Effects of Sodium-Glucose Co-transporter 2 Inhibition with Empaglifozin on Renal Structure and Function in Non-diabetic Rats with Left Ventricular Dysfunction After Myocardial Infarction.

BACKGROUND: The use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) is currently expanding to cardiovascular risk reduction in non-diabetic subjects, but renal (side-)effects are less well studied in this setting. METHODS: Male non-diabetic Sprague Dawley rats underwent permanent coronary artery ligation to induce MI, or sham surgery. Rats received chow containing empagliflozin (EMPA) (30 mg/kg/day) or control chow. Renal function and electrolyte balance were measured in metabolic cages. Histological and molecular markers of kidney injury, parameters of phosphate homeostasis and bone resorption were also assessed. RESULTS: EMPA resulted in a twofold increase in diuresis, without evidence for plasma volume contraction or impediments in renal function in both sham and MI animals. EMPA increased plasma magnesium levels, while the levels of glucose and other major electrolytes were comparable among the groups. Urinary protein excretion was similar in all treatment groups and no histomorphological alterations were identified in the kidney. Accordingly, molecular markers for cellular injury, fibrosis, inflammation and oxidative stress in renal tissue were comparable between groups. EMPA resulted in a slight increase in circulating phosphate and PTH levels without activating FGF23-Klotho axis in the kidney and bone mineral resorption, measured with CTX-1, was not increased. CONCLUSIONS: EMPA exerts profound diuretic effects without compromising renal structure and function or causing significant electrolyte imbalance in a non-diabetic setting. The slight increase in circulating phosphate and PTH after EMPA treatment was not associated with evidence for increased bone mineral resorption suggesting that EMPA does not affect bone health.

Public Health, HIV Care and Prevention, Human Rights and Democracy at a Crossroad in Brazil.

On January 2019, Brazil's new far-right president Jair Bolsonaro was sworn into office. Bolsonaro's administration supports downsizing the Brazilian Unified Health System (SUS), while increasing the size of the private health sector. The new administration might leave millions of Brazilians without medical care, including hundreds of thousands of people living with HIV/AIDS. Bolsonaro's administration, allied with a highly conservative Congress and sharp decreases in federal funding for public health, education and research, could jeopardize key health and human rights strategies focused on women, LGBTQ + individuals, Indigenous populations, and people living with HIV/AIDS.

Sexual and gender minorities rights in Latin America and the Caribbean: a multi-country evaluation.

BACKGROUND: Although the extent of legal inequities experienced by sexual and gender minorities (SGM) has declined during recent decades, this population still enjoys fewer legal protections and benefits than the non-gender-variant, heterosexual population. Herein we analyze the current scenario of SGM rights in Latin America and the Caribbean (LAC). METHODS: Policy documents and governmental strategies addressing SGM rights were analyzed within a timeline framework by three major LAC sub-regions: the Caribbean, Mesoamerica and South America. RESULTS: Our search identified 88 eligible documents addressing the following categories: (1) legal protections towards same-sex couples (decriminalization of same-sex acts among consenting adults, legal recognition of same-sex unions, same-sex marriage, adoption by same-sex couples), and (2) anti-discrimination laws (SGM allowed to serve openly in the military and anti-discrimination laws related to sexual orientation, gender identity and/or expression). The majority of Caribbean countries prohibit same-sex acts between consenting adults, while in Mesoamerica same-sex couples do not have equal marriage rights and are not allowed to adopt as a couple. In the Caribbean and Mesoamerica transgender people lack proper legal protection. Legislation to protect SGM rights in South America is the most inclusive and progressive in LAC. Several countries recognize same-sex marriage and the right of transgender people to legally change their name and gender. The majority of South American countries have some kind of anti-discrimination law, but no effective mechanisms to enforce these laws. In spite of those progresses, the LAC region registers the highest rate of violence and hate crimes against SGM in the world. CONCLUSION: In the Caribbean and Mesoamerica the overall discriminatory legislation exacerbates violence against SGM within a social and cultural context of strong sexist, gender stereotypes and widespread violence. This scenario is driving hundreds of SGM to leave their home countries. In spite of progressive legislations, several South American countries are currently controlled either by highly conservative leaders (e.g. Brazil and Chile) or by repressive dictators (Venezuela). The near future of the LAC region is unknown, but if such trends continue, severe human rights problems, including setbacks in SGM legal protections, are likely.

Produção e registro de informações em saúde no Brasil: panorama descritivo através do PMAQ-AB / Production and record of information in health in Brazil: a descriptive landscape through PMAQ-AB

Este estudo tem o objetivo de descrever condições de produção e registro das informações geradas nas Unidades Básicas de Saúde, por regiões agregadas e por porte populacional no Brasil. Fez-se uma análise de indicadores do banco de dados gerado pelo ciclo I do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), enfatizando as seguintes dimensões: condições de infraestrutura e informática, educação permanente e processo de trabalho. Encontraram-se diferenças nas variáveis analisadas. Aponta-se um sistema carente de recursos tecnológicos para elaboração de políticas de saúde mais equânimes.

The aim of this study is to describe conditions for production and record information engendered on basic unit health in Brazil, by aggregated region and by population size. An analysis of indicators of the database generated by cycle I of the Program for Access and Quality Improvement in Primary Care (PMAQ-AB) has been made, stressing the following dimensions: infrastructure and informatics conditions, permanent education, and labor process. Differences on the analyzed variables were found. The analysis suggests that the system that needs technological resources for the development of more equitable health policies.

Fatores condicionantes para o acesso às equipes da Estratégia Saúde da Família no Brasil / Factors affecting access to the Family Health Stategy teams in Brazil

O artigo analisa o acesso às equipes certificadas pelo Programa Nacional de Melhoria de Acesso e da Qualidade da Atenção Básica, tendo por categoria central o acesso potencial e duas dimensões: acolhimento e disponibilidade. A partir de questões selecionadas dos instrumentos da Avaliação Externa do Programa, geraram-se escores e três estratos. Os resultados confirmam que os fatores favoráveis ao acesso potencial foram: localização na região Sudeste, em capitais e municípios de maior porte e com maior número de equipes por unidade. Apesar dos progressos, os resultados indicam a necessidade de políticas e ações voltadas à qualificação da atenção prestada, especialmente nos municípios de pequeno porte.

The article aims to analyze access to teams certified by National Program for Access and Quality Improvement in Primary Care. The category studied was the potential access with two dimensions: embracement and availability. Data obtained from selected issues of instruments of External Evaluation of the program were sources of information and generate scores and three strata. The results show that favorable factors to the potential access were located in the Southeast, in capitals, bigger towns, and larger number of teams by health unit. Despite progresses, the results address to the need for policies and actions to qualify the care provided, especially in small towns.

Juventude positiva e aderência aos medicamentos antiretrovirais: estudo de caso com adolescentes vivendo com HIV/AIDS do Rio de Janeiro / Positive youth and adherence to antiretroviral medications: case study of adolescents living with HIV / AIDS in Rio de Janeiro

No início da epidemia, no Brasil, crianças que nasciam soropositivas para o HIV, tinham expectativa de vida que não ultrapassava a infância. Em conseqüência, familiares e profissionais de saúde freqüentemente não se engajavam em ações voltadas a preparar estas crianças para encarar questões específicas da adolescência e maturidade, tais como comportamentos sexuais, decisões reprodutivas e outros aspectos relacionados. No entanto, com a implantação do acesso gratuito e universal à terapia anti-retroviral de alta potência (HAART), e conseqüente aumento da expectativa de vida de crianças nascidas com HIV / AIDS, esses pacientes começaram efetivamente a alcançar a adolescência e juventude. O presente estudo utilizou metodologia qualitativa para avaliar aspectos relacionados à aderência ao tratamento e comportamento sexual de adolescentes vivendo com HIV/AIDS infectados verticalmente. O estudo foi realizado em 2008, no Serviço de Doenças Infecciosas e Parasitárias – Ambulatório de DIP – Adolescentes do Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF/UFRJ). Foram realizadas 20 entrevistas semi-estruturadas, 18 com adolescentes vivendo com HIV/AIDS e 2 entrevistas com infectologistas responsáveis pelo atendimento desses pacientes. Os roteiros de entrevistas abordaram questões relativas ao comportamento sexual, conhecimentos e práticas relacionadas ao HIV/AIDS e aderência à HAART. Os participantes tinham idades entre 15-20 anos, em media 8 anos de educação formal e todos estavam em HAART. Dez participantes referiram serem sexualmente ativos. Participantes sexualmente ativos relataram que dificuldades relacionadas com a revelação do diagnóstico influenciavam sua habilidade de negociar o uso de preservativos...

In the beginning of Brazilian AIDS epidemic, children born with HIV had a low life expectancy. As a consequence, family members and health professionals didn’t organizedinterventions aiming to prepare those children for adolescence and adulthood common difficulties, such as sexual and reproductive life decisions, among other issues. With the free and universal access to highly active antiretroviral therapy (HAART), and the life expectancy increase for children born with HIV, those patients started experiencing adolescence andyoung adulthood. The study utilized qualitative methods to explore HIV-positive young adults’ lifestyles, behaviors and HIV-related knowledge that might influence their effectiveadherence to ART and maintenance of safer behaviors over time. The study was conducted during 2008 at the Service of Infectious Diseases, Clementino Fraga Filho UniversityHospital, Federal University of Rio de Janeiro (HUCFF/UFRJ). Twenty in-depth interviews were conducted, 18 with adolescents living with HIV/AIDS and 2 with physicians responsiblefor their treatment and care. Interview topics included sexual risk behavior, HIV/STI knowledge and attitudes, and adherence to HAART. Participants were 15-20 years old with around 8 years of formal education, all participants were on HAART, and ten reported beingsexually active. Sexually active participants reported that disclosure difficulties influenced their ability to negotiate condom use. The vast majority of participants reported a great effort to feel and act as “a normal human being”, therefore being accepted by their social group...