An epidemiological index for drought vulnerability in the Rio Grande do Norte State, Brazil.

In the Northeast Brazil (NEB), the impacts of climate extreme events such as severe droughts are aggravated by poverty and poor socioeconomic conditions. In this region, such events usually result in the spread of endemic diseases, problems in water distribution, and agricultural losses, often leading to an increase in the population's vulnerability. Thus, this study aims to evaluate the microregions of the Rio Grande do Norte (RN) state, in the NEB, according to the Epidemiological Index for Drought Vulnerability (EIDV). We mapped and classified the microregions according to three dimensions of vulnerability: risk, susceptibility, and adaptive capacity. We also verified potential associations between drought risk and epidemiological vulnerability. The EIDV was calculated by considering the three dimensions of vulnerability as mutually exclusive events and applying the third axiom of probability. Then we carried out a cluster analysis in order to classify the microregions according to similarities in the EIDV. Odds ratio were also calculated in order to evaluate the odds of microregions having a high susceptibility to diseases and high vulnerability given the drought risk. Results showed that the Pau dos Ferros, Seridó Ocidental, Seridó Oriental, and Umarizal microregions were the most vulnerable, while Natal and Litoral Sul were the least vulnerable. Regarding the dimensions of vulnerability, we observed that almost the entire RN state exhibited high drought risk. Pau dos Ferros and Umarizal had the highest susceptibility and Litoral Nordeste presented the worst adaptive capacity to the effects of drought on health. The EIDV revealed that the population of the RN state needs improvements in living conditions and health, since socioeconomic status is one of the factors that most influence the vulnerability of microregions, which in turn is aggravated by drought risk.

Consistency of three different questionnaires for evaluating sexual function in healthy young women.

BACKGROUND: Most studies on female sexual dysfunction are performed in population inventories and under specific clinical conditions. These approaches are performed using validated psychometric scales. Different scales to assess sexual function use different numbers of questions to characterize their domains. They also may or may not include domains of interaction between sexual partners. The objective of this study was to compare the precision between scales to be able to analyze their accuracy for better diagnosis of sexual dysfunction. METHODS: Fifty (50) healthy young women were enrolled in this study. Three questionnaires (FSFI, SQ-F, and GRISS) were applied to assess sexual function (n = 44). The accuracy measured by the area under the ROC curve (AUC) for individual domains and to cross-validated pairwise comparison of the three analyzed instruments was used. Kruskall-Wallis test to analyze individual domains of the scales was also used.The P-value was established as 0.05. RESULTS: The results showed that all domains and total FSFI and GRISS scores were significantly different between normal and dysfunctional women, but not for SQ-F domains. Indeed, AUC accuracy varied from excellent-good domain discrimination for FSFI and GRISS, but fair-poor for SQ-F. For the paired comparison between the three questionnaires a fair accuracy was detected. The specificity percentage was around 84% whereas that for sensibility was low, around 30%. CONCLUSIONS: The best agreement was between FSFI and SQ-F, probably being related to high similar shared questions when compared to GRISS. The agreement between SQ-F and GRISS was low possible due to low number of questions in SQ-F to characterize similar domains. This study evidenced high agreement between scales to sensitivity and low agreement for specificity, thereby conferring fair accuracy between them. Thus, the limited grade for discriminatory capacity (AUC) for sexual response should be considered when comparing results from these three different questionnaires and also when comparing with other different scales. In addition, despite the diversity of scales, the high reliability and fit for their desire domain suggest that the FSFI scale has good accuracy for the current clinical assessment of women's sexual health. CLINICAL TRIAL REGISTRATION: NCT03241524 . Retrospectively registered on 08/02/2017.

The adaptive value of primate color vision for predator detection.

The complex evolution of primate color vision has puzzled biologists for decades. Primates are the only eutherian mammals that evolved an enhanced capacity for discriminating colors in the green-red part of the spectrum (trichromatism). However, while Old World primates present three types of cone pigments and are routinely trichromatic, most New World primates exhibit a color vision polymorphism, characterized by the occurrence of trichromatic and dichromatic females and obligatory dichromatic males. Even though this has stimulated a prolific line of inquiry, the selective forces and relative benefits influencing color vision evolution in primates are still under debate, with current explanations focusing almost exclusively at the advantages in finding food and detecting socio-sexual signals. Here, we evaluate a previously untested possibility, the adaptive value of primate color vision for predator detection. By combining color vision modeling data on New World and Old World primates, as well as behavioral information from human subjects, we demonstrate that primates exhibiting better color discrimination (trichromats) excel those displaying poorer color visions (dichromats) at detecting carnivoran predators against the green foliage background. The distribution of color vision found in extant anthropoid primates agrees with our results, and may be explained by the advantages of trichromats and dichromats in detecting predators and insects, respectively.

The dependence of hydropower planning in relation to the influence of climate in Northeast Brazil.

Water scarcity in Northeast Brazil has caused latent perturbations in hydropower generation, which is undesirable for Energy Planning. Thus, this study aims to identify the influence of climate on hydropower generation by Sobradinho Dam in Bahia by: (i) assessing the streamflow climatology (1964-2017) and rainfall (1964-2015) through time series analysis, hypothesis testing and cluster analysis; (ii) assessing hydropower generation (2000-2017) using climate and energy data, through principal component analysis and dynamic regression models. The results indicated reductions of up to 30% in the mean climatological streamflow patterns; and reductions in rainfall amounts of 22.9%, 13.3% and 12.4% at latitudes 9°, 12°and 13°South, respectively. Decreasing trends were found in simulations of hydropower generation under the influence of different climate variables. Thus, the hydroelectric system operates in contingency, due to the growing energy load demand resulting in more energy imports in Northeast Brazil.

Effect of predominant breastfeeding duration on infant growth: a prospective study using nonlinear mixed effect models.

OBJECTIVE: The aim of this study is to assess the effect of predominant breastfeeding duration on infant growth by means of repeated measurements model. METHODS: This prospective study is comprised of four follow-up evaluations at approximately 0.5, 2, 6 and 9 months after birth, including structured interviews that simultaneously gathered information regarding infant growth and breastfeeding practices. The study took place in a healthcare center in Rio de Janeiro, Brazil, from 1999 to 2001. Four hundred seventy-nine postpartum women and their newborns were enrolled in the cohort. Body weight and length measurements taken at five different occasions (birth, 0.5, 2, 6, and 9 months) constituted the dependent variables. We expressed the growth process using nonlinear mixed models. RESULTS: Infants with longer predominant breastfeeding duration, although growing faster in the first months of life, reached an inferior equilibrium body weight and length compared to infants who received nonhuman milk earlier in life. The age at which the rate of weight gain of the formula-fed infants becomes greater than that of the breastfed infants is approximately 6.75 months for boys and 7 months for girls. CONCLUSIONS: This study confirms the differences observed in infant growth according to different breastfeeding practices starting from the sixth month of life. Use of nonlinear models allowed for a greater precision of parameter estimates. We believe that this approach facilitates the analysis and interpretation of growth data at the individual and population levels.

Impacts of social support on symptoms in Brazilian women with fibromyalgia.

We aimed to assess the impact of social support on symptoms in Brazilian women with FM. An observational, descriptive study enrolling 66 women who met the 1990 American College of Rheumatology (ACR) criteria. Social support was measured by the Social Support Survey (MOS-SSS), functionality was evaluated using the Fibromyalgia Impact Questionnaire (FIQ), depression was assessed using the Beck Depression Inventory (BDI), anxiety was measured using the Hamilton Anxiety Scale (HAS), affectivity was measured by Positive and Negative Affect Schedule (PANAS), and algometry was carried out to record pressure pain threshold (PPth) and tolerance (PPTo) at 18 points recommended by the ACR. Patients were divided into normal (NSS) or poor social support (PSS) groups with PSS defined as having a MOS-SSS score below the 25th percentile of the entire sample. Mann-Whitney or Unpaired t-test were used to compare intergroup variables and Fisher's for categorical variables. Analysis of covariance and Pearson correlation test were used. No differences in sociodemographic variables between PSS and NSS were found. Differences between NSS and PSS groups were observed for all four subcategories of social support and MOS-SSS total score. Significant differences between NSS and PSS on depression (p=0.007), negative affect (p=0.025) and PPTh (p=0.016) were found. Affectionate subcategory showed positive correlation between pain and positive affect in PSS. Positive social interaction subcategory showed a negative correlation between FIQ and depression state. Therefore social support appears to contribute to ameliorate mental and physical health in FM.

[Nutritional status of elderly Brazilians: a multilevel approach]. / Estado nutricional de idosos no Brasil: uma abordagem multinível.

The objectives of this study were to diagnose the nutritional status of the elderly Brazilian population and to identify associated factors. The study used data from the Brazilian Household Budget Survey (2008/2009) for 20,114 elderly, whose nutritional status was assessed by body mass index (BMI). Associated factors were tested with the Pearson chi-square test and multilevel linear models. The hierarchical analysis showed a significant effect of state of Brazil on BMI variance (p-value = 0.001). The individual level showed a negative association (p-value < 0.001) with Asian-descendant race, male gender, living alone, and older age and a positive association with per capita income. Underweight was more prevalent among elderly in rural areas (26.3%) and in the Northeast (23.7%) and Central regions (20.9%), and obesity was more prevalent in the South (45.1%) and Southeast (38.3%) and in cities (39%). The study suggests the importance of further in-depth research on nutritional status of elderly based on contextual variables.

Estimating weight in elderly residents in nursing homes: which equation to use? / Estimativa de peso em idosos institucionalizados: qual equação utilizar?

INTRODUCTION: When it is impossible to measure weight in the elderly, estimation methods can be employed. However, such methods are not always applicable and can lead to estimation errors that compromise both the clinical practice and the results in epidemiological studies. OBJECTIVE: To compare and validate weight estimation methods in the elderly living in nursing homes in Natal, Rio Grande do Norte, Brazil. METHODS: The equations were evaluated qualitatively, by the reproducibility of the measurements that comprised them, and quantitatively, by the mean difference between the measured and the estimated weights, using Student's t -test for paired samples or ANOVA, the coefficient of determination (R²), root mean square error (RMSE), intra-class correlation coefficient (ICC) and graphical analysis of residuals. The significance value adopted was of p < 0.05. It was considered applicable when the equation presented R² > 0.7; lowest RMSE among the evaluated equations; ICC > 0.7; and respective 95% confidence interval with less distance between the upper and lower limits. RESULTS: We evaluated 315 elderly from 10 nursing homes in Natal. The mean body weight was higher in the younger elderly and those without mobility restriction. The qualitative analysis showed the equation 5 as having the best reproducibility, since it does not use skinfold measurements. The quantitative analysis revealed the equation 5 as the one with the best applicability across the studied population and in the different genders, age groups (60 - 69 years, 70 - 79 years, and 80 years or more), and mobility restriction conditions. CONCLUSION: The equation 5 was applicable for estimating weight in the evaluated population and in the different strata analyzed.

[Breastfeeding practices and infant growth: a longitudinal study in Rio de Janeiro, Brazil, 1999/2001]. / Amamentação e crescimento infantil: um estudo longitudinal em crianças do Rio de Janeiro, Brasil, 1999/2001.

Various studies have shown significant differences in growth patterns between breastfed and formula-fed infants. This paper aims to evaluate the effect of predominant breastfeeding duration on anthropometric profile and to detect determinants associated with growth in Brazilian infants. Four hundred and seventy nine infants were studied in a health center in Rio de Janeiro through a longitudinal study with four follow-up waves at 0.5, 2, 6, and 9 months. The response variables were body weight and length, collected according to a standardized procedure. Data analysis was performed having longitudinal mixed-effects model as the main statistical procedure. Gestational age, birth weight, and birth length were positively associated with weight and length gains. The positive effect showed that the longer breastfeeding lasts, the greater the weight gains. Infants born through vaginal delivery presented lower weight gains than those born by cesarean delivery. The results emphasize the need for health programs encouraging breastfeeding practices up to the sixth month of life.

Physical activity and sexual function in middle-aged women.

OBJECTIVE: To investigate the relationship between physical activity level and sexual function in middle-aged women. METHODS: A cross-sectional study with a sample of 370 middle-aged women (40-65 years old), treated at public health care facilities in a Brazilian city. A questionnaire was used containing enquiries on sociodemographic, clinical and behavioral characteristics: the International Physical Activity Questionnaire (IPAQ), short form, and the Female Sexual Function Index (FSFI). RESULTS: The average age of the women studied was 49.8 years (± 8.1), 67% of whom exhibited sexual dysfunction (FSFI ≤ 26.55). Sedentary women had a higher prevalence (78.9%) of sexual dysfunction when compared to active (57.6%) and moderately active (66.7%) females (p = 0.002). Physically active women obtained higher score in all FSFI domains (desire, arousal, lubrication, orgasm, satisfaction and pain) and total FSFI score (20.9), indicating better sexual function than their moderately active (18.8) and sedentary (15.6) counterparts (p <0.05). CONCLUSION: Physical activity appears to influence sexual function positively in middle-aged women.

Cuidado fisioterapêutico na função sexual feminina: intervenção educativa na musculatura do assoalho pélvico / Physical therapy care in female sexual function: educational intervention of the pelvic floor muscles

O estudo tem a finalidade de realizar uma intervenção educativa baseada em exercícios perineais de conscientização e fortalecimento da musculatura do assoalho pélvico (MAP) e de aplicar perineometria e palpação digital para comprovar sua eficácia. O treinamento destes músculos produz aumento na vascularização pélvica e na sensibilidade clitoriana, ocasionando otimização da satisfação sexual. A amostra foi constituída por 31 adultas jovens que atenderam aos critérios de inclusão. O assoalho pélvico foi avaliado através da palpação digital pelo método Perfect e pelos perineômetros Peritron (9300+) e Biofeedback pressório ou Perina, além da aplicação do questionário Female Sexual Function Index (FSFI). As mulheres foram submetidas a uma intervenção, sendo orientadas, através de cartilha, a realizarem em seus domicílios duas vezes semanais os exercícios de fortalecimento do assoalho pélvico. Mensalmente, as participantes foram reavaliadas pelos mesmos instrumentos e evoluíram para um novo nível de exercícios da MAP. Verificou-se potencialização da força da MAP ao longo da intervenção e melhora da satisfação sexual, tendo influência positiva mais significativa nas respostas sexuais envolvendo desejo, excitação e orgasmo. Conclui-se que é fundamental que haja uma interação multidisciplinar para trabalhar com disfunções sexuais da mulher e estabelecer um aumento da eficácia da terapêutica. (AU)

The study aimed to apply an educational intervention based on perineal exercises of awareness and strengthening of the pelvic floor muscles (PFM) and apply perineometry and digital palpation to prove its effectiveness. Training these muscles produces an increase in pelvic vascularity and clitoral sensitivity, resulting in optimization of sexual satisfaction. The sample consisted of 31 young adults who attended the inclusion criteria. The pelvic floor was assessed by digital palpation by Perfect method and the perineometer Peritron (9300+) and Biofeedback pressure Perina, in addition to the questionnaire Female Sexual Function Index (FSFI). The women were submitted to an intervention, being oriented to conduct in their households, twice a week, the strengthening exercises of the pelvic floor through a hornbook. Every month, the participants were re-evaluated by the same instruments and evolved to a new level of PFM exercises. There was potentiation of the PFM force during the intervention and improved sexual satisfaction, and most significant influence on the sexual responses involving desire, arousal and orgasm. It is concluded to be fundamental the existence of a multidisciplinary interaction to work with sexual dysfunction of women and provide therapeutic efficacy increase. (AU)

Influence of cortisol and DHEA-S on pain and other symptoms in post menopausal women with fibromyalgia.

OBJECTIVE: This study aims to assess cortisol and dehydroepiandrosterone sulfate (DHEA-S) levels in post-menopausal women with FMS and correlate it with pain threshold and tolerance, depression and quality of life. METHODS: We conducted a cross sectional observational study of 17 women with FMS (FMS group), and 19 healthy volunteers (CT group). Algometry, the Beck Depression Index (BDI) and Fibromyalgia Impact Questionnaire (FIQ) were used. Blood samples were collected in the morning (8:00-9:30 am) to determine cortisol and DHEA-S plasmatic levels by chemiluminescence. RESULTS: Significant differences between groups were recorded for pain threshold and tolerance (p< 0.0001), BDI (p< 0.0001) and all FIQ parameters (p< 0.0001). No significant differences in cortisol levels were found between the two groups (p=0.325). In the FMS group, a tangential effect was observed for DHEA-S (p=0.094) and positive correlations were found between DHEA-S, pain threshold (p=0.017) and pain tolerance (p=0.044). No correlation was observed between cortisol and DHEA-S levels and the variables of depression and quality of life for either group. CONCLUSIONS: There seems to be an influence of the decreased levels of DHEA-S and increased pain sensitivity in post-menopausal women with FMS.

Qualidade de vida relacionada à saúde dos cuidadores formais de idosos institucionalizados em Natal, Rio Grande do Norte / Calidad de vida relacionada con la salud de los cuidadores formales de personas mayores institucionalizados en Natal, Rio Grande do Norte / Health-related quality of life of formal caregivers of the institutionalized elderly in Natal, Rio Grande do Norte

O Brasil vem experimentando um processo de envelhecimento populacional que impõe desafios para atender às necessidades dos idosos, especialmente os dependentes funcionais. Nesse cenário, as instituições de longa permanência para idosos (ILPI) podem ser importantes para prover auxílio e amparo a esse grupo populacional e seus familiares. O objetivo desse estudo é caracterizar o perfil do cuidador de idosos institucionalizados em ILPI, abordando especificamente a qualidade de vida relacionada à saúde mensurada pelo instrumento SF-36. Foi também analisado o perfil sociodemográfico e ocupacional desses indivíduos. Os dados provêm de uma pesquisa realizada em 2012 entre os cuidadores formais ocupados em 11 das 12 ILPI cadastradas em Natal, RN. Foram entrevistados 92 cuidadores formais, representando 68% do universo desse grupo ocupacional. Realizaram-se análises descritivas do perfil do cuidador, distinguindo-se por natureza da ILPI (filantrópica ou privada), bem como testes estatísticos para verificar se as diferenças segundo a natureza das instituições eram significativas. A maior perda de saúde foi observada para o domínio "estado de saúde geral", seguido pelos domínios vitalidade e de dor, definidos pelo SF-36. A perda de saúde pode refletir, em certa medida, a sobrecarga de trabalho imposta aos cuidadores, em relação tanto à jornada de trabalho como ao elevado número de idosos sob a responsabilidade de cada cuidador. Não foram observadas diferenças significativas na qualidade de vida relacionada à saúde segundo natureza das instituições.

Brazil has experienced an aging population process that poses challenges to meet the needs of the elderly group, especially those with functional limitations. In this scenario, Long-Term Care (LTC) institutions for the elderly can be important to provide support and help to this population group and their families. The aim of this paper is to characterize the profile of the formal caregivers in LTC institutions. More specifically, this paper addresses the health-related quality of life (HRQoL) of this population group measured by the SF-36 instrument. Sociodemographic and occupational profile of these individuals is also discussed. The data come from a survey carried out in 2012 among the formal caregivers employed in 11 of the 12 ILPI registered in Natal, RN. Ninety two formal caregivers were interviewed and they represent 68% of the total universe of this group in the city. Descriptive analysis and statistical tests to verify differences between philanthropic and private institutions are provided. The greatest loss of HRQoL was observed for the general health perceptions dimension followed by vitality and bodily pain domains. The loss of HRQoL may reflect the excessive workload imposed on caregivers related to both working hours and the high number of elderly people under the responsibility of each caregiver. Non statistically significant differences were observed in the HRQoL between philanthropic and private institutions.

Brasil está experimentando un proceso de envejecimiento de la población que plantea desafíos para satisfacer a las necesidades de las personas mayores, sobre todo los dependientes funcionales. Instituciones de larga permanencia (ILP) para adultos mayores pueden ser una opción de ayuda y apoyo a este grupo de la población y sus familias. El objetivo de este artículo es caracterizar el perfil del cuidador de los ancianos institucionalizados y específicamente abordar la calidad de vida relacionada con la salud (CVRS) basado en el SF-36. También se analizó el perfil sociodemográfico y laboral de estas personas. Los datos provienen de una encuesta realizada en 2012 entre los cuidadores formales ocupados en 11 de las 12 ILP registradas en Natal, RN. Se entrevistó a 92 cuidadores formales, lo que representa el 68% del universo. Se realizaron análisis descriptivos y pruebas estadísticas para verificar las diferencias entre las instituciones filantrópicas y privadas. La mayor pérdida de la CVRS se observó para la dimensión de las percepciones de la salud general, seguida por los dominios de la vitalidad y dolor. La pérdida de la salud puede, en cierta medida, reflejar la mayor carga de trabajo impuesta a los cuidadores, tanto en relación con las horas de trabajo, así como el elevado número de adultos mayores bajo la responsabilidad de cada cuidador. No se observaron diferencias significativas en la CVRS entre las instituciones filantrópicas y privadas.

[Influence of menopausal symptoms on sexual function in middle-aged women]. / Influência dos sintomas climatéricos sobre a função sexual de mulheres de meia-idade.

PURPOSE: To evaluate the influence of climacteric symptoms on the sexual function in middle-aged women. METHODS: A cross-sectional population study was conducted on a sample of 370 middle-aged women, aged 40 to 65 years-old, cared for at the Basic Health Units in Natal, in the state of Rio Grande do Norte, Brazil. We used a questionnaire containing questions on sociodemographic, clinical, and behavioral characteristics. Sexual function was evaluated by the Female Sexual Function Index (FSFI), while the menopause symptoms by the Menopause Rating Scale (MRS). RESULTS: In the studied group, 67% of the women reported risk for sexual dysfunction (FSFI≤26.5). All FSFI domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) were lower in women with risk for sexual dysfunction (p<0.001). The arousal, orgasm, and pain domains were most likely to contribute to lower FSFI scores. All somatovegetative, urogenital, and psychological MRS symptoms were more elevated in women with risk for sexual dysfunction, being significant for all comparisons (p<0.001). Logistic regression analysis revealed that the likelihood of women with risks of sexual dysfunction to present hot flushes, depression, sexual problems, and vaginal dryness was, respectively, 2.1 (95%CI 1.2 - 3.5); 2.4 (95%CI 1.5 - 4.1); 2.3 (95%CI 1.4 - 3.8), and 2.2 (95%CI 1.3 - 3.6) times higher, respectively, compared to those without any risk. CONCLUSION: Climacteric symptoms seem to influence the sexual function in middle-aged women.

Impacts of social support on symptoms in Brazilian women with fibromyalgia / Impacto do apoio social sobre os sintomas de mulheres brasileiras com fibromialgia

ABSTRACT We aimed to assess the impact of social support on symptoms in Brazilian women with FM. An observational, descriptive study enrolling 66 women who met the 1990 American College of Rheumatology (ACR) criteria. Social support was measured by the Social Support Survey (MOS-SSS), functionality was evaluated using the Fibromyalgia Impact Questionnaire (FIQ), depression was assessed using the Beck Depression Inventory (BDI), anxiety was measured using the Hamilton Anxiety Scale (HAS), affectivity was measured by Positive and Negative Affect Schedule (PANAS), and algometry was carried out to record pressure pain threshold (PPth) and tolerance (PPTo) at 18 points recommended by the ACR. Patients were divided into normal (NSS) or poor social support (PSS) groups with PSS defined as having a MOS-SSS score below the 25th percentile of the entire sample. Mann-Whitney or Unpaired t-test were used to compare intergroup variables and Fisher's for categorical variables. Analysis of covariance and Pearson correlation test were used. No differences in sociodemographic variables between PSS and NSS were found. Differences between NSS and PSS groups were observed for all four subcategories of social support and MOS-SSS total score. Significant differences between NSS and PSS on depression (p = 0.007), negative affect (p = 0.025) and PPTh (p = 0.016) were found. Affectionate subcategory showed positive correlation between pain and positive affect in PSS. Positive social interaction subcategory showed a negative correlation between FIQ and depression state. Therefore social support appears to contribute to ameliorate mental and physical health in FM.

RESUMO Objetivou-se avaliar o impacto do apoio social sobre os sintomas de mulheres brasileiras com fibromialgia (FM). Trata-se de um estudo observacional descritivo que selecionou 66 mulheres que atendiam aos critérios do Colégio Americano de Reumatologia (ACR) de 1990. O apoio social foi medido com o Social Support Survey (MOS-SSS), a funcionalidade com o Questionário do Impacto da Fibromialgia (FIQ), a depressão com o Inventário de Depressão de Beck (BDI), a ansiedade com a Escala de Ansiedade de Hamilton (HAS), a afetividade com o Positive and Negative Affect Schedule (Panas) e foi feita algometria para registrar o limiar da dor à pressão (LDP) e a tolerância álgica à pressão (TAP) nos 18 pontos recomendados pelo ACR. Os pacientes foram divididos nos grupos apoio social normal (ASN) ou ruim (ASR); o ASR foi definido como uma pontuação nos MOS-SSS abaixo do percentil 25 da amostra total. Usou-se o teste de Mann-Whitney ou o teste t não pareado para comparar variáveis intergrupos e o de Fisher para as variáveis categóricas. Usaram-se a análise de covariância e o teste de correlação de Pearson. Não houve diferença nas variáveis sociodemográficas entre os grupos ASN e ASR. Observaram-se diferenças entre os grupos ASN e ASR para todas as quatro subcategorias de apoio social e pontuação total do MOS-SSS. Encontraram-se diferenças significativas entre o ASN e o ASR na depressão (p = 0,007), afeto negativo (p = 0,025) e LDP (p = 0,016). A subcategoria apoio afetivo mostrou correlação positiva entre a dor e o afeto positivo no grupo ASR. A subcategoria interação social positiva mostrou uma correlação negativa entre o FIQ e o estado de depressão. Portanto, o apoio social parece contribuir para a melhoria na saúde mental e física na FM.

Possible organizational effect of sex steroids on the stabilization of manual preference in female common marmosets (Callithrix jacchus).

Handedness has been widely studied in nonhuman primates. However, few studies investigate this behavior throughout ontogenetic development. To determine the influence of developmental stage in common marmoset (Callithrix jacchus) females, we used six animals, which were observed in food-reaching tests involving hand-use preference from the infantile to the adult phase. During this period, fecal samples were collected for sexual hormone analysis (estrogen and progesterone). The results point to correlations between age and stabilization of manual preference across the developmental phases. A relationship between progesterone and the intensity of hand use asymmetry was observed during the pubertal period, when the data was grouped into three phases: prepubertal, pubertal, and postpubertal. These data show increasing strength of hand preference during ontogenetic development and that sexual hormones may be involved in females.

[The meaning of health in sexual relations according to women treated under the Unified National Health System in Natal, Rio Grande do Norte State, Brazil]. / Os significados de saúde na relação sexual para mulheres assistidas pelo SUS na cidade de Natal, Rio Grande do Norte, Brasil.

The aim of this article is to discuss the social representations of "health in sexual relations" as reported by women treated under the Unified National Health System (SUS) in Natal, Rio Grande do Norte, Brazil. A total of 150 women were tested using the free word recall test, with "health in sexual relations" as the stimulus. Women were also asked about their sources of information on the subject. The results were obtained with content analysis and the EVOC software. We identified three representational dimensions: prevention, relationship with the partner, and quality of life. The central nucleus of social representation consisted of the elements "prevention" and "condoms". Likely sources for representation were television, health services, and dialogue with family members and partners. Representations were composed of concepts related to prevention, a good partner relationship, and overall well-being. The results illustrate the need to expand women's sexual health aspects that are considered relevant by the health system.

Estado nutricional de idosos no Brasil: uma abordagem multinível / Nutritional status of elderly Brazilians: a multilevel approach / Estado nutricional de ancianos en Brasil: un enfoque multinivel

Resumo: O objetivo deste estudo foi diagnosticar o estado nutricional da população idosa brasileira, identificando fatores associados. Utilizou-se dados da Pesquisa de Orçamentos Familiares (POF 2008/2009) de 20.114 idosos, cujo perfil nutricional foi avaliado segundo o índice de massa corporal (IMC). As análises de fatores associados foram testadas com base no teste de qui-quadrado de Pearson e modelos lineares multiníveis. Na análise hierárquica constatou-se efeito significativo da Unidade da Federação na variância do IMC (valor de p = 0,001). Em nível individual detectou-se associação negativa (valor de p < 0,001) com: cor/raça amarela, sexo masculino, idosos que residiam sozinhos e idade; e positiva com a renda per capita. Observou-se ainda, maiores prevalências de baixo peso em idosos residentes no estrato rural (26,3%) e nas regiões Nordeste (23,7%) e Centro-oeste (20,9%), e de obesidade em idosos que residem nas regiões Sul (45,1%) e Sudeste (38,3%) e no estrato urbano (39%). Sugere-se aprofundar o estudo das características do estado nutricional de idosos utilizando-se variáveis contextuais.

Abstract: The objectives of this study were to diagnose the nutritional status of the elderly Brazilian population and to identify associated factors. The study used data from the Brazilian Household Budget Survey (2008/2009) for 20,114 elderly, whose nutritional status was assessed by body mass index (BMI). Associated factors were tested with the Pearson chi-square test and multilevel linear models. The hierarchical analysis showed a significant effect of state of Brazil on BMI variance (p-value = 0.001). The individual level showed a negative association (p-value < 0.001) with Asian-descendant race, male gender, living alone, and older age and a positive association with per capita income. Underweight was more prevalent among elderly in rural areas (26.3%) and in the Northeast (23.7%) and Central regions (20.9%), and obesity was more prevalent in the South (45.1%) and Southeast (38.3%) and in cities (39%). The study suggests the importance of further in-depth research on nutritional status of elderly based on contextual variables.

Resumen: El objetivo de este estudio fue diagnosticar el estado nutricional de la población anciana brasileña, identificando factores asociados. Se utilizaron los datos de 20.114 ancianos, procedentes de la Investigación sobre Presupuestos Familiares (2008/2009), cuyo perfil nutricional fue evaluado según el índice de masa corporal (IMC). Los análisis de factores asociados se probaron a partir del test chi-cuadrado de Pearson y modelos lineales multiniveles. En el análisis jerárquico se constató el efecto significativo de la Unidad de la Federación en la variancia del IMC (valor de p = 0,001). En un nivel individual, se detectó una asociación negativa (valor de p < 0,001) con: color/raza oriental, sexo masculino, ancianos que residían solos y con la edad; y positiva con la renta per cápita. Se observaron incluso mayores prevalencias de bajo peso en ancianos residentes en el estrato rural (26,3%) y en la regiones Nordeste (23,7%) y Centro-oeste (20,9%), y de obesidad en ancianos residentes en las regiones Sur (45,1%) y Sudeste (38,3%) y en el estrato urbano (39%). Se sugiere profundizar en el estudio de las características del estado nutricional de ancianos, utilizando variables contextuales.

[Impact of physical activity on quality of life in middle-aged women: a population based study]. / Impacto da atividade física na qualidade de vida de mulheres de meia idade: estudo de base populacional.

PURPOSE: To evaluate the influence of physical activity on the quality of life of middle-aged women. METHODS: A population-based cross-sectional study was conducted on 370 women aged 40 to 65 years-old recruited from a population-based sample. Enrollment took place in Basic Health Units in each health district of the city (North, South, East, and West) from June to September 2011. According to the Municipal Health Department of the City, 20,801 women were assisted at the Basic Health Units during a one-year period. The sample size calculation was stratified by district and based on a 95% confidence level with a power of 80%, as well as an error estimate of 5% and it was considered proportional to the number of patients classified as having adequate quality of life (indicator >26) in the general population. Data were collected while women waited for their routine appointment at the Health Unit. WHOQOL-Bref was used to evaluate the quality of life, and menopause rating scale (MRS) was used to determine climacteric symptoms. The level of physical activity was assessed by means of the International Physical Activity Questionnaire (IPAQ). To obtain the classification of PA levels, we used three categories: sedentary, moderately active, and very active. Statistical analysis was performed using the Minitab software, version 16. RESULTS: The mean age of the subjects was 49.8 years-old (±8.1) and they were predominantly Caucasian (72.7%), married (61.6%), non-smokers (93.5%), and had High School education (47.8%). Using the WHOQOL, mean scores were found to be significantly different between the groups (low, moderate, and vigorous physical activity), classified according to the domains of quality of life (p<0.01). Concerning physical activity and climacteric symptoms, significant differences were found for all domains: psychological (p<0.01), vegetative-somatic (p<0.01), and urogenital (p<0.01). CONCLUSIONS: Physical activity improves quality of life in middle-aged women.

Estimativa de peso em idosos institucionalizados: qual equação utilizar? / Estimating weight in elderly residents in nursing homes: which equation to use?

RESUMO: Introdução: Na impossibilidade de mensuração do peso em idosos, métodos de estimativa podem ser empregados. Entretanto, tais métodos nem sempre são aplicáveis, podendo levar a erros de estimativa que comprometem tanto a prática clínica quanto resultados em estudos epidemiológicos. Objetivo: Comparar e validar métodos de estimativa de peso em idosos residentes em instituições de longa permanência de Natal, Rio Grande do Norte. Métodos: Avaliaram-se as equações qualitativamente pela reprodutibilidade das medidas que as compunham e, quantitativamente, pela diferença média entre o peso mensurado e os estimados, e utilizado o teste t de Student para amostras pareadas ou ANOVA, coeficiente de determinação (R²), raiz do erro quadrático médio (REQM), coeficiente de correlação intraclasse (CCI) e análise gráfica de resíduos. Adotou-se como valor de significância p < 0,05. Considerou-se aplicável quando a equação apresentava R² > 0,7; menor REQM dentre as equações avaliadas; CCI > 0,7; e respectivo intervalo de confiança 95% com menor distância entre os limites inferior e superior. Resultados: Avaliaram-se 315 idosos de 10 instituições de longa permanência de Natal. O peso corporal médio foi maior nos idosos mais jovens e sem restrição de mobilidade. A análise qualitativa mostrou a equação 5 como a de melhor reprodutilidade, uma vez que não utiliza medidas de dobras cutâneas. A análise quantitativa revelou a equação 5 como a de melhor aplicabilidade em toda a população avaliada e nos diferentes sexos, faixas etárias (60 a 69 anos, 70 a 79 anos e 80 anos ou mais) e condição de restrição de mobilidade. Conclusão: A equação 5 foi aplicável para a estimativa de peso na população avaliada e nos diferentes estratos analisados.

ABSTRACT: Introduction: When it is impossible to measure weight in the elderly, estimation methods can be employed. However, such methods are not always applicable and can lead to estimation errors that compromise both the clinical practice and the results in epidemiological studies. Objective: To compare and validate weight estimation methods in the elderly living in nursing homes in Natal, Rio Grande do Norte, Brazil. Methods: The equations were evaluated qualitatively, by the reproducibility of the measurements that comprised them, and quantitatively, by the mean difference between the measured and the estimated weights, using Student's t -test for paired samples or ANOVA, the coefficient of determination (R²), root mean square error (RMSE), intra-class correlation coefficient (ICC) and graphical analysis of residuals. The significance value adopted was of p < 0.05. It was considered applicable when the equation presented R² > 0.7; lowest RMSE among the evaluated equations; ICC > 0.7; and respective 95% confidence interval with less distance between the upper and lower limits. Results: We evaluated 315 elderly from 10 nursing homes in Natal. The mean body weight was higher in the younger elderly and those without mobility restriction. The qualitative analysis showed the equation 5 as having the best reproducibility, since it does not use skinfold measurements. The quantitative analysis revealed the equation 5 as the one with the best applicability across the studied population and in the different genders, age groups (60 - 69 years, 70 - 79 years, and 80 years or more), and mobility restriction conditions. Conclusion: The equation 5 was applicable for estimating weight in the evaluated population and in the different strata analyzed.