Magali Teresópolis Reis Amaral

Fatores associados à infecção pelo HIV/AIDS entre adolescentes e adultos jovens matriculados em Centro de Testagem e Aconselhamento no Estado da Bahia, Brasil

The study seeks to investigate factors associated with HIV infection among adolescents and young adults registered in the Counseling and Testing Center (CTC) of Feira de Santana, Bahia. An analytical study with a cross-sectional design was conducted using data from the CTC Information System in the period from 2007 to 2011. Information on 3,768 individuals were studied and the proportional difference was checked using the Pearson chi-squared test and stratified analysis by Prevalence Rate (PR) with confidence intervals of 95%, considering the serological status as the outcome. During the period under study, 73 young people were infected with HIV (1.94%). In the female population, statistically significant associations were identified for HIV status and drug use and consumption of alcohol and other drugs, as well as being married or in a stable relationship. In males, the consumption of other drugs and homosexual/bisexual orientation were associated with HIV status. In both sexes, in the category in a stable relationship the HIV status was associated with a partner using drugs and/or infected with a STD and/or HIV. These findings indicate the need for effective measures for the control and prevention of HIV infection among young people.

Gravidez na adolescência: análise de fatores de risco para baixo peso, prematuridade e cesariana

O objetivo do estudo foi analisar possiveis associacoes entre a faixa etaria materna ate 16 anos, com o peso e a idade gestacional do recem-nascido, assim como a ocorrencia de cesaria na. Estudo transversal com dados das Declaracoes de Nascidos Vivos/DN obtidos atraves do Sistema Nacional de Nascidos Vivos/SINASC, de Feira de Santana, Bahia, Brasil, no periodo 2006 a 2012. Nas analises, utilizou-se regressao logistica, em razao de odds (OR) e intervalo de confianca de 95 %, medindo a forca de associacao entre variaveis, ajustadas aos fatores de confundimento. Os Recem Nascidos de baixo peso e de peso insuficiente mostraram associacao significante com a faixa etaria materna (< 16 anos); e interacao estatistica do pre-natal inadequado e cesariana; em gestantes adolescentes com idade abaixo de 16 anos, a cesariana mostrou associacao significante com estado civil solteira (OR 1,24), pre-natal inadequado (OR 1,58) e Recem Nascidos de baixo peso (OR 1,34). Os dados sugerem que multiplos fatores podem interferir no tipo de parto e resultado gestacional de adolescentes em idade muito precoce, apontando a importância de investimentos em politicas e acoes direcionadas a esse grupo, considerado de alta vulnerabilidade aos agravos gestacionais e perinatais.

Iniciação e consumo de substâncias psicoativas entre adolescentes e adultos jovens de Centro de Atenção Psicossocial Antidrogas/CAPS-AD

The study seeks to characterize the initiation and consumption pattern of psychoactive substances among adolescents and young adults enrolled in an Alcohol and Drug Psychosocial Care Center (CAPS-AD). This study was conducted with records of attendance and the consumption pattern was classified in accordance with WHO: infrequent use (lifetime use, per year or up to five days per month); frequent use (6 to 19 times in the past 30 days); heavy use (≥ 20 times in the last 30 days). In the age group comparison, the test for proportion and association analysis was used and the prevalence and prevalence ratio was calculated with a significance level of 5% and 95% confidence interval. Of the total of adolescents and young adults treated between 2003 and 2008 (475), most were male, single, poorly educated, live with relations and have psychic symptoms. Statistical significance was found for age at initiation of use: adolescents compared to young adults started earlier (≤ 14 years): tobacco, marijuana, cocaine, crack and other SPA consumption. Among adolescents, significant results were found for the less frequent consumption of tobacco, more frequent use of alcohol, and heavy consumption of marijuana. These findings may contribute to the preventive and therapeutic CAPS-AD programs.O estudo tem como objetivo caracterizar a iniciacao e o padrao de consumo de substâncias psicoativas, entre adolescentes e adultos jovens matriculados em Centro de Atencao Psicossocial Alcool e Drogas - CAPS AD. Foram utilizados os registros dos atendimentos, sendo o padrao de consumo classificado segundo a OMS: uso pouco frequente (uso na vida, no ano ou no mes ate cinco dias); uso frequente (de seis ate 19 vezes nos ultimos 30 dias); uso pesado (> 20 vezes nos ultimos 30 dias); na comparacao das faixas etarias utilizou-se teste de proporcoes e para analise das associacoes, calculou-se prevalencia/P e razao de prevalencia/RP, com significância de 5% e intervalo de confianca 95%. No total de adolescentes e jovens atendidos entre 2003 e 2008 (475), a maioria foi masculina, solteira, com baixa escolaridade, coabitando com pais e sintomas psiquicos. Constatou-se significância estatistica para idade de iniciacao ao consumo: adolescentes, em relacao aos jovens iniciaram mais precocemente (< 14 anos): o consumo de tabaco; maconha, cocaina; crack e outras SPA. Entre adolescentes, verificou-se resultados significantes para consumo menos frequente de tabaco; mais frequente de alcool; e consumo pesado de maconha. Esses achados podem contribuir para programas preventivos e terapeuticos do CAPS-AD.

Violência sexual e coocorrências em crianças e adolescentes: estudo das incidências ao logo de uma década

The study analyzes the evolution of the incidence of sexual violence (SV) and co-occurrences between 2001 and 2010. The records of the Guardianship Councils in Feira de Santana, State of Bahia, Brazil were used and the incidence rates and graphs of the events during the period were calculated. Of the total of the different types of violence, 21.8 % involved co-occurrences, the majority being female, most frequently during adolescence. There was a high proportion of abuse in male children, with most offenders bring family members or acquaintances. The incidence of SV revealed an increasing trend in both sexes during the decade, more significantly in females in 2002 and 2009. The age groups indicated the same trend, with a higher proportion of cases in adolescence. The record of co-occurrences with SV was more pronounced in the second half of the decade, namely psychological violence in 2008, neglect in 2008 and physical violence in 2009. The conclusion is that the increase in the coefficients of sexual violence and co-occurrences may indicate an improvement of the reporting system of instances in reference, as well as greater citizen participation through the Dial 100 complaint hotline. The indicators help to prevent and control violence against children.

Sistema de Vigilância de Violências e Acidentes/VIVA e a notificação da violência infanto-juvenil, no Sistema Único de Saúde/SUS de Feira de Santana-Bahia, Brasil

The scope of the study is to analyze data of children and adolescents who are the victims of different forms of violence, registered in the Surveillance System for Violence and Accidents (VIVA/MS) in Feira de Santana in the state of Bahia, Brazil. The total number of records, since the implementation of VIVA in the city (01/2009 to 01/2011) was used and the analyses sought associations between characteristics of violence and profiles of victims and perpetrators. The results showed that children and adolescents were molested using different types of violence, including the use of physical force, verbal threats and weapons and sundry cases of personal injury. Approximately 35% were hospitalized and 15% died. Physical violence was more common among males during adolescence in the home environment and perpetrated by a family member. Sexual violence occurred with greater frequency among females during childhood and 55.5% of the cases occurred in the home environment and more frequently perpetrated by a family member or acquaintances. The results highlight the importance of investments in policies and programs for harm prevention and reduction, seeking to broaden coverage in the care and the enhancement of the information system and surveys of these indicators.

An International Survey of Screening and Management of Hypothyroidism during Pregnancy in Latin America

OBJECTIVE To determine how endocrinologists in Latin America deal with clinical case scenarios related to hypothyroidism and pregnancy. MATERIALS AND METHODS In January 2013, we sent an electronic questionnaire on current practice relating to management of hypothyroidism in pregnancy to 856 members of the Latin American Thyroid Society (LATS) who manage pregnant patients with thyroid disease. Subsequently, we have analyzed responses from physician members. RESULTS Two hundred and ninety-three responders represent clinicians from 13 countries. All were directly involved in the management of maternal hypothyroidism and 90.7% were endocrinologists. The recommendation of a starting dose of L-thyoxine for a woman diagnosed with overt hypothyroidism in pregnancy, preconception management of euthyroid women with known thyroid autoimmunity and approach related to ovarian hyperstimulation in women with thyroid peroxidase antibodies were widely variable. For women with known hypothyroidism, 34.6% of responders would increase L-thyroxine dose by 30-50% as soon as pregnancy is confirmed. With regard to screening, 42.7% of responders perform universal evaluation and 70% recommend TSH < 2.5 mUI/L in the first trimester and TSH < 3 mUI/L in the second and third trimester as target results in known hypothyroid pregnant women. CONCLUSION Deficiencies in diagnosis and management of hypothyroidism during pregnancy were observed in our survey, highlighting the need for improvement of specialist education and quality of care offered to patients with thyroid disease during pregnancy in Latin America.

Nutritional status of institutionalized elderly Brazilians: a study with the Mini Nutritional Assessment.

OBJECTIVE To assess the nutritional status of elderly living in nursing homes in the city of Salvador, Brazil and associated factors. METHODS Cross-sectional study performed with 359 individuals of both sexes, ages equal or over 60 years old, located in Nursing Homes in the urban area of the city of Salvador, Bahia, Brazil. RESULTS Regarding nutritional status according to Mini Nutritional Assessment (MNA), 66.3% of the evaluated elderly were malnourished and at risk of malnutrition. When comparing sexes, it has been observed that among men the prevalence of this condition (76.6%) was higher than in women (62.4%). It has been observed, as a result of the multivariate analysis, that only the variable functional capacity for Activities of Daily Living (ADL) was statistically significant. There was moderate correlation between MNA and Mini-Mental State Examination (r=0.454; p<0.0001), as well as between MNA and the ADL scale (r=0.569; p<0.0001). There was weak negative correlation between MNA total score and age (r=0.159; p=0.002). CONCLUSION Malnutrition and malnutrition risk were conditions of remarkable importance, with almost two-thirds of the elderly in this situation. ADL functional capacity must be monitored given their close relationship with the nutritional status of the elderly. An interdisciplinary approach in the context of institutionalization is needed due to the association between nutritional status and variables of different dimensions.

Baixo peso ao nascer em adolescentes e adultas jovens na Região Nordeste do Brasil

Objectives: to evaluate the association between characteristics relating to socio-demographic factors and the prenatal and delivery period of adolescent and young adult mothers whose newborns present with low weight at birth in State capitals and other municipalities in the Northeast region of Brazil, between 2011 and 2012. Methods: a hospital-based cross-sectional study was carried out at regional level in 2011 and 2012. Information was obtained by way of an interview with the mother immediately post-partum and from data contained in the medical records of mothers and newborns. A conceptual theoretical model was established with three hierarchical levels and the dependent variable was low weight at birth (LWB). Results: of the 3009 mothers interviewed, 9.7% had had newborns of low birth weight. The mothers who had received less than six prenatal consultations had a 1.7 times greater chance of giving birth to a child of low weight; a first pregnancy increased the risk of occurrence of LWB by an order of 1.5; while prematurity was the principal exposure factor, with 21 greater likelihood of this outcome. Conclusions: the study showed a high frequency of low birth weight among adolescent and young adult mothers, the main associated factors being an insufficient number of prenatal consultations, a first pregnancy and prematurity.

Notification of juvenile violence in Emergency Services of the Brazilian Unified Health System in Feira de Santana, Bahia, Brazil

OBJECTIVE To analyze the performance of professionals in the Emergency Units for the notification of cases of violence against children, considering sociodemographic characteristics, professional category and difficulties. METHODS Cross-sectional study with a simple random sample (n=200), selected from the universe of professionals (n=523) of these Emergency Units in Feira de Santana, Bahia, Brazil, from a regional general hospital and six polyclinics. Bivariate analyses and measures of association were performed to determine statistical significance. RESULTS Most professionals were female (82.5%), aged between 20 and 40 years old (75.5%), being nursing technicians (52.5%) and nurses (22.5%), 69.0% with a temporary employment contract. The notification was recorded by 69.5%, of them, and 60.0% asked for the opinion of another professional; 54.0% talked with the family and 42.9% reported to the Accident and Violence Surveillance System (VIVA). Statistical significance was observed in the nursing technicians category for the notification to sectors of reference, with a 95% confidence interval (95%CI) 1.28 - 2.09; and VIVA (95%CI 1.06 - 7.40). In the medical category, the significant result was not requesting the opinion of another professional (95%CI 1.02 - 3.51); not being afraid of judicial involvement (95%CI 1.19 - 4.06) and being trained in the violence matter (95%CI 1.21 - 5.00). The main difficulties cited were family omission (91.5%), fear of judicial involvement (63.5%) and lack of training (47.0%). CONCLUSION Most cases of violence seen at the Emergency Units were notified, however, less than 50% of professionals did not notify VIVA, pointing the need for institutional investment in technical support and ongoing training. Actions addressed to notification strengthen institutions and make the sector responsible for victim care and protection.

Factors associated with Specific Hypertensive Gestation Syndrome (SHGS) in postpartum adolescent and young adult mothers in the Northeast of Brazil: a multiple analysis of hierarchical models

Objectives: to analyze possible associations between Specific Hypertensive Gestation Syndrome (SHGS) and socio-demographic, prenatal, and delivery characteristics of young adult and teenage mothers. Methods: a hospital-based cross-sectional study and regional level, gathered from 54 municipalities in the Northeast region of Brazil from 2011-2012, using records from the National Survey, “Born in Brazil”. A theoretical conceptual model with three-level hierarchy was established, with SHGS being the outcome variable. A multivariate analysis was performed from the bivariate analysis and p-value, with a significance of < 0.2 by the Wald