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Aim Estimate the frequency of Human papilloma virus (HPV) 16 lineages in specimens of cervical cancer, relate the pathological factors in those variants and assess the response to treatment with radical chemoradiotherapy. Methods Samples of cervical cancer were collected from women referred to reference cancer hospital to test the presence of Human papilloma virus types DNA. The standard protocol of the service consisted of cisplatin based chemotherapy 40 mg/m² plus conventional pelvic irradiation in the dosis of 45-50.4 Gy and high dose rate brachytherapy of 28–30 Gy to Point A. The response to chemotherapy was avaliated after three months in those patients with HPV − 16 lineage. Results HPV DNA was detected in out 104 (88.1%) of the 118 patients. HPV-16 present in 63 patients (53%). Lineages of HPV 16 identified in 57 patients being: 33 (57.8%) lineage A, 2 lineage B (3.5%), 2 lineage C (3.5%) and 20 (35.0%) lineage D. The median age of the patients was 48.4 years (range 25–85 years). Squamous cell carcinoma was detected 48 times (84.2%). Adenocarcinoma were more likely to occur in lineage D, as three of the four cases occurred in this lineage. A total of 11patientes with HPV-16 variant were treated with chemoradiotherapy. After three months, was observed that nine of the eleven patients (81.8%) achieved complete response: five of the lineage A, two of the lineage C and two of the lineage D. The cases of partial response and progression of disease, one each, occurred in the lineage A. Conclusion Besides the small number of patients and HPV variants, we notice better response in patients with HPV 16 lineage A. Increasing the sample could be helpful to better associate the impact of HPV variants on cervical cancer treatment.

Açaí (

Diante dos avanços tecnológico-científicos, da demanda do paciente por mais exames e maior disponibilidade e funcionalidade dos métodos de imagem, além do envelhecimento e complexidade clínica da população, houve e continua havendo um significativo crescimento dos exames de diagnóstico por imagem e dos serviços nas últimas décadas. Existe uma falta de padronização do ensino de radiologia nas instituições, apontando a necessidade de reavaliação dos currículos médicos para se garantir o uso racional, consciente e eficaz dos recursos de imagem, com benefícios para o médico, para o paciente e para o sistema de saúde. Assim, buscou-se avaliar o nível de conhecimento dos médicos da atenção primária e residentes de clínica médica sobre os exames de imagem bem como seu uso racional através da indicação correta dos métodos em situações clínicas da prática diária. O estudo foi realizado com 123 médicos, integrantes da atenção primária à saúde e/ou residentes de clínica médica e São Luis, MA, por meio de questionário estruturado contendo questões sobre conhecimentos gerais e indicação dos métodos de imagem. De forma geral, houve maior nível de conhecimento expressado por percentual médio de acerto (%m.a) entre o grupo de médicos residentes (%m.a= 85,7 ±6,4) quando comparados aos médicos da AB (%m.a=78,2±15), com menos tempo de formados (%m.a=83,35±11,1). Médicos que atuam em serviço de urgência (84,70±7%) apresentaram maiores médias. Embora médicos da AB tenham tido bom aproveitamento em indicar exames de imagem em situações específicas, na maioria dos casos os residentes.

Background. Cardiovascular disease (CVD) is the leading cause of death in Western civilizations. The type of fatty acid which makes up the diet is related to the cardiovascular morbimortality and the formation of atheromas. Populations with high consumption of oils and fats have a higher number of deaths from CVD. Purpose. In the present study, the objective was to comparatively analyze the microcirculatory effects of unrefined babassu oil with olive oil in microcirculation and liver of male hamsters of the species Mesocricetus auratus, checking the permeability to macromolecules after ischemia-reperfusion (I/R) without and with topical application of histamine 5 × 10−6 M. This is an experimental study, using as model the hamster’s cheek pouch, which was prepared for intravital microscopy. The hamsters were divided into seven groups and orally treated for 14 days, twice a day (at 8 AM and 4 PM), orally received treatments in the following doses: unrefined babassu oil (BO) 0.02 mL/dose (group BO-2), 0.06 mL/dose (group BO-6), and 0.18 mL/dose (BO-18 group); extra virgin olive oil (OI) 0.02 mL/dose (group OI-2), 0.06 mL/dose (group OI-6), and 0.18 mL/dose (OI-18 group); and mineral oil (MO) 0.18 mL/dose (MO-18 group). The observations were made on the 15th day on the hamsters’ cheek pouch; the increase of vascular permeability induced by I/R with and without histamine application was evaluated, and in the liver the biological material was collected aseptically then fixed in 10% buffered formalin. Results. Microcirculatory analyses showed a significant reduction in the number of leaks after I/R with and without the topical use of histamine in animals treated with unrefined BO 0.06 mL/dose (BO-6) and 0.18 mL/dose (BO-18) compared to animals treated with OI. The BO group (p<0.001) presented a dose-response relationship for decreasing leaks after I/R with and without topical use of histamine. Histological liver analyses showed no fat deposition changes in any of the treatment groups. Phytochemical analyses evidenced a chemical compound (C31H60NO8) in unrefined BO but not in OI. Conclusions. This experiment demonstrates the protective effect of unrefined BO on the microcirculatory system and its greater dose effect than that of OI. Finding a chemical compound (C31H60NO8) that is present in BO but not in OI opens the possibility of investigating whether this chemical compound was responsible for the protective effect on membrane permeability.

This study aimed at the investigation of physicochemical characteristics of oils and the morphometric characteristics of fruits and seeds (almonds) of babassu (Orbignya phalerata Martius), by ecological region of the state of Maranhão. For this, samples of babassu were obtained from the following regions: Litoral, Cocais, Baixada, Cerrado and Pre-Amazonia of the state of Maranhão, and analyzed the following physicochemical parameters: acidity index, saponification index, refraction index and humidity using Analytical Standards of the Adolfo Lutz Institute. Fruits were collected from the same regions to analyze the morphometric characteristics by measuring the fruits and almonds of the studied species. The results indicate that the acidity indexes are within the maximum limit established by the ANVISA National Standard and the saponification indexes indicate the presence of medium to high molecular weight lipids. The refractometric results are in line with current standards and the moisture content was less than 1%. The lots of Orbignya phalerata Martius babassu presented a significant variability in size and weight for fruits and almonds by region.

Objetivo: estimar a prevalência de sintomas de distúrbios musculoesqueléticos em trabalhadores do extrativismo mineral. Método: Estudo de natureza quantitativa, descritiva e transversal que foi realizado no povoado de Pirinã, Município de Pinheiro, no estado do Maranhão. O universo da pesquisa compreendeu os trabalhadores do extrativismo de pedra. A amostra foi de conveniência por inclusão de indivíduos que apresentavam sintomatologia dolorosa em alguma região anatômica do corpo. A coleta dos dados foi feita mediante o uso de dois instrumentos, o Questionário Individual (QI) e o Questionário Nórdico de Sintomas Musculoesquelético (QNSM). Resultados: A maioria apresentou dor na coluna lombar, coluna dorsal, mãos/punhos, e ombros, necessitando de afastamento do trabalho. Em relação ao cansaço físico durante a jornada de trabalho, 80% referiram cansaço ao final da jornada de trabalho observou-se também que 23 trabalhadores possuíam mais de 10 anos de trabalho e laboravam de 3-4 horas por dia durante a semana. Considerações finais: Os resultados chamam a atenção quanto a recorrência da dor entre os trabalhadores rurais, dores estas que podem interferir em sua qualidade vida, causar sequelas irreversíveis e/ou crônicas e diminuir sua produtividade. A análise ergonômica neste contexto pode atuar prevenindo a incidência de acidentes e evitando incapacitações.

Background: Cervical cancer is the fourth most common type of cancer affecting women globally. In Brazil, it is the third most frequent type of cancer in women and HPV is present in approximately 90% of cases. Evidence suggests that variants of HPV 16 can interfere biologically and etiologically during the development of cervical cancer. Methods: Cervix tumor fragments were collected, their DNA was extracted, and nested PCR was used to detect HPV. Positive samples were sequenced to determine the viral genotype. To characterize the HPV 16 strains, positive samples PCR was used to amplify the LCR and E6 regions of the HPV 16 virus. Results: Data from 120 patients with cervical cancer were analyzed. Most women were between 41 and 54 years of age, had schooling until primary school, a family income between 1 and 2 times the minimum wage and were married/in a consensual union. There was no statistically significant association between HPV or socio-demographic variables and risk factors for cervical cancer (P < 0.05). HPV was present in 88 women (73%). The most prevalent types were HPV 16 (47/54%), HPV 18 (12/13.8%), HPV 35 (6/6.9%) and HPV 45 (5/5.7%). Of the 47 HPV 16 positive cases, variant A (49%) was present in 23 samples, followed by variant D in 20 cases (43%), and variants B and C in 2 cases each (4%).The most prevalent histological type of HPV 16 tumors was epidermoid carcinoma, followed by adenocarcinoma. There was a statistically significant association between HPV 16 variants and the tumors’ histological types (P < 0.001).Conclusions: Knowledge of HPV 16 variants will provide data on their influence on the pathological and oncogenic aspects of cervical lesions.

Background Flavonoids from a variety of fruits, including açaí, have beneficial antioxidant activity in several diseases, including cancer. Breast cancer is the second most prevalent cancer among Brazilian women. Studies have shown the action of flavonoids on neoplastic cells, as well as on diabetes and neurodegenerative and cardiovascular diseases. Objective To analyze the relationship between the consumption of açaí and the presence of chronic diseases in women residing in the rural area of São Luís, Maranhão. Methods A convenience sample of 150 women residing in the Maracanã neighborhood in São Luís, Maranhão, was used; the collected data included sociodemographic characteristics, habits, sexual and reproductive history, consumption of açaí, and history of cancer and other chronic diseases. The sample was divided into women who consumed açaí at least once a week (cases) and women who did not consume açaí (controls). Statistical analysis was performed to assess the relationships between those variables and the consumption of açaí. Results A total of 141 women (94%) consumed açaí. Among these, 79.3% were aged between 20 and 50 years, 78.67% were farmers or housewives, 64.67% were Pardo (mixed race), 76.67% were nonsmokers, 70% were not receiving hormonal therapy, 40.67% had already undergone mammography, 28% had already undergone breast ultrasound, and 27.33% had a family history of cancer, with breast cancer being the second most prevalent cancer. There was a higher prevalence of hypertension among women who did not consume açaí than that among those who did; however, previous cancer, family history of cancer, heart disease, and diabetes were more prevalent among the consumers of açaí. There were no statistically significant relationships. Conclusion Flavonoids are known to have a beneficial effect on some types of neoplastic cells and other diseases; therefore, larger studies are necessary to better evaluate the beneficial effects of consuming foods containing flavonoids on these diseases.

Objective: To evaluate the plasma cytokine levels during T cell-mediated inflammatory responses and compare the metabolic markers between overweight and obese perimenopausal women without systemic diseases. Methods: Sixty perimenopausal women were divided into two groups (overweight and obese). Participants in both groups had their waist-to-height ratio (WHtR) measured and blood samples collected for the evaluation of estradiol, fasting glucose, leptin, high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, IL-10, IL-17A levels, and lipid profile. Results: In univariate analysis, women with obesity showed increased WHtR, fasting glucose, leptin, and IL-6 (p < 0.05) levels; however, significant differences were not observed in IL-10 or IL-17A (p > 0.05) levels. In the receiver operating characteristic curve, the highest areas under the curve were shown for leptin (0.856) and IL-6 (0.706). IL-6 levels correlated with both hs-CRP (r = 0.302, p = 0.020) and leptin (r = 0.294, p = 0.022). However, in multivariate analysis, IL-6 was not associated with a greater likelihood of obesity (OR = 1.61; 95% CI: 0.82-3.15; p = 0.16), when potential confounders were considered. Conclusion: IL-6 levels varied between overweight and obese perimenopausal women, and this association was weaker when adjusted for other clinical variables.

Introduction: Climacteric women are susceptible to a number of changes, among them osteoporosis. Osteoporosis is a disease characterized by low bone mass and susceptibility to fracture. Currently, this disease is a public health issue, being necessary to recognize its risk factors. Objectives: Identify risk factors related to osteoporosis in women attending Propis/Proex/UFMA, tracing a socio-demographic characterization and considering community lifestyles. Material and methods: This is a transversal retrospective clinical with a quantitative approach study conducted between March and June 2013 in São Luís (MA) with 107 women treated at the Programa de Práticas de Integralidade em Saúde (Propis - Integrality Health Practice Program). The study was approved by the University Hospital Ethics Committee of UFMA under opinion no. 362/07. Data were tabulated and analyzed in the epidemiological Epi-Info® software, version 3.4.1. Results: The brown color was predominant, consensual relationships proved to be a protective factor and low education was a risk factor. The average age of the group with menopause was 54.1 years and without menopause was 31.3 years (p < 0.0001). The average age of menopause was 43.7 years. The irregular menstrual cycle was a protective factor. The average number of pregnancies was 4.56 for the group with menopause and 2.45 for the group without menopause, with most births occurring normally (p < 0.0001). Smoking, physical inactivity and caffeine intake were risk factors, while the absence of alcoholism and of soda intake were protective factors for the disease. Conclusion: The patients followed the socioeconomic and demographic profile of Maranhão. Most had menarche and menopause in appropriate periods, showed no positive family history of osteoporosis, did not usually drink alcohol, were sedentary and the caffeine intake was high. RESUMO Introdução: As mulheres no climatério estão suscetíveis a uma série de mudanças, entre elas a osteoporose. A osteoporose é uma doença caracterizada por uma baixa massa óssea e susceptibilidade à fratura. Atualmente, essa doença é um problema de saúde pública e é necessário reconhecer seus fatores de risco. Objetivos: Identificar os fatores de risco relacionados com a osteoporose em mulheres atendidas pelo Programa de Práticas de Integralidade em Saúde (Propis)/Proex/UFMA, traçar uma caracterização sociodemográfica e considerar o estilo de vida da comunidade. Material e métodos: Trata-se de um estudo transversal retrospectivo clínico com uma abordagem quantitativa, feito entre março e junho de 2013, em São Luís (MA), com 107 mulheres atendidas pelo Programa de Práticas de Integralidade em Saúde (Propis). O estudo foi aprovado pelo Comitê de Ética do Hospital Universitário da UFMA, sob parecer nº 362/07. Os dados foram tabulados e analisados com o software epidemiológico Epi-Info®, versão 3.4.1. Resultados: A etnia parda foi predominante, a união estável mostrou ser um fator protetor e a baixa escolaridade foi um fator de risco. A idade média do grupo com menopausa foi de 54,1 anos e a do sem menopausa de 31,3 anos (p < 0,0001). A idade média da menopausa foi de 43,7 anos. O ciclo menstrual irregular foi um fator protetor. O número médio de gestações foi de 4,56 para o grupo com menopausa e 2,45 para o grupo sem menopausa, com a maior parte dos partos normal (p < 0,0001). O tabagismo, a inatividade física e o consumo de cafeína foram fatores de risco, enquanto a ausência de alcoolismo e de ingestão de refrigerante foram fatores de proteção para a doença. Conclusão: Os pacientes seguiram o perfil socioeconômico e demográfico do Maranhão. A maior parte teve a menarca e a menopausa em períodos apropriados, não apresentava antecedentes familiares de osteoporose, não costumava ingerir bebida alcoólica, era sedentária e consumia uma elevada quantidade de cafeína.

Objetivo: Avaliar o perfil alimentar, estado nutricional, hábitos de vida e consumo de frequência alimentar de derivados de babaçu em comunidades quilombolas em uma cidade do estado do Maranhão, Brasil. Métodos: Foi realizado um estudo descritivo por meio de questionários de recordação de 24 horas, pesquisa de frequência alimentar de derivados de babaçu e dados antropométricos. O estudo foi realizado em comunidades quilombolas no nordeste do Brasil. Resultados: A amostra foi composta por 87 indivíduos com mais de 21 anos. A amostra apresentou 57,47% de participantes do sexo feminino e 42,53% do masculino, com faixa etária predominante entre 40 e 59 anos. De acordo com o estado nutricional, 47,13% foram classificados como eutróficos, 35,63% como obesos e 3,45% como baixo peso. Entre os indivíduos obesos e com sobrepeso, 69,76% eram do sexo feminino. As proteínas tiveram o maior percentual de adequação, 83,91%. Os carboidratos foram consumidos acima dos níveis recomendados, 27,59%. Conclusão: Os derivados de babaçu mais frequentemente ingeridos foram óleo e nozes. O estudo demonstrou alta prevalência de sobrepeso e obesidade. A proteína foi o macronutriente com a maior porcentagem de adequação da dieta. A ingestão de vitaminas A, C, E e B2 foi inadequada.

Background Human papillomavirus (HPV) is a member of the Papillomaviridae family. The prevalence of HPV genotypes may vary according to the region and the population studied. Quilombo communities are ethnic and racial groups with difficult access to health services compared to the general population in Brazil. The aim of this study was to identify specific HPV types correlating with sociodemographic/behavioral characteristics and cervical smear cytological abnormalities in Quilombola women. Methods This cross-sectional study included 395 Quilombola women users of the Unified Health System of the Municipalities of Maranhão for the screening of cervical cancer. The samples were analyzed for the presence of cytological abnormalities by conventional methods and tested for 37 HPV genotypes using polymerase chain reaction with primers PGMY09/11 followed by reverse line blot hybridization performed with the Linear Array HPV Genotyping Test kit by Roche Molecular System®. The association between HPV types and cytological diagnosis was investigated according to the different age groups. Results HPV infection was detected in 12.6% (50/395) of the women. Infections by high-risk HPV types were more frequent. Genotypes 68 (26.0%); 58 and 52 (20.0%); 31 (10.0%) and 62 (8.0%) were the most prevalent. The highest prevalence (42.0%) of HPV infection occurred in women diagnosed with high-grade squamous intraepithelial lesion. There was a statistically significant association between HPV infection and the detection of cytological abnormalities in all age groups except in women over 60 years. There was a statistically significant association between the municipality of origin and the number of partners with HPV infection. Conclusions It is important to incorporate new cervical cancer screening techniques incorporating the cervical-vaginal cytology. For further studies, it is necessary to determine the level of knowledge of Quilombola population on health-related issues including HPV infection and cervical cancer. This will contribute to the continuous improvement of healthcare coverage among the population and enhance the implementation of cancer care in the state of Maranhão.

A cross-sectional population-based study using questionnaire and anthropometric data was conducted on 968 university students of São Luís, Brazil, from which 590 showed up for blood collection. In the statistical analysis the Student t-test, Mann-Whitney and chi-square tests were used. The prevalence of metabolic syndrome by the Joint Interim Statement (JIS) criteria was 20.5%, almost three times more prevalent in men (32.2%) than in women (13.5%) (P < 0.001). The prevalence of insulin resistance was 7.3% and the prevalence of low HDL-cholesterol was high (61.2%), both with no statistically significant differences by sex. Men showed a higher percentage of smoking, overweight, high blood pressure, high blood glucose and increased fasting hypertriglyceridemia. Women were more sedentary. University students of private institutions had higher prevalences of sedentary lifestyle, obesity, abdominal obesity, elevated triglycerides and metabolic syndrome than students from public institutions. High prevalences of metabolic syndrome, insulin resistance and other cardiovascular risk factors were found in this young population. This suggests that the burden of these diseases in the future will be increased. Resumo Estudo transversal de base populacional, usando questionários e medidas antropométricas, feito em 968 universitários de São Luís, dos quais 590 realizaram também coleta de sangue. Na análise estatística foram utilizados os testes t de Student, Mann-Whitney e qui-quadrado. A prevalência de síndrome metabólica pelo critério Joint Interim Statement (JIS) foi de 20,5%, sendo quase três vezes mais prevalente nos homens (32,2%) do que nas mulheres (13,5%) (P < 0,001). A prevalência de resistência insulínica foi de 7,3% e a de HDL-colesterol diminuído foi elevada (61,2%), ambas sem diferença estatisticamente significante por sexo. Os homens apresentaram maior percentual de tabagismo, sobrepeso, hipertensão arterial, glicemia em jejum aumentada e hipertrigliceridemia. As mulheres eram mais sedentárias. Os universitários de instituições privadas tiveram maiores prevalências de sedentarismo, obesidade, obesidade abdominal, triglicerídeos aumentados e síndrome metabólica do que os alunos de instituições públicas. Prevalências elevadas de síndrome metabólica, resistência insulínica e outros fatores de risco cardiovascular foram encontradas nesta população jovem. Isto sugere que a carga destas doenças será elevada no futuro.

Este trabalho avalia o uso de álcool entre estudantes de Medicina da Universidade Federal do Maranhão (UFMA), São Luís, em 2010. Os estudantes responderam dois questionários autoaplicáveis: o primeiro continha informações gerais, e o segundo, o teste Audit, que rastreia consumo de risco. A pesquisa envolveu 337 estudantes, 54,8% do sexo masculino e 45,2% do sexo feminino. Duzentos e dezessete (64,2%) usavam bebidas alcoólicas. A situação considerada mais propícia para beber foram as festas de faculdade. A maioria dos etilistas (55,8%) encontrou-se na Zona I pelo escore do Audit (baixo risco para consumo de álcool); 38,2% na Zona II (médio risco); 4,6% na Zona III (alto risco); e 1,4% na Zona IV (altíssimo risco). Houve maior consumo de álcool entre os estudantes de períodos mais adiantados e entre aqueles que não residiam com os pais, com valores de p estatisticamente significantes. É necessário, portanto, orientar o estudante de Medicina sobre os riscos do consumo de álcool de forma nociva e as consequências que este hábito pode trazer para sua profissão. This study aims to evaluate alcohol consumption among medical students at the Federal University of Maranhão (UFMA), São Luís, Brazil, in 2010. Students completed two self-reported questionnaires: the first containing general information to be collected; and the second an AUDIT test, tracking the risks of their consumption. The research involved 337 students: 54.8% male and 45.2% female. Two hundred and seventeen (64.2%) reported consuming alcohol. The situations considered most suitable for drinking were college parties. Most of the drinkers (55.8%) fell within Zone I according to the AUDIT score (low-risk alcohol consumption); 38.2% were in Zone II (medium risk); 4.6% in Zone III (high risk); and 1,4% in Zone IV (very high risk). It was found that alcohol consumption was higher among students who were further advanced in their course and among those who did not live with their parents, who showed statistically significant p values. Medical students should therefore be educated on the detrimental risks of alcohol consumption and the consequences that these may entail for their profession.

Background The babassu palm tree is native to Brazil and is most densely distributed in the Cocais region of the state of Maranhão, in northeastern Brazil. In addition to the industrial use of refined babassu oil, the milk, the unrefined oil and the nuts in natura are used by families from several communities of African descendants as one of the principal sources of food energy. The objective of this study was to evaluate the effects of babassu oil on microvascular permeability and leukocyte-endothelial interactions induced by ischemia/reperfusion using the hamster cheek pouch microcirculation as experimental model. Methods Twice a day for 14 days, male hamsters received unrefined babassu oil (0.02 ml/dose [BO-2 group], 0.06 ml/dose [BO-6 group], 0.18 ml/dose [BO-18 group]) or mineral oil (0.18 ml/dose [MO group]). Observations were made in the cheek pouch and macromolecular permeability increase induced by ischemia/reperfusion (I/R) or topical application of histamine, as well as leukocyte-endothelial interaction after I/R were evaluated. Results The mean value of I/R-induced microvascular leakage, determined during reperfusion, was significantly lower in the BO-6 and BO-18 groups than in the MO one (P < 0.001). In addition, histamine-induced increase of microvascular permeability was significantly less pronounced in BO groups compared to MO one. No significant differences among groups in terms of leukocyte adhesion, concentrations of tumor necrosis factor alpha, interleukin 1, and interleukin 6 were found. Conclusions Our findings suggest that unrefined babassu oil reduced microvascular leakage and protected against histamine-induced effects in postcapillary venules and highlights that these almost unexploited nut and its oil might be secure sources of food energy.

ResumoIntroduçãoAs mulheres no climatério estão suscetíveis a uma série de mudanças, entre elas a osteoporose. A osteoporose é uma doença caracterizada por uma baixa massa óssea e susceptibilidade à fratura. Atualmente, essa doença é um problema de saúde pública e é necessário reconhecer seus fatores de risco.ObjetivosIdentificar os fatores de risco relacionados com a osteoporose em mulheres atendidas pelo Programa de Práticas de Integralidade em Saúde (Propis)/Proex/UFMA, traçar uma caracterização sociodemográfica e considerar o estilo de vida da comunidade.Material e métodosTrata‐se de um estudo transversal retrospectivo clínico com uma abordagem quantitativa, feito entre março e junho de 2013, em São Luís (MA), com 107 mulheres atendidas pelo Programa de Práticas de Integralidade em Saúde (Propis). O estudo foi aprovado pelo Comitê de Ética do Hospital Universitário da UFMA, sob parecer n̊. 362/07. Os dados foram tabulados e analisados com o software epidemiológico Epi‐Info®, versão 3.4.1.ResultadosA etnia parda foi predominante, a união estável mostrou ser um fator protetor e a baixa escolaridade foi um fator de risco. A idade média do grupo com menopausa foi de 54,1 anos e a do sem menopausa de 31,3 anos (p