Association of syndemic conditions and quality of life among people living with HIV/AIDS.

The syndemics theory seeks to understand the effect of multiple synergic problems in promoting poor health outcomes. To disentangle which and how syndemic conditions affect the quality of life (QoL) may be important to improve well-being of people living with HIV/AIDS (PLWHA). This study evaluates the association between syndemic conditions and QoL among PLWHA. We performed a secondary analysis using data obtained between 2014 and 2017 among PLWHA under care in Rio de Janeiro, Brazil. The outcomes were the six QoL domains (physical, psychological, level of independence, social relationships, environmental, and spirituality) measured through the World Health Organization Quality of Life in HIV infection scale, abbreviated version (WHOQOL-HIV-BREF). The independent variables were demographic and clinical characteristics, syndemic conditions (binge drinking, compulsive sexual behavior, polysubstance use, intimate partner violence, and depression), and syndemics (two or more syndemic conditions simultaneously). Bivariate analysis (t-test and ANOVA) and linear regressions were performed for each quality-of-life domain. The analytical sample comprised 1530 participants, mostly male at birth (64%) and with median age of 43 years. The syndemic conditions most frequently observed were binge drinking (56%), IPV (13%), and depression (9%). Both individual syndemic conditions and syndemics were associated with worse QoL. In the multivariate analysis, positive screening for depression was associated with worse QoL in all domains. Polysubstance users presented worse QoL at social and environmental domains. Intimate partner violence was associated with worse QoL at environment domain while binge drinking was associated with worse scores in the physical domain. The presence of syndemics increased the likelihood of worse scores in the psychological, social, and environment domains. Our study expands the understanding of QoL in PLWHA, as it considers a holistic/integral, multifactorial, and synergistic approach to the determinants of QoL. Seeking strategies that target syndemics may be important to improve patient-centered outcomes in health.Abbreviations: HIV/AIDS: human immunodeficiency virus/acquired immunodeficiency syndromeWHO: World Health OrganizationQoL: quality of lifeHRQoL: health-related quality of lifePLWHA: people living with HIV/AIDScART: combined antiretroviral therapyIPV: intimate partner violenceINI/FIOCRUZ: Evandro Chagas National Institute of Infectious DiseasesOswaldo Cruz FoundationSRH: self-rated healthVL: viral loadCD4: CD4 cell countNIAAA: National Institute on Alcohol Abuse and AlcoholismCSBcompulsive sexual behaviorWHO-ASSIST: alcoholsmoking and substance involvement screening test developed by the World Health OrganizationPHQ-2: Patient Health Questionnaire-2.

Feasibility of dried blood spot for hepatitis C diagnosis in vulnerable subjects and people living in remote areas from Brazil.

BACKGROUND: Agile, accessible and cheap diagnosis of hepatitis C virus (HCV) infection is essential to achieve the elimination of this infection, worldwide, as mandated by the World Health Organzation as part of its strategy for 2030. Dried blood spots (DBS) can be an attractive alternative for sample collection among people living in remote areas and vulnerable populations due to the less invasive collection, its biosafety, and storage & transportation of samples at room temperature. DESIGN: This study aims to estimate the usefulness of dried blood spot samples for the diagnosis and the assessment of HCV infection rates in three different settings in Brazil. Cross-sectional analysis of a sample collection from different populations, aiming to assess the performance of the testing algorithms and respective procedures among different populations with diverse background infection rates. METHODS: We reported the evaluation of DBS as alternative samples for detecting anti-HCV in different groups in real life conditions: (I) Vulnerable subjects living in remote areas of Southeast, North and Northeast Brazil (n = 1464); (II) Beauticians (n = 288); (III) People who use non-injectable drugs (n = 201); (IV) patients referred to outpatient care (n = 275). RESULTS: General assay accuracy was 99%, with a weighted kappa value of 0.9, showing an excellent performance. Sensitivities ranged from 87.5% to 100.0% between groups and specificities were above 99.2%. A total of 194 individuals had HCV RNA in serum and concordance of anti-HCV detection in DBS was 98.4%. CONCLUSIONS: DBS samples could be used for anti-HCV detection in different populations recruited in real life conditions and ambulatory settings, with a high overall sensitivity and specificity.

Polysubstance use in a Brazilian national sample: Correlates of co-use of alcohol and prescription drugs.

Background: Responses to problem substance use have largely focused on illicit drugs, but reports on rising prescription drug misuse worldwide raise questions about their combined use with alcohol and potential consequences. The current study assessed prevalence of alcohol in conjunction with nonmedical opioid and benzodiazepine use across a nationally representative sample of adults in Brazil. Methods: Cross-sectional data on prevalence were estimated from the 2015 Brazilian Household Survey on Substance Use. We estimated past month nonmedical use of benzodiazepines and alcohol and past month nonmedical use of opioids and alcohol among adults who reported any past-year alcohol use. Zero-inflated Poisson models assessed independent correlates of alcohol and nonmedical opioid use, and alcohol and nonmedical benzodiazepine use. Results: Among adults who reported past year alcohol use, 0.4% (N = 257,051) reported past month alcohol and non-medical benzodiazepine use, and 0.5% (N = 337,333) reported past month alcohol and non-medical opioid use. Factors independently associated with co-use of alcohol and benzodiazepines included having depression (adjusted prevalence ratio (aPR):4.61 (95%CI 1.76-12.08)), anxiety (aPR:4.21 (95%CI 1.59-11.16)) and tobacco use (aPR: 5.48 (95%CI 2.26-13.27)). Factors associated with past-month alcohol and opioid use included having experienced physical or a threat of violence (aPR: 4.59 (95%CI 1.89-11.14)), and tobacco use (aPR:2.81(95%CI:1.29-6.12)). Conclusions: Co-use of prescription drugs with alcohol remains relatively rare among Brazilians, but findings point to a unique profile of persons at risk. Results of this study are important in light of changing dynamics and international markets of prescription drugs and the need for more research on use of these substances on a global scale.

The cumulative effect of multiple dimensions of lifestyle on risky drinking during the Covid-19 pandemic.

Lifestyle impacts morbidity and mortality worldwide. Herein, we evaluated the association of a multidimensional lifestyle measure and its domains (diet/nutrition, substance use, physical activity, social, stress management, sleep, environmental exposure) with risky drinking. Also, we analyzed the cumulative effect of unhealthy domains in the likelihood of presenting risky drinking. To reach these objectives, data from a web survey conducted in Brazil and Spain was analyzed. The main outcome was risky drinking assessed by the AUDIT-C. Lifestyle was measured using the Short Multidimensional Inventory Lifestyle Evaluation (SMILE). Fixed logistic models were used to evaluate associations between lifestyle and risky drinking. Between April and May 2020, 22,785 individuals answered the survey. The prevalence of risky drinking was 45.6% in Brazil and 30.8% in Spain. The SMILE score was lower (unhealthier lifestyle) among at-risk drinkers. Worse scores on Diet, Substance use, Stress management and Environment were associated with an increased likelihood of risky drinking. The higher the number of unhealthy domains, the higher the likelihood of presenting risky drinking: adjusted odds ratio (aOR) for risky drinking was 1.15 (IC95% 0.98-1.35) and 23.42 (IC95% 3.08-178.02) for those presenting worse lifestyle in 1 and 5 domains, respectively. Finally, interactions suggest that improvement in lifestyle domains would have a larger effect in Spain than in Brazil. Our results suggest that future interventions aiming at reducing Risky drinking may benefit from strategies targeting multiple domains of lifestyle.

Substance use, self-rated health and HIV status in Brazil.

ABSTRACTWe compared the prevalence of of non-injecting drug use (NIDU) and Self-Rated Health (SRH) among individuals self-reporting as HIV-positive (PLWHA), HIV-negative and unknown at the III Brazilian Household Survey on Substance Use. Overall, 16,273 individuals, 12-65 years old, were interviewed in 2015. Prevalence and Standard Error (SE) were estimated considering the complex sample design and weight calibration. Chi-square tests with Rao-Scott adjustment were used to test independence between NIDU, SRH and HIV status. PLWHA presented higher frequencies of 12-month use for most substances than those reporting to be HIV-negative: alcohol use prevalence was 49.5% (SE 12.8) vs. 43.1% (SE 0.7), p = 0.34; tobacco 45.3% (SE 12.7) vs. 15.3% (SE 0.4), p < 0.01; amphetamines 1.7% (SE 1.7) vs. 0.3% (SE 0.1), p = 0.51; cannabis 10.5%(SE 6.7) vs. 2.5%(0.2), p = 0.06; powder cocaine 3.6% (SE 3.0) vs. 0.9% (SE 0.1), p = 0.45; crack-cocaine 5.3% (SE 3.2) vs. 0.3% (SE 0.1), p < 0.01; inhalants 3.6% (SE 3.0) vs. 0.2% (SE 0), p = 0.03; ketamine 1.7%(SE 1.7) vs. 0.1% (SE 0), p = 0.23; and opioids 1.7% (SE 1.7) vs. 1.4% (SE 0.2), p = 0.93. PLWHA also reported worse SRH. Our results and the scarcity of integrated substance use and HIV treatments call for innovative, cost-effective approaches to tackle these public health challenges.

Depression, Anxiety, and Lifestyle Among Essential Workers: A Web Survey From Brazil and Spain During the COVID-19 Pandemic.

BACKGROUND: Essential workers have been shown to present a higher prevalence of positive screenings for anxiety and depression during the COVID-19 pandemic. Individuals from countries with socioeconomic inequalities may be at increased risk for mental health disorders. OBJECTIVE: We aimed to assess the prevalence and predictors of depression, anxiety, and their comorbidity among essential workers in Brazil and Spain during the COVID-19 pandemic. METHODS: A web survey was conducted between April and May 2020 in both countries. The main outcome was a positive screening for depression only, anxiety only, or both. Lifestyle was measured using a lifestyle multidimensional scale adapted for the COVID-19 pandemic (Short Multidimensional Inventory Lifestyle Evaluation-Confinement). A multinomial logistic regression model was performed to evaluate the factors associated with depression, anxiety, and the presence of both conditions. RESULTS: From the 22,786 individuals included in the web survey, 3745 self-reported to be essential workers. Overall, 8.3% (n=311), 11.6% (n=434), and 27.4% (n=1027) presented positive screenings for depression, anxiety, and both, respectively. After adjusting for confounding factors, the multinomial model showed that an unhealthy lifestyle increased the likelihood of depression (adjusted odds ratio [AOR] 4.00, 95% CI 2.72-5.87), anxiety (AOR 2.39, 95% CI 1.80-3.20), and both anxiety and depression (AOR 8.30, 95% CI 5.90-11.7). Living in Brazil was associated with increased odds of depression (AOR 2.89, 95% CI 2.07-4.06), anxiety (AOR 2.81, 95%CI 2.11-3.74), and both conditions (AOR 5.99, 95% CI 4.53-7.91). CONCLUSIONS: Interventions addressing lifestyle may be useful in dealing with symptoms of common mental disorders during the strain imposed among essential workers by the COVID-19 pandemic. Essential workers who live in middle-income countries with higher rates of inequality may face additional challenges. Ensuring equitable treatment and support may be an important challenge ahead, considering the possible syndemic effect of the social determinants of health.

Utility of oral fluid samples for hepatitis B antibody detection in real life conditions.

BACKGROUND: Hepatitis B virus (HBV) testing in oral fluid samples may provide advantages in diagnosis, screening or prevalence studies, especially among individuals with venous access difficulties. This study aims to optimize one commercially available assay for detecting total anti-HBc marker in oral fluid samples and to evaluate its utility under real life conditions in different settings for the purposes of prevalence and diagnostic studies. METHODS: Oral fluid was collected using a Salivette device and some parameters were initially evaluated: type of elution buffer and sample volume. Thereafter, the utility of oral fluid samples for detection of anti-HBc was evaluated in real life conditions in which, 1296 individuals gave serum and oral fluid samples. All serum samples were submitted to commercial EIAs to detect total anti-HBc, according to the manufacturer's instructions and oral fluid samples according to previous optimization. RESULTS: In optimization evaluation, PBS/BSA 0.5% and 100 µL of oral fluid (volume was two-fold increased compared to serum in EIA) were chosen as transport buffer and sample volume. In the field study, anti-HBc was detected in 211 out of 1296 serum samples giving overall oral fluid sensitivity of 52.6% and specificity of 96%. Concordance was higher in ambulatory setting (67.7) compared to general population (31.8). Mean ± standard deviation values of optical density/cutoff (OD/CO) in serum samples were higher in false-negative oral fluid samples than those seen in true positive samples. Sensitivity was higher in those presenting active infection compared to anti-HBc isolate and past infection. Sensitivity also increased in the ambulatory group when HCV individuals were excluded. CONCLUSIONS: It was possible to optimize a commercial EIA for detecting anti-HBc in oral fluid samples and where the highest concordance was found in ambulatory settings and among individuals with active infection.

Alcohol use disorder in people with infectious and chronic diseases and mental disorders: Brazil, 2015. / Transtornos relacionados ao uso de álcool entre pessoas com doenças infecciosas, crônicas e mentais: Brasil, 2015.

The study aimed to estimate the prevalence of alcohol use disorder (AUD) and associated factors in Brazilian adults that reported chronic noncommunicable diseases (NCDs), mental disorders (MDs), and infectious diseases (IDs). This was a secondary analysis of the 3rd National Survey on Drug Use by the Brazilian Population in which the principal outcome was presence of AUD. Prevalence of AUD was estimated for three subgroups: individuals that reported NCDs, MDs, and IDs. Factors associated with AUD in each group were analyzed using logistic regression models. Of the 15,645 adults interviewed, 30.5% (95%CI: 29.4-31.5) reported NCDs, 17.6% (95%CI: 16.5-18.7) MDs, and 1.6% (95%CI: 1.2-1.9) IDs. Considering comorbidities, the analytical sample was 6,612. No statistically significant difference was found in the prevalence of AUD between individuals with NCDs (7.5% [95%CI: 6.1- 8.7]), MDs (8.4% [95%CI: 6.7-10.2]), and IDs (12.4% [95%CI: 7.0-17.8]). The main factors associated with AUD in all the groups were male sex and young adult age. Considering the high prevalence of AUD in all the groups, systematic screening of AUD is necessary in health services that treat NCDs, MDs, and IDs.

O objetivo do artigo é estimar a prevalência de transtornos relacionados ao uso de álcool (TRA) e fatores associados entre indivíduos da população brasileira que reportaram doenças crônicas não-transmissíveis (DCNT), transtornos mentais (TM) e doenças infeciosas (DI). Análise secundária do III Levantamento Nacional sobre o Uso de Drogas pela População Brasileira, cujo desfecho principal foi a presença de TRA. A prevalência de TRA foi estimada para três subgrupos: indivíduos que reportaram DCNT, TM e DI. Os fatores associados a TRA dentro de cada grupo foram analisados utilizando modelos de regressão logística. Dos 15.645 adultos entrevistados, 30,5% (IC95%: 29,4-31,5) reportaram DCNT, 17,6% (IC95%: 16,5-18,7) TM e 1,6% (IC95%: 1,2-1,9) DI. Considerando as comorbidades, a amostra analítica foi de 6.612. Não foi encontrada diferença estatisticamente significativa na prevalência de TRA entre indivíduos com DCNT (7,5% [IC95% 6,1-8,7]), TM (8,4% [IC95% 6,7-10,2]) e DI (12,4% [IC95% 7,0-17,8]). Os principais fatores associados a TRA, em todos os grupos, foram ser do sexo masculino e jovem. Considerando a alta prevalência de TRA em todos os grupos é necessário seu rastreio sistemático em serviços de saúde que atendam DCNT, TM e DI.

Prevalence of HIV infection among transgender women and travestis in Brazil: data from the TransOdara study.

OBJECTIVE: The aim of this study was to investigate the prevalence of human immunodeficiency virus (HIV) infection among transgender women and travestis and to analyze factors associated with HIV infection in Brazil. METHODS: TransOdara was a cross-sectional study on sexually transmitted infections among transgender women and travestis in five Brazilian cities between 2019 and 2021. Self-identified transgender women and travestis aged ≥18 years were recruited using respondent-driven sampling, completed an interviewer-led questionnaire, and provided samples to detect HIV. The outcome was the result of the rapid antigen testing for HIV. Adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) were obtained using Poisson regression with robust variance. RESULTS: Overall, this population was found to be especially vulnerable, with high levels of unstable housing and engagement in informal work. They usually resort to transactional sex as their main working activity. Half of them earned less than the Brazilian minimum wage, which characterizes a poor population living in dire conditions. The overall HIV prevalence was 34.40%. In the final model, the variables associated with the HIV prevalence were as follows: to be 31 years old or older, not studying at the moment they were interviewed, to be unemployed, and engaged in lifetime transactional sex. CONCLUSION: We found disproportionately high HIV prevalence among transgender women and travestis, compared with a low prevalence among respective segments of Brazil's general population, which highlights the context of vulnerability in this population. The data point to the urgency for intensification and expansion of access to HIV prevention and strategies to stop discrimination in health care (among other services and contexts) and provide comprehensive services for this population.

Multiple substance use and associated factors in transgender women and travestis: findings from the TransOdara Study, Brazil.

OBJECTIVE: To estimate the prevalence of concomitant substance consumption and analyze associated risk factors in a non-probabilistic sample of the Brazilian population of transgender women and travestis. METHODS: A cross-sectional study was conducted with recruitment via respondent-driven sampling. The sample included transgender women and travestis residing in São Paulo, Porto Alegre, Salvador, Manaus, and Campo Grande, aged 18 years or older, between 2019 and 2021. The outcome was the concomitant use of licit and illicit substances. The association between sociodemographic/behavioral factors and the outcome was analyzed through Poisson regression with mixed effects. Adjusted prevalence ratios (confidence interval of 95% - 95%CI) were estimated. RESULTS: The prevalence in the last 12 months of multiple substance use was 49.3%, of which 65.5% were alcohol, 52.9% tobacco, and 40.1% marijuana. Transgender women and travestis who use multiple substances face more violence (1.71; 95%CI 1.14-2.55), unemployment (1.58; 95%CI 1.05-2.37) and pervasive unstable work status (1.52; 95%CI 1.08-2.14), transactional sex (1.51; 95%CI 1.21-1.88) which can be their sole option to make a living, and are aged 18 to 24 years (1.37; 95%CI 1.14-1.65). CONCLUSION: The use of multiple substances may be an attempt to cope with distress and marginalization. Substance use has been associated with multiple harms and medical conditions. Comprehensive management and care should be provided, as defined by the key principles of the Brazilian Unified Health System. Health care should be integrated into structural interventions.

Lifestyle changes during the COVID-19 pandemic in Brazil: results from three consecutive cross-sectional web surveys.

OBJECTIVE: The importance of a healthy lifestyle in preventing morbidity and mortality is well-established. The COVID-19 pandemic brought about significant lifestyle changes globally, but the extent of these changes in the Brazilian population remains unclear. The objective of this study was to evaluate changes in lifestyle among the Brazilian general population during the first year of the pandemic. DESIGN: Three consecutive anonymous web surveys were carried out: survey 1 (S1)-April 2020, S2-August 2020 and S3-January 2021. SETTING: Brazil. PARTICIPANTS: The study included 19 257 (S1), 1590 (S2) and 859 (S3) participants from the general population, who were ≥18 years, of both sexes, with access to the internet, self-reporting living in Brazil and who agreed to participate after reading the informed consent. PRIMARY OUTCOME: Lifestyle changes were assessed using the Short Multidimensional Instrument for Lifestyle Evaluation-Confinement (SMILE-C). The SMILE-C assesses lifestyle across multiple domains including diet, substance use, physical activity, stress management, restorative sleep, social support and environmental exposures. We used a combination of bootstrapping and linear fixed-effect modelling to estimate pairwise mean differences of SMILE-C scores overall and by domain between surveys. RESULTS: In all the surveys, participants were mostly women and with a high education level. Mean SMILE-C scores were 186.4 (S1), 187.4 (S2) and 190.5 (S3), indicating a better lifestyle in S3 as compared with S1. The pairwise mean differences of the overall SMILE-C scores were statistically significant (p<0.001). We also observed a better lifestyle over time in all domains except for diet and social support. CONCLUSIONS: Our findings indicate that individuals from a large middle-income country, such as Brazil, struggled to restore diet and social relationships after 1 year of the pandemic. These findings have implications for monitoring the long-term consequences of the pandemic, as well as future pandemics.

U-SMILE: a brief version of the Short Multidimensional Inventory on Lifestyle Evaluation.

INTRODUCTION: Lifestyle Medicine comprises six domains: diet, substance use, physical activity, stress management, social connection, and sleep. The comprehensive assessment of lifestyle is challenging, but the "Short Multidimensional Inventory on Lifestyle Evaluation" (SMILE) was developed to fill out this gap. In this paper, we describe the development and the psychometric properties (internal consistency, concurrent and convergent validity) of a shorter version of the SMILE among university students. METHODS: Data from a cross-sectional study including 369 students from 10 Brazilian universities were used. Considering a theoretical nomological net, we performed exploratory factor analysis to obtain the most parsimonious, interpretable and good-fitting model. RESULTS: The final model was called U-SMILE, comprised 24 items, and presented acceptable internal consistency (Cronbach's α = 0.73, McDonald's ω = 0.79). To evaluate the concurrent validity of the U-SMILE, we compared it to the original SMILE and found a high correlation between the instruments (Spearman's r= 0.94). Furthermore, we evaluated convergent validity by examining the U-SMILE correlation with the PHQ-9 (Spearman's r= -0.517), and GAD-7 (Spearman's r= -0.356), two validated instruments to screen for depression and anxiety, respectively. DISCUSSION: Our findings suggest that the U-SMILE is a valid instrument for assessing lifestyle among university students. We recommend that the use of U-SMILE to evaluate overall lifestyle scores rather than individual domain scores. Finally, we discuss the importance of clarifying the definitions of lifestyle and related constructs in future research.

Would the Brazilian population support the alcohol policies recommended by the World Health Organization?

OBJECTIVE: To evaluate the support of the Brazilian population to the alcohol-policies proposed by the World Health Organization to decrease alcohol harm (specifically: to decrease alcohol availability and advertising, and to increase pricing). In addition, we evaluated the factors associated with being against those policies. METHODS: Data from 16,273 Brazilians, aged 12-65 years, interviewed in the 3rd Brazilian Household Survey on Substance Use (BHSU-3) were analyzed. The BHSU-3 is a nationwide, probability survey conducted in 2015. Individuals were asked if they would be against, neutral, or in favor of seven alcohol policies grouped as: 1) Strengthen restrictions on alcohol availability; 2) Enforce bans or restrictions on alcohol advertising, sponsorship, and promotion; and 3) Raise prices on alcohol through excise taxes and pricing. Generalized linear models were fitted to evaluate factors associated with being against each one of those policies and against all of policies. RESULTS: Overall, 28% of the Brazilians supported all the above mentioned policies, whereas 16% were against them. The highest rate of approval refers to restricting advertising (53%), the lowest refers to increasing prices (40%). Factors associated with being against all policies were: being male (AOR = 1.1; 95%CI: 1.0-1.3), not having a religion (AOR = 1.4; 95%CI: 1.1-1.8), being catholic (AOR = 1.3; 95%CI: 1.1-1.5), and alcohol dependence (AOR = 1.6; 95%CI: 1.1-2.4). CONCLUSIONS: The Brazilian government could count on the support of most of the population to restrict alcohol advertising. This information is essential to tackle the lobby of the alcohol industry and its clever marketing strategy.

Housing characteristics of crack cocaine users in Northeast Brazil, 2011-2013. / Características de usuários de crack quanto à situação de moradia no Nordeste brasileiro, 2011-2013.

We compared sociodemographic characteristics, substance use patterns, sexual behavior, use of health services, and criminal records of homeless vs. domiciled users. Data are from the Brazilian National Survey on Crack Use. A discriminant model and correspondence analysis cross-compared characteristics of users according to their housing status. The logistic model revealed associations between "living in the streets" and female gender and intermittent work. "Homelessness" was also associated with the use of tobacco and "oxi" in the previous 30 days, reliance on soup kitchens, low access to public mental health services, and arrests in the previous year. Correspondence analysis highlighted the spatial proximity of the variables as follows: "having traded sex for drugs", "informal work", "age 31 years or older", "access to public mental health services", "problems with law enforcement", and female gender with homeless crack users. People who smoke crack cocaine in Northeast Brazil are seldom studied. Their profiles, stratified according to their housing conditions, show subgroups with specific characteristics. While domiciled users have access to specialized clinics, homeless users basically reported access to free food and harm reduction services.

Objetivou-se comparar características sociodemográficas, padrões de consumo de substâncias, comportamento sexual, utilização de serviços de saúde e envolvimento criminal de usuários, domiciliados e em situação de rua. Dados secundários do Inquérito Nacional sobre Uso do Crack, utilizando análise discriminante e de correspondência para comparar características dos usuários segundo condição de moradia. O modelo final de regressão logística evidenciou associações entre "situação de rua" e ser do sexo feminino, trabalho descontínuo, consumo de tabaco e "oxi" nos últimos 30 dias, uso de serviços de alimentação gratuita, baixo acesso a tratamento e frequentes detenções no último ano. Na análise de correspondência observou-se proximidade no espaço analítico de "troca de sexo por drogas", "trabalho informal", "idade" >31 anos, "baixo acesso a CAPS-ad", "problemas com a justiça criminal" e "sexo feminino" com os usuários de crack desabrigados. Pouco se sabe sobre usuários de crack em contexto na região Nordeste do Brasil. Os resultados evidenciam dois subgrupos com características específicas. Enquanto os domiciliados têm acesso aos serviços de CAPS-ad e outras clínicas especializadas, os usuários em situação de rua relataram, basicamente, acesso a serviços de alimentação gratuita e redução de danos.

Underage drinking in Brazil: findings from a community household survey.

OBJECTIVES: Previous studies have estimated the 30-day prevalence of alcohol use to be approximately 21% among youth in Brazil, despite the legal drinking age of 18 years. The present study aimed to determine the prevalence of underage drinking and its associated factors among adolescents in Brazil. METHODS: The 3rd National Survey on Drug Use by the Brazilian Population (III Levantamento Nacional sobre o Uso de Drogas pela População Brasileira) is a nationwide, multi-stage, probability-sample household survey. Herein, youth between the ages of 12-17 years were included. Lifetime and 12-month alcohol use prevalence were estimated. Factors associated with 12-month alcohol use were evaluated through multivariate analysis considering survey weights and design. RESULTS: Overall, 628 youth were interviewed. Estimated lifetime and 12-month alcohol use were 34.3% (standard error [SE] = 1.9) and 22.2% (SE = 1.7), respectively. Factors associated with 12-month drinking were: other/no religion vs. Christianity; living in rural vs. urban areas; self-reported diagnosis of depression vs. no self-reported depression; lifetime tobacco use vs. no history of tobacco use; and any illicit drug use vs. no history of illicit drug use. CONCLUSION: Considering that alcohol use is a major risk factor for early death among Brazilian youth, our findings highlight the importance of preventative measures to reduce underage drinking.

Performance of HCV Antigen Testing for the Diagnosis and Monitoring of Antiviral Treatment: A Systematic Review and Meta-Analysis.

BACKGROUND AND AIMS: Active hepatitis C virus (HCV) infection is based on the detection of HCV RNA that it is effective but presents high cost and the need to hire trained personnel. This systematic review and meta-analysis is aimed at evaluating the diagnostic accuracy of HCV Ag testing to identify HCV cases and to monitor antiviral treatment including DAA treatment. METHODS: The studies were identified through a search in PubMed, Lilacs, and Scopus from 1990 through March 31, 2020. Cohort, cross-sectional, and randomized controlled trials were included. Two independent reviewers extracted data and assessed quality using an adapted Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Our primary outcome was to determine the accuracy of HCV Ag detection for the diagnosis, which we estimated using random-effects meta-analysis. RESULTS: Of 3,062 articles identified, 54 met our eligibility criteria. The studies described cohorts from 20 countries, including 14,286 individuals with chronic HCV individuals. Studies for ECLIA technology demonstrated highest quality compared to studies that used ELISA. The pooled sensitivity and specificity (95% CI) for HCV Ag detection of active HCV infection were 98.82% (95%CI = 98.04%; 99.30%) and 98.95% (95%CI = 97.84%; 99.49%), respectively. High concordance was found between HCV Ag testing and HCV RNA detection 89.7% and 95% to evaluate antiviral treatment. CONCLUSIONS: According to our findings, HCV Ag testing could be useful to identify HCV active cases in low-resource areas. For antiviral treatment, HCV Ag testing will be useful at the end of treatment.

Lifestyle predictors of depression and anxiety during COVID-19: a machine learning approach.

INTRODUCTION: Recent research has suggested an increase in the global prevalence of psychiatric symptoms during the COVID-19 pandemic. This study aimed to assess whether lifestyle behaviors can predict the presence of depression and anxiety in the Brazilian general population, using a model developed in Spain. METHODS: A web survey was conducted during April-May 2020, which included the Short Multidimensional Inventory Lifestyle Evaluation (SMILE) scale, assessing lifestyle behaviors during the COVID-19 pandemic. Depression and anxiety were examined using the PHQ-2 and the GAD-7, respectively. Elastic net, random forest, and gradient tree boosting were used to develop predictive models. Each technique used a subset of the Spanish sample to train the models, which were then tested internally (vs. the remainder of the Spanish sample) and externally (vs. the full Brazilian sample), evaluating their effectiveness. RESULTS: The study sample included 22,562 individuals (19,069 from Brazil, and 3,493 from Spain). The models developed performed similarly and were equally effective in predicting depression and anxiety in both tests, with internal test AUC-ROC values of 0.85 (depression) and 0.86 (anxiety), and external test AUC-ROC values of 0.85 (depression) and 0.84 (anxiety). Meaning of life was the strongest predictor of depression, while sleep quality was the strongest predictor of anxiety during the COVID-19 epidemic. CONCLUSIONS: Specific lifestyle behaviors during the early COVID-19 epidemic successfully predicted the presence of depression and anxiety in a large Brazilian sample using machine learning models developed on a Spanish sample. Targeted interventions focused on promoting healthier lifestyles are encouraged.

Persistently high hepatitis C rates in haemodialysis patients in Brazil [a systematic review and meta-analysis].

We conducted a systematic review and meta-analysis of studies assessing HCV infection rates in haemodialysis patients in Brazil (Prospero CRD #42021275068). We included studies on patients under haemodialysis, comprising both convenience samples and exhaustive information from selected services. Patients underwent HCV serological testing with or without confirmation by HCV RNA PCR. Exclusion criteria were the following: absence of primary empirical information and studies without information on their respective settings, study year, accurate infection rates, or full specification of diagnostic tests. Studies with samples ≤ 30 and serial assessments with repeated information were also excluded. Reference databases included PubMed, LILACS, Scopus, and Web of Science for the period 1989-2019. A systematic review was carried out, followed by two independent meta-analyses: (i) studies with data on HCV prevalence and (ii) studies with a confirmatory PCR (i.e., active infection), respectively. A comprehensive set of different methods and procedures were used: forest plots and respective statistics, polynomial regression, meta-regression, subgroup influence, quality assessment, and trim-and-fill analysis. 29 studies and 11,290 individuals were assessed. The average time patients were in haemodialysis varied from 23.5 to 56.3 months. Prevalence of HCV infection was highly heterogeneous, with a pronounced decrease from 1992 to 2001, followed by a plateau and a slight decrease in recent years. The summary measure for HCV prevalence was 34% (95% CI 26-43%) for studies implemented before 2001. For studies implemented after 2001, the corresponding summary measure was 11% (95% CI 8-15%). Estimates for prevalence of active HCV infection were also highly heterogeneous. There was a marked decline from 1996 to 2001, followed by a plateau and a slight increase after 2010. The summary measure for active HCV infection was 19% (95% CI 15-25%) in studies carried out before 2001. For studies implemented after 2001, the corresponding summary measure was 9% (95% CI 6-13%). Heterogeneity was pervasive, but different analyses helped to identify its underlying sources. Besides the year each study was conducted, the findings differed markedly between geographic regions and were heavily influenced by the size of the studies and publication biases. Our systematic review and meta-analysis documented a substantial decline in HCV prevalence among Brazilian haemodialysis patients from 1992 to 2015. CKD should be targeted with specific interventions to prevent HCV infection, and if prevention fails, prompt diagnosis and treatment. Although the goal of HCV elimination by 2030 in Brazil remains elusive, it is necessary to adopt measures to achieve micro-elimination and to launch initiatives towards targeted interventions to curb the spread of HCV in people with CKD, among other high-risk groups. This is of particular concern in the context of a protracted COVID-19 pandemic and a major economic and political crisis.

Health inequalities in Rio de Janeiro, Brazil: lower healthy life expectancy in socioeconomically disadvantaged areas.

OBJECTIVES: We investigated deprivation and inequalities in life expectancy and healthy life expectancy by location in Rio de Janeiro, Brazil. METHODS: We conducted a health survey of 576 adults in 2006. Census tracts were stratified by income level and categorization as a slum. We determined health status by degree of functional limitation, according to the approach proposed by the World Health Organization. We calculated healthy life expectancies by Sullivan's method with abridged life table. RESULTS: We found the worst indicators in the slum stratum. The life expectancy at birth of men living in the richest parts of the city was 12.8 years longer than that of men living in deprived areas. For both men and women older than age 65 years, healthy life expectancy was more than twice as high in the richest sector as in the slum sector. CONCLUSIONS: Our analysis detailed the excess burden of poor health experienced by disadvantaged populations of Rio de Janeiro. Policy efforts are needed to reduce social inequalities in health in this city, especially among the elderly.

Comparison between two race/skin color classifications in relation to health-related outcomes in Brazil.

BACKGROUND: This paper aims to compare the classification of race/skin color based on the discrete categories used by the Demographic Census of the Brazilian Institute of Geography and Statistics (IBGE) and a skin color scale with values ranging from 1 (lighter skin) to 10 (darker skin), examining whether choosing one alternative or the other can influence measures of self-evaluation of health status, health care service utilization and discrimination in the health services. METHODS: This is a cross-sectional study based on data from the World Health Survey carried out in Brazil in 2003 with a sample of 5000 individuals older than 18 years. Similarities between the two classifications were evaluated by means of correspondence analysis. The effect of the two classifications on health outcomes was tested through logistic regression models for each sex, using age, educational level and ownership of consumer goods as covariables. RESULTS: Both measures of race/skin color represent the same race/skin color construct. The results show a tendency among Brazilians to classify their skin color in shades closer to the center of the color gradient. Women tend to classify their race/skin color as a little lighter than men in the skin color scale, an effect not observed when IBGE categories are used. With regard to health and health care utilization, race/skin color was not relevant in explaining any of them, regardless of the race/skin color classification. Lack of money and social class were the most prevalent reasons for discrimination in healthcare reported in the survey, suggesting that in Brazil the discussion about discrimination in the health care must not be restricted to racial discrimination and should also consider class-based discrimination. The study shows that the differences of the two classifications of race/skin color are small. However, the interval scale measure appeared to increase the freedom of choice of the respondent.