Alcohol misuse and illicit drug use are associated with HCV/HIV co-infection.

We studied hepatitis C virus (HCV) prevalence and risk factors for HCV infection in a sample of Brazilian HIV-positive patients. A cross-sectional study was conducted with 580 HIV-positive patients from a specialized HIV/AIDS diagnosis and treatment centre in southern Brazil. All patients were interviewed for socio-demographic and risk factors and tested for HCV antibodies and HCV-RNA detection. A multivariate analysis was performed to identify risk factors for HCV infection. A total of 138 (24%) patients had past or chronic hepatitis C. The following risk factors were associated with HCV infection for each gender: alcohol misuse and injecting drug use in women (P < 0·001) and low educational level, smoking drug use, and injecting drug use in men (P < 0·01). These results suggest that alcohol misuse, low educational level, smoking drug use, and injecting drug use are probable risk factors for HCV infection in HIV-positive patients. This information contributes to an understanding of the epidemiology of HIV/HCV co-infection in Brazil.

[Health services utilization: a systematic review of related factors]. / Utilización de los servicios de salud: una revisión sistemática sobre los factores relacionados.

Health services utilization is determined by various factors. In order to study which factors are most important in different countries, a systematic review was conducted from 1970 to 1999. The mean number of visits, proportion of persons who see a doctor, and proportion that concentrate the most visits were similar. Children, childbearing-age women, and the elderly use health care services the most. Lower-income and less educated groups are also significantly associated with more frequent utilization. Increased health needs mediate more frequent utilization by these groups. However, the poorest groups may not receive adequate care, depending on the respective type of health system. Health need is one of the most important determinants in utilization, and if a health system's equity is to be analyzed, one must consider patterns of utilization among social groups in relation to the level of greatest need. Regularly visiting the same physician, a characteristic of accessibility to health care services, can determine more adequate utilization. This factor can reduce differences in health care among groups. The authors conclude by proposing a hierarchy of related factors.

[Drug use prevalence and school performance among adolescents]. / Prevalência do uso de drogas e desempenho escolar entre adolescentes.

OBJECTIVE: To assess the prevalence of drug use among teenagers. METHODS: A cross-sectional study was carried out in Pelotas, Southern Brazil, in 1998. An anonymous, self-administered questionnaire was answered by a sample of 2,410 students with ages ranging from 10 to 19 years old, registered in all public and private high schools of the area. The schools were visited up to three times to reach absent students. RESULTS: The attrition rate was 8%. The substances mostly used by the students were alcohol (86.8%), tobacco (41.0%), marijuana (13.9%), inhalants (11.6%), anxiolytic drugs (8.0%), amphetamines (4.3%), and cocaine (3.2%). Marijuana, inhalants and cocaine were used mainly by male students, while anxiolytics and amphetamines were used mainly by female students. Alcohol consumption in the last 30 days, frequent drug use, heavy drinking and alcohol intoxication were more prevalent among males. After controlling for confounding factors, there was still an association between drug use (except for alcohol and tobacco) and evening courses, higher degree of nonattendance in the previous month and higher rate of school failure. CONCLUSIONS: The prevalence of drug experimentation among high school teenagers is high, indicating the importance of early detection of risk groups and development of programs to prevent drug abuse and addiction.

[Oral contraceptive and breast cancer: a case-control study]. / Contraceptivos orais e câncer de mama: estudo de casos e controles.

OBJECTIVE: To investigate the association between breast cancer and the duration of use of oral contraceptives (OC), and age it started to be used in a population of Pelotas, Southern Brazil. METHODS: There were identified 250 incident cases of breast cancer in patients aged 20 to 60 years from records of pathology laboratories and there were enrolled 1,020 controls drawn from hospital and neighbourhood population. For 90 cases identified in Pelotas, 270 hospital controls and 270 neighbourhood controls were selected, for another 78 cases in Pelotas, 234 controls were selected, and for 82 cases from other municipalities, 246 hospital controls were selected. Controls were matched by age. Adjusted analysis was performed using conditional logistic regression. RESULTS: No association between oral contraceptive use and breast cancer was found (OR=1.1;CI95% 0.7 - 1.6 for hospital controls, and OR=0.9;CI95% 0.6 - 1.6 for neighbourhood controls) neither for different duration of use or starting age. To increase the test power, 250 cases and all 1020 controls were analyzed together, and an odds ratio of 1.6 (CI95% 1.0 - 2.4) was found for women older than 45 years of age who had been using oral contraceptives for five years or more. CONCLUSIONS: No evidence was found of a general association between oral contraceptive use and breast cancer. When analyzing the whole date set, with all neighbourhood and hospital controls together, for women older than 45 years of age who had been using oral contraceptives for more than 5 years, it was found an increased risk almost statistically significant (p=0.05).

[Assessment of diabetic patient management at primary health care level]. / Avaliação do cuidado prestado a pacientes diabéticos em nível primário.

OBJECTIVE: The characterization of diabetic patients seen at a primary health care clinic. METHODS: The case notes of 3,024 families were searched by means of a cross-sectional study for patients 30 to 75 years of age with a diagnosis of diabetes mellitus who had had a medical consultation during the previous five years. These patients were interviewed at their homes and were asked to come to the health center for physical examination and a plasma glucose test using glucosylated hemoglobin (GH). RESULTS: The prevalence of diabetes was 4%. The typical diabetic patient was a white women, > or = 50 years of age, from a family with a monthly income < or = 3 minimum wages. Compliance with GH was observed in 70% of the patients. Diet therapy was followed by less than one third of the patients and only one fifth were engaged in regular exercise. Nearly 70% were undergoing drug therapy (oral hypoglicemic agents or insulin); of these, only 15% used insulin. Most of the patients (66%) who agreed to have the GH test showed normal or fair glucose blood levels. CONCLUSIONS: Great efforts should be made by health teams to enhance diabetic patient education in order to promote compliance with recommendations regarding diet and exercise.

Psychiatric disorder and the use of benzodiazepines: an example of the inverse care law from Brazil.

BACKGROUND: A cross-sectional survey was conducted in Pelotas, southern Brazil, to assess the relationship between the use of benzodiazepines (BZD), minor psychiatric disorders (MPD) and social factors. METHODS: A representative sample (n = 1277) was interviewed using the Self-Reporting Questionnaire (SRQ-20) for MPD. Subjects were asked about the use of BZD in the preceding 2 weeks and were also asked for socioeconomic details. RESULTS: A total of 152 (11.9%; 95% CI 10.1-13.7) subjects had taken psychotropic drugs, with BZD being the most commonly reported (8%). The prevalence of MPD was 22.7% (95% CI 20.4-25.0): males 17.9% and females 26.5%. An inverse relationship was seen between level of income, schooling and prevalence of MPD (P < 0.001), but a positive relationship was found between income and BZD consumption (P < 0.05). CONCLUSIONS: These data suggest that the inverse care law operates in prescribing psychotropic medications for MPD.

Physicians' prescribing behaviour for diarrhoea in children: an ethnoepidemiological study in Southern Brazil.

With the aim of implementing an intervention program on physician's prescribing behaviour for diarrhoea in children under five, an ethnoepidemiological study was conducted in Pelotas (Brazil), from February to April 1993. Information on prescription of drugs was obtained through record review of 381 cases of diarrhoea provided by 33 medical doctors from eight health centres. Trained field workers observed a total of 54 clinical consultations due to diarrhoea. Brief exit interviews with the mothers were performed just after the observations. Twenty-seven open-ended home interviews were made with the mothers the day after they had been observed. After all observations had been completed, open-ended interviews were conducted with 21 physicians. The results showed that there is a misunderstanding of the role of ORS in the treatment of diarrhoea: mothers want something to "cut" diarrhoea and they notice that ORS does not act in this way and doctors do not explain the action of ORS in diarrhoea management. Comparing with record reviews, during observations a child had a lower probability of receiving an antibiotic or antidiarrheal drug prescription. This finding indicates that other variables than technical skills are involved in doctor's prescribing behaviour. A lack of ability or of motivation to deal with "anxious or difficult mothers" led some doctors to enhance antibiotic or other non-recommended drugs to manage diarrhoea. Therefore, efforts to improve the quality of case management of diarrhoea, through intervention programmes in the government health sector, are needed in Pelotas.

Use of amphetamine-like appetite suppressants: a cross-sectional survey in Southern Brazil.

In 1994 a cross-sectional survey was undertaken in Pelotas, Southern Brazil, to assess the prevalence of amphetamine-like appetite suppressant use. 1,277 adults were interviewed, and the prevalence of anorectic drug use was 1.3% (95% CI = 0.7-1.9): 15 women and one man, mainly from higher socioeconomic groups. Most of the users (81%) had a medical prescription. Forty-one different drugs had been prescribed. Mean length of use was 8.7 months. These findings are discussed in terms of the overreliance on anorectics as aids to dieting, the dangers of polypharmacy, and the risks of long-term use.

[Epidemiology of drug use during the first three months of life in a urban area of southern Brazil]. / Epidemiologia do consumo de medicamentos no primeiro trimestre de vida em centro urbano do sul do Brasil.

INTRODUCTION: The few studies on the use of medicines in children point to excessive use, and in these studies, physicians are those mainly responsible for the prescription of medicines. In order to get to know the patterns of consumption medicines better, a study was made in children in their first three months of life, according to social biological, food pattern and use of health services of variables. METHOD: The patterns of the use of medicines during the first three months of life in 655 urban children born in Pelotas, Brazil, in 1993, were described. Information on the use of medicines was collected during a two-week period in the first and third month of life. RESULTS: The use of medicines was reported by 65% of mothers at the 1st and 69% at the 3rd month of life. Seventeen per cent of children consumed three or more different medicines during those periods. Fixed combinations of three or more components-which was taken as an indicator of the poor of medicines quality-were consumed by 14% of the children at the 1st and 19% at the 3rd months of life. At the latter age, 20% of children had used a given medicine for one month or more. At the first month follow-up, Benzalkonium Chloride + Normal Saline Solution (nasal drops), Nystatin Mixture and Dimethicone + Homotropine were the most frequently used medicines. At the third month they were, Aspirin, Benzalkonium Chloride + Normal Saline Solution and Dimethicone + Homatropine. The main reasons for taking medicines were cramps at the first month and colds at the third. At the first month follow-up, children with three or more siblings used 64% less medicines than the older ones. Children who were not breast-fed at the end of the first month showed a 75% greater risk of use of medicines. Similar results were observed at the third month follow-up. Some of the medicines used were not recommendable for children. CONCLUSION: Since early age children are submitted to an intense use of medicines for almost every conceivable reason, with the risk of potential side-effects and the possible lead to medicine or other drugs addiction.

Stressful life events and minor psychiatric disorders: an estimate of the population attributable fraction in a Brazilian community-based study.

OBJECTIVE: A population-based survey was conducted in Pelotas, southern Brazil, to assess the specific and the combined contribution of life events and socioeconomic factors on the overall prevalence of minor psychiatric disorders (MPD). METHODS: The study covered a representative sample of the population aged fifteen years or older living in the urban area of the city. Using multi-stage sampling, a total of thirty census tracts and 600 households were selected. A standardized questionnaire assessed the presence of MPD (using the Self-Reporting Questionnaire-SRQ-20), the occurrence of life events (death of a relative, a relative with a chronic disease, loss of employment, divorce, migration, accident, and robbery/assault), and socioeconomic factors. RESULTS: The prevalence of MPD was 22.7 percent (17.9% males and 26.5% females) and increased with age. Significant linear relationships with education and income were observed: the less education and income, the higher the prevalence of MPD. All life events, except migration and accident, were positively associated with MPD. People who experienced divorce in the last year had a prevalence of MPD three times higher than those who had not. The likelihood of MPD increased linearly with the number of life events. The highest proportion of Population Attributable Fraction for any life events was 24 percent. CONCLUSIONS: These data suggest that life events can explain a substantial proportion of MPD and with socioeconomic factors may be related to the onset of MPD.

[Promotion of breast-feeding in urban localities of southern Brazil: a randomized intervention study]. / Promoção da amamentação em localidade urbana da região sul do Brasil: estudo de intervenção randomizado.

A randomized intervention trial to promote breast-feeding was carried out in southern Brazil. A group of 450 mothers and babies was visited at home 5, 10 and 20 days after birth and compared to a non-visited control group of the same size. Ninety-two per cent of the families visited received the three home visits planned. The evaluation of breast-feeding patterns and reasons for weaning took place 6 months after birth for both groups. Ninety-four per cent of the group visited and 92% of the non-visited controls group were traced on the occasion of the assessment. The intervention increased the duration of breast-feeding (median duration of 120 days in the group visited and 105 days in the controls; p = 0.03) and delayed the introduction of milk bottles (median age of introduction of 90 days in the group visited and 60 days in the controls; p = 0.01). Causes of weaning were classified as underlying, intermediate and immediate. The most common underlying cause of weaning was "the baby cried too much", which suggests that mothers should be taught about normal patterns of infant behaviour in the first weeks of life, particularly the need for crying, and the fact that this not necessarily reflects hunger.

[Epidemiology of drug consumption in children of a urban center of the southern region of Brazil]. / Epidemiologia do consumo de medicamentos em crianças de centro urbano da região sul do Brasil.

The consumption of medicines among a population-based cohort of 4,746 children born in 1982 in Pelotas, Brazil, was studied when the children were aged 3-4.5 years. Fifty six percent of the mothers reported that their children had taken one or more medicines during a two-week period; 29.5% of the products were fixed combinations of three or more components, (which was taken as an indicator of poor quality). Almost 10% of the children had used a given medicine for one month or more. Aspirin, combinations of vitamins and mineral supplements and cough and cold combinations were the medicines most frequently used. The commonest reasons for taking medicines were colds, fevers and lack of appetite. The latter was the commonest reason for long-term use and also for that of combinations. Physician's prescriptions were responsible for more than 60% of the medicines used (including dipyrone and appetite stimulants). In all social classes the consumption was above 50%. Children classified in the fifth quintile of family income consumed 14% more medicines than the those in the first quintile. Children with two or more older siblings consumed 12% less medicines than the elder ones. Malnourished children, according to weight for age, consumed 30% more medicines than the well-nourished. Children consulting a doctor four times or more during the three-month period before the interview were using two times more medicines than children who had had no consultation during the same period. The frequent use of aspirin is a reason for concern as it has been associated with Reye's syndrome in children. It is also important to stress the danger of poisoning resulting from medicines available at home. Another noteworthy aspect concerns the messages transmitted to the children regarding the use of medicines for almost every conceivable reason which could possibly lead to medicine or illicit drug addiction.

Do mothers overestimate breast feeding duration? An example of recall bias from a study in southern Brazil.

The problem of recall bias when reporting breast feeding duration is investigated. Data are presented from the follow-up of over 1,000 children from a birth cohort (1982) in southern Brazil, when they were on average 11, 23, and 47 months of age. Compared with the response given at 11 months of age, 24% of mothers misclassified the duration (grouped into 3-month categories) at age 23 months and 30% at age 47 months. Women who were richer and/or better educated were significantly more likely to report longer durations, while those poorer and less educated did not tend to misclassify more in one direction than in the other.

Birthweight, socio-economic status and growth of Brazilian infants.

A population-based cohort of 1458 Brazilian infants was followed from birth to 9-15 months of age to investigate the effects of birthweight and family income on subsequent growth. There was a strong association between birthweight and attained weight and length, while virtually no malnutrition among children who weighed more than 3000 g at birth; Children with lower birthweights tended to put on less weight during the first year, but these differences were no longer significant after controlling for family income. As a result, infants of lower birthweights tended to remain behind those of higher birthweights. Children from the wealthiest families gained 20% more weight than low-income infants, irrespective of birthweight. Low birthweight infants from high-income families were therefore likely to approach the standard weight at one year old while those from poor families lagged behind.