Risk factors for executive function impairment in adolescence: an analysis of data from the 2004 Pelotas Birth Cohort study

Objective: To investigate risk factors associated with impaired attention-related executive functions (EFs) at age 11 and working memory at age 15. Methods: Data from participants of the population-based 2004 Pelotas Birth Cohort at ages 11 (n=3,582) and 15 (n=1,950) were analyzed. The study measured attentional control, cognitive flexibility, and selective attention using the Test of Everyday Attention for Children (TEA-Ch). Spatial working memory was assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB). Logistic regression was employed to explore the relationship between perinatal and childhood exposures and EF impairment. Results: Low maternal education had a significant negative impact on EFs. At age 11, it was associated with decreased attentional control (OR = 3.04; 95%CI 2.09-4.43), and at age 15, it was linked to impaired spatial working memory (OR = 2.21; 95%CI 1.58-3.09). Additional risk factors included low household income, black or brown maternal skin color, high parity, prematurity, low birth weight, and multiple siblings. Breastfeeding, regardless of duration, was found to be a protective factor against impaired cognitive flexibility (OR = 0.38; 95%CI 0.22-0.65). Conclusion: This study underscores the lasting impact of perinatal exposures on EF development. Policies that mitigate the negative effects of risk factors and promote EF development, especially among vulnerable populations, are needed.

Risk factors for executive function impairment in adolescence: an analysis of data from the 2004 Pelotas Birth Cohort study.

OBJECTIVE: To investigate risk factors associated with impaired attention-related executive functions (EFs) at age 11 and working memory at age 15. METHODS: Data from participants of the population-based 2004 Pelotas Birth Cohort at ages 11 (n=3,582) and 15 (n=1,950) were analyzed. The study measured attentional control, cognitive flexibility, and selective attention using the Test of Everyday Attention for Children (TEA-Ch). Spatial working memory was assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB). Logistic regression was employed to explore the relationship between perinatal and childhood exposures and EF impairment. RESULTS: Low maternal education had a significant negative impact on EFs. At age 11, it was associated with decreased attentional control (OR = 3.04; 95%CI 2.09-4.43), and at age 15, it was linked to impaired spatial working memory (OR = 2.21; 95%CI 1.58-3.09). Additional risk factors included low household income, black or brown maternal skin color, high parity, prematurity, low birth weight, and multiple siblings. Breastfeeding, regardless of duration, was found to be a protective factor against impaired cognitive flexibility (OR = 0.38; 95%CI 0.22-0.65). CONCLUSION: This study underscores the lasting impact of perinatal exposures on EF development. Policies that mitigate the negative effects of risk factors and promote EF development, especially among vulnerable populations, are needed.

'This family rejection harmed my health as well': Intersections between the meanings of family and health for trans people and family members in a trans healthcare service in Brazil.

Transgender people deal with intense discrimination in every aspect of life. These experiences increase when they face family rejection. The research on social and family environment surrounding gender transition has been largely overlooked. We examine the meanings of family and health, and how these intersect, among trans people and their family members in a health service in Brazil. We conducted a qualitative study (between December 2017 and July 2018), an ethnography with the triangulation of three sources: interviews with 8 transgender men, 8 transgender women and 5 family members; a focus group with another 8 transgender men and approximately 100 h of field observation. Our study shows that family and health are interpreted as ideal protective environments, and seen as causes of disappointment, abandonment and illness. The meanings of family and health are interconnected and constituted in relation to each other. We also found that there are differences within these meanings of family and health when we consider the ethnicity and the economic status of the participants. The participants reported that the society education towards transsexuality is fundamental to improving trans people's quality of life. Our results challenge health services to provide comprehensive healthcare and assure health equity for transgender people.

The role of education on Cancer amenable mortality among non-Hispanic blacks & non-Hispanic whites in the United States (1989-2018).

BACKGROUND: Cancer mortality in the U.S. has fallen in recent decades; however, individuals with lower levels of education experienced a smaller decline than more highly educated individuals. This analysis aimed to measure the influence of education lower than a high school diploma, on cancer amenable mortality among Non-Hispanic Whites (NHW) and Non-Hispanic Blacks (NHB) in the U.S. from 1989 to 2018. METHODS: We analyzed data from 8.2 million death certificates of men and women who died from cancer between 1989 and 2018. We examined 5-year and calendar period intervals, as well as annual percent changes (APC). APC was adjusted for each combination of sex, educational level, and race categories (8 models) to separate the general trend from the effects of age. RESULTS: Our study demonstrated an increasing mortality gap between the least and the most educated NHW and NHB males and females who died from all cancers combined and for most other cancer types included in this study. The gap between the least and the most educated was broader among NHW males and females than among NHB males and females, respectively, for most malignancies. CONCLUSIONS: In summary, we reported an increasing gap in the age-adjusted cancer mortality among the most and the least educated NHW and NHB between 25 and 74 years of age. We demonstrated that although NHB exhibited the greatest age-adjusted mortality rates for most cancer locations, the gap between the most and the least educated was shown for NHW.

Continuity of psychiatric disorders between 6 and 11 years of age in the 2004 Pelotas Birth Cohort

Objective: To investigate the incidence and homotypic and heterotypic continuity of psychiatric disorders between ages 6 and 11. Methods: In 2004, all live births in the city of Pelotas, Brazil, were recorded (n=4,231). Psychiatric disorders were assessed by the Strengths and Difficulties Questionnaire (SDQ). SDQ subscale scores (emotional symptoms, conduct problems, hyperactivity/inattention, and peer relationship problems) were categorized as normal or abnormal. To examine associations between problems over time, odds ratios were computed using logistic regression. Results: Any SDQ difficulty was observed in 350 children (10.4%, 95%CI 9.4-11.5) at age 6 and 476 (14.2%, 95%CI 13.0-15.4) at age 11, with a higher prevalence among boys at both ages. Between ages 6 and 11, there was a 50 and a 45% increase in the prevalence of emotional and hyperactivity/inattention symptoms, respectively. Among those who had any SDQ difficulty at age 6, that status persisted in 81% at age 11. We found homotypic continuity of emotional symptoms, conduct problems, hyperactivity/inattention, and peer relationship problems. Conclusions: Our results indicate an increasing incidence of psychiatric disorders in this age group, with rates of disorders and continuity patterns similar to those observed in other studies.

Continuity of psychiatric disorders between 6 and 11 years of age in the 2004 Pelotas Birth Cohort.

OBJECTIVE: To investigate the incidence and homotypic and heterotypic continuity of psychiatric disorders between ages 6 and 11. METHODS: In 2004, all live births in the city of Pelotas, Brazil, were recorded (n=4,231). Psychiatric disorders were assessed by the Strengths and Difficulties Questionnaire (SDQ). SDQ subscale scores (emotional symptoms, conduct problems, hyperactivity/inattention, and peer relationship problems) were categorized as normal or abnormal. To examine associations between problems over time, odds ratios were computed using logistic regression. RESULTS: Any SDQ difficulty was observed in 350 children (10.4%, 95%CI 9.4-11.5) at age 6 and 476 (14.2%, 95%CI 13.0-15.4) at age 11, with a higher prevalence among boys at both ages. Between ages 6 and 11, there was a 50 and a 45% increase in the prevalence of emotional and hyperactivity/inattention symptoms, respectively. Among those who had any SDQ difficulty at age 6, that status persisted in 81% at age 11. We found homotypic continuity of emotional symptoms, conduct problems, hyperactivity/inattention, and peer relationship problems. CONCLUSIONS: Our results indicate an increasing incidence of psychiatric disorders in this age group, with rates of disorders and continuity patterns similar to those observed in other studies.

How many and which physicians? A comparative study of the evolution of the supply of physicians and specialist training in Brazil and Spain.

BACKGROUND: In the face of the medical workforce shortage, several countries have promoted the opening of medical schools and the expansion of undergraduate and specialization education in medicine. Few studies have compared the characteristics and effects of expanding the supply of general practitioners and specialist physicians between countries. Brazil and Spain, two countries with distinct historical processes and socioeconomic scenarios, yet both with universal public health systems and common aspects in training and medical work, have registered a significant increase in the number of physicians and can be used to understand the challenges of strategic planning for the medical workforce. METHODS: This study provides a descriptive approach using longitudinal data from official databases in Brazil and Spain from 1998 to 2017. Among the comparable indicators, the absolute numbers of physicians, the population size, and the physician's ratio by inhabitants were used. The number of medical schools and undergraduate places in public and private institutions, the supply of residency training posts, and the number of medical specialists and medical residents per 100 000 inhabitants were also used to compare both countries. Seventeen medical specialties with the highest number of specialists and comparability between the two countries were selected for further comparison. RESULTS: Due to the opening of medical schools, the density of physicians per 1 000 inhabitants grew by 28% in Spain and 51% in Brazil between 1998 and 2017. In that period, Spain and Brazil increased the supply of annual undergraduate places by 60% and 137%, respectively. There is a predominance of private institutions providing available undergraduate places, and the supply of medical residency posts is smaller than the contingent of medical graduates/general practitioners each year. CONCLUSION: Both countries have similar specialist densities in cardiology, dermatology, and neurosurgery specialties. However, family medicine and community in Spain has 91.27 specialists per 100 000 inhabitants, while in Brazil, the density is only 2.64. The comparative study indicated the complexity of the countries' decisions on increasing the medical supply of general practitioners and specialist physicians. Research and planning policies on the medical workforce must be aligned with the actual health needs of populations and health systems.

Contextualizing Evidence for Action on Diabetes in Low-Resource Settings-Project CEAD Part I: A Mixed-Methods Study Protocol.

Challenges remain for policy adoption and implementation to tackle the unprecedented and relentless increase in obesity, diabetes and other non-communicable diseases (NCDs), especially in low- and middle-income countries. The aim of this mixed-methods study is to analyse the contextual relevance and applicability to low-resource settings of a sample of evidence-based healthy public policies, using local knowledge, perceptions and pertinent epidemiological data. Firstly, we will identify and prioritise policies that have the potential to reduce the burden of diabetes in low-resource settings with a scoping review and modified Delphi method. In parallel, we will undertake two cross-sectional population surveys on diabetes risk and morbidity in two low-resource settings in Ecuador. Patients, community members, health workers and policy makers will analyse the contextual relevance and applicability of the policy actions and discuss their potential for the reduction in inequities in diabetes risk and morbidity in their population. This study tackles one of the greatest challenges in global health today: how to drive the implementation of population-wide preventative measures to fight NCDs in low resource settings. The findings will demonstrate how local knowledge, perceptions and pertinent epidemiological data can be used to analyse the contextual relevance and applicability of potential policy actions.

"Pra mim, foi assim: homossexual, travesti e, hoje em dia, trans": performatividade trans, família e cuidado em saúde / "It was like this for me: homosexual, transvestite, and, now, trans": trans performativity, family, and health care

Resumo A transexualidade é uma experiência identitária que emerge como resposta inevitável a uma forma de organizar a vida social e, consequentemente, o cuidado em saúde com base na produção de sujeitos. Objetivamos compreender como um contexto identitário trans mobiliza, na articulação com família e serviço de saúde, performances identitárias. Realizamos uma etnografia com entrevista semiestruturada e observação participante em um ambulatório especializado no cuidado trans-específico no Sistema Único de Saúde (SUS), entre dezembro de 2017 e julho de 2018. Durante o estudo, destacou-se a história de Marilda, por seu caráter emblemático ao narrar a transição de "homem homossexual" para "travesti" e, atualmente, para "mulher trans", em uma performance identitária que almeja o reconhecimento e o pertencimento familiar, bem como o acesso à saúde, à educação e a uma profissão distante da prostituição. Sua história permite compreender que as pessoas trans constroem significados diversos para suas vivências identitárias, com elementos que podem reiterar o binarismo e a heteronormatividade. Torna-se importante reconhecer, no âmbito da família e da saúde, que diferentes performances identitárias são possíveis e que seus sentidos poderão compor o cuidado integral em saúde de cada pessoa trans.

Abstract Transsexuality is an identity experience that emerges as an inevitable response to a way of organizing social life and, consequently, health care based on the production of subjects. We aim to understand how a certain trans identity context mobilizes identity performances, in articulation with family and health service. We performed an ethnography with a semi-structured interview and participant observation in a health service specialized in trans-specific care in the Brazilian National Health System (SUS), between December 2017 and July 2018. The story of Marilda was highlighted for being emblematic when narrating the transition from "homosexual man" to "transvestite" and, currently, to "trans woman," in an identity performance that aims for family recognition and belonging, access to health, education, and a profession other than prostitution. Her story allows us to understand that trans people construct different meanings for their identity experiences, with elements that can reiterate binarism and heteronormativity. It is important to recognize, within the family and health context, that different identity performances are possible and that their senses may compose the integral health care of each trans person.

Impact of maternal depression trajectories on offspring socioemotional competences at age 11: 2004 Pelotas Birth Cohort.

BACKGROUND: Maternal depression is associated with impairments in child behavioural and emotional development, although the effect of exposure to maternal depression until adolescence is underexplored in most studies. This longitudinal study examined the association between maternal depressive symptoms trajectories and offspring socioemotional competences at age 11. METHODS: We included 3,437 11-year-old adolescents from the 2004 Pelotas Birth Cohort Study. Maternal depressive symptoms were assessed during the follow-up waves. Adolescent socioemotional competences were peer relationship problems and prosocial behaviour, both assessed by Strengths and Difficulties Questionnaire (SDQ), and Locus of Control (LoC), assessed by Nowick-Strickland Internal-External Scale. We used multivariate linear and logistic regression models to examine the effects of maternal depression trajectories on offspring's socioemotional competences, adjusting for potential confounding variables. RESULTS: We identified five trajectories of maternal depressive symptoms: a "low" trajectory (32.6%), a "moderate low" (42.2%), a "increasing" (11.1%), a "decreasing" (9.2%), and a "high-chronic" trajectory (4.9%). Adolescents whose mothers had persistent depressive symptoms, either intermediate or high, had greater levels of peer relationship problems and lower levels of prosocial behaviour than those whose mothers had low depressive symptoms. These differences were not explained by socioeconomic, maternal, and child characteristics. Maternal depressive symptoms during offspring's life was not a predictor of LoC orientation. LIMITATIONS: Nearly 20% of original cohort were not included in the analysis due to missing data. Adolescent's socioemotional competences were ascertained by maternal report. CONCLUSION: Our study extended the evidences of the negative impact of severe and recurrent maternal depression on offspring's socioemotional competences until early adolescence.

Depression and excess mortality in the elderly living in low- and middle-income countries: Systematic review and meta-analysis.

OBJECTIVE: To investigate the association between depression and mortality in the elderly living in low- and middle-income countries. METHODS: A systematic review and meta-analysis was performed. We searched in five electronic databases for observational studies investigating the association between mortality and depression. Two reviewers worked independently to select articles, extract data, and assess study quality. RESULTS: A total of 10 studies including 13 828 participants (2402 depressed and 11 426 nondepressed) from six countries (Brazil, four articles; China, two articles; Botswana, India, South Africa, and South Korea, one article) were included. The overall unadjusted relative risk (RR) of mortality in depressed relative to nondepressed participants was 1.62 (95% CI, 1.39-1.88; P < 0.001), with high heterogeneity (I2  = 66%; 95% CI, 33-83; P < 0.005). After adjustment for publication bias, the overall RR decreased to 1.60 (95% CI, 1.37-1.86; P < 0.001). No significant differences were observed between subgroups except those defined by study quality. The high-quality studies had a pooled RR of 1.48 (95% CI, 1.32-1.67; P < 0.001), while the low-quality studies resulted had a pooled RR of 1.82 (95% CI, 1.25-2.65; P < 0.005). CONCLUSIONS: Depression is associated with excess mortality in the elderly living in low- and middle-income countries. In addition, this excess mortality does not differ substantially from that found in high-income countries. This suggests environmental factors occurring in low- and middle-income countries might not have a direct association with the excess mortality in the depressed elderly.

Grade 2 disabilities in leprosy patients from Brazil: Need for follow-up after completion of multidrug therapy.

BACKGROUND: Leprosy continues to be a public health problem in many countries. Difficulties faced by health services include late diagnosis, under-reporting of new cases, adequate monitoring of disabilities and treatment. Furthermore, systematic follow-up after completion of treatment is important, when new disabilities may occur, or existing disabilities may get worse. The objective of the present study was to determine the prevalence of leprosy-associated grade 2 disabilities (G2D) after completion of multidrug therapy (MDT) and to identify factors associated with G2D. METHODS: We performed a cross-sectional study of 222 leprosy cases registered in Vitória da Conquista, Bahia state, Brazil from 2001-2014. We performed a clinical examination of the study participants and collected socio-economic and clinical information by interview. We identified factors associated with grade 2 disability (G2D) using logis tic regression. RESULTS: In total, 38 (17.1%) participants were diagnosed with G2D, and 106 (47.7%) with grade 1 disabilities (G1D). The following independent factors were significantly associated with G2D: occurrence of leprosy reaction (adjusted OR = 2.5; 95%CI = 1.09-5.77), thickening and/or tenderness of one or more nerve trunks (adjusted OR = 3.0; CI = 1.13-8.01) and unemployment (adjusted OR = 7.17; CI = 2.44-21.07). CONCLUSIONS: This study shows that physical disabilities remain after completion of MDT and frequently occur in an endemic area in Brazil. Finding new ways to reduce the burden of disability are urgently needed, and may include systematic follow-up of patients after treatment completion combined with evidence-based preventative measures.

Psychosocial Work Conditions and Burnout Among Brazilian Bank Employees: A Cross-Sectional Study.

OBJECTIVES: Changes in the modern economy have affected the financial sector. Time pressures, excessive work demands, and job stress are frequent concerns among bank employees, which might predispose them to burnout symptoms. The objective of the present study was to investigate the association between burnout symptoms and exposure to psychosocial work conditions in bank employees. METHODS: A cross-sectional study of 1046 bank employees was carried out in Pará and Amapá, northern Brazil. We applied a self-administered questionnaire evaluating socio-demographic characteristics, burnout (Maslach Burnout Inventory), and two job stress models (Demand-Control-Support and Effort-Reward Imbalance). Two levels of burnout symptoms were analysed: moderate level of burnout (MLB) and high level of burnout (HLB). Logistic regression models were used to estimate associations between the two levels of burnout and the two stress models, controlling for relevant covariates. RESULTS: The overall prevalence of burnout was 71.8% (31.1% for HLB; 40.7% for MLB), regardless of gender. Exposure to adverse psychosocial conditions in the workplace, such as high strain, low social support at work, high effort/low reward, and over commitment showed strong association with HLB and MLB, and these associations were independent of age, gender, and other occupational characteristics. CONCLUSIONS: We found that psychosocial conditions in the financial sector involving high strain, low social support at work, high effort/low reward, and over commitment represent possible risk factors for moderate and HLB symptoms in bank employees.

Education and WHO recommendations for fruit and vegetable intake are associated with better cognitive function in a disadvantaged Brazilian elderly population: a population-based cross-sectional study.

Brazil has one of the fastest aging populations in the world and the incidence of cognitive impairment in the elderly is expected to increase exponentially. We examined the association between cognitive impairment and fruit and vegetable intake and associated factors in a low-income elderly population. A cross-sectional population-based study was carried out with 1849 individuals aged 65 or over living in São Paulo, Brazil. Cognitive function was assessed using the Community Screening Instrument for Dementia (CSI-D). Fruit and vegetable intake was assessed with a Food Frequency Questionnaire (FFQ) and categorized into quartiles of intake and into total daily fruit and vegetable intake using the cut-off points for the WHO recommendations (<400 grams/day or ≥ 400 grams/day). The association between cognitive impairment and each quartile of intake, and WHO recommendation levels, was evaluated in two separate multivariate logistic models. The WHO recommendations for daily intakes ≥ 400 grams/day were significantly associated with 47% decreased prevalence of cognitive impairment. An effect modification was found in both models between cognitive impairment and "years of education and physical activity" and "years of education and blood levels of HDL" So that, having 1 or more years of education and being physically active or having 1 or more years of education and levels higher than 50 mg/dl of HDL-cholesterol strongly decreased the prevalence of cognitive impairment. In this socially deprived population with very low levels of education and physical activity and fruit and vegetable intake, those who attained WHO recommendations, had 1 year or more of education and were physically active had a significantly lower prevalence of cognitive impairment. A more comprehensive understanding of the social determinants of mental health is needed to develop effective public policies in developing countries.

Consumo de frutas e hortaliças por idosos de baixa renda na cidade de São Paulo / Fruit and vegetable intake among low income elderly in the city of São Paulo, Southeastern Brazil

OBJETIVO: Estimar os fatores socioeconômicos e sociodemográficos associados ao consumo diário de cinco porções de frutas e hortaliças por idosos residentes em áreas de baixa renda, identificando as principais frutas e hortaliças que compõem a dieta desta população. MÉTODOS: Estudo transversal de base populacional com 2.066 idosos (>60 anos) de baixa renda residentes na cidade de São Paulo, SP, em 2003-2005. Para a avaliação do consumo de frutas e hortaliças foi aplicado questionário de freqüência alimentar. As respostas foram transformadas em consumo diário e comparadas às recomendações da Organização Mundial da Saúde (consumo de cinco ou mais porções diárias). A relação entre consumo recomendado de frutas e hortaliças e variáveis socioeconômicas foi avaliada mediante modelos de regressão logística. RESULTADOS: Dos participantes, 60,5 por cento eram mulheres e 39,5 por cento homens. Cerca de um terço dos idosos (n=723; 35,0 por cento) não consumia diariamente nenhum tipo de fruta ou hortaliça e 19,8 por cento relataram consumo diário de cinco ou mais porções de frutas e hortaliças. Este consumo esteve positivamente associado à renda e à escolaridade. CONCLUSÕES: O consumo de frutas e hortaliças de idosos de baixa renda do município de São Paulo mostrou-se insuficiente em relação às recomendações da Organização Mundial da Saúde e está associado a condições socioeconômicas desfavoráveis.

OBJECTIVE: To estimate the socioeconomic and sociodemographic factors associated with the daily intake of five servings of fruit and vegetables by elderly individuals living in low income areas, identifying the main fruits and vegetables which compose the diet of this population. METHODS: This is a cross-sectional population-based study with 2,066 low income elderly individuals (>60 years) living in the city of São Paulo, Southeastern Brazil, in 2003-2005. To assess the fruit and vegetable intake a Food Frequency Questionnaire was administered. The answers were transformed into daily intake and compared with the recommendations of the World Health Organization (five or more servings per day). The relationship between recommended fruit and vegetable intake and socioeconomic variables was analyzed using logistic regression models. RESULTS: Of the participants, 60.5 percent were women and 39.5 percent were men. Approximately one third of the elders (n=723; 35.0 percent) did not consume any kind of fruit or vegetable on a daily basis and 19.8 percent reported a daily intake of five or more servings of fruits and vegetables. This intake was positively associated with income and years of schooling. CONCLUSIONS: The fruit and vegetable intake of low income elderly individuals in the city of São Paulo was insufficient according to the recommendations of the World Health Organization and is associated with unfavorable socioeconomic conditions.

Fruit and vegetable intake among low income elderly in the city of São Paulo, Southeastern Brazil.

OBJECTIVE: To estimate the socioeconomic and sociodemographic factors associated with the daily intake of five servings of fruit and vegetables by elderly individuals living in low income areas, identifying the main fruits and vegetables which compose the diet of this population. METHODS: This is a cross-sectional population-based study with 2,066 low income elderly individuals (> or =60 years) living in the city of São Paulo, Southeastern Brazil, in 2003-2005. To assess the fruit and vegetable intake a Food Frequency Questionnaire was administered. The answers were transformed into daily intake and compared with the recommendations of the World Health Organization (five or more servings per day). The relationship between recommended fruit and vegetable intake and socioeconomic variables was analyzed using logistic regression models. RESULTS: Of the participants, 60.5% were women and 39.5% were men. Approximately one third of the elders (n=723; 35.0%) did not consume any kind of fruit or vegetable on a daily basis and 19.8% reported a daily intake of five or more servings of fruits and vegetables. This intake was positively associated with income and years of schooling. CONCLUSIONS: The fruit and vegetable intake of low income elderly individuals in the city of São Paulo was insufficient according to the recommendations of the World Health Organization and is associated with unfavorable socioeconomic conditions.

High prevalence of dementia among older adults from poor socioeconomic backgrounds in São Paulo, Brazil.

BACKGROUND: The aim of this study was to determine the prevalence of dementia in a socioeconomically disadvantaged population of older adults living in the city of São Paulo, Brazil. METHODS: A cross-sectional one-phase population-based study was carried out among all residents aged > or = 65 in defined census sectors of an economically disadvantaged area of São Paulo. Identification of cases of dementia followed the protocol developed by the 10/66 Dementia Research Group. RESULTS: Of 2072 individuals in the study, 105 met the criteria for a diagnosis of dementia, yielding a prevalence of 5.1%. Prevalence increased with age for both men and women after age 75 years, but was stable from 65 to 74 years. Low education and income were associated with increased risk of dementia. CONCLUSIONS: The prevalence of dementia among older adults from low socioeconomic backgrounds is high. This may be partly due to adverse socioeconomic conditions and consequent failure to compress morbidity into the latter stages of life. The increasing survival of poorer older adults with dementia living in developing countries may lead to a rapid increase in the prevalence of dementia worldwide.

[Development of a food frequency questionnaire to study diet and non-communicable diseases in adult population]. / Desenvolvimento de um questionário de freqüência alimentar para o estudo de dieta e doenças não transmissíveis.

The study purpose was to develop a food frequency questionnaire (FFQ) to investigate potential relationships between diet and non-communicable diseases. Two hundred adults were selected among attendees at the general outpatient clinic of Heart Institute of São Paulo, Brazil. A 98-food item list was created from 24-hour recalls, based on the weighted contribution of each food to energy intake and 21 nutrients. The questionnaire represented 96.8% of energy and at least 95% of the selected nutrients consumed by the study population. Once adapted and validated, this FFQ could be used in epidemiological studies in adult population.

Desenvolvimento de um questionário de freqüência alimentar para o estudo de dieta e doenças não transmissíveis / Development of a food frequency questionnaire to study diet and non-communicable diseases in adult population

O objetivo do estudo foi desenvolver um questionário de freqüência alimentar com o intuito de investigar possíveis relações entre dieta e doenças não transmissíveis. Foram estudados 200 indivíduos adultos, atendidos no ambulatório geral de um hospital cardiológico de São Paulo, SP. A lista de 98 alimentos do questionário de freqüência alimentar foi construída a partir de recordatórios de 24 horas, estimando-se a contribuição percentual de cada alimento para o consumo de energia e de 21 nutrientes. O questionário desenvolvido representou 96,8 por cento das calorias consumidas pela população estudada e ao menos 95 por cento da ingestão dos nutrientes selecionados. Uma vez adaptado e validado, esse questionário poderá ser utilizado em estudos epidemiológicos em populações adultas.