Multimorbidity was associated with an increase in risk of death. Multimorbidity measurement standardization is needed to produce more comparable estimates. Adjusted analysis which includes potential confounders might contribute to better understanding of causal relationships between multimorbidity and mortality.

although rates have remained stable in most of the states, they are still high in Brazil; broader public policies focusing on new dengue control strategies are necessary.

both outcomes were associated with different characteristics, depending on the sex of the adolescent.

Background The consumption of some food groups is associated with the risk of diabetes. However, there is no evidence from meta-analysis which evaluates the consumption of ultra-processed products in the risk of diabetes. This study aimed to review the literature assessing longitudinally the association between consumption of ultra-processed food and the risk of type 2 diabetes and to quantify this risk through a meta-analysis. Methods We conducted a systematic review and meta-analysis with records from PubMed, Latin American and Caribbean Literature in Health Sciences (LILACS), Scielo, Scopus, Embase, and Web of Science. We included longitudinal studies assessing ultra-processed foods and the risk of type 2 diabetes. The review process was conducted independently by two reviewers. The Newcastle Ottawa scale assessed the quality of the studies. A meta-analysis was conducted to assess the effect of moderate and high consumption of ultra-processed food on the risk of diabetes. Results In total 2272 records were screened, of which 18 studies, including almost 1.1 million individuals, were included in this review and 72% showed a positive association between ultra-processed foods and the risk of diabetes. According to the studies included in the meta-analysis, compared with non-consumption, moderate intake of ultra-processed food increased the risk of diabetes by 12% [relative risk (RR): 1.12; 95% confidence interval (CI): 1.06–1.17, I2 = 24%], whereas high intake increased risk by 31% (RR: 1.31; 95% CI: 1.21–1.42, I2 = 60%). Conclusions The consumption of ultra-processed foods increased the risk for type 2 diabetes as dose-response effect, with moderate to high credibility of evidence.

the counseling carried out by health professionals seems to favor the practice of healthy habits among elderly individuals.

Recent studies have identified a relationship between maternal body mass index during prepregnancy (BMI) and exclusive breastfeeding (EBF), which is less common among mothers with higher BMI. The purpose of this literature review is to provide a pooled effect for the association between maternal excess weight during prepregnancy and cessation of exclusive breastfeeding. A systematic review was performed using articles present in six databases (PubMed, Scopus, Web off Science, Science direct, CINAHL and LILACS) published till February 2017. Studies investigating the association between excess maternal weight during prepregnancy and cessation of exclusive breastfeeding were included in the review. A meta-analysis using random effects to obtain a pooled effect of the studied association was conducted only with studies reporting odds ratio (OR) or available data for the calculation. Univariate meta-regression was performed to evaluate possible sources of heterogeneity. Egger's tests were also performed to verify possible publication bias. From the 6889 studies identified, 102 were read in full and 17 were included in the meta-analysis, providing 28 estimates for the association. Overall, a positive association was observed between maternal excess weight during prepregnancy and cessation of exclusive breastfeeding (ES: 1.60 (95% CI: 1.47, 1.74), I: 93.2%). According to the used independent variables, no sources of heterogeneity were identified between studies Bias in publication was found. Maternal excess weight during prepregnancy was associated with cessation of exclusive breastfeeding. A standardized measure for exclusive breastfeeding is still needed for estimating its duration, in addition to further studies in developing countries to understand what could explain the heterogeneity of the findings.

Objective. To measure the prevalence of various care services offered to the elderly with diabetes mellitus in Brazil, and to assess the social inequalities in these services. Methods. This cross-sectional, population-based study was carried out in 2013. The care services offered were evaluated in terms of the following eight indicators: recommendations to lower carbohydrates, to measure blood glucose, and to examine the feet; requests made for blood tests, for glycated hemoglobin tests, and for glycemic curve tests; and whether service users had had their eyes or feet examined in the previous year. We used the slope index of inequality and the concentration index to assess the inequalities among wealth quintiles. Results. A total of 1 685 elderly persons with diabetes were evaluated. Overall, 41.7% of them had had their eyes examined in the preceding year, 35.4% had had their feet examined in the preceding year, and 10.9% had been offered all eight of the care services. The largest absolute differences (in percentage points) between the first (poorest) and fifth (richest) wealth quintiles in terms of the care services that were offered to the users were for: a recommendation to measure blood glucose (25.8), a glycated hemoglobin test request (27.4), a glycemic curve test request (31.9), having the eyes examined in the preceding year (29.3), and having the feet examined in the preceding year (27.0). Conclusion. There were notable inequalities in the prevalences of the care services. In the future, measurement of blood glucose and examination of the feet should be emphasized, especially for elderly persons in a lower socioeconomic level.

This study aimed to assess the attention paid by health professionals to elderly individuals with hypertension and related inequalities in Brazil, using level of schooling as the socioeconomic indicator. This was a cross-sectional study with data from the Brazilian National Health Survey, 2013. Attention was assessed according to the following indicators: recommendations for healthy eating, maintaining adequate weight, less salt, regular exercise, prevention of smoking and excessive drinking, and regular medical checkups with blood and urine tests, ECG, and stress test. The recommendations to consume less salt (91%), healthy diet (88%), and regular medical checkups (88%) were the most common. Elderly with complete university degrees showed the highest prevalence rates for recommendations to maintain a healthy diet (PR = 1.12), adequate weight (PR = 1.21), regular exercise (PR = 1.29), regular medical checkups (PR = 1.11), and stress test (PR = 2.26) and all the indicators combined (PR = 2.14) when compared to elderly without schooling. The attention paid to the elderly by health professionals is suboptimal throughout the country. In addition, inequalities in attention to the elderly's needs still persist. Given the growth in the elderly population and chronic non-communicable diseases, efforts are needed to improve the quality of their care and mitigate the related inequalities.