Lantana camara L. induces a multi-targeted cell death process in Leishmania amazonensis.

ETNOPHARMACOLOGICAL RELEVANCE: Lantana camara L. is a species known for its broad spectrum of bioactivities and is commonly used in folk therapy to address inflammatory, dermatological, gastrointestinal, intestinal worms and protozoan diseases. It boasts a diverse array of secondary metabolites such as terpenes, flavonoids, and saponins. However, despite its rich chemical profile, there remains a scarcity of studies investigating its antileishmanial properties. AIM OF THE STUDY: This research aims to explore the antileishmanial potential of L. camara, focusing also on its mechanism of action against Leishmania amazonensis. MATERIAL AND METHODS: The ethanolic extract of L. camara leaves (LCE) was obtained through static maceration, and its phytoconstituents were identified using UFLC-QTOF-MS. The colorimetric MTT method was conducted to determine the effect of LCE on promastigotes of L. amazonensis and murine macrophages. The anti-amastigote activity was evaluated by counting intracellular parasites in macrophages after Giemsa staining. Additionally, investigations into the mechanisms underlying its action were conducted using cellular and biochemical approaches. RESULTS: LCE exhibited significant activity against both promastigotes and intracellular amastigotes of L. amazonensis, with IC50 values of 12.20 µg/mL ± 0.12 and 7.09 µg/mL ± 1.24, respectively. These IC50 values indicate very promising antileishmanial activity, comparable to those found for the positive control miltefosine (5.10 µg/mL ± 1.79 and 8.96 µg/mL ± 0.50, respectively). Notably, LCE exhibited negligible cytotoxicity on macrophages (IC50 = 223.40 µg/mL ± 47.02), demonstrating selectivity towards host cells (SI = 31.50). The antileishmanial activity of LCE involved a multi-targeted cell death process, characterized by morphological and ultrastructural alterations observed through SEM and TEM analyses, as well as oxidative effects evidenced by the inhibition of trypanothione reductase, elevation of ROS and lipid levels, and mitochondrial dysfunction evaluated using DTNB, H2DCFDA, Nile red, and JC-1 assays. Additionally, extraction of ergosterol and double labeling with annexin V and PI revealed modifications to the organization and permeability of the treated parasite's plasma membrane. LCE was found to consist predominantly of terpenes, with lantadenes A, B, and C being among the eleven compounds identified through UFLC-QTOF-MS analysis. CONCLUSIONS: The extract of L. camara presents a diverse array of chemical constituents, prominently featuring high terpene content, which may underlie its antileishmanial properties through a combination of apoptotic and non-apoptotic mechanisms of cell death induced by LCE. This study underscores the therapeutic potential of L. camara as a candidate for antileishmanial treatment, pending further validation.

Psychometric evaluation of the Intersectional Discrimination Index for use in Brazil.

This cross-sectional study evaluated the configural and metric structures of the Intersectional Discrimination Index (InDI), an instrument that measures anticipated (InDI-A), dat-to-day (InDI-D), and major (InDI-M) discrimination. Data from a broader study, focused on the impacts of discrimination on the mental health of women living in Brazil, were used. Approximately 1,000 women, selected according to a convenience sampling scheme, answered the InDI and questions about sociodemographic characteristics in an electronic form that was administered in 2021. Exploratory factor analyses and exploratory structural equation modeling were applied to the first half of the sample; for the second, confirmatory factor analysis was conducted. Taken together, the findings suggest that each of the three measures is one-dimensional. However, unlike the study that originally proposed the InDI for use in Canada and the United States, we observed the presence of residual correlations in the three subscales evaluated, all of which were suggestive of content redundancy between specific pairs of items. The three measures showed moderate to strong factor loadings and acceptable fit to the data. InDI exhibited reasonable internal validity, potentially becoming a valuable instrument for investigating the health effects of intersectional discrimination in Brazil. Future studies should evaluate the consistency of these findings, examine the scalar structure of the instrument, and analyze its invariance among different marginalized groups.

One step further in mistreatment research: Assessing the scalability of the Explicit Discrimination Scale among Brazilian working-age adult respondents.

Though the Explicit Discrimination Scale (EDS) has been subjected to extensive psychometric evaluation in Brazil, the instrument has yet to be comprehensively assessed among working-age adult respondents in the country. This study aimed to fill this knowledge gap. Data from around 1200 diverse members of a cohort investigation were used to examine: (1) the positioning of respondents along the continuum of the EDS latent trait; (2) how well the corresponding items represent the EDS construct map; and (3) the extent to which the EDS items follow their expected levels of intensity. We assessed these properties with Loevinger's H, Guttman errors, and Item Response Theory parameters. Findings suggest that two abridged versions of the instrument-but especially the eight-item EDS-may adequately arrange respondents along the latent trait continuum. Analyses also revealed that scale items are reasonably spread over the construct map, with some discrepancy between the expected levels of intensity and their empirical positioning in the corresponding plot. The shortened versions of EDS have good psychometric properties among Brazilian working-age adult respondents. In addition to examining the invariance of the EDS across multiple groups, future psychometric evaluations should assess the external validity of the scale.

Access to medicines, the Unified Health System, and intersectional injustices.

OBJECTIVE: To estimate the prevalence of general and public access to prescription drugs in the Brazilian population aged 15 or older in 2019, and to identify inequities in access, according to intersections of gender, color/race, socioeconomic level, and territory. METHODS: We analyzed data from the 2019 National Health Survey with respondents aged 15 years or older who had been prescribed a medication in a healthcare service in the two weeks prior to the interview (n = 19,819). The outcome variable was access to medicines, subdivided into general access (public, private and mixed), public access (via the Unified Health System - SUS) for those treated by the SUS, and public access (via the SUS) for those not treated by the SUS. The study's independent variables were used to represent axes of marginalization: gender, color/race, socioeconomic level, and territory. The prevalence of general and public access in the different groups analyzed was calculated and the association of the outcomes with the aforementioned axes was estimated with odds ratios (OR) using logistic regression models. RESULTS: There was a high prevalence of general access (84.9%), when all sources of access were considered, favoring more privileged segments of the population, such as men, white, and those of high socioeconomic status. When only the medicines prescribed in the SUS were considered, there was a low prevalence (30.4% access) that otherwise benefited marginalized population segments, such as women, black, and people from low socioeconomic backgrounds. CONCLUSIONS: Access to medicines through the SUS proves to be an instrument for combating intersectional inequities, lending credence to the idea that the SUS is an efficient public policy for promoting social justice.

Factorial invariance of the abridged version of the Explicit Discrimination Scale among adults living in southern Brazil.

OBJECTIVE: The Explicit Discrimination Scale (EDS) was developed to assess experiences with discrimination in Brazilian epidemiologic surveys. Though previous analyses have demonstrated that the EDS has good configural, metric, and scalar properties, its invariance has not yet been investigated. In this study, we examined the factorial invariance of two abridged versions of the EDS, according to skin color/ethnicity, sex, socioeconomic status, and their intersections. METHODS: Data from the EpiFloripa Adult Study were used, which include a representative sample of adults residing in a state capital of southern Brazil (n=1,187). Over half of the respondents were women, and around 90% identified as white; the mean age of the participants was 39 years. Two abridged versions of the EDS were analyzed, with seven and eight items, using Multigroup Confirmatory Analysis and the Alignment method. RESULTS: The two versions of the scale may be used to provide estimates of discrimination that are comparable across skin color/ethnicity, sex, socioeconomic status, and their intersections. In the seven-item version of the scale, only one parameter lacked invariance (i.e., threshold of item i13 - called by names you do not like), specifically among black respondents with less than 12 years of formal education. CONCLUSION: The EDS may provide researchers with valid, reliable, and comparable estimates of discrimination between different segments of the population, including those at the intersections of skin color/ethnicity, sex, and socioeconomic status. However, future research is needed to determine whether the patterns we identified here are consistent in other population domains.

The intersecting effects of race, wealth, and education on AIDS incidence, mortality, and case-fatality rate: a Brazilian cohort study of 28.3 million individuals.

The relationships between race, education, wealth, their intersections and AIDS morbidity/mortality were analyzed in retrospective cohort of 28.3 million individuals followed for 9 years (2007-2015). Together with several sensitivity analyses, a wide range of interactions on additive and multiplicative scales were estimated. Race, education, and wealth were each strongly associated with all of the AIDS-related outcomes, and the magnitude of the associations increased as intersections were included. A significantly higher risk of illness (aRR: 3.07, 95%CI:2.67-3.53) and death (aRR: 4.96, 95%CI:3.99-6.16) from AIDS was observed at the intersection of Black race, lower educational attainment, and less wealth. A higher case-fatality rate (aRR: 1.62, 95%CI:1.18-2.21) was also seen for the same intersectional group. Historically oppressed groups lying at the intersections of race, education, and wealth, had a considerably higher risk of illness and death from AIDS. AIDS-related interventions will require the implementation of comprehensive intersectoral policies that follow an intersectionality perspective.

[Assessing experiences with discrimination in multiple social groups: invariance analysis of the Explicit Discrimination Scale in university students]. / Aferindo experiências com discriminação em múltiplos grupos sociais: análise de invariância da Escala de Discriminação Explícita em estudantes universitários.

This study evaluated the ability of the Explicit Discrimination Scale (EDS) to produce comparable estimates among respondents according to gender, color/race, and socioeconomic status. Analysis was based on data from two studies with students from Brazilian public universities. An abridged version of the EDS with eight items was evaluated by the alignment method. Findings indicated violation of invariance between color/race and gender groups. Reports of discriminatory experiences had better comparability between socioeconomic status strata. This study showed that EDS should be used with caution, especially to compare discrimination estimates between respondents of different colors/races and genders. The observed violation of invariance reinforces the need for additional research examining whether such a scenario persists in larger and more diverse samples from Brazil.

O objetivo foi avaliar a capacidade da Escala de Discriminação Explícita (EDE) de produzir estimativas comparáveis entre grupos de gênero, cor/raça e posição socioeconômica. A análise se baseou em dados de dois estudos, realizados com estudantes de universidades públicas brasileiras. Uma versão abreviada da EDE com oito itens foi avaliada, utilizando o método alignment (alinhamento). Nossos achados indicaram violação de invariância entre grupos de cor/raça e gênero. Os relatos de experiências discriminatórias tiveram melhor comparabilidade entre estratos de posição socioeconômica. Este estudo demonstrou que a EDE deve ser utilizada com cautela, especialmente para fazer comparações de estimativas de discriminação entre respondentes de cor/raça e gênero distintos. A violação de invariância observada reforça a necessidade de pesquisas adicionais, examinando se tal cenário se mantém em amostras mais amplas e diversas do país.

El objetivo fue evaluar la capacidad de la Escala de Discriminación Explícita (EDE) para producir estimaciones comparables entre grupos de género, color/raza y posición socioeconómica. El análisis se basó en los datos de dos estudios, realizados con estudiantes de universidades públicas brasileñas. Se evaluó una versión abreviada de la EDE con 8 ítems, utilizando el método alignment (alineación). Nuestros hallazgos indicaron una violación de la invariancia entre los grupos de color/raza y género. Los informes de experiencias discriminatorias fueron más comparables entre los estratos de posición socioeconómica. Este estudio demostró que la EDE debe usarse con precaución, especialmente para hacer comparaciones de estimaciones de discriminación entre encuestados distintos de color/raza y género. La violación de la invariancia observada refuerza la necesidad de investigaciones adicionales, examinando si tal escenario se mantiene muestras más amplias y diversas del país.

A Cross-sectional Online Questionnaire-based Survey About the Use of Compounded Medications in Veterinary Ophthalmology.

The aims of this survey were to determine how veterinary ophthalmologists worldwide use compounded ophthalmic drugs to treat ocular diseases, define their attitudes regarding compounding pharmacies, and identify commonly dispensed veterinary ophthalmic formulations as well as the diseases for which those preparations are most often prescribed. Respondents voluntar i ly and anonymously completed a questionnaire that was sent to a total of 1014 veterinary ophthalmologists at universities, specialty colleges, and ophthalmology associations in 24 countries. One hundred thirty (12.83%) veterinary ophthalmologists replied. Of those, 87 (66.92%) had worked in  veterinary ophthalmology for more than 10 years. Ten to 30% of their total prescriptions were compounded ophthalmic drugs, the most common of which were tacrolimus and cyclosporine for the treatment of keratoconjunctivitis sicca. Reported advantages of treatment with a compound included the accessibility of preparations that were not commercially available and the ability to customize formulations; reported disadvantages included brief shelf life, delivery time, and cost.

Discriminatory experiences among gay, bisexual, and other men who have sex with men, and transgender and non-binary individuals: a cross sectional analysis.

Background: Several systems of oppression combine in complex ways to impact the lives of minority populations. Following an intersectionality framework, we assessed the frequency and perceived reasons for discrimination among gay, bisexual, and other cisgender men who have sex with men (MSM) and transgender and non-binary individuals (TGNB), stratified by race. Methods: Online survey among MSM and TGNB ≥18 years living in Brazil, between November/2021 and January/2022. We used the 18-item Explicit Discrimination Scale to assess day-to-day experiences of differential treatment, and perceived discrimination. For each item, participants indicated their perceived reasons for differential treatment using 14 pre-defined options. Negative binomial regression models assessed if race was a significant predictor of discrimination. Subsequent models, stratified by race, examined associations of perceived reasons and number of reasons with perceived discrimination. Findings: Of 8464 MSM and TGNB, 4961 (58.6%) were White, 2173 (25.7%) Pardo (Brazil's official term for admixed populations), and 1024 (12.1%) Black. Black participants' scores for perceived discrimination (mean, standard deviation) were higher (10.2, 8.8) [Pardo (6.5, 6.8), White (5.2, 5.7)], and race was both the main reason for and the strongest predictor of perceived discrimination. The number of reasons participants used to interpret their discriminatory experiences was also a predictor of discrimination score among White, Pardo, and Black participants. Interpretation: LGBTQIA+phobia was highly prevalent among all participants. Additionally, our results indicated that Black MSM and TGNB participants were more frequently discriminated against than other racial groups, with racial discrimination uniquely contributing these experiences. Funding: Fundação Oswaldo Cruz, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro.

Antiracist ethos and the collective oral health as a pathway for life. / Ethos antirracista em saúde bucal coletiva como imperioso à vida.

This article proposes a reflection on the imperative of antiracism in collective oral health, which, as a science, field, core, and praxis, contributes significantly to the reconstruction of an ethos that considers equity and enables citizenship and democracy. As a paradigm, we assumed the concept of "Buccality" and the guidelines of the National Comprehensive Health Policy for the Black Population, emphasizing the defense of the right to health as a prerogative of the right to life and the combat against racism and all forms of discrimination systematically. As a critical exercise, we discussed the status quo of collective oral health. We pointed to adopting a racial pro-equity perspective as an intentional, political choice socially agreed upon with all of society for social justice. Finally, we propose recommendations for dismantling systemic racism in collective oral health.

Este artigo propõe uma reflexão sobre o imperativo do antirracismo na saúde bucal coletiva, a qual, como núcleo e práxis, pode contribuir de forma significativa para a (re)construção de um ethos que contemple a equidade e viabilize a cidadania e a democracia. Como paradigma, assumimos o conceito "Bucalidade" e as diretrizes da Política Nacional de Saúde Integral da População Negra, pela ênfase no direito à saúde como prerrogativa do direito à vida e no combate ao racismo e a todas as formas de discriminação, em quaisquer espaços, como indutor desse ethos. Como exercício crítico, abordamos o status quo da saúde bucal coletiva e apontamos para uma perspectiva pró-equidade racial como uma escolha intencional, política e pactuada socialmente em busca da justiça social. Por fim, trazemos proposições para a implementação desse ethos por assumir o enfrentamento do racismo sistêmico no campo da saúde bucal coletiva como inadiável para a preservação da vida-boca e aprimoramento da democracia.

A partial habituation method to test for anterograde and retrograde amnestic treatment effects: Evidence that antagonism of the NMDA receptor can induce anterograde but not retrograde amnestic effects.

BACKGROUND: A progressive decrease in spontaneous locomotion with repeated exposure to a novel environment has been assessed using both within and between-session measures. While both are well-established and reliable measurements, neither are useful alone as methods to concurrently assess treatment effects on acquisition and retention of habituation. NEW METHOD: We report a behavioral method that measures habituation by combining the within and between measurements of locomotion. We used a 30 min session divided into 6 five min blocks. In the first novel environment session activity was maximal in the first 5 min block but was reduced to a low level by the sixth block, indicative of within-session habituation. Using 8 daily sessions, we showed that this terminal block low level of activity progressed incrementally to the first block to achieve complete habituation. RESULTS/COMPARISON WITH EXISTING METHODS: Within-session activity across sessions was used to identify different stages of between session habituation. It was then possible to assess drug treatment effects from partial to complete habituation, so that treatment effects on retention of the previously acquired partial habituation, expressed as a reversion to an earlier within session habituation pattern (retrograde amnesia assessment), as well as the effects on new learning by the failure in subsequent sessions to acquire complete between-session habituation (anterograde amnesia assessment). CONCLUSIONS: The use of spontaneous motor activity to assess learning and memory effects provides the opportunity to assess direct treatment effects on behavior and motor activity in contrast to many learning and memory models.

Associations between psychological stress, discrimination, and oral health-related quality of life: the buffering effects of social support networks.

Stress and discrimination negatively affect quality of life, but social support may buffer their effects. This study aims: (1) to examine the associations between psychological stress, discrimination, and oral health-related quality of life (OHRQoL); and (2) to assess whether social support, stress and discrimination interact to modify their associations with OHRQoL. We used cross-sectional household-based data from a study including 396 individuals aged 14 years and over from families registered for government social benefits in a city in Southern Brazil. OHRQoL was measured with the Oral Impacts on Daily Performance (OIDP) scale; psychological stress was assessed with the Perceived Stress Scale (PSS); social support was assessed based on the number of close relatives or friends of the participant, and discrimination was assessed with a short version of the Everyday Discrimination Scale. Interactions were estimated using the relative excess of risk due to interaction (RERI). Adjusted effects were calculated with logistic regression. The prevalence of oral impacts among people with higher and lower PSS scores was 81.6% and 65.5%, respectively (p < 0.01). Social support was found to have no interactions with stress levels and discrimination. The association between social discrimination and OHRQoL (OIDP score > 0) was OR = 2.03 (95%CI: 1.23; 3.34) among people with a low level of stress, but was OR = 12.6 (95%CI: 1.31; 120.9) among those with higher levels (p = 0.09, for interaction). Individuals who reported experiencing higher levels of psychological stress and discrimination had worse OHRQoL; a synergistic effect with social support was not clear.

Associations between psychological stress, discrimination, and oral health-related quality of life: the buffering effects of social support networks / Associações entre estresse psicológico, discriminação e qualidade de vida relacionada à saúde bucal: os efeitos amortecedores das redes de apoio social / Asociaciones entre estrés psicológico, discriminación y calidad de vida relacionada con la salud bucal: los efectos atenuantes de las redes de apoyo social

Stress and discrimination negatively affect quality of life, but social support may buffer their effects. This study aims: (1) to examine the associations between psychological stress, discrimination, and oral health-related quality of life (OHRQoL); and (2) to assess whether social support, stress and discrimination interact to modify their associations with OHRQoL. We used cross-sectional household-based data from a study including 396 individuals aged 14 years and over from families registered for government social benefits in a city in Southern Brazil. OHRQoL was measured with the Oral Impacts on Daily Performance (OIDP) scale; psychological stress was assessed with the Perceived Stress Scale (PSS); social support was assessed based on the number of close relatives or friends of the participant, and discrimination was assessed with a short version of the Everyday Discrimination Scale. Interactions were estimated using the relative excess of risk due to interaction (RERI). Adjusted effects were calculated with logistic regression. The prevalence of oral impacts among people with higher and lower PSS scores was 81.6% and 65.5%, respectively (p < 0.01). Social support was found to have no interactions with stress levels and discrimination. The association between social discrimination and OHRQoL (OIDP score > 0) was OR = 2.03 (95%CI: 1.23; 3.34) among people with a low level of stress, but was OR = 12.6 (95%CI: 1.31; 120.9) among those with higher levels (p = 0.09, for interaction). Individuals who reported experiencing higher levels of psychological stress and discrimination had worse OHRQoL; a synergistic effect with social support was not clear.

O estresse e a discriminação afetam negativamente a qualidade de vida, mas o apoio social pode amortecer seus efeitos. Os objetivos deste estudo são: (1) examinar as associações entre estresse psicológico, discriminação e qualidade de vida relacionada à saúde bucal (QVRSB); e (2) avaliar se apoio social, estresse e discriminação interagem para modificar suas associações com QVRSB. Os dados são de uma pesquisa transversal de base domiciliar de um estudo que incluiu 396 indivíduos com 14 anos ou mais de famílias registradas para benefícios federais em uma cidade no sul do Brasil. A QVRSB foi mensurada pelo Impactos Orais no Desempenho Diário (OIDP), enquanto o estresse psicológico foi avaliado pela Escala de Estresse Percebido (PSS). Além disso, o apoio social foi avaliado pelo número de parentes ou amigos próximos e a discriminação por meio da Escala de Discriminação Diária (EDS). As interações foram estimadas por meio do excesso relativo de risco devido à interação (RERI). Os efeitos ajustados foram calculados por meio de regressão logística. A prevalência de impactos bucais entre as pessoas com maior e menor escores de PSS foi de 81,6% e 65,5%, respectivamente (p < 0,01). O apoio social mostra interações inclusivas com níveis de estresse e discriminação. A associação entre discriminação social e QVRSB (escore OIDP > 0) foi OR = 2,03 (IC95%: 1,23; 3,34) dentre pessoas com baixo nível de estresse, mas foi de OR = 12,6 (IC95%: 1,31; 120,9) dentre aqueles com níveis mais altos (p = 0,09, para interação). Indivíduos que relataram níveis mais elevados de estresse psicológico e discriminação apresentaram pior QVRSB; o efeito sinérgico com o apoio social não foi evidente.

El estrés y la discriminación afectan negativamente a la calidad de vida, pero el apoyo social puede mitigar sus efectos. Los objetivos de este estudio son: (1) examinar las asociaciones entre el estrés psicológico, la discriminación y la calidad de vida relacionada con la salud bucal (CVRSB); y (2) evaluar si el apoyo social, el estrés y la discriminación interactúan para modificar sus asociaciones con la CVRSB. Los datos provienen de una encuesta transversal de hogares cuyo estudio incluyó a 396 individuos de 14 años o más de familias registradas en beneficios del gobierno en una ciudad del Sur de Brasil. La CVRSB se midió mediante el Impactos Orales en el Rendimiento Diario (OIDP), mientras que el estrés psicológico se evaluó mediante la Escala de Estrés Percibido (PSS). El apoyo social se basó en el número de familiares o amigos cercanos, y la discriminación en la Escala de Discriminación Cotidiana (EDS). Las interacciones se estimaron mediante el excesivo de riesgo relativo debido a la interacción (RERI). Los efectos ajustados se calcularon mediante regresión logística. La prevalencia de impactos orales entre las personas con puntajes de PSS más altas y más bajas fue del 81,6% y del 65,5%, respectivamente (p < 0,01). El apoyo social presenta interacciones inclusivas con niveles de estrés y discriminación. La asociación entre discriminación social y OHRQoL (puntuación OIDP > 0) fue OR = 2,03 (IC95%: 1,23; 3,34) entre personas con un nivel bajo de estrés, pero fue OR = 12,6 (IC95%: 1,31; 120,9) entre aquellos con niveles más altos (p = 0,09, para interacción). Las personas que informaron tener niveles más elevados de estrés psicológico y discriminación tuvieron una peor CVRSB; el efecto sinérgico con el apoyo social no estaba claro.

Ethos antirracista em saúde bucal coletiva como imperioso à vida / Antiracist ethos and the collective oral health as a pathway for life

Resumo Este artigo propõe uma reflexão sobre o imperativo do antirracismo na saúde bucal coletiva, a qual, como núcleo e práxis, pode contribuir de forma significativa para a (re)construção de um ethos que contemple a equidade e viabilize a cidadania e a democracia. Como paradigma, assumimos o conceito "Bucalidade" e as diretrizes da Política Nacional de Saúde Integral da População Negra, pela ênfase no direito à saúde como prerrogativa do direito à vida e no combate ao racismo e a todas as formas de discriminação, em quaisquer espaços, como indutor desse ethos. Como exercício crítico, abordamos o status quo da saúde bucal coletiva e apontamos para uma perspectiva pró-equidade racial como uma escolha intencional, política e pactuada socialmente em busca da justiça social. Por fim, trazemos proposições para a implementação desse ethos por assumir o enfrentamento do racismo sistêmico no campo da saúde bucal coletiva como inadiável para a preservação da vida-boca e aprimoramento da democracia.

Abstract This article proposes a reflection on the imperative of antiracism in collective oral health, which, as a science, field, core, and praxis, contributes significantly to the reconstruction of an ethos that considers equity and enables citizenship and democracy. As a paradigm, we assumed the concept of "Buccality" and the guidelines of the National Comprehensive Health Policy for the Black Population, emphasizing the defense of the right to health as a prerogative of the right to life and the combat against racism and all forms of discrimination systematically. As a critical exercise, we discussed the status quo of collective oral health. We pointed to adopting a racial pro-equity perspective as an intentional, political choice socially agreed upon with all of society for social justice. Finally, we propose recommendations for dismantling systemic racism in collective oral health.

Psychometric evaluation of the Intersectional Discrimination Index for use in Brazil / Evaluación psicométrica del Intersectional Discrimination Index para uso en Brasil / Avaliação psicométrica do Intersectional Discrimination Index para uso no Brasil

Abstract: This cross-sectional study evaluated the configural and metric structures of the Intersectional Discrimination Index (InDI), an instrument that measures anticipated (InDI-A), dat-to-day (InDI-D), and major (InDI-M) discrimination. Data from a broader study, focused on the impacts of discrimination on the mental health of women living in Brazil, were used. Approximately 1,000 women, selected according to a convenience sampling scheme, answered the InDI and questions about sociodemographic characteristics in an electronic form that was administered in 2021. Exploratory factor analyses and exploratory structural equation modeling were applied to the first half of the sample; for the second, confirmatory factor analysis was conducted. Taken together, the findings suggest that each of the three measures is one-dimensional. However, unlike the study that originally proposed the InDI for use in Canada and the United States, we observed the presence of residual correlations in the three subscales evaluated, all of which were suggestive of content redundancy between specific pairs of items. The three measures showed moderate to strong factor loadings and acceptable fit to the data. InDI exhibited reasonable internal validity, potentially becoming a valuable instrument for investigating the health effects of intersectional discrimination in Brazil. Future studies should evaluate the consistency of these findings, examine the scalar structure of the instrument, and analyze its invariance among different marginalized groups.

Resumen: Este estudio transversal evaluó las estructuras configural y métrica del Intersectional Discrimination Index (InDI), un instrumento que mide la discriminación anticipada (InDI-A), diaria (InDI-D) y mayor (InDI-M). Se utilizaron datos de una encuesta más amplia, centrada en los impactos de la discriminación en la salud mental de las mujeres que viven en Brasil. Aproximadamente 1.000 mujeres, seleccionadas por conveniencia, respondieron el InDI y preguntas sobre características sociodemográficas en formulario electrónico, aplicado en el 2021. Mientras que en la primera mitad de la muestra se realizaron análisis factoriales exploratorios y se realizó un modelado por ecuaciones estructurales exploratorias, en la segunda se realizó un análisis factorial confirmatorio. En conjunto, los hallazgos sugieren que cada una de las tres medidas es unidimensional. Sin embargo, a diferencia del estudio que originalmente propuso el InDI para su uso en Canadá y Estados Unidos, observamos la presencia de correlaciones residuales en las tres subescalas evaluadas, todas ellas sugestivas de redundancia de contenido entre pares específicos de ítems. Las tres medidas presentaron cargas factoriales de moderadas a fuertes e índices de ajuste aceptables. El InDI exhibió indicadores de validez interna razonables, convirtiéndose potencialmente en un instrumento valioso para investigar los efectos de la discriminación interseccional para la salud en Brasil. Los estudios futuros deben evaluar la consistencia de estos hallazgos, examinar la estructura escalar del instrumento y analizar su invariancia entre diferentes grupos marginados.

Resumo: Este estudo transversal avaliou as estruturas configural e métrica do Intersectional Discrimination Index (InDI), um instrumento que afere discriminação antecipada (InDI-A), cotidiana (InDI-D) e maior (InDI-M). Dados de uma pesquisa mais ampla, voltada para os impactos da discriminação na saúde mental de mulheres residentes no Brasil, foram utilizados. Aproximadamente mil mulheres, selecionadas por conveniência, responderam ao InDI e a perguntas sobre características sociodemográficas em formulário eletrônico, aplicado em 2021. Enquanto na primeira metade da amostra foram realizadas análises fatoriais exploratórias e executada modelagem por equações estruturais exploratórias, na segunda foi conduzida análise fatorial confirmatória. Em conjunto, os achados sugerem que cada uma das três medidas é unidimensional. No entanto, diferentemente do estudo que originalmente propôs o InDI para uso no Canadá e nos Estados Unidos, observamos a presença de correlações residuais nas três subescalas avaliadas, todas elas sugestivas de redundância de conteúdo entre pares específicos de itens. As três medidas apresentaram cargas fatoriais moderadas a fortes e índices aceitáveis de ajuste. O InDI exibiu indicadores de validade interna razoáveis, potencialmente se tornando um valioso instrumento para a investigação dos efeitos para a saúde da discriminação interseccional no Brasil. Estudos futuros devem avaliar a consistência desses achados, examinar a estrutura escalar do instrumento e analisar sua invariância entre diferentes grupos marginalizados.

Weight bias and identity characteristics among students at a public university in Southern Brazil / Discriminação relacionada ao peso e suas vinculações com características identitárias entre estudantes de uma universidade pública no sul do Brasil

ABSTRACT Objective Despite the consequences of weight discrimination for health inequities, its relationship with identity characteristics remains poorly understood. We investigated whether and to what extent discrimination attributed to body weight is linked to sociodemographic and identity factors. Methods This cross-sectional study is based on a representative sample of undergraduate students from the Federal University of Santa Catarina. Information on perceived discrimination was collected using the brief version of the Explicit Discrimination Scale. Socioeconomic and demographic data were also collected. Results: The results showed that 22.8% of the sample reported experiencing discrimination for being "fat or thin" throughout their lives. Perceived weight discrimination was higher among respondents whose household heads had completed up to high school education, and among those who were overweight and rated their health as "poor." Conclusion Perceived weight discrimination was associated with significant factors linked to the stigmatization and pathologization of body weight. These findings should be considered in more inclusive approaches aimed at counteracting the embodiment of social inequalities.

RESUMO Objetivo Apesar das repercussões da discriminação pelo peso serem reconhecias nas iniquidades em saúde, sua relação com outras características identitárias ainda é pouco compreendida. Investigamos o quanto a experiência de discriminação relacionada ao peso corporal está vinculada a fatores sociodemográficos e aspectos identitários. Métodos Trata-se de um estudo transversal, baseado em amostra representativa dos graduandos da Universidade Federal de Santa Catarina. As informações sobre percepção de discriminação foram obtidas com a Escala de Discriminação Explícita, em sua versão reduzida. Dados socioeconômicos e demográficos também foram coletados. Resultados Os resultados demonstraram que 22,8% dos respondentes perceberam ter sido discriminados por "ser gordo ou magro" ao longo da vida. Esse tratamento diferencial esteve mais fortemente vinculado à percepção de discriminação por "apresentar determinado comportamento" ou "modo de se vestir". No modelo de regressão ajustado, a discriminação percebida por "ser gordo ou magro" foi maior para a faixa etária de 23 a 27 anos; para os respondentes cujos chefes do domicílio tinham até o ensino médio completo; e para aqueles com excesso de peso e autoavaliação de saúde "ruim". Conclusão A discriminação percebida por "ser gordo ou magro" esteve relacionada a importantes características e condições que se associam com o estigma e a patologização da gordura corporal. Tais achados devem ser considerados em abordagens mais inclusivas de combate à incorporação de injustiças sociais.

Access to medicines, the Unified Health System, and intersectional injustices / Acesso a medicamentos, o Sistema Único de Saúde e as injustiças interseccionais

ABSTRACT OBJECTIVE To estimate the prevalence of general and public access to prescription drugs in the Brazilian population aged 15 or older in 2019, and to identify inequities in access, according to intersections of gender, color/race, socioeconomic level, and territory. METHODS We analyzed data from the 2019 National Health Survey with respondents aged 15 years or older who had been prescribed a medication in a healthcare service in the two weeks prior to the interview (n = 19,819). The outcome variable was access to medicines, subdivided into general access (public, private and mixed), public access (via the Unified Health System - SUS) for those treated by the SUS, and public access (via the SUS) for those not treated by the SUS. The study's independent variables were used to represent axes of marginalization: gender, color/race, socioeconomic level, and territory. The prevalence of general and public access in the different groups analyzed was calculated and the association of the outcomes with the aforementioned axes was estimated with odds ratios (OR) using logistic regression models. RESULTS There was a high prevalence of general access (84.9%), when all sources of access were considered, favoring more privileged segments of the population, such as men, white, and those of high socioeconomic status. When only the medicines prescribed in the SUS were considered, there was a low prevalence (30.4% access) that otherwise benefited marginalized population segments, such as women, black, and people from low socioeconomic backgrounds. CONCLUSIONS Access to medicines through the SUS proves to be an instrument for combating intersectional inequities, lending credence to the idea that the SUS is an efficient public policy for promoting social justice.

RESUMO OBJETIVO Estimar as prevalências de acesso geral e público a medicamentos prescritos na população brasileira com 15 anos ou mais de idade em 2019 e identificar iniquidades de acesso, conforme intersecções de gênero, cor/raça, nível socioeconômico e território. MÉTODOS Foram analisados dados da Pesquisa Nacional de Saúde de 2019 com respondentes de 15 anos ou mais que tiveram prescrição de algum medicamento em atendimento de saúde realizado nas duas semanas anteriores à entrevista (n = 19.819). A variável de desfecho foi o acesso a medicamentos, subdividido em acesso geral (público, privado e misto), acesso público (via Sistema Único de Saúde - SUS) dos atendidos no SUS e acesso público (via SUS) dos não atendidos no SUS. As variáveis independentes do estudo foram utilizadas para representar eixos de marginalização: gênero, cor/raça, nível socioeconômico e território. Foram calculadas as prevalências de acesso geral e acesso público nos diferentes grupos analisados e a associação dos desfechos com os eixos mencionados foi estimada com odds ratios (OR) por meio de modelos de regressão logística. RESULTADOS Foi observada alta prevalência de acesso geral (84,9%), quando consideradas todas as fontes de obtenção, favorecendo segmentos populacionais de maior privilégio, como homens, brancos e de alto nível socioeconômico. Quando considerada apenas a obtenção no SUS dos medicamentos prescritos no próprio sistema, verificou-se uma baixa prevalência (30,4% de acesso), invertendo o acesso em benefício dos segmentos populacionais multiplamente marginalizados, como mulheres negras de baixo nível socioeconômico. CONCLUSÕES O acesso a medicamentos por meio do SUS demonstra ser um instrumento de combate às iniquidades interseccionais, evidenciando que o SUS é uma política pública eficiente na promoção da justiça social.

Aferindo experiências com discriminação em múltiplos grupos sociais: análise de invariância da Escala de Discriminação Explícita em estudantes universitários / Assessing experiences with discrimination in multiple social groups: invariance analysis of the Explicit Discrimination Scale in university students / Evaluación comparativa de experiencias de discriminación en múltiples grupos sociales: análisis de invariancia de la Escala de Discriminación Explícita en estudiantes universitarios

Resumo: O objetivo foi avaliar a capacidade da Escala de Discriminação Explícita (EDE) de produzir estimativas comparáveis entre grupos de gênero, cor/raça e posição socioeconômica. A análise se baseou em dados de dois estudos, realizados com estudantes de universidades públicas brasileiras. Uma versão abreviada da EDE com oito itens foi avaliada, utilizando o método alignment (alinhamento). Nossos achados indicaram violação de invariância entre grupos de cor/raça e gênero. Os relatos de experiências discriminatórias tiveram melhor comparabilidade entre estratos de posição socioeconômica. Este estudo demonstrou que a EDE deve ser utilizada com cautela, especialmente para fazer comparações de estimativas de discriminação entre respondentes de cor/raça e gênero distintos. A violação de invariância observada reforça a necessidade de pesquisas adicionais, examinando se tal cenário se mantém em amostras mais amplas e diversas do país.

Abstract: This study evaluated the ability of the Explicit Discrimination Scale (EDS) to produce comparable estimates among respondents according to gender, color/race, and socioeconomic status. Analysis was based on data from two studies with students from Brazilian public universities. An abridged version of the EDS with eight items was evaluated by the alignment method. Findings indicated violation of invariance between color/race and gender groups. Reports of discriminatory experiences had better comparability between socioeconomic status strata. This study showed that EDS should be used with caution, especially to compare discrimination estimates between respondents of different colors/races and genders. The observed violation of invariance reinforces the need for additional research examining whether such a scenario persists in larger and more diverse samples from Brazil.

Resumen: El objetivo fue evaluar la capacidad de la Escala de Discriminación Explícita (EDE) para producir estimaciones comparables entre grupos de género, color/raza y posición socioeconómica. El análisis se basó en los datos de dos estudios, realizados con estudiantes de universidades públicas brasileñas. Se evaluó una versión abreviada de la EDE con 8 ítems, utilizando el método alignment (alineación). Nuestros hallazgos indicaron una violación de la invariancia entre los grupos de color/raza y género. Los informes de experiencias discriminatorias fueron más comparables entre los estratos de posición socioeconómica. Este estudio demostró que la EDE debe usarse con precaución, especialmente para hacer comparaciones de estimaciones de discriminación entre encuestados distintos de color/raza y género. La violación de la invariancia observada refuerza la necesidad de investigaciones adicionales, examinando si tal escenario se mantiene muestras más amplias y diversas del país.

Iniquidades na assistência pré-natal no Brasil: uma análise interseccional / Inequities in prenatal care in Brazil: an intersectional analysis

Resumo O estudo investiga o impacto do intercruzamento de raça/cor, escolaridade e local de residência na não adequação do cuidado prestado em diferentes dimensões do pré-natal. Para tal, analisaram-se dados da Pesquisa Nacional de Saúde de 2013 com modelos de regressão logística múltipla. Os resultados sugerem que as variáveis operam em conjunto na não adequação ao pré-natal. As mulheres negras e as menos escolarizadas apresentaram maior probabilidade de não ter 6 consultas de pré-natal, iniciadas antes da 12ª semana de gestação. Mulheres de até 20 anos de idade, residentes nas regiões Norte, Nordeste e Centro-Oeste e menos escolarizadas foram menos submetidas aos exames laboratoriais e físicos preconizados. E, por último, mulheres negras e de até 20 anos de idade foram mais propensas a não receber orientações sobre o parto. Os achados reiteram a natureza multifacetada do problema e alertam para a insuficiência dos inquéritos populacionais, ao não incluir e não permitir a caracterização dos segmentos mais marginalizados da população, dificultando a investigação de realidades segundo uma perspectiva interseccional.

Abstract The present study investigates the intersecting impacts of race/color, education and place of residence on the non-adequacy of care provided in different dimensions of prenatal care. To this end, we analyzed data from the 2013 National Health Survey using multiple logistic regression models. The results suggest that the variables operate together to shape non-adequacy to prenatal care. Black women and those with less schooling were more likely to miss 6 prenatal consultations, starting before the 12th week of pregnancy. Women up to 20 years of age, those residing in the North, Northeast and Midwest regions and those with less schooling were less submitted to the recommended laboratory and physical exams. And, finally, black women and those up to 20 years of age were more likely to not receive guidance on childbirth. Our findings reiterate the multifaceted nature of the problem and point to the insufficiency of population surveys, by not including and not allowing the characterization of the most marginalized segments of the population, making it difficult to further investigate realities from an intersectional perspective.