Introdução: Informações de vida real relativas ao tratamento da hepatite C crônica com interferon peguilado (Peg-IFN) e ribavirina (RBV) servem para mensurar sua efetividade nos anos em que o seu uso foi amplamente difundido, além de auxiliar em tomada de decisões futuras. Objetivos: Avaliar a taxa de resposta virológica sustentada (RVS) nos pacientes com hepatite C crônica tratados com Peg-IFN e RBV, fora de protocolos de pesquisa. Determinar os fatores associados à obtenção de RVS, frequência e causas de interrupção precoce do tratamento e de redução ou interrupção temporária dos medicamentos. Métodos: Estudo observacional retrospectivo de uma coorte de pacientes de dois ambulatórios de um centro de referência brasileiro localizado em São Paulo/SP. Resultados: Dos 440 indivíduos analisados, 182 apresentaram RVS (prevalência: 41,4% [IC95%: 36,7 - 46,1]). A RVS ocorreu em 33,5% (104/310) dos pacientes com genótipo 1 e em 53,8% (7/13) e 60,5% (69/114) daqueles com genótipos 2 e 3, respectivamente. Após análise multivariada, a RVS esteve positiva e independentemente associada à presença dos genótipos 2 ou 3 (p < 0,001), ausência de esteatose (p = 0,025) e de tratamento prévio (p = 0,038). Os eventos adversos mais frequentemente relacionados à redução de dose ou suspensão temporária de Peg-IFN ou RBV foram anemia (15,6%) e plaquetopenia (3,9%). Dos eventos adversos que levaram 79 (18%) pacientes a interromper o tratamento precocemente, distúrbios psiquiátricos (15,1%) e anemia (13,9%) foram os mais frequentes. Conclusões: A taxa de RVS foi semelhante àquela obtida em outros estudos de vida real. A RVS esteve independentemente associada à: presença dos genótipos 2 ou 3, ausência de esteatose e ausência de tratamento prévio. As principais causas de redução de dose dos medicamentos foram anemia e plaquetopenia e de interrupção precoce do tratamento, desordens psiquiátricas, e citopenias / Introduction: The association of pegylated interferon (Peg-IFN) and ribavirin (RBV) was considered a first line treatment for chronic hepatitis C during the past decade. Routine clinical practice information and real-life treatment outcomes can guide future therapeutic strategies for this group of patients. Objectives: The main objective of our study was to determine the sustained virological response (SVR) rate under current clinical practice. The secondary objectives were: 1- to investigate the factors that before or during treatment could predict SVR 2- to identify the causes of treatment interruption. Method: This cross-sectional study enrolled hepatitis C patients treated with Peg-IFN and RBV in a tertiary outpatient clinic setting. Data were collected retrospectively on patients treated for hepatitis C. Demographics, treatment outcomes and potential predictors of outcome were recorded. Results: Among the 440 analyzed patients 182 achieved SVR (prevalence: 41.4% [95% CI: 36.7 to 46.1]). On an intention-to-treat basis, SVR rates were 33.5% (104/310), 53.8% (7/13) and 60.5% (69/114) in genotypes 1, 2 and 3 respectively. After multivariate analysis, SVR was independently associated with presence of genotypes 2 or 3 (p < 0.001), no hepatic steatosis (p=0.025) and absence of prior treatment (p = 0.038). Anemia (15.6%) and thrombocytopenia (3.9%) were the most frequent causes of treatment dose reduction. Among the adverse events that led 79 patients into treatment discontinuation, the most frequent were psychiatric complications (15.1%) and anemia (13.9%). Conclusion: In our cohort, the treatment success rate (SVR) was similar to that observed in other in real-life setting studies. The SVR was independently associated with: presence of genotypes 2 or 3, no hepatic steatosis and absence of prior treatment. Psychiatric disorders and anemia were the main causes of premature treatment discontinuation

Os objetivos deste estudo foram: (1) Descrever e analisar as principais características da hipertensão intracraniana em pacientes com meningoencefalite criptocócica e aids; (2) Descrever e comparar as características clínicas, epidemiológicas, laboratoriais e evolutivas associadas à presença de hipertensão intracraniana em pacientes com meningoencefalite criptocócica e aids; (3) Identificar fatores associados à má evolução em pacientes com meningoencefalite criptocócica e aids. Este é um estudo de coorte prospectivo que avaliou 34 pacientes soropositivos para o HIV internados no Instituto de Infectologia Emílio Ribas no período de janeiro de 2003 a março de 2004. Definição de caso: paciente com sinais e sintomas de meningoencefalite com cultura de líquor positiva para Cryptococcus neoformans. Hipertensão intracraniana foi definida como pressão liquórica inicial >= 200 mmH2O. Todos os pacientes receberam tratamento inicial com anfotericina B e aqueles casos que apresentaram hipertensão intracraniana foram submetidos a um algoritmo específico de punções diárias de alívio ou shunt. Os pacientes foram analisados durante o período de internação. Vinte e seis pacientes eram do gênero masculino (76,5%); com média de idade de 35,4 anos; com imunodepressão grave (média de cels T CD4+ = 35,4 anos). Sete (20,6%) pacientes souberam do diagnóstico da infecção pelo HIV a partir da criptococose, que foi a primeira doença definidora de aids em 61,8% dos casos. Hemocultura foi positiva em 52,9% dos casos. Hipertensão intracraniana ocorreu em 20 (58,9%) pacientes à admissão e em 25 (73,52%) em qualquer momento da evolução clínica. Os fatores associados estatisticamente à ocorrência de hipertensão intracraniana foram: turvação visual (P=0,02), alteração de nervos cranianos (P=0,03), e número de células fungicas no LCR > 100 células/ mm3 à admissão (P=0,036). As punções diárias de alívio foram eficazes em controlar a hipertensão intracraniana em 21 (62%) casos e shunt foi realizado em seis casos. A mortalidade geral foi de 26,5%, porém na maioria dos casos a causa do óbito foi atribuída à infecção hospitalar. Os fatores estatisticamente associados à evolução para óbito foram: hipertensão arterial sistêmica (P=0,048), coma (P=0,048), déficit motor (P=0,014) e número elevado de células fúngicas no líquido cefalorraquidiano (P=0,030). / The objectives of this study were: (1) To describe and analyze the main characteristics associated to elevated intracranial pressure in patients with Cryptococcal meningoencephalitis and aids. (2) To describe and to compare clinical, epidemiologic, laboratorial and outcome characteristics associated to elevated intracranial pressure in patients with Cryptococcal meningoencephalitis and aids (3) To identify associated factors to poor outcome in patients with Cryptococcal meningoencephalitis and aids This is a prospective cohort study that analyzed 34 HIV infected patients hospitalized at Emilio Ribas Institute during the period of January 2003 to March 2004. Case definition: Patients with clinical manifestations of meningoencephalitis and isolation of Cryptococcus neoformans from Cerebrospinal Fluid. Elevated intracranial pressure was defined as cerebrospinal fluid opening pressure >= 200 mmH2O. All patients were initially treated with amphotericin B and that who presented with elevated intracranial pressure were submitted to a specific algorithm of repeated lumbar drainage or shunt. The patients were followed during hospitalization period. Results: Twenty six patients were male (76.5%); with mean of age of 35, 4 years. The means of T CD4 count was 28,5 cell/ . Cryptococcosis led to diagnosis of HIV infection in 20,6% of patients, whereas it was the aids-defining disease in 61,8% of patients. Blood cultures were positive in 52,9% of cases. Elevated intracranial pressure was presented in 20 (58,9%) patients at admission, and in 25 patients (73,52%) during evolution. Elevated intracranial pressure was associated to visual turvation (P=0,02), cranial nerve abnormalities (P=0,03) and number of fungal cells ³ 100 cells/ mm3 at admission (P=0,036). Lumbar puncture was efficient to control elevated intracranial pressure in 21 (62%) cases and six patients were submitted to shunt. Overall mortality was 26,5%. Factors associated to death were: arterial hypertension (P=0,048), coma (P=0,048), motor deficits (P=0,014) and raised number of fungal cells in cerebrospinal fluid at admission (P=0,03).

Introdução: Estudos avaliando a prevalência de urticária crônica espontânea (UCE) no lúpus eritematoso sistêmico juvenil (LESJ), assim como possíveis fatores associados são restritos a poucos relatos de caso. Objetivos: Avaliar a prevalência de UCE em uma população expressiva de LESJ, assim como sua possível associação com dados demográficos, manifestações clínicas, alterações laboratoriais, atividade/dano cumulativo da doença e tratamento. Métodos: Um estudo de coorte multicêntrico retrospectivo foi realizado em 10 serviços de Reumatologia Pediátrica provenientes do Grupo Brasileiro de Lúpus e incluiu 852 pacientes com LESJ. UCE foi diagnosticada de acordo com o guideline do EAACI/GA2LEN/EDF/WAO. Os pacientes foram divididos em dois grupos para a avaliação das manifestações clínicas atuais, assim como parâmetros laboratoriais e tratamento: pacientes que tiveram UCE (avaliados durante o diagnóstico da urticária) e pacientes sem UCE (avaliados na última consulta). Resultados: A presença de urticária foi observada em 10/852 (1,17%) pacientes com LESJ. A comparação entre os pacientes com LESJ com e sem UCE revelou uma maior frequência de sintomas constitucionais (40% vs. 8%, p=0,005), envolvimento do sistema reticuloendotelial (30% vs. 3%, p=0,003), sintomas mucocutâneos (90% vs. 28%, p < 0,0001), manifestações musculoesqueléticas (50% vs. 6%, p < 0,0001) e necessidade de pulso de metilprednisolona (60% vs. 8%, p < 0,0001) no grupo com UCE. A frequência do uso de imunossupressor foi menor nos pacientes com UCE (20% vs. 61%, p=0,017). As medianas do SLEDAI-2K (12 vs. 2, p < 0,0001) e do VHS (40 vs. 19 mm/1a hora, p=0,024), foram maiores nos pacientes com UCE. Conclusões: Este foi o primeiro estudo que evidenciou a possível relação da UCE com LESJ. A UCE aconteceu predominantemente no início do curso do LESJ e esteve associada com uma atividade de doença moderada/alta e sem envolvimento de órgãos nobres / Background: Data regarding the prevalence of chronic spontaneous urticaria (CSU) in childhood-onset systemic lupus erythematosus (cSLE) patients and possible associated factors are limited to few case reports. The objectives of the present study were to assess CSU in a large cSLE population evaluating demographic data, clinical manifestations, disease activity/damage, laboratory abnormalities and treatment. Methods: A retrospective multicenter cohort study (Brazilian cSLE group) was performed in 10 Pediatric Rheumatology services including 852 cSLE patients. CSU was diagnosed according to EAACI/GA2LEN/EDF/WAO Guidelines. Patients with CSU (evaluated at urticaria diagnosis) and patients without CSU (evaluated at last visit) were assessed for lupus clinical/laboratory features and treatment. Results: CSU was observed in 10/852 (1.17%) cSLE patients. Comparison of cSLE patients with and without CSU revealed a higher frequency of constitutional (40% vs. 8%, p=0.006), reticuloendothelial system involvement (30% vs. 3%, p=0.003), mucocutaneous (90% vs. 28%, p < 0.0001) and musculoskeletal manifestations (50% vs. 6%, p < 0.0001) and methylprednisolone pulse therapy use (60% vs. 8%, p < 0.0001) in the former group. The frequency of immunosuppressive treatment was lower in patients with CSU(p=0.017). The median SLEDAI-2K (12 vs. 2, p < 0.0001) and ESR (40 vs. 19 mm/1sthour, p=0.024), was higher in patients with CSU. Conclusions: To our knowledge this was the first study that evidenced that CSU may be linked to cSLE. We also demonstrated that this particular skin manifestation occurs predominantly at disease onset and it was associated with lupus moderate/high disease activity without major organ involvement

Introdução: Neutropenia febril é uma emergência médica que demanda um diagnóstico precoce e administração de antibióticos o mais breve possível. A procalcitonina (PCT) é um marcador inflamatório que vem sendo utilizado como um indicador de infecção bacteriana grave. A detecção precoce do quadro séptico é difícil, principalmente numa população heterogênea como no caso dos neutropênicos febris. A possibilidade de um único exame laboratorial poder identificar precocemente os quadros de sepse contribuiria de forma significativa para melhorar o prognóstico destes pacientes. Objetivo: Avaliar os níveis de PCT como marcador de infecção sistêmica comparados aos níveis de proteína C-reativa (PCR) em pacientes neutropênicos febris. Métodos: Foram estudadas amostras de 65 pacientes com a finalidade de determinar as concentrações séricas de PCT, PCR e outros parâmetros hematológicos em três momentos diferentes: antes da febre, no momento da febre e 72 após o término da febre. Os pacientes foram divididos inicialmente em quatro grupos: com infecção sistêmica comprovada laboratorial ou clinicamente (I), com febre de origem indeterminada - FOI- (II), com infecção localizada (III) e com infecção fúngica confirmada (IV). Posteriormente, os grupos I e IV foram denominados de 1 (com infecção sistêmica) e os grupos II e III de 2 (sem infecção sistêmica). Treze pacientes não apresentaram febre durante a internação sendo excluídos da comparação PCT/PCR. Resultados: A concentração de PCT mostrou estar associada com o diagnóstico de infecção grave e neutropenia febril. Não houve correlação entre os níveis de PCT e PCR. Conclusão: Fica evidente que a PCT demonstrou ser um marcador útil para o diagnóstico de infecção sistêmica em neutropenia febril, sendo provavelmente, superior à PCR. Pode-se caracterizar a PCT como um auxiliar de indicador de infecção sistêmica já no primeiro dia de apresentação da febre. A PCT, ao contrário da PCR, foi capaz de distinguir entre infecção sistêmica e infecção localizada ou febre de origem indeterminada, tendo boa capacidade diagnóstica. Entretanto, a PCT não se correlacionou com o prognóstico, possivelmente pelo pequeno tamanho da amostra, apesar da curva ROC da PCT do grupo com infecção sistêmica com evolução para óbito ter delimitado uma área estatisticamente diferente da esperada pelo acaso. / Introduction: Febrile neutropenia is a medical emergency that calls for a precocious diagnosis and the administration of antibiotics as soon as possible. The procalcitonin (PCT) is an inflammatory marker that has been used as an indicator of severe bacterial infection. Considering that neutropenic population is heterogeneous, an early and only reliable laboratory test that could identify septic patients would be of great value to improve its outcome. Objective: Assess the diagnostic value of PCT as a marker of systemic infection, comparing with C-reactive protein (CRP) levels in febrile neutropenia. Methods: Sixty-five adults patients were enrolled in the study. Blood sample was collected in order to determine the serum concentrations of PCT, CRP and other hematological parameters at three different moments: before the beginning of fever, at the onset of fever and 72 hours after cessation of it. Firstly, the patients were divided into four groups: with clinical or laboratorial proven systemic infection (I), with fever of undetermined origin (FUO) (II), with localized infection (III) and with proven fungal infection (IV). After that, the groups I and IV were named as 1:- with systemic infection. The groups II and III were named 2:- without systemic infection. Thirteen patients did not present fever during evolution and were excluded from the PCT/PCR comparison among febrile patients. Results: The PCT concentration showed it was associated with the diagnosis of severe infection in febrile neutropenia. No correlation could be found between the levels of PCT and CRP. Conclusion: PCT seems to be an useful marker for the diagnosis of systemic infection in febrile neutropenia, probably better than CRP. We could assume that PCT could indicate systemic infection at the very first day of the outcome of fever. Only PCT (and not CRP) could be able to distinguish between systemic infection and localized infection or FUO, with excellent diagnostic capacity. However none of the markers (PCT and CRP) could be correlated to prognosis, possibly due to the small size of the sample. Nevertheless, PCT ROC curve for evolution to death as a result of systemic infection limit an area under the curve statistically different that expected by chance.

In the past decades there has been an improvement in the medical treatment of children born preterm or with reduced foetal growth. This has resulted in a much higher survival rate of these children, but also in a higher number of surviving children with chronic conditions. These changes have, in turn, increased interest in investigating the connection between birth-characteristics and outcomes in later life. The overall aim of the present thesis was to study the relations between birth-characteristics, subsequent hospitalisations, and childbearing by means of data available in Swedish population-based registries. The study population in this thesis consisted of women (and men in Paper III) born in 1973-75 according to the Medical Birth Register and the Total Population Register. Information available in other registries, such as the Hospital Discharge Register, was obtained by individual record linkage. In Paper I, 148,281 women, alive and living in Sweden at 13 years of age, were included. Of the women, 4.1% were born preterm and 5.4% were born small for gestational age, and approximately 30% of all women had given birth between 13 and 27 years of age. We found that reduced foetal growth and possibly preterm birth were related to the likelihood of giving birth during the study period. The intergenerational effects of preterm birth and reduced foetal growth were investigated in Paper II and the study population consisted of 38,720 mother-offspring pairs. An intergenerational effect of reduced foetal growth was found, and reduced foetal growth in the mother also increased the risk for preterm birth in the child. Paper III was concerned with 304,275 men and women living in Sweden at 13 years of age. Of these men and women, 30% were hospitalised during adolescence and early adulthood (i.e. between 12 and 23 years of age). We found that men and women born small for gestational age or preterm were more likely to be hospitalised, and that those born small for gestational age seemed to be more at risk compared to those born preterm. Finally, in Paper IV, the relation between hospitalisations during adolescence and the likelihood of giving birth was studied in 142,998 women living in Sweden at 20 years of age. We found that a majority of the causes of hospitalisation during adolescence were positively connected to the likelihood of giving birth between 20 and 27 years of age. The relations presented in Papers I-IV were evident although socio-economic characteristics were adjusted for.

Background: Reported rates of bipolar syndromes are highly variable between studies because of age differences, differences in diagnostic criteria, or restriction of sampling to clinical contacts. Method: In 1395 adolescents aged 14–17 years, DSM-IV (hypo)manic episodes (manic and hypomanic episodes combined), use of mental health care, and five ordinal subcategories representing the underlying continuous score of (hypo)manic symptoms (‘mania symptom scale’) were measured at baseline and approximately 1.5, 4 and 10 years later using the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI). Results: Incidence rates (IRs) of both (hypo)manic episodes and (hypo)manic symptoms (at least one DSM-IV core symptom) were far higher (714/105 person-years and 1720/105 person-years respectively) than traditional estimates. In addition, the risk of developing (hypo)manic episodes was very low after the age of 21 years [hazard ratio (HR) 0.031, 95% confidence interval (CI) 0.0050–0.19], independent of childhood disorders such as attention deficit hyperactivity disorder (ADHD). Most individuals with hypomanic and manic episodes were never in care (87% and 62% respectively) and not presenting co-morbid depressive episodes (69% and 60% respectively). The probability of mental health care increased linearly with the number of symptoms on the mania symptom scale. The incidence of the bipolar categories, in particular at the level of clinical morbidity, was strongly associated with previous childhood disorders and male sex. Conclusions: This study showed, for the first time, that experiencing (hypo)manic symptoms is a common adolescent phenomenon that infrequently predicts mental health care use. The findings suggest that the onset of bipolar disorder can be elucidated by studying the pathway from non-pathological behavioural expression to dysfunction and need for care.

Thesis (Ph.D. in Epidemiology) -- University of Colorado Denver, 2008. / Typescript. Includes bibliographical references (leaves 103-109). Free to UCD Anschutz Medical Campus. Online version available via ProQuest Digital Dissertations;

Thesis--University of Oklahoma. / Bibliography: leaves 70-75.

Objetivos Avaliamos a incidência de infecção hospitalar no CTI clínico-cirúrgico de um hospital escola no sul do Brasil. Foram utilizadas taxas ajustadas para o tempo de permanência dos pacientes e para o tempo de exposição aos procedimentos invasivos. Também investigamos a influência da causa básica de internação (trauma, neurológico e clínico-cirúrgico) nas taxas de infecções. Material e Métodos Os pacientes internados no CTI Clínico-cirúrgico de março a dezembro de 1999, foram prospectivamente seguidos para a detecção de infecção hospitalar. Para o diagnóstico de infecção hospitalar utilizou-se as definições do Centro de Controle e Prevenção de Doenças dos EUA (CDC) e as taxas foram calculadas de acordo com a metodologia NNIS (Sistema Nacional de Vigilância Epidemiológica). Resultados Foram acompanhados 686 pacientes (4201 pacientes-dia). Ocorreram 125 infecções hospitalares, sendo que a incidência global foi de 18,2% ou 29,8 infecções por 1000 pacientes-dia. Os sítios de infecção mais freqüente foram: pneumonia (40%), infecção urinária (24%) e septicemia primária (12,8%). As taxas de infecções hospitalares, associadas aos procedimentos invasivos, foram as seguintes: 32,2 pneumonias por 1000 ventiladores mecânico-dia, 9,7 infecções urinárias por 1000 sondas vesicais-dia e 7 septicemias por 1000 cateteres venosos centrais-dia. A incidência global de infecção nos pacientes com trauma (26,8) e neurológicos (20,7%) foi superior quando comparada com o grupo clínico-cirúrgico (12,2%), p < 0,001. Conclusões Encontramos altas taxas de infecções relacionadas com os procedimentos invasivos neste CTI. A causa básica de internação influenciou as taxas de infecção, sugerindo a necessidade de analisar-se estratificadamente os pacientes em CTI clínico-cirúrgico. / Objectives The incidence of nosocomial infections in the General ICU of the Hospital São Vicente de Paulo was evaluated using adjusted rates for patients’ lenght of stay and time of device exposure. We also determined the differences in the rates of infections according basic reason for admission (trauma, neurological, and medical-surgical). Material and Methods From March 1 to December 31 1999, patients in the General ICU were prospectively followed for detection of nosocomial infection during their stay. Diagnosis of nosocomial infection was made according to the Centers for Disease Control e Prevention (CDC) definitions and the rates were calculated according to the methods of the National Nosocomial Infections Surveillance (NNIS) System. Results Six hundred eighty-six patients (4,201 patient-days) were followed. One hundred twenty-five nosocomial infections occurred and the overall rate was 18.2% or 29.8 infections per 1,000 patient-days. The most commonly found infection sites were: pneumonia (40%), urinary tract infection (24%), and primary bloodstream infections (12.8%). Device-associated nosocomial infection rates were as follows: 32.2 pneumonias per 1,000 ventilator-days, 9.7 urinary infections per 1,000 indwelling urinary catheter-days, and 7 bloodstream infection per 1,000 central venous catheter-days. Overall incidence of infection in trauma (26.8) and neurological (20.7%) groups was higher than in the medical-surgical group (12.2%), p<0.001. Conclusions Our study found a high incidence of pneumonia and high rates of nosocomial infections associated with use of an invasive device in this ICU. The basic cause for admission affected infection rates, suggesting the need for a stratified analysis of patients in the General ICU by basic reason for admission.

Made available in DSpace on 2015-07-22T20:50:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-08-25 / Introdução: A incidência de demência é o maior problema de saúde pública em populações envelhecidas, particularmente em países em desenvolvimento, nos quais a população idosa tem envelhecido explosivamente. Identificar grupos de risco é de vital importância para implementar promoção de saúde. A Clinical Dementia Rating (CDR) é uma escala válida para classificar a gravidade de casos de demência (leve, moderada e grave) e também é capaz de identificar casos questionáveis (0,5), ou seja, indivíduos que apresentam alteração no seu desempenho cognitivo, mas ainda não preenchem critérios para demência. Há muitas evidências que este grupo tem taxa de conversão para demência mais alta que o grupo de idosos normais. Objetivos: Verificar a taxa de conversão para demência em uma coorte de idosos (70+) vivendo em São Paulo, na comunidade, com CDR de 0 ou de 0,5 e identificar fatores associados. Metodologia: Uma amostra com 156 membros da coorte (n=440) incluiu todos os idosos com um Mini-Mental State Examination (MMSE) abaixo ou igual a 26 pontos e uma amostra daqueles com MMSE acima de 26, todos clinicamente avaliados para demência incluindo uma bateria neuropsicológica (BNP) na linha de base. A versão portuguesa do CDR (validada pelos autores) foi aplicada nos parentes ou cuidadores dos selecionados. Após recusas e mortes, 95 idosos foram reavaliados em um intervalo de dois anos e seis meses, em média. A taxa de conversão foi analisada segundo as características demográficas, saúde mental, independência em atividades de vida diária (AVDS), presença de fatores de risco cardiovascular, desempenho na BNP e classificação CDR inicial, usando o método de regressão de Poisson, tanto nas análises univariadas como na multivariada com o logaritmo natural do tempo de exposição como uma variável offset. O valor de significância considerado foi 0,05. Resultados: Dos 95 idosos reavaliados, 15 já eram dementados na linha de base e não foram incluídos nesta análise. Dos oitenta que nos ficaram para estudar, a maioria era do sexo feminino (72%) e a média de idade era 80,7 anos. 20% eram analfabetos, enquanto 21% possuíam oito ou mais anos de escolaridade. Dentre esses 80 em risco de conversão para demência, 50% tinham CDR 0 e 50% CDR 0,5. Destes últimos, 70% apresentaram a somatória de boxes do CDR menor ou igual a 1 e 30% com esta somatória maior que 1. A taxa de conversão para demência no período foi de 91,3/1000 pessoas-ano e não houve significância entre taxa de conversão e idade ou baixa escolaridade ou gênero, assim como com rastreamento de saúde mental positivo, com dependência nas atividades de vida diária, presença de risco cardiovascular ou BNP alterada no início do seguimento. Houve uma taxa de conversão maior entre aqueles com CDR 0,5 e mais importante naqueles cuja somatória de escores boxes foi mais alta que 1 na avaliação inicial, com risco de 5,69 vezes maior destes em relação ao CDR 0. Na análise multivariada, o CDR 0,5 e a somatória de boxes mais elevada foram as variáveis que se associaram à taxa de conversão para demência de forma independente. Discussão: A taxa de conversão para demência foi alta, como esperado para uma coorte com idade avançada. Essa taxa de conversão, no período observado, foi mais alta entre aqueles com CDR=0,5, e mais alta ainda se a somatória de escores boxes fosse maior, sendo estas as únicas variáveis independentes relacionadas à conversão para demência. Cabe, pois, recomendar o CDR na prática clínica para acompanhar idosos a fim de identificar um grupo de maior risco para demência. / Introduction: Incidence of dementia is a major public health problem in aging populations, particularly in developing countries where the elderly population has grown explosively. Identification of risk groups is vital to implement health promotion. The Clinical Dementia Rating (CDR) is a valid scale to classify the severity of dementia cases (mild, moderate, severe), also enabling the identification of borderline cases, when the subject has no longer a normal cognitive status for his age, but hasn’t met criteria for dementia yet. There are many evidences that this group has a significantly higher rate of conversion to dementia than the normal group. Objective: This study aims to verify the conversion rate to dementia in a cohort of elderly (70+) living in São Paulo, a large urban center in Brazil, particularly among borderline cases with a CDR=0.5, and to identify associated factors. Methodology: A sample with 156 members of the cohort (n=440) included all the elderly with a MMSE below 26 and a sample of those with a MMSE equal or above 26, all clinically evaluated for dementia including a Neuropsychological Battery (NPB) at baseline. A Portuguese version of CDR (previously validated by authors) was applied to the closest relative or carer. After refusals and deaths, 95 elderly were re-evaluated after an average 2.6-years interval. The cumulative conversion rate of dementia was compared among demographic characteristics, mental health, Activities of Daily Living (ADL), vascular risk factors, NPB performance and initial classification of CDR, using Poisson Regression methods in both the univariate analysis and the multivariate analysis, with natural logarithm of exposure time as an offset variable. The value of significance accepted was 0.05. Results: 95 elderly were re-evaluated, but 15 were demented at baseline and not included in the present analysis. The majority of those studied (n=80) was women (72%), the average age was 80.7 years, and 20% were illiterate, while 21% had 8 or more years of education. Among those at risk of converting to dementia, 50% had a CDR 0 at baseline and 50% a CDR 0.5 - 70% with sum of boxes scores equals 1 or below, and 30% with sum of boxes scores greater than 1. The conversion rate of dementia in the period was 91.3/1000 person-years and there were no significant differences between the rates of conversion according to age, years of education, gender, mental health, altered NPB, presence of vascular risk factors and degree of independence in the ADL, at baseline. There was a significantly higher incidence rate among those with a CDR 0.5, and most importantly among those with a sum of the boxes scores greater than 1 at baseline, with a relative risk of 5.69 higher compared to CDR 0. In the multivariate analysis, the CDR 0.5 and the sum of the highest boxes scores were the only variables that were independently associated with a higher conversion rate to dementia. Discussion: The conversion rate to dementia was high, as expected given the cohort’s advanced age. The conversion rate to dementia, in the period observed, was higher among those with CDR=0.5 and higher if the sum of the boxes scores was above one. Those were the only variables independently associated to conversion. Hence, the CDR must be recommended in the clinical practice with elderly to identify those at a greater risk of dementia. / TEDE / BV UNIFESP: Teses e dissertações