Food environments in schools and in the immediate vicinity are associated with unhealthy food consumption among Brazilian adolescents.

BACKGROUND: Evidence of the influence of the school food environment on adolescent diet is still little explored in low- and middle-income countries. We aimed to evaluate the association between food environment in schools and the immediate vicinity and the regular consumption of unhealthy food among adolescents. METHODS: We used cross-sectional data collected by the Brazilian National Survey of School Health (PeNSE) from a representative sample of adolescents attending 9th grade public and private schools in Brazil, in 2012. We estimated students' regular consumption (>5days/week) of unhealthy food (soft drinks, bagged salty snacks, deep fried salty snacks and sweets) and school availability, in the cafeteria or an alternative outlet, of the same food plus some healthy options (fruit and natural fruit juice). We performed multilevel logistic regression models. RESULTS: Having a cafeteria inside school selling soft drinks (private schools OR=1.23; 95% CI=1.14-1.33; public schools OR=1.13; 95% CI=1.06-1.20) and deep fried salty snacks (private schools OR=1.41 95% CI=1.26-1.57; public schools OR=1.16 95% CI=1.08-1.24) was associated with a higher consumption of these unhealthy foods of among students. In private schools, cafeteria selling fruit and natural fruit juice was associated with lower student consumption of bagged salty snacks (OR=0.86; 95% CI 0.77-0.96) and soft drinks (OR=0.85; 95% CI=0.76-0.94). In addition, eating meals from the Brazilian School Food Program in public schools was associated with a lower consumption of unhealthy foods. CONCLUSIONS: Foods available in the school food environment are associated with the consumption of unhealthy food among adolescents in Brazil.

Dietary intake of Brazilian adolescents.

OBJECTIVE: To analyse the dietary intake of Brazilian adolescents and investigate its association with sociodemographic factors as well as health-risk and health-protective behaviours. DESIGN: Cross-sectional study. SETTING: The study was based on data supplied by the National Survey of Schoolchildren's Health (2012) on sociodemographic factors, dietary intake and health-risk and health-protective behaviours of schoolchildren in Brazil. A nutritional scale was elaborated combining markers of healthy and unhealthy diets. Poisson regression analysis was applied to investigate the association between the sociodemographic factors and regular intake (≥5 times/week) of selected foods; linear regression analysis was applied to investigate the association of sociodemographic and behavioural factors with nutritional scale score. SUBJECTS: A total of 109 104 adolescents attending the ninth year of education at 2842 schools in Brazil. RESULTS: Fewer than 30 % of the adolescents consumed raw or cooked vegetables on a regular basis, whereas more than one-third reported regular intake of sweets, soft drinks and sweet biscuits. Adolescents from the southern area and the oldest ones were those most exposed to inadequate dietary intake. The nutritional scale average score was higher in the students attending public school and exhibited a positive correlation with protective behaviours, such as being physically active, having meals with parents and eating breakfast, and a negative correlation with risk behaviours such as eating while studying or watching television and having smoked, drunk alcohol or used other drugs in the previous 30 d. CONCLUSIONS: The results indicate an association between undesirable nutritional habits and other risk behaviours among Brazilian adolescents.

Sociodemographic and behavioral factors associated with physical activity in Brazilian adolescents.

BACKGROUND: Physical activity in adolescents is associated with short- and long-term health benefits. Physical activity can occur in various domains and is influenced by a complex network of factors. The aims of this study are 1) to describe the physical activity of Brazilian adolescents in physical education classes, during leisure time, and during active commuting and 2) to investigate the socio-demographic and behavioral factors associated with physical activity. METHODS: The representative sample included 109,104 Brazilian students in the final year of elementary school from 2,842 schools. The weekly frequency and duration of physical activity were assessed. A variety of socio-demographic and behavioral factors were studied. A multiple Poisson regression analysis was used to test for associations between physical activity and the socio-demographic and behavioral variables. RESULTS: Most of the students (97.0%) engaged in physical activity in at least one of the domains studied, especially physical education at school (81.7%) and leisure time physical activity (67.5%). However, only 29% of the adolescents reached the recommended level of physical activity. Among the adolescents who reached the minimum recommended time for physical activity, the various domains contributed the following proportions to total physical activity: leisure time physical activity (PR 12.5; 95% CI 11.17-13.97), active commuting (PR 1.63; 95% CI 1.59-1.67), and physical education at school (PR 1.36; 95% CI 1.29-1.44). The weekly frequency of all activities was greater among boys than among girls. Moreover, nearly two-thirds (61.8%) of students spent more than two hours per day engaging in sedentary behaviors; the prevalence of sedentary behaviors was similar between boys and girls (59.0 and 64.5%, respectively).Total level of physical activity, leisure time physical activity, and active commuting were associated with higher nutritional scores. CONCLUSIONS: Physical activity is important in any health promotion program. Therefore, it is necessary to invest in policies and interagency initiatives that promote all domains and to ensure that the general population helps determine the scope and design of such policies.

[Recommendations for physical activity and health: consensus, controversies, and ambiguities]. / Recomendações para atividade física e saúde: consensos, controvérsias e ambiguidades.

OBJECTIVE: To compare the results of physical activity (PA) classification according to five international guidelines (American College of Sports Medicine, Institute of Medicine, Advisory Committee on International Physical Activity Questionnaire, World Health Organization, and European Union). METHODS: Cross-sectional study with 52 779 adults of both sexes, living in state capitals and the Federal District, selected using probability sampling. Data about duration, intensity, and frequency of weekly PA were obtained from a yearly survey conducted by the Health Ministry of Brazil (Risk and Protection Factors for Chronic Diseases Telephone Surveillance System-VIGITEL). RESULTS: The percent of participants classified as inactive by the five recommendations was similar. Among those who reported having engaged in PA, 45% were classified in the same activity level by all five guidelines (24.8% as insufficiently active, 10.6% as active, and 9.1% as very active). For the additional 55% who reported having engaged in PA, different classifications were obtained, ranging from insufficiently active to very active depending on the guideline. CONCLUSIONS: Nuances in the criteria used for each guideline translated into differences in classification of PA. Even though the overall goals of all guidelines are the same, the lack of agreement regarding the minimum recommended amount of PA impacts the development of policies to promote PA.

Racial iniquity in mortality from cervical cancer in Brazil: a time trend study from 2002 to 2021. / Iniquidade racial na mortalidade por câncer de colo de útero no Brasil: estudo de séries temporais de 2002 a 2021.

This ecological study examined time series, from 2002 to 20121, of age-adjusted coefficients of cervical cancer mortality, in Brazil, in women aged 20 years or more, by race. The information sources were Brazil's mortality information system (Sistema de Informação sobre Mortalidade - SIM) and the official bureau of statistics (Instituto Brasileiro de Geografia e Estatística - IBGE). Annual changes in age-adjusted mortality rates were calculated using the Prais-Winsten linear regression method. Black women die more and the rate is decreasing less. Racial inequality has increased over the years. In 2002, there were 0.08 more deaths per 100,000 women in the black population than among white women; in 2021, the number was one death. Health policymaking should consider racial differences in the implementation of strategies and goals.

O objetivo desse artigo é analisar séries temporais da mortalidade por câncer de colo do útero segundo raça/cor no Brasil de 2002 a 2021. Estudo ecológico de séries temporais com dados do Sistema de Informação sobre Mortalidade e informações populacionais do IBGE. Variações anuais das taxas de mortalidade ajustadas por idade de mulheres de 20 anos ou mais foram estimadas pelo modelo de regressão linear simples com correção de Prais-Winsten. Foram registrados 133.429 óbitos por câncer de colo de útero, destes, 51,2% foram de mulheres negras. As mulheres negras morrem mais e têm menor queda do coeficiente. Houve aumento da desigualdade racial ao longo dos anos. Em 2002, ocorriam 0,08 óbitos/100 mil mulheres a mais na população negra comparada com a população branca; em 2021 esse número é de aproximadamente 1 óbito. Para a elaboração de políticas de saúde da mulher devem ser consideradas as diferenças raciais na implementação de estratégias e metas.

Years of Potential Life Lost due to COVID-19 according to race/color and gender in Brazil between 2020 and 2021. / Anos Potenciais de Vida Perdidos devido à COVID-19, segundo a raça/cor e gênero, no Brasil, entre 2020 e 2021.

Mortality caused by the COVID-19 pandemic has impacted indicators of Years of Potential Life Lost (YPLL) worldwide. This study aimed to estimate the YPLL due to mortality caused by COVID-19, according to sex, age group, and race/color in Brazil, from March 2020 to December 2021. Deaths caused by COVID-19 were characterized, in which the rates and ratios of standardized YPLL rates, the average number of years of potential life lost (ANYPLL), and the average age at death (AAD) were estimated and compared. Overall, 13,776,969.50 potential years of life were lost, which resulted in an average loss of 22.5 potential years not lived. A greater loss of potential years of life was identified in men (58.12%) and in the age groups from 0 to 59 years in the black (58.92%) and indigenous (63.35%) populations, while in the age groups of 60 years and over, a greater loss of YPLL was observed in the white (45.89%) and yellow (53.22%) populations. Women recorded the highest ADD, with the exception of indigenous women. White men (1.63), brown men (1.59), and black men (1.61) had the highest rates when compared to white women. Although COVID-19 has a greater impact on the elderly, it was the black and indigenous populations under the age of 60 who had the greatest loss of potential years of life.

A mortalidade provocada pela pandemia da COVID-19 tem produzido impactos aos indicadores de Anos Potenciais de Vida Perdidos (APVP) em nível mundial. Objetiva-se estimar os APVP devido à mortalidade por COVID-19, segundo sexo, faixa etária e raça/cor, no período de março de 2020 a dezembro de 2021, no Brasil. Foram caracterizadas as mortes por COVID-19, estimadas e comparadas as taxas e razão de taxas padronizadas de APVP, a média de anos potenciais de vida não vividos (APVNV) e a idade média do óbito (IMO). No geral, foram perdidos 13.776.969,50 anos potenciais de vida, o que determinou uma perda média de 22,5 anos potenciais não vividos. Houve maior perda de anos potenciais de vida nos homens (58,12%) e nas faixas etárias de 0 a 59 anos nas populações negra (58,92%) e indígena (63,35%), enquanto nas faixas etárias de 60 anos e mais foi observada maior perda de APVP nas populações branca (45,89%) e amarela (53,22%). As mulheres registraram as maiores IMO, com exceção das mulheres indígenas. Homens brancos (1,63), pardos (1,59) e pretos (1,61) tiveram as maiores taxas em comparação às mulheres brancas. Apesar da COVID-19 ter tido maior impacto em idosos, foram as populações negra e indígena na faixa de menos de 60 anos quem teve maior perda de anos potenciais de vida.

Factors associated with homicides of women in Brazil, by race or colour, 2016-2020. / Fatores associados ao homicídio de mulheres no Brasil, segundo raça/cor, 2016-2020.

This ecological, time-trend study examined rates of homicide against women residing in Brazil, by state and race/colour, from 2016 to 2020, by performing. Multiple analysis by regression model on longitudinal data. During the study period, 20,405 homicides of women were recorded in Brazil. Standardised homicides rates were higher among black women (6.1/100,000) than among white women (3.4/100,000). From 2016 to 2020, rates decreased 25.2%, from 4.7 deaths per 100,000 women in 2016 to 3.5 in 2020, with a statistically significant downward trend among both black and white women. Statistically significant inverse relationships were found between female homicide rates and HDI, illiteracy rate and proportion of ill-defined causes. The average homicide rate decreased in 2019 and 2020, as compared with 2016. Despite the decreasing time trend in homicide rates for both black and white women, they differed substantially by race, with worse outcomes for black women.

O objetivo deste estudo é avaliar as taxas de homicídios contra mulheres residentes no Brasil, segundo unidades da federação e raça/cor, no período de 2016 a 2020. Trata-se de um estudo ecológico de tendência temporal. Foi realizada análise múltipla adotando-se modelo de regressão para dados longitudinais. No período, ocorreram no Brasil 20.405 homicídios de mulheres e as taxas padronizadas mostraram que as mulheres negras (6,1/100.000) apresentaram as maiores taxas, em comparação às brancas (3,4/100.000). O Brasil apresentou queda de 25,2% de 2016 a 2020. A taxa de homicídio variou de 4,7 mortes por 100 mil mulheres em 2016 para 3,5 em 2020, mas a tendência decrescente e estatisticamente significante foi observada nas taxas de mulheres negras e brancas. As variáveis IDH, taxa de analfabetismo e proporção de causas mal definidas apresentaram uma relação inversa e estatisticamente significante com as taxas de homicídio de mulheres. Nos anos de 2019 e 2020 houve uma diminuição da taxa média de homicídio em relação ao ano de 2016. Apesar do decrescimento na evolução temporal das taxas para negras e brancas, houve diferenças raciais importantes nos homicídios de mulheres, com piores resultados para as mulheres negras.

Adolescents, poverty areas, violence, and public health: an intersectional perspective.

OBJECTIVES: to discuss the influence of urban poverty on the context of violence among adolescents from an intersectional perspective. METHODS: the original research, of the action research type, analyzed data from 13 workshops. The participants were adolescents from both sexes, from 15 to 17 years old, from a public school in a peripheral neighborhood of São Paulo, SP. The methodological proposition of intersectional analysis guided the interpretation of the empirical material. RESULTS: the intersection of class and gender may increase the (re)production of violence in some men. The intersection of race/color, social class, and territory contributes to the construction of narratives that naturalize inequality and, thus, justify discrimination. FINAL CONSIDERATIONS: there is necessity of new public policies that consider the social contexts and experiences of the subjects that stem from the articulation of social markers.

Polymorphism in the Promoter Region of the IL18 Gene and the Association With Severity on Paracoccidioidomycosis.

Paracoccidioidomycosis (PCM) is an important endemic, systemic disease in Latin America caused by Paracoccidioides spp. This mycosis has been associated with high morbidity and sequels, and its clinical manifestations depend on the virulence of the infecting strain, the degree and type of immune response, infected tissues, and intrinsic characteristics of the host. The T helper(Th)1 and Th17/Th22 cells are related to resistance and control of infection, and a Th2/Th9 response is associated with disease susceptibility. In this study, we focused on interleukin(IL)-12p35 (IL12A), IL-18 (IL18), and IFN-γ receptor 1 (IFNGR1) genetic polymorphisms because their respective roles have been described in human PCM. Real-time PCR was employed to analyze IL12A-504 G/T (rs2243115), IL18-607 C/A (rs1946518), and IFNGR1-611 A/G (rs1327474) single nucleotide polymorphisms (SNP). One hundred forty-nine patients with the acute form (AF), multifocal chronic (MC), or unifocal chronic (UC) forms of PCM and 110 non-PCM individuals as a control group were included. In the unconditional logistic regression analysis adjusted by ethnicity and sex, we observed a high risk of the IL18-607 A-allele for both AF [p = 0.015; OR = 3.10 (95% CI: 1.24-7.77)] and MC groups [p = 0.023; OR = 2.61 (95% CI: 1.14-5.96)] when compared with UC. The IL18-607 A-allele associated risk for the AF and MC groups as well as the protective role of the C-allele in UC are possibly linked to higher levels of IL-18 at different periods of the course of the disease. Therefore, a novel role of IL18-607 C/A SNP is shown in the present study, highlighting its importance in the outcome of PCM.

The feminist perspective of intersectionality in the field of public health: a narrative review of the theoretical-methodological literature. / La perspectiva feminista de la interseccionalidad en el campo de la salud pública: revisión narrativa de las producciones teórico-metodológicas.

The intersectionality approach emerged in the late 1990s in the field of black feminist activism in the USA, as a critique of one-dimensional analyses of social inequalities. This descriptive-analytical narrative review presents the current state of theoretical-methodological inclusion of intersectionality in public health. Seven scientific literature databases were consulted: Web of Science, Embase, Cinahl, Scopus, Sociological Abstracts, Lilacs, and Medline, resulting in 1763 papers. After duplicates were eliminated and the titles and abstracts screened, 30 papers produced in five countries between 2006 and 2017 were selected. The analysis, structured into three central themes (theoretical-methodological debates, social markers - gender, race, ethnicity and sexual orientation - and health policies and practices), shows intersectionality to be a promising analytical resource for understanding and facing the global challenge of inequalities in health.

El abordaje de la interseccionalidad emergió a fines de la década de 1980, en el campo del activismo feminista negro en EEUU, como crítica a los análisis unidimensionales de las desigualdades sociales. Esta revisión narrativa descriptivo-analítica presenta el estado actual de la inclusión teórico-metodológica de la interseccionalidad en la salud pública. Se consultaron siete bases de bibliografía científica: Web of Science, Embase, Cinahl, Scopus, Sociological Abstracts, Lilacs y Medline, y se obtuvieron 1.763 artículos. Eliminados los duplicados y leídos los títulos y resúmenes, se seleccionaron 30 artículos producidos en cinco países entre 2006 y 2017. El análisis, estructurado en tres temas (debates teórico-metodológicos; marcadores sociales ­género, raza, etnicidad, orientación sexual­; y políticas y prácticas de salud), muestra que la interseccionalidad es un recurso analítico prometedor para la comprensión y el enfrentamiento del desafío global de las desigualdades en salud.

Time trends of physical activity in Curitiba, Brazil: 2006-2015. / Tendência temporal da participação em atividade física no lazer na cidade de Curitiba, Brasil (2006-2015).

OBJECTIVE: The identification of the time trend of physical activity can help in the evaluation of the effectiveness of programs aimed at the promotion of physical activity at the population scope. To analyze the temporal trend of leisure time physical activity in adults living in the city of Curitiba (Brazil), from 2006-2015. METHODS: This is a cross-sectional study with 19,183 adults, obtaining information on duration, intensity and weekly frequency of leisure-time physical activity from the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Inquiry. Adults who reported participating in leisure time physical activity at least once a week in the three months prior to the survey were considered active. RESULTS: Men's leisure-time physical activity was stable overtime (p = 0.28), while it increased significantly among women (1.86% per year, 95%CI 0.55; 3.37; p = 0.02). Men reported less activities with weekly frequency of one to two times (-3.75% per year, 95%CI -6.72; -0.67; p = 0.03) but more with weekly frequencies of five to six times (7.42% per year, 95%CI 4.54; 10.38; p = 0.001). No changes were observed in the frequency of physical activity among women. CONCLUSION: Monitoring indicators of physical activity in the city of Curitiba can assist legislators in building policies to promote physical activity.

INTRODUÇÃO: A tendência temporal da participação em atividade física pode auxiliar na avaliação da efetividade de programas voltados à sua promoção no âmbito populacional. O estudo analisou a tendência temporal da participação em atividade física no lazer de adultos residentes na cidade de Curitiba, Paraná, Brasil, no período de 2006 a 2015. MÉTODOS: Estudo transversal com dados secundários de 19.183 participantes, obtidos junto ao Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (2006 a 2015). Foram considerados ativos no lazer os adultos que referiram participar de atividades físicas no tempo livre pelo menos uma vez por semana nos três meses anteriores à realização do inquérito. RESULTADOS: A tendência temporal da prática de atividade de lazer foi estacionária em homens e crescente em mulheres (1,86% ao ano; IC95% 0,55 - 3,37). Os homens reduziram a participação em atividades realizadas 1 a 2 vezes por semana (-3,75% ao ano; IC95% -6,72 - -0,67) e aumentaram a participação em atividades realizadas de 5 a 6 vezes por semana (7,42% ao ano; IC95% 4,54 - 10,38). CONCLUSÃO: A continuidade da monitoração dos indicadores de atividade física na cidade de Curitiba pode auxiliar gestores a direcionarem políticas de promoção da atividade física.

Iniquidade racial na mortalidade por câncer de colo de útero no Brasil: estudo de séries temporais de 2002 a 2021 / Racial iniquity in mortality from cervical cancer in Brazil: a time trend study from 2002 to 2021

Resumo O objetivo desse artigo é analisar séries temporais da mortalidade por câncer de colo do útero segundo raça/cor no Brasil de 2002 a 2021. Estudo ecológico de séries temporais com dados do Sistema de Informação sobre Mortalidade e informações populacionais do IBGE. Variações anuais das taxas de mortalidade ajustadas por idade de mulheres de 20 anos ou mais foram estimadas pelo modelo de regressão linear simples com correção de Prais-Winsten. Foram registrados 133.429 óbitos por câncer de colo de útero, destes, 51,2% foram de mulheres negras. As mulheres negras morrem mais e têm menor queda do coeficiente. Houve aumento da desigualdade racial ao longo dos anos. Em 2002, ocorriam 0,08 óbitos/100 mil mulheres a mais na população negra comparada com a população branca; em 2021 esse número é de aproximadamente 1 óbito. Para a elaboração de políticas de saúde da mulher devem ser consideradas as diferenças raciais na implementação de estratégias e metas.

Abstract This ecological study examined time series, from 2002 to 20121, of age-adjusted coefficients of cervical cancer mortality, in Brazil, in women aged 20 years or more, by race. The information sources were Brazil's mortality information system (Sistema de Informação sobre Mortalidade - SIM) and the official bureau of statistics (Instituto Brasileiro de Geografia e Estatística - IBGE). Annual changes in age-adjusted mortality rates were calculated using the Prais-Winsten linear regression method. Black women die more and the rate is decreasing less. Racial inequality has increased over the years. In 2002, there were 0.08 more deaths per 100,000 women in the black population than among white women; in 2021, the number was one death. Health policymaking should consider racial differences in the implementation of strategies and goals.

Anos Potenciais de Vida Perdidos devido à COVID-19, segundo a raça/cor e gênero, no Brasil, entre 2020 e 2021 / Years of Potential Life Lost due to COVID-19 according to race/color and gender in Brazil between 2020 and 2021

Resumo A mortalidade provocada pela pandemia da COVID-19 tem produzido impactos aos indicadores de Anos Potenciais de Vida Perdidos (APVP) em nível mundial. Objetiva-se estimar os APVP devido à mortalidade por COVID-19, segundo sexo, faixa etária e raça/cor, no período de março de 2020 a dezembro de 2021, no Brasil. Foram caracterizadas as mortes por COVID-19, estimadas e comparadas as taxas e razão de taxas padronizadas de APVP, a média de anos potenciais de vida não vividos (APVNV) e a idade média do óbito (IMO). No geral, foram perdidos 13.776.969,50 anos potenciais de vida, o que determinou uma perda média de 22,5 anos potenciais não vividos. Houve maior perda de anos potenciais de vida nos homens (58,12%) e nas faixas etárias de 0 a 59 anos nas populações negra (58,92%) e indígena (63,35%), enquanto nas faixas etárias de 60 anos e mais foi observada maior perda de APVP nas populações branca (45,89%) e amarela (53,22%). As mulheres registraram as maiores IMO, com exceção das mulheres indígenas. Homens brancos (1,63), pardos (1,59) e pretos (1,61) tiveram as maiores taxas em comparação às mulheres brancas. Apesar da COVID-19 ter tido maior impacto em idosos, foram as populações negra e indígena na faixa de menos de 60 anos quem teve maior perda de anos potenciais de vida.

Abstract Mortality caused by the COVID-19 pandemic has impacted indicators of Years of Potential Life Lost (YPLL) worldwide. This study aimed to estimate the YPLL due to mortality caused by COVID-19, according to sex, age group, and race/color in Brazil, from March 2020 to December 2021. Deaths caused by COVID-19 were characterized, in which the rates and ratios of standardized YPLL rates, the average number of years of potential life lost (ANYPLL), and the average age at death (AAD) were estimated and compared. Overall, 13,776,969.50 potential years of life were lost, which resulted in an average loss of 22.5 potential years not lived. A greater loss of potential years of life was identified in men (58.12%) and in the age groups from 0 to 59 years in the black (58.92%) and indigenous (63.35%) populations, while in the age groups of 60 years and over, a greater loss of YPLL was observed in the white (45.89%) and yellow (53.22%) populations. Women recorded the highest ADD, with the exception of indigenous women. White men (1.63), brown men (1.59), and black men (1.61) had the highest rates when compared to white women. Although COVID-19 has a greater impact on the elderly, it was the black and indigenous populations under the age of 60 who had the greatest loss of potential years of life.

Fatores associados ao homicídio de mulheres no Brasil, segundo raça/cor, 2016-2020 / Factors associated with homicides of women in Brazil, by race or colour, 2016-2020

Resumo O objetivo deste estudo é avaliar as taxas de homicídios contra mulheres residentes no Brasil, segundo unidades da federação e raça/cor, no período de 2016 a 2020. Trata-se de um estudo ecológico de tendência temporal. Foi realizada análise múltipla adotando-se modelo de regressão para dados longitudinais. No período, ocorreram no Brasil 20.405 homicídios de mulheres e as taxas padronizadas mostraram que as mulheres negras (6,1/100.000) apresentaram as maiores taxas, em comparação às brancas (3,4/100.000). O Brasil apresentou queda de 25,2% de 2016 a 2020. A taxa de homicídio variou de 4,7 mortes por 100 mil mulheres em 2016 para 3,5 em 2020, mas a tendência decrescente e estatisticamente significante foi observada nas taxas de mulheres negras e brancas. As variáveis IDH, taxa de analfabetismo e proporção de causas mal definidas apresentaram uma relação inversa e estatisticamente significante com as taxas de homicídio de mulheres. Nos anos de 2019 e 2020 houve uma diminuição da taxa média de homicídio em relação ao ano de 2016. Apesar do decrescimento na evolução temporal das taxas para negras e brancas, houve diferenças raciais importantes nos homicídios de mulheres, com piores resultados para as mulheres negras.

Abstract This ecological, time-trend study examined rates of homicide against women residing in Brazil, by state and race/colour, from 2016 to 2020, by performing. Multiple analysis by regression model on longitudinal data. During the study period, 20,405 homicides of women were recorded in Brazil. Standardised homicides rates were higher among black women (6.1/100,000) than among white women (3.4/100,000). From 2016 to 2020, rates decreased 25.2%, from 4.7 deaths per 100,000 women in 2016 to 3.5 in 2020, with a statistically significant downward trend among both black and white women. Statistically significant inverse relationships were found between female homicide rates and HDI, illiteracy rate and proportion of ill-defined causes. The average homicide rate decreased in 2019 and 2020, as compared with 2016. Despite the decreasing time trend in homicide rates for both black and white women, they differed substantially by race, with worse outcomes for black women.

Detection of clinical and neurological signs in apparently asymptomatic HTLV-1 infected carriers: Association with high proviral load.

Several studies suggest that HTLV-1 infection may be associated with a wider spectrum of neurologic manifestations that do not meet diagnostic criteria for HAM/TSP. These conditions may later progress to HAM/TSP or constitute an intermediate clinical form, between asymptomatic HTLV-1 carriers and those with full myelopathy. Our aim was to determine the prevalence of HTLV-1-associated disease in subjects without HAM/TSP, and the relationship between these findings with HTLV-1 proviral load (PVL). METHODS: 175 HTLV-1-infected subjects were submitted to a careful neurological evaluation, during their regular follow up at the HTLV outpatient clinic of the Institute of Infectious Diseases "Emilio Ribas", São Paulo city, Brazil. Clinical evaluation and blinded standardized neurological screening were performed for all the subjects by the same neurologist (MH). RESULTS: After the neurological evaluation, 133 patients were classified as asymptomatic and 42 fulfilled the criteria for intermediate syndrome (IS). The mean age of the enrolled subjects was 46.3 years and 130 (74.3%) were females. Clinical classification shows that neurological symptoms (p<0.001), visual disorders (p = 0.001), oral conditions (p = 0.001), skin lesions (p<0.001), bladder disorders (p<0.001), and rheumatological symptoms (p = 0.001), were strongly associated to IS, except for disautonomy (p = 0.21). A multivariate analysis revealed that HTLV-1 proviral load, oral conditions, bladder disorders and rheumatological symptoms were independently associated with the IS. CONCLUSIONS: We found some early alterations in 42 patients (24%), particularly the presence of previously not acknowledged clinical and neurological symptoms, among subjects previously classified as "asymptomatic", who we reclassified as having an intermediate syndrome.

Comparison of diagnostic methods to detect Histoplasma capsulatum in serum and blood samples from AIDS patients.

BACKGROUND: Although early and rapid detection of histoplasmosis is essential to prevent morbidity and mortality, few diagnostic tools are available in resource-limited areas, especially where it is endemic and HIV/AIDS is also epidemic. Thus, we compared conventional and molecular methods to detect Histoplasma capsulatum in sera and blood from HIV/AIDS patients. METHODOLOGY: We collected a total of 40 samples from control volunteers and patients suspected of histoplasmosis, some of whom were also infected with other pathogens. Samples were then analyzed by mycological, serological, and molecular methods, and stratified as histoplasmostic with (group I) or without AIDS (group II), uninfected (group III), and infected with HIV and other pathogens only (group IV). All patients were receiving treatment for histoplasmosis and other infections at the time of sample collection. RESULTS: Comparison of conventional methods with nested PCR using primers against H. capsulatum 18S rRNA (HC18S), 5.8S rRNA ITS (HC5.8S-ITS), and a 100 kDa protein (HC100) revealed that sensitivity against sera was highest for PCR with HC5.8S-ITS, followed by immunoblotting, double immunodiffusion, PCR with HC18S, and PCR with HC100. Specificity was equally high for double immunodiffusion, immunoblotting and PCR with HC100, followed for PCR with HC18S and HC5.8-ITS. Against blood, sensitivity was highest for PCR with HC5.8S-ITS, followed by PCR with HC18S, Giemsa staining, and PCR with HC100. Specificity was highest for Giemsa staining and PCR with HC100, followed by PCR with HC18S and HC5.8S-ITS. PCR was less efficient in patients with immunodeficiency due to HIV/AIDS and/or related diseases. CONCLUSION: Molecular techniques may detect histoplasmosis even in cases with negative serology and mycology, potentially enabling early diagnosis.

Risk factors associated with HTLV-1 vertical transmission in Brazil: longer breastfeeding, higher maternal proviral load and previous HTLV-1-infected offspring.

HTLV-1 is transmitted primarily either through sexual intercourse or from mother to child. The mother/child pairs were classified as seroconcordant or serodiscordant. We analyzed mother to child transmission (MTCT) according to sociodemographic, clinical and epidemiological characteristics of the mother, child's gender and duration of breastfeeding. Between June 2006 and August 2016 we followed 192 mothers with HTLV-1 infection (mean age 41 years old), resulting in 499 exposed offspring, 288 (57.7%) of whom were tested for HTLV-1, making up the final sample for the study, along with their 134 respective mothers. Among the tested mother/child pairs, 41 (14.2%) were HTLV-1 positive, highlighted that seven of 134 family clusters concentrated 48.8% of positive cases. Variables associated with a positive child: breastfeeding duration ≥12 months, maternal PVL ≥100 copies/104 PBMC, mother's age at delivery >26 years old, and HTLV-1 in more than one child of the same mother. In a multiple logistic regression, breastfeeding ≥12 months, higher maternal PVL and ≥2 previous HTLV-1-infected children remained independently associated with the outcome. Thus, high maternal PVL and breastfeeding beyond 12 months were independently associated with MTCT of the HTLV-1 infection. Our results reinforce the need for both prenatal HTLV screening in endemic areas and for advising mothers on breastfeeding.

Personal, relational and school factors associated with involvement in fights with weapons among school-age youth in Brazil: a multilevel ecological approach.

OBJECTIVES: To investigate the association between personal, relational and school factors with involvement in fights with weapon among Brazilian school-age youth. METHODS: Using data from the Adolescent School-Based Health Survey 2015 (n = 102.072), we conducted multilevel logistic regression models. RESULTS: IFW was associated with female sex (OR = 0.45), and with older age (OR = 1.15), previous involvement in physical violence (OR = 2.05), history of peer verbal (OR = 1.14) and domestic victimization (OR = 2.11), alcohol use (OR = 2.42) and drug use (OR = 3.23). The relational variables (e.g., parent's supervision) were mostly negatively associated with IFW. At the school level, attending public school and attending schools in violent surroundings were both positively associated with IFW. The intraclass correlation coefficient estimated in the empty model showed that 5.77% of the variance of IFW was at school level. When all individual- and school-level variables were included in the model, the proportional changes in variance were 61.7 and 71.55%, respectively. CONCLUSIONS: IFW is associated with personal, relational and school factors. Part of the variance in IFW by school is explained by characteristics of the school context.

[Governance and regulation in health: challenges for health management in Greater Metropolitan São Paulo, Brazil]. / Governança e regulação na saúde: desafios para a gestão na Região Metropolitana de São Paulo, Brasil.

This paper discusses the relationship between the public and private sectors in the Unified National Health System (SUS), based on research whose objective was to identify governance strategies and mechanisms for public/private relations in the health sector, considering the search for equity in Greater Metropolitan Sao Paulo, Brazil. Governance was used as an analytical category, with health system regulation as the issue. Municipal and State health secretaries, members of health councils, and SUS staff were interviewed, and the empirical material was classified as: (a) regulatory mechanisms and instruments; (b) power loci; and (c) actors' positions concerning the SUS and its relationship to the private sector. Mechanisms and instruments have been created and used in the municipalities for regulation of their own services. Regulatory measures for the complementary and supplementary healthcare sector are practically nonexistent. There are numerous institutional power loci, seen more as places for submitting demands than as forums for negotiation. Despite some progress, governance appears to be more of a formal issue. Discussion is needed on the relationship between the public and private sectors and its regulation by municipalities in order to improve the health system.

Adolescents, poverty areas, violence, and public health: an intersectional perspective / Adolescentes, áreas de pobreza, violencia y salud pública: un enfoque interseccional / Adolescentes, áreas de pobreza, violência e saúde pública: um enfoque interseccional

ABSTRACT Objectives: to discuss the influence of urban poverty on the context of violence among adolescents from an intersectional perspective. Methods: the original research, of the action research type, analyzed data from 13 workshops. The participants were adolescents from both sexes, from 15 to 17 years old, from a public school in a peripheral neighborhood of São Paulo, SP. The methodological proposition of intersectional analysis guided the interpretation of the empirical material. Results: the intersection of class and gender may increase the (re)production of violence in some men. The intersection of race/color, social class, and territory contributes to the construction of narratives that naturalize inequality and, thus, justify discrimination. Final Considerations: there is necessity of new public policies that consider the social contexts and experiences of the subjects that stem from the articulation of social markers.

RESUMEN Objetivos: discutir la influencia de la pobreza urbana en el contexto de la violencia entre adolescentes bajo la perspectiva de la interseccionalidad. Métodos: la investigación original, de tipo investigación-acción, se analizó en 13 talleres. Participaron adolescentes de ambos los sexos, entre 15 y 17 años, de una escuela pública de un barrio de la periferia de São Paulo, SP. La propuesta metodológica de análisis interseccional dirigió la interpretación del material empírico. Resultados: la intersección de clase con género puede potencializar en algunos hombres la (re)producción de las violencias. La intersección de raza/color, clase social, género y territorio contribuye en la construcción de narrativas que naturalizan las desigualdades y, así, justifican las discriminaciones. Consideraciones Finales: son necesarias y oportunas políticas públicas que consideren los contextos sociales y experiencias de los sujetos resultantes de las articulaciones de los marcadores sociales.

RESUMO Objetivos: discutir a influência da pobreza urbana no contexto da violência entre adolescentes sob a perspectiva da interseccionalidade. Métodos: a pesquisa original, de tipo pesquisa-ação, analisou dados produzidos em 13 oficinas. Participaram adolescentes de ambos os sexos, entre 15 e 17 anos, de uma escola pública de um bairro de periferia de São Paulo, SP. A proposta metodológica de análise interseccional orientou a interpretação do material empírico. Resultados: a intersecção de classe com gênero pode potencializar em alguns homens a (re)produção das violências. A intersecção de raça/cor, classe social, gênero e território contribui na construção de narrativas que naturalizam as desigualdades e, assim, justificam as discriminações. Considerações Finais: são necessárias e oportunas políticas públicas que considerem os contextos sociais e experiências dos sujeitos resultantes das articulações dos marcadores sociais.