Urban Brazilian Population Research Articles

Incidence and progression of gingival recession over 4 years: A population‐based longitudinal study

To describe changes in gingival recession (GR) at buccal and palatal sites in adults over an average follow-up of 4years. Baseline data were obtained from a multistage probabilistic representative sample of 1023 individuals aged ≥35years from Porto Alegre, Brazil. Buccal and palatal/lingual GR were analysed. 402 individuals (6,862 teeth) were followed. At baseline, 3,356 (48.9%) teeth did not have GR at the buccal site and 1206 developed the condition overtime (incidence =35.9%; 95% CI 32.6-38.9). Percentage of incident teeth was higher among individuals with (42.3%) than those without (29.5%) periodontitis stages III/IV. Also, 38.5% of teeth with proximal attachment loss at follow-up had incident GR compared to 7.6% of those without proximal attachment loss. Incidence of palatal GR was observed in 32.5% of teeth (95% CI 29.7-35.3). Mean buccal and palatal/lingual GR incidence was 2.11mm and 2.33mm, whereas buccal and palatal/lingual GR progression equalled 0.40mm and 0.48mm. The prevalence of GR ≥3mm increased in individuals with (from 35.9% to 47.4%) and without (from 25.2 to 41.5%) periodontitis. Incidence and progression of GR are high in a general urban Brazilian population of adults.

Blood cadmium levels and sources of exposure in an adult urban population in southern Brazil

BackgroundCadmium (Cd) is a toxic metal that is widely present in the environment due to geologic and anthropogenic sources. Exposures to high Cd levels may cause nephrotoxicity, carcinogenicity, pulmonary and cardiovascular disease, among others. The goal of this study was to investigate in an adult urban population whether an association exists between sources and levels of Cd exposure and blood Cd concentrations. MethodsUsing a census-based design, a total of 959 adults, aged 40 years or older, were randomly selected. Information on socio-demographics, dietary, and lifestyle background was obtained by household interviews. Blood Cd levels were measured by inductively coupled-plasma mass spectrometry. Geometric means (GM) (95% CI) and the 50th percentile were determined, stratified by sex, age, race, education, income class, smoking status, consumption of vegetables, red meat and milk, occupation and blood pressure. To assess the association between Cd exposure and the aforementioned variables, we estimated the geometric mean ratio (GMR) (95%CI) of blood Cd concentrations. Results and conclusionThe geometric mean (95%CI) of blood Cd levels in the total population was 0.25 (0.22, 0.27) ug/dL. In a univariate analysis, significantly higher blood Cd levels were found in men (p < 0.001), current and former smokers (p < 0.001), alcohol drinkers (p < 0.001), those who never or almost never consumed milk (p < 0.001), and in subjects with higher diastolic blood pressure (p = 0.03). Significant correlations were found between the number of cigarettes consumed daily and blood Cd levels. Multivariate analysis confirmed higher blood Cd concentrations were associated with alcohol consumption (GMR 95%CI = 1.28, 1.04–1.59) and in former and current smokers (GMR 95% IC = 1.33, 1.06–1.67 and 4.23, 3.24–5.52, respectively). Our results shed novel information on variables associated with blood Cd levels in an urban Brazilian population, and should encourage additional research to prevent environmental Cd exposure, both in Brazil and globally.

Influence of genetic regulatory effects modified by environmental immune activation on periapical disease.

The objective of this study was to compare the periradicular responses in endodontic infections among members of two populations: an urban Brazilian population and a non-mixed indigenous population. Samples were collected immediately and 7 days after the cleaning and shaping procedures (after reducing the intracanal microbial load) in an attempt to characterize the expression of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-9, interferon (IFN)-γ, IL-17, IL-10, and the chemokines CXCR4, CCL2/monocyte chemotactic protein (MCP)-1, and CCR6. The endogenous cytokine and chemokine expression levels were analyzed using real-time PCR. Only the urban population showed a significant increase in TNF-α, CCL2/MCP-1, CXCR4, and CCR6 expression following the cleaning and shaping of the root canal system. The IFN-γ levels were increased at the 2nd collection (p < 0.05) in the indigenous population. In turn, a significant increase in IL-10 and IL-17 expression (p < 0.05) was observed after the cleaning and shaping procedures (2nd collection) in both populations. No significant differences in the IL-1β, IL-9, and CCL4 expression levels were observed between the 1st and 2nd collections in both populations. The results demonstrate a cytokine and chemokine expression profile that is specific to each analyzed population. However, immune modulation mediated by IL-10 began on the 7th day after the beginning of the endodontic treatment in both populations.

Assessment of Nutrient and Food Group Intakes across Sex, Physical Activity, and Body Mass Index in an Urban Brazilian Population.

The burden of preventable diet-related diseases is significant and becoming worse. Thus, accurately assessing food intake is crucial to guide public health policies and actions. Using food dietary recalls, we evaluated usual dietary intake according to physical activity and nutritional status in an adult urban population from Brasília, Brazil. The usual nutrient and energy intakes distributions were estimated using the Iowa State University (ISU) method. Energy and nutrient intakes were stratified by gender, age group, body mass index (BMI), and physical activity (PA). The prevalence of inadequate intake was highest for vitamins E and D. Both men and women had excessive sodium intake. The percentage of intakes below daily serving recommendations for food groups were 96% for cereals, 74% for vegetables, and 87% for dairy products, whereas percentage of intakes above daily serving recommendations were 97% for meat, 93% for pulses, and 99% for fat/oils. Energy and nutrient intakes were highest in overweight and physically active individuals within the categories of BMI and physical activity, respectively. Our study found that high-income urban Brazilians consume large quantities of meat, beans, fat/oils, and exhibit a low prevalence of nutrient inadequacies but have excessive sodium intake. Energy and nutrient intakes are highest among men, as well as overweight and physically active individuals.

Non-HDL cholesterol is a good predictor of the risk of increased arterial stiffness in postmenopausal women in an urban Brazilian population

OBJECTIVES:Increased arterial stiffness is an important determinant of the risk of cardiovascular disease. Lipid profile impairment, especially hypercholesterolemia, is associated with stiffer blood vessels. Thus, the aim of this study was to determine which of the five circulating lipid components (high-density lipoprotein cholesterol (HDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), low-density lipoprotein cholesterol (LDL), total cholesterol (TC) and triglycerides) is the best predictor of increased arterial stiffness in an urban Brazilian population.METHODS:A random sample of 1,662 individuals from the general population of Vitoria, Brazil (25-64 years), was selected, and lipid components were measured using standard methods. Pulse wave velocity was measured using a non-invasive automatic device, and increased arterial stiffness was defined as a pulse wave velocity ≥10 m/s.RESULTS:In men, only total cholesterol (OR=1.59; CI=1.02 to 2.48, p=0.04) was associated with the risk of increased arterial stiffness. In women, HDL-C (OR=1.99; CI=1.18 to 3.35, p=0.01) and non-HDL-C (OR=1.61; CI=1.01 to 2.56, p=0.04) were good predictors of the risk of increased arterial stiffness. However, these associations were only found in postmenopausal women (OR=2.06; CI=1.00 to 4.26, p=0.05 for HDL-C and OR=1.83; CI=1.01 to 3.33, p=0.04 for non-HDL-C).CONCLUSION:Our findings indicate that both HDL-C and non-HDL-C are good predictors of the risk of increased arterial stiffness in postmenopausal women in an urban Brazilian population and may be useful tools for assessing the risk of arterial stiffness.

MOLECULAR DETECTION OF CLARITHROMYCIN AND FLUOROQUINOLONES RESISTANCE IN HELICOBACTER PYLORI INFECTION, DIRECTLY APPLIED TO GASTRIC BIOPSIES, IN AN URBAN BRAZILIAN POPULATION.

- Antimicrobial resistance is the major factor leading to eradication failure in H. pylori treatment. Molecular tests are useful to detect genetic mutations predictive of clarithromycin and fluoroquinolones resistance. Knowledge of the local prevalence rate of resistance is important to define the best recommended treatment. - To assess the prevalence of primary resistance of H. pylori to clarithromycin and fluoroquinolones, using a molecular test, in a Southeastern urban Brazilian population. - A total of 72 H. pylori seropositive patients [65% female, mean age 39 (19-73) years] never treated before for this infection were studied. All patients underwent gastroscopy in addition to antrum and corpus biopsies and molecular test GenoType HelicoDR (Hain Life Science, Germany) to detect H. pylori and point mutations in genes responsible for clarithromycin and fluoroquinolone resistance. The molecular procedure was divided into three steps: DNA extraction from biopsy samples, a multiplex amplification with biotinylated primers and a reverse hybridization. The most frequent point mutations involved in resistance to the two antibiotics were evaluated. - Resistance to clarithromycin was detected in nine (12.5%) patients and to fluoroquinolones in eight (11.1%) patients. The point mutation A2147G was the most common (77.8%) among resistant strains to clarithromycin. In 50% of the resistant strains to fluoroquinolones, the mutant codon couldn't be identified. - The resistance rates to clarithromycin and fluorquinolones in a large urban population in the Southeast of Brazil were acceptable, suggesting that these drugs remain appropriate options to first and second-line of H. pylori treatment. The molecular test represents an adequate diagnostic tool for monitoring H. pylori resistance.

Refractive Errors Progression in Brazilian Low-Income School Children

Purpose: To assess the progression of refractive error (RE) in low-income school children in Sao Paulo, Brazil. Methods: The study population consisted of a cohort of children (11-14 years of age) from 9 randomly chosen public schools from a study performed in 2004-2005, with refraction in those with visual impairment (uncorrected distance visual acuity ≤ 20/40 in either eye). Eligible participants were those identified in the baseline study as visually impaired. Three years later, follow-up recruitment consisted of invitation for a free ophthalmic exam in the school facilities. Cycloplegic auto-refraction, cycloplegic subjective refraction and fundus examination were performed in those refracted at baseline and follow-up. Risk factors for refractive errors were investigated by administering questionnaires on family demographics, parental glasses usage and near work/outdoor activities. Results: A cohort of 218 children was eligible for a 3-year follow-up, with 136 examined. Myopic progression of -0.50 to -1.49 spherical equivalent (SE) was found in both eyes of 64 (47.1%) children, in 22 (16.2%) firstly right eyes tested only and in 15 (11.0%) second eyes tested only. Both eyes of 14 (10.3%) children had progressed < -1.50 SE, with 11 (8.1%) progressing only in their second eyes tested and 6 (4.4%) in their first eye tested. In multiple regression analysis myopic progression was associated with both parents wearing glasses (p<0.05). Conclusions: Very mild refractive error progression was detected in a low-income urban Brazilian school children population, confirming the previous finding of low prevalence of refractive errors leading to visual impairment in this population.

Serological statuses of pregnant women in an urban Brazilian population before and after the 2008 rubella immunization campaign

BackgroundVaccinating populations against rubella aims to mitigate viral circulation and to ensure that women of childbearing age are immunized to reduce the incidence of congenital rubella syndrome. This study determined the serological statuses of pregnant women in an urban Brazilian population before and after the national rubella immunization campaign that was undertaken in 2008, and it assessed the socio-demographic factors associated with seronegativity. MethodsPregnant women living in Maceió, Alagoas, Brazil, who participated in a municipal prenatal screening program that involved blood tests for rubella, were assessed between June 2007 and May 2012. Socio-demographic factors associated with seronegativity were assessed, including the year of the blood test, categorized as before or after the 2008 immunization campaign, and the women's birth cohorts, the women's ethnicities, the gestational ages at the first prenatal visit, and the women's districts of residence. ResultsA total of 54,717 capillary blood samples were tested for rubella. The prevalence of pregnant women who were seronegative for rubella declined from 9.4% before the national immunization campaign to 2.8% after the national immunization campaign. Women were more likely to be seronegative for rubella before and after the immunization campaign if they were born between 1990 and 2000 or delayed starting prenatal care. ConclusionsThe decline in the prevalence of pregnant women who were seronegative for rubella to <5% indicates that the 2008 Brazilian rubella immunization campaign was successful in Maceió.

Epidemiological evaluation of apical periodontitis prevalence in an urban Brazilian population.

The present study aimed to assess the prevalence of apical periodontitis (AP) in an urban Brazilian population according to gender, age group and tooth type. Data were collected from clinical files containing the medical and dental histories and periapical radiographs of 1,126 patients treated at the School of Dentistry at Universidade do Estado do Rio de Janeiro between March 2000 and December 2010. A total of 15,724 periapical radiographs were evaluated. All the radiographs were evaluated by two independent, previously calibrated endodontists (kappa = 0.88). Periapical areas on the radiographs were classified as N (normal) or AR (apical radiolucency). The frequency of AP and the 95% Confidence Interval (95%CI) were calculated according to gender, age group and tooth type. Differences between groups were calculated using the Z-test at a significance level of 5% (p < 0.05). AP was present in 7.87% of the samples, with 16.70% occurring on previously endodontically treated teeth and 44.65% occurring on teeth referred for endodontic treatment (TR-RCT). The frequency of AP was higher among females (64%) than among males (35%). The central and lateral maxillary incisors were the most frequently affected teeth. The frequency of AP was higher among individuals between 30 and 49 years of age. In this population, AP was more prevalent among females and among individuals between 30 and 49 years of age, and the central and lateral maxillary incisors were the most frequently affected teeth.

Influence of the C242T Polymorphism of the p22-phox Gene (CYBA) on the Interaction between Urinary Sodium Excretion and Blood Pressure in an Urban Brazilian Population

BackgroundReactive oxygen species are implicated in the physiopathogenesis of salt-induced hypertension and the C242T polymorphism of the p22-phox gene has been associated with higher superoxide production. This study investigated the impact of this polymorphism on the relationship between urinary sodium excretion (USE) and blood pressure levels in an urban Brazilian population.MethodsWe cross-sectionally evaluated 1,298 subjects from the city of Vitoria-ES, located in the Southeast region of Brazil, by clinical history, physical examination, anthropometry, analysis of laboratory parameters, USE measurement and p22-phox C242T polymorphism genotyping.ResultsNo significant differences in studied parameters were detected between the studied genotype groups (CC vs. CT+TT). Systolic blood pressure exhibited significant correlation with USE only in T allele carriers (r = 0.166; p<0.001), while diastolic blood pressure and hypertension status correlated with USE in both genotypes albeit more weakly in subjects with CC genotype (r = 0.098; p = 0.021 and r = 0.105; p = 0.013, respectively) than in T carriers (r = 0.236; p<0.001 and r = 0.213; p<0.001, respectively). Regression analyses adjusted for confounding factors showed that USE remained independently associated with systolic (p<0.001) and diastolic blood pressure (p<0.001) and hypertension status (p = 0.004) only in T allele carriers. Finally, higher diastolic and systolic blood pressure levels were detected in T allele carriers than in CC genotype individuals in the highest tertile of USE.ConclusionsThe p22-phox 242T allele is associated with higher blood pressure levels among subjects with higher USE in an urban Brazilian population.

Impact of diabetes mellitus on arterial stiffness in a representative sample of an urban Brazilian population

BackgroundIndependent of other cardiovascular (CV) risk factors, increased arterial stiffness has been established as a predictor of morbidity and mortality. The main aim of this study was to investigate the impact of diabetes on arterial stiffness in a representative sample of an urban Brazilian population plus Amerindians.MethodsA total of 1,415 individuals from the general population were randomly selected plus 588 Amerindians from a native community in Brazil. In addition, a sub-sample of 380 individuals from the general population had 5-year follow-up data. Pulse wave velocity (PWV) was measured with a non-invasive automatic device (Complior, Colson; Garges les Gonesses, France) and increased arterial stiffness was defined as PWV ≥ 12 m/s.ResultsIn the overall group, diabetic individuals had higher frequencies of increased arterial stiffness and hypertension. They also had higher values of PWV, body mass index, total cholesterol, triglycerides, systolic and diastolic blood pressures compared to non-diabetic individuals (p < 0.01). In an analysis stratified by hypertension, PWV values and increased arterial stiffness frequency were higher in diabetic individuals in both groups (hypertensive and non-hypertensive) (p < 0.05). Furthermore, higher risk for increased arterial stiffness was observed in the diabetic individuals from the overall group (OR = 2.27; CI = 1.47-3.52, p < 0.001) and from the hypertensive group (OR = 2.70; CI = 1.58-4.75, p < 0.001), adjusted for covariates. Regarding the ethnic stratification, diabetic individuals from Amerindian, White, and Mulatto (mixed-race) groups had higher PWV values and a greater frequency of increased arterial stiffness compared to non-diabetic individuals. Both diabetic and non-diabetic individuals had higher PWV values after 5 years. There was no significant difference in the 5-year PWV progression in diabetic compared to non-diabetic individuals.ConclusionsThese results confirm, in a sample of Brazilian population, that the presence of diabetes is associated with increased arterial stiffness and it may contribute in part to increased cardiovascular risk in diabetic patients.

Helicobacter pylori antibiotic resistance in Brazil: clarithromycin is still a good option

The antibiotic susceptibility is the cornerstone for the eradication therapies of Helicobacter pylori. To evaluate the prevalence of primary resistance of H. pylori was evaluated in an urban Brazilian population. H. pylori isolates were obtained from patients submitted to an upper gastrointestinal endoscopy for the evaluation of dyspeptic symptoms. Biopsies from antrum, corpus and fundus were taken to determine the antibiotic susceptibility of H. pylori isolates. The minimal inhibitory concentration of furazolidone and bismuth were routinely determined by agar dilution method and the minimal inhibitory for amoxicillin, clarithromycin, tetracycline, levofloxacin, and metronidazole were routinely determined with the E-test. Fifty-four patients were included. In vitro antimicrobial susceptibility of H. pylori strains were obtained from 39 patients. Resistance to metronidazole was detected in 20 patients (51%), to clarithromycin in 3 patients (8%), to levofloxacin in 9 patients (23%) and to bismuth in 2 patients (5%). There was no observed resistance to amoxicillin, tetracycline or furazolidone. Due to the low amoxicillin and clarithromycin resistance observed in this study, therapies using these antimicrobials remain appropriated first-line H. pylori therapy.

Diversity of the KIR gene cluster in an urban Brazilian population.

The activity of natural killer cells depends on the balance between activating and inhibitory signals coming from their receptors. Among these are the killer cell immunoglobulin-like receptors (KIR) that recognize specific HLA class I allotypes. Here we characterized KIR genetic diversity and their HLA ligands in the population of Curitiba, Paraná State (n = 164), and compared it with other worldwide populations. The distribution of 2DL4 alleles was also analyzed. The Curitiba population did not differ significantly from European and Euro-descendant populations, but as an admixed population showed higher genetic diversity. We found 27 KIR profiles, many of them uncommon in European populations, in agreement with the elevated historically recent gene flow in the study population. The frequencies of KIR genes and their respective HLA ligands were distributed independently and none of the analyzed individuals lacked functional KIR-HLA ligand combinations. KIR gene frequencies of 33 worldwide populations were consistent with geographic and ethnic distribution, in agreement with demography being the major factor shaping the observed gene content diversity of the KIR locus.

Association between mannose-binding lectin and interleukin-1 receptor antagonist gene polymorphisms and recurrent vulvovaginal candidiasis

The influence of functional polymorphisms in the genes coding for mannose-binding lectin (MBL) and interleukin-1 receptor antagonist (IL-1ra) on recurrent vulvovaginal candidiasis (RVVC) were examined in an urban Brazilian population. DNA was isolated from buccal swabs of 100 women with RVVC and 100 control women and tested by gene amplification for a single nucleotide polymorphism in codon 54 of the MBL2 gene and for a length polymorphism in intron 2 of the IL1RN gene. Genotype and allele frequencies were compared between groups. The frequency of the variant MBL2 B allele, associated with reduced circulating and vaginal MBL concentrations, was 27.0% in RVVC and 8.5% in control women (p<.0001). The MBL2 B,B genotype was present in 12% of RVVC patients and 1% of controls (p=.0025). The IL1RN 2 allele frequency, associated with the highest level of unopposed IL-1β activity, was 24.0% in RVVC and 23.4% in controls. The IL1RN genotype distribution was also similar in both groups. Carriage of the MBL2 codon 54 polymorphism, but not the IL1RN length polymorphism, predisposes to RVVC in Brazilian women.

Systemic lupus erythematosus: Association with KIR and SLC11A1 polymorphisms, ethnic predisposition and influence in clinical manifestations at onset revealed by ancestry genetic markers in an urban Brazilian population

Systemic lupus erythematosus (SLE) is an autoimmune disorder of the connective tissue with a wide and heterogeneous spectrum of manifestations, with renal and neurological involvement usually related to worse prognosis. SLE more frequently affects females of reproductive age, and a high prevalence and renal manifestation seem to be associated with non-European ethnicity. The present study aims to investigate candidate loci to SLE predisposition and evaluate the influence of ethnic ancestry in the disease risk and clinical phenotypic heterogeneity of lupus at onset. Samples represented by 111 patients and 345 controls, originated from the city of Belém, located in the Northern Region of Brazil, were investigated for polymorphisms in HLA-G, HLA-C, SLC11A1, MTHFR, CASP8 and 15 KIR genes, in addition to 89 Amerindian samples genotyped for SLC11A1. We also investigated 48 insertion/deletion ancestry markers to characterize individual African, European and Amerindian ancestry proportions in the samples. Predisposition to SLE was associated with GTGT deletion at the SLC11A1 3'UTR, presence of KIR2DS2 +/KIR2DS5 +/KIR3DS1 + profile, increased number of stimulatory KIR genes, and European and Amerindian ancestries. The ancestry analysis ruled out ethnic differences between controls and patients as the source of the observed associations. Moreover, the African ancestry was associated with renal manifestations.

Evidence for an association between haptoglobin and MnSOD (Val9Ala) gene polymorphisms in essential hypertension based on a Brazilian case-control study

Essential hypertension is a complex and multifactorial trait; genetic and environmental factors interact to produce the final phenotype. Studies have demonstrated association of hypertension with varied gene polymorphisms. However, demonstration of common genetic causes in the general population remains elusive. We investigated a possible association between hypertension and haptoglobin, angiotensin I-converting enzyme (ACE), glutathione S-transferases GSTM1 and GSTT1, MnSOD (Val9Ala), CAT (-21A/T), and GPX1 (Pro198Leu) gene polymorphisms in an urban Brazilian population group from Brasília. Although ACE has been reported to be one of the main polymorphisms associated with hypertension, we found no association with ACE's specific genotypes. However, a possible association with Hp1-1 and MnSOD Val/Ala genotypes suggests that, at least for the Brazilian population, polymorphisms related to oxidative stress should be more deeply investigated.

Prevalence and causes of visual impairment in a Brazilian population: The Botucatu Eye Study

BackgroundThis paper reports population-based data on the prevalence and causes of visual impairment among children and adults in Botucatu, Brazil.MethodsA population-based cross-sectional study was conducted involving a random start point and then systematic sampling of an urban Brazilian population in the city of Botucatu. There were approximately 3 300 individuals aged 1 to 91 years who were eligible to participate in the study. Of this sample, 2485 (75.3%) underwent ophthalmic examination. The ophthalmic examination included uncorrected (presenting) and best corrected distance visual acuity using standardized protocols. The primary cause of decreased visual acuity was identified for all patients with visual impairment.ResultsPresenting low vision and presenting blindness were found in 5.2% (95% CI: 4.3–6.1) and 2.2% (95% CI: 1.6–2.8) of the population, respectively. Unilateral presenting low vision and unilateral presenting blindness were found in 8.3% (95% CI: 7.2–9.5) and 3.7% (95% CI: 2.9–4.4) of the population respectively. Best corrected low vision was found in 1.3% of the population (95% CI: 0.9–1.7) and best corrected blindness was discovered in 0.4% of people (95% CI: 0.2–0.7). The main cause of presenting low vision was refractive error (72.3%) and cataract was the most prevalent cause of blindness (50%).ConclusionThe main causes of low vision and blindness in this Brazilian city were uncorrected refractive errors, cataract, and retinal diseases. Programs to further reduce the burden of visual impairment need to be targeted toward the correction of refractive error and surgery for cataracts.

Insertion/deletion polymorphism of the bradykinin type 2 receptor gene influence diastolic blood pressure

The contribution of kinins to the beneficial effects in cardiovascular risk reductions remains unclear. In this context, the present study examined whether the +9 bp/-9 bp polymorphism in bradykinin type 2 receptor gene, predicts hypertension risk in a large urban Brazilian population. Our finding indicated that the -9 bp allele may contribute to hypertension because of increased diastolic pressure.

Derivation and external validation of a simple prediction model for the diagnosis of type 2 Diabetes Mellitus in the Brazilian urban population

A risk score model was developed based in a population of 1,224 individuals from the general population without known diabetes aging 35 years or more from an urban Brazilian population sample in order to select individuals who should be screened in subsequent testing and improve the efficacy of public health assurance. External validation was performed in a second, independent, population from a different city ascertained through a similar epidemiological protocol. The risk score was developed by multiple logistic regression and model performance and cutoff values were derived from a receiver operating characteristic curve. Model's capacity of predicting fasting blood glucose levels was tested analyzing data from a 5-year follow-up protocol conducted in the general population. Items independently and significantly associated with diabetes were age, BMI and known hypertension. Sensitivity, specificity and proportion of further testing necessary for the best cutoff value were 75.9, 66.9 and 37.2%, respectively. External validation confirmed the model's adequacy (AUC equal to 0.72). Finally, model score was also capable of predicting fasting blood glucose progression in non-diabetic individuals in a 5-year follow-up period. In conclusion, this simple diabetes risk score was able to identify individuals with an increased likelihood of having diabetes and it can be used to stratify subpopulations in which performing of subsequent tests is necessary and probably cost-effective.

Prevalence of Refractive Errors in a Brazilian Population: The Botucatu Eye Study

Purpose: To determine the prevalence and demographic associations of refractive error in Botucatu, Brazil.Methods: A population-based, cross-sectional prevalence study was conducted, which involved random, household cluster sampling of an urban Brazilian population in Botucatu. There were 3000 individuals aged 1 to 91 years (mean 38.3) who were eligible to participate in the study. Refractive error measurements were obtained by objective refraction.Results: Objective refractive error examinations were performed on 2454 residents within this sample (81.8% of eligible participants). The mean age was 38 years (standard deviation (SD) 20.8 years, Range 1 to 91) and females comprised 57.5% of the study population. Myopia (spherical equivalent (SE) < − 0.5 dropters (D)) was most prevalent among those aged 30–39 years (29.7%; 95% confidence interval (CI) 24.8–35.1) and least prevalent among children under 10 years (3.8%; 95% confidence interval (CI) 1.6–7.3). Conversely hypermetropia (SE > 0.5D) was most prevalent among participants under 10 years (86.9%; 95% CI 81.6–91.1) and least prevalent in the fourth decade (32.5%; 95% CI 28.2–37.0). Participants aged 70 years or older bore the largest burden of astigmatism (cylinder at least −0.5D) and anisometropia (difference in SE of > 0.5D) with a prevalence of 71.7% (95% CI 64.8–78.0) 55.0% (95% CI 47.6–62.2) respectively. Myopia and hypermetropia were significantly associated with age in a bimodal manner (P < 0.001), whereas anisometropia and astigmatism increased in line with age (P < 0.001). Multivariate modeling confirmed age-related risk factors for refractive error and revealed several gender, occupation and ethnic-related risk factors. Conclusions: These results represent previously unreported data on refractive error within this Brazilian population. They signal a need to continue to screen for refractive error within this population and to ensure that people have adequate access to optical correction.