Aims The study aimed to evaluate the effectiveness of the government school‐based program #Tamojunto2.0, the third Brazilian version of the European drug prevention program, Unplugged, in preventing the use of alcohol and other drugs. Design A parallel, two‐arm cluster randomized controlled trial was conducted in 205 classes in 73 public schools (37 intervention and 36 control) with a baseline assessment and follow‐up after 9 months. Setting Schools in the cities of São Paulo, Fortaleza and Eusebio in Brazil. Participants A total of 5208 students in the 8th grade with a mean age of 13.2 years (standard deviation = 0.8 years) and an equal gender ratio. Intervention In 2019, the intervention group attended 12 classes of the program #Tamojunto2.0, under the supervision of a team from the Ministry of Health. The control group did not receive any intervention to prevent alcohol and drug use. Measurements The primary outcome measured was prevalence of binge drinking (five or more doses of alcohol in an occasion) within the past month. Secondary outcomes were prevalence of initiation and use of alcohol, tobacco, inhalants, marijuana and cocaine within the past month. Findings A statistically significant difference was not found in the prevalence of binge drinking within the past month between intervention and control groups [odds ratio (OR) = 0.934; 95% confidence interval (CI) = 0.761–1.146]. However, students who were exposed to the program were less likely to initiate alcohol use than those in the control group (OR = 0.782; 95% CI = 0.636–0.961). The Bayes factor for reduction in binge drinking was 0.01, providing evidence in favor of the null hypothesis for this variable. Conclusions The drug prevention program #Tamojunto 2.0 reduced alcohol initiation, but appeared not to reduce past‐month binge drinking among 8th grade students in Brazil.

Background Brazil is the most populous country with a public, universal and free health care system. The National Program for Access and Quality Improvement in Primary Care (PMAQ) was created to improve the quality of primary health care (PHC). Objective To evaluated whether progress generally has been made within Brazil’s PHC since PMAQ implementation, and if changes occurred uniformly in the country, while also identifying municipal characteristics that may have influenced the improvement. Methods This is an observational study using data from PMAQ external evaluation (2012 and 2014), a 1200-item survey used to evaluate Brazilian PHC quality. After confirming the groupings of items using factor analysis, we created 23 composed indexes (CIs) related to infrastructure and work process. Results On average, the large majority of CIs showed improvements between 2012 and 2014. Region and city size moderated changes in the PHC indices differently. Overall, there were better improvements in infrastructure in the Northeast compared with other country regions, and in smaller cities (10 000–20 000 people). Infrastructure indices appear to have improved equitably across the country. Work process improvements varied with city size and region. Conclusion Despite similar support of PMAQ across the country, improvements are not predictable nor homogeneous. Non-uniform improvements were seen in Brazil’s PHC. Though we do not directly evaluate the effectiveness of the PMAQ (financial reward) method, these initial findings suggest that it is a potentially useful tool to improve health systems, but additional support may be needed in regions that lag behind in quality improvements.

Introduction: Sexually transmitted diseases (STDs) are one of the major health problems in the world. Among STDs, the Human Papillomavirus (HPV) infection is the most prevalent one, since approximately five hundred thousand to one million people are infected with this virus each year. Objective: To evaluate the knowledge of nursing students about the HPV and vaccination. Methods: A descriptive study with quantitative approach performed in a private higher education institution in Fortaleza, Ceará, Brazil. The sample consisted of students from the 1st and the 7th semester of nursing. Data were collected through a semi-structured questionnaire and analyzed with the SPSS, version 14.0, and descriptive statistics. Results: By characterizing the students, it was observed that 50.8% are older than 25 years old, 52.5% of them study and live only with help from their parents, and 80.3% reported having an active sex life. When questioning about what HPV is, there was a significant association (p = 0.008), whereas 42.6% of freshmen and 57.4% of 7th semester students reported what an STD is, 93.3% of students in the first semester and 71.0 % in the 7th semester were unaware of the vaccine. Conclusion: Most nursing students at the research institution have not enough knowledge about the virus, its consequences, and preventive forms of treatment, which may negatively influence the vulnerability of this age group. Keywords: sexually transmitted diseases, papillomavirus vaccines, disease prevention, therapeutics. RESUMO Introdução:As doenças sexualmente transmissíveis (DSTs) constituem um dos maiores problemas de saúde do mundo. Dentre as DSTs, o papiloma vírus humano (HPV) é a doença mais prevalente, pois cerca de 500 mil a 1 milhão de pessoas se infectam com o vírus anualmente. Objetivo: Avaliar o conhecimento de acadêmicos de enfermagem acerca do HPV e sua vacinação. Métodos: Estudo descritivo, de abordagem quantitativa, realizado em instituição de ensino superior, privada, de Fortaleza, Ceará. A amostra foi composta por acadêmicos do 1º e do 7º semestres de enfermagem. Os dados foram coletados por meio de questionário semiestruturado, sendo analisados com auxilio do programa estatístico SPSS Versão 14.0 e estatística descritiva. Resultados: Ao caracterizar os estudantes, foi observado que 50,8% tem mais de 25 anos; 52,5% apenas estudam e vivem com ajuda dos pais; e 80,3% referiram ter vida sexual ativa. Ao se questionar sobre o que é o HPV, foi verificada associação significativa (p = 0,008), visto que 42,6% dos alunos ingressantes e 57,4% dos alunos do 7º semestre referiram ser uma DST; 93,3% dos alunos do 1° semestre e 71,0% dos concludentes desconhecem a existência da vacina. Conclusão: A maioria dos acadêmicos de enfermagem da instituição pesquisada não possuem conhecimento suficiente sobre o vírus, suas consequências, formas preventivas e de tratamento, o que pode influenciar negativamente na vulnerabilidade deste grupo etário. Palavras-chave: doenças sexualmente transmissíveis, vacinas contra papillomavírus,...

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Objective This study's main purpose is to evaluate factors associated with eating disorder (ED) symptoms among Brazilian adolescents. Method The sample consisted of 5,213 students, mean age 13.24 (SD ±0.01), in the eighth grade of 93 public schools from three Brazilian cities. Data were collected through an anonymous self‐report questionnaire, assessing: sociodemographics, use of alcohol, tobacco, illicit drugs, binge drinking, bullying, and ED symptoms. We used confirmatory factor analysis and multivariate linear regression. Results We found that high levels of bullying victimization, binge drinking and the use of unprescribed weight‐loss substances were associated with higher levels of ED symptoms to both genders. However, only among girls, the higher age (β = .10; 95% CI = 0.02; 0.17) and the use of illicit drugs (β = .21; 95% CI = 0.094; 0.34) were associated with increase in the ED symptoms. Discussion We demonstrate a significant association of ED symptoms with drug use and bullying, highlighting the importance of addressing these factors in the development of ED prevention strategies.