Preventing cognitive decline via digital inclusion and virtual game management: an intervention study with older adults in the community.

OBJECTIVE: To evaluate the impact of cognitive stimulation via digital inclusion and the practice of video games on the cognition of the older population. METHOD: This is a randomized controlled intervention study, nested in a population cohort study. Based on the application of the Clinical Dementia Rating (CDR) test, individuals aged 60 years or older with scores 0 and 0.5 were included and randomly allocated in the Intervention Group (IG) or Control Group (CG). Initially, 160 participants met the selection criteria and underwent neuropsychological evaluation via the Montreal Cognitive Assessment (MoCA), applied before and after intervention. The IG (n = 62) participated in computer-based intervention once a week for one-and-a-half hours, for 4 months. The CG (n = 47) participated in the mindfulness workshops held in the same period. RESULTS: The digital literacy intervention group averaged 2.6 points more in the MoCA after 4 months. The change in the final MoCA decreased in 0.46 points at each unit in the basal MoCA. Individuals with average schooling had an increase of 0.93 points in the change of the MoCA in relation to individuals with low or high schooling. CONCLUSION: Digital inclusion combined with the practice of video games has the potential to improve the cognition of the older population.

Use of integrative and complementary health practices by Brazilian population: results from the 2019 National Health Survey.

BACKGROUND: In 2006, Brazil implemented the National Policy on Integrative and Complementary Practices of the SUS. and in 2015, the Brazilian Ministry of Health issued a reinforcement to this policy to increase access to integrative and complementary health practices (ICHP). In this study, we described the prevalence of ICHP in Brazilian adults according to their sociodemographic characteristics, self-perceived health, and chronic diseases. METHODS: This is a nationally representative cross-sectional survey including 64,194 participants from the 2019 Brazilian National Health Survey. Types of ICHP were categorized according to their purposes: health promotion (Tai chi/Lian gong/Qi gong, yoga, meditation, and integrative community therapy) or therapeutic practices (acupuncture, auricular acupressure, herbal treatment and phytotherapy, and homeopathy). Participants were classified as non-practitioners and practitioners, who in turn were grouped according to use of ICHP in the last 12 months: only used health promotion practices (HPP); only used therapeutic practices (TP); used both (HPTP). Multinomial logistic regressions were performed to estimate the associations of ICHP with sociodemographic characteristics, self-perceived health status, and chronic diseases. RESULTS: Brazilian adults showed an ICHP use prevalence of 6.13% [95%CI = 5.75-6.54]. Compared to non-practitioners, women and middle-aged adults were more likely to use any ICHP. Afro-Brazilians were less likely to use both HPP and HPTP, whereas Indigenous people were more likely to use both HPP and TP. We found a positive gradient of association among participants with higher income and educational attainment and access to any ICHP. People from rural areas and those with negative self-perceived health were more likely to use TP. Participants with arthritis/rheumatism, chronic back problems, and depression were more likely to use any ICHP. CONCLUSIONS: We found that 6% of Brazilian adults reported using ICHP in the previous 12 months. Women, middle-aged individuals, chronic patients, people with depression, and wealthier Brazilians are more likely to use any type of ICHP. Of note, rather than suggesting to expand the offer of these practices in the Brazilian public health system, this study diagnosed Brazilians' behavior of seeking for complementary healthcare.

Panorama of Intimate Partner Violence Against Women in Brazil and its Association With Self-Perception of Health: Findings From a National Representative Survey.

Intimate partner violence (IPV) is a challenge in Brazil. The country holds one of the highest rates of femicide in the world, most of which are preceded by IPV. We conducted a cross-sectional study with 34,334 women, aged 18 to 59 years, from the 2019 Brazilian National Health Survey to analyze the prevalence of IPV and its subtypes among the Brazilian adult women in the last 12 months, encompassing their health consequences and the use of health services resulting from IPV. We also used logistic regression models to estimate the association of sociodemographic characteristics and self-perceived health status with IPV. The prevalence of IPV among Brazilian adult women in the last 12 months was 7.6% (95% confidence interval [CI] [7.0, 8.2]). Women aged 18 to 39 years, not married, and with income of up to 1 minimum wage (MW), had higher odds of suffering IPV. Among those who reported health consequences due to IPV, 69% reported psychological consequences, and 13.9% sought health care, mostly in primary or secondary health care services in the Brazilian Unified Health System (41.9%). Regarding the self-perceived health variables, women who reported eating problems (odds ratio [OR] = 1.29; [1.01, 1.65]), lack of interest/absence of pleasure (OR = 1.41; [1.11, 1.79]), depressive feelings (OR = 1.39; [1.03, 1.88]), feeling of failure (OR = 1.75; [1.36, 2.24]), and suicidal thoughts (OR = 1.73; [1.25, 2.41]) had greater odds of reporting IPV compared to those who did not report these same perceptions. The results show that younger, divorced or single, low-income women with eating problems and mental health disorders were more likely to suffer IPV. IPV often led to health problems, and many abused women sought support from public health services. Health professionals must be trained to identify and care for these women, thereby acting as allies in preventing and reducing IPV.

Effectiveness of D.A.R.E/Keepin' it REAL bullying prevention program among Brazilian students.

INTRODUCTION: Given the growing scientific evidence on the detrimental effects of bullying, several prevention programs have been implemented internationally to prevent this behavior among students. Brazil's Educational Program for Drug and Violence Resistance (PROERD) is an adaptation of US' DARE/Keepin' it REAL program, being the most widespread school-based prevention program in the country. However, it has been offered without any effectiveness evaluation. As such, this study evaluates the effectiveness of PROERD in reducing bullying perpetration and victimization among students. METHODS: Two cluster randomized controlled trials were carried out with 4030 students (1727 5th graders and 2303 7th graders) in 30 public schools in São Paulo, Brazil. The intervention group attended 10 PROERD classes taught by trained police officers whereas the control group underwent no intervention. Data were collected by self-administered questionnaires using smartphones at two moments (baseline preintervention and 9-month follow-up). Multilevel analysis included two paradigms, complete cases (CC) and intention-to-treat (ITT), using Full Information Maximum Likelihood (FIML) and Multiple Imputation (MI). RESULTS AND CONCLUSION: Results show no statistical difference between groups, indicating lack of evidence on PROERD's effectiveness in preventing bullying behaviors. The insufficient number of classes on bullying prevention and the lack of cultural adaptation may explain these unexpected results. New in-depth evaluation studies concerning the program's components and process are needed.

Reduced circulating folate among older adults caused by continuous work: nested cross-sectional study conducted in a country with folic acid fortification program.

Population aging is 1 of the biggest challenges facing public health today, and cognitive dysfunction is an important concern. Cognitive impairment may be associated with high folate concentrations and low vitamin B12 concentrations; the latter is a common problem among elderly people. Therefore, we hypothesized there was a high circulating folate concentration among older people living in a country with a mandatory folic acid fortification program. We conducted a cross-sectional study to investigate nutritional status of folate and vitamin B12 among aged people. Three dietary recalls, serum folate (sfolate), erythrocyte (red blood cell) folate (RBC folate), and serum vitamin B12 and homocysteine were collected. Linear regression models were used to investigate factors associated with circulating vitamins. We interviewed 169 participants. Half reported inadequate consumption of folate. However, RBC folate deficiency was observed in 27%, 13% in the serum, and a 10% excess of sfolate. One-quarter reported inadequate consumption of B12, but only 5% had deficiency. Factors negatively associated with circulating folate were continuous work and smoking, and positively associated with polyunsaturated fatty acid. Factor negatively associated with the circulating B12 were use of a dental prosthesis and intake of saturated fatty acid. Permanent investigation of excess of sfolate and B12 deficiency, especially among older adults living in countries exposed to a mandatory folic acid fortification program, is important because of the possible relation to the cognitive function.

Effectiveness of a school-based substance use prevention program taught by police officers in Brazil: Two cluster randomized controlled trials of the PROERD.

BACKGROUND: The Drug and Violence Resistance Educational Program (PROERD) is widely disseminated and implemented as a public policy in Brazil. PROERD's current curricula are the translation of the North American program DARE-Keepin'it REAL, based on the theories of socio-emotional learning and resistance training. The present study aims to evaluate the effectiveness of PROERD in the prevention of drug use. METHOD: Two PROERD curricula were analyzed through two cluster randomized controlled trials conducted with 4030 students (1727 5th graders and 2303 7th graders) in 30 public schools in São Paulo. The intervention group received ten PROERD classes delivered by trained police officers, and the control group received no intervention. Data collection was performed using self-administered questionnaires on smartphones at two points in time (baseline pre-intervention and nine months follow-up). The outcomes evaluated were initiation and recent drug use. Two different paradigms were used in a multilevel analysis: an analysis of complete cases (CC) and an intention to treat missing data through full information maximum likelihood and selection model. RESULTS: We found no evidence of the effectiveness of PROERD as an intervention for the prevention of drug use. For the conditional transition analysis, we found that 7th graders in the PROERD group who were already binge drinking at baseline had a significantly higher chance of maintaining this consumption pattern when compared to the control group. CONCLUSION: The lack of preventive effects found here suggests that a process evaluation may address concrete implementation and cultural adaptation issues.

Identification of pain in neonates: the adults' visual perception of neonatal facial features.

OBJECTIVE: To verify the visual attention of adults when assessing neonatal pain. STUDY DESIGN: 143 adults (59% health professionals) evaluated 20 pictures (2 pictures of 10 neonates' faces: at rest; during a painful procedure). Tobii-TX300 tracked the participants' eyes movement. For each picture, adults scored pain intensity (0 = no pain; 10 = maximum). Latent classes analysis was applied by cognitive diagnosis models-GDINA with two attributes (knowledge of pain presence/absence). Variables associated with belonging to the class of adults that correctly identified pictures of newborns with/without pain were identified by logistic regression. RESULTS: To identify neonatal pain, adults look at the mouth, eyes, and forehead in facial pictures. The latent class analysis identified four classes of adults: those that identify painful/painless neonates (YY-Class; n = 80); only painful neonates (n = 28); only painless neonates (n = 34) and none (n = 1). Being a health professional (OR: 2.29; 95% CI: 1.16-4.51), and each look at the nasolabial furrow (2.07; 1.19-3.62) increased the chance of belonging to the YY-class. CONCLUSIONS: Being a health professional and the visual fixation at the nasolabial furrow helped to identify the presence/absence of neonatal pain.

Neonatal mortality associated with perinatal asphyxia: a population-based study in a middle-income country.

BACKGROUND: It is challenging to decrease neonatal mortality in middle-income countries, where perinatal asphyxia is an important cause of death. This study aims to analyze the annual trend of neonatal mortality with perinatal asphyxia according to gestational age in São Paulo State, Brazil, during a 10-year period and to verify demographic, maternal and neonatal characteristics associated with these deaths. METHODS: Population-based study of neonatal deaths associated with perinatal asphyxia from 0 to 27 days in São Paulo State, Brazil, from 2004 to 2013. Perinatal asphyxia was considered as associated to death if intrauterine hypoxia, birth asphyxia or neonatal aspiration of meconium were noted in any line of the Death Certificate according to ICD-10. Poisson Regression was applied to analyze the annual trend of neonatal mortality rate according to gestational age. Kaplan-Meier curve was used to assess age at death during the 10-year study period. Hazard ratio of death during the neonatal period according to gestational age was analyzed by Cox regression adjusted by year of birth and selected epidemiological factors. RESULTS: Among 74,002 infant deaths in São Paulo State, 6648 (9%) neonatal deaths with perinatal asphyxia were studied. Neonatal mortality rate with perinatal asphyxia fell from 1.38‰ in 2004 to 0.95‰ in 2013 (p = 0.002). Reduction started in 2008 for neonates with 32-41 weeks, in 2009 for 28-31 weeks, and in 2011 for 22-27 weeks. Median time until 50% of deaths occurred was 25.3 h (95%CI: 24.0; 27.2). Variables independently associated with higher risk of death were < 7 prenatal visits, 1st minute Apgar score 0-3, and death at the same place of birth. Cesarean delivery compared to vaginal was protective against death with perinatal asphyxia for infants at 28-36 weeks. CONCLUSIONS: There was an expressive reduction in neonatal mortality rates associated with perinatal asphyxia during this 10-year period in São Paulo State, Brazil. Variables associated with these deaths highlight the need of public health policies to improve quality of regionalized perinatal care.

Adipokines in young survivors of childhood acute lymphocytic leukemia revisited: beyond fat mass.

PURPOSE: This cross-sectional study evaluated the relationship between adipokines (leptin, adiponectin, visfatin, and resistin) and adiposity indexes regarding sex and cranial radiotherapy exposure among young acute lymphocytic leukemia survivors. METHODS: A multivariate analysis of covariance (MANCOVA) was used to evaluate the joint effect of sex, cranial radiotherapy, and body mass index (BMI) z-score (model 1) or fat mass index (FMI) (model 2) on adipokines. RESULTS: This study included 55 survivors of childhood acute lymphocytic leukemia between 15 and 23 years of age from both sexes (56.4% female); 43.6% of the sample had undergone cranial radiotherapy (18-24 Gy). The BMI z-score, the FMI, and sex (P<0.050 for all) influenced at least one adipokine, while cranial radiotherapy exposure was marginal in model 2. Parameter estimates from the MANCOVA's final model showed that the BMI z-score (ß=-0.437, P=0.010) and the FMI (ß=-0.209, P=0.004) negatively influenced adiponectin, while the FMI positively affected resistin (ß=0.142, P=0.020). The relationship between leptin, visfatin, and the adiposity ndexes could not be established. In model 1, females presented with increased adiponectin (ß=-1.014, P=0.011) and resistin (ß=-1.067, P=0.002) levels; in model 2, female sex positively affected adiponectin (ß=-1.515, P=0.001) and marginally influenced resistin (ß=-0.707, P=0.054) levels. Cranial radiotherapy negatively determined visfatin levels in both final models (P<0.050). CONCLUSION: Changes in body fat may be associated with adipose tissue dysfunction and should be carefully evaluated in survivors of acute lymphocytic leukemia, considering both sex and cranial radiotherapy exposure, to treat disorders that may possibly aggravate their risk for early cardiovascular disease.

Abortion withdrawal of sexual violence pregnancy: the role of the sex offender / Desistência do abortamento de gestação decorrente de violência sexual: o papel do agressor sexual

INTRODUCTION: Unwanted pregnancy is a serious consequence for women who experience sexual violence. Although deciding on abortion is frequent in these cases, there is not much information on women who give up abortion in this circumstanceOBJECTIVE: To analyse the associated factors in abortion withdrawal of sexual violence pregnancyMETHODS: A cross-sectional epidemiological study with a convenience sample of adolescents and women with pregnancy due to sexual violence and requesting legal abortion between August 1994 and December 2012, at Hospital Pérola Byington, São Paulo, Brazil. Pregnant women who gave up abortion after receiving the procedure approval were included and, in another group, pregnant women who completed the abortion. The variables were selected from a digitized database and analyzed using SPSS 15.0 software. The outcome was abortion withdrawal. The study variables were age; low education level; gestational age; color/black ethnicity; not being united; declare religion; serious threat from the aggressor; known offender; and residence of the aggressor. Odds ratios with 95% confidence intervals were calculated. The analysis used Wald's chi-square test (χ2W) and logistic regression with variable of interest defined as the known aggressor. The research was approved by the Research Ethics Committee of the Federal University of São Paulo, Opinion No. 6767RESULTS: The study included 941 women, 849 (90.2%) who had an abortion and 92 (9.8%) who gave up after being approved. Age ranged from 10-46 years, mean 23.2 ± 7.9 years, gestational age 4-22 weeks, average 11.9 ± 4.5 weeks. Among those who gave up abortion, 12.0% were <14 years old; 50.0% had gestational age ≥ 13 weeks; 50.0% had low education; 14.2% were black; 90.2% single; 85.9% declared to have religion; 50.0% were threatened; 12.0% of the cases occurred at the perpetrator's residence and 53.3% of the victims were raped by known perpetrators. In logistic regression, the only significant variable was the known perpetrator, increasing the victim's chance of giving up abortion twiceCONCLUSION: The known sex offender has influenced the woman or adolescent's decision to give up legal abortion

INTRODUÇÃO: A gravidez forçada é uma grave consequência para mulheres que sofrem violência sexual. Embora decidir pelo aborto seja frequente nestes casos, há escassa informação sobre as mulheres que desistem de realizar ao aborto nessa circunstânciaOBJETIVO: Analisar os fatores associados na desistência do abortamento de gestação decorrente de violência sexualMÉTODO: A cross-sectional epidemiological study com amostra de conveniência de adolescentes e mulheres com gravidez decorrente de violência sexual e solicitação de aborto legal entre agosto de 1994 e dezembro de 2012, no Hospital Pérola Byington, São Paulo, Brasil. Foram incluídas gestantes que desistiram de realizar o aborto após receberem aprovação do procedimento e, em outro grupo, as gestantes que concluíram o aborto. As variáveis foram selecionadas de banco de dados digitalizado e analisadas em software SPSS 15.0. O desfecho foi desistência do aborto. As variáveis de estudo foram a idade, baixa escolaridade; idade gestacional; cor/etnia negra; não estar unida; declarar religião; grave ameaça do agressor; agressor conhecido; e residência do agressor. Foram calculadas as razões de chances (Odds Ratio) com intervalo de confiança de 95%. A análise utilizou teste de qui-quadrado de Wald (χ2W) e regressão logística com variável de interesse definida como o agressor conhecido. A pesquisa recebeu aprovação do Comitê de Ética e Pesquisa da Universidade Federal de São Paulo, Parecer nº 6767RESULTADOS: O estudo contou com 941 mulheres, sendo 849 (90,2%) que realizaram o aborto e 92 (9,8%) que desistiram após receberem aprovação. A idade variou de 10-46 anos, média 23,2±7,9 anos, com idade gestacional de 4-22 semanas, média 11,9±4,5 semanas. Entre as que desistiram do aborto, 12,0% tinham idade < 14 anos; 50,0% apresentaram idade gestacional ≥ 13 semanas; 50,0% tinham baixa escolaridade; 14,2% eram negras; 90,2% solteiras; 85,9% declararam ter religião; 50,0% sofreram ameaça; 12,0% dos casos ocorreram na residência do agressor e 53,3% das vítimas foram violentadas por agressores conhecidos. Na regressão logística, a única variável significante foi o agressor conhecido, aumentando em duas vezes a chance da vítima de desistir do abortoCONCLUSÃO: O agressor sexual conhecido exerceu influência na decisão da mulher ou adolescente de desistir do aborto legal

Educational interventions on nutrition among older adults: A systematic review and meta-analysis of randomized clinical trials.

Poor nutrition is a major risk factor for non-communicable diseases and nutritional deficiencies. Dietary interventions have been proposed to improve eating habits. The aim of this systematic review is to evaluate the efficacy of randomized clinical trials of nutritional interventions in food habits among older people. A systematic literature review using the MEDLINE, LILACS, Scopus, Cochrane Library, Web of Science and Google Scholar databases was conducted, according to PRISMA guidelines. The keywords were: food and nutrition education OR educación alimentaria y nutricional OR educação alimentar e nutricional AND clinical trial OR ensayo clínico OR ensaio clínico AND elderly OR aged OR anciano OR idoso AND human OR seres humanos. The pooled standardized mean differences (SMD) and 95 % confidence intervals (CIs) were estimated using a random-effects model. Heterogeneity among studies was assessed using I² tests. After screening based on the title and abstract, and a full-text assessment, 11 studies remained. Results of pooling eleven studies were as follows: SMD = 0.25 (95 % CI = 0.15 - 0.34; I² = 0,0%) for vegetable, SMD = 0.18 (95 % CI = 0.08 - 0.27; I² = 0,0%) for fruit and SMD = 0.27 (95 % CI = 0.18 - 0.36; I² = 58,3%) for fibre intake. Our results suggest that nutritional interventions were effective in increasing vegetable, fruit and fibre intake. However, these results should be analyzed carefully, due to the small number of studies included in the meta-analysis. Further studies should be encouraged due to the aging process.

Binge drinking and frequent or heavy drinking among adolescents: prevalence and associated factors / Binge drinking e beber frequente ou pesado entre os adolescentes: prevalência e fatores associados

Abstract Objective: To analyze the sociodemographic, school, and family factors associated with the patterns of binge drinking and frequent or heavy drinking among adolescents. Methods: This was a cross-sectional study, nested in a randomized controlled trial, of 6285 seventh and eighth grade adolescent students from Brazilian public schools. The associations between binge drinking (consumption of five or more doses of alcohol on a single occasion) in the last 12 months and frequent or heavy drinking (alcohol consumption on six or more days) in the last month and the several factors were analyzed through weighted logistic regression. Results: 16.5% of the students reported binge drinking in the year before the interview and 2.2% reported frequent/heavy drinking in the previous month. The factors associated with binge drinking were cigarette smoking (OR = 6.7, 95% CI = 3.96; 11.23), use of marijuana (OR = 2.2, 95% CI = 1.17; 4.31), use of inhalant drugs (OR = 3.0, 95% CI = 1.98; 4.43), exposure to a drunk relative (OR = 2.1, 95% C = 1.67; 2.53), practice of bullying (OR = 1.8, 95% CI = 1.47; 2.17), verbal aggression (OR = 1.7, 95%CI = 1.40; 2.14), and intermediate/low school grades (OR = 1.7, 95% CI = 1.35; 2.20). The factors associated with frequent/heavy drinking were cigarette smoking (OR = 2.5, 95% CI = 1.16; 5.22), use of marijuana (OR = 3.2, 95% CI = 1.32; 7.72), and physical aggression (OR = 2.2, 95% CI = 1.36; 3.50). Conclusions: The analyzed outcomes showed an association between the risk consumption of alcohol in early adolescence and low academic performance, involvement with other drugs, aggressiveness, and witnessing episodes of a family member's drunkenness. Considering the impact on public health of the damages caused by alcohol consumption during adolescence, these factors that showed such association should be considered in the development of preventive interventions.

Resumo Objetivo Analisar os fatores sociodemográficos, escolares e familiares associados aos padrões binge drinking, beber frequente ou beber pesado em adolescentes. Métodos Estudo transversal aninhado em ensaio controlado randomizado entre 6.387 estudantes do 7° e 8° anos de escolas públicas brasileiras. Associações entre o binge drinking (consumo de cinco ou mais doses de álcool em uma única ocasião) nos últimos 12 meses e o beber frequente/beber pesado (consumo de álcool em seis ou mais dias) no último mês e os diversos fatores foram analisados por meio de regressão logística ponderada. Resultados Dos estudantes, 16,5% reportaram ter praticado binge drinking no ano anterior à entrevista e 2,2% praticaram beber frequente/beber pesado no último mês. Os fatores associados ao binge drinking foram consumo de cigarro (OR = 6,7, IC95% = 3,96; 11,23), maconha (OR = 2,2, IC95% = 1,17; 4,31), uso de inalantes (OR = 3,0, IC95% = 1,98; 4,43), exposição a algum familiar embriagado (OR = 2,1, IC95% = 1,67; 2,53), prática de bullying (OR = 1,8, IC95% = 1,47; 2,17), agressão verbal (OR = 1,7, IC95% = 1,40; 2,14), notas médias e baixas (OR = 1,7, IC95% = 1,35; 2,20). Os fatores associados ao beber frequente/beber pesado foram o consumo de cigarro (OR = 2,5, IC95% = 1,16; 5,22), maconha (OR = 3,2, IC95% = 1,32; 7,72), agressão física (OR = 2,2, IC95% = 1,36; 3,50). Conclusões Os desfechos analisados evidenciaram associação do consumo de risco de álcool no início da adolescência com o baixo desempenho escolar, envolvimento com outras drogas, agressividade e vivência de episódios de embriaguez dos familiares. Considerando o impacto na saúde pública dos prejuízos decorrentes do consumo de risco de álcool na adolescência, estes fatores que evidenciaram associação devem ser considerados na construção de intervenções preventivas.

Responsiveness of the CCVUQ-Br quality of life questionnaire in chronic venous ulcer patients.

BACKGROUND: Responsiveness is a measure of an instrument's ability to reflect in its score the variability that has occurred in a patient's life as a result of an intervention. The CCVUQ-Br has been validated in Portuguese, but its responsiveness still needs to be tested. When this study has been completed, the CCVUQ-Br will be available for use as an instrument capable of detecting and reflecting in its score the changes that take place in the quality of life of people with venous ulcers. OBJECTIVES: To evaluate the responsiveness of the CCVUQ-Br. METHODS: A longitudinal intervention study was conducted at public and private centers for patients with venous ulcers. The sample comprised people with chronic venous ulcers due to start treatment and the variables analyzed were CCVUQ-Br score and its domain scores, a pain visual analog scale (pain VAS), and the Global Assessment of Change Scale, in addition to CEAP classification, and size of ulcer. The CCVUQ-Br was administered to 51 people about to start treatment who were recruited at random. The CCVUQ-Br was then re-administered 4 weeks after treatment had started. RESULTS: Mean CCVUQ-Br scores reduced from the first to the second administration. The highest mean score at baseline was for the Emotional Status domain, at 63.45, which dropped to 52.00 after 4 weeks. There were also correlations between changes in CCVUQ-Br scores and pain VAS ratings and CEAP class. With regard to the effect size, total CCVUQ-Br score and ulcer size exhibited high sensitivity, while pain VAS and the majority of the CCVUQ-Br domains had moderate sensitivity. CONCLUSIONS: The CCVUQ-Br questionnaire is sensitive in the Brazilian population and exhibited response to change in the sample tested.

Binge drinking and frequent or heavy drinking among adolescents: prevalence and associated factors.

OBJECTIVE: To analyze the sociodemographic, school, and family factors associated with the patterns of binge drinking and frequent or heavy drinking among adolescents. METHODS: This was a cross-sectional study, nested in a randomized controlled trial, of 6285 seventh and eighth grade adolescent students from Brazilian public schools. The associations between binge drinking (consumption of five or more doses of alcohol on a single occasion) in the last 12 months and frequent or heavy drinking (alcohol consumption on six or more days) in the last month and the several factors were analyzed through weighted logistic regression. RESULTS: 16.5% of the students reported binge drinking in the year before the interview and 2.2% reported frequent/heavy drinking in the previous month. The factors associated with binge drinking were cigarette smoking (OR=6.7, 95% CI=3.96; 11.23), use of marijuana (OR=2.2, 95% CI=1.17; 4.31), use of inhalant drugs (OR=3.0, 95% CI=1.98; 4.43), exposure to a drunk relative (OR=2.1, 95% C=1.67; 2.53), practice of bullying (OR=1.8, 95% CI=1.47; 2.17), verbal aggression (OR=1.7, 95%CI=1.40; 2.14), and intermediate/low school grades (OR=1.7, 95% CI=1.35; 2.20). The factors associated with frequent/heavy drinking were cigarette smoking (OR=2.5, 95% CI=1.16; 5.22), use of marijuana (OR=3.2, 95% CI=1.32; 7.72), and physical aggression (OR=2.2, 95% CI=1.36; 3.50). CONCLUSIONS: The analyzed outcomes showed an association between the risk consumption of alcohol in early adolescence and low academic performance, involvement with other drugs, aggressiveness, and witnessing episodes of a family member's drunkenness. Considering the impact on public health of the damages caused by alcohol consumption during adolescence, these factors that showed such association should be considered in the development of preventive interventions.

Protocol for a Nested Randomized Controlled Trial to Evaluate the Feasibility and Preliminary Efficacy of the Mindfulness Based Health Promotion Program on the Quality of Life of Older Adults Assisted in Primary Care-"The MBHP-Elderly Study".

Introduction: Population aging is a global phenomenon that has grown rapidly and progressively all over the world. Interventions that promote health must be studied and implemented to make the aging process be with quality of life. Depression and anxiety are the most common mental health conditions that compromise the quality of life on the elderly and it can cause damage to the autonomy and activities of daily life. Mindfulness training has been shown to improve psychological health and quality of life on adults. Studies involving Mindfulness-Based Interventions (MBIs) with older people are scarce in the literature, but they have been increasing in recent years showing promising results for healthy aging. This trial will investigate the feasibility and preliminary efficacy of an MBI on the quality of life of elderly assisted in the Primary Care. Materials and Methods: A cohort-nested randomized controlled trial with 3 assessment points (baseline, post-intervention and 1-year follow up) will be conducted to compare a MBI program (Mindfulness-Based Health Promotion) to a cognitive stimulation control-group in a Primary Care facility. One-hundred and two older adults will be recruited from a cohort of this facility and they will be randomized and allocated into an intervention group (N = 76) and the control group (N = 76). The primary outcome evaluated will be the improvement of quality of life assessed by the WHOQOL-BREF and WHOQOL-OLD. The secondary outcomes will be cognitive function, psychological health, sleep quality, self-compassion, and religiosity. Qualitative data will be assessed by focus group and the word free evocation technique. The feasibility of the program will also be evaluated by adherence and unwanted effects questionnaires. Discussion: This cohort-nested clinical trial will be the first mixed-methods study with 3 assessment points which will study the feasibility and preliminary efficacy of a mindfulness-based program for older people in Latin America population. If the findings of this study confirm the effectiveness of this program in this population it will be possible to consider it as intervention that might be implemented as public policy addressed to older people in healthcare systems. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03048708. Registered retrospectively on October 11th 2018.

Transition from nonuse to use of alcohol or binge drinking among adolescents: Secondary analysis of a randomized controlled trial.

OBJECTIVE: The objective of this study was to evaluate the predictors of the transition from nonuse of alcohol to the first use of alcohol and the first episode of binge drinking. METHODS: Data were drawn from a randomized controlled trial conducted with seventh- and eighth-grade students from 72 public schools over a 21-month period in six cities in Brazil. A total of 3298 students who reported that they had never consumed alcoholic beverages and had never engaged in binge drinking at baseline were included in this study. The two binary outcomes were tested concomitantly via structural equation modeling. Maximum likelihood estimates for logistic regression models were performed to evaluate how baseline data regarding risk factors, such as sociodemographic characteristics (socioeconomic status, gender, and age), school experiences (violence and perception of academic performance), and social variables (family and friends), affected the initiation of alcohol use and binge drinking at 9- and 21-month follow-up assessments. RESULTS: Older age, the perpetration of violent behaviors at baseline and the absence of the father living with the adolescent were predictors of both alcohol use initiation and binge drinking initiation. The #Tamojunto program showed iatrogenic effect for first alcohol use. CONCLUSIONS: The results indicate the need to develop and implement effective alcohol prevention programs that consider the main characteristics in the prediction model for alcohol consumption and binge drinking, including early intervention for aggressive behaviors at school and parental alcohol use.

Responsividade do questionário de qualidade de vida CCVUQ-Br em portadores de úlcera venosa crônica / Responsiveness of the CCVUQ-Br quality of life questionnaire in chronic venous ulcer patients

Resumo Contexto A responsividade consiste na capacidade de um instrumento em verificar se a pontuação reflete a variabilidade ocorrida na vida do paciente decorrente de uma intervenção. O CCVUQ-Br foi validado na língua portuguesa e necessita ter sua responsividade verificada. Quando finalizado este estudo, o CCVUQ-Br será utilizado como um instrumento capaz de perceber e refletir, na sua pontuação, as mudanças ocorridas na qualidade de vida do portador de úlcera venosa. Objetivos Avaliar a responsividade do CCVUQ-Br. Métodos Estudo de intervenção longitudinal, realizado em centros públicos e privados para pacientes com úlcera venosa. A amostra foi composta por portadores de úlcera venosa crônica submetidos à conduta terapêutica, tendo como variáveis as pontuações do CCVUQ-Br e de seus domínios, da escala visual analógica da dor (EVA dor) e da Escala de Avaliação Global de Mudança, além da classificação CEAP e o tamanho da úlcera. O CCVUQ-Br foi aplicado em 51 indivíduos submetidos a conduta terapêutica, recrutados de forma aleatória. Após 4 semanas, o CCVUQ-Br foi reaplicado. Resultados Houve diminuição das pontuações médias do CCVUQ-Br entre os dois momentos de aplicação, sendo que, no momento basal, a maior média de pontuação foi a do domínio Estado Emocional, com 63,45, diminuindo, após 4 semanas, para 52,00. Ainda apresentou correlações das mudanças com EVA dor e CEAP. Em relação ao tamanho do efeito, pode-se considerar que pontuação total do CCVUQ-Br e tamanho da úlcera apresentaram sensibilidade elevada, enquanto EVA dor e a maioria dos domínios do CCVUQ-Br apresentaram sensibilidade moderada . Conclusões O questionário CCVUQ-Br é sensível na população brasileira, apresentando garantia de resposta à amostra testada.

Abstract Background Responsiveness is a measure of an instrument's ability to reflect in its score the variability that has occurred in a patient's life as a result of an intervention. The CCVUQ-Br has been validated in Portuguese, but its responsiveness still needs to be tested. When this study has been completed, the CCVUQ-Br will be available for use as an instrument capable of detecting and reflecting in its score the changes that take place in the quality of life of people with venous ulcers. Objectives To evaluate the responsiveness of the CCVUQ-Br. Methods A longitudinal intervention study was conducted at public and private centers for patients with venous ulcers. The sample comprised people with chronic venous ulcers due to start treatment and the variables analyzed were CCVUQ-Br score and its domain scores, a pain visual analog scale (pain VAS), and the Global Assessment of Change Scale, in addition to CEAP classification, and size of ulcer. The CCVUQ-Br was administered to 51 people about to start treatment who were recruited at random. The CCVUQ-Br was then re-administered 4 weeks after treatment had started. Results Mean CCVUQ-Br scores reduced from the first to the second administration. The highest mean score at baseline was for the Emotional Status domain, at 63.45, which dropped to 52.00 after 4 weeks. There were also correlations between changes in CCVUQ-Br scores and pain VAS ratings and CEAP class. With regard to the effect size, total CCVUQ-Br score and ulcer size exhibited high sensitivity, while pain VAS and the majority of the CCVUQ-Br domains had moderate sensitivity. Conclusions The CCVUQ-Br questionnaire is sensitive in the Brazilian population and exhibited response to change in the sample tested.

Determination of the longitudinal sensitivity of the AVVQ-Brazil Quality of Life Questionnaire to non-surgical treatment of chronic venous disease.

BACKGROUND: Sensitivity determines the efficiency and quality of construction of an assessment measure, but studies of the subject are scarce in the literature. OBJECTIVE: To evaluate the longitudinal sensitivity of the AVVQ-Brazil to clinical changes after treatment for chronic venous disease (CVD). METHODS: A longitudinal intervention study, with 112 chronic venous patients receiving elective treatment, assessed with CEAP, VAPS, AVVQ-Brazil, and VEINES-QOL/Sym at pre-treatment (baseline) and post-treatment (4 weeks). Differences in the scores for the scales at different times were evaluated using Student's t test for paired samples and Wilcoxon's z, which were also used to asses individuals by CEAP grade and assessment time. Effect size, confidence intervals, and partial η2 were used to determine the sensitivity of changes in scale scores over time. Correlations between changes in the scores of the same scales and between different scales were measured using Pearson coefficients, Spearman coefficients, and Kendall's tau-b coefficient. RESULTS: The mean age of the patients was 59.51 years. The majority were female (82.1%), with standing for prolonged periods (49.1%), had completed secondary (22.3%) or higher (25%) education, and had CEAP C2 (28.6%) or C6 (32.1%) clinical severity. The following results were observed: mean scale scores reduced from baseline to post-treatment, except for the Extent of Varicosities domain of the AVVQ-Brazil and the VEINES-QOL/Sym scales; sensitivity was low for the AVVQ-Brazil and its domains and for the VAPS, and was from low to high for the other scales; there were improvements or maintenance of CEAP grade after treatment; and moderate to excellent correlations between changes in scale scores over time. CONCLUSIONS: The AVVQ-Brazil is sensitive to longitudinal clinical changes after treatment for CVD and is an important measure for assessment of QoL and of disease severity in Brazil.

Exposure to violence: associations with psychiatric disorders in Brazilian youth

Objective: The effects of exposure to violent events in adolescence have not been sufficiently studied in middle-income countries such as Brazil. The aims of this study are to investigate the prevalence of psychiatric disorders among 12-year-olds in two neighborhoods with different socioeconomic status (SES) levels in São Paulo and to examine the influence of previous violent events and SES on the prevalence of psychiatric disorders. Methods: Students from nine public schools in two neighborhoods of São Paulo were recruited. Students and parents answered questions about demographic characteristics, SES, urbanicity and violent experiences. All participants completed the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) to obtain DSM-IV diagnoses. The data were analyzed using weighted logistic regression with neighborhood stratification after adjusting for neighborhood characteristics, gender, SES and previous traumatic events. Results: The sample included 180 individuals, of whom 61.3% were from low SES and 39.3% had experienced a traumatic event. The weighted prevalence of psychiatric disorders was 21.7%. Having experienced a traumatic event and having low SES were associated with having an internalizing (adjusted OR = 5.46; 2.17-13.74) or externalizing disorder (adjusted OR = 4.33; 1.85-10.15). Conclusions: Investment in reducing SES inequalities and preventing violent events during childhood may improve the mental health of youths from low SES backgrounds.

Effectiveness evaluation of the school-based drug prevention program #Tamojunto in Brazil: 21-month follow-up of a randomized controlled trial.

INTRODUCTION: A school-based randomized controlled trial was conducted in 2014/2015 with students in 7th and 8th grades in 72 public schools in 6 Brazilian cities. A total of 5028 students were linked (75, 7%) in at least one of the two waves of follow-up (9 months and 21 months later). The principal research question was whether this 12-lesson program delays the initiation of alcohol, tobacco, inhalants and binge drinking among early adolescents when compared to usual care, that is, no prevention program in Brazilian schools, after 21 months of follow up. METHODS: Cox regression models were adjusted to evaluate the incidence of drug use. Generalized linear latent mixed models (GLLAMM) were used to evaluate changes in the prevalence of each drug over time and between groups. Findings The incidence analysis showed a negative effect of the program for alcohol initiation (aHR = 1.13, 95%CI 1.01; 127) but an opposite protective effect for the initiation of inhalant use (aHR = 0.79, 95%CI 0.66; 0.95). After 21 months, the prevalence of past-year use of alcohol changed from 30.1% to 49.8% in the intervention group and from 29.9% to 45.8% in the control group. Adolescents in the intervention group were 30% more likely to have reported past-year use of alcohol than students in the control group at 21 months (aOR = 1.30, 95%CI 1.02; 1.65). No effects of the program on past-month drug use were found. The Brazilian version of the Unplugged program may be misinterpreted by public school students, perhaps arousing their curiosity regarding alcohol use.