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BACKGROUND: Violence by young people is one of the most visible forms of violence and contributes greatly to the global burden of premature death, injury and disability. METHODS: The Global School-based Student Health Survey (GSHS), State of Lara, Venezuela (GSHS-Lara) is a school-based surveillance system. It comprises a repeated, cross-sectional, self-administered survey drawn from a representative sample of 7th to 9th grade students, performed in the school years 2003-2004 (GSHS-Lara 2004) and 2007-2008 (GSHS-Lara 2008). It explores, among other things, a general violence indicator such as school absenteeism due to feeling unsafe at school or on the way to or from school for any reason; and more specific indicators of violence such as robbery, bullying, physical fights and use of weapons, as well as exposure to lectures on how to prevent violence. Results are given in terms of prevalence percentage. RESULTS: Absenteeism doubled between the two study periods (10.8% to 20.8%). The number of students that were a victim of robbery remained high and without change both outside (14.2% and 14.8%) and inside school (21.7% and 22.0%). The number of victims of bullying was high and increasing (33.4% and 43.6%). Bullying associated with being physically attacked decreased (18.5% to 14.3%). Physical attacks without active participation and not associated with bullying were frequent (21.5%). Physical fighting with active participation prevalence remained high and without change (27.5% and 28.2%). Carrying a weapon almost doubled (4.3% to 7.1%). Less than 65% reported classes for violence prevention. CONCLUSIONS: The GSHS-Lara shows that violence is an important public health problem that needs to be addressed by the community and its authorities.

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El estudio de formas tempranas de presentación del lupus eritematoso sistémico (LES) permite optimizar su diagnóstico y tratamiento. Se revisaron las historias clínicas de pacientes con edad ≥12 años que cumplían con ≥4criterios del Colegio Americano de Reumatología (ACR). El término “presentación temprana del LES” se asignó al primer año de evolución de la enfermedad, comenzando con la fecha cuando el(los) primer(os) criterio(os) fue(ron) reportado(s) en la historia clínica. Los pacientes fueron agrupados si satisfacían cualquier combinación de ≥4, 2-3 ó 1 criterio(s) para la clasificación del LES a través del primer año de la enfermedad. El impacto sobre el diagnóstico temprano del LES fue estimado de acuerdo a la actitud del médico de atención primaria para descartar tempranamente la enfermedad. 115 pacientes fueron admitidos al estudio. Al final del primer año de evolución de la enfermedad, 68 (59,13%) reunieron <4 criterios vs. 47 (40,86%) que reunieron ≥4 criterios del CAR (p=0,05). Los pacientes que reunieron <4 criterios alcanzaron el mínimo número de criterios para LES (≥4) dentro de los siguientes 10 años (promedio 4,9 años). De los 68 pacientes que alcanzaron <4 criterios, 31 (45,58%) reunieron dos o tres criterios y 37 (54,41%) tan sólo un criterio (p=0,46). El más frecuente de los criterios solitarios fue el síndrome inflamatorio poliarticular, 26 (70,20%) comparado con un conjunto de manifestaciones cutáneas, hematológicas, neurológicas, cardiopulmonares, renales y falso VDRL positivo, 11 (29,72%) (p=0,01). Los pacientes con un número insuficiente de criterios para LES son más frecuentes que aquellos con ≥4 criterios positivos al final del primer año de presentación de la enfermedad. La manifestación de un solo criterio (comparado con los que tenían ≥2) se asoció con un retardo en el diagnóstico temprano del LES de por lo menos 1 año

The study of early systemic lupus erythematosus (SLE) presentation can optimize its diagnosis and treatment. The clinical charts of those patients ≥12 years old complied with ≥ 4 criteria for SLE of the American College of Rheumatology (ACR) were reviewed. The term “early presentation of SLE” corresponded to the first year of evolution of the disease, starting with the date when the first(s) criterion/criteria were reported in the chart. The patients were grouped if they complied with a combination of ≥4, 2-3 or 1 ACR criteria for the classification of SLE through the first year of disease. The impact over the early diagnosis of SLE was estimated according to the early performance of the primary care doctor in ruling out the disease. 115 patients were included. At the end of the first year, 68 patients (59.13%) met <4 ACR criteria vs. 47 (40.86%) who met ≥4 (p=0.05). Patients who met <4 criteria fulfilled ≥4 criteria within the next 10 years (mean= 4.9 years). Of the 68 cases with <4 ACR criteria, 31 (45.58%) met two or three criteria and 37 (54.41%) met one solitary criterion (p=0.46). The most frequent early single onset ACR criterion for SLE was the polyarticular inflammatory syndrome, 26 (70.20%) followed by a group of other single criterion that included cutaneous, hematologic, neurologic, cardiopulmonary, renal, and false-positive VDRL, 11 cases (29.72%) (p=0.01). An early solitary criterion-compared with those patients with ≥2- was associated with a lack of documentation in the medical chart- of constitutional symptoms, indication of serum antibodies and referral to specialist. Patients with an insufficient quota of ACR criteria for SLE exceeded those with ≥4 positive criteria at the end of the first year of the disease. Patients with a single criterion of presentation compared with those patients who started with ≥2 early criteria-were associated with a delay in the early diagnosis of SLE by at least one year

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BACKGROUND: Effective sexual health promotion programs need to be based on evidence; this study describes a set of sexual behavioral patterns, education and other subjects related to sexual life among 71th, 8th and 9th grade students in the State of Lara, Venezuela. METHODS: During 2003 to 2004 school period, 2070 students filled out the Global School Health Survey (GSHS)--a school based cross-sectional self-administered survey that explores, among other areas, sexual behavior. RESULTS: Students who responded that ever had intercourse, males 27% and females 3.8%; by grade, males 18.2% (7th) and 37.6 % (9th), and females 1.9% (7th) and 6.2% (9th). The group who had intercourse, 54.9% males and 25.3% females had it by age 12; 59% males and 78.6% females were sexually active in the past 12 months; 59.2% males and 43.2% females used condom in the last intercourse; and 48.3% males and 21.5% females has 2 or more sexual partners in their life. A disparity is present in school-based information, >63% for AIDS and <32% for sexual abuse. CONCLUSIONS: This study shows that a substantial number of students had sexual intercourse initiation at early age (<12), history of multiple sexual partners and low prevalence of condom use. An unbalanced coverage of information on AIDS and sexual abuse is highly prevalent in the school. However, the implementation and evaluation of comprehensive programs on healthy sexual life must take into account that still a majority of students report abstinence from sexual intercourse.

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The goal of this study was to evaluate the participation of small (diameter between 26 microns and 90 microns) and terminal (diameter between 10 microns and 25 microns) arterioles in the status lacunaris of the basal ganglia and to classify tortuous vascular profiles based on morphometry. Paraffin sections, 40 microns thick, of the basal ganglia from autopsied patients over the age of 45, were stained with PAS. A three-dimensional microscope, R400 (edge) was used to evaluate the structure of the blood vessels. Six patterns of the tortuous profiles were identified: simple kink, loop, knot, tangle, coil, and wave, and well as their combinations. Tortuous arterioles in the basal ganglia were present both in control group and status lacunaris cases. However, statistical Student's t-test analysis revealed a significant increment in the number of microfields containing tortuous terminal arterioles in the status lacunaris group (mean 7.50 +/- 4.62) versus the control group (mean 2.92 +/- 1.38) (p = 0.001). A risk for status lacunaris was associated with the increased frequency of tortuous terminal arterioles (Odd ratio = 1.94, 95%-Confidence Interval = 1.17-3.22) (p = 0.008) but not small arterioles (Odd ratio = 1.64, 95%-Confidence Interval = 0.62-4.38) (p = 0.39). Our findings suggest than an increased number of tortuous terminal arterioles is associated with status lacunaris. Six characteristic patterns of the tortuous profiles as well as their combinations were identified.

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