ABSTRACT Objective: To evaluate the cumulative incidence, risk factors, and outcomes of COVID-19 in patients with Cushing's disease (CD). Subjects and methods: In all, 60 patients with CD following up in our outpatient clinic answered via phone interview a questionnaire about the occurrence of COVID-19 infection documented by RT-PCR (including the diagnosis date and clinical outcome) and vaccination status. Clinical and biochemical data on disease activity (hypercortisolism) and comorbidities (obesity, diabetes mellitus, and hypertension) were obtained from the patients' electronic medical records. Risk ratios (RRs) of risk factors were obtained using univariate and multivariate analyses. Results: The cumulative incidence of COVID-19 in patients with CD during the observation period was 31.7%, which was higher than that in the general reference population (9.5%). The cumulative incidence of COVID-19 was significantly higher in patients with hypercortisolism (57% versus 17% in those without hypercortisolism, p = 0.012) and obesity (54% versus 9% in those without obesity, p < 0.001) but not in patients with hypertension or diabetes mellitus. On multivariate analysis, hypercortisolism and obesity were each independent risk factors for COVID-19 (RR 2.18, 95% CI 1.06-4.46, p = 0.033 and RR 5.19, 95% CI 1.61-16.74, p = 0.006, respectively). Conclusion: The incidence of COVID-19 in patients with CD was associated with hypercortisolism, as expected, and obesity, a novel and unexpected finding. Thus, correction of hypercortisolism and obesity should be implemented in patients with CD during the current and future COVID-19 outbreaks. Objective COVID19 COVID 19 COVID-1 Cushings Cushing s CD. . (CD) methods all 6 RTPCR RT PCR including outcome status (hypercortisolism (obesity mellitus records RRs (RRs analyses Results 317 31 7 31.7% 9.5%. 95 9.5% 9 5 (9.5%) 57% 57 (57 17 0.012 0012 0 012 54% 54 (54 0.001 0001 001 analysis 218 2 18 2.18 1.064.46, 106446 1.06 4.46, 1 06 4 46 1.06-4.46 0033 033 0.03 519 5.19 1.6116.74, 1611674 1.61 16.74, 61 16 74 1.61-16.74 0006 006 0.006 respectively. respectively respectively) Conclusion expected finding Thus outbreaks COVID1 COVID- (CD 3 31.7 9.5 (9.5% (5 0.01 01 0.00 000 00 21 2.1 064 1.064.46 10644 106 1.0 446 4.46 1.06-4.4 003 03 0.0 51 5.1 6116 1.6116.74 161167 161 1.6 1674 16.74 1.61-16.7 31. 9. (9.5 ( 2. 1.064.4 1064 10 1. 44 4.4 1.06-4. 0. 5. 611 1.6116.7 16116 167 16.7 1.61-16. (9. 1.064. 4. 1.06-4 1.6116. 1611 16. 1.61-16 (9 1.064 1.06- 1.6116 1.61-1 1.611 1.61-

Resumen: Este estudio analiza la inseguridad alimentaria y los factores asociados, en el área urbana de un municipio de la cuenca hidrográfica del río Amazonas, Amazonia occidental. Se trata de una encuesta transversal, de base poblacional, realizada en el período de agosto a noviembre del 2021, con 983 hogares seleccionados mediante muestreo probabilístico estratificado. Se utilizó el modelo de regresión logística multinomial, adoptando los siguientes criterios: valor de p < 20% en el análisis bivariado y valor de p < 5% para el ajuste multivariado. Los resultados de los análisis se describieron como odds ratios (OR) e intervalo de 95% de confianza (IC95%). Las siguientes variables se asociaron significativamente con la inseguridad alimentaria leve o moderada: inseguridad hídrica en el hogar, número de residentes ≥ 5 en el hogar, pertenecer a la clase socioeconómica “D” o “E”, tener padre, madre u otra persona como cabeza de familia y tener a algún residente como beneficiario del Programa Bolsa Familia. En el modelo de análisis para la inseguridad alimentaria severa se encontró que vivir en hogar con inseguridad hídrica, pertenecer a la clase socioeconómica D o E, tener padre, madre u otra persona como cabeza de familia, edad del jefe de familia < 55 años, y un ingreso familiar más bajo que dos salarios mínimos aumentó las probabilidades de sufrir inseguridad alimentaria grave, en comparación con aquellos en situación de seguridad alimentaria. En conclusión, se constató una alta prevalencia de inseguridad alimentaria en el Municipio de Itapiranga, en el interior del Amazonas, Región Norte de Brasil, asociada a la situación de vulnerabilidad social y económica, a la falta de servicios públicos y a la inseguridad hídrica de los hogares. Resumen asociados Amazonas occidental transversal poblacional 2021 98 estratificado multinomial criterios 20 multivariado OR (OR 95 IC95%. IC95 IC IC95% . (IC95%) moderada “D E , “E” padre Familia años grave conclusión Itapiranga Brasil económica 202 9 2 IC9 (IC95% “E (IC95 (IC9 (IC

Abstract: This study analyzed food insecurity and associated factors in the urban area of a municipality in the Amazon River basin, Western Amazon. This is a cross-sectional population-based study conducted from August to November 2021 with 983 households selected by stratified probability sampling. A multinomial logistic regression model was used, adopting the following criteria: p-value < 20% in the bivariate analysis and p-value < 5% for the multivariate adjustment. The results of the analyses were described as odds ratio (OR) and 95% confidence interval (95%CI). The following variables were significantly associated with mild or moderate food insecurity: household water insecurity; number of residents ≥ 5 in the household; belonging to socioeconomic class D or E; having a father, mother or another as the head of the family; and having any resident as a beneficiary of the Brazilian Income Transfer Program. The analysis model for severe food insecurity showed that living with household water insecurity; belonging to socioeconomic class D or E; having a father, mother or another as the head of the family; age of the head of the family < 55 years; and family income lower that two minimum wages increased the chances of severe food insecurity when compared to those with food security. In conclusion, this study found a high prevalence of food insecurity in the Municipality of Itapiranga, State of Amazonas, North Region of Brazil, associated with social and economic vulnerability, lack of public services, and household water insecurity. Abstract basin crosssectional cross sectional populationbased population based 202 98 sampling used criteria pvalue p value 20 adjustment OR (OR 95 95%CI. 95CI CI 95%CI . (95%CI) E father Program years security conclusion Itapiranga Amazonas Brazil vulnerability services 9 2 (95%CI

Resumo: Este estudo analisa a insegurança alimentar e os fatores a ela associados na área urbana de um município na bacia hidrográfica do Rio Amazonas, Amazônia Ocidental. Trata-se de pesquisa transversal, de base populacional, realizada de agosto a novembro de 2021, com 983 domicílios selecionados por amostragem probabilística estratificada. Empregou-se o modelo de regressão logística multinomial, adotando-se os seguintes critérios: valor de p < 20% na análise bivariada e valor de p < 5% para o ajuste multivariado. Os resultados das análises foram descritos como odds ratios (OR) e intervalo de 95% de confiança (IC95%). Foram significantemente associadas à insegurança alimentar leve ou moderada as seguintes variáveis: insegurança hídrica domiciliar, número de moradores ≥ 5 no domicílio, pertencer à classe socioeconômica D ou E, ter pai, mãe ou outro, como chefe da família e ter algum morador beneficiário do Programa Bolsa Família. No modelo de análise para a insegurança alimentar grave constatou-se que viver em insegurança hídrica domiciliar, pertencer à classe socioeconômica D ou E, ter pai, mãe ou outro chefe da família, e tendo este menos que 55 anos, e renda familiar menor que dois salários mínimos aumentaram as chances de insegurança alimentar grave, comparativamente àqueles em segurança alimentar. Em conclusão, verificou-se alta prevalência de insegurança alimentar no Município de Itapiranga, Amazonas, Região Norte do Brasil, associada à situação de vulnerabilidade social e econômica, à falta de serviços públicos e à insegurança hídrica domiciliar. Resumo Amazonas Ocidental Tratase Trata se transversal populacional 2021 98 estratificada Empregouse Empregou multinomial adotandose adotando critérios 20 multivariado OR (OR 95 IC95%. IC95 IC IC95% . (IC95%) variáveis domiciliar domicílio E pai Família constatouse constatou anos conclusão verificouse verificou Itapiranga Brasil econômica 202 9 2 IC9 (IC95% (IC95 (IC9 (IC

Resumo: Este estudo analisa a insegurança alimentar e os fatores a ela associados na área urbana de um município na bacia hidrográfica do Rio Amazonas, Amazônia Ocidental. Trata-se de pesquisa transversal, de base populacional, realizada de agosto a novembro de 2021, com 983 domicílios selecionados por amostragem probabilística estratificada. Empregou-se o modelo de regressão logística multinomial, adotando-se os seguintes critérios: valor de p < 20% na análise bivariada e valor de p < 5% para o ajuste multivariado. Os resultados das análises foram descritos como odds ratios (OR) e intervalo de 95% de confiança (IC95%). Foram significantemente associadas à insegurança alimentar leve ou moderada as seguintes variáveis: insegurança hídrica domiciliar, número de moradores ≥ 5 no domicílio, pertencer à classe socioeconômica D ou E, ter pai, mãe ou outro, como chefe da família e ter algum morador beneficiário do Programa Bolsa Família. No modelo de análise para a insegurança alimentar grave constatou-se que viver em insegurança hídrica domiciliar, pertencer à classe socioeconômica D ou E, ter pai, mãe ou outro chefe da família, e tendo este menos que 55 anos, e renda familiar menor que dois salários mínimos aumentaram as chances de insegurança alimentar grave, comparativamente àqueles em segurança alimentar. Em conclusão, verificou-se alta prevalência de insegurança alimentar no Município de Itapiranga, Amazonas, Região Norte do Brasil, associada à situação de vulnerabilidade social e econômica, à falta de serviços públicos e à insegurança hídrica domiciliar.

Abstract: This study analyzed food insecurity and associated factors in the urban area of a municipality in the Amazon River basin, Western Amazon. This is a cross-sectional population-based study conducted from August to November 2021 with 983 households selected by stratified probability sampling. A multinomial logistic regression model was used, adopting the following criteria: p-value < 20% in the bivariate analysis and p-value < 5% for the multivariate adjustment. The results of the analyses were described as odds ratio (OR) and 95% confidence interval (95%CI). The following variables were significantly associated with mild or moderate food insecurity: household water insecurity; number of residents ≥ 5 in the household; belonging to socioeconomic class D or E; having a father, mother or another as the head of the family; and having any resident as a beneficiary of the Brazilian Income Transfer Program. The analysis model for severe food insecurity showed that living with household water insecurity; belonging to socioeconomic class D or E; having a father, mother or another as the head of the family; age of the head of the family < 55 years; and family income lower that two minimum wages increased the chances of severe food insecurity when compared to those with food security. In conclusion, this study found a high prevalence of food insecurity in the Municipality of Itapiranga, State of Amazonas, North Region of Brazil, associated with social and economic vulnerability, lack of public services, and household water insecurity.

Resumen: Este estudio analiza la inseguridad alimentaria y los factores asociados, en el área urbana de un municipio de la cuenca hidrográfica del río Amazonas, Amazonia occidental. Se trata de una encuesta transversal, de base poblacional, realizada en el período de agosto a noviembre del 2021, con 983 hogares seleccionados mediante muestreo probabilístico estratificado. Se utilizó el modelo de regresión logística multinomial, adoptando los siguientes criterios: valor de p < 20% en el análisis bivariado y valor de p < 5% para el ajuste multivariado. Los resultados de los análisis se describieron como odds ratios (OR) e intervalo de 95% de confianza (IC95%). Las siguientes variables se asociaron significativamente con la inseguridad alimentaria leve o moderada: inseguridad hídrica en el hogar, número de residentes ≥ 5 en el hogar, pertenecer a la clase socioeconómica “D” o “E”, tener padre, madre u otra persona como cabeza de familia y tener a algún residente como beneficiario del Programa Bolsa Familia. En el modelo de análisis para la inseguridad alimentaria severa se encontró que vivir en hogar con inseguridad hídrica, pertenecer a la clase socioeconómica D o E, tener padre, madre u otra persona como cabeza de familia, edad del jefe de familia < 55 años, y un ingreso familiar más bajo que dos salarios mínimos aumentó las probabilidades de sufrir inseguridad alimentaria grave, en comparación con aquellos en situación de seguridad alimentaria. En conclusión, se constató una alta prevalencia de inseguridad alimentaria en el Municipio de Itapiranga, en el interior del Amazonas, Región Norte de Brasil, asociada a la situación de vulnerabilidad social y económica, a la falta de servicios públicos y a la inseguridad hídrica de los hogares.

Resumo: Introdução: A presença de estresse crônico, causado pelas atividades e exigências do curso de Medicina, pode levar ao que se chama de burnout, uma síndrome caracterizada por três dimensões: exaustão emocional, desumanização (ou despersonalização) e reduzida realização profissional. Diante do aumento da incidência de síndrome de burnout, sintomas de ansiedade e depressão, tentativas de suicídio e suicídio entre estudantes de Medicina, encarado como consequência de exigências cada vez maiores de alcance de sucesso profissional e financeiro em detrimento da saúde física e mental, entende-se a importância de estudar o assunto e propor medidas de prevenção e controle. Este estudo teve como objetivos avaliar e descrever os níveis de burnout e qualidade de vida dos estudantes de Medicina da Universidade Federal de São Paulo. Método: Foram avaliados os níveis de burnout e qualidade de vida dos alunos do primeiro ao sexto ano do curso de Medicina da Unifesp, a partir dos questionários MBI-SS e Whoqol-Bref, on-line, em plataforma REDCap. Resultados: Um total de 302 estudantes responderam aos questionários completos. Em relação ao MBI-SS, os estudantes apresentaram baixo valor no fator exaustão emocional e altos valores na descrença e eficácia profissional, indicando um burnout entre baixo e moderado. Observou-se também que estudantes do gênero feminino apresentaram maior tendência à exaustão emocional em comparação ao gênero masculino, bem como estudantes do primeiro e segundo anos apresentaram maiores valores de eficácia profissional quando comparados com os do terceiro e quarto anos, sem diferença entre os gêneros. A partir das respostas do Whoqol-Bref, os estudantes consideraram ter boa qualidade de vida. Esses resultados indicam possíveis fatores que podem interferir na qualidade de vida dos estudantes: a carga horária excessiva de atividades, modelo de ensino baseado em aulas expositivas extensas, ausência de estímulo e reconhecimento pelos seus esforços. Conclusão: Os estudantes de Medicina avaliados neste estudo têm boa qualidade de vida e níveis baixos ou moderados de burnout, atentando-se para as diferenças entre anos de curso e características sociodemográficas.

Abstract: Introduction: The presence of chronic stress, caused by the activities and demands of the medical course, can lead to what is called ‘burnout’, a syndrome characterized by three dimensions: emotional exhaustion, dehumanization (or depersonalization) and reduced professional achievement. Considering the increased incidence of burnout syndrome, anxiety and depression symptoms, suicide attempts and suicide rates among medical students, as a consequence of increasing demands for professional and financial success at the expense of physical and mental health, one understands the importance of studying the subject and proposing measures of prevention and control. The aim of this study was to evaluate and describe the levels of burnout and well-being of medical students at a Brazilian public university. Method: The stress and well-being levels of students from the first to the sixth year for the Medical Course at Universidade Federal de São Paulo were evaluated using MBI-SS and WHOQOL-BREF questionnaires, applied online on the REDCAP platform. Results: A total of 302 students completed the questionnaires. Regarding the MBI-SS, students showed a low value in the emotional exhaustion factor and high levels of professional disbelief and effectiveness, indicating a burnout that ranged from low to moderate. It was also observed that female students showed a greater tendency toward emotional exhaustion when compared to male ones, as well as the fact that students from the 1st and 2nd years showed higher values of professional effectiveness when compared with 3rd and 4th years, with no difference between genders. Based on the answers from WHOQUOL-BREF questionnaire, the students thought they had a good quality of life. Discussion: These results reinforce possible factors that might interfere with the students’ quality of life: excessive workload, teaching model based on extensive lectures, lack of stimulation, recognition for their efforts. Conclusion: The medical students evaluated in this study have a good quality of life and show low or moderate burnout levels.

Objective: The effects of exposure to violent events in adolescence have not been sufficiently studied in middle-income countries such as Brazil. The aims of this study are to investigate the prevalence of psychiatric disorders among 12-year-olds in two neighborhoods with different socioeconomic status (SES) levels in São Paulo and to examine the influence of previous violent events and SES on the prevalence of psychiatric disorders. Methods: Students from nine public schools in two neighborhoods of São Paulo were recruited. Students and parents answered questions about demographic characteristics, SES, urbanicity and violent experiences. All participants completed the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) to obtain DSM-IV diagnoses. The data were analyzed using weighted logistic regression with neighborhood stratification after adjusting for neighborhood characteristics, gender, SES and previous traumatic events. Results: The sample included 180 individuals, of whom 61.3% were from low SES and 39.3% had experienced a traumatic event. The weighted prevalence of psychiatric disorders was 21.7%. Having experienced a traumatic event and having low SES were associated with having an internalizing (adjusted OR = 5.46; 2.17-13.74) or externalizing disorder (adjusted OR = 4.33; 1.85-10.15). Conclusions: Investment in reducing SES inequalities and preventing violent events during childhood may improve the mental health of youths from low SES backgrounds.

RESUMO OBJETIVO Avaliar, após seis meses, a efetividade de uma intervenção digital na diminuição da prática de binge drinking entre frequentadores de baladas. MÉTODOS Foi realizado um inquérito de portal através de uma amostra probabilística em 31 baladas da cidade de São Paulo, a qual originou um ensaio controlado randomizado com 1.057 participantes. Aqueles classificados como uso problemático do álcool (n = 465) através do Alcohol Use Disorders Identification Test foram randomizados em dois grupos de estudo – intervenção e controle. A intervenção digital consistiu em expor os participantes a uma tela de feedback normativo sobre seu consumo de álcool, caracterizando os riscos associados à quantidade consumida, valores gastos com bebidas, beber e dirigir, classificação do risco do Alcohol Use Disorders Identification Test e dicas de redução de danos. RESULTADOS Houve uma redução significativa da prática de binge drinking na semana estimada em 38% entre os participantes do grupo intervenção após seis meses (p < 0,05). Porém, não houve redução significativa nos desfechos quando se analisam os grupos intervenção e controle e os tempos início e seis meses após, simultaneamente. CONCLUSÕES Não se pode concluir que as ferramentas digitais reduzem o padrão de binge drinking nos frequentadores de baladas paulistanas. São necessários mais estudos com esta metodologia devido ao caráter atrativo para esse grupo, tendo em vista a privacidade e a rapidez que as informações personalizadas são transmitidas.

ABSTRACT OBJECTIVE To evaluate the effectiveness of a web-based intervention in reducing binge drinking among nightclub patrons after six months. METHODS We carried out a website survey with probabilistic sample in 31 nightclubs in the city of São Paulo, Brazil, which originated a randomized controlled trial with 1,057 participants. Those classified as problem drinkers (n = 465) using the Alcohol Use Disorders Identification Test were randomized into two study groups – intervention and control. The web-based intervention consisted of exposing the participants to a normative feedback screen about their alcohol consumption, characterizing the risks associated with amount consumed, money spent on drinks, drinking and driving, risk classification of Alcohol Use Disorders Identification Test, and tips to reduce damage. RESULTS There was a significant reduction in the practice of binge drinking in the week estimated at 38% among participants in the intervention group after six months (p < 0.05). However, there was no significant reduction in the outcomes when we analyzed the intervention and control groups and at baseline and after sixth months, simultaneously. CONCLUSIONS We cannot conclude that digital tools reduce the pattern of binge drinking among party goers in São Paulo. More studies are needed with this methodology because of its attractiveness to this type of group, given the privacy and speed that personalized information is transmitted.

RESUMO OBJETIVO Avaliar, após seis meses, a efetividade de uma intervenção digital na diminuição da prática de binge drinking entre frequentadores de baladas. MÉTODOS Foi realizado um inquérito de portal através de uma amostra probabilística em 31 baladas da cidade de São Paulo, a qual originou um ensaio controlado randomizado com 1.057 participantes. Aqueles classificados como uso problemático do álcool (n = 465) através do Alcohol Use Disorders Identification Test foram randomizados em dois grupos de estudo – intervenção e controle. A intervenção digital consistiu em expor os participantes a uma tela de feedback normativo sobre seu consumo de álcool, caracterizando os riscos associados à quantidade consumida, valores gastos com bebidas, beber e dirigir, classificação do risco do Alcohol Use Disorders Identification Test e dicas de redução de danos. RESULTADOS Houve uma redução significativa da prática de binge drinking na semana estimada em 38% entre os participantes do grupo intervenção após seis meses (p < 0,05). Porém, não houve redução significativa nos desfechos quando se analisam os grupos intervenção e controle e os tempos início e seis meses após, simultaneamente. CONCLUSÕES Não se pode concluir que as ferramentas digitais reduzem o padrão de binge drinking nos frequentadores de baladas paulistanas. São necessários mais estudos com esta metodologia devido ao caráter atrativo para esse grupo, tendo em vista a privacidade e a rapidez que as informações personalizadas são transmitidas.

ABSTRACT OBJECTIVE To evaluate the effectiveness of a web-based intervention in reducing binge drinking among nightclub patrons after six months. METHODS We carried out a website survey with probabilistic sample in 31 nightclubs in the city of São Paulo, Brazil, which originated a randomized controlled trial with 1,057 participants. Those classified as problem drinkers (n = 465) using the Alcohol Use Disorders Identification Test were randomized into two study groups – intervention and control. The web-based intervention consisted of exposing the participants to a normative feedback screen about their alcohol consumption, characterizing the risks associated with amount consumed, money spent on drinks, drinking and driving, risk classification of Alcohol Use Disorders Identification Test, and tips to reduce damage. RESULTS There was a significant reduction in the practice of binge drinking in the week estimated at 38% among participants in the intervention group after six months (p < 0.05). However, there was no significant reduction in the outcomes when we analyzed the intervention and control groups and at baseline and after sixth months, simultaneously. CONCLUSIONS We cannot conclude that digital tools reduce the pattern of binge drinking among party goers in São Paulo. More studies are needed with this methodology because of its attractiveness to this type of group, given the privacy and speed that personalized information is transmitted.

OBJECTIVES: Approximately 20-40% of annual global neonatal deaths occur among infants with birthweights ≥2,500 g, and most of these deaths are associated with intrapartum asphyxia in low- and middle-income countries. This study aims to evaluate the peripartum variables associated with the need for resuscitation at birth of neonates weighing ≥2,500 g. METHOD: This case-control retrospective study was performed on data from all public reference maternity units in the state of Ceará, Northeast Brazil, between March 2009 and March 2010. The subjects were singleton neonates without malformations weighing ≥2,500 g, who required positive-pressure ventilation in the delivery room. The controls had a 1-minute Apgar score of ≥8 and did not undergo resuscitation. Variables associated with positive-pressure ventilation in the delivery room were evaluated via conditional multivariate logistic regression. RESULTS: Of the 2,233 live births with birth weights ≥2,500 g, 1-minute Apgar scores ≤7, and no malformations, 402 patients met the inclusion criteria, and they were paired with 402 controls. Risk variables for positive-pressure ventilation at birth were a gestational age <37 weeks (OR: 3.54; 95% CI: 1.14-10.92) and meconium-stained amniotic fluid (8.53; 4.17-17.47). Cervical examination at maternal admission (0.57; 0.38-0.84) and a written follow-up of the labor (0.68; 0.46-0.98) were identified as protective variables. CONCLUSIONS: Significant flaws in obstetric care are associated with the need for positive-pressure ventilation at birth for neonates weighing ≥2,500 g.

OBJECTIVE: The goal of the present study was to examine the decisions of pediatricians who teach neonatal resuscitation in Brazil, particularly those who start resuscitation in the delivery room for newborns born at 23-26 gestational weeks. METHODS: The present study was a cross-sectional study that used electronic questionnaires (Dec/11-Sep/13) sent to instructors of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. The primary outcome was the gestational age at which the respondent said that he/she would initiate positive pressure ventilation in the delivery room. Latent class analysis was used to identify the major profiles of these instructors, and logistic regression was used to identify variables associated with belonging to one of the derived classes. RESULTS: Of 685 instructors, 82% agreed to participate. Two latent classes were identified: ‘pro-resuscitation’ (instructors with a high probability of performing ventilation on infants born at 23-26 weeks) and ‘pro-limitation’ (instructors with a high probability of starting ventilation only for infants born at 25-26 weeks). In the multivariate model, compared with the ‘pro-limitation’ class, ‘pro-resuscitation’ pediatricians were more likely to be board-certified neonatologists and less likely to base their decision on the probability of the infant’s death or on moral/religious considerations. CONCLUSION: The pediatricians in the most aggressive group were more likely to be specialists in neonatology and to use less subjective criteria to make delivery room decisions.

OBJETIVO Analisar a tendência temporal da prevalência de uso de álcool e tabaco por estudantes brasileiros. MÉTODOS Foram analisados, entre 1989 e 2010, dados de cinco inquéritos epidemiológicos com estudantes do sexto ano do ensino fundamental ao terceiro do ensino médio, matriculados em escolas públicas nas 10 maiores capitais do Brasil. A amostra foi de 104.104 estudantes e os dados foram coletados em sala de aula. O instrumento de coleta – questionário de autopreenchimento da Organização Mundial da Saúde – e os procedimentos de amostragem e ponderação foram os mesmos nos cinco inquéritos. Teste de Qui-quadrado de tendências foi utilizado para comparar as prevalências entre os anos. RESULTADOS A prevalência de uso de álcool e tabaco variou nos anos e entre as capitais estudadas. O uso de álcool diminuiu em todas as 10 capitais (p < 0,001), em 21 anos. Houve também diminuição significativa do uso de tabaco em oito capitais (p < 0,001). A maior prevalência de uso de álcool foi observada na região Sudeste, em 1993 (72,8% em Belo Horizonte), e a menor, em Belém (30,6%), em 2010. A maior prevalência de uso do tabaco no último ano foi na região Sul, em 1997 (28,0% em Curitiba) e a menor na região Sudeste, em 2010 (7,8% em São Paulo). CONCLUSÕES A tendência de queda na prevalência de tabagismo e uso de álcool entre estudantes, observada em todo o País, pode estar relacionada com políticas antitabaco e antiálcool bem-sucedidas e abrangentes. Apesar destes resultados, a prevalência de uso de álcool no último ano continuou elevada em todas as regiões brasileiras.

OBJECTIVE To analyze temporal trends of the prevalence of alcohol and tobacco use among Brazilian students. METHODS We analyzed data published between 1989 and 2010 from five epidemiological surveys on students from the 6th to the 12th grade of public schools from the ten largest state capitals of Brazil. The total sample consisted of 104,104 students and data were collected in classrooms. The same collection tool – a World Health Organization self-reporting questionnaire – and sampling and weighting procedures were used in the five surveys. The Chi-square test for trend was used to compare the prevalence from different years. RESULTS The prevalence of alcohol and tobacco use varied among the years and cities studied. Alcohol consumption decreased in the 10 state capitals (p < 0.001) throughout 21 years. Tobacco use also decreased significantly in eight cities (p < 0.001). The highest prevalence of alcohol use was found in the Southeast region in 1993 (72.8%, in Belo Horizonte) and the lowest one in Belem (30.6%) in 2010. The highest past-year prevalence of tobacco use was found in the South region in 1997 (28.0%, in Curitiba) and the lowest one in the Southeast in 2010 (7.8%, in Sao Paulo). CONCLUSIONS The decreasing trend in the prevalence of tobacco and alcohol use among students detected all over the Country can be related to the successful and comprehensive Brazilian antitobacco and antialcohol policies. Despite these results, the past-year prevalence of alcohol consumption in the past year remained high in all Brazilian regions.

OBJETIVO Analisar a tendência temporal da prevalência de uso de álcool e tabaco por estudantes brasileiros. MÉTODOS Foram analisados, entre 1989 e 2010, dados de cinco inquéritos epidemiológicos com estudantes do sexto ano do ensino fundamental ao terceiro do ensino médio, matriculados em escolas públicas nas 10 maiores capitais do Brasil. A amostra foi de 104.104 estudantes e os dados foram coletados em sala de aula. O instrumento de coleta – questionário de autopreenchimento da Organização Mundial da Saúde – e os procedimentos de amostragem e ponderação foram os mesmos nos cinco inquéritos. Teste de Qui-quadrado de tendências foi utilizado para comparar as prevalências entre os anos. RESULTADOS A prevalência de uso de álcool e tabaco variou nos anos e entre as capitais estudadas. O uso de álcool diminuiu em todas as 10 capitais (p < 0,001), em 21 anos. Houve também diminuição significativa do uso de tabaco em oito capitais (p < 0,001). A maior prevalência de uso de álcool foi observada na região Sudeste, em 1993 (72,8% em Belo Horizonte), e a menor, em Belém (30,6%), em 2010. A maior prevalência de uso do tabaco no último ano foi na região Sul, em 1997 (28,0% em Curitiba) e a menor na região Sudeste, em 2010 (7,8% em São Paulo). CONCLUSÕES A tendência de queda na prevalência de tabagismo e uso de álcool entre estudantes, observada em todo o País, pode estar relacionada com políticas antitabaco e antiálcool bem-sucedidas e abrangentes. Apesar destes resultados, a prevalência de uso de álcool no último ano continuou elevada em todas as regiões brasileiras.

OBJECTIVE To analyze temporal trends of the prevalence of alcohol and tobacco use among Brazilian students. METHODS We analyzed data published between 1989 and 2010 from five epidemiological surveys on students from the 6th to the 12th grade of public schools from the ten largest state capitals of Brazil. The total sample consisted of 104,104 students and data were collected in classrooms. The same collection tool – a World Health Organization self-reporting questionnaire – and sampling and weighting procedures were used in the five surveys. The Chi-square test for trend was used to compare the prevalence from different years. RESULTS The prevalence of alcohol and tobacco use varied among the years and cities studied. Alcohol consumption decreased in the 10 state capitals (p < 0.001) throughout 21 years. Tobacco use also decreased significantly in eight cities (p < 0.001). The highest prevalence of alcohol use was found in the Southeast region in 1993 (72.8%, in Belo Horizonte) and the lowest one in Belem (30.6%) in 2010. The highest past-year prevalence of tobacco use was found in the South region in 1997 (28.0%, in Curitiba) and the lowest one in the Southeast in 2010 (7.8%, in Sao Paulo). CONCLUSIONS The decreasing trend in the prevalence of tobacco and alcohol use among students detected all over the Country can be related to the successful and comprehensive Brazilian antitobacco and antialcohol policies. Despite these results, the past-year prevalence of alcohol consumption in the past year remained high in all Brazilian regions.

PURPOSE: Atypical glands (ASAP) are diagnosed in 5.0% of prostate biopsies, and cancer identification in a rebiopsy is higher than 40.0%. The use of antibodies to mark basal cells is currently a common practice, in order to avoid rebiopsies. There has been no reported study that has reviewed characteristics of radical prostatectomies (RPs) when immunohistochemistry (IHC) was necessary for definitive diagnosis. MATERIALS AND METHODS: Out of 4127 biopsies examined from 2004 to 2008, 144 (3.5%) were diagnosed with ASAP. IHC was performed using antibody anti-34ßE12 and p63. The results of surgical specimens of 27 patients treated by RP after the diagnosis of prostate cancer (PC) was made using IHC (Group 1) were compared with 1040 patients where IHC was not necessary (Group 2). RESULTS: IHC helped to diagnose PC in 103 patients (71.5%). Twenty-seven (26.2%) underwent RP. In Group 1, two (7.4%) adenocarcinomas were insignificant versus 29 (2.9%) for Group 2. Patients from Group 1 were younger (p = 0.039), had lower Gleason scores (GS) (p < 0.001), lower percentage of Gleason pattern 4 (p < 0.001), and smaller tumors (p < 0.001). CONCLUSION: The use of IHC did not lead to diagnosis of insignificant tumors as illustrated by absence of differences in pathological stage or positive surgical margins in men submitted to RP. Therefore, our results suggest that this modality should be routinely used for a borderline biopsy and ASAP cases.

Cigarette smoking (CS) is the main risk factor for bladder cancer development. There are more than 100 carcinogens present in cigarette smoke. Among the potential mediators of CS-induced alterations is nuclear factor-kappa (NF-κB), which is responsible for the transcription of genes related to cell transformation, tumor promotion, angiogenesis, invasion and metastasis. Curcumin is a polyphenol compound derived from Curcuma longa that suppress cellular transformation, proliferation, invasion, angiogenesis, and metastasis by down regulating NF-κB and its regulated genes. The aim of our study was to assess the effects of curcumin in bladder urothelial carcinoma. We studied the effects of curcumin in vitro and in vivo using the orthotropic syngeneic bladder tumor animal model MB49. Curcumin promotes apoptosis of bladder tumor cells in vitro. In vivo tumors of animals treated with curcumin were significantly smaller as compared to controls. Using immunohistochemistry, we demonstrated a decrease in the expression of Cox-2 by 8% and Cyclin D1 by 13% in the animals treated with curcumin; both genes regulated by NF-κB and related to cell proliferation. In this study, we showed that curcumin acts in bladder urothelial cancer, possibly dowregulating NF-κB-related genes, and could be an option in the treatment of urothelial neoplasms. The results of our study suggest that further research is warranted to confirm our findings.