Long-Term Protective Effect of Tuberculosis Preventive Therapy in a Medium/High Tuberculosis Incidence Setting.

BACKGROUND: The duration of the protective effect of tuberculosis preventive therapy (TPT) is controversial. Some studies have found that the protective effect of TPT is lost after cessation of therapy among people with human immunodeficiency virus (HIV) in settings with very high tuberculosis incidence, but others have found long-term protection in low-incidence settings. METHODS: We estimated the incidence rate (IR) of new tuberculosis disease for up to 12 years after randomization to 4 months of rifampin or 9 months of isoniazid, among 991 Brazilian participants in a TPT trial in the state of Rio de Janeiro, with an incidence of 68.6/100 000 population in 2022. The adjusted hazard ratios (aHRs) of independent variables for incident tuberculosis were calculated. RESULTS: The overall tuberculosis IR was 1.7 (95% confidence interval [CI], 1.01- 2.7) per 1000 person-years (PY). The tuberculosis IR was higher among those who did not complete TPT than in those who did (2.9 [95% CI, 1.3-5.6] vs 1.1 [.4-2.3] per 1000 PY; IR ratio, 2.7 [1.0-7.2]). The tuberculosis IR was higher within 28 months after randomization (IR, 3.5 [95% CI, 1.6-6.6] vs 1.1 [.5-2.1] per 1000 PY between 28 and 143 months; IR ratio, 3.1 [1.2-8.2]). Treatment noncompletion was the only variable associated with incident tuberculosis (aHR, 3.2 [95% CI, 1.1-9.7]). CONCLUSIONS: In a mostly HIV-noninfected population, a complete course of TPT conferred long-term protection against tuberculosis.

Improving the knowledge management of marine megafauna strandings.

Although the marine megafauna often strands on beaches around the world, such as sea turtles and whales, stranding data are poorly managed and incorporated into management and conservation strategies. Here we use a knowledge value chain framework to call attention for the urgent need to improve our data architecture and knowledge management on marine megafauna strandings. We use Brazil, a continental megadiverse federative republic, as study model. After describing the main components and identifying the strengths and weaknesses of the current Brazilian data architecture, we propose 10 practical measures for its improvement involving researchers, companies, non-governmental organizations, legislators, policy makers, public agents, citizen scientists, and local communities. Although Brazil has notable strengths such as comprehensive environmental legislation, hundreds of scientists and dozens of prestigious research institutions, stranding data is not translated into technical-scientific knowledge; technical-scientific knowledge is not transformed into effective public regulations; deficient regulations lead to bad decisions and limited actions, which in turn result in ineffective management and conservation strategies. In light of the UN Decade of Ocean Science for Sustainable Development (2021-2030), we propose (1) expanding standardized beach monitoring projects to the entire Brazilian coast; (2) creating a governmental database with FAIR principles; (3) encouraging the development of broad citizen science initiatives; (4) funding scientists and research institutions; (5) boosting outreach activities among researchers to popularize the scientific knowledge; (6) raising awareness among legislators and policy makers on the problem of strandings; (7) updating the existing legal provisions on the environmental licensing of activities developed at sea; (8) hiring new environmental analysts and inspectors and improving the infrastructure of executing environmental agencies; (9) strengthening existing conservation networks with multiple stakeholders; and (10) making the results of the management and conservation strategies broadly accessible to society. These recommendations may also apply to other coastal countries around the world.

Landscape-scale forest cover drives the predictability of forest regeneration across the Neotropics.

Abandonment of agricultural lands promotes the global expansion of secondary forests, which are critical for preserving biodiversity and ecosystem functions and services. Such roles largely depend, however, on two essential successional attributes, trajectory and recovery rate, which are expected to depend on landscape-scale forest cover in nonlinear ways. Using a multi-scale approach and a large vegetation dataset (843 plots, 3511 tree species) from 22 secondary forest chronosequences distributed across the Neotropics, we show that successional trajectories of woody plant species richness, stem density and basal area are less predictable in landscapes (4 km radius) with intermediate (40-60%) forest cover than in landscapes with high (greater than 60%) forest cover. This supports theory suggesting that high spatial and environmental heterogeneity in intermediately deforested landscapes can increase the variation of key ecological factors for forest recovery (e.g. seed dispersal and seedling recruitment), increasing the uncertainty of successional trajectories. Regarding the recovery rate, only species richness is positively related to forest cover in relatively small (1 km radius) landscapes. These findings highlight the importance of using a spatially explicit landscape approach in restoration initiatives and suggest that these initiatives can be more effective in more forested landscapes, especially if implemented across spatial extents of 1-4 km radius.

Climate change should drive mammal defaunation in tropical dry forests.

Human-induced climate change has intensified negative impacts on socioeconomic factors, the environment, and biodiversity, including changes in rainfall patterns and an increase in global average temperatures. Drylands are particularly at risk, with projections suggesting they will become hotter, drier, and less suitable for a significant portion of their species, potentially leading to mammal defaunation. We use ecological niche modelling and community ecology biodiversity metrics to examine potential geographical range shifts of non-volant mammal species in the largest Neotropical dryland, the Caatinga, and evaluate impacts of climate change on mammal assemblages. According to projections, 85% of the mammal species will lose suitable habitats, with one quarter of species projected to completely lose suitable habitats by 2060. This will result in a decrease in species richness for more than 90% of assemblages and an increase in compositional similarity to nearby assemblages (i.e., reduction in spatial beta diversity) for 70% of the assemblages. Small-sized mammals will be the most impacted and lose most of their suitable habitats, especially in highlands. The scenario is even worse in the eastern half of Caatinga where habitat destruction already prevails, compounding the threats faced by species there. While species-specific responses can vary with respect to dispersal, behavior, and energy requirements, our findings indicate that climate change can drive mammal assemblages to biotic homogenization and species loss, with drastic changes in assemblage trophic structure. For successful long-term socioenvironmental policy and conservation planning, it is critical that findings from biodiversity forecasts are considered.

Preserving 40% forest cover is a valuable and well-supported conservation guideline: reply to Banks-Leite et al.

Banks-Leite et al. (2021) claim that our suggestion of preserving ≥ 40% forest cover lacks evidence and can be problematic. We find these claims unfounded, and discuss why conservation planning urgently requires valuable, well-supported and feasible general guidelines like the 40% criterion. Using region-specific thresholds worldwide is unfeasible and potentially harmful.

EQ-5D Brazilian population norms.

BACKGROUND: The EQ-5D-3L is a widely used generic health-related quality of life measure commonly applied to describe health outcomes and to measure disease burden. The aim of this study was to generate Brazilian population norms, stratified by age and gender, based on Brazilian preference weights for EQ-5D-3L. METHODS: A multicenter cross-sectional study was conducted in three Brazilian urban areas. The final sample consisted of 5774 respondents, aged from 18 to 64 years. Amongst other information, respondents were asked to self-report their health status using the EQ-5D-3L descriptive system and visual analog scale (EQ-VAS). Data on socio-demographic characteristics was obtained through specific questionnaires. The Brazilian TTO scoring algorithm was used to derive the utility values. Multivariate logistic regression models were fitted to analyze the influence of age, sex, education status and sample site on the presence of any problem for each dimension of EQ5D. RESULTS: Mean values were computed for both weighted index scores and self-rated health status (EQ-VAS), and stratified by gender and age groups. Health status declines with age, ranging between 0.87 for the youngest group 18-29 year-olds and 0.76 for 60-64-year-old. Men reported higher scores (0.85) than the woman (0.79). Lower education levels were associated with lower EQ-5D index score in most age groups. CONCLUSION: This study provides EQ-5D reference values for the Brazilian population. These values can be used by local decision-makers and researchers in economic evaluations and population health studies.

Designing optimal human-modified landscapes for forest biodiversity conservation.

Agriculture and development transform forest ecosystems to human-modified landscapes. Decades of research in ecology have generated myriad concepts for the appropriate management of these landscapes. Yet, these concepts are often contradictory and apply at different spatial scales, making the design of biodiversity-friendly landscapes challenging. Here, we combine concepts with empirical support to design optimal landscape scenarios for forest-dwelling species. The supported concepts indicate that appropriately sized landscapes should contain ≥ 40% forest cover, although higher percentages are likely needed in the tropics. Forest cover should be configured with c. 10% in a very large forest patch, and the remaining 30% in many evenly dispersed smaller patches and semi-natural treed elements (e.g. vegetation corridors). Importantly, the patches should be embedded in a high-quality matrix. The proposed landscape scenarios represent an optimal compromise between delivery of goods and services to humans and preserving most forest wildlife, and can therefore guide forest preservation and restoration strategies.

Socioeconomic differences among resident, users and neighbour populations of a protected area in the Brazilian dry forest.

Protected areas are an important strategy to safeguard biodiversity. However, if social development is not considered, biological conservation targets may not be achieved. In this empirical study, we assess the relationship between poverty and conservation goals in dry forests within a 62,000-ha Brazilian National Park (Caatinga biome). We conducted 81 structured household interviews between January and July of 2016 to assess socioeconomic, resource management and land-use variables. We used non-parametric analysis of variance to test for differences in socioecological variables among families living inside and outside the Park and both (double dwelling). The majority of families (76%) residing inside the Park were living below the poverty line while less than 14% in outside and double dwelling residences faced the same issue. Families living inside the park had lower socioeconomic conditions such as limited water availability, poor house infrastructure, low income, and high dependence on firewood than outside and double dwelling families. They were also more dependent on external financial support and natural resources. We found that failures in protected areas inception and implementation have driven people towards a mutually reinforcing and declining situation in which negative socioeconomic outcomes are associated with nature degradation. Therefore, our results suggest that the future of dry forests, characterized worldwide by the presence of low-income populations, will be largely dependent on conservation strategies that address poverty alleviation and human well-being.

Phylogenetic impoverishment of plant communities following chronic human disturbances in the Brazilian Caatinga.

Chronic disturbances, such as selective logging, firewood extraction and extensive grazing, may lead to the taxonomic and phylogenetic impoverishment of remaining old-growth forest communities worldwide; however, the empirical evidence on this topic is limited. We tested this hypothesis in the Caatinga vegetation--a seasonally dry tropical forest restricted to northeast Brazil. We sampled 11,653 individuals (adults, saplings, and seedlings) from 51 species in 29 plots distributed along a gradient of chronic disturbance. The gradient was assessed using a chronic disturbance index (CDI) based on five recognized indicators of chronic disturbances: proximity to urban center, houses and roads and the density of both people and livestock. We used linear models to test if mean effective number of lineages, mean phylogenetic distance and phylogenetic dispersion decreased with CDI and if such relationships differed among ontogenetic stages. As expected, the mean effective number of lineages and the mean phylogenetic distance were negatively related to CDI, and such diversity losses occurred irrespective of ontogeny. Yet the increase in phylogenetic clustering in more disturbed plots was only evident in seedlings and saplings, mostly because clades with more descendent taxa than expected by chance (e.g., Euphorbiaceae) thrived in more disturbed plots. This novel study indicates that chronic human disturbances are promoting the phylogenetic impoverishment of the irreplaceable woody flora of the Brazilian Caatinga forest. The highest impoverishment was observed in seedlings and saplings, indicating that if current chronic disturbances remain, they will result in increasingly poorer phylogenetically forests. This loss of evolutionary history will potentially limit the capacity of this ecosystem to respond to human disturbances (i.e., lower ecological resilience) and particularly their ability to adapt to rapid climatic changes in the region.

Taxonomic and functional divergence of tree assemblages in a fragmented tropical forest.

Tropical forests are being exposed to increasing levels of habitat loss and fragmentation, threatening the maintenance of global biodiversity. However, the effect that land-use change may have on the spatial dissimilarities in taxonomic and functional composition of remaining assemblages (i.e., taxonomic/functional ß-diversity) remains poorly understood. We examined a large vegetation database from an old and severely fragmented Atlantic forest landscape to test two alternative hypotheses: (1) tree assemblages experience a taxonomic and functional homogenization (reduced ß-diversity) between forest fragments and along forest edges, or alternatively, (2) these edge-affected forests show increased taxonomic and functional differentiation (increased ß-diversity) when compared to forest interior (reference) stands. Taxonomic and functional ß-diversity were examined via novel abundance-based metrics and considering functional traits related to plant dispersion, recruitment, and growth. Overall, taxonomic ß-diversity among fragments was significantly higher than among edge and reference plots. Edge plots also showed higher ß-diversity than reference plots, but only when considering dominant species. In functional terms, ß-diversity among reference plots was also lower than among forest fragments and among edge plots. These patterns support the landscape-divergence hypothesis, which postulates that variable human disturbances among forest fragments and along forest edges can lead to contrasting trajectories of vegetation changes, thus increasing the compositional and functional differentiation of tree communities in these emerging environments. Our results also show that such differentiation can preserve landscape-wide biodiversity, thus overriding negative effects of habitat fragmentation on local (α) diversity. Therefore, our findings demonstrate that forest fragments and forest edges can be more valuable for maintaining species diversity and ecosystem function in fragmented tropical landscapes than previously thought.

Multicentre, randomized, double-blind trial of intracoronary autologous mononuclear bone marrow cell injection in non-ischaemic dilated cardiomyopathy (the dilated cardiomyopathy arm of the MiHeart study).

AIMS: Pre-clinical and few clinical studies suggest that transplantation of autologous bone marrow mononuclear cells (BMNC) improves heart function in dilated cardiomyopathies. Our objective was to determine if intracoronary injection of autologous BMNC improves the left ventricular ejection fraction (LVEF) of patients with non-ischaemic dilated cardiomyopathy (NIDCM). METHODS AND RESULTS: This study was a multicentre, randomized, double-blind, placebo controlled trial with a follow-up of 12 months. Patients with NIDCM and LVEF <35% were recruited at heart failure ambulatories in specialized hospitals around Brazil. One hundred and sixty subjects were randomized to intracoronary injection of BMNC or placebo (1:1). The primary endpoint was the difference in change of LVEF between BMNC and placebo groups as determined by echocardiography. One hundred and fifteen patients completed the study. Left ventricular ejection fraction decreased from 24.0% (21.6-26.3) to 19.9% (15.4-24.4) in the BMNC group and from 24.3% (22.1-26.5) to 22.1% (17.4-26.8) in the placebo group. There were no significant differences in changes between cell and placebo groups for left ventricular systolic and diastolic volumes and ejection fraction. Mortality rate was 20.37% in placebo and 21.31% in BMNC. CONCLUSION: Intracoronary injection of autologous BMNC does not improve left ventricular function in patients with NIDCM. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00333827.

Association between Carotid Intima-media Thickness and Early-onset Coronary Artery Disease: Does the site of Sonographic Evaluation Matter?

BACKGROUND: Intima-media thickness (IMT) is frequently used for risk stratification (RS) due to the association with coronary artery disease (CAD). Nonetheless, the best carotid site to scan is uncertain, especially in the young. The aim of this study was to evaluate the diagnostic performance of IMT measurements performed at different carotid sites. METHODS: Eighty-nine subjects ≤45 years were studied (55 with known CAD and 34 controls). IMT measurements were performed at the common carotid (CC), bulb and internal branch (IB) of both carotid arteries, (2112 measures). The diagnostic performance of IMT measurements performed at different sites, regarding the presence of CAD, was evaluated with ROC curves. RESULTS: Carotid plaques were found in 20.0% of the patients and 6.0% of the controls. The diagnostic performance of carotid IMT measures obtained at the CC, bulb or IB was not significantly different, with the CC and IB being slightly better (AUC ROC =0.82 and 0.80 respectively). CONCLUSIONS: IMT measures obtained at different carotid sites are associated with CAD in young (≤45 years) individuals. The diagnostic performance of IMT measured at the CC and IB is the more accurate measure, and this may be the most adequate for the measurement of IMT in this population.

Exploring depth-related patterns of sponge diversity and abundance in marginal reefs.

Marine sponges play a vital role in the reef's benthic community; however, understanding how their diversity and abundance vary with depth is a major challenge, especially on marginal reefs in areas deeper than 30 m. To help bridge this gap, we used underwater videos at 24 locations between 2- and 62-meter depths on a marginal reef system in the Southwestern Atlantic to investigate the effect of depth on the sponge metacommunity. Specifically, we quantified the abundance, density, and taxonomic composition of sponge communities, and decomposed their gamma (γ) diversity into alpha (α) and beta (ß) components. We also assessed whether beta diversity was driven by species replacement (turnover) or by nesting of local communities (nestedness). We identified 2020 marine sponge individuals, which belong to 36 species and 24 genera. As expected, deep areas (i.e., those greater than 30 m) presented greater sponge abundance and more than eightfold the number of sponges per square meter compared to shallow areas. About 50% of the species that occurred in shallow areas (<30 m) also occurred in deep areas. Contrarily to expectations, alpha diversity of rare (0 D α), typical (1 D α), or dominant (2 D α) species did not vary with depth, but the shallow areas had greater beta diversity than the deep ones, especially for typical (1 D ß) and dominant (2 D ß) species. Between 92.7% and 95.7% of the beta diversity was given by species turnover both inside and between shallow and deep areas. Our results support previous studies that found greater sponge abundance and density in deep areas and reveal that species sorting is stronger at smaller depths, generating more beta diversity across local communities in shallow than deep areas. Because turnover is the major driver at any depth, the entire depth gradient should be considered in management and conservation strategies.

Does genome size increase with water depth in marine fishes?

A growing body of research suggests that genome size in animals can be affected by ecological factors. Half a century ago, Ebeling et al. proposed that genome size increases with depth in some teleost fish groups and discussed a number of biological mechanisms that may explain this pattern (e.g., passive accumulation, adaptive acclimation). Using phylogenetic comparative approaches, we revisit this hypothesis based on genome size and ecological data from up to 708 marine fish species in combination with a set of large-scale phylogenies, including a newly inferred tree. We also conduct modeling approaches of trait evolution and implement a variety of regression analyses to assess the relationship between genome size and depth. Our reanalysis of Ebeling et al.'s dataset shows a weak association between these variables, but the overall pattern in their data is driven by a single clade. Although new analyses based on our "all-species" dataset resulted in positive correlations, providing some evidence that genome size evolves as a function of depth, only one subclade consistently yielded statistically significant correlations. By contrast, negative correlations are rare and nonsignificant. All in all, we find modest evidence for an increase in genome size along the depth axis in marine fishes. We discuss some mechanistic explanations for the observed trends.

Strong floristic distinctiveness across Neotropical successional forests.

Forests that regrow naturally on abandoned fields are important for restoring biodiversity and ecosystem services, but can they also preserve the distinct regional tree floras? Using the floristic composition of 1215 early successional forests (≤20 years) in 75 human-modified landscapes across the Neotropic realm, we identified 14 distinct floristic groups, with a between-group dissimilarity of 0.97. Floristic groups were associated with location, bioregions, soil pH, temperature seasonality, and water availability. Hence, there is large continental-scale variation in the species composition of early successional forests, which is mainly associated with biogeographic and environmental factors but not with human disturbance indicators. This floristic distinctiveness is partially driven by regionally restricted species belonging to widespread genera. Early secondary forests contribute therefore to restoring and conserving the distinctiveness of bioregions across the Neotropical realm, and forest restoration initiatives should use local species to assure that these distinct floras are maintained.

Cost-Utility Analysis of Eculizumab for the Treatment of Paroxysmal Nocturnal Hemoglobinuria From the Perspective of the Brazilian Public Health System.

OBJECTIVE: To perform a first cost-utility analysis of eculizumab for the treatment of paroxysmal nocturnal hemoglobinuria from the perspective of the Brazilian Unified Health System. METHODS: A Markov decision model was developed for 35-year-old patients with symptomatic paroxysmal nocturnal hemoglobinuria. We used a cycle length of one month and a time horizon of 20 years. The effectiveness measure was the quality-adjusted life year (QALY). Data were extracted from clinical trials, historical cohorts, and Unified Health System databases. Resource use and costs were estimated from the perspective of the Unified Health System. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: The estimated gain in effectiveness with the use of eculizumab was 1.08 QALY through the incremental cost of R$10,959,375.95. The incremental cost-effectiveness ratio was R$10,139,542.84 per QALY, being 331.92 times greater than the Brazilian gross domestic product per capita. In the deterministic sensitivity analysis, the parameters related to the utilities of health states were associated with greater impact in the model. The results of the probabilistic sensitivity analysis with 1000 simulations evidence that 100% of the simulations were not considered cost-effective with the arbitrated willingness to pay R$30,548.40 and R$91,645.20 per QALY. CONCLUSIONS: The gain in effectiveness with the use of eculizumab was modest, associated with an unjustifiable incremental cost. Therefore, eculizumab is not a cost-effective drug compared with the current standard of care in the treatment of paroxysmal nocturnal hemoglobinuria from the Brazilian Unified Health System perspective.

Deep reefs are not refugium for shallow-water fish communities in the southwestern Atlantic.

The deep reef refugia hypothesis (DRRH) predicts that deep reef ecosystems may act as refugium for the biota of disturbed shallow waters. Because deep reefs are among the most understudied habitats on Earth, formal tests of the DRRH remain scarce. If the DRRH is valid at the community level, the diversity of species, functions, and lineages of fish communities of shallow reefs should be encapsulated in deep reefs.We tested the DRRH by assessing the taxonomic, functional, and phylogenetic diversity of 22 Brazilian fish communities between 2 and 62 m depth. We partitioned the gamma diversity of shallow (<30 m) and deep reefs (>30 m) into independent alpha and beta components, accounted for species' abundance, and assessed whether beta patterns were mostly driven by spatial turnover or nestedness.We recorded 3,821 fishes belonging to 85 species and 36 families. Contrary to DRRH expectations, only 48% of the species occurred in both shallow and deep reefs. Alpha diversity of rare species was higher in deep reefs as expected, but alpha diversity of typical and dominant species did not vary with depth. Alpha functional diversity was higher in deep reefs only for rare and typical species, but not for dominant species. Alpha phylogenetic diversity was consistently higher in deep reefs, supporting DRRH expectations.Profiles of taxonomic, functional, and phylogenetic beta diversity indicated that deep reefs were not more heterogeneous than shallow reefs, contradicting expectations of biotic homogenization near sea surface. Furthermore, pairwise beta-diversity analyses revealed that the patterns were mostly driven by spatial turnover rather than nestedness at any depth. Conclusions. Although some results support the DRRH, most indicate that the shallow-water reef fish diversity is not fully encapsulated in deep reefs. Every reef contributes significantly to the regional diversity and must be managed and protected accordingly.

Characterization of occupational accidents occurred at the Occupational Health Referral Center of the state of Amapá between 2007 and 2016.

INTRODUCTION: Occupational accidents involving biological material have consequences that range from physical damage to public expenses. The study of this topic may help evaluate conducts and form preventive measures. OBJECTIVES: To characterize the notifications of occupational accidents involving biological material that occurred between 2007 and 2016 in the state of Amapá, Brazil. METHODS: This is an observational, retrospective, and descriptive study with a data analysis that quantified occupational accidents with biological material reported between January 2007 and December 2016 and analyzed the most prevalent risk factors. RESULTS: Data were obtained from the Occupational Health Reference Center of the state of Amapá: 938 cases of occupational accidents with biological material were reported in the studied period. The main type of exposure was percutaneous (75.8%), the most common organic material was blood (68.4%), and the main causative agent was the hollow-bore needle (58.6%). Considering the reported cases, 80.8% of 745 individuals were vaccinated against hepatitis B and 2.4% of 252 individuals had positive anti-HIV. Regarding the clinical progression of the injured workers, in 91.9% of the cases these data were unknown or not recorded, and 47.4% of the patients who provided this information were discharged with no serological conversion. CONCLUSIONS: The main causes of occupational accidents were related to the use of sharps for intravenous drug administration and the inadequate disposal of this material, highlighting the need for stronger attention when performing these procedures. The high incidence of unknown/blank data hampered the correct serological follow-up of the patients and the epidemiological characterization of the accidents.

Exploring the predictors of health valuations of EQ 5D 3L with a mixed-effects linear model.

BACKGROUND: Information about how individual characteristics influence preferences about health states valuation are scare. The purpose of this study is to identify predictors of the EuroQol with five dimensions and 3 levels - EQ 5D-3L time-tradeoff valuation. RESEARCH DESIGN AND METHODS: We analyzed a dataset with a probabilistic sample of 5774 individuals. Two sets of independent variables for testing were defined: a set of forced variables composed of 10 dummy variables for EuroQol levels 2 and 3 of each health dimension and a set of demographic variables. RESULTS: The strongest predictors of health valuation were the self-reported health state and the 'belief in God,' with 0.11 utility units for each VAS unit and 0.11 utility units for 'yes' for the 'belief in God' parameter.Age had an impact of 0.0190 utility units for each 10-year interval. Having children had a small effect (0.0338 utility units for 'yes'), and the other characteristics studied had no significant impact. CONCLUSIONS: People who believe in God (or the afterlife) and those of greater age seem to be less prone to forgoing life years to avoid health problems. In our sample, older individuals valued health state higher than younger individuals.

Cutoff values for HOMA-IR associated with metabolic syndrome in the Study of Cardiovascular Risk in Adolescents (ERICA Study).

OBJECTIVE: The aim of this study was to determine the distribution of homeostatic model assessment of insulin resistance (HOMA-IR) values and define its cutoff associated with metabolic syndrome (MetS) in the participants of the Study of Cardiovascular Risk in Adolescents (Estudo de Risco Cardiovascular em Adolescentes). METHODS: MetS was defined according to the International Diabetes Federation criteria. HOMA-IR values were calculated and tabulated by corresponding percentiles for age and sex. Receiver operating characteristic curves were constructed to identify the optimal cutoff values of HOMA-IR associated with MetS in the total population and by sex. RESULTS: We evaluated 37 815 adolescents ages 12 to 17 y. The highest HOMA-IR medians were found among girls and boys ages 12 and 14 y, respectively. Thereafter, values tended to decrease with age. The optimal cutoff values of the HOMA-IR associated with MetS in the total population, in female adolescents, and in male adolescents were 2.80, 2.32, and 2.87, respectively. Insulin resistance was prevalent in 19.1% (95% confidence interval, 17.7-20.7) of the total population, and the prevalence was higher among girls and overweight Brazilian adolescents. CONCLUSIONS: These findings may serve as new reference points for detecting insulin resistance in Brazilian adolescents.