Exposure to stressful events during a peacekeeping mission may have a price: The impact on trait of negative and positive affect and mental health.

We evaluated the participants' negative affect, positive affect, post-traumatic stress disorder, and depression symptoms before and after a peacekeeping mission. Depression symptoms and positive affect after mission were significantly associated with exposure to stressful events during the mission, controlled by the respective characteristics before mission. Negative affect and post-traumatic stress disorder symptoms after mission had a tendency to be associated with exposure to stressful events during the mission, controlled by the respective characteristics before mission. In conclusion, even in healthy and physically active male peacekeepers, those more exposed to stressful events could be more vulnerable to present negative outcomes.

Depression subtypes and obesity in adults: A systematic review and meta-analysis.

Examining clinical features of depressive episodes may help elucidating the nature of association between depression and obesity, related to specific symptoms such as appetite and weight changes. This meta-analysis of observational studies evaluated whether subtypes of depression are associated with specific anthropometric profiles in adults. We searched MEDLINE, LILACS, PsycINFO, Scopus, Web of Science databases, and Grey Literature for articles published up to October 2016 that examined depressive subtypes and adiposity measures among adults. The pooled effect size was estimated with random effects models. The PRISMA guidelines were adopted to reporting results, and this review was registered in PROSPERO (CRD42016035685). A total of 22 articles were included in this systematic review, of which eight had data included in the meta-analysis, assessing 14 757 individuals with depression. Patients with atypical depression presented a 2.55 higher BMI score compared with those with melancholic depression. Subgroup analysis identified a differential distribution of anthropometric measures in studies conducted with Chinese populations. Among the remainder studies, only one reported discrepant results, possibly due to the exclusion of "weight change" in defining subtypes of depression. Atypical depression was significantly associated with elevated BMI compared with melancholic depression, deserving particular attention due to its clinical importance.

Validade de medidas autorrelatadas de peso corporal e estatura em participantes do estudo São Paulo Megacity / Validity of self-reported measures of body weight and height in participants of the São Paulo Megacity Mental Health Survey

Resumo Introdução A utilização de indicadores válidos na avaliação do estado nutricional populacional é muito importante. Objetivo Avaliou-se a concordância entre medidas aferidas e autorrelatadas de peso corporal, estatura e IMC, e identificou-se fatores que exercem influência sobre o autorrelato. Método Estudo transversal de base populacional de adultos da Região Metropolitana de SP (N=766). Cálculo dos coeficientes de correlação intraclasse e análises gráficas de Bland & Altman foram conduzidos, avaliando a concordância dessas medidas. Resultados Na amostra total, e para ambos os sexos, foram subestimados o peso corporal autorrelatado e, consequentemente, o IMC, enquanto a estatura autorrelatada foi superestimada. A imprecisão no autorrelato foi influenciada pelo sexo, idade, escolaridade e estado nutricional. A confiabilidade encontrada entre as medidas foi elevada em ambos os sexos e na amostra total (peso corporal CCI 0,951/IC 0,938-0,961; estatura CCI 0,870/IC 0,597-0,939; IMC CCI 0,865/IC 0,677-0,928). A prevalência de excesso de peso pelas medidas autorrelatadas mostrou-se subestimada (13%), quando comparada àquela calculada através das medidas aferidas. Conclusão O autorrelato pode ser influenciado por diversos fatores, produzindo medidas imprecisas. Sua utilização em inquéritos populacionais pode acarretar em uma importante subestimativa do risco de adoecimento e mortalidade prematura por doenças cardiovasculares e metabólicas associados ao excesso de peso.

Abstract Background The use of valid indicators for the evaluation of the nutritional status of the population was very important. Objective The concordance between measured and self-reported data of body weight and height and BMI were evaluated and the factors that exert influence on the self-report. Method This is a cross-sectional population-based study of adults from the Metropolitan Region of SP (N=766). Calculation of the intraclass correlation coefficients and graphical analyzes of Bland & Altman were conducted, evaluating the agreement of these measures. Results In the total sample and for both genders, the self-reported body weight and the BMI were underestimated, while the self-reported height was overestimated. The imprecision in self-report was influenced by gender, age, school level,and nutritional status. The agreement between the measures was high in both genders and in the total sample (weight ICC 0.951/CI 0.938-0.961; height ICC 0.870/CI 0.597-0.939; BMI ICC 0.865/CI 0.677-0.928). The prevalence of overweight by self-reported measures was underestimated (13%) when compared to that calculated by the measured data. Conclusion Self-report can be influenced by several factors, producing imprecise measures. Its use in population surveys may lead to an important underestimation of the risk of illness and premature mortality for cardiovascular and metabolic diseases associated with overweight.

Does CBT have lasting effects in the treatment of PTSD after one year of follow-up? A systematic review of randomized controlled trials.

INTRODUCTION: While several previous meta-analyses have documented the short-term efficacy of cognitive-behavioral therapy (CBT), its long-term efficacy remains unknown. Posttraumatic stress disorder (PTSD) is a serious, debilitating, often chronic and disabling disease. OBJECTIVE: To estimate the long-term efficacy of CBT in the treatment of PTSD by assessing the maintenance of the effect after one year of follow-up. METHOD: We performed a systematic review through electronic database searches including ISI Web of Science, PubMed, PsycInfo and Pilots. We included randomized studies in which CBT was compared with a control group (waiting list or usual care) in adults with PTSD that reported at least one year of CBT follow-up. RESULTS: Our search identified 2,324 studies and 8 were selected. CBT was shown to be effective in the treatment of PTSD in the post-treatment period. Improvement in PTSD symptoms was statistically significant in relation to the control group. The improvement observed in the treatment group or single group (formed by both treatment group and control group, which was submitted to the intervention after a few weeks on the waiting list) was maintained in the follow-up. CONCLUSION: Due to the lack of control groups in the follow-up period in six of the eight studies included in this review, there is still no proper methodological basis to assert that CBT has lasting effects in the treatment of PTSD. Our study found serious methodological shortcomings and the need to fill this gap in the literature through the development of studies with robust and sophisticated designs.

Does CBT have lasting effects in the treatment of PTSD after one year of follow-up? A systematic review of randomized controlled trials / A TCC possui efeitos duradouros no tratamento do TEPT após um ano de seguimento? Revisão sistemática de ensaios clínicos randomizados

Abstract Introduction: While several previous meta-analyses have documented the short-term efficacy of cognitive-behavioral therapy (CBT), its long-term efficacy remains unknown. Posttraumatic stress disorder (PTSD) is a serious, debilitating, often chronic and disabling disease. Objective: To estimate the long-term efficacy of CBT in the treatment of PTSD by assessing the maintenance of the effect after one year of follow-up. Method: We performed a systematic review through electronic database searches including ISI Web of Science, PubMed, PsycInfo and Pilots. We included randomized studies in which CBT was compared with a control group (waiting list or usual care) in adults with PTSD that reported at least one year of CBT follow-up. Results: Our search identified 2,324 studies and 8 were selected. CBT was shown to be effective in the treatment of PTSD in the post-treatment period. Improvement in PTSD symptoms was statistically significant in relation to the control group. The improvement observed in the treatment group or single group (formed by both treatment group and control group, which was submitted to the intervention after a few weeks on the waiting list) was maintained in the follow-up. Conclusion: Due to the lack of control groups in the follow-up period in six of the eight studies included in this review, there is still no proper methodological basis to assert that CBT has lasting effects in the treatment of PTSD. Our study found serious methodological shortcomings and the need to fill this gap in the literature through the development of studies with robust and sophisticated designs.

Resumo Introdução: Várias meta-análises anteriores documentaram a eficácia a curto prazo da terapia cognitivo-comportamental (TCC). No entanto, sua eficácia a longo prazo permanece desconhecida. O transtorno de estresse pós-traumático (TEPT) é uma doença crônica grave, debilitante e incapacitante. Objetivo: Estimar a eficácia a longo prazo da TCC no tratamento do TEPT, avaliando a manutenção do efeito após um ano de seguimento. Métodos: Realizamos uma revisão sistemática através de pesquisas nas bases de dados eletrônicas ISI Web of Science, PubMed, PsycInfo e Pilots. Incluímos estudos randomizados nos quais a TCC foi comparada com um grupo controle (lista de espera ou tratamento usual) em adultos com TEPT que relataram pelo menos um ano de seguimento da TCC. Resultados: A pesquisa identificou 2.324 estudos e 8 foram selecionados. A TCC mostrou-se eficaz no tratamento do TEPT no período pós-tratamento. A melhora nos sintomas de TEPT foi estatisticamente significativa em relação ao grupo controle. A melhora observada no grupo de tratamento ou grupo único (formado por ambos os grupos de tratamento e controle, que foi submetido à intervenção após algumas semanas na lista de espera) foi mantida no seguimento. Conclusão: Devido à ausência de grupo controle no período de follow-up em 6 dos 8 estudos incluídos nesta revisão, ainda não há base metodológica adequada para afirmar que a TCC tem efeitos duradouros no tratamento do TEPT. Nosso estudo encontrou graves deficiências metodológicas e a necessidade de preencher essa lacuna na literatura através de estudos com delineamentos robustos e sofisticados.

A cross-sectional study to compare levels of psychiatric morbidity between young people and adults exposed to violence in a large urban center.

BACKGROUND: Teenagers and young adults are more exposed to violence and traumatic events than adults, and these factors can be associated with mental disorders. This paper aims at investigating whether young people are more exposed to violence and traumatic events and to compare pattern of mental disorders with adults. METHODS: Cross-sectional study using the Composite International Diagnostic Interview, conducted between 2007 and 2008 with a randomly selected sample of 15 to 75 year-old residents of São Paulo, Brazil. RESULTS: Two thousand five hundred thirty-six participants were divided into two groups: 1096 (43.2 %) young people (15 to 24 years), and 1440 (56.8 %) adults (25 to 75 years). 12-month exposure to traumatic events was higher among young people (32.1 % vs. 20.6 %; p < 0.001). Assaultive violence was reported by 13.4 % of young people and 8.6 % of adults (p = 0.012); 20.1 % of young people and 13 % of adults reported suffering other injury or shocking events (p < 0.001); sudden death/life threatening illness of a close person was declared by 6.1 % of young people and 3.2 % of adults (p = 0.017). Prevalence of alcohol related disorders was higher among young people (5.4 % vs. 2.5 %; P = 0.032); depressive disorders were more prevalent among adults (9.0 % vs. 4.7 %; P = 0.004). Alcohol related disorders were associated to assaultive violence among young people (OR = 3.4; 95 % CI = 1.36 to 8.52; p = 0.004) and adults (OR = 2.38; 95 % CI = 1.23 to 4.61; p = 0.002). Phobic/anxiety disorders were associated to other injury or shocking events among young people (OR = 1.28; 95 % CI = 0.67 to 2.44; p = 0.025). Major depressive disorder was associated to assaultive violence among young people (OR = 2.27; 95 % CI = 1.09 to 4.74; p = 0.004) and adults (OR = 1.28; 95 % CI = 0.85 to 1.93; p = 0.009). CONCLUSION: Exposure to violence and traumatic events was higher among young people. Alcohol related disorders, depression and phobic/anxiety disorders were significantly higher among young people exposed to traumatic events. Despite the study design, high exposure to violence and traumatic events in this age group can be considered important factors in triggering mental disorders in this vulnerable age period.

CAMCOG - valores das subescalas em idosos normais com níveis diferentes de escolaridade. Aspectos preliminares / CAMCOG – Subscales values in normal elderly with different educational levels – Preliminary aspects

Introdução: O Exame Cognitivo Cambridge (CAMCOG) é um instrumento breve para avaliação cognitiva. É composto por subescalas que representam diversos domínios cognitivos (orientação, linguagem, memória, atenção, praxia, percepção, cálculo e pensamento abstrato). Escores totais adequados permitem definir comprometimento em nível de demência. Entretanto, tais escores totais nem sempre representam o desempenho real de um indivíduo, pois é possível obter escores baixos em determinado(s) domínio(s) e ainda manter um escore total dentro da variação normal. Objetivo: Obter valores do CAMCOG total e das subescalas de indivíduos idosos normais com diferentes níveis de escolaridade. O interesse crescente na definição de estágios pré-demência é uma razão importante do presente estudo. Métodos: Foram avaliados com CAMCOG idosos normais residindo na comunidade, divididos em três grupos de acordo com o nível de escolaridade. Foi realizada análise estatística para comparar a significância dos escores (total e subescalas) entre os grupos. Resultados: Os valores médios do CAMCOG total mostraram aumento com a escolaridade, o mesmo tendo sido observado em relação aos escores das subescalas. Conclusão: As subescalas do CAMCOG relacionados com os níveis de escolaridade são necessárias para identificar indivíduos que apresentam diminuição de valores em um ou mais domínios cognitivos, apesar de apresentar o escore total dentro da variação da normalidade, o que pode caracterizar um estado de comprometimento cognitivo pré-demência...

Introduction: The Cambridge Cognitive Examination (CAMCOG) is a brief tool for cognitive assessment. It is composed of subscales that represent various cognitivedomains (orientation, language, memory, attention, praxis, perception, calculation and abstract thinking). Appropriate total scores permit to define impairment in the dementia level. However, such total scores do not always represent the real performance of the subject as it is possible to obtain low scores in certain domain(s) yet maintaining a total score in the normal range. Objective: To obtain data of CAMCOG total and subscales scores of normal elderly subjects with different educational levels. The growing interest in defining pre-dementia stages is an important reason of the present study. Methods: Community living normal elderly, divided in three groups according to their education level were assessed with CAMCOG. Statistic analysis was performed to compare significance of the scores (total and subscales) among the groups. Results: Total CAMCOG mean values increased with education, and the same was observed in relation to the subscales scores. Conclusion: CAMCOG subscales related to education levels are necessary to identify subjects who present decreased values on one or more cognitive domain despite total scores within normal range, which may characterize a pre-dementia cognitive impairment state...

Resting vagal control and resilience as predictors of cardiovascular allostasis in peacekeepers.

The body's adaptive reaction to a stressful event, an allostatic response, involves vigorous physiological engagement with and efficient recovery from stress. Our aim was to investigate the influence of individual predispositions on cardiac responses to and recovery from a standardized psychosocial stress task (Trier Social Stress Task) in peacekeepers. We hypothesized that those individuals with higher trait resilience and those with higher resting vagal control would be more likely to present an allostatic response: a vigorous cardiac response to stress (i.e., reduction in interbeat intervals and heart rate variability (HRV)) coupled with a significant cardiac recovery in the aftermath. Fifty male military personnel with a mean age of 25.4 years (SD ± 5.99) were evaluated after returning from a peacekeeping mission. Electrocardiogram recordings were made throughout the experimental session, which consisted five conditions: basal, speech preparation, speech delivery, arithmetic task, and recovery. Mean interbeat intervals and HRV were calculated for each condition. An Ego-Resilience Scale and resting vagal control assessed individual predispositions. Stress tasks reduced interbeat intervals (tachycardia) and HRV in comparison with basal, with return to basal in the aftermath (p < 0.001, for all comparisons). Resilience and resting vagal control correlated positively with cardiac parameters for both stress reactivity and recovery (r ≥ 0.29; p < 0.05). In conclusion, peacekeepers showing higher trait resilience and those with higher resting vagal control presented a more adaptive allostatic reaction characterized by vigorous cardiac response to stress (i.e., tachycardia and vagal withdrawal) and efficient cardiac recovery after stress cessation.

A pragmatic trial in the Rio de Janeiro subway to capture smokers for a quitline: methodological challenges and opportunities

According to the World Health Organization, smoking is an important cause of death worldwide. To encourage smoking cessation, persuasive messages can be used to raise smokers' risk perception. This article discusses challenges and solutions in designing a study to evaluate the effect of two different communication strategies ("gains from quitting" vs. "losses from continuing smoking") in encouraging calls to a quitline. The authors conducted an intervention study in two subway stations for 4 weeks, considering only 1 strategy per station. Large posters containing non-age-specific images and texts, on the basis of the theme"shortness of breath," were displayed on central dividing columns on the boarding platforms. Call rates from the selected stations, and respective rate ratios, overall and per study week, were calculated. Passengers who were smokers, exposed to the positive-content message, called on average 1.7 times more often than did those exposed to the negative-content message (p = .01). Moreover, call rate ratios did not decline over the 4 weeks of the study (p = .40). The effectiveness findings suggest that antismoking campaigns could use positive-content messages in order to recruit a larger smoker population. The proposed methodology can also be used to evaluate effectiveness of messages for "capturing" individuals with other health problems (e.g., alcohol abuse), thereby increasing its potential impact

[Recruitment of smokers in the Rio de Janeiro subway, Brazil, as a strategy to increase access to quitline services: the impact of novelty]. / Estratégia de recrutamento de fumantes no metrô do Rio de Janeiro, Brasil, para ampliar o acesso a linhas telefônicas de apoio à cessação: impacto da novidade.

Creative and innovative strategies to recruit smokers are essential for improving tobacco control activities. Currently in Brazil, through health warning messages on cigarette packs, there is a permanent and intense spread of messages that provoke feelings of loss associated with smoking, which is important to encourage access to smoking quitlines. The study analyzed the call rate for telephone counseling after introducing a new strategy for reactive recruitment focused on the theme 'smoking causes shortness of breath', adapted to the subway setting in Rio de Janeiro, as compared to the rates for two existing reactive strategies. Regardless of age bracket, there was a higher response to the new proposed strategy. Despite the major awareness-raising in Brazil concerning the ills of tobacco, new communications formats approaching personally relevant themes can increase the number and range of smokers recruited for telephone counseling to support cessation.

Estratégia de recrutamento de fumantes no metrô do Rio de Janeiro, Brasil, para ampliar o acesso a linhas telefônicas de apoio à cessação: impacto da novidade / Recruitment of smokers in the Rio de Janeiro subway, Brazil, as a strategy to increase access to quitline services: the impact of novelty

Criatividade e inovação das estratégias de recrutamento de fumantes são fundamentais para aprimorar as ações de controle do tabagismo. Atualmente, no Brasil, por meio das imagens de advertência presentes nos maços de cigarros, há uma divulgação permanente e intensa de mensagens que provocam sentimentos de perda associados ao tabagismo, os quais são importantes para estimular o acesso a linhas telefônicas de apoio à cessação. Comparou-se a taxa de ligação para aconselhamento telefônico observada após introdução de nova estratégia de recrutamento reativo focada no tema "fumar é perder fôlego" e adaptada ao cenário do metrô do Rio de Janeiro, com as taxas verificadas para duas outras estratégias reativas existentes. Independentemente da faixa etária, houve maior resposta para a nova estratégia proposta. Apesar da grande sensibilização, no Brasil, quanto aos malefícios do tabaco, novos formatos de comunicação abordando temas de relevância pessoal podem aumentar a quantidade e diversidade da população de fumantes recrutada para serviços de aconselhamento telefônico de suporte à cessação.

Creative and innovative strategies to recruit smokers are essential for improving tobacco control activities. Currently in Brazil, through health warning messages on cigarette packs, there is a permanent and intense spread of messages that provoke feelings of loss associated with smoking, which is important to encourage access to smoking quitlines. The study analyzed the call rate for telephone counseling after introducing a new strategy for reactive recruitment focused on the theme "smoking causes shortness of breath", adapted to the subway setting in Rio de Janeiro, as compared to the rates for two existing reactive strategies. Regardless of age bracket, there was a higher response to the new proposed strategy. Despite the major awareness-raising in Brazil concerning the ills of tobacco, new communications formats approaching personally relevant themes can increase the number and range of smokers recruited for telephone counseling to support cessation.

Revisão sistemática e metanálise de intervenções terapêuticas: como melhor entendê-las? / Sistematic reviews and meta-analysis of therapeutic interventions: how to better understand them?

Na última década, Era da Medicina Baseada em Evidências, o número de metanálises cresceu significativamente. A metanálise combina estatisticamente os resultados de vários estudos e estes são considerados o mais alto nível de evidência quando são combinados de forma apropriada os resultados de ensaios clínicos metodologicamente bem conduzidos. Resultados de uma metanálise podem não corresponder à realidade, pelo fato de depender da qualidade dos estudos nela inseridos, além de diferenças clínicas e metodológicas entre os estudos incluídos. A crescente popularidade de metanálises e de revisões sistemáticas faz com que seja necessário melhor compreendê-las. O objetivo deste artigo é fazer com que o leitor entenda como é realizada uma metanálise/revisão sistemática e que tenha melhores condições de interpretá-la. A melhor compreensão da terminologia adotada e dos conceitos envolvidos na sua produção pode ajudar o clínico a avaliar melhor a qualidade de uma metanálise e a real importância de seus resultados para um paciente específico

In the era of evidence-based medicine, the number of meta-analysis dramatically increased in the last decade. Meta-analyses statistically combine the results of multiple studies and are considered to be the highest level of evidence when the results of high-quality randomized trials are combined in an appropriate way. Results from meta-analysis can very widely from the truth because of the large variation in the quality of the studies that have been pooled, and clinical and methodological differences between the pooled studies. The oppularity of meta-analysis in the literature provides one compelling reason for understanding the principles of critical appraisal. The purpose of this article is to educate the reader about how to interpret a meta-analysis. We explain some important aspects of conducting a meta-analysis. A better understanding of the basic terminology and concepts of a meta-analysis can help readers evaluate the quality of a meta-analysis and assess the potential relevance of its results for an individual patient

Características biológicas e evitabilidade de óbitos perinatais em uma localidade na cidade do Rio de Janeiro, 1999 a 2003 / Biological features and avoidability of perinatal deaths in the city of Rio de Janeiro locality from 1999 to 2003

OBJETIVOS: analisar os óbitos perinatais de uma maternidade pública do município do Rio de Janeiro, Brasil, quanto à características biológicas, critérios de evitabilidade, causas básicas e mortalidade por faixas de peso. MÉTODOS: o estudo de coorte foi realizado de 1999 a 2003, na Maternidade Leila Diniz do Hospital Municipal Raphael de Paula Souza, que é responsável por 50 por cento dos partos de uma área programática 4 (Jacarepaguá e Barra da Tijuca). Foram incluídos óbitos perinatais com peso igual ou superior a 500 g. O instrumento principal de coleta de dados foi a Ficha de Investigação de Óbito Perinatal. Foi aplicada a Classificação de Wigglesworth para avaliar evitabilidade. RESULTADOS: houve 512 óbitos perinatais (377 fetais e 135 neonatais precoces). Os óbitos neonatais se concentraram nos primeiros três dias de vida. Vinte e quatro por cento dos óbitos cursaram com retardo de crescimento intra-uterino. As principais causas foram afecções maternas (hipertensão e sífilis) e complicações de membrana, placenta e cordão. Foram considerados evitáveis cerca de 50 por cento dos óbitos. CONCLUSÕES: o percentual de óbitos evitáveis foi elevado, mais concentrado nos óbitos fetais ocorridos antes do parto, sugerindo inadequação do pré-natal.

OBJECTIVES: to analyze perinatal deaths in a public maternity hospital, located in the city of Rio de Janeiro, Brazil, according to biological characteristics, basic causes, avoidability and birth weight-specific mortality rates. METHODS: the coorte study was performed from 1999 to 2003 in the maternity Leila Diniz, Hospital Municipal Raphael de Paula Souza, assisting 50 percent of the births in the geographic/administrative area 4 (Jacarepaguá and Barra da Tijuca). Perinatal deaths in cases where birth weight was equal or superior to 500 g were included. A standardized tool - Perinatal Investigation Report - and medical records were used to collect data. Death causes were investigated and the Wigglesworth's Classification was applied to assess deaths' avoidability. RESULTS: there were 512 perinatal deaths (377 stillborns and 135 early neonatal deaths). Neonatal deaths tended to occur in the first three days of life. Twenty-four percent of the perinatal deaths occurred in newborns smaller than expected in relation to gestational age. The principal causes of death were maternal morbidities (hypertension and syphilis) and placental complications. According to Wigglesworth's Classification, 50 percent of the deaths were avoidable. CONCLUSIONS: the number of avoidable deaths was high, mainly stillbirths, and referred to conditions related to prenatal care.

Prevalence of hysteroscopic findings and histologic diagnoses in patients with abnormal uterine bleeding.

OBJECTIVE: To describe the prevalence of hysteroscopic findings and histologic diagnoses in patients with abnormal uterine bleeding (AUB). DESIGN: Retrospective series of consecutive patients. SETTING: Tertiary care university hospital and private office. PATIENT(S): Four thousand fifty-four hysteroscopies with biopsy in patients with AUB evaluated between June 1993 and December 2004. INTERVENTION(S): Hysteroscopies were performed using 2.9-mm or 4-mm telescopes with CO(2) or saline as the distension media. Biopsies were done with a 5-mm grasper or with a Novak's curette. MAIN OUTCOME MEASURE(S): Prevalence of hysteroscopic findings and histologic analysis of biopsies. RESULT(S): Endometrial polyp was the most frequent hysteroscopic finding, accounting for 1,374 (33.9%) cases. Normal uterine cavity and cervical canal were found in 814 (20.1%) patients. Submucous fibroids were diagnosed in 302 (7.5%) women. Normal endometrium was the most frequent histologic diagnosis, accounting for 1,888 (46.6%) cases. Endometrial polyp was found in 1,115 (27.5%) patients. Endometrial hyperplasia was diagnosed in 613 (15.1%) and endometrial cancer in 105 (2.6%) women. CONCLUSION(S): Endometrial polyps are the most frequent hysteroscopic findings in patients with AUB, whereas normal endometrium is the most frequent histologic diagnosis.

Risk factors for breast cancer: a systematic review of studies with female samples among the general population in Brazil.

A systematic review of studies was conducted to determine the characteristics of epidemiological research on risk factors for breast cancer in female samples from the general population in Brazil. Of the 23 articles identified, only 14 were selected for review. Most of the studies were from Southeast Brazil. Three were cross-sectional, conducted in specific populations, and 11 used case-control designs. The sample sizes varied from 40 to 164,269 women. Twenty-nine risk factors were researched, and among these, 11 were investigated in four or more studies. Nulliparity was the most frequent factor, found in 12 of the studies. Prevalence of the factors varied widely among the samples, and since the samples were heterogeneous and the studies presented several methodological limitations, a summary mean was not calculated.

Risk factors for breast cancer: a systematic review of studies with female samples among the general population in Brazil

Uma revisão sistemática de estudos foi realizada com o objetivo de conhecer as características da pesquisa epidemiológica sobre fatores de risco para câncer de mama em amostras de mulheres da populacão geral no Brasil. Dos 23 artigos identificados somente 14 foram selecionados. A maior parte deles foi oriunda da Região Sudeste do país. Três eram seccionais, desenvolvidos em populacões muito específicas, e 11 eram do tipo caso-controle. O tamanho das amostras variou de 40 a 164.269 mulheres. Foram pesquisados ao todo, 29 fatores de risco, e dentre estes, 11 foram investigados em quatro ou mais estudos. A nuliparidade foi o fator mais freqüente, estando presente em 12 deles. As prevalências para estes fatores variaram grandemente entre as amostras, e como estas eram heterogêneas e os estudos tinham algumas limitacões metodológicas, não se calculou uma medida-sumário para as mesmas.

[Reliability of the Portuguese-language version of the Social Phobia Inventory (SPIN) among adolescent students in the city of Rio de Janeiro]. / Confiabilidade da versão em Português do Inventário de Fobia Social (SPIN) entre adolescentes estudantes do Município do Rio de Janeiro.

It is believed that social phobia has its onset during adolescence and precedes other mental disorders; it is thus important to investigate the condition among young people. To date there is no self-reported scale validated for the Brazilian population. The present study investigated the reliability of the Portuguese-language version of the Social Phobia Inventory (SPIN) among adolescent students from public schools in the city of Rio de Janeiro. After SPIN was translated into Portuguese, a test-retest reliability study was carried out with 190 students. Intra-class correlation coefficient (ICC) and weighted kappa (kappaw2) were estimated, log-linear models were fitted, and Bland & Altman graphs were built. The Portuguese version showed good internal consistency (Cronbach's alpha=0.88) and good reliability for total score (ICC=0.78). Reliability for single items was not very good (kappaw2 between 0.32 and 0.65). The "semi-association" model fit most of the items best. Based on these findings we concluded that the Portuguese-language version of SPIN showed good reliability results, similar to those obtained with the original English-language version.

Confiabilidade da versão em Português do Inventário de Fobia Social (SPIN) entre adolescentes estudantes do Município do Rio de Janeiro / Reliability of the Portuguese-language version of the Social Phobia Inventory (SPIN) among adolescent students in the city of Rio de Janeiro

Acredita-se que a fobia social teria início na adolescência e que precederia outros transtornos mentais, sendo importante a sua investigação nos jovens. Até o momento, não há nenhuma escala de fobia social validada para a nossa população. Neste estudo investigou-se a confiabilidade da versão em Português do Social Phobia Inventory (SPIN) entre escolares adolescentes da rede pública do Município do Rio de Janeiro. Após a versão do SPIN para o Português, conduziu-se um estudo de confiabilidade teste-reteste com 190 adolescentes de duas escolas, estimando-se os coeficientes de correlação intraclasse (CCIC), kappa ponderado (kw²) e ajuste de modelos log-lineares. Foram ainda construídos gráficos Bland & Altman. Observou-se uma boa consistência interna (a de Cronbach = 0,88) e boa confiabilidade da pontuação total do instrumento (CCIC = 0,78). A confiabilidade das perguntas isoladas não foi tão boa (kw² variando de 0,32 a 0,65). O modelo log-linear de melhor ajuste aos dados na maior parte dos itens foi o de "semi-associação". Esses achados nos permitiram concluir que a versão em português do SPIN exibiu resultados de boa confiabilidade, semelhantes aos da versão original em Inglês.

[Perinatal mortality research in Brazil: review of methodology and results]. / Pesquisa sobre mortalidade perinatal no Brasil: revisão da metodologia e dos resultados.

The perinatal mortality rate remains a public health problem, demanding epidemiological studies to describe its magnitude and time trends, identify risk factors, and define adequate interventions. There are still methodological controversies, resulting in heterogeneous studies and possible biases. In Brazil, there has been a growing scientific output on this theme, mainly in the South and Southeast of the country. Twenty-four articles from 1996 to 2003 were reviewed, focusing on definitions and classifications, data sources, study designs, measurement of variables, statistical analysis, and results. The review showed an increasing utilization of data bases (mainly SINASC and SIM), few studies on stillbirth, the incorporation of classification schemes, and disagreement concerning risk factors.