Reliability and Validity Estimate of the Pro-Inflammatory/Anti-Inflammatory Food Intake Score in South American Pediatric Population: SAYCARE Study.

Chronic low-grade inflammation may be associated with the development of chronic non-communicable diseases in young populations, often lasting to adulthood. Studies show that the diet is related to chronic inflammation. The Pro-inflammatory/Anti-inflammatory Food Intake Score (PAIFIS) is an indicator that measures the inflammatory potential of the diet, with the help of validated tools that assess food consumption. The validation of tools that assess inflammatory dietary patterns in young populations to produce valid and reliable results is essential to guide disease prevention strategies for adulthood. METHODS: This study aimed to estimate the Pro-inflammatory/Anti-inflammatory Food Intake Score (PAIFIS) in children and adolescents in South America and to test its reliability and validity using a food frequency questionnaire (FFQ) and an inflammatory biomarker. This work consists of a validation study in a sample of children and adolescents conducted in South America (SAYCARE Study). The habitual consumption of food contributing to calculating the PAIFIS was obtained through an FFQ and 24 h Dietary Recall (24HDR). Reliability was tested using the FFQ (FFQ1 × FFQ2), using Spearman's correlation coefficient to estimate the agreement between measurements. The validity of the PAIFIS was tested using 24HDR and the inflammatory biomarker C-reactive protein (CRP) using Spearman's correlation and multilevel linear regression. RESULTS: For children and adolescents, pro- and anti-inflammatory food groups showed Spearman's correlation coefficients ranging from 0.31 to 0.66, convergent validity ranging from 0.09 to 0.40, and criterion validity for a reliability range from -0.03 to 0.18. The PAIFIS showed Spearman's correlation coefficients for reliability ranging from 0.61 to 0.69, convergent validity from 0.16 to 0.23, and criterion validity from -0.03 to 0.24. CONCLUSION: The PAIFIS showed acceptable reliability, weak convergent validity, and weak criterion validity in children and adolescents.

Evaluation of the Validity of a Food Frequency Questionnaire and 24-Hour Dietary Recall to Assess Dietary Iron Intake in Children and Adolescents from the South American Youth/Child Cardiovascular and Environmental Study.

BACKGROUND: A food frequency questionnaire (FFQ) for South American children and adolescents was developed, but its validity for assessing dietary iron intake has not been evaluated. OBJECTIVE: To evaluate the validity of the FFQ and 24-hour dietary recalls (24h-DR) for assessing dietary iron intake in children and adolescents. DESIGN: The South American Youth/Child Cardiovascular and Environmental study is a multicenter observational study, conducted in five South American cities: Buenos Aires (Argentina), Lima (Peru), Medellin (Colombia), Sao Paulo, and Teresina (Brazil). The FFQ assessed dietary intake over the previous 3 months, and the 24h-DR was completed three times (2 weekdays and 1 weekend day) with a minimum 5-day interval between recalls. Blood samples were collected to assess serum iron, ferritin, and hemoglobin levels. PARTICIPANTS AND SETTING: Data of 99 children (aged 3 to 10 years) and 50 adolescents (aged 11 to 17 years) from public and private schools were collected during 2015 to 2017. MAIN OUTCOME MEASURES: Dietary iron intake calculated from the FFQ (using the sum of daily iron intake in all food/food groups) and 24h-DR (mean of 3 days using the multiple source method). STATISTICAL ANALYSES PERFORMED: Dietary iron intake in relation to blood biomarkers were assessed using Spearman rank correlations adjusted for sex, age, and total energy intake, and the quadratic weighted κ coefficients for agreement. RESULTS: Spearman correlations showed very good coefficients (range = 0.78 to 0.85) for the FFQ in both age groups; for the 24h-DR, the coefficients were weak in children and adolescents (range = 0.23 to 0.28). The agreement ranged from 59.9% to 72.9% for the FFQ and from 63.9% to 81.9% for the 24h-DR. CONCLUSION: The South American Youth/Child Cardiovascular and Environmental study FFQ exhibited good validity to rank total dietary iron intake in children and adolescents, and as well as the 24h-DR, presented good strength of agreements when compared with serum iron and ferritin levels.

Which blood cutoff value should be used for vitamin A deficiency in children aged 3-10 years? A systematic review.

CONTEXT: Blood cutoff values for vitamin A deficiency in children aged 3-10 years have not been addressed in the literature. OBJECTIVE: To identify blood retinol concentrations for determining severe vitamin A deficiency in children aged 3-10 years. DATA SOURCES: The MEDLINE, Web of Science, Embase, and Scopus databases were searched. DATA EXTRACTION: Two reviewers independently extracted article data and assessed quality. DATA ANALYSIS: The hierarchical summary receiver operating characteristic models were applied for the diagnostic accuracy meta-analysis. This review is registered at PROSPERO (identifier: CRD42020149367). RESULTS: A total of 15 articles met the eligibility criteria, and 9 were included in the diagnostic accuracy meta-analysis. The summary estimates (95%CI) were: Sensitivity, 0.39 (0.20-0.62); specificity, 0.79 (0.65-0.88); positive likelihood ratio, 1.85 (1.33-2.57); and negative likelihood ratio, 0.77 (0.60-0.99). The area under the curve of the overall analysis was 0.68 (95%CI 0.63-0.72). CONCLUSIONS: Blood retinol concentrations have low diagnostic accuracy for severe vitamin A deficiency in children aged 3-10 years. Therefore, there is unclear evidence about the preferable cutoff point for determining severe vitamin A deficiency in children in this age group.

Risk score for failed trial of vaginal birth after a previous cesarean section including data of labor course.

AIM: There is much discussion about the advantages and disadvantages of a trial of labor after cesarean (TOLAC). Some data suggest the greater the likelihood of success, the lower the risks of TOLAC. Our goal was to identify clinical and demographic variables associated with a failed TOLAC, available at admission for spontaneous labor and until 3 h later, with the aim of building two scores for risk of failed TOLAC. METHODS: This is a nested case-control study with live births to women with one previous cesarean, in a public Brazilian teaching hospital. Preterm, induction, noncephalic presentations, twins, fetal malformations were excluded. Cases were failed TOLAC, and controls, the successful TOLAC. It was accessed the association of the cases with 20 variables (P < 0.05). Associated variables were tested in multivariate analysis to build the scores, which were internally validated. RESULTS: We included 260 TOLAC, 42 cases and 218 controls. We found 11 variables associated with failed TOLAC. In the score to be applied at admission, we included hypertension, fundal height, previous vaginal birth and dilatation at admission. In the second score hypertension, fundal height at admission, membrane status and difference in dilatation 3 h after admission. Both scores presented good performance in the receiver-operator curve (areas under curve: 0.73 and 0.84, respectively). Both scores were translated into nomograms for clinical use. CONCLUSION: Two scores were built for risk of failed TOLAC, to be applied at admission and 3 h later. We believe that choosing the more favorable cases makes risks of TOLAC lower.

Reliability and validity of body weight and body image perception in children and adolescents from the South American Youth/Child Cardiovascular and Environmental (SAYCARE) Study.

OBJECTIVE: To assess the reliability and validity of body weight (BW) and body image (BI) perception reported by parents (in children) and by adolescents in a South American population. DESIGN: Cross-sectional study. BW perception was evaluated by the question, 'Do you think you/your child are/is: severely wasted, wasted, normal weight, overweight, obese?' BI perception was evaluated using the Gardner scale. To evaluate reliability, BW and BI perceptions were reported twice, two weeks apart. To evaluate validity, the BW and BI perceptions were compared with WHO BMI Z-scores. Kappa and Kendall's tau-c coefficients were obtained. SETTING: Public and private schools and high schools from six countries of South America (Argentina, Peru, Colombia, Uruguay, Chile, Brazil).ParticipantsChildren aged 3-10 years (n 635) and adolescents aged 11-17 years (n 400). RESULTS: Reliability of BW perception was fair in children's parents (κ=0·337) and substantial in adolescents (κ=0·709). Validity of BW perception was slight in children's parents (κ=0·176) and fair in adolescents (κ=0·268). When evaluating BI, most children were perceived by parents as having lower weight. Reliability of BI perception was slight in children's parents (κ=0·124) and moderate in adolescents (κ=0·599). Validity of BI perception was poor in children's parents (κ=-0·018) and slight in adolescents (κ=0·023). CONCLUSIONS: Reliability of BW and BI perceptions was higher in adolescents than in children's parents. Validity of BW perception was good among the parents of the children and adolescents with underweight and normal weight.

Leptin and adiposity as mediators on the association between early puberty and several biomarkers in European adolescents: the HELENA Study.

Background Adolescents having early puberty (EP) are more likely to have obesity and increased cardiometabolic and inflammatory markers and atherosclerosis risk. We aimed to assess the indirect and mediated effects of leptin and adiposity on the relation between EP and cardiometabolic and inflammatory markers in European adolescents. Methods A sample of 511 adolescents with EP (12.5-17.5 years) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) cross-sectional study was studied. To assess whether leptin levels and adiposity mediate the relation between EP and several biomarkers, linear regression models for mediation analyses were performed. Results EP was positively associated with the atherogenic index (Ath-I) (ß=0.174; 95%CI 0.029-0.265) and negatively associated with the C-reactive protein (CRP) (ß=-0.284; 95%CI -0.542 to -0.028) in girls. These associations were fully mediated by leptin levels (9.5%) and adiposity (44%), respectively. Moreover, EP has indirect effects on the apolipoprotein A-1 (ApoA-1) levels through adiposity in girls (for body mass index [BMI], ß=0.014; 95%CI 0.005-0.028, and for waist circumference [WC], ß=0.011; 95%CI 0.003-0.024), and on ApoA-1 (ß=0.012; 95%CI 0.004-0.025), apolipoprotein B (ApoB) (ß=-0.004; 95%CI -0.011 to -0.0004) and CRP (ß=-0.265; 95%CI -0.819 to -0.047) through abdominal fat in boys. Conclusions Leptin levels and adiposity seem to play an important indirect and mediation role in the association between EP and cardiometabolic and inflammatory markers in adolescents. Weight control should be recommended in order to control the impaired cardiometabolic and inflammatory status arising in early pubertal adolescents.

The Effects of Acute Cannabis Use on Nontraffic Injury Risk: Reviewing the Available Literature and Identifying Ways Forward.

Recent evidence has indicated that cannabis use before driving is associated with a modest but increased risk for traffic-related injuries. However, the question of whether recent cannabis use is associated with a greater risk for other types of injuries remains unanswered. Aiming to understand better how acute cannabis use might affect the risk for all causes of injury, we have summarized the limited data available in the literature on the risk of non-traffic injuries associated with recent cannabis use. Very few studies were able to provide estimate risks for all injuries or injuries other than those related to road traffic injuries, with the limited evidence available showing mixed findings. The only significant risk found (in only one study) suggests an inverse association between all injuries and cannabis use. Study designs are limited, and the majority of studies have neither data on acute cannabis use among injured individuals nor a valid control group for estimating injury risk attributable to cannabis. In conclusion, studies of the association between cannabis and non-traffic injuries present several limitations, particularly regarding sampling strategies, injury risk assessment for different causes of injury, and a dose-response risk relationship with injury. Further studies, incorporating better design for different causes of injury and drug testing, are required to reach firmer conclusions on the association between cannabis use and non-traffic injury risk.

Validity and reliability of sleep time questionnaires in children and adolescents: A systematic review and meta-analysis.

Sleep duration has been associated with several health outcomes in children and adolescents. As an extensive number of questionnaires are currently used to investigate sleep schedule or sleep time, we performed a systematic review of criterion validation of sleep time questionnaires for children and adolescents, considering accelerometers as the reference method. We found a strong correlation between questionnaires and accelerometers for weeknights and a moderate correlation for weekend nights. When considering only studies performing a reliability assessment of the used questionnaires, a significant increase in the correlations for both weeknights and weekend nights was observed. In conclusion, moderate to strong criterion validity of sleep time questionnaires was observed; however, the reliability assessment of the questionnaires showed strong validation performance.

The combined effect of physical activity and sedentary behaviors on a clustered cardio-metabolic risk score: The Helena study.

BACKGROUND/OBJECTIVE: Increased physical activity (PA) and decreased sedentary behaviors (SBs) may have beneficial effects on cardio-metabolic risk in adolescents. The aim of this study was to examine the associations between independent/combined effects of PA and SB with individual/clustered cardio-metabolic risk factors. METHODS: A sample of 769 adolescents (12.5-17.5 years) from the HELENA cross-sectional study (Healthy Lifestyle in Europe by Nutrition in Adolescence) and with valid data on metabolic risk factors were included. RESULTS: Concerning moderate-to-vigorous-PA (MVPA) and vigorous-PA (VPA), measured with accelerometers, girls tended to do more MVPA (36%) and VPA (114%) than boys. Unadjusted analyses show a positive association between "PA ≥ 60 min/d; SB ≥ 2 h" and the ratio TC/HDL-c (ß = 0.27; 95%CI 0.01 to 0.52; p < 0.05), and a negative association between "MVPA ≥ 60 min/d; SB < 2h" with the ∑ 4Skinfolds (ß = -0.32; 95%CI -0.61 to -0.02; p<0.05). Moreover, "SB ≥ 2 h/d" was associated with increased cardio-metabolic risk (PR 1.59; 95%CI 1.05 to 2.39; p < 0.05), while "PA ≥ 60 min/d; SB < 2h" had a protective effect against cardio-metabolic risk (PR 0.48; 95%CI 0.25 to 0.91; p < 0.05). After adjustment for potential confounders, a positive association between SB and ∑ 4Skinfolds was shown (ß = 0.28; 95%CI 0.04 to 0.53; p < 0.05). Furthermore, VO2max (mL/kg/min) tends to increase in those participants who do higher VPA and less SB (p = 0.042), and there was a protective effect of "VPA ≥ 30 min/d; SB < 2h" against cardio-metabolic risk (PR 0.24; 95%CI 0.07 to 0.85; p < 0.05). CONCLUSION: The current study suggests that adolescents should be encouraged to decrease sedentary lifestyle and increase physical activity, especially vigorous physical activity, in order to reduce cardio-metabolic risk.

Prevalence of cardiovascular risk factors, the association with socioeconomic variables in adolescents from low-income region / Prevalencia de factores de riesgo cardiovascular, la asociación con las variables socioeconómicas en los adolescentes en región de baja renta

Objectives: To estimate the prevalence of obesity, overweight, abdominal obesity and high blood pressure in a sample of adolescents from a low-income city in Brazil and to estimate the relationship with the socioeconomic status of the family, the education level of the family provider and the type of school. Methods: This cross-sectional study randomly sampled 1,014 adolescents (54.8% girls), between 14-19 years of age, attending high school from Imperatriz (MA). The outcomes of this study were: obesity and overweight, abdominal obesity and high blood pressure (systolic and/ or diastolic). The independent variables were: socioeconomic status (SES) of the family, education level of the family provider (ELFP) and type of school. The confounding variables were: gender, age and physical activity level. Prevalence was estimated, and the association between the endpoints and the independent variables was analyzed using a prevalence ratio (PR), with a 95% confidence interval, estimated by Poisson regression. Results: The overall prevalence of obesity was 3.8%, overweight, 13.1%, abdominal obesity, 22.7% and high blood pressure, 21.3%. The adjusted analysis indicated that girls with high SES showed an increased likelihood to be overweight (PR=1.71 [95% IC: 1.13-2.87]), while private school boys had an increased likelihood of obesity (PR=1.79 [95% CI: 1.04-3.08]) and abdominal obesity (PR =1.64 [95% CI: 1.06-2.54]). Conclusion: The prevalence of CVDR is high in adolescents from this low-income region. Boys from private schools are more likely to have obesity and abdominal obesity, and girls with high SES are more likely to be overweight (AU)

Objetivos: Estimar la prevalencia de obesidad y sobrepeso, obesidad abdominal y hipertensión arterial en una muestra de adolescentes pertenecientes a una ciudad de baja renta en Brasil y su relación con el nivel socioeconómico, nivel educativo de lo responsable de la familia y tipo de escuela. Métodos: Estudio transversal con una muestra de 1014 adolescentes (54,8% chicas), con edades entre 14-19 años, estudiantes de las escuelas de la ciudad de Imperatriz (Brasil), seleccionadas por un muestreo aleatorio. Las variables dependientes evaluadas son: obesidad general y sobrepeso, obesidad abdominal, y tensión arterial alta (sistólica y/o diastólica). Las variables independientes son: nivel socioeconómico de la familia (NSO), el nivel de educación de lo responsable de la familia (NERF) y tipo de escuela. Las variables de confusión son: sexo, edad y nivel de actividad física. La prevalencia fue estimada, y la asociación entre las variables dependientes y las variables independientes se analizaron mediante razón de prevalencia (RP), con intervalo de confianza (IC) del 95%, estimado por la regresión de Poisson. Resultados: La prevalencia de la obesidad general fue de 3,8%, sobrepeso 13,1%, obesidad abdominal 22,7% y la tesión arterial alta 21,3%. Las análisis ajustadas indicaron que las chicas con NSO alto tienen mayor probabilidad de tener sobrepeso (RP=1,71 [IC95%: 1,13 a 2,87]), y chicos de las escuelas privadas tienen más probabilidad de tener obesidad (RP=1,79 [IC95%: 1.04- 3,08]) y obesidad abdominal (RP=1,64 [IC95%: 1,06 a 2,54]). Conclusión: La prevalencia de los FRC es alta en adolescentes de una región de baja renta. Los chicos de las escuelas privadas son más propensos a tener obesidad y obesidad abdominal, y las chicas con NSO alto son más propensas a tener sobrepeso (AU)

Neonatal outcomes of late preterm and early term birth.

OBJECTIVE: To compare neonatal deaths and complications in infants born at 34-36 weeks and six days (late preterm: LPT) with those born at term (37-41 weeks and six days); to compare deaths of early term (37-38 weeks) versus late term (39-41 weeks and six days) infants; to search for any temporal trend in LPT rate. STUDY DESIGN: A retrospective cohort study of live births was conducted in the Campinas State University, Brazil, from January 2004 to December 2010. Multiple pregnancies, malformations and congenital diseases were excluded. Control for confounders was performed. The level of significance was set at p<0.05. RESULTS: After exclusions, there were 17,988 births (1653 late preterm and 16,345 term infants). A higher mortality in LPT versus term was observed, with an adjusted odds ratio (OR) of 5.29 (p<0.0001). Most complications were significantly associated with LPT births. There was a significant increase in LPT rate throughout the study period, but no significant trend in the rate of medically indicated deliveries. A higher mortality was observed in early term versus late term infants, with adjusted OR: 2.43 (p=0.038). CONCLUSION: LPT and early term infants have a significantly higher risk of death.

Does beverage type and drinking context matter in an alcohol-related injury? Evidence from emergency department patients in Latin America.

BACKGROUND: Previous studies have already substantiated alcohol's causal role in injuries. Yet the role that alcoholic beverage preferences and the drinking context play in the risk for injury is still under-investigated. In this study, a cross-national comparison of the association between alcohol and injury focusing on beverage type preference and the drinking context is reported. METHODS: Emergency department (ED) injured patients were interviewed in eight countries from the Latin American and Caribbean (LAC) region. Data on the type of alcoholic beverage, total alcohol volume, and the place where the injury occurred were obtained from patients who reported any alcohol consumption within 6h prior to being injured. Patients who did not drink prior to injury were also asked about their typical drinking pattern and the injury place. Differences within- and between-groups were evaluated regarding patients' typical drinking and drinking before injury. RESULTS: Beer was the most prevalent beverage type usually consumed among injured patients across countries, however, patients who drank before injury had a higher typical consumption of spirits than those not drinking prior to injury. The total alcohol volume typically consumed and drinking in public settings were also found to be positively associated with alcohol-related injury. CONCLUSIONS: A similar beverage-specific association with alcohol-related injury was found across LAC countries, mainly attributed to beer consumption, and spirits drinkers seem to have a greater chance of becoming involved in injury events. Future prevention strategies should inform the public about harms from drinking associated with the context in which drinking takes place.

Prevalence of cardiovascular risk factors, the association with socioeconomic variables in adolescents from low-income region.

OBJECTIVES: To estimate the prevalence of obesity, overweight, abdominal obesity and high blood pressure in a sample of adolescents from a low-income city in Brazil and to estimate the relationship with the socioeconomic status of the family, the education level of the family provider and the type of school. METHODS: This cross-sectional study randomly sampled 1,014 adolescents (54.8% girls), between 14-19 years of age, attending high school from Imperatriz (MA). The outcomes of this study were: obesity and overweight, abdominal obesity and high blood pressure (systolic and/ or diastolic). The independent variables were: socioeconomic status (SES) of the family, education level of the family provider (ELFP) and type of school. The confounding variables were: gender, age and physical activity level. Prevalence was estimated, and the association between the endpoints and the independent variables was analyzed using a prevalence ratio (PR), with a 95% confidence interval, estimated by Poisson regression. RESULTS: The overall prevalence of obesity was 3.8%, overweight, 13.1%, abdominal obesity, 22.7% and high blood pressure, 21.3%. The adjusted analysis indicated that girls with high SES showed an increased likelihood to be overweight (PR=1.71 [95% IC: 1.13-2.87]), while private school boys had an increased likelihood of obesity (PR=1.79 [95% CI: 1.04-3.08]) and abdominal obesity (PR =1.64 [95% CI: 1.06-2.54]). CONCLUSION: The prevalence of CVDR is high in adolescents from this low-income region. Boys from private schools are more likely to have obesity and abdominal obesity, and girls with high SES are more likely to be overweight.

Objetivos: Estimar la prevalencia de obesidad y sobrepeso, obesidad abdominal y hipertensión arterial en una muestra de adolescentes pertenecientes a una ciudad de baja renta en Brasil y su relación con el nivel socioeconómico, nivel educativo de lo responsable de la familia y tipo de escuela. Métodos: Estudio transversal con una muestra de 1014 adolescentes (54,8% chicas), con edades entre 14-19 años, estudiantes de las escuelas de la ciudad de Imperatriz (Brasil), seleccionadas por un muestreo aleatorio. Las variables dependientes evaluadas son: obesidad general y sobrepeso, obesidad abdominal, y tensión arterial alta (sistólica y/o diastólica). Las variables independientes son: nivel socioeconómico de la familia (NSO), el nivel de educación de lo responsable de la familia (NERF) y tipo de escuela. Las variables de confusión son: sexo, edad y nivel de actividad física. La prevalencia fue estimada, y la asociación entre las variables dependientes y las variables independientes se analizaron mediante razón de prevalencia (RP), con intervalo de confianza (IC) del 95%, estimado por la regresión de Poisson. Resultados: La prevalencia de la obesidad general fue de 3,8%, sobrepeso 13,1%, obesidad abdominal 22,7% y la tesión arterial alta 21,3%. Las análisis ajustadas indicaron que las chicas con NSO alto tienen mayor probabilidad de tener sobrepeso (RP=1,71 [IC95%: 1,13 a 2,87]), y chicos de las escuelas privadas tienen más probabilidad de tener obesidad (RP=1,79 [IC95%: 1.04- 3,08]) y obesidad abdominal (RP=1,64 [IC95%: 1,06 a 2,54]). Conclusión: La prevalencia de los FRC es alta en adolescentes de una región de baja renta. Los chicos de las escuelas privadas son más propensos a tener obesi dad y obesidad abdominal, y las chicas con NSO alto son más propensas a tener sobrepeso.

A review of emergency room studies on alcohol and injuries conducted in Latin America and the Caribbean region.

ISSUES: Alcohol-attributable burden of injury is one of the most serious public health problems in Latin America and the Caribbean region (LAC). Although knowledge on alcohol's involvement in injuries has progressed along with the implementation of evidenced-based alcohol policies in developed countries, this was not true for the most part of LAC countries for which reducing alcohol-related injuries is an urgent necessity. APPROACH: A systematic review was performed in order to identify the most up-to-date information on alcohol and injuries derived from emergency room (ER) studies conducted in LAC. KEY FINDINGS: Findings corroborate that alcohol has a high prevalence among injured patients in the ER setting in LAC, with violence-related injuries showing an increased association with alcohol use compared to unintentional injuries. However, a large number of studies did not include all types of injury and the measurement of injury risk associated with alcohol consumption. The amount of alcohol consumed in the event and hazardous drinking patterns seem to be strongly associated with injury occurrence, as well as drinking in public spaces, but a paucity of data relating to social-contextual factors limits the interpretation of the heterogeneity in the magnitude of the association of alcohol and injuries found across studies. CONCLUSIONS: There is a lack of ER studies able to support strategies to reduce alcohol-related injuries in a region where effective alcohol policies are scant. Future research should focus on understanding how drinking influenced by local contexts and drinking behaviours may affect the risk of injury within each LAC country.

Reducing the legal blood alcohol concentration limit for driving in developing countries: a time for change? Results and implications derived from a time-series analysis (2001-10) conducted in Brazil.

AIMS: In Brazil, a new law introduced in 2008 has lowered the blood alcohol concentration limit for drivers from 0.06 to 0.02, but the effectiveness in reducing traffic accidents remains uncertain. This study evaluated the effects of this enactment on road traffic injuries and fatalities. DESIGN: Time-series analysis using autoregressive integrated moving average (ARIMA) modelling. SETTING: State and capital of São Paulo, Brazil. PARTICIPANTS: A total of 1,471,087 non-fatal and 51,561 fatal road traffic accident cases in both regions. MEASUREMENTS: Monthly rates of traffic injuries and fatalities per 100,000 inhabitants from January 2001 to June 2010. FINDINGS: The new traffic law was responsible for significant reductions in traffic injury and fatality rates in both localities (P<0.05). A stronger effect was observed for traffic fatality (-7.2 and -16.0% in the average monthly rate in the State and capital, respectively) compared to traffic injury rates (-1.8 and -2.3% in the State and capital, respectively). CONCLUSIONS: Lowering the blood alcohol concentration limit in Brazil had a greater impact on traffic fatalities than injuries, with a higher effect in the capital, where presumably the police enforcement was enhanced.

Risky behavior regarding drug use and HIV infection: an Internet questionnaire coupled with short education texts for Portuguese speakers.

Surveys of risky behavior relating to HIV/AIDS are generally made for groups at risk of infection, for which HIV/AIDS prevalence is usually expected to be higher than in the general population. Therefore, an educational homepage in Portuguese was created on the Internet to inform/ask internauts regarding knowledge and behavior. The internauts were classified as adolescents (13 to 25 years) and adults (>25 years). The number of STDs was reported as 1. 8 +/- 2. 6 infections (range: 1 to 20 infections); 43% used condoms during sexual intercourse. Alcohol consumption was reported by 63% and illicit drug use by 32% (marijuana 24% and inhalants 15%). Among the adolescents, 31% did not classified alcohol as a drug. The adults more frequently reported homosexuality, anal intercourse and STDs, although the adolescents also presented high rates of risky behavior. These results show the need to reach out to internauts through better control strategies. Different types of strategies must be encouraged, in order to reach people that use this means of communication and entertainment.

Risky behavior regarding drug use and HIV infection: an Internet questionnaire coupled with short education texts for Portuguese speakers

Surveys of risky behavior relating to HIV/AIDS are generally made for groups at risk of infection, for which HIV/AIDS prevalence is usually expected to be higher than in the general population. Therefore, an educational homepage in Portuguese was created on the Internet to inform/ask internauts regarding knowledge and behavior. The internauts were classified as adolescents (13 to 25 years) and adults (>25 years). The number of STDs was reported as 1. 8 ± 2. 6 infections (range: 1 to 20 infections); 43 percent used condoms during sexual intercourse. Alcohol consumption was reported by 63 percent and illicit drug use by 32 percent (marijuana 24 percent and inhalants 15 percent). Among the adolescents, 31 percent did not classified alcohol as a drug. The adults more frequently reported homosexuality, anal intercourse and STDs, although the adolescents also presented high rates of risky behavior. These results show the need to reach out to internauts through better control strategies. Different types of strategies must be encouraged, in order to reach people that use this means of communication and entertainment.

Levantamentos de comportamento de risco para HIV/AIDS são geralmente feitos para grupos de risco onde a prevalência é normalmente esperada ser maior que na população geral. Assim, foi criada uma homepage educacional em português para informar/perguntar sobre conhecimento e comportamento aos internautas. Os internautas foram classificados em grupos: adolescentes (13 a 25a) e adultos (>25a). DST foi relatada como 1,8 ± 2,6 infecções (intervalo de 1 a 20 infecções); 43 por cento usaram preservativo durante ralação sexual. Alcool foi referido por 63 por cento, droga ilícita por 32 por cento (maconha 24 por cento e inalantes 15 por cento). Trinta e um por cento dos jovens não classificaram álcool como droga. Adultos referiram maior freqüência em homossexualismo, sexo anal e DST, embora jovens apresentem altas taxas no comportamento de risco. Os resultados mostram necessidade de atingir internautas com melhores estratégias de controle. Diferentes tipos de estratégias devem ser encorajados, a fim de alcançar pessoas que usam este meio de comunicação e de entretenimento.

Estudo de comportamento associado à infecção pelo HIV e HCV em detentas de um presídio de São Paulo, Brasil / Behavior associated with HIV and HCV infection in female prison inmates in São Paulo, Brazil

Observa-se aumento do número de casos de AIDS e hepatite C entre mulheres, incluindo aquelas confinadas no sistema prisional. Este trabalho propôs estudar aspectos relacionados ao comportamento sexual e associados ao risco de transmissão do HIV e da hepatite C em detentas numa penitenciária de São Paulo, Brasil. É um estudo transversal realizado em 2000, aplicando questionários de comportamento e obtendo diagnósticos sorológicos para HIV e HCV. A medida de associação escolhida foi OR para análises bi e multivariada (regressão logística). Participaram do estudo 290 detentas. A prevalência observada para HIV e HCV foi de 13,9 por cento e 16,2 por cento, respectivamente. Associações estatisticamente significantes (p < 0,05) para HIV positivo foram observadas para as variáveis: parceiros com AIDS OR = 6,9 (2,7-35,2); usuários de drogas ingetáveis (UDI) OR = 3,3 (1,6-14,7); parceiro fixo OR=3,7 (1,5-8,3) e para HCV positivo com UDI OR = 13,7 (4,4-42,7); parceiro UDI OR = 4,9 (1,9-12,2); prisão anterior OR = 2,8 (1,2-6,5) ajustadas por: parceiros com AIDS, UDI, parceiro UDI, uso de drogas e prisão anterior. Concluiu-se que o risco parenteral foi associado com infecções pelo HIV e HCV, e o sexual, pelo HIV. Recomendam-se programas de prevenção adequados e continuados no ambiente carcerário.

An increase has been observed in AIDS and hepatitis C cases in women, including female prison inmates. This study focused on inmates' behavioral factors associated with risk of HIV and HCV transmission in a women's detention facility in São Paulo, Brazil. Behavioral questionnaires were applied and HIV and HCV serology were performed. The selected measure of association was odds ratio for both the bi and multivariate logistic regression analyses. 290 inmates participated in the study. HIV and HCV prevalence rates were 13.9 percent and 16.2 percent, respectively. Statistically significant associations were observed (p < 0.05) between HIV and the following variables: partner with AIDS OR = 6.9 (2.7-35.2); injection drug users (IDU) OR = 3.3 (1.6-14.7); regular partner OR = 3.7 (1.5-8.3), and between HCV and: IDU OR = 13.7 (4.4-42.7); IDU partner OR = 4.9 (1.9-12.2); previous arrest OR = 2.8 (1.2-6.5) adjusted for: partner with AIDS, IDU, IDU partner, drug user, and previous arrest. In conclusion, parenteral risk was associated with HIV and HCV infection and sexual risk with HIV. Appropriate and continuous preventive programs are recommended in the prison.

[Behavior associated with HIV and HCV infection in female prison inmates in São Paulo, Brazil]. / Estudo de comportamento associado à infecção pelo HIV e HCV em detentas de um presídio de São Paulo, Brasil.

An increase has been observed in AIDS and hepatitis C cases in women, including female prison inmates. This study focused on inmates' behavioral factors associated with risk of HIV and HCV transmission in a women's detention facility in São Paulo, Brazil. Behavioral questionnaires were applied and HIV and HCV serology were performed. The selected measure of association was odds ratio for both the bi and multivariate logistic regression analyses. 290 inmates participated in the study. HIV and HCV prevalence rates were 13.9% and 16.2%, respectively. Statistically significant associations were observed (p < 0.05) between HIV and the following variables: partner with AIDS OR = 6.9 (2.7-35.2); injection drug users (IDU) OR = 3.3 (1.6-14.7); regular partner OR = 3.7 (1.5-8.3), and between HCV and: IDU OR = 13.7 (4.4-42.7); IDU partner OR = 4.9 (1.9-12.2); previous arrest OR = 2.8 (1.2-6.5) adjusted for: partner with AIDS, IDU, IDU partner, drug user, and previous arrest. In conclusion, parenteral risk was associated with HIV and HCV infection and sexual risk with HIV. Appropriate and continuous preventive programs are recommended in the prison.

Introdução de programa educativo em DST na comunidade da favela do Moinho de Saõ Paulo - SP, Brasil / Instalation of a STD education program for the community of Moinho slum of São Paulo - SP, Brazil

Introdução: com este trabalho, buscamos soluções desejáveis na luta contra DST. Objetivo: identificar os comportamentos sexuais de rtisco e atuar na sua prevenção. Métodos: no final de 2003 e no primeiro semestre de 2004 foi realizado um programa educativo com mulheres desprotegidas da comunidade da favela do Moinho, neste programa foi aplicado um questionário face a face, dois grupos focais e três oficinas de sexo seguro foram conduzidas por duas psicólogas. Resultados: participaram do programa 29 mulheres com idade entre 20 e 54 anos, todas com filhos, sendo 72,4% com mais de cinco; 86,2% eram solteiras, 72,4% com Ensino Fundamental incompleto; 21,7 analfabetas; 55,2% são catadoras de papel e reciclam material; 65,5% referiram sífilis; e 34,5% não sabem o nome da doença que tiveram. A falta de confiança no parceiro sexual fica evidente no desenho "a cara da aids", no qual nove mulheres alegaram ser o pênis de seus companheiros. Conclusão: estas mulheres vivem em extrema pobreza numa metrópole como São Paulo e não percebem o risco na transmissão de DST.