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Objectives. To characterize the distribution profile of dengue, chikungunya, and Zika virus infections in Latin America and the Caribbean and to identify possible factors associated with the risk of dissemination and severity of these arboviruses. Methods. The protocol of this review was registered on the PROSPERO platform. Searches were carried out in the following databases: Virtual Health Library, MEDLINE/PubMed, and Embase. The search terms were: Zika virus, Zika virus infection, dengue, dengue virus, chikungunya virus, chikungunya fever, epidemiology, observational study, Latin America, and Caribbean region. Studies that addressed the distribution of these arboviruses and the risk factors associated with dengue, Zika virus disease, and chikungunya, published between January 2000 and August 2020 in English, Portuguese, and Spanish, were included. Results. Of 95 studies included, 70 identified risk factors, clinical manifestations, and outcomes for arbovirus infections and 25 described complications and/or deaths. The highest frequency of confirmed cases was for dengue. Brazil reported most cases of the three arboviruses in the period analyzed. Environmental and socioeconomic factors facilitated the proliferation and adaptation of vectors, and host-related factors were reported to aggravate dengue. Most deaths were due to chikungunya, Zika virus disease caused most neurological alterations, and dengue resulted in greater morbidity leading to more frequent hospitalization. Conclusions. The review provides a broad view of the three arboviruses and the intrinsic aspects of infections, and highlights the factors that influence the spread of these viruses in the populations studied. [ABSTRACT FROM AUTHOR]

This article describes progress in tackling noncommunicable diseases (NCDs) in the Americas since the Pan American Health Organization (PAHO) started its NCD program 25 years ago. Changes in the epidemiology of NCDs, NCD policies, health service capacity, and surveillance are discussed. PAHO's NCD program is guided by regional plans of action on specific NCDs and risk factors, as well as a comprehensive NCD plan. Its work involves implementing evidence-based World Health Organization technical packages on NCDs and their risk factors with the aim of achieving the Sustainable Development Goal target of a one third reduction in premature mortality caused by NCDs by 2030. Important advances have been made in the past 25 years in implementation of: policies on NCD risk factors; interventions to improve NCD diagnosis and treatment; and NCD surveillance. Premature mortality from NCDs decreased by 1.7% a year between 2000 and 2011 and 0.77% a year between 2011 and 2019. However, policies on risk factor prevention and health promotion need to be strengthened to ensure more countries are on track to achieving the NCD-related health goals of the Sustainable Development Goals by 2030. Actions are recommended for governments to raise the priority of NCDs by: making NCDs a core pillar of primary care services, using revenues from health taxes to invest more in NCD prevention and control; and implementing policies, laws, and regulations to reduce the demand for and availability of tobacco, alcohol, and ultra-processed food products. [ABSTRACT FROM AUTHOR]

This report describes the current status of the tobacco control measures contained in the Strategy and Plan of Action to Strengthen Tobacco Control in the Region of the Americas 2018-2022 (Pan American Health Organization) and the advances made in its application, identifying achievements from 2016 to 2020 and challenges that still need to be addressed in order to reach the expected goals. This analysis relied on data from the World Health Organization (WHO) Report on the Global Tobacco Epidemic from 2015, 2017, and 2019, and national regulations were analyzed to determine their consistency with WHO criteria. Significant progress has been made in implementation of the WHO Framework Convention on Tobacco Control in the Americas. By 2020, most countries had regulations on 100% smoke-free environments in indoor public places, workplaces, and public transport, and large graphic health warnings on tobacco packaging. The number of countries that ban tobacco advertising, promotion, and sponsorship and that tax tobacco at the minimum level recommended by WHO has doubled since 2016. However, the 2022 targets have not yet been reached for any of these measures or for ratification of the relevant international agreements. Although progress has been made in the Region, it has not been uniform. Unless the pace of application of the tobacco control measures contained in the Strategy and Plan of Action accelerates, it is unlikely that its targets will be met. Tobacco industry interference remains one of the main challenges. [ABSTRACT FROM AUTHOR]

During the past decade progress has been made from a public health perspective in advancing tobacco taxation policies in the World Health Organization's Region of the Americas, and there are important lessons to be learned from this experience. This report aims to systematize and distill the key lessons learned, both by documenting progress and paving the way toward a comprehensive approach to taxing other health-harming products, particularly those considered to be drivers of the noncommunicable disease epidemic, such as alcohol and sugar-sweetened beverages. A thorough review of publications and institutional documents was undertaken and discussions were held with experts about the experiences of the past decade. Broadly, the lessons can be characterized according to the main mechanisms that have fostered progress. These are the robust, consistent and standardized monitoring of tobacco taxes that has enabled comparisons between countries and across time; the setting of tax policy within a framework of multisectoral policy coherence; and the development of guidelines and the generation of independent evidence to support tobacco taxes and tackle harmful industry interference. Currently, progress in these areas is lagging for taxes on alcohol and sugar-sweetened beverages. Applying the lessons learned from the extensive experience with tobacco taxation can help advance progress in taxes on alcohol and sugar-sweetened beverages and capture the potential synergies to be gained from building a comprehensive approach. Although more work is needed in developing and implementing taxation policies across all three products, the findings from this report can assist in strengthening their public health objectives to tackle noncommunicable diseases and improve population health. [ABSTRACT FROM AUTHOR]

Objective. To characterize the epidemiological and clinical profile of individuals more likely to become infected with SARS-CoV-2 after the fully vaccination schedule in order to profile priority groups to receive a booster dose in situations of vaccine doses shortage as well as for maintenance of personal protective care. Methods. This cross-sectional study used data from hospitalized COVID-19 patients aged ≥18 years, who had been fully vaccinated and had a SARS-CoV-2 infection positive diagnosis collected from the SIVEP-Gripe database (Influenza Epidemiological Surveillance Information System) from January 18, 2021 to September 15, 2021. Demographic data, clinical symptoms and preexisting medical conditions (comorbidities) were analyzed. The primary outcome was in-hospital death. Results. The majority of hospitalized patients with vaccine breakthrough infection were ≥60 years old, male, with critical or severe COVID-19. The fatality rate was extremely high (50.27%) and more pronounced in elderly groups. The most prevalent symptoms were cough, dyspnea, respiratory distress, and low blood oxygen saturation. The most frequent comorbidities were heart disease and diabetes. High fatality rates were observed among patients admitted to the intensive care units (72.88%) and those who required invasive mechanical ventilation (87.82%). The main risk factors for an unfavorable outcome were older age, respiratory compromise, inactivated virus vaccine immunization, and preexisting medical conditions. Conclusions. We characterized the profile of hospitalized Brazilian patients with COVID-19 vaccine breakthrough infection and the risk factors for an unfavorable outcome. These data allow to identify priority groups to receive a booster dose and to continue using personal protection. [ABSTRACT FROM AUTHOR]

This article describes the situation of noncommunicable diseases (NCDs) in the Americas, implementation of NCD interventions according to key progress indicators, the impact of COVID-19 on NCD services, and ways to reprioritize NCDs following COVID-19. Information was retrieved from institutional data and through a supplementary scoping review of published articles related to NCDs and COVID-19 in the Americas published April 2020-November 2021. While NCDs account for 80.7% of all deaths in the Americas, implementation of a key set of NCD interventions has been limited, with only three countries reporting implementation of 12 or more of the 19 NCD indicators. By mid-May 2022, the Americas had reported about 29.9% of all COVID-19 cases in the world (154 million of 515 million) and 43.5% all COVID-19 deaths (2.7 million of 6.2 million). This pandemic has hampered progress on NCDs and significantly disrupted services for people who require ongoing care. Adaptive strategies, such as telehealth and mobile pharmacies, have been used to mitigate service disruptions. However, NCD prevention and management must be an integral part of recovering from the COVID-19 pandemic. This will require scaled up efforts to establish/re-establish and enforce policies on NCD risk factors, especially for tobacco control and obesity prevention, as well as greater investment in primary care and expansion of telemedicine and digital health solutions for continuous care for people with NCDs. Lastly, limited data are available on the impact of COVID-19 on NCDs, and hence NCD data and surveillance need to be strengthened. [ABSTRACT FROM AUTHOR]

HEARTS in the Americas is the regional adaptation of the World Health Organization's Global Hearts Initiative, which will be the model for risk management for cardiovascular disease (CVD) in primary health care in the Region of the Americas by 2025. It has already been implemented in 21 countries and 1045 primary health care centers throughout Latin America and the Caribbean. It takes a public health and health systems approach to systematically introduce simplified interventions at the primary health care level and focuses on hypertension as a clinical entry point. This paper introduces a new, improved application (app), the main component of which is the calculator for CVD risk and hypertension management. The paper summarizes the risk assessment approach and the methodology used by the World Health Organization to update its cardiovascular risk charts in 2019; describes the app, its use, functionality and validation process; and provides a set of practical recommendations for optimizing CVD risk and hypertension management by using the app in clinical practice. The HEARTS app is a powerful tool to improve the quality of care provided in primary health settings. The creation and dissemination of the HEARTS app is an essential step in the journey towards eliminating preventable CVD in the Americas. [ABSTRACT FROM AUTHOR]

HEARTS in the Americas is the regional adaptation of the World Health Organization's Global Hearts Initiative, which will be the model for risk management for cardiovascular disease (CVD) in primary health care in the Region of the Americas by 2025. It has already been implemented in 21 countries and 1045 primary health care centers throughout Latin America and the Caribbean. It takes a public health and health systems approach to systematically introduce simplified interventions at the primary health care level and focuses on hypertension as a clinical entry point. This paper introduces a new, improved application (app), the main component of which is the calculator for CVD risk and hypertension management. The paper summarizes the risk assessment approach and the methodology used by the World Health Organization to update its cardiovascular risk charts in 2019; describes the app, its use, functionality and validation process; and provides a set of practical recommendations for optimizing CVD risk and hypertension management by using the app in clinical practice. The HEARTS app is a powerful tool to improve the quality of care provided in primary health settings. The creation and dissemination of the HEARTS app is an essential step in the journey towards eliminating preventable CVD in the Americas. [ABSTRACT FROM AUTHOR]

Objective. To identify factors associated with chronic kidney disease of non-traditional causes among children in Guatemala. Methods. A cross-sectional survey was conducted. The study population was all pediatric patients with stage 5 chronic kidney disease active in FUNDANIER's pediatric nephrology unit (N = 156). Simple random sampling led to a total of 100 participants. Data collection consisted of a questionnaire addressing individual and household characteristics, access and utilization of health care, and place of residence when the disease began. Chronic kidney disease etiology was obtained from medical records. Municipality-level secondary data were collected. Descriptive statistics were estimated. Logistic regression was used for bivariate and multivariate analysis. Results. The odds ratio (OR) for almost all variables approached 1. Notable exceptions in household characteristics were mother's education level up to primary school (OR 2.2727) and living in an urban setting when symptoms began (OR 0.4035). Exceptions in municipal characteristics are zones with intensive small-scale agriculture (OR 3.8923) and those with intensive large-scale agriculture (OR 0.3338). P-values and confidence intervals show that the sample was not big enough to capture statistically significant associations between variables. Conclusions. Study findings suggest that factors associated with chronic kidney disease of non-traditional causes among children in Guatemala are intensive agricultural practices in their municipality of residence, and mother's level of education. Future research in children could use case-control designs or population-based studies in agricultural communities. Public health interventions that involve kidney function screening among children are recommended. [ABSTRACT FROM AUTHOR]

Objective. To 1) describe clinical characteristics of adult patients in Chile with severe acute respiratory infections (SARI) associated with influenza viruses, and 2) analyze virus subtypes identified in specimens collected from those patients, hospital resources used in clinical man- agement, clinical evolution, and risk factors associated with a fatal outcome, using observa- tional data from the SARI surveillance network (SARInet). Methods. Adults hospitalized from 1 July 2011 to 31 December 2015 with influenza- associated SARI at a SARI sentinel surveillance hospital in Santiago were identified and the presence of influenza in all cases confirmed by reverse transcription polymerase chain reaction (RT-PCR), using respiratory samples. Results. A total of 221 patients (mean age: 74.1 years) were hospitalized with influenza- associated SARI during the study period. Of this study cohort, 91.4% had risk factors for com- plications and 34.3% had been vaccinated during the most recent campaign. Pneumonia was the most frequent clinical manifestation, occurring in 57.0% of the cohort; other manifestations included influenza-like illness, exacerbated chronic bronchitis, decompensated heart failure, and asthmatic crisis. Cases occurred year-round, with an epidemic peak during autumn--winter. Both influenza A (H1N1pdm09 and H3N2) and B virus co-circulated. Critical care beds were required for 26.7% of the cohort, and 19.5% needed ventilatory assistance. Multivariate analy- sis identified four significant factors associated with in-hospital mortality: 1) being bedridden (adjusted odds ratio (aOR): 22.3; 95% confidence interval (CI): 3.0-164); 2) admission to criti- cal care unit (aOR: 8.9; CI: 1.44-55); 3) Pa02/Fi02 ratio < 250 (aOR: 5.8; CI: 1.02--33); and 4) increased serum creatinine concentration (> 1 mg/dL) (aOR: 5.47; CI: 1.20-24). Seasonal influ- enza vaccine was identified as a significant protective factor (aOR: 0.14; CI: 0.021-0.90). Conclusions. Influenza-associated SARI affected mainly elderly patients with underlying con- ditions. Most patients evolved to respiratory failure and more than one-quarter required critical care beds. Clinical presentation was variable. Death was associated with host characteristics and disease-associated conditions, and vaccine was protective. Virus type did not influence outcome. [ABSTRACT FROM AUTHOR]

Objective. To determine 1) the characteristics of males with a family history of prostate cancer who presented for screening and 2) the association between family history and diagnosis of prostate cancer in a cohort of screened Jamaican men. Methods. The study consisted of a prospective cohort of black men who screened at the Jamaica Cancer Society in Kingston between 2006 and 2016. Data were collected on: 1) age at screening and age at diagnosis of prostate cancer, 2) family history of prostate cancer, and 3) prostate-specific antigen (PSA) and digital rectal examination (DRE) findings. Results. Approximately 600 (21.4%) of screened men who reported data on family history (2 791 / 2 867) said they had a family history of prostate cancer. Men with a family history of prostate cancer 1) commenced screening at a younger age than men without a family history (P <0.001) and 2) tended to have a younger age at diagnosis of prostate cancer (P = 0.262). There was no significantly increased risk of prostate cancer in men with a reported family history of prostate cancer (odds ratio: 1.4; 95% confidence interval: 0.821-2.386; P = 0.217). Conclusions. Men with a family history of prostate cancer presented frequently for screening and earlier than those without. There was a lack of association between family history of prostate cancer and diagnosis. Further studies are needed to investigate this association and validate family histories. [ABSTRACT FROM AUTHOR]

Objective. To describe the estimated prevalence of noncommunicable diseases and their common risk factors among the adult population of Curitiba, Paraná, Brazil, based on results of the EPIdemiology of CURitiba: EvaluAtion of Noncommunicable diseases (EPICUREAN) study. Methods. This was a cross-sectional, population-based survey of 1 103 residents of Curitiba, grouped by age (18 - 39 years of age, 40 - 59, and ≥ 60 years), conducted in August 2013 - August 2014. Household interviews, anthropometry, blood pressure measurements, and fasting capillary glycemia were performed during two visits to each participant. The analyses included frequency distribution and prevalence estimates of main outcomes. Prevalence estimates, weighted by age and sex, were presented as absolute numbers and percentages. Results. Prevalence estimates for self-reported depression were 21.2%; hypertension, 31.2%; diabetes, 9.1%; self-reported dyslipidemia, 21.7%; obesity, 21.2%; current smoking, 16.1%; binge drinking, 23.4%; and insufficient physical activity, 35.1%. Prevalences of diabetes and hypertension were higher among individuals with less schooling and the elderly. Binge drinking and leisure-time physical activity were more prevalent in young adults. Men presented higher prevalences of overweight, current smoking, and harmful use of alcohol. Obesity and moderateto- severe risk of depression were more frequent among women and those with lower income. Conclusions. The prevalence of NCDs and common risk factors among the adult population of Curitiba are high and reveal a gradient of vulnerabilities by age, sex, education level, and income. To address health inequities and meet the needs of different population groups, the health system should monitor NCDs and risk factors and implement equitable public health policies. [ABSTRACT FROM AUTHOR]

Public health policies have been a priority issue in Chile since 1950. Major progress has been made in basic aspects of public health, such as drinking water coverage and the prioritization of primary health care, leading to communicable disease control, the reduction of maternal and child mortality, and the elimination of malnutrition. Through a mixed health care model, Chile has met the commitment in the Declaration of Alma-Ata to the attainment of an "acceptable level of health for all the people," achieving the best health and socioeconomic indicators in Latin America. However, attaining an acceptable level of health in the population is an open-ended goal, and progress in this direction appears to have stalled in Chile. The challenge is therefore to define the new health goals for the country, which is no longer a lowincome country but an upper middle-income country with a different profile of health problems. Specifically, Chile must continue to improve health care for its population through health policies focused on non-communicable diseases (such as cardiovascular disease and cancer), health promotion, and disease prevention. To accomplish this, the Ministry of Health must modernize its management and resume its role as the overseer of health objectives, a role that has been eclipsed by its administrative responsibilities. It must do so without losing the complementarity achieved between the public and private sector in order to minimize the current limitations of the public system. [ABSTRACT FROM AUTHOR]

Non-communicable diseases (NCDs) represent one of the greatest challenges for development of the 21st century due to their devastating social, economic and public health impact. The objective of this article are to describe the evolution and risk factors for NCDs in Cuba, mainly in the period 1990--2015, to outline actions undertaken by the Ministry of Public Health of Cuba, and to highlight the most important challenges with a focus on their prevention and control. The information is based on data collected and published by the Directorate of Medical Records and Health Statistics, research on risk factors, other studies and documentation of comprehensive actions. Mortality in Cuba is determined by four major health problems: cardiovascular diseases, malignant tumors, chronic diseases of the lower respiratory tract and diabetes mellitus, which together cause 68.0% of deaths. Cancer presents a growing trend, and chronic kidney disease emerges as a serious health problem. Cuba has a known baseline on risk factors, and hypertension and tobacco consumption are the main factors related to NCDs mortality. In line with the importance of these diseases, there are milestones and interventions with a positive impact, as well as gaps and challenges within the framework of the World Health Organization's Global Action Plan for the Prevention and Control of NCDs. [ABSTRACT FROM AUTHOR]

Worldwide, breast cancer is the most common disease in women and constitutes the second leading cause of cancer death in this population. The factors that contribute to the risk of occurrence are divided into nonmodifiable and modifiable factors. Although there are interventions in primary care to prevent the disease, these measures have not produced the desired changes in women's health. This article reviews the major modifiable risk factors for breast cancer and describes how these factors can affect the incidence of cancer in women. This information shows that modifiable risk factors (such as physical activity, diet, obesity, and use of alcohol and tobacco) can influence the occurrence of breast cancer, in part depending on the life stage of a woman, including menopausal status. Timely prevention at the primary care level is one of the most important areas on which health professionals need to focus in order to help reduce the incidence of breast cancer. [ABSTRACT FROM AUTHOR]

Objective. Develop a predictive dynamic model to estimate future scenarios for the incidence rate of type 2 diabetes mellitus (T2DM). Methods. A retrospective ecological study was conducted in 2013-2015 in the city of San Luis Potosí, Mexico. Secondary official data from the 58 municipalities making up the state of San Luis Potosí were analyzed. Linear correlation, multiple linear regression, and structural equations were carried out, and four predictive dynamic submodels were developed: T2DM, urban population, inhabited private dwellings that have television, and population aged 45-49 years. A holistic model was also developed. Results. The structural model explains 27.2% of total variance in type 2 diabetes mellitus. Percentage of inhabited dwellings that have television weighs 4.46 non-standard units on diabetes; that of urban population, 2.84; and that of population aged 45-49 years, 156.69. Estimated scenarios for T2DM per 100 000 population for the years 2015, 2020, 2025, and 2030 were 1,052.4, 1,413.7, 1,850.1, and 2,351.1 respectively. Conclusion. The T2DM scenario shows exponential growth from 2000 to 2030. Risk factors according to the weight they represent in occurrence of the disease were: population aged 45-49 years, inhabited private dwellings that have television, and urban population. [ABSTRACT FROM AUTHOR]

Objective. To analyze the profile of men who commit violence against their female intimate partners. Methods. A systematic review of the international literature published between 2000 and 2010 was conducted in the LILACS, MEDLINE, and SciELO databases. The search retrieved 3 452 articles, 33 of which were selected according to inclusion and exclusion criteria. The selected articles were analyzed for bibliometric data and socioeconomic characteristics of the men accused of committing violence against their partners. Results. Most articles were published between 2000 and 2010, in English, based on data reported by the victims. Some variables were associated with domestic violence, such as educational attainment and employment status of the offender. These variables did not include the duration of the relationships. Conclusions. There is a significant gap in literature regarding the study of motivations and conditioning factors behind perpetrators of domestic violence. Investigating these factors is important in order to establish measures against this type of violence. [ABSTRACT FROM AUTHOR]

Objective. To identify the factors associated with dental caries and periodontal diseases in indigenous populations in Latin America. Methods. The search was conducted between January and February 2012 in the following databases: MEDLINE/PubMed, SCOPUS, SciELO, and LILACS. The references of the identified articles were also searched. The initial search retrieved 74 articles, 33 of which were selected according to inclusion and exclusion criteria. The methodological quality of the studies was evaluated according to STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) recommendations. Results. Most of the populations studied were Brazilian, with the highest percentage of studies focusing on the Xingu and Xavante communities (31.6%). Most studies were cross-sectional. One of the studies showed a positive association between tooth loss and increasing age among the Guaraní population in Brazil, with the largest proportion of gingival bleeding among adolescent males and females showing a higher number of sextants excluded for tooth loss. Two Brazilian longitudinal studies with Xavante communities showed significant differences in the incidence of caries for age and sex. Conclusions. Increasing age and differences between sexes are possible factors associated with an increase in dental caries and periodontal diseases in the Guaraní and Xavante people in Brazil. The lack of studies with an appropriate methodology renders Latin American indigenous peoples epidemiologically invisible, hindering the production of knowledge on oral health status and on the development of strategies for oral disease prevention and health promotion in these populations. [ABSTRACT FROM AUTHOR]

Objective. To investigate protection or risk factors for dental fluorosis in permanent teeth of 6 to 8 year-old children in a neighborhood of Fortaleza, Brazil. Methods. This case-control study included 57 controls and 67 children with fluorosis affecting superior and inferior incisors teeth as determined by the Dean classification criteria. Presence of fluorosis was considered as the dependent variable. Data concerning independent variables were obtained through interviews with the parents. Fisher's exact test was used to determine associations between fluorosis and the independent variables. Odds ratios (OR) were calculated to investigate associations and likelihood of fluorosis in the case group, with 95% significance level. Results. Fluorosis was significantly associated with type of housing (owned, rented or squatted), but not with the source of drinking water or use of fluoridated toothpaste and fluoride supplements. Univariate analysis showed that the risk of fluorosis was higher in children who began drinking powdered milk mixed with water before 2 years of age (OR = 4.53; IC95%: 1.07-26.74) and in those who did not breastfeed (OR = 6.66; IC95%: 1.61-38.62). In the multivariate analysis, only breastfeeding was associated with fluorosis (4.54; IC95%: 1.21-16.66). Conclusions. Breastfeeding was a protection factor against fluorosis. More specific categorization criteria must be established to investigate relationships between fluorosis and socioeconomic class. [ABSTRACT FROM AUTHOR]

Objective. To identify relationships between tourism and health as well as the methods employed in studies about this topic. Method. The PubMed and SciELO databases were searched in March of 2008 using the following strategy: traveler or traveller or tourism or tourist AND risk or hazard or vulnerability AND health or surveillance. The following were excluded: articles on animal health, conceptual and review articles, articles about non-tourist travel, and articles written in languages other than Portuguese, English, Italian, and Spanish. Of 153 articles identified, 112 were excluded, and 41 articles were examined. Results. The number of articles on tourism and health increased from one in the 1970s to 34 in the 2000s. Most studies were carried out in Europe, followed by the Americas, and most covered insect-borne diseases, respiratory diseases transmitted from person to person, and gastrointestinal diseases. Mail, telephone, or face-to-face questionnaires were generally used for data collection. In terms of location, 21 studies were performed at the place of departure, 17 at the destination, and in 3 this information was not specified. Four studies were carried out before the trip, 9 during the trip, 24 after the trip, and 3 did not specify this information. Most studies focus on the tourist as a likely victim of health problems, unprepared to face situations of exposure during the trip. Conclusions. The need to implement health care policies aimed at the tourist population is evident, with emphasis on infectious diseases and emergency actions to detect outbreaks involving tourists. A tourist-specific surveillance and notification system is also necessary, together with measures to prepare health care institutions to meet the individual demands of this population. [ABSTRACT FROM AUTHOR]

Objectives. To estimate the prevalence and clustering of cardiovascular risk factors (hypertension, smoking, physical inactivity, excessive use of alcohol, inadequate diet, and central obesity) and investigate the association of these factors with health self-evaluation after adjustment for sociodemographic features and clinical diagnosis of diabetes and ischemic heart disease. Methods. We studied 9 211 Brazilians with age between 30 and 69 years, residents of 16 state capitals, included in a cross-sectional population-based study carried out by the Ministry of Health (Inquérito Domiciliar sobre Comportamentos de Risco e Morbidade Referida de Doenças e Agravos Não Transmissíveis, 2002-2003). The response variable was the score of cardiovascular risk factor clustering, which ranged from zero to 3: no exposure or exposure to 1, 2, and 3 or more risk factors. Data were analyzed using multinomial logistic regression, having as reference the category of zero risk factors, with and without hypertension. Results. The prevalence of all risk factors except alcohol consumption was higher than 25%. The presence of two or more risk factors occurred in 47.49%; 17.91% of the participants presented zero risk factors. The clustering of risk factors was inversely associated with income and schooling and higher in the age group between 50 and 59 years, without significant differences between sexes. Health self-evaluation was worse in participants with more risk factors. The inclusion of hypertension in the score resulted in a worsening of the risk profile with increase in age and in a significant association with reported ischemic heart disease and diabetes. Conclusions. The high prevalence of cardiovascular risk factors in Brazilian adults underscores the importance of policies aimed at reducing these factors. The association between worse self-perception of health and a higher number of cardiovascular risk factors calls attention to the importance, broadness and complexity of this subjective health marker in population surveys and suggests that self-perception of poor health is not sufficient to encourage healthy attitudes. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the frequency of sexually transmitted diseases (STD) and associated risk factors based on self-reporting by long-haul truck drivers in Brazil. Method. From October 2005-October 2006, 641 long-haul truck drivers that travel federal highway BR-153, traversing the country from south to north, were interviewed. A structured interview was used to collect sociodemographic data. The truck drivers also completed a self-administered questionnaire on risk behaviors and STD history. The data were adjusted and analyzed using logistic regression. Results. Of 641 drivers interviewed, 620 (96.7%) provided answers on STD history. Of these, 35.6% (95% confidence interval (CI) = 31.9-39.6) reported past or current STD. Being 30 years of age or older was statistically associated with having a history of STD. In addition, truck drivers who reported using amphetamines (odds ratio (OR) = 1.7; 95%CI = 1.1-2.6), having been incarcerated (OR = 2.2; 95%CI = 1.2-4.2), and sexual relations with sex professionals (OR = 1.9; 95%CI = 1.3-2.8) had increased odds for having a history of STD. Conclusion. These results confirm that Brazilian truck drivers are highly vulnerable to STD and show the importance of prevention programs targeting this specific group, one that is constantly on the move and may efficiently disseminate STD. [ABSTRACT FROM AUTHOR]

Objective. To study the prevalence of and major factors associated with recurrent wheezing in children younger than 13 years of age in the urban area of Rio Grande, in the state of Rio Grande do Sul, Brazil. Methods. The presence of recurrent wheezing was investigated in a cohort as part of a cross-sectional study that was begun in 1997 that focused on the morbidity from respiratory diseases in children then between 0 and 5 years of age. During home visits in 2004 a standardized questionnaire given by trained interviewers was used to obtain information concerning the family's socioeconomic and living conditions, maternal care during pregnancy and delivery, and children's current and previous morbidity patterns. The statistical analysis included the calculation of the odds ratio (OR) and 95% confidence interval (95% CI), with nonconditional logistic regression adjustment for potential confounding factors, according to a predefined hierarchical model. Results. Of the 775 children studied in 1997, 685 were located in 2004 (loss of 11.6%). In this group, the prevalence of recurrent wheezing at the time of the interview was 27.9%. After adjustment, the risk factors were: current rhinitis (OR = 45.7; 95% CI: 24.2 to 86.5), use of wood stove for cooking (OR = 2.7; 95% CI: 1.4 to 4.9), child's history of acute respiratory infection (OR - 2.1 ; 95% CI: 1.3 to 3.5), bottle feeding (OR = 2.1; 95% CI: 1.1 to 3.8), history of asthma in siblings (OR = 1.9; 95% CI: 1.2 to 3.2), maternal history of asthma (OR = 1.8; 95% CI: 1.1 to 2.9), and fewer than six prenatal medical consultations (OR = 1.6; 95% CI: 1.1 to 2.4). Paternal schooling < 9 years was a protective factor against recurrent wheezing (OR = 0.6; 95% CI: 0.4 to 0.9). Conclusions. These results suggest that the management of recurrent wheezing and asthma must consider checking for and simultaneously treating rhinitis. The measures to minimize the effects of recurrent wheezing should include educational and treatment programs focusing on asthma. [ABSTRACT FROM AUTHOR]

Objective. To determine if there is an association between low birthweight (< 2 500 g) and asthma. Results. The key words "asthma," "children," "birth weight," and "risk factors" were used to identify analytical epidemiological studies on humans that were published in English, Portuguese, or Spanish between 1990 and 2001 and that were indexed in either of two bibliographic databases: MEDLINE (PubMed) and Latin American and Caribbean Health Sciences (Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS)). We identified 41 articles dealing with the association between birthweight and asthma: 21 were longitudinal studies, 16 were cross-sectional studies, and 4 were case-control studies. Low birthweight was identified as a risk factor for asthma in 26 of the articles. Two studies found an inverse association between birthweight and risk for asthma, and 15 did not find any association. Conclusions. The association between birthweight and asthma remains controversial, mainly due to the extensive network of factors that contribute to the development of asthma. The association between low birthweight and asthma occurs mainly among children up to 5 years of age, and it decreases as age increases. Pulmonary function is an important factor that needs to be considered. Low birthweight children may have decreased pulmonary function and consequently develop asthma. On the other hand, these children may have asthma as a consequence of low birthweight, without pulmonary function being a factor. In the six studies comparing low birthweight children (< 2 500 g) with very low birthweight children (< 1 500 g), very low birthweight was associated with a greater risk for developing asthma. Finally, the contribution of intrauterine factors (such as nutrition) in the development of asthma is receiving increasing attention in the scientific literature. Controlling for possible confounding factors is essential to clarifying the relationship between birt. [ABSTRACT FROM AUTHOR]

Objective. To estimate the prevalence of anemia and to determine associated risk factors among infants receiving routine health care in public clinics in Brazil. Method. This cross-sectional study included 2 715 infants between 6 and 12 months old in 12 cities, in all five of the geographic regions of Brazil. Information regarding the child and its feeding habits was obtained from the mother or other caregiver, using a questionnaire. Nutritional status was determined based on height and weight measurements. The hemoglobin concentration was measured using the HemoCue portable hemoglobinometer. Anemia was defined as hemoglobin < 11 g/dL. The infants' eating habits were assessed based on what they were eating around the time of the questionnaire interviews. The association between anemia and the different variables was evaluated through bivariate analysis, followed by multiple logistic regression using a hierarchical selection model. Results. The prevalence of anemia for the entire group was 65.4%. Multiple regression analysis identified the following risk factors for anemia: living in the Southeastern Region of Brazil (odds ratio (OR) = 1.57, 95% confidence interval (95% CI) = 1.251.99), maternal age < 20 years (OR = 1.58, 95% CI = 1.21-2.07), birthweight < 2 500 g (OR = 2.09, 95% CI = 1.48-2.95), not being breast-fed (OR = 1.28, 95% CI = 1.02-1.61), receiving both breast milk and other foods (OR = 1.40, 95% CI = 1.10-1.78), and male gender (OR = 1.24, 95% CI = 1.06-1.46). Conclusions. The high proportion of anemic children indicates the need to emphasize, in prenatal and infant health programs, intervention measures for anemia control. Our results could guide these measures, focusing on the groups at greatest risk, such as low birthweight babies and the children of adolescent mothers. [ABSTRACT FROM AUTHOR]