Brazilian Adults Research Articles

Issues and challenges faced by Brazilian adults to learn English

In Brazil, all students in regular schools have English classes at some point in their lives, most of them usually start in 6th grade. However, when teachers and job interviewers ask about their knowledge, the answers show that they cannot speak, read, or write the language well. The Brazilian Educational Law of Guidelines and Bases requires a “foreign language” which may be Spanish, for example. When they become adults, it is essential to speak a second language to get better job opportunities. This study has investigated some aspects of English teaching/learning in Brazil, which may encourage many people to come to the U.S. to learn. Nowadays, there is a big wave of Brazilians coming to study English as an additional language. The study has mainly focused on adult Brazilian English learners living in the U.S. and it has identified the profile of these adult students, their motivation, their challenges, as well as issues about age, affection, and beliefs related to this topic. Palavras-chave: english learners; adults; USA.

Eating competence in caregivers of celiac children: A cross-sectional study performed in Brazil

ObjectivesEating competence is an intraindividual approach to eating, behaviors, and attitudes related to eating, with repercussions on the individual and family. In pediatric celiac disease, the family is involved in the gluten-free diet management, the only treatment available. A gluten-free diet might affect eating competence because gluten-free diet compliance requires knowledge about food, meal planning, and attention to food choices. The objective is to access eating competence in caregivers of children with celiac disease and the association between caregivers’ eating competence, children's adherence to a gluten-free diet, and sociodemographic data of participants. MethodsThis cross-sectional study used a snowball spread method by applying a questionnaire, including sociodemographic data, data related to health, eating habits, and the Satter Eating Competence Inventory version validated for the Brazilian population. The sample consisted of 220 Brazilian parents or caregivers of celiac disease children. The scores of the Satter Eating Competence Inventory version validated for the Brazilian population were described in terms of means, SDs, medians, and interquartile range. Student's t test and analysis of variance followed by Tukey's post hoc tests were applied, and the association with the variables of interest was analyzed using Pearson χ2 tests. The tests were conducted considering bilateral hypotheses and a 5% significance level. ResultsParticipants’ sex, schooling level, and income did not affect their eating competence. Competent eaters were mostly those with normal weight, following a gluten-free diet, with children complying with a gluten-free diet, and who have meals with family and prepare them at home. Different from vegetable consumption, participants’ eating competence did not differ considering the frequency of children's fruit consumption. ConclusionsThe caregivers of children with celiac disease have greater eating competence scores than general Brazilian adults, and caregivers of children with celiac disease who comply with the gluten-free diet have higher eating competence scores.

Daily routine impacts on leisure engagement: analysing Brazilian adults’ different interests

ABSTRACT The goal of the current study was to analyse the role of daily routine in shaping engagement in leisure activities during the COVID-19 pandemic. Research was conducted through an online questionnaire with 181 participants. Participants’ daily routine, such as work and domestic obligations, and sociodemographic characterization was accessed. Time dedicated to domestic obligations and education-related activities increased (p < .01). Work and sleep were negatively correlated (p < .001), while weekly leisure routine was negatively correlated with obligations (p < .05). Participants performed less leisure time activities of choice during the pandemic and presented a significant change in engagement in all leisure interests tested (p < .01), except for contemplation. Change in leisure time distribution throughout the daily routine was strongly correlated to social and tourist interests before and during the pandemic (p < .001). Overall, the pandemic promoted significant changes to individuals’ daily routine and leisure engagement.

Education and cognitive function among older adults in Brazil and Mexico

AbstractBackgroundEducation is a protective factor against cognitive impairment. Research on education and cognitive function has focused on high‐income countries, where education is higher. Thus, it is important to investigate this association in a context of lower education levels, such as the one in middle‐income countries. We use nationally representative data from the two largest countries in Latin America, Mexico and Brazil, to assess the benefits of education for cognitive function, and assess how sex and country modify this relationship.MethodsThe sample included adults 50 years or older from the 2015 waves of the Brazilian Longitudinal Study of Aging (ELSI) (n = 9,412) and the Mexican Health and Aging Study (MHAS) (n = 14,779). Participants were classified as cognitively impaired or not impaired using cognitive performance scores and a regression‐based approach. Education was categorized as 0, 1‐4, 5‐8, or &gt;8 years of education. We used logistic regression models to estimate the association of education with cognitive function adjusted for sociodemographic variables, chronic diseases, and health behaviors. We also investigated the modifying effec of sex and country by adding an interaction term in the fully adjusted model.ResultsParticipants of the ELSI had mean age 62.5±9.8 years, 54% were women, 13.3% had no formal education, and 6% were categorized as cognitively impaired. Participants of the MHAS had mean age 64.8±9.7 years, 55% were women, 18% had no formal education, and 5% were categorized as cognitively impaired (Table 1). Individuals with at least one year of education were less likely to have cognitive impairment than those with no formal education in both countries, with the highest reduction in the &gt;8 years category, followed by the 1‐4 and the 5‐8 education categories (Table 2). We found a three‐way interaction effect of education with country and sex (p&lt;0.001). Men in the MHAS had lower odds of cognitive impairment than men in the ELSI at all levels of education, but there was no difference for women (Figure 1).ConclusionHigher educational level was associated with lower odds of cognitive impairment in both countries. Men in Brazil had higher odds for cognitive impairment compared with men in Mexico.

A population‐based investigation of brain changes related to Alzheimer’s disease in middle‐aged adults in Brazil

AbstractBackgroundGiven the progressive nature of neurodegenerative pathologies, great effort has been made to create diagnostic tools for detecting neurodegenerative changes in their early stages. However, the lack of information about the frequency of neurodegenerative changes in mid‐age adults impacts biomarker interpretation and sensitivity improvement. In addition, recent clinicopathological studies have shown than even a low Alzheimer’s disease (AD) neuropathological burden can significantly impact neuropsychiatric function. Finally, clinicopathological studies point to a role of small cerebrovascular changes in the cognitive decline of individuals with zero or low neurodegenerative burden; however, it remains unclear if small vascular brain lesions can impact cognition in younger mid‐age individuals.MethodWe evaluated the presence of AD neuropathological changes and their relationship with cognitive impairment, neuropsychiatric symptoms and risk factors in a multiethnic and heterogeneous group under 65 years of age at the moment of death, most of them with low educational level (Table 1). A semi‐structured interview with an informant was performed to obtain socioeconomic and clinical data. Internationally accepted neuropathological criteria were used for pathologic diagnosis.ResultSome degree of neurofibrillary pathology was found in 53% (n = 145) of the individuals, while neuritic plaques were found in 10% (n = 26) of the cases, regardless of the presence of cognitive impairment or neuropsychiatric symptoms. AD‐type pathology burden was similar among individuals with and without cognitive impairment. However, a higher frequency of vascular pathology (p&lt;0.001) was found in individuals with cognitive impairment (Table 2). Some degree of neuropsychiatric symptoms was noted in 59% (n = 160) of the cases. High frequency of cerebrovascular risk factors such as hypertension (63.9%), smoking (58.5%) and alcohol intake (27.5%) was also observed in the entire sample (n = 275) (Table 1).ConclusionOur data shows that AD neuropathological changes can begin in mid‐age and corroborates findings from other series with predominantly older Caucasians of high scholarity that have demonstrated the role of vascular pathology in cognitive impairment. As vascular risks are preventable, aggressive measures to reduce these factors may impact the prevalence of cognition‐related dysfunction.

Socioeconomic determinants of cognition among older Brazilian adults: A life‐course approach

AbstractBackgroundThe prevalence of cognitive impairment is higher in low‐ and middle‐income countries compared to high‐income economies. Yet few nationally representative studies from Latin America have investigated life‐course socioeconomic factors related to the susceptibility to age‐associated cognitive impairment. In this study, we examined the associations of early‐ (education and food insecurity), mid‐ (employment stability), and late‐life (any personal income, household per capita income, and self‐perceived income) socioeconomic indicators with the risk of cognitive impairment, while simultaneously exploring whether gender plays an effect‐modifier role on these associations.MethodThe study population comprised Brazilian adults aged 50 years and over (N = 8710) from the Brazilian Longitudinal Study of Aging. Those with ≤ 1.5 SD on a global composite measure of cognition (N = 1005) were assigned to the cognitive impairment group. Unadjusted and mutually adjusted logistic regressions estimated odds ratios with 95% confidence intervals.ResultHigher midlife employment stability and late‐life household per capita income were positively associated with the health of adult cognition. Moreover, secondary analyses performed separately for males and females showed the higher the early‐life educational attainment, the lower the likelihood of impaired cognition among females but not among males. Conversely, having a source of income in old age showed a buffering role against cognitive impairment in males, but this association was not observed in females. No significant associations were noted for early‐life food insecurity or late‐life self‐perceived income.ConclusionThese findings may have implications for population health and health policy by advancing our understanding of socioeconomic determinants of mid‐to‐late‐adulthood cognition.

Comparison of total daily energy expenditure with dietary reference intakes values in a sample of urban, relatively active Brazilian adults: A doubly labeled water study.

This report aimed to describe the results of total daily energy expenditure (TDEE) assessed by doubly labeled water (DLWTDEE) and the adequacy of the dietary reference intakes (DRI) equations to estimate energy requirements (DRIER). A cross-sectional and observational study in a convenience sample of 40 healthy Brazilian adults (≥20 years; 21 women) living in a tropical urban region. Basal metabolic rate (BMR) was measured by indirect calorimetry, DLWTDEE was compared with DRIER using individual calculated physical activity level (PAL = DLWTDEE/BMR) in its estimation. BMR (5043 ± 548 kJ/day in women and 6213 ± 656 kJ/day in men), DLWTDEE (8372 ± 1324 kJ/day and 11 453 ± 1834 kJ/day), and PAL (1.66 ± 0.17 and 1.85 ± 0.30, respectively) were significantly higher in men. The DRIER significantly overestimated DLWTDEE by 13.7 ± 8.3% and 12.7 ± 10.7% in women and men, respectively. In the present sample of relatively active urban Brazilian subjects, the DRIER yielded inaccurate estimation of DLWTDEE. More data from low- and moderate-income countries are necessary to develop accurate estimates of TDEE.

Influence of personal characteristics on social appearance anxiety: A study with Brazilian adults

Influence of personal characteristics on social appearance anxiety: A study with Brazilian adults

Pathways linking educational attainment to cognitive functioning among older Brazilians

AbstractBackgroundCognitive impairment in Brazil is a growing population health concern. Studies suggest that Brazil may have one of the highest age‐standardized prevalence of Alzheimer’s disease and related dementias (ADRD) in the world. However, improving education attainment among older adults may lead to a decline in cognitive impairment across the population in the coming years. The purpose of this study is to examine the pathways that link educational attainment to cognitive functioning in Brazil, a highly unequal, resource rich society.MethodI use the 2016 Brazilian Longitudinal Study of Aging, a nationally representative study of Brazilian older adults 50+, to predicting cognitive functioning at first interview. I use structural equation modeling to predict direct and indirect effects of education via childhood socioeconomic characteristics, adulthood socioeconomic conditions, health behaviors and health conditions on overall cognitive functioning as well as specific domains of cognition (memory vs. non‐memory).ResultFindings provide evidence of both indirect and direct pathways from education to cognitive functioning. The indirect pathways were mainly found through adulthood SES achievement (although health conditions had their own association with cognitive functioning). Additionally, indirect effects were limited among adults with 8+ years of education, suggesting that prior to 8 years of education the impact of education on cognitive functioning may be through cognitive development that is carried forward into older adulthood.ConclusionThis study shows the importance of early childhood education and the potential benefits for later life cognitive functioning, which has broad implications for cognitive health in rapidly aging countries with more recent early childhood educational expansion.

Is Walk Score Associated With Physical Activity and Screen Time in Brazilian Older Adults?

This study aimed to examine the relationship between Walk Score index with walking to commuting, moderate-to-vigorous physical activity, and screen time in older adults. Georeferenced addresses were entered into the Walk Score platform. Walking to commute and moderate-to-vigorous physical activity were assessed using the International Physical Activity Questionnaire and categorized according to the World Health Organization recommendations. Screen time was analyzed through self-reported time watching television/being on the computer. We used binary logistic regression to estimate the association between variables. Older adults who lived in places with higher Walk Score had a higher prevalence of walking to commuting (odds ratio = 1.73; 95% confidence interval [1.18, 2.55]) and engaging in moderate-to-vigorous physical activity (odds ratio = 1.76; 95% confidence interval [1.05, 2.98]). A relationship also was observed between higher Walk Score and more time in screen time (odds ratio = 1.67; 95% confidence interval [1.19, 2.34]). The results showed that residing in a more walkable neighborhood increased the chances of the older adults spending 3hr or more in front of a screen.

Physical activity delayed the onset of cognitive impairment in middle‐aged and older adults with diabetes ‐ Findings from the ELSA‐Brasil Study

AbstractBackgroundPhysical inactivity and diabetes are known risk factors for cognitive impairment. Yet, few studies in large samples of cognitively diverse populations have been reported to assess this joint effect on cognitive function. Therefore, this study aimed to characterize the joint association of baseline diabetes and physical activity with cognitive decline and the risk of cognitive impairment in middle‐aged and older adults.MethodsLongitudinal data of the Estudo Longitudinal da Saúde do Adulto (ELSA‐Brasil, Longitudinal Study on Adult’s Health), an occupational cohort of Brazilian adults aged 35‐74, were analyzed. A standardized questionnaire distinguished physically active (≥150 min/week) from inactive participants. Cognitive function was examined using standardized tests to assess memory, language, and executive function at baseline and during follow‐up visit. Global cognitive function summed all three aspects and was described as z‐score differences from the sample average over follow‐up. Linear mixed models, Cox proportional regression models, and Laplace regression models, adjusted for sociodemographic and behavioral variables, were used to assess the relationship of diabetes and physical activity with change in cognitive function over time.ResultsParticipants (n = 12,214; 55.5% women; age [SD]: 51.4 [8.8]) had median follow‐up of 8.2 (0.6) years. During follow‐up, those physically active at baseline showed a slower less than average global cognitive decline (z‐score difference 0.22; 95%CI: 0.19, 0.24) and those with diabetes greater than average decline (z‐score difference ‐0.22; 95%CI: ‐0.26 ‐0.19). In those with diabetes, active adults aged 80 or older showed global cognitive function (z‐score ‐0.80; 95%CI: ‐0.90, ‐0.69) similar to inactive adults aged 70 (z‐score ‐0.69; 95%CI: ‐0.74, ‐0.65). While inactive participants had an increased risk of incident cognitive impairment independent of diabetes status (no diabetes: HR: 1.31; 95%CI: 1.13, 1.53; diabetes: HR: 1.21; 95%CI: 1.02, 1.44), among active adults, diabetes was not associated with incident cognitive impairment (HR: 0.93, 95%CI: 0.69, 1.27) compared to active participants with no diabetes. In participants with diabetes, physical inactivity anticipated in 3.15 (95%CI: 1.60, 4.69) years the onset of cognitive impairment. Results remained consistent after multiple sensitivity analyses.ConclusionPhysical activity attenuated the impact of diabetes on cognitive function in middle‐aged and older adults.

Functional limitation in the older Brazilian adults: Association with multimorbidity and socioeconomic conditions.

The aim of this study was to assess the association between multimorbidity and the presence of functional limitation in basic (BADL) and instrumental activities of daily living (IADL) among Brazilian older adults and to verify whether this association is moderated by socioeconomic conditions. Cross-sectional study with data from the Brazilian National Health Survey (PNS) (2019) for the Brazilian population aged 60 years and over. The dependent variables were functional limitation, based on self-reported difficulty in performing one or more activities of daily living, including six BADL (feeding, bathing, using the toilet, dressing, crossing a room on the same floor and getting out of bed) and four IADL (shopping, managing money, taking medication and using transportation). The independent variables were multimorbidity (presence of two or more self-reported chronic diseases) and socioeconomic measures (per capita household income, asset score, and education level). The association between multimorbidity and outcomes was assessed using adjusted logistic regression models. The moderating effect of socioeconomic conditions on the association between multimorbidity and functional limitations was assessed by including an interaction term. The final sample consisted of 22,725 individuals. The prevalence of functional limitation was 8.5% (95%CI: 7.9-9.2) and 18.6% (95%CI: 17.8-19.5) in BADL and IADL, respectively. Multimorbidity was associated with BADL [OR: 2.30 (95%CI: 1.93-2.74)] and IADL [OR: 2.26 (95%CI: 1.98-2.57)]. The odds of functional limitation were higher among individuals with lower levels of education and income, but there was no interaction between multimorbidity and socioeconomic position measures. Multimorbidity was associated with functional limitation (BADL and IADL) and socioeconomic conditions, and this association was constant across socioeconomic position levels.

Effects of Different Protocols of Moderate-Intensity Intermittent Hypoxic Training on Mental Health and Quality of Life in Brazilian Adults Recovered from COVID-19: The AEROBICOVID Double-Blind Randomized Controlled Study

The aim of this study was to investigate the effects of different protocols of moderate-intensity intermittent hypoxic training in patients who had recovered from COVID-19 on quality of life (QoL) and mental health. The sample of this clinical trial-controlled double-blind study consisted of 67 participants aged 30–69 years, who were organized randomly according to Normoxia, Hypoxia, Hypoxia Recovery or Control Group. Eight weeks of cycle ergometer training were performed with a frequency of three training sessions per week in normoxic or hypoxic conditions (with or without hypoxic recovery). Health-related QoL and Mental Health Status were evaluated by 12-Item Short Form Survey and Depression Anxiety and Stress Scale instruments, respectively. All training groups improved the QoL’s physical dimensions (Baseline–Post: Normoxia Group 42.1 (11.0)–48.7 (7.0), Hypoxia Group 46.9 (11.8)–53.5 (6.6) and Hypoxia Recovery Group 45.8 (9.2)–51.1 (5.3)) and mental dimensions (Baseline–Post: Normoxia Group 48.8 (7.9)–54.6 (4.6), Hypoxia Group 45.2 (7.7)–53.2 (3.8) and Hypoxia Recovery Group 46.5 (9.7)–52.0 (9.9)). Regarding mental health outcomes, all training groups decreased depressive symptoms (66.7% Normoxia, 31.2% Hypoxia Recovery and 31% Hypoxia groups), anxiety symptoms (46.5% Normoxia, 45.9% Hypoxia Recovery and 39.5% in the Hypoxia groups) and stress symptoms (40.6% Normoxia, 36.3% Hypoxia Recovery and 22.1% Hypoxia groups). Significant statistical difference was not found between groups. Normoxic and hypoxic training showed a similar effect on QoL and the mental health of Brazilian adults who had recovered from COVID-19.

Social Appearance Anxiety Scale: a psychometric investigation and evaluation of the influence of individual characteristics on social appearance anxiety in Brazilian adults who practice physical exercise.

Evaluating signs of anxiety related to body appearance is becoming increasingly important in contemporary society and, in this sense, the Social Appearance Anxiety Scale (SAAS) seems an interesting alternative of measurement. To evaluate the psychometric properties of the Portuguese version of the SAAS when applied to Brazilian adults who practice physical exercise and verify the influence of individual characteristics on participants' social appearance anxiety. This was a cross-sectional study conducted online. The participants completed the SAAS and a demographic questionnaire. The psychometric properties of the SAAS one-factor model were evaluated using confirmatory factor analysis. A structural model was built for men and women to verify the influence of individual characteristics of the participants on social appearance anxiety. 1,495 individuals participated in the study (70.8% women; mean age = 29.5, SD = 8.9 years). The data obtained with the SAAS presented good indicators of validity and reliability for both genders (CFI > 0.97, TLI > 0.97, SRMR = 0.04, α > 0.97, ω > 0.85). For both men and women, greater levels of social appearance anxiety were observed among younger participants, who had a higher body mass index, self-reported an eating disorder, and perceived a change in their body after the onset of the COVID-19 pandemic. For women specifically, higher income and having started physical exercise more recently were associated with greater levels of social appearance anxiety. The findings supported the validity and reliability of the data obtained with the SAAS and revealed that when investigating social appearance anxiety in future research and clinical protocols, specific individual characteristics should be considered.

Behavioral and metabolic risk factors associated with periodontitis in Brazil, 1990–2019: a multidimensional analysis for the Global Burden of Disease Study 2019

ObjectivesPeriodontitis is a non-communicable disease (NCD) that may be linked to other NCDs through shared risk factors. Accordingly, we analyzed the relationship between periodontitis and behavioral and metabolic risks common to NCDs in Brazilian adults over three decades.MethodsIndicators of periodontitis, behavioral risks (smoking, alcohol use, sugar-sweetened beverages (SSB), and physical activity), and metabolic risks (overweight/obesity, dyslipidemia, hyperglycemia, and hypertension) in Brazilian adults (25–49 y-old) between 1990 to 2019 were obtained from the Global Burden of Disease Study 2019. Data were adjusted for Gini index. Fixed-effects and Prais-Winsten regressions were performed (p < 0.05).ResultsThe prevalence of periodontitis has increased among Brazilians since 2005. High-SSB diet, alcohol use, and metabolic risks increased between 1990–2019, whereas smoking decreased. In crude models, periodontitis prevalence increased with alcohol use (2545.1; 95%CI: 2307.9–2782.3), high-SSB diet (365.5; 95%CI: 322.5–408.4), low physical activity (1784.4; 95%CI: 763.7–2805.0), overweight/obesity (172.3; 95%CI: 156.3–188.4), dyslipidemia (734.5; 95%CI: 624.7–844.2), and hyperglycemia (1774.3; 95%CI: 1555.9–1992.7). After adjustment for the Gini index, periodontitis prevalence raised with a high-SBB diet (1416.0; 95%CI: 1120.2–1711.8), overweight/obesity (629.9; 95%CI: 573.1–686.8), dyslipidemia (2035.8; 95%CI: 1728.1–2343.5), and hyperglycemia (8918.1; 95%CI: 7979.8–9856.3).ConclusionsPeriodontitis has increased in Brazil since 2005, despite the smoking reduction. Sugar-sweetened beverage was the behavioral risk that mostly accompanied the periodontal trend.Clinical relevanceOur results support upstream strategies targeting commercial, social, political, and structural determinants to tackle NCDs and reduce oral health inequities.

Prevalence and factors associated with possible cases of familial hypercholesterolemia in Brazilian adults: a cross-sectional study

This study aimed to estimate the prevalence of possible cases of FH and analyze associated factors in the adult Brazilian population. Cross-sectional study with laboratory data from the Brazilian National Health Survey, with 8521 participants. Possible cases of FH were defined according to the Dutch Lipid Clinic Network criteria. The prevalence and 95% confidence intervals (95% CI) of possible cases of FH were estimated according to sociodemographic variables, lifestyle, diabetes, hypertension, altered tests, treatment and self-rated health. Logistic regression was used to analyze the associations. The prevalence of possible cases of FH was 0.96%, higher in women, between 45 and 59 years, white race/skin color and others, less education, people with diabetes, hypertension and total cholesterol ≥ 310 mg/dL. The presence of FH was positively associated with regular self-rated health (OR 1.96; 95% CI 0.99–3.84), poor/very poor (OR 3.02; 95% CI 1.30–7.03) and negatively with black race/skin color (OR 0.10; 95% CI 0.02–0.46) and complete elementary school, incomplete high school (OR 0.47; 95% CI 0.23–0.98) and complete high school and more (OR 0.45; 95% CI 0.21–0.95). FH affects 1:104 Brazilian adults, these findings contribute to understanding the burden of disease in Brazil. Due to the scarcity of studies on FH in low- and middle-income countries, further studies are desirable.

Dimensions of religiosity, sociodemographic indicators, and self-rated health in Brazilian adults and older adults

ABSTRACT Prevalence of the importance attributed to four dimensions of religiosity and its associations according to religious affiliation, religious attendance, sociodemographic, and health indicators, was investigated in a representative Brazilian population aged ≥50 years (N = 7,369). Results showed greater prevalence of non-Catholics and regular attendees of religious services attributing greater importance to all four dimensions of religiosity, while men conferred little importance to all of them. Greater importance was attributed to virtues and moral values by individuals with ≥1 year of education; to social belonging by non-Catholics and Pardos; and to existential meaning by Protestants and individuals with 1–8 years of education.

Association between ultra-processed food consumption and the incidence of type 2 diabetes: the ELSA-Brasil cohort

BackgroundUltra-processed food (UPF) consumption increases the risk of type 2 diabetes in various high-income countries, with some variation in the magnitude across studies. Our objective was to investigate the association of UPF consumption and specific subgroups with incident type 2 diabetes in Brazilian adults.MethodsThe Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a multicenter cohort study of 15,105 adults (35–74 years) enrolled in public institutions in Brazil (2008–2010). We followed participants with two clinic visits (2012–2014; 2017–2019) and annual telephone surveillance. After excluding those with diabetes at baseline, who died or were lost in the follow-up, with missing data, with implausible energy food intake, or reporting bariatric surgery, there were 10,202 participants. We used the NOVA classification to assess UPF consumption based on a food frequency questionnaire. We defined type 2 diabetes by self-report, medication use, or comprehensive laboratory tests. We estimated relative risks (RR) and 95% confidence intervals (95% CI) using robust Poisson regression.ResultsMedian UPF consumption was 372 g/day. Over 8.2 (0.7) years of follow-up, we detected 1799 (17.6%) incident cases. After adjustment for socio-demographics, family history of diabetes, and behavioral risk factors, comparing the fourth (≥ 566 g/day) with the first (< 236 g/day) quartile of UPF distribution, RR was 1.24 (1.10–1.39); every 150 g/day increments in UPF consumption resulted in a RR of 1.05 (1.03–1.07). Reclassifying natural beverages with added sweeteners as UPF increased risk (RR 1.40; 1.25–1.58). Among UPF subgroupings, consumption of processed meats and sweetened beverages increased diabetes risk, while yogurt and dairy sweets decreased the risk (p < 0.05).ConclusionsUPF consumption increased the incidence of type 2 diabetes in Brazilian adults, with heterogeneity across specific food items. These findings add to previous evidence for the role of UPFs in the development of diabetes and other chronic diseases, supporting recommendations to avoid their intake in diabetes prevention and management.

Invasive disease by Streptococcus pneumoniae: a case report and a discussion about the immunization rates in older adults in Brazil

Invasive disease by Streptococcus pneumoniae has a high mortality rate, principally in old adults and children. This paper presents the progression and prognostic of a case of invasive pneumococcal disease in an elderly woman by vaccinal serotype and promotes a discussion about the monitorization of the vaccinal pneumococcal rate in an old adult population in Brazil.

Comparison of different methods of analysis of maxillary sinus volume and validation of a new proposal using cone beam computed tomography

Purposedevelop and validate a formula, through a discriminant analysis of sex estimation, evaluating maxillary sinus in cone beam computed tomography scans in a Brazilian population, comparing this formula with two other existing ones. Methods190 cone beam CT scans of Brazilian adults were retrospectively evaluated by an independent examiner. Measurements were performed in the right and left MS region: height, width, length, distance between the breasts, distance between infraorbital foramina, and volume in the ITK software. The sample was divided into female and male. T test, ANOVA, Tukey test and the ROC Curve was performed (p > 0,05). Resultsstatistically significant differences were found in relation to the maximum height of the MS both right (p = 0,001) and left (p = 0,026) between sexes and the maximum length in the right MS (p = 0,01). Regarding the comparison of MS volume according to the different analysis methods, statistically significant differences were found between sexes for the right MS when using the method by Bangi et al. (p = 0,012) and the volume of the left MS in females (p < 0,001). Comparing the three classification models, statistically significant differences were found between the proposed method and the classification by Bangi et al. (p < 0.007). The ROC curve showed greater accuracy in the classification proposed in this work. Conclusionthe new proposed formula obtained better predictions of sexual dimorphism, when compared to classifications already described in the literature.