Reliability of roadside oral fluid testing devices for ∆9 -tetrahydrocannabinol (∆9 -THC) detection.

Driving under the influence of cannabis (DUIC) is increasing worldwide, and cannabis is the most prevalent drug after alcohol in impaired driving cases, emphasizing the need for a reliable traffic enforcement strategy. ∆9 -tetrahydrocannabinol (THC) detection in oral fluid has great potential for identifying recent cannabis use; however, additional data are needed on the sensitivities, specificities, and efficiencies of different oral fluid devices for detecting cannabinoids at the roadside by police during routine traffic safety enforcement efforts. At the roadside, 8945 oral fluid THC screening tests were performed with four devices: AquilaScan®, Dräger DrugTest®, WipeAlyser Reader®, and Druglizer®. A total of 530 samples screened positive for THC (5.9%) and were analyzed by liquid chromatography-tandem mass spectrometry at multiple cutoff concentrations (2 ng/mL, 10 ng/mL, and manufacturers' recommended device cutoffs) to investigate device performance. Results varied substantially, with sensitivities of 0%-96.8%, specificities of 89.8%-98.5%, and efficiencies of 84.3%-97.8%. The Dräger DrugTest® outperformed the other devices with a 96.8% sensitivity, 97.1% specificity, and 97.0% efficiency at a 5-ng/mL LC-MS/MS confirmation cutoff. The WipeAlyser Reader® had good performance with a 91.4% sensitivity, 97.2% specificity, and 96.4% efficiency. AquilaScan® and Druglizer® had unacceptable performance for cannabinoid detection, highlighted by sensitivity <13%. The choice of roadside oral fluid testing device must offer good analytical performance for cannabinoids because of its high prevalence of use and impact on road safety.

Hematological inflammatory biomarkers in patients with alcohol and cocaine use disorders.

BACKGROUND: Neutrophil-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelets-lymphocyte ratio (PLR) are biomarkers easy-to-obtain and could be used in clinical practice to verify an inflammatory status and are associated with alcohol use disorder (AUD) and cocaine use disorder (CUD). Our aim was to compare NLR, MLR and PLR among men with AUD and CUD and to assess the relationship between these biomarkers and addiction-related outcomes. METHODS: This is a cross-sectional study comprising 979 inpatient men diagnosed with substance use disorder (391 with AUD and 588 with CUD) under hospital treatment for drug addiction. RESULTS: Individuals with AUD had higher NLR and MLR (p=0.041, p<0.001 respectively) compared to individuals with CUD. In the AUD group, positive correlations between age and MLR (r=0.111; p=0.029), NLR and liver enzymes ALT and AST (r=0.103, p=0.043; r=0.155, p=0.002; respectively), and MLR and ALT, AST and GGT levels were observed (r=0.173, p=0.001; r=0.242, p<0.001; r=0.167, p=0.001, respectively). Individuals with CUD showed a positive correlation between age and NLR (r=0.113; p=0.006). The presence of clinical comorbidities, HIV, HCV and syphilis were not associated with NLR, MLR, and PLR (p>0.05). CONCLUSION: These biomarkers are a rapid and inexpensive way to assess the effects of substance use on the inflammatory profile. Our findings contribute with valuable insights into the distinctive inflammatory profiles associated with AUD and CUD. These insights could guide further research and the development of more studies, which could include control groups, in order to refine the clinical applicability of these biomarkers.

Differential impact on suicide mortality during the COVID-19 pandemic in Brazil

Objectives: To compare suicide rates observed in Brazil after the onset of the COVID-19 pandemic with the estimated rate based on suicide deaths between 2010 and 2020, and identify sociodemographic variables associated with this outcome. Methods: Ecological time-series study. Data were obtained from Brazilian Unified Health System Department of Information Technology (DATASUS), with the structural break of the data set in March 2020. The number of actual suicides observed and the number of expected suicides if there were no COVID-19 pandemic were analyzed through bayesian structural time series modeling. Results: The overall incidence of suicides in Brazil remained stable after the start of the COVID-19 pandemic compared to what would be expected. However, there was a significant increase in suicide deaths among women (6.9%) and older adult (9.1%). Analysis by macro-regions of the country showed significant increases in suicide deaths in the Center-West (7.4%), Northeast (5.7%), and Southeast (10%). Stratified analyses revealed differences according to age, sex, education, and skin color. Conclusions: Despite stability in the overall number of suicides, this phenomenon occurs heterogeneously among different population groups and regions of Brazil. Rates have increased in populations with a history of poor access to health, which may have been more severely impacted by the pandemic.

Intenção de se vacinar contra a COVID-19 e hesitação vacinal no Sul do Brasil: prevalência e fatores associados / Intention to get vaccinated against COVID-19 and vaccine hesitation in Southern Brazil: prevalence and associated factors

INTRODUÇÃO: A vacinação contra a COVID-19 é um dos principais recursos de saúde pública para mitigar a pandemia globalmente. As taxas de vacinação dependem diretamente da aceitação e adesão da população. Sabese que a aceitação vacinal é muito heterogênea entre as diferentes regiões do globo, mas há poucos estudos avaliando a percepção geral das vacinas contra a COVID-19 no Brasil. OBJETIVO: Avaliar a intenção de vacinação contra COVID-19 entre moradores do Rio Grande do Sul (RS), Brasil, durante o início da campanha de vacinação no país, e identificar fatores associados à hesitação vacinal. MÉTODOS: Foi realizada uma pesquisa com coleta de dados online, que recrutou um total de 953 respondentes. O questionário foi divulgado em mídias digitais de março a maio de 2021, por meio do método de amostragem bola de neve. RESULTADOS: Aproximadamente 96% da amostra informou que pretendia tomar a vacina contra a COVID-19. A hesitação vacinal foi positivamente associada a ser casado, ter filhos e ser mais velho. Indivíduos sem intenção de se vacinar também foram mais propensos a não respeitar o distanciamento social e outras ações de proteção individual. CONCLUSÕES: Nossos achados estão de acordo com os dados atuais de cobertura vacinal no RS. Embora o Brasil esteja apresentando taxas de vacinação superiores à maioria dos países do mundo, devemos atentar para os grupos populacionais que não aderem à vacinação. Reforçamos a importância da constante divulgação científica e educação em saúde para toda a população como aliadas no fortalecimento das políticas públicas de vacinação.(AU)

INTRODUCTION: The vaccination against COVID-19 is one of the major public health resources to mitigate the global pandemic. Vaccination rates directly depends on the acceptance and adherence by the population. It is known that the vaccine acceptancy is very heterogeneous among different regions of the globe, but there are few studies evaluating the general perception of COVID-19 vaccines in Brazil. AIM: To evaluate the intention of vaccination against COVID-19 among residents of Rio Grande do Sul (RS), Brazil, during the beginning of the campaign in the country, and to identify factors associated with vaccine hesitancy. METHODS: An online survey was conducted, ending in a sample of 953 respondents. The questionnaire was divulgated through digital medias from March to May 2021, via a snowball sampling method. RESULTS: Approximal 96% of the sample informed they intended to take COVID-19 vaccine. Vaccine hesitancy was positively associated with being married, having children, and being older. Subjects with no intention to get vaccinated were also more likely to not respect social distancing and other individual protection actions. CONCLUSIONS: Our findings are in line with current vaccination coverage data in RS. Although Brazil is showing vaccination rates higher than most countries in the world, we must pay attention to population groups that do not adhere to vaccination. We reinforce the importance of constant science communication and health education for the whole population as allies in strengthening public policies for vaccination.(AU)

INTRODUCCIÓN: La vacunación contra el COVID-19 es uno de los principales recursos de salud pública para mitigar la pandemia. Las tasas de vacunación dependen directamente de la aceptación y adherencia por parte de la población. Se sabe que la aceptación de la vacuna es muy heterogénea entre las diferentes regiones del mundo, pero hay pocos estudios que evalúen la percepción general de las vacunas contra la COVID-19 en Brasil. OBJETIVO: Evaluar la intención de vacunación contra la COVID-19 entre los residentes de Rio Grande do Sul (RS), Brasil, e identificar factores asociados a la reticencia vacunal. MÉTODOS: Se realizó una encuesta en línea, finalizando en una muestra de 953 encuestados. El cuestionario fue divulgado a través de medios digitales de marzo a mayo de 2021, mediante un método de muestreo de bola de nieve. RESULTADOS: Aproximadamente 96% de la muestra informó que tenía la intención de recibir la vacuna COVID-19. La reticencia a la vacuna se asoció positivamente con estar casado, tener hijos y ser mayor. Los sujetos sin intención de vacunarse también tenían más probabilidades de no respetar el distanciamiento social y otras medidas de protección individual. CONCLUSIONES: Nuestros hallazgos están en línea con los datos actuales de cobertura de vacunación en RS. Debemos prestar atención a los grupos de población que no se adhieren a la vacunación. Reforzamos la importancia de la comunicación científica constante y la educación en salud para toda la población como aliados en el fortalecimiento de las políticas públicas de vacunación.(AU)

Differential impact on suicide mortality during the COVID-19 pandemic in Brazil.

OBJECTIVES: To compare suicide rates observed in Brazil after the onset of the COVID-19 pandemic with the estimated rate based on suicide deaths between 2010 and 2020, and identify sociodemographic variables associated with this outcome. METHODS: Ecological time-series study. Data were obtained from Brazilian Unified Health System Department of Information Technology (DATASUS), with the structural break of the data set in March 2020. The number of actual suicides observed and the number of expected suicides if there were no COVID-19 pandemic were analyzed through bayesian structural time series modeling. RESULTS: The overall incidence of suicides in Brazil remained stable after the start of the COVID-19 pandemic compared to what would be expected. However, there was a significant increase in suicide deaths among women (6.9%) and older adult (9.1%). Analysis by macro-regions of the country showed significant increases in suicide deaths in the Center-West (7.4%), Northeast (5.7%), and Southeast (10%). Stratified analyses revealed differences according to age, sex, education, and skin color. CONCLUSIONS: Despite stability in the overall number of suicides, this phenomenon occurs heterogeneously among different population groups and regions of Brazil. Rates have increased in populations with a history of poor access to health, which may have been more severely impacted by the pandemic.

A rapid review of machine learning approaches for telemedicine in the scope of COVID-19.

The COVID-19 pandemic has rapidly spread around the world. The rapid transmission of the virus is a threat that hinders the ability to contain the disease propagation. The pandemic forced widespread conversion of in-person to virtual care delivery through telemedicine. Given this gap, this article aims at providing a literature review of machine learning-based telemedicine applications to mitigate COVID-19. A rapid review of the literature was conducted in six electronic databases published from 2015 through 2020. The process of data extraction was documented using a PRISMA flowchart for inclusion and exclusion of studies. As a result, the literature search identified 1.733 articles, from which 16 articles were included in the review. We developed an updated taxonomy and identified challenges, open questions, and current data types. Our taxonomy and discussion contribute with a significant degree of coverage from subjects related to the use of machine learning to improve telemedicine in response to the COVID-19 pandemic. The evidence identified by this rapid review suggests that machine learning, in combination with telemedicine, can provide a strategy to control outbreaks by providing smart triage of patients and remote monitoring. Also, the use of telemedicine during future outbreaks could be further explored and refined.

First and second COVID-19 waves in Brazil: A cross-sectional study of patients' characteristics related to hospitalization and in-hospital mortality.

BACKGROUND: Background The second wave of the COVID-19 pandemic was more aggressive in Brazil compared to other countries around the globe. Considering the Brazilian peculiarities, we analyze the in-hospital mortality concerning socio-epidemiological characteristics of patients and the health system of all states during the first and second waves of COVID-19. METHODS: We performed a cross-sectional study of hospitalized patients with positive RT-PCR for SARS-CoV-2 in Brazil. Data was obtained from the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) and comprised the period from February 25, 2020, to April 30, 2021, separated in two waves on November 5, 2020. We performed a descriptive study of patients analyzing socio-demographic characteristics, symptoms, comorbidities, and risk factors stratified by age. In addition, we analyzed in-hospital and intensive care unit (ICU) mortality in both waves and how it varies in each Brazilian state. FINDINGS: Between February 25, 2020 and April 30, 2021, 678 235 patients were admitted with a positive RT-PCR for SARS-CoV-2, with 325 903 and 352 332 patients for the first and second wave, respectively. The mean age of patients was 59 · 65 (IQR 48 · 0 - 72 · 0). In total, 379 817 (56 · 00%) patients had a risk factor or comorbidity. In-hospital mortality increased from 34 · 81% in the first to 39 · 30% in the second wave. In the second wave, there were more ICU admissions, use of non-invasive and invasive ventilation, and increased mortality for younger age groups. The southern and southeastern regions of Brazil had the highest hospitalization rates per 100 000 inhabitants. However, the in-hospital mortality rate was higher in the northern and northeastern states of the country. Racial differences were observed in clinical outcomes, with White being the most prevalent hospitalized population, but with Blacks/Browns (Pardos) having higher mortality rates. Younger age groups had more considerable differences in mortality as compared to groups with and without comorbidities in both waves. INTERPRETATION: We observed a more considerable burden on the Brazilian hospital system throughout the second wave. Furthermore, the north and northeast of Brazil, which present lower Human Development Indexes, concentrated the worst in-hospital mortality rates. The highest mortality rates are also shown among vulnerable social groups. Finally, we believe that the results can help to understand the behavior of the COVID-19 pandemic in Brazil, helping to define public policies, allocate resources, and improve strategies for vaccination of priority groups. FUNDING: Coordinating Agency for Advanced Training of Graduate Personnel (CAPES) (C.F. 001), and National Council for Scientific and Technological Development (CNPq) (No. 309537/2020-7).

Increase in serum brain-derived neurotrophic factor levels during early withdrawal in severe alcohol users.

INTRODUCTION: Changes in brain-derived neurotrophic factor (BDNF) have been linked to the neuroadaptative consequences of chronic alcohol use and associated with disease severity and prognosis. Few studies have evaluated the influence of drug withdrawal and clinical and sociodemographic data on BDNF levels in severe alcohol users. OBJECTIVES: Our goals were (1) to evaluate variation in BDNF levels during alcohol withdrawal and, (2) to assess the influence of putative confounding factors on BDNF levels. METHODS: Our sample consists of 62 men with alcohol use disorder undergoing a detoxification process. Serum BDNF levels were measured using a commercial sandwich-ELISA kit, at two points: before and after the detoxification period. RESULTS: We found an increase in BDNF levels during alcohol withdrawal (25.4±9.6 at admission vs. 29.8±10.2 ng/ml at discharge; p < 0.001), even after controlling for potential confounders (positive family history, number of days between blood sample collections, and age) (Generalized Estimating Equation: coefficient = -4.37, 95% confidence interval [95%CI] -6.3; -2.4; p < 0.001). Moreover, individuals who had first-degree relative with alcohol dependence had smaller increases in BDNF levels than individuals with no family history (14.8 [95%CI -5.3; 35.6] vs. 35.3 [95%CI 15.4; 74.8]; p = 0.005). CONCLUSIONS: In summary, variation in BDNF levels seems to be influenced by withdrawal in severe alcohol users. A positive family history of alcohol dependence could also be a factor that influences variation in this biomarker.

Increase in serum brain-derived neurotrophic factor levels during early withdrawal in severe alcohol users

Abstract Introduction Changes in brain-derived neurotrophic factor (BDNF) have been linked to the neuroadaptative consequences of chronic alcohol use and associated with disease severity and prognosis. Few studies have evaluated the influence of drug withdrawal and clinical and sociodemographic data on BDNF levels in severe alcohol users. Objectives Our goals were (1) to evaluate variation in BDNF levels during alcohol withdrawal and, (2) to assess the influence of putative confounding factors on BDNF levels. Methods Our sample consists of 62 men with alcohol use disorder undergoing a detoxification process. Serum BDNF levels were measured using a commercial sandwich-ELISA kit, at two points: before and after the detoxification period. Results We found an increase in BDNF levels during alcohol withdrawal (25.4±9.6 at admission vs. 29.8±10.2 ng/ml at discharge; p < 0.001), even after controlling for potential confounders (positive family history, number of days between blood sample collections, and age) (Generalized Estimating Equation: coefficient = -4.37, 95% confidence interval [95%CI] -6.3; -2.4; p < 0.001). Moreover, individuals who had first-degree relative with alcohol dependence had smaller increases in BDNF levels than individuals with no family history (14.8 [95%CI -5.3; 35.6] vs. 35.3 [95%CI 15.4; 74.8]; p = 0.005). Conclusions In summary, variation in BDNF levels seems to be influenced by withdrawal in severe alcohol users. A positive family history of alcohol dependence could also be a factor that influences variation in this biomarker.

The next pandemic: impact of COVID-19 in mental healthcare assistance in a nationwide epidemiological study.

BACKGROUND: Studies have reported the worsening of psychiatric symptoms during the COVID-19 pandemic. However, few studies have evaluated the impact on the access to mental health services during COVID-19. Our aim was to analyze temporal trends and prediction of appointments held in Brazil's public health system, to compare the observed and expected number of mental healthcare appointments during the COVID-19 pandemics. METHODS: An ecological time-series study was performed, analyzing mental health appointments before and during the pandemic (from 2016 and 2020) from the Brazilian governmental database. The structural break in the data series was assessed using the Chow test, with the break considered in March 2020. Bayesian structural time-series models were used to estimate current average appointments and the predicted expectation if there was no pandemic. FINDINGS: Compared to the expected, between March and August 2020 about 28% less outpatient appointments in mental health were observed, totaling 471,448 individuals with suspended assistance. Group appointments and psychiatric hospitalizations were also severely impacted by the pandemic (decreased of 68% and 33%, respectively). On the other hand, mental health emergency consultations and home care increased during this period (36% and 52%, respectively). INTERPRETATION: Our findings demonstrate a dramatic change in mental health assistance during the COVID-19 pandemic, which corroborates a recent WHO survey. This phenomenon can aggravate the mental health crisis and generate a parallel pandemic that may last for a longer time than the COVID-19 pandemic. FUNDING: This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.

Making the COVID-19 Pandemic a Driver for Digital Health: Brazilian Strategies.

The COVID-19 outbreak exposed several problems faced by health systems worldwide, especially concerning the safe and rapid generation and sharing of health data. However, this pandemic scenario has also facilitated the rapid implementation and monitoring of technologies in the health field. In view of the occurrence of the public emergency caused by SARS-CoV-2 in Brazil, the Department of Informatics of the Brazilian Unified Health System created a contingency plan. In this paper, we aim to report the digital health strategies applied in Brazil and the first results obtained during the fight against COVID-19. Conecte SUS, a platform created to store all the health data of an individual throughout their life, is the center point of the Brazilian digital strategy. Access to the platform can be obtained through an app by the patient and the health professionals involved in the case. Health data sharing became possible due to the creation of the National Health Data Network (Rede Nacional de Dados em Saúde, RNDS). A mobile app was developed to guide citizens regarding the need to go to a health facility and to assist in disseminating official news about the virus. The mobile app can also alert the user if they have had contact with an infected person. The official numbers of cases and available hospital beds are updated and published daily on a website containing interactive graphs. These data are obtained due to creating a web-based notification system that uses the RNDS to share information about the cases. Preclinical care through telemedicine has become essential to prevent overload in health facilities. The exchange of experiences between medical teams from large centers and small hospitals was made possible using telehealth. Brazil took a giant step toward digital health adoption, creating and implementing important initiatives; however, these initiatives do not yet cover the entire health system. It is expected that the sharing of health data that are maintained and authorized by the patient will become a reality in the near future. The intention is to obtain better clinical outcomes, cost reduction, and faster and better services in the public health network.

Covid-19 and prisons: a reflection on public health and human rights / Covid-19 e prisões: Reflexões sobre saúde pública e direitos humanos / Covid-19 y las cárceles: Reflexión sobre la salud pública y los derechos humanos

Background and Objectives: The 2019 coronavirus pandemic (Covid-19) is a public health challenge. Identifying risk groups is essential for establishing prevention, screening, containment, and treatment strategies. In Brazil, prisons overcrowding and unhygienic conditions have been a historical problem that enables infectious diseases. This study sought to reflect upon incarcerated population vulnerability and present strategies to face the pandemic. Methods: This is a theoretical-reflective study based on the review of scientific publications and Covid-19 coping guidelines. Results: Prison populations are highly vulnerable to Sars-Cov-2 infections. Such vulnerability is aggravated by prisons' structural conditions, which accelerates diseases spread, especially respiratory illnesses, and hinders the adoption of preventive measures. Healthcare strategies aimed at this population are still scarce. Conclusion: Covid-19 outbreaks in prisons affect prisoners, staff, and family members, possibly leading the health system to an unprecedented collapse. Considering that, strategies to reduce coronavirus impact in prisons and on public health are urgent. Preventive measures of virus spread among this population must be supported by priority health measures, contingency protocols, and coordinated actions between the health and justice sectors.(AU)

Justificativa e Objetivos: A pandemia do coronavírus 2019 (Covid-19) é um problema de saúde pública desafiador. A identificação de grupos de risco é fundamental para o estabelecimento de estratégias de prevenção, rastreamento, contenção e tratamento. No Brasil, a superlotação e as condições insalubres das prisões são um problema histórico que facilita a disseminação de doenças. O objetivo deste estudo é refletir sobre a vulnerabilidade da população penitenciária e apresentar estratégias de enfrentamento à pandemia. Métodos: Estudo teórico-reflexivo construído a partir da revisão de publicações científicas e diretrizes de enfrentamento da Covid-19. Resultados: A PPL apresenta alta vulnerabilidade clínica para contaminação pelo Sars-Cov-2, o qual é agravado pelas condições estruturais das prisões que potencializam a disseminação de doenças, sobretudo respiratórias e dificultando o estabelecimento de medidas de prevenção. Surtos de Covid-19 em prisões afetam presos, funcionários e familiares e podem levar o sistema de saúde a um colapso sem precedentes. As estratégias de atenção a saúde desta população ainda são insuficientes. Conclusão: O estabelecimento de estratégias para reduzir o impacto do Covid-19 nas prisões e o seu reflexo na saúde pública é uma urgência. A prevenção da propagação do vírus nesta população deve ser apoiada por medidas prioritárias de saúde, implementação de protocolos de contingência e estabelecimento de ações coordenadas entre os setores de saúde e justiça.(AU)

Justificación y Objetivos: La pandemia de la enfermedad por coronavirus 2019 (Covid-19) es un problema de salud pública desafiante. La identificación de los grupos de riesgo es esencial para establecer estrategias de prevención, detección, contención y tratamiento. En Brasil, el hacinamiento y las condiciones insalubres en las cárceles son un problema histórico que facilita la propagación de enfermedades. El objetivo de este estudio es reflexionar sobre la vulnerabilidad de la población carcelaria al Covid-19 y presentar estrategias de afrontamiento a la pandemia. Métodos: Estudio teórico-reflexivo con base en la revisión de publicaciones científicas y guías de afrontamiento del Covid-19. Resultados: La población penitenciaria presenta una alta vulnerabilidad clínica a la contaminación por Sars-Cov-2 agravado por las condiciones estructurales de las cárceles, lo que aumenta la propagación de enfermedades, especialmente respiratorias, y dificulta el establecimiento de medidas preventivas. Los brotes del Covid-19 en las cárceles afectan a los presos, al personal y a los miembros de la familia, y podrían llevar al sistema de salud a un colapso sin precedentes. Las estrategias sanitarias de esta población aún son insuficientes. Conclusión: Las estrategias para reducir el impacto del Covid-19 en las cárceles y su impacto en la salud pública son urgentes. La prevención de la propagación del virus en esta población debe apoyarse en medidas prioritarias de salud, la implementación de protocolos de contingencia y el establecimiento de acciones coordinadas entre los sectores de salud y justicia.(AU)

Obsessive-compulsive disorder reinforcement during the COVID-19 pandemic.

The COVID-19 pandemic is unquestionably impacting on the mental health of the population worldwide. Fear of contamination can both increase levels of stress in healthy individuals and intensify psychiatric symptoms in patients with pre-existing conditions, especially obsessive-compulsive disorder (OCD). During the COVID-19 pandemic, the imminent risk of contamination creates a logical need for self-surveillance and hygiene habits. However, this kind of information can have drastic implications for subjects with OCD, since cognitive distortions and compensatory strategies (cleansing rituals) are no longer irrational or oversized - rather, these ideas become legitimate and socially accepted, generating plausible validation for the intensification of compulsive cleaning rituals. Patients who presented remission of OCD symptoms would be more likely to have a relapse, and subclinical patients may scale up and ultimately be diagnosed with OCD due to the reinforcement of their habits, emotions and thoughts.

From phone use to speeding and driving under influence: Identifying clusters of driving risk behaviors as an opportunity for targeted interventions.

Identifying the profile of risky behaviors among drivers is central to propose effective interventions. Due to the multidimensional and overlapping aspects of risky driving behaviors, cluster analysis can provide additional insights in order to identify specific subgroups of risk. This study aimed to identify clusters of driving risk behavior (DRB) among car drivers, and to verify intra-cluster differences concerning clinical and sociodemographic variables. We approached a total of 12,231 drivers and we included 6392 car drivers. A cluster algorithm was used to identify groups of car drivers in relation to the DRB: driving without a seat belt (SB), exceeding the speed limit (SPD), using a cell phone while driving (CELL), and driving after drinking alcohol (DUI). The algorithm classified drivers within five different DRB profiles. In cluster 1 (20.1%), subjects with a history of CELL. In cluster 2 (41.4%), drivers presented no DRB. In cluster 3 (9.3%), all drivers presented SPD. In cluster 4 (12.5%), drivers presented all DRB. In cluster 5 (16.6%), all drivers presented DUI. Clusters with DUI-related offenses (4 and 5) comprised more men (81.9 and 78.8%, respectively) than the overall sample (63.4%), with more binge drinking (50.9 and 45.7%) and drug use in the previous year (13.5 and 8.6%). Cluster 1 had a high years of education (14.4 ± 3.4) and the highest personal income (Md = 3000 IQR [2000-5000]). Cluster 2 had older drivers (46.6 ± 15), and fewer bingers (10.9%). Cluster 4 had the youngest drivers (34.4 ± 11.4) of all groups. Besides reinforcing previous literature data, our study identified five unprecedented clusters with different profiles of drivers regarding DRB. We identified an original and heterogeneous group of drivers with only CELL misuse, as well as other significant differences among clusters. Hence, our findings show that targeted interventions must be developed for each subgroup in order to effectively produce safe behavior in traffic.

O impacto da primeira onda da pandemia de Covid-19 na saúde mental de estudantes brasileiros / The impact of the first wave of the Covid-19 pandemic on the mental health of Brazilian students

Com a alta disseminação do novo coronavírus, foi necessário adotar intervenções de saúde pública com foco no distanciamento social para diminuir a transmissão do patógeno causador, o SARS-Cov-2. Contudo, essas medidas podem contribuir para o aumento do sofrimento emocional, gerando níveis mais elevados de ansiedade, depressão e estresse. Desse modo, o objetivo deste estudo foi investigar os efeitos da pandemia de Covid-19 na saúde mental de estudantes brasileiros através de uma pesquisa levantamento de dados on-line. A pesquisa foi realizada durante o período da primeira onda da pandemia no Brasil. Foram avaliadas variáveis sociodemográficas, de saúde mental, incluindo sintomas de depressão e ansiedade, e qualidade de vida em uma amostra final de 810 estudantes. Os sintomas psiquiátricos mais prevalentes foram ansiedade (89,5%), depressão (77,9%) e raiva (72,3%). Tempo de distanciamento social, idade e diagnóstico prévio de doenças psiquiátricas foram significativamente associados à maior gravidade dos sintomas de ansiedade e depressão. O alto grau de sofrimento emocional apresentado por essa amostra indica a necessidade de adotar estratégias que visem promover a saúde mental de estudantes, e proporcionar acompanhamento psicológico de alunos durante e após esse período crítico de isolamento social.(AU)

With the high spread of the new coronavirus, it was necessary to adopt public health interventions focused on social distancing to reduce the transmission of the causative pathogen, SARS-Cov-2. However, these measures can contribute to increased emotional distress, generating higher levels of anxiety, depression and stress. Thus, the aim of this study was to investigate the effects of the Covid-19 pandemic on the mental health of Brazilian students through an online data collection survey. The survey was carried out during the period of the first wave of the pandemic in Brazil. Sociodemographic, mental health (e.g., symptoms of depression and anxiety), and quality of life variables were evaluated in a final sample of 810 students. The most prevalent psychiatric symptoms were anxiety (89.5%), depression (77.9%) and anger (72.3%). Time of social distancing, age and previous diagnosis of psychiatric illness were significantly associated with greater severity of anxiety and depression symptoms. The high degree of emotional distress presented by this sample indicates the need to adopt strategies aimed at promoting the mental health of students and providing psychological support for students during and after this critical period of social isolation.(AU)

Con la alta propagación del nuevo coronavirus, fue necesario adoptar intervenciones de salud pública enfocadas en el distanciamiento social para reducir la transmisión del patógeno causante, SARS-Cov-2. Sin embargo, estas medidas pueden contribuir a aumentar la angustia emocional, generando mayores niveles de ansiedad, depresión y estrés. Por lo tanto, el objetivo de este estudio fue investigar los efectos de la pandemia Covid-19 en la salud mental de los estudiantes brasileños a través de una encuesta de recolección de datos en línea. La encuesta se llevó a cabo durante el período de la primera ola de la pandemia en Brasil. Se evaluaron variables sociodemográficas, de salud mental, incluyendo síntomas de depresión y ansiedad, y calidad de vida en una muestra final de 810 estudiantes. Los síntomas psiquiátricos más prevalentes fueron ansiedad (89,5%), depresión (77,9%) e ira (72,3%). El tiempo de distanciamiento social, la edad y el diagnóstico previo de enfermedad psiquiátrica se asociaron significativamente con una mayor gravedad de los síntomas de ansiedad y depresión. El alto grado de angustia emocional que presenta esta muestra indica la necesidad de adoptar estrategias dirigidas a promover la salud mental de los estudiantes y brindar apoyo psicológico a los estudiantes durante y después de este período crítico de aislamiento social.(AU)

Incidência de AIDS em idosos do Rio Grande do Sul de 1997 a 2017: um estudo ecológico / AIDS incidence in Rio Grande do Sul in elderly from 1997 to 2017: an ecological study / Incidencia de SIDA en personas mayores en Rio Grande do Sul de 1997 a 2017: un estudio ecológico

Justificativa e Objetivos: O Rio Grande do Sul está entre os estados brasileiros com maior percentual de idosos. Mas, apesar das altas taxas de HIV/AIDS que têm sido verificadas na população geral, existem poucas investigações científicas que exploram este tema na população idosa. Assim, o objetivo deste estudo foi identificar a incidência anual de AIDS na população com 60 anos ou mais de idade, residente no estado do Rio Grande do Sul (RS), Brasil, no período de 1997 a 2017, e comparar a diferença na taxa de infecção entre os sexos. Métodos: Estudo ecológico de série temporal. As informações sobre as notificações anuais de AIDS foram coletadas no TABNET, e os dados populacionais do RS foram consultados do TABNET e do site da Fundação de Economia e Estatística (FEE) do RS. A incidência anual foi calculada por 100 mil habitantes. Resultados: Entre 1997 e 2017 foram notificados 3.697 casos de AIDS em idosos no RS. No comparativo entre 1997 e 2017, a incidência anual de AIDS em idosos no RS aumentou de 3,92 para 13,71/100 mil habitantes, o que configura um crescimento de 249,93% (340,49% entre homens e 171,50% entre mulheres). Conclusão: O percentual de diagnósticos de AIDS em idosos no RS foi seis vezes superior ao evidenciado na população geral. A taxa em homens foi quase duas vezes mais alta do que a das mulheres. Isso pode decorrer do aumento da expectativa de vida e de fatores relacionados ao comportamento sexual, como o uso de medicações para impotência e reposição hormonal e de tecnologias de comunicação.(AU)

Background and Objectives: Rio Grande do Sul (RS) is one of the Brazilian states with the highest percentage of older adults. However, despite the high rates of HIV/AIDS that have been detected in the general population, there are few scientific investigations regarding its prevalence in the older adult population. Our goal is to identify the annual incidence of AIDS in the population aged 60 or over living in the State of RS, Brazil, from 1997 to 2017, and to compare the sex differences in infection rates. Methods: This was a time-series ecological study. Information on annual AIDS notifications was collected on TABNET, and population data of RS was collected on TABNET and the website of the Foundation of Economy and Statistics (FEE) of RS. The annual incidence was calculated per 100,000 inhabitants. Results: Between 1997 and 2017, 3,697 AIDS cases in older adults were notified in RS. In the comparison between 1997 and 2017, the annual incidence of AIDS in older adults in RS increased from 3.92 to 13.71/100,000 inhabitants, and a 249.93% increase (340.49% among men and 171.50% among women). Conclusion: The percentage of AIDS diagnostic in RS was six times higher in older adults than in the general population. The rate for men was almost twice as high as that for women. This may be due to increased life expectancy and other factors related to sexual behavior, such as medications for erectile dysfunction and hormonal replacement, and communication technologies.(AU)

Justificación y Objetivos: Rio Grande do Sul se encuentra entre los estados brasileños con el mayor porcentaje de personas mayores. Además, se han observado altas tasas de VIH/SIDA en la población general; sin embargo, hay pocas investigaciones científicas que exploren este tema. El objetivo de este estudio fue identificar la incidencia anual de SIDA en la población mayor de 60 años residente en Rio Grande do Sul, Brasil, en el periodo de 1997 a 2017, así como comparar la diferencia en la tasa de infección entre los sexos. Métodos: Estudio ecológico de series de tiempo. La información sobre las notificaciones anuales de SIDA se consultó en TABNET y los datos de población de ese estado se recopilaron en TABNET y en el sitio web de la Fundación de Economía y Estadística (FEE). La incidencia anual se calculó por 100 mil habitantes. Resultados: Entre 1997 y 2017 se reportaron 3.697 casos de SIDA en las personas mayores en este estado. En la comparación entre 1997 y 2017, la incidencia anual de SIDA en ancianos encontrada pasó de 3,92 a 13,71/100.000 habitantes, lo que representa un aumento del 249,93% (340,49% en hombres y 171,50% entre mujeres). Conclusiones: El porcentaje de diagnóstico de SIDA en personas mayores encontrado fue seis veces mayor al evidenciado en la población general. La tasa de los hombres fue casi el doble que la de las mujeres. Esto puede deberse al aumento de la esperanza de vida y factores relacionados con la conducta sexual, como el uso de medicamentos para la impotencia y el reemplazo hormonal y tecnologías de la comunicación.(AU)

Prediction of attempted suicide in men and women with crack-cocaine use disorder in Brazil.

BACKGROUND: Suicide is a severe health problem, with high rates in individuals with addiction. Considering the lack of studies exploring suicide predictors in this population, we aimed to investigate factors associated with attempted suicide in inpatients diagnosed with cocaine use disorder using two analytical approaches. METHODS: This is a cross-sectional study using a secondary database with 247 men and 442 women hospitalized for cocaine use disorder. Clinical assessment included the Addiction Severity Index, the Childhood Trauma Questionnaire, and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, totalling 58 variables. Descriptive Poisson regression and predictive Random Forest algorithm were used complementarily to estimate prevalence ratios and to build prediction models, respectively. All analyses were stratified by gender. RESULTS: The prevalence of attempted suicide was 34% for men and 50% for women. In both genders, depression (PRM = 1.56, PRW = 1.27) and hallucinations (PRM = 1.80, PRW = 1.39) were factors associated with attempted suicide. Other specific factors were found for men and women, such as childhood trauma, aggression, and drug use severity. The men's predictive model had prediction statistics of AUC = 0.68, Acc. = 0.66, Sens. = 0.82, Spec. = 0.50, PPV = 0.47 and NPV = 0.84. This model identified several variables as important predictors, mainly related to drug use severity. The women's model had higher predictive power (AUC = 0.73 and all other statistics were equal to 0.71) and was parsimonious. CONCLUSIONS: Our findings indicate that attempted suicide is associated with depression, hallucinations and childhood trauma in both genders. Also, it suggests that severity of drug use may be a moderator between predictors and suicide among men, while psychiatric issues shown to be more important for women.

The COVID-19 pandemic and its impact on substance use: Implications for prevention and treatment.

The COVID-19 pandemic has brought major challenges to healthcare systems and public health policies globally, as it requires novel treatment and prevention strategies to adapt for the impact of the pandemic. Individuals with substance user disorders (SUD) are at risk population for contamination due to multiple factors-attributable to their clinical, psychological and psychosocial conditions. Moreover, social and economic changes caused by the pandemic, along with the traditional difficulties regarding treatment access and adherence-will certainly worsen during this period, therefore aggravate their condition. In addition, this population are potential vectors of transmission. In that sense, specific strategies for prevention and treatment must be discussed. health care professionals dealing with SUD must be aware of the risks and challenges they will meet during and after the COVID-19 outbreak. Addiction care must be reinforced, instead of postponed, in order to avoid complications of both SUD and COVID-19 and to prevent the transmission of coronavirus.