Polycyclic aromatic hydrocarbons in seawater after the mysterious oil spill of 2019 on the Pernambuco coast, northeast Brazil.

In 2019, one of Brazil's most significant environmental disasters occurred, involving an oil spill that directly affected Pernambuco state. Contamination along the coast was evaluated by the quantification of polycyclic aromatic hydrocarbons (PAHs) in fifty seawater samples collected in the summer and winter of 2021. Analysis using fluorescence spectroscopy revealed that for all the samples, levels of dissolved/dispersed petroleum hydrocarbons (DDPHs) were higher than the regional baseline for tropical western shores of the Atlantic Ocean. GC-MS analyses quantified 17 PAHs in the samples, with highest total PAHs concentrations of 234 ng L-1 in summer and 33.3 ng L-1 in winter, which were consistent with the highest risks observed in ecotoxicity assays. The use of diagnostic ratios showed that the coast was impacted by a mixture of PAHs from petrogenic and pyrolytic sources. The results indicated the need for continuous monitoring of the regions affected by the 2019 spill.

Estradiol and Spironolactone Plasma Pharmacokinetics Among Brazilian Transgender Women Using HIV Pre-Exposure Prophylaxis: Analysis of Potential Interactions.

BACKGROUND AND OBJECTIVE: An important barrier to HIV prevention among transgender women (TGW) is the concern that oral pre-exposure prophylaxis (PrEP) negatively affects the efficacy of feminizing hormone therapy (FHT). We aimed to assess the impact of PrEP on FHT pharmacokinetics (PK) among TGW from Brazil. METHODS: We performed a drug-drug interaction sub-study among TGW enrolled in a daily oral PrEP demonstration study (PrEParadas, NCT03220152). Participants had a first PK assessment (PK1) 15 days after FHT (estradiol valerate 2-6 mg plus spironolactone 100-200 mg) initiation and then started PrEP (tenofovir disoproxil fumarate 300 mg/emtricitabine 200 mg). A second PK evaluation was performed 12 weeks later (PK2). Blood samples were collected prior and after the directly observed dosing (0, 0.5, 1, 2, 4, 6, 8, and 24 hours). Pharmacokinetic parameters of estradiol, spironolactone, and metabolites were estimated by non-compartmental analysis (Monolix 2021R2, Lixoft®) and compared as geometric mean ratios (GMRs, 90% confidence interval [CI]). RESULTS: Among 19 TGW who completed the substudy, median age was 26 years (interquartile range: 23-27.5). Estradiol area under the plasma concentration-time curve (AUCτ) and trough concentrations did not differ between PK1 and PK2 evaluations (GMR [90% CI]: 0.89 [0.76-1.04] and 1.06 [0.94-1.20], respectively). Spironolactone and canrenone AUCτ were statistically lower at PK2 than PK1 (0.76 [0.65-0.89] and 0.85 [0.78-0.94], respectively). Canrenone maximum concentration was also lower at PK2 than PK1 (0.82 [0.74-0.91]). CONCLUSION: Estradiol PK was not influenced by PrEP concomitant use. The small differences observed in some spironolactone and canrenone PK parameters should not prevent the concomitant use of estradiol-based FHT and PrEP. TRIAL REGISTRATION: This trial (NCT03220152) was registered on July 18, 2017.

Impact of feminizing hormone therapy on tenofovir and emtricitabine plasma pharmacokinetics: a nested drug-drug interaction study in a cohort of Brazilian transgender women using HIV pre-exposure prophylaxis.

OBJECTIVES: Potential interactions between feminizing hormone therapy (FHT) and pre-exposure prophylaxis (PrEP) may be a barrier to PrEP use among transgender women (TGW). We aimed to assess the impact of FHT on PrEP plasma pharmacokinetics (PK) among TGW. METHODS: This was a PK substudy of the effects of FHT on tenofovir disoproxil fumarate/emtricitabine nested to a trans-specific PrEP demonstration study (NCT03220152). Participants were assigned to receive PrEP only (noFHT) or standardized FHT (sFHT; oestradiol valerate 2-6 mg plus spironolactone 100-300 mg) plus PrEP for 12 weeks, after which they could start any FHT (aFHT). Short- and long-term PK assessment occurred at Weeks 12 and 30-48, respectively (plasma samples prior and 0.5, 1, 2, 4, 6, 8 and 24 h after dose). Non-compartmental PK parameters of tenofovir and emtricitabine were compared as geometric mean ratios (GMRs) between noFHT and PrEP and FHT (sFHT at short-term PK; aFHT at long-term PK) participants. RESULTS: No differences in tenofovir and emtricitabine plasma PK parameters were observed between the short-term PK of noFHT (n = 12) and sFHT participants (n = 18), except for emtricitabine Cmax [GMR: 1.15 (95% CI: 1.01-1.32)], or between noFHT short-term PK and aFHT long-term PK (n = 13). Most participants were on oestradiol valerate 2 mg at the short-term PK (56%) and 4 mg at the long-term PK (54%). Median (IQR) oestradiol levels were 56.8 (43.2-65.4) pg/mL at short-term PK (sFHT) and 44.8 (24.70-57.30) pg/mL at long-term PK (aFHT). No participants in this analysis seroconverted during the study. CONCLUSIONS: Our results indicate no interaction of FHT on tenofovir levels, further supporting PrEP use among TGW using FHT.

Low PrEP adherence despite high retention among transgender women in Brazil: the PrEParadas study.

INTRODUCTION: We aimed to evaluate daily oral pre-exposure prophylaxis (PrEP) uptake, retention, and adherence and predictors of study non-attendance and low PrEP adherence in a Brazilian trans-specific 48-week study (PrEParadas). METHODS: We enrolled transgender women (TGW) engaging in high-risk sexual behaviours between August 2017 and December 2018. PrEP adherence was based on tenofovir diphosphate concentrations in dried blood spots (DBS). We used random effects logistic regression models and ordinal models to estimate the odds of having a missed visit and of low PrEP adherence, respectively. Multivariable models were adjusted for variables with p-value<0.10 in the univariate analysis. RESULTS: From the 271 eligible, 130 participants were enrolled in the study (PrEP uptake: 48%), out of which 111 (85.4%) were retained at 48 weeks. Multivariable model for study non-attendance included study visit, age, main sexual partner and stimulant use. The odds of missing a visit increased after the week 24. Participants aged 18-24 (adjusted odds ratio [aOR] = 8.76, 95% CI: 2.09-36.7) and 25-34 years (aOR = 6.79, 95% CI: 1.72-26.8) compared to TGW aged 35+ years had significantly higher odds of having a missed visit. The odds of a missed visit were higher among participants reporting stimulant use (aOR = 4.99, 95% CI: 1.37-18.1) compared to no stimulant use. DBS levels at week 48 showed that 42 (38.5%), 14 (12.8%) and 53 (48.6%) of 109 participants had low, moderate and high PrEP adherence. Multivariable model for low PrEP adherence included study visit, age, schooling, race/colour, housing, binge drinking, stimulant use, feminizing hormone therapy (FHT) use and received text message. Low PrEP adherence was significantly higher among participants with less years of schooling (aOR = 6.71, 95% CI: 1.30-34.5) and had a borderline association with Black colour/race (aOR = 6.72, 95% CI: 0.94-47.8). Participants using the FHT available at the site had decreased odds of low PrEP adherence (aOR = 0.38, 95% CI: 0.16-0.88). No participant seroconverted over the course of the study. CONCLUSIONS: Although high PrEP retention can be achieved in a gender-affirming setting, PrEP adherence may be an important challenge faced among TGW due to social disparities. The scale-up of prevention tools like PrEP will have to address systemic social determinants as these stand as important barriers for TGW's access to health services.

[Breast cancer care from a suspected case detected in primary health care in São Paulo and Campinas, Brazil]. / Atenção ao câncer de mama a partir da suspeita na atenção primária à saúde nos municípios de São Paulo e Campinas, Brasil.

We aimed to identify factors that interfere in breast cancer (BC) suspected cases detected in Primary Health Care (PHC) that drive the referral to Specialized Care (SC) São Paulo and Campinas, Brazil. We interviewed 664 women (353 from São Paulo and 311 from Campinas) diagnosed with BC, referred to SC from PHC. Multilevel logistic regression analysis was used to the identification of associations between BC suspected cases by PHC and the socioeconomic and cancer care variables. The following showed a significant association: higher schooling level (OR = 0.59; 95% CI = 0.35-0.98); medical visit payment for cancer-related care (OR = 0.59; 95% CI = 0.36-0.96), continued attendance at PHC after beginning treatment at SC (OR = 0.62; 95% CI = 0.41-0.95); breast examined in PHC before referral to SC (OR = 1.61; 95% CI = 1.10-2.34) and first mammography requested in PHC (ECM) (OR = 2.81; 95% CI = 1.95-4.00). The request for mammography and the clinical breast examination is incorporated into the PHC for the early detection of BC in the cities. Continuing the care at the PHC and better socioeconomic conditions, such as having a higher education level and capacity to pay for care, can reduce the likelihood of suspected cases.

Buscou-se identificar fatores que interferem na suspeita do câncer de mama (CM) pela atenção primária à saúde (APS) que impulsionam o encaminhamento para a atenção especializada (AE) nos municípios de São Paulo e Campinas. Foram entrevistadas 664 mulheres (353 paulistanas e 311 campineiras) diagnosticadas com CM, encaminhadas para AE pela APS. Utilizou-se a análise de regressão logística multinível para a identificação das associações entre a suspeita do CM pela APS, variáveis socioeconômicas e atenção ao câncer. Mostraram associação significativa: nível superior de escolaridade (RC = 0,59; IC 95% = 0,35-0,98); pagamento de consulta médica para atendimento relacionado ao câncer (RC = 0,59; IC 95% = 0,36-0,96), continuou atendimento na APS após início do tratamento na AE (RC = 0,62; IC 95% = 0,41-0,95); mama examinada na APS (ECM) antes do encaminhamento para a AE (RC = 1,61; IC 95% = 1,10-2,34) e primeira mamografia solicitada na APS (RC = 2,81; IC 95% = 1,95-4,00). A solicitação da mamografia e o ECM são ações que têm sido incorporadas na APS para a detecção precoce do CM nos municípios. Continuar o atendimento na APS e melhores condições socioeconômicas, como ter nível superior de escolaridade e capacidade de pagar por atendimento, reduzem a chance da suspeita.

Occupational Profile, Psychosocial Aspects, and Work Ability of Brazilian Workers During COVID-19 Pandemic: IMPPAC Cohort.

BACKGROUND: The IMPPAC cohort (Implications of the COVID-19 pandemic on psychosocial aspects and work ability among Brazilian workers) seeks to understand the impact of the pandemic on Brazilian workers. This article describes the occupational profile, psychosocial aspects, and work ability determined during the baseline and follow-up measurements of the cohort. METHODS: Workers were invited to participate through media advertisements, social networks, and e-mails. From June to September 2020, 1211 workers were included in the cohort. Follow-up measurements finished on October 2021 with 633 workers. Data were collected through standardized questionnaires using Google Forms. Psychosocial aspects were assessed using the COPSOQ II-Br. Work ability was assessed using the Work Ability Index (WAI). RESULTS: At baseline and follow-up, high proportion of workers were in the risk zone with regard to work pace, emotional work demands, influence on work, work-family conflict, burnout, and stress. Approximately 75% of the workers reported good to excellent work ability at baseline and follow-up. CONCLUSION: The occupational profile, psychosocial aspects, and work ability of Brazilian workers from the IMPPAC cohort were described. Psychosocial aspects and WAI were similar at baseline and follow-up.

Interpersonal Violence and Passing: Results from a Brazilian Trans-specific Cross-sectional Study.

Trans women are specifically vulnerable to interpersonal violence. Being perceived as the gender that a transgender person identifies with, defined in some contexts as passing, may influence violence ratings. The EVAS (Violence and Health Self-Evaluation) study was a cross-sectional study that enrolled 121 trans women between 2019 and 2020 in Rio de Janeiro, Brazil, aiming to investigate the association between self-reported passing and different types of interpersonal violence. We enrolled 121 participants who had a median age of 36.3 (interquartile range [IQR] 13.7). Most of them were Black/mixed (78.5%) and had at least a high school education (63%). Most participants considered themselves as trans women (71.9%). Their median monthly income was $252.50 (IQR $302.50). Only 40 (33.1%) trans women had a main partner. Trans women with high passing had a higher prevalence of family violence and lower prevalence of observed police violence, violence in open and closed public spaces. Participants that reported a high passing had higher prevalence of family violence (p = .016); moreover, they reported observing less frequently police violence in the neighborhood they lived in for the last 12 months (p = .012) as well as having lower rates of suffering violence. Trans women who reported high passing had 81% (56%-92%) lower chance of suffering violence in open public places more than once, while prior racism experience had a positive association with violence in an open public place (aOR = 3.93, 95% CI [.48, 15.40]). Passing seems to protect from violence in public spaces, whilst it increases family violence. Data also suggest that observing police violence and violence in close public spaces. There is an urgent need to better understand the complex relationships around violence and foster its prevention.

Atenção ao câncer de mama a partir da suspeita na atenção primária à saúde nos municípios de São Paulo e Campinas, Brasil / Breast cancer care from a suspected case detected in primary health care in São Paulo and Campinas, Brazil

Resumo Buscou-se identificar fatores que interferem na suspeita do câncer de mama (CM) pela atenção primária à saúde (APS) que impulsionam o encaminhamento para a atenção especializada (AE) nos municípios de São Paulo e Campinas. Foram entrevistadas 664 mulheres (353 paulistanas e 311 campineiras) diagnosticadas com CM, encaminhadas para AE pela APS. Utilizou-se a análise de regressão logística multinível para a identificação das associações entre a suspeita do CM pela APS, variáveis socioeconômicas e atenção ao câncer. Mostraram associação significativa: nível superior de escolaridade (RC = 0,59; IC 95% = 0,35-0,98); pagamento de consulta médica para atendimento relacionado ao câncer (RC = 0,59; IC 95% = 0,36-0,96), continuou atendimento na APS após início do tratamento na AE (RC = 0,62; IC 95% = 0,41-0,95); mama examinada na APS (ECM) antes do encaminhamento para a AE (RC = 1,61; IC 95% = 1,10-2,34) e primeira mamografia solicitada na APS (RC = 2,81; IC 95% = 1,95-4,00). A solicitação da mamografia e o ECM são ações que têm sido incorporadas na APS para a detecção precoce do CM nos municípios. Continuar o atendimento na APS e melhores condições socioeconômicas, como ter nível superior de escolaridade e capacidade de pagar por atendimento, reduzem a chance da suspeita.

Abstract We aimed to identify factors that interfere in breast cancer (BC) suspected cases detected in Primary Health Care (PHC) that drive the referral to Specialized Care (SC) São Paulo and Campinas, Brazil. We interviewed 664 women (353 from São Paulo and 311 from Campinas) diagnosed with BC, referred to SC from PHC. Multilevel logistic regression analysis was used to the identification of associations between BC suspected cases by PHC and the socioeconomic and cancer care variables. The following showed a significant association: higher schooling level (OR = 0.59; 95% CI = 0.35-0.98); medical visit payment for cancer-related care (OR = 0.59; 95% CI = 0.36-0.96), continued attendance at PHC after beginning treatment at SC (OR = 0.62; 95% CI = 0.41-0.95); breast examined in PHC before referral to SC (OR = 1.61; 95% CI = 1.10-2.34) and first mammography requested in PHC (ECM) (OR = 2.81; 95% CI = 1.95-4.00). The request for mammography and the clinical breast examination is incorporated into the PHC for the early detection of BC in the cities. Continuing the care at the PHC and better socioeconomic conditions, such as having a higher education level and capacity to pay for care, can reduce the likelihood of suspected cases.

Prevalence and factors associated with suicidal behavior among trans women in Rio de Janeiro, Brazil.

BACKGROUND: Trans women face disproportionate burden of adverse health outcomes, including mental health issues. Very little is known about suicidal behavior among trans women in low- and middle-income settings, such as Brazil. We aimed to estimate the prevalence of lifetime suicidal behavior and to identify its associated factors among Brazilian trans women. METHODS: This was a cross-sectional study conducted among 345 trans women living in Rio de Janeiro, Brazil. We examined the prevalence of suicidal behavior (ideation and suicide attempt) and its associated factors using stepwise backward Poisson regression analysis with robust variance. RESULTS: Suicidal ideation was present among 47.25% of participants, and the prevalence of lifetime suicide attempt was 27.25%. Trans women with prior physical violence perpetrated by a family member had significantly higher prevalence of suicidal ideation (adjusted prevalence ratios [aPR]1.37), whereas those who reported sex work had lower prevalence ratio of suicidal ideation (aPR 0.76). Suicide attempt was significantly associated with living alone (aPR 1.48), physical violence by a casual partner (aPR 1.92), and sexual violence by a family member (aPR 1.69). Depression was significantly associated with both outcomes (aPR 1.90 for suicidal ideation and aPR 2.21 for suicide attempt). CONCLUSION: Suicidal behavior prevalence rates among Brazilian trans women were alarming and directly linked to violence and poor mental health. Effective mental health and public health policies addressing violence against trans women are urgently needed to prevent suicidal behavior among this highly vulnerable population.

Breast cancer screening in Primary Health Care in Brazil: a systematic review.

OBJECTIVES: to analyze care strategies for breast cancer screening in Primary Health Care in Brazil. METHODS: this is a systematic review following the Cochrane Collaboration recommendations. RESULTS: among 355 manuscripts, five were eligible. The patient navigation program by Community Health Agent stood out with the best result, among the strategies: flexibility of goals considering viability; community engagement; team training; active search of the target population by Community Health Agent; request for mammography by physicians; actions integrated to women's health; monitoring of mammography results, absent users, and population coverage by physician and nurse; and assessment of criteria for requesting screening mammography by means of an information system. The population coverage rate in the program ranged from 23% to 88%. CONCLUSIONS: Primary Health Care in Brazil presents devices with potential to induce the production of care for breast cancer screening.

Effect of an ergonomic intervention involving workstation adjustments on musculoskeletal pain in office workers-a randomized controlled clinical trial.

Office workers remain in a awkward position for long periods, which can lead to musculoskeletal symptoms. Ergonomic guidelines are recommended to avoid such problems. Evidence of the long-term effectiveness of ergonomic interventions is scarce. The aim of this randomised controlled trial was to compare pain intensity among office workers who received an ergonomic intervention and a control group before as well as 12, 24, and 36 wk after the intervention. Workers were randomly allocated to a control group (CG) and experimental group (EG). The EG received an ergonomic workstation intervention. Furniture measurements were related to individual anthropometric measurements to identify mismatches. The outcome was pain intensity, which was determined using a numerical pain scale and the Nordic Musculoskeletal Questionnaire. A linear mixed model was created with pain intensity as the dependent variable. Group and time were the independent variables. No significant interactions were found between group and time. Significant differences between groups were found for the pain intensity in the neck, shoulder, upper back, and wrist/hand (p<0.05), with lower intensity in the EG. The intervention reduced pain intensity in the neck, shoulder, upper back, and wrist/hand. However, no reduction in pain intensity was found for the lower back or elbow.

High risk and low HIV prevention behaviours in a new generation of young trans women in Brazil.

Adult trans women in Brazil are highly impacted by HIV, but little is known about risk for young trans women. Our study was conducted to compare the HIV prevalence and correlates of risk for young trans women ages 18-24 years old to adult trans women in Brazil. Trans women were recruited from Rio de Janeiro and Baixada (the metropolitan area of Rio de Janeiro), Brazil (N = 345). Youth ages 18-24 years of age had significantly greater odds of being HIV negative than adults (OR 0.4, 95% CI 0.2-0.6, p = 0.0002), but significantly lower odds of having post-exposure prophylaxis (PEP) knowledge (OR 0.5, 95% CI:0.3-0.9, p = 0.02) and PrEP awareness (OR 0.5, 95% CI: 0.3-0.8, p = 0.01). Young trans women also had significantly higher odds of using substances (OR 1.8, 95% CI 1.1-2.9, p = 0.02) and condomless anal intercourse with their last three sexual partners (OR 1.8, 95% CI: 1.1-3.0, p = 0.03) compared to adults. Already by age 24, one in four trans women in Brazil were infected with HIV pointing to a new generation at high risk of acquiring HIV. HIV prevention interventions are needed to change the healthcare system to reach and engage young trans women.

Breast cancer screening in Primary Health Care in Brazil: a systematic review / Cribado del cáncer de mama en la Atención Primaria de Salud en Brasil: una revisión sistemática / Rastreamento do câncer de mama na Atenção Primária à Saúde no Brasil: revisão sistemática

ABSTRACT Objectives: to analyze care strategies for breast cancer screening in Primary Health Care in Brazil. Methods: this is a systematic review following the Cochrane Collaboration recommendations. Results: among 355 manuscripts, five were eligible. The patient navigation program by Community Health Agent stood out with the best result, among the strategies: flexibility of goals considering viability; community engagement; team training; active search of the target population by Community Health Agent; request for mammography by physicians; actions integrated to women's health; monitoring of mammography results, absent users, and population coverage by physician and nurse; and assessment of criteria for requesting screening mammography by means of an information system. The population coverage rate in the program ranged from 23% to 88%. Conclusions: Primary Health Care in Brazil presents devices with potential to induce the production of care for breast cancer screening.

RESUMEN Objetivos: analizar las estrategias de atención para el cribado del cáncer de mama en la Atención Primaria de Salud en Brasil. Métodos: se trata de una revisión sistemática siguiendo las recomendaciones de la Colaboración Cochrane. Resultados: de 355 manuscritos, cinco fueron elegibles. El programa de navegación del paciente por parte del Agente de Salud Comunitaria se destacó con mejor resultado, entre las estrategias: flexibilidad de las metas considerando la viabilidad; participación de la comunidad; entrenamiento en equipo; búsqueda activa de la población objetivo por parte del Agente de Salud Comunitaria; solicitud de mamografía por parte de los médicos; acciones integradas a la salud de la mujer; el seguimiento de los resultados de las mamografías, las usuarias ausentes y la cobertura poblacional por médico y enfermero, y la evaluación de los criterios para solicitar la mamografía de cribado mediante un sistema de información. La tasa de cobertura de la población en el programa osciló entre 23% y 88%. Conclusiones: la Atención Primaria de Salud en Brasil presenta dispositivos con potencial para inducir la producción de cuidados para el cribado del cáncer de mama.

RESUMO Objetivos: analisar estratégias de cuidado para o rastreio do câncer de mama na Atenção Primária à Saúde no Brasil. Métodos: trata-se de uma revisão sistemática seguindo as recomendações da Colaboração Cochrane. Resultados: entre 355 manuscritos, foram elegíveis cinco. O programa de navegação do paciente pelo Agente Comunitário de Saúde destacou-se com o melhor resultado, dentre as estratégias: flexibilização das metas considerando a viabilidade; engajamento comunitário; treinamento da equipe; busca ativa da população-alvo pelo Agente Comunitário de Saúde; solicitação da mamografia por médicos; ações integradas à saúde da mulher; monitoramento do resultado da mamografia, das usuárias faltosas, e da cobertura da população por médico e enfermeiro e avaliação dos critérios de solicitação da mamografia de rastreamento por meio de sistema de informação. A taxa de cobertura da população no programa variou de 23% a 88%. Conclusões: a Atenção Primária à Saúde brasileira apresenta dispositivos com potencial indutor à produção de cuidado do rastreio do câncer de mama.

Breast cancer screening in Primary Health Care in Brazil: a systematic review / Cribado del cáncer de mama en la Atención Primaria de Salud en Brasil: una revisión sistemática / Rastreamento do câncer de mama na Atenção Primária à Saúde no Brasil: revisão sistemática

ABSTRACT Objectives: to analyze care strategies for breast cancer screening in Primary Health Care in Brazil. Methods: this is a systematic review following the Cochrane Collaboration recommendations. Results: among 355 manuscripts, five were eligible. The patient navigation program by Community Health Agent stood out with the best result, among the strategies: flexibility of goals considering viability; community engagement; team training; active search of the target population by Community Health Agent; request for mammography by physicians; actions integrated to women's health; monitoring of mammography results, absent users, and population coverage by physician and nurse; and assessment of criteria for requesting screening mammography by means of an information system. The population coverage rate in the program ranged from 23% to 88%. Conclusions: Primary Health Care in Brazil presents devices with potential to induce the production of care for breast cancer screening.

RESUMEN Objetivos: analizar las estrategias de atención para el cribado del cáncer de mama en la Atención Primaria de Salud en Brasil. Métodos: se trata de una revisión sistemática siguiendo las recomendaciones de la Colaboración Cochrane. Resultados: de 355 manuscritos, cinco fueron elegibles. El programa de navegación del paciente por parte del Agente de Salud Comunitaria se destacó con mejor resultado, entre las estrategias: flexibilidad de las metas considerando la viabilidad; participación de la comunidad; entrenamiento en equipo; búsqueda activa de la población objetivo por parte del Agente de Salud Comunitaria; solicitud de mamografía por parte de los médicos; acciones integradas a la salud de la mujer; el seguimiento de los resultados de las mamografías, las usuarias ausentes y la cobertura poblacional por médico y enfermero, y la evaluación de los criterios para solicitar la mamografía de cribado mediante un sistema de información. La tasa de cobertura de la población en el programa osciló entre 23% y 88%. Conclusiones: la Atención Primaria de Salud en Brasil presenta dispositivos con potencial para inducir la producción de cuidados para el cribado del cáncer de mama.

RESUMO Objetivos: analisar estratégias de cuidado para o rastreio do câncer de mama na Atenção Primária à Saúde no Brasil. Métodos: trata-se de uma revisão sistemática seguindo as recomendações da Colaboração Cochrane. Resultados: entre 355 manuscritos, foram elegíveis cinco. O programa de navegação do paciente pelo Agente Comunitário de Saúde destacou-se com o melhor resultado, dentre as estratégias: flexibilização das metas considerando a viabilidade; engajamento comunitário; treinamento da equipe; busca ativa da população-alvo pelo Agente Comunitário de Saúde; solicitação da mamografia por médicos; ações integradas à saúde da mulher; monitoramento do resultado da mamografia, das usuárias faltosas, e da cobertura da população por médico e enfermeiro e avaliação dos critérios de solicitação da mamografia de rastreamento por meio de sistema de informação. A taxa de cobertura da população no programa variou de 23% a 88%. Conclusões: a Atenção Primária à Saúde brasileira apresenta dispositivos com potencial indutor à produção de cuidado do rastreio do câncer de mama.

Low birth weight and the delay on the eruption of deciduous teething in children / Baixo peso ao nascer e atraso na erupção de dentes decíduos em crianças

Abstract Objectives: To analyze the association between low birth weight (LBW) and the occurrence of the delay on the eruption of deciduous teething (DEDT) in children from 04 to 30 months, living in Salvador, Bahia. Methods: A cross-sectional study involved 520 children at four to thirty months of age, from public, private and philanthropic daycares from two districts in Salvador. A descriptive analysis and unconditional logistic regression were done to estimate the odds ratios (ORs), using the Confidence Interval of 95% as a criterion for accepting associations. Poisson regression was used as an analytical strategy to obtain the prevalence ratio. Results: the prevalence of the delay on the eruption was 10.29%. There was a positive association between LBW and occurrence of DEDT among children with less than 24 months, both in the unadjusted model (PR=2.07, 95%CI= 0.96 4.44) as in the adjusted (adjusted PR=2, 27, 95%CI= 1.02 5.07). Conclusions: the variables of development and nutritional at birth and during the early life may be important predictors of the chronology of eruption. Further investigations should be carried out towards the adequate evaluation of the LBW role in the occurrence of the delay on the eruption.

Resumo Objetivos: analisar a associação entre o Baixo Peso ao Nascer (BPN) e a ocorrência de atraso na erupção da dentição decídua (AED) em crianças de 04 a 30 meses, residentes em Salvador-BA. Métodos: estudo transversal envolvendo 520 crianças que frequentavam creches públicas, privadas e filantrópicas de dois Distritos Sanitários de Salvador-Ba. Procedeu-se a análise descritiva e regressão logística não-condicional para estimação da oddsratios (ORs), empregando-se o Intervalo de Confiança a 95% como critério para aceitar as associações. A regressão de Poisson foi utilizada como estratégia analítica para obtenção da Razão de Prevalência. Resultados: a prevalência de atraso na erupção foi de 10,29%. Verificou-se uma associa-ção positiva entre BPN e ocorrência de AED entre as crianças com menos de 24 meses no modelo bruto (RP=2,07, IC95%= 0,96 4,44) e ajustado (RP ajustada=2,27, IC95%= 1,02 5,07). Conclusões: variáveis de desenvolvimento e nutricionais ao nascimento e durante a vida precoce podem ser importantes preditores do tempo de erupção, sendo necessárias outras investigações para uma adequada avaliação desta associação.

[Critical pathway of women facing violence: an integrative reviewLa ruta crítica que recorren las mujeres en situación de violencia: revisión integradora]. / Rota crítica de mulheres em situação de violência: revisão integrativa.

OBJECTIVE: To identify the critical pathway taken by women facing domestic violence in the world in their search for help. METHOD: An integrative review was performed. LILACS, MEDLINE/ PubMed, EMBASE, Scopus, and Web of Science databases were searched until year 2017. The following were inclusion criteria: full text available online, Portuguese, Spanish, or English as language of publication, focus on the theme of interest, and answering the guiding question (Which critical path is taken by women facing domestic violence?). RESULTS: Thirty-eight articles published from 2001 to 2017 were included. Factors driving the search for help included economic empowerment and increased schooling, severity of the violence, and presence of structured and qualified support services. Factors inhibiting the search for help were immigrant status, cultural gender norms, feelings of guilt, fear, and shame, lack of confidence and little knowledge and/or limited availability of formal support services. Children as well as family and community support may function as both inhibitors or drivers of the search for help. The types of formal help most often sought are police and health care services, whereas family, community, and religious leadership provide informal support. CONCLUSION: The critical pathway of women facing domestic violence in the world includes both formal and informal elements. Therefore, it is necessary to address sociocultural, community, and family issues so as to encourage women to break free from the violent environment and seek qualified formal support networks.

OBJETIVO: Conocer la ruta crítica que recorren las mujeres en situación de violencia doméstica en el mundo en su búsqueda de ayuda. MÉTODOS: Revisión integradora, con una búsqueda realizada en las bases de datos LILACS, MEDLINE vía PubMed, BASE, Scopus y Web of Science. No hubo restricción en cuanto al año inicial de las publicaciones, pero se estableció el 2017 como el año final. Se incluyeron artículos de texto completo disponible en línea, publicados en español, inglés o portugués, que trataran del tema de investigación y respondieran a la pregunta orientadora (¿Cuál es la ruta crítica que recorren las mujeres en situación de violencia doméstica?). RESULTADOS: Se incluyeron 38 artículos publicados desde el 2001 hasta el 2017. Entre los factores impulsores de la búsqueda de ayuda se encontraron el empoderamiento económico y el alto grado de escolaridad, la gravedad de la violencia y la existencia de servicios de apoyo estructurados y calificados. Como factores inhibidores se encontraron el hecho de que la mujer fuera inmigrante, la existencia de normas culturales de género, los sentimientos de culpa, miedo y vergüenza, la falta de confianza y el escaso conocimiento o la poca disponibilidad de servicios de apoyo formal. Los hijos y el apoyo de la familia y la comunidad pueden ser factores inhibidores o impulsores de la búsqueda de ayuda. Los tipos de ayuda formal más buscados son la policía y los servicios de salud, mientras que la familia, la comunidad y las autoridades religiosas se configuran como formas de apoyo informal. CONCLUSIÓN: La ruta crítica que recorren las mujeres en situación de violencia doméstica en el mundo comprende la búsqueda de ayuda formal e informal. Por lo tanto, es preciso trabajar en los aspectos socioculturales, comunitarios y familiares para incentivar a las mujeres a desvincularse de la situación de violencia, lo cual incluye la búsqueda de una red de apoyo formal calificada.

Analysis of the influence of low birth weight on the time of eruption of dental caries in children in early childhood.

OBJECTIVE: To estimate the time, in days, from the beginning of the monitoring until the occurrence of dental caries and its association with low birth weight in early childhood. METHODS: This longitudinal study, dynamic cohort type with a study population of 1,109 children from public, private, and philanthropic daycares in Salvador, Bahia. The independent variables considered were sociodemographic, perinatal, and behavioral, such as the type of breastfeeding. Survival analysis was used to estimate the time for the development of caries with the Kaplan-Meier method. The Cox Regression was used on the multivariate analysis to assess the association with low birth weight (LBW). RESULTS: Out of the total of 1,109 children, 419 developed the disease and the median time to the occurrence of caries was approximately 18 months. District of origin, type of daycare, age, skin color, maternal education, family income, living in a home with less than four rooms, breastfeeding habits, the presence of biofilm and of active white spot, and previous caries experience were identified as potential determinants of the time until the occurrence of caries. It was found a positive association between LBW and the time to the development of caries in both the not adjusted (RF = 1.21, 95 percent CI 0.88-1.65) and adjusted model (adjusted RF = 1.52, 95 percent CI 1.01-2.28). CONCLUSION: LBW was associated with dental caries.

Transcendendo: A Cohort Study of HIV-Infected and Uninfected Transgender Women in Rio de Janeiro, Brazil.

Purpose: Worldwide, the burden of adverse health conditions is substantial among travestis and transgender women (trans women). Transcendendo, the first trans-specific cohort in a low- or middle-income country, is an open cohort established in August 2015 to longitudinally evaluate the health aspects of trans women aged ≥18 years in Rio de Janeiro, Brazil. Methods: Study visits occur on an annual basis. Data on sociodemographics, behavioral, gender transition, affirmation procedures, hormone use, discrimination, violence, clinical and mental health, HIV prevention, and care (for those HIV-infected) are collected. Physical examination, anthropometric measurements, and laboratory tests are performed. Results: As of July 2017, 322 trans women were enrolled in the cohort with a median age of 31.5 years (interquartile range 25.7-39.5), of whom 174 (54%) were HIV-infected. The Transcendendo baseline information reinforces the scenario of marginalization and deprivation surrounding trans women. Most participants had low income (62.0% were living with below US$ 10.00/day), showed a very high engagement in sex work (78.6%), and reported increased occurrence of sexual (46.3%) and physical (54.0%) violence. Pre-exposure peophylaxis (PReP) was used by 18.8% of the HIV-uninfected trans women, only through research participation. Positive screening for depression (57.8%) and problematic use of tobacco (56.6%), cannabis (28.9%), cocaine (23.8%), and alcohol (21.5%) were high. Almost all participants (94.8%) reported hormone use at some point, mostly without medical supervision (78.7%). Conclusion: Our results describe a context of exclusion experienced by trans women, exposing vulnerabilities of this population in a middle-income country, with poor access to trans-specific care, HIV prevention and care, and mental health care. Addressing transgender experiences and needs can help the development of strategies to diminish stigma, improve health care environment, guide future research on trans morbidities, substance use, and trans-specific interventions to support health-related recommendations. Ultimately, it contributes to close the gaps concerning transgender health and reinforces that trans care cannot be disentangled from the social environment that surrounds trans women.

Rota crítica de mulheres em situação de violência: revisão integrativa

[RESUMO]. Objetivo. Conhecer a rota crítica de mulheres em situação de violência doméstica no mundo em sua busca por ajuda. Métodos. Revisão integrativa, com busca realizada nas bases de dados LILACS, MEDLINE via PubMed, EMBASE, Scopus e Web of Science. Não houve restrição quanto ao ano inicial das publicações, porém estabeleceu-se 2017 como ano final. Foram incluídos artigos com disponibilidade do texto integral on-line, publicados em português, inglês ou espanhol, que tratassem do tema da pesquisa e respondessem à pergunta norteadora (“Qual a rota crítica de mulheres em situação de violência doméstica?”). Resultados. Foram incluídos 38 artigos, publicados de 2001 a 2017. Entre os fatores impulsores da busca por ajuda identificaram-se empoderamento econômico e alta escolaridade, severidade da violência e presença de serviços de apoio estruturados e qualificados. Como inibidores identificaram-se o fato de a mulher ser imigrante, a existência de normas culturais de gênero, sentimentos de culpa, medo e vergonha, falta de confiança e pouco conhecimento e/ou disponibilidade limitada de serviços de apoio formal. Filhos, apoio da família e comunidade podem ser fatores inibidores ou impulsores da busca por ajuda. Os tipos de ajuda formal mais procurados são a polícia e os serviços de saúde, enquanto a família, a comunidade e as lideranças religiosas se configuram como apoios informais. Conclusão. A rota crítica das mulheres em situação de violência doméstica no mundo existe de maneira formal e informal. Portanto, é preciso trabalhar questões socioculturais, comunitárias e familiares para incentivar a mulher a romper com a situação de violência, incluindo a busca pela rede de apoio formal qualificada.

[ABSTRACT Objective. To identify the critical pathway taken by women facing domestic violence in the world in their search for help. Method. An integrative review was performed. LILACS, MEDLINE/ PubMed, EMBASE, Scopus, and Web of Science databases were searched until year 2017. The following were inclusion criteria: full text available online, Portuguese, Spanish, or English as language of publication, focus on the theme of interest, and answering the guiding question (Which critical path is taken by women facing domestic violence?). Results. Thirty-eight articles published from 2001 to 2017 were included. Factors driving the search for help included economic empowerment and increased schooling, severity of the violence, and presence of structured and qualified support services. Factors inhibiting the search for help were immigrant status, cultural gender norms, feelings of guilt, fear, and shame, lack of confidence and little knowledge and/or limited availability of formal support services. Children as well as family and community support may function as both inhibitors or drivers of the search for help. The types of formal help most often sought are police and health care services, whereas family, community, and religious leadership provide informal support. Conclusion. The critical pathway of women facing domestic violence in the world includes both formal and informal elements. Therefore, it is necessary to address sociocultural, community, and family issues so as to encourage women to break free from the violent environment and seek qualified formal support networks.

[RESUMEN]. Objetivo. Conocer la ruta crítica que recorren las mujeres en situación de violencia doméstica en el mundo en su búsqueda de ayuda. Métodos. Revisión integradora, con una búsqueda realizada en las bases de datos LILACS, MEDLINE vía PubMed, BASE, Scopus y Web of Science. No hubo restricción en cuanto al año inicial de las publicaciones, pero se estableció el 2017 como el año final. Se incluyeron artículos de texto completo disponible en línea, publicados en español, inglés o portugués, que trataran del tema de investigación y respondieran a la pregunta orientadora (¿Cuál es la ruta crítica que recorren las mujeres en situación de violencia doméstica?). Resultados. Se incluyeron 38 artículos publicados desde el 2001 hasta el 2017. Entre los factores impulsores de la búsqueda de ayuda se encontraron el empoderamiento económico y el alto grado de escolaridad, la gravedad de la violencia y la existencia de servicios de apoyo estructurados y calificados. Como factores inhibidores se encontraron el hecho de que la mujer fuera inmigrante, la existencia de normas culturales de género, los sentimientos de culpa, miedo y vergüenza, la falta de confianza y el escaso conocimiento o la poca disponibilidad de servicios de apoyo formal. Los hijos y el apoyo de la familia y la comunidad pueden ser factores inhibidores o impulsores de la búsqueda de ayuda. Los tipos de ayuda formal más buscados son la policía y los servicios de salud, mientras que la familia, la comunidad y las autoridades religiosas se configuran como formas de apoyo informal. Conclusión. La ruta crítica que recorren las mujeres en situación de violencia doméstica en el mundo comprende la búsqueda de ayuda formal e informal. Por lo tanto, es preciso trabajar en los aspectos socioculturales, comunitarios y familiares para incentivar a las mujeres a desvincularse de la situación de violencia, lo cual incluye la búsqueda de una red de apoyo formal calificada.

Barriers and facilitators to PrEP for transwomen in Brazil.

Pre-exposure prophylaxis (PrEP) is an important biomedical intervention that may help reduce the risk of HIV transmission among transwomen. To date, little research is available to inform interventions to increase uptake and adherence to PrEP among transwomen, especially in places outside the U.S. We conducted a qualitative study in 2015 with 34 adult transwomen in Rio de Janeiro, Brazil and assessed awareness, interest, barriers and facilitators to PrEP uptake and adherence for transwomen. Almost one third of participants had heard of PrEP, and most were interested and thought it would be beneficial for transwomen in their community. Barriers to PrEP included fear of being HIV positive resulting in low HIV testing and concerns about the ability to adhere to a daily PrEP regimen. The most prominent barrier to uptake was past experiences of transgender-identity related discrimination in the universal health care system that reduced willingness to seek PrEP or health care in general. Participants recommended technological solutions to PrEP health education information that could address uptake and adherence. This study informs efforts to increase PrEP use among transwomen in Brazil.