The intersection of race/ethnicity and socioeconomic status: inequalities in breast and cervical cancer mortality in 20,665,005 adult women from the 100 Million Brazilian Cohort.

OBJECTIVES: There is limited evidence regarding the impact of race/racism and its intersection with socioeconomic status (SES) on breast and cervical cancer, the two most common female cancers globally. We investigated racial inequalities in breast and cervical cancer mortality and whether SES (education and household conditions) interacted with race/ethnicity. DESIGN: The 100 Million Brazilian Cohort data were linked to the Brazilian Mortality Database, 2004-2015 (n = 20,665,005 adult women). We analysed the association between self-reported race/ethnicity (White/'Parda'(Brown)/Black/Asian/Indigenous) and cancer mortality using Poisson regression, adjusting for age, calendar year, education, household conditions and area of residence. Additive and multiplicative interactions were assessed. RESULTS: Cervical cancer mortality rates were higher among Indigenous (adjusted Mortality rate ratio = 1.80, 95%CI 1.39-2.33), Asian (1.63, 1.20-2.22), 'Parda'(Brown) (1.27, 1.21-1.33) and Black (1.18, 1.09-1.28) women vs White women. Breast cancer mortality rates were higher among Black (1.10, 1.04-1.17) vs White women. Racial inequalities in cervical cancer mortality were larger among women of poor household conditions, and low education (P for multiplicative interaction <0.001, and 0.02, respectively). Compared to White women living in completely adequate (3-4) household conditions, the risk of cervical cancer mortality in Black women with 3-4, 1-2, and none adequate conditions was 1.10 (1.01-1.21), 1.48 (1.28-1.71), and 2.03 (1.56-2.63), respectively (Relative excess risk due to interaction-RERI = 0.78, 0.18-1.38). Among 'Parda'(Brown) women the risk was 1.18 (1.11-1.25), 1.68 (1.56-1.81), and 1.84 (1.63-2.08), respectively (RERI = 0.52, 0.16-0.87). Compared to high-educated White women, the risk in high-, middle- and low-educated Black women was 1.14 (0.83-1.55), 1.93 (1.57-2.38) and 2.75 (2.33-3.25), respectively (RERI = 0.36, -0.05-0.77). Among 'Parda'(Brown) women the risk was 1.09 (0.91-1.31), 1.99 (1.70-2.33) and 3.03 (2.61-3.52), respectively (RERI = 0.68, 0.48-0.88). No interactions were found for breast cancer. CONCLUSION: Low SES magnified racial inequalities in cervical cancer mortality. The intersection between race/ethnicity, SES and gender needs to be addressed to reduce racial health inequalities.

Effects of maternal geohelminth infections on allergy in early childhood.

BACKGROUND: Maternal geohelminth infections during pregnancy may protect against allergy development in childhood. OBJECTIVE: We sought to investigate the effect of maternal geohelminths on the development of eczema, wheeze, and atopy during the first 3 years of life. METHODS: A cohort of 2404 neonates was followed to 3 years of age in a rural district in coastal Ecuador. Data on wheeze and eczema were collected by means of questionnaire and physical examination at 13, 24, and 36 months of age. Atopy was measured based on skin prick test (SPT) reactivity to 9 allergens at 36 months. Maternal stool samples were examined for geohelminths by microscopy. Data on potential confounders was collected after birth by questionnaire. RESULTS: Geohelminths were observed in 45.9% of mothers. Eczema and wheeze were reported for 17.7% and 25.9%, respectively, of 2069 (86.1%) children with complete follow-up to 3 years, and allergen SPT reactivity to any allergen was present in 17.2% and to house dust mite in 8.7%. Maternal geohelminth infections were not significantly associated with eczema (adjusted odds ratio [OR], 1.26; 95% CI, 0.98-1.61), wheeze (adjusted OR, 1.02; 95% CI, 0.82-1.27), and SPT reactivity to any allergen (adjusted OR, 0.79; 95% CI, 0.61-1.01). In subgroup analyses maternal geohelminths were associated with a significantly reduced risk of SPT reactivity to mite and other perennial allergens, and maternal ascariasis was associated with an increased risk of eczema and reduced risk of SPT reactivity to all allergens. CONCLUSION: Our data do not support a protective effect of maternal infections with geohelminth parasites during pregnancy against the development of eczema and wheeze in early childhood, although there was evidence in subgroup analyses for a reduction in SPT reactivity to house dust mites and perennial allergens.

Exposure to intimate partner violence and lack of asthma control in adults: a cross-sectional study.

BACKGROUND: Asthma is a chronic airway disease that affects 339 million people worldwide. It is a heterogeneous disease with different risks, including in family environments, where intimate partner violence occurs. OBJECTIVE: This study aimed to investigate the possible association between psychosocial factors and asthma control in adults exposed to intimate partner violence. DESIGN AND SETTING: This cross-sectional study was conducted at a Brazilian public higher education institution in Salvador, Bahia, Brazil. METHODS: The study population consisted of adults clinically diagnosed with severe asthma and those with mild/moderate asthma identified at an asthma referral outpatient clinic. The sample comprised 492 participants who underwent clinical evaluation and completed questionnaires to assess asthma control, depression, stress, and resilience. The Conflict Tactics Scale, which measures tactics for managing marital conflicts, was used to estimate the level of intimate partner violence. RESULTS: Of the 492 participants, 76.2% were women and 91% self-referenced color black/brown, 37.8% reported low family income, 87.4% reported low education level, 71.7% reported high stress, 32.5% reported low resilience, 18.5% reported moderate or severe depression, 83.3% reported resolute negotiation, 49.4% reported major psychological aggression, 19.6% reported major physical aggression, 15.5% reported major injury, and 7.3% reported major sexual coercion. Regression analysis revealed that sex was an effect modifier. CONCLUSION: Women in situations of social vulnerability, with low income and poor education, with depression, severe asthma, and those who used aggression to resolve marital conflicts had a profile associated with a lack of asthma control.

Simple Echocardiographic Parameters are Strong Predictors of the Cardiovascular Risk in Asymptomatic Individuals: Elsa-Brasil Cohort. / Parâmetros Ecocardiográficos Simples são Fortes Preditores de Risco Cardiovascular em Indivíduos Assintomáticos: Coorte Elsa-Brasil.

BACKGROUND: Several studies have evaluated echocardiographic abnormalities as predictors of cardiovascular risk; however, none have associated the global cardiovascular risk with echocardiographic abnormalities in the Brazilian population. OBJECTIVE: This study evaluates the association between the global cardiovascular risk (ASCVD score) and three echocardiographic abnormalities: left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD), and increased left atrium (LA) volume. METHODS: The study population was composed of participants from ELSA-Brasil who underwent echocardiography between 2008 and 2010 (n = 2973). They were asymptomatic and had no history of cardiovascular disease. The ASCVD score was calculated in two periods: 2008-2010 and 2012-2014. Prevalence ratios (PR) were estimated with 95% confidence intervals (CI). RESULTS: There is an association between echocardiographic abnormalities and high global cardiovascular risk (ASCVD score ≥ 7.5) in both study periods, separately. The combined global risk (low risk in the first period and high risk in the second period) was significantly associated only with LVDD (PR = 3.68, CI 95% 2.63-5.15) and LVH (PR = 2.20, 95% CI 1.62-3.00). CONCLUSION: Echocardiographic abnormalities (LVDD, LVH, and increased LA volume) are independent predictors of cardiovascular risk in Brazilian adults.

FUNDAMENTO: vários estudos avaliam alterações ecocardiográficas como preditores de risco cardiovascular; entretanto, nenhum associa risco cardiovascular global com alterações ecocardiográficas em brasileiros. OBJETIVO: Este estudo avalia a associação entre risco cardiovascular global (ASCVD) e achados ecocardiográficos como hipertrofia ventricular esquerda (HVE), disfunção diastólica (DDVE) e aumento do volume do átrio esquerdo (AE). MÉTODOS: A população foi composta por participantes do ELSA-Brasil que realizaram ecocardiografia entre 2008 e 2010 (n = 2.973). Eram assintomáticos e não tinham história de doença cardiovascular (DCV). O escore ASCVD foi calculado em dois períodos: 2008-2010 e 2012-2014. Razões de prevalência (RP) foram estimadas com intervalos de confiança (IC) de 95%. RESULTADOS: Evidenciou-se associação entre alterações ecocardiográficas e alto risco cardiovascular global (escore ASCVD ≥ 7,5) nos dois períodos do estudo, separadamente. O risco global combinado (baixo risco no primeiro período e alto risco no segundo período) teve associação significativa apenas com DDVE (RP = 3,68; IC 95%: 2,63-5,15) e HVE (RP = 2,20; IC 95%: 1,62­3,00). CONCLUSÃO: Alterações ecocardiográficas (DDVE, HVE e aumento do volume do AE) são preditores independentes de risco cardiovascular em adultos brasileiros sem DCV prévias.

Understanding the dynamics of asthma symptoms between childhood and adolescence using latent transition analysis.

OBJECTIVES: Asthma patterns in childhood are important predictors of unwanted outcomes in adolescence. We aimed to define asthma phenotypes in childhood and adolescence and evaluate the transitions between these phenotypes and factors potentially associated with the transitions. METHODS: Baseline (1445 children), first round (1363 children/early adolescents) and second round (1206 adolescents) data from the SCAALA Project in Salvador, Brazil, were used. Phenotypes were defined by latent class analysis at three time points. Transitions between phenotypes were described and the effects of factors associated with transition probabilities estimated using latent transition analysis. RESULTS: The "asymptomatic" and "symptomatic" phenotypes were identified. Approximately 5-6% of asymptomatic children in childhood/later childhood and early adolescence became symptomatic later in time. Maternal common mental disorders were identified as important risk factor for unhealthy states. CONCLUSIONS: Asthma manifestations are characterized by frequent movements, especially between childhood and adolescence. Our study, by simultaneously defining disease subtypes, and examining the transitions and their potential predictors, highlights the importance of longitudinal studies to advance the understanding of the effects of social, environmental and biological mechanisms underlying asthma trajectories over time.

Exposure to intimate partner violence and lack of asthma control in adults: a cross-sectional study

ABSTRACT BACKGROUND: Asthma is a chronic airway disease that affects 339 million people worldwide. It is a heterogeneous disease with different risks, including in family environments, where intimate partner violence occurs. OBJECTIVE: This study aimed to investigate the possible association between psychosocial factors and asthma control in adults exposed to intimate partner violence. DESIGN AND SETTING: This cross-sectional study was conducted at a Brazilian public higher education institution in Salvador, Bahia, Brazil. METHODS: The study population consisted of adults clinically diagnosed with severe asthma and those with mild/moderate asthma identified at an asthma referral outpatient clinic. The sample comprised 492 participants who underwent clinical evaluation and completed questionnaires to assess asthma control, depression, stress, and resilience. The Conflict Tactics Scale, which measures tactics for managing marital conflicts, was used to estimate the level of intimate partner violence. RESULTS: Of the 492 participants, 76.2% were women and 91% self-referenced color black/brown, 37.8% reported low family income, 87.4% reported low education level, 71.7% reported high stress, 32.5% reported low resilience, 18.5% reported moderate or severe depression, 83.3% reported resolute negotiation, 49.4% reported major psychological aggression, 19.6% reported major physical aggression, 15.5% reported major injury, and 7.3% reported major sexual coercion. Regression analysis revealed that sex was an effect modifier. CONCLUSION: Women in situations of social vulnerability, with low income and poor education, with depression, severe asthma, and those who used aggression to resolve marital conflicts had a profile associated with a lack of asthma control.

Association of sex and training phase with physical activity and sedentary behavior in nursing students / Associação do sexo e fase de formação com atividade física e comportamento sedentário em universitários de enfermagem

Abstract Physical Insufficient levels of physical activity and sedentary behavior are highly prevalent worldwide and associated with cardiometabolic diseases and may vary according to gender and academic training. The objective was to investigate the association of sex and academic training with the level of physical activity and time spent in sedentary behavior in nursing students. It is a cross-sectional study with 286 nursing students from a public university. A sociodemographic and academic characterization instrument and an extended version of the International Physical Activity Questionnaire were applied. Data were analyzed descriptively and by Pearson's Chi-Square/Fisher's Exact test. The significance level was 5%. 65.7% of university students were active. Men were more active in leisure (p=0.000) and commuting (p=0.03). There was no association between sex and semester and total physical activity level. The prevalence of time in sedentary behavior ≥ 8 h/day for seven, five days, and weekends were 39.3%, 57.1%, and 21.4% for men and 55.0%, 65.1%, and 43.0% for women. A more significant proportion of women showed time in sedentary behavior ≥ 8 h/day on weekends (p=0.015) than men. A higher proportion between the 1st and 5th semesters remained ≥ 8 h/day in sedentary behavior on seven (p=0.024) and five days (p=0.001) week compared to those between the 6th and 10th semesters. The prevalence of insufficient physical activity levels and a long time in sedentary behavior were high and influenced by gender and training phase. Men were more active in commuting and leisure than women. Sedentary behavior is associated with gender and a training phase.

Resumo Nível insuficiente de atividade física e comportamento sedentário estão associados a doenças cardiometabólicas e apresentam prevalências elevadas mundialmente e podem variar entre sexo e fase de formação de universitários (as) em enfermagem. Objetivou-se investigar a associação do sexo e da fase de formação acadêmica com o nível de atividade física e tempo em comportamento sedentário em universitários de enfermagem. Estudo transversal, com 286 universitários de enfermagem de uma Universidade pública. Aplicou-se instrumento de caracterização sociodemográfica, acadêmica e versão longa do Questionário Internacional de Atividade Física, analisados descritivamente e pelo teste Qui-Quadrado de Pearson/Exato de Fisher. O nível de significância foi de 5%. 65,7% dos universitários eram ativos. Homens foram mais ativos no lazer (p=0,000) e deslocamento (p=0,03). Não houve associação do sexo e do semestre com nível de atividade física total. As prevalências do tempo em comportamento sedentário ≥ 8 h/dia, durante sete, cinco dias e final de semana foram, respectivamente, 39,3%, 57,1% e 21,4% para homens e 55,0%, 65,1% e 43,0% para mulheres. Maior proporção de mulheres apresentou tempo em comportamento sedentário ≥ 8 h/dia no final de semana (p=0,015). Maior proporção entre o 1º e 5º semestres permaneciam ≥ 8 h/dia em comportamento sedentário em sete (p=0.024) e cinco dias (p=0.001) na semana comparados àqueles entre o 6º e 10º semestre. As prevalências do nível insuficiente de atividade física e tempo elevado em comportamento sedentário foram altas. Homens foram mais ativos no deslocamento e no lazer do que as mulheres. Comportamento sedentário se associou ao gênero e a fase de formação.

Highly Accurate Chimeric Proteins for the Serological Diagnosis of Chronic Chagas Disease: A Latent Class Analysis.

The existence of an imperfect reference standard presents complications when evaluating the unbiased performance of novel diagnostic techniques. This is especially true in the absence of a gold standard, as is the case in chronic Chagas disease (CD) diagnosis. To circumvent this constraint, we elected to use latent class analysis (LCA). Previously, our group demonstrated the high performance of four Trypanosoma cruzi-chimeric proteins (Molecular Biology Institute of Paraná [IBMP]-8.1, -8.2, -8.3, and -8.4) for CD diagnosis using several distinct immunoassays. Although commercial tests had previously been established as a reference standard, the diagnostic performance of these chimeric antigens could present bias because these tests fail to produce 100% accurate results. Thus, we used LCA to assess the performance of these IBMP chimeric antigens in chronic CD diagnosis. Using the LCA model as a gold standard, sensitivity and specificity values ranged from 93.5% to 99.4% and 99.6% to 100%, respectively. The accuracy values were 96.2% for IBMP-8.2, approximately 98% for IBMP-8.1 and IBMP-8.3, and nearly 100% for IBMP-8.4. For IBMP-8.1 and IBMP-8.2, higher positive predictive values were associated with increases in hypothetical prevalence. Similarly, higher hypothetical prevalence resulted in lower negative predictive values for IBMP-8.1, IBMP-8.2, and IBMP-8.3. In addition, samples with serodiscordant results from commercial serological tests were analyzed using LCA. Molecular Biology Institute of Paraná -8.1 demonstrated potential for use in confirmatory testing with regard to samples with inconsistent results. Moreover, our findings further confirmed the remarkable performance of the IBMP-8.4 antigen to diagnose chronic CD in both endemic and non-endemic areas.

Growth patterns in early childhood: Better trajectories in Afro-Ecuadorians independent of sex and socioeconomic factors.

The first years of life are the most dynamic period for childhood growth. There are limited data available on growth patterns of infants and children living in rural Latin America. The aim of this study was to describe the growth patterns from birth to 5years in children living in a rural District of tropical coastal Ecuador using data from a birth cohort of 2404 neonates. We hypothesize that there would be growth differences according to ethnicity and sex. Evaluations were conducted at birth or until 2weeks of age and at 7, 13, 24, 36 and 60months during clinic and home visits. Individual growth trajectories for weight-for-age, height-for-age and weight/height-for-age Z-scores were estimated using multilevel models. Girls were lighter and shorter than boys at birth. However, Afro-Ecuadorian children (versus mestizo or indigenous) were longer/taller and heavier throughout the first 5years of life and had greater mean trajectories for HAZ and WAZ independent of sex and socioeconomic factors. Our data indicate that ethnicity is a determinant of growth trajectories during the first 5years of life independent of socioeconomic factors in a birth cohort conducted in a rural region of Latin America.

Parâmetros Ecocardiográficos Simples são Fortes Preditores de Risco Cardiovascular em Indivíduos Assintomáticos: Coorte Elsa-Brasil / Simple Echocardiographic Parameters are Strong Predictors of the Cardiovascular Risk in Asymptomatic Individuals: Elsa-Brasil Cohort

Resumo Fundamento vários estudos avaliam alterações ecocardiográficas como preditores de risco cardiovascular; entretanto, nenhum associa risco cardiovascular global com alterações ecocardiográficas em brasileiros. Objetivo Este estudo avalia a associação entre risco cardiovascular global (ASCVD) e achados ecocardiográficos como hipertrofia ventricular esquerda (HVE), disfunção diastólica (DDVE) e aumento do volume do átrio esquerdo (AE). Métodos A população foi composta por participantes do ELSA-Brasil que realizaram ecocardiografia entre 2008 e 2010 (n = 2.973). Eram assintomáticos e não tinham história de doença cardiovascular (DCV). O escore ASCVD foi calculado em dois períodos: 2008-2010 e 2012-2014. Razões de prevalência (RP) foram estimadas com intervalos de confiança (IC) de 95%. Resultados Evidenciou-se associação entre alterações ecocardiográficas e alto risco cardiovascular global (escore ASCVD ≥ 7,5) nos dois períodos do estudo, separadamente. O risco global combinado (baixo risco no primeiro período e alto risco no segundo período) teve associação significativa apenas com DDVE (RP = 3,68; IC 95%: 2,63-5,15) e HVE (RP = 2,20; IC 95%: 1,62-3,00). Conclusão Alterações ecocardiográficas (DDVE, HVE e aumento do volume do AE) são preditores independentes de risco cardiovascular em adultos brasileiros sem DCV prévias.

Abstract Background Several studies have evaluated echocardiographic abnormalities as predictors of cardiovascular risk; however, none have associated the global cardiovascular risk with echocardiographic abnormalities in the Brazilian population. Objective This study evaluates the association between the global cardiovascular risk (ASCVD score) and three echocardiographic abnormalities: left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD), and increased left atrium (LA) volume. Methods The study population was composed of participants from ELSA-Brasil who underwent echocardiography between 2008 and 2010 (n = 2973). They were asymptomatic and had no history of cardiovascular disease. The ASCVD score was calculated in two periods: 2008-2010 and 2012-2014. Prevalence ratios (PR) were estimated with 95% confidence intervals (CI). Results There is an association between echocardiographic abnormalities and high global cardiovascular risk (ASCVD score ≥ 7.5) in both study periods, separately. The combined global risk (low risk in the first period and high risk in the second period) was significantly associated only with LVDD (PR = 3.68, CI 95% 2.63-5.15) and LVH (PR = 2.20, 95% CI 1.62-3.00). Conclusion Echocardiographic abnormalities (LVDD, LVH, and increased LA volume) are independent predictors of cardiovascular risk in Brazilian adults.

Nível de conhecimento sobre suporte básico de vida dos estudantes de odontologia / Knowledge level of basic life support among dentistry students

Introdução: As doenças cardiovasculares são responsáveis por vinte por cento das mortes na população acima de trinta anos de idade e correspondem a um grave problema da saúde pública no Brasil.Dessas doenças a parada cardiorrespiratória é o quadro emergencial predominante. Nesse contexto, destaca-se a importância do conhecimento sobre as manobras de suporte básico de vida e manutenção da vida do paciente até a chegada de uma equipe de suporte avançado. Objetivo: Avaliar o nível de conhecimento dos estudantes de Odontologia da Universidade Federal de Juiz de Fora quanto ao suporte básico de vida. Material e métodos: Questionário contendo questões de múltipla escolha, aplicado a 126 alunos, abordando as condutas para o suporte básico de vida de acordo com as diretrizes atuais da American Heart Association. Para avaliar o nível de conhecimento foram utilizadas duas categorias com base no percentual individual de acertos das questões: nível de conhecimento satisfatório (acertos ≥51%) e nível de conhecimento insatisfatório (acertos ≤50%).Resultados: 104 (82,5%) estudantes acertaram até 50% do questionário. 100 estudantes (79,4%) responderam não ter recebido treinamento prático para o suporte básico de vida, enquanto que 26 (20,6%) afirmaram ter recebido algum treinamento, embora sem certificação pela American Heart Association.Quanto à capacitação teórica, 77(61,1%) estudantes afirmaram ter recebido alguma orientação durante a graduação. Ao comparar os resultados entre os alunos do 1º, 6º e 10º período, observa-se uma evolução do conhecimento apenas entre o 1º e o 6º período, não havendo melhoria significante no aprendizado entre o 6º e 10º período. Conclusão:Os estudantes de Odontologia do campus sede da Universidade Federal de Juiz de Fora apresentam nível de conhecimento insatisfatório sobre a atuação no suporte básico de vida.

Introduction: The cardiovascular diseases are responsible for twenty percent of deaths among the population over thirty years of age, which means they are a serious public health problem in Brazil, being the cardiopulmonary arrest the main emergency situation of these diseases. In this context, the knowledge about the basic life support is crucial for the maintenance of the patient's life until the arrival of advanced support. Objective: Evaluating the knowledge of the dentistry students of the Juiz de Fora Federal University about basic life support. Material and methods: A questionnaire applied to 126 students, composed by fourteen multiple choice questions about the conduct for basic life support according to the current guidelines of the American Heart Association. In order to evaluate the knowledge level, two different categories based on the student's score have been utilized: satisfactory knowledge level (rightanswers≥51%) and unsatisfactory knowledge level (rightanswers≤50%). Results: 104 (82,5%) of the students scored up to 50% of the questionnaire. 100 students (79,4%) claimed that they hadn't received any training for basic life support, while 26 (20,6%) claimed that they had received some training, although without the American Heart Association certification. 77 (61,1%) claimed that they had received some theoretical orientation during the graduation. By comparing the results between1st, 6th and 10th grade students, evolution has only been noticed between 1st and 6th grades. However, no significant evolution has been noticed between 6thand 10th grades. Conclusion: The dentistry students of the Juiz de Fora Federal University have presented unsatisfactory knowledge level on basic life support.

Acesso aos serviços de saúde: fatores associados ao envolvimento de gestantes com drogas / Access to health services: factors associated to the involvement of pregnant women with drugs / Acceso a los servicios de salud: factores asociados al envolvimiento de gestantes con drogas

O envolvimento com o álcool e outras drogas é um fator de vulnerabilidade para as mulheres, sobretudo na fase da gestação. O objetivo do trabalho foi verificar a associação entre as características de acesso aos serviços de saúde e o envolvimento de gestantes com álcool e outras drogas. Estudo transversal realizado com 268 gestantes cadastradas no programa de pré-natal de uma maternidade pública de Salvador (BA). Houve predomínio de gestantes na faixa etária de 20 e 29 anos (57,8%). Do total, 82,2% fazia uso exclusivo de serviços públicos de saúde e tiveram acesso imediato ao pré-natal, 83,6% não participaram de atividades educativas e 51,1% não receberam orientação sobre drogas. Concluiu-se que, embora não tenha havido associação estatística, o envolvimento com as drogas pode influenciar na adesão e qualidade do pré-natal, o que torna imperiosa a realização de intervenções assistenciais direcionadas às necessidades das gestantes e de seus companheiros.

Involvement with alcohol and other drugs is a vulnerability factor for women, overall when pregnant. The objectof the paper is to verify association among characteristics of access to health services and involvement of pregnantwomen with alcohol and other drugs. A cross-sectional study, performed with 268 pregnant women registered in aprenatal program of a public maternity in Salvador (BA). There was a predominance of pregnant women in theage group of 20 to 29 years (57.8%). Out of the total, 82.2% made exclusive use of public health services and hadimmediate access to prenatal care (82.2%), 83.6% did not participate in educational activities and 51.1% didnot receive guidance on drugs. The information demonstrates that despite not having any statistical association,involvement with drugs can influence compliance and quality of prenatal care, which causes the necessity of careintervention, guided to the requirements of the pregnant woman and companions.

Envolvimiento con alcohol y otras drogas es un factor de vulnerabilidad para mujeres, especialmente cuando estánembarazadas. El objetivo del trabajo es verificar la asociación entre características de acceso a los servicios de salud yel envolvimiento de gestantes con alcohol y otras drogas. Estudio transversal realizado con 268 gestantes catastradasen el programa de prenatal de una maternidad pública de Salvador (BA). Hubo predominio de gestantes en el grupode edad de 20 y 29 años (57,8%). Del total, 82,2% hacia uso exclusivo de servicios públicos de salud y tuvieron accesoinmediato al prenatal (82,2%), 83,6% no participaron de actividades educativas y 51,1% no recibieron orientaciónsobre drogas. Los datos muestran que aunque no haya tenido asociación estadística, el envolvimiento con drogaspuede influenciar en la adhesión y calidad del prenatal, lo que torna necesario la realización de intervencionesasistenciales, direccionadas a las necesidades de las gestantes y sus compañeros.