Dual visual impairment and contrast sensitivity among community-dwelling older adults: a cross-sectional study from the PrevQuedas Brazil trial / Duplo déficit visual e sensibilidade ao contraste em idosos da comunidade: estudo transversal do PrevQuedas Brasil

OBJECTIVE: To investigate the importance of improving visual assessment for community-dwelling older adult fallers. METHODS: Cross-sectional study with eligible older adults (> 60 years old) living in the community and who suffered at least one fall in the last 12 months from the PrevQuedas Brasil clinical trial. Sociodemographic data, information on previous falls, physical and functional assessment (BOMFAQ and FES-I) were collected. We evaluated impairments in visual acuity and contrast sensitivity using the Snellen E chart and low-contrast visual acuity tests, respectively. Dual visual impairment refers to the presence of both impairments. For statistical analysis we compared the participants in relation to the number of falls (single fallers or recurrent fallers) using Chi-square or Fisher's exact test and the significance level was <0.05 for all analyses. RESULTS: Visual acuity, low contrast sensitivity, and dual visual impairment were associated with recurrent falls (OR 1.85); visual impairment was more prevalent among the oldest old. Approximately 90% of the participants reported using glasses, and 63.80% used multifocal lenses. Dual impairment was identified in 143 (20.30%) participants. In multivariate logistic regression, the predictive variables for recurrent falls were low contrast sensitivity (95%CI 1.15­2.47), dual visual impairment (95%CI 1.16­2.83), and self-perceived fall risk (95%CI 1.16­2.46) which was measured using the Falls Efficacy Scale-International. CONCLUSION: Older adults with dual visual impairment are more likely to suffer recurrent falls. Low contrast sensitivity is crucial for fall risk assessment

OBJETIVO: Este estudo investiga a importância de avaliar a visão de idosos caidores na comunidade. METODOLOGIA: Estudo transversal com idosos elegíveis (> 60 anos) residentes na comunidade e que sofreram pelo menos uma queda nos últimos 12 meses do ensaio clínico PrevQuedas Brasil. Foram coletados dados sociodemográficos, informações sobre quedas pregressas, exames físicos e funcionais (BOMFAQ e FES-I). Avaliamos os comprometimentos da acuidade visual e da sensibilidade ao contraste por meio da Tabela E de Snellen e testes de acuidade visual de baixo contraste, respectivamente. O duplo déficit visual refere-se à presença de ambas as deficiências. Para análise estatística comparamos os idosos com relação ao número de quedas (caidores únicos ou caidores recorrentes) usando Qui-quadrado ou Teste exato de Fisher e o nível de significância foi <0.05 para todas as análises. RESULTADOS: Baixa acuidade visual, baixa sensibilidade ao contraste e duplo déficit visual foram associados a quedas recorrentes com odds ratio ­ OR 1,85, frequentemente mais prevalente entre os idosos longevos. Cerca de 90,00% dos idosos relataram usar óculos e 63,80% usavam lentes multifocais. O duplo déficit visual foi identificado em 143 (20,30%) participantes. Nos modelos de regressão logística multivariados, verificamos que as variáveis preditoras para queda recorrente foram a baixa sensibilidade ao contraste (intervalo de confiança ­ IC95% 1,15­2,47), duplo déficit (IC95% 1,16­2,83) e a autopercepção do risco de cair (IC95% 1,16­2,46) medido pela Falls Efficacy Scale-International. CONCLUSÃO: Idosos com baixa sensibilidade ao contraste e duplo déficit visual têm maiores chances de sofrerem múltiplas quedas quando comparados com idosos que possuem apenas baixa acuidade visual. Assim, a baixa sensibilidade ao contraste é essencial na avaliação do risco de quedas dos idosos

Exposure to violence: associations with psychiatric disorders in Brazilian youth

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

Effectiveness of a web-based intervention in reducing binge drinking among nightclub patrons / Efetividade de uma intervenção digital na diminuição da prática de binge drinking entre frequentadores de baladas

ABSTRACT OBJECTIVE To evaluate the effectiveness of a web-based intervention in reducing binge drinking among nightclub patrons after six months. METHODS We carried out a website survey with probabilistic sample in 31 nightclubs in the city of São Paulo, Brazil, which originated a randomized controlled trial with 1,057 participants. Those classified as problem drinkers (n = 465) using the Alcohol Use Disorders Identification Test were randomized into two study groups - intervention and control. The web-based intervention consisted of exposing the participants to a normative feedback screen about their alcohol consumption, characterizing the risks associated with amount consumed, money spent on drinks, drinking and driving, risk classification of Alcohol Use Disorders Identification Test, and tips to reduce damage. RESULTS There was a significant reduction in the practice of binge drinking in the week estimated at 38% among participants in the intervention group after six months (p < 0.05). However, there was no significant reduction in the outcomes when we analyzed the intervention and control groups and at baseline and after sixth months, simultaneously. CONCLUSIONS We cannot conclude that digital tools reduce the pattern of binge drinking among party goers in São Paulo. More studies are needed with this methodology because of its attractiveness to this type of group, given the privacy and speed that personalized information is transmitted.

RESUMO OBJETIVO Avaliar, após seis meses, a efetividade de uma intervenção digital na diminuição da prática de binge drinking entre frequentadores de baladas. MÉTODOS Foi realizado um inquérito de portal através de uma amostra probabilística em 31 baladas da cidade de São Paulo, a qual originou um ensaio controlado randomizado com 1.057 participantes. Aqueles classificados como uso problemático do álcool (n = 465) através do Alcohol Use Disorders Identification Test foram randomizados em dois grupos de estudo - intervenção e controle. A intervenção digital consistiu em expor os participantes a uma tela de feedback normativo sobre seu consumo de álcool, caracterizando os riscos associados à quantidade consumida, valores gastos com bebidas, beber e dirigir, classificação do risco do Alcohol Use Disorders Identification Test e dicas de redução de danos. RESULTADOS Houve uma redução significativa da prática de binge drinking na semana estimada em 38% entre os participantes do grupo intervenção após seis meses (p < 0,05). Porém, não houve redução significativa nos desfechos quando se analisam os grupos intervenção e controle e os tempos início e seis meses após, simultaneamente. CONCLUSÕES Não se pode concluir que as ferramentas digitais reduzem o padrão de binge drinking nos frequentadores de baladas paulistanas. São necessários mais estudos com esta metodologia devido ao caráter atrativo para esse grupo, tendo em vista a privacidade e a rapidez que as informações personalizadas são transmitidas.

Factors associated with the need for ventilation at birth of neonates weighing >/=; 2, 500 g

OBJECTIVES: Approximately 20-40% of annual global neonatal deaths occur among infants with birthweights ≥2,500 g, and most of these deaths are associated with intrapartum asphyxia in low- and middle-income countries. This study aims to evaluate the peripartum variables associated with the need for resuscitation at birth of neonates weighing ≥2,500 g. METHOD: This case-control retrospective study was performed on data from all public reference maternity units in the state of Ceará, Northeast Brazil, between March 2009 and March 2010. The subjects were singleton neonates without malformations weighing ≥2,500 g, who required positive-pressure ventilation in the delivery room. The controls had a 1-minute Apgar score of ≥8 and did not undergo resuscitation. Variables associated with positive-pressure ventilation in the delivery room were evaluated via conditional multivariate logistic regression. RESULTS: Of the 2,233 live births with birth weights ≥2,500 g, 1-minute Apgar scores ≤7, and no malformations, 402 patients met the inclusion criteria, and they were paired with 402 controls. Risk variables for positive-pressure ventilation at birth were a gestational age <37 weeks (OR: 3.54; 95% CI: 1.14-10.92) and meconium-stained amniotic fluid (8.53; 4.17-17.47). Cervical examination at maternal admission (0.57; 0.38-0.84) and a written follow-up of the labor (0.68; 0.46-0.98) were identified as protective variables. CONCLUSIONS: Significant flaws in obstetric care are associated with the need for positive-pressure ventilation at birth for neonates weighing ≥2,500 g.