Mechanical ventilation in patients in the intensive care unit of a general university hospital in southern Brazil: an epidemiological study.

OBJECTIVES: To determine the characteristics, the frequency and the mortality rates of patients needing mechanical ventilation and to identify the risk factors associated with mortality in the intensive care unit (ICU) of a general university hospital in southern Brazil. METHOD: Prospective cohort study in patients admitted to the ICU who needed mechanical ventilation for at least 24 hours between March 2004 and April 2007. RESULTS: A total of 1,115 patients admitted to the ICU needed mechanical ventilation. The mortality rate was 51%. The mean age (± standard deviation) was 57±18 years, and the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 22.6±8.3. The variables independently associated with mortality were (i) conditions present at the beginning of mechanical ventilation, age (hazard ratio: 1.01; p<0.001); the APACHE II score (hazard ratio: 1.01; p<0.005); acute lung injury/acute respiratory distress syndrome (hazard ratio: 1.38; p=0.009), sepsis (hazard ratio: 1.33; p=0.003), chronic obstructive pulmonary disease (hazard ratio: 0.58; p=0.042), and pneumonia (hazard ratio: 0.78; p=0.013) as causes of mechanical ventilation; and renal (hazard ratio: 1.29; p=0.011) and neurological (hazard ratio: 1.25; p=0.024) failure, and (ii) conditions occurring during the course of mechanical ventilation, acute lung injuri/acute respiratory distress syndrome (hazard ratio: 1.31; p<0.010); sepsis (hazard ratio: 1.53; p<0.001); and renal (hazard ratio: 1.75; p<0.001), cardiovascular (hazard ratio: 1.32; p≤0.009), and hepatic (hazard ratio: 1.67; p≤0.001) failure. CONCLUSIONS: This large cohort study provides a comprehensive profile of mechanical ventilation patients in South America. The mortality rate of patients who required mechanical ventilation was higher, which may have been related to the severity of illness of the patients admitted to our ICU. Risk factors for hospital mortality included conditions present at the start of mechanical ventilation conditions that occurred during mechanical support.

Mechanical ventilation in patients in the intensive care unit of a general university hospital in southern Brazil: an epidemiological study

OBJECTIVES: To determine the characteristics, the frequency and the mortality rates of patients needing mechanical ventilation and to identify the risk factors associated with mortality in the intensive care unit (ICU) of a general university hospital in southern Brazil. METHOD: Prospective cohort study in patients admitted to the ICU who needed mechanical ventilation for at least 24 hours between March 2004 and April 2007. RESULTS: A total of 1,115 patients admitted to the ICU needed mechanical ventilation. The mortality rate was 51%. The mean age (± standard deviation) was 57±18 years, and the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 22.6±8.3. The variables independently associated with mortality were (i) conditions present at the beginning of mechanical ventilation, age (hazard ratio: 1.01; p<0.001); the APACHE II score (hazard ratio: 1.01; p<0.005); acute lung injury/acute respiratory distress syndrome (hazard ratio: 1.38; p=0.009), sepsis (hazard ratio: 1.33; p=0.003), chronic obstructive pulmonary disease (hazard ratio: 0.58; p=0.042), and pneumonia (hazard ratio: 0.78; p=0.013) as causes of mechanical ventilation; and renal (hazard ratio: 1.29; p=0.011) and neurological (hazard ratio: 1.25; p=0.024) failure, and (ii) conditions occurring during the course of mechanical ventilation, acute lung injuri/acute respiratory distress syndrome (hazard ratio: 1.31; p<0.010); sepsis (hazard ratio: 1.53; p<0.001); and renal (hazard ratio: 1.75; p<0.001), cardiovascular (hazard ratio: 1.32; p≤0.009), and hepatic (hazard ratio: 1.67; p≤0.001) failure. CONCLUSIONS: This large cohort study provides a comprehensive profile of mechanical ventilation patients in South America. The mortality rate of patients who required mechanical ventilation was higher, which may have been related to the severity of illness of the patients admitted to our ICU. Risk factors for hospital mortality included conditions present at the start of mechanical ventilation conditions that occurred during mechanical support.

The epidemiology of cancer in Angola-results from the cancer registry of the national oncology centre of Luanda, Angola.

Knowledge of the epidemiological profile of cancer is a key step in planning national cancer policy. The main objective of this study was to characterize the epidemiological profile of cancer in Angola based on cases of cancer registered at the National Oncology Centre (NOC) of Luanda, the only Angolan hospital to specialize in cancer treatment and diagnosis. The study consisted of a cross-sectional historical review of cases treated at the NOC between 2007 and 2011. The following variables were analysed: tumour location, diagnostic basis, and source of referral, as well as patient age, sex, place of residence, and the stage of the disease. The NOC registered a total of 4,791 patients throughout the study period, at an annual average of 958 cases. The most commonly diagnosed cancers were breast (20.5%), cervical (16.5%), and head and neck cancer (10.6%), followed by lymphoma (7.2%), Kaposi sarcoma (6.1%), and prostate cancer (4%). A total of 76% of patients were under 60 years old, and 10% were less than 15 years old. Of the total number of patients with cancer treated at the NOC, 77.3% lived in the Luanda province. Staging data were only available for patients with breast or cervical cancer, and an analysis of this variable showed that most of these individuals were in advanced stages of the disease. In the absence of a population-based cancer registry, this study constitutes a reasonable assessment of the epidemiological profile of cancer in Angola.

Avaliação da qualidade do cuidado a idosos nos serviços da rede pública de atenção primária à saúde de Porto Alegre, Brasil / Assessing the quality of care for the elderly in services from public primary health care in Porto Alegre, Brazil / La evaluación de la calidad de la atención a los ancianos en los servicios públicos de atención primaria de salud en Porto Alegre, Brasil

Introdução: O envelhecimento populacional gera maiores necessidades em saúde e torna-se um desafio para os serviços de saúde. A Atenção Primária à Saúde (APS) tem papel fundamental na promoção do envelhecimento saudável e no controle das multimorbidades. Objetivo: Avaliar a qualidade dos serviços públicos provedores de APS em Porto Alegre-RS, Brasil, na prestação do cuidado aos idosos. Métodos: Estudo transversal de base populacional, realizado em 2007, que entrevistou 212 idosos atendidos nos quatro tipos de serviços públicos da cidade: as unidades Básicas de Saúde, as equipes da Estratégia Saúde da Família, o Serviço de Saúde Comunitária do Grupo Hospitalar Conceição (SSC-GHC) e o Centro de Saúde Escola Murialdo. Resultados: Houve diferença significativa para os atributos Acesso-utilização, Longitudinalidade, Coordenação do cuidado e dos sistemas de informações, e Orientação familiar e comunitária. O SSC-GHC apresentou uma prevalência de 55,8% (p<0,001) do alto escore geral de APS, números superiores aos demais serviços. O escore geral das práticas preventivas mostrou uma diferença significativa quando foram comparados os serviços em relação ao escore geral de APS, com média de 3,9 (IC 95%=3,60-4,32) entre os idosos que referiram baixo escore e 5,9 (IC 95%=5,3-6,5) entre os que referiram alto escore. Discussão: Os resultados mostram escores baixos em todos os tipos de serviços. Os serviços com alto escore geral de APS apresentam prevalências maiores de práticas preventivas. Conclusões: Serviços orientados à APS apresentam-se mais efetivos e oferecem melhores cuidados preventivos recomendados para os idosos.

Introduction: The aging population creates a greater demand creates a greater demand for health services and becomes a challenge for the health care system. Primary Health Care (PHC) plays a fundamental role in promoting healthy aging and controlling multi-morbidity. Objective: To assess the quality of care provided to elderly patients in public PHC in Porto Alegre, Rio Grande do Sul state, Brazil. Methods: A cross-sectional population-based study carried out in 2007, with interviews conducted with 212 elderly patients from four types of municipal public services: Primary Health Centers, Family Health Strategy teams, the "Conceição" Hospital Community Health Service (CH/CHS), and the "Murialdo" School Health Center. Results: There were significant differences between the centers investigated regarding the following attributes: Access-utilization, Longitudinality, Care coordination and information systems, and Family and community orientation. The CH/CHS showed prevalence of 55.8% (p<0.001) for the overall PHC high score - higher figures in comparison with the other services. The overall score of preventive practices showed a significant association with the services to the overall PHC score, with an average of 3.9 (CI 95%=3.60-4.32) among the elderly who presented low scores and 5.9 (CI 95%=5.3-6.5) among those presenting high scores. Discussion: The results show low scores in all types of services. The services with a high overall PHC score present higher preventive practice prevalence. Conclusions: PHC-oriented services are more effective and offer greater quality of preventive care recommended for the elderly.

Introducción: El aumento de la longevidad crea una mayor demanda de servicios de salud y se convierte en un reto para el sistema de atención de salud. La Atención Primaria de Salud (APS) tiene un papel fundamental en la promoción del envejecimiento saludable y en el control de las multimorbilidades. Objetivo: Evaluar la calidad de los proveedores de servicios públicos de APS en Porto Alegre-RS, Brasil, en la atención a los ancianos. Métodos: Estudio transversal de base poblacional, realizado en 2007, que entrevistó a 212 ancianos atendidos en los 4 tipos de servicios públicos de la ciudad: los Centros de Salud de Atención Primaria, los equipos de la Estrategia de Salud de la Familia, el Servicio de Salud Comunitaria del Grupo Hospitalario Conceição (SSC/GHC) y el Centro de Salud Escuela Murialdo. Resultados: Hubo diferencias significativas para los atributos Accesibilidad, Longitudinalidad, Coordinación del cuidado y de los sistemas de información, y Orientación familiar y comunitaria. El SSC/GHC mostró una prevalencia del 55,8% (p<0,001) de la puntuación total máxima de APS, números superiores a los de otros servicios. La puntuación total de las prácticas preventivas mostró una diferencia significativa al comparar los servicios con la puntuación total de la APS, con una media de 3,9 (IC 95%=3,60-4,32) entre los ancianos que presentaron baja puntuación y 5,9 (IC 95%=5,3-6,5) entre los que presentaron puntuación más alta. Discusión: Los resultados muestran puntuaciones bajas en todos los tipos de servicios. Los servicios con una alta puntuación total de APS tienen una mayor prevalencia de prácticas preventivas. Conclusiones: Servicios orientados a la APS se muestran más eficaces y ofrecen mejores cuidados preventivos para los ancianos.

Predictors of positive Blood Alcohol Concentration (BAC) in a sample of Brazilian drivers / Preditores de alcoolemia positiva em uma amostra de motoristas brasileiros

OBJECTIVE: To verify the frequency of positive Blood Alcohol Concentration (BAC) among drivers and to examine associated factors in a cross-sectional study of Brazilian state capitals. METHODS: 3,398 drivers were approached on highways crossing all 27 Brazilian capitals from 12 p.m. to 12 a.m. (Fridays and Saturdays). They were breathalyzed and data on their driving characteristics and alcohol consumption were collected. Multivariate logistic regression following a hierarchical conceptual framework was used to evaluate associated factors. RESULTS: The overall weighted prevalence of positive BAC (> 0.1 mg/L) was 4.2%. The multivariate analysis showed that education up to 8 years (OR = 2.0; 95% CI: 1.4-3.0), age > 30 years (OR = 2.6; 95% CI: 1.8-3.8), type of vehicle (cars: OR = 3.0; 95% CI: 1.7-5.1; motorcycles: OR = 3.7; 95% CI: 2.1-6.4), binge drinking (OR = 1.7; 95% CI: 1.3-2.4), having been breathalyzed before (OR = 2.6; 95% CI: 1.8-3.7), and purpose of the trip (coming from a party: OR = 1.9; 95% CI: 1.3-3.0; leisure trip: OR = 1.7; 95% CI: 1.32.4; driving after 8 p.m.: OR = 1.7; 95% CI: 1.3-2.3) were independently associated with DUI. CONCLUSION: Study findings suggest that selected external environmental factors, such as socioeconomic and demographic characteristics as well as personal characteristics like alcohol consumption and the relationship between drinking and driving were associated with positive BAC among Brazilian drivers. Results can help to inform drinking and driving policy and preventive approaches.

OBJETIVO: Verificar a frequência de alcoolemia positiva entre os motoristas e examinar fatores associados em um estudo transversal nas capitais brasileiras. MÉTODOS: 3.398 motoristas foram abordados em rodovias que atravessam todas as 27 capitais brasileiras nos horários entre 12:00 e 00:00 (sextas e sábados). Eles realizaram o teste do etilômetro e foram coletados dados sobre suas características de condução e consumo de álcool. Para avaliar os fatores associados, foi realizada uma regressão logística multivariável seguindo um quadro conceitual hierárquico. RESULTADOS: A prevalência de alcoolemia positiva (> 0,1 mg/L) foi de 4,2%. A regressão logística múltipla mostrou que educação (até 8 anos de estudo: OR = 2,0; IC 95%: 1,4-3,0), idade (> 30 anos: OR = 2,6; IC 95%: 1,8-3,8), tipo de veículo (dirigir um carro: OR = 3,0; IC 95%: 1,7-5,1; conduzir uma motocicleta: OR = 3,7; IC 95%: 2,1-6,4), consumo excessivo de álcool (OR = 1,7; IC 95%: 1,3-2,4), ter realizado o teste do etilômetro anteriormente (OR = 2,6; IC 95%: 1,8-3,7), e a finalidade da viagem (retorno de uma festa: OR = 1,9; IC 95%:1,3-3,0; viagem de lazer: OR = 1,7; IC 95%: 1,3-2,4; e estar dirigindo após as 20 horas: OR = 1,7; IC 95%: 1,3-2,3) foram independentemente associados com o dirigir sob influência de álcool. CONCLUSÃO: Os resultados sugerem que fatores ambientais externos selecionados, tais como características socioeconômicas e demográficas, bem como características pessoais, como o consumo de álcool e comportamento em relação a beber e dirigir, foram associados com alcoolemia positiva entre os motoristas brasileiros. Os resultados podem ajudar a orientar políticas em relação a beber e dirigir e abordagens preventivas.

Regional differences associated with drinking and driving in Brazil / Diferenças regionais entre os fatores associados ao beber e dirigir no Brasil

OBJECTIVE: To evaluate regional differences and similarities associated with drinking and driving (DUI) in the five Brazilian macro-regions. METHOD: A roadside survey was conducted in the 27 Brazilian state capitals. A total of 3,398 drivers were randomly selected and given a structured interview and a breathalyzer test. To determine the predictors of positive blood alcohol concentration (BAC) in each region, a MANOVA was performed, and 3 groups were used as follows: 1) North and Northeast, 2) South and Midwest, and 3) Southeast. A Poisson robust regression model was performed to assess the variables associated with positive BAC in each group. RESULTS: Of all surveyed drivers, 2,410 had consumed alcohol in the previous 12 months. Most were male, with a median age of 36. Leisure as the reason for travel was associated with positive BAC in all 3 groups. Low schooling, being older than 30, driving cars or motorcycles and having been given a breathalyzer test at least once in their lives predicted DUI in at least two different groups. CONCLUSIONS: Factors , especially low schooling and leisure as a reason for travel, associated with drinking and driving were similar among regions, although certain region-specific features were observed. This information is important for aiming to reduce DUI in the country.

OBJETIVO: Avaliar diferenças e similaridades em relação a beber e dirigir (DUI) nas cinco macroregiões brasileiras. MÉTODO: Um roadside survey foi realizado nas 27 capitais brasileiras. Foram selecionados aleatoriamente 3.398 condutores que responderam a uma entrevista estruturada e foram testados com uso de etilômetro. Para a construção de modelos preditivos de alcoolemia positiva (BAC), as regiões foram agrupadas de acordo com sua similaridade, obtida por MANOVA, em: 1) Norte e Nordeste; 2) Sul e Centro-Oeste; 3) Sudeste. Em cada grupo foi realizado um modelo de regressão robusta para estimar as variáveis associadas a BAC. RESULTADOS: Dentre os condutores, 2.410 ingeriram bebidas alcoólicas nos 12 meses anteriores, sendo a maioria composta por homens com idade mediana de 36 anos. A única variável associada a BAC em todos os grupos foi ter lazer como motivo da viagem. Baixa escolaridade, idade > 30 anos, dirigir carros/motos e ter realizado teste de bafômetro previamente foram associadas a BAC em ao menos dois grupos. CONCLUSÕES: Os fatores associados a DUI foram semelhantes nas regiões, especialmente o motivo da viagem e a escolaridade, embora algumas especificidades regionais tenham sido observadas. Estas informações são estratégicas para políticas públicas destinadas a redução do DUI.

Infecção genital pelo HPV e Chlamydia trachomatis em mulheres assintomáticas: prevalência, fatores associados e relação com lesões cervicais / HPV and Chlamydia trachomatis genital infection among non-symptomatic women: prevalence, associated factors and relationship with cervical lesions

O objetivo do estudo foi descrever a prevalência do papilomavírus humano e da Chlamydia trachomatis entre mulheres assintomáticas na região Sul do Brasil. Estudo transversal, com 1.217 esfregaços cervicais testados para citologia, papilomavírus humano e Chlamydia trachomatis-DNA. Os resultados foram estimados por regressão logística múltipla. As prevalências de papilomavírus humano, Chlamydia trachomatis-DNA e coinfecção foram de 28,4, 12,6, e 6,5%, respectivamente. A infecção por papilomavírus humano foi associada com a raça não branca, estar empregada e ter parceiro sexual com história de condiloma genital. A infecção por Chlamydia trachomatis apresentou associação com o início da atividade sexual em idade ?20 anos e estar empregada. A coinfecção apresentou associação com ter ?3 parceiros sexuais. Anormalidades citológicas do colo versus papilomavírus humano e coinfecção apresentaram associação significativa (p>0,001). Elevadas prevalências de papilomavírus humano, Chlamydia trachomatis e coinfecção foram observadas em uma população de mulheres assintomáticas e os resultados indicam a importância de medidas de prevenção e promoção da saúde.

[Use of medication by the elderly in urban and rural areas in southern Brazil: a population-based study]. / Uso de medicamentos entre idosos residentes em áreas urbanas e rurais de município no Sul do Brasil: um estudo de base populacional.

The study aimed to measure use of medication and polypharmacy among the elderly in Carlos Barbosa, Rio Grande do Sul State, Brazil, and to compare socio-demographic, economic, and health characteristics in relation to area of residence (urban versus rural) in a random sample of 811 persons 60 year of age or older. Interviews were used to collect data on socio-demographic characteristics, chronic illnesses, and self-reported use of medications. The association between area of residence and medication or polypharmacy was adjusted for confounders using Poisson regression with robust variance. Prevalence rates for use of medication and polypharmacy were higher among older persons living in the urban area. Living in the urban area was positively and independently associated with use of medication (PR = 1.10; 95%CI: 1.02-1.20) and polypharmacy (PR = 1.83; 95%CI: 1.27-2.65) in this group of elderly in southern Brazil.

Uso de medicamentos entre idosos residentes em áreas urbanas e rurais de município no Sul do Brasil: um estudo de base populacional / Use of medication by the elderly in urban and rural areas in southern Brazil: a population-based study

O objetivo foi verificar a prevalência de uso de medicamentos e de polifarmácia entre idosos de Carlos Barbosa, Rio Grande do Sul, Brasil, e comparar as características sociodemográficas e de saúde associadas ao uso, segundo o local de moradia. Foi avaliada uma amostra aleatória de 811 idosos com 60 anos ou mais, moradores na área urbana ou rural. Dados sociodemográficos, doenças crônicas, qualidade de vida e medicamentos autorreferidos foram coletados em entrevistas presenciais. Associação entre local de moradia e uso de medicamentos ou polifarmácia, ajustada para potenciais confundidores, foi avaliada por regressão de Poisson com ajuste robusto da variância. A prevalência de uso de medicamentos e de polifarmácia foi maior entre os idosos urbanos. Morar na área urbana apresentou associação positiva e independente com uso de medicamentos (RP = 1,10; IC95 por cento: 1,02-1,20) e polifarmácia (RP = 1,83; IC95 por cento: 1,27-2,65). Morar na área urbana está associado à maior prevalência de uso de medicamentos e de polifarmácia entre idosos.

The study aimed to measure use of medication and polypharmacy among the elderly in Carlos Barbosa, Rio Grande do Sul State, Brazil, and to compare socio-demographic, economic, and health characteristics in relation to area of residence (urban versus rural) in a random sample of 811 persons 60 year of age or older. Interviews were used to collect data on socio-demographic characteristics, chronic illnesses, and self-reported use of medications. The association between area of residence and medication or polypharmacy was adjusted for confounders using Poisson regression with robust variance. Prevalence rates for use of medication and polypharmacy were higher among older persons living in the urban area. Living in the urban area was positively and independently associated with use of medication (PR = 1.10; 95 percentCI: 1.02-1.20) and polypharmacy (PR = 1.83; 95 percentCI: 1.27-2.65) in this group of elderly in southern Brazil.

Predictors of positive Blood Alcohol Concentration (BAC) in a sample of Brazilian drivers.

OBJECTIVE: To verify the frequency of positive Blood Alcohol Concentration (BAC) among drivers and to examine associated factors in a cross-sectional study of Brazilian state capitals. METHODS: 3,398 drivers were approached on highways crossing all 27 Brazilian capitals from 12 p.m. to 12 a.m. (Fridays and Saturdays). They were breathalyzed and data on their driving characteristics and alcohol consumption were collected. Multivariate logistic regression following a hierarchical conceptual framework was used to evaluate associated factors. RESULTS: The overall weighted prevalence of positive BAC (> 0.1 mg/L) was 4.2%. The multivariate analysis showed that education up to 8 years (OR = 2.0; 95% CI: 1.4-3.0), age > 30 years (OR = 2.6; 95% CI: 1.8-3.8), type of vehicle (cars: OR = 3.0; 95% CI: 1.7-5.1; motorcycles: OR = 3.7; 95% CI: 2.1-6.4), binge drinking (OR = 1.7; 95% CI: 1.3-2.4), having been breathalyzed before (OR = 2.6; 95% CI: 1.8-3.7), and purpose of the trip (coming from a party: OR = 1.9; 95% CI: 1.3-3.0; leisure trip: OR = 1.7; 95% CI: 1.32.4; driving after 8 p.m.: OR = 1.7; 95% CI: 1.3-2.3) were independently associated with DUI. CONCLUSION: Study findings suggest that selected external environmental factors, such as socioeconomic and demographic characteristics as well as personal characteristics like alcohol consumption and the relationship between drinking and driving were associated with positive BAC among Brazilian drivers. Results can help to inform drinking and driving policy and preventive approaches.

Regional differences associated with drinking and driving in Brazil.

OBJECTIVE: To evaluate regional differences and similarities associated with drinking and driving (DUI) in the five Brazilian macro-regions. METHOD: A roadside survey was conducted in the 27 Brazilian state capitals. A total of 3,398 drivers were randomly selected and given a structured interview and a breathalyzer test. To determine the predictors of positive blood alcohol concentration (BAC) in each region, a MANOVA was performed, and 3 groups were used as follows: 1) North and Northeast, 2) South and Midwest, and 3) Southeast. A Poisson robust regression model was performed to assess the variables associated with positive BAC in each group. RESULTS: Of all surveyed drivers, 2,410 had consumed alcohol in the previous 12 months. Most were male, with a median age of 36. Leisure as the reason for travel was associated with positive BAC in all 3 groups. Low schooling, being older than 30, driving cars or motorcycles and having been given a breathalyzer test at least once in their lives predicted DUI in at least two different groups. CONCLUSIONS: Factors , especially low schooling and leisure as a reason for travel, associated with drinking and driving were similar among regions, although certain region-specific features were observed. This information is important for aiming to reduce DUI in the country.

Association of interleukin-6 in women with persistence of DNA-HPV: a nested case-control study.

OBJECTIVE: To identify the role of Interleukin-6, IL-10 and their epidemiological association in women with persistence of DNA-HPV. DESIGN AND METHODS: A nested case-control study within a longitudinal cohort study. Cervical specimens and blood samples were collected at enrolment from asymptomatic women who looked for a service of public health in a district of Porto Alegre, Brazil. A logistic regression analysis was performed with 95% confidence intervals. The outcome was the persistence of DNA-HPV infection. RESULTS: The analysis showed that the age of the first intercourse below 20 years old (OR = 19.65, IC 95% 2.43-68.85), four or more sexual partners during lifetime (OR = 5.67, IC 95% 1.28-24.99), women with a previous altered Pap smear (OR = 10.17, IC 95% 1.80-57.33), marital status (OR = 12.94, IC 95% 2.43-68.85) and IL6 ≤ 3.106 pg/ml were associated with persistence of HPV infection. IL-10 were not associated with the HPV persistence. CONCLUSION: The present study suggests that IL-6 levels may be a marker of HPV DNA persistence, although further investigation is necessary.

Factors associated with alcohol and drug use among traffic crash victims in southern Brazil.

OBJECTIVE: To investigate the prevalence of and factors associated with alcohol- or drug-related traffic crashes (TC) in a sample of TC victims who were admitted to the two emergency rooms of Porto Alegre in southern Brazil. METHODS: A cross-sectional study with consecutive samples was used. Victims of non-fatal TCs (as drivers, passengers or pedestrians) who had presented at emergency rooms during the 45 days of data collection were selected. Subjects participated in a structured interview, were breathalyzed and underwent salivary drug testing. A multinomial logistic regression model was used to verify factors associated with alcohol or drug use. RESULTS: Of the 609 victims who participated in the interview, 72% were male, and the median age was 29 years (interquartile range 23.0-40.0 years). The drivers were mostly men (p<0.001), with a higher binge drinking rate (p=0.003) and marijuana use (p=0.005) than seen in pedestrian and passengers. The prevalence of a positive blood alcohol concentration (BAC) ranged from 7.8% among the drivers to 9.2% among the pedestrians (p=0.861), and the cannabis prevalence was 13.3% among the drivers. The variables associated with an alcohol-related accident were binge drinking in the prior 12 months (OR 2.4; CI 95% 1.1-5.1) and coming from a party/bar (OR 8.7; CI 95% 2.8-26.7). Alcohol abuse or dependence increased by 5.2-fold the chance of another substance-related TC. CONCLUSION: The large number of individuals found in TC-related emergency room visits in a short time frame is evidence of the Brazilian epidemic of TC. The data showed that alcohol abuse or dependence also increases the risk of intoxication by other drugs, and they point to alcohol and drug use as a major problem requiring specific TC-related public policies and law enforcement.

Chlamydia trachomatis and human papillomavirus coinfection: association with p16INK4a and Ki67 expression in biopsies of patients with pre-neoplastic and neoplastic lesions.

The objective of this study was to identify the frequency of coinfection by human papillomavirus (HPV) and Chlamydia trachomatis (CT) in cervical lesions and relate it with immunohistochemical expression of p16INK4a and Ki67, both oncogenicity markers. A cross-sectional study with 86 women from primary care units in southern Brazil was conducted. Cervical swabs were collected for HPV-DNA and CT-DNA detection, through the polymerase chain reaction technique (PCR). The immunohistochemical analysis was performed on biopsy cervical tissue material to identify the expression of p16INK4a and Ki67 cell cycle markers. About 83 % were positive for HPV-DNA and 19% had coinfection with CT-DNA. Among coinfected women, 56% expressed p16INK4a. There was a statistically significant association between the histological grade of the lesion and Ki67 expression. All high-grade lesions, 50% of low-grade lesions and 31% of negative biopsies expressed Ki67 (p = 0.004). A total of 37% of coinfected women expressed both markers. In conclusion, although more than half of the coinfected patients have expressed p16INK4a and more than one third have expressed both markers, these results suggest no association between those variables. However, other studies involving larger samples are necessary to corroborate such findings.

Chlamydia trachomatis and human papillomavirus coinfection: association with p16INK4a and Ki67 expression in biopsies of patients with pre-neoplastic and neoplastic lesions

The objective of this study was to identify the frequency of coinfection by human papillomavirus (HPV) and Chlamydia trachomatis (CT) in cervical lesions and relate it with immunohistochemical expression of p16INK4a and Ki67, both oncogenicity markers. A cross-sectional study with 86 women from primary care units in southern Brazil was conducted. Cervical swabs were collected for HPV-DNA and CT-DNA detection, through the polymerase chain reaction technique (PCR). The immunohistochemical analysis was performed on biopsy cervical tissue material to identify the expression of p16INK4a and Ki67 cell cycle markers. About 83 percent were positive for HPV-DNA and 19 percent had coinfection with CT-DNA. Among coinfected women, 56 percent expressed p16INK4a. There was a statistically significant association between the histological grade of the lesion and Ki67 expression. All high-grade lesions, 50 percent of low-grade lesions and 31 percent of negative biopsies expressed Ki67 (p = 0.004). A total of 37 percent of coinfected women expressed both markers. In conclusion, although more than half of the coinfected patients have expressed p16INK4a and more than one third have expressed both markers, these results suggest no association between those variables. However, other studies involving larger samples are necessary to corroborate such findings.

Malnutrition and associated variables in an elderly population of Criciúma, SC.

OBJECTIVE: Determining malnutrition and associated variables in the elderly. METHODS: A cross-sectional study was conducted among elderly people vaccinated against influenza in order to evaluate their nutritional status. Nutritional assessment was performed with the Mini Nutritional Assessment. To verify association of studied variables with the outcome, odds ratios was estimated using multiple logistic regression. RESULTS: A total of 236 elderly patients were recruited. The Mini Nutritional Assessment identified three patients (1.3%) with malnutrition and 59 (25%) at risk of malnutrition. Factors with a positive association to the outcome were psychological stress or acute disease in the past three months, weight loss (< 3 kg) during the last three months and sores or skin ulcers. On the other hand, consuming two or more servings of fruits or vegetables daily, eating meat, fish or poultry every day and drinking more than three cups of fluids per day were negatively associated to malnutrition and risk of malnutrition. CONCLUSION: The low prevalence of malnutrition found in this study may be due to the study sample of elderly individuals in good health. Some factors related to a recent health problem (psychological stress or acute disease) seem to be positively associated while regular consumption of fluids and certain foods seem to be negatively associated with malnutrition.

Malnutrition and associated variables in an elderly population of Criciúma, SC / Desnutrição e variáveis associadas em uma população de idosos em Criciúma-SC

OBJECTIVE: Determining malnutrition and associated variables in the elderly. METHODS: A cross-sectional study was conducted among elderly people vaccinated against influenza in order to evaluate their nutritional status. Nutritional assessment was performed with the Mini Nutritional Assessment. To verify association of studied variables with the outcome, odds ratios was estimated using multiple logistic regression. RESULTS: A total of 236 elderly patients were recruited. The Mini Nutritional Assessment identified three patients (1.3 percent) with malnutrition and 59 (25 percent) at risk of malnutrition. Factors with a positive association to the outcome were psychological stress or acute disease in the past three months, weight loss (< 3 kg) during the last three months and sores or skin ulcers. On the other hand, consuming two or more servings of fruits or vegetables daily, eating meat, fish or poultry every day and drinking more than three cups of fluids per day were negatively associated to malnutrition and risk of malnutrition. CONCLUSION: The low prevalence of malnutrition found in this study may be due to the study sample of elderly individuals in good health. Some factors related to a recent health problem (psychological stress or acute disease) seem to be positively associated while regular consumption of fluids and certain foods seem to be negatively associated with malnutrition.

OBJETIVO: Determinar a desnutrição e suas variáveis associadas em idosos. MÉTODOS: Estudo transversal foi conduzido entre idosos vacinados contra a gripe, a fim de medir o seu estado nutricional. A avaliação nutricional foi realizada por meio da Mini Avaliação Nutricional. Para verificar a associação das variáveis estudadas com o resultado foi estimada a odds ratios usando a regressão logística múltipla. RESULTADOS: No total 236 idosos foram recrutados. A mini avaliação nutricional identificou três pacientes (1,3 por cento) com desnutrição e 59 (25 por cento) em risco de desnutrição. Os fatores com uma associação positiva para o resultado foi o estresse psicológico ou doença aguda nos últimos três meses, perda de peso < 3 kg durante os últimos três meses e feridas ou úlceras na pele. Por outro lado, o consumo de duas ou mais porções de frutas ou vegetais ao dia, consumir carne, peixe ou frango todos os dias e beber mais de três xícaras por dia de fluidos foram negativamente associadas à desnutrição e risco de desnutrição. CONCLUSÃO: A baixa prevalência de desnutrição encontrada neste estudo é, provavelmente, devido à amostra estudada de idosos em boa saúde. Alguns fatores como problema de saúde recente (estresse psicológico ou doença aguda) parecem estar positivamente associados a desnutrição e risco de desnutrição, enquanto o consumo regular de fluidos e alguns tipos de alimentos parece estar associado negativamente com desnutrição.

Depressão e relação com idade em cuidadores de familiares portadores de síndrome demencial / Depression related to age in family caregivers of patients with dementia

Avaliou-se a presença de sintomas depressivos em cuidadores de familiares portadores de síndrome demencial comparados a não cuidadores e a relação deste desfecho em três faixas etárias. Participaram 84 cuidadores e 101 não cuidadores que residiam na região metropolitana de Porto Alegre, RS, Brasil. Aplicou-se um questionário de dados sociodemográficos e o Inventário Beck de Depressão. Os cuidadores revelaram níveis mais elevados de sintomas depressivos e com maior gravidade nos aspectos cognitivos e afetivos do inventário de depressão quando comparados aos não cuidadores. Foram encontrados níveis mais baixos de sintomas de depressão em indivíduos de maior faixa etária (65 a 83 anos). São discutidas as limitações do inventário na avaliação de sintomas de depressão em pessoas idosas. Ressalta-se a necessidade de suporte psicológico e apoio social aos cuidadores de familiares com síndrome demencial.(AU)

Depression symptoms related to age in family caregivers of dementia patients compared to non-caregivers were evaluated. Eighty-four family caregivers to dementia patients and one hundred and one non-caregivers that lived in Porto Alegre (Brazil) region participated of this study. They answered a sociodemographic questionnaire and the Beck Depression Inventory. The caregivers presented higher degree of depression symptoms and higher degree of cognitive and affective aspects of depression inventory those non-caregivers. Lowest degree of depression symptoms were presented by the oldest participants. Limitations of the inventory to evaluate depression in older people were discussed. The study emphasizes the necessity of psychological and social support to family caregivers of dementia patients.(AU)

Depressão e relação com idade em cuidadores de familiares portadores de síndrome demencial / Depression related to age in family caregivers of patients with dementia

Avaliou-se a presença de sintomas depressivos em cuidadores de familiares portadores de síndrome demencial comparados a não cuidadores e a relação deste desfecho em três faixas etárias. Participaram 84 cuidadores e 101 não cuidadores que residiam na região metropolitana de Porto Alegre, RS, Brasil. Aplicou-se um questionário de dados sociodemográficos e o Inventário Beck de Depressão. Os cuidadores revelaram níveis mais elevados de sintomas depressivos e com maior gravidade nos aspectos cognitivos e afetivos do inventário de depressão quando comparados aos não cuidadores. Foram encontrados níveis mais baixos de sintomas de depressão em indivíduos de maior faixa etária (65 a 83 anos). São discutidas as limitações do inventário na avaliação de sintomas de depressão em pessoas idosas. Ressalta-se a necessidade de suporte psicológico e apoio social aos cuidadores de familiares com síndrome demencial.

Depression symptoms related to age in family caregivers of dementia patients compared to non-caregivers were evaluated. Eighty-four family caregivers to dementia patients and one hundred and one non-caregivers that lived in Porto Alegre (Brazil) region participated of this study. They answered a sociodemographic questionnaire and the Beck Depression Inventory. The caregivers presented higher degree of depression symptoms and higher degree of cognitive and affective aspects of depression inventory those non-caregivers. Lowest degree of depression symptoms were presented by the oldest participants. Limitations of the inventory to evaluate depression in older people were discussed. The study emphasizes the necessity of psychological and social support to family caregivers of dementia patients.

Efficacy of human papillomavirus vaccines: a systematic quantitative review.

Human papillomavirus (HPV) types cause approximately 70% of cervical cancer worldwide. Two vaccines have been recently evaluated in randomized controlled trials: the bivalent vaccine for HPV 16 and 18 (Cervarix, GlaxoSmithKline Biologicals, Rixensart, Belgium) and the quadrivalent vaccine for HPV 6, 11, 16, and 18 (Gardasil, Merck and Co, Inc, Whitehouse Station, NJ). We have performed a systematic review of all randomized controlled trials in which vaccines against HPV were compared with placebo regarding efficacy, safety, and immunogenicity. Six studies met the inclusion criteria, which included 47,236 women. The first objective in this systematic review was to assess vaccine efficacy in the prevention of cytologically and/or histologically proven lesions. And the secondary objective was the evaluation of safety and vaccine immunogenicity. Bivalent and quadrivalent HPV vaccines significantly reduced the rate of lesions in the cervix, vulva, vagina, and anogenital region, with efficacy of 93% (95% confidence interval [CI], 87-96) and 62% (95% CI, 27-70), respectively, when compared with the control groups according to intention to treat. Regarding safety, we found more symptoms in the bivalent vaccine group (35%; 95% CI, 5-73) when compared with the control groups. In regard to vaccine immunogenicity, there was seroconversion in the group that received the vaccine when compared with the placebo group in the bivalent and quadrivalent vaccines. Prophylactic vaccination can prevent HPV infection in women aged 9 to 26 years not previously infected with the HPV subtypes covered by the vaccines. To evaluate cervical cancer incidence and mortality, a longer follow-up is necessary.