Adolescents' knowledge of HPV and sexually transmitted infections at public high schools in São Paulo: A cross-sectional study.

PURPOSE: To assess the knowledge of students from public high schools in poor communities about HPV and Sexually Transmitted Infections and their attitude towards and prevention of such diseases. PATIENTS AND METHODS: Cross-sectional study with adolescents from public schools of São Paulo - Brazil. Participants were selected for an interview by a randomization program. A questionnaire about knowledge, attitudes, and preventive practices regarding STIs, including HPV, according to sex was administered and answers were analyzed by the Poisson regression model with robust variance. RESULTS: Median age of the 269 participants was 16 years. The majority was of African descent (68.8%, n = 185), most (74%, n = 199) were religious and the vast majority (90.7%, n = 244) lived with their parents. The Poisson regression revealed statistically significant sex-related differences regarding the following questions: "Do you know how it is prevented?" (PR = 1.12 [1.03‒1.23], p = 0.007); "Have you ever been concerned with HPV?" (PR = 1.10 [1.02‒1.19], p = 0.011); "Have you ever sought health care due to concerns about HPV?" (PR = 1.09 [1.04‒1.14], p < 0.001); "Do you know what a Pap Smear is?" (PR = 1.24 [1.13‒1.36], p < 0.001); "Do you know what the cervix is?" (PR = 1.23 [1.13‒1.34], p < 0.001); "Do you know what cervical cancer is?" (PR = 1.13 [1.04‒1.22], p = 0.004). CONCLUSIONS: The present results show that adolescents from public schools in poor communities in São Paulo City know little about HPV and cervical cancer. Male adolescents know less than female adolescents and are less concerned with health care.

Determinants of Lack of Access to Treatment for Women Diagnosed with Breast Cancer in Brazil.

Access to timely treatment is essential for the probability of the cure and reduction of severe breast cancer cases. In Brazil, legislation states that cancer treatment must start within 60 days of diagnosis. This study analyzed the factors associated with lack of access to breast cancer treatment in women with a confirmed diagnosis inserted in the health system. We collected secondary data from Brazilian women with a diagnosis and without treatment from January to December 2019 through the Cancer Hospital Registers developed by the National Cancer Institute. Our findings indicate that most women (60.11%) are diagnosed with stage II cancer but are without treatment. Most of them are aged 18-70 years, non-white race/color, have a low educational level and are from the Southeast Brazilian region. In addition, social inequalities are determinant in women's lack of access to breast cancer treatment.

Adolescents' knowledge of HPV and sexually transmitted infections at public high schools in São Paulo: A cross-sectional study

Abstract Purpose To assess the knowledge of students from public high schools in poor communities about HPV and Sexually Transmitted Infections and their attitude towards and prevention of such diseases. Patients and methods Cross-sectional study with adolescents from public schools of São Paulo - Brazil. Participants were selected for an interview by a randomization program. A questionnaire about knowledge, attitudes, and preventive practices regarding STIs, including HPV, according to sex was administered and answers were analyzed by the Poisson regression model with robust variance. Results Median age of the 269 participants was 16 years. The majority was of African descent (68.8%, n = 185), most (74%, n = 199) were religious and the vast majority (90.7%, n = 244) lived with their parents. The Poisson regression revealed statistically significant sex-related differences regarding the following questions: "Do you know how it is prevented?" (PR = 1.12 [1.03‒1.23], p = 0.007); "Have you ever been concerned with HPV?" (PR = 1.10 [1.02‒1.19], p = 0.011); "Have you ever sought health care due to concerns about HPV?" (PR = 1.09 [1.04‒1.14], p < 0.001); "Do you know what a Pap Smear is?" (PR = 1.24 [1.13‒1.36], p < 0.001); "Do you know what the cervix is?" (PR = 1.23 [1.13‒1.34], p < 0.001); "Do you know what cervical cancer is?" (PR = 1.13 [1.04‒1.22], p = 0.004). Conclusions The present results show that adolescents from public schools in poor communities in São Paulo City know little about HPV and cervical cancer. Male adolescents know less than female adolescents and are less concerned with health care.

Relationship between income inequality, socioeconomic development, vulnerability index, and maternal mortality in Brazil, 2017.

BACKGROUND: Public health recognizes that health conditions depend on factors related to the development patterns income distribution, degree of poverty, working conditions, among other social determinants. The objective of this study was to analyze the association of maternal mortality with the Human Development Index (HDI), Gini Index, Income per capita, and the Social Vulnerability. METHOD: The study analyzed the relationship between MMR and socioeconomic indicators in the 26 federative units and the Federal District of Brazil, in 2017. The socioeconomic indicators used in the study were: HDI, Gini Index, Income per capita, and SVI. Crude and adjusted linear regression were performed between maternal mortality and socioeconomic indicators. RESULTS: When analyzing which socioeconomic determinants that are related to maternal mortality ratio rates, a higher per capita income positive effect was observed for lower MMR (ß = - 150.8; CI 95% -289.9 to - 11.7; r2 = 0.17; p = 0.035), as well as a trend of higher MMR in relation to the SVI (ß = 97.7; CI 95% -12.2 to 207.6; r2 = 0.12; p = 0.079). In model found by the stepwise forward selections, only the per capita income was um index related to less RMM (ß = - 0.02; CI 95% -0.05 to - 0.002; r2 = 0.15; p = 0.028). CONCLUSION: The findings showed that the per capita income has a negative association MMR in the different states of Brazil, but seems canceled because of the other socioeconomic determinants related to the poor live conditions.

Brazilian National Policy of Comprehensive Women's Health Care and mortality during climacteric period: has anything changed?

BACKGROUND: The National Policy for Integral Attention to Women's Health Care (PNAISM) was implemented in 2004, with monitoring of potential benefits. One of the life cycles of women contemplated in this health policy was the importance of health care during the climacteric. Prevention and health promotion are actions carried out by the Brazil National Health System and enshrined in health Brazilian policies for women. Thus, our purpose was to identify climacteric women's main causes of death as well as the mortality trends of such causes, especially after implementation of PNAISM. METHODS: An ecological study was conducted from 2018 to 2020. Data were retrieved from the Brazilian Health Department by accessing the mortality information system of the National Health Information, divided into periods 1996-2004 and 2005-2016 the latter to correspond with the implementation of the National Policy. The death records of Brazilian women aged 40 to 64 years who had a designated cause of death were retrieved. Trends and differences between periods were evaluated using linear regression. The significance level was set at 5%. RESULTS: The main causes of death in women from 1996 to 2016 were circulatory system diseases (22.47%, 697,636 deaths), neoplasms (19.69%, 611,495 deaths), respiratory system diseases (5.5%, 170,716 deaths), endocrine, nutritional, and metabolic disorders (5.27%, 163,602 deaths), and digestive system diseases (3.74%, 116.280 deaths). Analyzing the changes in the major causes of death of climacteric women after implementation of the PNAISM we observed that mortality from circulatory system diseases and endocrine and nutritional diseases were significantly declined in post-PNAISM period: (ß = - 3.63; 95% CI - 4.54 to - 2.73 r2 = 0.87; p < 0.001; ß = - 0.51; 95% CI, - 0.71 to - 0.31; R2 = 0.73; p < 0.001, respectively). No changes were observed in mortality from neoplasms and respiratory system diseases in post-PNAISM period (p = 0,765; p = 0,233, respectively). CONCLUSIONS: After implementation of the PNAISM, we observed a downward trend in rates of mortality from diseases of the circulatory and digestive systems and from endocrine, nutritional, and metabolic diseases but stability in the rates of death from neoplasm and respiratory system diseases.

Autologous Infusion of Bone Marrow and Mesenchymal Stromal Cells in Patients with Chronic Obstructive Pulmonary Disease: Phase I Randomized Clinical Trial.

BACKGROUND AND OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is characterized by the destruction of alveolar walls, chronic inflammation and persistent respiratory symptoms. There is no curative clinical treatment for COPD. In this context, cell-based therapy is a promising therapeutic alternative for COPD. Thus, in this open, controlled and randomized Phase I Clinical Trial, we aimed to assess the safety of the infusion of autologous bone marrow mononuclear cells (BMMC), adipose-derived mesenchymal stromal cells (ADSC) and, especially, the safety of concomitant infusion (co-infusion) of BMMC and ADSC as a new therapeutic alternative for COPD. The rationale for co-infusion of BMMC and ADSC is based on the hypothesis of an additive or synergistic therapeutic effect resulting from this association. METHODS: To achieve the proposed objectives, twenty patients with moderate-to-severe COPD were randomly divided into four groups: control group - patients receiving conventional treatment; BMMC group - patients receiving only BMMC; ADSC group - patients receiving only ADSC, and co-infusion group - patients receiving the concomitant infusion of BMMC and ADSC. Patients were assessed for pulmonary function, biochemical profile, and quality of life over a 12 months follow-up. RESULTS: No adverse events were detected immediately after the infusion of BMMC, ADSC or co-infusion. In the 12-month follow-up, no causal relationship was established between adverse events and cell therapy procedures. Regarding the efficacy, the BMMC group showed an increase in forced expiratory volume (FEV1) and diffusing capacity for carbon monoxide (DLCO). Co-infusion group showed a DLCO, and gas exchange improvement and a better quality of life. CONCLUSION: The results obtained allow us to conclude that cell-based therapy with co-infusion of BMMC and ADSC is a safe procedure and a promising therapeutic for COPD. However, additional studies with a greater number of patients are needed before randomized and controlled Phase III clinical trials can be implemented.

Correction to: Regional disparities in the flow of access to breast cancer hospitalizations in Brazil in 2004 and 2014.

An amendment to this paper has been published and can be accessed via the original article.

Regional disparities in the flow of access to breast cancer hospitalizations in Brazil in 2004 and 2014.

BACKGROUND: Access to the diagnosis and treatment of breast cancer in Brazil is marked by immense inequalities in the provision of specialized assistance, which leads patients to seek treatment outside the place of residence. To evaluate the variations between 2004 and 2014 in the distribution of flow between place of residence and care, and the average distance traveled for treatment of breast cancer in the administrative regions and federal states of Brazil. METHOD: Analysis of secondary data from the years 2004 and 2014, extracted from the Department of Informatics of the Unified Health System through the Hospital Information System. Data from Hospitalization Release Authorizations were collected, and the maps were created with TabWin 3.6 software. Descriptive analysis was performed on Stata® (StataCorp, LC) 11.0. RESULTS: In the total flow, it was observed that there was a decrease in referrals between 2004 and 2014 in most regions. In 2004 the main direction of flow was in the Midwest and Southeast regions. In 2014, however, the intensity of these admissions was centralized in the Southeast region. In relation to the average distance traveled, the North, Northeast, and Midwest regions had the highest values of displacement. Of the 27 federative units, 17 presented an increase in average distance between these periods. CONCLUSION: Despite the improvement in the hospitalization of residents, in most regions and federal units, Brazilians still travel great distances when they require treatment for breast cancer.

Waiting Time between Breast Cancer Diagnosis and Treatment in Brazilian Women: An Analysis of Cases from 1998 to 2012.

Brazilian law requires that treatment for breast cancer begin within 60 days of diagnosis. This waiting time is an indicator of accessibility to health services. The aim of this study was to analyze which factors are associated with waiting times between diagnosis and treatment of breast cancer in women in Brazil between 1998 and 2012. Information from Brazilian women diagnosed with breast cancer between 1998 and 2012 was collected through the Hospital Registry of Cancer (HRC), developed by the National Cancer Institute (INCA). We performed a secondary data analysis, and found that the majority of women (81.3%) waited for ≤60 days to start treatment after being diagnosed. Those referred by the public health system, aged ≥50 years, of nonwhite race, diagnosed at stage I or II, and with low levels of education waited longer for treatment to start. We observed that only 18.7% experienced a delay in starting treatment, which is a positive reflection of the quality of the care network for the diagnosis and treatment of breast cancer. We also observed inequalities in access to health services related to age, region of residence, stage of the disease, race, and origin of referral to the health service.

Medication non-adherence in patients with type 2 diabetes mellitus with full access to medicines.

PURPOSE: The pharmacological treatment for Type 2 diabetes mellitus (T2DM) is continuous and adherence to medication is critical for disease control. Restricted access to medicines is one of the most important barriers to adherence to T2DM treatment. This study aimed to evaluate other factors for medication non-adherence by studying patients with full access to oral hypoglycemic agents. METHODS: Cross-sectional study with 300 patients receiving their medication without costs from a referral center for diabetes care in Crato, Ceará (Brazil). Participants were recruited from January to December 2017. Information was obtained by self-applied questionnaires, and the drugs used were confirmed in the prescription. Adherence to medication was determined by the Morisky Medication Adherence Scale (MMAS-4). Patient perceptions of drugs were assessed by the Beliefs about Medicines Questionnaire (BMQ). RESULTS: Only 22.7% of participants met the criterion of high adherence to medication. The most frequent characteristics in the low adherence group were married; hypertension; no regular physical activity; therapy based on the combination of two or more oral antidiabetic agents without insulin; low score in the BMQ necessity scale. Necessity score in BMQ increased with age and the number of medications used and decreased if the patient had family members with the same disease and had children. CONCLUSIONS: Full access to medicines did not assure high adherence to pharmacological treatment of type 2 diabetes mellitus. Distinctive factors to medication non-adherence may be found and specific barriers should be considered when planning actions for improving adherence in such populations.

Factors associated with perceived quality of life in artisanal fishermen: a cross-sectional study.

OBJECTIVE: To analyze a combination of socioeconomic and demographic characteristics, chronotype, stress perception and level of physical activity with the perception of quality of life in artisanal fishermen. RESULTS: Several variables were associated with lower scores of quality of life domains: workload (P = 0.047), age (P = 0.01), economic class D-E (P = 0.04) and perceived stress scores (P = 0.01) for scores physical domain; workload (P = 0.03) and perceived stress (P < 0.001) for scores psychological domain; Perceived stress (P < 0.001) and age (P = 0.01) for social domain scores; economic class D-E (P = 0.03) and perceived stress (P = 0.01) for environment domain scores; perceived stress (P = 0.01) and age (P = 0.01) for general quality of life scores and; female sex (P = 0.04) and age (P = 0.02) for the score of satisfaction with quality of life.

Factors associated with blood pressure disorders in Afro-descendant children and adolescents.

BACKGROUND: Hypertension (AH) is an emerging disease that has rapidly increased in the last decades throughout the world. The increase in blood pressure (BP) is observed with growth and development and, although the manifestation of the disease is rare in childhood and adolescence, its occurrence is increasing and the causes are likely to be from different combinations of factors. Afrodescendants have been consistently observed in many populations, including Brazil, which has the largest population of Afrodescendants outside Africa; nevertheless, data is scarce on the disease in children and adolescents. In this study, we investigated BP disorders in children and adolescents of "Quilombola" populations of the state of Tocantins, northern Brazil, and determined the disease occurrence with some factors, namely food consumption, body composition, anthropometric measures, and biochemical data. METHODS: We carried out a cross-sectional study with 67 children aged 10-17 years, comparing the variables studied between the normotensive and non-normotensive groups, using the Chi-square test for qualitative variables and the appropriate tests, according to data adherence to the Gaussian distribution for the quantitative variables. High blood pressure was defined as mean systolic or diastolic blood pressure ≥ 90 percentile for age, height, gender. RESULTS: The rate of adolescents with BP disorders was 19.4% (prehypertension 14.9% and hypertension 4.5%). There were no significant differences between the sexes for high blood pressure. In the Poisson regression analysis, the high fat percentage was associated with elevated blood pressure (p = 0.021) for adolescents. Similar associations were observed for non-HDL-c (p < 0.001) and low calcium intake (p = 0.015). CONCLUSION: Most children and adolescents in "Quilombola" communities had normal blood pressure. However, higher levels of dyslipidemia and low calcium intake are factors associated with prehypertension in the population studied with high BP.

Post-radical prostatectomy urinary incontinence: is there any discrepancy between medical reports and patients' perceptions?

BACKGROUND: Post-radical prostatectomy urinary incontinence (PPI) negatively affects the quality of life of patients. Accurate identification of the problem by physicians is essential for adequate postoperative management. In this study we sought to access whether there is, for urinary incontinence, any discrepancy between medical reports and the perception of patients. METHODS: We performed a retrospective analysis of medical records of 337 patients subjected to radical retropubic prostatectomy (RRP) between 2005 and 2010. Sociodemographic variables were collected, as well as continence status over the course of treatment. Next, we contacted patients by phone to determine continence status at present and at time of their last appointment, as well as to apply ICIQ - SF questionnaire. Poisson regression model with robust variance was used to estimate the factors associated with discrepancy, using the stepwise backward strategy. Software used was Stata® (StataCorp, LC) version 11.0. RESULTS: There is discrepancy between medical reports and patients' perceptions in 42.2% of cases. This discrepancy was found in 56% of elderly patients and 52% of men with low schooling, with statistical significance in these groups (p = 0.069 and 0.0001, respectively), whereas in multivariate regression analysis the discrepancy rate was significantly higher in black men (discrepancy rate of 52.6%) with low schooling (p = 0.004 and 0.043, respectively). CONCLUSION: There is discrepancy between medical reports and the perception of black men with low schooling in respect to post-radical prostatectomy urinary incontinence and a need for more thorough investigation of this condition in patients that fit this risk profile.

Effects of the high-inequality of income on the breast cancer mortality in Brazil.

As well as breast cancer mortality, the income inequality in Brazil is different between Federative units, including between units of the same region. To assess the effects of the high-inequality of income on breast cancer mortality in Brazilian Federative Units, in the 2010 year. This is an ecologic study. Deaths from breast cancer in Brazilian women according to Federative units were obtained from the Department of Informatics of the Unified Health System. Mortality by breast cancer was estimated per 100,000 women and age-standardized by the direct method according to World Health Organization population. Income inequality was measured by the Gini index obtained from the United Nations Development Programme. The High-inequality of income was classified by the third tercile of the distribution from the Gini index of the Federative units. Univariate analysis was performed according to data normality. Linear regressions were performed by the stepwise backward method. The confidence level was 5%. Stata® (Stata Corp, LC) 11.0. was used. The High-inequality of income was associated with worse social and demographic indicators. The age-standardized breast cancer mortality was larger in the high-inequality of income Federative units. In the adjusted analysis, these Federative units presented a mean of 2 more deaths (ranging from the 0.4 to 3.7 deaths, r² = 0.79; p = 0.018) by breast cancer per 100,000 women when compared to the Federative units without high-inequality of income. In the Brazilian Federative units, the high-inequality of income was associated with age-standardized breast cancer mortality more.

Decline in Stroke Mortality Between 1997 and 2012 by Sex: Ecological Study in Brazilians Aged 15 to 49 Years.

This study aimed to analyse the time trends of stroke mortality between 1997 and 2012 according to sex in Brazilians aged 15 to 49 years. This ecological study used data obtained from the Mortality Information System, which is available from the National Health System Department of Informatics - DATASUS and maintained by the Brazilian Ministry of Health. Stroke definition included International Classification of Disease version 10 (ICD-10) codes I60, I61, I63, and I64. Crude and age-standardized mortality rates and respective 95% confidence intervals were estimated per 100,000 inhabitants and stratified by age, region, year, and sex. Linear regression models were used to analyse the time trends with a confidence level of 95%. The statistical program used was Stata 11.0. Between 1997 and 2012, there were 124,866 deaths due to stroke in Brazilians aged 15 to 49 years. There was a decreasing linear trend in stroke mortality among men (ß = -0.46, p < 0.001, R2 = 0.95) and women (ß = -0.40, p < 0.001, R2 = 0.98) during this period. Overall there was no significant difference in stroke mortality trends by sex, except with respect to the age group of 40 to 49 years where there was a difference in the decrease of stroke mortality between men and women (interaction sex * year: ß = 0.238, p = 0.012, R² = 0.96). Mortality rates decrease significantly over time in men and women in the age group 15 to 49 years old, but there is only significant difference in the decrease of rates by sex only in the age group from 40 to 49 years old.

Time trend of breast cancer mortality in BRAZILIAN men: 10-year data analysis from 2005 to 2015.

BACKGROUND: Male Breast Cancer (MBC) is rare, which makes its understanding and treatment be extrapolated from what is known about the occurrence in women, with few epidemiological studies, with few epidemiological studies. Therefore, the aim of the present paper was to study breast cancer mortality in adult males in Brazil and its administrative regions between 2005 and 2015. METHODS: Ecological study with data on MBC mortality in adults between 2005 and 2015. Data were obtained from the Mortality Information System of the Department of Informatics of SUS (the Unified Health System of the country). Descriptive statistics were used for MBC mortality and linear regression to analyze the relationship between mortality and the country's administrative regions. Percentage Change (PC) and Annual Percentage Change (APC) were the trend measures used for MBC mortality for the period. RESULTS: Between 2005 and 2015, there were 1521 deaths due to MBC in adults in Brazil. Regarding mortality by region, there was great oscillation in the rates of the country as a whole (PC = 113,87; ß = 0,009 (IC95% 0,000 - 0,018); r2 = 0,381; P = 0,043). The highest increase in MBC mortality occurred in patients aged 80 years or older (PC = 161,04; ß = 0,201 (IC95% 0,640 - 0,339); r2 = 0,550; P = 0,009) and there was significant increase in deaths for the 50-54-year age group (PC = 224,01; ß = 0,135 (CI95% 0,052; 0,218); r2 = 0,601; P = 0,005). CONCLUSION: Mortality in adults due to MBC increased in Brazil during the study period with the highest percentage increase occurring for individuals aged 80 years or older.

Influence of sexual maturation status on the relationship between body adiposity indicators and age: a cross-sectional study.

OBJECTIVES: To determine the influence of sexual maturation status on adiposity indicators of children and adolescents. RESULTS: 2412 individuals participated, 1285 (47.4%) males and 1408 (52.6%) females. There was moderate to weak correlation between age and adiposity indicators for both sexes. By analyzing the relationship between age and body fat indexes adjusted for Sexual Maturation Status, several changes were observed, mainly in girls. Precocious maturation was associated with increased adiposity indicators in girls, whereas late maturation was associated with decreased adiposity indicators in both sexes. Precocious maturation was associated with increased adiposity indicators in girls, whereas late maturation was associated with decreased adiposity indicators in both sexes.

Association between vitamin D plasma concentrations and VDR gene variants and the risk of premature birth.

BACKGROUND: Premature birth is the main cause of mortality in children under 1 year, and vitamin D deficiency during gestation is associated with prematurity. The effects of vitamin D are mediated by its receptor, which is encoded by the VDR gene. VDR variants-such as single nucleotide variation (SNV)-are associated with increased risk of prematurity, but there are conflicting results. We evaluated serum vitamin D concentrations and the frequency of TaqI/A > G, BsmI/C > T, ApaI/C > A, and FokI/A > T VDR variants in mothers and preterm (PTN) and full-term (FTN) newborns. METHODS: We conducted a case-control study comprising 40 pairs of mothers and their PTNs (gestational age < 32 weeks and/or weight < 1500 g), and 92 pairs of mothers and FTNs as controls. Genotyping was performed by real-time PCR, and plasma vitamin D concentrations were measured by electrochemiluminescence. RESULTS: Vitamin D levels were significantly lower in PTN mothers. Genotypes TaqI/GG and BsmI/TT, and haplotypes AAG (TaqI/A-ApaI/A-FokI/G) and GCA (TaqI/G-ApaI/C-FokI/A) were significantly more frequent in PTN mothers, and genotypes TaqI/AG, ApaI/AA, and FokI/AG resulted in significantly lower vitamin D levels. Genotypes BsmI/TT and ApaI/AA were associated with vitamin D deficiency and 2.36 and 7.99 times greater likelihood of PTB, respectively. Vitamin D levels were also lower in PTNs, although it was not statistically significant. Genotypes BsmI/TT, ApaI/AA, and FokI/GG, and haplotype GAG (TaqI/G-ApaI/A-FokI/G) were significantly more frequent in PTNs. Those with FokI/GG genotypes had significantly lower vitamin D levels. CONCLUSIONS: VDR variants contribute to variations in vitamin D concentrations and the increased risk of prematurity.

The burden of stroke in Brazil in 2016: an analysis of the Global Burden of Disease study findings.

OBJECTIVE: To analyze the epidemiological stroke data of Brazil according to the Global Burden of Disease (GBD) study in 2016 and secondary data from the GBD database. RESULTS: The highest percentage of deaths due to stroke in general occurred in individuals aged 70 years or over (60.2%; 95% confidence interval [CI] 59.9-60.5%) followed by that in men (52.9%; 95% CI 52.6-53.2%). Ischemic stroke was the most common type, accounting for 61.8% (95% CI 61.5-62.1%) of deaths due to stroke in 2016. Most of the epidemiological indicators (incidence, prevalence, mortality-to-incidence ratio, mortality, disability-adjusted life years, years lost due to disability, and years of life lost) of stroke in general or either type of stroke were higher in men and those aged 70 years or over. Stroke data in Brazil are a major concern and represent a real health challenge for the coming decades. Men and individuals aged 70 years or older appear to represent the groups with the highest epidemiological parameters and risk for the various stroke outcomes. However, this does not mean the female data are irrelevant, which, although representing a lower risk than the male data, also raise the need for policies aimed at prevention and improvement in the treatment of stroke and its sequelae.

Pelvic floor disorders in postpartum adolescents in the Western Amazon: a cross-sectional study.

PURPOSE: To analyze the postpartum pelvic floor disorders (PFD) and mode of delivery among adolescents, late adolescents, and young women from Western Amazon. PATIENTS AND METHODS: Cross-sectional study was carried out in the urban area of Western Amazon in the city of Rio Branco, Acre, Brazil, from October 2016 to February 2017. This is a convenience sample of women up to 30 years who completed six months postpartum, separated in three groups according to maternal age: adolescents (age ≤19 years), late adolescents (20-24 years), and young women (25-30 years). Participants were home interviewed and answered Pelvic Floor Distress Inventory-20 (PFDI-20). Delivery clinical data were collected from patient's medical records. RESULTS: In total, 285 participants were interviewed: 41 adolescents, 103 late adolescents, and 141 young women. After controlling for confounding factors, prevalences of PFD were higher in the adolescents' group compared with the young women's group (urinary incontinence [UI], prevalence ratio [PR] = 1.75, 95% CI 1.14-2.69; urge urinary incontinence [UUI], PR = 1.88, 95% CI 1.02-3.47; stress urinary incontinence, PR = 2.00, 95% CI 1.11-3.62; fecal incontinence [FI], PR = 4.40, 95% CI 1.36-14.27). PFDI-20 scores also presented higher values in the adolescent group (Pelvic Organ Prolapse Distress Inventory [POPDI], PR = 2.02, 95% CI 1.49-2.75; urinary distress inventory [UDI], PR = 2.09, 95% CI 1.47-2.98; PFDI, PR = 2.12, 95% CI 1.47-2.98). Analyzing the influence of cesarean section, adolescents have higher prevalence of UI (PR = 1.84, 95% CI 1.04-3.26, P=0.037), UUI (PR = 2.36, 95% CI 1.03-5.40, P=0.042), and FI (PR = 4.09, 95% CI 1.21-13.81, P=0.023). In addition, POPDI (PR = 2.15, 95% CI 1.60-2.89, P<0.001), UDI (PR = 2.25, 95% CI 1.61-3.16, P<0.001), and PFDI (PR = 2.27, 95% CI 1.68-3.08, P<0.001) scores are also higher among adolescents where the baby is born by cesarean section. CONCLUSION: Adolescents present higher prevalence and symptoms of PFD; furthermore, cesarean delivery has a greater negative influence on the pelvic floor of adolescents when compared with young women. This reinforces the importance of PFD investigation among the adolescent population, mainly in developing countries which have high rates of adolescent pregnancy and cesarean section.