Signs And Symptoms Associated With Sexually Transmitted Infections In Brazil, 2005 [sinais E Sintomas Associados às Doenças Sexualmente Transmissíveis No Brasil, 2005]

Objective: Sexually transmitted infections (STIs) are a major determinant of population disease burden worldwide. The objective of the study was to assess self-reported morbidity associated to STIs according to gender. Methods: The study data were obtained from a 2005 study consisting of a multistage probabilistic sample of 5,040 respondents, aged 16-65 years, living in urban areas in Brazil. These data were compared with those from a previous 1998 study. Bivariate analyses were carried out using Pearson's chi-square test and simple linear regression followed by logistic regression. Results: In both men and women, the variables: previous HIV testing, personal belief in unfaithful love, and number of sexual partners in a lifetime were significantly associated to STIs. In women only, the covariates: low family income, living in the Mid-West, Southeast and South regions, and reporting of physical violence were independently associated to STIs. In men, the variables associated were: age group (35 years or more), living in the South region and in the state of São Paulo, and self-perceived HIV infection risk. Conclusions: Signs and symptoms associated to STIs have strong gender differences in the general population and education interventions should be specifi cally targeted to either men or women.42SUPPL. 198106Boily, M.C., Anderson, R.M., Human immunodeficiency virus transmission and the role of other sexually transmitted diseases. Measures of association and study design (1996) Sex Transm Dis, 23 (4), pp. 312-332Bradner, C.H., Ku, L., Lindberg, L.D., Older, but not wiser: How men get information about AIDS and sexually transmitted diseases after high school (2000) Fam Plann Perspect, 32 (1), pp. 33-38Bussab W de O, Grupo de Estudos em População, Sexualidade e Aids. Plano amostral da Pesquisa Nacional sobre Comportamento Sexual e Percepções sobre HIV/Aids, 2005. Rev Saude Publica. 2008;42(Supl 1):12-20Carret, M.L.V., Fassa, A.G., Silveira, D.S., Bertoldi, A.D., Hallal, P.C., Sexually transmitted diseases symptoms in adults: Prevalence and risk factors (2004) Rev Saude Publica, 38 (1), pp. 76-84Cook, R.L., May, S., Harrison, L.H., Moreira, R.I., Ness, R.B., Batista, S., High prevalence of sexually transmitted diseases in young women seeking HIV testing in Rio de Janeiro, Brazil (2004) Sex Transm Dis, 31 (1), pp. 67-72Crossman, S.H., The challenge of pelvic inflammatory disease (2006) Am Fam Physician, 73 (5), pp. 859-864Codes, J.S., Cohen, D.A., Melo, N.A., Teixeira, G.G., Leal, A.S., Silva, T.J., Detecção de doençãs sexualmente transmissíveis em ambientes clínicos e não clínicos na Cidade de Salvador, Bahia, Brasil (2006) Cad Saude Publica, 22 (2), pp. 325-334Eng, T.R., Butler, W.T., (1997) The Hidden epidemic: Confronting sexually transmitted diseases, , Washington, DC: National Academy Press;Fennema, J.S., van Ameijden, E.J., Coutinho, R.A., van den Hoek, J.A., Validity of self-reported sexually transmitted diseases in a cohort of drug-using prostitutes in Amsterdam: Trends from 1986 to 1992 (1995) Int J Epidemiol, 24 (5), pp. 1034-1041Fleming, D.T., Wasserheit, J.N., From epidemiological synergy to public health policy and practice: The contribution of other sexually transmitted diseases to sexual transmission of HIV infection (1999) Sex Transm Infect, 75 (1), pp. 3-17França Junior, I., Calazans, G., Zucchi, E.M., Grupo de Estudos em População, Sexualidade e Aids. Mudanças no âmbito da testagem anti-HIV no Brasil entre 1998 e 2005. (2008) Rev Saude Publica, 42 (SUPL 1), pp. 84-97Franks, P., Gold, M.R., Fiscella, K., Sociodemographics, self-rated health, and mortality in the US (2003) Soc Sci Med, 56 (12), pp. 2505-2514Gerrard, M., Gibbons, F.X., Bushman, B.J., Relation between perceived vulnerability to HIV and precautionary sexual behavior (1996) Psychol Bull, 119 (3), pp. 390-409Gregson, S., Nyamukapa, C.A., Garnett, G.P., Mason, P.R., Zhuwau, T., Carael, M., Sexual mixing patterns and sex-differentials in teenage exposure to HIV infection in rural Zimbabwe (2002) Lancet, 359 (9321), pp. 1896-1903Harrington, K.F., DiClemente, R.J., Wingood, G.M., Crosby, R.A., Person, S., Oh, M.K., Validity of self-reported sexually transmitted diseases among African American female adolescents participating in an HIV/STD prevention intervention trial (2001) Sex Transm Dis, 28 (8), pp. 468-471Hobbs, C.G., Sterne, J.A., Bailey, M., Heyderman, R.S., Birchall, M.A., Thomas, S.J., Human papillomavirus and head and neck cancer: A systematic review and meta-analysis (2006) Clin Otolaryngol, 31 (4), pp. 259-266(2006) Disease control priorities in developing countries, , Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al. editors, Washington, DC: World Bank Publications;Moherdaui, F., Vuylsteke, B., Siqueira, L.F., dos Santos Junior, M.Q., Jardim, M.L., de Brito, A.M., Validation of national algorithms for the diagnosis of sexually transmitted diseases in Brazil: Results from a multicentre study (1998) Sex Transm Infect, 74 (SUPPL. 1), pp. S38-S43Moodley, P., Sturm, A.W., Management of vaginal discharge syndrome: How effective is our strategy? (2004) Int J Antimicrob Agents, 24 (SUPPL. 1), pp. S4-S7Padian, N.S., Shiboski, S.C., Hitchcock, P.J., Risk factors for acquisition of sexually transmitted diseases and development of complications (1991) Reseach issues in human behavior and sexually transmitted diseases in the AIDS era, , Wasserheit JN, Aral SO, Holmes KK, editors, Washington, DC: American Society for Microbiology;Quinn TC, Overbaugh J. HIV/AIDS in women: an expanding epidemic. Science. 2005;308(5728):1582-3Quinn, T.C., Association of sexually transmitted diseases and infection with the human immunodeficiency virus: Biological cofactors and markers of behavioural interventions (1996) Int J STD AIDS, 7 (SUPPL. 2), pp. 17-24Rodrigues, C.S., Guimaraes, M.D., Grupo Nacional de Estudo sobre Sifilis Congenita. Positividade para sífilis em puérperas: Ainda um desafio para o Brasil. (2004) Rev Panam Salud Publica, 16 (3), pp. 168-175Tanfer, K., Cubbins, L.A., Billy, J.O.G., Gender, race, class and self-reported sexually transmitted disease incidence (1995) Fam Plann Perspect, 27 (5), pp. 196-20

Distribution of HCV genotypes among different exposure categories in Brazil

Hepatitis C virus (HCV) infection is widespread and responsible for more than 60% of chronic hepatitis cases. HCV presents a genetic variability which has led to viral classification into at least 6 genotypes and a series of subtypes. These variants present characteristic geographical distribution, but their association with different responses to treatment with interferon and severity of disease still remains controversial. The aim of this study was to investigate the patterns of distribution of HCV genotypes among different exposure categories in Brazil. Two hundred and fifty anti-HCV positive samples were submitted to HCV-RNA detection by RT-PCR and their genotype was determined by restriction fragment length polymorphism (RFLP) analysis. In addition, the genotype/subtype of 60 samples was also determined by a reverse hybridization assay. HCV 1 was the most prevalent (72.0%), followed by type 3 (25.3%), HCV 2 (2.0%) and HCV 4 (0.7%). The HCV genotype distribution varied among the different exposure categories, with HCV 1 being more frequent among blood donors, hemophiliacs and hemodialysis patients. A high frequency of HCV 3 was observed in cirrhotic patients, blood donors from the South of Brazil and injecting drug users (IDUs). The general distribution of the HCV genotype in Brazil is similar to that in other regions of the world

C-reactive protein and later preeclampsia: systematic review and meta-analysis taking into account the weight status

OBJECTIVES: This study aims to determine whether high C-reactive protein (CRP) concentration during pregnancy is associated with later preeclampsia and whether weight status (BMI) is a potential modifier of the relation between CRP and preeclampsia. METHODS: Twenty-three studies were included in a systematic literature review and a subset of 18 in a meta-analysis. Weighted mean difference (WMD) [with their 95% confidence intervals (CI)] of CRP in preeclampsia and control groups was the estimator. A quality assessment was carried out using a scale specifically developed for this study. Meta-regression with estimates for study characteristics and inter-arm differences and sensitivity and subgroup analysis was employed. Statistical heterogeneity was investigated using I(2) statistic. RESULTS: The pooled estimated CRP between 727 women, who developed preeclampsia and 3538 controls was 2.30 mg/l (95% CI: 1.27-3.34). The heterogeneity among studies was high (I(2) = 92.8). The WMD was found to be lower in studies comprising preeclampsia and control groups with similar BMI [WMD = 0.85 (95% CI: 0.10-1.61); I(2) = 25.3%] compared with studies among which BMI was significantly elevated in the preeclampsia group [2.01 (95% CI: 1.23-2.78); I(2) = 0.0%], which may explain the high heterogeneity of pooled data. Meta-regression results confirmed that difference in BMI between groups modifies the association of CRP and preeclampsia. High quality studies represented 30%. CONCLUSION: The pooled WMD suggest that women with higher levels of CRP may have an increased risk of developing preeclampsia. This association seems to be modified by confounders, such as BMI. Further studies of high methodological quality are needed

Drug And Alochol Use: Main Findings Of A National Survey, Brazil 2005 [consumo De álcool E Drogas: Principais Achados De Pesquisa De âmbito Nacional, Brasil 2005]

Objective: To assess alcohol and drug use in a representative sample of the urban Brazilian population and their correlation with sexual and reproductive health. Methods: Data from a national population-based survey with a complex sampling, performed in 2005 was used. A total of 5,040 individuals from both genders, in the age group from 16 to 65 years old, were interviewed. Issues regarding drug and alcohol use and sexual behavior were assessed. Bivariate and multivariate analyses were used. Results: Alcohol was the most frequently used substance, with reports of regular use in the lives of 18% of interviewees. Use of illegal drugs was mentioned by 9% of the interviewees especially marijuana and snorted cocaine; injected drugs use was not frequent. There was a decrease in snorted cocaine use and an increase in marijuana use (in the last 12 months), compared to results of a similar survey conducted in 1998. History of sexual abuse was a risk factor for drug use and regular alcohol use. Interviewees mentioning the role of religion in their background, being White, and female were less likely to use alcohol in a regular way, which is especially prevalent among elderly males.Leisure activities and absence of current religious practice were associated with drug use. Conclusions: The regular or irregular alcohol use is prevalent in the urban Brazilian population, whereas injected drug use is rare. Over the last decade there was a decline in cocaine use. A history of sexual abuse was central to later use of alcohol and drugs.42SUPPL. 1109117Bastos, F.I., Bertoni, N., Hacker, M.A., Grupo de Estudos em População, Sexualidade e Aids. Consumo de álcool e drogas: Principais achados de pesquisa de âmbito nacional, Brasil 2005. (2008) Rev Saude Publica, 42 (SUPL 1), pp. 109-117Bastos, F.I., Caiaffa, W., Rossi, D., Vila, M., Malta, M., The children of Mama Coca: Coca, cocaine and the fate of harm reduction in South America (2007) Int J Drug Policy, 18 (2), pp. 99-106Bussab W de O, Grupo de Estudos em População, Sexualidade e Aids. Plano amostral da Pesquisa Nacional sobre Comportamento Sexual e Percepções sobre HIV/Aids, 2005. Rev Saude Publica. 2008;42(Supl 1):12-20Colliver, J.D., Compton, W.M., Gfroerer, J.C., Condon, T., Projecting drug use among aging baby boomers in 2020 (2006) Ann Epidemiol, 16 (4), pp. 257-265Galduróz, J.C., Noto, A.R., Nappo, S.A., Carlini, E.A., Household survey on drug abuse in Brazil: Study involving the 107 major cities of the country-2001 (2005) Addict Behav, 30 (3), pp. 545-556Galduróz, J.C., Noto, A.R., Nappo, S.A., Carlini, E.L., First household survey on drug abuse in Sao Paulo, Brazil, 1999: Principal findings (2003) Rev Paul Med, 121 (6), pp. 231-237Galvan, F.H., Caetano, R., Alcohol use and related problems among ethnic minorities in the United States (2003) Alcohol Res Health, 27 (1), pp. 87-94Mahalik, J.R., Burns, S.M., Syzdek, M., Masculinity and perceived normative health behaviors as predictors of men's health behaviors (2007) Soc Sci Med, 64 (11), pp. 2201-2209Markos, A.R., Alcohol and sexual behaviour (2005) Int J STD AIDS, 16 (2), pp. 123-127Michalak, L., Trocki, K., Bond, J., Religion and alcohol in the U.S. National Alcohol Survey: How important is religion for abstention and drinking? (2007) Drug Alcohol Depend, 87 (2-3), pp. 268-280Miller M. The dynamics of substance use and sex networks in HIV transmission. J Urban Health. 2003;80(4 Suppl 3):iii88-96Simoes, A.A., Bastos, F.I., Moreira, R.I., Lynch, K.G., Metzger, D.S., A randomized trial of audio computer and inperson interview to assess HIV risk among drug and alcohol users in Rio de Janeiro, Brazil (2006) J Subst Abuse Treat, 30 (3), pp. 237-243Strathdee, A.S., Bastos, F.I., (2002) Intertwining epidemics: Injection drug use and HIV infection, pp. 636-639. , Breslow L, editors. Encyclopedia of public health. Nova York: Macmillan;Widom, C.S., Marmorstein, N.R., White, H.R., Childhood victimization and illicit drug use in middle adulthood (2006) Psychol Addict Behav, 20 (4), pp. 394-403Zinberg, N.E., (1984) Drug, set and setting: The basis for controlled intoxicant use, , New Haven: Yale University Press;Zlotnick, C., Johnson, D.M., Stout, R.L., Zywiak, W.H., Johnson, J.E., Schneider, R.J., Childhood abuse and intake severity in alcohol disorder patients (2006) J Trauma Stress, 19 (6), pp. 949-95

Use Of Psychoactive Substances And Contraceptive Methods By The Brazilian Urban Population, 2005 [uso De Substâncias Psicoativas E Métodos Contraceptivos Pela População Urbana Brasileira, 2005]

Objective: To analyze the relationship between utilization patterns for condoms and other contraceptive methods and the consumption of alcohol and drugs. Methods: Exploratory study based on data from a probabilistic sample of 5,040 interviewees aged 16 to 65 years living in large urban regions of Brazil in 2005. The data were collected by means of questionnaires. The chi-square automatic interaction classifi cation tree technique was used to study the use of condoms among interviewees of both sexes and other contraceptive methods among women, at the time of the last vaginal sexual intercourse. Results: Among young and middle-aged adults of both sexes and young men in stable relationships, condom use was less frequent among those who said they used psychoactive substances (alcohol and/or illegal drugs). The possible modulating effect of psychoactive substances on contraceptive practices among mature women seems to be more straightforward, compared to the more subtle effects observed among younger women, for whom the different social classes they belonged to seemed to play a more important role. Conclusions: Despite the limitations resulting from an exploratory study, the fact that this was a representative sample of the urban population of Brazil and not from vulnerable populations, reinforces the need to implement integrated public policies directed towards the general population, with regard to preventing drug consumption, alcohol abuse, sexually transmitted infections, HIV/AIDS and unwanted pregnancy and promoting sexual and reproductive health.42SUPPL. 1118126Blankenship, K.M., Friedman, S.R., Dworkin, S., Mantell, J.E., Structural interventions: Concepts, challenges and opportunities for research (2006) J Urban Health, 83 (1), pp. 59-72Bradner, C.H., Ku, L., Lindberg, L.D., Older, but not wiser: How men get information about AIDS and sexually transmitted diseases after high school (2000) Fam Plann Perspect, 32 (1), pp. 33-38Breiman, L., Friedman, J., Stone, C.J., Olshen, R., (1984) Classification and regression trees, , Pacific Grove, CA: Wadsworth;Bussab W de O, Grupo de Estudos em População, Sexualidade e Aids. Plano amostral da Pesquisa Nacional sobre Comportamento Sexual e Percepções sobre HIV/Aids, 2005. Rev Saude Publica. 2008;42(Supl 1):12-20Methamphetamine use and HIV risk behaviors among heterosexual men preliminary results from five northern California counties, December 2001-November 2003 (2006) MMWR Morb Mortal Wkly Rep, 55 (10), pp. 273-277. , Centers for Disease Control and Prevention CDCEhrenstein, V., Horton, N.J., Samet, J.H., Inconsistent condom use among HIV-infected patients with alcohol problems (2004) Drug Alcohol Depend, 73 (2), pp. 159-166Fortenberry, J.D., Orr, D.P., Katz, B.P., Brizendine, E.J., Blythe, M.J., Sex under the influence. A diary self-report study of substance use and sexual behavior among adolescent women (1997) Sex Transm Dis, 24 (6), pp. 313-319Holmes, K.K., Levine, R., Weaver, M., Effectiveness of condoms in preventing sexually transmitted infections (2004) Bull World Health Organ, 82 (6), pp. 454-461Demographic and behavioral predictors of sexual risk in the NIMH multisite HIV prevention trial (1997) AIDS, 11 (SUPPL. 2), pp. 2-27. , National Institute of Mental Health NIMHPiccolo, F.D., Knauth, D.R., Uso de drogas e sexualidade em tempos de AIDS e redução de danos. (2002) Horiz Antropol, 8 (17), pp. 127-145Rehm, J., Taylor, B., Room, R., Global burden of disease from alcohol, illicit drugs and tobacco (2006) Drug Alcohol Rev, 25 (6), pp. 503-513Room, R., Graham, K., Rehm, J., Jernigan, D., Monteiro, M., Drinking and its burden in a global perspective: Policy considerations and options (2003) Eur Addict Res, 9 (4), pp. 165-175Schor, N., Ferreira, A.F., Machado, V.L., França, A.P., Pirotta, K.C.M., Alvarenga, A.T., Mulher e anticoncepção: Conhecimento e uso de métodos anticoncepcionais. (2000) Cad Saude Publica, 16 (2), pp. 377-384Simbayi, L.C., Kalichman, S.C., Cain, D., Cherry, C., Jooste, S., Mathiti, V., Alcohol and risks for HIV/AIDS among sexually transmitted infection clinic patients in Cape Town, South Africa (2006) Subst Abus, 27 (4), pp. 37-43Souza, C.T., Diaz, T., Sutmoller, F., Bastos, F.I., The association of socioeconomic status and use of crack/cocaine with unprotected anal sex in a cohort of men who have sex with men in Rio de Janeiro, Brazil (2002) J Acquir Immune Defic Syndr, 29 (1), pp. 95-100Strathdee SA, Sherman SG. The role of sexual transmission of HIV infection among injection and non-injection drug users. J Urban Health. 2003;80(4 Suppl 3):iii7-14Szwarcwald, C.L., Bastos, F.I., Gravato, N., Lacerda, R., Chequer, P.N., Castilho, E.A., The relationship of illicit drug consume to HIV-infection among commercial sex workers (CSWs) in the city of Santos, São Paulo, Brazil (1998) Int J Drug Policy, 9 (6), pp. 427-436Vieira, E.M., Badiani, R., Dal Fabbro, A.L., Rodrigues Junior, A.L., Características do uso de métodos anticoncepcionais no Estado de São Paulo. (2001) Rev Saude Publica, 36 (3), pp. 263-270Weiser, S.D., Leiter, K., Heisler, M., McFarland, W., Percy-de Korte, F., DeMonner, A population-based study on alcohol and high-risk sexual behaviors in Botswana (2006) PLoS Med, 3 (10), pp. e392West, R., Addiction, ethics and public policy (1997) Addiction, 92 (9), pp. 1061-107