"Mesmo que a gente seja a mão que cuida": médicas negras e racismo estrutural no contexto da atenção primária à saúde / "Even if we are the caring hand": Black doctors and structural racism in the context of primary health care

Resumo Trata-se de estudo sobre o racismo estrutural na formação e na ocupação de trabalhadoras e trabalhadores negros atuando na atenção primária à saúde (APS) no município do Rio de Janeiro, a partir da experiência de médicas negras. Realizou-se um estudo qualitativo, utilizando grupo focal, conduzido em novembro de 2022. Utilizou-se o interacionismo simbólico como referência para a interpretação relacionada às situações que compõem as experiências/vivências a partir do racismo. Os achados foram reunidos em dois eixos: manifestação do racismo estrutural e institucional no âmbito do SUS; e como o racismo atravessa os processos de trabalho em saúde e suas repercussões. Os resultados revelam uma continuidade das implicações do racismo desde a formação de médicas negras até o trabalho na APS, tornando-se um obstáculo na reorganização do processo de trabalho na perspectiva territorial de atenção à saúde. As participantes identificam o racismo institucional e estrutural na negligência da gestão, na violência do território e na vacância de médicos nas equipes desses territórios, limitando a oferta de um cuidado adequado. É necessário desvelar e aprofundar a compreensão do caráter estrutural do racismo da organização do trabalho em saúde, tendo como imagem-objetivo a saúde como direito.

Abstract This study scrutinizes structural racism's influence on the training and work of Black professionals in primary health care (PHC) in Rio de Janeiro, particularly focusing on the experiences of Black female physicians. Employing a qualitative approach via a Focus Group, conducted in November 2022, we adopted symbolic interactionism to interpret racism-related experiences. Our findings encompass two primary dimensions: the manifestation of structural and institutional racism within the Unified Health System (SUS), and how racism permeates health work processes and consequences. Results highlight enduring impacts, spanning education to PHC roles, hindering healthcare process recalibration. Participants identify institutional and structural racism, from managerial neglect to territorial violence and physician scarcity, constraining comprehensive care. It is crucial to unveil and grasp racism's structural essence within healthcare, aligned with the vision of health as a fundamental right.

Educational technologies for HIV prevention in black people: scope review / Tecnologías educativas para la prevención del VIH en negros: revisión del alcance / Tecnologias educativas para prevenção do HIV em negros: revisão de escopo

ABSTRACT Objective: To map the educational technologies implemented for HIV prevention in black people. Method: Scope review, performed according to the recommendations of The Joanna Briggs Institute, in Medline/PubMed, Embase, LILACS, CINAHL, Scopus, Cochrane and PsycINFO databases, using the Preferred Reporting Items for Systematic reviews and Meta- Analyses extension for Scoping Reviews (PRISMA-ScR). Results: There were 14 studies published between 1999 and 2020. The main health impacts for black people involved a reduction in rates of unprotected sex, greater use of condoms, a decrease in risky behaviors, a minimization of the number of partners, a greater request for HIV testing and an increase in the use of Pre-exposure prophylaxis (PrEP). Conclusion: The educational technologies mapped were: workshops, courses, messages, dramatization, videos, application, pamphlet, media and radio campaigns, Facebook groups, website, computer programs and multimedia software.

RESUMEN Objetivo: Mapear las tecnologías educativas implementadas para la prevención del VIH en negros. Método: Revisión de alcance, realizada de acuerdo con las recomendaciones de The Joanna Briggs Institute, en las bases de datos Medline/PubMed, Embase, LILACS, CINAHL, Scopus, Cochrane y PsycINFO, utilizando Preferred Reporting Items for Systematic reviews y Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). Resultados: Se publicaron 14 estudios entre 1999 y 2020. Los principales impactos en la salud de los negros involucraron una reducción en las tasas de sexo sin protección, mayor uso de condones, una disminución en los comportamientos de riesgo, una minimización del número de parejas, una mayor solicitud de pruebas de VIH y un aumento en el uso de Pre-exposición profilaxis (PrEP). Conclusión: Las tecnologías educativas mapeadas fueron: talleres, cursos, mensajes, dramatización, videos, aplicación, folleto, campañas en medios y radio, grupos de Facebook, sitio web, programas informáticos y software multimedia.

RESUMO Objetivo: Mapear as tecnologias educativas implementadas para prevenção do HIV em negros. Método: Revisão de escopo, realizada conforme as recomendações do The Joanna Briggs Institute, nas bases de dados Medline/PubMed, Embase, LILACS, CINAHL, Scopus, Cochrane e PsycINFO, utilizando-se do instrumento Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Resultados: Encontraram-se 14 estudos publicados entre 1999 e 2020. Os principais impactos para saúde dos negros envolveram a redução das taxas de relações sexuais desprotegidas, o maior uso de preservativos, a diminuição de comportamentos de risco, a minimização do número de parceiros, a maior solicitação de testagens para HIV e o aumento do uso de Profilaxia Pré-exposição (PrEP). Conclusão: As tecnologias educativas mapeadas foram: workshops, cursos, mensagens, dramatização, vídeos, aplicativo, panfleto, campanhas de mídia e de rádio, grupos de Facebook, site, programas de computadores e softwares multimídia.

O lugar das práticas artístico-culturais na constituição da negritude para negros/as de pele clara / El lugar de las prácticas artístico-culturales en la constitución de la negritud para negros/as de piel clara / The place of artistic-cultural practices in the constitution of blackness for light-skinned black people

Resumo Este artigo tem como objetivo compreender o processo de identificação e pertencimento racial de pessoas negras de pele clara mediante análise das expressões artístico-culturais e os efeitos subjetivos para sua racialização. Optamos por analisar aqui as expressões artístico-culturais trazidas pelos/as participantes e os efeitos subjetivos no constituir-se como negro/a. A imersão em práticas artístico-culturais, expressas por meio de múltiplas dimensões da linguagem pelo corpo performático, pode impulsionar a identidade negra positiva, construindo imagens identificatórias que estimulam outras narrativas sobre si, seu corpo e sua negritude. Dentre as expressões artístico-culturais trazidas pelos/as participantes destacam-se o Sopapo poético, o slam e o rap, que são formas de aquilombamento por meio de escrevivências, dos corpoemas, das oralituras e das atrevivências. Podemos concluir que as produções estéticas de negritude são fundamentais para o processo de tornar-se negro.

Resumen Este artículo tiene como objetivo comprender el proceso de identificación y pertenencia racial de personas negras de piel clara mediante el análisis de expresiones artístico-culturales y los efectos subjetivos en su racialización. Optamos por analizar aquí las expresiones artístico-culturales aportadas por los/as participantes y los efectos subjetivos en la construcción de su identidad como negro/a. La inmersión en prácticas artístico-culturales, expresadas a través de múltiples dimensiones del lenguaje en el cuerpo performativo, puede impulsar una identidad negra positiva, construyendo imágenes identificatorias que estimulan otras narrativas sobre uno mismo, su cuerpo y su negritud. Entre las expresiones artístico-culturales aportadas por los/as participantes, destacan el Sopapo poético, el slam y el rap, que son formas de comunidad a través de la escrevivencias, los corpoemas, la oralidad y las experiencias audaces. Podemos concluir que las producciones estéticas de la negritud son fundamentales para el proceso de convertirse en negro/a.

Abstract This article aims to understand the process of racial identification and belonging of light-skinned Black individuals through the analysis of artistic-cultural expressions and their subjective effects on their racialization. We chose to examine here the artistic-cultural expressions brought by the participants and the subjective effects on their self-identification as Black. Immersion in artistic-cultural practices, expressed through multiple dimensions of language in the performative body, can promote positive Black identity by constructing identifying images that stimulate other narratives about oneself, one's body, and one's blackness. Among the artistic-cultural expressions brought by the participants, the poetic Sopapo, Slam, and rap stand out as forms of aquilombamento through escrevivências, corpoemas, oralitura, and atrevivências. We can conclude that the aesthetic productions of blackness are essential to the process of becoming Black.

Transtorno depressivo em mulheres no período pós-parto: análise segundo a raça/cor autorreferida / Trastorno depresivo en mujeres en el período posparto: análisis según raza/color autodeclarado / Depressive disorder among postpartum women: an analysis according to self-reported race/color

Resumo Objetivo Identificar a raça/cor autorreferida por mulheres com 60 dias de pós-parto; identificar a prevalência do indicativo de transtorno depressivo nessas mulheres e verificar a associação entre o indicativo de transtorno depressivo e o quesito raça/cor autorreferida. Métodos Estudo transversal desenvolvido em um município do interior paulista. Foram utilizados, para a coleta de dados, um instrumento com dados sociodemográficos e a Escala de Depressão Pós-Natal de Edimburgo. Os dados foram analisados utilizando-se o Statistical Package for Social Sciences, SPSS, versão 17.0. Resultados Participaram deste estudo 186 mulheres, 60,8% referiram ser da cor parda, 24,2% apresentaram indicativo de transtorno depressivo e, entre estas, 81,7% eram da raça negra. O indicativo de transtorno depressivo associou-se às variáveis: número de filhos (p=0,006), gestação planejada (p=0,04) e tipo de parto (p< 0,001). Conclusão Os resultados deste estudo contribuem para maior visibilidade da temática da saúde mental das mulheres, especificamente das mulheres negras, pois, mesmo que não tenha sido identificada associação significativa dentre aquelas que apresentaram indicativo de transtorno depressivo, a maioria era da raça negra.

Resumen Objetivo Identificar la raza/color autodeclarado por mujeres con 60 días de posparto, identificar la prevalencia de indicios de trastorno depresivo en esas mujeres y verificar la relación entre los indicios de trastorno depresivo y el ítem raza/color autodeclarado. Métodos Estudio transversal realizado en un municipio del interior paulista. Para la recopilación de datos, se utilizó un instrumento con datos sociodemográficos y la Escala de Depresión Posnatal de Edimburgo. Para analizar los datos se utilizó el Statistical Package for Social Sciences, SPSS, versión 17.0. Resultados Participaron en el estudio 186 mujeres, el 60,8 % declararon ser de color pardo, el 24,2 % presentó indicios de trastorno depresivo y, entre ellas, el 81,7 % era de raza negra. Los indicios de trastorno depresivo se relacionaron a las variables: número de hijos (p=0,006), embarazo planeado (p=0,04) y tipo de parto (p< 0,001). Conclusión Los resultados de este estudio contribuyen para una mayor visibilidad del tema de salud mental de las mujeres, específicamente de mujeres negras, ya que, aunque no se haya identificado una relación significativa entre las que presentaron indicios de trastorno depresivo, la mayoría era de raza negra.

Abstract Objective To identify the race/color self-reported by women 60 days postpartum; to identify the prevalence of signs of depressive disorder among these women and to verify the association between signs of depressive disorder and the self-reported race/color. Methods Cross-sectional study carried out in a noncapital city in the state of São Paulo. An instrument with sociodemographic data and the Edinburgh Postnatal Depression Scale were used for data collection. Data was analyzed using the Statistical Package for Social Sciences, SPSS, version 17.0. Results A total of 186 women participated in this study, 60.8% reported being brown, 24.2% had signs of depressive disorder and, among these, 81.7% were black. Signs of depressive disorder were associated with the variables: number of children (p=0.006), planned pregnancy (p=0.04) and type of delivery (p< 0.001). Conclusion The results of this study contribute to greater visibility of the issue of women's mental health, specifically of black women, because even though no significant association was identified among those who showed signs of depressive disorder, most were black.

Does Home Remedy Use Contribute to Medication Nonadherence Among Blacks with Hypertension?

Background: Home remedies (HRs) are described as foods, herbs, and other household products used to manage chronic conditions. The objective of this study was to examine home remedy (HR) use among Blacks with hypertension and to determine if home remedy use is correlated with blood pressure and medication adherence. Methods: Data for this cross-sectional study were obtained from the TRUST study conducted between 2006-2008. Medication adherence was measured using the Morisky Medication Adherence Scale, and HR use was self-reported. Multivariable associations were quantified using ordinal logistic regression. Results: The study sample consisted of 788 Blacks with hypertension living in the southern region of the United States. HR use was associated with higher systolic (HR users 152.79, nonusers 149.53; P=.004) and diastolic blood pressure (HR users 84.10, nonusers 82.14 P=.005). Use of two or more HRs was associated with low adherence (OR: .55, CI: .36-.83, P= .004). Conclusion: The use of HR and the number of HRs used may be associated with medication nonadherence, and higher systolic and diastolic blood pressure among Blacks with hypertension. Medication nonadherence is of critical importance for individuals with hypertension, and it is essential that health care providers be aware of health behaviors that may serve as barriers to medication adherence, such as use of home remedies.

Natação e questões étnico-raciais: representações midiáticas / Swimming and ethnic-racial issues: media representations / Natación y cuestiones étnico-raciales: representaciones mediáticas

Resumo: Este estudo busca analisar o discurso midiático e suas representações sobre dois atletas da natação brasileira de alto rendimento no contexto da discussão étnico-racial: Etiene Medeiros e Edvaldo Valério. Esta pesquisa é de natureza qualitativa. Demonstrou-se nos resultados que o discurso midiático se apropria acriticamente de tradições científicas de bases biológicas que naturalizam a ausência de negros no cenário competitivo da natação mundial.

Abstract: This study analyzes media discourses and their representations about two Brazilian high-performance swimmers in the ethnic-racial debate: Etiene Medeiros e Edvaldo Valério. This research is qualitative, and its results demonstrated that media discourses uncritically appropriate biological scientific traditions that naturalize the absence of blacks at the competitive scenario of international swimming.

Resumen: Este estudio tiene como objetivo analizar el discurso mediático y sus representaciones sobre dos nadadores brasileños de alto rendimiento en el contexto de la discusión étnico-racial: Etiene Medeiros y Edvaldo Valério. Esta investigación es de naturaleza cualitativa. Se ha demostrado en los resultados que el discurso mediático se apropia de manera acrítica de las tradiciones científicas de bases biológicas que naturalizan la ausencia de negros en el escenario competitivo de la natación mundial.

Entre o debate público e o silêncio: análise da cobertura jornalística online sobre a questão do suicídio de adolescentes e jovens negros no Brasil / Between public debate and silence: analysis of online journalist coverage about the suicide of black teenagers and youth in Brazil / Entre debate público y silencio: análisis de la cobertura periodística online sobre el tema del suicidio de adolescentes y jóvenes en Brasil

Este artigo objetiva analisar o fomento do debate público promovido pela cobertura jornalística on-line sobre a questão do suicídio de adolescentes e jovens negros no Brasil. Para isso, foram selecionadas três reportagens de três veículos de comunicação: G1 ­ Ciência e Saúde (ligado às Organizações Globo), Nexo (jornal digital independente) e o Alma Preta (agência de jornalismo especializada na temática étnica do Brasil). Com o uso de teorias sobre prática jornalística, opinião pública e silêncio, além do emprego da hermenêutica de profundidade, este estudo concluiu que a mídia não promove integralmente o debate público sobre a questão. O G1 ­ Ciência e Saúde reproduziu o discurso da mídia hegemônica, não dando voz para os negros; o Nexo foi o jornal que tratou o tema de forma mais completa, com uso de dados e fontes, sendo negra uma delas; e o Alma Preta foi o que menos abriu espaço para identificação do público negro, com a ausência de fontes e falta de representação.

This article aims to analyze the public debate at online journalistic coverage on the issue of suicide among black teenagers and young people in Brazil. For this, three news from three media were selected: G1 Ciência e Saúde (linked to Globo Organizations), Nexo (independent digital newspaper) and Alma Preta (journalism agency specializing in ethnic issues in Brazil). Using theories of journalistic practice, public opinion and silence, as well as the use of deep hermeneutics, this study concluded that the media does not fully promote public debate on the issue. G1 ­ Ciência e Saúde reproduced the hegemonic media discourse, giving no voice to blacks; Nexo was the newspaper that dealt with the theme most completely, using data and sources, one of them being black; and Alma Preta was the least open to the identification of the black public, with the absence of sources and lack of representation.

Este artículo tiene como objetivo analizar el debate público a través de la cobertura periodística online sobre el tema del suicidio entre adolescentes y jóvenes negros en Brasil. Para esto se seleccionaron tres medios: G1 ­ Ciência e Saúde (vinculado a Organizaciones Globo), Nexo (periódico digital independiente) y Alma Preta (agencia de periodismo especializada em temas étnicos en Brasil). Utilizando teorías de práctica periodística, opinión pública y silencio, así como el uso de una hermenéutica profunda, este estudio concluyó que los medios no promueven completamente el debate público sobre el tema. G1 ­ Ciência e Saúde reprodujo el discurso de los medios hegemónicos, sin dar voz a los negros; Nexo fue el periódico que trató el tema más completamente, utilizando datos y fuentes; y Alma Preta fue la menos abierta a la identificación del público negro, con la ausencia de fuentes y la falta de representación.

Everyday Discrimination Experience and Depressive Symptoms in Urban Black, Guyanese, Hispanic, and White Adults.

BACKGROUND: Discrimination experience is a stressor that may disproportionately affect the mental health of minority populations. AIMS: We examined the association between discrimination experience and depressive symptoms among four urban racial/ethnic groups. METHOD: Cross-sectional community-based health survey data for Black (n = 434), Guyanese (n = 180), Hispanic (n = 173), and White (n = 809) adults aged ⩾18 years were collected in Schenectady, New York, in 2013. Discrimination experience was measured with the Everyday Discrimination Scale (EDS), and depressive symptoms were measured with the Center for Epidemiologic Studies-Depression (CES-D) scale. Logistic regression models for the association between EDS and major depressive symptoms (CES-D ⩾ 16) were fitted for each racial/ethnic group. The final model adjusted for age, sex, education, income, smoking, alcohol binge drinking, emotional/social support, and perceived stress. RESULTS: The mean EDS scores varied significantly across groups (p < .001), with 2.6 in Hispanics, 2.2 in Whites, 2.0 in Blacks, and 1.1 in the Guyanese. There was a consistent and significant independent association between EDS and major depressive symptoms in the crude model and at each step of covariate adjustment in each group. Fully adjusted odds ratios were 1.28 (95% confidence interval [CI; 1.16, 1.41]) in Blacks, 1.83 in the Guyanese [1.36, 2.47], 1.23 in Hispanics [1.07, 1.41], and 1.24 [1.16, 1.33] in Whites. The presence of covariates did not significantly modify the main effect in each group. CONCLUSIONS: This study suggests that discrimination experience can be one of the fundamental social causes of depression. It may be feasible to assess discrimination experience as a risk factor of depression in individuals of all racial/ethnic backgrounds.

Saúde Mental e Racismo Contra Negros: Produção Bibliográfica Brasileira dos Últimos Quinze Anos / Mental Health and Racism against Blacks: Brazilian Publications within the Last Fifteen Years / Salud Mental y Racismo Contra Negros: Producción Bibliográfica Brasileña de los Últimos Quince Años

Opressão, agressão e violência são práticas que afetam a saúde mental da pessoa alvo. O racismo, como crença na superioridade de algumas raças sobre outras, que justifica a desigualdade entre os grupos, é uma forma de opressão, de agressão e de violência. O objetivo geral desta revisão sistemática foi encontrar na literatura científica brasileira estudos sobre o impacto do racismo na saúde mental de negros no Brasil; o objetivo específico foi verificar a contribuição da Psicologia nesse tópico. Foram realizadas buscas nas plataformas SciELO e Lilacs, referentes ao período de 1999 a 2014, as quais retornaram 509 artigos, que foram filtrados segundo critérios definidos. Dezenove artigos foram considerados relevantes para análise, mesmo que não tratando exclusivamente do impacto do racismo na saúde mental. Concluiu-se que o tema tem baixa produção acadêmica no Brasil de modo geral, pouca contribuição da Psicologia e menos ainda das demais disciplinas afetas aos CAPS (Centros de Assistência Psicossocial), espaços de assistência pública à saúde mental, buscados majoritariamente pela população negra de baixa renda, dependente dos serviços de saúde pública....(AU)

Oppression, aggression and violence are practices that affect the mental health of the target person. Racism, the belief that some races are superior to others, which justifies inequalities among groups, is a form of oppression, aggression and violence. The general objective of this systematic review was to find in the Brazilian scientific literature studies on the impact of racism on mental health of the black population in Brazil; the secondary objective was to verify the contributions of psychology to this topic. Searches, carried out in SciELO and Lilacs platforms, returned 509 articles, that were filtered according to criteria of interest. Nineteen articles were considered relevant for analysis, even if they did not deal exclusively with the impact of racism on mental health. It was found that this subject has low academic production in Brazil, low contribution from Psychology and even less, or none, from other disciplines related to the CAPS (Psychosocial Assistance Centers), public agencies for mental health care requested mainly by low income black population dependent on public health services....(AU)

Oppression, aggression and violence are practices that affect the mental health of the target person. Racism, the belief that some races are superior to others, which justifies inequalities among groups, is a form of oppression, aggression and violence. The general objective of this systematic review was to find in the Brazilian scientific literature studies on the impact of racism on mental health of the black population in Brazil; the secondary objective was to verify the contributions of psychology to this topic. Searches, carried out in SciELO and Lilacs platforms, returned 509 articles, that were filtered according to criteria of interest. Nineteen articles were considered relevant for analysis, even if they did not deal exclusively with the impact of racism on mental health. It was found that this subject has low academic production in Brazil, low contribution from Psychology and even less, or none, from other disciplines related to the CAPS (Psychosocial Assistance Centers), public agencies for mental health care requested mainly by low income black population dependent on public health services....(AU)

From the West Indies to Africa: A universal generational decline in health among blacks in the United States.

Research shows that foreign-born blacks have better health profiles than their U.S.-born counterparts. Less is known, however, regarding whether black immigrants' favorable health outcomes persist across generations or whether these patterns differ across the diverse sending regions for black immigrants. In this study, we use data from the 1996-2014 waves of the March Current Population Survey (CPS) to investigate generational differences in self-rated health among blacks with West Indian, Haitian, Latin American, and African ancestry. We show that first-generation black immigrants have a lower probability of reporting fair/poor health than third/higher generation blacks. The health advantage of the first generation over the third/higher generation is slightly more prounced among the foreign-born who migrated to the United States after age 13. Second-generation immigrants with two foreign-born parents are generally less likely to report their health as fair/poor than the third/higher generation. However, we find no evidence that self-reported fair/poor health varies between second-generation immigrants with mixed nativity parents (only one foreign-born parent) and the third/higher generation. These general patterns hold across each of the ancestral subgroups in the study sample. In summary, our findings highlight a remarkable convergence in health across immigrant generations among blacks in the United States.

The Burden of Cardiovascular Disease in Sub-Saharan Africa and the Black Diaspora.

For over four decades the National Medical Association (NMA) and the Association of Black Cardiologists (ABC) have sought to bring to national attention the disparate burden of cardiovascular disease (CVD) among African Americans. However, systematic inquiry has been inadequate into the burden of CVD in the poor countries of Sub-Saharan Africa (SSA) and the African diaspora in the Americas outside the USA. However, recently, the Global Burden of Disease Study (GBD) has offered new tools for such inquiry. Several initial efforts in that direction using 2010 data have been published. This article highlights some new findings for SSA for 2016. It also suggests that NMA and ABC further this effort by direct advocacy and collaboration with the GBD to make estimates of CVD burden in African Americans and South American Blacks explicitly available in future iterations.

Factors associated with elevated blood pressure or hypertension in Afro-Caribbean youth: a cross-sectional study.

BACKGROUND: Although several studies have identified risk factors for high blood pressure (BP), data from Afro-Caribbean populations are limited. Additionally, less is known about how putative risk factors operate in young adults and how social factors influence the risk of high BP. In this study, we estimated the relative risk for elevated BP or hypertension (EBP/HTN), defined as BP ≥ 120/80 mmHg, among young adults with putative cardiovascular disease (CVD) risk factors in Jamaica and evaluated whether relative risks differed by sex. METHODS: Data from 898 young adults, 18-20 years old, were analysed. BP was measured with a mercury sphygmomanometer after participants had been seated for 5 min. Anthropometric measurements were obtained, and glucose, lipids and insulin measured from a fasting venous blood sample. Data on socioeconomic status (SES) were obtained via questionnaire. CVD risk factor status was defined using standard cut-points or the upper quintile of the distribution where the numbers meeting standard cut-points were small. Relative risks were estimated using odds ratios (OR) from logistic regression models. RESULTS: Prevalence of EBP/HTN was 30% among males and 13% among females (p < 0.001 for sex difference). There was evidence for sex interaction in the relationship between EBP/HTN and some of risk factors (obesity and household possessions), therefore we report sex-specific analyses. In multivariable logistic regression models, factors independently associated with EBP/HTN among men were obesity (OR 8.48, 95% CI [2.64-27.2], p < 0.001), and high glucose (OR 2.01, CI [1.20-3.37], p = 0.008), while high HOMA-IR did not achieve statistical significance (OR 2.08, CI [0.94-4.58], p = 0.069). In similar models for women, high triglycerides (OR 1.98, CI [1.03-3.81], p = 0.040) and high HOMA-IR (OR 2.07, CI [1.03-4.12], p = 0.039) were positively associated with EBP/HTN. Lower SES was also associated with higher odds for EBP/HTN (OR 4.63, CI [1.31-16.4], p = 0.017, for moderate vs. high household possessions; OR 2.61, CI [0.70-9.77], p = 0.154 for low vs. high household possessions). Alcohol consumption was associated with lower odds of EBP/HTN among females only; OR 0.41 (CI [0.18-0.90], p = 0.026) for drinking <1 time per week vs. never drinkers, and OR 0.28 (CI [0.11-0.76], p = 0.012) for drinking ≥3 times per week vs. never drinkers. Physical activity was inversely associated with EBP/HTN in both males and females. CONCLUSION: Factors associated with EBP/HTN among Jamaican young adults include obesity, high glucose, high triglycerides and high HOMA-IR, with some significant differences by sex. Among women lower SES was positively associated with EBP/HTN, while moderate alcohol consumption was associated lower odds of EBP/HTN.

High Risk of Depression in High-Income African American Boys.

BACKGROUND: Despite the well-established literature on the protective effect of socioeconomic status (SES) on physical and mental health, there are a few reports on poor mental health of blacks with high SES. Using a national sample, this study investigated the association between household income and risk of major depressive disorder (MDD) in black youth based on ethnicity, gender, and their intersection. METHODS: One thousand one hundred seventeen black adolescents (810 African Americans and 360 Caribbean blacks) were included in the current study. Household income was the main predictor. MDD (lifetime, 12-month, and 30-day) was the main outcome. Age was the covariate. Ethnicity and gender were the focal moderators. Logistic regressions were used for data analysis. RESULTS: In the pooled sample, household income was not associated with risk of MDD (lifetime, 12-month, or 30-day). We found significant interactions between income and gender on lifetime and 12-month MDD, suggesting a stronger protective effect of income on MDD for females than males. We also found significant interaction between income and ethnicity on 30-day MDD, suggesting stronger protective effect of income against MDD for Caribbean blacks than African Americans. In African American males, high household income was associated with higher risk of lifetime, 12-month, and 30-day MDD. For Caribbean black males and females, high household income was associated with lower odds of 30-day MDD. CONCLUSION: Findings suggest that ethnicity and gender influence how socioeconomic resources such as income are associated with MDD risk among black youth. Higher household income may be associated with higher risk of MDD for African American males.

Ethnic and Nativity Differences in the Social Support-Physical Health Association Among Black Americans.

Despite an abundant literature on social support and health, relatively less is known about how support and its impact on physical health vary within the Black population. Using the National Survey of American Life (NSAL), this paper examines which sources and types of support are associated with physical health among African Americans, U.S.-born Caribbean Blacks and foreign-born Caribbean Blacks. The results showed that for U.S.-born Caribbean Blacks, being married was especially beneficial to health. Closeness to family was associated with better health while negative interactions with family members was associated with worse health for African Americans and foreign-born Caribbean Blacks. Different sources of instrumental support affected all three groups. Overall, the findings reveal that, among Black Americans, the association between social support and physical health is contingent upon ethnicity, nativity, and the ways in which social support and health are operationalized.

Desenvolvimento e validação do instrumento Percepção sobre Discriminação Racial Interpessoal nos Serviços de Saúde (DRISS) / Development and validity of the instrument Perception on Interpersonal Racial Discrimination in Healthcare Facilities (DRISS)

OBJETIVO: Desenvolver e validar um instrumento de medida das percepções sobre discriminação racial interpessoal no contexto dos serviços de saúde brasileiros. METODOLOGIA: Estudo do tipo metodológico conduzido com base na Teoria Clássica dos Testes para elaboração e validação psicométrica de instrumento. Para o desenvolvimento do pool de itens inicial, três fontes foram utilizadas: revisão de literatura sobre escalas já existentes; estudo qualitativo; e, sugestões de especialistas sobre racismo/desigualdades em saúde. O instrumento inicialmente proposto (versão 1) constava de 50 itens. Buscou-se verificar as evidências de validade de conteúdo e constructo e, para isso, a coleta de dados foi dividida em duas etapas. A primeira etapa consistiu na avaliação do instrumento proposto junto ao comitê de especialistas e a segunda etapa consistiu no preenchimento do instrumento pela população-alvo. A análise dos dados foi realizada no R e Stata 14.2. RESULTADOS: Na validação de face e conteúdo, a versão 1 foi submetida à avaliação por comitê de especialistas composto por um metodologista, um profissional de língua portuguesa, três especialistas em relações étnico-raciais e três membros da população-alvo. Dos 50 itens elaborados originalmente, foram excluídos 28 e restaram 22 (versão 2). O CVR (razão de validade de conteúdo) médio dos itens que restaram foi 0,74. Com relação à concordância entre os especialistas, o PABAK foi 0,30, considerado razoável. Entretanto, dos 22 itens que compuseram a versão 2, dois foram desmembrados, o que gerou a versão 3, com 24 itens. A versão 3 foi construída na plataforma digital Research Eletronic Data Capture (REDCap) e foi divulgada entre setembro e dezembro de 2017 por meio de um link (via redes sociais como Facebook e Whatsapp) que direcionou os respondentes para o instrumento. Ao todo, 480 pessoas acessaram o link, mas apenas 158 finalizaram o preenchimento do instrumento. A maior parte dos respondentes foi do sexo feminino (87,0%), autoclassificada como de raça/cor preta ou parda (97,5%) e pertencente ao grupo econômico A e B (61,4%). Prosseguiu-se com a avaliação da validade de constructo por meio da análise fatorial exploratória. KMO (Kaiser-Meyer-Okin) foi 0,736; o teste de esfericidade de Bartlett foi p<0,001; todas as cargas fatorias estiveram entre 0,3 e 0,9; e as comunalidades abaixo de 0,4. A avaliação do índice de confiabilidade Ômega de Mcdonald total foi 0,87, valor considerado bom. Dessa forma, produziu-se a versão 4, denominada DRISS, com 19 itens no total e seis dimensões, que são: sintomas somáticos, preparo, expressão emocional, percepção social, reação, consequências emocionais. Não foi observada diferença estatisticamente significativa nas médias dos escores em relação à idade, escolaridade, grupo econômico e outras variáveis sociodemográficas. CONCLUSÕES: Este estudo produziu uma escala que mede a percepção sobre discriminação racial interpessoal no contexto dos serviços de saúde, denominada DRISS, que apresenta adequadas propriedades psicométricas. O DRISS é direcionado especificamente às/aos usuárias/os dos serviços de saúde. Em nível populacional, produzirá dados relevantes para a tomada de decisões programáticas com foco na redução da discriminação racial nos serviços de saúde e consequente diminuição das iniquidades raciais em saúde.

OBJECTIVE: To develop and validate an instrument to measure perceptions about interpersonal racial discrimination in Brazilian healthcare facilities context. METHODOLOGY: This is a methodological study based on Classical Theory of Tests. For the development of the initial items pool, three sources were used: literature review on existing scales; qualitative study; and, expert on racism health inequalities suggestions. Initially, the version 1 was composed by 50 items. In order to test content and construct validity evidence, data collection was divided into two steps. The first step consisted of the analysis of version 1 instrument to an expert committee and the second step consisted of the submission of the instrument to the target population. Data analysis was performed with R and Stata 14.2. RESULTS: Face and content validation of version 1 was performed by expert committee composed by a psychometrist, a Portuguese language expert, three experts in ethnic-racial relations and three members of the target population. From the 50 originally drafted items, 28 were excluded and 22 remained (version 2). The average CVR (content validity ratio) of the items was 0.74. Regarding the agreement among the experts, PABAK was 0.30, considered reasonable. Two items from version 2 were dismembered, which generated version 3, with 24 items. Version 3 was included on the Research Eletronic Data Capture (REDCap) digital platform and was released between September and December 2017 in a link (via social networks like Facebook and Whatsapp). Altogether, 480 people accessed the link, but only 158 completed the instrument. Most respondents were female (87.0%), self-classified as black or brown (97.5%) and were at economic group A and B (61.4%). We proceeded with the evaluation of construct validity through exploratory factorial analysis. KMO (Kaiser-Meyer-Okin) was 0.736; Bartlett Sphericity Test was p <0.001; all factor loads were between 0.3 and 0.9; and commonalities below 0.4. The McDonalds Omega Total reliability rating was 0.87, which is considered good. In this way, version 4, named DRISS, was produced with a total of 19 items and six dimensions, that are: somatic symptoms, preparation, emotional expression, social perception, reaction, and emotional consequences. No statistically significant difference was observed in the means of the DRISS scores in relation to age, schooling, economic group and other sociodemographic variables. CONCLUSIONS: This study produced a scale that measures the 'perception about interpersonal racial discrimination in the healthcare facilities context, called DRISS, with adequate psychometric properties. DRISS is specifically targeted to the health services users. At the population level, it may produce relevant data for programmatic decision-making focused on reducing racial discrimination in healthcare facilities, and as a consequence, racial inequities in health.

Racismo e julgamento social na internet: crianças e jovens negros como alvos / Racism and social judgment on internet: black children and young people as targets

Este estudo teve como objetivo avaliar o preconceito racial, emitido na internet, contra crianças e jovens negros em conflito com a Lei, mediante o julgamento social atribuído. Para tanto, selecionaram-se notícias que retratam a apreensão de jovens negros, acusados ou suspeitos de terem cometido roubos. Foram analisados, por meio do software IRAMUTEQ, 879 comentários sobre essas notícias, os quais constituíram um único corpus submetido a uma Classificação Hierárquica Descendente (CHD) e a Análises de Similitude. A CHD reteve 83,32% dos segmentos de texto, dividindo o corpus em três classes. Os resultados indicaram expressivo preconceito racial contra crianças e jovens negros, estigmatizando-os e legitimando as suas mortes. Significativamente, predomina nos comentários a concepção dos jovens como uma ameaça à ordem social, responsabilizando a ausência dos pais, a permissividade da Lei e as pessoas envolvidas com a promoção de Direitos Humanos. Em síntese, o estudo traz contribuições para a análise do preconceito racial na internet contra jovens negros em conflito com a lei, possibilitando avaliar expressões do preconceito e da discriminação racial no Brasil.

This study aims to evaluate the racial prejudice, issued over the internet, against black children in conflict with the law, through the attributed social judgment. Therefore, reports were selected that portray the apprehension of young black people, accused or suspected of having committed robberies. Through IRAMUTEQ software, 879 comments on the news were analyzed which constituted a single corpus submitted to a Descending Hierarchical Classification (DHC) and Similitude Analysis. The DHC retained 83,32% of the text segments, dividing the corpus into three classes. The results indicated expressive racial prejudice against black children and young people, stigmatizing them and legitimizing their deaths. Significantly, it predominates on the comments the concept of young people as a threat to the social order, blaming the absence of the parents, the permissiveness of the law and the people involved in the promotion of Human Rights. In summary, this study brings contributions to the analysis of racial prejudice over the internet against young black people in conflict with the law, making it possible to evaluate expressions of prejudice and racial discrimination in Brazil.

O extermínio de jovens negros pobres no Brasil: práticas biopolíticas em questão / The extermination of young poor black in Brazil: practices biopolitics in question / El exterminio de los jóvenes negros pobres en Brasil: las prácticas biopolíticas en cuestión

Este artigo versa sobre a prática de extermínio de jovens pobres e negros, com baixa escolaridade, moradores das periferias urbanas brasileiras, em uma análise da biopolítica em Foucault. O crescente e massivo genocídio desse grupo, somado ao aumento do contingente de aprisionamento dessa população, assinala que o Brasil optou por duas táticas de segurança em defesa social contra um suposto inimigo penal: cadeia e caixão. Interrogar essa realidade e colocá-la em questão é uma inquietação de quem atua com pesquisas em direitos a serem garantidos e protegidos. A crítica à militarização do cotidiano e às subjetividades baseadas no medo e na insegurança deve ser uma pauta da Psicologia, na formação, na extensão, na pesquisa e na publicação.

This article deals with the practice of extermination of poor young people and blacks, with low schooling, residents of suburbs Brazilian, in an analysis biopolitics, in Foucault. The growing and massive genocide of this group plus the increase in the quota for trapping this population notes that Brazil has opted for two tactics of security, in social defense against an alleged criminal enemy, chain and coffin Ask this reality and put it in question is a concern for anyone who works with research social rights to be guaranteed and protected. The criticism of the militarization of everyday life and the subjectivities based on fear and insecurity must be an agenda of Psychology in the areas of education and training, extension, research and publication.

En este artículo se refiere a la práctica de la exterminación de los jóvenes pobres y negros, con baja escolaridad, los residentes de los suburbios brasileños, en un análisis de la biopolítica, en Foucault. La creciente y genocidio en gran escala de este grupo y el aumento de la cuota de captura esta población observa que el Brasil ha optado por dos tácticas de seguridad, de defensa social contra un presunto delincuente enemigo, cadena y ataúd preguntar a esta realidad y se la pone en cuestión es una preocupación para cualquier persona que trabaja en la investigación que se les garanticen los derechos y la protección. Las críticas a la militarización de la vida cotidiana y las subjetividades basadas en el miedo y la inseguridad debe ser un programa de psicología en las áreas de educación y capacitación, extensión, investigación y publicación.

Educational health disparities in hypertension and diabetes mellitus among African descent populations in the Caribbean and the USA: a comparative analysis from the Spanish town cohort (Jamaica) and the Jackson heart study (USA).

BACKGROUND: Studies have suggested that social inequalities in chronic disease outcomes differ between industrialized and developing countries, but few have directly compared these effects. We explored inequalities in hypertension and diabetes prevalence between African-descent populations with different levels of educational attainment in Jamaica and in the United States of America (USA), comparing disparities within each location, and between countries. METHODS: We analyzed baseline data from the Jackson Heart Study (JHS) in the USA and Spanish Town Cohort (STC) in Jamaica. Participants reported their highest level of educational attainment, which was categorized as 'less than high school' (HS). Educational disparities in the prevalence of hypertension and diabetes were examined using prevalence ratios (PR), controlling for age, sex and body mass index (BMI). RESULTS: Analyses included 7248 participants, 2382 from STC and 4866 from JHS, with mean age of 47 and 54 years, respectively (p < 0.001). Prevalence for both hypertension and diabetes was significantly higher in the JHS compared to STC, 62% vs. 25% (p < 0.001) and 18% vs. 13% (p < 0.001), respectively. In bivariate analyses there were significant disparities by education level for both hypertension and diabetes in both studies; however, after accounting for confounding or interaction by age, sex and BMI these effects were attenuated. For hypertension, after adjusting for age and BMI, a significant education disparity was found only for women in JHS, with PR of 1.10 (95% CI 1.04-1.16) for < HS vs > HS and 1.07 (95% CI 1.01-1.13) for HS vs > HS. For diabetes; when considering age-group and sex specific estimates adjusted for BMI, among men: significant associations were seen only in the 45-59 years age-group in JHS with PR 1.84 (95% CI 1.16-2.91) for < HS vs > HS. Among women, significant PR comparing < HS to > HS was seen for all three age-groups for JHS, but not in STC; PR were 3.95 (95% CI 1.94-8.05), 1.53 (95% CI 1.10-2.11) and 1.32 (95% CI 1.06-1.64) for 25-44, 45-59 and 60-74 age-groups, respectively. CONCLUSION: In Jamaica, educational disparities were largely explained by age, sex and BMI, while in the USA these disparities were larger and persisted after accounting these variables.

Da base da pirâmide social à "elite" do sistema: um estudo de caso sobre as diversas incursões de uma mulher negra, nordestina e militante / Of the base of social pyramid to the "elite" of the system: a case study about the various incursions of a black woman, northeastern and militant / De la base de la pirâmide social hasta la "elite" del sistema: un estudio de caso sobre las diversas incursiones de una mujer de negra, del noreste y militante

Este trabalho buscou compreender a incidência do viés racial e suas interseccionalidades a partir da construção metodológica de uma história oral de vida, visando descrever e analisar a conformação e os sentidos tomados pelo processo identitário de uma mulher negra, professora universitária e de origem pobre. Dandara, nosso sujeito emblemático, encontra muitos empecilhos para realizar seu projeto, ao longo de sua história. Neste ínterim, a interseccionalidade gênero-raça-pobreza pode ser considerada fator determinante às diversas barreiras enfrentadas por nossa colaboradora ao seu processo de emancipação. Porém, cabe demarcarmos que a incidência da questão racial não pode ser eclipsada ou diluída pelos demais fatores, pois ela representa, de forma ativa, uma variável relevante que, ao longo dos séculos, instituiu o aprisionamento do contingente aos estratos sociais inferiores do sistema brasileiro.

This study aimed to understand the impact of racial bias and its intersectionalities from the methodological construction of an oral history of life, aiming to describe and analyze the conformation and senses of identity process taken by a black woman, university professor and poor backgrounds. Dandara, our emblematic subject, finds many obstacles to realize his project, throughout its history. In the interim, intersectionality gender-race-poverty can be considered a determinant factor in the various barriers faced by our collaborator their process of emancipation. However, it should stake out that the incidence of racial issue can not be eclipsed or diluted by other factors because it represents the active form, a relevant variable that over the centuries, instituted the imprisonment of the contingent to the lower strata of the Brazilian system.

Este studio tuvo como objetivo comprender el impacto de la cuestión racial y sus interseccionalidades desde la construcción metodológica de una historia oral de la vida, con el objetivo de describir y analizar la conformación y sentidos del proceso de identidad adoptada por una mujer negra, profesora universitaria de origen humilde. Dandara, nuestro individuo emblemático, encuentra muchos obstáculos para hacer realidad su proyecto, a lo largo de su historia. En este contexto, la interseccionalidad de género-raza-la pobreza se puede considerar un factor determinante en las diversas barreras que enfrentan nuestro colaborador su proceso de emancipación. Sin embargo, se debe replantear que la incidencia de la cuestión racial no puede ser eclipsado o diluido por otros factores, ya que representa la forma activa, una variable relevante que durante los siglos, instituyó el encarcelamiento del contingente a los estratos más inferiores del sistema brasileño.

Um estudo sobre o pensamento social de jovens universitários acerca da justiça e das cotas raciais / A study on the social thinking of university students about justice and racial quotas

Este artigo visa estudar os conceitos de justiça e de cotas raciais de jovens favoráveis, desfavoráveis e neutros em relação às cotas raciais. Para entender a produção de saber referente à frequente rejeição a essa temática recorreu-se ao aporte teórico das Representações sociais. Para tanto, foram entrevistados de forma semiestruturada 14 estudantes divididos em trêsposicionamentos frente às cotas raciais: favoráveis, desfavoráveis e neutros. A amostra foi composta por estudantes da Universidade do Estado do Rio de Janeiro (UERJ), Universidade Federal de Uberlândia (UFU) e Universidade Federal Rural do Rio de Janeiro (UFRRJ). Os dados foram analisados com uma análise de conteúdo segundo Bardin (2000). A análise das 14entrevistas obteve um total de 144 unidades de registro contabilizadas e inseridas em 55 unidades de significação que, por sua vez, foram incluídos em 21 categorias. Os resultados demonstram que os participantes de todos os posicionamentos tiveram dificuldade de definir o conceito de justiça. Além disso, ligada à noção de justiça, surge a questão da igualdade, mas focalizada sob aspectos muito distintos para os sujeitos, pois enquanto os favoráveis defendem as cotas enquanto uma medida de promoção da igualdade, os desfavoráveis a criticam por acreditar que estas ferem a mesma. Os sujeitos desfavoráveis, apesar de rejeitarem as cotas para negros, demonstram aceitação das cotas sociais, e os resultados referentes aos participantesneutros demonstram um grau de polifasia cognitiva, uma vez que levantam respostas distintas econtrárias umas às outras típicas, mais precisamente apresentam argumentos dos dois posicionamentos polarizados referentes às cotas...

This article aims to study the concepts of justice and racial quotas favorable,unfavorable and neutral young people in relation to racial quotas. To understand the production of knowledge regarding the frequent rejection of this theme, we used the theoretical framework of social representations. Therefore, the interview was made in a semi-structured form with 14 students divided into three positions about racial quotas: favorable, unfavorable or neutral. The sample consisted of students from Rio de Janeiro State University (UERJ), Federal University ofUberlandia (UFU) and Federal University Rural Rio de Janeiro (UFRRJ). Data was analyzed with a content analysis according to Bardin (2000). The analysis of the 14 interviews obtained a total of 144 registration units counted and placed in 55 subjects who, in turn, were included in 21-targetsubjects. The results showed that participants in all positions found it difficult to define the concept of justice. In addition, linked to the notion of justice, the question arises of equality, but focused on very different aspects of the subject, while the favorable advocate quotas as a way ofpromoting equality, the unfavorable ones criticize it because they believe that these hurt the same. Some of the people who were against the quotas for black people accept the shares ofsocial dimensions, and the results regarding the neutral participants showed a degree of cognitive polyphasia, since they have raised distinct and opposit typical responses. More precisely, the typical responses embrace arguments from both of the polarized positions relating to quotas...