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Introduction Adverse drug reactions (ADRs) to anti-infectives affect especially hospitalized children and contribute to increased morbidity, mortality, length of stay, and costs in healthcare systems. Objective To assess ADRs associated with anti-infective use in Brazilian hospitalized children. Methods A prospective cohort study was conducted in 5 public hospitals over 6 months. Children aged 0–11 years and 11 months who were hospitalized for more than 48 h and prescribed anti-infectives for over 24 h were included. Results A total of 1020 patients met the inclusion criteria. Of these, 152 patients experienced 183 suspected ADRs. Most reactions were related to the gastrointestinal system (65.6%), followed by skin reactions (18.6%). Most reactions were classified as probable causality (58.5%), moderate severity (61.1%), and unavoidable (56.2%). Our findings showed that ADRs were associated with increased length of stay (P <.001), increased length of therapy (P <.015), increased days of therapy (P =.038), and increased number of anti-infectives prescribed per patient (P <.001). Conclusion Almost 15% of hospitalized children exposed to anti-infectives presented suspected ADRs. Their occurrence was classified as probable, of moderate severity, and unavoidable. ADRs were significantly influenced by the length of hospital stay and the number of anti-infectives prescribed per patient. [ABSTRACT FROM AUTHOR]

We employ Newcomb–Benford law (NBL) to evaluate the reliability of COVID-19 figures in Brazil. Using official data from February 25 to September 15, we apply a first digit test for a national aggregate dataset of total cases and cumulative deaths. We find strong evidence that Brazilian reports do not conform to the NBL theoretical expectations. These results are robust to different goodness of fit (chi-square, mean absolute deviation and distortion factor) and data sources (John Hopkins University and Our World in Data). Despite the growing appreciation for evidence-based-policymaking, which requires valid and reliable data, we show that the Brazilian epidemiological surveillance system fails to provide trustful data under the NBL assumption on the COVID-19 epidemic. [ABSTRACT FROM AUTHOR]

Background To evaluate the early age of onset (AOO) of alcohol consumption and its association with sociodemographic, nutritional and lifestyle characteristics. Methods A national cross-sectional multi-centered study assessed 12–17-year old adolescents from 1247 public and private schools in 124 Brazilian municipalities with more than 100 000 habitants. Our variable of interest was the AOO of alcohol consumption. Covariates comprised sociodemographic status, lifestyle habits and nutritional parameters. We used adapted survival models to investigate the association between covariates and the AOO of alcohol consumption. Results From a sample of 67 672 adolescents, 50% were females. The mean AOO of alcohol consumption was 12.9 years. Male adolescents had a lower mean age of alcohol experimentation when compared to females in Northeast and South regions. The difference between private and public school for AOO was observed only for the Northeast Region (12.6 versus 13.1, respectively). Adolescents who reported smoking or mental health problems or from the Southern Region presented earlier alcohol use. Physical activity and overweight were positively associated with earlier use of alcohol. Conclusions There is no homogeneity in the AOO of alcohol consumption among adolescents, which should be considered when formulating public policies and government campaigns directed toward reducing alcohol consumption. [ABSTRACT FROM AUTHOR]

The aim of this article was to evaluate associations between body mass index (BMI) and use of and distance from subjects homes of elements of the food and physical activity environments and use of social assistance environment, in schoolchildren from 7 to 14 years living in Florianópolis (South Brazil), stratified by monthly family income. A cross-sectional study was conducted with a probabilistic sample of 2152 schoolchildren. Univariate and multivariate linear regression analyses were conducted to test for associations between BMI and the use of and distance from supermarkets, bakeries and farmers' markets; use of and distance from parks/playgrounds and football pitches; and use of health centers, Reference Centers for Social Assistance, instructional facilities, residents associations, religious groups and a Brazilian program for cash transfer. Overweight and obesity rates were 21.5 and 12.7%, respectively. Among schoolchildren from low-income families, living more than 11 min' walk from parks/playgrounds was associated with higher BMI (β = 0.53; 95% CI = 0.33–0.73). In the high-income strata, a longer distance from home to football pitches was associated with lower BMI (β = −0.49; 95% CI = −0.69; −0.29). Neither food nor social assistance environments were associated with BMI of schoolchildren, even when analyzed by income strata. [ABSTRACT FROM AUTHOR]

Introduction Ovarian cancer (OC) is the most lethal gynecological tumor. In Brazil, there are important regional differences regarding mortality rates for the same cancer type. Objectives To analyze the progression of OC mortality rates in Brazil and its regions, in age groups over 50 years, between 2000 and 2015. Methods Ecological longitudinal study carried out using secondary data from DATASUS (Brazil's public health system database) regarding deaths due to OC in women living in Brazil between 2000 and 2015. We calculated gross and adjusted mortality, estimated the impact of death of OC and proportional mortality rate of all cancer types in women between the age of 50 and 79 years. Results There were 34.335 deaths due to OC in women in the referred age interval, with a 9% increase in mortality adjusted for age, a 0.05% (P = 0.012) trend and a 24.67% increase in the proportional mortality due to all causes with a 0.02% (P < 0.001) trend. There were statistically significant increases in mortality rates due to OC in the age groups of 50–54 (28,4%, P < 0,05) and 75–79 years (25,1%, P < 0,05). Conclusion Although there are oscillations in mortality rates of OC in Brazil and its regions over the period studied, this parameter has remained relatively stable. [ABSTRACT FROM AUTHOR]

Background To evaluate the association between sociodemographic conditions and the quality of life (QoL) in adults and investigate whether these inequalities are greater among individuals with long-lasting chronic health conditions. Methods Cross-sectional analysis of the second wave (2012) of the EpiFloripa Study, a population-based cohort of 1720 adults living in Southern Brazil. QoL domains (physical, psychological, social relationships and environmental) were evaluated using the WHOQoL-BREF. Unadjusted and adjusted means of QoL according to socioeconomic and demographic variables were estimated and stratified by the presence of long-lasting chronic conditions (heart disease, stroke, diabetes, hypertension, chronic kidney disease, cirrhosis, tendinitis, arthritis, rheumatism and/or fibromyalgia) were peformed in 2016. Results Among 1222 interviewed adults (56.6% females, mean age 41.7 ± 11.4 years; follow-up rate 71.1%), the prevalence of 1+ long-lasting chronic disease was 37.3% (95%CI: 34.4–40.3). Their effect on the QoL was four times higher on the physical component (−9.6; 95%CI −12.1; −7.1) than on the other domains. Adults aged 40+ years with black skin colour or lower educational level had a lower physical QoL score only when any chronic disease was present. Among those with some chronic illness, the psychological domain was also lower among those aged 40+ years and with a lower family income. No interaction between sociodemographic variables and chronic diseases was observed for the other QoL domains. Conclusions The occurrence of long-lasting chronic diseases is associated with inequalities in QoL (physical and psychological domains), with stronger adverse effects among older adults, blacks and individuals with lower income or educational levels. [ABSTRACT FROM AUTHOR]

Among the causes of obesity, environmental factors have also been studied, in addition to genetic, social, psychological, and hormonal factors. The distribution of food outlets, facilitating or hindering food acquisition, can promote body weight control by encouraging healthier food habits. The objective of this study was to investigate associations between environmental availability and utilization of food outlets and overweight/obesity in 7 to 14-year-old schoolchildren in Florianópolis, in the South of Brazil. A logistic regression analysis identified a positive association between overweight/obesity in 2195 schoolchildren and the presence of restaurants in the vicinity of their homes (buffer = 400 meters). Being a member of a family that utilizes public markets/greengrocers was also positively associated with overweight/obesity in the sample investigated. Identifying the distribution of these establishments in the vicinity of the homes of schoolchildren in middle-income countries is an important element in understanding the role played by the food environment in weight gain in a variety of different settings. [ABSTRACT FROM AUTHOR]

Objective. To determine the frequency of immunodeficiency-like states in SLE and related clinical features. Methods. Three hundred and fifteen SLE patients and 301 controls were evaluated for C4A and C4B gene copy number, immunoglobulin isotypes, IgG subclasses, total haemolytic complement (CH50), C2, C3 and neutrophil oxidative burst. C2 and C3 genes were sequenced in cases of low C2 or C3 levels. Those presenting abnormal CH50 with normal C2 and C3 underwent C1q-C9 determination. Patients with active SLE and abnormal results were re-tested after the flare or were excluded if no remission was attained. Fifteen patients were excluded on this basis. Persistent abnormal results characterized an immunodeficiency-like state. Results. A significantly higher percentage of SLE patients presented an immunodeficiency-like state compared with controls (28.7% vs 3.3%; P < 0.001), especially low immunoglobulin serum levels. Rigorous testing confirmed only two cases of C2 deficiency carriers among the SLE patients. There were significantly more SLE patients with less than two C4A copies compared with controls. SLE patients had higher frequency of low IgG2, IgG3, IgG4 and IgM levels compared with controls. Patients with low IgG3 or IgG4 presented higher frequency of lupus nephropathy. Patients with low IgM had longer disease duration, older age at SLE onset and lower frequency of oral ulcers. Conclusion. An immunodeficiency-like state is present in a sizable fraction of SLE patients. Further studies are warranted to determine the impact of these immunodeficiency states and whether they are a primary condition or are secondary to confounding factors, including SLE itself. [ABSTRACT FROM AUTHOR]

Background and objective: C-reactive protein (CRP) is a widely used cardiovascular risk marker, but questions remain about its role in the disability process in old age. This study examines the associations between CRP levels and physical performance in old age in different societies. Methods: data were collected during the baseline survey of IMIAS in 2012 in Kingston (Canada), Saint-Hyacinthe (Canada), Manizales (Colombia) and Natal (Brazil). Approximately 200 men and 200 women aged 65-74 were recruited at each site. CRP was assessed using a high sensitivity assay and categorised as low (<1 mg/l), moderate (1-3 mg/l), high (3-10 mg/l) and very high (≥ 10 mg/l). Participants were interviewed at home; blood pressure, weight and height were measured. Physical function was assessed with the Short Physical Performance Battery (SPPB) and hand grip strength. Data were analysed using descriptive statistics, bivariate analysis (χ²) and linear or logistic regression. Results: CRP was significantly associated with low hand grip strength and poor physical performance in bivariate analyses. Hand grip strength association with CRP disappeared after adjustment by socioeconomic factors and health behaviours. The odds of poor physical function was OR = 2.67 [95% CI 1.43-4.99] comparing the highest and lowest CRP categories after adjustment by relevant covariates. The three SPPB components were assessed separately. Graded associations between low CRP and faster gait speed and shorter time to rise from a chair were observed in adjusted models. Association between impaired balance and CRP was attenuated after adjustment by relevant covariates, OR =1.15 [0.65-2.04]. Conclusions: CRP could be a possible pathway from inflammation to physical decline in older populations. [ABSTRACT FROM AUTHOR]

Background. Low back pain (LBP) is an important health problem in all developed countries and is associated with high levels of disability. Evidence-based clinical practice guidelines usually recommend different physical therapy interventions to manage this condition. However, those interventions usually result in small to moderate clinical effects. Recent studies suggest that interventions based on subgroup classifications may improve the effect sizes compared with rehabilitation programs where the same interventions were applied to all patients. Objective. This study will investigate the efficacy of treatment based on a Movement System Impairment (MSI)- based classification model for patients with chronic LBP compared with general exercise. The primary outcomes will be pain intensity and disability at 2 months after randomization. Design. The study is a 2-arm, prospectively registered, randomized controlled trial with a blinded assessor. Setting. The study setting will be a university physical therapy clinic in Brazil. Participants. A total of 148 individuals with chronic LBP will participate in the study. Intervention. Included individuals will be randomly allocated to participate in an 8-week treatment program based on the MSI-based classification or a general exercise program of stretching and strengthening exercises. Measurements. Pain intensity, disability, and global impression of recovery will be assessed by a blinded assessor at baseline and at follow-up appointments after treatment (2 months) and 4 and 6 months after randomization. Limitations. Therapists will not be blinded. Conclusions. The results of this study may contribute to a better understanding of the efficacy of treatments based on classification of participants with chronic LBP into subgroups. [ABSTRACT FROM AUTHOR]

We assessed the impact of the 2010 revisions to Brazil's self-regulatory alcohol marketing code using expert and adolescent raters.~Aims~Objective~Five popular TV beer ads were selected. Ads were rated based on the 2010 Brazilian self-regulatory marketing code. The expert group (N = 31) represented health-related professions; the adolescent group (N = 110) were public high school students.~Methods~Methods~At least 1 ad violated 11 of 17 guidelines included in the study. Ratings by experts and adolescents were similar. Both found violations in all sections of the self-regulatory code, but significant group differences were seen in applying the section that prohibits the promotion of excessive alcohol consumption, with experts identifying more violations than adolescents.~Results~Results~Beer ads in the sample systematically violated the self-regulatory standards for alcohol advertising in Brazil according to both experts and youth. Public policies for more effective restrictions and prohibitions in alcohol ads should be considered.~Conclusion~Conclusions [ABSTRACT FROM AUTHOR]

Background. The physical signs of impending death have not been well characterized in cancer patients. A better understanding of these signs may improve the ability of clinicians to diagnose impending death. We examined the frequency and onset of 10 bedside physical signs and their diagnostic performance for impending death. Methods.We systematically documented 10 physical signs every 12 hours from admission to death or discharge in 357 consecutive patients with advanced cancer admitted to two acute palliative care units. We examined the frequency and median onset of each sign from death backward and calculated their likelihood ratios (LRs) associated with death within 3 days. Results. In total, 203 of 357 patients (52 of 151 in the U.S., 151 of 206 in Brazil) died. Decreased level of consciousness, Palliative Performance Scale #20%, and dysphagia of liquids appeared at high frequency and.3 days before death and had low specificity (,90%) and positive LR (,5) for impending death. In contrast, apnea periods, Cheyne-Stokes breathing, death rattle, peripheral cyanosis, pulselessness of radial artery, respiration with mandibular movement, and decreased urine output occurred mostly in the last 3 days of life and at lower frequency. Five of these signs had high specificity (.95%) and positive LRs for death within 3 days, including pulselessness of radial artery (positive LR: 15.6; 95% confidence interval [CI]: 13.7-17.4), respiration with mandibular movement (positive LR: 10; 95% CI: 9.1-10.9), decreased urine output (positive LR: 15.2; 95% CI: 13.4-17.1), Cheyne-Stokes breathing (positive LR: 12.4; 95% CI: 10.8-13.9), and death rattle (positive LR: 9; 95% CI: 8.1-9.8). Conclusion.We identified highly specific physical signs associated with death within 3 days among cancer patients. [ABSTRACT FROM AUTHOR]

Objective To evaluate the degree of knowledge about pain management and opioids use by professionals working at three pediatric units. Design This is a cross-sectional study. Setting This study was carried out at three pediatric units (pediatrics, intensive care unit, and oncology) of Hospital de Clínicas de Porto Alegre, which is a university hospital located in southern Brazil. Subject The subjects of this study include physicians, pharmacists, physiotherapists, nurses, nursing technicians, and nursing assistants. Methods Cross-sectional study carried out in a university hospital in southern Brazil. A self-applicable semi-structured questionnaire was handed out to 182 professionals from December 2011 to March 2012. Results The response rate was 67% (122); the average percentage of correct answers was 63.2 ± 1.4%. The most frequent errors were: an opioid must not be used if the cause of pain is unknown (47%; 54/115); patients often develop respiratory depression (42.3%; 22/52); and confusion about symptoms of withdrawal, tolerance, and dependency syndromes (81.9%; 95/116). Only 8.8% (10/114) reported the use of pain scales to identify pain in children. The most often cited hindrance to control pain was the difficulty to measure and spot pain in pediatric patients. Finally, 50.8% (62/122) of them did not have any previous training in pain management. Conclusions Problems in the processes of pain identification, measurement, and treatment have been found. Results suggest that there is a need for both an investment in continuing education of professionals and the development of protocols to optimize the analgesic therapy, thus preventing increased child suffering. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to estimate the prevalence of driving after drinking (DUI) and its associated factors in low and high alcohol outlet density areas (LAOD and HAOD) in Porto Alegre, Brazil. Methods: A probability 3-stage sampling survey was conducted, and 683 drivers who were leaving alcohol outlets (AOs) and had been drinking were interviewed, breathalyzed and saliva was collected for drag screening. Prevalences were assessed using domain estimation and DUI predictors were assessed using logistic models. Results: It was estimated that 151,573 drivers drank at the AO, and intention to DUI was more prevalent in LAOD (59.3 versus 46.1 % in HAOD, P = 0.003). On the other hand, HAOD had higher proportions of interviewees with a blood alcohol concentration (BAC) of >0.06% (46.6 versus 30.7%, P = 0.002) as well as a more frequent use of cocaine (9.3 versus 2.4%, P = 0.086). In the logistic models, drinking in a LAOD stratum was found to be associated with DUI (OR 1.72 (1.17-2.5)) and the two AO density areas presented different factors independently associated with DUI: THC use was significantly associated with the outcome in the HAOD stratum (OR 17.7 (5.1-61.8)), whereas an AUDIT score of >20 was positively associated with DUI in LAOD (OR 23.75 (1.5-364.0)). Conclusions: High prevalences of driving under the influence of alcohol were evident in both the high and the low outlet density areas, although with different characteristics. Thorough enforcement of the legislation by random breath testing and sobriety checkpoints should be combined with AO licensing in order to reduce high levels of DUI and traffic accidents. [ABSTRACT FROM AUTHOR]

Objective To translate the original English version of the Profile of Chronic Pain: Screen ( PCP: S) into Brazilian Portuguese and examine basic psychometric properties of the translated version. We investigated ceiling and floor effects, internal consistency, factor structure, convergent validity, and the ability of the Brazilian PCP: S ( B- PCP: S) to discriminate persons with pain who were either employed or not working, or in treatment or not in treatment. Methods The Brazilian Portuguese version of the Profile of Chronic Pain: Screen ( B- PCP: S) was administered to a sample of 414 adults (men = 67). Pain catastrophizing was also assessed. Subsamples with special conditions (working despite pain [N = 116] vs not working due to pain [N = 122], and not receiving treatment for pain [N = 119] vs receiving treatment [N = 119]) were identified to investigate the discriminative properties of B- PCP: S. Results For the B- PCP: S, Cronbach's α values were 0.76 (severity), 0.88 (interference), and 0.87 (emotional burden). Confirmatory factor analysis supported the original, English language three-factor structure, with the comparative fit index = 0.93, root mean square error of approximation = 0.075, and normed fit index = 0.93. Significant correlations were found between pain intensity, pain interference, and emotional burden, and a criterion measure of catastrophizing (correlation coefficients ranged from 0.48 to 0.66, P < 0.01). B- PCP: S scores (severity, interference, and emotional burden) were higher in subjects under a doctor's care for pain and in those not working due to pain. Conclusion This B- PCP: S version was found to be a reliable instrument, with basic evidence of validity for the evaluation of pain severity, interference, and emotional burden in Brazilian Portuguese adults. The profile of B-PCP:S scores was similar to that observed in the original version. [ABSTRACT FROM AUTHOR]

Although low- and middle-income countries still bear the burden of major infectious diseases, chronic noncommunicable diseases are becoming increasingly common due to rapid demographic, epidemiologic, and nutritional transitions. However, information is generally scant in these countries regarding chronic disease incidence, social determinants, and risk factors. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) aims to contribute relevant information with respect to the development and progression of clinical and subclinical chronic diseases, particularly cardiovascular diseases and diabetes. In this report, the authors delineate the study’s objectives, principal methodological features, and timeline. At baseline, ELSA-Brasil enrolled 15,105 civil servants from 5 universities and 1 research institute. The baseline examination (2008–2010) included detailed interviews, clinical and anthropometric examinations, an oral glucose tolerance test, overnight urine collection, a 12-lead resting electrocardiogram, measurement of carotid intima-media thickness, echocardiography, measurement of pulse wave velocity, hepatic ultrasonography, retinal fundus photography, and an analysis of heart rate variability. Long-term biologic sample storage will allow investigation of biomarkers that may predict cardiovascular diseases and diabetes. Annual telephone surveillance, initiated in 2009, will continue for the duration of the study. A follow-up examination is scheduled for 2012–2013. [ABSTRACT FROM PUBLISHER]