Belief patterns and drug use in a sample of Brazilian youth: an exploratory latent class analysis

Objective: Adolescent substance abuse is a public health concern worldwide, and its prevention is the subject of numerous programmatic efforts. Yet, little research exists on the structure of drug-related belief patterns in youth and their utility in preventive program planning. The aim of this study is to determine the structure of drug-related beliefs among 12-15-year-old students in Brazil using latent class analysis. Methods: De-identified survey data were obtained from the baseline sample (n=6,176) of a randomized controlled trial on the #Tamojunto drug use prevention program in Brazilian middle schools. Using 11 survey items assessing drug-related beliefs as indicators, four models were run and assessed for goodness-of-fit. For the best fitting model, demographic variables and substance use across latent classes were assessed. Results: Model fit statistics indicated that the best fit was a three-class solution, comprising a large Drug-Averse Beliefs class (80.9%), a smaller Permissive Beliefs class (12.7%), and an Inconsistent Beliefs class (6.4%). Respondents in the Permissive Beliefs and Inconsistent Beliefs classes reported greater past-year drug use, were slightly older and less likely to be female than those in the Drug-Averse Beliefs class. Conclusions: These results indicate that conceptualizing drug beliefs as a categorical latent variable may be useful for informing prevention. Longitudinal studies are needed to establish temporality and assess further applicability of this construct.

Sociodemographic factors associated with smoking risk perception in adolescents in São Paulo, Brazil

Objective: We examined the sociodemographic factors associated with smoking risk perceptions (SRP) in youth living in two very different neighborhoods in the city of São Paulo, Brazil: a middle-class central area (Vila Mariana) and a poor outer-city area (Capão Redondo). Methods: A cross-sectional survey was conducted with 180 public school-attending youth (all aged 12 years) and their parents. SRP was evaluated through self-reports. Weighted multinomial logistic regression was used to examine factors associated with SRP. Results: Smoking was considered a high-risk behavior by 70.9% of adolescents. There were significant differences in SRP associated with socioeconomic status (SES) and maternal smoking status. Having a non-smoking mother was positively associated with perceiving smoking as having low to moderate risk versus no risk (OR=3.91 [95%CI 1.27-12.02]). Attending school in Capão Redondo was associated with perceiving smoking as having high risk compared to no risk (OR=3.00 [95%CI 1.11-8.12]), and low SES was negatively associated with perceiving at least some risk in smoking versus perceiving no risk in this behavior. Conclusions: Youth whose mothers smoke appear to have lower SRP than those whose mothers do not smoke. Living in a poor outer-city area was associated with higher SRP.

Quality of life related to health for heart failure patients / Calidad de vida relacionada con la salud de pacientes con insuficiencia cardíaca / Qualidade de vida relacionada à saúde em pacientes com insuficiência cardíaca

ABSTRACT Objective: To assess the quality of life related to health for heart failure patients and to relate sociodemographic and clinical data. Method: It is an observational and transversal study, with quantitative approach, carried out in a heart failure ambulatory in the state of Pernambuco. Results: In the sample (n=101), there was prevalence of men older than 60 years old, married and professionally inactive. The quality of life related to health, based on the Minnesota Living With Heart Failure Questionnaire, was considered moderate (34.3±21.6), being significantly related to age (p=0.004), functional class (p<0.001), and patients with chagasic cardiopathy (p=0.02). Conclusion: The quality of life in the HF group of chagasic etiology was more compromised, specially in the emotional dimension. It is suggested that studies on the hypothesis that longer ambulatory follow-up improves quality of life and that having Chagas disease interferes negatively with the quality of life of heart failure patients.

RESUMEN Objetivo: Evaluar la calidad de vida relacionada con la salud de los pacientes con insuficiencia cardíaca (IC) y relacionar los datos sociodemográficos y clínicos. Método: Se trata de estudio observacional, de corte transversal, con abordaje cuantitativo realizado en Ambulatorio de insuficiencia cardíaca en el estado de Pernambuco. Resultados: En la muestra (n=101) hubo un predominio de hombres, mayores de 60 años de edad, casados y profesionalmente inactivos. La calidad de vida relacionada con la salud, desde el cuestionario Minnesota Living With Heart Failure Questionnaire, fue moderada (34,3±21,6), presentando una relación significativa con la edad (p=0,004), la clase funcional (p<0,001) y en pacientes con cardiopatía chagásica (p=0,02). Conclusión: La calidad de vida en el grupo IC de etiología chagásica estuvo más comprometida, principalmente la dimensión emocional. Se recomienda realizar estudios que aborden las hipótesis de que el mayor tiempo de seguimiento ambulatorio mejora la calidad de vida y de que tener la enfermedad de Chagas interfiere negativamente en la calidad de vida de pacientes con insuficiencia cardíaca.

RESUMO Objetivo: Avaliar a qualidade de vida relacionada à saúde dos pacientes com insuficiência cardíaca e relacionar aos dados sociodemográficos e clínicos. Método: Trata-se de estudo observacional, de corte transversal, com abordagem quantitativa realizado em ambulatório de insuficiência cardíaca no estado de Pernambuco. Resultados: Na amostra (n=101) houve predominância de homens, maiores de 60 anos, casados, profissionalmente inativos. A qualidade de vida relacionada à saúde, a partir do questionário Minnesota Living With Heart Failure Questionnaire foi considerada moderada (34,3±21,6), apresentando relação significativa com idade (p=0,004), classe funcional (p<0,001) e em pacientes com cardiopatia chagásica (p=0,02). Conclusão: A qualidade de vida no grupo IC de etiologia chagásica esteve mais comprometida, especialmente na dimensão emocional. Sugere-se a realização de estudos abordando as hipóteses de que maior tempo de acompanhamento ambulatorial melhora a qualidade de vida e que ter doença de Chagas interfere negativamente na qualidade de vida de pacientes com insuficiência cardíaca.

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.

Intrafamilial and extrafamilial sexual assault and its association with alcohol consumption / Agresión sexual intrafamiliar y extrafamiliar y su asociación con el consumo de alcohol

ABSTRACT OBJECTIVE Analyze the prevalence of intrafamilial and extrafamilial sexual assault in adolescents of Peru and its association with alcohol consumption. METHODS We used a two-step and stratified probabilistic sampling to select male and female students in secondary education from all over Peru. The study included data from 54,756 students with information on demographics, alcohol and drug use, and sexual assault. The statistical analysis considered the complex sampling and we conducted two independent analyses by type of sexual assault (intrafamilial and extrafamilial), stratified by the sex of the victim. RESULTS The prevalence of life of intrafamilial sexual assaults (5.4%, 95%CI 5.0-5.8) was similar to that of extrafamilial sexual assaults (6.1%, 95%CI 5.6-6.6). Alcohol consumption in the past year was associated with intrafamilial and extrafamilial sexual assaults that occurred in the same period after adjusting for confounders. Alcohol consumption in the past year was associated with non-physical and physical forms of intrafamilial and extrafamilial sexual assaults in the disaggregated analysis by type of assault. Alcohol consumption in the past year was associated with extrafamilial rape only among females (ORa = 2.8; 95%CI 1.3-5.9). CONCLUSIONS Sexual assault against adolescent males and females by family members is a frequent form of victimization that is associated with alcohol consumption in Peru. It is important to examine this form of victimization among adolescents, especially those who consume alcohol.

RESUMEN OBJETIVO Analizar la prevalencia de las agresiones sexuales intrafamiliares y extrafamiliares en adolescentes del Perú y su asociación con el consumo de alcohol. MÉTODOS Se utilizó un muestreo probabilístico bietápico y estratificado para seleccionar estudiantes varones y mujeres de educación secundaria de todo el Perú. Los datos de 54,756 estudiantes que incluían información demográfica, sobre consumo de alcohol y drogas, y agresión sexual fueron incluidos en el estudio. En el análisis estadístico se consideró el muestreo complejo y se condujeron dos análisis independientes por el tipo de agresión sexual (intrafamiliar y extrafamiliar), estratificado por el sexo de la víctima. RESULTADOS La prevalencia de vida de las agresiones sexuales intrafamiliares (5.4%, IC95% 5.0-5.8) fue similar al de las agresiones extrafamiliares (6.1%, IC95% 5.6-6.6). El consumo de alcohol en el último año se asoció con las agresiones sexuales intrafamiliares y extrafamiliares que ocurrieron en el mismo periodo después de ajustar por los factores de confusión. El consumo de alcohol en el último año se asoció a las formas no físicas y físicas de agresión sexuales intrafamiliares y extrafamiliares en el análisis desagregado por tipo de agresión. El consumo de alcohol en el último año se asoció con las violaciones sexuales extrafamiliares sólo entre las mujeres (ORa = 2.8; IC95% 1.3-5.9). CONCLUSIONES La agresión sexual de adolescentes mujeres y varones por miembros familiares es una forma frecuente de victimización que se asocia al consumo de alcohol en el Perú. Es importante indagar por esta forma de victimización en adolescentes, especialmente los que consumen alcohol.

Cardiac Magnetic Resonance-Verified Myocardial Fibrosis in Chagas Disease: Clinical Correlates and Risk Stratification / Fibrose Miocárdica Definida por Ressonância Magnética Cardíaca em Doença de Chagas: Correlações Clínicas e Estratificação de Risco

Abstract Background: Chagas disease (CD) is an important cause of heart failure and mortality, mainly in Latin America. This study evaluated the morphological and functional characteristics of the heart as well the extent of myocardial fibrosis (MF) in patients with CD by cardiac magnetic resonance (CMR). The prognostic value of MF evaluated by myocardial-delayed enhancement (MDE) was compared with that via Rassi score. Methods: This study assessed 39 patients divided into 2 groups: 28 asymptomatic patients as indeterminate form group (IND); and symptomatic patients as Chagas Heart Disease (CHD) group. All patients underwent CMR using the techniques of cine-MRI and MDE, and the amount of MF was compared with the Rassi score. Results: Regarding the morphological and functional analysis, significant differences were observed between both groups (p < 0.001). Furthermore, there was a strong correlation between the extent of MF and the Rassi score (r = 0.76). Conclusions: CMR is an important technique for evaluating patients with CD, stressing morphological and functional differences in all clinical presentations. The strong correlation with the Rassi score and the extent of MF detected by CMR emphasizes its role in the prognostic stratification of patients with CD.

Resumo Fundamento: A doença de Chagas (DC) é importante causa de insuficiência cardíaca e mortalidade, principalmente na América Latina. Este estudo avaliou as características morfológicas e funcionais do coração, assim como a extensão da fibrose miocárdica (FM) em pacientes com DC através de ressonância magnética cardíaca (RMC). O valor prognóstico da FM avaliada por realce tardio miocárdico (RTM) foi comparado àquele do escore de Rassi. Métodos: Avaliação de 39 pacientes divididos em 2 grupos: grupo 'forma indeterminada' (IND), 28 pacientes assintomáticos; e grupo 'cardiopatia chagásica' (CC), pacientes sintomáticos. Todos os pacientes foram submetidos a RMC com as técnicas de cine-RM e RTM, sendo a quantidade de FM evidenciada ao exame comparada ao escore de Rassi. Resultados: As análises morfológica e funcional mostraram significativas diferenças entre os 2 grupos (p < 0,001). Houve ainda uma forte correlação entre a extensão da FM e o escore de Rassi (r = 0,76). Conclusões: A RMC é uma importante técnica para avaliar pacientes com DC, ressaltando as diferenças morfológicas e funcionais em todas as apresentações clínicas. A forte correlação entre o escore de Rassi e a extensão da FM detectada por RMC enfatiza seu papel na estratificação prognóstica de pacientes com DC.

Sexual behavior among high school students in Brazil: alcohol consumption and legal and illegal drug use associated with unprotected sex

OBJECTIVE: Alcohol and other drug use appears to reduce decision-making ability and increase the risk of unsafe sex, leading to possible unplanned pregnancies, sexually transmitted diseases/human immunodeficiency virus/HIV transmission, and multiple sexual partners. This study aimed to test the hypothesis that risky sexual behaviors among adolescents are associated with legal and illegal drug use. METHODS: A national cross-sectional survey of 17,371 high-school students was conducted in 2010. Students were selected from 789 public and private schools in each of the 27 Brazilian state capitals by a multistage probabilistic sampling method and answered a self-report questionnaire. Weighted data were analyzed through basic contingency tables and logistic regressions testing for differences in condom use among adolescents who were sexually active during the past month. RESULTS: Approximately one third of the high school students had engaged in sexual intercourse in the month prior to the survey, and nearly half of these respondents had not used a condom. While overall sexual intercourse was more prevalent among boys, unsafe sexual intercourse was more prevalent among girls. Furthermore, a lower socioeconomic status was directly associated with non-condom use, while binge drinking and illegal drug use were independently associated with unsafe sexual intercourse. CONCLUSION: Adolescent alcohol and drug use were associated with unsafe sexual practices. School prevention programs must include drug use and sexuality topics simultaneously because both risk-taking behaviors occur simultaneously. .

The tobacco dependence dimension in Colombia / Dimensión de la dependencia del tabaco en Colombia

This epidemiological study of a sample of smokers from the general population of Colombia examined the population distribution and dimensionality of eight hypothesized inter-correlated clinical features (CFs) associated with tobacco dependence syndrome (TDS). Data were drawn from interviews of 4 426 smokers conducted in a national survey in Colombia as part of the World Mental Health Survey Initiative. Daily smokers completed a Spanish-language TDS module, and the 237 smokers who had begun smoking during the five years prior to the assessment were selected. Confirmatory factor analysis (CFA) for a unidimensional TDS provided discrimination and difficulty parameter estimates. Two CFs that were reported very infrequently among the study sample were dropped from the CFA. Among the six remaining CFs, discrimination (D1) estimates ranged from 1.1 to 6.0 and difficulty (D2) estimates ranged from 1.1 to 2.2, providing evidentiary support for a unidimensional tobacco dependence construct. The Spanish-language TDS module used in this study could serve as a valuable tool in future studies for evaluating public health outreach and early intervention programs directed toward community residents who have begun smoking tobacco.

En el presente estudio epidemiológico de una muestra de fumadores de la población general de Colombia se examinó la distribución y la magnitud de ocho características clínicas interrelacionadas en forma hipotética, que se asocian con el síndrome de dependencia del tabaco. Los datos se extrajeron de las entrevistas realizadas a 4-426 fumadores en una encuesta nacional en Colombia, que formó parte de la Iniciativa de la Encuesta de Salud Mental Mundial. Los fumadores habituales completaron un módulo de evaluación del síndrome de dependencia del tabaco y se escogieron los 237 fumadores que habían comenzado el consumo de tabaco en los cinco años que precedieron a la evaluación. El análisis factorial confirmatorio del modelo unidimensional del síndrome de dependencia del tabaco proporcionó los índices de discriminación y de dificultad de cada variable. Dos características clínicas que se notificaron con muy poca frecuencia en la muestra del estudio se excluyeron del análisis factorial. El índice de discriminación de las seis características restantes osciló entre 1,1 y 6,0, y el índice de dificultad fluctuó entre 1,1 y 2,2, con lo cual se demostró la validez de un modelo unidimensional de la dependencia. El módulo de evaluación en español del síndrome de dependencia del tabaco usado en este estudio podría constituir un instrumento valioso en estudios futuros destinados a evaluar los programas de salud pública de divulgación y de intervención temprana dirigidos a los residentes de la comunidad que han comenzado a fumar.

Validation of the Santa Casa evaluation of spasticity scale / Validação da escala de avaliação da espasticidade Santa Casa

Spasticity is a clinical condition that has negative repercussions on function. A scale capable of quantifying the severity and impact of an injury is fundamental to the rehabilitation process. The objective of this study was to retest and validate the Santa Casa evaluation of spasticity scale, a descriptive assessment of activities of daily living, transfers and locomotion. We analyzed spasticity and functional status in 97 hemiparetic patients. With statistical significance (p<0.05), this new scale demonstrated reliability in assessing clinical-functional conditions and reproducibility as a daily assessment scale for use during rehabilitation.

A espasticidade é uma condição clínica que pode repercutir negativamente na condição funcional. Um instrumento de avaliação capaz de mensurar a gravidade e a conseqüência da lesão torna-se ferramenta fundamental ao processo de reabilitação. O objetivo foi reproduzir e validar a Escala de Avaliação da Espasticidade Santa Casa (EAESC), instrumento descritivo correspondente às atividades de vida diária, transferências e locomoção. Analisou-se a espasticidade e condição funcional de 97 pacientes hemiparéticos. Com significância estatística (p<0,05), a EAESC mostrou-se sensível à análise das condições clínico-funcionais, sendo hábil sua reprodutibilidade como instrumento rotineiro de avaliação à reabilitação.

Pathological gambling in women: a review

Pathological gambling was only recently recognized as a psychiatric disorder (DSM-III, APA, 1980). Most studies of pathological gambling include only male subjects. Despite the paucity of information, it is likely that at least one-third of pathological gamblers are women. The objective of this article is to review clinical and epidemiological characteristics of female gamblers as compared to their male counterparts. MEDLINE and PsycINFO were searched for investigational studies and reviews of the past 10 years on clinical (sociodemographic, course and progression, psychiatric comorbidities, genetics, and personality) and epidemiological aspects of female gamblers. Other relevant articles were also selected from reference lists. It is concluded that the current literature indicates some common characteristics in female and male gamblers, but it also indicates the possibility that each gender may carry etiopathogenic differences that when better understood should lead to improved treatment and prevention strategies

Postpartum blues syndrome in Brazilian women: an investigation of associated factors

OBJETIVOS: Determinar as associaçöes entre Síndrome de Depressäo Pós-parto e fatores sociodemográficos, obstétricos e psiquiátricos numa amostra de mulheres brasileiras. PACIENTES E MÉTODOS: Neste estudo, comparamos uma amostra de 86 mulheres no pós-parto com uma mostra de 75 mulheres no final do puerpério, utilizando o Blues Questionnaire. RESULTADOS: As mulheres no pós-parto e as mulheres no final do puerpério apresentaram uma distribuiçäo significativamente diferente nos percentis da escala (P<0.01). Os fatores de risco sócio-demográficos, obstétricos e psiquiátricos pesquisados näo apresentaram Odds Ratios significativos em relaçäo ao Blues Questionnaire. CONCLUSÄO: a Síndrome de Depressäo Pós-parto em mulheres brasileiras parece ser caracterizada por alteraçöes da situaçäo mental da mäe que ocorrem no terceiro, quarto e quinto dias após o parto mas os resultados da aplicaçäo do Blues Questionnaire näo parecem estar associados com os fatores sócio-demográficos, obstétricos e psiquiátricos pesquisados