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To describe the performance of machine learning (ML) applied to predict future metabolic syndrome (MS), and to estimate lifestyle changes effects in MS predictions.We analyzed data from 17,182 adults attending a checkup program sequentially (37,999 visit pairs) over 17 years. Variables on sociodemographic attributes, clinical, laboratory, and lifestyle characteristics were used to develop ML models to predict MS [logistic regression, linear discriminant analysis, k-nearest neighbors, decision trees, Light Gradient Boosting Machine (LGBM), Extreme Gradient Boosting]. We have tested the effects of changes in lifestyle in MS prediction at individual levels.All models showed adequate calibration and good discrimination, but the LGBM showed better performance (Sensitivity = 87.8 %, Specificity = 70.2 %, AUC-ROC = 0.86). Causal inference analysis showed that increasing physical activity level and reducing BMI by at least 2 % had an effect of reducing the predicted probability of MS by 3.8 % (95 % CI = -4.8 %; -2.7 %).ML models based on data from a checkup program showed good performance to predict MS and allowed testing for effects of lifestyle changes in this prediction. External validation is recommended to verify models' ability to identify at-risk individuals, and potentially increase their engagement in preventive measures.

Aims: Non-alcoholic hepatic steatosis (HS) is associated with hypertension and increased cardiovascular risk. While Blood pressure hyper-reactive response (HRR) during peak exercise indicates an increased risk of incident hypertension and increased cardiovascular risk, no data on the association of non-alcoholic HS and HRR exists. In this study, we have evaluated the association of HS with HRR. Methods: We included 13 410 consecutive individuals with a mean age: 42.4 ± 8.9 years, 3561 (26.6%) female with normal resting blood pressure and without a previous diagnosis of hypertension, who underwent symptom limited exercise treadmill test, abdominal ultrasonography and clinical and laboratory evaluation. HS was detected by abdominal ultrasonography. HRR was defined by a peak exercise systolic blood pressure >220 mmHg and/or elevation of 15 mmHg or more in diastolic blood pressure from rest to peak exercise. Results: The prevalence of HS was 29.5% ( n = 3956). Overall, 4.6% ( n = 619) of the study population presented a HRR. Subjects with HS had a higher prevalence of HRR (8.1 vs. 3.1%, odds ratio 2.8, 95% CI 2.4—3.3, P

Objectives To evaluate the PSA in a large population of Brazilian men undergone to check up, and correlate the PSA cutoffs with prostate size and urinary symptoms. Materials and Methods This is a cross sectional study performed with men between 40 and 70 years undergone to check-up. All men were undergone to urological evaluation, digital rectal examination, prostate-specific antigen, and ultrasonography The exclusion criteria were men who used testosterone in the last six months, or who were using 5 alpha-reductase inhibitors. Results A total of 5015 men with an average age of 49.0 years completed the study. Most men were white and asymptomatic. The PSA in the three different aging groups were 0.9 ± 0.7ng/dL for men between 40 and 50; 1.2 ± 0.5ng/dL for men between 50 and 60; and 1.7 ± 1.5ng/dL for men greater than 60 years (p=0.001). A total of 192 men had PSA between 2.5 and 4ng/ml. From these men 130 were undergone to prostate biopsy. The predictive positive value of biopsy was 25% (32/130). In the same way, 100 patients had PSA >4ng/mL. From these men, 80 were undergone to prostate biopsy. In this group, the predictive positive value of biopsy was 40% (32/100). The Gleason score was 6 in 19 men (60%), 7 in 10 men (31%) and 8 in 3 men (9%). Conclusions The PSA level of Brazilian men undergone to check up was low. There was a positive correlation with aging, IPSS and prostate size.

Current definition of the metabolic syndrome (MetS) is intended to identify individuals with multiple cardiovascular risk factors related to insulin resistance and central obesity. However, many centrally obese individuals featuring insulin resistance do not meet current criteria for MetS diagnosis

Introduction: the occurrence of a monoclonal gammopathy (MG) is identified in approximately 3% of the population older than 50 years in US and Europe, and is usually an occasional finding. There is very few data about the prevalence of MG in the general population in Brazil and in Latin America, especially in individuals undergoing routine health checkups (HC). Objectives: to evaluate the prevalence of MG in a general population undergoing routine HC in Brazil. Also, to compare demographic and laboratory data between individuals with and without MG. Methods: between January and December 2014, patients with 45 years of age or older who presented for a routine HC at a general hospital in Sao Paulo, Brazil, had a blood sample tested for serum protein electrophoresis (SPEP). Independently of the previous general medical history of these individuals, the reason for going to the hospital was only the HC and not any specific medical diagnostic or treatment procedure. Samples with a positive SPEP for MG were further submitted to serum immunofixation (IF) and serum free light chain assays (FLC- Freelite ®-The Binding Site, UK). The study was approved by the IRB and all participants signed an informed consent. Results: during the 12 months period, 3,095 individuals were studied, 2,393 men (77.3%) and 702 women (22.7%). MG was detected in 37 (1.2%), 31 men (1.3%) and 6 women (0.9%), p=0.35. The table shows the age distribution: there is an increase in the prevalence of MG for the older age groups, and this was statistically significant for individuals with 65 years or older when compared to those less than 55 years old. Age Range (years) MG negative MG positive p 45-54 2,081 (99.0%) 20 (1.0%) 55-64 841 (98.5%) 13 (1.5%) 0.19 ≥ 65 136 (97.1%) 4 (2.9%) 0.04 All 37 cases also presented a positive IF. The immunoglobulin involved was IgG in 28 cases (75.7%), IgM in 5 (13.5%), IgA in 2 (5.4%) and a double MG in 2 (5.4%). The FLC ratio of the patients with a MG ranged from 0.28 to 38.50 and one case showed a very high abnormal FLC ratio of >55.0 (normal FLC ratio range = 0.26 to 1.65). The analysis showed an abnormal FLC ratio in 9 samples (24.3%). The total gammaglobulin levels were significantly higher in the population with MG then in the population without MG (median results were respectively 1.16 g/dL and 1.06 g/dL, p< 0,001). There was no difference in the hemoglobin levels in the two groups (median levels respectively 14.4 g/dL and 14.7 g/dL, p=0.65). Conclusion: it was observed that 1.2% of this general Brazilian population showed a MG. This prevalence is lower than reported in the medical literature in other countries for this age group, but may be explained by the also lower number of individuals older than 65 years studied. The presence of a MG increased significantly with age, as reported in other observations. These results are useful as a reference for epidemiological analysis of MG studies performed in the region. Larger regional studies should be performed, including analysis of environmental and behavioral factors. Disclosures No relevant conflicts of interest to declare.

OBJETIVO: Caracterizar as desigualdades sociais, que se configuram em condições de risco aos agravos respiratórios em crianças e descrever os usos de técnicas de geoprocessamento na identificação de grupos sociais homogêneos e as ações de intervenção no âmbito da promoção da saúde. MÉTODOS: A área estudada foi a abrangida por um centro de saúde-escola, localizado no município de São Paulo. A partir dos resultados do censo de 1991, foram processados estatisticamente os dados dos domicílios integrantes de 49 setores censitários da área estudada, obtendo-se a média ponderada das variáveis sociais e ambientais representativas dos referidos setores. Em conjunto com representantes da população local, foram selecionadas variáveis que constituíram indicadores compostos referentes à inserção social e à qualidade do domicílio como subsídio à comparação dos setores e sua estratificação em relação ao potencial de exposição às condições de risco para os agravos respiratórios. Foram identificados quatro grupos homogêneos, segundo o grau de exposição às condições de risco, utilizando-se técnicas de geoprocessamento. RESULTADOS: Foi possível visualizar espacialmente os grupos que retratavam diferentes carências no território estudado. O instrumental metodológico utilizado revelou-se de grande importância para a formulação de ações diferenciadas no âmbito local em serviços que atuam em regiões geográficas delimitadas. CONCLUSÕES: O estudo contribuiu para o reconhecimento das condições de risco no território de responsabilidade de uma unidade básica de saúde, possibilitando a discussão e equacionamento coletivo e intersetorial dos problemas relacionados aos agravos respiratórios na infância, na perspectiva da promoção de eqüidade e melhoria de condições de saúde da população infantil. OBJECTIVE: To characterize social inequalities that represent risk conditions for respiratory tract diseases in children and to describe geoprocessing techniques to identify homogeneous social groups and intervention actions for health promotion. METHODS: The study area comprised the surroundings of a health school center in the city of São Paulo. Based on 1991 census, housing data on 49 census units in the study area were statistically analyzed and it was obtained the mean of characteristic social and environment variables in these units. Together with local representatives, variables were selected that made up composite indicators related to social insertion and housing quality to allow identifying different conditions of potential exposure to respiratory tract diseases. Using geoprocessing techniques, four homogeneous groups were identified in terms of potential exposure to risk conditions for respiratory diseases. RESULTS: It was obtained a spatial configuration of the groups reflecting different needs in the study area. The methodological instruments used revealed to be important for the development of local actions to be implemented in services that operate in specific geographical areas. CONCLUSIONS: The study contributed to the identification of risk conditions in the health center area, making it possible the joint and inter-sector discussion of conditions related to respiratory tract diseases in children, aiming at promoting equity and improving child health.

Objective: To evaluate the impact of traditional check-up appointment on the progression of the cardiovascular risk throughout time. Methods: This retrospective cohort study included 11,126 medical records of asymptomatic executives who were evaluated between January, 2005 and October, 2008. Variables included participants’ demographics characteristics, smoking habit, history of cardiovascular diseases, diabetes, dyslipidemia, total cholesterol, HDL, triglycerides, glucose, c-reactive protein, waist circumference, hepatic steatosis, Framingham score, metabolic syndrome, level of physical activity, stress, alcohol consumption, and body mass index. Results: A total of 3,150 patients was included in the final analysis. A worsening was observed in all risk factors, excepting in smoking habit, incidence of myocardial infarction or stroke and in the number of individuals classified as medium or high risk for cardiovascular events. In addition, a decrease in stress level and alcohol consumption was also seen. Conclusion: The adoption of consistent health policies by companies is imperative in order to reduce the risk factors and the future costs associated with illness and absenteeism. RESUMO Objetivo: Avaliar o impacto do modelo tradicional de check-up na progressão do risco cardiovascular ao longo do tempo. Métodos: Estudo coorte-retrospectivo com análise de 11.126 prontuários de executivos assintomáticos, atendidos entre janeiro de 2005 e outubro de 2008. Foram observados dados demográficos, tabagismo, doenças cardiovasculares, diabetes, dislipidemia prévios, valores de colesterol total e frações, triglicérides, glicemia, proteína C-reativa, circunferência de cintura, esteatose hepática, escore de Framingham, síndrome metabólica, nível de atividade física, estresse, consumo de álcool e índice de massa corporal. Resultados: Foram incluídos 3.150 pacientes. Houve piora de todos fatores de risco, com exceção do tabagismo, do aumento na incidência de doenças cardiovasculares e da população com risco médio ou alto para eventos cardiovasculares. Houve ainda redução na prevalência de pouco ativos, estresse e consumo de álcool. Conclusão: É prioritária a adoção de políticas de saúde por parte das empresas, para a melhora da condição de saúde e a redução dos custos advindos das doenças, além do absenteísmo a eles associados.