificar os padrões de comportamento de estilo de vida e sua associação com características sociodemográficas. Utilizou-se como base de dados a Pesquisa Nacional de Saúde de 2019, com adultos (≥ 18 anos) diabéticos. Os padrões de saúde foram definidos pela Análise de Classes Latentes em quatro domínios: tabagismo, consumo de bebidas alcoólicas, atividade física e alimentação. Foi aplicada análise de regressão multinominal para identificar a associação entre os padrões de comportamento e as variáveis sociodemográficas de interesse. Identificou-se três padrões de comportamento: a Classe 1 corresponde a 17% da amostra e compreende indivíduos com maior probabilidade de comportamentos de risco ligados à alimentação; a Classe 2 (baixos nível de atividade física e consumo de frutas e hortaliças) compreende 71,2% da amostra; e a Classe 3 (11,8% da população) reúne os indivíduos com menor chance de desenvolver comportamentos de risco. Indivíduos com 45 anos ou mais, com baixa escolaridade e sem plano de saúde têm menos chances de pertencer à Classe 1. Homens, que não fazem visitas regulares ao médico têm maiores chances de pertencer à Classe 2, bem como aqueles com 45 anos ou mais, com baixa escolaridade.

Waist circumference in the prediction of obesity-related adverse pregnancy outcomes.

The aim of this study is to evaluate the diagnostic properties of waist circumference in the prediction of obesity-related gestational outcomes. Pregnant women 20 years or older were consecutively enrolled in six Brazilian State capitals from 1991 to 1995. Weight, height, and waist circumference were measured and an oral glucose tolerance test was performed. Patients were followed through childbirth by chart review. Diagnostic performance for the different outcomes, as measured by area under the receiver operating characteristic (ROC) curve, was estimated through logistic regression. Areas under the ROC curve (95%CI) for waist circumference were 0.621(0.589-0.652) for gestational diabetes, 0.640 (0.588-0.692) for preeclampsia, and 0.645(0.617-0.673) for macrosomia. These areas were similar to those for BMI (p > 0.05). A waist circumference of 82 cm jointly maximized sensitivity (63%) and specificity (57%). Cutoff points of 23 kg/m(2) for pre-pregnancy BMI and 26 kg/m(2) for BMI at enrollment produced similar diagnostic properties. In conclusion, waist circumference predicts obesity-related adverse pregnancy outcomes at least as well as BMI.

Spatial data analysis and the use of maps in scientific health articles.

INTRODUCTION: Despite the growing number of studies with a characteristic element of spatial analysis, the application of the techniques is not always clear and its continuity in epidemiological studies requires careful evaluation. OBJECTIVE: To verify the spread and use of those processes in national and international scientific papers. METHOD: An assessment was made of periodicals according to the impact index. Among 8,281 journals surveyed, four national and four international were selected, of which 1,274 articles were analyzed regarding the presence or absence of spatial analysis techniques. RESULTS: Just over 10% of articles published in 2011 in high impact journals, both national and international, showed some element of geographical location. CONCLUSION: Although these percentages vary greatly from one journal to another, denoting different publication profiles, we consider this percentage as an indication that location variables have become an important factor in studies of health.

Self-perceived body image and body satisfaction of adolescents / Imagem corporal autopercebida e satisfação corporal de adolescentes

Abstract Objectives: to evaluate self-perceived body image and body satisfaction of adolescents and their associated factors. Methods: across-sectional study carried out with 200 adolescents from a non-govern-mental organization of Campinas-SP. Self-perceived body image was assessed using a scale of silhouettes and body satisfaction by body areas. Association between sociodemographic and anthropometric data and body image and satisfaction were assessed by logistic regres-sion. Results: seventy percent of normal weight boys and 88% of girls wrongly perceived their nutritional status according to the objective standards. The prevalence of body dissatisfac-tion was 76.5%. Twenty-two percent of adolescents reported dissatisfaction with their body shape. Self-perceived body image was associated with nutritional status (OR= 0.25; CI95%=0.09-0.73), abdominal obesity (Waist/Height ratio- WHR) (OR=26.57; CI95%=3.98-177.18), and gender (OR=2.65; CI95%=1.16-6.05). Conclusions: we identified an important distortion and dissatisfaction with body shape. Girls, overweight/obese adolescents and those with abdominal obesity have more chance to this condition. These findings can subsidize actions that deal with the issue of acceptance of self-image, preventing more serious disorders that may directly affect the health of young-sters.

Resumo Objetivos: avaliar a imagem corporal autopercebida e a satisfação corporal de adoles-centes e seus fatores associados. Métodos: estudo transversal realizado com 200 adolescentes de uma organização não governamental de Campinas-SP. A imagem corporal autopercebida foi avaliada por meio de escala de silhuetas e a satisfação corporal por áreas do corpo. A associação entre dados sociodemográficos e antropométricos e imagem e satisfação corporal foi avaliada por regressão logística. Resultados: setenta por cento dos meninos com peso normal e 88% das meninas perce-beram erroneamente seu estado nutricional de acordo com os parâmetros objetivos. A prevalência de insatisfação corporal foi de 76,5%. Vinte e dois por cento dos adolescentes relataram insatisfação com a forma corporal. A autopercepção da imagem corporal foi asso-ciada ao estado nutricional (OR= 0,25; IC95%=0,09-0,73), obesidade abdominal (Relação cintura estatura- RCE) (OR=26,57; IC95%=3,98-177,18) e sexo (OR=2,65; IC95%=1,16-6,05). Conclusões: identificou-se uma importante distorção e insatisfação com a forma corporal. Meninas, adolescentes com sobrepeso / obesidade e aqueles com obesidade abdo-minal têm mais chances de apresentar dessa condição. Esses achados podem subsidiar ações que tratam da questão da aceitação da autoimagem, prevenindo distúrbios mais graves que podem afetar diretamente a saúde dos jovens.

Analysis of cardiovascular risk and carotid intima-media thickness in patients with psoriasis

Abstract Background: Psoriasis is associated with atherosclerosis and increased cardiovascular risk. Currently, an automated ultrasound, called quantitative intima media thickness, has proven to be a useful method to evaluate subclinical atherosclerosis. Objectives: To compare increased cardiovascular risk in psoriasis patients receiving two types of treatments: Methotrexate and tumor necrosis factor inhibitor and to evaluate the correlation between the Framingham score and quantitative intima media thickness. Methods: Fifty patients with plaque psoriasis were selected from June 2017 to July 2018, divided into two groups, receiving methotrexate and tumor necrosis factor inhibitor. Measurement of abdominal circumference, blood pressure, body mass index and presence of metabolic syndrome were performed. Afterwards, the patients were evaluated for increased cardiovascular risk with the Framingham score and for the quantitative intima media thickness of the carotid arteries. Results: The mean age was 54.8 (±12.5) with a slight male predominance (58%). Overall, 84% of the patients had elevated waist circumference, 82% had a body mass index above ideal, and 50% had a metabolic syndrome. For the correlation between quantitative intima media thickness and Framingham Score, Pearson's linear correlation coefficient was 0.617 (p < 0.001), indicating a moderate to strong positive association. Study limitations: The protective effect of the therapies cited in relation to the increased cardiovascular risk was not evaluated. Conclusions: A moderate to strong positive association was found correlating the Framingham Score values with the quantitative intima media thickness measurement and it is not possible to state which drug has the highest increased cardiovascular risk.

[Correlates of smoking in pregnant women in six Brazilian cities]. / Fatores associados ao fumo em gestantes avaliadas em cidades brasileiras.

OBJECTIVE: To evaluate sociodemographic and lifestyle correlates of smoking in pregnant women sampled from hospitals. METHODS: A cross-sectional study was conducted in 5,539 pregnant women aged 20 or more who sought medical attention in prenatal clinics of affiliate hospitals of the Brazilian National Health System in the cities of Manaus, Fortaleza, Salvador, Rio de Janeiro, São Paulo, and Porto Alegre from 1991 to 1995. Interviews were conducted using a standardized questionnaire that covered sociodemographics and smoking habits before and during pregnancy. Current smoking was defined as smoking at least one cigarette/day, former smoking as reporting having smoked at least one cigarette/day but having quit, and never smoking as never having smoked one cigarette/day. RESULTS: Smoking during pregnancy was associated with lower education (OR=2.13; CI 95%: 1.76-2.57) and greater parity (OR=1.84; CI 95%: 1.53-2.21). Positive associations were also found with increased gestational age and alcohol consumption. No significant association was found with skin color or occupation status. A protective effect was observed for women married or living with a partner (OR=0.55 CI 95%: 0.42-0.72). Having Manaus' women as a reference, Porto Alegre's women showed the greatest risk for smoking in pregnancy (OR=5.00; CI 95%: 3.35-7.38), followed by São Paulo's (OR=3.42; CI 95%: 2.25-5.20), Rio de Janeiro (OR=2.53; CI 95%: 1.65-3.88) and Fortaleza's (OR=2.56; CI 95%: 1.74-3.78). CONCLUSIONS: The study findings are similar to those described in the literature regarding education, parity, and marital status. However, no association with skin color was seen in the multivariate analysis. Former smokers had sociodemographic characteristics more similar to non-smokers than former smokers.

[The importance of memory bias in obtaining age of menarche by recall method in Brazilian adolescents]. / Importância do viés de memória na obtenção da idade da menarca pelo método recordatório em adolescentes brasileiras.

OBJECTIVE: To compare the age at menarche obtained by recall method according to the time elapsed since the event, in order to verify the importance of the recall bias. SUBJECTS AND METHODS: Were evaluated 1,671 girls (7-18 years) at schools in Campinas-SP regarding the occurrence of menarche by the status quo method (menarche: yes or no) and the recall method (date of menarche, for those who mentioned it). The age at menarche obtained by the status quo method was calculated by logit, which considers the whole group, and the age obtained by the recall method was calculated as the average of the mentioned age at menarche. In this group, the age at menarche was obtained by the difference between the date of the event and the date of birth. Girls who reported menarche (883, 52.8%) were divided into four groups according to the time elapsed since the event. To analyze the results, we used ANOVA and logistic regression for the analysis, with a significance level of 0.05. RESULTS: The age at menarche calculated by logit was 12.14 y/o (95% CI 12.08 to 12.20). Mean ages obtained by recall were: for those who experienced menarche within the previous year 12.26 y/o (±1.14), between > 1-2 years before, 12.29 y (±1.22); between > 2-3 years before, 12.23 y/o (±1.27); and more than 3 years before, 11.55y/o (±1.24), p < 0.001. CONCLUSION: The age at menarche obtained by the recall method was similar for girls who menstruated within the previous 3 years (and approaches the age calculated by logit); when more than 3 years have passed, the recall bias was significant.

Prevalence of weight excess according to age group in students from Campinas, SP, Brazil.

OBJECTIVE: To evaluate the prevalence of weight excess in children and adolescents attending public and private schools of Campinas, Southeast Brazil, according to age group. METHODS: Cross-sectional study that enrolled 3,130 students from 2010 to 2012. The weight and the height were measured and the body mass index (BMI) was calculated. The students were classified by BMI Z-score/age curves of the World Health Organization (WHO)-2007 (thinness, normal weight, overweight and obesity) and by age group (7-10, 11-14 and 15-18 years). Multinomial logistic regression analysis was applied to verify variables associated to overweight and obesity. RESULTS: Among the 3,130 students, 53.7% attended public schools and 53.4% were girls. The prevalence of weight excess (overweight or obesity) was higher in private schools (37.3%) than in public ones (32.9%) and among males (37.5%), compared to females (32.7%; p<0.05). The chance of having weight excess in children aged 7-10 years was more than twice of those over 15 years old (OR 2.4; 95%CI 2.0-3.0) and it was 60% higher for the group with 11-14 years old (OR 1.6; 95%CI 1.3-2.0). The chance of being obese was three times higher in 7-10 years old children than in the adolescents with 15-18 years old (OR 4.4; 95%CI 3.3-6.4) and 130% higher than the group with 11-14 years old (OR 2.3; 95%CI 1.6-3.2). CONCLUSIONS: The prevalence of weight excess in Campinas keeps increasing at an alarming rate, especially in the younger age group.