Luciana Scarlazzari Costa

Homicídios e desigualdades sociais no Município de São Paulo

OBJECTIVEnThe relation between income and mortality due to violence has been studied in recent years. The Synthesis of Social Indicators of 2002 [Sintese de Indicadores Sociais, 2002], published by The Brazilian Institute of Geography and Statistics (IBGE), states that one of the most outstanding characteristic of Brazilian society is inequality. The proposal of this ecological study was to test the association between homicide rates, and some health and socioeconomic indicators.nnnMETHODSnThis is an ecological cross-sectional study. Data regarding Sao Paulo City, Brazil in the year 2000 was analyzed. The association between homicide coefficients and the following five indicators were tested: infant mortality rates, monthly average income of household heads, percentage of adolescents aged 15 to 17 years not attending school, proportion of pregnant adolescent women aged 14 to 17 years and demographic density. Pearsons correlation coefficient and a multiple linear regression model were utilized to test these associations.nnnRESULTSnThe municipal homicide rate was 57.3/100,000. The correlation between homicide rates and average monthly income was strong and negative (r=-0.65). Higher homicide rates were found in the districts whose inhabitants had lower incomes and lower rates were found in those districts whose inhabitants had higher incomes. The correlation between homicide rates and proportion of adolescents not attending school was positive and strong (r=0.68). The correlation between homicide rates and the proportion of pregnant adolescent women was positive and strong (r=0.67). The correlation between homicides and the rate of infant mortality was r=0.24 (for all: p<0.05). The correlation between demographic density and homicides was not significant. Although the univariate regression was positive for four indicators, the multivariate regression test was only significant for average monthly income (negative) and proportion of adolescents not attending school (positive) (for both indicators: p<0.01).nnnCONCLUSIONSnThe findings highlight the problem of homicides and socioeconomic disparities in S. Paulo City. Economic development and reducing socioeconomic inequality may have an impact on the rates of mortality due to violence.

Assessing caries, dental plaque and salivary flow in asthmatic adolescents using inhaled corticosteroids.

BACKGROUNDnA number of studies have reported that inhaled corticosteroids may cause a greater incidence of caries, reduced salivary flow, changes in saliva composition and an increased frequency of dental plaque, probably through alterations in the oral microbiota. The objective was to compare the frequency of caries, dental plaque and non-stimulated salivary flow rate among asthmatic adolescents using inhaled corticosteroids and non-asthmatic adolescents, as well as the salivary biochemical parameters (pH and leucocytes) in both groups.nnnMETHODSnThis research has a descriptive cross-sectional design to compare dental health of 40 asthmatics on inhaled corticosteroids and 40 non-asthmatic adolescents (median age 13 years).nnnRESULTSnThe findings were a higher number of tooth surfaces affected by dental caries (median 4 versus 1.5), and more dental plaques (median 70.5 versus 60.7) among asthmatic adolescents. They also had a significantly higher frequency of salivary leucocytes. The non-stimulated salivary flow was similar in both groups.nnnCONCLUSIONSnThe results suggest an association between the use of inhaled corticosteroids and an increased risk of dental caries and bacterial plaque, which calls for special attention of these patients by doctors and dental health professionals.

Validity and reliability of a self-efficacy expectancy scale for adherence to antiretroviral therapy for parents and carers of children and adolescents with HIV/AIDS.

OBJECTIVEnTo validate and evaluate the reproducibility of a self-efficacy (SE) scale for adherence to antiretroviral therapy in children and adolescents with HIV/AIDS, taking into account the perspective of parents/guardians.nnnMETHODSnThe study was carried out at the Hospital-Dia, Centro de Referência e Treinamento em DST/AIDS (CRT/SP), in São Paulo, Brazil. The parents/guardians of 54 children and adolescents aged 6 months to 20 years were interviewed during routine consultations at our service. Data on SE were collected using the Self-Efficacy for Following Anti-Retroviral Prescription Scale, and SE scores were calculated in two different ways: factor analysis and a predefined formula. The scales internal consistency was verified using Cronbachs alpha coefficient. Validity was tested by comparing the mean scores of a group of patients who did adhere to antiretroviral treatment with those of a group that did not (Mann-Whitney test) and by calculating the Spearman correlation coefficient for agreement between scores and clinical parameters. Reproducibility was verified using the Wilcoxon test, intraclass correlation coefficients (r(icc)) and Bland-Altman plots.nnnRESULTSnThe SE scale demonstrated good internal consistency (alpha = 0.87) and good reproducibility (r(icc) = 0.69 and r(icc) = 0.75). In terms of validity, the SE scale was capable of differentiating adherent patients from those who did not adhere to their antiretroviral treatment (p = 0.002) and exhibited a significant correlation with CD4 counts (r = 0.28; p = 0.04).nnnCONCLUSIONSnThe SE scale can be used to assess adherence to antiretroviral therapy in children and adolescents with HIV/AIDS, taking into account the perspective of parents/carers.

Validação e reprodutibilidade de uma escala de auto-eficácia para adesão ao tratamento anti-retroviral em pais ou cuidadores de crianças e adolescentes vivendo com HIV/AIDS

OBJECTIVE: To validate and evaluate the reproducibility of a self-efficacy (SE) scale for adherence to antiretroviral therapy in children and adolescents with HIV/AIDS, taking into account the perspective of parents/guardians. METHODS: The study was carried out at the Hospital-Dia, Centro de Referencia e Treinamento em DST/AIDS (CRT/SP), in Sao Paulo, Brazil. The parents/guardians of 54 children and adolescents aged 6 months to 20 years were interviewed during routine consultations at our service. Data on SE were collected using the Self-Efficacy for Following Anti-Retroviral Prescription Scale, and SE scores were calculated in two different ways: factor analysis and a predefined formula. The scales internal consistency was verified using Cronbachs acoefficient. Validity was tested by comparing the mean scores of a group of patients who did adhere to antiretroviral treatment with those of a group that did not (Mann-Whitney test) and by calculating the Spearman correlation coefficient for agreement between scores and clinical parameters. Reproducibility was verified using the Wilcoxon test, intraclass correlation coefficients (ricc) and Bland-Altman plots. RESULTS: The SE scale demonstrated good internal consistency (a= 0.87) and good reproducibility (ricc = 0.69 and ricc = 0.75). In terms of validity, the SE scale was capable of differentiating adherent patients from those who did not adhere to their antiretroviral treatment (p = 0.002) and exhibited a significant correlation with CD4 counts (r = 0.28; p = 0.04). CONCLUSIONS: The SE scale can be used to assess adherence to antiretroviral therapy in children and adolescents with HIV/AIDS, taking into account the perspective of parents/carers.

Time Trend of the Male Proportion at Birth in Brazil, 1979–2004

Several studies suggest that exposure to environmental endocrine disrupters can reduce the number of male births, and therefore, the male proportion at birth (also denominated birth ratio or sex ratio at birth) can be used as a sentinel health indicator. This work aimed to analyze the trend of male births in Brazil, according to their distribution by states and capitals. An ecological descriptive time series was carried out using polynomial regression, showing a declining trend for male proportion at birth in Brazil (1979–1994), followed by an upward trend until 2004. A decline on the proportion of male births was observed in Brazil between 1979 and 1993, followed by a subsequent rise of this ratio between 1995 and 2004, wherein the mean proportion of male births in Brazil rose from 51.05 to 51.18, representing a relative increase of 0.25%. The states of São Paulo (Southwest region) and Acre (Western Amazon), as well as some capitals–Cuiabá (Western Region), Palmas (Amazon) and Rio Branco (Amazon)–showed increasing trends, which suggests the influence of socio-demographic changes. In contrast, a declining trend in the State of Ceará State (Northeast region), with a 0.35% yearly decrease was observed. As a whole, these results suggest the influence of different environmental factors (demographic changes, public health services distribution, and population exposure to endocrine disruptor substances) influencing the time trend of birth ratio in the Brazilian population during the last decades.

Health Related Quality of Life Assessment questionnaire for children aged 5 to 11 years with HIV/AIDS: cross-cultural adaptation for the Portuguese language

The objective of this study is to describe preliminary results from the cross-cultural adaptation of the Quality of Life Assessment Questionnaire, used to measure health related quality of life (HRQL) in Brazilian children aged between 5 and 11 with HIV/AIDS. The cross-cultural model evaluated the Concept, Item, Semantic and Measurement Equivalences (internal consistency and intra-observer reliability). Evaluation of the conceptual, item, semantic equivalences showed that the Portuguese version is pertinent for the Brazilian context. Four of seven domains showed internal consistency above 0.70 (α: 0.76-0.90) and five of seven revealed intra-observer reliability (ricc: 0.41-0.70). This first Portuguese version of the HRQL questionnaire can be understood as a valuable tool for assessing childrens HRQL, but further studies with large samples and more robust analyses are recommended before use in the Brazilian context.