Clinical and epidemiological features of AIDS/tuberculosis comorbidity

Considering the relevance of AIDS/tuberculosis comorbidity worldwide, especially in Brazil, this study was developed to describe the clinical and epidemiological features of the comorbid cases identified from 1989 to 1997 by the epidemiology service of the Hospital das Clínicas of the Universidade de São Paulo. METHODS: Databases containing information on all identified AIDS/tuberculosis cases cared for at the hospital were used to gather information on comorbid cases. RESULTS: During the period, 559 patients were identified as presenting with AIDS/tuberculosis comorbidity. Risk behavior for AIDS was primarily heterosexual contact (38.9%), followed by intravenous drug use (29.3%) and homosexual/bisexual contact (23.2%). Regarding clinical features, there were higher rates of extrapulmonary tuberculosis when compared to tuberculosis without comorbidity. There was an increase in reporting of AIDS by ambulatory units during the period. Epidemiologically, there was a decrease in the male/female ratio, a predominance in the 20 to 39 year-old age group, and a majority of individuals who had less than 8 years of schooling and had low professional qualifications. CONCLUSIONS: High rates of AIDS/tuberculosis cases at our hospital indicate the need for better attention towards early detection of tuberculosis, especially in its extrapulmonary form. Since the population that attends this hospital tends to be of a lower socioeconomic status, better management of AIDS and tuberculosis is required to increase the rates of treatment adherence and thus lower the social costs.

Impact of alcohol intoxication and withdrawal syndrome on social phobia and panic disorder in alcoholic inpatients

PURPOSE: To investigate the impact of alcohol intoxication and withdrawal on the course of social phobia and panic disorder. METHOD: A group of 41 alcoholic inpatients undergoing detoxification therapy were interviewed using the SCID-I (DSM-IV) and questions to detect fluctuations in the course of social phobia and panic disorder as a function of the different phases in alcohol dependence (intoxication, withdrawal, and lucid interval). RESULTS: Only 1 (2.4%) patient presented panic disorder throughout life, and 9 (21.9%) had panic attacks during alcohol intoxication or during the withdrawal syndrome. Sixteen (39%) alcoholic patients showed social phobia with onset prior to drug use. However, drinking eventually became unable to alleviate social phobia symptoms or worsened such symptoms in 31.2% of social-phobic patients. While patients with social phobia reported a significant improvement in psychiatric symptoms during alcohol intoxication, patients experiencing panic attacks worsened significantly during intoxication. In the withdrawal phase, patients with social phobia tended to have more and more intense phobic symptoms. CONCLUSION: Our findings indicate that the impact of alcohol intoxication is different for social phobia as compared to panic disorder, at first decreasing the social-phobic symptoms but later aggravating them. In panic disorder, the impact of intoxication by alcohol is more harmful, at least in the short term.

Cinco para ouvir: discursos de ex-reclusos/as sobre a Prisão

Dissertação de mestrado integrado em Psicologia

A Brazilian version of the "Children's Interview for Psychiatric Syndromes" (ChIPS)

OBJETIVE: The advance of research in child and adolescent psychiatry in Brazil heavily depends on the existence of instruments for the investigation of psychiatric syndromes adapted to Brazilian Portuguese. METHODS: This article describes a careful process of translation of the Children's Interview for Psychiatric Syndromes for the purpose of use in research in Brazil. The Children's Interview for Psychiatric Syndromes has a version for parents (P-ChIPs) and a version for children (ChIPS). In this article, the sections of P-ChIPS referring to attention-deficit hyperactivity disorder, oppositional-defiant disorder, conduct disorder, mania/hypomania, anorexia nervosa, bulimia nervosa and psychotic disorders were translated to Brazilian Portuguese. The sections of the ChIPS referring to substance use disorders, social anxiety disorder, specific phobias, obsessive-compulsive disorder, generalized anxiety disoder, separation anxiety disorder, post-traumatic disorders and depression/dysthimia were also adapted. Each section was translated by two independent translators and later discussed in a committee composed of experts in the field of Psychiatry and a professional of the field of linguistics. RESULT: A final version containing an interview for the main psychiatric syndromes was defined. CONCLUSION: The translated P-ChIPS is a helpful instrument in children and adolescent clinical evaluation.

Convergent validation study of the Contemplation Ladder for application via telephone in tobacco users

OBJECTIVE: This work was designed to validate the Portuguese version of the Contemplation Ladder, whose purpose is to assess the motivational phase to quit smoking among tobacco users using a telephone service. METHOD: A cross-sectional study was conducted in a nationwide drug use information hotline. In order to assess the convergent validation, the correlation between the Contemplation Ladder and the URICA Scale was calculated, which was previously validated. RESULTS: The study included 271 tobacco users. Statistically significant correlations were found between the Contemplation Ladder scores and the scores of the URICA precontemplation (r=-0.16; p<0.01), action (r=0.15; p<0.01) and maintenance (r=0.18; p<0.01) subscales. The correlation between the URICA Scale compound score and the Contemplation Ladder was also significant (r=0.31; p<0.01). CONCLUSION: The results of our study suggest that the Contemplation Ladder can be an efficient substitute for the URICA scale (whose application lasts at least 20 minutes), without submitting the interviewee to a heavy load of questions. The study presented evidences of convergent validity for the Contemplation Ladder when applied via telephone in tobacco users.

Estudo do autorrelato de adesão e uso problemático de álcool em uma população de indivíduos com AIDS em uso de HAART

OBJETIVO: O objetivo deste estudo foi analisar a força de associação entre as variáveis autorrelato de adesão à medicação e uso problemático de álcool em uma população de indivíduos com AIDS que fazem uso de HAART. MÉTODO: Foram entrevistados 103 pacientes com AIDS, em uso de HAART há pelo menos seis meses, que frequentavam o ambulatório do Instituto de Doenças Tropicais Natan Portela (IDTNP), localizado na cidade de Teresina, PI. A variável independente estudada foi o uso problemático de álcool, além de variáveis sociodemográficas. O questionário utilizado para avaliar o uso problemático de álcool foi o AUDIT (Alcohol Use Disorders Identification Test). A variável dependente avaliada neste estudo foi o autorrelato de adesão ao tratamento para o HIV. Para sua mensuração, optou-se por utilizar o QSAM (Questionário Simplificado de Adesão à Medicação), por tratar-se de um questionário bastante simples e de fácil aplicação. RESULTADOS: A frequência de AUDIT > 08 foi de 33%; já o autorrelato de adesão, avaliado pelo QSAM, foi positivo em 45% da amostra. Testada a associação entre a frequência de QSAM positivo e o AUDIT positivo, encontrou-se forte associação entre essas variáveis (p = 0,004). CONCLUSÃO: Conclui-se deste estudo que o autorrelato de falha na adesão ao HAART aferido por meio do QSAM é um fator de risco para a presença de uso problemático de álcool.

Consumo de álcool por frequentadores de academia de ginástica

Objetivo Como não há na literatura informações sobre o perfil de consumo alcoólico entre desportistas, o objetivo deste trabalho foi avaliar o perfil de consumo alcoólico por frequentadores de academia de ginástica associando com a antropometria e a intensidade do treino. Métodos Foram convidados a participar do estudo indivíduos praticantes de musculação, por no mínimo seis meses, com idade entre 20 e 40 anos, de ambos os sexos. Foram realizadas medidas antropométricas e de composição corporal. Para avaliação do consumo alcoólico, utilizou-se o questionário AUDIT (The Alcohol Use Disorders Identification Test). A intensidade do treino foi identificada por meio de um questionário semiestruturado. Resultados Dos participantes, 74,1% (n = 35) disseram ter feito uso de álcool. Além disso, 19 voluntários (38,8%) apresentaram comportamento de risco para o consumo de álcool (AUDIT ≥ 8). Considerando o consumo alcoólico em binge, 32 voluntários (65,3%) consumiram seis ou mais doses de álcool em alguma ocasião no ano anterior, não havendo diferença entre os sexos. A adiposidade corporal estava acima dos valores recomendados entre os que relataram consumo em binge. Não houve associação entre a intensidade do treinamento físico e o consumo de álcool em binge, nem entre a intensidade do treinamento e o comportamento de risco para o consumo de álcool. Conclusão A maioria dos desportistas apresentou consumo de bebidas alcoólicas no padrão binge, não sendo associado à intensidade do treinamento. Este não condiz com os seus objetivos ao frequentar academias de ginástica. A adiposidade corporal estava acima dos valores recomendados.

Estudo transversal sobre o uso de risco de álcool em uma amostra de estudantes de uma universidade federal brasileira

Objetivo Avaliar o padrão de consumo de álcool entre estudantes de uma universidade federal brasileira que faz parte do Programa de Apoio a Planos de Reestruturação e Expansão das Universidades Federais (REUNI) e identificar os grupos mais expostos a problemas relacionados ao uso de álcool e fatores associados. Métodos Caracteriza-se como um estudo descritivo, quantitativo e de delineamento transversal no qual se aplicou um questionário de caracterização sociodemográfica e o The Alcohol Use Disorders Identification Test (AUDIT) em 787 estudantes universitários de uma universidade federal brasileira. Resultados Entre os estudantes, 82,9% se enquadraram no grupo que faz consumo de baixo risco e 17,1%, no grupo que faz um consumo de risco. A análise de correspondência detectou que os estudantes do gênero masculino, os que não possuíam religião, que praticavam atividade física esporadicamente e que residiam em repúblicas se caracterizaram como pertencentes ao grupo de risco em relação ao consumo de álcool. Conclusões Os resultados indicam predominância de consumo de álcool de baixo risco entre os estudantes e sugerem uma relação entre consumo de álcool de maior risco e gênero masculino, não possuir religião, praticar atividade física esporadicamente e residir em repúblicas. Essas informações devem ser consideradas em programas preventivos no ambiente universitário.

Perfil do consumo de álcool de usuários de uma unidade de Atenção Primária à Saúde

Objetivo Descrever o perfil de consumo de álcool de usuários adultos de uma unidade de Atenção Primária à Saúde, segundo características sociodemográficas. Métodos Inquérito domiciliar desenvolvido com usuários de uma unidade de Atenção Primária à Saúde na cidade do Rio de Janeiro, Brasil. Em 2010, amostra de 301 indivíduos respondeu a um instrumento de coleta que continha o Alcohol Use Disorders Identification Test e variáveis de caracterização sociodemográfica. Análises univariadas com distribuição de frequências simples e bivariadas com diferenças avaliadas pelo teste X2 e pelo teste exato de Fisher foram conduzidas, considerando-se um nível de significância de 0,05. Resultados O consumo de álcool de pessoas do sexo masculino, jovens, de baixa escolaridade, não casadas, empregadas e sem religião mostrou-se mais perigoso para a saúde. Conclusão Ações preventivas em saúde voltadas para o controle do consumo abusivo de álcool devem estar dirigidas para os grupos mais vulneráveis. É importante enfatizar ações de promoção à saúde de forma a evitar a iniciação e a manutenção de consumo perigoso de álcool, bem como sua evolução para casos de dependência.

Effects of propranolol on the QT dispersion in congestive heart failure

OBJECTIVE - Studies have shown that therapy with beta-blockers reduces mortality in patients with heart failure. However, there are no studies describing the effects of propranolol on the QT dispersion in this population. The objective of this study was to assess the electrophysiological profile, mainly QT dispersion, of patients with heart failure regularly using propranolol. METHODS - Fifteen patients with heart failure and using propranolol were assessed over a period of 12 months. Twelve-lead electrocardiograms (ECG) were recorded prior to the onset of beta-blocker therapy and after 3 months of drug use. RESULTS - A significant reduction in heart rate, in QT dispersion and in QTc dispersion was observed, as was also an increase in the PR interval and in the QT interval, after the use of propranolol in an average dosage of 100 mg/day. CONCLUSION - Reduction in QT dispersion in patients with heart failure using propranolol may explain the reduction in the risk of sudden cardiac death with beta-blocker therapy, in this specific group of patients.

Velhas e novas drogas: impactos da toxicodependência: estudo de caso na cidade de Braga

Dissertação de mestrado em Sociologia (área de especialização em Organizações e Trabalho)

Post-Acute Coronary Syndrome Alcohol Abuse: Prospective Evaluation in the ERICO Study

Background:Some studies have indicated alcohol abuse as one of the contributors to the development of cardiovascular disease, particularly coronary heart disease. However, this relationship is controversial.Objective:To investigate the relationship between post-acute coronary syndrome (ACS) alcohol abuse in the Acute Coronary Syndrome Registry Strategy (ERICO Study).Methods:146 participants from the ERICO Study answered structured questionnaires and underwent laboratory evaluations at baseline, 30 days and 180 days after ACS. The Alcohol Use Disorders Identification Test (AUDIT) was applied to assess harmful alcohol consumption in the 12 months preceding ACS (30 day-interview) and six months after that.Results:The frequencies of alcohol abuse were 24.7% and 21.1% in the 12 months preceding ACS and six months after that, respectively. The most significant cardiovascular risk factors associated with high-risk for alcohol abuse 30 days after the acute event were: male sex (88.9%), current smoking (52.8%) and hypertension (58.3%). Six months after the acute event, the most significant results were replicated in our logistic regression, for the association between alcohol abuse among younger individuals [35-44 year-old multivariate OR: 38.30 (95% CI: 1.44-1012.56) and 45-54 year-old multivariate OR: 10.10 (95% CI: 1.06-96.46)] and for smokers [current smokers multivariate OR: 51.09 (95% CI: 3.49-748.01) and past smokers multivariate OR: 40.29 (95% CI: 2.37-685.93)].Conclusion:Individuals younger than 54 years and smokers showed a significant relation with harmful alcohol consumption, regardless of the ACS subtype.

Influence of Smoking Consumption and Nicotine Dependence Degree in Cardiac Autonomic Modulation

Abstract Background: Smoking consumption alters cardiac autonomic function. Objective: Assess the influence of the intensity of smoking and the nicotine dependence degree in cardiac autonomic modulation evaluated through index of heart rate variability (HRV). Methods: 83 smokers, of both genders, between 50 and 70 years of age and with normal lung function were divided according to the intensity of smoking consumption (moderate and severe) and the nicotine dependency degree (mild, moderate and severe). The indexes of HRV were analyzed in rest condition, in linear methods in the time domain (TD), the frequency domain (FD) and through the Poincaré plot. For the comparison of smoking consumption, unpaired t test or Mann-Whitney was employed. For the analysis between the nicotine dependency degrees, we used the One-way ANOVA test, followed by Tukey's post test or Kruskal-Wallis followed by Dunn's test. The significance level was p < 0,05. Results: Differences were only found when compared to the different intensities of smoking consumption in the indexes in the FD. LFun (62.89 ± 15.24 vs 75.45 ± 10.28), which corresponds to low frequency spectrum component in normalized units; HFun (37.11 ± 15.24 vs 24.55 ± 10.28), which corresponds to high frequency spectrum component in normalized units and in the LF/HF ratio (2.21 ± 1.47 vs 4.07 ± 2.94). However, in the evaluation of nicotine dependency, significant differences were not observed (p > 0.05). Conclusion: Only the intensity of smoking consumption had an influence over the cardiac autonomic modulation of the assessed tobacco smokers. Tobacco smokers with severe intensity of smoking consumption presented a lower autonomic modulation than those with moderate intensity.

Percepción de riesgo, estrés y consumo de drogas. Estudio transcultural entre adolescentes de Barcelona y Bogotá

Este estudio explora las diferencias en los hábitos de consumo de sustancias psicoactivas, entre jóvenes de Barcelona y Bogotá. Evalúa la influencia de la percepción de riesgo sobre hábitos de consumo y estrategias de afrontamiento. Adicionalmente examina la influencia de la gravedad percibida de una situación estresante sobre estas últimas. Participaron 865 jóvenes de ambas ciudades, entre los 15 y los 18 años. Se utilizaron las variables de riesgo estudiadas por Benthin, Slovic y Severson (1993) para evaluar la percepción de riesgo. Los hábitos de consumo se evaluaron mediante la frecuencia, la intención de consumo, así como la edad de inicio. Se utilizó el CRI:Youth de Moos (1992) para determinar las estrategias de afrontamiento y la valoración del problema estresante. Se encontró que existen diferencias en la edad en que se inicia el consumo de alcohol y en la que se embriagan por primera vez según el género, la ciudad donde residen y la edad del adolescente. Los jóvenes de Barcelona tienen una propensión y un consumo real de marihuana y tabaco mayor que los jóvenes de Bogotá. Percibir placer o beneficios predice un incremento en la intención y la frecuencia de consumo de la mayoría de las sustancias. La facilidad para acceder a éstas sólo presenta una asociación con el uso frecuente del tabaco. Los datos sugieren que la gravedad percibida de estresores relativos a las drogas y la ciudad de residencia tienen un efecto sobre la utilización de las estrategias de evitación y aproximación cognitiva. Adicionalmente no se detectaron diferencias en función de las estrategias de afrontamiento empleadas según las variables de percepción de riesgo a excepción de la presión percibida, la cual aumenta el uso de la reevaluación del problema y la búsqueda de recompensas.

Morbidity and aging in HIV-infected persons: the Swiss HIV cohort study.

BACKGROUND: Patterns of morbidity and mortality among human immunodeficiency virus (HIV)-infected individuals taking antiretroviral therapy are changing as a result of immune reconstitution and improved survival. We studied the influence of aging on the epidemiology of non-AIDS diseases in the Swiss HIV Cohort Study. METHODS: The Swiss HIV Cohort Study is a prospective observational cohort established in 1988 with continuous enrollment. We determined the incidence of clinical events (per 1000 person-years) from January 2008 (when a new questionnaire on non-AIDS-related morbidity was introduced) through December 2010. Differences across age groups were analyzed using Cox regression, adjusted for CD4 cell count, viral load, sex, injection drug use, smoking, and years of HIV infection. RESULTS: Overall, 8444 (96%) of 8848 participants contributed data from 40,720 semiannual visits; 2233 individuals (26.4%) were aged 50-64 years, and 450 (5.3%) were aged ≥65 years. The median duration of HIV infection was 15.4 years (95% confidence interval [CI], 9.59-22.0 years); 23.2% had prior clinical AIDS. We observed 994 incident non-AIDS events in the reference period: 201 cases of bacterial pneumonia, 55 myocardial infarctions, 39 strokes, 70 cases of diabetes mellitus, 123 trauma-associated fractures, 37 fractures without adequate trauma, and 115 non-AIDS malignancies. Multivariable hazard ratios for stroke (17.7; CI, 7.06-44.5), myocardial infarction (5.89; 95% CI, 2.17-16.0), diabetes mellitus (3.75; 95% CI, 1.80-7.85), bone fractures without adequate trauma (10.5; 95% CI, 3.58-30.5), osteoporosis (9.13; 95% CI, 4.10-20.3), and non-AIDS-defining malignancies (6.88; 95% CI, 3.89-12.2) were elevated for persons aged ≥65 years. CONCLUSIONS: Comorbidity and multimorbidity because of non-AIDS diseases, particularly diabetes mellitus, cardiovascular disease, non-AIDS-defining malignancies, and osteoporosis, become more important in care of HIV-infected persons and increase with older age.