Time series analysis of the suicide attempts assisted by firefighters from 2017 to 2021 in São Paulo, Brazil.

OBJECTIVE: This study aimed to analyze the time trends of suicide attempts assisted by the Fire Department of the Military Police of the State of São Paulo (Corpo de Bombeiros da Polícia Militar do Estado de São Paulo - CBPMESP) from 2017 to 2021, between sexes. METHODS: This is an ecological study of 11,435 suicide attempts assisted by CBPMESP calls from January 2017 to December 2021. Three seasonal auto-regressive integrated moving average with exogenous (SARIMAX) models were adjusted considering total population, only men, and only women. RESULTS: The total occurrences of suicide attempts were stationary in the prepandemic period but had an increased growth pattern after the pandemic began. This trend was higher among men, due to (1) lower assistance of suicide attempts during early pandemic than in the prepandemic period and (2) significant increased assistance after the beginning of vaccination against COVID-19, followed by a decrease, but with a tendency to increase, in the long-term pandemic. CONCLUSION: Our results indicate a growth in the long-term suicide attempts during COVID-19. The beginning of vaccination was not considered significant in the reduction of CBPMESP attendances. These results corroborate the need for a multisectoral national suicide prevention strategy to mitigate the effects of the pandemic on mental health in the State of São Paulo.

Suicide Attempts Assisted By Firefighters According to Traumatic Brain Injury.

Studies worldwide have reported increasing trends in suicides and attempts during the pandemic. The literature shows that improving surveillance and monitoring of suicide and attempts requires broad multisectoral prevention strategies. In Brazil, the São Paulo State Fire Department (CBPMESP) makes up the emergency response team for suicide and suicide attempted calls and public emergencies. Given this context, this paper sought to describe the characteristics of suicide attempts assisted by the CBPMESP according to traumatic brain injury (TBI), between 2018 and 2020, measured by the Glasgow Coma Scale (GCS). For this purpose, a descriptive study of 6,582 suicide attempts attended by CBPMESP was carried out. The factors associated with trauma brain injury according to the Glasgow Coma Scale (dependent variable) were analyzed by a multinomial regression model. Results show a significant increase of 8.0% (p = 0.039) in the number of calls responded by CBPMESP between 2018 and 2020. Men presented a higher prevalence of more violent methods for suicide attempts, namely firearms and hanging, followed by severe TBI; in women, severe TBI occurred mostly by hanging. Despite the increase in fatal suicide attempts during the pandemic, time to attend to victim acted as a protective factor for preventing severe TBI in men and women.

Primary health care performance according to clusters of convergent municipalities in the state of São Paulo.

OBJECTIVE: To describe the performance of Primary Health Care, according to conglomerates of São Paulo cities that present homogeneous indicators. METHODS: This is a descriptive study, based on secondary data extracted from official sources of the Unified Health System, for the year 2018. An analysis matrix was created, with the proposition of performance (access, effectiveness and adequacy) and context indicators (population, health determinants and financing) selected and organized in dimensions and sub-dimensions. Cluster Analysis was used to identify the groups of homogeneous municipalities. RESULTS: 645 municipalities were divided in 6 conglomerates. Clusters 2 and 3 were formed predominantly by small municipalities with greater access to health; cluster 3 has less social vulnerability and greater investment in health. Clusters 1, 4 and 5 were formed by the largest municipalities with less access to health; cluster 4 presents greater social vulnerability, less coverage of private health plans and a greater percentage of health resources; cluster 5 was characterized by greater Gross Domestic Product per capita and greater coverage of private health plans. Cluster 6, formed by the city of São Paulo, was a particular case. Cluster 2 drew attention, as it was shown to have increased coverage, but signaled lower efficacy and adequacy levels. Cluster 3 had the best performance among all clusters. CONCLUSION: These findings can support regional and municipal management, given the complexity of the territory of São Paulo, pointing to scenarios that demand broader public management initiatives.

Adesão à Terapia Hormonal Adjuvante com Tamoxifeno e Anastrozol utilizando ARMS-12 e MMAS-4 / Adherence to Adjuvant Hormone Therapy with Tamoxifen and Anastrozole using ARMS-12 and MMAS-4 / Adherencia a la Terapia Hormonal Adyuvante con Tamoxifeno y Anastrozol utilizando ARMS-12 y MMAS-4

Introdução: Entre os cânceres de mama, aproximadamente 75% das mulheres são receptores hormonais positivos, sendo estas mais propensas a responderem à hormonioterapia com anastrozol e tamoxifeno. Apesar de eficazes, apresentam taxas significativas de não adesão. Objetivo: Avaliar a adesão à terapia hormonal adjuvante com tamoxifeno e anastrozol em pacientes atendidos nos Ambulatórios da Mastologia e de Quimioterapia do Hospital São Paulo entre os anos de 2019 e 2020. Método: Estudo transversal com 102 mulheres, realizado entre os meses de setembro de 2019 e março de 2020. A adesão à terapia hormonal adjuvante foi avaliada utilizando-se as escalas Morisky Medication Adherence Scale (MMAS-4) e Adherence to Refills and Medications Scale of 12 items (ARMS-12). Resultados: A média de idade foi de 61,5 anos (59,3-63,6). Entre as pacientes, 27,7% faziam uso de tamoxifeno e 72,3% de anastrozol. Relataram desconforto em relação ao uso do medicamento 84,4%, sendo as ondas de calor (42,2%) e as dores articulares (55,9%) os mais frequentes. A escala de ARMS>12 foi pontuada por 79,2%; cerca de 90% das mulheres pontuaram a MMAS-4 até dois pontos, porém não houve diferença significativa entre os tipos de hormônios utilizados para escalas de adesão (p=0,815 e p=0,489). Conclusão: A adesão à hormonioterapia observada foi relativamente baixa, independentemente da endocrinoterapia, podendo essas pacientes estarem em risco de inadequação quanto à resposta clínica

Introduction: Among breast cancers, approximately 75% of women are hormone receptors-positive, and these are more likely to respond to hormone therapy with anastrozole and tamoxifen. Although effective, they have significant rates of non-adherence. Objective: To evaluate adherence to adjuvant hormone therapy with tamoxifen and anastrozole in patients consulted at the Mastology and Chemotherapy Outpatient Clinic of Hospital São Paulo between 2019 and 2020. Method: Cross-sectional study carried out with 102 women between September 2019 and March 2020. Adherence to hormone therapy was evaluated using the Morisky Medication Adherence Scale (MMAS-4) and Adherence to Refills and Medications Scale of 12 items (ARMS-12). Results: The mean age was 61.5 years (59.3-63.6). Among the patients, 27.7% used tamoxifen and 72.3%, anastrozole. 84.4% of them reported discomfort in using the medication, the most frequent were hot flashes (42.2%) and joint pain (55.9%). 79.2% scored the ARMS>12 scale, about 90% of the women scored MMAS-4 up to 2 points, but there was no significant difference between the types of hormones used for adhesion scales (p=0.815 to p=0.489). Conclusion: Adherence to hormone therapy was relatively low, regardless of the hormone used, and these patients may be at risk of inadequate clinical response

Introducción: Entre los cánceres de mama, aproximadamente el 75% de las mujeres son receptores hormonales positivos, y estas son más propensas a responder a la terapia hormonal con anastrozol y tamoxifeno. Aunque son eficaces, tienen tasas significativas de no adherencia. Objetivo: Evaluar la adhesión a la terapia hormonal adyuvante con tamoxifeno y anastrozol en pacientes atendidas en las Clínicas Ambulatorias de Mastología y Quimioterapia del Hospital São Paulo entre 2019 y 2020. Método: Este es un estudio transversal realizado con 102 mujeres entre septiembre de 2019 y marzo de 2020. La terapia hormonal adjunta se evaluó utilizando las escalas Morisky Medication Adherence Scale (MMAS-4) e Adherence to Refills and Medications Scale of 12 items (ARMS-12). Resultados: La edad media fue de 61,5 años (59,3-63,6). Entre las pacientes, el 27,7% utilizaron tamoxifeno y el 72,3% anastrozol. El 84,4% de ellas reportaron molestias en relación con el uso del medicamento, siendo los más frecuentes los sofocos (42,2%) y el dolor articular (55,9%). 79,2% puntuaron la escala ARMS>12, alrededor del 90% de las mujeres obtuvieron MMAS-4 hasta dos puntos, pero no hubo diferencia significativa entre los tipos de hormonas utilizadas para escalas de adhesión (p=0,815 a p=0,489). Conclusión: La adherencia de la terapia hormonal observada fue relativamente baja, independientemente de la hormona utilizada, y estas mujeres pueden estar en riesgo de respuesta clínica inadecuada

Time series analysis of the suicide attempts assisted by firefighters from 2017 to 2021 in São Paulo, Brazil / Análise de séries temporais das tentativas de suicídio atendidas por bombeiros de 2017 a 2021 em São Paulo, Brasil

ABSTRACT Objective: This study aimed to analyze the time trends of suicide attempts assisted by the Fire Department of the Military Police of the State of São Paulo (Corpo de Bombeiros da Polícia Militar do Estado de São Paulo — CBPMESP) from 2017 to 2021, between sexes. Methods: This is an ecological study of 11,435 suicide attempts assisted by CBPMESP calls from January 2017 to December 2021. Three seasonal auto-regressive integrated moving average with exogenous (SARIMAX) models were adjusted considering total population, only men, and only women. Results: The total occurrences of suicide attempts were stationary in the prepandemic period but had an increased growth pattern after the pandemic began. This trend was higher among men, due to (1) lower assistance of suicide attempts during early pandemic than in the prepandemic period and (2) significant increased assistance after the beginning of vaccination against COVID-19, followed by a decrease, but with a tendency to increase, in the long-term pandemic. Conclusion: Our results indicate a growth in the long-term suicide attempts during COVID-19. The beginning of vaccination was not considered significant in the reduction of CBPMESP attendances. These results corroborate the need for a multisectoral national suicide prevention strategy to mitigate the effects of the pandemic on mental health in the State of São Paulo.

RESUMO Objetivo: Analisar as tendências temporais das tentativas de suicídio atendidas pelo Corpo de Bombeiros da Polícia Militar do Estado de São Paulo (CBPMESP) de 2017 a 2021, entre os sexos. Métodos: Estudo ecológico de 11.435 tentativas de suicídio atendidas pelo CBPMESP de janeiro de 2017 a dezembro de 2021. Três modelos autorregressivos integrados e de médias móveis sazonais multiplicativos com variáveis explicativas (SARIMAX) foram ajustados considerando-se a população total, apenas homens e apenas mulheres. Resultados: As ocorrências totais de tentativas de suicídio foram estacionárias no período pré-pandemia, mas tiveram um padrão de crescimento aumentado após o início da pandemia. Essa tendência foi maior entre os homens, seguindo o seguinte padrão: (a) menor ocorrência de tentativas de suicídio entre homens no início da pandemia quando comparado ao período pré-pandemia; e (b) aumento significativo das ocorrências após o início da vacinação contra COVID-19 no Estado de São Paulo, seguido de queda, mas com tendência de aumento na pandemia de longo prazo. Conclusão: Nossos resultados indicam aumento nas tentativas de suicídio em longo prazo durante a COVID-19. O início da vacinação não foi considerado significativo na diminuição dos atendimentos do CBPMESP. Esses resultados corroboram a necessidade de uma estratégia nacional multissetorial de prevenção ao suicídio para mitigar os efeitos da pandemia na saúde mental no Estado de São Paulo.

Percepção de farmacêuticos na implantação do Cuidado Farmacêutico na Atenção Básica / Pharmacists' perceptions on the implementation of Pharmaceutical Care in Primary Care

Resumo O artigo descreve a percepção de 10 farmacêuticos da Atenção Básica (AB) de uma região do município de São Paulo que participaram do processo de implantação do Cuidado Farmacêutico. A partir de uma pesquisa qualitativa com grupos focais e abordagem descritiva, os conteúdos foram analisados utilizando-se a Análise de Conteúdo. Das 52 unidades de registro organizadas em 10 categorias, resultaram três sínteses sobre o processo de implantação do CF. Nesse contexto, foi possível descrever o papel do farmacêutico na AB após a implantação dos serviços clínicos, de modo a identificar suas percepções, dificuldades e avanços. Os resultados demonstraram aspectos positivos, além da necessidade de uma mudança gradual no perfil e nas competências dos farmacêuticos para o desenvolvimento de serviços clínicos, ultrapassando os limites da categoria e dependendo do trabalho em equipe realizado na AB. Logo, os resultados promovem os diferentes papéis dos atores envolvidos nesta prática (usuários, equipe de saúde, gestores e farmacêuticos) e valorizam novas formas de cuidado no SUS.

Abstract The article describes the perception of 10 pharmacists from the Primary Health Care (PHC) of a region in the municipality of São Paulo that participated in the process of implementing the Pharmaceutical Care (PC). Based on qualitative research with focus groups and descriptive approach, contents were reviewed using the Content Analysis. The 52 registration units organized in 10 categories resulted in three summaries about the PC implementation process. In this context, we could describe the role of pharmacists in PHC after the implementation of clinical services, in order to identify their perceptions, difficulties and advances. Results unveiled positive aspects, besides the need for gradual change in the profile and competences of pharmacists to develop clinical services, extrapolating the category boundaries, and depending on the teamwork performed at PHC. Therefore, results promote the different roles of the players involved in this practice (users, health team, managers, and pharmacists), and value new forms of care in the Brazilian Health System (SUS).

Primary health care performance according to clusters of convergent municipalities in the state of São Paulo / Desempenho da atenção primária à saúde, segundo clusters de municípios convergentes no estado de São Paulo

ABSTRACT: Objective: To describe the performance of Primary Health Care, according to conglomerates of São Paulo cities that present homogeneous indicators. Methods: This is a descriptive study, based on secondary data extracted from official sources of the Unified Health System, for the year 2018. An analysis matrix was created, with the proposition of performance (access, effectiveness and adequacy) and context indicators (population, health determinants and financing) selected and organized in dimensions and sub-dimensions. Cluster Analysis was used to identify the groups of homogeneous municipalities. Results: 645 municipalities were divided in 6 conglomerates. Clusters 2 and 3 were formed predominantly by small municipalities with greater access to health; cluster 3 has less social vulnerability and greater investment in health. Clusters 1, 4 and 5 were formed by the largest municipalities with less access to health; cluster 4 presents greater social vulnerability, less coverage of private health plans and a greater percentage of health resources; cluster 5 was characterized by greater Gross Domestic Product per capita and greater coverage of private health plans. Cluster 6, formed by the city of São Paulo, was a particular case. Cluster 2 drew attention, as it was shown to have increased coverage, but signaled lower efficacy and adequacy levels. Cluster 3 had the best performance among all clusters. Conclusion: These findings can support regional and municipal management, given the complexity of the territory of São Paulo, pointing to scenarios that demand broader public management initiatives.

RESUMO: Objetivo: Descrever o desempenho da atenção primária à saúde, segundo clusters de municípios paulistas que apresentaram indicadores homogêneos. Métodos: Trata-se de um estudo descritivo, com base em dados secundários extraídos de fontes oficiais do Sistema Único de Saúde, referentes ao ano de 2018. Foi elaborada uma matriz de análise, com a proposição de indicadores de desempenho (acesso, efetividade e adequação) e contexto (população, determinantes de saúde e financiamento), selecionados e organizados em dimensões e subdimensões. Para identificar os grupos de municípios homogêneos, foi utilizada a análise de cluster Resultados: Dos 645 municípios, constituíram-se seis clusters. Os clusters 2 e 3 foram formados, predominantemente, por municípios pequenos e com maior acesso; entre eles, o cluster 3 apresentou menor vulnerabilidade social e maior investimento em saúde. Os clusters 1, 4 e 5, em contrapartida, foram formados por municípios maiores e com menor acesso; entre eles, o cluster 4 apresentou maior vulnerabilidade social, menor cobertura de planos privados de saúde e maior percentual de recursos utilizados em saúde; e o cluster 5, maior produto interno bruto per capita e maior cobertura de planos privados de saúde. O cluster 6, formado pelo município de São Paulo, demonstrou ser um caso particular. Ainda, o cluster 2 chamou atenção. Apresentando maior cobertura, sinalizou menor efetividade e adequação. Entre todos os clusters, o cluster 3 alcançou o melhor desempenho. Conclusão: Os resultados podem subsidiar a gestão regional e municipal, diante da complexidade do território paulista, apontando para cenários que demandam maiores inciativas de gestão pública.

The relationship between level of education and moral judgment toward who abuse drugs.

The aim of the present study is to verify the differences of the moral judgment toward the people who abuse drugs according to the schooling of the participants. This is the Brazilian part of a multicentric study. N=180 individuals in a community in Brasília, DF, Brazil; following consent, descriptive data were collected by anonymous interviewer-administered questionnaire that included socio-demographic, educational level and the history of drug use. Participants were predominantly females, middle-aged, married, employed, religious, with high school education; higher schooling considered alcohol abusers, marijuana, cocaine and crack are important as anyone else; the majority with lower education level knew someone who used drugs, but no association was found regarding drug use and schooling; in the unadjusted logistic regression model, positive associations were found between higher schooling and 'who use drugs are as important as anyone else' for all drugs studied; after adjusted, the association remained only for marijuana (all p<0.05). The negative attitude surrounding drugs issue can be an important obstacle. The results suggest that education can help to reduce the stigma associated; public policies would be important to minimizing social harm caused by stigmatized visions of drug users.

Analysis of gaps in alcohol policies in Brazil using the Pan American Health Organization's Alcohol Policy Scoring.

BACKGROUND: National alcohol policies need to be systematized and evaluated to identify the gaps that should be filled by future laws. This study aims to search for and classify Brazilian public alcohol policies at the federal and state levels, based on the ten Alcohol Policy Scoring (APS) domains used by the Pan American Health Organization (PAHO), to identify any gaps METHODS: Documental research was carried out in two phases: document identification and content analysis. The search included laws, decrees, and ordinances for alcohol referred to in this text as regulatory documents (RD), enacted until December 31, 2019, in Brazil and its 26 states and the Federal District. The APS was used to classify and score the RD, which consists of ten policy domains (including pricing, availability, marketing, and health services), weighted according to the level of scientific evidence of each strategy RESULTS: We identified and categorized 435 valid RD (21 national laws and 414 state laws). Overall, Brazilian alcohol policies account for 51.6% (255/494) of the APS score. In the pricing policy domain, the second most robust indicator of the APS, the policy gap reached 87% in 25 states, demonstrating a weakness. Only the federal laws against drink-driving include all the recommended dimensions. There are important legislative contradictions in the definition of an alcoholic beverage and in the content of the policies to control marketing CONCLUSION: At the national level, the federal government adopted alcohol policies in several of the PAHO policy domains but enacted RD with little practical effect. At the subnational level, despite the autonomy to complement federal laws, the states have not yet addressed the most important gaps.

Physical activity patterns in a representative sample of adolescents from the largest city in Latin America: a cross-sectional study in Sao Paulo.

OBJECTIVES: We examined the patterns of total and domain-specific physical activity (PA) by sex, socioeconomic status and maternal education level in adolescents from Sao Paulo city, Brazil. DESIGN: Cross-sectional study. PARTICIPANTS: We included a representative sample of 2682 (52.2% boys) adolescents aged 14-15 years from public and private schools in Sao Paulo, 2017. Socioeconomic status was assessed using a wealth index derived from principal component analysis. Descriptive analyses evaluated differences in total and domain-specific PA by sex, socioeconomic status and maternal education level. OUTCOME MEASURES: We collected data on the frequency and duration that adolescents spent in each PA domain (active transportation, leisure PA and physical education classes) through a self-report questionnaire. RESULTS: On average, adolescents spent 197.7 min/week (95% CI 190.6-204.8) in total PA. The proportion of adolescents achieving at least 60 min/day (≥420 min/week) was 12.7% (95% CI 11.4-14.1), with a higher prevalence in boys (18.3%) and in those with higher socioeconomic status (17.4%). Similar patterns were observed for leisure PA and physical education classes. Active transportation was higher in girls (46.0 min/week; 95% CI 42.6-49.6) than in boys (43.4 min/week, 95% CI 39.9-46.6). Boys and adolescents with higher socioeconomic status and higher maternal education level had higher levels of total PA. CONCLUSIONS: We found a variation in patterns of total and domain-specific PA by sex, socioeconomic status and maternal education level in adolescents from Sao Paulo. Initiatives for promoting PA in adolescents should take these findings into account.

Heavy episodic drinking trends in the Brazilian state capitals and Federal District, 2006-2018: an ecological time series analysis. / Tendência do beber episódico excessivo nas capitais brasileiras e no Distrito Federal, 2006-2018: um estudo ecológico de séries temporais.

OBJECTIVE: To assess heavy episodic drinking trends in the 26 Brazilian state capitals and Federal District, overall and according to sex. METHODS: This was an ecological time series study of heavy episodic drinking patterns among adults, from 2006 to 2018. The data were obtained from VIGITEL Survey time series. Prais-Winsten regression was used. RESULTS: In the period studied a stationary heavy episodic drinking trend was found in 23 out of the 27 state capitals, with the exception of Macapá, where there was a decrease in this practice, and in São Paulo, Florianópolis and the Federal District, where an increase was found. There were important differences by sex in relation to heavy episodic drinking, with a tendency to increased consumption among women in seven state capitals. CONCLUSION: There was no reduction in heavy episodic drinking in most capitals, showing the urgency of implementing interventions to reduce alcohol consumption among the Brazilian population.

Cancer cases and deaths attributable to lifestyle risk factors in Chile.

BACKGROUND: To identify modifiable risk factors that contribute to cancer holds important public health relevance for setting up prevention strategies. Therefore, the aim of this study was to estimate the proportion of cancer cases and deaths attributable to alcohol consumption, high body mass index (BMI), low fruits and vegetables consumption, lack of physical activity, tobacco smoking, and passive smoking in Chile in 2018. METHODS: We retrieved data from a national representative survey to describe the distribution of six lifestyle risk factors. Relative risks of each risk factor-cancer pair were obtained from published meta-analysis and pooled cohort studies. Cancer cases and deaths were obtained from the GLOBOCAN 2018. RESULTS: Nearly 30% of all cancer cases (15,097 out of 50,320 cases) and 36% of all cancer deaths (10,155 out of 28,010 deaths) in Chile in 2018 were attributable to lifestyle risk factors. Smoking and high BMI accounted for most of the cancer cases (9232 and 4394, respectively) and deaths (6868 and 2572). The cancer burden of other lifestyle risk factors varied by sex. In men, the proportion of all cancer cases attributed to alcohol were 3.7% compare to 2.0% for women. Cancers cases and deaths of the larynx, lung, oral/cavity, esophagus and bladder could be at least halved if lifestyle risk factors were eliminated. CONCLUSION: Smoking and high BMI were the leading causes of preventable cancer cases and deaths within the six lifestyles factors considered. Cancer prevention strategies should consider evidence-based interventions and public policies to encourage the adoption of a healthier lifestyle.

Signs of altered psychomotor capacity and use of alcohol and other drugs among nightclub patrons who drive in the city of São Paulo, Brazil.

Objectives: To investigate the occurrence of signs of altered psychomotor capacity (SAPC) associated with the violation of the dry law at the exits of nightclubs in the city of São Paulo, Brazil.Methods: Data from drivers participating in the Balada com Ciência project were used. Alcohol dosages were measured with breathalyzer test. The use of other drugs was obtained by interviewees' self-report. SAPC (speech, walking, glazed eyes, and alcohol odor) were verified by the interviewers at the time of the interview and categorized as "no sign" or "at least one sign". All measurements were evaluated at the exit of the nightclubs. The population description considered the sample weighting. Logistic regression analysis evaluated the association between the occurrence of SAPC, alcohol and other drugs use, controlling for sociodemographic variables.Results: At nightclubs, the SAPC among drivers are about 8 times higher when the breath alcohol concentration is above 0.05 mg/L if compared with those who did not drink alcohol, and about 30 times higher when the alcohol concentration was ≥ 0.34 mg/L in exhaled air. This finding is not generally verified in the literature for those who report the use of drugs inside nightclubs, which is interesting, since 20.4% of the interviewed population reported using drugs in the places surveyed.Conclusion: This study suggests the potential of using the Perham (2007) physical test for alcohol intoxication in sobriety checkpoints at the exit of nightclubs. However, the verification of these signs is not enough for the identification of drug use by drivers.

Tendência do beber episódico excessivo nas capitais brasileiras e no Distrito Federal, 2006-2018: um estudo ecológico de séries temporais / Tendencia del consumo episódico excesivo de alcohol en las capitales brasileñas y el Distrito Federal, 2006-2018: un estudio ecológico de series temporales / Heavy episodic drinking trends in the Brazilian state capitals and Federal District, 2006-2018: an ecological time series analysis*

Objetivo: Avaliar as tendências do beber episódico excessivo nas 26 capitais brasileiras e no Distrito Federal, geral e por sexo. Métodos:Estudo ecológico de séries temporais do padrão de beber episódico excessivo entre adultos, entre os anos de 2006 a 2018. Os dados foram obtidos da série histórica do Vigitel. Empregou-se regressão de Prais-Winsten. Resultados: No período estudado, observou-se tendência estacionária de beber episódico excessivo em 23 das 27 capitais brasileiras; na capital Macapá, observou-se diminuição dessa prática; e nas capitais São Paulo e Florianópolis, assim como no Distrito Federal, tendência crescente nesse consumo. Há importantes diferenças no beber episódico excessivo por sexo, com tendência de aumento entre mulheres em sete capitais. Conclusão: Não houve redução do beber episódico excessivo na maioria das capitais, evidenciando a urgência da implantação de intervenções visando reduzir o consumo de álcool na população brasileira.

Objetivo: Evaluar las tendencias del consumo episódico excesivo de alcohol en las 26 capitales brasileñas y el Distrito Federal, total y según el sexo. Métodos: Estudio ecológico de series temporales del patrón de consumo excesivo de alcohol episódico entre adultos, de 2006 a 2018. Los datos se obtuvieron de la serie histórica de Vigitel. Se utilizó la regresión de Prais-Winsten. Resultados: Se observó una tendencia estacionaria al consumo episódico excesivo de alcohol entre 2006 y 2018 en 23 de 27 de las capitales brasileñas; con excepción de Macapá donde hubo una disminución en esta práctica, y en las capitales São Paulo, Florianópolis y Distrito Federal, donde se encontró una tendencia creciente. Existen diferencias importantes por sexo, con aumento del consumo entre las mujeres en siete capitales. Conclusión: No hubo reducción en el consumo episódico excesivo de alcohol en la mayoría de las capitales, lo que demuestra la urgencia de implementar intervenciones para reducir el consumo de alcohol en la población brasileña.

Objective: To assess heavy episodic drinking trends in the 26 Brazilian state capitals and Federal District, overall and according to sex. Methods: This was an ecological time series study of heavy episodic drinking patterns among adults, from 2006 to 2018. The data were obtained from VIGITEL Survey time series. Prais-Winsten regression was used. Results: In the period studied a stationary heavy episodic drinking trend was found in 23 out of the 27 state capitals, with the exception of Macapá, where there was a decrease in this practice, and in São Paulo, Florianópolis and the Federal District, where an increase was found. There were important differences by sex in relation to heavy episodic drinking, with a tendency to increased consumption among women in seven state capitals. Conclusion: There was no reduction in heavy episodic drinking in most capitals, showing the urgency of implementing interventions to reduce alcohol consumption among the Brazilian population.

Nutrition status of elderly smokers and former smokers of São Paulo City, Brazil. / Estado nutricional de idosos fumantes e ex-fumantes da cidade de São Paulo, Brasil.

OBJECTIVES: The concomitance of smoking and poor dietary habits represents a worsened prognosis of health and quality of life for elderly. The aim of this study was to characterize the nutritional status of elderly who were smokers and former smokers and residents of São Paulo city. METHODS: A cross-sectional study was conducted in 2010 with a representative sample of 1,345 individuals aged 60 years and over, who were part of the elderly cohort monitored at the SABE Study. Sociodemographic, health, and nutritional aspects of the elderly were described, according to their tobacco use in life. RESULTS: The proportion of smokers and former smokers was 12.9 and 54.7%, 11.0 and 25.2%, and 11.8 and 37.2% for male, female, and total population, respectively. For both genders, increasing age decreased the proportion of smokers. The proportion of proper fruit intake was smaller for female smokers. Poorer nutritional status was observed in smokers, who had fewer meals per day and greater frequency of underweight compared with elderly nonsmokers. CONCLUSION: Considering the impact of inappropriate eating habits and smoking on health, elderly smokers deserve special attention on their nutritional status.

OBJETIVO: A concomitância de fumo e maus hábitos alimentares representa uma piora no prognóstico da saúde e na qualidade de vida dos idosos. O objetivo deste estudo foi caracterizar o estado nutricional de idosos fumantes e ex-fumantes residentes na cidade de São Paulo. MÉTODOS: Foi realizado um estudo transversal em 2010, com uma amostra representativa de 1.345 indivíduos com 60 anos ou mais, que fazem parte da coorte de idosos acompanhados pelo Estudo Saúde, Bem-Estar e Envelhecimento (SABE). Foram descritos os aspectos sociodemográficos, de saúde e nutricionais dos idosos de acordo com o uso de tabaco na vida. RESULTADOS: A proporção de fumantes e ex-fumantes foi de, respectivamente, 12,9 e 54,7% para o sexo masculino; 11,0 e 25,2% para o sexo feminino; e de 11,8 e 37,2% para a população total do estudo. Para ambos os sexos, com o aumento da idade, diminuiu a proporção de fumantes. A proporção de idosas fumantes com ingestão adequada de frutas foi menor. Fumantes apresentaram pior estado nutricional, com menos refeições por dia e maior frequência de baixo peso. CONCLUSÃO: Considerando-se o impacto do hábito alimentar inadequado e de fumar sobre a saúde, os fumantes idosos merecem atenção especial sobre o seu estado nutricional.

Estado nutricional de idosos fumantes e ex-fumantes da cidade de São Paulo, Brasil / Nutrition status of elderly smokers and former smokers of São Paulo City, Brazil

RESUMO: Objetivo: A concomitância de fumo e maus hábitos alimentares representa uma piora no prognóstico da saúde e na qualidade de vida dos idosos. O objetivo deste estudo foi caracterizar o estado nutricional de idosos fumantes e ex-fumantes residentes na cidade de São Paulo. Métodos: Foi realizado um estudo transversal em 2010, com uma amostra representativa de 1.345 indivíduos com 60 anos ou mais, que fazem parte da coorte de idosos acompanhados pelo Estudo Saúde, Bem-Estar e Envelhecimento (SABE). Foram descritos os aspectos sociodemográficos, de saúde e nutricionais dos idosos de acordo com o uso de tabaco na vida. Resultados: A proporção de fumantes e ex-fumantes foi de, respectivamente, 12,9 e 54,7% para o sexo masculino; 11,0 e 25,2% para o sexo feminino; e de 11,8 e 37,2% para a população total do estudo. Para ambos os sexos, com o aumento da idade, diminuiu a proporção de fumantes. A proporção de idosas fumantes com ingestão adequada de frutas foi menor. Fumantes apresentaram pior estado nutricional, com menos refeições por dia e maior frequência de baixo peso. Conclusão: Considerando-se o impacto do hábito alimentar inadequado e de fumar sobre a saúde, os fumantes idosos merecem atenção especial sobre o seu estado nutricional.

ABSTRACT: Objectives: The concomitance of smoking and poor dietary habits represents a worsened prognosis of health and quality of life for elderly. The aim of this study was to characterize the nutritional status of elderly who were smokers and former smokers and residents of São Paulo city. Methods: A cross-sectional study was conducted in 2010 with a representative sample of 1,345 individuals aged 60 years and over, who were part of the elderly cohort monitored at the SABE Study. Sociodemographic, health, and nutritional aspects of the elderly were described, according to their tobacco use in life. Results: The proportion of smokers and former smokers was 12.9 and 54.7%, 11.0 and 25.2%, and 11.8 and 37.2% for male, female, and total population, respectively. For both genders, increasing age decreased the proportion of smokers. The proportion of proper fruit intake was smaller for female smokers. Poorer nutritional status was observed in smokers, who had fewer meals per day and greater frequency of underweight compared with elderly nonsmokers. Conclusion: Considering the impact of inappropriate eating habits and smoking on health, elderly smokers deserve special attention on their nutritional status.

Medicine poisoning mortality trend by gender and age group, São Paulo State, Brazil, 1996-2012. / Tendência da mortalidade por intoxicação medicamentosa entre gêneros e faixas etárias no Estado de São Paulo, Brasil, 1996-2012.

This study looked into mortality due to medicinal drug poisoning by age, gender and intent among the population of the state of São Paulo. The adjusted time sequence of mortality due to drug poisoning was developed based on data available in the DATASUS Mortality Data System for 1996 to 2012. We checked the variables for magnitude and trends. We found an increase in adjusted mortality starting in 2005, and more so as of 2009, confirmed by a 95% CI for the average annual rate of change. (AARC) We did not find the same trend in overall mortality in the state (AARC = -0.22%, 95% CI = -1.12 - 0.69) for specific, external cause mortality (AARC = -3.14%, 95% CI = -4.75 - -1.49) and for mortality due to accidental drug poisoning (AARC=+9,76%, 95% IC = -12.16 - 37.14). The largest increase was found in intentional self-poisoning with medicinal drugs (AARC = +10.64%, 95% CI = 6.92 - 14.40), and among the younger subjects (largest magnitude). The trend in mortality due to drug poisoning in the State of São Paulo, the importance of intent and mortality among the younger population reiterate the need to implement control measures.

Resumo O estudo verificou a tendência da mortalidade por intoxicação medicamentosa por faixas etárias, sexo e intenção, na população do estado de São Paulo. A série temporal de mortalidade por intoxicação medicamentosa ajustada foi construída a partir de dados do Sistema de Informações sobre Mortalidade do DATASUS (1996 a 2012). Foram verificadas a magnitude e a tendência para as variáveis estudadas. Observou-se tendência crescente de mortalidade ajustada a partir de 2005, que se acentuou a partir de 2009, o que foi confirmado pelo valor do IC95% para a taxa de variação anual média. Tal tendência não foi verificada para a mortalidade geral para o estado (TVAM = -0,22%; IC95% = -1,12 ­ 0,69), para a mortalidade específica por causas externas (TVAM = -3,14%; IC95% = -4,75 ­ -1,49) e para a mortalidade por intoxicação medicamentosa acidental (TVAM = +9,76%, IC95% = -12,16 ­ 37,14). A autointoxicação medicamentosa intencional foi a que mais cresceu no período (TVAM = +10,64%, IC95% = 6,92 ­ 14,49), assim como a mortalidade entre os mais jovens (maior magnitude). A tendência observada para a mortalidade por intoxicação medicamentosa no estado de São Paulo, a relevância da componente intencional e da mortalidade entre as faixas etárias mais jovens ressaltam a necessidade de implementação de medidas de controle.

Tendência da mortalidade por intoxicação medicamentosa entre gêneros e faixas etárias no Estado de São Paulo, Brasil, 1996-2012 / Medicine poisoning mortality trend by gender and age group, São Paulo State, Brazil, 1996-2012

Resumo O estudo verificou a tendência da mortalidade por intoxicação medicamentosa por faixas etárias, sexo e intenção, na população do estado de São Paulo. A série temporal de mortalidade por intoxicação medicamentosa ajustada foi construída a partir de dados do Sistema de Informações sobre Mortalidade do DATASUS (1996 a 2012). Foram verificadas a magnitude e a tendência para as variáveis estudadas. Observou-se tendência crescente de mortalidade ajustada a partir de 2005, que se acentuou a partir de 2009, o que foi confirmado pelo valor do IC95% para a taxa de variação anual média. Tal tendência não foi verificada para a mortalidade geral para o estado (TVAM = -0,22%; IC95% = -1,12 - 0,69), para a mortalidade específica por causas externas (TVAM = -3,14%; IC95% = -4,75 - -1,49) e para a mortalidade por intoxicação medicamentosa acidental (TVAM = +9,76%, IC95% = -12,16 - 37,14). A autointoxicação medicamentosa intencional foi a que mais cresceu no período (TVAM = +10,64%, IC95% = 6,92 - 14,49), assim como a mortalidade entre os mais jovens (maior magnitude). A tendência observada para a mortalidade por intoxicação medicamentosa no estado de São Paulo, a relevância da componente intencional e da mortalidade entre as faixas etárias mais jovens ressaltam a necessidade de implementação de medidas de controle.

Abstract This study looked into mortality due to medicinal drug poisoning by age, gender and intent among the population of the state of São Paulo. The adjusted time sequence of mortality due to drug poisoning was developed based on data available in the DATASUS Mortality Data System for 1996 to 2012. We checked the variables for magnitude and trends. We found an increase in adjusted mortality starting in 2005, and more so as of 2009, confirmed by a 95% CI for the average annual rate of change. (AARC) We did not find the same trend in overall mortality in the state (AARC = -0.22%, 95% CI = -1.12 - 0.69) for specific, external cause mortality (AARC = -3.14%, 95% CI = -4.75 - -1.49) and for mortality due to accidental drug poisoning (AARC=+9,76%, 95% IC = -12.16 - 37.14). The largest increase was found in intentional self-poisoning with medicinal drugs (AARC = +10.64%, 95% CI = 6.92 - 14.40), and among the younger subjects (largest magnitude). The trend in mortality due to drug poisoning in the State of São Paulo, the importance of intent and mortality among the younger population reiterate the need to implement control measures.

Characteristics of clients using a community-based drug treatment service ('CAPS-AD') in Brazil: An exploratory study.

BACKGROUND: Substance use is common in Brazil. In order to improve availability of substance misuse care services, over 400 Psycho-Social Care Centres for Alcohol and Drugs (CAPS-AD) - providing community-based care - have been established following mental health care reform (2001). Information on CAPS-AD clients and outcomes is limited. The present study examined select characteristics of local CAPS-AD clients. METHODS: N=143 adult CAPS-AD clients in Ceilândia (suburb of Brasília, Federal District) participated in a 1-week 'snapshot' assessment of service users (February 2015). Following consent, descriptive data were collected by a brief, anonymous interviewer-administered questionnaire that included socio-demographic, drug use, treatment history and needs/barriers information. RESULTS: Participants were predominantly male; middle-aged; unemployed; married; with middle-school education; primary problem drugs indicated were alcohol and cocaine/crack; half had prior treatment histories and indicated that treatment was externally motivated; 60% reported ways to improve treatment and possible reasons for treatment discontinuation; in multi-variate analyses, the latter was associated with employment and education status (both p<.05). CONCLUSION: CAPS-AD services appear to have increased low-barrier substance misuse treatment availability in Brazil, as well as attract individuals new to the treatment system. Various potential barriers to continuing in treatment should be addressed and more research on CAPS-AD clients and outcomes is needed.