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Visceral adipose tissue (VAT) is associated with various metabolic disorders, and adipokines, secreted by adipose tissue, are involved in their pathogenesis. This study investigated associations between VAT/subcutaneous adipose tissue (SAT) ratio, inflammatory markers, and cardiovascular (CV) risk-score in adults. Plasma levels of adipokines, plasma lipid profile, blood pressure, and body composition (using dual-emission x-ray absorptiometry) were determined. CV risk-score based on the American College of Cardiology and the American Heart Association (ACC/AHA) score was calculated in a sample of 309 Brazilian civil servants aged <60 years. Participants' VAT/SAT ratio were categorized into quartiles. Among males, plasma leptin (2.8 ng/mL) and C reactive protein (CRP) (0.2 mg/dL) (P<0.05) levels were higher at P75 and P50 than P5, and the highest calculated CV risk-score was observed at P75 (7.1%). Among females, higher plasma adiponectin levels were observed at P25 (54.3 ng/mL) compared with P75 (36 ng/mL) (P<0.05). Higher plasma CRP levels were observed at P75 (0.4 mg/dL) compared with P5 (0.1 mg/dL) (P<0.05). Higher CV risk-score was observed at P75 (2.0%) compared with P5 (0.7%). In both sexes, VAT and VAT/SAT ratio were directly associated with plasma leptin, CRP, and CV risk-score, and inversely associated with adiponectin; SAT was directly associated with plasma leptin and CRP (P<0.01); interleukin (IL)-10 and CRP were directly associated with adiponectin and leptin, respectively (P<0.05). Among men only, IL-10 (inversely) and CRP (directly) were associated with CV risk-score (P=0.02). Our results strengthened the relevance of the VAT/SAT ratio in cardiovascular risk.

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Visceral adipose tissue (VAT) is associated with various metabolic disorders, and adipokines, secreted by adipose tissue, are involved in their pathogenesis. This study investigated associations between VAT/subcutaneous adipose tissue (SAT) ratio, inflammatory markers, and cardiovascular (CV) risk-score in adults. Plasma levels of adipokines, plasma lipid profile, blood pressure, and body composition (using dual-emission x-ray absorptiometry) were determined. CV risk-score based on the American College of Cardiology and the American Heart Association (ACC/AHA) score was calculated in a sample of 309 Brazilian civil servants aged <60 years. Participants' VAT/SAT ratio were categorized into quartiles. Among males, plasma leptin (2.8 ng/mL) and C reactive protein (CRP) (0.2 mg/dL) (P<0.05) levels were higher at P75 and P50 than P5, and the highest calculated CV risk-score was observed at P75 (7.1%). Among females, higher plasma adiponectin levels were observed at P25 (54.3 ng/mL) compared with P75 (36 ng/mL) (P<0.05). Higher plasma CRP levels were observed at P75 (0.4 mg/dL) compared with P5 (0.1 mg/dL) (P<0.05). Higher CV risk-score was observed at P75 (2.0%) compared with P5 (0.7%). In both sexes, VAT and VAT/SAT ratio were directly associated with plasma leptin, CRP, and CV risk-score, and inversely associated with adiponectin; SAT was directly associated with plasma leptin and CRP (P<0.01); interleukin (IL)-10 and CRP were directly associated with adiponectin and leptin, respectively (P<0.05). Among men only, IL-10 (inversely) and CRP (directly) were associated with CV risk-score (P=0.02). Our results strengthened the relevance of the VAT/SAT ratio in cardiovascular risk.

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SETTING: Two consecutive trials were conducted to evaluate the effectiveness of a public health approach to identify and correct problems in the care cascade for household contacts (HHCs) of TB patients in three Brazilian high TB incidence cities.METHODS: In the first trial, 12 clinics underwent standardised evaluation using questionnaires administered to TB patients, HHCs and healthcare workers, and analysis of the cascade of latent TB care among HHCs. Six clinics were then randomised to receive interventions to strengthen management of latent TB infection (LTBI), including in-service training provided by nurses, work process organisation and additional clinic-specific solutions. In the second trial, a similar but streamlined evaluation was conducted in two clinics, who then received initial and subsequent intensive in-service training provided by a physician.RESULTS: In the evaluation phase of both trials, many HHCs were identified, but few started LTBI treatment. After the intervention, the number of HHCs initiating treatment per 100 active TB patients increased by 10 (95%CI - 11 to 30) in the first trial, and by 44 (95%CI 26 to 61) in the second trial.DISCUSSION: A public health approach with standardised evaluation, local decisions for improvements, followed by intensive initial and in-service training appears promising for improved LTBI management.

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Understanding the social determinants of telomere length is critical to evaluate the risk of early biological aging. We investigated sex differences on the association between socioeconomic status (SES) and demographic markers and leukocyte telomere length (LTL) in Brazilian adults. This cross-sectional study was conducted in a subsample (women=228; men=200) nested within the Pro-Saúde study, a prospective cohort study of university civil servants in Rio de Janeiro, Brazil (2012-2013). Adjusted multivariate models were used to test the relationship between SES markers (marital status, educational attainment, father's educational attainment, race/skin color, household income, and childhood experience of food deprivation) and LTL. After adjusting for age and potential health-related confounders, lower educational attainment was associated with shorter LTL among men (ß=-0.05, 95% confidence interval (CI)=95%CI: -0.10, 0.00, P=0.03). In women, LTL was inversely associated with unmarried status (ß=-0.05, 95%CI: -0.09, 0.00, P=0.03), lower father's educational attainment (ß=-0.05, 95%CI: -0.13, 0.00, P=0.04), and childhood experience of food deprivation (ß=-0.07, 95%CI: -0.13, 0.00, P=0.04). Our findings suggested that the association between SES markers and LTL differs according to sex. SES markers able to induce lifelong stress, reflected in LTL, appeared to be more related to individual factors in men, whereas in women they were family-related.

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OBJECTIVE: To explore the relationship between availability of different types of retail food stores and consumption of fruit and leafy vegetables. STUDY DESIGN: This study is a cross-sectional study. METHODS: Data were derived from 2032 adults living in the city of Rio de Janeiro, Brazil, participating in the longitudinal Pro-Saude Study. Exposure to street markets, fruit and vegetable stores, groceries and markets, unhealthy food outlets, restaurants, and supermarkets within 1600 m buffers was obtained by georeferencing residential addresses. Consumption of fruit and leafy vegetables was assessed via two single questions, categorized as 'yes' (≥4 days/week) and 'no' (<3 days/week). Multiple logistic regression models were used to assess relationships of interest adjusted for surrounding average monthly income, sex, age, education, and family income per capita. RESULTS: Except for supermarkets, the presence of a greater number of retail food stores - irrespective of the type - was associated with higher odds of consumption of fruit and leafy vegetables than with areas with a lower number (e.g. odds ratio = 1.47; 95% confidence interval = 1.13-1.91). CONCLUSIONS: The greater availability of several types of retail food stores close to participants' residences was associated with higher consumption of fruit and leafy vegetables in Rio de Janeiro.

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Understanding the social determinants of telomere length is critical to evaluate the risk of early biological aging. We investigated sex differences on the association between socioeconomic status (SES) and demographic markers and leukocyte telomere length (LTL) in Brazilian adults. This cross-sectional study was conducted in a subsample (women=228; men=200) nested within the Pro-Saúde study, a prospective cohort study of university civil servants in Rio de Janeiro, Brazil (2012-2013). Adjusted multivariate models were used to test the relationship between SES markers (marital status, educational attainment, father's educational attainment, race/skin color, household income, and childhood experience of food deprivation) and LTL. After adjusting for age and potential health-related confounders, lower educational attainment was associated with shorter LTL among men (β=-0.05, 95% confidence interval (CI)=95%CI: -0.10, 0.00, P=0.03). In women, LTL was inversely associated with unmarried status (β=-0.05, 95%CI: -0.09, 0.00, P=0.03), lower father's educational attainment (β=-0.05, 95%CI: -0.13, 0.00, P=0.04), and childhood experience of food deprivation (β=-0.07, 95%CI: -0.13, 0.00, P=0.04). Our findings suggested that the association between SES markers and LTL differs according to sex. SES markers able to induce lifelong stress, reflected in LTL, appeared to be more related to individual factors in men, whereas in women they were family-related.

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OBJECTIVE: To investigate the association between routine visits for dental checkup and self-perceived oral health. METHODS: Cross-sectional data from a study of university employees in Rio de Janeiro - The Pró-Saúde Study. Self-perceived oral health and the reported pattern and frequency of visits to the dentist were obtained through a multidimensional self-administered questionnaire. RESULTS: Data were obtained from 3252 participants. When compared with individuals who reported self-perceived oral health as good ('very good', 'good' or 'fair') individuals who reported self-perceived oral health as bad ('bad' or 'very bad') were significantly more likely to be older, male, less educated, poorer; they also reported more frequently to have lost more teeth and not visiting the dentist for routine dental 'checkup'. Among those who reported visiting for dental checks at least annually, 3% reported bad oral health, as opposed to 15% among those who reported visiting the dentist only when in trouble. Compared with those who reported visiting the dentist at least annually, odds ratio of bad oral health was 3.9 (95% CI, 2.68-5.67) for subjects who reported visiting only when in trouble, 2.6 (95% CI, 1.51-4.62) who reported visiting for dental checks less frequently than once every 2 years, and 1.4 (95% CI, 0.77-2.52) for subjects who reported visiting for dental checks once every 2 years, after controlling for sex, age, education, income and tooth loss. CONCLUSIONS: Not visiting the dentist for a routine dental check increased the chance of reporting one's own oral health as bad. In any case, the habit of visiting for dental 'checkup, once per year or once every 2 years was associated with nearly all the individuals perceiving his/her oral health positively. However, in order to gather more solid scientific data to guide public policies it is necessary to perform longitudinal studies, especially experiments in different populations focused mainly on the socioeconomic characteristics and dental clinical conditions.

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BACKGROUND: Since age at menarche has been associated with socio-economic status, its downward secular trend might vary according to the different socio-economic status levels of the family in which women lived during their childhood. AIM: This study seeks to describe secular trends in age at menarche for Brazilian women whose fathers had different levels of educational attainment. SUBJECTS AND METHODS: A self-administered questionnaire was applied to 2053 women born between 1931 and 1977. Multiple linear regression models were employed to estimate trends in age at menarche according to categories of educational level of the participants' father. RESULTS: The age at first menstruation varied from 7 to 19 years, with a mean age of 12.3 years (+/- 1.64 SD). The reduction in age at menarche was 2.4 months per decade for all women. Among daughters of fathers with less than 8 years of schooling this reduction was 3.6 months per decade, and among daughters of fathers with 8 years or more of study it was 1.2 months per decade. CONCLUSION: Improvements in living conditions in Brazil over the last decades seem to have had a stronger effect on the reduction of the age at menarche among women who lived their childhood in worse socio-economic standards.

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We describe methodological steps in the selection of questions on social networks and support for a cohort study of 4,030 employees from a public university in Rio de Janeiro. First, group discussions with volunteers were conducted to explore the adequacy of related concepts. Next, questions in the Medical Outcomes Study questionnaire were submitted to standard "forward-" and "back-translation" procedures. The questions were subsequently evaluated through five stages of pre-tests and a pilot study. No question had a proportion of non-response greater than 5%. Pearson correlation coefficients between questions were distant from both zero and unity; correlation between all items and their dimension score was higher than 0.80 in most cases. Finally, Cronbach Alpha coefficients were above 0.70 within each dimension. Results suggest that social networks and support will be adequately measured and will allow for the investigation of their associations with health outcomes in a Brazilian population.

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