Daniela Benzano Bumaguin

Highly reported prevalence of drinking and driving in Brazil: data from the first representative household study

OBJECTIVE Brazil lacks information about driving under the influence of alcohol (DUI) originated from representative samples obtained from the general population. METHOD 333 subjects with a valid drivers license and drinking in the last 12 months were drawn from a multistaged sample of 2,346 adults from the first Brazilian Household Survey of Patterns of Alcohol Use. A multivariate analysis was conducted to understand the associations between risk factors and driving after drinking three or more drinks. RESULTS the overall DUI prevalence reported in the sample was 34.7% - 42.5% among males and 9.2% among females. Being male (OR = 6.0, 95% CI 2.9-12.6), having a previous DUI accident (OR = 7.9, 95% CI 2.5-24.9), binging in the last year (OR = 2.2, 95% CI 1.03-4.5) and having an unfavorable opinion towards policies (OR = 2.9, 95% CI 1.4-6.2) remained associated with heavy drinking and driving after model adjustments. DISCUSSION This was the first study evaluating driving under the influence of alcohol in a representative sample of the Brazilian population. The prevalence of DUI found is alarming, and possibly underestimated in the sample. Results demonstrate the need for more studies on this association and show directions towards preventive strategies for the specific high-risk group of male drivers with previous problems with alcohol and unfavorable opinions about prevention policies.

HIV seroprevalence among drug users: an analysis of selected variables based on 10 years of data collection in Porto Alegre, Brazil.

Data from five studies were pooled to describe associations between drug use and HIV. The Risk Assessment. Battery in Porto Alegre, Brazil, was used to collect data from 1449 subjects in 5 separate studies conducted between 1995 and 2004. The subjects were divided into categories based on their pattern of drug use: (1) injection drug users (IDUs), (2) crack smokers, (3) frequent drug users, and (4) infrequent cocaine/alcohol/marijuana users. The sample consisted primarily of young males with low education and income levels. Half of the subjects reported frequent condom use, and exchanges involving drugs, sex, and money were infrequent (although more common in groups 1 and 2). The overall seroprevalence was 20.6%, and the prevalence was different across the four groups, showing a linear decrease from group 1 (57.1%) to group 4 (11.7%). The IDU and crack-smoking groups showed similarities in their risk levels when compared with the other two groups, and individuals in group 1, 2, and 3 were more likely to report having had four or more sex partners. After controlling for all other risk factors, IDU, males having sex with males, and crack use were highly associated with HIV (OR 7.30, 95% CI: 5.10.10.40; OR 3.04, 95%CI: 1.89,4.80; OR 2.03, 95%CI: 1.40, 2.92, respectively). The findings confirm that poverty, low education, and IDU remain risk factors for HIV in Porto Alegre, Brazil, and the study identities crack smoking as a new risk factor.

Brazilian female crack users show elevated serum aluminum levels

OBJECTIVE There is no information in the literature on the impact of crack smoking using crushed aluminum cans as makeshift pipes, a common form of crack use in Brazil. Since aluminum intake is associated with neurological damage, we measured serum aluminum levels in crack smokers. The objective of this study was to ascertain the levels of aluminum in crack users who smoke on makeshift aluminum pipes. METHOD 71 female crack smokers, their mean age being 28.0 (+/- 7.7), provided information about their drug use, and had blood samples tested for serum aluminum level. RESULTS 56 (79%) subjects smoked crack from crushed can pipes, while 15 (21%) smoked from other containers. Fifty-two (73.2%) out of the 71 subjects presented a serum aluminum level of 2 microg/l and 13 (18.3%) had a serum aluminum level of 6 microg/l cut-off point, which is above the reference value. When compared to non-drug users matched by their mean age and gender, they had similar median values and interquartile ranges for serum aluminum level [3 (2-4.6) for crack smokers; 2.9 (1.6-4.1) for controls], but with different means and standard deviations (4.7 +/- 4.9 and 2.9 +/- 1.7, respectively). DISCUSSION Crack smokers have high serum aluminum level, but we are unsure of its complete association with aluminum cans. Further studies are needed. If such association is proven true in future research, further issues will be raised in dealing with this important disorder, including proper planning and evaluation of public health policies in this area.

Age of Sexual Initiation, Psychiatric Symptoms, and Sexual Risk Behavior among Ecstasy and LSD Users in Porto Alegre, Brazil: A Preliminary Analysis

Ecstasy and LSD use is widespread in large Brazilian cities, but there is limited information on their use among young, middle-class, club goers in Brazil. We conducted standardized face-to-face interviews with 200 male and female ecstasy and/or LSD users, focusing on drug use and sexual history, current risk behaviors, and psychiatric symptomatology. Participants with early sexual debut (before 14) were more likely to report lifetime use of marijuana and powder and crack cocaine than those with later sexual initiation. Early sexual debut was associated with past year sexual risk behaviors, including having sex while high (Prevalence Ratio (PR)=1.3), having two or more sex partners (PR=1.3), as well as history of sexual abuse (PR=13.6). Depression and anxiety scores were similar by age of sexual initiation. The implications of these findings are discussed.

Maternal syphilis and accomplishing sexual partner treatment: still a huge gap:

Congenital syphilis (CS) is a preventable epidemic disease for which control is hindered by socioeconomic and health system issues. Inadequately treated maternal syphilis (MaS) commonly has serious adverse obstetric outcomes. This study – which is a cross-sectional study in a Brazilian large urban public Mother and Child hospital, making use of secondary data – evaluated the occurrence of treatment of sexual partners (SP) among women with MaS. The results showed that 771 MaS cases were identified from 2007 to 2014. No information on SP treatment was available in 570 (73.9%) cases. Of the 201 cases presenting information, 25 (12.4%) SP were treated. Out of 164 women having six or more prenatal visits, 25 (15.2%) SP received treatment. Data analyzed biennially have shown a growing trend of cases without collected information, ranging from 27.2% in 2007–2008 to 87.5% in 2013–2014. No linear trend in proportions of treated SP (maximum 7.4% SP treated) was found. Thus, in this study, it has been concluded that the proportion of SP adequately treated was consistently low, and the quality of information deteriorated during the studied period. Prenatal care per se, as provided, was not effective in delivering adequate treatment of SP. Creative integrated services with SP active participation are greatly needed if CS is to be controlled.

Clinical signs of alcohol intoxication as markers of refusal to provide blood alcohol readings in emergency rooms: an exploratory study

Literature on alcohol and injury – particularly traffic accidents – focuses mostly on hospital emergency rooms, since these represent a potential point of recurrent alcohol abuse or dependence, as well as a significant source for screening, brief intervention, and referral for treatment.1,2 However, some studies report that social, cultural, and environmental factors influence the validity of self‐reported data.3 In addition, enforcement of drinking and driving laws is associated with denial of drinking among those injured in a motor vehicle accident,4 and this is of particular significance in emergency rooms, where fast decisions must be taken in life‐threatening situations. When self‐reports are compared with estimates of blood alcohol concentration (BAC), the longer the time between an injury and admission to an emergency room, the less likely a person is to report previous drinking, even with a positive blood alcohol concentration.4 Cherpitel5 states that the concordance of negative self‐reports of consumption with breath‐analyzer readings remains high in emergency ROOM populations regardless of when the breath‐analyzer reading is obtained; however, it appears best to obtain the reading before interviewing the patient, since it increases the negative predictive value of the test. Although emergency room alcohol testing rates are similar, ranging from 70% to 90%,6,7 limited research has been conducted on those who refuse to be tested, and a better understanding of those who refuse might result in a more accurate estimate of alcohol prevalence among people involved in traffic injuries. Emergency room protocols for identifying a drunk driver or victim are also not standardized across countries, and BAC testing may not be available as a standard tool for screening in some emergency rooms, particularly in developing countries. Therefore, the identification of a drunk driver or accident victim may still rely on a thorough clinical examination to determine alcohol intoxication, which without continuous training, can lead to misleading results. Consequently, this study aimed to examine the association between clinical signs of alcohol intoxication and refusals to participate in a traffic accident survey among emergency rooms cases in two major trauma centers of a Brazilian state capital.