Ecologies of violence in urban peripheries during health emergencies / Ecología de violencias en las periferias urbanas durante emergencias sanitarias / Ecologia de violências nas periferias urbanas em tempos de emergências sanitárias

Violence is a health problem and a determinant of health emergencies, with structural dimensions going beyond interpersonal physical aggression. In the present text, we outline the ecologies of violence and relate them to pandemic experiences in a favela of São Paulo city, taking the perspective of One Health of Peripheries. We show how imposed precariousness, exploitation, persecution, territorial expulsions, incarceration practices, and household aggressions harm peripheral subjects and find in health emergencies the possibility of elevating themselves to the condition of a syndemic of violences. This has happened in the Covid-19 pandemic, in recent epidemics, and it is expected to happen in the next health emergency. Through de ecologies of violence, we hope to give more visibility to the entanglement that frustrates prevention and protection efforts in the face of health emergencies. Entanglement between marginalizing apparatuses, modalities of violence, and health emergencies, materialized in multispecies collectives.

La violencia es un problema de salud y un determinante de emergencias sanitarias, con dimensiones estructurales que van más allá de las agresiones físicas interpersonales. En el presente texto esbozamos la ecología de violencias y la relacionamos con vivencias de la pandemia en una favela de la ciudad de São Paulo, bajo la perspectiva de Una Salud de las Periferias. Mostromaos como precariedad impuesta, exploración, persecución, expulsiones territoriales, prácticas de encarcelamiento y agresiones intradomiciliares violentan sujetos periféricos y encuentran en las emergencias sanitarias posibilidades de convertirse en sindemia de violencias. Eso sucedió en la pandemia de Covid-19, en epidemias recientes y se espera que suceda en la próxima emergencia sanitaria. Por medio de la ecología de violencias le damos más visibilidad a la imbricación que frustra tentativas de prevención y protección frente a emergencias sanitarias. Imbricación entre dispositivos marginalizantes, modalidades de violencia e emergencias sanitarias, materializada en colectivos multiespécies.

A violência é um problema de saúde e um determinante das emergências sanitárias, com dimensões estruturais que vão além das agressões físicas interpessoais. No presente texto esboçamos a noção de ecologia de violências e a relacionamos com vivências da pandemia em uma favela paulistana, na perspectiva da Saúde Única em Periferias. Mostramos como marginalização, precariedade imposta, exploração, perseguição, expulsões territoriais, práticas de encarceramento e agressões no ambiente domiciliar violentam sujeitos periféricos e encontram nas emergências sanitárias possibilidades de se elevar à condição de sindemia de violências. Isso aconteceu na pandemia de Covid-19, em epidemias anteriores, e espera-se que aconteça na próxima emergência sanitária. Por meio da ecologia de violência damos mais visibilidade à imbricação que frustra tentativas de prevenção e proteção frente a emergências sanitárias. Imbricação entre dispositivos marginalizantes, modalidades de violência e emergências sanitárias, materializada em coletivos multiespécies.

Risk Factors and Spatiotemporal Analysis of Classical Swine Fever in Ecuador.

Classical swine fever (CSF) is one of the most important re-emergent swine diseases worldwide. Despite concerted control efforts in the Andean countries, the disease remains endemic in several areas, limiting production and trade opportunities. In this study, we aimed to determine the risk factors and spatiotemporal implications associated with CSF in Ecuador. We analysed passive surveillance and vaccination campaign datasets from 2014 to 2020; Then, we structured a herd-level case-control study using a logistic and spatiotemporal Bayesian model. The results showed that the risk factors that increased the odds of CSF occurrence were the following: swill feeding (OR 8.53), time until notification (OR 2.44), introduction of new pigs during last month (OR 2.01) and lack of vaccination against CSF (OR 1.82). The spatiotemporal model showed that vaccination reduces the risk by 33%. According to the priority index, the intervention should focus on Morona Santiago and Los Rios provinces. In conclusion, the results highlight the complexity of the CSF control programs, the importance to improve the overall surveillance system and the need to inform decision-makers and stakeholders.

Intra-urban spatial variability of breast and cervical cancer mortality in the city of São Paulo: analysis of associated factors. / Variabilidade espacial intraurbana da mortalidade por câncer de mama e do colo do útero no município de São Paulo: análise dos fatores associados.

OBJECTIVE: To identify spatial variability of mortality from breast and cervical cancer and to assess factors associated in the city of São Paulo. METHODS: Between 2009 and 2016, 10,124 deaths from breast cancer and 2,116 deaths from cervical cancer were recorded in the Mortality Information System among women aged 20 years and over. The records were geocoded by address of residence and grouped according to Primary Health Care coverage areas. A spatial regression modeling was put together using the Bayesian approach with a Besag-York-Mollié structure to verify the association of deaths with selected indicators. RESULTS: Mortality rates from these types of cancer showed inverse spatial patterns. These variables were associated with breast cancer mortality: travel time between one and two hours to work (RR - relative risk: 0.97; 95%CI - credible interval: 0.93-1.00); women being the head of the household (RR 0.97; 95%CI 0.94-0.99) and deaths from breast cancer in private health institutions (RR 1.04; 95%CI 1.00-1.07). The following variables were associated with mortality from cervical cancer: travel time to work between half an hour and one hour (RR 0.92; 95%CI 0.87-0.98); per capita household income of up to 3 minimum wages (RR 1.27; 95%CI 1.18-1.37) and ratio of children under one year of age related to the female population aged 15 to 49 years (RR 1.09; 95%CI 1.01-1.18). CONCLUSION: The predicted RR for mortality from these cancers were calculated and associated with the socioeconomic conditions of the areas covered.

OBJETIVO: Identificar a variabilidade espacial da mortalidade por câncer de mama e colo do útero e avaliar fatores associados à mortalidade por esses cânceres no município de São Paulo. MÉTODOS: Entre 2009 e 2016 foram registrados, no Sistema de Informações sobre Mortalidade, 10.124 óbitos por câncer de mama e 2.116 óbitos por câncer do colo do útero em mulheres com 20 anos e mais. Os registros foram geocodificados por endereço de residência e agregados segundo território adstrito. Foram realizadas modelagens de regressão espacial utilizando-se a abordagem bayesiana com estrutura de Besag-York-Mollié para verificar a associação dos óbitos com indicadores selecionados. RESULTADOS: As taxas de mortalidade por esses cânceres apresentaram padrões espaciais inversos. As variáveis associadas à mortalidade por câncer de mama foram: tempo de deslocamento para o trabalho entre uma e duas horas (risco relativo ­ RR 0,97; intervalo de credibilidade ­ IC95% 0,93­1,00); mulheres responsáveis pelo domicílio (RR 0,97; IC95% 0,94­0,99) e óbitos por câncer de mama ocorridos em estabelecimentos privados (RR 1,04; IC95% 1,00­1,07). À mortalidade por câncer do colo do útero, estiveram associados: tempo de deslocamento para o trabalho entre meia e uma hora (RR 0,92; IC95% 0,87­0,98); rendimento domiciliar até três salários-mínimos (RR 1,27; IC95% 1,18­1,37); e razão de menores de um ano em relação à população feminina de 15 a 49 anos (RR 1,09; IC95% 1,01­1,18). CONCLUSÃO: Foram calculados os RR preditos para a mortalidade por esses cânceres, que estiveram associados às condições socioeconômicas das áreas de abrangência.

Problematizando as alteridades para uma compreensão feminista e decolonial da Saúde Única em Periferias / Problematizing alterities for a feminist and decolonial understanding of One Health of Peripheries

Resumo Neste trabalho, refletimos sobre o modo como diversas figuras de alteridade são alvo de marginalização e o que isso implica em termos de reconhecimento nas gramáticas políticas que estabelecem quem pode se tornar um sujeito da saúde. A partir de contribuições feministas e decoloniais, discutimos algumas premissas ontológicas acerca da relação entre humanos, não humanos e a natureza, para alargar o entendimento da Saúde Única em Periferias. Também incorporamos narrativas de adolescentes que moram na favela Jardim São Remo (São Paulo, SP) e atuam como Agentes Mirins da Saúde Única em Periferias. Em diálogo com eles, exploramos o processo de exclusão constitutiva das favelas, apoiado em retóricas que não reconhecem a pluralidade das configurações coletivas e reforçam a figura das favelas como ameaça à segurança pública. Em contraposição a esse projeto, trazemos os princípios de reflorestamento e da confluência de alteridades significativas para reforçar a justiça multiespécie promovida pela práxis da Saúde Única em Periferias.

Abstract In this work, we reflect on how different figures of alterity are targets of marginalization and what this implies in terms of recognition in political grammars that establish who can become a subject of health. Based on feminist and decolonial contributions, we discuss some ontological assumptions about the relationship between humans, non-humans, and nature to broaden the understanding of the One Health of Peripheries. We also incorporate some narratives of adolescents who live in the Jardim São Remo favela (São Paulo, SP) and act as One Health of Peripheries Young Agents. In dialogue with them, we explore the process of constitutive exclusion of favelas, based on rhetorics that do not recognize the plurality of collective configurations and reinforce the figure of favelas as a threat to public security. In contrast to this project, we bring the principles of reforestation and confluence of significant alterities to reinforce the multispecies justice promoted by the praxis of One Health of Peripheries.

Variabilidade espacial intraurbana da mortalidade por câncer de mama e do colo do útero no município de São Paulo: análise dos fatores associados / Intra-urban spatial variability of breast and cervical cancer mortality in the city of São Paulo: analysis of associated factors

RESUMO Objetivo: Identificar a variabilidade espacial da mortalidade por câncer de mama e colo do útero e avaliar fatores associados à mortalidade por esses cânceres no município de São Paulo. Métodos: Entre 2009 e 2016 foram registrados, no Sistema de Informações sobre Mortalidade, 10.124 óbitos por câncer de mama e 2.116 óbitos por câncer do colo do útero em mulheres com 20 anos e mais. Os registros foram geocodificados por endereço de residência e agregados segundo território adstrito. Foram realizadas modelagens de regressão espacial utilizando-se a abordagem bayesiana com estrutura de Besag-York-Mollié para verificar a associação dos óbitos com indicadores selecionados. Resultados: As taxas de mortalidade por esses cânceres apresentaram padrões espaciais inversos. As variáveis associadas à mortalidade por câncer de mama foram: tempo de deslocamento para o trabalho entre uma e duas horas (risco relativo — RR 0,97; intervalo de credibilidade — IC95% 0,93-1,00); mulheres responsáveis pelo domicílio (RR 0,97; IC95% 0,94-0,99) e óbitos por câncer de mama ocorridos em estabelecimentos privados (RR 1,04; IC95% 1,00-1,07). À mortalidade por câncer do colo do útero, estiveram associados: tempo de deslocamento para o trabalho entre meia e uma hora (RR 0,92; IC95% 0,87-0,98); rendimento domiciliar até três salários-mínimos (RR 1,27; IC95% 1,18-1,37); e razão de menores de um ano em relação à população feminina de 15 a 49 anos (RR 1,09; IC95% 1,01-1,18). Conclusão: Foram calculados os RR preditos para a mortalidade por esses cânceres, que estiveram associados às condições socioeconômicas das áreas de abrangência.

ABSTRACT Objective: To identify spatial variability of mortality from breast and cervical cancer and to assess factors associated in the city of São Paulo. Methods: Between 2009 and 2016, 10,124 deaths from breast cancer and 2,116 deaths from cervical cancer were recorded in the Mortality Information System among women aged 20 years and over. The records were geocoded by address of residence and grouped according to Primary Health Care coverage areas. A spatial regression modeling was put together using the Bayesian approach with a Besag-York-Mollié structure to verify the association of deaths with selected indicators. Results: Mortality rates from these types of cancer showed inverse spatial patterns. These variables were associated with breast cancer mortality: travel time between one and two hours to work (RR - relative risk: 0.97; 95%CI - credible interval: 0.93-1.00); women being the head of the household (RR 0.97; 95%CI 0.94-0.99) and deaths from breast cancer in private health institutions (RR 1.04; 95%CI 1.00-1.07). The following variables were associated with mortality from cervical cancer: travel time to work between half an hour and one hour (RR 0.92; 95%CI 0.87-0.98); per capita household income of up to 3 minimum wages (RR 1.27; 95%CI 1.18-1.37) and ratio of children under one year of age related to the female population aged 15 to 49 years (RR 1.09; 95%CI 1.01-1.18). Conclusion: The predicted RR for mortality from these cancers were calculated and associated with the socioeconomic conditions of the areas covered.

Apparent prevalence and risk factors for bovine tuberculosis in the state of Paraná, Brazil: an assessment after 18 years since the beginning of the Brazilian program.

Bovine tuberculosis (bTB) impacts considerably animal production and one health worldwide. To describe the prevalence, risk factors, and spatial pattern of the disease in the state of Paraná, Brazil, a cross-sectional study was conducted from September 2018 to February 2019. The area was divided into seven regions. Within each region, farms were randomly selected, and a predetermined number of cows was selected and tested by a comparative cervical tuberculin test. 17,210 animals were tested across 1757 farms. Herd prevalence of bTB-infected herds in Paraná was 2.5% [1.87-3.00%]. It has varied from 0.8 to 3.98% among seven regions, with clustering being detected in the west, central, and northeast areas. Animal prevalence was 0.35% [0.21-0.59%] and has varied from 0.08 to 0.6% among the pre-set regions. No major shifts in the prevalence of bTB were detected since 2007. Large-sized herds, dairy production, and feeding with whey were detected to be correlated with the presence of bTB. Exclusively among dairy herds, veterinary assistance from cooperatives, possession of self-owned equipment to cool milk, and feeding with whey were correlated with the disease. Considering these results, it is recommended that the state of Paraná seek to implement a surveillance system for the detection of bTB-infected herds transforming them into free ones, if possible, incorporating elements of risk-based surveillance. Health education is also recommended to inform farmers about the risks of introducing animals without testing and of feeding raw whey to calves.

Adverse event classification and signal detection of data from the customer service and pharmacovigilance of a multinational veterinary pharmaceutical company.

The pharmacovigilance of a veterinary company may include the analysis of spontaneous reports of adverse events (AE) related to its products. The present study developed an AE classification flowchart to analyze AE notified to the customer service and pharmacovigilance department of a multinational veterinary pharmaceutical company in Brazil. The product-AE binomials using the flowchart were characterized in terms of their frequencies and subsequently, three signal detection models were used: Reporting Odds Ratio, Bayesian confidence propagation neural network, and Gamma Poisson Shrinker. The signals detected with the three methods were classified according to their intensity, always with the most intense signal in the first position. Among the signals detected by the three methods, the positions of each signal were summed to obtain an aggregated classification that considered the results of the three methods and allowed a serial interpretation. Among the 531 reports, 20 types of AE; 88 product-AE binomials were identified. From the total of reports, seven were signs identified by the three methods. The classification of AE following explicit criteria and the combined use of more than one signal detection method enhances spontaneous-reports-based pharmacovigilance.

Spatio-temporal dynamics of dengue-related deaths and associated factors.

Since the reintroduction of dengue viruses in 1987, Sao Paulo State (SP), Brazil, has experienced recurrent epidemics in a growing number of municipalities, each time with more cases and deaths. In the present study, we investigated the spatio-temporal dynamics of dengue-related deaths and associated factors in SP. This was an ecological study with spatial and temporal components, based on notified dengue-related deaths in the municipalities of SP between 2007 and 2017. A latent Gaussian Bayesian model with Poisson probability distribution was used to estimate the standardized mortality ratios (SMR) for dengue and relative risks (RR) for the socioeconomic, demographic, healthcare-related, and epidemiological factors considered. Epidemiological factors included the annual information on the number of circulating serotypes. A total of 1,019 dengue-related deaths (0.22 per 100,000 inhabitant-years) between 2007 and 2017 were confirmed in SP by laboratory testing. Mortality increased with age, peaking at 70 years or older (1.41 deaths per 100,000 inhabitant-years). Mortality was highest in 2015, and the highest SMR values were found in the North, Northwest, West, and coastal regions of SP. An increase of one circulating serotype, one standard deviation in the number of years with cases, and one standard deviation in the degree of urbanization were associated with increases of 75, 35, and 45% in the risk of death from dengue, respectively. The risk of death from dengue increased with age, and the distribution of deaths was heterogeneous in space and time. The positive relationship found between the number of dengue serotypes circulating and years with cases at the municipality/micro-region level indicates that this information can be used to identify risk areas, intensify surveillance and control measures, and organize healthcare to better respond to this disease.

Pink October and mammograms: when health communication misses the target. / Outubro Rosa e mamografias: quando a comunicação em saúde erra o alvo.

Breast cancer is the most frequently diagnosed type of cancer and is the leading cause of death from cancer in the female population. Screening mammograms and early treatment are the most frequently used means to attempt to reduce this mortality and are promoted during Pink October, an annual awareness-raising campaign. However, recent studies have correlated the increase in screening with higher morbidity and mortality, due to overdiagnosis and overtreatment. The current study assessed searches related to breast cancer and mammogram in Google Trends from 2004 to 2019 in terms of trend, seasonality, and distribution in Brazilian states. The study also evaluatedH the correlation between the number of searches in Google Trends and the number of screening mammograms. The two series showed a seasonal pattern with peaks in October, and there was an excess in tests performed outside the recommended age bracket. Pink October transmitted and popularized health information and induced behaviors related to this information, which are three desirable aspects in health communication and education. However, the campaign also generated an excess in screening mammograms and did not encourage autonomy and free and informed consent. Pink October revealed both the potential of mass communication in health and the need for messages to be aligned with the best available scientific evidence.

O câncer de mama é o tipo de câncer mais diagnosticado e a principal causa de morte por câncer na população feminina. As mamografias de rastreamento e o tratamento precoce são geralmente os meios mais utilizados na tentativa de reduzir essa mortalidade e são incentivados no Outubro Rosa, uma campanha de divulgação anual. Contudo, estudos recentes têm relacionado o aumento do rastreamento com uma maior morbimortalidade em razão do sobrediagnóstico e do sobretratamento. No presente estudo, avaliaram-se as buscas relativas ao câncer de mama e à mamografia no Google Trends, entre 2004 e 2019, em termos da tendência, da sazonalidade e da distribuição nas Unidades Federativas brasileiras. Avaliou-se também a correlação entre a quantidade de buscas no Google Trends e a quantidade de exames de rastreamento mamográfico. As duas séries tiveram um padrão sazonal com picos em outubro, e houve excesso de exames realizados fora da faixa etária recomendada. O Outubro Rosa transmitiu informações de saúde, as popularizou e induziu comportamentos relativos a informações transmitidas; três aspectos desejáveis na comunicação e na educação em saúde. Porém, gerou um excesso de mamografias de rastreamento e não incentivou a autonomia e o consentimento livre e esclarecido. O Outubro Rosa mostrou o potencial da comunicação em saúde para massas e a necessidade de que as mensagens sejam alinhadas com as melhores evidências científicas.

El cáncer de mama es el tipo de cáncer más diagnosticado y la principal causa de muerte por cáncer en la población femenina. Las mamografías de rastreo y el tratamiento precoz son generalmente los medios más utilizados en la tentativa de reducir esa mortalidad, y son incentivados en el Octubre Rosa, una campaña de divulgación anual. No obstante, estudios recientes han relacionado el aumento del rastreo con una mayor morbimortalidad, debido al sobrediagnóstico y al sobretratamiento. En el presente estudio se evaluaron las búsquedas relativas al cáncer de mama, y a la mamografía en Google Trends entre 2004 y 2019, en términos de tendencia, de estacionalidad y de su distribución en las Unidades Federativas brasileñas. Se evaluó también la correlación entre la cantidad de búsquedas en Google Trends y la cantidad de exámenes de rastreo mamográfico. Las dos series tuvieron un patrón estacional con picos en octubre, y hubo un exceso de exámenes realizados fuera de la franja etaria recomendada. Octubre Rosa transmitió información de salud, la popularizó e indujo a comportamientos relacionados con la información transmitida; tres aspectos deseables en la comunicación y educación en salud. Sin embargo, generó un exceso de mamografías de rastreo y no incentivó la autonomía y el consentimiento libre e informado. Octubre Rosa mostró el potencial de la comunicación en salud para las masas y la necesidad de que los mensajes estén alineados con mejores evidencias científicas.

Seroprevalence and risk factors for bovine brucellosis in the state of Paraná, Brazil: an analysis after 18 years of ongoing control measures.

Seroprevalence and risk factors of bovine brucellosis (Brucella abortus) in herds and cattle were estimated by a cross-sectional study in the state of Paraná, Brazil. The state was divided into seven regions and a random, two-stage sampling was performed on properties and cattle from each region between 2018 and 2019. Serum samples were collected from 11,592 cows over 24 months from 1,757 properties and a questionnaire was applied to identify potential risk factors. As recommended by the National Program for the Control and Eradication of Animal Brucellosis and Tuberculosis (PNCEBT), serological testing for the detection of anti-Brucella antibodies included the buffered plate agglutination test (screening test) and the fluorescence polarization assay (confirmatory test). The seroprevalence of bovine brucellosis on properties and in cattle was 4.87% (95% confidence interval [CI]: 3.98-5.93%) and 2.24% (95% CI: 1.47-3.41%), respectively. Multiple logistic regression analysis identified larger herd size and failure to test for brucellosis as risk factors for the presence of anti-B. abortus antibodies. These results demonstrate no change in the prevalence when comparing initial studies conducted in 2002. Given our findings, it is recommended that policies for brucellosis control include a widespread vaccination program for higher prevalence areas and eradication approach to lower prevalence areas. All steps related to correct immunization of the herds should be verified and improved by training and education. Health education action must be carried out informing farmers about the risks of introducing animals not tested for brucellosis into their herds and the benefits of testing their herds regularly.

One Health of Peripheries: Biopolitics, Social Determination, and Field of Praxis.

Amid the urgency to solve countless and severe health problems, asking what is health or who can and must have it may seem like a waste of time. However, some responses can reveal prevailing practices that divert attention from fundamental problems, thus maintaining privileges and deepening health inequities. One Health of Peripheries arises from these questions and takes three interdependent senses. The first refers to attributes determining the well-being and suffering of peripheral multispecies collectives: a state, a process, the realization of capacities. The second problematizes marginalizing apparatuses that define health and who can and should have it. The third encompasses practices in more-than-human social spaces in which, and through which, One Health is experienced, understood, and transformed. The qualification of health as "one" does not refer to the lack of plurality, nor to the simple aggregation of health fragments (human + animal + environmental), but to the complexity of health in a field with peripheral places, ensuing from margins to privilege those who are inside and legitimize the exploitation of those who are outside. The interaction among margins creates degrees and kinds of privilege and vulnerability that materialize epidemiologic profiles while articulating different peripheral strengths and needs supports a collective resistance to break margins. Social determination, a key concept in the (Latin American) collective health movement, underlies such profiles. However, this movement overlooks the more-than-human dimension of social determination; that is to say, One Health of Peripheries is a blind spot of collective health. The cartography of One Health of Peripheries has unique needs regarding participation, research, and inclusive policies for the decolonial promotion of healthy lifestyles.

From Modern Planetary Health to Decolonial Promotion of One Health of Peripheries.

The concept of Planetary Health has recently emerged in the global North as a concern with the global effects of degraded natural systems on human health. It calls for urgent and transformative actions. However, the problem and the call to solve it are far from new. Planetary health is a colonial approach that disregards alternative knowledge that over millennia have accumulated experiences of sustainable and holistic lifestyles. It reinforces the monolog of modernity without realizing that threats to "planetary health" reside precisely in its very approach. It insists on imposing its recipes on political, epistemological, and ontological peripheries created and maintained through coloniality. The Latin American decolonial turn has a long tradition in what could be called a "transformative action," going beyond political and economic crises to face a more fundamental crisis of civilization. It deconstructs, with other decolonial movements, the fallacy of a dual world in which the global North produces epistemologies, while the rest only benefit from and apply those epistemologies. One Health of Peripheries is a field of praxis in which the health of multispecies collectives and the environment they comprise is experienced, understood, and transformed within symbolic and geographic peripheries, ensuing from marginalizing apparatuses. In the present article, we show how the decolonial promotion of One Health of Peripheries contributes to think and advance decentralized and plural practices to attend to glocal realities. We propose seven actions for such promotion.

One Health of Peripheries: biopolitics, social determination and field of praxis / Una Salud de las Periferias: biopolítica, determinación social y campo de praxis / Saúde Única em Periferias: biopolítica, determinação social e campo de práxis

Amid the urgency to solve countless and severe health problems, asking what is health or who can and must have it may seem like a waste of time. However, some responses can reveal prevailing practices that divert attention from fundamental problems, thus maintaining privileges and deepening health inequities. One Health of Peripheries arises from these questions and takes three interdependent senses. The first refers to attributes determining the well-being and suffering of peripheral multispecies collectives: a state, a process, the realization of capacities. The second problematizes marginalizing apparatuses that define health and who can and should have it. The third encompasses practices in more-than-human social spaces in which, and through which, One Health is experienced, understood, and transformed. The qualification of health as "one" does not refer to the lack of plurality, nor to the simple aggregation of health fragments (human + animal + environmental), but to the complexity of health in a field with peripheral places, ensuing from margins to privilege those who are inside and legitimize the exploitation of those who are outside. The interaction among margins creates degrees and kinds of privilege and vulnerability that materialize epidemiologic profiles while articulating different peripheral strengths and needs supports a collective resistance to break margins. Social determination, a key concept in the (Latin American) collective health movement, underlies such profiles. However, this movement overlooks the more-than-human dimension of social determination; that is to say, One Health of Peripheries is a blind spot of collective health. The cartography of One Health of Peripheries has unique needs regarding participation, research, and inclusive policies for the decolonial promotion of healthy lifestyles.

Frente a la urgencia para resolver innúmeros e severos problemas de salud, preguntar que es salud y quien puede e debe tenerla puede parecer una perdida de tiempo. Sin embargo, algunas respuestas revelan prácticas prevalecientes para desviar la atención de problemas fundamentales que mantienen privilegios y profundizan iniquidades de salud. Una Salud de las Periferias surge de eses cuestionamientos y adquiere tres sentidos interdependientes. El primer se refiere a atributos que determinan el buen vivir y el sufrimiento de colectivos multiespécie periféricos: estados, procesos, realización de capacidades. El segundo problematiza dispositivos de marginalización que definen la salud y quien puede y debe tenerla. El tercero abarca piráticas en espacios sociales más-que-humanos en los cuáles, y por los cuáles, Una Salud es vivida, entendida y transformada. La calificación de la salud como "una" no se refiere a la falta de pluralidad ni a la simple agregación de fragmentos de salud (humana + animal + ambiental), sino a la complejidad de la salud en un campo con lugares periféricos, producto de márgenes para privilegiar a los que están dentro y legitimar la exploración de los que están fuera. La interacción entre márgenes crea grados y tipos de privilegio y vulnerabilidad que materializan perfiles epidemiológicos, mientras que la articulación de diferentes fuerzas y necesidades periféricas apoyan resistencias colectivas para romper márgenes. La determinación social da la salud que explica esos perfiles epidemiológicos es un concepto clave en el movimiento de la salud colectiva. No obstante, ese movimiento omite la dimensión más-que-humana de la determinación social; esto es, Una Salud de las Periferias es un punto ciego de la salud colectiva. La cartografía da Una Salud de las Periferias tiene necesidades específicas en términos de participación, investigación y políticas inclusivas para promover decolonialmente estilos de vida saludables.

Diante da urgência para resolver inúmeros e severos problemas de saúde, perguntar que é saúde e quem pode e deve tê-la pode parecer uma perda de tempo. Entretanto, algumas respostas revelam práticas prevalecentes que desviam a atenção de problemas fundamentais, mantendo assim privilégios e aprofundando iniquidades de saúde. A Saúde Única em Periferias surge desses questionamentos e assume três sentidos interdependentes. O primeiro refere-se a atributos que determinam o bem viver e o sofrimento de coletivos multiespécie periféricos: estados, processos, realização de capacidades. O segundo problematiza dispositivos de marginalização que definem a saúde e quem pode e deve tê-la. O terceiro abrange práticas em espaços sociais mais-que-humanos em que, e pelas que, a Saúde Única é vivenciada, entendida e transformada. A qualificação da saúde como "única" não se refere à falta de pluralidade nem à simples agregação de fragmentos de saúde (humana + animal + ambiental), mas à complexidade da saúde num campo com lugares periféricos, decorrentes de margens para privilegiar os que estão dentro e legitimar a exploração dos que estão fora. A interação entre margens cria graus e tipos de privilégio e vulnerabilidade que materializam perfis epidemiológicos, enquanto a articulação de diferentes forças e necessidades periféricas apoia resistências coletivas para romper margens, A determinação social da saúde que explica esses perfis epidemiológicos é um conceito chave no movimento da saúde coletiva. Porém, esse movimento omite a dimensão mais-que-humana da determinação social; isto é, a Saúde Única em Periferias é um ponto cego da saúde coletiva. A cartografia da Saúde Única em Periferias tem necessidades específicas em termos de participação, pesquisa e políticas inclusivas para promover decolonialmente estilos de vida saudáveis.

From modern Planetary Health to decolonial promotion of One Health of Peripheries

The concept of Planetary Health has recently emerged in the global North as a concern with the global effects of degraded natural systems on human health. It calls for urgent and transformative actions. However, the problem and the call to solve it are far from new. Planetary health is a colonial approach that disregards alternative knowledge that over millennia have accumulated experiences of sustainable and holistic lifestyles. It reinforces the monologue of modernity without realizing that threats to "planetary health" reside precisely in its very approach. It insists on imposing its recipes on political, epistemological, and ontological peripheries created and maintained through coloniality. The Latin American decolonial turn has a long tradition in what could be called a "transformative action", going beyond political and economic crises to face a more fundamental crisis of civilization. It deconstructs, with other decolonial movements, the fallacy of a dual world in which the global North produces epistemologies, while the rest only benefit from and apply those epistemologies. One Health of Peripheries is a field of praxis in which the health of multispecies collectives and the environment they comprise is experienced, understood, and transformed within symbolic and geographic peripheries, ensuing from marginalizing apparatuses. In the present article, we show how the decolonial promotion of One Health of Peripheries contributes to think and advance decentralized and plural practices to attend to local realities. We propose seven actions for such promotion.

Outubro Rosa e mamografias: quando a comunicação em saúde erra o alvo / Octubre Rosa y mamografías: cuando la comunicación en salud confunde el objetivo / Pink October and mammograms: when health communication misses the target

O câncer de mama é o tipo de câncer mais diagnosticado e a principal causa de morte por câncer na população feminina. As mamografias de rastreamento e o tratamento precoce são geralmente os meios mais utilizados na tentativa de reduzir essa mortalidade e são incentivados no Outubro Rosa, uma campanha de divulgação anual. Contudo, estudos recentes têm relacionado o aumento do rastreamento com uma maior morbimortalidade em razão do sobrediagnóstico e do sobretratamento. No presente estudo, avaliaram-se as buscas relativas ao câncer de mama e à mamografia no Google Trends, entre 2004 e 2019, em termos da tendência, da sazonalidade e da distribuição nas Unidades Federativas brasileiras. Avaliou-se também a correlação entre a quantidade de buscas no Google Trends e a quantidade de exames de rastreamento mamográfico. As duas séries tiveram um padrão sazonal com picos em outubro, e houve excesso de exames realizados fora da faixa etária recomendada. O Outubro Rosa transmitiu informações de saúde, as popularizou e induziu comportamentos relativos a informações transmitidas; três aspectos desejáveis na comunicação e na educação em saúde. Porém, gerou um excesso de mamografias de rastreamento e não incentivou a autonomia e o consentimento livre e esclarecido. O Outubro Rosa mostrou o potencial da comunicação em saúde para massas e a necessidade de que as mensagens sejam alinhadas com as melhores evidências científicas.

El cáncer de mama es el tipo de cáncer más diagnosticado y la principal causa de muerte por cáncer en la población femenina. Las mamografías de rastreo y el tratamiento precoz son generalmente los medios más utilizados en la tentativa de reducir esa mortalidad, y son incentivados en el Octubre Rosa, una campaña de divulgación anual. No obstante, estudios recientes han relacionado el aumento del rastreo con una mayor morbimortalidad, debido al sobrediagnóstico y al sobretratamiento. En el presente estudio se evaluaron las búsquedas relativas al cáncer de mama, y a la mamografía en Google Trends entre 2004 y 2019, en términos de tendencia, de estacionalidad y de su distribución en las Unidades Federativas brasileñas. Se evaluó también la correlación entre la cantidad de búsquedas en Google Trends y la cantidad de exámenes de rastreo mamográfico. Las dos series tuvieron un patrón estacional con picos en octubre, y hubo un exceso de exámenes realizados fuera de la franja etaria recomendada. Octubre Rosa transmitió información de salud, la popularizó e indujo a comportamientos relacionados con la información transmitida; tres aspectos deseables en la comunicación y educación en salud. Sin embargo, generó un exceso de mamografías de rastreo y no incentivó la autonomía y el consentimiento libre e informado. Octubre Rosa mostró el potencial de la comunicación en salud para las masas y la necesidad de que los mensajes estén alineados con mejores evidencias científicas.

Breast cancer is the most frequently diagnosed type of cancer and is the leading cause of death from cancer in the female population. Screening mammograms and early treatment are the most frequently used means to attempt to reduce this mortality and are promoted during Pink October, an annual awareness-raising campaign. However, recent studies have correlated the increase in screening with higher morbidity and mortality, due to overdiagnosis and overtreatment. The current study assessed searches related to breast cancer and mammogram in Google Trends from 2004 to 2019 in terms of trend, seasonality, and distribution in Brazilian states. The study also evaluatedH the correlation between the number of searches in Google Trends and the number of screening mammograms. The two series showed a seasonal pattern with peaks in October, and there was an excess in tests performed outside the recommended age bracket. Pink October transmitted and popularized health information and induced behaviors related to this information, which are three desirable aspects in health communication and education. However, the campaign also generated an excess in screening mammograms and did not encourage autonomy and free and informed consent. Pink October revealed both the potential of mass communication in health and the need for messages to be aligned with the best available scientific evidence.

Feline sporotrichosis: social vulnerability and prioritization of geographic areas in Guarulhos, SP, Brazil / Esporotricose felina: vulnerabilidade social e priorização de áreas geográficas em Guarulhos, SP, Brasil

Over the past two decades, many Brazilian cities have been reporting an increasing incidence and spread of feline sporotrichosis. The disease is neglected, and little is known about the causal processes underlying its epidemic occurrence. This study characterized the spatiotemporal dynamics of feline sporotrichosis in Guarulhos. Moreover, we proposed and tested a causal explanation for its occurrence and zoonotic transmission, giving a key role to social vulnerability. A direct acyclic graph represented the causal explanation, while Bayesian spatial models supported its test as well as the attribution of a risk-based priority index to the census tracts of the city. Between 2011 and 2017, the disease grew exponentially and the spatial spread increased. The model findings showed a dose-response pattern between an index of social vulnerability and the incidence of feline sporotrichosis. This pattern was not strictly monotonic, so some census tracts received a higher priority index than others with higher vulnerability. According to our causal explanation, there will not be effective prevention of feline and zoonotic sporotrichosis as long as social inequities continue imposing precarious livelihoods.(AU)

Nas últimas duas décadas, diversas cidades brasileiras têm relatado um aumento na incidência esporotricose felina e sua disseminação. A doença é negligenciada e pouco se sabe sobre os processos causais que estão envolvidos na sua ocorrência epidêmica. Neste estudo, foi caracterizada a dinâmica espaço-temporal da esporotricose felina em Guarulhos. Além disso, é proposta e testada uma explicação causal para sua ocorrência e transmissão zoonótica, atribuindo um papel fundamental à vulnerabilidade social. Um grafo acíclico direcionado representou a explicação causal, enquanto modelos espaciais Bayesianos foram usados para testá-la e para atribuir um índice de prioridade baseado em risco aos setores censitários da cidade. Entre 2011 e 2017, a doença cresceu exponencialmente e a sua disseminação espacial aumentou. Os resultados do modelo mostraram um padrão de dose-resposta entre um índice de vulnerabilidade social e a incidência de esporotricose felina. Esse padrão não foi estritamente monotônico, já que alguns setores censitários receberam um índice de prioridade mais alto do que outros com maior vulnerabilidade. Segundo nossa explicação causal, não haverá prevenção efetiva da esporotricose felina e zoonótica enquanto as iniquidades sociais continuarem impondo condições de vida precárias.(AU)

Spatial pattern of mortality from breast and cervical cancer in the city of São Paulo.

OBJECTIVE: To verify the spatial pattern of mortality from breast and cervical cancer in areas of primary health care, considering socioeconomic conditions. METHODS: This is an ecological study, from January 2000 to December 2016. The study area is the municipality of São Paulo, Brazil, and its 456 coverage areas of primary health units. Information on deaths of women aged 20 years or over were geocoded according to residence address. We calculated mortality rates, standardized by age, and smoothed by the local empirical Bayesian method, and grouped into three or two years to reduce the random fluctuation of the data. In addition, bivariate global and local Moran indexes were calculated to verify the existence of spatial agglomeration of standardized mortality rates with a domain of socioeconomic condition, elaborated based on the Índice Paulista de Vulnerabilidade Social (IPVS - São Paulo Index of Social Vulnerability). RESULTS: The success rate of geocoding was 98.9%. Mortality from breast cancer, without stratification by time, showed a pattern with higher rates located in central regions with better socioeconomic conditions. It showed a decrease at the end of the period and a change in spatial pattern, with increased mortality in peripheral regions. On the other hand, mortality from cervical cancer remained with the highest rates in peripheral regions with worse socioeconomic conditions, despite being reduced over time. CONCLUSION: The spatial pattern of mortality from the studied cancers, over time, suggests association with the best socioeconomic conditions of the municipality, either as protection (cervical) or risk (breast). This knowledge may direct resources to prevent and promote health in the territories.

Total antibiotic use in a state-wide area and resistance patterns in Brazilian hospitals: an ecologic study

ABSTRACT Introduction: Use of antibiotic and bacterial resistance is the result of a complex interaction not completely understood. Objectives: To evaluate the impact of entire antimicrobial use (community plus hospitals) on the incidence of bloodstream infections in intensive care units adjusted by socioeconomic factors, quality of healthcare, and access to the healthcare system. Design: Ecologic study using a hierarchical spatial model. Setting: Data obtained from 309 hospitals located in the state of São Paulo, Brazil from 2008 to 2011. Participants: Intensive care units located at participant hospitals. Outcome: Hospital acquired bloodstream infection caused by MDRO in ICU patients was our primary outcome and data were retrieved from São Paulo Health State Department. Socioeconomic and healthcare indexes data were obtained from IBGE (Brazilian Foundation in charge of national decennial census) and SEADE (São Paulo Planning and Development Department). Information on antimicrobial sales were obtained from IMS Brazil. We divided antibiotics into four different groups (1-4). Results: We observed a direct association between the use of group 1 of antibiotics and the incidences of bloodstream infections caused by MRSA (1.12; 1.04-1.20), and CR-Acinetobacter sp. (1.19; 1.10-1.29). Groups 2 and 4 were directly associated to VRE (1.72; 1.13-2.39 and 2.22; 1.62-2.98, respectively). Group 2 was inversely associated to MRSA (0.87; 0.78-0.96) and CR-Acinetobacter sp. (0.79; 0.62-0.97). Group 3 was inversely associated to Pseudomonas aeruginosa (0.69; 0.45-0.98), MRSA (0.85; 0.72-0.97) and VRE (0.48; 0.21-0.84). No association was observed for third generation cephalosporin-resistant Klebsiella pneumoniae and Escherichia coli. Conclusions: The association between entire antibiotic use and resistance in ICU was poor and not consistent for all combinations of antimicrobial groups and pathogens even after adjusted by socioeconomic indexes. Selective pressure exerted at the community level seemed not to affect the incidences of MDRO infection observed in intensive care setting.

Total antibiotic use in a state-wide area and resistance patterns in Brazilian hospitals: an ecologic study.

INTRODUCTION: Use of antibiotic and bacterial resistance is the result of a complex interaction not completely understood. OBJECTIVES: To evaluate the impact of entire antimicrobial use (community plus hospitals) on the incidence of bloodstream infections in intensive care units adjusted by socioeconomic factors, quality of healthcare, and access to the healthcare system. DESIGN: Ecologic study using a hierarchical spatial model. SETTING: Data obtained from 309 hospitals located in the state of São Paulo, Brazil from 2008 to 2011. PARTICIPANTS: Intensive care units located at participant hospitals. OUTCOME: Hospital acquired bloodstream infection caused by MDRO in ICU patients was our primary outcome and data were retrieved from São Paulo Health State Department. Socioeconomic and healthcare indexes data were obtained from IBGE (Brazilian Foundation in charge of national decennial census) and SEADE (São Paulo Planning and Development Department). Information on antimicrobial sales were obtained from IMS Brazil. We divided antibiotics into four different groups (1-4). RESULTS: We observed a direct association between the use of group 1 of antibiotics and the incidences of bloodstream infections caused by MRSA (1.12; 1.04-1.20), and CR-Acinetobacter sp. (1.19; 1.10-1.29). Groups 2 and 4 were directly associated to VRE (1.72; 1.13-2.39 and 2.22; 1.62-2.98, respectively). Group 2 was inversely associated to MRSA (0.87; 0.78-0.96) and CR-Acinetobacter sp. (0.79; 0.62-0.97). Group 3 was inversely associated to Pseudomonas aeruginosa (0.69; 0.45-0.98), MRSA (0.85; 0.72-0.97) and VRE (0.48; 0.21-0.84). No association was observed for third generation cephalosporin-resistant Klebsiella pneumoniae and Escherichia coli. CONCLUSIONS: The association between entire antibiotic use and resistance in ICU was poor and not consistent for all combinations of antimicrobial groups and pathogens even after adjusted by socioeconomic indexes. Selective pressure exerted at the community level seemed not to affect the incidences of MDRO infection observed in intensive care setting.