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Background: Few reports have investigated the association between human T-lymphotropic virus type 1 (HTLV-1) and tuberculosis (TB) in countries where both infections are endemic. This study estimates the incidence of TB in a cohort infected with HTLV-1, compared with non-infected individuals, over a ten-year period., Methods: Retrospective cohort study involving the cross-matching of records of individuals for whom a HTLV serology was performed at a referral center for HTLV (CHTLV) with a database of TB cases from Sinan-the Information System on Diseases of Compulsory Declaration between 2002 and 2012., Results: From a cohort of 6,495 individuals, 1,711 were infected with HTLV-1. A total of 73 TB cases occurred during the study period: 33 HTLV-1-infected patients and 40 uninfected individuals. The incidence density for TB in the HTLV-1 infected group was 3.3 person-years per 1,000 individuals and 1.1 person-years per 1,000 individuals in the group HTLV-1 uninfected group. The relative risk of developing TB in the group of patients infected with HTLV-1 was 2.6 (CI 95 % 1.6-4.2) in comparison with HTLV-1 uninfected group. Compared to individuals with isolated TB, those in the HTLV-1 infected group who had TB were older (p = 0.005) and had lower education levels (p = 0.02). No differences were observed with respect to the clinical/radiological presentation, nor in the outcome of TB and prevalence of HIV infection, when comparing among the HTLV-1-infected and uninfected groups., Conclusions: Patients infected with HTLV-1 are more susceptible to TB. The epidemiological characteristics of HTLV-1/TB subjects and those infected with TB overlap.

The main objective of the study was identify the prevalence and factors associated with leisure time physical activity (LTPA) in adult participants of the Longitudinal Study of Adult Health (ELSA-Brasil). The LTPA was measured using the International Physical Activity Questionnaire (IPAQ), long version. A hierarchical ecological model was built with the possible factors associated with LTPA distributed across blocks. We estimated crude and adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) using logistic regression. In men, being more educated, having a high family income, living in environments with conditions and opportunities for PA, being retired and being overweight were positively associated, while current smoking, obesity and abdominal obesity were associated negatively with the LTPA. Among women, being over 60years old, being more educated, having a high family income, living in an environment with conditions and opportunities for PA practice and being retired were positively associated, while being overweight, obese and having abdominal obesity were associated negatively with the LTPA. The proposed ecological model explains the LTPA through the social, physical and personal environment and highlights gender differences in physical activity., (Copyright © 2016 Elsevier Inc. All rights reserved.)

In this study, we evaluated the psychometric properties of the items to measure the work-family conflict and the time use for personal care and leisure, included in the baseline questionnaire of the Longitudinal Study of Adult Health (ELSA-Brazil). We evaluated temporal stability (7-14 days) using kappa statistic and the validity of the construct by the correlation of Kendall's tau with other variables. Test-retest stability was discreet to moderate and the correlations were compatible with the underlying theory. Future studies in the context of ELSA-Brazil and in other populations will complement the assessment of its relevance. RESUMO Neste estudo, avaliamos as propriedades psicométricas dos itens para mensurar o conflito trabalho-família e o uso do tempo para cuidado pessoal e lazer, incluídos no questionário da linha de base do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Foram avaliadas a estabilidade temporal (7-14 dias) utilizando estatística kappa e a validade do construto pela correlação tau de Kendall com outras variáveis. A estabilidade teste-reteste foi discreta a moderada e as correlações, compatíveis com a teoria subjacente. Estudos futuros no contexto do ELSA-Brasil e em outras populações complementarão a avaliação da sua pertinência.

The aim of this study was to investigate the association between exposure to non-ionizing electromagnetic radiation from mobile phone base stations and psychiatric symptoms. In a cross-sectional study in Salvador, Bahia State, Brazil, 440 individuals were interviewed. Psychiatric complaints and diagnoses were the dependent variables and distance from the individual's residence to the base station was considered the main independent variable. Hierarchical logistic regression analysis was conducted to assess confounding. An association was observed between psychiatric symptoms and residential proximity to the base station and different forms of mobile phone use (making calls with weak signal coverage, keeping the mobile phone close to the body, having two or more chips, and never turning off the phone while sleeping), and with the use of other electronic devices. The study concluded that exposure to electromagnetic radiation from mobile phone base stations and other electronic devices was associated with psychiatric symptoms, independently of gender, schooling, and smoking status. The adoption of precautionary measures to reduce such exposure is recommended.

Objectives: To propose plausible criteria with which to identify menopausal women with PCOS., Study Design: A cross-sectional study involving the baseline data of 713 menopausal women at admission to the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) in Salvador, Bahia, Brazil., Main Outcome Measures: PCOS was identified by the presence of two of three criteria. (1) A history of amenorrhea or oligomenorrhea (OL) (regular intermenstrual intervals ≥35 days during reproductive life); (2) clinical or biochemical hyperandrogenism (HA), identified by a score ≥5 points in a hirsutism questionnaire constructed and validated for women in this age group, or total or free testosterone ≥ the 95th percentile for women considered normal; (3) insulin resistance (IR) (a homeostatic model assessment [HOMA] index≥2.2). Validation was performed using probable epidemiological endpoints., Results: According to these criteria, 7.6% of the women in the sample had PCOS. Of these, 7.4% had HA and OL, 72.2% had HA and IR, 14.8% had OL and IR and 5.6%, had HA, OL and IR. Women with PCOS were younger, had had fewer pregnancies and entered menopause earlier. Positive associations were found between PCOS and overweight (PR: 1.31; 95%CI: 1.18-1.46), obesity (1.44; 1.01-2.06), carbohydrate metabolism disorders (impaired glucose tolerance and diabetes mellitus) (1.30; 1.03-1.65), and with diabetes alone (1.41; 0.83-2.39), although this latter association failed to reach statistical significance., Conclusion: The women selected in accordance with these criteria had the characteristics of PCOS that are not only expected, but also widely associated with this disorder., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Little research in Brazil has focused on the quality of care following unsafe abortion. This article presents the first step in the development of an instrument to assess hospital care provided by the Brazilian Unified National Health System in three cities of Brazil. Along with related criteria, four key dimensions of care were defined: wellcome and guidance, technical quality of care, continuity of care, and supplies and physical environment. The authors performed a cross-cultural adaptation of a set of items proposed by the World Health Organization. Following an assessment of the dimensions and criteria not captured by this set, the researchers decided to adapt questions from related studies and to add others developed by the research team itself. The questionnaire was pretested in 52 patients from three cities to assess the acceptance, understanding, and time of application and to make final adjustments. The instrument totaled 55 items organized according to different stages of care. Its expanded use depends on subsequent psychometric assessments, currently underway.

Background: As the most frequent pathway of vertical transmission of HTLV-1 is breast-feeding, and considering the higher prevalence in women, it is very important to perform screening examinations for anti-HTLV-1 antibodies as part of routine prenatal care. So far, no studies of HTLV-1 seroprevalence in pregnant women in the Southern region of Bahia, Brazil, have been described., Methods: Pregnant women were selected at the two regional reference centers for health care from Southern Bahia. A total of 2766 pregnant women attending the antenatal unit between November 2008 and May 2010 have been analyzed. An extra blood sample was drawn during their routine antenatal testing. A standardized questionnaire was applied and all positive plasma samples were tested by ELISA and were confirmed by Western Blot and PCR. Besides that, positive women were contacted and visited. The family members that were present during the visit were asked to be serologically screened to the virus. A prospective study was also carried out and newborns were followed up to two years for evaluation of vertical transmission., Results: HTLV prevalence was 1.05% (CI 95%: 0.70-1.50). There was no association of HTLV-1 infection with age, education, income and ethnic differences. The association with marital status was borderline (OR = 7.99; 95% CI 1.07-59.3; p = 0.042). In addition, 43 family members of the HTLV-1 seropositive women have been analyzed and specific reactivity was observed in 32.56%, including two children from previous pregnancy., Conclusion: It is very important to emphasize that the lack of HTLV-1 screening in pregnant women can promote HTLV transmission especially in endemic areas. HTLV screening in this vulnerable population and the promotion of bottle-feeding for children of seropositive mothers could be important cost-effective methods to limit the vertical transmission. Besides that, our data reinforce the need to establish strategies of active surveillance in household and family contacts as important epidemiological surveillance actions for the early detection of virus infection and the prevention of transmission by sexual or and parenteral contact.

Background: The importance of tight blood glucose control among outpatients with diabetes mellitus is well established, however, the management of diabetes in the hospital setting is generally considered secondary in importance. This study sought to assess glycemic control and diabetes management in adult patients admitted to hospitals in Brazil., Methods: A cross-sectional and nationwide survey was conducted from July 2010 to January 2012. Eligible cases were 18 years of age or older, had a diagnosis of diabetes and a hospitalization length of stay ≥72 hours. Socio-demographic information, hospitalization details, and data on diabetes diagnosis, management and treatment were collected for all patients by chart review. Information on all blood glucose (BG) readings for a maximum of 20 consecutive days of hospitalization was recorded for each patient., Results: Overall, 2,399 patients were surveyed in 24 hospitals located in 13 cities from all five Brazilian regions. The prevalence of patients presenting hyperglycemic (BG >180 mg/dL) or hypoglycemic (BG <70 mg/dL) events was 89.4% and 30.9% in patients in general wards, and 88.2% and 27.7% in those in Intensive Care Units (ICUs), respectively. In addition, a BG measure >180 mg/dL was recorded in two-thirds of the patient-days. A high proportion of patients were treated with sliding-scale insulin regimen alone in the general wards (52.0%) and in the ICUs (69.2%), and only 35.7% and 3.9% received appropriate insulin therapy in general wards (basal + bolus insulin) and in ICUs (continuous IV insulin), respectively., Conclusions: Inpatient glycemic control and diabetes management needs improvement. Opportunities to improve care in Brazilian hospitals include expanded use of intravenous insulin and subcutaneous basal-bolus insulin protocols, avoiding use of sliding-scale insulin alone, increased frequency of blood glucose monitoring, and institution wide quality improvement efforts targeting both physician and nursing behavior.

Objective: To present the recruitment and communication strategies of the ELSA-Brasil (Estudo Longitudinal de Saúde do Adulto - Brazilian Longitudinal Study for Adult Health)., Methods: The strategies were directed at dissemination, institutionalization and recruitment. The communication actions intended to promote the strengthening of a positive institutional image for the study, knowledge management and an effective dialogue with its target audience. An official website was created in order to communicate with different audiences, to disseminate scientific knowledge, and to contribute to consolidate the image of the study within society., Results: We recruited 16,435 men and women, active employees and retirees of six public institutions of education and research, to constitute the cohort of 15,105 participants. The recruitment goals were fully achieved in the six centers, with a slight predominance of women and of younger adults, and slightly fewer employees with lower level of schooling., Conclusions: The strategies used were adequate and essential to the successful inclusion and participation of the employees.

Abortion is a serious health problem in Brazil and complications can be avoided by adequate and timely care. The article evaluates the quality of care given to women admitted for abortion in hospitals operated by the Unified Health System, in Salvador, Recife and São Luis, the benchmarks being Ministry of Health norms and user satisfaction. The article analyzes 2804 women admitted to hospital for abortion complications in 19 hospitals, between August and December 2010. Four dimensions were defined: reception and guidance; inputs and physical environment; technical quality and continuity of care. There was a closer fit to norms on reception and guidance. Social support and the right to information were not well rated in all three cities. The technical quality of care was rated poor. With respect to inputs and physical environment, cleanliness was the least adequate criterion. Continuity of care was the most critical situation in all three cities, due to the lack of scheduled follow-up appointments, information about care available after hospital discharge, the risk of further pregnancy and family planning. Abortion care falls short of that advocated under Brazilian norms and by international agencies.

Renal failure is common in patients with glomerular disease. Although renal failure may result from the glomerular lesion itself, it is also observed in patients with minimal glomerular alterations. Degenerative changes and necrosis of the tubular epithelium are common findings in kidney biopsies from these patients. The aim of this work is to examine the association between acute tubular necrosis (ATN) and renal failure in patients with glomerulopathy and to estimate the relationship between the degree of ATN and renal failure in these patients. Data on age, sex, presence of nephrotic syndrome, and renal failure were recorded for 149 patients, who underwent a renal biopsy for the diagnosis of glomerulopathy. The biopsies were reviewed, and ATN, when present, was classified as one of four grades depending on its intensity. The mean age of the patients was 21 ± 16 years. Eighty patients (54%) were male, 43 (42%) had renal failure, 104 (72%) had nephrotic syndrome, and 66 (45%) had minimal change disease or focal segmental glomerulosclerosis. ATN was present in 115 (77%) patients. The frequency of renal failure was directly correlated with the intensity of ATN [odds ratio (OR) of 26.0 for patients with grade 2 lesions and OR of 45.5 for patients with grade 3 lesions]. ATN is a common finding in the biopsies of patients with glomerulopathy. The severity of ATN is directly associated with the frequency of renal failure in these patients.

This study evaluated the association between adolescent pregnancy and the completion of basic education, mediated by macrosocial indicators. A cross-sectional household survey was conducted with individuals between the ages of 18 and 24 in three Brazilian cities. For the purposes of this study, individuals between the ages of 20 and 24 were selected from this sample survey that included 4,634 people. A total of 29.6% of the girls declared that they had become pregnant prior to reaching the age of 20, while 21.4% of the boys stated that they had made a girl pregnant in adolescence. Girls from households with a per capita family income of US$70 or less and who became pregnant at least once during adolescence were more likely to have not completed basic education; whereas from households with a per capita family income of US$70 or less, with parents who separated before the adolescent reached the age of 20 and that had made a partner pregnant prior reaching the age of 20 were more likely to have not completed basic education. It is vital that the school system provides girls and boys with guidance on sexuality and contraception and encourages them to remain in education.

Context: Adolescent pregnancy has been associated with the early childbearing experience of the mothers of adolescents, and young people's education level is believed to be an important factor in this phenomenon., Methods: In 2002, a representative household survey collected data from 3,050 young men and women aged 20-24 in three Brazilian cities. The main measures were mother's age at first birth, daughter's age at first pregnancy and son's age when he first impregnated a partner; ages were dichotomized as younger than 20 and 20 or older. The distribution of respondents by both their own and their mothers' reproductive experience was analyzed in relation to various characteristics, and logistic regressions assessed possible associations between these variables and pregnancy experience., Results: Thirty percent of women reported getting pregnant before age 20, and 21% of men said they were younger than 20 when they first impregnated a partner. Of these groups, 34% of women and 31% of men reported that their mothers had first given birth at the same age. Both women and men were more likely to have had an early pregnancy experience if their mother had had a child before age 20 (odds ratios, 2.0 and 2.3, respectively). Among women, this positive association disappeared in the final model after adjusting for their education level, whereas among men the association remained after similar adjustment (1.8)., Conclusions: Daughters' and sons' level of education appears to be an important factor in the repetition of adolescent fertility across generations. Efforts are needed to increase access to education and to encourage young people to remain in school.

This study investigated contraceptive use during first sexual intercourse among 2.790 young men and women. The GRAVAD household survey in three Brazilian capital cities involved interviews in a probabilistic sample. A hierarchical logistic regression analysis was used. Variables grouped as: macro-social, socialization and sexual initiation, context of sexual initiation, and characteristics of the interviewee and his or her partner. The prevalence of contraceptive use was 68.3% for women and 65.3% for men. Among women, contraception use was associated to: per capita monthly family income, color/race, and the use of women's magazines as a source of information on pregnancy and contraception. For both genders, use was more frequent when partners discussed pregnancy prevention before intercourse, when sexual initiation was delayed and in a motel, and when the partner was patient. The interval between the start of the relationship and sexual initiation appeared associated to use during sexual initiation for men. Results suggest that macro-social factors determine more frequent contraception use during sexual initiation for women, while for men the relational context is more important.

This paper describes the relationship between school trajectory and incidence of teenage pregnancy. A cross-sectional residence-based questionnaire was applied, interviewing 4,634 youth ages 18 to 24 years, selected through a stratified three-stage sample. For the present study, young people ages 20 to 24 years (65.6%) were chosen, with teenage pregnancy rates of 29.5% for females and 21.4% for males (in relation to their partners). Sexual debut was reported by 87% of women and 95.3% of men. The majority of young people reported irregular school trajectory, with 39% enrolled in school at the time of the study. Nearly half of those who had interrupted their studies at least once reported a teenage pregnancy. The main reasons for interrupting their studies were pregnancy and children for women and work for men. School dropout due to teenage pregnancy was mentioned by 40.1% of women for whom the outcome of pregnancy was a child. However, 20.5% had already dropped out of school before becoming pregnant.

Objective: There has been a growing interest in patterns of contraceptive use among adolescents, due, in particular, to the social relevance attached to pregnancy in this age group. Therefore, the objective of the study was to investigate factors associated with the use of contraceptive methods among female and male adolescent students., Method: A cross-sectional study was conducted, by means of self-applied questionnaires, among 4,774 students ranging from 11 to 19 years of age. Prevalence with respect to the use of contraceptive methods during the first experience of sexual intercourse as well as the most recent one was calculated both separately, that is, for each of these events, and in conjunction as a measure of consistent use. Logistic regression was carried out for simultaneous analysis of factors associated with the use of contraceptive methods and in order to calculate adjusted measures., Results: Among the 1,664 students who reported being sexually active, the factors positively associated with the consistent use of contraceptive methods among male students included a) postponing their first experience of sexual intercourse and interaction with a stable partner, b) the family as a potential supplier of contraceptive methods, and c) access to health services. On the other hand, among female students factors positively associated with the consistent use of contraceptive methods included a) recent sexual initiation, and b) having a father as their source of information regarding sexuality, contraception and STD/AIDS prevention. Pregnancy was reported by 6.4% of the boys and 18.1% of the girls, its absence was associated with the consistent use of contraceptives by them (the girls) (Odds Ratio=3.83; 2.06-7.15)., Conclusions: The results confirm the complexity of determining contraceptive behavior among adolescents and therefore reinforce the need to include multi-dimensional aspects of this theme in order to ensure the efficacy of sex education programs.

This study aims to estimate the prevalence of adolescent pregnancy (AP) in three Brazilian cities Salvador, Rio de Janeiro, and Porto Alegre and to examine the profiles of pregnant girls and their partners in relation to pregnancy outcomes. Data for a retrospective assessment of AP were collected using an interview-based household survey applied to a stratified sample of males and females aged 18-24. A total of 4,634 individuals were interviewed (85.2 % of the eligible individuals). 21.4% of males and 29.5% of females aged 20-24 reported AP, but few such pregnancies had taken place before age 15 (0.6% and 1.6%). Pregnancy between adolescent partners was reported by 55.1% of males and 27.9% of females. 79.8% of the latter became pregnant while involved in a stable relationship with an older partner. AP levels varied inversely to schooling and income levels. 72.2% of females and 34.5% of males carried their first AP to completion, and more cases of induced abortion were reported by male partners in pregnancies (41.3%) than by females (15.3%). With the birth of the first child, 25.0% of women interrupted their studies temporarily and 17.3% definitively. However, 42.1% of primiparous mothers were already outside school before pregnancy.