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.

COVID-19 in Northeast Brazil: achievements and limitations in the responses of the state governments. / COVID-19 no Nordeste brasileiro: sucessos e limitações nas respostas dos governos dos estados.

The COVID-19 pandemic has been most severe in the poorest regions of Brazil, such as the states of the Northeast Region. The lack of national policies for pandemic control forced state and municipal authorities to implement public health measures. The aim of this study is to show the effect of these measures on the epidemic. The highest incidence of COVID-19 among the nine states in the Northeast was recorded in Sergipe, Paraíba and Ceará. Piauí, Paraíba and Ceará were the states that most tested. Factors associated with transmission included the high proportion of people in informal work. States with international airports played an important role in the entry of the virus and the initial spread, especially Ceará. All states applied social distancing measures, banned public events and closed schools. The response was a significant increase in social distancing, especially in Ceará and Pernambuco, a decline in the reproduction rate (Rt), and a separation of the curve of observed cases versus expected cases if the non-pharmacological interventions had not been implemented in all states. Poverty, inequality, and the high rates of informal work provide clues to the intensity of COVID-19 in the region. On the other hand, the measures taken early by the governments mitigated the effects of the pandemic.

No Brasil, a pandemia da COVID-19 tem sido severa nos estados das regiões mais pobres, como o Nordeste. A falta de políticas nacionais para controle da pandemia levou as autoridades estaduais e municipais a implementarem medidas de saúde pública. O objetivo deste estudo é mostrar o efeito dessas medidas na epidemia. A maior incidência da COVID-19 entre os nove estados do Nordeste foi registrada em Sergipe, Paraíba e Ceará. O Piauí, a Paraíba e Ceará foram os que mais testaram. Muitos estados apresentavam alta proporção de pessoas em trabalho informal. Estados com aeroportos internacionais tiveram importante papel na entrada e disseminação inicial do vírus, em especial o Ceará. Todos os estados aplicaram medidas de distanciamento social, proibição de eventos públicos e fechamento de unidades de ensino. As respostas foram o aumento significativo de distanciamento social, em especial Ceará e Pernambuco, a queda do número de reprodução (Rt) e a separação da curva dos casos observados da curva dos casos esperados sem as intervenções não medicamentosas em todos os estados. A pobreza, a desigualdade e as altas taxas de trabalho informal fornecem pistas do porquê da intensidade da COVID-19 na região. Por outro lado, as medidas de mitigação tomadas precocemente pelos governantes amenizaram os efeitos da pandemia.

COVID-19 no Nordeste brasileiro: sucessos e limitações nas respostas dos governos dos estados / COVID-19 in Northeast Brazil: achievements and limitations in the responses of the state governments

Resumo No Brasil, a pandemia da COVID-19 tem sido severa nos estados das regiões mais pobres, como o Nordeste. A falta de políticas nacionais para controle da pandemia levou as autoridades estaduais e municipais a implementarem medidas de saúde pública. O objetivo deste estudo é mostrar o efeito dessas medidas na epidemia. A maior incidência da COVID-19 entre os nove estados do Nordeste foi registrada em Sergipe, Paraíba e Ceará. O Piauí, a Paraíba e Ceará foram os que mais testaram. Muitos estados apresentavam alta proporção de pessoas em trabalho informal. Estados com aeroportos internacionais tiveram importante papel na entrada e disseminação inicial do vírus, em especial o Ceará. Todos os estados aplicaram medidas de distanciamento social, proibição de eventos públicos e fechamento de unidades de ensino. As respostas foram o aumento significativo de distanciamento social, em especial Ceará e Pernambuco, a queda do número de reprodução (Rt) e a separação da curva dos casos observados da curva dos casos esperados sem as intervenções não medicamentosas em todos os estados. A pobreza, a desigualdade e as altas taxas de trabalho informal fornecem pistas do porquê da intensidade da COVID-19 na região. Por outro lado, as medidas de mitigação tomadas precocemente pelos governantes amenizaram os efeitos da pandemia.

Abstract The COVID-19 pandemic has been most severe in the poorest regions of Brazil, such as the states of the Northeast Region. The lack of national policies for pandemic control forced state and municipal authorities to implement public health measures. The aim of this study is to show the effect of these measures on the epidemic. The highest incidence of COVID-19 among the nine states in the Northeast was recorded in Sergipe, Paraíba and Ceará. Piauí, Paraíba and Ceará were the states that most tested. Factors associated with transmission included the high proportion of people in informal work. States with international airports played an important role in the entry of the virus and the initial spread, especially Ceará. All states applied social distancing measures, banned public events and closed schools. The response was a significant increase in social distancing, especially in Ceará and Pernambuco, a decline in the reproduction rate (Rt), and a separation of the curve of observed cases versus expected cases if the non-pharmacological interventions had not been implemented in all states. Poverty, inequality, and the high rates of informal work provide clues to the intensity of COVID-19 in the region. On the other hand, the measures taken early by the governments mitigated the effects of the pandemic.

Risk-taking behavior and impulsivity among HCV-infected patients.

The association between risk behaviors and hepatitis C virus (HCV) has been extensively studied. It is also proved that impulsivity is associated with risk behaviors. However, there is a lack of studies investigating the association between HCV and impulsivity, a characteristic that can contribute directly to these risk behaviors. This study aimed to investigate HCV-infected individuals' impulsivity and whether this feature mediates risk behavior. Adult patients with liver diseases (n=269) were divided into two groups: viral group (n=157) - patients with HCV and nonviral group (n=112). Risk behaviors were evaluated by a sociodemographic questionnaire. Impulsivity was assessed through Barratt Impulsiveness Scale - BIS-11. Psychiatric comorbidities were investigated by the Mini International Neuropsychiatric Interview 5.0.0. The viral group patients had higher impulsivity than the nonviral group in all domains: attentional impulsivity, motor impulsivity, and nonplanning. Risk behaviors were also shown to be associated with impulsivity levels. Our results suggest that HCV-infected patients are more impulsive than individuals with other liver diseases, even when analyses are controlled for the presence of comorbid mental disorders. In addition, at-risk behavior was significantly mediated by impulsivity.

Hepatitis C virus infection as a traumatic experience.

OBJECTIVE: The purpose of this study was to evaluate whether individuals consider their HCV infection to be a potentially traumatic experience. Additionally, we investigated its association with Post-Traumatic Stress Disorder (PTSD) and the impact of PTSD diagnosis on health-related quality of life (HRQoL) in HCV infected subjects. METHODS: We conducted a cross-sectional survey of 127 HCV-infected outpatients recruited at a University Hospital in Salvador, Brazil. All subjects answered an orally-administered questionnaire to gather clinical and socio-demographic data. We investigated traumatic experiences and the subject's perception of the disease using the Trauma History Questionnaire. PTSD and other psychiatric diagnoses were assessed through the Mini International Neuropsychiatric Interview-Brazilian Version 5.0.0 (M.I.N.I. PLUS). HRQoL was assessed using Short-Form 36 (SF-36). RESULTS: Approximately 38.6% of the patients considered hepatitis C to be a traumatic experience. Of these, 60.7% had a PTSD diagnosis. PTSD was associated with significant impairment in quality of life for individuals in seven SF-36 domains as shown bymultivariate analysis: Role-Physical (ß: -24.85; 95% CI: -42.08; -7.61), Bodily Pain (ß: -19.36; 95% CI: -31.28; -7.45), General Health (ß: -20.79; 95% CI: -29.65; -11.92), Vitality (ß: -11.92; 95% CI: -20.74; -3.1), Social Functioning (ß: -34.73; 95% CI: -46.79; -22.68), Role-Emotional (ß: -26.07; 95% CI: -44.61; -7.53), Mental Health (ß: -17.46; 95% CI: -24.38; -10.54). CONCLUSION: HCV is frequently a traumatic experience and it is strongly associated with PTSD diagnosis. PTSD significantly impaired HRQoL.

Factors related to periodontal disease in a rural population.

To estimate the prevalence and related aspects of periodontitis in a rural area of the State of Bahia, Brazil, this cross-sectional study was carried out in the village of Matinha dos Pretos, Feira de Santana County, Bahia, among 172 subjects ranging from 20 to 60 years of age. During household visits, a full-mouth periodontal exam was performed on each subject, who also answered a questionnaire about socio-demographic, economic and health-related issues. The factors assessed were plaque index, bleeding on probing index, probing depth, gingival recession or hyperplasia measurements. Clinical attachment loss was also calculated. The multivariate logistic regression method was used to evaluate the relative contribution of these factors to the periodontitis condition. The prevalence of periodontitis was 24.4%. The following factors were all positively associated with the presence of periodontitis: being male (OR = 1.58; 1.00 - 2.53), being 30 years of age or older (OR = 2.80; 1.00 - 7.39), living in a house where there was more than one person per room (OR = 1.53; 0.96 - 2.45), being a cigarette or pipe smoker or ex-smoker (OR = 1.49; 0.92 - 2.39), having a plaque index of over 65% (OR = 2.97; 2.72 - 7.39) and more than four missing teeth (OR = 1.51; 0.82 - 2.78). The authors concluded that socioeconomic and biological factors, especially poor oral hygiene and older age, are positively associated with periodontitis in the rural population of a small village in the county of Feira de Santana, State of Bahia, Brazil.

Factors related to periodontal disease in a rural population / Fatores associados à doença periodontal em uma população rural

To estimate the prevalence and related aspects of periodontitis in a rural area of the State of Bahia, Brazil, this cross-sectional study was carried out in the village of Matinha dos Pretos, Feira de Santana County, Bahia, among 172 subjects ranging from 20 to 60 years of age. During household visits, a full-mouth periodontal exam was performed on each subject, who also answered a questionnaire about socio-demographic, economic and health-related issues. The factors assessed were plaque index, bleeding on probing index, probing depth, gingival recession or hyperplasia measurements. Clinical attachment loss was also calculated. The multivariate logistic regression method was used to evaluate the relative contribution of these factors to the periodontitis condition. The prevalence of periodontitis was 24.4 percent. The following factors were all positively associated with the presence of periodontitis: being male (OR = 1.58; 1.00 - 2.53), being 30 years of age or older (OR = 2.80; 1.00 - 7.39), living in a house where there was more than one person per room (OR = 1.53; 0.96 - 2.45), being a cigarette or pipe smoker or ex-smoker (OR = 1.49; 0.92 - 2.39), having a plaque index of over 65 percent (OR = 2.97; 2.72 - 7.39) and more than four missing teeth (OR = 1.51; 0.82 - 2.78). The authors concluded that socioeconomic and biological factors, especially poor oral hygiene and older age, are positively associated with periodontitis in the rural population of a small village in the county of Feira de Santana, State of Bahia, Brazil.

Para estimar a prevalência e os fatores associados à periodontite em uma área rural do Estado da Bahia foi realizado um estudo transversal com 172 indivíduos, de 20 a 60 anos de idade residentes no povoado de Matinha dos Pretos, Feira de Santana (BA). Durante visitas domiciliares, um exame clínico periodontal completo foi realizado para cada indivíduo, que também respondeu a um questionário a respeito de fatores sociodemográficos, econômicos e relacionados à saúde. Foram avaliados índice de placa, índice de sangramento à sondagem, profundidade de sondagem, medidas de recessão ou hiperplasia e calculada a perda de inserção clínica. Utilizou-se análise de regressão logística multivariada para avaliar a contribuição relativa desses fatores para a periodontite. A prevalência da doença periodontal foi de 24,42 por cento. Ser homem (OR = 1,58; 1,00 - 2,53), ter 30 anos ou mais de idade (OR = 2,80; 1,00 - 7,39), residir em casas com mais de uma pessoa por cômodo (OR = 1,53; 0,96 - 2,45), fumar ou ser ex-fumante de cigarro ou cachimbo (OR = 1,49; 0,92 - 2,39), ter índice de placa maior do que 65 por cento (OR = 2,97; 2,72 - 7,39) e mais de quatro dentes ausentes (OR = 1,51; 0,82 - 2,78) estiveram associados positivamente com a presença de doença. Concluiu-se que fatores socioeconômicos e biológicos, especialmente a higiene bucal inadequada e idade elevada, estão associados positivamente com a presença de periodontite na população rural de um povoado no Estado da Bahia, Brasil.

[Maternal periodontal disease as a factor associated with low birth weight]. / Doença periodontal materna como fator associado ao baixo peso ao nascer.

OBJECTIVE: Recent studies have presented evidence that periodontal disease in pregnant women may be a determining factor for low birth weight. The present investigation was carried out to verify whether or not there is an association between maternal periodontal disease and low birth weight. METHODS: This was a case-control study on 302 women, of whom 102 were the mothers of live newborns of low weight (case group) and 200 were the mothers of live newborns of normal birth weight (control group). The existence of an association between periodontal disease and low birth weight was evaluated by means of a multivariate logistic regression model that considered other risk factors for low weight. RESULTS: The two groups were comparable with regard to age, height, pre-gestational weight, smoking, alcohol use, previous diseases, marital status, socioeconomic status, frequency of tooth-brushing and use of dental floss, number of meals per day and visits to the dentist. Periodontal disease was diagnosed in 57.8% of the mothers in the case group and 39.0% in the control group. Logistic regression analysis indicated a positive association between periodontal disease and low birth weight (unadjusted OR=2.15; 95% CI: 1.32-3.48), especially among the mothers with schooling of less than or equal to four years (ORadjusted=3.98; 95% CI: 1.58-10.10). CONCLUSIONS: Periodontal disease is a possible risk factor for low birth weight.

Doença periodontal materna como fator associado ao baixo peso ao nascer / Maternal periodontal disease as a factor associated with low birth weight

OBJETIVO: Estudos recentes têm apresentado evidências de que a doença periodontal em gestantes pode ser um dos determinantes do baixo peso ao nascer. Realizou-se estudo para verificar a existência de associação entre doença periodontal materna e baixo peso ao nascer. MÉTODOS: Estudo do tipo caso-controle com 302 mulheres, sendo 102 mães de nascidos vivos de baixo peso (grupo caso) e 200 mães de nascidos vivos com peso normal (grupo controle). A existência de associação entre doença periodontal e baixo peso ao nascer foi avaliada mediante modelo multivariado de regressão logística, considerando outros fatores de risco para o baixo peso. RESULTADOS: Ambos os grupos de mães eram comparáveis no que se refere a idade, altura, peso pré-gestacional, tabagismo, alcoolismo, doenças prévias, estado civil, situação socioeconômica, número de escovações e uso de fio dental, número de refeições diárias, e visitas ao dentista. A doença periodontal foi diagnosticada em 57,8 por cento das mães do grupo caso e 39,0 por cento do grupo controle. A análise de regressão logística indicou associação positiva entre doença periodontal e baixo peso ao nascer (ORbruto=2,15; IC 95 por cento: 1,32-3,48), especialmente entre as mães com escolaridade menor ou igual a quatro anos (ORajustada=3,98; IC 95 por cento: 1,58-10,10). CONCLUSÕES: A doença periodontal é um possível fator de risco para o baixo peso ao nascer.