BackgroundTwo criteria based on a 2 h 75 g OGTT are being used for the diagnosis of gestational diabetes (GDM), those recommended over the years by the World Health Organization (WHO), and those recently recommended by the International Association for Diabetes in Pregnancy Study Group (IADPSG), the latter generated in the HAPO study and based on pregnancy outcomes. Our aim is to systematically review the evidence for the associations between GDM (according to these criteria) and adverse outcomes.MethodsWe searched relevant studies in MEDLINE, EMBASE, LILACS, the Cochrane Library, CINHAL, WHO-Afro library, IMSEAR, EMCAT, IMEMR and WPRIM. We included cohort studies permitting the evaluation of GDM diagnosed by WHO and or IADPSG criteria against adverse maternal and perinatal outcomes in untreated women. Only studies with universal application of a 75 g OGTT were included. Relative risks (RRs) and their 95% confidence intervals (CI) were obtained for each study. We combined study results using a random-effects model. Inconsistency across studies was defined by an inconsistency index (I2) > 50%.ResultsData were extracted from eight studies, totaling 44,829 women. Greater risk of adverse outcomes was observed for both diagnostic criteria. When using the WHO criteria, consistent associations were seen for macrosomia (RR = 1.81; 95%CI 1.47-2.22; p < 0.001); large for gestational age (RR = 1.53; 95%CI 1.39-1.69; p < 0.001); perinatal mortality (RR = 1.55; 95% CI 0.88-2.73; p = 0.13); preeclampsia (RR = 1.69; 95%CI 1.31-2.18; p < 0.001); and cesarean delivery (RR = 1.37;95%CI 1.24-1.51; p < 0.001). Less data were available for the IADPSG criteria, and associations were inconsistent across studies (I2 ≥ 73%). Magnitudes of RRs and their 95%CIs were 1.73 (1.28-2.35; p = 0.001) for large for gestational age; 1.71 (1.38-2.13; p < 0.001) for preeclampsia; and 1.23 (1.01-1.51; p = 0.04) for cesarean delivery. Excluding either the HAPO or the EBDG studies minimally altered these associations, but the RRs seen for the IADPSG criteria were reduced after excluding HAPO.ConclusionsThe WHO and the IADPSG criteria for GDM identified women at a small increased risk for adverse pregnancy outcomes. Associations were of similar magnitude for both criteria. However, high inconsistency was seen for those with the IADPSG criteria. Full evaluation of the latter in settings other than HAPO requires additional studies.

Abdominal adipocyte size is related to body fat distribution. Adipocyte size in a person seems to be globally regulated by factors independent of variations in body fat distribution.

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Objective: To determine whether dietary supplementation with a linolenic acid (ALA) can modify established and emerging cardiovascular risk markers. Design: Systematic review and meta-analysis of randomised controlled trials identified by a search of Medline, Embase, Cochrane Controlled Trials Register (CENTRAL), and the metaRegister of Controlled Trials (mRCT). Patients: All human studies were reviewed. Main outcome measures: Changes in concentrations of total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, very low density lipoprotein (VLDL) cholesterol, triglyceride, fibrinogen, and fasting plasma glucose, and changes in body mass index, weight, and systolic and diastolic blood pressure.Results: 14 studies with minimum treatment duration of four weeks were reviewed. ALA had a significant effect on three of the 32 outcomes examined in these studies. Concentrations of fibrinogen (0.17 mmol/l, 95% confidence interval (CI) 20.30 to 20.04, p = 0.01) and fasting plasma glucose (0.20 mmol/l, 95% CI 20.30 to 20.10, p , 0.01) were reduced. There was a small but clinically unimportant decrease in HDL (0.01 mmol/l, 95% CI 20.02 to 0.00, p , 0.01). Treatment with ALA did not significantly modify total cholesterol, triglycerides, weight, body mass index, LDL, diastolic blood pressure, systolic blood pressure, VLDL, and apolipoprotein B. Conclusions: Although ALA supplementation may cause small decreases in fibrinogen concentrations and fasting plasma glucose, most cardiovascular risk markers do not appear to be affected. Further trials are needed, but dietary supplementation with ALA to reduce cardiovascular disease cannot be recommended.T he cardiovascular benefits of fish oil are now well established, 1 , but it is unclear whether a linolenic acid (ALA) confers similar benefits. ALA is a plant v-3 fatty acid, precursor of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), the two main v-3 polyunsaturated fatty acids found in fish oils.2 However, unlike fish oils, ALA is inexpensive to produce and is more palatable than cod liver oil.Clinical trials of dietary supplementation such as the Lyon diet heart study, in which ALA was a component, suggest that ALA may confer cardiovascular benefits.3 This has led to calls for trials specifically evaluating the effect of substituting oils containing ALA.We therefore systematically reviewed randomised controlled trials to investigate the impact of ALA on cardiovascular risk markers. METHODSWe searched Medline, Embase, and the Cochrane Controlled Trials Register (CENTRAL) databases for published studies and the metaRegister of Controlled Trials (mRCT) for unpublished studies by using the search terms linolenic acid, plant oils, flax, linseed, canola, rapeseed, perilla, juglans, pumpkin, and purslane with a standard search filter to identify randomised controlled trials. We identified additional studies by searching references cited in identified primary studies. We restricted our search to studies of humans and included a...

The results are supportive of the use of nystatin and disinfecting agents in the treatment of DS, but clinicians need to be aware that individual studies had high risk of bias and that the overall quality of the individual reports was judged to be low.

This study aimed to estimate the prevalence of genital, anal and oral HPV infection in Brazil through systematic review and meta-analysis. Methods We searched EMBASE, LILACS, MEDLINE, Web of Science and SciELO from inception to December 2018. Original research articles that assessed the prevalence of genital (i.e., cervical, penile), anal and oral HPV infection in Brazil were selected in pairs by independent authors. No sex, age, HPV vaccination, language or date restrictions were applied. HPV prevalence was estimated and stratified according to risk factors population and by geographic area throughout the country. The study prevalence was pooled using a random effects model. Analysis was performed using R (version 3.5.2), packages meta version 4.9-4 and metaphor 2.0-0. This review is registered on PROSPERO under protocol number CRD42016032751. Results We identified 3,351 references. After the screening process, 139 of them were eligible for this systematic review (57,513 total participants). Prevalence of cervical HPV was 25.41% (95% CI 22.71-28.32). Additionally, prevalence was 36.21% (95% CI 23.40, 51.33) in the penile region, 25.68% (95%CI 14.64, 41.04) in the anal region, and 11.89% (95%CI 6.26, 21.43) in the oral region. Subgroup analysis showed prevalence in each anatomic site was higher in high-risk populations. Conclusion The prevalence of HPV is high in the Brazilian population and varies by population risk and anatomic body site, with lower rates in the oral cavity compared to that in the cervical, penile

Objetivo: Avaliar a concordância do padrão de fatores de risco de mulheres que desenvolvem diabetes gestacional e pré-eclâmpsia. Métodos: Estudo de coorte prospectivo em clínicas de atendimento pré-natal do Sistema Único de Saúde de seis capitais do Brasil, 4.766 mulheres grávidas de 20 a 48 anos de idade foram arroladas de maneira consecutiva entre a 20º e 28º semanas de gestação. O hábito de fumar e os fatores de risco tradicionais para pré-eclâmp-sia e diabetes gestacional foram obtidos por entrevista no arrolamento. diabetes gestacional foi diagnosticada usando um teste oral de tolerância a glicose com 75 g e pré-eclâmpsia por meio de revisão de prontuário. Resultados: diabetes gestacional e pré-eclâmpsia são associadas com idade (rc 2,07; 95% Ic 1,65-2,23 e rc 1,55; 95% Ic 1,08-2,23, respectivamente), índice de massa corporal pré-gestacional (rc 1,62; 95% Ic 1,40-3,53 e rc 1,83; 95% Ic 1,52-4,80, respectivamente) e ganho de peso precocemente durante a gestação (rc 1,28; 95% Ic 1,12-1,47 e rc 1,27; 95% Ic 1,06-1,52, respectivamente).

BackgroundIn addition to screening by Pap smears, vaccination against human papillomavirus (HPV) can dramatically reduce cervical cancers caused by the virus. The acceptance of HPV vaccination is directly related to HPV knowledge. This research aimed to evaluate knowledge about HPV and vaccination among men and women aged 16–25 years who use the public health system in Brazil.MethodsThis was a cross-sectional, multicenter study of sexually active young adults recruited from 119 primary care units between 2016 and 2017. All participants answered a face-to-face standardized questionnaire.ResultsOf 8581 participants, the mean percentage of correct answers about HPV and vaccination was 51.79% (95% CI 50.90-52.67), but 75.91% (95% CI 74.13-77.69) had awareness of the HPV vaccination. Women answered a higher proportion of questions correctly than men did (p = 0.0003). Lower education level was the variable that most interfered with knowledge. The best information sources for knowledge were both health professionals and the media (1.33%, 95% CI 1.03-1.70).ConclusionsThe results emphasize the importance of educational programs about HPV and vaccination among young adults, especially in socially disadvantaged populations. These findings can help to increase the vaccination rate in the country and to stimulate public health policies.