Demographic, socioeconomic, and health structure factors associated with the use of HIV pre-exposure prophylaxis in Brazil: A nationwide ecological study.

Aims: To assess the cumulative rate of HIV Pre-Exposure Prophylaxis (PrEP) users in Brazil since its 2018 implementation and to analyze the association between PrEP usage and state-level structural factors. Methods: A nationwide ecological study from 2018 to 2022 was conducted, examining the 5-year cumulative rate of PrEP users in relation to demographic, socioeconomic, and healthcare infrastructure variables. Multiple linear regression analysis identified significant predictors of PrEP utilization. Results: Between 2018 and 2022, 124,796 individuals used PrEP, with a cumulative rate of 61.5 per 100,000 population. The highest usage was in Minas Gerais, São Paulo, and Santa Catarina, while the lowest was in Distrito Federal, Maranhão, and Alagoas. Regression analysis showed that higher PrEP usage was associated with lower population density, a younger median age, a lower male to female ratio, and reduced social vulnerability. Additionally, PrEP usage was positively associated with the density of medical doctors and the number of dispensing units. Conclusions: The study reveals significant regional disparities in PrEP usage across Brazil, influenced by socioeconomic and healthcare factors. It highlights the need for targeted public health strategies to enhance PrEP access and uptake, especially in socially vulnerable regions.

CD4+ Th1 and Th17 responses and multifunctional CD8 T lymphocytes associated with cure or disease worsening in human visceral leishmaniasis.

Introduction: In VL, a proinflammatory phenotype is typically associated with enhanced phagocytosis and a Th1 mediated immune response resulting in infection control. In contrast, an anti-inflammatory phenotype, associated with a predominant regulatory response, typically enables intracellular multiplication of Leishmania parasites and disease progression. Methods: To investigate the impact of chemotherapy on Th2 and Th17 immune responses in patients with visceral leishmaniasis (VL), we assessed all combinations of intracellular expression of IFN-γ, IL-10, IL-4 and IL-17 in the CD4+ and CD8+ T cell populations of peripheral blood mononuclear cell (PBMC) samples from patients, after antigenic stimulation with Leishmania lysate, throughout treatment and follow-up. As increases in spleen and liver sizes and decreases in hematocrit, hemogloblin, erythrocytes, monocytes, leukocytes and platelets levels are strongly related to the disease, we studied the correlations between the frequencies of T cells producing the afore mentioned cytokines, individually and in combination, and these variables, as markers of disease or cure. Results: We found that the frequency of IFN-γ-producingCD4+ T cells increased until the end of chemotherapy with Glucantime® or AmBisome ®, while IL-10, IL-4 and IL-17-producing CD4+ T cells peaked on day 7 following the start of treatment. Although the frequency of CD4+IL-17+ cells decreased during treatment an increase was observed after clinical cure. The frequency of CD4+ T cells producing only IFN-γ or IL-17 correlated with blood monocytes levels. Frequencies of double-producers of IFN-γ and IL-10 or IL-4 correlated positively with eosinophils and platelets levels. Together, this suggest that IFN-γ drives the immune response towards Th1 at cure. In contrast, and associated with disease or Th2 response, the frequency of CD4+ IL-10+ cells correlated positively with spleen sizes and negatively with circulating monocyte levels, while the frequency of CD4+ producing both IL-4 and IL-10 correlated negatively with platelets levels. The frequency of CD8+ single-producers of IFN-γ increased from day 21 to 90 while that of single-producers of IL-10 peaked on day 7, of IL-4 on day 30 and of IL-17, on day 180. IFN-γ expression in CD8+ single- and double-producers of cytokines was indicative of an immune response associated with cure. In contrast, frequencies of CD8+ double-producers of IL-4 and IL-10, IL-4 and IL-17 and IL-10 and IL-17 and producers of three and four cytokines, were associated with disease and were low after the cure. Frequencies of CD8+ T cells producing IFN-γ alone or with IL-17 were positively correlated with platelets levels. In contrast, as markers of disease: 1) frequencies of single producers of IL-10 correlated negatively with leukocytes levels, 2) frequencies of double producers of IL-4 and IL-10 correlated negatively with platelet, leukocyte, lymphocyte and circulating monocyte levels, 3) frequencies of triple-producers of IFN-γ, IL-4 and IL-10 correlated negatively with platelet, leukocyte and neutrophil levels and 4) frequencies of producers of IFN-γ, IL-4, IL-10 and IL-17 simultaneously correlated positively with spleen size, and negatively with leukocyte and neutrophil levels. Discussion: Our results confirmed that the clinical improvement of VL patients correlates with the decrease of an IL-4 and IL-10 CD4+Th2 response, the recovery of CD4+ Th1 and Th17 responses and the frequency of CD8+ single-producers of IFN-γ and double producers of IFN-γ and IL-17.

Vulnerabilities to illnesses in women living on the border of the Guiana Shield mines.

OBJECTIVE: To analyze the the vulnerabilities to illnesses in women living on the border of the Guiana Shield mines: Brazil, French Guiana, and Suriname. METHOD: Descriptive, exploratory field study with a qualitative approach. Data collection took place with 19 women who were living in the mining context, in April 2018. The interviews were recorded and transcribed in full and subsequently analyzed in the light of the concept of vulnerability. RESULTS: Women aged between 30 and 39 years, predominantly black and brown, on a common-law marriage, multiparous, of low level of education, and with work activities related to mining. Three empirical categories emerged: Exposure to environmental and life conditions in the mines: vulnerabilities to illnesses in women; Sexual and reproductive health in the context of borders: the invisibility between legality and illegality; Gendered facets of violence in the mines on the border of the Guiana Shield. CONCLUSION: Vulnerability is marked in the three dimensions of the concept: in the difficult access to health services, in the discontinued treatment, and in the disparity in health policies within countries, which are important aspects of vulnerability and health conditions.

COVID-19 recurrence is related to disease-early profile T cells while detection of anti-S1 IgG is related to multifunctional T cells.

COVID-19 is caused by SARS-CoV-2 infection and leads from asymptomatic to severe outcomes. The recurrence of the COVID-19 has been described, however, mechanisms involved remains unclear. Thus, the work aimed to investigate the role of multifunctional T cells in patients with recurrent COVID-19. We evaluated clinical characteristics, presence of anti-S1 and anti-Nucleocapsid IgG in patients' sera, and multifunctional T cells (for IFN-γ, IL-2, and TNF-α) in patients with multiple episodes of COVID-19 and controls. Data demonstrate that patients with recurrent COVID-19 have a T cell pattern predominantly related to IFN-γ production. Also, patients with COVID-19 history and absence of anti-S1 IgG had lower levels of CD4+ IFN + IL-2 + TNF + T cells independently of number of disease episodes. Complementary, vaccination changed the patterns of T cells phenotypes and induced IgG seroconversion, despite not induce higher levels of multifunctional T cells in all patients. In conclusion, the data suggest that recurrent disease is related to early-disease T cell profile and absence of anti-S1 IgG is related to lower multifunctional CD4 T cell response, what suggests possibility of new episodes of COVID-19 in these patients.

Association between genetic variants in TREM1, CXCL10, IL4, CXCL8 and TLR7 genes with the occurrence of congenital Zika syndrome and severe microcephaly.

Congenital Zika syndrome (CZS) is a cluster of malformations induced by Zika virus (ZIKV) infection and the underline mechanisms involved in its occurrence are yet not fully understood. Along with epidemiological and environmental factors, the genetic host factors are suggested as important to the CZS occurrence and development, however, few studies have evaluated this. This study enrolled a total of 245 individuals in a case-control association study compound a cohort of high specific interest constituted by 75 mothers who had delivered CZS infants, their 76 infants, and 47 mothers that had delivered healthy infants, and their 47 infants. Sixteen single-nucleotide polymorphisms on TREM1, CXCL10, IL4, CXCL8, TLR3, TLR7, IFNR1, CXCR1, IL10, CCR2 and CCR5 genes were genotyped to investigate their association as risk factors to CZS. The results show an association between C allele at TREM1 rs2234246 and C allele at IL4 rs224325 in mothers infected with ZIKV during pregnancy, with the increased susceptibility to CZS occurrence in their infants and the SNP CXCL8 rs4073 and the G allele at CXCL10 rs4508917 with presence of CZS microcephaly in the infants. Furthermore, the T allele at CXCL8 rs4073 and TRL7 rs179008 SNPs were associated with the severity of microcephaly in children with CZS. These results suggest that these polymorphisms in genes of innate immune responses addressed here are associated to increased risk of occurrence and severity of CZS in pregnant mothers infected with ZIKV and their CZS infants.

Vulnerabilities to illnesses in women living on the border of the Guiana Shield mines / Vulnerabilidades por la enfermedad de las mujeres en las minerías fronterizas del Escudo Guayanés* / Vulnerabilidades para o adoecimento de mulheres em garimpos na fronteira do Escudo das Guianas

ABSTRACT Objective: To analyze the the vulnerabilities to illnesses in women living on the border of the Guiana Shield mines: Brazil, French Guiana, and Suriname. Method: Descriptive, exploratory field study with a qualitative approach. Data collection took place with 19 women who were living in the mining context, in April 2018. The interviews were recorded and transcribed in full and subsequently analyzed in the light of the concept of vulnerability. Results: Women aged between 30 and 39 years, predominantly black and brown, on a common-law marriage, multiparous, of low level of education, and with work activities related to mining. Three empirical categories emerged: Exposure to environmental and life conditions in the mines: vulnerabilities to illnesses in women; Sexual and reproductive health in the context of borders: the invisibility between legality and illegality; Gendered facets of violence in the mines on the border of the Guiana Shield. Conclusion: Vulnerability is marked in the three dimensions of the concept: in the difficult access to health services, in the discontinued treatment, and in the disparity in health policies within countries, which are important aspects of vulnerability and health conditions.

RESUMEN Objetivo: Analizar las vulnerabilidades por la enfermedad de las mujeres en zonas mineras en la frontera del Escudo Guayanés: Brasil, Guayana Francesa y Surinam. Método: Investigación de campo, descriptiva, exploratoria, con enfoque cualitativo. La recolección de datos se realizó con 19 mujeres que vivían el contexto de las minerías, en abril de 2018. Las entrevistas fueron grabadas y transcritas en su totalidad y posteriormente analizadas a la luz del concepto de vulnerabilidad. Resultados: Mujeres de 30 a 39 años, predominantemente negras y pardas, unión estable, multíparas, baja escolaridad y con actividades laborales afines a la minería. Surgieron tres categorías empíricas: Exposición a las condiciones ambientales y de vida en las minerías: vulnerabilidades de las mujeres a enfermarse; salud sexual y reproductiva en el contexto de las fronteras: la invisibilidad entre la legalidad y la ilegalidad; facetas de género de la violencia en las minerías de la frontera del escudo guayanés. Conclusión: La vulnerabilidad se acentúa en las tres dimensiones del concepto, a saber, el difícil acceso a los servicios de salud, la interrupción del tratamiento y la disparidad en las políticas de salud entre países, son aspectos importantes para la vulnerabilidad y las condiciones de salud.

RESUMO Objetivo: Analisar as vulnerabilidades para o adoecimento de mulheres em áreas de garimpos da fronteira do Escudo das Guianas: Brasil, Guiana Francesa e Suriname. Método: Pesquisa de campo, descritiva, exploratória, de abordagem qualitativa. A coleta de dados ocorreu com 19 mulheres que vivenciavam o contexto de garimpagem, em abril de 2018. As entrevistas foram gravadas e transcritas na íntegra e posteriormente analisadas à luz do conceito de vulnerabilidade. Resultados: Mulheres com idade entre 30 e 39 anos, predominantemente pretas e pardas, união estável, multíparas, baixa escolaridade e com atividades de trabalho relacionadas à garimpagem. Emergiram três categorias empíricas: Exposição às condições ambientais e de vida nos garimpos: vulnerabilidades para o adoecimento de mulheres; Saúde sexual e reprodutiva no contexto de fronteiras: a invisibilidade entre a legalidade e a ilegalidade; Facetas gendradas da violência nos garimpos da fronteira do escudo das Guianas. Conclusão: A vulnerabilidade é acentuada nas três dimensões do conceito, quais sejam: a dificuldade de acesso aos serviços de saúde, tratamento descontinuado e disparidade nas políticas de saúde entre os países, que são aspectos importantes à vulnerabilidade e condições de saúde.

Use of N-acetylcysteine as treatment adjuvant regulates immune response in visceral leishmaniasis: Pilot clinical trial and in vitro experiments.

This investigation aimed to assess the effect of N-acetylcysteine (NAC) as an adjuvant treatment to alleviate visceral leishmaniasis (VL). The present work includes both blinded randomized clinical intervention and experimental in vitro studies. The clinical trial included 60 patients with VL randomly allocated into two groups: a test group (n = 30) treated with meglumine antimoniate plus NAC (SbV + NAC) and a control group (n = 30) treated with meglumine antimoniate only (SbV). The primary outcome was clinical cure (absence of fever, spleen and liver sizes reduction, and hematological improvement) in 180 days. The cure rate did not differ between the groups; both groups had similar results in all readout indices. The immunological parameters of the patients treated with SbV + NAC showed higher sCD40L in sera during treatment, and the levels of sCD40L were negatively correlated with Interleukin-10 (IL-10) serum levels. In addition, data estimation showed a negative correlation between the sCD40L levels and the spleen size in patients with VL. For the in vitro experiments, peripheral blood mononuclear cells (PBMCs) or PBMC-derived macrophages from healthy donors were exposed to soluble Leishmania antigen (SLA) or infected with stationary promastigotes of Leishmania infantum in the presence or absence of NAC. Results revealed that NAC treatment of SLA-stimulated PBMCs reduces the frequency of monocytes producing IL-10 and lowers the frequency of CD4+ and CD8+ T cells expressing (pro-)inflammatory cytokines. Together, these results suggest that NAC treatment may modulate the immune response in patients with VL, thus warranting additional investigations to support its case use as an adjuvant to antimony therapy for VL.

Insight Into the Long Noncoding RNA and mRNA Coexpression Profile in the Human Blood Transcriptome Upon Leishmania infantum Infection.

Visceral leishmaniasis (VL) is a vector-borne infectious disease that can be potentially fatal if left untreated. In Brazil, it is caused by Leishmania infantum parasites. Blood transcriptomics allows us to assess the molecular mechanisms involved in the immunopathological processes of several clinical conditions, namely, parasitic diseases. Here, we performed mRNA sequencing of peripheral blood from patients with visceral leishmaniasis during the active phase of the disease and six months after successful treatment, when the patients were considered clinically cured. To strengthen the study, the RNA-seq data analysis included two other non-diseased groups composed of healthy uninfected volunteers and asymptomatic individuals. We identified thousands of differentially expressed genes between VL patients and non-diseased groups. Overall, pathway analysis corroborated the importance of signaling involving interferons, chemokines, Toll-like receptors and the neutrophil response. Cellular deconvolution of gene expression profiles was able to discriminate cellular subtypes, highlighting the contribution of plasma cells and NK cells in the course of the disease. Beyond the biological processes involved in the immunopathology of VL revealed by the expression of protein coding genes (PCGs), we observed a significant participation of long noncoding RNAs (lncRNAs) in our blood transcriptome dataset. Genome-wide analysis of lncRNAs expression in VL has never been performed. lncRNAs have been considered key regulators of disease progression, mainly in cancers; however, their pattern regulation may also help to understand the complexity and heterogeneity of host immune responses elicited by L. infantum infections in humans. Among our findings, we identified lncRNAs such as IL21-AS1, MIR4435-2HG and LINC01501 and coexpressed lncRNA/mRNA pairs such as CA3-AS1/CA1, GASAL1/IFNG and LINC01127/IL1R1-IL1R2. Thus, for the first time, we present an integrated analysis of PCGs and lncRNAs by exploring the lncRNA-mRNA coexpression profile of VL to provide insights into the regulatory gene network involved in the development of this inflammatory and infectious disease.

TREM-1 Expression on the Surface of Neutrophils in Patients With Visceral Leishmaniasis Is Associated With Immunopathogenesis.

Visceral leishmaniasis (VL) is a systemic chronic and potentially fatal disease for humans. Mechanisms related to the dysregulation of the inflammatory response may be involved in both the pathogenesis and prognosis of VL. Triggering Receptor Expressed on Myeloid Cells-1 (TREM-1) is a receptor constitutively expressed on neutrophils and monocyte subsets. The protein serves to regulate and amplify inflammatory responses. This study aimed to evaluate the expression profile of TREM-1 on the surface of neutrophils from patients with VL at varying time points during leishmanicidal treatment. For this purpose, neutrophils were isolated from the peripheral blood of patients with VL at different stages of treatment, which include 0, 7, and 30 days after treatment. Surface TREM-1 expression was assessed by immunophenotyping neutrophil populations. In addition, the association of TREM-1 expression on the surface of neutrophils with clinical and laboratory parameters and serum levels of inflammatory mediators was also evaluated. Results demonstrate a lower surface expression of TREM-1 in VL patients in the absence of treatment. However, increased levels of TREM-1 expression were observed 7 and 30 days after the start of treatment, with levels similar to those of healthy controls. TREM-1 expression was directly correlated with lymphocyte and erythrocyte count and indirectly correlated with spleen and liver size. Furthermore, elevated levels of TREM-1 expression were also correlated with lower serum levels of interleukin (IL)-22. Taken together, these results suggest that infection by Leishmania infantum leads to depressed TREM-1 expression on the neutrophil surface and may contribute to the inflammatory imbalance that characterizes active VL disease.

Women's perception of labor and birth care: obstacles to humanization.

OBJECTIVES: to understand women's perception regarding the care received during labor and birth. METHODS: this is a descriptive-exploratory, qualitative study carried out with 54 postpartum women from hospitals in the Metropolitan Region II of the state of Rio de Janeiro, from January to December 2018, using semi-structured interviews submitted to content analysis. RESULTS: puerperal women's perceptions about the childbirth care they received indicated the use of interventions, such as pressure maneuvers on the uterine fundus during the expulsion period - Kristeller maneuver, episiotomy and repeated vaginal examination and without consent. The use of institutional routines, such as zero diet, horizontal birth and disrespect. FINAL CONSIDERATIONS: despite the encouragement of public humanization policies, the technocratic model is still present in obstetric care during childbirth. The humanization of obstetric care requires changes in attitudes and care paradigms, in order to guarantee respect and the right to quality care.

Analysis of breast cancer survival in a northeastern Brazilian state based on prognostic factors: A retrospective cohort study.

Breast cancer is a major health problem worldwide. Analysis of breast cancer epidemiology in emerging countries enables assessment of prognostic factors, cancer care quality, and the equity of resource distribution. We aimed to estimate the overall (OS) and cancer-specific survival (SS) of breast cancer patients in the northeastern Brazilian state of Sergipe to identify independent prognostic factors. We analyzed a cohort for the factors age at diagnosis, place of residence, time to treatment, staging, and molecular classification, using the Kaplan-Meier method, log-rank test, Pearson's chi-squared test and Cox regression model. The outcome was the vital status at the end of the study. Our analysis showed an OS probability of 0.72 and an SS probability of 0.75. In multivariate analysis, time to treatment within 60 days, stage IV, and triple-negative classification remained independent prognostic factors for both OS [unadjusted hazard ratio (HRp) 1.50 (1.21; 1.86), HRp 16.56 (8.35; 32.85), and HRp 2.73 (1.73; 4.29), respectively] and SS [HRp 1.43 (1.13; 1.81), HRp 20.53 (9.45; 44.56), and HRp 3.14 (1.88; 5.26), respectively]. Better survival was demonstrated for the following patients: those receiving their first treatment after 60 days, with an OS of 52.5 months (51.2; 53.8) and SS of 53.5 months (52.3; 54.7); stage I patients, with an OS of 58.8 months (57.7; 60.0) and SS of 59.2 months (58.1; 60.3); patients without nodal metastasis, with an OS of 54.2 months (53.0; 55.4) and SS of 55.6 months (54.5; 56.7); and patients with luminal A classification, with an OS of 56.8 months (55.0; 58.5) and SS of 57.8 months (56.2; 59.4). This study identified independent prognostic factors and that OS and SS were lower for patients from Sergipe than for patients in high-income areas. Therefore, determining the profiles of breast cancer patients in this population will inform specific cancer care.

Women's perception of labor and birth care: obstacles to humanization / Percepción de las mujeres en el trabajo de parto y el cuidado del parto: obstáculos para la humanización / Percepção de mulheres na assistência ao parto e nascimento: obstáculos para a humanização

ABSTRACT Objectives: to understand women's perception regarding the care received during labor and birth. Methods: this is a descriptive-exploratory, qualitative study carried out with 54 postpartum women from hospitals in the Metropolitan Region II of the state of Rio de Janeiro, from January to December 2018, using semi-structured interviews submitted to content analysis. Results: puerperal women's perceptions about the childbirth care they received indicated the use of interventions, such as pressure maneuvers on the uterine fundus during the expulsion period - Kristeller maneuver, episiotomy and repeated vaginal examination and without consent. The use of institutional routines, such as zero diet, horizontal birth and disrespect. Final Considerations: despite the encouragement of public humanization policies, the technocratic model is still present in obstetric care during childbirth. The humanization of obstetric care requires changes in attitudes and care paradigms, in order to guarantee respect and the right to quality care.

RESUMEN Objetivos: comprender la percepción de las mujeres sobre la asistencia recibida durante el trabajo de parto y el parto. Métodos: estudio descriptivo-exploratorio, cualitativo, realizado con 54 puérperas de hospitales de la II Región Metropolitana del estado de Río de Janeiro, de enero a diciembre de 2018, mediante entrevistas semiestructuradas sometidas a análisis de contenido. Resultados: las percepciones de las puérperas sobre la atención recibida del parto indicaron el uso de intervenciones, como maniobras de presión sobre el fondo uterino en el período expulsivo - maniobra de Kristeller, episiotomía y toque vaginal repetido y sin consentimiento. El uso de rutinas institucionales, como dieta cero, parto horizontal y falta de respeto. Consideraciones Finales: a pesar del impulso de las políticas públicas de humanización, el modelo tecnocrático sigue presente en la atención obstétrica durante el parto. La humanización de la atención obstétrica requiere cambios de actitudes y paradigmas de atención, a fin de garantizar el respeto y el derecho a una atención de calidad.

RESUMO Objetivos: compreender a percepção das mulheres quanto à assistência recebida durante o parto e nascimento. Métodos: estudo descritivo-exploratório, qualitativo, realizado com 54 puérperas de hospitais da Região Metropolitana II do estado do Rio de Janeiro, de janeiro a dezembro de 2018, utilizando entrevistas semiestruturadas submetidas à análise de conteúdo. Resultados: as percepções das puérperas sobre a assistência ao parto recebida apontaram a utilização de intervenções, tais como manobras de pressão sobre o fundo uterino no período expulsivo - manobra de Kristeller, episiotomia e toque vaginal repetidos e sem consentimento. A utilização de rotinas institucionais, como a dieta zero, parto horizontal e desrespeito. Considerações Finais: apesar do incentivo das políticas públicas de humanização, o modelo tecnocrático ainda se faz presente na assistência obstétrica ao parto. A humanização da assistência obstétrica requer mudanças de atitudes e paradigmas assistenciais, a fim de garantir respeito e direito à assistência de qualidade.

Association of IL-9, IL-10, and IL-17 Cytokines With Hepatic Fibrosis in Human Schistosoma mansoni Infection.

This is a case series study to evaluate immunological markers associated with schistosomiasis advanced fibrosis, including 69 patients from an endemic area from the State of Sergipe and from the Hepatology Service of the University Hospital in Sergipe, Brazil. Hepatic fibrosis was classified based on Niamey protocol for ultrasonography (US). Immune response to Schistosoma mansoni antigens was evaluated by stimulating peripheral blood mononuclear cells (PBMCs) from these patients with either adult worm (SWAP-10 µg/ml) or egg (SEA-10 µg/ml) antigens or purified protein derivative of turberculin (PPD-10 µg/ml) or phytohemagglutinin (PHA-1 µg/ml) for 72 h. The levels of IFN-γ, TNF-α, IL-5, IL-10, and IL-17 were measured in these supernatants by ELISA and IL-9 by Luminex. Single nucleotide polymorphisms in IL-17, IL10, and CD209 genes were genotyped using TaqMan probe by qPCR. Higher levels of IL-9, IL-10, and IL-17 were found in PBMC supernatants of patients with advanced hepatic fibrosis. Direct correlations were detected between IL-9 and IL-17 levels with US spleen sizes, portal vein diameters, and periportal thickening. The CD209 rs2287886 AG polymorphism patients produce higher IL-17 levels. Together, these data suggest a role of these cytokines in the immunopathogenesis of advanced fibrosis in human schistosomiasis.

Narratives of pregnant women with AIDS: in search of a theoretical model for medical practice problems / Narrativas de mulheres gestantes com AIDS: em busca de um modelo teórico para os problemas da prática

Introduction: In the care of pregnant women with acquired immunodeficiency syndrome (AIDS), it is often not clear who these patients are, how they behave in the face of diagnosis and pregnancy, how they live their disease, what it means for them to carry a child at risk, as well as the possibility of spreading the virus and not being able to breastfeed. Objective: To analyze the life memories of pregnant women with AIDS. Methods: This qualitative cartographic study sought to trace, touch, and understand what these women feel or remember about their lives through life narratives. Results: The sample consisted of ten women whose narratives generated three categories of living in the different life stages. The study produced a concentration of 515 units of analysis and analyzed 160 statements, with 11 themes related to memories about family dynamics and its problems. Conclusion: We expect to contribute to the renewal of the practice, discourse, and language, as an exclusive work and teaching network about the importance of listening to the human being when obtaining data outside our area of knowledge.

Introdução: O cuidar da mulher gestante com AIDS, muitas das vezes não se percebem quem são elas, como se comportam diante do diagnóstico e da gestação, como elas vivem sua doença, o que representa gestar um filho, colocando-o em risco e a possibilidade de transmitir o vírus e não poder amamentar. Objetivo: Analisar as lembranças de vida de mulheres gestantes com AIDS. Métodos: Estudo qualitativo baseado na cartografia, que buscou rastrear, pousar, tocar e compreender o que estas mulheres sentem ou lembram do seu viver, por meio da narrativa de vida. Resultados: Trata-se de resultado de pesquisa para obtenção do título de Doutor. Participaram dez mulheres, cujas narrativas geraram três categorias de viver nas diferentes etapas da vida. A categoria gerou uma concentração de 515 unidades de registro, 160 unidades com 11 temas sobre as lembranças que estão relacionados a dinâmica familiar e seus problemas. Conclusão: Espera-se que se possa renovar a prática, o discurso, a linguagem, como rede exclusiva no trabalho e no ensino, sobre a importância da escuta do ser humano, quando se obtém dados fora da área de conhecimento.

Trypanosoma cruzi vectors and reservoirs in Southern Sergipe.

INTRODUCTION: Chagas disease is a health problem that affects approximately 7 million people worldwide, according to the World Health Organization. Vector transmission is one of the most important routes in South and Central American countries. Between 2013 and 2019, municipalities of Sergipe sent 507 triatomines for analysis, unveiling the largest records found in the south in the villages of Poço da Clara, Alagoinhas and Pilões, and the municipality of Tobias Barreto. The high prevalence of infected vectors in these localities motivated this epidemiological study. METHODS: After educational lectures on the vectors and risks of the disease, a structured questionnaire was administered to identify areas and risk factors for transmission of the parasite. The data guided the collection of vectors and blood samples from domestic reservoirs. RESULTS: The studied region is considered endemic for triatomines infected by Trypanosoma cruzi with three species of vectors; the highest prevalence was Panstrongylus lutzi (54.83%), followed by Triatoma pseudomaculata (43.54%), and Triatoma tibiamaculata (1.61%). In the villages in this study, 100% of the vectors were found intradomically. The coexistence of residents with domestic animals was reported by 62.04% (255) of those surveyed. Forty-one small animals that were actively living with humans at home in the localities were evaluated serologically. No infection was observed in the domestic animals. CONCLUSIONS: There are favorable conditions for the domiciliation of triatomines in the evaluated locations, contributing to the risk of vectorial transmission of Chagas disease.

Trends in prostate cancer incidence and mortality to monitor control policies in a northeastern Brazilian state.

Prostate cancer differently affects different regions of the world, displaying higher rates in more developed areas. After the implementation of prostate-specific antigen (PSA) testing, several studies described rising rates globally, but it is possible that indolent lesions are being detected given the lack of changes in mortality data. The Brazilian government recommends against PSA screening in the male population regardless of age, but the Urology Society issued a report recommending that screening should start at 50 years old for certain men and for those aged ≥75 years with a life expectancy exceeding 10 years. In this study, we examined the incidence and mortality rates of invasive prostate cancer over time in the Sergipe state of Brazil. The databases of the Aracaju Cancer Registry and Mortality Information System were used to calculate age-standardized rates for all prostate tumors (International Classification of Diseases 10th edition: C61 and D07.5) in the following age ranges: 20-44, 45-54, and ≥65 years. We identified 3595 cases of cancer, 30 glandular intraepithelial high-grade lesions, and 3269 deaths. Using the Joinpoint Regression Program, we found that the incidence of prostate cancer dramatically increased over time until the mid-2000s for all age groups, after which the rates declined. Prostate cancer mortality rates increased until 2005, followed by a non-significant annual percent change of 22.0 in 2001-2005 and a stable rate thereafter. We noticed that the increases and decreases of the incidence rates of prostate cancer were associated with the screening recommendations. Meanwhile, the increased mortality rates did not appear to be associated with decreased PSA testing; instead, they were linked to the effects of age and improvements in identification of the cause of death. Thus, we do not believe a PSA screening program would benefit the population of this study.

Trends in the incidence and mortality of colorectal cancer in a brazilian city.

OBJECTIVES: This study was conducted to analyze the trends in colorectal cancer (CRC) incidence and mortality in the city of Aracaju, Sergipe State, Brazil, between 1996 and 2015 with Joinpoint Regression Program 4.7.0.0 and to identify the geographical distribution of CRC in the municipality. RESULTS: A total of 1322 cases of CRC and 467 CRC-related deaths during the study period were included. In total, 40% of the incident cases and 43% of the deaths occurred in men, while 60% of the incident cases and 57% of the deaths occurred in women. Males who were 20 to 44 years old had the most significant trend in growth. Among women, those in the group aged 45 to 64 years had the highest observed annual percent change (APC). In both sexes, mortality was stable. Regarding the geographic distribution, there were constant hotspots in the northeast region of the municipality. This study showed a significant increase in incidence, mainly in young men between 20 and 44 years of age, but stable mortality in Aracaju.

Trends in cervical cancer and its precursor forms to evaluate screening policies in a mid-sized Northeastern Brazilian city.

Cervical cancer is a health issue that disproportionately affects developing countries, where the Papanicolaou test (Pap smear) remains an important screening tool. Brazilian government recommendations have focused screening on the female population aged from 25 to 64 years old. In this study, we examined the incidence and mortality rates of invasive cervical cancer lesions and the incidence rates of in situ precancerous cervical lesions, aiming to calculate their respective statistics over time in a mid-sized Brazilian city, Aracaju. The 1996-2015 database from the Aracaju Cancer Registry and Mortality Information System was used to calculate age standardized rates for all invasive cervical tumors (International code of diseases, ICD-10: C53) and preinvasive cervical lesions (ICD-10: D06) in the following patient age ranges; ≤ 24, 25-34, 35-44, 45-54, 55-64 and ≥ 65 years old. We identified 1,030 cancer cases, 1,871 in situ lesions and 334 deaths. Using the Joinpoint Regression Program, we calculated the annual percentage incidence changes and our analyses show that cervical cancer incidence decreased up to 2008, increased up to 2012 and decreased again thereafter, a significant trend in all age groups from 25 years. The incidence of precursor lesions increased from 1996 to 2005 and has since decreased, a result significant in all age groups until 64 years. Cervical cancer mortality has decreased by 3.8% annually and trend analysis indicates that Pap smears have been effective in decreasing cancer incidence and mortality. However, recent trends shown here show a decreasing incidence of in situ lesions and may indicate either a real decrease or incomplete catchment. Thus, we suggest health policies should be re-considered and include sufficient screening and HPV vaccination strategies to avoid cervical cancer resurgence in the population.

Percepção de Preconceito num Quilombo Urbano do Sul do Brasil / Perception of Discrimination in an Urban Quilombo in the South Region of Brazil / Percepción de Discriminación en un Quilombo Urbano en el Sur de Brasil

O negro, e por consequência as populações quilombolas, em uma sociedade racista e preconceituosa, participa de um processo de (re)construção identitária que passa, necessariamente, por questões culturais, históricas, de território e de parentesco. Nesse sentido, o objetivo deste estudo foi conhecer a percepção de moradores de um quilombo sobre o preconceito racial vivenciado por eles. Para isso, realizou-se uma pesquisa qualitativa, descritiva e exploratória, tendo como participantes seis residentes em posições de liderança num quilombo urbano: duas adolescentes, dois adultos e duas idosas. Foram feitas entrevistas com perguntas semiestruturadas, abordando história de vida e percepção sobre discriminação racial. Os dados foram gravados e filmados, para, posteriormente, serem transcritos. Para a análise, utilizou-se a Análise de Conteúdo Temática. Os principais resultados apontaram diferenças significativas entre a percepção de adolescentes, por um lado, e adultos e idosos, por outro. Os adultos e as idosas indicaram não se sentirem discriminados por serem negros e moradores de quilombo, ao contrário das adolescentes, que referiram sofrer bullying por esses motivos na escola e em ambientes públicos como shoppings e comércios em geral. As idosas relataram sentir-se discriminadas em função da idade, mas nunca pela sua negritude ou pelo local onde moram. Entende-se que esta percepção tão diferente entre jovens, adultos e idosos deva-se, principalmente, ao nível de escolaridade mais elevado das adolescentes e, consequentemente, à sua maior capacidade reflexiva. Esta lhes permite perceber por si mesmas aquilo que não lhes foi dito no grupo familiar e que lhes foi ocultado nos debates escolares....(AU)

Black people in a racist and discriminating society, specifically the quilombola population, undergo an identity (re)construction process which certainly includes cultural, historical, territorial and kinship issues. This study verified the perception of quilombo dwellers regarding the racial discrimination they go through. A qualitative, descriptive, exploratory research was conducted with six residents in leadership positions in an urban quilombo: two teenage girls, two adults in their fourties and two older women. They answered a semistructured interview about their life stories and their perception of racial discrimination. The data were recorded, filmed, and later transcripted. Afterwards, they were analyzed according to Thematic Content Analysis. The main results pointed out significant differences in the way teenagers perceive racial discrimination compared to adults and older adults. These claimed not having been through situations in which they were discriminated because of their color or for living in a quilombo. On the other hand, the teenagers reported having gone through bullying at school and public places, like malls and retail places in general. The older women said they felt discriminated because of their age, but never because of their color or the place where they live. It is assumed that these big differences in perception are mainly due to the higher educational level of teenagers and, consequently, to their higher reflection ability. This ability enables them to perceive for themselves facts and realities that their familiar group never mentioned and that debates at school have always hidden from them....(AU)

El negro, en consecuencia, la población quilombola, en una sociedad racista e intolerante participa en un proceso de (re)construcción identitaria que pasa, necesariamente, por cuestiones culturales, históricas, territoriales y de parentesco. El objetivo de este estudio fueconocer la percepción de los moradores de un quilombo sobre la discriminación racial vivida por ellos. Para eso, se realizó una investigación cualitativa, descriptiva y exploratoria, en la cual participaron seis residentes en posición de liderazgo en un quilombo urbano: dos adolescentes, dos adultos y dos ancianas. Se realizaron entrevistas con preguntas semiestructuradas,abordando la historia de vida y percepción sobre discriminación racial. Los datos fueron grabados y filmados, y posteriormente fueron transcritos. Para el análisis, se utilizó el análisis de contenido temático. Los principales resultados apuntaron diferencias significativas entre la percepción de adolescentes, por un lado, y de adultos y ancianos, por otro. Los adultos y las ancianas refirieron no sentirse discriminados por ser negros y moradores de quilombo, a diferencia de las adolescentes, que refirieron sufrir acoso escolar y en los entornos públicos como centros comerciales y comercio en general. Las ancianas refirieron sentirse discriminadas en función de la edad, pero nunca por su negritud o por el lugar donde viven. Se entiende que esa percepción tan diferente entre jóvenes y adultos y ancianos se debe principalmente al nivel de escolaridad más elevado de las adolescentes y, consecuentemente, a su mayor capacidad reflexiva. Esta les permite percibir por sí mismas lo que no les fue dicho en el grupo familiar y que les fue ocultado en los debates escolares....(AU)