Short-term effects of the strengthening families Program (SFP 10-14) in Brazil: a cluster randomized controlled trial.

INTRODUCTION: This study reports the evaluation of the short-term effects of the Strengthening Families Program (SFP 10-14), adapted as Famílias Fortes (Strong Families) in Brazil, on preventing adolescent drug use and improving parenting behaviors. METHODS: A two-arm, parallel cluster randomized controlled trial was conducted in 60 Social Assistance Reference Centers (SARC) from 12 Brazilian municipalities. In each city, the SARC were randomly assigned to the intervention or control group. A total of 805 families participated in the study, each contributing data from one parent or legal guardian and one adolescent totaling 1,610 participants. Data collection occurred before intervention implementation and 6 months after baseline collection. Data were analyzed using multilevel mixed-effects modeling with repeated measures in two different paradigms: Intention to Treat (ITT) and Per protocol (PP). The study was registered in the Brazilian Ministry of Health Register of Clinical Trials (REBEC), under protocol no. RBR-5hz9g6z. RESULTS: Considering the ITT paradigm, the program reduced the chance of parents and legal guardians being classified as negligent by 60% (95%CI 0.21; 0.78), increased the use of nonviolent discipline by caregivers (Coef 0.33, 95%CI 0.01; 0.64) and decreased the chance of adults exposing adolescents to their drunken episodes by 80% (95%CI 0.06; 0.54). No program effects were observed on outcomes related to adolescent drug use. Similar results were found for the PP paradigm. CONCLUSION: The positive effects on family outcomes suggest preventive potential of the program among the Brazilian population. Long-term evaluations are necessary to verify if the program can also achieve the drug use reduction goals not observed in the short term.

The role of monitoring skills in mediating the association between parent's hazardous alcohol consumption and adolescents' drinking.

BACKGROUND: This study aimed to investigate whether parental monitoring skills mediate the effect of hazardous parental alcohol consumption on adolescents' lifetime alcohol use. METHODS: This three wave longitudinal study was conducted with 884 families (n = 1,768 participants) to evaluate the effectiveness of a family-based drug prevention program for adolescents and parents across 12 Brazilian cities. We used structural equation mediation modeling to analyze the effect of hazardous parental alcohol consumption at baseline on adolescents' lifetime alcohol use at 12-month follow-up, mediated by parental monitoring skills latent dimension at 6-month follow-up. RESULTS: We found a significant indirect effect of parents' hazardous alcohol use on adolescents' alcohol use through parental monitoring (OR:1.18, 95%CI:1.02;1.36). CONCLUSION: Our finding underscores the importance of comprehensive preventive family alcohol approaches targeting adolescent alcohol use, which should consider both parental drinking behavior and monitoring practices.

A cluster randomized controlled trial evaluating the effectiveness of the school-based drug prevention program #Tamojunto2.0.

AIMS: The study aimed to evaluate the effectiveness of the government school-based program #Tamojunto2.0, the third Brazilian version of the European drug prevention program, Unplugged, in preventing the use of alcohol and other drugs. DESIGN: A parallel, two-arm cluster randomized controlled trial was conducted in 205 classes in 73 public schools (37 intervention and 36 control) with a baseline assessment and follow-up after 9 months. SETTING: Schools in the cities of São Paulo, Fortaleza and Eusebio in Brazil. PARTICIPANTS: A total of 5208 students in the 8th grade with a mean age of 13.2 years (standard deviation = 0.8 years) and an equal gender ratio. INTERVENTION: In 2019, the intervention group attended 12 classes of the program #Tamojunto2.0, under the supervision of a team from the Ministry of Health. The control group did not receive any intervention to prevent alcohol and drug use. MEASUREMENTS: The primary outcome measured was prevalence of binge drinking (five or more doses of alcohol in an occasion) within the past month. Secondary outcomes were prevalence of initiation and use of alcohol, tobacco, inhalants, marijuana and cocaine within the past month. FINDINGS: A statistically significant difference was not found in the prevalence of binge drinking within the past month between intervention and control groups [odds ratio (OR) = 0.934; 95% confidence interval (CI) = 0.761-1.146]. However, students who were exposed to the program were less likely to initiate alcohol use than those in the control group (OR = 0.782; 95% CI = 0.636-0.961). The Bayes factor for reduction in binge drinking was 0.01, providing evidence in favor of the null hypothesis for this variable. CONCLUSIONS: The drug prevention program #Tamojunto 2.0 reduced alcohol initiation, but appeared not to reduce past-month binge drinking among 8th grade students in Brazil.

Being bullied and using drugs are associate with eating disorder symptoms in Brazilian students.

OBJECTIVE: This study's main purpose is to evaluate factors associated with eating disorder (ED) symptoms among Brazilian adolescents. METHOD: The sample consisted of 5,213 students, mean age 13.24 (SD ±0.01), in the eighth grade of 93 public schools from three Brazilian cities. Data were collected through an anonymous self-report questionnaire, assessing: sociodemographics, use of alcohol, tobacco, illicit drugs, binge drinking, bullying, and ED symptoms. We used confirmatory factor analysis and multivariate linear regression. RESULTS: We found that high levels of bullying victimization, binge drinking and the use of unprescribed weight-loss substances were associated with higher levels of ED symptoms to both genders. However, only among girls, the higher age (ß = .10; 95% CI = 0.02; 0.17) and the use of illicit drugs (ß = .21; 95% CI = 0.094; 0.34) were associated with increase in the ED symptoms. DISCUSSION: We demonstrate a significant association of ED symptoms with drug use and bullying, highlighting the importance of addressing these factors in the development of ED prevention strategies.

Variation in primary health care services after implementation of quality improvement policy in Brazil.

BACKGROUND: Brazil is the most populous country with a public, universal and free health care system. The National Program for Access and Quality Improvement in Primary Care (PMAQ) was created to improve the quality of primary health care (PHC). OBJECTIVE: To evaluated whether progress generally has been made within Brazil's PHC since PMAQ implementation, and if changes occurred uniformly in the country, while also identifying municipal characteristics that may have influenced the improvement. METHODS: This is an observational study using data from PMAQ external evaluation (2012 and 2014), a 1200-item survey used to evaluate Brazilian PHC quality. After confirming the groupings of items using factor analysis, we created 23 composed indexes (CIs) related to infrastructure and work process. RESULTS: On average, the large majority of CIs showed improvements between 2012 and 2014. Region and city size moderated changes in the PHC indices differently. Overall, there were better improvements in infrastructure in the Northeast compared with other country regions, and in smaller cities (10 000-20 000 people). Infrastructure indices appear to have improved equitably across the country. Work process improvements varied with city size and region. CONCLUSION: Despite similar support of PMAQ across the country, improvements are not predictable nor homogeneous. Non-uniform improvements were seen in Brazil's PHC. Though we do not directly evaluate the effectiveness of the PMAQ (financial reward) method, these initial findings suggest that it is a potentially useful tool to improve health systems, but additional support may be needed in regions that lag behind in quality improvements.

Análise dos casos de sífilis congênita em Sobral, Ceará: contribuições para assistência pré-natal / Analysis of cases of congenital syphilis in Sobral, Ceará: contributions to prenatal care

A sífilis é uma doença infecciosa crônica, causada pela bactéria Treponema pallidum e adquirida através do contato sexual. A transmissão vertical da gestante infectada não tratada ou tratada inadequadamente ocorre com frequência, resultando na sífilis congênita. Objetivo: este estudo teve oobjetivo de analisar o perfil dos nove casos de sífilis congênita de Sobral, Ceará, ocorridos em 2010. Métodos: trata-se de uma pesquisa documental, do tipo exploratório-descritiva. Os dados foram coletados a partir dos prontuários dos casos e do Sistema de Informação de Agravos de Notificação. Para conhecera tendência da doença no município, primeiramente se resgatou a incidência de sífilis congênita em Sobral, de 2007 a 2010. Posteriormente os dados foramestratificados em variáveis e apresentados na forma de gráficos e tabelas. Resultados: das nove gestantes, sete eram solteiras, seis eram usuárias de álcoole/ou outras drogas e, de acordo com o registro da ocupação, três eram profissionais do sexo. Em relação ao número de consultas realizadas no pré-natal,seis realizaram o total recomendado, porém constatou-se que o intervalo entre as consultas era inadequado à idade gestacional. Todas as mães foram inadequadamente tratadas e, no momento da pesquisa, somente uma criança se encontrava com o seguimento realizado de forma adequada ao protocolo do Ministério da Saúde. Conclusão: conclui-se que as mães das crianças que adquiriram sífilis congênita possuem baixo nível social e comportamento de risco que as colocam em vulnerabilidade para contrair doenças sexualmente transmissíveis. Constatou-se também que houve deficiências na assistência à saúde em todos os casos, contribuindo para a incidência dos casos.

The syphilis is a chronic infectious disease, caused by the bacteria Treponema pallidum and acquired through the sexual contact. The vertical transmission, of the pregnant woman not infected treated or treated inadequately, it happens frequently, resulting in the congenital syphilis. Objective: Thisstudy had the objective of analyzing the profile of the nine cases of congenital syphilis of Sobral, Ceará, happened in 2010. Methods: It is a documental research, of the exploratory-descriptive type. The data were collected starting from the handbooks of the cases and of the System of Information of Offences of Notification. To know the tendency of the disease in the municipal district, firstly the incidence of congenital syphilis was rescued in Sobral, from 2007 to2010. Later the data were stratified in variables and presented in the form of graphs and tables. Results: Of the nine pregnant women, seven were single, six were users of alcohol e/ou other drugs and, in agreement with the registration of the occupation, three were professional of the sex. In relation to the number of consultations accomplished in the prenatal, six accomplished the recommended total, however it was verified that the distribution of those consultationswas inadequate to the age gestational. All the mothers were inadequately treated and, in the moment of the research, only a child met with the following accomplished appropriately to the protocol of ministry of Health. Conclusion: The explanation to the pregnant women about the gravity of the disease, the transmission way, the consequences for the concept and the need of treating the partner are fundamental points for the prevention of the congenital syphilis.