Tarcísio Matos de Andrade

Musculação, uso de esteróides anabolizantes e percepção de risco entre jovens fisiculturistas de um bairro popular de Salvador, Bahia, Brasil

Recent studies in different countries have shown an increase in anabolic steroid consumption among young people and the harm caused by indiscriminate use. In Brazil, research on steroid abuse is scarce. The present study examines the risk perception of health problems associated with anabolic steroid consumption among young working-class adults engaged in body-building practices in a poor neighborhood in the city of Salvador, Bahia. The methodology involved an anthropological approach based on qualitative research techniques consisting of ethnography, in-depth interviews, and a focus group with steroid users. The data describe the most common substances consumed and highlight the lack of information among interviewees concerning potential related health hazards, showing that for many steroid consumers the quest for muscle-mass development to achieve an idealized body supersedes the risk of harmful side effects. The results indicate the need for culturally sensitive measures to prevent steroid abuse among youth.Estudos recentes em diferentes paises tem apontado o aumento do consumo de esteroides anabolizantes entre jovens fisiculturistas e atletas, e os danos a saude causados pelo seu uso indiscriminado. No Brasil, estudos sobre o uso de anabolizantes sao escassos. No presente trabalho, examina-se a percepcao de risco a saude, associada ao consumo de anabolizantes, entre jovens fisiculturistas de um bairro pobre da cidade de Salvador. A metodologia privilegiou metodos de coleta de dados qualitativos tais como etnografia, entrevistas semi-estruturadas e grupo focal com usuarios de anabolizantes. Os dados produzidos descrevem as principais substâncias utilizadas e os padroes de uso, e apontam a falta de informacao dos jovens entrevistados sobre a extensao dos danos a saude decorrentes do consumo de anabolizantes, mostrando que para muitos, o desejo de desenvolver massa muscular e alcancar o corpo ideal se sobrepoe ao risco de efeitos colaterais. Os resultados indicam a necessidade de se desenvolver acoes culturalmente apropriadas, voltadas para a prevencao do abuso de anabolizantes junto a essa populacao.

Burnout Syndrome and associated factors among medical students: a cross-sectional study

OBJECTIVES: To assess the prevalence and levels of burnout syndrome among medical students at the Universidade Federal de Sergipe-Brazil and to identify associated factors. METHODS: A cross-sectional study was performed with randomly selected students in 2009. The Maslach Burnout Inventory/Student Survey (MBI-SS) and a structured questionnaire on socio-demographic characteristics, the educational process, and individual aspects were used. Statistical evaluation of multiple variables was performed through backward stepwise logistic regression analysis. RESULTS: The prevalence of burnout was 10.3% (n = 369). The prevalence was higher among those who did not have confidence in their clinical skills (Odds Ratio–OR = 6.47), those who felt uncomfortable with course activities (OR = 5.76), and those who did not see the coursework as a source of pleasure (OR = 4.68). CONCLUSION: There was a significant prevalence of burnout among the medical students studied. Three variables, in particular, were associated with burnout and were directly related to the medical education process. Preventive and intervention measures must be adopted, and longitudinal studies should be conducted.

Assessing risk behaviors and prevalence of sexually transmitted and blood-borne infections among female crack cocaine users in salvador - Bahia, Brazil

Crack cocaine use is associated with risky sexual behaviors and sexually transmitted infections (STIs), including HIV. We investigated sociodemographic and behavioral characteristics and infection rates in female crack cocaine users from impoverished communities of Salvador, Bahia, Brazil. A sample of 125 female crack cocaine users was recruited. Overall, the interviewees had low educational level and high rate of unemployment (close to 90%). One-third (37%) reported having traded sex for money or drugs, and 58% reported that they had not used condoms during intercourse in the last 30 days. The prevalence of infections was low: HIV-1.6%; HCV-2.4%; HBV- 0.8%; HTLV I/II-4.0%; and syphilis-4.0%. The combination of dire poverty and high prevalence of risk behaviors turn such populations a preferential target of initiatives aiming to reduce drug-related harm and promote social development. Low infection rates should not be viewed with complacency, but as a window of opportunity to implement prevention initiatives and reduce social marginalization.

Brazilian Response to the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Epidemic among Injection Drug Users

The Brazilian response to the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic is being observed all over the world because of its success. Understanding the role of injection drug users (IDUs) in the epidemic and the political response thereto is a key factor in the control of the epidemic in Brazil. This paper summarizes some of the most important analyses of the Brazilian response to the HIV/AIDS epidemic among and from IDUs. Key elements of the response include the support of the Brazilian Universal Public Health System, the provision of universal access to highly active antiretroviral therapy, and the creation of harm reduction projects that are politically and financially supported by the federal government. The response among and from IDUs is a key element in overall control of the HIV/AIDS epidemic. The response to the epidemic among and from IDUs has been headed in the correct direction since its beginning and is now being intensively expanded.

Exploring sex differences in drug use, health and service use characteristics among young urban crack users in Brazil

IntroductionStudies have shown important gender differences among drug (including crack) users related to: drug use patterns; health risks and consequences; criminal involvement; and service needs/use. Crack use is prevalent in Brazil; however, few comparative data by sex exist. We examined and compared by sex key drug use, health, socio-economic indicators and service use in a bi-city sample of young (18–24 years), regular and marginalized crack users in Brazil.MethodsStudy participants (total n = 159; n = 124 males and n = 35 females) were recruited by community-based methods from impoverished neighborhoods in Rio de Janeiro and Salvador. Assessments occurred by an anonymous interviewer-administered questionnaire and serum collection for blood-borne virus testing between November 2010 and June 2011. Descriptive statistics and differences for key variables by sex were computed; in addition, a ‘chi-squared automatic interaction detector’ (‘CHAID’) analysis explored potential primary factors differentiating male and female participants.ResultsMost participants were non-white, and had low education and multiple income sources. More women had unstable housing and income from sex work and/or panhandling/begging, whereas more men were employed. Both groups indicated multi-year histories of and frequent daily crack use, but virtually no drug injection histories. Men reported more co-use of other drugs. More women were: involved in sex-for-drug exchanges; Blood-Borne Virus (BBV) tested and HIV+. Both groups reported similar physical and mental health patterns; however women more commonly utilized social or health services. The CHAID analysis identified sex work; paid work; begging/panhandling; as well as physical and mental health status (all at p < 0.05) as primary differentiating factors by sex.ConclusionsCrack users in our study showed notable differences by sex, including socio-economic indicators, drug co-use patterns, sex risks/work, BBV testing and status, and service utilization. Results emphasize the need for targeted special interventions and services for males and female crack users in Brazil.

Risk Factors for Human T Cell Lymphotropic Virus Type I among Injecting Drug Users in Northeast Brazil: Possibly Greater Efficiency of Male to Female Transmission

It was observed in the city of Salvador, State of Bahia, the highest seroprevalence of human T cell lymphotropic virus type 1 (HTLV-I) infection in Brazil as demonstrated by national wide blood bank surveys. In this paper, we report results of an investigation of drug use and sexual behavior associated with HTLV-I infection among male and female injecting drug users (IDUs) in Salvador. A cross sectional study was conducted in the Historical District of Salvador from 1994-1996 (Projeto Brasil-Salvador) and 216 asymptomatic IDUs were selected using the snowball contact technique. Blood samples were collected for serological assays. Sera were screened for human immunodeficiency virus (HIV-1/2) and HTLV-I/II antibodies by ELISA and confirmed by Western blot. The overall prevalence of HTLV-I/II was 35.2% (76/216). The seroprevalence of HTLV-I, HTLV-II and HIV-I was for males 22%, 11.3% and 44.1% and for females 46.2%, 10.3% and 74.4% respectively. HTLV-I was identified in 72.4% of HTLV positive IDUs. Variables which were significantly associated with HTLV-I infection among males included needle sharing practices, duration of injecting drug use, HIV-I seropositivity and syphilis. Among women, duration of injecting drug use and syphilis were strongly associated with HTLV-I infection. Multivariate analysis did not change the direction of these associations. Sexual intercourse might play a more important role in HTLV-I infection among women than in men.

Sintomas depressivos entre internos de medicina em uma universidade pública brasileira

OBJECTIVE: To estimate, among Medical School intern students, the prevalence of depressive symptoms and their severity, as well as associated factors. METHODS: Cross-sectional study in May 2008, with a representative sample of medical intern students (n = 84) from Universidade Federal de Sergipe (UFS). Beck Depression Inventory (BDI) and a structured questionnaire containing informationon sociodemographic variables, teaching-learning process, and personal aspects were used. The exploratory data analysis was performed by descriptive and inferential statistics. Finally, the analysis of multiple variables by logistic regression and the calculation of simple and adjusted OR swith their respective 95% confidence intervals were performed. RESULTS: The general prevalence was 40.5%, with 1.2% (95% CI: 0.0-6.5) of severe depressive symptoms; 4.8% (95% CI: 1.3-11.7) of moderate depressive symptoms; and 34.5% (95% CI: 24.5-45.7) of mild depressive symptoms. The logistic regression revealed the variables with a major impact associated with the emergence of depressive symptoms: thoughts of dropping out (OR 6.24; p = 0.002); emotional stress (OR 7.43;p = 0.0004); and average academic performance (OR 4.74; p = 0.0001). CONCLUSION: The high prevalence of depressive symptoms in the study population was associated with variables related to the teaching-learning process and personal aspects, suggesting immediate preemptive measures regarding Medical School graduation and student care are required.

Common mental disorders among medical students at Universidade Federal de Sergipe: a cross-sectional study

OBJECTIVE Estimate the prevalence of common mental disorder and its associated factors among medical students of the Universidade Federal de Sergipe. METHOD A cross-sectional study was carried out, applying Self Reporting Questionnaire-20 to 473 students from the 512 medical students enrolled in 2006 and compared with compared with a structured questionnaire by the authors containing information on the socio-demographic characteristics, the teaching-learning process and the psycho-emotional experiences of the students. Freshmen were excluded after initial comparison with the students already exposed to the medical course. Statistical analysis by multiple logistic regression after calculating simple and adjusted odds ratio (OR). RESULTS The general prevalence of common mental disorder was 40% (n = 473); after exclusion of the freshmen it increased to 42.5% among students from the 2nd to the 12th semester. It was higher among those who did not have faith in their acquisition of the skills needed to become a good doctor (OR = 2.82), who felt less comfortable about course activities (OR = 3.75), who considered themselves emotionally stressed (OR = 2.14), among those who did not consider themselves happy (OR = 2.85), who believed that the course did not match their expectations (OR = 1.64) and those who had a prior diagnosis of mental disorder by a psychiatrist (OR = 3.78). CONCLUSION The results suggest the necessity of changes to the teaching-learning process and the establishment of a preventive mental health program for medical students.

HTLV-I in Northeast Brazil: Differences for Male and Female Injecting Drug Users

BACKGROUND To investigate the seroprevalence of HTLV-I infection among male and female injecting drug users (IDUs). METHODS A cross-sectional study conducted in Salvador, Brazil, from 1994 to 1996 (Projeto Brasil-Salvador). The study population of 216 asymptomatic IDUs was selected using snowball contact technique. Data on demographics, sexual behavior, and drug use practices were obtained and blood samples collected for serologic assays. Sera were screened for HIV-1/2 and HTLV-I and HTLV-II antibodies by enzyme-linked immunosorbent assay (ELISA) and confirmed by Western blot. RESULTS The overall prevalence of HTLV-I/II was 35.2% (76 of 216). The seroprevalence of HTLV-I, HTLV-II, and HIV-1 was for males 22.0%, 11.3%, and 44.1%, and for females 46.2%, 10.3%, and 74.4%, respectively. Specific seroprevalence of HTLV-I infection demonstrated linear trend with increasing age and increasing duration of drug use. Using univariate analysis, the variables that were significantly associated with HTLV-I infection among males included needle sharing practices, duration of IDU, HIV-1 seropositivity, and positive test result for syphilis. Among women, duration of injecting drug use and positive test result for syphilis were strongly associated with HTLV-I infection. CONCLUSIONS Retrovirus infection is highly prevalent among IDUs in Salvador, Brazil and HTLV-I is more common that HTLV-II. Duration of drug use is an important correlate of HTLV-I infection.

Performance of rapid hepatitis C virus antibody assays among high- and low-risk populations

BACKGROUND Rapid tests for the detection of antibodies to hepatitis C virus (anti-HCV) can facilitate access to diagnosis. OBJECTIVES This study aimed to evaluate the performance of rapid tests for anti-HCV detection in the sera, whole blood, and oral fluid samples from individuals with different endemicity profiles and risk behaviors. STUDY DESIGN Three groups donated biological samples that were tested using three anti-HCV rapid tests (WAMA, Bioeasy and OraSure): (I) suspected cases of hepatitis C, (II) individuals who were living in remote areas in Brazil and (III) crack users and beauty professionals. Reproducibility, repeatability and cross-reactivity to other infectious agents (dengue, HIV, malaria, and syphilis) were also evaluated. RESULTS In group I, specificities varied from 93.75% to 100% and sensitivities varied from 76.03% to 93.84% according to the EIA results. When anti-HCV/HCV RNA-reactive sera samples were considered true-positive HCV cases, the sensitivities and specificities varied from 86.3% to 99.09% and 93.75% to 100%, respectively. In group II, the OraSure rapid test presented the best performance. In group III, the Bioeasy assay performed best using saliva and whole blood and the OraSure assay performed best using oral fluid samples. The reproducibility and repeatability of the WAMA and Bioeasy tests were excellent. The level of concordance between the HCV EIAs and the rapid tests using samples that were reactive for other infectious agents varied from 82.35% to 100% for the WAMA assay and 94.11% to 100% for the Bioeasy assay. CONCLUSION All of the rapid tests could be used to identify active HCV infection among individuals with different endemicity profiles and risk behaviors.