Prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infections among adolescent men who have sex with men and transgender women in Salvador, Northeast Brazil.

Adolescent men who have sex with men (AMSM) and transgender women (ATGW) enrolled as part of the PrEP1519 study between April 2019 and February 2021 in Salvador were tested for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections.We performed real-time polymerase chain reaction using oropharyngeal, anal, and urethral swabs; assessed factors associated with NG and CT infections using multivariable Poisson regression analysis with robust variance; and estimated the prevalence ratios (PRs) and 95% confidence intervals (95% CIs). In total, 246 participants were included in the analyses (median age: 18.8; IQR: 18.2-19.4 years). The overall oropharyngeal, anal, and urethral prevalence rates of NG were 17.9%, 9.4%, 7.6%, and 1.9%, respectively. For CT, the overall, oropharyngeal, anal, and urethral prevalence rates were 5.9%, 1.2%, 2.4%, and 1.9%, respectively. A low level of education, clinical suspicion of STI (and coinfection with Mycoplasma hominis were associated with NG infection. The prevalence of NG and CT, especially extragenital infections, was high in AMSM and ATGW. These findings highlight the need for testing samples from multiple anatomical sites among adolescents at a higher risk of STI acquisition, implementation of school-based strategies, provision of sexual health education, and reduction in barriers to care.

Factors associated to HIV prevalence among adolescent men who have sex with men in Salvador, Bahia State, Brazil: baseline data from the PrEP1519 cohort.

Adolescent men who have sex with men (AMSM) are at a heightened vulnerability for human immunodeficiency virus (HIV). This study aimed to estimate the prevalence of HIV and associated individual, social, and programmatic factors among AMSM in Salvador, Bahia State, Brazil. This is a cross-sectional study which analyzed baseline data from the PrEP1519 cohort in Salvador. Descriptive, bivariate, and multivariate analyses were conducted using the dimensions of vulnerability to HIV as hierarchical levels of analysis. Logistic regression models were used to estimate the odds ratios (OR) of the association between predictor variables and HIV infection. The prevalence of HIV infection among the 288 AMSM recruited to the project was 5.9% (95%CI: 3.7-9.3). Adjusted analysis showed a statistically significant association between self-identifying as a sex worker (OR = 3.74, 95%CI: 1.03-13.60) and HIV infection. Other associations with borderline statistical significance were the use of application programs to find sexual partners (OR = 3.30, 95%CI: 0.98-11.04), low schooling level (OR = 3.59, 95%CI: 0.96-13.41), failing to be hired or being dismissed from a job because of sexual orientation (OR = 2.88, 95%CI: 0.89-9.28), and not using health services as a usual source of care (OR = 3.14, 95%CI: 0.97-10.17). We found a high HIV prevalence among AMSM in Salvador. Furthermore, our study found that individual, social, and programmatic factors were associated with HIV infection among these AMSM. We recommend intensifying HIV combined-prevention activities for AMSM.

Violence, Discrimination, and High Levels of Symptoms of Depression Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil.

PURPOSE: This study aimed at describing the prevalence of symptoms of depression among 15-19 year old adolescent men who have sex with men (aMSM) and transgender women (aTGW), who were recruited in an HIV pre-exposure prophylaxis cohort study in three Brazilian capital cities. The study also examined potential associations, including violence and discrimination, with severe symptoms of depression among aMSM. METHODS: This is a cross-sectional study of baseline data among 730 aMSM and 56 aTGW recruited between February 2019 and February 2021. Sociodemographic and behavioral data were collected. The 20-item Center for Epidemiologic Studies Depression scale was used to screen for symptoms of depression. Scores of ≥22 points indicate the presence of severe symptoms associated with major depression. Logistic regression was used to assess independent associations among aMSM, adjusting for sociodemographic variables. RESULTS: Our findings indicate a high prevalence of symptoms of depression (overall prevalence = 58.5% and 69.6%; 21.2% and 25.0% for mild/moderate, and 37.3% and 44.6% for severe) among these aMSM and aTGW, respectively. Psychological violence (aOR = 1.74; 95% CI = 1.12-2.70), sexual violence (aOR = 1.79; 95% CI = 1.07-2.98), and discrimination due to sexual orientation (aOR = 1.71; 95% CI = 1.23-2.38) were independently associated with severe symptoms of depression in aMSM. DISCUSSION: The high prevalence of severe symptoms of depression and its association with psychological and sexual violence and discrimination creates cycles of vulnerability and carries important public health implications. Thus, our findings indicate public policies should consider assessing depression, psychological and sexual violence, as well as discrimination, especially in populations that will be targeted by interventions, such as the use of pre-exposure prophylaxis.

Medication use among quilombola and non-quilombola rural adolescents in the countryside of Bahia, Brazil. / Uso de medicamentos entre adolescentes rurais quilombolas e não quilombolas no interior da Bahia, Brasil.

This study aims to describe the use of prescribed and non-prescribed medications and associated factors among adolescents living in rural, quilombolas and non-quilombolas communities in the interior of Bahia, Brazil. This is a population-based survey with 390 adolescents between 10 and 19 years old in 2015. Prevalence and odds ratio for use of prescribed and non-prescribed medication, and multiple analysis was conducted by Multinomial Logistic Regression. Among the interviewees, 13.6% used only prescribed medications and 14.4% only used non-prescribed medications. Quilombolas demonstrated a greater diversity of pharmaceutical specialties used. The low prevalence of medication use in both groups of adolescents suggests less access to these products. Despite this, it was observed the irrational use of medication, mainly as self-medication. Quilombola adolescents, although they belong to the same area of coverage of other communities, presented different associated factors when compared to the non-quilombola group: the presence of toothache in the last 6 months and have had a regular source of care increased the use of prescribed medications.

Este estudo visa descrever o uso de medicamentos prescritos e não prescritos e fatores associados entre adolescentes residentes em comunidades rurais, quilombolas e não quilombolas, do interior da Bahia, Brasil. Trata-se de um inquérito populacional com 390 adolescentes entre 10 e 19 anos de idade, realizado em 2015. Foram estimadas prevalências e odds ratio para uso de medicamentos prescritos e não prescritos, e análise múltipla foi conduzida por Regressão Logística Multinomial. Entre os entrevistados, 13,6% fez uso apenas de medicamentos prescritos e 14,4% fez uso apenas de medicamentos não prescritos. Os quilombolas demonstraram uma maior diversidade de especialidades farmacêuticas utilizadas. A baixa prevalência no uso de medicamentos nos dois grupos de adolescentes sugere um menor acesso a esses produtos. Apesar disso, observou-se a utilização irracional de medicamentos, principalmente como automedicação. Os adolescentes quilombolas, mesmo dentro da área de abrangência das outras comunidades, apresentaram diferentes fatores associados quando comparado ao grupo não quilombola: a presença de dor de dente nos últimos 6 meses e procurar o mesmo serviço de saúde aumentaram o uso de medicamentos prescritos.

Health service utilization by Quilombola and non-Quilombola adolescents living in a rural area in the semi-arid region of the state of Bahia, Brazil. / Utilização de serviços de saúde por adolescentes rurais quilombolas e não quilombolas do semiárido baiano, Brasil.

This article describes health service utilization by Quilombola and non-Quilombola adolescents living in a rural area in the semi-arid region of Bahia. Quantitative and qualitative methods were used to gain a more in-depth understanding of the object of study. A cross-sectional household survey was conducted with 390 adolescents. Health service utilization was described using frequency distribution and 95% confidence intervals. Discussions were held with four focus groups, which were transcribed and analyzed using content analysis. The most commonly reported usual place of care was the local family care center (70,0%) and 15,1% of the adolescents had sought health care in the last 15 days. The main reason for seeking care was illness (37,3%). The findings of the qualitative component of the study reveal multiple factors influencing access to services, including long waiting times, lack of prioritization of adolescent care and geographical barriers. Health services should attempt to get closer adolescents and provide care tailored to the specific needs of this group.

Este estudo descreve a utilização de serviços de saúde por adolescentes quilombolas e não quilombolas residentes em uma área rural do semiárido baiano. Métodos quantitativos e qualitativos foram utilizados para que se conseguisse uma maior aproximação com o objeto de análise. Foi realizado um estudo transversal com 390 adolescentes. A utilização de serviços de saúde foi descrita por meio da distribuição de frequências e respectivos intervalos de confiança 95%. Formaram-se quatro grupos focais que foram transcritos e analisados por meio da análise de conteúdo. A Unidade de Saúde da Família foi relatada como o serviço comumente procurado para atendimento de necessidades de saúde (70,0%). A procura por serviços de saúde nos últimos 15 dias foi de 15,1% e o principal motivo foi por doença (37,3%). O componente qualitativo revelou múltiplos contextos que influenciaram no acesso aos serviços, como elevado tempo de espera, falta de priorização nos atendimentos e barreiras geográficas. Os serviços de saúde devem estar mais próximos dos adolescentes com um cuidado em saúde que considere as particularidades desse grupo.

Prescription of off-label and unlicensed drugs for preterm infants in a neonatal intensive care unit. / Prescrição de medicamentos off-label e sem licença para prematuros de unidade de terapia intensiva neonatal.

OBJECTIVE: To evaluate the use of off-label and unlicensed medications in preterm infants hospitalized in a neonatal intensive care unit. METHODS: This nonconcurrent cohort study included preterm infants admitted to 3 neonatal intensive care units in 2016 and 2017 who were followed up during the neonatal period. The type and number of medications used were recorded for the entire period and classified based on the Anatomical Therapeutic Chemical. Descriptive and bivariate data analyses were performed to assess associations between the number of drugs used (total, off-label and unlicensed) and the explanatory variables of interest. RESULTS: Four hundred preterm infants received 16,143 prescriptions for 86 different pharmaceuticals; 51.9% of these medications were classified as off-label and 23.5% as unlicensed. The most prescribed drugs were gentamicin and ampicillin (17.5% and 15.5% among off-label, respectively) and caffeine (75.5% among unlicensed). The results indicated significant associations between the use of off-label drugs and lower gestational age, low birth weight, lower 5-minute Apgar score, advanced resuscitation maneuver in the delivery room and death. The prescription of unlicensed drugs was associated with lower gestational age, low birth weight and 5-minute Apgar score below 7. CONCLUSION: Neonates admitted to neonatal intensive care units are highly exposed to off-label and unlicensed medications. Further studies are needed to achieve greater safety and quality of drug therapy used in neonatology.

OBJETIVO: Avaliar o uso de medicamentos off-label e sem licença em recém-nascidos prematuros hospitalizados em unidade de terapia intensiva neonatal. MÉTODOS: Estudo de coorte não concorrente, incluindo prematuros admitidos em três unidades de terapia intensiva neonatais, nos anos de 2016 e 2017, acompanhados durante o período neonatal. O uso de medicamentos e o número foram registrados para todo o período e classificados segundo a Anatomical Therapeutic Chemical. Foram realizadas análises descritivas e bivariadas dos dados para avaliar associações entre o número de medicamentos utilizados (total, off-label e sem licença) e as variáveis explicativas de interesse. RESULTADOS: Os 400 neonatos prematuros utilizaram 16.143 medicamentos, com 86 especialidades diferentes; 51,9% desses itens foram classificados como off-label e 23,5% como sem licença. Os mais prescritos foram gentamicina e ampicilina (17,5% e 15,5% dos off-label, respectivamente) e cafeína (75,5% dos não licenciados). O estudo demonstrou associações significativas do uso de medicamentos off-label com a menor idade gestacional, baixo peso ao nascer, menor escore de Apgar no quinto minuto, manobra de reanimação avançada em sala de parto e óbito. Com os medicamentos não licenciados, foram verificadas associações com a menor idade gestacional, baixo peso ao nascer e escore de Apgar no quinto minuto menor que 7. CONCLUSÃO: Os neonatos internados em unidades de terapia intensiva neonatais são muito expostos ao uso de medicamentos off-label e sem licença. Tornam-se necessários mais investimentos em estudos para alcançar maior segurança e qualidade da terapêutica medicamentosa empregada em neonatologia.

Premature birth: topics in physiology and pharmacological characteristics.

OBJECTIVE: To review the main physiological and pharmacological changes related to prematurity, to promote the evidence-based clinical practice. METHODS: This is a narrative review whose research was carried out in the ScienceDirect and Medline databases via PubMed, searching for articles in any language from January 2000 to February 2020. RESULTS: Premature newborns are born before completing the maturation process that prepares them for extrauterine life, which occurs especially in the last weeks of pregnancy. Therefore, they have their own characteristics in development. Several physiological peculiarities stand out, such as disturbances in glucose regulation, adrenal function, thermoregulation, immunity, in addition to changes in liver, renal and respiratory functions. Pharmacological aspects were also highlighted, involving pharmacokinetics and pharmacodynamics. CONCLUSIONS: Despite the recent advances in prematurity, it is still an area with many uncertainties, since several changes occur quickly and there are ethical issues that make studies difficult. Thus, it is clear that the therapeutic management of premature infants is still very much based on clinical practice.

Evaluation of blood pressure through home monitoring in brazilian primary care: a feasibility study.

Blood pressure measurements taken in a clinical setting are subject to errors, therefore there are advantages to monitoring blood pressure at home, especially in in patients diagnosed with hypertension. The study describes the feasibility of home monitoring to assess blood pressure in primary care and compares blood pressure measured at home and during a medical consultation. This cross-sectional study was carried out with patients whose used home blood pressure in the morning and evening, thrice for seven consecutive day sat home. Participants included patients older than 18 years with suspected whitecoat hypertension, taking antihypertensives, or those intolerant of ambulatory blood pressure monitoring, and excluded patients who did not follow the protocol, suffered from an irregular heart rate, and pregnant women. Of the 134 patients who participated in the study, 63.3% had altered blood pressure when measured at health facilities and 48% had higher blood pressure at home. The mean difference between the methods was 10.1 mmHg for systolic and 4.3 mmHg for diastolic. The prevalence of whitecoat hypertension was 19.4%. Blood pressure monitoring at home is a practicable strategy in the Brazilian healthcare system.

Comparison of cardiovascular risk calculators in patients with diabetes.

OBJECTIVE: Cardiovascular risk stratification is an important clinical practice to estimate the severity of cardiovascular disease in patients with type 2 diabetes. This study aimed to compare the stratification of global cardiovascular risk with the specific risk stratification for patients with type 2 diabetes, seen at specialized outpatient clinics, and to evaluate possible differences in diagnoses and treatments. METHODS: A total of 122 patients with type 2 diabetes treated at two specialized outpatient clinics, from 2017 to 2019, were studied. The cardiovascular risk stratification calculators, global risk score, Cardiovascular Risk Stratification Calculator, and United Kingdom Prospective Diabetes Study-Risk Engine, were used to calculate the risk of death from cardiovascular disease. The agreement between these calculators was analyzed using the kappa index. The indications for the use of statins and acetylsalicylic acid for the group studied were evaluated according to the Brazilian Diabetes Society Guideline. RESULTS: There was a low degree of agreement among the three risk calculators. The global risk score calculator showed insignificant agreement with the Cardiovascular Risk Stratification Calculator (kappa=0.0816; p=0.0671). There was no agreement between the global risk score calculator and United Kingdom Prospective Diabetes Study-Risk Engine (kappa=-0.099), or between the Cardiovascular Risk Stratification Calculator and United Kingdom Prospective Diabetes Study-Risk Engine (kappa=-0.0095). CONCLUSION: The substantial disagreements among the cardiovascular risk calculators may lead to different diagnoses and may consequently influence therapeutic strategies. The findings herein highlight the need for specific validated cardiovascular risk calculators for patients with DM2 that can reliably estimate risk in these individuals.

[Periodic occupational examination: an opportunity for diagnosis and monitoring of chronic noncommunicable diseases in men]. / Exame ocupacional periódico: oportunidade de diagnóstico e monitoramento de doença crônica não transmissível em homens.

The study aimed to estimate the prevalence of arterial hypertension as the principal marker of chronic noncommunicable diseases (NCDs) and to identify associated modifiable factors in male workers. Baseline data were used from a longitudinal study with a sample of 1,024 male workers 18 years or older in a municipality in Northeast Brazil. The marker for NCDs was arterial hypertension, defined as systolic pressure ≥ 140mmHg and/or diastolic pressure ≥ 90mmHg and/or prior diagnosis of arterial hypertension and/or use of antihypertensive medication. Poisson regression with robust variance was used, adopting hierarchical entry of variables. Population attributable fractions (PAFs) were calculated for the lifestyle variables to measure the impact of modifiable factors on workers' health. Prevalence of hypertension was 28.6% (95%CI: 25.9-31.5). Distal factors associated with hypertension were age > 40 years, black skin color, and family income ≥ 3 times the monthly minimum wage. Intermediate factors were alcohol abuse, smoking, high self-rated salt intake, and physical inactivity. Proximal factors were overweight and obesity. Calculation of PAFs showed that a reduction or elimination of unhealthy lifestyle habits and behaviors in this population group would reduce the prevalence of the target NCD, hypertension, by 56.1%. The identification of modifiable factors and the ways they can negatively impact male workers' health allows planning interventions in the workplace itself to reach the largest number of individuals, aimed at reducing the harmful effects of NCDs.

Objetivou-se estimar a prevalência de hipertensão arterial, como principal marcador de doença crônica não transmissível (DCNT), e identificar os fatores modificáveis associados, em trabalhadores homens. Foram utilizados dados da linha de base de um estudo longitudinal com uma amostra de 1.024 trabalhadores homens com 18 anos ou mais de um município do Nordeste do Brasil. O marcador de DCNT foi a hipertensão arterial, definida por pressão arterial sistólica ≥ 140mmHg e/ou pressão arterial diastólica ≥ 90mmHg e/ou diagnóstico prévio de hipertensão arterial e/ou uso de medicamentos anti-hipertensivos. Empregou-se a regressão de Poisson com variância robusta, adotando a entrada hierárquica de variáveis. Foram calculadas frações atribuíveis populacionais (FAP) para as variáveis de estilo de vida, a fim de dimensionar o impacto dos fatores modificáveis na saúde dos trabalhadores. A prevalência da hipertensão arterial nesta população foi de 28,6% (IC95%: 25,9-31,5), os fatores distais: idade > 40 anos, cor da pele preta e renda familiar ≥ 3 salários mínimos; fatores intermediários: consumo abusivo de álcool, consumo de tabaco, percepção de um consumo elevado de sal e inatividade física e o fator proximal: sobrepeso e obesidade associaram-se positivamente com a hipertensão arterial. O cálculo da FAP permitiu observar que se ocorresse a redução ou eliminação de hábitos e comportamentos relacionados ao estilo de vida deste público, reduziria em 56,1% a prevalência da DCNT estudada. A identificação de fatores modificáveis e como estes podem interferir negativamente na saúde de trabalhadores homens possibilita o planejamento de intervenções no próprio local de trabalho, a fim de alcançar o maior número de indivíduos, visando reduzir os efeitos deletérios das DCNT.

El objetivo fue estimar la prevalencia de hipertensão arterial, como principal marcador de enfermedad crónica no transmisible (ECNT), así como identificar factores modificables asociados, en hombres trabajadores. Se utilizaron datos de la línea de base, procedentes de un estudio longitudinal, con una muestra de 1.024 hombres trabajadores con 18 años o más de un municipio del Nordeste de Brasil. El marcador de ECNT fue la hipertensão arterial, definida por presión arterial sistólica ≥ 140mmHg y/o presión arterial diastólica ≥ 90mmHg y/o diagnóstico previo de hipertensão arterial y/o uso de medicamentos antihipertensivos. Se empleó la regresión de Poisson con varianza robusta, adoptando la entrada jerárquica de variables. Se calcularon fracciones atribuibles poblacionales (FAP) en las variables de estilo de vida, a fin de dimensionar el impacto de los factores modificables en la salud de los trabajadores. La prevalencia de la hipertensão arterial en esta población fue de 28,6% (IC95%: 25,9-31,5), los factores distales: edad > 40 años, color de piel negra y renta familiar ≥ 3 salarios mínimos; factores intermedios: consumo abusivo de alcohol, consumo de tabaco, percepción de un consumo elevado de sal e inactividad física y el factor proximal: sobrepeso y obesidad se asociaron positivamente con la hipertensão arterial. El cálculo de la FAP permitió observar que, si se produjese una reducción o eliminación de hábitos y comportamientos relacionados con el estilo de vida de este público, se reduciría en un 56,1% la prevalencia de la ECNT estudiada. La identificación de factores modificables y cómo pueden interferir negativamente en la salud de hombres trabajadores posibilita la planificación de intervenciones en el propio lugar de trabajo, con el fin de alcanzar al mayor número de individuos para reducir los efectos mortíferos de las ECNT.

National Adolescent School-based Health Survey - PeNSE 2015: Sedentary behavior and its correlates.

OBJECTIVE: To investigate the association between sedentary behavior (SB) and sociodemographic, social support, behavioral, and health variables among Brazilian adolescents. METHODS: The 2015 National Adolescent School-based Health Survey (PeNSE) was a cross-sectional study consisting of 102,072 Brazilian ninth-graders (mainly aged 13-15 years). SB was defined as the time (in hours) watching television, using a computer, playing video games, talking to friends, or doing other activities in a sitting position. For analysis purposes, SB was categorized into different cut-offs as per the sample distribution quartiles: >2 versus <2 (25th percentile); >4 versus <4 (50th 26 percentile) and >6 versus <6 (75th 27 percentile). We employed Poisson univariate and multivariate regression analyses with robust variance and hierarchical entry of variables for each cut-off point. RESULTS: The prevalence rates of each SB cut-off point were 68.15% (CI: 67.44-68.86), 44.15% (CI: 43.40-44.90) and 24.97% (CI:24.37-25.57) for >2, >4 and >6 hours, respectively. The following characteristics were positively and significantly associated with each SB cut-off point in the final models: females, current employment, higher household economic status and higher maternal schooling, lower levels of parents checking homework, tobacco and alcohol use, soft drink and fruit consumption, and regular, poor or very poor self-assessed health status. Conversely, students who self-declared brown were less likely to be classified as a SB cut-off point. Significant associations with age, report of close friends, and physical activity varied by different SB cut-off points. CONCLUSION: Understanding the SB correlates in their different dimensions contributes to the identification of subgroups of adolescents with higher SB prevalence, which is crucial in the development and improvement of public policies. The demographic and behavioral characterization of these groups can guide the development of future intervention strategies, considering the school and family contexts of these adolescents.

Community-based interventions for detection and management of diabetes and hypertension in underserved communities: a mixed-methods evaluation in Brazil, India, South Africa and the USA.

INTRODUCTION: As non-communicable disease (NCD) burden rises worldwide, community-based programmes are a promising strategy to bridge gaps in NCD care. The HealthRise programme sought to improve hypertension and diabetes management for underserved communities in nine sites across Brazil, India, South Africa and the USA between 2016 and 2018. This study presents findings from the programme's endline evaluation. METHODS: The evaluation utilises a mixed-methods quasi-experimental design. Process indicators assess programme implementation; quantitative data examine patients' biometric measures and qualitative data characterise programme successes and challenges. Programme impact was assessed using the percentage of patients meeting blood pressure and A1c treatment targets and tracking changes in these measures over time. RESULTS: Almost 60 000 screenings, most of them in India, resulted in 1464 new hypertension and 295 new diabetes cases across sites. In Brazil, patients exhibited statistically significant reductions in blood pressure and A1c. In Shimla, India, and in South Africa, country with the shortest implementation period, there were no differences between patients served by facilities in HealthRise areas relative to comparison areas. Among participating patients with diabetes in Hennepin and Ramsey counties and hypertension patients in Hennepin County, the percentage of HealthRise patients meeting treatment targets at endline was significantly higher relative to comparison group patients. Qualitative analysis identified linking different providers, services, communities and information systems as positive HealthRise attributes. Gaps in health system capacities and sociodemographic factors, including poverty, low levels of health education and limited access to nutritious food, are remaining challenges. CONCLUSIONS: Findings from Brazil and the USA indicate that the HealthRise model has the potential to improve patient outcomes. Short implementation periods and strong emphasis on screening may have contributed to the lack of detectable differences in other sites. Community-based care cannot deliver its full potential if sociodemographic and health system barriers are not addressed in tandem.

[Incipient tobacco use and associated factors among adolescents from the rural area of Vitória da Conquista in the Brazilian state of Bahia]. / Experimentação de tabaco e fatores associados entre adolescentes da zona rural de Vitória da Conquista, BA, Brasil.

The aim of this study is to describe incipient tobacco use and associated factors among adolescents from the rural zone of southwestern Bahia. It was based on data from the cross-sectional Adolescer research project among 390 adolescents conducted in 2015. Data were analyzed using frequency and chi-square measurements and Poisson regression with robust variance to estimate the prevalence ratios (PR) for incipient tobacco use in relation to the explanatory variables. Among the adolescents, 5.1% had smoked at some stage and 0.3% smoked regularly. The following variables were associated with incipient smoking: male gender (PR = 6.46); having had sexual intercourse at some stage in life (PR = 20.55); having parents who rarely or never understood their problems (PR=7.89); having 3 or more friends (PR = 0.10). Despite low incipient smoking or the prevalence of regular smoking, which indicate the adoption of a healthier lifestyle or greater autonomy and decision-making ability for non-smoking, it is acknowledged that there is no safe level of exposure to tobacco. The recommendation is that an intersectoral partnership between education and health be created to foster health promotion and disease prevention, with an emphasis on curtailing smoking habits.

O objetivo deste artigo é descrever a experimentação do tabaco e fatores associados em adolescentes da zona rural do sudoeste da Bahia. Este foi um recorte da pesquisa Adolescer, do tipo seccional, em 2015, com 390 adolescentes. Os dados foram analisados através de medidas de frequência e qui-quadrado; e regressão de Poisson, com variância robusta, para estimar as razões de prevalências (RP) para a experimentação do tabaco em relação às variáveis explicativas. Dos adolescentes, 5,1% experimentaram cigarro alguma vez na vida e 0,3% faziam uso regular. Mostraram-se associados à experimentação: sexo masculino (RP = 6,46); ter tido relação sexual alguma vez na vida (RP = 20,55); ter pais que raramente ou nunca entenderem os seus problemas (RP = 7,89); ter 3 ou mais amigos (RP = 0,10). Apesar das baixas prevalências de experimentação do tabaco e do seu uso regular, que indicam a adoção de um estilo de vida mais saudável ou ainda uma maior autonomia e capacidade de decisão para o não consumo, sabe-se que não existe nível seguro de exposição ao tabaco. Sugere-se o estabelecimento de parceria intersetorial educação-saúde para fortalecer ações de promoção da saúde e prevenção de doenças, com ênfase no tabagismo.

Nutritional aspects of people affected by leprosy, between 2001 and 2014, in semi-arid Brazilian municipalities. / Aspectos nutricionais de pessoas acometidas por hanseníase, entre 2001 e 2014, em municípios do semiárido brasileiro.

The study aimed to characterize food insecurity, nutritional status, and eating habits of people affected by leprosy. This is a descriptive cross-sectional study based on a census population. We evaluated 276 cases, reported in the Notifiable Diseases Information System, between 2001 and 2014, in the municipalities of Vitória da Conquista and Tremedal, in the state of Bahia. Food insecurity was estimated according to the Brazilian Food Insecurity Scale. We collected weight and height measurements, meal frequency, and household, socioeconomic, psychosocial and clinical variables. The prevalence of food insecurity was 41.0% among the study population - 28.3% mild, 8.0% moderate and 4.7% severe. Overweight/obesity was estimated in 60.1% of the study participants, and excessive salt intake was reported by 8.6%. Beans and red meat were the most regularly consumed foods; there was low consumption of milk, raw and cooked vegetables, and fruits. This population presented high food insecurity prevalence, inadequate eating habits and nutritional status, reflecting nutritional vulnerability. The insertion of nutritional assistance in the leprosy control programmes is recommended, to improve health care.

O estudo buscou caracterizar a insegurança alimentar, o estado nutricional e os hábitos alimentares de pessoas acometidas por hanseníase. Trata-se de um estudo transversal descritivo, de população censitária, em que foram avaliados 276 casos, notificados no Sistema de Informação de Agravos de Notificação, entre 2001 e 2014, nos municípios de Vitória da Conquista e Tremedal, Bahia. Na análise foi empregada a Escala Brasileira de Insegurança Alimentar. Foram coletadas medidas de peso e altura, frequência alimentar, variáveis domiciliares, socioeconômicas, psicossociais e clínicas. A prevalência de insegurança alimentar foi de 41,0% na população; sendo 28,3% leve, 8,0% moderada e 4,7% grave. O sobrepeso/obesidade foi estimado em 60,1% das pessoas avaliadas e o consumo excessivo de sal foi relatado por 8,6%. O feijão e a carne vermelha foram os alimentos mais regularmente consumidos e houve baixo consumo de leite, hortaliças cruas e cozidas e frutas. A insegurança alimentar apresentou elevada prevalência, associada à inadequação do hábito alimentar e estado nutricional, refletindo a vulnerabilidade nutricional desta população. Recomenda-se a inserção da assistência nutricional às políticas públicas da hanseníase, como forma de qualificar a atenção à saúde.

[Eating behavior of quilombola and non-quilombola adolescents from the rural area of the semiarid region of the state of Bahia, Brazil]. / Hábitos alimentares de adolescentes quilombolas e não quilombolas da zona rural do semiárido baiano, Brasil.

The scope of this article is to describe the food consumption and eating behavior of quilombola and non-quilombola adolescents from the rural area of Southwest Bahia. A cross-sectional study with 390 adolescents aged 10 to 19 years was conducted in 2015, using an adapted PeNSE and PNS questionnaire. Food consumption was assessed by the frequency of healthy and unhealthy food markers in the previous 7 days. Eating breakfast was used as a marker of healthy eating behavior and having meals while watching TV as being unhealthy. Frequency distribution was carried out and the differences between quilombola and non-quilombola groups were assessed using the chi-square test. The prevalence ratio (PR) estimated the association of food consumption and eating behavior and the variables of interest. Low fruit consumption (30.8%), vegetables (44.3%) and milk (24.4%) was observed. Comparison between the groups revealed lower consumption of vegetables (PR = 0.73), fruit (PR = 0.67) and milk (PR = 0.68) among quilombola than among non-quilombola adolescents. Public policies targeted at nutritional assistance specific to rural adolescents are recommended, since bad eating habits can prevail throughout life and lead to poor health conditions.

O objetivo deste artigo é descrever o consumo e o comportamento alimentar de adolescentes quilombolas e não quilombolas da zona rural do sudoeste baiano. Estudo transversal com 390 adolescentes de 10 a 19 anos em 2015, utilizando questionário adaptado da PeNSE e PNS. O consumo alimentar foi avaliado pela frequência nos últimos 7 dias de alimentos marcadores de alimentação saudável e não saudável. Realizar o desjejum foi marcador de comportamento saudável e, realizar refeição enquanto assistia TV, de não saudável. Foi realizada distribuição de frequências e as diferenças entre os grupos quilombola e não quilombola foram testadas com qui-quadrado. A razão de prevalência (RP) estimou a associação do consumo e comportamento alimentar e as variáveis de interesse. Observou-se baixo consumo de frutas (30,8%), hortaliças (44,3%) e leite (24,4%). Quando comparados, os quilombolas tiveram consumo de feijão maior (RP = 1,11), entretanto, o consumo de hortaliças (RP = 0,73), frutas (RP = 0,67) e leite (RP = 0,68) foi inferior ao dos não quilombolas. Recomendam-se políticas públicas voltadas à assistência nutricional, específicas aos adolescentes rurais, uma vez que os maus hábitos alimentares podem permanecer ao longo da vida e levar a condições precárias de saúde.

Factors associated to HIV prevalence among adolescent men who have sex with men in Salvador, Bahia State, Brazil: baseline data from the PrEP1519 cohort / Fatores associados à prevalência do HIV entre homens adolescentes que fazem sexo com homens em Salvador, Bahia, Brasil: dados da linha de base da coorte PrEP1519 / Factores asociados a la prevalencia de VIH entre hombres adolescentes que tienen sexo con hombres en Salvador, Bahia, Brasil: datos de referencia de la cohorte PrEP1519

Adolescent men who have sex with men (AMSM) are at a heightened vulnerability for human immunodeficiency virus (HIV). This study aimed to estimate the prevalence of HIV and associated individual, social, and programmatic factors among AMSM in Salvador, Bahia State, Brazil. This is a cross-sectional study which analyzed baseline data from the PrEP1519 cohort in Salvador. Descriptive, bivariate, and multivariate analyses were conducted using the dimensions of vulnerability to HIV as hierarchical levels of analysis. Logistic regression models were used to estimate the odds ratios (OR) of the association between predictor variables and HIV infection. The prevalence of HIV infection among the 288 AMSM recruited to the project was 5.9% (95%CI: 3.7-9.3). Adjusted analysis showed a statistically significant association between self-identifying as a sex worker (OR = 3.74, 95%CI: 1.03-13.60) and HIV infection. Other associations with borderline statistical significance were the use of application programs to find sexual partners (OR = 3.30, 95%CI: 0.98-11.04), low schooling level (OR = 3.59, 95%CI: 0.96-13.41), failing to be hired or being dismissed from a job because of sexual orientation (OR = 2.88, 95%CI: 0.89-9.28), and not using health services as a usual source of care (OR = 3.14, 95%CI: 0.97-10.17). We found a high HIV prevalence among AMSM in Salvador. Furthermore, our study found that individual, social, and programmatic factors were associated with HIV infection among these AMSM. We recommend intensifying HIV combined-prevention activities for AMSM.

Homens adolescentes que fazem sexo com homens (AHSH) apresentam vulnerabilidade aumentada ao HIV. O estudo teve como objetivo estimar a prevalência de HIV e fatores individuais, sociais e programáticos entre AHSH em Salvador, Bahia, Brasil. O estudo transversal foi baseado na análise dos dados da linha de base da coorte PrEP1519 em Salvador. Foram realizadas análises descritivas, bivariadas e multivariadas, usando as dimensões de vulnerabilidade ao HIV como níveis analíticos hierárquicos. Foram usados modelos de regressão logística para estimar as razões de chances (OR) da associação entre as variáveis preditoras e a infecção pelo HIV. A prevalência de infecção pelo HIV entre os 288 AHSH recrutados pelo projeto foi de 5,9% (IC95%: 3,7-9,3). A análise ajustada mostrou uma associação estatisticamente significativa entre a autoidentificação como profissional do sexo (OR = 3,74, IC95%: 1,03-13,60) e a infecção pelo HIV. Outras associações com significância estatística limítrofe foram: uso de aplicativos para achar parceiros sexuais (OR = 3,30, IC95%: 0,98-11,04), menor escolaridade (OR = 3,59, IC95%: 0,96-13,41), história de não ter sido contratado ou de ter sido demitido em função da orientação sexual (OR = 2,88, IC95%: 0,89-9,28) e falta de uso de serviços de saúde como fonte usual de cuidados (OR = 3,14, IC95%: 0,97-10,17). Foi encontrada uma alta prevalência de HIV entre AHSH em Salvador. Além disso, o estudo mostrou que fatores encontrados nas dimensões individual, social e programática estiveram associados à infecção pelo HIV entre esses AHSH. Recomendamos a intensificação das atividades de prevenção combinada entre AHSH.

Los hombres adolescentes que tienen sexo con hombres (AHSH) sufren más vulnerabilidad ante el VIH. El objetivo de este estudio fue estimar la prevalencia de VIH y los factores asociados individuales, sociales, y programáticos asociados entre AHSH en Salvador, Bahia, Brasil. Se trata de un estudio transversal, basado en el análisis de los datos de referencia de la cohorte PrEP1519 en Salvador. Se realizaron análisis descriptivos, bivariados, y multivariados usando las dimensiones de vulnerabilidad respecto al VIH, como los niveles jerárquicos de análisis. Los modelos de regresión logística se usaron para estimar las odds ratios (OR) de la asociación entre las variables predictoras y la infección por VIH. La prevalencia de infección por VIH entre los 288 AHSH reclutados para el proyecto fue 5,9% (IC95%: 3,7-9,3). El análisis ajustado reveló una asociación estadísticamente significativa entre autoidentificarse como un trabajador sexual (OR = 3,74, IC95%: 1,03-13,60) y la infección por VIH. Otras asociaciones con una significación estadística marginal fueron: uso de apps para encontrar pareja sexual (OR = 3,30, IC95%: 0,98-11,04), menos años de educación (OR = 3,59, IC95%: 0,96-13,41), no estar contratado o ser despedido de un trabajo debido a la orientación sexual (OR = 2,88, IC95%: 0,89-9,28), y no usar los servicios de salud como recurso habitual de atención sanitaria (OR = 3,14, IC95%: 0,97-10,17). Se identificó una alta prevalencia de VIH entre AHSH en Salvador. Asimismo, nuestro estudio halló que los factores desde una perspectiva individual, dimensión social, y dimensión programática estuvieron asociados con una infección por VIH entre AHSH. Recomendamos que se intensifiquen las actividades combinadas de prevención contra el VIH para AHSH.

Factors associated to HIV prevalence among adolescent men who have sex with men in Salvador, Bahia State, Brazil: baseline data from the PrEP1519 cohort / Fatores associados à prevalência do HIV entre homens adolescentes que fazem sexo com homens em Salvador, Bahia, Brasil: dados da linha de base da coorte PrEP1519 / Factores asociados a la prevalencia de VIH entre hombres adolescentes que tienen sexo con hombres en Salvador, Bahia, Brasil: datos de referencia de la cohorte PrEP1519

Adolescent men who have sex with men (AMSM) are at a heightened vulnerability for human immunodeficiency virus (HIV). This study aimed to estimate the prevalence of HIV and associated individual, social, and programmatic factors among AMSM in Salvador, Bahia State, Brazil. This is a cross-sectional study which analyzed baseline data from the PrEP1519 cohort in Salvador. Descriptive, bivariate, and multivariate analyses were conducted using the dimensions of vulnerability to HIV as hierarchical levels of analysis. Logistic regression models were used to estimate the odds ratios (OR) of the association between predictor variables and HIV infection. The prevalence of HIV infection among the 288 AMSM recruited to the project was 5.9% (95%CI: 3.7-9.3). Adjusted analysis showed a statistically significant association between self-identifying as a sex worker (OR = 3.74, 95%CI: 1.03-13.60) and HIV infection. Other associations with borderline statistical significance were the use of application programs to find sexual partners (OR = 3.30, 95%CI: 0.98-11.04), low schooling level (OR = 3.59, 95%CI: 0.96-13.41), failing to be hired or being dismissed from a job because of sexual orientation (OR = 2.88, 95%CI: 0.89-9.28), and not using health services as a usual source of care (OR = 3.14, 95%CI: 0.97-10.17). We found a high HIV prevalence among AMSM in Salvador. Furthermore, our study found that individual, social, and programmatic factors were associated with HIV infection among these AMSM. We recommend intensifying HIV combined-prevention activities for AMSM.

Homens adolescentes que fazem sexo com homens (AHSH) apresentam vulnerabilidade aumentada ao HIV. O estudo teve como objetivo estimar a prevalência de HIV e fatores individuais, sociais e programáticos entre AHSH em Salvador, Bahia, Brasil. O estudo transversal foi baseado na análise dos dados da linha de base da coorte PrEP1519 em Salvador. Foram realizadas análises descritivas, bivariadas e multivariadas, usando as dimensões de vulnerabilidade ao HIV como níveis analíticos hierárquicos. Foram usados modelos de regressão logística para estimar as razões de chances (OR) da associação entre as variáveis preditoras e a infecção pelo HIV. A prevalência de infecção pelo HIV entre os 288 AHSH recrutados pelo projeto foi de 5,9% (IC95%: 3,7-9,3). A análise ajustada mostrou uma associação estatisticamente significativa entre a autoidentificação como profissional do sexo (OR = 3,74, IC95%: 1,03-13,60) e a infecção pelo HIV. Outras associações com significância estatística limítrofe foram: uso de aplicativos para achar parceiros sexuais (OR = 3,30, IC95%: 0,98-11,04), menor escolaridade (OR = 3,59, IC95%: 0,96-13,41), história de não ter sido contratado ou de ter sido demitido em função da orientação sexual (OR = 2,88, IC95%: 0,89-9,28) e falta de uso de serviços de saúde como fonte usual de cuidados (OR = 3,14, IC95%: 0,97-10,17). Foi encontrada uma alta prevalência de HIV entre AHSH em Salvador. Além disso, o estudo mostrou que fatores encontrados nas dimensões individual, social e programática estiveram associados à infecção pelo HIV entre esses AHSH. Recomendamos a intensificação das atividades de prevenção combinada entre AHSH.

Los hombres adolescentes que tienen sexo con hombres (AHSH) sufren más vulnerabilidad ante el VIH. El objetivo de este estudio fue estimar la prevalencia de VIH y los factores asociados individuales, sociales, y programáticos asociados entre AHSH en Salvador, Bahia, Brasil. Se trata de un estudio transversal, basado en el análisis de los datos de referencia de la cohorte PrEP1519 en Salvador. Se realizaron análisis descriptivos, bivariados, y multivariados usando las dimensiones de vulnerabilidad respecto al VIH, como los niveles jerárquicos de análisis. Los modelos de regresión logística se usaron para estimar las odds ratios (OR) de la asociación entre las variables predictoras y la infección por VIH. La prevalencia de infección por VIH entre los 288 AHSH reclutados para el proyecto fue 5,9% (IC95%: 3,7-9,3). El análisis ajustado reveló una asociación estadísticamente significativa entre autoidentificarse como un trabajador sexual (OR = 3,74, IC95%: 1,03-13,60) y la infección por VIH. Otras asociaciones con una significación estadística marginal fueron: uso de apps para encontrar pareja sexual (OR = 3,30, IC95%: 0,98-11,04), menos años de educación (OR = 3,59, IC95%: 0,96-13,41), no estar contratado o ser despedido de un trabajo debido a la orientación sexual (OR = 2,88, IC95%: 0,89-9,28), y no usar los servicios de salud como recurso habitual de atención sanitaria (OR = 3,14, IC95%: 0,97-10,17). Se identificó una alta prevalencia de VIH entre AHSH en Salvador. Asimismo, nuestro estudio halló que los factores desde una perspectiva individual, dimensión social, y dimensión programática estuvieron asociados con una infección por VIH entre AHSH. Recomendamos que se intensifiquen las actividades combinadas de prevención contra el VIH para AHSH.

Oral health of quilombola and non-quilombola rural adolescents: a study of hygiene habits and associated factors. / Saúde bucal de adolescentes rurais quilombolas e não quilombolas: um estudo dos hábitos de higiene e fatores associados.

This study evaluated oral hygiene habits and their association with sociocultural, environmental factors and factors related to the use of dental services among Quilombola and non-Quilombola rural adolescents from inland Bahia. Thiswas a cross-sectional study conducted in 2015. Prevalence and prevalence ratios were estimated for the outcomes and multiple Poisson regression analysis with robust variance was performed. We interviewed 390 adolescents, of which 42.8% were Quilombola. Poor tooth brushing and non-flossing were found in 33.3% and 46.7% of adolescents, respectively. Poor tooth brushing was increased by male gender (PR = 1.45), not living with both parents (PR = 1.45), lower hand hygiene habit (PR = 1.72) and worse oral health self-assessment (PR = 1.38). Non-flossing was associated with economic level E (PR = 1.54), older age (PR = 0.91), lower hand hygiene habit (PR = 1.53) and worse oral health self-assessment (PR = 1.33). Different associated factors were observed between Quilombola and non-Quilombola. It is necessary to consider the specificities of the populations for the promotion of adolescent oral health and the importance of the intersectoriality between education and health and care to families.

Este estudo avaliou os hábitos de higiene bucal e sua associação com fatores socioculturais, ambientais e relacionados à utilização de serviços odontológicos entre adolescentes rurais quilombolas e não quilombolas do interior da Bahia. Foi um estudo transversal realizado em 2015. Estimaram-se prevalências e razões de prevalências para os desfechos e foi conduzida análise múltipla por regressão de Poisson com variância robusta. Foram entrevistados 390 adolescentes, 42,8% quilombolas. Escovação dentária insatisfatória e não uso do fio dental foram encontrados em 33,3% e 46,7% dos adolescentes, respectivamente. Mostraram aumentar a escovação dentária insatisfatória: sexo masculino (RP = 1,45), não morar com ambos os pais (RP = 1,45), menor hábito de lavar as mãos (RP = 1,72) e pior autoavaliação da saúde bucal (RP = 1,38). Com o não uso de fio dental, mostraram-se associados: nível econômico E (RP = 1,54), maior idade (RP = 0,91) menor hábito de lavar as mãos (RP = 1,53) e pior autoavaliação da saúde bucal (RP = 1,33). Distintos fatores associados foram observados entre quilombolas e não quilombolas. Ressalta-se a necessidade de se considerar as especificidades das populações para a promoção da saúde bucal dos adolescentes e a importância da intersetorialidade entre educação e saúde e a atenção às famílias.

Sexual behavior and associated factors in rural adolescents.

OBJECTIVE: To describe the sexual behavior and to identify associated factors in adolescents from rural communities in Bahia, Brazil. METHODS: This is a cross-sectional, population-based, and household-based study, carried out in 2015 with adolescents aged 10 to 19 years. We described the variables of sexual intercourse in life and in the last 12 months, age at first intercourse, condom use and number of partners, guidance on pregnancy, AIDS, or other sexually transmitted infections, and guidance on how to get condoms. The analysis was performed for the total sample and for the quilombola and nonquilombola strata. We used Poisson regression, with robust variance, to estimate the prevalence ratios for sexual intercourse in relation to the explanatory variables. RESULTS: A total of 390 adolescents were interviewed, of them 42.8% were quilombolas, 51.3% females, and the median age was 14.8 years. Of these adolescents, 26.4% reported sexual intercourse (28.1% quilombolas and 25.1% non-quilombolas), and the median age of the first relation was 15 years; 77.7% of them mentioned condom use in the last intercourse and more than half received guidance on pregnancy, AIDS, or other sexually transmitted infections and received no guidance on how to get free condoms. Age (PR = 1.42) and alcohol use experimentation (PR = 2.41) were positively associated with sexual intercourse after adjustment. In the quilombola stratum, age (RP = 1.37), having three or more close friends (PR = 1.37), and experimentation with alcohol (PR = 2.60) were associated. In the non-quilombola stratum, age (PR = 1.43), black persons (PR = 2.06), and alcohol use experimentation (PR = 2.68) were associated. CONCLUSIONS: Lack of information and exposure to behaviors such as alcohol use experimentation are conditions that need to be addressed in health promotion strategies and in strategies for the prevention of sexual health problems in rural adolescents. Intersectoral partnerships between education and health also need to be strengthened to promote the autonomous and safe exercise of sexuality in this population.

Early death, morbidity and pharmacotherapy in extremely premature and very premature in neonatal intensive care units / Morte precoce, morbidade e farmacoterapia em prematuros extremos e muito prematuros em unidades de terapia intensiva neonatal

Abstract Objectives: to evaluate the evolution of extremely preterm and very preterm infants admitted to neonatal intensive care units, regarding the use of ventilatory support, morbidities, medication use, death, survival and viability. Methods: a non-concurrent cohort study, with 163 very premature and extreme newborns hospitalized in three neonatal intensive care units, during 2016 and 2017. A descriptive analysis of the data obtained from the medical records was performed. The outcomes studied were the use of ventilatory support, morbidities, medication use, death and causes of death. A survival curve was constructed and a viability limit was defined. Results: in the study, 28.2% were extreme and 71.8% were very premature. In this order of subgroups, the need for mechanical ventilation was higher for the extremes (65.2% and 41.0%) and the main diagnosis was early sepsis (78.6% and 82.6). Off-label (60.5% and 47.9%) and off-license (25.3% and 29.0%) medications were used. Most deaths (57.8%) occurred between the extremes, mainly due to septic shock. Survival was lower for the lowest gestational ages and the limit of viability was between 26 and 27 weeks. Conclusions: the main morbidities were from the respiratory system, with high use of off-label and unlicensed medications. Extremes had a greater demand for intensive care in addition to needing more drugs and progressing more to death.

Resumo Objetivos: avaliar a evolução dos prematuros extremos e muito prematuros internados em unidades de terapia intensiva neonatais, quanto ao uso de suporte ventilatório e de medicamentos, óbito, sobrevida e viabilidade. Métodos: estudo de coorte não concorrente, com 163 recém-nascidos muito prematuros e extremos internados em três unidades de terapia intensiva neonatais, durante 2016 e 2017. Realizou-se análise descritiva dos dados obtidos dos prontuários. Os desfechos estudados foram o uso de suporte ventilatório, morbidades, uso de medicamentos, óbito e causas de óbito. Foi construída curva de sobrevivência e delimitado um limite de viabilidade. Resultados: no estudo, 28,2% eram extremos e 71,8% muito prematuros. Nessa ordem de subgrupos, a necessidade de ventilação mecânica foi maior para os extremos (65,2% e 41,0%) e o principal diagnóstico foi sepse precoce (78,6% e 82,6).Medicamentos off-label (60,5% e 47,9%) e sem-licença (25,3% e 29,0%) foramutilizados. A maioria dos óbitos (57,8%) ocorreu entre os extremos, principalmente por choque séptico. A sobrevivência foi menor para as menores idades gestacionais e o limite de viabilidade ficou entre 26 e 27 semanas. Conclusões: as principais morbidades foram do sistema respiratório, com alto uso de medicamentos off-label e sem licença. Extremos tiveram maior demanda de cuidados intensivos além de necessitarem de mais medicamentos e evoluírem mais ao óbito.