Suicide mortality among youth in southern Brazil: a spatiotemporal evaluation of socioeconomic vulnerability

Objective: To conduct a geospatial analysis of suicide deaths among young people in the state of Paraná, southern Brazil, and evaluate their association with socioeconomic and spatial determinants. Methods: Data were obtained from the Mortality Information System and the Brazilian Institute of Geography and Statistics. Data on suicide mortality rates (SMR) were extracted for three age groups (15-19, 20-24, and 25-29 years) from two 5-year periods (1998-2002 and 2008-2012). Geospatial data were analyzed through exploratory spatial data analysis. We applied Bayesian networks algorithms to explore the network structure of the socioeconomic predictors of SMR. Results: We observed spatial dependency in SMR in both periods, revealing geospatial clusters of high SMR. Our results show that socioeconomic deprivation at the municipality level was an important determinant of suicide in the youth population in Paraná, and significantly influenced the formation of high-risk SMR clusters. Conclusion: While youth suicide is multifactorial, there are predictable geospatial and sociodemographic factors associated with high SMR among municipalities in Paraná. Suicide among youth aged 15-29 occurs in geographic clusters which are associated with socioeconomic deprivation. Rural settings with poor infrastructure and development also correlate with increased SMR clusters.

Suicide mortality among youth in southern Brazil: a spatiotemporal evaluation of socioeconomic vulnerability.

OBJECTIVE: To conduct a geospatial analysis of suicide deaths among young people in the state of Paraná, southern Brazil, and evaluate their association with socioeconomic and spatial determinants. METHODS: Data were obtained from the Mortality Information System and the Brazilian Institute of Geography and Statistics. Data on suicide mortality rates (SMR) were extracted for three age groups (15-19, 20-24, and 25-29 years) from two 5-year periods (1998-2002 and 2008-2012). Geospatial data were analyzed through exploratory spatial data analysis. We applied Bayesian networks algorithms to explore the network structure of the socioeconomic predictors of SMR. RESULTS: We observed spatial dependency in SMR in both periods, revealing geospatial clusters of high SMR. Our results show that socioeconomic deprivation at the municipality level was an important determinant of suicide in the youth population in Paraná, and significantly influenced the formation of high-risk SMR clusters. CONCLUSION: While youth suicide is multifactorial, there are predictable geospatial and sociodemographic factors associated with high SMR among municipalities in Paraná. Suicide among youth aged 15-29 occurs in geographic clusters which are associated with socioeconomic deprivation. Rural settings with poor infrastructure and development also correlate with increased SMR clusters.

Participation in Cervical Screening by Self-collection, Pap, or a Choice of Either in Brazil.

Most cervical cancers occur in women who do not participate in cervical-cancer screening. We therefore evaluated adherence to screening for clinic-based Pap testing, self-collected sampling for HPV testing, and choice of the 2 among 483 unscreened/underscreened women in Brazil. Three public Basic Health Units (BHU) were each randomly assigned to three arms: (i) Pap testing at the BHU (N = 160), (ii) "Self&HPV" (self-collection for HPV testing) (N = 161), and (iii) "Choice" between self-collection and HPV testing and Pap test at the local BHU (N = 162). The theory-based (PEN-3 and Health Belief Model) intervention in all three arms was implemented by trained Community Health Workers (CHW) at participants' home. With the first invitation, 60.0% in the Pap arm, 95.1% [154 of 161 (95.7%) who selected Self&HPV and 0 of 1 (0.0%) who selected Pap] in the Choice arm, and 100% in the Self&HPV arm completed screening. By the second invitation to choose a method of screening in the Choice arm, 100% completed screening. After three invitations, 75.0% of women in the Pap arm completed screening. Adherence to screening differed by study arm (P < 0.001). In conclusion, Self&HPV testing is a promising strategy for unscreened/underscreened women who are recalcitrant or unable to undergo clinic-based cervical screening to complement the screening modality used in the general population. In Brazil, where Pap testing is recommended for routine cervical screening, training CHWs in behavior change strategies and offering Self&HPV or Choice could greatly improve screening population coverage by reaching the unscreened/underscreened populations.

Case Reports: Prolonged Detection of Zika Virus RNA in Vaginal and Endocervical Samples from a Brazilian Woman, 2018.

Zika virus (ZIKV) infection is an emerging public health problem, associated with increased risk for Guillain-Barré syndrome and adverse fetal outcomes, including congenital microcephaly. Zika virus sexual transmission is known, but detection of the virus in different parts of the female reproductive tract is not well established. In this case report, we describe prolonged detection of ZIKV RNA in the vaginal secretion and endocervical mucosa from a Brazilian woman convalescent to ZIKV infection. A viral load of 2 × 102 copies/mL was detected up to 31 days after symptom onset in both samples. Other biological fluids, including whole blood, plasma, serum, urine, and saliva samples, were negative for ZIKV RNA. These findings advance the understanding of ZIKV infection and provide data for additional testing strategies.

Cervical Cancer Screening among Underscreened and Unscreened Brazilian Women: Training Community Health Workers to be Agents of Change.

BACKGROUND: Despite the availability of cervical cancer screening programs in Brazil, some women do not participate in these programs owing to structural and/or interpersonal/intrapersonal barriers, resulting in high cervical cancer incidence and mortality. Integrating community health workers (CHWs) into the delivery of cervical cancer screening interventions is potentially a feasible strategy to address these barriers. OBJECTIVES: This study aimed to implement and evaluate a CHW training to deliver a brief intervention to promote cervical cancer screening among underscreened and unscreened women in Brazil. METHODS: The curriculum addressed cervical cancer and screening, behavioral intervention strategies, and protection of human subjects in research. Pretest and post-test questionnaires assessed changes in CHW objective and perceived knowledge as well as perceived skills and confidence (N = 15). RESULTS: There was a significant increase in objective and perceived knowledge about cervical cancer, behavior change strategies, and protection of human subjects in research between pretest and post-test, but not in self-perception about skills and confidence to motivate women to engage in cervical cancer screening. CONCLUSIONS: Improvements in CHW knowledge about cervical cancer screening and behavior change represents a step forward toward successful interventions, but adaptations are needed to boost their self-confidence and perceived skills with regard to their ability to promote behavior change at the community level.

Association of human papillomavirus, Neisseria gonorrhoeae and Chlamydia trachomatis co-infections on the risk of high-grade squamous intraepithelial cervical lesion.

The link between high-risk human Papillomavirus (HR-HPV) and other sexually transmitted diseases (STDs) in the risk of developing cervical cancer still unclear. Thus, in this report we investigated the rates of co-infections between HPV and other important non-HPV STDs in different cervical findings using a multiplex polymerase chain reaction (M-PCR) to simultaneously detect Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, HSV-1 and -2, and Treponema pallidum. A total of 838 women aged 18 to 68 years were screened using Papanicolaou smears for cervical abnormalities, HPV and non-HPV STDs using PCR and M-PCR methods. A total of 614 (73.3%) of the women had normal cytology (NILM) and 224 (26.7%) women exhibited abnormal cytology (≥ ASC-US). HPV-DNA prevalence was 33.9%, and HPV-16 was the most prevalent genotype in women with NILM and ≥ ASC-US cytology. Non-HPV STDs were detected in 30.4% women and T. vaginalis was the most prevalent one (11.6%). A higher increased risk of ≥ ASC-US and HSIL occurred in co-infections of HR-HPV with C. trachomatis and N. gonorrhoeae. Co-infections of HPV-DNA and HR-HPV with HSV-2 exhibited a similar increased risk but only with ≥ ASC-US. Co-infections of HPV-DNA and HR-HPV with T. vaginalis demonstrated a similar increased risk of ≥ ASC-US and HSIL. We found that C. trachomatis and N. gonorrhoeae were the primary pathogens associated with HR-HPV for the increased risk for all grades of cervical abnormalities but mainly for HSIL, suggesting a possible synergistic action in cervical lesions progression. Our results reinforce the hypothesis that some non-HPV STDs might play a role as co-factors in HPV-mediated cervical carcinogenesis. These data improve our understanding of the etiology of SCC and may also be useful for disease prevention.

[The factors associated with physical inactivity in a city in southern Brazil]. / Fatores associados à inatividade física no lazer em município do Sul do Brasil.

OBJECTIVE: This study was aimed at determining the prevalence of and factors associated with gender-related physical inactivity in an urban area of a city in southern Brazil. METHODS: Data was obtained from a survey monitoring risk factors regarding chronic non-communicable diseases (NCD) in adults living in Maringá, Paraná, and the random sampling of 453 people living in the chosen urban area. RESULTS: The sample involved 351 women and 102 men; women's physical inactivity rate was 87.5 % and 86.3 % for men. Multivariate regression stated that women aged 50 to 59 years of age were physically active (p=0.01) and those having received 0-8 years of education had become inactive during their leisure time (p=0.02). Compared to males, women who reported being ex-smokers were classified as being active (p=0.03) and those who recognized their state of health as fair were classified as having become inactive during their spare time (p=0.04). CONCLUSION: Inactivity was thus observed amongst both males and females in the target population, even though risk varied and there were distinct protection levels; this would therefore soon become a modifiable risk factor. NCD prevention and control measures must thus be taken through surveillance strategies and monitoring the population's health status.

Risk factors for cervical HPV infection and genotypes distribution in HIV-infected South Brazilian women.

BACKGROUND: Human Papillomavirus (HPV) infection is particularly burdensome for women infected with human immunodeficiency virus (HIV), which increases their risk of developing cervical lesions and cancer (CC). We conducted a molecular study of the distribution of cervical HPV genotypes and the risk factors for this infection in HIV-infected Brazilian women. FINDINGS: Cervical and endocervical samples for Papanicolaou screening and HPV detection were collected from 178 HIV-infected women using highly active antiretroviral therapy (HAART) of Maringá city/Brazil. Risk factors were assessed using a standardized questionnaire, and the data regarding to HIV infection from medical records. HPV was detected by polymerase chain reaction (PCR), and genotyping using PCR-restriction fragment length polymorphism analysis. HIV infection was well controlled, but women with a current CD4+ T lymphocyte count between 200-350 cells/mm3 (37.6%) had a two-fold greater risk of HPV infection than those with > 350 cells/mm3 (26.4%). HPV was associated with parity ≥3, hormonal contraceptive use and current smoker. HPV infection occurred with high frequency (46.6%) but a low frequency of cervical abnormalities was detected (7.30%), mainly low-grade squamous intraephitelial cervical lesions (LSIL) (84.6%). A high frequency of multiple HPV infections was detected (23.0%), and the most frequent HPV genotype was HPV-72 (6.7%), followed by -16, -31 and -51 (6.14% each). CONCLUSIONS: We showed that HAART use does not protect HIV-infected women from HPV, but appear to exert some protection against cervical lesions development. This study provides other important information about risk factors and cervical HPV in HIV-infected women, which can contribute to planning protocols.

Fatores associados à inatividade física no lazer em município do Sul do Brasil / The factors associated with physical inactivity in a city in southern Brazil / Factores asociados con la inactividad física en una ciudad en el Sur de Brasil

Objetivo O objetivo deste estudo foi verificar a prevalência e fatores associados à inatividade física no lazer, segundo sexo, em residentes da área urbana de um município do Sul do Brasil. Métodos Os dados foram obtidos da pesquisa de monitoramento de fatores de risco para doenças crônicas não transmissíveis em adultos da cidade de Maringá, Paraná, através de inquérito populacional e amostra de 453 indivíduos. Resultados Foram avaliados 351 mulheres e 102 homens. A taxa de inatividade física no lazer foi de 87,5 % e 86,3 % para as mulheres e homens, respectivamente. Após regressão multivariada, notou-se que as mulheres com idade entre 50 e 59 anos estão fisicamente ativas (p=0,01), e aquelas com 0 a 8 anos de estudo, apresentaram-se inativas no lazer (p=0,02). E relação aos homens, os que declararam ser ex-fumantes, classificaram-se como ativos (p=0,03) e os que reconheceram o estado de saúde como regular, apresentaram-se inativos no lazer (p=0,04). Conclusão Foi possível perceber que embora com variáveis de risco e proteção distintas, a inatividade na população adulta encontra-se presente em ambos os sexos, e logo, por ser um fator de risco modificável, deve integrar-se no rol das medidas de prevenção e controle de doenças, através de estratégias de vigilância e monitoramento do estado de saúde da população.

Objective This study was aimed at determining the prevalence of and factors associated with gender-related physical inactivity in an urban area of a city in southern Brazil. Methods Data was obtained from a survey monitoring risk factors regarding chronic non-communicable diseases (NCD) in adults living in Maringá, Paraná, and the random sampling of 453 people living in the chosen urban area. Results The sample involved 351 women and 102 men; women's physical inactivity rate was 87.5 % and 86.3 % for men. Multivariate regression stated that women aged 50 to 59 years of age were physically active (p=0.01) and those having received 0-8 years of education had become inactive during their leisure time (p=0.02). Compared to males, women who reported being ex-smokers were classified as being active (p=0.03) and those who recognized their state of health as fair were classified as having become inactive during their spare time (p=0.04). Conclusion Inactivity was thus observed amongst both males and females in the target population, even though risk varied and there were distinct protection levels; this would therefore soon become a modifiable risk factor. NCD prevention and control measures must thus be taken through surveillance strategies and monitoring the population's health status.

Objetivo El objetivo de este estudio fue determinar la prevalencia y los factores asociados con inactividad física, por sexo, en los residentes de un área urbana en una ciudad del sur de Brasil. Métodos Los datos se obtuvieron de una encuesta de seguimiento de los factores de riesgo de enfermedades crónicas entre los adultos de la ciudad de Maringá, Paraná, de la cual se tomó una muestra de 453 personas. Resultados Se estudiaron 351 mujeres y 102 hombres. La tasa de inactividad física fue del 87,5 % y del 86,3 % para las mujeres y los hombres, respectivamente. Después de un análisis de regresión multivariada, se observó que las mujeres de edades comprendidas entre 50 y 59 años son físicamente activas (p=0,01), y las que tienen 0-8 años de estudio se han convertido en inactivas durante el tiempo libre (p=0,02). En comparación, los hombres que reportaron ser ex fumadores fueron clasificados como activos (p=0,03) y los que reconocen el estado de salud como regular, se habían convertido en inactivos durante el tiempo libre (p=0,04). Conclusión Se pudo observar que, si bien con diferentes riesgos y distinta protección, la inactividad en adultos está presente en ambos sexos, y que se convierte en un factor de riesgo modificable. Las medidas de prevención y de control de las enfermedades se deben integrar a través de estrategias de vigilancia y seguimiento del estado de salud de la población.

Excess weight and abdominal obesity in postmenopausal Brazilian women: a population-based study.

BACKGROUND: The menopause is associated with a tendency to gain weight. Several alterations in fat deposits occur, leading to changes in the distribution of body fat. There are strong indications that, in middle age, obesity is associated with increased mortality. This study set out to determine the factors associated with the prevalence of overweight and abdominal obesity in postmenopausal women in a population-based study in Brazil. METHODS: The sample included 456 women, aged 45-69 years, residing in the urban area of Maringa, Parana. Systematic sampling, with a probability proportional to the size of the census sector, was performed. Behavioral, economic, and sociodemographic data were collected, and body mass index (BMI) and waist circumference (WC) were determined. RESULTS: According to BMI criteria (≥25.0 kg/m2), 72.6% of the women were overweight, and according to WC (≥88 cm), 63.6% had abdominal obesity. Based on logistic regression analysis, the factors that were most closely associated with overweight were: having three or more children (odds ratio (OR): 1.78; 95% confidence interval (CI): 1.06-3.00); and not taking hormone replacement therapy (OR: 1.69; 95% CI: 1.06-2.63). The prevalence of abdominal obesity was positively associated with greater parity (OR: 1.34, 95% CI: 1.05-1.72) and age older than 65 years (OR: 1.50; 95% CI: 1.03-2.19). CONCLUSIONS: This study found that the prevalences of overweight and abdominal obesity were higher for postmenopausal women who had three or more children. Age over 65 years was also a risk factor for abdominal obesity and no use of hormonal replacement therapy was a risk factor for overweight.

Differences in the mutation of the p53 gene in exons 6 and 7 in cervical samples from HIV- and HPV-infected women.

BACKGROUND: Human Papillomavirus (HPV) infection is a serious problem for human immunodeficiency virus (HIV)-infected women, increases their risk of cervical lesions and cancer. In cervical carcinogenesis, mutations in the p53 gene occur most frequently within exons 5-8. To our knowledge, no previous studies have analyzed mutations in exons 5-8 of the p53 gene in HIV- and HPV-infected women. In our study, we verified these mutations in women with and without cervical abnormalities. FINDINGS: The study included 160 women, divided into three groups: (1) 83 HPV- and HIV-infected women (HIV group); (2) 37 HPV-infected/HIV-uninfected (control group); and (3) 40 normal cytology/DNA-HPV negative/HIV-uninfected women (negative control p53 reactions). HPV-DNA was detected using polymerase chain reaction (PCR) and genotyping by PCR-restriction fragment length polymorphism analysis. Using primers for exons 5-8, the mutation of the p53 gene was verified by PCR-single strand conformational polymorphism. The total mutation of the p53 gene in exons 5-8 was not significantly associated with the HIV and control groups. The mutations in exon 7 were the highest in the HIV group (43.8%) and in exon 6 in the control group (57.2%) (p = 0.0793) suggesting a tendency toward differential mutation in exon 7 in the HIV group. CONCLUSIONS: Our study provides preliminary evidence that the mutation in exon 7 might be an important differentiating factor for cervical carcinogenesis in HIV-infected women. This aspect deserves an additional cross-sectional and longitudinal study using a larger sample size with a higher number of High-grade squamous intraephitelial lesion (HSIL) to observe the evolution of cervical lesions.

Simultaneous detection of seven sexually transmitted agents in human immunodeficiency virus-infected Brazilian women by multiplex polymerase chain reaction.

We determined the prevalence of seven clinically important pathogens that cause sexually transmitted infections (STIs) (Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, herpes simplex virus 1 [HSV-1], HSV-2, and Treponema pallidum), by using a multiplex polymerase chain reaction (M-PCR) in samples from Brazilian woman infected with human immunodeficiency virus 1 (HIV-1) and uninfected Brazilian women (controls). The M-PCR assay identified all STIs tested for and surprisingly, occurred association between the control and STIs. This association was probably caused by excellent HIV infection control and regular monitoring in these women established by public health strategies in Brazil to combat HIV/acquired immunodeficiency syndrome. Studies using this M-PCR in different populations may help to better elucidate the roles of STIs in several conditions.

Preliminary evaluation of Hitchens-Pike-Todd-Hewitt medium (HPTH) for detection of Group B Streptococci in pregnant women.

We aimed to compare Hitchens-Pike-Todd-Hewitt (HPTH) enrichment broth, Todd-Hewitt broth, and direct culture onto blood sheep agar containing selective antimicrobial (ABA) in screening Group B Streptococci (GBS) carriage in pregnant women. From April to June 2007, duplicate lower vaginal and duplicate anorectal specimens of 102 pregnant women at 35 weeks of gestation or more, who were assisted at Santa Casa de Misericórdia Hospital, Maringá, Paraná, Brazil, were screened by GBS using HPTH, Todd-Hewitt broth, and ABA. Twenty-five (24.5%) pregnant women had one or more positive culture for GBS in those media. The positive rate for each medium was 21.6% (22/102) in the HPTH, 12.8% (13/102) in ABA, and 11.8% (12/102) in Todd-Hewitt broth. HPTH seems to be a high satisfactory medium for screening GBS in vaginal and anorectal samples in pregnant women and additional studies would be interesting in a larger number of pregnant women and in different laboratories.

Antifungal activity of propolis extract against yeasts isolated from vaginal exudates.

OBJECTIVE: The objective of this study was to evaluate the in vitro antifungal activity of propolis extract against yeasts Candida albicans and Candida non-albicans isolated from vaginal exudates, in comparison with nystatin. DESIGN: Ninety-seven (97) vaginal yeasts strains were evaluated. These strains were obtained from different clinical conditions, isolated and stored at the Sector of Medical Mycology of the State University of Maringá (Paraná, Brazil). The assays of susceptibility to nystatin and propolis extracts (PE) were conducted through microdilution in broth (National Committee for Clinical Laboratory Standards-NCCLS, M-27A Document of 1997). RESULTS: All the yeasts tested were inhibited by low concentrations of PE (maximum of 393.19 mug/mL of the total flavonoid content), including an isolate resistant to nystatin, regardless of the clinical conditions of the women and the species of yeast isolated. CONCLUSIONS: The PE showed an outstanding performance against the tested vaginal yeast strains, and could be included among the novel therapeutic options for the treatment of vulvovaginal candidiasis.