RCAAP Repository

Este estudo tem como objetivo avaliar a qualidade da informação sócio-econômica e demográfica, por Unidade Federada (UF) do Sistema de Informações sobre Mortalidade (SIM). A finalidade é reconhecer sua potencialidade no monitoramento da desigualdade da mortalidade infantil no Brasil. Utilizaram-se como indicadores de qualidade a acessibilidade, oportunidade, claridade metodológica, incompletitude e consistência. Selecionaram-se as variáveis: raça da criança, peso ao nascer, semanas de gestação, assistência médica, parturição, escolaridade, idade e ocupação materna. Foram revisadas a documentação do SIM e a literatura sobre indicadores associados com a mortalidade infantil, estimaram-se proporções de incompletitude, por região e UF, e identificaram-se fatores que a influenciam a partir de regressões logísticas. Constatou-se que, apesar da acessibilidade da base de dados e da relevância de suas variáveis, o SIM possui sérios problemas de qualidade que incluem instruções confusas no manual para informação ignorada, má classificação da ocupação materna, ausência de identificação sobre a raça do informante e elevada proporção de incompletitude da informação. Conclui-se que o SIM não é uma fonte de dados adequada para monitorar, avaliar e planejar ações sobre desigualdade em saúde infantil.

O objetivo deste artigo foi averiguar o perfil do atendimento preventivo em deficiência mental na rede básica de saúde pública do Município de Maringá, Paraná, Brasil. A amostra foi composta por 90 médicos(as) das áreas de Ginecologia e Obstetrícia, Pediatria, Clínica Geral, Programa Saúde da Família e 66 enfermeiros(as). Foi aplicado questionário, por autopreenchimento, com respostas de múltipla escolha, entre agosto e dezembro de 2003. As variáveis qualitativas foram comparadas pelo teste do qui-quadrado, com nível de significância de 5%. São apresentados dados parciais relacionados à percepção e ao conhecimento de profissionais de saúde sobre deficiência mental: 75% não foram capazes de assinalar a alternativa correta sobre a prevalência; 25% não sabem qual a contribuição do genoma para a etiologia; 37% não sabem se existe prevenção para a deficiência mental; 28% não se sentem seguros para orientar sobre o efeito teratogênico do etanol; 35% referiram insegurança para orientar sobre amniocentese. Os dados demonstraram que os participantes têm baixa percepção da relevância da deficiência mental para a morbidade da população e necessitam de maiores informações sobre os aspectos genéticos e ambientais relacionados a tal condição.

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This article discusses the changes in injecting drug use from 1998 to 2003 in Buenos Aires, Argentina. The Rapid Situation Assessment and Response methodology was used to obtain the information. Quantitative and qualitative techniques were triangulated: 140 current IDUs and 35 sex partners of injection drug users (IDUs) were surveyed; 17 in-depth interviews with the surveyed IDUs and 2 focus groups were held, as well as ethnographic observations. The way in which risk and care practices among injecting drug users changed and the influence of the HIV/ AIDS epidemic on this process are described. In recent years, the frequency of injection practices and sharing of injecting equipment has decreased, while injecting drug use is a more hidden practice in a context of increasing impact of the disease in the injecting drug use social networks and changes in the price and quality of drugs. Knowledge about these changes helps build harm reduction activities oriented to IDUs in their particular social context.

The HIV/AIDS epidemic among injection drug users (IDUs) in Brazil has been unique in terms of temporal and geographical contrasts. This analysis explores these contrasts through the use of multilevel modeling. Standardized AIDS incidence rates among IDUs for Brazilian municipalities (1986-2000) were used as the dependent variable, with a set of social indicators as independent variables (covariates). In some States of the North/Northeast, the epidemic among IDUs has been incipient. The São Paulo epidemic extended to reach a network of municipalities, most of which located far from the capital. More recently, on a smaller scale, a similar extension has been observed in the southernmost States of the country. Both "number of physicians per inhabitant" and "standard distance to the State capital" were found to be associated with AIDS incidence. AIDS cases among IDUs appeared to cluster in wealthier, more developed municipalities. The relative weight of such extensive dissemination in key, heavily populated States prevails in the Brazilian IDU epidemic, defining a central-western-southeastern strip of wealthier middle-sized municipalities and more recently a southern strip of municipalities deeply affected by the epidemic in this population.

The present study aims to evaluate the current operation of Brazilian syringe exchange programs (SEP). After consulting national and regional networks of people working in projects/ programs aiming to reduce drug-related harm, we identified 134 potential participant programs. Unfortunately, only 45 SEPs answered a survey, even after repeated attempts. The survey addressed: coverage, funding, procurement of basic supplies, managerial capacity, and the local political environment. Findings were triangulated with in-depth interviews with key informants. The main findings included: satisfactory adherence to the initiatives and adequate documentation, but deficiencies in terms of coverage and monitoring, and uneven procurement of resources. Program personnel work mostly on a provisional basis, despite the efforts of local coordinators. Most programs are funded by the National STDs/AIDS Program. A comprehensive agenda aiming to improve current operations should include: concerted efforts to improve local and regional databanks, incentives/sanctions toward full accountability of initiatives carried by the programs, and a genuine culture of monitoring and evaluation.

This study assessed 1,144 Brazilian injecting drug users (IDUs) recruited on the street through outreach syringe exchange programs by two multi-center cross-sectional studies: 287 IDUs were recruited during the AjUDE-Brasil I Project and 857 during the AjUDE-Brasil II Project. IDU characteristics related to drug use and sexual behavior, and legal and health conditions for the two studies were compared, using decision tree and logistic regression for each individual study, with HIV infection as the outcome. Fifty-two percent of IDUs were HIV-infected in AjUDE I versus 36.5% in AjUDE II. In both studies, HIV infection was independently associated with: mean background HIV prevalence for each site (OR = 2.17; 10.66), HCV seropositive status (OR = 19.79; 15.48), and men who reported ever having sex with other men (OR = 2.10; 2.09). Incarceration (OR = 1.41) and 8 or more years of injecting drug (OR = 2.13) were also associated with HIV in AjUDE II. The high HIV infection rates and high prevalence of both parenteral and sexual risk behaviors in the context of syringe-exchange programs are of great concern and demand thorough surveillance and renewed prevention strategies.

This paper presents the results of a study with a two-occasion capture-recapture design. The data are part of the AjUDE-Brasil II Project, carried out in 2000-2001. Estimation of the size of the IDU population attending a syringe-exchange program (SEP) in São José do Rio Preto, Salvador, and Porto Alegre, Brazil, was performed using Chao's model. Capture probabilities were also estimated. For Porto Alegre a comparison of the results from the AjUDE-Brasil I and AjUDE-Brasil II Projects was performed. Results are also presented for error rates secondary to the choice of matching criteria.

The object of this study is to compare female and male injection drug users (IDUs) in terms of sociodemographic profile and aspects of their initiation to the use of injection drugs. It was a cross-sectional and multicentric study realized in 2000-2001 in six Brazilian syringe-exchange programs. 146 women and 709 men were interviewed, with average ages of 29.5 and 28.3 years, respectively. Both began injection drug use at similar ages, 18.6 and 19.3, for women and men, respectively, although women report more frequently than men that they were initiated by a sexual partner to acquiring drugs and syringes, and to the act of injection. Compared to men, women report significantly more regular sexual partners (83% versus 72%); fewer casual partners (39% versus 58%), more use of injection drugs with their partners, as well as more "exchange" of sex for drugs. Among HIV-seropositive individuals, women show less education, had more chance of their sexual partners participating in their initiation to injection drugs, and report sexual partners that used injection drugs more frequently. Female IDUs exhibit aspects of behavior indicating greater vulnerability to HIV infection than do males.

This study compared healthcare utilization by injection drug users (IDUs) and non-IDUs. Data were abstracted from patients' medical records, admitted on HIV/AIDS treatment centers, between 1986 and 2002, forming a non-concurrent cohort study. Variables included: sociodemographics, HIV/AIDS exposure group, healthcare utilization (consultations, procedures, and prescriptions). Descriptive analyses included age-period and cohort effects. Out of 170 patients, with an average age of 30 years, 39.4% were IDUs, 71.8% were males and had low levels of education. At the first consultation, 86.5% neither received an ARV prescription nor had a request for CD4 or viral load. Injection drug users, as compared to non-IDUs, were less likely to receive ARV prescriptions and requests for CD4 lymphocyte and viral load counts, even though the number of consultations did not differ between the two groups. Healthcare utilization increased in calendar-year in the non-IDUs group, parallel to the implementation of the Brazilian health policy of universal care. However, this favorable trend was not observed among IDUs. Differential outcomes for HIV/AIDS among IDUs, towards worse prognosis, suggest difficulties in terms of adherence and follow-up of ARV therapy in this population.

This study aimed to characterize the profiles of injecting drug users (IDUs) who were unaware of their HIV serostatus, given the importance of this information for prevention strategies, especially in this vulnerable population, key to the HIV/AIDS dynamic. As part of a cross-sectional multi-city survey, IDUs were interviewed and HIV-tested by the ELISA technique. IDUs were categorized according to knowledge of their own HIV status as either aware or unaware. Means, averages, and proportions were compared between the groups using bi- and multivariate analyses. Of 857 IDUs interviewed, 34.2% were unaware of their HIV serostatus. Those who were unaware were more likely: to have been recruited at sites where the HIV prevalence rate was considered medium (> 10 to 50%; odds ratio = 8.0) or high (> 50%; 4.0); to be illiterate (OR = 4.54); to have no prior HIV test (OR = 2.22); to be male (OR = 1.81); and to have been enrolled more recently in syringe-exchange programs (OR = 1.69). HIV prevention programs should target both individuals at risk and HIV-positive individuals. Programs to expand access to HIV testing are pivotal and should be tailored to specific contexts and populations.

This paper presents AIDS incidence and mortality among injecting drug users (IDUs) reached by the AjUDE-Brasil II Project. From a cross-sectional survey, 478 IDUs were interviewed in three Brazilian cities: Porto Alegre, São José do Rio Preto, and Itajaí. The cohort was followed up in the Brazilian surveillance database for AIDS and mortality during 2000 and 2001. AIDS incidence was 1.1 cases per 100 person-years, and the mortality rate was 2.8 deaths per 100 person-years. AIDS cases only occurred in IDUs who reported ever having shared injecting equipment. Female gender (RR = 5.30), homelessness (RR = 6.16), and report of previous sexual relations with same-sex partners (RR = 6.21) were associated with AIDS. Deaths occurred only among males. Homelessness (RR = 3.00), lack of income (RR = 2.65), HIV seropositive status (RR = 4.52), and no history of incarceration (RR = 3.71) were also associated with death. These findings support evidence that gender and socioeconomic conditions are both determinants of morbidity and mortality in Brazilian IDUs.

This study aimed to characterize sexual and drug-use behaviors in injecting drug users (IDUs) in relation to single hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection and HCV/HIV co-infection. The sample consisted of 272 IDUs enrolled in the AjUDE-Brasil I Project, a cross-sectional multi-center study conducted in five Brazilian cities in 1998. Data were collected with a structured questionnaire using self-reported risk behavior, and HCV and HIV serological status used ELISA on filter paper. IDUs were clustered in four distinct groups: HCV/HIV seronegative; HCV mono-infected; HIV mono-infected; and HCV/HIV co-infected. Active sharing of injecting equipment was associated with HCV infection (p = 0.001). Sexual behavior variables, especially male same-sex sexual relations, were consistently associated with HIV infection. HCV/HIV co-infection was associated with both sexual and drug use variables. It was possible to distinguish different behavioral indicators for HCV and HIV infection and co-infection in this population.

This study aims to characterize the profile of male injecting drug users who have sex with other men (MSM IDUs) recruited through a cross-sectional multi-city survey (AjUDE-Brasil II Project) in six Brazilian cities, in 2000-2001. MSM IDUs were compared to other male IDUs using bivariate and multivariate procedures (logistic regression and answer tree analysis with the CHAID algorithm). Among the 709 male IDUs, 187 (26.4%) reported ever having had sex with other men, while only 37 reported sex with other men in the previous six months. MSM IDUs were more likely to be unemployed (OR = 2.3), to have injected tranquilizers (OR = 3.6), and to be HIV-seropositive (OR = 2.1), compared to other male IDUs. Male same-sex relations in this subgroup appear to be associated with strategies to finance drug consuming habits, including sex for drugs with occasional female partners or obtaining injection paraphernalia from occasional sex partners. Further studies should focus on this especially vulnerable subgroup of IDUs, due to the bidirectional and complex interrelationships between their drug injecting habits and sexual risk behaviors.

The context of first drug injection and its association with ongoing injecting practices and HCV (hepatitis C virus) infection were investigated. Injection drug users (IDUs) (N = 606) were recruited in "drug scenes" (public places, bars) in Rio de Janeiro, Brazil, interviewed, and tested for HCV. Sharing of needles/syringes was more prevalent at the first injection (51.3%) than at the baseline interview (36.8%). Those who shared syringes/needles at first injection were more likely to be currently engaged in direct/indirect sharing practices. Among young injectors (< 30 years), those reporting sharing of needles/ syringes at the first injection were about four times more likely to have been infected by HCV. Hepatitis C virus prevalence among active IDUs (n = 272) was 11%. Prison history and longer duration of drug injection were identified as independent predictors of HCV infection. To effectively curb HCV transmission among IDUs and minimize harms associated with risk behaviors, preventive strategies should target individuals initiating drug injection beginning with their very first injection and discourage the transition from non-injecting use to the self-injection of illicit drugs.

To prevent or mitigate an AIDS epidemic among injecting drug users (IDUs), effective activities need to be implemented on a large enough scale to reach and assist sufficient numbers of drug users and thereby change their risk behaviors related to drug use and sex. Recent work by UNAIDS on "high coverage sites", adopting the above strategies, has shown that one of the key elements in achieving high coverage is ongoing and sophisticated advocacy. High coverage harm reduction sites were studied through literature search and site visits, including key informant interviews, review of service statistics, and data analysis, in order to document the steps that led to scaling up, the way coverage was defined in these sites, and the lessons learned from their efforts. Syringe-exchange programs can achieve high coverage of IDUs. Monitoring to determine regular reach (those who are in regular contact with harm reduction services) should be added to uniform data collection carried out by harm reduction programs. Advocacy is crucial to achieving high coverage.

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We systematically reviewed the literature on the association between coffee consumption and gastric cancer and performed a meta-analysis of the results. Published cohort and case-control studies were identified in PubMed and reference lists. Random effects meta-analysis was used to pool effects from 23 studies, and heterogeneity was explored by stratification and meta-regression. The odds ratio (OR) for the overall association between coffee and gastric cancer (highest vs. lowest category of exposure) was 0.97 (95%CI: 0.86-1.09), similar for cohort (OR = 1.02; 95%CI: 0.76-1.37) and case-control studies (population-based: OR = 0.90; 95%CI: 0.70-1.15; hospital-based: OR = 0.97; 95%CI: 0.83-1.13). The OR was 1.26 (95%CI: 1.02-1.57) when considering five studies conducted in the USA, 0.97 (95%CI: 0.82-1.14) for the five Japanese studies, 0.98 (95%CI: 0.81-1.17) for the six studies from Europe, and 0.64 (95%CI: 0.47-0.86) for the two studies from South America. In this meta-analysis we found no adverse effect of coffee associated with gastric cancer. Knowledge on the level of exposure to different coffee constituents may provide a deeper understanding of this reassuring result and the real role of coffee on cancer risk.