Gender and Violence in the Daily Routine of Community Health Workers in Fortaleza, Brazil.

Community Health Workers (CHWs) are the link between the Brazilian primary health care system and the community. Since CHWs live in the same neighborhoods they work, they are involved in what happens in the community, including observants and or potential targets of violence. However, it is not known if female and male CHWs perceive and suffer violence similarly. This study aimed to investigate the violence to which CHWs are exposed and if female CHWs experience and or perceive violence the same way as male CHWs. A structured questionnaire was used to collect information from CHWs. Two periods (2019 [n=1402] and 2021 [n=364]) were compared. The data show that more than 80% of CHWs were exposed to violence, either as victims or witnesses within the community they served. In general, while the occurrence of violence towards CHWs decreased, their perception of community violence increased. Over time, the perception of urban/community violence remained constant among male CHWs, but increased among female CHWs, as shown by the significant rise between 2019 and 2021 in the percentage of female CHWs reporting witnessing or hearing about manifestations of violence (e.g., physical aggression; assault; stabbing; lethal gunshot; non-lethal gunshot; and gang violence). Among male CHWs, perception only increased with regard to the item assault. Given the complexity of violence and its repercussions on the daily routines of CHWs, intersectoral and interdisciplinary partnerships between health workers and other stakeholders are needed to create strategies capable of dealing with expressions of violence in the territories served.

Characterization and Prevalence of Elder Abuse in Brazil.

We aimed to assess the prevalence and characterize the profile of elder abuse in Brazil in this quantitative descriptive and exploratory study using a document analysis of cases of elder abuse against people aged 60 and over reported to Brazil's Notifiable Disease Information System (Sistema de Informação de Agravos de Notificação-SINAN) from 2009 to 2013. Association between age groups (older adults and non-older adults) and (a) characteristics of the victims (gender, age, and race), (b) characteristics of the violence (type of violence, place of occurrence, and repeated violence) and, (c) characteristics of the perpetrator (gender, suspected alcohol consumption, and victim-perpetrator relationship) were assessed using the chi-square test and odds ratios (OR) with a 95% confidence interval. Statistical significance was set at p< .05. Elder abuse accounted for 5.7% of all cases of violence, with a higher prevalence among women (54.3%). Older men and older white people were more likely to suffer violence compared with their non-older peers (OR=1.75 and OR=1.47, respectively). Financial abuse (OR=5.95), violence resulting from legal intervention (OR=1.24), repeated violence (OR=1.22), and torture (OR=1.08) were at higher chances of occurring among older adults. In all, 30.3% of the cases of elder abuse were perpetrated by their children and 22% of the perpetrators were suspected to have consumed alcohol. Older adults were 30 times more likely to be abused by their children and eight times by caregivers and presented 2.37 more chances of evolving to death due to violence and 1.8 more chances to suffer violence in the household. The cases of elder abuse reported to SINAN highlight the greater fragility of this population group. In addition to reporting this public health problem, governmental and non-governmental actions are necessary to provide older adults with a healthy aging and ensure their rights, dignity, and autonomy.

Disorder of Sex Development: A Case of Late-Diagnosed Ovotestis and Its Postsurgical Follow-up.

BACKGROUND: True hermaphroditism is characterized by the presence of both testicular and ovarian tissue. This case report aimed to describe a case of ovotestis in adolescents. CASE: A 17-year-old patient presented with undifferentiated genitalia. Thelarche occurred at age 14, menarche occurred at age 15, and menstruation was regular. Physical examination showed female phenotype, Tanner IV breasts, gynecoid hair, enlarged clitoris, and labia majora symphysis with a single orifice. The patient presented high levels of total testosterone. The left gonad contained typical ovarian tissue and the right gonad contained both seminiferous tubules and ovarian tissue (ovotestis). Vaginoscopy revealed a single orifice (urethra and vagina). Right gonadectomy confirmed the presence of ovotestis. SUMMARY AND CONCLUSION: Knowledge of true hermaphroditism is important for early diagnosis and proper management.

Clinical and epidemiological differences in diabetes: A cross-sectional study of the Brazilian population compared with the French GERODIAB cohort.

AIMS: This study aimed to compare the sociodemographic and epidemiological profiles between Brazilian and French older people with type 2 diabetes mellitus. METHODS: Quantitative analytical study of 248 type 2 diabetes patients aged 65+ years receiving care in a center for integrated diabetes and hypertension care. The data were compared with the GERODIAB study conducted in France. RESULTS: The participants' mean age was 73.16 ± 6.4 years, with 162 (65.4%) participants aged less than 75 years and 38 (15.3%) over 80 years old. Almost all the participants (99.2%) lived at home, 35 (14.1%) were uneducated, and 17 (6.9%) had completed higher education. The majority (232 older people) were retired. Most of the median values of the variables differed statistically (p < 0.001) between the two populations. Peripheral vascular disease, diabetic neuropathy, foot wound, amputation, hypoglycemia, hyperosmolarity and other intercurrent infections differed statistically (p < 0.001) between the two populations. Most of the medication use variables differed significantly (p < 0.05) between Brazilians and the French. CONCLUSIONS: The statistically significant differences between the two populations reveal better conditions among the French participants, which highlights the importance of the scientific evidence found in the French study for developing public health actions targeted at Brazilian diabetic older people.

What is the relative impact of primary health care quality and conditional cash transfer program in child mortality?

OBJECTIVE: Evaluate how coverage and quality of primary health care (PHC) and a conditional cash transfer (CCT) program associate with child mortality in Brazil. METHODS: Multivariate linear regression models and least absolute shrinkage and selection estimator (LASSO) were utilized with the municipal level child mortality rate as the key dependent variable. PHC quality with PHC and CCT coverage were the independent variables. The quality of the Brazilian PHC was assessed using the Brazilian National Program for Access and Quality Improvement in PHC data. PHC and CCT coverage were calculated based on Brazilian official databases. Human developmental index (HDI), municipality size, and country region were used as control variables. A total of 3441 municipalities were evaluated. RESULTS: We found that ESF (Estratégia Saúde da Família) quality variables PLANNING [Family Health Team Planning activities], CITYSUPPORT [municipality support for Family Health Strategy activities], EXAMS [exams offered and priority groups seen by the family health team], and PRENATAL [prenatal care and exams provided by the family health team], as well as HDI, percentage of PHC coverage, percentage of CCT coverage, and population size have significant and negative relationships with 1-year-old child mortality. LASSO regression results confirmed these associations. Quality is an important element of effective social service provision. CONCLUSION: This exploration represents one of the first investigations into the role of PHC system quality, and how it is related to health outcomes, while also considering PHC and conditional cash transfer program coverage. Quality of PHC, measured by work process variables, plays an important role in child mortality. Efforts on PHC quality and coverage, as well as on CCT program coverage, are important to child mortality reduction. Therefore, this is an important finding to other PHC public health services.

Geriatric dentistry in Brazilian universities.

OBJECTIVE: The purpose of this study was to investigate the teaching of geriatric dentistry in Brazilian universities. MATERIALS AND METHODS: This study consisted of questionaires regarding the training in geriatric dentistry in 104 dental schools included in the National Institute of Education Research (INEP) in 2001. In order to calculate the sample (a random stratified one), the confidence interval was set at 99% and a maximum permitted error of 3% was adopted. Pearson's chi-square test was used in the inferential analysis. RESULTS: From the 64 dental courses which were studied, only 25 included geriatric dentistry in the curriculum. From 1857 students who were involved in the study, 41% sought knowledge outside the dental school and 98% considered that it was important that this subject should be included in the curriculum. There was statistical significance between geriatric dentistry teaching and the students' preference as well as the prospect of working with this group of the population. Geriatric dentistry as an individual subject was absent from the curriculum in two-thirds of the dental courses investigated. Knowledge was often transmitted as part of dental prosthetics and most of the students stated that they would want to be able to treat elderly people. It was relevant to note that senior students expected to work in this field. CONCLUSION: Dental students in Brazil do not have adequate training in geriatric dentistry.