Reporting of observational studies is often inadequate, hampering the assessment of their strengths and weaknesses and, consequently, the generalization of study results. The initiative named Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) developed a checklist of 22 items, the STROBE Statement, with recommendations about what should be included in a more accurate and complete description of observational studies. Between June and December 2008, a group of Brazilian researchers was dedicated to the translation and adaptation of the STROBE Statement into Portuguese. The present study aimed to show the translation into Portuguese, introduce the discussion on the context of use, the potential and limitations of the STROBE initiative. Clinical trials and observational studies in the context of modern biomedical researchRandomized clinical trials have been described as the gold standard for biomedical research as they show high internal validity and, consequently, greater accuracy in the effi cacy and effectiveness evaluation of several therapeutic and preventive health practices. 4 However, public health studies have frequently dealt with problems where this study design is not adequate and/or ethical, or, yet, for which the translation of randomized controlled trial fi ndings into concrete intervention and/or treatment conditions faces great diffi culties due to the lack of external validity of fi ndings obtained in a clinical trial context. According to Victora et al,26 randomized clinical trials frequently represent an inadequate choice to assess the performance and impact of large scale interventions, especially in contexts of heterogeneity, whether they are social, economic and/or geographic in nature. In addition, there are operational aspects that can hinder or even preclude the implementation of clinical trials: individuals may not want to be randomized for a given intervention group, randomized selection may not be possible or ethically acceptable in the research context, or, yet, only participants with certain characteristics might accept to be selected. 31 In view of the impossibility or inadequacy of implementation of randomized clinical trials, whether due to ethical or operational questions, observational studies appear as a more feasible solution and, in cohort studies, are relevant alternatives to evaluate the impact of interventions throughout time. 22Observational studies are more adequate to evaluate rare or late side effects associated with certain treatments and they often provide a more accurate indication of what can be achieved in routine clinical practice, once they take The adverse effects of non-steroidal anti-infl ammatory drugs on cardiovascular morbi-mortality has been documented in studies with large sample sizes and longterm follow-up. Until then, these side effects had been imperceptible in the context of clinical trials and even of pharmacovigilance, involving a small number of cases and/or having a relatively short follow-up period. 10Previous...

BackgroundThe Brazilian response towards AIDS epidemic is well known, but the absence of a systematic review of vulnerable populations ─ men who have sex with men (MSM), female sex workers (FSW), and drug users (DU) remains a main gap in the available literature. Our goal was to conduct a systematic review and meta-analysis of studies assessing HIV prevalence among MSM, FSW and DU, calculating a combined pooled prevalence and summarizing factors associated the pooled prevalence for each group.MethodsNine electronic databases (MEDLINE via PubMed, EMBASE, Cochrane CENTRAL, AIDSLINE, AMED, CINAHL, TOXNET, SciELO, and ISI-Web of Science) were searched for peer-reviewed papers published in English, French, Spanish or Portuguese, from 1999 to 2009. To be included in the review, studies had to measure HIV prevalence and/or incidence as the primary outcome among at least one specific population under analysis.ResultsThe studies targeting the three populations analyzed mostly young participants aged 30 years or less. Among FSW, eight studies were selected (3,625 participants), consistently identifying higher condom use with sexual clients than with occasional and stable partners. The combined HIV prevalence for FSW was 6.2 (95% CI: 4.4-8.3). Ten studies targeting MSM were identified (6,475 participants). Unprotected anal intercourse was commonly reported on those studies, but with great variability according to the nature of the relationship - stable vs. occasional sex partners - and sexual practice - receptive vs. insertive anal sex. Pooled HIV prevalence for MSM was 13.6 (95% CI: 8.2-20.2). Twenty nine studies targeting DU were identified (13,063 participants). Those studies consistently identified injection drug use and syringe/needle sharing as key predictors of HIV-infection, as well as engagement in sex work and male-to-male sex. The combined HIV prevalence across studies targeting DU was 23.1 (95% CI: 16.7-30.2).ConclusionsFSW, MSM and DU from Brazil have a much risk of acquiring HIV infection compared to the general population, among which HIV prevalence has been relatively low (~0.6%). Those vulnerable populations should be targeted by focused prevention strategies that provide accurate information, counseling and testing, as well as concrete means to foster behavior change (e.g. access to condoms, drug abuse treatment, and clean syringes in the case of active injecting drug users), tailored to gender and culture-specific needs. Programs that provide these services need to be implemented on public health services throughout the country, in order to decrease the vulnerability of those populations to HIV infection.

As taxas médias de incidência da AIDS em adultos no Brasil foram estimadas para os períodos 1987-89, 1990-92 e 1993-96, segundo o município de residência dos casos. Nas análises foram utilizadas as variáveis "tamanho da população do município de residência"; "proporção de população que vive em área urbana" e "concentração de pobreza", estratificando-se por sexo e categoria de exposição. A Região Sudeste apresenta menor ritmo de crescimento em contraste com os aclives acentuados das regiões Norte e Sul, do 2º ao 3º intervalo. Cotejando-se as variações das taxas de incidência de 1990-92 a 1993-96 por região ou tamanho de população, obtém-se maiores aumentos relativos entre as mulheres. Nas cidades grandes, a categoria "homo/bissexuais" prevalece, decrescendo proporcionalmente à medida que cresce o número de casos por transmissão heterossexual. Nos municípios médios predominam os usuários de drogas injetáveis e nos menores há aumento dos casos por transmissão heterossexual. A epidemia - ainda fenômeno urbano - dá sinais de expansão nos municípios rurais, intensificando-se naqueles situados abaixo do limite crítico regional do índice de pobreza. Há disseminação crescente da epidemia nos municípios mais pobres.

This article analyzes the temporal distribution of reported AIDS cases by level of education used as a proxy variable for individual socioeconomic status. All AIDS cases aged 20-69 years and reported through May 29, 1999May 29, , with date of diagnosis between 1986May 29, -1996

Despite the fact that subtype C appeared in southern Brazil more recently than subtype B, it is now the predominant strain in Rio Grande. The epidemic spread of subtype C could be taking place in Brazil, and possibly in south America, a phenomenon similar to that seen in other countries where this subtype is now totally dominant.

Sporotrichosis associated with zoonotic transmission remains a relevant public health problem in Rio de Janeiro, Brazil, affecting a large at-risk population, which includes HIV-infected individuals. We assessed patients co-infected by Sporothrix spp. and HIV over time in the context of an unabated sporotrichosis epidemic.A retrospective cohort retrieved information from a National reference institute for infectious diseases regarding 48 patients with sporotrichosis-HIV co-infection (group 1) as well as 3,570 patients with sporotrichosis (group 2), from 1987 through March 2013. Most patients from group 1 were male (68.8%), whereas women were predominant in group 2 (69.1%; p<0.0001). Patients from group 1 were younger than those from group 2 (μ = 38.38±10.17 vs. 46.34±15.85; p<0.001) and differed from group 2 in terms of their race/ethnic background, with 70.8% non-white patients in group 1 vs. 38.6% from group 2 (p<0.0001). Close to half (∼44%) of the patients from group 1 were hospitalized due to sporotrichosis over time, whereas hospitalization was very unlikely in group 2, among whom approximately 1% were hospitalized over time. Dissemination of sporotrichosis was the main cause of hospitalization in both groups, although it was more common among hospitalized patients from group 1 (19/21 [90.5%] vs. 16/37 [43.2%]; p<0.001). Over the period under analysis, eight patients died due to sporotrichosis (3/48 vs. 5/3,570). The diagnosis of sporotrichosis elicited HIV testing and subsequent diagnosis in 19/48 patients, whereas 23/48 patients were simultaneously diagnosed with the two infections.HIV infection aggravates sporotrichosis, with a higher incidence of severe disseminated cases and a higher number of hospitalizations and deaths. Underserved populations, among whom sporotrichosis has been propagated, have been affected by different transmissible (e.g., HIV) and non-transmissible diseases. These populations should be targeted by community development programs and entitled to integrated management and care of their superimposed burdens.

This paper discusses methodologies for analyzing relations between social inequalities, marginalization, prejudice, and vulnerability to HIV/AIDS

HIV-1-positive individuals were recruited from January 1993 to December 1996 from several cohorts receiving follow-up in the city of Rio de Janeiro, Brazil, to evaluate HIV-1 genetic variability and the potential association with modes of transmission. HIV-1 subtyping was carried out using the heteroduplex mobility assay (HMA), and those samples corresponding to the typical Brazilian subtype B variant were further identified based on the Fok I restriction fragment length polymorphism (RFLP). DNA sequencing was performed to evaluate one case of subtype D infection. From the 131 HIV-1-positive individuals analyzed, 106 (80.9%) could be identified as infected by subtype B and 20 (15.3%) by subtype F. One of the samples (0.8%) was classified as subtype D. DNA samples from 4 patients (3.0%) did not yield polymerase chain reaction (PCR)-amplified products to be typed. Based on the Fok I RFLP, 39 of the 106 subtype B samples (37%) were identified as corresponding to the typical Brazilian subtype B variant containing the GWGR motif at the tip of the V3 loop. No statistically significant association could be detected between HIV-I subtypes and modes of transmission, exposure categories, or gender. This is the first reported case of HIV-1 subtype D infection in Brazil.