Pontos positivos e negativos observados em uma experiência prática com pares educativos em prevenção de aids numa escola secundária em São Paulo, Brasil

Peer education is an important educational tool used internationally presenting good ratings of its effectiveness. This article aims to understand the implementation process of Peer Education as a Brazilian’s Prevention Program rolled in a model periphery São Paulo’s school among its students during 2003 and 2004. This study was enrolled into phases: Identification of the main problems facing the school to the epidemic HIV / AIDS, to elaborate and apply a questionnaire on 115 students, and implementation of workshops on safe sex. They were then highlighted the strengths and weakness of the process. As strengths highlighted are: development of the supplement to the questionnaire, acceptance of the materials used in workshops and routines adopted with emphasis on the use of condoms. As weakness highlighted are: resistance from school imposing limits in the process, obstruction in the inclusion of questions in the questionnaire, indication of peer education and lack of time for their staff.Pares educativos são uma importante ferramenta educativa utilizada internacionalmente com boas avaliações na eficácia. O presente estudo tem por objetivo avaliar o processo de implantação de pares educativos como programa de prevenção em uma escola modelo da periferia de São Paulo, com alunos de ensino médio, no período de 2003 a 2004. O trabalho foi aplicado em fases: identificação dos principais problemas frente à epidemia HIV/aids naquela escola, elaboração e aplicação de um questionário em 115 alunos e realização de quatro oficinas de sexo seguro. Na implantação desse processo foram destacados os principais pontos positivos e negativos. Como pontos positivos destacaram-se: elaboração do questionário, aceitação de materiais didáticos utilizados nas oficinas. Como pontos negativos destacaram-se: resistência da escola impondo limites no processo; obstrução na inserção do problema principal desta escola no questionário, indicação dos pares educativos e falta de tempo dos funcionários

HIV infection among pregnant women attended in testing and counseling centers for AIDS

OBJETIVO: Estimar a prevalência do HIV e identificar comportamentos sexuais de risco para a infecção em gestantes que realizaram rotina da assistência pré-natal. MÉTODOS: Estudo transversal com base em registros de atendimentos de 8.002 gestantes (25% do total dos municípios) residentes em 27 municípios da Região Sul do Brasil, em 2003, que realizaram testes anti-HIV em Centro de Testagem e Aconselhamento que realizavam pré-natal. Foram coletadas informações sociodemográficas e comportamentais, além dos resultados de testes para sífilis e HIV, nas consultas de aconselhamento individual registradas em banco de dados do Sistema de Informações dos Centros de Testagem e Aconselhamento. Foram excluídas da base de dados as gestantes que buscaram os Centros para confirmação de sorologia anterior e aquelas encaminhadas ao serviço por apresentarem sintomas de Aids. RESULTADOS: Do total de gestantes estudadas, 0,5% (IC 95%=0,3-0,6) foram positivas para o HIV. A única variável associada com a soropositividade para o HIV foi o nível de escolaridade. A maioria das gestantes se expôs basicamente por meio de relações sexuais sem preservativos com o parceiro único com quem mantinham relação estável. As gestantes mais jovens, solteiras, desempregadas e de menor escolaridade constituíram o grupo de maior exposição. CONCLUSÕES: O Sistema de Informações dos Centros de Testagem e Aconselhamento revelou-se útil à vigilância epidemiológica da infecção pelo HIV e dos comportamentos de risco no segmento de gestantes e pode vir a sê-lo em relação a outras populações. __________________________________________________________________________________________________________________ ABSTRACTOBJECTIVE: To estimate HIV prevalence and identify high-risk sexual behavior for infection in pregnant women who were given prenatal assistance. METHODS: Cross-sectional study based on attendance records of 8,002 pregnant women (25% of all municipalities) who lived in 27 municipalities in Southern Brazil in 2003 and had anti-HIV tests done in a testing and counseling center that performed prenatal assistance. Sociodemographic and behavioral data were gathered, as well as syphilis and HIV test results, during the individual counseling sessions registered in the data bank of the Sistema de Informações dos Centros de Testagem e Aconselhamento (Information System on Testing and Counseling Centers). Women who sought the centers for confirmation of previous serology or were referred to this service due to the presence of AIDS symptoms were excluded from the data base. RESULTS: A total of 0.5% of all the pregnant women analyzed (CI 95%=0.3;0.6) were HIV positive. The only variable associated with HIV seropositivity was schooling. The majority of them were basically exposed through unprotected sexual intercourse with the only partner they had a steady relationship with. Younger pregnant women who were single, unemployed and had lower level of education constituted the group with highest exposure. CONCLUSIONS: The Sistema de Informações dos Centros de Testagem e Aconselhamento turned out to be useful for the epidemiological surveillance of HIV infection and high-risk behavior among pregnant women and could also be useful as regards other populations

Potential biases in the classification, analysis and interpretations in cross-sectional study: commentaries – surrounding the article "resting heart rate: its correlations and potential for screening metabolic dysfunctions in adolescents"

Abstract\ud \ud Background\ud Resting heart rate reflects sympathetic nerve activity. A significant association between resting heart rate (HR) and all causes of cardiovascular mortality has been reported by some epidemiologic studies. Despite suggestive evidence, resting heart rate (RHR) has not been formally explored as a prognostic factor and potential therapeutic outcome and, therefore, is not generally accepted in adolescents.\ud \ud \ud Discussion\ud The core of the debate is the methodological aspects used in "Resting heart rate: its correlations and potential for screening metabolic dysfunctions in adolescents"; the points are: cutoff used for cluster RHR, two different statistical models used to analyze the same set of variables, one for continuous data, and another for categorical data; interpretation of p-value < 0.05, sampling process involving two random stages, analysis of design effect and the parameters of screening tests.\ud \ud \ud Summary\ud Aspects that must be taken into account for evaluation of a screening test to measure the potential for discrimination for a common variable (population with outcome vs. no outcome population), the main indicators are: sensitivity, specificity, accuracy, positive predictive value and negative predictive value. The measures of argumentation equality (CI) or difference (p-valor) are important to validate these indicators but do not indicate quality of screening

Infecção pelo HIV entre gestantes atendidas nos centros de testagem e aconselhamento em Aids

OBJECTIVE: To estimate HIV prevalence and identify high-risk sexual behavior for infection in pregnant women who were given prenatal assistance. METHODS: Cross-sectional study based on attendance records of 8,002 pregnant women (25% of all municipalities) who lived in 27 municipalities in Southern Brazil in 2003 and had anti-HIV tests done in a testing and counseling center that performed prenatal assistance. Sociodemographic and behavioral data were gathered, as well as syphilis and HIV test results, during the individual counseling sessions registered in the data bank of the Sistema de Informações dos Centros de Testagem e Aconselhamento (Information System on Testing and Counseling Centers). Women who sought the centers for confirmation of previous serology or were referred to this service due to the presence of AIDS symptoms were excluded from the data base. RESULTS: A total of 0.5% of all the pregnant women analyzed (CI 95%=0.3;0.6) were HIV positive. The only variable associated with HIV seropositivity was schooling. The majority of them were basically exposed through unprotected sexual intercourse with the only partner they had a steady relationship with. Younger pregnant women who were single, unemployed and had lower level of education constituted the group with highest exposure. CONCLUSIONS: The Sistema de Informações dos Centros de Testagem e Aconselhamento turned out to be useful for the epidemiological surveillance of HIV infection and high-risk behavior among pregnant women and could also be useful as regards other populations.OBJETIVO: Estimar a prevalência do HIV e identificar comportamentos sexuais de risco para a infecção em gestantes que realizaram rotina da assistência pré-natal. MÉTODOS: Estudo transversal com base em registros de atendimentos de 8.002 gestantes (25% do total dos municípios) residentes em 27 municípios da Região Sul do Brasil, em 2003, que realizaram testes anti-HIV em Centro de Testagem e Aconselhamento que realizavam pré-natal. Foram coletadas informações sociodemográficas e comportamentais, além dos resultados de testes para sífilis e HIV, nas consultas de aconselhamento individual registradas em banco de dados do Sistema de Informações dos Centros de Testagem e Aconselhamento. Foram excluídas da base de dados as gestantes que buscaram os Centros para confirmação de sorologia anterior e aquelas encaminhadas ao serviço por apresentarem sintomas de Aids. RESULTADOS: Do total de gestantes estudadas, 0,5% (IC 95%=0,3-0,6) foram positivas para o HIV. A única variável associada com a soropositividade para o HIV foi o nível de escolaridade. A maioria das gestantes se expôs basicamente por meio de relações sexuais sem preservativos com o parceiro único com quem mantinham relação estável. As gestantes mais jovens, solteiras, desempregadas e de menor escolaridade constituíram o grupo de maior exposição. CONCLUSÕES: O Sistema de Informações dos Centros de Testagem e Aconselhamento revelou-se útil à vigilância epidemiológica da infecção pelo HIV e dos comportamentos de risco no segmento de gestantes e pode vir a sê-lo em relação a outras populações

Skipping breakfast is associated with adiposity markers especially when sleep time is adequate in adolescents

Adolescence is a critical stage of development and has an important influence on energy balancerelated behaviours (EBRBs). When adolescents are associated with obesity it can lead to increased cardiometabolic risk. Here we assess if EBRBs adopted by adolescents included in a subsample are associated with markers of total and abdominal adiposity in a multicentre European study, Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA-CSS) and a Brazilian study, Brazilian Cardiovascular Adolescent Health (BRACAH study), and whether sleep duration influence the association between skipping breakfast, physical activity and sedentary behaviours, with total and abdominal obesity (AO). Multilevel linear regression models using fixed and random intercepts were used to analyse the association between markers of obesity and EBRBs. Skipping breakfast was the prevalent behaviour in association with obesity among European and Brazilian boys besides European girls, even after stratification by sleep time. Moreover, European boys who slept properly and skipped breakfast had an increased waist circumference (WC), while body mass index (BMI) increased in Brazilian boys. Among Brazilian boys less sleep was protective for total obesity (β = −0.93 kg/m2; 95% CI: −1.80; −0.07). European girls when they were more sedentary, showed an increase in WC, especially for those who reported they slept adequately. Skipping breakfast was associated with total and AO in adolescents independent of sleep duration.The HELENA-CSS took place with the financial support of the European Community Sixth RTD Framework Program (contract FOOD-CT-2005-007034). This study was also supported by a grant from the Spanish Ministry of Health: Maternal, Child Health and Development Network (numberRD08/0072) and grants from the Spanish Ministry of Education (EX-2008-0641) and the Swedish Heart-Lung Foundation (20090635). And supported by grants from the Spanish Ministry of Science and Innovation (JCI-2010-07055 and RYC-2010-05957). The authors thanked for the contribution of the HELENA Study Group. We are grateful for the financial support to the authors: Dr. Elsie C. O. Forkert was given a post-doctoral schoolarship from the Sao Paulo Research Foundation FAPESP (proc.2018/02887-6). Dr. Augusto César F. De Moraes was given a post-doctoral scholarship from the National Council for Scientific and Technological Development (CNPq: proc. 313772/2014-2) and the São Paulo Research Foundation FAPESP (proc. 2014/13367-2 and 2015/14319-4). Full Prof. Luis A. Moreno was given a scholarship of a visiting professor from São Paulo Research Foundation FAPESP (proc. 2015/11406-3). Dr Prof Heráclito B Carvalho is in receipt of an advanced scientist scholarship from the National Council for Scientific and Technological Development (CNPq: proc. 300951/2015-9)

Sampling and processing blood samples within the South American Youth/Child cARdiovascular and Environmental (SAYCARE) Study

Obesity and overweight in children and adolescents is increasing rapidly worldwide; however, scarce data have been reported from South America countries. With the purpose of assessing hyperlipidemia, insulin resistance and chronic inflammation, the evaluation of blood biomarkers such as glucose, lipoproteins and chronic inflammation proteins is required. In the context of the SAYCARE study, in children and adolescents (3 to 18 years) from seven South American cities, our aim was to assess the impact of pre analytical conditions on different biomarkers evaluated in 474 fresh serum samples, in different country centers. We also evaluated the stability according to time and frozen storage within this study across the concordance of the results obtained from the 49 blood samples measured in three different centers. Significant correlations as well as concordance were observed in TG, Total-C, HDL-C and glucose between Buenos Aires and São Paulo. The samples evaluated in Teresina and São Paulo presented similar results, with exception of total cholesterol. We observed acceptable concordance between Buenos Aires vs São Paulo and Teresina vs São Paulo, suggesting that samples could be processed in each of these centers. This concordance is a consequence of the strict pre analytical conditions previously established in the SAYCARE study

Association between mode of delivery and maternal complications in a public hospital in Greater Metropolitan São Paulo, Brazil

O estudo objetivou avaliar associação entre via de parto e complicações maternas. Realizou-se coorte retrospectiva com partos ocorridos durante o ano de 2003, em um hospital público. As complicações avaliadas foram: infecção, hemorragia, histerectomia, rotura uterina, lesão de órgão contíguo, trombose venosa profunda e embolia pulmonar. Utilizou-se a odds ratio (OR) e os testes de qui-quadrado de Pearson e de Fisher, além da regressão logística. Estabeleceu-se o nível de 0,05 como significante. Foram encontradas 15 complicações. Tomando-se o parto vaginal como referência, encontrou-se associação entre cesárea e as complicações tomadas em conjunto. Analisando-se variáveis confundidoras, encontrou-se associação das complicações com hipertensão, soropositividade para HIV, placenta prévia e descolamento prematuro de placenta. Após controle para estas quatro variáveis, manteve-se a associação entre cesárea e complicações (OR = 9,7; p = 0,04). Encontrou-se também associação entre complicações e cesárea eletiva comparada ao parto vaginal (OR = 4,7; p = 0,02), e maior proporção de complicações, no limite da significância estatística, nas cesáreas eletivas comparadas à "tentativa de parto vaginal" (OR = 3; p = 0,058). Conclui-se que a cesárea associa-se a complicações maternas, mesmo após a realização de vários ajustes.The purpose of this study was to assess the relationship between mode of delivery and maternal complications, based on a retrospective cohort of all births at a public hospital in 2003. Complications included: infection, hemorrhage, hysterectomy, uterine rupture, lesions in adjacent organs, deep venous thrombosis, and pulmonary embolism. The analysis used odds ratio (OR), chi-squared test, and Fisher's exact test, besides logistic regression. Fifteen complications were identified. Taking vaginal delivery as the reference, an association was found between cesarean section and overall complications. Analysis of confounding showed an association between hypertension, HIV, placenta previa, and abruptio placentae. After controlling for these variables, an association remained between overall complications and cesarean section (OR = 9.7; p = 0.04). Another analysis comparing elective cesareans and vaginal deliveries also showed an increased risk for cesarean (OR = 4.7; p = 0.02). Finally, comparing elective cesareans with trial of labor, we found an increased proportion of complications in elective cesareans, with borderline significance (OR = 3; p = 0.058). We concluded that cesarean section is associated with maternal morbidity, even after controlling for confounders

Reliability and validity of an FFQ for South American children and adolescents from the SAYCARE study

Objective:The purpose of this study was to analyse the reliability and validity of a semi-quantitative FFQ to assess food group consumption in South American children and adolescents.Design:The SAYCARE (South American Youth/Child cARdiovascular and Environmental) study is an observational, multicentre, feasibility study performed in a sample of 3-to 18-year-old children and adolescents attending private and public schools from six South American countries. Participants answered the FFQ twice with a two-week interval and three 24-h dietary recalls. Intraclass and Spearman''s correlations, weighted Cohen''s kappa (¿w), percentage of agreement and energy-adjusted Pearson''s correlation coefficients were calculated.Setting:Seven cities in South America (Buenos Aires, Lima, Medelin, Montevideo, Santiago, Sao Paulo and Teresina).Subjects:A sample of 200 children and 244 adolescents for reliability analyses and 252 children and 244 adolescents for validity analyses were included.Results:Depending on the food group, for children and adolescents, reliability analyses resulted in Spearman''s coefficients from 0·47 to 0·73, intraclass correlation coefficients from 0·66 to 0·99, ¿w coefficients from 0·35 to 0·63, and percentage of agreement between 72·75 and 83·52 %. In the same way, validity analyses resulted in Spearman''s coefficients from 0·17 to 0·37, energy-adjusted Pearson''s coefficients from 0·17 to 0·61, ¿w coefficients from 0·09 to 0·24, and percentages of agreement between 45·79 and 67·06 %.Conclusion:The SAYCARE FFQ achieved reasonable reliability and slight-moderate validity for almost all food groups intakes. Accordingly, it can be used for the purpose of ranking the intake of individuals within a population

Reliability and validity of a questionnaire for physical activity assessment in South American children and adolescents: The SAYCARE Study

ABSTRACT: The objective of this article is to test the reliability and validity of the new and innovative physical activity (PA) questionnaire. Methods: Subsamples from the South American Youth/Child Cardiovascular and Environment Study (SAYCARE) study were included to examine its reliability (children: n 5 161; adolescents: n 5 177) and validity (children: n 5 82; adolescents: n 5 60). The questionnaire consists of three dimensions of PA (lei-sure, active commuting, and school) performed during the last week. To assess its validity, the subjects wore accelerometers for at least 3 days and 8 h/d (at least one weekend day). The reliability was analyzed by correlation coefficients. In addition, Bland-Altman analysis and a multilevel regression were applied to estimate the measurement bias, limits of agreement, and influence of contextual variables. Results: In children, the questionnaire showed consistent reliability (q 5 0.56) and moderate validity (q 5 0.46), and the contextual variable variance explained 43.0% with 222.9 min/d bias. In adolescents, the reliability was higher (q 5 0.76) and the validity was almost excellent (q 5 0.88), with 66.7% of the variance explained by city level with 16.0 min/d PA bias. Conclusions: The SAYCARE PA questionnaire shows acceptable (in children) to strong (in adolescents) reliability and strong validity in the measurement of PA in the pediatric population from low- to middle-income countries

Vitamins and iron blood biomarkers are associated with blood pressure levels in European adolescents. The HELENA study

[Objectives]: Previous research showed that low concentration of biomarkers in the blood during adolescence (i.e., iron status; retinol; and vitamins B6, B12, C, and D) may be involved in the early stages of development of many chronic diseases, such as hypertension. The aim was to evaluate if iron biomarkers and vitamins in the blood are associated with blood pressure in European adolescents.[Methods]: Participants from the Healthy Lifestyle in Europe by Nutrition in Adolescence cross-sectional study (N = 1089; 12.5–17.5 y; 580 girls) were selected by complex sampling. Multilevel linear regression models examined the associations between iron biomarkers and vitamins in the blood and blood pressure; the analyses were stratified by sex and adjusted for contextual and individual potential confounders.[Results]: A positive association was found in girls between RBC folate concentration and systolic blood pressure (SBP) (β = 3.19; 95% confidence interval [CI], 0.61–5.77), although no association between the vitamin serum biomarkers concentrations and diastolic blood pressure (DBP) was found. In boys, retinol was positively associated with DBP (β = 3.84; 95% CI, 0.51–7.17) and vitamin B6 was positively associated with SBP (β = 3.82; 95% CI, 1.46–6.18). In contrast, holotranscobalamin was inversely associated with SBP (β = −3.74; 95% CI, −7.28 to −0.21).[Conclusions]: Levels of RBC folate and vitamin B6 in blood may affect BP in adolescents. In this context, programs aimed at avoiding high BP levels should promote healthy eating behavior by focusing on the promotion of vegetable proteins and foods rich in vitamin B12 (i.e., white meat and eggs), which may help to achieve BP blood control in adolescents.The HELENA Study was financially support by the European Community SixthRTD Framework Programme (contract FOOD-CT-2005-007034). The writing group takes sole responsibility for the content of this article. This study was also supported by a grant from the Spanish Ministry of Health: Maternal, Child Health and Development Network (number RD08/0072), grant from the Spanish Ministry of Education (EX-2008-0641; AP-2008-03806) and the Swedish Heart-Lung Foundation (20090635). ACdeM received scholarship from S~ao PauloResearch FoundationdFAPESP (proc. 2011/11137-1 and 2011/20662-2). LAM received scholarship of visiting professor from the Brazilian government by Science without Borders Program by CNPq (National Counsel of Technological and Scientific Development) and CAPES (Coordination of Improvement of Higher Education Personnel) (proc. 007/2012). The GENUD Research Group cofinancedby the European Regional Development Fund (MICINN-FEDER)Peer reviewe