Brazilian Adults Research Articles

Comparing NIRA and Traditional Network Approaches: AStudy Case With Antisocial Personality Disorder Traits.

This study explores the NodeIdentifyR algorithm (NIRA) as a novel network analysis method for examining Antisocial Personality Disorder (ASPD) traits. Using a sample of 2230 Brazilian adults (aged 18-73 years) who responded to ASPD-related factors of the Personality Inventory for DSM-5 (PID-5), we applied NIRA to an ASPD network and compared its results with traditional network analysis methods. Our findings revealed that deceitfulness emerged as the most central trait across both methodologies. NIRA provided additional insights, indicating that simulated decreases in the likelihood of irresponsibility reduced the presence of other traits, while a simulated increase in deceitfulness amplified the likelihood of other ASPD pathological traits. Our results suggest that traditional network centrality measures converge with NIRA's simulated increase results, but NIRA's simulated decrease provides additional information not captured by traditional centrality estimates. We recommend further research to validate these findings across different psychopathologies and refine NIRA use in clinical settings. The insights from this study could serve as a foundation for developing targeted interventions and enhancing our understanding of ASPD trait dynamics.

Understanding the relationships between 24-hour movement behavior, community mobility and the neighborhood built environment for healthy aging in Brazil: The EpiMove study protocol.

The population is aging rapidly worldwide, impacting public health, with countries in the Global South, such as Brazil, aging faster than developed nations. The 24-hour movement behavior is crucial for healthy aging, but its relationship with the neighborhood built environment is underresearched, especially for older adults. The EpiMove Study uses accelerometers and GPS to investigate the relationships between 24-hour movement behavior, community mobility and the neighborhood built environment for healthy aging in older Brazilian adults. The EpiMove Study is a representative cross-sectional study of older adults aged 60 years and older from an urban area in the southern region of Brazil. It consists of two phases. Phase 1 involves conducting home interviews to gather subjective measures of the neighborhood built environment and physical activity. Phase 2 involves delivering devices to participants' homes and collecting objective data on 24-hour movement behavior via wrist-worn wGT3X-BT ActiGraph accelerometers and community-based active transportation via hip-mounted GPS Qstarz-1000XT devices. The data are collected simultaneously over seven consecutive days, along with the participants' reasons for adhering to the study protocol. The EpiMove study will provide a better understanding of the relationships between the perceived neighborhood environment and 24-hour movement behaviors and community-based active transportation among older adults, with a particular focus on whether environmental factors influence these behaviors, which are crucial for healthy aging. The results from the EpiMove study could offer essential evidence for developing public policies and urban interventions that support healthier and more equitable environments for aging populations, particularly in rapidly urbanizing regions.

Association between oral health and physical performance in Brazilian older adults: SABE cohort study

BackgroundOral health is recognized as integral to general health and impaired dentition status may affect physical performance among older adults. This study evaluated the longitudinal association between clinical and self-reported oral health measures and physical performance (outcome) in Brazilian older adults.MethodsThis was a longitudinal study that used data from the second (year 2006), third (year 2010) and fourth (year 2015) waves of the Health Well-being and Aging Study conducted in Brazil. Physical performance, evaluated using the Short Physical Performance Battery (SPPB), was the dependent variable. Independent variables of interest were the number of teeth, presence of periodontal pocket, use of dental prostheses, and poor perceived oral health. The association between oral health measures and physical function was analyzed using generalized estimating equations with an ordinal regression model.ResultsIn the total sample, every additional tooth was associated with a greater chance of achieving a higher score on the SPPB test. Individuals wearing dental prostheses had higher chances of having higher scores than those not wearing them. In the analyses for the dentate sample, the presence of a periodontal pocket was not associated with SPPB and the increase in the number of teeth increased the chance of achieving a higher score.ConclusionA greater number of teeth, and using dentures, were associated with higher physical performance. Periodontal disease was not associated with the outcome.

Clinical biomarker-based biological age predicts deaths in Brazilian adults: the ELSA-Brasil study.

Biological age is a construct that seeks to evaluate the biological wear and tear process of the organism that cannot be observed by chronological age. We estimate individuals' biological age based on biomarkers from multiple systems and validate it through its association with mortality from natural causes. Biological age was estimated in 12,109 participants (6621 women and 5488 men) from the first visit of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) who had valid data for the biomarkers used in the analyses. Biological age was estimated using the Klemera and Doubal method. The difference between chronological age and biological age (Δage) was computed. Cox proportional hazard models stratified by sex were used to assess whether Δage was associated with mortality risk after a median follow-up of 9.1years. The accuracy of the models was estimated by the area under the curve (AUC). Δage had equal mean for men and women, with greater variability for men. Cox models showed that every 1-year increase in Δage was associated with increased mortality in men (HR (95% CI) 1.21; 1.17-1.25) and women (HR (95% CI) 1.24; 1.15-1.34), independently of chronological age. Results of the AUC demonstrated that the predictive power of models that only included chronological age (AUC chronological age = 0.7396) or Δage (AUC Δage = 0.6842) was lower than those that included both, chronological age and Δage (AUC chronological age + Δage = 0.802), in men. This difference was not observed in women. We demonstrate that biological age is strongly related to mortality in both genders and is a valid predictor of death in Brazilian adults, especially among men.

Explaining how a psychosocial intervention (PROACTIVE) based on behavioural activation improved outcomes of depression in older adults living in deprived regions of Brazil: The mediating roles of reduced loneliness and stepped care

BackgroundThe PROACTIVE trial was a task-shared, stepped and collaborative care, psychosocial intervention based on psychoeducation and behavioural activation in 715 older adults (60–94 years; mean (SD) 68·6 (6.9) years; 74·1 % female), that was highly effective at improving recovery from depression among older adults in Brazil. Here we investigate mediators of the intervention's effectiveness. MethodsCausal mediation analysis using interventional indirect effects, simultaneously decomposed the total effect of PROACTIVE on recovery from depression (PHQ-9 < 10) into multiple indirect effects including: dose of intervention (numbers of sessions and activities completed); social support (Luben Social Network Scale); perceived loneliness (UCLA questionnaire); and additional sessions offered to participants who did not respond during the initial phase of the stepped care intervention. ResultsOf the intervention's total effect (difference in probability of recovery from depression between the intervention and control arms 0·216 [bias-corrected 95 % CI: 0·149, 0·291]): 13 % was mediated through reduced loneliness (0·028 [0·013, 0·046]); and 25 % through attending additional sessions for participants who did not initially respond to the intervention (0·055 [0·007, 0·102]). LimitationsDue to limitations in our sample size our study may lack power to detect some nuances such as interactions between different mediators. ConclusionsOur findings emphasise the importance of a home-based intervention to improve depression outcomes where participants are encouraged to self-select activities to mitigate against loneliness. Importantly, our findings suggest that the intervention's stepped-care component offering additional sessions to participants who did not experience an early response shows promise in ensuring a sustained recovery from depression.

Inverse and Direct Effect of Serum DDE Exposure on the Distribution of Leukocyte Telomere Length in Brazilian Adults: The Pró-Saúde Study

Inverse and Direct Effect of Serum DDE Exposure on the Distribution of Leukocyte Telomere Length in Brazilian Adults: The Pró-Saúde Study

New variants of the DAD1 and OXA1L genes are associated with asthma and atopy in an adult population

Asthma is a complex disease characterized by reversible and intermittent airway obstruction that has shown a high prevalence and unacceptable mortality in adults. In recent years, several genome-wide association studies (GWAS) have identified variants linked to asthma susceptibility. The DAD1 gene is known for regulating programmed cell death, and OXA1L is described for its involvement in mitochondrial biogenesis and oxidative phosphorylation. The present study aimed to identify variants in the DAD1 and OXA1L genes and to evaluate the association with asthma and atopy markers in adults. 1,084 individuals were divided into mild to moderate asthma, severe asthma, and participants with no asthma (controls). Association analyses were performed using a multivariate logistic regression model adjusted for sex, age, body mass index (BMI), smoking, forced expiratory volume in 1 s (FEV1), and component ancestry master (PC1) using PLINK 1.9 software. This study identified new variants in the DAD1 and OXA1L genes that had never been described before. The C allele of rs200470407 in OXA1L was negatively associated with poor asthma control (OR: 0.32; p-value 0.049) and increased IL-13 (p-value < 0.0001). The alternative allele of rs1681577 was associated with severe asthma (OR: 2.23; p-value 0.01), pulmonary obstruction (OR: 4.12; p-value 0.046), and eosinophilia (OR: 2.42; p-value < 0.001). Our findings demonstrate that variants in the DAD1 and OXA1L genes are linked to asthma and atopy in Brazilian adults.

Prevalence of motoric cognitive risk syndrome among older adults in Brazil and evaluation of effect modification by race.

Motoric cognitive risk syndrome (MCRS) is a pre-dementia syndrome of growing interest, yet it remains understudied in Latin America with a significant lack of information on the interaction between its risk factors and race. To estimate the prevalence of MCRS among older adults in Brazil, investigate its association with various clinical and sociodemographic variables, and explore the potential of effect modification by race. This cross-sectional, population-based study was conducted among community-dwelling older adults in Brazil, with data collected between 2015 and 2016. The diagnosis of MCRS was established following the standard recommended by the original study that first described it. We used Poisson regression models to analyze the association between MCRS and a list of 21 variables identified from a systematic review. A total of 4677 participants aged 60 years and older were included. The prevalence of MCRS in the Brazilian population of older adults was 4.34% (95% CI: 3.20%-5.48%). Higher levels of education and physical activity showed protective associations with MCRS, while depression and stroke demonstrated risk associations. A significant cross-over interaction between race and depression regarding MCRS was observed, such that the association of depression with MCRS was approximately three times higher among White individuals than Black individuals. Our results challenge previous estimates that Latin America is the region with the highest prevalence of MCRS among older adults and signal the need for further studies to better investigate the modification of effect of the association between depression and MCRS by race.

Exploring the Relationship Between Cooking and Food Skills and Eating Competence Among Brazilian Adults

Exploring the Relationship Between Cooking and Food Skills and Eating Competence Among Brazilian Adults

Abstract 4136776: Prognostic Value of Resting Heart Rate and Heart Rate Variability in the 12-lead Electrocardiogram: Mortality Data From the CODE Nationwide Database

Introduction: Resting Heart Rate (HR) and Heart Rate Variability (HRV) reflect autonomic control, and are implicated as prognostic factors. We aimed to evaluate the prognostic value of HR and HRV in a cohort from a nationwide telemedicine network. Methods: We assessed unique ECGs recorded from patients ≥16 years-old, from the tele-ECG database of the Telehealth Network of Minas Gerais, Brazil, between 2010 and 2017. Variables of interest were HR and standard deviation of normal RR intervals (SDNN). Self-informed data were collected: sex, age, risk factors (hypertension, dyslipidemia, diabetes, smoking) and comorbidities (myocardial infarction, Chronic Obstructive Pulmonary Disease, and Chagas disease). Outcomes of interest were all-cause and cardiovascular mortality, assessed by ICD codes reported in death certificates, through linkage with the Mortality Information System. Cox regression was applied to evaluate the association between HR and HRV and the outcomes, in 4 models: 1. Unadjusted; 2. Adjusted for sex and age; 3. Model 2 + risk factors + clinical comorbidities; 4. Model 3 + HRV or HR, respectively. Results: At total 992.611 individuals were included, median age of 55 years, 60% women. In 6 years, there were 33.292 deaths (3,37%), 21% due to cardiovascular causes. Patients who died had higher prevalence of all risk factors and comorbidities, as well as higher HR: 76 (IQR 66-87) vs. 74 (IQR 65-83) bpm, p&lt;0.001 and lower HRV: 84 (IQR 51-127) vs. 114 (IQR 74-153), p&lt;0.001. After adjustments (model 4), all HR quartiles were independently associated a progressively increased risk of all-cause mortality, being 88% higher for the 4 th quartile (HR=1.88 (95%CI 1.77–1.89). Similarly, the 1 st and 2 nd HRV quartiles remained associated with increased all-cause mortality (1 st quartile HR=1.42 (95%CI 1.37–1.47) in the final model. For cardiovascular mortality, HR was also an independent predictor, with a progressively higher risk, with a 77% increase (HR=1.77 95%CI 1.65–1.91) in the 4 th quartile. HRV was also an independent predictor of cardiovascular death, with a 33% risk increase (HR=1.33, 95%CI 1.23–1.44) for the 1 st quartile. Male gender, age, and all risk factors and comorbidities were also independent predictors of all-cause and cardiovascular mortality. Conclusions: In a large cohort of Brazilian adults, baseline HR and HRV were independent predictors of all-cause and cardiovascular mortality, after adjustment for clinical variables and autonomic indexes.

Ultra-processed food consumption is related to screen time among Brazilian adolescents, adults, and older adults.

The aim of this study was to investigate the association between screen time and ultra-processed food consumption (UPF) across the lifespan. Data from the 2019 Brazilian National Health Survey, a cross-sectional and population-based study, was used. UPF consumption was evaluated using a score, calculated by summing the positive answers to questions about the consumption of 10 UPF subgroups on previous day. Scores ≥5 represented high UPF consumption. Daily time spent engaging with television or other screens was self-reported. Crude and adjusted models were obtained through Poisson regression and results were expressed in prevalence ratios by age group. The sample included 2,315 adolescents, 65,803 adults, and 22,728 older adults. Prevalence of UPF scores ≥5 was higher according to increased screen time, with dose-response across all age groups and types of screen time. Adolescents, adults, and older adults watching TV for ≥6 hours/day presented prevalence of UPF scores ≥5 1.8 (95% CI 1.2-2.9), 1.9 (95% CI 1.6-2.3) and 2.2 (95% CI 1.4-3.6) times higher, respectively, compared to those who did not watch TV. For other screens, prevalence of UPF scores ≥5 was 2.4 (95% CI 1.3-4.1) and 1.6 (95% CI 1.4-1.9) times higher for adolescents and adults using screens for ≥6 hours/day, respectively, while for older adults only screen times of 2-<3 and 3-<6 hours were significantly associated with UPF scores ≥5. Screen time was associated with high consumption of UPF in all age groups. Considering these associations when planning and implementing interventions would be beneficial for public health across the lifespan.

Relative effect of warning labels on food choice: Case study with four product categories after the implementation of the Brazilian regulation

Warning labels have been implemented in different countries around the globe, including Brazil, to encourage healthier food choices. The aims of the present study were to evaluate the relative effect of different warning labels, brands and nutrition marketing claims on the food choice after the implementation of the Brazilian front-of package nutrition labelling regulation. Packages of four categories were designed considering the following factors: brand (familiar vs. unfamiliar), nutritional warning (present or absent), textual nutrition marketing claims (present or absent) and visual nutritional marketing claims (present or absent). A total of 850 Brazilian adults were recruited by a marketing agency. Participants were randomly allocated to one of two experimental conditions: black magnifier (n = 403) and black octagon (n = 447). They completed a choice task involving two out of four product categories: chocolate flavored milk, cookies, granola, and iced tea. The packaging was designed considering four factors: The presence of warning labels encouraged product choice in three of the four categories. However, brand and textual nutrition marketing claims had a larger effect. These results suggest the need to introduce comprehensive packaging regulations to reduce the prevalence of nutrition marketing claims on unhealthy products, as well as communication campaigns to raise awareness of the benefits of taking into account warning labels when making food purchases.

Suicidal behaviors questionnaire-revised: Adaptation and psychometric properties of the Brazilian version

Suicidal behaviors are a significant concern in Latin American countries. However, validated scales in Brazil do not address all behaviors on the suicide spectrum. We aimed to adapt the Suicidal Behaviors Questionnaire-Revised (SBQ-R) for Brazil. The SBQ-R was independently translated, back-translated, and evaluated by experts—two thousand eight hundred ninety-eight participants (68.30% women; M = 27.42; A = 18–69) from Brazil. The SBQ-R items presented adequate reliability (ω = .86). Confirmatory factor analysis (CFA) confirmed the construct validity (χ2(df) = 52.707(2), p<.001; CFI = .997; TLI = .992; RMSEA = .052; SRMR = .024). Multigroup CFA indicated that the SBQ-R is invariant for gender, sexual orientation, race, and education level. The SBQ-R has convergent validity for depression (r = 0.61), anxiety (r = 0.49), stress (r = 0.49), impulsivity (r = 0.40), hopelessness (r = 0.60) and divergent validity, with gender and sexual minorities showing higher levels of suicidal behaviors. The Brazilian SBQ-R is designated for use by Brazilian adults. Future studies must investigate the predictive validity of the SBQ-R in clinical samples.

Factors Associated with Dietary Diversity in Community-Dwelling Brazilian Older Adults.

Older populations are at high risk of nutritional inadequacy and monotonous diets, and assessing dietary diversity can be a practical measure to indicate groups at nutritional risk. We aimed to explore the dietary diversity of older adults enrolled in primary health care services in Brazil and to evaluate its associated factors. In this cross-sectional study, we evaluated the dietary diversity score (DDS) of 581 participants (≥60 years) registered in primary care services. All foods mentioned in a 24 h food recall were classified into 10 groups, and factors associated with the DDS were analyzed using hierarchical linear regression models in two blocks: (1) sociodemographic and (2) health conditions and lifestyle. The mean DDS was 5.07 (±1.34), and 67.5% of the sample reached the minimum dietary diversity (≥5 groups). In the final model, income, previous diagnosis of cancer, and sporadic intake of alcohol were positively associated with DDS. In contrast, cognitive decline, sedentary lifestyle, and anorexia of aging were negatively associated with DDS. These findings show that the entire structural, economic, and social system needs to facilitate access to quality food, adequate places and conditions for the practice of physical activity, and policies regarding tobacco and alcohol abuse, in addition to nutritional guidance.

Understanding the Structure of Subjective Well-Being: A Study with Brazilian Adults

Understanding the Structure of Subjective Well-Being: A Study with Brazilian Adults

Emotional Suffering After the COVID-19 Pandemic: Grieving the Loss of Family Members in Brazil.

(1) Background: Brazil has been severely affected by the COVID-19 pandemic, with over 700,000 deaths and, consequently, a drastic increase in the number of bereaved individuals. This study aims to understand the emotional suffering after the COVID-19 pandemic in Brazilian adults whose family members have died due to COVID-19. (2) Methods: A clinical-qualitative, cross-sectional, descriptive-exploratory study with a sample composed of 10 bereaved family members was used. Data collection took place in July 2021 through individual semi-structured interviews conducted via video call. The interviews were fully transcribed and subjected to thematic analysis. The corpus was analyzed based on Parkes' theory of mourning, in dialog with research conducted in the pandemic context. (3) Results: The results were organized into three categories: Living the anticipation of loss in an unknown world; Living through grief in a changed world; and Glimpsing a new possibility of living. (4) Conclusions: The rupture of the presumed world in times of the pandemic, the impossibility of bidding farewell to deceased loved ones, and low levels of social support hindered the process of mourning during the health crisis.

Dental age estimation in adults using the Lamendin criteria: Validation of a bayesian model in the Brazilian population

Age estimation provides information for biological profile, which is used as an important data during the process of to aid in the identification of bodies of deceased persons. Lamendin et al. proposed a simplified dental age estimation technique for adults based on the analysis of periodontal recession height, root height, and root translucency height. These characteristics were used to build a multi-population database that served in the development of a Bayesian model, known as the Forensic International Dental Database (FIDB). However, before this research, this model did not incorporate dental information from the Brazilian population. The aim of this article was to validate the application of the FIDB Bayesian statistical model for estimating dental age in samples from the Brazilian population and compare it to Lamendin's technique. A cross-sectional study was conducted using 230 dental elements extracted for therapeutic reasons and stored in a biobank. Two independent and calibrated examiners collected the data, considering the randomization of dental samples. Intra- and inter-examiner reliability analysis included the re-evaluation of 20 % (n = 40) of the sample. For statistical analyses, the data were organized in Microsoft© Excel© 365 version 2204 (Microsoft Corp., Redmond, WA, USA) spreadsheets, and R version 4.0.2 (R Foundation, Vienna, Austria) and IBM® SPSS® version 23.0 (SPSS Inc., IBM, Chicago, IL, USA) software were used. After applying inclusion and exclusion criteria, the final sample comprised 200 intact dental elements from 84 male and 116 female individuals. According to the Kolmogorov-Smirnov test, the data did not show a normal distribution, and the Intraclass Correlation Coefficient indicated that intra- and inter-examiner agreements were adequate. Through the Mann-Whitney U test, statistically significant differences between sexes were not observed. In terms of overall accuracy, the Bayesian model and the original Lamendin´s technique showed a mean absolute error of 9.39 years and 9.95, respectively. Regarding bias, it was generally 0.15 years for the Bayesian model and 5.62 years for the original Lamendin´s technique. The Wilcoxon classification test revealed no statistically significant difference between chronological and estimated ages, but only for the Bayesian model. It can be concluded that the developed Bayesian statistical model was able to estimate the age of Brazilian adults satisfactorily, and overall, the error rates were acceptable.

Gender-specific associations between sleep stages and cardiovascular risk factors.

Sleep characteristics are associated with cardiovascular disease (CVD) risk and both sleep and CVD risk vary by gender. Our objective was to examine associations between polysomnographic sleep characteristics and CVD risk after excluding moderate-severe sleep apnea, and whether gender modifies these associations. This was a cross-sectional study with at-home polysomnography in adults in Brazil (n= 1,102 participants with apnea-hypopnea index (AHI)<15 events/hour). Primary exposures were N3, REM, wake after sleep onset (WASO), arousal index (AI) and AHI, and outcomes were blood pressure (BP) and lipid levels. Associations between sleep and BP varied by gender. In women, more N3 was associated with lower systolic BP (-0.40 mmHg per 10 minutes, 95%CI -0.71, -0.09), lower diastolic BP (-0.29 mmHg per 10 minutes, 95%CI -0.50, -0.07), and lower odds of hypertension (OR 0.94, 95%CI 0.89, 0.98). In men, more WASO was associated with higher systolic BP (0.41 mmHg per 10 minutes, 95%CI 0.08, 0.74) and higher odds of hypertension (OR 1.07, 95%CI 1.01, 1.14). No interactions by gender were observed for lipids. More WASO was associated with lower total cholesterol (-0.71 per 10 minutes, 95%CI -1.37, -0.05). Higher AHI was associated with higher total cholesterol (+0.97 per event/hour, 95%CI 0.24, 1.70) and higher LDL (+0.84 per event/hour, 95%CI 0.04, 1.64). N3 is more strongly associated with BP in women, which is consistent with other studies demonstrating gender differences in BP control and CVD risk and adds a novel risk factor. Longitudinal and interventional studies are required to determine whether changes in N3 result in BP changes.

Impulse Control Deficits and Loneliness/Depression

This study aimed to assess the prevalence of problematic internet use (PIU) among Brazilian adults and its cognitive and emotional factors. A total of 294 individuals (144 men, 149 women, 1 undisclosed) aged 18 to 55 years (M=29.31, SD=7.99) participated, completing various instruments: a sociodemographic and internet use questionnaire, the generalized problematic internet use scale (GPIUS-2), the online cognition scale (OCS), the depression anxiety stress scale-21 (DASS-21), and the difficulties in emotional regulation scale (DERS). The prevalence of PIU was 17.4% (n=49). Younger participants reported higher rates of PIU. GPIUS-2 scores positively correlated with DERS and DASS-21 subscales. Network analysis highlighted impulse control deficits and loneliness/depression as key factors associated with PIU, with anxiety indirectly related through stress. These findings highlight the link between emotional difficulties and PIU, suggesting the need for guidelines to promote healthier internet use.

Development and Validation of Dimensional Clinical Personality Inventory 2 (IDCP-2) Algorithms to Assess ICD-11 Personality Trait Domain Qualifiers.

With the advent of the new diagnostic model for personality disorders in the 11th revision of the International Classification of Diseases (ICD-11), researchers and practitioners in World Health Organization signatory countries are urged to implement it. This study aims to develop a brief, reliable, and valid scale for assessing maladaptive personality traits according to the ICD-11 model, using the item pool of the Dimensional Clinical Personality Inventory (IDCP-2). Quantitative and qualitative criteria for item selection were applied to a sample of 251 Brazilian adults. As a result, the 25 items (five items per factor) were selected, demonstrating promising evidence of validity based on the internal structure with a database of 1,659 Brazilian adults. In addition, we found good evidence of validity based on relationships with external variables, particularly those related to personality pathology, in a sample of 617 Brazilian adults. The implications of these findings are discussed.